Three-dimensional morphological analysis of cervical foraminal stenosis using dynamic flexion-extension computed tomography images |
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| Institution: | 1. Department of Orthopedic Surgery, Niigata University, Medical and Dental General Hospital, 1-757 Asahimachidori, Chuoku, Niigata City, Niigata, 951-8510, Japan;2. Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinko-cho, Chuoku, Niigata City, Niigata, 950-8556, Japan;3. Department of Orthopedic Surgery, Niigata Minami Hospital, 2007-6 Toyano, Chuoku, Niigata City, Niigata, 950-8601, Japan;4. Department of Orthopedic Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuoku, Niigata City, Niigata, 950-1197, Japan;5. Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-uonuma City, Niigata, 949-7302, Japan;1. Niigata Spine Surgery Center, Niigata, Japan;2. Dept. of Orthopaedic Surgery, Niigata University Hospital, Japan;1. Keio University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan;2. Kobe Medical Center, Department of Orthopaedic Surgery, Kobe, Japan;3. Kanazawa University, Department of Orthopaedic Surgery, Kanazawa, Japan;4. Meijo Hospital, Department of Orthopaedic Surgery, Nagoya, Japan;5. Tokyo Shinjuku Medical Center, Department of Spine Surgery, Tokyo, Japan;6. Toyota Kosei Hospital, Department of Orthopaedic Surgery, Toyota, Japan;7. Japan Spinal Deformity Institute, Nagoya, Japan;1. Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan;2. Department of Orthopaedic Surgery, Aichi Medical University, Japan;1. Niigata Spine Surgery Center, Niigata, Japan;2. Ishii Orthopaedic and Rehabilitation Clinic, Gyoda, Japan;3. Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan;4. Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan;1. Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata City, Niigata, 951-8510 Japan;2. Department of Orthopaedic Surgery, Niigata Medical Center, Niigata City, Niigata, 950-2022 Japan;3. Department of Orthopaedic Surgery, Nagaoka Central Hospital, Nagaoka City, Niigata, 954-8653 Japan;4. Department of Health and Sports, Niigata University of Health and Welfare, Niigata City, Niigata, 950-3198 Japan;5. Division of Orthopaedic Biomechanics, Hokuetsu Hospital, Shibata City, Niigata, 957-0018 Japan |
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| Abstract: | BackgroundMorphological features of foraminal stenosis in cervical spondylotic radiculopathy and the adequate extent of facet resection in posterior cervical foraminotomy remain uncertain. Herein, we evaluated quantitatively foraminal widths in cervical spondylotic radiculopathy on dynamic flexion-extension computed tomography using a novel three-dimensional analysis method and determined the extent of facet resection in posterior cervical foraminotomy.MethodsSeventeen patients undergoing posterior cervical foraminotomy for cervical spondylotic radiculopathy were evaluated. A neuroforamen three-dimensional model was built from preoperative images of flexion-extension computed tomography myelography, and an ordinary cervical spine coordinate system and an original neuroforaminal coordinate system, were established. In the neuroforaminal coordinate system, minimum areas perpendicular to the long axis by the slices from inlet to outlet of neuroforamen and narrowest foraminal width in a slice of minimum area were measured. The location of the narrowest region from inlet of the foramen was calculated. Ratios of minimum and sufficient facet resection were obtained from the location of the narrowest region in the neuroforaminal coordinate system.ResultsThe narrowest foraminal widths (flexion/extension) in the cervical spine coordinate system and the neuroforaminal coordinate system were 2.9/2.3 and 2.6/1.9 mm, respectively. The mean values of the location of the narrowest region (flexion/extension) were 0.27/0.22 and 0.50/0.45 mm, respectively, and the narrowest region in the neuroforaminal coordinate system was located on the outer side than in the cervical spine coordinate system (p < 0.001). The ratios of minimum and sufficient facet resection were 23 ± 8% and 32 ± 9%, respectively.ConclusionsThe narrowest regions both in flexion and extension are located at the middle of the foramen based on the neuroforaminal coordinate system. Ordinary evaluation of axial computed tomography images likely underestimates the extent of facet resection, whereas certain extent of facet resection does not exceed 50% in cases with single-level cervical spondylotic radiculopathy.Study designA retrospective case control study. |
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