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

Abstract

Objectives

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

Methods

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.

Results

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.

Conclusion

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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Abbreviations

CC:

Corpus callosum

CG:

Cingulum

Cho:

Choline

Cr:

Creatine

CS:

Cervical spondylosis

CSM:

Cervical spondylosis myelopathy

CST:

Corticospinal tract

DTI:

Diffusion tensor imaging

EMG:

Electromyography

FA:

Fractional anisotropy

fMRI:

Functional magnetic resonance imaging

Glx:

Glutamate and glutamine

MCP:

Middle cerebellar peduncle

MD:

Mean diffusivity

mIno:

Myoinositol

mJOHA:

Modified Japanese Orthopaedic Association Scoring System.

MR:

Magnetic resonance

NAA:

N-Acetyl aspartate

RD:

Radial diffusivity

SMA:

Supplementary motor area

TBSS:

Tract-based spatial statistics

VBM:

Voxel-based morphometry

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Acknowledgments

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.

Funding

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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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). https://doi.org/10.1007/s00330-019-06352-z

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Keywords

  • Spondylosis
  • Spine
  • Brain
  • Neural plasticity