1
|
Zhang Q, Ding H. Meta-analysis of resting-state fMRI in cervical spondylosis patients using AES-SDM. Front Neurol 2024; 15:1439939. [PMID: 39381074 PMCID: PMC11460301 DOI: 10.3389/fneur.2024.1439939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/21/2024] [Indexed: 10/10/2024] Open
Abstract
Background Resting-state functional magnetic resonance imaging (rs-fMRI) reveals diverse neural activity patterns in cervical spondylosis (CS) patients. However, the reported results are inconsistent. Therefore, our objective was to conduct a meta-analysis to synthesize the findings from existing rs-fMRI studies and identify consistent patterns of neural brain activity alterations in patients with CS. Materials and methods A systematic search was conducted across PubMed, Web of Knowledge, Embase, Google Scholar, and CNKI for rs-fMRI studies that compared CS patients with healthy controls (HCs), up to January 28, 2024. Significant cluster coordinates were extracted for comprehensive analysis. Results We included 16 studies involving 554 CS patients and 488 HCs. CS patients demonstrated decreased brain function in the right superior temporal gyrus and left postcentral gyrus, and increased function in the left superior frontal gyrus. Jackknife sensitivity analysis validated the robustness of these findings, and Egger's test confirmed the absence of significant publication bias (p > 0.05). Meta-regression showed no significant impact of age or disease duration differences on the results. Conclusion This meta-analysis confirms consistent alterations in specific brain regions in CS patients, highlighting the potential of rs-fMRI to refine diagnostic and therapeutic strategies. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024496263.
Collapse
Affiliation(s)
- Qin Zhang
- Guizhou Second People’s Hospital, Guiyang, Guizhou, China
- Guizhou Provincial People’s Hospital, Guiyang, Guizhou Province, China
| | - Hui Ding
- Guizhou Second People’s Hospital, Guiyang, Guizhou, China
| |
Collapse
|
2
|
Herzberg MP, Nielsen AN, Luby J, Sylvester CM. Measuring neuroplasticity in human development: the potential to inform the type and timing of mental health interventions. Neuropsychopharmacology 2024:10.1038/s41386-024-01947-7. [PMID: 39103496 DOI: 10.1038/s41386-024-01947-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/17/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
Neuroplasticity during sensitive periods, the molecular and cellular process of enduring neural change in response to external stimuli during windows of high environmental sensitivity, is crucial for adaptation to expected environments and has implications for psychiatry. Animal research has characterized the developmental sequence and neurobiological mechanisms that govern neuroplasticity, yet gaps in our ability to measure neuroplasticity in humans limit the clinical translation of these principles. Here, we present a roadmap for the development and validation of neuroimaging and electrophysiology measures that index neuroplasticity to begin to address these gaps. We argue that validation of measures to track neuroplasticity in humans will elucidate the etiology of mental illness and inform the type and timing of mental health interventions to optimize effectiveness. We outline criteria for evaluating putative neuroimaging measures of plasticity in humans including links to neurobiological mechanisms shown to govern plasticity in animal models, developmental change that reflects heightened early life plasticity, and prediction of neural and/or behavior change. These criteria are applied to three putative measures of neuroplasticity using electroencephalography (gamma oscillations, aperiodic exponent of power/frequency) or functional magnetic resonance imaging (amplitude of low frequency fluctuations). We discuss the use of these markers in psychiatry, envision future uses for clinical and developmental translation, and suggest steps to address the limitations of the current putative neuroimaging measures of plasticity. With additional work, we expect these markers will significantly impact mental health and be used to characterize mechanisms, devise new interventions, and optimize developmental trajectories to reduce psychopathology risk.
Collapse
Affiliation(s)
- Max P Herzberg
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.
| | - Ashley N Nielsen
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.
| | - Joan Luby
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Chad M Sylvester
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
- Taylor Family Institute for Innovative Psychiatric Research, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
3
|
Ishaque AH, Alvi MA, Pedro K, Fehlings MG. Imaging protocols for non-traumatic spinal cord injury: current state of the art and future directions. Expert Rev Neurother 2024; 24:691-709. [PMID: 38879824 DOI: 10.1080/14737175.2024.2363839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Non-traumatic spinal cord injury (NTSCI) is a term used to describe damage to the spinal cord from sources other than trauma. Neuroimaging techniques such as computerized tomography (CT) and magnetic resonance imaging (MRI) have improved our ability to diagnose and manage NTSCIs. Several practice guidelines utilize MRI in the diagnostic evaluation of traumatic and non-traumatic SCI to direct surgical intervention. AREAS COVERED The authors review practices surrounding the imaging of various causes of NTSCI as well as recent advances and future directions for the use of novel imaging modalities in this realm. The authors also present discussions around the use of simple radiographs and advanced MRI modalities in clinical settings, and briefly highlight areas of active research that seek to advance our understanding and improve patient care. EXPERT OPINION Although several obstacles must be overcome, it appears highly likely that novel quantitative imaging features and advancements in artificial intelligence (AI) as well as machine learning (ML) will revolutionize degenerative cervical myelopathy (DCM) care by providing earlier diagnosis, accurate localization, monitoring for deterioration and neurological recovery, outcome prediction, and standardized practice. Some intriguing findings in these areas have been published, including the identification of possible serum and cerebrospinal fluid biomarkers, which are currently in the early phases of translation.
Collapse
Affiliation(s)
- Abdullah H Ishaque
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Karlo Pedro
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Cheng L, Zhang J, Xi H, Li M, Hu S, Yuan W, Wang P, Chen L, Zhan L, Jia X. Abnormalities of brain structure and function in cervical spondylosis: a multi-modal voxel-based meta-analysis. Front Neurosci 2024; 18:1415411. [PMID: 38948928 PMCID: PMC11211609 DOI: 10.3389/fnins.2024.1415411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Background Previous neuroimaging studies have revealed structural and functional brain abnormalities in patients with cervical spondylosis (CS). However, the results are divergent and inconsistent. Therefore, the present study conducted a multi-modal meta-analysis to investigate the consistent structural and functional brain alterations in CS patients. Methods A comprehensive literature search was conducted in five databases to retrieve relevant resting-state functional magnetic resonance imaging (rs-fMRI), structural MRI and diffusion tensor imaging (DTI) studies that measured brain functional and structural differences between CS patients and healthy controls (HCs). Separate and multimodal meta-analyses were implemented, respectively, by employing Anisotropic Effect-size Signed Differential Mapping software. Results 13 rs-fMRI studies that used regional homogeneity, amplitude of low-frequency fluctuations (ALFF) and fractional ALFF, seven voxel-based morphometry (VBM) studies and one DTI study were finally included in the present research. However, no studies on surface-based morphometry (SBM) analysis were included in this research. Due to the insufficient number of SBM and DTI studies, only rs-fMRI and VBM meta-analyses were conducted. The results of rs-fMRI meta-analysis showed that compared to HCs, CS patients demonstrated decreased regional spontaneous brain activities in the right lingual gyrus, right middle temporal gyrus (MTG), left inferior parietal gyrus and right postcentral gyrus (PoCG), while increased activities in the right medial superior frontal gyrus, bilateral middle frontal gyrus and right precuneus. VBM meta-analysis detected increased GMV in the right superior temporal gyrus (STG) and right paracentral lobule (PCL), while decreased GMV in the left supplementary motor area and left MTG in CS patients. The multi-modal meta-analysis revealed increased GMV together with decreased regional spontaneous brain activity in the left PoCG, right STG and PCL among CS patients. Conclusion This meta-analysis revealed that compared to HCs, CS patients had significant alterations in GMV and regional spontaneous brain activity. The altered brain regions mainly included the primary visual cortex, the default mode network and the sensorimotor area, which may be associated with CS patients' symptoms of sensory deficits, blurred vision, cognitive impairment and motor dysfunction. The findings may contribute to understanding the underlying pathophysiology of brain dysfunction and provide references for early diagnosis and treatment of CS. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, CRD42022370967.
Collapse
Affiliation(s)
- Lulu Cheng
- School of Foreign Studies, China University of Petroleum (East China), Qingdao, China
- Shanghai Center for Research in English Language Education, Shanghai International Studies University, Shanghai, China
| | - Jianxin Zhang
- School of Foreign Studies, China University of Petroleum (East China), Qingdao, China
| | - Hongyu Xi
- School of Western Studies, Heilongjiang University, Harbin, China
| | - Mengting Li
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Su Hu
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Wenting Yuan
- School of Western Studies, Heilongjiang University, Harbin, China
- English Department, Heilongjiang International University, Harbin, China
| | - Peng Wang
- Department of Language, Literature and Communication, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychology, Education, and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Lanfen Chen
- School of Medical Imaging, Shandong Second Medical University, Weifang, Shandong, China
| | - Linlin Zhan
- School of Western Studies, Heilongjiang University, Harbin, China
| | - Xize Jia
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| |
Collapse
|
5
|
Kuang C, Zha Y. Neurodegeneration within the rostral spinal cord is associated with brain gray matter volume atrophy in the early stage of cervical spondylotic myelopathy. Spinal Cord 2024; 62:214-220. [PMID: 38454066 DOI: 10.1038/s41393-024-00971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
STUDY DESIGN Case-control study. OBJECTIVES Investigating the association between neurodegeneration within rostral spinal cord and brain gray matter volume (GMV) and assessing the relationship between remote neurodegenerative changes and clinical outcomes at the early phase of Cervical Spondylotic Myelopathy (CSM). SETTING University/hospital. METHODS Using Spinal Cord Toolbox, spinal cord morphometrics (cross-sectional area [CSA], gray matter area [GMA], white matter area [WMA]) of 40 patients with CSM and 28 healthy controls (HCs) were computed and compared using two-sample t test. Brain GMV of the two groups was analyzed using voxel-based morphometry approach. Pearson's correlation between spinal cord morphometrics and altered brain GMV and Spearman's relationship between remote neurodegenerations and clinical outcomes were conducted in CSM group. RESULTS Compared to HCs, CSA and WMA at C2/3 and GMV in right postcentral gyrus (PoCG.R) and left supplementary motor area (SMA.L) were significantly decreased in patients with CSM. CSA and WMA at C2/3 were associated with GMV in SMA.L and MCG.R in patients with CSM. CSA at C2/3 and GMV in PoCG.R were related to modified Japanese Orthopedic Association score in patients with CSM. CONCLUSIONS The associations between CSA and WMA at C2/3 and GMV in SMA.L and MCG.R suggest a concordant change pattern and adaptive mechanisms for neuronal plasticity underlying remote neurodegeneration in early CSM. The atrophy of CSA at C2/3 and GMV loss in PoCG.R can serve as potential neuroimaging biomarkers of early structural changes within spinal cord and brain preceding marked clinical disabilities in patients with CSM.
Collapse
Affiliation(s)
- Cuili Kuang
- Department of Radiological, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yunfei Zha
- Department of Radiological, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
| |
Collapse
|
6
|
Shao Z, Tan Y, Zhan Y, He L. Modular organization of functional brain networks in patients with degenerative cervical myelopathy. Sci Rep 2024; 14:8593. [PMID: 38615051 PMCID: PMC11016091 DOI: 10.1038/s41598-024-58764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/03/2024] [Indexed: 04/15/2024] Open
Abstract
Previous studies have indicated that brain functional plasticity and reorganization in patients with degenerative cervical myelopathy (DCM). However, the effects of cervical cord compression on the functional integration and separation between and/or within modules remain unclear. This study aimed to address these questions using graph theory. Functional MRI was conducted on 46 DCM patients and 35 healthy controls (HCs). The intra- and inter-modular connectivity properties of the whole-brain functional network and nodal topological properties were then calculated using theoretical graph analysis. The difference in categorical variables between groups was compared using a chi-squared test, while that between continuous variables was evaluated using a two-sample t-test. Correlation analysis was conducted between modular connectivity properties and clinical parameters. Modules interaction analyses showed that the DCM group had significantly greater inter-module connections than the HCs group (DMN-FPN: t = 2.38, p = 0.02); inversely, the DCM group had significantly lower intra-module connections than the HCs group (SMN: t = - 2.13, p = 0.036). Compared to HCs, DCM patients exhibited higher nodal topological properties in the default-mode network and frontal-parietal network. In contrast, DCM patients exhibited lower nodal topological properties in the sensorimotor network. The Japanese Orthopedic Association (JOA) score was positively correlated with inter-module connections (r = 0.330, FDR p = 0.029) but not correlated with intra-module connections. This study reported alterations in modular connections and nodal centralities in DCM patients. Decreased nodal topological properties and intra-modular connection in the sensory-motor regions may indicate sensory-motor dysfunction. Additionally, increased nodal topological properties and inter-modular connection in the default mode network and frontal-parietal network may serve as a compensatory mechanism for sensory-motor dysfunction in DCM patients. This could provide an implicative neural basis to better understand alterations in brain networks and the patterns of changes in brain plasticity in DCM patients.
Collapse
Affiliation(s)
- Ziwei Shao
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Clinical Research Center for Medical Imaging In Jiangxi Province, Nanchang, China
| | - Yongming Tan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Clinical Research Center for Medical Imaging In Jiangxi Province, Nanchang, China
| | - Yaru Zhan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Clinical Research Center for Medical Imaging In Jiangxi Province, Nanchang, China
| | - Laichang He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
- Clinical Research Center for Medical Imaging In Jiangxi Province, Nanchang, China.
| |
Collapse
|
7
|
Khan AF, Muhammad F, Mohammadi E, O'Neal C, Haynes G, Hameed S, Walker B, Rohan ML, Yabluchanskiy A, Smith ZA. Beyond the aging spine - a systematic review of functional changes in the human brain in cervical spondylotic myelopathy. GeroScience 2024; 46:1421-1450. [PMID: 37801201 PMCID: PMC10828266 DOI: 10.1007/s11357-023-00954-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Abstract
Cervical Spondylotic Myelopathy (CSM) is a degenerative condition that leads to loss of cervical spinal cord integrity, typically affecting the aged population. Emerging fMRI-based evidence suggests that the brain is also affected by CSM. This systematic review aimed to understand the usefulness of brain fMRI in CSM. A comprehensive literature search was conducted until March 2023 according to PRISMA guidelines. The inclusion criteria included original research articles in English, primarily studying the human brain's functional changes in CSM using fMRI with at least 5 participants. The extracted data from each study included demographics, disease severity, MRI machine characteristics, affected brain areas, functional changes, and clinical utilities. A total of 30 studies met the inclusion criteria. Among the fMRI methods, resting-state fMRI was the most widely used experimental paradigm, followed by motor tasks. The brain areas associated with motor control were most affected in CSM, followed by the superior frontal gyrus and occipital cortex. Functional changes in the brain were correlated to clinical metrics showing clinical utility. However, the evidence that a specific fMRI metric correlating with a clinical metric was "very low" to "insufficient" due to a low number of studies and negative results. In conclusion, fMRI can potentially facilitate the diagnosis of CSM by quantitatively interrogating the functional changes of the brain, particularly areas of the brain associated with motor control. However, this field is in its early stages, and more studies are needed to establish the usefulness of brain fMRI in CSM.
Collapse
Affiliation(s)
- Ali Fahim Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA.
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Christen O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Brynden Walker
- College of Arts and Sciences, University of Oklahoma, Norman, OK, USA
| | | | - Andriy Yabluchanskiy
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zachary Adam Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| |
Collapse
|
8
|
Akimoto H, Suzuki H, Kan S, Funaba M, Nishida N, Fujimoto K, Ikeda H, Yonezawa T, Ikushima K, Shimizu Y, Matsubara T, Harada K, Nakagawa S, Sakai T. Resting-state functional magnetic resonance imaging indices are related to electrophysiological dysfunction in degenerative cervical myelopathy. Sci Rep 2024; 14:2344. [PMID: 38282042 PMCID: PMC10822854 DOI: 10.1038/s41598-024-53051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/27/2024] [Indexed: 01/30/2024] Open
Abstract
The age-related degenerative pathologies of the cervical spinal column that comprise degenerative cervical myelopathy (DCM) cause myelopathy due spinal cord compression. Functional neurological assessment of DCM can potentially reveal the severity and pathological mechanism of DCM. However, functional assessment by conventional MRI remains difficult. This study used resting-state functional MRI (rs-fMRI) to investigate the relationship between functional connectivity (FC) strength and neurophysiological indices and examined the feasibility of functional assessment by FC for DCM. Preoperatively, 34 patients with DCM underwent rs-fMRI scans. Preoperative central motor conduction time (CMCT) reflecting motor functional disability and intraoperative somatosensory evoked potentials (SEP) reflecting sensory functional disability were recorded as electrophysiological indices of severity of the cervical spinal cord impairment. We performed seed-to-voxel FC analysis and correlation analyses between FC strength and the two electrophysiological indices. We found that FC strength between the primary motor cortex and the precuneus correlated significantly positively with CMCT, and that between the lateral part of the sensorimotor cortex and the lateral occipital cortex also showed a significantly positive correlation with SEP amplitudes. These results suggest that we can evaluate neurological and electrophysiological severity in patients with DCM by analyzing FC strengths between certain brain regions.
Collapse
Affiliation(s)
- Hironobu Akimoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Shigeyuki Kan
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Hiroshima, 734-8553, Japan
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kazuhiro Fujimoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroaki Ikeda
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Teppei Yonezawa
- Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kojiro Ikushima
- Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yoichiro Shimizu
- Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, 755-8505, Japan
| | - Kenichiro Harada
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, 755-8505, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| |
Collapse
|
9
|
Rafati Fard A, Mowforth OD, Yuan M, Myrtle S, Lee KS, Banerjee A, Khan M, Kotter MR, Newcombe VFJ, Stamatakis EA, Davies BM. Brain MRI changes in degenerative cervical myelopathy: a systematic review. EBioMedicine 2024; 99:104915. [PMID: 38113760 PMCID: PMC10772405 DOI: 10.1016/j.ebiom.2023.104915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction globally. Associated neurological symptoms and signs have historically been explained by pathobiology within the cervical spine. However, recent advances in imaging have shed light on numerous brain changes in patients with DCM, and it is hypothesised that these changes contribute to DCM pathogenesis. The aetiology, significance, and distribution of these supraspinal changes is currently unknown. The objective was therefore to synthesise all current evidence on brain changes in DCM. METHODS A systematic review was performed. Cross-sectional and longitudinal studies with magnetic resonance imaging on a cohort of patients with DCM were eligible. PRISMA guidelines were followed. MEDLINE and Embase were searched to 28th August 2023. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. A qualitative synthesis of the literature is presented as per the Synthesis Without Meta-Analysis (SWiM) reporting guideline. The review was registered with PROSPERO (ID: CRD42022298538). FINDINGS Of the 2014 studies that were screened, 47 studies were identified that used MRI to investigate brain changes in DCM. In total, 1500 patients with DCM were included in the synthesis, with a mean age of 53 years. Brain alterations on MRI were associated with DCM both before and after surgery, particularly within the sensorimotor network, visual network, default mode network, thalamus and cerebellum. Associations were commonly reported between brain MRI alterations and clinical measures, particularly the Japanese orthopaedic association (JOA) score. Risk of bias of included studies was low to moderate. INTERPRETATION The rapidly expanding literature provides mounting evidence for brain changes in DCM. We have identified key structures and pathways that are altered, although there remains uncertainty regarding the directionality and clinical significance of these changes. Future studies with greater sample sizes, more detailed phenotyping and longer follow-up are now needed. FUNDING ODM is supported by an Academic Clinical Fellowship at the University of Cambridge. BMD is supported by an NIHR Clinical Doctoral Fellowship at the University of Cambridge (NIHR300696). VFJN is supported by an NIHR Rosetrees Trust Advanced Fellowship (NIHR302544). This project was supported by an award from the Rosetrees Foundation with the Storygate Trust (A2844).
Collapse
Affiliation(s)
- Amir Rafati Fard
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
| | - Melissa Yuan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Samuel Myrtle
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Keng Siang Lee
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Arka Banerjee
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maaz Khan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Mark R Kotter
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Virginia F J Newcombe
- PACE Section, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Emmanuel A Stamatakis
- PACE Section, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| |
Collapse
|
10
|
Guo X, Li J, Su Q, Song J, Cheng C, Chu X, Zhao R. Transcriptional correlates of frequency-dependent brain functional activity associated with symptom severity in degenerative cervical myelopathy. Neuroimage 2023; 284:120451. [PMID: 37949259 DOI: 10.1016/j.neuroimage.2023.120451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Neuroimaging techniques provide insights into the brain abnormalities secondary to degenerative cervical myelopathy (DCM) and their association with neurological deficits. However, the neural correlates underlying the discrepancy between symptom severity and the degree of spinal cord compression, as well as the transcriptional correlates of these cortical abnormalities, remain unknown in DCM patients. METHODS In this cross-sectional study, which collected resting-state functional MRI (rs-fMRI) images and the Japanese Orthopedic Association (JOA) score, enrolled 104 participants (54 patients and 50 healthy controls). The frequency-dependent amplitude of low-frequency fluctuation (ALFF) was obtained for all participants. We investigated the ALFF differences between mild-symptom DCM patients and severe-symptom DCM patients while carefully matching the degree of compression between these two groups via both univariate comparison and searchlight classification for three frequency bands (e.g., Slow-4, Slow-5, and Full-band). Additionally, we identified genes associated with symptom severity in DCM patients by linking the spatial patterns of gene expression of Allen Human Brain Atlas and brain functional differences between mild symptom and severe symptom groups. RESULTS (1) We found that the frequency-specific brain activities within the sensorimotor network (SMN), visual network (VN), and default mode network (DMN) were associated with the varying degrees of functional impairment in DCM patients; (2) the frequency-specific brain activity within the SMN correlated with the functional recovery in patients with DCM; (3) a spatial correlation between the brain-wide expression of genes involved in neuronal migration and the brain functional activities associated with symptom severity was identified in DCM patients. CONCLUSION In conclusion, our study bridges gaps between genes, cell classes, biological processes, and brain functional correlates of DCM. While our findings are correlational in nature, they suggest that the neural activities of sensorimotor cortices in DCM are associated with the severity of symptoms and might be associated with neuronal migration within the brain.
Collapse
Affiliation(s)
- Xing Guo
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei 061017, China
| | - Jie Li
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei 061017, China; Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Qian Su
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei 061017, China; Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin 300060, China
| | - Jiajun Song
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Cai Cheng
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei 061017, China.
| | - Xu Chu
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, China.
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
| |
Collapse
|
11
|
Hejrati N, Pedro K, Alvi MA, Quddusi A, Fehlings MG. Degenerative cervical myelopathy: Where have we been? Where are we now? Where are we going? Acta Neurochir (Wien) 2023; 165:1105-1119. [PMID: 37004568 DOI: 10.1007/s00701-023-05558-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/06/2023] [Indexed: 04/04/2023]
Abstract
Degenerative cervical myelopathy (DCM), a recently coined term, encompasses a group of age-related and genetically associated pathologies that affect the cervical spine, including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL). Given the significant contribution of DCM to global disease and disability, there are worldwide efforts to promote research and innovation in this area. An AO Spine effort termed 'RECODE-DCM' was initiated to create an international multistakeholder consensus group, involving patients, caregivers, physicians and researchers, to focus on launching actionable discourse on DCM. In order to improve the management, treatment and results for DCM, the RECODE-DCM consensus group recently identified ten priority areas for translational research. The current article summarizes recent advancements in the field of DCM. We first discuss the comprehensive definition recently refined by the RECODE-DCM group, including steps taken to arrive at this definition and the supporting rationale. We then provide an overview of the recent advancements in our understanding of the pathophysiology of DCM and modalities to clinically assess and diagnose DCM. A focus will be set on advanced imaging techniques that may offer the opportunity to improve characterization and diagnosis of DCM. A summary of treatment modalities, including surgical and nonoperative options, is then provided along with future neuroprotective and neuroregenerative strategies. This review concludes with final remarks pertaining to the genetics involved in DCM and the opportunity to leverage this knowledge toward a personalized medicine approach.
Collapse
Affiliation(s)
- Nader Hejrati
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Karlo Pedro
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ayesha Quddusi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada.
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
12
|
Fan N, Zhao B, Liu L, Yang W, Chen X, Lu Z. Dynamic and Static Amplitude of Low-Frequency Fluctuation Is a Potential Biomarker for Predicting Prognosis of Degenerative Cervical Myelopathy Patients: A Preliminary Resting-State fMRI Study. Front Neurol 2022; 13:829714. [PMID: 35444605 PMCID: PMC9013796 DOI: 10.3389/fneur.2022.829714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to explore the clinical value of the static amplitude of low-frequency fluctuation (sALFF) and dynamic amplitude of low-frequency fluctuation (dALFF) in the identification of brain functional alterations in degenerative cervical myelopathy (DCM) patients. Methods Voxel-wise sALFF and dALFF of 47 DCM patients and 44 healthy controls were calculated using resting-state fMRI data, and an intergroup comparison was performed. The mean of sALFF or dALFF data were extracted within the resultant clusters and the correlation analysis of these data with the clinical measures was performed. Furthermore, whole-brain-wise and region-wise multivariate pattern analyses (MVPAs) were performed to classify DCM patients and healthy controls. sALFF and dALFF were used to predict the prognosis of DCM patients. Results The findings showed that (1) DCM patients exhibited higher sALFF within the left thalamus and putamen compared with that of the healthy controls. DCM patients also exhibited lower dALFF within bilateral postcentral gyrus compared with the healthy controls; (2) No significant correlations were observed between brain alterations and clinical measures through univariate correlation analysis; (3) sALFF (91%) and dALFF (95%) exhibited high accuracy in classifying the DCM patients and healthy controls; (4) Region-wise MVPA further revealed brain regions in which functional patterns were associated with prognosis in DCM patients. These regions were mainly located at the frontal lobe and temporal lobe. Conclusion In summary, sALFF and dALFF can be used to accurately reveal brain functional alterations in DCM patients. Furthermore, the multivariate approach is a more sensitive method in exploring neuropathology and establishing a prognostic biomarker for DCM compared with the conventional univariate method.
Collapse
|
13
|
Martin AR, Tetreault L, Nouri A, Curt A, Freund P, Rahimi-Movaghar V, Wilson JR, Fehlings MG, Kwon BK, Harrop JS, Davies BM, Kotter MRN, Guest JD, Aarabi B, Kurpad SN. Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 9]. Global Spine J 2022; 12:130S-146S. [PMID: 34797993 PMCID: PMC8859711 DOI: 10.1177/21925682211057484] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE The current review aimed to describe the role of existing techniques and emerging methods of imaging and electrophysiology for the management of degenerative cervical myelopathy (DCM), a common and often progressive condition that causes spinal cord dysfunction and significant morbidity globally. METHODS A narrative review was conducted to summarize the existing literature and highlight future directions. RESULTS Anatomical magnetic resonance imaging (MRI) is well established in the literature as the key imaging tool to identify spinal cord compression, disc herniation/bulging, and inbuckling of the ligamentum flavum, thus facilitating surgical planning, while radiographs and computed tomography (CT) provide complimentary information. Electrophysiology techniques are primarily used to rule out competing diagnoses. However, signal change and measures of cord compression on conventional MRI have limited utility to characterize the degree of tissue injury, which may be helpful for diagnosis, prognostication, and repeated assessments to identify deterioration. Early translational studies of quantitative imaging and electrophysiology techniques show potential of these methods to more accurately reflect changes in spinal cord microstructure and function. CONCLUSION Currently, clinical management of DCM relies heavily on anatomical MRI, with additional contributions from radiographs, CT, and electrophysiology. Novel quantitative assessments of microstructure, perfusion, and function have the potential to transform clinical practice, but require robust validation, automation, and standardization prior to uptake.
Collapse
Affiliation(s)
- Allan R Martin
- Department of Neurological Surgery, 8789University of California Davis, Davis, CA, USA
| | - Lindsay Tetreault
- Department of Neurology, 5894New York University, Langone Health, Graduate Medical Education, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, 27230University of Geneva, Geneva, Switzerland
| | - Armin Curt
- University Spine Center, 31031Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, 31031Balgrist University Hospital, Zurich, Switzerland
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, Toronto, ON, Canada
| | - Brian K Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - James S Harrop
- Department of Neurological Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin M Davies
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
| | - Mark R N Kotter
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
| | - James D Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, 12235University of Miami, Miami, FL, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, 1479University of Maryland, Baltimore, MD, USA
| | - Shekar N Kurpad
- Department of Neurosurgery, 5506Medical College of Wisconsin, Wauwatosa, WI, USA
| |
Collapse
|
14
|
The Correlation between Functional Connectivity of the Primary Somatosensory Cortex and Cervical Spinal Cord Microstructural Injury in Patients with Cervical Spondylotic Myelopathy. DISEASE MARKERS 2022; 2022:2623179. [PMID: 35096201 PMCID: PMC8791726 DOI: 10.1155/2022/2623179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
Objectives To explore functional connectivity reorganization of the primary somatosensory cortex, the chronic microstructure damage of the cervical spinal cord, and their relationship in cervical spondylotic myelopathy (CSM) patients. Methods Thirty-three patients with CSM and 23 healthy controls (HCs) were recruited for rs-fMRI and cervical spinal cord diffusion tensor imaging (DTI) scans. Six subregions (including leg, back, chest, hand, finger and face) of bilateral primary somatosensory cortex (S1) were selected for seed-based whole-brain functional connectivity (FC). Then, we calculated the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of the cervical spinal cord. Correlation analysis was conducted between FC values of brain regions and DTI parameters of cervical spinal cord (ADC, FA), and their relationship with each other and clinical parameters. Results Compared with the HC group, the CSM group showed decreased FC between areas of the left S1hand, the left S1leg, the right S1chest, and the right S1leg with brain regions. The mean FA values of the cervical spinal cord in CSM patients were positively correlated with JOA scores. Especially, the FApos values of bilateral posterior funiculus were positively correlated with JOA scores. The ADC and FA values of bilateral posterior funiculus in the cervical spinal cord were also positively correlated with the FC values. Conclusions There was synchronization between chronic cervical spinal cord microstructural injury and cerebral cortex sensory function compensatory recombination. DTI parameters of the posterior cervical spinal cord could objectively reflect the degree of cerebral cortex sensory function impairment to a certain extent.
Collapse
|
15
|
Zhao R, Guo X, Wang Y, Song Y, Su Q, Sun H, Liang M, Xue Y. Functional MRI evidence for primary motor cortex plasticity contributes to the disease's severity and prognosis of cervical spondylotic myelopathy patients. Eur Radiol 2022; 32:3693-3704. [PMID: 35029735 DOI: 10.1007/s00330-021-08488-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/30/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the brain mechanism of non-correspondence between diseases severity and compression degree of the spinal cord in cervical spondylotic myelopathy (CSM) patients and to test the utility of brain imaging biomarkers for predicting prognosis of CSM. METHODS We calculated voxel-wise zALFF from 54 CSM patients and 50 healthy controls using resting-state fMRI data. In analysis 1, we identified the brain regions exhibited significant differences of zALFF between CSM patients and healthy controls. In analyses 2 through 3, we investigated the zALFF differences between light-symptom CSM patients and severe-symptom CSM patients while carefully matching the degree of compression between these two groups. In analysis 4, we tested the utility of zALFF within the primary motor cortex (M1) for predicting the prognosis of CSM. RESULTS We found that (1) compared with the healthy controls, CSM patients exhibited higher ALFF within left M1, bilateral superior frontal gyrus, and lower zALFF within right precuneus and calcarine, suggesting altered brain neural activity in CSM patients; (2) after matching the compression degree, the CSM patients with more severe clinical symptoms exhibited higher zALFF within M1, indicating cortical function contributes to disease's severity of CSM; (3) taking the M1 zALFF as features in the prognosis prediction model improves the prediction accuracy, indicating that the M1 zALFF provide additional value for predicting the prognosis of CSM patients following decompression surgery. CONCLUSION The functional state of M1 contributes to the disease's severity of CSM and can provide complementary information for predicting the prognosis of CSM following decompression surgery. KEY POINTS • Cervical spondylotic myelopathy (CSM) patients exhibited increased zALFF within the primary motor cortex (M1), bilateral superior frontal gyrus, and decreased zALFF within the right precuneus and calcarine. • After matching the compression degree, the CSM patients with more severe clinical symptoms exhibited higher zALFF within M1, indicating cortical function contributes to disease severity of CSM. • zALFF within M1 provided additional value for predicting the prognosis of CSM patients.
Collapse
Affiliation(s)
- Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xing Guo
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yang Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - YingChao Song
- School of Medical Imaging, Tianjin Medical University and Tianjin Key Laboratory of Functional Imaging, Tianjin, 300203, China
| | - Qian Su
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin, 300060, China
| | - HaoRan Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Meng Liang
- School of Medical Imaging, Tianjin Medical University and Tianjin Key Laboratory of Functional Imaging, Tianjin, 300203, China.
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin, 300060, China.
| | - Yuan Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300070, China.
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| |
Collapse
|
16
|
Wei W, Wang T, Abulizi T, Li B, Liu J. Altered Coupling Between Resting-State Cerebral Blood Flow and Functional Connectivity Strength in Cervical Spondylotic Myelopathy Patients. Front Neurol 2021; 12:713520. [PMID: 34566857 PMCID: PMC8455933 DOI: 10.3389/fneur.2021.713520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Changes in regional neural activity and functional connectivity in cervical spondylotic myelopathy (CSM) patients have been reported. However, resting-state cerebral blood flow (CBF) changes and coupling between CBF and functional connectivity in CSM patients are largely unknown. Methods: Twenty-seven CSM patients and 24 sex/age-matched healthy participants underwent resting-state functional MRI and arterial spin labeling imaging to compare functional connectivity strength (FCS) and CBF between the two groups. The CBF–FCS coupling of the whole gray matter and specific regions of interest was also compared between the groups. Results: Compared with healthy individuals, CBF–FCS coupling was significantly lower in CSM patients. The decrease in CBF–FCS coupling in CSM patients was observed in the superior frontal gyrus, bilateral thalamus, and right calcarine cortex, whereas the increase in CBF–FCS coupling was observed in the middle frontal gyrus. Moreover, low CBF and high FCS were observed in sensorimotor cortices and visual cortices, respectively. Conclusion: In general, neurovascular decoupling at cortical level may be a potential neuropathological mechanism of CSM.
Collapse
Affiliation(s)
- Wuzeng Wei
- Department of Joints, Tianjin Hospital, Tianjin University, Tianjin, China.,Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Tao Wang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Tuersong Abulizi
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Bing Li
- Department of Joints, Tianjin Hospital, Tianjin University, Tianjin, China.,Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Jun Liu
- Department of Joints, Tianjin Hospital, Tianjin University, Tianjin, China.,Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| |
Collapse
|
17
|
Cao Y, Zhan Y, Du M, Zhao G, Liu Z, Zhou F, He L. Disruption of human brain connectivity networks in patients with cervical spondylotic myelopathy. Quant Imaging Med Surg 2021; 11:3418-3430. [PMID: 34341720 DOI: 10.21037/qims-20-874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/08/2021] [Indexed: 02/05/2023]
Abstract
Background Brain functional plasticity and reorganization in patients with cervical spondylotic myelopathy (CSM) is increasingly being explored and validated. However, specific topological alterations in functional networks and their role in CSM brain functional reorganization remain unclear. This study investigates the topological architecture of intrinsic brain functional networks in CSM patients using graph theory. Methods Functional MRI was conducted on 67 CSM patients and 60 healthy controls (HCs). The topological organization of the whole-brain functional network was then calculated using theoretical graph analysis. The difference in categorical variables between groups was compared using a chi-squared test, while that between continuous variables was evaluated using a two-sample t-test. Nonparametric permutation tests were used to compare network measures between the two groups. Results Small-world architecture in functional brain networks were identified in both CSM patients and HCs. Compared with HCs, CSM patients showed a decreased area under the curve (AUC) of the characteristic path length (FDR q=0.040), clustering coefficient (FDR q=0.037), and normalized characteristic path length (FDR q=0.038) of the network. In contrast, there was an increased AUC of normalized clustering coefficient (FDR q=0.014), small-worldness (FDR q=0.009), and global network efficiency (FDR q=0.027) of the network. In local brain regions, nodal topological properties revealed group differences which were predominantly in the default-mode network (DMN), left postcentral gyrus, bilateral putamen, lingual gyrus, and posterior cingulate gyrus. Conclusions This study reported altered functional topological organization in CSM patients. Decreased nodal centralities in the visual cortex and sensory-motor regions may indicate sensory-motor dysfunction and blurred vision. Furthermore, increased nodal centralities in the cerebellum may be compensatory for sensory-motor dysfunction in CSM, while the increased DMN may indicate increased psychological processing in CSM patients.
Collapse
Affiliation(s)
- Yuan Cao
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.,Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yaru Zhan
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Miao Du
- College of Electrical Engineering of Sichuan University, Chengdu, China
| | - Guoshu Zhao
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Zhili Liu
- Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Laichang He
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| |
Collapse
|
18
|
Xu J, Zhou X, Xu C, Xu C, Ding X, Jin K, Yan M, Ma J, Wu X, Ye J, Mo W, Yuan W. Clinical study on improving postoperative symptoms of cervical spondylotic myelopathy by Qishe pill. Medicine (Baltimore) 2020; 99:e21994. [PMID: 32899045 PMCID: PMC7478389 DOI: 10.1097/md.0000000000021994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is the most serious type of cervical spondylosis, which is often treated surgically in patients with progressive neurological symptoms following ineffective conservative treatment. However, some patients have residual symptoms such as neck pain, stiffness, and C5 nerve palsy after surgery. The Qishe pill can effectively relieve the symptoms of neck pain and numbness, but there is no evidence showing the efficacy and safety of the Qishe pill in treating symptoms after spinal cord surgery. METHODS/DESIGN A multicenter, randomized controlled clinical trial will be conducted to evaluate the efficacy and safety of the Qishe Pill. A total of 330 patients with CSM who receive surgical treatment will be randomly divided into 2 groups, treated for 12 weeks and with a 1-year follow-up. The primary outcome will be Japanese Orthopaedic Association score from the baseline to 4 weeks, 12 weeks, 24 weeks, and 48 weeks after surgery. Secondary outcomes will include Visual Analogue Scale score, Neck Disability Index, and imaging indicators (including magnetic resonance imaging and X-ray). Additionally, adverse reactions will be observed and recorded as safety indicators. DISCUSSION Although the Qishe pill can effectively improve the discomfort of the neck and upper limbs in clinical applications, there is a lack of clinical research on postoperative patients. This study will investigate the efficacy and safety of the Qishe pill in treating postoperative symptoms of CSM. TRIAL REGISTRATION Clinical Trials.gov ID: ChiCTR1900028173. Registered on 17 December 2019.
Collapse
Affiliation(s)
- Jinhai Xu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Xiaoning Zhou
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Chen Xu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chongqing Xu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Xing Ding
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Kun Jin
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Ming Yan
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Junming Ma
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Xuequn Wu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Jie Ye
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Wen Mo
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Wen Yuan
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
19
|
Kuang C, Zha Y, Liu C, Chen J. Altered Topological Properties of Brain Structural Covariance Networks in Patients With Cervical Spondylotic Myelopathy. Front Hum Neurosci 2020; 14:364. [PMID: 33100992 PMCID: PMC7500316 DOI: 10.3389/fnhum.2020.00364] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 01/24/2023] Open
Abstract
Background Brain structural alterations play an important role in patients with cervical spondylotic myelopathy (CSM). However, while there have been studies on regional brain structural alterations, only few studies have focused on the topological organization of the brain structural covariance network. This work aimed to describe the structural covariance network architecture alterations that are possibly linked to cortex reorganization in patients with CSM. Methods High-resolution anatomical images of 31 CSM patients and 31 healthy controls (HCs) were included in the study. The images were acquired using a sagittal three-dimensional T1-weighted BRAVO sequence. Firstly, the gray matter volume of 90 brain regions of automated anatomical labeling atlas were computed using a VBM toolbox based on the DARTEL algorithm. Then, the brain structural covariance network was constructed by thresholding the gray matter volume correlation matrices. Subsequently, the network measures and nodal property were calculated based on graph theory. Finally, the differences in the network metrics and nodal property between groups were compared using a non-parametric test. Results Patients with CSM showed larger global efficiency and smaller local efficiency, clustering coefficient, characteristic path length, and sigma values than HCs. Patients with CSM had greater betweenness in the left superior parietal gyrus (SPG.L) and the left supplementary motor area (SMA.L) than HCs. Besides, patients with CSM had smaller betweenness in right middle occipital gyrus. The brain structural covariance networks of CSM patients exhibited equal resilience to random failure as those of HCs. However, the maximum relative size of giant connected components was approximately 10% larger in HCs than in CSM patients, upon removal of 44 nodes in targeted attack. Conclusion These observed alternations in global network measures in CSM patients reflect that the brain structural covariance network in CSM exhibits the less optimal small-world model compared to that in HCs. Increased betweenness in SPG.L and SMA.L seems to be related to cortex reorganization to recover multiple sensory functions after spinal cord injury in CSM patients. The network resilience of patients with CSM exhibiting a relative mild vulnerability, compared to HCs, is probably attributable to the balance and interplay between cortex reorganization and ongoing degeneration.
Collapse
Affiliation(s)
- Cuili Kuang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunfei Zha
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changsheng Liu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
20
|
CORR Insights®: Resting-state Amplitude of Low-frequency Fluctuation is a Potentially Useful Prognostic Functional Biomarker in Cervical Myelopathy. Clin Orthop Relat Res 2020; 478:1681-1682. [PMID: 32282537 PMCID: PMC7310372 DOI: 10.1097/corr.0000000000001242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
21
|
Resting-state Amplitude of Low-frequency Fluctuation is a Potentially Useful Prognostic Functional Biomarker in Cervical Myelopathy. Clin Orthop Relat Res 2020; 478:1667-1680. [PMID: 32011371 PMCID: PMC7310516 DOI: 10.1097/corr.0000000000001157] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cervical MRI is the standard diagnostic imaging technique for patients with cervical myelopathy. However, the utility of conventional cervical MRI as a predictive biomarker for surgical recovery remains unclear, partly because of the limited information obtained from this anatomically small area. Brain resting-state functional MRI (rs-fMRI) may help identify candidate predictive biomarkers. Two analytical methods that assess local spontaneous brain activity are widely used for rs-fMRI: functional connectivity between two brain regions and amplitude of low-frequency fluctuation (ALFF). In our previous analysis of functional connectivity, we discovered that brain functional connectivity may be a predictive biomarker for neurologic recovery in patients with cervical myelopathy; however, the functional connectivity analysis identified a correlation with only one clinical outcome (the 10-second test). To establish a comprehensive prediction measure, we need to explore other brain biomarkers that can predict recovery of other clinical outcomes in patients with cervical myelopathy. QUESTIONS/PURPOSES We aimed to (1) elucidate preoperative ALFF alterations in patients with cervical myelopathy and how ALFF changes after surgery, with a focus on postoperative normalization and (2) establish a predictive model using preoperative ALFF by investigating the correlation between preoperative ALFF and postoperative clinical recovery in patients with cervical myelopathy. METHODS Between August 2015 and June 2017, we treated 40 patients with cervical myelopathy. Thirty patients met our prespecified inclusion criteria, all were invited to participate, and 28 patients opted to do so (93%; 14 men and 14 women; mean age: 67 years). The 28 patients and 28 age- and sex-matched controls underwent rs-fMRI (twice for patients with cervical myelopathy: before and 6 months after cervical decompression surgery). We analyzed the same study population that was used in our earlier study investigating functional connectivity. Controls had none of the following abnormalities: neck or arm pain, visual or auditory disorders, cognitive disorder, structural brain disorder, a history of brain surgery, mental and neurologic disorders, and medications for the central nervous system. We performed ALFF comparisons between preoperative patients with cervical myelopathy and controls, analyzed postoperative ALFF changes in patients with cervical myelopathy, and performed a correlation analysis between preoperative ALFF and clinical recovery in these patients. Clinical outcomes in the cervical myelopathy group were assessed using the 10-second test, the Japanese Orthopaedic Association upper-extremity motor (JOA-UEM) score, JOA upper-extremity sensory score (JOA-UES), and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire for upper-extremity function (JOACMEQ-UEF) score before and 6 months after surgery, which is when we believe these scores generally reach a plateau. A total of 93% of those enrolled (26 of 28 patients) were analyzed both preoperatively and postoperatively; the other two were lost to follow-up. RESULTS The cervical myelopathy group had an increase in ALFF in the bilateral primary sensorimotor cortices (right, cluster size = 850 voxels, t-value = 6.10; left, cluster size = 370 voxels, t-value = 4.84) and left visual cortex (cluster size = 556 voxels, t-value = 4.21) compared with the control group. The cervical myelopathy group had a decrease in ALFF in the bilateral posterior supramarginal gyrus (right, cluster size = 222 voxels, t-value = 5.09; left, cluster size = 436 voxels, t-value = 5.28). After surgery, the bilateral sensorimotor cortices (right, cluster size = 468 voxels, t-value = 6.74; left, cluster size = 167 voxels, t-value = 5.40) and left visual cortex (cluster size = 3748 voxels, t-value = 6.66) showed decreased ALFF compared with preoperative ALFF, indicating postoperative normalization of spontaneous brain activities in these regions. However, the bilateral posterior supramarginal gyrus did not show an increase in ALFF postoperatively, although ALFF in this region decreased preoperatively. Greater levels of ALFF at the left and right frontal pole and left pars opercularis of the inferior frontal gyrus before surgery in the cervical myelopathy group were correlated with larger improvements in the JOACMEQ-UEF score 6 months after surgery (r = 0.784; p < 0.001, r = 0.734; p < 0.001 and r = 0.770, respectively; p < 0.001). The prediction formula, based on preoperative ALFF values in the left frontal pole, was as follows: the predicted postoperative improvement in the JOACMEQ-UEF score = 34.6 × preoperative ALFF value - 7.0 (r = 0.614; p < 0.001). CONCLUSIONS Our findings suggest that preoperative ALFF may be a biomarker for postoperative recovery in that it predicted postoperative JOACMEQ-UEF scores. To establish a comprehensive prediction measure for neurologic recovery in patients with cervical myelopathy, a multicenter study is underway. LEVEL OF EVIDENCE Level II, diagnostic study.
Collapse
|
22
|
Volumetric and functional connectivity alterations in patients with chronic cervical spondylotic pain. Neuroradiology 2020; 62:995-1001. [PMID: 32296878 DOI: 10.1007/s00234-020-02413-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/24/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To explore the structural and functional alterations of the whole brain in patients with chronic cervical spondylotic pain (cCSP). METHODS The whole-brain three-dimensional (3D) T1 and resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired in 31 patients with cCSP and 30 age- and sex-matched healthy controls. 3D T1 and rs-fMRI data were processed using statistical parametric mapping (SPM) and data processing and analysis of brain imaging (DPABI) toolbox. The parametric differences of voxel-based morphometry (VBM) and resting-state functional connectivity (rs-FC) were calculated between groups, then these measures were correlated with the score of visual analogue scale (VAS) and other clinical indices in patients with cCSP. RESULTS Patients with cCSP exhibited reduced gray matter volume (GMV) in the right middle cingulate cortex (MCC), right superior temporal gyrus (STG) and right precuneus compared to healthy controls. Furthermore, patients with cCSP displayed decreased functional connectivity between the right precuneus and bilateral medial prefrontal cortex (mPFC). Additionally, GMV of the right MCC, right STG, and right precuneus, together with rs-FC of the right precuneus to bilateral mPFC, were negatively correlated with the VAS respectively. CONCLUSIONS Our study revealed cerebral morphological and functional abnormalities during the pain process in patients with cCSP, which may provide alternative information for the treatment of cCSP.
Collapse
|
23
|
MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression. Eur Radiol 2019; 30:357-369. [DOI: 10.1007/s00330-019-06352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
|
24
|
Towards prognostic functional brain biomarkers for cervical myelopathy: A resting-state fMRI study. Sci Rep 2019; 9:10456. [PMID: 31320690 PMCID: PMC6639260 DOI: 10.1038/s41598-019-46859-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/05/2019] [Indexed: 02/02/2023] Open
Abstract
Recently, there has been increasing interest in strategies to predict neurological recovery in cervical myelopathy (CM) based on clinical images of the cervical spine. In this study, we aimed to explore potential preoperative brain biomarkers that can predict postoperative neurological recovery in CM patients by using resting-state functional magnetic resonance imaging (rs-fMRI) and functional connectivity (FC) analysis. Twenty-eight patients with CM and 28 age- and sex-matched healthy controls (HCs) underwent rs-fMRI (twice for CM patients, before and six months after surgery). A seed-to-voxel analysis was performed, and the following three statistical analyses were conducted: (i) FC comparisons between preoperative CM and HC; (ii) correlation analysis between preoperative FCs and clinical scores; and (iii) postoperative FC changes in CM. Our analyses identified three FCs between the visual cortex and the right superior frontal gyrus based on the conjunction of the first two analyses [(i) and (ii)]. These FCs may act as potential biomarkers for postoperative gain in the 10-second test and might be sufficient to provide a prediction formula for potential recovery. Our findings provide preliminary evidence supporting the possibility of novel predictive measures for neurological recovery in CM using rs-fMRI.
Collapse
|
25
|
Abstract
Previous studies have shown compensatory adaptive changes in cerebral functions before surgery in patients with cervical spondylotic myelopathy (CSM), especially in the sensorimotor cortices. However, the structural changes in the sensorimotor cortices in patients with CSM remain poorly understood. The aim of this study was to assess the volumetric changes in the sensorimotor cortices using morphological MRI and to correlate these changes with clinical scales. We hypothesize that CSM causes atrophy in the sensorimotor cortices, which results in functional changes during CSM progression. The study participants included 30 CSM patients and 25 matched healthy controls. The patients underwent brain morphological MRI before surgery. Compared with the healthy controls, the patients with CSM showed significant atrophy in the primary somatosensory cortex (S1), the primary motor cortex (M1), the somatosensory association cortex, and the supplementary motor area. The gray matter volumes in the S1 and M1 were correlated positively with the motor scores of the Japanese Orthopedic Association in patients with CSM. The change in supplementary motor area correlated with the sphincter scores of the Japanese Orthopedic Association in CSM patients. Our findings provide new insights into the compensatory reaction in CSM patients.
Collapse
|
26
|
Kuang C, Zha Y. Abnormal intrinsic functional activity in patients with cervical spondylotic myelopathy: a resting-state fMRI study. Neuropsychiatr Dis Treat 2019; 15:2371-2383. [PMID: 31686821 PMCID: PMC6708884 DOI: 10.2147/ndt.s209952] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE We employed resting-state fMRI analyses to reveal central functional reorganization in the brains of patients with cervical spondylotic myelopathy (CSM) and to provide complementary evidence of cortex reorganization in these patients. PATIENTS AND METHODS We obtained Fisher's z transformation amplitude of low-frequency fluctuations (zALFF) and Fisher's z transformation regional homogeneity (zReHo) measurements from 33 patients with CSM and 33 healthy controls (HC) and used the brain regions with significant alterations in the zALFF or zReHo values as seed regions. Then, we calculated Pearson's correlation coefficients between the resting-state time courses of each seed and the time series of the rest of the brain. Lastly, we computed correlations between the altered zALFF, zReHo, and functional connectivity with Japanese Orthopaedic Association scores, Neck Disability Index score, and the duration of symptoms in patients with CSM. RESULTS zALFF and zReHo values were increased in the left medial superior frontal gyrus (lSFGmed) and left supramarginal gyrus (lSMG) in patients with CSM compared with those in the HC group. Selecting lSFGmed as the seed, we observed increased functional connectivity between it and the left postcentral gyrus (lPoCG) and left rolandic operculum and decreased functional connectivity with the right medial superior frontal gyrus in patients with CSM. In addition, there was a significant increase in the functional connectivity between the lSMG (seed) and the left calcarine and lPoCG in patients with CSM. However, we did not find any significant correlation between the resting-state findings and the clinical performance of patients with CSM. CONCLUSION These observed intrinsic functional changes in the patients with CSM may be related to functional reorganization and reflect the innate cortical plasticity in patients with CSM. Notably, the increased connectivity between the lPoCG and the two seed ROIs indicates the adaptive changes in patients with CSM. These findings provide complementary evidence of cortex reorganization in CSM.
Collapse
Affiliation(s)
- Cuili Kuang
- Radiological Department, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
| | - Yunfei Zha
- Radiological Department, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
| |
Collapse
|
27
|
Chen J, Wang Z, Tu Y, Liu X, Jorgenson K, Ye G, Lin C, Liu J, Park J, Lang C, Liu B, Kong J. Regional Homogeneity and Multivariate Pattern Analysis of Cervical Spondylosis Neck Pain and the Modulation Effect of Treatment. Front Neurosci 2018; 12:900. [PMID: 30574062 PMCID: PMC6292425 DOI: 10.3389/fnins.2018.00900] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Objects: We investigated brain functional alteration in patients with chronic cervical spondylosis neck pain (CSNP) compared to healthy controls (HCs) and the effect of intervention. Methods: 104 CSNP patients and 96 matched HCs were recruited. Patients received 4 weeks of treatment. Resting-state fMRI and Northwick Park Neck Pain Questionnaire (NPQ) were collected before and after treatment. Resting state regional homogeneity (rs-ReHo) and multivariate pattern analysis (MVPA) were applied to (1) investigate rs-ReHo differences between CSNP patients and controls and the effect of longitudinal treatment and (2) classify CSNP patients from HCs and predict clinical outcomes before treatment using MVPA. Results: We found that (1) CSNP patients showed decreased rs-ReHo in the left sensorimotor cortex and right temporo-parietal junction (rTPJ), and rs-ReHo at the rTPJ significantly increased after treatment; (2) rs-ReHo at rTPJ was associated with NPQ at baseline, and pre- and post-treatment rs-ReHo changes at rTPJ were associated with NPQ changes in CSNP patients; and (3) MVPA could discriminate CSNP patients from HCs with 72% accuracy and predict clinical outcomes with a mean absolute error of 19.6%. Conclusion: CSNP patients are associated with dysfunction of the rTPJ and sensorimotor area. Significance: rTPJ plays on important role in the pathophysiology and development of CSNP.
Collapse
Affiliation(s)
- Jun Chen
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Zengjian Wang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Xian Liu
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Kristen Jorgenson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Guoxi Ye
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Chenlin Lin
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jianhua Liu
- Key Laboratory for Studying Regularities and Mechanism of Acu-moxibustion, Department of Acu-moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Joel Park
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Courtney Lang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Bo Liu
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| |
Collapse
|
28
|
Zhou F, Huang M, Wu L, Tan Y, Guo J, Zhang Y, He L, Gong H. Altered perfusion of the sensorimotor cortex in patients with cervical spondylotic myelopathy: an arterial spin labeling study. J Pain Res 2018; 11:181-190. [PMID: 29391824 PMCID: PMC5769569 DOI: 10.2147/jpr.s148076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective Advanced magnetic resonance imaging studies have shown functional plasticity or reorganization and metabolite alterations of N-acetyl aspartate in the sensorimotor cortex (SMC), a hallmark region and key brain network, in patients with cervical spondylotic myelopathy (CSM). However, the nature of perfusion in the SMC and the relationship between regional cerebral blood flow (CBF), motor function scores, and structural damage of the cervical cord in patients with CSM are not fully understood. Materials and methods All right-handed participants underwent pseudo-continuous arterial spin labeling pulse sequence scanning, and CBF was then calculated and compared between CSM and healthy groups. Clinical and structural associations were assessed in the SMC. Receiver operating characteristic (ROC) and leave-one-out cross-validation analyses were used to estimate the sensitivity and specificity of the significantly altered CBF in the SMC to distinguish myelopathy-related impairment. Results A total of 18 pairs of CSM patients and well-matched healthy subjects were included in the analyses. Compared with healthy subjects, CSM patients exhibited significantly decreased CBF in the left premotor ventral/precentral operculum (PMv/PrCO) and the bilateral dorsal anterior cingulate cortex (dACC); and increased CBF in the left paracentral lobule (PCL), the right PCL/supplementary motor area (PCL/SMA), and the right postcentral gyrus (PoCG; Gaussian random field correction at P<0.01). In the CSM group, the CBF values in the right PoCG were negatively correlated with Japanese Orthopaedic Association scores, and the CBF values in several regions were negatively correlated with Neck Disability Index scores. Finally, the ROC analysis revealed that significantly increased CBF in the left PCL, the right PCL/SMA, and the right PoCG discriminated patients with myelopathy-related impairment from healthy subjects. Conclusion Regional CBF was reduced in operculum-integrated (PMv/PrCO) and motor control (dACC) regions but increased in sensory (PoCG) and motor-sensory processing (PCL/SMA) regions in patients with CSM.
Collapse
Affiliation(s)
- Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Muhua Huang
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Lin Wu
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Yongming Tan
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Jianqiang Guo
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Yong Zhang
- Department of Pain Clinic, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Laichang He
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Honghan Gong
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| |
Collapse
|
29
|
Martin AR, Tadokoro N, Tetreault L, Arocho-Quinones EV, Budde MD, Kurpad SN, Fehlings MG. Imaging Evaluation of Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:33-45. [DOI: 10.1016/j.nec.2017.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
30
|
Nouri A, Martin AR, Mikulis D, Fehlings MG. Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques. Neurosurg Focus 2017; 40:E5. [PMID: 27246488 DOI: 10.3171/2016.3.focus1667] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Degenerative cervical myelopathy encompasses a spectrum of age-related structural changes of the cervical spine that result in static and dynamic injury to the spinal cord and collectively represent the most common cause of myelopathy in adults. Although cervical myelopathy is determined clinically, the diagnosis requires confirmation via imaging, and MRI is the preferred modality. Because of the heterogeneity of the condition and evolution of MRI technology, multiple techniques have been developed over the years in an attempt to quantify the degree of baseline severity and potential for neurological recovery. In this review, these techniques are categorized anatomically into those that focus on bone, ligaments, discs, and the spinal cord. In addition, measurements for the cervical spine canal size and sagittal alignment are also described briefly. These tools have resulted collectively in the identification of numerous useful parameters. However, the development of multiple techniques for assessing the same feature, such as cord compression, has also resulted in a number of challenges, including introducing ambiguity in terms of which methods to use and hindering effective comparisons of analysis in the literature. In addition, newer techniques that use advanced MRI are emerging and providing exciting new tools for assessing the spinal cord in patients with degenerative cervical myelopathy.
Collapse
Affiliation(s)
- Aria Nouri
- Divisions of 1 Neurosurgery and Spine Program and.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Allan R Martin
- Divisions of 1 Neurosurgery and Spine Program and.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - David Mikulis
- Brain Imaging & Behaviour Systems, University of Toronto; and.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Divisions of 1 Neurosurgery and Spine Program and.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Jiang J, Gu L, Bao D, Hong S, He W, Tan Y, Zeng X, Gong H, Zhang D, Zhou F. Altered homotopic connectivity in postherpetic neuralgia: a resting state fMRI study. J Pain Res 2016; 9:877-886. [PMID: 27826209 PMCID: PMC5096754 DOI: 10.2147/jpr.s117787] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective The aim of this study was to explore interhemispheric intrinsic connectivity in patients with postherpetic neuralgia (PHN). Methods We obtained resting-state functional magnetic resonance imaging data from 18 right-handed PHN patients (11 males, 7 females; mean age, 59.67±8.41 years) and 18 well-matched healthy controls (11 males, 7 females; mean age, 38.50±7.51 years). Interhemispheric connectivity was examined using voxel-mirrored homotopic connectivity (VMHC), and seed-based functional connectivity analysis was performed. Results Compared with the healthy controls, the patients with PHN showed abnormally decreased homotopic connectivity in the dorsolateral prefrontal cortex and the precuneus and posterior cingulate cortex (PCUN/PCC). The decreased VMHC in the PCUN/PCC was positively correlated with the visual analog scale of PHN in the PHN patient group (ρ=0.651; P=0.006). Receiver operating characteristic (ROC) analysis revealed that the areas under the curves for the two brain regions were 0.898 for the prefrontal cortex and 0.923 for the PCUN/PCC, which indicated that the VMHC could be used to discriminate PHN patients from healthy controls. A subsequent seed-based functional connectivity analysis revealed widely disrupted intrinsic connectivity between the regions that showed local homotopic connectivity deficits and the areas subserving the default-mode network. Conclusion Our results indicated reduced interhemispheric functional connectivity in patients with PHN, which seems to be an important new avenue to investigate to better understand the nature of disconnection of the functional architecture in patients with PHN.
Collapse
Affiliation(s)
| | - Lili Gu
- Department of Pain, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Dan Bao
- Department of Pain, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | | | | | | | | | | | - Daying Zhang
- Department of Pain, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | | |
Collapse
|
32
|
Pu J, Xu H, Wang Y, Cui H, Hu Y. Combined nonlinear metrics to evaluate spontaneous EEG recordings from chronic spinal cord injury in a rat model: a pilot study. Cogn Neurodyn 2016; 10:367-73. [PMID: 27668016 PMCID: PMC5018015 DOI: 10.1007/s11571-016-9394-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/09/2016] [Accepted: 06/23/2016] [Indexed: 11/26/2022] Open
Abstract
Spinal cord injury (SCI) is a high-cost disability and may cause permanent loss of movement and sensation below the injury location. The chance of cure in human after SCI is extremely limited. Instead, neural regeneration could have been seen in animals after SCI, and such regeneration could be retarded by blocking neural plasticity pathways, showing the importance of neural plasticity in functional recovery. As an indicator of nonlinear dynamics in the brain, sample entropy was used here in combination with detrended fluctuation analysis (DFA) and Kolmogorov complexity to quantify functional plasticity changes in spontaneous EEG recordings of rats before and after SCI. The results showed that the sample entropy values were decreased at the first day following injury then gradually increased during recovery. DFA and Kolmogorov complexity results were in consistent with sample entropy, showing the complexity of the EEG time series was lost after injury and partially regained in 1 week. The tendency to regain complexity is in line with the observation of behavioral rehabilitation. A critical time point was found during the recovery process after SCI. Our preliminary results suggested that the combined use of these nonlinear dynamical metrics could provide a quantitative and predictive way to assess the change of neural plasticity in a spinal cord injury rat model.
Collapse
Affiliation(s)
- Jiangbo Pu
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People’s Republic of China
| | - Hanhui Xu
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People’s Republic of China
| | - Yazhou Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People’s Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, People’s Republic of China
| | - Hongyan Cui
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People’s Republic of China
| | - Yong Hu
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People’s Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, People’s Republic of China
| |
Collapse
|
33
|
Martin AR, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, Cadotte DW, Crawley A, Ginsberg H, Mikulis DJ, Fehlings MG. Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI. Neuroimage Clin 2015; 10:192-238. [PMID: 26862478 PMCID: PMC4708075 DOI: 10.1016/j.nicl.2015.11.019] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/23/2015] [Accepted: 11/27/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A recent meeting of international imaging experts sponsored by the International Spinal Research Trust (ISRT) and the Wings for Life Foundation identified 5 state-of-the-art MRI techniques with potential to transform the field of spinal cord imaging by elucidating elements of the microstructure and function: diffusion tensor imaging (DTI), magnetization transfer (MT), myelin water fraction (MWF), MR spectroscopy (MRS), and functional MRI (fMRI). However, the progress toward clinical translation of these techniques has not been established. METHODS A systematic review of the English literature was conducted using MEDLINE, MEDLINE-in-Progress, Embase, and Cochrane databases to identify all human studies that investigated utility, in terms of diagnosis, correlation with disability, and prediction of outcomes, of these promising techniques in pathologies affecting the spinal cord. Data regarding study design, subject characteristics, MRI methods, clinical measures of impairment, and analysis techniques were extracted and tabulated to identify trends and commonalities. The studies were assessed for risk of bias, and the overall quality of evidence was assessed for each specific finding using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS A total of 6597 unique citations were identified in the database search, and after full-text review of 274 articles, a total of 104 relevant studies were identified for final inclusion (97% from the initial database search). Among these, 69 studies utilized DTI and 25 used MT, with both techniques showing an increased number of publications in recent years. The review also identified 1 MWF study, 11 MRS studies, and 8 fMRI studies. Most of the studies were exploratory in nature, lacking a priori hypotheses and showing a high (72%) or moderately high (20%) risk of bias, due to issues with study design, acquisition techniques, and analysis methods. The acquisitions for each technique varied widely across studies, rendering direct comparisons of metrics invalid. The DTI metric fractional anisotropy (FA) had the strongest evidence of utility, with moderate quality evidence for its use as a biomarker showing correlation with disability in several clinical pathologies, and a low level of evidence that it identifies tissue injury (in terms of group differences) compared with healthy controls. However, insufficient evidence exists to determine its utility as a sensitive and specific diagnostic test or as a tool to predict clinical outcomes. Very low quality evidence suggests that other metrics also show group differences compared with controls, including DTI metrics mean diffusivity (MD) and radial diffusivity (RD), the diffusional kurtosis imaging (DKI) metric mean kurtosis (MK), MT metrics MT ratio (MTR) and MT cerebrospinal fluid ratio (MTCSF), and the MRS metric of N-acetylaspartate (NAA) concentration, although these results were somewhat inconsistent. CONCLUSIONS State-of-the-art spinal cord MRI techniques are emerging with great potential to improve the diagnosis and management of various spinal pathologies, but the current body of evidence has only showed limited clinical utility to date. Among these imaging tools DTI is the most mature, but further work is necessary to standardize and validate its use before it will be adopted in the clinical realm. Large, well-designed studies with a priori hypotheses, standardized acquisition methods, detailed clinical data collection, and robust automated analysis techniques are needed to fully demonstrate the potential of these rapidly evolving techniques.
Collapse
Affiliation(s)
- Allan R Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Izabela Aleksanderek
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Lindsay Tetreault
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - David W Cadotte
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Crawley
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Howard Ginsberg
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Zhou F, Wu L, Liu X, Gong H, Luk KDK, Hu Y. Characterizing Thalamocortical Disturbances in Cervical Spondylotic Myelopathy: Revealed by Functional Connectivity under Two Slow Frequency Bands. PLoS One 2015; 10:e0125913. [PMID: 26053316 PMCID: PMC4460123 DOI: 10.1371/journal.pone.0125913] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Recent advanced MRI studies on cervical spondylotic myelopathy (CSM) revealed alterations of sensorimotor cortex, but the disturbances of large-scale thalamocortical systems remains elusive. The purpose of this study was to characterizing the CSM-related thalamocortical disturbances, which were associated with spinal cord structural injury, and clinical measures. Methods A total of 17 patients with degenerative CSM and well-matched control subjects participated. Thalamocortical disturbances were quantified using thalamus seed-based functional connectivity in two distinct low frequencies bands (slow-5 and slow-4), with different neural manifestations. The clinical measures were evaluated by Japanese Orthopaedic Association (JOA) score system and Neck Disability Index (NDI) questionnaires. Results Decreased functional connectivity was found in the thalamo-motor, -somatosensory, and -temporal circuits in the slow-5 band, indicating impairment of thalamo-cortical circuit degeneration or axon/synaptic impairment. By contrast, increased functional connectivity between thalami and the bilateral primary motor (M1), primary and secondary somatosensory (S1/S2), premotor cortex (PMC), and right temporal cortex was detected in the slow-4 band, and were associated with higher fractional anisotropy values in the cervical cord, corresponding to mild spinal cord structural injury. Conclusions These thalamocortical disturbances revealed by two slow frequency bands inform basic understanding and vital clues about the sensorimotor dysfunction in CSM. Further work is needed to evaluate its contribution in central functional reorganization during spinal cord degeneration.
Collapse
Affiliation(s)
- Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital, NanChang University, Nanchang, Jiangxi, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lin Wu
- Department of Radiology, the First Affiliated Hospital, NanChang University, Nanchang, Jiangxi, China
| | - Xiaojia Liu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Honghan Gong
- Department of Radiology, the First Affiliated Hospital, NanChang University, Nanchang, Jiangxi, China
| | - Keith Dip-Kei Luk
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yong Hu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- * E-mail:
| |
Collapse
|
35
|
Intrinsic functional plasticity of the sensory-motor network in patients with cervical spondylotic myelopathy. Sci Rep 2015; 5:9975. [PMID: 25897648 PMCID: PMC4404678 DOI: 10.1038/srep09975] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/23/2015] [Indexed: 12/13/2022] Open
Abstract
Several neuroimaging studies have suggested brain reorganisation in patients with cervical spondylotic myelopathy (CSM); however, the changes in spontaneous neuronal activity that are associated with connectedness remain largely unknown. In this study, functional connectivity strength (FCS), a data-driven degree centrality method based on a theoretical approach, was applied for the first time to investigate changes in the sensory-motor network (SMN) at the voxel level. Comparatively, CSM not only showed significantly decreased FCS in the operculum-integrated regions, which exhibited reduced resting-state functional connectivity (rsFC) around the Rolandic sulcus, but it also showed increased FCS in the premotor, primary somatosensory, and parietal-integrated areas, which primarily showed an enhanced rsFC pattern. Correlation analysis showed that altered FCS (in the left premotor-ventral/precentral-operculum, right operculum-parietale 4, and right S1) was associated with worsening Japanese Orthopaedic Association scores and that the rsFC pattern was influenced by cervical cord micro-structural damage at the C2 level. Together, these findings suggest that during myelopathy, the intrinsic functional plasticity of the SMN responds to the insufficient sensory and motor experience in CSM patients. This knowledge may improve our understanding of the comprehensive functional defects found in CSM patients and may inspire the development of new therapeutic strategies in the future.
Collapse
|