[Morphometric study of age-related changes of the spinal cord]

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

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.

Pathological changes of the spinal cord in centenarians

In order to study the changes that occur in the spinal cords of the aged, 19 centenarian spinal cords from two men and 17 women (age range, 100-116 years at death; mean, 103 years) were pathologically examined. Cross-sections at each segmental level of the 19 autopsied spinal cords were examined for histopathological changes. The cross-sectional area and flattening ratio at the level of the C7 segment were measured. The size of the cords had some negative correlation with age, but the individual variation was considerably large. Among the 19 centenarians, macroscopic anteroposterior flattening appeared in the lower cervical cords in six individuals. In these cases, various degrees of neuron loss were observed in the anterior horn. White matter degeneration appeared frequently, especially in the posterior column. In 12 cases, myelin loss in the fasciculus of Goll at the cervical level was observed. The degeneration of the fasciculus of Goll was considered to be upward wallerian degeneration secondary to posterior root damage at the lumbosacral level. These changes seemed to be produced by disorders in the spinal canal or surrounding tissue, such as cervical spondylosis, degeneration of the intervertebral disk and spinal canal stenosis. Argyrophilic structures such as neurofibrillary tangles and neuropil threads were observed in 16 cases; however, this incidence was less than in the brain. Medial thickening of the anterior spinal artery was found in four cords. Amyloidangiopathy was noted in only one cord. Necrosis and hemorrhage due to vascular disturbance were not found.