Morphometry of the lower lumbar spinal canal among a sample of the Saudi population: Are we at risk?

Abstract

Objectives: Lumbar disk bulge is a common cause of lower back pain. A high percentage of patients improve with conservative management, but unfortunately, some do not. We postulate that an anatomically narrowed lumbar spinal canal might contribute to this variation in response to conservative management. One of the major causes of spinal stenosis is idiopathic congenital-developmental stenosis, and here, we aimed to observe if this non-modifiable risk factor is present among the Saudi population, by analyzing the lower lumbar canal dimensions in computed tomography (CT) scan axial cuts, which might be later a reference and guide in clinical practice. Methods: This retrospective descriptive study included 279 patients aged 20–40years old. We included those who underwent diagnostic CT abdomen and CT lumbar spine with no evidence of lumbar spinal disease or fracture at the level where measures were taken from the axial cuts. Furthermore, exclusion criteria included gross spinal pathologies such as fractures, tumors, deformities, major chronic systemic diseases, congenital anomalies (dwarfism), and metallic artifacts. Results: Of the 279 patients, 137 (49%) were male and 142 (51%) were female. Different measurements were taken from the CT scan of axial cuts of the lower lumbar canal (L3, L4, and L5). The pattern of segmental variation of the lower lumbar vertebral canal was found to be like other populations. In contrast, the mean lower lumbar vertebral canal diameters were characteristically different from the other population (non-compensating). Conclusion: In the Saudi population, anterior-posterior and interpedicular diameters were narrowed (non-compensating). We found a high prevalence (32%) of trefoil configuration in the Saudi population.