BACKGROUND AND PURPOSE: Non-myelopathic degenerative cervical spinal cord compression (NMDC) frequently occurs throughout aging and may progress to potentially irreversible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression severity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract-specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. METHODS: High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relationships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific microstructural changes in DCM patients was also explored. RESULTS: The study identified diffusion-derived abnormalities in the gray matter, dorsal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the compression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked potentials, respectively, whereas electromyography outcomes corresponded with gray matter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. CONCLUSIONS: Outcomes imply the necessity of high-resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies.

Center for Magnetic Resonance Research Department of Radiology University of Minnesota Minneapolis Minnesota USA

Central European Institute of Technology Masaryk University Brno Czechia

Department of Biomedical Engineering University Hospital Olomouc Czechia

Department of Medicine 3 Clinical Division of Endocrinology and Metabolism Medical University of Vienna Vienna Austria

Department of Neurology Faculty of Medicine and Dentistry Palacký University Olomouc Czechia

Department of Neurology University Hospital Brno Brno Czechia

Department of Radiology and Nuclear Medicine University Hospital Brno Brno Czechia

Division of Clinical Behavioral Neuroscience Department of Pediatrics University of Minnesota Minneapolis Minnesota USA

Faculty of Medicine Masaryk University Brno Czechia

Functional Neuroimaging Unit CRIUGM University of Montreal Montreal Quebec Canada

High Field MR Centre Department of Biomedical Imaging and Image guided Therapy Medical University of Vienna Vienna Austria

Mila Quebec AI Institute Montreal Quebec Canada

NeuroPoly Lab Institute of Biomedical Engineering Polytechnique Montreal Montreal Quebec Canada

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Eur J Neurol. 2022 Aug;29(8):2551. doi: 10.1111/ene.15352. PubMed

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