1549. Does The Renin-angiotensin System Alter Clinical and Imaging Features of Spinal Cord Compression in Symptomatic Cervical Spondylosis?

Authors: Alexander Perdomo-Pantoja, MD; Alejandro Chara, BS; Samuel Kalb, MD; Corinna Zygourakis; Ali Ahmed, BS; Zachary Pennington, BS; Timothy F. Witham, MD; Nicholas Theodore (Baltimore, MD)

Introduction:
Cervical spondylosis may lead to spinal cord compression, poor vascular perfusion, and ultimately cervical myelopathy. Studies suggest a neuroprotective effect of renin-angiotensin system (RAS) inhibitors in the brain, but there is limited data on their impact on the spinal cord. We examined whether RAS blockers and other antihypertensive drugs are correlated with preoperative clinical/functional status and radiological markers of cord compression in patients with symptomatic cervical spondylosis.
Methods:
A retrospective study of 120 symptomatic degenerative cervical stenosis patients. Demographic data, comorbidities, antihypertensive medications, and functional status (including modified Japanese Orthopedic Association (mJOA) and Nurick grading scales) were collected. We evaluated % canal compromise, % cord compromise, surface area of T2 signal cord change, and pixel intensity of signal cord change compared to normal cord on T2-weighted MRI sequences.
Results:
Of the 120 patients, 35.5% were female and 64.5% male; median age=57.7 years; 53.7% smokers; 24.8% diabetics. 70 patients (57.9%) had hypertension, of which 68 were taken anti-hypertensive medication: 21 angiotensin-II receptor blockers [ARBs], 22 angiotensin-converting enzyme inhibitors [ACEIs], and 25 other medications). Patients treated with ARBs displayed a higher signal intensity ratio (a lower signal intensity in the compressed cord area) compared to those untreated (p=.03). Patients receiving ACEI’s or diuretics had lower preoperative mJOA (worse functional status) compared to non-hypertensive patients (p=.003, .01, .01). Hypertensive patients and those receiving calcium antagonists or diuretics had higher preoperative Nurick scores (worse functional status) compared to non-hypertensive patients (p=.01, .02, .01).
Conclusion:
In cervical spinal cord compression patients, RAS inhibitors were associated with higher SIR (less signal intensity change) than untreated patients. Also, those cervical stenosis patients with hypertension and treated with ACEIs/diuretics/calcium antagonists displayed worse preoperative functional status compared to non-hypertensive patients. Further studies are needed to confirm an effect of RAS inhibitors in spinal cord damage.