title: A comparison of computed tomography measures for diagnosing cervical spinal stenosis associated with myelopathy: a case-control study.
abstract: METHODS
  Retrospective comparative study.
  
  
  OBJECTIVE
  To assess differences in computed tomography (CT) imaging parameters between patients with cervical myelopathy and controls.
  
  
  BACKGROUND
  There is a lack of information regarding the best predictor of symptomatic stenosis based on osseous canal dimensions. We postulate that smaller osseous canal dimensions increase the risk of symptomatic central stenosis.
  
  
  METHODS
  CT images and medical records of patients with cervical myelopathy (19 patients, 8 males; average age, 64.4±13.4 years) and controls (18 patients, 14 males; average age, 60.4±11.0 years) were collected. A new measure called the laminar roof pitch angle (=angle between the lamina) was conducted along with linear measures, ratios and surrogates of canal perimeter and area at each level C2-C7 (222 levels). Receiver-operator curves were used to assess the diagnostic value of each. Rater reliability was assessed for the measures.
  
  
  RESULTS
  The medial-lateral (ML) diameter (at mid-pedicle level) and calculated canal area (=anterior-posterior.×ML diameters) were the most accurate and highly reliable. ML diameter below 23.5 mm and calculated canal area below 300 mm(2) generated 82% to 84% sensitivity and 67% to 68% sensitivity. No significant correlations were identified between age, height, weight, body mass in dex and gender for each of the CT measures.
  
  
  CONCLUSIONS
  CT measures including ML dimensions were most predictive. This study is the first to identify an important role for the ML dimension in cases of slowly progressive compressive myelopathy. A ML reserve may be protective when the canal is progressively compromised in the anterior-posterior dimension.
authors.affiliation: Department of Orthopaedics, Landstuhl Regional Medical Center, Landstuhl, Germany.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Freedman
authors.affiliation: Department of Orthopaedics, Emory University Orthopaedics and Spine Center, Atlanta, GA, USA.
authors.forename: C Edward
authors.initials: CE
authors.lastname: Hoffler
authors.affiliation: Department of Orthopaedics, Landstuhl Regional Medical Center, Landstuhl, Germany.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Cameron
authors.affiliation: Department of Orthopaedics, Emory University Orthopaedics and Spine Center, Atlanta, GA, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Rhee
authors.affiliation: Department of Orthopaedics, Emory University Orthopaedics and Spine Center, Atlanta, GA, USA.
authors.forename: Maneesh
authors.initials: M
authors.lastname: Bawa
authors.affiliation: Department of Orthopaedics, Landstuhl Regional Medical Center, Landstuhl, Germany.
authors.forename: David G
authors.initials: DG
authors.lastname: Malone
authors.affiliation: Department of Orthopaedics, Emory University Orthopaedics and Spine Center, Atlanta, GA, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bent
authors.affiliation: Department of Orthopaedics, Emory University Orthopaedics and Spine Center, Atlanta, GA, USA.
authors.forename: Tim S
authors.initials: TS
authors.lastname: Yoon
keywords: Cervical cord; Cervicle vertebrae; Spinal cord compression; Spinal cord diseae; Spinal stenosis