In cervical spondylotic myelopathy spinal cord motion is focally increased at the level of stenosis: a controlled cross-sectional study

Wolf, Katharina; Hupp, Markus; Friedl, Susanne; Sutter, Reto; Klarhöfer, Markus; Grabher, Patrick; Freund, Patrick; Curt, Armin

doi:10.1038/s41393-018-0075-1

Cited by 25 publications

(78 citation statements)

References 31 publications

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“…blood pressure, heart rate) remains unknown. Previous studies report different parameters of spinal cord motions 4,6,7 and therefore are not readily comparable. Additionally, PC MRI readouts are influenced by a varying, so called “phase drift” 10 , ending in false velocity values, caused by a baseline offset error.…”

Section: Introductionmentioning

confidence: 89%

“…In addition, conventional MRI provides only static information, while PC-MRI evaluates dynamic mechanical factors which might contribute to the development of cervical myelopathy 8,9 . Interestingly, increased spinal cord motion was associated with sensory deficits 4,6 , impaired electrophysiological readouts 6 and decreased functional scores in DCM patients 7 . Thus, altered spinal cord motion might be a potential surrogate of spinal cord dysfunction.…”

Section: Introductionmentioning

confidence: 95%

“…Cardiac-gated velocity measurements can be mapped over the heart cycle resulting in a flow-profile 2,3 . In patients with degenerative cervical myelopathy (DCM), several studies applying 2D PC-MRI reported increased spinal cord motion at the level of a cervical spinal stenosis 4–7 . A better insight into pathophysiological processes contributing to spinal cord dysfunction is fundamental for understanding different disease stages that may be less appreciable when only relying on static anatomic measures.…”

Section: Introductionmentioning

confidence: 99%

“…While measurements of CSF flow have been shown to be less reliable and rather complex (i.e. not easy to implement and run for clinical application) at the level of stenosis 7 , spinal cord motion appears as an attractive alternative. The latter is easy to apply and provides parameters that potentially allow to evaluate the extent of cervical dysfunction and could eventually be used to predict the course of DCM.…”

Section: Introductionmentioning

confidence: 99%

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Segmental differences of cervical spinal cord motion: advancing from confounders to a diagnostic tool

Hupp

Vallotton

Brockmann

et al. 2019

Sci Rep

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Increased cranio-caudal spinal cord motion is associated with clinical impairment in degenerative cervical myelopathy. However, whether spinal cord motion holds potential as a neuroimaging biomarker requires further validation. Different confounders (i.e. subject characteristics, methodological problems such as phase drift, etc.) on spinal cord motion readouts have to be considered. Twenty-two healthy subjects underwent phase contrast MRI, a subset of subjects (N = 9) had repeated scans. Parameters of interest included amplitude of velocity signal, maximum cranial respectively maximum caudal velocity, displacement (=area under curve of the velocity signal). The cervical spinal cord showed pulse synchronic oscillatory motions with significant differences in all readouts across cervical segments, with a maximum at C5. The Inter-rater reliability was excellent for all readouts. The test-retest reliability was excellent for all parameters at C2 to C6, but not for maximum cranial velocity at C6 and all readouts at C7. Spinal cord motion was correlated with spinal canal size, heart rate and body size. This is the first study to propose a standardized MRI measurement of spinal cord motion for further clinical implementation based on satisfactory phase drift correction and excellent reliability. Understanding the influence of confounders (e.g. structural conditions of the spine) is essential for introducing cord motion into the diagnostic work up.

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Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Segmental differences of cervical spinal cord motion: advancing from confounders to a diagnostic tool

Hupp

Vallotton

Brockmann

et al. 2019

Sci Rep

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“…15 Recently, more sophisticated MR protocols demonstrated higher spinal cord motion at the level of stenosis that correlated with disability. 16 Neurophysiological studies, that is, motor-evoked potential (MEP) and somatosensory-evoked potential (SEP), support the diagnosis and aid in the prognosis of the outcomes, 17 and intraoperative neurophysiologic monitoring can be used to detect imminent spinal cord damage. 18 Contact heat-evoked potentials (CHEPs) may increase the sensitivity of conventional neurophysiology assessments for spinal conduction deficits.…”

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confidence: 99%

Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study

et al. 2020

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IntroductionDegenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression.Methods and analysisTwenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt’s) CSFP—findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging.Ethics and disseminationThe study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis.Trial registration numberClinicalTrials.gov Registry (NCT02170155).

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Spinal cord motion and CSF flow in the cervical spine of 70 healthy participants

et al. 2023

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Pulsatile spinal cord and CSF velocities related to the cardiac cycle can be depicted by phase‐contrast MRI. Among patients with spontaneous intracranial hypotension, we have recently described relevant differences compared with healthy controls in segment C2/C3. The method might be a promising tool to solve clinical and diagnostic ambiguities. Therefore, it is important to understand the physiological range and the effects of clinical and anatomical parameters in healthy volunteers. Within a prospective study, 3D T2‐weighted MRI for spinal canal anatomy and cardiac‐gated phase‐contrast MRI adapted to CSF flow and spinal cord motion for time‐resolved velocity data and derivatives were performed in 70 participants (age 20–79 years) in segments C2/C3 and C5/C6. Correlations were analyzed by multiple linear regression models; p < 0.01 was required to assume a significant impact of clinical or anatomical data quantified by the regression coefficient B. Data showed that in C2/C3, the CSF and spinal cord craniocaudal velocity ranges were 4.5 ± 0.9 and 0.55 ± 0.15 cm/s; the total displacements were 1.1 ± 0.3 and 0.07 ± 0.02 cm, respectively. The craniocaudal range of the CSF flow rate was 8.6 ± 2.4 mL/s; the CSF stroke volume was 2.1 ± 0.7 mL. In C5/C5, physiological narrowing of the spinal canal caused higher CSF velocity ranges and lower stroke volume (C5/C6 B = +1.64 cm/s, p < 0.001; B = −0.4 mL, p = 0.002, respectively). Aging correlated to lower spinal cord motion (e.g., B = −0.01 cm per 10 years of aging, p < 0.001). Increased diastolic blood pressure was associated with lower spinal cord motion and CSF flow parameters (e.g., C2/C3 CSF stroke volume B = −0.3 mL per 10 mmHg, p < 0.001). Males showed higher CSF flow and spinal cord motion (e.g., CSF stroke volume B = +0.5 mL, p < 0.001; total displacement spinal cord B = +0.016 cm, p = 0.002). We therefore propose to stratify data for age and sex and to adjust for diastolic blood pressure and segmental narrowing in future clinical studies.

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In cervical spondylotic myelopathy spinal cord motion is focally increased at the level of stenosis: a controlled cross-sectional study

Abstract: CRPP Neurorehab of the University of Zurich, Switzerland.

Cited by 25 publications

References 31 publications

Segmental differences of cervical spinal cord motion: advancing from confounders to a diagnostic tool

Segmental differences of cervical spinal cord motion: advancing from confounders to a diagnostic tool

Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study

Spinal cord motion and CSF flow in the cervical spine of 70 healthy participants

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