Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The pathophysiology of cervical spinal cord injury: what are the differences between traumatic injury and degenerative disorder


Study design

Retrospective comparative clinical study.


To establish eligible diagnostic criteria for traumatic cervical spinal cord injury (TCSCI) without major fracture or dislocation and create a definitive clinical protocol by comparing the pathophysiology of CSCI in both traumatic and degenerative disorders.


Fukuoka, Japan.


A total of 21 TCSCI patients and 16 rapid progressive clinical deterioration of cervical spondylotic myelopathy (rp-CSM: additional cervical spinal cord injury with an existing cervical myelopathy) patients with impairment graded as C or D on the American Spinal Injury Association (ASIA) Impairment Scale were included in the study. Magnetic resonance (MR) images and ASIA motor scores were evaluated for all of the patients at the time of admission and 12 months postoperatively.


The T2-weighted MR images for all patients showed an abnormally high intramedullary signal in the area of the injured segment at the first examination. At 12 months post-surgery, 47.62% of patients with TCSCI and none with rp-CSM had an abnormally low intramedullary signal change on T1-weighted MR images. The neurological improvement with rp-CSM was significantly greater than that with TCSCI at 12 months postoperatively.


Our results suggest that the pathophysiology of CSCI between traumatic injury and degenerative disorder are similar, but not identical. The most important factor in the early pathophysiological differential diagnosis between these two pathologies is the presence of an existing cervical myelopathy. We believe that early prognosis with eligible diagnosis for CSCI may lead to early preparations for social rehabilitation in each case.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: T1 and T2-weighted MR images before decompression surgery.
Fig. 2: T1 and T2-weighted MR images at 12 months postoperatively.

Data availability

All data supporting the findings of this study are available within the article and its Supplementary Materials.


  1. Gupta SK, Rajeev K, Khosla VK, Sharma BS, Paramjit, Mathsriya SN, et al. Spinal cord injury without radiographic abnormality in adults. Spinal Cord. 1999;37:726–9.

    CAS  Article  Google Scholar 

  2. Harrop JS, Sharan A, Ratliff J. Central cord injury: pathophysiology, management, and outcomes. Spine J. 2006;6:198S–206S.

    Article  Google Scholar 

  3. Koyanagi I, Iwasaki Y, Hida K, Akino M, Imamura H, Abe H, et al. Acute cervical cord injury without fracture or dislocation of the spinal column. J Neurosurg. 2000;93:15–20.

    CAS  PubMed  Google Scholar 

  4. Shimada K, Tokioka T. Sequential MR studies of cervical cord injury: correlation with neurological damage and clinical outcome. Spinal Cord. 1999;37:410–5.

    CAS  Article  Google Scholar 

  5. Shimada K, Tokioka T. Sequential MRI studies in patients with cervical cord injury but without bony injury. Paraplegia. 1995;33:573–8.

    CAS  PubMed  Google Scholar 

  6. Tewari MK, Gifti DS, Singh P, Khosla VK, Mathuriya SN, Gupta SK, et al. Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients. Surg Neurol. 2005;63:204–9.

    Article  Google Scholar 

  7. Bose B, Northrup BE, Osterholm JL, Cotler JM, DiTunno JF. Reanalysis of central cervical cord injury management. Neurosurgery. 1984;15:367–72.

    CAS  Article  Google Scholar 

  8. Chen TY, Dickman CA, Eleraky M, Sonntag VKH. The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine. 1998;23:2398–403.

    CAS  Article  Google Scholar 

  9. La Rosa G, Conti A, Cardali S, Cacciola F, Tomasello F. Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of literature using a metaanalytical approach. Spinal Cord. 2004;42:503–12.

    Article  Google Scholar 

  10. Yamazaki T, Yanaka K, Fujita K, Kamezaki T, Uemura K, Nose T. Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol. 2005;63:95–9.

    Article  Google Scholar 

  11. Itoh Y, Mazaki T, Koshimune K, Morita T, Mizuno S. Randomized controlled study of treatment for acute cervical cord injury with spinal canal stenosis but without radiographic evidence of trauma (SCIWORET): operative or conservative treatment. J Spine Res. 2011;2:965–7.

    Google Scholar 

  12. Kawano O, Ueta T, Shiba K, Iwamoto Y. Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: a multicenter prospective study. Spinal Cord. 2010;48:548–53.

    CAS  Article  Google Scholar 

  13. Takao T, Morishita Y, Okada S, Maeda T, Katoh F, Ueta T, et al. Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation. Eur Spine J. 2013;22:2228–31.

    Article  Google Scholar 

  14. Morishita Y, Matsushita A, Maeda T, Ueta T, Naito M, Shiba K. Rapid progressive clinical deterioration of cervical spondylotic myelopathy. Spinal Cord. 2015;9:408–12.

    Article  Google Scholar 

  15. Ohshio I, Hatayama A, Kaneda K, Takahata M, Nagashima K. Correlation between histopathologic features and magnetic resonance images of spinal cord lesions. Spine. 1993;18:1140–9.

    CAS  Article  Google Scholar 

  16. Weirich SD, Cotler HB, Narayama PA, Hazle JD, Jackson EF, Coupe KJ, et al. Histopathologic correlation of magnetic resonance imaging signal patterns in a spinal cord injury model. Spine. 1990;15:630–8.

    CAS  Article  Google Scholar 

Download references


This work was supported by Grant-in-aid for Scientific Research (C) from The Japanese Ministry of Education, Culture, Sports, Science and Technology (Grant Number 19K09662) and ZENKYOREN (National Mutual Insurance Federation of Agricultural Cooperatives).

Author information

Authors and Affiliations



OK was responsible for conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results. TM was responsible for drafted or revised the manuscript for important intellectual content, and approved the final version.

Corresponding author

Correspondence to Yuichiro Morishita.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Morishita, Y., Kawano, O. & Maeda, T. The pathophysiology of cervical spinal cord injury: what are the differences between traumatic injury and degenerative disorder. Spinal Cord Ser Cases 8, 50 (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI:


Quick links