Supraspinal functional and structural plasticity in patients undergoing surgery for degenerative cervical myelopathy

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  • 1 Departments of Radiological Sciences,
  • | 2 Neurosurgery, and
  • | 3 Psychiatry and Biobehavioral Sciences, and
  • | 4 Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California, Los Angeles; and
  • | 5 Department of Psychology, University of California, Los Angeles, California
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OBJECTIVE

The aim of this study was to investigate cerebral reorganization, both structurally and functionally, occurring in patients with degenerative cervical myelopathy (DCM) after surgical decompression.

METHODS

In the current observational study of 19 patients, high-resolution T1-weighted structural MRI and resting-state functional MRI scans were obtained pre- and postoperatively in patients with DCM and healthy controls (HCs). The resting-state functional MRI data were utilized to perform region-of-interest (ROI)–to-ROI and ROI-to-voxel functional connectivity (FC) analysis and were similarly compared between and within cohorts. Macroscopic structural plasticity was evaluated by assessing for changes in cortical thickness within the DCM cohort after decompression surgery.

RESULTS

Prior to surgery, FC patterns were significantly different between DCM patients and HCs in cerebral areas responsible for postural control, motor regulation, and perception and integration of sensory information. Significantly stronger FC between the cerebellum and frontal lobes was identified in DCM patients postoperatively compared with DCM patients preoperatively. Additionally, increased FC between the cerebellum and primary sensorimotor areas was found to be positively associated with neurological improvement in patients with DCM. No macroscopic structural changes were observed in the DCM patients after surgery.

CONCLUSIONS

These results support the authors’ hypothesis that functional changes within the brain are associated with effective postoperative recovery, particularly in regions associated with motor regulation and with perception and integration of sensory information. In particular, increased FC between the cerebellum and the primary sensorimotor after surgery appears to be associated with neurological improvement. Macroscopic morphological changes may be too subtle to be detected within 3 months after surgery.

ABBREVIATIONS

DCM = degenerative cervical myelopathy; FC = functional connectivity; fMRI = functional MRI; HC = healthy control; mJOA = modified Japanese Orthopaedic Association; ROI = region of interest; SMA = supplementary motor area.

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Contributor Notes

Correspondence Langston T. Holly: David Geffen School of Medicine, University of California, Los Angeles, CA. lholly@mednet.ucla.edu.

INCLUDE WHEN CITING Published online June 11, 2021; DOI: 10.3171/2020.11.SPINE201688.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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