Degenerative Cervical Myelopathy

Background: Degenerative Cervical Myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults. Despite its prevalence, DCM is underdiagnosed, with delays contributing to lifelong disability. This thesis explores the mechanisms underlying DCM using structural, clinical, imaging, and microbiological data. Aims and Objectives:This thesis explores the mechanistic underpinnings of DCM by integrating structural, radiological, clinical, and biological insights. It evaluates whether novel diagnostic tools, such as diffusion tensor imaging (DTI), along with microbiome profiling, enhancing our understanding of DCM pathogenesis, disease progression, and treatment outcomes. Methods: A multimodal approach including Narrative review A retrospective MRI based corelation study A retrospective paired MRI and X-Ray based correlation study A Prospective Clinical signs and symptoms study A Case-control Advanced Imaging study The EMERALD study Key Findings: Radiological Correlation: Disc bulge and advanced Pfirrmann grades were significantly associated with the presence of IISI. However, the strength of these associations was weak (phi and Cramer’s V < 0.1), highlighting the multifactorial etiology of DCM. Clinical Assessment: Among 20 DCM patients, signs such as the Hoffman, Tromner, and Babinski reflexes were variably present. Loss of dexterity, gait disturbance, and hand numbness were commonly reported symptoms. Qualitative insights revealed substantial delays in recognition of early motor symptoms by both patients and providers. Imaging Biomarkers: DTI revealed reduced fractional anisotropy in the cervical spinal cord of symptomatic patients, consistent with axonal injury,supporting the use of DTI as a functional adjunct to conventional MRI in diagnosing DCM. Microbiome Analysis: Gut microbiota composition differed significantly between the surgical group and healthy controls. Notably, genera such as Roseburia and Ruminococcus were significantly underrepresented in the neck pain group, while Prevotella was elevated in those with poor surgical outcomes. Discussion: This PhD thesis advocates a multidimensional approach to DCM, integrating functional imaging, clinical phenotyping, and microbiome data to move beyond a structural model. It supports the RECODE-DCM agenda by informing diagnostics, biomarkers, and personalized care.