Free area of the spinal canal and Torg’s ratio in acute cervical trauma and degenerative disease: MANCOVA and correlational analyses.

Background: The two of the most common indications for magnetic resonance (MR) imaging of the cervical spine include acute spine trauma and degenerative disease. Objective: We aimed to correlate the measurements of the free area of the spinal canal (FASC), a new approach to the cervical spinal canal compromise, with the Torg´s ratio quantification of the cervical spine. Methods: Cross-sectional study including 50 cervical-spine MR evaluations of patients with acute cervical trauma or degenerative disease. We used multivariate analysis of covariance (MANCOVA) to identify the type of lesion, intervertebral level and gender differences between FASC and Torg´s ratio quantification of the cervical spine; age was the controlled covariate. Correlates between FASC and Torg´s ratio were obtained at each intervertebral level. Results: There was a non-significant interaction between the type of lesion, gender and intervertebral levels between FASC and Torg´s ratio measurements, F (8, 456) 0.260, p = .978; Wilks' Lambda 0.991; with a small effect size (partial η2 = .005). Among the main effects, only the gender was statistically significant: F (2, 228) = 3.682, p = .027. The age (controlled covariate) was non-significantly related to FASC and Torg´s ratio quantification: F (2, 228) = .098, p = .907. The Pearson´s correlation coefficient depicted a poor, non-significant agreement between FASC and Torg´s ratio. Conclusions: FASC provide an integrative evaluation of the cervical spinal canal compromise in acute, cervical spine trauma and degenerative disease. Further observations and correlation with specific neurological symptoms, surgical findings and outcome are necessary to assess the usefulness of FASC in clinical settings.

Download Full-text

Paleopathological Features of the Cervical Spine in the Early Middle Ages: Natural History of Degenerative Diseases

Neurosurgery ◽

10.1227/01.neu.0000094951.54541.18 ◽

2003 ◽

Vol 53 (6) ◽

pp. 1418-1424 ◽

Cited By ~ 14

Author(s):

Jochen Weber ◽

Alfred Czarnetzki ◽

Axel Spring

Keyword(s):

Cervical Spine ◽

Middle Ages ◽

Spinal Canal ◽

Spinal Canal Stenosis ◽

Degenerative Disease ◽

Degenerative Changes ◽

Facet Joints ◽

Early Middle Ages ◽

Canal Stenosis ◽

Cervical Spinal Canal

Abstract OBJECTIVE Trauma and degenerative joint disease are the most common pathological conditions observed in archaeological skeletal remains. We describe the prevalence of different types of cervical bone diseases observed in the early Middle Ages (6th to 8th centuries AD). METHODS Human skeletons were excavated from Germanic row graves in southwestern Germany. One hundred ninety-six cervical spines thus obtained were examined for bone disease. The degenerative changes were classified into Grades 1 (marginal osteophytes), 2 (uneven joint surfaces), and 3 (osseous ankylosis). Cervical spinal canal stenosis was defined as anteroposterior diameters of <11 mm and intervertebral foraminal stenosis as <3.0 mm in the smallest diameter. RESULTS Of the skeletons, 27.5% demonstrated degenerative changes of the cervical spine. The mean age of the skeletons at the time of death was 33.4 years, compared with 43.7 years for those with degenerative disease. Degenerative changes of the vertebral bodies (usually Grades 1 and 2) were most common in the C5–C6 (12.4%, P < 0.05) and C6–C7 (15.3%, P < 0.05) segments. The medial (6.1%) and lateral (0.6%) atlantoaxial joints were rarely involved in degenerative disease. The facet joints from C3–C4 to C6–C7 demonstrated degenerative changes (usually Grades 1 and 2) in 8.0 to 11.8% of cases. The C2–C3 facet joints were significantly involved in degenerative disease in 19.7% of cases (P < 0.05), one-fourth of which demonstrated osseous ankylosis. We observed cervical spinal canal stenosis in 5 skeletons (2.6%) and osseous intervertebral foraminal stenoses in 12 (6.1%). Isolated cases of other pathological processes, i.e., spondylitis ankylopoietica, occipitalization of the atlas and axis, and an odontoid fracture with pseudoarthrosis, were also recorded. CONCLUSION In the early Middle Ages, the prevalence of degenerative cervical spine disease was the same as that observed today. The C2–C3 facet joints demonstrated high rates of degenerative disease.

Download Full-text

Artificial Pedicle Screw Reconstruction of the Cervical Spine after Lateral Paramedian Transpedicular Approach for Lesions of the Ventral Cervical Spinal Canal

Operative Neurosurgery ◽

10.1227/01.neu.0000176413.390650.58 ◽

2005 ◽

Vol 57 (suppl_4) ◽

pp. ONS-281-ONS-285 ◽

Cited By ~ 2

Author(s):

Frank L. Acosta ◽

Christopher P. Ames

Keyword(s):

Cervical Spine ◽

Spinal Canal ◽

Spinal Stability ◽

Novel Technique ◽

Transpedicular Approach ◽

Spinal Lesions ◽

Cervical Spinal Canal ◽

Cervical Pedicle ◽

Lateral Mass Screws ◽

Multiple Levels

Abstract OBJECTIVE: We describe in detail the anatomic and surgical principles of a lateral cervical paramedian transpedicular approach, a novel technique that provides access to the ventral cervical spinal canal. We also describe single-stage posterior column reconstruction of the cervical spine in which traditional cervical lateral mass screws are used simultaneously to reconstruct the cervical pedicle and to allow for three-column stabilization in a continuous posterior screw-rod construct after this approach. METHODS: This technique is a modification of traditional thoracic posterolateral extracavitary approaches and has been used by our group for the resection of intradural and extradural spinal lesions, as we illustrate. RESULTS: This approach is particularly useful in cases where significant pathological characteristics of the trachea or esophagus preclude an anterior approach to the cervical spine and in cases in which multiple levels are involved. CONCLUSION: Cervical spinal stability is enhanced, because all cervical levels are incorporated into the final screw-rod construct.

Download Full-text

Do the cervical spinal canal dimensions predict pre-myelopathic changes of cervical spinal cord? - a magnetic resonance image study

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401569 ◽

2015 ◽

Vol 04 (03) ◽

pp. 139-144

Author(s):

Smitha S Nair ◽

A S Lakshmi ◽

Ushadevi K B. ◽

A K Gupta

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Spinal Canal ◽

Cervical Spinal Cord ◽

Spin Echo ◽

Cervical Region ◽

Cervical Canal ◽

Image Study ◽

Cervical Spinal Canal ◽

Spin Echo Sequence

Abstract Background and aims: The cervical region is the most mobile portion of the spinal column and it is here that the earliest disc degenerations are encountered. Hence it is of great interest to neurologists and neurosurgeons. Degenerative arthritic changes in the cervical spine secondary to ageing may result in bony and soft tissue overgrowth causing encroachment on the cervical spinal canal resulting in cervical canal stenosis. This may predispose to compressive myelopathy. The study aims to determine the predictability of myelopathy based on the dimensions of spinal canal at the cervical region. Materials and methods: The study included 600 patients who underwent MRI scan of cervical spine in the Department of Imaging Sciences and Interventional Radiology, Sree Chithra Thirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala. It included patients of different age groups of both sexes who were classified into six groups. T1 weighted axial images were obtained using spin echo sequence. The axial slices were made at the mid vertebral levels from C2-C7 vertebrae. The anteroposterior diameters of spinal canal in axial images at mid cervical vertebral levels from C2-C7 were measured. Analysis of data was done by mean, standard deviation, independent sample t test, ANOVA and Chi square test. Results: The mean anteroposterior diameter of the canal at different cervical vertebral levels decreases as age advances. Tbe premyelopathic changes were more in males which may be attributed to change in canal shape. Conclusion: Cervical spinal canal dimensions are useful to predict premyelopathic changes of cervical spinal cord.

Download Full-text

Torg’s ratio in normal adult nepalese population

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i1.17207 ◽

2017 ◽

Vol 18 (1) ◽

pp. 5-9

Author(s):

Badri Rijal ◽

R K Pokharel ◽

S Paudel ◽

L L Shah

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Spinal Stenosis ◽

Spinal Canal ◽

Cervical Spinal Cord ◽

Canal Stenosis ◽

Cervical Spinal Canal ◽

Cord Injury ◽

History Of ◽

Cervical Spinal Stenosis

Introduction: Acute cervical trauma occasionally leads to cervical canal stenosis in some individuals in spite of minor trauma. The spinal canal-to-vertebral body ratio (Torg-Pavlov ratio) has been proposed for assessing developmental spinal canal stenosis. It is not affected by magnification, and is measured on lateral plain films of cervical vertebrae. The result of this study may help in better understanding of the Torg’s ratio, which is more reliable than direct measuring of the mid-sagittal diameter of the cervical spinal canal in the diagnosis of cervical spinal stenosis or predicting the prognosis of cervical spinal cord injury. If Torg’s ratio is below normal there is risk of cervical cord injury whereas relatively safe in large Torg’s ratio. Torg’s ratio can be accessed even in rural areas where x-rays are easily available and more economical than MRI and CT scan. It can assess the risk of cord injury during sports and outdoor activities and help individuals’ choose safe carrier in sports or others activities.Methods: In order to ascertain the normal values of the Torg’s ratio in adults Nepalese, hundred sets of cervical vertebral columns of hundred adult Nepalese population of age group 20-40 years were examined. Consecutive patients presenting with history of neck pain with normal x-ray findings or history of trauma without cervical spine injury from Orthopaedic OPD (out patients department) and emergency department of Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu from March 2011 to August 2012 were included in the study.Results: There were 48 males and 52 females with age ranging from 20 yrs to 40 yrs with the mean of 30.34±5.36 years. The normal average canal/body ratio of the cervical spine is 0.99 +/- 0.09 in male and 1.01 +/- 0.07 in female. It was observed that the ratio of the antero-posterior diameters of cervical spinal canal and vertebral bodies showed sexual dimorphism.Conclusion: The Torg’s ratio is the same irrespective of gender and height. The result of this study will help in better understanding of the Torg’s ratio, which is more reliable than direct measuring of the mid-sagittal diameter of the cervical spinal canal in the diagnosis of cervical spinal stenosis or predicting the prognosis of cervical spinal cord injury.JSSN 2015; 18 (1), Page: 5-9

Download Full-text

Cervical spinal canal body ratio in normal individuals and Stenosis with Cervical Myelopathy: A simple but novel study using a graph paper over a plain X-ray lateral view of the cervical spine

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3161 ◽

2020 ◽

Vol 11 (4) ◽

pp. 5388-5394

Author(s):

Elangovan D ◽

Prem Gowtham E ◽

Kanchana B ◽

Karthikeyan D ◽

Mohan S

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Cervical Myelopathy ◽

Spinal Canal ◽

Lateral View ◽

Healthy Individuals ◽

X Ray ◽

Cervical Spinal Canal ◽

Graph Paper ◽

Minimal Trauma

Cervical spine spondylosis is so prevalent in almost all because it is a degenerative disease. Cervical spine spondylosis is a condition caused by the narrowing of the space required for the spinal cord and the nerve roots that pass through the spine to the rest of the body. Suspected cases or warranted cases are advised to avoid trauma or stress to prevent a dreadful complication that is myelopathy. This research is to study and assess the Cervical Spine Canal Body Ratio in healthy individuals and also in patients with myelopathy. The cervical spinal canal and body with disc space ratio are measured using lateral view plain X-ray of the cervical spine, placed over a graph paper. This test was done both in healthy individuals from the age group of twenty-five to thirty-five of female and male. Out of these, twelve patients were with cervical myelopathy. Cervical Spinal canal stenosis may be either congenital or acquired. The content of the canal that is the Spinal cord is more likely to get compromised when the canal is shallow even a minimal trauma or degenerative arthrosis can precipitate myelopathy. In healthy individuals it is unit and when <0.85 it indicates stenosis. This simple, less expensive study can be done even in a peripheral set up. The healthy Canal Body ratio is 0.97 to 1.02. In myelopathy it is about 0.8. Corresponding sagittal diameter is 18 to 21 mm in normal and 9 to 11 mm in cervical stenosis.

Download Full-text

The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine

European Spine Journal ◽

10.1007/s00586-009-0968-y ◽

2009 ◽

Vol 18 (6) ◽

pp. 877-883 ◽

Cited By ~ 75

Author(s):

Yuichiro Morishita ◽

Masatoshi Naito ◽

Henry Hymanson ◽

Masashi Miyazaki ◽

Guizhong Wu ◽

...

Keyword(s):

Cervical Spine ◽

Spinal Canal ◽

Pathological Changes ◽

Cervical Spinal Canal ◽

Canal Diameter ◽

The Relationship

Download Full-text

Computerized Tomography-Based Morphometric Analysis of Cervical Spinal Canal in Central Indian Population

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1703962 ◽

2020 ◽

Vol 11 (02) ◽

pp. 274-277

Author(s):

Ambuj Kumar ◽

Subhash Sahu ◽

Shivank Sethi ◽

Shailendra Ratre ◽

Vijay Parihar ◽

...

Keyword(s):

Cervical Spine ◽

Statistical Analysis ◽

Ct Scan ◽

Computerized Tomography ◽

Spinal Canal ◽

Indian Population ◽

P Value ◽

Cervical Spinal Canal ◽

Canal Diameter ◽

Significant Difference

Abstract Objective Normal cervical spine canal morphometry is critical for understanding the pathology of certain diseases and for proper preoperative planning. Computerized tomography (CT) scan can replace older conventional radiography techniques by providing more accurate morphometric measurements. This study was aimed to find out various dimensions of the cervical spinal canal of central Indian population. Materials and Methods A prospective study was conducted including 100 consecutive cervical spine CT scan of asymptomatic adult subjects. The anteroposterior sagittal canal diameter (SCD), transverse canal diameter (TCD), canal surface area (CSA), and Pavlov-Torg Ratio (PTR) from C2 to C7 were calculated. Statistical Analysis Data were entered in Microsoft Excel Sheet 2007 and statistical analysis was performed by IBM SPSS statistics 2.0 version. p-Value < 0.05 was considered as significant. Results Age ranged from 18 years to 77 years with mean age 39.5 years. There was no significant difference in all the dimensions (SCD, TCD, CSA) in male and female except at C2 level, where SCD, TCD, and CSA were significant larger in male. The mean SCD, TCD, and CSA is largest at C2 level (14.4 ± 1.63 mm, 21.57 ± 1.59 mm, and 156.20 ± 24.98 mm2, respectively) and smallest at C4 level (12.77 ± 1.48 mm, 20.37 ± 1.72 mm, and 130.42 ± 21.20 mm2). PTR showed very little variation. Conclusion Normal values of cervical spinal canal could serve as a future reference. CT scan provides more accurate measurement. More studies are needed as there could be variations in dimensions in different regions in India.

Download Full-text

Estimation of CSF Flow Resistance in the Upper Cervical Spine

The Neuroradiology Journal ◽

10.1177/197140091302600118 ◽

2013 ◽

Vol 26 (1) ◽

pp. 106-110 ◽

Cited By ~ 8

Author(s):

K-A. Mardal ◽

G. Rutkowska ◽

S. Linge ◽

V. Haughton

Keyword(s):

Cervical Spine ◽

Healthy Volunteers ◽

Subarachnoid Space ◽

Spinal Canal ◽

Flow Resistance ◽

Upper Cervical Spine ◽

Csf Flow ◽

Cervical Spinal Canal ◽

Upper Cervical ◽

Chiari I

Chiari I patients have increased CSF velocities in the foramen magnum due hypothetically to increased pressure gradients or reduced flow resistance. We calculated flow resistance in the cervical spinal canal in a group of subjects with and without the Chiari malformation. Eight subjects including healthy volunteers and Chiari I patients were studied. From 3D high resolution MR images of the cervical spine mathematical models of the subarachnoid spaces were created by means of standard programs for segmentation and discretization. Oscillatory flow through the subarachnoid space was simulated. Cross-sectional area of the subarachnoid space was computed at each level from C1 through C4 and the length of this spinal canal segment was measured. Peak caudad CSF flow velocity at each level was plotted against cross-section area. CSF volumetric flux and resistance were calculated for each subject. The correlation between velocity and resistance was calculated. In all subjects, peak velocities increased progressively from C1 to C4 by 0.6 to 0.7 cm/s per level. Spinal canal areas diminished from C1 to C5 in each subject at a rate of 0.25 to 0.29 cm2per level. Resistance averaged 4.3 pascal/ml/s in the eight subjects; 3.8 pascal/ml/s in patients with tonsilar herniation and 6.0 pascal/ml/s in volunteers. Velocity correlated inversely with resistance (R2= 0.6). CSF velocities correlated inversely with the flow resistance in the upper cervical spinal canal. Resistance tends to be lower in Chiari I patients than in healthy volunteers.

Download Full-text

Stenosis of cervical spinal canal due to ossification of posterior longitudinal ligament

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto64062 ◽

1996 ◽

Vol 3 (1) ◽

pp. 12-15

Author(s):

A. I. Protsenko ◽

V. K. Nikuradze ◽

M. A. Klyuchnikov ◽

K. T. Hudoiberdiev

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Spinal Canal ◽

Posterior Longitudinal Ligament ◽

Spinal Canal Stenosis ◽

Complete Elimination ◽

Canal Stenosis ◽

Cervical Spinal Canal ◽

Partial Elimination ◽

Positive Results

Authors present their experience with 36 cases of spinal canal stenosis due to ossification of posterior longitudinal ligament in cervical spine. Ligament ossification extent was found to be local (1 segment) or segmental (2-3 segments). Clinical examination showed cervical myelopathy of various severity. Diagnosis of cervical spinal canal stenosis was determined mainly by CT and MRT. All patients underwent surgical treatment - anterior transcorporal decompression of spinal cord. Positive results were achieved in 34 patients including 22 patients with complete elimination of myelopathy, 9 patients with partial elimination and 3 patients with stopping of the process progression. In 2 patients, surgical procedure was inefficient.

Download Full-text

Fiberoptic bronchoscopy versus video laryngoscopy guided intubation in patients with craniovertebral junction instability: A cinefluroscopic comparison

Surgical Neurology International ◽

10.25259/sni_522_2020 ◽

2021 ◽

Vol 12 ◽

pp. 92

Author(s):

Sanket Agrawal ◽

Pravin Salunke ◽

Shailesh Gupta ◽

Amlan Swain ◽

Kiran Jangra ◽

...

Keyword(s):

Cervical Spine ◽

General Anesthesia ◽

Spinal Canal ◽

Fiberoptic Bronchoscopy ◽

Craniovertebral Junction ◽

Cervical Spinal Canal ◽

Bony Landmarks ◽

Canal Diameter ◽

Number Of Patients ◽

Upper Cervical

Background: Manipulation during endotracheal intubation in patients with craniovertebral junction (CVJ) anomalies may cause neurological deterioration due to underlying instability. Fiberoptic-bronchoscopy (FOB) is better than video laryngoscope (VL) for minimizing cervical spine movement during intubation. However, evidence suggesting superiority of FOB in patients with CVJ instability is lacking. We prospectively compared dynamic movements of the upper cervical spine during intubation using FOB with VL in patients with CVJ anomalies. Methods: A prospective, randomized, and clinical trial was conducted in 62 patients of American Society of Anaesthesiologist Grade I-II aged between 12 and 65 years with CVJ anomalies. Patients were randomized for intubation under general anesthesia with either VL or FOB. The intubation process was done with application of skeletal traction and recorded cinefluroscopically. The dynamic interrelationship of bony landmarks (horizontal, vertical, and diagonal distances between fixed points on posterior C1 and C2) was analyzed to indirectly calculate alteration of the upper cervical spinal canal diameter (at CVJ). Atlanto-dental interval (ADI) was calculated wherever possible. Results: The alteration in canal diameter (using bony landmarks) at CVJ during intubation was not significant with the use of either VL or FOB (P > 0.05). In 41 patients, where ADI could be measured, ADI was reduced (increased spinal canal diameter) in a greater number of patients in VL group when compared to FOB group (P < 0.05). Conclusion: Using rigid skull traction, intubation under general anesthesia with VL offers similar advantage as FOB in terms of the spinal kinematics in patients with CVJ anomalies/instability. Nevertheless, greater number of patients intubated with VL may have an advantage of increased cervical spinal canal diameter when compared to FOB.

Download Full-text