scholarly journals Is microdiffusion imaging able to improve the detection of cervical myelopathy? Study protocol of a prospective observational trial (MIDICAM-Trial)

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029153
Author(s):  
Marc Hohenhaus ◽  
Karl Egger ◽  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
Marco Reisert ◽  
...  
Keyword(s):  
Study Protocol ◽  
Cervical Myelopathy ◽  
Clinical Symptoms ◽  
Negative Control ◽  
Observational Trial ◽  
Conventional Mri ◽  
Diffusion Parameters ◽  
Registration Number ◽  
Degenerative Cervical Myelopathy ◽  
Tissue Alterations

IntroductionThe diagnosis of degenerative cervical myelopathy (DCM) is difficult in numerous patients due to the limited correlation of clinical symptoms, electrophysiology and MRI. This applies especially for early disease stages with mild symptoms or in uncertainty due to comorbidities. Conventional MRI myelopathy signs show a restricted sensitivity to clinical symptoms of at most 60%. It is desirable to select patients for surgical treatment as early as possible before irreversible neurological damage occurs. To improve treatment, a more reliable imaging is necessary. Microdiffusion imaging (MIDI) is an innovative MRI modality to depict tissue alterations within one voxel based on diffusion-weighted imaging (DWI) postprocessing. By separating the affected area into several mesoscopic compartments, pathological changes might be detected more sensitive through this subtle tissue resolution. We hypothesise, that MIDI shows myelopathic alterations more sensitive than conventional MRI and improves the correlation to functional impairment.Methods and analysisIn this prospective, observational trial, 130 patients with a relevant degenerative cervical spinal stenosis receive MRI including MIDI and a standard clinical and electrophysiological assessment. Special subvoxel diffusion parameters are calculated. Clinical follow-ups are conducted after 3, 6 and with additional MRI and electrophysiology after 12 months. The primary endpoint is the sensitivity of MIDI to detect functional myelopathy defined by clinical and electrophysiological features correlated to conventional MRI myelopathy signs. Twenty healthy subjects will be included as negative control. The results will provide new insights into the development of mesoscopic spinal cord alterations in DCM associated to the clinical course. Aim is to improve the diagnostics of incipient myelopathy through this new modality.Ethics and disseminationThe study protocol is approved by the Ethics Committee of the University of Freiburg (reference 261/17). The results will be published in a peer-reviewed journal.Trial registration numberDRKS00012962.

scholarly journals Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy

2021 ◽  
Vol 10 (17) ◽  
pp. 3965
Author(s):  
Talia C. Oughourlian ◽  
Chencai Wang ◽  
Noriko Salamon ◽  
Langston T. Holly ◽  
Benjamin M. Ellingson
Keyword(s):  
Cervical Myelopathy ◽  
Clinical Symptoms ◽  
Gray Matter Volume ◽  
Brain Regions ◽  
Cortical Volume ◽  
Female Patients ◽  
Asymptomatic Patients ◽  
Compensation Mechanisms ◽  
Male Patients ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is a progressive condition characterized by degeneration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord and presentation of clinical symptoms. Compared to healthy controls (HCs), studies have shown DCM patients experience structural and functional reorganization in the brain; however, sex-dependent cortical differences in DCM patients remains largely unexplored. In the present study, we investigate the role of sex differences on the structure of the cerebral cortex in DCM and determine how structural differences may relate to clinical measures of neurological function. T1-weighted structural MRI scans were acquired in 85 symptomatic and asymptomatic patients with DCM and 90 age-matched HCs. Modified Japanese Orthopedic Association (mJOA) scores were obtained for patients. A general linear model was used to determine vertex-level significant differences in gray matter volume (GMV) between the following groups (1) male HCs and female HCs, (2) male patients and female patients, (3) male patients and male HCs, and (4) female patients and female HCs. Within patients, males exhibited larger GMV in motor, language, and vision related brain regions compared to female DCM patients. Males demonstrated a significant positive correlation between GMV and mJOA score, in which patients with worsening neurological symptoms exhibited decreasing GMV primarily across somatosensory and motor related cortical regions. Females exhibited a similar association, albeit across a broader range of cortical areas including those involved in pain processing. In sensorimotor regions, female patients consistently showed smaller GMV compared with male patients, independent of mJOA score. Results from the current study suggest strong sex-related differences in cortical volume in patients with DCM, which may reflect hormonal influence or differing compensation mechanisms.

scholarly journals 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

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037332
Author(s):  
Carl Moritz Zipser ◽  
Nikolai Pfender ◽  
Jose Miguel Spirig ◽  
Michael Betz ◽  
Jose Aguirre ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Spinal Cord Compression ◽  
Study Protocol ◽  
Cervical Myelopathy ◽  
Fluid Pressure ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Degenerative Cervical Myelopathy

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).

scholarly journals Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?

2020 ◽  
Vol 9 (3) ◽  
pp. 759 ◽  
Author(s):  
Rocco Severino ◽  
Aria Nouri ◽  
Enrico Tessitore
Keyword(s):  
Cervical Myelopathy ◽  
Diffusion Tensor ◽  
Inverse Correlation ◽  
Postoperative Outcome ◽  
Definitive Treatment ◽  
Conduction Time ◽  
Japanese Orthopedic Association ◽  
Conventional Mri ◽  
T2 Hyperintensity ◽  
Degenerative Cervical Myelopathy

Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM.

Association Between Paraspinal Muscle Morphology, Clinical Symptoms, and Functional Status in Patients With Degenerative Cervical Myelopathy

Spine ◽  
2017 ◽  
Vol 42 (4) ◽  
pp. 232-239 ◽  
Author(s):  
Maryse Fortin ◽  
Octavian Dobrescu ◽  
Matthew Courtemanche ◽  
Carolyn J. Sparrey ◽  
Carlo Santaguida ◽  
...  
Keyword(s):  
Functional Status ◽  
Cervical Myelopathy ◽  
Clinical Symptoms ◽  
Paraspinal Muscle ◽  
Muscle Morphology ◽  
Degenerative Cervical Myelopathy

scholarly journals Management of degenerative cervical myelopathy – An update

2016 ◽  
Vol 62 (9) ◽  
pp. 886-894 ◽  
Author(s):  
ANDREI F. JOAQUIM ◽  
ENRICO GHIZONI ◽  
HELDER TEDESCHI ◽  
WELLINGTON K. HSU ◽  
ALPESH A. PATEL
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Clinical Symptoms ◽  
Surgical Techniques ◽  
The Other ◽  
Surgical Approaches ◽  
Japanese Orthopedic Association ◽  
Advantages And Disadvantages ◽  
Clinical Magnetic Resonance Imaging ◽  
Degenerative Cervical Myelopathy

SUMMARY Introduction Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adult patients. Patients generally present with a slow, progressive neurological decline or a stepwise deterioration pattern. In this paper, we discuss the most important factors involved in the management of DCM, including a discussion about the surgical approaches. Method The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results Although the diagnosis is clinical, magnetic resonance imaging (MRI) is the study of choice to confirm stenosis and also to exclude the differential diagnosis. The severity the clinical symptoms of DCM are evaluated by different scales, but the modified Japanese Orthopedic Association (mJOA) and the Nürick scale are probably the most commonly used. Spontaneous clinical improvement is rare and surgery is the main treatment form in an attempt to prevent further neurological deterioration and, potentially, to provide some improvement in symptoms and function. Anterior, posterior or combined cervical approaches are used to decompress the spinal cord, with adjunctive fusion being commonly performed. The choice of one approach over the other depends on patient characteristics (such as number of involved levels, site of compression, cervical alignment, previous surgeries, bone quality, presence of instability, among others) as well as surgeon preference and experience. Conclusion Spine surgeons must understand the advantages and disadvantages of all surgical techniques to choose the best procedure for their patients. Further comparative studies are necessary to establish the superiority of one approach over the other when multiple options are available.

Association between Paraspinal Muscle Morphology, Clinical Symptoms and Functional Status in Patients with Degenerative Cervical Myelopathy

2016 ◽  
Vol 16 (10) ◽  
pp. S200 ◽  
Author(s):  
Maryse Fortin ◽  
Octavian Dobrescu ◽  
Matthew Courtemanche ◽  
Carolyn Sparrey ◽  
Carlo Santaguida ◽  
...  
Keyword(s):  
Functional Status ◽  
Cervical Myelopathy ◽  
Clinical Symptoms ◽  
Paraspinal Muscle ◽  
Muscle Morphology ◽  
Degenerative Cervical Myelopathy

Correlation of axial loaded magnetic resonance imaging with clinical symptoms in lumbar spinal canal stenosis patients

MedPharmRes ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 15-19
Author(s):  
Son Nguyen ◽  
Son Vi ◽  
Hoat Luu ◽  
Toan Do
Keyword(s):  
Spinal Canal ◽  
Clinical Symptoms ◽  
Axial Loading ◽  
Spinal Canal Stenosis ◽  
Leg Pain ◽  
Cross Sectional ◽  
Canal Stenosis ◽  
Conventional Mri ◽  
Frame System ◽  
Lumbar Spinal

There are cases when symptoms are available but no abnormal stenosis is found in MRI and vice versa. Axial-loaded MRI has been shown that it can demonstrate more accurately the real status of spinal canal stenosis than conventional MRI. This is the first time we applied a new system that we have recreated from the original loading frame system in order to fit with the demands of Vietnamese people. Sixty-two patients were selected from Phu Tho Hospital in Phu Tho Province, Vietnam, who fulfilled the inclusion criteria. The Anterior-posterior diameter (APD), Dura Cross-sectional Area (DSCA) in conventional MRI and axial loaded MRI, and changes in APD and DCSA were determined at the single most constricted intervertebral level. The APD and DCSA in axial loaded MRI had very good significant correlations with VAS for back pain (rs=0.83, 0.79), leg pain (rs=0.69, 0.57) and JOA score (rs=0.70, 0.65). APD and DCSA in axial loaded MRI significantly correlated with the severity of symptoms. Our axial loading MRI provides more valuable information than the conventional MRI for assessing patients with LSCS.

scholarly journals Spine Treatment Appraisal Report (STAR): Does Riluzole Improve Outcomes in Patients Undergoing Decompression Surgery for Degenerative Cervical Myelopathy?

2021 ◽  
pp. 219256822199740
Author(s):  
Joseph R. Dettori
Keyword(s):  
Cervical Myelopathy ◽  
Decompressive Surgery ◽  
Decompression Surgery ◽  
Phase 3 ◽  
Double Blind ◽  
Safety And Efficacy ◽  
Double Blind Placebo ◽  
Degenerative Cervical Myelopathy

Fehlings MG, Badhiwala JH, Ahn H, et al. Safety and efficacy of riluzole in patients undergoing decompressive surgery for degenerative cervical myelopathy (CSM-Protect): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Neurol. 2020.

scholarly journals Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms

2021 ◽  
Vol 10 (6) ◽  
pp. 1214
Author(s):  
Ji Tu ◽  
Jose Vargas Castillo ◽  
Abhirup Das ◽  
Ashish D. Diwan
Keyword(s):  
Cervical Myelopathy ◽  
Molecular Mechanisms ◽  
Current Knowledge ◽  
Imaging Techniques ◽  
Disease Process ◽  
Classification Systems ◽  
Molecular Features ◽  
Formidable Challenge ◽  
Long Term Treatment ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.

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