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Håkansson S, Tuci M, Bolliger M, Curt A, Jutzeler CR, Brüningk SC. Data-driven prediction of spinal cord injury recovery: An exploration of current status and future perspectives. Exp Neurol 2024; 380:114913. [PMID: 39097073 DOI: 10.1016/j.expneurol.2024.114913] [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] [Received: 04/30/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
Spinal Cord Injury (SCI) presents a significant challenge in rehabilitation medicine, with recovery outcomes varying widely among individuals. Machine learning (ML) is a promising approach to enhance the prediction of recovery trajectories, but its integration into clinical practice requires a thorough understanding of its efficacy and applicability. We systematically reviewed the current literature on data-driven models of SCI recovery prediction. The included studies were evaluated based on a range of criteria assessing the approach, implementation, input data preferences, and the clinical outcomes aimed to forecast. We observe a tendency to utilize routinely acquired data, such as International Standards for Neurological Classification of SCI (ISNCSCI), imaging, and demographics, for the prediction of functional outcomes derived from the Spinal Cord Independence Measure (SCIM) III and Functional Independence Measure (FIM) scores with a focus on motor ability. Although there has been an increasing interest in data-driven studies over time, traditional machine learning architectures, such as linear regression and tree-based approaches, remained the overwhelmingly popular choices for implementation. This implies ample opportunities for exploring architectures addressing the challenges of predicting SCI recovery, including techniques for learning from limited longitudinal data, improving generalizability, and enhancing reproducibility. We conclude with a perspective, highlighting possible future directions for data-driven SCI recovery prediction and drawing parallels to other application fields in terms of diverse data types (imaging, tabular, sequential, multimodal), data challenges (limited, missing, longitudinal data), and algorithmic needs (causal inference, robustness).
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Affiliation(s)
- Samuel Håkansson
- ETH Zürich, Department of Health Sciences and Technology (D-HEST), Zürich, Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland.
| | - Miklovana Tuci
- ETH Zürich, Department of Health Sciences and Technology (D-HEST), Zürich, Switzerland; Spinal Cord Injury Center, University Hospital Balgrist, University of Zürich, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zürich, Switzerland
| | - Catherine R Jutzeler
- ETH Zürich, Department of Health Sciences and Technology (D-HEST), Zürich, Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland
| | - Sarah C Brüningk
- ETH Zürich, Department of Health Sciences and Technology (D-HEST), Zürich, Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland
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2
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Lebret A, Frese S, Lévy S, Curt A, Callot V, Freund P, Seif M. Spinal cord blood perfusion deficit is associated with clinical impairment after spinal cord injury. J Neurotrauma 2024. [PMID: 39323313 DOI: 10.1089/neu.2024.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
Spinal cord injury (SCI) results into intramedullary microvasculature disruption and blood perfusion deficit at and remote from the injury site. However, the relationship between remote vascular impairment and functional recovery remains understudied. We characterized perfusion impairment in vivo, rostral to the injury, using MRI, and investigated its association with lesion extent and impairment following SCI. Twenty-one chronic cervical SCI patients and 39 healthy controls (HC) underwent a high-resolution MRI protocol, including intravoxel incoherent motion (IVIM) and T2*-weighted MRI covering C1-C3 cervical levels, as well as T2-weighted MRI to determine lesion volumes. IVIM matrices (i.e., blood volume fraction, velocity, flow indices, and diffusion) and cord structural characteristics were calculated to assess perfusion changes and cervical cord atrophy, respectively. SCI patients additionally underwent a standard clinical examination protocol to assess functional impairment. Correlation analysis was used to investigate associations between IVIM parameters with lesion volume and sensorimotor dysfunction. Cervical cord white and grey matter were atrophied (27.60% and 21.10%, p < 0.0001, respectively) above the cervical cord injury, accompanied by a lower blood volume fraction (-22.05%, p < 0.001) and a higher blood velocity-related index (+38.72%, p < 0.0001) in SCI patients compared to HC. Crucially, grey matter remote perfusion deficit correlated with larger lesion volumes and clinical impairment. This study shows clinically eloquent perfusion deficit rostral to a SCI, its magnitude driven by injury severity. These findings indicate trauma-induced widespread microvascular alterations beyond the injury site. Perfusion MRI matrices in the spinal cord hold promise as biomarkers for monitoring treatment effects and dynamic changes in microvasculature integrity following SCI.
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Affiliation(s)
- Anna Lebret
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland;
| | - Sabina Frese
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Medical University of Vienna, High Field MR Center, Wien, Austria;
| | - Simon Lévy
- Siemens Healthcare Pty Ltd, MR Research Collaborations, Hawthorn East, Victoria, Australia
- Aix-Marseille Université, CNRS, UMR 7339, Centre de Résonance Magnétique Biologique et Médicale (CRMBM-CEMEREM), Marseille, France
- Hôpital Universitaire Timone, CEMEREM, Marseille, France;
| | - Armin Curt
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland;
| | - Virginie Callot
- Aix-Marseille Université, CNRS, UMR 7339, Centre de Résonance Magnétique Biologique et Médicale (CRMBM-CEMEREM), Marseille, France
- Hôpital Universitaire Timone, CEMEREM, Marseille, France;
| | - Patrick Freund
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Wellcome Trust Centre for Neuroimaging, Department of Brain Repair and Rehabilitation, London, United Kingdom of Great Britain and Northern Ireland;
| | - Maryam Seif
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany;
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Alvi MA, Pedro KM, Quddusi AI, Fehlings MG. Advances and Challenges in Spinal Cord Injury Treatments. J Clin Med 2024; 13:4101. [PMID: 39064141 PMCID: PMC11278467 DOI: 10.3390/jcm13144101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Spinal cord injury (SCI) is a debilitating condition that is associated with long-term physical and functional disability. Our understanding of the pathogenesis of SCI has evolved significantly over the past three decades. In parallel, significant advances have been made in optimizing the management of patients with SCI. Early surgical decompression, adequate bony decompression and expansile duraplasty are surgical strategies that may improve neurological and functional outcomes in patients with SCI. Furthermore, advances in the non-surgical management of SCI have been made, including optimization of hemodynamic management in the critical care setting. Several promising therapies have also been investigated in pre-clinical studies, with some being translated into clinical trials. Given the recent interest in advancing precision medicine, several investigations have been performed to delineate the role of imaging, cerebral spinal fluid (CSF) and serum biomarkers in predicting outcomes and curating individualized treatment plans for SCI patients. Finally, technological advancements in biomechanics and bioengineering have also found a role in SCI management in the form of neuromodulation and brain-computer interfaces.
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Affiliation(s)
- Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.A.A.); (K.M.P.); (A.I.Q.)
| | - Karlo M. Pedro
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.A.A.); (K.M.P.); (A.I.Q.)
- Department of Surgery and Spine Program, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Ayesha I. Quddusi
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.A.A.); (K.M.P.); (A.I.Q.)
| | - Michael G. Fehlings
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.A.A.); (K.M.P.); (A.I.Q.)
- Department of Surgery and Spine Program, University of Toronto, Toronto, ON M5T 1P5, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada
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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.
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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
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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.
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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
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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.
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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
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Ahmed RU, Medina‐Aguinaga D, Adams S, Knibbe CA, Morgan M, Gibson D, Kim J, Sharma M, Chopra M, Davison S, Sherwood LC, Negahdar M, Bert R, Ugiliweneza B, Hubscher C, Budde MD, Xu J, Boakye M. Predictive values of spinal cord diffusion magnetic resonance imaging to characterize outcomes after contusion injury. Ann Clin Transl Neurol 2023; 10:1647-1661. [PMID: 37501362 PMCID: PMC10502634 DOI: 10.1002/acn3.51855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/21/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES To explore filtered diffusion-weighted imaging (fDWI), in comparison with conventional magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI), as a predictor for long-term locomotor and urodynamic (UD) outcomes in Yucatan minipig model of spinal cord injury (SCI). Additionally, electrical conductivity of neural tissue using D-waves above and below the injury was measured to assess correlations between fDWI and D-waves data. METHODS Eleven minipigs with contusion SCI at T8-T10 level underwent MRI at 3T 4 h. post-SCI. Parameters extracted from region of interest analysis included Daxial from fDWI at injury site, fractional anisotropy and radial diffusivity from DTI above the injury site along with measures of edema length and cord width at injury site from T2 -weighted images. Locomotor recovery was assessed pre- and weekly post-SCI through porcine thoracic injury behavior scale (PTIBS) and UD were performed pre- and at 12 weeks of SCI. D-waves latency and amplitude differences were recorded before and immediately after SCI. RESULTS Two groups of pigs were found based on the PTIBS at week 12 (p < 0.0001) post-SCI and were labeled "poor" and "good" recovery. D-waves amplitude decreased below injury and increased above injury. UD outcomes pre/post SCI changed significantly. Conventional MRI metrics from T2 -weighted images were significantly correlated with diffusion MRI metrics. Daxial at injury epicenter was diminished by over 50% shortly after SCI, and it differentiated between good and poor locomotor recovery and UD outcomes. INTERPRETATION Similar to small animal studies, fDWI from acute imaging after SCI is a promising predictor for functional outcomes in large animals.
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Affiliation(s)
- Rakib Uddin Ahmed
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Daniel Medina‐Aguinaga
- Department of Anatomical Sciences and NeurobiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Shawns Adams
- Department of NeurosurgeryDuke UniversityRaleighNorth CarolinaUSA
| | - Chase A. Knibbe
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Monique Morgan
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Destiny Gibson
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Joo‐won Kim
- Department of RadiologyBaylor College of MedicineHoustonTexasUSA
- Department of PsychiatryBaylor College of MedicineHoustonTexasUSA
| | - Mayur Sharma
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Manpreet Chopra
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Steven Davison
- Comparative Medicine Research UnitUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Leslie C. Sherwood
- Comparative Medicine Research UnitUniversity of LouisvilleLouisvilleKentuckyUSA
| | - M.J. Negahdar
- Department of RadiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Robert Bert
- Department of RadiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Charles Hubscher
- Department of Anatomical Sciences and NeurobiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Matthew D. Budde
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- Clement J. Zablocki Veterans Affairs Medical CenterMilwaukeeWisconsinUSA
| | - Junqian Xu
- Department of RadiologyBaylor College of MedicineHoustonTexasUSA
- Department of PsychiatryBaylor College of MedicineHoustonTexasUSA
| | - Maxwell Boakye
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
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8
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Advances in monitoring for acute spinal cord injury: a narrative review of current literature. Spine J 2022; 22:1372-1387. [PMID: 35351667 DOI: 10.1016/j.spinee.2022.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 02/03/2023]
Abstract
Spinal cord injury (SCI) is a devastating condition that affects about 17,000 individuals every year in the United States, with approximately 294,000 people living with the ramifications of the initial injury. After the initial primary injury, SCI has a secondary phase during which the spinal cord sustains further injury due to ischemia, excitotoxicity, immune-mediated damage, mitochondrial dysfunction, apoptosis, and oxidative stress. The multifaceted injury progression process requires a sophisticated injury-monitoring technique for an accurate assessment of SCI patients. In this narrative review, we discuss SCI monitoring modalities, including pressure probes and catheters, micro dialysis, electrophysiologic measures, biomarkers, and imaging studies. The optimal next-generation injury monitoring setup should include multiple modalities and should integrate the data to produce a final simplified assessment of the injury and determine markers of intervention to improve patient outcomes.
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9
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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.
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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
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10
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Abstract
PURPOSE OF REVIEW This review covers recent advances in identifying conventional and quantitative neuroimaging spinal cord biomarkers of lesion severity and remote spinal cord pathology following traumatic spinal cord injury (SCI). It discusses the potential of the most sensitive neuroimaging spinal cord biomarkers to complement clinical workup and improve prediction of recovery. RECENT FINDINGS At the injury site, preserved midsagittal tissue bridges - based on conventional sagittal T2-weighted scans - can be identified in the majority of SCI patients; its width being predictive of recovery. Remote from the injury, diffusion indices, and myelin/iron-sensitive neuroimaging-based changes are sensitive to secondary disease processes; its magnitude of change being associated with neurological outcome. SUMMARY Neuroimaging biomarkers reveal focal and remote cord pathology. These biomarkers show sensitivity to the underlying disease processes and are clinically eloquent. Thus, they improve injury characterization, enable spatiotemporal tracking of cord pathology, and predict recovery of function following traumatic SCI. Neuroimaging biomarkers, therefore, hold potential to complement the clinical diagnostic workup, improve patient stratification, and can serve as potential endpoints in clinical trials.
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Affiliation(s)
- Dario Pfyffer
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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11
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Jogia T, Kopp MA, Schwab JM, Ruitenberg MJ. Peripheral white blood cell responses as emerging biomarkers for patient stratification and prognosis in acute spinal cord injury. Curr Opin Neurol 2021; 34:796-803. [PMID: 34608075 PMCID: PMC8631147 DOI: 10.1097/wco.0000000000000995] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW To date, prognostication of patients after acute traumatic spinal cord injury (SCI) mostly relies on the neurological assessment of residual function attributed to lesion characteristics. With emerging treatment candidates awaiting to be tested in early clinical trials, there is a need for wholistic high-yield prognostic biomarkers that integrate both neurogenic and nonneurogenic SCI pathophysiology as well as premorbid patient characteristics. RECENT FINDINGS It is becoming clearer that effective prognostication after acute SCI would benefit from integrating an assessment of pathophysiological changes on a systemic level, and with that, extend from a lesion-centric approach. Immunological markers mirror tissue injury as well as host immune function and are easily accessible through routine blood sampling. New studies have highlighted the value of circulating white blood cells, neutrophils and lymphocytes in particular, as prognostic systemic indicators of SCI severity and outcomes. SUMMARY We survey recent advances in methods and approaches that may allow for a more refined diagnosis and better prognostication after acute SCI, discuss how these may help deepen our understanding of SCI pathophysiology, and be of use in clinical trials.
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Affiliation(s)
- Trisha Jogia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Marcel A. Kopp
- Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan M. Schwab
- Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Belford Center for Spinal Cord Injury, Departments of Neuroscience and Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Marc J. Ruitenberg
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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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: 12] [Impact Index Per Article: 4.0] [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.
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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
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