PMC9448914_01
MR images and Radiographic before treatment. (A,B) Lumbar magnetic resonance imaging and computed tomography showed explosive L1 fracture with severe SCI. (C) Postoperative radiograph.
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F1
T12-L1 vertebral flexion and stretch fracture accompanied by traumatic spinal stenosis (Figures 1A,B). The final diagnosis was SCI with paraplegia (The American Spinal Injury Association impairment scale: B). The posterior thoracic T12-L2 pedicle screw system was used for distraction reduction, internal fixation, lamina decompression, and bone graft fusion (Figure 1C). Table 3). The imaging data of patient after rehabilitation in Supplementary Figure 1.
Schematic of EA stimulation. (A) Sacral nerve EA stimulation on the patient. (B) Ultrasonographic images of the S4 (a short arrow) and S3 (a long arrow) foramen. (C) Ultrasonographic images of the T12 to the L2 vertebrae. (D) Spinal nerve EA stimulation on the patient. (E) EA distribution of spinal nerve stimulation. (F) EA stimulation of the head on the patient.
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According to that article, the four therapeutic EA electrodes (HUA CHENG.30 mm x 75 mm) were located in the S3 and S4 foramen connected with an electro stimulator (sd Z-III electroacupuncture instrument, Hwato brand, China) at 20 Hz with 220 ms wave width, which is similar with the sacral nerve stimulator (Figures 2A,B). The spinal nerve was imaged in transverse cross-sectional (a short axis) and longitudinal (a long axis) views between T12 and L1 to locate the electrical stimulation (Figure 2C). The six needles were arranged in a hexagonal pattern to create an electric field stimulus at the affected area (Figure 2D). The depth of EA is about 3.5 cm, not more than 1/2 of the ligamentum flavum. Six needles were left in place at six points connected to an electro stimulator (SdZ-III electronic acupuncture therapy instrument, Hwato brand, China) to apply a continuous waveform, at 50 Hz and with 220-ms wave width for 1 h (Figure 2E). The EA electrode was inserted 1.5 cm in front of the central sulcus and extended along with the skull to the front of the forehead (Figure 2F).
The changes of the patient's function during the study period. (A) The results show the voiding volume and the volume of the urethral catheter. The right coordinate axis shows the voiding volume and urethral catheter output. The left axis displays the times of urethral catheterization times. (B) The ASIA score curve of the patient. (C) The FIM score curve of the patient.
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After the urethral catheter was removed, the residual urine volume was detected, which was only 80 ml, proving that urinary retention in the bladder had improved (Figure 3A). When a combination of the spinal cord and head stimulation was added, the motor score (64 to 73) and the sensory score (160 to 186) both showed significant change (Figure 3B). In the FIM score, the value did not change significantly before sacral EA stimulation (67 to 81) but increased significantly (81 to 114) after sacral EA stimulation (Figure 3C).
Photos of the patient walking before and after treatment. (A) Before treatment, walk with the help of walkabout orthosis. (B) After treatment, walk with the help of ankle-foot orthosis.
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In terms of lower-limb muscle tone, the patient could only walk with a Walkabout orthosis in May 2020 (Figure 4A); she was able to walk with an ankle-foot orthosis in September 2020 (Figure 4B).