Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
Brain. 2021 Mar 3;144(2):420-433. doi: 10.1093/brain/awaa423.
Spinal cord epidural stimulation (scES) has enabled volitional lower extremity movements in individuals with chronic and clinically motor complete spinal cord injury and no clinically detectable brain influence. The aim of this study was to understand whether the individuals' neuroanatomical characteristics or positioning of the scES electrode were important factors influencing the extent of initial recovery of lower limb voluntary movements in those with clinically motor complete paralysis. We hypothesized that there would be significant correlations between the number of joints moved during attempts with scES prior to any training interventions and the amount of cervical cord atrophy above the injury, length of post-traumatic myelomalacia and the amount of volume coverage of lumbosacral enlargement by the stimulation electrode array. The clinical and imaging records of 20 individuals with chronic and clinically motor complete spinal cord injury who underwent scES implantation were reviewed and analysed using MRI and X-ray integration, image segmentation and spinal cord volumetric reconstruction techniques. All individuals that participated in the scES study (n = 20) achieved, to some extent, lower extremity voluntary movements post scES implant and prior to any locomotor, voluntary movement or cardiovascular training. The correlation results showed that neither the cross-section area of spinal cord at C3 (n = 19, r = 0.33, P = 0.16) nor the length of severe myelomalacia (n = 18, r = -0.02, P = 0.93) correlated significantly with volitional lower limb movement ability. However, there was a significant, moderate correlation (n = 20, r = 0.59, P = 0.006) between the estimated percentage of the lumbosacral enlargement coverage by the paddle electrode as well as the position of the paddle relative to the maximal lumbosacral enlargement and the conus tip (n = 20, r = 0.50, P = 0.026) with the number of joints moved volitionally. These results suggest that greater coverage of the lumbosacral enlargement by scES may improve motor recovery prior to any training, possibly because of direct modulatory effects on the spinal networks that control lower extremity movements indicating the significant role of motor control at the level of the spinal cord.
脊髓硬膜外刺激 (scES) 使慢性和临床完全性脊髓损伤且无临床可检测到的大脑影响的个体能够进行自愿的下肢运动。本研究的目的是了解个体的神经解剖学特征或 scES 电极的位置是否是影响临床完全性瘫痪个体下肢自愿运动初始恢复程度的重要因素。我们假设，在接受任何训练干预之前，通过 scES 进行尝试时移动的关节数量与颈椎损伤上方的脊髓萎缩程度、外伤性脊髓软化长度以及刺激电极阵列对腰骶部增大的容积覆盖量之间存在显著相关性。对 20 名接受 scES 植入术的慢性和临床完全性脊髓损伤患者的临床和影像学记录进行了回顾和分析，使用 MRI 和 X 射线整合、图像分割和脊髓容积重建技术。所有参与 scES 研究的个体（n=20）在接受 scES 植入后并在进行任何运动、自愿运动或心血管训练之前，都在某种程度上实现了下肢自愿运动。相关结果表明，C3 脊髓的横截面积（n=19，r=0.33，P=0.16）和严重脊髓软化长度（n=18，r=-0.02，P=0.93）均与自愿下肢运动能力无显著相关性。然而，在使用 paddle 电极覆盖腰骶部增大的估计百分比以及 paddle 相对于腰骶部增大和圆锥尖端的位置与自愿移动的关节数量之间存在显著的中度相关性（n=20，r=0.59，P=0.006）。这些结果表明，scES 对腰骶部增大的更大覆盖范围可能会改善训练前的运动恢复，这可能是因为它对控制下肢运动的脊髓网络产生直接调节作用，这表明脊髓水平的运动控制起着重要作用。
