A Study of Examinations and Surgical Determinants of Compressive Cervical Myelopathy: The Relationship between MRI Quantifications and Motor Evoked Potentials

A Study of Examinations and Surgical Determinants of Compressive Cervical Myelopathy: The Relationship between MRI Quantifications and Motor Evoked Potentials | 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 A Study of Examinations and Surgical Determinants of Compressive Cervical Myelopathy: The Relationship between MRI Quantifications and Motor Evoked Potentials Hiroki Fukui, Toshio Nakamae, Kazuto Nakao, Yuki Kido, Shuhei Kawaguchi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8035314/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Apr, 2026 Read the published version in European Spine Journal → Version 1 posted 15 You are reading this latest preprint version Abstract Introduction: Motor evoked potentials measured by transcranial magnetic stimulation (Tc-MEPs) have been used to evaluate functional impairment in compressive cervical myelopathy (CCM). Central motor conduction time (CMCT), calculated from the difference between MEP latency and peripheral nerve conduction time, is often prolonged in patients with CCM, providing a quantitative indicator of neurological dysfunction. Intramedullary signal changes on MRI at sites of spinal cord compression are also observed; however, few studies have quantitatively assessed these changes. This study, quantified intramedullary signal alterations using contrast ratio (CR) to examine their relationship with CMCT and their influence on surgical decision -making. Methods: We analyzed 137 patients with suspected CCM who underwent Tc-MEP assessment between 2018 and 2024. CMCT for the upper and lower extremities was calculated from Tc-MEP results. On T2-weighted sagittal MRI, the region of interest was placed at the level of greatest spinal stenosis, and the MRI signal intensity (SI narrow) at this site was measured. Signal intensity of the normal spinal cord, at the T1 level (SI cord) was also recorded. CR was calculated as: CR = (SI narrow – SI cord) / (SI narrow + SI cord). Age, sex, and Japanese Orthopaedic Association (JOA) score at initial presentation were evaluated for associations with surgery. Results: Lower-limb CMCT was positively correlated with CR (correlation coefficient = 0.209, p = 0.01). Multivariate analysis demonstrated that sex, intramedullary signal changes at the stenotic level, and JOA score were significantly associated with surgical intervention. Relationships were observed among intramedullary signal abnormalities, delayed CMCT, lower JOA scores, and the likelihood of surgery. Discussion: This study demonstrates a positive correlation between lower-limb CMCT and CR, suggesting that CR measurement may aid in evaluating CCM severity. Moreover, surgical decisions were influenced by multiple factors, including intramedullary MRI changes, electrophysiological findings, and clinical presentation. Thus, comprehensive consideration of symptoms, imaging, and physiological assessments remains essential for treatment planning in patients with CCM. Intramedullary signal changes Central motor conduction time Magnetic resonance imaging compressive cervical myelopathy Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Apr, 2026 Read the published version in European Spine Journal → Version 1 posted Editorial decision: Revision requested 28 Dec, 2025 Reviews received at journal 07 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviews received at journal 28 Nov, 2025 Reviews received at journal 18 Nov, 2025 Reviewers agreed at journal 15 Nov, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviewers invited by journal 09 Nov, 2025 Editor assigned by journal 06 Nov, 2025 Submission checks completed at journal 06 Nov, 2025 First submitted to journal 05 Nov, 2025 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. 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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-8035314","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":546872368,"identity":"6901d9c6-7eee-4c91-bfb0-156d3e3bea91","order_by":0,"name":"Hiroki 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Potentials","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-spine-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"esjo","sideBox":"Learn more about [European Spine Journal](http://link.springer.com/journal/586)","snPcode":"586","submissionUrl":"https://submission.springernature.com/new-submission/586/3","title":"European Spine Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Intramedullary signal changes, Central motor conduction time, Magnetic resonance imaging, compressive cervical myelopathy","lastPublishedDoi":"10.21203/rs.3.rs-8035314/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8035314/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e\u003cp\u003eMotor evoked potentials measured by transcranial magnetic stimulation (Tc-MEPs) have been used to evaluate functional impairment in compressive cervical myelopathy (CCM). Central motor conduction time (CMCT), calculated from the difference between MEP latency and peripheral nerve conduction time, is often prolonged in patients with CCM, providing a quantitative indicator of neurological dysfunction. Intramedullary signal changes on MRI at sites of spinal cord compression are also observed; however, few studies have quantitatively assessed these changes. This study, quantified intramedullary signal alterations using contrast ratio (CR) to examine their relationship with CMCT and their influence on surgical decision -making.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eWe analyzed 137 patients with suspected CCM who underwent Tc-MEP assessment between 2018 and 2024. CMCT for the upper and lower extremities was calculated from Tc-MEP results. On T2-weighted sagittal MRI, the region of interest was placed at the level of greatest spinal stenosis, and the MRI signal intensity (SI narrow) at this site was measured. Signal intensity of the normal spinal cord, at the T1 level (SI cord) was also recorded. CR was calculated as: CR = (SI narrow \u0026ndash; SI cord) / (SI narrow\u0026thinsp;+\u0026thinsp;SI cord). Age, sex, and Japanese Orthopaedic Association (JOA) score at initial presentation were evaluated for associations with surgery.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eLower-limb CMCT was positively correlated with CR (correlation coefficient\u0026thinsp;=\u0026thinsp;0.209, p\u0026thinsp;=\u0026thinsp;0.01). Multivariate analysis demonstrated that sex, intramedullary signal changes at the stenotic level, and JOA score were significantly associated with surgical intervention. Relationships were observed among intramedullary signal abnormalities, delayed CMCT, lower JOA scores, and the likelihood of surgery.\u003c/p\u003e\u003ch2\u003eDiscussion:\u003c/h2\u003e\u003cp\u003eThis study demonstrates a positive correlation between lower-limb CMCT and CR, suggesting that CR measurement may aid in evaluating CCM severity. Moreover, surgical decisions were influenced by multiple factors, including intramedullary MRI changes, electrophysiological findings, and clinical presentation. Thus, comprehensive consideration of symptoms, imaging, and physiological assessments remains essential for treatment planning in patients with CCM.\u003c/p\u003e","manuscriptTitle":"A Study of Examinations and Surgical Determinants of Compressive Cervical Myelopathy: The Relationship between MRI Quantifications and Motor Evoked Potentials","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 15:05:07","doi":"10.21203/rs.3.rs-8035314/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-29T02:06:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-07T12:55:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T21:10:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83344211905443911435099577453813598775","date":"2025-12-01T19:58:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T15:51:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168992598386757197974671188286960783256","date":"2025-12-01T06:26:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-28T14:00:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-18T10:40:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269343314507171910518660617784985055337","date":"2025-11-15T05:29:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50358213766243503326228438743450219856","date":"2025-11-15T03:48:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284399442219572202960824076951613485158","date":"2025-11-10T14:00:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-09T17:59:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-06T08:03:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-06T07:59:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Spine Journal","date":"2025-11-05T07:09:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-spine-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"esjo","sideBox":"Learn more about [European Spine Journal](http://link.springer.com/journal/586)","snPcode":"586","submissionUrl":"https://submission.springernature.com/new-submission/586/3","title":"European Spine Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1b1ca0e8-9756-4aea-b405-696e849d6753","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T16:07:03+00:00","versionOfRecord":{"articleIdentity":"rs-8035314","link":"https://doi.org/10.1007/s00586-026-09913-1","journal":{"identity":"european-spine-journal","isVorOnly":false,"title":"European Spine Journal"},"publishedOn":"2026-04-06 15:57:31","publishedOnDateReadable":"April 6th, 2026"},"versionCreatedAt":"2025-11-19 15:05:07","video":"","vorDoi":"10.1007/s00586-026-09913-1","vorDoiUrl":"https://doi.org/10.1007/s00586-026-09913-1","workflowStages":[]},"version":"v1","identity":"rs-8035314","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8035314","identity":"rs-8035314","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}