Characterizing brain network alterations in cervical spondylotic myelopathy using static and dynamic functional network connectivity and machine learning.

BACKGROUND

Cervical spondylotic myelopathy (CSM) is a debilitating condition that affects the cervical spine, leading to neurological impairments. While the neural mechanisms underlying CSM remain poorly understood, changes in brain network connectivity, particularly within the context of static and dynamic functional network connectivity (sFNC and dFNC), may provide valuable insights into disease pathophysiology. This study investigates brain-wide connectivity alterations in CSM patients using both sFNC and dFNC, combined with machine learning approaches, to explore their potential as biomarkers for disease classification and progression.

METHODS

A total of 191 participants were included in this study, comprising 108 CSM patients and 83 healthy controls (HCs). Resting-state fMRI data were used to derive functional connectivity networks (FCNs), which were further analyzed to obtain sFNC and dFNC features. K-means clustering was applied to identify distinct dFNC states, and machine learning models, including support vector machine (SVM), decision tree (DT), linear discriminant analysis (LDA), logistic regression (LR), and random forests (RF), were constructed to classify CSM patients and HCs based on FNC features.

RESULTS

The sFNC analysis revealed significant alterations in brain network connectivity in CSM patients, including enhanced connectivity between the posterior default mode network (pDMN) and ventral attention network (vAN), and between the right and left frontoparietal networks (rFPN and lFPN), alongside weakened connectivity in multiple other network pairs. K-means clustering of dFNC identified four distinct functional states, with CSM patients exhibiting altered connectivity in State 1 and State 3. Machine learning models based on sFNC demonstrated excellent classification performance, with the SVM model achieving an AUC of 0.92, accuracy of 85.86%, and sensitivity and specificity both exceeding 0.80. Models based on dFNC also performed well, with the State 3-based model yielding an AUC of 0.91 and accuracy of 84.97%.

CONCLUSIONS

Our findings highlight significant alterations in both sFNC and dFNC in CSM patients, suggesting that these connectivity changes may reflect underlying neural mechanisms of the disease. Machine learning models based on FNC features, particularly SVM, exhibit strong potential for classifying CSM patients and may serve as valuable neuroimaging biomarkers for diagnosis and monitoring disease progression. Future research should explore longitudinal studies and multimodal neuroimaging approaches to further validate these findings.