Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy.

Talia C Oughourlian,Noriko Salamon,Chencai Wang,Benjamin M Ellingson,Langston T Holly

doi:10.3390/jcm10173965

Abstract

Degenerative cervical myelopathy (DCM) is a progressive condition characterized by degeneration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord and presentation of clinical symptoms. Compared to healthy controls (HCs), studies have shown DCM patients experience structural and functional reorganization in the brain; however, sex-dependent cortical differences in DCM patients remains largely unexplored. In the present study, we investigate the role of sex differences on the structure of the cerebral cortex in DCM and determine how structural differences may relate to clinical measures of neurological function. T1-weighted structural MRI scans were acquired in 85 symptomatic and asymptomatic patients with DCM and 90 age-matched HCs. Modified Japanese Orthopedic Association (mJOA) scores were obtained for patients. A general linear model was used to determine vertex-level significant differences in gray matter volume (GMV) between the following groups (1) male HCs and female HCs, (2) male patients and female patients, (3) male patients and male HCs, and (4) female patients and female HCs. Within patients, males exhibited larger GMV in motor, language, and vision related brain regions compared to female DCM patients. Males demonstrated a significant positive correlation between GMV and mJOA score, in which patients with worsening neurological symptoms exhibited decreasing GMV primarily across somatosensory and motor related cortical regions. Females exhibited a similar association, albeit across a broader range of cortical areas including those involved in pain processing. In sensorimotor regions, female patients consistently showed smaller GMV compared with male patients, independent of mJOA score. Results from the current study suggest strong sex-related differences in cortical volume in patients with DCM, which may reflect hormonal influence or differing compensation mechanisms.

Highlights

Degenerative cervical myelopathy (DCM) is a chronic condition involving the progressive deterioration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord [1,2]
Patients demonstrate increased anatomical and functional connectivity within sensorimotor and pain related brain regions associated with patient symptom severity [8,9], possibly due to compensatory mechanisms resulting from spinal cord neuronal atrophy [5,6,8,9,10,11]
Following the overlapping of significant clusters observed in the male group and significant clusters observed in the female group, we identified common cortical regions showing significant correlations between gray matter volume (GMV) and modified Japanese Orthopedic Association (mJOA) in both male and female groups

Summary

Introduction

Degenerative cervical myelopathy (DCM) is a chronic condition involving the progressive deterioration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord [1,2]. Patients demonstrate increased anatomical and functional connectivity within sensorimotor and pain related brain regions associated with patient symptom severity [8,9], possibly due to compensatory mechanisms resulting from spinal cord neuronal atrophy [5,6,8,9,10,11]. These previous studies have identified unique anatomic features associated with DCM, the potential of sex as a biological variable in this disease remains largely unexplored

Methods

Results

Discussion

Conclusion