Neural space integrity of the lower cervical spine: effect of anterior lesions.

STUDY DESIGN: A repeated measures study design was used to evaluate intervertebral foramen and spinal canal neural space integrity subsequent to sequential surgical anterior lesions of the lower cervical spine in a human cadaver model. OBJECTIVE: To investigate the degree to which sequential ablation of anterior vertebral elements places the neural structures at risk of injury. SUMMARY OF BACKGROUND DATA: Classic instability management utilizing functional-structural criteria has been widely examined associating specific lesions or pathologies to a degree of mechanical instability. Unfortunately, these studies have not assessed the neuroprotective role of the vertebral column. METHODS: Eight human cadaveric lower cervical spines were instrumented with transducers to measure geometrical changes in the intervertebral foramen and spinal canal. Sequential lesions were performed anteriorly on the anterior and middle column structures (C4-C5 disc and C5 vertebra), and their effects on neural space integrity and range of motion were measured under physiologic loading. RESULTS: Range of motion significantly increased with successively more destructive lesions, whereas the spinal canal exhibited few changes. Intervertebral foramen integrity was statistically reduced for corpectomy (66% intact), hemivertebrectomy (62% intact) and full vertebrectomy (57% intact) lesions when loaded in concomitant extension and ipsilateral bending (4 Nm). CONCLUSIONS: Lesions more extensive than a surgical discectomy have significant effects on the cervical neural foramens specifically when the spine is placed in extension, ipsilateral bending, and coupled ipsilateral bending and extension. Our study establishes a quantitative relationship between the risk of neural structure compression and anterior lesions of the spinal column under physiologic loading.

Neural space integrity of the lower cervical spine: effect of normal range of motion.

STUDY DESIGN: An experimental investigation of intervertebral foramen and spinal canal neural space integrity was performed throughout physiologic range of motion of the lower cervical spine in intact human cadaver specimens. OBJECTIVE: To investigate cervical positions that might place the neural tissues of the spine in heightened risk of injury. To meet this objective the following hypotheses were tested: 1) spinal canal integrity varies with specific normal range of motion positions of the lower cervical spine, and 2) intervertebral foramen integrity is dependent on and unique for different physiologic positions of the lower cervical spine. SUMMARY OF BACKGROUND DATA: Cervical spine injuries are frequently associated with compressive damage to neurologic tissues and consequently poor clinical outcomes. Neurologic injury typically occurs from disc, ligamentous, or bony occlusion of the spinal canal and intervertebral foraminal spaces dynamically during an injury event or with abnormal alignment and position after the injury event. Prior studies have shown pressure and geometric changes in cervical spine neural spaces in certain cervical spine positions. However, to the authors' knowledge, this is the first research effort aimed at elucidating the integrity of the cervical spine neural spaces throughout the normal physiologic range of motion. METHODS: The authors instrumented 17 fresh-frozen unembalmed cadaveric human cervical spines (C3-C7) with specially designed intervertebral foramen occlusion transducers and a spinal canal occlusion transducer. The specimens were loaded with pure bending moments to produce simulated physiologic motions of the lower cervical spine. The resulting occlusion profiles for the intervertebral foramen and spinal canal were recorded along with the 6-degree of freedom position of the cervical spine. Because these occlusion measurements describe the ability of the spine to preserve the space for the neural structures, the authors define this neuroprotective role of the vertebral column as neural space integrity. RESULTS: The range of motion developed experimentally in this study compared well with published reports of normal cervical motion. Thus, subsequent changes in neural space integrity may be regarded as resulting from normal human cervical spine motion. No significant change in the spinal canal space was detected for any physiologic motion; however, intervertebral foramen integrity was significantly altered in extension, ipsilateral bending, combined ipsilateral bending and extension, and combined contralateral bending with extension when compared with intact upright neutral position. CONCLUSIONS: This study defines the range of neural space integrity associated with simulated physiologic motion of the lower cervical spine in an experimental setting. This information may be useful in comparing neural space changes in pathologic conditions and may enhance refinement of neurologic injury prevention strategies.