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Metabolite and functional profile of patients with cervical spondylotic myelopathy.
- Source :
-
Journal of neurosurgery. Spine [J Neurosurg Spine] 2017 May; Vol. 26 (5), pp. 547-553. Date of Electronic Publication: 2017 Feb 03. - Publication Year :
- 2017
-
Abstract
- OBJECTIVE The goal of this study was to compare the recovery of neuronal metabolism and functional reorganization in the primary motor cortex (M1) between mild and moderate cervical spondylotic myelopathy (CSM) following surgical intervention. METHODS Twenty-eight patients with CSM underwent 3-T MRI scans that included spectroscopy and functional MRI, before surgery and 6 months postsurgery. The classification of severity was based on the modified Japanese Orthopaedic Association questionnaire. Mild and moderate myelopathy were defined by modified Japanese Orthopaedic Association scores > 12 of 18 (n = 15) and 9-12 (n = 13), respectively. Ten healthy control subjects underwent 2 MRI scans 6 months apart. Metabolite levels were measured in the M1 contralateral to the greater deficit side in patients with CSM and on both sides in the controls. Motor function was assessed using a right finger-tapping paradigm and analyzed with BrainVoyager QX. RESULTS Patients with mild CSM had a lower preoperative N-acetylaspartate to creatine (NAA/Cr) ratio compared with moderate CSM, suggesting mitochondrial dysfunction. Postsurgery, NAA/Cr in moderate CSM decreased to the levels observed in mild CSM. Preoperatively, patients with mild CSM had a larger volume of activation (VOA) in the M1 than those with moderate CSM. Postoperatively, the VOAs were comparable between the mild and moderate CSM groups and had shifted toward the primary sensory cortex. CONCLUSIONS The NAA/Cr ratio and VOA size in the M1 can be used to discriminate between mild and moderate CSM. Postsurgery, the metabolite profile of the M1 did not recover in either group, despite significant clinical improvement. The authors proposed that metabolic impairment in the M1 may trigger the recruitment of adjacent healthy cortex to achieve functional recovery.
- Subjects :
- Aspartic Acid analogs & derivatives
Aspartic Acid metabolism
Creatine metabolism
Decompression, Surgical
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Male
Middle Aged
Motor Activity
Motor Cortex diagnostic imaging
Neuronal Plasticity physiology
Prospective Studies
Recovery of Function
Severity of Illness Index
Somatosensory Cortex diagnostic imaging
Somatosensory Cortex metabolism
Spinal Cord Diseases diagnostic imaging
Spondylosis diagnostic imaging
Surveys and Questionnaires
Treatment Outcome
Cervical Vertebrae surgery
Motor Cortex metabolism
Spinal Cord Diseases metabolism
Spinal Cord Diseases surgery
Spondylosis metabolism
Spondylosis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1547-5646
- Volume :
- 26
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of neurosurgery. Spine
- Publication Type :
- Academic Journal
- Accession number :
- 28156205
- Full Text :
- https://doi.org/10.3171/2016.9.SPINE151507