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

Abstract

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.

Utility of MRI in Quantifying Tissue Injury in Cervical Spondylotic Myelopathy

“…There is emerging evidence that structural changes occur beyond the spinal cord in the brain [6,[46][47][48][49]. For example, a recent study investigating the interrelationship between brains' gray matter and subcortical white matter alterations in CSM patients reported that cortical thinning of sensorimotor and pain-related regions was associated with more severe clinical symptoms (Figure 3F,G) [6].…”

Degenerative Cervical Myelopathy and Spinal Cord Injury: Introduction to the Special Issue

“…The pathological impacts of DCM and tSCI are not limited to the SC; downstream and upstream neural pathways have been shown to significantly affect cortical volume with an increased connectivity within sensorimotor and pain related cortical regions which may affect patient perceived pain and symptom burden over time [ 5 ]. Oughourlian et al [ 5 ] were one of the first to assess sex related differences in cerebral cortex changes, utilizing a vertex level linear model ( n = 85).…”

“…The pathological impacts of DCM and tSCI are not limited to the SC; downstream and upstream neural pathways have been shown to significantly affect cortical volume with an increased connectivity within sensorimotor and pain related cortical regions which may affect patient perceived pain and symptom burden over time [ 5 ]. Oughourlian et al [ 5 ] were one of the first to assess sex related differences in cerebral cortex changes, utilizing a vertex level linear model ( n = 85). They found significant differences between male and female DCM patients, including significantly less grey matter volume (GMV) changes in females over a broader range of cortical areas compared to their male counterparts despite no differences between GMV volumetric differences amongst controls.…”