Dimensions of the cervical neural foramen in conditions of spinal deformity: an ex vivo biomechanical investigation using specimen-specific CT imaging.
Dimensions of the cervical neural foramen in conditions of spinal deformity: an ex vivo biomechanical investigation using specimen-specific CT imaging.
复制标题
脊柱畸形条件下颈神经孔的尺寸：使用标本特异性 CT 成像进行离体生物力学研究。
DOI：
10.1007/s00586-016-4409-4
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Patwardhan,AvinashG
中科院分区：
文献类型：
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作者：
Smith,ZacharyA;Khayatzadeh,Saeed;Bakhsheshian,Joshua;Harvey,Michael;Havey,RobertM;Voronov,LeonardI;Muriuki,MuturiG;Patwardhan,AvinashG
目的颈椎病患者常表现为颈痛、神经根病或脊髓病。随着退行性病变的进展，多种因素，包括椎间盘高度丢失、胸椎后凸和小关节发生性变化，都可能增加神经结构受压的风险。本研究调查颈椎畸形，包括向前头部姿势（FHP）和上胸椎后凸畸形的影响，对颈椎神经foramen. MethodsPositive的13人颈椎标本（枕-T1，年龄50.6岁;范围21-67）的解剖进行了评估，在规定的颈椎矢状面错位使用以前报道的实验模型。颈椎矢状畸形的两个特征，C2-C7矢状垂直排列（SVA）和T1椎骨的矢状角（T1倾斜），被改变以产生各种颈椎排列不良。通过测量椎体位置和方向记录姿势变化。椎体运动数据与基于CT的解剖学模型相结合，该模型允许评估下颈椎节段的椎间孔面积作为增加C2-C7 SVA和改变T1 tilt. ResultsC 2-C7 SVA从中立位增加导致下颈椎神经孔面积增加（最大增加在C4-C5：13.8 ± 15.7%，P< 0.01）。从过度后凸姿势（更大的T1倾斜）增加SVA也增加了下颈椎节段的神经孔面积（C5-C6表现出最大的增加：13.4 ± 9.6%，P< 0.01）。颈椎神经孔的面积随着T1倾斜度的增加而减小，下颈椎的减小幅度更大，尤其是C5-C6（−8.6 ± 7.0%，P< 0.01）和C6-C7（−9.6 ± 5.6%，P< 0.01）。与此相反，增加颈椎SVA增加下颈椎神经孔面积。上胸椎后凸畸形增加的患者可能会以颈椎SVA增加作为一种代偿机制来增加下颈椎神经孔面积。
PurposePatients with cervical spondylosis commonly present with neck pain, radiculopathy or myelopathy. As degenerative changes progress, multiple factors including disc height loss, thoracic kyphosis, and facetogenic changes can increase the risk of neural structure compression. This study investigated the impact of cervical deformity including forward head posture (FHP) and upper thoracic kyphosis, on the anatomy of the cervical neural foramen.MethodsPostural changes of 13 human cervical spine specimens (Occiput-T1, age 50.6 years; range 21–67) were assessed in response to prescribed cervical sagittal malalignments using a previously reported experimental model. Two characteristics of cervical sagittal deformities, C2–C7 sagittal vertical alignment (SVA) and sagittal angle of the T1 vertebra (T1 tilt), were varied to create various cervical malalignments. The postural changes were documented by measuring vertebral positions and orientations. The vertebral motion data were combined with specimen-specific CT-based anatomical models, which allowed assessments of foraminal areas of subaxial cervical segments as a function of increasing C2–C7 SVA and changing T1 tilt.ResultsIncreasing C2–C7 SVA from neutral posture resulted in increased neural foraminal area in the lower cervical spine (largest increase at C4–C5: 13.8 ± 15.7 %,P< 0.01). Increasing SVA from a hyperkyphotic posture (greater T1 tilt) also increased the neural foraminal area in the lower cervical segments (C5–C6 demonstrated the largest increase: 13.4 ± 9.6 %,P< 0.01). The area of the cervical neural foramen decreased with increasing T1 tilt, with greater reduction occurring in the lower cervical spine, specifically at C5–C6 (−8.6 ± 7.0 %,P< 0.01) and C6–C7 (−9.6 ± 5.6 %,P< 0.01).ConclusionAn increase in thoracic kyphosis (T1 tilt) decreased cervical neural foraminal areas. In contrast, an increase in cervical SVA increased the lower cervical neural foraminal areas. Patients with increased upper thoracic kyphosis may respond with increased cervical SVA as a compensatory mechanism to increase their lower cervical neural foraminal area.