Cervical Spine and Cord Angle Mismatch in the Pathogenesis of Myelopathy

Cervical myelopathy is a complex pathology and dynamic compression of the tethered cervical cord, which may be responsible for clinical symptoms. Patients with cervical canal stenosis who had magnetic resonance imaging in flexion and extension positions were retrospectively reviewed. All cases were evaluated in Nurick grade. The cervical parameters—cervical cord (CC) angle, cervical lordosis, and spine/cord (S/C) angle ratio—were measured on the magnetic resonance imaging. Mean values of these parameters were compared between nonmyelopathic (Nurick grade 0) and myelopathic groups (Nurick grades 1–5). A multinomial ordinal logistic regression was used to predict outcome for Nurick grade using the CC angle, the cervical lordosis angle, and the S/C angle ratio as independent variables. A total of 65 patients (35 men) with the mean age of 58.6 ± 11.4 years were analyzed. A comparison of means between Nurick grade 0 against each of myelopathic grades 1–5 revealed significant differences only for the S/C angle ratio. A cumulative comparison between nonmyelopathic and myelopathic grades for the S/C angle ratio showed significant difference of 0.29 (1.16 ± 0.5 vs. 1.45 ± 0.6, respectively; P < 0.05). Cumulative comparison for the CC angle difference in flexion and extension lordosis did not show substantial differences. The S/C angle ratio was the only significant parameter in the prediction of the Nurick grade with an odds ratio of 2.63 (95% confidence interval 2.11–2.79). A positive correlation between Nurick grade and cervical spine and cord angle mismatch was found. •A mismatch between cervical spine and cord angle in flexion and extension positions was found to be correlated with the severity of myelopathy.•More spine/cord angle ratio was associated with higher Nurick grade.•A comparison between patients with and without myelopathiac also found a significant difference for spine/cord angle ratio.•Mismatch between cervical spine and cord angulation in the dynamic positions may cause repetitive microtrauma of the spinal cord.