Spinal cord diffusion tensor imaging predicts balance in degenerative cervical myelopathy.

Introduction: 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. Methods: 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 Results: Dorsal column FA ( Conclusion: 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.