Neurological
Temporo-spatial trajectories show differences below and above SCIs
According to study results published in the Journal of Neurology, Neurosurgery and Psychiatry, pronounced spatiotemporal dynamics of tissue-specific neurodegeneration above and below spinal cord injuries (SCIs) were found.
SCI causes neurodegeneration across the neuraxis, but little is known about the gray and white matter trajectories of the spinal cord above and below the injury. While there is no cure for SCI, a better understanding of these processes can be beneficial for the long-term recovery and management of those with SCI.
Between 2016 and 2019, patients with traumatic (n = 13) or non-traumatic (n = 3) paraplegia and healthy control persons (n = 10) were enrolled in the current study at the Balgrist University Hospital in Switzerland. Over the course of 1.5 years, participants underwent magnetic resonance imaging (MRI) at 3 time points to identify tissue-specific neurodegeneration.
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The patients and healthy controls had mean ages of 50.3 ± 16.0 years and 45.3 ± 19.2 years, respectively. A total of 3 participants in each cohort were women. Of the patients with an injury, 8 had quadriplegia and 8 had paraplegia, classified according to the American Spinal Injury Association Impairment Scale A (n = 2), B (n = 1), C (n = 2) and D (n =. ). 11).
During the study, upper and lower extremity motor scores improved by 1.5 points per log month (95% CI, 0.6-2.3 points per log month; P = 0.002) and 2.4 points per log month (95% CI, -0.8 to 5.6.). Points per log month; P = .131). Significant improvements in the Spinal Cord Independence Measure (SCIM) were reported (mean value 10.5 points per log month; P = 0.005), but not for light touch values (P = 0.11) and needle stick values (P = 0.718).
In patients with assessable lesions, the mean sagittal lesions 2 months after injury had an average width of 4.9 ± 2.2 mm, a length of 19.9 ± 17.0 mm, and an area of 70.2 ± 70.9 mm2 on. The width of the lesions tended to decrease significantly over time (P = 0.016), but no changes in lesion length or area were reported.
2 months after surgery, spinal cord injuries were associated with decreased spinal cord area (mean difference -7.9%; P = 0.008) and white matter area (mean difference -9.7%; P = 0.004) at C2 / C3 .
Above the injury at C2 / C3, patients with spinal cord injury had a decrease in the spinal cord area at a rate of 0.42% per month (P = 0.002), the gray matter area at a rate of 0.70% per month (P = 0.004) and white matter area at a rate of 0.34% per month (P = 0.020). In the lumbar enlargement, below the injury, the decreases in the spinal cord and white matter areas progressed by 0.35% per month (P <0.001 and P = 0.007, respectively).
The fractional anisotropy values in the dorsal column at C2 / C3 at the start of the study correlated negatively with the SCIM follow-up scores (z-score, 4.18; P = .037) and the radial diffusivity at the start of the study was negative with the SCIM follow-up scores. up scores (Z-Score, 4.01; P = 0.035).
One of the limitations of the study was the fact that these results may not generalize to all patients with spinal cord injury, as most participants had heterogeneous injury types and severity levels.
The authors of the study came to the conclusion that the temporal dynamic trajectories of patients with paraplegia differed above and below the injury. “The clinical eloquence of these results is reflected in the clinicopathological association between early degenerative changes and functional and neurological recovery. These MRI measurements could be used to track the effectiveness of therapeutic interventions, including rehabilitation. “
Disclosure: Several authors stated links to industry. For a full list of the details, see the original article.
reference
David G, Pfyffer D, Vallotton K, et al. Longitudinal changes in the gray and white matter of the spinal cord after a spinal cord injury. J Neurol Neurosurg Psychiatry. Published online August 2, 2021. doi: 10.1136 / jnnp-2021-326337