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Spinal Cord Injury ll: Pathophysiology

Spinal Cord Injury ll: Pathophysiology

Spinal cord injury progresses through two interconnected phases: primary injury and secondary injury.Primary InjuryPrimary injury happens at the moment of trauma and involves immediate mechanical damage to the spinal cord.Compression happens when broken vertebrae, herniated discs, or accumulating blood (such as a hematoma) press directly against the spinal cord, distorting its normal shape and function. In cases of contusion, the cord is bruised by a blunt force (like penetrating injuries or...

Secondary Spinal Cord Injury llI: Pathophysiology

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Early Ischemia and Ionic ImbalanceWithin minutes of spinal cord injury, a secondary cascade begins, progressing over hours to weeks. Vascular damage reduces blood flow, causing ischemia and mitochondrial dysfunction. ATP depletion leads to ion pump failure, membrane depolarization, sodium influx, potassium efflux, and water accumulation, resulting in cellular swelling. Increased intracellular calcium further disrupts mitochondria and accelerates cellular injury.Excitotoxicity and Neuronal...

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Related Experiment Video

Updated: May 7, 2026

Assessing Forelimb Function after Unilateral Cervical SCI using Novel Tasks: Limb Step-alternation, Postural Instability and Pasta Handling

Assessing Forelimb Function after Unilateral Cervical SCI using Novel Tasks: Limb Step-alternation, Postural Instability and Pasta Handling

Published on: September 16, 2013

Forgoing Upper-Extremity Reconstructive Surgery After Cervical Spinal Cord Injury: A Qualitative Prospective Cohort

Shady Elmaraghi¹, Allison J L'Hotta², Aimee S James³

¹Department of Plastic Surgery, Vanderbilt University, Nashville, TN.

The Journal of Hand Surgery

|August 8, 2025

Summary

Many individuals with spinal cord injury (SCI) avoid upper extremity surgery due to fear, unrealistic expectations, or past negative experiences. Improved communication about surgical risks and benefits is needed.

Keywords:

Nerve transfer surgery qualitative surgical decision-making tendon transfer surgery tetraplegia

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Structured Motor Rehabilitation After Selective Nerve Transfers

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Last Updated: May 7, 2026

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Structured Motor Rehabilitation After Selective Nerve Transfers

Structured Motor Rehabilitation After Selective Nerve Transfers

Published on: August 15, 2019

Area of Science:

Neuroscience
Orthopedic Surgery
Rehabilitation Medicine

Background:

Restoration of upper extremity (UE) function is a top priority for individuals with cervical spinal cord injury (SCI).
Tendon transfer (TT) surgery rates are low in the US despite positive outcomes.
Newer nerve transfer (NT) options have expanded treatment possibilities for SCI-related UE dysfunction.

Purpose of the Study:

To investigate why eligible individuals with SCI choose not to undergo UE reconstruction surgery.
To understand decision-making factors in the context of both traditional TT and newer NT procedures.

Main Methods:

Qualitative study involving semistructured interviews with adults with midcervical SCI who declined UE surgery and their caregivers.
Interviews were transcribed, coded, and analyzed using conventional content analysis.
Findings were summarized into themes adhering to COREQ guidelines.

Main Results:

Sixteen participants (94% male, mean age 39) and eight caregivers provided data.
Key reasons for forgoing surgery included fear of functional decline, desire for greater gains, adjustment to existing function, competing priorities, expectation of natural recovery, and prior negative healthcare experiences.
Barriers exist for both TT and NT procedures.

Conclusions:

Despite advancements in NT augmenting TT for UE restoration in SCI, significant barriers to surgical reconstruction persist.
Enhanced shared decision-making is crucial, requiring detailed information on surgical risks, outcomes, and comparative data against natural recovery.
Effective but underutilized surgical options for SCI patients need better patient understanding.