A quantitative method to find the maximum level of spinal cord compression in degenerative cervical myelopathy

Degenerative cervical myelopathy (DCM) is a progressive non-traumatic spine condition predominantly affecting individuals above the age of 50 years. It is associated with compression of the cervical spinal cord (SC), which can occur at one or multiple vertebral levels. However, SC tissue injury, particularly at the maximum level of compression (MCL), is typically a focal point of interest. Currently, there is no standardized approach for MCL localization, with researchers often relying on the visual inspection of magnetic resonance imaging (MRI) scans. Such inspection is often performed manually, which is time-consuming and can introduce bias. The present study explores the applicability of SC morphometric measures for precise MCL localization in DCM patients. We retrospectively analyzed 15 DCM patients (mean age: 57.8 years; 3 males) scanned on a GE MRI scanner adhering to the generic spine protocol. The T2-weighted structural data were processed semi-automatically using the spinal cord toolbox. SC morphometric measures including the anterior-posterior (AP) diameter, maximum SC compression (MSCC), and compression ratio (CR) were calculated. Our results show that AP diameter decreased, MSCC increased, and CR decreased at the site of compression. Furthermore, the maximum and minimum of MSCC and CR plots against the cervical SC length, respectively can be used to quantitatively locate the MCL in DCM patients. Such automation in the process of localizing MCL in DCM studies can help reduce time and minimize operator bias. Future work involves increasing sample size to further validate current findings.