脊髓型颈椎病减压术后功能重塑的多模态磁共振研究

Cervical spondylotic myelopathy (CSM) caused by vertebrae or the adjacent soft tissue degeneration of chronic spinal cord compression is the most common type of spinal cord dysfunction in middle-aged and elderly people.Surgery decompression is the primary treatment for relieve symptoms in CSM patients. The majority of studies on spinal cord compression focus on functional recovery and reorganization of the compression of the spinal cord and after decompression remodeling,however the sensorimotor cortex (SMC) function reorganization effect on clinical functional recovery and the relationship between spinal cord function restore is not very clear. In previous work by our group, we demonstrated abnormal function of SMC and the alteration of thalamo-cortical synchronization of sensorimotor circuits in patients with CSM, may influence functional reorganization.Base on this, we explore the alteration of cortical morphology, structure, metabolites, task and resting-state fMRI by multi-modality MRI (vMRI,DTI,MRS, task-fMRI and rs-fMRI) as it applies to imaging sensorimotor and whole brain damage of CSM patients; Comparison of preoperative and postoperative of functional MRI and DTI topography in the spinal cord and brain data, and clinciclly functional evaluation data in order to investigate the reorganization mechanism of brain. To make comparison across patients and controls and their disease severity(clinical evaluated score), duration of symptoms and the mean fractional anisotropy (FA) values in the cervical cord (means spinal cord damage severity) were collected to assess its clinical relevance and medical imaging marker in pre-surgery. This study provides a new insight into understanding of the plasticity pathophysiology of cortex - spinal cord in preoperative or post-surgery in cervical myelopathy patients, and to provid the theory foundation and technical support of the cortical functional reorganization of other patients with spinal cord injury.

脊髓型颈椎病(CSM)是由椎体及相邻软组织退变造成脊髓慢性压迫性病变，是中老年人非外伤性肢体功能损害的常见原因。外科减压是CSM患者缓解症状的主要疗法。以往研究集中于受压脊髓及其解压后的功能重塑，然感觉运动皮质(SMC)功能重塑对临床功能恢复的影响及其与脊髓功能重塑间的关系尚不十分清楚。本组初步发现CSM患者术前存在fMRI可检测到的SMC功能异常、皮质-丘脑连接异常，可能对术后功能重塑起到重要作用。基于此，本研究拟采用多模态磁共振技术(vMRI、DTI、MRS、Task-fMRI和rs-fMRI)从形态、结构、代谢、任务和静息态功能多角度探讨CSM患者减压术后脊髓和皮质功能重塑的可能病理生理机制，皮质重塑对脊髓功能重塑的影响，结合临床功能评估遴选CSM可能的术前预后影像学标志。本研究有望揭示CSM患者术前术后皮质中枢-脊髓交互作用的可能机制，为理解其他类型脊髓损伤提供理论基础和技术支持。

脊髓型颈椎病（CSM）因脊髓慢性压迫损害感觉运动神经功能，是中老年人非外伤性肢体功能损害的常见原因。外科减压是CSM患者缓解症状的主要疗法，但脊髓损伤程度与临床症状并不一一相关、减压术后患者功能恢复差异性大，推测颈髓减压术前、术后脊髓-大脑中枢可能参与CSM患者感觉运动功能维持和恢复，但是涉及神经影像机制尚待研究。为此，本研究通过对比术前、术后CSM患者脊髓和大脑结构与功能网络（结构、代谢、任务和静息态脑功能）等系列变化探索以CSM为模型慢性脊髓损伤及修复特点，及CSM减压术后功能恢复的相关机制。本研究初步发现CSM颈髓微结构损伤与大脑皮层感觉代偿重组存在同步性，脊髓损伤后除了脊髓本身自我修复外，同时大脑初级感觉运动皮层调整神经投射网络，两者共同参与逆转CSM脊髓损伤患者的部分功能障碍，助于解释CSM外科减压后部分患者在术后症状没有得到改善，甚至加重，同时也提示脑和脊髓的术前神经影像学定量成像可能预判CSM手术时机及术后疗效。减压术前CSM 患者颈髓 DTI 成像参数（ADC、FA值）能够评估脊髓损伤后的功能损害；减压术后，残留正常脊髓纤维侧芽生长能力、大脑感觉运动皮层重塑能力将是影响后期功能恢复的重要因素，也可以解释CSM患者胸部、背部、手指、上肢、下肢等功能损害及恢复不一致等问题。.本课题不仅证实CSM 患者脊髓与大脑存在不同程度结构和功能损害，这些重叠的损伤与修复影响到CSM 患者远期疗效，有利于临床医生术前预判手术时间及手术价值，有助于解释患者临床症状与脊髓压迫程度不一致、术后疗效不理想等问题，为患者手术风险判断提供一定的参考价值。