Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults. Previous supraspinal investigations have primarily focused on cortical changes in this patient population. As the nexus between the brain and the spinal cord, the brainstem has been understudied in patients with DCM. The current study examined the structural and functional connectivity between the brainstem and cortex in DCM patients using probabilistic tractography and resting-state functional MRI. A total of 26 study patients and 32 neurologically intact, healthy volunteers (HCs) participated in this prospective analysis. The study cohort included DCM patients (n = 18), as well as neurologically asymptomatic patients with evidence of cervical spine degenerative changes and spinal cord compression (n = 8). Results of the study demonstrated significant differences in fiber density (FD), fiber cross-section (FDC), and the functional connectivity (FC) between the study cohort and HCs. Through seeding the brainstem, the study cohort showed reductions in FD and FDC along the corticospinal tract, including regions extending through the corona radiata and internal capsule. By correlating FD and FDC with the Neck Disability Index (NDI), and the modified Japanese Orthopaedic Association (mJOA), we identified increasing total volume of projections to the thalamus, basal ganglia, and internal capsule, and increased functional connectivity to visual network and the posterior parietal cortices. These results support our hypothesis that DCM patients tend to have long-term FC reorganization not only localized to sensorimotor regions, but also to regulatory and visual processing regions, designed to ultimately preserve neurological function.

退行性脊髓型颈椎病 (DCM) 是成人脊髓损伤的最常见原因。以前的脊柱上研究主要集中在该患者群体的皮质变化。作为大脑和脊髓之间的纽带，脑干在 DCM 患者中尚未得到充分研究。目前的研究使用概率纤维束成像和静息状态功能 MRI 检查了 DCM 患者脑干和皮层之间的结构和功能连接。共有 26 名研究患者和 32 名神经功能完好的健康志愿者 (HC) 参与了这项前瞻性分析。研究队列包括 DCM 患者（n = 18），以及有颈椎退行性改变和脊髓受压证据的无神经症状患者（n = 8）。研究结果表明，研究队列和 HC 之间的纤维密度 (FD)、纤维横截面 (FDC) 和功能连接性 (FC) 存在显着差异。通过接种脑干，研究队列显示沿皮质脊髓束的 FD 和 FDC 减少，包括通过放射冠和内囊延伸的区域。通过将 FD 和 FDC 与颈部残疾指数 (NDI) 和改良的日本骨科协会 (mJOA) 相关联，我们确定了增加对丘脑、基底神经节和内囊的投射总量，并增加了与视觉网络和后顶叶皮质。这些结果支持我们的假设，即 DCM 患者往往有长期的 FC 重组，不仅限于感觉运动区域，