Degenerative cervical myelopathy (DCM) is a severe consequence of degenerative cervical spinal cord (CSC) compression. The non-myelopathic stage of compression (NMDC) is highly prevalent and often progresses to disabling DCM. This study aims to disclose markers of progressive neurochemical alterations in NMDC and DCM by utilizing an approach based on state-of-the-art proton magnetic resonance spectroscopy (¹H-MRS). Proton-MRS data were prospectively acquired from 73 participants with CSC compression and 47 healthy controls (HCs). The MRS voxel was centered at the C2 level. Compression-affected participants were clinically categorized as NMDC and DCM, radiologically as mild (MC) or severe (SC) compression. CSC volumes and neurochemical concentrations were compared between cohorts (HC vs. NMDC vs. DCM and HC vs. MC vs. SC) with general linear models adjusted for age and height (p_FWE < 0.05) and correlated to stenosis severity, electrophysiology, and myelopathy symptoms (p < 0.05). Whereas the ratio of total creatine (tCr) to total N-acetylaspartate (tNAA) increased in NMDC (+11%) and in DCM (+26%) and SC (+21%), myo-inositol/tNAA, glutamate + glutamine/tNAA, and volumes changed only in DCM (+20%, +73%, and −14%) and SC (+12%, +46%, and −8%, respectively) relative to HCs. Both tCr/tNAA and myo-inositol/tNAA correlated with compression severity and volume (−0.376 < r < −0.259). Myo-inositol/tNAA correlated with myelopathy symptoms (r = −0.670), whereas CSC volume did not. Short-echo ¹H-MRS provided neurochemical signatures of CSC impairment that reflected compression severity and clinical significance. Whereas volumetry only reflected clinically manifest myelopathy (DCM), MRS detected neurochemical changes already before the onset of myelopathy symptoms.

中文翻译：

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退行性压迫颈脊髓病理学的体内分子特征

退行性脊髓型颈椎病 (DCM) 是退行性颈脊髓 (CSC) 压迫的严重后果。压迫的非脊髓病阶段 (NMDC) 非常普遍，并且经常进展为禁用 DCM。本研究旨在通过利用基于最先进的质子磁共振波谱 ( ¹H-MRS）。Proton-MRS 数据是从 73 名 CSC 压缩参与者和 47 名健康对照组 (HC) 中前瞻性获得的。MRS 体素以 C2 水平为中心。受压迫的参与者在临床上分为 NMDC 和 DCM，在放射学上分为轻度 (MC) 或重度 (SC) 压迫。使用针对年龄和身高调整的一般线性模型（p _FWE < 0.05）并与狭窄严重程度、电生理学和脊髓病症状 ( p  < 0.05)。而总肌酸 (tCr) 与总N的比率-乙酰天冬氨酸 (tNAA) 在 NMDC (+11%) 和 DCM (+26%) 和 SC (+21%)、肌醇/tNAA、谷氨酸 + 谷氨酰胺/tNAA 中增加，并且体积仅在 DCM (+20 %、+73% 和 -14%）和 SC（分别为 +12%、+46% 和 -8%）相对于 HC。tCr/tNAA 和 myo-inositol/tNAA 都与压缩严重程度和体积相关（-0.376 < r < -0.259）。肌醇/tNAA 与脊髓病症状相关（r  = -0.670），而 CSC 体积则没有。短回波¹ H-MRS 提供了反映压迫严重程度和临床意义的 CSC 损伤的神经化学特征。体积测定仅反映临床表现型脊髓病 (DCM)，MRS 在脊髓病症状发作之前就已检测到神经化学变化。