Dynamic Cervical Spinal Canal Stenosis: Identifying Imaging Risk Factors in Extended Positions.

IF 2.3 Q2 ORTHOPEDICS
Shogo Matsumoto, R. Aoyama, J. Yamane, Ken Ninomiya, Yuichiro Takahashi, Kazuya Kitamura, Satoshi Nori, Satoshi Suzuki, U. Anazawa, T. Shiraishi
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Abstract

Study Design A retrospective study at a single academic institution. Purpose This study aimed to identify imaging risk factors for stenosis in extended neck positions undetectable in preoperative neutral magnetic resonance imaging (MRI) and improving decompression strategies for cervical spine disorders. Overview of Literature Cervical disorders are influenced by various dynamic factors, with spinal stenosis appearing during neck extension. Despite the diagnostic value of dynamic cervical MRI, standard practice often uses neutral-position MRI, potentially influencing surgical outcomes. Methods This study analyzed 143 patients who underwent decompression surgery between 2012 and 2014, who had symptomatic cervical disorders and MRI evidence of spinal cord or nerve compression but had no history of cervical spine surgery. Patient demographics, disease type, Japanese Orthopedic Association score, and follow-up periods were recorded. Spinal surgeons conducted radiological evaluations to determine stenosis levels using computed tomography myelography or MRI in neutral and extended positions. Measurements such as dural tube and spinal cord diameters, cervical alignment, range of motion, and various angles and distances were also analyzed. The residual space available for the spinal cord (SAC) was also calculated. Results During extension, new stenosis frequently appeared caudal to the stenosis site in a neutral position, particularly at C5/C6 and C6/C7. A low SAC was identified as a significant risk factor for the development of new stenosis in both the upper and lower adjacent disc levels. Each 1-mm decrease in SAC resulted in an 8.9- and 2.7-fold increased risk of new stenosis development in the upper and lower adjacent disc levels, respectively. A practical SAC cutoff of 1.0 mm was established as the threshold for new stenosis development. Conclusions The study identified SAC narrowing as the primary risk factor for new stenosis, with a clinically relevant cutoff of 1 mm. This study highlights the importance of local factors in stenosis development, advocating for further research to improve outcomes in patient with cervical spine disorders.
动态颈椎管狭窄症:识别伸展体位下的成像风险因素。
研究设计在一家学术机构进行的回顾性研究.目的本研究旨在确定术前中性位磁共振成像(MRI)无法检测到的颈部伸展位狭窄的影像学风险因素,并改进颈椎疾病的减压策略.文献综述颈椎疾病受各种动态因素的影响,椎管狭窄会在颈部伸展时出现。尽管动态颈椎磁共振成像具有诊断价值,但标准实践通常使用中立位磁共振成像,这可能会影响手术效果。本研究分析了在 2012 年至 2014 年期间接受减压手术的 143 例患者,这些患者均有症状性颈椎疾病和磁共振成像显示脊髓或神经受压,但无颈椎手术史。记录了患者的人口统计学特征、疾病类型、日本骨科协会评分和随访时间。脊柱外科医生使用计算机断层扫描髓核成像或核磁共振成像,在中立位和伸展位进行放射学评估,以确定狭窄程度。此外,还对硬膜管和脊髓直径、颈椎排列、活动范围以及各种角度和距离等测量数据进行了分析。结果在中立位时,新的狭窄经常出现在狭窄部位的尾端,尤其是在C5/C6和C6/C7。低SAC被认为是上部和下部相邻椎间盘水平出现新狭窄的重要风险因素。SAC每降低1毫米,上下相邻椎间盘水平出现新狭窄的风险分别增加8.9倍和2.7倍。结论该研究发现SAC狭窄是导致新狭窄的主要风险因素,临床相关的临界值为1毫米。这项研究强调了局部因素在狭窄发展过程中的重要性,主张进一步开展研究,以改善颈椎疾病患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Asian Spine Journal
Asian Spine Journal ORTHOPEDICS-
CiteScore
5.10
自引率
4.30%
发文量
108
审稿时长
24 weeks
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