Radiographic Indicators of Craniocervical Instability: Analyzing Variance of Normative Supine and Upright Imaging in a Healthy Population.

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-10-28 DOI:10.1097/BSD.0000000000001715
Alan J Gordillo, Matt Magro, Derrick Obiri-Yeboah, Arpan A Patel, Vorster Sarel, Alexander Spiessberger
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Abstract

Study design: Single-institution retrospective review.

Objective: To establish baseline ranges and variability of 7 radiographic measurements of the cervical spine in a healthy patient population as potential diagnostic tools for craniocervical instability.

Summary of background data: Craniocervical instability, common in patients with connective tissue disease such as Ehlers-Danlos Syndrome, often presents with a wide range of symptoms, including neck pain. Current diagnostic methods employ a range of clinical and radiographic features, but diagnostic challenges remain due to missed indications on static imaging and a lack of standardized measurement values and normalized variance.

Methods: Seventy-two healthy patients with cervical imaging were analyzed. Surgimap software was used to annotate supine computed tomography images, flexion, extension, and neutral x-ray images for measurement. These measurements included the atlanto-dental interval, clival-axial angle, basion-dens interval, basion-axis interval, perpendicular basion to the inferior aspect of C2, also known as Grabb Oakes measurement, and the hard palate to C1 and hard palate to C2. Statistical analysis assessed differences among imaging modalities, and coefficients of variation were calculated for each measurement.

Results: Our cohort consisted of a total of 72 patients with a mean age of 64 (SD: 13.54). All measurements except for the basion-axial interval and atlanto-dental interval demonstrated a significant difference between extension and flexion x-ray measurements. clivo-axial angle, hard palate to C1, and hard palate to C2 demonstrated the lowest coefficients of variance across imaging modalities.

Conclusion: Understanding normal variance in cervical measurements is invaluable for accurate CCI diagnosis. Using a cohort of healthy patients, this study delineates the distribution and spread of 7 cervical measurements, delineating reference values and variability in these key measurements and highlighting their potential for use as imaging markers for CCI.

Level of evidence: Level III.

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颅颈不稳的放射学指标:分析健康人群中标准仰卧位和直立位成像的差异。
研究设计单个机构回顾性研究:目的:确定健康患者群体中颈椎 7 项放射学测量的基线范围和变异性,作为颅颈不稳的潜在诊断工具:颅颈不稳常见于患有埃勒斯-丹洛斯综合征等结缔组织疾病的患者,通常会出现包括颈部疼痛在内的多种症状。目前的诊断方法采用了一系列临床和影像学特征,但由于静态成像漏诊、缺乏标准化测量值和归一化差异,诊断仍面临挑战:方法:对 72 名健康患者的颈椎成像进行了分析。采用 Surgimap 软件对仰卧位计算机断层扫描图像、屈曲、伸展和中立位 X 光图像进行注释测量。这些测量包括寰齿间距、龈轴角、基底-窦间距、基底-轴间距、垂直基底至 C2 下侧(也称为 Grabb Oakes 测量)、硬腭至 C1 和硬腭至 C2。统计分析评估了不同成像模式之间的差异,并计算了每次测量的变异系数:我们的队列中共有 72 名患者,平均年龄为 64 岁(标准差:13.54)。除基底-轴间隙和寰齿-齿间隙外,其他所有测量值在伸展和屈曲 X 光测量值之间均存在显著差异。在各种成像模式中,基底-轴角、硬腭至 C1 和硬腭至 C2 的变异系数最小:结论:了解颈椎测量的正常差异对于准确诊断CCI非常重要。本研究利用一组健康患者,描述了 7 项颈椎测量值的分布和扩散情况,划定了这些关键测量值的参考值和变异性,并强调了它们作为 CCI 影像标记的应用潜力:证据等级:III 级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Spine Surgery
Clinical Spine Surgery Medicine-Surgery
CiteScore
3.00
自引率
5.30%
发文量
236
期刊介绍: Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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