Spinal cord changes in Neurodegenerative and Neuroinflammatory Diseases

The spinal cord plays a critical role in the nervous system. Structurally, morphological changes in the spinal cord directly reflect nerve fiber tract reorganization and may indicate underlying pathological alterations in gray and white matter. Structural remodeling of the spinal cord underlies its functional impairments. This presents a range of clinical manifestations, such as partial or complete loss of voluntary motor control, altered reflexes, abnormal muscle tone, muscular atrophy, and sensory deficits. Spinal cord imaging provides researchers with a direct approach to explore morphological alterations. Innovations in artificial intelligence and automated processing software now enable quantitative analysis of volumetric structural changes. Currently, spinal cord imaging markers play an increasingly prominent role in tracking disease progression and elucidating pathogenic mechanisms across neurological disorders. Despite these advances, these markers have yet to fully capture the complexity of the clinical disease presentation. This article aims to systematically review recent advances in spinal cord imaging and pathology across neurodegenerative and neuroinflammatory diseases. Furthermore, it proposes future research directions for spinal cord studies leveraging current imaging analysis techniques. This review comprehensively summarizes existing research on spinal cord imaging and pathological features in varied neurological diseases. It focuses on the relationships between spinal cord imaging markers and clinical features, disease severity, predictive value in clinical contexts and discusses future research directions for spinal cord quantification in neurological disorders.