Muscle fiber type morphology and distribution in paraplegic patients with traumatic cord lesion. Histochemical and ultrastructural aspects of rectus femoris muscle.

Biopsies of the rectus femoris muscle of 22 paraplegic patients with complete acute spinal cord transection due to trauma were taken for enzyme-histochemical and electron-microscopic studies in successive stages starting from occurrence of the accident (1-17 months). Ingravescent muscular atrophy was demonstrated with a progressive decrease in the fiber diameter and changes in the fiber type distribution with predominant type II atrophy in the first stage and type I atrophy in the later stage of the cord transection. Muscular "neurogenic" changes, such as angular dark atropic fibers, targetoid fibers, and type predominance are frequently observed. Myopathic alterations are observed in a low percentage in the later stages of the lesion. The ultrastructural findings are characterized by myofibrillar alterations and by dilatation and proliferative phenomena of the sarcoplasmic reticulum and T-system. There are ingravescent accumulation of lipid, interstitial fibrosis and microcirculatory alterations. The possible mechanism of "central" muscle atrophy is reviewed and discussed with reference to the morphological findings.