Spinal cord imaging markers and recovery of standing with epidural stimulation in individuals with clinically motor complete spinal cord injury

Abstract

Spinal cord epidural stimulation (scES) is an intervention to restore motor function in those with severe spinal cord injury (SCI). Spinal cord lesion characteristics assessed via magnetic resonance imaging (MRI) may contribute to understand motor recovery. This study assessed relationships between standing ability with scES and spared spinal cord tissue characteristics at the lesion site. We hypothesized that the amount of lateral spared cord tissue would be related to independent extension in the ipsilateral lower limb. Eleven individuals with chronic, clinically motor complete SCI underwent spinal cord MRI, and were subsequently implanted with scES. Standing ability and lower limb activation patterns were assessed during an overground standing experiment with scES. This assessment occurred prior to any activity-based intervention with scES. Lesion hyperintensity was segmented from T2 axial images, and template-based analysis was used to estimate spared tissue in anterior, posterior, right, and left spinal cord regions. Regression analysis was used to assess relationships between imaging and standing outcomes. Total volume of spared tissue was related to left (p = 0.007), right (p = 0.005), and bilateral (p = 0.011) lower limb extension. Spared tissue in the left cord region was related to left lower limb extension (p = 0.019). A positive trend (p = 0.138) was also observed between right spared cord tissue and right lower limb extension. In this study, MRI measures of spared spinal cord tissue were significantly related to standing outcomes with scES. These preliminary results warrant future investigation of roles of supraspinal input and MRI-detected spared spinal cord tissue on lower limb motor responsiveness to scES.

Predicting Outdoor Walking 1 Year After Spinal Cord Injury: A Retrospective, Multisite External Validation Study

“…A patient who falls on the less-favorable end of the CPR will likely not return to outdoor walking, thus a rehabilitation program focusing on compensatory strategies such as wheelchair skills and other nongait interventions might be implemented 23,24. In time, neuromodulatory interventions such as noninvasive spinal cord stimulation or surgically implanted spinal cord stimulation may be more widely available for this latter group 25–27. Furthermore, the outdoor walking CPR could help with anticipating equipment and caregiver needs at time of discharge from rehabilitation.…”

Stimulation of the cuneiform nucleus enables training and boosts recovery after spinal cord injury

“…These patients can be identified and stratified by conventional MRI together with electrophysiological measurements and clinical assessments. Epidural spinal cord stimulation has yielded promising results in studies on motor complete spinal cord-injured patients, 21 , 30 , 81 yet a relevant proportion of motor complete patients responding to epidural stimulation has been suggested to be anatomically incomplete, 78 , 80 and thus the contribution of supraspinal inputs transmitted via spared, dormant fibres at the lesion site to observed volitional motor output with epidural stimulation cannot be excluded.…”

Effect of Epidural Pulsed Radiofrequency with Neuro-Stimulation in Management of Thoracic Spinal Cord Injury

“…Concerning walking all the 37 patient was unable to walk before stimulation but after one year many patients start assisted walking using the walkers, crutches, or long lower limb brace, depend on Functional Ambulation Category scoring and score interpretation (23), results were good as 6 patients remain un walkers score 0, 1 score 1, 12 score 2, 13 score 3, 5 score 4, and no patient reach to totally normal score 5, compare to studies used implanted spinal cord injury like Smith, Andrew C et al in a study on 11 patients diagnosed as complete spinal injury reached to similar results (34). The improvement of trunk stability and assisted walking lead to increase in dependence performance in activity of daily livings, we used Barthel index score to compare the functional outcome before and after stimulation the mean score was 16.76±2.93 and became 65.21±10.56 after one year this transfer the 37 patients from total dependency to 19 patients of severe dependency and 18 patients moderate dependency which is better compare Gupta, A et al, Who follow the functional outcome of such patients after 2 years of rehabilitation only (35).…”