The Natural History of Traumatic Spinal Cord Injury Using fMRI, MRS and DTI
Condition: Central Cord Syndrome
MeSH terms: Spinal Cord Injuries; Central Cord Syndrome
Study type: Observational

Summary: 
      Traumatic spinal cord injury is a common injury to the spine and can lead to a clinical
      syndrome called central cord syndrome (CCS). CCS is an incomplete spinal cord injury where
      one starts to lose more motor function in the upper rather than lower extremities. It affects
      a wide range of the population from the young to the old. However, the natural history of CCS
      is poorly understood.

      Research has shown that the injury resulting in CCS might be due to the pinching or
      compressing of the spinal cord. This creates damage to a part of the spinal cord and creates
      difficulties in the signal getting through. We believe that we can gain a better
      understanding of the natural history of incomplete spinal cord injury as well as the recovery
      process.

      It is possible to track many changes in the brain and motor function through a variety of
      methods. One can track the concentrations of different chemicals (metabolites) by using
      magnetic resonance spectroscopy (MRS), changes in brain activation by using functional
      magnetic resonance imaging (fMRI) and thread-like nerve fibers in the spine by using
      diffusion tensor imaging (DTI). In our study we will be detecting differences in brain
      metabolism and activation of different parts of the brain during specific movement and in the
      nerve fibers in the brain.

      We hypothesize that there will be decreased levels of N-acetylaspartate (NAA, a putative
      marker of neuronal function) and decreased levels of glutamate (the primary excitatory
      neurotransmitter) in the motor cortex in patients with CCS when compared with controls. Over
      time, we hypothesize that the normalization of metabolite levels will correlate with the
      extent of neurologic recovery. We also hypothesize a reorganization of brain activation
      patterns with time such that patients will show increased volumes of activation in the motor
      cortex with recovery and that this will correlate with the extent of neurologic outcome. Over
      time, we predict that there will be normalization of the fibre track anatomy that will
      correlate with neurological recovery.
    

Detailed description: 
      The long-term goal of this project is to develop predictors of neurological recovery based on
      brain metabolism, brain activation patterns, and fibre tracks in patients with traumatic CCS.
      The objective of this preliminary study is to evaluate metabolic changes, brain activation
      pattern reorganization and altered spinal cord fibre tracks in patients suffering from
      traumatic CCS to gain a better understanding of the natural history of this condition.
      Magnetic resonance spectroscopy (MRS), functional magnetic resonance imaging (fMRI), and
      diffusion tensor imaging (DTI) will be used to investigate the changes in brain metabolite
      concentrations, cerebral cortical activation, and fibre tract anatomy, respectively, in
      patients and controls.

      Ten patients having traumatic CCS will be recruited from the Clinical Neurological Sciences
      Department at the London Health Sciences Centre, University Campus. All participants will
      undergo an fMRI, MRS and DTI scan of the motor cortex to measure the volume of activation,
      signal intensity and levels of NAA and glutamate. The CCS participants will have three scans,
      one acutely (up to 48 hours after injury), one subacutely (15 days after injury), and one
      late (6 months after injury). Healthy volunteers will have two scans six months apart to
      determine reproducibility.

      Clinical changes will be measured using validated disease specific scoring instruments
      including the Japanese Orthopedic Association scale (JOA), ASIA/ISCOS Impairment Scale, and
      the Neck Disability Index (NDI). General quality of life will be measured using the 36-item
      Short-Form Health Survey (SF-36). A blinded investigator will administer these instruments
      prior to the scan at all time points.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Ten patients and ten controls will be recruited from the Clinical Neurological Sciences
        outpatient clinic at the London Health Sciences Centre, University Campus
      
Keywords: cervical spondylotic myelopathy; spinal cord compression; magnetic resonance spectroscopy; functional magnetic resonance imaging; brain plasticity