The impact of disease time, cervical alignment and range of motion on cervical vertebral HU value in surgery patients with cervical spondylosis

The impact of disease time, cervical alignment and range of motion on cervical vertebral HU value in surgery patients with cervical spondylosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The impact of disease time, cervical alignment and range of motion on cervical vertebral HU value in surgery patients with cervical spondylosis zhiqiang wang, Zaowei Zhong, Haoyu Feng, Jun Mei, Xiaoning Feng, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2560666/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Mar, 2023 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 7 You are reading this latest preprint version Abstract Study Design: This study was a retrospective review. Objective: Bone mineral density (BMD) at the surgical site is associated with complications of surgical internal fixation, it is very important to study the cervical BMD of patients with cervical spondylosis who need surgery and the related factors that affect cervical BMD. It is still unclear whether the age-related influence of disease time, cervical alignment, and ROM on cervical vertebral Hounsfield unit (HU) value. Methods： This retrospective study was conducted on patients who underwent cervical surgery at one institution between January 2014 and December 2021. For age, sex, body mass index (BMI), disease type, comorbidities, neck pain, disease time, C2-7 cobb angle (CA), cervical range of motion and the C2-C7 vertebral HU value were recorded. The association between cervical HU value and each parameter of interest was assessed using the Pearson correlation coefficient. Multivariable linear regression analysis was performed to examine the relative influence of the multiple factors on cervical vertebral HU value. Results： Among patients younger than 50 years old, the HU value of the cervical vertebral in females was higher than that in males, but after the age of 50 years old, the female was lower than that in males and decreased significantly after 60 years old. In addition, cervical HU value was significantly correlated with the disease time, flexion CA and ROM. Our age-related subgroup of multivariate linear regression analyses that disease time and flexion CA negative affected C6-7 HU value in more than 60 years old males and in more than 50 years old females. Conclusions： Disease time and flexion CA were negative affecting the C6-7 HU values in more than 60 years old males and in more than 50 years old females. more attention should be paid to bone quality in cervical spondylosis patients with longer disease time and larger convex of flexion CA. Cervical vertebral Bone mineral density Hounsfield units Disease time Flexion C2-7 cobb angle Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction As the elderly population continues to increase and lifestyle changes, the incidence of cervical spondylosis has increased and patients requiring surgical treatment also raised[ 1 ]. Bone mineral density (BMD) at the surgical site is associated with complications of surgical internal fixation, such as screw pullout, titanium mesh cage (TMC) subsidence, pseudarthrosis, and so on[ 2 , 3 ]. therefore, it is very important to study the cervical BMD of patients with cervical spondylosis who need surgery and the related factors that affect cervical BMD. Dual-energy X-ray absorptiometry (DXA) is currently the gold standard for measuring BMD and diagnosing osteoporosis[ 4 ]. However, the BMD is measured in the lumbar spine and femoral neck, Osteoporotic fracture occurs in 10% of patients with a normal T value, and the T value of degenerative diseases cannot accurately reflect the BMD of the patient at the surgical site[ 5 , 6 ]. At present, the application of Hounsfield units (HU) value by computerized tomography (CT) examination for BMD measurement has been applied to the spine. Several reports have shown that the HU value of the cervical vertebral was closely related to BMD and varied significantly among vertebral levels[ 7 – 9 ]. Our previous research suggested that patients with a low HU value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period after anterior cervical corpectomy and fusion[ 10 ]. Therefore, measurement of vertebral HU values at the surgical level may be a more accurate method for assessing regional BMD and predicting complications. BMD is affected by many factors such as age, sex, weight, smoking, genetics, exercise, etc.[ 11 – 13 ]. However, there are few studies on the impact of cervical BMD. Cervical spondylosis with degenerative changes can predispose to cervical spine pathologies such as cervical kyphosis, cervical stiffness, and neck pain. These may affect the alignment of the cervical spine and subject the cervical vertebral to a variety of loads. It has been reported that even during static neutral positions and simple planar movements such as flexion/extension, head weight and neck muscle engagement can create variable loads between the vertebral levels[ 14 , 15 ]. The length of the disease time also affects the pathologies of cervical vertebrae. However, it is still unclear whether the age-related influence of disease time, cervical alignment, and ROM on cervical vertebral HU value in surgery patients with Cervical spondylosis. In this study, we measured the HU value based on preoperative cervical CT and analyzed general patient information and radiologic evaluation, we clarified the age-related influence of disease time, cervical alignment, and ROM on cervical vertebral HU value. Materials And Methods Patient Population This was a retrospective study and was approved by the Ethical Committee of our hospital. We reviewed cervical spondylosis patients undergoing surgery in our hospital between January 2014 and December 2021 in our orthopedic department. The basic information of patients was inquired according to the case system, The disease time was determined according to the patient's complaint in the case system. In this work, the inclusion criteria were as follows: [ 1 ] diagnosis of cervical spondylosis; [ 2 ] patients with preoperative cervical CT and X-ray within 1 week before surgery; [ 3 ] accept cervical surgery at our orthopedic department. The exclusion criteria were as follows: [ 1 ] patients with spine infection, spine tumor, spine trauma, and metabolic bone disease; [ 2 ] merged cervical spine Posterior longitudinal ligament ossification or multiple osteosclerosis; [ 3 ] long-term use of hormones or combined with immune diseases; [ 4 ] patient with nervous system disorders such as demyelinating disease; [ 5 ] a history of previous spinal surgery; [ 6 ] diagnosed with osteoporosis and treated with medication; [ 7 ] incomplete radiologic data. HU Measurements All patients in our hospital underwent three-dimensional reconstructive cervical CT (PHILIPS, Brilliance, slice thickness 1.5 mm, distance 1.5 mm, tube voltage 120 kV) within 1 week before surgery. we use the picture archiving and communication system (PACS) measurement of the C2-C7 HU value. HU values were measured using CT scans according to a previously described method [ 16 ]. the average HU values of each vertebral body based on the axial plane inferior only to the superior endplate, middle of the vertebral body, and axial plane superior only to the inferior endplate. The HU value was measured by placing the largest elliptical region of interest (ROI) at the mid-vertebral body and the ROI was chosen to include as much trabecular bone as possible and to avoid cortical bone and heterogeneous areas, such as cortical bone margins, osteophytes, and osteosclerosis. The average of HU values measured from the three ROIs was regarded as the HU for the individual vertebral. (Fig. 1) Radiographic Measurements Radiologic parameters on plain radiographs of neutral, flexion, and extension included C2-7 cobb angle (CA). Lateral X-ray images were obtained while the patients were standing and in a straightforward position. Flexion and extension radiography was performed with the neck in maximum flexion and extension position. The CA was defined by the cobb angle formed between the lower endplate of C2 and C7. On the cervical spine dynamic X-ray film, parallel lines were drawn along the lower endplate of C2 and the lower endplate of C7 respectively, and the angle between the two parallel lines was the cervical Cobb angle (Convex is a positive value, kyphosis is a negative value). cervical ROM = extension CA –flexion CA. (Fig. 2) Statistical Analysis Statistical analysis was conducted using SPSS software (version 26.0, USA). After an agreement was reached between the observers, each parameter was independently measured twice by 2 orthopedic spine surgeons. Categorical variables are presented as absolute numbers and percentages, and continuous variables are presented as mean ± standard deviations. All data are normally distributed. An analysis of variance (ANOVA) was performed to identify different cervical HU values among inter-group comparisons. The independent sample t-test was used for Intra-group comparison. The association between cervical HU value and each parameter of interest was assessed using the Pearson correlation coefficient (r). The strength of the correlation was classified as negligible (0.00–0.10), weak (0.10–0.39), moderate (0.40–0.69), strong (0.70–0.89) and very strong (0.90–1.00)[ 17 ]. Multivariate linear regression analysis was carried out to examine the age- and sex-related influence of disease time, cervical alignment and ROM on the cervical HU value. P < 0.05 was considered to indicate a statistically significant difference. Results Demographic Characteristics We reviewed 1094 cervical spondylosis patients who underwent surgery between January 2014 and December 2021, a total of 913 patients met the inclusion criteria (Fig. 3). included 563 males and 350 females, with a mean age of 55.98 ± 10.61 years (range, 26–85 years). The average disease time were 22.64 ± 30.98 months in male and 31.89 ± 38.59 months in female. Table 1 illustrates the demographic characteristics of the subjects in this study. Table 1 Demographic characteristics Variable Mean/N Sd/% Age (years) 55.98 10.61 70 74 8.11 Sex Male 563 61.66 70 47 5.15 Female 350 38.34 70 27 2.96 Body mass index (kg/m2) 24.91 5.63 Combined neck pain 315 34.50 Disease time (months) male 22.64 30.98 female 31.89 38.59 Comorbidities 330 36.14 Hypertension 169 18.51 Diabetes 59 6.46 Cardiac disease 25 2.74 Merged 77 8.43 Disease type Radiculopathy 90 9.86 Spondylosis 657 71.96 Mixed 166 18.18 HU value C2 371.86 83.23 C3 360.13 76.28 C4 372.50 79.36 C5 360.93 79.79 C6 319.35 73.40 C7 274.08 61.27 ( Values are the mean and standard deviation or number and percentage. ) The Trend Of C2-c7 Vertebral Hu Value The cervical HU value was different at each level (Fig. 4 & Table 1 ). C2-C5 HU values are maintained at a baseline (ranging from 360.13 ± 76.28 to372.5 ± 79.36), The decrease was obvious at C6 (319.35 ± 73.40), and the C7 vertebral had the minimum HU value (274.08 ± 61.27). Therefore, according to the trend of HU value of C2-C7 cervical vertebral, we divided cervical vertebral HU value into upper cervical vertebral (average HU value of C2-5 vertebral), lower cervical vertebral (average HU value of C6-7 vertebral) and overall cervical vertebral (C2- C7 vertebral average HU value). Table 2 cervical HU values by age and sex grouping ages Sex number of cases C2 C3 C4 C5 C6 C7 average C2-C5 average C6-C7 Average C2-7 <40 66 404.52 ± 81.25 400.02 ± 79.69 414.05 ± 80.54 403.96 ± 79.27 368.75 ± 79.04 313.35 ± 64.93 405.64 ± 78.07 341.05 ± 70.28 384.11 ± 73.88 M 48 385.99 ± 80.57 383.69 ± 77.20 394.95 ± 77.99 381.44 ± 72.59 350.88 ± 77.29 295.92 ± 61.79 386.52 ± 75.13 323.40 ± 67.43 365.48 ± 71.04 F 18 453.94 ± 61.15 443.56 ± 71.02 464.98 ± 64.87 464.02 ± 64.85 416.43 ± 63.75 359.83 ± 49.21 456.63 ± 62.58 388.13 ± 55.60 433.79 ± 57.65 40–50 215 404.18 ± 70.41 390.36 ± 66.32 369.96 ± 77.40 398.70 ± 68.53 356.14 ± 62.29 307.45 ± 50.53 399.96 ± 64.81 331.80 ± 54.72 377.24 ± 60.09 M 125 392.07 ± 65.81 378.98 ± 64.03 393.02 ± 68.37 382.79 ± 65.19 339.89 ± 57.55 292.82 ± 46.10 386.72 ± 61.96 316.36 ± 49.96 363.26 ± 56.51 F 90 420.99 ± 73.45 406.17 ± 66.55 425.49 ± 65.20 420.80 ± 67.24 378.70 ± 61.88 327.78 ± 49.60 418.36 ± 64.50 353.24 ± 54.07 396.65 ± 59.81 51–60 304 373.06 ± 81.65 358.55 ± 74.25 347.29 ± 76.55 358.02 ± 78.60 315.43 ± 68.61 270.18 ± 57.66 364.90 ± 74.47 292.80 ± 61.86 340.86 ± 68.63 M 180 382.44 ± 78.58 364.95 ± 71.96 377.53 ± 74.49 366.05 ± 78.33 320.99 ± 68.48 272.54 ± 56.06 372.74 ± 71.98 296.76 ± 60.80 347.42 ± 66.38 F 124 359.44 ± 84.38 349.25 ± 76.80 358.97 ± 80.48 346.36 ± 77.83 307.36 ± 68.28 266.75 ± 59.99 353.51 ± 76.81 287.06 ± 63.17 331.36 ± 70.95 61–70 254 344.03 ± 83.94 336.13 ± 73.98 347.29 ± 76.55 333.62 ± 73.15 291.53 ± 67.04 250.73 ± 55.01 340.27 ± 73.56 271.13 ± 59.40 317.22 ± 67.35 M 163 367.85 ± 81.94 358.33 ± 71.21 371.88 ± 74.00 357.68 ± 71.46 311.15 ± 66.88 263.88 ± 56.03 363.93 ± 70.51 287.52 ± 59.64 338.46 ± 65.16 F 91 301.37 ± 69.68 296.35 ± 61.35 303.26 ± 59.67 290.52 ± 54.05 256.38 ± 51.35 227.18 ± 44.51 297.87 ± 58.58 241.78 ± 46.46 279.18 ± 53.19 >70 74 339.47 ± 79.02 325.62 ± 70.32 333.25 ± 71.21 318.55 ± 75.27 280.02 ± 68.92 238.24 ± 58.60 329.22 ± 70.68 259.13 ± 61.79 305.86 ± 65.97 M 47 361.12 ± 70.19 347.75 ± 63.80 356.41 ± 65.77 345.28 ± 70.59 310.25 ± 61.87 255.84 ± 59.24 352.64 ± 63.51 283.05 ± 58.40 329.44 ± 59.69 F 27 301.79 ± 80.58 287.09 ± 65.23 292.93 ± 62.65 272.02 ± 59.59 227.40 ± 45.12 207.59 ± 43.55 288.46 ± 64.61 217.49 ± 43.04 264.80 ± 56.20 Sum 913 371.86 ± 83.23 360.13 ± 76.28 372.50 ± 79.36 360.93 ± 79.79 319.35 ± 73.40 274.08 ± 61.27 366.36 ± 76.44 296.71 ± 65.91 343.14 ± 71.45 (Values are the mean ± standard deviation. M: male; F: female.) Influence Of Age And Sex On Cervical Vertebral Hu Value We divided the patients into 5 groups by 10 years old, since we collected fewer cervical surgery patients younger than 30 years and older than 80 years, we included these patients into the less than 40 years groups and more than 70 years groups. First, we observed the cervical vertebral HU value changes with age, the results suggest that the less than 40 age group was no statistical difference compared to the 40–50 age group (P = 1.000,384.11 ± 73.88 vs377.24 ± 60.09), between 60–70 age group and the more than 70 age group were also no statistical difference (P = 1.000, 317.22 ± 67.35 vs 305.86 ± 65.97), the 50–60 age group(340.86 ± 68.63) was significantly different compared to less than 50 and more than 60 age groups(P<0 .0001). (Table 2 & Fig. 5A) Next, we study the effect of sex in different age groups on C2-5, C6-7and C2-7 average HU values. In less than 50 age groups, males had lower total HU values than females(P<0.0001, in the less than 40 age group,365.48 ± 71.04 vs433.79 ± 57.65, in the 40–50 age group, 363.26 ± 56.51 vs 396.65 ± 59.81), whereas in the 50–60 age group, HU values in males started to be higher than in females, the difference was slightly statistically significant in C2-5(P = 0.027,372.74 ± 71.98 vs 353.51 ± 76.81) and C2-7(P = 0.045, 347.42 ± 66.38 vs 331.36 ± 70.95), and there was no statistical difference in C6-7(P = 0.179, 296.76 ± 60.80 vs 287.06 ± 63.17), Indicates that the HU value of the C6-7 may have more obvious changes. In more than 60 age groups, males had higher cervical HU values than females(P<0 .0001, in the 60–70 age group, 338.46 ± 65.16 vs 279.18 ± 53.19, in more than 70 age group, 329.44 ± 59.69 vs 264.80 ± 56.20).(Table 2 & Fig. 5B-D) Then, according to correlation analysis, there were weak but significant negative correlations between age and C2–5 (r=-0.153, p < 0.0001), C6-7 (r=-0.223, p < 0.0001), C2-7 (r =-0.178, p < 0.0001) average HU value in males. However, in females, there was moderate statistical correlation between age and C2-5 (r=-0.630, p < 0.0001), C2-7 (r =-0.658, p < 0.0001) average HU value. Importantly, there were strong correlations between age and C6-7 (r=-0.693, p < 0.0001) average HU value in females. (Fig. 6) Influence Of Disease Time On Cervical Vertebral Hu Value We found that C2-5, C6-7, and C2-7 average HU values decreased with the increased disease time and there were weak but significant negative correlations between disease time and C2–5 (r=-0.145, p < 0.0001), C6-7 (r=-0.154, p < 0.0001), C2-7 (r =-0.151, p < 0.0001) average HU values. (Fig. 7) Influence Of Cervical Alignment And Rom On Cervical Vertebral Hu Value There was negligible but significant correlation between neutral CA and C6-7 (r=-0.078, p = 0.0019) average HU value. Between extension CA and cervical HU value were no significant correlations (p>0.05, respectively). there were significant positive correlations between cervical ROM and cervical HU value, but only the C6-7(r = 0.128, p = 0.0001) average HU value has weak correlations. However, there were weak but significant correlations between flexion CA and C2–5 (r=-0.151, p < 0.0001), C6-7 (r=-0.224, p < 0.0001), C2-7 (r =-0.117, p < 0.0001) average HU value. (Fig. 8) Results Of Subgroup Analysis We next performed subgroup analyses according to age and sex, there were no statistically significant differences in the cervical HU values between the groups less than 40 years old and 40–50 years old and between the groups aged more than 70 years old and 60–70 years old. Therefore, we divided patients into three subgroups: the less than 50 years old, the 50–60 years old, and the more than 60 years old. We performed subgroup analyses to study the influence of disease time, flexion CA, and cervical ROM on the HU value of the cervical. As presented in Table 3 , when C2-5, C6-7, and C2-7 average HU value as the dependent variables, then disease time, flexion CA and cervical ROM were taken together as independent variables. Adjusted for age (not for age subgroup analyses), BMI, neck pain, comorbidities and disease type, our age-related subgroup of multivariate linear regression analyses that disease time and flexion CA negative affected C6-7 HU value in more than 60 years old males and in more than 50 years old females. In other words, the C6-7 average HU value decreases with the longer disease time and larger convex of flexion CA. Whereas disease time, flexion CA and cervical ROM were not affected cervical HU value in less than 60 years old in males and less than 50 years old in females. Table 3 Results of multivariate linear regression analyses Age group dependent variable Independent variables Male Female B SE β p value B SE β p value all C2-5 HU value age -0.850 0.286 -0.134 0.003 -5.264 0.412 -0.615 <0.0001 disease time -0.164 0.097 -0.073 0.093 -0.308 0.095 -0.139 0.001 flexion CA -0.460 0.354 -0.069 0.194 -0.687 0.438 -0.082 0.118 cervical ROM -0.077 0.276 -0.014 0.781 -0.027 0.331 -0.004 0.936 C6-7 HU value age -0.965 0.240 -0.177 <0.0001 -4.906 0.331 -0.658 <0.0001 disease time -0.209 0.082 -0.108 0.011 -0.279 0.076 -0.145 <0.0001 flexion CA -0.818 0.297 -0.142 0.006 -0.892 0.351 -0.122 0.012 cervical ROM -0.041 0.232 -0.009 0.860 -0.139 0.266 -0.025 0.601 C2-7 HU value age -0.888 0.263 -0.151 0.001 -5.144 0.377 -0.637 <0.0001 disease time -0.179 0.090 -0.086 0.047 -0.298 0.087 -0.143 0.001 flexion CA -0.065 0.255 -0.013 0.077 -0.755 0.400 -0.096 0.060 cervical ROM 0.208 0.247 0.039 0.799 -0.064 0.302 -0.011 0.833 <50 C2-5 HU value age -0.425 0.878 -0.039 0.629 -5.732 1.472 -0.392 <0.0001 disease time 0.184 0.195 0.079 0.344 -0.084 0.174 -0.050 0.630 flexion CA 0.056 0.653 0.009 0.931 0.018 0.796 0.003 0.982 cervical ROM 0.207 0.469 0.045 0.659 -0.304 0.584 -0.070 0.604 C6-7 HU value age -1.049 0.726 -0.116 0.150 -4.968 1.247 -0.400 <0.0001 disease time 0.037 0.161 0.019 0.820 0.032 0.148 0.032 0.826 flexion CA -0.274 0.540 -0.052 0.613 -0.140 0.675 -0.027 0.836 cervical ROM 0.169 0.388 0.044 0.663 -0.353 0.495 -0.096 0.477 C2-7 HU value age -0.633 0.809 -0.022 0.435 -5.478 1.365 -0.404 <0.0001 disease time 0.135 0.179 0.063 0.452 -0.045 0.162 -0.029 0.779 flexion CA -0.054 0.602 -0.009 0.929 -0.035 0.738 -0.006 0.963 cervical ROM 0.195 0.432 0.046 0.653 -0.320 0.542 -0.079 0.556 50–60 C2-5 HU value age -0.748 1.951 -0.030 0.702 -10.640 2.376 -0.395 <0.0001 disease time 0.039 0.157 0.020 0.801 -0.343 0.162 -0.179 0.036 flexion CA -0.651 0.685 -0.090 0.344 -0.800 0.770 -0.100 0.301 cervical ROM -0.346 0.555 -0.059 0.533 -0.275 0.578 -0.046 0.635 C6-7 HU value age -0.993 1.585 -0.002 0.545 -7.560 1.919 -0.341 <0.0001 disease time -0.024 0.132 -0.014 0.853 -0.390 0.131 -0.247 0.003 flexion CA -0.868 0.575 -0.142 0.133 -1.305 0.622 -0.198 0.038 cervical ROM -0.295 0.466 -0.060 0.527 -0.379 0.467 -0.077 0.418 C2-7 HU value age -0.829 1.797 -0.036 0.645 -9.613 2.175 -0.386 60 C2-5 HU value age -0.807 0.908 -0.060 0.375 -0.139 1.073 -0.013 0.897 disease time -0.678 0.172 -0.273 <0.0001 -0.361 0.151 -0.220 0.019 flexion CA -0.464 0.547 -0.067 0.398 -1.117 0.668 -0.184 0.097 cervical ROM 0.111 0.445 0.020 0.803 0.761 0.528 0.157 0.153 C6-7 HU value age -0.102 0.769 -0.009 0.895 -1.593 0.784 -0.185 0.045 disease time -0.587 0.145 -0.275 <0.0001 -0.365 0.111 -0.285 0.001 flexion CA -0.984 0.463 -0.167 0.035 -1.072 0.488 -0.226 0.030 cervical ROM 0.177 0.377 0.037 0.639 0.615 0.386 0.163 0.114 C2-7 HU value age -0.572 0.837 -0.046 0.495 -0.624 0.951 -0.063 0.513 disease time -0.648 0.158 -0.281 <0.0001 -0.362 0.134 -0.245 0.008 flexion CA -0.637 0.504 -0.100 0.208 -1.102 0.592 -0.201 0.065 cervical ROM 0.133 0.410 0.0269 0.746 0.712 0.468 0.163 0.131 (Adjusted for age (not for age subgroup analyses), BMI, neck pain, comorbidities, and disease type. Bold values indicate statistically significant. BMI, neck pain, comorbidities, and disease type data are not shown.) Discussion In this retrospective study, we clarify the age-related influences of disease time, cervical alignment, and ROM on the cervical HU value. Importantly, cervical HU value was significantly correlated with the disease time, flexion CA and cervical ROM. In addition, disease time and flexion CA were negative affecting the C6-7 HU value in more than 60 years old males and in more than 50 years old females. Our results found that cervical vertebral HU value varies by level, C2-C5 HU values are maintained at a baseline, the decrease was obvious at C6 and the C7 vertebral had the minimum HU value. Our cervical HU values are similar to previous investigations in the cervical spine[ 18 , 19 ]. Francis[ 18 ] et al examined 201 cervical spines CTs and reported mean C2-C7 HU values remarkably similar to ours, suggesting that the lowest HU scores in the lower cervical spine, which may partially explain the high rate of mechanical complications in multilevel anterior fusions. Because the BMD of the cervical is closely related to perioperative complications and patients with osteoporosis were more likely to undergo revision surgery with implant failure[ 20 ]. Our study divided cervical vertebral HU value into upper cervical vertebral (average HU value of C2-5 vertebral), lower cervical vertebral (average HU value of C6-7 vertebral), and overall cervical vertebral (C2- C7 vertebral average HU value). It is better to study the influence of different factors on cervical BMD according to bone characteristics. The effect of age and sex on bone quality has been confirmed by many studies[ 5 , 21 ]. we found that cervical HU value significantly decreased with age, especially in females. Our results suggest that the less than 40 age group was no statistical difference compared to the 40–50 age group, between 60–70 age group and the more than 70 age group also no statistical difference, the 50–60 age group was significantly different compared to less than 50 and more than 60 age groups. Females lose more bone during perimenopause, in less than 50 age groups, males had lower total HU values than females, whereas, in the 50–60 age group, HU values in males started to be higher than in females, especially in C6-7. In more than 60 age groups, males had higher total HU values than females. similar results were reported in previous investigations[ 4 , 22 , 23 ]. Therefore, according to age, we performed subgroup analysis to analyze the impact of disease time, flexion CA and cervical ROM on cervical HU value. Our study showed that cervical HU values decreased with increased disease time and there were weak but significant negative correlations. Multivariate analyses suggest that the C6-7 HU value was affected by disease time. Gou et al[ 24 ] suggest that the duration of symptoms was an independent risk factor for poor post-operative efficacy in patients with degenerative cervical myelopathy. Another study showed that intervertebral disc degeneration is related to osteopenia of adjacent vertebrae[ 25 ]. We think it may be due to the influence of the cervical on the mechanical duration of the pathological state and the disease time of long-term cervical loading may affect bone mineral density. Our correlation analysis demonstrated that flexion CA and cervical ROM were significantly associated with the cervical HU value, especially in the C6-7 HU value. A mechanical study showed that compression increases cranially to caudally throughout the cervical spine. Conversely, in a neutral posture, there is a constant anterior shear at each joint level. Compression increased twofold throughout the cervical with flexion[ 26 ]. In response to these different long-term loading patterns, the bone tissue adapts among vertebral levels. BMD may be influenced to a greater extent by the type and direction of shear, torsion, and bending loading. Clinical studies indicate that the incidence of disc degeneration was most severely seen at C5/C6 and C6/C7 discs and significantly increased with age[ 27 ]. Another study showed that cervical flexion is associated with neck pain worse, the patient may avoid flexion to reduce pain resulting in decreased flexion[ 28 ]. Taken together, our findings confirm the effect of flexion CA on the C6-7 HU value, especially in more than 60 years old males and in more than 50 years old females. This study has several limitations. First, this study did not consider all clinical factors (BMI, ethnicity, smoking, etc.), and patient symptoms such as neck pain, neck stiffness were not available, additional studies are necessary. Second, we did not conduct a DXA examination, which is no proven association between DXA and HU values in the present study. Third, the number of subjects aged less than 30 and more than 80 years was small, the results in the age population may be less accurate in those age groups. Fourth, we collected disease time from our hospital's case data, some patients' symptoms may not be persistent and disease severity not be quantified. Fifth, the upper and lower cervical was anatomically complex and there may be other influencing factors that affect the HU value of the cervical. Last but not least, in this study, the HU value and clinical data were obtained from a single hospital, prospective multicenter investigations are further needed to account for other factors to extend our results. In summary, we found that disease time and flexion CA were negative affecting the C6-7 HU values in more than 60 years old males and in more than 50 years old females. Therefore, surgeons should pay more attention to bone quality in those patients with longer disease time and larger convex of flexion CA. Abbreviations ROM range of motion HU Hounsfield units CT computed tomography TMC titanium mesh cage BMD bone mineral density DXA Dual-energy X-ray absorptiometry ROI region of interest PACS the picture archiving and communication system CA C2-7 cobb angle. Declarations Ethical approval and consent to participate This study was reviewed by the Scientific Research Ethics Committee of Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) and ethical approval was obtained (NO. SBQLL-2022-047). All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by Scientific Research Ethics Committee of Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences). Informed consent was obtained from all subjects or their legal guardians. Consent for publication Not applicable. Availability of data and materials The datasets and materials supporting the conclusions of this article are included within the article, further inquiries can be directed to the corresponding author. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding Not applicable. Author’s contributions ZQW, and LS designed this study. ZWZ reviewed electronic patient records. LS, and HYF performed surgeries. XNF, JM performed radiographic analysis. BYW performed data analysis and interpretation. ZQW prepared the manuscript, tables, and figures. All authors have read and approved the final manuscript. Acknowledgements Not applicable. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. References Badhiwala, J.H., C.S. Ahuja, M.A. Akbar, C.D. Witiw, F. Nassiri, J.C. Furlan, A. Curt, J.R. Wilson, and M.G. Fehlings Degenerative cervical myelopathy - update and future directions. Nat Rev Neurol.2020; 16 (2):108–124. Chang, H.K., J. Ku, J. Ku, Y.H. Kuo, C.C. Chang, C.L. Wu, J.F. Lirng, J.C. Wu, W.C. Huang, H. Cheng, and S.M. Hsu Correlation of bone density to screw loosening in dynamic stabilization: an analysis of 176 patients. Sci Rep.2021; 11 (1):17519. Pinto, E.M., J.R. Neves, A. Teixeira, R. Frada, P. Atilano, F. Oliveira, T. Veigas, and A. Miranda Efficacy of Hounsfield Units Measured by Lumbar Computer Tomography on Bone Density Assessment: A Systematic Review. Spine (Phila Pa 1976).2022; 47 (9):702–710. Kanis, J.A. Diagnosis of osteoporosis and assessment of fracture risk. Lancet.2002; 359 (9321):1929–36. Oka, R., M. Ohira, S. Suzuki, T. Yoshida, H. Koide, T. Tanaka, and I. Tatsuno Fracture risk assessment tool (FRAX) and for the diagnosis of osteoporosis in Japanese middle-aged and elderly women: Chiba bone survey. Endocr J.2018; 65 (2):193–202. Grampp, S., H.K. Genant, A. Mathur, P. Lang, M. Jergas, M. Takada, C.C. Gluer, Y. Lu, and M. Chavez Comparisons of noninvasive bone mineral measurements in assessing age-related loss, fracture discrimination, and diagnostic classification. J Bone Miner Res.1997; 12 (5):697–711. Sebro, R. and C. De la Garza-Ramos Utilizing machine learning for opportunistic screening for low BMD using CT scans of the cervical spine. J Neuroradiol.2022. Tang, R., I.B. Ye, Z.B. Cheung, J.S. Kim, and S.K. Cho Age-related Changes in Cervical Sagittal Alignment: A Radiographic Analysis. Spine (Phila Pa 1976).2019; 44 (19):E1144-E1150. Han, K., S.T. You, H.J. Lee, I.S. Kim, J.T. Hong, and J.H. Sung Hounsfield unit measurement method and related factors that most appropriately reflect bone mineral density on cervical spine computed tomography. Skeletal Radiol.2022; 51 (10):1987–1993. Wang, Z., J. Mei, X. Feng, C. Deng, X. Tian, J. Lv, and L. Sun Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion. J Orthop Surg Res.2022; 17 (1):355. Azimi-Shomali, S., A. Farshbaf-Khalili, F. Eslamian, N. Dolatkhah, and N. Ghassab-Abdollahi The Relationship Between Usual Daily Physical Activity With Serum Markers Related to Bone Metabolism and Demographic Characteristics in Postmenopausal Women Aged 50–65 Years. J Phys Act Health.2022; 19 (6):417–424. Kanto, A., Y. Kotani, K. Murakami, J. Tamaki, Y. Sato, S. Kagamimori, N. Matsumura, and M. Iki Risk factors for future osteoporosis in perimenopausal Japanese women. Menopause.2022. Deng, G., L. Yin, K. Li, B. Hu, X. Cheng, L. Wang, Y. Zhang, L. Xu, S. Xu, L. Zhu, J. Shao, X. Hao, J. Zhou, J. Tang, W. Li, Y. Jiang, and X. Cheng Relationships between anthropometric adiposity indexes and bone mineral density in a cross-sectional Chinese study. Spine J.2021; 21 (2):332–342. Liu, F., J. Cheng, R.D. Komistek, M.R. Mahfouz, and A. Sharma In vivo evaluation of dynamic characteristics of the normal, fused, and disc replacement cervical spines. Spine (Phila Pa 1976).2007; 32 (23):2578–84. Pospiech, J., D. Stolke, H.J. Wilke, and L.E. Claes Intradiscal pressure recordings in the cervical spine. Neurosurgery.1999; 44 (2):379–84; discussion 384-5. Schreiber, J.J., P.A. Anderson, H.G. Rosas, A.L. Buchholz, and A.G. Au Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am.2011; 93 (11):1057–63. Schober, P., C. Boer, and L.A. Schwarte Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg.2018; 126 (5):1763–1768. Lovecchio, F., B. Ang, P.K. Louie, C. Chaudary, S.P. Shah, A. Punyala, Y.C. Yao, M. Steinhaus, M.H. McCarthy, R. Huang, D. Lebl, V. Lafage, T.J. Albert, S. Iyer, S. Qureshi, and H.J. Kim Bone Density Distribution in the Cervical Spine. Global Spine J.2022:21925682221098965. Wang, M., P.V. Mummaneni, Z. Xi, C.C. Chang, J. Rivera, J. Guinn, R. Mayer, and D. Chou Lower Hounsfield units on CT are associated with cage subsidence after anterior cervical discectomy and fusion. J Neurosurg Spine.2020:1–8. Guzman, J.Z., Z.M. Feldman, S. McAnany, A.C. Hecht, S.A. Qureshi, and S.K. Cho Osteoporosis in Cervical Spine Surgery. Spine (Phila Pa 1976).2016; 41 (8):662–8. Dalzell, N., S. Kaptoge, N. Morris, A. Berthier, B. Koller, L. Braak, B. van Rietbergen, and J. Reeve Bone micro-architecture and determinants of strength in the radius and tibia: age-related changes in a population-based study of normal adults measured with high-resolution pQCT. Osteoporos Int.2009; 20 (10):1683–94. Yong, E.L. and S. Logan Menopausal osteoporosis: screening, prevention and treatment. Singapore Med J.2021; 62 (4):159–166. Wang, Y., Y. Tao, M.E. Hyman, J. Li, and Y. Chen Osteoporosis in china. Osteoporos Int.2009; 20 (10):1651–62. Guo, S., T. Lin, R. Wu, Z. Wang, G. Chen, and W. Liu The Pre-Operative Duration of Symptoms: The Most Important Predictor of Post-Operative Efficacy in Patients with Degenerative Cervical Myelopathy. Brain Sci.2022; 12 (8). Liang, X., Q. Liu, J. Xu, W. Ding, and H. Wang Hounsfield Unit for Assessing Bone Mineral Density Distribution Within Cervical Vertebrae and Its Correlation With the Intervertebral Disc Degeneration. Front Endocrinol (Lausanne).2022; 13 :920167. Barrett, J.M., C. McKinnon, and J.P. Callaghan Cervical spine joint loading with neck flexion. Ergonomics.2020; 63 (1):101–108. Tao, Y., F. Galbusera, F. Niemeyer, R. Jonas, D. Samartzis, D. Vogele, and H.J. Wilke The impact of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis: a large-scale radiologic study. Eur Spine J.2021; 30 (9):2434–2442. Mousavi-Khatir, R., S. Talebian, N. Toosizadeh, G.R. Olyaei, and N. Maroufi The effect of static neck flexion on mechanical and neuromuscular behaviors of the cervical spine. J Biomech.2018; 72 :152–158. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Mar, 2023 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Major revision 24 Feb, 2023 Reviews received at journal 10 Feb, 2023 Reviewers agreed at journal 09 Feb, 2023 Reviewers invited by journal 09 Feb, 2023 Editor assigned by journal 07 Feb, 2023 Submission checks completed at journal 07 Feb, 2023 First submitted to journal 07 Feb, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2560666","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":174290630,"identity":"0c82cd2c-cfbc-43d4-9d97-463352e81507","order_by":0,"name":"zhiqiang wang","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"zhiqiang","middleName":"","lastName":"wang","suffix":""},{"id":174290631,"identity":"d363cd4b-a671-4073-ad8e-c500029ada25","order_by":1,"name":"Zaowei Zhong","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zaowei","middleName":"","lastName":"Zhong","suffix":""},{"id":174290632,"identity":"d3a63a12-79a9-4a89-9777-55daee78d313","order_by":2,"name":"Haoyu Feng","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haoyu","middleName":"","lastName":"Feng","suffix":""},{"id":174290633,"identity":"49b733d0-96e5-4f6c-9321-1116df2ac76d","order_by":3,"name":"Jun Mei","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Mei","suffix":""},{"id":174290634,"identity":"3b935eec-03d0-4b4a-bca0-80df94dea726","order_by":4,"name":"Xiaoning Feng","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoning","middleName":"","lastName":"Feng","suffix":""},{"id":174290635,"identity":"aef22992-003c-4451-85ae-9519d59131e4","order_by":5,"name":"Beiyang Wang","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Beiyang","middleName":"","lastName":"Wang","suffix":""},{"id":174290636,"identity":"ef9dd986-03e2-4c33-a516-ac1d0e97d677","order_by":6,"name":"Lin Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYHACxgMJDAxy/OzNBx8kVNQQpwekxViy51iywYMzx4jUAsSJG27kmEk+bGEmrFx+Ru6BAw93QLRUJDawMfC3dyfg1WJwIy/hQOIZBuOZZ56V3UjcIcMgcebsBvxaJHIMDiS2Mcj2HU/ediPxDBtQJBe/FvkZEC2MDQcSzAoS25gJa2G4AdGiOOFEihkDUVoMzrwBawEHskTCmWM8BP0i355j+PBnGyQqP/6oqJHjb+8l4DAI+A9n8RCjfBSMglEwCkYBAQAAwTtQ6BwjTX8AAAAASUVORK5CYII=","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Lin","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2023-02-07 14:59:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2560666/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2560666/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13018-023-03675-y","type":"published","date":"2023-03-10T19:31:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":32710028,"identity":"72cf4057-b47d-400c-a18d-a99ef42814c6","added_by":"auto","created_at":"2023-02-09 15:14:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10706132,"visible":true,"origin":"","legend":"\u003cp\u003eMid-sagittal(A) and axial CT images demonstrating the measurement of vertebral HU value on the axial plane inferior only to the superior endplate(B), middle of the vertebral(C), and axial plane superior only to the inferior endplate(D). (The first letter C stands for cervical vertebra, which consists of seven segments from top to bottom, denoted by C1-C7, the same as T1)\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/4805b7e0bd305067cc7d9fbd.png"},{"id":32710032,"identity":"36e8a607-132f-440b-9ee7-76237641512f","added_by":"auto","created_at":"2023-02-09 15:14:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8886274,"visible":true,"origin":"","legend":"\u003cp\u003eRadiologic parameters on plain radiographs of neutral(A), flexion(B) and extension(C)included C2-7 cobb angle (CA).\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/ea756d96f3f94282bd4936ae.png"},{"id":32712105,"identity":"2ccf838a-db13-4f17-87bb-db72d044422c","added_by":"auto","created_at":"2023-02-09 15:30:54","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":166476,"visible":true,"origin":"","legend":"\u003cp\u003eA flowchart of patients was included in the study.\u003c/p\u003e","description":"","filename":"figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/db984d10d631f76cca4a287c.jpg"},{"id":32711715,"identity":"429dc824-ec1b-4b99-89a8-d25e2a56d399","added_by":"auto","created_at":"2023-02-09 15:22:54","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":302725,"visible":true,"origin":"","legend":"\u003cp\u003eThe trend of C2-C7 vertebral HU value. C2-C5 HU values are maintained at a baseline, The decrease was obvious at C6 and the C7 vertebral had the minimum HU value.\u003c/p\u003e","description":"","filename":"figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/c45c5b54a7788fef52675842.png"},{"id":32710030,"identity":"1620f9a1-8661-45fd-8e68-8272c0977409","added_by":"auto","created_at":"2023-02-09 15:14:54","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":773891,"visible":true,"origin":"","legend":"\u003cp\u003ebox plots showing the trend of cervical spine HU value with age groups(A) and the median value and range of C2-5(B), C6-7(C), C2-7(D) average HU value by age and sex (****indicates significant difference between males and females, p \u0026lt; 0.0001)\u003c/p\u003e","description":"","filename":"figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/470a148b5bb57f374bb729cc.png"},{"id":32710027,"identity":"0c050d23-fa2f-4cc6-9e75-6711df178980","added_by":"auto","created_at":"2023-02-09 15:14:54","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":553346,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between age and C2-5(A), C6-7(B), and C2-7(C)average HU value in males and females.\u003c/p\u003e","description":"","filename":"figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/236429d3399dc380637ac2a2.png"},{"id":32710025,"identity":"1a580f62-9294-4ed3-80bd-fd92e2df198c","added_by":"auto","created_at":"2023-02-09 15:14:54","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":92347,"visible":true,"origin":"","legend":"\u003cp\u003ecorrelation analysis between disease time and C2-5, C6-7, C2-7 vertebral HU value.\u003c/p\u003e","description":"","filename":"figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/a02e8b83272263b84c99ba97.png"},{"id":32711717,"identity":"af5c53d8-a28d-4794-9254-6caa5be53876","added_by":"auto","created_at":"2023-02-09 15:22:54","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":1930201,"visible":true,"origin":"","legend":"\u003cp\u003ecorrelation analysis between neutral(A), flexion(B), extension (C) CA, cervical ROM(D), and cervical HU value.\u003c/p\u003e","description":"","filename":"figure8.png","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/45486d0a81ece25bf661e14f.png"},{"id":44721707,"identity":"660703f4-d0c5-4069-80da-bcb63eebf83f","added_by":"auto","created_at":"2023-10-16 19:39:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5709991,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2560666/v1/edf773f1-5641-4780-a297-1d434b72c607.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The impact of disease time, cervical alignment and range of motion on cervical vertebral HU value in surgery patients with cervical spondylosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs the elderly population continues to increase and lifestyle changes, the incidence of cervical spondylosis has increased and patients requiring surgical treatment also raised[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Bone mineral density (BMD) at the surgical site is associated with complications of surgical internal fixation, such as screw pullout, titanium mesh cage (TMC) subsidence, pseudarthrosis, and so on[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. therefore, it is very important to study the cervical BMD of patients with cervical spondylosis who need surgery and the related factors that affect cervical BMD.\u003c/p\u003e \u003cp\u003eDual-energy X-ray absorptiometry (DXA) is currently the gold standard for measuring BMD and diagnosing osteoporosis[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the BMD is measured in the lumbar spine and femoral neck, Osteoporotic fracture occurs in 10% of patients with a normal T value, and the T value of degenerative diseases cannot accurately reflect the BMD of the patient at the surgical site[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. At present, the application of Hounsfield units (HU) value by computerized tomography (CT) examination for BMD measurement has been applied to the spine. Several reports have shown that the HU value of the cervical vertebral was closely related to BMD and varied significantly among vertebral levels[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Our previous research suggested that patients with a low HU value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period after anterior cervical corpectomy and fusion[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, measurement of vertebral HU values at the surgical level may be a more accurate method for assessing regional BMD and predicting complications.\u003c/p\u003e \u003cp\u003eBMD is affected by many factors such as age, sex, weight, smoking, genetics, exercise, etc.[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, there are few studies on the impact of cervical BMD. Cervical spondylosis with degenerative changes can predispose to cervical spine pathologies such as cervical kyphosis, cervical stiffness, and neck pain. These may affect the alignment of the cervical spine and subject the cervical vertebral to a variety of loads. It has been reported that even during static neutral positions and simple planar movements such as flexion/extension, head weight and neck muscle engagement can create variable loads between the vertebral levels[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The length of the disease time also affects the pathologies of cervical vertebrae. However, it is still unclear whether the age-related influence of disease time, cervical alignment, and ROM on cervical vertebral HU value in surgery patients with Cervical spondylosis.\u003c/p\u003e \u003cp\u003eIn this study, we measured the HU value based on preoperative cervical CT and analyzed general patient information and radiologic evaluation, we clarified the age-related influence of disease time, cervical alignment, and ROM on cervical vertebral HU value.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003ePatient Population\u003c/h2\u003e\n\u003cp\u003eThis was a retrospective study and was approved by the Ethical Committee of our hospital. We reviewed cervical spondylosis patients undergoing surgery in our hospital between January 2014 and December 2021 in our orthopedic department. The basic information of patients was inquired according to the case system, The disease time was determined according to the patient's complaint in the case system. In this work, the inclusion criteria were as follows: [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e] diagnosis of cervical spondylosis; [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e] patients with preoperative cervical CT and X-ray within 1 week before surgery; [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e] accept cervical surgery at our orthopedic department. The exclusion criteria were as follows: [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e] patients with spine infection, spine tumor, spine trauma, and metabolic bone disease; [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e] merged cervical spine Posterior longitudinal ligament ossification or multiple osteosclerosis; [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e] long-term use of hormones or combined with immune diseases; [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e] patient with nervous system disorders such as demyelinating disease; [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e] a history of previous spinal surgery; [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e] diagnosed with osteoporosis and treated with medication; [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e] incomplete radiologic data.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eHU Measurements\u003c/h3\u003e\n\u003cp\u003eAll patients in our hospital underwent three-dimensional reconstructive cervical CT (PHILIPS, Brilliance, slice thickness 1.5 mm, distance 1.5 mm, tube voltage 120 kV) within 1 week before surgery. we use the picture archiving and communication system (PACS) measurement of the C2-C7 HU value. HU values were measured using CT scans according to a previously described method [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. the average HU values of each vertebral body based on the axial plane inferior only to the superior endplate, middle of the vertebral body, and axial plane superior only to the inferior endplate. The HU value was measured by placing the largest elliptical region of interest (ROI) at the mid-vertebral body and the ROI was chosen to include as much trabecular bone as possible and to avoid cortical bone and heterogeneous areas, such as cortical bone margins, osteophytes, and osteosclerosis. The average of HU values measured from the three ROIs was regarded as the HU for the individual vertebral. (Fig.\u0026nbsp;1)\u003c/p\u003e\n\u003ch3\u003eRadiographic Measurements\u003c/h3\u003e\n\u003cp\u003eRadiologic parameters on plain radiographs of neutral, flexion, and extension included C2-7 cobb angle (CA). Lateral X-ray images were obtained while the patients were standing and in a straightforward position. Flexion and extension radiography was performed with the neck in maximum flexion and extension position. The CA was defined by the cobb angle formed between the lower endplate of C2 and C7. On the cervical spine dynamic X-ray film, parallel lines were drawn along the lower endplate of C2 and the lower endplate of C7 respectively, and the angle between the two parallel lines was the cervical Cobb angle (Convex is a positive value, kyphosis is a negative value). cervical ROM\u0026thinsp;=\u0026thinsp;extension CA \u0026ndash;flexion CA. (Fig.\u0026nbsp;2)\u003c/p\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eStatistical analysis was conducted using SPSS software (version 26.0, USA). After an agreement was reached between the observers, each parameter was independently measured twice by 2 orthopedic spine surgeons. Categorical variables are presented as absolute numbers and percentages, and continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations. All data are normally distributed. An analysis of variance (ANOVA) was performed to identify different cervical HU values among inter-group comparisons. The independent sample t-test was used for Intra-group comparison. The association between cervical HU value and each parameter of interest was assessed using the Pearson correlation coefficient (r). The strength of the correlation was classified as negligible (0.00\u0026ndash;0.10), weak (0.10\u0026ndash;0.39), moderate (0.40\u0026ndash;0.69), strong (0.70\u0026ndash;0.89) and very strong (0.90\u0026ndash;1.00)[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. Multivariate linear regression analysis was carried out to examine the age- and sex-related influence of disease time, cervical alignment and ROM on the cervical HU value. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate a statistically significant difference.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eDemographic Characteristics\u003c/h3\u003e\n\u003cp\u003eWe reviewed 1094 cervical spondylosis patients who underwent surgery between January 2014 and December 2021, a total of 913 patients met the inclusion criteria (Fig.\u0026nbsp;3). included 563 males and 350 females, with a mean age of 55.98\u0026thinsp;\u0026plusmn;\u0026thinsp;10.61 years (range, 26\u0026ndash;85 years). The average disease time were 22.64\u0026thinsp;\u0026plusmn;\u0026thinsp;30.98 months in male and 31.89\u0026thinsp;\u0026plusmn;\u0026thinsp;38.59 months in female. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the demographic characteristics of the subjects in this study.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic characteristics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean/N\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSd/%\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e(years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.61\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.22\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e215\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23.55\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e304\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33.30\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026ndash;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e254\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27.82\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e563\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e61.66\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.26\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13.69\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e180\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19.71\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026ndash;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17.85\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.15\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e350\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38.34\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.97\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.86\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13.58\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026ndash;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.97\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.96\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBody mass index\u003c/strong\u003e(kg/m2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.63\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCombined neck pain\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e315\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDisease time\u003c/strong\u003e(months)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30.98\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003efemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38.59\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e330\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36.14\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e169\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18.51\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.46\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiac disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.74\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMerged\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.43\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDisease type\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRadiculopathy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.86\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpondylosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e657\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71.96\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMixed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e166\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHU value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eC2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e371.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e83.23\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eC3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e360.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e76.28\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eC4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e372.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79.36\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eC5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e360.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79.79\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eC6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e319.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e73.40\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eC7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e274.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e61.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003e\u003cstrong\u003e(\u003c/strong\u003eValues are the mean and standard deviation or number and percentage.\u003cstrong\u003e)\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe Trend Of C2-c7 Vertebral Hu Value\u003c/p\u003e\n\u003cp\u003eThe cervical HU value was different at each level (Fig.\u0026nbsp;4 \u0026amp; Table\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). C2-C5 HU values are maintained at a baseline (ranging from 360.13\u0026thinsp;\u0026plusmn;\u0026thinsp;76.28 to372.5\u0026thinsp;\u0026plusmn;\u0026thinsp;79.36), The decrease was obvious at C6 (319.35\u0026thinsp;\u0026plusmn;\u0026thinsp;73.40), and the C7 vertebral had the minimum HU value (274.08\u0026thinsp;\u0026plusmn;\u0026thinsp;61.27). Therefore, according to the trend of HU value of C2-C7 cervical vertebral, we divided cervical vertebral HU value into upper cervical vertebral (average HU value of C2-5 vertebral), lower cervical vertebral (average HU value of C6-7 vertebral) and overall cervical vertebral (C2- C7 vertebral average HU value).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ecervical HU values by age and sex grouping\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eages\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003enumber of cases\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC2\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC3\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC4\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC5\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC6\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC7\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eaverage C2-C5\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eaverage C6-C7\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAverage C2-7\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e404.52\u0026thinsp;\u0026plusmn;\u0026thinsp;81.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e400.02\u0026thinsp;\u0026plusmn;\u0026thinsp;79.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e414.05\u0026thinsp;\u0026plusmn;\u0026thinsp;80.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e403.96\u0026thinsp;\u0026plusmn;\u0026thinsp;79.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e368.75\u0026thinsp;\u0026plusmn;\u0026thinsp;79.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e313.35\u0026thinsp;\u0026plusmn;\u0026thinsp;64.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e405.64\u0026thinsp;\u0026plusmn;\u0026thinsp;78.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e341.05\u0026thinsp;\u0026plusmn;\u0026thinsp;70.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e384.11\u0026thinsp;\u0026plusmn;\u0026thinsp;73.88\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e385.99\u0026thinsp;\u0026plusmn;\u0026thinsp;80.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e383.69\u0026thinsp;\u0026plusmn;\u0026thinsp;77.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e394.95\u0026thinsp;\u0026plusmn;\u0026thinsp;77.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e381.44\u0026thinsp;\u0026plusmn;\u0026thinsp;72.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e350.88\u0026thinsp;\u0026plusmn;\u0026thinsp;77.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e295.92\u0026thinsp;\u0026plusmn;\u0026thinsp;61.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e386.52\u0026thinsp;\u0026plusmn;\u0026thinsp;75.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e323.40\u0026thinsp;\u0026plusmn;\u0026thinsp;67.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e365.48\u0026thinsp;\u0026plusmn;\u0026thinsp;71.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e453.94\u0026thinsp;\u0026plusmn;\u0026thinsp;61.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e443.56\u0026thinsp;\u0026plusmn;\u0026thinsp;71.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e464.98\u0026thinsp;\u0026plusmn;\u0026thinsp;64.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e464.02\u0026thinsp;\u0026plusmn;\u0026thinsp;64.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e416.43\u0026thinsp;\u0026plusmn;\u0026thinsp;63.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e359.83\u0026thinsp;\u0026plusmn;\u0026thinsp;49.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e456.63\u0026thinsp;\u0026plusmn;\u0026thinsp;62.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e388.13\u0026thinsp;\u0026plusmn;\u0026thinsp;55.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e433.79\u0026thinsp;\u0026plusmn;\u0026thinsp;57.65\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e215\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e404.18\u0026thinsp;\u0026plusmn;\u0026thinsp;70.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e390.36\u0026thinsp;\u0026plusmn;\u0026thinsp;66.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e369.96\u0026thinsp;\u0026plusmn;\u0026thinsp;77.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e398.70\u0026thinsp;\u0026plusmn;\u0026thinsp;68.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e356.14\u0026thinsp;\u0026plusmn;\u0026thinsp;62.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e307.45\u0026thinsp;\u0026plusmn;\u0026thinsp;50.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e399.96\u0026thinsp;\u0026plusmn;\u0026thinsp;64.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e331.80\u0026thinsp;\u0026plusmn;\u0026thinsp;54.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e377.24\u0026thinsp;\u0026plusmn;\u0026thinsp;60.09\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e392.07\u0026thinsp;\u0026plusmn;\u0026thinsp;65.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e378.98\u0026thinsp;\u0026plusmn;\u0026thinsp;64.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e393.02\u0026thinsp;\u0026plusmn;\u0026thinsp;68.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e382.79\u0026thinsp;\u0026plusmn;\u0026thinsp;65.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e339.89\u0026thinsp;\u0026plusmn;\u0026thinsp;57.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e292.82\u0026thinsp;\u0026plusmn;\u0026thinsp;46.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e386.72\u0026thinsp;\u0026plusmn;\u0026thinsp;61.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e316.36\u0026thinsp;\u0026plusmn;\u0026thinsp;49.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e363.26\u0026thinsp;\u0026plusmn;\u0026thinsp;56.51\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e420.99\u0026thinsp;\u0026plusmn;\u0026thinsp;73.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e406.17\u0026thinsp;\u0026plusmn;\u0026thinsp;66.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e425.49\u0026thinsp;\u0026plusmn;\u0026thinsp;65.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e420.80\u0026thinsp;\u0026plusmn;\u0026thinsp;67.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e378.70\u0026thinsp;\u0026plusmn;\u0026thinsp;61.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e327.78\u0026thinsp;\u0026plusmn;\u0026thinsp;49.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e418.36\u0026thinsp;\u0026plusmn;\u0026thinsp;64.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e353.24\u0026thinsp;\u0026plusmn;\u0026thinsp;54.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e396.65\u0026thinsp;\u0026plusmn;\u0026thinsp;59.81\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e51\u0026ndash;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e304\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e373.06\u0026thinsp;\u0026plusmn;\u0026thinsp;81.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e358.55\u0026thinsp;\u0026plusmn;\u0026thinsp;74.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e347.29\u0026thinsp;\u0026plusmn;\u0026thinsp;76.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e358.02\u0026thinsp;\u0026plusmn;\u0026thinsp;78.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e315.43\u0026thinsp;\u0026plusmn;\u0026thinsp;68.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e270.18\u0026thinsp;\u0026plusmn;\u0026thinsp;57.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e364.90\u0026thinsp;\u0026plusmn;\u0026thinsp;74.47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e292.80\u0026thinsp;\u0026plusmn;\u0026thinsp;61.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e340.86\u0026thinsp;\u0026plusmn;\u0026thinsp;68.63\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e180\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e382.44\u0026thinsp;\u0026plusmn;\u0026thinsp;78.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e364.95\u0026thinsp;\u0026plusmn;\u0026thinsp;71.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e377.53\u0026thinsp;\u0026plusmn;\u0026thinsp;74.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e366.05\u0026thinsp;\u0026plusmn;\u0026thinsp;78.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e320.99\u0026thinsp;\u0026plusmn;\u0026thinsp;68.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e272.54\u0026thinsp;\u0026plusmn;\u0026thinsp;56.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e372.74\u0026thinsp;\u0026plusmn;\u0026thinsp;71.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e296.76\u0026thinsp;\u0026plusmn;\u0026thinsp;60.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e347.42\u0026thinsp;\u0026plusmn;\u0026thinsp;66.38\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e359.44\u0026thinsp;\u0026plusmn;\u0026thinsp;84.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e349.25\u0026thinsp;\u0026plusmn;\u0026thinsp;76.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e358.97\u0026thinsp;\u0026plusmn;\u0026thinsp;80.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e346.36\u0026thinsp;\u0026plusmn;\u0026thinsp;77.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e307.36\u0026thinsp;\u0026plusmn;\u0026thinsp;68.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e266.75\u0026thinsp;\u0026plusmn;\u0026thinsp;59.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e353.51\u0026thinsp;\u0026plusmn;\u0026thinsp;76.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e287.06\u0026thinsp;\u0026plusmn;\u0026thinsp;63.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e331.36\u0026thinsp;\u0026plusmn;\u0026thinsp;70.95\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e61\u0026ndash;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e254\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e344.03\u0026thinsp;\u0026plusmn;\u0026thinsp;83.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e336.13\u0026thinsp;\u0026plusmn;\u0026thinsp;73.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e347.29\u0026thinsp;\u0026plusmn;\u0026thinsp;76.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e333.62\u0026thinsp;\u0026plusmn;\u0026thinsp;73.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e291.53\u0026thinsp;\u0026plusmn;\u0026thinsp;67.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e250.73\u0026thinsp;\u0026plusmn;\u0026thinsp;55.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e340.27\u0026thinsp;\u0026plusmn;\u0026thinsp;73.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e271.13\u0026thinsp;\u0026plusmn;\u0026thinsp;59.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e317.22\u0026thinsp;\u0026plusmn;\u0026thinsp;67.35\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e367.85\u0026thinsp;\u0026plusmn;\u0026thinsp;81.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e358.33\u0026thinsp;\u0026plusmn;\u0026thinsp;71.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e371.88\u0026thinsp;\u0026plusmn;\u0026thinsp;74.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e357.68\u0026thinsp;\u0026plusmn;\u0026thinsp;71.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e311.15\u0026thinsp;\u0026plusmn;\u0026thinsp;66.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e263.88\u0026thinsp;\u0026plusmn;\u0026thinsp;56.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e363.93\u0026thinsp;\u0026plusmn;\u0026thinsp;70.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e287.52\u0026thinsp;\u0026plusmn;\u0026thinsp;59.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e338.46\u0026thinsp;\u0026plusmn;\u0026thinsp;65.16\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e301.37\u0026thinsp;\u0026plusmn;\u0026thinsp;69.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e296.35\u0026thinsp;\u0026plusmn;\u0026thinsp;61.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e303.26\u0026thinsp;\u0026plusmn;\u0026thinsp;59.67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e290.52\u0026thinsp;\u0026plusmn;\u0026thinsp;54.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e256.38\u0026thinsp;\u0026plusmn;\u0026thinsp;51.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e227.18\u0026thinsp;\u0026plusmn;\u0026thinsp;44.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e297.87\u0026thinsp;\u0026plusmn;\u0026thinsp;58.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e241.78\u0026thinsp;\u0026plusmn;\u0026thinsp;46.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e279.18\u0026thinsp;\u0026plusmn;\u0026thinsp;53.19\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e339.47\u0026thinsp;\u0026plusmn;\u0026thinsp;79.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e325.62\u0026thinsp;\u0026plusmn;\u0026thinsp;70.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e333.25\u0026thinsp;\u0026plusmn;\u0026thinsp;71.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e318.55\u0026thinsp;\u0026plusmn;\u0026thinsp;75.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e280.02\u0026thinsp;\u0026plusmn;\u0026thinsp;68.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e238.24\u0026thinsp;\u0026plusmn;\u0026thinsp;58.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e329.22\u0026thinsp;\u0026plusmn;\u0026thinsp;70.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e259.13\u0026thinsp;\u0026plusmn;\u0026thinsp;61.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e305.86\u0026thinsp;\u0026plusmn;\u0026thinsp;65.97\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e361.12\u0026thinsp;\u0026plusmn;\u0026thinsp;70.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e347.75\u0026thinsp;\u0026plusmn;\u0026thinsp;63.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e356.41\u0026thinsp;\u0026plusmn;\u0026thinsp;65.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e345.28\u0026thinsp;\u0026plusmn;\u0026thinsp;70.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e310.25\u0026thinsp;\u0026plusmn;\u0026thinsp;61.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e255.84\u0026thinsp;\u0026plusmn;\u0026thinsp;59.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e352.64\u0026thinsp;\u0026plusmn;\u0026thinsp;63.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e283.05\u0026thinsp;\u0026plusmn;\u0026thinsp;58.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e329.44\u0026thinsp;\u0026plusmn;\u0026thinsp;59.69\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e301.79\u0026thinsp;\u0026plusmn;\u0026thinsp;80.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e287.09\u0026thinsp;\u0026plusmn;\u0026thinsp;65.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e292.93\u0026thinsp;\u0026plusmn;\u0026thinsp;62.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e272.02\u0026thinsp;\u0026plusmn;\u0026thinsp;59.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e227.40\u0026thinsp;\u0026plusmn;\u0026thinsp;45.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e207.59\u0026thinsp;\u0026plusmn;\u0026thinsp;43.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e288.46\u0026thinsp;\u0026plusmn;\u0026thinsp;64.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e217.49\u0026thinsp;\u0026plusmn;\u0026thinsp;43.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e264.80\u0026thinsp;\u0026plusmn;\u0026thinsp;56.20\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e913\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e371.86\u0026thinsp;\u0026plusmn;\u0026thinsp;83.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e360.13\u0026thinsp;\u0026plusmn;\u0026thinsp;76.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e372.50\u0026thinsp;\u0026plusmn;\u0026thinsp;79.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e360.93\u0026thinsp;\u0026plusmn;\u0026thinsp;79.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e319.35\u0026thinsp;\u0026plusmn;\u0026thinsp;73.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e274.08\u0026thinsp;\u0026plusmn;\u0026thinsp;61.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e366.36\u0026thinsp;\u0026plusmn;\u0026thinsp;76.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e296.71\u0026thinsp;\u0026plusmn;\u0026thinsp;65.91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e343.14\u0026thinsp;\u0026plusmn;\u0026thinsp;71.45\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"12\"\u003e(Values are the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. M: male; F: female.)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eInfluence Of Age And Sex On Cervical Vertebral Hu Value\u003c/h3\u003e\n\u003cp\u003eWe divided the patients into 5 groups by 10 years old, since we collected fewer cervical surgery patients younger than 30 years and older than 80 years, we included these patients into the less than 40 years groups and more than 70 years groups.\u003c/p\u003e\n\u003cp\u003eFirst, we observed the cervical vertebral HU value changes with age, the results suggest that the less than 40 age group was no statistical difference compared to the 40\u0026ndash;50 age group (P\u0026thinsp;=\u0026thinsp;1.000,384.11\u0026thinsp;\u0026plusmn;\u0026thinsp;73.88 vs377.24\u0026thinsp;\u0026plusmn;\u0026thinsp;60.09), between 60\u0026ndash;70 age group and the more than 70 age group were also no statistical difference (P\u0026thinsp;=\u0026thinsp;1.000, 317.22\u0026thinsp;\u0026plusmn;\u0026thinsp;67.35 vs 305.86\u0026thinsp;\u0026plusmn;\u0026thinsp;65.97), the 50\u0026ndash;60 age group(340.86\u0026thinsp;\u0026plusmn;\u0026thinsp;68.63) was significantly different compared to less than 50 and more than 60 age groups(P\u0026lt;0 .0001). (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;5A)\u003c/p\u003e\n\u003cp\u003eNext, we study the effect of sex in different age groups on C2-5, C6-7and C2-7 average HU values. In less than 50 age groups, males had lower total HU values than females(P\u0026lt;0.0001, in the less than 40 age group,365.48\u0026thinsp;\u0026plusmn;\u0026thinsp;71.04 vs433.79\u0026thinsp;\u0026plusmn;\u0026thinsp;57.65, in the 40\u0026ndash;50 age group, 363.26\u0026thinsp;\u0026plusmn;\u0026thinsp;56.51 vs 396.65\u0026thinsp;\u0026plusmn;\u0026thinsp;59.81), whereas in the 50\u0026ndash;60 age group, HU values in males started to be higher than in females, the difference was slightly statistically significant in C2-5(P\u0026thinsp;=\u0026thinsp;0.027,372.74\u0026thinsp;\u0026plusmn;\u0026thinsp;71.98 vs 353.51\u0026thinsp;\u0026plusmn;\u0026thinsp;76.81) and C2-7(P\u0026thinsp;=\u0026thinsp;0.045, 347.42\u0026thinsp;\u0026plusmn;\u0026thinsp;66.38 vs 331.36\u0026thinsp;\u0026plusmn;\u0026thinsp;70.95), and there was no statistical difference in C6-7(P\u0026thinsp;=\u0026thinsp;0.179, 296.76\u0026thinsp;\u0026plusmn;\u0026thinsp;60.80 vs 287.06\u0026thinsp;\u0026plusmn;\u0026thinsp;63.17), Indicates that the HU value of the C6-7 may have more obvious changes. In more than 60 age groups, males had higher cervical HU values than females(P\u0026lt;0 .0001, in the 60\u0026ndash;70 age group, 338.46\u0026thinsp;\u0026plusmn;\u0026thinsp;65.16 vs 279.18\u0026thinsp;\u0026plusmn;\u0026thinsp;53.19, in more than 70 age group, 329.44\u0026thinsp;\u0026plusmn;\u0026thinsp;59.69 vs 264.80\u0026thinsp;\u0026plusmn;\u0026thinsp;56.20).(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;5B-D)\u003c/p\u003e\n\u003cp\u003eThen, according to correlation analysis, there were weak but significant negative correlations between age and C2\u0026ndash;5 (r=-0.153, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), C6-7 (r=-0.223, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), C2-7 (r =-0.178, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) average HU value in males. However, in females, there was moderate statistical correlation between age and C2-5 (r=-0.630, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), C2-7 (r =-0.658, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) average HU value. Importantly, there were strong correlations between age and C6-7 (r=-0.693, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) average HU value in females. (Fig.\u0026nbsp;6)\u003c/p\u003e\n\u003cp\u003eInfluence Of Disease Time On Cervical Vertebral Hu Value\u003c/p\u003e\n\u003cp\u003eWe found that C2-5, C6-7, and C2-7 average HU values decreased with the increased disease time and there were weak but significant negative correlations between disease time and C2\u0026ndash;5 (r=-0.145, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), C6-7 (r=-0.154, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), C2-7 (r =-0.151, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) average HU values. (Fig.\u0026nbsp;7)\u003c/p\u003e\n\u003cp\u003eInfluence Of Cervical Alignment And Rom On Cervical Vertebral Hu Value\u003c/p\u003e\n\u003cp\u003eThere was negligible but significant correlation between neutral CA and C6-7 (r=-0.078, p\u0026thinsp;=\u0026thinsp;0.0019) average HU value. Between extension CA and cervical HU value were no significant correlations (p\u0026gt;0.05, respectively). there were significant positive correlations between cervical ROM and cervical HU value, but only the C6-7(r\u0026thinsp;=\u0026thinsp;0.128, p\u0026thinsp;=\u0026thinsp;0.0001) average HU value has weak correlations. However, there were weak but significant correlations between flexion CA and C2\u0026ndash;5 (r=-0.151, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), C6-7 (r=-0.224, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), C2-7 (r =-0.117, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) average HU value. (Fig.\u0026nbsp;8)\u003c/p\u003e\n\u003ch3\u003eResults Of Subgroup Analysis\u003c/h3\u003e\n\u003cp\u003eWe next performed subgroup analyses according to age and sex, there were no statistically significant differences in the cervical HU values between the groups less than 40 years old and 40\u0026ndash;50 years old and between the groups aged more than 70 years old and 60\u0026ndash;70 years old. Therefore, we divided patients into three subgroups: the less than 50 years old, the 50\u0026ndash;60 years old, and the more than 60 years old. We performed subgroup analyses to study the influence of disease time, flexion CA, and cervical ROM on the HU value of the cervical.\u003c/p\u003e\n\u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, when C2-5, C6-7, and C2-7 average HU value as the dependent variables, then disease time, flexion CA and cervical ROM were taken together as independent variables. Adjusted for age (not for age subgroup analyses), BMI, neck pain, comorbidities and disease type, our age-related subgroup of multivariate linear regression analyses that disease time and flexion CA negative affected C6-7 HU value in more than 60 years old males and in more than 50 years old females. In other words, the C6-7 average HU value decreases with the longer disease time and larger convex of flexion CA. Whereas disease time, flexion CA and cervical ROM were not affected cervical HU value in less than 60 years old in males and less than 50 years old in females.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eResults of multivariate linear regression analyses\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAge group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003edependent variable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eIndependent variables\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"12\" align=\"left\"\u003e\n\u003cp\u003eall\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC2-5 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.850\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.286\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-5.264\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.412\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.615\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.164\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.097\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.073\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.093\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.308\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.095\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.460\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.354\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.069\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.194\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.687\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.438\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.082\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.118\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.077\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.276\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.781\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.027\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.331\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.936\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC6-7 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.965\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.240\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.177\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-4.906\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.331\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.658\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.209\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.082\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.279\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.076\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.145\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.818\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.297\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.892\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.351\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.041\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.232\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.860\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.266\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.601\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC2-7 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.888\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.263\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-5.144\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.377\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.637\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.090\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.086\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.298\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.087\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.143\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.065\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.255\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.077\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.755\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.096\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.060\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.208\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.039\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.799\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.064\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.302\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.833\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"12\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC2-5 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.425\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.878\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.039\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.629\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-5.732\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.472\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.392\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.184\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.079\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.344\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.084\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.050\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.630\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.056\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.653\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.931\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.796\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.982\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.207\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.469\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.045\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.659\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.304\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.584\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.070\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.604\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC6-7 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.049\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.726\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.116\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-4.968\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.161\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.820\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.148\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.826\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.274\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.540\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.052\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.613\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.140\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.675\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.027\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.836\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.169\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.388\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.044\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.663\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.353\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.495\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.096\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.477\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC2-7 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.633\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.809\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.435\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-5.478\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.404\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.063\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.452\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.045\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.162\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.029\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.779\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.054\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.602\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.929\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.035\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.738\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.963\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.432\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.046\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.653\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.320\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.542\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.079\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.556\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"12\" align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC2-5 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.748\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.951\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.030\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.702\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-10.640\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.376\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.395\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.039\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.157\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.801\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.343\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.162\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.036\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.651\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.685\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.090\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.344\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.800\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.770\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.301\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.346\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.555\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.533\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.578\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.046\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.635\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC6-7 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.993\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.585\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.545\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-7.560\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.919\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.341\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.132\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.853\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.390\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.868\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.575\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.305\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.622\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.198\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.295\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.466\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.060\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.527\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.379\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.467\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.077\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.418\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC2-7 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.829\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.797\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.645\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-9.613\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.175\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.386\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.363\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.286\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.900\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.359\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.148\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.202\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.723\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.631\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.254\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.969\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.705\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.172\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.329\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.511\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.061\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.520\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.310\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.529\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.056\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.559\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"12\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt;60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC2-5 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.807\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.908\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.060\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.375\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.073\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.897\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.678\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.172\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.273\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.361\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.220\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.464\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.547\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.067\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.398\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.668\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.184\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.097\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.445\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.803\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.761\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.528\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.157\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.153\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC6-7 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.769\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.895\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.593\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.784\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.185\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.045\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.587\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.145\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.285\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.984\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.463\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.072\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.488\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.226\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.030\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.177\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.377\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.639\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.615\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.386\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.114\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eC2-7 HU value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.572\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.837\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.046\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.495\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.624\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.951\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.063\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.513\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edisease time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.648\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.158\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.281\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.362\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.245\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eflexion CA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.637\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.504\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.208\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.592\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.065\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecervical ROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.410\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0269\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.746\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.712\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.468\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.131\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"11\"\u003e(Adjusted for age (not for age subgroup analyses), BMI, neck pain, comorbidities, and disease type. Bold values indicate statistically significant. BMI, neck pain, comorbidities, and disease type data are not shown.)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective study, we clarify the age-related influences of disease time, cervical alignment, and ROM on the cervical HU value. Importantly, cervical HU value was significantly correlated with the disease time, flexion CA and cervical ROM. In addition, disease time and flexion CA were negative affecting the C6-7 HU value in more than 60 years old males and in more than 50 years old females.\u003c/p\u003e \u003cp\u003eOur results found that cervical vertebral HU value varies by level, C2-C5 HU values are maintained at a baseline, the decrease was obvious at C6 and the C7 vertebral had the minimum HU value. Our cervical HU values are similar to previous investigations in the cervical spine[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Francis[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] et al examined 201 cervical spines CTs and reported mean C2-C7 HU values remarkably similar to ours, suggesting that the lowest HU scores in the lower cervical spine, which may partially explain the high rate of mechanical complications in multilevel anterior fusions. Because the BMD of the cervical is closely related to perioperative complications and patients with osteoporosis were more likely to undergo revision surgery with implant failure[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our study divided cervical vertebral HU value into upper cervical vertebral (average HU value of C2-5 vertebral), lower cervical vertebral (average HU value of C6-7 vertebral), and overall cervical vertebral (C2- C7 vertebral average HU value). It is better to study the influence of different factors on cervical BMD according to bone characteristics.\u003c/p\u003e \u003cp\u003eThe effect of age and sex on bone quality has been confirmed by many studies[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. we found that cervical HU value significantly decreased with age, especially in females. Our results suggest that the less than 40 age group was no statistical difference compared to the 40\u0026ndash;50 age group, between 60\u0026ndash;70 age group and the more than 70 age group also no statistical difference, the 50\u0026ndash;60 age group was significantly different compared to less than 50 and more than 60 age groups. Females lose more bone during perimenopause, in less than 50 age groups, males had lower total HU values than females, whereas, in the 50\u0026ndash;60 age group, HU values in males started to be higher than in females, especially in C6-7. In more than 60 age groups, males had higher total HU values than females. similar results were reported in previous investigations[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Therefore, according to age, we performed subgroup analysis to analyze the impact of disease time, flexion CA and cervical ROM on cervical HU value.\u003c/p\u003e \u003cp\u003eOur study showed that cervical HU values decreased with increased disease time and there were weak but significant negative correlations. Multivariate analyses suggest that the C6-7 HU value was affected by disease time. Gou et al[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] suggest that the duration of symptoms was an independent risk factor for poor post-operative efficacy in patients with degenerative cervical myelopathy. Another study showed that intervertebral disc degeneration is related to osteopenia of adjacent vertebrae[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. We think it may be due to the influence of the cervical on the mechanical duration of the pathological state and the disease time of long-term cervical loading may affect bone mineral density.\u003c/p\u003e \u003cp\u003eOur correlation analysis demonstrated that flexion CA and cervical ROM were significantly associated with the cervical HU value, especially in the C6-7 HU value. A mechanical study showed that compression increases cranially to caudally throughout the cervical spine. Conversely, in a neutral posture, there is a constant anterior shear at each joint level. Compression increased twofold throughout the cervical with flexion[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In response to these different long-term loading patterns, the bone tissue adapts among vertebral levels. BMD may be influenced to a greater extent by the type and direction of shear, torsion, and bending loading. Clinical studies indicate that the incidence of disc degeneration was most severely seen at C5/C6 and C6/C7 discs and significantly increased with age[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Another study showed that cervical flexion is associated with neck pain worse, the patient may avoid flexion to reduce pain resulting in decreased flexion[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Taken together, our findings confirm the effect of flexion CA on the C6-7 HU value, especially in more than 60 years old males and in more than 50 years old females.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, this study did not consider all clinical factors (BMI, ethnicity, smoking, etc.), and patient symptoms such as neck pain, neck stiffness were not available, additional studies are necessary. Second, we did not conduct a DXA examination, which is no proven association between DXA and HU values in the present study. Third, the number of subjects aged less than 30 and more than 80 years was small, the results in the age population may be less accurate in those age groups. Fourth, we collected disease time from our hospital's case data, some patients' symptoms may not be persistent and disease severity not be quantified. Fifth, the upper and lower cervical was anatomically complex and there may be other influencing factors that affect the HU value of the cervical. Last but not least, in this study, the HU value and clinical data were obtained from a single hospital, prospective multicenter investigations are further needed to account for other factors to extend our results.\u003c/p\u003e \u003cp\u003eIn summary, we found that disease time and flexion CA were negative affecting the C6-7 HU values in more than 60 years old males and in more than 50 years old females. Therefore, surgeons should pay more attention to bone quality in those patients with longer disease time and larger convex of flexion CA.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erange of motion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHounsfield units\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etitanium mesh cage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebone mineral density\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDXA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDual-energy X-ray absorptiometry\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eregion of interest\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePACS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe picture archiving and communication system\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eC2-7 cobb angle.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed by the Scientific Research Ethics Committee of Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) and ethical approval was obtained (NO. SBQLL-2022-047). All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by Scientific Research Ethics Committee of Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences). Informed consent was obtained from all subjects or their legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets and materials supporting the conclusions of this article are included within the article, further inquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZQW, and LS designed this study. ZWZ reviewed electronic patient records. LS, and HYF performed surgeries. XNF, JM performed radiographic analysis. BYW performed data analysis and interpretation. ZQW prepared the manuscript, tables, and figures. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Conflicting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBadhiwala, J.H., C.S. Ahuja, M.A. Akbar, C.D. Witiw, F. Nassiri, J.C. Furlan, A. Curt, J.R. Wilson, and M.G. Fehlings Degenerative cervical myelopathy - update and future directions. 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J Biomech.2018; \u003cb\u003e72\u003c/b\u003e:152\u0026ndash;158.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cervical vertebral, Bone mineral density, Hounsfield units, Disease time, Flexion C2-7 cobb angle","lastPublishedDoi":"10.21203/rs.3.rs-2560666/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2560666/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy Design: \u003c/strong\u003e\u0026nbsp;This study was a retrospective review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003e\u0026nbsp;Bone mineral density (BMD) at the surgical site is associated with complications of surgical internal fixation, it is very important to study the cervical BMD of patients with cervical spondylosis who need surgery and the related factors that affect cervical BMD. It is still unclear whether the age-related influence of disease time, cervical alignment, and ROM on cervical vertebral Hounsfield unit (HU) value.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods：\u003c/strong\u003e This retrospective study was conducted on patients who underwent cervical surgery at one institution between January 2014 and December 2021. For age, sex, body mass index (BMI), disease type, comorbidities, neck pain, disease time, C2-7 cobb angle (CA), cervical range of motion and the C2-C7 vertebral HU value were recorded. The association between cervical HU value and each parameter of interest was assessed using the Pearson correlation coefficient. Multivariable linear regression analysis was performed to examine the relative influence of the multiple factors on cervical vertebral HU value.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults：\u003c/strong\u003e Among patients younger than 50 years old, the HU value of the cervical vertebral in females was higher than that in males, but after the age of 50 years old, the female was lower than that in males and decreased significantly after 60 years old. In addition, cervical HU value was significantly correlated with the disease time, flexion CA and ROM. Our age-related subgroup of multivariate linear regression analyses that disease time and flexion CA negative affected C6-7 HU value in more than 60 years old males and in more than 50 years old females.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions：\u003c/strong\u003e Disease time and flexion CA were negative affecting the C6-7 HU values in more than 60 years old males and in more than 50 years old females. more attention should be paid to bone quality in cervical spondylosis patients with longer disease time and larger convex of flexion CA.\u003c/p\u003e","manuscriptTitle":"The impact of disease time, cervical alignment and range of motion on cervical vertebral HU value in surgery patients with cervical spondylosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-02-09 15:14:49","doi":"10.21203/rs.3.rs-2560666/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-02-24T09:29:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-02-10T08:50:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25e74f8f-f760-4128-bf0c-0a254c8b908c","date":"2023-02-09T13:15:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-02-09T08:55:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-02-08T03:44:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-02-08T02:19:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2023-02-07T14:52:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"182d7eb1-79de-48bf-ba4b-530e5cc039bb","owner":[],"postedDate":"February 9th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T19:35:21+00:00","versionOfRecord":{"articleIdentity":"rs-2560666","link":"https://doi.org/10.1186/s13018-023-03675-y","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2023-03-10 19:31:18","publishedOnDateReadable":"March 10th, 2023"},"versionCreatedAt":"2023-02-09 15:14:49","video":"","vorDoi":"10.1186/s13018-023-03675-y","vorDoiUrl":"https://doi.org/10.1186/s13018-023-03675-y","workflowStages":[]},"version":"v1","identity":"rs-2560666","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2560666","identity":"rs-2560666","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}