Disability, atrophy and cortical reorganization following spinal cord injury

Brain, 2011 · DOI: 10.1093/brain/awr093 · Published: May 1, 2011

Spinal Cord Injury Neuroimaging Neurology

Simple Explanation

Traumatic spinal cord injury (SCI) can lead to changes in the brain's structure and function, which can affect a person's disability level. The study investigated how SCI affects the spinal cord and brain, and how these changes relate to functional changes in the sensorimotor cortex. The researchers used MRI to assess structural changes in the spinal cord and brain of SCI subjects compared to controls. They also used fMRI to measure brain activity during handgrip and nerve stimulation tasks to see how the brain reorganizes after SCI. The study found that SCI leads to spinal cord atrophy, cortical atrophy, and cortical reorganization. The amount of reorganization is linked to the extent of spinal cord atrophy and the degree of disability experienced by the individual.

Study Duration

Not specified

Participants

10 subjects with cervical spinal cord injury and 16 controls

Evidence Level

Level 3: Cross-sectional study using MRI and fMRI

Key Findings

1
Subjects with SCI had a 30% reduced cord area compared to controls, indicating spinal cord atrophy.
2
Smaller white matter volume was observed in the pyramids and left cerebellar peduncle in SCI subjects.
3
SCI subjects showed increased activation in the left primary motor cortex leg area during handgrip and in the left primary sensory cortex face area during median nerve stimulation, but no increased activation following tibial nerve stimulation compared to controls.

Research Summary

This study investigated the impact of traumatic spinal cord injury (SCI) on structural integrity, cortical reorganization, and disability by assessing anatomical changes in the spinal cord and brain and exploring their relationship to functional changes in the sensorimotor cortex. The study found that SCI leads to cord atrophy, cortical atrophy of primary motor and sensory cortex, and cortical reorganization of the sensorimotor system. The degree of cortical reorganization is predicted by spinal atrophy and is associated with significant disability. The researchers suggest that the imaging parameters used in the study, such as cervical cord area, BOLD signal, and grey matter volume in specific brain regions, could serve as potential biomarkers for future clinical trials focused on spinal cord repair.

Practical Implications

Biomarker Development

Identifies potential imaging biomarkers (spinal cord area, BOLD signal, gray matter volume) for assessing SCI severity and treatment effectiveness in clinical trials.

Understanding Cortical Reorganization

Provides insights into how the brain adapts after SCI, revealing the relationship between spinal atrophy, cortical reorganization, and functional disability.

Clinical Assessment

Highlights the importance of sensitive clinical measures of hand function for assessing the impact of SCI and monitoring recovery.

Study Limitations

1
Sample size may have low power for weak effects.
2
Possibility of subtle co-contractions of leg muscles during handgrip, which could contribute to activation in the primary motor cortex leg area.
3
The American Spinal Injury Associations standard of clinical assessment lacks the sensitivity to delineate minimal change in psychometric properties of motor and sensory function

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