Cervical Spinal Canal Stenosis: A Comparison of Incidence and Severity Between the Population of Curaçao and Literature

Introduction: Degenerative spine conditions are the most common cause of spinal cord injury in the elderly population and comprises, degenerative disc disease, cervical spondylotic myelopathy (CSM), ossification, and hypertrophy of the spinal ligaments, which may result in cervical spinal canal stenosis(CSCS).
To assess the incidence and severity of CSCS, based on morphologic parameters of the spinal canal and spinal cord, in the population of Curaçao compared to literature. In addition, the prevalence of ossification of the posterior longitudinal and flavum ligaments (OPLL/OLF) was calculated and compared to literature.

Methods: Retrospective descriptive study analyzing data gathered from patients with known symptomatic CSCS as confirmed on MRI scans, from 01-2017 until 12-2020. The anterio-posterior diameter, cross-sectional surface area of the spinal canal, spinal cord and dural sac were measured at mid-vertebral and intervertebral disc level on MRI scans. The degree of OPLL and OLF were assessed on CT scans. Additionally, the annual incidence of CSCS was calculated.

Results: 278 patients (155 males) were recruited. The annual incidence of CSCS was 55.9/100 000 people, which is 13-fold higher compared to literature findings. In men and women, the narrowest spinal canal was at C4-C5 with a mean diameter of 8.2mm and 8.5mm, respectively. The mean diameter at non-stenotic levels was 12.9mm at mid-vertebral level and 11.8mm at disc level, being consistently lower than the internationally accepted 13mm threshold defining normality versus stenosis. The prevalence of OPLL and OLF was 4.7%(n=13) and 2.5%(n=7), respectively, which is comparable with reports from Asia, but higher compared to USA cohorts.

Conclusion : The annual incidence of CSCS in the population of Curaçao was substantially higher compared to reports from North America and Western Europe. Remarkably, the diameter at non-stenotic cervical levels were consistently below 13mm, and the prevalence of OPLL/OLF were similar to Asians, but higher compared to Caucasians.