创伤性颈脊髓损伤患者华勒氏变性的磁共振成像研究

doi:10.3969/j.issn.1006-9771.2024.04.015

Abstract

Abstract:

Objective To explore the signal characteristics of Wallerian degeneration (WD) of the spinal cord in patients with traumatic cervical spinal cord injury.

Methods A retrospective analysis was conducted. From January, 2015 to December, 2021, the clinical data of 191 patients with traumatic cervical spinal cord injury in Beijing Boai Hospital were included. According to sagittal and axial T₂-weighted images (T₂WI) of routine cervical magnetic resonance imaging (MRI), the patients were divided into WD group and non-WD group. The gender, age, mechanism of injury, American Spinal Injury Association Impairment Scale (AIS), neurological level, and time interval to obtain MRI after injury were compared between two groups. The characteristics of WD in dorsal column (DC), lateral spinothalamic tract (ST) and lateral corticospinal tract (CS) were analyzed.

Results A total of 115 cases (60.2%) showed WD. There were significant differences in age, mechanism of injury, AIS grade, and time interval to obtain MRI after injury between two groups (Z > 3.820, χ² > 9.104, P< 0.05). In WD group, the occurrence rates of WD in DC and ST above the injury site were 100% and 87%, respectively. Below the injury site, the occurrence rate of WD in CS was 35.7%. Based on the pattern of WD signal appearance, three groups were identified: 15 cases (13%) had only DC signal changes, 59 cases (51.3%) had changes in both DC and ST, and 41 cases (35.7%) had changes in all the three locations (DC, ST and CS). There was significant difference in the time interval to obtain MRI after injury (H = 90.794, P< 0.05) among three groups, while there was no significance in AIS grade (P> 0.05).

Conclusion Routine MRI examination with T₂WI could detect WD signals in patients with traumatic cervical spinal cord injury, and the occurrence of WD is associated with post-injury time.

Key words: traumatic cervical spinal cord injury, Wallerian degeneration, magnetic resonance imaging, American Spinal Injury Association Impairment Scale

CLC Number:

R651.2

YUAN Yuan, ZHOU Hongjun, WEI Bo, CONG Xinying, LIU Genlin, ZHENG Ying, HAO Chunxia, ZHANG Ying, WANG Yiji, KANG Haiqiong, LU Xiaolei, MENG Qianru. Wallerian degeneration in patients with traumatic cervical spinal cord injury: a magnetic resonance imaging study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 487-492.

Figures/Tables 4

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Table 1

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References 29

[1]	WALLER A. Experiments on the section of the glosso-pharyngeal and hypoglossal nerves of the frog, and observations of the alterations produced thereby in the structure of their primitive fibres[J]. Edinb Med Surg J, 1851, 76(189): 369-376.
[2]	KOLIATSOS V E, ALEXANDRIS A S. Wallerian degeneration as a therapeutic target in traumatic brain injury[J]. Curr Opin Neurol, 2019, 32(6): 786-795. doi: 10.1097/WCO.0000000000000763 pmid: 31633494
[3]	LLOBET ROSELL A, NEUKOMM L J. Axon death signalling in Wallerian degeneration among species and in disease[J]. Open Biol, 2019, 9(8): 190118. doi: 10.1098/rsob.190118
[4]	COLEMAN M P, HÖKE A. Programmed axon degeneration: from mouse to mechanism to medicine[J]. Nat Rev Neurosci, 2020, 21(4): 183-196. doi: 10.1038/s41583-020-0269-3 pmid: 32152523
[5]	ZHANG K, JIANG M, FANG Y. The drama of Wallerian degeneration: the cast, crew, and script[J]. Annu Rev Genet, 2021, 55: 93-113. doi: 10.1146/annurev-genet-071819-103917 pmid: 34351802
[6]	FORBRIG R, DANEK A. Wallerian degeneration of the pyramidal tract[J]. Dtsch Arztebl Int, 2022, 119(9): 141. doi: 10.3238/arztebl.m2022.0013 pmid: 35535722
[7]	KESER Z, FARIA A V, HILLIS A E. Progressive crossed cerebellar Wallerian degeneration after hemispheric infarct[J]. Stroke, 2022, 53(4): e143-e144. doi: 10.1161/STROKEAHA.122.038915 pmid: 35306835
[8]	DANIEL P M, STRICH S J. Histological observations on Wallerian degeneration in the spinal cord of the baboon, Papio papio[J]. Acta Neuropathol, 1969, 12(4): 314-328. pmid: 4979891
[9]	LINDBERG P G, BENSMAIL D, BUSSEL B, et al. Wallerian degeneration in lateral cervical spinal cord detected with diffusion tensor imaging in four chronic stroke patients[J]. J Neuroimaging, 2011, 21(1): 44-48. doi: 10.1111/j.1552-6569.2009.00409.x pmid: 19732295
[10]	VALENCIA M P, CASTILLO M. MRI findings in posttraumatic spinal cord Wallerian degeneration[J]. Clin Imaging, 2006, 30(6): 431-433. doi: 10.1016/j.clinimag.2006.05.031
[11]	KASHANI H, FARB R, KUCHARCZYK W. Magnetic resonance imaging demonstration of a single lesion causing Wallerian degeneration in ascending and descending tracts in the spinal cord[J]. J Comput Assist Tomogr, 2010, 34(2): 251-253. doi: 10.1097/RCT.0b013e3181c34626 pmid: 20351516
[12]	FISCHER T, STERN C, FREUND P, et al. Wallerian degeneration in cervical spinal cord tracts is commonly seen in routine T₂-weighted MRI after traumatic spinal cord injury and is associated with impairment in a retrospective study[J]. Eur Radiol, 2021, 31(5): 2923-2932. doi: 10.1007/s00330-020-07388-2 pmid: 33125565
[13]	ORTEGA M A, FRAILE-MARTINEZ O, GARCÍA-MONTERO C, et al. A comprehensive look at the psychoneuroimmunoendocrinology of spinal cord injury and its progression: mechanisms and clinical opportunities[J]. Mil Med Res, 2023, 10(1): 26. doi: 10.1186/s40779-023-00461-z pmid: 37291666
[14]	STERNER R C, STERNER R M. Immune response following traumatic spinal cord injury: pathophysiology and therapies[J]. Front Immunol, 2023, 13: 1084101. doi: 10.3389/fimmu.2022.1084101
[15]	YU H, LIU Z, PANG M, et al. Wallerian degeneration assessed by multimodal MRI of cervical spinal cord is associated with neurological impairment after spinal cord injury[J]. [ahead of print]. J Neurotrauma, 2024. doi: 10.1089/neu.2023.0305. Epub ahead of print. PMID: 38204213.
[16]	李建军, 王方永,译. 脊髓损伤神经学分类国际标准(2011年修订)[J]. «中国康复理论与实践», 2011, 17(10): 963-972.
	LI J J, WANG F Y. International Standards for Neurological Classification of Spinal Cord Injury[J]. Chin J Rehabil Theory Pract, 2011, 17(10): 963-972
[17]	FREUND P, SEIF M, WEISKOPF N, et al. MRI in traumatic spinal cord injury: from clinical assessment to neuroimaging biomarkers[J]. Lancet Neurol, 2019, 18(12): 1123-1135. doi: S1474-4422(19)30138-3 pmid: 31405713
[18]	KUHN M J, MIKULIS D J, AYOUB D M, et al. Wallerian degeneration after cerebral infarction: evaluation with sequential MR imaging[J]. Radiology, 1989, 172(1): 179-182. doi: 10.1148/radiology.172.1.2740501 pmid: 2740501
[19]	BUSS A, PECH K, MERKLER D, et al. Sequential loss of myelin proteins during Wallerian degeneration in the human spinal cord[J]. Brain, 2005, 128(Pt 2): 356-364. doi: 10.1093/brain/awh355 pmid: 15634734
[20]	KIRSHBLUM S, SNIDER B, EREN F, et al. Characterizing natural recovery after traumatic spinal cord injury[J]. J Neurotrauma, 2021, 38(9): 1267-1284. doi: 10.1089/neu.2020.7473
[21]	BECERRA J L, BREIER J I, WISNEWSKI T W, et al. In vivo proton magnetic resonance spectroscopy of the human cervical spinal cord[J]. Magn Reson Med, 2001, 45(6): 902-906.
[22]	BECERRA J L, PUCKETT W R, HIESTER E D, et al. MR-pathologic comparisons of Wallerian degeneration in spinal cord injury[J]. Am J Neuroradiol, 1995, 16(1): 125-133. pmid: 7900580
[23]	CONFORTI L, GILLEY J, COLEMAN M P. Wallerian degeneration: an emerging axon death pathway linking injury and disease[J]. Nat Rev Neurosci, 2014, 15(6): 394-409. doi: 10.1038/nrn3680 pmid: 24840802
[24]	BRÜLL M, GEESE N, CELARDO I, et al. Preparation of viable human neurites for neurobiological and neurodegeneration studies[J]. Cells, 2024, 13(3): 242. doi: 10.3390/cells13030242
[25]	KOU Y, YUAN Y, LI Q, et al. Neutrophil peptide 1 accelerates the clearance of degenerative axons during Wallerian degeneration by activating macrophages after peripheral nerve crush injury[J]. Neural Regen Res, 2024, 19(8): 1822-1827. doi: 10.4103/1673-5374.387978 pmid: 38103249
[26]	KHAZMA T, GROSSMAN A, GUEZ-HADDAD J, et al. Structure-function analysis of ceTIR-1/hSARM1 explains the lack of Wallerian axonal degeneration in C. elegans[J]. Cell Rep, 2023, 42(9): 113026. doi: 10.1016/j.celrep.2023.113026
[27]	WALLER T J, COLLINS C A. Opposing roles of Fos, Raw, and SARM1 in the regulation of axonal degeneration and synaptic structure[J]. Front Cell Neurosci, 2023, 17: 1283995.
[28]	DAVID G, VALLOTTON K, HUPP M, et al. Extent of cord pathology in the lumbosacral enlargement in non-traumatic versus traumatic spinal cord injury[J]. J Neurotrauma, 2022, 39(9-10): 639-650. doi: 10.1089/neu.2021.0389
[29]	DAVID G, MOHAMMADI S, MARTIN A R, et al. Traumatic and nontraumatic spinal cord injury: pathological insights from neuroimaging[J]. Nat Rev Neurol, 2019, 15(12): 718-731. doi: 10.1038/s41582-019-0270-5 pmid: 31673093

项目	合计	WD组(n = 115)	非WD组(n = 76)	χ²/Z值	P值
性别/n
女	28	15	13	0.603	0.531
男	163	100	63
年龄/岁	45.00(32.00, 56.00)	33(25.00, 45.50)	54(46.75, 61.00)	3.820	< 0.001
损伤机制/n
无骨折脱位	90	44	46	9.104	0.003
骨折/脱位	101	71	30
AIS 分级/n
A^a	45	34	11	16.413	< 0.001
B^a	26	20	6
C^ab	39	26	13
D^b	81	35	46
神经平面
C_2-4	132	77	55	0.628	0.428
C_5-8	59	38	21
获得MRI时间/d	97(37, 197)	108(51.5, 200)	93.5(28.75, 175.75)	94.618	< 0.001

项目	WD			H值	P值
项目	DC	DC+ST	DC+ST+CS	H值	P值
AIS分级/n				0.493	0.096
A	4	20	10
B	2	10	8
C	6	12	8
D	3	17	15
时间差/d	35(22,73)	115(92,227)	211(154,326)	90.794	< 0.001

Wallerian degeneration in patients with traumatic cervical spinal cord injury: a magnetic resonance imaging study

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