Abstract
In degenerative cervical myelopathy (DCM), focally increased spinal cord motion has been observed for C5/C6, but whether stenoses at other cervical segments lead to similar pathodynamics and how severity of stenosis, age, and gender affect them is still unclear. We report a prospective matched-pair controlled trial on 65 DCM patients. A high-resolution 3D T2 sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) and a phase-contrast magnetic resonance imaging (MRI) sequence were performed and automatically segmented. Anatomical and spinal cord motion data were assessed per segment from C2/C3 to C7/T1. Spinal cord motion was focally increased at a level of stenosis among patients with stenosis at C4/C5 (n = 14), C5/C6 (n = 33), and C6/C7 (n = 10) (p < 0.033). Patients with stenosis at C2/C3 (n = 2) and C3/C4 (n = 6) presented a similar pattern, not reaching significance. Gender was a significant predictor of higher spinal cord dynamics among men with stenosis at C5/C6 (p = 0.048) and C6/C7 (p = 0.033). Age and severity of stenosis did not relate to spinal cord motion. Thus, the data demonstrates focally increased spinal cord motion depending on the specific level of stenosis. Gender-related effects lead to dynamic alterations among men with stenosis at C5/C6 and C6/C7. The missing relation of motion to severity of stenosis underlines a possible additive diagnostic value of spinal cord motion analysis in DCM.
Highlights
The anatomical degenerations of the cervical spine, which may lead to the syndrome of degenerative cervical myelopathy (DCM) are well established [1,2,3,4]
Recent findings based on phase-contrast magnetic resonance imaging (MRI) (PC-MRI) have demonstrated significantly increased craniocaudal spinal cord motion among patients with degenerative cervical myelopathy (DCM) at the most commonly affected segment C5/C6 [8,9,10,11,12]
Relevant stenosis was defined as depleted cerebrospinal fluid (CSF)-space anterior and posterior or marked compression of the spinal cord visually diagnosed in T2-weighted MRI; mild to moderate degeneration at other segments not fulfilling these criteria were accepted
Summary
The anatomical degenerations of the cervical spine, which may lead to the syndrome of degenerative cervical myelopathy (DCM) are well established (e.g., disc protrusions, ossification of ligaments, etc.) [1,2,3,4]. To date and in contrast to the expected dynamic behavior, the extent of spinal cord motion cannot yet be associated to measurements of the severity of spinal stenosis at C5/C6 reflected by the compression ratio (n = 12) [10], or the adapted maximum canal compromise (aMCC; n = 29) [12]. This missing relationship indicates the need of either further refinements of anatomical assessments or the existence of influencing factors beyond local anatomy. MRI-based measurements of spinal cord dynamics may provide additive diagnostic information
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