Acta Neurochirurgica

, Volume 160, Issue 5, pp 923–932 | Cite as

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

  • Lumír Hrabálek
  • Pavel Hok
  • Petr Hluštík
  • Eva Čecháková
  • Tomáš Wanek
  • Pavel Otruba
  • Miroslav Vaverka
  • Petr Kaňovský
Original Article - Spine



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.


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.


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.


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.


Cervical spondylotic myelopathy Functional magnetic resonance imaging Motor evoked potentials Sensorimotor system Corticospinal tract 





analysis of variance


central motor conduction time


cervical spondylotic myelopathy


diffusion-weighted imaging


echo planar imaging


functional MR imaging


full width at half maximum


general linear model

Group A

abnormal MEP

Group B

borderline MEP

Group N

normal MEP


lower extremity


left wrist


month 0


month 6


month 12


motor evoked potentials


modified Japanese Orthopaedic Association score


Montreal Neurological Institute


magnetization prepared rapid acquisition gradient echo


magnetic resonance imaging


Neck Disability Index




region of interest


right wrist


standard deviation


somatosensory evoked potentials


supplementary motor area


upper extremity


visual analogue scale



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


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

Compliance with ethical standards

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.


  1. 1.
    Aleksanderek I, Stevens TK, Goncalves S, Bartha R, Duggal N (2017) Metabolite and functional profile of patients with cervical spondylotic myelopathy. J Neurosurg Spine:1–7Google Scholar
  2. 2.
    Allison JD, Meador KJ, Loring DW, Figueroa RE, Wright JC (2000) Functional MRI cerebral activation and deactivation during finger movement. Neurology 54(1):135–142CrossRefPubMedGoogle Scholar
  3. 3.
    Bednařík J, Kadaňka Z, Dušek L, Keřkovský M, Voháňka S, Novotný O, Urbánek I, Kratochvílová D (2008) Presymptomatic spondylotic cervical myelopathy: an updated predictive model. Eur Spine J 17(3):421–431CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bednařík J, Kadaňka Z, Dušek L, Novotný O, Šurelová D, Urbánek I, Prokeš B (2004) Presymptomatic spondylotic cervical cord compression. Spine 29(20):2260–2269CrossRefPubMedGoogle Scholar
  5. 5.
    Bednařík J, Kadaňka Z, Voháňka S, Stejskal L, Vlach O, Schröder R (1999) The value of somatosensory- and motor-evoked potentials in predicting and monitoring the effect of therapy in spondylotic cervical myelopathy. Prospective randomized study. Spine 24(15):1593–1598CrossRefPubMedGoogle Scholar
  6. 6.
    Dong Y, Holly LT, Albistegui-Dubois R, Yan X, Marehbian J, Newton JM, Dobkin BH (2008) Compensatory cerebral adaptations before and evolving changes after surgical decompression in cervical spondylotic myelopathy. J Neurosurg Spine 9(6):538–551CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Duggal N, Rabin D, Bartha R, Barry RL, Gati JS, Kowalczyk I, Fink M (2010) Brain reorganization in patients with spinal cord compression evaluated using fMRI. Neurology 74(13):1048–1054CrossRefPubMedGoogle Scholar
  8. 8.
    Grabner G, Janke AL, Budge MM, Smith D, Pruessner J, Collins DL (2006) Symmetric atlasing and model based segmentation: an application to the hippocampus in older adults. Med Image Comput Comput Assist Interv 9(Pt 2):58–66PubMedGoogle Scholar
  9. 9.
    Holly LT, Dong Y, Albistegui-DuBois R, Marehbian J, Dobkin B (2007) Cortical reorganization in patients with cervical spondylotic myelopathy. J Neurosurg Spine 6(6):544–551CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hrabálek L, Hluštík P, Hok P, Čecháková E, Wanek T, Otruba P, Vaverka M, Kaňovský P (2015) Influence of cervical spondylotic spinal cord compression on cerebral cortical adaptation. Radiological study. Acta Chir orthop Traum čech 82(6):404–411Google Scholar
  11. 11.
    Hrabálek L, Hluštík P, Hok P, Wanek T, Otruba P, Čecháková E, Vaverka M, Kaňovský P (2014) Effects of spinal cord decompression in patients with cervical spondylotic myelopathy oncortical brain activations. Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti 93(11):530–535Google Scholar
  12. 12.
    Jenkinson M, Beckmann CF, Behrens TEJ, Woolrich MW, Smith SM (2012) FSL. NeuroImage 62(2):782–790CrossRefPubMedGoogle Scholar
  13. 13.
    Jurkiewicz MT, Mikulis DJ, McIlroy WE, Fehlings MG, Verrier MC (2007) Sensorimotor cortical plasticity during recovery following spinal cord injury: a longitudinal fMRI study. Neurorehabil Neural Repair 21(6):527–538CrossRefPubMedGoogle Scholar
  14. 14.
    Kadaňka Z, Keřkovský M, Bednařík J, Jarkovský J (2007) Cross-sectional transverse area and hyperintensities on magnetic resonance imaging in relation to the clinical picture in cervical spondylotic myelopathy. Spine 32(23):2573–2577CrossRefPubMedGoogle Scholar
  15. 15.
    Kalsi-Ryan S, Karadimas SK, Fehlings MG (2013) Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist 19(4):409–421CrossRefPubMedGoogle Scholar
  16. 16.
    Keřkovský M, Bednařík J, Dušek L, Šprláková-Puková A, Urbánek I, Mechl M, Válek V, Kadaňka Z (2012) Magnetic resonance diffusion tensor imaging in patients with cervical spondylotic spinal cord compression: correlations between clinical and electrophysiological findings. Spine 37(1):48–56CrossRefPubMedGoogle Scholar
  17. 17.
    Kowalczyk I, Duggal N, Bartha R (2012) Proton magnetic resonance spectroscopy of the motor cortex in cervical myelopathy. Brain 135(Pt 2):461–468CrossRefPubMedGoogle Scholar
  18. 18.
    Manto M, Bower J, Conforto A et al (2012) Consensus paper: roles of the cerebellum in motor control—the diversity of ideas on cerebellar involvement in movement. Cerebellum 11(2):457–487CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Penhune VB, Steele CJ (2012) Parallel contributions of cerebellar, striatal and M1 mechanisms to motor sequence learning. Behav Brain Res 226(2):579–591CrossRefPubMedGoogle Scholar
  20. 20.
    Tam S, Barry RL, Bartha R, Duggal N (2010) Changes in functional magnetic resonance imaging cortical activation after decompression of cervical spondylosis: case report. Neurosurgery 67(3):E863–E864Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryPalacký University Olomouc and University Hospital OlomoucOlomoucCzech Republic
  2. 2.Department of NeurologyPalacký University Olomouc and University Hospital OlomoucOlomoucCzech Republic
  3. 3.Department of RadiologyPalacký University Olomouc and University Hospital OlomoucOlomoucCzech Republic

Personalised recommendations