Journal of Spinal Cord Medicine最新文献

{"title":"Vasopressin-induced hyponatremia during mean arterial pressure augmentation in acute spinal cord injury: A multicenter retrospective cohort study.","authors":"Heather Corello, Cassie A Barton, Andrew J Webb, Jordan Smith, James Wright, Martin Schreiber","doi":"10.1080/10790268.2025.2560717","DOIUrl":"https://doi.org/10.1080/10790268.2025.2560717","url":null,"abstract":"<p><strong>Background: </strong>MAP augmentation is a guideline-recommended intervention in acute spinal cord injury (SCI), and vasopressin can be used to achieve mean arterial pressure (MAP) goals. Vasopressin could contribute to hyponatremia in SCI, but this relationship is poorly described.</p><p><strong>Methods: </strong>This was a multicenter, retrospective, observational cohort of patients with acute SCI who received vasopressin only for MAP augmentation and developed hyponatremia. Patients were excluded if vasopressin was used for <6 h or for an alternative indication (<i>e.g.</i> shock states). The primary outcome was the probability hyponatremia was caused by vasopressin, determined using the Naranjo Adverse Drug Reaction Probability Scale.</p><p><strong>Results: </strong>Twenty patients with SCI received vasopressin for MAP augmentation and 17 (85%) developed hyponatremia. Seventy percent of patients received an American Spinal Injury Association Impairment Scale (AIS) classification at admission: AIS A (42%), AIS B (50%), and AIS C (8%). MAP augmentation (mean goal of 87 (±7) mm Hg) was maintained for 5 (±2) days. The median Naranjo score was 7 (range 4-9), constituting a \"probable\" association of vasopressin with hyponatremia. Hyponatremia (Na <135 mEq/L) developed within 30 (±20) hours of vasopressin initiation, with a nadir at 129 (±4) mEq/L. Sodium declined by 8 mEq/L on average for every 24 h of vasopressin exposure. Hyponatremia resolved 12 (±9) hours after vasopressin discontinuation. Five patients were rechallenged with vasopressin and 4 (80%) re-developed hyponatremia.</p><p><strong>Conclusion: </strong>Vasopressin used for MAP augmentation was associated with hyponatremia in patients with SCI who received it strictly for MAP augmentation and resolved after discontinuation. Providers should exercise caution when selecting vasopressin for MAP augmentation in acute SCI.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does autonomic nervous system dysfunction impact on ureteric jet Doppler waveform formation in patients with neurogenic bladder related to spinal cord injury?","authors":"İlkay Karabay, Bilge Yılmaz, Merve Örücü Atar, Tuncer Ergin","doi":"10.1080/10790268.2025.2563954","DOIUrl":"https://doi.org/10.1080/10790268.2025.2563954","url":null,"abstract":"<p><strong>Background: </strong>Autonomic nervous system (ANS) dysfunction in individuals with spinal cord injury (SCI) may have an impact on Ureteric Jet Doppler Waveform (UJDW) types.</p><p><strong>Objective: </strong>The aims of the study were (1) to determine UJDW types in individuals with SCI, (2) to evaluate the factors that affect these UJDW types, and (3) to examine the possible indirect effect of ANS dysfunction on these UJDW types.</p><p><strong>Materials and methods: </strong>This cross-sectional study included twenty individuals with SCI (study group) and twenty-four healthy volunteers (control group). The appearance of UJDW forms and bladder wall thicknesses were collected by urinary Doppler ultrasound (USG) in both groups. Bladder pressure and abdominal pressure were recorded when the bladder was full after Doppler USG examination.</p><p><strong>Results: </strong>The most common types of UJDW detected in participants with SCI were monophasic and biphasic wave patterns. When the study group and control groups were compared in terms of UJDW types, monophasic wave percentage median values were higher in the study group than in the control group (p = 0.001). The median values of the percentage of biphasic waves were higher in individuals with lesion level ≤ thoracic (T) 7 compared to individuals with lesion level ≥ T6 (p = 0.011). The monophasic wave form was not found at a higher rate in individuals with lesion level ≥ T6 level compared to the individuals with lesion level ≤ T7.</p><p><strong>Conclusion: </strong>The findings of this study may suggest that the monophasic form is not evidence of ANS dysfunction in individuals with SCI.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of spinal cord injury in the context of closed head injury.","authors":"Teleale F Gebeyehu, Chris J Neal, Kristopher G Hooten, Daniela A Perez-Chadid, Daniel Franco, James Harrop","doi":"10.1080/10790268.2025.2555656","DOIUrl":"https://doi.org/10.1080/10790268.2025.2555656","url":null,"abstract":"<p><strong>Design: </strong>Retrospective Study.</p><p><strong>Background: </strong>The incidence of traumatic brain injury (TBI) in patients with spinal cord injury (SCI) is well documented. However, the incidence of SCI specifically in patients with closed head injury (CHI) is understudied. SCI and CHI are underdiagnosed, and this can be complicated history. Facilities are often focused on patients' primary issues, and with polytrauma patients' cognitive impairment, CHI can be missed. Thus, this study aimed to determine the incidence of SCI in patients with CHI.</p><p><strong>Methods and materials: </strong>This retrospective study used Pennsylvania Trauma Systems Foundation database to identify patients with SCI among those with CHI (2010 through 2020 end) and described the patient demographics; incidence per year; frequencies of the various causes and types of injuries; and the underlying CHI in terms of frequencies of diagnosis and severity. The frequencies of various diagnoses associated with SCI, neurologic level of injury, severity and the associated vertebral fractures, and in-hospital mortality were also described.</p><p><strong>Results: </strong>Among patients with CHI, 2.6% were found to have SCI. Patients mostly affected were male (73.5%), Caucasian (78.4%), and a mean age (SD, range) of 46.3 (15.5, 19-70) years. Blunt injury, predominantly in the form of motor vehicle collisions (55.7%) and falls (34.6%) constituted the main causes. Cervical spine was most affected (76.2%), with C1-C4 region comprising the most injuries (39%), followed by thoracic spine (26.4%). Vertebral Fracture (VF) was noted in 47.1%; C5-C7 was the most fractured region (28.9%). VF levels matched SCI levels in 52-70%. Complete SCI was diagnosed in 18.6% of patients. The mean duration of stay in hospital was 11 days (range 0-262). In-hospital mortality was noted in 8.2% of patients.</p><p><strong>Conclusion: </strong>The CHI should not necessarily be severe to have a suspicion of SCI. The clinical findings of SCI in CHI mostly follow the pattern in dual diagnosis of TBI/SCI, such as frequent involvement of cervical spine with less involvement of the thoracic and lumbar sections of the spine. An appropriate clinical suspicion to screen and follow management protocols for SCI is recommended for the best patient care.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-14"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal cord injury Veterans access to dental care: Barriers and limitations.","authors":"Jonathan Lee, Suha Muqeet, Katherine Sherman, Christopher White, Kenneth Lee, Denis Castillo","doi":"10.1080/10790268.2025.2554016","DOIUrl":"https://doi.org/10.1080/10790268.2025.2554016","url":null,"abstract":"<p><strong>Context/objective: </strong>Oral hygiene is crucial for basic health by preventing systemic diseases. People with spinal cord injuries (SCI) in previous studies identified cost, physical barriers (such as chair lifts), and dental fear as barriers to dental care. Our study observes whether Veterans with SCI are receiving appropriate dental care, and if not, to identify the barriers.</p><p><strong>Design: </strong>Cross-sectional survey during their annual exam, inpatient stays, or outpatient visits.</p><p><strong>Setting: </strong>Clement J. Zablockie Veterans Affairs Medical Center Spinal Cord Injury/Disorders Program.</p><p><strong>Participants: </strong>188 Veterans with SCI (<i>n </i>= 188).</p><p><strong>Results: </strong>157 (83.5%) Veterans reported having received dental care since their SCI. Most reported receiving post-SCI dental care at a non-VA clinic (63.3%) and at least annually (63.3%). Some of these Veterans reported being unable to receive dental care since their SCI (23.4%) and identified barriers: lack of insurance (60.0%), money (30.0%), physical obstacles (6.7%), and \"other\" reasons (10.0%). Veterans who were white (black OR 0.518, CI 0.157-1.709; other OR 0.181, CI 0.053-0.620), had dental insurance (OR 5.778, CI 1.258-26.547), and/or had VA dental care eligibility (OR 4.782, CI 1.516-15.085) were more likely to have received dental care since SCI. However, most did not report having insurance (70.9%) or VA eligibility for dental care (63.1%).</p><p><strong>Conclusions: </strong>Sex, age and level of injury were not related to dental care access, but race, insurance, and VA care eligibility were. Similar to the general population, finances were the most-reported barrier to dental care. Prioritizing early intervention, financial aid, and preventive measures can enhance the health of Veterans with SCIs.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-7"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No discernible effect of vitamin D supplementation on secondary outcomes in chronic spinal cord injury: Findings from a randomized controlled trial.","authors":"Anneke Hertig-Godeschalk, Joelle L Flueck, Anke Scheel-Sailer, Claudio Perret, Martin W G Brinkhof","doi":"10.1080/10790268.2025.2557078","DOIUrl":"https://doi.org/10.1080/10790268.2025.2557078","url":null,"abstract":"<p><strong>Context: </strong>Sufficient vitamin D levels (serum 25(OH)D>75 nmol/L) have been associated with secondary health conditions and functional outcomes in individuals with chronic spinal cord injury (SCI). This study evaluated the effects of vitamin D3 supplementation on these outcomes.</p><p><strong>Design: </strong>Randomized, placebo-controlled, double-blind clinical trial.</p><p><strong>Setting: </strong>Specialized SCI center.</p><p><strong>Participants: </strong>Participants included 42 individuals living with SCI for at least three years and exhibiting insufficient 25(OH)D levels at baseline (seven females, 35 males, mean age 48±10 years, 10 with tetraplegia, 32 with paraplegia).</p><p><strong>Interventions: </strong>Participants were randomly assigned to receive placebo, medium-dose (24'000 IU every four weeks), or high-dose (24'000 IU every two weeks) vitamin D3 supplementation for 12 months.</p><p><strong>Outcome measures: </strong>For 12 months, the following parameters were evaluated at three-month intervals: 25(OH)D levels; occurrence of urinary tract infections, pressure injuries, falls, and pain; handgrip strength; functional independence; levels of fatigue, anxiety, and depression.</p><p><strong>Results: </strong>Of the participants who received supplementation, 33% achieved sufficient 25(OH)D levels. Pain was reported by 79% of participants during the study, while falls (57%), urinary tract infections (55%), and pressure injuries (21%) were reported less frequently. Vitamin D3 supplementation demonstrated no measurable effect on any of the investigated parameters (all <i>P</i>-values ≥ 0.19).</p><p><strong>Conclusion: </strong>Vitamin D3 supplementation resulted in sufficient 25(OH)D levels in only a minority of participants, which may account for the absence of effects on secondary outcomes relevant to SCI. Future studies should investigate the efficacy of higher supplementation doses, particularly for individuals with clinically relevant levels of the respective outcomes.<b>Trial registration:</b> The study was registered at ClinicalTrials.gov (registration ID: NCT04652544).</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the relationship between spinal alignment and trunk muscle strength, sitting balance and function in spinal cord injury.","authors":"Serdar Turoglu, Saadet Selin Koç, Salman Usman Shehu, Ayfer Ezgi Yilmaz, Nebahat Sezer, Bihter Akınoğlu","doi":"10.1080/10790268.2025.2557079","DOIUrl":"https://doi.org/10.1080/10790268.2025.2557079","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the relationship between spinal alignment and trunk muscle strength, sitting balance and functionality in individuals with spinal cord injury.</p><p><strong>Methods: </strong>This study included 46 individuals with spinal cord injury (SCI) at T7 or below (AIS A or B) (mean age: 38.93 ± 14.43). Spinal alignment in a sitting posture was assessed using the DIERS Formetric Functional Spine and Posture Analysis System, while trunk muscle strength was measured with the DIERS Myoline Isometric Muscle Force Analysis System. Trunk balance was evaluated using the Trunk Control Test (TCT), Function in Sitting Test (FIST), and Modified Functional Reach Test (mFRT). Functional ability and independence were assessed with the Spinal Cord Independence Measure (SCIM-III).</p><p><strong>Results: </strong>The analysis of the relationship between spinal alignment and trunk isometric muscle strength revealed a moderate positive correlation between trunk extensor strength and trunk length (r_s = -0.502) and a moderate negative correlation with vertebral rotation (+max) (r_s = -0.555). Also, a moderate negative correlation was found between trunk flexor strength and vertebral rotation (+max) (r_s = -0.480). No correlation was found between the spinal alignment and balance and functionality.</p><p><strong>Conclusions: </strong>This study shows that trunk extensor strength is significantly associated with spinal alignment parameters, such as vertebral rotation and trunk length, in individuals with spinal cord injury. However, no relationship was found between spinal alignment and sitting balance or functional performance. These results suggest that combining postural assessment and trunk strengthening in rehabilitation may help improve posture and mobility.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation goals for hand and upper extremity function after cervical spinal cord injury: A retrospective study.","authors":"Tamara Selman, Rachel Holland, Julia M Harrison, Ben Keefe, Edman Abukar, Sonja McVeigh, Alexander Whelan, Emily M Krauss","doi":"10.1080/10790268.2025.2557080","DOIUrl":"https://doi.org/10.1080/10790268.2025.2557080","url":null,"abstract":"<p><strong>Context: </strong>Patient goals are critical when determining surgical options for restoration of hand function in spinal cord injury (SCI).</p><p><strong>Objective: </strong>We characterized the discussion of goals specific to hand function during acute rehabilitation admission at a single Canadian center following cervical SCI, before the introduction of a hand surgery program for the tetraplegia population.</p><p><strong>Methods: </strong>A retrospective chart review of a single-center adult rehabilitation hospital from 2012 to 2022 of traumatic cervical SCI admissions was conducted. Charts were reviewed for discussion of specific goals that require hand function and recorded for analysis. Hand function goals were categorized and mapped to Canadian Occupational Performance Measures (COPM) domains, and patterns were analyzed on a population level.</p><p><strong>Results: </strong>Over ten years, 134 individuals with acute traumatic SCI were admitted, 88 met study inclusion criteria with documented goals requiring hand function, and 32 unique goal types were recorded. The most common goal domain across all AIS categories was functional mobility. Motor complete patients primarily had self-care goals. Leisure and productivity goals were overall rarely captured. Most documented goals focused on basic activities of daily living (ADLs).</p><p><strong>Conclusions: </strong>We observed a historical emphasis on hand function goals of ADLs, but not capturing the depth and breadth of other domains where hand function is essential. With the development of hand surgery programs in the tetraplegia population, standardized tools and detailed discussion of hand function goals may better capture patient priorities, including productivity and leisure, and improve our discussion of functional outcomes when evaluating the success of surgery.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The combined effects of rTMS and upper extremity robotic therapy for restoring upper extremity function in patients with spinal cord injury: A randomized controlled trial.","authors":"Jung Eun Lim, Hye-Jin Lee, Duk Youn Cho, Onyoo Kim","doi":"10.1080/10790268.2025.2554019","DOIUrl":"https://doi.org/10.1080/10790268.2025.2554019","url":null,"abstract":"<p><strong>Context/objective: </strong>Non-invasive neuromodulation may be an effective treatment for stimulating motor and functional recovery of the upper extremities after spinal cord injury (SCI). We aimed to investigate the effects of combining repetitive transcranial magnetic stimulation (rTMS) with robotic therapy. We compared upper extremity function in patients who received rTMS and robot therapy to those who received sham rTMS and robot therapy.</p><p><strong>Design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>Rehabilitation center.</p><p><strong>Participants: </strong>Thirty patients with SCI were randomized into two groups: an intervention group (IG) receiving rTMS plus robotic therapy and a control group (CG) receiving sham rTMS with robotic therapy.</p><p><strong>Interventions: </strong>The IG received 15 sessions of combined rTMS and robotic therapy over 5 weeks (3 sessions per week), while the CG received sham rTMS with robotic therapy.</p><p><strong>Outcome measures: </strong>Functional assessments pre- and post-intervention included the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), grip strength, pain levels, the modified Ashworth scale (MAS), and the Korean version of the Spinal Cord Independence Measure III (KSCIM-III).</p><p><strong>Results: </strong>Both groups showed significant post-treatment improvements in GRASSP domains (Strength, Sensation, Quantitative Prehension), with no significant intergroup differences. Grip strength, pain, and MAS scores improved in both groups without significant differences. In KSCIM-III, the IG showed significant gains in feeding and grooming, while the CG significantly improved in wheelchair-to-toilet/tub transfers.</p><p><strong>Conclusions: </strong>This study suggests that combining rTMS with upper extremity robotic therapy may have potential benefits for upper extremity function in patients with SCI. However, the addition of rTMS did not demonstrate clear superiority over robotic therapy alone. Further research with larger cohorts and optimized protocols is warranted to clarify its therapeutic value.<b>Trial registration:</b> Clinical Research Information Service, Republic of Korea identifier: KCT0004443.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":1.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty assessment in acute spinal cord injury surgery: Insights from the risk analysis index and broader neurosurgical context.","authors":"Omar Sbaih, Stefan Prvulovic, Shubhang Bhalla, Michael Covell, Christian A Bowers","doi":"10.1080/10790268.2025.2554011","DOIUrl":"https://doi.org/10.1080/10790268.2025.2554011","url":null,"abstract":"<p><p><b>Context:</b> Frailty has emerged as a key determinant of surgical outcomes, surpassing chronological age and comorbidity indices in prognostic value. The Risk Analysis Index (RAI), a multidomain frailty assessment tool, has shown strong predictive utility in spine surgery. Recent analyses specifically evaluated RAI in urgent surgical intervention for acute traumatic spinal cord injury (SCI), where timely outcome prediction is critical.<b>Findings:</b> In 10,000 SCI patients, frailty demonstrated a graded association with adverse 30-day outcomes. Mortality increased from 1.5% in robust individuals (RAI 0-20) to 11.8% in very frail patients (RAI >41), paralleled by increased non-home discharge and complications. The RAI consistently outperformed the modified frailty index (mFI-5), achieving c-statistics >0.72 for mortality and discharge outcomes. These results align with broader spine surgery literature, where the RAI has demonstrated superior discrimination compared to mFI-5 across elective cases, degenerative conditions, spinal deformity, and tumor surgery. Predictive strength reflects incorporation of functional and nutritional domains, which comorbidity-based indices miss. Importantly, RAI-based analyses have identified high-risk subsets even in lower-risk cohorts, such as anterior cervical discectomy, underscoring its generalizability.<b>Conclusion/Clinical Relevance:</b> The RAI reliably predicts short-term outcomes after SCI and across diverse spine surgery populations, outperforming simpler frailty measures. Its integration into neurosurgical assessment enables more accurate risk stratification, informs perioperative management, and supports shared decision-making. Routine use of the RAI may guide multidisciplinary optimization and resource allocation, and future interventions targeting frail patients may leverage its predictive capacity to improve outcomes.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-4"},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-frequency antidromic pelvic neuromodulation as a potential enhancer of recovery after spinal cord injury: hypothetical promotion of spinal Renshaw cells and corticovagal plasticity.","authors":"Marc Possover, Henrique Mendonca Abrao","doi":"10.1080/10790268.2024.2414146","DOIUrl":"https://doi.org/10.1080/10790268.2024.2414146","url":null,"abstract":"<p><strong>Objectives: </strong>In all patients, LFAS To explore the effect of low frequency antidromic stimulation (LFAS) of the pelvic somatic serves on intestinal peristalsis and heart rate in individuals with chronic spinal cord ird injury and spasticity.</p><p><strong>Setting: </strong>Hospital in Zürich, Switzerland.</p><p><strong>Methods: </strong>Ten consecutive patients underwent laparoscopic implantation of neuroprosthesis to sciatic/femoral nerves - the LION procedure: 5 patients with Thoracic (T) SCI AIS A, 1 patient T4 AIS C, 1 patient C3 AIS A, and 3 patients with cervical injury (AIS B/C). At the end of the implantation, intestinal peristalsis observed laparoscopically was recorded before and after starting with LFAS at 10 Hz. On the first postoperative day, heart rates before and after the beginning of the same LFAS were checked. Statistical analyses were performed using a paired Student's <i>t</i>-test.</p><p><strong>Results: </strong>LFAS Of the pelvic somatic nerves induced strong peristalsis in the small bowel and ascending/transverse colon without affecting the urinary bladder or descending colon/rectum, and a significant slowing of the heart rate in 8 patients with an overall reduction from 96.3 bpm (bpm) (P < 0.01).</p><p><strong>Conclusions: </strong>This case series study reports on the effect of continuous antidromic pelvic neuromodulation (CAPN) on extraspinal somatic and autonomic pathways in chronic SCI. The discussion poses a novel hypothesis about the effect of CAPN on spinal pathways and activation of corticospinal pathways and neuroplasticity via the Renshaw cells. A rationale is provided for CAPN-induced activation of the vagus nerve (VN) and the existence of anastomotic pathways between the lumbosacral somatic nerves and the VN, and the capability of an activation of the motor functions of the VN. A second hypothesis is posed for the activation of cortico-vagal plasticity that may improve recovery after complete SCI by combining CAPN with neuromodulation of the VN.Trial registration NCT03441256.</p>","PeriodicalId":50044,"journal":{"name":"Journal of Spinal Cord Medicine","volume":" ","pages":"1-7"},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}