Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques

Degenerative cervical myelopathy encompasses a spectrum of age-related structural changes of the cervical spine that result in static and dynamic injury to the spinal cord and collectively represent the most common cause of myelopathy in adults. Although cervical myelopathy is determined clinically, the diagnosis requires confirmation via imaging, and MRI is the preferred modality. Because of the heterogeneity of the condition and evolution of MRI technology, multiple techniques have been developed over the years in an attempt to quantify the degree of baseline severity and potential for neurological recovery. In this review, these techniques are categorized anatomically into those that focus on bone, ligaments, discs, and the spinal cord. In addition, measurements for the cervical spine canal size and sagittal alignment are also described briefly. These tools have resulted collectively in the identification of numerous useful parameters. However, the development of multiple techniques for assessing the same feature, such as cord compression, has also resulted in a number of challenges, including introducing ambiguity in terms of which methods to use and hindering effective comparisons of analysis in the literature. In addition, newer techniques that use advanced MRI are emerging and providing exciting new tools for assessing the spinal cord in patients with degenerative cervical myelopathy.

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Congenital Cervical Spine Stenosis in a Multicenter Global Cohort of Patients With Degenerative Cervical Myelopathy: An Ambispective Report Based on a Magnetic Resonance Imaging Diagnostic Criterion

Neurosurgery ◽

10.1093/neuros/nyx521 ◽

2018 ◽

Vol 83 (3) ◽

pp. 521-528 ◽

Cited By ~ 5

Author(s):

Aria Nouri ◽

Lindsay Tetreault ◽

Satoshi Nori ◽

Allan R Martin ◽

Anick Nater ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Cervical Spine ◽

Magnetic Resonance ◽

Surgical Outcomes ◽

Cervical Myelopathy ◽

Spinal Canal ◽

Resonance Imaging ◽

Baseline Severity ◽

Degenerative Cervical Myelopathy

Abstract BACKGROUND Congenital spinal stenosis (CSS) of the cervical spine is a risk factor for acute spinal cord injury and development of degenerative cervical myelopathy (DCM). OBJECTIVE To develop magnetic resonance imaging (MRI)-based criteria to diagnose preexisting CSS and evaluate differences between patients with and without CSS. METHODS A secondary analysis of international prospectively collected data between 2005 and 2011 was conducted. We examined the data of 349 surgical DCM patients and 27 controls. Spinal canal and cord anteroposterior diameters were measured at noncompressed sites to calculate spinal cord occupation ratio (SCOR). Torg–Pavlov ratios and spinal canal diameters from radiographs were correlated with SCOR. Clinical and MRI factors were compared between patients with and without CSS. Surgical outcomes were also assessed. RESULTS Calculation of SCOR was feasible in 311/349 patients. Twenty-six patients with CSS were identified (8.4%). Patients with CSS were younger than patients without CSS (P = .03) and had worse baseline severity as measured by the modified Japanese Orthopedic Association score (P = .04), Nurick scale (P = .05), and Neck Disability Index (P < .01). CSS patients more commonly had T2 cord hyperintensity changes (P = .09, ns) and worse SF-36 Physical Component scores (P = .06, ns). SCOR correlated better with Torg–Pavlov ratio and spinal canal diameter at C3 than C5. Patients with SCOR ≥ 65% were also younger but did not differ in baseline severity. CONCLUSION SCOR ≥ 70% is an effective criterion to diagnose CSS. CSS patients develop myelopathy at a younger age and have greater impairment and disability than other patients with DCM. Despite this, CSS patients have comparable duration of symptoms, MRI presentations, and surgical outcomes to DCM patients without CSS.

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Importance of Sagittal Alignment of the Cervical Spine in the Management of Degenerative Cervical Myelopathy

Neurosurgery Clinics of North America ◽

10.1016/j.nec.2017.09.004 ◽

2018 ◽

Vol 29 (1) ◽

pp. 69-82 ◽

Cited By ~ 5

Author(s):

Thomas J. Buell ◽

Avery L. Buchholz ◽

John C. Quinn ◽

Christopher I. Shaffrey ◽

Justin S. Smith

Keyword(s):

Cervical Spine ◽

Cervical Myelopathy ◽

Sagittal Alignment ◽

Degenerative Cervical Myelopathy

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Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE DCM Research Priority Number 9]

Global Spine Journal ◽

10.1177/21925682211057484 ◽

2021 ◽

pp. 219256822110574

Author(s):

Allan R. Martin ◽

Lindsay Tetreault ◽

Benjamin M. Davies ◽

Armin Curt ◽

Patrick Freund ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Myelopathy ◽

Tissue Injury ◽

Quantitative Imaging ◽

Cord Compression ◽

Narrative Review ◽

Imaging Tool ◽

Spinal Cord Dysfunction ◽

Degenerative Cervical Myelopathy ◽

And Function

Study Design Narrative review. Objective The current review aimed to describe the role of existing techniques and emerging methods of imaging and electrophysiology for the management of degenerative cervical myelopathy (DCM), a common and often progressive condition that causes spinal cord dysfunction and significant morbidity globally. Methods A narrative review was conducted to summarize the existing literature and highlight future directions. Results Anatomical magnetic resonance imaging (MRI) is well established in the literature as the key imaging tool to identify spinal cord compression, disc herniation/bulging, and inbuckling of the ligamentum flavum, thus facilitating surgical planning, while radiographs and computed tomography (CT) provide complimentary information. Electrophysiology techniques are primarily used to rule out competing diagnoses. However, signal change and measures of cord compression on conventional MRI have limited utility to characterize the degree of tissue injury, which may be helpful for diagnosis, prognostication, and repeated assessments to identify deterioration. Early translational studies of quantitative imaging and electrophysiology techniques show potential of these methods to more accurately reflect changes in spinal cord microstructure and function. Conclusion Currently, clinical management of DCM relies heavily on anatomical MRI, with additional contributions from radiographs, CT, and electrophysiology. Novel quantitative assessments of microstructure, perfusion, and function have the potential to transform clinical practice, but require robust validation, automation, and standardization prior to uptake.

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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 ◽

10.1136/bmjopen-2020-037332 ◽

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).

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P90 A systematic review of spinal cord serum and cerebrospinal fluid biomarkers for use in degenerative cervical myelopathy

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.147 ◽

2019 ◽

Vol 90 (3) ◽

pp. e45.3-e46 ◽

Cited By ~ 3

Author(s):

M Stewart ◽

S Smith ◽

B Davies ◽

P Hutchinson ◽

M Kotter

Keyword(s):

Spinal Cord ◽

High Throughput ◽

Cervical Myelopathy ◽

Evidence Base ◽

Cord Compression ◽

Response To Treatment ◽

Csf Biomarkers ◽

Spinal Cord Damage ◽

Cerebrospinal Fluid Biomarkers ◽

Degenerative Cervical Myelopathy

ObjectivesWhilst radiological evidence of compression is the hallmark of degenerative cervical myelopathy [DCM], it is unable to stage or prognosticate. Moreover, asymptomatic spinal cord compression is common and therefore new methods of assessing spinal cord function are required. We aimed to: 1) Evaluate the evidence-base for serum and CSF biomarkers of spinal cord damage in diagnosis, prognosis or predicting response to treatment in DCM 2) Identify serum and CSF biomarkers of spinal cord damage studied in other conditions, which may have relevance to DCM.DesignScoping review.SubjectsHuman only.MethodsA search of MEDLINE and EMBASE was performed. Studies involving DCM patients or biomarkers relevant to spinal cord pathobiology were included.Results852 results were screened, of which 83 were included. 9 studies explored 12 biomarkers in DCM. NFH (n=3), S100b and NSE (n=2) received most study. 74 studies explored a further 118 biomarkers in other conditions; S100b (n=13), NFH (n=11) and GFAP (n=10) received most study. Overall, 72 studies used targeted approaches, in which candidate biomarkers were chosen in advance. 11 used unbiased approaches, in which high throughput analyses identified candidate biomarkers during the study.ConclusionsThe evidence-base for use of biomarkers in DCM is limited. Whilst targeted approaches have identified a number of candidate spinal cord markers, few have shown clinical utility. There is a shift towards investigating panels of multiple markers and unbiased, high-throughput approaches.

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Short-term predictive potential of quantitative assessment of spinal cord impairment in patients undergoing French-door Laminoplasty for degenerative cervical myelopathy: preliminary results of an exploratory study exploiting intraoperative ultrasound data

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03319-w ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Guoliang Chen ◽

Jiachun Li ◽

Fuxin Wei ◽

Qiao Ji ◽

Wenyuan Sui ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Myelopathy ◽

Quantitative Assessment ◽

Japanese Orthopaedic Association ◽

Intraoperative Ultrasound ◽

Cord Compression ◽

Postoperative Mri ◽

Degenerative Cervical Myelopathy ◽

Gray Values

Abstract Background To study the correlation of neurological function in degenerative cervical myelopathy (DCM) patients with quantitative assessment of spinal cord compression and impairment by intraoperative ultrasound imaging (IOUSI). Methods Twenty-three patients who underwent French-Door laminoplasty for multilevel DCM were followed for 6 months. Modified Japanese Orthopaedic Association (mJOA) score and cervical MRI were assessed before surgery and at postoperative 6 months. IOUS, used to guide decompression, were recorded. The anteroposterior diameter (APD) and the gray values of the IOUSI hyperechogenicity of the midsagittal IOUSI at the narrowest level and at the lesion-free level, and the APD and traverse diameter at the traverse maximum compression level of IOUSI were measured. Maximum spinal cord compression (MSCC), compression rate (CR), and IOUSI gray value ratio (Rgray) were calculated. The appearance of preoperative T2W MRI increased signal intensity (ISI), and the signal change rate (SCR) on postoperative T2W MRI of 9 patients were also measured and calculated, and compared with that of IOUSI hyperechogenicity. Results Average mJOA score increased significantly from 11.57 ± 2.67 before surgery to 15.39 ± 1.50 at 6 months after surgery, with an average recovery rate (RR) of 71.11 ± 22.81%. The difference between the appearance of preoperative T2W MRI ISI and IOUSI hyperechogenicity was not significant. Spearman correlation analysis found that the IOUSI Rgray were negatively correlated with the RR of mJOA score with a coefficient of − 0.77, and the IOUSI Rgray was not correlated with the postoperative MRI SCR. Conclusions In DCM patients, the gray values of IOUSI can be measured accurately. The IOUSI Rgray correlated with postoperative neurological recovery significantly.

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Degenerative Cervical Myelopathy: Pathophysiology and Current Treatment Strategies

Asian Spine Journal ◽

10.31616/asj.2020.0490 ◽

2020 ◽

Vol 14 (5) ◽

pp. 710-720

Author(s):

Sung Hoon Choi ◽

Chang-Nam Kang

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Surgical Approach ◽

Cervical Myelopathy ◽

Clinical Manifestations ◽

Treatment Strategies ◽

Clinical Syndrome ◽

Intervertebral Disk ◽

Medical Systems ◽

Degenerative Cervical Myelopathy

<p>Chronic compression or ischemia of the spinal cord in the cervical spine causes a clinical syndrome known as cervical myelopathy. Recently, a new term “degenerative cervical myelopathy (DCM)” was introduced. DCM encompasses spondylosis, intervertebral disk herniation, facet arthrosis, ligamentous hypertrophy, calcification, and ossification. The pathophysiology of DCM includes structural and functional abnormalities of the spinal cord caused by static and dynamic factors. In nonoperative patients, cervical myelopathy has a poor prognosis. Surgical treatments, such as anterior or posterior decompression accompanying arthrodesis, arthroplasty, or laminoplasty, should be considered for patients with chronic progressive cervical myelopathy. Surgical decompression can prevent the progression of myelopathy and improve the neurologic status, functional outcomes, and quality of life, irrespective of differences in medical systems and sociocultural determinants of health. The anterior surgical approach to the cervical spine has the advantage of removing or floating the intervertebral disk, osteophytes, and ossification of the posterior longitudinal ligament that compress the spinal cord directly. The posterior surgical approach to the cervical spine is mainly used for multisegment spinal cord compression in patients with cervical lordosis. In this review article, we addressed the pathophysiology, clinical manifestations, differential diagnosis, and treatment options for DCM.</p>

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Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History

Journal of Clinical Medicine ◽

10.3390/jcm10163626 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3626

Author(s):

Melissa Lannon ◽

Edward Kachur

Keyword(s):

Spinal Cord ◽

Cervical Myelopathy ◽

Clinical Presentation ◽

Signs And Symptoms ◽

Cord Compression ◽

Upper Extremities ◽

Medical Practitioners ◽

Cord Injury ◽

Neurologic Disability ◽

Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is a leading cause of spinal cord injury and a major contributor to morbidity resulting from narrowing of the spinal canal due to osteoarthritic changes. This narrowing produces chronic spinal cord compression and neurologic disability with a variety of symptoms ranging from mild numbness in the upper extremities to quadriparesis and incontinence. Clinicians from all specialties should be familiar with the early signs and symptoms of this prevalent condition to prevent gradual neurologic compromise through surgical consultation, where appropriate. The purpose of this review is to familiarize medical practitioners with the pathophysiology, common presentations, diagnosis, and management (conservative and surgical) for DCM to develop informed discussions with patients and recognize those in need of early surgical referral to prevent severe neurologic deterioration.

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Cervical instability in a patient with rheumatoid arthritis

Polish Annals of Medicine ◽

10.29089/2020.20.00148 ◽

2021 ◽

Author(s):

Victoria Perovic-Kaczmarek ◽

Julita Czech ◽

Beata Tarnacka

Keyword(s):

Rheumatoid Arthritis ◽

Spinal Cord ◽

Cervical Spine ◽

Cervical Myelopathy ◽

Cord Compression ◽

Joint Involvement ◽

Cervical Instability ◽

X Ray ◽

Cervical Spine Surgery ◽

Neurological Improvement

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune connective tissue disease characterized by symmetrical arthritis associated with extra-articular changes. Although peripheral joint involvement is the dominant symptom of RA, many patients develop cervical spine involvement in the course of the disease, manifesting as cervical instability. Aim: The aim of this study is to describe a case of an RA patient with spinal myelopathy to increase awareness of this complication, hoping that its early diagnosis may prevent further serious consequences. Case study: A 63-year-old patient, who was diagnosed with RA 18 years ago, was admitted to the Rheumatology Clinic due to suspected exacerbation of rheumatic disease. Functional X-Ray and MRI was performed, which showed instability in the C3–C4 segment with spinal cord compression. Subsequently, the patient underwent cervical spine surgery. After the surgery and rehabilitation, the patient demonstrated neurological improvement. Results and discussion: Every patient diagnosed with RA should be educated about the possibility of a complication of cervical instability and be familiar with the neurological symptoms that may result from it. If cervical instability and subsequent cervical myelopathy are detected early, the symptoms may be reversible or significantly reduced by surgical spinal cord decompression and cervical stabilization. Conclusions: It is very important to perform a functional X-ray of the cervical spine to exclude instability, especially before rehabilitation treatment. Neck pain in patients diagnosed with RA may indicate cervical instability that requires more thorough neurological examination to exclude cervical myelopathy.

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