Compensatory brainstem functional and structural connectivity in patients with degenerative cervical myelopathy by probabilistic tractography and functional MRI

Wang, Chencai; Laiwalla, Azim; Salamon, Noriko; Ellingson, Benjamin M.; Holly, Langston T.

doi:10.1016/j.brainres.2020.147129

Cited by 18 publications

(16 citation statements)

References 45 publications

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“…Furthermore, significant positive associations between GMV and mJOA scores were found in both male and female groups primarily across somatosensory and motor related cortical regions. Such findings are consistent with previous reports in which cortical alterations and cerebral reorganization were correlated with neurological function, proposing a compensatory relationship between cortical alterations and symptom progression in patients with cervical spondylosis [5,10,35]. A positive association between GMV and mJOA appears to confirm that patients with worsening neurological symptoms exhibit decreasing GMV across sensorimotor related cortices.…”

Section: Sex-dependent Cortical Volumetric Differences In Patientssupporting

confidence: 92%

“…Studies have shown that, when compared to healthy subjects, DCM patients exhibit significant reductions in cortical volume in somatosensory, motor, and cerebellar cortices [5][6][7]. Furthermore, patients demonstrate increased anatomical and functional connectivity within sensorimotor and pain related brain regions associated with patient symptom severity [8,9], possibly due to compensatory mechanisms resulting from spinal cord neuronal atrophy [5,6,[8][9][10][11]. Although these previous studies have identified unique anatomic features associated with DCM, the potential of sex as a biological variable in this disease remains largely unexplored.…”

Section: Introductionmentioning

confidence: 99%

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Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy

Oughourlian

Wang

Salamon

et al. 2021

JCM

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Degenerative cervical myelopathy (DCM) is a progressive condition characterized by degeneration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord and presentation of clinical symptoms. Compared to healthy controls (HCs), studies have shown DCM patients experience structural and functional reorganization in the brain; however, sex-dependent cortical differences in DCM patients remains largely unexplored. In the present study, we investigate the role of sex differences on the structure of the cerebral cortex in DCM and determine how structural differences may relate to clinical measures of neurological function. T1-weighted structural MRI scans were acquired in 85 symptomatic and asymptomatic patients with DCM and 90 age-matched HCs. Modified Japanese Orthopedic Association (mJOA) scores were obtained for patients. A general linear model was used to determine vertex-level significant differences in gray matter volume (GMV) between the following groups (1) male HCs and female HCs, (2) male patients and female patients, (3) male patients and male HCs, and (4) female patients and female HCs. Within patients, males exhibited larger GMV in motor, language, and vision related brain regions compared to female DCM patients. Males demonstrated a significant positive correlation between GMV and mJOA score, in which patients with worsening neurological symptoms exhibited decreasing GMV primarily across somatosensory and motor related cortical regions. Females exhibited a similar association, albeit across a broader range of cortical areas including those involved in pain processing. In sensorimotor regions, female patients consistently showed smaller GMV compared with male patients, independent of mJOA score. Results from the current study suggest strong sex-related differences in cortical volume in patients with DCM, which may reflect hormonal influence or differing compensation mechanisms.

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Section: Sex-dependent Cortical Volumetric Differences In Patientssupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy

Oughourlian

Wang

Salamon

et al. 2021

JCM

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“…Interestingly, recent studies have shown an association between DCM and cerebral reorganization, seemingly to compensate for functional impairment. The majority of studies have focused on cortical reorganization, however similar changes have been observed in the brainstem [9] and the thalamus [10]. This reorganization has been seen across a number of modalities, including arterial spin labelling functional MRI (fMRI) [11], blood oxygen level dependent (BOLD) fMRI [10,12], and navigated transcranial magnetic stimulation (nTMS) [13].…”

Section: Topics 21 Pathophysiologymentioning

confidence: 97%

Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History

Lannon

Kachur

2021

JCM

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Degenerative cervical myelopathy (DCM) is a leading cause of spinal cord injury and a major contributor to morbidity resulting from narrowing of the spinal canal due to osteoarthritic changes. This narrowing produces chronic spinal cord compression and neurologic disability with a variety of symptoms ranging from mild numbness in the upper extremities to quadriparesis and incontinence. Clinicians from all specialties should be familiar with the early signs and symptoms of this prevalent condition to prevent gradual neurologic compromise through surgical consultation, where appropriate. The purpose of this review is to familiarize medical practitioners with the pathophysiology, common presentations, diagnosis, and management (conservative and surgical) for DCM to develop informed discussions with patients and recognize those in need of early surgical referral to prevent severe neurologic deterioration.

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“…A new line of evidence is emerging that may help to explain this clinical stability, showing that “supra-spinal” and cortical changes may facilitate adaptation of neurological function. 92 , 93 It has been recently suggested that a “functional reserve capacity,” which is facilitated by new cortical motor connection in the supplementary motor region, may provide a compensatory mechanism in patients with spinal cord compression and may mask spinal cord sufferance. 92 While further work to support these findings is necessary, such a mechanism may help to explain the clinical stability, or even occasional clinical improvement, in neurological status seen in DCM patients, despite ongoing spinal cord compression.…”

Section: Introductionmentioning

confidence: 99%

Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]

Nouri

Tessitore

Molliqaj

et al. 2022

Global Spine Journal

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Study Design: Narrative review. Objectives: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM). Methods: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM. Results: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals’ risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years. Conclusion: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.

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Compensatory brainstem functional and structural connectivity in patients with degenerative cervical myelopathy by probabilistic tractography and functional MRI

Cited by 18 publications

References 45 publications

Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy

Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy

Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History

Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]

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