Cerebral White Matter Alterations Revealed by Multiple Diffusion Metrics in Cervical Spondylotic Patients with Pain: A TBSS Study

Objective The aims of the present study were to investigate white matter alterations and their associations with the clinical variables in cervical spondylotic (CS) patients with pain. Design Cross-sectional study. Setting Chinese community. Subjects Forty-two CS patients with pain and 42 matched healthy participants were ultimately recruited from August 2018 to September 2019. Methods Tract-based spatial statistics (TBSS) analysis was performed to investigate the differences of DTI-derived indices (fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD)) between the patients and healthy controls throughout brain white matter. The relationship of the severity of cervical pain and affective disturbance to aberrant DTI indices in the patients was also examined using spearman correlation analyses. Results The CS patients with pain showed decreased FA in the genu, body, and splenium portions of corpus callosum (CC), and increased MD and RD along with decreased FA in anterior corona radiata (ACR) compared with healthy controls, whereas no significant difference of AD was observed between groups. Additionally, lower FA of the genu part of CC together with higher MD of the left ACR were statistically correlated with the pain severity in the patient group. Conclusions Decreased FA coupled with increased MD and RD was detected in multiple white matter regions, and several DTI metrics in certain white matter tracts had moderate relationships with the pain severity in the CS patients with pain. These observations may provide alternative imaging clues for the evaluation of the pathophysiological characteristics of CS pain.

Automated summary

This study investigated white matter alterations in cervical spondylotic patients with pain and their associations with clinical variables. The results showed decreased fractional anisotropy (FA) and increased mean diffusivity (MD) and radial diffusivity (RD) in multiple white matter regions of these patients. Furthermore, certain DTI metrics were found to have moderate relationships with the severity of pain. These findings provide alternative imaging clues for evaluating the pathophysiological characteristics of cervical spondylotic pain.