Degenerative cervical myelopathy (DCM) is a severe consequence of degenerative cervical spinal cord (CSC) compression. The non-myelopathic stage of compression (NMDC) is highly prevalent and often progresses to disabling DCM. This study aims to disclose markers of progressive neurochemical alterations in NMDC and DCM by utilizing an approach based on state-of-the-art proton magnetic resonance spectroscopy (1H-MRS). Proton-MRS data were prospectively acquired from 73 participants with CSC compression and 47 healthy controls (HCs). The MRS voxel was centered at the C2 level. Compression-affected participants were clinically categorized as NMDC and DCM, radiologically as mild (MC) or severe (SC) compression. CSC volumes and neurochemical concentrations were compared between cohorts (HC vs. NMDC vs. DCM and HC vs. MC vs. SC) with general linear models adjusted for age and height (pFWE < 0.05) and correlated to stenosis severity, electrophysiology, and myelopathy symptoms (p < 0.05). Whereas the ratio of total creatine (tCr) to total N-acetylaspartate (tNAA) increased in NMDC (+11%) and in DCM (+26%) and SC (+21%), myo-inositol/tNAA, glutamate + glutamine/tNAA, and volumes changed only in DCM (+20%, +73%, and -14%) and SC (+12%, +46%, and -8%, respectively) relative to HCs. Both tCr/tNAA and myo-inositol/tNAA correlated with compression severity and volume (-0.376 < r < -0.259). Myo-inositol/tNAA correlated with myelopathy symptoms (r = -0.670), whereas CSC volume did not. Short-echo 1H-MRS provided neurochemical signatures of CSC impairment that reflected compression severity and clinical significance. Whereas volumetry only reflected clinically manifest myelopathy (DCM), MRS detected neurochemical changes already before the onset of myelopathy symptoms.

Department of Biomedical Engineering University Hospital Olomouc Czechia

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

Department of Imaging Methods Faculty of Medicine University of Ostrava 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 Palacky University Olomouc Czechia

Department of Neurology University Hospital Brno Brno Czechia

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

Department of Radiology University Hospital Brno Brno Czechia

Faculty of Medicine Masaryk University Brno Czechia

Multimodal and Functional Imaging Laboratory Central European Institute of Technology Brno Czechia

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