Adult-Lifespan Segment-Specific Normative Atlas of Cervical Spinal Cord Morphology, With Exploratory Application in Degenerative Cervical Myelopathy

Objective: To establish an adult-lifespan segment-specific normative atlas of cervical spinal cord morphometry as a physiologically adjusted reference and to explore its application in degenerative cervical myelopathy (DCM).Methods: We included 829 healthy volunteers and 210 surgically treated DCM patients undergoing cervical magnetic resonance imaging (MRI) from 2019 to 2023. Follow-up MRI was obtained in a stratified random sample of 207 healthy volunteers and 42 patients. Axial T2-weighted images at C2–3 to C6–7 were segmented semiautomatically. Cross-sectional area (CSA) was the primary morphometric measure; right-left and anteroposterior diameters (APDs) were complementary measures. In healthy volunteers, sex-stratified, level-specific models including age, age², magnetic field strength, and scanner manufacturer were used to construct the atlas and compute z-scores. In DCM, z-scores were summarized as CompMinZ and NonCompMinZ and explored in relation to clinical outcomes.Results: In healthy volunteers, CSA showed a nonlinear pattern, with smaller values at older ages. Longitudinal changes were age dependent: CSA, right-left diameter, and APD increased in younger adults, were stable in midlife, and declined in older adults. In DCM, z-scores were most negative at compressed levels, while noncompressed segments also frequently fell below the normative mean. Z-score metrics showed exploratory associations with neurological status and postoperative outcomes. In the postoperative subset, CompMinZ showed the strongest association with recovery rate, whereas maximum spinal cord compression was not significantly associated with recovery rate.Conclusion: An adult-lifespan, segment-specific normative atlas of cervical spinal cord morphometry provides a physiologically adjusted reference for interpreting cervical cord morphologic variation and deviation, with exploratory application in surgically treated DCM.