Morphologic change and astrocyte response to unilateral spinal cord compression in rabbits

In myelopathy, unilateral compression of the spinal cord in cases of disc herniation would be expected to produce Brown-Séquard syndrome. However, a transverse lesion syndrome occurs in most clinical cases. In order to reveal the mechanism by which unilateral compression induces transverse damage to the spinal cord, damage of the gray and white matter in each half of the spinal cord were evaluated quantitatively to determine the density of GFAP-positive astrocytes. The cervical spinal cord in rabbits was unilaterally compressed with a small screw. The area of each half of the damaged cord and the density of GFAP-positive astrocytes of the compressed and contralateral halves were investigated one week after the surgery. No apparent paralysis was observed during the period of observation. As the compression increased, the area of the compressed half of the spinal cord decreased significantly compared to the contralateral half. The densities of GFAP-positive astrocytes in the gray matter and the anterior funiculus increased significantly in the compressed half. There were no significant differences in the densities at the lateral and dorsal funiculi between the compressed and contralateral halves. The tissue damage in the gray matter of the compressed half was markedly higher. No significant difference between the two halves in damage was seen in the lateral funiculus, where in the lateral pyramidal and the dorsal spinocerebellar tracts are found. These findings provide evidence of the mechanistic basis for the spinal cord damage that leads to transverse lesion syndrome in unilateral compression myelopathy.     

Cervical ossification of the posterior longitudinal ligament: factors affecting the effect of posterior decompression

Objective: Decompression procedures for cervical myelopathy of ossification of the posterior longitudinal ligament (OPLL) are anterior decompression with fusion, laminoplasty, and posterior decompression with fusion. Preoperative and postoperative stress analyses were performed for compression from hill-shaped cervical OPLL using 3-dimensional finite element method (FEM) spinal cord models.

Methods: Three FEM models of vertebral arch, OPLL, and spinal cord were used to develop preoperative compression models of the spinal cord to which 10%, 20%, and 30% compression was applied; a posterior compression with fusion model of the posteriorly shifted vertebral arch; an advanced kyphosis model following posterior decompression with the spinal cord stretched in the kyphotic direction; and a combined model of advanced kyphosis following posterior decompression and intervertebral mobility. The combined model had discontinuity in the middle of OPLL, assuming the presence of residual intervertebral mobility at the level of maximum cord compression, and the spinal cord was mobile according to flexion of vertebral bodies by 5°, 10°, and 15°.

Results: In the preoperative compression model, intraspinal stress increased as compression increased. In the posterior decompression with fusion model, intraspinal stress decreased, but partially persisted under 30% compression. In the advanced kyphosis model, intraspinal stress increased again. As anterior compression was higher, the stress increased more. In the advanced kyphosis +?intervertebral mobility model, intraspinal stress increased more than in the only advanced kyphosis model following decompression. Intraspinal stress increased more as intervertebral mobility increased.

Conclusion: In high residual compression or instability after posterior decompression, anterior decompression with fusion or posterior decompression with instrumented fusion should be considered.     

不同载荷条件下颈脊髓过伸损伤的应力分布特征

目的 利用有限元法研究不同载荷条件下颈脊髓过伸损伤时脊髓内不同区域的应力分布特征. 方法 利用颈脊髓的三维有限元模型(此模型由8484个节点和14 297个单元组成),进入Ansys前处理器,设置边界条件和不同大小的载荷配置:第Ⅰ种载荷配置:后伸载荷0.0015 N,压缩载荷1N;第Ⅱ种载荷配置:后伸载荷0.0030 N,压缩载荷2 N;第Ⅲ种载荷配置:后伸载荷0.0045 N,压缩载荷3N;第Ⅳ种载荷配置:后伸载荷0.0060 N,压缩载荷4 N;第Ⅴ种载荷配置:后伸载荷0.0075 N,压缩载荷5N.模拟不同损伤情况,进入求解模块,进行过伸损伤负载模拟计算,最后进入Ansys后处理器,读取并分析颈脊髓横断面9个不同功能区域(颈脊髓白质前索、侧索外侧部、侧索内侧部、后索外侧部、后索内侧部、灰质前角、前角底部、后角尖和头部及后角颈部)的应力分析结果. 结果 颈脊髓损伤断面应力云图提示应力主要集中于灰质前角、后角和白质前索、侧索内侧和后索外侧内,并且其平均应力依次减小.随着施加载荷的增大,灰白质内各个部位的应力均明显增加,灰质前角内的应力增幅最大.灰质前角和白质侧索的应力增幅值比较差异有统计学意义(P<0.05),后角和白质前索分别与后索应力增幅值比较差异均有统计学意义(P<0.05),后角和白质前索应力增幅值比较差异无统计学意义(P>0.05). 结论 轻度颈脊髓过伸损伤主要造成白质前索和灰质前后角损伤,表现为以上肢为主的运动和感觉异常.随着损伤载荷加大,应力分布向相邻白质扩展,载荷加大后前角支配手内肌的神经元细胞较其他部位损伤更严重.     

Spinal cord injury following operative shoulder intervention: A case report

Abstract

Context

Cervical myelopathy is a spinal cord dysfunction that results from extrinsic compression of the spinal cord, its blood supply, or both. It is the most common cause of spinal cord dysfunction in patients greater than 55 years of age.

Findings: A

57-year-old male with right shoulder septic arthritis underwent surgical debridement of his right shoulder and sustained a spinal cord injury intraoperatively. The most likely etiology is damage to the cervical spinal cord during difficult intubation requiring multiple attempts in this patient with underlying asymptomatic severe cervical stenosis.

Conclusion

Although it is not feasible to perform imaging studies on all patients undergoing intubation for surgery, this patient's outcome would suggest consideration of inclusion of additional pre-surgical screening examination techniques, such as testing for a positive Hoffman's reflex, is appropriate to detect asymptomatic patients who may have underlying cervical stenosis.     

Biomechanical analysis of cervical spondylotic myelopathy: The influence of dynamic factors and morphometry of the spinal cord

Abstract

Objective

Patients with cervical spondylotic myelopathy (CSM) have the same clinical symptoms that vary according to the degree of spinal cord compression and the cross-sectional cord shape. We used a three-dimensional finite element method (3D-FEM) to analyze the stress distributions of the spinal cord with neck extension under three cross-sectional cord shapes.

Methods

Experimental condition for the 3D-FEM spinal cord, ligamentum flavum, and anterior compression shape (central, lateral, and diffuse types) was established. To simulate neck extension, the spinal cord was extended by 20° and the ligamentum flavum was shifted distally according to movement of the cephalad lamina.

Results

The stress distribution in the spinal cord increased due to invagination of the ligamentum flavum into the neck extension. The range of stress distribution observed for the diffuse type was wider than for the central and lateral types. In addition, the stress distribution in the spinal cord was increased by the pincer movement of the ligamentum flavum and by the anterior compression of the spinal cord. The range of stress distribution observed for the diffuse type under antero-posterior compression was also wider than for the central and lateral types.

Conclusion

This simulation model showed that the clinical symptoms of CSM due to compression of the diffuse type may be stronger than for the central and lateral types. Therefore, careful follow-up is recommended for anterior compression of the spinal cord of diffuse type.     

颈椎病伴椎管狭窄患者再手术问题探讨

目的：探讨颈椎病伴椎管狭窄患者再手术的原因、手术方式及其相关问题。方法：我院2002年7月～2003年12月对40例颈椎病伴椎管狭窄术后疗效不佳或症状复发的患者进行了后路多节段（5个或以上）减压手术。根据其手术治疗方式及影像学资料分析再手术原因，并进行术后疗效评价。结果：经前路手术者再手术的主要原因为：（1）伴有多节段颈椎管狭窄因素时，只选择部分压迫重的节段行减压融合15例；（2）经前路多节段（≥3个节段）减压融合后，相邻节段继续退变，出现新的脊髓压迫表现及椎间不稳定9例；（3）伴有OPLL时，行部分节段前路减压融合后，病变呈进展表现，产生或加重对脊髓的压迫8例。经后路手术者再手术的原因为：（1）后路减压节段不够5例（包括1例前后路联合手术者）；（2）后路减压不充分3例。再手术后随访1．3～2．7年，平均2．1年，所有患者脊髓功能获得一定的提高，JOA评分改善率为51．3％。结论：颈椎病伴椎管狭窄病例再手术的主要原因为椎管狭窄因素仍然存在，经后路多节段（5个或以上）减压手术治疗可彻底去除颈椎管狭窄因素，有效解除脊髓前、后方所受的压迫，可获得较满意的临床疗效。     

Biomechanical study of cervical flexion myelopathy using a three-dimensional finite element method

OBJECT: The goal of this study was to perform a biomechanical study of cervical flexion myelopathy (CFM) using a finite element method. METHODS: A 3D finite element model of the spinal cord was established consisting of gray matter, white matter, and pia mater. After the application of semi-static compression, the model underwent anterior flexion to simulate CFM. The flexion angles used were 5 degrees and 10 degrees , and stress distributions inside the spinal cord were then evaluated. RESULTS: Stresses on the spinal cord were very low under semi-static compression but increased after 5 degrees of flexion was applied. Stresses were concentrated in the gray matter, especially the anterior and posterior horns. The stresses became much higher after application of 10 degrees of flexion and were observed in the gray matter, posterior funiculus, and a portion of the lateral funiculus. CONCLUSIONS: The 5 degrees model was considered to represent the mild type of CFM. This type corresponds to the cases described in the original report by Hirayama and colleagues. The main symptom of this type of CFM is muscle atrophy and weakness caused by the lesion of the anterior horn. The 10 degrees model was considered to represent a severe type of CFM and was associated with lesions in the posterior fand lateral funiculi. This type of CFM corresponds to the more recently reported clinical cases with combined long tract signs and sensory disturbance.     

Gray matter of the bovine cervical spinal cord is mechanically more rigid and fragile than the white matter

The gray matter of the cervical spinal cord has been thought to be equally or less rigid than the white matter. Based on this assumption, various studies have been conducted on the changes of stress distributions within the spinal cord under mechanical compression, although the mechanical properties of the white and gray matters had not been fully elucidated. The present study measured the mechanical properties of the white and gray matter of bovine spinal cords. For both the white and gray matter, the stress-strain curves had a nonlinear region, followed by a linear region, and then a region where the stresses plateaued before failure. In the nonlinear region, stress was not significantly different between the gray and white matter samples (strain approximately 0-10%), while stress and Young's modulus in the gray matter was significantly higher than the white matter in the linear part of the curve. The gray matter ruptured at lower strains than the white matter. These findings demonstrated the gray matter is more rigid and fragile than the white matter, and the conventional assumption (i.e., the white matter is more rigid than the gray matter) is not correct. We then applied our data to computer simulations using the finite element method, and confirmed that simulations agreed with actual magnetic resonance imaging findings of the spinal cord under compression. In future computer simulations, including finite element method using our data, changes in stress and strain within the cervical spinal cord under compression would be clarified in more detail, and our findings would also help to elucidate the area which can easily receive histologic damage or which could have hemodynamic disorders under mechanical compression, as well as severity and location of biochemical and molecular biological changes.     

Canal diameter, anteroposterior compression ratio, and spondylotic myelopathy of the cervical spine

Nine patients with cervical spondylotic myelopathy, diagnosed during life, were subjected to detailed clinicopathologic study. The degree of cord destruction was in good correlation with the ratio of the anteroposterior diameter to the transverse diameter, designated as an anteroposterior compression ratio. Within the factors responsible for decrease in the ratio, developmental narrowing of the spinal canal was the most significant, and multiplicity of spondylotic protrusion less so. The former resulted in an extensive demyelination of the posterolateral funiculus and infarction of the gray matter. Recurrent trauma proved to cause distinct manifestations and cord pathology. Clinicopathologic correlations were also examined from the neurologic findings at the terminal stage.     

颈髓挥鞭样损伤的回顾性研究

目的通过对临床资料的回顾性分析,探讨颈髓挥鞭样损伤病例手术的必要性。方法根据治疗方式和损伤后MR I所示脊髓受压程度的不同,将2004年4月～2006年4月收治的36例过伸性颈椎损伤患者分成3组：非手术治疗组（8例）、受压不明显者手术组（10例）、受压明显者手术组（18例）;比较3组间治疗前后的ASIA评分及Frankel分级改变。结果所有患者获得12～24个月随访,神经功能行ASIA评分及Frankel分级,手术组均高于非手术治疗组（P〈0.05）。结论过伸性颈脊髓损伤尽早手术减压是最大限度恢复神经功能的关键。凡存在明显神经功能障碍、MR I提示有颈髓损伤,无论是否有明显脊髓受压者都应早期手术。手术可避免因颈椎管高压和颈椎不稳造成的继发性脊髓损伤,保证其远期疗效。     

Catecholamines in experimental spinal cord lesions associated with spinal arachnoiditis

Catecholamines in the spinal cord and cerebrospinal fluid of dogs with arachnoiditis induced by cisternal kaolin injection were measured by radioenzymatic assay. The levels of noradrenaline in the gray matter of the cervical cord and the cerebrospinal fluid were highest in 1st week (mean values, 127.8 ng/g and 856.0 pg/ml), whereas those in the gray matter of the thoracic and thoracolumbar cord increased to 175.0 and 210.0 ng/g in average respectively in 12th week. The increase in the level of noradrenaline in the gray matter seemed to be related with degenerative cord lesions in almost all segments, while most segments with cavitation indicated low noradrenaline level.     

大鼠脊髓损伤后巢蛋白在脊髓组织中的表达

目的探讨大鼠脊髓损伤后巢蛋白(nestin)的表达规律及其意义。方法30只Wister成年大鼠,随机分为正常对照组(A组)、损伤组(B组)。采用Allen打击模型(25g·cm),在T10段造成急性脊髓损伤,于损伤后1d、3d、1周、4周、8周进行取材,对距离损伤中心5mm处脊髓进行nestin免疫组化检测。应用图像分析软件进行nestin阳性区域面积侧算。结果A组脊髓室管膜细胞只可见极少数细胞胞浆内nestin表达,白质中几乎无表达。B组中nestin于损伤后24h表达于室管膜以及软膜,灰质和白质亦有少量表达,1周达到高峰(P<0.05),4周明显下降,8周时很少或几乎无表达。结论脊髓组织的许多部位可能存在具有分化和更新潜能的祖细胞,脊髓损伤后这些细胞被激活,在功能恢复中可能发挥着重要的作用。     

Systematic review of melatonin levels in individuals with complete cervical spinal cord injury

Context: Pineal melatonin production is mediated by afferent signaling pathways that navigate through the cervicothoracic spinal cord. Melatonin profiles in individuals with complete cervical spinal cord injury (SCI) have not been systematically reviewed despite this proposed pathway.

Objectives: The primary objective was to understand melatonin profiles in individuals with complete cervical SCI, as compared to healthy controls and those with thoracolumbar and incomplete cervical SCI. Secondary objectives were to understand the impact of injury chronicity and melatonin supplementation on melatonin values in adults with complete cervical SCI.

Methods: This review (PROSPERO ID: CRD42017073767) searched several databases and gray literature sources from January 1978 to August 2017. Studies were eligible if they evaluated melatonin levels (blood, saliva or urinary metabolite measurements) in adults with complete cervical SCI. 390 studies were screened and 12 studies met final selection criteria. Given the heterogeneity in study designs, a narrative analysis was performed.

Results: There is evidence that adults with complete cervical SCI have absent diurnal melatonin rhythms as compared to healthy controls and individuals with thoracolumbar SCI below T3. There is limited evidence comparing levels in individuals with incomplete tetraplegia. There is insufficient evidence describing profiles immediately (<2 weeks) after cervical SCI. Based on a limited number of studies, melatonin supplementation does not appear to improve sleep outcomes in adults with long-standing complete cervical SCI.

Conclusions: Future research should explore melatonin levels acutely after cervical SCI and the impact of supplementation on non-sleep outcomes.     

Cervical spinal cord multiple sclerosis: evaluation with 2D multi-echo recombined gradient echo MR imaging

Abstract

Objective: The two-dimensional multi-echo recombined gradient echo (MERGE) technique automatically acquires and sums multiple gradient echoes at various echo times in cervical spine magnetic resonance (MR) imaging. This technique increases the grey–white matter contrast within the spinal cord and should also improve the depiction of cervical cord lesions. The aim of this study was to qualitatively and quantitatively evaluate MERGE imaging compared with T2-weighted fast spin-echo (T2WFSE) imaging for depicting multiple sclerosis (MS) lesions in the cervical cord.

Methods: Nineteen consecutive patients (10 males and 9 females; age range 22–62 years, mean age 43.6 years) with clinically diagnosed MS were examined with cervical spinal cord MR imaging at 3 T including both MERGE and T2WFSE imaging. Qualitative evaluation for MS lesion conspicuity was performed. The quantitative criterion utilized to compare MERGE imaging with T2WFSE imaging was the lesion-to-background contrast-to-noise ratio (CNR).

Results: MERGE imaging showed 79 lesions and missed 1 that was depicted on T2WFSE imaging. T2WFSE imaging showed 46 lesions and missed 34 that were depicted on MERGE imaging. MERGE imaging was markedly superior to T2WFSE imaging in rendering greater lesion conspicuity. In the quantitative evaluation, the lesion-to-background CNR upon MERGE imaging was significantly higher than that upon T2WFSE imaging (P < 0.001, paired t-test).

Conclusions: MERGE imaging in the cervical spinal cord increases detection and conspicuity of MS lesions. Strong consideration should be given to utilizing axial MERGE images in the diagnosis and follow-up study of cervical cord MS.     

Comparison of spinal cord evoked potentials and peripheral nerve evoked potentials by electric stimulation of the spinal cord under acute spinal cord compression in cats

STUDY DESIGN: Spinal cord evoked potentials and peripheral nerve evoked potentials after spinal cord stimulation were recorded under acute spinal cord compression in 19 cats. OBJECTIVES: To investigate the effects of acute compression upon grey matter and white matter by comparing both potentials. METHODS: We compared peripheral nerve evoked potentials, recorded at the biceps brachii branch of the musculocutaneous nerve, with descending spinal cord evoked potentials, recorded from the lumbar spinal cord, by stimulation to the C2 level, under compression of the C6 segment. RESULTS: The amplitude of both potentials decreased with increased compression. The second wave of peripheral nerve evoked potentials, which are motor fibre action potentials, decreased sooner than those of the spinal cord evoked potentials. CONCLUSION: These findings indicate that peripheral nerve evoked potentials are sensitive to acute damage of the segmented compression. This suggests that grey matter is more vulnerable to compression than white matter.     

Gross quantitative measurements of spinal cord segments in human

STUDY DESIGN: Anatomical measurement. OBJECTIVE: To obtain quantitative anatomical data on each spinal cord segment in human, and determine the presence of correlations between the measures. SETTING: Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan, Korea. METHODS: A total of 15 embalmed Korean adult human cadavers (13 males, two females; mean age 57.3 years) were used. The length of each cord segment was defined as the root attachment length plus the upper inter-root length. After performing a total vertebrectomy, a transverse cut was made at the approximate proximal and distal point of each segment from segment C3 to S5. Sagittal and transverse diameters at the proximal end of each segment, and cross-sectional area, height, and volume of the segment were measured. RESULTS: The transverse diameter was largest at segment C5, and decreased progressively to segment T8. However, the sagittal diameter of each segment did not change distinctly with the segment. The cervical and lumbar enlargements were determined by the transverse diameters of the segments. Segment C5 had the largest cross-sectional area, at 75.0 mm(2). Segment T6 was the longest, averaging 22.4 mm in length. The longest segment in the cervical spinal cord was segment C5, at 15.5 mm, and segment L1 in the lumbar spinal cord. The volume was largest at segment C5, with a value of 1173.9 mm(3). CONCLUSIONS: We found characteristic quantitative differences in the values of the parameters measured in the thoracic spinal cord compared to those measured in the cervical and lumbar or lumbosacral spinal cords. These measurements of spinal cord segments appear to provide valuable and practical standard quantitative features and may provide basic data for understanding the morphometric characteristics relevant to pathophysiologic conditions of the spinal cord.     

Relationship between posttraumatic ischemia and hemorrhage in the injured rat spinal cord as shown by colloidal carbon angiography

Adult female Wistar rats underwent extradural clip compression injury of the spinal cord at T-1. A force of 40 g was applied for 1 minute; this moderately severe injury renders animals paraparetic. We performed colloidal carbon angiography with Aquablak on four animals at 15 minutes, 2 hours, and 24 hours after injury. The entire spinal cord was then removed, frozen, and sectioned serially at 250 micron. The sections were examined microscopically for patterns of ischemia and hemorrhage at the site of compression injury and at adjacent and remote sites in the spinal cord. There was a marked lack of filling of the arterioles, capillaries, and venules at the injury site. In addition, there was a specific anatomical distribution of the ischemic areas in that ischemia of the white matter occurred in areas supplied by arteries that traversed adjacent hemorrhagic gray matter. For example, ischemia of the ventral funiculus was consistently seen adjacent to hemorrhage in the ventral gray matter. Similarly, ischemia of the dorsal white columns was related to hemorrhagic lesions surrounding the feeding vessels in the dorsal gray matter. This study also demonstrates the usefulness of a new colloidal carbon suspension (Aquablak) for documenting the pathophysiology of posttraumatic ischemia of the spinal cord. The results suggest that ischemic lesions in the white matter are anatomically related to hemorrhagic lesions in the gray matter. The pathophysiology of this relationship is unknown, but may include thrombosis, vasospasm, or direct injury of the feeding vessels.     

A multilevel noncontiguous spinal fracture with cervical and thoracic spinal cord injury

Introduction and importanceA multi-level non-contiguous spinal fracture (MNSF) caused by a high-energy impact is a type of complex traumatic injury that is been frequently initially missed, and resulting in delayed diagnosis which adversely affects can result in spinal deformity and neurological deficit. This report describes the operative management of a patient with MNSF with spinal cord injury involving the cervical and thoracic vertebrae by cervical orthosis and posterior thoracic decompression and fusion.Case presentationAn 18-year-old male presented with extensive neck pain and paraplegia (ASIA A), following a motor vehicle accident. Radiographic imaging revealed MNSF: a non-displaced spinous process fracture of C5 (AO Spine subaxial cervical injury classification A0) with spinal cord injury combined with fracture-dislocation of T5 to T9 (AO Spine thoracolumbar injury classification C3). Posterior thoracic decompression and fusion was performed at T3 to T8. After the patient underwent the thoracic spine and cervical orthosis treatment, He received rehabilitation program and training transfer with wheelchair without caregiver. His sitting and balance were significantly improved at the 6 months follow-up. Although the lower extremity functions (ASIA A) may not improve due to the severe spinal cord injury.Clinical discussionMNSF with spinal cord injury following a high-velocity accident is an unstable and complex injury. Important of the clinical assessment and according to the injuries the treatment may vary.ConclusionsCervical orthosis was alternative treatment to preserve cervical motion treatment and posterior thoracic decompression with fixation is an effective option for patients in this MNSF with spinal cord injury.     

Electrophysiological, histological, and behavioral studies in a cat with acute compression of the spinal cord

We made an animal model of cervical spinal cord injury in a cat and performed electrophysiological, histological, and behavioral studies. The cervical spinal cord injury model was made by inserting a screw through the fourth cervical vertebral body of the cat. After the injury, muscle tonus of the limbs and trunk diminished. The cat was able to walk and to perform target reaching after the injury, although the trunk was unstable and the movement of the forelimb was ataxic. Atrophy of the back muscle remained. The cat was unable to stand bipedally. These behavioral disturbances suggested dysfunction of the ventral funiculus. After behavioral analysis for 3 months, an electrophysiological study was performed. Action potentials of the ventral funiculus evoked by stimulation of the lateral vestibular nucleus or the medial longitudinal fasciculus were recorded at several levels of the cervical cord. They were diminished at levels caudal to the compression site. After the recording, the cervical cord was studied histologically. There was demyelination and gliosis in the ventral funiculus and in part of the ventrolateral funiculus at or near the injured site. Electrophysiological and histological findings were in good agreement with the behavioral ones. Behavioral studies seem useful for evaluating the function of the spinal cord, especially for assessing the injured system in the spinal cord. Received: March 28, 2000 / Accepted: September 13, 2000     

The effect of renin-angiotensin system blockers on spinal cord dysfunction and imaging features of spinal cord compression in patients with symptomatic cervical spondylosis

BACKGROUND CONTEXTCervical spondylosis may lead to spinal cord compression, poor vascular perfusion, and ultimately, cervical myelopathy. Studies suggest a neuroprotective effect of renin-angiotensin system (RAS) inhibitors in the brain, but limited data exist regarding their impact on the spinal cord.PURPOSETo investigate whether RAS blockers and other antihypertensive drugs are correlated with preoperative functional status and imaging markers of cord compression in patients with symptomatic cervical spondylosis.STUDY DESIGNRetrospective observational study.PATIENT SAMPLEIndividuals with symptomatic degenerative cervical stenosis who underwent surgery.OUTCOME MEASURESImaging features of spinal cord compression and functional status (modified Japanese Orthopedic Association [mJOA] and Nurick grading scales).METHODSTwo hundred sixty-six operative patients with symptomatic degenerative cervical stenosis were included. Demographic data, comorbidities, antihypertensive medications, and functional status (including mJOA and Nurick grading scales) were collected. We evaluated canal compromise, cord compromise, surface area of T2 signal cord change, and pixel intensity of signal cord change compared with normal cord on T2-weighted magnetic resonance imaging sequences.RESULTSOf 266 patients, 41.7% were women, 58.3% were men; median age was 57.2 years; 20.6% smoked tobacco; 24.7% had diabetes mellitus. One hundred forty-nine patients (55.8%) had hypertension, 142 (95.3%) of these were taking antihypertensive medications (37 angiotensin-II receptor blockers [ARBs], 44 angiotensin-converting enzyme inhibitors, and 61 other medications). Patients treated with ARBs displayed a higher signal intensity ratio (ie, less signal intensity change in the compressed cord area) compared with untreated patients without hypertension (p=.004). Patients with hypertension had worse preoperative mJOA and Nurick scores than those without (p<.001). In the multivariate analysis, ARBs remained an independent beneficial factor for lower signal intensity change (p=.04), whereas hypertension remained a risk factor for worse preoperative neurological status (p<.01).CONCLUSIONSIn our study, patients with hypertension who were treated with RAS inhibitors had decreased T2-weighted signal intensity change than untreated patients without hypertension. Patients with hypertension also had worse preoperative functional status. Prospective case-control studies may deepen understanding of RAS modulators in the imaging and functional status of chronic spinal cord compression.