Predicting Cervical Stenosis Using Morphological Biomarkers: A Thiel Study With Osteological and MRI Analysis

Cervical canal stenosis (CCS) compresses the spinal cord due to degenerative changes, abnormal spinal curvature, and decreased disc height (DH). The Cobb angle (CA) measures the spinal curvature, whose abnormality can lead to CCS. The Torg ratio (TR) is used for detecting CCS, and ethnic variations have been reported. Cervical morphometry is a potential biomarker for predicting CCS, and early diagnosis is crucial for restoring neurological function. This study aimed to investigate whether bony (BM) and MRI morphometrics (ligamentum flavum (LF) and DH) could predict CCS in the elderly Modern Scottish population by examining their relationship with TR, age, and sex difference. Basic descriptive and advanced multivariate statistics were used. The BM showed less variability and more reliability. Sex impacted BM significantly more than age. Males had higher measurements than females in most categories except for CA and TR. Moderate to severe sagittal scoliosis was observed in extension (CA of 38.7 - 41.1) degrees. The highest mean obtained from the BM study was the 6th cervical canal diameter (24.9mm). The DH had a weak correlation with the 5th anterior and posterior vertebral body height (VBHA/VBHP) ratio. DH and VBHA/VBHP ratios could be the biomarkers of choice. The relationship between the biomarkers of BM and MRI is very weak and non-significant, possibly due to the inequality of MRI's sample size with that of the BM, pixel resolution size, poor imaging, and software limitations. In conclusion, morphometric biomarkers have the potential to predict CCS. They can substitute X-rays for MRI in CCS diagnoses, thereby reducing patient waiting periods in the NHS. They may also help in countries with limited MRI access. However, caution is advised when interpreting the results, as this is the first attempt to develop a biomarker.