Large Vertebral Body, in Addition to Narrow Spinal Canal, Are Risk Factors for Cervical Myelopathy

Aims The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort. Methods This was a radiological analysis of 2,387 participants who underwent L1-S1 MRI. Means and ranges were calculated for age, sex, BMI, and MRI measurements. Anteroposterior (AP) vertebral canal diameters were used to differentiate those with DSS from controls. Other imaging parameters included vertebral body dimensions, spinal canal dimensions, disc degeneration scores, and facet joint orientation. Mann-Whitney U and chi-squared tests were conducted to search for measurement differences between those with DSS and controls. In order to identify possible associations between DSS and MRI parameters, those who were statistically significant in the univariate binary logistic regression were included in a multivariate stepwise logistic regression after adjusting for demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported where appropriate. Results Axial AP vertebral canal diameter (p < 0.001), interpedicular distance (p < 0.001), AP dural sac diameter (p < 0.001), lamina angle (p < 0.001), and sagittal mid-vertebral body height (p < 0.001) were significantly different between those identified as having DSS and controls. Narrower interpedicular distance (OR 0.745 (95% CI 0.618 to 0.900); p = 0.002) and AP dural sac diameter (OR 0.506 (95% CI 0.400 to 0.641); p < 0.001) were associated with DSS. Lamina angle (OR 1.127 (95% CI 1.045 to 1.214); p = 0.002) and right facet joint angulation (OR 0.022 (95% CI 0.002 to 0.247); p = 0.002) were also associated with DSS. No association was observed between disc parameters and DSS. Conclusion From this large-scale cohort, the canal size is found to be independent of body stature. Other than spinal canal dimensions, abnormal orientations of lamina angle and facet joint angulation may also be a result of developmental variations, leading to increased likelihood of DSS. Other skeletal parameters are spared. There was no relationship between DSS and soft tissue changes of the spinal column, which suggests that DSS is a unique result of bony maldevelopment. These findings require validation in other ethnicities and populations. Level of Evidence: I (diagnostic study) Cite this article: Bone Joint J 2021;103-B(4):725–733.

Download Full-text

Risk Factors Affecting Cage Retropulsion into the Spinal Canal Following Posterior Lumbar Interbody Fusion: Association with Diffuse Idiopathic Skeletal Hyperostosis

Asian Spine Journal ◽

10.31616/asj.2020.0434 ◽

2020 ◽

Author(s):

Shinichi Kato ◽

Nobuki Terada ◽

Osamu Niwa ◽

Mitsuko Yamada

Keyword(s):

Risk Factors ◽

Spinal Canal ◽

Interbody Fusion ◽

Diffuse Idiopathic Skeletal Hyperostosis ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Factors Affecting

Download Full-text

Congenital Cervical Spine Stenosis in a Multicenter Global Cohort of Patients With Degenerative Cervical Myelopathy: An Ambispective Report Based on a Magnetic Resonance Imaging Diagnostic Criterion

Neurosurgery ◽

10.1093/neuros/nyx521 ◽

2018 ◽

Vol 83 (3) ◽

pp. 521-528 ◽

Cited By ~ 5

Author(s):

Aria Nouri ◽

Lindsay Tetreault ◽

Satoshi Nori ◽

Allan R Martin ◽

Anick Nater ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Cervical Spine ◽

Magnetic Resonance ◽

Surgical Outcomes ◽

Cervical Myelopathy ◽

Spinal Canal ◽

Resonance Imaging ◽

Baseline Severity ◽

Degenerative Cervical Myelopathy

Abstract BACKGROUND Congenital spinal stenosis (CSS) of the cervical spine is a risk factor for acute spinal cord injury and development of degenerative cervical myelopathy (DCM). OBJECTIVE To develop magnetic resonance imaging (MRI)-based criteria to diagnose preexisting CSS and evaluate differences between patients with and without CSS. METHODS A secondary analysis of international prospectively collected data between 2005 and 2011 was conducted. We examined the data of 349 surgical DCM patients and 27 controls. Spinal canal and cord anteroposterior diameters were measured at noncompressed sites to calculate spinal cord occupation ratio (SCOR). Torg–Pavlov ratios and spinal canal diameters from radiographs were correlated with SCOR. Clinical and MRI factors were compared between patients with and without CSS. Surgical outcomes were also assessed. RESULTS Calculation of SCOR was feasible in 311/349 patients. Twenty-six patients with CSS were identified (8.4%). Patients with CSS were younger than patients without CSS (P = .03) and had worse baseline severity as measured by the modified Japanese Orthopedic Association score (P = .04), Nurick scale (P = .05), and Neck Disability Index (P < .01). CSS patients more commonly had T2 cord hyperintensity changes (P = .09, ns) and worse SF-36 Physical Component scores (P = .06, ns). SCOR correlated better with Torg–Pavlov ratio and spinal canal diameter at C3 than C5. Patients with SCOR ≥ 65% were also younger but did not differ in baseline severity. CONCLUSION SCOR ≥ 70% is an effective criterion to diagnose CSS. CSS patients develop myelopathy at a younger age and have greater impairment and disability than other patients with DCM. Despite this, CSS patients have comparable duration of symptoms, MRI presentations, and surgical outcomes to DCM patients without CSS.

Download Full-text

Anatomy of the Spinal Cord

10.1093/med/9780197512166.003.0007 ◽

2021 ◽

pp. 60-67

Author(s):

Jennifer A. Tracy

Keyword(s):

Spinal Cord ◽

Vertebral Body ◽

Spinal Canal ◽

Conus Medullaris ◽

Lower Limbs ◽

Cervical Cord ◽

Filum Terminale ◽

Upper Limbs ◽

Descending Pathways ◽

Lumbar Vertebral Body

The spinal cord begins as the cervical cord immediately below the medulla and extends through the spinal canal, where it becomes the thoracic, lumbar, sacral, and coccygeal parts of the cord. In most persons, the spinal cord proper ends at the lower portion of the first lumbar vertebral body, where it forms the conus medullaris and, finally, the filum terminale. A cervical enlargement contains the innervation pathways of the upper limbs; a lumbar enlargement contains the pathways of the lower limbs. This chapter reviews ascending and descending pathways in the spinal cord.

Download Full-text

Cervical Spinal Canal Plasticity in Children as Determined by the Vertebral Body Ratio Technique

Spine ◽

10.1097/00007632-199010000-00004 ◽

1990 ◽

Vol 15 (10) ◽

pp. 1003-1005

Author(s):

MURRAY D. ROBINSON ◽

BRUCE NORTHRUP ◽

ROBERT SABO

Keyword(s):

Vertebral Body ◽

Spinal Canal ◽

Cervical Spinal Canal

Download Full-text

Vertebral hemangioma coincident with metastasis of colon adenocarcinoma

Journal of Neurosurgery Spine ◽

10.3171/2015.6.spine141205 ◽

2016 ◽

Vol 24 (3) ◽

pp. 506-509 ◽

Cited By ~ 2

Author(s):

Krzysztof Zapałowicz ◽

Grażyna Bierzyńska-Macyszyn ◽

Bartłomiej Stasiów ◽

Aleksandra Krzan ◽

Beata Wierzycka ◽

...

Keyword(s):

Colon Cancer ◽

Vertebral Body ◽

Spinal Canal ◽

Cancer Metastasis ◽

Histopathological Examination ◽

Colon Adenocarcinoma ◽

Quadriceps Muscle ◽

Right Hemicolectomy ◽

Tissue Mass ◽

Colon Cancer Metastasis

The authors report on colon cancer metastasis to the L-3 vertebra, which had been previously found to be involved by an asymptomatic hemangioma. A 61-year-old female patient was admitted after onset of lumbar axial pain and weakness of the right quadriceps muscle. Her medical history included colon cancer that had been diagnosed 3 years earlier and was treated via a right hemicolectomy followed by chemotherapy. Presurgical imaging revealed an asymptomatic hemangioma in the L-3 vertebral body. Computed tomography and MRI of the spine were performed after admission and revealed a hemangioma in the L-3 vertebral body as well as a soft-tissue mass protruding from the L-3 vertebral body to the spinal canal. Treatment consisted of vertebroplasty of the hemangioma, left L-3 hemilaminectomy, and removal of the pathological mass from the spinal canal and the L-3 vertebral body. Histopathological examination revealed the presence of colon cancer metastasis and a hemangioma in the same vertebra.

Download Full-text