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Ab s t r Ac t Background and introduction: Intrathecal sodium nitroprusside (ITSNP) has shown marked recovery in various causes of paraplegias after proper surgical decompression of the spinal cord and stabilization of vertebra. Until now, we were unable to predict paraplegias’ recovery post-ITSNP bedside effectively, either by clinical or by any investigatory modality (somato sensory-evoked potential (SSEP) and motor-evoked potential (MEP)).1 We present our work on the grading system and predictability for paraplegics using acupuncture-like TENS (AL-TENS) with ITSNP in various thoracolumbosacral cases. AL-TENS causes pain relief by well-known gate theory at the spinal cord by activating A-alpha nerve fibers which activates A-delta fibers for muscle spindle, and then pain fibers are inhibited by Renshaw cells at the spinal cord. The present work uses this cascade of various transmissions of nerves via a normal or damaged (complete or partial) spinal cord and utilizing this pathway to predict the feasibility of ITSNP in paraplegics. Our hypothesis works on this fact that the various nerves passing through the spinal cord and toward the brain can be utilized to use the quantitative measure for spinal cord injured patients and their recovery. Aims/study design: The aim of the study is to prognosticate the post-ITSNP effect by AL-TENS in thoracolumbosacral paraplegia cases in the pre-ITSNP phase, a prospective study. Materials and methods: Thirteen paraplegia patients (11 male patients and 3 females, and 3 complete paraplegias and 10 partial paraplegias) with zone of partial preservation (ZPP) cases were considered in whom pre-ITSNP-AL-TENS and post-ITSNP-TENS have been done. The mean time for superfusion was 9.69 months. ITSNP was administered at a dosage of 0.2 mg/kg body weight at the L3/4 level using a 20G LP needle. Preand post-ITSNP was monitored by AL-TENS. Results: Post-ITSNP-AL-TENS showed 23.84% benefit overall and 23.32% in American Spinal Injury Association (ASIA) grading in thoracolumbosacral paraplegia cases. Complete paraplegia cases did not show any change while partial paraplegias (with ZPP) showed 31% recovery in post-ITSNP-TENS and 33.34% in ASIA grading. Thus, AL-TENS showed a favorable modality to predict the ITSNP feasibility in thoracolumbosacral paraplegia cases. If preITSNP-TENS showed 8 mAmp or more, there will be no response to ITSNP. This effect of post-ITSNP-TENS has increased to 34.96% after 24 hours. After 1 week, it became 39.19% and after 21 days, it had reached 44.16%. Conclusion: ITSNP with the help of TENS done in paraplegic cases helped us to prognosticate the future outcome.

journal of spinal surgery

Acupuncture-like TENS (AL-TENS) as a Quantitative Measure for the Feasibility of Intrathecal Sodium Nitroprusside Superfusion in Paraplegics for Physiological Recovery—A Pilot Study (13 Cases)