Pub Date : 2025-07-08DOI: 10.1038/s41393-025-01100-1
Carlotte Kiekens
Narrative review. To summarize the key messages presented during the ISCoS lecture at the 63rd ISCoS Annual Meeting, focusing on the global rehabilitation landscape, particularly regarding spinal cord injury. Not applicable. The review starts by providing an overview of the World Health Organization (WHO) Rehabilitation 2030 initiative. It then describes how to bridge evidence with rehabilitation practice and the role of CochraneRehab. Rehabilitation is contextualized within Rehabilitation 2030 and the World Health Assembly resolution on strengthening rehabilitation in health systems, highlighting significant policy shifts and technical tools developed by the WHO. The increase in global rehabilitation needs is outlined, citing estimates that nearly one-third of the global population could benefit from rehabilitation services. The role of CochraneRehab is discussed as a catalyst for enhancing primary research quality, evidence synthesis, and knowledge dissemination in rehabilitation. The review advocates for alternative study designs and innovative methodologies, including big data and artificial intelligence, to address persistent evidence gaps in spinal cord injury. In this pivotal moment for global rehabilitation, all stakeholders must unite to implement the WHA resolution and advocate for quality rehabilitation services in health systems and high-quality, innovative research methods to address evidence gaps like those in spinal cord injury care. This requires generating and disseminating evidence-based interventions and overcoming the inherent challenges of implementing these changes in everyday clinical practice.
{"title":"Empowering lives of people with SCI: unlocking the transformative potential of the World Health Assembly’s resolution on rehabilitation – the 2024 ISCoS lecture","authors":"Carlotte Kiekens","doi":"10.1038/s41393-025-01100-1","DOIUrl":"10.1038/s41393-025-01100-1","url":null,"abstract":"Narrative review. To summarize the key messages presented during the ISCoS lecture at the 63rd ISCoS Annual Meeting, focusing on the global rehabilitation landscape, particularly regarding spinal cord injury. Not applicable. The review starts by providing an overview of the World Health Organization (WHO) Rehabilitation 2030 initiative. It then describes how to bridge evidence with rehabilitation practice and the role of CochraneRehab. Rehabilitation is contextualized within Rehabilitation 2030 and the World Health Assembly resolution on strengthening rehabilitation in health systems, highlighting significant policy shifts and technical tools developed by the WHO. The increase in global rehabilitation needs is outlined, citing estimates that nearly one-third of the global population could benefit from rehabilitation services. The role of CochraneRehab is discussed as a catalyst for enhancing primary research quality, evidence synthesis, and knowledge dissemination in rehabilitation. The review advocates for alternative study designs and innovative methodologies, including big data and artificial intelligence, to address persistent evidence gaps in spinal cord injury. In this pivotal moment for global rehabilitation, all stakeholders must unite to implement the WHA resolution and advocate for quality rehabilitation services in health systems and high-quality, innovative research methods to address evidence gaps like those in spinal cord injury care. This requires generating and disseminating evidence-based interventions and overcoming the inherent challenges of implementing these changes in everyday clinical practice.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 9","pages":"477-481"},"PeriodicalIF":2.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An integrated bioinformatics data study. This study uses bioinformatics analysis to map the microglial landscape, investigate key signaling pathways, and reveal the molecular mechanisms that facilitate SCI recovery. Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. In this study, we performed an integrative bioinformatics analysis of single-cell RNA sequencing (scRNA-seq), spatial transcriptomic (ST), and bulk RNA-seq datasets from the Gene Expression Omnibus (GEO), utilizing R packages (Seurat, DESeq2, limma, GSVA) and the Enrichr platform. Single-cell and spatial transcriptomic profiling uncovered dynamic shifts in the microglial landscape post-SCI, characterized by the suppression of innate microglial populations alongside the expansion of reactive microglial subsets. Mechanistically, the TGFβ signaling pathway was identified as a critical regulator of innate microglial migration, promoting functional recovery after SCI. Conversely, reactive microglia exhibiting heightened Trem2 expression were found to exacerbate neuroinflammatory responses and drive neural cell death. These findings collectively indicate that targeting the dual regulatory axis of Trem2-mediated neuroinflammation and TGFβ-driven repair mechanisms may offer a synergistic therapeutic strategy to enhance functional recovery following spinal cord injury.
{"title":"Microglial landscape and signaling in spinal cord injury","authors":"Qingsheng Zhou, Jianchao Liu, Qiongxuan Fang, Chunming Zhang, Wei Liu, Yifeng Sun","doi":"10.1038/s41393-025-01103-y","DOIUrl":"10.1038/s41393-025-01103-y","url":null,"abstract":"An integrated bioinformatics data study. This study uses bioinformatics analysis to map the microglial landscape, investigate key signaling pathways, and reveal the molecular mechanisms that facilitate SCI recovery. Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. In this study, we performed an integrative bioinformatics analysis of single-cell RNA sequencing (scRNA-seq), spatial transcriptomic (ST), and bulk RNA-seq datasets from the Gene Expression Omnibus (GEO), utilizing R packages (Seurat, DESeq2, limma, GSVA) and the Enrichr platform. Single-cell and spatial transcriptomic profiling uncovered dynamic shifts in the microglial landscape post-SCI, characterized by the suppression of innate microglial populations alongside the expansion of reactive microglial subsets. Mechanistically, the TGFβ signaling pathway was identified as a critical regulator of innate microglial migration, promoting functional recovery after SCI. Conversely, reactive microglia exhibiting heightened Trem2 expression were found to exacerbate neuroinflammatory responses and drive neural cell death. These findings collectively indicate that targeting the dual regulatory axis of Trem2-mediated neuroinflammation and TGFβ-driven repair mechanisms may offer a synergistic therapeutic strategy to enhance functional recovery following spinal cord injury.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"418-425"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-04DOI: 10.1038/s41393-025-01102-z
Priya Iyer, Gary J. Farkas, Sherri L. LaVela, Shashivadan P. Hirani, Samford Wong
An eDelphi survey. To develop the Spinal Cord Injury (SCI) basic and extended nutrition datasets for adults with SCI for the International Spinal Cord Society (ISCoS). This international eDelphi study, administered in Australia, will be conducted virtually, overseen by a Research Advisory Group. An expert panel will be recruited internationally to participate in a three-round eDelphi survey to develop the ISCoS basic and extended nutrition datasets. An a priori criterion will be implemented, defining strong consensus as an interquartile range (IQR) ≤ 1 and consensus as an IQR > 1/≤2. Mean and standard deviation will be calculated to measure convergence and stability depending on the data. Agreement will be determined as ≥ 80% per statement (Likert scale ratings of 4 and 5). A content analysis approach will be utilised to synthesise free-text responses.
{"title":"Protocol for developing the nutrition dataset for the international spinal cord society: an international eDelphi approach","authors":"Priya Iyer, Gary J. Farkas, Sherri L. LaVela, Shashivadan P. Hirani, Samford Wong","doi":"10.1038/s41393-025-01102-z","DOIUrl":"10.1038/s41393-025-01102-z","url":null,"abstract":"An eDelphi survey. To develop the Spinal Cord Injury (SCI) basic and extended nutrition datasets for adults with SCI for the International Spinal Cord Society (ISCoS). This international eDelphi study, administered in Australia, will be conducted virtually, overseen by a Research Advisory Group. An expert panel will be recruited internationally to participate in a three-round eDelphi survey to develop the ISCoS basic and extended nutrition datasets. An a priori criterion will be implemented, defining strong consensus as an interquartile range (IQR) ≤ 1 and consensus as an IQR > 1/≤2. Mean and standard deviation will be calculated to measure convergence and stability depending on the data. Agreement will be determined as ≥ 80% per statement (Likert scale ratings of 4 and 5). A content analysis approach will be utilised to synthesise free-text responses.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"432-436"},"PeriodicalIF":2.2,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-02DOI: 10.1038/s41393-025-01101-0
Cameron M. Gee, Kendra R. Todd
Clinical recommendations are typically developed based on published data. However, if not all data are published this may influence the accuracy and effectiveness of recommendations. We examined whether failure to publish clinical trial data is a problem in physical activity (PA) research involving people with spinal cord injury (SCI). This article reports features of 102 PA trials registered on ClinicalTrials.gov including participants with SCI, of which 63% had associated papers. Target enrolment was achieved in 41% of published trials and 85% of participants enrolled completed trials. Only 60% of papers stated hypotheses, of which 76% were supported. We discuss why ~2/5 trials remain unpublished, whether researcher prefer to ‘file-drawer’ negative findings, and/or editors/reviewers look favourably on positive findings. We stress the importance of transparently reporting all results from SCI-PA studies regardless of positive/negative directionality and raise concern regarding the influence of publication biases and selective data reporting on clinical recommendations.
{"title":"Features of registered clinical trials and associated papers on physical activity involving people with spinal cord injury","authors":"Cameron M. Gee, Kendra R. Todd","doi":"10.1038/s41393-025-01101-0","DOIUrl":"10.1038/s41393-025-01101-0","url":null,"abstract":"Clinical recommendations are typically developed based on published data. However, if not all data are published this may influence the accuracy and effectiveness of recommendations. We examined whether failure to publish clinical trial data is a problem in physical activity (PA) research involving people with spinal cord injury (SCI). This article reports features of 102 PA trials registered on ClinicalTrials.gov including participants with SCI, of which 63% had associated papers. Target enrolment was achieved in 41% of published trials and 85% of participants enrolled completed trials. Only 60% of papers stated hypotheses, of which 76% were supported. We discuss why ~2/5 trials remain unpublished, whether researcher prefer to ‘file-drawer’ negative findings, and/or editors/reviewers look favourably on positive findings. We stress the importance of transparently reporting all results from SCI-PA studies regardless of positive/negative directionality and raise concern regarding the influence of publication biases and selective data reporting on clinical recommendations.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"444-446"},"PeriodicalIF":2.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-28DOI: 10.1038/s41393-025-01097-7
Nisaharan Srikandarajah, Simon Clark, Martin Wilby, Tony Marson, Adam Noble
Qualitative, semi structured interviews. Cauda Equina Syndrome (CES) is a neurological emergency that can cause permanent disability to the lower limbs, including pain, weakness, and bladder, bowel and sexual dysfunction. There is little evidence on the lived experience of patients with different severities of CES. This study sought to address this. The interviews were conducted with persons who had experienced CES and been operated on for this condition in the UK. A sampling frame was used on a pre-existing database to select a maximum variation sample. Interviews were audio recorded and transcribed for thematic analysis supported by NVivo. Data saturation was achieved with 22 patients (12 female, 10 male) of whom 10 had CES-incomplete and 12 had CES-complete. Average age was 46 years and time since the operation was 62 months. Most interviews took place at the patients’ home or workplace. Data analysis identified 4 main data themes: (1) Varying priorities of physical health; (2) A fragmented healthcare service; (3) The process of adjustment; and 4) Anticipatory anxiety and diminished sense of self-worth. The identified themes confirm that CES can be a chronic condition, which requires holistic support to address the long-term outcomes. This highlights the importance of using the Cauda Equina Syndrome Core Outcome Set (CESCOS) in CES research studies to record these outcomes.
{"title":"A qualitative study of experiencing cauda equina syndrome and its aftercare in the UK","authors":"Nisaharan Srikandarajah, Simon Clark, Martin Wilby, Tony Marson, Adam Noble","doi":"10.1038/s41393-025-01097-7","DOIUrl":"10.1038/s41393-025-01097-7","url":null,"abstract":"Qualitative, semi structured interviews. Cauda Equina Syndrome (CES) is a neurological emergency that can cause permanent disability to the lower limbs, including pain, weakness, and bladder, bowel and sexual dysfunction. There is little evidence on the lived experience of patients with different severities of CES. This study sought to address this. The interviews were conducted with persons who had experienced CES and been operated on for this condition in the UK. A sampling frame was used on a pre-existing database to select a maximum variation sample. Interviews were audio recorded and transcribed for thematic analysis supported by NVivo. Data saturation was achieved with 22 patients (12 female, 10 male) of whom 10 had CES-incomplete and 12 had CES-complete. Average age was 46 years and time since the operation was 62 months. Most interviews took place at the patients’ home or workplace. Data analysis identified 4 main data themes: (1) Varying priorities of physical health; (2) A fragmented healthcare service; (3) The process of adjustment; and 4) Anticipatory anxiety and diminished sense of self-worth. The identified themes confirm that CES can be a chronic condition, which requires holistic support to address the long-term outcomes. This highlights the importance of using the Cauda Equina Syndrome Core Outcome Set (CESCOS) in CES research studies to record these outcomes.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"426-431"},"PeriodicalIF":2.2,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-24DOI: 10.1038/s41393-025-01096-8
Jia Li, Matthew Farrow, Kerollos Ibrahim, Dana M. McTigue, John Kramer, Bobo Tong, Catherine Jutzeler, Linda Jones, Ceren Yarar-Fisher
{"title":"Racial differences in serological markers across the first year of injury in spinal cord injury: responses to the letter to editor","authors":"Jia Li, Matthew Farrow, Kerollos Ibrahim, Dana M. McTigue, John Kramer, Bobo Tong, Catherine Jutzeler, Linda Jones, Ceren Yarar-Fisher","doi":"10.1038/s41393-025-01096-8","DOIUrl":"10.1038/s41393-025-01096-8","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"447-448"},"PeriodicalIF":2.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-17DOI: 10.1038/s41393-025-01095-9
Vishal Kumar, Sharath Raj
{"title":"Letter to the editor: Racial differences in serological markers across the first year of injury in spinal cord injury: a retrospective analysis of a multicenter interventional study by Jia Li et al.","authors":"Vishal Kumar, Sharath Raj","doi":"10.1038/s41393-025-01095-9","DOIUrl":"10.1038/s41393-025-01095-9","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 8","pages":"449-449"},"PeriodicalIF":2.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-10DOI: 10.1038/s41393-025-01094-w
Steven Kirshblum, Brittany Snider, Einat Engel-Haber
A narrative review and perspective based on the experience of a single site in the U.S recruiting participants for clinical trials during the subacute phase (2 weeks to 3 months) following a traumatic spinal cord injury (SCI). To discuss challenges and propose strategies for enrolling individuals with SCI in research during the subacute phase within a comprehensive inpatient rehabilitation program. Acute rehabilitation hospitals where patients with SCI typically spend part of the subacute post-injury period. This review draws on the authors’ experience in research recruitment and retention. Key barriers and potential solutions are explored from both a practical and conceptual standpoint. Challenges identified include heterogeneous impairments, older age, higher incidence of incomplete injuries, placement issues, competition among studies, limited patient volume, tight rehabilitation schedules, logistical and medical concerns, and misalignment of research measures with clinical practices. Based on experience and literature review, strategic planning including integration of individuals with lived experience into the study design team, patient education, simplified consent processes, flexible research protocols, collaboration between clinical and research teams, and patient-centered approaches can enhance recruitment efforts. Research recruitment during the subacute phase of SCI presents numerous medical, injury-specific, and systems-based challenges. However, this period remains critical for advancing research influencing long-term outcomes for individuals with SCI. We recommend a collaborative, patient-centered approach that integrates research within clinical care, guided by practical experience and informed by existing literature, which can improve recruitment efforts and ultimately support meaningful advancements in SCI rehabilitation research.
{"title":"Challenges and strategies for spinal cord injury research recruitment in rehabilitation hospitals: a single center perspective","authors":"Steven Kirshblum, Brittany Snider, Einat Engel-Haber","doi":"10.1038/s41393-025-01094-w","DOIUrl":"10.1038/s41393-025-01094-w","url":null,"abstract":"A narrative review and perspective based on the experience of a single site in the U.S recruiting participants for clinical trials during the subacute phase (2 weeks to 3 months) following a traumatic spinal cord injury (SCI). To discuss challenges and propose strategies for enrolling individuals with SCI in research during the subacute phase within a comprehensive inpatient rehabilitation program. Acute rehabilitation hospitals where patients with SCI typically spend part of the subacute post-injury period. This review draws on the authors’ experience in research recruitment and retention. Key barriers and potential solutions are explored from both a practical and conceptual standpoint. Challenges identified include heterogeneous impairments, older age, higher incidence of incomplete injuries, placement issues, competition among studies, limited patient volume, tight rehabilitation schedules, logistical and medical concerns, and misalignment of research measures with clinical practices. Based on experience and literature review, strategic planning including integration of individuals with lived experience into the study design team, patient education, simplified consent processes, flexible research protocols, collaboration between clinical and research teams, and patient-centered approaches can enhance recruitment efforts. Research recruitment during the subacute phase of SCI presents numerous medical, injury-specific, and systems-based challenges. However, this period remains critical for advancing research influencing long-term outcomes for individuals with SCI. We recommend a collaborative, patient-centered approach that integrates research within clinical care, guided by practical experience and informed by existing literature, which can improve recruitment efforts and ultimately support meaningful advancements in SCI rehabilitation research.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 7","pages":"385-391"},"PeriodicalIF":2.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-09DOI: 10.1038/s41393-025-01098-6
Anthony E. Seddio, Sahir S. Jabbouri, Rajiv S. Vasudevan, Michael J. Gouzoulis, Wesley Day, Gwyneth C. Maloy, Arya G. Varthi, Daniel R. Rubio, Jonathan N. Grauer
Retrospective longitudinal cohort study. To characterize: (1) incidence and trends of diving-related spine injuries (DRSI) and diving-related spinal cord injury (DRSCI) in the United States and (2) risk-factors associated with DRSCI. Using a large, national, multi-insurance administrative dataset of over 161 million patients, those who suffered a DRSIs were identified and characterized. Persons who suffered a DRSIs were analyzed from 2010–2021. Estimated annual percentage change (EAPC) was calculated by log-linear regression. For those with DRSCI, risk-factors were assessed by multivariable logistic regression. Of 3829 persons who suffered DRSIs, the cervical spine was most frequently involved (53.0%). EAPCs of DRSIs at the cervical, thoracic, and lumbar spine significantly decreased over the studied years (−4.69, −6.81, and −4.88%, respectively; p < 0.05 for all), while DRSCI demonstrated a nonsignificant trend (p = 0.081). Among the 629 (16.4%) with DRSCI, risk-factors included: prior cervical spine surgery (OR 13.31, p < 0.001), history of cervical spondylolisthesis (OR 5.36, p < 0.001), male sex (OR 2.69, p < 0.001), history of cervical stenosis (OR 2.26, p < 0.001), coastal states (OR 1.38, p = 0.012), higher Elixhauser Comorbidity Index (OR 1.15, p < 0.001), and older age (OR 1.01, p = 0.029). The rate of DRSIs of the cervical, thoracic, and lumbar spine has significantly decreased in recent years in the United States. However, the nonsignificant trend in DRSCI highlights the importance of continued public health initiatives. Among those with DRSCI, several unique risk-factors were identified, laying the foundation for the refinement of current diving injury prevention programs.
{"title":"The incidence and trends of diving-related spine injuries in the United States and risk factors associated with spinal cord injury","authors":"Anthony E. Seddio, Sahir S. Jabbouri, Rajiv S. Vasudevan, Michael J. Gouzoulis, Wesley Day, Gwyneth C. Maloy, Arya G. Varthi, Daniel R. Rubio, Jonathan N. Grauer","doi":"10.1038/s41393-025-01098-6","DOIUrl":"10.1038/s41393-025-01098-6","url":null,"abstract":"Retrospective longitudinal cohort study. To characterize: (1) incidence and trends of diving-related spine injuries (DRSI) and diving-related spinal cord injury (DRSCI) in the United States and (2) risk-factors associated with DRSCI. Using a large, national, multi-insurance administrative dataset of over 161 million patients, those who suffered a DRSIs were identified and characterized. Persons who suffered a DRSIs were analyzed from 2010–2021. Estimated annual percentage change (EAPC) was calculated by log-linear regression. For those with DRSCI, risk-factors were assessed by multivariable logistic regression. Of 3829 persons who suffered DRSIs, the cervical spine was most frequently involved (53.0%). EAPCs of DRSIs at the cervical, thoracic, and lumbar spine significantly decreased over the studied years (−4.69, −6.81, and −4.88%, respectively; p < 0.05 for all), while DRSCI demonstrated a nonsignificant trend (p = 0.081). Among the 629 (16.4%) with DRSCI, risk-factors included: prior cervical spine surgery (OR 13.31, p < 0.001), history of cervical spondylolisthesis (OR 5.36, p < 0.001), male sex (OR 2.69, p < 0.001), history of cervical stenosis (OR 2.26, p < 0.001), coastal states (OR 1.38, p = 0.012), higher Elixhauser Comorbidity Index (OR 1.15, p < 0.001), and older age (OR 1.01, p = 0.029). The rate of DRSIs of the cervical, thoracic, and lumbar spine has significantly decreased in recent years in the United States. However, the nonsignificant trend in DRSCI highlights the importance of continued public health initiatives. Among those with DRSCI, several unique risk-factors were identified, laying the foundation for the refinement of current diving injury prevention programs.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 7","pages":"352-358"},"PeriodicalIF":2.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-07DOI: 10.1038/s41393-025-01087-9
Jean Jacques Wyndaele
Narrative Review. To focus on the knowledge on afferent sensory nervous pathways related to the lower urinary tract (LUT), in individuals with spinal cord injury (SCI). We made a narrative review in which are summarized different primary studies from which conclusions may be drawn in a systematic way and from a holistic point of view, contributed by researcher’s own experience and existing theories. The knowledge on sensation in the LUT has grown during the last decade: advances in the basic science of bladder sensing relating to (a) the bladder wall-urothelial cells, sensory nerves, interstitial cells, and smooth muscle cells and (b) putative chemo/mechanosensors in the urethra-paraneurons or “brush cells” have helped to enlighten the different sensations related to bladder filling and voiding. Clinically there are diverse ways to evaluate the sensory function after SCI. After SCI, most patients retain the ability to be aware of the LUT, through bladder filling sensations, the feeling of passage through the urethra, pain and feeling unstable bladder contractions. They relate to different spinal afferent pathways, and their investigations permit valuable information on the spinal cord’s condition and the completeness of its disruption. Therapeutic advantages to be explored may be to train the sensation awareness, to guide the frequency of CIC, to better determine the role of sacral stimulation. The knowledge on pelvic afferent sensory nervous pathways of the LUT after SCI, offers important diagnostic and therapeutic data.
{"title":"Focus on afferent sensory nervous pathways of the lower urinary tract after SCI. Tribute to Sir Ludwig Guttmann","authors":"Jean Jacques Wyndaele","doi":"10.1038/s41393-025-01087-9","DOIUrl":"10.1038/s41393-025-01087-9","url":null,"abstract":"Narrative Review. To focus on the knowledge on afferent sensory nervous pathways related to the lower urinary tract (LUT), in individuals with spinal cord injury (SCI). We made a narrative review in which are summarized different primary studies from which conclusions may be drawn in a systematic way and from a holistic point of view, contributed by researcher’s own experience and existing theories. The knowledge on sensation in the LUT has grown during the last decade: advances in the basic science of bladder sensing relating to (a) the bladder wall-urothelial cells, sensory nerves, interstitial cells, and smooth muscle cells and (b) putative chemo/mechanosensors in the urethra-paraneurons or “brush cells” have helped to enlighten the different sensations related to bladder filling and voiding. Clinically there are diverse ways to evaluate the sensory function after SCI. After SCI, most patients retain the ability to be aware of the LUT, through bladder filling sensations, the feeling of passage through the urethra, pain and feeling unstable bladder contractions. They relate to different spinal afferent pathways, and their investigations permit valuable information on the spinal cord’s condition and the completeness of its disruption. Therapeutic advantages to be explored may be to train the sensation awareness, to guide the frequency of CIC, to better determine the role of sacral stimulation. The knowledge on pelvic afferent sensory nervous pathways of the LUT after SCI, offers important diagnostic and therapeutic data.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 7","pages":"348-351"},"PeriodicalIF":2.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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