Utility of MRI in Quantifying Tissue Injury in Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM) is a condition that worsens over time if not treated, but early diagnosis and treatment can help slow its progression and improve symptoms. Magnetic Resonance Imaging (MRI) is increasingly used to diagnose and manage CSM because it provides detailed images and data about the cervical spinal cord and brain, allowing for accurate evaluation of tissue injury. This review aims to provide an understanding of how MRI methods are used to investigate functional and structural changes in the central nervous system (CNS) in CSM. It also identifies challenges that limit the clinical usefulness of these neuroimaging methods. The review covers clinical metrics for evaluating CSM severity, MRI methods for assessing tissue injury at both macrostructural and microstructural levels, the utility of functional MRI (fMRI) in CSM research, and challenges and potential solutions for improving the clinical utility of MRI methods.

• 1
  MRI methods, including T1-weighted and T2-weighted imaging, are used to assess macro-level tissue injury in the cervical spinal cord (CSC), but they may not detect minor abnormalities. More advanced MRI methods like diffusion-weighted imaging (DWI) can detect microstructural tissue injuries earlier in the disease progression.
• 2
  Functional MRI (fMRI) is used to assess compensatory functional reorganization in the brain, demonstrating the impact of CSM beyond the spinal cord. fMRI can examine functional changes in both the white and gray matter of the spinal cord and the brain in CSM.
• 3
  Region-specific volume loss or atrophy of the CSC and brain can potentially be used as biomarkers reflecting the pathology of CSM. Specifically, cortical thinning of sensorimotor and pain-related regions was associated with more severe clinical symptoms.