Abstract
BackgroundCervical pillar hyperplasia (CPH) is a recently described phenomenon of unknown etiology and clinical significance. Global assessment of pillar hyperplasia of the cervical spine as a unit has not shown a relationship with degenerative joint disease, but a more sensible explanation of the architectural influence of CPH on cervical spine biomechanics may be segment-specific.ObjectiveThe objective of this study was to determine the level of association between degenerative joint disease (DJD) and cervical pillar hyperplasia (CPH) in an age- and gender-matched sample on a [cervical spine] by-level basis.Research MethodsTwo-hundred and forty radiographs were collected from subjects ranging in age between 40 and 69 years. The two primary outcome measures used in the study were the segmental presence/absence of cervical pillar hyperplasia from C3 to C6, and segment-specific presence/absence of degenerative joint disease from C1 to C7. Contingency Coefficients, at the 5% level of significance, at each level, were used to determine the strength of the association between CPH and DJD. Odds Ratios (OR) with their 95% Confidence Intervals (95% CI) were also calculated at each level to assess the strength of the association.ResultsOur study suggests that an approximately two-to-one odds, or a weak-to-moderate correlation, exists at C4 and C5 CPH and adjacent level degenerative disc disease (DDD); with the strongest (overall) associations demonstrated between C4 CPH and C4–5 DDD and between C5 CPH and C5–6 DDD. Age-stratified results demonstrated a similar pattern of association, even reaching the initially hypothesized OR ≥ 5.0 (95% CI > 1.0) or "moderately-strong correlation of C ≥ .4 (p ≤ .05)" in some age categories, including the 40–44, 50–59, and 60–64 years of age subgroups; these ORs were as follows: OR = 5.5 (95% CI 1.39–21.59); OR = 6.7 (95% CI 1.65–27.34); and OR = 5.3 (95% CI 1.35–21.14), respectively.ConclusionOur results suggest that CPH has around two-to-one odds, that is, only a weak-to-moderate association with the presence of DJD (DDD component) at specific cervical spine levels; therefore, CPH may be but one of several factors that contributes (to a clinically important degree) to the development of DJD at specific levels in the cervical spine.
Highlights
Cervical pillar hyperplasia (CPH) is a recently described phenomenon of unknown etiology and clinical significance
Our results suggest that cervical pillar hyperplasia (CPH) has around two-to-one odds, that is, only a weak-tomoderate association with the presence of degenerative joint disease (DJD) (DDD component) at specific cervical spine levels; CPH may be but one of several factors that contributes to the development of DJD at specific levels in the cervical spine
The C-coefficients and Odds Ratios (OR) for the segmental relationships between cervical pillar hyperplasia (CPH) and degenerative joint disease (DJD) across all age groups (40–69 years) indicate that the strongest associations of statistical significance occurred at C4 and C5; these correlation coefficients and ORs were all considerably weaker than the initially proposed clinically impor
Summary
Cervical pillar hyperplasia (CPH) is a recently described phenomenon of unknown etiology and clinical significance. Global assessment of pillar hyperplasia of the cervical spine as a unit has not shown a relationship with degenerative joint disease, but a more sensible explanation of the architectural influence of CPH on cervical spine biomechanics may be segment-specific. Its etiology and clinical significance are presently unknown; studies have shown that CPH is a frequently overlooked etiology for the loss of the cervical lordosis [2,3] While these findings were disputed by several authors [5,6,7,8,9], other consequences of cervical pillar hyperplasia are not known at the present time. The architecture of the cervical pillars cannot be modified by conservative therapy; clinicians should be aware that some of the symptoms may be attributed to degeneration and may influence the expected prognosis of the management of neck pain in those particular patients
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