Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Medical Biophysics


Dr. Robert Bartha

2nd Supervisor

Dr. Neil Duggal

Joint Supervisor


Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in older adults. CSM can present abruptly with severe symptoms of neurological impairment or insidiously with a slow stepwise deterioration. There is no current imaging modality or biomarker that can help predict which patient will successfully respond to conservative versus surgical treatment. The goal of this thesis was to follow CSM patients longitudinally to assess how brain function, metabolism, and structure correlate to clinical outcomes in the context of recovering neurological function following surgery.

Chapter 1 of this thesis will provide a detailed literature review of the current controversies in treating CSM. Novel imaging techniques that can elucidate cortical adaptations in CSM patients will be discussed. Chapter 2 characterizes the metabolite profile of CSM patients and whether metabolites such as N-Acetylaspartate, a marker of neuronal health, can distinguish CSM patients from healthy controls. Chapter 3 will investigate whether metabolite changes in the primary motor cortex of CSM patients recover following successful surgical intervention and able to predict neurological recovery. The structural integrity of the white matter adjacent to the primary motor and sensory cortices will also be assessed. Chapter 4 will investigate the cortical adaptation and reorganization in mild and moderate CSM severities, prior to and following decompressive surgery. This thesis utilizes novel methods to explore how the cortex attempts to adapt and compensate for neurological deficit, distal to the site of injury, and identify new imaging biomarkers for characterization of CSM severity and predicting functional recovery.