Variation in Anisotropy of the Spinal Cord in Patients With Hyperkyphosis

Study Overview
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Brief Summary
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Spinal cord compression is commonly seen in patients with severe kyphosis. However, conventional morphologic magnetic resonance imaging (MRI) was unable to detect the damage in microstructural integrity of the spinal cord around the apical vertebrae in these patients. The aim of the study was to evaluate the neuronal metrics/microstructure of the spinal cord around apical region in patients with hyperkyphosis using diffusion tensor imaging (DTI).

Detailed Description
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Spinal cord compression is commonly seen in patients with severe kyphosis. However, conventional morphologic magnetic resonance imaging (MRI) was unable to detect the damage in microstructural integrity of the spinal cord around the apical vertebrae in these patients. The aim of the study was to evaluate the neuronal metrics/microstructure of the spinal cord around apical region in patients with hyperkyphosis using diffusion tensor imaging (DTI). Twenty-four patients with hyperkyphosis aged 46.1±22.8 years who underwent 3.0T MRI examination with DTI sequence were prospectively enrolled from July 2022 to January 2023. Patients were divided into three groups according to spinal cord/cerebrospinal fluid architecture (CSF) on sagittal-T2 MRI of the thoracic apex: Type A-circular cord with visible CSF, Type B-circular cord but no visible CSF at apical dorsal, and Type 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 (SDAR) were evaluated using Pearson correlation coefficients.

Official Title
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Variation in Anisotropy of the Spinal Cord Around Apical Region in Patients With Hyperkyphosis: A Pilot Study Using Diffusion Tensor Imaging

Conditions
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Hyperkyphosis

Intervention / Treatment
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* Radiation: Variation in anisotropy of the Spinal Cord using diffusion tensor imaging


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: diagnosis of hyperkyphosis; the apex located at the thoracal region (T1-T12); full DTI data; records of detailed and systematic neurological physical examination. Exclusion Criteria: any case with active infection, tumor, or trauma; any cases of comorbidity of neurofibromatosis type I; any cases combined with spinal syringomyelia, split cord malformations or diastematomyelia, tethered cord syndrome; previous spinal surgery.

Ages Eligible for Study
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Minimum Age: 11 Years
Maximum Age: 78 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Type A<br>Type A was defined as a round/oval spinal cord shape with visible cerebrospinal fluid (CSF) between the cord and the apical vertebrae. | Radiation: Variation in anisotropy of the Spinal Cord using diffusion tensor imaging<br>* All examinations were performed on a 3.0-T MRI machine with a 12-channel spine special coil (Ingenia CX, Philips Healthcare, Best, the Netherlands). The multi-sequence MRI protocol included conventional T1-weighted (sag & tra), T2-weighted (sag & tra), and DTI sequence.<br>|
| Type B<br>Type B was defined as a round/oval spinal cord shape with no CSF between the apical vertebrae and spinal cord. | Radiation: Variation in anisotropy of the Spinal Cord using diffusion tensor imaging<br>* All examinations were performed on a 3.0-T MRI machine with a 12-channel spine special coil (Ingenia CX, Philips Healthcare, Best, the Netherlands). The multi-sequence MRI protocol included conventional T1-weighted (sag & tra), T2-weighted (sag & tra), and DTI sequence.<br>|
| Type C<br>Type C cord was defined as a spinal cord that is fattened/deformed by the vertebral body, with no visible CSF between the apex and the cord. | Radiation: Variation in anisotropy of the Spinal Cord using diffusion tensor imaging<br>* All examinations were performed on a 3.0-T MRI machine with a 12-channel spine special coil (Ingenia CX, Philips Healthcare, Best, the Netherlands). The multi-sequence MRI protocol included conventional T1-weighted (sag & tra), T2-weighted (sag & tra), and DTI sequence.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fractional anisotropy (FA) values | Raw DTI data were postprocessed on FuncTool (GE) software. After an initial correction of geometric distortions, the color-coded FA maps were generated. | preoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global kyphosis (GK) in degrees | Measured on anteroposterior and lateral radiographs and defined as the angle from upper to lower most tilted end vertebrae. | preoperative | 
| Sagittal deformity angular ratio (SDAR) | Divided GK by the number of levels spanning the curve. | preoperative |