scholarly journals T1 Mapping for Microstructural Assessment of the Cervical Spinal Cord in the Evaluation of Patients with Degenerative Cervical Myelopathy

2021 ◽  
Author(s):  
G. Baucher ◽  
H. Rasoanandrianina ◽  
S. Levy ◽  
L. Pini ◽  
L. Troude ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
T1 Mapping ◽  
Cervical Spinal Cord ◽  
Degenerative Cervical Myelopathy

scholarly journals Increasing awareness of degenerative cervical myelopathy: a preventative cause of non-traumatic spinal cord injury

Spinal Cord ◽  
2021 ◽  
Author(s):  
Carl M. Zipser ◽  
Konstantinos Margetis ◽  
Karlo M. Pedro ◽  
Armin Curt ◽  
Michael Fehlings ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Myelopathy ◽  
Cervical Spinal Cord ◽  
Neurological Impairment ◽  
Common Data Elements ◽  
Cord Injury ◽  
Data Elements ◽  
Degenerative Cervical Myelopathy ◽  
Work Up

AbstractDegenerative cervical myelopathy (DCM) is a common non-traumatic spinal cord disorder and characterized by progressive neurological impairment. Generally, it is still underdiagnosed and referral to spine specialists is often late, when patients already present with incomplete cervical spinal cord injury (SCI). To improve early diagnosis and accelerate referral, diagnostic criteria for DCM are required. Recently, AO Spine RECODE- DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) (aospine.org/recode), an international, interdisciplinary and interprofessional initiative, including patients with DCM, was funded with the aim to accelerate knowledge discovery that can change outcomes. In this perspective we advocate for the participation of SCI specialists in this process, where the expertise and perspective on this disorder and requirements for the diagnostic and therapeutic work up is well developed.

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 ◽  
2018 ◽  
Vol 83 (3) ◽  
pp. 521-528 ◽  
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.

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

2016 ◽  
Vol 40 (6) ◽  
pp. E5 ◽  
Author(s):  
Aria Nouri ◽  
Allan R. Martin ◽  
David Mikulis ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Structural Changes ◽  
Sagittal Alignment ◽  
Measurement Techniques ◽  
Cord Compression ◽  
Age Related ◽  
Magnetic Resonance Imaging Assessment ◽  
Degenerative Cervical Myelopathy

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.

scholarly journals The Natural History of Degenerative Cervical Myelopathy and the Rate of Hospitalization Following Spinal Cord Injury: An Updated Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 28S-34S ◽  
Author(s):  
Lindsay A. Tetreault ◽  
Spyridon Karadimas ◽  
Jefferson R. Wilson ◽  
Paul M. Arnold ◽  
Shekar Kurpad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Natural History ◽  
Cervical Myelopathy ◽  
Cochrane Collaboration ◽  
Level Of Evidence ◽  
Cord Injury ◽  
History Of ◽  
Degenerative Cervical Myelopathy

Study Method: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a degenerative spine disease and the most common cause of spinal cord dysfunction in adults worldwide. The objective of this study is to determine the natural history of DCM by updating the systematic review by Karadimas et al. The specific aims of this review were (1) to describe the natural history of DCM and (2) to determine potential risk factors of disease progression. Method: An updated search based on a previous protocol was conducted in PubMed and the Cochrane Collaboration library for studies published between November 2012 and February 15, 2015. Results: The updated search yielded 3 additional citations that met inclusion criteria and reported the incidence of spinal cord injury and severe disability in patients with DCM. Based on 2 retrospective cohort studies, the incidence rate of hospitalization for spinal cord injury is 13.9 per 1000 person-years in patients with cervical spondylotic myelopathy and 4.8 per 1000 person-years in patients with myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). In a third small prospective study, the risk of being wheelchair bound or bedridden was 66.7% in DCM patients with OPLL. Conclusion: The overall level of evidence for these estimated rates of hospitalization following spinal cord injury was rated as low.

scholarly journals The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

2021 ◽  
Vol 14 ◽  
pp. 117863882110546
Author(s):  
Celine I Partha Sarathi ◽  
Oliver D Mowforth ◽  
Amil Sinha ◽  
Faheem Bhatti ◽  
Aniqah Bhatti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Surgical Outcome ◽  
Assessment Tool ◽  
Hospital Readmissions ◽  
Functional Improvement ◽  
Current Evidence ◽  
Degenerative Cervical Myelopathy

Introduction: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. Methods: A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. Results: In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. Conclusion: Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.

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

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.

scholarly journals 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 ◽  
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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