The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine |
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Authors: | Yuichiro Morishita Masatoshi Naito Henry Hymanson Masashi Miyazaki Guizhong Wu Jeffrey C Wang |
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Institution: | (1) Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, CA 90095, USA;(2) Department of Orthopaedic Surgery, Fukuoka University, Fukuoka, Japan;(3) UCLA Comprehensive Spine Center, 1250 16th Street, Suite 745, Santa Monica, CA 90404, USA |
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Abstract: | A congenitally narrow cervical spinal canal has been established as an important risk factor for the development of cervical
spondylotic myelopathy. However, few reports have described the mechanism underlying this risk. In this study, we investigate
the relationship between cervical spinal canal narrowing and pathological changes in the cervical spine using positional magnetic
resonance imaging (MRI). Two hundred and ninety-five symptomatic patients underwent cervical MRI in the weight-bearing position
with dynamic motion (flexion, neutral, and extension) of the cervical spine. The sagittal cervical spinal canal diameter and
cervical segmental angular motion were measured and calculated. Each segment was assessed for the extent of intervertebral
disc degeneration and cervical cord compression. Based on the sagittal canal diameter, the subjects were classified into three
groups: A, subjects with a congenitally narrow canal, diameter of less than 13 mm; B, subjects with a normal canal, diameter
of 13–15 mm; C, subjects with a wide canal, diameter of more than 15 mm. When compared with Groups A and B, the disc degeneration
grades at the C3-4, C5-6, and C6-7 segments and the cervical cord compression scores at the C3-4 and C5-6 segments showed
significant differences. Additionally, when compare with Groups A and C, the disc degeneration grades at all segments, except
C2-3, and the cervical cord compression scores at all segments, except C2-3, showed significant differences. With respect
to the cervical kinematics, few differences in the kinematics were observed between Groups B and C, however, the kinematics
in Group A was different with other two groups. In Group A, the segmental mobility at the C4-5 and C6-7 segments were significantly
higher than those observed in Group B, and the segmental mobility at the C3-4 segment was significantly lower than that observed
in Groups B or C. We demonstrated the unique pathological and kinematic traits of cervical spine that exist in a congenitally
narrow canal. We hypothesize that kinematic trait associated with a congenitally narrow canal may greatly contribute to pathological
changes in the cervical spine. Our results suggest that cervical spinal canal diameter of less than 13 mm may be associated
with an increased risk for development of pathological changes in cervical intervertebral discs. Subsequently, the presence
of a congenitally narrow canal can expose individuals to a greater risk of developing cervical spinal stenosis. |
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Keywords: | A congenitally narrow canal Cervical spine Intervertebral disc Cervical spinal stenosis Positional MRI |
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