374 Feasibility of Postoperative Diffusion Weighted Imaging to Assess Neural Recovery in Cervical Spondylotic Myelopathy

Abstract

INTRODUCTION: Following decompressive surgery for cervical spondylotic myelopathy (CSM), advanced diffusion-weighted MRI, such as diffusion basis spectrum imaging (DBSI), may hold significant value by quantifying and tracking spinal cord microstructure. However, there is a paucity of studies investigating this topic, likely due to challenges in resolving signal distortions from spinal instrumentation. METHODS: A single-center prospective study enrolled 50 CSM patients and 20 control patients. All patients underwent preoperative and repeat diffusion-weighted MRI at two-year follow-up. All CSM patients underwent decompressive cervical surgery. DBSI metrics were extracted from the C3 spinal cord level only to minimize image artifact and reduce partial volume effects. DBSI anisotropic tensors evaluated white matter tracts through fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. DBSI isotropic tensors assessed extra-axonal pathology through restricted and non-restricted fraction. RESULTS: Of 50 CSM patients, 27 patients underwent both baseline and postoperative diffusion-weighted MRI scans with sufficient quality for analysis. This included 15 mild, 7 moderate, and 5 severe CSM patients, who were followed up to 23.2 (5.6, range 11.1-32.8) months. All preoperative C3 DBSI measures were significantly different between CSM and control patients (p < 0.001), except DBSI fractional anisotropy (p = 0.31). At two-year follow-up, the same significance pattern was found, except DBSI radial diffusivity lost statistical significance (p = 0.75). When assessing change in C3 DBSI measures, CSM patients exhibited significant decreases in DBSI radial diffusivity (p = 0.02). Among control patients, there was no significant difference in DBSI metrics between timepoints. CONCLUSIONS: DBSI may have potential in the postoperative setting to inform clinicians of white matter tract recovery after decompressive cervical surgery for CSM.