Recovery Of Spinal Cord Function Research Articles

Beneficial Effects of Ascorbic Acid and Alpha-tocopherol on the Locomotor Functional Recovery of Spinal Cord Injured Rats

Beneficial Effects of Ascorbic Acid and Alpha-tocopherol on the Locomotor Functional Recovery of Spinal Cord Injured Rats

Application of a paraplegic gait orthosis in thoracolumbar spinal cord injury.

Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord (below T4) injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.

Transdifferentiation of differentiated stem cells contributes to remyelination.

Evidence suggests that transdifferentiation of mesenchymal stem cells (MSCs) into various neuronal cells contributes to functional recovery after experimental spinal cord injury. Qiu et al. have recently published an exciting article in Stem Cell Research & Therapy demonstrating the transdifferentiation of already differentiated MSCs that contributes to remyelination of injured/regenerating axons, and thereby to functional recovery of spinal cord injured animals. The authors highlight the importance of interaction between neurotrophin-3 and tropomyosin receptor kinase C for the observed effects. This study provided important evidence that manipulation of rat bone marrow-derived MSCs before transplantation could enhance the therapeutic benefit of cell-based treatment.

Application of titanium plate reconstruction in laminoplasty during the thoracolumbar burst fractures

Objective To investigate the application value of using reconstruction of the posterior wall of vertebral canal with titantium plate and bone grafting in the thoracolumbar burst fracture surgery. Methods Twenty-seven patients with thoracolumbar burst fracture with spinal cord injury were treated with posterior pedicle screw fixation+ holo-laminectomy+ titanium plate bending for reconstruction of posterior expansive laminoplasty, and the depressurized lamina process was trimmed into bone grains and were mixed with allogeneic bone for bone grafting along the titanium plate surface. The kyphotic Cobb angle, bone graft fusion, and neurological recovery were of the patients were assessed after procedure. Results The postoperative CT and MRI findings in 27 patients suggested that the vertebral canal volume recovered well, the spinal cord compression relieve was satisfactory. The neurological function of 16 patients was improved during the hospitalization. All patients were followed up after discharge. They were followed up for 12 to 30 months (mean 17.8 months). Their final neurological function was improved in 21 patients compare with before procedure (ASIA grade: type A 3 cases, type B 6 cases, type C 8 cases, and type D 10 cases), and 14 of them recovered completely, 7 recovered partially, and 6 did not have any changes (ASIA grade: type A 3 cases, type B 3 cases, type C 3 cases, type D 4 cases, and type E 14 cases). The function improvement rate of the patients was 78% (21/27) after procedure. No symptoms of delayed spinal cord compression were observed during the follow up period. The internal fixation screw rods of 9 patients were removed from 13 to 21 months after procedure because of their personal reasons, but the forming titantium plates were reserved. All patients did not have the phenomena including increased kyphosis angle, titantium plate shift, deformation, and decreased vertebral canal volume. The bone grafting fusion rate was 100%. No spine instability was observed. There was no significant differences in the lost degrees of kyphosis angle and the height change ratio of the injured vertebrae (P>0.05). Conclusions Using titanium plate for laminoplasty and bone grafting are simple, safe and reliable after surgical reduction decompression and fixation in the treatment of thoracolumbar burst fractures with spinal cord injury. It is conducive to maintaining the integrity and stability of spines. The recovery of spinal cord function is satisfactory. Key words: Titanium plate; Thoracolumbar fracture; Fracture

Delayed Neurologic Deficit after Thoracolumbar Kyphosis Correction: One Case Report

Study design: Case Report. Objective: To present one case suffering from delayed neurologic deficit after kyphosis deformity correction and analyze its potential etiological factors, how to identify and treat it. Summary of background data: Tardive neurologic deficits occur much less than acute ones after corrections of spinal deformities. Currently some risk factors, such as postoperative hypotension, deformity severity, and intraoperative haemorrhage are considered to be related with its occurrence and worsening though the true mechanisms are not clear. Extrinsic cord compression should be excluded by radiographic examinations before conservative treatments, such as improving blood perfusion, eliminating cord edema, suppressing local inflammation; promoting neurite outgrowth can be applied. If these don’t lead to functional recovery of spinal cord, emergency operation returning the cord to its former kyphotic position can also be considered. Methods: This 44 year-old female patient demonstrated thoracolumbar kyphosis of 136.9° combined with incompetence of spinal cord before operation, and underwent posterior vertebra column resection with the kyphotic correction of 68.8°. No neurologic dysfunction was found during operation. Results: Neurologic deficit appeared on the sixth day after operation, showing motion disability and sensation weakening of both lower extremities. Imaging examinations failed to reveal mechanical compression, such as haematoma or displaced implant. After use of glucocorticoid, gamma globulin, monosialotetrahexosylganglioside, alprostadil and rehabilitation therapies, her myodynamia of both lower extremities recovered greatly, especially muscles extensor, however, her sensation didn’t ameliorate. Conclusions: Delayed-onset neurologic deficit is rarely seen. Detailed history collection and meticulous physical examination are strongly recommended. Early identification and correct treatments can avert incomplete spinal cord from permanent damage.

Collagen scaffolds modified with collagen-binding bFGF promotes the neural regeneration in a rat hemisected spinal cord injury model

Nerve conduit is one of strategies for spine cord injury (SCI) treatment. Recently, studies showed that biomaterials could guide the neurite growth and promote axon regeneration at the injury site. However, the scaffold by itself was difficult to meet the need of SCI functional recovery. The basic fibroblast growth factor (bFGF) administration significantly promotes functional recovery after organ injuries. Here, using a rat model of T9 hemisected SCI, we aimed at assessing the repair capacity of implantation of collagen scaffold (CS) modified by collagen binding bFGF (CBD-bFGF). The results showed that CS combined with CBD-bFGF treatment improved survival rates after the lateral hemisection SCI. The CS/CBD-bFGF group showed more significant improvements in motor than the simply CS-implanted and untreated control group, when evaluated by the 21-point Basso-Beattie-Bresnahan (BBB) score and footprint analysis. Both hematoxylin and eosin (H&E) and immunohistochemical staining of neurofilament (NF) and glial fibrillary acidic protein (GFAP) demonstrated that fibers were guided to grow through the implants. These findings indicated that administration of CS modified with CBD-bFGF could promote spinal cord regeneration and functional recovery.

The Importance of Early Decompression Combined with Bone Grafting and Internal Fixation and Early Electric Stimulation in the Treatment of Severe Injury of Spinal Cord

Objective: To explore the anterior/posterior decompression, bone graft, internal fixation combined with postoperative early stimulation in the treatment of cervical spine trauma complicated with spinal cord injury treatment. Methods: From 2005 January to 2014 December, 40 patients with cervical spine fracture, dislocation of injury associated with spinal cord injury were treated with anterior/posterior decompression, bone graft, internal fixation operation combined early electrical stimulation after operation. Results: 40 cases were followed up from 12 months to 6 years. Bone graft healed well, no case of plate and screws loosening, rupture and other complications, symptoms of spinal cord injury improved satisfactorily. Preoperative spinal cord injury Frankel grade: A grade 24 cases, B grade 4 cases, C grade 5 cases, D grade 7 cases, postoperative recovery to B grade 2 cases, E grade 26 cases. According to the Japanese Department of orthopedics Society (JOA) criteria score, postoperative improvement rate was 89.26%. Conclusion: Anterior/posterior spinal canal decompression, bone graft, early internal fixation operation combined with postoperative early electrical stimulation in the treatment of patients with cervical spine injury associated with spinal cord injury, can prevent or alleviate the secondary spinal cord injury and other complications, provide effective fixation spinal segmental stability, promote the recovery of spinal cord function, achieve a satisfactory effect.

Peripheral Nerve Grafts and Chondroitinase ABC Application Improves Functional Recovery After Complete Spinal Cord Transection

Background: Peripheral nerve grafts (PNGs) in the spinal cord support axonal regeneration and functional recovery. Chondroitinase ABC (ChABC) has been used to break down chondroitin sulfate proteoglycans (CSPGs) that inhibit axonal regeneration. If ChABC is effectively delivered to the injury site, CSPGs can be broken down so axons can pass through the distal interface between the graft and the spinal cord before CSPG accumulation has an adverse impact on recovery. Methods: In this study, we tested the synergistic effect of using predegenerated PNGs as scaffolds for axonal growth, while delivering ChABC via oligo-(polyethylene glycol) fumarate (OPF) tubes, to promote functional recovery after complete spinal cord injury in rats. Results: Our results show that: 1) PNGs anatomically incorporated into the spinal cord after a complete transection, 2) thousands of axons regenerated into the PNGs, 3) cholera toxin-B labeled axons crossed through the graft, and 4) the combination of PNGs and ChABC restored significantly better locomotor function than controls. Conclusions: Our study showed that PNGs can establish a good anatomical bridge after SCI and set the stage for functional recovery. doi: http://dx.doi.org/10.4021/jnr209w

Injectable alginate hydrogel loaded with GDNF promotes functional recovery in a hemisection model of spinal cord injury

We hypothesized that local delivery of GDNF in spinal cord lesion via an injectable alginate hydrogel gelifying in situ would support spinal cord plasticity and functional recovery. The GDNF release from the hydrogel was slowed by GDNF encapsulation in microspheres compared to non-formulated GDNF (free GDNF). When injected in a rat spinal cord hemisection model, more neurofilaments were observed in the lesion when the rats were treated with free GDNF-loaded hydrogels. More growing neurites were detected in the tissues surrounding the lesion when the animals were treated with GDNF microsphere-loaded hydrogels. Intense GFAP (astrocytes), low βIII tubulin (neural cells) and RECA-1 (endothelial cells) stainings were observed for non-treated lesions while GDNF-treated spinal cords presented less GFAP staining and more endothelial and nerve fiber infiltration in the lesion site. The animals treated with free GDNF-loaded hydrogel presented superior functional recovery compared with the animals treated with the GDNF microsphere-loaded hydrogels and non-treated animals.

Peripheral Nerve Grafts and Chondroitinase ABC Application Improves Functional Recovery After Complete Spinal Cord Transection

Background: Peripheral nerve grafts (PNGs) in the spinal cord support axonal regeneration and functional recovery. Chondroitinase ABC (ChABC) has been used to break down chondroitin sulfate proteoglycans (CSPGs) that inhibit axonal regeneration. If ChABC is effectively delivered to the injury site, CSPGs can be broken down so axons can pass through the distal interface between the graft and the spinal cord before CSPG accumulation has an adverse impact on recovery. Methods: In this study, we tested the synergistic effect of using predegenerated PNGs as scaffolds for axonal growth, while delivering ChABC via oligo-(polyethylene glycol) fumarate (OPF) tubes, to promote functional recovery after complete spinal cord injury in rats. Results: Our results show that: 1) PNGs anatomically incorporated into the spinal cord after a complete transection, 2) thousands of axons regenerated into the PNGs, 3) cholera toxin-B labeled axons crossed through the graft, and 4) the combination of PNGs and ChABC restored significantly better locomotor function than controls. Conclusions: Our study showed that PNGs can establish a good anatomical bridge after SCI and set the stage for functional recovery. J Neurol Res. 2013;3(3-4):85-95 doi: https://doi.org/10.4021/jnr209w

Ethyl pyruvate promotes spinal cord repair by ameliorating the glial microenvironment

Spinal cord injury (SCI) triggers a series of endogenous processes, including neuroinflammation and reactive astrogliosis, which may contribute to the failure of neural regeneration and functional recovery. In the present study, the effect of ethyl pyruvate on spinal cord repair was explored. Functional assessment and histological analyses of astrogliosis, neuroinflammation, neuronal survival and axonal regeneration were performed to investigate the effects of ethyl pyruvate (0.086, 0.215, 0.431 or 0.646 mmol·kg(-1) ·day(-1) ) on spinal cord repair in a rat model of SCI. The effect of ethyl pyruvate (5, 10 or 15 mM) on astrocytic activation was also evaluated in an in vitro'scratch-wound' model. Functional assessment showed evident improvement of behavioural functions in the ethyl pyruvate-treated rats. Reactive astrogliosis was significantly inhibited in vivo, after injection of ethyl pyruvate (0.431 mmol·kg(-1) day(-1) ), and in vitro'scratch-wound' model in the presence of 10 or 15 mM ethyl pyruvate. The difference between effective concentration in vitro and in vivo suggests that the inhibitory effect of ethyl pyruvate on astrogliosis in damaged spinal cord is indirect. In addition, ethyl pyruvate (0.431 mmol·kg(-1) day(-1) ) attenuated SCI-induced neuroinflammation; it decreased the Iba-1-, ED-1- and CD11b-positive cells at the lesion site. Importantly, histological analyses showed a significantly greater number of surviving neurons and regenerative axons in the ethyl pyruvate-treated rats. Ethyl pyruvate was shown to inhibit astrogliosis and neuroinflammation, promote neuron survival and neural regeneration, and improve the functional recovery of spinal cord, indicating a potential neuroprotective effect of ethyl pyruvate against SCI.

A rat chronic pain model of spinal cord contusion injury.

Spinal cord injury-induced pain is a common clinical problem affecting adversely the quality of daily lives of spinal cord injured patients. Management with current pain medications can only lead to partial pain relief in some spinal cord injured patients, which is usually associated with unfavorable side effects. Development of specific medications for spinal cord injury-induced pain states relies on identification of new targets and/or pathways that contribute to chronic pain development post injury. We describe here the generation of a spinal cord contusion injury model that mimics the etiology and phenotypes of chronic pain states in spinal cord injured patients. Therefore, this model can be a useful tool for studying spinal cord injury mechanisms, functional recovery, research, and development of new medications for better functional and symptomatic improvements, including pain management.

Neuroprotective Effect of Vaccination with Autoantigen-Pulsed Dendritic Cells After Spinal Cord Injury

Studies have shown that the development of a properly controlled autoreactive T cell response can serve as a therapeutic approach for spinal cord injury (SCI). Thus, vaccination with mature dendritic cells (DCs) pulsed with central nervous system (CNS) antigens that can prime autoreactive T cells have the potential for treating SCI. Mature DCs pulsed with spinal cord homogenate (SCH), nonpulsed mature DC or phosphate-buffer solution (PBS) were injected into spinal cord-injured mice peritoneally. The functional recovery of spinal cord was measured by Basso mouse scale and footprint analysis. Spinal cord specimen was preserved for immunohistochemical staining to detect T cell infiltration, differentiation of neural stem/progenitor cells, and tissue preservation. RT-PCR and enzyme linked immunosorbent assay (ELISA) was used to detect the expression of cytokines and neurotrophic factors. Vaccination with DCs pulsed with SCH promoted pronounced functional recovery from SCI. The neuroprotection induced by SCH-pulsed DCs (SCH-DC) correlated to the accumulation of CD4(+) T cells in the lesion site. SCH-DC markedly affected the production of interferon-γ, interleukin-12, and granulocyte-macrophage colony stimulating factor. SCH-DC also promoted expression of neurotrophic factors in the injured spinal cord and spleen cells. Furthermore, vaccination with SCH-DC enhanced neuronal differentiation of neural stem/progenitor cells, and it led to better tissue preservation. The results of the present study suggest that DC-mediated immune regulation may be a potential therapeutic approach aimed at shifting the balance between immune and nerve cells in order to treat SCI.

Supplement moderate zinc as an effective treatment for spinal cord injury

Spinal cord repair is a challenging task that has puzzled clinical specialists and scientists for a long time. Zinc plays an important role in regulating the expression of brain-derived neurotrophic factor (BDNF) in nervous system, which can improve the pathological state of neurons and promote regeneration of injured neurons, reduce neuronal apoptosis. Our previous studies demonstrated that the serum zinc levels in SCI model group were significantly decreased and zinc concentrations in spinal cord were gradually increased in 24 h after SCI, which induces the up-regulation of zinc transporter 1 (ZnT-1). The mRNA levels of ZnT1 and BDNF were both increased after SCI, and there is a positive correlation between them. Excess zinc exposure has been proved to be a risk factor for neuron death in brain and spinal cord injuries, but supplement of the right amount of zinc may be useful in promoting the recovery of spinal cord function.

Distrabution and migration of olfuctory ensheathing cells transplanted into the contused spinal cord of rats

Objective To observe the migration and distribution of OECs in injured spinal cord and discuss their relation with the recovery of spinal cord function. Methods The rats were contused by a force of 10 g · 25 mm with NYU-impactor at T10 level. The OECs acutely isolated from green fluorescence protein （GFP） rats were purified, identified and then transplanted into the injured site and the rostral and caudal parts of the spinal cord one week after injury, with total volume of the transplanted OECs for 90 000/μl. Within 13 weeks after transplantation, the migration and distribution of OECs were qualitatively observed on the cryo-sections under fluorescence light microscope. The area and the length of OECs distribution were semi-quantitatively determined. The locomotor function of the spinal cord was appraised by BBB score. Results OECs were located collectively in the transplanted site at early stage after transplantation and then spread gradually mainly along the long axis of the cord. OECs could be found in the cavity of the contused spinal cord. The area and the length of OECs distribution were increased from 1.33 mm2 and 4.23 mm respectively at one week to 3.30 mm2 and 7.68 mm respectively at 13 weeks after transplantation. In the meantime, the locomotor function was gradually improved. Conclusion OECs can migrate within the contused spinal cord, as may contribute to the recovery of locomotor function. Key words: Spinal cord injuries; Cell transplantation; Olfactory ensheathing cells

Combined NgR vaccination and neural stem cell transplantation promote functional recovery after spinal cord injury in adult rats

after spinal cord injury (SCI), there are many adverse factors at the lesion site such as glial scar, myelin-derived inhibitors, cell loss and deficiency of neurotrophins that impair axonal regeneration. Therefore, combination therapeutic strategies might be more effective than a single strategy for promoting functional recovery after SCI. In the present study, we investigated whether a Nogo66 receptor (NgR) vaccine, combined with neural stem cell (NSC) transplantation, could promote better functional recovery than when NgR vaccine or NSCs were used alone. adult rats were immunized with NgR vaccine at 1 week after a contusive SCI at the thoracic level, and the NSCs, obtained from green fluorescent protein transgenic rats, were transplanted into the injury site at 8 weeks post injury. The functional recovery of the animals under various treatments was evaluated by three independent behavioural tests, that is, Basso, Beattie and Bresnahan locomotor rating scale, footprint analysis and grid walking. the combined therapy with NgR vaccination and NSC transplantation protected more ventral horn motor neurones in the injured spinal cord and greater functional recovery than when they were used alone. Furthermore, NgR vaccination promoted migration of engrafted NSCs along the rostral-caudal axis of the injured spinal cords, and induced their differentiation into neurones and oligodendrocytes in vivo. the combination therapy of NgR vaccine and NSC transplantation exhibited significant advantages over any single therapy alone in this study. It may represent a potential new therapy for SCI.

Reduction of lesion in injured rat spinal cord and partial functional recovery of motility after bone marrow derived mesenchymal stem cell transplantation

This study aimed to analyze the effect of rat bone marrow-mesenchymal stem cells (rBM-MSCs) delivery on lesion site after spinal cord injury, and to observe the functional recovery after transplantation. MSCs were isolated from rat femurs and tibias. The experimental rat population was divided into four groups: only laminectomy (1); laminectomy+trauma (2); laminectomy+trauma+PBS (3); laminectomy+trauma+MSCs (4). Their motility were scored regularly. After 4-weeks, rats were sacrificed, and their spinal cords were examined for GFP labeled rBM-MSCs by immunostainings. In the early posttraumatic period, the ultrastructures of spinal cord tissue were preserved in Group 4. The majority of cells forming the ependymal region around the central canal were found to be MSCs. The gray-and-white-matter around the ependymal region were composed of Nestin+/GFAP+ cells, with astrocytic-like appearance. The scores showed significant motor recovery in Group 4, especially in hind limb functions. However, no obvious change was observed in other groups. The increase Nestin+/GFAP+ cells in the gray-and-white-matter around the ependymal region could indicate the potential to self-renew and plasticity. Thus, transplantation of rBM-MSCs might be an effective strategy to improve functional recovery following spinal cord trauma. In conclusion, molecular factors in cell fate decisions could be manipulated to enhance reparative potential of cell-based therapy.

The Effects of Different Rehabilitation Strategies on the Functional Recovery of Spinal Cord Injured Rats

An experimental study. To investigate the effects of different rehabilitation strategies on functional recovery of partial spinal cord of injured rats. Activity-based rehabilitation is promising strategy for improving functional recovery following spinal cord injury (SCI). Twenty-four female Sprague-Dawley rats weighing 180 to 220 g were anesthetized with chloral hydrate (450 mg kg⁻¹) by intraperitoneal injection, and laminectomy was performed at T7-T8 level, leaving the dura intact. A compression plate (2.2 × 5.0 mm) loaded with weight of 35 g was placed on the exposed cord for 5 minutes to create partial SCI. Animals were divided into 3 groups of 8 rats each. Group 1 served as control (SCI + without treadmill and swimming training). Whereas rats in Groups 2 and 3 were subjected to SCI as mentioned previously and received swimming training 5 minutes for Group 2 and treadmill training 5 minutes for Group 3 each day, which occurred beginning 14 days postsurgery and continued for 14 days. The spontaneous coordinate activity (SCA), Basso, Beattie, and Bresnahan (BBB), and Tarlov locomotor scores were used to assess functional recovery of spinal cord injured rats. Day 1 (baseline, 14 days after the surgery), there was no significant difference among the means for SCA, BBB, and Tarlov scores of all groups. After day 1, Groups 1, 2, and 3 showed continuous improvement in their BBB, Tarlov, and SCA scores. This improvement was maintained throughout the duration of the study with different levels for each group. By the end of the study, trained Groups 2 and 3 showed statistically significant improvement in their SCA, BBB, and Tarlov scores compared with Group 1 (P < 0.05). These results suggest that 2 weeks of treadmill locomotor training and swimming training may have positive effects on functional recovery after partial SCI.

Sustained Expression of Vascular Endothelial Growth Factor and Angiopoietin-1 Improves Blood–Spinal Cord Barrier Integrity and Functional Recovery after Spinal Cord Injury

Spinal cord injury (SCI) results in immediate disruption of the spinal vascular network, triggering an ischemic environment and initiating secondary degeneration. Promoting angiogenesis and vascular stability through the induction of vascular endothelial growth factor (VEGF) and angiopoietin-1 (Ang-1), respectively, provides a possible therapeutic approach in treating SCI. We examined whether supplementing the injured environment with these two factors, which are significantly reduced following injury, has an effect on lesion size and functional outcome. Sustained delivery of both VEGF(165) and Ang-1 was realized using viral vectors based on the adeno-associated virus (AAV), which were injected directly into the lesion epicenter immediately after injury. Our results indicate that the combined treatment with VEGF and Ang-1 resulted in both reduced hyperintense lesion volume and vascular stabilization, as determined by magnetic resonance imaging (MRI). Western blot analysis indicated that the viral vector expression was maintained into the chronic phase of injury, and that the use of the AAV vectors did not exacerbate infiltration of microglia into the lesion epicenter. The combined treatment with AAV-VEGF and AAV-Ang-1 improved locomotor recovery in the chronic phase of injury. These results indicate that combining angiogenesis with vascular stabilization may have potential therapeutic applications following SCI.

Posttraumatic spinal cord tethering and syringomyelia: surgical treatment and long-term outcome

Permanent neurological loss after spinal cord injury (SCI) is a well-known phenomenon. There has also been a growing recognition and improved understanding of the pathophysiological mechanisms of late progressive neurological loss, which may occur after SCI as a result of posttraumatic spinal cord tethering (SCT), myelomalacia, and syringomyelia. A clinical study of 404 patients sustaining traumatic SCIs and undergoing surgery to arrest a progressive myelopathy caused by SCT, with or without progressive myelomalacia and cystic cavitation (syringomyelia) was undertaken. Both objective and subjective long-term outcomes were evaluated. To the authors' knowledge, this is the first series of this size correlating long-term patient perception of outcome with long-term objective outcome analyses. During the period from January 1993 to November 2003, 404 patients who had previously sustained traumatic SCIs underwent 468 surgeries for progressive myelopathies attributed to tethering of the spinal cord to the surrounding spinal canal, with or without myelomalacia and syrinx formation. Forty-two patients were excluded because of additional pathological entities that were known to contribute to a progressive myelopathy. All surgeries were performed by the same neurosurgeon at a single SCI treatment center and by using a consistent surgical technique of spinal cord detethering, expansion duraplasty, and when indicated, cyst shunting. Outcome data were collected up to 12 years postoperatively. Comparisons of pre- and postoperative American Spinal Injury Association sensory and motor index scores showed no significant change when only a single surgery was required (86% of patients). An outcome questionnaire and phone interview resulted in > 90% of patients self-assessing arrest of functional loss; > 50% of patients self-assessing improvement of function; 17 and 18% self-assessing improvement of motor and sensory functions to a point greater than that achieved at any time postinjury, respectively; 59% reporting improvement of spasticity; and 77% reporting improvement of hyperhidrosis. Surgery for spinal cord detethering, expansion duraplasty, and when indicated, cyst shunting, is a successful treatment strategy for arresting a progressive myelopathy related to posttraumatic SCT and syringomyelia. Results suggest that surgery leads to functional return in ~ 50% of patients, and that in some patients posttraumatic SCT limits maximal recovery of spinal cord function postinjury. A patient's perception of surgery's failure to arrest the progressive myelopathy corresponds closely with the need for repeat surgery because of retethering, cyst reexpansion, and pseudomeningocele formation.