Cahill Catherine W, Radcliffe Kristen E, Reitman Charles
Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX.
Thomas Jefferson University Department of Orthopedic Surgery, Rothman Institute, Egg Harbor, NJ.
Int J Spine Surg. 2017 Dec 5;11(5):36. doi: 10.14444/4036. eCollection 2017.
Very little normative CT scan data exist defining expected relationships of vertebral structures in the intact cervical spine. Better understanding of normal relationships should improve sensitivity of injury detection, particularly for facet subluxation. The purpose of this paper was to describe the normal anatomical relationships and most sensitive measurements to detect abnormal alignment in the subaxial cervical spine.
A group of 30 CT scans with no documented cervical spine injury were utilized from an established data base in a trauma population. Twenty-two anatomical measurements were made for each level of the subaxial cervical spine using Microview software. For the purposes of measurement, the upper confidence limit of normal was reported as two standard deviations from the mean.
The novel, CT based measurements of bone articulation were generally smaller and had lower confidence intervals compared to traditional radiographic measurements of midline structures (such as interspinous distance, interlaminar widening, disc space widening). The upper limit of normal of facet joint height was reported (1.54mm anterior, 1.27mm posterior, and 2.0mm midportion) which may help identify distractive-flexion injuries. The upper limit of normal vertebral translation (2.0mm) was also reported to identify translation/rotation injuries.
Normal CT measurements for the subaxial cervical spine, especially in the facets, were found to have small confidence limits and variation. Based upon these findings, we conclude that facet measurements and translation may be better screening tools than traditional radiographic criteria based upon midline structures. Using these measurements may improve detection of cervical spine injuries warranting further imaging or investigation and reducing missed injuries.
Improved understanding of normal anatomic measures in the subaxial spine will allow for better screening and identification of injuries.
This was approved by the Office of Research Institutional Review Board, Baylor College of Medicine.
关于完整颈椎中椎体结构的预期关系，现有的规范性CT扫描数据非常少。更好地了解正常关系应能提高损伤检测的敏感性，尤其是对于小关节半脱位。本文的目的是描述下颈椎的正常解剖关系以及检测异常排列最敏感的测量方法。
从创伤人群的既定数据库中选取了30例无颈椎损伤记录的CT扫描。使用Microview软件对下颈椎的每个节段进行22项解剖学测量。为了测量的目的，正常范围的上限报告为均值加两个标准差。
与传统的中线结构X线测量（如棘突间距离、椎板间增宽、椎间盘间隙增宽）相比，基于CT的新型骨连接测量通常数值更小且置信区间更低。报告了小关节高度的正常上限（前部1.54mm，后部1.27mm，中部2.0mm），这可能有助于识别牵张屈曲损伤。还报告了椎体平移的正常上限（2.0mm）以识别平移/旋转损伤。
发现下颈椎的正常CT测量值，尤其是在小关节方面，具有较小的置信区间和变异性。基于这些发现，我们得出结论，与基于中线结构的传统X线标准相比，小关节测量和平移可能是更好的筛查工具。使用这些测量方法可能会改善颈椎损伤的检测，从而有必要进行进一步的影像学检查或调查，并减少漏诊的损伤。
更好地了解下颈椎的正常解剖测量将有助于更好地筛查和识别损伤。
本研究获得了贝勒医学院研究机构审查委员会办公室的批准。
