Cho Newton, Al-Shawwa Abdul, Jacobs W Bradley, Evaniew Nathan, Bouchard Jacques, Casha Steve, duPlessis Stephan, Lewkonia Peter, Nicholls Fred, Soroceanu Alex, Swamy Ganesh, Thomas Kenneth C, Yang Michael M H, Cohen-Adad Julien, Cadotte David W
Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary , Alberta , Canada.
Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary , Alberta , Canada.
Neurosurgery. 2025 Apr 3;97(3):681-690. doi: 10.1227/neu.0000000000003428.
Degenerative cervical myelopathy (DCM) is the most common cause of spinal dysfunction globally. Despite surgical intervention, motor dysfunction may persist in many patients. The purpose of this study was to comprehensively examine specific spinal cord tract changes in patients with DCM, to better understand potential substrates for compensatory recovery of function.
Cervical spinal cord MRI scans with diffusion tensor imaging were performed in patients with DCM and in healthy volunteers. Spinal Cord Toolbox was used to register the PAM50 template, which includes a probabilistic atlas of the white matter tracts of the spinal cord, to the imaging data. Fractional anisotropy (FA) was extracted for each tract at C3 above the level of maximal compression and compared between patients with DCM and healthy volunteers and between patients with mild vs moderate to severe DCM.
We included 25 patients with DCM (13 mild and 12 moderate to severe) and 6 healthy volunteers. FA was significantly reduced in DCM subjects relative to healthy volunteers for the lateral corticospinal tract (mild DCM vs healthy ∆ = -0.13, P = .018; moderate to severe DCM vs healthy ∆ = -0.11, P = .047), fasciculus gracilis (mild DCM vs healthy ∆ = -0.16, P = .010; moderate to severe DCM vs healthy ∆ = -0.13, P = .039), and fasciculus cuneatus (mild DCM vs healthy ∆ = -0.16, P = .007; moderate to severe DCM vs healthy ∆ = -0.15, P = .012). There were no differences in FA for all tracts between mild and moderate-to-severe DCM subjects.
Patients with DCM had altered diffusion tensor imaging signal in their lateral corticospinal tract, fasciculus gracilis, and fasciculus cuneatus in comparison with healthy volunteers. These findings indicate that DCM is characterized by injury to these structures, which suggests that other tracts within the cord could potentially act as substrates for compensatory motor recovery.
退行性颈椎脊髓病（DCM）是全球脊髓功能障碍最常见的原因。尽管进行了手术干预，但许多患者的运动功能障碍可能仍然存在。本研究的目的是全面检查DCM患者特定脊髓束的变化，以更好地了解功能代偿恢复的潜在基础。
对DCM患者和健康志愿者进行颈椎脊髓MRI扫描及弥散张量成像。使用脊髓工具箱将包含脊髓白质束概率图谱的PAM50模板配准到成像数据上。在最大压迫水平上方的C3处提取各束的分数各向异性（FA），并在DCM患者与健康志愿者之间以及轻度与中度至重度DCM患者之间进行比较。
我们纳入了25例DCM患者（13例轻度和12例中度至重度）和6名健康志愿者。与健康志愿者相比，DCM受试者的外侧皮质脊髓束（轻度DCM与健康对照∆ = -0.13，P = 0.018；中度至重度DCM与健康对照∆ = -0.11，P = 0.047）、薄束（轻度DCM与健康对照∆ = -0.16，P = 0.010；中度至重度DCM与健康对照∆ = -0.13，P = 0.039）和楔束（轻度DCM与健康对照∆ = -0.16，P = 0.007；中度至重度DCM与健康对照∆ = -0.15，P = 0.012）的FA显著降低。轻度与中度至重度DCM受试者之间所有束的FA均无差异。
与健康志愿者相比，DCM患者的外侧皮质脊髓束、薄束和楔束的弥散张量成像信号发生了改变。这些发现表明，DCM的特征是这些结构受损，这表明脊髓内的其他束可能潜在地作为运动代偿恢复的基础。
