Rajiv Gandhi University of Health Sciences s103

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALOREANNEXURE-1 PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION1. NAME OF THE CANDIDATE AND DR.JYOTHILAKSHMI.G.L. ADDRESS C/O NANJAPPA C.N. #977 , SECOND FLOOR, 66TH CROSS, RAJAJINAGAR 5TH BLOCK BANGALORE 2. NAME OF THE INSTITUTION KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES,BSK II STAGE , BANGALORE - 560070 3. COURSE OF STUDY AND SUBJECT M.D.ANATOMY4. DATE OF ADMISSION TO THE 04/05/2010 COURSE5. TITLE OF THE TOPIC ANALYSIS OF DIMENSIONS OF CERVICAL SPINAL CANAL IN ADULT MALE AND FEMALE SUBJECTS BY PLAIN RADIOGRAPHY6. BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR THE STUDY ENCLOSED(ANNEXURE – II) 6.2 REVIEW OF LITERATURE ENCLOSED(ANNEXURE – III) 6.3 OBJECTIVES OF THE STUDY ENCLOSED(ANNEXURE – IV)7. MATERIALS AND METHODS 7.1 SOURCE OF DATA ENCLOSED(ANNEXURE – V) 7.2 METHOD OF COLLECTION OF ENCLOSED(ANNEXURE – V) DATA( including the sampling procedure , if any) 7.3Does this study require any NO investigations or interventions to be conducted on patients or other humans or animals?If so please describe briefly. 7.4 Has ethical clearance been obtained YES from your institution in case of 7.3? ENCLOSED(ANNEXURE – VI)8. LIST OF REFERENCES ENCLOSED(ANNEXURE – VII)9. SIGNATURE OF CANDIDATE 10. REMARKS OF THE GUIDE DR.JYOTHILAKSHMI G.L POST GRADUATE STUDENT IS PERSUING “ANALYSIS OF DIMENSIONS OF CERVICAL SPINAL CANAL IN ADULT MALE AND FEMALE SUBJECTS BY PLAIN RADIOGRAPHY” FOR DISSERTATION AS AN ORIGINAL WORK IN THE DEPARTMENT OF ANATOMY , KIMS , BANGALORE, UNDER MY GUIDANCE 11. NAME AND DESIGNATION OF THE DR.JAYANTHI.K.S. GUIDE PROFESSOR AND HOD DEPARTMENT OF ANATOMY , KIMS,BANGALORE 11.1. SIGNATURE11.2. CO-GUIDE(IF ANY) DR.SRINIVASA BABU C.R. PROFESSOR AND HOD DEPARTMENT OF RADIODIAGNOSIS , KIMS,BANGALORE 11.3 SIGNATURE11.4 HEAD OF THE DEPARTMENT DR.JAYANTHI.K.S. PROFESSOR AND HOD DEPARTMENT OF ANATOMY , KIMS,BANGALORE 11.5 SIGNATURE12. REMARKS OF CHAIRMAN AND PRINCIPAL 12.1 SIGNATURE RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALOREANNEXURE-II6. BRIEF RESUME OF THE INTENDED WORK:6.1 NEED FOR THE STUDY:The word 'cervix' in Latin means 'neck'. The word “Cervical” means related to or pertaining to neck. “ Stenosis ” means abnormal narrowing of a canal.Vertebral column is located in the median plane of the body. It consists of 33 vertebrae which are classified as cervical , thoracic, lumbar and pelvic vertebrae based on their location and whose function is to support the trunk and protect the spinal cord.Cervical vertebrae are 7 in number. The canal of each cervical vertebra, except for the atlas and axis is three-sided i.e. triangular. Base is formed by the posterior surface of the vertebral body.The sides are formed by the laminae of the vertebra. The cross-section of the spinal cord which lies within the canal is ellipsoidal. As the interpedicular or transverse distance is nearly twice the sagittal diameter of the canal, there is more room for the cord to expand sideways and less in the antero-posterior direction. For this reason, the antero-posterior diameter of the cervical spinal canal is considered the most useful measurement.1The anteroposterior (AP) diameter of the normal adult male cervical spinal canal has a mean value of 17-18 mm from 3rd cervical certbral level to 7th cervical vertebral level. Cervical spinal canal stenosis is associated with an anteroposterior diameter of less than 12 mm.2In presence of critical bony canal stenosis, a minor degree of disc prolapse or a small osteophyte will lead to major neurological symptoms.Acute and chronic neck pain due to canal stenosis has become a major health care problem. Spinal canal stenosis resulting in radicular pain is common in the cervical and lumbar regions.Studies in this field have reported that male and female subjects have shown significant differences in vertebral body and vertebral canal dimensions . Because a large vertebral body is thought to be associated with a large osteophyte and large disc protrusion, men who have a large vertebral body by disposition are more likely to undergo cervical myelopathy than women.3The canal-to-body ratio or Torg's ratio has been described as a reliable means for assessing the the stenosis of the spinal canal and detecting those who are at risk of cervical neuropraxia. It is determined by dividing the sagittal spinal canal diameter by the corresponding sagittal vertebral body diameter. A ratio of 0.82 or less indicates cervical spinal canal stenosis .The canal-to-body ratio is used to screen athletes who are at risk of this injury. The use of ratio method avoids magnification errors resulting from non standardized filmtube distances. 4 These correlations between cervical spinal canal and vertebral body dimensions have been seldom analysed in Indian population. Few studies have been done on cervical spinal canal dimensions when compared to lumbar spinal canal. This study aims to assesss the cervical spinal canal dimensions in male and female subjects among South Indian population. ANNEXURE – III6.2 REVIEW OF THE LITERATURE:Interest stems mainly from a high frequency of cervical spondylosis and spondylotic myelopathy seen in the ageing community. It is widely believed that the dimensions of the cervical spinal canal, particularly the antero-posterior diameter, play an important contributory role in the causation of spondylotic myelopathy. A study was done on plain radiographs of 400 subjects belonging to different ethnic groups such as Chinese,Malayans,Indians and others. The results indicated that the local individuals had a narrow anteroposterior diameter of the cervical spinal canal when compared to Western subjects and probably more prone to myelopathic changes. The study also noted that anteroposterior diameter of the cervical spinal canal in local females was narrower than those in local males by 1-1.5 mm.1The sagittal diameter of the cervical spinal canal is measured from the posterior surface of the midvertebral body to the nearest surface of the same segmental spinolaminar junction line. The normal sagittal diameter of the spinal canal at C1 is 22mm, C2 is 20mm , C3-C5 is 17mm. When the sagittal diameter of the cervical spinal canal is <12 mm on a plain radiograph, stenosis may be present. The most accurate value is obtained by using canal to body ratio. A ratio<0.82 is significant for spinal stenosis.2This study involved the radiographic analysis of the cervical spinal canal in healthy young adults comprising of 105 men and 114 women to investigate the size correlations among the vertebral height, anteroposterior diameter of the vertebral body and anteroposterior diameter of the spinal canal. The study showed that the height and the anteroposterior diameter of the vertebral body were both larger in males than in females but the anteroposterior diameter of the spinal canal was similar for both sexes. The height of the vertebral body did not correlate with the spinal canal size at any segment in both sexes, whereas the anteroposterior diameter of the vertebral body had significant correlation with the size of the spinal canal in males but not in females. A significantly small canal/body ratio in men may implicate the prevalence of cervical myelopathy.3A study done to assess the variations in Torgs ratio(canal-to-body ratio) with gender in patients with neck pain included 45 women and 45 men of mean age 33 yrs and 30yrs respectively. The measurements were done on plain lateral radiographs using vernier calipers. Women had smaller sagittal spinal canal and vertebral body diameters at all levels. The narrowest sagittal spinal canal diameters measured were at C4 level in men and at C2 level in women. The mean Torg Ratio was 0.73 at C4 in men and 0.80 at C2 in women. The Torg ratio is an indicator of cervical canal stenosis and may help to identify patients at risk for cervical spinal cord injuries.4A study was done on 90 sets of cervical vertebrae to ascertain the normal values of the mid-sagittal canal diameter and the canal/body ratio of the cervical spine in Korean adults. The average normal mid-sagittal canal diameters from C3 through C7 noted were 13.2 +/- 1.3 millimeters in male and 13.1 +/- 2.6 millimeters in female. The normal average canal/body ratio of the cervical spine is 0.93 +/- 0.10 in male and 1.02 +/- 0.09 in female. The mid-sagittal canal diameter is largest in the White population and smallest in Asian. The authors concluded that measurement of the canal/body ratio is more reliable than direct measuring of the mid-sagittal diameter of the cervical spinal canal in the diagnosis of cervical spinal stenosis or predicting the prognosis of cervical spinal cord injury.5ANNEXURE – IV6.3 OBJECTIVES OF THE STUDY:To assess the cervical spinal dimensions and to investigate the sex discrepancy in the following:1. The anteroposterior diameter of the vertebral canal2. The transverse diameter of the vertebral canal3. Height of the vertebral body 4. The anteroposterior diameter of the vertebral body5. Canal/body ratio (Torg's ratio) ANNEXURE – VMATERIALS AND METHODS :7.1 SOURCE OF DATA:Study will be done on plain radiographs obtained from the department of Radiodiagnosis, Kempegowda Institute Of Medical Sciences, Bangalore. 7.2 METHOD OF COLLECTION OF DATA:1. Study design : Comparative study2. Sample design : Convenience sampling.3.Duration of study : One and a half years.4.Sample size : 300 adult radiographs comprising an equal number of both sexes .5. Inclusion criteria : Radiographs of subjects belonging to the age group 18-35yrs.6.Exclusion criteria : Radiographs of subjects with - congenital spinal abnormalities (eg.spina bifida of atlas, occipitalisation of atlas , subaxial synostosis , congenital block vertebra, cervical rib) -fracture/dislocation due to trauma.The study will be done on 300 plain anteroposterior and lateral radiographs of subjects of known sex. The following measurements will be taken using a distance measuring tool of a computer software.1. The anteroposterior diameter of the vertebral canal 2. The transverse diameter of the vertebral canal 3. Height of the vertebral body 4. The anteroposterior diameter of the vertebral body 5. Canal/body ratio (Torg's ratio)The relevant findings will be noted. Each of the measurement will be taken twice and then average is taken to reduce the bias errors. Values of male and female subjects will be compared . Values will be compared with previous studies for their statistical significance.Descriptive statistics like percentages, mean and standard deviation will be used to analyse the data obtained. The inferential statistics will be done using student ‘t’ test . The results will be considered statistically significant when p < 0.05. 7.3 Does this study require any investigations or interventions to be conducted on patients or other humans or animals?If so please describe briefly.The study will be done on radiographs obtained from the department of Radiodiagnosis, KIMS. The details of the subjects involved in the study will be anonymised/ not disclosed.The study does not require any investigations or interventions to be conducted on patients or other humans or animals.7.4 Has ethical clearance been obtained from your institution in case of 7.3?Yes. Enclosed.( ANNEXURE – VI) ANNEXURE-VIIList of references:1.Oon C.L.,“The Sagittal diameter of the cervical spinal canal”, Singapore medical Journal,15(3):218-2222.Yochum & Rowe’s Essentials of Skeletal Radiology, 3rd edition,2005, 2093.Hukuda S, Kojima Y "Sex discrepancy in the canal/body ratio of the cervical spine implicating the prevalence of cervical myelopathy in men" Spine 27(3):250-34 .Özlen Karabulut*, Zülfü Karabulu "The Variations of Torg Ratio with Gender in Patients with Neck Pain" Dicle Tıp Dergisi 34(4): 272-2745. Hwan-Mo Lee,Nam-Hyun Kim, Ho-Jeong Kim and In-Hyuk Chung , “Mid-Sagittal Diameter And Vertebral Canal/Body Ratio Of The Cervical Spine In Koreans” , Yonsei Medical Journal.35(4),446-452

Rajiv Gandhi University of Health Sciences s103

Details

Download

Copyright

We respect the copyrights and intellectual property rights of all users. All uploaded documents are either original works of the uploader or authorized works of the rightful owners.

Support