Morphological changes in nerve rootlets in patients with cervical radiculopathy assessed using computed tomography myelogram

BACKGROUND: There are only a few reports that utilize computed tomography myelogram (CTM) to define cervical nerve rootlet compromise in patients with radiculopathy. Here, we assessed the characteristic morphological changes in nerve rootlets in 32 cases with cervical radiculopathy by analyzing CTMs warranting anterior foraminotomy. METHODS: CTMs were analyzed to elucidate morphological changes in nerve rootlets in 31 patients/32 cases with cervical radiculopathy. Notably, three of the four neurosurgeons evaluating these CTM had to agree on the presence of “significant” changes consisting of contrast-enhanced defects near the entrance of the intervertebral foramen on axial sections. RESULTS: Our findings included; posterior deviation of the ventral rootlet on the sagittal section (63%), ventral rootlet meandering or horizontalization (52%), and dorsal rootlet meandering (39%) on the coronal section. Furthermore, 16% of cervical nerve rootlets may exhibit an abnormal course proximal to the compression site (i.e., the definition of the “rootlet stagnation sign”). CONCLUSION: CTM better defines the anatomy, pathology, and radiology impacting the anterior or posterior cervical roots in patients presenting with cervical radiculopathy.