Cortical Reorganizations for Recovery from Depressive State After Spinal Decompression Surgery

Background: Depressed mood following neuronal damage not only impedes functional recovery but also negatively affects quality of life for many patients. Depressed patients with cervical myelopathy often show improvement in both mood and motor function after spinal decompression surgery; however, the neural mechanism underlying this psychological benefit from surgery remains unclear. The aim of this study was to clarify the brain sites that relate to alleviation of depression after spinal decompression surgery.

Methods: We compared brain activity of patients with cervical myelopathy (n = 6) with healthy participants (n = 5) using functional magnetic resonance imaging. We then analyzed functional magnetic resonance imaging data to find the brain regions that correlated with depression severity (n = 12; 6 preoperative patients and 6 postoperative patients) and compared preoperative imaging data with postoperative imaging data from patients.

Results: Spinal decompression surgery alleviated depression and diminished anterior cingulate cortex activity. Simultaneously, supplementary motor area activity, which was increased in patients with myelopathy compared with control subjects, was diminished after surgery.

Conclusions: Traditionally, surgical indications for myelopathy are determined by the severity of sensorimotor symptoms without considering psychological symptoms. We anticipate our results will lead to more informed surgical decisions for cervical spondylosis myelopathy.