Compensatory cerebral adaptations before and evolving changes after surgical decompression in cervical spondylotic myelopathy.
OBJECTIVE
The goal of this study was to compare cortical sensorimotor adaptations associated with neurological deterioration and then recovery following surgical decompression for cervical spondylotic myelopathy (CSM).


METHODS
Eight patients with CSM underwent functional MR (fMR) imaging during wrist extension and the 3-finger pinch task, along with behavioral assessments before and 3 and 6 months after surgery. Six healthy control volunteers were scanned twice.


RESULTS
Cervical spine MR imaging demonstrated successful cord decompression. The patients improved after surgery on the modified Japanese Orthopaedic Association score for the upper extremity, which correlated with the changes in task-associated activation in specific sensorimotor regions of interest. Pinch-related activation in sensorimotor cortex contralateral to the movement paradigm was reduced before surgery then increased toward the extent of healthy controls after surgery. Before surgery, patients showed broader activation in ipsilateral sensorimotor cortex during wrist extension than during pinch, but activations became similar to those of healthy controls after surgery. Pinch-related activation volume in the ipsilateral sensorimotor cortex and the magnitude of activation in the contralateral dorsal premotor cortex evolved linearly across time after surgery, along with wrist extension-related activation magnitude in the contralateral supplementary motor area.


CONCLUSIONS
Serial fMR imaging studies in CSM can capture the adaptations in specific sensorimotor cortices that accompany clinical deterioration and postsurgical improvement in sensorimotor function associated with damage and partial recovery of conduction in corticospinal pathways. These adaptive regions can be monitored by serial fMR imaging to detect a critical loss of supraspinal reserve in compensatory plasticity, which might augment clinical information about the need for surgical decompression.
Dong
Yun
Y
Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095-1769, USA.
Holly
Langston T
LT
Albistegui-Dubois
Richard
R
Yan
Xiaohong
X
Marehbian
Jonathan
J
Newton
Jennifer M
JM
Dobkin
Bruce H
BH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D002574:Cervical Vertebrae; D015331:Cohort Studies; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D055009:Spondylosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome