Tsai Sheng-Tzung, Chen Yu-Chen, Cheng Hung-Yu, Lin Chun-Hsiang, Lin Huan-Chen, Yang Chich-Haung, Liang Chung-Chao, Chen Shin-Yuan
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Tzu Chi Med J. 2020 Aug 26;33(1):29-33. doi: 10.4103/tcmj.tcmj_53_20. eCollection 2021 Jan-Mar.
Spinal cord injury (SCI) usually leads to disconnection between traversing neuronal pathway. The impairment of neural circuitry and its ascending and descending pathway usually leave severe SCI patients with both motor disability and loss of sensory function. In addition to poor quality of life, SCI patients not only have disabling respiratory function, urinary retention, impaired sexual function, autonomic dysregulation but also medical refractory neuropathic pain in the long term. Some translational studies demonstrated that spinal networks possess a dynamic state of synaptic connection and excitability that can be facilitated by epidural spinal cord stimulation. In addition, preliminary human studies also confirmed that spinal cord stimulation enables stepping or standing in individuals with paraplegia as well. In this review, we examined the plausible interventional mechanisms underlying the effects of epidural spinal cord stimulation in animal studies. Following the success of translational research, chronic paralyzed subjects due to SCI, defined as motor complete status, regained their voluntary control and function of overground walking and even stepping for some. These progresses lead us into a new hope to help SCI patients to walk and regain their independent life again.
脊髓损伤(SCI)通常会导致交叉神经元通路的中断。神经回路及其上行和下行通路的损伤通常会使严重的SCI患者同时出现运动功能障碍和感觉功能丧失。除了生活质量差之外,SCI患者长期不仅存在呼吸功能障碍、尿潴留、性功能受损、自主神经失调,还会出现药物难治性神经性疼痛。一些转化研究表明,脊髓网络具有动态的突触连接和兴奋性状态,硬膜外脊髓刺激可以促进这种状态。此外,初步的人体研究也证实,脊髓刺激能够使截瘫患者实现行走或站立。在这篇综述中,我们研究了动物研究中硬膜外脊髓刺激作用的可能干预机制。随着转化研究的成功,因SCI导致慢性瘫痪的受试者(定义为运动完全性状态)恢复了他们的自主控制能力以及地面行走甚至部分人的踏步功能。这些进展给我们带来了新的希望,即帮助SCI患者再次行走并重新获得独立生活。