Motor unit number index detects the effectiveness of surgical treatment in improving distal motor neuron loss in patients with incomplete cervical spinal cord injury

Abstract Background Recovery of motor dysfunction is important for patients with incomplete cervical spinal cord injury (SCI). To enhance the recovery of muscle strength, both research and treatments mainly focus on injury of upper motor neurons at the direct injury site. However, accumulating evidences have suggested that SCI has a downstream effect on the peripheral nervous system, which may contribute to the poor improvement of the muscle strength after operation. The aim of this study is to investigate the impact of early vs. delayed surgical intervention on the lower motor neurons (LMNs) distal to the injury site in patients with incomplete cervical SCI. Methods Motor unit number index (MUNIX) was performed on the tibialis anterior (TA), extensor digitorum brevis (EDB) and abductor hallucis (AH) in 47 patients with incomplete cervical SCI (early vs. delayed surgical-treatment: 17 vs. 30) and 34 healthy subjects approximately 12 months after operation. All patients were further assessed by American spinal injury association (ASIA) motor scales and Medical Research Council (MRC) scales. Results There are no difference of both ASIA motor scores and MRC scales between the patients who accepted early and delayed surgical treatment (P > 0.05). In contrast, the patients undergoing early surgical treatment showed lower MUSIX values in both bilateral EDB and bilateral TA, along with greater MUNIX values in both right-side EDB and right-side TA, compared to the patients who accepted delayed surgical treatment (P < 0.05). Conclusions Cervical SCI has a negative effect on the LMNs distal to the injury site. Early surgical intervention in Cervical SCI patients may improve the dysfunction of LMNs distal to the injury site, reducing secondary motor neuron loss, and eventually improving clinical prognosis.

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Motor unit number index detects the effectiveness of surgical treatment in improving distal motor neuron loss in patients with incomplete cervical spinal cord injury

10.21203/rs.3.rs-18138/v2 ◽

2020 ◽

Author(s):

Jun Li ◽

Yancheng Zhu ◽

Yang Li ◽

ShiSheng He ◽

Deguo Wang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Treatment ◽

Muscle Strength ◽

Motor Neurons ◽

Surgical Intervention ◽

Cervical Spinal Cord ◽

Injury Site ◽

Cord Injury ◽

Motor Neuron Loss

Abstract Background Recovery of motor dysfunction is important for patients with incomplete cervical spinal cord injury (SCI). To enhance the recovery of muscle strength, both research and treatments mainly focus on injury of upper motor neurons at the direct injury site. However, accumulating evidences have suggested that SCI has a downstream effect on the peripheral nervous system, which may contribute to the poor improvement of the muscle strength after operation. The aim of this study is to investigate the impact of early vs. delayed surgical intervention on the lower motor neurons (LMNs) distal to the injury site in patients with incomplete cervical SCI. Methods Motor unit number index (MUNIX) was performed on the tibialis anterior (TA), extensor digitorum brevis (EDB) and abductor hallucis (AH) in 47 patients with incomplete cervical SCI (early vs. delayed surgical-treatment: 17 vs. 30) and 34 healthy subjects approximately 12 months after operation. All patients were further assessed by American spinal injury association (ASIA) motor scales and Medical Research Council (MRC) scales. Results There are no difference of both ASIA motor scores and MRC scales between the patients who accepted early and delayed surgical treatment (P > 0.05). In contrast, the patients undergoing early surgical treatment showed lower MUSIX values in both bilateral EDB and bilateral TA, along with greater MUNIX values in both right-side EDB and right-side TA, compared to the patients who accepted delayed surgical treatment (P < 0.05). Conclusions Cervical SCI has a negative effect on the LMNs distal to the injury site. Early surgical intervention in Cervical SCI patients may improve the dysfunction of LMNs distal to the injury site, reducing secondary motor neuron loss, and eventually improving clinical prognosis.

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Motor unit number index detects the effectiveness of surgical treatment in improving distal motor neuron loss in patients with incomplete cervical spinal cord injury

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03567-w ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jun Li ◽

Yancheng Zhu ◽

Yang Li ◽

Shisheng He ◽

Deguo Wang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Treatment ◽

Motor Neuron ◽

Motor Unit ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Neuron Loss ◽

Cord Injury ◽

Motor Neuron Loss

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Restoration of breathing after opioid overdose and spinal cord injury using temporal interference stimulation

Communications Biology ◽

10.1038/s42003-020-01604-x ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Michael D. Sunshine ◽

Antonino M. Cassarà ◽

Esra Neufeld ◽

Nir Grossman ◽

Thomas H. Mareci ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Neurons ◽

Drug Overdose ◽

Cervical Spinal Cord ◽

Opioid Overdose ◽

Electrode Position ◽

Spinal Motor Neurons ◽

Cord Injury ◽

Low Amplitude

AbstractRespiratory insufficiency is a leading cause of death due to drug overdose or neuromuscular disease. We hypothesized that a stimulation paradigm using temporal interference (TI) could restore breathing in such conditions. Following opioid overdose in rats, two high frequency (5000 Hz and 5001 Hz), low amplitude waveforms delivered via intramuscular wires in the neck immediately activated the diaphragm and restored ventilation in phase with waveform offset (1 Hz or 60 breaths/min). Following cervical spinal cord injury (SCI), TI stimulation via dorsally placed epidural electrodes uni- or bilaterally activated the diaphragm depending on current and electrode position. In silico modeling indicated that an interferential signal in the ventral spinal cord predicted the evoked response (left versus right diaphragm) and current-ratio-based steering. We conclude that TI stimulation can activate spinal motor neurons after SCI and prevent fatal apnea during drug overdose by restoring ventilation with minimally invasive electrodes.

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Segmental analysis in cervical spinal cord injury reveals the recovery potential of hand muscles with preserved corticospinal tract: Insights beyond impairment scales

10.1101/2021.11.30.21265051 ◽

2021 ◽

Author(s):

Gustavo Balbinot ◽

Guijin Li ◽

Sukhvinder Kalsi-Ryan ◽

Rainer Abel ◽

Doris Maier ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Muscle Strength ◽

Evoked Potentials ◽

Corticospinal Tract ◽

Cervical Spinal Cord ◽

Hand Muscles ◽

Recovery Potential ◽

Strength Recovery ◽

Cord Injury

Cervical spinal cord injury (SCI) severely impacts widespread bodily functions with extensive impairments for individuals, who prioritize regaining hand function. Although prior work has focused on the recovery at the person-level, the factors determining the recovery potential of individual muscles are poorly understood. There is a need for changing this paradigm in the field by moving beyond person-level classification of residual strength and sacral sparing to a muscle-specific analysis with a focus on the role of corticospinal tract (CST) sparing. The most striking part of human evolution involved the development of dextrous hand use with a respective expansion of the sensorimotor cortex controlling hand movements, which, because of the extensive CST projections, may constitute a drawback after SCI. Here, we investigated the muscle-specific natural recovery after cervical SCI in 748 patients from the European Multicenter Study about SCI (EMSCI), one of the largest datasets analysed to date. All participants were assessed within the first 4 weeks after SCI and re-assessed at 12, 24, and 48 weeks. Subsets of individuals underwent electrophysiological multimodal evaluations to discern CST and lower motor neuron (LMN) integrity [motor evoked potentials (MEP): N = 203; somatosensory evoked potentials (SSEP): N = 313; nerve conduction studies (NCS): N = 280]. We show the first evidence of the importance of CST sparing for proportional recovery in SCI, which is known in stroke survivors to represent the biological limits of structural and functional plasticity. In AIS D, baseline strength is a good predictor of segmental muscle strength recovery, while the proportionality in relation to baseline strength is lower for AIS B/C and breaks for AIS A. More severely impaired individuals showed non-linear and more variable recovery profiles, especially for hand muscles, while measures of CST sparing (by means of MEP) improved the prediction of hand muscle strength recovery. Therefore, assessment strategies for muscle-specific motor recovery in acute SCI improve by accounting for CST sparing and complement gross person-level predictions. The latter is of paramount importance for clinical trial outcomes and to target neurorehabilitation of upper limb function, where any single muscle function impacts the outcome of independence in cervical SCI.

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Comparison of Early Surgical Treatment With Conservative Treatment of Incomplete Cervical Spinal Cord Injury Without Major Fracture or Dislocation in Patients With Pre-existing Cervical Spinal Stenosis

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001065 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Subum Lee ◽

Chunghwan Kim ◽

Jung-Ki Ha ◽

Sang Ku Jung ◽

Jin Hoon Park

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Treatment ◽

Conservative Treatment ◽

Spinal Stenosis ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Cord Injury ◽

Cervical Spinal Stenosis ◽

Early Surgical Treatment

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Improvement of Tetraplegia and Respiratory Symptoms with Complex Korean Medicine Treatment After Traumatic Cervical Spinal Cord Injury: A Case Report

Journal of Acupuncture Research ◽

10.13045/jar.2020.00213 ◽

2020 ◽

Vol 37 (4) ◽

pp. 275-280

Author(s):

Eunbyul Cho ◽

Hyeonjun Woo ◽

Nam geun Cho

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Muscle Strength ◽

Barthel Index ◽

Respiratory Symptoms ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Korean Medicine ◽

Independent Measure ◽

Cord Injury

This study reports the effectiveness of traditional Korean medicine in treating tetraplegia and respiratory symptoms (including dyspnea) after traumatic cervical spinal cord injury surgery. The patient was treated with complex Korean medical treatment including electroacupuncture, pharmacopuncture, and herbal medicine. The manual muscle test (expanded Medical Research Council system) was used to measure the patient’s muscle strength. The Korean version of the modified Barthel index and the functional independent measure were used to evaluate the patient’s independence in performing daily activities. Following 2 hospitalizations and treatments, the patient’s muscle strength improved > 4+ score for all joints, and the Korean version of the modified Barthel index and functional independent measure scores increased from 26 to 79 and 56 to 95, respectively. Symptoms of dyspnea, coughing, and sputum gradually improved and finally disappeared during hospitalization. This study suggests complex Korean medicine treatment may be effective in the rehabilitation of post-surgical cervical spinal cord injury patients.

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