Normal cervical spine morphometry and cervical spinal stenosis in asymptomatic professional football players. Plain film radiography, multiplanar computed tomography, and magnetic resonance imaging.

Diagnosis of cervical spinal stenosis or instability rests on the objective findings depicted on static and dynamic radiographs. Before abnormal spinal morphometry can be determined, it is first necessary to establish normal values for the specific patient population being evaluated. Several studies have attempted to establish norms for plain film measurements of the cervical spine in children and adults, but few have applied consistent methods for generating precise measurements. The first part of this study established normal values for cervical spinal morphometry and segmental spinal motion in the elite athlete. The second part of this study determined the most accurate screening method for detecting cervical spinal stenosis. Three sagittal diameters of the cervical spinal canal were compared to determine which represented the smallest midline diameter on static and dynamic radiographs. The Torg ratio was also evaluated as a method to detect significant cervical spinal stenosis and was shown to have a high sensitivity but poor positive predictive value. The study clarified why the ratio yields a large number of false positive cases. From the results of this study, an algorithm has been developed for the evaluation of stenosis of the cervical spine in athletes.