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. 2023 May;165(5):1121-1131.
doi: 10.1007/s00701-023-05526-5. Epub 2023 Feb 23.

Human spinal cord tissue is an underutilised resource in degenerative cervical myelopathy: findings from a systematic review of human autopsies

Esmee Dohle  1 , Sophie Beardall  2 , Aina Chang  2 , Karla P Corral Mena  3 , Luka Jovanović  2 , Upamanyu Nath  4 , Keng Siang Lee  5   6 , Alexandria H Smith  2 , Arun J Thirunavukarasu  2 , Alvaro Yanez Touzet  3 , Emma Jane Norton  7 , Oliver D Mowforth  8 , Mark R N Kotter  8 , Benjamin M Davies  8
Affiliations

Human spinal cord tissue is an underutilised resource in degenerative cervical myelopathy: findings from a systematic review of human autopsies

Esmee Dohle et al. Acta Neurochir (Wien). 2023 May.

Abstract

Study design: Systematic review.

Background: Although degenerative cervical myelopathy (DCM) is the most prevalent spinal cord condition worldwide, the pathophysiology remains poorly understood. Our objective was to evaluate existing histological findings of DCM on cadaveric human spinal cord tissue and explore their consistency with animal models.

Methods: MEDLINE and Embase were systematically searched (CRD42021281462) for primary research reporting on histological findings of DCM in human cadaveric spinal cord tissue. Data was extracted using a piloted proforma. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. Findings were compared to a systematic review of animal models (Ahkter et al. 2020 Front Neurosci 14).

Results: The search yielded 4127 unique records. After abstract and full-text screening, 19 were included in the final analysis, reporting on 150 autopsies (71% male) with an average age at death of 67.3 years. All findings were based on haematoxylin and eosin (H&E) staining. The most commonly reported grey matter findings included neuronal loss and cavity formation. The most commonly reported white matter finding was demyelination. Axon loss, gliosis, necrosis and Schwann cell proliferation were also reported. Findings were consistent amongst cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. Cavitation was notably more prevalent in human autopsies compared to animal models.

Conclusion: Few human spinal cord tissue studies have been performed. Neuronal loss, demyelination and cavitation were common findings. Investigating the biological basis of DCM is a critical research priority. Human spinal cord specimen may be an underutilised but complimentary approach.

Keywords: Autopsy; Degenerative cervical myelopathy; Histology; Ossification posterior longitudinal ligament; Pathophysiology; Systematic review.

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Conflict of interest statement

Benjamin M Davies has received research grants from NIHR (Clinical Doctoral Research Fellowship and POLYFIX DCM) and is a founder of MoveMed and myelopathy.org. Mark RN Kotter has received research grants from NIHR and the Education Evolution Trust, sits on the AO Spine Spinal Cord Injury Forum, has a board seat on bit.bio and is a trustee for myelopathy.org. All other authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
PRISMA diagram
Fig. 2
Fig. 2
Heat map of common locations of neuronal loss in included studies (n = 17)
Fig. 3
Fig. 3
Proportion of autopsies reporting pathological findings. Error bars reflect 95% CI. For CSM, n = 133 cases. For OPLL, n = 17 cases
Fig. 4
Fig. 4
Venn diagram of findings commonly reported in human autopsy and animal model studies of DCM
See this image and copyright information in PMC

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