Enhancing evaluation of cervical spine: Thresholds for normal CT relationships in the subaxial cervical spine

Catherine W. Cahill; Kristen E. Radcliffe; Charles Reitman

doi:10.14444/4036

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Fig. 1
Coronal and Sagittal Disc measurements. Right UVJ (A), Coronal Mid Disc (B), Left UVJ (C). Anterior Disc Height (D), Sagittal Mid Disc (E), Posterior Disc Height (F), Interspinous Distance (G).
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Fig. 2
Axial and sagittal facet measurements. Lateral facet (A), Axial mid facet (B), Medial facet (C). Posterior facet (D), Sagital mid facet (E), Anterior facet (F). Facet overlap (G).
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Fig. 3
Combined right and left facet and UVJ 95% confidence intervals and disc height 95% confidence interval.

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Table 1

Descriptive Statistics of Cervical Measurements.

		N	Mean	Std. Deviation	Std. Error	95% Confidence Interval for Mean		Minimum	Maximum	95% Upper CI	95% Lower CI
		N	Mean	Std. Deviation	Std. Error	Lower Bound	Upper Bound	Minimum	Maximum	95% Upper CI	95% Lower CI
Left Uncovertebral Joint (Coronal)	C23	58	1.79	.853	.158	1.47	2.12	1	4	3.50	0.09
	C34	58	1.83	.756	.140	1.54	2.12	1	4	3.34	0.32
	C45	58	1.44	.586	.111	1.22	1.67	0	3	2.62	0.27
	C56	58	1.33	.524	.097	1.13	1.53	0	2	2.37	0.28
	C67	58	1.93	.599	.111	1.70	2.16	1	3	3.13	0.73
	Average	290	1.67	.706	.059	1.55	1.78	0	4	3.08	0.25
Right Uncovertebral Joint (Coronal)	C23	29	1.6990	.80166	.14886	1.3940	2.0039	.68	4.10	3.30	0.10
	C34	29	1.5914	.83313	.15471	1.2745	1.9083	.52	4.12	3.26	0.00
	C45	29	1.3724	.63461	.11784	1.1310	1.6138	.00	3.41	2.64	0.10
	C56	29	1.2145	.60589	.11251	.9840	1.4450	.00	2.51	2.43	0.00
	C67	29	1.8093	.82818	.15379	1.4943	2.1243	.81	3.57	3.47	0.15
	Average	145	1.5373	.76824	.06380	1.4112	1.6634	.00	4.12	3.07	0.00
Middle Disc (Mid Coronal)	C23	29	4.9972	.73483	.13645	4.7177	5.2768	3.25	6.19	6.47	3.53
	C34	29	4.7810	1.04291	.19366	4.3843	5.1777	2.22	7.10	6.87	2.70
	C45	29	4.8176	1.15149	.21383	4.3796	5.2556	1.12	6.48	7.12	2.51
	C56	29	4.6193	1.09779	.20386	4.2017	5.0369	1.93	6.62	6.81	2.42
	C67	29	5.0262	.95944	.17816	4.6613	5.3912	2.52	6.95	6.95	3.11
	Average	145	4.8483	1.00505	.08347	4.6833	5.0133	1.12	7.10	6.86	2.84
Left Medial Facet (Coronal)	C23	29	.5759	.24939	.04631	.4810	.6707	.13	1.08	1.07	0.08
	C34	29	.5945	.23343	.04335	.5057	.6833	.17	1.00	1.06	0.13
	C45	29	.5117	.27290	.05068	.4079	.6155	.17	1.21	1.06	0.00
	C56	29	.7093	.32663	.06065	.5851	.8336	.14	1.54	1.36	0.06
	C67	29	.4855	.23009	.04273	.3980	.5730	.10	.88	0.95	0.03
	Average	145	.5754	.27265	.02264	.5306	.6201	.10	1.54	1.12	0.03
Right Medial Facet (Coronal	C23	29	.6003	.22422	.04164	.5151	.6856	.17	1.03	1.05	0.15
	C34	29	.6121	.21333	.03961	.5309	.6932	.19	1.04	1.04	0.19
	C45	29	.5759	.25569	.04748	.4786	.6731	.16	1.16	1.09	0.06
	C56	29	.6586	.31088	.05773	.5404	.7769	.00	1.20	1.28	0.04
	C67	29	.5131	.22372	.04154	.4280	.5982	.18	.96	0.96	0.07
	Average	145	.5920	.24931	.02070	.5511	.6329	.00	1.20	1.09	0.09
Left Midpoint Facet (Coronal)	C23	29	1.05	.406	.075	.89	1.20	0	2	1.86	0.24
	C34	29	1.31	.465	.086	1.13	1.49	0	2	2.24	0.38
	C45	29	1.38	.416	.077	1.22	1.54	1	2	2.21	0.55
	C56	29	1.19	.352	.065	1.05	1.32	1	2	1.89	0.48
	C67	29	1.02	.334	.062	.89	1.15	0	2	1.69	0.35
	Average	145	1.19	.417	.035	1.12	1.26	0	2	2.02	0.36
Right Midpoint Facet (Coronal)	C23	29	1.0476	.39446	.07325	.8975	1.1976	.58	1.86	1.84	0.26
	C34	29	1.3548	.43048	.07994	1.1911	1.5186	.54	2.49	2.22	0.49
	C45	29	1.3528	.43262	.08033	1.1882	1.5173	.52	2.47	2.22	0.49
	C56	29	1.3369	.53409	.09918	1.1337	1.5401	.36	2.59	2.41	0.27
	C67	29	1.0597	.43697	.08114	.8934	1.2259	.36	2.32	1.93	0.19
	Average	145	1.2303	.46507	.03862	1.1540	1.3067	.36	2.59	2.16	0.30
L Lateral Facet (Coronal)	C23	29	.5434	.24766	.04599	.4492	.6377	.00	1.10	1.04	0.05
	C34	29	.4966	.22241	.04130	.4120	.5812	.12	.99	0.94	0.05
	C45	29	.5366	.24415	.04534	.4437	.6294	.12	1.11	1.02	0.05
	C56	29	.4907	.27985	.05197	.3842	.5971	.00	1.28	1.05	0.00
	C67	29	.4717	.26301	.04884	.3717	.5718	.00	.91	1.00	0.00
	Average	145	.5078	.25017	.02078	.4667	.5489	.00	1.28	1.01	0.01
Right Lateral Facet (Coronal)	C23	29	.4555	.22389	.04157	.3704	.5407	.00	.98	0.90	0.01
	C34	29	.4648	.22808	.04235	.3781	.5516	.17	.84	0.92	0.01
	C45	29	.5510	.25890	.04808	.4526	.6495	.16	1.12	1.07	0.03
	C56	29	.5452	.29488	.05476	.4330	.6573	.00	1.41	1.13	0.00
	C67	29	.5600	.20920	.03885	.4804	.6396	.21	1.07	0.98	0.14
	Average	145	.5153	.24573	.02041	.4750	.5556	.00	1.41	1.01	0.02
Interspinous Distance (Sagittal)	C23	29	15.7624	2.75350	.51131	14.7150	16.8098	7.70	20.95	21.27	10.26
	C34	29	14.6317	1.76001	.32683	13.9623	15.3012	12.24	19.16	18.15	11.11
	C45	29	14.0155	1.84557	.34271	13.3135	14.7175	10.09	16.52	17.71	10.32
	C56	29	13.1521	1.56348	.29033	12.5574	13.7468	10.32	16.47	16.28	10.03
	C67	29	14.1241	1.81533	.33710	13.4336	14.8147	11.46	19.20	17.75	10.49
	Average	145	14.3372	2.14344	.17800	13.9853	14.6890	7.70	20.95	18.62	10.05
Vertebral Body Translation (Sagittal)	C23	29	.5841	.86261	.16018	.2560	.9123	-1.09	3.86	2.31	0.00
	C34	29	.5369	.64093	.11902	.2931	.7807	-.84	1.74	1.82	0.00
	C45	29	.5210	.72608	.13483	.2448	.7972	-1.57	1.70	1.97	0.00
	C56	29	.0855	.88789	.16488	-.2522	.4233	-1.53	1.93	1.86	0.00
	C67	29	.2131	.91067	.16911	-.1333	.5595	-1.50	1.45	2.03	0.00
	Average	145	.3881	.82582	.06858	.2526	.5237	-1.57	3.86	2.04	0.00
Anterior Disc Height (Sagittal)	C23	29	2.6990	.83906	.15581	2.3798	3.0181	1.13	4.40	4.38	1.02
	C34	29	2.8310	.85043	.15792	2.5075	3.1545	1.05	4.32	4.53	1.13
	C45	29	3.4552	.94400	.17530	3.0961	3.8143	1.42	5.89	5.34	1.57
	C56	29	3.1310	1.15688	.21483	2.6910	3.5711	.00	5.19	5.44	0.82
	C67	29	3.4262	1.10487	.20517	3.0059	3.8465	.99	5.26	5.64	1.22
	Average	145	3.1085	1.02094	.08478	2.9409	3.2761	.00	5.89	5.15	1.07
Middle Disc Height (Sagittal)	C23	29	4.888	.7602	.1412	4.598	5.177	3.0	6.4	6.41	3.37
	C34	29	4.848	1.1929	.2215	4.394	5.301	1.8	7.1	7.23	2.46
	C45	29	4.922	1.1833	.2197	4.472	5.372	1.1	6.7	7.29	2.56
	C56	29	4.656	1.2052	.2238	4.198	5.115	1.8	6.5	7.07	2.25
	C67	29	5.244	1.1833	.2197	4.794	5.694	1.3	6.7	7.61	2.88
	Average	145	4.911	1.1191	.0929	4.728	5.095	1.1	7.1	7.15	2.67
Posterior Disc Height (Sagittal)	C23	29	2.3107	.70818	.13151	2.0413	2.5801	.99	4.45	3.73	0.89
	C34	29	2.1069	.74378	.13812	1.8240	2.3898	.43	3.56	3.59	0.62
	C45	29	2.4521	.65815	.12222	2.2017	2.7024	1.07	3.74	3.77	1.14
	C56	29	1.9945	.84608	.15711	1.6727	2.3163	.00	4.13	3.69	0.30
	C67	29	2.1941	.97373	.18082	1.8238	2.5645	.45	3.87	4.14	0.25
	Average	145	2.2117	.79891	.06635	2.0805	2.3428	.00	4.45	3.81	0.61
Left Anterior Facet (Sagittal)	C23	29	.7966	.30543	.05672	.6804	.9127	.00	1.32	1.41	0.19
	C34	29	.8421	.29392	.05458	.7303	.9539	.24	1.43	1.43	0.25
	C45	29	.9179	.26513	.04923	.8171	1.0188	.38	1.44	1.45	0.39
	C56	29	.9355	.39853	.07401	.7839	1.0871	.00	1.76	1.73	0.14
	C67	29	.9038	.39755	.07382	.7526	1.0550	.00	1.65	1.70	0.11
	Average	145	.8792	.33606	.02791	.8240	.9343	.00	1.76	1.55	0.21
Right Anterior Facet (Sagittal)	C23	29	.8566	.38400	.07131	.7105	1.0026	.21	1.83	1.62	0.09
	C34	29	.8648	.27684	.05141	.7595	.9701	.33	1.36	1.42	0.31
	C45	29	.9162	.33646	.06248	.7882	1.0442	.00	1.62	1.59	0.24
	C56	29	.8821	.37869	.07032	.7380	1.0261	.00	1.52	1.64	0.12
	C67	29	.7931	.30833	.05725	.6758	.9104	.00	1.54	1.41	0.18
	Average	145	.8626	.33704	.02799	.8072	.9179	.00	1.83	1.54	0.19
Left Posterior Facet (Sagittal)	C23	29	.6290	.29975	.05566	.5149	.7430	.00	1.22	1.23	0.03
	C34	29	.7166	.29220	.05426	.6054	.8277	.00	1.23	1.30	0.13
	C45	29	.6634	.27198	.05051	.5600	.7669	.14	1.18	1.21	0.12
	C56	29	.7324	.29715	.05518	.6194	.8454	.26	1.51	1.33	0.14
	C67	29	.5210	.26208	.04867	.4213	.6207	.21	1.29	1.05	0.00
	Average	145	.6525	.29105	.02417	.6047	.7003	.00	1.51	1.23	0.07
Right Posterior Facet (Sagittal)	C23	29	.6834	.25688	.04770	.5857	.7812	.13	1.21	1.20	0.17
	C34	29	.7752	.37371	.06940	.6330	.9173	.00	1.39	1.52	0.03
	C45	29	.6862	.30326	.05631	.5709	.8016	.24	1.53	1.29	0.08
	C56	29	.7872	.29044	.05393	.6768	.8977	.31	1.37	1.37	0.21
	C67	29	.6003	.25693	.04771	.5026	.6981	.00	1.12	1.11	0.09
	Average	145	.7065	.30303	.02517	.6567	.7562	.00	1.53	1.31	0.10
Left Middle Facet (Sagittal)	C23	29	.9766	.39113	.07263	.8278	1.1253	.00	2.15	1.76	0.19
	C34	29	1.2566	.39229	.07285	1.1073	1.4058	.60	2.04	2.04	0.47
	C45	29	1.2341	.39665	.07366	1.0833	1.3850	.57	2.21	2.03	0.44
	C56	29	1.1710	.32102	.05961	1.0489	1.2931	.48	1.74	1.81	0.53
	C67	29	.9700	.32733	.06078	.8455	1.0945	.43	1.58	1.62	0.32
	Average	145	1.1217	.38303	.03181	1.0588	1.1845	.00	2.21	1.89	0.36
Right Middle Facet (Sagittal)	C23	29	.9917	.35350	.06564	.8573	1.1262	.46	1.84	1.70	0.28
	C34	29	1.2634	.50039	.09292	1.0731	1.4538	.45	2.45	2.26	0.26
	C45	29	1.3114	.48074	.08927	1.1285	1.4942	.20	2.39	2.27	0.35
	C56	29	1.3210	.51341	.09534	1.1257	1.5163	.37	2.41	2.35	0.29
	C67	29	.9717	.37353	.06936	.8296	1.1138	.41	2.11	1.72	0.22
	Average	145	1.1719	.47011	.03904	1.0947	1.2490	.20	2.45	2.11	0.23

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Table 2

Descriptive Statistics of Cervical Measurements with Sides Combined.

		Mean	Std. Deviation	Std. Error	95% Confidence Interval for Mean		Minimum	Maximum	95% Upper CI	95% Lower CI
		Mean	Std. Deviation	Std. Error	Lower Bound	Upper Bound	Minimum	Maximum	95% Upper CI	95% Lower CI
Uncovertebral Joint (Coronal)	C23	1.75	.827	.154	1.43	2.06	1	4	3.40	0.09
	C34	1.71	.794	.148	1.41	2.01	1	4	3.30	0.12
	C45	1.41	.610	.114	1.17	1.64	0	3	2.63	0.19
	C56	1.27	.565	.105	1.06	1.49	0	3	2.40	0.14
	C67	1.87	.714	.133	1.60	2.14	1	4	3.30	0.44
	Average	1.60	.737	.061	1.48	1.72	0	4	3.08	0.13
Middle Disc (Mid Coronal)	C23	4.9972	.73483	.13645	4.7177	5.2768	3.25	6.19	6.47	3.53
	C34	4.7810	1.04291	.19366	4.3843	5.1777	2.22	7.10	6.87	2.70
	C45	4.8176	1.15149	.21383	4.3796	5.2556	1.12	6.48	7.12	2.51
	C56	4.6193	1.09779	.20386	4.2017	5.0369	1.93	6.62	6.81	2.42
	C67	5.0262	.95944	.17816	4.6613	5.3912	2.52	6.95	6.95	3.11
	Average	4.8483	1.00505	.08347	4.6833	5.0133	1.12	7.10	6.86	2.84
Medial Facet (Coronal)	C23	.5881	.23681	.04397	.4980	.6782	.13	1.08	1.06	0.11
	C34	.6033	.22338	.04148	.5183	.6882	.17	1.04	1.05	0.16
	C45	.5438	.26429	.04908	.4433	.6443	.16	1.21	1.07	0.02
	C56	.6840	.31875	.05919	.5627	.8052	.00	1.54	1.32	0.05
	C67	.4993	.22690	.04213	.4130	.5856	.10	.96	0.95	0.05
	Average	.5837	.26098	.02167	.5409	.6265	.00	1.54	1.11	0.06
Midpoint Facet (Coronal)	C23	1.05	.400	.074	.90	1.20	0	2	1.85	0.25
	C34	1.33	.448	.083	1.16	1.50	0	2	2.23	0.44
	C45	1.37	.424	.079	1.21	1.53	1	2	2.22	0.52
	C56	1.26	.443	.082	1.09	1.43	0	3	2.15	0.38
	C67	1.04	.386	.072	.89	1.19	0	2	1.81	0.27
	Average	1.21	.441	.037	1.14	1.28	0	3	2.09	0.33
Lateral Facet (Coronal)	C23	.4995	.23578	.04378	.4098	.5892	.00	1.10	0.97	0.03
	C34	.4807	.22524	.04183	.3950	.5664	.12	.99	0.93	0.03
	C45	.5438	.25153	.04671	.4481	.6395	.12	1.12	1.05	0.04
	C56	.5179	.28736	.05336	.4086	.6272	.00	1.41	1.09	0.00
	C67	.5159	.23610	.04384	.4261	.6057	.00	1.07	0.99	0.04
	Average	.5116	.24795	.02059	.4709	.5523	.00	1.41	1.01	0.02
Interspinous Distance (Sagittal)	C23	15.7624	2.75350	.51131	14.7150	16.8098	7.70	20.95	21.27	10.26
	C34	14.6317	1.76001	.32683	13.9623	15.3012	12.24	19.16	18.15	11.11
	C45	14.0155	1.84557	.34271	13.3135	14.7175	10.09	16.52	17.71	10.32
	C56	13.1521	1.56348	.29033	12.5574	13.7468	10.32	16.47	16.28	10.03
	C67	14.1241	1.81533	.33710	13.4336	14.8147	11.46	19.20	17.75	10.49
	Average	14.3372	2.14344	.17800	13.9853	14.6890	7.70	20.95	18.62	10.05
Vertebral Body Translation (Sagittal)	C23	.5841	.86261	.16018	.2560	.9123	-1.09	3.86	2.31	0.00
	C34	.5369	.64093	.11902	.2931	.7807	-.84	1.74	1.82	0.00
	C45	.5210	.72608	.13483	.2448	.7972	-1.57	1.70	1.97	0.00
	C56	.0855	.88789	.16488	-.2522	.4233	-1.53	1.93	1.86	0.00
	C67	.2131	.91067	.16911	-.1333	.5595	-1.50	1.45	2.03	0.00
	Average	.3881	.82582	.06858	.2526	.5237	-1.57	3.86	2.04	0.00
Anterior Disc Height (Sagittal)	C23	2.6990	.83906	.15581	2.3798	3.0181	1.13	4.40	4.38	1.02
	C34	2.8310	.85043	.15792	2.5075	3.1545	1.05	4.32	4.53	1.13
	C45	3.4552	.94400	.17530	3.0961	3.8143	1.42	5.89	5.34	1.57
	C56	3.1310	1.15688	.21483	2.6910	3.5711	.00	5.19	5.44	0.82
	C67	3.4262	1.10487	.20517	3.0059	3.8465	.99	5.26	5.64	1.22
	Average	3.1085	1.02094	.08478	2.9409	3.2761	.00	5.89	5.15	1.07
Middle Disc Height (Sagittal)	C23	4.888	.7602	.1412	4.598	5.177	3.0	6.4	6.41	3.37
	C34	4.848	1.1929	.2215	4.394	5.301	1.8	7.1	7.23	2.46
	C45	4.922	1.1833	.2197	4.472	5.372	1.1	6.7	7.29	2.56
	C56	4.656	1.2052	.2238	4.198	5.115	1.8	6.5	7.07	2.25
	C67	5.244	1.1833	.2197	4.794	5.694	1.3	6.7	7.61	2.88
	Average	4.911	1.1191	.0929	4.728	5.095	1.1	7.1	7.15	2.67
Posterior Disc Height (Sagittal)	C23	2.3107	.70818	.13151	2.0413	2.5801	.99	4.45	3.73	0.89
	C34	2.1069	.74378	.13812	1.8240	2.3898	.43	3.56	3.59	0.62
	C45	2.4521	.65815	.12222	2.2017	2.7024	1.07	3.74	3.77	1.14
	C56	1.9945	.84608	.15711	1.6727	2.3163	.00	4.13	3.69	0.30
	C67	2.1941	.97373	.18082	1.8238	2.5645	.45	3.87	4.14	0.25
	Average	2.2117	.79891	.06635	2.0805	2.3428	.00	4.45	3.81	0.61
Anterior Facet (Sagittal)	C23	.8266	.34472	.06401	.6954	.9577	.00	1.83	1.52	0.14
	C34	.8534	.28538	.05299	.7449	.9620	.24	1.43	1.42	0.28
	C45	.9171	.30079	.05586	.8027	1.0315	.00	1.62	1.52	0.32
	C56	.9088	.38861	.07216	.7610	1.0566	.00	1.76	1.69	0.13
	C67	.8484	.35294	.06554	.7142	.9827	.00	1.65	1.55	0.14
	Average	.8709	.33655	.02795	.8156	.9261	.00	1.83	1.54	0.20
Posterior Facet (Sagittal)	C23	.6562	.27832	.05168	.5503	.7621	.00	1.22	1.21	0.10
	C34	.7459	.33296	.06183	.6192	.8725	.00	1.39	1.41	0.08
	C45	.6748	.28762	.05341	.5654	.7842	.14	1.53	1.25	0.10
	C56	.7598	.29380	.05456	.6481	.8716	.26	1.51	1.35	0.17
	C67	.5607	.25950	.04819	.4620	.6594	.00	1.29	1.08	0.04
	Average	.6795	.29704	.02467	.6307	.7282	.00	1.53	1.27	0.09
Middle Facet (Sagittal)	C23	.9841	.37232	.06914	.8425	1.1258	.00	2.15	1.73	0.24
	C34	1.2600	.44634	.08288	1.0902	1.4298	.45	2.45	2.15	0.37
	C45	1.2728	.43870	.08146	1.1059	1.4396	.20	2.39	2.15	0.40
	C56	1.2460	.41721	.07747	1.0873	1.4047	.37	2.41	2.08	0.41
	C67	.9709	.35043	.06507	.8376	1.1042	.41	2.11	1.67	0.27
	Average	1.1468	.42657	.03542	1.0767	1.2168	.00	2.45	2.00	0.29