Increasing awareness of degenerative cervical myelopathy: a preventative cause of non-traumatic spinal cord injury

Zipser, Carl Moritz; Margetis, Konstantinos; Pedro, Karlo M.; Curt, Armin; Fehlings, Michael G.; Sadler, Iwan; Tetreault, Lindsay; Davies, Benjamin

doi:10.1038/s41393-021-00711-8

Cited by 14 publications

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References 11 publications

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“…Degenerative changes of the cervical spine may result in cervical spinal stenosis with consecutive spinal cord compression leading to the clinical imprint of degenerative cervical myelopathy (DCM). DCM is the most common cause of nontraumatic incomplete spinal cord injury 1,2 . While standard of care is decompressive surgery in DCM patients with moderate and severe impairments, treatment decisions (operative vs. conservative) in mild DCM are still challenging 3 .…”

Section: Introductionmentioning

confidence: 99%

“…DCM is the most common cause of nontraumatic incomplete spinal cord injury. 1 , 2 While standard of care is decompressive surgery in DCM patients with moderate and severe impairments, treatment decisions (operative vs. conservative) in mild DCM are still challenging. 3 The clinical assessments such as modified Japanese Orthopaedic Association (mJOA) score are good ad hoc measures but are rather insensitive to reveal deterioration at an early stage of DCM and to identify patients at risk.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of axial and sagittal spinal cord motion measurements in degenerative cervical myelopathy

Pfender

Rösner

Zipser

et al. 2022

Journal of Neuroimaging

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Background and Purpose:The timing of decision-making for a surgical intervention in patients with mild degenerative cervical myelopathy (DCM) is challenging. Spinal cord motion phase contrast MRI (PC-MRI) measurements can reveal the extent of dynamic mechanical strain on the spinal cord to potentially identify high-risk patients. This study aims to determine the comparability of axial and sagittal PC-MRI measurements of spinal cord motion with the prospect of improving the clinical workup.Methods: Sixty-four DCM patients underwent a PC-MRI scan assessing spinal cord motion. The agreement of axial and sagittal measurements was determined by means of intraclass correlation coefficients (ICCs) and Bland-Altman analyses. Results:The comparability of axial and sagittal PC-MRI measurements was good to excellent at all cervical levels (ICCs motion amplitude: .810-.940; p < .001). Significant differences between axial and sagittal amplitude values could be found at segments C3 and C4, while its magnitude was low (C3: 0.07 ± 0.19 cm/second; C4: −0.12 ± 0.30 cm/second). Bland-Altman analysis showed a good agreement between axial and sagittal PC-MRI scans (coefficients of repeatability: minimum −0.23 cm/second at C2; maximum −0.58 cm/second at C4). Subgroup analysis regarding anatomic conditions (stenotic vs. nonstenotic segments) and different velocity encoding (2 vs. 3 cm/second) showed comparable results. Conclusions:This study demonstrates good comparability between axial and sagittal spinal cord motion measurements in DCM patients. To this end, axial and sagittal PC-MRI are both accurate and sensitive in detecting pathologic cord motion. Therefore, such measures could identify high-risk patients and improve clinical decision-making (ie, timing of decompression).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of axial and sagittal spinal cord motion measurements in degenerative cervical myelopathy

Pfender

Rösner

Zipser

et al. 2022

Journal of Neuroimaging

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“…In patients presenting with clinical evidence of DCM, MRI allows to support the diagnosis and exclude differential diagnoses ( 14 ). Generally, timely surgical spinal canal decompression is recommended to halt the disease progression and provide symptom relief ( 14 – 16 ). Surgical decompression is recommended in patients with clinical signs of cervical myelopathy and moderate-severe symptoms of DCM, accompanied by spinal canal narrowing with cord compression ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid pressure dynamics reveal signs of effective spinal canal narrowing in ambiguous spine conditions

et al. 2022

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Spinal canal narrowing with consecutive spinal cord compression is considered a key mechanism in degenerative cervical myelopathy (DCM). DCM is a common spine condition associated with progressive neurological disability, and timely decompressive surgery is recommended. However, the clinical and radiological diagnostic workup is often ambiguous, challenging confident proactive treatment recommendations. Cerebrospinal fluid pressure dynamics (CSFP) are altered by spinal canal narrowing. Therefore, we aim to explore the potential value of bedside CSFP assessments for qualitative and quantitative assessment of spinal canal narrowing in DCM. In this prospective case series, seven patients with DCM underwent bedside lumbar puncture with measurement of CSFP dynamics and routine CSF analysis (NCT02170155). The patients were enrolled when standard diagnostic algorithms did not permit a clear treatment decision. Measurements include baseline CSFP, cardiac-driven CSFP peak-to-trough amplitude (CSFPp), and the Queckenstedt's test (firm pressure on jugular veins) in neutral and reclined head position. From the Queckenstedt's test, proxies for craniospinal elastance (i.e., relative pulse pressure coefficient; RPPC-Q) were calculated analogously to infusion testing. CSFP metrics were deemed suspicious of canal narrowing when numbers were lower than the minimum value from a previously tested elderly spine-healthy cohort (N = 14). Mean age was 56 ± 13 years (range, 38–75; 2F); symptom severity was mostly mild to moderate (mean mJOA, 13.5 ± 2.6; range, 9–17). All the patients showed some extent of cervical stenosis in the MRI of unclear significance (5/7 following decompressive cervical spine surgery with an adjacent level or residual stenosis). Baseline CSFP was normal except for one patient (range, 4.7–17.4 mmHg). Normal values were found for CSFPp (0.4–1.3 mmHg) and the Queckenstedt's test in normal head positioning (9.-25.3 mmHg). During reclination, the Queckenstedt's test significantly decreased in one, and CSFPp in another case (>50% compared to normal position). RPPC-Q (0.07–0.19) aligned with lower values from spine-healthy (0.10–0.44). Routine CSF examinations showed mild total protein elevation (mean, 522 ± 108 mg/ml) without further evidence for the disturbed blood brain barrier. Intrathecal CSFP measurements allow discerning disturbed from normal CSFP dynamics in this population. Prospective longitudinal studies should further evaluate the diagnostic utility of CSFP assessments in DCM.

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“…Spinal cord injury (SCI) is a refractory disease of the central nervous system that not only causes permanent disabilities for individuals but also represents a huge burden to families and healthcare systems ( Ahuja et al, 2017 ; Huang et al, 2020 ). The most common causes of SCI are traffic accidents and falls; degenerative cervical myelopathy can also progress to incomplete SCI if not recognized and treated timely ( Zipser et al, 2021 ). According to a global investigation of SCI, falls and road injuries are the most common causes in most countries and regions ( James et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Correlation Analysis Between Magnetic Resonance Imaging-Based Anatomical Assessment and Behavioral Outcome in a Rat Contusion Model of Chronic Thoracic Spinal Cord Injury

Xing

Jia

et al. 2022

Front. Neurosci.

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Although plenty of evidences from preclinical studies have led to potential treatments for patients with spinal cord injury (SCI), the failure to translate promising preclinical findings into clinical advances has long puzzled researchers. Thus, a more reliable combination of anatomical assessment and behavioral testing is urgently needed to improve the translational worth of preclinical studies. To address this issue, the present study was designed to relate magnetic resonance imaging (MRI)-based anatomical assessment to behavioral outcome in a rat contusion model. Rats underwent contusion with three different heights to simulate various severities of SCI, and their locomotive functions were evaluated by the grid-walking test, Louisville swim scale (LSS), especially catwalk gait analysis system and basic testing, and Basso, Beattie, Bresnahan (BBB) score. The results showed that the lesion area (LA) is a better indicator for damage assessment compared with other parameters in sagittal T2-weighted MRI (T2WI). Although two samples are marked as outliers by the box plot analysis, LA correlated closely with all of the behavioral testing without ceiling effect and floor effect. Moreover, with a moderate severity of SCI in a contusion height of 25 mm, the smaller the LA of the spinal cord measured on sagittal T2WI the better the functional performance, the smaller the cavity region and glial scar, the more spared the myelin, the higher the volatility, and the thicker the bladder wall. We found that LA significantly related with behavior outcomes, which indicated that LA could be a proxy of damage assessment. The combination of sagittal T2WI and four types of behavioral testing can be used as a reliable scheme to evaluate the prognosis for preclinical studies of SCI.

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Increasing awareness of degenerative cervical myelopathy: a preventative cause of non-traumatic spinal cord injury

Cited by 14 publications

References 11 publications

Comparison of axial and sagittal spinal cord motion measurements in degenerative cervical myelopathy

Comparison of axial and sagittal spinal cord motion measurements in degenerative cervical myelopathy

Cerebrospinal fluid pressure dynamics reveal signs of effective spinal canal narrowing in ambiguous spine conditions

Correlation Analysis Between Magnetic Resonance Imaging-Based Anatomical Assessment and Behavioral Outcome in a Rat Contusion Model of Chronic Thoracic Spinal Cord Injury

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