Spinal cord injury can cause significant degeneration beyond the original injury site, researchers from NeuRA and UNSW Sydney have found.

The study used magnetic resonance imaging (MRI) to identify measurable changes elsewhere in the spinal cord, prompting calls to view spinal cord injuries in the context of the broader nervous system.

Dr Yann Quidé and Professor Sylvia Gustin led the multinational research collaboration in the largest imaging study of this kind to date. MRIs of 52 people with thoracic spinal cord injury were examined and compared with scans from neurologically healthy people matched for age and sex.

“Our findings show that spinal cord injury is not simply a local event,” Prof Gustin said.

“Even when the original injury occurs in the thoracic region of the spinal cord, we can detect measurable structural changes in the cervical spinal cord, many levels away from the injury.”

The researchers found that people with thoracic spinal cord injury had a significantly smaller cross-sectional area of the cervical spinal cord, located in the neck, as well as reductions in its front-to-back and side-to-side dimensions. The spinal cord was also more flattened in shape.

Importantly, these structural changes were identified in people whose injury was in the thoracic region of the spinal cord, meaning the cervical spinal cord itself had not been directly injured. 

“This is important because recovery after spinal cord injury is often considered primarily in terms of what happens at the site of injury,” Dr Quidé said. 

“Our results suggest that we need to think more broadly about spinal cord injury as a condition that can affect the nervous system well beyond the original lesion.”

The researchers also examined whether chronic neuropathic pain, a common and often debilitating consequence of spinal cord injury, was associated with structural changes in the cervical spinal cord. 

They found that increased flattening of the cervical spinal cord was particularly evident among people experiencing chronic neuropathic pain, raising the possibility that remote structural changes may be linked to important clinical consequences of spinal cord injury. 

The findings provide new evidence that neurodegenerative processes following spinal cord injury may extend along the spinal cord through connected ascending and descending neural pathways.

The researchers suggest that MRI-based measures of cervical spinal cord structure, particularly cross-sectional area and spinal cord shape, could potentially serve as biomarkers of neurodegeneration following spinal cord injury.

Such biomarkers could help researchers better understand how spinal cord injury progresses over time, identify individuals who may be at greater risk of secondary degeneration, and support the development and evaluation of new treatments aimed at protecting the nervous system and improving recovery.

“Understanding how and where degeneration occurs after spinal cord injury is a critical step towards developing treatments that can protect remaining neural pathways and maximise recovery,” Prof Gustin said.

The study highlights the importance of considering the whole nervous system when studying spinal cord injury and developing new therapeutic approaches.

The researchers hope that a better understanding of these remote changes will ultimately help advance new approaches to spinal cord injury treatment and rehabilitation.

The study was published in the European Journal of Neurology as ​“Cervical atrophy following complete thoracic spinal cord injury: Insights from a multinational cohort”. 

The report can be read here.