Structural and functional imaging markers in Degenerative Cervical Myelopathy

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PROJECT SUMMARY/ABSTRACT Degenerative cervical myelopathy (DCM) is the most common cause of spinal injury in patients over 55 years of age. It has a profound health care impact, leading to more than 100,000 operations a year and upwards of $2 billion in health care expenditure. Unfortunately, traditional cervical spine MRI techniques are imperfect predictors of ongoing spinal injury and cannot predict which patients will respond well to intervention. Further, there is a critical gap in our understanding of how the spinal cord is injured during ongoing degenerative compression. The application of new imaging technologies may help close this gap. Our previous work, during K23 studies, has shown the utility of both white matter (WM) imaging markers and spinal cord morphometrics for monitoring ongoing injury as well as predicting recovery. The development of tract-specific WM imaging methods, as proposed in this work, may aid in translating these findings to clinical care. Further, our work shows the volume of the cervical cord gray matter (GM) is decreased in DCM. Utilizing a novel spinal cord fMRI methodology, we have additionally seen decreased GM activation in DCM patients, a change that associates with patient symptoms. These findings challenge the traditional view that DCM is a disease primarily of the WM. An objective of our proposed studies is to utilize a newly developed Consensus spine imaging protocol to substantiate the role of WM markers in tracking spinal injury, a critical next step in the translation of these imaging results. Further, we develop a new fMRI methodology that is used to show that GM activity is decreased in the injured cord. Our central hypothesis is that while markers of WM injury are the leading predictor of symptoms of neural injury in DCM patients, GM injury also plays a key role in each patient’s clinical symptoms. We will test this hypothesis by developing new tract specific markers and novel spinal fMRI methodology. Building upon our previous experience, we will compare the alterations of both WM and GM markers in these patients, with the goal of enhancing our ability to accurately predict both ongoing injury and early recovery after surgery. These findings will have a significant positive impact on human health by providing new understanding of the drivers of spinal injury in degenerative cervical compressive disease and developing new markers of injury that may enhance our ability to monitor and treat injury as well as prognosticate recovery.