Cervical traumatic spinal cord injury (SCI) is a devastating condition that can result in tetraplegia. Early surgical decompression and rehabilitative efforts in cervical SCI patients has been shown to improve neurological outcomes. In this study, we sought to evaluate the impact of various factors at the time of injury and throughout the rehabilitative period on motor functional independence after 1 and 5 years after injury in patients undergoing cervical spinal cord decompression. A longitudinal, retrospective cohort study from the multicenter spinal cord injury Model Systems (SCIMS) database was conducted on patients who presented between 1998 and 2011 with motor Functional Independence Measure (mFIM) scores at rehabilitation admission (RA) and discharge (DC) from inpatient rehabilitation (IPR), year 1, and year 5. Patients who had undergone surgical decompression with neurological levels of injury limited to the cervical region and those with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A and B were included. The mFIM score was utilized to calculate changes in mFIM (ΔmFIM) scores over each respective time period. Multivariable logistical regression was performed to identify longitudinal predictors associated with functional independence controlling for demographics, SCI etiology and level, vertebral bony fracture/dislocation, associated injuries, AIS grade, and discharge disposition. A total of 351 patients were included. A majority were 15-29 years old (53.6%) and 80.1% male. Vehicular-related etiologies (49.9%) were most commonly implicated as the mechanism of cervical SCI. Most patients were AIS grade A at the time of RA (66.4%), with an average time from injury to RA of 19 days (IQR 11-32) for all patients. A total of 131 patients required ventilatory support at the time of RA, and of those, only 12 eventually became FI by year 5. Although the number of patients requiring ventilatory support decreased from 131 to 20 by year 5, no additional patients became FI if they required support at the time of DC or year 1. By 1 year, 43 (12.3%) patients achieved functional independence, and an additional 12 (3.42%) achieved functional independence by year 5. Although those with AIS B injuries (aOR = 5.23, P = 0.0014) and AIS improvement (aOR = 5.14, P = 0.0004) had a greater likelihood of FI by year 1, year 1 FI was more strongly predicted by greater ΔmFIM score during a shorter IPR time period (ΔmFIM score during IPR, aOR = 14.2, P < 0.0001). While AIS grade and AIS improvement were no longer predictive of year 5 FI (P > 0.09 for both), the ΔmFIM score during IPR remained as the strongest predictor towards achieving FI by year 5 (aOR = 23.1, P < 0.0001). Furthermore, a stratified analysis of those patients who did not achieve FI at year 1 revealed that the ΔmFIM score during IPR was an even greater predictor of FI at year 5 (aOR = 53.0, P < 0.0001). A similar relationship was observed where stratification of patients by AIS grade showed that AIS A injuries demonstrated a higher likelihood of 5-year FI due to ΔmFIM score during IPR (aOR = 51.3, P = 0.0002 vs. AIS B: aOR = 42.2, P = 0.0009). Similarly, stratification by need for ventilatory support at RA revealed those who did require ventilatory assistance at RA also had a higher likelihood of 5-year FI due to ΔmFIM score during IPR (aOR = 171, P = 0.035). In patients who suffered an AIS A/B cervical SCI, IPR contributed to achieving functional independence in up to 5 years after the inciting injury. By year 1, 12.3% of patients achieved functional independence, and from years 1 to 5, an additional 3.42% of patients achieved functional independence. Although AIS B patients and patients with AIS improvement had improved outcomes at year 1, only the ΔmFIM score during IPR predicted eventual FI status by year 5. Due to the increased likelihood attaining functional independence at year 5 in AIS A SCI, carries emphasized importance for patients who do not attain functional independence by year 1. Our study highlights the crucial role of early and aggressive rehabilitation following surgical intervention toward ultimate functional independence in traumatic cervical SCI patients enduring complete loss of motor function.
spinal cord injury (SCI) is a debilitating condition that can lead to severe motor deficits. This study aimed to evaluate the therapeutic effects of hederagenin, a Chinese herbal medicinal ingredient, on motor recovery and the inflammatory response in rat models of SCI. We used the Allen weight-drop technique to create a Sprague-Dawley rat model of spinal cord injury. We then administered hederagenin (10 mg/kg) via intraperitoneal injection for 28 consecutive days. Third-class first-class hospital. The Basso-Beattie-Bresnahan (BBB) scores were evaluated. Histological analyses were performed via hematoxylin and eosin staining. The levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) in SCI rat spinal cord tissues were evaluated by immumohistochemical staining. Microglial activation markers (Iba-1) and M2 phenotypic markers (CD206) were assessed by Immunofluorescence staining. PPAR-γ in rats were assessed by western blotting (WB). The Basso-Beattie-Bresnahan (BBB) scoring system assessed locomotor function, and revealed significant improvements in BBB score in hederagenin-treated rats starting from the fifth day post-surgery. We also found elevated levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) in the spinal cord tissues of SCI rats, which significantly decreased after hederagenin Treatment. We also analyzed Microglial activation markers were analyzed, including Iba-1. Our results showed increased expression of CD206 in response to hederagenin, indicating that it promotes M2 polarization and reduces microglial activation. Additionally, hederagenin increased the expression of peroxisome proliferator-activated receptor-γ (PPAR-γ) in rats with SCI. However, the PPAR-γ inhibitor GW966 reversed the above roles of hederagenin. Our results indicate that hederagenin not only aids in the recovery of motor function in SCI rats but also diminishes inflammation while fostering neuroprotection via the modulation of microglial activity. This effect may be linked to the activation of the PPAR-γ signaling pathway. These results provide compelling evidence for the potential of hederagenin as a therapeutic agent for SCI and warrant further investigation into its clinical applications in neuroregeneration and inflammation modulation.
Providing accurate walking prognosis following spinal cord injury (SCI) is challenging. Assessment of SCI lesion characteristics, captured on T2-weighted MRI, may improve return-to-walking prediction. One characteristic, the midsagittal tissue bridge (MSTB), has shown promising association with a return of sensorimotor function. The purpose of this study was to determine the association between the presence or absence of early-assessed MSTBs and walking ability 1-year post-SCI. Inpatient Rehabilitation Facility. This retrospective cohort study examined the imaging and walking outcome data of 264 individuals with traumatic SCI. Contingency tables were built to analyze the odds of a return to walking based on the presence or absence of a MSTB. For the entire sample, the odds of walking with present versus absent MSTBs was 8.5 (95%CI: 4.2, 16.8, P < .0001). Similar results were found when isolating only individuals with American Spinal Injury Association Impairment Scale (AIS) B and C injuries. For this AIS B/C subgroup, the odds of walking with present versus absent MSTBs was 4.96 (95%CI: 1.08, 22.89, P < .0401). This study found a strong association between the presence or absence of early-assessed MSTBs and walking ability 1-year post-SCI for individuals throughout the SCI severity spectrum. These findings suggest the potential importance of having MRI evidence of this spared neural tissue to increase the likelihood of walking recovery. The assessment of MSTBs presence/absence in the subacute phase of injury may assist clinicians in developing plans of care appropriately balanced between walking recovery strategies and maximizing independence with alternate modes of locomotion.
To develop the clinical prediction rule (CPR) of upper urinary tract deterioration (UUTD) outcome at three years, which is the average diagnostic timepoint, in patients with traumatic spinal cord injury (TSCI). Retrospective cohort study. Department of Rehabilitation Medicine, Maharaj Nakorn Chiang Mai Hospital. TSCI patients with onset of injury in January 2008December 2020. After screening the medical records of 714 TSCI patients, clinical and urodynamic parameter data from 176 patients, collected at 3-18 months after SCI, were retrospectively analyzed. CPR was developed to predict UUTD at three years after SCI by conducting logistic regression analysis. The performance of the model was evaluated in terms of both discrimination and calibration using the AuROC and calibration plot, respectively. The incidence of UUTD was 18.8% (33/176) with a mean duration of 3.72 years after the onset of injury. The developed CPR consists of three predictive factors: completeness of SCI (American Spinal Injury Association - ASIA Impairment Scale [AIS] C), presence of detrusor overactivity, and the occurrence of autonomic dysreflexia during a urodynamic study, to predict UUTD at three years after SCI. The developed CPR had acceptable discriminative (AuROC = 0.711 [95%CI:0.603-0.819]) and calibrating performance (nearly approximate observed and predicted risk graphs and Brier Score = 0.1245). Our developed CPR for prognosing UUTD at three years after TSCI was established and demonstrated acceptable performance in both discrimination and calibration. However, a further external validation study is needed before applying this CPR in other clinical contexts.
This study aims to evaluate the effectiveness of aerobic exercise training on neuropathic pain and quality of life (QoL) in individuals with spinal cord injury (SCI). Single-blinded, two-group, randomized controlled trial. 28 individuals with SCI with neurological level of injury from T2 to L2. Using a 1:1 allocation ratio, the participants were randomly assigned to one of the two groups. The intervention group performed high-intensity interval training (HIIT) using an arm ergometer based on the peak heart rate achieved during a 6-minute push test. The control group performed metronome-guided free-hand arm aerobic exercise. In both groups, the intervention was delivered as 30-minute sessions, four times a week for 6 weeks. Using the Friedman test, the comparison of pain intensity, scores of pain interference items, and QoL showed statistically significant improvement (P < 0.05) in both groups at different time frames. In both groups, the median rating of pain intensity scores changed from 7 at baseline to 4 at mid-intervention and to 3 at post-intervention. The comparison between both groups showed no statistically significant difference in any of the outcome measures. This study concludes that irrespective of the intensity, 3 and 6 weeks of aerobic exercise training performed for 30 min a day, 4 times per week, along with conventional physiotherapy, is effective for improving neuropathic pain and QoL of individuals with SCI. Clinical Trials Registry India identifier: CTRI/2023/08/056257. Key pointsThis study demonstrates the effectiveness of a non-pharmacological, feasible, and clinically applicable aerobic exercise intervention in reducing neuropathic pain and improving QoL in individuals with SCI.A reliable and replicable methodology was employed using accessible tools, such as a smartwatch and metronome, to achieve the target heart rate and exercise intensity.The findings support the integration of structured aerobic exercise into conventional SCI rehabilitation programs for its potential therapeutic benefits.This research contributes to the growing body of evidence supporting exercise-based interventions as a safe and practical adjunct to standard neuropathic pain management in SCI.
A systematic approach to undertaking spinal cord injury (SCI) related research will maximize the use of limited research funds and ensure that all stakeholders collaborate to address barriers to producing relevant, impactful research. To examine the breadth and scope of Australian SCI research published between January 2018 and September 2025. A systematic search of five relevant databases for Australian spinal cord injury research published from January 2018 to September 2025 was completed. A total of 271 eligible studies were included. Most publications reported clinical research (n = 233; 86%), with rehabilitation being the largest clinical research category (n = 76; 32.5%). The majority (n = 163; 70%) reported either cross-sectional, qualitative or retrospective designs, and more than half of all clinical studies were conducted at a single site only (n = 136; 58.4%). Most preclinical publications (n = 38; 14%) focused on discovery science and secondary conditions, with research into neuroprotection and regeneration representing the next largest category. Sixteen publications, all clinical, engaged people with lived experience in the research process. This review identified several issues that impact the efficiency and impact of SCI research in Australia, many of which are relevant to other jurisdictions. Issues include limited multi-center collaborations in both clinical and preclinical research, low engagement of people with lived experience in the research process, and a dearth of research from primary care. To maximize the use of finite research funds, all stakeholders with an interest in SCI outcomes should work together to define research priorities and strategically address barriers to producing relevant, impactful research.
Infiltrations of the spine can be used to treat nociceptive or neuropathic pain. There is little data in the literature on the use of spinal injections in patients with paraplegia. The aim of this study is to determine whether patients with spinal cord injury experienced improvement in pain and spasticity following spinal injection. 19 (9 female, 10 male) patients (5 patients AIS A, 5 patients AIS C, 9 patients AIS D), including 9 tetraplegic and 10 paraplegic patients, with 22 injection techniques and a follow-up of 4.2 months (1-12 months) were retrospectively examined in our spinal cord injury Center in 2022 and 2023. The pain intensity on the NRS (Numerical Rating Scale), the MAS (Modified Ashworth Scale) for the graduation of muscle tone and the Spinal Cord Independence Measurement (SCIM) were assessed before infiltration and as part of the follow-up examination. Image intensifier-assisted facet and sacroiliac joint infiltrations were performed in 12 patients, CT-guided nerve root infiltrations and epidural injections in 10 patients with corresponding symptoms and image morphological correlate without complications. In all patients, a statistically significant reduction in pain on the NRS could be achieved (4.05 ± 1.84; p < 0.0001). A trend towards improvement was documented in the analysis of the MAS (0.14 ± 0.35; p = 0.08), whereas a significant improvement was statistically detected in the analysis of the SCIM (-15.59 ± 18.23; p = 0.0006). Our study represents the first retrospective exploratory analysis (phase I-style feasibility study) after spinal injection in patients with spinal cord injury. The primary results in terms of pain intensity, muscle tone and independence are promising and, in our view, represent a further therapeutic approach in addition to pharmacological and non-pharmacological therapy options. However, further investigations are necessary for this.
Spinal cord injury is a complex and long-term condition that profoundly affects individuals across physical, emotional, social, and economic domains. This study aimed to explore the multidimensional structure of health-related quality of life (HRQoL) in individuals with spinal cord injury (SCI), incorporating patients' perspectives and extending the scope to include economic benefits and disease-related barriers. Using a grounded theory approach, we conducted semi-structured in-depth interviews with 32 adult patients receiving care at a public physiotherapy hospital to gain insights into their lived experiences. In some interviews, family members were present and provided contextual or supportive input when patients had physical or communication limitations. Data were analyzed inductively using the constant comparative. We developed a comprehensive conceptual model of extended HRQoL in SCI. The model comprises seven main dimensions, fifteen sub-dimensions, and thirty-two interrelated concepts. The economic burden of the disease emerged as the core category influencing all other dimensions. The identified extended HRQoL dimensions included physical/medical health, functional health, emotional health, social health, economic benefits, and disease-related barriers. In this study, extended HRQoL refers to a holistic framework that integrates traditional health domains with economic support mechanisms and structural barriers that affect daily life and access to care. This framework provides a nuanced understanding of the diverse factors influencing HRQoL in SCI populations and underscores the importance of integrating psychosocial, environmental, and economic domains into rehabilitation strategies.
The objective was to evaluate mobility outcomes in individuals with exclusively motor-complete spinal cord injuries. This systematic review included single-arm studies identified through searches in MEDLINE, Cochrane Library, and Embase databases, focusing on motor-complete spinal cord injuries and various types of exoskeletons. This review adopted a single-arm synthesis approach to provide descriptive estimates of performance during device-assisted walking, rather than comparative effectiveness. Performance parameters such as speed, time, distance, and the SCIM III (Spinal Cord Independence Measure) obtained during device use were evaluated. Studies with any follow-up duration were included, and a total of 10 studies met the eligibility criteria. The search covered studies published approximately between November 2012 and May 2024. Data were synthesized using a random-effects model to generate descriptive estimates. In the analysis of data from 130 participants, performance-based outcomes during device-assisted ambulation were reported. The pooled mean distance in the 6-minute walk test (6MWT) was 74.41 meters (95% CI [42.57-106.25]; I² = 98%). The pooled mean time to complete the 10-meter walk test (10MWT) was 100.02 s (95% CI [27.11-172.94]; I² = 96%), with a corresponding pooled mean gait speed of 0.18 m/s (95% CI [0.11-0.26]; I² = 98%). The pooled mean SCIM III score obtained in the study context was 57.79 (95% CI [50.08-65.50]; I² = 86%). This meta-analysis provides descriptive estimates of walking performance during robotic exoskeleton - assisted walking in adults with motor-complete spinal cord injuries. Given the single-arm design and high heterogeneity, results should be interpreted as descriptive estimates of device-assisted capacity rather than causal functional improvement. Controlled longitudinal studies are needed to assess clinical relevance beyond assisted use.
Bone loss following spinal cord injury (SCI) leads to an increased risk of fragility fractures, especially at the knee and hip. While research to date has primarily focused on mitigating bone loss in the acute phase, our recent publication demonstrated an improvement in bone mineral and strength at the lumbar spine and hip, but not the knee, in women with chronic SCI and osteoporosis after 12 months of romosozumab therapy. This paper presents 12 months of follow-up treatment with oral alendronate, which aimed to determine whether prior gains could be maintained with transition of therapy in the same sample. Ten study participants completed the alendronate treatment. Dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) scans were taken at the end of the treatment year to quantify changes to bone mineral density (BMD) and CT-based finite element (FE) estimations of fracture strength. Second year results were compared to the first year of romosozumab treatment data using non-parametric analyses. No significant changes between the month-12 and month-24 visits were observed for BMD at the lumbar spine (P = .432) or total hip (P = .432). Correspondingly, no significant change in FE-derived strength at the proximal femur (P = .695) was observed. There were no appreciable changes in BMD or bone strength at the knee following the alendronate intervention. Overall, one year of treatment with monthly romosozumab followed by one year of treatment with weekly alendronate, significantly increased and maintained bone mineral at the hip, but not the knee, in women with chronic SCI and secondary osteoporosis.
Bowel dysfunction is a common and distressing consequence of spinal cord injury (SCI), with profound effects on physical, psychological, and social well-being. Despite its high prevalence, there is limited consolidated evidence regarding patients' lived experiences, which are essential for improving care. To synthesize qualitative research findings on the experiences of individuals with SCI regarding bowel management. A qualitative meta-synthesis was conducted following PRISMA guidelines. Systematic searches were performed in Google Scholar, MEDLINE, CINAHL, PubMed, Web of Science, and Springer Nature Journals between June 3 and June 28, 2024. Studies were appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Data were analyzed through Sandelowski and Barroso's two-stage meta-synthesis method. The review was prospectively registered in PROSPERO (CRD420250578291). Twelve qualitative studies involving 210 participants from seven countries were included. Three overarching themes emerged: (1) Challenges in bowel management, encompassing physical complications, emotional burden, and social restrictions; (2) Perceived shortcomings and expectations, reflecting inadequate professional support and a strong desire for independence; and (3) Managing the difficult process, highlighting self-care adjustments, social support, and consideration of invasive interventions such as colostomy. Bowel management is a central yet challenging aspect of life for individuals with SCI, affecting all domains of quality of life. Findings underscore the need for patient-centered strategies, enhanced professional education, and early discussion of all management options to improve care outcomes.
spinal cord injury (SCI) is a pathological condition in which the structure and function of the spinal cord are damaged due to trauma or disease. Patients with SCI often suffer from neuropathic pain. Virtual reality (VR) is a promising intervention for pain management. However, the effect of VR in managing neuropathic pain in patients with SCI remains unclear. The purpose of this study was to evaluate the effect of VR on neuropathic pain in patients with SCI. This study adhered to PRISMA guidelines and was registered on PROSPERO. PubMed, Embase and Web of Science databases were searched for studies involving VR, pain, and anxiety in patients with SCI published up to February 2025. We assessed the risk of bias using the Cochrane ROB tool and the ROBINS-I tool. A meta-analysis of the included data was conducted using RevMan 5.4 software. A total of seven studies were included, including four pre-post studies and three RCTs. Overall, VR intervention significantly reduced neuropathic pain in SCI patients (MD = -2.26, 95% CI: -2.89 to -1.63, P < 0.001). VR was more effective than non-VR conditions (SMD = -0.99, 95% CI [-1.51, -0.48]). VR demonstrated efficacy in relieving neuropathic pain among SCI patients. Furthermore, VR provided superior pain relief compared to non-VR conditions. However, additional high-quality research is warranted to explore further the comparative effectiveness of VR interventions relative to other treatments and to identify the optimal intervention parameters and protocols.
Retrospective data analysis. To investigate the diagnostic approach and therapeutic management of urethra-cutaneous fistulas (UCF) in people with spinal cord injury/disorder (SCI/D). Specialized tertiary German center for spinal cord injury. We retrospectively evaluated the data of SCI/D patients with UCF who were admitted for inpatient treatment from November 1st 2001 to August 31st 2025. A descriptive statistical analysis of the data was performed. Seventeen study participants were included; all were male with complete SCI/D according to AIS type A, with a median age at diagnosis of UCF of 61.0 years (IQR 52.0-67.0). Two people with spina bifida were included, while all others had traumatic SCI. The median latency period between the onset of SCI/D and the occurrence of UCF was 31.0 years (IQR 25.0-42.0). For bladder voiding, 11 study participants performed catheter-free reflex voiding using a urinary sheath (condom catheter), and 6 study participants performed intermittent self-catheterization (ISC). For the treatment of UCF, all patients underwent urinary diversion, 13 of them with suprapubic catheterisation. Eight patients were treated conservatively following catheter urinary diversion, while a total of 9 patients underwent surgery for UCF; 3 of them including cystectomy. Only three patients underwent urethral reconstruction, and an intact urethra allowing resumption of ISC could be achieved in 2 patients. The management of UCF in people with SCI/D remains a major challenge. Based on our experience, we present a management algorithm that should be evaluated in a larger, preferably multicenter study.
The Falls-Efficacy Scale-International (FES-I) was developed to assess concern for falling in older adults. This measure has since been used with people with motor incomplete spinal cord injuries (iSCI) in research and clinical practice, but the psychometric properties have not yet been determined in this population. The objectives of this research study were to determine (1) the test-retest reliability of the FES-I in people with chronic iSCI, and (2) the validity (i.e. convergent and known-groups) of the FES-I in people with chronic and subacute iSCI. Secondary data from three studies were used; two studies included participants with chronic iSCI (n = 20; n = 25), and one study included participants with subacute iSCI (n = 40). Data from one study that included participants with chronic iSCI were used to determine the test-retest reliability of the measure. Data from all studies were used to determine the convergent validity of FES-I scores with the Activities-specific Balance Confidence (ABC) Scale and known-group validity for both chronic and subacute populations. FES-I scores were found to be reliable in people with chronic iSCI (ICC = 0.91) and showed moderately strong correlations with ABC scale scores in both chronic (r = -0.71, P < 0.001) and subacute (r = -0.88, P < 0.001) participants. Known-group validity was only found for FES-I scores and people with a self-reported fear of falling in the subacute population. The FES-I is a reliable and valid measure for use in iSCI research and clinical practice; further research is needed to determine predictive and descriptive validity.
Glial fibrillary acidic protein antibody-associated astrocytopathy (GFAP-A) is an autoimmune central nervous system inflammatory disorder diagnosed via cerebrospinal fluid (CSF) glial fibrillary acidic protein-immunoglobulin G detection. Clinically, it typically presents with meningoencephalitis or myelitis, accompanied by periventricular perivascular enhancement on brain magnetic resonance imaging (MRI) (findings that guide most routine diagnoses). Yet isolated spinal cord abnormalities (with negative brain MRI) in GFAP-A remain rarely reported, especially when occurring in patients with comorbidities like diabetes mellitus and active infection; these overlapping conditions often mask GFAP-A's typical features, consequently increasing the risk of clinical misdiagnosis. By reporting this atypical case, the study aims to supplement the existing imaging spectrum of GFAP-A and provide practical diagnostic references for complex clinical scenarios where underlying diseases obscure classic GFAP-A manifestations. It further carries significance in emphasizing the critical role of CSF GFAP-immunoglobulin G detection: this biomarker enables accurate identification of such atypical cases, directly addressing the misdiagnosis risk highlighted earlier. A 47-year-old Chinese male patient with a 13-year history of type 2 diabetes mellitus was admitted to the hospital due to fever and headache. Initially, the patient was diagnosed with upper respiratory tract infection based on positive Mycoplasma pneumoniae and parainfluenza virus antibodies; however, his symptoms persisted and worsened after treatment with moxifloxacin combined with oseltamivir. Emergency CSF examination showed increased pressure, elevated protein level, and monocytosis. Subsequent examination results revealed positive glial fibrillary acidic protein antibodies in the CSF; combined with lumbar MRI showing linear enhancement on the surface of the cauda equina nerves (and negative brain MRI findings), the patient was diagnosed with GFAP-A. The patient received anti-infection treatment, intracranial pressure reduction, and blood glucose control. After receiving the treatment, the patient's symptoms improved and he was discharged. At the 2-month follow-up after discharge, the patient still had postural tremor in both upper limbs, but no pathological reflexes were elicited. This case confirms that GFAP-A can be detected with positive spinal cord MRI findings alone, while negative brain MRI findings. Its key clinical significance lies in emphasizing the diagnostic value of CSF glial fibrillary acidic protein antibody detection for atypical cases, providing a new reference for the imaging spectrum of GFAP-A.
Posttraumatic syringomyelia (PTS) is a rare complication arising from spinal cord injury (SCI), characterized by the emergence of a cavity filled with fluid within the spinal cord parenchyma. The management of PTS remains a subject of debate. This study aimed to examine initial symptoms, surgical treatments, and surgical outcomes of PTS.Study Design/Setting: Systematic review. Keywords were chosen according to MeSH and Emtree terms in the Medline and Embase databases, respectively, and systematically searched in the Medline and Embase databases until March 2023. Mechanism of injury, level of injury, past treatment history, procedure, surgical complications, follow-up time, sensory, motor, pain and other assessments before and after surgery as well as the overall outcome of the surgery were extracted. We stratified the findings into three sections: (a) findings from provided summary statistics in longitudinal and before-after studies, (b) findings from studies that provided detailed characteristics of patients, and (c) findings from case reports. After evaluation of 3232 unique records, 68 articles were included in this systematic review. Data of 1175 patients were included from 37 longitudinal and before-after studies and 31 case-reports. The level of injury is predominantly thoracolumbar, and cyst sizes are generally larger than 1 centimeter. Our study found that surgical treatment of PTS leads to an overall improvement in signs and symptoms (range: 58.02-93.5%) particularly in sensory symptoms (range: 24.77-44.1%), motor function (range: 41.83-54.35%), pain (range: 54.2-56.31%) and spasticity symptoms (up to 54.4%) in the patients. These results, retrieved from before-after and longitudinal studies, were also confirmed by case-reports. Surgical interventions, ranging from cyst removal to shunting procedures, showed overall effectiveness, with the majority of patients experiencing improved neurological symptoms, particularly in pain, motor weakness, and spasticity.
Traumatic spinal cord injury (TSCI) without concurrent vertebral fracture is a phenomenon often described in pediatrics. There is limited evidence regarding factors that predispose adults to this rarer injury. To determine different factors that increase the odds of TSCI without vertebral fracture. Retrospective case-control study. Participating sites of the Spinal Cord Injury Model Systems (SCIMS) database. Patients aged 18 or older presenting at a registered SCIMS center following TSCI between 2006 and 2021. None. Logistic regression identified variables associated with TSCI without vertebral fracture (OR > 1). This study included 2,524 patients, of whom 501 did not suffer a vertebral fracture. Patients with incomplete SCI at cervical levels and those of more advanced age were less likely to have a concurrent vertebral fracture. Penetrating injury (OR = 4.13 [95% CI: 2.72, 6.28], P < 0.0001) and medical/surgical complications (OR = 50.30 [95% CI: 27.80, 95.90], P < 0.0001) dramatically increased the odds of suffering SCI without vertebral fracture compared to non-penetrating injuries. Overall results were similar when only blunt injuries were analyzed, except that complete injuries at T1-S5 (OR = 0.41 [95% CI: 0.17, 0.96], P = 0.044) were associated with vertebral fracture. Adults may experience biomechanical stresses similar to those proposed in pediatric populations. The findings of this study can be used to screen patients with suspected spinal cord injury without obvious signs of spinal trauma.
Spinal cord injury (SCI) disrupts gut microbiota composition, resulting in dysbiosis that can worsen neuroinflammation and impede post-injury recovery. Short-chain fatty acids (SCFA), metabolites produced by the gut microbiome with anti-inflammatory properties, offer a promising avenue for improving recovery and rehabilitation outcomes. We aimed to compile a summary of the human and animal evidence on the potential benefits of SCFA or SCFA  - producing bacteria in individuals with SCI. Three databases (EMBASE, Medline (Ovid) and Web of Science) were searched from inception until 19 October 2023. No language restrictions were applied. Title and abstract screening, data extraction and risk of bias assessments were done independently by two reviewers. A total of 2492 studies were retrieved, 69 full-text studies were reviewed, and 13 studies were included (11 animal and 2 human). Human studies, which involved participants with chronic SCI, linked gut dysbiosis (a proxy for low SCFA production) and human metabolic profiles, suggesting a potential role for microbiome-targeted interventions even in later stages of injury. Evidence from animal studies, predominantly in acute and sub-acute models of SCI, consistently associated SCFA interventions with improved motor function, reduced tissue damage and favorable changes in inflammatory and oxidative stress markers. Fecal microbiota transplantation and probiotics improved motor function and reduced lesion size in animal models. Gut microbiome modulations through treatments such as melatonin, moxibustion, and intermittent fasting was correlated with improved motor outcomes and increased abundance of SCFA-producing bacteria. This review highlights the potential of targeting the gut microbiota and SCFAs as therapeutic strategies for SCI recovery. However, despite promising results in animal models, human evidence remains limited.
Individuals with incomplete spinal cord injury (iSCI) often have reduced gait capacity. Passive assistive devices can provide support, but they are usually suboptimal in terms of gait efficiency and speed. Exosuits, soft actively powered devices, provide additional torques around the leg joints that may improve gait capacity. The aim of this study was to investigate the effect of a bilaterally configured exosuit providing hip and knee extension support on gait capacity in individuals with iSCI. Thirty-one participants with iSCI received a five-session training program to adapt to the exosuit (MyoSuit). They subsequently performed the 10-Meter Walk Test at preferred and maximum walking speed and the 6-Minute Walk Test (6MWT), under two conditions: walking with the exosuit and walking without it. Preferred walking speed was significantly lower with the exosuit compared to walking without (median difference: -0.03 m/s, p = 0.002, r=-0.6). No significant differences were found for maximum walking speed (median difference: -0.04 m/s, p = 0.08), walking distance during the 6MWT (median difference: -11 m, p = 0.11), or perceived exertion during the 6MWT (median difference: 0, p = 0.41). A significantly lower preferred walking speed when walking with the bilaterally configured exosuit was found, although the median difference remained well below the minimal clinically important difference of 0.15 m/s. We conclude that a bilaterally configured exosuit providing hip and knee extension support (MyoSuit) does not improve gait capacity in individuals with iSCI, which implies that limited effects on ambulation in the home and community settings must be expected as well.Trial registration: Clinicaltrials.gov NCT05605912. Registered on October 19, 2022.
Spinal cord injury (SCI) community-based organizations (CBOs) have the potential to inform research so that findings are more relevant and applicable. To support SCI CBOs to meaningfully engage in research partnerships, an understanding of their context is needed. Identify and describe the context of Canadian and American SCI CBOs that offer programs and services to people with SCI. An environmental scan was conducted using an integrated knowledge translation approach. A list of Canadian and American SCI CBOs was created using community partners' networks and national-level nonprofit organization search engines. Data from CBOs' websites on programs and services, mission/vision statements, commitments to inclusion, diversity, equity, accessibility, and social justice (IDEAS), financial information, and research/research partnership activities were extracted and analyzed abductively. Two hundred two SCI CBOs were identified. CBOs were described using 34 co-developed categories: organizational statements (n = 8), IDEAS commitments (n = 10), and programs/services offered (n = 16). Revenue and expenses varied greatly across SCI CBOs. Study recruitment advertisements, knowledge translation tools, and research-informed articles were how websites discussed research. Descriptions of engagement in research partnerships varied. This environmental scan was used to identify, collate, and describe contextual factors of SCI CBOs from non-peer-reviewed sources, representing an initial characterization of SCI CBO context, grounded in SCI CBO representatives' perspectives. This initial characterization can support researchers, research users, and funders to build capacity for the meaningful engagement of SCI CBOs in research partnerships, such as informing the design of research projects and grants that align with organizational values and account for financial constraints.