ORIGINAL RESEARCH article
Front. Neurol.
Sec. Applied Neuroimaging
Chronic spinal cord injury is associated with morphometric brain changes in functional networks beyond the sensorimotor system
Provisionally accepted
Lorenzo Diana1
Jothini Sritharan1,2
Vanessa Vallesi1,3Nicola Brunello1,4Rajeev K Verma1,2,5
Giuseppe A Zito1,2*- 1Swiss Paraplegic Research, Nottwil, Switzerland
- 2Faculty of Health Sciences and Medicine, Universitat Luzern, Lucerne, Switzerland
- 3Support Centre for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
- 4Universitat Bern, Bern, Switzerland
- 5Swiss Paraplegic Centre, Nottwil, Switzerland
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Spinal cord injury (SCI) leads to motor and sensory deficits, triggering widespread neurodegeneration across the central nervous system. While sensorimotor brain changes have been widely studied, growing evidence suggests that SCI also affects regions involved in cognition, emotion, and pain regulation—domains frequently altered in the chronic stage. However, morphological alterations in higher-order brain networks remain poorly characterized. To address this gap, we investigated structural brain changes in chronic SCI using voxel-based and surface-based morphometry, focusing on large-scale functional networks. We retrospectively analyzed high-resolution T1-weighted MRI data from 45 individuals with chronic traumatic SCI and 45 matched controls. Gray matter volume and cortical thickness were estimated with CAT12. Group comparisons and associations with clinical measures—including time since injury, sensorimotor impairment, and chronic pain—were assessed using whole-brain and region-based morphometry mapped to the Schaefer functional atlas. Compared to controls, SCI participants showed reduced volume in the precentral gyrus (sensorimotor network), increased volume in the right precuneus (executive control network) and reduced cortical thickness in the left temporal pole (limbic network). Longer time since injury and greater sensorimotor deficits were associated with atrophy in sensorimotor, temporo-parietal, and prefrontal regions spanning executive, attentional, default mode, and salience networks. Additionally, chronic pain was linked to atrophy in the sensorimotor cortex, basal ganglia, and cerebellum. These findings suggest that chronic SCI is associated with widespread morphometric changes beyond the sensorimotor system. Such alterations may underlie cognitive, emotional, and pain-related symptoms, and represent potential biomarkers of secondary health complications following SCI.
Keywords: Chronic spinal cord injury, secondary health issues, voxel-based morphometry, Surface-based morphometry, Functional Networks
Received: 31 Jul 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Diana, Sritharan, Vallesi, Brunello, Verma and Zito. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Giuseppe A Zito, giuseppe.zito@paraplegie.ch
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