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Tomodensitometric bone anatomy of the intervertebral foramen of the lower cervical spine: measurements and comparison of foraminal volume in healthy individuals and patients suffering from cervicobrachial neuralgia due to foraminal stenosis

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

Degenerative foraminal stenosis of the cervical spine can lead to cervicobrachial neuralgias. Computed tomography (CT)-scan assists in the diagnosis and evaluation of foraminal stenosis. The main objective of this study is to determine the bony dimensions of the cervical intervertebral foramen and to identify which foraminal measurements are most affected by degenerative disorders of the cervical spine. These data could be applied to the surgical treatment of this pathology, helping surgeons to focus on specific areas during decompression procedures.

Methods

A descriptive study was conducted between two groups: an asymptomatic one (young people with no evidence of degenerative cervical spine disorders) and a symptomatic one (experiencing cervicobrachial neuralgia due to degenerative foraminal stenosis). Using CT scans, we determined a method allowing measurements of the following foraminal dimensions: foraminal height (FH), foraminal length (FL), foraminal width in its lateral part ((UWPP, MWPP and IWPP (respectively Upper, Medial and Inferior Width of Pedicle Part)) and medial part (UWMP, MWMP and IWMP (respectively Upper, Medial and Inferior Width of Medial Part)), and disk height (DH). Foraminal volume (FV) was calculated considering the above data. Mean volumes were measured in the asymptomatic group and compared to the values obtained in the symptomatic group.

Results

Both groups were made up of 10 patients, and a total of 50 intervertebral discs (100 intervertebral foramina) were analyzed in each group. Comparison of C4C5, C5C6 and C6C7 levels between both groups showed several significant decreases in foraminal dimensions (p < 0.05) as well as in foraminal volume (p < 0.001) in the symptomatic group. The most affected dimensions were UWPP, MWPP, UWMP, MWMP and FV. The most stenotic foraminal areas were the top of the uncus and the posterior edge of the lower plate of the overlying vertebra.

Conclusion

Using a new protocol for measuring foraminal volume, the present study refines the current knowledge of the normal and pathological anatomy of the lower cervical spine and allows us to understand the foraminal sites most affected by degenerative stenosis. Those findings can be applied to foraminal stenosis surgeries. According to our results, decompression of the foramen in regard of both uncus osteophytic spurs and inferior plate of the overlying vertebra might be an important step for spinal nerves release.

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Availability of data and material

Data transparency: P. Coudert had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Data are available on request to the corresponding author.

Code availability

Not applicable.

Abbreviations

3D MPR:

Three-dimensional multiplanar reconstruction

AE:

Area of the ellipse

BMI:

Body Mass Index

CD:

Compact disc

CT:

Computed tomography

DH:

Disc height

DICOM:

Digital imaging and communication in medicine

FH:

Foraminal height

FL:

Foraminal length

FV:

Foraminal volume

FW:

Foraminal width

ICC:

Intraclass correlation coefficients

IWMP:

Inferior width of medial part

IWPP:

Inferior width of pedicle part

MRI:

Magnetic resonance imaging

MWMP:

Middle width of medial part

MWPP:

Middle width of pedicle part

SD:

Standard deviation

UWMP:

Upper width of medial part

UWPP:

Upper width of pedicle part

References

  1. Boijsen E (1954) The cervical spinal canal in intraspinal expansive processes. Acta Radiol 42:101–115

    Article  CAS  Google Scholar 

  2. Brigham CD, Tsahakis PJ (1995) Anterior cervical foraminotomy and fusion. Spine 20:766–770

    Article  CAS  Google Scholar 

  3. Cinotti G, De Santis P, Nofroni I et al (2002) Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine 27:223–229

    Article  Google Scholar 

  4. Czervionke LF, Daniels DL, Ho PS et al (1998) Cervical neural foramina: correlative anatomic and MR imaging study. Radiology 169:753–759

    Article  Google Scholar 

  5. De Palma AF, Rothman RH (1970) The intervertebral disc. WB Saunders, Philadelphia

    Google Scholar 

  6. Ebraheim NA, An HS, Xu R et al (1996) The quantitative anatomy of the cervical nerve root groove and the intervertebral foramen. Spine 21:1619–1623

    Article  CAS  Google Scholar 

  7. Freedman BA, Hoffler CE, Cameron BM et al (2015) A comparison of computed tomography measures for diagnosing cervical spinal stenosis associated with myelopathy: a case-control study. Asian Spine J 9:22–29

    Article  Google Scholar 

  8. Friedenberg ZB, Miller WT (1963) Degenerative disc disease of the cervical spine: a comparative study of asymptomatic and symptomatic patients. J Bone Joint Surg Am 45:1171–1178

    Article  CAS  Google Scholar 

  9. Landis JR, Koch GG (1997) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  Google Scholar 

  10. Moore KL (2001) Anatomie médicale, aspects fondamentaux et applications cliniques. De Boeck Superieur ed, 1st edn, Paris

  11. Murphey F, Simmons JC, Brunson B (1973) Ruptured cervical discs, 1939 to 1972. Clin Neurosurg 20:9–17

    Article  CAS  Google Scholar 

  12. Naji P, Alsufyani NA, Lagravère MO (2014) Reliability of anatomic structures as landmarks in three-dimensional cephalometric analysis using CBCT. Angle Orthod 84:762–772

    Article  Google Scholar 

  13. Oda J, Tanaka H, Tsuzuki N (1998) Intervertebral disc changes with aging of human cervical vertebra. From the neonate to the eighties. Spine 13:1205–1211

    Article  Google Scholar 

  14. Park JY, Hwang JT, Oh KS et al (2014) Revisit to scapular dyskinesis: three-dimensional wing computed tomography in prone position. J Shoulder Elbow Surg 23:821–828

    Article  Google Scholar 

  15. Polston DW (2007) Cervical radiculopathy. Neurol Clin 25:373–385

    Article  Google Scholar 

  16. Rühli FJ, Müntener M, Henneberg M (2006) Human osseous intervertebral foramen width. Am J Phys Anthropol 129:177–188

    Article  Google Scholar 

  17. Ruofu Z, Huilin Y, Xiaoyun H et al (2008) CT evaluation of cervical pedicle in a Chinese population for surgical application of transpedicular screw placement. Surg Radiol Anat SRA 30:389–396

    Article  Google Scholar 

  18. Shim JH, Park CK, Lee JH et al (2009) A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen. Eur Spine J 18:1109–1116

    Article  Google Scholar 

  19. Singh K, Masuda K, Thonar EJ-MA et al (2009) Age-related changes in the extracellular matrix of nucleus pulposus and anulus fibrosus of human intervertebral disc. Spine 34:10–16

    Article  Google Scholar 

  20. Sonntag VKH, Vishteh AG (2001) Anterior cervical discectomy. Neurosurgery 49(4):909–912

    CAS  PubMed  Google Scholar 

  21. Tanaka N, Fujimoto Y, An HS et al (2000) The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine 25:286–291

    Article  CAS  Google Scholar 

  22. Taylor TK, Melrose J, Burkhardt D et al (2000) Spinal biomechanics and aging are major determinants of the proteoglycan metabolism of intervertebral disc cells. Spine 25:3014–3020

    Article  CAS  Google Scholar 

  23. Vital JM, Lavignolle B, Pointillart V et al (2004) Cervicalgie commune et névralgies cervicobrachiales. EMC Rhumatol Orthopédie 1:196–217

    Article  Google Scholar 

  24. Wong JJ, Côté P, Quesnele JJ et al (2014) The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J Off J North Am Spine Soc 14:1781–1789

    Article  Google Scholar 

  25. Yang R, Ma M, Huang L et al (2018) Influences of different lower cervical bone graft heights on the size of the intervertebral foramen: multiple planar dynamic measurements with laser scanning. Lasers Med Sci 33:627–635

    Article  Google Scholar 

  26. Yoshihara H (2017) Indirect decompression in spinal surgery. J Clin Neurosci 44:63–68

    Article  Google Scholar 

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Acknowledgements

Amaury Lainé for grammar and spelling check. The work described has not been published before and it is not under consideration for publication anywhere else. Its publication has been approved by all co-authors, as well as by the responsible authorities at the institute where the work has been carried out.

Funding

The authors did not receive support from any organization for the submitted work.

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Author notes

  1. P. Coudert and G. Lainé contributed equally to this work.

Authors and Affiliations

  1. Department of Spine Surgery, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France

    P. Coudert, V. Pointillart, C. Damade, L. Boissiere, J. M. Vital, B. Bouyer & O. Gille

  2. Department of Neurosurgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France

    G. Lainé

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  1. P. Coudert
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Contributions

PC: protocol development, data collection, management and analysis. GL: data analysis, manuscript writing and editing. VP: manuscript editing. CD: manuscript Editing. LB: manuscript editing. JMV: manuscript editing. BB: data analysis, manuscript editing. OG: project development, protocol development, data management, manuscript editing.

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Correspondence to G. Lainé.

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The authors have no relevant financial or non-financial interests to disclose.

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Because of its retrospective design and in accordance with the requested opinion of the ethical committee of the Bordeaux University Hospital, no ethics committee approval is required.

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Coudert, P., Lainé, G., Pointillart, V. et al. Tomodensitometric bone anatomy of the intervertebral foramen of the lower cervical spine: measurements and comparison of foraminal volume in healthy individuals and patients suffering from cervicobrachial neuralgia due to foraminal stenosis. Surg Radiol Anat 44, 883–890 (2022). https://doi.org/10.1007/s00276-022-02941-8

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