Lateral Corticospinal Tract and Dorsal Column Damage: Predictive Relationships With Motor and Sensory Scores at Discharge From Acute Rehabilitation After Spinal Cord Injury.
Andrew C Smith, Denise R O'Dell, Stephanie R Albin and 7 others
PMID 34371017WHAT IT FOUND
MRI measures of spared spinal cord tissue at about one month post-injury predicted motor and sensory function at discharge from rehab.
More spared lateral corticospinal tract tissue correlated with better leg strength, and more spared dorsal column tissue correlated with better light touch sensation.
Key findings
01Spared tissue in the lateral corticospinal tract, measured on standard MRI about one month after injury, significantly predicted ipsilateral lower extremity motor function at discharge from inpatient rehabilitation.
02Spared tissue in the dorsal column significantly predicted light touch sensory function at discharge from inpatient rehabilitation.
03Participants who converted from a motor complete to a motor incomplete injury grade had significantly greater spared lateral corticospinal tract tissue than those who remained motor complete.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The method requires extensive manual image processing and specialized training, making it currently impractical for routine clinical use. The study was retrospective, so variables like rehabilitation intensity and timing of surgery were not available for analysis. There was a significant time gap (average 11 weeks) between the MRI and the functional assessment, during which neuroplastic changes could have occurred. The analysis did not separate light touch scores above and below the injury level, which may have weakened the sensory predictions. A ceiling effect in neurological recovery may have limited the ability to detect stronger relationships between tissue sparing and function.
Declared interests
The authors declared no conflicts of interest. The study was part of a larger NIH-funded parent project.
The easy way to misread this
Do not assume that a low percentage of spared lateral corticospinal tract tissue means a patient will have no voluntary motor recovery. The relationship was moderate, not strong, and some participants with little sparing still demonstrated voluntary lower limb activation.