{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:31:09Z","timestamp":1787754669902,"version":"build-2784847793"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2016,7,20]]},"abstract":"\n Background:<\/jats:title>\n Developmental cervical stenosis of the spinal canal predisposes patients to neural compression and loss of function. The Torg-Pavlov ratio has been shown to provide high sensitivity but low specificity for identifying developmental cervical stenosis. A more sensitive and specific radiographic index has not been reported to our knowledge. The objective of this study was to develop and provide an objective, sensitive, and specific radiographic index to assess for developmental cervical stenosis.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n The C3 through C6 levels of the cervical spine were analyzed on lateral radiographs of 150 adult patients to determine the spinolaminar line-to-lateral mass distance (SL), lateral mass-to-posterior vertebral body distance (LM), spinolaminar line-to-vertebral body (canal) diameter (CD), and vertebral body diameter (VB). Ratios of these measurements were calculated to eliminate magnification effects. The corresponding true spinal canal diameter was measured using computed tomography (CT) midsagittal sections. Receiver operating characteristic (ROC) curve analysis was performed to identify a radiographic measurement ratio with optimal sensitivity and specificity, using a true canal diameter of <12 mm to define developmental cervical stenosis.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Several of the measured ratios demonstrated a strong correlation with the true canal diameter at all cervical levels. However, ROC curve analysis showed that only an LM\/CD ratio of \u22650.735 indicated a canal diameter of <12 mm (developmental cervical stenosis). The sensitivity of this ratio at C5 was 83% and its specificity at C5 was 74%. An LM\/CD ratio of \u22650.735 measured only at the C5 level also indicated developmental cervical stenosis at any cervical level from C3 through C6 with 76% sensitivity and 80% sensitivity. Other ratios, including the Torg-Pavlov ratio, did not demonstrate an adequate statistical profile to indicate developmental cervical stenosis. The accuracy of the LM\/CD ratio was not adversely affected by the patient\u2019s sex.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n This analysis provided a novel index for identifying developmental cervical stenosis: the C5 lateral mass\/canal diameter (LM\/CD) ratio. We believe that this ratio is the best radiographic measurement available to screen for developmental cervical stenosis in the adult spine patient population. It provides an objective radiographic screening tool for physicians to detect developmental cervical stenosis and decide whether additional imaging or surgical referral is appropriate.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Diagnostic\n Level II<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.15.01231","type":"journal-article","created":{"date-parts":[[2016,7,20]],"date-time":"2016-07-20T14:13:02Z","timestamp":1469023982000},"page":"1206-1214","source":"Crossref","is-referenced-by-count":17,"title":["A Novel Radiographic Indicator of Developmental Cervical Stenosis"],"prefix":"10.2106","volume":"98","author":[{"given":"Phillip H.","family":"Horne","sequence":"first","affiliation":[{"name":"Duke Orthopaedics of Raleigh, Raleigh, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas P.","family":"Lampe","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Herzog","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd J.","family":"Albert","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"9","key":"bib1-20230714","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.2106\/00004623-198668090-00008","article-title":"Neurapraxia of the cervical spinal cord with transient quadriplegia","volume":"68","author":"Torg","year":"1986","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1148\/radiology.164.3.3615879","article-title":"Cervical spinal stenosis: determination with vertebral body ratio method","volume":"164","author":"Pavlov","year":"1987","journal-title":"Radiology."},{"issue":"6","key":"bib3-20230714","doi-asserted-by":"crossref","first-page":"843","DOI":"10.3171\/jns.1997.87.6.0843","article-title":"Cervical cord neurapraxia: classification, pathomechanics, morbidity, and management guidelines","volume":"87","author":"Torg","year":"1997","journal-title":"J Neurosurg."},{"issue":"1","key":"bib4-20230714","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1249\/00149619-200202000-00008","article-title":"Cervical spinal stenosis with cord neurapraxia: evaluations and decisions regarding participation in athletics","volume":"1","author":"Torg","year":"2002","journal-title":"Curr Sports Med Rep."},{"issue":"6","key":"bib5-20230714","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.spinee.2013.02.006","article-title":"Predicting the risk and severity of acute spinal cord injury after a minor trauma to the cervical spine","volume":"13","author":"Aebli","year":"2013","journal-title":"Spine J."},{"issue":"6","key":"bib6-20230714","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.spinee.2012.10.039","article-title":"The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine","volume":"13","author":"Aebli","year":"2013","journal-title":"Spine J."},{"issue":"16","key":"bib7-20230714","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1097\/00007632-200108150-00006","article-title":"The Torg\u2014Pavlov ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population","volume":"26","author":"Yue","year":"2001","journal-title":"Spine (Phila Pa 1976)."},{"issue":"2","key":"bib8-20230714","first-page":"105","article-title":"Measurement of cervical canal sagittal diameter in Chinese males with cervical spondylotic myelopathy","volume":"54","author":"Chen","year":"1994","journal-title":"Zhonghua Yi Xue Za Zhi (Taipei)."},{"issue":"2","key":"bib9-20230714","doi-asserted-by":"crossref","first-page":"376","DOI":"10.2106\/JBJS.F.00437","article-title":"Prevalence of cervical spine stenosis. Anatomic study in cadavers","volume":"89","author":"Lee","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib10-20230714","doi-asserted-by":"crossref","first-page":"S178","DOI":"10.1097\/00007632-199106001-00001","article-title":"Normal cervical spine morphometry and cervical spinal stenosis in asymptomatic professional football players. Plain film radiography, multiplanar computed tomography, and magnetic resonance imaging","volume":"16","author":"Herzog","year":"1991","journal-title":"Spine (Phila Pa 1976)."},{"issue":"1","key":"bib11-20230714","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1302\/0301-620X.81B1.0810110","article-title":"Determining the sagittal dimensions of the canal of the cervical spine. The reliability of ratios of anatomical measurements","volume":"81","author":"Blackley","year":"1999","journal-title":"J Bone Joint Surg Br."},{"issue":"2","key":"bib12-20230714","first-page":"61","article-title":"Does the cervical canal to body ratio predict spinal stenosis?","volume":"55","author":"Moskovich","year":"1996","journal-title":"Bull Hosp Jt Dis."},{"issue":"4","key":"bib13-20230714","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.spinee.2003.11.011","article-title":"Variation of the cervical spinal Torg ratio with gender and ethnicity","volume":"4","author":"Lim","year":"2004","journal-title":"Spine J."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201607200-00009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:30:48Z","timestamp":1787751048000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201607200-00009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,20]]},"references-count":13,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.15.01231","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,20]]}}}