Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy.
Department of Neurosurgery, ARNAS Garibaldi, P.O. Garibaldi Nesima, 95122, Catania, Italy.
Neurosurg Rev. 2023 Jun 26;46(1):149. doi: 10.1007/s10143-023-02062-9.
Cervical spondylotic myelopathy (CSM) is a degenerative disease representing the most common spinal cord disorder in the adult population. It is characterized by chronic compression leading to neurological dysfunction due to static and dynamic injury of the spinal cord in cervical spine. These insidious damage mechanisms can result in the reorganization of cortical and subcortical areas. The cerebral cortex can reorganize due to spinal cord injury and may play a role in preserving neurological function. To date, the gold standard treatment of cervical myelopathy is surgery, comprising anterior, posterior, and combined approaches. However, the complex physiologic recovery processes involving cortical and subcortical neural reorganization following surgery are still inadequately understood. It has been demonstrated that diffusion MRI and functional imaging and techniques, such as transcranial magnetic stimulation (TMS) or functional magnetic resonance imaging (fMRI), can provide new insights into the diagnosis and prognosis of CSM. This review aims to shed light on the state-of-the-art regarding the pattern of cortical and subcortical areas reorganization and recovery before and after surgery in CSM patients, underlighting the critical role of neuroplasticity.
颈椎脊髓病（CSM）是一种退行性疾病，代表了成年人群中最常见的脊髓疾病。它的特征是慢性压迫导致由于颈椎脊髓的静态和动态损伤导致神经功能障碍。这些隐匿性的损伤机制可能导致皮质和皮质下区域的重组。大脑皮层可能由于脊髓损伤而重新组织，并可能在保护神经功能方面发挥作用。迄今为止，颈椎脊髓病的金标准治疗方法是手术，包括前路、后路和联合方法。然而，术后涉及皮质和皮质下神经重组的复杂生理恢复过程仍未得到充分理解。已经证明，弥散磁共振成像和功能成像技术，如经颅磁刺激（TMS）或功能磁共振成像（fMRI），可以为 CSM 的诊断和预后提供新的见解。本综述旨在阐明 CSM 患者手术前后皮质和皮质下区域重组和恢复的最新情况，强调神经可塑性的关键作用。
