Department of Health.
Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.
Medicine (Baltimore). 2021 Jan 29;100(4):e24190. doi: 10.1097/MD.0000000000024190.
Using voxel-based morphometry (VBM), we studied cortical gray matter volume changes in patients with cervical spondylotic myelopathy (CSM) before and after cervical cord surgical decompression. We then discussed the structural damage mechanisms and the neural plasticity mechanisms involved in postsurgical CSM.Forty-five presurgical CSM patients, 41 of the same group followed-up 6 months after decompression surgery and 45 normal controls (NC) matched for age, sex and level of education underwent high-resolution 3-dimensional T1-weighted scans by 3.0 T MR. Then, VBM measurements were compared and cortical gray matter volume alterations were assessed among pre- or postsurgical CSM patients and NC, as well as correlations with clinical indexes by Pearson correlation.Compared with NC, presurgical CSM patients showed reduced gray matter volume in the left caudate nucleus and the right thalamus. After 6 months, postsurgical CSM patients had lower gray matter volume in the bilateral cerebellar posterior lobes but had higher gray matter volume in the brain-stem than did presurgical CSM patients. Postsurgical CSM patients had significantly lower gray matter volume in the left caudate nucleus but greater regional gray matter volume in the right inferior temporal gyrus, the right middle orbitofrontal cortex (OFC) and the bilateral lingual gyrus / precuneus /posterior cingulate cortex than did NC. Abnormal areas gray volume in presurgical CSM and postsurgical CSM patients showed no significant correlation with clinical data (P > .05).Myelopathy in the cervical cord may cause chronic cerebral structural damage before and after the decompression stage, markedly in outlier brain regions involving motor execution/control, vision processing and the default mode network and in areas associated with brain compensatory plasticity to reverse downstream spinal cord compression and respond to spinal cord surgical decompression.
使用基于体素的形态计量学（VBM），我们研究了颈椎脊髓病（CSM）患者颈椎脊髓减压前后皮质灰质体积的变化。然后，我们讨论了涉及手术后 CSM 的结构损伤机制和神经可塑性机制。
我们对 45 例术前 CSM 患者、41 例同一组患者在减压手术后 6 个月进行了随访以及 45 名年龄、性别和教育程度相匹配的正常对照组（NC）进行了 3.0T MR 的高分辨率 3 维 T1 加权扫描。然后，通过 Pearson 相关性比较了 VBM 测量值和皮质灰质体积变化，并评估了术前或术后 CSM 患者与 NC 之间的关系，以及与临床指标的相关性。
与 NC 相比，术前 CSM 患者的左侧尾状核和右侧丘脑灰质体积减少。6 个月后，术后 CSM 患者双侧小脑后叶灰质体积降低，但脑干灰质体积高于术前 CSM 患者。术后 CSM 患者左侧尾状核灰质体积明显降低，但右侧下颞叶、右侧中额眶回和双侧舌回/楔前叶/后扣带回皮质的区域灰质体积较大，与 NC 相比。术前和术后 CSM 患者的异常区域灰质体积与临床数据无显著相关性（P>.05）。
颈髓病变在减压前后可能导致慢性脑结构损伤，明显的是涉及运动执行/控制、视觉处理和默认模式网络的局灶性脑区以及与大脑代偿性可塑性相关的脑区，以逆转下游脊髓压迫并对脊髓手术减压作出反应。
