Effect of Lumbar Spinal Point Injection on Sitting Function in Children with Cerebral Palsy

Objective: To observe the effect of lumbar spinal point injection on sitting function in children with cerebral palsy. Method: Sixty-two children with post-confirmed cerebral palsy were randomly divided into control group and treatment group, 31 each. The control group was given conventional rehabilitation treatment, and the treatment group was given lumbar chiropspinal acupoint injection on the basis of the treatment method of the control group. After 3 consecutive courses of treatment, the sitting score of the two groups before and after treatment (GMFM88) was used to evaluate the sitting score before and after treatment. Outcome: Before treatment, the two groups were evaluated and the differences were not statistically significant (p > 0.05), which was comparable. The two groups (GMFM88) after treatment had significantly increased the differential values, and the difference was statistically significant compared with the same group before treatment (p Conclusion: Conventional rehabilitation combined with lumbar spinal point injection can effectively improve the sitting motor function of children with cerebral palsy.

Muscle Strength, Lumbar Curve, Fear of Movement and Functional Disability among Patients with Lumbar Disc Herniation: A Review

Introduction: Lumbar disc herniation (LDH) refers to the rupture of the fibrous annulus of the intervertebral discs. Lumbar curvature may lead to the occurrence of lumbar disc degeneration. Fear of movement may worsen their disc herniation and cause further pain and injury. LDH conditions impact the individuals’ quality of life, to explore the relationship between lumbar curve, muscle strength, fear of movement and functional disability among patients with LDH. Methods: An electronic search was conducted on PubMed, Medline, Science Direct, Springerlink, Google Scholar and a hand search from reference lists was reviewed. Publications were included in human studies, patients 25 - 85 years of age, original studies and published in English language journals from January 2002 to December 2023. Result: In total, 64 articles were researched through the online search engines, and 9 papers were found through manual searches of reference lists. As a result, a total of 11 articles were included for the purpose of this review. The comprehensive analysis revealed the presence of eight cross-sectional studies, two retrospective studies and one experimental study. A minimum of 25 participants and a maximum of 360 participants were included. Ten studies included both genders, only one studies included healthy adults and patients with LDH but these studies didn’t mention gender. Results showed that the factors influencing LDH can be categorized into non-modifiable factors, such as gender, age, height or others. Modifiable factors included increased BMI, DM, smoking, alcohol, employment status, lifestyle and health problems or psychology. Conclusion: Females with greater VASC may be at risk of LDH. The lumbar extensor muscles indicated a localized disc herniation or nerve root pathology in patients with LDH. The fear of movement may lead to psychological consequences and reduce functional disability among patients with LDH.

Reorganization of spinal neural circuitry and functional recovery after spinal cord injury

The ability of the adult central nervous system to reorganize its circuits over time is the key to understand the functional improvement in subjects with spinal cord injury （SCI）. Adaptive changes within spared neuronal circuits may occur at cortical, brainstem, or spinal cord level, both above and below a spinal lesion （Bareyre et al., 2004）. At each level the reorganization is a very dynamic process, and its degree is highly variable, depending on several factors, including the age of the subject when SCI has occurred and the rehabilitative therapy. The use of electrophysiological techniques to assess these functional changes in neural networks is of great interest, because invasive methodologies as employed in preclinical models can obviously not be used in clinical studies.

Neural prostheses for restoring functions lost after spinal cord injury

Spinal cord injury（SCI）is a debilitating condition that affects more than 2.5 million individuals worldwide（Thuret et al.,2006）.In addition to its devastating effects on the individual,this disease is a heavy burden to the society in terms of health care costs, which are estimated in billions of dollars annually in most developed countries （Cadotte and Fehlings, 2011）.

Fine motor skill training enhances functional plasticity of the corticospinal tract after spinal cord injury

Following central nervous system injury, axonal sprouts form distal to the injury site and extend into the denervated area, reconstructing neural circuits through neural plasticity. How to facilitate this plasticity has become the key to the success of central nervous system repair. It remains controversial whether fine motor skill training contributes to the recovery of neurological function after spinal cord injury. Therefore, we established a rat model of unilateral corticospinal tract injury using a pyramidal tract cutting method. Horizontal ladder crawling and food ball grasping training procedures were conducted 2 weeks before injury and 3 days after injury. The neurological function of rat forelimbs was assessed at 1, 2, 3, 4, and 6 weeks after injury. Axon growth was observed with biotinylated dextran amine anterograde tracing in the healthy corticospinal tract of the denervated area at different time periods. Our results demonstrate that compared with untrained rats, functional recovery was better in the forelimbs and forepaws of trained rats. The number of axons and the expression of growth associated protein 43 were increased at the injury site 3 weeks after corticospinal tract injury. These findings confirm that fine motor skill training promotes central nervous system plasticity in spinal cord injury rats.

Rebuilding motor function of the spinal cord based on functional electrical stimulation

Rebuilding the damaged motor function caused by spinal cord injury is one of the most serious challenges in clinical neuroscience.The function of the neural pathway under the damaged sites can be rebuilt using functional electrical stimulation technology.In this study,the locations of motor function sites in the lumbosacral spinal cord were determined with functional electrical stimulation technology.A three-dimensional map of the lumbosacral spinal cord comprising the relationship between the motor function sites and the corresponding muscle was drawn.Based on the individual experimental parameters and normalized coordinates of the motor function sites,the motor function sites that control a certain muscle were calculated.Phasing pulse sequences were delivered to the determined motor function sites in the spinal cord and hip extension,hip flexion,ankle plantarflexion,and ankle dorsiflexion movements were successfully achieved.The results show that the map of the spinal cord motor function sites was valid.This map can provide guidance for the selection of electrical stimulation sites during the rebuilding of motor function after spinal cord injury.

Functional changes after spinal lesions: implications for interventions

We have known for many years that the spinal cord can generate some basic locomotor outputs under specific experimental conditions without any input from the brain or the periphery（Stuart and Hultborn,2008）.However,when inputs from the brain are lost following spinal cord injury（SCI）,the mammalian spinal cord is unable to generate normal,goal-directed locomotor outputs.

Extrinsic inhibitors in axon sprouting and functional recovery after spinal cord injury

The limited axonal growth after central nervous system （CNS） injury such as spinal cord injury presents a major challenge in promoting repair and recovery. The literature in axonal repair has focused mostly on frank regeneration of injured axons. Here, we argue that sprouting of uninjured axons, an innate repair mech- anism of the CNS, might be more amenable to modulation in order to promote functional repair. Extrinsic inhibitors of axonal growth modulate axon sprouting after injury and may serve as the first group of therapeutic targets to promote functional repair.

Electrophysiological functional recovery in a rat model of spinal cord hemisection injury following bone marrow-derived mesenchymal stem cell transplantation under hypothermia

Following successful establishment of a rat model of spinal cord hemisection injury by resecting right spinal cord tissues, bone marrow stem cells were transplanted into the spinal cord lesions via the caudal vein while maintaining rectal temperature at 34 ± 0.5°C for 6 hours （mild hypothermia）. Hematoxylin-eosin staining showed that astrocytes gathered around the injury site and formed scars at 4 weeks post-transplantation. Compared with rats transplanted with bone marrow stem cells under normal temperature, rats transplanted with bone marrow stem cells under hypothermia showed increased numbers of proliferating cells （bromodeoxyuridine-positive cells）, better recovery of somatosensory-evoked and motor-evoked potentials, greater Basso, Beattie, and Bresnahan locomotor rating scores, and an increased degree of angle in the incline plate test. These findings suggested that hypothermia combined with bone marrow mesenchymal stem cells transplantation effectively promoted electrical conduction and nerve functional repair in a rat model of spinal cord hemisection injury.

Locally transplanted enteric glia improve functional and structural recovery in a rat model of spinal cord injury

BACKGROUND： We have previously reported that adult enteric glia （EG） facilitate the growth of transected dorsal root axons into the uninjured spinal cord to form functional connections with their targets. OBJECTIVE： The present study investigated the effects of EG on spinal cord function, tissue injury, and axonal regeneration following transplantation into injured rat spinal cords, according to histological and functional outcomes. DESIGN, TIME AND SETTING： A randomized controlled animal experiment was performed at McMaster University, Canada from January 2006 to March 2008. MATERIALS： EG were isolated from rat intestine, METHODS： One week following spinal cord crush, female Wistar rats were injected with an EG suspension （2 μL, 1 × 10^5/μL, n = 10） or with the same volume of fresh culture medium alone （control animals, n = 11）. The third group did not receive any injection following laminectomy and served as the sham-operated controls （n = 5）. MAIN OUTCOME MEASURES： Behavior was tested prior to transplantation and weekly following transplantation, with nine behavioral examinations in total. Open field, hind limb placement response foot orientation response, and inclined plane test were utilized. Immediately following the final behavioral examination, spinal cord T9 to L1 segments were harvested for immunohistochemical and hematoxylin-eosin staining to determine astroglial scarring, axonal regeneration and spinal cord lesion size. RESULTS： Rats with EG transplantation exhibited significantly better locomotor function with reduced tissue damage, compared with the control rats. Cystic cavities were present 2 months after injury in spinal cords from both control groups. In contrast, rats injected with EG did not present with cystic lesions. In addition, the injury site consisted of cellular material and nerve fibers, and axonal regeneration was apparent, with dense labeling of neurofilament-positive axons within the injury site. Moreover, regenerating axons were intimately associated with transplanted EG. CONCLUSION： These data indicated that EG enhanced functional improvement, which was associated with reduced tissue damage and axonal regeneration following transplantation into injured spinal cords.

Early Functional Outcome of Posterior Spinal Decompression for Lumbar Spinal Stenosis at a Tertiary Health Institution, South East Nigeria

Background: Surgical treatment of lumbar spinal stenosis by posterior spinal decompression may be indicated if non-surgical management for the symptoms of low back and lower limbs radicular pains is unsuccessful and/or in patients with persisting or worsening neurological deficits. It has been reported to be an effective treatment modality in well selected patients. This procedure is however not without possible complications which can adversely affect the outcome of treatment in the affected patients. This prospective study was therefore undertaken to evaluate the early functional outcome of posterior spinal decompression for lumbar spinal stenosis at our health institution. Method: All patients with symptomatic lumbar spinal stenosis admitted for posterior spinal decompression and who met the inclusion criteria were recruited with their written informed consent. The patients’ pain severity and functional disability were assessed preoperatively with visual analogue scale (VAS) and Oswestry Disability Index (ODI). The VAS and ODI were also used to reassess the patients postoperatively, at 2 weeks, 6 weeks and 12 weeks respectively. All intraoperative and/or postoperative complications were documented and the results were analyzed. Results: The patients’ mean preoperative lower back pain and leg pain VAS score was 8.26 ± 1.46 while the mean preoperative ODI was 62.4% ±13.56. The commonest combination of spinal decompressive procedure done in the patients was laminectomy + foraminotomy in 10 (25% patients). The most common decompressed spinal level was L4/L5 (89.7%);while almost equal number of patients had either one spinal level or two-spinal level decompression (43.6% and 46.1% respectively). Postoperative pain assessment showed a mean VAS of 3.79 ± 1.15, 2.55 ± 1.27 and 2.00 ± 1.41 at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). Functional outcome assessment with ODI was 34% ± 11.79%, 24% ± 10.75% and 18.12% ± 10.61% at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). The commonest surgical complication seen was dura tear which occurred in nine patients (23.1%). Conclusion: There was significant reduction in low back and radicular pains with consequent functional improvement in majority of the patients who had posterior spinal decompression for lumbar spinal stenosis at our health institution. There were few complications of which dura tear was the commonest.

Promoting functional recovery by inhibition of repulsive guidance molecule-a after spinal cord injury

Spinal cord injury（SCI）leads to permanent disability with motor and sensory dysfunctions.The mature mammalian central nervous system（CNS）possesses a limited capacity to regenerate/regrow after injury.

Propriospinal interneurons in the spotlight for anatomical and functional recovery after spinal cord injury

Spinal cord injury（SCI）with consecutive paralysis below the lesion level is a severe disorder affecting the patient for the rest of his or her life.So far,there is no known fundamental intervention strategy for efficiently helping those patients regain their motor abilities,despite intense research in this area.Thus,effective treatment for those patients is still an open question. A spinal cord injury is accompanied by a prima- ry, severe and irreversible neuronal cell death in the trauma region, fol- lowed by a secondary extensive cell necrosis in the lesion surrounding areas. Nevertheless, recent studies indicate that regeneration after spinal cord injury could be possible if three substantial steps are fulfilled： （1） reduction of the inhibitory environment at the SCI lesion site, （2） iden- tification of a neural substrate to establish new spinal circuits, and （3） support of these circuits to form permanent, functional motor, sensory, or autonomic connections （Dru and Hoh, 2015）.

Anatomical changes in the somatosensory system after large sensory loss predict strategies to promote functional recovery after spinal cord injury

Among cases of spinal cord injury are injuries involving the dorsal column in the cervical spinal cord that interrupt the major cutaneous afferents from the hand to the cuneate nucleus（Cu）in the brainstem.Deprivation of touch and proprioceptive inputs consequently impair skilled hand use.

Functional evaluation using several evoked spinal cord potentials in elderly patients with cervical spondylotic myelopathy

BACKGROUND ： The recordings of evoked spinal cord potentials following epidural spinal cord stimulation are thought to be generated by volleys traversing the dorsal column pathway, and it may not directly reflect conduction defects in corticospinat tracts of cervical spinal cord. To our knowledge there has been few report using several evoked spinal cord potentials in function evaluation of the cervical spinal cord in eldedy patients with cervical spondylotic myelopathy （CSM）. OBJECTIVE： To investigate the function states of the cervical spinal cord in elderly patients with CSM and explore its pathophysictogic mechanism. DESIGN： Case observation SETTING ： Department of Orthopedics for the aged, Shenzhen Pingle Hospital of Orthopedics. Department of Orthopedic Surgery, Yamaguchi University School of Medicine. PARTICIPANTS ： A total of 23 eldedy patients with CSM who received treatment in the Department of Orthopedic Surgery, Yamaguchi University School of Medicine of Japan from January 2003 to February 2004 were enrolled in this study. Inclusive criteria： ① Multiple intervertebral levels of cervical spinal cord compression confirmed by MRI, e.g. 3 or more than 3 levels of compressin. ② Age ≥ 70 years old. ③ Numbness and sensory disturbance in the upper limbs and showed hyperreflexia in the lower limbs. Exclusive criteria： Patients with abnormal motor and sensory nerve conduction velocities in both upper and lower limbs were excluded. METHODS： Evoked spinal cord potentials （ESCPs） following transcranial electric stimulation （TCE-ESCPs）, epidural spinal cord stimulation （SpinaI-ESCPs） and median nerve stimulation （MN-ESCPs） were recorded in 23 patients from posterior epidural space intreoperatively. The abnormalities of TCE-ESCPs were defined as attenuation of amplitude of the D wave. The most cranial intervertebral level showing abnormal TCE-ESCPs with a marked reduction in size of the negative peak （reduction of over 50%） was considered as the upper level of the spinal cord lesion with respect to the corticospinal tract in white matter. The abnormalities of SpinaI-ESCPs were defined as marked reduction in the size of negative peak （reduction of over 50%）. The most caudal intervertebral level showing abnormal SpinaI-ESCPs was considered as the lower level of the spinal cord lesion with respect to the dorsal column pathway in white matter. The abnormalities of MN-ESCPs were defined as attenuation of the N13 amplitude,which was considered as the lesion level of the spinal cord with respect to the dorsal horn in gray matter. Radiological investigation： Lateral view of plain X-ray films was obtained in flexion and extension of the cervical spine. Instability of the cervical intervertebral level was determined as horizontal displacement of the vertebral body of over 3 mm. MAIN OUTCOME MEASURES ： The results of examination of TCE-ESCPs, SpinaI-ESCPs and MN-ESCPs in el- dedy patients with CSM. RESULTS： The 23 eldedy patients with CSM were participated in the result analysis. ①TCE-ESCPs： The impairment of the corticospinal tract in white matter at single intervertebral level was revealed in 18 of 23 patients by recordings of TCE-ESCPs （sensitivity 78%）. In the 18 patients, the lesion level was shown at the up- per cervical segment in 14 patients （C3-4n=10 and C4-5n=4）, and at the lower cervical segment in 4 patients （C5-6n=4）. ②Spinal-ESCPs： The impairment of the dorsal column pathway of white matter at single intervertebral level was revealed in 17 of 23 patients, by recordings of Spinal-ESCPs （sensitivity 74%）. In the 17 patients, the lesion level was presented at the upper cervical segment in 14 patients （C3-4n=10 and C4-5n=4）, and at the lower cervical segment in 3 patients （C5-6 n=3）. ③MN-ESCPs： All patients revealed abnormal MN-ESCPs at one or more intervertebral levels （sensitivity 100%）. The impairment at single intervertebral level was demonstrated in 17 patients, and the impairment at multiple intervertebral levels was shown in 4 patients （3 patients at the C3-4, C4-4, and C5-4~6, and one patient at the C4-5, C5-6, and C6-7）. ④Radiological findings： The Instability of the intervertebral level at the C3-4 or C4-5 motion segment was seen in 15 patients, with a total of 20 levels, and where 10 were at the C3-4 intervertebral level and 5 were at the C3-4, C4-5 intervertebral level. CONCLUSION ： The results suggest that in most elderly patients with CSM who have multiple intervertebral level compressions of the cervical spinal cord on MRI, white matter is impaired at the single cervical intervertebral level, and not only the dorsal column pathway, but also the corticospinal tract can be affected. Combined the findings of radiography, the excessive motion and instability of the C3-4 or C4-5 intervertebral level plays an important role in inducing the long tract lesion in elderly patients with CSM.

Early methylprednisolone impact treatment for sensory and motor function recovery in patients with acute spinal cord injury A self-control study

BACKGROUND： For the treatment of spinal cord injury, any pathological changes of the injured tissue should be primarily corrected or reversed. Any remaining fibrous function and neurons with intact structure should be retained, and the toxic substances caused by ischemia-hypoxia following spinal cord injury, should be eliminated to create a favorable environment that would promote neural functional recovery. OBJECTIVE： This study was designed to investigate the effects of the impact of early methylprednisolone-treatment on the sensory and motor function recovery in patients with acute spinal cord injury. DESIGN： A self-control observation. SETTING： Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China. PARTICIPANTS： Forty-three patients with acute spinal cord injury were admitted to the Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, between October 2005 and September 2007. These patients were recruited for the present study. The patients comprised 33 males and 10 females, and all met with the inclusive criteria namely, the time between suffering from acute spinal cord injury and receiving treatment was less than or equal to eight hours. METHODS： According to the protocol determined by the State Second Conference of Acute Spinal Cord Injury of USA, all patients received the drop-wise administration of a 30-mg/kg dose of methylprednisolone （H200040339, 500 mg/bottle, Pharmacia N.V/S.A, Belgium） for 15 minutes within 8 hours post injury. After a 45-minute interval, methylprednisolone was administered at 5.4 mg/kg/h for 23 hours. MAIN OUTCOME MEASURES： Prior to and post treatment, acupuncture sense and light touch scoring were performed at 28 dermatomic area key points, including occipital tuberosity and supraclavicular fossa. At the same time, motor scoring of key muscles among 10 pairs of sarcomeres was also performed. RESULTS： All 43 patients participated in the final analysis. There was no significant difference of sensory and motor scores in patients with complete acute spinal cord injury between prior to and post methylprednisolone impact treatment （P 〉 0.05）. The motor score was significantly decreased in patients with incomplete acute spinal cord injury post methylprednisolone impact treatment （P 〈 0.01 ）. CONCLUSION： Early methylprednisolone impact may improve the motor function of patients with incomplete acute spinal cord injury. However, it has no influences on patients with complete acute spinal cord injury.

Exercise promotes motor functional recovery in rats with corticospinal tract injury:anti-apoptosis mechanism

Studies have shown that exercise interventions can improve functional recovery after spinal cord injury, but the mechanism of action remains unclear. To investigate the mechanism, we estab-lished a unilateral corticospinal tract injury model in rats by pyramidotomy, and used a single pellet reaching task and horizontal ladder walking task as exercise interventions postoperatively. Functional recovery of forelimbs and forepaws in the rat models was noticeably enhanced after the exercises. Furthermore, TUNEL staining revealed signiifcantly fewer apoptotic cells in the spinal cord of exercised rats, and western blot analysis showed that spinal cord expression of the apopto-sis-related protein caspase-3 was signiifcantly lower, and the expression of Bcl-2 was signiifcantly higher, while the expression of Bax was not signiifantly changed after exercise, compared with the non-exercised group. Expression of these proteins decreased with time after injury, towards the levels observed in sham-operated rats, however at 4 weeks postoperatively, caspase-3 expression remained signiifcantly greater than in sham-operated rats. The present ifndings indicate that a re-duction in apoptosis is one of the mechanisms underlying the improvement of functional recovery by exercise interventions after corticospinal tract injury.

Methylprednisolone promotes recovery of neurological function after spinal cord injury： association with Wnt/β-catenin signaling pathway activation

Some studies have indicated that the Wnt/β-catenin signaling pathway is activated following spinal cord injury, and expression levels of specific proteins, including low-density lipoprotein receptor related protein-6 phosphorylation, β-catenin, and glycogen synthase kinase-3β, are significantly altered. We hypothesized that methylprednisolone treatment contributes to functional recovery after spinal cord injury by inhibiting apoptosis and activating the Wnt/β-catenin signaling pathway. In the current study, 30 mg/kg methylprednisolone was injected into rats with spinal cord injury immediately post-injury and at 1 and 2 days post-injury. Basso, Beattie, and Bresnahan scores showed that methylprednisolone treatment significantly promoted locomotor functional recovery between 2 and 6 weeks post-injury. The number of surviving motor neurons increased, whereas the lesion size significantly decreased following methylprednisolone treatment at 7 days post-injury. Additionally, caspase-3, caspase-9, and Bax protein expression levels and the number of apoptotic cells were reduced at 3 and 7 days post-injury, while Bcl-2 levels at 7 days post-injury were higher in methylprednisolone-treated rats compared with saline-treated rats. At 3 and 7 days post-injury, methylprednisolone up-regulated expression and activation of the Wnt/β-catenin signaling pathway, including low-density lipoprotein receptor related protein-6 phosphorylation, β-catenin, and glycogen synthase kinase-3β phosphorylation. These results indicate that methylprednisolone-induced neuroprotection may correlate with activation of the Wnt/β-catenin signaling pathway.

Deferoxamine improves neurological function in a rat model of experimental spinal cord injury

A rat model of spinal cord injury was established using modified Allen＇s method and treated with the ferric iron-chelating agent, deferoxamine. Hematoxylin-eosin, Nissl and Perl＇s Prussian blue staining, at 7 14 days following spinal cord injury, showed that following deferoxamine treatment, glial cells proliferation increased significantly, nerve cell morphology was improved and hemosiderin was significantly reduced in the injury region. At 1 56 days following injury, Basso, Beattie, and Bresnahan Locomotor Rating Scale scores were increased, while latencies of somatosensory-evoked potentials and motor-evoked potentials were decreased. Results demonstrate that deferoxamine can promote neurological functional recovery after experimental spinal cord injury in rats.

Improvement of neurological function in rats with spinal cord injury after the transplantation of neural stem cells directly differentiated from bone marrow mesenchymal stem cells

Objective To study the effect and mechanism of neurological function recovery in rats with spinal cord injury ( SCI) rats after transplantation of neural stem cells which are directly differentiated from bone marrow mesenchymal stem cells ( BMSC ) ,and to investigate the suitable engraftment time. Methods BMSC at 3rd passage were differentiated into neural stem cells ( NSC) , and immunofluorescence staining was used to