Three-dimensional Spinal Canal Morphometric Analysis and Relevant Spinal Cord Occupational Ratios in Congenital Cervical Spinal Stenosis: A Classification Algorithm of the Stenosis Phenotypes and Data-driven Decompression Approach

• Published in: World neurosurgery Vol. 187; pp. e982 - e996
• Main Authors: Kitab, Sameer A., AbdulKareem, Salam B., Wakefield, Andrew E., Benzel, Edward C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2024
• Subjects: Adult; Aged; Algorithms; Cervical myelopathy; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - pathology; Congenital cervical stenosis; Decompression; Decompression, Surgical - methods; Developmental; Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Middle Aged; MRI; Phenotype; Retrospective Studies; Spinal Canal - diagnostic imaging; Spinal Canal - pathology; Spinal Cord - diagnostic imaging; Spinal Cord - pathology; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - pathology; Spinal Stenosis - surgery; Developmental; CSA; Cervical myelopathy; CCS; RD; RV; MRI; Congenital cervical stenosis; ACDF; Decompression; AP
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.05.024

No standardized magnetic resonance imaging (MRI) parameters have defined the 3-dimensional morphoanatomy and relevant spinal cord occupation ratios (occupation of spinal cord dimensions/similar dimensions within the spinal canal) in congenital cervical stenosis (CCS).
A retrospective, comparative analysis was conducted on 200 patients >18 years of age with myelopathy and CCS (mean age, 52.4 years) and 200 age-matched controls with no myelopathy or radiculopathy. The variables assessed from high resolution MRI included sagittal and axial spinal canal dimensions (MRI Torg-Pavlov ratios) from C3 to C7. Morphometric dimensions from the sagittal retrodiscal and retrovertebral regions as well as axial MRI dimensions were compared. Sagittal and axial spinal cord occupation ratios were defined and correlated with spinal canal dimensions.
Multivariate analyses indicated reduced sagittal and axial anteroposterior (AP) spinal canal dimensions and a large reduction in transverse spinal canal dimensions at all spinal levels. There was a small significant correlation between AP sagittal spinal canal dimensions and axial transverse spinal canal dimensions at C3-C5, but not at C5-C6. Small correlations were noted between AP sagittal spinal canal dimensions and AP axial spinal cord and axial cross-sectional area occupation ratios at C3-C6, but there was no correlation with axial mediolateral spinal cord occupation ratios.
The stenosis effect can involve any dimension, including the transverse spinal canal dimension, independent of other dimensions. Owing to the varied observed morphoanatomies, a classification algorithm that defines CCS specific phenotypes was formulated. Objectivizing the stenosis morphoanatomy may allow for data-driven patient-focused decompression approaches in the future.