Spinal cord stimulation (SCS) represents an established neuromodulatory intervention for refractory neuropathic pain (NP), yet the cellular mechanisms underlying its anti-inflammatory effects remain incompletely defined. The activation of astrocytes, especially polarization into the A1-like phenotype, is crucial for the persistence of central sensitization. This study aimed to investigate whether the analgesic effects of SCS are associated with modulation of astrocyte activation and calcium ions (Ca2+) / calcineurin (CaN) / nuclear factors of activated T cells 4 (NFAT4) pathway signaling in the spinal dorsal horn. In a rat model of chronic constriction injury (CCI), the present study found that SCS significantly ameliorated mechanical allodynia and reduced spinal levels of proinflammatory cytokines. Furthermore, SCS suppressed spinal dorsal horn astrocyte activation and attenuated their polarization toward the A1-like phenotype. In association with these changes, SCS reduced CCI-induced spinal Ca2+ elevation, downregulated CaN and NFAT4 expression, and decreased NFAT4 nuclear translocation. In vitro experiments further demonstrated that inhibition of CaN or NFAT4 similarly attenuated astrocyte activation, A1-like polarization, and proinflammatory cytokine release. The findings suggest that the analgesic effect of SCS in NP is associated with suppression of Ca2+/CaN/NFAT4 pathway signaling and attenuation of neurotoxic A1-like astrocyte polarization and neuroinflammation. This study supports the involvement of an astrocyte-related Ca2+/CaN/NFAT4 signaling axis in the biological effects of SCS and provides a potential therapeutic target for improving neuromodulation-based pain management. Graphical Abstract. Spinal cord stimulation alleviates neuropathic pain and is associated with reduced Ca2+/CaN/NFAT4 pathway signaling, astrocyte activation, and A1-like polarization in the spinal dorsal horn. Spinal cord stimulation reverses the activation of the Ca2+/CaN/NFAT4 signaling pathway in spinal dorsal horn caused by peripheral nerve injury, thereby inhibiting NFAT4 nuclear translocation. This suppresses A1-like astrocyte polarization and proinflammatory cytokine release, alleviating neuropathic pain.

To analyse the short-term effectiveness of soft bracing in the treatment of adolescent idiopathic scoliosis (AIS) patients in terms of the correction success rate, daily wear time and comfort levels and explore the sources of heterogeneity. A literature search was performed using PubMed, EMBASE, Web Of Science, and Cochrane Library from the establishment of the literature database to April 2023. According to the evaluation criteria for the effectiveness of bracing from the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) and the evaluation indicators of the success rate in previous studies, the success rate was defined as a Cobb angle ≤ 5° curve progression at maturity and a terminal follow-up angle < 45°. The success rate of soft bracing was compared with that of observation and rigid bracing. The daily wear time and comfort levels of soft bracing were compared with those of rigid bracing. The data were analyzed using RevMan 5.4, Stata 15.0 and IBM SPSS 25.0. Twelve studies involving 510 patients were included in the meta-analysis. In the single-arm analysis of 12 studies, the success rate of soft braces was 70

Neuropathic pain has a complex pathogenesis and poses significant treatment challenges. In recent years, exercise has garnered increasing attention as a nonpharmacological intervention for the management of neuropathic pain. This review systematically examines the research progress on the neurobiological mechanisms of exercise in the treatment of neuropathic pain, including its effects on improving neuroinflammation, alleviating oxidative stress, modulating neuroplasticity, influencing the descending pain modulation system, and regulating gene expression and epigenetic modifications. Additionally, this review summarizes the application and therapeutic effects of various exercise interventions in different types of neuropathic pain, such as neuropathic pain after spinal cord injury, chemotherapy-induced peripheral neuropathy, diabetic peripheral neuropathy, and neuropathic pain in multiple sclerosis, on the basis of current clinical research. It also explores future research directions and trends in this field. By integrating basic research and clinical evidence, this review aims to provide a theoretical basis and practical guidance for exercise therapy in patients with neuropathic pain. Although existing evidence supports the analgesic potential of exercise, future high-quality clinical studies are needed to optimize individualized exercise prescriptions and further explore its molecular and neural circuit mechanisms. Mechanism and clinical application of exercise therapy for neuropathic pain. Exercise exerts analgesic effects through multiple mechanisms, including modulation of neuroinflammation, oxidative stress, neuroplasticity, descending pain modulatory system, and epigenetics. For neuropathic pain of different etiologies, exercise programs can be customized to accurately regulate specific pathological links.

Neuropathic pain is a common and severe type of chronic pain, and its pathogenesis has not been fully defined. Increasing evidence shows that spinal astrocytes play indispensable roles in the occurrence and development of neuropathic pain. Most studies have suggested that activated astrocytes can crosstalk with other glial cells and neurons through morphological and functional changes, exacerbating the development of pain. However, reactive astrocytes have a dual role. As a defense mechanism, reactive astrocytes have roles in increasing neuroprotection and stimulating neurogenesis. Studies have demonstrated a potentially beneficial role for astrocyte activation in neuropathic pain. In addition, the therapeutic mechanisms of multiple drugs and neuromodulatory techniques are thought to be related to astrocytes. This review highlights the recent advances and significance of spinal astrocytes, emphasizing the need for a better understanding of their roles in the pathogenesis and treatment of neuropathic pain.

ObjectiveTo investigate the differences and regularity of gait and muscle activation characteristics parameters in the Locomotion Dysfunction Grade (LDG) scale assessment in elderly individuals, and analyse the correlation between objective parameters and scale grading. Thus, to propose a novel detection mode for elderly individuals, which combined the LDG scale with objective detection. It can not only provide quantitative data for intelligent evaluation and rehabilitation, but also provided more accurate reference for the classification of care levels in elderly care policies.MethodsElderly individuals (n = 159) who underwent gait analysis and sEMG at the Chinese Rehabilitation Research Center from January 2019 to September 2023 were included. According to the LDG scale, the elderly individuals were divided into four groups, namely, the LDG4, LDG5, LDG6 groups and the healthy control group. Four indicators, namely, spatiotemporal, kinematic, dynamic gait parameters and muscle activation characteristics data, were collected. Changes in these characteristics of elderly individuals with lower extremity motor dysfunction were evaluated and analysed statistically.ResultsThe spatiotemporal gait parameters were significantly lower in the LDG4, LDG5, LDG6 groups than in the healthy control group. The double support phase was positively correlated with the LDG, while the swing phase, step length and velocity were negatively correlated (P < 0.05). The movement angles of both hips, knees and ankles were significantly limited and negatively correlated with the LDG (P < 0.05). Compared with those in the healthy control group, the centre of pressure (COP) path length were greater, and the average COP velocity was significantly lower (P < 0.05) in the LDG4, LDG5, LDG6 groups. The regularity of muscle activation clearly changed. The root mean square of the gastrocnemius medialis was positively correlated with LDG (P < 0.05), while the tibialis anterior showed no regularity.ConclusionAs the LDG increased, the differences in spatiotemporal, kinematic and dynamic gait parameters between elderly individuals with motor dysfunction and the healthy individuals gradually increased. The muscle activation characteristics parameters showed an abnormal activation pattern. These parameters were correlated with the LDG, providing a more comprehensive and objective assessment of lower extremity motor function in elderly individuals, improve assessment accuracy, and help accurate rehabilitation.

PURPOSE:To investigate the incidence and influencing factors of bone loss in patients with spinal cord injury (SCI). METHODS:A retrospective case-control study was conducted. Patients with SCI in our hospital from January 2019 to March 2023 were collected. According to the correlation between bone mineral density (BMD) at different sites, the patients were divided into the lumbar spine group and the hip joint group. According to the BMD value, the patients were divided into the normal bone mass group (t > -1.0 standard deviation) and the osteopenia group (t ≤ -1.0 standard deviation). The influencing factors accumulated as follows: gender, age, height, weight, cause of injury, injury segment, injury degree, time after injury, start time of rehabilitation, motor score, sensory score, spasticity, serum value of alkaline phosphatase, calcium, and phosphorus. The trend chart was drawn and the influencing factors were analyzed. SPSS 26.0 was used for statistical analysis. Correlation analysis was used to test the correlation between the BMD values of the lumbar spine and bilateral hips. Binary logistic regression analysis was used to explore the influencing factors of osteoporosis after SCI. p < 0.05 was considered statistically significant. RESULTS:The incidence of bone loss in patients with SCI was 66.3%. There was a low concordance between bone loss in the lumbar spine and the hip, and the hip was particularly susceptible to bone loss after SCI, with an upward trend in incidence (36% - 82%). In this study, patients with SCI were divided into the lumbar spine group (n = 100) and the hip group (n = 185) according to the BMD values of different sites. Then, the lumbar spine group was divided into the normal bone mass group (n = 53) and the osteopenia group (n = 47); the hip joint group was divided into the normal bone mass group (n = 83) and the osteopenia group (n = 102). Of these, lumbar bone loss after SCI is correlated with gender and weight (p = 0.032 and < 0.001, respectively), and hip bone loss is correlated with gender, height, weight, and time since injury (p < 0.001, p = 0.015, 0.009, and 0.012, respectively). CONCLUSIONS:The incidence of bone loss after SCI was high, especially in the hip. The incidence and influencing factors of bone loss in the lumbar spine and hip were different. Patients with SCI who are male, low height, lightweight, and long time after injury were more likely to have bone loss.

The mechanisms of secondary injury following spinal cord injury are complicated. The role of ferroptosis, which is a newly discovered form of regulated cell death in the neurovascular unit(NVU), is increasingly important. Ferroptosis inhibitors have been shown to improve neurovascular homeostasis and attenuate secondary spinal cord injury(SCI). This review focuses on the mechanisms of ferroptosis in NVU cells and NVU-targeted therapeutic strategies according to the stages of SCI, and analyzes possible future research directions.

Traumatic spinal cord injury is a devastating disorder characterized by sensory, motor, and autonomic dysfunction that severely compromises an individual's ability to perform activities of daily living. These adverse outcomes are closely related to the complex mechanism of spinal cord injury, the limited regenerative capacity of central neurons, and the inhibitory environment formed by traumatic injury. Disruption to the microcirculation is an important pathophysiological mechanism of spinal cord injury. A number of therapeutic agents have been shown to improve the injury environment, mitigate secondary damage, and/or promote regeneration and repair. Among them, the spinal cord microcirculation has become an important target for the treatment of spinal cord injury. Drug interventions targeting the microcirculation can improve the microenvironment and promote recovery following spinal cord injury. These drugs target the structure and function of the spinal cord microcirculation and are essential for maintaining the normal function of spinal neurons, axons, and glial cells. This review discusses the pathophysiological role of spinal cord microcirculation in spinal cord injury, including its structure and histopathological changes. Further, it summarizes the progress of drug therapies targeting the spinal cord microcirculation after spinal cord injury.

Objective: Hip subluxation is a common complication in children with spinal cord injury. This study aimed to investigate the incidence and influencing factors of hip subluxation and discuss prevention strategies.Methods: Medical records of children with spinal cord injury were reviewed. The inclusion criteria were as follows: (1) the patient was younger than 18 years old when injured; (2) absence of traumatic or congenital pathological changes of the hip at the time of injury. The migration percentage and acetabular index were selected to evaluate hip stability and acetabulum development. Influencing factors of sex, age, injury duration, severity, level, and spasticity were analyzed.Results: A total of 146 children were enrolled. Twenty-eight children presented with hip subluxation and were significantly younger at the time of injury than those with normal hips (P = 0.002). The incidence of hip subluxation increased with the prolonged injury duration. Injury before age 6, complete injury, and flaccid lower extremities were significant influencing factors (P = 0.003, 0.004, and 0.015, respectively). The risk of hip subluxation decreased by 18% for every year older in injury age (P = 0.031) and decreased by 85% in children with spasticity (P = 0.018) than those without. However, the risk of hip subluxation in children with injury duration longer than 1 year was 7.1 times higher than those with shorter injury duration (P < 0.001).Conclusions: The incidence of hip subluxation in children with spinal cord injury increased with the injury duration. Younger children had immature hip development. Due to complete injury and flaccid muscle, lack of protection around the hip may lead to subluxation. Follow-up and prevention of hip subluxation need the joint effort of medical staff and families.

Objective To avoid deviation caused by the traditional scale method, the present study explored the accuracy, advantages, and disadvantages of different objective detection methods in evaluating lower extremity motor function in elderly individuals. Methods Studies on lower extremity motor function assessment in elderly individuals published in the PubMed, Web of Science, Cochrane Library and EMBASE databases in the past five years were searched. The methodological quality of the included trials was assessed using RevMan 5.4.1 and Stata, followed by statistical analyses. Results In total, 19 randomized controlled trials with a total of 2626 participants, were included. The results of the meta-analysis showed that inertial measurement units (IMUs), motion sensors, 3D motion capture systems, and observational gait analysis had statistical significance in evaluating the changes in step velocity and step length of lower extremity movement in elderly individuals (P < 0.00001), which can be used as a standardized basis for the assessment of motor function in elderly individuals. Subgroup analysis showed that there was significant heterogeneity in the assessment of step velocity [SMD=-0.98, 95%CI(-1.23, -0.72), I-2 = 91.3%, P < 0.00001] and step length [SMD=-1.40, 95%CI(-1.77, -1.02), I-2 = 86.4%, P < 0.00001] in elderly individuals. However, the sensors (I-2 = 9%, I-2 = 0%) and 3D motion capture systems (I-2 = 0%) showed low heterogeneity in terms of step velocity and step length. The sensitivity analysis and publication bias test demonstrated that the results were stable and reliable. Conclusion observational gait analysis, motion sensors, 3D motion capture systems, and IMUs, as evaluation means, play a certain role in evaluating the characteristic parameters of step velocity and step length in lower extremity motor function of elderly individuals, which has good accuracy and clinical value in preventing motor injury. However, the high heterogeneity of observational gait analysis and IMUs suggested that different evaluation methods use different calculation formulas and indicators, resulting in the failure to obtain standardized indicators in clinical applications. Thus, multimodal quantitative evaluation should be integrated.

Evoked compound action potential (ECAP) is an important parameter in close-loop spinal cord stimulation (SCS). The recording electrode is typically positioned proximal to the stimulation electrode to capture the antegrade ECAP signals generated by ascending fibers. However, relatively little research has been conducted on retrograde ECAPs. This study investigated retrograde ECAPs using custom-made epidural electrodes in 11 adult male Sprague-Dawley rats. Results show that the average motor threshold (MT) and ECAP threshold (ECAPT) for 11 anesthetized rats were 218.18 +/- 69.54 mu A and 107.27 +/- 27.96 mu A, respectively. The ECAP amplitudes increased with increasement of the stimulation current and pulse width (PW), and were larger in awake rats than in anesthetized rats. Additionally, aside from ECAPs recorded by a commercial electrophysiological recorder, ECAPs were also recorded by a custom-made amplifier for the purpose of future long-term implantation, but the custom-made amplifier showed lower signal to noise ratio than the commercial amplifier. In conclusion, this study illustrates that retrograde ECAP may also be considered as a feedback signal for close-loop SCS and more sophisticated ECAP recording circuits are needed to form a close-loop system.

BACKGROUND:Traditional sacroiliac joint (SIJ) provocation tests have been used to diagnose SIJ pain. However, this can simply be changed to chronic SIJ dysfunction (cSIJD) manifests as mechanical changes in the pelvis and lower extremities in addition to pain. A novel composite of physical examinations based on the iliac pronation, pubic tubercle tenderness, and plantar fascia tenderness tests (IPP triple tests) was designed for the diagnosis of cSIJD.OBJECTIVES:To evaluate IPP triple tests in the diagnosis of cSIJD and differential diagnosis from lumbar disc herniation (LDH) in comparison with traditional provocation tests.STUDY DESIGN:Prospective single-blind controlled study.SETTING:This study was conducted at the Department of Spine and Spinal Cord Surgery of China Rehabilitation Research Center in Beijing, China.METHODS:One hundred and sixty-six patients were assigned into the cSIJD group, LDH group, or healthy control group. The cSIJD diagnosis was confirmed by SIJ injection. The diagnosis of LDH was confirmed according to the 2014 North American Spine Association diagnosis and treatment guidelines for LDH. All patients were examined with IPP triple tests and traditional provocation tests. The sensitivity, specificity, positive and negative likelihood ratios, and areas under the curve (AUCs) were used to evaluate the diagnostic accuracy of the composites or single of the IPP triple tests, and traditional provocation tests. The Delong's test was used for the comparison among AUCs. The kappa analysis was used for the IPP triple tests and traditional provocation tests compared with the reference standard (REF). The independent t test and chi-square test were used to analyze the influence factors (i.e., age, gender), and group on diagnostic accuracy.RESULTS:There was no statistical difference in gender (chi-squared = 0.282, P = 0.596) and age (F = 0.096, P = 0.757) between the 3 groups. The AUC of the iliac pronation test was 0.903 when it was used alone; the AUC of the novel composites of the IPP triple tests was 0.868 (95% confidence interval [CI] = 0.802-0.919); and the diagnostic accuracy of the traditional provocation test was relatively low (AUC = 0.597, 95% CI = 0.512-0.678). The diagnostic accuracy of the IPP triple tests was higher than that of the traditional provocation test, P < 0.05. Kappa consistency comparison showed that the kappa value between the IPP triple tests and the REF was 0.229, the kappa between the traditional provocation test and the REF was 0.052. The age of the patients with inaccurate diagnosis was higher than that of the patients with accurate diagnosis in both methods (traditional tests, P = 0.599; IPP:P = 0.553). Different types of diseases (groups) affect the accuracy of diagnosis, the proportion of inaccuracy of traditional provocation tests was higher than that of the IPP triple tests (77.8% vs 23.6%) in cSIJD, while the 2 methods have high differential diagnostic accuracy in LDH (96.77%) and control groups (97.56%).LIMITATIONS:Small size of LDH patients and differences in physical tests among examiners.CONCLUSIONS:The novel composites of IPP triple tests have higher accuracy than the traditional provocation tests in diagnosing cSIJD and both have good accuracy in differentiating cSIJD from LDH. IPP triple tests may be an alternative physical examination for clinical screening of cSIJD.

目的:观察综合康复治疗对创伤性颈脊髓中央损伤综合征(traumatic central cord syndrome,TCCS)患者神经功能和生活质量的改善情况,并进行多维度疗效评价.方法:回顾性分析2016年1月～2021年12月我院收治的90例TCCS患者,其中男74例,女16例,年龄27～85岁(56.6±10.7岁),根据综合康复治疗前是否接受了颈椎手术分为术后康复组(82例)和单纯康复组(8例).两组患者在年龄、性别、脊髓损伤程度等方面均无统计学差异(P＞0.05).所有患者均接受1～3个月的物理治疗、作业治疗、膀胱管理等综合康复治疗.收集患者入院和出院时的美国脊髓损伤协会(American Spinal Injury Assosication,ASIA)残损分级(ASIA impairment scale,AIS)和运动评分(motor score,MS)、国际功能分类康复组合(ICF-RS)评分,并进行组间比较;统计患者膀胱功能变化和并发症情况,全面评估TCCS患者的神经功能恢复情况,多维度评价康复措施的疗效.结果:综合康复治疗前AIS分级C级48例,D级42例,治疗后27例患者C级改善为D级(术后康复组23例,单纯康复组4例),余63例AIS分级无变化,但治疗后下肢和上肢的MS较治疗前显著提高(P＜0.05).组间MS评分无统计学差异(P＞0.05).患者ICF-RS所有条目中,"b280痛觉"、"d240控制应激和其他心理需求"评分变化治疗前后无统计学差异(P＞0.05);余条目评分均较治疗前有提高,且有统计学差异(P＜0.05),组间比较无统计学差异(P＞0.05).33例患者由导尿恢复至自主排尿.脊髓损伤并发症占比前2名的是痉挛(54.4％)和神经痛(23.3％),痉挛与MS恢复程度无显著相关性(P=-0.06).结论:综合康复治疗对TCCS患者神经功能恢复有明显促进作用,无论是术后康复还是单纯康复的TCCS患者其综合功能均获得了明显改善.ICF-RS条目细致,适于TCCS这一特殊类型脊髓损伤患者的评估.

Oscillating field stimulation(OFS) is a potential method for treating spinal cord injury. Although it has been used in spinal cord injury(SCI) therapy in basic and clinical studies, its underlying mechanism and the correlation between its duration and nerve injury repair remain poorly understood. In this study, we established rat models of spinal cord contusion at T10 and then administered 12 weeks of OFS. The results revealed that effectively promotes the recovery of motor function required continuous OFS for more than 6 weeks. The underlying mechanism may be related to the effects of OFS on promoting axon regeneration, inhibiting astrocyte proliferation, and improving the linear arrangement of astrocytes. This study was approved by the Animal Experiments and Experimental Animal Welfare Committee of Capital Medical University(supplemental approval No. AEEI-2021-204) on July 26, 2021.

OBJECTIVE To investigate the clinical characteristics of children with traumatic spinal cord injury (SCI) admitted to a research rehabilitation center between 2011 and 2020, with a view to generate crucial data for understanding and prevention of pediatric traumatic SCI. DESIGN Retrospective cohort study. SETTING The National Rehabilitation Research Center of China, Beijing, China. PARTICIPANTS Medical records and imaging data of children with traumatic SCI admitted to the rehabilitation research center from 2011 to 2020. INTERVENTIONS Not applicable. OUTCOME MEASURES Data on age, sex, cause of injury, neurological level of injury, impairment scale of SCI and details of spine fracture or dislocation were all collected and analyzed. RESULTS A total of 351 patients were included in the study, including 133 males (37.9%) and 218 females (62.1%). There were 231 cases (65.8%) without spine fracture or dislocation. SCI without fracture or dislocation (SCIWORA) was the most common in children between the age of 5 and 14 years (77.9%), and injuries caused by sports were the most common in girls (90.8%). Among sports injuries, those due to a special dance movement called "Xia-Yao" in Chinese, which involves hyperextension of the trunk, constituted the majority, with the neurological level of injuries located predominantly in the middle (34.6%) and lower (44.2%) thoracic levels. CONCLUSION Girls between the ages of 5 and 14 years constituted the majority of SCIWORA injuries at the thoracic levels, which were caused mainly by "Xia-Yao". Overall, careful attention should be paid to prevent this kind of injury in children.

目的:康复辅具适配可以有效帮助脊髓损伤(spinal cord injury,SCI)患者康复.现阶段,我国正面临着辅具适配服务人员总量不足,分布不均和基层工作人员专业能力不足等多重问题,因此,本研究提出了基于案例推理-规则推理混合推理的脊髓损伤患者智能辅具适配系统.方法:本研究基于临床的125例SCI病例信息,建立了 SCI案例库,首先基于案例推理(case-based reasoning,CBR)通过K近邻(k-nearest neighbor,KNN)和相似度检测算法查找相关历史案例集的辅具适配组合,然后利用基于规则推理(rule-based reasoning,RBR)对辅具适配组合进行修正,最终输出适配的辅具组合.结果:本研究对25个SCI患者适配辅具来实现算法验证.结果显示:推荐移动类辅具、矫形器类辅具、个人生活自理类辅具和沟通和信息类辅助器具平均命中率分别为:83.66％、96％、85％和92％.平均召回率分别为:50.69％、62.67％、49.78％和 24％.结论:本系统利用CBR方法提高了决策的效率,RBR提高了决策的针对性.通过运用在线辅具适配系统,有效缓解了康复辅具适配率低和康复人才全国性缺乏和区域性分配不均的问题,具有良好的应用前景.

PURPOSE:The long-term situation of children with spinal cord injury (SCI) was investigated, and suggestions for helping them better return to the society were provided. METHODS:SCI patients less than 18 years old hospitalized in Beijing Boai Hospital from January 2011 to December 2020 were retrospectively analyzed. Information including motor function, complications, characteristic changes, self-care abilities, school attendance and social participation were collected by telephone interview and electronic questionnaire. All the answers were statistically analyzed. RESULTS:A total of 86 cases were enrolled, 77 girls and 9 boys, with a median injury age of 6 years and 2 months. The follow-up time was 3-130 months. The main cause of trauma in these children was sport injury (66.3%), the thoracic spinal cord was involved the most (91.9%), and complete SCIs accounted for the majority (76.7%). In terms of complications, children with complete SCIs were more likely to have urinary incontinence, constipation and characteristic changes (p < 0.05); whereas the incomplete SCIs often have spasticity (p < 0.05). As to the daily living abilities, children with incomplete lumbar SCIs were more capable to accomplish personal hygiene, transfer, and bathing independently than those with complete injuries, or cervical/thoracic SCIs, respectively (p < 0.05). Moreover, children older than 9 years care more able to dress and transfer independently than the youngers (p < 0.05). Wheelchair users accounted for 84.9% and more than half of them were able to propel wheelchair independently, and those who move passively in wheelchairs were mostly introverted kids (p < 0.05). Almost all (93.8%) children with incomplete injuries were able to walk independently. Most (79.1%) children continued to attending school, and 41.9% participated in interest classes. Unfortunately, 67.4% of the children spent less time playing with their peers than before the injury. CONCLUSION:SCIs impair physical structures and function of children, affect their independence in daily living, and restrict school attendance and social interaction. Comprehensive rehabilitation after injury is a systematic work. Medical staff and caregivers should not only pay attention to neurological function, but also help them improve self-care abilities. It is also important to balance rehabilitation training and school work and social participation.

Background Percutaneous endoscopic lumbar discectomy (PELD) is a promising minimally invasive treatment for lumbar disc herniation (LDH). Postoperative rehabilitation can improve patient outcomes. Not only rehabilitation for surgical trauma but also rehabilitation for lumbar spine and lower kinetic chain dysfunction should be performed. The aims of this study were to investigate the efficacy of a lumbar kinetic chain training for staged rehabilitation after PELD for LDH. Methods Fifty one LDH patients treated with PELD were studied. After surgery, patients underwent lumbar kinetic chain training for staged rehabilitation( staged group) or regular low back rehabilitation (regular group). The staged rehabilitation programme included three phases from 2 to 6, 7–12, and 13–24 weeks postoperatively, and different physical therapies were performed during these phases. The low back pain visual analogue scale (VAS), JOA score, ODI, SF-36, and cross-sectional area of the lumbar multifidus on MRI were assessed, and gait analysis was performed. Results Twenty five patients in staged group and twenty six patients in regular group were included. There were no significant differences in age or sex between the two groups at baseline ( p > 0.05). The VAS score decreased and the JOA and SF-36 scores increased in both groups from baseline to 6 weeks ( P < 0.05). In the staged group, compared with the regular group, the VAS and ODI scores were lower and the JOA and SF-36 scores were higher at 6 weeks ( P < 0.05); the VAS and ODI scores were lower and the SF-36 score was higher at 12 weeks ( P < 0.05); the SF-36 score was higher at 24 weeks ( P < 0.05); the cross-sectional area of the lumbar multifidus showed no differences at 12 weeks ( P > 0.05); and the left-right support ratio of gait was higher at 24 weeks ( P < 0.05). Conclusions The staged rehabilitation programme for LDH after PELD promoted postoperative recovery, and the efficacy of lumbar kinetic chain training was higher than that of regular low back muscle exercise.

PURPOSE:To investigate the long-term (> 7 years) clinical outcomes of percutaneous endoscopic lumbar discectomy for lumbar degenerative disease to address postoperative problems including postoperative dysesthesia (POD), residual back pain and segmental instability.METHODS:Inclusion and exclusion criteria were established. All patients who met the above criteria were treated by PELD using the transforaminal approach. Limited discectomy was performed to preserve the disc material in the intervertebral space as much as possible. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back pain (VAS-B) and leg pain (VAS-L) and Modified MacNab's criterion were used for clinical evaluation. Radiographic parameters including height of intervertebral disc and segmental instability were also evaluated.RESULTS:Forty-two patients (24 men and 18 women) who met our inclusion and exclusion criteria were included in our study. The average follow-up period was 95.71±5.63 months (ranging from 87 to 105 months). There were no neurological complications associated with the operation. POD was found in 14.29% of patients, while only 2 patients (4.76%) complained of mild dysesthesia at final follow-up. Two patients (4.76%) required revision surgery during the follow-up period. The final follow-up ODI, JOA score, VAS-B and VAS-L were significantly better than preoperative values. The average disc-height ratio was 84.52±5.66% of the preoperative disc height. No instability at the operation level was noted at final follow-up.CONCLUSION:Our study showed that PELD using the transforaminal approach can provide favorable results after a long-term follow-up period. POD is a common complication at initial prognosis. Limited discectomy can preserve the disc height well and minimize the risk of residual back pain.

背景:腰椎间孔镜手术解除了腰椎间盘突出所致的神经根压迫,而术后康复不仅包括手术创伤的康复,还应包括腰椎间盘突出症伴随的腰肌损害和骨盆下肢功能失衡的康复.目的:将基于McKenzie技术的腰椎运动链训练应用于椎间孔镜术后分期康复,评估该康复方案的有效性和可行性.方法:选择中国康复研究中心北京博爱医院2012年1月至2018年12月收治的腰椎间盘突出症患者62例,均接受侧路椎间孔镜治疗,术后利用随机数字表法分为试验组与对照组,每组31例.试验组术后根据预设康复方案进行基于McKenzie技术的腰椎运动链远程分期康复指导,一期术后2-6周、二期术后7-12周,三期术后13-24周;对照组进行常规的腰椎术后康复指导.术后康复前及康复训练6,12,24周,评估两组腰痛目测类比评分、日本骨科协会下腰痛JOA评分、Oswestry功能障碍指数评分、SF-36健康调查简表评分;康复训练12周,利用MRI扫描检测腰椎多裂肌横截面积;康复训练24周,利用三维运动采集与分析系统进行步态分析.研究通过中国康复研究中心北京博爱医院伦理委员会审查,审批号(2019-011-1).结果 与结论:①康复训练后,两组的腰痛目测类比评分、Oswestry功能障碍指数评分、JOA评分、SF-36评分均较康复前有不同程度的改善;试验组康复训练6,12周的目测类比评分、Oswestry功能障碍指数评分低于对照组(P＜0.05),康复训练6周的JOA评分高于对照组(P＜0.05),康复训练6,12,24周的SF-36评分高于对照组(P＜0.05);②两组腰椎多裂肌横截面积比较差异无显著性意义(P＞0.05);③步态分析显示,试验组康复训练24周的支撑相左右侧比值大于对照组(P＜0.05);④结果表明,腰椎间盘突出症椎间孔镜术后分期康复方案符合该疾病术后恢复特点,具有良好的有效性和可行性.