| Objective:To reconstruct the cervical neural foramen using 3D digital simulation of computed tomography(CT)scan data,to accurately measure the smallest oblique sagittal area of the cervical neural foramen,to attempt to propose quantitative diagnostic criteria for cervical neural foramen stenosis,to evaluate the value of the smallest oblique sagittal area of the neural foramen in detecting cervical spondylotic radiculopathy(CSR),and to assess its significance in the treatment decision of CSR.METHODS:The clinical data of patients with CSR in our hospital from June 2016 to June 2020 were retrospectively analyzed.(1)The neural foramen was reconstructed in Mimics software using the patient’s cervical spine CT data,and the smallest oblique sagittal area of the neural foramen was measured.(2)The subject operating characteristic curve(ROC)was applied to determine the optimal threshold for the diagnosis of cervical neural foramen stenosis with minimum cross-sectional area and to evaluate the diagnostic accuracy.(3)Patients were categorized into patients with positive and negative parameters based on the size of the patient’s smallest oblique sagittal area value of the neural foramen compared with the best previously calculated critical value.To compare the changes in visual analog scale(VAS),neck disability index(NDI)and Japanese Orthopaedic Association score(JOA)during the treatment period in patients with positive and negative parameters in the surgical and non-surgical groups,patients were followed up for at least 24 months after treatment.RESULTS:A total of 1056 neural foramen including C4/5 to C7/T1 were measured in 132 patients with bony stenosis of the cervical neural foramen,of which 495(46.88%)showed positive clinical neurological examination.The optimal threshold determined by the ROC curve was 25.95 mm2 and had a high sensitivity and specificity(sensitivity 74.1%,specificity 80.9%)with an area under the curve(AUC)of 0.827(95%CI:0.803-0.849).In the surgical group,patients with both positive and negative parameters showed a significant improvement in their symptoms,with no statistically significant difference.In the non-surgical group,for patients with negative parameters,there was a mean reduction of 10.32 in NDI score,a mean increase of 2.86 in JOA score,and a mean improvement of 2.46 points in neck VAS score;for patients with positive parameters,there was a 2.35 reduction in NDI score,a 0.88 increase in JOA score,and a 0.42 improvement in neck VAS score.Patients with negative parameters showed better symptom improvement than those with positive parameters,and the difference was statistically significant(p<0.01).CONCLUSION:Three-dimensional digital simulation reconstruction of CT data is a good measurement method for accurate measurement of the cervical neural foramen,and the optimal cut-off value of the smallest oblique sagittal area of the neural foramen has some diagnostic value for bony stenosis of the cervical neural foramen.The patients all showed significant improvement in their symptoms after surgery,and the smallest oblique sagittal area of the neural foramen did not seem to predict the outcome of surgery.However,in nonoperative patients,symptomatic improvement was better in patients with negative parameters than in those with positive parameters,this suggests that conservative treatment may only be appropriate for patients with negative parameters and that patients with positive parameters may not be suitable for conservative treatment... |
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