Quantifying Nerve Compression: A Methodical Approach to Calculating Nerve Occupancy within the Foramen for Diagnostic Precision in Lumbar Foraminal Stenosis: Part-3 of a Comprehensive Series

Quantifying Nerve Compression: A Methodical Approach to Calculating Nerve Occupancy within the Foramen for Diagnostic Precision in Lumbar Foraminal Stenosis: Part-3 of a Comprehensive Series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quantifying Nerve Compression: A Methodical Approach to Calculating Nerve Occupancy within the Foramen for Diagnostic Precision in Lumbar Foraminal Stenosis: Part-3 of a Comprehensive Series Renat Nurmukhametov, Manuel De Jesus Encarnacion Ramirez, Medet Dosanov, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7472403/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background. Foraminal neuropathy involves stenosis at the level of the foramen leading to nerve compression causing pain, sensory disturbances, and muscle weakness. It results from the narrowing of the neural foramen due to degenerative, traumatic, or congenital factors. Quantifying nerve occupancy within the foramen can illuminate potential compression issues and guide clinical decisions, particularly in lumbar foraminal stenosis (LFS). Results. This six-year retrospective cohort study on 800 patients at NCC No. 2, Moscow, focused on quantifying nerve occupancy in the foramen using high-resolution MRI. Inclusion criteria included symptoms of nerve compression and prior spinal imaging. Advanced imaging software provided precise volumetric measurements of the foraminal spaces and nerves. The percentage of foramen occupied by the nerve was calculated to assess compression. The study found a progressive increase in nerve occupancy and symptom severity from L1/L2 to L5/S1 levels. High nerve occupancy percentages correlated with higher pain (VAS scores) and disability (ODI scores). L4/L5 and L5/S1 showed the most significant nerve compression and symptom severity, indicating critical sites for LFS diagnosis and treatment. Conclusions. This study advances understanding of lumbar foraminal stenosis by quantifying nerve occupancy. The findings highlight the importance of targeting lower lumbar levels in diagnosis and treatment, emphasizing the correlation between high nerve occupancy and symptom severity. This methodological approach enhances clinical precision and outcomes in managing foraminal stenosis. Foraminal stenosis nerve compression lumbar degenerative Volumetric MRI Analysis Radiculopathy Diagnostics Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Lumbar foraminal stenosis (LFS), defined as the compression or constriction of spinal nerves as they exit the vertebral column, represents a critical intersection between neurology and spinal anatomy. This condition frequently manifests as radiculopathy, arising when the neural foramen—the bony canal through which the spinal nerve root traverses—becomes narrowed or obstructed. Such compression is clinically significant, as it can impair neural function and result in pain, sensory deficits, and motor weakness. The etiology of foraminal neuropathy is multifactorial, encompassing degenerative, traumatic, and congenital factors that alter foraminal dimensions and contribute to nerve compromise. 1 The intricate interaction between the spinal nerve and the foraminal architecture through which it courses is central to understanding the pathophysiology of neuropathic disorders. The foramen functions as a vital neural conduit, and its structural integrity is essential for maintaining normal nerve physiology. Pathological changes that reduce the foraminal dimensions, whether in size or shape, can precipitate symptoms of compression such as pain, paresthesias, or weakness. This highlights the importance of quantifying the proportion of foraminal space occupied by the nerve, as such measurements may provide insights into the degree of compression and guide diagnostic and therapeutic decision-making. The pathogenesis of LFS is primarily rooted in degenerative changes of the spine. Structural deterioration of the intervertebral discs can lead to disc height reduction, bulging, and eventual collapse. These alterations cause the superior articular process to shift anterosuperiorly, resulting in subluxation. 2 – 3 This biomechanical disruption compromises spinal stability, promotes osteophyte formation, and induces thickening of the ligamentum flavum. Collectively, these changes alter segmental mechanics, redistribute loading forces unevenly, and place further stress on adjacent spinal elements. 4 – 5 With progression, annular fissures, facet joint hypertrophy, and distortion of disc architecture exacerbate foraminal narrowing and increase the likelihood of nerve compression. 6 The concept of nerve occupancy quantification is based on the anatomical relationship between the nerve and its osseous canal. Because nerve roots are vulnerable to compression from degenerative, traumatic, or congenital changes, accurate understanding of their spatial dynamics within the foramen is crucial. 1 The advent of high-resolution imaging has allowed for precise anatomical measurement of these relationships, enabling clinicians to evaluate foraminal dimensions with far greater accuracy. 7 This is particularly important in cases of foraminal stenosis, where nerve root accommodation is compromised, making a quantifiable diagnostic approach indispensable. 8 Traditionally, the evaluation of nerve compression has relied on clinical examination, imaging interpretation, and electrophysiological testing. 9 While valuable, these methods lack the ability to directly measure the extent of foraminal occupancy by the nerve. A standardized method to calculate the percentage of the foramen occupied by the nerve therefore represents an important step forward. Such an approach not only bridges the gap between subjective clinical impressions and objective quantification but also correlates with symptom severity and treatment outcomes. Ultimately, it offers a more precise framework for understanding the degree of nerve compression in LFS and supports more targeted therapeutic strategies. 10 Methods Study Design and Setting This investigation represents the third installment of a comprehensive series on LFS, with a particular emphasis on quantifying nerve occupancy within the foramen to enhance diagnostic precision. The study was designed as a retrospective cohort analysis and conducted at the NCC No. 2 Federal State Budgetary Scientific Institution, Russian Scientific Center named after Acad. B.V. Petrovsky. Data were collected over a six-year period, spanning January 2017 to December 2023. Participants Inclusion criteria consisted of: (1) age ≥ 18 years; (2) clinical presentation consistent with nerve compression regardless of diagnosis, including radicular pain, paresthesias, or motor weakness; and (3) availability of high-resolution spinal imaging as part of routine diagnostic assessment. Exclusion criteria were: (1) history of prior spinal surgery, (2) evidence of spinal malignancy, and (3) contraindications to magnetic resonance imaging (MRI). Imaging and Volumetric Measurement All participants underwent high-resolution MRI of the lumbar spine. Imaging was performed using a standardized protocol to ensure reproducibility and minimize inter-patient variability. Examinations were conducted on a 1.5-Tesla Sonata MRI scanner (Siemens Medical System, Erlangen, Germany). The protocol employed a turbo spin-echo technique with a repetition time (TR) of 3150 milliseconds and an echo time (TE) of 100 milliseconds, with total acquisition completed within approximately three minutes. Both T1- and T2-weighted sequences were obtained, with emphasis on 2-mm sagittal slices. Particular attention was given to T2-weighted parasagittal images acquired bilaterally, allowing for detailed visualization of the foraminal anatomy. Volumetric analysis of the foraminal and neural structures was performed using advanced imaging software capable of precise segmentation and three-dimensional quantification. Foramina volumes were calculated based on their geometric configuration, most commonly approximated as cylindrical or elliptical cylinders, and in more complex cases as irregular prisms. Nerve volume within each foramen was estimated by identifying its narrowest cross-sectional area and applying the assumption of a cylindrical morphology. All volumetric measurements were independently conducted by a team of experienced radiologists and neurologists, each blinded to the clinical data of the participants to minimize interpretation bias. Interobserver variability was addressed through consensus review when discrepancies occurred. Foramina Measurements In order to calculate the volume of the foramina several parameters are first obtained from the MRI. The diameter of the nerve (D) = Minor diameter (D2) (D) or radius (r), can be measured from sagittal view MRI (Fig. 1 – 2 ). Length of the nerve segment of interest (L), which in the context of foramina would be the depth or length of the nerve in coronal view MRI (Fig. 3 ). The formula to calculate the volume (V) of a cylinder (an approximation of the nerve) is: V = πr 2 L Where: V is the volume, r is the radius of the nerve, L is the length of the nerve segment (or the depth of the foramen), π is a mathematical constant (approximately 3.14159). Nerve Measurements This can be more challenging because nerves are not perfectly geometric shapes. However, you can approximate the nerve's volume by treating it as a cylinder or using its cross-sectional area from imaging data. The formula for the volume of a cylinder (V = πr2 h), where r is the radius of the nerve (assuming it's circular in cross-section) and ℎ is the length of the nerve segment that corresponds to the depth of the foramen (Figs. 1 – 3 ). Nerve/Foramen Ratio (N/F Ratio) In order to calculate the percentage of the nerve occupying the foramen, which essentially quantifies how much of the foramina's space is filled by the nerve, the foramen’s volume most also be measured. This percentage can provide insights into the spatial relationship between the nerve and the foramen, helping to identify potential compression or constriction issues. The N/F R can be calculated using geometric formulas based on the shape of the foramen (e.g., cylindrical or elliptical cylinder), using dimensions obtained from imaging studies as we described in the part two of our comprehensive series (Fig. 4 – 5 ). 9 N/F Ratio = (Volume of the Foramen/Volume of the Nerve​)×100 Clinical Relevance Understanding the percentage of the foramen occupied by the nerve is crucial in diagnosing conditions like foraminal stenosis and in planning interventions. A higher occupancy percentage could correlate with symptoms of nerve compression, such as pain, numbness, and weakness. Conversely, a lower percentage might be considered normal, provided there are no symptoms or other indications of pathology. Thus, symptomatic patients were evaluated with the visual analog scale (VAS) for radicular pain and the Oswestry Disability Index (ODI) for functional status. It is important to note that this calculation provides a simplified model. Actual clinical assessments may require more sophisticated imaging and analysis techniques to accurately understand the spatial dynamics between the nerve and the foramen. Statistical Analysis Descriptive statistics were used to summarize the patient demographics and clinical characteristics. The mean and standard deviation (SD) were calculated for continuous variables, while frequencies and percentages were used for categorical variables. The relationship between the percentage of foraminal occupancy and clinical symptoms was analyzed using logistic regression models, adjusting for potential confounders such as age, sex, and the presence of comorbid conditions. To analyze the data, we deployed descriptive statistics for summarizing patient demographics and clinical characteristics. Relationships between the percentage of foraminal occupancy by the nerve and clinical symptoms were examined through logistic regression models, with adjustments for confounders such as age, sex, and comorbid conditions. Statistical significance was set at a p-value of < 0.05. IBM SPSS Statistics version 25.0 was used for all statistical computations. Ethical Considerations Our study received approval from the Institutional Review Board at the hosting institution, ensuring compliance with both institutional and national ethical standards, as well as the Helsinki Declaration. Informed consent was a prerequisite for all study participants. Results Eight hundred patients met the inclusion criteria and consented to radiological image analysis. Radiological evaluations were performed in conjunction with VAS and ODI assessments. Table 1 presents the average nerve and foraminal volumes, as well as the calculated nerve occupancy percentages at each lumbar level. As expected, foraminal volume increased progressively in the caudal direction, whereas the average occupancy of the nerve within the foramen demonstrated a gradual decline. Table 1 Comparative table of average nerve occupancy percentages across 800 patients Level Side Average Volume of Nerve*±SD Average Volume of Foramen*±SD Average Occupancy (%) ± SD L1/L2 R 288.35 ± 30.45 555.59 ± 35.60 51.89 ± 3.20 L1/L2 L 295.69 ± 28.90 591.65 ± 40.75 49.97 ± 6.10 L2/L3 R 302.51 ± 33.15 688.33 ± 42.47 43.95 ± 5.35 L2/L3 L 309.21 ± 35.20 698.10 ± 48.88 44.31 ± 4.85 L3/L4 R 317.11 ± 29.67 757.89 ± 43.52 41.84 ± 5.80 L3/L4 L 306.74 ± 32.10 768.63 ± 55.30 39.91 ± 4.99 L4/L5 R 310.24 ± 31.05 772.11 ± 46.78 40.84 ± 5.65 L4/L5 L 316.53 ± 38.40 781.26 ± 49.22 40.52 ± 5.50 L5/S1 R 321.13 ± 34.73 798.31 ± 41.99 40.23 ± 4.40 L5/S1 L 325.46 ± 36.88 790.28 ± 44.05 41.84 ± 6.25 *mm3, SD: standard deviation Table 2 summarizes the relationship between nerve occupancy and clinical symptoms. A clear trend was observed in which higher occupancy percentages corresponded with elevated VAS and ODI scores, particularly at the lower lumbar levels. Patients at L4/L5 and L5/S1 exhibited the highest mean occupancy (72–73%), alongside the highest mean VAS (8.2–9.0) and ODI (70–75%). Table 2 Nerve occupancy and symptom severity in lumbar foraminal stenosis Level Side Number of Patients Average Nerve Occupancy ± SD (%) Average VAS Score ± SD Average ODI ± SD (%) L1/L2 R 9 58 ± 2 4 ± 1.1 20–40 ± 10 L1/L2 L 13 61 ± 2.5 4 ± 1.3 20–40 ± 10 L2/L3 R 17 63 ± 2.2 6.5 ± 0.9 40 ± 3 L2/L3 L 8 64 ± 7.0 7.0 ± 1.2 43 ± 6 L3/L4 R 50 66 ± 3 8.0 ± 1.0 55 ± 7 L3/L4 L 55 68 ± 2.8 8.5 ± 1.1 60 ± 8 L4/L5 R 105 70 ± 3.5 8.0 ± 0.8 65 ± 6 L4/L5 L 90 72 ± 3.2 8.2 ± 1.3 70 ± 9 L5/S1 R 85 72 ± 4.0 8.5 ± 1.2 75 ± 10 L5/S1 L 75 73 ± 3.8 9.0 ± 1.0 72 ± 11 SD: standard deviation, VAS: visual analog scale, ODI: Oswestry Disability Index Correlation analysis revealed a strong positive association between nerve occupancy and symptom severity. Occupancy correlated significantly with both VAS scores (r = 0.91, p < 0.001) and ODI scores (r = 0.98, p < 0.001), indicating that increasing nerve compression is closely linked to both pain intensity and functional impairment. Figure 6 illustrates the average nerve occupancy, VAS, and ODI scores across lumbar levels (L1/L2 to L5/S1) in patients with lumbar foraminal stenosis. The chart shows a clear caudal increase, with nerve occupancy rising from 59.5% at L1/L2 to 72.5% at L5/S1, normalized VAS scores (originally 0–10, scaled to 0–100) increasing from 40 to 87.5, and ODI scores rising from 30–73.5%. These differences were statistically significant (ANOVA: F = 30.1, p = 0.001 for occupancy; F = 93.4, p < 0.001 for VAS; F = 96.1, p < 0.001 for ODI), highlighting more severe nerve compression and symptom burden at lower lumbar levels, particularly L4/L5 and L5/S1. Post-hoc comparisons confirmed that lower lumbar levels (L4/L5 and L5/S1) had significantly higher occupancy and worse clinical scores compared with more cranial segments. Taken together, these results highlight a consistent and statistically robust relationship between nerve occupancy and clinical outcomes. Higher occupancy within the neural foramen, particularly at the caudal lumbar levels, is strongly associated with greater pain and disability, underscoring the diagnostic and clinical relevance of this volumetric method. Discussion Our study builds on the normative volumetric data established in the second part of this series, providing a robust anatomical baseline for identifying pathological changes in LFS. 9 By analyzing 8,000 foramina from 800 patients, we observed a consistent increase in foraminal volume from L1/L2 to L5/S1, reflecting the greater biomechanical demands on the lower lumbar spine. The slight left-right asymmetry in foraminal volumes, with the left typically larger, could stem from subtle anatomical variations or imaging artifacts, though our high inter- and intraobserver reliability (ICC = 0.91 and 0.95) underscores the method's consistency. Shifting focus to nerve occupancy, this third installment introduces a novel large-scale quantification using high-resolution MRI. Unlike prior work limited to 2D assessments, our 3D volumetric approach captures the nerve's spatial dynamics more accurately, revealing a caudal escalation in occupancy that peaks at L5/S1. 11 This pattern aligns with heightened symptom severity, as evidenced by strong correlations with VAS scores (r = 0.91, p < 0.001) and ODI scores (r = 0.98, p < 0.001). Such findings echo reports where increased foraminal narrowing correlates with worse pain and disability, particularly in degenerative cases. 12 – 13 These results reinforce the vulnerability of L4/L5 and L5/S1 to degenerative changes, driven by cumulative mechanical stress from daily activities and aging. Studies in populations like those with achondroplasia highlight similar patterns, where reduced foraminal dimensions exacerbate nerve compression. 10 Clinically, this suggests prioritizing lower lumbar evaluation in symptomatic patients, potentially enabling earlier interventions to halt progression and improve quality of life. MRI remains pivotal in linking anatomy to symptoms, with advanced sequences like 3D CISS offering superior resolution for detecting impingement. 15 Patients with radiculopathy often display higher occupancy on imaging, correlating with sensory or motor deficits. Integrating technologies such as 3D modeling and augmented reality enhances preoperative planning, allowing surgeons to visualize complex foraminal anatomy and reduce risks. 16 – 17 Looking ahead, longitudinal studies are essential to track LFS progression, as current evidence on natural history is limited and often shows variable symptom evolution over years. 18 Investigating biomechanical contributors—like facet arthrosis, disc degeneration, and dynamic postural changes—could identify predictive factors for stenosis development. 19 Comparative trials assessing surgical versus conservative strategies would further refine guidelines, incorporating patient-reported outcomes for holistic evaluation. Machine learning (ML) holds promise for automating diagnostics, with models trained on MRI data achieving high accuracy in detecting and grading stenosis, often outperforming manual assessments in speed and reliability. 20 – 23 These tools could integrate volumetric metrics with clinical scores, aiding in personalized treatment decisions. 24 – 25 This research stands out as the first to apply extensive volumetric analysis linking foraminal anatomy to nerve occupancy on this scale, surpassing traditional 2D methods in capturing 3D complexity. By establishing occupancy thresholds and correlating them with VAS and ODI (Tables 1 and 2 ), we offer a framework for more precise diagnostics and interventions. Future explorations of genetic factors might uncover biomarkers for early detection. The synergy between clinical symptoms and imaging-based nerve occupancy provides a nuanced approach to managing conditions such as foraminal stenosis. By comprehensively understanding the spatial dynamics between nerves and the foramen, clinicians can better predict the clinical outcomes of various therapeutic interventions. The relationship between the nervous system and the skeletal structure it navigates is fundamental to understanding a plethora of neuropathic conditions. At the heart of this relationship lies the foramen, a crucial passageway through which nerves transit from their origins in the spinal cord to their vast destinations throughout the body. The foramina, serving as conduits, are subject to spatial limitations that, when compromised, can precipitate a range of clinical manifestations owing to nerve compression or irritation. In agreement with Özer et al. (2022) and Modi et al. (2008), our data suggest that these levels are particularly vulnerable to stenosis and neurovascular impingement, especially in anatomically predisposed populations such as individuals with achondroplasia. 10 , 26 Ahn et al. (2014) also reported a strong association between nerve compression and elevated VAS and ODI scores, aligning with our results. 27 Given the high burden at L5/S1, early identification of pathological compression here may prompt more timely intervention. Our previous findings support the use of surgical decompression at this level, which demonstrated favorable outcomes in selected patients. 28 Additionally, the standard deviation in symptom scores across patients suggests individual variability, underscoring the need for patient-specific treatment plans. Patients with marked radiculopathy, sensory deficits, or motor weakness typically exhibit higher degrees of foraminal narrowing and nerve impingement on imaging. Advanced MRI techniques such as 3D CISS sequences improve spatial resolution, enabling a more nuanced assessment of the foraminal contents and surrounding structures. This imaging clarity facilitates precise surgical planning and enhances the effectiveness of conservative interventions. There is a notable association between high nerve occupancy and elevated VAS/ODI scores, reinforcing the relevance of volumetric MRI metrics in clinical evaluation. 29 The incorporation of technologies like 3D modeling and augmented reality (AR) further augments this approach. With precise reconstructions of the lumbar foramina, 3D models improve the accuracy of spatial analysis, while AR tools provide surgeons with immersive preoperative planning capabilities. 30 Future studies should aim to capture the temporal progression of LFS. Longitudinal research would elucidate the natural course of increasing nerve occupancy and evolving symptoms, as well as the long-term efficacy of both surgical and conservative treatments. Comparative effectiveness research evaluating surgical, pharmacological, and rehabilitative strategies could further refine treatment paradigms. 31 – 32 Emerging machine learning (ML) applications offer powerful tools to enhance diagnostic accuracy and optimize treatment decisions. 24 ML models can be trained to detect foraminal narrowing and nerve root compression from MRI datasets, often surpassing human performance in consistency and speed. Advanced segmentation algorithms can quantify nerve occupancy metrics, correlating these with symptom severity to support clinical decision-making. 33 Volumetric data, when correlated with clinical metrics such as VAS and ODI, enables a more integrated approach to patient assessment and care planning (Table 1 , Table 2 ). This multi-dimensional strategy enhances diagnostic precision, improves targeting of interventions, and supports outcome tracking over time. Randomized controlled trials and longitudinal studies incorporating patient-reported outcomes would strengthen this foundation and enable more personalized therapeutic approaches. Furthermore, exploring genetic and molecular contributors to foraminal narrowing could lead to early biomarkers and targeted therapies. Several limitations should be noted. The cross-sectional design precludes assessment of disease progression. Although imaging protocols were standardized, variability across MRI platforms could introduce measurement inconsistencies. While the cohort was demographically balanced, generalizability may be limited due to regional anatomical variations. Long-term outcomes were not assessed, and the study did not include post-surgical follow-up to determine prognostic utility of nerve occupancy measurements. Finally, despite high interobserver agreement, some measurement variability remains inevitable, and additional calibration could improve consistency. Conclusions This study represents a methodological advancement in the field by being the first to apply large-scale volumetric analysis to assess the relationship between foraminal anatomy and nerve occupancy. Prior approaches relied on 2D imaging, limiting spatial accuracy. Our technique leverages high-resolution MRI to generate precise, reproducible measurements that capture the three-dimensional complexity of the lumbar foramina. By defining normative and pathological occupancy thresholds, our findings may help refine diagnostic criteria and surgical indications. List of Abbreviations LFS lumbar foraminal stenosis MRI magnetic resonance imaging TR repetition time TE echo time N/F R Nerve/Foramen Ratio VAS Visual analog scale ODI Oswestry Disability Index SD standard deviation Declarations Ethics approval and consent to participate Ethics board approval from NCC No. 2 Federal State Budgetary Scientific Institution Russian Scientific Center named after Acad. B.V. Petrovsky (010424) was obtained prior to the study. The study was carried out according to the latest revision of the Helsinki Declaration regarding medical research involving human subjects. Informed verbal consent was acquired from all patients before the study. Consent for publication A verbal patient consent form from all the patients was obtained. Availability of data and material All data related to this study can be requested from the corresponding author via e-mail. Competing interests The authors have no competing interests related to this study. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. No corporate, government or institutional funding has been received. Authors' contributions All listed authors made substantial contributions to the conception, data acquisition, analysis, drafting, and final approval of the manuscript. 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09:10:28","extension":"html","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100771,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7472403/v1/ca3f68905f06b493e27a59ae.html"},{"id":93023674,"identity":"bfc646de-4152-4d94-a72a-97a243886c57","added_by":"auto","created_at":"2025-10-08 09:10:27","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":110810,"visible":true,"origin":"","legend":"\u003cp\u003eMajor diameter (D1): Nerve measurement in MRI in the sagittal plane\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7472403/v1/84f6c5fd5a246f51487836ae.jpg"},{"id":93022302,"identity":"ac0690cb-5155-4f8f-8923-2a8f64da1cab","added_by":"auto","created_at":"2025-10-08 09:02:27","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55330,"visible":true,"origin":"","legend":"\u003cp\u003eMajor diameter (D1): correlation in the measurement of the foramen and the measurements of the nerve in the MRI sagittal view\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7472403/v1/c956822e7d537861e62b5fda.jpg"},{"id":93024751,"identity":"e425a7b9-daa5-441b-b8f7-7036afc7f501","added_by":"auto","created_at":"2025-10-08 09:18:27","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":42024,"visible":true,"origin":"","legend":"\u003cp\u003eCoronal view; the calculation of the nerve length in the foramen area in two different patients.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7472403/v1/7a74e0913411d4a3a47a9ed8.jpg"},{"id":93022304,"identity":"015337f0-266c-4886-a120-8904b3c59416","added_by":"auto","created_at":"2025-10-08 09:02:27","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":137554,"visible":true,"origin":"","legend":"\u003cp\u003eLeft side Major diameter (D1): The longest distance across the foramen. Minor diameter (D2): The shortest distance across the foramen, perpendicular to D1. The distance from the entrance of the foramen to its exit at the foramen.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7472403/v1/c5cecc6337bb8413b2d48087.jpg"},{"id":93024752,"identity":"2980dcee-8996-4002-9313-c89d0bd07f48","added_by":"auto","created_at":"2025-10-08 09:18:27","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":118499,"visible":true,"origin":"","legend":"\u003cp\u003eRight side Major diameter (D1): The longest distance across the foramen. Minor diameter (D2): The shortest distance across the foramen, perpendicular to D1. Deep: The distance from the entrance of the foramen to its exit at the foramen (H)\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7472403/v1/fc23ac3649a21b48495bd057.jpg"},{"id":93023681,"identity":"fe7496a4-059a-471d-afa3-ae1ab77f0e48","added_by":"auto","created_at":"2025-10-08 09:10:28","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":127293,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart showing nerve occupancy, VAS, and ODI scores across lumbar levels, with significant differences (ANOVA: F = 30.1, p = 0.001 for occupancy; F = 93.4, p \u0026lt; 0.001 for VAS; F = 96.1, p \u0026lt; 0.001 for ODI). VAS scores (originally 0–10) were normalized to 0–100 by multiplying by 10 for visualization. Data represent averages of right and left sides from 800 patients (Table 2).\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7472403/v1/2427eb89aa32b49a23141325.jpg"},{"id":101752296,"identity":"1db7789b-8c9a-492e-adfd-1830574b8a0b","added_by":"auto","created_at":"2026-02-03 10:26:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1514758,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7472403/v1/8cab4f48-84a4-4ed1-82a6-23421fe8d33d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quantifying Nerve Compression: A Methodical Approach to Calculating Nerve Occupancy within the Foramen for Diagnostic Precision in Lumbar Foraminal Stenosis: Part-3 of a Comprehensive Series","fulltext":[{"header":"Background","content":"\u003cp\u003eLumbar foraminal stenosis (LFS), defined as the compression or constriction of spinal nerves as they exit the vertebral column, represents a critical intersection between neurology and spinal anatomy. This condition frequently manifests as radiculopathy, arising when the neural foramen\u0026mdash;the bony canal through which the spinal nerve root traverses\u0026mdash;becomes narrowed or obstructed. Such compression is clinically significant, as it can impair neural function and result in pain, sensory deficits, and motor weakness. The etiology of foraminal neuropathy is multifactorial, encompassing degenerative, traumatic, and congenital factors that alter foraminal dimensions and contribute to nerve compromise.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe intricate interaction between the spinal nerve and the foraminal architecture through which it courses is central to understanding the pathophysiology of neuropathic disorders. The foramen functions as a vital neural conduit, and its structural integrity is essential for maintaining normal nerve physiology. Pathological changes that reduce the foraminal dimensions, whether in size or shape, can precipitate symptoms of compression such as pain, paresthesias, or weakness. This highlights the importance of quantifying the proportion of foraminal space occupied by the nerve, as such measurements may provide insights into the degree of compression and guide diagnostic and therapeutic decision-making.\u003c/p\u003e\u003cp\u003eThe pathogenesis of LFS is primarily rooted in degenerative changes of the spine. Structural deterioration of the intervertebral discs can lead to disc height reduction, bulging, and eventual collapse. These alterations cause the superior articular process to shift anterosuperiorly, resulting in subluxation.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e This biomechanical disruption compromises spinal stability, promotes osteophyte formation, and induces thickening of the ligamentum flavum. Collectively, these changes alter segmental mechanics, redistribute loading forces unevenly, and place further stress on adjacent spinal elements.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e With progression, annular fissures, facet joint hypertrophy, and distortion of disc architecture exacerbate foraminal narrowing and increase the likelihood of nerve compression.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe concept of nerve occupancy quantification is based on the anatomical relationship between the nerve and its osseous canal. Because nerve roots are vulnerable to compression from degenerative, traumatic, or congenital changes, accurate understanding of their spatial dynamics within the foramen is crucial.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The advent of high-resolution imaging has allowed for precise anatomical measurement of these relationships, enabling clinicians to evaluate foraminal dimensions with far greater accuracy.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e This is particularly important in cases of foraminal stenosis, where nerve root accommodation is compromised, making a quantifiable diagnostic approach indispensable.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTraditionally, the evaluation of nerve compression has relied on clinical examination, imaging interpretation, and electrophysiological testing.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e While valuable, these methods lack the ability to directly measure the extent of foraminal occupancy by the nerve. A standardized method to calculate the percentage of the foramen occupied by the nerve therefore represents an important step forward. Such an approach not only bridges the gap between subjective clinical impressions and objective quantification but also correlates with symptom severity and treatment outcomes. Ultimately, it offers a more precise framework for understanding the degree of nerve compression in LFS and supports more targeted therapeutic strategies.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis investigation represents the third installment of a comprehensive series on LFS, with a particular emphasis on quantifying nerve occupancy within the foramen to enhance diagnostic precision. The study was designed as a retrospective cohort analysis and conducted at the NCC No. 2 Federal State Budgetary Scientific Institution, Russian Scientific Center named after Acad. B.V. Petrovsky. Data were collected over a six-year period, spanning January 2017 to December 2023.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eInclusion criteria consisted of: (1) age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (2) clinical presentation consistent with nerve compression regardless of diagnosis, including radicular pain, paresthesias, or motor weakness; and (3) availability of high-resolution spinal imaging as part of routine diagnostic assessment. Exclusion criteria were: (1) history of prior spinal surgery, (2) evidence of spinal malignancy, and (3) contraindications to magnetic resonance imaging (MRI).\u003c/p\u003e\n\u003ch3\u003eImaging and Volumetric Measurement\u003c/h3\u003e\n\u003cp\u003eAll participants underwent high-resolution MRI of the lumbar spine. Imaging was performed using a standardized protocol to ensure reproducibility and minimize inter-patient variability. Examinations were conducted on a 1.5-Tesla Sonata MRI scanner (Siemens Medical System, Erlangen, Germany). The protocol employed a turbo spin-echo technique with a repetition time (TR) of 3150 milliseconds and an echo time (TE) of 100 milliseconds, with total acquisition completed within approximately three minutes. Both T1- and T2-weighted sequences were obtained, with emphasis on 2-mm sagittal slices. Particular attention was given to T2-weighted parasagittal images acquired bilaterally, allowing for detailed visualization of the foraminal anatomy.\u003c/p\u003e\u003cp\u003eVolumetric analysis of the foraminal and neural structures was performed using advanced imaging software capable of precise segmentation and three-dimensional quantification. Foramina volumes were calculated based on their geometric configuration, most commonly approximated as cylindrical or elliptical cylinders, and in more complex cases as irregular prisms. Nerve volume within each foramen was estimated by identifying its narrowest cross-sectional area and applying the assumption of a cylindrical morphology. All volumetric measurements were independently conducted by a team of experienced radiologists and neurologists, each blinded to the clinical data of the participants to minimize interpretation bias. Interobserver variability was addressed through consensus review when discrepancies occurred.\u003c/p\u003e\n\u003ch3\u003eForamina Measurements\u003c/h3\u003e\n\u003cp\u003eIn order to calculate the volume of the foramina several parameters are first obtained from the MRI. The diameter of the nerve (D)\u0026thinsp;=\u0026thinsp;Minor diameter (D2) (D) or radius (r), can be measured from sagittal view MRI (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Length of the nerve segment of interest (L), which in the context of foramina would be the depth or length of the nerve in coronal view MRI (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe formula to calculate the volume (V) of a cylinder (an approximation of the nerve) is:\u003c/p\u003e\n\u003ch3\u003eV = πr 2 L\u003c/h3\u003e\n\u003cp\u003eWhere:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eV is the volume,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003er is the radius of the nerve,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eL is the length of the nerve segment (or the depth of the foramen),\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eπ is a mathematical constant (approximately 3.14159).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eNerve Measurements\u003c/h2\u003e\u003cp\u003eThis can be more challenging because nerves are not perfectly geometric shapes. However, you can approximate the nerve's volume by treating it as a cylinder or using its cross-sectional area from imaging data. The formula for the volume of a cylinder (V\u0026thinsp;=\u0026thinsp;πr2 h), where r is the radius of the nerve (assuming it's circular in cross-section) and ℎ is the length of the nerve segment that corresponds to the depth of the foramen (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eNerve/Foramen Ratio (N/F Ratio)\u003c/h3\u003e\n\u003cp\u003eIn order to calculate the percentage of the nerve occupying the foramen, which essentially quantifies how much of the foramina's space is filled by the nerve, the foramen\u0026rsquo;s volume most also be measured. This percentage can provide insights into the spatial relationship between the nerve and the foramen, helping to identify potential compression or constriction issues.\u003c/p\u003e\u003cp\u003eThe N/F R can be calculated using geometric formulas based on the shape of the foramen (e.g., cylindrical or elliptical cylinder), using dimensions obtained from imaging studies as we described in the part two of our comprehensive series (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eN/F Ratio = (Volume of the Foramen/Volume of the Nerve​)×100\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eClinical Relevance\u003c/h2\u003e\u003cp\u003eUnderstanding the percentage of the foramen occupied by the nerve is crucial in diagnosing conditions like foraminal stenosis and in planning interventions. A higher occupancy percentage could correlate with symptoms of nerve compression, such as pain, numbness, and weakness. Conversely, a lower percentage might be considered normal, provided there are no symptoms or other indications of pathology. Thus, symptomatic patients were evaluated with the visual analog scale (VAS) for radicular pain and the Oswestry Disability Index (ODI) for functional status.\u003c/p\u003e\u003cp\u003eIt is important to note that this calculation provides a simplified model. Actual clinical assessments may require more sophisticated imaging and analysis techniques to accurately understand the spatial dynamics between the nerve and the foramen.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics were used to summarize the patient demographics and clinical characteristics. The mean and standard deviation (SD) were calculated for continuous variables, while frequencies and percentages were used for categorical variables. The relationship between the percentage of foraminal occupancy and clinical symptoms was analyzed using logistic regression models, adjusting for potential confounders such as age, sex, and the presence of comorbid conditions.\u003c/p\u003e\u003cp\u003eTo analyze the data, we deployed descriptive statistics for summarizing patient demographics and clinical characteristics. Relationships between the percentage of foraminal occupancy by the nerve and clinical symptoms were examined through logistic regression models, with adjustments for confounders such as age, sex, and comorbid conditions. Statistical significance was set at a p-value of \u0026lt;\u0026thinsp;0.05. IBM SPSS Statistics version 25.0 was used for all statistical computations.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e Our study received approval from the Institutional Review Board at the hosting institution, ensuring compliance with both institutional and national ethical standards, as well as the Helsinki Declaration. Informed consent was a prerequisite for all study participants.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eEight hundred patients met the inclusion criteria and consented to radiological image analysis. Radiological evaluations were performed in conjunction with VAS and ODI assessments. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the average nerve and foraminal volumes, as well as the calculated nerve occupancy percentages at each lumbar level. As expected, foraminal volume increased progressively in the caudal direction, whereas the average occupancy of the nerve within the foramen demonstrated a gradual decline.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparative table of average nerve occupancy percentages across 800 patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSide\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAverage Volume of Nerve*\u0026plusmn;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAverage Volume of Foramen*\u0026plusmn;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAverage Occupancy (%)\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL1/L2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e288.35\u0026thinsp;\u0026plusmn;\u0026thinsp;30.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e555.59\u0026thinsp;\u0026plusmn;\u0026thinsp;35.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e51.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL1/L2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e295.69\u0026thinsp;\u0026plusmn;\u0026thinsp;28.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e591.65\u0026thinsp;\u0026plusmn;\u0026thinsp;40.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e49.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL2/L3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e302.51\u0026thinsp;\u0026plusmn;\u0026thinsp;33.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e688.33\u0026thinsp;\u0026plusmn;\u0026thinsp;42.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e43.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL2/L3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e309.21\u0026thinsp;\u0026plusmn;\u0026thinsp;35.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e698.10\u0026thinsp;\u0026plusmn;\u0026thinsp;48.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e44.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL3/L4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e317.11\u0026thinsp;\u0026plusmn;\u0026thinsp;29.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e757.89\u0026thinsp;\u0026plusmn;\u0026thinsp;43.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e41.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL3/L4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e306.74\u0026thinsp;\u0026plusmn;\u0026thinsp;32.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e768.63\u0026thinsp;\u0026plusmn;\u0026thinsp;55.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e39.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL4/L5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e310.24\u0026thinsp;\u0026plusmn;\u0026thinsp;31.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e772.11\u0026thinsp;\u0026plusmn;\u0026thinsp;46.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e40.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL4/L5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e316.53\u0026thinsp;\u0026plusmn;\u0026thinsp;38.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e781.26\u0026thinsp;\u0026plusmn;\u0026thinsp;49.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e40.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL5/S1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e321.13\u0026thinsp;\u0026plusmn;\u0026thinsp;34.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e798.31\u0026thinsp;\u0026plusmn;\u0026thinsp;41.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e40.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL5/S1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e325.46\u0026thinsp;\u0026plusmn;\u0026thinsp;36.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e790.28\u0026thinsp;\u0026plusmn;\u0026thinsp;44.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e41.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*mm3, SD: standard deviation\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the relationship between nerve occupancy and clinical symptoms. A clear trend was observed in which higher occupancy percentages corresponded with elevated VAS and ODI scores, particularly at the lower lumbar levels. Patients at L4/L5 and L5/S1 exhibited the highest mean occupancy (72\u0026ndash;73%), alongside the highest mean VAS (8.2\u0026ndash;9.0) and ODI (70\u0026ndash;75%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNerve occupancy and symptom severity in lumbar foraminal stenosis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSide\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of Patients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAverage Nerve Occupancy\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAverage VAS Score\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAverage ODI\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL1/L2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e58\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e20\u0026ndash;40\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL1/L2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e20\u0026ndash;40\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL2/L3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e40\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL2/L3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e43\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL3/L4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e55\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL3/L4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e60\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL4/L5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e70\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL4/L5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e70\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL5/S1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e75\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL5/S1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e72\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eSD: standard deviation, VAS: visual analog scale, ODI: Oswestry Disability Index\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCorrelation analysis revealed a strong positive association between nerve occupancy and symptom severity. Occupancy correlated significantly with both VAS scores (r\u0026thinsp;=\u0026thinsp;0.91, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ODI scores (r\u0026thinsp;=\u0026thinsp;0.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that increasing nerve compression is closely linked to both pain intensity and functional impairment.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e illustrates the average nerve occupancy, VAS, and ODI scores across lumbar levels (L1/L2 to L5/S1) in patients with lumbar foraminal stenosis. The chart shows a clear caudal increase, with nerve occupancy rising from 59.5% at L1/L2 to 72.5% at L5/S1, normalized VAS scores (originally 0\u0026ndash;10, scaled to 0\u0026ndash;100) increasing from 40 to 87.5, and ODI scores rising from 30\u0026ndash;73.5%. These differences were statistically significant (ANOVA: F\u0026thinsp;=\u0026thinsp;30.1, p\u0026thinsp;=\u0026thinsp;0.001 for occupancy; F\u0026thinsp;=\u0026thinsp;93.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for VAS; F\u0026thinsp;=\u0026thinsp;96.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for ODI), highlighting more severe nerve compression and symptom burden at lower lumbar levels, particularly L4/L5 and L5/S1. Post-hoc comparisons confirmed that lower lumbar levels (L4/L5 and L5/S1) had significantly higher occupancy and worse clinical scores compared with more cranial segments.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTaken together, these results highlight a consistent and statistically robust relationship between nerve occupancy and clinical outcomes. Higher occupancy within the neural foramen, particularly at the caudal lumbar levels, is strongly associated with greater pain and disability, underscoring the diagnostic and clinical relevance of this volumetric method.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study builds on the normative volumetric data established in the second part of this series, providing a robust anatomical baseline for identifying pathological changes in LFS.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e By analyzing 8,000 foramina from 800 patients, we observed a consistent increase in foraminal volume from L1/L2 to L5/S1, reflecting the greater biomechanical demands on the lower lumbar spine. The slight left-right asymmetry in foraminal volumes, with the left typically larger, could stem from subtle anatomical variations or imaging artifacts, though our high inter- and intraobserver reliability (ICC\u0026thinsp;=\u0026thinsp;0.91 and 0.95) underscores the method's consistency.\u003c/p\u003e\u003cp\u003eShifting focus to nerve occupancy, this third installment introduces a novel large-scale quantification using high-resolution MRI. Unlike prior work limited to 2D assessments, our 3D volumetric approach captures the nerve's spatial dynamics more accurately, revealing a caudal escalation in occupancy that peaks at L5/S1.\u003csup\u003e11\u003c/sup\u003e This pattern aligns with heightened symptom severity, as evidenced by strong correlations with VAS scores (r\u0026thinsp;=\u0026thinsp;0.91, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ODI scores (r\u0026thinsp;=\u0026thinsp;0.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Such findings echo reports where increased foraminal narrowing correlates with worse pain and disability, particularly in degenerative cases.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThese results reinforce the vulnerability of L4/L5 and L5/S1 to degenerative changes, driven by cumulative mechanical stress from daily activities and aging. Studies in populations like those with achondroplasia highlight similar patterns, where reduced foraminal dimensions exacerbate nerve compression.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Clinically, this suggests prioritizing lower lumbar evaluation in symptomatic patients, potentially enabling earlier interventions to halt progression and improve quality of life.\u003c/p\u003e\u003cp\u003eMRI remains pivotal in linking anatomy to symptoms, with advanced sequences like 3D CISS offering superior resolution for detecting impingement.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Patients with radiculopathy often display higher occupancy on imaging, correlating with sensory or motor deficits. Integrating technologies such as 3D modeling and augmented reality enhances preoperative planning, allowing surgeons to visualize complex foraminal anatomy and reduce risks.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eLooking ahead, longitudinal studies are essential to track LFS progression, as current evidence on natural history is limited and often shows variable symptom evolution over years.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Investigating biomechanical contributors\u0026mdash;like facet arthrosis, disc degeneration, and dynamic postural changes\u0026mdash;could identify predictive factors for stenosis development.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Comparative trials assessing surgical versus conservative strategies would further refine guidelines, incorporating patient-reported outcomes for holistic evaluation.\u003c/p\u003e\u003cp\u003eMachine learning (ML) holds promise for automating diagnostics, with models trained on MRI data achieving high accuracy in detecting and grading stenosis, often outperforming manual assessments in speed and reliability.\u003csup\u003e\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e These tools could integrate volumetric metrics with clinical scores, aiding in personalized treatment decisions.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis research stands out as the first to apply extensive volumetric analysis linking foraminal anatomy to nerve occupancy on this scale, surpassing traditional 2D methods in capturing 3D complexity. By establishing occupancy thresholds and correlating them with VAS and ODI (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), we offer a framework for more precise diagnostics and interventions. Future explorations of genetic factors might uncover biomarkers for early detection.\u003c/p\u003e\u003cp\u003eThe synergy between clinical symptoms and imaging-based nerve occupancy provides a nuanced approach to managing conditions such as foraminal stenosis. By comprehensively understanding the spatial dynamics between nerves and the foramen, clinicians can better predict the clinical outcomes of various therapeutic interventions. The relationship between the nervous system and the skeletal structure it navigates is fundamental to understanding a plethora of neuropathic conditions. At the heart of this relationship lies the foramen, a crucial passageway through which nerves transit from their origins in the spinal cord to their vast destinations throughout the body. The foramina, serving as conduits, are subject to spatial limitations that, when compromised, can precipitate a range of clinical manifestations owing to nerve compression or irritation.\u003c/p\u003e\u003cp\u003eIn agreement with \u0026Ouml;zer et al. (2022) and Modi et al. (2008), our data suggest that these levels are particularly vulnerable to stenosis and neurovascular impingement, especially in anatomically predisposed populations such as individuals with achondroplasia.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Ahn et al. (2014) also reported a strong association between nerve compression and elevated VAS and ODI scores, aligning with our results.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Given the high burden at L5/S1, early identification of pathological compression here may prompt more timely intervention. Our previous findings support the use of surgical decompression at this level, which demonstrated favorable outcomes in selected patients.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Additionally, the standard deviation in symptom scores across patients suggests individual variability, underscoring the need for patient-specific treatment plans.\u003c/p\u003e\u003cp\u003ePatients with marked radiculopathy, sensory deficits, or motor weakness typically exhibit higher degrees of foraminal narrowing and nerve impingement on imaging. Advanced MRI techniques such as 3D CISS sequences improve spatial resolution, enabling a more nuanced assessment of the foraminal contents and surrounding structures. This imaging clarity facilitates precise surgical planning and enhances the effectiveness of conservative interventions.\u003c/p\u003e\u003cp\u003eThere is a notable association between high nerve occupancy and elevated VAS/ODI scores, reinforcing the relevance of volumetric MRI metrics in clinical evaluation.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e The incorporation of technologies like 3D modeling and augmented reality (AR) further augments this approach. With precise reconstructions of the lumbar foramina, 3D models improve the accuracy of spatial analysis, while AR tools provide surgeons with immersive preoperative planning capabilities.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eFuture studies should aim to capture the temporal progression of LFS. Longitudinal research would elucidate the natural course of increasing nerve occupancy and evolving symptoms, as well as the long-term efficacy of both surgical and conservative treatments. Comparative effectiveness research evaluating surgical, pharmacological, and rehabilitative strategies could further refine treatment paradigms.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eEmerging machine learning (ML) applications offer powerful tools to enhance diagnostic accuracy and optimize treatment decisions.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e ML models can be trained to detect foraminal narrowing and nerve root compression from MRI datasets, often surpassing human performance in consistency and speed. Advanced segmentation algorithms can quantify nerve occupancy metrics, correlating these with symptom severity to support clinical decision-making.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eVolumetric data, when correlated with clinical metrics such as VAS and ODI, enables a more integrated approach to patient assessment and care planning (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This multi-dimensional strategy enhances diagnostic precision, improves targeting of interventions, and supports outcome tracking over time. Randomized controlled trials and longitudinal studies incorporating patient-reported outcomes would strengthen this foundation and enable more personalized therapeutic approaches. Furthermore, exploring genetic and molecular contributors to foraminal narrowing could lead to early biomarkers and targeted therapies.\u003c/p\u003e\u003cp\u003eSeveral limitations should be noted. The cross-sectional design precludes assessment of disease progression. Although imaging protocols were standardized, variability across MRI platforms could introduce measurement inconsistencies. While the cohort was demographically balanced, generalizability may be limited due to regional anatomical variations. Long-term outcomes were not assessed, and the study did not include post-surgical follow-up to determine prognostic utility of nerve occupancy measurements. Finally, despite high interobserver agreement, some measurement variability remains inevitable, and additional calibration could improve consistency.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study represents a methodological advancement in the field by being the first to apply large-scale volumetric analysis to assess the relationship between foraminal anatomy and nerve occupancy. Prior approaches relied on 2D imaging, limiting spatial accuracy. Our technique leverages high-resolution MRI to generate precise, reproducible measurements that capture the three-dimensional complexity of the lumbar foramina. By defining normative and pathological occupancy thresholds, our findings may help refine diagnostic criteria and surgical indications.\u003c/p\u003e"},{"header":"List of Abbreviations","content":"\u003cp\u003eLFS lumbar foraminal stenosis\u003c/p\u003e\u003cp\u003eMRI magnetic resonance imaging\u003c/p\u003e\u003cp\u003eTR repetition time\u003c/p\u003e\u003cp\u003eTE echo time\u003c/p\u003e\u003cp\u003eN/F R Nerve/Foramen Ratio\u003c/p\u003e\u003cp\u003eVAS Visual analog scale\u003c/p\u003e\u003cp\u003eODI Oswestry Disability Index\u003c/p\u003e\u003cp\u003eSD standard deviation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics board approval from NCC No. 2 Federal State Budgetary Scientific Institution Russian Scientific Center named after Acad. B.V. Petrovsky (010424) was obtained prior to the study. The study was carried out according to the latest revision of the Helsinki Declaration regarding medical research involving human subjects. Informed verbal consent was acquired from all patients before the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA verbal patient consent form from all the patients was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data related to this study can be requested from the corresponding author via e-mail.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. No corporate, government or institutional funding has been received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll listed authors made substantial contributions to the conception, data acquisition, analysis, drafting, and final approval of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge all the patients giving consent to have their results published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll published figures are original and belongs to the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBreemer MC, Malessy MJA, Notenboom RGE. Origin, branching pattern, foraminal and intraspinal distribution of the human lumbar sinuvertebral nerves. 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Quantifying lumbar foraminal volumetric dimensions: normative data and implications for stenosis\u0026mdash;part 2 of a comprehensive series. Med Sci. 2024;12(3):34.\u003c/li\u003e\n\u003cli\u003eModi HN, Suh SW, Song HR, Yang JH. Lumbar nerve root occupancy in the foramen in achondroplasia: a morphometric analysis. Clin Orthop Relat Res. 2008;466(4):907-13.\u003c/li\u003e\n\u003cli\u003eGunasekaran VS, Hejdak D, Meyer B, Klein A, Koch K. Quantitative correlation of lumbar foraminal stenosis with local morphological metrics. Eur Spine J. 2021;30(11):3319-3323.\u003c/li\u003e\n\u003cli\u003eEltes PE, Kiss L, Bereczki F, et al. A novel three-dimensional volumetric method to measure indirect decompression after percutaneous cement discoplasty. J Orthop Translat. 2021;28:131-139.\u003c/li\u003e\n\u003cli\u003eWorth AJ, Hartman A, Bridges JP, Jones BR, Mayhew JIG. Medium-Term Outcome and CT Assessment of Lateral Foraminotomy at the Lumbosacral Junction in Dogs with Degenerative Lumbosacral Stenosis. Vet Comp Orthop Traumatol. 2018;31(1):37-43.\u003c/li\u003e\n\u003cli\u003eTacconi L, Signorelli F, Giordan E. Is Full Endoscopic Lumbar Discectomy Less Invasive Than Conventional Surgery? A Randomized MRI Study. World Neurosurg. 2020;138:e867-e875.\u003c/li\u003e\n\u003cli\u003eHohenhaus M, Klingler JH, Scholz C, et al. Quantification of cervical spinal stenosis by automated 3D MRI segmentation of spinal cord and cerebrospinal fluid space. Spinal Cord. 2024;62(7):371-377.\u003c/li\u003e\n\u003cli\u003eAltun S, Alkan A, Altun İ. LSS-VGG16: Diagnosis of Lumbar Spinal Stenosis With Deep Learning. Clin Spine Surg. 2023;36(5):E180-E190.\u003c/li\u003e\n\u003cli\u003evan der Graaf JW, Brundel L, van Hooff ML, et al. AI-based lumbar central canal stenosis classification on sagittal MR images is comparable to experienced radiologists using axial images. Eur Radiol. 2025;35(4):2298-2306.\u003c/li\u003e\n\u003cli\u003eByvaltsev VA, Kalinin AA, Hernandez PA, et al. Molecular and Genetic Mechanisms of Spinal Stenosis Formation: Systematic Review. Int J Mol Sci. 2022;23(21):13479.\u003c/li\u003e\n\u003cli\u003eGellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013 Apr;9(4):216-24.\u003c/li\u003e\n\u003cli\u003eHallinan JTPD, Zhu L, Yang K, et al. Deep Learning Model for Automated Detection and Classification of Central Canal, Lateral Recess, and Neural Foraminal Stenosis at Lumbar Spine MRI. Radiology. 2021;300(1):130-138.\u003c/li\u003e\n\u003cli\u003eWang T, Wang A, Zhang Y, et al. A novel deep learning system for automated diagnosis and grading of lumbar spinal stenosis based on spine MRI: model development and validation. Neurosurg Focus. 2025;59(1):E6.\u003c/li\u003e\n\u003cli\u003eSuzuki H, Kokabu T, Yamada K, et al. Deep learning-based detection of lumbar spinal canal stenosis using convolutional neural networks. Spine J. 2024;24(11):2086-2101.\u003c/li\u003e\n\u003cli\u003eBharadwaj UU, Christine M, Li S, et al. Deep learning for automated, interpretable classification of lumbar spinal stenosis and facet arthropathy from axial MRI. Eur Radiol. 2023;33(5):3435-3443.\u003c/li\u003e\n\u003cli\u003eWang T, Chen R, Fan N, et al. Machine Learning and Deep Learning for Diagnosis of Lumbar Spinal Stenosis: Systematic Review and Meta-Analysis. J Med Internet Res. 2024;26:e54676.\u003c/li\u003e\n\u003cli\u003eYang X, Zhang Y, Li Y, Wu Z. Performance of Artificial Intelligence in Diagnosing Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976). 2025;50(10):E179-E196.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zer AF, Akyoldaş G, \u0026Ccedil;evik OM, Aydın AL, Hekimoğlu M, Sasani M, et al. Lumbar foraminal stenosis classification that guides surgical treatment. Int J Spine Surg. 2022;16(4):666-73.\u003c/li\u003e\n\u003cli\u003eAhn Y, Song SK. Transforaminal endoscopic lumbar foraminotomy for octogenarian patients. Front Surg. 2024;11:1324843. \u003c/li\u003e\n\u003cli\u003eNurmukhametov R, Dosanov M, Medetbek A, et al. Comparative analysis of open transforaminal lumbar interbody fusion and Wiltse transforaminal lumbar interbody fusion approaches for treating single-level lumbar spondylolisthesis: a single-center retrospective study. Surgeries. 2023;4(4):623-34.\u003c/li\u003e\n\u003cli\u003eTumko V, Kim J, Uspenskaia N, et al. A neural network model for detection and classification of lumbar spinal stenosis on MRI. Eur Spine J. 2024;33(3):941-948.\u003c/li\u003e\n\u003cli\u003eDe Jesus Encarnacion Ramirez M, Chmutin G, Nurmukhametov R, et al. Integrating Augmented Reality in Spine Surgery: Redefining Precision with New Technologies. Brain Sci. 2024;14(7):645.\u003c/li\u003e\n\u003cli\u003eNurmukhametov R, Medetbek A, Ramirez ME, Afsar A, Sharif S, Montemurro N. Factors affecting return to work following endoscopic lumbar foraminal stenosis surgery: A single-center series. Surg Neurol Int. 2023;14:408. \u003c/li\u003e\n\u003cli\u003eBozkurt I, Canbolat C, Paksoy K, et al. Return-to-work after interlaminar endoscopic sequestrectomy: case series. Egypt J Neurol Psychiatry Neurosurg 2024;60, 24.\u003c/li\u003e\n\u003cli\u003eFan G, Wang D, Li Y, et al. Machine Learning Predicts Decompression Levels for Lumbar Spinal Stenosis Using Canal Radiomic Features from Computed Tomography Myelography. Diagnostics (Basel). 2023;14(1):53. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Foraminal stenosis, nerve compression, lumbar degenerative, Volumetric MRI Analysis, Radiculopathy Diagnostics","lastPublishedDoi":"10.21203/rs.3.rs-7472403/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7472403/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground.\u003c/h2\u003e\u003cp\u003eForaminal neuropathy involves stenosis at the level of the foramen leading to nerve compression causing pain, sensory disturbances, and muscle weakness. It results from the narrowing of the neural foramen due to degenerative, traumatic, or congenital factors. Quantifying nerve occupancy within the foramen can illuminate potential compression issues and guide clinical decisions, particularly in lumbar foraminal stenosis (LFS).\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e\u003cp\u003eThis six-year retrospective cohort study on 800 patients at NCC No. 2, Moscow, focused on quantifying nerve occupancy in the foramen using high-resolution MRI. Inclusion criteria included symptoms of nerve compression and prior spinal imaging. Advanced imaging software provided precise volumetric measurements of the foraminal spaces and nerves. The percentage of foramen occupied by the nerve was calculated to assess compression. The study found a progressive increase in nerve occupancy and symptom severity from L1/L2 to L5/S1 levels. High nerve occupancy percentages correlated with higher pain (VAS scores) and disability (ODI scores). L4/L5 and L5/S1 showed the most significant nerve compression and symptom severity, indicating critical sites for LFS diagnosis and treatment.\u003c/p\u003e\u003ch2\u003eConclusions.\u003c/h2\u003e\u003cp\u003eThis study advances understanding of lumbar foraminal stenosis by quantifying nerve occupancy. The findings highlight the importance of targeting lower lumbar levels in diagnosis and treatment, emphasizing the correlation between high nerve occupancy and symptom severity. This methodological approach enhances clinical precision and outcomes in managing foraminal stenosis.\u003c/p\u003e","manuscriptTitle":"Quantifying Nerve Compression: A Methodical Approach to Calculating Nerve Occupancy within the Foramen for Diagnostic Precision in Lumbar Foraminal Stenosis: Part-3 of a Comprehensive Series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 09:02:23","doi":"10.21203/rs.3.rs-7472403/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab19aeba-8751-4321-a77b-577484bdccad","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-30T09:58:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 09:02:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7472403","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7472403","identity":"rs-7472403","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}