Surgical intervention combined with weight-bearing walking training improves neurological recoveries in 320 patients with clinically complete spinal cord injury: a prospective self-controlled study

Liu, Yansheng; Xie, Jiaxin; Niu, Fang; Xu, Zhexi; Tan, Pengju; Cai-hong, Shen; Gao, Hongkun; Song, Lei; So, Kwok‐Fai; Wu, Wutian; Chen, Chen; Gao, Sujuan; Xu, Xiao–Ming; Zhu, Hui

doi:10.4103/1673-5374.297080

Cited by 8 publications

(4 citation statements)

References 48 publications

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“…Interestingly, we observed that older age was not associated with worse surgical outcomes in terms of neurological improvement or complication rates 11 . Despite the higher prevalence of tethering in older patients, surgical intervention appeared to be equally effective across age groups, with similar rates of neurological improvement and complication rates observed 12 . This finding contrasts with some previous studies suggesting that older age may be a predictor of poorer surgical outcomes in spinal cord injury patients.…”

Section: Discussionmentioning

confidence: 83%

Spinal Cord Tethering after Trauma and Impact of Age and Surgical Outcome

Khattak,

Ujjan,

Raza

et al. 2024

PJMHS

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Introduction: Spinal cord tethering, a condition where the spinal cord becomes attached or fixed to surrounding tissues, can occur following trauma, leading to a range of neurological deficits and complications. Objectives: The main objective of the study is to find the spinal cord tethering after trauma and impact of age and surgical outcome in local population of Pakistan. Material and methods: This retrospective study was conducted in Ayub Medical Complex Abbottabad from January 2023 to August 2023. Data was collected from 50 patients of spinal cord tethering patients. Data collection involved a comprehensive review of the medical records of patients. Relevant demographic information, including age at the time of trauma, gender, and comorbidities, was extracted. Clinical details such as mechanism of injury, level and severity of spinal cord injury, duration of symptoms and preoperative neurological status were documented. Results: Data were collected from 50 SCI patients. The mean age of the patients was 45 ± 10.5 years and there were 60% male and 40% female patients. The most common mechanisms of injury were motor vehicle accidents (50%), followed by falls (30%) and sports-related injuries (20%). Regarding the spinal level affected, the majority of injuries were cervical (60%), followed by thoracic (30%) and lumbar (10%). Neurological improvement was observed in 40% of patients, with complete improvement in 40% and partial improvement in 20%, while 40% showed no improvement. Complications were reported in a subset of patients, with cerebrospinal fluid leaks occurring in 15%, wound infections in 10%, and other complications in 5% of cases. Reoperation was necessary in 10% of patients, while 90% did not require further surgical intervention. Age and neurological improvement showed non-significant differences between groups (p > 0.05), while length of hospital stay differed significantly (p = 0.018). Complications and functional improvement did not vary significantly between groups (p > 0.05) Practical Implication: This study's practical implications offer vital benefits to the community. The identification of age as a critical component in spinal cord tethering after trauma enables healthcare practitioners to more accurately evaluate risk and customize therapies. Furthermore, our research emphasizes how successful surgical therapies are for patients of all ages, giving patients confidence in their available treatment alternatives. Further improving patient care is pushing for individualized treatment options and being aware of related consequences. Conclusion: It is concluded that age influences the occurrence of spinal cord tethering following trauma, with older patients being more susceptible to this complication. However, surgical intervention appears to be equally effective across age groups, with comparable rates of neurological improvement and complications. Keywords: Spinal cord tethering, Trauma, Age impact, Surgical outcome, Neurological improvement, Complications

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Section: Discussionmentioning

confidence: 83%

Spinal Cord Tethering after Trauma and Impact of Age and Surgical Outcome

Khattak,

Ujjan,

Raza

et al. 2024

PJMHS

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“…Upper Extremity With over half of SCI patients suffering from cervical injuries, restoring arm and hand function is essential for daily activities and independence 56 , 57 . For elbow extension, nerve transfers from the teres minor or axillary nerve to the radial nerve’s triceps branch are effective, with the infraspinatus compensating for teres minor sacrifices 28 , 58 .…”

Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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Background: The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. Methods: A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE’s ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. Results: Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14–26 score in upper extremity compared to 2.35–26 in the control group. The overall reduction in Modified Ashworth score was 0.76–2 compared to 0–1 in the control group. Range of motion (ROM) increased 18.4–80° in elbow, 20.4–110° in wrist and 18.8–130° in forearm, while ROM changed −4.03°−20° in elbow, −2.08°−10° in wrist, −2.26°−20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. Conclusion: Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a ‘bypass’ for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.

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“…Furthermore, SCI patients in ICU will definitely halt the early rehabilitation like mobility training with walking aids, which is key to neurologic recovery. 9 The length of hospital stay (LoS-hospital) is another indicator of the occupation of medical resources. 10 However, little attention is paid to the prolonged length of ICU stay (LoS-ICU) or LoS-hospital of the critical SCI patients in ICU.…”

mentioning

confidence: 99%

“…A prolonged stay in an intensive care unit (ICU) will take up a disproportionate amount of medical resources, 8 as it hinders the enrollment of other critical patients. Furthermore, SCI patients in ICU will definitely halt the early rehabilitation like mobility training with walking aids, which is key to neurologic recovery 9 . The length of hospital stay (LoS-hospital) is another indicator of the occupation of medical resources 10 .…”

mentioning

confidence: 99%