J Korean Neurosurg Soc.  2015 Sep;58(3):242-247. 10.3340/jkns.2015.58.3.242.

Brain Activation Evoked by Sensory Stimulation in Patients with Spinal Cord Injury : Functional Magnetic Resonance Imaging Correlations with Clinical Features

• Lee JK
• Oh CH
• Kim JY
• Park HC
• Yoon SH

• KMID: 2191374
• DOI: http://doi.org/10.3340/jkns.2015.58.3.242

Abstract

OBJECTIVE
The purpose of this study is to determine whether the changes of contralateral sensorimotor cortical activation on functional magnetic resonance imaging (fMRI) can predict the neurological outcome among spinal cord injury (SCI) patients when the great toes are stimulated without notice.
METHODS
This study enrolled a total of 49 patients with SCI and investigated each patient's preoperative fMRI, postoperative fMRI, American Spinal Injury Association (ASIA) score, and neuropathic pain occurrence. Patients were classified into 3 groups according to the change of blood oxygenation level dependent (BOLD) response on perioperative fMRI during proprioceptive stimulation with repetitive passive toe movements : 1) patients with a response of contralateral sensorimotor cortical activation in fMRI were categorized; 2) patients with a response in other regions; and 3) patients with no response. Correlation between the result of fMRI and each parameter was analyzed.
RESULTS
In fMRI data, ASIA score was likely to show greater improvement in patients in group A compared to those belonging to group B or C (p<0.001). No statistical significance was observed between the result of fMRI and neuropathic pain (p=0.709). However, increase in neuropathic pain in response to the signal change of the ipsilateral frontal lobe on fMRI was statistically significant (p=0.030).
CONCLUSION
When there was change of BOLD response at the contralateral sensorimotor cortex on perioperative fMRI after surgery, relief of neurological symptoms was highly likely for traumatic SCI patients. In addition, development of neuropathic pain was likely to occur when there was change of BOLD response at ipsilateral frontal lobe.

Keyword

Functional MRI; Spinal cord injury; Proprioceptive; Neuropathic pain

MeSH Terms

Asia
Brain*
Frontal Lobe
Humans
Magnetic Resonance Imaging
Neuralgia
Oxygen
Spinal Cord Injuries*
Spinal Cord*
Spinal Injuries
Toes
Oxygen

Figure

• 

  Fig. 1 An 18-year-old female was admitted after an automobile accident, and was confirmed to have initial ASIA score A (C4 level). A : On the initial spinal MRI, bursting fractures of C5, T3, and T4, as well as severe cord contusion were found. B : Functional MRI (fMRI) was taken 3 months after anterior and posterior fixation surgery. On the fMRI, a signal change was observed in the contralateral primary sensorimotor cortex. After surgery and 6 months conservative treatment, the ASIA score was upgraded to ASIA score B. Her follow up period was 20 months and there was no further improvement. ASIA : American Spinal Injury Association.

• 

  Fig. 2 A 40-year-old female was admitted to this hospital after a pedestrian traffic accident. She was confirmed to have initial ASIA score B (T8 level). A : On the initial spinal MRI, T7 bursting fracture, dislocation, and severe cord contusion were found. B : Functional MRI (fMRI) was taken 2 weeks after posterior decompression and fixation surgery. There was no positive signal in the postoperative fMRI data, despite surgery and treatment. Despite follow up of 20 months, there was no neurologic improvement. ASIA : American Spinal Injury Association.

• 

  Fig. 3 A 41-year-old male was admitted after falling from a height of 5 meters. He was confirmed to have ASIA score A (T12 level). A : On the initial spinal MRI, T12 bursting fracture, dislocation, and severe cord contusion were found. B : Functional MRI (fMRI) was taken 1 week after posterior decompression and fixation surgery. In the fMRI data, there was a signal change in the ipsilateral frontal lobe. After surgery, he was followed up for 36 months, but there was no improvement of follow-up ASIA score. EMG and EP showed no abnormality, but he continued to have neuropathic pain. ASIA : American Spinal Injury Association, EMG : electromyography, EP : electrophysiology study.

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