MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression



To investigate the effect of cervical spondylosis (CS) in the brain with a combination of advanced neuroimaging techniques.


Twenty-seven patients with CS and 24 age- and gender-matched healthy controls were studied. Disease severity was quantified using the Modified Japanese Orthopaedic Association Scoring System (mJOHA). Magnetic resonance (MR) imaging of the brain and spinal cord, functional MR imaging (fMRI) with a bilateral rest/finger-tapping paradigm, brain diffusion tensor imaging (DTI), voxel-based morphometry (VBM), and MR spectroscopy of the sensorimotor cortex were performed.


A total of 92.3% of patients had more than one herniated disc. In the MRI, 33.33% presented signs of myelopathy. The mJOHA score was 13.03 ± 2.83. Compared with controls, DTI results showed significant lower FA values in Corpus callosum, both corticospinal tracts and middle cerebellar peduncles (p < 0.05 corrected). Only in CS patients fMRI results showed activation in both globus pallidi, caudate nucleus, and left thalamus (p < 0.001). Subject-specific activation of the BOLD signal showed in CS patients lower activation in the sensorimotor cortex and increased activation in both cerebellum hemispheres (p < 0.05 corrected). VBM showed bilateral clusters of gray matter loss in the sensorimotor cortex and pulvinar nucleus (p < 0.05 corrected) of CS patients. NAA/Cr was reduced in the sensorimotor cortex of CS patients (p < 0.05). Linear discriminant and support vector machine analyses were able to classify > 97% of CS patients with parameters obtained from the fMRI, DTI, and MRS results.


CS may lead to distal brain damage affecting the white and gray matter of the sensorimotor cortex causing brain atrophy and functional adaptive changes.

Key Points

• This study suggests that patients with cervical spondylosis may present anatomical and functional adaptive changes in the brain.

• Cervical spondylosis may lead to white matter damage, gray matter volume loss, and functional adaptive changes in the sensorimotor cortex.

• The results reported in this work may be of value to better understand the effect of prolonged cervical spine compression in the brain.

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Fig. 1
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Fig. 6



Corpus callosum








Cervical spondylosis


Cervical spondylosis myelopathy


Corticospinal tract


Diffusion tensor imaging




Fractional anisotropy


Functional magnetic resonance imaging


Glutamate and glutamine


Middle cerebellar peduncle


Mean diffusivity




Modified Japanese Orthopaedic Association Scoring System.


Magnetic resonance


N-Acetyl aspartate


Radial diffusivity


Supplementary motor area


Tract-based spatial statistics


Voxel-based morphometry


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The authors would like to thank the following people: our subjects for their time and help. Our MR technologists Mr. David González García, Miss. Patricia Lucena Ibáñez, Ms. Evelyn Teruel Sanchez, and Ms. Maria Vicenta Picazo Panadero for their outstanding technical support during the acquisition of the studies. Mr. Mikel Val for his invaluable help and advice in the SVM analysis. We would also like to show our gratitude to the anonymous reviewers who provided insight and expertise that greatly improved the manuscript.


This work was supported in part by Grant No. RTI2018-098969-B-100 from the Spanish Government and by the Bidons Egara Research Chair.

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Correspondence to Ángela Bernabéu-Sanz.

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The scientific guarantor of this publication is Dr. Ángela Bernabeu-Sanz.

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Statistics and biometry

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Written informed consent was obtained from all subjects (patients) in this study.

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Bernabéu-Sanz, Á., Mollá-Torró, J.V., López-Celada, S. et al. MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression. Eur Radiol 30, 357–369 (2020).

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  • Spondylosis
  • Spine
  • Brain
  • Neural plasticity