Xie Bingyong, Ni Haoyu, Yao Jiyuan, Xu Zhibin, Bian Sicheng, Wang Haoxiang, Zhu Kun, Wu Xianyong, Song Peiwen, Wu Yuanyuan, Yu Yongqiang, Dong Fulong
Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Commun Med (Lond). 2025 May 22;5(1):191. doi: 10.1038/s43856-025-00909-4.
Degenerative cervical myelopathy (DCM) represents a prevalent etiology of neurological dysfunction, for which cervical decompression surgery (CDS) constitutes the principal therapeutic intervention. Advanced magnetic resonance imaging (MRI) techniques are crucial in elucidating the cerebral alterations associated with neuroinjury resulting from DCM.
In this prospective cohort study, we conducted an analysis of data from 54 patients with DCM both before and after surgery, as well as 57 healthy controls (HC), using functional MRI in combination with high-resolution structural MRI. The primary metrics included the z score transformation amplitude of low-frequency fluctuations (zALFF), functional connectivity (FC), and gray matter volume (GMV). Neurological function was evaluated through standardized clinical scores. Statistical analyses were employed to compare preoperative and postoperative changes, as well as to examine correlations with patient recovery outcome.
Here we show that DCM patients exhibit significant preoperative alterations in zALFF, FC, and GMV within critical brain regions associated with sensory processing, motor control, and cognitive integration. Postoperatively, an increase in zALFF within Postcentral_R region, along with increased FC with motor-related areas, which correlates positively with neurological recovery. Moreover, GMV shows a widespread reduction before and after surgery.
Our study reveals functional alterations within the brain are closely associated with effective surgical recovery, especially concerning the remodeling of the ascending and descending pathways along the brain-spinal cord axis. Moreover, macrostructural changes manifest more gradually, with the recovery of brain function depending more on compensation and remodeling within neural networks than solely on structural restoration.
退行性颈椎脊髓病（DCM）是神经功能障碍的常见病因，颈椎减压手术（CDS）是其主要的治疗手段。先进的磁共振成像（MRI）技术对于阐明与DCM所致神经损伤相关的脑部改变至关重要。
在这项前瞻性队列研究中，我们对54例DCM患者手术前后的数据以及57名健康对照者（HC）的数据进行了分析，采用功能MRI结合高分辨率结构MRI。主要指标包括低频波动的z评分转换幅度（zALFF）、功能连接性（FC）和灰质体积（GMV）。通过标准化临床评分评估神经功能。采用统计分析比较术前和术后的变化，并检验与患者恢复结果的相关性。
我们发现，DCM患者在与感觉处理、运动控制和认知整合相关的关键脑区的zALFF、FC和GMV术前有显著改变。术后，中央后回区域的zALFF增加，与运动相关区域的FC增加，这与神经功能恢复呈正相关。此外，GMV在手术前后均呈现广泛减少。
我们的研究表明，大脑内的功能改变与有效的手术恢复密切相关，特别是在沿脑脊髓轴的上下行通路重塑方面。此外，宏观结构变化表现得更为渐进，脑功能的恢复更多地依赖于神经网络内的代偿和重塑，而不仅仅是结构修复。
