Torg’s ratio in normal adult nepalese population
AbstractIntroduction: Acute cervical trauma occasionally leads to cervical canal stenosis in some individuals in spite of minor trauma. The spinal canal-to-vertebral body ratio (Torg-Pavlov ratio) has been proposed for assessing developmental spinal canal stenosis. It is not affected by magnification, and is measured on lateral plain films of cervical vertebrae. The result of this study may help in better understanding of the Torg's ratio, which 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. If Torg’s ratio is below normal there is risk of cervical cord injury whereas relatively safe in large Torg’s ratio. Torg’s ratio can be accessed even in rural areas where x-rays are easily available and more economical than MRI and CT scan. It can assess the risk of cord injury during sports and outdoor activities and help individuals’ choose safe carrier in sports or others activities.Methods: In order to ascertain the normal values of the Torg's ratio in adults Nepalese, hundred sets of cervical vertebral columns of hundred adult Nepalese population of age group 20-40 years were examined. Consecutive patients presenting with history of neck pain with normal x-ray findings or history of trauma without cervical spine injury from Orthopaedic OPD (out patients department) and emergency department of Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu from March 2011 to August 2012 were included in the study.Results: There were 48 males and 52 females with age ranging from 20 yrs to 40 yrs with the mean of 30.34±5.36 years. The normal average canal/body ratio of the cervical spine is 0.99 +/- 0.09 in male and 1.01 +/- 0.07 in female. It was observed that the ratio of the antero-posterior diameters of cervical spinal canal and vertebral bodies showed sexual dimorphism.Conclusion: The Torg's ratio is the same irrespective of gender and height. The result of this study will help in better understanding of the Torg's ratio, which 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.
2. Rao RD, Currier BL, Albert TJ, Bono CM, Marawar SV, Poelstra KA, et al. Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management. J Bone Joint Surg Am 2007;89:1360-78.
3. Prasad SS, Malley M, Caplan M, Shackleford IM, Pydisetty RK. MRI measurements of the cervical spine and their correlation to Pavlov’s ratio. Spine 2003;28:1263-8.
4. Maqbool A, Athar Z, Hussain L. Midsagittal diameter of cervical spine and Torg’s ratio of the cervical spine in Pakistanis. Pak J Med Sci. 2003;19:203-10.
5. Nadalo LA. Spinal stenosis.Emedicine[serial on the internet].2009Sept 2; Available from: http:// www.emedecine.com.
6. Torg JS, Csorcoran TA, Thibault LE, Pavlov H, Sennett BJ, Naranja RT et al. cervical cord neurapraxia: classification, pathomechanics, morbidity, and management guidelines. J Neurosurg. 1997; 87:843-50.
7. Torg JS. neurapraxia of the cervical spinal cord with transient quadriplegia. J Bone Joint surg AM1986; 68:1354-1370.
8. Kelly JD, Aliquo D, Sitler MR, Odgers C, Moyer RA. Association of burners with cervical canal and foraminal stenosis. Am J Sports Med. 2000; 28:214-7.
9. Pavlov H, Torg JS, Robie B, Jahre C. Cervical spinal stenosis. Determination with vertebral body ratio method. Radiology 1987;164:771–5. Cited by Tierney RT, Maldjian C, Mattacola CG, Straub SJ, Sitler MR. Cervical spine stenosis measures in normal subjects. J Athl Train 2002;37:190–3.
10. Koyanagi I, Iwasaki Y, Hida K, Akino M, Imamura H, Abe H. Acute cervical cord injury without fracture or dislocation of the spinal column. J Neurosurg. 2000;93:15-20.
11. M. A. Kathole, R. A. Joshi, N. G. Herekar, S.S. Jadhav et al .Dimensions of Cervical Spinal Canal and Vertebrae and Their Relevance in Clinical Practice. international journal of recent trends in science and technology.2012;3(2):54-58.
12. Tjahjadi D, Onibala M Z. Torg ratios based on cervical lateral plain films in normal subjects. Univ Med 2010;29:8-10.
13. M.Gupta, V. Bharihoke, S. K. Bhargava , N. Agrawal, et al. Size of the Vertebral Canal – A correlative study of measurements in radiographs and dried bones. J. anat. Soc. India.1998; 47: 1- 6.
14. Suk KS, Kim KT, Lee JH, Lee SH, Kim J, Kim JY, et al . Reevaluation of the Pavlov ratio in patients with cervical myelopathy. clin.Orthopaed Surg. 2009;1:6-10.
15. Lim JK, Wong HK.Variation of the cervical spinal Torg ratio with gender and ethnicity. Spine 2004; 4:396–401.
16. Tjahjadi D, Onibala M Z. Torg ratios based on cervical lateral plain films in normal subjects. Univ Med 2010;29:10-13.
17. G.Tossel, M.C.Bosman. Dimension of the cervical spinal canal in the South African Negroid population. University of Pretonia.2007.p.70-71.
18. Sirikonda SP, Michael OM, Mark Caplan, et al. MRI Measurements of the Cervical Spine and Their Correlation to Pavlov’s Ratio. Spine. 2002; 28( 12): 1263–1268.
19. H. isrel, Tassia, Dr.josep, et al. Dan David Laboratory: Dedicated to the search and modern humans: clinical anatomy.2007.
Copyright and Open Access Policy
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
JSSN applies the Creative Commons Attribution (CC BY) license to all works we publish. Under the CC BY license, authors retain ownership of the copyright for their article, but authors allow anyone to download, reuse, reprint, distribute, and/or copy articles in JSSN, so long as the original authors and source are cited. No permission is required from the authors or the publishers.
Article by JSSN is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://www.jssn.org.np/index.php?journal=jssn.