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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Research Article

Free Area of the Spinal Canal and Torg’s Ratio in Acute Cervical Trauma and Degenerative Disease: MANCOVA and Correlational Analyses

Author(s): Lidieth Martinez-Martinez, Jose Domingo Perez-Perez, Jose Luis Soto-Hernandez, Roberto Corona-Cedillo and Ernesto Roldan-Valadez*

Volume 17, Issue 3, 2021

Published on: 19 July, 2020

Page: [366 - 373] Pages: 8

DOI: 10.2174/1573405616666200720002059

Price: $65

Abstract

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: A cross-sectional study including 50 cervical-spine MR evaluations of patients with acute cervical trauma or degenerative disease was performed. 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.

Conclusion: FASC provides 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 clinical outcomes are necessary to assess the usefulness of FASC in clinical settings.

Keywords: Cervical spine, free area of the spinal canal, magnetic resonance imaging, spinal stenosis, spondylarthritis, torg´s ratio.

Graphical Abstract

[1]
Yamahata H, Hiwatari T, Yonenaga M, et al. CT morphometric analysis of the cervical spinal canal with special reference to the correlation with the vertebral level. J Orthop Sci 2020; S0949-2658(20)30127-5.
[PMID: 32418799]
[2]
Torg JS, Pavlov H, Genuario SE, et al. Neurapraxia of the cervical spinal cord with transient quadriplegia. J Bone Joint Surg Am 1986; 68(9): 1354-70.
[http://dx.doi.org/10.2106/00004623-198668090-00008] [PMID: 3782207]
[3]
Wilkinson HA, LeMay ML, Ferris EJ. Roentgenographic correlations in cervical spondylosis. Am J Roentgenol Radium Ther Nucl Med 1969; 105(2): 370-4.
[http://dx.doi.org/10.2214/ajr.105.2.370] [PMID: 5764660]
[4]
Boijsen E. The cervical spinal canal in intraspinal expansive processes. Acta Radiol 1954; 42(2): 101-15.
[http://dx.doi.org/10.3109/00016925409175101] [PMID: 13197111]
[5]
Hinck VC, Hopkins CE, Savara BS. Sagittal diameter of the cervical spinal canal in children. Radiology 1962; 79: 97-108.
[http://dx.doi.org/10.1148/79.1.97] [PMID: 13907511]
[6]
Pavlov H, Torg JS, Robie B, Jahre C. Cervical spinal stenosis: determination with vertebral body ratio method. Radiology 1987; 164(3): 771-5.
[http://dx.doi.org/10.1148/radiology.164.3.3615879] [PMID: 3615879]
[7]
Tierney RT, Maldjian C, Mattacola CG, Straub SJ, Sitler MR. Cervical spine stenosis measures in normal subjects. J Athl Train 2002; 37(2): 190-3.
[PMID: 12937434]
[8]
Torg JS, Corcoran TA, Thibault LE, et al. Cervical cord neurapraxia: classification, pathomechanics, morbidity, and management guidelines. J Neurosurg 1997; 87(6): 843-50.
[http://dx.doi.org/10.3171/jns.1997.87.6.0843] [PMID: 9384393]
[9]
Song KJ, Choi BW, Kim SJ, Kim GH, Kim YS, Song JH. The relationship between spinal stenosis and neurological outcome in traumatic cervical spine injury: an analysis using Pavlov’s ratio, spinal cord area, and spinal canal area. Clin Orthop Surg 2009; 1(1): 11-8.
[http://dx.doi.org/10.4055/cios.2009.1.1.11] [PMID: 19884992]
[10]
Okada Y, Ikata T, Yamada H, Sakamoto R, Katoh S. Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine 1993; 18(14): 2024-9.
[http://dx.doi.org/10.1097/00007632-199310001-00016] [PMID: 8272953]
[11]
Nouri A, Tetreault L, Nori S, Martin AR, Nater A, Fehlings MG. 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 2018; 83(3): 521-8.
[http://dx.doi.org/10.1093/neuros/nyx521] [PMID: 29462433]
[12]
Nouri A, Montejo J, Sun X, et al. Cervical cord-canal mismatch: A new method for identifying redisposition to spinal cord injury. World Neurosurg 2017; 108: 112-7.
[http://dx.doi.org/10.1016/j.wneu.2017.08.018] [PMID: 28807778]
[13]
Cao JM, Zhang JT, Yang DL, Yang YP, Xia HH, Yang L. Imaging factors that distinguish between patients with asymptomatic and Ssymptomatic cervical spondylotic myelopathy with mild to moderate cervical spinal cord compression. Med Sci Monit 2017; 23: 4901-8.
[http://dx.doi.org/10.12659/MSM.906937] [PMID: 29028790]
[14]
Kumar A, Sahu S, Sethi S, et al. Computerized tomography-based morphometric analysis of cervical spinal canal in central indian population. J Neurosci Rural Pract 2020; 11(2): 274-7.
[http://dx.doi.org/10.1055/s-0040-1703962] [PMID: 32367983]
[15]
Ross MD, Elliott R. Cervical cord compressive myelopathy in a man with a primary complaint of knee pain. J Spinal Cord Med 2010; 33(4): 431-4.
[http://dx.doi.org/10.1080/10790268.2010.11689724] [PMID: 21061905]
[16]
Kasch H, Kongsted A, Qerama E, Bach FW, Bendix T, Jensen TS. A new stratified risk assessment tool for whiplash injuries developed: from a prospective observational study. BMJ Open 2013; 3(1): e002050.
[http://dx.doi.org/10.1136/bmjopen-2012-002050] [PMID: 23370009]
[17]
Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons Am Fam Physician 2000; 62(5): 1064-70.
[18]
Field F. Analysis of covariance, ANCOVA (GLM 2). Discovering Statistics Using SPSS. London: SAGE Publications Ltd 2009; pp. 395-420.
[19]
Cohen JW. Statistical power analysis for the behavioral sciences Hillsdale 2nd. NJ1988.
[http://dx.doi.org/10.4324/9780203771587]
[20]
Chan YH. Biostatistics 104: correlational analysis. Singapore Med J 2003; 44(12): 614-9.
[PMID: 14770254]
[21]
Chiewvit P, Tritrakarn SO, Phawjinda A, Chotivichit A. Predictive value of magnetic resonance imaging in cervical spondylotic myelopathy in prognostic surgical outcome. J Med Assoc Thai 2011; 94(3): 346-54.
[PMID: 21560843]
[22]
Van Schoor H, Stephan Konzb S. Males/females: An anthropometric comparison for modelling missing data. Int J Ind Ergon 1996; 17(5): 437-40.
[http://dx.doi.org/10.1016/0169-8141(95)00064-X]
[23]
Kang Y, Lee JW, Koh YH, et al. New MRI grading system for the cervical canal stenosis. AJR Am J Roentgenol 2011; 197(1): W134-40.
[http://dx.doi.org/10.2214/AJR.10.5560] [PMID: 21700974]
[24]
Rüegg TB, Wicki AG, Aebli N, Wisianowsky C, Krebs J. The diagnostic value of magnetic resonance imaging measurements for assessing cervical spinal canal stenosis. J Neurosurg Spine 2015; 22(3): 230-6.
[http://dx.doi.org/10.3171/2014.10.SPINE14346] [PMID: 25525959]
[25]
Furlan JC, Kailaya-Vasan A, Aarabi B, Fehlings MG. A novel approach to quantitatively assess posttraumatic cervical spinal canal compromise and spinal cord compression: a multicenter responsiveness study. Spine 2011; 36(10): 784-93.
[http://dx.doi.org/10.1097/BRS.0b013e3181e7be3a] [PMID: 21192294]
[26]
Morishita Y, Naito M, Wang JC. Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels. Int Orthop 2011; 35(10): 1517-22.
[PMID: 21113592]
[27]
Torg JS, Naranja RJ Jr, Pavlov H, Galinat BJ, Warren R, Stine RA. The relationship of developmental narrowing of the cervical spinal canal to reversible and irreversible injury of the cervical spinal cord in football players. J Bone Joint Surg Am 1996; 78(9): 1308-14.
[http://dx.doi.org/10.2106/00004623-199609000-00003] [PMID: 8816644]
[28]
Matsuura P, Waters RL, Adkins RH, Rothman S, Gurbani N, Sie I. Comparison of computerized tomography parameters of the cervical spine in normal control subjects and spinal cord-injured patients. J Bone Joint Surg Am 1989; 71(2): 183-8.
[http://dx.doi.org/10.2106/00004623-198971020-00003] [PMID: 2918002]
[29]
Prasad SS, O’Malley M, Caplan M, Shackleford IM, Pydisetty RK. MRI measurements of the cervical spine and their correlation to Pavlov’s ratio. Spine 2003; 28(12): 1263-8.
[http://dx.doi.org/10.1097/01.BRS.0000065570.20888.AA] [PMID: 12811269]
[30]
Humphreys SC, Hodges SD, Patwardhan A, Eck JC, Covington LA, Sartori M. The natural history of the cervical foramen in symptomatic and asymptomatic individuals aged 20-60 years as measured by magnetic resonance imaging. A descriptive approach. Spine 1998; 23(20): 2180-4.
[http://dx.doi.org/10.1097/00007632-199810150-00007] [PMID: 9802158]
[31]
Ezra D, Slon V, Kedar E, et al. The torg ratio of C3-C7 in African Americans and European Americans: A skeletal study. Clin Anat 2019; 32(1): 84-9.
[http://dx.doi.org/10.1002/ca.23269] [PMID: 30198179]

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