Degenerative cervical myelopathy (DCM) is a consequence of a degenerative disease of the cervical spine leading to stenosis of the cervical canal and eventually to compression of the cervical spinal cord. DCM involves about 2% of the population and despite all accessible therapeutic options it could lead to a significant disability. Signs of cervical spinal cord compression detected with magnetic resonance imaging (MRI), however, end up in clinically symptomatic myelopathy in a smaller part of individuals with compression, while the rest remains without clinical symptoms and signs of cervical myelopathy - so called non-myelopathic degenerative cervical cord compression (NMDCC). The prevalence of NMDCC increases with age and in a population older than 60 years of age NMDCC involves at least one third of individuals. The review recapitulates current knowledge on a natural course of NMDCC, predictors of progression into DCM stage and a role of innovative quantitative MRI techniques in both research and practical management of degenerative cervical compression.

Degenerativní cervikální myelopatie (DCM) je následkem degenerativního onemocnění krční páteře vedoucího ke stenóze spinálního kanálu a následné míšní kompresi. DCM postihuje přibližně 2 % populace a vede i při současných metodách léčby k významné disabilitě. Známky komprese krční míchy zjištěné pomocí magnetické rezonance (MR) však vedou k manifestní myelopatii pouze u menší části nemocných, zatímco u většiny zůstává komprese bez klinických známek myelopatie - tzv. nemyelopatická komprese krční míchy (NMDCC). Prevalence NMDCC narůstá s věkem a v populaci nad 60 let věku postihuje minimálně 1/3 jedinců. Přehled přináší rekapitulaci dosavadních poznatků o přirozeném průběhu NMDCC, prediktorech progrese do stadia DCM a úloze inovativních kvantitativních MR technik ve výzkumu a praktickém managementu degenerativní míšní komprese.

• MeSH
• komprese míchy * diagnóza   etiologie   patologie   MeSH
• krční obratle patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• nemoci míchy diagnóza   etiologie   patologie   MeSH
• spinální stenóza etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

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.

• MeSH
• difuzní magnetická rezonance MeSH
• komprese míchy * diagnostické zobrazování   MeSH
• krční obratle diagnostické zobrazování   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mícha diagnostické zobrazování   MeSH
• nemoci míchy * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

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.

• MeSH
• dospělí MeSH
• inositol metabolismus   MeSH
• komprese míchy metabolismus   patologie   MeSH
• krční mícha * MeSH
• krční obratle MeSH
• kreatin metabolismus   MeSH
• kyselina asparagová analogy a deriváty   metabolismus   MeSH
• kyselina glutamová metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie * MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• studie případů a kontrol MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Degenerative cervical myelopathy (DCM) is a chronic progressive disease of the cervical spinal cord. Osteoarthritic degeneration (spondylosis, facet hypertrophy, and degenerative disc disease), ligament changes (ossification of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum) may lead to the spinal cord compression and result in neurological deficits. It is manifested as clumsy hands syndrome, gait impairment, and bladder problems. The latest clinical guidelines recommend surgery for patients with moderate and severe DCM. For patients with mild DCM (or non-myelopathic patients with radiculopathy), the guidelines suggest that either surgery or a supervised trial of structured rehabilitation. The nonoperative treatment with serial clinical follow-up should be reserved for asymptomatic patients with imaging evidence of cervical spinal cord compression.

Degenerativní cervikální myelopatie (DCM) je chronické, progresivní onemocnění krční míchy. Degenerativní procesy (spondylóza, hypertrofie facetových kloubů, výhřezy plotének) včetně postižení vazů (osifikace zadního podélného vazu, hypertrofie ligamentum flavum) vedou k míšní kompresi a rozvoji možného neurologického deficitu. Ten se projevuje zejména syndromem neobratných rukou, zhoršením chůze a sfinkterovou insuficiencí. Podle současných doporučení by měli být nemocní se střední a těžkou formou DCM léčeni operativně. U pacientů s lehkou formou DCM a pacientů bez klinických známek myelopatie, avšak s projevy radikulopatie, by měla být navržena buď operační léčba, či cílená rehabilitace. Jedinci s průkazem významné míšní komprese (avšak bez klinických známek myelopatie či radikulopatie) by měli být pravidelně klinicky sledováni.

• MeSH
• diagnostické techniky neurologické MeSH
• klinický obraz nemoci MeSH
• komprese míchy diagnóza   etiologie   patologie   terapie   MeSH
• krční obratle patologie   MeSH
• lidé MeSH
• nemoci míchy * diagnóza   patologie   terapie   MeSH
• neurologické vyšetření metody   MeSH
• spinální stenóza diagnóza   etiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Degenerative spinal cord compression is a frequent pathological condition with increasing prevalence throughout aging. Initial non-myelopathic cervical spinal cord compression (NMDC) might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties, longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI, diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, and magnetic resonance spectroscopy (1H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients consistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels, caused by demyelination and axonal injury, MT and 1H-MRS, along with advanced and tract-specific diffusion MRI, recently revealed microstructural alterations, also rostrally pointing to Wallerian degeneration. Recent studies also disclosed a significant relationship between microstructural damage and functional deficits, as assessed by qMRI and electrophysiology, respectively. Thus, tract-specific qMRI, in combination with electrophysiology, critically extends our understanding of the underlying pathophysiology of degenerative spinal cord compression and may provide predictive markers of DCM development for accurate patient management. However, the prognostic value must be validated in longitudinal studies.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Degenerativní cervikální myelopatie (DCM) je způsobena kompresí krční míchy stenózou krčního míšního kanálu. Relativní odolnost míšní tkáně k mechanické kompresi však může vést k nemyelopatické degenerativní kompresi krční míchy (NMDCCC). Rutinní MR techniky jsou schopny detekovat kompresi míchy, ale nejsou schopny spolehlivě odlišit nemyelopatickou kompresi a symptomatickou myelopatii. Pokročilé MR techniky, jako magneticko-rezonanční spektroskopie (MRS) a difúzí vážená MR (dMRI), představují nový nástroj pro zhodnocení subtilních změn mikrostruktury a biochemického složení míšní tkáně. Současně jsou však tyto techniky vzhledem k velikosti míchy a jejímu uložení v míšním kanálu technicky velmi náročné. Využití pokročilého 3T MR scanneru spolu s novými MR technikami u kohorty 50 zdravých dobrovolníků, 50 NMDCCC a 50 DCM pacientů zvýší citlivost MR v časné detekci kompresivních změn míšní tkáně a pomůže najít citlivé MR markery, které odliší DCM a NMDCCC. Korelace MR nálezů s tíží míšní komprese a klinické disability pomůže určit jejich relevanci při plánování chirurgické dekomprese.; Degenerative cervical myelopathy (DCM) is caused by compression due to cervical canal stenosis. The relative resilience of the spinal cord tissue to the mechanical compression leads to non-myelopathic degenerative cervical cord compression (NMDCCC). Routine MRI techniques could detect spinal cord compression, but not to distinguish DCM and NMDCCC. Advanced MR techniques, such as diffusion MRI and magnetic resonance spectroscopy, provide unique tools for assessing subtle changes in spinal cord microstructure and biochemical composition, respectively, but are prone to technical challenges due to small size and position of the spinal cord. The utilization of advanced 3T scanner along with novel MRI/MRS techniques in a cohort of 50 NMDCC, 50 DCM and 50 healthy individuals will increase the sensitivity for detection of spinal cord changes and will establish sensitive markers of spinal cord tissue alteration with potential to distinguish NMDCC and DCM subjects. MRI outcomes will be related to severity of compression and clinical measures to establish their relevance in surgical planning.

• MeSH
• biologické markery MeSH
• difuzní magnetická rezonance metody   MeSH
• komprese míchy diagnostické zobrazování   MeSH
• magnetická rezonanční spektroskopie metody   MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• radiologie, nukleární medicína a zobrazovací metody
• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR

Impaired gait is one of the cardinal symptoms of degenerative cervical myelopathy (DCM) and frequently its initial presentation. Quantitative gait analysis is therefore a promising objective tool in the disclosure of early cervical cord impairment in patients with degenerative cervical compression. The aim of this cross-sectional observational cohort study was to verify whether an objective and easily-used walk and run test is capable of detecting early gait impairment in a practical proportion of non-myelopathic degenerative cervical cord compression (NMDCC) patients and of revealing any correlation with severity of disability in DCM. The study group consisted of 45 DCM patients (median age 58 years), 126 NMDCC subjects (59 years), and 100 healthy controls (HC) (55.5 years), all of whom performed a standardized 10-m walk and run test. Walking/running time/velocity, number of steps and cadence of walking/running were recorded; analysis disclosed abnormalities in 66.7% of NMDCC subjects. The DCM group exhibited significantly more pronounced abnormalities in all walk/run parameters when compared with the NMDCC group. These were apparent in 84.4% of the DCM group and correlated closely with disability as quantified by the modified Japanese Orthopaedic Association scale. A standardized 10-m walk/run test has the capacity to disclose locomotion abnormalities in NMDCC subjects who lack other clear myelopathic signs and may provide a means of classifying DCM patients according to their degree of disability.

• Publikační typ
• časopisecké články MeSH

Diffusion magnetic resonance imaging (dMRI) proved promising in patients with non-myelopathic degenerative cervical cord compression (NMDCCC), i.e., without clinically manifested myelopathy. Aim of the study is to present a fast multi-shell HARDI-ZOOMit dMRI protocol and validate its usability to detect microstructural myelopathy in NMDCCC patients. In 7 young healthy volunteers, 13 age-comparable healthy controls, 18 patients with mild NMDCCC and 15 patients with severe NMDCCC, the protocol provided higher signal-to-noise ratio, enhanced visualization of white/gray matter structures in microstructural maps, improved dMRI metric reproducibility, preserved sensitivity (SE = 87.88%) and increased specificity (SP = 92.31%) of control-patient group differences when compared to DTI-RESOLVE protocol (SE = 87.88%, SP = 76.92%). Of the 56 tested microstructural parameters, HARDI-ZOOMit yielded significant patient-control differences in 19 parameters, whereas in DTI-RESOLVE data, differences were observed in 10 parameters, with mostly lower robustness. Novel marker the white-gray matter diffusivity gradient demonstrated the highest separation. HARDI-ZOOMit protocol detected larger number of crossing fibers (5-15% of voxels) with physiologically plausible orientations than DTI-RESOLVE protocol (0-8% of voxels). Crossings were detected in areas of dorsal horns and anterior white commissure. HARDI-ZOOMit protocol proved to be a sensitive and practical tool for clinical quantitative spinal cord imaging.

• MeSH
• biomedicínské inženýrství MeSH
• difuzní magnetická rezonance * MeSH
• dospělí MeSH
• komprese míchy diagnostické zobrazování   patologie   MeSH
• krční obratle patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci míchy diagnostické zobrazování   patologie   MeSH
• poměr signál - šum MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• shluková analýza MeSH
• studie případů a kontrol MeSH
• zobrazování difuzních tenzorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

STUDY DESIGN: Narrative review. OBJECTIVES: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM). METHODS: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM. RESULTS: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years. CONCLUSION: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.

• Publikační typ
• časopisecké články MeSH