Evaluating Intervertebral Foramen Measurements for Patients with Anterior Cervical Disc Surgery in Oblique CT
Abstract
Objective: It is particularly difficult to determine the level of radiculopathy pain. Because radicular pain usually doesn't fit the dermatomal map. unlike the foramen lumbar vertebrae, where the cervical nerve root is exerted, it has a slope of approximately 45 degrees to the vertebrae in the axical plane and 10-15 degrees in the horizontal plane. Due to this structure of cervical foremen, the evaluation of conventional ct results in incorrect or incomplete diagnosis. In our study, we compared the change in cervical foramen patients with anterior cervical discectomy and cage (fusion) to oblique ct reconstructive and preop and postop.
Methods: CT images were acquired in a 64 slice CT system (60–80 mAs, 120 kVp, FC86 reconstruction core and 2.0 mm slice thickness at 2.0 mm intervals). Oblique sagittal images were created with OsiriX Lite v. 12.0.1 version and measurements were performed. For each level, the area has been measured in addition to the short and long axle length of the neural foramens from the pre-op and post-op oblique sagittal images.
Results: In our study, 98 cervical intervertebral foramen oblique CT de preop-postop, long axle, short axle and field measurements were evaluated with 43 patients from 16/01/2019 to 03/02/2020, 3 patients with two levels of anterior ceral discectomy + interbody cage. Right side, long axle, short axle, and area respectively; 13,37%, 5,99%, 16,87% increase. Left side, long axle, short axle, and area respectively, increased by 14,27%, 7,11%, 23,20%
Conclusion: The cage, which is placed on the intervertebral level, will increase the area of the foramen, increase the space of the foramen, and allow the nerve to decompression. This is why it is necessary to insert the material with the highest height of the intervertebral disk level that can be placed during surgery.
Methods: CT images were acquired in a 64 slice CT system (60–80 mAs, 120 kVp, FC86 reconstruction core and 2.0 mm slice thickness at 2.0 mm intervals). Oblique sagittal images were created with OsiriX Lite v. 12.0.1 version and measurements were performed. For each level, the area has been measured in addition to the short and long axle length of the neural foramens from the pre-op and post-op oblique sagittal images.
Results: In our study, 98 cervical intervertebral foramen oblique CT de preop-postop, long axle, short axle and field measurements were evaluated with 43 patients from 16/01/2019 to 03/02/2020, 3 patients with two levels of anterior ceral discectomy + interbody cage. Right side, long axle, short axle, and area respectively; 13,37%, 5,99%, 16,87% increase. Left side, long axle, short axle, and area respectively, increased by 14,27%, 7,11%, 23,20%
Conclusion: The cage, which is placed on the intervertebral level, will increase the area of the foramen, increase the space of the foramen, and allow the nerve to decompression. This is why it is necessary to insert the material with the highest height of the intervertebral disk level that can be placed during surgery.
Keywords
References
- 1. Edwards CC 2nd, Riew KD, Anderson PA, Hilibrand AS, Vaccaro AF. Cervical myelopathy: current diagnostic and treatment strategies. Spine J. 2003;3:68–81.
- 2. Murphy DR, Hurwitz EL, Gerrard JK, & Clary R. Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specifc dermatome? Chiropr. Osteopat. 2009;17:9.
- 3. Anderberg L, Annertz M, Rydholm U, Brandt L. & Säveland H. Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur. Spine J. 2016;15:794–801.
- 4. Smith GW, Robinson RA: The treatment of certain cervicalspine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 40:607–623, 1958.
- 5. Robinson RA, Smith GW: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;96:223–224.
- 6. Bose B. Anterior cervical fusion using Caspar plating: analysis of results and review of the literature. Surg Neurol. 1998;49:25–31.
- 7. Shim JH, Park CK, Lee JH, Choi JW, Lee DC, Kim DH. et. Al. A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen Eur Spine J. 2009;18:1109–1116
- 8. Pait TG, Killefer JA, Arnautovic KI. Surgical anatomy of the anterior cervical spine: The disc space, vertebral artery, and associated bony structures. Neurosyrgery. 1996;39: 769-776.
- 9. Bernhardt M, Bridwell KH. Segmental analysis of the sagittal plante aligment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine. 1989;24: 727-21.
- 10. Bland JH, Boushey DR. Anatomy and physiology of the cervical spine. Semin Arthritis Rheum. 1990;20:1–20.