Cortical Reorganization Is Associated with Surgical Decompression of Cervical Spondylotic Myelopathy

Green, Andrew; Fook‐Chong, S.; Tiruchelvarayan, Rajendra; Guo, Chang; Yue, Wai-Mun; Chen, John; Lo, Yew Long

doi:10.1155/2015/389531

Cited by 13 publications

(12 citation statements)

References 56 publications

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“…Finally, 11 articles were included in this review and 21 were excluded because they did not meet the inclusion criteria (Figure ). The excluded articles are shown in Table …”

Section: Resultsmentioning

confidence: 99%

Neuroplasticity Modifications Following a Lower‐Limb Amputation: A Systematic Review

Molina‐Rueda

Navarro-Fernández

Cuesta-Gómez

et al. 2019

PM&R

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Background: Although there are studies that have examined brain functional reorganization following upper-limb amputation, understanding of the brain changes that occur in people with lower-limb amputation is limited. Objective: To investigate modifications in the brain following lower-limb amputation. Methods: We included case-control studies that evaluate neuroplasticity in the central nervous system using neuroimaging techniques. A literature search was conducted using MEDLINE, CINAHL, Web of Science, Scopus, and Cochrane. Results: Eleven articles were included (total n = 204 people with unilateral lower-limb amputation). These studies showed an increase in cerebellar gray matter volume in prosthesis users, as well as a decrease in thickness of the premotor cortex, orbitofrontal cortex, temporo-occipital junction, precentral gyrus, visual areas, and somatosensory cortex. Regarding white matter, the trials observed a decrease in the integrity at the corona radiata, the connections between the premotor areas, the fronto-occipital fasciculus and the corpus callosum. In addition, a decreased functional connectivity between cortical and subcortical areas has been described. Conclusions: Lower-limb amputation causes changes in several brain structures that may occur in the absence of pain and regardless of prosthesis use. The modifications observed include thinning or loss of gray matter volume, decrease in the integrity of the white matter connections between brain structures and changes in the functional connectivity between cortical and subcortical areas.

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“…Finally, 11 articles were included in this review and 21 were excluded because they did not meet the inclusion criteria (Figure ). The excluded articles are shown in Table …”

Section: Resultsmentioning

confidence: 99%

Neuroplasticity Modifications Following a Lower‐Limb Amputation: A Systematic Review

Molina‐Rueda

Navarro-Fernández

Cuesta-Gómez

et al. 2019

PM&R

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“…Green et al 19 performed TMS and motor function testing 1 month prior to and 4 months after surgery for CSM. They showed that the sum amplitude of motor evoked potentials (sMEPs) and number of focal points at which MEPs were elicited (N) were significantly greater in CSM patients than in controls.…”

Section: Discussionmentioning

confidence: 99%

“…35 Not many studies have correlated the postoperative motor improvement with plasticity. 19 Some studies have shown adaptive changes in bilateral primary motor cortex (M1), supplementary motor area (SMA), premotor area (PMA), cingulate motor area, parietal cortex, and contralateral primary somatosensory cortex (S1) in cases of SCI [8][9][10][11][27][28][29]33,40 and cervical compressive myelopathy due to spondylosis. 13,14,23,38 In this study we aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using functional MRI (fMRI).…”

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confidence: 99%

Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery

Bhagavatula¹,

Shukla²,

Sadashiva³

et al. 2016

FOC

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OBJECTIVE The physiological mechanisms underlying the recovery of motor function after cervical spondylotic myelopathy (CSM) surgery are poorly understood. Neuronal plasticity allows neurons to compensate for injury and disease and to adjust their activities in response to new situations or changes in their environment. Cortical reorganization as well as improvement in corticospinal conduction happens during motor recovery after stroke and spinal cord injury. In this study the authors aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using blood oxygen level–dependent (BOLD) functional MRI (fMRI). METHODS Twenty-two patients having symptoms related to cervical cord compression due to spondylotic changes along with 12 age- and sex-matched healthy controls were included in this study. Patients underwent cervical spine MRI and BOLD fMRI at 1 month before surgery (baseline) and 6 months after surgery. RESULTS Five patients were excluded from analysis because of technical problems; thus, 17 patients made up the study cohort. The mean overall modified Japanese Orthopaedic Association score improved in patients following surgery. Mean upper-extremity, lower-extremity, and sensory scores improved significantly. In the preoperative patient group the volume of activation (VOA) was significantly higher than that in controls. The VOA after surgery was reduced as compared with that before surgery, although it remained higher than that in the control group. In the preoperative patient group, activations were noted only in the left precentral gyrus (PrCG). In the postoperative group, activations were seen in the left postcentral gyrus (PoCG), as well as the PrCG and premotor and supplementary motor cortices. In postoperative group, the VOA was higher in both the PrCG and PoCG as compared with those in the control group. CONCLUSIONS There is over-recruitment of sensorimotor cortices during nondexterous relative to dexterous movements before surgery. After surgery, there was recruitment of other cortical areas such as the PoCG and premotor and supplementary motor cortices, which correlated with improvement in dexterity, but activation in these areas was greater than that found in controls. The results show that improvement in dexterity and finer movements of the upper limbs is associated with recruitment areas other than the premotor cortex to compensate for the damage in the cervical spinal cord.

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“…It is also known that the intraoperative MEPI alone might not be adequate for predicting postoperative results. Several studies, 22 including ours, 5 have shown that cortical reorganization over 6 months and beyond may contribute to functional improvement during the postoperative recovery phase, possibly even up to 2 years later. 23 Improvement in upper limb dexterity has also been shown to be related to recruitment in motor areas including the postcentral gyrus, precentral gyrus, and premotor and supplementary motor areas 24 over a 6-month postoperative period and beyond.…”

Section: Jcnmentioning

confidence: 71%

“…1,2 There is evidence from previous studies that the improvement of motor function after surgical decompression in CSM patients occurs via synaptic changes and dendritic sprouting in the cortical and spinal cord neuron pools. [3][4][5] In CSM, compression of descending corticospinal tracts results in desynchronization of I-wave volleys evoked by single-pulse transcranial magnetic stimulation (TMS) of the primary motor cortex. A prospective study of 141 CSM patients demonstrated a strong correlation of MRI findings with central motor conduction times in terms of sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Motor Evoked Potential Improvement in Cervical Spondylotic Myelopathy: Comparison of Cortical Stimulation Parameters

Zhu

Soh

et al. 2020

J Clin Neurol

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Background and Purpose Intraoperative monitoring of the motor pathways is a routine procedure for ensuring the integrity of descending motor tracts during spinal surgery. Intraoperative motor evoked potential improvement (MEPI) may be associated with a better postsurgical outcome in cervical spondylotic myelopathy (CSM). To compare the efficacy of two cortical stimulation parameters in eliciting MEPI intraoperatively during CSM surgery. Methods We studied 69 patients who underwent decompression surgery for CSM over a 9-month period using either 5 (Group 1) or 9 (Group 2) stimuli. MEPI was defined as the increase in the amplitude of MEPs from baseline at the end of CSM surgery just prior to skin closure. Results An MEPI of 100% from baseline was observed in 10 patients (53%) in Group 1 and 36 patients (72%) in Group 2. Comparisons of the baseline mean MEP amplitudes of muscles bilaterally between Groups 1 and 2 did not reveal any significant differences. Supramaximal stimulation showed that a significantly higher mean intensity was required for Group 1 than for Group 2. Conclusions MEPI is observed in a much larger proportion of cervical decompression surgery cases than previously thought. Intraoperative MEPI with longer-train cortical stimulation may reflect adequacy of decompression and provide additional guidance for the surgical procedure.

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Cortical Reorganization Is Associated with Surgical Decompression of Cervical Spondylotic Myelopathy

Cited by 13 publications

References 56 publications

Neuroplasticity Modifications Following a Lower‐Limb Amputation: A Systematic Review

Neuroplasticity Modifications Following a Lower‐Limb Amputation: A Systematic Review

Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery

Intraoperative Motor Evoked Potential Improvement in Cervical Spondylotic Myelopathy: Comparison of Cortical Stimulation Parameters

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