Spinal cord demyelination predicts neurological deterioration in patients with mild degenerative cervical myelopathy

BMJ Neurology Open · 2025-01-01 · 2 citations

Background: Degenerative cervical myelopathy (DCM) is the most common form of atraumatic spinal cord injury globally. Clinical guidelines regarding surgery for patients with mild DCM and minimal symptoms remain uncertain. This study aims to identify imaging and clinical predictors of neurological deterioration in mild DCM and explore pathophysiological correlates to guide clinical decision-making. Methods: Patients with mild DCM underwent advanced MRI scans that included T2-weighted, diffusion tensor imaging and magnetisation transfer (MT) sequences, along with clinical outcome measures at baseline and 6-month intervals after enrolment. Quantitative MRI (qMRI) metrics were derived above and below maximally compressed cervical levels (MCCLs). Various machine learning (ML) models were trained to predict 6 month neurological deterioration, followed by global and local model interpretation to assess feature importance. Results: A total of 49 patients were followed for a maximum of 2 years, contributing 110 6-month data entries. Neurological deterioration occurred in 38% of cases. The best-performing ML model, combining clinical and qMRI metrics, achieved a balanced accuracy of 83%, and an area under curve-receiver operating characteristic of 0.87. Key predictors included MT ratio (demyelination) above the MCCL in the dorsal and ventral funiculi and moderate tingling in the arm, shoulder or hand. qMRI metrics significantly improved predictive performance compared to models using only clinical (bal. acc=68.1%) or imaging data (bal. acc=57.4%). Conclusions: Reduced myelin content in the dorsal and ventral funiculi above the site of compression, combined with sensory deficits in the hands and gait/balance disturbances, predicts 6-month neurological deterioration in mild DCM and may warrant early surgical intervention.

Focal compression of the cervical spinal cord alone does not indicate high risk of neurological deterioration in patients with a diagnosis of mild degenerative cervical myelopathy

Journal of the Neurological Sciences · 2024-05-09 · 7 citations

Degenerative Cervical Myelopathy (DCM) is the functional derangement of the spinal cord resulting from vertebral column spondylotic degeneration. Typical neurological symptoms of DCM include gait imbalance, hand/arm numbness, and upper extremity dexterity loss. Greater spinal cord compression is believed to lead to a higher rate of neurological deterioration, although clinical experience suggests a more complex mechanism involving spinal canal diameter (SCD). In this study, we utilized machine learning clustering to understand the relationship between SCD and different patterns of cord compression (i.e. compression at one disc level, two disc levels, etc.) to identify patient groups at risk of neurological deterioration. 124 MRI scans from 51 non-operative DCM patients were assessed through manual scoring of cord compression and SCD measurements. Dimensionality reduction techniques and k-means clustering established patient groups that were then defined with their unique risk criteria. We found that the compression pattern is unimportant at SCD extremes (≤14.5 mm or > 15.75 mm). Otherwise, severe spinal cord compression at two disc levels increases deterioration likelihood. Notably, if SCD is normal and cord compression is not severe at multiple levels, deterioration likelihood is relatively reduced, even if the spinal cord is experiencing compression. We elucidated five patient groups with their associated risks of deterioration, according to both SCD range and cord compression pattern. Overall, SCD and focal cord compression alone do not reliably predict an increased risk of neurological deterioration. Instead, the specific combination of narrow SCD with multi-level focal cord compression increases the likelihood of neurological deterioration in mild DCM patients.

Advanced MRI metrics improve the prediction of baseline disease severity for individuals with degenerative cervical myelopathy

The Spine Journal · 2024-04-26 · 6 citations

A feasibility study of smartphone sensors to assess the effect of acute high altitude (3,800 m) exposure on cognition and motor function in healthy participants

bioRxiv (Cold Spring Harbor Laboratory) · 2023-10-10

ABSTRACT Acute exposure to hypoxia at attitude has neurologic effects. Some subjects develop severe neurologic symptoms, including Parkinsonism, when hypoxic at high altitude as part of an Acute Mountain Sickness syndrome. Digital health technologies can provide continuous monitoring and objective, real-world measures of movement disorders, but only limited validation data of wearable sensors is available in the high-altitude setting. This equipment validation and feasibility study assessed smartphone microphone and accelerometer function at sea level and 12470 feet (3,800 m) to assess their potential value to predict and prevent neurologic features of acute mountain sickness. A feasibility study of standardized assessments of motor, speech and cognitive tasks was performed in 3 normal subjects at sea level and at altitude. All subjects were hypoxic at altitude with O 2 saturations ranging from 77-81%. Shaker table (range of frequencies) and high-fidelity speaker (range of frequencies) controls confirmed high correlation of observed and expected measurements for microphone and accelerometer under all conditions. The feasibility study demonstrated that under conditions of hypoxia at attitude, fine motor skills are impaired; visual short-term memory is not impaired but has longer response time; gait and balance is impaired, and a postural tremor develops with frequencies below 10 Hz. Future studies could use these wearable sensors to further assess effects at altitude of more severe hypoxia with applications in the high-altitude environment for Parkinson’s Disease patients, with further opportunity for aviation and military use.

Spinal Cord Morphology in Degenerative Cervical Myelopathy Patients; Assessing Key Morphological Characteristics Using Machine Vision Tools

Journal of Clinical Medicine · 2021-02-23 · 19 citations

Despite Degenerative Cervical Myelopathy (DCM) being the most common form of spinal cord injury, effective methods to evaluate patients for its presence and severity are only starting to appear. Evaluation of patient images, while fast, is often unreliable; the pathology of DCM is complex, and clinicians often have difficulty predicting patient prognosis. Automated tools, such as the Spinal Cord Toolbox (SCT), show promise, but remain in the early stages of development. To evaluate the current state of an SCT automated process, we applied it to MR imaging records from 328 DCM patients, using the modified Japanese Orthopedic Associate scale as a measure of DCM severity. We found that the metrics extracted from these automated methods are insufficient to reliably predict disease severity. Such automated processes showed potential, however, by highlighting trends and barriers which future analyses could, with time, overcome. This, paired with findings from other studies with similar processes, suggests that additional non-imaging metrics could be added to achieve diagnostically relevant predictions. Although modeling techniques such as these are still in their infancy, future models of DCM severity could greatly improve automated clinical diagnosis, communications with patients, and patient outcomes.

2019–2020

Neurology Clinical Practice · 2021-02-01

The Editors wish to acknowledge the individuals who have completed peer reviews for the journal over the last 2 years. Your constructive comments and commitment to submitting timely reviews help us to ensure that NCP remains the premier source of information for practicing neurologists.

Comparison of ¹⁸F-Fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging for locally advanced breast cancer staging: A prospective study from a tertiary hospital cancer centre in the Western Cape

South African Journal of Oncology · 2020-09-10 · 1 citations

Background: Breast cancer is the second most common cancer in adults and the most frequent cancer diagnosed in women. In South Africa, breast cancer accounts for 38.5% of cancers diagnosed in women. Since the presence, extent and location of distant metastases is one important prognostic factor in locally advanced breast cancer (LABC), accurate staging at diagnosis is crucial to ensure that patients receive the appropriate treatment. Increasing evidence shows that the use of 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) for disease staging of LABC may improve diagnostic sensitivity. Aim: The aim of this study was to prospectively assess the difference in diagnostic accuracy between whole-body PET/PET-CT and conventional imaging (CI) for staging LABC. Setting: The breast cancer outpatient clinic at Groote Schuur Hospital in Cape Town, South Africa. Methods: A total of 42 participants with clinical stage III and a select few stage II breast cancer underwent both 18 F-FDG PET/CT and CI. Results: The 18 F-FDG PET/CT found significantly more ( p = 0.0077) distant metastatic sites than CI (36% vs. 21%). The 18 F-FDG PET/CT upstaged 9 (21.4%) of patients from clinical stage IIIa to stage IIIc, and changed in management of 54% of patients. Thirty-eight per cent of the patients had their clinical stage unchanged. One of five suspected metastatic sites 18 F FDG PET/CT on biopsy was positive for malignancy. Conclusion: The 18 F-FDG PET/CT is useful for staging locally advanced non-inflammatory infiltrating ductal carcinoma of the breast. Use of 18 F-FDG PET/CT was superior to conventional imaging in assessing metastatic mediastinal lymphadenopathy, but with a poor specificity. The use of 18 F-FDG PET/CT in LABC is useful, with the biopsy of isolated suspicious lesions for metastasis increasing its accuracy.

The Role of Magseed in Wide Local Excision for Breast Cancer Post-Neoadjuvant Chemotherapy

European Journal of Surgical Oncology · 2020-01-29

Mark W. Mahowald, MD (1943–2020)

Neurology · 2020-06-09 · 1 citations

Small Vessel Disease

Stroke · 2020-12-07 · 3 citations