Spinal cord injury with a narrow spinal canal: utilizing Torg's ratio method of analyzing cervical spine radiographs

Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data

Identifying the prevalence of degenerative spinal pathologies and relevant demographic risk factors is important for understanding spine injury risk, prevention, treatment, and outcome, and for distinguishing acute injuries from degenerative pathologies. Prevalence data in the literature are often based on small-scale studies focused on a single type of pathology. This study evaluates the prevalence of diagnosis of selected degenerative spinal pathology diagnoses using Medicare insurance claim data in the context of published smaller-scale studies. In addition, the data are used to evaluate whether the prevalence is affected by age, sex, diagnosed obesity, and the use of medical imaging. The Medicare Claims 5% Limited Data Set was queried to identify diagnoses of degenerative spinal pathologies. Unique patient diagnoses per year were further evaluated as a function of age, gender, and obesity diagnosis. Participants were also stratified by coding for radiological imaging accompanying each diagnosis. The overall prevalence of diagnosed spinal degenerative disease was 27.3% and increased with age. The prevalence of diagnosed disc disease was 2.7 times greater in those with radiology. The results demonstrate that degenerative findings in the spine are common, and, since asymptomatic individuals may not receive a diagnosis of degenerative conditions, this analysis likely underestimates the general prevalence of these conditions.

[Cervical myelopathy after low grade distortion of the cervical spine. Possible association with pre-existing spondylosis of the cervical spine]

A patient with spondylosis deformans of the cervical spine with no neurological deficits developed rapidly progressive tetraparesis 1 day after a whiplash injury due to a car accident (rear end collision), although initially there were no clinical symptoms. Surgical decompression and spondylodesis led to relief of the neurological deficits. This case demonstrates that even a low grade whiplash injury (grade 1) can cause severe neurological symptoms later and that a degenerative disease of the spine is a predisposing factor.

Quantification of pediatric and adult cervical vertebra-anatomical characteristics by age and gender for automotive application

OBJECTIVE

The cervical anatomy has been shown to affect injury patterns in vehicle crashes. Characterizing the spine anatomy and changes associated with growth and gender is important when assessing occupant protection. In this study, selected cervical characteristics were quantified.

METHODS

Computed tomography (CT) scans of 750 patients were selected from the University of Michigan trauma database; 314 were children and 436 were adults. Four variables were obtained: the maximum spinal canal radius, vertebral body depth, facet angles, and retroversion angles.

RESULTS

The cervical spine measurements varied with age and gender. The body depth increased nonlinearly with age. The average vertebral body depth at C4 was 9.2 ± 0.38 mm in the 0-3 age group, 15.7 ± 0.29 mm in the 18-29 age group, and 17.2 ± 0.46 mm in the 60+ age group. Pediatric and adult males had larger vertebral body depth than females overall, irrespective of vertebral level (P <.001). Compared to females, the vertebral body depth was 8-9 percent greater in male children and 13-16 percent greater in adult males. The average radius varied with gender, with male children generally having a larger radius than females irrespective of vertebral level (P <.001). Overall, spinal canal radius was smallest in the 0-3 and 60+ age groups and largest in the 18-29 age group. The C4 radius was 5.91 ± 0.17, 6.28 ± 0.14, and 6.73 ± 0.17 mm respectively. The radius was larger in the 4-7 age group than in the 0-3 age group, irrespective of vertebral level (P <.0001). There were nonsignificant radius changes between the 4-7 and 8-11 age groups and the 8-11 and age 12-17 groups, suggesting that the size of the spinal cord reaches near maturation by the age of 7. Facet angles decreased with age in children and increased with age in adults. The average facet angles were largest in the 0-3 age group (P <.1, C2-C6). Adult facet angles were greater in the 60+ age group than in the 18-29 age group (P <.0001, C2-C6). Males had larger facet angles than females overall (P <.01 at C2, C5-C7). The retroversion angles were largest at C6 and C7. They increased with age in children and decreased in the adult population; they were larger (5-22%) in the 18-29 age group than in the 60+ age group (P <.0001, C2-C6).

CONCLUSIONS

The results obtained in this study help explain variations in cervical anatomical changes associated with age and gender. The information is useful when assessing differences in injury patterns between different segments of the population. Anatomical measurements of the cervical spine should be considered for the development of models used to assess injury mechanisms for various occupant age groups.

[Paraparesis following stable L4 burst fracture Possible correlation with preexisting degenerative stenosis of the spinal canal]

A patient with degenerative stenosis of the lumbar spinal canal developed paraparesis of both legs following a stable L4 burst fracture. However, neither the stenosis nor the fracture have caused a significant narrowing of the spinal canal. Surgical decompression and dorsal stabilization has led to relief of the neurological deficit. This case demonstrates that even a stable burst fracture may cause paraparesis and that a degenerative spinal canal stenosis is a predisposing factor.

Morphometry of the spinal canal at cervical region in asymptomatic military young men

Spinal canal measurements obtainned from radiographic imaging studies are an integral part of diagnostic evaluation of cervical spine stenosis. Before abnormal spinal morphometry can be determined, it is first necessary to establish normal values for the specific patient population being evaluated. Cervical spinal canal stenosis increase risk of quadriplegia after "minor trauma" in the head or neck, mainly in athletes who participate in contact or collision sports. Prospective and random selection of 500 plain film of the lateral cervical spine in young militaries population in age group 18-20 years old. Those were performed a hundred set of film were for each geographic region, including Manaus, Recife, São Paulo, Porto Alegre and Campo Grande. The first part of this study established normal values for cervical morphometry. The second part determined the most accurate screenning method for detecting cervical spinal stenosis. Normal spinal canal mean value for C3 was 18,27mm, C4 17,98mm, C5 18,33mm and 18,76mm in C6. The TORG ratio was evaluated as a method to detect significant cervical spinal stenosis and was shown to have sensitivity and high positive predictive value. It was observed TORG's ratio of 0,80 or less in 14,4% of the X-rays.

Anteroposterior diameter of the vertebral canal in cervical region: comparison of anatomical, computed tomographic, and plain film measurements

The purpose was to compare the computed tomographic and plain film measurements with those of anatomical specimens to determine the antero-posterior diameter of the spinal canal in cervical region. Antero-posterior diameters of 75 cervical vertebral canals (15 sets of C3-C7) were measured anatomically at two different levels. Computed tomographic and plain film measurements were also obtained at the corresponding levels. Considering anatomical measurements as the gold standard, plain film and computed tomographic measurements were statistically compared. Interobserver and intraobserver differences were also evaluated. At the uppermost pedicle levels, there was no statistically significant difference between plain films and anatomical measurements, a good correlation. However, at lowermost pedicle level there was a statistically significant difference between plain films and anatomical measurements but not between tomographic and anatomical measurements. Our results suggest that plain films can accurately estimate cervical spinal canal mid-sagittal diameter at the uppermost pedicle level and be used as a first step examination for the evaluation of cervical spinal stenoses.