Neural Regeneration Research ›› 2024, Vol. 19 ›› Issue (12): 2773-2784.doi: 10.4103/NRR.NRR-D-23-01198

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Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury: a randomized controlled study

Hui Zhu1, James D. Guest2, Sarah Dunlop3, 4, Jia-Xin Xie5, Sujuan Gao6, Zhuojing Luo7, Joe E. Springer8, Wutian Wu9, Wise Young10, Wai Sang Poon11, Song Liu1, Hongkun Gao1, Tao Yu1, Dianchun Wang1, Libing Zhou9, Shengping Wu1, Lei Zhong1, Fang Niu1, Xiaomei Wang1, Yansheng Liu1, *, Kwok-Fai So9, *, Xiao-Ming Xu12, *, †#br#   

  1. 1Kunming Tongren Hospital, Kunming, Yunnan Province, China; 2Neurological Surgery, and the Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA; 3School of Biological Sciences, The University of Western Australia, Perth, WA, Australia; 4Minderoo Foundation, Perth, WA, Australia; 5Clinical Center for Spinal Cord Injury, Kunming General Hospital of Chengdu Military Command, Kunming, Yunnan Province, China; 6Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA; 7Department of Orthopedic Spinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China; 8Spinal Cord and Brain Injury Research Center, Department of Physical Medicine and Rehabilitation, University of Kentucky College of Medicine, Lexington, KY, USA; 9Guangdong-HongKong-Macau Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China; 10W. M. Keck Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ, USA; 11Neurosurgery Department, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administration Region, China; 12Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
  • Online:2024-12-15 Published:2024-03-30
  • Contact: Yansheng Liu, BS, 807354743@qq.com; Kwok-Fai So, PhD, hrmaskf@hku.hk; Xiao-Ming Xu, MD, PhD, xu26@iupui.edu.
  • Supported by:
    This study was supported by Hong Kong Spinal Cord Injury Fund (HKSCIF), China (to HZ).

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Abstract: For patients with chronic spinal cord injury, the conventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection, pressure sores, osteoporosis, and deep vein thrombosis. Surgery is rarely performed on spinal cord injury in the chronic phase, and few treatments have been proven effective in chronic spinal cord injury patients. Development of effective therapies for chronic spinal cord injury patients is needed. We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal cord injury to compare intensive rehabilitation (weight-bearing walking training) alone with surgical intervention plus intensive rehabilitation. This clinical trial was registered at ClinicalTrials.gov (NCT02663310). The goal of surgical intervention was spinal cord detethering, restoration of cerebrospinal fluid flow, and elimination of residual spinal cord compression. We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement, reduced spasticity, and more rapid bowel and bladder functional recovery than weight-bearing walking training alone. Overall, the surgical procedures and intensive rehabilitation were safe. American Spinal Injury Association Impairment Scale improvement was more common in T7–T11 injuries than in T2–T6 injuries. Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

Key words: chronic spinal cord injury, intensive rehabilitation, locomotor training, neurological recovery, surgical intervention, weight-bearing walking training