183: Cervical atrophy after thoracic spinal cord injury: role of neuropathic pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Imaging (e.g. fMRI, PET, MRS)

Background and Aims: Spinal cord injury (SCI) results in neurodegeneration both at and above the lesion site. While cervical cord atrophy is well characterized in populations of mixed cervical, thoracic and/or lumbar injuries, the remote morphological changes in cervical cord following isolated thoracic SCI remain unclear. The present study aimed to quantify cervical spinal cord morphology at C2-C3 in individuals with thoracic SCI and compare these metrics to matched controls.

Methods: Participants from this multinational study were 60 adults with chronic thoracic SCI and 60 neurologically healthy controls matched for age and sex. Extracted cervical metrics included mean cross-sectional area (CSA), antero-posterior (AP) and right-left (RL) diameters, eccentricity, solidity, orientation, and cord length. Group differences were assessed using linear mixed models adjusted for age, sex and scanning sites. We further explored the impact of SCI-related chronic neuropathic pain on these metrics.

Results: Compared to controls, the thoracic SCI group showed significantly reduced cervical CSA, along with smaller AP and RL diameters, consistent with remote atrophy, and increased eccentricity, indicating a more flattened cord profile. Solidity, orientation, and cord length showed no group differences, supporting metric reliability and the absence of segmentation artefacts. Compared to controls, increased eccentricity only was driven by people experiencing chronic neuropathic pain.

Conclusions: Thoracic SCI is associated with significant remote cervical cord degeneration, even in the absence of direct cervical injury. Results highlight that neurodegenerative processes propagate along ascending and descending spinal pathways. Cervical morphometry metrics, particularly CSA and eccentricity, may represent biomarkers of distal neurodegeneration following thoracic SCI, and inform future therapeutic strategies.

References: NA

Presenting Author: Yann Quidé
Submitting Author: Yann Quidé

Senior Author: Sylvia Gustin

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Negin Hesam-Shariati: PhD - NeuroRecovery Research Hub, School of Psychology, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW, Australia
• Zina Trost: PhD - Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
• Thiago Folly de Campos: BPthy - NeuroRecovery Research Hub, School of Psychology, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW, Australia
• William R. Willoughby: PhD - Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
• Mark Bolding: PhD - Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
• Rachel E. Cowan: PhD - Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
• Pauline Zahara: BPthy - NeuroRecovery Research Hub, School of Psychology, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW, Australia
• Sylvia M. Gustin: PhD - NeuroRecovery Research Hub, School of Psychology, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW, Australia