Division of Neurosurgery, University of Western Ontario, London, Ontario, Canada, N6A 5A5.
Neurology. 2010 Mar 30;74(13):1048-54. doi: 10.1212/WNL.0b013e3181d6b0ea. Epub 2010 Mar 3.
This prospective study characterizes the reorganization that occurs within the primary sensorimotor cortices following decompression of cervical spinal stenosis.
Twelve right-handed patients with cervical myelopathy underwent blood oxygenation level dependent functional MRI (fMRI) prior to decompression and 6 months following surgery. Ten right-handed controls also underwent fMRI. All subjects performed a finger-tapping paradigm with the right hand. Volume time course data were corrected for temporal serial correlation and % normalized before inclusion in the general linear model. Activation maps were created for each group using a threshold of p < 0.005 with Bonferroni correction. Between-group differences in left hemisphere volume of activation (VOA) were measured along the precentral gyrus (PrCG) and postcentral gyrus (PoCG). Each subject also completed clinical questionnaires.
Prior to surgery, patients demonstrated a larger VOA (1.23 cm(3), t(max) = 11.8) in comparison to controls within the PrCG. This difference increased following surgery (2.99 cm(3), t(max) = 13.6). Within the PoCG, controls demonstrated a larger VOA (0.53 cm(3), t(max) = 8.28) than preoperative patients. This difference decreased by 0.12 cm(3) (t(max) = 7.05) following surgery. Preoperatively, patients had a 21.7 cm(3) VOA (t(max) = 29.4) within the sensorimotor cortex with the center of gravity located within Brodmann area (BA) 3. Following surgery, the VOA increased to 23.1 cm(3) (t(max) = 26.1) within BA 3. There were significant improvements in clinical outcomes following surgery.
Spinal cord compression resulted in an increase in volume of activation (VOA) within the precentral gyrus (PrCG) and a loss of VOA within the postcentral gyrus (PoCG) in comparison to controls. Surgical decompression results in cortical reorganization with enlarging VOA within both the PrCG and PoCG.
本前瞻性研究描绘了颈椎管狭窄减压后初级感觉运动皮质内发生的重组。
12 名右利手的颈椎病患者在减压前和手术后 6 个月接受血氧水平依赖功能磁共振成像（fMRI）检查。10 名右利手的对照者也接受了 fMRI 检查。所有受试者均用右手进行手指敲击范式。在包含在一般线性模型之前，对时间序列相关性和%进行了体积时间过程数据校正。使用 p < 0.005 的阈值和 Bonferroni 校正为每个组创建激活图。沿着中央前回（PrCG）和中央后回（PoCG）测量左侧半球激活体积（VOA）的组间差异。每位受试者还完成了临床问卷。
手术前，与对照组相比，患者在 PrCG 内显示出更大的 VOA（1.23 cm3，t(max) = 11.8）。手术后，这一差异增加到 2.99 cm3（t(max) = 13.6）。在 PoCG 中，对照组的 VOA 大于术前患者（0.53 cm3，t(max) = 8.28）。手术后，这一差异减少了 0.12 cm3（t(max) = 7.05）。术前，患者的感觉运动皮层的 VOA 为 21.7 cm3（t(max) = 29.4），重心位于布罗德曼区（BA）3 内。手术后，VOA 在 BA3 内增加到 23.1 cm3（t(max) = 26.1）。手术后临床结果有显著改善。
脊髓压迫导致与对照组相比，中央前回（PrCG）的激活体积（VOA）增加，中央后回（PoCG）的 VOA 减少。手术减压导致 PrCG 和 PoCG 内的 VOA 增大，从而导致皮质重组。
