Traumatic and nontraumatic spinal cord injury: pathological insights from neuroimaging

Abstract

Pathophysiological changes in the white and gray matter resulting from spinal cord injury can be revealed by magnetic resonance imaging (MRI) techniques that provides sensitive markers of macro-and microstructural integrity with important histological correlates. This review highlights spinal cord pathology in traumatic spinal cord injury (tSCI) and in non-traumatic spinal cord injury (i.e. degenerative cervical myelopathy (DCM)), detected by means of cross-sectional area measurements and spinal cord diffusion tensor imaging (DTI), and outlines the current trends and future directions.Cord MRI findings in these pathologies have provided important insights into the pathophysiological processes not just at the focal injury site, but also rostral and caudal to the spinal injury. Interestingly, although tSCI and DCM have different etiologies, they show similar magnitudes of remote tissue specific cord pathology, which suggests similar secondary degenerative mechanisms in tSCI and DCM.Advanced quantitative MRI protocols sensitive to tissue specific cord pathology have the potential to enhance current diagnosis and, more importantly, predict outcome in patients with traumatic and non-traumatic spinal cord injury. It is a promising area of research ripe for further study.

Wallerian degeneration in cervical spinal cord tracts is commonly seen in routine T2-weighted MRI after traumatic spinal cord injury and is associated with impairment in a retrospective study

“…Advanced MRI techniques such as diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are used to depict early changes, attributed to acute WD [4,11,12,14]. Other advanced techniques include magnetization transfer.…”

“…Histopathologic changes have been shown to precede visible changes on MRI in the cervical spinal cord and WD begins as early as 8 days after injury [8]. Few studies have addressed tract-specific WD in the spinal cord with focus on the dorsal column (DC) and the lateral corticospinal tract (CS) using advanced MRI methods such as high angular diffusionweighted imaging, magnetization transfer, diffusion tensor imaging, or fractional anisotropy [1,4,[9][10][11][12][13][14]. However, it is not clear whether WD can commonly be detected on the clinical MRI examinations that the patients with traumatic spinal cord injury (tSCI) receive as part of standard care.…”

Exosome-Mediated siRNA pool Inhibits Axonal Growth Inhibitor in Cortical Neurons of Spinal Cord Injury in Rats

“…SCI is a common disease affecting the nervous system, it also causes the onset of paralysis, paresthesia, and nerve pains. [21] Despite great efforts have been made to improve the functional outcome of patients, SCI remains an issue to be solved with existing therapeutics measures to date. Lately, biological therapeutics provide an alternative for SCI patients assisting in the realization of spinal cord regeneration in the future.…”

Polymer-Based Scaffold Strategies for Spinal Cord Repair and Regeneration

“…The glutamate receptor competitors or other kinds of repressions of the N-methyl-d-aspartate (NMDA) receptor were applied to protect neurons. Neurotrophins, including brain-derived neurotrophic factor (BDNF), facilitate functional recovery through regulating inflammatory cytokine levels (David et al, 2019). iNOS is a crucial pacifier of oxidative stress during neuroinflammation induced by SCI.…”

“…Spinal cord injury (SCI) constitutes a considerable portion of the global injury burden is mainly caused by falls and road accidents (Wagner et al, 2018;David et al, 2019;Hutson and Di Giovanni, 2019). In 2016, the global number of prevalent cases of SCI was 27.04 million.…”