Tissue bridges predict recovery after traumatic and ischemic thoracic spinal cord injury

Abstract

ObjectiveTo investigate the spatiotemporal evolution and predictive properties of intramedullary damage and midsagittal tissue bridges at the epicenter of a thoracic spinal cord injury (SCI) using MRI.MethodsWe retrospectively assessed midsagittal T2-weighted scans from 25 patients with thoracic SCI (14 traumatic, 11 ischemic) at 1 month post-SCI. In 12 patients with SCI, linear mixed-effects models on serial MRI explored temporal trajectories of quantifiable lesion markers (area, length, and width) and tissue bridges. Using partial correlation analysis, we assessed associations between structural lesion characteristics at 1 month post-SCI and recovery at 1 year postinjury, adjusting for baseline clinical status, age, and sex.ResultsLesion area decreased by 5.68 mm2 (p = 0.005), lesion length by 2.14 mm (p = 0.004), and lesion width by 0.13 mm (p = 0.004) per month. Width of tissue bridges increased by 0.06 mm (p = 0.019) per month, being similar in traumatic and ischemic SCI (p = 0.576). Smaller lesion area, length, width, and wider tissue bridges at 1 month post-SCI predicted better recovery at 1-year follow-up.ConclusionsOver time, the immediate area of cord damage shrunk while the cystic cavity became demarcated. Adjacent to the cyst, midsagittal tissue bridges became visible. The width of tissue bridges at 1 month post-SCI predicted recovery at 1 year follow-up. Measures of lesion area and tissue bridges early after traumatic and ischemic thoracic SCI therefore allow characterizing the evolution of focal cord damage and are predictive of recovery in thoracic SCI. Thus, lesion extent and tissue bridges hold potential to improve diagnosis and patient stratification in interventional trials.

Tissue bridges predict neuropathic pain emergence after spinal cord injury

“…Tissue bridge data from a small subset of the study population was previously reported in a different context. [9][10][11]…”

“…7 8 Preserved tissue bridges adjacent to the intramedullary lesion cavity, which can be identified in all patients with incomplete SCI, 9 are permissive for electrophysiological information flow and the size of which is predictive of functional recovery. [9][10][11] Importantly, NP below the level of injury develops over time. 12 This suggests that fractions of sensory pathways within preserved tissue bridges become active over time and may affect both ascending and descending modulatory systems.…”

“…This study aimed to explore the value of spared midsagittal tissue bridges (ventral and dorsal) derived from conventional T2-weighted (T2w) serial scans [9][10][11] in predicting the emergence and maintenance of SCI-related NP. Therefore, we investigated the relationships between the width of ventral and dorsal tissue bridges and pain intensity as well as its clinical characteristics.…”

Pericytes improve locomotor recovery after spinal cord injury in male and female neonatal rats

“…In contrast to stimulated pericyte and collagen treatment, pericyte‐treated males and females produced neurofilament that spanned the wounded area (Figure 5). Similarly, tissue bridges across the wounded area have been associated with improved recovery after SCI in humans 50 . The rescue of neurofilament density as compared to controls and maintenance of blood flow perfusion in female rats injected with stimulated pericytes, however, did not lead to functional motor recovery in the current study.…”

Targeted Inhibition of STAT3 in Neural Stem Cells Promotes Neuronal Differentiation and Functional Recovery in Rats with Spinal Cord Injury

“…After SCI, the limited regenerative capacity of the adult mammalian spinal cord has been attributed to the formation of cavities and glial scars that interrupt the ascending and descending pathways [17][18][19]. Now, NSC transplantation is considered an appropriate choice for treating SCI [20].…”