■变性脊髓型颈椎病(DCM)是非创伤性不完全性脊髓损伤的最常见原因,但对其病理生理学了解甚少。由于在标准MRI中观察到的脊髓压迫通常无法解释患者的状态,评估DCM的新诊断技术是研究重点之一。在健康对照(HC)中,通过相位对比MRI(PC-MRI)观察到颈脊髓的轻微心脏相关的颅尾振荡,而在患有退行性颈椎病的患者中,它们在病理上增加。是否横向振荡(即,前-后和右-左)也不知道DCM患者的变化。
■我们在所有三个空间方向上同时评估了脊髓运动(即,颅尾,前-后,和左右)使用矢状位PC-MRI,并将18例HC的生理振荡与72例DCM椎管狭窄患者的病理变化进行了比较。感兴趣的参数是速度信号的幅度(即,在心动周期中的最大正峰值到最大负峰值)。
■大多数患者患有轻度DCM(mJOA评分16(14-18)分),大多数(68.1%)出现多节段狭窄。与HC相比,DCM患者的所有节段的椎管均明显收缩。在HCs的生理条件下,颈脊髓在颅尾和前后方向振荡,而左右运动是边缘的[例如,C5段振幅:颅尾:0.40(0.27-0.48)cm/s;前后:0.18(0.16-0.29)cm/s;左右:0.10(0.08-0.13)cm/s]。与HC相比,由于非狭窄的主要病理生理变化,DCM患者的颅尾振荡大大增加[例如,段C5振幅:0.79(0.49-1.32)cm/s]和狭窄段[。Procedure,段C5振幅:0.99(0.69-1.42)cm/s])。相比之下,右-左[例如,段C5振幅:非狭窄段:0.20(0.13-0.32)cm/s;狭窄段:0.11(0.09-0.18)cm/s]和前后振荡[例如,C5段振幅:非狭窄段:0.26(0.15-0.45)cm/s;狭窄段:0.11(0.09-0.18)cm/s]保持与HC相当的低幅度。
■颈髓的颅尾振荡增加是主要的病理生理变化,可以使用PC-MRI对DCM患者进行量化。这项研究将脊髓振荡作为反映DCM患者动态机械脊髓应力的相关生物标志物,可能导致功能丧失。
UNASSIGNED: Degenerative 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.
UNASSIGNED: We 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.
UNASSIGNED: Most 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.
UNASSIGNED: Increased 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.