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Davies BM, Mowforth O, Gharooni AA, Tetreault L, Nouri A, Dhillon RS, Bednarik J, Martin AR, Young A, Takahashi H, Boerger TF, Newcombe VFJ, Zipser CM, Freund P, Koljonen PA, Rodrigues-Pinto R, Rahimi-Movaghar V, Wilson JR, Kurpad SN, Fehlings MG, Kwon BK, Harrop JS, Guest JD, Curt A, Kotter MRN. A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time. Global Spine J 2022; 12:78S-96S. [PMID: 35174728 PMCID: PMC8859710 DOI: 10.1177/21925682211057546] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Literature Review (Narrative). OBJECTIVE To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. METHODS Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework. RESULTS Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual's vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. CONCLUSION Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.
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Affiliation(s)
| | - Oliver Mowforth
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | | | - Lindsay Tetreault
- New York University, Langone Health, Graduate Medical Education, Department of Neurology, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Genève, Switzerland
| | - Rana S. Dhillon
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Allan R. Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Adam Young
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Virginia FJ Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Carl Moritz Zipser
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James D. Guest
- Department of Neurosurgery and the Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
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Zheng W, Xu F, Chen H, Wang N, Xiao W, Liang Y, Wen S. Time course of diffusion tensor imaging metrics in the chronic spinal cord compression rat model. Acta Radiol 2019; 60:653-662. [PMID: 30142996 DOI: 10.1177/0284185118795335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) provides information about water molecule diffusion in spinal cord. PURPOSE This study was aimed to investigate DTI changes in the different stages of compressive spinal cord induced by water-absorbing material implantation. MATERIAL AND METHODS The spinal cord compression was administered over the fourth cervical vertebral level in rat. Rat models were divided into five subgroups according to compression stages: sham group, group A: three-day compression rat models; group B: 12-day compression rat models; group C: 20-day compression rat models; group D: 60-day compression rat models. DTI including fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in the compressive spinal cord were collected. The relationship between the Basso, Beattie, and Bresnahan (BBB) scores and DTI metrics was further explored. RESULTS Compared with the sham group, BBB scoring of rat model showed a decreased tendency from group A ( P < 0.05) to group B ( P < 0.05). Then the motor function of rat model hindlimbs was recovered in some degree from group C ( P < 0.05) to group D ( P < 0.05) but had significant motor defects when compared with the normal level ( P < 0.05). The DTI metrics results revealed that chronic spinal cord compression resulted in lower FA value and higher ADC value at the compressive spinal cord level assessed at all four time-points ( P < 0.05). DTI metrics also showed a close correlation with motor function ( P < 0.05). CONCLUSION DTI is an optimal pre-clinical imaging tool to reflect locomotor performance and pathological status of compressive spinal cord epicenter in chronic spinal cord compression rat model.
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Affiliation(s)
- Weipeng Zheng
- Department of Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - Fangtian Xu
- Department of Orthopedics, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Haoyi Chen
- Department of Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - Ning Wang
- Department of Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - Wende Xiao
- Department of Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, PR China
- Department of Orthopedics, First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - YingJie Liang
- Department of Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, PR China
- Department of Orthopedics, First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Shifeng Wen
- Department of Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, PR China
- Department of Orthopedics, First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
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Changes in diffusion tensor imaging indices of the lumbosacral enlargement correlate with cervical spinal cord changes and clinical assessment in patients with cervical spondylotic myelopathy. Clin Neurol Neurosurg 2019; 186:105282. [PMID: 31569059 DOI: 10.1016/j.clineuro.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/03/2019] [Accepted: 02/09/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We examined whether changes in diffusion tensor imaging (DTI) indices of the lumbosacral enlargement are similar to those at the cervical level, and correlate with clinical assessments in patients with cervical spondylotic myelopathy (CSM). PATIENTS AND METHODS Patients with CSM and healthy volunteers (40-42/group) received DTI scans at both lumbosacral enlargement and cervical spinal cord. Modified Japanese Orthopedic Association (mJOA) score was also recorded for those with CSM. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of DTI in the two groups were compared. We also examined the correlation between DTI indices (ADC and FA) of the lumbosacral enlargement and those of the cervical spinal cord, and between DTI indices and mJOA in the CSM group. RESULTS Compared with the values of healthy subjects, the ADC values of patients with CSM were significantly increased, and FA values were significantly decreased at both cervical spinal cord and lumbosacral enlargement. Changes in FA value of the cervical cord showed a positive correlation to those of the lumbosacral enlargement in the CSM group. Importantly, a linear correlation was detected between mJOA score and DTI indices (ADC and FA) of the cervical cord, as well as FA value of the lumbosacral enlargement in the CSM group. CONCLUSION DTI indices, especially FA, of the lumbosacral enlargement correlate with clinical assessments of patients with CSM, and hence may be useful for evaluating the severity of cervical cord injury.
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