Medicine › Pathology and Forensic Medicine

Spinal Cord Injury Research

Works Count: 37144

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Description

This cluster of papers focuses on the pathophysiology, epidemiology, and treatment strategies for spinal cord injury. It covers topics such as neurological classification, recovery priorities, epidemiological trends, inflammation, neuroprotection, physical activity participation, and clinical trial guidelines. The papers also explore neuromodulation, functional recovery, and the role of various therapeutic interventions in improving outcomes for individuals with spinal cord injury.

Keywords

Spinal Cord Injury; Neurological Classification; Epidemiology; Recovery; Inflammation; Neuroprotection; Physical Activity; Clinical Trials; Neuromodulation; Functional Recovery

Transplanted embryonic stem cells survive, differentiate and promote recovery in injured rat spinal cord

1999-12-01

John W. McDonald , Xiao-Zhong Liu , Yun Qu +5 more

International Standards For Neurological Classification Of Spinal Cord Injury

2003-01-01

Ralph J. Marino , Tarcísio Eloy Pessoa de Barros Filho , Fin Biering‐Sørensen +6 more

(2003). International Standards For Neurological Classification Of Spinal Cord Injury. The Journal of Spinal Cord Medicine: Vol. 26, No. sup1, pp. S50-S56. (2003). International Standards For Neurological Classification Of Spinal Cord Injury. The Journal of Spinal Cord Medicine: Vol. 26, No. sup1, pp. S50-S56.

Neuronal and Glial Apoptosis after Traumatic Spinal Cord Injury

1997-07-15

Xiao Z. Liu , Xiao‐Ming Xu , Rong Hu +7 more

Cell death was examined by studying the spinal cords of rats subjected to traumatic insults of mild to moderate severity. Within minutes after mild weight drop impact (a 10 gm … Cell death was examined by studying the spinal cords of rats subjected to traumatic insults of mild to moderate severity. Within minutes after mild weight drop impact (a 10 gm weight falling 6.25 mm), neurons in the immediate impact area showed a loss of cytoplasmic Nissl substances. Over the next 7 d, this lesion area expanded and cavitated. Terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate–biotin nick end labeling (TUNEL)-positive neurons were noted primarily restricted to the gross lesion area 4–24 hr after injury, with a maximum presence at 8 hr after injury. TUNEL-positive glia were present at all stages studied between 4 hr and 14 d, with a maximum presence within the lesion area 24 hr after injury. However 7 d after injury, a second wave of TUNEL-positive glial cells was noted in the white matter peripheral to the lesion and extending at least several millimeters away from the lesion center. The suggestion of apoptosis was supported by electron microscopy, as well as by nuclear staining with Hoechst 33342 dye, and by examination of DNA prepared from the lesion site. Furthermore, repeated intraperitoneal injections of cycloheximide, beginning immediately after a 12.5 mm weight drop insult, produced a substantial reduction in histological evidence of cord damage and in motor dysfunction assessed 4 weeks later. Present data support the hypothesis that apoptosis dependent on active protein synthesis contributes to the neuronal and glial cell death, as well as to the neurological dysfunction, induced by mild-to-moderate severity traumatic insults to the rat spinal cord.

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Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data

1992-01-01

Michael B. Bracken , Mary Jo Shepard , William F. Collins +7 more

✓ The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr … ✓ The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute spinal cord injury are reported and compared with placebo results. In patients treated with methylprednisolone within 8 hours of injury, increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury. For motor function, this difference was statistically significant (p = 0.030), and was found in patients with total sensory and motor loss in the emergency room (p = 0.019) and in those with some preservation of motor and sensory function (p = 0.024). Naloxone-treated patients did not show significantly greater recovery. Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10) as compared with those given placebo. Complication and mortality rates were similar in either group of treated patients as compared with the placebo group. The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma, but only if it can be started within 8 hours of injury.

A Monitored Contusion Model of Spinal Cord Injury in the Rat

1992-01-01

John A. Gruner

Graded Histological and Locomotor Outcomes after Spinal Cord Contusion Using the NYU Weight-Drop Device versus Transection

1996-06-01

D. Michele Basso , Michael S. Beattie , Jacqueline C. Bresnahan

Spinal Cord Repair in Adult Paraplegic Rats: Partial Restoration of Hind Limb Function

1996-07-26

Henrich Cheng , Yihai Cao , Lar̀s Olson

Complete spinal cord gaps in adult rats were bridged with multiple intercostal nerve grafts that redirected specific pathways from white to gray matter. The grafted area was stabilized with fibrin … Complete spinal cord gaps in adult rats were bridged with multiple intercostal nerve grafts that redirected specific pathways from white to gray matter. The grafted area was stabilized with fibrin glue containing acidic fibroblast growth factor and by compressive wiring of posterior spinal processes. Hind limb function improved progressively during the first 6 months, as assessed by two scoring systems. The corticospinal tract regenerated through the grafted area to the lumbar enlargement, as did several bulbospinal pathways. These data suggest a possible repair strategy for spinal cord injury.

Apoptosis and delayed degeneration after spinal cord injury in rats and monkeys

1997-01-01

Maria J. Crowe , Jacqueline C. Bresnahan , Sheri L. Shuman +2 more

International Standards for Neurological and Functional Classification of Spinal Cord Injury

1997-05-01

Frederick Maynard , Michael B. Bracken , Graham H. Creasey +7 more

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Basso Mouse Scale for Locomotion Detects Differences in Recovery after Spinal Cord Injury in Five Common Mouse Strains

2006-05-01

D. Michele Basso , Lesley C. Fisher , Aileen J. Anderson +3 more

Genetically engineered mice are used extensively to examine molecular responses to spinal cord injury (SCI). Inherent strain differences may confound behavioral outcomes; therefore, behavioral characterization of several strains after SCI … Genetically engineered mice are used extensively to examine molecular responses to spinal cord injury (SCI). Inherent strain differences may confound behavioral outcomes; therefore, behavioral characterization of several strains after SCI is warranted. The Basso, Beattie, Bresnahan Locomotor Rating Scale (BBB) for rats has been widely used for SCI mice, but may not accurately reflect their unique recovery pattern. This study's purpose was to develop a valid locomotor rating scale for mice and to identify strain differences in locomotor recovery after SCI. We examined C57BL/6, C57BL/10, B10.PL, BALB/c, and C57BL/6x129S6 F1 strains for 42 days after mild, moderate, and severe contusive SCI or transection of the mid thoracic spinal cord. Contusions were created using the Ohio State University electromagnetic SCI device which is a displacement-driven model, and the Infinite Horizon device, which is a force-driven model. Attributes and rankings for the Basso Mouse Scale for Locomotion (BMS) were determined from frequency analyses of seven locomotor categories. Mouse recovery differed from rats for coordination, paw position and trunk instability. Disagreement occurred across six expert raters using BBB (p < 0.05) but not BMS to assess the same mice. BMS detected significant differences in locomotor outcomes between severe contusion and transection (p < 0.05) and SCI severity gradations resulting from displacement variations of only 0.1 mm (p < 0.05). BMS demonstrated significant face, predictive and concurrent validity. Novice BMS raters with training scored within 0.5 points of experts and demonstrated high reliability (0.92–0.99). The BMS is a sensitive, valid and reliable locomotor measure in SCI mice. BMS revealed significantly higher recovery in C57BL/10, B10.PL and F1 than the C57BL/6 and BALB/c strains after moderate SCI (p < 0.05). The differing behavioral response to SCI suggests inherent genetic factors significantly impact locomotor recovery and must be considered in studies with inbred or genetically engineered mouse strains.

The cellular inflammatory response in human spinal cords after injury

2006-06-09

Judith C. Fleming , M. D. Norenberg , David A. Ramsay +6 more

Spinal cord injury (SCI) provokes an inflammatory response that generates substantial secondary damage within the cord but also may contribute to its repair. Anti-inflammatory treatment of human SCI and its … Spinal cord injury (SCI) provokes an inflammatory response that generates substantial secondary damage within the cord but also may contribute to its repair. Anti-inflammatory treatment of human SCI and its timing must be based on knowledge of the types of cells participating in the inflammatory response, the time after injury when they appear and then decrease in number, and the nature of their actions. Using post-mortem spinal cords, we evaluated the time course and distribution of pathological change, infiltrating neutrophils, monocytes/macrophages and lymphocytes, and microglial activation in injured spinal cords from patients who were 'dead at the scene' or who survived for intervals up to 1 year after SCI. SCI caused zones of pathological change, including areas of inflammation and necrosis in the acute cases, and cystic cavities with longer survival (Zone 1), mantles of less severe change, including axonal swellings, inflammation and Wallerian degeneration (Zone 2) and histologically intact areas (Zone 3). Zone 1 areas increased in size with time after injury whereas the overall injury (size of the Zones 1 and 2 combined) remained relatively constant from the time (1-3 days) when damage was first visible. The distribution of inflammatory cells correlated well with the location of Zone 1, and sometimes of Zone 2. Neutrophils, visualized by their expression of human neutrophil alpha-defensins (defensin), entered the spinal cord by haemorrhage or extravasation, were most numerous 1-3 days after SCI, and were detectable for up to 10 days after SCI. Significant numbers of activated CD68-immunoreactive ramified microglia and a few monocytes/macrophages were in injured tissue within 1-3 days of SCI. Activated microglia, a few monocytes/macrophages and numerous phagocytic macrophages were present for weeks to months after SCI. A few CD8(+) lymphocytes were in the injured cords throughout the sampling intervals. Expression by the inflammatory cells of the oxidative enzymes myeloperoxidase (MPO) and nicotinamide adenine dinucleotide phosphate oxidase (gp91(phox)), and of the pro-inflammatory matrix metalloproteinase (MMP)-9, was analysed to determine their potential to cause oxidative and proteolytic damage. Oxidative activity, inferred from MPO and gp91(phox) immunoreactivity, was primarily associated with neutrophils and activated microglia. Phagocytic macrophages had weak or no expression of MPO or gp91(phox). Only neutrophils expressed MMP-9. These data indicate that potentially destructive neutrophils and activated microglia, replete with oxidative and proteolytic enzymes, appear within the first few days of SCI, suggesting that anti-inflammatory 'neuroprotective' strategies should be directed at preventing early neutrophil influx and modifying microglial activation.

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Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?

2006-01-03

Michel Wyndaele , J-J Wyndaele

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Therapeutic interventions after spinal cord injury

2006-07-20

Sandrine Thuret , Lawrence Moon , Fred H. Gage

Recent trends in mortality and causes of death among persons with spinal cord injury

1999-11-01

Michael J. De Vivo , James S. Krause , Daniel P. Lammertse

Epidemiology, Demographics, and Pathophysiology of Acute Spinal Cord Injury

2001-12-01

Lali H.S. Sekhon , Michael G. Fehlings

Spinal cord injury occurs through various countries throughout the world with an annual incidence of 15 to 40 cases per million, with the causes of these injuries ranging from motor … Spinal cord injury occurs through various countries throughout the world with an annual incidence of 15 to 40 cases per million, with the causes of these injuries ranging from motor vehicle accidents and community violence to recreational activities and workplace-related injuries. Survival has improved along with a greater appreciation of patterns of presentation, survival, and complications. Despite much work having been done, the only treatment to date known to ameliorate neurologic dysfunction that occurs at or below the level of neurologic injury has been intravenous methylprednisolone therapy. Much research over the past 30 to 40 years has focused on elucidating the mechanisms of spinal cord injury, with the complex pathophysiologic processes slowly being unraveled. With a greater understanding of both primary and secondary mechanisms of injury, the roles of calcium, free radicals, sodium, excitatory amino acids, vascular mediators, and apoptosis have been elucidated. This review examines the epidemiology, demographics, and pathophysiology of acute spinal cord injury.

Repertoire of microglial and macrophage responses after spinal cord injury

2011-06-15

Samuel David , Antje Kroner

Targeting Recovery: Priorities of the Spinal Cord-Injured Population

2004-10-01

Kim D. Anderson

In the United States alone, there are more than 200,000 individuals living with a chronic spinal cord injury (SCI). Healthcare for these individuals creates a significant economic burden for the … In the United States alone, there are more than 200,000 individuals living with a chronic spinal cord injury (SCI). Healthcare for these individuals creates a significant economic burden for the country, not to mention the physiological, psychological, and social suffering these people endure everyday. Regaining partial function can lead to greater independence, thereby improving quality of life. To ascertain what functions are most important to the SCI population, in regard to enhancing quality of life, a novel survey was performed in which subjects were asked to rank seven functions in order of importance to their quality of life. The survey was distributed via email, postal mail, the internet, interview, and word of mouth to the SCI community at large. A total of 681 responses were completed. Regaining arm and hand function was most important to quadriplegics, while regaining sexual function was the highest priority for paraplegics. Improving bladder and bowel function was of shared importance to both injury groups. A longitudinal analysis revealed only slight differences between individuals injured <3 years compared to those injured >3 years. The majority of participants indicated that exercise was important to functional recovery, yet more than half either did not have access to exercise or did not have access to a trained therapist to oversee that exercise. In order to improve the relevance of research in this area, the concerns of the SCI population must be better known and taken into account. This approach is consistent with and emphasized by the new NIH roadmap to discovery.

Inflammation and its role in neuroprotection, axonal regeneration and functional recovery after spinal cord injury

2007-07-02

Dustin J. Donnelly , Phillip G. Popovich

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Epidemiology of traumatic spinal cord injury: trends and future implications

2012-01-24

Michael J. DeVivo

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Global prevalence and incidence of traumatic spinal cord injury

2014-09-01

Michael G. Fehlings , Anoushka Singh , Lindsay Tetreault +2 more

Global prevalence and incidence of traumatic spinal cord injury Anoushka Singh*, Lindsay Tetreault*, Suhkvinder Kalsi-Ryan, Aria Nouri, Michael G FehlingsToronto Western Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada *These … Global prevalence and incidence of traumatic spinal cord injury Anoushka Singh*, Lindsay Tetreault*, Suhkvinder Kalsi-Ryan, Aria Nouri, Michael G FehlingsToronto Western Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada *These authors contributed equally to this paper Background: Spinal cord injury (SCI) is a traumatic event that impacts a patient's physical, psychological, and social well-being and places substantial financial burden on health care systems. To determine the true impact of SCI, this systematic review aims to summarize literature reporting on either the incidence or prevalence of SCI. Methods: A systematic search was conducted using PubMed, MEDLINE, MEDLINE in process, EMBASE, Cochrane Controlled Trial Register, and Cochrane Database of Systematic Reviews to identify relevant literature published through June 2013. We sought studies that provided regional, provincial/state, or national data on the incidence of SCI or reported estimates of disease prevalence. The level of evidence of each study was rated using a scale that evaluated study design, methodology, sampling bias, and precision of estimates. Results: The initial search yielded 5,874 articles, 48 of which met the inclusion criteria. Forty-four studies estimated the incidence of SCI and nine reported the prevalence, with five discussing both. Of the incidence studies, 14 provided figures at a regional, ten at a state or provincial level and 21 at a national level. The prevalence of SCI was highest in the United States of America (906 per million) and lowest in the Rhone-Alpes region, France (250 per million) and Helsinki, Finland (280 per million). With respect to states and provinces in North America, the crude annual incidence of SCI was highest in Alaska (83 per million) and Mississippi (77 per million) and lowest in Alabama (29.4 per million), despite a large percentage of violence injuries (21.2%). Annual incidences were above 50 per million in the Hualien County in Taiwan (56.1 per million), the central Portugal region (58 per million), and Olmsted County in Minnesota (54.8 per million) and were lower than 20 per million in Taipei, Taiwan (14.6 per million), the Rhone-Alpes region in France (12.7 per million), Aragon, Spain (12.1 per million), Southeast Turkey (16.9 per million), and Stockholm, Sweden (19.5 per million). The highest national incidence was 49.1 per million in New Zealand, and the lowest incidences were in Fiji (10.0 per million) and Spain (8.0 per million). The majority of studies showed a high male-to-female ratio and an age of peak incidence of younger than 30 years old. Traffic accidents were typically the most common cause of SCI, followed by falls in the elderly population. Conclusion: This review demonstrates that the incidence, prevalence, and causation of SCI differs between developing and developed countries and suggests that management and preventative strategies need to be tailored to regional trends. The rising aging population in westernized countries also indicates that traumatic SCI secondary to falls may become an increasing public health challenge and that incidence among the elderly may rise with increasing life expectancy. Keywords: SCI, causation, epidemiology

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The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate

2013-02-26

Bonsan B. Lee , R A Cripps , Michael Fitzharris +1 more

Literature review.Update the global maps for traumatic spinal cord injury (TSCI) and incorporate methods for extrapolating incidence data.An initiative of the International Spinal Cord Society (ISCoS) Prevention Committee.A search of … Literature review.Update the global maps for traumatic spinal cord injury (TSCI) and incorporate methods for extrapolating incidence data.An initiative of the International Spinal Cord Society (ISCoS) Prevention Committee.A search of Medline/Embase was performed (1959-Jun/30/2011). Enhancement of data-quality 'zones' including individual data-ranking as well as integrating regression techniques to provide a platform for continued regional and global estimates.A global-incident rate (2007) is estimated at 23 TSCI cases per million (179,312 cases per annum). Regional data are available from North America (40 per million), Western Europe (16 per million) and Australia (15 per million). Extrapolated regional data are available for Asia-Central (25 per million), Asia-South (21 per million), Caribbean (19 per million), Latin America, Andean (19 per million), Latin America, Central (24 per million), Latin America-Southern (25 per million), Sub-Saharan Africa-Central (29 per million), Sub-Saharan Africa-East (21 per million).It is estimated that globally in 2007, there would have been between 133 and 226 thousand incident cases of TSCI from accidents and violence. The proportion of TSCI from land transport is decreasing/stable in developed but increasing in developing countries due to trends in transport mode (transition to motorised transport), poor infrastructure and regulatory challenges. TSCIs from low falls in the elderly are increasing in developed countries with ageing populations. In some developing countries low falls, resulting in TSCI occur while carrying heavy loads on the head in young people. In developing countries high-falls feature, commonly from trees, balconies, flat roofs and construction sites. TSCI is also due to crush-injuries, diving and violence.The online global maps now inform an extrapolative statistical model, which estimates incidence for areas with insufficient TSCI data. The accuracy of this methodology will be improved through the use of prospective, standardised-data registries.

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Current status of acute spinal cord injury pathophysiology and emerging therapies: promise on the horizon

2008-11-01

James W. Rowland , Gregory W. J. Hawryluk , Brian K. Kwon +1 more

This review summarizes the current understanding of spinal cord injury pathophysiology and discusses important emerging regenerative approaches that have been translated into clinical trials or have a strong potential to … This review summarizes the current understanding of spinal cord injury pathophysiology and discusses important emerging regenerative approaches that have been translated into clinical trials or have a strong potential to do so. The pathophysiology of spinal cord injury involves a primary mechanical injury that directly disrupts axons, blood vessels, and cell membranes. This primary mechanical injury is followed by a secondary injury phase involving vascular dysfunction, edema, ischemia, excitotoxicity, electrolyte shifts, free radical production, inflammation, and delayed apoptotic cell death. Following injury, the mammalian central nervous system fails to adequately regenerate due to intrinsic inhibitory factors expressed on central myelin and the extracellular matrix of the posttraumatic gliotic scar. Regenerative approaches to block inhibitory signals including Nogo and the Rho-Rho–associated kinase pathways have shown promise and are in early stages of clinical evaluation. Cell-based strategies including using neural stem cells to remyelinate spared axons are an attractive emerging approach.

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A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury

2003-04-05

Philip J. Siddall , Joan M. McClelland , Susan B. Rutkowski +1 more

A longitudinal cohort study of 100 people with traumatic spinal cord injury (SCI) was performed to determine the prevalence and severity of different types of pain (musculoskeletal, visceral, neuropathic at-level, … A longitudinal cohort study of 100 people with traumatic spinal cord injury (SCI) was performed to determine the prevalence and severity of different types of pain (musculoskeletal, visceral, neuropathic at-level, neuropathic below-level) at 5 years following SCI. Prospective data on the characteristics of pain up to 6 months following injury had been collected previously and allowed comparisons between the presence of pain at different time points. In addition, we sought to determine the relationship between the presence of pain and physical factors related to the injury such as level of lesion, completeness and clinical SCI syndrome. We also obtained information regarding mood, global self-rated health and the impact of pain on function. Of the 100 subjects in the original cohort, 73 were available for follow up. When all types of pain were included, 59 of the 73 subjects (81%) reported the presence of pain. Musculoskeletal pain was the most common type of pain experienced and was present in 43 subjects (59%), at-level neuropathic pain was present in 30 subjects (41%), below-level neuropathic pain was present in 25 subjects (34%) and visceral pain was present in four subjects (5%). Overall, 58% reported their pain as severe or excruciating and those with visceral pain were most likely to rate their pain in these categories. There was no relationship between the presence of pain overall and level or completeness of lesion, or type of injury. However, tetraplegics were more likely to report below-level neuropathic pain. This study prospectively demonstrates the differing time courses of different types of pain over the first 5 years following SCI. There was a strong correlation between the presence of both types of neuropathic pain at 5 years and earlier time points but both visceral pain and musculoskeletal pain demonstrated a poor correlation between time points. Chronic visceral pain occurs in a small percentage of patients and does not correlate with the presence of visceral pain early following injury. Those with neuropathic pain early following their injury are likely to continue to experience ongoing pain and the pain is likely to be severe. In contrast, chronic musculoskeletal pain is more common but less likely to be severe and cannot be predicted by the presence of pain in the first 6 months following injury.

Implantation of stimulated homologous macrophages results in partial recovery of paraplegic rats

1998-07-01

Otto Rapalino , Orly Lazarov , Eugenia Agranov +7 more

The ReWalk Powered Exoskeleton to Restore Ambulatory Function to Individuals with Thoracic-Level Motor-Complete Spinal Cord Injury

2012-09-06

Alberto Esquenazi , Mukul Talaty , Andrew Packel +1 more

Objective The aim of this study was to assess the safety and performance of ReWalk in enabling people with paraplegia due to spinal cord injury to carry out routine ambulatory … Objective The aim of this study was to assess the safety and performance of ReWalk in enabling people with paraplegia due to spinal cord injury to carry out routine ambulatory functions. Design This was an open, noncomparative, nonrandomized study of the safety and performance of the ReWalk powered exoskeleton. All 12 subjects have completed the active intervention; three remain in long-term follow-up. Results After training, all subjects were able to independently transfer and walk, without human assistance while using the ReWalk, for at least 50 to 100 m continuously, for a period of at least 5 to 10 mins continuously and with velocities ranging from 0.03 to 0.45 m/sec (mean, 0.25 m/sec). Excluding two subjects with considerably reduced walking abilities, average distances and velocities improved significantly. Some subjects reported improvements in pain, bowel and bladder function, and spasticity during the trial. All subjects had strong positive comments regarding the emotional/psychosocial benefits of the use of ReWalk. Conclusions ReWalk holds considerable potential as a safe ambulatory powered orthosis for motor-complete thoracic-level spinal cord injury patients. Most subjects achieved a level of walking proficiency close to that needed for limited community ambulation. A high degree of performance variability was observed across individuals. Some of this variability was explained by level of injury, but other factors have not been completely identified. Further development and application of this rehabilitation tool to other diagnoses are expected in the future.

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)

2012-02-23

Michael G. Fehlings , Alexander R. Vaccaro , Jefferson R. Wilson +7 more

Background There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with … Background There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (<24 hours after injury) versus late (≥24 hours after injury) decompressive surgery after traumatic cervical SCI. Methods We performed a multicenter, international, prospective cohort study (Surgical Timing in Acute Spinal Cord Injury Study: STASCIS) in adults aged 16–80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was ordinal change in ASIA Impairment Scale (AIS) grade at 6 months follow-up. Secondary outcomes included assessments of complications rates and mortality. Findings A total of 313 patients with acute cervical SCI were enrolled. Of these, 182 underwent early surgery, at a mean of 14.2(±5.4) hours, with the remaining 131 having late surgery, at a mean of 48.3(±29.3) hours. Of the 222 patients with follow-up available at 6 months post injury, 19.8% of patients undergoing early surgery showed a ≥2 grade improvement in AIS compared to 8.8% in the late decompression group (OR = 2.57, 95% CI:1.11,5.97). In the multivariate analysis, adjusted for preoperative neurological status and steroid administration, the odds of at least a 2 grade AIS improvement were 2.8 times higher amongst those who underwent early surgery as compared to those who underwent late surgery (OR = 2.83, 95% CI:1.10,7.28). During the 30 day post injury period, there was 1 mortality in both of the surgical groups. Complications occurred in 24.2% of early surgery patients and 30.5% of late surgery patients (p = 0.21). Conclusion Decompression prior to 24 hours after SCI can be performed safely and is associated with improved neurologic outcome, defined as at least a 2 grade AIS improvement at 6 months follow-up.

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Cellular inflammatory response after spinal cord injury in sprague-dawley and lewis rats

1997-01-20

Phillip G. Popovich , Ping Wei , Bradford T. Stokes

The distribution of microglia, macrophages, T-lymphocytes, and astrocytes was characterized throughout a spinal contusion lesion in Sprague-Dawley and Lewis rats by using immunohistochemistry. The morphology, spatial localization, and activation state … The distribution of microglia, macrophages, T-lymphocytes, and astrocytes was characterized throughout a spinal contusion lesion in Sprague-Dawley and Lewis rats by using immunohistochemistry. The morphology, spatial localization, and activation state of these inflammatory cells were described both qualitatively and quantitatively at 12 hours, 3, 7, 14, and 28 days after injury. By use of OX42 and ED1 antibodies, peak microglial activation was observed within the lesion epicenter of both rat strains between three and seven days post-injury preceding the bulk of monocyte influx and macrophage activation (seven days). Rostral and caudal to the injury site, microglial activation plateaued between two and four weeks post-injury in the dorsal and lateral funiculi as indicated by morphological transformation and the de-novo expression of major histocompatibility class II (MHC II) molecules. Similar to the timing of microglial reactions, T-lymphocytes maximally infiltrated the lesion epicenter between three and seven days post-injury. Reactive astrocytes, while present in the acute lesion, were more prominent at later survival times (7–28 days). These cells were interspersed with activated microglia but appeared to surround and enclose tissue sites occupied by reactive microglia and phagocytic macrophages. Thus, trauma-induced central nervous system (CNS) inflammation, regardless of strain, occurs rapidly at the site of injury and involves the activation of resident and recruited immune cells. In regions rostral or caudal to the epicenter, prolonged activation of inflammatory cells occurs preferentially in white matter and primarily consists of activated microglia and astrocytes. Differences were observed in the magnitude and duration of macrophage activation between Sprague-Dawley (SD) and Lewis (LEW) rats throughout the lesion. Increased expression of complement type 3 receptors (OX42) and macrophage-activation antigens (ED1) persisted for longer times in LEW rats while expression of MHC class II molecules was attenuated in LEW compared to SD rats at all times examined. Variations in the onset and duration of T-lymphocyte infiltration also were observed between strains with twice as many T-cells present in the lesion epicenter of Lewis rats by 3 days post-injury. These strain-specific findings potentially represent differences in corticosteroid regulation of immunity and may help predict a range of functional neurologic consequences affected by neuroimmune interactions. J. Comp. Neurol. 377:443–464, 1997. © 1997 Wiley-Liss, Inc.

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials

2006-12-19

James W. Fawcett , Armin Curt , John D. Steeves +7 more

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Spinal Cord Injury Facts and Figures at a Glance

2013-01-01

"Spinal Cord Injury Facts and Figures at a Glance." The Journal of Spinal Cord Medicine, 36(1), pp. 1–2 "Spinal Cord Injury Facts and Figures at a Glance." The Journal of Spinal Cord Medicine, 36(1), pp. 1–2

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Evidence for a Spinal Central Pattern Generator in Humans<sup>a</sup>

1998-11-01

M.R. Dimitrijević , Yuri P. Gerasimenko , Michaela M. Pinter

A bstract : Non‐patterned electrical stimulation of the posterior structures of the lumbar spinal cord in subjects with complete, long‐standing spinal cord injury, can induce patterned, locomotor‐like activity. We show … A bstract : Non‐patterned electrical stimulation of the posterior structures of the lumbar spinal cord in subjects with complete, long‐standing spinal cord injury, can induce patterned, locomotor‐like activity. We show that epidural spinal cord stimulation can elicit step‐like EMG activity and locomotor synergies in paraplegic subjects. An electrical train of stimuli applied over the second lumbar segment with a frequency of 25 to 60 Hz and an amplitude of 5‐9 V was effective in inducing rhythmic, alternating stance and swing phases of the lower limbs. This finding suggests that spinal circuitry in humans has the capability of generating locomotor‐like activity even when isolated from brain control, and that externally controlled sustained electrical stimulation of the spinal cord can replace the tonic drive generated by the brain.

Functional recovery following traumatic spinal cord injury mediated by a unique polymer scaffold seeded with neural stem cells

2002-02-26

Yang D. Teng , Erin Lavik , Xianlu Qu +5 more

To better direct repair following spinal cord injury (SCI), we designed an implant modeled after the intact spinal cord consisting of a multicomponent polymer scaffold seeded with neural stem cells. … To better direct repair following spinal cord injury (SCI), we designed an implant modeled after the intact spinal cord consisting of a multicomponent polymer scaffold seeded with neural stem cells. Implantation of the scaffold–neural stem cells unit into an adult rat hemisection model of SCI promoted long-term improvement in function (persistent for 1 year in some animals) relative to a lesion-control group. At 70 days postinjury, animals implanted with scaffold-plus-cells exhibited coordinated, weight-bearing hindlimb stepping. Histology and immunocytochemical analysis suggested that this recovery might be attributable partly to a reduction in tissue loss from secondary injury processes as well as in diminished glial scarring. Tract tracing demonstrated corticospinal tract fibers passing through the injury epicenter to the caudal cord, a phenomenon not present in untreated groups. Together with evidence of enhanced local GAP-43 expression not seen in controls, these findings suggest a possible regeneration component. These results may suggest a new approach to SCI and, more broadly, may serve as a prototype for multidisciplinary strategies against complex neurological problems.

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Restoring Voluntary Control of Locomotion after Paralyzing Spinal Cord Injury

2012-05-31

Rubia van den Brand , Janine Heutschi , Quentin Barraud +7 more

Regaining Limb Movement Despite many years of intensive research, there is still an urgent need for novel treatments to help patients restore motor function after spinal cord injuries. van den … Regaining Limb Movement Despite many years of intensive research, there is still an urgent need for novel treatments to help patients restore motor function after spinal cord injuries. van den Brand et al. (p. 1182 ) produced left and right hemisections at different levels of the rat thoracic spinal cord to cause complete hind limb paralysis mimicking the situation in humans with spinal cord injury. Systemic application of pharmacological agents, combined with a multisystem rehabilitation program including a robotic postural neuroprosthesis, restored voluntary movements of both hind limbs.

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Reactive Astrocytes Protect Tissue and Preserve Function after Spinal Cord Injury

2004-03-03

Jill Faulkner , Julia Herrmann , Michael J. Woo +3 more

Reactive astrocytes are prominent in the cellular response to spinal cord injury (SCI), but their roles are not well understood. We used a transgenic mouse model to study the consequences … Reactive astrocytes are prominent in the cellular response to spinal cord injury (SCI), but their roles are not well understood. We used a transgenic mouse model to study the consequences of selective and conditional ablation of reactive astrocytes after stab or crush SCI. Mice expressing a glial fibrillary acid protein-herpes simplex virus-thymidine kinase transgene were given mild or moderate SCI and treated with the antiviral agent ganciclovir (GCV) to ablate dividing, reactive, transgene-expressing astrocytes in the immediate vicinity of the SCI. Small stab injuries in control mice caused little tissue disruption, little demyelination, no obvious neuronal death, and mild, reversible functional impairments. Equivalent small stab injuries in transgenic mice given GCV to ablate reactive astrocytes caused failure of blood-brain barrier repair, leukocyte infiltration, local tissue disruption, severe demyelination, neuronal and oligodendrocyte death, and pronounced motor deficits. Moderate crush injuries in control mice caused focal tissue disruption and cellular degeneration, with moderate, primarily reversible motor impairments. Equivalent moderate crush injuries combined with ablation of reactive astrocytes caused widespread tissue disruption, pronounced cellular degeneration, and failure of wound contraction, with severe persisting motor deficits. These findings show that reactive astrocytes provide essential activities that protect tissue and preserve function after mild or moderate SCI. In nontransgenic animals, crush or contusion SCIs routinely exhibit regions of degenerated tissue that are devoid of astrocytes. Our findings suggest that identifying ways to preserve reactive astrocytes, to augment their protective functions, or both, may lead to novel approaches to reducing secondary tissue degeneration and improving functional outcome after SCI.

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Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study

2011-05-24

Susan J. Harkema , Yury Gerasimenko , Jonathan E. Hodes +7 more

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International standards for neurological classification of spinal cord injury (Revised 2011)

2011-11-01

Steven Kirshblum , Stephen P. Burns , Fin Biering‐Sørensen +7 more

This article represents the content of the booklet, International Standards for Neurological Classification of Spinal Cord Injury, revised 2011, published by the American Spinal Injury Association (ASIA). For further explanation … This article represents the content of the booklet, International Standards for Neurological Classification of Spinal Cord Injury, revised 2011, published by the American Spinal Injury Association (ASIA). For further explanation of the clarifications and changes in this revision, see the accompanying article (Kirshblum S., et al. J Spinal Cord Med. 2011:doi 10.1179/107902611X13186000420242 The spinal cord is the major conduit through which motor and sensory information travels between the brain and body. The spinal cord contains longitudinally oriented spinal tracts (white matter) surrounding central areas (gray matter) where most spinal neuronal cell bodies are located. The gray matter is organized into segments comprising sensory and motor neurons. Axons from spinal sensory neurons enter and axons from motor neurons leave the spinal cord via segmental nerves or roots. In the cervical spine, there are 8 nerve roots. Cervical roots of C1-C7 are named according to the vertebra above which they exit (i.e. C1 exits above the C1 vertebra, just below the skull and C6 nerve roots pass between the C5 and C6 vertebrae) whereas C8 exists between the C7 and T1 vertebra; as there is no C8 vertebra. The C1 nerve root does not have a sensory component that is tested on the International Standards Examination. The thoracic spine has 12 distinct nerve roots and the lumbar spine consists of 5 distinct nerve roots that are each named accordingly as they exit below the level of the respective vertebrae. The sacrum consists of 5 embryonic sections that have fused into one bony structure with 5 distinct nerve roots that exit via the sacral foramina. The spinal cord itself ends at approximately the L1-2 vertebral level. The distal most part of the spinal cord is called the conus medullaris. The cauda equina is a cluster of paired (right and left) lumbosacral nerve roots that originate in the region of the conus medullaris and travel down through the thecal sac and exit via the intervertebral foramen below their respective vertebral levels. There may be 0, 1, or 2 coccygeal nerves but they do not have a role with the International Standards examination in accordance with the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Each root receives sensory information from skin areas called dermatomes. Similarly each root innervates a group of muscles called a myotome. While a dermatome usually represents a discrete and contiguous skin area, most roots innervate more than one muscle, and most muscles are innervated by more than one root. Spinal cord injury (SCI) affects conduction of sensory and motor signals across the site(s) of lesion(s), as well as the autonomic nervous system. By systematically examining the dermatomes and myotomes, as described within this booklet, one can determine the cord segments affected by the SCI. From the International Standards examination several measures of neurological damage are generated, e.g., Sensory and Motor Levels (on right and left sides), NLI, Sensory Scores (Pin Prick and Light Touch), Motor Scores (upper and lower limb), and ZPP. This booklet also describes the ASIA (American Spinal Injury Association) Impairment Scale (AIS) to classify the severity (i.e. completeness) of injury. This booklet begins with basic definitions of common terms used herein. The section that follows describes the recommended International Standards examination, including both sensory and motor components. Subsequent sections cover sensory and motor scores, the AIS classification, and clinical syndromes associated with SCI. For ease of reference, a worksheet (Appendix 1) of the recommended examination is included, with a summary of steps used to classify the injury (Appendix 2). A full-size version for photocopying and use in patient records has been included as an enclosure and may also be downloaded from the ASIA website (www.asia-spinalinjury.org). Additional details regarding the examination and e-Learning training materials can also be obtained from the website15.

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Spinal-cord injury

2002-02-01

John W. McDonald , Cristina Sadowsky

Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms

1991-07-01

Charles H. Tator , Michael G. Fehlings

✓ In patients with spinal cord injury, the primary or mechanical trauma seldom causes total transection, even though the functional loss may be complete. In addition, biochemical and pathological changes … ✓ In patients with spinal cord injury, the primary or mechanical trauma seldom causes total transection, even though the functional loss may be complete. In addition, biochemical and pathological changes in the cord may worsen after injury. To explain these phenomena, the concept of the secondary injury has evolved for which numerous pathophysiological mechanisms have been postulated. This paper reviews the concept of secondary injury with special emphasis on vascular mechanisms. Evidence is presented to support the theory of secondary injury and the hypothesis that a key mechanism is posttraumatic ischemia with resultant infarction of the spinal cord. Evidence for the role of vascular mechanisms has been obtained from a variety of models of acute spinal cord injury in several species. Many different angiographic methods have been used for assessing microcirculation of the cord and for measuring spinal cord blood flow after trauma. With these techniques, the major systemic and local vascular effects of acute spinal cord injury have been identified and implicated in the etiology of secondary injury. The systemic effects of acute spinal cord injury include hypotension and reduced cardiac output. The local effects include loss of autoregulation in the injured segment of the spinal cord and a marked reduction of the microcirculation in both gray and white matter, especially in hemorrhagic regions and in adjacent zones. The microcirculatory loss extends for a considerable distance proximal and distal to the site of injury. Many studies have shown a dose-dependent reduction of spinal cord blood flow varying with the severity of injury, and a reduction of spinal cord blood flow which worsens with time after injury. The functional deficits due to acute spinal cord injury have been measured electrophysiologically with techniques such as motor and somatosensory evoked potentials and have been found proportional to the degree of posttraumatic ischemia. The histological effects include early hemorrhagic necrosis leading to major infarction at the injury site. These posttraumatic vascular effects can be treated. Systemic normotension can be restored with volume expansion or vasopressors, and spinal cord blood flow can be improved with dopamine, steroids, nimodipine, or volume expansion. The combination of nimodipine and volume expansion improves posttraumatic spinal cord blood flow and spinal cord function measured by evoked potentials. These results provide strong evidence that posttraumatic ischemia is an important secondary mechanism of injury, and that it can be counteracted.

Identification of Two Distinct Macrophage Subsets with Divergent Effects Causing either Neurotoxicity or Regeneration in the Injured Mouse Spinal Cord

2009-10-28

Kristina A. Kigerl , John C. Gensel , Daniel P. Ankeny +3 more

Macrophages dominate sites of CNS injury in which they promote both injury and repair. These divergent effects may be caused by distinct macrophage subsets, i.e., “classically activated” proinflammatory (M1) or … Macrophages dominate sites of CNS injury in which they promote both injury and repair. These divergent effects may be caused by distinct macrophage subsets, i.e., “classically activated” proinflammatory (M1) or “alternatively activated” anti-inflammatory (M2) cells. Here, we show that an M1 macrophage response is rapidly induced and then maintained at sites of traumatic spinal cord injury and that this response overwhelms a comparatively smaller and transient M2 macrophage response. The high M1/M2 macrophage ratio has significant implications for CNS repair. Indeed, we present novel data showing that only M1 macrophages are neurotoxic and M2 macrophages promote a regenerative growth response in adult sensory axons, even in the context of inhibitory substrates that dominate sites of CNS injury (e.g., proteoglycans and myelin). Together, these data suggest that polarizing the differentiation of resident microglia and infiltrating blood monocytes toward an M2 or “alternatively” activated macrophage phenotype could promote CNS repair while limiting secondary inflammatory-mediated injury.

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A Sensitive and Reliable Locomotor Rating Scale for Open Field Testing in Rats

1995-02-01

D. Michele Basso , Michael S. Beattie , Jacqueline C. Bresnahan

Behavioral assessment after spinal cord contusion has long focused on open field locomotion using modifications of a rating scale developed by Tarlov and Klinger (1954). However, on-going modifications by several … Behavioral assessment after spinal cord contusion has long focused on open field locomotion using modifications of a rating scale developed by Tarlov and Klinger (1954). However, on-going modifications by several groups have made interlaboratory comparison of locomotor outcome measures difficult. The purpose of the present study was to develop an efficient, expanded, and unambiguous locomotor rating scale to standardize locomotor outcome measures across laboratories. Adult rats (n = 85) were contused at T7-9 cord level with an electromagnetic or weight drop device. Locomotor behavior was evaluated before injury, on the first or second postoperative day, and then for up to 10 weeks. Scoring categories and attributes were identified, operationally defined, and ranked based on the observed sequence of locomotor recovery patterns. These categories formed the Basso, Beattie, Bresnahan (BBB) Locomotor Rating Scale. The data indicate that the BBB scale is a valid and predictive measure of locomotor recovery able to distinguish behavioral outcomes due to different injuries and to predict anatomical alterations at the lesion center. Interrater reliability tests indicate that examiners with widely varying behavioral testing experience can apply the scale consistently and obtain similar scores. The BBB Locomotor Rating Scale offers investigators a more discriminating measure of behavioral outcome to evaluate treatments after spinal cord injury.

The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury

1994-02-01

John F. Ditunno , W Young , William H. Donovan +1 more

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A Randomized, Controlled Trial of Methylprednisolone or Naloxone in the Treatment of Acute Spinal-Cord Injury

1990-10-25

Abstract Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury, but whether any treatment is clinically effective remains uncertain. We evaluated the efficacy … Abstract Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury, but whether any treatment is clinically effective remains uncertain. We evaluated the efficacy and safety of methylprednisolone and naloxone in a multicenter randomized, double-blind, placebo-controlled trial in patients with acute spinal-cord injury, 95 percent of whom were treated within 14 hours of injury. Methylprednisolone was given to 162 patients as a bolus of 30 mg per kilogram of body weight, followed by infusion at 5.4 mg per kilogram per hour for 23 hours. Naloxone was given to 154 patients as a bolus of 5.4 mg per kilogram, followed by infusion at 4.0 mg per kilogram per hour for 23 hours. Placebos were given to 171 patients by bolus and infusion. Motor and sensory functions were assessed by systematic neurologic examination on admission and six weeks and six months after injury. After six months the patients who were treated with methylprednisolone within eigh...

Traumatic spinal cord injury

2017-04-26

Christopher S. Ahuja , Jefferson R. Wilson , Satoshi Nori +4 more

Traumatic Spinal Cord Injury—Repair and Regeneration

2017-02-21

Christopher S. Ahuja , Satoshi Nori , Lindsay Tetreault +5 more

Abstract BACKGROUND: Traumatic spinal cord injuries (SCI) have devastating consequences for the physical, financial, and psychosocial well-being of patients and their caregivers. Expediently delivering interventions during the early postinjury period … Abstract BACKGROUND: Traumatic spinal cord injuries (SCI) have devastating consequences for the physical, financial, and psychosocial well-being of patients and their caregivers. Expediently delivering interventions during the early postinjury period can have a tremendous impact on long-term functional recovery. PATHOPHYSIOLOGY: This is largely due to the unique pathophysiology of SCI where the initial traumatic insult (primary injury) is followed by a progressive secondary injury cascade characterized by ischemia, proapoptotic signaling, and peripheral inflammatory cell infiltration. Over the subsequent hours, release of proinflammatory cytokines and cytotoxic debris (DNA, ATP, reactive oxygen species) cyclically adds to the harsh postinjury microenvironment. As the lesions mature into the chronic phase, regeneration is severely impeded by the development of an astroglial-fibrous scar surrounding coalesced cystic cavities. Addressing these challenges forms the basis of current and upcoming treatments for SCI. MANAGEMENT: This paper discusses the evidence-based management of a patient with SCI while emphasizing the importance of early definitive care. Key neuroprotective therapies are summarized including surgical decompression, methylprednisolone, and blood pressure augmentation. We then review exciting neuroprotective interventions on the cusp of translation such as Riluzole, Minocycline, magnesium, therapeutic hypothermia, and CSF drainage. We also explore the most promising neuroregenerative strategies in trial today including Cethrin™, anti-NOGO antibody, cell-based approaches, and bioengineered biomaterials. Each section provides a working knowledge of the key preclinical and patient trials relevant to clinicians while highlighting the pathophysiologic rationale for the therapies. CONCLUSION: We conclude with our perspectives on the future of treatment and research in this rapidly evolving field.

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Cell transplantation therapy for spinal cord injury

2017-04-25

Peggy Assinck , Greg J. Duncan , Brett J. Hilton +2 more

A Randomized, Controlled Trial of Methylprednisolone or Naloxone in the Treatment of Acute Spinal-Cord Injury

1990-05-17

Michael B. Bracken , M J Shepard , William F. Collins +7 more

Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury, but whether any treatment is clinically effective remains uncertain. Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury, but whether any treatment is clinically effective remains uncertain.

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Targeted neurotechnology restores walking in humans with spinal cord injury

2018-10-25

Fabien B. Wagner , Jean-Baptiste Mignardot , Camille G. Le Goff-Mignardot +7 more

Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms

2019-03-22

Arsalan Alizadeh , Scott M. Dyck , Soheila Karimi‐Abdolrezaee

Traumatic spinal cord injury (SCI) is a life changing neurological condition with substantial socioeconomic implications for patients and their care-givers. Recent advances in medical management of SCI has significantly improved … Traumatic spinal cord injury (SCI) is a life changing neurological condition with substantial socioeconomic implications for patients and their care-givers. Recent advances in medical management of SCI has significantly improved diagnosis, stabilization, survival rate and well-being of SCI patients. However, there has been small progress on treatment options for improving the neurological outcomes of SCI patients. This incremental success mainly reflects the complexity of SCI pathophysiology and the diverse biochemical and physiological changes that occur in the injured spinal cord. Therefore, in the past few decades, considerable efforts have been made by SCI researchers to elucidate the pathophysiology of SCI and unravel the underlying cellular and molecular mechanisms of tissue degeneration and repair in the injured spinal cord. To this end, a number of preclinical animal and injury models have been developed to more closely recapitulate the primary and secondary injury processes of SCI. In this review, we will provide a comprehensive overview of the recent advances in our understanding of the pathophysiology of SCI. We will also discuss the neurological outcomes of human SCI and the available experimental model systems that have been employed to identify SCI mechanisms and develop therapeutic strategies for this condition.

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Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms

2020-10-13

Anam Anjum , Muhammad Dain Yazid , Muhammad Daud +6 more

Spinal cord injury (SCI) is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Its pathophysiology comprises acute and chronic phases and incorporates a cascade … Spinal cord injury (SCI) is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Its pathophysiology comprises acute and chronic phases and incorporates a cascade of destructive events such as ischemia, oxidative stress, inflammatory events, apoptotic pathways and locomotor dysfunctions. Many therapeutic strategies have been proposed to overcome neurodegenerative events and reduce secondary neuronal damage. Efforts have also been devoted in developing neuroprotective and neuro-regenerative therapies that promote neuronal recovery and outcome. Although varying degrees of success have been achieved, curative accomplishment is still elusive probably due to the complex healing and protective mechanisms involved. Thus, current understanding in this area must be assessed to formulate appropriate treatment modalities to improve SCI recovery. This review aims to promote the understanding of SCI pathophysiology, interrelated or interlinked multimolecular interactions and various methods of neuronal recovery i.e., neuroprotective, immunomodulatory and neuro-regenerative pathways and relevant approaches.

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Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study

1997-05-28

Michael B. Bracken

Administration of Methylprednisolone for 24 or 48 Hours or Tirilazad Mesylate for 48 Hours in the Treatment of Acute Spinal Cord Injury

1997-05-28

Michael B. Bracken

<h3>Objective.</h3> —To compare the efficacy of methylprednisolone administered for 24 hours with methyprednisolone administered for 48 hours or tirilazad mesylate administered for 48 hours in patients with acute spinal cord … <h3>Objective.</h3> —To compare the efficacy of methylprednisolone administered for 24 hours with methyprednisolone administered for 48 hours or tirilazad mesylate administered for 48 hours in patients with acute spinal cord injury. <h3>Design.</h3> —Double-blind, randomized clinical trial. <h3>Setting.</h3> —Sixteen acute spinal cord injury centers in North America. <h3>Patients.</h3> —A total of 499 patients with acute spinal cord injury diagnosed in National Acute Spinal Cord Injury Study (NASCIS) centers within 8 hours of injury. <h3>Intervention.</h3> —All patients received an intravenous bolus of methylprednisolone (30 mg/kg) before randomization. Patients in the 24-hour regimen group (n=166) received a methylprednisolone infusion of 5.4 mg/kg per hour for 24 hours, those in the 48-hour regimen group (n=167) received a methylprednisolone infusion of 5.4 mg/kg per hour for 48 hours, and those in the tirilazad group (n=166) received a 2.5 mg/kg bolus infusion of tirilazad mesylate every 6 hours for 48 hours. <h3>Main Outcome Measures.</h3> —Motor function change between initial presentation and at 6 weeks and 6 months after injury, and change in Functional Independence Measure (FIM) assessed at 6 weeks and 6 months. <h3>Results.</h3> —Compared with patients treated with methylprednisolone for 24 hours, those treated with methylprednisolone for 48 hours showed improved motor recovery at 6 weeks (<i>P</i>=.09) and 6 months (<i>P</i>=.07) after injury. The effect of the 48-hour methylprednisolone regimen was significant at 6 weeks (<i>P</i>=.04) and 6 months (<i>P</i>=.01) among patients whose therapy was initiated 3 to 8 hours after injury. Patients who received the 48-hour regimen and who started treatment at 3 to 8 hours were more likely to improve 1 full neurologic grade (<i>P</i>=.03) at 6 months, to show more improvement in 6-month FIM (<i>P</i>=.08), and to have more severe sepsis and severe pneumonia than patients in the 24-hour methylprednisolone group and the tirilazad group, but other complications and mortality (<i>P</i>=.97) were similar. Patients treated with tirilazad for 48 hours showed motor recovery rates equivalent to patients who received methylprednisolone for 24 hours. <h3>Conclusions.</h3> —Patients with acute spinal cord injury who receive methylprednisolone within 3 hours of injury should be maintained on the treatment regimen for 24 hours. When methylprednisolone is initiated 3 to 8 hours after injury, patients should be maintained on steroid therapy for 48 hours.

Enduring benefits of exercise after spinal cord injury: Insights from a case study

2025-06-24

Candace Vermaak , Lovemore Kunorozva | African Journal of Disability

Spinal cord injuries (SCIs), while relatively rare, profoundly alter the lives of those affected. Among the diverse causes of SCI, traumatic sporting injuries represent 8.7% of newly reported cases. Despite … Spinal cord injuries (SCIs), while relatively rare, profoundly alter the lives of those affected. Among the diverse causes of SCI, traumatic sporting injuries represent 8.7% of newly reported cases. Despite the life-altering consequences of SCI, physical activity (PA) can mitigate some of these impacts. This case study highlights the long-term benefits of sustained PA and its crucial role in fostering a cascade of positive outcomes post-SCI. We present the case of an elite South African athlete, 'Jim', who sustained a complete SCI at the C6 level at the age of 16 in 2012 following a fall during dismount in a gymnastics competition. Jim's rehabilitation journey began shortly after the injury, encompassing formal inpatient care, alternative therapies and ultimately a return to competitive sports. By 2015, Jim resumed athletic activities, beginning with shot put and discus before transitioning to wheelchair racing, which became a pivotal aspect of his recovery. The case emphasises how sustained PA led to Jim's significant physical and mental improvements, such as weight loss, enhanced self-esteem, increased mobility and greater independence in daily living. Moreover, sport provided Jim with a renewed sense of purpose and direction. This case underscores the importance of creating ongoing opportunities for individuals with SCI to continue their recovery long after discharge from inpatient rehabilitation. This case study illustrates how sustained PA contributed to a cascade of positive outcomes in Jim's recovery following SCI, offering valuable insights from his lived experience.

Racial differences in serological markers across the first year of injury in spinal cord injury: responses to the letter to editor

2025-06-24

Jia Li , Matthew Farrow , Kerollos Ibrahim +6 more | Spinal Cord

Perioperative management in acute and chronic spinal cord injury, narrative review

2025-06-23

Israel Valdez-Resendiz , Estefany Nohemí Salgado-Camarillo , Fernanda Hernández-Morales +2 more | Journal of Anesthesia Analgesia and Critical Care

Cumulative Transcutaneous Spinal Stimulation with Locomotor Training Safely Improves Trunk Control in Children with Spinal Cord Injury: Pilot Study

2025-06-21

Liubov Amirova , Anastasia Keller , Goutam Singh +6 more | Children

Background/Objectives: Non-invasive spinal cord transcutaneous stimulation (scTS) has expanded the therapeutic landscape of spinal cord injury (SCI) rehabilitation, offering potential benefits beyond compensatory approaches to paralysis. Children with SCI are … Background/Objectives: Non-invasive spinal cord transcutaneous stimulation (scTS) has expanded the therapeutic landscape of spinal cord injury (SCI) rehabilitation, offering potential benefits beyond compensatory approaches to paralysis. Children with SCI are particularly susceptible to developing neuromuscular scoliosis due to trunk muscle paralysis and ongoing skeletal growth, making targeted interventions crucial. As demonstrated in adults and pediatrics with SCI, the ability of scTS to acutely and safely enable an upright posture and trunk control could be leveraged as a therapeutic adjunct. Activity-based locomotor training (AB-LT) alone significantly improves trunk control in children with SCIs; combining it with scTS may enhance outcomes. This pilot study evaluated the safety, feasibility, and cumulative effects of AB-LT combined with scTS on trunk control in children with SCI. Methods: Three children with SCI completed 19 to 64 sessions of combined AB-LT and scTS. Adverse effects were monitored session to session, and trunk control was assessed pre- and post-intervention. Results: Across 130 interventions in three participants, 88.5% of sessions were free from adverse effects. Reported adverse events included autonomic dysreflexia (5.4%), skin redness at electrode sites (4.6%), and headaches (1.5%). No significant impact of scTS on fatigue or central hemodynamic parameters was observed. Post-intervention, all participants demonstrated improved trunk control during quiet and perturbed sitting. Conclusions: These findings provide the first evidence supporting the safety and feasibility of this combinatorial approach in pediatric SCI rehabilitation while emphasizing the importance of monitoring skin integrity and signs of autonomic dysreflexia. This intervention shows potential synergistic benefits, warranting further research to confirm efficacy and optimize therapeutic protocols.

Nasal Delivery of Engineered Exosomes via a Thermo‐Sensitive Hydrogel Depot Reprograms Glial Cells for Spinal Cord Repair

2025-06-20

Yansong Wang , Jingsong Liu , Pengfei Li +7 more | Advanced Science

Abstract Spinal cord injury (SCI) presents formidable therapeutic challenges due to its multifaceted pathological complexity. Here, this work reports engineered macrophage‐derived exosomes overexpressing GNA12 and GNA13 (G12G13MExos) that reprogram macrophages … Abstract Spinal cord injury (SCI) presents formidable therapeutic challenges due to its multifaceted pathological complexity. Here, this work reports engineered macrophage‐derived exosomes overexpressing GNA12 and GNA13 (G12G13MExos) that reprogram macrophages toward the M2c anti‐inflammatory phenotype and astrocytes into a neuroprotective phenotype. G12G13MExos enhance astrocyte‐mediated clearance of myelin debris, glutamate homeostasis, and synapse formation while fostering astrocyte‐neuron crosstalk. These effects improve neuronal survival and drove neural stem cell differentiation into V2a neurons, facilitating neural circuit reconstruction. This work develops a chitosan‐based thermosensitive hydrogel that functions as a “nasal exosome intelligent slow‐release depot” to enable efficient and targeted exosome delivery. This delivery system bypasses hepatic and renal sequestration and overcomes the blood‐spinal cord barrier, significantly enhancing therapeutic efficacy. This strategy integrates engineered exosomes with a responsive delivery platform, modulating the inflammatory microenvironment, enhancing cellular crosstalk, and promoting neural repair. This comprehensive approach offers a promising translational avenue for SCI treatment and other central nervous system disorders.

Early repetitive transcranial magnetic stimulation in the spinal cord region for the treatment of spinal cord injury: A case report

2025-06-20

Yang Ningning , Qi Xiao , Tao Liu +1 more | Medicine

Currently, the global incidence of spinal cord injury (SCI) ranges from approximately 10.4 to 83 cases per million individuals, with an estimated 500,000 new cases diagnosed annually. Current clinical treatments … Currently, the global incidence of spinal cord injury (SCI) ranges from approximately 10.4 to 83 cases per million individuals, with an estimated 500,000 new cases diagnosed annually. Current clinical treatments for SCI primarily include early surgical intervention, pharmacological therapy, and personalized rehabilitation programs. Transcranial magnetic stimulation (TMS) is a noninvasive, painless, and relatively safe treatment option that avoids the side effects and dependency associated with medications. In recent years, TMS has emerged as a promising approach in SCI rehabilitation. However, TMS is often administered late in the course of treatment and typically requires stimulation of multiple sites, which can be time-consuming, cumbersome, and may limit its effectiveness. Recently, we conducted ultra-early single-site TMS on a patient with SCI. Notably, the patient experienced rapid recovery from both motor and sensory impairments, representing a highly successful application of TMS in SCI treatment. The patient is a 57-year-old male who developed low back pain a week ago without any apparent cause. After sitting for extended periods, the pain intensified, making it difficult to turn over. He experienced numbness and weakness in both lower limbs, as well as sensory numbness in the saddle area. The rehabilitation evaluation concluded an incomplete SCI, with significant muscle weakness in both lower limbs accompanied by pain, rendering the patient dependent on others for daily care. TMS was administered as a single-target treatment for the L4/L5 intervertebral disc. The treatment parameters included a frequency of 25 Hz, 20 single stimuli per session, a stimulation duration of 0.8 seconds, an interval of 15 seconds between sessions, 76 repetitions per session, and a total of 1520 stimuli per session. The treatment was administered once daily for 5 consecutive days each week, followed by 2 days of rest, and repeated the following week. After 1 week of treatment, the pain in both lower limbs was significantly alleviated. After 2 weeks, the patient was able to walk independently without the aid of a walker, exhibiting a cross-domain gait. Four weeks later, the patient could walk independently with a normal gait and was able to perform activities of daily living independently. Both the modified Barthel Index and Spinal Cord Independence Measure scores showed significant improvement. The treatment plan adopted for this patient was swift, timely, and precisely targeted, leading to rapid improvements in mobility, sensory function, and activities of daily living in both lower limbs, thereby enabling a quicker recovery of professional and social activity abilities.

Prevalence of Metabolic Syndrome Among Individuals With Spinal Cord Injury: A Cross-Sectional Analysis

2025-06-20

Seda Sabah Özcan , Belgin Erhan | Cureus

Segmentation of clinical imagery for improved epidural stimulation to address spinal cord injury

2025-06-20

Jordan Matelsky , Pawan Sharma , Erik C. Johnson +6 more | medRxiv (Cold Spring Harbor Laboratory)

Spinal cord injury (SCI) can severely impair motor and autonomic function, with long-term consequences for quality of life. Epidural stimulation has emerged as a promising intervention, offering partial recovery by … Spinal cord injury (SCI) can severely impair motor and autonomic function, with long-term consequences for quality of life. Epidural stimulation has emerged as a promising intervention, offering partial recovery by activating neural circuits below the injury. To make this therapy effective in practice, precise placement of stimulation electrodes is essential, and that requires accurate segmentation of spinal cord structures in MRI data. We present a protocol for manual segmentation tailored to SCI anatomy, and evaluated a deep learning approach using a U-Net architecture to automate this segmentation process. Our approach yields accurate, efficient segmentation that identify potential electrode placement sites with high fidelity. Preliminary results suggest that this framework can accelerate SCI MRI analysis and improve planning for epidural stimulation, helping bridge the gap between advanced neurotechnologies and real-world clinical application with faster surgeries and more accurate electrode placement.

Exercise training promotes nerve cell repair and regeneration after spinal cord injury

2025-06-19

Tianyu Zhai , Shuting Ren , Si-Jin Qian +7 more | Neural Regeneration Research

Abstract Spinal cord injury is a severe neurological condition characterized by the permanent loss of nerve cell function and a failure in neural circuit reconstruction-key factors contributing to disability. Therefore, … Abstract Spinal cord injury is a severe neurological condition characterized by the permanent loss of nerve cell function and a failure in neural circuit reconstruction-key factors contributing to disability. Therefore, exploring effective strategies to promote the repair and regeneration of nerve cells after spinal cord injury is crucial for optimizing patient prognosis. The purpose of this paper is to conduct an in-depth review of the pathological changes in nerve cells after spinal cord injury and to present the state of research on the role of exercise training in promoting the repair and regeneration of nerve cells after spinal cord injury. In terms of the intrinsic growth capacity of neurons, disruptions in the dynamic balance between growth cones and the cytoskeleton, the dysregulation of transcription factors, abnormal protein signaling transduction, and altered epigenetic modifications collectively hinder axonal regeneration. Additionally, the microenvironment of neurons undergoes a series of complex changes, initially manifesting as edema, which may be exacerbated by spinal cord ischemiareperfusion injury, further increasing the extent of nerve cell damage. The abnormal proliferation of astrocytes leads to the formation of glial scars, creating a physical barrier to nerve regeneration. The inflammatory response triggered by the excessive activation of microglia negatively impacts the process of nerve repair. Non-invasive interventions involving exercise training have shown significant potential in promoting nerve repair as part of a comprehensive treatment strategy for spinal cord injury. Specifically, exercise training can reshape the growth cone and cytoskeletal structures of neurons, regulate transcription factor activity, modulate protein signaling pathways, and influence epigenetic modifications, thereby activating the intrinsic repair mechanisms of neurons. Moreover, exercise training can regulate the activation state of astrocytes, optimize the inflammatory response and metabolic processes, promote astrocyte polarization, enhance angiogenesis, reduce glial scar formation, and modulate the expression levels of nerve growth factors. It also effectively helps regulate microglial activation, promotes axonal regeneration, and improves phagocytic function, thereby optimizing the microenvironment for nerve repair. In terms of clinical translation, we summarize the preliminary results of new drug research and development efforts, the development of innovative devices, and the use of exercise training in promoting clinical advancements in nerve repair following spinal cord injury, while considering their limitations and future application prospects. In summary, this review systematically analyzes findings relating to the pathological changes occurring in nerve cells after spinal cord injury and emphasizes the critical role of exercise training in facilitating the repair and regeneration of nerve cells. This work is expected to provide new ideas and methods for the rehabilitation of patients with spinal cord injury.

Neuromodulation techniques for the treatment of spinal cord injury: current progress, challenges, and future prospects

2025-06-19

Wenqiang Li , Zhian Chen , Hua Liu +3 more | European journal of medical research

Traumatic Jumped Cervical Facets in Adult Patients

2025-06-19

Danielle E. Chipman , Thomas J. Ryan , Christopher Lucasti +6 more | Clinical Spine Surgery A Spine Publication

Study Design: Retrospective case series. Objective: The objective of this study is to report on the demographics, symptoms, and treatment course of a series of adult trauma patients who presented … Study Design: Retrospective case series. Objective: The objective of this study is to report on the demographics, symptoms, and treatment course of a series of adult trauma patients who presented with jumped facets. Summary of Background Data: Jumped facets are rare traumatic cervical spine injuries that result in significant instability. These can be unilateral or bilateral, and they are often associated with serious spinal cord injuries. Methods: All patients over 18 years old who presented at a single level 1 trauma center between September 2015 to March 2023 with a cervical spine injury were identified. Patients were included if they had jumped facets diagnosed on computed tomography (CT) scans. Patients were excluded if they were under 18 years old and/or did not have a diagnosis of jumped facets. Demographics, cervical spine characteristics, American Spinal Injury Association (ASIA) impairment scale scores, treatment course, and intrahospital data for all patients were collected. Results: Of the 554 patients identified, 11 patients met the final inclusion and exclusion criteria. The average age of the participants was 50.6 ± 22.1 years; 72.7% were male. The most common mechanism of injury, 9 (81.8%) patients, was a motor vehicle crash (MVC). All injury levels fell between levels C4 and C7. Six (54.5%) patients had motor and sensory deficits. Two (18.2%) patients had an ASIA score of A. All patients underwent surgical treatment, and 7 (63.6%) patients were treated with both an anterior and posterior approach. Patients spent a median of 12.0 (IQR: 10.0) days in the hospital. Conclusions: In this series of patients, the majority of patients who sustained jumped facets were middle-aged men who were involved in an MVC. While most patients did not have complete spinal cord injuries, all patients underwent urgent reduction and stabilization. Therefore, in an attempt to best help patients regain as much function as possible, we recommend prompt reduction and stabilization. Level of Evidence: Level IV.

Xanthoxylin Regulating the Inflammatory Microenvironment After Spinal Cord Injury Through Inhibition of the NF-κB Signaling Pathway

2025-06-19

Zihao Fan , Lei Ye , Shijie Wang +5 more | NeuroMolecular Medicine

Glial cell crosstalk in the local microenvironment following spinal cord injury

2025-06-19

Erliang Li , Yingchao Gao , Jianfeng Zhang +4 more | Brain Research Bulletin

Spinal cord injury (SCI) has a high incidence, significant rates of disability, and substantial economic costs. The response of glial cells is crucial for spinal cord regeneration following SCI. However, … Spinal cord injury (SCI) has a high incidence, significant rates of disability, and substantial economic costs. The response of glial cells is crucial for spinal cord regeneration following SCI. However, the roles of various glial cell types in SCI pathology and their interactions with other cellular targets remain poorly understood. Using single-cell RNA sequencing, we characterized the local microenvironment following SCI and isolated three glial cell types-microglia, astrocytes, and oligodendrocytes-at the injury site. Immunofluorescence confirmed the differential expression of these cell types in spinal cord tissues. Four subtypes of microglia were identified: activated, dividing, homeostatic, and inflammatory. Astrocytes were categorized into 11 clusters, while oligodendrocytes were classified into eight clusters. Enrichment analysis indicated that the loss of oligodendrocytes was associated with ferroptosis. The glial cell crosstalk network revealed various interactions, including TIMP1-FGFR2 and PLXNB2-PTN in astrocytes and oligodendrocytes, as well as LGALS3-MERTK, GPR37L1-PSAP, TFRSF1A-GRN, and PGRMC2-CCL4L2 in astrocytes and microglia. A total of 75 drugs were identified through target-drug screening. This study suggests potential differentiation and intricate crosstalk among these three cell types, provides a theoretical framework for simulating the glial cellular microenvironment of SCI, and establishes a foundation for future interventions aimed at targeting various glial cell processes in the treatment of SCI.

Exacerbation of neuronal senescence after spinal cord injury: Role of the macrophage-derived transforming growth factor-β1-SMAD2 signaling axis

2025-06-19

Haiwen Feng , Hongda Wang , Junjin Li +7 more | Neural Regeneration Research

Abstract Neuronal degeneration and inflammation are hallmark features of spinal cord injury that severely hinder functional recovery. As key regulators of the post-injury microenvironment, macrophages can promote either tissue repair … Abstract Neuronal degeneration and inflammation are hallmark features of spinal cord injury that severely hinder functional recovery. As key regulators of the post-injury microenvironment, macrophages can promote either tissue repair or exacerbate damage. Among macrophage secreted factors, transforming growth factor-beta 1 has emerged as a critical mediator of pathological changes. In this study, we show the pivotal role of macrophage-derived transforming growth factor-beta 1 in driving neuronal senescence and impairing functional recovery after spinal cord injury. In a mouse spinal cord injury model, transforming growth factor-beta 1 levels were significantly increased at the injury site, accompanied by increased mothers against decapentaplegic homolog 2 (SMAD2) phosphorylation and upregulation of neuronal senescence markers such as p16 INK4a and β-galactosidase activity. Treatment with LY-364947, a SMAD2 phosphorylation inhibitor, markedly reduced the number of senescent neurons, mitigated tissue degeneration, and improved motor function recovery. Additionally, macrophage depletion using clodronate liposomes lowered transforming growth factor-beta 1 levels at the injury site and attenuated neuronal senescence. These findings highlight the transforming growth factor-beta 1-SMAD2 signaling axis as a potential therapeutic target to reduce neuronal senescence and enhance functional recovery following spinal cord injury.

Improving recovery from traumatic spinal cord injury: targeting remyelination versus white matter remodeling

2025-06-19

Bethany R. Kondiles , Wolfram Tetzlaff | Neural Regeneration Research

Research progress on the mechanisms of endogenous neural stem cell differentiation in spinal cord injury repair

2025-06-18

Tianwei Wang , Qing Han , Shi Lv +6 more | Frontiers in Cellular Neuroscience

Spinal cord injury (SCI) is a devastating condition with limited self-repair capacity, resulting in long-term disabilities. Endogenous neural stem cells (eNSCs), which are present in the adult central nervous system … Spinal cord injury (SCI) is a devastating condition with limited self-repair capacity, resulting in long-term disabilities. Endogenous neural stem cells (eNSCs), which are present in the adult central nervous system (CNS), hold significant potential for repairing neural damage following SCI. These cells can proliferate, migrate to the injury site, and differentiate into various neural cell types, including neurons and glial cells. However, after SCI, eNSCs predominantly differentiate into astrocytes, with minimal neuronal differentiation, thereby hindering effective neural regeneration. This review summarizes the key mechanisms underlying the differentiation of eNSCs into neurons, focusing on the molecular signaling pathways that regulate their fate, including the Notch, Wnt/β-catenin, Sonic Hedgehog, and PI3K/Akt pathways. It also discusses the microenvironment’s role, including factors such as hypoxia, extracellular matrix components, and inflammatory cytokines, which influence eNSCs differentiation. The review also highlights potential therapeutic strategies to enhance eNSCs differentiation into neurons, including biomaterials and multimodal approaches that combine pharmacological, physical, and tissue engineering techniques. Despite progress in understanding eNSCs biology and signaling mechanisms, challenges remain in optimizing therapeutic strategies for SCI repair. Future research should focus on overcoming these limitations, emphasizing refining treatment timing, drug delivery systems, and the development of personalized therapies to promote effective neural regeneration and functional recovery after SCI.

Neurorehabilitation and white matter repair in traumatic spinal cord injury: a dialogue between clinical and preclinical studies

2025-06-18

Vito Antonio Baldassarro , Ilaria Baroncini , Laura Calzà +7 more | Frontiers in Neurology

The central nervous system (CNS) has very limited repair capabilities, and the functional adaptation/compensation after acute injuries is attributed to the significant plasticity of neural circuits, in particular at the … The central nervous system (CNS) has very limited repair capabilities, and the functional adaptation/compensation after acute injuries is attributed to the significant plasticity of neural circuits, in particular at the synaptic level. However, neurons are only one of the cellular components of the CNS, with gray matter (GM) comprising around 50% of its structure, compared to white matter (WM), where oligodendrocytes (Ols) form the myelin sheath and ensure the isolation of axons for proper electrical conductivity elicited by action potentials. WM is characterized by two remarkable properties: myelin plasticity, defined as experience-induced changes in myelination that mediate long-lasting changes in neural circuit function, and myelin repair, which can be complete and functionally effective and represents the CNS's only true reparative capability. Oligodendrocyte precursor cells (OPCs), accounting for 5–8% of the total CNS cells, are responsible for myelin plasticity and repair. OPCs are generated during development, are widely distributed across both white and gray matter, and remain quiescent until appropriate stimuli, such as functional requests or injuries, arise. Under these conditions, endogenous OPCs, as well as new OPCs derived from the proliferation and differentiation of endogenous neural stem cells, migrate toward axons and differentiate into mature OLs capable of wrapping axons and forming the myelin sheaths. In this review article, we discuss WM plasticity and myelin repair through OPC-dependent endogenous regeneration within the context of spinal cord injury (SCI) and related neurorehabilitation approaches. Clinical data, such as imaging information, pertain to changes in WM during various phases of SCI and have been collected in different rehabilitation contexts. Preclinical data focus on physical stimuli that can enhance the myelin repair capacity of OPCs within the context of the oligo-axon unit. The potential role of myelin regeneration by endogenous stem/precursor cells is finally discussed in the context of regenerative neurorehabilitation for SCI.

The time-dependent efficacy of early surgical decompression in patients with traumatic spinal cord injury: A systematic review and meta-analysis

2025-06-18

Xiaolong Li , Yuan Yuan , Yilin Chen +3 more | Journal of Spinal Cord Medicine

Numerous studies have demonstrated that early surgical intervention in patients with traumatic spinal cord injury leads to superior recovery of various indicators, including neurological function, compared to late surgical intervention. … Numerous studies have demonstrated that early surgical intervention in patients with traumatic spinal cord injury leads to superior recovery of various indicators, including neurological function, compared to late surgical intervention. However, some relevant clinical randomized controlled trials have indicated that the motor function recovery of patients undergoing early surgical decompression does not show a significant advantage during initial follow-up periods. The benefits of early surgical decompression become more apparent as the follow-up duration extends. Therefore, this study aims to evaluate the prognosis of early versus late surgical intervention on traumatic spinal cord injury and to analyze whether the prognostic benefits of early surgical decompression in traumatic spinal cord injury patients are time-dependent. We performed a systematic review and meta-analysis by searching the PubMed, Embase, and Cochrane Library databases for randomized controlled trials and quasi-randomized controlled trials that addressed the timing of surgical intervention for traumatic spinal cord injury. The data extracted from all included studies were processed and analyzed utilizing the RevMan 5.4 software. Eight studies involving 702 patients were included in this analysis, with 345 patients in the early surgery group and 357 patients in the late surgery group. The results showed that the early surgery group had a significantly higher rate of improvement in AIS grade (OR = 1.50; 95% CI: 1.05-2.15; p = 0.03) and a shorter hospital stay (MD = -4.76; 95% CI: -9.19 - -0.32; p = 0.04) compared to the late surgery group. Although there was no significant difference in total motor scores between the two groups in the early postoperative period, the pooled data still favored the early surgery group (MD = 4.43; 95% CI: 1.23-7.63; p = 0.007). There was no significant difference in postoperative complications between the two groups (RR = 0.61; 95% CI: 0.30-1.22; p = 0.16). Early surgical decompression leads to better prognosis in patients with traumatic spinal cord injury and shows a trend of more obvious advantages in motor function recovery with longer follow-up time than late surgical intervention.

Predictive Factors Affecting the Need for Mechanical Ventilation in Acute Traumatic Cervical Spinal Cord Injury

2025-06-18

Chonnawee Chaisawasthomrong , Atthaporn Boongird | Journal of Neurotrauma

Acute traumatic cervical spinal cord injuries (TCSCI) are associated with significant mortality and morbidity, particularly when complicated by neurogenic respiratory failure. While upper cervical-level injuries are established risk factors for … Acute traumatic cervical spinal cord injuries (TCSCI) are associated with significant mortality and morbidity, particularly when complicated by neurogenic respiratory failure. While upper cervical-level injuries are established risk factors for mechanical ventilation, patients with acute injuries below the fifth cervical level without significant chest trauma may also require ventilatory support. However, reliable early predictors remain unclear. This study aims to identify the primary predictors of early mechanical ventilation needs in patients with acute TCSCI. We conducted a retrospective analysis of 148 cases of TCSCI treated between 2019 and 2022. Among these, 27 cases (18.24%) required ventilatory support. Multivariate analysis revealed that a compression grade of 2 or higher, exceeding 25% on Computed Tomography (CT) (adjusted odds ratio [aOR]: 10.18; 95% CI: 2.03-50.94; p < 0.001), and a cord contusion length spanning at least two levels on Magnetic Resonance Imaging (MRI) (aOR: 2.11; 95% CI: 1.06-4.22; p = 0.03) were significant independent predictors. CT-based spinal cord compression measurements showed a strong correlation with MRI findings (linear regression coefficient = 0.88, 95% CI: 0.80-0.96; Spearman's rho = 0.90; both p < 0.001). The regression line was closely aligned with the equality line, indicating CT can reliably approximate MRI. Noninferiority testing revealed no significant difference in predicting mechanical ventilation risk between modalities (p = 0.21). Survival analyses stratified by compression grades demonstrated similar predictive performance, with higher compression grades (2-4) associated with increased risk of ventilation over time. These findings suggest that the degree of cord compression and cord contusion length are reliable, noninvasive predictors of the need for mechanical ventilation in TCSCI, emphasizing the importance of early recognition, cost-effective health care management, and prognostic counseling. The Subaxial Injury Classification and Severity Scale demonstrated borderline significance (sensitivity 81.5%, specificity 87.6%). The study found that patients with >25% cervical spinal cord compression had significantly poorer outcomes compared to those with ≤25% compression, including longer hospital stays, lower survival rates, worse pre-treatment neurological status, and higher complication rates. Surgical treatment, particularly the posterior approach, was more common in the >25% compression group; however, post-treatment neurological improvement was observed only in cases of grade 2 degree compression, not grades 3 and 4 in CT and MRI. In contrast, the ≤25% compression group demonstrated better outcomes, with greater post-treatment improvement. [Figure: see text].

Letter to the editor: Racial differences in serological markers across the first year of injury in spinal cord injury: a retrospective analysis of a multicenter interventional study by Jia Li et al.

2025-06-17

Vishal Kumar , Sharath Raj | Spinal Cord

The Effects of Inspiratory Muscle Training in Individuals With Cervical Spinal Cord Injuries: A Systematic Review and Meta-Analysis

2025-06-17

Diane Tran , Ha Thi Le , Tho Thi Quynh Chu +2 more | Annals of Rehabilitation Medicine

The effect of inspiratory muscle training (IMT) on cervical spinal cord injury (SCI) remains controversial. This study aimed to assess the efficacy of IMT in enhancing breathing muscle strength, pulmonary … The effect of inspiratory muscle training (IMT) on cervical spinal cord injury (SCI) remains controversial. This study aimed to assess the efficacy of IMT in enhancing breathing muscle strength, pulmonary function, and quality of life (QoL) among patients with cervical SCI. A search was performed using the PubMed, Cochrane Library, Scopus, Embase, and Web of Science databases through December 2023. This review was conducted according to PRISMA guidelines and the Cochrane Library Handbook. The meta-analysis used mean differences (MDs) or standardized mean differences to pool the results. The Risk of Bias 2 and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) were used to assess the methodological quality of the included studies. This systematic review included five randomized controlled trials (202 participants). The results of the meta-analysis showed that IMT significantly improved maximal inspiratory pressure (MIP) with MD 12.13 cmH2O (95% confidence interval [CI] 4.22 to 20.03), maximal expiratory pressure (MEP) with MD 8.98 cmH2O (95% CI 6.96 to 11.00), and vital capacity (VC) with MD 0.25 L (95% CI 0.21 to 0.28). There were no significant improvements in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and QoL. The quality of the evidence ranged from very low to moderate, owing to bias and heterogeneity. Our results showed that IMT may improve MIP, MEP, and VC, but not FEV1, FVC, or QoL, in patients with cervical SCI. Further large-scale studies are required to determine this effect's optimal dosage and duration.

Tire Deformation-Based Regulation of Braking Torque in Manual Wheelchairs Equipped with Reverse Locking Modules

2025-06-17

Bartosz Wieczorek , Łukasz Warguła , Marcin Giedrowicz | PLoS ONE

Moving in a manual wheelchair involves overcoming various architectural and terrain barriers. One of the obstacles that most burdens the muscular system and generates a high risk of instability is … Moving in a manual wheelchair involves overcoming various architectural and terrain barriers. One of the obstacles that most burdens the muscular system and generates a high risk of instability is the climb up a slope. This article presents a comprehensive regulation method that allows for achieving the desired braking torque of the locking module based solely on tire deformation measurements, rather than the previously used contact force. To address the research problem, a research method was developed, consisting of three experimental tests and one mathematical analysis. The experiments included the measurement of the sliding force moment (E1), braking torque (E2), and tire deformation (E3). Using these methods, a measurement procedure was formulated to allow the measurement of the braking torque generated by the reverse locking module through tire deformation. Research on braking torque M h showed that for wheelchairs with 24’’x1’’ wheels and a tire pressure of 4-7 bar, tire deformation e T , depending on the diameter of the pressing roller, ranges from mm to mm. For a constant roller diameter of 70 mm, to achieve a torque of 7.5 Nm, the deformation was mm, and for 12 Nm – mm. The sliding force FZ increased by 57% with the user’s mass rising from 50 kg to 90 kg (from N to N at a pressure of 7 bar). ANOVA analysis confirmed that both the nominal contact force F dN and the diameter of the roller d r had a significant impact on the braking torque M h . Verification of the developed mathematical model of braking torque as a function of tire deformation showed an error range of 3% to 7%.

Muscle oxygen saturation to determine lactate thresholds in spinal cord injury population

2025-06-17

Jose Luis Sánchez‐Jiménez , Rosa María Cibrián Ortiz de Anda , María Vázquez-Fariñas +3 more | International Journal of Sports Medicine

This study aimed to compare the intensity when thresholds occur determined with muscle oxygen saturation and blood lactate concentration during a graded exercise test in an arm-crank ergometer. Twenty-nine participants … This study aimed to compare the intensity when thresholds occur determined with muscle oxygen saturation and blood lactate concentration during a graded exercise test in an arm-crank ergometer. Twenty-nine participants were included, divided into non-spinal cord injury (N=12) and spinal cord injury (N=17) groups. Participants underwent a graded exercise test with 3-min steps and 1-min rest intervals. Blood lactate concentration was measured at baseline and after each step, while muscle oxygen saturation was continuously registered in the biceps brachii. Agreement between methods was good at first threshold (non-spinal cord injury: ICC = 0.46; spinal cord injury: ICC = 0.51) and excellent at second threshold (non-spinal cord injury: ICC = 0.82; spinal cord injury: ICC = 0.92). No significant differences were found between groups in bias for first and second lactate threshold (p > 0.05). In conclusion, muscle oxygen saturation is valid and reliable for second lactate threshold determination, with stronger agreement than the first lactate threshold during graded exercise tests using arm-cranking in biceps brachii in non-spinal cord injury and spinal cord injury.

Assessment of quality of life and psychologic status in chronic-phase patients with cervical spinal cord injury: Correlation with clinical symptoms and evaluation tools

2025-06-17

Isamu Sasaki , Gentaro Kumagai , Kanichiro Wada +4 more | Journal of Spinal Cord Medicine

This cross-sectional study examined the correlation and adequacy of the Japanese Orthopaedics Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) for assessing patients with cervical spinal cord injury (SCI). Cross-sectional study. Single … This cross-sectional study examined the correlation and adequacy of the Japanese Orthopaedics Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) for assessing patients with cervical spinal cord injury (SCI). Cross-sectional study. Single hospital. 38 patients in the chronic phase after cervical SCI (32 men, mean age 67.0 years). Outcome measures included the association between JOACMEQ scores and bodily symptoms such as neck pain, neuropathic pain in the upper or lower extremities, and chest discomfort; visual analogue scale (VAS) scores for cervical, chest, upper, and lower extremity pain; and the Cronbach's alpha internal consistency of responses between the Medical Outcomes Study 36-item Short Form Health Survey, EuroQOL 5 Dimension, Hospital Anxiety and Depression Scale, and the JOACMEQ. Pain or numbness was reported by 94.7% of patients. Among the 38 patients, 7 (18.4%) had a confirmed diagnosis of depression and 3 (7.9%) had a confirmed diagnosis of anxiety. JOACMEQ domain scores correlated with bodily symptoms, and SF-36 and HADS scores. Cronbach's alpha of the JOACMEQ in patients with SCI was ∼0.8 across all domains except bladder function. JOACMEQ scores significantly correlated with bodily symptoms and established QOL and mental health measures. Furthermore, the JOACMEQ showed good internal consistency in this study. Compared with conventional assessment methods, the JOACMEQ is a simpler instrument for assessing quality of life, including psychologic status, in patients with cervical SCI.

Effectiveness of Sensory Electrical Stimulation Augmented Virtual Reality Training on Sitting Balance and Quality of Life in individuals with Incomplete Spinal Cord Injury: Study Protocol for a Randomized Controlled Trial

2025-06-17

Nasser D Chowdhary , Stuti Khanna , Garima Wadhwa +1 more | Research Square (Research Square)

<title>Abstract</title> <bold>Background</bold>: Individuals with incomplete Spinal Cord Injury (iSCI) often face significant impairments in sitting balance and mobility due to trunk instability. These challenges can severely impact functional abilities, participation … <title>Abstract</title> <bold>Background</bold>: Individuals with incomplete Spinal Cord Injury (iSCI) often face significant impairments in sitting balance and mobility due to trunk instability. These challenges can severely impact functional abilities, participation in daily activities and overall Quality of Life (QoL). Studies have highlighted the potential of virtual reality (VR) training to improve sitting balance in individuals with iSCI. Furthermore, Sensory Electrical Stimulation (SES) has shown positive effects on sitting balance in various neurological populations. However, research exploring the combined effectiveness of VR and SES on sitting balance and QoL specifically within the iSCI human population remains limited. <bold>Methodology</bold>: This study will be a double-blind parallel, two-group, randomized controlled trial that aims to evaluate the effectiveness of SES augmented VR training on sitting balance and QoL in individuals with iSCI. A total of 22 participants with iSCI, with a neurological level of injury between T6 and T12 will be recruited from the rehabilitation department at the Indian Spinal Injuries Centre, adhering to inclusion criteria. Participants will be randomly assigned to one of two groups using a 1:1 allocation ratio. The intervention group will engage in VR-based balance training along with SES application, while the control group will solely engage in VR-based balance training. Both groups will undergo interventions consisting of 30-minute sessions, five times a week for a duration of 4 weeks. <bold>Outcome measures</bold>: The assessment of sitting balance will be done using the Modified Functional Reach Test (mFRT) and the Star Test using the Tecnobody Prokin 252 Trunk Sensor. Additionally, the International Spinal Cord Society Quality of Life Basic Data Set (ISCoS QoL BDS) Version 1.0 will be used to measure QoL. <bold>Discussion</bold>: The effectiveness of the SES augmented VR based balance training program will be evaluated based on the changes in the mFRT, Star Test (Prokin 252 Trunk Sensor) and ISCoS Quality of Life Basic Data Set Version 1.0 following four weeks of intervention. This trial aims to enhance understanding of how SES augmented VR training can improve sitting balance and QoL in individuals with iSCI. <bold>Trial Registration</bold>: The trial is registered with the Clinical Trials Registry – India on 18<sup>th</sup> April 2024 with registration number CTRI/2024/04/065897.

Cardiovascular and Locomotor Recovery Following Hindlimb Muscle Stretching of Rodents with a Clinically Relevant Model of Spinal Cord Injury

2025-06-16

Morgan Forston , Greta M. Cesarz , D. S. Wood +2 more | Journal of Neurotrauma

Physical therapy stretching remains one of the most prevalent therapies for patients with spinal cord injury (SCI); however, we have previously shown that daily hindlimb muscle stretching of rats following … Physical therapy stretching remains one of the most prevalent therapies for patients with spinal cord injury (SCI); however, we have previously shown that daily hindlimb muscle stretching of rats following a T10 SCI significantly disrupts their hindlimb locomotor function, likely through maladaptive sprouting of nociceptive afferents and modulation of lumbar spinal circuitry. Despite these clinically significant findings, mid-thoracic contusion models do not represent a majority of clinical injuries and are not effective for modeling the loss of cardiovascular control and autonomic complications that patients with higher level SCI experience. Therefore, the objective of the current study was to examine the effects of hindlimb stretching on the locomotor and cardiovascular function of rats with a T2 SCI. Twenty-six female Sprague-Dawley rats received a moderate T2 contusion (25 g/cm) and were divided into SCI Control (n = 14) and Stretched (n = 12) groups. Our daily hindlimb stretching protocol was initiated at week 5 post-SCI and administered 5 days/week for 4 weeks before a portion of the animals from each group were euthanized. The remaining animals (Control: n = 8, Stretched: n = 6) recovered for 3 weeks before euthanasia. Locomotor function was assessed using the Basso, Beattie and Bresnahan Open Field Locomotor Scale and kinematic gait analysis. Additionally, cardiovascular indices were collected using echocardiography at baseline, pre-stretching, post-stretching, and post-recovery timepoints. Four weeks of daily stretching led to transient disruption of locomotor function as well as reduced overnight activity followed by robust improvements in locomotion once stretching was no longer administered. Although stretching did not appear to have a dramatic effect on cardiovascular indices, both groups displayed significant changes over time in cardiac output and stroke volume. Furthermore, immunohistochemistry staining revealed that stretching did not exacerbate Calcitonin Gene-Related Protein (CGRP+) nociceptor sprouting in the lumbar dorsal horn, contrary to the effects we have shown in T10 stretched animals. Overall, these results indicate that hindlimb stretching following a high-thoracic SCI does not appear to aberrantly modulate lumbar spinal circuitry as has been shown in low thoracic injuries. Additionally, stretching combined with a T2 SCI does not result in cardiovascular dysfunction, although future work must be conducted to determine whether stretching triggers autonomic events and maladaptive plasticity near the spinal lesion.

Letter to the editor: “Exploring the potential of routine serological markers in predicting neurological outcomes in spinal cord injury” by Jan Matthias et al

2025-06-16

Shashank Chaurasia , Vishal Kumar | Experimental Neurology

A brief summary of the clinical experience of Professor AN Junming in treating spinal cord injury with FANG’s scalp acupuncture plus body acupuncture

2025-06-16

Yanfang Liu , Qi An , Junming An | Journal of Acupuncture and Tuina Science

Spinal cord injury modeling: from modeling to evaluation using rats as examples

2025-06-16

Shuai Wang , Shaoxi Cai , Zhihua Zhu +3 more | Frontiers in Neurology

Spinal cord injury (SCI), with its enormous impact on individuals and society, seriously affects patients’ quality of life and is the focus and challenge of current medical research. The selection … Spinal cord injury (SCI), with its enormous impact on individuals and society, seriously affects patients’ quality of life and is the focus and challenge of current medical research. The selection of appropriate SCI models and the reduction of heterogeneity between models are crucial for basic research on SCI. Although many articles have summarized and compared various SCI models, there are limited descriptions of how to further select the model animals after selecting the type of model, the degree of SCI, the use of anesthesia and analgesia, experience with modeling techniques, preoperative and postoperative care, management of common complications, sample collection, and evaluation of the spinal cord after injury. This paper aims to provide a practical guide for researchers who need to construct SCI models by combining the experimental experience of our research team in modeling and other related research literature. These guidelines will promote the standardization of SCI models, thus providing a solid foundation for in-depth research on SCI and the development of therapeutic strategies.

The Role of Medical and Psychological Rehabilitation in Spinal Cord Injury (SCI)

2025-06-15

Zh. Sulaimanov , A. Koichubekov , К. А. Азимбаев +1 more | Bulletin of Science and Practice

The problem of rehabilitation of patients who have suffered a spinal cord injury (SCI) is one of the most difficult in the health care system. Medical and psychological rehabilitation assistance … The problem of rehabilitation of patients who have suffered a spinal cord injury (SCI) is one of the most difficult in the health care system. Medical and psychological rehabilitation assistance plays an important role in recovery, aimed at minimizing the consequences of injury and adapting patients to new living conditions. An integrated approach, including psychotherapy, helps improve the quality of life and rapid adaptation of patients. Psychological support helps cope with stress and depression. The importance of interdisciplinary cooperation in patient adaptation to the disease is outlined.

[Effect of removing microglia from spinal cord on nerve repair after spinal cord injury in mice].

2025-06-15

Qilong Jiang , Chao Qi , Yuerong Sun +3 more | PubMed

To investigate the effects of removing microglia from spinal cord on nerve repair and functional recovery after spinal cord injury (SCI) in mice. Thirty-nine 6-week-old female C57BL/6 mice were randomly … To investigate the effects of removing microglia from spinal cord on nerve repair and functional recovery after spinal cord injury (SCI) in mice. Thirty-nine 6-week-old female C57BL/6 mice were randomly divided into control group ( n=12), SCI group ( n=12), and PLX3397+SCI group ( n=15). The PLX3397+SCI group received continuous feeding of PLX3397, a colony-stimulating factor 1 receptor inhibitor, while the other two groups were fed a standard diet. After 14 days, both the SCI group and the PLX3397+SCI group were tested for ionized calcium binding adapter molecule 1 (Iba1) to confirm that the PLX3397+SCI group had completely depleted the spinal cord microglia. The SCI model was then prepared by clamping the spinal cord in both the SCI group and the PLX3397+SCI group, while the control group underwent laminectomy. Preoperatively and at 1, 3, 7, 14, 21, and 28 days postoperatively, the Basso Mouse Scale (BMS) was used to assess the hind limb function of mice in each group. At 28 days, a footprint test was conducted to observe the gait of the mice. After SCI, spinal cord tissue from the injury site was taken, and Iba1 immunofluorescence staining was performed at 7 days to observe the aggregation and proliferation of microglia in the spinal cord. HE staining was used to observe the formation of glial scars at the injury site at 28 days; glial fibrillary acidic protein (GFAP) immunofluorescence staining was applied to astrocytes to assess the extent of the injured area; neuronal nuclei antigen (NeuN) immunofluorescence staining was used to evaluate neuronal survival. And 5-hydroxytryptamine (5-HT) immunofluorescence staining was performed to assess axonal survival at 60 days. All mice survived until the end of the experiment. Immunofluorescence staining revealed that the microglia in the spinal cord of the PLX3397+SCI group decreased by more than 95% compared to the control group after 14 days of continuous feeding with PLX3397 ( P<0.05). Compared to the control group, the BMS scores in the PLX3397+SCI group and the SCI group significantly decreased at different time points after SCI ( P<0.05). Moreover, the PLX3397+SCI group showed a further decrease in BMS scores compared to the SCI group, and exhibited a dragging gait. The differences between the two groups were significant at 14, 21, and 28 days ( P<0.05). HE staining at 28 days revealed that the SCI group had formed a well-defined and dense gliotic scar, while the PLX3397+SCI group also developed a gliotic scar, but with a more blurred and loose boundary. Immunofluorescence staining revealed that the number of microglia near the injury center at 7 days increased in the SCI group than in the control group, but the difference between groups was not significant ( P>0.05). In contrast, the PLX3397+SCI group showed a significant reduction in microglia compared to both the control and SCI groups ( P<0.05). At 28 days after SCI, the area of spinal cord injury in the PLX3397+SCI group was significantly larger than that in SCI group ( P<0.05); the surviving neurons significantly reduced compared with the control group and SCI group ( P<0.05). The axonal necrosis and retraction at 60 days after SCI were more obvious. The removal of microglia in the spinal cord aggravate the tissue damage after SCI and affecte the recovery of motor function in mice, suggesting that microglia played a neuroprotective role in SCI.

PENGARUH TERAPI OKSIGEN HIPERBARIK TERHADAP PERBAIKAN PERSEPSI COCHLEAR PADA SUDDEN DEAFNESS

2025-06-15

Azzeldine Aliya zahira | Surabaya Biomedical Journal

Tujuan Penelitian: Gangguan pendengaran sensorineural mendadak adalah kondisimenurunnya kemampuan pendengaran atau tuli secara mendadak yang ditandai dengan penurunan pendengaran untuk mendengar setidaknya 30 dB yang diukur lebih dari tiga frekuensi … Tujuan Penelitian: Gangguan pendengaran sensorineural mendadak adalah kondisimenurunnya kemampuan pendengaran atau tuli secara mendadak yang ditandai dengan penurunan pendengaran untuk mendengar setidaknya 30 dB yang diukur lebih dari tiga frekuensi secara berturutan yang terjadi dalam waktu 72 jam. Salah satu manajemen tuli mendadak yang sering dilakukan dalam jangka waktu yang pendek adalah terapi oksigen hiperbarik. Penelitian ini bertujuan untuk memahami pengaruh terapi oksigen hiperbarik terhadap perbaikan persepsi koklea pada gangguan pendengaran mendadak.Metode: Penelitian ini disusun dengan desain deskriptif, dengan metode studi literatur dengan jurnal yang dipublikasikan tahun 2017 hingga 2022.Hasil: Temuan menunjukkan bahwa terapi oksigen hiperbarik diketahui berpengaruh terhadap perbaikan persepsi koklea pada pasien yang mengalami gangguan pendengaran mendadak,setelah pemberian terapi dengan rata-rata waktu satu hingga dua minggu, dengan tekanan 1,8 ATA hingga 2 ATA, baik dikombinasikan dengan kortikosteroid maupun terapi oksigen hiperbarik saja.Kata kunci: Gangguan Pendengaran Mendadak, Koklea, Terapi Oksigen Hiperbarik

Coaching in the Special Olympics: A Comprehensive Annotated Bibliography of Resources and the Need for Continued Research in Canada

2025-06-14

Justin Heenan , Susan Sumner | International Journal of Educational Studies

Special Olympics is a global movement dedicated to promoting inclusion and fostering a sense of community through sports for individuals with intellectual disabilities. In Canada, the organization serves over 42,000 … Special Olympics is a global movement dedicated to promoting inclusion and fostering a sense of community through sports for individuals with intellectual disabilities. In Canada, the organization serves over 42,000 athletes, providing lifelong athletic opportunities from childhood through adulthood. This annotated bibliography examines 34 resources on coaching in the Special Olympics, including peer-reviewed articles and grey literature with a practical focus. It highlights the ongoing nature of Special Olympics programming, which occurs weekly in communities worldwide, contrasting with the perception of it being limited to occasional Olympic events. Research underscores the benefits of Special Olympics participation, while also highlighting the need for coaching resources. Further empirical research is needed to evaluate the impact of coaching interventions and to enhance coach development and athlete experiences within the Canadian context specifically. Continued research is essential for fostering long-term success within the Special Olympics community.

Positive Effects of (+)-Epicatechin on Traumatic Spinal Cord Injury Recovery

2025-06-14

Cristian González , Rodrigo Mondragón‐Lozano , Hermelinda Salgado‐Ceballos +5 more | Biomolecules

Neurological damage from traumatic spinal cord injury (SCI) results in a grade of disability ranging from mild to severe motor and sensory dysfunction. It occurs more frequently in men of … Neurological damage from traumatic spinal cord injury (SCI) results in a grade of disability ranging from mild to severe motor and sensory dysfunction. It occurs more frequently in men of productive age. Treatment essentially consists of anti-inflammatories and rehabilitation. Other treatments are only partially effective, and inadequate treatment and secondary conditions often cause premature mortality. The search for pharmacological approaches is a continuous effort. This study aimed to assess the effects of a natural compound on spinal cord injury (SCI) as an alternative damage prevention maneuver. We evaluated the protective effects of the flavanol (+)-epicatechin (EC) in a rat model of moderate trauma-induced SCI on protein markers of damage events. The results showed that EC induced significant protection against SCI. No changes were found in angiopoietin-1, beclin-1, myelin basic protein, glial fibrillary acidic protein, neurofilament heavy polypeptide, and neuronal nuclear antigen after the injury, suggesting that damage progression was impeded. The reduction in damage translates into better movement. The results suggest that (+)-epicatechin may be a suitable alternative for treating SCI.

Immunomodulatory Biomaterials for Spinal Cord Injury

2025-06-13

Pengxiang Yang | Royal Society of Chemistry eBooks

Spinal cord injury remains a daunting clinical challenge with limited treatment options and rehabilitation methods. It is closely associated with an insufficient regenerative capacity and a severe inflammatory microenvironment following … Spinal cord injury remains a daunting clinical challenge with limited treatment options and rehabilitation methods. It is closely associated with an insufficient regenerative capacity and a severe inflammatory microenvironment following injury. Intervention with immunomodulatory biomaterials enables better control and management of the microenvironment, facilitating debris clearance, subsiding inflammation reactions, and establishing a conducive environment for nerve regeneration. This chapter discusses the detrimental effects of excessive immune responses and inflammation on nerve regeneration following spinal cord injury, emphasizing the effects of natural, synthetic, or hybrid materials. It explores the latest research findings and potential future research directions in utilizing these immunological principles and biomaterials to intervene in the inflammatory microenvironment and thereby mediate repair and regeneration.

Impact of a structured pulmonary rehabilitation program on respiratory function in patients with spinal cord injuries and correlates

2025-06-13

Bhuvana Krishna , Anupam Gupta , Navin B. Prakash +2 more | Journal of the International Society of Physical and Rehabilitation Medicine

Background: A structured pulmonary rehabilitation protocol can have favorable effect on the respiratory dysfunction in patients with spinal cord injuries (SCI) of different duration. Methods: In a pre-post quasi-experimental study … Background: A structured pulmonary rehabilitation protocol can have favorable effect on the respiratory dysfunction in patients with spinal cord injuries (SCI) of different duration. Methods: In a pre-post quasi-experimental study patients with traumatic and nontraumatic SCI admitted in the unit for inpatient rehabilitation were assessed with pulmonary function tests (PFT) on day 1 and after 2 weeks of training (24 sessions). A structured pulmonary rehabilitation program was provided to all the recruited patients. Parameters like tidal volume (VT), vital capacity (VC), forced vital capacity (FVC), forced expiratory flow at 1sec (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), and chest expansion were recorded and compared pretraining and posttraining. Results: Thirty-four patients (21 males) completed the training with ages ranging from 18 to 65 years (mean: 39.3, SD: 14.2). Nineteen had nontraumatic SCI and duration of lesion less than 12 weeks. Thirteen patients had complete motor and 21 had incomplete motor lesions. Chest expansion (22.2 vs 29.9 mm) and VC (1.7 vs 2.11 L) showed significant improvement posttraining ( P < 0.001). SBC and FVC showed significant improvement posttraining in lower cervical and dorsal but not in upper cervical lesions. No significant posttraining effect was observed according to severity or duration of SCI ( P > 0.05). Conclusions: A well-structured pulmonary rehabilitation program has a positive effect on respiratory function, which in turn improves SCI patients' endurance, independence, and quality of life, and decreases the risk of pulmonary complications.

Investigating the role of disulfidoptosis in spinal cord injury and development of a novel diagnostic model

2025-06-12

Chao Wang , Yu Lu , Haiqiang Ma | Acta Orthopaedica et Traumatologica Turcica

Preventive and therapeutic effects of Tanshinone IIA on spinal cord injury without radiographic abnormality by regulating microglial phenotype polarization

2025-06-12

Luchun Xu , Yukun Ma , Guozheng Jiang +7 more | International Immunopharmacology

Development and Evaluation of a 3D Motion Capture Model for Upper Extremity Kinematics During Wheelchair Maneuvering in Individuals with Spinal Cord Injuries: A Pilot Study

2025-06-12

Lina Bunketorp Käll , Guðni Rafn Harðarson , Erik Tullin +3 more | Bioengineering

Spinal cord injury (SCI) often necessitates the use of a manual wheelchair, which can overload the shoulders and contribute to upper extremity (UE) pain. Currently, no standardized methods exist to … Spinal cord injury (SCI) often necessitates the use of a manual wheelchair, which can overload the shoulders and contribute to upper extremity (UE) pain. Currently, no standardized methods exist to assess UE kinematics during wheelchair propulsion. This study aimed to develop and evaluate a marker-based motion capture model for analyzing UE movement during wheelchair use, with a secondary goal of assessing test–retest reliability. The study was conducted in two phases: (1) development of the motion analysis model and (2) reliability testing. Eleven participants with SCI were included. Reliability was assessed using intraclass correlation coefficients (ICCs) across 15 movement parameters, including total range of motion and minimum and maximum movement values. The model demonstrated good test–retest reliability. For minimum movement, 12 of 15 parameters were significant (ICC = 0.681–0.965). For maximum movement, 13 of 15 were significant (ICC = 0.726–0.981). For total range of motion, 12 of 15 showed significant reliability (ICC = 0.596–0.952). In conclusion, the motion capture model showed promising reliability for assessing UE kinematics during wheelchair maneuvering in individuals with SCI. However, due to the small sample size, further research is needed to validate and refine the model.

Comparing morbidity and mortality in adult patients with acute traumatic cervical spinal cord injury in 2013–2017 and 2018–2022: a retrospective 10-year national trend analysis

2025-06-12

Aladine A. Elsamadicy , Paul Serrato , Selma Belkasim +5 more | Journal of Clinical Neuroscience

Acute administration of tibolone reduces oxidative stress and inflammation in a rat model of traumatic spinal cord injury

2025-06-12

Guadalupe Bautista-Poblet , Angélica Coyoy-Salgado , Herlinda Bonilla‐Jaime +7 more | Neurological Research

As a complex condition, spinal cord injury (SCI) has devastating consequences for physical, financial, social, and emotional well-being. After SCI, damage increases due to oxidative stress (OS) and inflammation, mechanisms … As a complex condition, spinal cord injury (SCI) has devastating consequences for physical, financial, social, and emotional well-being. After SCI, damage increases due to oxidative stress (OS) and inflammation, mechanisms which have been identified as potential therapeutic targets. Tibolone (TIB), a selective tissue estrogen activity regulator (STEAR), has neuroprotective properties demonstrated in some experimental models. We investigated the effect of TIB on OS and inflammation in a rat model of traumatic SCI.Methods: Moderate contusion SCI was produced at thoracic level 9 (T9) in male Sprague Dawley rats. The animals were then divided into groups and received oral doses of TIB (0.1, 1, and 10 mg/kg) at various times (30 minutes, 24, and 48 hours). Animals underwent euthanasia 72 hours after the SCI. Spinal cord tissue and serum samples were collected for the analysis of OS (superoxide dismutase activity (SOD), malondialdehyde (MDA) levels, and protein carbonyl concentration), and inflammation markers (IL-6, IL-1β, and TNFα concentration). TIB administration significantly increased SOD activity in the spinal cord tissue but not in the serum. In contrast, TIB decreased MDA and carbonyl levels in both samples. Also, TIB decreased pro-inflammatory cytokine levels (IL-6, IL-1β, and TNFα) in the spinal cord tissue and serum. The best results were observed with the 0.1 mg/kg dose. TIB demonstrated a protective effect by decreasing OS and inflammation after SCI, suggesting an estrogenic effect of this STEAR. However, further studies should be conducted to elucidate the exact mechanism by which TIB exerts neuroprotection after SCI.

Engineering Mesenchymal Stem Cells with Antioxidant Catalase‐Loaded Metal–Organic Frameworks for Targeted Spinal Cord Injury Therapy

2025-06-11

Shiyun Xian , Shuguang Yang , Zhouzhou Liao +6 more | Advanced Functional Materials

Abstract Spinal cord injury (SCI) therapy is challenging because of the associated irreversible neurological deficits. These deficits are caused by primary damage and secondary pathological processes such as oxidative stress … Abstract Spinal cord injury (SCI) therapy is challenging because of the associated irreversible neurological deficits. These deficits are caused by primary damage and secondary pathological processes such as oxidative stress and inflammation. Although mesenchymal stem cells (MSC) demonstrate potential in SCI treatment by promoting tissue repair and neuroprotection, the high reactive oxygen species (ROS) levels in the SCI microenvironment compromise their therapeutic efficacy. In this study, an MSC‐based cell–drug conjugate (CDC) system is developed by conjugating catalase (CAT)‐loaded metal–organic frameworks (MOF) to MSC, generating a C@M‐MSC platform. The C@M‐MSC system maintains MSC viability, preserves stemness, and mitigates ROS‐induced cellular damage. Furthermore, C@M‐MSC substantially modulates the inflammatory microenvironment by reducing inflammatory cytokine production and shifting microglial polarization toward the anti‐inflammatory M2 phenotype. In vivo studies confirm the targeted accumulation of C@M‐MSC in SCI lesions. This accumulation improves motor functioning, bladder control, and neuronal recovery. Thus, the C@M‐MSC system is a versatile therapeutic strategy that mitigates oxidative stress and enhances tissue repair, offering potential applications beyond SCI. It offers a foundation for broader clinical applications in regenerative medicine and can be integrated with other therapeutic strategies.