Functional alterations across motor, visual, and attention cerebellar and cortical networks in patients with asymptomatic spinal cord compression.

Objective: The goal of this study was to investigate the patterns of functional connectivity (FC) in patients with asymptomatic cervical spinal cord compression and determine how the patterns differ from those in healthy controls and correlate with spinal compression and Neck Disability Index (NDI) scores.

Methods: This cross-sectional study consisted of 45 patients with asymptomatic spinal cord compression (ASCC) and 35 healthy controls (HCs) with resting-state functional MRI (rs-fMRI) scans. The patients with ASCC also had sagittal and axial T2-weighted cervical spine MRI scans. The rs-fMRI scans were used for region of interest to region of interest analyses that generated brain networks of FC that could be compared between and within groups.

Results: The patients with ASCC had stronger FC between visual and motor regions than the HCs, with the intracalcarine cortex (occipital cortex) as the largest hub of connection strength differences. Within the ASCC cohort, the cerebellar region associated with attention (multi-domain task battery [MDTB] region 5) was the hub of functional changes related to the severity of spinal compression. However, the NDI scores of patients covaried most with functional connections of the left superior parietal lobule.

Conclusions: This study indicated that functional brain changes are evident before neurological symptoms appear. These alterations in FC patterns reflect a systematic reorganization of neural dynamics, suggesting that the brain adaptively reconfigures its computational architecture to compensate for compromised signal transmission through the compressed spinal cord. Patients with ASCC appear to rely more on visual information to maintain normal sensorimotor function, as proprioception information is likely compromised due to spinal compression. Their functional changes in the subregion of the cerebellum involved in attention indicate possible strain on multitasking and working memory. Finally, connectivity differences related to NDI scores support the idea that the superior parietal lobule helps to compensate for motor difficulties. These early adaptations in brain computation could serve as crucial biomarkers for disease progression, potentially enabling more precise timing of clinical interventions in this challenging patient population.