Morphologic changes in the cervical neural foramen due to flexion and extension: in vivo imaging study

Dimensional measurement of cervical neural foramen at various positions, using reformatted computed tomography.

To examine the morphologic changes in the neural foramen during flexion and extension of the cervical spine in vivo.

Previous cadaveric studies have shown the effect of cervical spinal motion on dimensions of the neural foramen. However, little information is available about dynamic morphologic changes in the cervical neural foramen in vivo.

Cervical CT images of seven healthy volunteers were taken at the neutral position, maximum extension, and maximum flexion, and were reconstructed in the oblique plane perpendicular to the long axis of each neural foramen from the C3-C4 to C6-C7 level. Measured parameters included foraminal height, width, cross-sectional area, and segmental sagittal rotation at each spinal level. Differences in neural foraminal dimensions among these positions were analyzed. Correlations of segmental sagittal rotation with differences in dimensions between flexion and extension were analyzed.

Flexion significantly increased the foraminal height (by 1.0 mm; 11%), foraminal width (by 1.0 mm; 16%), and foraminal area (by 12 mm2; 28%) (P < 0.01). Extension significantly decreased the foraminal height (by 0.9 mm; 10%), foraminal width (by 1.4 mm; 22%), and foraminal area (by 8.0 mm2; 17%) (P < 0.01). Segmental sagittal rotation significantly positively correlated with % change in foraminal height (r = 0.434, P < 0.01) and area (r = 0.504, P < 0.01).

The present results are consistent with those of previous in vitro studies and may explain the clinical observation that cervical extension aggravates symptoms in patients with cervical radiculopathy and that flexion often relieves them.