Spinal cord structure-function relationships in degenerative cervical myelopathy

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ABSTRACT: Degenerative cervical myelopathy (DCM) is the commonest cause of spinal cord dysfunction in older adults and an important cause of disability and impaired quality of life. Conventional MRI, which is used for surgical planning, does not distinguish irreversible spinal cord damage and is frequently inconsistent with clinical examination. Routine clinical assessment for DCM relies on subjective symptom scores, and lacks objective quantifiable measures of function. Neither of these current standards of practice overcome the disassociation between radiology and clinical function in DCM, and neither are strong predictors of surgical outcome. To overcome the lack of pathological specificity of diffusion tensor imaging (DTI), we developed filtered diffusion weighted imaging (fDWI), which enhances detection of axonal injury. We developed metal-suppression multi- spectral diffusion weighted imaging (MSI-DWI) to assess post-surgical spinal cord microstructure in the presence of spinal instrumentation. To better identify the functional correlates of these novel imaging approaches, we demonstrate techniques to assess subtle sensorimotor dysfunction in DCM. The long term goal of this project is to incorporate advanced multi-parametric spinal cord MRI in the routine clinical assessment of DCM to improve diagnosis and prognostication of surgical outcome. The overall objective of this project is to determine if quantification of spinal cord microstructure and function can disambiguate clinico-radiologic data in DCM and improve prognostication of outcome after surgery for DCM. The first aim will determine if multi-parametric MRI measures of axonal injury (fDWI) and demyelination (magnetization transfer [MT] imaging) can outperform conventional MRI for structure-function correlations. To achieve the second aim, we will use quantitative tests of motor, sensory and balance function to objectively track functional recovery after surgery and determine if these measures are superior to standard symptom scores. The third aim will use post-surgical MSI-DWI to detect microstructural changes in the decompressed spinal cord that are associated with quantitative function after surgery. Together, the successful completion of these aims will advance the clinical translational of multiparametric spinal cord MRI for diagnosis, prognostication and monitoring of spinal cord integrity in DCM.