Intervertebral Foramen Research Articles

Multiple Meningocele in Klippel-Feil Syndrome: Case Report

Klippel–Feil syndrome (KFS) is a rare congenital skeletal malformation characterized by the fusion of various cervical and occasionally thoracic and lumbar vertebrae. It may be seen as the fusion between two vertebras of all cervical vertebras, Congenital cervical fusion occurs as a result of failure in normal segmentation of cervical summits. Cause of this failure is unknown and occurs at second-eight weeks of gestation. 25 years old, patient presented to our counseling center with a 4-month history of progressive dysphagia. Ent exam showed a soft retropharyngeal mass displacing the left tonsil measuring a little about 6 cm with no sign of ulceration or local inflammation, a short neck was noted with a limitation of flexion and extension movement and low-lying hairline with a psychomotor retardation; which raises the suspicion of Klippel Feil syndrome undiagnosed. Cervical magnetic resonance imaging (MRI) was done which showed a cervical cystic formation compressive oval well limited with regular contours and fluid content with dark aspect in T1 weighted sequences and bright in T2 weighted sequences with regular wall enhanced after injection of gadolinium measuring 8.2*4.3 cm spread over 8.9 cm high This formation appears to continue with the subarachnoid spaces of the posterior cerebral fossa through the hypoglossal nerve canal with doubt about involvement of the jugular foramen. Thoracic CT scan demonstrated a lateral cystic mass exiting out of the intervertebral foramen of T6-T7 showing the same characteristics as the cervical formation above. Klippel-Feil syndrome is a rare congenital skeletal malformation characterized by fusion of several cervical and sometimes thoracic and lumbar vertebrae, leading to a low hairline and a short neck. The pathological feature is congenital fusion of two or more cervical vertebrae. The fusion is thought to be associated with reduced expression of the Pax gene in sclerotomes during chondrification of the vertebra. Klippel-Feil syndrome is usually diagnosed in childhood. However, associated abnormalities may delay diagnosis. The challenge for the specialist is to recognize concomitant abnormalities and perform the appropriate work-up for the diagnosis of Klippel-Feil syndrome.

Multiacquisition with variable resonance image combination T2 (MAVRIC SL T2) for postoperative cervical spine with artificial disc replacement

Anterior cervical discectomy with artificial disc replacement (ADR) is an effective treatment of cervical degenerative disc disease. However, postoperative MRI due to recurrent neck/radicular pain is limited due to severe metallic artifacts of artificial disc instrument. Multiacquisition with variable resonance image combination selective T2 (MAVRIC SL T2) has been developed as an MRI technique for metal artifact reduction but has not been evaluated for the postoperative cervical spine with ADR. In our study, we compared MAVRIC SL T2 with the fast spin echo (FSE) T2-weighted sequence (T2WI), which was an essential MR sequence for evaluation of the cervical neural structure, for metallic artifact reduction in the post-operative cervical spine with ADR. Our study revealed MAVRIC SL T2 showed smaller signal void areas, less distortion and signal pile-up, and was more clinically useful than T2WI (p < 0.05). The spinal cord, vertebral bodies, both neural foramina, and anterior paravertebral soft tissue were significantly more visible with MAVRIC SL T2 than with T2WI (p < 0.05). MAVRIC SL T2 might be a useful technique for the evaluation of postoperative cervical spine with ADR and complements T2WI in the evaluation of the spinal cord and nerve roots which were important structures for post-operative recurrent neck/radicular pain.

Spread of local anesthetics after erector spinae plane block: an MRI study in healthy volunteers

BackgroundErector spinae plane block (ESPB) is a truncal fascial block with a disputed mechanism and anatomical site of effect. This study aimed to perform a one-sided ESPB and use MRI...

A broad and variable lumbosacral myotome map uncovered by foraminal nerve root stimulation.

The human myotome is fundamental to the diagnosis and treatment of neurological disorders. However, this map was largely constructed decades ago, and its breadth, variability, and reliability remain poorly described, limiting its practical use. The authors used a novel method to reconstruct the myotome map in patients (n = 42) undergoing placement of dorsal root ganglion electrodes for the treatment of chronic pain. They electrically stimulated nerve roots (n = 79) in the intervertebral foramina at T12-S1 and measured triggered electromyography responses. L4 and L5 stimulation resulted in quadriceps muscle (62% and 33% of stimulations, respectively) and tibialis anterior (TA) muscle (25% and 67%, respectively) activation, while S1 stimulation resulted in gastrocnemius muscle activation (46%). However, L5 and S1 both resulted in abductor hallucis (AH) muscle activation (17% and 31%), L5 stimulation resulted in gastrocnemius muscle stimulation (42%), and S1 stimulation in TA muscle activation (38%). The authors also mapped the breadth of the myotome in individual patients, finding coactivation of adductor and quadriceps, quadriceps and TA, and TA and gastrocnemius muscles under L3, L4, and both L5 and S1 stimulation, respectively. While the AH muscle was commonly activated by S1 stimulation, this rarely occurred together with TA or gastrocnemius muscle activation. Other less common coactivations were also observed throughout T12-S1 stimulation. The muscular innervation of the lumbosacral nerve roots varies significantly from the classic myotome map and between patients. Furthermore, in individual patients, each nerve root may innervate a broader range of muscles than is commonly assumed. This finding is important to prevent misdiagnosis of radicular pathologies.

Environmental perception and control of gastrointestinal immunity by the enteric nervous system.

The enteric nervous system (ENS) forms a versatile sensory system along the gastrointestinal tract that interacts with most cell types in the bowel. Herein, we portray host-environment interactions at the intestinal mucosal surface through the lens of the enteric nervous system. We describe local cellular interactions as well as long-range circuits between the enteric, central, and peripheral nervous systems. Additionally, we discuss recently discovered mechanisms by which enteric neurons and glia respond to biotic and abiotic environmental changes and how they regulate intestinal immunity and inflammation. The enteric nervous system emerges as an integrative sensory system with manifold immunoregulatory functions under both homeostatic and pathophysiological conditions.

Contralateral inclinatory approach for decompression of the lateral recess and same-level foraminal lesions using unilateral biportal endoscopy: A technical report.

Unilateral biportal endoscopic (UBE)surgery is being increasingly adopted as a minimally invasive technique. The purpose of the current study was to introduce a novel surgical technique for lateral recess and same-level foraminal decompression by the contralateral inclinatory approach with unilateral biportal endoscopy(CIA-UBE) at the lumbar level. Between January 2020 and February 2022, 10 patients suffering from lateral recess and same-level foraminal stenosis at the lumbar level underwent UBE surgery by contralateral inclinatory approach (CIA-UBE). Magnetic resonance imaging (MRI) scans were examined after surgery to measure the cross-sectional area (CSA) of the spinal canal (CSA-SC), the CSA of the intervertebral foramen (CSA-IVF), and the CSA of the facet joint (CSA-FJ). Postoperative radiologic images using computed tomography (CT) were obtained to investigate the existence of facet joint violation. Clinical outcomes were assessed using Oswestry Disability Index (ODI) scores and visual analogue scale (VAS) scores for buttock and radicular pain. Ten levels were decompressed, and the mean age of the patients was 56.92 ± 13.26 years. The mean follow-up period was 7.60 ± 4.47 months. The average operative time was 85.14 ± 25.65 min. Postoperative CT and MRI revealed ideal neural decompression of the treated segments in all patients. CSA-IVF and CSA-FJ improved significantly, indicating good foraminal and lateral recess decompression with less damage to facet joints. Preoperative VAS and ODI scores improved significantly after surgery. CIA-UBE may be an effective surgical treatment of the lateral recess and same-level foraminal stenosis at the lumbar level, which provides successful surgical decompression for traversing and exiting nerve roots with a better operative view and easier surgical manipulation. This approach may also help to maximize the preservation of the facet joint.

Pigmented villonodular synovitis of the cervical spine: a case report

Pigmented villonodular synovitis (PVNS) is a proliferative disease of the synovial membranes. Large joints are most commonly affected, while PVNS rarely affects the spine. We present a 70-year-old female patient with PVNS in the cervical spine who experienced both radiculopathy and myelopathy. An osteolytic lesion was observed over the sixth and seventh intervertebral foramina on the right cervical vertebrae on the radiological examination, and surgery was performed to remove the tumor and stabilize the cervical spine. Partial tumor resection was performed to preserve the right seventh cervical root. She was pathologically diagnosed with PVNS. After surgery, the patient's symptoms improved, and no recurrence was observed at outpatient follow-up 1 year later. In consideration of the recurrence rate, complete resection of the tumor is considered the standard treatment, but additional research is needed because there is no standard for adjuvant treatment in cases of incomplete resection or for methods to reduce the recurrence rate.

MRI changes of adjacent segments after transforaminal lumbar interbody fusion (TLIF) and foraminal endoscopy: A case-control study.

Background:Intervertebral foramen endoscopy has developed rapidly, but compared with transforaminal lumbar interbody fusion (TLIF), the progress of degeneration is unknown. We aim to compare the changes of intervertebral disc and intervertebral foramen in adjacent segments after TLIF and endoscopic discectomy for patients with lumbar disc herniation (LDH).Methods:From 2014 to 2017, 87 patients who were diagnosed with single-level LDH and received surgery of TLIF (group T, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up (FU). The neurological function was originally evaluated by the Japanese Orthopaedic Association (JOA) scores. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration Pfirrmann scores.Results:There was no significant difference in baseline characteristics, JOA improvement rate, reoperation rate and complications between the two groups. The age, average blood loss, average hospital stays and average operation time in group F were lower than those in group T. During the last FU, HIS, CA and FA decreased in both groups, and the changes in group T were more significant than those in group F (P < .05). There was no significant difference in FH changes between the two groups (P > .05).Conclusion:Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar disc height loss and intervertebral foramina reduction in the adjacent segment after endoscopic surgery is lower.

Cervical selective nerve root injection alleviates chronic refractory pain after brachial plexus avulsion: a case report

BackgroundIntractable chronic pain, as well as motor, sensory, and autonomic neuropathy, significantly reduces the quality of life of brachial plexus avulsion (BPA) patients. We report the successful application of cervical selective nerve root injection (CSNRI) in a patient with BPA.Case presentationA 40-year-old man had been diagnosed with complete left BPA due to a motorcycle accident and underwent intercostal nerve transplantation at the age of 18 years and had been experiencing pain ever since. His pain increased after fracture of the left humerus, and he was referred to our pain management clinic. As his exacerbated pain was suspected to be due to peripheral nerve hypersensitivity, we performed repetitive ultrasound-guided CSNRI (3 mL of 1% mepivacaine of each) targeted C5 and 6 intervertebral foramina, and his symptoms gradually improved.ConclusionsRepetitive CSNRI may help diagnose and treat BPA-associated peripheral neuropathic pain, even in patients diagnosed with BPA.

PO121 / #596 BIOMECHANICAL IMPACT OF INTERSPINOUS SPACERS ON SAGITTAL ALIGNMENT IN PATIENTS WITH LUMBAR SPINAL STENOSIS: E-POSTER VIEWING

Lumbar Spinal Stenosis (LSS) is characterized as a narrowing of the spinal canal and/or intervertebral foramina and often results in leg pain and other symptoms when walking or standing. Sagittal alignment of the spine helps describe the normal orientation of the spine in the sagittal plane.1 LSS patients generally tend to bend forward to relieve their neurological symptoms. As a consequence, their sagittal alignment may be affected.2 Limited information related to the relationship of sagittal alignment in LSS patients following treatment with indirect decompression is available.

Сакрализация позвонка LV (синдром Бертолотти): обзор литературы

Introduction The resultant cause of pain syndrome in the lumbosacral spine in the contemporary population are dysplasia and anomalies of the development of vertebral segments, among which the sacralization of the L5 vertebra (Bertolotti syndrome) is often diagnosed. In the domestic medical literature, few publications on this pathology have been found. Methods Scientific studies for this literature review were obtained from PubMed, eLIBRARY, CYBERLENINNKA. Eighty scientific articles were used. The search for literature sources was carried out with the following keywords: sacralization of the L5 vertebra, Bertolotti Syndrome. Results and discussion In the course of the analysis, it was established that the rate of diagnosis of sacralization of the L5 vertebra ranges from 4 to 36 % of cases. It is equally detected among males and females. This pathology is frequently found in children and adolescents. Pain in the lumbar spine and sacrum is the leading clinical symptom of the disease. The severity of pain on the visual analogue scale mainly corresponds to 5 points. Scoliosis, spondylolistesis, herniated disks, spina bifida posterior may exacerbate the clinical symptoms of the associated sacralization of the L5 vertebra. During the examination of patients, plain radiography, computed tomography and magnetic resonance imaging are used. Cases of sacralization of the L5 vertebra are divided into 7 types, according to the classification of A.E. Castellvi et al. (1984). Treatment of vertebrogenic pain syndrome is carried out both conservatively (drug therapy, therapeutic blockades) and surgically (resection of the L5 transverse process, decompression of the stenotic intervertebral foramina, transpedicular fusion, radiofrequency ablation).

PLEURAL EFFUSION AS AN INITIAL PRESENTATION OF EXTRAMEDULLARY ACUTE MYELOID LEUKEMIA: A RARE PHENOMENON

PLEURAL EFFUSION AS AN INITIAL PRESENTATION OF EXTRAMEDULLARY ACUTE MYELOID LEUKEMIA: A RARE PHENOMENON

A Rare Case of Epithelioid Hemangioma Presenting as an Isolated Sacral Mass

Epithelioid hemangioma (EH) is an uncommon benign vascular tumor of mesenchymal origin. It mainly presents as expanding nodules around the ear, the forehead, and long bones. Only a handful of cases have been found in cervical, thoracic, lumbar, and sacral vertebrae as lytic lesions with pain and neurological impairment. We present the case of a 36-year-old female with an incidental finding of a sacral mass along with inguinal lymphadenopathy on imaging. Initially, there were no symptoms. The mass gradually progressed and later showed an extraosseous extension with involvement of sacral neural foramina and nerve roots causing severe low back pain and weakness of the left lower extremity. Differential diagnoses initially included secondary metastases and chordoma. However, the biopsy of the mass revealed findings consistent with an EH. To our knowledge, this is the first case of EH presenting as an isolated mass in the sacrum and the third case of EH involving the sacrum in continuation with other vertebrae.EH should be in our differential diagnoses when there is a sacral mass.

Magnetic Resonance Imaging of Lumbar Spine in Lower Backache: A Comparative Study on Gender Basis

Objective: To compare the clinical features of lower backache with Magnetic Resonance Imaging (MRI) findings on gender basis. Study design &amp; Setting: A cross-sectional descriptive study was carried out among male &amp; female patients with a backache at Sir Syed Hospital, Karachi. This study conducted from 1st Jan 2020 to 1st June 2020. We studied 90 patients by using the non-probability convenient sampling technique. Methodology: Lower backache is a common problem that creates disability. MRI lumbar spine without contrast were reviewed with clinical complaints. Performa was used after the ethical approval from Institutional Research and Ethical committee. Components focused during the study in MRI findings at different spinal levels were disc bulging, neural foraminal compromise, nerve root compression, ligamentum flavum and facet joint hypertrophy. Results: The results showed that the mean age of 90 patients was 44.64 years. On MRI imaging 46(86.8%) males and 26(70.3%) females had disc desiccation but multi-level disc osteophyte complexes were demonstrated more in females 11(29.7%). Diffuse disc bulge is more in males at L4-5 and L5-S1 level 49(92.5%) than in females 34(91.9%) at L4-5 and 33(89.2%) at L5-S1 level with mild to moderate spinal canal stenosis. The narrowing of Neural foramen is almost similar at L4-5 level in both gender but more at L5-S1 in females 35(94.6%) as compared to males 49(92.5%) with nerve root compression. Overall male patients tended to have slightly more disc degenerative changes than females. Conclusion: Lower Lumbar disc disease is a common problem showing significant disc space narrowing and bulges slightly more in our male population than females.

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion.

The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr’s paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting surgeons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissue-sparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.

Anatomic description of the basivertebral nerve and meningeal branch of the spinal nerve in the dog

PurposeThe existence of the basivertebral nerve and meningeal branch of the spinal nerve has not been proven in dogs to date. The objectives of this study are to 1) determine whether dogs have a meningeal branch of the spinal nerve (MBSN) and a basivertebral nerve (BVN) and to (2) describe anatomical characteristics of these two nerves. Authors also put forward a discussion on the possible clinical relevance of these findings. Material and methodsDissections were performed on six embalmed dogs at the Veterinary Faculty of Barcelona with the use of stereomicroscopy and microsurgery equipment. ResultsThe MBSN (grossly) and BVN (grossly and histologically) were identified in the cervical, thoracic, and lumbar region in all dog specimens. In addition, other small fibers (suspected nerves) entering the vertebral body through small foramina close to the end plates were identified. Histological examination of the tissues confirmed the presence of nerve fibers (myelinated and unmyelinated) in suspected BVN samples. Results of the present study indicated that dogs have BVNs. Also, suspected nerve fibers were identified among the epidural fat, running from the intervertebral foramina, that likely represent the MBSN. ConclusionThese findings open up the discussion on extrapolation of treatment options employed in human medicine for “low back pain”, such as BVN ablation, which is discussed in this article. Further anatomic and clinical studies of the innervation for the vertebral body, periosteum, vasculature, dorsal longitudinal ligament and anulus fibrosus are necessary to elucidate possible anatomical variants and breed differences as well as potential clinical (e.g., therapeutic) relevance.

Lumbar cistern Candida intradural abscess following epidural anesthesia

This report describes a case of an immunocompetent patient with an intradural abscess from Candida dubliniensis. The majority of fungal spine infections, although rare in general, are due to Aspergillus or C. albicans through systemic fungemia. To date, there have only been two reports of spondylodiscitis from C. dubliniensis. A 37-year-old immunocompetent female patient presented to the neurosurgical service for worsening headaches with nausea, vomiting, vision changes, and weight loss. MRI studies showed diffuse leptomeningeal enhancement of the distal spinal cord, conus medullaris, and nerve roots of the cauda equina extending beyond the neural foramina bilaterally. She had persistent symptoms and no clear diagnosis on lumbar puncture or systemic testing therefore L5-S1 laminectomy for an intradural tissue biopsy was performed. During surgery, cultures were taken and grew colonies of C. dubliniensis. This organism has been reported rarely in the literature as being an infectious agent, thus diagnosing remains a challenge but should be considered in patients with a suggestive history.

Assessment of the Asymmetry of the Intervertebral Foramina within the Lower Motion Segments of the Lumbar Spine on the Computer Tomography Sections

Asymmetry in the degenerative lumbar spine may eventually evolve to debilitating scoliosis. The point where it starts to accelerate in some individuals is obscure. Discreet preclinical asymmetry may be a prognostic feature of the condition. The aim of this study was to assess the asymmetry of the intervertebral foramina of lower lumbar motion segments of the spine based on morphometric measurements using novel techniques of three-dimensional imaging. Computed tomography scans of 19 subjects with axial low back pain aged 50 to 78 of both sexes were digitally processed, and 3D reconstruction of L4/L5 and L5/S1 motion segments were obtained. The planes of intervertebral foramina were defined in reference to the axis of the pedicles bordering the intervertebral canal and the measurements were performed yielding absolute values in millimeters. The circumference ranged from 33.4 mm to 63.86 mm on the left side and from 33.01 mm to 73.54 mm on the right side. The horizontal dimension ranged from 6.86 mm to 17.84 mm on the left side and from 5.41 mm to 17.63 mm on the right side. The vertical dimension ranged from 10.17 mm to 23.65 mm on the left side and from 9.04 mm to 29.69 mm on the right side. All the measurements were combined to assess the asymmetry. Only in three cases (15%), symmetry in both segments was confirmed. No defined lateralization of asymmetry was found, as well as no significant link between the sex and age could be confirmed. This is the first study confirming the asymmetry among the intervertebral foramina. It seems that it is the dominant phenotype for intervertebral foramina. As the observed asymmetry lacks the dominant lateralization, it may be linked with the same trait of degenerative scoliosis. Though no direct link between the age and sex was confirmed in this study, it suggests other factors should be considered in prediction of the progress and magnitude of the deformity.

Correlation between C7-T1 Intervertebral Foramen Area and Sagittal Parameters in Patients with Cervical Spondylotic Myelopathy.

Cervical spondylotic myelopathy (CSM) is an incomplete spinal cord injury characterized with pain and stiffness in the neck and motor and sensory dysfunction. This study aims to determine whether C7-T1 intervertebral foramen area could be used as a parameter to evaluate the sagittal curvature of cervical spine. Patients with clinical manifestations of spinal cord compression were hospitalized in our hospital from September 2018 to August 2019. All patients were diagnosed with CSM by nuclear magnetic imaging and other imaging methods. C2-C7 Cobb angle and T1 slop (T1S) were measured on the sagittal, T2-weighted magnetic resonance image of cervical spine, and C7-T1 intervertebral foramen area were measured using oblique cervical spine X-rays. Patients were divided into two groups according to the value of C2-C7 Cobb angle, including lordosis group (C2-C7 Cobb angle >10°, n=45) and straight group (C2-7 Cobb angle ≤10°, n=55). The reliability of the data was evaluated by intraclass correlation coefficient (ICC), and the correlation of the imaging parameters was analyzed by Pearson correlation. A total of 100 patients diagnosed with CSM hospitalized in our department were included. The ICC of the cervical parameters was 0.73. C7-T1 intervertebral foramen area was 40.69 ± 11.44 and 39.95 ± 10.94 mm2 in lordosis and straight group, respectively. The results showed that C7-T1 intervertebral foramen area was positively correlated with both C2-C7 Cobb angle (r=0.23, p=0.02) and T1S (r=0.21, p=0.03). In lordosis group, there was a positive correlation between C7 and T1 intervertebral foramen area and C2-C7 Cobb angle (r=0.69, p < 0.01) and T1S (r=0.34, p=0.02). However, in straight group, C7-T1 intervertebral foramen area was not correlated with either C2-C7 Cobb angle or T1S. C7-T1 intervertebral foramen area measured by oblique X-ray could be an effective method to evaluate the sagittal balance of cervical vertebrae for CSM patients with cervical lordosis.

Changes in the lumbar intervertebral foramen between supine and standing posture in patients with adult spinal deformity: a study with upright computed tomography.

To quantitatively assess the impact of supine and standing positions on the morphological changes in the lumbar intervertebral foramen (LIF) in patients with adult spinal deformity (ASD) using upright CT and conventional supine CT. Thirty patients with ASD were prospectively enrolled in this study. All subjects underwent standing whole spine posterior/anterior radiographs, lateral radiographs, and whole spine CT, both in the supine and upright standing positions. Two orthopedic surgeons independently measured nine radiographic parameters in the radiograph and the lumbar foraminal area (FA) and height (FH) in supine and upright CT. Statistical analyses were performed to evaluate the risk of LIF decrease when standing upright compared to the supine position. The chi-squared, t test, Pearson's coefficients, intra- and inter-rater reliabilities, and ROC curves were calculated. The level of significance was set at p < 0.05. Among the 300 LIFs, both the lumbar FA and FH were either increased or decreased by > 5% in approximately 30% of LIFs each. The FA decreased in the lower lumbar spine. The concave side had a significantly higher rate of decreased FA and FH than the convex side (p < 0.05 and < 0.05, respectively). ROC analysis showed that narrowing of the intervertebral disc (cutoff > 0.05°) is a risk factor for decreased FA and FH. This study describes the details of the changes in the neuroforamen using a novel upright CT. In patients with ASD, approximately 30% of LIFs either increased or decreased in size by > 5% when standing. The risk factors for LIF decrease are the lower lumbar spine, concave side, and narrow side of the disc wedge.