{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T21:17:20Z","timestamp":1787951840166,"version":"build-2784847793"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS129724"],"award-info":[{"award-number":["R01NS129724"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults and a major contributor to balance impairment and gait instability. Surgical decompression halts disease progression, but predicting post-surgical functional recovery remains challenging. Conventional MRI poorly reflects spinal cord microstructural integrity, limiting its ability to quantify sensorimotor deficits or predict outcomes. Diffusion tensor imaging (DTI) provides quantitative measures of tract-specific microstructure and may serve as a more sensitive biomarker for functional impairment and recovery in DCM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a prospective longitudinal cohort of 57 DCM patients undergoing surgical decompression, pre-operative spinal cord DTI was acquired at 3T. DTI metrics: fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD), and filtered apparent diffusion coefficient (D\n                      <jats:sub>axial<\/jats:sub>\n                      ) were extracted from dorsal, lateral, and ventral funiculi and gray matter at the C2 level. Functional outcomes included the Berg Balance Scale (BBS), Functional Gait Assessment (FGA), 10-Meter Walk Test (10MWT), and Eyes Closed Feet Together (ECFT) test, assessed pre-operatively and at 3 months post-surgery. General linear models examined baseline DTI\u2013function associations; linear mixed-effects models assessed DTI prediction of post-operative improvement. Covariates were selected by pre-screening at\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.10.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Dorsal column FA (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.034,\n                      <jats:italic>q<\/jats:italic>\n                      = 0.086) and RD (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.025,\n                      <jats:italic>q<\/jats:italic>\n                      = 0.086) were associated with baseline BBS. Dorsal column MD (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.010,\n                      <jats:italic>q<\/jats:italic>\n                      = 0.026) and RD (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009,\n                      <jats:italic>q<\/jats:italic>\n                      = 0.026) predicted post-operative BBS improvement. Lateral funiculi Daxial (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.008,\n                      <jats:italic>q<\/jats:italic>\n                      = 0.038) predicted post-operative FGA improvement. Gray matter FA was associated with baseline FGA (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.014,\n                      <jats:italic>q<\/jats:italic>\n                      = 0.070). Ventral funiculi metrics showed no significant associations. Forty-nine participants completed 3-month follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pre-operative C2-level DTI metrics demonstrate tract-specific associations with balance and gait function in DCM. Dorsal column microstructure was most strongly associated with static balance, while lateral funiculi and gray matter microstructure related more closely to dynamic balance and gait. These findings support spinal cord DTI as a quantitative imaging biomarker for functional prognostication and post-surgical outcome prediction in DCM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2026.1911141","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T20:26:10Z","timestamp":1787948770000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Spinal cord diffusion tensor imaging predicts balance in degenerative cervical myelopathy"],"prefix":"10.3389","volume":"20","author":[{"given":"Viprav B.","family":"Raju","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanne","family":"Hauer","sequence":"additional","affiliation":[{"name":"Joint Department of Biomedical Engineering, Marquette University-Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Jalloh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjishnu","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Budde","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Koch","sequence":"additional","affiliation":[{"name":"Applied Sciences Institute, Hospital for Special Surgery","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"Schmit","sequence":"additional","affiliation":[{"name":"Joint Department of Biomedical Engineering, Marquette University-Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Vedantam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"138","DOI":"10.3389\/fnins.2020.00138","article-title":"the pathophysiology of degenerative cervical myelopathy and the physiology of recovery following decompression","volume":"14","author":"Akter","year":"2020","journal-title":"Front. Neurosci."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2062","DOI":"10.1177\/21925682231166605","article-title":"Does ending a posterior construct proximally at C2 versus C3 impact patient reported outcomes in degenerative cervical myelopathy patients up to 24 months after the surgery?","volume":"14","author":"Algarni","year":"2024","journal-title":"Glob. Spine J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.1016\/j.spinee.2024.04.028","article-title":"Advanced MRI metrics improve the prediction of baseline disease severity for individuals with degenerative cervical myelopathy","volume":"24","author":"Al-Shawwa","year":"2024","journal-title":"Spine J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1097\/BRS.0b013e31828e23a8","article-title":"Preoperative magnetic resonance imaging is associated with baseline neurological status and can predict postoperative recovery in patients with cervical spondylotic myelopathy","volume":"38","author":"Arvin","year":"2013","journal-title":"Spine"},{"key":"B5","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1038\/s41582-019-0303-0","article-title":"Degenerative cervical myelopathy \u2014 update and future directions","volume":"16","author":"Badhiwala","year":"2020","journal-title":"Nat. Rev. Neurol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"103473","DOI":"10.1016\/j.media.2025.103473","article-title":"Towards contrast-agnostic soft segmentation of the spinal cord","volume":"101","author":"B\u00e9dard","year":"2025","journal-title":"Med. Image Anal."},{"key":"B7","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B: Stat. Methodol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1097\/00002517-199109000-00005","article-title":"Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy","volume":"4","author":"Benzel","year":"1991","journal-title":"J. Spinal Disord."},{"key":"B9","first-page":"S7","article-title":"Measuring balance in the elderly: validation of an instrument","volume":"83","author":"Berg","year":"1992","journal-title":"Can. J. Public Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.gaitpost.2024.02.014","article-title":"People with degenerative cervical myelopathy have impaired reactive balance during walking","volume":"109","author":"Boerger","year":"2024","journal-title":"Gait Posture"},{"key":"B11","doi-asserted-by":"publisher","first-page":"784263","DOI":"10.3389\/fnagi.2022.784263","article-title":"Degeneration of the sensorimotor tract in degenerative cervical myelopathy and compensatory structural changes in the brain","volume":"14","author":"Chen","year":"2022","journal-title":"Front. Aging Neurosci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"4611","DOI":"10.1038\/s41596-021-00588-0","article-title":"Generic acquisition protocol for quantitative MRI of the spinal cord","volume":"16","author":"Cohen-Adad","year":"2021","journal-title":"Nat. Protoc."},{"key":"B13","doi-asserted-by":"publisher","first-page":"14","DOI":"10.21037\/amj-23-196","article-title":"Early versus late intervention for degenerative cervical myelopathy: what are the outcomes?\u2014a review of the current literature","volume":"9","author":"Connelly","year":"2024","journal-title":"AME Med J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1828","DOI":"10.3390\/jcm9061828","article-title":"The functional relevance of diffusion tensor imaging in patients with degenerative cervical myelopathy","volume":"9","author":"d'Avanzo","year":"2020","journal-title":"JCM"},{"key":"B15","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1038\/s41582-019-0270-5","article-title":"Traumatic and nontraumatic spinal cord injury: pathological insights from neuroimaging","volume":"15","author":"David","year":"2019","journal-title":"Nat. Rev. Neurol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1089\/neur.2025.0011","article-title":"Progressive remote axonal degeneration following spinal cord injury: a histological and MRI study","volume":"6","author":"David","year":"2025","journal-title":"Neurotrauma Rep."},{"key":"B17","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.neuroimage.2017.10.041","article-title":"PAM50: Unbiased multimodal template of the brainstem and spinal cord aligned with the ICBM152 space","volume":"165","author":"De Leener","year":"2018","journal-title":"Neuroimage"},{"key":"B18","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.neuroimage.2016.10.009","article-title":"SCT: spinal cord toolbox, an open-source software for processing spinal cord MRI data","volume":"145","author":"De Leener","year":"2017","journal-title":"Neuroimage"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1007\/s00701-023-05526-5","article-title":"Human spinal cord tissue is an underutilised resource in degenerative cervical myelopathy: findings from a systematic review of human autopsies","volume":"165","author":"Dohle","year":"2023","journal-title":"Acta Neurochir."},{"key":"B20","doi-asserted-by":"publisher","first-page":"472","DOI":"10.3171\/2017.7.SPINE176","article-title":"Reproducibility, temporal stability, and functional correlation of diffusion MR measurements within the spinal cord in patients with asymptomatic cervical stenosis or cervical myelopathy","volume":"28","author":"Ellingson","year":"2018","journal-title":"J. Neurosurg. Spine"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e16297","DOI":"10.1111\/ene.16297","article-title":"Quantifying neurodegeneration of the cervical cord and brain in degenerative cervical myelopathy: a multicentre study using quantitative magnetic resonance imaging","volume":"31","author":"Freund","year":"2024","journal-title":"Eur. J. Neurol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1016\/S1474-4422(19)30138-3","article-title":"MRI in traumatic spinal cord injury: from clinical assessment to neuroimaging biomarkers","volume":"18","author":"Freund","year":"2019","journal-title":"Lancet Neurol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1016\/j.ejrad.2013.06.011","article-title":"Correlation study of 3T-MR-DTI measurements and clinical symptoms of cervical spondylotic myelopathy","volume":"82","author":"Gao","year":"2013","journal-title":"Eur. J. Radiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2329","DOI":"10.1089\/neu.2017.4980","article-title":"Neurodegeneration in the spinal ventral horn prior to motor impairment in cervical spondylotic myelopathy","volume":"34","author":"Grabher","year":"2017","journal-title":"J. Neurotrauma"},{"key":"B25","doi-asserted-by":"publisher","first-page":"24636","DOI":"10.1038\/srep24636","article-title":"Voxel-based analysis of grey and white matter degeneration in cervical spondylotic myelopathy","volume":"6","author":"Grabher","year":"2016","journal-title":"Sci. Rep."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2621","DOI":"10.3390\/biomedicines10102621","article-title":"Clinical and research MRI techniques for assessing spinal cord integrity in degenerative cervical myelopathy-a scoping review","volume":"10","author":"He","year":"2022","journal-title":"Biomedicines"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1089\/neu.2013.2897","article-title":"Ex vivo diffusion tensor imaging of spinal cord injury in rats of varying degrees of severity","volume":"30","author":"Jirjis","year":"2013","journal-title":"J. Neurotrauma"},{"key":"B28","doi-asserted-by":"publisher","first-page":"268","DOI":"10.46292\/sci19-00069","article-title":"Reliability and validity of the functional gait assessment in incomplete spinal cord injury","volume":"26","author":"Kahn","year":"2020","journal-title":"Top. Spinal Cord Inj. Rehabil."},{"key":"B29","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.1089\/neu.2019.6379","article-title":"Diffusion tensor imaging in acute spinal cord injury: a review of animal and human studies","volume":"36","author":"Kaushal","year":"2019","journal-title":"J. Neurotrauma"},{"key":"B30","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1093\/neuros\/nyz325","article-title":"Trajectory of improvement in myelopathic symptoms from 3 to 12 months following surgery for degenerative cervical myelopathy","volume":"86","author":"Khan","year":"2020","journal-title":"Neurosurg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"66","DOI":"10.4161\/pri.23499","article-title":"Grey matter damage in multiple sclerosis: a pathology perspective","volume":"7","author":"Klaver","year":"2013","journal-title":"Prion"},{"key":"B32","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1002\/mrm.28751","article-title":"Diffusion-prepared fast spin echo for artifact-free spinal cord imaging","volume":"86","author":"Lee","year":"2021","journal-title":"Magn. Reson. Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s12883-020-01752-x","article-title":"Evaluation of microstructural changes in spinal cord of patients with degenerative cervical myelopathy by diffusion kurtosis imaging and investigate the correlation with JOA score","volume":"20","author":"Liu","year":"2020","journal-title":"BMC Neurol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e0195733","DOI":"10.1371\/journal.pone.0204082","article-title":"Monitoring for myelopathic progression with multiparametric quantitative MRI","volume":"13","author":"Martin","year":"2018","journal-title":"PLoS ONE"},{"key":"B35","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1007\/s00234-021-02635-9","article-title":"Spatial correspondence of spinal cord white matter tracts using diffusion tensor imaging, fibre tractography, and atlas-based segmentation","volume":"63","author":"McLachlin","year":"2021","journal-title":"Neuroradiology"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1089\/neu.2018.5964","article-title":"Longitudinal In Vivo Diffusion Magnetic Resonance Imaging Remote from the Lesion Site in Rat Spinal Cord Injury","volume":"36","author":"Motovylyak","year":"2019","journal-title":"J. Neurotrauma"},{"key":"B37","doi-asserted-by":"publisher","first-page":"101997","DOI":"10.1016\/j.jcot.2022.101997","article-title":"Role of diffusion tensor imaging and tractography in spinal cord injury","volume":"33","author":"Nanda","year":"2022","journal-title":"J. Clin. Orthop. Trauma"},{"key":"B38","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1090\/S0025-5718-1980-0572855-7","article-title":"Updating quasi-Newton matrices with limited storage","volume":"35","author":"Nocedal","year":"1980","journal-title":"Math. Comp."},{"key":"B39","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1111\/j.1750-3639.2004.tb00056.x","article-title":"Cell Death Mechanisms Following Traumatic Brain Injury","volume":"14","author":"Raghupathi","year":"2004","journal-title":"Brain Pathol."},{"key":"B40","unstructured":"Romberg\n              M. H.\n            \n          \n          A Manual of the Nervous Diseases of Man.\n          \n          1853"},{"key":"B41","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1089\/neu.2019.6694","article-title":"Cervical cord neurodegeneration in traumatic and non-traumatic spinal cord injury","volume":"37","author":"Seif","year":"2020","journal-title":"J. Neurotrauma"},{"key":"B42","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1038\/s41393-024-01041-1","article-title":"Is neck pain a marker for something serious? Like myelopathy","volume":"62","author":"Sial","year":"2024","journal-title":"Spinal Cord"},{"key":"B43","doi-asserted-by":"publisher","first-page":"3784","DOI":"10.1111\/ene.15027","article-title":"Diffusion magnetic resonance imaging reveals tract-specific microstructural correlates of electrophysiological impairments in non-myelopathic and myelopathic spinal cord compression","volume":"28","author":"Valo\u0161ek","year":"2021","journal-title":"Eur. J. Neurol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1227\/NEU.0000000000000171","article-title":"Diffusion tensor imaging of the spinal cord: insights from animal and human studies","volume":"74","author":"Vedantam","year":"2014","journal-title":"Neurosurgery"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1002\/mrm.26059","article-title":"Diffusion MRI noise mapping using random matrix theory","volume":"76","author":"Veraart","year":"2016","journal-title":"Magn. Reson. Med."},{"key":"B46","article-title":"\u201cFully automatic vertebrae and spinal cord segmentation using a hybrid approach combining nnU-Net and iterative algorithm,\u201d","volume-title":"Proceedings of the 32nd Annual Meeting of the International Society for Magnetic Resonance in Medicine","author":"Warszawer","year":"2024"},{"key":"B47","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/S0031-9406(05)61264-3","article-title":"Refining the ten-metre walking test for use with neurologically impaired people","volume":"88","author":"Watson","year":"2002","journal-title":"Physiotherapy"}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1911141\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T20:26:12Z","timestamp":1787948772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1911141\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":47,"alternative-id":["10.3389\/fnins.2026.1911141"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2026.1911141","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"1911141"}}