The prevalence of congenital cervical stenosis differs based on race

Congenital cervical stenosis (CCS) is a rare condition involving a narrowed spinal canal due to developmental anomalies. CCS heightens the risk of neurologic deficits and acute spinal cord injury posttrauma, influencing return-to-play decisions for contact athletes. Additionally, CCS patients are prone to cervical myelopathy as degenerative changes progress with age. Limited evidence-based literature exists addressing the epidemiology of CCS, including the effects of race.

To investigate the anatomical differences and prevalence of CCS as it pertains to race and ethnicity.

Single center retrospective cross-sectional study.

A total of 343 patients with cervicalgia between the years of 1999 and 2023.

Radiographic measurements of anatomical parameters were collected and CCS was defined as a sagittal canal diameter (SCD) of less than 10 mm at 2 or more vertebral levels (C3-7) at the pedicle.

We screened 5,395 cervical MRIs from a single institution. Exclusion criteria included patients under 18 and over 50 years, prior cervical spine surgery, congenital fusions, spinal malignancy, or active smoking history. For each patient, axial measurements were taken at each level, including coronal vertebral body length, anteroposterior vertebral body length, pedicle width, pedicle length, laminar length, anteroposterior lateral mass length, posterior canal distance, apex-to-vertebral body, lamina-disc angle (LDA), lamina-pedicle angle, and anteroposterior spinal cord diameter.

CCS prevalence varied significantly among ethnic groups; Black (39.3%), Asian (33.6%), and Hispanic (22%) patients demonstrated significantly higher CCS rates than White patients (7.5%) (x² [3, N=343] = 30.04, p<.05). Blacks and Asians showed consistently smaller SCDs at all pedicle levels compared to Whites, who had the largest SCDs overall (p<.001). Average SCDs were 11.4 mm (White), 10.4 mm (Black), 10.5 mm (Asian), and 11 mm (Hispanic). Additionally, LDAs were larger in Asians, Blacks, and Hispanics compared to Whites, leading to a significantly decreased cross-sectional canal area (p<.001).

Our study indicates a statistically significant correlation between race/ethnicity and CCS prevalence. Black and Asian patients had the highest CCS rates, smallest SCDs, and largest LDAs. These anatomical differences may predispose these subjects to the development of cervical myelopathy compared to those with normal spinal canal diameters. Increased knowledge base of the epidemiology of this condition may lead to personalized clinical management and possibly early intervention to prevent spinal cord injuries in these patients.