基于 1000 例患者的 CT 诊断先天性腰椎狭窄的解剖学参数。

From the Loma Linda University School of Medicine, Loma Linda, CA (Shin, Brandt, Oliinik, Im, Marciniak, Vyhmeister, Razzouk), Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD (Kagabo), Twin Cities Spine Center, Minneapolis, MN (Ramos), Department of Dental Education Services (Oyoyo), Department of Radiology (Wycliffe), Loma Linda University Medical Center, Loma Linda, CA, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Lipa), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Bono), Division of Orthopaedic Surgery, Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, CA (Cheng), Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA (Danisa).

J Am Acad Orthop Surg. 2024 Nov 15;32(22):e1186-e1195. doi: 10.5435/JAAOS-D-24-00425. Epub 2024 Aug 9.

INTRODUCTION

Quantitative parameters for diagnosis of congenital lumbar stenosis (CLS) have yet to be universally accepted. This study establishes parameters for CLS using CT, assessing the influences of patient sex, race, ethnicity, and anthropometric characteristics.

METHODS

Interpedicular distance (IPD), pedicle length, canal diameter, and canal area were measured using 1,000 patients between 18 and 35 years of age who were without spinal pathology.

RESULTS

Irrespective of disk level, threshold values for CLS were 16.1 mm for IPD, 3.9 mm for pedicle length, 11.5 mm for canal diameter, and 142.5 mm 2 for canal area. Notable differences based on patient sex were observed, with men demonstrating larger CLS threshold values with respect to IPD and canal area across all vertebral levels from L1 to L5. Based on patient anthropometric factors, no strong or moderate associations were observed between any spinal measurement and patient height, weight, or body mass index across all levels from L1 to L5. However, notable differences were observed based on patient race and ethnicity from L1 to L5. Asian patients demonstrated the largest pedicle lengths, followed by White, Hispanic, and Black patients in descending order. White patients demonstrated the largest IPD, canal AP diameter, and canal area, followed by Asian, Hispanic, and Black patients in descending order. Black patients demonstrated the smallest values across all anatomic measurements relative to Asian, White, and Hispanic patients.

CONCLUSION

This study reports 25,000 measurements of lumbar central canal dimensions to establish quantitative thresholds for the diagnosis of CLS. Although not influenced by patient height, weight, or body mass index as one might intuit, canal dimensions were influenced by patient sex, race, and ethnicity. These findings may help explain differences in predisposition or prevalence of lumbar nerve root compression among patients of different races, which can be important when considering rates of surgery and access to care.

简介

先天性腰椎管狭窄症（CLS）的定量诊断参数尚未得到普遍认可。本研究使用 CT 建立了 CLS 的参数，评估了患者性别、种族、民族和人体测量特征的影响。

方法

在 1000 名年龄在 18 至 35 岁之间且无脊柱病变的患者中，测量了椎间孔距离（IPD）、椎弓根长度、椎管直径和椎管面积。

结果

无论椎间盘水平如何，CLS 的阈值分别为 IPD 为 16.1mm、椎弓根长度为 3.9mm、椎管直径为 11.5mm、椎管面积为 142.5mm 2 。观察到基于患者性别的显著差异，男性在 L1 至 L5 的所有椎骨水平上，IPD 和椎管面积的 CLS 阈值均大于女性。基于患者的人体测量因素，在 L1 至 L5 的所有水平上，没有观察到任何脊柱测量值与患者身高、体重或体重指数之间存在强烈或中度关联。然而，基于患者种族和民族，在 L1 至 L5 之间观察到显著差异。亚洲患者的椎弓根长度最大，其次是白人、西班牙裔和黑人患者。白人患者的 IPD、椎管前后径和椎管面积最大，其次是亚洲人、西班牙裔和黑人患者。黑人患者在所有解剖测量值中均表现出最小的值，相对于亚洲人、白人和西班牙裔患者。

结论

本研究报告了 25000 次腰椎中央椎管尺寸测量，以建立 CLS 诊断的定量阈值。尽管与患者的身高、体重或体重指数无关，正如人们可能直觉认为的那样，但管腔尺寸受到患者性别、种族和民族的影响。这些发现可能有助于解释不同种族患者腰椎神经根受压的易感性或患病率的差异，这在考虑手术率和获得治疗的机会时非常重要。