Correlation Study Between Spinal Cord Function, Spinal Cord Morphology and Cervical Spine Alignments in Patients With Hirayama Disease

Abstract

Objective This study aimed to explore the relationship between diffusion tensor imaging (DTI) parameters, cervical spine alignments, and spinal cord morphological parameters in patients with Hirayama disease (HD). Methods In this retrospective cohort study, 41 HD patients were recruited from the Huashan hospital from July 2017 to November 2021. Patients received X-rays, conventional magnetic resonance (MR), and DTI scans in flexion and neutral positions. The DTI parameters assessed were calculated using the region of interest (ROI) method. Paired t-tests were performed on the DTI parameters of neck flexion and neutral position. Cervical spine alignments, including flexion and neutral Cobb angles, were measured, and range of motion (ROM) was calculated. Spinal cord morphological parameters were measured, including spinal cord atrophy (SCA) and loss of attachment (LOA). Spearman’s correlation analysis between DTI parameters, cervical spine alignments, and spinal cord morphological parameters was performed. Results In comparing DTI parameters, segments of the C3/4, C4/5, C6/7, and lower cervical spine were significantly different, while segments of C5/6 were not significantly different. In Spearman’s correlation analysis, the flexion Cobb angle was significantly correlated with the fractional anisotropy (FA) value ( R2 = .111, P = .033) and apparent diffusion coefficient (ADC) value ( R2 = .119, P = .027). Flexion FA values were correlated with SCA in C4/5 ( R2 = .211, P = .003), C5/6 ( R2 = .454, P < .001), and C6/7 ( R2 = .383, P < .001) while flexion ADC values were correlated with SCA in the C4/5 ( R2 = .178, P = .006), C5/6 ( R2 = .388, P < .001) and C6/7 segments ( R2 = .187, P = .005). Conclusion The DTI parameters were correlated with the flexion Cobb angle and the SCA. These data support the dynamic cervical flexion compression hypothesis and indicate that the degree of SCA may be used to assess the condition of HD patients quantitatively.