Association of Preoperative Cervical Spine Alignment With Spinal Cord Magnetic Resonance Imaging Hyperintensity and Myelopathy Severity
Bibliographic record
Abstract
In Brief Study Design. This is an ambispective analysis of a prospectively followed cohort of patients with cervical spondylotic myelopathy (CSM). Objective. The goal of this study was to evaluate the impact of sagittal alignment on magnetic resonance imaging (MRI) abnormalities in the cervical spinal cord as well as myelopathy severity in a prospective series of surgical patients. Summary of Background Data. There is emerging evidence that sagittal alignment of the cervical spine in patients with CSM may be associated with disease severity. The impact on actual spinal cord pathology is unclear, with suspected mechanisms including focal static ventral compression, repeated dynamic injury, and increased cord intramedullary tension. The relationship between sagittal imbalance and disease severity remains undefined. Methods. An ambispective analysis of prospectively collected data was performed of surgical patients with CSM at a single tertiary-care neurosurgical center. Demographic data and measures of neurological disability were collected and analyzed for dependency on cervical spine alignment parameters including qualitative (kyphotic vs. lordotic) and quantitative (sagittal Cobb angle (C2–C7) and sagittal vertical axis (SVA, C2–C7)). MRI cord signal hyperintensity at the most pathological level was also evaluated for dependency on the same alignment metrics. Multiple logistic regression analysis was used at the 0.05 level of significance with correction for multiple comparisons. Results. Among 124 patients with CSM, kyphotic alignment was seen in 34% of patients and hyperintense T2 MRI signal was observed in 55% of patients. No difference in MRI signal or myelopathy severity was observed in univariate analysis on global alignment. Among patients with kyphosis, quantitative MRI parameters and myelopathy severity were both correlated with increasing SVA, an observation not seen among patients with lordosis. Conclusion. Global sagittal alignment and SVA interactively associate with quantitative MRI spinal cord signal abnormalities and worse CSM-related disability. The reciprocal relationships of SVA effect in patients with kyphosis and those with lordosis may reflect an optimal spinal alignment to achieve during surgical management. Level of Evidence: 2 Sagittal alignment affects cervical spondylotic myelopathy by altering cord longitudinal tension and axial compression. Among prospectively followed patients, myelopathy severity correlated with sagittal vertical axis, worst for patients with kyphosis with increasing imbalance, with reciprocal relationship between patients with kyphosis and those with lordosis. There may be an ideal alignment to achieve as surgical objective.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".