Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy
IntroductionDegenerative cervical myelopathy (DCM) is the most common cause of non-traumatic incomplete spinal cord injury, but its pathophysiology is poorly understood. As spinal cord compression observed in standard MRI often fails to explain a patient's status, new diagnostic techniques to a...
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1217526/full |
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| author | Nikolai Pfender Nikolai Pfender Jan Rosner Jan Rosner Carl M. Zipser Carl M. Zipser Susanne Friedl Susanne Friedl Martin Schubert Martin Schubert Reto Sutter Markus Klarhoefer José M. Spirig Michael Betz Patrick Freund Mazda Farshad Armin Curt Armin Curt Markus Hupp |
| author_facet | Nikolai Pfender Nikolai Pfender Jan Rosner Jan Rosner Carl M. Zipser Carl M. Zipser Susanne Friedl Susanne Friedl Martin Schubert Martin Schubert Reto Sutter Markus Klarhoefer José M. Spirig Michael Betz Patrick Freund Mazda Farshad Armin Curt Armin Curt Markus Hupp |
| author_sort | Nikolai Pfender |
| collection | DOAJ |
| description | IntroductionDegenerative cervical myelopathy (DCM) is the most common cause of non-traumatic incomplete spinal cord injury, but its pathophysiology is poorly understood. As spinal cord compression observed in standard MRI often fails to explain a patient's status, new diagnostic techniques to assess DCM are one of the research priorities. Minor cardiac-related cranio-caudal oscillations of the cervical spinal cord are observed by phase-contrast MRI (PC-MRI) in healthy controls (HCs), while they become pathologically increased in patients suffering from degenerative cervical myelopathy. Whether transversal oscillations (i.e., anterior–posterior and right–left) also change in DCM patients is not known.MethodsWe assessed spinal cord motion simultaneously in all three spatial directions (i.e., cranio-caudal, anterior–posterior, and right–left) using sagittal PC-MRI and compared physiological oscillations in 18 HCs to pathological changes in 72 DCM patients with spinal canal stenosis. The parameter of interest was the amplitude of the velocity signal (i.e., maximum positive to maximum negative peak) during the cardiac cycle.ResultsMost patients suffered from mild DCM (mJOA score 16 (14–18) points), and the majority (68.1%) presented with multisegmental stenosis. The spinal canal was considerably constricted in DCM patients in all segments compared to HCs. Under physiological conditions in HCs, the cervical spinal cord oscillates in the cranio-caudal and anterior–posterior directions, while right–left motion was marginal [e.g., segment C5 amplitudes: cranio-caudal: 0.40 (0.27–0.48) cm/s; anterior–posterior: 0.18 (0.16–0.29) cm/s; right–left: 0.10 (0.08–0.13) cm/s]. Compared to HCs, DCM patients presented with considerably increased cranio-caudal oscillations due to the cardinal pathophysiologic change in non-stenotic [e.g., segment C5 amplitudes: 0.79 (0.49–1.32) cm/s] and stenotic segments [.g., segment C5 amplitudes: 0.99 (0.69–1.42) cm/s]). In contrast, right–left [e.g., segment C5 amplitudes: non-stenotic segment: 0.20 (0.13–0.32) cm/s; stenotic segment: 0.11 (0.09–0.18) cm/s] and anterior–posterior oscillations [e.g., segment C5 amplitudes: non-stenotic segment: 0.26 (0.15–0.45) cm/s; stenotic segment: 0.11 (0.09–0.18) cm/s] remained on low magnitudes comparable to HCs.ConclusionIncreased cranio-caudal oscillations of the cervical cord are the cardinal pathophysiologic change and can be quantified using PC-MRI in DCM patients. This study addresses spinal cord oscillations as a relevant biomarker reflecting dynamic mechanical cord stress in DCM patients, potentially contributing to a loss of function. |
| first_indexed | 2024-03-11T11:44:21Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T11:44:21Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-28355401b8eb42a290bd8a212a5606be2023-11-09T15:10:56ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-11-011410.3389/fneur.2023.12175261217526Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathyNikolai Pfender0Nikolai Pfender1Jan Rosner2Jan Rosner3Carl M. Zipser4Carl M. Zipser5Susanne Friedl6Susanne Friedl7Martin Schubert8Martin Schubert9Reto Sutter10Markus Klarhoefer11José M. Spirig12Michael Betz13Patrick Freund14Mazda Farshad15Armin Curt16Armin Curt17Markus Hupp18Spinal Cord Injury Center, Balgrist University Hospital, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, Zurich, SwitzerlandSpinal Cord Injury Center, Balgrist University Hospital, Zurich, SwitzerlandDepartment of Neurology, University Hospital Bern, Inselspital, Bern, SwitzerlandSpinal Cord Injury Center, Balgrist University Hospital, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, Zurich, SwitzerlandSpinal Cord Injury Center, Balgrist University Hospital, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, Zurich, SwitzerlandSpinal Cord Injury Center, Balgrist University Hospital, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, Zurich, SwitzerlandRadiology, Balgrist University Hospital, Zurich, SwitzerlandSiemens Healthineers AG, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, Zurich, SwitzerlandSpinal Cord Injury Center, Balgrist University Hospital, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, Zurich, SwitzerlandSpinal Cord Injury Center, Balgrist University Hospital, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, Zurich, SwitzerlandSpinal Cord Injury Center, Balgrist University Hospital, Zurich, SwitzerlandIntroductionDegenerative cervical myelopathy (DCM) is the most common cause of non-traumatic incomplete spinal cord injury, but its pathophysiology is poorly understood. As spinal cord compression observed in standard MRI often fails to explain a patient's status, new diagnostic techniques to assess DCM are one of the research priorities. Minor cardiac-related cranio-caudal oscillations of the cervical spinal cord are observed by phase-contrast MRI (PC-MRI) in healthy controls (HCs), while they become pathologically increased in patients suffering from degenerative cervical myelopathy. Whether transversal oscillations (i.e., anterior–posterior and right–left) also change in DCM patients is not known.MethodsWe assessed spinal cord motion simultaneously in all three spatial directions (i.e., cranio-caudal, anterior–posterior, and right–left) using sagittal PC-MRI and compared physiological oscillations in 18 HCs to pathological changes in 72 DCM patients with spinal canal stenosis. The parameter of interest was the amplitude of the velocity signal (i.e., maximum positive to maximum negative peak) during the cardiac cycle.ResultsMost patients suffered from mild DCM (mJOA score 16 (14–18) points), and the majority (68.1%) presented with multisegmental stenosis. The spinal canal was considerably constricted in DCM patients in all segments compared to HCs. Under physiological conditions in HCs, the cervical spinal cord oscillates in the cranio-caudal and anterior–posterior directions, while right–left motion was marginal [e.g., segment C5 amplitudes: cranio-caudal: 0.40 (0.27–0.48) cm/s; anterior–posterior: 0.18 (0.16–0.29) cm/s; right–left: 0.10 (0.08–0.13) cm/s]. Compared to HCs, DCM patients presented with considerably increased cranio-caudal oscillations due to the cardinal pathophysiologic change in non-stenotic [e.g., segment C5 amplitudes: 0.79 (0.49–1.32) cm/s] and stenotic segments [.g., segment C5 amplitudes: 0.99 (0.69–1.42) cm/s]). In contrast, right–left [e.g., segment C5 amplitudes: non-stenotic segment: 0.20 (0.13–0.32) cm/s; stenotic segment: 0.11 (0.09–0.18) cm/s] and anterior–posterior oscillations [e.g., segment C5 amplitudes: non-stenotic segment: 0.26 (0.15–0.45) cm/s; stenotic segment: 0.11 (0.09–0.18) cm/s] remained on low magnitudes comparable to HCs.ConclusionIncreased cranio-caudal oscillations of the cervical cord are the cardinal pathophysiologic change and can be quantified using PC-MRI in DCM patients. This study addresses spinal cord oscillations as a relevant biomarker reflecting dynamic mechanical cord stress in DCM patients, potentially contributing to a loss of function.https://www.frontiersin.org/articles/10.3389/fneur.2023.1217526/fullspinal cord motionspinal cord oscillationsspinal stenosisdegenerative cervical myelopathyphase contrast MRI |
| spellingShingle | Nikolai Pfender Nikolai Pfender Jan Rosner Jan Rosner Carl M. Zipser Carl M. Zipser Susanne Friedl Susanne Friedl Martin Schubert Martin Schubert Reto Sutter Markus Klarhoefer José M. Spirig Michael Betz Patrick Freund Mazda Farshad Armin Curt Armin Curt Markus Hupp Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy Frontiers in Neurology spinal cord motion spinal cord oscillations spinal stenosis degenerative cervical myelopathy phase contrast MRI |
| title | Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy |
| title_full | Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy |
| title_fullStr | Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy |
| title_full_unstemmed | Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy |
| title_short | Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy |
| title_sort | increased cranio caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy |
| topic | spinal cord motion spinal cord oscillations spinal stenosis degenerative cervical myelopathy phase contrast MRI |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1217526/full |
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