Normalizing spinal cord compression measures in degenerative cervical myelopathy

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY Spine Journal Pub Date : 2025-09-01 Epub Date: 2025-03-26 DOI:10.1016/j.spinee.2025.03.012

Sandrine Bédard MSc , Jan Valošek PhD , Maryam Seif PhD , Armin Curt MD , Simon Schading-Sassenhausen MSc , Nikolai Pfender MD , Patrick Freund MD, PhD , Markus Hupp MD , Julien Cohen-Adad PhD

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Abstract

Background context

Accurate and automatic MRI measurements are relevant for assessing spinal cord compression severity in degenerative cervical myelopathy (DCM) and guiding treatment. The widely-used maximum spinal cord compression (MSCC) index has limitations. Firstly, it normalizes the anteroposterior cord diameter by that above and below the compression but does not account for cord size variation along the superior-inferior axis, making MSCC sensitive to compression level. Secondly, cord shape varies across individuals, making MSCC sensitive to this variability. Thirdly, MSCC is typically calculated by an expert-rater from a single sagittal slice, which is time-consuming and prone to variability.

Purpose

This study proposes a fully automatic pipeline to compute MSCC.

Design

We developed a normalization strategy for traditional MSCC (anteroposterior diameter) using a healthy adults database (n = 203) to address cord anatomy variability across individuals and evaluated additional morphometrics (transverse diameter, area, eccentricity, and solidity).

Patient sample

DCM patient cohort of n = 120.

Outcome measures

Receiver operating characteristic (ROC) and area under the curve (AUC) were used as evaluation metrics.

Methods

We validated the method in a mild DCM patient cohort against manually derived morphometrics and predicted the therapeutic decision (operative/conservative) using a stepwise binary logistic regression incorporating demographics and clinical scores.

Results

The automatic and normalized MSCC measures correlated significantly with clinical scores and predicted the therapeutic decision more accurately than manual MSCC. Significant predictors included upper extremity sensory dysfunction, T2w hyperintensity, and the proposed MRI-based measures. The model achieved an area under the curve of 0.80 in receiver operating characteristic analysis.

Conclusion

This study introduced an automatic method for computing normalized measures of cord compressions from MRIs, potentially improving therapeutic decisions in DCM patients. The method is open-source and available in Spinal Cord Toolbox v6.0 and above.

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退行性脊髓型颈椎病脊髓压迫措施正常化。

背景：准确和自动的MRI测量与评估退行性颈椎病（DCM）脊髓压迫严重程度和指导治疗相关。广泛使用的最大脊髓压迫指数（MSCC）有其局限性。首先，它通过压缩前后的脐带直径归一化，但不考虑沿上下轴的脐带大小变化，使MSCC对压缩水平敏感。其次，脐带形状因人而异，使得MSCC对这种变异性很敏感。第三，MSCC通常由专家从单个矢状面切片计算，这是耗时且容易变化的。目的：本研究提出一种全自动管道计算MSCC。设计：我们使用健康成人数据库（n=203）开发了传统MSCC（前后径）的标准化策略，以解决个体间脐带解剖的可变性，并评估其他形态计量学（横向直径、面积、偏心率和坚固度）。患者样本：DCM患者队列n=120。结果测量：以受试者工作特征（ROC）和曲线下面积（AUC）作为评价指标。方法：我们在轻度DCM患者队列中验证了该方法，并使用结合人口统计学和临床评分的逐步二元logistic回归预测治疗决策（手术/保守）。结果：自动和标准化MSCC测量与临床评分显著相关，预测治疗决策比手动MSCC更准确。重要的预测因素包括上肢感觉功能障碍、T2w高强度和基于mri的测量。在接收机工作特性分析中，该模型的曲线下面积为0.80。结论：本研究引入了一种自动计算核磁共振成像脊髓受压标准化测量的方法，有可能改善DCM患者的治疗决策。该方法是开源的，可在脊髓工具箱v6.0及以上版本中使用。

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来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.