Recovery of thalamic damage after decompression by 1H-MRS in combination with Diffusion Tensor Imaging(DTI) in patients with cervical spondylotic myelopathy.

BACKGROUND

To access the changes of thalamic metabolites before and after surgery in patients with Cervical Spondylotic Myelopathy (CSM) using Hydrogen Proton Magnetic Resonance Spectroscopy (1H-MRS) combined with Diffusion Tensor Imaging (DTI) and to investigate its association with improvement in neurological function.

METHODS

Forty-eight CSM patients who underwent cervical decompression surgery from December 2022 to June 2023 were included, and 33 healthy volunteers were recruited. All subjects underwent bilateral thalamic 1H-MRS and DTI scans before the surgical procedure, and subsequently again 6 months later. Neurological function was assessed pre-operatively and post-operatively (6 months) in all patients with CSM using the modified Japanese Orthopaedic Association (mJOA). The changes of mJOA (△mJOA = postoperative mJOA - preoperative mJOA) were employed as an indicator of neurological improvement. The pro- and postoprative N-acetylaspartate/creatine (NAA/Cr), choline/creatine (Cho/Cr), myo-inositol /creatine (mI/Cr), glutamate and glutamine complex/creatine (Glx/Cr) fractional anisotropy (FA), apparent diffusion coefficient (ADC) were statistically compared in CSM patients and healthy controls (HCs). A correlation analysis was conducted to determine the relationship between alterations in pre- and postoperative metabolite ratios (△NAA/Cr, △Cho/Cr, △mI/Cr, △Glx/Cr), △FA, △ADC and ΔmJOA.

RESULTS

Results Compared to the HCs, patients with CSM showed significantly pre- and post-operative NAA/Cr (t = -4.988, P < 0.001; t = -3.562, P = 0.001), Cho/Cr (t = -5.946, P < 0.001; t = -2.764, P = 0.007), mI/Cr (t = -3.988, P < 0.001; t = -2.079, P = 0.041) and FA (t = -4.884, P < 0.001; t = -3.813, P < 0.001). There was no difference in Glx/Cr and ADC between patients in patients with CSM, either preoperatively or postoperatively, compared to HCs. Post-operative NAA/Cr (t = -2.805, P = 0.007), mI/Cr (t = -3.285, P = 0.003) and FA (t = -2.690, P = 0.007) were increased in CSM patients compared to pre-operative NAA/Cr and mI/Cr. In CSM patients, ΔmI/Cr correlated significantly with ΔmJOA (r = 0.4782, P < 0.001).

CONCLUSION

The preliminary findings indicate that metabolites in the thalamus of CSM patients exhibit changes following surgery. Additionally, it has been demonstrated that elevated post operiative mI correlates with improvements in neurological function.