Abstract
In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Twenty patients and 18 controls were assessed with high-resolution MRI protocols above the level of stenosis. Cross-sectional areas of grey matter (GM), white matter (WM), and posterior columns (PC) were measured to determine atrophy. Diffusion indices assessed tract-specific integrity of PC and lateral corticospinal tracts (CST). Regression analysis was used to reveal relationships between MRI measures and clinical impairment. Patients showed mainly sensory impairment. Atrophy was prominent within the cervical WM (13.9%, p = 0.004), GM (7.2%, p = 0.043), and PC (16.1%, p = 0.005). Fractional anisotropy (FA) was reduced in the PC (−11.98%, p = 0.006) and lateral CST (−12.96%, p = 0.014). In addition, radial (+28.47%, p = 0.014), axial (+14.72%, p = 0.005), and mean (+16.50%, p = 0.001) diffusivities were increased in the PC. Light-touch score was associated with atrophy (R2 = 0.3559, p = 0.020) and FA (z score 3.74, p = 0.003) in the PC, as was functional independence and FA in the lateral CST (z score 3.68, p = 0.020). This study demonstrates voxel-based degeneration far above the stenosis at a level not directly affected by the compression and provides unbiased readouts of tract-specific changes that relate to impairment.
Highlights
In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM)
Impairment was assessed on the modified Japanese Orthopaedic Association score which identified ten patients suffering from mild, nine from moderate and one from severe Cervical spondylotic myelopathy (CSM)
We found that the intra-subject variability was about Δ-fractional anisotropy (FA) = 0.02, which is 3% when compared to the reported averaged FA values in the spinal cord (0.02/0.66*100 = 3%)
Summary
We made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Neurological impairment is mainly caused through chronic cord compression and deterioration of blood supply triggering degeneration of neural tissue in grey and white matter in the spinal cord at the level of stenosis[2,3]. For example the advent of a common anatomical spinal cord template[7], probabilistic tracts[7], and optimization of post-processing techniques[8] have opened the avenue for unbiased voxel-based morphometry (VBM) analysis (i.e. without an a priori hypothesis) of volumetric as well. As microstructural changes[7,8] This enables the spatial localization of cord pathology and the determination of its relation with clinical impairment[9,10]
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