The relevance of MRI for predicting neurological recovery following cervical traumatic spinal cord injury

Martineau, Joanie; Goulet, Julien; Richard-Denis, Andréane; Mac-Thiong, Jean-Marc

doi:10.1038/s41393-019-0295-z

Cited by 26 publications

(27 citation statements)

References 28 publications

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“…Nevertheless, when we included initial AIS grades as a predictor, the inclusion of the MRI measure did not add significant predictive value. This suggests that, similar to a recent previous study, initial AIS grades remain the most optimal predictor, if clinically available [25]. Another limitation is that, due to the nature of our experimental design, our axial damage ratio cut-off score of 0.374 is specific to our cohort, and these results need to be validated in additional independent cohorts before an axial damage ratio cut-off score can be generalizable to the population with SCI as a whole.…”

Section: Limitationssupporting

confidence: 57%

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

et al. 2020

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Study design Retrospective. Objectives Primary: to assess if axial damage ratios are predictors of future walking after spinal cord injury (SCI), and if they add any predictive value if initial neurological impairment grades are available. Secondary: to determine if lateral spinal cord regions are predictors of future lower extremity motor scores (LEMS). Setting University/hospital. Methods Axial T2-weighted MRIs were used. Axial damage ratios and non-damaged lateral cord volumes were calculated. Each participant answered at 1 year after SCI, “Are you able to walk for 150 feet? (45.72 meters)” For the secondary aim, right and left LEMS were used. Results In total, 145 participants were selected. Individuals that could walk had smaller ratios than those that were unable. Walking and axial damage ratios were negatively correlated. A 0.374 ratio cut-off showed optimal sensitivity/specificity. When initial neurological grades were used, axial damage ratios did not add predictive value. Forty-two participants had LEMS available and were included for the secondary aim. Right cord regions and right LEMS were positively correlated and left regions and left LEMS, but these variables were also correlated with each other. Conclusions Axial damage ratios were significant predictors of walking ability 1 year after SCI. However, this measure did not add predictive value over initial neurological grades. Lateral cord regions correlated with same-side LEMS, but the opposite was also found, calling this biomarker’s specificity into question. Axial damage ratios may be useful in predicting walking after SCI if initial neurological grades are unavailable. Sponsorship This research was funded by a National Institutes of Health award, National Institute of Child Health and Development—NIH R03HD094577.

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Section: Limitationssupporting

confidence: 57%

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

et al. 2020

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“…They reported that the intramedullary lesion length (IMLL) 24,25 and the Brain and Spinal Injury Center (BASIC) score 25 are strong predictors of AIS grade conversion at 6 and 12 months post-SCI, respectively. Moreover, Martineau et al 36 and Dalkilic et al 37 showed that presence 36 or length 37 of intramedullary hemorrhage, lesion length, 36 and cord expansion length (ie, entire length of cord that was enlarged as compared with normal) 37 predicted motor score recovery 36,37 and AIS grade conversion. 36 Supported by findings in the literature, 15,38 we observed that from 70 patients, 28 converted on the ISNCSCI-based impairment scale over 12 months post-SCI with different conversion chances between AIS grades.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Martineau et al 36 and Dalkilic et al 37 showed that presence 36 or length 37 of intramedullary hemorrhage, lesion length, 36 and cord expansion length (ie, entire length of cord that was enlarged as compared with normal) 37 predicted motor score recovery 36,37 and AIS grade conversion. 36 Supported by findings in the literature, 15,38 we observed that from 70 patients, 28 converted on the ISNCSCI-based impairment scale over 12 months post-SCI with different conversion chances between AIS grades. While patients initially classified as AIS C have the greatest chance to convert, patients with AIS grade B have a lower conversion chance, followed by grade A and then D. Those who converted to an AIS grade of C or D had a larger width of ventral tissue bridges at baseline.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Midsagittal Tissue Bridges on Functional Recovery After Spinal Cord Injury

Pfyffer

Vallotton

Curt

et al. 2020

Neurorehabil Neural Repair

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Background The majority of patients with spinal cord injury (SCI) have anatomically incomplete lesions and present with preserved tissue bridges, yet their outcomes vary. Objective To assess the predictive value of the anatomical location (ventral/dorsal) and width of preserved midsagittal tissue bridges for American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade conversion and SCI patient stratification into recovery-specific subgroups. Methods This retrospective longitudinal study includes 70 patients (56 men, age: 52.36 ± 18.58 years) with subacute (ie, 1 month) SCI (45 tetraplegics, 25 paraplegics), 1-month neuroimaging data, and 1-month and 12-month clinical data. One-month midsagittal T2-weighted scans were used to determine the location and width of tissue bridges. Their associations with functional outcomes were assessed using partial correlation and unbiased recursive partitioning conditional inference tree (URP-CTREE). Results Fifty-seven (81.4%) of 70 patients had tissue bridges (2.53 ± 2.04 mm) at 1-month post-SCI. Larger ventral ( P = .001, r = 0.511) and dorsal ( P < .001, r = 0.546) tissue bridges were associated with higher AIS conversion rates 12 months post-SCI (n = 39). URP-CTREE analysis identified 1-month ventral tissue bridges as predictors of 12-month total motor scores (0.4 mm cutoff, P = .008), recovery of upper extremity motor scores at 12 months (1.82 mm cutoff, P = .002), 12-month pin-prick scores (1.4 mm cutoff, P = .018), and dorsal tissue bridges at 1 month as predictors of 12-month Spinal Cord Independence Measure scores (0.5 mm cutoff, P = .003). Conclusions Midsagittal tissue bridges add predictive value to baseline clinical measures for post-SCI recovery. Based on tissue bridges’ width, patients can be classified into subgroups of clinical recovery profiles. Midsagittal tissue bridges provide means to optimize patient stratification in clinical trials.

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“…It was originally thought that detection of intramedullary hemorrhage was predictive of a complete injury. However, MRI studies have demonstrated small amounts of hemorrhage in incomplete lesions [45,46]. The anatomic location of the hemorrhage closely corresponds to the neurological level of injury and the presence of frank hemorrhage implies a poor potential for neurological recovery [26,45].…”

Section: Terminology Classification and Type Of Scimentioning

confidence: 99%

“…However, MRI studies have demonstrated small amounts of hemorrhage in incomplete lesions [45,46]. The anatomic location of the hemorrhage closely corresponds to the neurological level of injury and the presence of frank hemorrhage implies a poor potential for neurological recovery [26,45]. Spinal cord edema is defined as abnormal high signal intensity seen on MRI T2‐weighted images that reflect a focal accumulation of intracellular and interstitial fluid in response to injury.…”

Section: Terminology Classification and Type Of Scimentioning

confidence: 99%

Antibiotics with therapeutic effects on spinal cord injury: a review

Afshari

Roudsari

Lashgari

et al. 2020

Fundamemntal Clinical Pharma

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Accumulating evidence indicates that a considerable number of antibiotics exert anti‐inflammatory and neuroprotective effects in different central and peripheral nervous system diseases including spinal cord injury (SCI). Both clinical and preclinical studies on SCI have found therapeutic effects of antibiotics from different families on SCI. These include macrolides, minocycline, β‐lactams, and dapsone, all of which have been found to improve SCI sequels and complications. These antibiotics may target similar signaling pathways such as reducing inflammatory microglial activity, promoting autophagy, inhibiting neuronal apoptosis, and modulating the SCI‐related mitochondrial dysfunction. In this review paper, we will discuss the mechanisms underlying therapeutic effects of these antibiotics on SCI, which not only could supply vital information for investigators but also guide clinicians to consider administering these antibiotics as part of a multimodal therapeutic approach for management of SCI and its complications.

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The relevance of MRI for predicting neurological recovery following cervical traumatic spinal cord injury

Cited by 26 publications

References 28 publications

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

Predictive Value of Midsagittal Tissue Bridges on Functional Recovery After Spinal Cord Injury

Antibiotics with therapeutic effects on spinal cord injury: a review

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