Incidence and age and gender profiles of hyperplasia in individual cervical vertebrae

Journal of International Medical Research, Jul 2016

Objective To analyze the incidence and age and gender profiles of hyperplasia in individual cervical vertebrae.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://imr.sagepub.com/content/44/4/917.full.pdf

Incidence and age and gender profiles of hyperplasia in individual cervical vertebrae

Downloaded from imr.sagepub.com by guest on July Incidence and age and gender profiles of hyperplasia in individual cervical vertebrae Min Li Shuyong Liu Qingkui Kong Haitao Sun Xia Zhang Guangbin Wang Objective: To analyze the incidence and age and gender profiles of hyperplasia in individual cervical vertebrae. Methods: In this retrospective study, computed tomography three-dimensional reconstruction images of cervical vertebrae from patients with neck discomfort were analyzed for the presence of hyperplasia and compared with age and gender data. Results: Scans from a total of 580 patients (352 males, 228 females) were analyzed. The highest incidence of hyperplasia was seen in C2 (25%), followed by C1 (23%), C6 (16%), C5 (15%), C7 (9%), C4 (8%) and C3 (4%). Patients with C2 hyperplasia were the youngest and those with C1 hyperplasia were the second youngest, while patients with C7 hyperplasia were the oldest. Of those with C2, C1 and C7 hyperplasia, males were significantly younger than females, whereas of those with C3, C4, C5 and C6 hyperplasia, females were significantly younger than males. Conclusions: Hyperplasia of the cervical spine shows different age and gender profiles among the seven vertebrae. These findings may be helpful for the early recognition of cervical hyperplasia and highlight the importance of protecting the atlanto-axial joint in daily life. eol>Cervical vertebrae; hyperplasia; age; gender Introduction Hyperplasia of the cervical vertebrae is a common condition in middle aged and elderly people.1 However, with changes such as increased time spent working at a desk or driving, resulting in long periods of inactivity with a poor posture, the morbidity of this disease is increasing year on year, 1School of Medicine, Shandong University, Jinan, Shandong Province, China 2Department of Radiology, Taian City Central Hospital, Shandong Province, China *Min Li and Shuyong Liu are the co-first authors of this article. with patients becoming progressively younger.2,3 Cervical hyperplasia has commonly been reported in cervical vertebrae C4, C5, C6 and C7,4 but such reports are often based on conventional X-ray plain films, which do not show the upper cervical spine (C1 and C2) clearly.5 The use of computed tomography (CT), together with multiplanar reconstruction, provides a clear image of all seven cervical vertebrae without any blind areas. The present study aimed to investigate differences associated with age and gender in the incidence of hyperplasia in individual cervical vertebrae as seen on CT multiplanar reconstruction images. Patients and methods Patients Data from consecutive patients presenting with neck discomfort who had undergone 64-section spiral CT of the cervical spine between January 2010 and December 2012 at the Department of Radiology, Taian City Central Hospital, Shandong Province, China, were retrieved retrospectively. Patients with a history of trauma of the cervical spine, infective or inflammatory conditions of the spine, cervical tumours, dysplasia, metabolic disease or surgical procedures of the cervical spine were excluded from the study. The study protocol was approved by the Ethics Committee of the Taian City Central Hospital, Shandong Province, China. The requirement for patient consent was waived due to the retrospective nature of the study. Image analysis All patients had undergone a 64-section spiral CT scan of the cervical spine in a supine position with the head advanced using a SOMATOM Sensation 64 CT scanner (Siemens, Erlangen, Germany). The scanning parameters used were a tube current of 300 mA, a tube voltage of 120 kV, a scan slice of 3.0 mm, a scan interval of 3.0 mm, a sharp kernel (B60s) and a field of view of 155 155 mm. After routine scanning, three-dimensional reconstruction was performed using a slice thickness of 0.75 mm and an increment of 0.7 mm. Cervical hyperplasia was defined as the presence of one or more of the following features on the CT scan: lip-like or lace-like appearance of the anterior, posterior, superior or inferior edge of the vertebral body, lace-like appearance , osteophytes or a bone bridge formed by fusion of two adjacent osteophytes.6 CT scans were analyzed independently by two experienced radiologists (Q.K. and S.L.) who were blinded to each other’s assessment and to the patient’s information. Any discrepancy was resolved by discussion. Statistical analyses Data was presented as the number of patients or as the mean SD. Associations between age and gender and the presence of hyperplasia in different cervical vertebrae were analyzed using one-way analysis of variance and the 2-test. A P-value < 0.05 was considered to be statistically significant. All statistical analyses were performed using SPSS software version 17 (SPSS Inc., Chicago, IL, USA). Results A total of 580 patients were included in the study; of these, 352 were male and 228 were female. They ranged in age from 13 to 70 years, with a mean age of 38.5 years. A total of 1 356 hyperplastic vertebrae were seen on computed tomography (Figure 1). The distribution of hyperplasia in the individual cervical vertebrae is given in Table 1. Hyperplasia occurred with the highest frequency in C2 (25%), followed by C1 (23%), C6 (16%), C5 (15%), C7 (9%), C4 (8%) and C3 (4%). Hyperplasia was significantly more likely to occur in C1 and C2 than in the other cervical vertebrae (P < 0.05). The incidence of hyperplasia was higher in females than in males in C1, C2, C5, C6 and C7 (P < 0.05). The mean SD ages of patients with hyperplasia according to the cervical vertebra affected are given in Table 2 and Figure 2. There was a significant difference (P < 0.05) in the age of patients according to the cervical vertebra affected, with patients with C2 hyperplasia being the youngest, followed by patients with C1 hyperplasia, while patients with C7 hyperplasia were the oldest (Table 2). In patients with C2, C1 or C7 hyperplasia, male patients were significantly younger than female patients, while in patients with C3, C4, C5 or C6 hyperplasia, female patients were significantly younger than male patients. Discussion Hyperplasia of the upper cervical spine vertebrae and of the posterior edge of vertebrae in the lower cervical spine are difficult to detect using plain film X-rays.5,7,8 In contrast, CT multiplanar reconstruction is able to show the detailed structure of the vertebral bodies5,9–13 and was therefore used in the present study to document hyperplasia of the cervical vertebrae. Previous studies have reported that hyperplasia of C1 and C2 (the atlas and axis) is seen mostly in patients with cervical spine symptoms aged 40–57 years, with C2 being the last of the cervical vertebrae to develop hyperplasia.2,6,14,15 In the present study, hyperplasia of C1 and C2 was seen at a mean SD age of 47.97 13.23 years and 44.12 19.98 years, respectively, which is consistent with previous studies, and occurred at a younger age in male compared with female patients. In addition, hyperplasia occurred with the highest frequency in C2, followed by C1, C6, C5, C7, C4 and C3, which is in contrast to previously published reports. However, in most of the previously reported studies, conventional plain film Xrays were used, in which the upper cervical spine overlaps with maxillofacial structures. As a result, such films only show the distance between the odontoid process of the axis and the lateral mass of the atlas, with mild bone hyperplasia being poorly demonstrated.5,7,8 In the present study CT multiplanar threedimensional reconstruction was used, which is the gold standard for the detection of osteoarthritis of C1 and C2.10 In addition, few studies have focused on the C1/C2 region, although these joints make a significant contribution to the mobility of the spine.16–18 The present study revealed that C2 is the earliest and the most frequently affected vertebra in cervical hyperplasia, followed by C1. Vertebra Age (years) 30 60 50 40 20 10 0 Male, no hyperplasia Male, hyperplasia Female, no hyperplasia Female, hyperplasia Total, no hyperplasia Total, hyperplasia C1 C2 C3 C4 C5 C6 C7 This may be explained by the anatomical relationships of the cervical vertebrae and their movements. The cervical spine moves more than 600 times each hour,2 with considerable impact on the atlas and axis. C1 and C2 are highly specialized vertebrae that provide considerable mobility for the skull and cervical spine in terms of rotation, flexion and extension.19 A greater degree of rotation is possible at the atlanto-axial joint than between the other cervical vertebrae. Rotation occurs around the odontoid process, with a range of movement of about 45 . As a whole, the neck can rotate up to 90 , half of which occurs at the atlanto-axial joint,20,21 with the other half being due to rotation of the other cervical vertebrae. Once the head and upper cervical vertebrae have rotated by 20–30 , the lower cervical vertebrae then rotate in order to complete the entire 90 rotation. The atlas and axis are therefore involved early in cervical movements and are responsible for a large part of the activity range of the neck. The present study also found that C7 was the last vertebrae to show hyperplasia. This may due to the fact that C7 mobility is less than that of the other cervical vertebrae. In the present study, hyperplasia in C1, C2 and C7 occurred at a younger age in males than in females, whereas hyperplasia in C3, C4, C5 and C6 occurred at a younger age in females than in males. In addition, the incidence of hyperplasia was higher in females than in males in C1, C2, C5, C6 and C7. The reasons for these differences are not clear and warrant further study. One major weakness of the present study is its retrospective design, with the possibility of selection bias. In addition, the study focused on bone hyperplasia and did not consider changes to the intervertebral discs or early cystic degenerative changes in the odontoid process,3 and the hyperplasia was not graded. The study also did not analyze other factors that may affect bone hyperplasia, such as occupation and hormone levels. Lastly, the study did not investigate the relationship between hyperplasia seen on CT images and clinical symptoms. In conclusion, the present study showed the pattern of development of cervical vertebra hyperplasia, with associated differences in age and gender. C2 was the most frequently affected vertebra, with a female predominance. These findings may be helpful for the early recognition of cervical hyperplasia and highlight the importance of protecting the atlanto-axial joint in daily life. Declaration of conflicting interests The authors declare that there is no conflict of interest. Funding This research received no specific grant from any funding agency in the public, commercial, or notfor-profit sectors. 1. Zhang A , Yin S and Xia J. X-ray analysis of cervical spine in 334 patients . Chin J Convalescent Med 2007 ; 3 : 172 - 174 . 2. Badve SA , Bhojraj S , Nene A , et al. Occipitoatlanto-axial osteoarthritis: a cross sectional clinico-radiological prevalence study in high risk and general population . Spine (Phila Pa 1976 ) 2010 ; 35 : 434 - 438 . 3. Betsch MW , Blizzard SR , Shinseki MS , et al. Prevalence of degenerative changes of the atlanto-axial joints . Spine J 2015 ; 15 : 275 - 280 . 4. Berlemann U , Laubli R and Moore RJ . Degeneration of the atlanto-axial joints: a histological study of 9 cases . Acta Orthop Scand 2002 ; 73 : 130 - 133 . 5. Liu K , Lu Y , Cheng D , et al. The prevalence of osteoarthritis of the atlanto-odontoid joint in adults using multidetector computed tomography . Acta Radiol 2014 ; 55 : 95 - 100 . 6. Zapletal J , Hekster RE , Straver JS , et al. Atlanto-odontoid osteoarthritis. Appearance and prevalence at computed tomography . Spine (Phila Pa 1976 ) 1995 ; 20 : 49 - 53 . 7. Zapletal J and de Valois JC . Radiologic prevalence of advanced lateral C1-C2 osteoarthritis . Spine (Phila Pa 1976 ) 1997 ; 22 : 2511 - 2513 . 8. Zapletal J , Hekster RE , Wilmink JT , et al. Atlantoodontoid osteoarthritis: comparison of lateral cervical projection and CT . Eur Spine J 1995 ; 4 : 238 - 241 . 9. Novelline RA , Rhea JT , Rao PM , et al. Helical CT in emergency radiology . Radiology 1999 ; 213 : 321 - 339 . 10. Genez BM , Willis JJ , Lowrey CE , et al. CT findings of degenerative arthritis of the atlantoodontoid joint . AJR Am J Roentgenol 1990 ; 154 : 315 - 318 . 11. Tsukagoshi S , Ota T , Fujii M , et al. Improvement of spatial resolution in the longitudinal direction for isotropic imaging in helical CT . Phys Med Biol 2007 ; 52 : 791 - 801 . 12. Fishman EK and Lawler LP . CT angiography: principles, techniques and study optimization using 16-slice multidetector CT with isotropic datasets and 3D volume visualization . Crit Rev Comput Tomogr 2004 ; 45 : 355 - 388 . 13. van Meurs JB and Uitterlinden AG . Osteoarthritis year 2012 in review: genetics and genomics . Osteoarthritis Cartilage 2012 ; 20 : 1470 - 1476 . 14. Lestini WF and Wiesel SW . The pathogenesis of cervical spondylosis . Clin Orthop Relat Res 1989 ; 239 : 69 - 93 . 15. Rudy IS , Poulos A , Owen L , et al. The correlation of radiographic findings and patient symptomatology in cervical degenerative joint disease: a cross-sectional study . Chiropr Man Therap 2015 ; 23 : 9 . 16. Adams LP , Tregidga A , Driver-Jowitt JP , et al. Analysis of motion of the head . Spine (Phila Pa 1976 ) 1994 ; 19 : 266 - 271 . 17. Penning L. Normal movements of the cervical spine . AJR Am J Roentgenol 1978 ; 130 : 317 - 326 . 18. Robertson PA , Tsitsopoulos PP , Voronov LI , et al. Biomechanical investigation of a novel integrated device for intra-articular stabilization of the C1-2 (atlantoaxial) joint . Spine J 2012 ; 12 : 136 - 142 . 19. White AA and Panjabi MM. Clinical biomechanics of the spine . 2nd ed. Philadephia: JB Lippincott , 1990 , pp. 92 - 97 . 20. Lakshmanan P , Jones A , Howes J , et al. CT evaluation of the pattern of odontoid fractures in the elderly - relationship to upper cervical spine osteoarthritis . Eur Spine J 2005 ; 14 : 78 - 83 . 21. Iai H , Goto S , Yamagata M , et al. Threedimensional motion of the upper cervical spine in rheumatoid arthritis . Spine (Phila Pa 1976 ) 1994 ; 19 : 272 - 276 .


This is a preview of a remote PDF: http://imr.sagepub.com/content/44/4/917.full.pdf

Min Li, Shuyong Liu, Qingkui Kong, Haitao Sun, Xia Zhang, Guangbin Wang. Incidence and age and gender profiles of hyperplasia in individual cervical vertebrae, Journal of International Medical Research, 2016, 917-922, DOI: 10.1177/0300060516645038