Abstract
Purpose
To evaluate the neuronal metrics/microstructure of the spinal cord around apical region in patients with hyperkyphosis using diffusion tensor imaging (DTI).
Methods
Thirty-seven patients with hyperkyphosis aged 45.5 ± 19.6 years old who underwent 3.0 T magnetic resonance imaging (MRI) examination with DTI sequence were prospectively enrolled from July 2022 to July 2023. Patients were divided into three groups according to spinal cord/ cerebrospinal fluid (CSF) architecture on sagittal-T2 MRI of the thoracic apex (the axial spinal cord classification): Group A—circular cord with visible CSF, Group B—circular cord without visible CSF at apical dorsal, and Group C—spinal cord deformed without intervening CSF. The fractional anisotropy (FA) values acquired from DTI were compared among different groups. Correlations between DTI parameters and global kyphosis (GK)/sagittal deformity angular ratio (sagittal DAR) were evaluated using Pearson correlation coefficients.
Results
In all patients, FA values were significantly lower at apical level as compared with those at one level above or below the apex (0.548 ± 0.070 vs. 0.627 ± 0.056 versus 0.624 ± 0.039, P < 0.001). At the apical level, FA values were significantly lower in Group C than those in Group B (0.501 ± 0.052 vs. 0.598 ± 0.061, P < 0.001) and Group A (0.501 ± 0.052 vs. 0.597 ± 0.019, P < 0.001). Moreover, FA values were significantly lower in symptomatic group than those in non-symptomatic group (0.498 ± 0.049 v. 0.578 ± 0.065, P < 0.001). Pearson correlation analysis showed that GK (r2 = 0.3945, P < 0.001) and sagittal DAR (r2 = 0.3079, P < 0.001) were significantly correlation with FA values at apical level.
Conclusion
In patients with hyperkyphosis, the FA of spinal cord at apical level was associated with the neuronal metrics/microstructure of the spinal cord. Furthermore, the DTI parameter of FA at apical level was associated with GK and sagittal DAR.
Level of evidence
4.
Similar content being viewed by others
References
Zhang Z, Wang H, Zheng W (2015) Compressive myelopathy in congenital kyphosis of the upper thoracic spine: a retrospective study of 6 cases. J Spin Disord Tech 30(8):E1098–E1103
Macagno AE, O’Brien M (2006) Thoracic and thoracolumbar kyphosis in adults. Spine 31(Suppl):161–170
Wu X, Xiong G, Hua W et al (2021) Adjacent segment degeneration and spinal cord compression in rigid angular kyphosis of spinal tuberculosis and its intraoperative management strategy. J Spinal Cord Med 44(3):375–382. https://doi.org/10.1080/10790268.2019.1624428
Zeng Y, Chen Z, Guo Z et al (2014) The posterior surgical treatment for focal kyphosis in upper-middle thoracic spine. Eur Spine J: Off publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 23(11):2291–2298
Rajasekaran S, Kanna RM, Shetty AP (2012) Diffusion tensor imaging of the spinal cord and its clinical applications. Bone Joint J 94(8):1024–1031
Zhu F, Liu Y, Zeng L et al (2021) Evaluating the severity and prognosis of acute traumatic cervical spinal cord injury: a novel classification using diffusion tensor imaging and diffusion tensor tractography. Spine (Phila Pa 1976) 46(10):687–94. https://doi.org/10.1097/BRS.0000000000003923
Yan H, Zhu Z, Liu Z et al (2015) Diffusion tensor imaging in cervical syringomyelia secondary to Chiari I malformation: preliminary results. Spine (Phila Pa 1976) 40(7):E381-7. https://doi.org/10.1097/BRS.0000000000000781
Facon D, Ozanne A, Fillard P et al (2005) MR diffusion tensor imaging and fiber tracking in spinal cord compression. Am Soc Neuroradiol 26(6):1587–1594
Hendrix, Philipp, Christoph et al (2015) Spinal diffusion tensor imaging: a comprehensive review with emphasis on spinal cord anatomy and clinical applications. Clin Anat 28(1):88–95
Rutman AM, Petersonc DJ, Cohen WA et al (2018) Diffusion tensor imaging of the spinal cord: clinical value, investigational applications, and technical limitations. Curr Probl Diagn Radiol 47(4):257–269
Rindler RS, Chokshi FH, Malcolm JG et al (2017) Spinal diffusion tensor imaging in evaluation of preoperative and postoperative severity of cervical spondylotic myelopathy: systematic review of literature. World Neurosurg 99:150–158
Maki S, Koda M, Ota M et al (2018) Reduced field-of-view diffusion tensor imaging of the spinal cord shows motor dysfunction of the lower extremities in patients with cervical compression myelopathy. Spine 43(2):89–96. https://doi.org/10.1097/BRS.0000000000001123
Zheng W, Ruan X, Wei X et al (2019) Diffusion tensor magnetic resonance imaging in chronic spinal cord compression. J Vis Exp 147:e59069. https://doi.org/10.3791/59069
Shabani S, Kaushal M, Budde MD et al (2020) Diffusion tensor imaging in cervical spondylotic myelopathy: a review. J Neurosurg Spine. https://doi.org/10.3171/2019.12.SPINE191158
Ahuja K, Ifthekar S, Mittal S et al (2022) Role of diffusion tensor imaging in neurological prognostication in spinal tuberculosis–a prospective pilot study. Eur J Radiol 157:110530. https://doi.org/10.1016/j.ejrad.2022.110530
Ailon T, Shaffrey CI, Lenke LG et al (2015) Progressive spinal kyphosis in the aging population. Neurosurgery 77(Suppl 4):S164–S172. https://doi.org/10.1227/NEU.0000000000000944
Fon GT, Pitt MJ, Thies JR AC (1980) Thoracic kyphosis: range in normal subjects. AJR Am J Roentgenol 134(5):979–83. https://doi.org/10.2214/ajr.134.5.979
Qian BP, Wang XH, Qiu Y et al (2012) The influence of closing-opening wedge osteotomy on sagittal balance in thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison with closing wedge osteotomy. Spine 37(16):1415–1423
Wang XB, Lenke LG, Thuet E et al (2016) Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine 41(18):1
Sielatycki JA, Cerpa M, Baum G et al (2020) A novel MRI-based classification of spinal cord shape and CSF presence at the curve apex to assess risk of intraoperative neuromonitoring data loss with thoracic spinal deformity correction [J]. Spine Deform 8(4):655–661. https://doi.org/10.1007/s43390-020-00101-9
Faul F, Erdfelder E, Buchner A et al (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–60
Chang KW, Cheng CW, Chen HC et al (2009) Correction hinge in the compromised cord for severe and rigid angular kyphosis with neurologic deficits. Spine 34(10):1040–1045
Sariali E, Panier S, Glorion C (2009) Mechanical spinal cord compression at the apex of a kyphosis: a propos of one case. Review of the literature. Eur Spine J 18 (Suppl 2):160–4. https://doi.org/10.1007/s00586-008-0733-7
Fiani B, Noblett C, Nanney J et al (2020) Diffusion tensor imaging of the spinal cord status post trauma. Surg Neurol Int 11:276. https://doi.org/10.25259/SNI_495_2020
Martin NT, Barousse R, Amrhein TJ et al (2020) Optimizing diffusion-tensor imaging acquisition for spinal cord assessment: physical basis and technical adjustments. Radiographics 40(2):403–27. https://doi.org/10.1148/rg.2020190058
Li DC, Malcolm JG, Rindler RS et al (2017) The role of diffusion tensor imaging in spinal pathology: a review. Neurol India 65(5):982–992
Huisman TA, Loenneker T, Barta G et al (2006) Quantitative diffusion tensor MR imaging of the brain: field strength related variance of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) scalars. Eur Radiol 16(8):1651–1658. https://doi.org/10.1007/s00330-006-0175-8
Liu W, Qiu J, Zhu Z et al (2022) Intraoperative neurophysiological monitoring alerts during three-column osteotomy: incidence and risk factors. J Clin Neurophysiol. https://doi.org/10.1097/WNP.0000000000000924
Wang XB, Lenke LG, Thuet E et al (2016) Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine (Phila Pa 1976) 41(18):1447–55. https://doi.org/10.1097/BRS.0000000000001547
Jain N, Saini NS, Kumar S et al (2016) Correlation of diffusion tensor imaging parameters with neural status in Pott’s spine. SICOT J 2:21. https://doi.org/10.1051/sicotj/2016014
Abbas S, Jain AK, Saini NS et al (2015) Diffusion tensor imaging observation in Pott’s spine with or without neurological deficit. Indian J Orthop 49(3):289–299. https://doi.org/10.4103/0019-5413.156195
Mathew SE, Milbrandt TA, Shaughnessy WJ et al (2021) Is the axial spinal cord classification predictive of intraoperative neurologic alert for pediatric scoliosis patients? An independent retrospective validation study. Spine Deform 9(2):395–401
Shimizu K, Nakamura M, Nishikawa Y et al (2005) Spinal kyphosis causes demyelination and neuronal loss in the spinal cord: a new model of kyphotic deformity using juvenile Japanese small game fowls. Spine 30(21):2388–2392
Acknowledgements
This work was supported by National Natural Science Foundation of China (NSFC) (No. 82272545) and Jiangsu Provincial Medical Innovation Center of Orthopedic Surgery (CXZX202214). The authors thank all the patients who participated in this study and the staff from the Drum Tower Hospital, Nanjing, China.
Author information
Authors and Affiliations
Contributions
All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors. The manuscript has been read and approved by all the authors, and each author believes the manuscript represents honest work. The authors affirm that all patients provided informed consent for publication.
Corresponding author
Ethics declarations
Conflicts of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Xu, H., Zhou, J., Ling, C. et al. Potential impairment of spinal cord around the apical vertebral level in hyperkyphotic patients: findings from diffusion tensor imaging. Eur Spine J 33, 1256–1264 (2024). https://doi.org/10.1007/s00586-024-08144-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-024-08144-6