• Jatta Berberat, Lukas Andereggen, Philipp Gruber, Oliver Hausmann, Reza FathiAliAUniversity of Bern, Bern, Switzerland.Neurochirurgie Fathi AG, Aarau, Switzerland., and Luca Remonda.
• Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.
• Spine. 2023 Aug 1; 48 (15): 104110461041-1046.

Study DesignMulticenter prospective observational study.ObjectiveDiffusion tensor imaging in flexion extension improves the diagnosis of degenerative cervical myelopathy (DCM). We aimed to provide an imaging biomarker for the detection of DCM.Summary Of Background DataDCM is the most common form of spinal cord dysfunction in adults; however, imaging surveillance for myelopathy remains poorly characterized.Patients And MethodsSymptomatic DCM patients were examined in maximum neck flexion-extension and neutral positions in a 3T-magnetic resonance imaging scanner and allocated to 2 groups: (1) Patients with visible intramedullary hyperintensity (IHIS) on T2-weighted imaging (IHIS+, n = 10); and (2) Patients without IHIS (IHIS-, n = 11). Range of motion, space available for the spinal cord, apparent diffusion coefficient (ADC), axial diffusivity (AD), radial diffusivity, and fractional anisotropy were measured and compared between the neck positions and between the groups as well as between control (C2/3) and pathologic segments.ResultsSignificant differences between the control level (C2/3) and pathologic segments were appreciated for the IHIS+ group at neutral neck position in AD; at flexion in ADC and AD; and at neck extension in ADC, AD, and fractional anisotropy values. For the IHIS- group, significant differences between the control level (C2/3) and pathologic segments were found only for ADC values in neck extension. When comparing diffusion parameters between groups, radial diffusivity was significantly different in all 3 neck positions.ConclusionSignificant increases in ADC values between the control and pathologic segments were found for both groups in neck extension only. This may serve as a diagnostic tool to identify early changes in the spinal cord related to myelopathy to indicate potentially reversible spinal cord injury and support the indication for surgery in select circumstances.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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