Imaging protocols for non-traumatic spinal cord injury: current state of the art and future directions

ABSTRACT

Introduction

Non-traumatic spinal cord injury (NTSCI) is a term used to describe damage to the spinal cord from sources other than trauma. Neuroimaging techniques such as computerized tomography (CT) and magnetic resonance imaging (MRI) have improved our ability to diagnose and manage NTSCIs. Several practice guidelines utilize MRI in the diagnostic evaluation of traumatic and non-traumatic SCI to direct surgical intervention.

Areas covered

The authors review practices surrounding the imaging of various causes of NTSCI as well as recent advances and future directions for the use of novel imaging modalities in this realm. The authors also present discussions around the use of simple radiographs and advanced MRI modalities in clinical settings, and briefly highlight areas of active research that seek to advance our understanding and improve patient care.

Expert opinion

Although several obstacles must be overcome, it appears highly likely that novel quantitative imaging features and advancements in artificial intelligence (AI) as well as machine learning (ML) will revolutionize degenerative cervical myelopathy (DCM) care by providing earlier diagnosis, accurate localization, monitoring for deterioration and neurological recovery, outcome prediction, and standardized practice. Some intriguing findings in these areas have been published, including the identification of possible serum and cerebrospinal fluid biomarkers, which are currently in the early phases of translation.

KEYWORDS:

• Cervical myelopathy
• degenerative cervical myelopathy
• imaging biomarker
• perfusion imaging
• intraoperative ultrasound
• IoUS

Article highlights

• Non-traumatic spinal cord injury is a term used to describe damage to the spinal cord that comes from sources other than trauma.

• The clinical management of non-traumatic spinal cord injury heavily relies on anatomical MRI for diagnosis and decision-making.

• The translational potential of microstructural MRI features such as myelin content, axonal integrity, gliosis, hypoxia, and neuronal loss are important advancements.

• Novel biomarkers, such as serial measures of ratio of T2*w signal intensity between white matter (WM) and gray matter (GM), will help quantify deterioration of myelopathy in order to facilitate early surgical intervention.

• Numerous developments in a variety of scientific domains (such as biomedical engineering, imaging, electronics, nanotechnology, etc.) have aided in the improvement of neuronavigation systems and the development of intraoperative ultrasound (IoUS) for spine surgery

Declaration of interest

MG Fehlings is supported by the Robert Campeau Family Foundation/Dr. C.H. Tator Chair in Brain and Spinal Cord Research at University Health Network, Canada. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.