Reorganization of Brain Functions in Patients With Cervical Myelopathy Using fMRI and MRS
Condition: Spinal Cord Diseases
MeSH terms: Spinal Cord Diseases; Bone Marrow Diseases
Study type: Observational

Summary: 
      Decompressive surgery to relieve symptoms of spinal cord compression due to dysfunction, such
      as arthritis, has proved variable in success. Past research has reported that approximately
      one-third of surgery patients improved, one-third remained the same and one-third worsened.
      Currently, there are no reliable tests that can predict the outcome following surgery. We are
      hoping that this study will change that.

      Using functional MRI (fMRI), we wish to investigate the relationship between clinical
      symptoms and the recovery of brain activation following surgery. One can also track the
      concentrations of different chemicals (metabolites) by using magnetic resonance spectroscopy
      (MRS). We hypothesize that the recovery of normal brain activation patterns will coincide
      with clinical improvement. Our objective in this study is to explore the potential role of
      fMRI as a tool to prognose patients with cervical myelopathy.

      Twenty-five patients with cervical myelopathy will be imaged using a high-powered (3 Tesla)
      fMRI scanner before and six months following surgery. In addition, ten healthy controls will
      be imaged to provide a baseline measure. Both the patient and control groups will complete
      questionnaires at the time of their scans. These will provide information concerning the
      subjective experience of the individuals throughout recovery. We will compare brain
      activation patterns of control and patient groups to investigate how the brain heals
      following decompressive surgery.
    

Detailed description: 
      Degenerative arthritis is a universal concomitant of human aging, affecting 51% of the adult
      population. Arthritis of the spine is the most common cause of acquired spinal cord
      dysfunction and can manifest in subtle symptoms, such as diminished balance and dexterity, or
      profound symptoms, such as paralysis and incontinence. In cases where dysfunction results in
      severe spinal cord compression, surgery is performed. However, surgical outcomes are not
      always beneficial. Past research has reported that approximately one-third of surgery
      patients improved, one-third remained the same and one-third worsened. Currently, there are
      no reliable tests that can predict outcome following surgery. We are hoping that this study
      will change that.

      Twenty-five patients will undergo 45 minute imaging sessions pre-operatively and six months
      post-operatively. Ten controls will undergo 45 minute imaging sessions twice to provide a
      baseline comparison and reproducibility. During each session, one motor task (finger tapping)
      and 1 sensory task (hand brushing) will be performed for 2 minutes at 10 second intervals. We
      wish to compare the change in volume extent, and location, and intensity of brain activation
      levels before and after surgery. We will also compare fMRI signal response differences
      between controls and patients. We hypothesize that the degree to which brain activation
      shifts towards normalcy (that of controls) will correlate with the degree of neurological
      recovery postoperatively.

      Data will be analyzed using software developed at the Robarts Research Institute.
    

Intervention name(s): Decompressive cervical spine surgery; fMRI and MRS scan
Intervention type(s): Procedure; Procedure
Intervention description(s): Treatment group (25 patients) will undergo decompressive anterior cervical spine surgery
Healthy volunteers will ONLY undergo two scans 6 months apart.; A scan pre-op and 6 months post-op.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Twenty-five patients and ten controls will be recruited from the Clinical Neurological
        Sciences outpatient clinic at the London Health Sciences Centre, University Campus
      
Keywords: Functional MRI; Cervical myelopathy; Cervical radiculopathy; Brain plasticity and regeneration