The associations between radiological and neurological findings of degenerative cervical myelopathy: radiological analysis based on kinematic CT myelography and evoked potentials of the spinal cord

Masahiro Funaba MD, PhD1, Yasuaki Imajo MD, PhD1, Hidenori Suzuki MD, PhD1, Norihiro Nishida MD, PhD1, Yuji Nagao MD, PhD1, Takuya Sakamoto MD1, Kazuhiro Fujimoto MD, PhD1, and Takashi Sakai MD, PhD1
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  • 1 Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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OBJECTIVE

Neurological and imaging findings play significant roles in the diagnosis of degenerative cervical myelopathy (DCM). Consistency between neurological and imaging findings is important for diagnosing DCM. The reasons why neurological findings exhibit varying sensitivity for DCM and their associations with radiological findings are unclear. This study aimed to identify associations between radiological parameters and neurological findings in DCM and elucidate the utility of concordance between imaging and neurological findings for diagnosing DCM.

METHODS

One hundred twenty-one patients with DCM were enrolled. The Japanese Orthopaedic Association (JOA) score, radiological parameters, MRI and kinematic CT myelography (CTM) parameters, and the affected spinal level (according to multimodal spinal cord evoked potential examinations) were assessed. Kinematic CTM was conducted with neutral positioning or at maximal extension or flexion of the cervical spine. The cross-sectional area (CSA) of the spinal cord, dynamic change in the CSA, C2–7 range of motion, and C2–7 angle were measured. The associations between radiological parameters and hyperreflexia, the Hoffmann reflex, the Babinski sign, and positional sense were analyzed via multiple logistic regression analysis.

RESULTS

In univariate analyses, the upper- and lower-limb JOA scores were found to be significantly associated with a positive Hoffmann reflex and a positive Babinski sign, respectively. In the multivariate analysis, a positive Hoffmann reflex was associated with a higher MRI grade (p = 0.026, OR 2.23) and a responsible level other than C6–7 (p = 0.0017, OR 0.061). A small CSA during flexion was found to be significantly associated with a positive Babinski sign (p = 0.021, OR 0.90). The presence of ossification of the posterior longitudinal ligament (p = 0.0045, OR 0.31) and a larger C2–7 angle during flexion (p = 0.01, OR 0.89) were significantly associated with abnormal great toe proprioception (GTP).

CONCLUSIONS

This study found that the Hoffmann reflex is associated with chronic and severe spinal cord compression but not the dynamic factors. The Babinski sign is associated with severe spinal cord compression during neck flexion. The GTP is associated with large cervical lordosis. These imaging features can help us understand the characteristics of the neurological findings.

ABBREVIATIONS

ATR = Achilles tendon reflex; CSA = cross-sectional area; CSAE = CSA in extension; CSAF = CSA in flexion; CSAN = CSA in the neutral position; CSM = cervical spondylotic myelopathy; CTM = CT myelography; DCM = degenerative cervical myelopathy; GTP = great toe proprioception; JOA = Japanese Orthopaedic Association; MN = median nerve; OPLL = ossification of the posterior longitudinal ligament; PTR = patellar tendon reflex; ROM = range of motion; SCEP = spinal cord evoked potential; SVA = sagittal vertical axis; TCE = transcranial electrically evoked; UN = ulnar nerve.

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Contributor Notes

Correspondence Masahiro Funaba: Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan. funa51.mf@gmail.com.

INCLUDE WHEN CITING Published online July 9, 2021; DOI: 10.3171/2020.11.SPINE201626.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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