Chencai Wang1, Benjamin M Ellingson1,2,3, Noriko Salamon1, Langston T Holly4,5. 1. Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. 2. Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. 3. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. 4. Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. 5. Department of Orthopaedics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Abstract
BACKGROUND: It remains unknown if the progressive loss of axonal conduction along sensorimotor tracts can be recovered after surgery in patients with degenerative cervical myelopathy (DCM) and if subsequent adaptive microstructural changes are associated with the neurological improvement. OBJECTIVE: To investigate the upstream recovery of microstructural integrity and reorganization of microstructural connectivity that occurs in patients with DCM after surgical decompression. METHODS: Preoperative and postoperative cerebral diffusion tensor imaging and diffusion spectrum imaging data were collected for 22 patients with DCM (age = 56.9 ± 9.1 years). Paired t-tests were used to identify significant microstructural changes within cohorts, and correlation analysis was used to identify whether those changes are associated with neurological improvement. RESULTS: Before surgery, higher structural connectivity (SC) was observed in the prefrontal/frontal lobes, anterior cingulate, the internal and external capsules, and the anterior, posterior, and superior regions of the corona radiata fibers. Following surgery, an increased modified Japanese Orthopaedic Association score was associated with increased SC from the primary sensorimotor regions to the posterior cingulate and precuneus; increased SC between the cerebellum and the bilateral lingual gyri; and decreased SC from areas of the limbic system to the basal ganglia and the frontal lobe. In addition, increased fractional anisotropy and normalized quantitative anisotropy values along white matter fibers responsible for conveying sensory information and motor coordination and planning were associated with neurological improvement of patients with DCM after surgery. CONCLUSION: Recovery of microstructural integrity along the corticospinal tract and other sensorimotor pathways, together with supraspinal reorganization of microstructural connectivity within sensory and motor-related regions, was associated with neurological improvement after surgical decompression.
BACKGROUND: It remains unknown if the progressive loss of axonal conduction along sensorimotor tracts can be recovered after surgery in patients with degenerative cervical myelopathy (DCM) and if subsequent adaptive microstructural changes are associated with the neurological improvement. OBJECTIVE: To investigate the upstream recovery of microstructural integrity and reorganization of microstructural connectivity that occurs in patients with DCM after surgical decompression. METHODS: Preoperative and postoperative cerebral diffusion tensor imaging and diffusion spectrum imaging data were collected for 22 patients with DCM (age = 56.9 ± 9.1 years). Paired t-tests were used to identify significant microstructural changes within cohorts, and correlation analysis was used to identify whether those changes are associated with neurological improvement. RESULTS: Before surgery, higher structural connectivity (SC) was observed in the prefrontal/frontal lobes, anterior cingulate, the internal and external capsules, and the anterior, posterior, and superior regions of the corona radiata fibers. Following surgery, an increased modified Japanese Orthopaedic Association score was associated with increased SC from the primary sensorimotor regions to the posterior cingulate and precuneus; increased SC between the cerebellum and the bilateral lingual gyri; and decreased SC from areas of the limbic system to the basal ganglia and the frontal lobe. In addition, increased fractional anisotropy and normalized quantitative anisotropy values along white matter fibers responsible for conveying sensory information and motor coordination and planning were associated with neurological improvement of patients with DCM after surgery. CONCLUSION: Recovery of microstructural integrity along the corticospinal tract and other sensorimotor pathways, together with supraspinal reorganization of microstructural connectivity within sensory and motor-related regions, was associated with neurological improvement after surgical decompression.
Authors: Lumír Hrabálek; Pavel Hok; Petr Hluštík; Eva Čecháková; Tomáš Wanek; Pavel Otruba; Miroslav Vaverka; Petr Kaňovský Journal: Acta Neurochir (Wien) Date: 2018-03-25 Impact factor: 2.216
Authors: Patrick Freund; Nikolaus Weiskopf; John Ashburner; Katharina Wolf; Reto Sutter; Daniel R Altmann; Karl Friston; Alan Thompson; Armin Curt Journal: Lancet Neurol Date: 2013-07-02 Impact factor: 44.182
Authors: Michael G Fehlings; Lindsay A Tetreault; K Daniel Riew; James W Middleton; Bizhan Aarabi; Paul M Arnold; Darrel S Brodke; Anthony S Burns; Simon Carette; Robert Chen; Kazuhiro Chiba; Joseph R Dettori; Julio C Furlan; James S Harrop; Langston T Holly; Sukhvinder Kalsi-Ryan; Mark Kotter; Brian K Kwon; Allan R Martin; James Milligan; Hiroaki Nakashima; Narihito Nagoshi; John Rhee; Anoushka Singh; Andrea C Skelly; Sumeet Sodhi; Jefferson R Wilson; Albert Yee; Jeffrey C Wang Journal: Global Spine J Date: 2017-09-05