Quatitative MRI of the Spinal Cord in Cervical Myelopathy: Assessment of Microstuctural Damage for Outcome Improvement

Rationale Degenerative cervical myelopathy (DCM) is a common chronic disorder and the most common cause of spinal cord dysfunction in adults, potentially leading to severe functional impairment with high social costs. More than 70% of people younger than 65 years have pathologic or radiologic evidence of cervical degenerative disease. Symptoms of cervical compression develop in about 25% of these people. Consequently, identifying optimal treatment strategies and clinical care pathways for DCM has become a key public health priority. DCM is caused by a progressive deterioration of osseocartilaginous components of the cervical spine leading to a narrowing of the spinal canal and compression of the long tracts and local segmental elements of the Spinal Cord (SC). DCM can lead to progressive disability and paralysis owing to chronic SC compression.

In DCM, an early diagnosis and monitoring are pivotal to avoid or constrain a neurological damage that may persist even after appropriate treatment is provided. Diagnosis of DCM requires agreement between clinical and imaging findings (MRI).

Quantitative MRI of the SC could provide a new objective system for identification of patients who require surgery before developing irreversible clinical damage, and to avoid surgical treatment in those who do not require it. Additionally, quantitative MRI, in combination with clinical data such as, neuromotor tests, could provide an important approach to assess the effectiveness of the therapeutical approach.

The plan with this project is to validate a newer clinically feasible quantitative MRI protocol to depict spinal cord microstructural changes determined by degenerative cervical spine disease, that is highly frequent in the adult population. Investigators are confident that to identify quantitative MRI-derived metrics that could objectively quantify spinal cord damage in degenerative cervical myelopathy, and that could depict microstructural modifications even before neurological signs or signal alterations on morphological MRI sequences are evident. This could be of pivotal importance for more precise indication to surgery and to prevent clinically significant damage that might not be recovered even after surgical treatment. These data will be measured and validated by neurophysiological findings, and compared to current scales and ad-hoc battery of neuromotor skill assessment tests.

Clinical, neurophysiological, biometric and imaging follow-up will be performed to assess the predictive power of the identified metrics.