Morphometric analysis of cervical neuroforaminal dimensions from C2–T1 using computed tomography of 1,000 patients

Abstract

BACKGROUNDRace and sex differences are not consistently reported in the literature. Fundamentally, anatomical differences of cervical neuroforaminal dimensions (CNFD) amongst these groups would be important to know. PURPOSETo establish normative radiographic morphometric measurements of CNFD and uncover the influence of patient sex, race, and ethnicity while also considering anthropometric characteristics. STUDY DESIGNRetrospective radiographic morphometric study. PATIENT SAMPLEA total of 1,000 patients between 18 and 35 years of age who were free of spinal pathology. OUTCOME MEASURESForaminal height, axial width, and area of cervical neural foramen. METHODSCervical CTs were reviewed to measure CNFD, defined as follows: foraminal height, axial width, and area. Statistical analyses were performed to assess associations between CNFD, and patient height, weight, sex, race, and ethnicity. RESULTSCNFD measurements followed a bimodal distribution pattern moving caudally from C2–T1. Irrespective of disc level, cervical CNFD were as follows: left and right widths of 6.6±1.5 and 6.6±1.5 mm, heights of 9.4±2.4 and 9.4±3.2 mm, and areas of 60.0±19.5 and 60.6±20.7 mm2. Left and right foraminal width were highest at C2–C3 and lowest at C3–C4. Left and right foraminal height were highest at C7–T1 and C6–C7, respectively and lowest at C3–C4. Left and right foraminal areas were highest at C2–C3 and lowest at C3–C4. Significant differences were observed for all CNFD measurements across disc levels. CNFD did not vary based on laterality. Significant CNFD differences were observed with respect to patient sex, race, and ethnicity. Male height and area were larger compared to females. In contrast, female foraminal width was larger compared to males. The Asian cohort demonstrated the largest foraminal widths. White and Hispanic patients demonstrated the largest foraminal heights and areas. Black patients demonstrated the smallest foraminal widths, heights, and areas. Patient height and weight were only weakly correlated with CNFD measurements across all levels from C2–T1. CONCLUSIONSThis study describes 36,000 normative measurements of 12,000 foramina from C2–T1. CNFD measurements vary based on disc level, but not laterality. Contrasting left- versus right-sided neuroforamina of the same level may aid in determining the presence of unilateral stenosis. Patient sex, race, and ethnicity are associated with CNFD, while patient anthropometric factors are weakly correlated with CNFD.