Brain tissue properties and morphometry assessment after chronic complete spinal cord injury

AbstractThere is much controversy about the potential impact of spinal cord injury (SCI) on brain’s anatomy and function, which is mirrored in the substantial divergence of findings between animal models and human imaging studies. Given recent advances in quantitative magnetic resonance imaging (MRI) we sought to tackle the unresolved question about the link between the presumed injury associated volume differences and underlying brain tissue property changes in a cohort of chronic complete SCI patients. Using the established computational anatomy methods of voxel-based morphometry (VBM) and voxel-based quantification (VBQ) we performed statistical analyses of grey matter volume and parameter maps indicative for brain’s myelin, iron and free tissue water content in complete SCI patients (n=14) and healthy individuals (n=14). Our whole-brain analysis showed significant white matter volume loss in the rostral and dorsal part of the spinal cord consistent with Wallerian degeneration of proprioceptive axons in the lemniscal tract in SCI subjects, which correlated with spinal cord atrophy assessed with quantification of the spinal cord cross-sectional area at cervical level. The latter finding suggests that Wallerian degeneration of the lemniscal tract represents a main contributor to the observed spinal cord atrophy, which is highly consistent with preclinical ultrastructural/histological evidence of remote changes in the central nervous system secondary to SCI. Structural changes in the brain representing remote changes in the course of chronic SCI could not be confirmed with conventional VBM or VBQ statistical analysis. Whether and how MRI based brain morphometry and brain tissue property analysis will inform clinical decision making and clinical trial outcomes in spinal cord medicine remains to be determined.

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Absence of localized grey matter volume changes in the motor cortex following spinal cord injury

Brain Research ◽

10.1016/j.brainres.2004.08.060 ◽

2004 ◽

Vol 1028 (1) ◽

pp. 19-25 ◽

Cited By ~ 31

Author(s):

Adrian Philip Crawley ◽

Michael Todd Jurkiewicz ◽

Annabella Yim ◽

Sujiva Heyn ◽

Mary Caroline Verrier ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Cortex ◽

Grey Matter ◽

Grey Matter Volume ◽

Volume Changes ◽

Matter Volume ◽

Cord Injury

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Independent spinal cord atrophy measures correlate to motor and sensory deficits in individuals with spinal cord injury

Spinal Cord ◽

10.1038/sc.2010.87 ◽

2010 ◽

Vol 49 (1) ◽

pp. 70-75 ◽

Cited By ~ 59

Author(s):

H Lundell ◽

D Barthelemy ◽

A Skimminge ◽

T B Dyrby ◽

F Biering-Sørensen ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Atrophy ◽

Sensory Deficits ◽

Cord Injury

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Optimizing Clinical Decision Making in Acute Traumatic Spinal Cord Injury

Journal of Neurotrauma ◽

10.1089/neu.2016.4926 ◽

2017 ◽

Vol 34 (20) ◽

pp. 2841-2842 ◽

Cited By ~ 7

Author(s):

Michael G. Fehlings ◽

Vanessa K. Noonan ◽

Derek Atkins ◽

Anthony S. Burns ◽

Christiana L. Cheng ◽

...

Keyword(s):

Decision Making ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Decision Making ◽

Clinical Decision ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Genetic influences on cellular reactions to spinal cord injury: Activation of macrophages/microglia and astrocytes is delayed in mice carrying a mutation (WldS) that causes delayed Wallerian degeneration

The Journal of Comparative Neurology ◽

10.1002/(sici)1096-9861(19960729)371:3<469::aid-cne9>3.0.co;2-0 ◽

1996 ◽

Vol 371 (3) ◽

pp. 469-484 ◽

Cited By ~ 50

Author(s):

Minoru Fujiki ◽

Ziyin Zhang ◽

Lloyd Guth ◽

Oswald Steward

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Wallerian Degeneration ◽

Genetic Influences ◽

Cord Injury

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Towards a Mobile Gait Analysis for Patients with a Spinal Cord Injury: A Robust Algorithm Validated for Slow Walking Speeds

Sensors ◽

10.3390/s21217381 ◽

2021 ◽

Vol 21 (21) ◽

pp. 7381

Author(s):

Charlotte Werner ◽

Chris Awai Awai Easthope ◽

Armin Curt ◽

László Demkó

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Gait Analysis ◽

Clinical Decision Making ◽

Inertial Sensors ◽

Clinical Decision ◽

Cord Injury ◽

Spatio Temporal ◽

The Individual ◽

Walking Speeds

Spinal cord injury (SCI) patients suffer from diverse gait deficits depending on the severity of their injury. Gait assessments can objectively track the progress during rehabilitation and support clinical decision making, but a comprehensive gait analysis requires far more complex setups and time-consuming protocols that are not feasible in the daily clinical routine. As using inertial sensors for mobile gait analysis has started to gain ground, this work aimed to develop a sensor-based gait analysis for the specific population of SCI patients that measures the spatio-temporal parameters of typical gait laboratories for day-to-day clinical applications. The proposed algorithm uses shank-mounted inertial sensors and personalized thresholds to detect steps and gait events according to the individual gait profiles. The method was validated in nine SCI patients and 17 healthy controls walking on an instrumented treadmill while wearing reflective markers for motion capture used as a gold standard. The sensor-based algorithm (i) performed similarly well for the two cohorts and (ii) is robust enough to cover the diverse gait deficits of SCI patients, from slow (0.3 m/s) to preferred walking speeds.

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Correlation Between Duration From Injury and Bone Mineral Density in Individuals With Spinal Cord Injury

Annals of Rehabilitation Medicine ◽

10.5535/arm.20169 ◽

2021 ◽

Vol 45 (1) ◽

pp. 1-6

Author(s):

Hyehoon Choi ◽

So-youn Chang ◽

Jaewan Yoo ◽

Seong Hoon Lim ◽

Bo Young Hong ◽

...

Keyword(s):

Bone Mineral Density ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Correlation Analysis ◽

Bone Mineral ◽

Structural Changes ◽

Negative Relationship ◽

Mineral Density ◽

Femur Neck ◽

Cord Injury

Objective To investigate the correlation between bone mineral density (BMD) and duration of injury in individuals with spinal cord injury (SCI).Methods Patients with SCI who visited the outpatient department between January 2009 and January 2019 were enrolled. Patients’ most recent dual energy X-ray absorptiometry images were reviewed. According to the 2007 International Society for Clinical Densitometry guidelines, vertebrae with a local structural change were excluded when deriving spine BMD. If one or no vertebra is suitable for evaluation, spine BMD was judged as “improper for assessment”. Correlation analysis was performed between duration from injury and BMD Z-scores of the hip and spine.Results Among 83 individuals with SCI, the spines of 44 were judged as improper for assessment. The correlation analysis showed a significant negative relationship between the duration from injury and femur neck BMD (r=-0.40, p<0.01) and total proximal femur BMD (r=-0.39, p<0.01). However, no significant correlation was found between the duration from injury and spine BMD Z-score.Conclusion The duration of SCI correlated with hip BMD, but not with spine BMD. Further, more than half of the individuals with SCI could not undergo spinal assessment due to local structural changes. Therefore, spine BMD measurement is not an appropriate method for predicting future fracture risk in those with SCI.

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Wallerian degeneration in cervical spinal cord tracts is commonly seen in routine T2-weighted MRI after traumatic spinal cord injury and is associated with impairment in a retrospective study

European Radiology ◽

10.1007/s00330-020-07388-2 ◽

2020 ◽

Author(s):

Tim Fischer ◽

Christoph Stern ◽

Patrick Freund ◽

Martin Schubert ◽

Reto Sutter

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Wallerian Degeneration ◽

Evoked Potential ◽

Corticospinal Tract ◽

Cervical Spinal Cord ◽

Dorsal Column ◽

Traumatic Spinal Cord Injury ◽

Spinothalamic Tract ◽

Cord Injury

Abstract Objectives Wallerian degeneration (WD) is a well-known process after nerve injury. In this study, occurrence of remote intramedullary signal changes, consistent with WD, and its correlation with clinical and neurophysiological impairment were assessed after traumatic spinal cord injury (tSCI). Methods In 35 patients with tSCI, WD was evaluated by two radiologists on T2-weighted images of serial routine MRI examinations of the cervical spine. Dorsal column (DC), lateral corticospinal tract (CS), and lateral spinothalamic tract (ST) were the analyzed anatomical regions. Impairment scoring according to the American Spinal Injury Association Impairment Scale (AIS, A–D) as well as a scoring system (0–4 points) for motor evoked potential (MEP) and sensory evoked potential (SEP) was included. Mann-Whitney U test was used to test for differences. Results WD in the DC occurred in 71.4% (n = 25), in the CS in 57.1% (n = 20), and in 37.1% (n = 13) in the ST. With WD present, AIS grades were worse for all tracts. DC: median AIS B vs D, p < 0.001; CS: B vs D, p = 0.016; and ST: B vs D, p = 0.015. More pathological MEP scores correlated with WD in the DC (median score 0 vs 3, p < 0.001) and in the CS (0 vs 2, p = 0.032). SEP scores were lower with WD in the DC only (1 vs 2, p = 0.031). Conclusions WD can be detected on T2-weighted scans in the majority of cervical spinal cord injury patients and should be considered as a direct effect of the trauma. When observed, it is associated with higher degree of impairment. Key Points • Wallerian degeneration is commonly seen in routine MRI after traumatic spinal cord injury. • Wallerian degeneration is visible in the anatomical regions of the dorsal column, the lateral corticospinal tract, and the lateral spinothalamic tract. • Presence of Wallerian degeneration is associated with higher degree of impairment.

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Spinal Cord Injuries the Facts of Neuropathology: Opportunities and Limitations

Current Neuropsychiatry and Clinical Neuroscience Reports ◽

10.33702/cncnr.2019.1.1.1 ◽

2019 ◽

Vol 1 (1) ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Byron A Kakulas

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Nervous System ◽

Wallerian Degeneration ◽

Spinal Cord Injuries ◽

Neurological Status ◽

Research Projects ◽

Human Spinal Cord ◽

The Third ◽

Cord Injury

It is essential for research projects which are undertaken to find a “cure” for human spinal cord injury (SCI) to be consistent with the neuropathological facts of the disorder. In this respect there are three main points to be taken into account. Firstly, the researcher should be aware that simple transection of the spinal cord is not a feature of human SCI. The usual lesion is one of compression and disruption with haemorrhage. The second and most important aspect of human SCI is to understand that Wallerian degeneration inevitably ensues following disruption of the axon. Wallerian degeneration is progressive and inexorable and unlike the peripheral nervous system CNS axons do not regenerate. The third and more helpful fact is that in the majority (71%) of SCI autopsies a small amount of white matter, myelin and axons, was found to be preserved at the level of injury. Re-activation of these dormant, axons offers the opportunity for improvement of the SCI patient’s neurological status by means of restorative neurology (RN).

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