Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review

Degenerative spinal cord compression is a frequent pathological condition with increasing

prevalence throughout aging. Initial non-myelopathic cervical spinal cord compression (NMDC)

might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While

quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties,

longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM

are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI,

diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, and magnetic resonance

spectroscopy (1H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients

consistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels,

caused by demyelination and axonal injury, MT and 1H-MRS, along with advanced and tract-specific

diffusion MRI, recently revealed microstructural alterations, also rostrally pointing to Wallerian

degeneration. Recent studies also disclosed a significant relationship between microstructural damage

and functional deficits, as assessed by qMRI and electrophysiology, respectively. Thus, tract-specific

qMRI, in combination with electrophysiology, critically extends our understanding of the underlying

pathophysiology of degenerative spinal cord compression and may provide predictive markers

of DCM development for accurate patient management. However, the prognostic value must be

validated in longitudinal studies.