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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2016 May 05


language: English

Fractional anisotropy to quantify cervical spondylotic myelopathy severity

Rory K. MURPHY 1, Peng SUN 2, Rowland H. HAN 3, Kim J. GRIFFIN 2, Joanne WAGNER 4, Chester K. YARBROUGH 1, Neill M. WRIGHT 1, Ian G. DORWARD 1, Daniel K. RIEW 5, Michael P. KELLY 6, Paul SANTIAGO 1, Lukas P. ZEBALA 6, Kathryn TRINKAUS 7, Wilson Z. RAY 1, Sheng K. SONG 2

1 Department of Neurosurgery, Washington University, St. Louis, USA; 2 Department of Radiology, Washington University, St. Louis, USA; 3 Washington University School of Medicine, St. Louis, USA; 4 Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, USA; 5 Department of Orthopedic Surgery, Columbia University, New York, USA; 6 Department of Orthopedic Surgery, Washington University, St. Louis, USA; 7 Division of Biostatistics, Washington University School of Medicine, St. Louis, USA


BACKGROUND: A number of clinical tools exist for measuring the severity of cervical spondylotic myelopathy (CSM). Several studies have recently described the use of non-invasive imaging biomarkers to assess severity of disease. These imaging markers may provide an additional tool to measure disease progression and represent a surrogate marker of response to therapy. Correlating these imaging biomarkers with clinical quantitative measures is critical for accurate therapeutic stratification and quantification of axonal injury.
METHODS: Fourteen patients and seven healthy control subjects were enrolled. Patients were classified as mildly (7) or moderately (7) impaired based on mJOA. All patients underwent diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI) analyses. In addition to standard neurological examination, all participants underwent 30 meter walking test, 9-hole peg test, grip strength, key pinch, and vibration sensation thresholds in the index finger and great toe. Differences in assessment scores between controls, mild and moderate CSM patients were correlated with DTI and DBSI derived fractional anisotropy (FA).
RESULTS: Clinically, 30-meter walking times were significantly longer in the moderately impaired group than in the control group. Maximum 9-hole peg test times were significantly longer in both the mildly and moderately impaired groups as compared to normal controls. Scores on great toe vibration sensation thresholds were lower in the mildly impaired and moderately impaired groups as compared to controls. We found no clear evidence for any differences in minimum grip strength, minimum key pinch, or index finger vibration sensation thresholds. There were moderately strong associations between DTI and DBSI FA values and 30-meter walking times and 9-hole peg test.
CONCLUSION: The 30-meter walking test and 9-hole peg test were both moderately to strongly associated with DTI/DBSI FA values. FA may represent an additional measure to help differentiate and stratify patients with mild or moderate CSM.

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