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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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Emmenegger TM, Pfyffer D, Curt A, Schading-Sassenhausen S, Hupp M, Ashburner J, Friston K, Weiskopf N, Thompson A, Freund P. Longitudinal motor system changes from acute to chronic spinal cord injury. Eur J Neurol 2024; 31:e16196. [PMID: 38258488 DOI: 10.1111/ene.16196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND PURPOSE In acute spinal cord injury (SCI), magnetic resonance imaging (MRI) reveals tissue bridges and neurodegeneration for 2 years. This 5-year study aims to track initial lesion changes, subsequent neurodegeneration, and their impact on recovery. METHODS This prospective longitudinal study enrolled acute SCI patients and healthy controls who were assessed clinically-and by MRI-regularly from 3 days postinjury up to 60 months. We employed histologically cross-validated quantitative MRI sequences sensitive to volume, myelin, and iron changes, thereby reflecting indirectly processes of neurodegeneration and neuroinflammation. General linear models tracked lesion and remote changes in volume, myelin- and iron-sensitive magnetic resonance indices over 5 years. Associations between lesion, degeneration, and recovery (using the Spinal Cord Independence Measure [SCIM] questionnaire and the International Standards for Neurological Classification of Spinal Cord Injury total motor score) were assessed. RESULTS Patients' motor scores improved by an average of 12.86 (95% confidence interval [CI] = 6.70-19.00) points, and SCIM by 26.08 (95% CI = 17.00-35.20) points. Within 3-28 days post-SCI, lesion size decreased by more than two-thirds (3 days: 302.52 ± 185.80 mm2 , 28 days: 76.77 ± 88.62 mm2 ), revealing tissue bridges. Cervical cord and corticospinal tract volumes transiently increased in SCI patients by 5% and 3%, respectively, accompanied by cervical myelin decreases and iron increases. Over time, progressive atrophy was observed in both regions, which was linked to early lesion dynamics. Tissue bridges, reduced swelling, and myelin content decreases were predictive of long-term motor score recovery and improved SCIM score. CONCLUSIONS Studying acute changes and their impact on longer follow-up provides insights into SCI trajectory, highlighting the importance of acute intervention while indicating the potential to influence outcomes in the later stages.
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Affiliation(s)
- Tim M Emmenegger
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dario Pfyffer
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Armin Curt
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Markus Hupp
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - John Ashburner
- Wellcome Trust Centre for Neuroimaging, Queen Square Institute of Neurology, University College London, London, UK
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Queen Square Institute of Neurology, University College London, London, UK
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Felix Bloch Institute for Solid State Physics, Faculty of Physics and Earth Sciences, Leipzig University, Leipzig, Germany
| | - Alan Thompson
- Queen Square Multiple Sclerosis Centre, Institute of Neurology, University College London, London, UK
| | - Patrick Freund
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Wellcome Trust Centre for Neuroimaging, Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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3
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Scheuber MI, Guidolin C, Martins S, Sartori AM, Hofer AS, Schwab ME. Electrical stimulation of the cuneiform nucleus enhances the effects of rehabilitative training on locomotor recovery after incomplete spinal cord injury. Front Neurosci 2024; 18:1352742. [PMID: 38595973 PMCID: PMC11002271 DOI: 10.3389/fnins.2024.1352742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
Most human spinal cord injuries are anatomically incomplete, leaving some fibers still connecting the brain with the sublesional spinal cord. Spared descending fibers of the brainstem motor control system can be activated by deep brain stimulation (DBS) of the cuneiform nucleus (CnF), a subnucleus of the mesencephalic locomotor region (MLR). The MLR is an evolutionarily highly conserved structure which initiates and controls locomotion in all vertebrates. Acute electrical stimulation experiments in female adult rats with incomplete spinal cord injury conducted in our lab showed that CnF-DBS was able to re-establish a high degree of locomotion five weeks after injury, even in animals with initially very severe functional deficits and white matter lesions up to 80-95%. Here, we analyzed whether CnF-DBS can be used to support medium-intensity locomotor training and long-term recovery in rats with large but incomplete spinal cord injuries. Rats underwent rehabilitative training sessions three times per week in an enriched environment, either with or without CnF-DBS supported hindlimb stepping. After 4 weeks, animals that trained under CnF-DBS showed a higher level of locomotor performance than rats that trained comparable distances under non-stimulated conditions. The MLR does not project to the spinal cord directly; one of its main output targets is the gigantocellular reticular nucleus in the medulla oblongata. Long-term electrical stimulation of spared reticulospinal fibers after incomplete spinal cord injury via the CnF could enhance reticulospinal anatomical rearrangement and in this way lead to persistent improvement of motor function. By analyzing the spared, BDA-labeled giganto-spinal fibers we found that their gray matter arborization density after discontinuation of CnF-DBS enhanced training was lower in the lumbar L2 and L5 spinal cord in stimulated as compared to unstimulated animals, suggesting improved pruning with stimulation-enhanced training. An on-going clinical study in chronic paraplegic patients investigates the effects of CnF-DBS on locomotor capacity.
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Affiliation(s)
- Myriam I. Scheuber
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- ETH Phenomics Center, ETH Zurich, Zurich, Switzerland
| | - Carolina Guidolin
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- ETH Phenomics Center, ETH Zurich, Zurich, Switzerland
| | - Suzi Martins
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- ETH Phenomics Center, ETH Zurich, Zurich, Switzerland
| | - Andrea M. Sartori
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- ETH Phenomics Center, ETH Zurich, Zurich, Switzerland
| | - Anna-Sophie Hofer
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- ETH Phenomics Center, ETH Zurich, Zurich, Switzerland
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin E. Schwab
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- ETH Phenomics Center, ETH Zurich, Zurich, Switzerland
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Kaptan M, Pfyffer D, Konstantopoulos CG, Law CS, Weber II KA, Glover GH, Mackey S. Recent developments and future avenues for human corticospinal neuroimaging. Front Hum Neurosci 2024; 18:1339881. [PMID: 38332933 PMCID: PMC10850311 DOI: 10.3389/fnhum.2024.1339881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Non-invasive neuroimaging serves as a valuable tool for investigating the mechanisms within the central nervous system (CNS) related to somatosensory and motor processing, emotions, memory, cognition, and other functions. Despite the extensive use of brain imaging, spinal cord imaging has received relatively less attention, regardless of its potential to study peripheral communications with the brain and the descending corticospinal systems. To comprehensively understand the neural mechanisms underlying human sensory and motor functions, particularly in pathological conditions, simultaneous examination of neuronal activity in both the brain and spinal cord becomes imperative. Although technically demanding in terms of data acquisition and analysis, a growing but limited number of studies have successfully utilized specialized acquisition protocols for corticospinal imaging. These studies have effectively assessed sensorimotor, autonomic, and interneuronal signaling within the spinal cord, revealing interactions with cortical processes in the brain. In this mini-review, we aim to examine the expanding body of literature that employs cutting-edge corticospinal imaging to investigate the flow of sensorimotor information between the brain and spinal cord. Additionally, we will provide a concise overview of recent advancements in functional magnetic resonance imaging (fMRI) techniques. Furthermore, we will discuss potential future perspectives aimed at enhancing our comprehension of large-scale neuronal networks in the CNS and their disruptions in clinical disorders. This collective knowledge will aid in refining combined corticospinal fMRI methodologies, leading to the development of clinically relevant biomarkers for conditions affecting sensorimotor processing in the CNS.
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Affiliation(s)
- Merve Kaptan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Dario Pfyffer
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christiane G. Konstantopoulos
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christine S.W. Law
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kenneth A. Weber II
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gary H. Glover
- Radiological Sciences Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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5
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Mokhtari T, Uludag K. Role of NLRP3 Inflammasome in Post-Spinal-Cord-Injury Anxiety and Depression: Molecular Mechanisms and Therapeutic Implications. ACS Chem Neurosci 2024; 15:56-70. [PMID: 38109051 DOI: 10.1021/acschemneuro.3c00596] [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: 12/19/2023] Open
Abstract
The majority of research on the long-term effects of spinal cord injury (SCI) has primarily focused on neuropathic pain (NP), psychological issues, and sensorimotor impairments. Among SCI patients, mood disorders, such as anxiety and depression, have been extensively studied. It has been found that chronic stress and NP have negative consequences and reduce the quality of life for individuals living with SCI. Our review examined both human and experimental evidence to explore the connection between mood changes following SCI and inflammatory pathways, with a specific focus on NLRP3 inflammasome signaling. We observed increased proinflammatory factors in the blood, as well as in the brain and spinal cord tissues of SCI models. The NLRP3 inflammasome plays a crucial role in various diseases by controlling the release of proinflammatory molecules like interleukin 1β (IL-1β) and IL-18. Dysregulation of the NLRP3 inflammasome in key brain regions associated with pain processing, such as the prefrontal cortex and hippocampus, contributes to the development of mood disorders following SCI. In this review, we summarized recent research on the expression and regulation of components related to NLRP3 inflammasome signaling in mood disorders following SCI. Finally, we discussed potential therapeutic approaches that target the NLRP3 inflammasome and regulate proinflammatory cytokines as a way to treat mood disorders following SCI.
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Affiliation(s)
- Tahmineh Mokhtari
- Hubei Key Laboratory of Embryonic Stem Cell Research, Faculty of Basic Medical Sciences, Hubei University of Medicine, Shiyan 442000, Hubei, People's Republic of China
- Department of Histology and Embryology, Faculty of Basic Medical Sciences, Hubei University of Medicine, Shiyan 442000, Hubei, People's Republic of China
| | - Kadir Uludag
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, People's Republic of China
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6
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Thornton WA, Marzloff G, Ryder S, Best A, Rasheed K, Coons D, Smith AC. The presence or absence of midsagittal tissue bridges and walking: a retrospective cohort study in spinal cord injury. Spinal Cord 2023; 61:436-440. [PMID: 37120699 PMCID: PMC10524884 DOI: 10.1038/s41393-023-00890-6] [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: 08/10/2022] [Revised: 02/27/2023] [Accepted: 03/10/2023] [Indexed: 05/01/2023]
Abstract
STUDY DESIGN Cohort study. Retrospective analysis of T2-weighted magnetic resonance images (MRIs) and clinical documentation. OBJECTIVES To evaluate the relationship between the presence/absence and widths of midsagittal tissue bridges and walking ability among veterans with cervical, predominantly chronic SCI. SETTING University research and hospital setting. METHODS T2-weighted midsagittal MRIs of 22 United States veterans with cervical spinal cord injuries were examined. The presence/absence of midsagittal tissue bridges were determined, and the widths of present ventral and dorsal tissue bridges were measured. Midsagittal tissue bridge characteristics were related to each participant's ability to walk based off examination of clinical documentation. RESULTS Fourteen of the analyzed participant images revealed the presence of midsagittal tissue bridges. Ten of those individuals (71%) possessed overground walking ability. The 8 individuals with no apparent tissue bridges were all unable to walk. There was a significant correlation between walking and widths of ventral midsagittal tissue bridges (r = 0.69, 95%CI: 0.52, 0.92, p < 0.001), as well as dorsal midsagittal tissue bridges (r = 0.44, 95%CI: 0.15, 0.73, p = 0.039). CONCLUSION The evaluation of midsagittal tissue bridges may be useful in various rehabilitation settings to help inform patients' plan of care, allocation of neuromodulatory resources, and appropriate stratification into research cohorts.
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Affiliation(s)
- W A Thornton
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, USA.
| | - G Marzloff
- Rocky Mountain Regional VA Medical Center Spinal Cord Injury & Disorders Center, Aurora, CO, USA
| | - S Ryder
- Rocky Mountain Regional VA Medical Center Spinal Cord Injury & Disorders Center, Aurora, CO, USA
| | - A Best
- Rocky Mountain Regional VA Medical Center Spinal Cord Injury & Disorders Center, Aurora, CO, USA
| | - K Rasheed
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, USA
| | - D Coons
- Rocky Mountain Regional VA Medical Center Spinal Cord Injury & Disorders Center, Aurora, CO, USA
| | - A C Smith
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, USA
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7
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Yu H, Chen D, Jiang H, Fu G, Yang Y, Deng Z, Chen Y, Zheng Q. Brain morphology changes after spinal cord injury: A voxel-based meta-analysis. Front Neurol 2022; 13:999375. [PMID: 36119697 PMCID: PMC9477418 DOI: 10.3389/fneur.2022.999375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Spinal cord injury (SCI) remodels the brain structure and alters brain function. To identify specific changes in brain gray matter volume (GMV) and white matter volume (WMV) following SCI, we conducted a voxel-based meta-analysis of whole-brain voxel-based morphometry (VBM) studies. Methods We performed a comprehensive literature search on VBM studies that compared SCI patients and healthy controls in PubMed, Web of Science and the China National Knowledge Infrastructure from 1980 to April 2022. Then, we conducted a voxel-based meta-analysis using seed-based d mapping with permutation of subject images (SDM-PSI). Meta-regression analysis was performed to identify the effects of clinical characteristics. Results Our study collected 20 studies with 22 GMV datasets and 15 WMV datasets, including 410 patients and 406 healthy controls. Compared with healthy controls, SCI patients showed significant GMV loss in the left insula and bilateral thalamus and significant WMV loss in the bilateral corticospinal tract (CST). Additionally, a higher motor score and pinprick score were positively related to greater GMV in the right postcentral gyrus, whereas a positive relationship was observed between the light touch score and the bilateral postcentral gyrus. Conclusion Atrophy in the thalamus and bilateral CST suggest that SCI may trigger neurodegeneration changes in the sensory and motor pathways. Furthermore, atrophy of the left insula may indicate depression and neuropathic pain in SCI patients. These indicators of structural abnormalities could serve as neuroimaging biomarkers for evaluating the prognosis and treatment effect, as well as for monitoring disease progression. The application of neuroimaging biomarkers in the brain for SCI may also lead to personalized treatment strategies. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021279716, identifier: CRD42021279716.
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Affiliation(s)
- Haiyang Yu
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Duanyong Chen
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai Jiang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guangtao Fu
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuhui Yang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhantao Deng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanfeng Chen
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Research Department of Medical Science, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Qiujian Zheng
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Orthopedics, Southern Medical University, Guangzhou, China
- Yuanfeng Chen
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8
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Kim KD, Lee KS, Coric D, Harrop JS, Theodore N, Toselli RM. Acute Implantation of a Bioresorbable Polymer Scaffold in Patients With Complete Thoracic Spinal Cord Injury: 24-Month Follow-up From the INSPIRE Study. Neurosurgery 2022; 90:668-675. [PMID: 35442254 PMCID: PMC9067089 DOI: 10.1227/neu.0000000000001932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Based on 6-month data from the InVivo Study of Probable Benefit of the Neuro-Spinal Scaffold for Safety and Neurological Recovery in Patients with Complete Thoracic Spinal Cord Injury (INSPIRE) study (NCT02138110), acute implantation of an investigational bioresorbable polymer device (Neuro-Spinal Scaffold [NSS]) appeared to be safe in patients with complete thoracic spinal cord injury (SCI) and was associated with an ASIA Impairment Scale (AIS) conversion rate that exceeded historical controls. OBJECTIVE To evaluate outcomes through 24 months postimplantation. METHODS INSPIRE was a prospective, open-label, multicenter, single-arm study. Eligible patients had traumatic nonpenetrating SCI with a visible contusion on MRI, AIS A classification, neurological level of injury at T2-T12, and requirement for open spine surgery ≤96 hours postinjury. RESULTS Nineteen patients underwent NSS implantation. Three patients had early death determined by investigators to be unrelated to the NSS or its implantation procedure. Seven of 16 evaluable patients (44%) had improvement of ≥1 AIS grade at 6 months (primary end point) to AIS B (n = 5) or AIS C (n = 2). Three patients with AIS B at 6 months had further neurological improvement to AIS C by 12 (n = 2) and 24 (n = 1) months, respectively; none have deteriorated per latest available follow-up. No unanticipated or serious adverse device effects were reported. CONCLUSION In this small group of patients with complete thoracic SCI, acute NSS implantation within the spinal cord appeared to be safe with no long-term neurological issues identified during the 24-month follow-up. Patients remain stable, with additional AIS conversions observed in some patients at 12 months and beyond. These data further support the safety and probable benefit of NSS implantation in this patient population.
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Affiliation(s)
- Kee D. Kim
- Department of Neurological Surgery, UC Davis, Sacramento, California, USA;
| | - K. Stuart Lee
- Division of Neurosurgery, Vidant Health, Greenville, North Carolina, USA;
| | - Domagoj Coric
- Department of Neurosurgery, Atrium Healthcare, Charlotte, North Carolina, USA;
- Spine Division, Atrium Musculoskeletal Institute, Charlotte, North Carolina, USA;
- Carolina NeuroSurgery and Spine Associates, Charlotte, North Carolina, USA;
| | - James S. Harrop
- Department of Neurological and Orthopedic Surgery, Division of Spine and Peripheral Nerve Surgery, and Delaware Valley SCI Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA;
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9
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Hofer AS, Scheuber MI, Sartori AM, Good N, Stalder SA, Hammer N, Fricke K, Schalbetter SM, Engmann AK, Weber RZ, Rust R, Schneider MP, Russi N, Favre G, Schwab ME. Stimulation of the cuneiform nucleus enables training and boosts recovery after spinal cord injury. Brain 2022; 145:3681-3697. [PMID: 35583160 PMCID: PMC9586551 DOI: 10.1093/brain/awac184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Severe spinal cord injuries result in permanent paraparesis in spite of the frequent sparing of small portions of white matter. Spared fibre tracts are often incapable of maintaining and modulating the activity of lower spinal motor centres. Effects of rehabilitative training thus remain limited. Here, we activated spared descending brainstem fibres by electrical deep brain stimulation of the cuneiform nucleus of the mesencephalic locomotor region, the main control centre for locomotion in the brainstem, in adult female Lewis rats. We show that deep brain stimulation of the cuneiform nucleus enhances the weak remaining motor drive in highly paraparetic rats with severe, incomplete spinal cord injuries and enables high-intensity locomotor training. Stimulation of the cuneiform nucleus during rehabilitative aquatraining after subchronic (n = 8 stimulated versus n = 7 unstimulated versus n = 7 untrained rats) and chronic (n = 14 stimulated versus n = 9 unstimulated versus n = 9 untrained rats) spinal cord injury re-established substantial locomotion and improved long-term recovery of motor function. We additionally identified a safety window of stimulation parameters ensuring context-specific locomotor control in intact rats (n = 18) and illustrate the importance of timing of treatment initiation after spinal cord injury (n = 14). This study highlights stimulation of the cuneiform nucleus as a highly promising therapeutic strategy to enhance motor recovery after subchronic and chronic incomplete spinal cord injury with direct clinical applicability.
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Affiliation(s)
- Anna-Sophie Hofer
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Myriam I Scheuber
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Andrea M Sartori
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nicolas Good
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Stephanie A Stalder
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nicole Hammer
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Kai Fricke
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Sina M Schalbetter
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Anne K Engmann
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Rebecca Z Weber
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Ruslan Rust
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Marc P Schneider
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Natalie Russi
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Giacomin Favre
- Department of Economics, University of Zurich, 8032 Zurich, Switzerland
| | - Martin E Schwab
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
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10
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Nedumaran L, Rebekah G, Tharion E, Tharion G. Initial Autonomic Parameters and Subsequent Short-Term Neurological Recovery after Inpatient Rehabilitation, in Traumatic Cervical Spinal Cord Injury Patients. Neurorehabil Neural Repair 2022; 36:269-273. [PMID: 35227121 DOI: 10.1177/15459683221081060] [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: 11/15/2022]
Abstract
BACKGROUND It is unknown whether assessment of autonomic pathway integrity in newly injured traumatic cervical spinal cord injury (SCI) patients contributes to their neurological prognosis. OBJECTIVE The objective is to investigate the relationship of heart rate variability (HRV) and sympathetic skin response (SSR) at initial evaluation of American Spinal Injury Association Impairment Scale (AIS) A/B tetraplegic patients, with their short-term neurological recovery. METHODS In this prospective cohort study, short-term HRV indices and SSR to supra-lesional stimuli were computed in 24 acute traumatic cervical AIS A/B SCI patients at admission for rehabilitation. The relationship of these autonomic parameters with motor and sensory score improvement, AIS grade improvement, and time taken for recovery was tested, respectively, with Spearman's correlation coefficient test, Fisher's exact test, and Kaplan-Meier analysis. RESULTS SSR was present in 11 (45.8%) patients at initial evaluation. After rehabilitation, 5 (20.8%) patients improved from AIS A/B to AIS C (greater recovery), while the rest remained at AIS A/B (lesser recovery). Both AIS improvement and mean time for 'greater' recovery did not associate with the presence/absence of SSR. Further, HRV indices did not correlate with improvement in motor or sensory scores. CONCLUSIONS Interim neurological recovery was not related to autonomic parameters of short-term HRV indices and SSR in the AIS A/B tetraplegic patients of our study. Interestingly, about half of the patients with clinically complete SCI had evidence of preserved autonomic function. Our data add to the knowledge base of autonomic findings in cervical SCI patients and will promote research relating neurophysiological parameters and recovery.
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Affiliation(s)
- Latha Nedumaran
- Department of Physiology, 30025Christian Medical College, Vellore, TN, India
| | - Grace Rebekah
- Department of Biostatistics, 30025Christian Medical College, Vellore, TN, India
| | - Elizabeth Tharion
- Department of Physiology, 30025Christian Medical College, Vellore, TN, India
| | - George Tharion
- Department of Physical Medicine and Rehabilitation, 30025Christian Medical College, Vellore, TN, India
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11
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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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12
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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.
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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
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13
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Pfyffer D, Freund P. Spinal cord pathology revealed by MRI in traumatic spinal cord injury. Curr Opin Neurol 2021; 34:789-795. [PMID: 34619692 DOI: 10.1097/wco.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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14
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Rao JS, Zhao C, Bao SS, Feng T, Xu M. MRI metrics at the epicenter of spinal cord injury are correlated with the stepping process in rhesus monkeys. Exp Anim 2021; 71:139-149. [PMID: 34789621 PMCID: PMC9130044 DOI: 10.1538/expanim.21-0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinical evaluations of long-term outcomes in the early-stage spinal cord injury (SCI) focus on macroscopic motor performance and are limited in their prognostic precision. This study was designed to investigate the sensitivity of the magnetic resonance imaging (MRI) indexes to the data-driven gait process after SCI. Ten adult female rhesus monkeys were subjected to thoracic SCI. Kinematics-based gait examinations were performed at 1 (early stage) and 12 (chronic stage) months post-SCI. The proportion of stepping (PS) and gait stability (GS) were calculated as the outcome measures. MRI metrics, which were derived from structural imaging (spinal cord cross-sectional area, SCA) and diffusion tensor imaging (fractional anisotropy, FA; axial diffusivity, λ//), were acquired in the early stage and compared with functional outcomes by using correlation analysis and stepwise multivariable linear regression. Residual tissue SCA at the injury epicenter and residual tissue FA/remote normal-like tissue FA were correlated with the early-stage PS and GS. The extent of lesion site λ///residual tissue λ// in the early stage after SCI was correlated with the chronic-stage GS. The ratios of lesion site λ// to residual tissue λ// and early-stage GS were predictive of the improvement in the PS at follow-up. Similarly, the ratios of lesion site λ// to residual tissue λ// and early-stage PS best predicted chronic GS recovery. Our findings demonstrate the predictive power of MRI combined with the early data-driven gait indexes for long-term outcomes. Such an approach may help clinicians to predict functional recovery accurately.
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Affiliation(s)
- Jia-Sheng Rao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University
| | - Can Zhao
- Institute of Rehabilitation Engineering, China Rehabilitation Science Institute.,School of Rehabilitation, Capital Medical University
| | - Shu-Sheng Bao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University
| | - Ting Feng
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University
| | - Meng Xu
- Department of Orthopedics, The First Medical Center of PLA General Hospital
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15
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Kikkert S, Pfyffer D, Verling M, Freund P, Wenderoth N. Finger somatotopy is preserved after tetraplegia but deteriorates over time. eLife 2021; 10:e67713. [PMID: 34665133 PMCID: PMC8575460 DOI: 10.7554/elife.67713] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Previous studies showed reorganised and/or altered activity in the primary sensorimotor cortex after a spinal cord injury (SCI), suggested to reflect abnormal processing. However, little is known about whether somatotopically specific representations can be activated despite reduced or absent afferent hand inputs. In this observational study, we used functional MRI and a (attempted) finger movement task in tetraplegic patients to characterise the somatotopic hand layout in primary somatosensory cortex. We further used structural MRI to assess spared spinal tissue bridges. We found that somatotopic hand representations can be activated through attempted finger movements in the absence of sensory and motor hand functioning, and no spared spinal tissue bridges. Such preserved hand somatotopy could be exploited by rehabilitation approaches that aim to establish new hand-brain functional connections after SCI (e.g. neuroprosthetics). However, over years since SCI the hand representation somatotopy deteriorated, suggesting that somatotopic hand representations are more easily targeted within the first years after SCI.
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Affiliation(s)
- Sanne Kikkert
- Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH ZürichZürichSwitzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University of ZürichZürichSwitzerland
| | - Dario Pfyffer
- Spinal Cord Injury Center, Balgrist University Hospital, University of ZürichZürichSwitzerland
| | - Michaela Verling
- Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH ZürichZürichSwitzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of ZürichZürichSwitzerland
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College LondonLondonUnited Kingdom
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College LondonLondonUnited Kingdom
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - Nicole Wenderoth
- Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH ZürichZürichSwitzerland
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16
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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.
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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.
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17
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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: 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.
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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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