title: Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery.
abstract: 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.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Indira Devi
authors.initials: ID
authors.lastname: Bhagavatula
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Shukla
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Nishanth
authors.initials: N
authors.lastname: Sadashiva
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Praveen
authors.initials: P
authors.lastname: Saligoudar
authors.affiliation: Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Chandrajit
authors.initials: C
authors.lastname: Prasad
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Dhananjaya I
authors.initials: DI
authors.lastname: Bhat
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D002574:Cervical Vertebrae; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011597:Psychomotor Performance / Q000502:physiology; D013118:Spinal Cord Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D055009:Spondylosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: BA = Brodmann area; BOLD = blood oxygen level–dependent; COG = center of gravity; CSM = cervical spondylotic myelopathy; FCS = functional connectivity strength; M1 = primary motor cortex; MEP = motor evoked potential; N = number of focal points at which MEPs elicited; PMA = premotor area; PoCG = postcentral gyrus; PrCG = precentral gyrus; S1 = primary somatosensory cortex; SCI = spinal cord injury; SMA = supplementary motor area; TMS = transcranial magnetic stimulation; VOA = volume of activation; cervical spondylotic myelopathy; cortical plasticity; fMRI = functional MRI; functional magnetic resonance imaging; mJOA = modified Japanese Orthopaedic Association; rsFC = resting-state functional connectivity; sMEPs = sum amplitude of MEPs; tmax = maximum t value