{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T01:32:24Z","timestamp":1776475944461,"version":"3.51.2"},"reference-count":39,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH\/NINDS","award":["2R01NS078494-06"],"award-info":[{"award-number":["2R01NS078494-06"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Degenerative cervical myelopathy (DCM) is a progressive condition characterized by degeneration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord and presentation of clinical symptoms. Compared to healthy controls (HCs), studies have shown DCM patients experience structural and functional reorganization in the brain; however, sex-dependent cortical differences in DCM patients remains largely unexplored. In the present study, we investigate the role of sex differences on the structure of the cerebral cortex in DCM and determine how structural differences may relate to clinical measures of neurological function. T1-weighted structural MRI scans were acquired in 85 symptomatic and asymptomatic patients with DCM and 90 age-matched HCs. Modified Japanese Orthopedic Association (mJOA) scores were obtained for patients. A general linear model was used to determine vertex-level significant differences in gray matter volume (GMV) between the following groups (1) male HCs and female HCs, (2) male patients and female patients, (3) male patients and male HCs, and (4) female patients and female HCs. Within patients, males exhibited larger GMV in motor, language, and vision related brain regions compared to female DCM patients. Males demonstrated a significant positive correlation between GMV and mJOA score, in which patients with worsening neurological symptoms exhibited decreasing GMV primarily across somatosensory and motor related cortical regions. Females exhibited a similar association, albeit across a broader range of cortical areas including those involved in pain processing. In sensorimotor regions, female patients consistently showed smaller GMV compared with male patients, independent of mJOA score. Results from the current study suggest strong sex-related differences in cortical volume in patients with DCM, which may reflect hormonal influence or differing compensation mechanisms.<\/jats:p>","DOI":"10.3390\/jcm10173965","type":"journal-article","created":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T11:39:03Z","timestamp":1630496343000},"page":"3965","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy"],"prefix":"10.3390","volume":"10","author":[{"given":"Talia C.","family":"Oughourlian","sequence":"first","affiliation":[{"name":"UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA"},{"name":"Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"},{"name":"Neuroscience Interdepartmental Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chencai","family":"Wang","sequence":"additional","affiliation":[{"name":"UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA"},{"name":"Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noriko","family":"Salamon","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Langston T.","family":"Holly","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin M.","family":"Ellingson","sequence":"additional","affiliation":[{"name":"UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA"},{"name":"Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"},{"name":"Neuroscience Interdepartmental Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1056\/NEJMra2003558","article-title":"Degenerative Cervical Spondylosis","volume":"383","author":"Theodore","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","first-page":"176","article-title":"Cervical Spondylotic Myelopathy","volume":"16","author":"Tracy","year":"2010","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1136\/bmj.39127.608299.80","article-title":"Cervical spondylosis and neck pain","volume":"334","author":"Binder","year":"2007","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1097\/BRS.0b013e3182a7f2c3","article-title":"Pathophysiology and Natural History of Cervical Spondylotic Myelopathy","volume":"38","author":"Karadimas","year":"2013","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1093\/neuros\/nyy066","article-title":"Alterations in Cortical Thickness and Subcortical Volume are Associated with Neurological Symptoms and Neck Pain in Patients with Cervical Spondylosis","volume":"84","author":"Woodworth","year":"2018","journal-title":"Neurosurgery"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102624","DOI":"10.1016\/j.nicl.2021.102624","article-title":"Cortical volume reductions as a sign of secondary cerebral and cerebellar impairment in patients with degenerative cervical myelopathy","volume":"30","author":"Mainz","year":"2021","journal-title":"NeuroImage Clin."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1007\/s00234-020-02413-z","article-title":"Volumetric and functional connectivity alterations in patients with chronic cervical spondylotic pain","volume":"62","author":"Yang","year":"2020","journal-title":"Neuroradiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jocn.2019.08.008","article-title":"Neck disability in patients with cervical spondylosis is associated with altered brain functional connectivity","volume":"69","author":"Holly","year":"2019","journal-title":"J. Clin. Neurosci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e740","DOI":"10.1016\/j.wneu.2018.07.257","article-title":"Resting-State Functional Magnetic Resonance Imaging Connectivity of the Brain Is Associated with Altered Sensorimotor Function in Patients with Cervical Spondylosis","volume":"119","author":"Woodworth","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"147129","DOI":"10.1016\/j.brainres.2020.147129","article-title":"Compensatory brainstem functional and structural connectivity in patients with degenerative cervical myelopathy by probabilistic tractography and functional MRI","volume":"1749","author":"Wang","year":"2020","journal-title":"Brain Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"544","DOI":"10.3171\/spi.2007.6.6.5","article-title":"Cortical reorganization in patients with cervical spondylotic myelopathy","volume":"6","author":"Holly","year":"2007","journal-title":"J. Neurosurg. Spine"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"K\u00f6vesdi, E., Szab\u00f3-Meleg, E., and Abrah\u00e1m, I.M. (2020). The Role of Estradiol in Traumatic Brain Injury: Mechanism and Treatment Potential. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22010011"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.expneurol.2014.01.008","article-title":"Sex steroids and neuroprotection in spinal cord injury: A review of preclinical investigations","volume":"259","author":"Elkabes","year":"2014","journal-title":"Exp. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2683","DOI":"10.1002\/cne.23066","article-title":"Neuroprotective effects of testosterone on motoneuron and muscle morphology following spinal cord injury","volume":"520","author":"Byers","year":"2012","journal-title":"J. Comp. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1089\/neu.2017.5329","article-title":"Protective Effects of Estradiol and Dihydrotestosterone following Spinal Cord Injury","volume":"35","author":"Sengelaub","year":"2018","journal-title":"J. Neurotrauma"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1007\/s12035-017-0400-2","article-title":"Estrogen Attenuates Local Inflammasome Expression and Activation after Spinal Cord Injury","volume":"55","author":"Zendedel","year":"2017","journal-title":"Mol. Neurobiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1080\/10790268.2015.1114224","article-title":"Effects of progesterone and vitamin D on outcome of patients with acute traumatic spinal cord injury; a randomized, double-blind, placebo controlled study","volume":"39","author":"Aminmansour","year":"2015","journal-title":"J. Spinal Cord Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1089\/neu.2013.3162","article-title":"Progesterone Reduces Secondary Damage, Preserves White Matter, and Improves Locomotor Outcome after Spinal Cord Contusion","volume":"31","author":"Lima","year":"2014","journal-title":"J. Neurotrauma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1089\/neu.2010.1586","article-title":"Acute Serum Hormone Levels: Characterization and Prognosis after Severe Traumatic Brain Injury","volume":"28","author":"Wagner","year":"2011","journal-title":"J. Neurotrauma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/jnc.14678","article-title":"Sex hormones modulate pathogenic processes in experimental traumatic brain injury","volume":"150","author":"Kirchhoff","year":"2019","journal-title":"J. Neurochem."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1089\/neu.2010.1686","article-title":"Time- and Dose-Dependent Neuroprotective Effects of Sex Steroid Hormones on Inflammatory Cytokines after a Traumatic Brain Injury","volume":"30","author":"Sarkaki","year":"2013","journal-title":"J. Neurotrauma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3389\/fendo.2019.00261","article-title":"Sex Differences in Sex Hormone Profiles and Prediction of Consciousness Recovery After Severe Traumatic Brain Injury","volume":"10","author":"Zhong","year":"2019","journal-title":"Front. Endocrinol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"802","DOI":"10.3389\/fneur.2020.00802","article-title":"Considerations for Studying Sex as a Biological Variable in Spinal Cord Injury","volume":"11","author":"Stewart","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1097\/00007632-200109010-00014","article-title":"Interobserver and Intraobserver Reliability of the Japanese Orthopaedic Association Scoring System for Evaluation of Cervical Compression Myelopathy","volume":"26","author":"Yonenobu","year":"2001","journal-title":"Spine"},{"key":"ref_25","unstructured":"(2021, August 30). Imaging Data Parkinson\u2019s Progression Markers Initiative (PPMI). Available online: https:\/\/onlinelibrary.wiley.com\/doi\/pdfdirect\/10.1002\/acn3.644."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1006\/nimg.1998.0396","article-title":"Cortical Surface-Based Analysis: II: Inflation, Flattening, and a Surface-Based Coordinate System","volume":"9","author":"Fischl","year":"1999","journal-title":"NeuroImage"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.neuroimage.2006.01.021","article-title":"An automated labeling system for subdividing the human cerebral cortex on MRI scans into gyral based regions of interest","volume":"31","author":"Desikan","year":"2006","journal-title":"NeuroImage"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"617.e1","DOI":"10.1016\/j.neurobiolaging.2010.07.013","article-title":"Normal age-related brain morphometric changes: Nonuniformity across cortical thickness, surface area and gray matter volume?","volume":"33","author":"Lemaitre","year":"2012","journal-title":"Neurobiol. Aging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1093\/cercor\/bhh032","article-title":"Thinning of the Cerebral Cortex in Aging","volume":"14","author":"Salat","year":"2004","journal-title":"Cereb. Cortex"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1006\/nimg.2001.0857","article-title":"Cerebral Asymmetry and the Effects of Sex and Handedness on Brain Structure: A Voxel-Based Morphometric Analysis of 465 Normal Adult Human Brains","volume":"14","author":"Good","year":"2001","journal-title":"NeuroImage"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.neuroimage.2007.03.063","article-title":"Sex differences in regional gray matter in healthy individuals aged 44\u201348 years: A voxel-based morphometric study","volume":"36","author":"Chen","year":"2007","journal-title":"NeuroImage"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"8774","DOI":"10.1523\/JNEUROSCI.0115-09.2009","article-title":"Minute Effects of Sex on the Aging Brain: A Multisample Magnetic Resonance Imaging Study of Healthy Aging and Alzheimer\u2019s Disease","volume":"29","author":"Fjell","year":"2009","journal-title":"J. Neurosci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.neurobiolaging.2006.05.018","article-title":"Age and gender effects on human brain anatomy: A voxel-based morphometric study in healthy elderly","volume":"28","author":"Smith","year":"2007","journal-title":"Neurobiol. Aging"},{"key":"ref_34","first-page":"1","article-title":"Sex differences in gray matter volume: How many and how large are they really?","volume":"10","author":"Aguirre","year":"2019","journal-title":"Biol. Sex Differ."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"538","DOI":"10.3171\/SPI.2008.10.0831","article-title":"Compensatory cerebral adaptations before and evolving changes after surgical decompression in cervical spondylotic myelopathy","volume":"9","author":"Dong","year":"2008","journal-title":"J. Neurosurg. Spine"},{"key":"ref_36","first-page":"357","article-title":"MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression","volume":"30","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.pmrj.2011.07.008","article-title":"Prevalence of Testosterone Deficiency After Spinal Cord Injury","volume":"3","author":"Durga","year":"2011","journal-title":"PM&R"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1179\/2045772313Y.0000000122","article-title":"Age-related prevalence of low testosterone in men with spinal cord injury","volume":"37","author":"Bauman","year":"2013","journal-title":"J. Spinal Cord Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/01.aco.0000433060.59939.fe","article-title":"Functional MRI and pain","volume":"26","author":"Fomberstein","year":"2013","journal-title":"Curr. Opin. Anaesthesiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/17\/3965\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:54:05Z","timestamp":1760165645000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/17\/3965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,1]]},"references-count":39,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["jcm10173965"],"URL":"https:\/\/doi.org\/10.3390\/jcm10173965","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.740734089.793590291","asserted-by":"object"}]},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,1]]}}}