Defining multilevel developmental cervical spinal stenosis using MRI.

IF 4.9 1区医学 Q1 ORTHOPEDICS Bone & Joint Journal Pub Date : 2024-11-01 DOI:10.1302/0301-620X.106B11.BJJ-2024-0166.R2

Prudence W H Cheung, Justin H M Leung, Vivien W Y Lee, Jason P Y Cheung

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Abstract

Aims: Developmental cervical spinal stenosis (DcSS) is a well-known predisposing factor for degenerative cervical myelopathy (DCM) but there is a lack of consensus on its definition. This study aims to define DcSS based on MRI, and its multilevel characteristics, to assess the prevalence of DcSS in the general population, and to evaluate the presence of DcSS in the prediction of developing DCM.

Methods: This cross-sectional study analyzed MRI spine morphological parameters at C3 to C7 (including anteroposterior (AP) diameter of spinal canal, spinal cord, and vertebral body) from DCM patients (n = 95) and individuals recruited from the general population (n = 2,019). Level-specific median AP spinal canal diameter from DCM patients was used to screen for stenotic levels in the population-based cohort. An individual with multilevel (≥ 3 vertebral levels) AP canal diameter smaller than the DCM median values was considered as having DcSS. The most optimal cut-off canal diameter per level for DcSS was determined by receiver operating characteristic analyses, and multivariable logistic regression was performed for the prediction of developing DCM that required surgery.

Results: A total of 2,114 individuals aged 64.6 years (SD 11.9) who underwent surgery from March 2009 to December 2016 were studied. The most optimal cut-off canal diameters for DcSS are: C3 < 12.9 mm, C4 < 11.8 mm, C5 < 11.9 mm, C6 < 12.3 mm, and C7 < 13.3 mm. Overall, 13.0% (262 of 2,019) of the population-based cohort had multilevel DcSS. Multilevel DcSS (odds ratio (OR) 6.12 (95% CI 3.97 to 9.42); p < 0.001) and male sex (OR 4.06 (95% CI 2.55 to 6.45); p < 0.001) were predictors of developing DCM.

Conclusion: This is the first MRI-based study for defining DcSS with multilevel canal narrowing. Level-specific cut-off canal diameters for DcSS can be used for early identification of individuals at risk of developing DCM. Individuals with DcSS at ≥ three levels and male sex are recommended for close monitoring or early intervention to avoid traumatic spinal cord injuries from stenosis.

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利用核磁共振成像确定多级发育性颈椎管狭窄症。

目的：发育性颈椎管狭窄（DcSS）是众所周知的退行性颈椎脊髓病（DCM）的易患因素，但对其定义还缺乏共识。本研究旨在根据 MRI 定义 DcSS 及其多层次特征，评估 DcSS 在普通人群中的患病率，并评估 DcSS 在预测 DCM 发病中的作用：这项横断面研究分析了 DCM 患者（95 人）和普通人群（2,019 人）C3 至 C7 的 MRI 脊椎形态参数（包括椎管、脊髓和椎体的前胸（AP）直径）。来自 DCM 患者的特定水平 AP 中位椎管直径用于筛查人群队列中的狭窄水平。多层次（≥ 3 个椎体水平）AP 椎管直径小于 DCM 中值的个体被视为患有 DcSS。通过接收器操作特征分析确定了DcSS每级椎管直径的最佳临界值，并对需要手术的DCM进行了多变量逻辑回归预测：研究对象为2009年3月至2016年12月期间接受手术治疗的2114名患者，年龄为64.6岁（SD 11.9）。DcSS的最理想截断管径为：C3 < 12.9 mm、C3 < 12.9 mm、C3 < 12.9 mm、C3 < 12.9 mm：C3<12.9毫米，C4<11.8毫米，C5<11.9毫米，C6<12.3毫米，C7<13.3毫米。总体而言，13.0% 的人群（2,019 人中的 262 人）患有多级 DcSS。多层 DcSS（几率比 (OR) 6.12 (95% CI 3.97 to 9.42)；p < 0.001）和男性（OR 4.06 (95% CI 2.55 to 6.45)；p < 0.001）是预测 DCM 发病的因素：结论：这是首个基于磁共振成像对多级管腔狭窄的DcSS进行定义的研究。DcSS的特异性管腔直径可用于早期识别DCM高危人群。建议对DcSS≥三级且性别为男性的患者进行密切监测或早期干预，以避免狭窄造成的脊髓外伤。

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

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

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