Cortical reorganization in patients with cervical spondylotic myelopathy

Object. Recent investigations have demonstrated that the cerebral cortex can reorganize as a result of spinal cord injury and may play a role in preserving neurological function. Reorganization of cortical representational maps in patients with cervical spondylotic myelopathy (CSM) has not been previously described. The authors sought to determine the feasibility of using functional magnetic resonance (fMR) imaging in patients with CSM to investigate changes in the cortical representation of the wrist and ankle before and after surgical intervention. Methods. Four patients with clinical and imaging evidence of CSM were prospectively enrolled in this study. The patients underwent preoperative neurological examination, functional assessment, cervical imaging, and brain fMR imaging. The fMR imaging activation task undertaken was either wrist extension or ankle dorsiflexion, depending on whether the patient's primary impairment was hand dysfunction or gait difficulty. The cohort then underwent further evaluations at 6 weeks and 3 and 6 months postoperatively. In addition, five healthy volunteers underwent fMR imaging at two different time points and served as controls. In the healthy volunteers fMR imaging demonstrated areas of focal cortical activation limited to the contralateral primary motor area for the assigned motor tasks; the activation patterns were stable throughout repeated imaging. In comparison, in patients with CSM IMR imaging demonstrated expansion of the cortical representation of the affected extremity. Surgical decompression resulted in improvements in neurological function and reorganization of the representational map. Conclusions. The findings of this preliminary study demonstrate the potential of fMR imaging to assess changes in cortical representation before and after surgical intervention in patients with CSM. A future study involving a larger cohort of patients as well as the stratification of patients with CSM, based on the aforementioned factors that influence cortical adaptation, will allow a more detailed quantitative analysis.