1
|
Smith AC, Ahmed RU, Weber KA, Negahdar M, Gibson D, Boakye M, Rejc E. Spinal cord lesion MRI and behavioral outcomes in a miniature pig model of spinal cord injury: exploring preclinical potential through an ad hoc comparison with human SCI. Spinal Cord Ser Cases 2024; 10:44. [PMID: 38977671 PMCID: PMC11231227 DOI: 10.1038/s41394-024-00658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
STUDY DESIGN prospective case series of Yucatan miniature pig spinal cord contusion injury model with comparison to human cases of spinal cord injury (SCI). OBJECTIVES to describe magnetic resonance imaging (MRI) measures of spinal cord lesion severity along with estimates of lateral corticospinal tracts spared neural tissue in both a less severe and more severe contusion SCI model, as well as to describe their corresponding behavioral outcome changes. SETTING University laboratory setting. METHODS Following a more severe and less severe SCI, each pig underwent spinal cord MRI to measure lesion characteristics, along with locomotor and urodynamics outcomes testing. RESULTS In the pig with more severe SCI, locomotor and urodynamic outcomes were poor, and both the spinal cord lesion volume and damage estimates to the lateral corticospinal tracts were large. Conversely, in the pig with less severe SCI, locomotor and urodynamic outcomes were favorable, with the spinal cord lesion volume and damage estimates to the lateral corticospinal tracts being less pronounced. For two human cases matched on estimates of damage to the lateral corticospinal tract regions, the clinical presentations were similar to the pig outcomes, with more limited mobility and more limited bladder functional independence in the more severe case. CONCLUSIONS Our initial findings contribute valuable insights to the emergent field of MRI-based evaluation of spinal cord lesions in pig models, offering a promising avenue for understanding and potentially improving outcomes in spinal cord injuries.
Collapse
Affiliation(s)
- Andrew C Smith
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA.
| | - Rakib Uddin Ahmed
- University of Louisville School of Medicine, Department of Neurosurgery, Louisville, KY, USA
| | - Kenneth A Weber
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, CA, USA
| | - MohammadJavad Negahdar
- University of Louisville School of Medicine, Department of Radiology, Louisville, KY, USA
| | - Destiny Gibson
- University of Louisville School of Medicine, Department of Neurosurgery, Louisville, KY, USA
| | - Maxwell Boakye
- University of Louisville School of Medicine, Department of Neurosurgery, Louisville, KY, USA
| | - Enrico Rejc
- University of Udine, Department of Medicine, Udine, Italy
- Kessler Foundation, West Orange, NJ, USA
| |
Collapse
|
2
|
Thornton WA, Smulligan K, Weber KA, Tefertiller C, Mañago M, Sevigny M, Wiley L, Stevens-Lapsley J, Smith AC. Lesion characteristics are associated with bowel, bladder, and overall independence following cervical spinal cord injury. J Spinal Cord Med 2024:1-9. [PMID: 38958637 DOI: 10.1080/10790268.2024.2363005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
CONTEXT/OBJECTIVE There is a growing global interest in quantifying spinal cord lesions and spared neural tissue using magnetic resonance imaging (MRI) in individuals with spinal cord injury (SCI). The primary objective of this study was to assess the relationships between spinal cord lesion characteristics assessed on MRI and bowel, bladder, and overall independence following SCI. DESIGN Retrospective, exploratory study. PARTICIPANTS 93 individuals with cervical SCI who were enrolled in a local United States Model Systems SCI database from 2010 to 2017. METHODS Clinical and MRI data were obtained for potential participants, and MRIs of eligible participants were analyzed. Explanatory variables, captured on MRIs, included intramedullary lesion length (IMLL), midsagittal ventral tissue bridge width (VTBW), midsagittal dorsal tissue bridge width (DTBW), and axial damage ratio (ADR). OUTCOME MEASURES Bowel and bladder management scale of the Functional Independence Measure (FIM) and FIM total motor score. RESULTS When accounting for all four variables, only ADR was significantly associated with bowel independence (OR = 0.970, 95% CI: 0.942-0.997, P = 0.030), and both ADR and IMLL were strongly associated with bladder independence (OR = 0.967, 95% CI: 0.936-0.999, P = 0.046 and OR = 0.948, 95% CI: 0.919-0.978, P = 0.0007, respectively). 32% of the variation in overall independence scores were explained by all four predictive variables, but only ADR was significantly associated with overall independence after accounting for all other predictive variables (β = -0.469, 95% CI: -0.719, -0.218, P = 0.0004). CONCLUSIONS Our results suggest that the MRI-measured extent of spinal cord lesion may be predictive of bowel, bladder, and overall independence following cervical SCI.
Collapse
Affiliation(s)
- Wesley A Thornton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
- Craig Hospital, Englewood, Colorado, USA
| | - Katherine Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Mark Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Laura Wiley
- Department of Biostatistics & Informatics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
3
|
Valošek J, Cohen-Adad J. Reproducible Spinal Cord Quantitative MRI Analysis with the Spinal Cord Toolbox. Magn Reson Med Sci 2024; 23:307-315. [PMID: 38479843 PMCID: PMC11234946 DOI: 10.2463/mrms.rev.2023-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
The spinal cord plays a pivotal role in the central nervous system, providing communication between the brain and the body and containing critical motor and sensory networks. Recent advancements in spinal cord MRI data acquisition and image analysis have shown a potential to improve the diagnostics, prognosis, and management of a variety of pathological conditions. In this review, we first discuss the significance of standardized spinal cord MRI acquisition protocol in multi-center and multi-manufacturer studies. Then, we cover open-access spinal cord MRI datasets, which are important for reproducible science and validation of new methods. Finally, we elaborate on the recent advances in spinal cord MRI data analysis techniques implemented in the open-source software package Spinal Cord Toolbox (SCT).
Collapse
Affiliation(s)
- Jan Valošek
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
4
|
Karthik EN, Valosek J, Smith AC, Pfyffer D, Schading-Sassenhausen S, Farner L, Weber KA, Freund P, Cohen-Adad J. SCIseg: Automatic Segmentation of T2-weighted Intramedullary Lesions in Spinal Cord Injury. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.03.24300794. [PMID: 38699309 PMCID: PMC11065035 DOI: 10.1101/2024.01.03.24300794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Purpose To develop a deep learning tool for the automatic segmentation of T2-weighted intramedullary lesions in spinal cord injury (SCI). Material and Methods This retrospective study included a cohort of SCI patients from three sites enrolled between July 2002 and February 2023. A deep learning model, SCIseg, was trained in a three-phase process involving active learning for the automatic segmentation of intramedullary SCI lesions and the spinal cord. The data consisted of T2-weighted MRI acquired using different scanner manufacturers with heterogeneous image resolutions (isotropic/anisotropic), orientations (axial/sagittal), lesion etiologies (traumatic/ischemic/hemorrhagic) and lesions spread across the cervical, thoracic and lumbar spine. The segmentations from the proposed model were visually and quantitatively compared with other open-source baselines. Wilcoxon signed-rank test was used to compare quantitative MRI biomarkers (lesion volume, lesion length, and maximal axial damage ratio) computed from manual lesion masks and those obtained automatically with SCIseg predictions. Results MRI data from 191 SCI patients (mean age, 48.1 years ± 17.9 [SD]; 142 males) were used for model training and evaluation. SCIseg achieved the best segmentation performance for both the cord and lesions. There was no statistically significant difference between lesion length and maximal axial damage ratio computed from manually annotated lesions and those obtained using SCIseg. Conclusion Automatic segmentation of intramedullary lesions commonly seen in SCI replaces the tedious manual annotation process and enables the extraction of relevant lesion morphometrics in large cohorts. The proposed model segments lesions across different etiologies, scanner manufacturers, and heterogeneous image resolutions. SCIseg is open-source and accessible through the Spinal Cord Toolbox.
Collapse
Affiliation(s)
- Enamundram Naga Karthik
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
| | - Jan Valosek
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| | - Andrew C Smith
- Department of Physical Medicine and Rehabilitation Physical Therapy Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Dario Pfyffer
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Lynn Farner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
5
|
Smith AC, Draganich C, Thornton WA, Berliner JC, Lennarson PJ, Rejc E, Sevigny M, Charlifue S, Tefertiller C, Weber KA. A Single Dermatome Clinical Prediction Rule for Independent Walking 1 Year After Spinal Cord Injury. Arch Phys Med Rehabil 2024; 105:10-19. [PMID: 37414239 PMCID: PMC10766862 DOI: 10.1016/j.apmr.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To derive and validate a simple, accurate CPR to predict future independent walking ability after SCI at the bedside that does not rely on motor scores and is predictive for those initially classified in the middle of the SCI severity spectrum. DESIGN Retrospective cohort study. Binary variables were derived, indicating degrees of sensation to evaluate predictive value of pinprick and light touch variables across dermatomes. The optimal single sensory modality and dermatome was used to derive our CPR, which was validated on an independent dataset. SETTING Analysis of SCI Model Systems dataset. PARTICIPANTS Individuals with traumatic SCI. The data of 3679 participants (N=3679) were included with 623 participants comprising the derivation dataset and 3056 comprising the validation dataset. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported ability to walk both indoors and outdoors. RESULTS Pinprick testing at S1 over lateral heels, within 31 days of SCI, accurately identified future independent walkers 1 year after SCI. Normal pinprick in both lateral heels provided good prognosis, any pinprick sensation in either lateral heel provided fair prognosis, and no sensation provided poor prognosis. This CPR performed satisfactorily in the middle SCI severity subgroup. CONCLUSIONS In this large multi-site study, we derived and validated a simple, accurate CPR using only pinprick sensory testing at lateral heels that predicts future independent walking after SCI.
Collapse
Affiliation(s)
- Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.
| | - Christina Draganich
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO; Craig Hospital, Englewood, CO
| | - Wesley A Thornton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Jeffrey C Berliner
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Peter J Lennarson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
| | - Enrico Rejc
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY; Department of Medicine, University of Udine, Udine, Italy
| | | | | | | | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA
| |
Collapse
|
6
|
Elliott JM, Walton DM, Albin SR, Courtney DM, Siegmund GP, Carroll LJ, Weber KA, Smith AC. Biopsychosocial sequelae and recovery trajectories from whiplash injury following a motor vehicle collision. Spine J 2023; 23:1028-1036. [PMID: 36958668 PMCID: PMC10330498 DOI: 10.1016/j.spinee.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND CONTEXT Five out of 10 injured in a motor vehicle collision (MVC) will develop persistent pain and disability. It is unclear if prolonged symptoms are related to peritraumatic pain/disability, psychological distress, muscle fat, lower extremity weakness. PURPOSE To test if widespread muscle fat infiltration (MFI) was (1) unique to those with poor recovery, (2) present in the peritraumatic stage, (3) related to known risk factors. STUDY DESIGN/SETTING A cohort study, single-center academic hospital. PATIENT SAMPLES A total of 97 men and women (age 18-65) presenting to an urban academic emergency medicine department following MVC, but not requiring inpatient hospitalization. PRIMARY OUTCOME MEASURE Neck disability at 12-months. METHODS Participants underwent magnetic resonance imaging (MRI) to quantify neck and lower extremity MFI, completed questionnaires on pain/disability and psychological distress (< 1-week, 2-weeks, 3-, and 12-months) and underwent maximum volitional torque testing of their lower extremities (2-weeks, 3-, and 12-months). Percentage score on the Neck Disability Index at 12-months was used for a model of (1) Recovered (0%-8%), (2) Mild (10%-28%), and (3) Moderate/Severe (≥ 30%). This model was adjusted for BMI and age. RESULTS Significant differences for neck MFI were revealed, with the Recovered group having significantly lower neck MFI than the Mild and Moderate/Severe groups at all time points. The Mild group had significantly more leg MFI at 12-months (p=.02) than the Recovered group. There were no other significant differences at any other time point. Lower extremity torques revealed no group differences. The Traumatic Injury Distress Scale (TIDS) and MFI of the neck at 1-week postinjury significantly predicted NDI score at 12-months. CONCLUSIONS Higher neck MFI and distress may represent a risk factor though it is unclear whether this is a pre-existing phenotype or result of the trauma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02157038.
Collapse
Affiliation(s)
- J M Elliott
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, The Kolling Institute, 10 Westbourne St, St Leonards, New South Wales, 2065, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Chicago, IL 60611, USA.
| | - D M Walton
- Faculty of Health Sciences, School of Physical Therapy, Western University Canada Schulich School of Medicine and Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada; Department of Psychiatry, Western University Canada, 151 Richmond St, London, Ontario N6A 5C1, Canada
| | - S R Albin
- School of Physical Therapy, Regis University, 3333 Regis Boulevard Denver, CO 80221-1099, USA
| | - D M Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - G P Siegmund
- MEA Forensics, 11151 Horseshoe Way, Richmond, British Columbia V7A 4S5, Canada
| | - L J Carroll
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - K A Weber
- Division of Pain Medicine, Stanford School of Medicine, 900 Blake Wilbur Dr, Palo Alto, CA 94304, USA
| | - A C Smith
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, 12631 E 17th Ave, Aurora, CO 80045, USA
| |
Collapse
|
7
|
Trò R, Roascio M, Tortora D, Severino M, Rossi A, Cohen-Adad J, Fato MM, Arnulfo G. Diffusion Kurtosis Imaging of Neonatal Spinal Cord in Clinical Routine. FRONTIERS IN RADIOLOGY 2022; 2:794981. [PMID: 37492682 PMCID: PMC10365122 DOI: 10.3389/fradi.2022.794981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 07/27/2023]
Abstract
Diffusion kurtosis imaging (DKI) has undisputed advantages over the more classical diffusion magnetic resonance imaging (dMRI) as witnessed by the fast-increasing number of clinical applications and software packages widely adopted in brain imaging. However, in the neonatal setting, DKI is still largely underutilized, in particular in spinal cord (SC) imaging, because of its inherently demanding technological requirements. Due to its extreme sensitivity to non-Gaussian diffusion, DKI proves particularly suitable for detecting complex, subtle, fast microstructural changes occurring in this area at this early and critical stage of development, which are not identifiable with only DTI. Given the multiplicity of congenital anomalies of the spinal canal, their crucial effect on later developmental outcome, and the close interconnection between the SC region and the brain above, managing to apply such a method to the neonatal cohort becomes of utmost importance. This study will (i) mention current methodological challenges associated with the application of advanced dMRI methods, like DKI, in early infancy, (ii) illustrate the first semi-automated pipeline built on Spinal Cord Toolbox for handling the DKI data of neonatal SC, from acquisition setting to estimation of diffusion measures, through accurate adjustment of processing algorithms customized for adult SC, and (iii) present results of its application in a pilot clinical case study. With the proposed pipeline, we preliminarily show that DKI is more sensitive than DTI-related measures to alterations caused by brain white matter injuries in the underlying cervical SC.
Collapse
Affiliation(s)
- Rosella Trò
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Monica Roascio
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | | | | | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Mila—Quebec AI Institute, Montreal, QC, Canada
| | - Marco Massimo Fato
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Gabriele Arnulfo
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| |
Collapse
|
8
|
Tefertiller C, Rozwod M, VandeGriend E, Bartelt P, Sevigny M, Smith AC. Transcutaneous Electrical Spinal Cord Stimulation to Promote Recovery in Chronic Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 2. [PMID: 36004322 PMCID: PMC9396932 DOI: 10.3389/fresc.2021.740307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To evaluate the impact of using transcutaneous electrical spinal cord stimulation (TSCSTSCS) on upper and lower extremity function in individuals with chronic spinal cord injury (SCI). Design: Prospective case series. Setting: SCI specific rehabilitation hospital. Participants: A convenience sample (N = 7) of individuals with tetraplegia who had previously been discharged from outpatient therapy due to a plateau in progress. Interventions: Individuals participated in 60 min of upper extremity (UE) functional task-specific practice (FTP) in combination with TSCS and 60 min of locomotor training in combination with TSCS 5x/week. Main Outcome Measures: The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS), LE motor score (LEMS), sensation (light touch and pin prick), Nine-Hole Peg Test, 10 meter walk test, 6 min walk test, and 5 min stand test. Results: Seven individuals (four motor complete; three motor incomplete) completed 20–80 sessions UE and LE training augmented with TSCS and without any serious adverse events. Improvements were reported on the CUE-T in all seven individuals. Two individuals improved their ASIA impairment scale (AIS) classification (B to C; C to D) and two individuals improved their neurologic level of injury by one level (C4–C5; C5–C6). Sensation improved in five individuals and all four who started out with motor complete SCIs were able to voluntarily activate their LEs on command in the presence of stimulation. Conclusion: Individuals with chronic SCI who had previously demonstrated a plateau in function after an intensive outpatient therapy program were able to improve in a variety of UE and LE outcomes in response to TSCS without any adverse events. This was a small pilot study and future fully powered studies with comparative interventions need to be completed to assess efficacy.
Collapse
Affiliation(s)
- Candace Tefertiller
- Craig Hospital, Englewood, CO, United States
- *Correspondence: Candace Tefertiller
| | | | | | | | | | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, CO, United States
| |
Collapse
|
9
|
Smith AC, O’Dell DR, Albin SR, Berliner JC, Dungan D, Robinson E, Elliott JM, Carballido-Gamio J, Stevens-Lapsley J, Weber KA. Lateral Corticospinal Tract and Dorsal Column Damage: Predictive Relationships With Motor and Sensory Scores at Discharge From Acute Rehabilitation After Spinal Cord Injury. Arch Phys Med Rehabil 2022; 103:62-68. [PMID: 34371017 PMCID: PMC8712383 DOI: 10.1016/j.apmr.2021.07.792] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine if lateral corticospinal tract (LCST) integrity demonstrates a significant predictive relationship with future ipsilateral lower extremity motor function (LEMS) and if dorsal column (DC) integrity demonstrates a significant predictive relationship with future light touch (LT) sensory function post spinal cord injury (SCI) at time of discharge from inpatient rehabilitation. DESIGN Retrospective analyses of imaging and clinical outcomes. SETTING University and academic hospital. PARTICIPANTS A total of 151 participants (N=151) with SCI. INTERVENTIONS Inpatient rehabilitation. MAIN OUTCOME MEASURES LEMS and LT scores at discharge from inpatient rehabilitation. RESULTS In 151 participants, right LCST spared tissue demonstrated a significant predictive relationship with right LEMS percentage recovered (β=0.56; 95% confidence interval [CI], 0.37-0.73; R=0.43; P<.001). Left LCST spared tissue demonstrated a significant predictive relationship with left LEMS percentage recovered (β=0.66; 95% CI, 0.50-0.82; R=0.51; P<.001). DC spared tissue demonstrated a significant predictive relationship with LT percentage recovered (β=0.69; 95% CI, 0.52-0.87; R=0.55; P<.001). When subgrouping the participants into motor complete vs incomplete SCI, motor relationships were no longer significant, but the sensory relationship remained significant. Those who had no voluntary motor function but recovered some also had significantly greater LCST spared tissue than those who did not recover motor function. CONCLUSIONS LCST demonstrated significant moderate predictive relationships with lower extremity motor function at the time of discharge from inpatient rehabilitation, in an ipsilesional manner. DC integrity demonstrated a significant moderate predictive relationship with recovered function of LT. With further development, these neuroimaging methods might be used to predict potential deficits after SCI and to provide corresponding targeted interventions.
Collapse
Affiliation(s)
- Andrew C. Smith
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO USA,Regis University School of Physical Therapy, Denver, CO USA
| | - Denise R. O’Dell
- Regis University School of Physical Therapy, Denver, CO USA,Craig Hospital, Englewood, CO USA
| | | | | | - David Dungan
- Craig Hospital, Englewood, CO USA,Radiology Imaging Associates, Denver, CO USA
| | | | - James M. Elliott
- Faculty of Medicine and Health, The University of Sydney, Northern Sydney Local Health District, The Kolling Research Institute, St Leonards, Sydney, Australia
| | | | - Jennifer Stevens-Lapsley
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO USA
| | - Kenneth A. Weber
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, CA USA
| |
Collapse
|
10
|
Spinal cord imaging markers and recovery of standing with epidural stimulation in individuals with clinically motor complete spinal cord injury. Exp Brain Res 2021; 240:279-288. [PMID: 34854934 DOI: 10.1007/s00221-021-06272-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/20/2021] [Indexed: 02/04/2023]
Abstract
Spinal cord epidural stimulation (scES) is an intervention to restore motor function in those with severe spinal cord injury (SCI). Spinal cord lesion characteristics assessed via magnetic resonance imaging (MRI) may contribute to understand motor recovery. This study assessed relationships between standing ability with scES and spared spinal cord tissue characteristics at the lesion site. We hypothesized that the amount of lateral spared cord tissue would be related to independent extension in the ipsilateral lower limb. Eleven individuals with chronic, clinically motor complete SCI underwent spinal cord MRI, and were subsequently implanted with scES. Standing ability and lower limb activation patterns were assessed during an overground standing experiment with scES. This assessment occurred prior to any activity-based intervention with scES. Lesion hyperintensity was segmented from T2 axial images, and template-based analysis was used to estimate spared tissue in anterior, posterior, right, and left spinal cord regions. Regression analysis was used to assess relationships between imaging and standing outcomes. Total volume of spared tissue was related to left (p = 0.007), right (p = 0.005), and bilateral (p = 0.011) lower limb extension. Spared tissue in the left cord region was related to left lower limb extension (p = 0.019). A positive trend (p = 0.138) was also observed between right spared cord tissue and right lower limb extension. In this study, MRI measures of spared spinal cord tissue were significantly related to standing outcomes with scES. These preliminary results warrant future investigation of roles of supraspinal input and MRI-detected spared spinal cord tissue on lower limb motor responsiveness to scES.
Collapse
|
11
|
Seáñez I, Capogrosso M. Motor improvements enabled by spinal cord stimulation combined with physical training after spinal cord injury: review of experimental evidence in animals and humans. Bioelectron Med 2021; 7:16. [PMID: 34706778 PMCID: PMC8555080 DOI: 10.1186/s42234-021-00077-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022] Open
Abstract
Electrical spinal cord stimulation (SCS) has been gaining momentum as a potential therapy for motor paralysis in consequence of spinal cord injury (SCI). Specifically, recent studies combining SCS with activity-based training have reported unprecedented improvements in motor function in people with chronic SCI that persist even without stimulation. In this work, we first provide an overview of the critical scientific advancements that have led to the current uses of SCS in neurorehabilitation: e.g. the understanding that SCS activates dormant spinal circuits below the lesion by recruiting large-to-medium diameter sensory afferents within the posterior roots. We discuss how this led to the standardization of implant position which resulted in consistent observations by independent clinical studies that SCS in combination with physical training promotes improvements in motor performance and neurorecovery. While all reported participants were able to move previously paralyzed limbs from day 1, recovery of more complex motor functions was gradual, and the timeframe for first observations was proportional to the task complexity. Interestingly, individuals with SCI classified as AIS B and C regained motor function in paralyzed joints even without stimulation, but not individuals with motor and sensory complete SCI (AIS A). Experiments in animal models of SCI investigating the potential mechanisms underpinning this neurorecovery suggest a synaptic reorganization of cortico-reticulo-spinal circuits that correlate with improvements in voluntary motor control. Future experiments in humans and animal models of paralysis will be critical to understand the potential and limits for functional improvements in people with different types, levels, timeframes, and severities of SCI.
Collapse
Affiliation(s)
- Ismael Seáñez
- Biomedical Engineering, Washington University in St. Louis, St. Louis, USA. .,Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, USA.
| | - Marco Capogrosso
- Neurological Surgery, University of Pittsburgh, Pittsburgh, USA.,Department of Physical Medicine and Rehabilitation, Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| |
Collapse
|
12
|
Schading S, Emmenegger TM, Freund P. Improving Diagnostic Workup Following Traumatic Spinal Cord Injury: Advances in Biomarkers. Curr Neurol Neurosci Rep 2021; 21:49. [PMID: 34268621 PMCID: PMC8282571 DOI: 10.1007/s11910-021-01134-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Traumatic spinal cord injury (SCI) is a life-changing event with drastic implications for patients due to sensorimotor impairment and autonomous dysfunction. Current clinical evaluations focus on the assessment of injury level and severity using standardized neurological examinations. However, they fail to predict individual trajectories of recovery, which highlights the need for the development of advanced diagnostics. This narrative review identifies recent advances in the search of clinically relevant biomarkers in the field of SCI. RECENT FINDINGS Advanced neuroimaging and molecular biomarkers sensitive to the disease processes initiated by the SCI have been identified. These biomarkers range from advanced neuroimaging techniques, neurophysiological readouts, and molecular biomarkers identifying the concentrations of several proteins in blood and CSF samples. Some of these biomarkers improve current prediction models based on clinical readouts. Validation with larger patient cohorts is warranted. Several biomarkers have been identified-ranging from imaging to molecular markers-that could serve as advanced diagnostic and hence supplement current clinical assessments.
Collapse
Affiliation(s)
- Simon Schading
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tim M Emmenegger
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| |
Collapse
|
13
|
Berliner JC, O'Dell DR, Albin SR, Dungan D, Sevigny M, Elliott JM, Weber KA, Abdie DR, Anderson JS, Rich AA, Seib CA, Sagan HGS, Smith AC. The influence of conventional T 2 MRI indices in predicting who will walk outside one year after spinal cord injury. J Spinal Cord Med 2021; 46:501-507. [PMID: 33798025 PMCID: PMC10116921 DOI: 10.1080/10790268.2021.1907676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT/OBJECTIVE Magnetic resonance imaging (MRI) indices of spinal cord damage are predictive of future motor function after spinal cord injury (SCI): hyperintensity length, midsagittal tissue bridges, and Brain and Spinal Injury Center (BASIC) scores. Whether these indices are predictive of outdoor walking after SCI is unknown. The primary purpose was to see if these MRI indices predict the ability to walk outdoors one-year after SCI. The secondary purpose was to determine if MRI indices provide additional predictive value if initial lower extremity motor scores are available. DESIGN Retrospective. Clinical T2-weighted MRIs were used to quantify spinal cord damage. Three MRI indices were calculated: midsagittal ventral tissue bridges, hyperintensity length, BASIC scores. SETTING Academic hospital. PARTICIPANTS 129 participants with cervical SCI. INTERVENTIONS Inpatient rehabilitation. OUTCOMES MEASURES One year after SCI, participants self-reported their outdoor walking ability. RESULTS Midsagittal ventral tissue bridges, hyperintensity length, and BASIC scores significantly correlated with outdoor walking ability (R = 0.34, P < 0.001; R = -0.25, P < 0.01; Rs = -0.35, P < 001, respectively). Using midsagittal ventral tissue bridges and hyperintensity length, the final adjusted R2 for model 1 = 0.19. For model 2, the adjusted R2 using motor scores alone = 0.81 and MRI variables were non-significant. All five participants with observable intramedullary hemorrhage reported they were unable to walk one block outdoors. CONCLUSIONS The MRI indices were significant predictors of outdoor walking ability, but when motor scores were available, this was the strongest predictor and neither midsagittal tissue bridges nor hyperintensity length contributed additional value. MRI indices may be a quick and convenient supplement to physical examination when motor testing is unavailable.
Collapse
Affiliation(s)
| | - Denise R O'Dell
- Craig Hospital, Englewood, Colorado, USA.,Regis University School of Physical Therapy, Denver, Colorado, USA
| | | | - David Dungan
- Craig Hospital, Englewood, Colorado, USA.,Radiology Imaging Associates, Denver, Colorado, USA
| | | | - James M Elliott
- Faculty of Medicine and Health, The University of Sydney, Northern Sydney Local Health District, The Kolling Research Institute, St Leonards, Sydney, Australia
| | - Kenneth A Weber
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, California, USA
| | - Daniel R Abdie
- Regis University School of Physical Therapy, Denver, Colorado, USA
| | - Jack S Anderson
- Regis University School of Physical Therapy, Denver, Colorado, USA
| | - Alison A Rich
- Regis University School of Physical Therapy, Denver, Colorado, USA
| | - Carly A Seib
- Regis University School of Physical Therapy, Denver, Colorado, USA
| | - Hannah G S Sagan
- Regis University School of Physical Therapy, Denver, Colorado, USA
| | - Andrew C Smith
- Regis University School of Physical Therapy, Denver, Colorado, USA.,Department of Physical Medicine and Rehabilitation Physical Therapy Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
14
|
Macromolecular changes in spinal cord white matter characterize whiplash outcome at 1-year post motor vehicle collision. Sci Rep 2020; 10:22221. [PMID: 33335188 PMCID: PMC7747591 DOI: 10.1038/s41598-020-79190-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022] Open
Abstract
Each year, whiplash injuries from motor vehicle collisions (MVC) affect millions worldwide, with no strong evidence of pathology. While the majority recover soon after the injury, the same is not true for roughly 20% reporting higher levels of pain and distress, without diagnostic options. This study used magnetization transfer (MT) imaging to quantify white matter integrity in 78 subjects with varying levels of pain, 1 year after MVC. MT images of the cervical spinal cord were collected parallel to the intervertebral disks. MT ratios (MTR) were calculated in select white matter tracts along with MTR homogeneity (MTRh) at each level. Significant differences were observed between clinical outcome groups in the left and right spinothalamic tracts (p = 0.003 and 0.020) and MTRh (p = 0.009). MTRh was elevated in females with poor recovery versus females reporting recovery (p < 0.001) or milder symptoms (p < 0.001), and in males reporting recovery (p = 0.007) or no recovery (p < 0.001). There was a significant interaction between recovery status and sex (p = 0.015). MT imaging identified tract specific and regional changes in white matter integrity suggesting potential insults to the cord. Additionally, significant MTRh differences between sexes were observed, characterizing the heterogeneity of whiplash recovery and worse outcomes in females.
Collapse
|
15
|
Rejc E, Smith AC, Weber KA, Ugiliweneza B, Bert RJ, Negahdar M, Boakye M, Harkema SJ, Angeli CA. Spinal Cord Imaging Markers and Recovery of Volitional Leg Movement With Spinal Cord Epidural Stimulation in Individuals With Clinically Motor Complete Spinal Cord Injury. Front Syst Neurosci 2020; 14:559313. [PMID: 33192348 PMCID: PMC7654217 DOI: 10.3389/fnsys.2020.559313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/28/2020] [Indexed: 01/07/2023] Open
Abstract
Previous studies have shown that epidural stimulation of the lumbosacral spinal cord (scES) can re-enable lower limb volitional motor control in individuals with chronic, clinically motor complete spinal cord injury (SCI). This observation entails that residual supraspinal connectivity to the lumbosacral spinal circuitry still persisted after SCI, although it was non-detectable when scES was not provided. In the present study, we aimed at exploring further the mechanisms underlying scES-promoted recovery of volitional lower limb motor control by investigating neuroimaging markers at the spinal cord lesion site via magnetic resonance imaging (MRI). Spinal cord MRI was collected prior to epidural stimulator implantation in 13 individuals with chronic, clinically motor complete SCI, and the spared tissue of specific regions of the spinal cord (anterior, posterior, right, left, and total cord) was assessed. After epidural stimulator implantation, and prior to any training, volitional motor control was evaluated during left and right lower limb flexion and ankle dorsiflexion attempts. The ability to generate force exertion and movement was not correlated to any neuroimaging marker. On the other hand, spared tissue of specific cord regions significantly and importantly correlated with some aspects of motor control that include activation amplitude of antagonist (negative correlation) muscles during left ankle dorsiflexion, and electromyographic coordination patterns during right lower limb flexion. The fact that amount and location of spared spinal cord tissue at the lesion site were not related to the ability to generate volitional lower limb movements may suggest that supraspinal inputs through spared spinal cord regions that differ across individuals can result in the generation of lower limb volitional motor output prior to any training when epidural stimulation is provided.
Collapse
Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Andrew C Smith
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, United States
| | - Kenneth A Weber
- Department of Anethesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Robert J Bert
- Department of Radiology, University of Louisville, Louisville, KY, United States
| | | | - Maxwell Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States.,Department of Bioengineering, University of Louisville, Louisville, KY, United States
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States.,Department of Bioengineering, University of Louisville, Louisville, KY, United States
| |
Collapse
|
16
|
Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study. Spinal Cord 2020; 59:693-699. [PMID: 33024298 PMCID: PMC8021607 DOI: 10.1038/s41393-020-00561-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 01/07/2023]
Abstract
Study design Retrospective. Objectives Primary: to assess if axial damage ratios are predictors of future walking after spinal cord injury (SCI), and if they add any predictive value if initial neurological impairment grades are available. Secondary: to determine if lateral spinal cord regions are predictors of future lower extremity motor scores (LEMS). Setting University/hospital. Methods Axial T2-weighted MRIs were used. Axial damage ratios and non-damaged lateral cord volumes were calculated. Each participant answered at 1 year after SCI, “Are you able to walk for 150 feet? (45.72 meters)” For the secondary aim, right and left LEMS were used. Results In total, 145 participants were selected. Individuals that could walk had smaller ratios than those that were unable. Walking and axial damage ratios were negatively correlated. A 0.374 ratio cut-off showed optimal sensitivity/specificity. When initial neurological grades were used, axial damage ratios did not add predictive value. Forty-two participants had LEMS available and were included for the secondary aim. Right cord regions and right LEMS were positively correlated and left regions and left LEMS, but these variables were also correlated with each other. Conclusions Axial damage ratios were significant predictors of walking ability 1 year after SCI. However, this measure did not add predictive value over initial neurological grades. Lateral cord regions correlated with same-side LEMS, but the opposite was also found, calling this biomarker’s specificity into question. Axial damage ratios may be useful in predicting walking after SCI if initial neurological grades are unavailable. Sponsorship This research was funded by a National Institutes of Health award, National Institute of Child Health and Development—NIH R03HD094577.
Collapse
|
17
|
Weber KA, Chen Y, Paliwal M, Law CS, Hopkins BS, Mackey S, Dhaher Y, Parrish TB, Smith ZA. Assessing the spatial distribution of cervical spinal cord activity during tactile stimulation of the upper extremity in humans with functional magnetic resonance imaging. Neuroimage 2020; 217:116905. [PMID: 32387628 PMCID: PMC7386934 DOI: 10.1016/j.neuroimage.2020.116905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/24/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022] Open
Abstract
Dermatomal maps are a mainstay of clinical practice and provide information on the spatial distribution of the cutaneous innervation of spinal nerves. Dermatomal deficits can help isolate the level of spinal nerve root involvement in spinal conditions and guide clinicians in diagnosis and treatment. Dermatomal maps, however, have limitations, and the spatial distribution of spinal cord sensory activity in humans remains to be quantitatively assessed. Here we used spinal cord functional MRI to map and quantitatively compare the spatial distribution of sensory spinal cord activity during tactile stimulation of the left and right lateral shoulders (i.e. C5 dermatome) and dorsal third digits of the hands (i.e., C7 dermatome) in healthy humans (n = 24, age = 36.8 ± 11.8 years). Based on the central sites for processing of innocuous tactile sensory information, we hypothesized that the activity would be localized more to the ipsilateral dorsal spinal cord with the lateral shoulder stimulation activity being localized more superiorly than the dorsal third digit. The findings demonstrate lateralization of the activity with the left- and right-sided stimuli having more activation in the ipsilateral hemicord. Contradictory to our hypotheses, the activity for both stimulation sites was spread across the dorsal and ventral hemicords and did not demonstrate a clear superior-inferior localization. Instead, the activity for both stimuli had a broader than expected distribution, extending across the C5, C6, and C7 spinal cord segments. We highlight the complexity of the human spinal cord neuroanatomy and several sources of variability that may explain the observed patterns of activity. While the findings were not completely consistent with our a priori hypotheses, this study provides a foundation for continued work and is an important step towards developing normative quantitative spinal cord measures of sensory function, which may become useful objective MRI-based biomarkers of neurological injury and improve the management of spinal disorders.
Collapse
Affiliation(s)
- Kenneth A Weber
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA.
| | - Yufen Chen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Monica Paliwal
- Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christine S Law
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - Benjamin S Hopkins
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sean Mackey
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - Yasin Dhaher
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Todd B Parrish
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zachary A Smith
- Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
18
|
Karlsson A, Peolsson A, Elliott J, Romu T, Ljunggren H, Borga M, Dahlqvist Leinhard O. The relation between local and distal muscle fat infiltration in chronic whiplash using magnetic resonance imaging. PLoS One 2019; 14:e0226037. [PMID: 31805136 PMCID: PMC6894804 DOI: 10.1371/journal.pone.0226037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/17/2019] [Indexed: 12/13/2022] Open
Abstract
The objective of this study was to investigate the relationship between fat infiltration in the cervical multifidi and fat infiltration measured in the lower extremities to move further into understanding the complex signs and symptoms arising from a whiplash trauma. Thirty-one individuals with chronic whiplash associated disorders, stratified into a mild/moderate group and a severe group, together with 31 age- and gender matched controls were enrolled in this study. Magnetic resonance imaging was used to acquire a 3D volume of the neck and of the whole-body. Cervical multifidi was used to represent muscles local to the whiplash trauma and all muscles below the hip joint, the lower extremities, were representing widespread muscles distal to the site of the trauma. The fat infiltration was determined by fat fraction in the segmented images. There was a linear correlation between local and distal muscle fat infiltration (p<0.001, r2 = 0.28). The correlation remained significant when adjusting for age and WAD group (p = 0.009) as well as when correcting for age, WAD group and BMI (p = 0.002). There was a correlation between local and distal muscle fat infiltration within the severe WAD group (p = 0.0016, r2 = 0.69) and in the healthy group (p = 0.022, r2 = 0.17) but not in the mild/moderate group (p = 0.29, r2 = 0.06). No significant differences (p = 0.11) in the lower extremities’ MFI between the different groups were found. The absence of differences between the groups in terms of lower extremities’ muscle fat infiltration indicates that, in this particular population, the whiplash trauma has a local effect on muscle fat infiltration rather than a generalized.
Collapse
Affiliation(s)
- Anette Karlsson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- * E-mail:
| | - Anneli Peolsson
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - James Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW, Australia
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Thobias Romu
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Helena Ljunggren
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - Magnus Borga
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
19
|
Cadotte DW, Akbar MA, Fehlings MG, Stroman PW, Cohen-Adad J. What Has Been Learned from Magnetic Resonance Imaging Examination of the Injured Human Spinal Cord: A Canadian Perspective. J Neurotrauma 2019; 35:1942-1957. [PMID: 30074873 DOI: 10.1089/neu.2018.5903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Magnetic resonance imaging (MRI) has transformed the way surgeons and researchers study and treat spinal cord injury. In this narrative review, we explore the historical context of imaging the human spinal cord and describe how MRI has evolved from providing the first visualization of the human spinal cord in the 1980s to a remarkable set of imaging tools today. The article focuses in particular on the role of Canadian researchers to this field. We begin by outlining the clinical context of traumatic injury to the human spinal cord and describe why current MRI standards fall short when it comes to treating this disabling condition. Parts 2 and 3 of this work explore an exciting and dramatic shift in the use of MRI technology to aid in our understanding and treatment of traumatic injury to the spinal cord. We explore the use of functional imaging (part 2) and structural imaging (part 3) and explore how these techniques have evolved, how they are used, and the challenges that we face for continued refinement and application to patients who live with the neurological and functional deficits caused by injury to the delicate spinal cord.
Collapse
Affiliation(s)
- David W Cadotte
- 1 University of Calgary Spine Program, Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary , Foothills Medical Centre, Calgary, Alberta, Canada
| | - M Ali Akbar
- 2 Department of Surgery, Division of Neurosurgery and Spinal Program, Toronto Western Hospital, University of Toronto , Toronto, Ontario, Canada
| | - Michael G Fehlings
- 2 Department of Surgery, Division of Neurosurgery and Spinal Program, Toronto Western Hospital, University of Toronto , Toronto, Ontario, Canada
| | - Patrick W Stroman
- 3 Centre for Neuroscience Studies, Queens University , Kingston, Ontario, Canada
| | - Julien Cohen-Adad
- 4 NeuroPoly Lab, Institute of Biomedical Engineering , Polytechnique Montreal, Montreal, Quebéc, Canada .,5 Functional Neuroimaging Unit, CRIUGM, Université de Montréal , Montreal, Quebéc, Canada
| |
Collapse
|
20
|
Pfyffer D, Huber E, Sutter R, Curt A, Freund P. Tissue bridges predict recovery after traumatic and ischemic thoracic spinal cord injury. Neurology 2019; 93:e1550-e1560. [PMID: 31541012 PMCID: PMC6815206 DOI: 10.1212/wnl.0000000000008318] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the spatiotemporal evolution and predictive properties of intramedullary damage and midsagittal tissue bridges at the epicenter of a thoracic spinal cord injury (SCI) using MRI. Methods We retrospectively assessed midsagittal T2-weighted scans from 25 patients with thoracic SCI (14 traumatic, 11 ischemic) at 1 month post-SCI. In 12 patients with SCI, linear mixed-effects models on serial MRI explored temporal trajectories of quantifiable lesion markers (area, length, and width) and tissue bridges. Using partial correlation analysis, we assessed associations between structural lesion characteristics at 1 month post-SCI and recovery at 1 year postinjury, adjusting for baseline clinical status, age, and sex. Results Lesion area decreased by 5.68 mm2 (p = 0.005), lesion length by 2.14 mm (p = 0.004), and lesion width by 0.13 mm (p = 0.004) per month. Width of tissue bridges increased by 0.06 mm (p = 0.019) per month, being similar in traumatic and ischemic SCI (p = 0.576). Smaller lesion area, length, width, and wider tissue bridges at 1 month post-SCI predicted better recovery at 1-year follow-up. Conclusions Over time, the immediate area of cord damage shrunk while the cystic cavity became demarcated. Adjacent to the cyst, midsagittal tissue bridges became visible. The width of tissue bridges at 1 month post-SCI predicted recovery at 1 year follow-up. Measures of lesion area and tissue bridges early after traumatic and ischemic thoracic SCI therefore allow characterizing the evolution of focal cord damage and are predictive of recovery in thoracic SCI. Thus, lesion extent and tissue bridges hold potential to improve diagnosis and patient stratification in interventional trials.
Collapse
Affiliation(s)
- Dario Pfyffer
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.) and Radiology (R.S.), Balgrist University Hospital, Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (P.F.), University Hospital Zurich, Switzerland
| | - Eveline Huber
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.) and Radiology (R.S.), Balgrist University Hospital, Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (P.F.), University Hospital Zurich, Switzerland
| | - Reto Sutter
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.) and Radiology (R.S.), Balgrist University Hospital, Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (P.F.), University Hospital Zurich, Switzerland
| | - Armin Curt
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.) and Radiology (R.S.), Balgrist University Hospital, Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (P.F.), University Hospital Zurich, Switzerland
| | - Patrick Freund
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.) and Radiology (R.S.), Balgrist University Hospital, Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Neurology (P.F.), University Hospital Zurich, Switzerland.
| |
Collapse
|
21
|
Seif M, Gandini Wheeler-Kingshott CA, Cohen-Adad J, Flanders AE, Freund P. Guidelines for the conduct of clinical trials in spinal cord injury: Neuroimaging biomarkers. Spinal Cord 2019; 57:717-728. [PMID: 31267015 PMCID: PMC6760553 DOI: 10.1038/s41393-019-0309-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
Traumatic spinal cord injury (SCI) leads to immediate neuronal and axonal damage at the focal injury site and triggers secondary pathologic series of events resulting in sensorimotor and autonomic dysfunction below the level of injury. Although there is no cure for SCI, neuroprotective and regenerative therapies show promising results at the preclinical stage. There is a pressing need to develop non-invasive outcome measures that can indicate whether a candidate therapeutic agent or a cocktail of therapeutic agents are positively altering the underlying disease processes. Recent conventional MRI studies have quantified spinal cord lesion characteristics and elucidated their relationship between severity of injury to clinical impairment and recovery. Next to the quantification of the primary cord damage, quantitative MRI measures of spinal cord (rostrocaudally to the lesion site) and brain integrity have demonstrated progressive and specific neurodegeneration of afferent and efferent neuronal pathways. MRI could therefore play a key role to ultimately uncover the relationship between clinical impairment/recovery and injury-induced neurodegenerative changes in the spinal cord and brain. Moreover, neuroimaging biomarkers hold promises to improve clinical trial design and efficiency through better patient stratification. The purpose of this narrative review is therefore to propose a guideline of clinically available MRI sequences and their derived neuroimaging biomarkers that have the potential to assess tissue damage at the macro- and microstructural level after SCI. In this piece, we make a recommendation for the use of key MRI sequences-both conventional and advanced-for clinical work-up and clinical trials.
Collapse
Affiliation(s)
- Maryam Seif
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Claudia Am Gandini Wheeler-Kingshott
- Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Adam E Flanders
- Regional Spinal Cord Injury Center of the Delaware Valley, Department of Radiology, Division of Neuroradiology, Thomas Jefferson University, 1087 Main Building, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Patrick Freund
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland. .,Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, United Kingdom. .,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany. .,Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
22
|
Abstract
Persistent spinal (traumatic and nontraumatic) pain is common and contributes to high societal and personal costs globally. There is an acknowledged urgency for new and interdisciplinary approaches to the condition, and soft tissues, including skeletal muscles, the spinal cord, and the brain, are rightly receiving increased attention as important biological contributors. In reaction to the recent suspicion and questioned value of imaging-based findings, this paper serves to recognize the promise that the technological evolution of imaging techniques, and particularly magnetic resonance imaging, is allowing in characterizing previously less visible morphology. We emphasize the value of quantification and data analysis of several contributors in the biopsychosocial model for understanding spinal pain. Further, we highlight emerging evidence regarding the pathobiology of changes to muscle composition (eg, atrophy, fatty infiltration), as well as advancements in neuroimaging and musculoskeletal imaging techniques (eg, fat-water imaging, functional magnetic resonance imaging, diffusion imaging, magnetization transfer imaging) for these important soft tissues. These noninvasive and objective data sources may complement known prognostic factors of poor recovery, patient self-report, diagnostic tests, and the "-omics" fields. When combined, advanced "big-data" analyses may assist in identifying associations previously not considered. Our clinical commentary is supported by empirical findings that may orient future efforts toward collaborative conversation, hypothesis generation, interdisciplinary research, and translation across a number of health fields. Our emphasis is that magnetic resonance imaging technologies and research are crucial to the advancement of our understanding of the complexities of spinal conditions. J Orthop Sports Phys Ther 2019;49(5):320-329. Epub 26 Mar 2019. doi:10.2519/jospt.2019.8793.
Collapse
|
23
|
Cummins DP, Connor JR, Heller KA, Hubert JS, Kates MJ, Wisniewski KR, Berliner JC, O’Dell DR, Elliott JM, Weber KA, Smith AC. Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging. Spinal Cord Ser Cases 2019; 5:20. [PMID: 31240117 PMCID: PMC6461921 DOI: 10.1038/s41394-019-0164-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/24/2022] Open
Abstract
Study design Retrospective study. Objectives To establish the inter-rater reliability in the quantitative evaluation of spinal cord damage following cervical incomplete spinal cord injury (SCI) utilizing magnetic resonance imaging (MRI). MRI was used to perform manual measurements of the cranial and caudal boundaries of edema, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume in 10 participants with cervical incomplete SCI. Setting Academic university setting. Methods Structural MRIs of 10 participants with SCI were collected from Northwestern University's Neuromuscular Imaging and Research Lab. All manual measures were performed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Intraclass correlation coefficients (ICC) were used to determine inter-rater reliability across seven raters of varying experience. Results High-to-excellent inter-rater reliability was found for all measures. ICC values for cranial/caudal levels of involvement, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume were 0.99, 0.98, 0.90, 0.84, and 0.93, respectively. Conclusions Manual MRI measures of spinal cord damage are reliable between raters. Researchers and clinicians may confidently utilize manual MRI measures to quantify cord damage. Future research to predict functional recovery following SCI and better inform clinical management is warranted.
Collapse
Affiliation(s)
| | | | | | | | - Megan J. Kates
- Regis University School of Physical Therapy, Denver, CO USA
| | | | | | - Denise R. O’Dell
- Regis University School of Physical Therapy, Denver, CO USA
- Craig Hospital, Englewood, CO USA
| | - James M. Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Sydney, NSW Australia
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL 60611 USA
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Kenneth A. Weber
- Stanford University Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, CA USA
| | | |
Collapse
|
24
|
Motovylyak A, Skinner NP, Schmit BD, Wilkins N, Kurpad SN, Budde MD. Longitudinal In Vivo Diffusion Magnetic Resonance Imaging Remote from the Lesion Site in Rat Spinal Cord Injury. J Neurotrauma 2018; 36:1389-1398. [PMID: 30259800 DOI: 10.1089/neu.2018.5964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Diffusion tensor imaging (DTI) has demonstrated success as a biomarker of spinal cord injury (SCI) severity as shown from numerous pre-clinical studies. However, artifacts from stabilization hardware at the lesion have precluded its use for longitudinal assessments. Previous research has documented ex vivo diffusion changes in the spinal cord both caudal and cranial to the injury epicenter. The aim of this study was to use a rat contusion model of SCI to evaluate the utility of in vivo cervical DTI after a thoracic injury. Forty Sprague-Dawley rats underwent a thoracic contusion (T8) of mild, moderate, severe, or sham severity. Magnetic resonance imaging (MRI) of the cervical cord was performed at 2, 30, and 90 days post-injury, and locomotor performance was assessed weekly using the Basso, Bresnahan, and Beattie (BBB) scoring scale. The relationships between BBB scores and MRI were assessed using region of interest analysis and voxel-wise linear regression of DTI, and free water elimination (FWE) modeling to reduce partial volume effects. At 90 days, axial diffusivity (ADFWE), mean diffusivity (MDFWE), and free water fraction (FWFFWE) using the FWE model were found to be significantly correlated with BBB score. FWE was found to be more predictive of injury severity than conventional DTI, specifically at later time-points. This study validated the use of FWE technique in spinal cord and demonstrated its sensitivity to injury remotely.
Collapse
Affiliation(s)
- Alice Motovylyak
- 1 Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathan P Skinner
- 2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,3 Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian D Schmit
- 1 Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Natasha Wilkins
- 2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shekar N Kurpad
- 2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew D Budde
- 2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
25
|
O’Dell DR, Weber KA, Berliner JC, Elliott JM, Connor JR, Cummins DP, Heller KA, Hubert JS, Kates MJ, Mendoza KR, Smith AC. Midsagittal tissue bridges are associated with walking ability in incomplete spinal cord injury: A magnetic resonance imaging case series. J Spinal Cord Med 2018; 43:268-271. [PMID: 30346248 PMCID: PMC7054908 DOI: 10.1080/10790268.2018.1527079] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context: Following spinal cord injury (SCI), early prediction of future walking ability is difficult, due to factors such as spinal shock, sedation, impending surgery, and secondary long bone fracture. Accurate, objective biomarkers used in the acute stage of SCI would inform individualized patient management and enhance both patient/family expectations and treatment outcomes. Using magnetic resonance imaging (MRI) and specifically a midsagittal T2-weighted image, the amount of tissue bridging (measured as spared spinal cord tissue) shows potential to serve as such a biomarker. Ten participants with incomplete SCI received MRI of the spinal cord. Using the midsagittal T2-weighted image, anterior and posterior tissue bridges were calculated as the distance from cerebrospinal fluid to the damage. Then, the midsagittal tissue bridge ratio was calculated as the sum of anterior and posterior tissue bridges divided by the spinal cord diameter. Each participant also performed a 6-minute walk test, where the total distance walked was measured within six minutes.Findings: The midsagittal tissue bridge ratio measure demonstrated a high level of inter-rater reliability (ICC = 0.90). Midsagittal tissue bridge ratios were significantly related to distance walked in six minutes (R = 0.68, P = 0.03).Conclusion/clinical relevance: We uniquely demonstrated that midsagittal tissue bridge ratios were correlated walking ability. These preliminary findings suggest potential for this measure to be considered a prognostic biomarker of residual walking ability following SCI.
Collapse
Affiliation(s)
- Denise R. O’Dell
- School of Physical Therapy, Regis University, Denver, Colorado, USA,Craig Hospital, Englewood, Colorado, USA
| | - Kenneth A. Weber
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | | | - James M. Elliott
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia,Department of Physical Therapy and Human Movement Sciences, Northwestern University Evanston, Illinois, USA,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jordan R. Connor
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - David P. Cummins
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | | | - Joshua S. Hubert
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - Megan J. Kates
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | | | - Andrew C. Smith
- School of Physical Therapy, Regis University, Denver, Colorado, USA,Correspondence to: Andrew C. Smith, Regis University School of Physical Therapy, 3333 Regis Boulevard, Peter Claver Hall, Suite 423D, Denver, CO 80221, USA; Ph: +1 (303) 458 4985.
| |
Collapse
|