Spine-Related Disability Following Combat Injury

Rivera, Jessica C.; Anderson, Edward G.; Jenné, Joel; Topp, Raymond

doi:10.3113/jsoa.2014.0136

Cited by 23 publications

(36 citation statements)

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“…Additionally, prospective longitudinal data are not currently available to determine if chronic VML-related functional deficits are static or are progressively improving or worsening after injury. A recent retrospective analysis of wounded service members evacuated from the battlefield indicated that disability following VML injury received a progressively worsening score as time after injury progressed [Rivera and Corona, 2016]. Relatedly, a prospective analysis of patients with limb-threatening trauma categorized as presenting soft tissue injury indicated a decline in already poor functional outcomes 2-7 years after injury MacKenzie et al, 2005].…”

Section: Synopsis Of Clinical Vml Case Reports and Studiesmentioning

confidence: 99%

Pathophysiology of Volumetric Muscle Loss Injury

Corona

Wenke

Ward

2016

Cells Tissues Organs

134

108

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Volumetric muscle loss (VML) injuries are prevalent in civilian and military trauma patients and are known to impart chronic functional deficits. The frank loss of muscle tissue that defines VML injuries is beyond the robust reparative and regenerative capacities of mammalian skeletal muscle. Given the nature of VML injuries, there is a clear need to develop therapies that promote de novo regeneration of skeletal muscle fibers, which can integrate with the remaining musculature and restore muscle strength. However, the pathophysiology of VML injuries is not completely defined, and, therefore, there may be other opportunities to improve functional outcomes other than de novo regeneration. Herein, clinical and preclinical studies of VML were reviewed to ascertain salient manifestations of VML injury that can impair limb function and muscle strength. The limited clinical data available highlighted proliferative fibrosis secondary to VML injury as a viable target to improve limb range of motion. Selected preclinical studies that used standardized neuromuscular functional assessments broadly identified that the muscle mass remaining after VML injury is performing suboptimally, and, therefore, percent VML strength deficits are significantly worse than can be explained by the initial frank loss of contractile machinery. Potential mechanisms of suboptimal strength of the remaining muscle mass suggested within the literature include intramuscular nerve damage, muscle architectural perturbations, and diminished transmission of force. Collectively, both clinical and preclinical data indicate a complex pathophysiology after VML that presents multiple therapeutic targets. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

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Section: Synopsis Of Clinical Vml Case Reports and Studiesmentioning

confidence: 99%

Pathophysiology of Volumetric Muscle Loss Injury

Corona

Wenke

Ward

2016

Cells Tissues Organs

134

108

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“…Orthopedic extremity trauma is a major problem in both military and civilian populations, resulting in long‐term functional disability and substantial medical cost . Volumetric muscle loss (VML) injury is the traumatic loss or surgical removal of skeletal muscle that is often accompanied by severe neuromusculoskeletal injuries.…”

mentioning

confidence: 99%

“…While skeletal damage will typically repair successfully, skeletal muscle strength deficits persist, ostensibly due to substantial, irrecoverable loss of contractile protein. These injuries result in chronic functional limitations that have been shown to further deteriorate over time . Currently, there is no regenerative standard of care for VML injuries, allowing the affected musculature to follow a path of continued degeneration, which is compounded by an apparent low efficacy of physical rehabilitation .…”

mentioning

confidence: 99%

Impact of volumetric muscle loss injury on persistent motoneuron axotomy

et al. 2018

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“…In support of this possibility, a prospective study of patients with severe limb extremity trauma demonstrated worsening SIP scores during the initial seven years post-injury [MacKenzie et al, 2005]. And, a retrospective study of physical assessment board evaluations of a cohort of wounded Servicemembers with type III open fracture found a progressive worsening of VML related disability ratings [Rivera and Corona, In Press 2016]. Furthermore, due to the nature of these injuries especially among the battlefield injured many VML injuries occur relatively early in adulthood, thus long-term degeneration of the muscle tissue may contribute to the development and/or acceleration of other co-morbidities (e.g., low back pain, osteoarthritis, metabolic syndrome, and cardiovascular disease).…”

Section: Clinical Perspective On Rehabilitation and Regeneration Follmentioning

confidence: 99%

Regenerative and Rehabilitative Medicine: A Necessary Synergy for Functional Recovery from Volumetric Muscle Loss Injury

Greising

Dearth

Corona

2016

Cells Tissues Organs

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Volumetric muscle loss (VML) is a complex and heterogeneous problem due to significant traumatic or surgical loss of skeletal muscle tissue. The consequences of VML are substantial functional deficits in joint range of motion and skeletal muscle strength, resulting in life-long dysfunction and disability. Traditional physical medicine and rehabilitation paradigms do not address the magnitude of force loss due to VML and related musculoskeletal comorbidities. Recent advancements in regenerative medicine have set forth encouraging and emerging therapeutic options for VML injuries. There is significant potential that combined rehabilitative and regenerative therapies can restore limb and muscle function following VML injury in a synergistic manner. This review presents the current state of the VML field, spanning clinical and preclinical literature, with particular focus on rehabilitation and regenerative medicine in addition to their synergy. Moving forward, multidisciplinary collaboration between clinical and research fields is encouraged in order to continue to improve the treatment of VML injuries and specifically address the encompassing physiology, pathology, and specific needs of this patient population. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

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Spine-Related Disability Following Combat Injury

Cited by 23 publications

References 0 publications

Pathophysiology of Volumetric Muscle Loss Injury

Pathophysiology of Volumetric Muscle Loss Injury

Impact of volumetric muscle loss injury on persistent motoneuron axotomy

Regenerative and Rehabilitative Medicine: A Necessary Synergy for Functional Recovery from Volumetric Muscle Loss Injury

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