International Orthopaedics

, Volume 35, Issue 10, pp 1517–1522 | Cite as

Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels

  • Yuichiro Morishita
  • Masatoshi Naito
  • Jeffrey C. Wang
Original Paper


The lower cervical segments are commonly the level responsible for cervical spondylotic myelopathy; however, we rarely encounter stenosis at the upper cervical segment in a clinical setting. We assumed that there might be some differences between the pathogenetic mechanisms underlying the development of cervical canal stenosis at different segments. We performed positional MRI in the weight-bearing position for 295 consecutive symptomatic patients. All subjects were classified into four groups (A: normal; B: C3-4 stenosis; C: C5-6 stenosis; D: two-level cervical segments stenosis, stenosis at C3-4 and C5-6). Age, sagittal cervical canal diameter, cervical intervertebral disc degeneration, cervical cord compression, and cervical mobilities were evaluated for each group. Group B showed a narrow cervical spinal canal structure at the C3 to C4 pedicle levels, while groups C and D showed narrow structures at the C4 to C6 pedicle levels in the cervical spine. Additionally, the sagittal cervical canal diameters at all pedicle levels, except C7, in group D were significantly smaller than those observed in group C. We demonstrated the differences in the pathogenetic processes for the development of cervical spinal canal stenosis between C3-4, C5-6, and two-level cervical segments stenosis. Our results suggest that the developmental morphological structure of the cervical spinal canal plays an important role in the development of cervical canal stenosis at different segments. Moreover, individuals with sagittal cervical canal diameters of less than 13 mm may be exposed to an increased risk for future development of cervical spinal canal stenosis at the upper cervical segments following stenosis at the lower cervical segments.


Cervical Spine Cervical Spondylotic Myelopathy Cervical Canal Cervical Segment Functional Spinal Unit 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Yuichiro Morishita
    • 1
  • Masatoshi Naito
    • 1
  • Jeffrey C. Wang
    • 2
  1. 1.Department of Orthopedic SurgeryFukuoka UniversityFukuokaJapan
  2. 2.Department of Orthopedic SurgeryUniversity of California at Los AngelesLos AngelesUSA

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