The effects of age, pathology, and fusion on cervical neural foramen area

Abstract

Cervical radiculopathy is a relatively common neurological disorder, often resulting from mechanical compression of the nerve root within the neural foramen. Anterior cervical discectomy and fusion (ACDF) is a common treatment for radicular symptoms that do not resolve after conservative treatment. One mechanism by which ACDF is believed to resolve symptoms is by replacing degenerated disc tissue with bone graft to increase the neural foramen area, however in vivo evidence demonstrating this is lacking. The aim of this study was to evaluate the effects of age, pathology, and fusion on bony neural foramen area. Participants included 30 young adult controls (<35 years old), 23 middle‐aged controls (36 to 60 years old), and 36 cervical arthrodesis patients tested before and after ACDF surgery. Participants’ cervical spines were imaged in the neutral, full flexion, and full extension positions while seated within a biplane radiography system. A validated model‐based tracking technique determined three‐dimensional vertebral position and orientation and automated software identified the neural foramen area in each head position. The neural foramen area decreased throughout the entire sub‐axial cervical spine with age and pathology, however, no changes in neural foramen area were observed due solely to replacing degenerated disc tissue with bone graft. The neural foramen area was not associated with disc height in young adult controls, but moderate to strong associations were observed in middle‐aged controls. The results provide evidence to inform the debate regarding localized versus systemic spinal degeneration and provide novel insight into the mechanism of pain relief after ACDF.

Changes in intervertebral sagittal alignment of the cervical spine from supine to upright

“…As indicated earlier, we theorize this occurs due to the degenerative process over the entire cervical spine, not only at the symptomatic motion segments, leading to stiffer intervertebral discs throughout the entire cervical spine. This finding agrees with our previous results that demonstrated bony changes occur throughout the entire cervical spine in the presence of one‐level or two‐level pathology 33 . Our findings further agree with previous results characterizing overall and level‐dependent changes in orientation the lumbar spine when moving from supine to upright, including reduced lordosis, and reduced segmental motion associated with intervertebral disc degeneration 34–36 …”

“…This finding agrees with our previous results that demonstrated bony changes occur throughout the entire cervical spine in the presence of one-level or two-level pathology. 33 Our findings further agree with previous results characterizing overall and level-dependent changes in orientation the lumbar spine when moving from supine to upright, including reduced lordosis, and reduced segmental motion associated with intervertebral disc degeneration. [34][35][36] Controls and patients had increased C2-C3 and C3-C4 anterior disc height with a corresponding decrease in posterior disc height when upright compared with supine.…”

Evaluation of Dynamic Foraminal Stenosis with Positional MRI in Patients with C6 Radiculopathy‐Mimicking Pain: A Prospective Radiologic Cohort Study

“…Uncovertebral joint osteophytes or protruded disc may also cause root impingement despite unaffected foraminal dimensions. More recently, Le Vasseur and friends presented that degenerative changes in older ages are more related with foraminal dimension decrease in their in vivo study [ 12 ].…”

“…In the literature, different methods have been used to evaluate the foraminal size in the cervical spine. More recently, a 3D model-based matching technique from MRI images or biplane radiography systems [ 12 , 17 ] was used. Previously, in vitro cadaveric studies were based on clipper or probe measurement techniques of foramens [ 10 , 15 ].…”

Linear parameters of the thoracic vertebrae in adults in the second period of adulthood

“…Современные методы исследования, в частности, компьютерная томография, позволяют изучить данные параметры прижизненно с высокой точностью [11,15,16]. Сведения о диапазоне индивидуальной изменчивости линейных параметров позвонков востребованы для оценки результатов диагностических методов исследования, а также для оптимизации оперативных доступов, применяемых для хирургической коррекции заболеваний позвоночного столба [12,14].…”