Torg Ratio Research Articles

Three-dimensional Spinal Canal Morphometric Analysis and Relevant Spinal Cord Occupational Ratios in Congenital Cervical Spinal Stenosis: A Classification Algorithm of the Stenosis Phenotypes and Data-driven Decompression Approach

No standardized magnetic resonance imaging (MRI) parameters have defined the 3-dimensional morphoanatomy and relevant spinal cord occupation ratios (occupation of spinal cord dimensions/similar dimensions within the spinal canal) in congenital cervical stenosis (CCS). A retrospective, comparative analysis was conducted on 200 patients >18 years of age with myelopathy and CCS (mean age, 52.4 years) and 200 age-matched controls with no myelopathy or radiculopathy. The variables assessed from high resolution MRI included sagittal and axial spinal canal dimensions (MRI Torg-Pavlov ratios) from C3 to C7. Morphometric dimensions from the sagittal retrodiscal and retrovertebral regions as well as axial MRI dimensions were compared. Sagittal and axial spinal cord occupation ratios were defined and correlated with spinal canal dimensions. Multivariate analyses indicated reduced sagittal and axial anteroposterior (AP) spinal canal dimensions and a large reduction in transverse spinal canal dimensions at all spinal levels. There was a small significant correlation between AP sagittal spinal canal dimensions and axial transverse spinal canal dimensions at C3-C5, but not at C5-C6. Small correlations were noted between AP sagittal spinal canal dimensions and AP axial spinal cord and axial cross-sectional area occupation ratios at C3-C6, but there was no correlation with axial mediolateral spinal cord occupation ratios. The stenosis effect can involve any dimension, including the transverse spinal canal dimension, independent of other dimensions. Owing to the varied observed morphoanatomies, a classification algorithm that defines CCS specific phenotypes was formulated. Objectivizing the stenosis morphoanatomy may allow for data-driven patient-focused decompression approaches in the future.

Important Morphometric Values and Anatomical Ratios Obtained from Cervical Magnetic Resonance Imaging Images and their Differences from the Literature in Terms of Evaluation of Myelopathy

Objective: A Torg ratio of 0.80 or less is considered positive support for the diagnosis of cervical spinal canal stenosis. In our study, it was aimed to determine the morphometric values of the spinal cord, spinal canal, and vertebral body, to calculate the subarachnoid distance, and to examine the differences in Torg ratio according to cervical vertebra levels and between genders in young adult individuals belonging to our community. Materials and Methods: The study was performed on magnetic resonance imaging (MRI) images (28–35 years, 50 men and 50 women, retrospectively). Results: The Torg ratio was found to be <0.80 in 194 of 350 measurements made at 7 levels (55.4%) in men and in 83 of 350 measurements in women (23.7%). The Torg ratio value was found to be higher in women than men at C3–T1 levels (P < 0.01). There is a positive and highly significant relationship between the Torg ratio and “canal-cord distance” (P < 0.01). Spinal canal diameter was found to be <14 mm in 235 vertebrae (67.1%) in men and 282 vertebrae (80.6%) in women. In addition, it was found below 12 mm in 12.6% of men and 16% of women. Conclusion: In our study, the Torg ratio was found below 0.80 in a significant part of our cases. Therefore, it would be appropriate to revise the Torg ratio separately for different populations in MRI measurements. It is clear that there is a need for planning epidemiological studies consisting of control–patient groups in the future, especially for many societies.

Influence of clinical and radiological parameters on the likelihood of neurological improvement after surgery for degenerative cervical myelopathy.

Degenerative cervical myelopathy (DCM) is routinely treated with surgical decompression, but disparate postoperative outcomes are frequently observed, ranging from complete neurological recovery to persistent decline. Although numerous clinical and radiological factors have been independently associated with failure to improve, the relative impact of these proposed risk factors remains obscure. In this study, the authors assess the combined role of clinical and radiographic parameters in contributing to failure to attain neurological improvement after surgery. A consecutive series of patients who underwent surgery for DCM between July 2013 and August 2018 at a single institution was identified from a prospectively maintained database. Retrospective chart review was undertaken to record perioperative clinical and radiographic parameters. Failure to improve on the last follow-up evaluation after surgery, defined as a change in modified Japanese Orthopaedic Association (mJOA) score less than 2, was the primary outcome in univariate and multivariate analyses. The authors included 183 patients in the final cohort. In total, 109 (59.6%) patients improved (i.e., responders with ΔmJOA score ≥ 2) after surgery and 74 (40.4%) were nonresponders with ΔmJOA score < 2. Baseline demographic variables and comorbidity rates were similar, whereas baseline Nurick score was the only clinical variable that differed between responders and nonresponders (2.7 vs 3.0, p = 0.02). In contrast, several preoperative radiographic variables differed between the groups, including presence and degree of cervical kyphosis, number of levels with bidirectional cord compression, presence and number of levels with T2-weighted signal change, intramedullary lesion (IML) length, Torg ratio, and both narrowest spinal canal and cord diameter. On multivariate analysis, preoperative degree of kyphosis at C2-7 (OR 1.19, p = 0.004), number of levels with bidirectional compression (OR 1.83, p = 0.003), and IML length (OR 1.14, p < 0.001) demonstrated the highest predictive power for nonresponse (area under the receiver operating characteristic curve 0.818). A risk factor point system that predicted failure of improvement was derived by incorporating these 3 variables. When a large spectrum of both clinical and radiographic variables is considered, the degree of cervical kyphosis, number of levels with bidirectional compression, and IML length are the most predictive of nonresponse after surgery for DCM. Assessment of these radiographic factors can help guide surgical decision-making and more appropriately stratify patients in clinical trials.

Morphometric analysis of cervical canal stenosis using computerized tomography (CT) scan in a North Indian Community

Introduction: Cervical spinal stenosis is a frequent condition that causes a lot of pain and disability. To avoid long-term disability as a result of irreversible spinal cord injury, quick diagnosis and treatment are required. Cervical vertebrae have smaller bodies than other vertebrae, and their purpose is to support the head, protect the spinal cord, and permit head movement. Material and Methods: A case control study has been undertaken at a tertiary care setting of Uttar Pradesh for a period of 1 year from June 2020 to May 2021. Patients with either cervical spine stenosis or facet joint arthrosis or both aged between 20 to 80 years of either gender who attended Out-patient departments of the hospitals were involved. Results: A sum of 83 individuals were made part of the Case group and 50 patients were included as the Controls. Around 50% of the case population were females (n=42) and 56% of the controls were males (n=28). The Mean±SD Torg ratio of C3 cervical vertebra among the case group was 0.78±0.05, where as it was 0.84±0.06 in the control group. Mean±SD Torg ratio of C4 cervical vertebra among the case group was 0.76±0.05, whereas it was 0.83±0.08 in the control group.

Morphometric Analysis of the Cervical Canal Using Computed Tomography Scan Among Patients With Neck Pain in North India.

IntroductionCervical spinal stenosis is a common disease that results in considerable morbidity and disability. To avoid long-term disability caused by irreversible spinal cord damage, quick diagnosis and treatment are required. To our knowledge, until recently, there has been no report or study evaluating the cervical canal stenosis and associated facet joint arthrosis as the major cause of neck pain, so the current study used computed tomography (CT) scans to determine the prevalence of cervical canal stenosis and facet joint osteoarthrosis in patients who presented with neck pain, including its relationship with age, sex, and cervical spinal levels (C3-C7).MethodsThe current clinical descriptive cross-sectional study was conducted in the Department of Anatomy and Radiodiagnosis at Santosh Medical College, Ghaziabad, for a period of 24 months among newly diagnosed outpatient department (OPD) cases of neck pain (18 years or older) with suspected cervical canal stenosis and facet joint arthrosis. Clinical history, patient-specific clinical examination, and relevant information were obtained in a structured data collection schedule through interviews during OPD hours. All of the participants underwent a CT scan of the cervical region. The independent factors (age, gender, height, and weight) were used in a multiple linear regression analysis of neck pain grading, Torg ratio (TR), and right and left facet joint degeneration, which were expressed as R-squared (R2) and adjusted R-squared (aR2). Statistical tests were executed at a 5% level of significance; an association was considered significant if the p-value was <0.05.ResultsA total of 83 subjects were enrolled in this study with equal representation from both sexes, i.e., males (49.4%) and females (50.6%). The transverse vertebral canal (T-VC) diameter was narrowest at the level of C3 (25.00 ± 1.13) and gradually increased at the level of C6 (25.18 ± 1.14) in this study. The mean TR of cervical vertebrae C3-C4 dropped gradually from C3 (0.78 ± 0.05) to C7 (0.76 ± 0.05) in this study. Severe left and right facet joint degeneration were observed in 13.3% and 10.5% of study subjects, respectively. In almost every subject, neck pain was a neurological symptom, so multiple linear regression analysis of neck pain grading was carried out with the independent variables (age, gender, height, and weight) and it was found to be not significant (R2 = 0.0617, aR2 = 0.0136, p = 0.2842).ConclusionThe articulations of the posterior arch of the vertebrae are known as facet joints. They are a vital component of the vertebral column's structural stability. The superior and inner articular facets of the vertebrae are joined by these joints, which are encased in a fibrous capsule.

Sexual Dimorphism in Cervical Spine – A Magnetic Resonance Imaging Study

Background: Morphometric measurements of the spinal cord provide important clues regarding neural and spinal injuries. They are also of forensic importance and can be used to determine sex of an individual. These parameters have been shown to vary across age groups and ethnicity. Currently, there is a paucity of data regarding these parameters in Maharashtra, India. Therefore, studies are required to provide reference values for spinal canal parameters for this population. Aims: To study the cervical spinal canal morphometric differences in males and females in the west Maharashtra population. Materials and Methods: A comparative, retrospective study was conducted on 70 subjects aged between 18 and 70 years (36 males, 34 females). The sagittal vertebral body diameter, the sagittal spinal canal diameter, and the sagittal spinal cord diameter were measured at the C3–C7 level by magnetic resonance imaging. The space available for the spinal cord and Torg's ratio were determined. Statistical Analysis Used: Mann–Whitney U-test and unpaired t-test were used to calculate significant difference at P &lt; 0.05. Results: Mean age of the patients was 48.53 ± 14.67 years. There was significant difference in the sagittal spinal canal diameter and spinal cord diameter (P = 0.000107 and P = 2.20e−16, respectively) from C3 to C7. In all the cases, the Torg's ratio of females (0.97–1.04) was higher than in males (0.89–0.95) and varied significantly (P &lt; 0.05). Conclusions: The study provides reference morphometric values for combined Torg's ratio and individually in males and females in the Kolhapur population.

Torg ratio in normal ageing population: no risk of stenosis

Torg ratio in normal ageing population: no risk of stenosis

Measurement of cervical spinal canal diameter by radiographs to study the degree of cervical spinal canal stenosis in an Indian population; Predictive value of Torgs ratio to assess cervical spinal canal stenosis

Cervical myelopathy a debilitating degenerative condition occurs due to cervical spinal canal stenosis, the incidence of which increases significantly with age and is more common above the age of 50 years. Imaging of the spinal canal is an indispensable procedure for evaluation of cervical myelopathy and standard lateral radiographs remain the recommended initial imaging study of choice. The present study was undertaken to measure the cervical spinal canal diameter by lateral radiographs of the cervical spine and to study the degree of cervical spinal canal stenosis in symptomatic patients and asymptomatic cases. The canal body ratio and its reliability to assess cervical spinal canal stenosis and risk of cervical myelopathy was evaluated.In this study 200 cases who presented to the radiology department for radiographs of cervical spine, were divided into symptomatic and asymptomatic cases and were grouped age wise. Measurements of the cervical vertebral body and cervical spinal canal were taken. Torg ratio was assessed. The measurements were analyzed statistically and results tabulated.Cervical spinal canal diameter was lower in symptomatic cases as compared to asymptomatic cases across all age groups and the lowest value was measured at C3 level. All the symptomatic cases had Torg ratio of less than 0.82, and that of C3 was lowest. The data analysis showed the sensitivity of the Torg ratio as 100%. 40% of patients above 50 years were symptomatic and had cervical spinal canal stenosis on lateral radiographs.Our results suggest that plain films can estimate the cervical spinal canal midsagittal diameter and be used as a first step examination for the evaluation of cervical spinal stenosis. The importance of canal body ratio in lateral cervical radiographs for determining the stenosis of cervical spinal canal is confirmed.

The torg ratio of C3-C7 in African Americans and European Americans: A skeletal study.

The ratio between the sagittal diameter of the spinal canal and the sagittal diameter of the vertebral body, known as the "Torg ratio", is often used to test for spinal canal narrowing. Here, we investigate this ratio in a large population, consisting of two ethnicities, both sexes and three age groups. Measurements were taken on the dry cervical verterbrae (C3-C7) of 277 individuals using a digital apparatus allowing for the recording of 3D coordinates of a set of landmarks on the vertebral body. Vertebral body and vertebral foramen lengths were compared across the different subgroups. Vertebral body and vertebral foramen lengths differ significantly between males and females and between African Americans and European Americans. With age, the vertebral body length increases while the foramen length does not undergo significant changes. These anatomical differences are reflected in differences in the Torg ratio calculated for the different subgroups. In conclusion, our findings suggest that a hard cutoff on the Torg ratio used to define a pathological narrowing of the cervical spine should be adapted to the population the patients come from. Clin. Anat. 32: 84-89, 2019. © 2018 Wiley Periodicals, Inc.

Determination of cervical stenosis in rugby players using an alternative radiographic method

PurposeTo find a radiographic method that best correlates with the mean subaxial cervical space available for the cord (MSCSAC) by using a fixed size parameter as radiographic reference, in contrast...

Reproducibility, temporal stability, and functional correlation of diffusion MR measurements within the spinal cord in patients with asymptomatic cervical stenosis or cervical myelopathy

OBJECTIVE The purpose of this study was to quantify the reproducibility, temporal stability, and functional correlation of diffusion MR characteristics in the spinal cord in patients with cervical stenosis with or without myelopathy. The association between longitudinal diffusion tensor imaging (DTI) measurements and serial neurological function assessment was explored at both the group and individual level. METHODS Sixty-six nonoperatively treated patients with cervical stenosis were prospectively followed (3 months to > 5 years) using synchronous serial MRI and functional outcome assessment. A total of 183 separate MRI examinations were performed, separated by at least 3 months, and each patient had a minimum of 2 MRI scans (range 2-5 scans). Anatomical and DTI measurements were performed within the spinal cord at the C1-2 region as well as at the area of highest compression. Coefficients of variance (COVs) were compared across measurements in both reference tissue and areas of compression for anatomical measurements, fractional anisotropy (FA), and mean diffusivity (MD). The correlation between diffusion MR measures at the site of compression and evaluations of neurological function assessed using the modified Japanese Orthopaedic Association (mJOA) scale at multiple time points was evaluated. RESULTS The COVs for anatomical measurements (Torg ratio and canal diameter) were between 7% and 10%. The median COV for FA measurements at the site of compression was 9%, and for reference tissue at C1-2 it was 6%. The median COV for MD at the site of compression was approximately 12%, and for reference tissue at C1-2 it was 10%. The FA and MD measurements of C1-2 averaged 0.61 and 0.91 μm2/msec, respectively, whereas the FA and MD measurements at the site of compression averaged 0.51 and 1.26 μm2/msec, respectively. Both FA (slope = 0.037; R2 = 0.3281, p < 0.0001) and MD (slope = -0.074; R2 = 0.1101, p = 0.0084) were significantly correlated with the mJOA score. The FA decreased by approximately 0.032 units per mJOA unit decrease (R2 = 0.2037, p < 0.0001), whereas the MD was increased by approximately 0.084 μm2/msec for every mJOA unit decrease (R2 = 0.1016, p < 0.0001). CONCLUSIONS Quantitative DTI measurements of the spinal cord in patients with cervical stenosis with or without myelopathy have a median COV of 5%-10%, similar to anatomical measurements. The reproducibility of these measurements and significant correlation with functional outcome status suggest a potential role in the evaluation and longitudinal surveillance of nonoperatively treated patients. With respect to the specific DTI measurements, FA within the spinal cord appears slightly more sensitive to neurological function and more stable than measures of MD. Therefore, DTI of the spinal cord may be a clinically feasible imaging technique for longitudinally monitoring patients with cervical spondylotic myelopathy.

The importance of torg ratio in patients with ankylosing spondylitis

The importance of torg ratio in patients with ankylosing spondylitis

Imaging Factors that Distinguish Between Patients with Asymptomatic and Symptomatic Cervical Spondylotic Myelopathy with Mild to Moderate Cervical Spinal Cord Compression.

BackgroundNot all patients with spinal cord compression due to cervical spondylotic myelopathy (CSM) have clinical symptoms and signs. The aim of this study was to investigate and compare the imaging findings in asymptomatic and symptomatic patients with CSM with mild to moderate cervical spinal cord compression.Material/MethodsA retrospective clinical study included 68 patients. Group A (n=30) had no symptoms and signs; group B (n=38) had symptoms and signs of cervical myelopathy. The age, sex, body mass index (BMI), history of steroid treatment, duration of symptoms, number of spondylotic cervical segments, Torg ratio, range of motion (ROM), incidence of cervical segmental instability, overall curvature of the cervical spine, direction of spinal cord compression, and spinal cord magnetic resonance imaging (MRI) signal intensity were compared.ResultsFor groups A and B, the Torg ratio was 90.3% and 83.6% (P<0.05), the incidence of cervical segmental instability was 23.3% and 65.8% (P<0.05), and the incidence of a spinal cord high intensity signal was 13.3% and 86.9% (P<0.05). Logistic regression analysis showed myelopathy as a dependent variable, independently associated with cervical segmental instability (OR=5.898, P=0.037), an MRI T2-weighted intramedullary high signal (OR=9.718, P=0.002), and Torg ratio (OR=0.155, P=0.006).ConclusionsCervical segmental instability, a high intramedullary signal on T2-weighted MRI, and the Torg ratio had the greatest capacity to distinguish between asymptomatic and symptomatic patients with CSM with mild to moderate cervical spinal cord compression.

A practical radiographic visual estimation technique for the prediction of developmental narrowing of cervical spinal canal

To determine if visual spinal canal percentage of facet overlap could be used as a rapid visual pre-screening test to detect developmental bony spinal canal narrowing on lateral cervical radiographs. Lateral cervical spine radiographs with radiology report documenting developmental narrowing of the spine canal were retrospectively identified. Cohort was supplemented with additional images without such documentation. Utilizing a radiology work station, one reader (Orthopaedics) calculated the Torg ratio at C3-C6. Two readers (Radiology, Primary Care Sports Medicine) visually estimated percentage (≥80, ≥90, 100%) of spinal canal overlaid by facet articulations C3-C6 for all cases independently. Statistical analysis included accuracy tests and kappa test for comparing the gold standard and inter-, intra-observer reliability, respectively. 96 lateral images were included; 25 had abnormal radiology reports. High specificity (range, 91-93%) and true negative predictive values (range, 88-93%) achieved consistent statistical significance for relationship between facet/canal overlap and Torg ratio for both combined and individual data points. Sensitivity values (range, 59-75%) showed a trend toward association, with statistical significance for only the C3 level at 80% overlap. Interobserver agreement was substantial. Intra-observer reliability was moderate to perfect. Visual estimation of percentage of facet overlap of the spinal canal is a valid tool to identify individuals with potential developmental narrowing of the spinal canal as a screening prompt to select which patients may need formal calculation utilizing accepted metrics. Advances in knowledge Visual estimation of percentage of facet overlap from lateral radiographs can predict developmental narrowing of cervical spinal canal.

MRI Study on Spinal Canal Morphometry: An Indian Study.

A large proportion of adults suffer from neck pain at some points of their life and show altered ranges of spinal canal morphometry in various studies. The differences in values are also seen due to genetic, hormonal and other factors too. Torg's ratio is a widely accepted measurement to eliminate such discrepancies. The measurement of Space Available for Cord (SAC) is also gaining importance as spinal stenosis is a contributor to neck pain. (1) To examine the cervical spinal canal and spinal cord morphometric determinants in symptomatic sub-Himalayan North Bengal population and to compare the obtained data with other populations; (2) To determine whether Torg's ratio vary with gender or not; (3) To determine SAC values in symptomatic individuals. Magnetic Resonance Imaging (MRI) based on midsagittal diameter of vertebral body, spinal canal, spinal cord and its Torg's ratio and SAC value of the lower cervical spine (C3-C7) from 71 symptomatic adults were recorded at the Radiology Department of North Bengal Medical College and Hospital, Bengal, India. Individuals with any evidence of trauma, infection, neoplasia or any congenital anomalies related to spinal canal and below 18 years of age were excluded from the study. The average diameter for vertebral body was significantly larger in males. The average diameter for spinal canal, spinal cord and values of Torg's ratio and SAC has no significant gender difference. But the mean value of Torg's ratio is greater in females is due to smaller vertebral body size in females. It is interpreted from our study that sagittal spinal canal diameter, Torg's ratio and SAC value did not show any significant gender difference. But sagittal vertebral body's diameter showed sexual dimorphism which influenced the mean value of Torg's ratio.

Neck Injury - Rugby

HISTORY: A 19-year-old rugby player sustained a neck injury while tackling. The mechanism of injury involved axial compression followed by lateral flexion of the neck. He suffered no loss of consciousness and immediately reported bilateral parasthesia of the upper limbs with no associated neck pain. His cervical spine was stabilised and the player was removed from the field in a spine board. PHYSICAL EXAMINATION: His symptoms lasted approximately 45 seconds and by the time he arrived in the medical room for secondary examination, he had no residual symptoms of parasthesia. The athlete was non tender on palpation of the cervical spinous processes, his neck movements were within normal range and no specific neurological symptoms were noted on flexion, extension or lateral rotation. He had normal sensation, reflexes and strength of his upper and lower extremities. DIFFERENTIAL DIAGNOSIS: 1. Cervical Spinal Cord Injury 2. Cervical Disc Lesion 3. Cervical Spondylosis TESTS AND RESULTS: XRAY showed no obvious structural lesions, no fractures, subluxations, or displaced vertebrae. MRI and myelogram confirmed bulging intervertabrael discs at C3/4, C4/5 and C5/6 level. Central disc herniation and an annular tear was noted at C4/5. There was no CSF anteriorly over C4-C6. Measurement of his spinal canal diameter on these levels indicated a width of 8-10mm. He had a reduced TORG ratio of 0.6. FINAL/WORKING DIAGNOSIS: Congenital Cervical Stenosis TREATMENT AND OUTCOMES: The player consulted two orthopedic spine specialists for opinion and was advised to discontinue rugby and refrain from any future participation in contact sport. Although the athlete experienced no further symptoms, athletes who have cervical spine stenosis are at increased risk for serious nerve injuries. On further enquiry, the athlete reported a 2 year history of intermittent symptoms following rugby-related neck trauma. A history of recurrent episodes of temporary paraplegia or quadriplegia is an ominous sign and justifies the decision to withdraw the athlete from future participation in contact sport.

Torg ratios based on cervical lateral plain films in normal subjects

Torg ratios based on cervical lateral plain films in normal subjects

Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score.

Context:Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial.Aims:Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM.Settings and Design:Retrospective.Materials and Methods:This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as good if the patient had mJOA score ≥16 and poor if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed.Statistics:Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score.Results:Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5.Conclusions:Clinical parameters are better predictors of the outcome as compared to radiological findings, following surgery in CCM. A simple scoring system based on clinicoradiological parameters is suggested in this paper to predict the outcome following surgery in cases of CCM.

Quantification of pediatric cervical growth: anatomical changes in the sub-axial spine.

ObjectiveIn order to provide normal values of the pediatric sub-axial cervical spinal canal and vertebral body growth pattern using computed tomographic scans, a total of 318 patients less than 10 years old were included.MethodsThe growth of the vertebral body and canal space was investigated using four different age groups. The Torg ratio (TR) was calculated and all patients were classified into a low TR group and a high TR group according to a cutoff value of 1.0. To account for spinal curvature, the C3-7 angle was measured.ResultsVery little axial expansion and growth in height were observed (2.9 mm and 3.4 mm, respectively), and the spinal canal increments (1.8 mm) were much smaller than the dimensions of the vertebral body. The mean TR values were 1.03±0.14 at the C3 vertebral level, 1.02±0.13 at C4, 1.05±0.13 at C5, 1.04±0.13 at C6, and 1.02±0.12 at C7 in all patients. The mean sub-axial angle (C3-7) was 7.9±10.6° (range: -17-47°).ConclusionThe upper sub-axial spinal canal continuously increased in size compared to the lower sub-axial spine after 8 years of age. Considerable decrements in the TR was found after late childhood compared to younger ages. Generally, there were no significant differences between boys and girls in vertical length of the cervical vertebrae. However, the axial dimension of the vertebral body and the spinal canal space varied according to gender.

Morphometric Analysis of the Corpus, Spinal Canal and Torg Ratio Using Midsagittal Cervical Vertebrae Computed Tomography Scan: Indonesian Population

Objective: To determine the normal ranges of cervical spinal canal morphometry in Indonesian population and to compare the acquired data collected from other populations Methods: Computed tomography measurements on the diameter of midsagital spinal canal and corpus of cervical vertebrae and its Torg ratio from the lower cervical (C3-C7) canal from 24 normal Indonesian adults were performed at the Radiology Department of Dr. Hasan Sadikin General Hospital. Patients who had cervical spine disorders and those under 20 years old were exluded. We used computed tomography scan midsagittal view to measure the aforementioned parameters. Results: The average diameter for the cervical spinal canals for the Indonesian population is comparable with those of other Asian populations such as Hongkong and India, albeit with smaller Torg ratio. Conclusions: This study reports the normal radiological anatomy of the midsagital spinal canal and corpus of cervical vertebrae as well as Torg ratio from the lower cervical vertebrae among Indonesian population. The measurements result of this study shows that, although slightly smaller, the measurement results for those parameters are identical with other Asian populations. Keywords: Corpus cervical vertebrae, midsagittal cervical spinal canal, Torg ratio DOI : 10.15850/ijihs.v2n1.285