Montes-González Iris Tatiana, Griswold Dylan Paul, Peralta-Pizza Fernando, Israel-Romero José Alberto, Mier-García Juan Felipe, Soriano-Sanchez José Antonio
Clínica Imbanaco, Cali, Valle del Cauca, Colombia.
Clínica Sebastián de Belalcázar, Cali, Valle del Cauca, Colombia.
Front Med (Lausanne). 2025 Feb 17;12:1525218. doi: 10.3389/fmed.2025.1525218. eCollection 2025.
Cervical spondylotic myelopathy (CSM) is a common degenerative condition characterized by narrowing of the cervical spinal canal, leading to progressive spinal cord injury and functional decline. While magnetic resonance imaging (MRI) is the gold standard for diagnosing CSM, it has limitations in predicting clinical outcomes. Magnetic resonance spectroscopy (MRS) offers metabolic insights that may enhance diagnostic and prognostic capabilities in CSM.
We conducted a systematic review following the PRISMA guidelines. Comprehensive literature searches were performed in PubMed, OVID, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials up to June 2023. Studies included human subjects with CSM, a cohort of at least 10 patients, and reported primary data on cervical spine MRS findings correlated with clinical scales such as the modified Japanese Orthopaedic Association (mJOA) scale, both pre- and post-operatively.
Six prospective studies involving 123 patients (average age 45.8 to 63 years) met the inclusion criteria. Common symptoms were neck pain, radicular upper-limb pain, paresthesia, and motor impairment. MRS findings indicated that symptomatic CSM patients had reduced N-acetyl aspartate to creatine (NAA/Cr) ratios and elevated choline to creatine (Cho/Cr) and choline to NAA (Cho/NAA) ratios compared to healthy controls. Lactate peaks were detected in a significant proportion of symptomatic patients, suggesting hypoxic or inflammatory injury. Decreased NAA/Cr and increased Cho/NAA ratios correlated with lower mJOA scores, indicating more severe myelopathy. Post-operative increases in NAA/Cr ratios and decreases in Cho/NAA ratios were associated with improved mJOA scores, highlighting the prognostic value of these metabolites.
MRS provides valuable metabolic information correlating with clinical severity and functional outcomes in CSM. Reduced NAA/Cr and elevated Cho/Cr and Cho/NAA ratios are associated with more severe disease and may predict surgical recovery. MRS shows promise as a non-invasive tool for enhancing the diagnosis and management of CSM. Further research is needed to standardize protocols, validate findings in larger cohorts, and integrate MRS into clinical practice.
脊髓型颈椎病（CSM）是一种常见的退行性疾病，其特征为颈椎管狭窄，导致脊髓损伤逐渐加重和功能衰退。虽然磁共振成像（MRI）是诊断CSM的金标准，但在预测临床结果方面存在局限性。磁共振波谱（MRS）提供的代谢信息可能会增强CSM的诊断和预后评估能力。
我们按照PRISMA指南进行了系统综述。截至2023年6月，在PubMed、OVID、EMBASE、Web of Science和Cochrane对照试验中央注册库中进行了全面的文献检索。纳入的研究对象为患有CSM的人类受试者，样本量至少为10例患者，并报告了颈椎MRS检查结果的原始数据，这些数据与术前和术后的临床量表（如改良日本骨科协会（mJOA）量表）相关。
六项涉及123例患者（平均年龄45.8至63岁）的前瞻性研究符合纳入标准。常见症状包括颈部疼痛、上肢放射性疼痛、感觉异常和运动障碍。MRS检查结果表明，与健康对照组相比，有症状的CSM患者的N-乙酰天门冬氨酸与肌酸（NAA/Cr）比值降低，胆碱与肌酸（Cho/Cr）以及胆碱与NAA（Cho/NAA）比值升高。在相当比例的有症状患者中检测到乳酸峰，提示存在缺氧或炎症损伤。NAA/Cr降低和Cho/NAA升高与较低的mJOA评分相关，表明脊髓病更严重。术后NAA/Cr比值升高和Cho/NAA比值降低与mJOA评分改善相关，突出了这些代谢物的预后价值。
MRS提供了与CSM临床严重程度和功能结果相关的有价值的代谢信息。NAA/Cr降低以及Cho/Cr和Cho/NAA升高与更严重的疾病相关，可能预测手术恢复情况。MRS有望成为一种增强CSM诊断和管理的非侵入性工具。需要进一步研究来规范方案，在更大样本队列中验证研究结果，并将MRS纳入临床实践。
