A Comparison of Computed Tomography Measures for Diagnosing Cervical Spinal Stenosis Associated with Myelopathy: A Case-Control Study.
- Author:
Brett A FREEDMAN
1
;
C Edward HOFFLER
;
Brian M CAMERON
;
John M RHEE
;
Maneesh BAWA
;
David G MALONE
;
Melissa BENT
;
Tim S YOON
Author Information
- Publication Type:Comparative Study ; Original Article
- Keywords: Cervical cord; Cervicle vertebrae; Spinal stenosis; Spinal cord compression; Spinal cord diseae
- MeSH: Body Weight; Case-Control Studies*; Constriction, Pathologic; Humans; Male; Medical Records; Retrospective Studies; Spinal Cord Compression; Spinal Cord Diseases*; Spinal Stenosis*
- From:Asian Spine Journal 2015;9(1):22-29
- CountryRepublic of Korea
- Language:English
- Abstract: STUDY DESIGN: Retrospective comparative study. PURPOSE: To assess differences in computed tomography (CT) imaging parameters between patients with cervical myelopathy and controls. OVERVIEW OF LITERATURE: 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. METHODS: 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. RESULTS: The medial-lateral (ML) diameter (at mid-pedicle level) and calculated canal area (=anterior-posterior. x ML diameters) were the most accurate and highly reliable. ML diameter below 23.5 mm and calculated canal area below 300 mm2 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. CONCLUSIONS: 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.
