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Increased spinal cord movements in cervical spondylotic myelopathy


Vavasour, Irene M; Meyers, Sandra M; Macmillan, Erin L; Mädler, Burkhard; Li, David K B; Rauscher, Alexander; Vertinsky, Talia; Venu, Vic; Mackay, Alex L; Curt, Armin (2014). Increased spinal cord movements in cervical spondylotic myelopathy. The Spine Journal, 14(10):2344-2354.

Abstract

BACKGROUND CONTEXT: Magnetic resonance imaging is a very useful diagnostic test for cervical spondylotic myelopathy (CSM) since it can identify degenerative changes within the spinal cord (SC), disclose the extent, localisation and kind of SC compression, and help rule out other SC disorders. However, the relationships between changes in cerebrospinal fluid (CSF) flow, cord motion, the extent and severity of spinal canal stenosis, and the development of CSM symptoms are not well understood.

PUPOSE: The purpose of this study was to evaluate if changes in the velocity of CSF and SC movements provide additional insight into the pathophysiological mechanisms underlying CSM beyond MRI observations of cord compression. Study Design/Setting: Prospective radiological study of recruited patients PATIENT SAMPLE: 13 CSM subjects and 15 age and gender matched controls OUTCOME MEASURES: MRI measures included CSF and spinal cord movement. Cervical cord condition was assessed by the Japanese Orthopaedic Association (JOA) score, compression ratio and somatosensory evoked potentials (SSEP) of the tibial and ulnar nerves.

METHODS: Phase contrast imaging at the level of stenosis for patients and level C5 for controls as well as T2-weighted imaging were compared to clinical findings. This study was funded by the Cervical Spine Research Society ($60000).

RESULTS: CSF velocity was significantly reduced in CSM subjects as compared to controls, and was related to cord compression ratio. Changes in CSF velocity and cord compression were not correlated with clinical measures (JOA scores, SSEP) or the presence of T2 hyperintensities. Spinal cord movements, i.e. cord displacement and velocity in the cranio-caudal axis, were increased in CSM patients. Increased spinal cord movements (i.e. total cord displacement) both in the controls and CSM subjects were associated with altered spinal conduction as assessed by SSEP.

CONCLUSIONS: This study revealed rather unexpected increased cord movements in the cranio-caudal axis in CSM patients, which may contribute to myelopathic deteriorations in combination with spinal canal compression. Understanding the relevance of cord movements with respect to supporting the clinical CSM diagnosis or disease monitoring requires further long term follow-up studies.

Abstract

BACKGROUND CONTEXT: Magnetic resonance imaging is a very useful diagnostic test for cervical spondylotic myelopathy (CSM) since it can identify degenerative changes within the spinal cord (SC), disclose the extent, localisation and kind of SC compression, and help rule out other SC disorders. However, the relationships between changes in cerebrospinal fluid (CSF) flow, cord motion, the extent and severity of spinal canal stenosis, and the development of CSM symptoms are not well understood.

PUPOSE: The purpose of this study was to evaluate if changes in the velocity of CSF and SC movements provide additional insight into the pathophysiological mechanisms underlying CSM beyond MRI observations of cord compression. Study Design/Setting: Prospective radiological study of recruited patients PATIENT SAMPLE: 13 CSM subjects and 15 age and gender matched controls OUTCOME MEASURES: MRI measures included CSF and spinal cord movement. Cervical cord condition was assessed by the Japanese Orthopaedic Association (JOA) score, compression ratio and somatosensory evoked potentials (SSEP) of the tibial and ulnar nerves.

METHODS: Phase contrast imaging at the level of stenosis for patients and level C5 for controls as well as T2-weighted imaging were compared to clinical findings. This study was funded by the Cervical Spine Research Society ($60000).

RESULTS: CSF velocity was significantly reduced in CSM subjects as compared to controls, and was related to cord compression ratio. Changes in CSF velocity and cord compression were not correlated with clinical measures (JOA scores, SSEP) or the presence of T2 hyperintensities. Spinal cord movements, i.e. cord displacement and velocity in the cranio-caudal axis, were increased in CSM patients. Increased spinal cord movements (i.e. total cord displacement) both in the controls and CSM subjects were associated with altered spinal conduction as assessed by SSEP.

CONCLUSIONS: This study revealed rather unexpected increased cord movements in the cranio-caudal axis in CSM patients, which may contribute to myelopathic deteriorations in combination with spinal canal compression. Understanding the relevance of cord movements with respect to supporting the clinical CSM diagnosis or disease monitoring requires further long term follow-up studies.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:23 January 2014
Deposited On:14 Apr 2014 15:52
Last Modified:08 Dec 2017 05:12
Publisher:Elsevier
ISSN:1529-9430
Publisher DOI:https://doi.org/10.1016/j.spinee.2014.01.036
PubMed ID:24462810

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