A New grading system based on T2-weighted axial MRI for Cervical Canal stenosis

Abstract

Background: Cervical Canal Stenosis (CCS) is a common cervical disease that occurs during and after middle age. There are a variety of grading systems and Measurement methods based on X-ray, Computed Tomography(CT) for cervical canal stenosis. Although many authors measured and classified cervical canal stenosis on the basis of T2-weighted sagittal MRI after the appearance of magnetic resonance, the research on Cervical Canal Stenosis remains to be improved. To explore a more detailed grading system on MRI for cervical canal stenosis and could be used to the clinical diagnosis and treatment.Methods: We retrospectively studied 200 patients with cervical spinal stenosis. Cervical canal stenosis was classified according to the T2-weighted axial MRI with the most serious compression into the following grades: grade 0,normal; grade 1, mild canal stenosis with obliteration of anterior or posterior of cerebrospinal fluid (CSF) space ; grade 2, moderate canal stenosis with obliteration of both sides of the CSF space but no significant changes in spinal morphology; Grade 3, severe canal stenosis with spinal cord deformity, 3A the oppression ratio of cervical spinal cord is under 50%, 3B the angle of the protrusion less than 90°; Grade 4, serious canal stenosis with spinal cord deformity and the oppression ratio of cervical spinal cord is exceeding 50%, 4A the non-ossification protrusion, 4B the ossific protrusion. We collected the relevant clinical and imaging data of the patients and analyzed the relationship between them and our new grading system. Patients were followed up one year later.Results: Our new grading system was easy to learn and communication. The the ICC reliabilities between six readers was between 0.817-0.865. And the Effective sagittal spinal canal was significantly different along with our grades at each disc level. In terms of clinical data, our grading system is correlated with the patient's preoperative mJOA score and had impact on the choice of surgical strategy. Conclusions: We suggest our new grading system can provided as a reliable assessment that can guide clinical treatment for Cervical Canal Stenosis.