Invited Review: Neuromuscular consequences of spinal cord injury: New mechanistic insights and clinical considerations-Article

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The document delves into the neuromuscular impact of spinal cord injury (SCI) and its focus on lower motor neurons (LMNs). Recent findings suggest that damage to LMNs plays a crucial role in paralysis after SCI, alongside disruptions in the corticospinal tract. The review outlines how SCI affects motor units by reducing their numbers, disrupting signal transmission, force generation, and excitability. It highlights the relevance of these insights for innovative treatments like nerve transfer surgery for SCI and stresses the importance of electrodiagnostic assessments to evaluate LMN health and identify suitable candidates for such surgeries. Recognizing LMN lesions is vital for surgical planning and post-operative care, underscoring the necessity for detailed electrodiagnostic evaluations to differentiate between upper and LMN lesions and inform prognosis and treatment decisions for SCI patients undergoing nerve transfer surgery. The document concludes by advocating for further research on how motor units adapt post-SCI to enhance clinical outcomes. Additionally, it discusses studies on electromyography (EMG) and nerve transfer surgeries for SCI patients, underlining the significance of LMN health in predicting prognosis and treatment success. The impact of LMN lesions on muscle strength recovery and long-term outcomes in SCI patients is explored, emphasizing the importance of intact LMN function for optimal improvement. The document underlines the need for comprehensive electrodiagnostic evaluations to distinguish between upper and lower motor neuron lesions during nerve transfer surgeries for SCI patients, suggesting the potential mechanism of transsynaptic degeneration causing electrodiagnostic abnormalities below the level of SCI. It concludes by proposing that a deeper understanding of LMN adaptations post-SCI could lead to enhanced therapeutic approaches and improved patient outcomes.

Keywords

neuromuscular impact

spinal cord injury

lower motor neurons

paralysis

corticospinal tract

motor units

nerve transfer surgery

electrodiagnostic assessments

LMN lesions

electromyography