In addition to the primary damage, traumatic spinal cord injury (SCI) involves complex pathophysiologic processes at distant cord areas from the injury. The study by David et al.1 assessed the interaction between degenerative processes at and caudal to a cervical SCI lesion using diffusion tensor imaging (DTI)–derived metrics including fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity, and their relation to electrophysiologic and clinical measures of the lower extremity. DTI metrics are sensitive biomarkers of SCI between acute and chronic stages, and has the potential to provide insight into axonal integrity within and adjacent to the SCI lesion noninvasively.2

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