School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
EBioMedicine. 2024 Jan;99:104915. doi: 10.1016/j.ebiom.2023.104915. Epub 2023 Dec 19.
Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction globally. Associated neurological symptoms and signs have historically been explained by pathobiology within the cervical spine. However, recent advances in imaging have shed light on numerous brain changes in patients with DCM, and it is hypothesised that these changes contribute to DCM pathogenesis. The aetiology, significance, and distribution of these supraspinal changes is currently unknown. The objective was therefore to synthesise all current evidence on brain changes in DCM.
A systematic review was performed. Cross-sectional and longitudinal studies with magnetic resonance imaging on a cohort of patients with DCM were eligible. PRISMA guidelines were followed. MEDLINE and Embase were searched to 28th August 2023. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. A qualitative synthesis of the literature is presented as per the Synthesis Without Meta-Analysis (SWiM) reporting guideline. The review was registered with PROSPERO (ID: CRD42022298538).
Of the 2014 studies that were screened, 47 studies were identified that used MRI to investigate brain changes in DCM. In total, 1500 patients with DCM were included in the synthesis, with a mean age of 53 years. Brain alterations on MRI were associated with DCM both before and after surgery, particularly within the sensorimotor network, visual network, default mode network, thalamus and cerebellum. Associations were commonly reported between brain MRI alterations and clinical measures, particularly the Japanese orthopaedic association (JOA) score. Risk of bias of included studies was low to moderate.
The rapidly expanding literature provides mounting evidence for brain changes in DCM. We have identified key structures and pathways that are altered, although there remains uncertainty regarding the directionality and clinical significance of these changes. Future studies with greater sample sizes, more detailed phenotyping and longer follow-up are now needed.
ODM is supported by an Academic Clinical Fellowship at the University of Cambridge. BMD is supported by an NIHR Clinical Doctoral Fellowship at the University of Cambridge (NIHR300696). VFJN is supported by an NIHR Rosetrees Trust Advanced Fellowship (NIHR302544). This project was supported by an award from the Rosetrees Foundation with the Storygate Trust (A2844).
退行性颈椎脊髓病（DCM）是全球成人脊髓功能障碍的最常见原因。历史上，与颈椎相关的神经症状和体征可以用颈椎内的病理生理学来解释。然而，影像学的最新进展揭示了 DCM 患者存在大量的脑改变，并且假设这些改变导致了 DCM 的发病机制。目前尚不清楚这些中枢神经系统以上变化的病因、意义和分布。因此，本研究旨在综合所有关于 DCM 患者脑改变的现有证据。
进行了系统评价。纳入了使用磁共振成像对 DCM 患者队列进行的横断面和纵向研究。研究遵循 PRISMA 指南。检索了 MEDLINE 和 Embase 数据库，截至 2023 年 8 月 28 日。进行了重复的标题/摘要筛选、数据提取和偏倚风险评估。根据无荟萃分析的综合方法（SWiM）报告指南，对文献进行定性综合。该综述在 PROSPERO 注册（ID：CRD42022298538）。
在筛选出的 2014 项研究中，确定了 47 项使用 MRI 研究 DCM 患者脑改变的研究。共纳入了 1500 例 DCM 患者，平均年龄为 53 岁。MRI 显示的脑改变与 DCM 术前和术后均相关，尤其是在感觉运动网络、视觉网络、默认模式网络、丘脑和小脑。MRI 改变与临床指标，特别是日本矫形协会（JOA）评分之间的关联经常被报道。纳入研究的偏倚风险为低至中度。
快速发展的文献为 DCM 患者的脑改变提供了越来越多的证据。我们已经确定了改变的关键结构和途径，尽管这些变化的方向和临床意义仍存在不确定性。现在需要进行更多样本量更大、表型更详细、随访时间更长的研究。
ODM 得到了剑桥大学学术临床研究员职位的支持。BMD 得到了剑桥大学（NIHR300696）NIHR 临床博士研究员职位的支持。VFJN 得到了 NIHR Rosetrees 信托基金高级研究员（NIHR302544）的支持。这个项目得到了 Rosetrees 基金会与 Storygate 信托基金（A2844）的资助。
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