Neuroanatomical mapping of the lumbosacral spinal cord in individuals with chronic spinal cord injury

Brain Communications, 2023 · DOI: https://doi.org/10.1093/braincomms/fcac330 · Published: December 19, 2022

Spinal Cord Injury Neuroimaging Neurology

Simple Explanation

This study explores the neuroanatomical characteristics of the lumbosacral spinal cord in individuals with chronic spinal cord injury (SCI) using high-resolution MRI scans. The research aims to understand how the variability in spinal cord anatomy among individuals impacts the outcomes of spinal cord electrical stimulation (scES) interventions. The findings highlight the importance of considering individual-specific spinal cord anatomy when planning and implementing scES to maximize functional benefits for patients with SCI.

Study Duration

Not specified

Participants

12 individuals with chronic, motor complete spinal cord injury

Evidence Level

Not specified

Key Findings

1
The length of the spinal column and spinal cord, location of the conus tip, and the relationship between spinal cord and vertebral levels at the lumbosacral enlargement vary across individuals.
2
There is no statistically significant correlation between the length of the spinal column and the length of the spinal cord.
3
The location of spinal cord levels with respect to the electrode contacts varies across individuals and impacts the recruitment patterns of neurophysiological responses.

Research Summary

This study introduces a neuroimaging and analysis protocol to identify spinal cord levels at the lumbosacral enlargement, assess anatomical variability, locate epidural stimulation electrodes, and link stimulation levels to motor responses in individuals with chronic SCI. High-resolution MRI scans revealed significant variability in spinal cord anatomy among individuals, impacting the effectiveness of epidural stimulation. The study emphasizes the importance of individualized approaches to spinal cord stimulation. MRI-based spinal cord modeling can guide the prediction and preplanning of optimal epidural stimulation paddle placement, maximizing functional outcomes. This highlights the critical role of individual spinal cord characteristics in achieving maximum benefits with electrical stimulation.

Practical Implications

Personalized Spinal Cord Stimulation

The findings suggest a need for personalized approaches to spinal cord stimulation, considering individual anatomical variations to optimize electrode placement and stimulation parameters.

Improved Surgical Planning

MRI-based spinal cord modeling can be used for pre-surgical planning to ensure optimal epidural stimulation paddle placement, potentially improving functional outcomes.

Refined Stimulation Techniques

Understanding the relationship between stimulation location and neurophysiological responses can lead to more refined stimulation techniques, maximizing the benefits of spinal cord electrical stimulation.

Study Limitations

1
The sample size of 12 participants may limit the generalizability of the findings.
2
The study focuses on individuals with chronic, motor-complete spinal cord injury, potentially limiting applicability to other SCI populations.
3
The study does not fully explore the impact of injury severity, mechanism, or residual fibers on neuromodulatory effects.

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