Frontiers in Neurology (Jun 2024)

Potential thresholds of critically increased cardiac-related spinal cord motion in degenerative cervical myelopathy

  • Nikolai Pfender,
  • Catherine R. Jutzeler,
  • Michèle Hubli,
  • Paulina S. Scheuren,
  • Paulina S. Scheuren,
  • Dario Pfyffer,
  • Dario Pfyffer,
  • Carl M. Zipser,
  • Jan Rosner,
  • Jan Rosner,
  • Susanne Friedl,
  • Reto Sutter,
  • José M. Spirig,
  • Michael Betz,
  • Martin Schubert,
  • Maryam Seif,
  • Maryam Seif,
  • Patrick Freund,
  • Patrick Freund,
  • Mazda Farshad,
  • Armin Curt,
  • Armin Curt,
  • Markus Hupp

DOI
https://doi.org/10.3389/fneur.2024.1411182
Journal volume & issue
Vol. 15

Abstract

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IntroductionNew diagnostic techniques are a substantial research focus in degenerative cervical myelopathy (DCM). This cross-sectional study determined the significance of cardiac-related spinal cord motion and the extent of spinal stenosis as indicators of mechanical strain on the cord.MethodsEighty-four DCM patients underwent MRI/clinical assessments and were classified as MRI+ [T2-weighted (T2w) hyperintense lesion in MRI] or MRI− (no T2w-hyperintense lesion). Cord motion (displacement assessed by phase-contrast MRI) and spinal stenosis [adapted spinal canal occupation ratio (aSCOR)] were related to neurological (sensory/motor) and neurophysiological readouts [contact heat evoked potentials (CHEPs)] by receiver operating characteristic (ROC) analysis.ResultsMRI+ patients (N = 31; 36.9%) were more impaired compared to MRI− patients (N = 53; 63.1%) based on the modified Japanese Orthopedic Association (mJOA) subscores for upper {MRI+ [median (Interquartile range)]: 4 (4–5); MRI−: 5 (5–5); p < 0.01} and lower extremity [MRI+: 6 (6–7); MRI−: 7 (6–7); p = 0.03] motor dysfunction and the monofilament score [MRI+: 21 (18–23); MRI−: 24 (22-24); p < 0.01]. Both patient groups showed similar extent of cord motion and stenosis. Only in the MRI− group displacement identified patients with pathologic assessments [trunk/lower extremity pin prick score (T/LEPP): AUC = 0.67, p = 0.03; CHEPs: AUC = 0.73, p = 0.01]. Cord motion thresholds: T/LEPP: 1.67 mm (sensitivity 84.6%, specificity 52.5%); CHEPs: 1.96 mm (sensitivity 83.3%, specificity 65.6%). The aSCOR failed to show any relation to the clinical assessments.DiscussionThese findings affirm cord motion measurements as a promising additional biomarker to improve the clinical workup and to enable timely surgical treatment particularly in MRI− DCM patients.Clinical trial registrationwww.clinicaltrials.gov, NCT 02170155.

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