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Abstract
ObjectiveTo assess whether preserved dorsal and ventral midsagittal tissue bridges after traumatic cervical spinal cord injury (SCI) encode tract-specific electrophysiologic properties and are predictive of appropriate recovery.MethodsIn this longitudinal study, we retrospectively assessed MRI scans at 1 month after SCI that provided data on width and location (dorsal vs ventral) of midsagittal tissue bridges in 28 tetraplegic patients. Regression analysis assessed associations between midsagittal tissue bridges and motor- and sensory-specific electrophysiologic recordings and appropriate outcome measures at 12 months after SCI.ResultsGreater width of dorsal midsagittal tissue bridges at 1 month after SCI identified patients who were classified as being sensory incomplete at 12 months after SCI (p = 0.025), had shorter sensory evoked potential (SEP) latencies (r = −0.57, p = 0.016), and had greater SEP amplitudes (r = 0.61, p = 0.001). Greater width of dorsal tissue bridges predicted better light-touch score at 12 months (r = 0.40, p = 0.045) independently of baseline clinical score and ventral tissue bridges. Greater width of ventral midsagittal tissue bridges at 1 month identified patients who were classified as being motor incomplete at 12 months (p = 0.002), revealed shorter motor evoked potential (MEP) latencies (r = −0.54, p = 0.044), and had greater ratios of MEP amplitude to compound muscle action potential amplitude (r = 0.56, p = 0.005). Greater width of ventral tissue bridges predicted better lower extremity motor scores at 12 months (r = 0.41, p = 0.035) independently of baseline clinical score and dorsal tissue bridges.ConclusionMidsagittal tissue bridges, detectable early after SCI, underwrite tract-specific electrophysiologic communication and are predictors of appropriate sensorimotor recovery. Neuroimaging biomarkers of midsagittal tissue bridges may be integrated into the diagnostic workup, prediction of recovery, and patients' stratification in clinical trials.
Highlights
In this longitudinal study, we retrospectively assessed MRI scans at 1 month after spinal cord injury (SCI) that provided data on width and location of midsagittal tissue bridges in 28 tetraplegic patients
We investigated whether the width of midsagittal tissue bridges differed in patients with sensory or motor completeness at 12 months after SCI compared to incomplete patients using a t test
Over the 12 months after SCI, patients recovered by 7 ± 8 points on the lower extremity motor score (LEMS) (p < 0.0001, n = 28), by 8 ± 15 points on the light-touch score (p = 0.0061, n = 27), by 8 ± 21 points on the pinprick score (p = 0.0254, n = 17), and by 36 ± 30 on the spinal cord independence measure (SCIM) score (p < 0.0001, n = 26)
Summary
We retrospectively assessed MRI scans at 1 month after SCI that provided data on width and location (dorsal vs ventral) of midsagittal tissue bridges in 28 tetraplegic patients. Study participants We retrospectively collected imaging, electrophysiologic, and clinical data for 28 patients with traumatic cervical SCI who were admitted between January 2005 and September 2014 at the University Hospital Balgrist, Zurich, Switzerland. This cohort included a subgroup of patients previously reported in a study focused on the combined widths of tissue bridges.[2] Patients with cervical SCI and disease duration of no longer than 2 months before the first assessment who took part in a 12month follow-up assessment were eligible to participate.
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