140 Brain Reorganization Reveals the Structure-Function Paradox in Degenerative Cervical Myelopathy (DCM)

INTRODUCTION: Degenerative cervical myelopathy is the most common cause of chronic spinal cord injury. The decision to operate is commonly surgeon dependent, and often varies greatly in cases of mild compression. METHODS: A 3.0T MRI scanner acquired resting state fMRI (rs-fMRI), functional MRI (fMRI) and structural scans from 30 DCM patients and 22 HCs. Quantitative clinical assessments were performed to associate brain changes and DCM severity. RESULTS: DCM patients had variations in both cortical thickness and functional connectivity patterns compared to controls. Specifically, pronounced cortical thinning in critical regions including bilateral precentral/prefrontal gyri, pars triangularis, postcentral gyrus, and visual cortices (p = 0.04). Concurrently, alterations in functional connectivity were significant, characterized by a diminished connection between the sensorimotor cortices and brain areas (ex: insular cortex, Heschl's gyrus). These changes associated with motor deficits (p < 0.0001). The reductions in thickness in motor regions were associated with reduced dexterity (R 2 = 0.33,p < 0.0007;R 2 = 0.34,p = 0.005). Interestingly, mJOA scores (the gold standard) correlated only with thickness changes in the contralateral precuneus, without a significant link to sensorimotor thickness or functional connectivity alterations. CONCLUSIONS: These findings underscore that DCM precipitates significant cortical thinning and functional connectivity modifications key regions of sensory/motor processing, findings associated with quantifiable motor impairments. These findings suggest “upstream” changes play a critical role in this disease and influence response to treatment.