Normalizing Spinal Cord Compression Morphometric Measures: Application in Degenerative Cervical Myelopathy

Abstract

Objective: Automatic and robust characterization of spinal cord shape from MRI images is relevant to assess the severity of spinal cord compression in degenerative cervical myelopathy (DCM) and to guide therapeutic strategy. Despite its popularity, the maximum spinal cord compression (MSCC) index has practical limitations to objectively assess the severity of cord compression. Firstly, it is computed by normalizing the anteroposterior cord diameter by that above and below the level of compression, but it does not account for the fact that the spinal cord itself varies in size along the superior-inferior axis, making this MSCC sensitive to the level of compression. Secondly, spinal cord shape varies across individuals, making MSCC also sensitive to the size and shape of every individual. Thirdly, MSCC is typically computed by the expert-rater on a single sagittal slice, which is time-consuming and prone to inter-rater variability. In this study, we propose a fully automatic pipeline to compute MSCC. Methods: We extended the traditional MSCC (based on the anteroposterior diameter) to other shape metrics (transverse diameter, area, eccentricity, and solidity), and proposed a normalization strategy using a database of healthy adults (n=203) to address the variability of the spinal cord anatomy between individuals. We validated the proposed method in a cohort of DCM patients (n=120) with manually derived morphometric measures and predicted the therapeutic decision (operative/conservative) using a stepwise binary logistic regression including demographics, clinical scores, and electrophysiological assessment. Results: The automatic and normalized MSCC measures significantly correlated with clinical scores and predicted the therapeutic decision with higher accuracy than the manual MSCC. Results show that the sensory dysfunction of the upper extremities (mJOA subscore), the presence of myelopathy and the proposed MRI-based normalized morphometric measures were significant predictors of the therapeutic decision. The model yielded an area under the curve of the receiver operating characteristic of 80%. Conclusion: The study introduced an automatic method for computation of normalized MSCC measures of cord compression from MRI scans, which is an important step towards better informed therapeutic decisions in DCM patients. The method is open-source and available in the Spinal Cord Toolbox v6.0.