Proposing a Framework to Understand the Role of Imaging in Degenerative Cervical Myelopathy: Enhancement of MRI Protocols Needed for Accurate Diagnosis and Evaluation

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

doi:10.1097/brs.0000000000004389

Cited by 15 publications

(5 citation statements)

References 36 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It may be difficult to distinguish patients with DCM from those without using MRI characteristics due to poor correlation between imaging findings and disease severity. 77 Based on the results of these three studies, the presence of neck pain is moderately to highly sensitive for diagnosing DCM, but not specific. While these findings carry face validity, many of the other results from KQ1 do not.…”

Section: Discussionmentioning

confidence: 99%

The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review

Jiang,

Davies,

Zipser

et al. 2023

Global Spine Journal

Self Cite

View full text Add to dashboard Cite

Study Design Delayed diagnosis of degenerative cervical myelopathy (DCM) is associated with reduced quality of life and greater disability. Developing diagnostic criteria for DCM has been identified as a top research priority. Objectives This scoping review aims to address the following questions: What is the diagnostic accuracy and frequency of clinical symptoms in patients with DCM? Methods A scoping review was conducted using a database of all primary DCM studies published between 2005 and 2020. Studies were included if they (i) assessed the diagnostic accuracy of a symptom using an appropriate control group or (ii) reported the frequency of a symptom in a cohort of DCM patients. Results This review identified three studies that discussed the diagnostic accuracy of various symptoms and included a control group. An additional 58 reported on the frequency of symptoms in a cohort of patients with DCM. The most frequent and sensitive symptoms in DCM include unspecified paresthesias (86%), hand numbness (82%) and hand paresthesias (79%). Neck and/or shoulder pain was present in 51% of patients with DCM, whereas a minority had back (19%) or lower extremity pain (10%). Bladder dysfunction was uncommon (38%) although more frequent than bowel (23%) and sexual impairment (4%). Gait impairment is also commonly seen in patients with DCM (72%). Conclusion Patients with DCM present with many different symptoms, most commonly sensorimotor impairment of the upper extremities, pain, bladder dysfunction and gait disturbance. If patients present with a combination of these symptoms, further neuroimaging is indicated to confirm the diagnosis of DCM.

show abstract

Section: Discussionmentioning

confidence: 99%

The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review

Jiang,

Davies,

Zipser

et al. 2023

Global Spine Journal

Self Cite

View full text Add to dashboard Cite

show abstract

“…The underlying pathophysiology of DCM is attributed to immediate (i.e., direct or static) cord compression, spinal malalignment leading to altered cord tension, impaired vascular supply, and repeated dynamic injury (2)(3)(4). Cervical MRI is deemed essential for diagnosing DCM (5). However, the extent of spinal canal stenosis (as a proxy of static cord compression) insufficiently explains the disease severity and progression (6,7).…”

Section: Introductionmentioning

confidence: 99%

Potential thresholds of critically increased cardiac-related spinal cord motion in degenerative cervical myelopathy

Pfender,

Jutzeler,

Hubli

et al. 2024

Front. Neurol.

Self Cite

View full text Add to dashboard Cite

IntroductionNew diagnostic techniques are a substantial research focus in degenerative cervical myelopathy (DCM). This cross-sectional study determined the significance of cardiac-related spinal cord motion and the extent of spinal stenosis as indicators of mechanical strain on the cord.MethodsEighty-four DCM patients underwent MRI/clinical assessments and were classified as MRI+ [T2-weighted (T2w) hyperintense lesion in MRI] or MRI− (no T2w-hyperintense lesion). Cord motion (displacement assessed by phase-contrast MRI) and spinal stenosis [adapted spinal canal occupation ratio (aSCOR)] were related to neurological (sensory/motor) and neurophysiological readouts [contact heat evoked potentials (CHEPs)] by receiver operating characteristic (ROC) analysis.ResultsMRI+ patients (N = 31; 36.9%) were more impaired compared to MRI− patients (N = 53; 63.1%) based on the modified Japanese Orthopedic Association (mJOA) subscores for upper {MRI+ [median (Interquartile range)]: 4 (4–5); MRI−: 5 (5–5); p < 0.01} and lower extremity [MRI+: 6 (6–7); MRI−: 7 (6–7); p = 0.03] motor dysfunction and the monofilament score [MRI+: 21 (18–23); MRI−: 24 (22-24); p < 0.01]. Both patient groups showed similar extent of cord motion and stenosis. Only in the MRI− group displacement identified patients with pathologic assessments [trunk/lower extremity pin prick score (T/LEPP): AUC = 0.67, p = 0.03; CHEPs: AUC = 0.73, p = 0.01]. Cord motion thresholds: T/LEPP: 1.67 mm (sensitivity 84.6%, specificity 52.5%); CHEPs: 1.96 mm (sensitivity 83.3%, specificity 65.6%). The aSCOR failed to show any relation to the clinical assessments.DiscussionThese findings affirm cord motion measurements as a promising additional biomarker to improve the clinical workup and to enable timely surgical treatment particularly in MRI− DCM patients.Clinical trial registrationwww.clinicaltrials.gov, NCT 02170155.

show abstract

“…Several pathophysiological factors are important for the assessment of degenerative cervical spine disease and can be visualized using different Magnetic Resonance Imaging (MRI) techniques [ 1 – 3 ]. Essential is the anatomical configuration of the spinal canal and its narrowing, which is commonly evaluated on conventional T2-weighted sequences.…”

Section: Introductionmentioning

confidence: 99%

Quantification of cervical spinal stenosis by automated 3D MRI segmentation of spinal cord and cerebrospinal fluid space

Hohenhaus,

Klingler,

Scholz

et al. 2024

Spinal Cord

View full text Add to dashboard Cite

Design Prospective diagnostic study. Objectives Anatomical evaluation and graduation of the severity of spinal stenosis is essential in degenerative cervical spine disease. In clinical practice, this is subjectively categorized on cervical MRI lacking an objective and reliable classification. We implemented a fully-automated quantification of spinal canal compromise through 3D T2-weighted MRI segmentation. Setting Medical Center - University of Freiburg, Germany. Methods Evaluation of 202 participants receiving 3D T2-weighted MRI of the cervical spine. Segments C2/3 to C6/7 were analyzed for spinal cord and cerebrospinal fluid space volume through a fully-automated segmentation based on a trained deep convolutional neural network. Spinal canal narrowing was characterized by relative values, across sever segments as adapted Maximal Canal Compromise (aMCC), and within the index segment as adapted Spinal Cord Occupation Ratio (aSCOR). Additionally, all segments were subjectively categorized by three observers as “no”, “relative” or “absolute” stenosis. Computed scores were applied on the subjective categorization. Results 798 (79.0%) segments were subjectively categorized as “no” stenosis, 85 (8.4%) as “relative” stenosis, and 127 (12.6%) as “absolute” stenosis. The calculated scores revealed significant differences between each category (p ≤ 0.001). Youden’s Index analysis of ROC curves revealed optimal cut-offs to distinguish between “no” and “relative” stenosis for aMCC = 1.18 and aSCOR = 36.9%, and between “relative” and “absolute” stenosis for aMCC = 1.54 and aSCOR = 49.3%. Conclusion The presented fully-automated segmentation algorithm provides high diagnostic accuracy and objective classification of cervical spinal stenosis. The calculated cut-offs can be used for convenient radiological quantification of the severity of spinal canal compromise in clinical routine.

show abstract

Proposing a Framework to Understand the Role of Imaging in Degenerative Cervical Myelopathy: Enhancement of MRI Protocols Needed for Accurate Diagnosis and Evaluation

Cited by 15 publications

References 36 publications

The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review

The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review

Potential thresholds of critically increased cardiac-related spinal cord motion in degenerative cervical myelopathy

Quantification of cervical spinal stenosis by automated 3D MRI segmentation of spinal cord and cerebrospinal fluid space

Contact Info

Product

Resources

About