Open AccessThe neuroanatomical–functional paradox in spinal cord injury
Author(s) -
Karim Fouad,
Phillip G. Popovich,
Marcel A. Kopp,
Jan M. Schwab
Publication year - 2020
Publication title -
nature reviews. neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 7.271
H-Index - 150
eISSN - 1759-4766
pISSN - 1759-4758
DOI - 10.1038/s41582-020-00436-x
Subject(s) - medicine , spinal cord injury , lesion , context (archaeology) , neuroscience , physical medicine and rehabilitation , spinal cord , psychology , surgery , psychiatry , paleontology , biology
Although lesion size is widely considered to be the most reliable predictor of outcome after CNS injury, lesions of comparable size can produce vastly different magnitudes of functional impairment and subsequent recovery. This neuroanatomical-functional paradox is likely to contribute to the many failed attempts to independently replicate findings from animal models of neurotrauma. In humans, the analogous clinical-radiological paradox could explain why individuals with similar injuries can respond differently to rehabilitation. We describe the neuroanatomical-functional paradox in the context of traumatic spinal cord injury (SCI) and discuss the underlying mechanisms of the paradox, including the concepts of lesion-affected and recovery-related networks. We also consider the various secondary complications that further limit the accuracy of outcome prediction in SCI and provide suggestions for how to increase the predictive, translational value of preclinical SCI models.