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Abstract
Objective: This prospective study characterizes the reorganization that occurs within the primary sensorimotor cortices following decompression of cervical spinal stenosis.
Methods: Twelve right-handed patients with cervical myelopathy underwent blood oxygenation level dependent functional MRI (fMRI) prior to decompression and 6 months following surgery. Ten right-handed controls also underwent fMRI. All subjects performed a finger-tapping paradigm with the right hand. Volume time course data were corrected for temporal serial correlation and % normalized before inclusion in the general linear model. Activation maps were created for each group using a threshold of p < 0.005 with Bonferroni correction. Between-group differences in left hemisphere volume of activation (VOA) were measured along the precentral gyrus (PrCG) and postcentral gyrus (PoCG). Each subject also completed clinical questionnaires.
Results: Prior to surgery, patients demonstrated a larger VOA (1.23 cm3, tmax = 11.8) in comparison to controls within the PrCG. This difference increased following surgery (2.99 cm3, tmax = 13.6). Within the PoCG, controls demonstrated a larger VOA (0.53 cm3, tmax = 8.28) than preoperative patients. This difference decreased by 0.12 cm3 (tmax = 7.05) following surgery. Preoperatively, patients had a 21.7 cm3 VOA (tmax = 29.4) within the sensorimotor cortex with the center of gravity located within Brodmann area (BA) 3. Following surgery, the VOA increased to 23.1 cm3 (tmax = 26.1) within BA 3. There were significant improvements in clinical outcomes following surgery.
Conclusions: Spinal cord compression resulted in an increase in volume of activation (VOA) within the precentral gyrus (PrCG) and a loss of VOA within the postcentral gyrus (PoCG) in comparison to controls. Surgical decompression results in cortical reorganization with enlarging VOA within both the PrCG and PoCG.
Glossary
- BA=
- Brodmann area;
- BOLD=
- blood oxygenation level dependent;
- COG=
- center of gravity;
- CSM=
- cervical spondylotic myelopathy;
- fMRI=
- functional MRI;
- GLM=
- general linear model;
- JOA=
- Japanese Orthopedic Association;
- NDI=
- Neck Disability Index;
- PoCG=
- postcentral gyrus;
- PrCG=
- precentral gyrus;
- RF=
- radiofrequency;
- SCC=
- spinal cord compression;
- SCI=
- spinal cord injury;
- TE=
- echo time;
- TI=
- inversion time;
- TR=
- repetition time;
- VOA=
- volume of activation;
- VTC=
- volume time course.
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