Byline: Yansheng. Liu, Jia-Xin. Xie, Fang. Niu, Zhexi. Xu, Pengju. Tan, Caihong. Shen, Hongkun. Gao, Song. Liu, Zhengwen. Ma, Kwok-Fai. So, Wutian. Wu, Chen. Chen, Sujuan. Gao, Xiao-Ming. Xu, Hui. Zhu
Although a large number of trials in the SCI field have been conducted, few proven gains have been realized for patients. In the present study, we determined the efficacy of a novel combination treatment involving surgical intervention and long-term weight-bearing walking training in spinal cord injury (SCI) subjects clinically diagnosed as complete or American Spinal Injury Association Impairment Scale (AIS) Class A (AIS-A). A total of 320 clinically complete SCI subjects (271 male and 49 female), aged 16-60 years, received early ([less-than or equal to] 7 days, n = 201) or delayed (8-30 days, n = 119) surgical interventions to reduce intraspinal or intramedullary pressure. Fifteen days post-surgery, all subjects received a weight-bearing walking training with the 'Kunming Locomotion Training Program (KLTP)' for a duration of 6 months. The neurological deficit and recovery were assessed using the AIS scale and a 10-point Kunming Locomotor Scale (KLS). We found that surgical intervention significantly improved AIS scores measured at 15 days post-surgery as compared to the pre-surgery baseline scores. Significant improvement of AIS scores was detected at 3 and 6 months and the KLS further showed significant improvements between all pair-wise comparisons of time points of 15 days, 3 or 6 months indicating continued improvement in walking scores during the 6-month period. In conclusion, combining surgical intervention within 1 month post-injury and weight-bearing locomotor training promoted continued and statistically significant neurological recoveries in subjects with clinically complete SCI, which generally shows little clinical recovery within the first year after injury and most are permanently disabled. This study was approved by the Science and Research Committee of Kunming General Hospital of PLA and Kunming Tongren Hospital, China and registered at ClinicalTrials.gov (Identifier: NCT04034108) on July 26, 2019.
Traumatic spinal cord injury (SCI) is a severe medical problem experienced by humans with high mortality and long-term morbidity (Li et al., 2014; Ahuja et al., 2017a; Tang et al., 2019). While the majority of the injuries occur to the cervical spinal cord, they were also found at all spinal levels including the thoracic, lumbar and sacral levels resulting in devastating motor, sensory and autonomic dysfunctions below the level of injury (Onifer et al., 2007). In addition to the enormous financial burdens for necessary surgeries, care and rehabilitation, there exists profound social and emotional costs to patients and their families. Despite all efforts, neurological recovery remains very limited particularly for patients admitted with clinically complete SCI or classified as American Spinal Injury Association Impairment Scale-A (AIS-A) (Hadley et al., 2002; Zhu et al., 2008; Hadley and Walters, 2013; Li et al., 2014). Notably, patients with a SCI generally show little clinical recovery within the first year after injury and most are permanently disabled (Fawcett et al., 2007; Freund et al., 2013). Although a large number of trials in the SCI field have been conducted,...