Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function

Abstract

BackgroundLatest studies show that low-energy extracorporeal shock wave therapy (ESWT) can upregulate levels of vascular endothelial growth factor (VEGF). VEGF can ease nervous tissue harm after spinal cord injury (SCI). This study aims to explore whether low-energy ESWT can promote expression of VEGF, protect nervous tissue after SCI, and improve motor function.MethodsNinety adult female rats were divided into the following groups: Group A (simple laminectomy), Group B (laminectomy and low-energy ESWT), Group C (spinal cord injury), and Group D (spinal cord injury and low-energy ESWT). Impinger was used to cause thoracic spinal cord injury. Low-energy ESWT was applied as treatment after injury three times a week, for 3 weeks. After SCI, the Basso, Beattie, and Bresnahan (BBB) scale was used to evaluate motor function over a period of 42 days at different time points. Hematoxylin and eosin (HE) staining was used to evaluate nerve tissue injury. Neuronal nuclear antigen (NeuN) staining was also used to evaluate loss of neurons. Polymerase chain reaction was used to detect messenger RNA (mRNA) expression of VEGF and its receptor fms-like tyrosine kinase 1 (Flt-1). Immunostaining was used to evaluate VEGF protein expression level in myeloid tissue.ResultsBBB scores of Groups A and B showed no significant result related to dyskinesia. HE and NeuN staining indicated that only using low-energy ESWT could not cause damage of nervous tissue in Group B. Recovery of motor function at 7, 35, and 42 days after SCI in Group D was better than that in Group C (P<0.05). Compared with Group C, number of NeuN-positive cells at 42 days after SCI increased significantly (P<0.05). The mRNA levels of VEGF and Flt-1 and VEGF expression at 7 days after SCI in Group D were significantly higher than those in Group C (P<0.05).ConclusionLow-energy ESWT promotes expression of VEGF, decreases secondary damage of nerve tissue, and improves recovery of motor function. It can be regarded as one mode of clinical routine adjunctive therapy for spinal injury.

Effect of Botulinum Toxin Injection and Extracorporeal Shock Wave Therapy on Nerve Regeneration in Rats with Experimentally Induced Sciatic Nerve Injury

“…Extracorporeal shock waves at lower energy improve regeneration in several tissues, such as wounds, pressure ulcers, and chronic tendinopathy [29][30][31][32]. Several recent studies have investigated the role of shock waves in regeneration after peripheral nerve damage.…”

Ultrasound and shock-wave stimulation to promote axonal regeneration following nerve surgery: a systematic review and meta-analysis of preclinical studies

“…In contrast, extracorporeal shock waves are single, predominantly positive pressure waves with high amplitudes, short duration and rapid rise times. For lower energies, there is evidence to improve regeneration in several tissues such as wounds, ulcers, burned skin, ischemic myocardium and others 17 – 20 . Moreover, ESWT is clinically used to treat nonunion fractures 21 .…”

ESWT Diminishes Axonal Regeneration following Repair of the Rat Median Nerve with Muscle-In-Vein Conduits but Not after Autologous Nerve Grafting

“…This study’s main hypothesis was that regeneration of the murine median nerve following reconstruction with ANGs, i.e., the gold-standard method, or with MVCs, i.e., nonneural tissue, can be enhanced by a single postoperative application of low-energy defocused ESWT. The pro-regenerative effects of ESWT have been shown in the context of various musculoskeletal and neurological diseases, including carpal tunnel syndrome [ 50 , 51 , 52 , 53 ], spinal cord injury [ 54 , 55 , 56 , 57 , 58 ] and PNI in vivo [ 17 , 19 , 20 , 27 , 58 , 59 , 60 ]. Of note, to the best of our knowledge, all the PNI studies were performed in the sciatic nerve model of the rat, and four of the seven studies we retrieved featured a sciatic crush injury [ 19 , 58 , 59 , 60 ], e.g., axonotmesis.…”