Cortical Activation Changes in Hirayama Disease After Anterior Cervical Decompression and Fusion

Hong-Li Wang; Yi-Wei Wu; Jian Song; Jian-Yuan Jiang; Fei-Zhou Lu; Xiao-Sheng Ma; Xin-Lei Xia

doi:10.1016/j.wneu.2018.05.045

Cortical Activation Changes in Hirayama Disease After Anterior Cervical Decompression and Fusion

World Neurosurg. 2018 Aug:116:e588-e594. doi: 10.1016/j.wneu.2018.05.045. Epub 2018 May 16.

Authors

Hong-Li Wang¹, Yi-Wei Wu², Jian Song¹, Jian-Yuan Jiang³, Fei-Zhou Lu⁴, Xiao-Sheng Ma¹, Xin-Lei Xia¹

Affiliations

¹ Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
³ Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: jianyuanjiang@sina.com.
⁴ Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China; The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China.

PMID: 29777890
DOI: 10.1016/j.wneu.2018.05.045

Abstract

Background: Spinal cord injury may cause cortical reconstruction. We, therefore explored the changes in cortical activation before and after anterior cervical decompression and fusion surgery in patients with Hirayama disease (HD).

Methods: In total, 17 cases with HD underwent anterior cervical decompression and fusion surgery. Blood oxygenation level-dependent functional magnetic resonance imaging scan was performed preoperatively, 3 months, 6 months, and 1 year after surgery. Activated voxels were compared between both hands after adjusting for head motion, slice timing, spatial normalization, and image smoothing. Grip strength also was tested in both hands.

Results: A retrospective review indicated that the grip strength of the asymptomatic hand was significantly stronger than the symptomatic hand at the time point before the surgery, 3 months after surgery, 6 months after surgery, and 1 year after surgery (P < 0.001). The grip strength of both symptomatic and asymptomatic hands continuously increased within 6 months after surgery (P < 0.05), but it stopped at 1 year after the surgery. The symptomatic limb tends to produce bilateral activation in the primary motor area (M1) during motor tasks. Both contralateral and ipsilateral M1 activation were stronger in symptomatic hand tasks preoperatively (P < 0.05). Both contralateral and ipsilateral activation in M1 during symptomatic hand tasks began to reduce after surgery, and statistical significance was observed 6 months after surgery (P < 0.05). Contralateral activation was relatively even over 6 months of the surgery (P > 0.05).

Conclusions: After surgery, pathologic reconstruction may have occurred in the primary motor cortex. Recovery of motor function in the symptomatic limb was accompanied by decreased ipsilateral and contralateral M1 activation, as well as symptom improvement. These findings suggested that postoperative cortical activation changes may reflect functional recovery in HD.

Keywords: Anterior decompression and fusion; BOLD-fMRI; Cortical activation; Hirayama disease.

MeSH terms

Adolescent
Cervical Vertebrae / diagnostic imaging
Cervical Vertebrae / surgery*
Decompression, Surgical / trends*
Female
Hand Strength / physiology
Humans
Male
Motor Cortex / diagnostic imaging
Motor Cortex / physiology*
Retrospective Studies
Spinal Fusion / trends*
Spinal Muscular Atrophies of Childhood / diagnostic imaging
Spinal Muscular Atrophies of Childhood / physiopathology*
Spinal Muscular Atrophies of Childhood / surgery*
Young Adult

Supplementary concepts

Amyotrophy, monomelic