Abstract
Study design
Level-, age-, and gender-matched controlled cross-sectional cohort study.
Objectives
To investigate alterations of spinal cord (SC) motion within cervical spondylotic myelopathy (CSM) across the cervical spinal segments and its relation to cerebrospinal fluid (CSF)-flow, anatomic conditions, and clinical parameters.
Setting
University Hospital Balgrist, Zurich, Switzerland.
Methods
Overall, 12 patients suffering from CSM at level C5 and 12 controls underwent cardiac-gated 2D phase-contrast-MRI at level C2 and C5 and standard MRI sequences. Parameters of interest: Velocity measurements of SC and CSF (area under the curve = total displacement (normalization for duration of the heart cycle), total displacement ratio (C5/C2; intraindividual normalization for confounders)), spinal canal diameters, clinical motor- and sensory scores, and performance measures.
Results
Interrater reliability was excellent for SC motion at both levels and for CSF flow at C2, but not reliable for CSF flow at C5. Within controls, SC motion at C2 positively correlated with SC motion at C5 (p = 0.000); this correlation diminished in patients (p = 0.860). SC total displacement ratio was significantly increased in patients (p = 0.029) and correlated with clinical impairment (p = 0.017). Morphometric measures of the extent of stenosis were not related to SC motion or clinical symptoms.
Conclusion
The findings revealed physiological interactions of CSF flow and SC motion across the cervical spine in healthy controls while being diminished in CSM patients. Findings of focally increased SC motion at the level of stenosis were related to clinical impairment and might be promising as a diagnostic and prognostic marker in CSM.
Sponsorship
CRPP Neurorehab of the University of Zurich, Switzerland.
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Acknowledgements
We would like to thank PD Dr. Martin Schubert and the staff of the Neurophysiology Lab, Spinal Cord Injury Center, Balgrist University Hospital Zürich, Switzerland and Alexandra Naef and Barbara Wagner, Department of Radiology, University Hospital Balgrist, Zürich, Switzerland.
Funding
The study was supported by the CRPP Neurorehab of the University of Zurich, Switzerland. The study was approved by the ethics committee of the University of Zurich, KEK-ZH 2012-0343; written informed consent off all participants for publication was received.
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MK is employed by Siemens Healthcare AG, Zürich, Switzerland. The remaining authors declare that they have no conflict of interest.
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Wolf, K., Hupp, M., Friedl, S. et al. In cervical spondylotic myelopathy spinal cord motion is focally increased at the level of stenosis: a controlled cross-sectional study. Spinal Cord 56, 769–776 (2018). https://doi.org/10.1038/s41393-018-0075-1
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DOI: https://doi.org/10.1038/s41393-018-0075-1
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