Potential thresholds of critically increased cardiac-related spinal cord motion in degenerative cervical myelopathy

Nikolai Pfender; Catherine R Jutzeler; Michèle Hubli; Paulina S Scheuren; Dario Pfyffer; Carl M Zipser; Jan Rosner; Susanne Friedl; Reto Sutter; José M Spirig; Michael Betz; Martin Schubert; Maryam Seif; Patrick Freund; Mazda Farshad; Armin Curt; Markus Hupp

doi:10.3389/fneur.2024.1411182

Potential thresholds of critically increased cardiac-related spinal cord motion in degenerative cervical myelopathy

Front Neurol. 2024 Jun 24:15:1411182. doi: 10.3389/fneur.2024.1411182. eCollection 2024.

Authors

Nikolai Pfender¹, Catherine R Jutzeler², Michèle Hubli¹, Paulina S Scheuren^{1

3}, Dario Pfyffer^{1

4}, Carl M Zipser¹, Jan Rosner^{1

5}, Susanne Friedl¹, Reto Sutter⁶, José M Spirig⁷, Michael Betz⁷, Martin Schubert¹, Maryam Seif^{1

8}, Patrick Freund^{1

8}, Mazda Farshad⁷, Armin Curt^{1

7}, Markus Hupp¹

Affiliations

¹ Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
² Department of Health Sciences and Technology, ETH, Zurich, Zurich, Switzerland.
³ International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴ School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.
⁵ Department of Neurology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
⁶ Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
⁷ University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
⁸ Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.

Abstract

Introduction: New diagnostic techniques are a substantial research focus in degenerative cervical myelopathy (DCM). This cross-sectional study determined the significance of cardiac-related spinal cord motion and the extent of spinal stenosis as indicators of mechanical strain on the cord.

Methods: Eighty-four DCM patients underwent MRI/clinical assessments and were classified as MRI+ [T2-weighted (T2w) hyperintense lesion in MRI] or MRI- (no T2w-hyperintense lesion). Cord motion (displacement assessed by phase-contrast MRI) and spinal stenosis [adapted spinal canal occupation ratio (aSCOR)] were related to neurological (sensory/motor) and neurophysiological readouts [contact heat evoked potentials (CHEPs)] by receiver operating characteristic (ROC) analysis.

Results: MRI+ patients (N = 31; 36.9%) were more impaired compared to MRI- patients (N = 53; 63.1%) based on the modified Japanese Orthopedic Association (mJOA) subscores for upper {MRI+ [median (Interquartile range)]: 4 (4-5); MRI-: 5 (5-5); p < 0.01} and lower extremity [MRI+: 6 (6-7); MRI-: 7 (6-7); p = 0.03] motor dysfunction and the monofilament score [MRI+: 21 (18-23); MRI-: 24 (22-24); p < 0.01]. Both patient groups showed similar extent of cord motion and stenosis. Only in the MRI- group displacement identified patients with pathologic assessments [trunk/lower extremity pin prick score (T/LEPP): AUC = 0.67, p = 0.03; CHEPs: AUC = 0.73, p = 0.01]. Cord motion thresholds: T/LEPP: 1.67 mm (sensitivity 84.6%, specificity 52.5%); CHEPs: 1.96 mm (sensitivity 83.3%, specificity 65.6%). The aSCOR failed to show any relation to the clinical assessments.

Discussion: These findings affirm cord motion measurements as a promising additional biomarker to improve the clinical workup and to enable timely surgical treatment particularly in MRI- DCM patients.

Clinical trial registration: www.clinicaltrials.gov, NCT02170155.

Keywords: cervical cord; cervical spondylotic myelopathy (CSM); degenerative cervical myelopathy (DCM); phase contrast MRI (PC-MRI); spinal cord motion; spinal cord oscillations; spinal stenosis.

Associated data

ClinicalTrials.gov/NCT02170155

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study (i.e., cost for MRI examinations) was supported by Balgrist Stiftung, Zurich, Switzerland. CJ was supported by a Swiss National Science Foundation (SNSF) Ambizione Grant (#PZ00P3_186101) and a Wings for Life Research Foundation Grant (#2017_044, #ID 2020_118). PF is funded by a SNSF Eccellenza Professorial Fellowship grant (PCEFP3_181362/1). MSe is funded by grants from Wings for life charity (WFL-CH-19/20), International Foundation for Research in Paraplegia (IRP; research grant 2022-01; P189), Balgrist Stiftung and Hurka Foundation. CZ reports a grant from the Swiss Paraplegia Foundation (FoKo_2019_01) and an IRP research grant (P190). PS is supported by the IRP (P198F). The radiology department has an academic research collaboration with Siemens Healthineers, Bayer, and Balzano Informatik. The funding sources were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.