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Longitudinal brain activation changes related to electrophysiological findings in patients with cervical spondylotic myelopathy before and after spinal cord decompression: an fMRI study

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Abstract

Background

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction, potentially leading to severe disability. Abnormal cervical spine magnetic resonance imaging (MRI) and motor evoked potentials (MEPs) are independent predictors of disease progression. Abnormal MRI is accompanied by various activation changes in functional brain MRI (fMRI), whereas preoperative and postoperative fMRI adaptations associated with abnormal preoperative MEP remain unknown.

Methods

Twenty patients (9 males, average age 56.6) with evidence of spinal cord compression on MRI and clinical signs of mild CSM were included. Participants were classified according to their preoperative MEP and underwent three brain fMRI examinations: before surgery, 6, and 12 months after surgery while performing repeated extension-flexion of each wrist.

Results

Functional MRI activation was compared between two subsets of patients, with normal and clearly abnormal MEP (right wrist: 8 vs. 8; left wrist: 7 vs. 9). At baseline, abnormal MEPs were associated with hyperactivation in the cerebellum. At the first follow-up, further hyperactivations emerged in the contralateral sensorimotor cortices and persisted for 1 year. In normal baseline MEP, activation mostly decreased in the ipsilateral sensorimotor cortex postoperatively. The ipsilateral sensorimotor activation after 1-year follow-up correlated with baseline MEP.

Conclusions

Abnormal corticospinal MEP findings in cervical spondylotic myelopathy were associated with differences in brain activation, which further increased after spinal cord decompression and did not resolve within 12-month follow-up. In summary, surgery may come too late for those patients with abnormal MEP to recover completely despite their mild clinical signs and symptoms.

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Abbreviations

AP:

anteroposterior

ANOVA:

analysis of variance

CMCT:

central motor conduction time

CSM:

cervical spondylotic myelopathy

DWI:

diffusion-weighted imaging

EPI:

echo planar imaging

fMRI:

functional MR imaging

FWHM:

full width at half maximum

GLM:

general linear model

Group A:

abnormal MEP

Group B:

borderline MEP

Group N:

normal MEP

LE:

lower extremity

LW:

left wrist

M0:

month 0

M6:

month 6

M12:

month 12

MEP:

motor evoked potentials

mJOA:

modified Japanese Orthopaedic Association score

MNI:

Montreal Neurological Institute

MPRAGE:

magnetization prepared rapid acquisition gradient echo

MRI:

magnetic resonance imaging

NDI:

Neck Disability Index

PEEK:

polyetheretherketon

ROI:

region of interest

RW:

right wrist

SD:

standard deviation

SEP:

somatosensory evoked potentials

SMA:

supplementary motor area

UE:

upper extremity

VAS:

visual analogue scale

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Acknowledgements

This study was supported by the grant IGA MZ ČR NT 14609.

Funding

This study was supported by the grant IGA MZ ČR NT 14609.

Author information

Author notes

  1. Lumír Hrabálek and Pavel Hok contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova, 185/6, Olomouc, 775 20, Czech Republic

    Lumír Hrabálek, Tomáš Wanek & Miroslav Vaverka

  2. Department of Neurology, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova, 185/6, 775 20, Olomouc, Czech Republic

    Pavel Hok, Petr Hluštík, Pavel Otruba & Petr Kaňovský

  3. Department of Radiology, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova, 185/6, 775 20, Olomouc, Czech Republic

    Eva Čecháková

Authors
  1. Lumír Hrabálek
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  2. Pavel Hok
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Corresponding author

Correspondence to Pavel Hok.

Ethics declarations

Prior to study initiation, the study protocol was approved by the institutional ethics committee. Informed consent was obtained from each study participant prior to any study procedure.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Animal experiments

This article does not contain any studies with animals performed by any of the authors.

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Hrabálek, L., Hok, P., Hluštík, P. et al. Longitudinal brain activation changes related to electrophysiological findings in patients with cervical spondylotic myelopathy before and after spinal cord decompression: an fMRI study. Acta Neurochir 160, 923–932 (2018). https://doi.org/10.1007/s00701-018-3520-1

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  • DOI: https://doi.org/10.1007/s00701-018-3520-1

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