![]() Still, electrical stimulation has been demonstrated to effect persistent changes in connectivity and synaptic strength of stimulated circuits in experimental models of the intact and injured CNS. However, despite documented improvements in functional recovery from a combination of rehabilitation with neural stimulation, rehabilitation alone remains the only therapy of standard practice for chronic neural injury 4, 5, 6, 7. The concept of electrical stimulation as a potential therapy for central nervous system (CNS) trauma has gained traction in recent years. Yet, they have garnered notably less attention compared to interventions that target lower limb functions, such as standing and walking. Hand and arm recovery is the top ranked treatment priority for those suffering from cervical SCI 2, 3, thus interventions to target hand and arm recovery are of critical importance. Paralysis of the hand is a common condition following cervical spinal cord injury (SCI), brain trauma, or stroke 1. Further, electrophysiology mapping of the ventral spinal cord revealed the ventral approach was suitable to target muscle groups of the rat forelimb and, at a single electrode lead position, different stimulation protocols could be applied to achieve unique activation patterns of the muscles of the forelimb. Our approach allowed for preservation of mobility following surgery and was suitable for long term stimulation strategies in awake, freely functioning animals. We therefore designed a novel approach for epidural stimulation of the rat spinal cord using a wireless stimulation system and ventral electrode array. Penetrating wire electrodes have been explored in rodent and pig models and, while they have proven beneficial in the injured spinal cord, the negative aspects of spinal parenchymal penetration (e.g., gliosis, neural tissue damage, and obdurate inflammation) are of concern when considering therapeutic potential. They suggest that the presence of SI change in otherwise mild CSM may not necessarily warrant an operative intervention.Electrical stimulation of the cervical spinal cord is gaining traction as a therapy following spinal cord injury however, it is difficult to target the cervical motor region in a rodent using a non-penetrating stimulus compared with direct placement of intraspinal wire electrodes. have found that among patients with clinically mild CSM with SI change on MRI, only 44% had neurologic deterioration or undergone surgery over the course of 10 years. Instead, in a retrospective study, Oshima et al. However, there was no significant correlation between the SI change and severity of clinical symptoms or deterioration of myelopathy, or exacerbation of CSM in patients managed conservatively. A correlation of worse outcomes at 6 months and 12 months with presence of hypointensity on T1-weighted imaging (T1WI), hyperintensity on T2WI, area on T2WI, sagittal extent on T2WI were reported. There was a significant correlation of SI change and presence of clinical myelopathy and a correlation of SI ratio with recovery rate. This change in intensity is known to be associated with more severe disease and a worse prognosis. T1 hypointensity should be considered a sign of more advanced disease. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). ![]() However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. Myelopathic signs are useful for the clinical diagnosis of CSM. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. The natural course of patients with cervical stenosis and signs of myelopathy is quite variable. ![]()
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