Heterogeneity among traumatic spinal cord injuries at the thoracolumbar junction: helping select patients for clinical trials.
Abstract: Retrospective analysis. Methods: China Rehabilitation Research Center, Beijing, China. Objective: A retrospective study that documents the modalities and clarifies the heterogeneity among spinal cord injuries (SCIs) caused by trauma to the thoracolumbar vertebral junction. Methods: X-ray and MRI imaging, neurological records, and the urodynamics results of 190 patients were reviewed and used to categorize different SCI modalities. First, injuries were divided into complete and incomplete injuries using the International Standard for Neurological Classification of Spinal Cord Injury. Next, the complete injuries were further grouped using the neurological level of injury and Long T2 signal from mid-sagittal MRI images, whereas the bulboconvernosus reflexes were also used as a reference to detect injury to the sacral cord. Results: The SCI modalities were classified into five categories: pure complete epiconus lesion with caudal cord intact (G1), complete epiconus injury with conus medullaris (CM) totally involved in the lesion (G2), CM syndrome, cauda equine syndrome without sacral sparing (G3 and G4), and incomplete injury (G5). Conclusions: The heterogeneity of SCIs at the thoracolumbar junction was documented, a criterion we propose to be of great significance when selecting patients for clinical trials. In particular, the G2 group, which comprises nearly one third of the patients with epiconus lesions, is sometimes mistaken as G1, an observation that has thus far received insufficient attention.
Publication Date: 2019-06-25 PubMed ID: 31239531PubMed Central: PMC8075873DOI: 10.1038/s41393-019-0317-xGoogle Scholar: Lookup
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Summary
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The research study focuses on categorizing the various types of spinal cord injuries (SCIs) at the thoracolumbar junction through a retrospective review, aiming to assist in selecting eligible patients for clinical trials.
Study Methodology
- The study took place at China Rehabilitation Research Center in Beijing, and involved a detailed review of X-ray and MRI imaging, neurological records, and the urodynamics results of 190 patients who suffered from spinal cord injuries due to trauma to the thoracolumbar vertebral junction.
- The injuries were first divided into complete and incomplete injuries per the International Standard for Neurological Classification of Spinal Cord Injury.
- Complete injuries were further categorized based on the neurological level of injury and Long T2 signal drawn from mid-sagittal MRI images. The bulboconvernosus reflexes were specifically used as an indicator to determine injury to the sacral cord.
Findings and Results
- After a thorough review and analysis, the spinal cord injuries were segmented into five distinct categories: pure complete epiconus lesion with intact caudal cord (G1), complete epiconus injury with the entire conus medullaris involved in the lesion (G2), conus medullaris syndrome, cauda equine syndrome without sacral sparing (G3 and G4), and incomplete injuries (G5).
- The results indicated that the injuries presented a variation at the thoracolumbar junction, a factor that the researchers suggest is crucial when determining patients’ eligibility for clinical trials.
Conclusions and Implications
- The study concludes by emphasizing the heterogeneity of spinal cord injuries at the thoracolumbar junction, presenting a criterion proposed to help in selecting patients for clinical trials.
- The researchers draw particular attention to the G2 group which consists of almost one third of patients with epiconus lesions, often mistaken as G1. They argue this is an area that has not received enough attention to date.
The main thrust of this study is to highlight the importance of studying the wide-ranging types of spinal cord injuries for the purpose of effectively conducting clinical trials. By doing so, it underscores the need for further attention in this field.
Cite This Article
APA
Liu SJ, Wang Q, Tang HH, Bai JZ, Wang FY, Lv Z, Chen SZ, Liu JS, Hong Y, Zhang JW.
(2019).
Heterogeneity among traumatic spinal cord injuries at the thoracolumbar junction: helping select patients for clinical trials.
Spinal Cord, 57(11), 972-978.
https://doi.org/10.1038/s41393-019-0317-x Publication
Researcher Affiliations
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Anesthesiology, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China.
- Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China. 13910158172@163.com.
- Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China. 13910158172@163.com.
MeSH Terms
- Adolescent
- Adult
- Aged
- Clinical Trials as Topic / methods
- Female
- Humans
- Lumbar Vertebrae / diagnostic imaging
- Lumbar Vertebrae / injuries
- Magnetic Resonance Imaging / methods
- Male
- Middle Aged
- Patient Selection
- Retrospective Studies
- Spinal Cord Injuries / diagnostic imaging
- Spinal Cord Injuries / epidemiology
- Spinal Cord Injuries / rehabilitation
- Thoracic Vertebrae / diagnostic imaging
- Thoracic Vertebrae / injuries
- Young Adult
Conflict of Interest Statement
The authors declare that they have no conflict of interest.
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Citations
This article has been cited 1 times.- Zavvarian MM, Toossi A, Khazaei M, Hong J, Fehlings M. Novel innovations in cell and gene therapies for spinal cord injury.. F1000Res 2020;9.
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