联合神经生理学与神经影像学方法揭示脊髓型颈椎病的结构-功能悖论

Combined Neurophysiologic and Neuroimaging Approach to Reveal the Structure-Function Paradox in Cervical Myelopathy.

作者信息

Scheuren Paulina Simonne, David Gergely, Kramer John Lawrence Kipling, Jutzeler Catherine Ruth, Hupp Markus, Freund Patrick, Curt Armin, Hubli Michèle, Rosner Jan

机构信息

From the Spinal Cord Injury Center (P.S.S., G.D., M. Hupp, P.F., A.C., M. Hubli, J.R.), Balgrist University Hospital, University of Zurich, Switzerland; International Collaboration on Repair Discoveries (ICORD) (J.L.K.K.), Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine (J.L.K.K.), University of British Columbia, Vancouver, Canada; Department of Biosystems Science and Technology (C.R.J.), Swiss Federal Institute of Technology Zurich, Switzerland; Wellcome Centre for Human Neuroimaging (P.F.), UCL Institute of Neurology, UCL, London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Switzerland.

出版信息

Neurology. 2021 Oct 11;97(15):e1512-e1522. doi: 10.1212/WNL.0000000000012643.

DOI:10.1212/WNL.0000000000012643

PMID:34380751

Abstract

BACKGROUND AND OBJECTIVES

To explore the so-called structure-function paradox in individuals with focal spinal lesions by means of tract-specific MRI coupled with multimodal evoked potentials and quantitative sensory testing.

METHODS

Individuals with signs and symptoms attributable to cervical myelopathy (i.e., no evidence of competing neurologic diagnoses) were recruited at the Balgrist University Hospital, Zurich, Switzerland, between February 2018 and March 2019. We evaluated the relationship between the extent of structural damage within spinal nociceptive pathways (i.e., dorsal horn, spinothalamic tract, anterior commissure) assessed with atlas-based MRI and (1) the functional integrity of spinal nociceptive pathways measured with contact heat-, cold-, and pinprick-evoked potentials and (2) clinical somatosensory phenotypes assessed with quantitative sensory testing.

RESULTS

Sixteen individuals (mean age 61 years) with either degenerative (n = 13) or posttraumatic (n = 3) cervical myelopathy participated in the study. Most individuals presented with mild myelopathy (modified Japanese Orthopaedic Association score >15; n = 13). A total of 71% of individuals presented with structural damage within spinal nociceptive pathways on MRI. However, 50% of these individuals presented with complete functional sparing (i.e., normal contact heat-, cold-, and pinprick-evoked potentials). The extent of structural damage within spinal nociceptive pathways was not associated with functional integrity of thermal (heat: = 0.57; cold: = 0.49) and mechano-nociceptive pathways ( = 0.83) or with the clinical somatosensory phenotype (heat: = 0.16; cold: = 0.37; mechanical: = 0.73). The amount of structural damage to the spinothalamic tract did not correlate with spinothalamic conduction velocity ( > 0.05; ρ = -0.11).

DISCUSSION

Our findings provide neurophysiologic evidence to substantiate that structural damage in the spinal cord does not equate to functional somatosensory deficits. This study recognizes the pronounced structure-function paradox in cervical myelopathies and underlines the inevitable need for a multimodal phenotyping approach to reveal the eloquence of lesions within somatosensory pathways.

摘要

背景与目的

通过特定束路的磁共振成像（MRI）结合多模式诱发电位和定量感觉测试，探索患有局灶性脊髓损伤的个体中所谓的结构-功能悖论。

方法

2018年2月至2019年3月期间，在瑞士苏黎世的巴尔格里斯特大学医院招募了有颈髓病体征和症状（即无其他竞争性神经学诊断证据）的个体。我们评估了基于图谱的MRI评估的脊髓伤害性感受通路（即背角、脊髓丘脑束、前连合）内结构损伤程度与（1）通过接触热、冷和针刺诱发电位测量的脊髓伤害性感受通路的功能完整性，以及（2）通过定量感觉测试评估的临床躯体感觉表型之间的关系。

结果

16名个体（平均年龄61岁）参与了研究，其中13例为退行性颈髓病，3例为创伤后颈髓病。大多数个体表现为轻度颈髓病（改良日本骨科协会评分>15；n = 13）。共有71%的个体在MRI上显示脊髓伤害性感受通路存在结构损伤。然而，这些个体中有50%表现出完全的功能保留（即接触热、冷和针刺诱发电位正常）。脊髓伤害性感受通路内的结构损伤程度与热（热：r = 0.57；冷：r = 0.49）和机械性伤害感受通路的功能完整性（r = 0.83）或临床躯体感觉表型（热：r = 0.16；冷：r = 0.37；机械性：r = 0.73）均无关。脊髓丘脑束的结构损伤量与脊髓丘脑束传导速度无关（P>0.05；ρ = -0.11）。