Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
Spine (Phila Pa 1976). 2010 Nov 15;35(24):E1381-5. doi: 10.1097/BRS.0b013e3181e8958f.
Retrospective cross-sectional study.
This study aimed to elucidate the relationship between developmental spinal canal stenosis (DCS) and morphologic features in the cervical spine by comparing the features between DCS and nondevelopmental spinal canal stenosis (NDCS).
DCS is an important predisposing factor for cervical myelopathy. Further, various posterior cervical spinal instrumentations have been developed. However, no study has specifically addressed the cervical posterior morphology of DCS.
A total of 52 consecutive patients underwent cervical spine computed tomography myelography. Axial images of the largest pedicle diameter were selected from C3 to C7 vertebrae and 260 images were analyzed. The following parameters were measured: spinal canal longitudinal diameter (SCLD), spinal canal transverse diameter, osseous spinal canal area, dural sac area, spinal cord area, pedicle outer width, pedicle axis length, pedicle transverse angulation, lateral mass longitudinal diameter, lateral mass transverse diameter, lamina outer width, and lamina axis length. The participants were classified into 2 groups: DCS group (SCLD <12 mm at any level) and NDCS group (SCLD ≧12 mm at all levels).
The mean osseous spinal canal area and dural sac area at C3-C5 in the DCS group were less than those in the NDCS group. The mean spinal cord area did not differ significantly at C3-C7 between the groups. The mean pedicle outer width at C6 and C7 in the DCS group was less than that in NDCS group. The mean lateral mass transverse diameter at C5 and mean lateral mass longitudinal diameter at C3, C5, and C6 in the DCS group were less than those in the NDCS group.
Myelopathy is expected to progress in patients with DSC and these patients with severe neurologic symptoms may need cervical operation. However, posterior screw insertions should be considered more carefully than in NDCS patients.
回顾性横断面研究。
本研究旨在通过比较发育性椎管狭窄（DCS）与非发育性椎管狭窄（NDCS）的颈椎形态特征，阐明 DCS 与颈椎形态之间的关系。
DCS 是颈椎脊髓病的重要诱发因素。此外，已经开发出各种颈椎后路脊柱器械。然而，尚无研究专门针对 DCS 的颈椎后路形态。
共对 52 例连续接受颈椎 CT 脊髓造影的患者进行了研究。从 C3 到 C7 椎体选择最大椎弓根直径的轴向图像，共分析了 260 个图像。测量了以下参数：椎管纵向直径（SCLD）、椎管横径、骨性椎管面积、硬脊膜囊面积、脊髓面积、椎弓根外宽、椎弓根轴长、椎弓根横倾角、侧块纵向直径、侧块横向直径、椎板外宽、椎板轴长。将患者分为 2 组：DCS 组（任何水平 SCLD＜12mm）和 NDCS 组（所有水平 SCLD≥12mm）。
DCS 组 C3-C5 的骨性椎管面积和硬脊膜囊面积均小于 NDCS 组。C3-C7 两组脊髓面积无显著差异。DCS 组 C6 和 C7 的椎弓根外宽小于 NDCS 组。DCS 组 C5 的侧块横径和 C3、C5、C6 的侧块纵向直径均小于 NDCS 组。
DCS 患者的脊髓病可能会进展，这些有严重神经症状的患者可能需要进行颈椎手术。然而，与 NDCS 患者相比，后路螺钉插入应更加谨慎。
