| Objective:1Cervical spondylosis is a common and frequently occurring illness, with a wide range of people suffering from it, especially cervical spondylotic radiculopathy and its mixed type, which account for about50%to60%. Shooting cervical oblique X-ray film is routine for the diagnosis, and45degrees are often promoted in Textbooks and literature, but the outcome can not show completely the cervical oblique anatomy, and it is founded that the size of different intervetevral foramina are asymmetry, overlapping phenomenon can be observed on the film. Clinically, the value of the cervical oblique X-ray film on the intervertebral foramina has been widely debated. In this study, cervical oblique X-film on intervertebral foramina are observed from different angles, the aim is to explore the significance of the cervical oblique X-rays in the clinical diagnosis of cervical spondylosis.2With the development of medical science and technology and the cognition of cervical spondylosis, the basic and clinical research of cervical spondylosis is increasingly ongoing depth. There are two methods of research of cervical intervertebral foramina and its surrounding tissues, anatomical study and imaging studies, but precise data is difficult to obtain due to the complexity of the intervertebral foramina, three-dimensional CT and morphology of the intervertebral foramima is a favorable technology for the observation and accurate measurement of the intervertebral foramina, and at the same time to conduct the statistically analysis.3The intervebral foramina and its cervical nerve roots are observed and measured and morphological description are made to explore the mechanicsm of the intervebral foramina stenosis. And anatomical observations to further explore the value of the X-ray, CT on the intervertebral foramina.Methods:1Ten Adult fresh complete cervical specimens were applied, with the born place, gender and age unknown, and there were no structral damage. They were placed in a-70℃refrigerator cryopreservation. Before experiments, they were taken out and thawed in the refrigerator at4℃for24hours, then the paravertebral muscles and fascia were removed with the anterior longitudinal ligament, zygapophysial joints and articular capsule retained from segment C1to T1vertebral body and intervertebral capsule. The degree of cervical lordosis angle is30degree. The specimens were fixed by posterior cervical prone bit position, the soft tissue of the back of the neck of them were removed, with the entire cervical spine and C2～C8exposed, then the intervertebral foramina were examned along the nerve root. The specimens were sawed from the seventh cervical hacksaw along the vertebral midline, with the spinal cord and its dura mater cleared away. Mark the intervertebral foramen from the endostoma:in the the intervertebral foramina, the upper and lower bounds, respectively, is under the medial margin of the pedicle of the vertebral arch, the anterior border is the back of the vertebral body, intervertebral disc and the juncture of the Luschka joint and the pedicle of the vertebral arch; the posterior wall is ligamenta flava, and the juncture of the zygapophysial joints and the pedicle of the vertebral arch. Mark the cervical intervertebral foramina fromthe external aperture:in intervertebral foramina, the upper and lower bounds, respectively, is the lateral border of the pedicle of the vertebral arch, the anterior border is the back of the vertebral body, the intervertebral disc and the juncture of Luschka joints with the pedicle of the vertebral arch; the posterior wall is ligament flava, and the junction of the transverse foramen side of ygapophysial joints and pedicle of the vertebral arch. With the specimens fixed in the bracket, took the GE-Definium6000model X-ray machine to shoot the anterior to posterior film with the cassettes paralleled to the coronal plane of specimens, and the center of the tube was perpendicular to the coronal plane, adopting the standing position when projection. The exposing intensity is71KV,500AM, and the projection distance is150cm. Then along the counterclockwise rotation of specimens,30°,40°,45°,50°,60°,70°oblique were taken, with the conditions the same.2Ten healthy volunteers (5males,5females, mean age27.6years)were involved. Selected conditions:(1)<35years of age, normal body development;(2) no history of cervical spine injuries;(3) no common symptoms of cervical spondylosis like acid neck, pain, swelling and discomfort, upper extremity radicular pain, fatigue, unparalleled lower extremity weakness, walking instability;(4)The physical examination is normal like the neck mobility, tenderness, and both the neck compression test and brachial plexus traction test are negative, limb muscle strength, muscle tone, tendon reflexes is normal, superficial sensation no diminish and pathological signs is negative;(5)no abnormalby neck CT scan;(6) volunteer to bear the damage during the experimental process of X-ray. Volunteers were supinated in the bed of the CT scan, with the neck in neutral position (horizontal positioning lines are vertical to the cervical longitudinal axis, and the vertical positioning line is level to the cervical longitudinal axis), voltage of120kV, current240mA, slice layer of thickness0.625mm, pitch0.531, rotation time1s. CT scan images were import to Mimics10.01of three-dimensional medical image reconstruction software, three-dimensional model of the cervical spine were then build. The application Mimics10.01image were applied, three times were carried out to different people and averaged were adopted. SPSS13.0were applied to analyze the data.3There were five complete specimens of fresh neck and five anti-corrosion specimens, with the gender, age, born place not included. The skin, fascia, muscle and other tissue of the rear and both sides of the cervical spine were removed, with the intervertebral foramina and the adjacent nerves and blood vessels exposed. The fat in intervertebral foramina were cleared away, and the vertebral plate when ncessary. morphology describes of the intervertebral foramina and the nerve roots in them were made, and they were observed and measured with a vernier caliper (accuracy0.02mm) including the following data:(1) length of the cervical intervertebral foramima:from the edge of the inside of the mid-point of the pedicle of vertebral arch to the lateral midpoint of it;(2) anteroposterior diameter of intervertebral foramina:from the juncture of lower edge of the uncinate process and the upper edge of the next uncinate process to the mid-point of the juncture of the upper and lower articular process;(3)vertical diameters:the distance between the midpoint of the lower edge of the pedicle of vertebral arch and the midpoint of the upper edge of the next pedicle of vertebral arch;(4) the diameters of the nerve roots in intervertebral foramina:anteroposterior diameter and vertical diameter of the nerve roots in the intervertebral foramina. morphological observations of spinal cord and cervical intervertebral foramina were made. statistical software SPSS13.0were applied for statistical analysis.Results:1The outcomes of X-ray on the intervertebral foramina from different angles were different, when took from the45degrees oblique radiography, the wire on the external aperture of C3-C4and C4-C5intervertebral foramina formed the largest area; when from the60degrees, C6-C7, C7-T1showed good, while the upper external aperture of C3-C4, C4-C5intervertebral foramina is not ideal, when from the40degrees,45degrees, the wire on the external aperture of C3-C5intervertebral foramina formed the largest area, while C5-T1less deal; when from the60degrees, the wire on the external aperture of C5-T1intervertebral foramina formed the largest area, while C3-C5less ideal, and C3-T1can not show. At the same cervical intervertebral foramina, the wire on external aperture and endostoma do not coincide, and the location of the wire on endostoma was high then those on external aperture, this phenomenon were especially apparent in C5-C6, C6-C7, C7-T1. the area surrounded by wire on external aperture was larger than on endosoma; when took from the30degree, the area surrounded by wire on external aperture of C3-T1intervertebral foramina were much larger than on endostoma. When from the60degrees, the wire on external aperture of C3-T1intervertebral foramina displayed well, while on endostoma can not display.2The horizontal position of cervical intervertebral foramina:cervical intervertebral foramina were showed of a funnel-shaped, respectively, the data of anteroposterior diameter of the external aperture and the endostoma of cervical intervertebral foramina. Through CT three-dimensional reconstruction, the morphology of cervical intervertebral foramina varied, most were approximate elliptic, ellipsoid, and few was slender. The most part of the morphology of cervical intervertebral foramina were approximate elliptic, countering about71%, followed by the approximate round, of21%, the least was slender,of8%. No obvious abnormalities of the morphology of the left and right sides of the same two intervertebral foraminal were observed. Through CT three-dimensional reconstruction, the morphology of the external aperture and the endostoma of cervical intervertebral foramina were similar, most were approximate round, ellipsoid, few was slender.3The morphology of the endostoma of cervical intervertebral foramina:cervical intervertebral foramina is a bony lacuna, composed of the notch of adjacent pedicle of vertebral arch, the external aperture and endostoma of cervical intervertebral foramina were the internal and external side edge of adjacent pedicle of vertebral arch respectively. Spinal dura mater migrates into intervertebral foramina, within the endostoma of intervertebral foramina were a large amount of soft tissue, at the same time. From the sagittal plane, most of the morphology of cervical intervertebral foramina were approximate elliptic, ellipsoid. The cervical spinal and spinal cord:the spinal cord was located in vertebral canal, and stretched to be the medulla oblongata, the morphology was cylindrical, and relatively flat. The spinal cord were the spinal pia mater, spinal arachnoid and dura mater sequentially. The posterior view of cervical spinal cord:vascular and nerve root accompanied into the intervertebral foramina; the anterior view of cervical spinal cord:the branches of anterior spinal artery together with cervical nerve root accompanied into the intervertebral foramina. Denticulate ligament ran between the anterior and the posterior of cervical nerve roots, and through spinal pia mater to fix on spinal dura mater.The shape of cervical nerve root:spinal nerve was composed by anterior roots and posterior root at the intervertebral foramina. cervical nerve roots in the spinal canal is located inferior to the above of pedicle of vertebral arch, the lateral posterior of uncinate process and the anterior medial of the superior articular process, the included angel of C2～C7cervical nerve root in the sagittal plane and spinal cord is about45-57degrees, and the angle increased gradually. Cervical nerve root in the intervertebral foramina:15of C2,13of C3,16of C4,11of C5,17of C6,14of C7nerve roots walked through the bottom in cervical intervertebral foramina;5of C2,7of C3,4of C4,9of C5,3of C6,6of C7nerve roots through the top of intervertebral foramina. There were expansion of cervical nerve roots when passing through intervertebral foramina, the main part of the cervical nerve roots were still located in the groove, walking in the rear of vertebral artery and the upper of the lateral of articular process, and is confined to the cervical intervertebral foramina at the transverse process.the soft tissue within the intervertebral foramina:the spinal cord extended into the intervertebral foramina, there were adipose tissue within the intervertebral foramina, and small blood vessels ran below close to the nerve root, among10specimens,14small vessels were observed in the intervertebral foramina.Conclusions:1The cervical vertebra disease is a clinical common diseases and frequently-occurring disease, clinically Shoting cervical oblique X-ray film is routine for the diagnosis.45degrees were often used as the projection angle clinically, but this study found that this method can not well show the whole cervical spine. Therefore there were some limitations of the cervical vertebra oblique X-ray on cervical intervertebral foramina, and it is not qualified as a routine examination in the diagnosis of cervical spondylosis.2CT observation of cervical intervertebral foramina, from the horizontal position:the endostoma of intervertebral foramina was narrow than the external aperture, but the entire intervertebral foramina was irregular in shape. From the anteroposterior axes:the most of the morphology of intervertebral foramina was approximate the round, ellipsoid, few for slender. The most of the morphology of intervertebral formina were approximate elliptic, accounting about71%, followed by the approximate round, of about21%, the least was slender, of about8%. There was no obvious abnormalities of the morphology of the left and right sides of the same two intervertebral foramina.3The external aperture of intervertebral foramina was narrow than the endostoma, the main cause of this was due to the anteroposterior diameter of the cervical intervertebral formina, clinical recommendations were made on operations to improve the anteroposterior diameter mainly.4CT3D reconstruction technology can display multiple intervertebral foramina, and its images were intuitive, real, like physical specimens, it can be arbitrary rotation and cutting, and show different parts of osteophyte, hyperosteogeny which caused intervertebral foramina stenosis, observe the degree and scope of intervertebral foramina stenosis, it can provide more diagnostic information than ordinary CT, it is a good method to assess intervertebral foraminal stenosis, can be used in the design of operation schemes, and to improve effectiveness and safety of operation. But CT scan on cervical intervertebral foramina has limitations on showing the soft tissue within intervertebral foramina.5In addition to nerve root within cervical intervertebral foramina, there were vessels, adipose tissue and the periosteum and other soft tissue. inflammatory edema of soft tissues in intervertebral foramina due to chronic injury can result in the reduction of space of cervical intervertebral foramina, and compression of the nerve roots, and then ischemia and hypoxia of nerve roots, further aggravated the local pathological changes, and then the clinical symptoms of cervical spondylotic radiculopathy.6Generally there were vessels within the intervertebral foramina, for the cervical nerve block was easy to cause a drug injected into the blood vessels, resulting in adverse reaction, it is needed to be careful. |
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