Anatomie osseuse tomodensitométrique de la portion pédiculaire du foramen intervertébral du rachis cervical inférieur : cartographie dans une population asymptomatique et comparaison aux foramens sténosés d’une population névralgique

Abstract : Common cervicobrachial neuralgia is a frequent disease that brings the surgeon to follow patients and operate them when medical conservative treatment results are in failure or in signs of neurological severity. The two main etiologies are soft disc herniation and more frequently the degenerative foraminal stenosis. The CT scan is an essential exam for the diagnosis and evaluation of foraminal stenosis, it is the most efficient for the analysis of the bone structure and the osseous part of roots compression. To our knowledge, the bone tomography anatomy of the cervical intervertebral foramen has not been studied with precision. The objectives of this study were to determine, through a protocol of measurements, the bone dimensions of the cervical intervertebral foramen of the lower cervical spine in a young and asymptomatic population, and to identify, by comparison with a neuralgic population, what were the most affected measurement by the cervical spondylotic disease. Material and methods: we conducted a descriptive retrospective study of two populations: an asymptomatic population who was less than 30 years old with a cervical spine CT scan in an extra-spinal indication and a population with a clinically significant degenerative foraminal stenosis who had a CT scan during the pre-operative assessment. We determined a method allowing the realization of different tomography measurements (foraminal height (HF), foraminal length (LF), foraminal width opposite to the inferior cervical endplate (lfPi), foraminal width opposite to the top of the uncus (lfsu) , foraminal width opposite to the base of the uncus (lfbu), these last 3 widths were also measured at the medial entrance of the foramen in the recess (lrPi, lrsu and lrbu), disc height (HD) and local angulation (AD)) in all cervical intervertebral foramen of the lower cervical spine (C3C4 to C7T1). We also calculated the volume of the pedicle portion of the studied foramens (VF). Our statistical analysis determined averages and standards deviations of the foraminal dimensions measurements and volume in the asymptomatic population according to the cervical levels. We also studied the possible correlations according to the sex, the morphological parameters and between the studied factors. Intrarater and interrater reliability of our measurements was analyzed by the calculation of intraclass correlation coefficients (ICC). Then we compared the measurements between the asymptomatic population and the significant stenotic foramens of the neuralgic population in order to determine the significant differences. Results: we studied 100 foramens in 10 asymptomatic patients and 100 including 23 significant stenotic foramens, in 10 neuralgic patients. Our measurements were reliable (ICC>0,9) with a precision to the tenth of a millimeter. We determined the osseous dimensions and the volume of the intervertebral foramens at all cervical levels of the lower cervical spine into the asymptomatic population. Regarding foraminal length (LF), foraminal height (HF), and disc height (HD), we found a significant correlation (p <0.05) related to the gender. The comparison of the C4C5, C5C6 and C6C7 levels with the stenotic foramen of the neuralgic population showed several significant decreases (p <0.001) of the measurements as well as a significant decrease (p <0.001) of the VF. The most significant decreasing dimensions were lfPi, lfsu, lrPi, lrsu and VF. Conclusion: this study allowed us to determine the osseous cervical foraminal dimensions in a young, asymptomatic population before the beginning of the spondylotic disease. This work also showed us that the most stenotic foraminal areas are those opposite to the top of the uncus and to the posterior edge of the inferior cervical endplate of the overlying vertebra. These results, may help the surgeon to better decompress cervical roots in the intervertebral foramen. An interesting result of our study was VF: this parameter, not very well-known in the current literature, seems to be the most representative of the cervical intervertebral foramen. It seems important to continue this study with a dedicated work about the volume (measured and non-calculated) of the cervical intervertebral foramen.
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Master Thesis
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Pierre Coudert. Anatomie osseuse tomodensitométrique de la portion pédiculaire du foramen intervertébral du rachis cervical inférieur : cartographie dans une population asymptomatique et comparaison aux foramens sténosés d’une population névralgique. Médecine humaine et pathologie. 2018. ⟨dumas-02091557⟩

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