Neurophysiological changes following traumatic spinal lesions in man

Neurophysiological observations were made on normal subjects and on 57 patients who had had injuries to the spinal cord. The amplitude of the muscle compound action potential (M response) recorded from triceps surae in response to supramaximal stimulation of the tibial nerve was reduced in the patients indicating that there are changes in motor units below the level of a spinal lesion in man. In the patients who were clinically spastic it was found that: (1) The proportion of the triceps surae motoneuron pool reflexly activated either by tapping the Achilles tendon or by stimulating the tibial nerve just below the threshold of the alpha motoneuron axons (H reflex) was greater than in normal subjects. This can be explained by an increase in the excitability of central reflex pathways. (2) Vibration of the tendo Achilles depressed the H reflex less effectively than in normal subjects. This may indicate altered transmission in the premotoneuronal portion of the H reflex pathway. (3) The H reflex elicited 50 and 100 ms after a standardised conditioning stimulus to the tibial nerve and expressed as percentage of the unconditioned reflex was greater than in normal subjects. This could reflect a change in the excitability of motoneurons or of interneurons.