Linde Lukas D, Dengler Jana, Curt Armin, Schubert Martin, Abel Rainer, Weidner Norbert, Röhrich Frank, Berger Michael J, Fox Ida K
International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
Division of Plastic Surgery, Tory Trauma Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4 N 3M5, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, 555 University Avenue, Room 5426, Toronto, Ontario, M5 G 1×8, Canada.
Ann Phys Rehabil Med. 2025 Jun;68(5):101959. doi: 10.1016/j.rehab.2025.101959. Epub 2025 Mar 29.
Lower motor neuron (LMN) dysfunction caused by anterior horn cell damage in the ventral gray matter during spinal cord injury (SCI) may impact long-term prognosis.
To determine the influence of the 3-month ulnar compound muscle action potentials (CMAP; representative of C8-T1 spinal segmental LMN integrity) on hand muscle strength and function, 12 months following SCI.
We completed retrospective analyses of the European Multicenter Study about SCI (EMSCI) database. Included participants had traumatic SCI (motor complete or incomplete), initial neurological level of injury C1-C8, and ulnar CMAP from the abductor digiti minimi in at least one limb, 3 months after injury. We trichotomized 3-month ulnar CMAP into absent (CMAP = 0.0 mV), reduced (CMAP <6.0 mV), and normal (CMAP ≥6.0 mV), and constructed logistical regression models to predict 12-month C8 and T1 motor scores, dichotomized into poor (≤3) and functional (>3). We explored relationships between trichotomized 3-month ulnar CMAP and 12-month functional Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) and Spinal Cord Independence Measure (SCIM) upper limb sub-scales, using non-parametric statistics.
Data from 318 participants (253 males), 46.8 years old (SD 18.4), resulted in CMAP and corresponding motor scores in 629 limbs. Adjusted logistical regression models were significant for C8 and T1 motor scores, with absent (C8 36.6, 95 % CI 12.9-133; T1 38.7, 95 % CI 11.2-24) and reduced (C8 11.0, 95 % CI 6.7-18.4; T1 7.93, 95 % CI 5.2-12.3) CMAP, predictive of poor 12-month motor scores. 12-month GRASSP (n = 30) and SCIM scores were significantly higher in those with normal 3-month ulnar CMAPs than absent and reduced.
There is a 7 to 38-fold higher likelihood that SCI individuals with reduced or absent 3-month ulnar CMAP will demonstrate poor hand motor scores at 12 months. This aligns with significantly worse GRASSP and SCIM functional scores. Our findings justify adding LMN health measures in prognostic modeling after SCI.
脊髓损伤（SCI）期间，前角细胞在脊髓灰质腹侧受损导致的下运动神经元（LMN）功能障碍可能影响长期预后。
确定伤后12个月时，3个月的尺神经复合肌肉动作电位（CMAP；代表C8 - T1脊髓节段LMN完整性）对手部肌肉力量和功能的影响。
我们对欧洲多中心脊髓损伤研究（EMSCI）数据库进行了回顾性分析。纳入的参与者患有创伤性SCI（运动完全性或不完全性），初始损伤神经平面为C1 - C8，且在伤后3个月至少一侧肢体有来自小指展肌的尺神经CMAP。我们将3个月的尺神经CMAP分为消失（CMAP = 0.0 mV）、降低（CMAP <6.0 mV）和正常（CMAP≥6.0 mV）三组，并构建逻辑回归模型来预测12个月时的C8和T1运动评分，分为差（≤3）和功能良好（>3）两类。我们使用非参数统计方法探讨了三分法的3个月尺神经CMAP与12个月时功能分级重新定义的力量、感觉和抓握评估（GRASSP）以及脊髓独立性测量（SCIM）上肢子量表之间的关系。
318名参与者（253名男性）的数据，年龄46.8岁（标准差18.4），共629条肢体有CMAP及相应运动评分。调整后的逻辑回归模型对C8和T1运动评分具有显著意义，CMAP消失（C8为36.6，95%置信区间12.9 - 133；T1为38.7，95%置信区间11.2 - 24）和降低（C8为11.0，95%置信区间6.7 - 18.4；T1为7.93，95%置信区间5.2 - 12.3）可预测12个月时运动评分差。3个月尺神经CMAP正常者的12个月GRASSP（n = 30）和SCIM评分显著高于CMAP消失和降低者。
3个月尺神经CMAP降低或消失的SCI个体在12个月时手部运动评分差的可能性高出7至38倍。这与GRASSP和SCIM功能评分显著更差相符。我们的研究结果证明在SCI后的预后模型中增加LMN健康测量指标是合理的。
