الفهرس 
Anatomy of the Cervical Spinal Cord
Vascular supply of the spinal cordOnly 14 pages are availabe for public view
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Abstract
Cervical spondylotic myelopathy (CSM) is a degenerative condition of the cervical spine causing spinal dysfunction in adults. It‘s one of the most prevalent and increasingly observed neurological disorders in geriatric population. It was important to develop a non-invasive imaging technique for early evaluation of CSM; X-ray and better CT may be useful in the initial evaluation of cervical spondylotic changes. However, MRI remains the imaging modality of choice for CSM particularly T2 weighted images which can evaluate any intra-medullary high signal intensity reflecting pathological changes in the cervical cord (myelopathy). CSM represents a clinic-radiological challenge due to the mismatch between the patient‘s presentation and the conventional MR findings due to lack of detection of detailed cervical cord microstructural changes. Diffusion tensor imaging (DTI) is an application of DWI that provides unique quantitative information about the microstructural features of white matter in the central nervous system. DTI results are quantified by two primary parameters, the fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Our study aimed at assessment of the role of MR diffusion tensor imaging (DTI) in the evaluation of cervical spondylotic myelopathy. It was carried out on 30 patients presenting with neurological symptoms of CSM as well as 30 subjects as a control group. The ages of the studied patients ranged from 25 to 73 years with a mean of 44.6 ± 12.2 years. The included patients were subjected to thorough data collection and examined by a neurosurgeon who adopted the European myelopathy score to grade the severity of CSM. Patients were sorted into three categories and there was a significant correlation between EMS and DTI. All the studied subjects at both patients and control group were examined with MRI including routine MRI sequences as well as diffusion tensor imaging. Conventional MRI revealed spinal cord abnormalities in the form of signal changes in 5 cases (16.7%), while tractography revealed changes in cord integrity in 3 patients (10%) in the form of waist morphology in two patients and partial interruption in one patient. In the remaining 27 patients, the spinal cord appeared grossly normal on qualitative tractographic analysis. Cervical spondylotic myelopathy patients had significant decrease in FA and increase in ADC at the most compressed parts of the spinal cord. Our study revealed that the mean FA value and ADC value were (0.456 ± 0.068 and 1.644± 0.285) respectively in affected segments compared to (0.608±0.042 and1.051± 0.123) in healthy segments at control group respectively. We found high statistically significant results correlating the reduction in FA values with the type of discs‘ lesions and cord affection i.e. the more severe the cord affection (discs indenting the cord or causing cord malacia) and disc lesions (protrusion and extrusion), the more reduction in FA values. Fractional anisotropy and ADC parameters had higher sensitivity (97.0% and 88.1% respectively) than conventional T2 WIs (13.4%) for detection of early compressive myelopathy. Furthermore, FA is more sensitive than ADC in diagnosing CSM with cut off values ≤0.56 and >1.23 respectively in differentiating between patients and control groups. This can improve the clinical outcome and help in treatment plans.