PREVALENCE OF SPASTICITY AND BELOW-LEVEL NEUROPATHIC PAIN RELATED TO SPINAL CORD INJURY LEVEL AND DAMAGE TO THE LOWER SPINAL SEGMENTS

JOURNAL OF REHABILITATION MEDICINE, 2020 · DOI: 10.2340/20030711-1000039 · Published: August 31, 2020

Spinal Cord Injury Neurology Pain Management

Simple Explanation

Following a spinal cord injury, symptoms of increased nerve cell activity in the central nervous system appear, e.g. involuntary muscle activity (spasticity), below level neuropathic pain and urinary leakage. This chart review showed that leg spasticity was more frequent in patients with a cervical or thoracic spinal cord injury if the patients had no signs of damage to the lumbar spinal cord and roots. This suggests that the mechanisms behind leg spasticity are mainly restricted to the lumbar spinal cord. For this pain, additional mechanisms other than lesions of the spino-thalamic tract must be considered

Study Duration

Not specified

Participants

269 patients with spinal cord injury from segments C1 to T11

Evidence Level

Not specified

Key Findings

1
Among 161 patients without damage to the lumbar spinal cord and roots, 87% of those with cervical spinal cord injury experienced spasticity, compared with 85% with thoracic spinal cord injury.
2
The corresponding figures for patients in whom damage to the lumbar spinal cord and roots was present were 57% and 52%, respectively.
3
Below-level spinal cord injury neuropathic pain was not associated with damage to the lumbar spinal cord and roots.

Research Summary

This study shows that patients with a cervical or thoracic SCI concurrent with signs of damage to LSCR have a lower prevalence of spasticity. As expected, no such association was found for BLSCIN pain. In the group without damage to LSCR, the SCI level had no significant effect on spasticity, troublesome spasticity and BLSCIN pain. Spasticity and BLSCIN pain were not associated.

Practical Implications

Spasticity Mechanisms

Future studies of the neuronal mechanisms behind spasticity should mainly be directed to the lumbar segments.

Pain Generator Localization

The suggested localization of a pain generator just above the level of the SCI supports further investigation into the use of intrathecal gabapentin.

LSCR Damage

The lower prevalence of spasticity in patients with LSCR damage points to the possibility that degeneration of the lumbar spine contributes peripheral paresis on top of the central paresis of the legs in elderly patients.

Study Limitations

1
The prevalence of BLSCIN pain may have been underestimated, as evoked neurogenic pain was not included.
2
The prevalence of spasticity may also have been underestimated, as patients experiencing muscle stiffness may have given negative answers to questions regarding involuntary muscle activity.
3
Radiological determination of vertebral damage was estimated visually and was therefore necessarily subjective.

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