Association Between Spinal Canal Sagittal Diameter Dynamics and T2- Weighted MRI Intramedullary Hyperintensity in Cervical Spondylotic Myelopathy Patients

Association Between Spinal Canal Sagittal Diameter Dynamics and T2- Weighted MRI Intramedullary Hyperintensity in Cervical Spondylotic Myelopathy Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Spinal Canal Sagittal Diameter Dynamics and T2- Weighted MRI Intramedullary Hyperintensity in Cervical Spondylotic Myelopathy Patients Feiyu Zu, Hao Qi, Chenchen Wang, Zenghui Zhao, Zhaoxuan Wang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4242152/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to explore the dynamic changes in the spinal canal sagittal diameter and their association with increased intramedullary signal intensity on MRI T2-weighted imaging (T2WI) in patients with cervical spondylotic myelopathy (CSM), providing clinical guidance for diagnosing and selecting appropriate treatment approaches. Materials and Methods Clinical data from 72 patients diagnosed with CSM and treated at the Third Hospital of Hebei Medical University were collected and subjected to comparative analysis. The patients were divided into two groups based on the signal intensity on preoperative cervical MRI T2WI (Group I, which exhibited hyperintensity, and Group II, which showed no signal changes). Statistical analysis was conducted comparing the two groups in terms of gender, lesion segment, age, BMI, duration of symptoms, preoperative JOA score, spinal cord compression rate, cervical curvature, total cervical ROM, intervertebral space ROM, and the sagittal diameter of the cervical spinal canal in lateral, hyperextension, and hyperflexion positions. Results The study included 40 males and 32 females, with an average age of 51.49 ± 7.23 years. No significant differences were found in age, BMI, symptom duration, preoperative JOA score, spinal cord compression rate, cervical physiological curvature, total cervical ROM, intervertebral space ROM, and the distribution of gender and segment (p>0.05). However, both the total superior and inferior variation values of the cervical canal sagittal diameter during neck flexion and extension activities were significantly lower in Group I than in Group II (p = 0.001), indicating negative changes. The interobserver reliability was high. Conclusion The dynamics of the sagittal diameter of the cervical spinal canal play a crucial role in the progression of CSM. This aspect should be given significant attention and can inform the assessment and selection of clinical treatment plans for patients with CSM. Spinal Canal Sagittal Diameter Cervical Spondylotic Myelopathy Increased Signal Intensity Magnetic Resonance Imaging Figures Figure 1 Figure 2 Figure 3 Introduction Cervical spondylotic myelopathy (CSM) is a progressive spinal disease resulting from degenerative changes in the cervical vertebrae, intervertebral discs, ligaments, and related structures, leading to compressing the cervical spinal cord and blood vessels [ 1 – 3 ]. Patients with CSM exhibit typical symptoms and signs, encompassing numbness in extremities, sensory dysfunctions, impairments in precise motor movements, abnormal gait patterns, enhanced reflex actions, and positive pathological indicators [ 4 – 5 ]. The pathology of CSM progresses a transition from a state of reversibility to irreversible damage [ 6 ]. Magnetic Resonance Imaging (MRI), as an irreplaceable imaging technique, enables the visualization of the degree of compression on the cervical spinal cord and the changes in the signal within the compressed spinal cord [ 7 – 8 ], serving as the gold standard for the diagnosis and assessment of CSM. Related studies have indicated that the increased signal intensity on cervical MRI T2-weighted images (T2WI) in patients with CSM is correlated with a significant reduction in therapeutic outcomes [ 9 – 10 ]. In conclusion, the early diagnosis and provision of effective treatment to patients are of paramount importance [ 11 ]. Previous research predominantly focused on the correlation between signal changes on T2WI and outcomes, with comparatively limited investigation into the specific causes behind these signal alterations. The spinal canal is the passage through which the spinal cord travels. When the width of the spinal canal changes, whether due to disc herniation exerting pressure or the spinal canal itself becoming narrower, it may result in the compression of the spinal cord space, which is detrimental to the spinal cord. Additionally, the width of the spinal canal may undergo potential changes during flexion and extension movements of the cervical spine [ 12 ]. Therefore, this study investigated the dynamic changes in the sagittal diameter of the spinal canal and their relationship with increased intramedullary signal intensity in the spinal cord on MRI T2WI in patients with CSM, aiming to offer clinical guidance for diagnosing and selecting appropriate treatment options. Materials and Methods Study Design This study, which is comparative in nature, analyzed cervical spine X-rays taken from neutral lateral and over flexion-extension views. Informed consent was obtained from all patients. All methods were conducted in accordance with the relevant guidelines and regulations of our hospital. The clinical data of 72 patients diagnosed with CSM, who were hospitalized in the Department of Spinal Surgery at our hospital from August 2022 and January 2024, were collected. The inclusion criteria were: 1. Classic symptoms and signs consistent with CSM (including neck and shoulder soreness, numbness or weakness in the upper or lower limbs, decreased fine motor skills in the hands, unstable gait, increased muscle tone, decreased muscle strength, and positive pyramidal tract signs); 2. Radiographic evidence of cervical spinal cord compression on X-rays or MRI; 3. Lesion segment at C4-5 or C5-6. Exclusion criteria included the following: 1. Other types of cervical spondylosis such as radicular, vertebral artery, and sympathetic types; 2. Neoplastic diseases; 3. History of cervical surgery; 4. Cervical spinal cord injury caused by trauma; 5. Incomplete imaging data. Patient information that satisfied the inclusion and exclusion criteria was retrieved by this study via the medical and imaging systems of our hospital. The general data collected encompassed gender, age, body mass index (BMI), duration of symptoms, and preoperative Japanese Orthopaedic Association (JOA) Spinal Function Scores. Radiographic examination Comprehensive radiological data of the subjects, including neutral lateral, over flexion-extension X-rays, and cervical spine MRI, were collected. The cervical spine X-ray examination involved the patients allowing their shoulders to hang naturally, without leaning forwards or backwards. For the hyperextension position, patients were asked to straighten their necks, bringing the occipital region as close as possible to the back of the neck, without leaning back and ensuring their shoulders remained level. For the hyperflexion position, patients were instructed to bend their necks so that the chin was as close to the chest as possible, avoiding leaning forwards, hunching, or raising their shoulders. The MRI examination required the patient to lie in a supine position and utilized a high-resolution 1.5 T MRI machine (Siemens, Erlangen, Germany). Radiographic measurements Based on the spinal cord signal intensity observed on MRI T2WI, patients were divided into two groups: Group I, which exhibited hyperintensity, and Group II, which showed no signal changes. Radiographic measurements were performed independently by two doctors with more than 2 years of related experience and the average of the measurements was used for analysis. The measured parameters included: the spinal cord compression rate at the segment most severely compressed before surgery, cervical physiological curvature, total cervical range of motion (ROM), and the ROM of intervertebral space at the lesion segment, as well as the sagittal diameter of the cervical spinal canal in lateral, hyperextension, and hyperflexion positions. Measurement of the spinal cord compression rate is based on the ratio of the maximum transverse diameter (T) to the minimum sagittal diameter (S) of the spinal cord at the segment most compressed on T2WI cross-sections (Fig. 1 ). Physiological curvature refers to the angle between the line parallel to the posterior edge of the C2 vertebra and the line parallel to the posterior edge of the C7 vertebra, the total cervical ROM is the sum of this angle measured in the hyperextension and hyperflexion positions. The ROM of the intervertebral space at the lesion segment is calculated as the sum of the angles formed by the intervertebral space in hyperextension and hyperflexion images (Fig. 2 ). The sagittal diameter of the spinal canal in lateral and hyperflexion positions was measured as the distance from the midpoint of the vertebral body’s posterior edge to the nearest point on the junction of the bilateral laminae. In the hyperextension position, the sagittal diameter of the spinal canal was the distance between the lower posterior corner of the vertebral body and the upper base of the spinous process of the inferior adjacent vertebra [ 13 ] (Fig. 3 ). The superior/inferior hyperextension/hyperflexion variation value is the difference in the sagittal diameter of the spinal canal in the hyperextension or hyperflexion position compared to the lateral position near the lesion intervertebral space (for example, the sagittal diameters of the spinal canal in the lateral, hyperextension, and hyperflexion positions are noted as a1, a2, a3 for the superior spinal canal, and as β1, β2, β3 for the inferior spinal canal, with the superior hyperextension variation value, superior hyperflexion variation value, inferior hyperextension variation value, and inferior hyperflexion variation value being a2-a1, a3-a1, β2-β1, and β3-β1, respectively). The total superior variation value is the sum of the superior hyperextension variation value and superior hyperflexion variation value, and the total inferior variation value is the sum of the inferior hyperextension variation value and inferior hyperflexion variation value. These two parameters reflect the overall trend of changes in the spinal canal sagittal diameter during cervical flexion and extension movements. Statistical Analysis Quantitative data are presented as the X̄ ± SD. The data were analyzed using the Statistical Product and Service Solutions software (version 26.0; SPSS, Chicago, IL). The intraclass correlation coefficient (ICC) was utilized to assess the interobserver reliability of the measurements. The chi-square test was applied to compare rates. The normality of the parameters was evaluated using the Shapiro-Wilk test. Parameters adhering to a normal distribution were subjected to t-test analysis, whereas those not conforming were analyzed with the Mann-Whitney U test. A p-value less than 0.05 was deemed indicative of statistically significant differences. Results 72 patients (40 males and 32 females), with a mean age of 51.49 ± 7.23 years, were recruited for this study. Patient Characteristics were summarized in Table 1 . Several notable radiographic differences were identified among the parameters. Table 1 Patient Characteristics Characteristics Number Percentage Sex Male 40 56 Female 32 44 Segment C4-5 43 60 C5-6 29 40 High Signal Yes 42 58 No 30 42 Characteristics Mean SD Age (y) 51.49 7.23 BMI 25.94 3.44 Between Group I and Group II, no significant statistical differences were found in age, BMI, duration of symptoms, preoperative JOA score, spinal cord compression rate, cervical curvature, total cervical ROM, and intervertebral space ROM (p > 0.05). However, the total superior variation value in Group I was significantly lower than that in Group II (-2.27 ± 1.26 vs 2.26 ± 1.47, p = 0.001), and the total inferior variation value in Group I was also significantly lower than that in Group II (-1.00 ± 0.91 vs 0.64 ± 1.95, p = 0.001) (Table 2 ). The spinal canal sagittal diameter in Group I showed negative changes during cervical flexion and extension. Additionally, no significant statistical differences were observed in the distribution of sex and segment between Group I and Group II (p > 0.05) (Table 3 ). The interobserver reliability of the measurements and time record was good (ICC = 0.853). Table 2 Comparison of Parameters in Different Signal Groups Characteristics Group P I II N 42 30 Age (y) 50.93 ± 8.01 52.27 ± 6.03 0.366 BMI 25.38 ± 2.40 26.73 ± 4.45 0.437 Duration of Symptoms (mo) 6.40 ± 7.86 7.50 ± 5.19 0.125 Preoperative JOA score (score) 11.10 ± 2.16 11.90 ± 2.31 0.161 Spinal Cord Compression Rate (%) 37.26 ± 5.04 38.26 ± 4.86 0.615 Cervical Curvature (°) 18.56 ± 9.43 15.38 ± 7.51 0.131 Total Cervical ROM (°) 40.49 ± 10.84 37.44 ± 10.41 0.237 Intervertebral Space ROM (°) 8.74 ± 3.67 8.74 ± 3.54 0.941 Total Superior Variation Value (mm) -2.27 ± 1.26 2.26 ± 1.47 0.001 * Total Inferior Variation Value (mm) -1.00 ± 0.91 0.64 ± 1.95 0.001 * * P < 0.05. Table 3 Gender and Segment of patients in different signal Groups Sex Segment Group Male Female C4-5 C5-6 I 24 18 23 19 II 16 14 20 10 χ² 0.103 1.031 P 0.748 0.310 Discussion In 1987, Takahashi et al. first documented the presence of high signal intensity on MRI T2WI in patients with CSM. Their study suggested a correlation between this elevated spinal cord signal intensity and factors such as spinal cord compression and reduced spinal canal volume [ 14 ], and several scholars have categorized intramedullary high signals and observed that patients with high signal intensity on T2WI tend to exhibit a less favorable clinical prognosis [ 8 , 15 – 16 ]. Furthermore, previous research has largely focused on the relationship between increased intramedullary signals and patients’ less-than-ideal postoperative outcomes [ 17 – 18 ]. Yet, investigations into the risk factors and precise causes of these increased signals remain underdeveloped and warrant further exploration. Xu et al. investigated the correlation between the duration of the disease course and high spinal cord signal intensity on T2WI. Their findings indicated that patients with a longer duration of illness and smaller spinal canal volumes are more prone to developing high spinal cord signals [ 19 ]. Lei et al.’s research pointed out that male gender and severe spinal cord compression are independent risk factors for high signal intensity on spinal cord MRI T2WI in CSM patients [ 20 ]. Additionally, Ogino et al., through autopsy studies, discovered that the degree of spinal cord compression correlates with the severity of the pathology [ 21 ]. In this study, we considered the unavoidable neck flexion and extension activities in the daily lives of patients and conducted the analyses of general and imaging data in CSM patients. The findings indicated no significant statistical differences between the two patient groups (those with and without high spinal cord signals on T2WI) regarding age, BMI, symptom duration, preoperative JOA score, spinal cord compression rate, cervical physiological curvature, total cervical ROM, intervertebral space ROM and the distribution of gender and segment. However, an important observation was noted: both the total superior and inferior variation values of the cervical canal sagittal diameter during neck movements were markedly lower in Group I than in Group II, showing negative changes. This suggested that if the sagittal diameter of the spinal canal generally exhibits a narrowing trend during neck flexion-extension activities, bone and soft tissues, such as intervertebral discs, and ligaments, could exert long-term and repeated compression on the spinal cord. This “pincers mechanism” may be one of the key factors in the generation of high signal intensity on spinal cord T2WI. In this study, the lesion segment was selected as the C4-5 or C5-6, which displayed comparable activity levels and were marginally larger than other segments [ 22 – 23 ], to minimize potential errors in the analysis. Lee et al. established a range for the sagittal diameter of the cervical canal and defined cervical spinal stenosis as a sagittal diameter of less than 12mm [ 24 ]. In our sample, there were only 8 cases of cervical spinal stenosis (3 in Group I and 5 in Group II), and no statistical differences were observed between the two groups. In summary, our study showed that the sagittal diameter of the cervical spinal canal, during neck flexion and extension, underwent dynamic changes, which is correlated with the presence of high signal intensity on cervical MRI T2WI in CSM patients. This underscored the necessity of considering and addressing these dynamic changes when assessing and developing treatment strategies for CSM patients, in order to ensure optimal treatment efficacy. The primary limitation of our study lies in its retrospective design. Further research employing a prospective approach is warranted. Conclusion The dynamics of the sagittal diameter of the cervical spinal canal play a crucial role in the progression of CSM. This aspect should be given significant attention and can inform the assessment and selection of clinical treatment plans for patients with CSM. Abbreviations CSM, cervical spondylotic myelopathy; MRI, Magnetic Resonance Imaging; T2WI, T2-weighted images; BMI, body mass index; JOA, Japanese Orthopaedic Association; ROM, range of motion; SPSS, Statistical Product and Service Solutions software; ICC, intraclass correlation coefficient. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the Third Hospital of Hebei Medical University and all subjects enrolled provided informed consent. Availability of data and material The datasets used or analyzed during the study are available from the corresponding author on reasonable request. Competing interests There is no conflict of interest between the authors. Funding No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Authors’ contributions First authors: Feiyu Zu. Corresponding authors: Di Zhang. FYZ and DZ conceived the study and wrote the manuscript. HQ, CCW, and ZHZ contributed to the data collection and statistical analysis. CXW, WC, ZYH, and RX ensured the integrity of the study. All authors read and approved the final manuscript and consented to publishing it. Acknowledgments Special thanks to all staff members who contributed to this research. References Kato, S., Nouri, A., Reihani-Kermani, H., Oshima, Y., Cheng, J., & Fehlings, M. G. (2018). 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The Journal of Bone and Joint Surgery. American Volume, 89(2), 376-380. https://doi.org/10.2106/JBJS.F.00437 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4242152","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":291047721,"identity":"7c2b84a0-cb6e-4e68-b000-d6597e72ca24","order_by":0,"name":"Feiyu Zu","email":"","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Feiyu","middleName":"","lastName":"Zu","suffix":""},{"id":291047722,"identity":"f5d325f4-626b-4b79-9d44-6e99a62b2c53","order_by":1,"name":"Hao Qi","email":"","orcid":"","institution":"The Third Hospital of Hebei Medical 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Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBACefb2AwcSftjw8EswsEGEDhDQYthzJvHBx540OckZxGphuJFgbDiD7bCxwQ1itTD2HEiT5uFhTtx8u/nYo5ttDHJ8NxIYPxfg0cLO3nhMmseCLXHbnWPpxrltDMaSNxKYpWcQtoUncduNHDNpoJbEDTcS2Jh58PvFTJqHTSJx84z8byAt9cRoAXnfwNhAIocNpCXBgJAWaCAnyEncSDM3zjknYTjzzMNmaXxaoFH5n4d/RvKzxzllNvJ8x5MPfsbrMDQgAcSMDSRoGAWjYBSMglGADQAAMGtQB+rRIL4AAAAASUVORK5CYII=","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":true,"prefix":"","firstName":"Di","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-04-09 13:12:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4242152/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4242152/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54995142,"identity":"03369f46-bf3b-4bc2-b1d6-66008dd8ccbd","added_by":"auto","created_at":"2024-04-19 17:53:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":364090,"visible":true,"origin":"","legend":"\u003cp\u003eThe spinal cord compression rate： the ratio of the maximum transverse diameter (T) to the minimum sagittal diameter (S) of the spinal cord at the segment most compressed on T2WI cross-section\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4242152/v1/5f46c9fbba5963a579dc685b.png"},{"id":54995143,"identity":"9098a6bd-7c90-4a2d-b503-f7fec3aa37c5","added_by":"auto","created_at":"2024-04-19 17:53:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":414323,"visible":true,"origin":"","legend":"\u003cp\u003e(a), The cervical physiological curvature; (b), The angle formed by thelesion intervertebral space in hyperextension position; (c), The angle formed by thelesion intervertebral space in hyperflexion position\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4242152/v1/2f167810e5e528acac9bc2f1.png"},{"id":54995144,"identity":"06fce787-70a8-4958-adfd-e18ac2649695","added_by":"auto","created_at":"2024-04-19 17:53:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":391314,"visible":true,"origin":"","legend":"\u003cp\u003e(a), The sagittal diameter of the spinal canal in lateral position; (b), The sagittal diameter of the spinal canal in hyperextension position; (c), The sagittal diameter of the spinal canal in hyperflexion position\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4242152/v1/cf703f5f4ee6c8638d9ae2b5.png"},{"id":55265192,"identity":"80b4ace3-1a77-4f64-aeea-5ad9bbd501a9","added_by":"auto","created_at":"2024-04-25 01:57:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2091754,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4242152/v1/401922a0-fbbb-45f2-a0bd-88925aacb539.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Spinal Canal Sagittal Diameter Dynamics and T2- Weighted MRI Intramedullary Hyperintensity in Cervical Spondylotic Myelopathy Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical spondylotic myelopathy (CSM) is a progressive spinal disease resulting from degenerative changes in the cervical vertebrae, intervertebral discs, ligaments, and related structures, leading to compressing the cervical spinal cord and blood vessels [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Patients with CSM exhibit typical symptoms and signs, encompassing numbness in extremities, sensory dysfunctions, impairments in precise motor movements, abnormal gait patterns, enhanced reflex actions, and positive pathological indicators [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The pathology of CSM progresses a transition from a state of reversibility to irreversible damage [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMagnetic Resonance Imaging (MRI), as an irreplaceable imaging technique, enables the visualization of the degree of compression on the cervical spinal cord and the changes in the signal within the compressed spinal cord [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], serving as the gold standard for the diagnosis and assessment of CSM. Related studies have indicated that the increased signal intensity on cervical MRI T2-weighted images (T2WI) in patients with CSM is correlated with a significant reduction in therapeutic outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In conclusion, the early diagnosis and provision of effective treatment to patients are of paramount importance [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Previous research predominantly focused on the correlation between signal changes on T2WI and outcomes, with comparatively limited investigation into the specific causes behind these signal alterations.\u003c/p\u003e \u003cp\u003eThe spinal canal is the passage through which the spinal cord travels. When the width of the spinal canal changes, whether due to disc herniation exerting pressure or the spinal canal itself becoming narrower, it may result in the compression of the spinal cord space, which is detrimental to the spinal cord. Additionally, the width of the spinal canal may undergo potential changes during flexion and extension movements of the cervical spine [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, this study investigated the dynamic changes in the sagittal diameter of the spinal canal and their relationship with increased intramedullary signal intensity in the spinal cord on MRI T2WI in patients with CSM, aiming to offer clinical guidance for diagnosing and selecting appropriate treatment options.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study, which is comparative in nature, analyzed cervical spine X-rays taken from neutral lateral and over flexion-extension views. Informed consent was obtained from all patients. All methods were conducted in accordance with the relevant guidelines and regulations of our hospital.\u003c/p\u003e \u003cp\u003eThe clinical data of 72 patients diagnosed with CSM, who were hospitalized in the Department of Spinal Surgery at our hospital from August 2022 and January 2024, were collected. The inclusion criteria were: 1. Classic symptoms and signs consistent with CSM (including neck and shoulder soreness, numbness or weakness in the upper or lower limbs, decreased fine motor skills in the hands, unstable gait, increased muscle tone, decreased muscle strength, and positive pyramidal tract signs); 2. Radiographic evidence of cervical spinal cord compression on X-rays or MRI; 3. Lesion segment at C4-5 or C5-6. Exclusion criteria included the following: 1. Other types of cervical spondylosis such as radicular, vertebral artery, and sympathetic types; 2. Neoplastic diseases; 3. History of cervical surgery; 4. Cervical spinal cord injury caused by trauma; 5. Incomplete imaging data. Patient information that satisfied the inclusion and exclusion criteria was retrieved by this study via the medical and imaging systems of our hospital. The general data collected encompassed gender, age, body mass index (BMI), duration of symptoms, and preoperative Japanese Orthopaedic Association (JOA) Spinal Function Scores.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eRadiographic examination\u003c/h2\u003e \u003cp\u003eComprehensive radiological data of the subjects, including neutral lateral, over flexion-extension X-rays, and cervical spine MRI, were collected. The cervical spine X-ray examination involved the patients allowing their shoulders to hang naturally, without leaning forwards or backwards. For the hyperextension position, patients were asked to straighten their necks, bringing the occipital region as close as possible to the back of the neck, without leaning back and ensuring their shoulders remained level. For the hyperflexion position, patients were instructed to bend their necks so that the chin was as close to the chest as possible, avoiding leaning forwards, hunching, or raising their shoulders. The MRI examination required the patient to lie in a supine position and utilized a high-resolution 1.5 T MRI machine (Siemens, Erlangen, Germany).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eRadiographic measurements\u003c/h2\u003e \u003cp\u003eBased on the spinal cord signal intensity observed on MRI T2WI, patients were divided into two groups: Group I, which exhibited hyperintensity, and Group II, which showed no signal changes. Radiographic measurements were performed independently by two doctors with more than 2 years of related experience and the average of the measurements was used for analysis. The measured parameters included: the spinal cord compression rate at the segment most severely compressed before surgery, cervical physiological curvature, total cervical range of motion (ROM), and the ROM of intervertebral space at the lesion segment, as well as the sagittal diameter of the cervical spinal canal in lateral, hyperextension, and hyperflexion positions.\u003c/p\u003e \u003cp\u003eMeasurement of the spinal cord compression rate is based on the ratio of the maximum transverse diameter (T) to the minimum sagittal diameter (S) of the spinal cord at the segment most compressed on T2WI cross-sections (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Physiological curvature refers to the angle between the line parallel to the posterior edge of the C2 vertebra and the line parallel to the posterior edge of the C7 vertebra, the total cervical ROM is the sum of this angle measured in the hyperextension and hyperflexion positions. The ROM of the intervertebral space at the lesion segment is calculated as the sum of the angles formed by the intervertebral space in hyperextension and hyperflexion images (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe sagittal diameter of the spinal canal in lateral and hyperflexion positions was measured as the distance from the midpoint of the vertebral body\u0026rsquo;s posterior edge to the nearest point on the junction of the bilateral laminae. In the hyperextension position, the sagittal diameter of the spinal canal was the distance between the lower posterior corner of the vertebral body and the upper base of the spinous process of the inferior adjacent vertebra [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe superior/inferior hyperextension/hyperflexion variation value is the difference in the sagittal diameter of the spinal canal in the hyperextension or hyperflexion position compared to the lateral position near the lesion intervertebral space (for example, the sagittal diameters of the spinal canal in the lateral, hyperextension, and hyperflexion positions are noted as a1, a2, a3 for the superior spinal canal, and as β1, β2, β3 for the inferior spinal canal, with the superior hyperextension variation value, superior hyperflexion variation value, inferior hyperextension variation value, and inferior hyperflexion variation value being a2-a1, a3-a1, β2-β1, and β3-β1, respectively). The total superior variation value is the sum of the superior hyperextension variation value and superior hyperflexion variation value, and the total inferior variation value is the sum of the inferior hyperextension variation value and inferior hyperflexion variation value. These two parameters reflect the overall trend of changes in the spinal canal sagittal diameter during cervical flexion and extension movements.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data are presented as the X̄ \u0026plusmn; SD. The data were analyzed using the Statistical Product and Service Solutions software (version 26.0; SPSS, Chicago, IL). The intraclass correlation coefficient (ICC) was utilized to assess the interobserver reliability of the measurements. The chi-square test was applied to compare rates. The normality of the parameters was evaluated using the Shapiro-Wilk test. Parameters adhering to a normal distribution were subjected to t-test analysis, whereas those not conforming were analyzed with the Mann-Whitney U test. A p-value less than 0.05 was deemed indicative of statistically significant differences.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e72 patients (40 males and 32 females), with a mean age of 51.49\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23 years, were recruited for this study. Patient Characteristics were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Several notable radiographic differences were identified among the parameters.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSegment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC4-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC5-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Signal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBetween Group I and Group II, no significant statistical differences were found in age, BMI, duration of symptoms, preoperative JOA score, spinal cord compression rate, cervical curvature, total cervical ROM, and intervertebral space ROM (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the total superior variation value in Group I was significantly lower than that in Group II (-2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26 vs 2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47, p\u0026thinsp;=\u0026thinsp;0.001), and the total inferior variation value in Group I was also significantly lower than that in Group II (-1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91 vs 0.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95, p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The spinal canal sagittal diameter in Group I showed negative changes during cervical flexion and extension. Additionally, no significant statistical differences were observed in the distribution of sex and segment between Group I and Group II (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The interobserver reliability of the measurements and time record was good (ICC\u0026thinsp;=\u0026thinsp;0.853).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Parameters in Different Signal Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.93\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.27\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.73\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Symptoms (mo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative JOA score (score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal Cord Compression Rate (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.26\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCervical Curvature (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.56\u0026thinsp;\u0026plusmn;\u0026thinsp;9.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.38\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Cervical ROM (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.49\u0026thinsp;\u0026plusmn;\u0026thinsp;10.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.44\u0026thinsp;\u0026plusmn;\u0026thinsp;10.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervertebral Space ROM (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.74\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.74\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Superior Variation Value (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Inferior Variation Value (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGender and Segment of patients in different signal Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSegment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eC4-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eC5-6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn 1987, Takahashi et al. first documented the presence of high signal intensity on MRI T2WI in patients with CSM. Their study suggested a correlation between this elevated spinal cord signal intensity and factors such as spinal cord compression and reduced spinal canal volume [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and several scholars have categorized intramedullary high signals and observed that patients with high signal intensity on T2WI tend to exhibit a less favorable clinical prognosis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Furthermore, previous research has largely focused on the relationship between increased intramedullary signals and patients\u0026rsquo; less-than-ideal postoperative outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Yet, investigations into the risk factors and precise causes of these increased signals remain underdeveloped and warrant further exploration.\u003c/p\u003e \u003cp\u003eXu et al. investigated the correlation between the duration of the disease course and high spinal cord signal intensity on T2WI. Their findings indicated that patients with a longer duration of illness and smaller spinal canal volumes are more prone to developing high spinal cord signals [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Lei et al.\u0026rsquo;s research pointed out that male gender and severe spinal cord compression are independent risk factors for high signal intensity on spinal cord MRI T2WI in CSM patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Additionally, Ogino et al., through autopsy studies, discovered that the degree of spinal cord compression correlates with the severity of the pathology [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this study, we considered the unavoidable neck flexion and extension activities in the daily lives of patients and conducted the analyses of general and imaging data in CSM patients. The findings indicated no significant statistical differences between the two patient groups (those with and without high spinal cord signals on T2WI) regarding age, BMI, symptom duration, preoperative JOA score, spinal cord compression rate, cervical physiological curvature, total cervical ROM, intervertebral space ROM and the distribution of gender and segment. However, an important observation was noted: both the total superior and inferior variation values of the cervical canal sagittal diameter during neck movements were markedly lower in Group I than in Group II, showing negative changes. This suggested that if the sagittal diameter of the spinal canal generally exhibits a narrowing trend during neck flexion-extension activities, bone and soft tissues, such as intervertebral discs, and ligaments, could exert long-term and repeated compression on the spinal cord. This \u0026ldquo;pincers mechanism\u0026rdquo; may be one of the key factors in the generation of high signal intensity on spinal cord T2WI.\u003c/p\u003e \u003cp\u003eIn this study, the lesion segment was selected as the C4-5 or C5-6, which displayed comparable activity levels and were marginally larger than other segments [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], to minimize potential errors in the analysis. Lee et al. established a range for the sagittal diameter of the cervical canal and defined cervical spinal stenosis as a sagittal diameter of less than 12mm [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In our sample, there were only 8 cases of cervical spinal stenosis (3 in Group I and 5 in Group II), and no statistical differences were observed between the two groups.\u003c/p\u003e \u003cp\u003eIn summary, our study showed that the sagittal diameter of the cervical spinal canal, during neck flexion and extension, underwent dynamic changes, which is correlated with the presence of high signal intensity on cervical MRI T2WI in CSM patients. This underscored the necessity of considering and addressing these dynamic changes when assessing and developing treatment strategies for CSM patients, in order to ensure optimal treatment efficacy.\u003c/p\u003e \u003cp\u003eThe primary limitation of our study lies in its retrospective design. Further research employing a prospective approach is warranted.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe dynamics of the sagittal diameter of the cervical spinal canal play a crucial role in the progression of CSM. This aspect should be given significant attention and can inform the assessment and selection of clinical treatment plans for patients with CSM.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCSM, cervical spondylotic myelopathy; MRI, Magnetic Resonance Imaging; T2WI, T2-weighted images; BMI, body mass index; JOA, Japanese Orthopaedic Association; ROM, range of motion; SPSS, Statistical Product and Service Solutions software; ICC, intraclass correlation coefficient.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Third Hospital of Hebei Medical University and all subjects enrolled provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used or analyzed during the study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest between the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst authors: Feiyu Zu. Corresponding authors: Di Zhang. FYZ and DZ conceived the study and wrote the manuscript. HQ, CCW, and ZHZ contributed to the data collection and statistical analysis. CXW, WC, ZYH, and RX ensured the integrity of the study. All authors read and approved the final manuscript and consented to publishing it.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpecial thanks to all staff members who contributed to this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKato, S., Nouri, A., Reihani-Kermani, H., Oshima, Y., Cheng, J., \u0026amp; Fehlings, M. G. (2018). 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The spine journal: official journal of the North American Spine Society, 14(8), 1601\u0026ndash;1610. https://doi.org/10.1016/j.spinee.2013.09.038\u003c/li\u003e\n\u003cli\u003eEpstein N. E. (2018). High cord signals on magnetic resonance and other factors predict poor outcomes of cervical spine surgery: A review. Surgical Neurology International, 9, 13. https://doi.org/10.4103/sni.sni_450_17\u003c/li\u003e\n\u003cli\u003eZhang, J. T., Wang, L. F., Wang, S., Li, J., \u0026amp; Shen, Y. (2016). Risk factors for poor outcome of surgery for cervical spondylotic myelopathy. Spinal cord, 54(12), 1127\u0026ndash;1131. https://doi.org/10.1038/sc.2016.64\u003c/li\u003e\n\u003cli\u003eMcCormick, J. R., Sama, A. J., Schiller, N. C., Butler, A. J., \u0026amp; Donnally, C. J., 3rd (2020). Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management. 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Neuroradiology, 29(6), 550\u0026ndash;556. https://doi.org/10.1007/BF00350439\u003c/li\u003e\n\u003cli\u003eVedantam, A., Jonathan, A., \u0026amp; Rajshekhar, V. (2011). Association of magnetic resonance imaging signal changes and outcome prediction after surgery for cervical spondylotic myelopathy. Journal of neurosurgery. Spine, 15(6), 660\u0026ndash;666. https://doi.org/10.3171/2011.8.SPINE11452\u003c/li\u003e\n\u003cli\u003eArvin, B., Kalsi-Ryan, S., Mercier, D., Furlan, J. C., Massicotte, E. M., \u0026amp; Fehlings, M. G. (2013). Preoperative magnetic resonance imaging is associated with baseline neurological status and can predict postoperative recovery in patients with cervical spondylotic myelopathy. Spine, 38(14), 1170\u0026ndash;1176. https://doi.org/10.1097/BRS.0b013e31828e23a8\u003c/li\u003e\n\u003cli\u003eWu, F., Qingjun, M., \u0026amp; Zhang, K. (2008). Correlation between postoperative MRI signal changes and operative outcomes in cervical spondylotic myelopathy. Chinese Journal of Orthopaedics, 28, 535-540.\u003c/li\u003e\n\u003cli\u003eZhang, P., Shen, Y., Zhang, Y. Z., Ding, W. Y., \u0026amp; Wang, L. F. (2011). Significance of increased signal intensity on MRI in prognosis after surgical intervention for cervical spondylotic myelopathy. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia, 18(8), 1080\u0026ndash;1083. https://doi.org/10.1016/j.jocn.2010.12.023\u003c/li\u003e\n\u003cli\u003eXu, Z., Xiao, L., Liu, C., Zhao, Q., Zhang, Y., \u0026amp; Xu, H. (2023). Correlation Analysis of Surgical Efficacy and Risk Factors of Cervical Spondylotic Myelopathy with High Signal Intensity on MRI-T2WI. Current medical imaging, 19(2), 142\u0026ndash;148. https://doi.org/10.2174/1573405618666220111121650\u003c/li\u003e\n\u003cli\u003eYu, L., Miao, Y., Liu, X., et al. (2016). Risk factors of spinal cord increased signal intensity on T2-weighted magnetic resonance imaging in patients with cervical spondylotic myelopathy. Chinese Journal of Spine and Spinal Cord, 26(7), 585-590.\u003c/li\u003e\n\u003cli\u003eOgino, H., Tada, K., Okada, K., Yonenobu, K., Yamamoto, T., Ono, K., \u0026amp; Namiki, H. (1983). Canal diameter, anteroposterior compression ratio, and spondylotic myelopathy of the cervical spine. Spine, 8(1), 1\u0026ndash;15. https://doi.org/10.1097/00007632-198301000-00001\u003c/li\u003e\n\u003cli\u003eCao, Q., Tang, X., Li, G., et al. (2013). Comparison of intramedullary high signal intensity changes and clinical significance after application of methylprednisolone or dexamethasone in perioperative period for cervical spondylotic myelopathy. Orthopedic Journal of China, 2013, 21(3): 217 -222.\u003c/li\u003e\n\u003cli\u003eZhang, X., Wang, S., Zhang, X., et al. (2012). To investigate the correlation between the segmental activity of the functional units and extent of the vertebral canal stenosis in the lower cervical spine. Journal of China Clinic Medical Imaging. 2012, 23(1): 25-28.\u003c/li\u003e\n\u003cli\u003eLee, M. J., Cassinelli, E., \u0026amp; Riew, K. D. (2007). Prevalence of cervical spine stenosis. Anatomic study in cadavers. The Journal of Bone and Joint Surgery. American Volume, 89(2), 376-380. https://doi.org/10.2106/JBJS.F.00437\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Spinal Canal Sagittal Diameter, Cervical Spondylotic Myelopathy, Increased Signal Intensity, Magnetic Resonance Imaging","lastPublishedDoi":"10.21203/rs.3.rs-4242152/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4242152/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aimed to explore the dynamic changes in the spinal canal sagittal diameter and their association with increased intramedullary signal intensity on MRI T2-weighted imaging (T2WI) in patients with cervical spondylotic myelopathy (CSM), providing clinical guidance for diagnosing and selecting appropriate treatment approaches.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMaterials and Methods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eClinical data from 72 patients diagnosed with CSM and treated at the Third Hospital of Hebei Medical University were collected and subjected to comparative analysis. The patients were divided into two groups based on the signal intensity on preoperative cervical MRI T2WI (Group I, which exhibited hyperintensity, and Group II, which showed no signal changes). Statistical analysis was conducted comparing the two groups in terms of gender, lesion segment, age, BMI, duration of symptoms, preoperative JOA score, spinal cord compression rate, cervical curvature, total cervical ROM, intervertebral space ROM, and the sagittal diameter of the cervical spinal canal in lateral, hyperextension, and hyperflexion positions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study included 40 males and 32 females, with an average age of 51.49\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23 years. No significant differences were found in age, BMI, symptom duration, preoperative JOA score, spinal cord compression rate, cervical physiological curvature, total cervical ROM, intervertebral space ROM, and the distribution of gender and segment (p\u0026gt;0.05). However, both the total superior and inferior variation values of the cervical canal sagittal diameter during neck flexion and extension activities were significantly lower in Group I than in Group II (p\u0026thinsp;=\u0026thinsp;0.001), indicating negative changes. The interobserver reliability was high.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe dynamics of the sagittal diameter of the cervical spinal canal play a crucial role in the progression of CSM. This aspect should be given significant attention and can inform the assessment and selection of clinical treatment plans for patients with CSM.\u003c/p\u003e","manuscriptTitle":"Association Between Spinal Canal Sagittal Diameter Dynamics and T2- Weighted MRI Intramedullary Hyperintensity in Cervical Spondylotic Myelopathy Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 17:53:28","doi":"10.21203/rs.3.rs-4242152/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c97897be-f409-40b9-be38-f256042db6fd","owner":[],"postedDate":"April 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-21T10:57:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-19 17:53:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4242152","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4242152","identity":"rs-4242152","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}