Department of Orthopedic Surgery, Baylor College of Medicine, 1709 Dryden Rd, 12th Floor, Houston, TX 77030, USA.
Spine J. 2010 Mar;10(3):230-7. doi: 10.1016/j.spinee.2009.12.025.
Traumatic injury to the spine is evaluated and treated based on the perceived stability of the spine. Recent classification schemes have established the importance of evaluating the discoligamentous complex to fully comprehend stability. There are a variety of techniques to evaluate the discoligamentous complex, including assessment of interspinous distance. However, there currently are no clinically validated methods to define and assess abnormal interspinous widening.
The purpose of the study was to provide reference data and evidence to support the objective use of spinous process widening in the diagnosis of cervical spine injury and instability.
The study was designed to be biomechanical and observational.
Distances between spinous processes were measured from lateral flexion-extension X-rays of 156 skeletally mature asymptomatic subjects who reported never having had neck symptoms as well as 12 whole human cadavers before and after creating increasingly severe damage to posterior structures. Cervical interspinous distances were measured and then normalized to the width of the C4 vertebral end plate. The change in the distance from flexion to extension was also calculated.
Descriptive statistics, including the 95% confidence intervals for each cervical level were tabulated for 863 levels in 149 analyzable asymptomatic volunteers. In the simulated cadaver model, interspinous widening was highly specific and mildly sensitive for detecting damage to the posterior structures of the cervical spine.
This study provides reference data that can be used to quantitatively assess interspinous process widening in the cervical spine. Application of the reference data to a cadaver model of cervical trauma suggests that although objective evidence of abnormal widening may be uncommon, when present, it is suggestive of extensive damage to the cervical spine. Derived from this data were two "rule of thumb" criteria to identify abnormal interspinous widening in flexion X-rays; when greater than 30% relative to an adjacent level (40% between C1-C2 and C2-C3) or greater than 50% of the anterior-posterior width of the C4 vertebral body (30% for C2-C3).
脊柱创伤的评估和治疗基于脊柱稳定性的感知。最近的分类方案已经确定了评估椎间盘-韧带复合体以全面理解稳定性的重要性。有多种技术可用于评估椎间盘-韧带复合体，包括棘突间距离的评估。然而，目前还没有临床验证的方法来定义和评估异常的棘突间增宽。
本研究旨在提供参考数据和证据，以支持客观使用棘突宽度来诊断颈椎损伤和不稳定。
本研究设计为生物力学和观察性研究。
从 156 名骨骼成熟、无颈部症状的无症状受试者的侧屈-伸展 X 光片中测量棘突间的距离，以及在对后结构造成越来越严重的损伤前后对 12 具全人尸体进行测量。测量颈椎棘突间的距离，然后将其归一化为 C4 椎体终板的宽度。还计算了从屈曲到伸展的距离变化。
描述性统计数据，包括 149 名可分析无症状志愿者的 863 个颈椎水平的 95%置信区间，均进行了列表。在模拟尸体模型中，棘突间增宽对检测颈椎后结构损伤具有高度特异性和轻度敏感性。
本研究提供了可用于定量评估颈椎棘突间增宽的参考数据。将参考数据应用于颈椎创伤的尸体模型表明，尽管异常增宽的客观证据可能不常见，但当存在时，它提示颈椎广泛损伤。从这些数据中得出了两个“经验法则”标准，以识别屈曲 X 光片中的异常棘突间增宽；当与相邻水平相比增加 30%以上（C1-C2 和 C2-C3 之间为 40%，C2-C3 之间为 50%）或增加 C4 椎体前后宽度的 50%以上（C2-C3 之间为 30%）。
