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Abstract
Traumatic SCI is an insult to the spinal cord which can result in permanent and often severe neurologic deficits and disability. It is perhaps the most devastating orthopedic injury possible. Nearly 80% of SCI patients in the US national database are young males. It is associated with alteration of normal motor, sensory, and autonomic functions (Reiter, 2009).
Changes in endocrine function of the reproductive system of patients with SCI, and decrease testosterone hormone level have been reported also in many studies. The relationships between SCI and increased body fat accumulation, decreased muscle mass and strength, depression, and low life satisfaction have been also well documented. Low testosterone levels may be a causal or exacerbating factor for all of these health problems among men with SCI (Schopp et al, 2006).
Conversely, testosterone supplementation increases muscle mass and decreases fat mass in hypogonadal men. Moreover, recent data suggest that testosterone may also exert neurotrophic and neuroregenerative actions on injured nerve tissues (Singh et al, 2003) (Bialek et al, 2004).
The ultimate objective of this study was to assess the level of testosterone and the role of TRT in improving motor function and rehabilitation outcome in male patients with traumatic incomplete SCI with paraparesis.
10 male patients were selected for this study; aged between 19-49 years; all were chosen having traumatic and incomplete paraparesis, in the subacute period of the injury. All these patients underwent thorough neurological assessment, measurement of both LL extensors muscle strength was done for all patients using hand-held dynamometer, and main muscle strength was 40.00±12.89 Kg/F.
ASIA scoring of all patients was done, and patients with ASIA impairment scale C or D only were selected, mean ASIA motor score of our patients was 24±18.20, and mean ASIA sensory score was 60.10±6.99.
Level of testosterone was assessed in all patients initially, and patients who had low serum testosterone levels only were included in our study. Mean serum testosterone in all our patients was 1.994±0.2075 ng/ml.
All patients were randomly classified into two groups; one group (II) received traditional rehabilitation program for paraplegia, and the other group (I) received the same rehabilitation program plus testosterone enthanate intramuscular injections twice monthly. Follow up of all patients was done 3 months later including; neurological examination, ASIA scores, muscle strength measurement of both lower limbs with hand-held dynamometer. Results were blotted in tables, compared and analyzed statistically.
Muscle strength of both lower limbs measured by hand-held dynamometer after treatment was higher in group I with statistically significant difference (p=0.047) between both groups. Group I had statistically more significant different discharge ASIA motor scores than men in group II (P = 0.003 and 0.005, respectively). Moreover, muscle strength change after treatment was higher in group I with a highly significant difference (p = 0.001).
We found a significant positive correlation between disease duration and testosterone level (p = 0.47) and (r = 0.580), correlation between disease duration and mean spasticity score after treatment was positive and statistically significant (p=0.039).