Clin Orthop Surg.  2009 Mar;1(1):11-18. 10.4055/cios.2009.1.1.11.

The Relationship between Spinal Stenosis and Neurological Outcome in Traumatic Cervical Spine Injury: An Analysis using Pavlov's Ratio, Spinal Cord Area, and Spinal Canal Area

• Song KJ
• Choi BW
• Kim SJ
• Kim GH
• Kim YS
• Song JH

• KMID: 1127909
• DOI: http://doi.org/10.4055/cios.2009.1.1.11

Abstract

BACKGROUND: This study examined the relationship between four radiological parameters (Pavlov's ratio, sagittal diameter, spinal cord area, and spinal canal area) in patients with a traumatic cervical spine injury, as well as the correlation between these parameters and the neurological outcome.
METHODS
A total of 212 cervical spinal levels in 53 patients with a distractive-extension injury were examined. The following four parameters were measured: Pavlov's ratio on the plain lateral radiographs, the sagittal diameter, the spinal cord area, and the spinal canal area on the MRI scans. The Pearson correlation coefficients between the parameters at each level and between the levels of each parameter were evaluated. The correlation between the radiological parameters and the spinal cord injury status classified into four categories, A (complete), B (incomplete), C (radiculopathy), and D (normal) was assessed.
RESULTS
The mean Pavlov's ratio, sagittal diameter, spinal cord area and spinal canal area was 0.84, 12.9 mm, 82.8 mm2 and 236.8 mm2, respectively. An examination of the correlation between the radiological spinal stenosis and clinical spinal cord injury revealed an increase in the values of the four radiological parameters from cohorts A to D. Pavlov's ratio was the only parameter showing statistically significant correlation with the clinical status (p = 0.006).
CONCLUSIONS
There was a correlation between the underlying spinal stenosis and the development of neurological impairment after a traumatic cervical spine injury. In addition, it is believed that Pavlov's ratio can be used to help determine and predict the neurological outcome.

Keyword

Spinal stenosis; Traumatic cervical spine injury; Pavlov's ratio; Spinal cord area; Spinal canal area

MeSH Terms

Adult
Aged
Analysis of Variance
Cervical Vertebrae/*radiography
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neck Injuries/*radiography
Retrospective Studies
Spinal Canal/pathology/*radiography
Spinal Cord Injuries/pathology/*radiography
Spinal Stenosis/pathology/*radiography
Young Adult

Figure

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  Fig. 1 Pavlov's ratio at each level from C3 to C7.

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  Fig. 2 The sagittal diameters of the spinal canal were measured at the midvertebra level on the MR T2 sagittal images from C3 to C7.

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  Fig. 3 From T2 axial images, (A) the area of the cord, (B) the area of spinal canal area were measured from C3 to C7.

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