Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia.
Department of Biomedical Engineering, University Hospital, Olomouc, Czechia.
Eur J Neurol. 2021 Nov;28(11):3784-3797. doi: 10.1111/ene.15027. Epub 2021 Aug 4.
Non-myelopathic degenerative cervical spinal cord compression (NMDC) frequently occurs throughout aging and may progress to potentially irreversible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression severity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract-specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM.
High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relationships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific microstructural changes in DCM patients was also explored.
The study identified diffusion-derived abnormalities in the gray matter, dorsal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the compression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked potentials, respectively, whereas electromyography outcomes corresponded with gray matter microstructure. DCM disability corresponded with microstructure alteration in lateral columns.
Outcomes imply the necessity of high-resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies.
非脊髓型颈椎病性颈脊髓压迫症（NMDC）在整个衰老过程中经常发生，并且可能进展为潜在的不可逆转的退行性颈椎病性脊髓病（DCM）。虽然标准的临床磁共振成像（MRI）和电生理学测量分别评估压迫严重程度和神经功能障碍，但 NMDC 和 DCM 患者的潜在微观结构缺陷仍需确定。本研究旨在建立电生理学缺陷的特定于束的扩散 MRI 标志物，以预测无症状 NMDC 向有症状 DCM 的进展。
对 103 例 NMDC 和 21 例 DCM 患者与 60 例健康对照者进行高分辨率 3T 扩散 MRI 采集，以揭示弥散改变以及特定于束的弥散指标与相应的电生理学指标和压迫严重程度之间的关系。还探讨了 DCM 患者残疾程度（采用改良日本矫形协会评分评估）与 DCM 患者特定于束的微观结构变化之间的关系。
本研究发现，灰质、背侧和外侧束的弥散异常与慢性退行性脊髓压迫中的跨突触变性和脱髓鞘一致，DCM 比 NMDC 更严重。弥散指标在 C3-6 区域以及 C3 以上受压水平受到影响，DCM 比 NMDC 更严重的是向头侧的缺陷。外侧运动束和背侧感觉束的改变分别与运动和感觉诱发电位相关，而肌电图结果与灰质微观结构相对应。DCM 残疾与侧柱的微观结构改变相对应。
研究结果表明，需要进行高分辨率的特定于束的弥散 MRI 监测退行性脊柱病变的纵向研究。
