Brain, Spine and Nerves

Extracorporeal Shock Wave Therapy (ESWT) in Acute Traumatic Complete (AIS A) and Incomplete (AIS B-D) Cross-sectional Lesions on Motor and Sensory Function Within Six Months After Injury – It has been hypothesized that there are two mechanisms of acute traumatic spinal cord injury (SCI): the primary mechanical damage and the secondary injury due to additional pathological processes initiated by the primary injury. Neurological damage due to laceration, contusion, distraction or compression of the spinal cord is called ”primary injury”. This mechanical injury leads to a cascade of biochemical and pathological changes, described as ”secondary injury”, which occurs minutes to weeks after the initial trauma and causes further neurological deterioration. This secondary cascade involves vascular changes, an inflammatory response, neurotoxicity, apoptosis and glial scarring, and further compromises neurological impairment after traumatic spinal cord injury. Edema, ischemia and loss of autoregulation continue to spread bi-directionally from the initial lesion along the spinal cord for up to 72 hours after the trauma. It has been postulated that the damage caused by the primary injury mechanism is irreversible and therapeutic approaches in recent years have focused on modulating the secondary injury cascade. Researchers found significantly greater numbers of myelinated fibers in peripheral nerves after a single ESWT application in an experimental model on rats after a homotopic nerve autograft into the sciatic nerve.  More..

Shock waves promote spinal cord repair via TLR3 – Spinal cord injury (SCI) remains a devastating condition with poor prognosis and very limited treatment options. Affected patients are severely restricted in their daily activities. Shock wave therapy (SWT) has shown potent regenerative
properties in bone fractures, wounds, and ischemic myocardium via activation of the innate immune receptor TLR3. Here, we report on the efficacy of SWT for regeneration of SCI. SWT improved motor function and decreased lesion size in WT but not Tlr3–/– mice via inhibition of neuronal degeneration and IL6-dependent recruitment and differentiation of neuronal progenitor cells. Both SWT and TLR3 stimulation enhanced neuronal sprouting and improved neuronal survival, even in human spinal cord cultures. We identified tlr3 as crucial enhancer of spinal cord regeneration in zebrafish. Our findings
indicate that TLR3 signaling is involved in neuroprotection and spinal cord repair and suggest that TLR3 stimulation via SWT could become a potent regenerative treatment option.  More..

The Use of Shock Waves in Peripheral Nerve Regeneration:New Perspectives? – Low-energy extracorporeal shock wave treatment (ESWT) is a relatively new therapeutic tool that is widely used for the treatment of epicondylitis and plantar fasciitis and tofoster bone and wound healing. Shock waves, sonic pulses with high energy impact,are thought to induce biochemical changes within the targeted tissues through mechanotransduction. The biological effects of ESWT are manifested in improved vas-cularization, the local release of growth factors, and local anti-inflammatory effects, butthe target cells too are influenced. ESWT appears to have differential effects on peripheral nerves and has been proved to promote axonal regeneration after axotomy. This review discusses the effects of ESWT on intact and injured peripheral nerves and suggests a multiple mechanism of action More..

Ultrasound and shock-wave stimulation to promote axonal regeneration following nerve surgery: a systematic review and meta-analysis of preclinical studies – Limited regeneration after nerve injury often leads to delayed or incomplete reinnervation and consequently insufficient muscle function. Following nerve surgery, application of low-intensity ultrasound or extracorporeal shock waves may promote nerve regeneration and improve functional outcomes. Because currently clinical data is unavailable, we performed a meta-analysis following the PRISMA-guidelines to investigate the therapeutic effect of ultrasound and shock wave therapies on motor nerve regeneration. Ten ultrasound-studies (N=445 rats) and three shock-wave studies (N=110rats) were identified from multiple databases. We calculated the difference in means or standard sized mean difference with 95% confidence intervals for motor function, nerve conduction velocity and histomorphological parameters of treated versus sham or non-treated animals. Ultrasound treatment showed significantly faster nerve conduction, increased axonal regeneration with thicker myelin and improved motor function on sciatic functional index scale (week two: DM[95%CI]: 19,03[13,2 to 25,6],71 animals; week four: 7,4[5,4 to 9,5], 47 animals). Shock wave induced recovery improvements were temporarily significant. In conclusion, there is significant evidence for low-intensity ultrasound but not for extracorporeal shock wave treatment to improve nerve regeneration. Prospective clinical trials should therefore investigate available FDA-approved ultrasound devices as adjunct postoperative treatment following nerve surgery  More..

Extracorporeal shock wave therapy effectively prevented diabetic neuropathy – We tested the hypothesis that extracorporeal shock wave (ECSW) therapy can effectivelyprotect sciatic nerve (SN) from diabetes mellitus (DM)-induced neuropathy in leptin-deficient (ob/ob) mice. Methodsand results: Eighteen-week C57BL/6 mice (n=8) served as age-matched controls (group 1) and ob/ob mice (n=16)were categorized into DM (group 2) and DM + ECSW (0.12 mJ/mm2for 4 times of 200 impulses at 3-week intervals)(group 3). The animals were sacrificed two weeks post-ECSW. In vitro results showed that the protein expressionsof oxidative stress (NOX-1, NOX-2, oxidized protein), inflammation (MMP-9, TNF-α, iNOS), apoptosis (Bax, cleavedcaspase-3, & PARP), and DNA-damage marker (γ-H2AX) were significantly higher in RT4-D6P2T (schwannoma cellline) treated by menadione (25 μM) compared with control group and were significantly reversed after ECSW (0.12mJ/mm2, 200 impulses) (all p<0.001).  More..

Motor and Sensory Schwann Cell Phenotype Commitment is Diminished by Extracorporeal Shockwave Treatment in vitro – The gold standard for peripheral nerve regeneration uses a sensory autograft to bridge a motor/sensory defect site. For motor nerves to regenerate, Schwann cells
(SC) myelinate the newly grown axon. Sensory SCs have a reduced ability to produce myelin, partially explaining low success rates of autografts. This issue is masked in pre-clinical research by the excessive use of the rat sciatic nerve defect model, utilizing a mixed nerve with motor and sensory SCs. Aim of this study was to utilize extracorporeal shockwave treatment as a novel tool to influence SC phenotype.  More..

Shock Wave Treatment Protects From Neuronal Degeneration via a Toll-Like Receptor 3 Dependent Mechanism: Implications of a First-Ever Causal Treatment for Ischemic Spinal Cord Injury – Background-—Paraplegia following spinal cord ischemia represents a devastating complication of both aortic surgery and endovascular aortic repair. Shock wave treatment was shown to induce angiogenesis and regeneration in ischemic tissue by
modulation of early inflammatory response via Toll-like receptor (TLR) 3 signaling. In preclinical and clinical studies, shock wave treatment had a favorable effect on ischemic myocardium. We hypothesized that shock wave treatment also may have a beneficial effect on spinal cord ischemia.  More..

Extracorporeal shockwave treatment: A novel tool to improve Schwann cell isolation and culture – ​As new approaches for peripheral nerve regeneration are sought, there is an increasing demand for native Schwann cells for in vitro testing and/or reimplantation. Extracorporeal shockwave treatment (ESWT) is an emergent technology in the field of regenerative medicine that has also recently been shown to improve peripheral nerve regeneration.
Methods. In this study, we elucidate the effects of ESWT on Schwann cell isolation and culture. Rat sciatic nerves were dissected and treated with ESWT, and Schwann cells were isolated and cultured for 15 passages. Results. Single treatment of the whole nerve ex vivo led to significantly increased extracellular adenosinetriphosphate as an immediate consequence, and subsequently a number of effects on the culture were observed, starting with a significantly increased Schwann cell yield after isolation. In the ESWT group, the quality of culture, reflected in consistently higher purity (S100b, morphology), proliferation rate (5-bromo-2-deoxyuridine, population doublings per passage) and expression of regenerative phenotype-
associated markers (P75, glial fibrillary acidic protein, c-Jun), was significantly improved. In contrast, the control group exhibited progressively senescent behavior, reflected in a decrease of proliferation, loss of specific markers and increase in P16INK4A expression.  More..

TRT SoftWaves®  – a new regenerative therapy for paraplegia – Extracorporeal softwave therapy (ESWT) is widely used in clinical practice. In addition to its original use in kidney stone disintegration, shock waves are now used for the treatment of a variety of regenerative indications. Mechanotransduction stimulates the body’s biological healing processes at the cellular level. In areas of wound healing, orthopaedics or erectile dysfunction, very good, well-founded treatment successes are achieved. The molecular mechanism of action is based on the activation of cellular signaling molecules which stimulate the blood circulation (vascularisation) of the affected tissue. 1–7 SoftWaves induce the proliferation and migration of cells, have anti-apoptotic, anti-inflammatory as well as analgesic effects.  More..

Extracorporal SoftWave Treatment to Improve Nerve Regeneration – Extracorporeal softwave treatment is CE certified in Austria, Europe and licensed for indications like achillodynia, epicondylitis, or tendinitis calcanea. The Orthogold 100 device by MTS Medical UG will be used for this study. Defocused low-energy extracorporeal shock wave therapy (ESWT) has gained acceptance as a therapeutic tool in different medical settings. It has been shown, that shock waves stimulate of the metabolic activity of different cell type, including osteoblasts, tenocytes, endothelial cells and chondrocytes. Furthermore, it has proved effective in clinical applications relating to bone and wound healing and myocardial ischaemia. Until now, no studies have been performed regarding the effects of ESWT on regeneration of peripheral nerve injuries in humans.  More..

A prospective, randomized, controlled, single centre trial to assess the efficacy and safety of radial extracorporeal shockwave therapy in patients with chronic non-specific low back pain –  (Balagué et al., 2012). Non-specific low back pain is common and affects people of all ages (e.g., Carraggee, 2005; Bhangle et al., 2009; Maher et al., 2017). Non-specific low back pain is defined as low back pain not attributable to a recognizable, known specific pathology (e.g., infection, tumour, osteoporosis, fracture, structural deformity, inflammatory disorder, radicular syndrome, or cauda equina syndrome) More..

Prof. M. Kravchik. Focused shockwave therapy in the treatment of the spine. Oxford, UK Non-invasive treatment of herniated discs by focused shock wave therapy – (​Non-invasive treatment of herniated discs by focused shockwave therapy) – In orthopedic practice meets a number of pathologies, surgical treatment which is necessary because of the inefficiency of the traditional conservative therapy. These pathologies, in particular, diseases of the spine – such as protrusion, herniated disc, low back pain, osteoporosis and spondylitis. At present, there are solutions of non-surgical treatment of these diseases – manual therapy, skeletal traction, epidural blockade, physiotherapy etc.  More..

The efficacy of ultrasound-guided extracorporeal shockwave therapy in patients with cervical spondylosis and nuchal ligament calcification –(Tz-Yan Lin, Jing-Ting Chen, Yu-Yu Chen, Tien-Wen Chen , Chia-Ling Lee, Chia-Hsin Chen, Mao-Hsiung Huang) – We investigated the effects of extracorporeal shockwave therapy (ESWT) on the rehabilitation of cervical spondylosis with nuchal ligament (NL) calcification under X-ray and ultrasound guidance. Sixty patients with cervical spondylosis and calcification of NL were selected and randomly assigned to three groups: A, B, and C.  More..

Shock wave treatment reduces neuronal degeneration upon spinal cord ischemia and improves symptoms in a first-in-man trial – Powerpoint abstract. More..

Shock wave treatment protects from neuronal degeneration via a toll-like receptor 3 dependent mechanism: implications of a first-ever causal treatment for ischemic spinal cord injury – Paraplegia following spinal cord ischemia represents a devastating complication of both aortic surgery and endovascular aortic repair. Shock wave treatment was shown to induce angiogenesis and regeneration in ischemic tissue by modulation of early inflammatory response via Toll-like receptor (TLR) 3 signaling. In preclinical and clinical studies, shock wave treatment had a favorable effect on ischemic myocardium. We hypothesized that shock wave treatment also may have a beneficial effect on spinal cord ischemia.  More..

The Effects of Extracorporeal Shock Wave Therapy in Patients with Coccydynia: A Randomized Controlled Trial –(Shih-Feng Lin, Yi-Jen Chen, Hung-Pin Tu , Chia-Ling Lee, Ching-Lin Hsieh , Wen-Lan Wu , Chia-Hsin Chen) – Coccydynia is pain in the coccygeal region, and usually treated conservatively. Extracorporeal shock wave therapy (ESWT) was incorporated as non-invasive treatment of many musculoskeletal conditions. However, the effects of ESWT on coccydynia are less discussed. More..

Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases –(Yousef Marwan, MBBS, Wael Husain, MBBS, FRCSC , Waleed Alhajii, MBBS, MSc, Facharztb , Magdy Mogawer, MBBS) – Extracorporeal shock wave therapy (ECSWT) has been used widely for musculoskeletal conditions; however, no reports are available about its use for coccydynia. More..

Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases – (Yousef Marwan, • Bashar Dahrab • Ali Esmaeel • Samir Abdulrazik Ibrahim • Jassim Al-Failakawi) – Coccydynia can lead to significant functional disability and worsening of quality of life if not properly managed. In this study, we aim to assess the outcomes of extracorporeal shock wave therapy in patients with coccydynia.  More..

Mechano-transduction effect of shock waves in the treatment of lumbar facet joint pain:Comparative effectiveness evaluation…. – (Charles University in Prague, 2nd Faculty of Medicine, Department of Neurology, Prague, Czech Republic Center for Rehabilitation and Treatment of Spine Pain, Prague, Czech Republic  Czech Technical University, Faculty of Biomedical Engineering, Kladno, Czech Republic  Bridgeland Sport and Spine Center, Calgary, Canada) –  Lumbar facet joints (FJ) is a common source of low back pain and contributes approximmately on one third of chronic low back pain. Medial branch radiofrequency neurotomy is considered as a gold standard in the treatment of facet joint pain. Corticosteroid injections have also presented effect in FJ pain.   More..

Extracorporeal shockwave therapy versus exercise program in patients with low back pain: short-term results of a randomised controlled trial. – (Notarnicola, Maccagnano, Gallone, Mastromauro, Rifino, Pesce, Covelli , Moretti B) The physiotherapy treatment of low back pain (LBP) with physical stimulation offers different possibilities of application. Until now, the physical therapies used in LBP are laser therapy, ultrasonotherapy and currents. More..

 Effectiveness of extracorporeal shock wave for low back pain (A protocol of systematic review) – (​Wei Wei, Hua-yu Tang, Yu-zhi Li, Tian-shu Wang) – : Previous clinical trials have reported that extracorporeal shock wave (EPSW) can be used to treat low back pain (LBP), and have achieved satisfied effect. However, its effectiveness is still inconclusive. Thus, this systematic review will aim to assess the effectiveness and safety of EPSW for patients with LBP.  More..

Effects of Extracorporeal Shockwave Therapy on Patients with Chronic Low Back Pain and Their Dynamic Balance Ability – (Department of Physical Therapy, Youngdong University) – [Purpose] The purpose of the present study was to examine the effects of extracorporeal shockwave therapy (ESWT) for patients with chronic low back pain and their dynamic balance ability. [Subjects] Twenty-eight patients with chronic low back were divided into an extracorporeal shockwave therapy group (ESWTG: n=13) and a conservative physical therapy group (CPTG, n=15).   More..

 Spark Wave® Therapy – a New Method for Peripheral Nerve Regeneration –(MTS Science) – Peripheral nerve injuries affect millions of people every year. After trauma or surgery, patients often require autologous nerve grafting, which is the „gold standard“, but nevertheless a complex and demanding surgical procedure with low chances of success. The choice of graft type and optimal regeneration conditions are crucial for the final result.Scientists of the Ludwig-Boltzmann-Institute in Vienna rise to the challenge by utilizing Spark Wave Technology which is, due to its cell activating effect in various tissues, a highly emergent technology in the field of regenerative medicine (e. g. in urology and orthopaedics).  More..

Benefits of Spark Wave Therapy in neuronal regeneration – (MTS Science) – Extracorporeal shock wave therapy (ESWT) is widely used in clinical practice. In addition to its original use in kidney stone disintegration, shock waves are now used for the treatment of a variety of regenerative indications. Mechanotransduction stimulates the body’s biological healing processes at the cellular level. In areas of wound healing, orthopaedics or erectile dysfunction, very good, well-founded treatment successes are achieved.  More..

Symptomatic treatment of unresponsive wakefulness syndrome with transcranial focused extracorporeal shock waves – (​H. Lohse-Busch, U. Reime and R. Falland Outpatient Department for Manual Medicine – Movement Disorder Center, Rheintalklinik, Bad Krozingen, Germany) – Can stimulation of nerve growth factors by focused transcranial extracorporeal shock wave therapy (TESWT) be made effective for persons within unresponsive wakefulness syndrome (apallic syndrome)?  More..

​STORZ MEDICAL’s NEUROLITH® receives CE approval – Transcranial Pulse Stimulation (TPS) on the central nervous system of patients with Alzheimer’s disease – In December 2018, STORZ MEDICAL has received the CE approval for the NEUROLITH®, a new therapy system for the treatment of neurological diseases. The technology behind the NEUROLITH® is called Transcranial Pulse Stimulation (TPS). TPS consists of short acoustic pulses with an ultrasound frequency range that permits a well-focused stimulation of the brain at a depth of up to 5 cm.  More..

Extracorporeal shockwave treatment: A novel tool to improve Schwann cell isolation and culture – (​AUVA Research Center, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology,Vienna, Austria, 2 Austrian Cluster for Tissue Regeneration,Vienna, Austria, and 3 Department of Biochemical Engineering, University of Applied Sciences TechnikumWien,Vienna, Austria) – As new approaches for peripheral nerve regeneration are sought, there is an increasing demand for native Schwann cells for in vitro testing and/or reimplantation. Extracorporeal shockwave treatment (ESWT) is an emergent technology in the field of regenerative medicine that has also recently been shown to improve peripheral nerve regeneration. Methods. In this study, we elucidate the effects of ESWT on Schwann cell isolation and culture.  More..

Shock wave treatment protects from neuronal degeneration via a toll-like receptor 3 dependent mechanism: implications of a first-ever causal treatment for ischemic spinal cord injury – (Daniela Lobenwein, MD; Can Tepek€oyl€u, MD; Radoslaw Kozaryn, MD; Elisabeth J. Pechriggl, MD; Mario Bitsche, Msc; Michael Graber; Helga Fritsch, MD; Severin Semsroth, MD; Nadia Stefanova, MD; Patrick Paulus, MD; Martin Czerny, MD; Michael Grimm, MD; Johannes Holfeld, MD) – Paraplegia following spinal cord ischemia represents a devastating complication of both aortic surgery and endovascular aortic repair. Shock wave treatment was shown to induce angiogenesis and regeneration in ischemic tissue by modulation of early inflammatory response via Toll-like receptor (TLR) 3 signaling. In preclinical and clinical studies, shock wave treatment had a favorable effect on ischemic myocardium. We hypothesized that shock wave treatment also may have a beneficial effect on spinal cord ischemia.  More..

 Low energy shock wave therapy induces angiogenesis in acute hind-limb ischemia via VEGF receptor 2 phosphorylation – (​University Hospital for Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria, 2 Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Innsbruck Medical University, Innsbruck, Austria, 3 University Hospital for Dermatology and Venerology, Innsbruck Medical University, Innsbruck, Austria, 4 University Hospital for Internal Medicine III, Department of Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria, 5 Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital, Frankfurt am Main, Germany) – : Low energy shock waves have been shown to induce angiogenesis, improve left ventricular ejection fraction and decrease angina symptoms in patients suffering from chronic ischemic heart disease. Whether there is as well an effect in acute ischemia was not yet investigated.  More..

Extracorporeal shock wave therapy (ESWT) for the treatment of spasticity in persons with spinal cord injury – (Swiss Paraplegic Centre Nottwil) – Spasticity is the most problematic self-reported secondary medical problem in patients with spinal cord injury. It has the potential to negatively influence quality of life through restricting activities of daily living. Problematic spasticity can cause pain and fatigue, disturb sleep, contribute to the development of contractures and pressure ulcers, and has a negative effect on patients morbidity. For this reason there is enormous interest in therapeutic interventions addressing to decrease spasticity in persons with spinal cord injury. Recently, studies reported positive effects of extracorporeal shock wave therapy on spasticity in patients with stroke, focal limb dystonia and cerebral palsy. To date, no studies are published, assessing the effect of extracorporeal shock wave therapy on focal spasticity in patients with spinal cord injury.  More..

Symptomatic treatment of unresponsive wakefulness syndrome with transcranial focused extracorporeal shock waves – ​(Outpatient Department for Manual Medicine – Movement Disorder Center, Rheintalklinik, Bad Krozingen, Germany) – Can stimulation of nerve growth factors by focused transcranial extracorporeal shock wave therapy (TESWT) be made effective for persons within unresponsive wakefulness syndrome (apallic syndrome)? More..

Shockwave therapy differentially stimulates endothelial cells: implications on the control of inflammation via toll-like receptor 3 – (Johannes Holfeld, Can Tepeköylü, Radoslaw Kozaryn, Anja Urbschat, Kai Zacharowski, Michael Grimm, and Patrick Paulus) – Shock wave therapy (SWT) reportedly improves ventricular function in ischemic heart failure. Angiogenesis and inflammation modulatory effects were described. However, the mechanism remains largely unknown. We hypothesized that SWT modulates inflammation via toll-like receptor 3 (TLR3) through the release of cytosolic RNA. SWT was applied to human umbilical vein endothelial cells (HUVECs) with 250 impulses, 0.08 mJ/mm2 and 3 Hz. More..

Low-energy shock wave for enhancing recruitment of endothelial progenitor cells: a new modality to increase efficacy of cell therapy in chronic hind limb ischemia – (Alexandra Aicher, MD; Christopher Heeschen, MD; Ken-ichiro Sasaki, MD; Carmen Urbich, PhD; Andreas M. Zeiher, MD; Stefanie Dimmeler, PhD) – Stem and progenitor cell therapy is a novel approach to improve neovascularization and function of ischemic tissue. Enhanced tissue expression of chemoattractant factors such as stromal cell–derived factor 1 and vascular endothelial growth factor is crucial for the recruitment of circulating endothelial progenitor cells (EPCs) during acute ischemia. In chronic ischemia, however, expression of these chemoattractants is less pronounced, which results in insufficient EPC recruitment into the target tissue. Therefore, we investigated the effect of targeted extracorporeal shock wave (SW) application in order to facilitate EPC recruitment into nonischemic and chronic ischemic tissue.  More..

 Biological mechanism of musculoskeletal shockwaves

Dr. Lohse Bush, first brain treatments– (Power Point)

Extracorporeal shock waves Improve pareses in 8 cases of spinal cord injury and 3 cases of myelomeningocele. ​