Freedman Brett A, Hoffler C Edward, Cameron Brian M, Rhee John M, Bawa Maneesh, Malone David G, Bent Melissa, Yoon Tim S
Department of Orthopaedics, Landstuhl Regional Medical Center, Landstuhl, Germany.
Department of Orthopaedics, Emory University Orthopaedics and Spine Center, Atlanta, GA, USA.
Asian Spine J. 2015 Feb;9(1):22-9. doi: 10.4184/asj.2015.9.1.22. Epub 2015 Feb 13.
Retrospective comparative study.
To assess differences in computed tomography (CT) imaging parameters between patients with cervical myelopathy and controls.
There is a lack of information regarding the best predictor of symptomatic stenosis based on osseous canal dimensions. We postulate that smaller osseous canal dimensions increase the risk of symptomatic central stenosis.
CT images and medical records of patients with cervical myelopathy (19 patients, 8 males; average age, 64.4±13.4 years) and controls (18 patients, 14 males; average age, 60.4±11.0 years) were collected. A new measure called the laminar roof pitch angle (=angle between the lamina) was conducted along with linear measures, ratios and surrogates of canal perimeter and area at each level C2-C7 (222 levels). Receiver-operator curves were used to assess the diagnostic value of each. Rater reliability was assessed for the measures.
The medial-lateral (ML) diameter (at mid-pedicle level) and calculated canal area (=anterior-posterior.×ML diameters) were the most accurate and highly reliable. ML diameter below 23.5 mm and calculated canal area below 300 mm(2) generated 82% to 84% sensitivity and 67% to 68% sensitivity. No significant correlations were identified between age, height, weight, body mass in dex and gender for each of the CT measures.
CT measures including ML dimensions were most predictive. This study is the first to identify an important role for the ML dimension in cases of slowly progressive compressive myelopathy. A ML reserve may be protective when the canal is progressively compromised in the anterior-posterior dimension.
回顾性比较研究。
评估脊髓型颈椎病患者与对照组之间计算机断层扫描（CT）成像参数的差异。
基于骨性椎管尺寸，缺乏关于症状性狭窄最佳预测指标的信息。我们推测较小的骨性椎管尺寸会增加症状性中央管狭窄的风险。
收集脊髓型颈椎病患者（19例，男性8例；平均年龄64.4±13.4岁）和对照组（18例，男性14例；平均年龄60.4±11.0岁）的CT图像和病历。在C2 - C7各节段（共222个节段）进行一项名为椎板顶间距角（=椎板间夹角）的新测量以及线性测量、椎管周长和面积的比率及替代指标。使用受试者操作特征曲线评估各项指标的诊断价值。对测量指标进行评分者信度评估。
内外侧（ML）直径（在椎弓根中点水平）和计算得出的椎管面积（=前后径×ML直径）最为准确且可靠性高。ML直径低于23.5 mm以及计算得出的椎管面积低于300 mm²时敏感性为82%至84%，特异性为67%至68%。各项CT测量指标与年龄、身高、体重、体重指数及性别之间均未发现显著相关性。
包括ML尺寸在内的CT测量指标预测性最强。本研究首次确定了ML尺寸在缓慢进展性压迫性脊髓病病例中的重要作用。当椎管在前后径方向逐渐受损时，ML储备可能具有保护作用。
