Distinct Patterns of Cortical Morphology Reorganization in Children with Complete and Incomplete Spinal Cord Injuries

Pediatric spinal cord injury (SCI) induces extensive neuroplastic changes in the developing brain; however, the patterns of cortical remodeling associated with complete (CSCI) and incomplete (ICSCI) injuries remain poorly understood. In this study, high-resolution structural magnetic resonance imaging was used to assess cortical morphological alterations in 72 pediatric SCI patients (38 CSCI and 34 ICSCI) and 37 age-matched healthy controls (HCs). Key cortical metrics-including surface area, thickness, volume, and curvature-were analyzed to characterize injury-related reorganization. Significant group differences were identified across multiple cortical regions. Compared with HCs, both CSCI and ICSCI patients exhibited reduced surface area in the left primary somatosensory cortex (S1), with CSCI patients showing significantly greater surface area than ICSCI. In the left posterior cingulate cortex (PCC), surface area was significantly reduced in the CSCI group compared with ICSCI. Cortical thickness analysis revealed that both patient groups showed increased thickness in the bilateral superior and middle temporal regions, but decreased thickness in the left paracentral lobule, inferior insula, and right supramarginal gyrus (SMG). Notably, CSCI patients had significantly lower thickness in the right SMG than ICSCI patients. For cortical volume, both SCI groups exhibited increased volume in the bilateral transverse frontopolar cortex, with the CSCI group showing significantly greater volume in the right hemisphere compared with ICSCI. No significant differences were found in cortical curvature across groups. Correlation analyses showed that surface area in the left PCC was positively associated with sensory scores across all patients. In ICSCI patients, right frontopolar volume positively correlated with both motor and sensory scores. Receiver operating characteristic analysis demonstrated that surface area (left S1, PCC), cortical thickness (right SMG), and cortical volume (right transverse frontopolar cortex) could differentiate CSCI from ICSCI, with a combined classification model achieving an area under the curve of 0.7980. Our findings indicated that CSCI and ICSCI are associated with distinct patterns of cortical reorganization in regions related to sensory processing and affective-cognitive integration. These results highlight the diagnostic potential of multidimensional cortical morphometry and support its relevance in guiding individualized, neuromodulation-based rehabilitation strategies in pediatric SCI.