Cervical Compressive Myelopathy Research Articles

Outcome associated with use of winged expandable titanium cage following cervical corpectomy: an institutional experience

BackgroundIn patients with spinal cord compression behind the cervical vertebra who presented with myelopathy, one of the treatment modalities is anterior cervical corpectomy followed by insertion of graft or implant. Autogenous bone graft has been the choice of implant for corpectomy in the past, but due to donor site complications, it has been majorly replaced with other implants like titanium made expandable and non-expandable cages. Studies on titanium made implants for cervical compressive myelopathy have mostly focused on expandable cages with separate plates. Studies on hybrid cages and winged expandable titanium cages with (WETC) are lacking, especially in patients with poor Nurick grade. Here, we present clinical outcomes and side effects of WETC use following cervical corpectomy in 81 participants from a tertiary care center from Eastern India with 6 months of follow-up.ResultsWe observed a considerable improvement in clinical outcomes which was measured using Nurick grade as mean scores changed from 4.06 ± 0.85 during the pre-operative stage to 2.85 ± 1.16 post-operation (P < 0.05). There was also a considerable improvement in the pain status as in the pre-operative stage there were three patients with mild pain, 53 with moderate and 25 with severe pain, but post-operation there were 53 patients with mild pain, only two with moderate pain and none with severe pain (P < 0.00001). In these participants, we observed that post-surgical Nurick grade was not associated with age, gender or time since first symptoms but was strongly associated with pre-surgical Nurick grade at P < 0.05.ConclusionWith WETC (in situ plate), we were able to obtain good outcomes with less serious complication in patients with poor Nurick grade. As size of implant is prefixed and can be expanded in WETC, it takes relatively less time to insert, thus leading to shorter operative time. With good endplate preparation and avoiding over expansion of cage, WETC avoids complications.

Long-term results of treatment of a patient with basilar invagination complicated by distal kyphosis and compressive ischemic cervical myelopathy: a clinical case and a brief literature review

Objective. To present a clinical case of surgical correction of a craniovertebral anomaly complicated after 8 years by distal junctional kyphosis, stenosis, antelisthesis of the C5 vertebra and compressive ischemic cervical myelopathy in the C5–C6 segment.Material and Methods. When treating a 56-year-old patient with multiple anomalies of the craniovertebral region, differentiated surgical technologies were consistently used due to the development of late complications. The sequence and rationale for surgical decision making is described.Results. Initially, the patient underwent transoral decompression and posterior occipitocervical fixation, and after 8 years - reinstallation of the system with distal extension of the instrumentation zone to the C7 vertebra with indirect posterior decompression of the spinal cord, anterior discectomy with direct decompression and cage fixation at the C5–C6 level. Regression of myelopathic syndrome, correction of orthopedic status and significant improvement in functional status were achieved.Conclusion. A rare clinical observation demonstrates a combination of basilar invagination with assimilation of the atlas, which has provided rationale for two-stage surgical treatment in one surgical session (1st stage – transoral resection of the dens and 2/3 of the C2 vertebral body with anterior decompression of the spinal cord, and 2nd stage – occipitocervical fixation). The use of extended systems in this case caused the development of a clinically significant syndrome of the distal adjacent level, which required repeated surgical treatment after 8 years.

Evaluation of Epiconus and Conus Medullaris Disorders due to Thoracolumbar Vertebral Fracture using Motor Evoked Potentials.

A retrospective case-control study. To characterize the motor evoked potential (MEP) when the epiconus or conus medullaris is compressed by a fracture of the T12 or L1 vertebra. Although the characteristics of compressive cervical and thoracic myelopathy with transcranial magnetic stimulation MEP have been reported, the MEP parameters in compressive disorders of the epiconus and conus medullaris have not yet been characterized. Twenty patients with T12 or L1 vertebral fractures who had lower extremity symptoms due to compression of the epiconus or conus medullaris were included. These patients were compared with 28 healthy controls and 32 patients with cervical spondylotic radiculopathy (CSR) without spinal cord compression. MEPs of abductor hallucis muscles were recorded using transcranial magnetic stimulation and electrical stimulation of the tibial nerve. MEP latency, central motor conduction time (CMCT), and peripheral conduction time (PCT) were evaluated. MEP latency, CMCT, and PCT were significantly longer in patients with fractures than in healthy controls and patients with CSR. MEP latency was most accurate for differentiating patients with fracture from healthy controls (cutoff value, 40.0 ms, sensitivity, 95.0%; specificity, 100%), and CMCT was most accurate for comparing patients with fracture and CSR (cutoff value, 15.5 ms, sensitivity, 80.0%; specificity, 93.8%). In the distinction between patients with fracture and CSR, 16 of the 20 patients with fracture exceeded the cutoff values for any of the parameters, and 12 of them exceeded the cutoff values for all parameters. There was no significant correlation between the linear distance from the most inferior end of the spinal cord to the site of compression and any of the MEP parameters. Both CMCT and PCT are often prolonged in compressive lesions of the epiconus and conus medullaris, and MEP latency and CMCT are useful in the diagnosis.

Pseudoathetosis: An Unusual Initial Presentation of Compressive Cervical Myelopathy.

Pseudoathetosis: An Unusual Initial Presentation of Compressive Cervical Myelopathy.

Compressive Cervical Myelopathy Related with Hemodialysis-Associated Amyloidoma

Compressive Cervical Myelopathy Related with Hemodialysis-Associated Amyloidoma

Gait Analysis by the Severity of Gait Disturbance in Patients with Compressive Cervical Myelopathy

Gait Analysis by the Severity of Gait Disturbance in Patients with Compressive Cervical Myelopathy

Monomelic Amyotrophy/Hirayama Disease: Surgical Outcome in a Large Cohort of Indian Patients

Hirayama disease (HD) is a cervical compressive myelopathy. Anterior cervical discectomy and fusion (ACDF) is identified as the best surgical approach. We evaluated surgical outcomes and factors influencing ACDF in HD. Between 2015 and 2019, 126 patients with HD underwent ACDF. Contrast magnetic resonance imaging of the cervical spine in full flexion was performed. Clinical examination and preoperative/postoperative assessment of hand function using Fugl-Meyer assessment, Jebsen-Taylor hand function test, and handheld dynamometry were performed at 3-monthly intervals for 1 year. Surgical outcomes were assessed as per the Odom criteria and Hirayama outcome questionnaire. Age at onset and duration of illness were 12-31 years (mean, 18 ± 2.7) and 1-96 months (32.7 ± 24.4), respectively. All patients had progressive weakness and wasting of the affected limb. Cord atrophy was seen in 97.1%, with epidural detachment and engorgement of the posterior epidural venous plexus in all. All patients underwent ACDF. Of these patients, 54% had an excellent/good outcome and 39% had a satisfactory outcome as per the Odom scale at last follow-up (mean, 44.9 ± 16.5 months) after surgery. Handheld dynamometry showed improvement from preoperative values to 1 year follow-up. Duration of illness and age at onset had a negative correlation and the preoperative Fugl-Meyer score had a positive correlation with improvement. ACDF resulted in remarkable improvement or stabilization in neurologic deficits in many patients with HD. Because motor disability ensues over time, early surgical intervention during the progressive phase is advocated.

Degenerative changes in the intervertebral joints of the cervical spine after anterior interbody fusion and intervertebral disc arthroplasty

Objective. To study the effect of arthroplasty and anterior interbody fusion in the cervical spine on degenerative changes in the adjacent intervertebral joints.Material and Methods. A retrospective cohort study included 46 patients (22 with cervical total disc arthroplasy – CTDA, and 24 with anterior cervical discectomy and fusion – ACDF) with symptoms of cervical spondylogenic compression myelopathy and/or radiculopathy. The degree of degeneration of facet joints adjacent to the operated segments was evaluated 12 months after surgical treatment. Degenerative changes in the cervical spine were assessed using CT according to the Okamoto classification. Vidar Dicom Viewer 3.2 software was used to view images and evaluate intervertebral joints. Statistical processing was performed using IBM SPSS Statistics 23. Data were presented as median and 25th and 75th percentiles – Me [Q1; Q3].Results. The mean age of patients in both groups was 47 [39; 52] years (Mann – Whitney U-test, p = 0.047). In the ACDF group it was 48 [42; 55] years and in the CTDA group – 42 [36; 52] years. Comparison of degenerative changes in the ACDF group before and after treatment (Wilcoxon analysis) showed a statistically significant difference in the cranial (p = 0.023), and caudal (p = 0.001) joints, with the progression of degeneration degree. In the CTDA group, no difference between pre- and post-treatment degeneration degree (Wilcoxon analysis) was found in either cranial joints (p = 0.157) or caudal joints (p = 0.161).Conclusion. Surgeries to stabilize spinal segments in degenerative diseases undeniably affect the development of the adjacent level syndrome. However, the use of endoprosthetic technology makes it possible to aggravate the degree of degenerative changes in the intervertebral joints of adjacent segments to a lesser extent.

Radiographic and computed tomographic features of a subarachnoid diverticulum causing compressive cervical myelopathy in a yearling Warmblood horse

SummaryA 1‐year‐old Belgian Warmblood with a previously known history of successfully repaired temporal and parietal bone fractures sustained at 14 days of age was presented for investigation of a recent, acute and progressive quadrilateral ataxia. The owner reported a lack of coordination and difficulty getting up, with progressing paresis 2 weeks prior to the presentation. Neurological examination revealed pronounced hypermetria/dysmetria in the walk and trot in all four limbs. No evidence of cranial nerve deficits was observed. The horse was in good general condition with unremarkable clinical parameters. Survey lateral radiographs of the cervical spine revealed significant signs of cervical vertebral malformation, including hypertrophy of the articular process joints, indicating narrowing of the spinal canal with suspected cervical stenotic myelopathy. Cervical computed tomographic (CT) myelography revealed the presence of multiple dorsal subarachnoid diverticula causing significant spinal cord compression at multiple locations, with osteoarthrosis of the cervical articular process joints. Due to a poor prognosis and guarded surgical outcome, the owner declined further treatment, and the horse was discharged with conservative corticosteroid treatment. The patient was euthanised shortly after the initial presentation due to progressive worsening signs. To the authors' knowledge, CT myelography findings in a yearling with cervical subarachnoid multiple diverticula have not been previously published. This case illustrates the usefulness of advanced imaging techniques, such as CT myelography, in combination with static and dynamic radiography to provide a better and more accurate diagnosis.

Etomidate versus Propofol as Induction Agents in Patients Undergoing Decompressive Procedures for Cervical Compressive Myelopathy with and without Impaired Heart Rate Variability

Abstract Background Patients with cervical compressive myelopathy (CCM) are known to have autonomic dysfunction, which can impact surgical outcomes. In such patients, screening patients for heart rate variability (HRV) may enable the anesthesiologist to predict hypotension, thereby attempting to modify the anesthetic technique. This study aimed to compare the hemodynamic changes in CCM patients between propofol and etomidate induction. Methods Sixty CCM patients aged 18 to 70 years underwent an autonomic function test using HRV before decompressive surgery. The selected patients were randomized into two groups of 30 patients each to receive either etomidate or propofol for induction of anesthesia. The groups were compared for hemodynamic changes, the incidence of pain on injection, and the occurrence of myoclonus. While analyzing the hemodynamic changes, the two groups were subdivided into four groups, namely, propofol group with or without autonomic dysfunction (AD) and etomidate group with or without AD. Results In the abnormal HRV group, patients induced with propofol showed a significantly higher incidence of hypotension at 3-minute (p = 0.02) and 5-minute (p = 0.04) time points. On the other hand, in HRV normal patients, induction with propofol showed a significantly higher (p = 0.03) incidence of hypotension at 5 minutes. During induction, higher grades of pain (p = 0.01) were observed in the propofol group, whereas the occurrence of myoclonus was more in the etomidate group (p = 0.07). Conclusion As compared with propofol, the use of etomidate in patients with CCM undergoing decompressive procedures reduces hypotensive episodes, more so in patients with impaired HRV. Thus, HRV-based AD categorization may assist in optimal management of postinduction hypotension in patients with CCM.

Clinical outcome of surgical management of mild cervical compressive myelopathy based on minimum clinically important difference

BACKGROUND CONTEXTCervical compressive myelopathy (CCM), caused by cervical spondylosis (cervical spondylotic myelopathy [CSM]) or ossification of the posterior longitudinal ligament (OPLL), is a common neurological disorder in the elderly. For moderate/severe CCM, surgical management has been the first-line therapeutic option. Recently, surgical management is also recommended for mild CCM, and a few studies have reported the surgical outcome for this clinical population. Nonetheless, the present knowledge is insufficient to determine the specific surgical outcome of mild CCM. PURPOSETo examine the surgical outcomes of mild CCM while considering the minimum clinically important difference (MCID). STUDY DESIGNRetrospective study. PATIENT SAMPLEPatients who underwent subaxial cervical surgery for CCM caused by CSM and OPLL between 2013 and 2022 were enrolled. OUTCOME MEASURESThe Japanese Orthopedic Association score (JOA score) was employed as the clinical outcomes. Based on previous reports, the JOA score threshold to determine mild myelopathic symptoms was set at ≥14.5 points, and the MCID of the JOA score for mild CCM was set at 1 point. METHODSThe patients with a JOA score of ≥14.5 points at baseline were stratified into the mild CCM and were examined while considering the MCID. The mild CCM cohort was dichotomized into the improvement group, including the patients with an achieved MCID (JOA score ≥1 point) or with a JOA score of 17 points (full mark) at 1 year postoperatively, and the nonimprovement group, including the others. Demographics, symptomatology, radiographic findings, and surgical procedure were compared between the two groups and studied using the receiver operating characteristic (ROC) curve. RESULTSOf 335 patients with CCM, 43 were stratified into the mild CCM cohort (mean age, 58.5 years; 62.8% male). Among them, 25 (58.1 %) patients were assigned to the improvement group and 18 (41.9 %) were assigned to the nonimprovement group. The improvement group was significantly younger than the nonimprovement group; however, other variables did not significantly differ. ROC curve analysis showed that the optimal cutoff point of the patient's age to discriminate between the improvement and nonimprovement groups was 58 years with an area under the curve of 0.702 (p=.015). CONCLUSIONSIn the present study, the majority of patients with mild CCM experienced improvement reaching the MCID of JOA score at 1 year postoperatively. The present study suggests that for younger patients with mild CCM, especially those aged below 58 years, subjective neurological recovery is more likely to be obtained. Meanwhile, the surgery takes on a more prophylactic significance to halt disease progression for older patients. The results of this study can help in the decision-making process for this clinical population.

Propriospinal Myoclonus and Cervical Dystonia Developed by Compressive Cervical Myelopathy

Propriospinal Myoclonus and Cervical Dystonia Developed by Compressive Cervical Myelopathy

Unilateral biportal endoscopic supralaminar, posterior spinous process sparing approach for en bloc cervical laminectomy in case of cervical osteochondroma causing myelopathy: A case report

Background ContextCervical osteochondroma is a rare cause of myelopathy. Traditional treatment is open laminectomy with or without fusion. There is limited literature on unilateral bi-portal endoscopic en-bloc resection of cervical osteochondroma. Study DesignWe describe a case of a 39-year-old male diagnosed with cervical compressive myelopathy. The pathologic site is located on the ventral surface of C4 lamina. Herein we describe a step-by-step method of unilateral biportal endoscopy (UBE) en-bloc resection of extra-dural sublaminar osteochondroma for patient who had cervical myeloradiculopathy. Spinous process sparing osteotomy was performed to conserve the spinous process and supraspinous ligament.. Outcome MeasuresThe patient was successfully treated via UBE and the operative time was 50 minutes with no intra-operative complications. Patient symptoms improved in the immediate postoperative period and by 3 months he regained fine motor functions of hand. ConclusionsUnilateral biportal endoscopic en bloc cervical laminectomy can effectively decompress cervical spine and remove posterior benign cervical tumor. UBE preserves musculature and posterior ligamentous complex and thus reduces postoperative neck pain and postlaminectomy kyphosis.

MRI and CT findings of compressive cervical myelopathy in a dog with suspected immune‐mediated polyarthritis presenting with tetraparesis

AbstractAn 11‐month‐old, male, entire Great Dane dog presented with acute‐onset non‐ambulatory tetraparesis. Three months before presentation, the dog was treated for a suspected dog bite injury. Examination revealed pyrexia (39.7°C) and marked multiple joint swelling, with cervicalgia and non‐ambulatory tetraparesis. Based on clinicopathological findings and diagnostic imaging, a diagnosis of type II immune‐mediated polyarthritis was reached. The tetraparesis was investigated using magnetic resonance imaging and computed tomography, allowing the identification of compressive cranial cervical myelopathy secondary to severe occipitoatlantoaxial joint and multiple facet joint distension. The patient was initially treated with antimicrobial therapy with resolution of the pyrexia. Given the persistent severe multiple joint swelling and tetraparesis, immunosuppressive therapy was started. Due to refractory disease and poor prognosis, euthanasia was elected 97 days following presentation. To the authors’ knowledge, compressive cervical myelopathy associated with immune‐mediated polyarthritis has not been previously reported in the veterinary literature.

Shapes of cervical articular process joints and association with histological evidence of osteochondrosis in Warmblood foals: A post-mortem study.

Osteochondrosis dissecans (OCD) of articular process joints (APJs) is involved in cervical vertebral compressive myelopathy (CVM). Biomechanical forces, important in development of OCD, depend on joint conformation. Oval and flat APJ surfaces are considered normal. To identify and grade gross shape variation of cervical and cranial thoracic APJ surfaces and determine association with histological evidence of osteochondrosis. Case series. Eight hundred and four cervical and cranial thoracic APJ surfaces of 30 foals were evaluated for shape(s) and grades, and were correlated with osteochondrosis. Three top view shapes (oval, pointed, elongated) and seven lateral view shapes (flat, convex, concave, stepped, bevelled, folded edge, raised edge) were regularly encountered. The oval top view shape was most common. Flat and bevelled were the most common lateral view shapes. General shape grade of caudal articular surfaces was significantly higher than of cranial surfaces. The combinations of an oval top view shape and the lateral view shapes folded edge, concave, or flat with additional raised edge and/or folded edge (flat +), were more likely to have OC than oval with convex, bevelled or flat lateral view shapes (normal vs. oval and folded, odds ratio [OR] 2.49 [95% confidence intervals (CIs) 1.13-5.67]; normal vs. oval and flat +, OR 2.77 [95% CI 1.15-6.85]; oval and convex vs. oval and folded, OR 3.20 [95% CI 1.35-8.20]; oval and convex vs. oval and flat +, OR 3.56 [95% CI 1.43-9.54]; oval and bevelled vs. oval and concave, OR 2.02 [95% CI 1.14-3.60]; oval and bevelled vs. oval and folded, OR 3.50 [95% CI 1.91-6.60]; oval and bevelled vs. oval and flat +, OR 3.90 [95% CI 2.00-7.70]). Most foals (21/30) were less than 1 month old. Lack of observer reliability scores for shape and shape grade. APJs shape might contribute to CVM by increased likelihood to have OC.

Differentiating Neurodegenerative Disease From Compressive Cervical Myelopathy Using Motor-Evoked Potentials.

A retrospective case-control study. To differentiate neurodegenerative diseases from compressive cervical myelopathy (CCM) using motor-evoked potentials (MEPs). When considering surgery for CCM, it may be necessary to differentiate the condition from a neurodegenerative disease. A total of 30 healthy volunteers, 52 typical CCM patients with single-level compression of the spinal cord at C4-5 or C5-6, 7 patients with amyotrophic lateral sclerosis (ALS), and 12 patients with demyelinating disease of the central nervous system, including 11 patients with multiple sclerosis and 1 patient with neuromyelitis optica spectrum disorder, formed our study population. MEPs were recorded from the bilateral abductor digiti minimi (ADM) and abductor hallucis (AH) muscles using transcranial magnetic stimulation and electrical stimulation of the ulnar and tibial nerves. Central motor conduction time, peripheral conduction time, amplitude of MEPs, and frequency of F waves were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff value for distinguishing between CCM and ALS. Significant differences were observed in the amplitude of MEPs and frequency of F waves evoked by peripheral nerve stimulation between patients with CCM and ALS. The MEP amplitude of AH was more accurate in differentiating between the two diseases compared with ADM (cutoff value, 11.2 mV, sensitivity, 87.5%; specificity, 85.7%). All 7 patients with ALS showed reduced frequency of F waves from ADM or AH, but none of the healthy volunteers or patients with other diseases demonstrated this finding. Moreover, there were no significant differences between CCM and demyelinating disease of the central nervous system in any of the assessments. The amplitude of MEPs and frequency of F waves evoked by peripheral nerve stimulation could be helpful in differentiating ALS from CCM.

Studies in the Falls Efficacy Scale-International for patients with cervical compressive myelopathy: Reliability, validity, and minimum clinically important difference

Context Patients with cervical compressive myelopathy (CCM) often complain of body balance problems, such as fear of falling and bodily unsteadiness. However, no accepted patient-reported outcome measures (PROMs) for this symptomatology exist. The Falls Efficacy Scale-International (FES-I) is one of the most widely used PROMs for evaluating impaired body balance in various clinical fields. Objective To examine reliability, validity, and minimum clinically important difference (MCID) of the FES-I for the evaluation of impaired body balance in patients with CCM. Methods Patients who underwent surgery for CCM were retrospectively reviewed. The FES-I was administered preoperatively and at 1 year postoperatively. Further, cJOA-LE score (subscore for lower extremities in the Japanese Orthopaedic Association score for cervical myelopathy) and stabilometric data, obtained at the same time points of the FES-I administration, were analyzed. Reliability was examined through internal consistency with Cronbach’s alpha. Convergent validity was studied using correlation analysis. The MCID was estimated using anchor- and distribution-based methods. Results Overall, 151 patients were included for analysis. Cronbach’s alpha coefficient was the acceptable value of 0.97 at both baseline and 1 year postoperatively. As for convergent validity, the FES-I had significant correlations with the cJOA-LE score and stabilometric parameters both at baseline and 1 year postoperatively. The MCID calculated using anchor- and distribution-based methods was 5.5 and 10, respectively. Conclusion FES-I is a reliable and valid PROM to evaluate body balance problems for the CCM population. The established thresholds of MCID can help clinicians recognize the clinical significance of changes in patient status.

The ferroptosis activity is associated with neurological recovery following chronic compressive spinal cord injury.

Chronic compressive spinal cord injury in compressive cervical myelopathy conditions can lead to rapid neurological deterioration in the early phase, followed by partial self-recovery, and ultimately an equilibrium state of neurological dysfunction. Ferroptosis is a crucial pathological process in many neurodegenerative diseases; however, its role in chronic compressive spinal cord injury remains unclear. In this study, we established a chronic compressive spinal cord injury rat model, which displayed its most severe behavioral and electrophysiological dysfunction at 4 weeks and partial recovery at 8 weeks after compression. Bulk RNA sequencing data identified enriched functional pathways, including ferroptosis, presynapse, and postsynaptic membrane activity at both 4 and 8 weeks following chronic compressive spinal cord injury. Transmission electron microscopy and malondialdehyde quantification assay confirmed that ferroptosis activity peaked at 4 weeks and was attenuated at 8 weeks after chronic compression. Ferroptosis activity was negatively correlated with behavioral score. Immunofluorescence, quantitative polymerase chain reaction, and western blotting showed that expression of the anti-ferroptosis molecules, glutathione peroxidase 4 (GPX4) and MAF BZIP transcription factor G (MafG), in neurons was suppressed at 4 weeks and upregulated at 8 weeks following spinal cord compression. There was a positive correlation between the expression of these two molecules, suggesting that they may work together to contribute to functional recovery following chronic compressive spinal cord injury. In conclusion, our study determined the genome-wide expression profile and ferroptosis activity of a consistently compressed spinal cord at different time points. The results showed that anti-ferroptosis genes, specifically GPX4 and MafG, may be involved in spontaneous neurological recovery at 8 weeks of chronic compressive spinal cord injury. These findings contribute to a better understanding of the mechanisms underlying chronic compressive spinal cord injury and may help identify new therapeutic targets for compressive cervical myelopathy.

Differentiation Between Compressive Cervical and Thoracic Myelopathy Using the Central Motor Conduction Time Ratio.

Thoracic myelopathy is a rare condition whose diagnosis is often missed or delayed. This study aimed to differentiate between cervical and thoracic myelopathy using motor-evoked potential testing. The authors included 835 patients with compressive cervical myelopathy and 94 patients with compressive thoracic myelopathy. Myelopathy using motor-evoked potentials were recorded from the bilateral abductor digiti minimi and abductor hallucis muscles through transcranial magnetic stimulation. The peripheral conduction time was measured through electrical stimulation of the ulnar and tibial nerves; moreover, the central motor conduction time (CMCT) was calculated by subtracting the peripheral conduction time from the myelopathy using motor-evoked potential latency. The most accurate differentiation between compressive cervical myelopathy and compressive thoracic myelopathy was achieved by the CMCT ratios (CMCT-ADM:CMCT-AH; cutoff value of 0.490, sensitivity of 83.0%, and specificity of 80.5%). After excluding patients with compressive cervical myelopathy who had spinal cord compression at C6-7, the cutoff value was 0.490, with a sensitivity of 83.0% and specificity of 87.3%. Determining the CMCT ratio (cutoff value of 0.490) through motor-evoked potential testing could facilitate differentiation between compressive cervical myelopathy and compressive thoracic myelopathy.

Cerebrospinal fluid and serum proteomic profiles accurately distinguish neuroaxonal dystrophy from cervical vertebral compressive myelopathy in horses

Cervical vertebral compressive myelopathy (CVCM) and equine neuroaxonal dystrophy/degenerative myeloencephalopathy (eNAD/EDM) are leading causes of spinal ataxia in horses. The conditions can be difficult to differentiate, and there is currently no diagnostic modality that offers a definitive antemortem diagnosis. Evaluate novel proteomic techniques and machine learning algorithms to predict biomarkers that can aid in the antemortem diagnosis of noninfectious spinal ataxia in horses. Banked serum and cerebrospinal fluid (CSF) samples from necropsy-confirmed adult eNAD/EDM (n = 47) and CVCM (n = 25) horses and neurologically normal adult horses (n = 45). . A subset of serum and CSF samples from eNAD/EDM (n=5) and normal (n=5) horses was used to evaluate the proximity extension assay (PEA). All samples were assayed by PEA for 368 neurologically relevant proteins. Data were analyzed using machine learning algorithms to define potential diagnostic biomarkers. Of the 368 proteins, 84 were detected in CSF and 146 in serum. Eighteen of 84 proteins in CSF and 30/146 in serum were differentially abundant among the 3 groups, after correction for multiple testing. Modeling indicated that a 2-protein test using CSF had the highest accuracy for discriminating among all 3 groups. Cerebrospinal fluid R-spondin 1 (RSPO1) and neurofilament-light (NEFL), in parallel, predicted normal horses with an accuracy of 87.18%, CVCM with 84.62%, and eNAD/EDM with 73.5%. Cross-species platform. Uneven sample size. Proximity extension assay technology allows for rapid screening of equine biologic matrices for potential protein biomarkers. Machine learning analysis allows for unbiased selection of highly accurate biomarkers from high-dimensional data.