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Cord & Nerves

Spinal cord and nerve root pathology, including Cauda Equina Syndrome and MESCC — diagnostic urgency, surgical decompression, and management of traumatic injury.

Overview

Evaluation for late nerve transfer surgery in spinal cord injury (SCI) requires predicting the degree of lower motor neuron injury [2]. Rapid reduction and stabilization of injuries causing spinal cord compression are critical for optimizing long-term neurologic and functional outcomes [4]. Surgical decompression and fixation play a significant role in the management of spinal cord injury, though it remains controversial whether early decompression following spinal cord injury conveys a benefit in neurological outcome [27]. Prognosticating neurologic recovery, managing secondary complications, and utilizing contemporary rehabilitation approaches are key perspectives for maximizing function and facilitating community reintegration in spinal cord-injured patients [18].

Nerve transfer surgery expands reconstructive options for restoring upper extremity function following spinal cord injury by adding new motor donors to the pool available through tendon transfers [46]. Early referral is necessary to allow nerve transfer options to be viable in spinal cord injury [51]. The contralateral C7 transfer to the lower trunk via a subcutaneous tunnel across the anterior surface of the chest and neck for total brachial plexus root avulsion shortens the nerve graft needed and nerve regeneration distance [52]. This approach decreases the number of neurorrhaphy sites and makes full use of donor nerves, which may benefit hand flexion restoration [52]. Combined nerve and tendon transfer in patients with tetraplegia may offer benefits for restoring grasp function [61].

Traditional methods to reconstruct the brachial plexus may result in less than ideal functional outcomes in patients with traumatic brachial plexus injury and complete spinal cord injury due to associated upper motor neuron injury [62]. Barriers to upper extremity reconstruction persist despite the advent of newer nerve transfers that augment traditional tendon transfer options to restore upper extremity movement in spinal cord injury [57]. There is no superior surgical intervention for pure cervical radiculopathy based on clinical outcome and safety [16]. Evoked responses serve as a sensitive indicator of central nervous system integrity and are useful for monitoring the spinal cord for damage during surgery [66]. However, evoked response monitoring has limitations in precisely locating the site or degree of damage [66].

Anatomy & Pathophysiology

Neural & Cord Anatomy

The organization of intrathecal nerve roots at the level of the conus medullaris constitutes a three-dimensional anatomy that aids in understanding neurological deficits secondary to trauma, high lumbar-disc herniations, and tumors in the thoracolumbar junction [25]. In adolescent idiopathic scoliosis, pushing conditions warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve [1]. Specifically, 14.7% of patients with adolescent idiopathic scoliosis and curves of ≥70° had a type-3 cord [30].

Cervical Spine Vulnerability

The intrinsic dimensions of the cervical spinal canal, specifically the shape defined by the ratio of sagittal to transverse diameter, may constitute a predisposition to spinal cord injury in the cervical segments [29]. Non-cervical diffuse idiopathic skeletal hyperostosis significantly increases the risk of severe cervical spinal cord injury, suggesting that thoracolumbar rigidity may biomechanically compromise cervical spine vulnerability during trauma [77]. Klippel-Feil syndrome can alter spinal mechanical activity and increase susceptibility to spinal cord injury following minor trauma, even without fracture or dislocation [67].

Imaging & Assessment

Magnetic resonance imaging of acute spinal injury provides excellent visualization of neurologic and soft-tissue structures in a noninvasive format [19]. Kinematic MRI demonstrates dynamic pathoanatomical changes, such as canal stenosis in different positions, in patients with cervical spinal cord injury without fracture and dislocation [15]. MRI-based assessment of paraspinal extensor muscle fatty infiltration in acute cervical spinal cord injury patients underscores the importance of the paravertebral extensor muscles in the context of cervical SCI [79]. Physical examination of the spine includes inspection, palpation, range of motion testing, and neurologic evaluation to identify spinal pathology, nonspinal conditions, and signs of symptom magnification [70].

Pathophysiology & Biomechanics

A novel rabbit model of angular kyphosis provides a reliable platform for investigating the pathophysiology of spinal deformities and evaluating therapeutic interventions [44]. Fundamental muscle-tendon-joint mechanics studies allow for single-stage surgical reconstruction of hand function and early postoperative activity-based training in patients with cervical spinal cord injuries [48]. The swimming test may represent a method of detecting true supraspinally controlled locomotion in the assessment of functional outcome following spinal cord injury [89].

Surgical Implications

Alignment and the characteristics and location of spinal cord compression help determine the ideal surgical approach for cervical spondylotic myelopathy [82]. Long-term spinal stability remains a significant challenge in transposition of the compressed spinal cord in kyphoscoliotic patients with neurological deficit, often requiring additional fusion procedures [83]. Modified posterior osteotomy for osteoporotic vertebral collapse with neurological dysfunction can significantly preserve vertebral height, increase vertebral canal volume, correct kyphotic angle, and improve postoperative neurological function [80]. Percutaneous surgical treatment of thoracolumbar fracture in ankylosing spondylitis can improve patients' pain, neurological function and kyphotic deformity and achieve effects similar to traditional methods [90].

Classification

Narakas: The Narakas classification for brachial plexus birth injury may not precisely correspond with the injury at the root level as seen on MRI [75].

Other Considerations: Neurological classification alone does not determine movement patterns, as wheelchair propulsion strategies vary significantly among individuals with identical spinal cord injury level [71].

Clinical Presentation

History and Symptom Onset: In idiopathic scoliosis, pushing conditions warrant attention to the lower spinal cord and nerve roots on both sides of the main thoracic curve [1]. For late nerve transfer surgery, evaluation requires predicting the degree of lower motor neuron injury even years post-spinal cord injury [2]. Timing of symptoms, imaging results, and development of atypical symptoms help distinguish Guillain-Barré syndrome from other postoperative spinal complications [3]. Early investigation is warranted in the presence of cervical vertebral anomalies and associated intermittent and significant pain [35]. Non-compressive neurological disease should be considered in patients with a lack of sensory disturbance who present with bilateral extensive paresis or no neurological abnormality in the upper extremity [38].

Imaging and Diagnostic Limitations: Spinal cord injury can occur in the presence of normal MRI, as the absence of spinal cord signals on T2 does not rule out injury [14]. In patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by physical examination and pain drawing [10]. There is a lack of sufficient high-quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy [11]. Future research should address issues to establish the clinical utility of the neurological examination for cervical radiculopathy [36].

Physical Examination and Electrodiagnostics: Imaging and electrodiagnostic studies are essential for evaluating traumatic brachial plexopathy, enabling clarification of surgical options, prognostication, and formulation of postoperative management [12]. Electromyography is useful for localizing sciatic nerve lesions and determining severity (axonotmesis) in acetabular fracture cases, but its predictive value for clinical outcome is limited [31]. When clinical symptoms and signs are inconsistent with imaging findings, a detailed physical examination of the sciatic nerve is beneficial to avoid misdiagnosis of malignant sciatic nerve tumors [32].

Specific Clinical Patterns: Charcot neuroarthropathy of the hand is rare but may develop after central or peripheral neurological disorders [13]. Four types of neurological patterns emerged in achondroplastic dwarfs based on onset, symptoms, and physical examination, allowing for a reliable prognosis related to the pattern [34].

Investigations

MRI: Magnetic resonance imaging of acute spinal injury provides excellent visualization of neurologic and soft-tissue structures in a noninvasive format [19]. In patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by physical examination and pain drawing [10]. There is a lack of sufficient high-quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy [11]. The absence of spinal cord signals on T2 does not rule out spinal cord injury, which can occur in the presence of normal MRI [14]. MRI performed early after traction injury to the brachial plexus provides useful additional information towards establishing the level of the lesion and provides information about injury to the plexus outside the spinal canal [50]. Multi-shot echo-planar diffusion tensor imaging (ms-DTI) can detect microstructural changes in affected cord segments and reflect functional improvement in cervical spondylotic myelopathy [65]. It would be useful to know the normal profile of diffusion tensor imaging (DTI) values by location of each nerve root to detect subtle abnormalities in each nerve root [73]. A lumbosacral MRI could be used to diagnose cauda equina syndrome safely in patients under the age of 55 years, but further research is needed to assess safety and efficacy before changes to existing protocols can be recommended [63].

CT: High resolution CTM may differentiate central from peripheral intradural rupture, while improved MRI techniques may eventually replace invasive myelography for late referrals [53].

Other Considerations: Pushing conditions in idiopathic scoliosis warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve [1]. The timing of symptoms, imaging results, and development of atypical symptoms can help distinguish Guillain-Barré syndrome from other postoperative spinal complications [3]. Imaging and electrodiagnostic studies form an essential part of the evaluation of patients with traumatic brachial plexopathy, enabling clarification of surgical options, prognostication of outcome, and formulation of postoperative management [12]. Patients with complete neurological deficits but no radiographic abnormalities have a poor prognosis for recovery of neurological function [28]. Myelography provides the most reliable preoperative information for guiding cervical disc excision [72]. A prediction model based on six clinical and MRI features can be used to assess the probability of developing irreversible neurological dysfunction in patients with cervical spinal cord injury [74].

Treatment

Surgical Decompression and Stabilization

Rapid reduction and stabilization of injuries causing spinal cord compression are critical steps in optimizing long-term neurologic and functional outcomes [4]. Surgical decompression and fixation occupy a significant role in management of spinal cord injury, but it remains controversial whether early decompression following spinal cord injury conveys a benefit in neurological outcome [27]. Early surgical intervention in Cervical SCI patients may improve the dysfunction of lower motor neurons distal to the injury site, reducing secondary motor neuron loss, and eventually improving clinical prognosis [42]. Early and ultra-early surgical intervention benefits the prevention of neuropathic pain in patients with incomplete traumatic spinal cord injury (AIS B, C, and D), while no such association was found in AIS A patients [47]. The complete disappearance of deficits in spinal cord function after surgery was the most robust predictor of survival in metastatic spinal cord compression from non-small-cell lung cancer treated with surgery and adjuvant therapies [20]. On the basis of clinical outcome and safety, there is no superior surgical intervention for pure cervical radiculopathy [16]. Conservative management is indicated for patients with fractures and dislocations of the spine complicating ankylosing spondylitis without neural involvement, while immediate exploration followed by fusion is indicated for those with progressive neural involvement or instability [45]. A progressive neurological deficit is an absolute indication for operative treatment in thoracic myelopathy caused by cervicothoracic diastematomyelia [69].

Non-Operative Management

Acute cervical radiculopathy generally has a self-limited clinical course, with up to a 75% rate of spontaneous improvement, making nonsurgical treatment the appropriate initial approach for most patients [60]. If the neurological deficit is not severe and if there is clinical improvement, nonoperative treatment remains an option for symptomatic cervical epidural hematoma [64]. The outcome following nonoperative treatment of stable patients with lumbosacral subdural hematoma has been encouraging, with most authors reporting recovery of neurological function [54]. In the face of any neural deficit associated with eosinophilic granuloma of the spine, radiation therapy in low doses to the spine is indicated [59].

Neurophysiologic Monitoring

With appropriate warning from a nerve-monitoring protocol, action was taken such that no sciatic neurologic deficit occurred in any of the sixty-three patients monitored during revision total hip arthroplasty [9]. No technique can predict delayed-onset paraplegia, and intraoperative neurophysiologic monitoring has no indication in discal and degenerative spine surgery [56].

Rehabilitation and Multidisciplinary Care

It is unlikely that a single approach can uniformly address all of the issues associated with spinal cord injury, thus a multidisciplinary approach will be needed [7]. Advances in medical care and rehabilitation continue to improve, but treatment outcomes following tissue regeneration for spinal cord injury remain dismal [8]. The purpose of this review article is to provide a surgeon's perspective on prognosticating neurologic recovery, managing secondary complications, and utilizing contemporary rehabilitation approaches to maximize function and facilitate reintegration into the community for spinal cord-injured patients [18].

Management of Specific Complications and Conditions

Pushing conditions also warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve in idiopathic scoliosis [1]. The manuscript reviews normal anatomy and physiology of the urinary system, discusses pathophysiology secondary to spinal cord injury including autonomic dysrefia, and outlines recent guidelines for diagnosis, evaluation, treatment, and follow-up of neurogenic bladder to prevent renal impairment [5]. Consensus on the optimal timing of surgical intervention for degenerative cervical myelopathy remains lacking, particularly for patients with mild symptoms or asymptomatic cord compression [6].

Emerging Therapies and Pharmacological Interventions

Recent advances in cervical spinal cord stimulation have demonstrated improved efficacy as a therapeutic intervention for restoring hand functions in individuals with spinal cord injuries or stroke, yielding significant improvements in grip force, proximal arm strength and muscle activation with both immediate and sustained effects [39]. Compared to conventional treatments, Chinese medicine is effective in alleviating the symptoms of spinal cord injury [41]. Cell therapy is a rapidly evolving treatment methodology with basic science and early phase I/II human trials showing promise, though the ideal algorithm for spinal cord injury treatment remains unclear [43]. Resolving complexities in spinal cord injury treatments may take time and careful clinical trials will be required to ensure efficacy and safety [40].

Complications

Nerve palsy: Idiopathic scoliosis surgery warrants attention to the lower spinal cord and nerve roots on both sides of the main thoracic curve [1]. In revision total hip arthroplasty, appropriate warning from nerve-monitoring protocols can prevent sciatic neurologic deficits [9]. Nerve injury during total hip arthroplasty with high-riding developmental dysplasia usually occurs during exposure and reduction processes [81]. Patients with high-risk factors for C5 nerve root palsy following posterior cervical spinal canal expansion and reconstruction require close follow-up and timely intervention to reduce symptom incidence and improve quality of life [26]. Neurological survivorship following primary decompressive surgery for degenerative cervical myelopathy is 89.3% at 5 years and 77.3% at 10 years [24]. No detectable complications or neurological morbidity ensued in a series using somatosensory evoked potentials during Harrington instrumentation for scoliosis [86].

Spinal cord and root injury: Rapid reduction and stabilization of injuries causing spinal cord compression are critical for optimizing long-term neurologic and functional outcomes [4]. Treatment outcomes following tissue regeneration for spinal cord injury remain dismal despite advances in medical care and rehabilitation [8] [22]. Long-term neuroprotection via force-limited distance-measurable nerve root retractor plus intraoperative neurophysiological monitoring in posterior lumbar interbody fusion remains unproven and requires validation in prospective randomized trials [22]. Spontaneous transposition of the spinal cord in scoliosis permitted a patient to live to age 44 with only a transient neurological deficit despite severe pulmonary embarrassment and vascular shunting [84]. Earlier recognition and treatment of chronic anterior cervical spinal-cord injury following trauma would have prevented neurological disability [85]. Careful preoperative appraisal and radical exposure of the nerve root are necessary to identify and treat causes of nerve-root involvement in negative disc exploration cases [87].

Cauda equina syndrome: Long-term follow-up of cauda equina syndrome patients reveals that many continue to experience sexual issues, with rates ranging from 14% to 100% [17]. Persistent severe back pain and ongoing autonomic dysfunction are frequently reported in cauda equina syndrome patients at a mean follow-up of five years [21].

Other Considerations: Late nerve transfer surgery evaluation for spinal cord injury requires predicting the degree of lower motor neuron injury even years post-injury [2]. Guillain-Barré syndrome is a rare postoperative spinal complication that can be distinguished from other complications by symptom timing, imaging results, and atypical symptom development [3]. Charcot neuroarthropathy of the hand is rare but may develop after central or peripheral neurological disorders, such as cervical central cord syndrome [13]. Spine surgeons must understand short- and long-term management of neurogenic bowel and bladder care in spinal cord injury patients to minimize complications and optimize rehabilitation potential [55].

Recovery

Light activity (weeks): Evidence does not specify a week range for light activity or return to desk work.

Full activity (months): Evidence does not specify a month range for full activity or return to sport.

Complete recovery / outcome plateau (months): Regenerating axons can grow over great distances to establish functional connections, and muscle fibers can survive denervation for at least sixteen months and fully recover upon reinnervation [49]. Long-term follow-up of cauda equina syndrome patients reveals that many continue to experience sexual issues, with rates ranging from 14% to 100% [17]. Persistent severe back pain and ongoing autonomic dysfunction were frequently reported at a mean follow-up of five years in long-term core outcomes for cauda equina syndrome [21]. Autonomic and non-autonomic dysfunction is common in long-term follow-up of cauda equina syndrome patients, even in those with the most optimistic prognosis [58].

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, or weight-bearing progression.

Functional milestones: Neurological survivorship following primary decompressive surgery for degenerative cervical myelopathy is 89.3% at 5 years and 77.3% at 10 years [24]. The complete disappearance of deficits in spinal cord function after surgery is the most robust predictor of survival in patients with metastatic spinal cord compression from non-small-cell lung cancer [20].

Other Considerations: Rapid reduction and stabilization of injuries causing spinal cord compression are critical for optimizing long-term neurologic and functional outcomes [4]. Consensus on the optimal timing of surgical intervention for degenerative cervical myelopathy remains lacking, particularly for patients with mild symptoms or asymptomatic cord compression [6]. Treatment outcomes following tissue regeneration for spinal cord injury remain dismal despite advances in medical care and rehabilitation [8]. Appropriate warning from a nerve-monitoring protocol during revision total hip arthroplasty allows for action that prevents sciatic neurologic deficit [9]. Long-term neuroprotection from the use of a force-limited distance-measurable nerve root retractor plus intraoperative neurophysiological monitoring remains unproven and requires validation in prospective randomized trials [22]. Patients with high-risk factors for C5 nerve root palsy following posterior cervical spinal canal expansion and reconstruction require close follow-up and timely intervention to reduce symptom incidence and improve quality of life [26]. Patients with complete neurological deficits but no radiographic abnormalities have a poor prognosis for recovery of neurological function [28]. Early decompression did not show a statistically significant correlation with improved outcomes in long-term core outcomes for cauda equina syndrome [58]. Successful outcomes for thoracic myelopathy depend on early recondition of the pathology and appropriate surgical referral in cases of progressive neurologic deterioration [91]. The best postoperative results for cervical spondylotic myelopathy are obtained for patients managed with decompression within six months to one year after symptom onset [92]. The best postoperative results for cervical spondylotic myelopathy are obtained for patients with early mild findings [92]. The best postoperative results for cervical spondylotic myelopathy are obtained for patients with a postoperative spinal cord transverse area greater than forty square millimeters [92]. Removal of intradural neurofibroma lesions resulted in complete relief of symptoms in most cases, despite all patients having neurological deficits at the time of definitive surgery [93]. Changes in somatosensory evoked potentials and spinal cord function can be reversed when appropriate treatment is given at the optimum time during spinal arthrodesis for scoliosis [94]. Late nerve transfer surgery can be evaluated for individuals with spinal cord injury even years post-injury [2].

Key Evidence

  • [L5] Pushing conditions also warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve. (10.1186/s12891-024-07832-0)
  • [L2] This is important information for clinicians evaluating people for late nerve transfer surgery even years post-SCI. (10.1016/j.jhsa.2019.11.003)
  • [L5] The timing of symptoms, imaging results, and the development of atypical symptoms can help distinguish this rare possibility from other postoperative spinal complications. (10.5435/jaaos-d-16-00572)
  • [L5] Rapid reduction and stabilization of injuries causing spinal cord compression are critical steps in optimizing long-term neurologic and functional outcomes. (10.5435/00124635-199905000-00003)
  • [L5] This manuscript reviews normal anatomy and physiology of the urinary system, discusses pathophysiology secondary to spinal cord injury including autonomic dysreflexia, and outlines recent guidelines for diagnosis, evaluation, treatment, and follow-up of neurogenic bladder to prevent renal impairment. (10.3390/jpm12060968)
  • [L5] The review highlights that consensus on the optimal timing of surgical intervention for degenerative cervical myelopathy remains lacking, particularly for patients with mild symptoms or asymptomatic cord compression. (10.1530/eor-2025-0070)
  • [L4] It is unlikely that a single approach can uniformly address all of the issues associated with spinal cord injury, thus a multidisciplinary approach will be needed. (10.5435/00124635-201004000-00004)
  • [L5] Advances in medical care and rehabilitation continue to improve, but treatment outcomes following tissue regeneration for spinal cord injury remain dismal. (10.5435/jaaos-d-14-00314)
  • [L3] With appropriate warning from this nerve-monitoring protocol, action was taken such that no sciatic neurologic deficit occurred in any of the sixty-three patients monitored. (10.2106/00004623-200200002-00007)
  • [L3] In patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by a physical examination and a pain drawing. (10.1186/1471-2474-11-202)
  • [L1] There is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy. (10.1186/s12891-016-1236-z)
  • [L5] Imaging and electrodiagnostic studies form an essential part of the evaluation of the patient with traumatic brachial plexopathy, enabling clarification of surgical options, prognostication of outcome and formulation of postoperative management. (10.1177/1753193411422313)
  • [L4] CNA of the hand is rare but may develop after central or peripheral neurological disorders. (10.1186/s12891-022-05502-7)
  • [L5] The absence of spinal cord signals on T2 does not rule out spinal cord injury, which can occur in the presence of normal MRI. (10.1016/j.otsr.2011.07.007)
  • [L4] Kinematic MRI demonstrated dynamic pathoanatomical changes, such as canal stenosis in different positions, in patients with cervical spinal cord injury without fracture and dislocation. (10.1186/s13018-023-03745-1)
  • [L1] On the basis of clinical outcome and safety, there is no superior surgical intervention for pure cervical radiculopathy. (10.2106/jbjs.20.00324)
  • [L2] However, long-term follow-up of cauda equina syndrome patients revealed that many continued to experience sexual issues (14% to 100%). (10.1186/s12891-025-08736-3)
  • [L5] The purpose of this review article is to provide a surgeon's perspective on prognosticating neurologic recovery, managing secondary complications, and utilizing contemporary rehabilitation approaches to maximize function and facilitate reintegration into the community for spinal cord-injured patients. (10.5435/jaaos-d-18-00559)
  • [L5] Magnetic resonance imaging of acute spinal injury provides excellent visualization of neurologic and soft-tissue structures in a noninvasive format. (10.5435/00124635-199805000-00001)
  • [L4] The complete disappearance of deficits in spinal cord function after surgery was the most robust predictor of survival. (10.2106/jbjs.n.01124)
  • [L3] Persistent severe back pain and ongoing autonomic dysfunction were frequently reported at a mean follow-up of five years. (10.1302/0301-620x.103b9.bjj-2021-0094.r1)
  • [L3] Long-term neuroprotection remains unproven and requires validation in prospective randomized trials. (10.1186/s13018-025-06429-0)
  • [L3] The study reports neurological survivorship of 89.3% at 5 years and 77.3% at 10 years following primary decompressive surgery for DCM. (10.2106/jbjs.22.00218)
  • [L5] This previously undescribed three-dimensional anatomy may aid in understanding neurological deficits secondary to trauma, high lumbar-disc herniations, and tumors in the thoracolumbar junction. (10.2106/00004623-199072100-00010)
  • [L1] Patients with these high-risk factors require close follow-up and timely intervention to reduce the incidence of C5 nerve root palsy symptoms and improve their quality of life. (10.1186/s12891-026-09534-1)
  • [Paper] Surgical decompression and fixation occupy a significant role in management of spinal cord injury, but it remains controversial whether early decompression following spinal cord injury conveys a benefit in neurological outcome. (10.1016/j.injury.2009.01.046)
  • [Case_report] Patients with complete neurological deficits but no radiographic abnormalities have a poor prognosis for recovery of neurological function. (10.1007/s001670050212)
  • [L3] The intrinsic dimensions of the cervical spinal canal, specifically the shape defined by the ratio of sagittal to transverse diameter, may constitute a predisposition to spinal cord injury in the cervical segments. (10.2106/00004623-198971020-00003)
  • [L3] This study demonstrated that 14.7% of patients with AIS and curves of ≥70° had a type-3 cord. (10.2106/jbjs.24.01353)
  • [L4] Electromyography is useful for localizing the lesion and determining severity (axonotmesis), but its predictive value for clinical outcome is limited. (10.2106/00004623-199308000-00005)
  • [L4] When clinical symptoms and signs are inconsistent with imaging findings, a detailed physical examination of the sciatic nerve is beneficial to avoid misdiagnosis. (10.1186/s12891-021-04728-1)
  • [L4] Four types of neurological patterns emerged based on onset, symptoms, and physical examination, allowing for a reliable prognosis related to the pattern. (10.2106/00004623-197759010-00016)
  • [L4] Future research should address these issues to establish the clinical utility of the neurological examination for cervical radiculopathy. (10.1186/s12891-025-08560-9)
  • [L3] Non-compressive neurological disease should be considered in patients with a lack of sensory disturbance who present with bilateral extensive paresis or no neurological abnormality in the upper extremity. (10.1186/s12891-026-09559-6)
  • [L5] Recent advances in cervical spinal cord stimulation have demonstrated improved efficacy as a therapeutic intervention for restoring hand functions in individuals with spinal cord injuries or stroke, yielding significant improvements in grip force, proximal arm strength and muscle activation with both immediate and sustained effects. (10.1177/17531934241307515)
  • [Paper] Resolving complexities in spinal cord injury treatments may take time and careful clinical trials will be required to ensure efficacy and safety. (10.1016/j.injury.2009.01.040)
  • [L1] Compared to conventional treatments, Chinese medicine is effective in alleviating the symptoms of SCI. (10.1186/s13018-025-06129-9)
  • [L3] Early surgical intervention in Cervical SCI patients may improve the dysfunction of LMNs distal to the injury site, reducing secondary motor neuron loss, and eventually improving clinical prognosis. (10.1186/s12891-020-03567-w)
  • [L4] Cell therapy is a rapidly evolving treatment methodology with basic science and early phase I/II human trials showing promise, though the ideal algorithm for spinal cord injury treatment remains unclear. (10.5435/jaaos-d-14-00375)
  • [L5] It provides a reliable platform for investigating the pathophysiology of spinal deformities and evaluating therapeutic interventions. (10.1186/s13018-025-06220-1)
  • [L4] Conservative management is indicated for patients without neural involvement, while immediate exploration followed by fusion is indicated for those with progressive neural involvement or instability. (10.2106/00004623-196749020-00012)
  • [L5] Nerve transfer surgery has expanded reconstructive options for restoring upper extremity function following spinal cord injury by adding new motor donors to the pool available through tendon transfers. (10.1177/17531934211027460)
  • [L3] Early and ultra-early surgical intervention benefits the prevention of neuropathic pain in patients with incomplete traumatic spinal cord injury (AIS B, C, and D), while no such association was found in AIS A patients. (10.1186/s13018-023-04355-7)
  • [L5] The authors present fundamental muscle-tendon-joint mechanics studies that allow for single-stage surgical reconstruction of hand function and early postoperative activity-based training in patients with cervical spinal cord injuries. (10.1177/1753193419827814)
  • [L4] Regenerating axons can grow over great distances to establish functional connections, and muscle fibers can survive denervation for at least sixteen months and fully recover upon reinnervation. (10.2106/00004623-199306000-00013)
  • [L4] MRI performed early after traction injury to the brachial plexus provides useful additional information towards establishing the level of the lesion and provides information about injury to the plexus outside the spinal canal. (10.1054/jhsb.1999.0234)
  • [L5] This review aims to equip reconstructive hand surgeons with a sound understanding of the basic principles of SCI and recovery and provide a rationale for when to intervene with surgery, highlighting the urgent need for early referral to allow nerve transfer options to be viable. (10.1016/j.jhsa.2023.01.008)
  • [L5] This approach shortens the nerve graft needed and nerve regeneration distance, decreases the number of neurorrhaphy sites, and makes full use of the donor nerves, which may benefit hand flexion restoration. (10.1186/s13018-019-1068-2)
  • [L4] High resolution CTM may differentiate central from peripheral intradural rupture, while improved MRI techniques may eventually replace invasive myelography for late referrals. (10.1054/jhsb.2000.0555)
  • [L5] The outcome following nonoperative treatment of stable patients has been encouraging, with most authors reporting recovery of neurological function. (10.2106/00004623-200408000-00022)
  • [L5] Spine surgeons should understand how to manage neurogenic bowel and bladder care on both a short- and long-term basis to minimize the risk for complications and optimize potential for rehabilitation. (10.5435/jaaos-d-21-00873)
  • [L4] However, no technique can predict delayed-onset paraplegia, and monitoring has no indication in discal and degenerative surgery. (10.1016/j.otsr.2013.07.005)
  • [L4] Despite the advent of newer nerve transfers that augment traditional tendon transfer options to restore upper extremity movement in spinal cord injury, barriers to upper extremity reconstruction persist. (10.1016/j.jhsa.2025.06.005)
  • [L3] Autonomic and non-autonomic dysfunction is common in long-term follow-up of cauda equina syndrome patients, even in those with the most optimistic prognosis, and early decompression did not show a statistically significant correlation with improved outcomes. (10.1302/0301-620x.103b9.bjj-2021-1152)
  • [L4] The authors believe that in the face of any neural deficit, radiation therapy in low doses to the spine is indicated. (10.2106/00004623-198163040-00021)
  • [L5] Acute cervical radiculopathy generally has a self-limited clinical course, with up to a 75% rate of spontaneous improvement, making nonsurgical treatment the appropriate initial approach for most patients. (10.5435/00124635-200708000-00005)
  • [L3] The study suggests that a combined nerve and tendon transfer in patients with tetraplegia may offer benefits. (10.1177/17531934251338008)
  • [L4] Expectations should be tempered in these patients as traditional methods to reconstruct the brachial plexus may result in less than ideal functional outcomes due to the associated upper motor neuron injury. (10.1177/1558944718787893)
  • [L4] A LS lumbosacral MRI could be used to diagnose CES safely in patients under the age of 55 years, but further research is needed to assess safety and efficacy before changes to existing protocols can be recommended. (10.1302/0301-620x.102b4.bjj-2019-0645.r2)
  • [L4] If the neurological deficit is not severe and if there is clinical improvement, nonoperative treatment remains an option for symptomatic cervical epidural hematoma. (10.2106/00004623-200102000-00014)
  • [L2] ms-DTI can detect microstructural changes in affected cord segments and reflect functional improvement. (10.1302/0301-620x.102b9.bjj-2020-0468.r1)
  • [L5] The evoked response is a sensitive indicator of the integrity of the central nervous system and serves as a useful tool for monitoring the spinal cord for damage during surgery, despite limitations in precisely locating the site or degree of damage. (10.2106/00004623-198668060-00037)
  • [Case_report] Klippel-Feil syndrome can alter spinal mechanical activity and increase susceptibility to spinal cord injury following minor trauma, even without fracture or dislocation. (10.1186/s12891-023-06760-9)
  • [Case_report] A progressive neurological deficit is an absolute indication for operative treatment. (10.2106/00004623-198971020-00019)
  • [L4] Wheelchair propulsion strategies vary significantly among individuals with identical SCI level, demonstrating that neurological classification alone does not determine movement patterns. (10.1186/s12891-025-08987-0)
  • [L4] It would be useful to know the normal profile of DTI values by location of each nerve root so that we can detect subtle abnormalities in each nerve root. (10.1186/s12891-015-0576-4)
  • [L3] We constructed a prediction model based on six clinical and MRI features that can be used to assess the probability of developing irreversible neurological dysfunction in patients with cervical spinal cord injury. (10.1186/s12891-023-06570-z)
  • [L2] Our results suggest the Narakas classification may not precisely correspond with the injury at the root level, as seen on MRI. (10.1016/j.jhsa.2025.06.015)
  • [L3] This study demonstrates that non-c DISH significantly increases the risk of severe cervical SCI, suggesting that thoracolumbar rigidity may biomechanically compromise cervical spine vulnerability during trauma. (10.1186/s12891-026-09609-z)
  • [L4] This finding underscores the importance of the paravertebral extensor muscles in the context of cervical SCI and may guide future therapeutic strategies. (10.1186/s12891-024-07808-0)
  • [L4] It can significantly preserve vertebral height, increase vertebral canal volume, correct kyphotic angle, and improve postoperative neurological function. (10.1186/s13018-023-04189-3)
  • [L3] Nerve injury usually occurred during the processes of exposure and reduction. (10.1302/0301-620x.101b11.bjj-2019-0341.r2)
  • [L5] Alignment and the characteristics and location of spinal cord compression help determine the ideal surgical approach. (10.5435/jaaos-d-14-00250)
  • [L4] However, long-term spinal stability remains a significant challenge, often requiring additional fusion procedures. (10.2106/00004623-196042060-00010)
  • [L4] The spontaneous transposition of the spinal cord permitted the patient to live to age forty-four with only a transient neurological deficit despite severe pulmonary embarrassment and vascular shunting caused by the deformity. (10.2106/00004623-197557040-00005)
  • [L4] No detectable complications were encountered and no neurological morbidity ensued in the series. (10.2106/00004623-197860040-00016)
  • [L5] The swimming test may represent a method of detecting true supraspinally controlled locomotion. (10.1016/j.injury.2009.01.038)
  • [L3] This procedure can improve patients' pain, neurological function and kyphotic deformity and achieve effects similar to traditional methods, making it an ideal surgical treatment for thoracolumbar fractures in AS patients. (10.1186/s13018-022-03378-w)
  • [L5] Successful outcomes depend on early recondition of the pathology and appropriate surgical referral in cases of progressive neurologic deterioration. (10.5435/jaaos-d-23-00984)
  • [L5] The best postoperative results are obtained for patients managed with decompression within six months to one year after symptom onset, those with early mild findings, and those with a postoperative spinal cord transverse area greater than forty square millimeters. (10.2106/00004623-199409000-00020)
  • [L4] All patients had neurological deficits at the time of definitive surgery, and removal of the lesions resulted in complete relief of symptoms in most cases. (10.2106/00004623-197658070-00031)
  • [L4] The study demonstrates the value of spinal cord monitoring in the detection of neurological injury in a high-risk patient, showing that changes in somatosensory evoked potentials and spinal cord function can be reversed when appropriate treatment is given at the optimum time. (10.2106/00004623-199811000-00016)

See Also

References

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b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.