Incomplete SCI Research Articles

A national cross-sectional survey on community spinal cord injury individuals profiles, health-related quality of life and support services in China: implications for healthcare and rehabilitation

BackgroundSpinal cord injury (SCI) results in severe, permanent functional changes and has become a global health priority due to its high incidence, cost, and disability rate. Current national epidemiological data on SCI in China are limited and outdated. This study aimed to provide a comprehensive, national cross-sectional investigation of SCI epidemiology in China.MethodsThis cross-sectional study included 3055 SCI participants aged 8 to 78 years, conducted from May to September 2023. Data collected encompassed demographic characteristics, employment status, etiology, years lived with disability (YLD), family structure, caregiving status, income, health insurance, paralysis type, and health-related quality of life (HRQoL). Descriptive statistics analyses were used to assess demographic and injury characteristics. Group differences were assessed using t-tests, one-way ANOVA and Chi-square tests. Significant factors were examined using multivariate regression analysis.ResultsThe majority (88.9%) of respondents were aged 15 to 59 years, with a male-to-female ratio of 2.36:1. Car accidents caused 45.4% of tetraplegia cases, falls caused 35.9% of paraplegia cases, and myelitis was the leading cause of non-traumatic SCI. Among paraplegia participants, 65.5% had complete SCI, while 53.1% of tetraplegia participants had incomplete SCI. Functional improvement was reported by 9.58% of participants. Half (50.3%) of the respondents were unemployed, and 75% had incomes below the national average. HRQoL was significantly lower in the SCI population compared to controls, mainly influenced by injury site, income, age and etiology (p < 0.05).ConclusionsSCI participants in China exhibit low HRQoL and reemployment rates. Accessible community and vocational rehabilitation programs, alongside robust public medical services, are essential for enhancing reemployment and HRQoL among SCI participants, reducing the overall disease burden.

Enhancing balance and mobility in incomplete spinal cord injury with an overground gait trainer.

Prospective intervention study. The study aimed to assess the effect of Andago on balance, overground walking speed, independence levels, fear of falling, and quality of life in patients with acute motor incomplete Spinal Cord Injury. The study was conducted in Ankara/Türkiye. Five participants, classified as AIS D, underwent an eight-week treatment regimen, including three days a week of Andago-assisted walking and balance exercises, supplemented by two days a week of 40-minute sessions of conventional in-bed exercises. Berg Balance Scale scores increased significantly by 129% (p = 0.043). Overground walking speed calculated from 10MWT improved by 33% (p = 0.042). WISCI II levels improved significantly compared to baseline scores (p = 0.041). In the mobility subscale of SCIM III, the total SCIM III scores increased significantly (p = 0.042, p = 0.043, respectively). However, there was no significant improvement in WHOQOL-BREF scores (p = 0.080). The use of Andago facilitated functional progress in patients with acute incomplete SCI, emphasizing the importance of challenging balance and walking activities in triggering motor learning.

Poster (Knowledge Generation) ID 1985240

Background Following a spinal cord injury, there is a significant loss of monoamines below the lesion. In the rat model, exogenous administration of the serotonin precursor, 5-hydroxytryptophan (5HTP), increases neural excitability through augmentation of spinal serotonin levels. To determine whether this compensatory mechanism can be harnessed to restore serotonergic modulation in humans after SCI, participants visited the lab on four occasions where they received i) placebo, ii) carbidopa, iii) 50mg 5HTP+carbidopa, or iv) 100mg 5HTP+carbidopa in a randomized, crossover design. Cutaneomuscular reflexes (CMR) were obtained pre-drug and 30, 60, 90 and 120-min post-drug intake. Surface electromyography was also recorded during a pedalling movement pre- and post-drug. Results Nine participants with chronic, complete SCI (35.3±5.5 years) and four participants with chronic, incomplete SCI (47.0±19.7years) were enrolled. Following ingestion of 100mg 5HTP only, the short polysynaptic and long-lasting reflex components of the CMR were significantly increased by ∼ 86±61% and 58±17% respectively in individuals with complete SCI. No significant changes were noted in the cohort of individuals with incomplete SCI. Integrated EMG during pedalling was increased in multiple lower extremity muscles during the extension and flexion phases of the cycle following both 50-mg (82±15% and 51±7%) and 100-mg 5HTP (140±27% and 130±16%) in individuals with more severe injuries, but not in those with incomplete injuries. Conclusion Ingestion of 5HTP facilitates neural excitability and induces rhythmic muscle activity in previously inactive muscles during an assisted pedalling movement in individuals with chronic, complete SCI. This has significant clinical implications for rehabilitation after SCI.

1216 Epidemiology, Management, and Outcome of Traumatic Spinal Cord Injury at Two Hospitals in the South-West Region of Cameroon: A Five-Year Retrospective Review

Abstract Aim To determine the prevalence, patterns, management, and outcome of traumatic spinal cord injury (TSCI) at the Buea Regional Hospital (BRH) and Limbe Regional Hospital (LRH). Method We performed a descriptive cross-sectional study with a retrospective data collection of cases of TSCI admitted from January 1st, 2017, to December 31st, 2021. Chi-square was used for bivariate analysis assessing correlation between various patterns and outcome of TSCI. The p-value was considered statistically significant if &amp;lt;0.05. Results TSCI represented 1% of hospital admissions. The majority were males (79.2%), and within the 25-44 years age group (55.6%). Referred patients represented 48.6% of cases. The most prevalent etiology was falls (43.7%). More than half (66.7%) had an incomplete SCI which correlated with the level of spine injury (p = 0.018). A spine CT scan was the neuroimaging modality of choice (65.3%). The treatment modalities varied, and the majority (92.3%) of those requiring surgery were operated on greater than 48 hours after injury. The morbidity rate was 36.1%, the severity of neurological injury improved in 23.6%, and the mortality rate was 16.9%. The level of spine injury and the initial severity of neurological injury correlated with the neurological outcome (p = 0.017; p = 0.007), and survival post-injury (p = 0.029; p = 0.006). Conclusions Males of the working age group are most at risk of TSCI. Most causes of TSCI at the are preventable, and their management deviates from recommendations. Their morbidity and mortality rates are high reflecting the realities of TSCI in sub-Saharan Africa.

Robotic locomotor training in a low-resource setting: a randomized pilot and feasibility trial

Purpose Activity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT), an innovative technique, aims to enhance rehabilitation outcomes. This study aimed to conduct a randomized pilot and feasibility trial of a locomotor training program within South Africa. Materials and methods Individuals with chronic traumatic motor incomplete tetraplegia (n = 16). Each intervention involved 60-minute sessions, 3x per week, for 24-weeks. Outcomes included feasibility measures and functional capacity. Results 17 out of 110 individuals initiated the program (recruitment rate = 15.4%) and 16 completed the program (drop-out rate = 5.8%) and attended sessions (attendance rate = 93.9%). Both groups showed a significant increase in upper extremity motor score (MS) and abdominal strength post intervention. Only the RLT group showed a significant change in lower extremity MS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group. Conclusions Feasibility rates of the intervention and functional outcomes justify a subsequent powered RCT comparing RLT to ABT as an effective rehabilitation tool for potentially improving functional strength and walking capacity in people with incomplete SCI.

Profiling Immunological Phenotypes in Individuals During the First Year After Traumatic Spinal Cord Injury: A Longitudinal Analysis.

Abstract Individuals with SCI are severely affected by immune system changes, resulting in increased risk of infections and persistent systemic inflammation. While recent data support that immunological changes after SCI differ in the acute and chronic phases of living with SCI, only limited immunological phenotyping in humans is available. To characterize dynamic molecular and cellular immune phenotypes over the first year, we assess RNA (bulk-RNA sequencing), protein, and flow cytometry (FACS) profiles of blood samples from 12 individuals with SCI at 0-3 days and at 3, 6, and 12 months post injury (MPI) compared to 23 uninjured individuals (controls). We identified 967 differentially expressed (DE) genes in individuals with SCI (FDR <0.001) compared to controls. Within the first 6 MPI we detected a reduced expression of NK cell genes, consistent with reduced frequencies of CD56bright, CD56dim NK cells present at 12 MPI. Over 6MPI, we observed increased and prolonged expression of genes associated with inflammation (e.g. HMGB1, Toll-like receptor signaling) and expanded frequencies of monocytes acutely. Canonical T-cell related DE genes (e.g. FOXP3, TCF7, CD4) were upregulated during the first 6 MPI and increased frequencies of activated T cells at 3-12 MPI. Neurological injury severity was reflected in distinct whole blood gene expression profiles at any time after SCI, verifying a persistent 'neurogenic' imprint. Overall, 2876 DE genes emerge when comparing motor complete to motor incomplete SCI (ANOVA, FDR <0.05), including those related to neutrophils, inflammation, and infection. In summary, we identify a dynamic immunological phenotype in humans, including molecular and cellular changes which may provide potential targets to reduce inflammation, improve immunity, or serve as candidate biomarkers of injury severity.

Functional electrical stimulation therapy for upper extremity rehabilitation following spinal cord injury: a pilot study.

Pilot study. To examine if functional electrical stimulation therapy (FEST) improves neuromuscular factors underlying upper limb function in individuals with SCI. A tertiary spinal cord rehabilitation center specialized in spinal cord injury care in Canada. We examined 29 muscles from 4 individuals living with chronic, cervical, and incomplete SCI. The analysis was focused on the changes in muscle activation, as well as on how the treatment could change the ability to control a given muscle or on how multiple muscles would be coordinated during volitional efforts. There was evidence of gains in muscle strength, activation, and median frequency after the FEST. Gains in muscle activation indicated the activation of a greater number of motor units and gains in muscle median frequency the involvement of higher threshold, faster motor units. In some individuals, these changes were smaller but accompanied by increased control over muscle contraction, evident in a greater ability to sustain a volitional contraction, reduce the co-contraction of antagonist muscles, and provide cortical drive. FEST increases muscle strength and activation. Enhanced control of muscle contraction, reduced co-contraction of antagonist muscles, and a greater presence of cortical drive were some of the findings supporting the effects of FEST at the sensory-motor integration level.

186 A Multi-Center, Randomized, Placebo-Controlled, Double-Blinded Trial of Efficacy and Safety of Riluzole in Acute Spinal Cord Injury Study (RISCIS)

INTRODUCTION: Riluzole, a sodium-glutamate antagonist which is FDA approved for ALS has shown promising pre-clinical results and is clinically safe in SCI patients. METHODS: The RISCIS trial is an international, multi-center, prospective, double-blinded, randomized, placebo-controlled Phase II/III trial. Patients with ASIA A-C, C4-C8 SCI and &lt;12 hours from injury were randomized between Riluzole, at an oral dose of 100mg BID for the first 24 hours followed by 50mg BID for the following 13 days, and placebo control. RESULTS: Due to the impact of the global COVID-19 pandemic this trial was terminated prior to completion. 193 patients were randomized with a follow-up rate of 82.7% at 180-days. No statistical difference was noted in the demographics and baseline injury characteristics between the two groups. At 6 months there was a median gain in total motor scores (TOTM) of 30.0 in the Riluzole group compared to 20.0 for the Placebo group. The improved motor outcomes did not reach statistical significance. Given the decreased sample size, additional sensitivity analyses were conducted. In the ASIA-C population, Riluzole was a significant improver of total motor scores (coefficient estimate: 14.10, p = 0.020) and upper motor scores (CE: 7.68, p = 0.040) at 6 months. ASIA B patients had higher reported independence, as measured by the SCIM score (45.3 vs. 27.3; p = 0.071) and change in mental health scores as measured by the SF-36 mental health domain (2.01 vs. -11.58; p: 0.0205) at 180 days. CONCLUSIONS: Despite the premature termination of the RISCIS trial due to the COVID-19 pandemic, 193 subjects were recruited into this trial. Primary analysis showed a 10-motor point gain in riluzole-treated subjects which did not reach significance. However, on secondary analysis, incomplete cervical SCI subjects (AIS B and C) showed significant gains in functional recovery.

Pulmonary Function Improves in Persons with Paraplegia after Partial Body Weight Supported Treadmill Training: a Prospective Randomized Study

Objectives: To evaluate changes in Pulmonary Function Test (PFT) parameters in individuals with paraplegia following Partial Body Weight Supported Treadmill Training (PBWSTT).&#x0D; Design: Randomized controlled trial&#x0D; Setting: Inpatient rehabilitation facility&#x0D; Participants: Adults with chronic SCI (n = 42).&#x0D; Intervention: Patients were randomly allocated in CR group (N= 20) receiving Conventional Rehabilitation or in PBWSTT group (N=22) receiving both Conventional Rehabilitation and PBWSTT for 4 weeks. &#x0D; Main outcome measure(s): Changes in % predicted PFT parameter for the subject’s age, sex and BMI.&#x0D; Results: With PBWSTT, significant PFT changes were VC (P =.009), PEF (p = .001) and ERV (p = .032). In complete SCI, PEF (p = .026) improved, while in incomplete SCI VC (p = .005), ERV (p = .029), PEF( p = .001) improved with PBWSTT. In upper neurological level of injury (NLI) (T6-T11), PBWSTT improved PEF (p = .004) alone while in lower NLI (T12-L2), with PBWSTT both ERV (p = .016) and PEF (p = .035) improved.&#x0D; Conclusions: With added PBWSTT most parameters including Vital Capacity, the global measure of PFT, improved significantly, especially in Lower NLI and incomplete SCI. The positive role of this noninvasive exercise based intervention in improving lung functions comes as an added benefit to the usual benefit of locomotion. This may encourage researchers to design future larger studies to validate it aiming the inclusion of PBWSTT in routine SCI rehabilitation protocols.

Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review.

Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale. Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Compromised T-cell immunity in patients with spinal cord injury and its relationship with injury characteristics.

The aim of this study was to investigate in vivo and in vitro cellular immune responses in patients with chronic (spinal cord injury; SCI), determine the effects of autonomic dysfunction on cellular immune response, and determine the effect of completeness of the injury at different levels on cellular immune response. Forty-nine patients (42 males, 7 females; mean age: 35.5±13.4 years; range, 18 to 68 years) with chronic (time since injury >6 months) traumatic SCI were included in this cross sectional study between March 2013 and December 2013. Patients were allocated into two groups: Group 1, patients with an injury at T7 or below, and Group 2, patients with an injury at T6 or above. All patients in Group 2 had a history of autonomic dysreflexia and orthostatic hypotension. Intradermal skin tests were applied to the participants to reveal delayed T-cell responses. The percentages of cluster of differentiation (CD)3+ T cells and CD3+ T cells expressing CD69 and CD25 were analyzed by flow cytometry for the detection of activated T cells including all T-cell subsets. When patients with complete injuries were compared, the CD45+ cell percentage was found to be significantly higher in patients in Group 2. Patients with an incomplete SCI had increased skin response to candida antigens compared to complete SCI patients. Incomplete SCI patients also had higher percentages of lymphocytes and CD3+CD25+ and CD3+CD69+ T cells compared to patients with complete SCI. T-cell activity is impaired in chronic SCI patients with higher levels of injury, and the completeness of injury and autonomic dysfunction gain prominence as compromising factors in T-cell immunity.

Use of a Novel Mixed Reality Application For Over Ground Gait Speed Modulation

<h3>Research Objectives</h3> To examine gait modulation and variability among individuals using a novel mixed reality (MR) visual feedback application. <h3>Design</h3> Block randomized cross-over design and case study. <h3>Setting</h3> Clinical research laboratory. <h3>Participants</h3> Twelve individuals without known walking impairment and one individual with an incomplete thoracic SCI. <h3>Interventions</h3> Visual feedback of the participants' gait speed was provided by an application developed for a commercially available MR head-mounted device (HMD). Participants were asked to match their gait speed to a holographic floating ball during three conditions: 85%, 100%, and 115% of their self-selected speed. The ball was green if participants matched the target speed, blue if the gait was too slow, and disappeared if the gait was too fast. Participants completed 21 (participant with SCI) or 30 (other participants) 10-meter trials. <h3>Main Outcome Measures</h3> Gait speed matching error, and variability in stride length, and stride time. <h3>Results</h3> Participants met the target speeds with a 6% rate of error (< 0.1 m/s error). Among individuals without walking impairment, error decreased after the first of 30 walking trials using the MR device and was consistent across all target speeds. The individual with SCI exhibited a higher error in their 4th and 6th walking trials, which occurred at the slower speed (85%). Both groups showed more variability in stride length and stride time when using the MR-HMD device. <h3>Conclusions</h3> Individuals without known walking impairment required minimal practice to successfully adjust walking speed to match a visual target from a MR-HMD. However, individuals with gait impairments may require additional training or have more difficulty at slower speeds than individuals without gait impairment. Further research is needed on the effectiveness of MR visual feedback in clinical populations with gait impairments. <h3>Author(s) Disclosures</h3> Co-author Randy Trumbower received contracted research support from Onward. Megan Dass completed an internship at Microsoft. The authors have no other conflicts of interest to report.

Brain and spinal cord paired stimulation coupled with locomotor training facilitates motor output in human spinal cord injury.

Combined interventions for neuromodulation leading to neurorecovery have gained great attention by researchers to resemble clinical rehabilitation approaches. In this randomized clinical trial, we established changes in the net output of motoneurons innervating multiple leg muscles during stepping when transcranial magnetic stimulation (TMS) of the primary motor cortex was paired with transcutaneous spinal (transspinal) stimulation over the thoracolumbar region during locomotor training. TMS was delivered before (TMS-transspinal) or after (transspinal-TMS) transspinal stimulation during the stance phase of the less impaired leg. Ten individuals with chronic incomplete or complete SCI received at least 20 sessions of training. Each session consisted of 240 paired stimuli delivered over 10-min blocks for 1 h during robotic assisted step training on a motorized treadmill. Body weight support, leg guidance force and treadmill speed were adjusted based on each subject's ability to step without knee buckling or toe dragging. Most transspinal evoked potentials (TEPs) recorded before and after each intervention from ankle and knee muscles during assisted stepping were modulated in a phase-dependent pattern. Transspinal-TMS and locomotor training affected motor neuron output of knee and ankle muscles with ankle TEPs to be modulated in a phase-dependent manner. TMS-transspinal and locomotor training increased motor neuron output for knee but not for ankle muscles. Our results support that targeted brain and spinal cord stimulation alters responsiveness of neurons over multiple spinal segments in people with chronic SCI. Noninvasive stimulation of the brain and spinal cord along with locomotor training is a novel neuromodulation method that can become a promising modality for rehabilitation in humans after SCI.

Neurorehabilitation Through Synergistic Man-Machine Interfaces Promoting Dormant Neuroplasticity in Spinal Cord Injury: Protocol for a Nonrandomized Controlled Trial.

BackgroundSpinal cord injury (SCI) constitutes a major sociomedical problem, impacting approximately 0.32-0.64 million people each year worldwide; particularly, it impacts young individuals, causing long-term, often irreversible disability. While effective rehabilitation of patients with SCI remains a significant challenge, novel neural engineering technologies have emerged to target and promote dormant neuroplasticity in the central nervous system.ObjectiveThis study aims to develop, pilot test, and optimize a platform based on multiple immersive man-machine interfaces offering rich feedback, including (1) visual motor imagery training under high-density electroencephalographic recording, (2) mountable robotic arms controlled with a wireless brain-computer interface (BCI), (3) a body-machine interface (BMI) consisting of wearable robotics jacket and gloves in combination with a serious game (SG) application, and (4) an augmented reality module. The platform will be used to validate a self-paced neurorehabilitation intervention and to study cortical activity in chronic complete and incomplete SCI at the cervical spine.MethodsA 3-phase pilot study (clinical trial) was designed to evaluate the NeuroSuitUp platform, including patients with chronic cervical SCI with complete and incomplete injury aged over 14 years and age-/sex-matched healthy participants. Outcome measures include BCI control and performance in the BMI-SG module, as well as improvement of functional independence, while also monitoring neuropsychological parameters such as kinesthetic imagery, motivation, self-esteem, depression and anxiety, mental effort, discomfort, and perception of robotics. Participant enrollment into the main clinical trial is estimated to begin in January 2023 and end by December 2023.ResultsA preliminary analysis of collected data during pilot testing of BMI-SG by healthy participants showed that the platform was easy to use, caused no discomfort, and the robotics were perceived positively by the participants. Analysis of results from the main clinical trial will begin as recruitment progresses and findings from the complete analysis of results are expected in early 2024.ConclusionsChronic SCI is characterized by irreversible disability impacting functional independence. NeuroSuitUp could provide a valuable complementary platform for training in immersive rehabilitation methods to promote dormant neural plasticity.Trial RegistrationClinicalTrials.gov NCT05465486; https://clinicaltrials.gov/ct2/show/NCT05465486International Registered Report Identifier (IRRID)PRR1-10.2196/41152

Motor Neuroplastic Effects of a Novel Paired Stimulation Technology in an Incomplete Spinal Cord Injury Animal Model.

Paired stimulation of the brain and spinal cord can remodel the central nervous tissue circuitry in an animal model to induce motor neuroplasticity. The effects of simultaneous stimulation vary according to the extent and severity of spinal cord injury. Therefore, our study aimed to determine the significant effects on an incomplete SCI rat brain and spinal cord through 3 min and 20 min stimulations after 4 weeks of intervention. Thirty-three Sprague Dawley rats were classified into six groups: (1) normal, (2) sham, (3) iTBS/tsDCS, (4) iTBS/ts-iTBS, (5) rTMS/tsDCS, and (6) rTMS/ts-iTBS. Paired stimulation of the brain cortex and spinal cord thoracic (T10) level was applied simultaneously for 3–20 min. The motor evoked potential (MEP) and Basso, Beattie, and Bresnahan (BBB) scores were recorded after every week of intervention for four weeks along with wheel training for 20 min. Three-minute stimulation with the iTBS/tsDCS intervention induced a significant (p < 0.050 *) increase in MEP after week 2 and week 4 treatments, while 3 min iTBS/ts-iTBS significantly improved MEP (p < 0.050 *) only after the week 3 intervention. The 20 min rTMS/ts-iTBS intervention showed a significant change only in post_5 min after week 4. The BBB score also changed significantly in all groups except for the 20 min rTMS/tsDCS intervention. iTBS/tsDCS and rTMS/ts-iTBS interventions induce neuroplasticity in an incomplete SCI animal model by significantly changing electrophysiological (MEP) and locomotion (BBB) outcomes.

P115. Intraoperative sensory signals predict prognosis for patients with traumatic cervical spinal cord injury

<h3>BACKGROUND CONTEXT</h3> Traumatic cervical spinal cord injury (tCSCI) is a devasting life-altering event. Prognosis is largely determined by the formal neurological assessment known as International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), which is graded using the American Spinal Injury Association Impairment Scale grade (AIS grade). AIS grade A is designated as a loss of sacral motor and sensory functions and is associated with the worst prognosis. Many studies have shown that AIS grades are a predictor for neurologic recovery and functional status postinjury. However, the timing of the ISNCSCI exam and AIS grade can greatly influence the reliability of the prognosis. Intraoperative neuromonitoring is routinely used during spine surgery to detect injuries to the spinal cord or nerve roots by measuring signal transmission. However, in patients with SCI, the role of intraoperative neuromonitoring as a potential prognostic tool has not been studied. <h3>PURPOSE</h3> The purpose of this study was to assess if detected signals during intraoperative neuromonitoring portends a greater likelihood of recovery for patients with tCSCI. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study at a high-volume, academic level I trauma center. <h3>PATIENT SAMPLE</h3> A total of 49 patients undergoing decompression and surgical fixation of following tCSCI. <h3>OUTCOME MEASURES</h3> Improvement in ASIA motor score and AIS grade conversion rate. <h3>METHODS</h3> Patients undergoing decompression and surgical fixation following tCSCI were retrospectively reviewed at a single high-volume, academic level I trauma center. Improvement in ASIA motor score and AIS grade conversion rates at final followup were compared between patients with detectable intraoperative neuromonitoring upper extremity somatosensory evoked potential (SSEP) signals and those without detectable signals. Motor evoked potentials (MEP) were not routinely performed. <h3>RESULTS</h3> A total of 49 patients with tCSCI underwent decompression and surgical fixation with intraoperative neuromonitoring. Seventeen patients with complete SCI and 32 patients with AIS grades B or C on admission were included in the study with a mean followup of 14.3 months. Patients with incomplete SCI had detectable lower extremity SSEPs more often compared to patients with complete SCI (56.3% vs 23.5%, p = 0.028). However, there was no difference in detectable upper extremity SSEPs between complete and incomplete SCI (65.6% vs 58.8%, p=0.638). Of the 17 patients with complete SCI, patients with detectable upper extremity SSEPs cohort had a higher rate of AIS grade conversion compared to the nondetectable cohort (80.0% vs 28.6%, p = 0.034). Furthermore, the detectable upper extremity SSEPs cohort had greater ASIA motor scores on admission (25.9 vs 5.4, p=0.002), at final follow-up (54.0 vs 8.9, and with overall improvement (26.1 vs 3.4, p=0.021) compared to the non-detectable cohort. Patients with detectable lower extremity SSEPs had similar ASIA motor scores on admission (21.5 vs 16.2, 0.609) but higher ASIA motor scores at final followup (57.5 vs 27.1, p=0.041) compared to the nondetectable cohort. Of the 32 patients with incomplete SCI, there was no difference in AIS grade conversion or ASIA motor scores between the detectable and non-detectable SSEP cohorts. <h3>CONCLUSIONS</h3> The presence of upper extremity SSEP signals in patients who present with complete tCSCI portended a better prognosis with greater likelihood of conversion to an incomplete AIS grade and greater motor score at final followup. These results demonstrate an objective and measurable marker of prognosis that can be used for clinical decision making and patient counseling regarding neurologic recovery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Spinal cord injury and spinal fracture in patients with ankylosing spondylitis

BackgroundSpinal cord injury (SCI) and spinal fracture are major complications in patients with ankylosing spondylitis (AS) who sustain spinal trauma. The purpose of this study was to investigate the incidence, predictors, and sequelae of spinal trauma in patients with AS.MethodsThis retrospective study included patients with AS who were admitted for spinal trauma between January 1, 2006, and June 30, 2016. The study compared clinical outcomes of patients between group 1: SCI alone, group 2: spinal fracture alone (no SCI), and group 3: both SCI and spinal fracture.ResultsOf the 6285 patients with AS admitted during the retrospective study period, only 105 suffered from spinal trauma and were enrolled in the study. Case number in group 1, 2, and 3 was 11(10.48%), 45(42.85%), and 49(46.67%), respectively. Among the patients with spinal fractures, 52.1% had SCI. Bamboo spine was significantly more prevalent in the fracture group than in the nonfracture group (78.7% vs. 36.4%; P = 0.006). Patients with SCI had more instances of subluxation or dislocation (48.3% vs. 8.9%; P < 0.001) and more cases of spinal epidural hematoma (SEH; 21.7% vs. 2.2%; P = 0.003) than patients without SCI. The rate of delayed diagnosis for spinal fracture was 31.4%, with one-third of patients developing delayed SCI. Among the patients with incomplete SCI, 58.3% achieved neurological improvement after treatment (P = 0.004).ConclusionsPatients with AS and bamboo spine at radiograph had a higher rate of spinal fracture, which may be an important factor in SCI in patients with AS. Spinal fractures involving the C3–C7 region, subluxation or dislocation, severe spinal fracture, and SEH were found to be predictive of SCI, and SCI in patients with AS resulted in higher mortality and complication rates.

Advancing Peripheral Nerve Graft Transplantation for Incomplete Spinal Cord Injury Repair.

Peripheral nerves have a propensity for axon growth and regeneration that the central nervous system lacks (CNS). However, CNS axons can also grow long distances if introduced to a graft harvested from a peripheral nerve (PNGs), which is the rationale for using PNGs as repair strategy for injuries of the spinal cord. From a clinical perspective, PNGs provide interesting possibilities with potential to repair the injured spinal cord. First, there are numerous options to harvest autologous grafts associated with low risk for the patient. Second, a PNG allow axons to grow considerable distances and can, by the surgical procedure, be navigated to specific target sites in the CNS. Furthermore, a PNG provides all necessary biological substrates for myelination of elongating axons. A PNG can thus be suited to bridge axons long distances across an injury site and restore long tracts in incomplete SCI. Experimentally, locomotor functions have been improved transplanting a PNG after incomplete injury. However, we still know little with regard to the formation of new circuitries and functional outcome in association to when, where, and how grafts are inserted into the injured spinal cord, especially for sensory functions. In this perspective, we discuss the advantages of PNG from a clinical and surgical perspective, the need for adding/repairing long tracts, how PNGs are best applied for incomplete injuries, and the unexplored areas we believe are in need of answers.

Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report

Background and aim: Spinal tuberculosis (STB) is a hazardous type of bone tuberculosis that could affect the entire spine, with predilection towards the lower thoracic level. Upper cervical spondylitis occurred only at 0.3 – 1% of all STB cases, but this rare type leads to severe consequences, including tetraplegia, autonomic dysfunction, and respiratory impairment. This case reported long CTLSO rigid external stabilisation reasoning to boost protection whilst recovering tuberculosis despite stable internal stabilisation. Methods: A 34-year-old male came with one year of worsening low-back pain, unintentional weight loss, and gradual loss of power and sensation of both feet within a month. Physical examination showed kyphotic deformity, tenderness, key-muscle-strength 3, and sensory impairment for lower extremities, with no autonomic disturbances. Laboratory works showed chronic ongoing infection. Whole-spine MRI showed multiple spondylodiscitis with multi-focal paravertebral abscesses at C3 – C5, C7 – T3, T9 – T12, L1, severe canal stenosis and anterior segment destruction of T12. Results: The patient was diagnosed with SCI AIS D with a neurological level of L3 secondary to T12 vertebra destruction from STB. He underwent abscess evacuation, debridement, and posterior stabilisation at T10 – L3 and debridement of abscess at C3 – C5 without the need for stabilisation. After procedures, the spine was further stabilised by a CTSLO brace with flexion, extension, lateral flexion, rotation stop. Inward rehabilitation includes incremental mobilisation, upper-limb-extensor-group-strengthening-programme, balance-exercise with ambulation training. Patient discharged with status: ambulate independently with a walker. To date, the patient has returned to work with independent ambulation. Conclusion: Type-III STB was indicated for surgical procedures. Instability of upper cervical prevented patient to performed loadbearing activity thus lowering patient functional outcomes. CTLSO supplementation was given to compensate for 3 lesion sites, the upper cervical, mid-thoracic, and lower-thoracic. For the C3 – C5 lesion, there was no internal stabilisation, so a proper external mode of stabilisation should be given. However, for the thoracic level, CTLSO was given due to (1) incomplete SCI lesion in the absence of deteriorating neurological deficit,c(2) porous nature of STB, and (3) good prognostic recovery of STB with anti-TB medication leading to the reversible neurological deficit.

The Effects of Robotic Walking and Activity-Based Training on Bladder Complications Associated with Spinal Cord Injury

Background: Traditional Activity-based Training (ABT) and novel Robotic Locomotor Training (RLT) demonstrate promising results for reducing secondary complications associated with SCI, including bladder dysfunction. However, there is a need for increased evidence through randomised controlled trials (RCTs). This study aimed to determine the effect of RLT compared to ABT on bladder function in individuals with incomplete SCI involved in a pilot randomised controlled trial. Methods: Sixteen participants with motor incomplete tetraplegia (&gt;1 year) were recruited. The RLT and ABT involved 60-minute sessions, 3× per week for 24 weeks. The International Lower Urinary Tract Function Basic Data Set was used to assess self-reported bladder health and function over 24 weeks. Results: Across participants, intermittent catheterization, either by self or attendant was used by most of the participants (44%), followed by indwelling catheters (31%). No significant group differences were found for the bladder outcomes over time, except for improvements in urinary function (p = 0.04) at week 24. The odds ratio of 0.26, indicated that the RLT group was less likely to have an improvement in bladder function compared to the ABT group. Both groups tended to show a pattern of decreasing urinary incontinence over time. Conclusions: The ABT group experienced greater benefits in bladder function, but both groups showed a tendency of decreased urinary incontinence over time. Both RLT and ABT interventions may positively benefit the neural circuitries controlling urogenital functions in persons with SCI. RCTs involving larger sample sizes are warranted to further examine these preliminary results.