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Denervation impacts muscle quality and knee bone mineral density after spinal cord injury

Spinal Cord volume 61, pages 276–284 (2023)Cite this article

Subjects

Abstract

Study design

Cross-sectional study.

Objectives

To compare muscle size, body composition, bone mineral density (BMD), and metabolic profiles in denervated versus innervated individuals with spinal cord injury (SCI).

Setting

Hunter Holmes McGuire Veterans Affairs (VA) Medical Center.

Methods

Body composition, bone mineral density (BMD), muscle size, and metabolic parameters were collected in 16 persons with chronic SCI (n = 8 denervated, n = 8 innervated) using dual-energy x-ray absorptiometry (DXA), magnetic resonance imaging (MRI), and fasting blood samples. BMR was measured by indirect calorimetry.

Results

Percent differences of the whole thigh muscle cross-sectional area (CSA; 38%), knee extensor CSA (49%), vasti CSA (49%), and rectus femoris CSA (61%) were smaller in the denervated group (p < 0.05). Leg lean mass was also lower (28%) in the denervated group (p < 0.05). Whole muscle intramuscular fat (IMF%; 15.5%), knee extensor IMF% (22%), and % fat mass (10.9%) were significantly greater in the denervated group (p < 0.05). Knee distal femur and proximal tibia BMD were lower in the denervated group, 18–22% and 17–23%; p < 0.05. Certain indices of metabolic profile were more favorable in the denervated group though were not significant.

Conclusions

SCI results in skeletal muscle atrophy and dramatic changes in body composition. Lower motor neuron (LMN) injury results in denervation of the lower extremity muscles which exacerbates atrophy. Denervated participants exhibited lower leg lean mass and muscle CSA, greater muscle IMF, and reduced knee BMD compared to innervated participants. Future research is needed to explore therapeutic treatments for the denervated muscles after SCI.

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Fig. 1: Representative magnetic resonance images of right and left thigh cross-sectional area (CSA) of denervated and innervated participants.
Fig. 2: Muscle cross sectional area (CSA) following denervation.
Fig. 3: Bone mineral density (BMD) following denervation.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request and after receiving approval from our research office for data sharing. The data were uploaded as Supplementary Material for review process only. After acceptance of the paper, the data will be available upon email communications with the corresponding author.

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Acknowledgements

The work was supported by the Department of Veteran Affairs (VA) Merit Program [Application # 1 I01 RX002649-01A; Protocol ID: B2649-R] by ASG. We would like to thank all the SCI participants who contributed their time and effort to complete the current work.

Author information

Authors and Affiliations

  1. Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA

    Ahmad M. Alazzam, Jacob A. Goldsmith, Refka E. Khalil & Ashraf S. Gorgey

  2. Radiology Services, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA

    M. Rehan Khan

  3. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA

    Ashraf S. Gorgey

Authors
  1. Ahmad M. Alazzam
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  2. Jacob A. Goldsmith
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  3. Refka E. Khalil
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  4. M. Rehan Khan
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  5. Ashraf S. Gorgey
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Contributions

AMA: formal analysis, investigation, writing original draft, reviewed scientific evidence, software, development of figures. JAG: assisted with original draft, formal analysis, critical feedback, data curation. REK and MRK aided in data curation, software, investigation, and resources. ASG: formal analysis, investigation, writing original draft, reviewed scientific evidence, critical feedback, supervision and approving of final draft as well as providing the funding source.

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Correspondence to Ashraf S. Gorgey.

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Alazzam, A.M., Goldsmith, J.A., Khalil, R.E. et al. Denervation impacts muscle quality and knee bone mineral density after spinal cord injury. Spinal Cord 61, 276–284 (2023). https://doi.org/10.1038/s41393-023-00885-3

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