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Sample records for chronic spinal epidural

  1. Aspergillus spinal epidural abscess

    SciTech Connect

    Byrd, B.F. III; Weiner, M.H.; McGee, Z.A.

    1982-12-17

    A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.

  2. Effects of Lumbosacral Spinal Cord Epidural Stimulation for Standing after Chronic Complete Paralysis in Humans

    PubMed Central

    Rejc, Enrico; Angeli, Claudia; Harkema, Susan

    2015-01-01

    Sensory and motor complete spinal cord injury (SCI) has been considered functionally complete resulting in permanent paralysis with no recovery of voluntary movement, standing or walking. Previous findings demonstrated that lumbosacral spinal cord epidural stimulation can activate the spinal neural networks in one individual with motor complete, but sensory incomplete SCI, who achieved full body weight-bearing standing with independent knee extension, minimal self-assistance for balance and minimal external assistance for facilitating hip extension. In this study, we showed that two clinically sensory and motor complete participants were able to stand over-ground bearing full body-weight without any external assistance, using their hands to assist balance. The two clinically motor complete, but sensory incomplete participants also used minimal external assistance for hip extension. Standing with the least amount of assistance was achieved with individual-specific stimulation parameters, which promoted overall continuous EMG patterns in the lower limbs muscles. Stimulation parameters optimized for one individual resulted in poor standing and additional need of external assistance for hip and knee extension in the other participants. During sitting, little or negligible EMG activity of lower limb muscles was induced by epidural stimulation, showing that the weight-bearing related sensory information was needed to generate sufficient EMG patterns to effectively support full weight-bearing standing. In general, electrode configurations with cathodes selected in the caudal region of the array at relatively higher frequencies (2560 Hz) resulted in the more effective EMG patterns for standing. These results show that human spinal circuitry can generate motor patterns effective for standing in the absence of functional supraspinal connections; however the appropriate selection of stimulation parameters is critical. PMID:26207623

  3. Spontaneous spinal epidural haemorrhage complicating transjugular intrahepatic portosystemic stent shunting.

    PubMed Central

    McLellan, S.; de Silva, R.; Sandercock, P. A.; Hayes, P. C.; Dillon, J.; Redhead, D.

    1997-01-01

    A patient with chronic liver disease and portal hypertension who developed acute spinal cord compression following transjugular intrahepatic portosystemic stent shunting is described. Radiological and pathological examinations revealed an epidural haematoma. Images Figure PMID:9497978

  4. Spinal and epidural anesthesia

    MedlinePLUS

    ... effect in about 10 to 20 minutes. It works well for longer procedures. Women often have an epidural during childbirth. A small tube (catheter) is often left in place. You can receive more medicine through the catheter ...

  5. Spinal epidural extramedullary haematopoiesis in ?-thalassaemia intermedia

    PubMed Central

    Wong, Kin Hoi; Li, Allen; Lui, Tun Hing; Sit, Yan Kit

    2014-01-01

    A 22-year-old man known to have ?-thalassaemia intermedia since childhood presented with bilateral lower limb weakness after spinal anaesthesia for an elective minor operation of his left leg. MRI and CT scans were performed to rule out acute epidural haematoma; coincidental imaging features of marrow hyperplasia and spinal epidural extramedullary haematopoiesis were found. This article will present and discuss the imaging features, differential diagnosis, management and literature review of the rare occurrence of extramedullary haematopoiesis in the spinal epidural space. PMID:24390965

  6. Epidural spinal myelolipoma in a dog.

    PubMed

    Ueno, Hiroshi; Miyake, Tsuyoshi; Kobayashi, Yoshiyasu; Yamada, Kazutaka; Uzuka, Yuji

    2007-01-01

    Epidural spinal myelolipoma was diagnosed in a 13-year-old, male Siberian husky that was referred for evaluation of progressive pelvic limb paresis and urinary incontinence. An epidural mass was detected by magnetic resonance imaging and computed tomography. The mass was removed and identified histopathologically as an epidural myelolipoma. Pelvic limb paresis improved after surgery, but urinary retention associated with neurological bladder dysfunction persisted. PMID:17339292

  7. Four cases of spinal epidural angiolipoma.

    PubMed

    Sim, Kenneth; Tsui, Alpha; Paldor, Iddo; Kaye, Andrew H; Gaillard, Frank

    2016-03-01

    Spinal angiolipomas are uncommon benign tumours composed of mature fatty tissue and abnormal vascular elements, most commonly found within the posterior spinal epidural space. Most tumours are located within the mid-thoracic spine; in contrast thoracolumbar junction and purely lumbar angiolipomas are rare. We report a case series of four spinal angiolipomas, including a thoracolumbar junction and a purely lumbar tumour. PMID:26778809

  8. Spinal epidural abscess in brucellosis

    PubMed Central

    Boyaci, Ahmet; Boyaci, Nurefsan; Tutoglu, Ahmet; Sen Dokumac?, Dilek

    2013-01-01

    Involvement of the skeletal system is a common complication of brucellosis. However, muscle involvement or paraspinal abscess formation are rare complications. Paraspinal abscess usually develops secondary to spondylitis. A case is reported here of a 33-year-old woman with symptoms of night sweats, fever and low back pain. Rose-Bengal test for brucellosis was positive and Brucella standard tube agglutination test was positive at a titre of 1/160. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16?weeks. On day 14 of treatment, decline was observed in the patients symptoms. In the presence of inflammatory lower back pain and fever, brucellosis should be considered particularly in the endemic areas. Furthermore, tuberculosis should be remembered in the differential diagnosis when a spinal epidural abscess is determined. PMID:24072838

  9. Evaluation and management of spinal epidural abscess.

    PubMed

    DeFroda, Steven F; DePasse, J Mason; Eltorai, Adam E M; Daniels, Alan H; Palumbo, Mark A

    2016-02-01

    Spinal epidural abscess (SEA) is an uncommon and potentially catastrophic condition. SEA often presents a diagnostic challenge, as the "classic triad" of fever, spinal pain, and neurological deficit is evident in only a minority of patients. When diagnosis is delayed, irreversible neurological damage may ensue. To minimize morbidity, an appropriate level of suspicion and an understanding of the diagnostic evaluation are essential. Infection should be suspected in patients presenting with axial pain, fever, or elevated inflammatory markers. Although patients with no known risk factors can develop SEA, clinical concern should be heightened in the presence of diabetes, intravenous drug use, chronic renal failure, immunosuppressant therapy, or a recent invasive spine procedure. When the clinical profile is consistent with the diagnosis of SEA, gadolinium-enhanced magnetic resonance imaging of the spinal column should be obtained on an emergent basis to delineate the location and neural compressive effect of the abscess. Rapid diagnosis allows for efficient treatment, which optimizes the potential for a positive outcome. Journal of Hospital Medicine 2016;11:130-135. 2015 Society of Hospital Medicine. PMID:26540492

  10. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials

    PubMed Central

    Meng, Hai; Fei, Qi; Wang, Bingqiang; Yang, Yong; Li, Dong; Li, Jinjun; Su, Nan

    2015-01-01

    Background Epidural injections of anesthetic with or without steroids are widely used for treating lumbar spinal stenosis, a common cause of chronic low back pain, but there is a lack of rigorous data comparing the effectiveness of epidural injections of anesthetic with and without steroids. This meta-analysis presents a current, comprehensive picture of how epidural injections of anesthetic with steroids compare with those using local anesthetic alone. Methods PubMed, Embase, Web of Science, and Cochrane Library databases were searched from their inception through February 5, 2015. Weight mean difference, risk ratio, and 95% confidence intervals were calculated. A random effects model or fixed effects model was used to pool the estimates, according to the heterogeneity between the included studies. Results We included 13 randomized controlled trials, involving 1,465 patients. Significant pain relief (?50%) was demonstrated in 53.7% of patients administered with epidural injections of anesthetic with steroids (group 1) and in 56.4% of those administered with local anesthetic alone (group 2). Patients showed a reduction in numeric rating scale pain score of 3.7 and 3.6 in the two groups, respectively. Significant functional improvement was achieved in 65.2% of patients in group 1 and 63.1% of patients in group 2, with Oswestry Disability Index reductions of 13.8 and 14.5 points, respectively. The overall number of injections per year was 3.21.3 and 3.41.2 with average total relief per year of 29.319.7 and 33.819.3 weeks, respectively. The opioid intakes decreased from baseline by 12.4 and 7.8 mg, respectively. Among the outcomes listed, only total relief time differed significantly between the two groups. Conclusion Both epidural injections with steroids or with local anesthetic alone provide significant pain relief and functional improvement in managing chronic low back pain secondary to lumbar spinal stenosis, and the inclusion of steroids confers no advantage compared to local anesthetic alone. PMID:26316704

  11. Melioidosis presenting as spinal epidural abscess.

    PubMed

    Ganesan, D; Puthucheary, S D; Waran, V

    2003-12-01

    Central nervous system melioidosis is an unusual infection in humans. This article reports a case of melioidosis presenting as an acute spinal epidural abscess. A discussion of this case and its management together with a brief review of melioidosis of the central nervous system is presented. PMID:14756491

  12. Management of infiltrating spinal epidural angiolipoma

    PubMed Central

    Nadi, Mustafa M.; Nadi, Arwa M.; Zabara, Mohammad Y.; Ahmad, Tahani M.

    2015-01-01

    Angiolipomas of the spine are rare benign tumors commonly presenting with compressive myelopathy. The present report describes a case of spinal angiolipoma with thoracic mediastinal extension in a 50-year-old woman. She presented with a long-standing history of mid-back pain with progressive lower extremities weakness. An MRI showed a heterogeneously enhancing mass located in the posterior epidural space of the thoracic spine with mediastinal extension. Histopathological examination demonstrated features consistent with spinal angiolipoma. This report emphasizes the diagnosis and therapeutic management options of infiltrating spinal angiolipomas. PMID:25864069

  13. Monoplegia after combined spinal epidural anesthesia.

    PubMed

    Balaban, Onur; Grkan, Yavuz; Ku?, Alparslan; Toker, Kamil; Solak, Mine

    2013-01-01

    Serious neurological complications after neuraxial block, including permanent neurological injury, are rare in contemporary anesthetic practice. We report a case of a 36 year old female undergoing a venous stripping operation under combined spinal epidural anesthesia (CSE). The CSE procedure was completed after a second attempt at the L4-L5 level and the surgery was completed uneventfully. After full recovery of motor block in the recovery room, the patient was discharged to the surgical ward. Epidural patient controlled analgesia with levobupivacine 0.125% and fentanyl 2 g/ml was initiated. 10 hours after surgery, right lower limb sensory loss and monoplegia occurred. The epidural catheter was removed and normal MRI findings were noted. After one month of physical therapy treatment and two months follow up the patient was able to walk with the aid of a walking stick. We discuss factors that might have contributed to radiculopathy and neurotoxicity as a cause of neurologic deficit. PMID:24264554

  14. An unusual case of spinal cord compression from concomitant spinal epidural lipomatosis and Hodgkin's lymphoma

    PubMed Central

    Ahmadzai, Hasib; Khalil, Ali; Mitchell, Ruth A.; Kwok, Bernard

    2016-01-01

    Spinal epidural lipomatosis (SEL) results from an abnormal accumulation of unencapsulated fat within the epidural space and is a rare cause of spinal cord compression, which needs to be considered with a high index of suspicion. It most commonly occurs secondary to chronic corticosteroid use and endocrinopathies. Idiopathic cases are highly associated with obesity. We report an unusual case of idiopathic thoracic SEL in a 69-year-old male, with an adjacent infiltrative Hodgkin's lymphoma and associated vertebral crush fracture, which resulted in ataxia and sensory loss. Magnetic resonance imaging scans displayed extensive SEL and an infiltrative disease process causing thoracic cord compression. Surgical decompression confirmed the presence of extensive epidural lipomatosis and Hodgkin's lymphoma and subsequently led to improvement in neurological symptoms. To our knowledge, this is the first reported case of concomitant SEL with an adjacent Hodgkin's lymphoma resulting in cord compression. PMID:26962199

  15. [Continuous epidural morphine for postoperative pain relief after spinal surgery--use of an epidural catheter placed at the time of surgery].

    PubMed

    Kondo, U; Yokota, S; Nonogaki, M; Nishiwaki, K; Kimura, T; Komatsu, T; Shimada, Y

    1997-08-01

    Postoperative analgesia by continuous epidural morphine infusion after spinal surgery was investigated in a retrospective study. An epidural catheter was placed by surgeons at the time of surgery. Postoperative pain was less intense and use of analgesics and sedative was less frequent in patients with continuous epidural morphine (n = 41) as compared with patients without continuous epidural morphine (n = 41). Among the patients with continuous epidural morphine, postoperative pain in patients (n = 16) with the dura opened or dural rent during surgery was less intense and the uses of analgesics and sedative was less frequent as compared with patients (n = 25) without the dural rent. There were no severe complications except for respiratory depression in a patient with chronic obstructive pulmonary disease. Our study demonstrated the ease of insertion of an epidural catheter at the time of surgery and the good quality of epidural analgesia after spinal surgery. PMID:9283164

  16. Epidural Injections for Spinal Pain

    MedlinePLUS

    ... neck, more serious complications, such as spinal cord injury, stroke, or death, are possible if the needle is placed incorrectly. However, your doctor will use imaging guidance and a sterile technique to minimize these ...

  17. Spontaneous Recovery of Paraplegia Caused by Spinal Epidural Hematoma after Removal of Epidural Catheter

    PubMed Central

    Nitahara, Keiichi

    2014-01-01

    We report a patient who developed paraplegia caused by a spinal epidural hematoma after removal of an epidural catheter, which resolved spontaneously. A 60-year-old woman underwent thoracoscopic partial resection of the left lung under general anesthesia combined with epidural anesthesia. She neither was coagulopathic nor had received anticoagulants. Paraplegia occurred 40 minutes after removal of the epidural catheter on the first postoperative day. Magnetic resonance images revealed a spinal epidural hematoma. Surgery was not required as the paraplegia gradually improved until, within 1 hour, it had completely resolved. Hypoesthesia had completely resolved by the third postoperative day. PMID:24876976

  18. Efficacy of Epidural Injections in the Treatment of Lumbar Central Spinal Stenosis: A Systematic Review

    PubMed Central

    Manchikanti, Laxmaiah; Kaye, Alan David; Manchikanti, Kavita; Boswell, Mark; Pampati, Vidyasagar; Hirsch, Joshua

    2015-01-01

    Context: Lumbar central spinal stenosis is common and often results in chronic persistent pain and disability, which can lead to multiple interventions. After the failure of conservative treatment, either surgical or nonsurgical modalities such as epidural injections are contemplated in the management of lumbar spinal stenosis. Evidence Acquisition: Recent randomized trials, systematic reviews and guidelines have reached varying conclusions about the efficacy of epidural injections in the management of central lumbar spinal stenosis. The aim of this systematic review was to determine the efficacy of all three anatomical epidural injection approaches (caudal, interlaminar, and transforaminal) in the treatment of lumbar central spinal stenosis. A systematic review was performed on randomized trials published from 1966 to July 2014 of all types of epidural injections used in the management of lumbar central spinal stenosis. Methodological quality assessment and grading of the evidence was performed. Results: The evidence in managing lumbar spinal stenosis is Level II for long-term improvement for caudal and lumbar interlaminar epidural injections. For transforaminal epidural injections, the evidence is Level III for short-term improvement only. The interlaminar approach appears to be superior to the caudal approach and the caudal approach appears to be superior to the transforaminal one. Conclusions: The available evidence suggests that epidural injections with local anesthetic alone or with local anesthetic with steroids offer short- and long-term relief of low back and lower extremity pain for patients with lumbar central spinal stenosis. However, the evidence is Level II for the long-term efficacy of caudal and interlaminar epidural injections, whereas it is Level III for short-term improvement only with transforaminal epidural injections. PMID:25789241

  19. Spontaneous Spinal Epidural Hematoma on the Ventral Portion of Whole Spinal Canal: A Case Report

    PubMed Central

    Lee, Hyun-Ho; Kim, Young; Ha, Young-Soo

    2015-01-01

    Spontaneous spinal epidural hematoma is an uncommon but disabling disease. This paper reports a case of spontaneous spinal epidural hematoma and treatment by surgical management. A 32-year-old male presented with a 30-minute history of sudden headache, back pain, chest pain, and progressive quadriplegia. Whole-spinal sagittal magnetic resonance imaging (MRI) revealed spinal epidural hematoma on the ventral portion of the spinal canal. Total laminectomy from T5 to T7 was performed, and hematoma located at the ventral portion of the spinal cord was evacuated. Epidural drainages were inserted in the upper and lower epidural spaces. The patient improved sufficiently to ambulate, and paresthesia was fully recovered. Spontaneous spinal epidural hematoma should be considered when patients present symptoms of spinal cord compression after sudden back pain or chest pain. To prevent permanent neurologic deficits, early and correct diagnosis with timely surgical management is necessary. PMID:26512277

  20. Spontaneous Spinal Epidural Hematoma; a Case Report.

    PubMed

    Motamedi, Maryam; Baratloo, Alireza; Majidi, Alireza; Rahmati, Farhad; Shahrami, Ali

    2014-01-01

    Spontaneous spinal epidural hematoma (SSHE) is a rare entity can have several reasons. Its prevalence in population is 0.1 per 100,000 with the male to female ratio of 1/4:1. For the first time Jackson in 1869 reported a case of SSHE and after that, it was declared as several hundred cases in literatures. Here, a case of SSHE was reported in a 52-year-old male referred to emergency department following severe low back pain. PMID:26495379

  1. Prospective clinical evaluation of two combined spinal-epidural kits.

    PubMed

    Paech, M J; Evans, S F

    1995-10-01

    One hundred combined spinal epidural kits (Portex, n = 51, Mallinckrodt, n = 49) were evaluated clinically by twelve anaesthetists with respect to performance of the loss-of-resistance syringe, epidural needle and spinal needle, and success in establishing single-segment combined spinal-epidural anaesthesia for caesarean section. Similar components included a plastic loss-of-resistance device, a Tuohy epidural needle, 26 or 27 gauge pencil-point spinal needle and closed end, three-lateral-eye epidural catheter. The Mallinckrodt kit incorporated a "back-eye" design for exit of the spinal needle from the epidural needle. The epidural and the subarachnoid spaces were satisfactorily identified on 98 occasions. Most anaesthetists preferred the Mallinckrodt kit packaging and the Portex loss-of-resistance syringe, although the latter may have been biased by familiarity with this device. The portex spinal needle was more likely to be felt penetrating the dura (P = 0.02) and aspiration of cerebrospinal fluid was more frequently described as easy (P = 0.01). The most common criticisms of both kits were difficulty controlling the spinal needle position after entry into the subarachnoid space and subjectively, a high degree of resistance to injection through the spinal needle. PMID:8787262

  2. Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

    SciTech Connect

    Tok, Chung Hong Kaur, Shaleen; Gangi, Afshin

    2011-02-15

    Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202-211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202-211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

  3. Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection for the Treatment of Chronic Radicular Pain Caused by Lumbar Foraminal Spinal Stenosis: A Retrospective Comparative Study

    PubMed Central

    Park, Yongbum; Lee, Woo Yong; Ahn, Jae Ki; Nam, Hee-Seung

    2015-01-01

    Objective To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure. Methods This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score. Results ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point. Conclusion Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary. PMID:26798608

  4. Spinal Epidural Hematoma Related to Intracranial Hypotension

    PubMed Central

    Cha, Kyung Han; Kim, Chang Hyun; Lee, Ho Kook; Moon, Jae Gon

    2013-01-01

    A 45-year-old female patient visited the hospital complaining of severe sudden headache and posterior neck pain. The patient did not have any traumatic history or abnormal neurologic finding. The patient had sudden quadriplegia and sensory loss. Cervical spine MRI scan was taken, and the compatible findings to acute epidural hematoma were shown. The emergency operation was performed. After the operation, the patient recovered all motor and senses. As there was CSF leakage in the postoperative wound, this was confirmed by cervical spinal computed tomography (CT). Then lumbar drainage was thus performed. The opening pressure upon lumbar puncture was not measured as it was very low. As a result of continous CSF leakage, dural repair was performed. After the operation, the patient had been discharged without neurologic deficits. In this case, it is sensible to suspect intracranial hypotension as a possible cause of spinal EDH. PMID:24757490

  5. Spinal epidural hematoma related to intracranial hypotension.

    PubMed

    Cha, Kyung Han; Cho, Tack Geun; Kim, Chang Hyun; Lee, Ho Kook; Moon, Jae Gon

    2013-09-01

    A 45-year-old female patient visited the hospital complaining of severe sudden headache and posterior neck pain. The patient did not have any traumatic history or abnormal neurologic finding. The patient had sudden quadriplegia and sensory loss. Cervical spine MRI scan was taken, and the compatible findings to acute epidural hematoma were shown. The emergency operation was performed. After the operation, the patient recovered all motor and senses. As there was CSF leakage in the postoperative wound, this was confirmed by cervical spinal computed tomography (CT). Then lumbar drainage was thus performed. The opening pressure upon lumbar puncture was not measured as it was very low. As a result of continous CSF leakage, dural repair was performed. After the operation, the patient had been discharged without neurologic deficits. In this case, it is sensible to suspect intracranial hypotension as a possible cause of spinal EDH. PMID:24757490

  6. [Successful anesthetic management in a patient with chronic obstructive pulmonary disease (COPD) using dexmedetomidine and combined spinal-epidural anesthesia for low anterior resection of the rectum].

    PubMed

    Kitamura, Hiroaki; Kitayama, Mayuko; Tanimo, Takashi; Yamaki, Ryouichi; Komatsu, Hisao

    2012-08-01

    A 70-year-old man with a severe COPD was scheduled for low anterior resection of the rectum because of rectal cancer. After a week of respiratory rehabilitation, respiratory function was much improved. We selected combined spinal-epidural anesthesia (CSEA) and dexmedetomidine to preserve spontaneous breathing. We obtained appropriate sedative and antianxiety effect without causing respiratory depression and hemodynamic changes. Dexmedetomidine was useful for anesthesia for a patient with severe COPD without causing respiratory depression. PMID:22991807

  7. Morphofunctional changes in spinal cord neurons after epidural lidocaine.

    PubMed

    Boikova, N V; Volchkov, V A; Strashnov, V I; Tomson, V V

    2004-07-01

    Morphofunctional and histoenzymological changes in spinal cord neurons of mongrel dogs were studied after epidural administration of isobaric 2% lidocaine solution. Control animals received epidural 0.9% sodium chloride. The results obtained from these studies provide evidence for the absence of pathological structural-metabolic changes in nerve tissue after treatment with lidocaine. The occurrence of certain morphofunctional rearrangements in spinal cord neurons were typical of animals of both the experimental and control groups. The changes recorded varied within the limits of physiological variation and provided evidence predominantly of the functional response of these nerve tissue structures to epidural injections of both sodium chloride and lidocaine. PMID:15368907

  8. Imaging diagnosis--Spinal epidural hemangiosarcoma in a dog.

    PubMed

    de la Fuente, Cristian; Pumarola, Mart; Aor, Snia

    2014-01-01

    An 8-year-old, male Boxer was examined for an acute onset of ambulatory paraparesis. Neurologic examination was consistent with a T3-L3 myelopathy. Myelography revealed an extradural spinal cord compression in the region of the T10-T13 vertebrae. On magnetic resonance (MR) imaging, a well-defined epidural mass lesion was detected. The mass was mildly hyperintense on T1-weighted, hyperintense on T2-weighted and STIR images compared to normal spinal cord and enhanced strongly and homogenously. Postmortem examination confirmed a primary epidural hemangiosarcoma. Findings indicated that the MRI characteristics of spinal epidural hemangiosarcoma may mimic other lesions including meningioma and epidural hemorrhages/hematomas of non-neoplastic etiology. PMID:23815770

  9. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess

    PubMed Central

    Bang, Jin Hyuk

    2015-01-01

    Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus. PMID:26512268

  10. Facilitation of Stepping with Epidural Stimulation in Spinal Rats: Role of Sensory Input

    PubMed Central

    Lavrov, Igor; Courtine, Grgoire; Dy, Christine J.; van den Brand, Rubia; Fong, Andy J.; Gerasimenko, Yuri; Zhong, Hui; Roy, Roland R.; Edgerton, V. Reggie

    2010-01-01

    We investigated the role of afferent information during recovery of coordinated rhythmic activity of the hindlimbs in rats with a complete spinal cord section (~T8) and unilateral deafferentation (T12-S2) to answer the following questions: 1) Can bilateral stepping be generated with only afferent projections intact on one side? 2) Can the sensory input from the non-deafferented side compensate for the loss of the afferent input from the deafferented side through the crossed connections within the lumbosacral spinal cord? 3) Which afferent projections to the spinal cord from the non-deafferented side predominantly mediate the effect of epidural stimulation to facilitate stepping? Recovery of stepping ability was tested under the facilitating influence of epidural stimulation at the S1 spinal segment or epidural stimulation plus quipazine, a 5-HT agonist. All chronic spinal rats were able to generate stepping-like patterns on a moving treadmill on the non-deafferented, but not deafferented, side 37 weeks after surgery when facilitated by epidural stimulation. Adaptation to the loss of unilateral afferent input was evident at 7 weeks after surgery, when some movements occurred on the deafferented side. Spinal cord evoked potentials were observed on both sides, although middle (monosynaptic) and late (long-latency) responses were more prominent on the non-deafferented side. The afferent information arising from the non-deafferented side, however, eventually could mediate limited restoration of hindlimb movements on the deafferented side. These data suggest that facilitation of stepping with epidural stimulation is mediated primarily through ipsilateral afferents that project to the locomotor networks. PMID:18667609

  11. Spinal surgery: an unusual case of spinal epidural abscess.

    PubMed

    Vaught, Kevin A

    2009-01-01

    Southeast Missouri Hospital in Cape Girardeau, Missouri, admitted a patient from an outside hospital with back pain and progressive quadriparesis. Imaging revealed an extensive spinal epidural abscess that extended from the craniocervical junction to the sacral spine. Because of the patient's critical condition and the need to minimize the duration of surgery and anesthesia, two surgical teams simultaneously operated on the patient on the day of admission. One team performed a decompressive laminectomy of C1 through C7 and T1 through T6, while the other team performed, through a separate skin incision, a decompressive laminectomy on T11, L2, L3, and L4 as well as partial evacuation of a psoas abscess. The extensive laminectomies were required due to the adherent granulomatous nature of the abscess. Simple irrigation and intraoperative aspiration with suction was ineffective. The patient remained in the hospital for approximately three weeks and was discharged to a long-term acute care facility. Over the next five months her motor function gradually improved and she was discharged to home. Currently, she remains at home, free of significant pain and able to ambulate independently. PMID:19753924

  12. The evolution of spinal/epidural neostigmine in clinical application: Thoughts after two decades

    PubMed Central

    Lauretti, Gabriela Rocha

    2015-01-01

    Since the first clinical application of analgesia following spinal anticholinesterase by 1940's, several clinical double-blind studies have been conducted to date, where intrathecal doses of neostigmine in humans ranged from 750 to 1 ?g, due to side-effects. Conversely, epidural neostigmine has been evaluated in proportionally higher doses and represents an alternative, but still deserves more investigation concerning both acute and chronic pain, as it seems devoid of important side-effects. PMID:25558203

  13. Spontaneous spinal epidural hemorrhage from intense piano playing.

    PubMed

    Chang, Hui-Ju; Su, Fang Jy; Huang, Ying C; Chen, Shih-Han

    2014-06-01

    Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagulopathies; platelet dysfunction; vascular malformation; tumors; uncontrolled hypertension; pregnancy; and, very rarely, activities requiring Valsalva. Herein we reported the case of a young pianist who was attacked by SSEH during piano practice. Playing the piano is a joyful, relaxing entertainment; however, this musical activity can be a highly demanding physical and mental exercise for pianists. Emotional and expressive performance, especially in professional performing, has been reported to result in significant increase of sympathetic and decrease of parasympathetic activities and thus influence the cardiorespiratory variables. The increased biomechanical stress from fluctuating hemodynamics was thought to trigger the rupture of her spinal arteriovenous malformation. PMID:24418452

  14. Spinal epidural abscess: a rare complication of olecranon bursitis

    PubMed Central

    Evans, Rhys D.R.; Thaya, Moe; Chew, Ne Siang; Gibbons, Charles E.R.

    2009-01-01

    Spinal epidural abscess is a rare but potentially fatal condition if left untreated. We report the case of a 67-year old man who presented to the Accident and Emergency department complaining of acute onset of inter-scapular back pain, left leg weakness and loss of sensation in the left foot. On examination he was found to be pyrexial with long tract signs in the left lower leg. In addition he had a left sided olecranon bursitis of three weeks duration. Blood tests revealed raised inflammatory markers and a staphylococcal bacteremia. Magnetic resonance imaging (MRI) confirmed the diagnosis of spinal epidural abscess and he subsequently underwent a three level laminectomy with good resolution of his back pain and neurological symptoms. He has made a complete recovery with a prolonged course of intravenous antibiotics. PMID:21808663

  15. Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

    PubMed Central

    Bakhshi, Rochana Girish; Jagtap, Sheetal R.

    2011-01-01

    Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000-40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief. PMID:24765361

  16. Spinal osteotomy in the presence of massive lumbar epidural scarring.

    PubMed

    Arlet, Vincent

    2015-01-01

    The combination of Massive epidural scarring and spinal deformity represents the ultimate challenge for the spinal deformity surgeon. This is observed more and more as the population is aging and the number of spine surgery is increasing. In assessing the patient with spinal deformity and epidural scarring, one should carry out a thorough medical work up including Dexa scan, comorbidities, and in most cases a Myelo-CT scan that will identify the extent of the previous fusion, the fixed or semi-rigid nature of the deformity with complete anterior fusion or only bone bridges, the evaluation of the previous instrumentation (if present) with possible screw misplacement, or halo around the screws, the extent of the previous laminectomy, the spinal stenosis and possible arachnoiditis and or meningocele. Once the requirement of deformity correction has been established with specific attention to the pelvic incidence and amount of lordosis required two basic choices can be made. The first one is to perform the spine realignment outside the massive epidural scarring whether this will be performed through simple posterior osteotomies, TLIF combined with Smith-Petersen osteotomies or Pedicle subtraction osteotomies. One should not forget about all the possibilities of an anterior or lateral approach to the spine that can also judiciously realign the spine at the level or at distance of the massive epidural scarring. These anterior realignments have to be supplemented with posterior fixation and or osteotomies. The other alternative is to perform the spine osteotomy at the level of the massive epidural scarring preferably at the junction of normal dura and epidural scar. Working around the dura that will require to be thinned down before the osteotomy is performed represents another challenge where incidental durotomies are not infrequent. During the closing of the osteotomy the dura may not be as giving as a normal dura and too aggressive closure of the osteotomy may not be possible. Instead a closing/opening osteotomy may be preferable, but will require an additional anterior column support. Attention to anterior column reconstruction and solid posterior instrumentation (iliac screws, four rods) should be given to all these revisions to have a long-lasting result. PMID:25427670

  17. Lumbar Epidural Steroid Injection for Painful Spasticity in Cervical Spinal Cord Injury: A Case Report

    PubMed Central

    Bang, Hyun; Chun, Seong Min; Park, Hee Won; Bang, Moon Suk

    2015-01-01

    We report a case of a 53-year-old male with traumatic cervical spinal cord injury (SCI). He could not maintain a standing position because of painful spasticity in his lower limbs. A magnetic resonance imaging and electromyography indicated chronic lumbosacral radiculopathy, explaining his chronic low back pain before the injury. For diagnostic as well as therapeutic purposes, transforaminal epidural steroid injection (ESI) to the right L5 root was performed. After the intervention, the spasticity decreased and his ambulatory function improved. This case illustrates that lumbar radiculopathy concomitant with a cervical SCI can produce severe spasticity and it can be dramatically improved by ESI. PMID:26361605

  18. Comparison of epidural and combined spinal-epidural analgesia in the management of labour without pain.

    PubMed

    Kayacan, N; Ertugrul, F; Cete, N; Coskunfirat, N; Akar, M; Karsli, B; Erman, M

    2006-01-01

    The effects of combined spinal-epidural analgesia (CSEA) and epidural analgesia (EA) were studied in 50 healthy parturients randomly allocated to receive bupivacaine plus fentanyl either epidurally, or intrathecally and epidurally. Significant differences from baseline values were seen in systolic blood pressure at all time-points except for 4 h in the EA group and at 3 and 4 h in the CSEA group. Significant differences from baseline values were seen in diastolic blood pressure at 1, 2, 3 and 4 h in the EA group, whereas no significant differences from baseline were seen in the CSEA group. Pain scores in both groups were significantly decreased compared with baseline and all scores, except at 2h, were significantly lower in the CSEA group compared with the EA group. The duration of labour and total amount of drugs used were significantly decreased and cervical dilatation was faster with CSEA compared with EA. In conclusion, CSEA was associated with more rapid onset of analgesia and faster progress in cervical dilatation compared with EA, and can be used safely for labour analgesia. PMID:17294991

  19. The potential contributing effect of ketorolac and fluoxetine to a spinal epidural hematoma following a cervical interlaminar epidural steroid injection: a case report and narrative review.

    PubMed

    Chien, George C Chang; McCormick, Zack; Araujo, Marco; Candido, Kenneth D

    2014-01-01

    Cervical interlaminar epidural steroid injections (ESIs) are commonly performed as one part of a multi-modal analgesic regimen in the management of upper extremity radicular pain. Spinal epidural hematoma (SEH) is a rare complication with a reported incidence ranging from 1.38 in 10,000 to 1 in 190,000 epidurals. Current American Society of Regional Anesthesia (ASRA), American Society of Interventional Pain Physicians (ASIPP), and the International Spine Intervention Society (ISIS) recommendations are that non-steroidal anti-inflammatory drugs (NSAIDs) do not need to be withheld prior to epidural anesthesia. We report a case wherein intramuscular ketorolac and oral fluoxetine contributed to a SEH and tetraplegia following a cervical interlaminar (ESI). A 66 year-old woman with chronic renal insufficiency and neck pain radiating into her right upper extremity presented for evaluation and was deemed an appropriate CESI candidate. Cervical magnetic resonance imaging (MRI) revealed multi-level neuroforaminal stenosis and degenerative intervertebral discs. Utilizing a loss of resistance to saline technique, an 18-gauge Tuohy-type needle entered the epidural space at C6-7. After negative aspiration, 4 mL of saline with 80 mg of methyl-prednisolone was injected. Immediately thereafter, the patient reported significant spasmodic-type localized neck pain with no neurologic status changes. A decision was made to administer 30 mg intramuscular ketorolac as treatment for the spasmodic-type pain. En route home, she developed a sudden onset of acute tetraplegia. She was brought to the emergency department for evaluation including platelet and coagulation studies which were normal. MRI demonstrated an epidural hematoma extending from C5 to T7. She underwent a bilateral C5-T6 laminectomy with epidural hematoma evacuation and was discharged to an acute inpatient rehabilitation hospital. Chronic renal insufficiency, spinal stenosis, female gender, and increasing age have been identified as risk factors for SEH following epidural anesthesia. In the present case, it is postulated that after the spinal vascular system was penetrated, hemostasis was compromised by the combined antiplatelet effects of ketorolac, fluoxetine, fish oil, and vitamin E. Although generally well tolerated, the role of ketorolac, a potent anti-platelet medication used for pain relief in the peri-neuraxial intervention period, should be seriously scrutinized when other analgesic options are readily available. Although the increased risk of bleeding for the alternative medications are minimal, they are nevertheless well documented. Additionally, their additive impairment on hemostasis has not been well characterized. Withholding NSAIDs, fluoxetine, fish oil, and vitamin E in the peri-procedural period is relatively low risk and should be considered for all patients with multiple risk factors for SEH. PMID:24850120

  20. Spontaneous spinal epidural haematoma mimicking acute coronary syndrome

    PubMed Central

    Mohammed, Noor; Shahid, Muhammad; Haque, Munirul; Qureshi, Masood

    2015-01-01

    Spontaneous spinal epidural hematoma (SSEH) is an acute neurological emergency which carries significant morbidity unless diagnosed and treated in a timely fashion. Some cases of SSEH are idiopathic but there is a well-recognised association with deranged coagulation and abnormalities of clotting. In recent years there has been increasing availability of novel anti-platelet agents, often prescribed in the setting of suspected acute coronary syndromes (ACS) and following percutaneous coronary interventions and these agents also present an increased risk of SSEH. We present a case of SSEH following an acute presentation with chest pain and treatment with dual anti-platelet therapy. PMID:26807374

  1. Chronic adhesive arachnoiditis after repeat epidural blood patch.

    PubMed

    Carlswrd, C; Darvish, B; Tunelli, J; Irestedt, L

    2015-08-01

    Epidural blood patching is an effective treatment for postdural puncture headache but has potential risks. Arachnoiditis is a very rare disabling condition and few cases have been described following an epidural blood patch. We present a case of chronic adhesive arachnoiditis in a parturient treated with a repeat epidural blood patch. A healthy 29-year-old woman had an accidental dural puncture following epidural insertion during labour. Initial treatment of postdural puncture headache with an epidural blood patch was ineffective and was therefore repeated. She gradually developed severe neurological symptoms consistent with arachnoiditis confirmed with magnetic resonance imaging. Despite intensive multimodal treatment with analgesics and physiotherapy, her neurological condition remains unresolved two years later. This serious but rare complication should encourage caution when treating parturients with postdural puncture headache with a repeat epidural blood patch. PMID:26119259

  2. Spontaneous spinal epidural hematoma presenting as paraplegia after cardiac surgery.

    PubMed

    Kin, Hajime; Mukaida, Masayuki; Koizumi, Junichi; Kamada, Takeshi; Mitsunaga, Yoshino; Iwase, Tomoyuki; Ikai, Akio; Okabayashi, Hitoshi

    2016-03-01

    An 86-year-old woman was scheduled to undergo aortic valve replacement and coronary artery bypass graft. On postoperative day 3, she developed sudden-onset neck pain followed by weakness in the right arm. Her symptoms worsened with time, and she developed paraplegia. At 60 h after the first complaint, spontaneous spinal epidural hematoma (SSEH) from C2 to C6 with spinal cord compression was diagnosed from a magnetic resonance image of the cervical region. We decided on conservative therapy because operative recovery was impossible. Delayed diagnosis led to grievous results in the present case. When neurological abnormalities follow neck or back pain after open heart surgery, SSEH must be considered in the differential diagnosis. Further, if it is suspected, early cervical computed tomography/magnetic resonance imaging and surgery should be considered. PMID:24722959

  3. [Combined spinal epidural and general anesthesia in abdominal surgery].

    PubMed

    Zori?, Sava; Stamenkovi?, Dusica; Stevanovi?, Slobodan; Malenkovi?, Vesna; Diki?, Svetlana Dragojevi?; Randelovi?, Tomislav; Bilanovi?, Dragoljub

    2003-01-01

    Almost ten years has past since Eldor described combined spinal-epidural-general anaesthesia (CSEOGA) as a new concept in anaesthesia in which all of these components can be used, with sub-anaesthetic doses of drugs, due to its sinergist effect. The clinics studies has not demonstrated crucial advantages CSEGA comparing with combined epidural-general anaesthesia (CEDGA), in sense of analgesia, pulmonary function and neuro-hormomal inhibition. However we have been routinely practising our technique CSEGA in big abdominal and thoraco-abdominal surgery, since 1997. This study is a retrospective analysis of our technique and clinic observations, during 4.5 years, which include 293 patients. Their demographic characteristics can be seen in table 2. We perform combined spinal-epidural anaesthesia (CSE) in one or two interspinal spaces, depending on the type of surgery, but always before induction in general anaesthesia (GA). For preemptive and intraoperative analgesia we use 0.25% plain bupivacaine (B), both for spinal (SA) and epidural (ED) blockade. The most important detail in our technique, despite precise order to administrate drugs, is analgesic solution (AS) which contain B 4.5 mg, fentanyl (Fe) 50 mcg and morphine hydrochloride (Mo) 0.2 mg, in total volume of 3 ml, in SA. After the ED test dose with 2% lidocaine 60 mg (3 ml), before the induction in GA, we inject more 10 ml B, but intraoperative analgesia is almost performed with B 3 to 5 ml in intermittent bolus doses. This ED bolus dosis is particularly important, partly to sufficiently cephalic migration of the SA somatosensorieblock, as well as for intraoperative analgesia. For very light GA only artificial ventilation with 66% N2O in O2 and muscle relaxation with paneuronium is needed. Co analgesia with intravenous (i.v.) Fe, was exceptionally seldom needed, except for induction. Intraoperative drugs consumption was very small as we see in table 5. With adequate liquid compensation, this technique achieve exceptionally intraoperative homodynamic stability in patients, despite to long and big operations. Postoperative analgesia are supplied by SA the first 24 hours, but the next 72 ours is performed with intermittent ED bolus doses of 0.12% B with 2 mg Mo in total volume of 15 ml and 10 ml, depending on the epidural catheter (EDK) position in lumbar or thoracic part of spine. The break through of postoperative pain was between 20% to 34%, which was suppressed with metamisol. According to the verbal rating scale (VRS < 1) 90% patients were satisfied with this analgesia, which gave possibilities to mobilization and rehabilitation even the first postoperative day. All clinical sings show that thanks to inhibition of spinal and supraspinal sensitization, all principles of the preemptive analgesia (PA), inhibition of neuro-hormonal stress reaction are met and postoperative outcome is improved and satisfied. The complications we had were insignificant, in time observed and without any consequences. PMID:15017859

  4. ACR Appropriateness Criteria® Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis.

    PubMed

    Lo, Simon Shek-Man; Ryu, Samuel; Chang, Eric L; Galanopoulos, Nicholas; Jones, Joshua; Kim, Edward Y; Kubicky, Charlotte D; Lee, Charles P; Rose, Peter S; Sahgal, Arjun; Sloan, Andrew E; Teh, Bin S; Traughber, Bryan J; Van Poznak, Catherine; Vassil, Andrew D

    2015-07-01

    Metastatic epidural spinal cord compression (MESCC) is an oncologic emergency and if left untreated, permanent paralysis will ensue. The treatment of MESCC is governed by disease, patient, and treatment factors. Patient's preferences and goals of care are to be weighed into the treatment plan. Ideally, a patient with MESCC is evaluated by an interdisciplinary team promptly to determine the urgency of the clinical scenario. Treatment recommendations must take into consideration the risk-benefit profiles of surgical intervention and radiotherapy for the particular individual's circumstance, including neurologic status, performance status, extent of epidural disease, stability of the spine, extra-spinal disease status, and life expectancy. In patients with high spinal instability neoplastic score (SINS) or retropulsion of bone fragments in the spinal canal, surgical intervention should be strongly considered. The rate of development of motor deficits from spinal cord compression may be a prognostic factor for ultimate functional outcome, and should be taken into account when a treatment recommendation is made. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:25974663

  5. Thoracic epidural spinal angiolipoma with coexisting lumbar spinal stenosis: Case report and review of the literature

    PubMed Central

    Benvenutti-Regato, Mario; De la Garza-Ramos, Rafael

    2015-01-01

    Background Spinal angiolipomas (SALs) are uncommon benign lesions that may present insidiously with back pain or acutely with weakness due to tumor bleeding/thrombosis. Given their rarity, these lesions are often overlooked in the differential diagnosis of epidural masses. The purpose of this article is to report the case of an epidural SAL and to conduct a literature review on the topic. Methods A case report and review of the literature using the PubMed/Medline databases. All case reports and case series were reviewed up to June 2015. Results A 65-year old female presented with neurogenic claudication and magnetic resonance imaging (MRI) revealed lumbar spinal stenosis. Following decompressive surgery, she experienced symptom resolution, but three months postoperatively she presented to the emergency department with acute paraparesis. A thoracic MRI revealed a lesion located between T8 and T10 causing severe spinal cord compression. Following emergent laminectomy and en bloc resection, the patient regained function and the lesion was diagnosed as SAL. Our literature review revealed 178 reported cases, with a female and thoracic predominance. The majority of patients underwent surgical treatment, achieving a gross total resection in most cases. Similarly, complete symptom resolution was the most common outcome. Conclusion Spinal angiolipomas are uncommon spinal tumors. However, they may be treated as any other space-occupying lesion, and surgical resection allows for complete symptom recovery in most patients. PMID:26767159

  6. Epidural analgesia after spinal surgery via intervertebral foramen.

    PubMed

    Sice, P J A; Chan, D; MacIntyre, P A

    2005-03-01

    Patients undergoing major spinal surgery may experience significant postoperative pain. Epidural analgesia has previously been shown to be safe and effective and may confer some advantages over opioid-based postoperative analgesia. We discuss the case of a 47-yr-old female patient undergoing the prolonged anterior component of a lower thoracic/upper lumbar spine correction involving the stripping of the diaphragm from the lower thoracic spine and retraction of the left lower lobe of the lung. Despite initially planning opioid-based postoperative analgesia, a joint anaesthetic and surgical decision was made to use epidural analgesia in an attempt to avoid potential postoperative respiratory complications. Because of the surgical anatomy of the correction, the catheter was inserted via the T11 intervertebral foramen. A bolus of bupivacaine 0.25% intraoperatively with a postoperative infusion of bupivacaine 0.167% with diamorphine 0.1 mg ml(-1) provided excellent analgesia. The technique was associated with no postoperative complications. PMID:15619602

  7. Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases

    SciTech Connect

    Mahadevan, Anand; Floyd, Scott; Wong, Eric; Jeyapalan, Suriya; Groff, Michael; Kasper, Ekkehard

    2011-12-01

    Purpose: When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials: SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy Multiplication-Sign 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results: The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions: SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.

  8. [Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma -stroke mimic and pitfalls for diagnosis].

    PubMed

    Hara, Naoyuki; Otonari, Tatsuya; Nishihara, Nobuharu; Ota, Taisei; Kuriyama, Masaru

    2014-01-01

    Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma were presented. We examined the point similar to that of stroke. During the initial visit of our hospital, the patients showed the hemiplegia in 10 cases (62.5%), Horner syndrome in 4 cases (25%), the painless onset in 1 case (6.3%). And one case showed the impairment of consciousness due to vagal reflex in severe pain onset, which was similar to those of subarachnoid hemorrhage. MRI images are useful to confirm the diagnosis. The frequent site of hematoma was the lower cervical spinal cord. The oval shaped hematomas shifted to the left or right in spinal canals, compressed spinal cords in axial image, which was a cause of hemiplegia. Many cases developed during active periods, and the hemorrhage might be relevant to oral antithrombotic agent, C hepatitis, and chronic renal failure. Rapidly progressive cases were indications for emergency surgery, but conservative therapy is also possible and was better prognosis. PMID:24943075

  9. Corticosteroids for Pain of Spinal Origin: Epidural and Intraarticular Administration.

    PubMed

    Schilling, Louisa S; Markman, John D

    2016-02-01

    Targeted interventional delivery of corticosteroids remains a mainstay of treatment for spinal pain syndromes because this approach has a wider therapeutic index than other approaches. The best evidence for analgesic efficacy is in subacute radicular syndromes associated with new-onset or recurrent lumbar radiculitis. Complications often relate to drug delivery technique as much as actions of the steroid itself and require careful consideration and vigilance by the administering physician. Considerable uncertainty persists concerning which patients with chronic pain are most likely to benefit from corticosteroid injections. Matching this treatment option with specific spinal pain syndromes remains a major challenge. PMID:26611556

  10. Therapeutic Effect of Epidurally Administered Lipo-Prostaglandin E1 Agonist in a Rat Spinal Stenosis Model

    PubMed Central

    Park, Sang Hyun; Choe, Ghee Young; Moon, Jee Yeon; Nahm, Francis Sahngun; Kim, Yong Chul

    2014-01-01

    Background A lipo-prostaglandin E1 agonist is effective for the treatment of neurological symptoms of spinal stenosis when administered by an oral or intravenous route. we would like to reveal the therapeutic effect of an epidural injection of lipo-prostaglandin E1 on hyperalgesia in foraminal stenosis. Methods A total of 40 male Sprague-Dawley rats were included. A small stainless steel rod was inserted into the L5/L6 intervertebral foramen to produce intervertebral foraminal stenosis and chronic compression of the dorsal root ganglia (DRG). The rats were divided into three groups: epidural PGE1 (EP) (n = 15), saline (n = 15), and control (n = 10). In the EP group, 0.15 µg.kg-1 of a lipo-PGE1 agonist was injected daily via an epidural catheter for 10 days from postoperative day 3. In the saline group, saline was injected. Behavioral tests for mechanical hyperalgesia were performed for 3 weeks. Then, the target DRG was analyzed for the degree of chromatolysis, chronic inflammation, and fibrosis in light microscopic images. Results From the fifth day after lipo-PGE1 agonist injection, the EP group showed significant recovery from mechanical hyperalgesia, which was maintained for 3 weeks (P < 0.05). Microscopic analysis showed much less chromatolysis in the EP group than in the saline or control groups. Conclusions An epidurally administered lipo-PGE1 agonist relieved neuropathic pain, such as mechanical hyperalgesia, in a rat foraminal stenosis model, with decreasing chromatolysis in target DRG. We suggest that epidurally administered lipo-PGE1 may be a useful therapeutic candidate for patients with spinal stenosis. PMID:25031807

  11. Low dose combined spinal-epidural anaesthesia for caesarean section in a patient with peripartum cardiomyopathy.

    PubMed

    Pirlet, M; Baird, M; Pryn, S; Jones-Ritson, M; Kinsella, S M

    2000-07-01

    A patient with peripartum cardiomyopathy was scheduled for elective caesarean section after stabilization on medical therapy. Wer performed a combined spinal epidural using one ml 0.5% hyperbaric bupivacaine (5 mg) with 0.3 mg diamorphine for the spinal. The epidural was topped up with 10 mL bupivacaine 0.5%. Significant haemodynamic changes consisted of reduction in heart rate and hypotension after the spinal, and tachycardia after delivery. The benefits and risks of this approach are discussed. PMID:15321091

  12. Spinal subdural hematoma with cauda equina syndrome: A complication of combined spinal epidural anesthesia

    PubMed Central

    Singhal, Neha; Sethi, Priyanka; Jain, Jitesh Kumar; Agarwal, Saurabh

    2015-01-01

    Combined spinal-epidural anesthesia (CSE) is considered safe in lower limb surgeries. We report a case of sudden neurological deterioration in a stable postoperative patient who was given CSE for total knee replacement and low molecular weight heparin in postoperative period. On the 4th postoperative day, she developed sudden onset weakness in left lower limb along with bladder incontinence. Magnetic resonance imaging spine revealed a subdural hematoma at L2-L3 level. Immediate laminectomy along with cord decompression was done and patient recovered well except for a persistent foot drop on left side. PMID:25948911

  13. Hemophilia A in a Senior Patient: A Case Report of Spinal Epidural Hematoma as First Presentation

    PubMed Central

    Jung, Woo Shik; Lee, Jae Il

    2015-01-01

    Hemophilia A is a hereditary coagulation disorder. Most cases are diagnosed at birth or at least during childhood. A spontaneous spinal epidural hematoma was developed in a 74-year-old male patient who hadn't had a family or past medical history of bleeding disorders. On magnetic resonance imaging, epidural hematoma at L1-2 was accompanied by spinal stenosis at L4-5 and spondylolytic spondylolisthesis at L5. Hematoma evacuation and surgery for distal lumbar lesions were performed at once. After transient improvement, complete paraplegia was developed due to redevelopment of large epidural hematomas at L1-2 and L4-S1 which blocked epidural canal completely. Emergency evacuation was performed and we got to know that he had a hemophilia A. Factor VIII was 28% of normal value. Mild type hemophilia A could have not been diagnosed until adulthood. Factor VIII should have been replaced before the surgical decompression. PMID:26097663

  14. Spinal Cord Stimulation for Chronic Limb Ischemia

    PubMed Central

    Naoum, Joseph J.; Arbid, Elias J.

    2013-01-01

    The treatment of chronic limb ischemia involves the restoration of pulsatile blood flow to the distal extremity. Some patients cannot be treated with endovascular means or with open surgery; some may have medical comorbidities that render them unfit for surgery, while others may have persistent ischemia or pain even in the face of previous attempts at reperfusion. In spinal cord stimulation (SCS), a device with electrodes is implanted in the epidural space to stimulate sensory fibers. This activates cell-signaling molecules that in turn cause the release of vasodilatory molecules, a decrease in vascular resistance, and relaxation of smooth muscle cells. SCS also suppresses sympathetic vasoconstriction and pain transmission. When patient selection is based on microcirculatory parameters, SCS therapy can significantly improve pain relief, halt the progression of ulcers, and potentially achieve limb salvage. PMID:23805343

  15. Paraplegia after epidural-general anesthesia in a Morquio patient with moderate thoracic spinal stenosis

    PubMed Central

    Krane, Elliot J.; Tomatsu, Shunji; Theroux, Mary C.; Lee, Roland R.

    2014-01-01

    Purpose We describe an instance in which complete paraplegia was evident immediately postoperatively after apparently uneventful lumbar epidural-general anesthesia in a patient with Morquio Type A syndrome (Morquio A) with moderate thoracic spinal stenosis. Clinical features A 16-yr-old male with Morquio A received lumbar epidural-general anesthesia for bilateral distal femoral osteotomies. Preoperative imaging had revealed a stable cervical spine and moderate thoracic spinal stenosis with a mild degree of spinal cord compression. Systolic blood pressure (BP) was maintained within 20% of the pre-anesthetic baseline value. The patient sustained a severe thoracic spinal cord infarction. The epidural anesthetic contributed to considerable delay in the recognition of the diagnosis of paraplegia. Conclusion This experience leads us to suggest that, in patients with Morquio A, it may be prudent to avoid the use of epidural anesthesia without very firm indication, to support BP at or near baseline levels in the presence of even moderate spinal stenosis, and to avoid flexion or extension of the spinal column in intraoperative positioning. If the spinal cord/column status is unknown or if the patient is known to have any degree of spinal stenosis, we suggest that the same rigorous BP support practices that are typically applied in other patients with severe spinal stenosis, especially stenosis with myelomalacia, should apply to patients with Morquio A and that spinal cord neurophysiological monitoring should be employed. In the event that cord imaging is not available, e.g., emergency procedures, it would be prudent to assume the presence of spinal stenosis. PMID:25323122

  16. A Rare Case of Malignant Lymphoma Occurred at Spinal Epidural Space: A Case Report

    PubMed Central

    Cho, Hyun-Jun; Hur, Junseok W.; Jin, Sung-Won; Cho, Tai-Hyoung; Park, Jung-Yul

    2015-01-01

    The sacral spinal epidural space is an uncommon site for primary malignant lymphomas, presenting with symptoms associated with cauda equina compression. Especially, lumbo-sacral epidural lymphoma has been reported to be very rare. We present a rare case of 29-year-old male with sacral spinal epidural malignant lymphoma. The patient complained of tingling sensation in his buttocks that was radiating to his calf. The neurological examination was normal. Magnetic resonance imaging (MRI) with contrast showed a well-defined extradural mass lesion at the mid L5 to mid S2 level. The lesion was iso- to hypointense on T1 and T2 weighted images and showed homogenous enhancement and a focal enhancement in the L5 vertebral body on post-contrast images. The patient underwent a L5-S2 laminectomy and subtotal excision of the lesion. Intra-operatively, the lesion was extradural and not densely adherent to the dura; the lesion was friable, not firm, fleshy, brownish and hypervascular. The histologic diagnosis was grade 2 non-Hodgkin's follicular lymphoma. Even though the primary spinal epidural non-Hodgkin's lymphoma is a very rare disease, clinicians should take it into consideration in the differential diagnosis of patients with spinal epidural tumor. PMID:26512278

  17. A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anaesthesia for Percutaneous Nephrolithotomy

    PubMed Central

    Nandanwar, Avinash S; Patil, Yogita; Baheti, Vidyasagar H.; Tanwar, Harshwardhan V.; Patwardhan, Sujata K.

    2015-01-01

    Introduction Percutaneous nephrolithotomy (PCNL) is done under general anaesthesia in most of the centres. Associated complications and cost are higher for general anaesthesia than for regional anaesthesia. Present study is designed to compare the efficacy of epidural block versus spinal anaesthesia with regards to intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, Postoperative complications and patient satisfaction in patients undergoing PCNL. Materials and Methods After taking Ethical Committee clearance, patients were randomly allocated into 2 groups using table of randomization (n= 40 each) Group E- Epidural block, Group S- Spinal block. Various parameters like intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, postoperative complications and patient satisfaction were studied in these groups. Statistical Analysis Quantitative data was analysed using unpaired t-test and qualitative data was analysed using chi-square test. Results Twenty four times in Epidural as compared to fifteen times in spinal anaesthesia two or more attempts required. Mean time (min) required to achieve the block of anaesthesia in group E and group S was 15.45±2.8 and 8.52±2.62 min respectively. Mean arterial pressure (MAP) at 5 min, 10 min and 15 min were significantly lower in spinal group as compared to epidural group. After 30 minutes, differences were not significant but still MAP was lower in spinal group. After 30 minutes difference in heart rate between two groups was statistically significant and higher rate recorded in spinal group till the end of 3 hours. Postoperative VAS score was significantly higher in spinal group and 4 hours onwards difference was highly significant. Postoperative Nausea Vomiting (PONV) Score was significantly higher in spinal group as compared to epidural group. Conclusion For PCNL, segmental epidural block is better than spinal anaesthesia in terms of haemodynamic stability, postoperative analgesia, patient satisfaction and reduced incidence of PONV. Epidural anaesthesia is difficult to execute and takes longer time to act as compared to spinal block which limits its use. PMID:26436021

  18. Sudden onset of paraplegia caused by hemorrhagic spinal epidural angiolipoma. A case report.

    PubMed

    Akhaddar, Ali; Albouzidi, Abderrahmane; Elmostarchid, Brahim; Gazzaz, Miloudi; Boucetta, Mohamed

    2008-09-01

    Spinal epidural angiolipoma is a rare benign tumor containing vascular and mature adipose elements. A slow progressive clinical course was mostly presented and rarely a fluctuating course during pregnancy. The authors report the original case of spontaneous spinal epidural bleeding resulting from thoracic epidural angiolipoma who presented with hyperacute onset of paraplegia, simulating an extradural hematoma. The patient was admitted with sudden non-traumatic hyperacute paraplegia during a prolonged walk. Neurologic examination showed sensory loss below T6 and bladder disturbances. Spinal MRI revealed a non-enhanced heterogeneous thoracic epidural lesion, extending from T2 to T3. A bilateral T2-T4 laminectomy was performed to achieve resection of a lipomatous tumor containing area of spontaneous hemorrhage. The postoperative course was uneventful with complete neurologic recovery. Histologic examination revealed the tumor as an angiolipoma. Because the prognosis after rapid surgical management of this lesion is favorable, the diagnosis of spinal angiolipoma with bleeding should be considered in the differential diagnosis of hyperacute spinal cord compression. PMID:18228054

  19. Treatment of holocord spinal epidural abscess via alternating side unilateral approach for bilateral laminectomy.

    PubMed

    Hwang, Roy; Yung, Brian H; Sedney, Cara; Miele, Vincent J

    2015-01-01

    To date, this is the first reported case of the surgical management of a holocord epidural abscess done through level-skipping laminectomies. It is also the first reported case of these laminectomies being performed via an alternating side unilateral approach for this condition. A 51-year-old patient presenting with progressive lower extremity weakness secondary to a spinal epidural abscess extending from C4 to S1. A minimally disruptive method of relieving the spinal cord compression via evacuation of the abscess was employed successfully. This report demonstrates the efficacy of level skipping laminectomies via a unilateral approach for holocord epidural abscesses (extending 20 vertebral levels). Performing the laminectomies via a unilateral approach as well as alternating the side of the approach minimized iatrogenic instability risk. Both strategies were designed to minimize incision size, tissue disruption, and the amount of muscular weakness/imbalance postoperatively. PMID:26050292

  20. Spinal epidural hematoma caused by pseudogout: a case report and literature review.

    PubMed

    deSouza, R M; Uff, C; Galloway, M; Dorward, N L

    2014-06-01

    Study Design Case report. Objective We present the first reported case of spontaneous spinal epidural hematoma secondary to calcium pyrophosphate crystal deposition disease (pseudogout) in a 75-year-old woman. Methods A retrospective review of the patient's case notes was undertaken and the limited literature on this subject reviewed. Results This patient presented with sudden-onset lower limb paresis, sensory loss, urinary retention, and back pain. Magnetic resonance imaging showed an epidural hematoma, which was evacuated. Histologic specimens of the clot showed calcium pyrophosphate dihydrate crystal deposits (pseudogout). Conclusion The importance of histopathologic review of surgical specimens is highlighted when considering the differential diagnosis of apparently spontaneous spinal epidural hematoma. PMID:25072005

  1. Lumbar puncture complicated by spinal epidural hematoma in a child with leukemia

    PubMed Central

    Hatzipantelis, Emmanuel; Kyriakidis, Ioannis; Pavlou, Evangelos; Pavlidou, Efterpi; Stamou, Maria; Foroglou, Nikolaos; Papageorgiou, Theodotis; Hatzistilianou, Maria

    2015-01-01

    Key Clinical Message We report a case of spinal epidural hematoma (SEH) preceded by diagnostic lumbar puncture (LP) in a 5-year-old boy with acute lymphoblastic leukemia. MRI confirmed the presence of SEH between T7 and L5 levels, but the patient showed fast recovery during the next hours and conservative management was elected. PMID:26185634

  2. [Cesarean Section Under Combined Spinal and Epidural Anesthesia for a Pregnant Woman with Primary Biliary Cirrhosis].

    PubMed

    Hyoda, Akira; Komasawa, Nobuyasu; Matsunami, Sayuri; Minami, Toshiaki

    2015-12-01

    We report the successful anesthetic management of a pregnant woman with primary biliary cirrhosis (PBC) and autoimmune hepatitis who underwent cesarean section. A 35 year-old pregnant woman with PBC was diagnosed with preterm rupture of membranes (PROM). Emergent cesarean section was scheduled. AST and ALT were elevated and she complained of itching due to PBC. Hydrocortisone 50 mg was intravenously administered. Spinal anesthesia was initiated with 2.4 ml of 0.5% bupivacaine hydrochloride and 10 g fentanyl at L3-4; sensory loss (T2) was confirmed. Morphine was not included in spinal anesthesia to avoid worsening of the itching. Epidural anesthesia at T12-L1 was performed for postoperative pain control. Surgery proceeded uneventfully and postoperative pain control was satisfactory. Combined spinal and epidural anesthesia was beneficial for the perioperative management of a pregnant woman with PBC and autoimmune hepatitis. PMID:26790326

  3. Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: case report.

    PubMed

    Ou, Chang-Hsien; Wang, Hao-Kuang; Yang, Tzu-Hsien; Liang, Cheng-Loong; Wong, Ho-Fai

    2015-08-01

    The authors report an extremely rare case of spinal intraosseous epidural arteriovenous fistula (AVF) with perimedullary vein reflux causing symptoms of myelopathy. The intraosseous fistula tracts were completely obliterated with Onyx embolic agent, resulting in a total resolution of symptoms. The unique features of this case include the rare location of the fistula in the vertebral body and the association of the fistula with a compressive fracture. Imaging studies confirmed these hemodynamic findings and provided clarity and direct evidence regarding the association of epidural AVF formation with the vertebral compressive fracture. The authors also propose a possible disease evolution based on the previously adduced reflux-impending mechanism. PMID:26052621

  4. Chronic measurement of epidural pressure with an induction-powered oscillator transducer.

    PubMed

    Rylander, H G; Taylor, H L; Wissinger, J P; Story, J L

    1976-04-01

    An induction-powered oscillator transducer (IPOT) was designed for the chronic measurement of epidural pressure. The transducer was completely implantable so all pressure measurements were made through the intact skin. The IPOT had a linear pressure range from -50 to +200 cm H2O, was sensitive to 1 mm H2O and had a zero drift of less than 1 mm H2O/day under full load. Zero drift was minimized by using a hermetically-sealed metal bellows transducing element which was chemically treated to prevent corrosion and creep. The correlation between epidural pressure and intraventricular pressure was determined during the first 24 hours after implantation in six dogs. Epidural pressure was found to be a linear function of intraventricular fluid pressure. Epidural pressure and intraventricular pressure were essential equal provided the epidural wedge pressure was minimized by proper insertion of the transducer. The correlation between epidural pressure and intraventricular pressure was determined after chronic implantation in five dogs. Epidural pressure was a linear function of intraventricular pressure in the chronically implanted dogs, but epidural pressure was not equal to intraventricular pressure. After chronic implantation, the epidural pressure transducer was not responsive to changes in intraventricular pressure because of mechanical changes in the dura. The dura became stiff and non-compliant. Maximum correlation between epidural pressure and intraventricular fluid pressure in chronic implantations will depend on judicious material selection and mechanical design at the transducer-dura interface. PMID:1255235

  5. Development of a multi-electrode array for spinal cord epidural stimulation to facilitate stepping and standing after a complete spinal cord injury in adult rats

    PubMed Central

    2013-01-01

    Background Stimulation of the spinal cord has been shown to have great potential for improving function after motor deficits caused by injury or pathological conditions. Using a wide range of animal models, many studies have shown that stimulation applied to the neural networks intrinsic to the spinal cord can result in a dramatic improvement of motor ability, even allowing an animal to step and stand after a complete spinal cord transection. Clinical use of this technology, however, has been slow to develop due to the invasive nature of the implantation procedures, the lack of versatility in conventional stimulation technology, and the difficulty of ascertaining specific sites of stimulation that would provide optimal amelioration of the motor deficits. Moreover, the development of tools available to control precise stimulation chronically via biocompatible electrodes has been limited. In this paper, we outline the development of this technology and its use in the spinal rat model, demonstrating the ability to identify and stimulate specific sites of the spinal cord to produce discrete motor behaviors in spinal rats using this array. Methods We have designed a chronically implantable, rapidly switchable, high-density platinum based multi-electrode array that can be used to stimulate at 1100Hz and 110V in both monopolar and bipolar configurations to examine the electrophysiological and behavioral effects of spinal cord epidural stimulation in complete spinal cord transected rats. Results In this paper, we have demonstrated the effectiveness of using high-resolution stimulation parameters in the context of improving motor recovery after a spinal cord injury. We observed that rats whose hindlimbs were paralyzed can stand and step when specific sets of electrodes of the array are stimulated tonically (40Hz). Distinct patterns of stepping and standing were produced by stimulation of different combinations of electrodes on the array located at specific spinal cord levels and by specific stimulation parameters, i.e., stimulation frequency and intensity, and cathode/anode orientation. The array also was used to assess functional connectivity between the cord dorsum to interneuronal circuits and specific motor pools via evoked potentials induced at 1Hz stimulation in the absence of any anesthesia. Conclusions Therefore the high density electrode array allows high spatial resolution and the ability to selectively activate different neural pathways within the lumbosacral region of the spinal cord to facilitate standing and stepping in adult spinal rats and provides the capability to evoke motor potentials and thus a means for assessing connectivity between sensory circuits and specific motor pools and muscles. PMID:23336733

  6. Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord

    NASA Astrophysics Data System (ADS)

    Sharpe, Abigail N.; Jackson, Andrew

    2014-02-01

    Objective. Electrical stimulation of the spinal cord has potential applications following spinal cord injury for reanimating paralysed limbs and promoting neuroplastic changes that may facilitate motor rehabilitation. Here we systematically compare the efficacy, selectivity and frequency-dependence of different stimulation methods in the cervical enlargement of anaesthetized monkeys. Approach. Stimulating electrodes were positioned at multiple epidural and subdural sites on both dorsal and ventral surfaces, as well as at different depths within the spinal cord. Motor responses were recorded from arm, forearm and hand muscles. Main results. Stimulation efficacy increased from dorsal to ventral stimulation sites, with the exception of ventral epidural electrodes which had the highest recruitment thresholds. Compared to epidural and intraspinal methods, responses to subdural stimulation were more selective but also more similar between adjacent sites. Trains of stimuli delivered to ventral sites elicited consistent responses at all frequencies whereas from dorsal sites we observed a mixture of short-latency facilitation and long-latency suppression. Finally, paired stimuli delivered to dorsal surface and intraspinal sites exhibited symmetric facilitatory interactions at interstimulus intervals between 2-5 ms whereas on the ventral side interactions tended to be suppressive for near-simultaneous stimuli. Significance. We interpret these results in the context of differential activation of afferent and efferent roots and intraspinal circuit elements. In particular, we propose that distinct direct and indirect actions of spinal cord stimulation on motoneurons may be advantageous for different applications, and this should be taken into consideration when designing neuroprostheses for upper-limb function.

  7. Neuroprotective effect of epidural hypothermia after spinal cord lesion in rats

    PubMed Central

    Barbosa, Marcello Oliveira; Cristante, Alexandre Fogaa; dos Santos, Gustavo Bispo; Ferreira, Ricardo; Marcon, Raphael Martus; de Barros Filho, Tarcisio Eloy Pessoa

    2014-01-01

    OBJECTIVES : To evaluate the neuroprotective effect of epidural hypothermia in rats subjected to experimental spinal cord lesion. METHODS: Wistar rats (n?=?30) weighing 320-360 g were randomized to two groups (hypothermia and control) of 15 rats per group. A spinal cord lesion was induced by the standardized drop of a 10-g weight from a height of 2.5 cm, using the New York University Impactor, after laminectomy at the T9-10 level. Rats in the hypothermia group underwent epidural hypothermia for 20 minutes immediately after spinal cord injury. Motor function was assessed for six weeks using the Basso, Beattie and Bresnahan motor scores and the inclined plane test. At the end of the final week, the rats' neurological status was monitored by the motor evoked potential test and the results for the two groups were compared. RESULTS: Analysis of the Basso, Beattie and Bresnahan scores obtained during the six-week period indicated that there were no significant differences between the two groups. There was no significant difference between the groups in the inclined plane test scores during the six-week period. Furthermore, at the end of the study, the latency and amplitude values of the motor evoked potential test were not significantly different between the two groups. CONCLUSION: Hypothermia did not produce a neuroprotective effect when applied at the injury level and in the epidural space immediately after induction of a spinal cord contusion in Wistar rats. PMID:25141116

  8. Epidural spinal compression as an initial presentation of Hodgkin lymphoma.

    PubMed

    Abu-Bonsrah, Nancy; Boah, Akwasi Ofori; Goodwin, C Rory; Larman, Tatianna; Crane, Genevieve M; Sciubba, Daniel M

    2016-04-01

    Classical Hodgkin lymphoma (CHL) commonly arises in lymph nodes and initial presentation with extranodal disease is rare. We report a patient who presented with progressively worsening back pain, lower extremity weakness and numbness concerning for a myelopathic process of uncertain etiology. MRI revealed an epidural soft tissue mass with cord displacement, for which she underwent resection. Histological analysis of the surgical specimen demonstrated CHL. Further investigation revealed an anterior mediastinal mass, consistent with spread from a more typical location. PMID:26723857

  9. Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis

    PubMed Central

    Liu, Kuan; Liu, Pengcheng; Liu, Run; Wu, Xing; Cai, Ming

    2015-01-01

    Purpose To investigate the effectiveness and safety of epidural steroid injections in patients with lumbar spinal stenosis (LSS). Methods We performed a search on the CENTRAL, Pubmed, Embase and Cochrane databases up to September 2014. We recovered 17 original articles, of which only 10 were in full compliance with the randomized controlled trial (RCT) criteria. These articles were reviewed in an independent and blinded way by two reviewers who were previously trained to extract data and score their quality by the criteria of the Cochrane Handbook (5.1.0). Results We accepted ten studies with 1,010 participants. There is minimal evidence that shows that epidural steroid injections are better than lidocaine alone, regardless of the mode of epidural injection. There is a fair short-term and long-term benefit for treating spinal stenosis with local anesthetic and steroids. Conclusions This meta-analysis suggests that epidural steroid injections provide limited improvement in short-term and long-term benefits in LSS patients. PMID:25678775

  10. Spinal Epidural Hematoma After Thrombolysis for Deep Vein Thrombosis with Subsequent Pulmonary Thromboembolism: A Case Report

    SciTech Connect

    Han, Young-Min Kwak, Ho-Sung; Jin, Gong-Young; Chung, Gyung-Ho; Song, Kyung-Jin

    2006-06-15

    A 38-year-old male was initially admitted for left leg swelling. He was diagnosed as having deep vein thrombosis (DVT) in the left leg and a pulmonary thromboembolism by contrast-enhanced chest computed tomography (CT) with delayed lower extremity CT. The DVT was treated by thrombolysis and a venous stent. Four hours later, he complained of severe back pain and a sensation of separation of his body and lower extremities; he experienced paraplegia early in the morning of the following day. Magnetic resonance imaging showed a spinal epidural hematoma between T11 and L2, which decompressed following surgery. We, therefore, report a case of a spinal epidural hematoma after thrombolysis in a case of DVT with a pulmonary thromboembolism.

  11. Descending volleys generated by efficacious epidural motor cortex stimulation in patients with chronic neuropathic pain.

    PubMed

    Lefaucheur, Jean-Pascal; Holsheimer, Jan; Goujon, Colette; Keravel, Yves; Nguyen, Jean-Paul

    2010-06-01

    Epidural motor cortex stimulation (EMCS) is a therapeutic option for chronic, drug-resistant neuropathic pain, but its mechanisms of action remain poorly understood. In two patients with refractory hand pain successfully treated by EMCS, the presence of implanted epidural cervical electrodes for spinal cord stimulation permitted to study the descending volleys generated by EMCS in order to better appraise the neural circuits involved in EMCS effects. Direct and indirect volleys (D- and I-waves) were produced depending on electrode polarity and montage and stimulus intensity. At low-intensity, anodal monopolar EMCS generated D-waves, suggesting direct activation of corticospinal fibers, whereas cathodal EMCS generated I2-waves, suggesting transsynaptic activation of corticospinal tract. The bipolar electrode configuration used in chronic EMCS to produce maximal pain relief generated mostly I3-waves. This result suggests that EMCS induces analgesia by activating top-down controls originating from intracortical horizontal fibers or interneurons but not by stimulating directly the pyramidal tract. The descending volleys elicited by bipolar EMCS are close to those elicited by transcranial magnetic stimulation using a coil with posteroanterior orientation. Different pathways are activated by EMCS according to stimulus intensity and electrode montage and polarity. Special attention should be paid to these parameters when programming EMCS for pain treatment. PMID:20188091

  12. Sudden Sensorineural Hearing Loss after Orthopedic Surgery under Combined Spinal and Epidural Anesthesia

    PubMed Central

    Vilhena, Ditza; Pereira, Lus; Duarte, Delfim; Oliveira, Nuno

    2016-01-01

    Postoperative hearing loss following nonotologic surgery is rare. For patients undergoing subarachnoid anesthesia, the loss of cerebral spinal fluid and hence the drop in intracranial pressure can result in hearing loss and cranial nerve palsy. We report a case in which a patient sustained orthopedic surgery under combined spinal and epidural anesthesia complicated by severe and persistent sensorineural hearing loss. This report is a reminder that postoperative sudden sensorineural hearing loss is a poorly understood complication. A high index of suspicion is required for early diagnosis of this complication, although prompt treatment does not guarantee a good outcome. PMID:26904339

  13. Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord

    PubMed Central

    Sharpe, Abigail N; Jackson, Andrew

    2014-01-01

    Objective Electrical stimulation of the spinal cord has potential applications following spinal cord injury for reanimating paralysed limbs and promoting neuroplastic changes that may facilitate motor rehabilitation. Here we systematically compare the efficacy, selectivity and frequency-dependence of different stimulation methods in the cervical enlargement of anaesthetized monkeys. Approach Stimulating electrodes were positioned at multiple epidural and subdural sites on both dorsal and ventral surfaces, as well as at different depths within the spinal cord. Motor responses were recorded from arm, forearm and hand muscles. Main results Stimulation efficacy increased from dorsal to ventral stimulation sites, with the exception of ventral epidural electrodes which had the highest recruitment thresholds. Compared to epidural and intraspinal methods, responses to subdural stimulation were more selective but also more similar between adjacent sites. Trains of stimuli delivered to ventral sites elicited consistent responses at all frequencies whereas from dorsal sites we observed a mixture of short-latency facilitation and long-latency suppression. Finally, paired stimuli delivered to dorsal surface and intraspinal sites exhibited symmetric facilitatory interactions at interstimulus intervals between 25 ms whereas on the ventral side interactions tended to be suppressive for near-simultaneous stimuli. Significance We interpret these results in the context of differential activation of afferent and efferent roots and intraspinal circuit elements. In particular, we propose that distinct direct and indirect actions of spinal cord stimulation on motoneurons may be advantageous for different applications, and this should be taken into consideration when designing neuroprostheses for upper-limb function. PMID:24654267

  14. Fentanyl versus tramadol with levobupivacaine for combined spinal-epidural analgesia in labor

    PubMed Central

    Chatrath, Veena; Khetarpal, Ranjana; Sharma, Sujata; Kumari, Pratibha; Sudha; Bali, Kusum

    2015-01-01

    Background: Neuraxial labor analgesia using new local anesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Combined spinal-epidural analgesia (CSEA) has become the preferred method for labor analgesia as it combines benefits of both spinal analgesia and flexibility of the epidural catheter. Adding opioids to local anesthetic drugs provide rapid onset and prolonged analgesia but may be associated with several maternal and fetal adverse effects. The purpose of this study is to compare fentanyl and tramadol used in CSEA in terms of duration of analgesia and frequency of the adverse fetomaternal outcome. Materials and Methods: A total of 60 primiparas with a singleton pregnancy in active labor were given CSEA after randomly allocating them in two groups of 30 each. Group I received intrathecal 2.5 mg levobupivacaine + 25 ?g fentanyl followed by epidural top ups of 20 ml 0.125% solution of the same combination. Group II received 25 mg tramadol instead of fentanyl. Epidural top ups were given when parturient complained of two painful contractions (visual analogue scale ? 4). Data collected were demographic profile of the patients, analgesic qualities, side- effects and the fetomaternal outcome. Results: Patients in Group II had significantly prolonged analgesia (145 9 minutes) than in Group I (95 7 minutes). Patients receiving fentanyl showed rapid onset of analgesia, but there were more incidence of side-effects like shivering, pruritus, transient fetal bradycardia, hypotension, nausea and vomiting. Only side-effect in the tramadol group was nausea and vomiting. During labor, maternal satisfaction was excellent. Conclusions: Adding tramadol to local anesthetic provides prolonged analgesia with minimal side effects. Fentanyl, when used as adjuvant to local anesthetic, has a rapid onset of analgesia but has certain fetomaternal side-effects. PMID:26240543

  15. Dorsal spinal epidural psammomatous meningioma in an adult male

    PubMed Central

    Pandey, Sharad; Singh, Kulwant; Sharma, Vivek; Ghosh, Amrita; Suman, Saurabh

    2016-01-01

    Meningiomas are benign in nature and arise from the arachnoid cells. They are mostly situated in the intracranial compartment, whereas spinal meningiomas are rare. Approximately, in 10% of cases, an extradural component is seen but an exclusively extradural meningioma is quite uncommon. However, WHO Grade II (atypical) and Grade III (anaplastic) tumors can behave aggressively. We reported a case of purely extradural psammomatous meningioma in an adult male affecting the dorsal spine although uncommon meningiomas should be included in the differential diagnosis of extradural intraspinal masses. PMID:26933358

  16. Dorsal spinal epidural psammomatous meningioma in an adult male.

    PubMed

    Pandey, Sharad; Singh, Kulwant; Sharma, Vivek; Ghosh, Amrita; Suman, Saurabh

    2016-01-01

    Meningiomas are benign in nature and arise from the arachnoid cells. They are mostly situated in the intracranial compartment, whereas spinal meningiomas are rare. Approximately, in 10% of cases, an extradural component is seen but an exclusively extradural meningioma is quite uncommon. However, WHO Grade II (atypical) and Grade III (anaplastic) tumors can behave aggressively. We reported a case of purely extradural psammomatous meningioma in an adult male affecting the dorsal spine although uncommon meningiomas should be included in the differential diagnosis of extradural intraspinal masses. PMID:26933358

  17. Endovascular coil embolization of a spinal epidural arteriovenous fistula with associated cord compression from an enlarging venous varix.

    PubMed

    Ding, Dale; Starke, Robert M; Manka, David; Crowley, R Webster; Liu, Kenneth C

    2015-12-01

    Spinal arteriovenous fistulas (AVFs) completely isolated to the epidural compartment are exceedingly rare. As such, the optimal management of these lesions is poorly defined. The aim of this technical note is to describe our endovascular technique for the occlusion of a purely epidural AVF of the thoracic spine associated with cord compression from an associated enlarging venous varix. A 40-year-old male presented with severe right-sided back pain and anterior thigh numbness after a sports-related back injury six months previously. Spinal magnetic resonance imaging (MRI) showed an enhancing, extradural mass lesion at T12. Spinal angiography revealed an epidural AVF supplied by a radicular branch of the right T12 subcostal artery and draining into the paravertebral lumbar veins, as well as an adjacent 20??13?mm(2) contrast-filling sac, compatible with a dilated venous varix. There was no evidence of intradural venous drainage. We elected to proceed with endovascular treatment of the lesion. At the time of embolization five days later, the venous varix had enlarged to 26??16?mm(2). The T12 epidural AVF was completely occluded with two coils, without residual or recurrent AVF on follow-up angiography one month later. The patient made a full recovery, and complete resolution of the venous varix and cord compression were noted on MRI at three months follow-up. Endovascular coil embolization can be successfully employed for the treatment of appropriately selected spinal epidural AVFs. Cord compression from an enlarging venous varix can be treated concurrently with endovascular occlusion of an associated spinal epidural AVF. PMID:26464290

  18. Activation of spinal locomotor circuits in the decerebrated cat by spinal epidural and/or intraspinal electrical stimulation.

    PubMed

    Lavrov, Igor; Musienko, Pavel E; Selionov, Victor A; Zdunowski, Sharon; Roy, Roland R; Edgerton, V Reggie; Gerasimenko, Yury

    2015-03-10

    The present study was designed to further compare the stepping-like movements generated via epidural (ES) and/or intraspinal (IS) stimulation. We examined the ability to generate stepping-like movements in response to ES and/or IS of spinal lumbar segments L1-L7 in decerebrate cats. ES (5-10 Hz) of the dorsal surface of the spinal cord at L3-L7 induced hindlimb stepping-like movements on a moving treadmill belt, but with no rhythmic activity in the forelimbs. IS (60 Hz) of the dorsolateral funiculus at L1-L3 (depth of 0.5-1.0mm from the dorsal surface of the spinal cord) induced quadrupedal stepping-like movements. Forelimb movements appeared first, followed by stepping-like movements in the hindlimbs. ES and IS simultaneously enhanced the rhythmic performance of the hindlimbs more robustly than ES or IS alone. The differences in the stimulation parameters, site of stimulation, and motor outputs observed during ES vs. IS suggest that different neural mechanisms were activated to induce stepping-like movements. The effects of ES may be mediated more via dorsal structures in the lumbosacral region of the spinal cord, whereas the effects of IS may be mediated via more ventral propriospinal networks and/or brainstem locomotor areas. Furthermore, the more effective facilitation of the motor output during simultaneous ES and IS may reflect some convergence of pathways on the same interneuronal populations involved in the regulation of locomotion. PMID:25446455

  19. Dexamethasone added to Local Lidocaine for Infiltration along the Spinal-Epidural Needle Pathway Decreases Incidence and Severity of Backache after Gynecological Surgery

    PubMed Central

    Gao, Wei; Ren, Yi; Cui, Guang Xiao

    2015-01-01

    Background The aim of this study was to evaluate the effect of dexamethasone added to local lidocaine infiltration on incidence and severity of backache after combined spinal-epidural anesthesia for gynecological surgery. Material/Methods We randomly allocated 160 patients to receive either local lidocaine infiltration along the pathway of the spinal-epidural needle (Group L) or local dexamethasone and lidocaine infiltration (Group DL). The incidence and scores for back pain were evaluated on the first, second, and third day (acute lumbago) and first, second, and sixth month (chronic lumbago) after surgery. Fentanyl consumption for management of back pain was recorded. Results The incidence of acute, subacute, and chronic back pain was significantly lower in the DL group than the L group (P<0.05 for all comparisons). The VAS score for back pain on the first and second day and first and second month, were significantly lower in the DL group than the L group (P=0.0028, P=0.017; P<0.001, both), but there were no significant differences on the third day and sixth month. Fentanyl consumption in the first 3 postoperative days was significantly lower in the DL group than in the L group (P<0.001). The incidence of back pain during the first, second, and sixth month in patients who did not have preoperative lumbago were significantly lower in the DL group than in the L group (P<0.001, both). Conclusions Addition of dexamethasone to local lidocaine infiltration effectively decreases the incidence and severity of back pain after combined spinal-epidural anesthesia implemented for gynecological surgery. PMID:25785683

  20. A Fully Implantable Stimulator With Wireless Power and Data Transmission for Experimental Investigation of Epidural Spinal Cord Stimulation.

    PubMed

    Xu, Qi; Hu, Dingyin; Duan, Bingyu; He, Jiping

    2015-07-01

    Epidural spinal cord stimulation (ESCS) combined with partial weight-bearing therapy (PWBT) has been shown to facilitate recovery of functional walking for individuals after spinal cord injury (SCI). The investigation of neural mechanisms of recovery from SCI under this treatment has been conducted broadly in rodent models, yet a suitable ESCS system is still unavailable. This paper describes a practical, programmable, and fully implantable stimulator for laboratory research on rats to explore fundamental neurophysiological principles for functional recovery after SCI. The ESCS system is composed of a personal digital assistant (PDA), an external controller, an implantable pulse generator (IPG), lead extension, and stimulating electrodes. The stimulation parameters can be programmed and adjusted through a graphical user interface on the PDA. The external controller is placed on the rat back and communicates with the PDA via radio-frequency (RF) telemetry. An RF carrier from the class-E power amplifier in the external controller provides both data and power for the IPG through an inductive link. The IPG is built around a microcontroller unit to generate voltage-regulated pulses delivered to the bipolar electrode for ESCS in rats. The encapsulated IPG measures 22 mm 23 mm 7 mm with a mass of ? 3.78 g. This fully implantable batteryless stimulator provided a simplified and efficient method to carry out chronic experiments in untethered animals for medical electro-neurological research. PMID:25680207

  1. Surgical Management of Cervical Spinal Epidural Abscess Caused by Brucella Melitensis : Report of Two Cases and Review of the Literature

    PubMed Central

    zbek, Zht; Gko?lu, Abdlkerim; Menk, Ahmet

    2012-01-01

    Spinal epidural abscess, if especially caused by Brucellosis is a very rare disease which is usually a consequence of spondylodiscitis. The spinal column can be affected at any joint; however, the lumbar spine is the most common region, especially at the level of the L4-5 and L5-S1. The frequency of spinal involvement usually seen at the lumbar, thoracic and cervical spine respectively. As an occupational disease in farmers, veterinaries, butchers, laboratory staff and shepherds, brucellosis can also occur by direct contact to animals and infected materials or ingestion of raw cheese, milk or unpasteurized milk products. In this study, we presented two cases with cervical spinal epidural abscess caused by brucella melitensis, which was successfully treated by surgical approach. Initial treatment was combined with antibiotic therapy after the surgery for 3 months. PMID:22949972

  2. Multimodal Approach to the Management of Metastatic Epidural Spinal Cord Compression (MESCC) Due to Solid Tumors

    SciTech Connect

    Tancioni, Flavio; Navarria, Pierina; Lorenzetti, Martin A.; Pedrazzoli, Paolo; Masci, Giovanna; Mancosu, Pietro; Alloisio, Marco; Morenghi, Emanuela; Santoro, Armando; Rodriguez y Baena, Riccardo; Scorsetti, Marta

    2010-12-01

    Purpose: To assess the impact of a multidisciplinary approach for treatment of patients with metastatic epidural spinal cord compression in terms of feasibility, local control, and survival. Methods and Materials: Eighty-nine consecutive patients treated between January 2004 and December 2007 were included. The most common primary cancers were lung, breast, and kidney cancers. Ninety-eight surgical procedures were performed. Radiotherapy was performed within the first month postoperatively. Clinical outcome was evaluated by modified visual analog scale for pain, Frankel scale for neurologic deficit, and magnetic resonance imaging or computed tomography scan. Nearly all patients (93%) had back pain before treatment, whereas major or minor preoperative neurologic deficit was present in 62 cases (63%). Results: Clinical remission of pain was obtained in the vast majority of patients (91%). Improvement of neurologic deficit was observed in 45 cases (72.5%). Local relapse occurred in 10%. Median survival was 11 months (range, 0-46 months). Overall survival at 1 year was 43.6%. Type of primary tumor significantly affected survival. Conclusions: In patients with metastatic epidural spinal cord compression, the combination of surgery plus radiotherapy is feasible and provides clinical benefit in most patients. The discussion of each single case within a multidisciplinary team has been of pivotal importance in implementing the most appropriate therapeutic approach.

  3. Lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a diabetic patient.

    PubMed

    Vallianou, N; Gounari, P; Skourtis, A; Kougias, M; Sioula, E

    2013-10-01

    Pyomyositis is a rarely encountered infection among diabetics, which usually affects lower extremities. Herein, we present a case of lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a patient with poorly controlled diabetes mellitus. PMID:24041607

  4. Treatment of inoperable coronary disease and refractory angina: spinal stimulators, epidurals, gene therapy, transmyocardial laser, and counterpulsation.

    PubMed

    Svorkdal, Nelson

    2004-03-01

    Intractable angina from refractory coronary disease is a severe form of myocardial ischemia for which revascularization provides no prognostic benefit. Inoperable coronary disease is also accompanied by a "vicious cycle" of myocardial dystrophy from a chronic alteration of the cardiac sympathetic tone and sensitization of damaged cardiac tissues. Several adjunctive treatments have demonstrated efficacy when revascularization is either unsuccessful or contraindicated. Spinal cord stimulation modifies the neurologic input and output of the heart by delivering a very low dose of electrical current to the dorsal columns of the high thoracic spinal cord. Neural fibers then release CGRP and other endogenous peptides to the coronary circulation reducing myocardial oxygen demand and enhancing vasodilation of collaterals to improve the myocardial blood flow of the most diseased regions of the heart. Randomized study has shown the survival data at five years is comparable to bypass for high-risk patients. Transmyocardial laser revascularization creates small channels into ischemic myocardium in an effort to enhance flow though studies have shown no improvement in prognosis over medical therapy alone. Enhanced external counterpulsation uses noninvasive pneumatic compression of the legs to improve diastolic filling of the coronary vessels and promote development of collateral flow. The compressor regimen requires thirty-five hours of therapy over a seven-week treatment period. Therapeutic angiogenesis requires injection of cytokines to promote neovascularization and improve myocardial perfusion into the regions affected by chronic ischemia. Phase 3 trials are pending. High thoracic epidural blockade produces a rapid and potent sympatholysis, coronary vasodilation and reduced myocardial oxygen demand in refractory coronary disease. This technique can be used as an adjunct to bypass surgery or medical therapy in chronic or acute unstable angina. Epidurals are easy to perform and often available for outpatient or inpatient use. The rapid anti-ischemic effect may complement therapeutic angiogenesis or other interventions with delayed onset to clinical benefit. A new era for interventional and implant cardiology is beginning to emerge as more clinicians, including cardiologists, gradually learn new procedures to safely provide more therapeutic options for patients suffering refractory angina. PMID:15372127

  5. CHRONIC PAIN FOLLOWING SPINAL CORD INJURY

    PubMed Central

    Masri, Radi; Keller, Asaf

    2013-01-01

    Most patients with insults to the spinal cord or central nervous system suffer from excruciating, unrelenting, chronic pain that is largely resistant to treatment. This condition affects a large percentage of spinal cord injury patients, and numerous patients with multiple sclerosis, stroke and other conditions. Despite the recent advances in basic science and clinical research the pathophysiological mechanisms of pain following spinal cord injury remain unknown. Here we describe a novel mechanism of loss of inhibition within the thalamus that may predispose for the development of this chronic pain and discuss a potential treatment that may restore inhibition and ameliorate pain. PMID:23281514

  6. Combined spinal-epidural anesthesia for lumbar discectomy in a patient with asymptomatic severe aortic stenosis: a case report

    PubMed Central

    Kim, Young Sung; Park, Ji Hye; Lee, Shin Young; Kim, Heezoo; Lee, Il-ok; Kong, Myoung-Hoon

    2014-01-01

    The use of neuraxial anesthesia has traditionally been contraindicated in patients with severe aortic stenosis. However, general anesthesia can be riskier than neuraxial anesthesia for severe aortic stenosis patients undergoing spinal surgeries in the prone position as this can cause a major reduction in cardiac output secondary to diminished preload. In addition, general anesthesia, muscle relaxation, and positive-pressure ventilation can decrease venous return and reduce vascular tone, further compromising cardiac output. Combined spinal-epidural anesthesia with closely monitored, careful titration of the local anesthetic dose can be an efficient and safe anesthetic method for managing such patients. We describe the successful management of combined spinal-epidural anesthesia in an asymptomatic severe aortic stenosis patient scheduled for lumbar discectomy. PMID:25237450

  7. Cervical spinal cord injection of epidural corticosteroids; comprehensive longitudinal study including multiparametric MRI

    PubMed Central

    Cohen-Adad, Julien; Buchbinder, Bradley; Oaklander, Anne Louise

    2012-01-01

    Despite widespread use, the efficacy of epidural corticosteroid injections (ESI) for osteoarthritis-associated neck or radicular pain remains uncertain, so even rare serious complications enter into discussions about use. However various factors impede investigation and publication of serious adverse events. To that end, we developed new magnetic resonance imaging (MRI) techniques for spinal cord white-matter quantification and employed best-available physiological tests to characterize a cervical spinal cord lesion caused by inadvertent intramedullary injection of Depo-Medrol. A 29-year-old woman with mild cervical osteoarthritis had 2 years of headache and neck pain (concussion and whiplash) after two minor motor-vehicle accidents. During C56 ESI, she developed new left-sided motor and sensory symptoms and MRI demonstrated a new left dorsal spinal cord cavity. Mild left-sided motor and sensory symptoms have persisted for more than 2 years, during which time we performed serial neurological examinations, standard electrodiagnostics, somatosensory evoked potentials, and transcranial measurement of corticospinal central motor conduction time (CMCT). We used 3 tesla MRI with a 32-channel coil developed for high-resolution cervical spinal cord structural imaging, diffusion tensor imaging (DTI) and magnetization transfer (MT). T2*-weighted signal, DTI and MT metrics showed delayed spread of the lesion across four vertebral levels rostrally, consistent with Wallerian degeneration within the ascending left dorsal columns. However only CMCT metrics detected objective correlates of her left hemiparesis and bilateral hyperreflexia. DTI and MT metrics may better distinguish between post-traumatic demyelination and axonal degeneration than conventional MRI. These tests should be considered to better characterize similar spinal cord injuries. PMID:22964435

  8. [Combined rehabilitation treatment of patients with spinal dystrophy using epidural pharmacotherapy].

    PubMed

    Likhachev, M Iu; Razumov, A N; Sidorov, V D

    2004-01-01

    The article presents the results of treatment of 70 patients with spinal lumbosacral dystrophy complicated by dislocation of the intervertebral disks. All the patients had long-term history of the disease and exacerbation resistant to conservative treatment. Later, this treatment was changed for epidural long-term local pharmacotherapy (ELLP). The effect of this treatment was assessed by changes in pain syndrome in early and long-term periods, in MRT and CT images. ELLP proved effective as the response reached 83.2%. The maximal 95% response was achieved in combined treatment: ELLP + physio-, balneo-, kinesitherapy, massage. MRT and CT image dynamics show that pathological substrate disappears or significantly decreases in size in 83.4% cases. PMID:15216786

  9. Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy.

    PubMed Central

    Rickford, J. K.; Speedy, H. M.; Tytler, J. A.; Lim, M.

    1988-01-01

    The results of a prospective randomised evaluation of general anaesthesia (GA), epidural anaesthesia (EA) and spinal anaesthesia (SA) for extracorporeal shockwave lithotripsy are presented. GA provided speed and reliability but resulted in a high incidence of postoperative nausea, vomiting and sore throat. Both regional techniques conferred the advantages of an awake, cooperative patient, but EA required a longer preparation time than SA and more supplementary treatment with fentanyl or midazolam. A major drawback associated with the use of SA was a 42% incidence of postspinal headache. All three techniques were associated with hypotension on placement in the hoisl; bath immersion resulted in significant rises in blood pressure in the EA and SA groups and a more variable (overall non-significant) response in the GA group. PMID:3044238

  10. Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression

    SciTech Connect

    Thomas, Kenneth C.; Nosyk, Bohdan; Fisher, Charles G.; Dvorak, Marcel; Patchell, Roy A.; Regine, William F.; Loblaw, Andrew; Bansback, Nick; Guh, Daphne; Sun, Huiying; Anis, Aslam . E-mail: aslam.anis@ubc.ca

    2006-11-15

    Purpose: A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches. Methods and Materials: In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death. In this study, an incremental cost-effectiveness analysis was performed from a societal perspective. Costs related to treatment and posttreatment care were estimated and extended to the lifetime of the cohort. Weibull regression was applied to extrapolate outcomes in the presence of censored clinical effectiveness data. Results: From a societal perspective, the baseline incremental cost-effectiveness ratio (ICER) was found to be $60 per additional day of ambulation (all costs in 2003 Canadian dollars). Using probabilistic sensitivity analysis, 50% of all generated ICERs were lower than $57, and 95% were lower than $242 per additional day of ambulation. This analysis had a 95% CI of -$72.74 to 309.44, meaning that this intervention ranged from a financial savings of $72.74 to a cost of $309.44 per additional day of ambulation. Using survival as the measure of effectiveness resulted in an ICER of $30,940 per life-year gained. Conclusions: We found strong evidence that treatment of metastatic epidural spinal cord compression with surgery in addition to radiotherapy is cost-effective both in terms of cost per additional day of ambulation, and cost per life-year gained.

  11. Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection

    PubMed Central

    Kim, Myungsoo

    2015-01-01

    Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma. PMID:26361532

  12. Can We Prevent a Postoperative Spinal Epidural Hematoma by Using Larger Diameter Suction Drains?

    PubMed Central

    Kim, Jin Hak; Chang, Byung Kwon; Lee, Jae Il

    2016-01-01

    Background Epidural hematoma is a rare but serious complication. According to previous studies, it is not prevented by suction drains. This study evaluated the following alternative hypothesis: the larger the diameter of a suction drain, the less the remaining epidural hematoma after spinal surgery. Methods This was a randomized prospective study. Patients who underwent posterior lumbar decompression and instrumented fusion were divided into two groups: the large drain (LD, 2.8-mm-diameter tube) and small drain (SD, 1.6-mm-diameter tube) groups according to the diameter of the suction drains. All patients were consecutive and allocated alternately according to the date of operations. Suction drains were removed on day 3 and magnetic resonance imaging was performed on day 7 postoperatively. The size of remaining hematomas was measured by the degree of thecal sac compression in cross section using the following 4-point numeric scale: G1, less than one quarter; G2, between one quarter and half; G3, more than half; and G4, more than subtotal obstruction. Results There were 39 patients with LDs and 38 with SDs. They did not differ significantly in terms of sex, number of fusion segments, revision or not, antiplatelet medication, intraoperative injection of tranexamic acid. However, patient age differed significantly between the two groups (LD, 63.3 years and < SD, 68.6 years; p = 0.007). The two groups did not differ significantly in terms of prothrombin time, activated partial thromboplastin time, platelet number, blood loss, or operation duration. However, platelet function analysis exhibited a significant difference (LD, 164.7 seconds and < SD, 222.3 seconds; p = 0.002). The two blinded readers showed high consistency (Kappa value = 0.740; p = 0.000). The results of reader 1 were as follows: LD and SD had 21 and 21 cases of G1, 9 and 11 cases of G2, 6 and 6 cases of G3, and 3 and 0 cases of G4, respectively. The results of reader 2 were as follows: LD and SD had 22 and 23 cases of G1, 7 and 9 cases of G2, 7 and 6 cases of G3, and 3 and 0 cases of G4, respectively. There was no difference between the two groups (reader 1, p = 0.636; reader 2, p = 0.466). Conclusions The alternative hypothesis was rejected. Therefore, postoperative spinal epidural hematoma would not be prevented by LD. PMID:26929803

  13. Treatment of Spinal Epidural Abscess and Predisposing Factors of Motor Weakness: Experience with 48 Patients

    PubMed Central

    Ju, Min-Wook; Kwon, Hyon-Jo; Kim, Seon-Hwan; Koh, Hyeon-Song; Youm, Jin-Young; Song, Shi-Hun

    2015-01-01

    Objective Spinal epidural abscess (SEA) can be fatal if untreated, so early diagnosis and treatment are essential. We conducted a retrospective study to define its clinical features and evaluate the risk factors of motor weakness. Methods We retrospectively analyzed the medical records and images of patients with SEA who had been hospitalized in our institute from January 2005 to June 2012. Pyogenic SEA patients were categorized as patients without motor weakness (Group A) and with motor weakness (Group B). Abscess volume was measured using the Gamma-Plan program. Intervertebral foramen height and posterior disc height were measured to evaluate degree of spinal stenosis. Results Of 48 patients with pyogenic SEA, 33 (68%) were treated surgically, and 15 (32%) were treated with antibiotics. Eleven patients had weakness and abscess volume was unrelated to motor weakness. Old age, 'spare room' (abscess volume subtracted from spinal volume) and intervertebral foramen height and posterior disc height were statistically significant. Among the 48 patients, 43 (85%) had good outcome and erythrocyte sedimentation rate (ESR) was the only meaningful prognostic factor (p=0.014). The cut-off value of ESR was 112mm/h with 80% sensitivity and 79% specificity and had borderline significance (p=0.062). Conclusion SEA needs emergent diagnosis and treatment. Motor weakness is the most important factor in treatment decision. By careful image reading, early surgical treatment can be an option for selected patients with severe spinal stenosis for prevent motor weakness. Inflammatory markers, especially ESR, are valuable to identify worsening of SEA. PMID:26512265

  14. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

    PubMed Central

    Mehta, Nandita; Gupta, Sunana; Sharma, Atul; Dar, Mohd Reidwan

    2015-01-01

    Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. PMID:26664202

  15. Epidural Hematoma Complication after Rapid Chronic Subdural Hematoma Evacuation: A Case Report

    PubMed Central

    Akpinar, Aykut; Ucler, Necati; Erdogan, Uzay; Yucetas, Cem Seyho

    2015-01-01

    Patient: Male, 41 Final Diagnosis: Healty Symptoms: Headache Medication: Clinical Procedure: Chronic subdural hematoma Specialty: Neurosurgery Objective: Diagnostic/therapeutic accidents Background: Chronic subdural hematoma generally occurs in the elderly. After chronic subdural hematoma evacuation surgery, the development of epidural hematoma is a very rare entity. Case Report: We report the case of a 41-year-old man with an epidural hematoma complication after chronic subdural hematoma evacuation. Under general anesthesia, the patient underwent a large craniotomy with closed system drainage performed to treat the chronic subdural hematoma. After chronic subdural hematoma evacuation, there was epidural leakage on the following day. Conclusions: Although trauma is the most common risk factor in young CSDH patients, some other predisposing factors may exist. Intracranial hypotension can cause EDH. Craniotomy and drainage surgery can usually resolve the problem. Because of rapid dynamic intracranial changes, epidural leakages can occur. A large craniotomy flap and silicone drainage in the operation area are key safety points for neurosurgeons and hydration is essential. PMID:26147957

  16. A fully implanted programmable stimulator based on wireless communication for epidural spinal cord stimulation in rats.

    PubMed

    Zhou, Hui; Xu, Qi; He, Jiping; Ren, Hangkong; Zhou, Houlun; Zheng, Kejia

    2012-03-15

    Clinical research indicates that the epidural spinal cord stimulation (ESCS) has shown potential in promoting locomotor recovery in patients with incomplete spinal cord injury (ISCI). This paper presents the development of a fully implantable voltage-regulated stimulator with bi-directional wireless communication for investigating underlying neural mechanisms of ESCS facilitating motor function improvement. The stimulation system consists of a computer, an external controller, an implantable pulse generator (IPG), a magnet, the extension leads and a stimulation electrode. The telemetry transmission between the IPG and the external controller is achieved by a commercially available transceiver chip with 2.4GHz carrier band. The magnet is used to activate the IPG only when necessary to minimize the power consumption. The encapsulated IPG measures 33mm24mm8mm, with a total mass of ?12.6g. Feasibility experiments are conducted in three Sprague-Dawley rats to validate the function of the stimulator, and to investigate the relationship between lumbar-sacral ESCS and hindlimb electromyography (EMG) responses. The results show that the stimulation system provides an effective tool for investigation of ESCS application in motor function recovery in small animals. PMID:22085835

  17. Delayed diagnosis of cauda eqina syndrome with perineural cyst after combined spinal-epidural anesthesia in hemodialysis patient.

    PubMed

    Ishiguro, Shigeo; Akeda, Koji; Tsujii, Masaya; Sudo, Akihiro

    2013-09-01

    Symptomatic Tarlov (perineural cysts) are uncommon. In the following hemodialysis case, cauda equina syndrome was not detected after combined spinal-epidural anesthesia untilthe patient reported a lack of sensation in the perianal area 14 days postoperatively. She had normal motor function of her extremities. A laminectomy and cyst irrigation was performed. After the operation, her sphincter disturbance subsided gradually and her symptoms had disappeared. PMID:24066221

  18. Delayed Diagnosis of Cauda Eqina Syndrome with Perineural Cyst after Combined Spinal-Epidural Anesthesia in Hemodialysis Patient

    PubMed Central

    Akeda, Koji; Tsujii, Masaya; Sudo, Akihiro

    2013-01-01

    Symptomatic Tarlov (perineural cysts) are uncommon. In the following hemodialysis case, cauda equina syndrome was not detected after combined spinal-epidural anesthesia untilthe patient reported a lack of sensation in the perianal area 14 days postoperatively. She had normal motor function of her extremities. A laminectomy and cyst irrigation was performed. After the operation, her sphincter disturbance subsided gradually and her symptoms had disappeared. PMID:24066221

  19. Role of EVICEL Fibrin Sealant to Assist Hemostasis in Cranial and Spinal Epidural Space: A Neurosurgical Clinical Study.

    PubMed

    Gazzeri, Roberto; Fiore, Claudio; Galarza, Marcelo

    2015-05-01

    A variety of techniques have been used to stop venous bleeding from the cranial and spinal epidural space. These generally consist of packing with oxidized regenerated cellulose, fibrillar collagen, and so forth, and in cranial surgery, tack-up sutures. Bipolar coagulation may also be used to control bleeding from spinal venous plexus, but it may bear the risk of healthy nervous tissue injury: dissipation of heat from the tips of the bipolar forceps may induce thermal injury to adjacent neural structures. Quick and safe hemostasis reduces the duration of surgery. Efficient control of bleeding is also a prerequisite for the realization of the planned therapeutic procedure, that is, the result of surgery, and can thereby reduce perioperative morbidity. Fibrin sealant is safely used to increase hemostasis and to treat cerebrospinal leakage. Between January 2014 and March 2015, the authors used injection of fibrin sealant (EVICEL, Johnson & Johnson Wound Management, Somerville, NJ) into the cranial and spinal epidural space to assist in hemostasis in 97 patients. EVICEL injection was used in 81 cases of cranial surgery and 16 cases of spinal surgery. When the venous bleeding continued from the epidural space after packing with classical hemostatic agents, fibrin sealant was used to stop venous bleeding. When arterial bleeding was present, fibrin sealant was not used. In all cases, the results were judged to be excellent with stoppage of epidural bleeding, or good with mild persistent oozing. During the 10-minute observation period, no patients treated with EVICEL required additional hemostatic measures. No complications related to the fibrin glue were encountered. PMID:26055033

  20. What are we waiting for? An argument for early surgery for spinal epidural abscesses

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: In the article: Timing and prognosis of surgery for spinal epidural abscess (SEA): A review, Epstein raises one major point; it is imperative that spinal surgeons take back decision-making from our medical cohorts and reinstitute early surgery (<24 h) to better treat SEAs. Methods: Spine surgeons recognize the clinical triad (e.g., fever [50%], spinal pain [92100%], and neurological deficits [47%]) for establishing the diagnosis of an SEA. We also appreciate the multiple major risk factors for developing SEA; diabetes (1530%), elevated white blood cell count (>12.5), high C-reactive protein (>115), positive blood cultures, radiographic cord compression, and significant neurological deficits (e.g., 1945%). Results: Recognizing these risk factors should prompt early open surgery (<24 h from the onset of a neurological deficit). Open surgery better defines the correct/multiple organisms present, and immediately provides adequate/thorough neurological decompression (with fusion if unstable). Although minimally invasive surgery may suffice in select cases, too often it provides insufficient biopsy/culture/irrigation/decompression. Most critically, nonsurgical options result in unacceptably high failure rates (e.g., 41-42.5-75% requiring delayed surgery), while risking permanent paralysis (up to 22%), and death (up to 25%). Conclusion: As spine surgeons, we need to take back decision-making from our medical cohorts and advocate for early surgery to achieve better outcomes for our patients. Why should anyone accept the >41-42.5 to up to the 75% failure rate that accompanies the nonsurgical treatment of SEA, much less the >25% mortality rate? PMID:26605113

  1. Commentary: Unnecessary preoperative epidural steroid injections lead to cerebrospinal fluid leaks confirmed during spinal stenosis surgery

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: Increasingly, older patients with severe spinal stenosis/instability undergo multiple unnecessary preoperative epidural spinal injections (ESI), despite their risks and lack of long-term benefits. Here we add to the list of risks by showing how often preoperative ESI lead to punctate cerebrospinal fluid (CSF) fistulas documented during subsequent surgery (e.g. multilevel laminectomies with non-instrumented fusions). Methods: A series of 39 patients with spinal stenosis/instability prospectively underwent multilevel laminectomy/non-instrumented fusion utilizing lamina autograft and NanOss Bioactive. We asked how often preoperative ESI were performed in this population and how frequently they contributed to operatively confirmed punctate cerebrospinal fluid (CSF) fistulas. Notably, CSF leaks were clearly attributed to ESI, as they were located centrally/paracentrally at the L4-L5 level, just below hypertrophied/ossified yellow ligament (OYL), and were the exact size of a Tuohy needle with clean edges. Results: An average of 4.1 (range 2-12) preoperative ESI were performed in 33 of 39 patients undergoing average 4.3 level laminectomies and 1.3 level non-instrumented fusions; 6 (18.2%) patients exhibited operatively confirmed, punctate CSF fistulas attributed to these ESI. The most recent injections were administered between 2 and 5 weeks prior to surgery (average 3.9 weeks). Fistulas were primarily repaired with 7-0 GORE-TEX sutures and fibrin Sealant (Tisseel). Conclusions: Of 33 patients undergoing multilevel laminectomies with non-instrumented fusions receiving preoperative ESI, 6 (18.2%) had operatively confirmed punctate CSF fistulas due to preoperative ESI performed an average of 4.1 times per patient. PMID:25289153

  2. Randomized trial of epidural injections for spinal stenosis published in the New England Journal of Medicine: further confusion without clarification.

    PubMed

    Manchikanti, Laxmaiah; Candido, Kenneth D; Kaye, Alan D; Boswell, Mark V; Benyamin, Ramsin M; Falco, Frank J E; Gharibo, Christopher G; Hirsch, Joshua A

    2014-01-01

    Randomized controlled trials are considered the hallmark of evidence-based medicine. This conveys the idea that up-to-date evidence applied consistently in clinical practice, in combination with clinicians' individual expertise and patients own preference/expectations are enjoined to achieve the best possible outcome. Since its inception in 1990s, evidence-based medicine has evolved in conjunction with numerous changes in the healthcare environment. However, the benefits of evidence-based medicine have not materialized for spinal pain including surgical interventions. Consequently, the debate continues on the efficacy and medical necessity of multiple interventions provided in managing spinal pain. Friedly et al published a randomized controlled trial of epidural glucocorticoid injections for spinal stenosis in the July 2014 edition of the highly prestigious New England Journal of Medicine. This was accompanied by an editorial from Andersson. This manuscript provided significant sensationalism for the media and confusion for the spine community. This randomized trial of epidural glucocorticoid injections for spinal stenosis and accompanying editorial concluded that epidural injections of glucocorticoids plus lidocaine offered minimal or no short-term benefit as compared with epidural injections of lidocaine alone, with the editorial emphasizing proceeding directly to surgical intervention. In addition media statements by the authors also emphasized the idea that exercise or surgery might be better options for patients suffereing from narrowing of the spinal canal. The interventional pain management community believes that there are severe limitations to this study, manuscript, and accompanying editorial. The design, inclusion criteria, outcomes assessment, analysis of data and interpretation, and conclusions of this trial point to the fact that this highly sophisticated and much publicized randomized trial may not be appropriate and lead to misinformation. The design of the trial was inappropriate with failure to include existing randomized trials, with inclusion criteria that did not incorporate conservative management,or caudal epidural injections. Simultaneously, acute pain patients were included, multilevel stenosis and various other factors were not identified. The interventions included lumbar interlaminar and transforaminal epidural injections with highly variable volumes of medication being injected per patient. Outcomes assessment was not optimal with assessment of the patients at 3 and 6 weeks for a procedure which provides on average 3 weeks of relief and utilizing an instrument which is more appropriately utilized in acute and subacute low back pain. Analysis of the data was hampered by inadequate subgroup analysis leading to inappropriate interpretation. Based on the available data epidural local anesthetic with steroids was clearly superior at 3 weeks and potentially at 6 weeks. Further, both treatments were effective considering the baseline to 3 week and 6 week assessment, appropriate subgroup analysis seems to have yielded significant superiority for interlaminar epidural injections compared to transforaminal epidural injections with local anesthetic with or without steroids specifically with proportion of patients achieving greater than 50% improvement at 3 and 6 week levels. This critical assessment shows that this study suffers from a challenging design, was premised on the exclusion of available high-quality literature, and had inadequate duration of follow-up for an interventional technique with poor assessment criteria and reporting. Finally the analysis and interpretation of data has led to inaccurate and inappropriate conclusions which we do not believe is based on scientific evidence. PMID:25054398

  3. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A.; McManus, Carla D.; Pampati, Vidyasagar

    2013-01-01

    Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied. Study Design: A prospective evaluation. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis. Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter. Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12, 18 and 24 months post treatment. The primary outcome measure was 50% or more improvement in pain scores and ODI scores. Results: Overall, a primary outcome or significant pain relief and functional status improvement of 50% or more was seen in 71% of patients at the end of 2 years. The overall number of procedures over a period of 2 years were 5.7 2.73. Limitations: The lack of a control group and a prospective design. Conclusions: Significant relief and functional status improvement as seen in 71% of the 70 patients with percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic function limiting low back and lower extremity pain with central spinal stenosis after failure of conservatie management and fluoroscopically directed epidural injections. PMID:23289005

  4. An Implantable Versatile Electrode-Driving ASIC for Chronic Epidural Stimulation in Rats.

    PubMed

    Giagka, Vasiliki; Eder, Clemens; Donaldson, Nick; Demosthenous, Andreas

    2015-06-01

    This paper presents the design and testing of an electrode driving application specific integrated circuit (ASIC) intended for epidural spinal cord electrical stimulation in rats. The ASIC can deliver up to 1 mA fully programmable monophasic or biphasic stimulus current pulses, to 13 electrodes selected in any possible configuration. It also supports interleaved stimulation. Communication is achieved via only 3 wires. The current source and the control of the stimulation timing were kept off-chip to reduce the heat dissipation close to the spinal cord. The ASIC was designed in a 0.18- ?m high voltage CMOS process. Its output voltage compliance can be up to 25 V. It features a small core area (<;0.36 mm(2)) and consumes a maximum of 114 ?W during a full stimulation cycle. The layout of the ASIC was developed to be suitable for integration on the epidural electrode array, and two different versions were fabricated and electrically tested. Results from both versions were almost indistinguishable. The performance of the system was verified for different loads and stimulation parameters. Its suitability to drive a passive epidural 12-electrode array in saline has also been demonstrated. PMID:25134089

  5. Timing and prognosis of surgery for spinal epidural abscess: A review

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: The nonsurgical versus surgical management of spinal epidural abscesses (SEAs) remains controversial. Even with the best preoperative screening for multiple risk factors, high nonoperative failure rates are attended by considerable morbidity (e.g., irreversible paralysis) and mortality. Therefore, the focus remains on early surgery. Methods: Most papers promote early recognition of the clinical triad (e.g., fever [50%], spinal pain [92–100%], and neurological deficits [47%]) for SEA. They also identify SEA-related risk factors for choosing nonsurgical versus surgical approaches; advanced age (>65 or 80), diabetes (15–30%), cancer, intravenous drug abuse (25%), smoking (23%), elevated white blood cell count (>12.5), high C-reactive protein >115, positive blood cultures, magnetic resonance imaging/computed tomographic documented cord compression, and significant neurological deficits (e.g., 19–45%). Results: Surgical options include: decompressions, open versus minimally invasive biopsy/culture/irrigation, or fusions. Up to 75% of SEA involve the thoracolumbar spine, and 50% are located ventrally. Wound cultures are positive in up to 78.8% of cases and are often (60%) correlated with positive blood cultures. The most typical offending organism is methicillin resistant Staphylococcus aureus, followed by methicillin sensitive S. aureus. Unfortunately, the failure rates for nonoperative treatment of SEA remain high (e.g., 41–42.5%), contributing to significant morbidity (22% risk of permanent paralysis), and mortality (3–25%). Conclusion: The vast majority of studies advocated early surgery to achieve better outcomes for treating SEA; this avoids high failure rates (41–42.5%) for nonoperative therapy, and limits morbidity/mortality rates. PMID:26605109

  6. Design and fabrication of a multi-electrode array for spinal cord epidural stimulation.

    PubMed

    Chang, Chih-Wei; Lo, Yi-Kai; Gad, Parag; Edgerton, Reggie; Liu, Wentai

    2014-01-01

    A detailed design, fabrication, characterization and test of a flexible multi-site platinum/polyimide based electrode array for electrical epidural stimulation in spinal cord prosthesis is described in this paper. Carefully designed 8.4 ?m-thick structure fabrication flow achieves an electrode surface modification with 3.8 times enhanced effective surface area without extra process needed. Measured impedance and phase of two type of electrodes are 2.350.21 K? and 2.100.11 K?, -34.258.07 and -27.718.27 at 1K Hz, respectively. The fabricated arrays were then in-vitro tested by a multichannel neural stimulation system in physiological saline to validate the capability for electrical stimulation. The measured channel isolation on adjacent electrode is about -34dB. Randles cell model was used to investigate the charging waveforms, the model parameters were then extracted by various methods. The measured charge transfer resistance, double layer capacitance, and solution resistance are 1.9 K?, 220 nF and 15 K?, respectively. The results show that the fabricated array is applicable for electrical stimulation with well characterized parameters. Combined with a multichannel stimulator, this system provides a full solution for versatile neural stimulation applications. PMID:25571566

  7. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    PubMed Central

    Minato, Tsuyoki; Miyagi, Masayuki; Saito, Wataru; Shoji, Shintaro; Nakazawa, Toshiyuki; Inoue, Gen; Imura, Takayuki; Minehara, Hiroaki; Matsuura, Terumasa; Kawamura, Tadashi; Namba, Takanori; Takahira, Naonobu; Takaso, Masashi

    2016-01-01

    We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case. PMID:26989542

  8. Cervical radicular pain: the role of interlaminar and transforaminal epidural injections.

    PubMed

    Manchikanti, Laxmaiah; Falco, Frank J E; Diwan, Sudhir; Hirsch, Joshua A; Smith, Howard S

    2014-01-01

    Chronic neck pain and cervical radicular pain are relatively common in the adult population. Treatment for chronic radicular pain recalcitrant to conservative management includes surgical management as well as interventional techniques with epidural injections utilizing either an interlaminar approach or transforaminal approach. Although there have been multiple systematic reviews and randomized clinical trials of cervical interlaminar epidural injections, the literature is sparse in reference to cervical transforaminal epidural injections. Overall, there is good evidence for the effectiveness of cervical interlaminar epidural injections in managing cervical disc herniation and fair evidence in managing central spinal stenosis and postsurgery syndrome. The evidence is poor, however, for cervical transforaminal epidural injections. Complications with cervical interlaminar epidural injections are rare, but more commonly occur with transforaminal epidural injections and can be fatal. Emerging concepts in pain include further randomized trials; proper placebo design; focus on control design (either active control or placebo control); and appropriate methodologic quality assessment and evidence synthesis. PMID:24338702

  9. Primary pyogenic spinal epidural abscess: How late is too late and how bad is too bad? - A study on surgical outcome after delayed presentation.

    PubMed

    Avanali, Raghunath; Ranjan, Manish; Ramachandran, Sudheesh; Devi, Bhagavatula I; Narayanan, Vinayak

    2016-02-01

    Spinal epidural abscess is a rare clinical entity with considerable morbidity. Even with prompt diagnosis and treatment, many patients are left with persistent residual neurological deficits. The present study details the outcome in 23 patients of primary pyogenic spinal epidural abscess, addressing the outcome following late presentation at a neurological facility. At presentation only 2 patients had relatively preserved neurological status. Eleven patients were paraplegic. All the patients underwent laminectomy and evacuation of abscess. A good functional outcome was observed in almost half of the patients, and there was a significant reduction in the number of the patients with severe disability. Factors influencing the outcome are described in this study. PMID:26158193

  10. Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar; Benyamin, Ramsin

    2012-01-01

    Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source. PMID:23055773

  11. Decoding of motor intentions from epidural ECoG recordings in severely paralyzed chronic stroke patients

    NASA Astrophysics Data System (ADS)

    Spler, M.; Walter, A.; Ramos-Murguialday, A.; Naros, G.; Birbaumer, N.; Gharabaghi, A.; Rosenstiel, W.; Bogdan, M.

    2014-12-01

    Objective. Recently, there have been several approaches to utilize a brain-computer interface (BCI) for rehabilitation with stroke patients or as an assistive device for the paralyzed. In this study we investigated whether up to seven different hand movement intentions can be decoded from epidural electrocorticography (ECoG) in chronic stroke patients. Approach. In a screening session we recorded epidural ECoG data over the ipsilesional motor cortex from four chronic stroke patients who had no residual hand movement. Data was analyzed offline using a support vector machine (SVM) to decode different movement intentions. Main results. We showed that up to seven hand movement intentions can be decoded with an average accuracy of 61% (chance level 15.6%). When reducing the number of classes, average accuracies up to 88% can be achieved for decoding three different movement intentions. Significance. The findings suggest that ipsilesional epidural ECoG can be used as a viable control signal for BCI-driven neuroprosthesis. Although patients showed no sign of residual hand movement, brain activity at the ipsilesional motor cortex still shows enough intention-related activity to decode different movement intentions with sufficient accuracy.

  12. Evidence-based guideline for neuropathic pain interventional treatments: Spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks

    PubMed Central

    Mailis, Angela; Taenzer, Paul

    2012-01-01

    BACKGROUND: The Special Interest Group of the Canadian Pain Society has produced consensus-based guidelines for the pharmacological management of neuropathic pain. The society aimed to generate an additional guideline for other forms of neuropathic pain treatments. OBJECTIVE: To develop evidence-based recommendations for neuropathic pain interventional treatments. METHODS: A task force was created and engaged the Institute of Health Economics in Edmonton, Alberta, to survey the literature pertaining to multiple treatments. Sufficient literature existed on four interventions only: spinal cord stimulation; epidural injections; intravenous infusions; and nerve blocks. A comprehensive search was conducted for systematic reviews, randomized controlled trials and evidence-based clinical practice guidelines; a critical review was generated on each topic. A modified United States Preventive Services Task Force tool was used for quality rating and grading of recommendations. RESULTS: Investigators reviewed four studies of spinal cord stimulation, 19 studies of intravenous infusions, 14 studies of epidural injections and 16 studies of nerve blocks that met the inclusion criteria. The task force chairs rated the quality of evidence and graded the recommendations. Feedback was solicited from the members of the task force. CONCLUSION: There is sufficient evidence to support recommendations for some of these interventions for selected neuropathic pain conditions. This evidence is, at best, moderate and is often limited or conflicting. Pain practitioners are encouraged to explore evidence-based treatment options before considering unproven treatments. Full disclosure of risks and benefits of the available options is necessary for shared decision making and informed consent. PMID:22606679

  13. Management of Chronic Pain of Cervical Disc Herniation and Radiculitis with Fluoroscopic Cervical Interlaminar Epidural Injections

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A.; Pampati, Vidyasagar; Wargo, Bradley W.; Malla, Yogesh

    2012-01-01

    Study Design: A randomized, double-blind, active controlled trial. Objective: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis. Summary of Background Data: Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature. Methods: One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Primary outcome measure was ? 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight. Results: Significant pain relief and functional status improvement (? 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group. Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis. PMID:22859902

  14. Combined spinal-epidural analgesia for labor: breakthrough or unjustified invasion?

    PubMed

    Landau, Ruth

    2002-04-01

    The combined spina-epidural (CSE) technique has become increasingly popular for labor analgesia. The advantages of the CSE include more rapid onset of analgesia, reduced total drug dosage, minimal or no motor blockade, and increased patient satisfaction. CSE has also been associated with more rapid cervical dilation when compared to epidural analgesia in nulliparous women in early labor. Despite these potential advantages, the indications for CSE versus epidural analgesia remain unclear and controversial. This review should allow better understanding of the benefits and risks of this technique, and bearing in mind that no ultimate neuraxial analgesic exists, it would seem that CSE should be considered a major breakthrough in the management of labor analgesia. PMID:12005469

  15. Chronic complications of spinal cord injury

    PubMed Central

    Sezer, Nebahat; Akkuş, Selami; Uğurlu, Fatma Gülçin

    2015-01-01

    Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients’ functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI. PMID:25621208

  16. How Effective Is a Virtual Consultation Process in Facilitating Multidisciplinary Decision-Making for Malignant Epidural Spinal Cord Compression?

    SciTech Connect

    Fitzpatrick, David; St Luke's Hospital, Dublin ; Grabarz, Daniel; Centro Oncologia Mendel and Associados, Sao Paulo ; Wang, Lisa; Bezjak, Andrea; Fehlings, Michael G.; Fosker, Christopher; Rampersaud, Raja; Wong, Rebecca K.S.

    2012-10-01

    Purpose: The purpose of this study was to assess the accuracy of a virtual consultation (VC) process in determining treatment strategy for patients with malignant epidural spinal cord compression (MESCC). Methods and Materials: A prospective clinical database was maintained for patients with MESCC. A virtual consultation process (involving exchange of key predetermined clinical information and diagnostic imaging) facilitated rapid decision-making between oncologists and spinal surgeons. Diagnostic imaging was reviewed retrospectively (by R.R.) for surgical opinions in all patients. The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation. Results: After excluding 20 patients who were referred directly to the spinal surgeon, 125 patients were eligible for virtual consultation. Of the 46 patients who had a VC, surgery was recommended in 28 patients and actually given to 23. A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical candidates. The overall accuracy of the virtual consultation process was estimated at 92%. Conclusion: The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer. This can potentially shorten treatment decision time and enhance clinical outcomes.

  17. A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain [ISRCTN 16558617

    PubMed Central

    Manchikanti, Laxmaiah; Boswell, Mark V; Rivera, Jose J; Pampati, Vidya Sagar; Damron, Kim S; McManus, Carla D; Brandon, Doris E; Wilson, Sue R

    2005-01-01

    Background Postoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described. Methods A prospective, randomized, double-blind trial was conducted to determine the outcome of spinal endoscopic adhesiolysis to reduce pain and improve function and psychological status in patients with chronic refractory low back and lower extremity pain. A total of 83 patients were evaluated, with 33 patients in Group I and 50 patients in Group II. Group I served as the control, with endoscopy into the sacral level without adhesiolysis, followed by injection of local anesthetic and steroid. Group II received spinal endoscopic adhesiolysis, followed by injection of local anesthetic and steroid. Results Among the 50 patients in the treatment group receiving spinal endoscopic adhesiolysis, significant improvement without adverse effects was shown in 80% at 3 months, 56% at 6 months, and 48% at 12 months. The control group showed improvement in 33% of the patients at one month and none thereafter. Based on the definition that less than 6 months of relief is considered short-term and longer than 6 months of relief is considered long-term, a significant number of patients obtained long-term relief with improvement in pain, functional status, and psychological status. Conclusion Spinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects. PMID:16000173

  18. Successful Spinal Cord Stimulator Trial and Permanent Implant in Patient with Diabetic Peripheral Neuropathy on Chronic Dual Antiplatelet Therapy.

    PubMed

    Covert, Brian P; Nobles, Ryan H

    2015-01-01

    The safety of neuraxial anesthetic techniques in the setting of oral and parenteral anticoagulation is an area of growing interest and clinical inquiry as the multitude of anticoagulant medications rapidly increases. Additionally, the indications for spinal cord stimulation therapy are evolving as both technique and technology in the field continue to advance. The estimated incidence of spinal hematoma following epidural injection has been estimated to be 1 in 150,000-200,000. However, there is very little data on the risk of indwelling spinal cord simulation leads and chronic use of anticoagulant medications. We would like to report a recent case for consideration in which a spinal cord stimulator trial was successful and led to permanent spinal cord stimulator implantation in a patient with diabetic peripheral neuropathy taking life-long aspirin and clopidogrel therapy secondary to extensive coronary and carotid atherosclerosis. The report serves as a novel case to encourage exploration into the topic of anticoagulation therapy with indwelling spinal cord stimulator leads. The case brings up a number of critical questions that cannot clearly be answered with the current literature and some interesting topics for discussion including the need for acute systemic anticoagulation in the future for vascular interventions and risk stratification for those patients selected for spinal cord stimulation. PMID:26431144

  19. The effect of pre-emptive intravenous Dexketoprofen + thoracal epidural analgesia on the chronic post-thoracotomy pain

    PubMed Central

    Comez, Mehmet; Celik, Mine; Dostbil, Aysenur; Aksoy, Mehmet; Ahiskalioglu, Ali; Erdem, Ali Fuat; Aydin, Yener; ?nce, ?lker

    2015-01-01

    Post thoracotomy chronic pain is a severe problem that affects the majority of patients and decreases the quality of life. The purpose of this study is to evaluate the long-term effects of thoracal epidural levobupivacaine and intravenous dexketoprofen analgesia formed pre-emptively on the wound site pain after major thoracotomy operations. This randomised, prospective and double-blind study was performed with 60 patients undergoing thoracic surgery. Patients were divided into three groups; Control Group (Group C), Pre-emptive Epidural Group (Group PE) and Pre-emptive Dexketoprofen + Epidural Group (Group PED). Patients in the Group C did not receive epidural analgesics and i.v. dexketoprofen before and during the operation. 10-15 ml 0.125% levobupivacaine was given to cases in Group PE pre-emptively through epidural catheter before the anesthesia induction. The cases in Group PED were given 10-15 ml 0.125% epidural levobupivacaine and 50 mg dexketoprofen with i.v. infusion pre-emptively. The VAS score was found to be lower in Group PED during postoperative 24 and 48 hours and before the discharge (P<0.05). The VAS score was similar in all groups during the first and third months (P>0.05). A statistically significant decrease was determined in the VAS score in Group PED during the sixth month, compared to the other groups (P<0.05). When the scores of Patient Satisfaction Scale (PSS) of the cases were compared, they were found to be higher in Group PED as statistically significant during the discharge period (P<0.001). Scores of PSS were higher in Group PED as statistically significant during the postoperative month 6 (P = 0.008). Combined application of pre-emptive intravenous dexketoprofen and thoracal epidural analgesia reduce the chronic post-thoracotomy pain. PMID:26221376

  20. Epidural analgesia in obstetrics.

    PubMed

    Tan, T K

    1998-03-01

    An ideal analgesic for labour would preferably be non-invasive, as effective as spinals and epidurals without their attendant complications and is safe to mother and child and should not complicate the labour process. Analgesia for labouring women ranges from the use of opioid injections to invasive methods, chiefly epidural injections. Each has its advantages and drawbacks. This article provides a review of analgesic methods and techniques for labouring women. It focuses mainly on the role of epidurals, how it is utilised by anaesthetists and the differing methods of drug delivery through the epidural route. It discusses various concoctions of local anaesthetics and adjuvants used. The epidural route is probably the most effective and most commonly used invasive route for achieving analgesia during labour. Local anaesthetics of varying concentrations are administered as intermittent boluses or as a continuous infusion. Adjuvant drugs are able to enhance the quality and duration of the analgesia. Opioids including fentanyl and sufentanil, and clonidine are discussed. The use of patient-controlled epidural analgesia and combined spinal-epidural analgesia are reviewed. Ambulatory or mobile epidurals are increasingly popular. They are known to improve maternal satisfaction because of preservation of motor power. Ambulation may help with cervical dilatation and engagement, and abolition of backpain, among other advantages. This article describes the methods of establishing mobile epidurals and offers guidelines on safe ambulation and contraindications to its use. PMID:9663317

  1. Cost effectiveness of epidural steroid injections to manage chronic lower back pain

    PubMed Central

    2012-01-01

    Background The efficacy of epidural steroid injections in the management of chronic low back pain is disputed, yet the technique remains popular amongst physicians and patients alike. This study assesses the cost effectiveness of injections administered in a routine outpatient setting in England. Methods Patients attending the Nottingham University Hospitals Pain Clinic received two injections of methylprednisolone plus levobupivacaine at different dosages, separated by at least 12?weeks. Prior to each injection, and every week thereafter for 12?weeks, participants completed the EQ-5D health-related quality of life instrument. For each patient for each injection, total health state utility gain relative to baseline was calculated. The cost of the procedure was modelled from observed clinical practice. Cost effectiveness was calculated as procedure cost relative to utility gain. Results 39 patients provided records. Over a 13-week period commencing with injection, mean quality adjusted life year (QALY) gains per patient for the two dosages were 0.028 (SD 0.063) and 0.021 (SD 0.057). The difference in QALYs gained by dosage was insignificant (paired t-test, CIs -0.019 0.033). Based on modelled resource use and data from other studies, the mean cost of an injection was estimated at 219 (SD 83). The cost utility ratio of the two injections amounted to 8,975 per QALY gained (CIs 5,480 22,915). However, at costs equivalent to the tariff price typically paid to providers by health care purchasers, the ratio increased to 27,459 (CIs 16,779 70,091). Conclusions When provided in an outpatient setting, epidural steroid injections are a short term, but nevertheless cost effective, means of managing chronic low back pain. However, designation of the procedure as a day case requires the National Health Service to reimburse providers at a price which pushes the procedure to the margin of cost effectiveness. Trial registration ISRCTN 43299460 PMID:23016755

  2. A Malignant Transformation of a Spinal Epidural Mass from Ganglioneuroblastoma to Neuroblastoma

    PubMed Central

    Bilgic, Bilge; Aras, Yavuz; Izgi, Nail

    2015-01-01

    Ganglioneuromas are benign tumors. Surgical excision is the treatment of choice with very good prognosis. However, neuroblastomatous malignant transformation of ganglioneuromas was previously reported. We report a patient with spinal neuroblastoma recurrent from a ganglioneuroblastoma after disease free survival of 13 years. This is one of the rare examples of spinal neuroblastoma and to our knowledge the second case report with malignant transformation from a ganglioneuroblastoma or a ganglioneuroma. The present case is the only report in the literature with further genetic investigations. PMID:25810863

  3. The influence of pain sensitivity on the treatment outcome of transforaminal epidural steroid injection in patients with lumbar spinal stenosis.

    PubMed

    Kim, Ho-Joong; Yeom, Jin S; Lee, Joon Woo; Chang, Bong-Soon; Lee, Choon-Ki; Lee, Gun-Woo; Im, Seung-Bin; Kim, Han Jo

    2014-06-01

    The aim of this study was to investigate the effect of individual pain sensitivity on the results of transforaminal epidural steroid injection (TFESI) for the patients with lumbar spinal stenosis (LSS). Seventy-seven patients with LSS were included in this study. Prospectively planned evaluations were performed twice consecutively before and 2 months after TFESI. These included a detailed medical history, a physical examination, and completion of a series of questionnaires, including pain sensitivity questionnaire (PSQ), Oswestry disability index (ODI), and visual analog scale (VAS) for back and leg pain. The correlations were analyzed among variables between total PSQ/PSQ-moderate/PSQ-minor and pain and disability level measured by VAS for back/leg pain and ODI both before and 2 months after TFESI. Two months after TFESI, there were significant decreases in VAS for back/leg pain and ODI compared with those before injection. Before injection, VAS for back pain and leg pain was highly associated with the PSQ scores including total PSQ and PSQ subscores after adjustment for age, BMI, and grade of canal stenosis. However, any subscores of PSQ and total PSQ scores were not correlated with either VAS for back pain/leg pain or ODI 2 months after TFESI with adjustment made to age, BMI, gender, and grade of canal stenosis. This study highlights that individual pain sensitivity does not influence the outcomes of TFESI treatment in patients with LSS, even though pain sensitivity has a significant negative correlation with symptom severity of LSS. PMID:23734752

  4. Spinal cord pathology in chronic experimental Toxoplasma gondii infection

    PubMed Central

    Möhle, L.; Parlog, A.; Pahnke, J.

    2014-01-01

    Infection with the protozoan Toxoplasma (T.) gondii causes chronic infection of the central nervous system and can lead to life-threatening encephalomyelitis in immunocompromised patients. While infection with T. gondii has long time been considered asymptomatic in immunocompetent hosts, this view is challenged by recent reports describing links between seropositivity and behavioral alterations. However, past and current researches are mainly focused on the brain during Toxoplasma encephalitis, neglecting the spinal cord as a key structure conveying brain signals into motion. Therefore, our study aimed to fill the gap and describes the spinal cord pathology in an experimental murine model of toxoplasmosis. In the spinal cord, we found distinct histopathological changes, inflammatory foci and T. gondii cysts similar to the brain. Furthermore, the recruitment of immune cells from the periphery was detected. Moreover, resident microglia as well as recruited monocytes displayed an increased MHC classes I and II expression. Additionally, the expression of pro- and anti-inflammatory cytokines was enhanced in the brain as well as in the spinal cord. In summary, the pathology observed in the spinal cord was similar to the previously described changes in the brain during the infection. This study provides the first detailed description of histopathological and immunological alterations due to experimental T. gondii induced myelitis in mice. Thus, our comparison raises awareness of the importance of the spinal cord in chronic T. gondii infection. PMID:24678407

  5. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar

    2012-01-01

    Background Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. Methods A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1) and the other group did (group 2). There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment. Results Significant pain relief and functional status improvement (primary outcome) defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months. Conclusion Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis. PMID:23091395

  6. Severe hypotension related to high negative pressure suction drainage on a thoracic epidural drain during multilevel spinal fixation.

    PubMed

    Brahmbhatt, Anjalee; Hall, Nicholas D P; Bradley, William Pierre Litherland

    2013-11-15

    Hypotension or bradycardia or both related to intracranial hypotension after craniotomy has been reported in the literature. However, such reports are uncommon with thoracic epidural drains. We describe a case in which application of high negative pressure suction to a thoracic epidural drain caused a sudden decrease in arterial blood pressure. PMID:25611959

  7. Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature

    PubMed Central

    Vergori, Alessandra; Cerase, Alfonso; Migliorini, Lucia; Pluchino, Maria Grazia; Oliveri, Giuseppe; Arrigucci, Umberto; De Luca, Andrea; Montagnani, Francesca

    2015-01-01

    Spinal epidural abscesses (SEAs) are unusual bacterial infections, with possible devastating neurologic sequelae. Despite abundance of case series in adults, reports in children are scanty. We describe a spontaneous SEA due to methicillin susceptible Staphylococcus aureus (MSSA) in a previously healthy 15-year old male, and we perform a literature review regarding management of pediatric SEAs without risk factors, from 2001 to 2014. We found a total of 12 cases (8 males, average age 9.6 years). Clinical presentation was mainly fever, back pain and elevation of inflammation markers. All cases were initially misdiagnosed. Lumbar puncture was performed in 36% of patients. Etiological diagnosis was obtained in 8 cases. MSSA was isolated in 4 patients, methicillin-resistant S. aureus in 1 patient, and S. aureus with unknown susceptibility patterns in 2 cases. The average of therapy duration was 6 weeks. Patients’ spine was always evaluated by gadolinium-enhanced magnetic resonance imaging; most abscesses were localized at thoracic and lumbar area, without osteomyelitis. In 8 cases, laminectomy and/or abscess drainage were performed in association with medical therapy; 3 cases were successfully treated with antimicrobial therapy only; no data were available in one case. A good outcome was obtained in all patients, except a reported residual headache and paraspinal pain lasting for 3 years. The rarity and the possible differential diagnosis can lead to underestimate SEA occurrence in children without risk factors. It seems therefore essential to maintain a high attention to pediatric SEAs. A prompt diagnosis and adequate therapy are essential prognostic factors for remission. PMID:26793474

  8. Case Study of a Spinal Epidural Capillary Hemangioma: A 4-Year Postoperative Follow-Up

    PubMed Central

    Seferi, Arsen; Alimehmeti, Ridvan; Vyshka, Gentian; Bushati, Teona; Petrela, Mentor

    2013-01-01

    Study Design?Case study. Objectives?We report the case of a 58-year-old Caucasian man, who presented with a 4-month history of increasing low back pain and gait difficulty. Objective neurologic examination revealed a severe paraparetic symptomatology without any sphincter involvement. Methods?Spinal magnetic resonance imaging (MRI) showed an extradural mass formation situated dorsally at the level of thoracic vertebrae T2 to T4. Results?A laminectomy was performed with total removal of the mass; histology suggested a highly vascularized lesion with lobular architecture, which seems a very rare case, compatible with a capillary hemangioma. Conclusions?A careful follow-up for the next 4 years, including control MRIs every postoperative year, showed a very good neurologic condition of the patient and no recurrence on imaging findings. PMID:24494182

  9. Chronic generalized spinal muscular atrophy of infancy and childhood

    PubMed Central

    Pearn, J. H.; Wilson, J.

    1973-01-01

    Recent studies have shown that the acute fatal form of infantile spinal muscular atrophy (acute Werdnig-Hoffmann disease or spinal muscular atrophy Type I) is a distinct genetic and clinical entity. This has prompted clinical re-examination of the disease known as `arrested Werdnig-Hoffmann disease' which hitherto was thought to be a spectrum variant of the acute fatal form. A total of 18 such patients with the chronic generalized form of spinal muscular atrophy has been known to The Hospital for Sick Children over the past 10 years. Patients with this characteristic clinical syndrome comprise approximately one-fifth of children with chronic spinal muscular atrophy. Clinically, no patient was even able to crawl normally or progress further with motor milestones. Median age of clinical onset is 6 months of age, and life expectancy ranges from 2 years to the third decade. Inevitable spinal and joint deformities occur by the second decade of life. Management should be based on vigorous antibiotic therapy, orthopaedic and neurological surveillance, and a carefully planned educational programme aimed at realistic employment in late adolescence. ImagesFIG. 4p772-b PMID:4749680

  10. Epidural injections for back pain

    MedlinePLUS

    ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back ... procedure does not cure the cause of your back pain. You will need to continue back exercises and ...

  11. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

    PubMed Central

    Manchikanti, Laxmaiah; Nampiaparampil, Devi E.; Manchikanti, Kavita N.; Falco, Frank J.E.; Singh, Vijay; Benyamin, Ramsin M.; Kaye, Alan D.; Sehgal, Nalini; Soin, Amol; Simopoulos, Thomas T.; Bakshi, Sanjay; Gharibo, Christopher G.; Gilligan, Christopher J.; Hirsch, Joshua A.

    2015-01-01

    Background: The efficacy of epidural and facet joint injections has been assessed utilizing multiple solutions including saline, local anesthetic, steroids, and others. The responses to these various solutions have been variable and have not been systematically assessed with long-term follow-ups. Methods: Randomized trials utilizing a true active control design were included. The primary outcome measure was pain relief and the secondary outcome measure was functional improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the criteria developed by the American Society of Interventional Pain Physicians (ASIPP) for assessing interventional techniques. An evidence analysis was conducted based on the qualitative level of evidence (Level I to IV). Results: A total of 31 trials met the inclusion criteria. There was Level I evidence that local anesthetic with steroids was effective in managing chronic spinal pain based on multiple high-quality randomized controlled trials. The evidence also showed that local anesthetic with steroids and local anesthetic alone were equally effective except in disc herniation, where the superiority of local anesthetic with steroids was demonstrated over local anesthetic alone. Conclusion: This systematic review showed equal efficacy for local anesthetic with steroids and local anesthetic alone in multiple spinal conditions except for disc herniation where the superiority of local anesthetic with steroids was seen over local anesthetic alone. PMID:26005584

  12. Posttraumatic Stress Disorder After High-Dose-Rate Brachytherapy for Cervical Cancer With 2 Fractions in 1 Application Under Spinal/Epidural Anesthesia: Incidence and Risk Factors

    SciTech Connect

    Kirchheiner, Kathrin; Czajka-Pepl, Agnieszka; Scharbert, Gisela; Wetzel, Léonore; Sturdza, Alina; Dörr, Wolfgang; Pötter, Richard

    2014-06-01

    Purpose: To investigate the psychological consequences of high-dose-rate brachytherapy with 2 fractions in 1 application under spinal/epidural anesthesia in the treatment of locally advanced cervical cancer. Methods and Materials: In 50 patients with locally advanced cervical cancer, validated questionnaires were used for prospective assessment of acute and posttraumatic stress disorder (ASD/PTSD) (Impact of Event Scale–Revision), anxiety/depression (Hospital Anxiety and Depression Scale), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Cervical Cancer 24), physical functioning (World Health Organization performance status), and pain (visual analogue scale), before and during treatment and 1 week and 3 months after treatment. Qualitative interviews were recorded in open format for content analysis. Results: Symptoms of ASD occurred in 30% of patients 1 week after treatment; and of PTSD in 41% 3 months after treatment in association with this specific brachytherapy procedure. Pretreatment predictive variables explain 82% of the variance of PTSD symptoms. Helpful experiences were the support of the treatment team, psychological support, and a positive attitude. Stressful factors were pain, organizational problems during treatment, and immobility between brachytherapy fractions. Conclusions: The specific brachytherapy procedure, as performed in the investigated mono-institutional setting with 2 fractions in 1 application under spinal/epidural anesthesia, bears a considerable risk of traumatization. The source of stress seems to be not the brachytherapy application itself but the maintenance of the applicator under epidural anesthesia in the time between fractions. Patients at risk may be identified before treatment, to offer targeted psycho-social support. The patients' open reports regarding helpful experiences are an encouraging feedback for the treatment team; the reported stressful factors serve as a basis for improvement of patient management, especially regarding pain control.

  13. Attributes of quiet stance in the chronic spinal cat.

    PubMed

    Fung, J; Macpherson, J M

    1999-12-01

    Standing is a dynamic task that requires antigravity support of the body mass and active regulation of the position of the body center of mass. This study examined the extent to which the chronic spinal cat can maintain postural orientation during stance and adapt to changes in stance distance (fore-hindpaw separation). Intact cats adapt to changes in stance distance by maintaining a constant horizontal orientation of the trunk and changing orientation of the limbs, while keeping intralimb geometry constant and aligning the ground reaction forces closely with the limb axes. Postural adaptation was compared in four cats before and after spinalization at the T(6) level, in terms of the forces exerted by each paw against the support, body geometry (kinematics) and electromyographic (EMG) activity recorded from chronic, indwelling electrodes, as well as the computed net torques in the fore and hindlimbs. Five fore-hindpaw distances spanning the preferred distance were tested before spinalization, with a total range of 20 cm from the shortest to the longest stance. After spinalization, the cats were trained on a daily basis to stand on the force platform, and all four cats were able to support their full body weight. Three of the four cats could adapt to changes in stance distance, but the range was smaller and biased toward the shorter distances. The fourth cat could stand only at one stance distance, which was 8 cm shorter than the preferred distance before spinalization. All cats shifted their center of pressure closer to the forelimbs after spinalization, but the amount of shift could largely be accounted for by the weight loss in the hindquarters. The three cats that could adapt to changes in stance distance used a similar strategy as the intact cat by constraining the trunk and changing orientation of the limb axes in close relation with the forces exerted by each limb. However, different postures in the fore- and hindlimbs were adopted, particularly at the scapula (more extended) and pelvis (tipped more anteriorly). Other changes from control included a redistribution of net extensor torque across the joints of the forelimb and of the hindlimb. We concluded that the general form of body axis orientation is relatively conserved in the spinal cat, suggesting that the lumbosacral spinal circuitry includes rudimentary set points for hindlimb geometry. Both mechanical and neural elements can contribute toward maintaining body geometry through stiffness regulation and spinal reflexes. PMID:10601441

  14. Intraoperative conditions and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia

    PubMed Central

    Hanoura, Samy Elsayed; Hassanin, Rabei; Singh, Rajvir

    2013-01-01

    This study was designed to evaluate the effect of adding dexmedetomidine to regular mixture of epidural drugs for pregnant women undergoing elective cesarean section with special emphasis on their sedative properties, ability to improve quality of intraoperative, postoperative analgesia, and neonatal outcome. Materials and Methods: Fifty women of ASA physical status I or II at term pregnancy were enrolled randomly to receive plain bupivacaine plus fentanyl (BF Group) or plain bupivacaine plus mixture of fentanyl and dexmedetomidine (DBF Group). Incidence of hypotension, bradycardia, Apgar scores, intraoperative pain assessment, onset of postoperative pain, sedation scores, and side effects were recorded. Results: No difference in the times taken for block to reach T4 sensory level, to reach the highest level of sensory block, and interval between first neuraxial injection and onset of surgery between the groups was noted. Onset of postoperative pain was significantly delayed in the DBF group (P = 0.001), the need for supplementary fentanyl was significantly less in DBF group (P = 0.03), no significant difference was noted between both groups regarding neonatal Apgar scores as well as the incidence of hypotension, bradycardia, nausea, vomiting, and duration of motor blockade. DBF group had significantly less incidence of shivering (P = 0.03). Conclusion: Adding dexmedetomidine to regular mixture of epidural anesthetics in women undergoing elective cesarean section improved intraoperative conditions and quality of postoperative analgesia without maternal or neonatal significant side effects. PMID:25885827

  15. Microscopic epidural lesions in goats given repeated epidural injections of morphine: use of a modified autopsy procedure.

    PubMed

    Larsen, J J; Svendsen, O; Andersen, H B

    1986-01-01

    Epidural catheterization was performed in six goats. Five days later either saline or 20 mg (5 mg/ml) preservative free morphine was injected epidurally once daily for 8 days. The goats were sacrificed 4, 24 or 48 hours after the last injection. The lumbar part of columna was removed in toto for microscopic examination of the spinal cord and the entire epidural space after decalcification and transverse sectioning. After saline, minimal changes including a fibrous membrane surrounding the catheter, scattered fat cell necrosis, scattered small focal cell infiltrations and occasionally focal haemorrhages were seen. After morphine the changes were considerably more severe including diffuse cellular inflammatory reaction in the epidural space, fat cell necrosis, occasionally focal exudative inflammation and chronic inflammatory reaction in the vicinity of the fibrous membrane demarcating position of the catheter. It is concluded that the present modified autopsy procedure permits microscopic examination of the epidural space. It has been shown that repeated administration of morphine caused tissue damage in the epidural space of goats. The human predictability of the results obtained is unknown. However, the results are encouraging for investigations with similar procedure in humans. PMID:3953294

  16. Epidural Lysis of Adhesions

    PubMed Central

    Lee, Frank; Jamison, David E.; Hurley, Robert W.

    2014-01-01

    As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections. PMID:24478895

  17. Epidural Steroid Injections Are Associated with Less Improvement in the Treatment of Lumbar Spinal Stenosis: A subgroup analysis of the SPORT

    PubMed Central

    Radcliff, Kris; Kepler, Christopher; Hilibrand, Alan; Rihn, Jeffrey; Zhao, Wenyan; Lurie, Jon; Tosteson, Tor; Vaccaro, Alexander; Albert, Todd; Weinstein, James

    2013-01-01

    Summary of Background Data Lumbar spinal stenosis is a common incidental finding among adults over the age of 60, The use of ESI in these patients is common, although there is little evidence in the literature to demonstrate the long-term benefit of ESI in the treatment of lumbar stenosis. Objective The hypothesis of this study was that patients who received epidural steroid injections (ESI) during initial treatment as part of the Spine Patient Outcomes Research Trial (SPORT) would have improved clinical outcomes and a lower rate of crossover to surgery compared to patients who did not receive ESI. Methods Patients with lumbar spinal stenosis who received epidural steroid injections within the first three months of enrollment in SPORT (ESI) were compared to patients who did not receive epidural injections during the first three months of the study (No ESI). Results There were 69 ESI patients and 207 No-ESI patients. There were no significant differences in demographic factors, baseline clinical outcome scores, or operative details although there was a significant increase in baseline preference for nonsurgical treatment among ESI patients (62% vs. 33%, p <0.001). There was an average 26 minute increase in operative time and an increased length of stay by 0.9 days among the ESI patients who ultimately underwent surgical treatment. Averaged over four years, there was significantly less improvement in SF36 PF among surgically treated ESI patients (ESI 14.8 vs. No-ESI 22.5, p=0.025). In addition, there was also significantly less improvement among the nonsurgically treated patients in SF36 BP (ESI 7.3 vs. No-ESI 16.7, p=0.007) and SF36 PF (ESI 5.5 vs. No-ESI 15.2, p=0.009). Of the patients assigned to surgical treatment, there was a significantly increased crossover to nonsurgical treatment among patients who received an ESI (ESI 33% vs. No ESI 11%, p=0.012). Of the patients assigned to non-operative treatment, there was a significantly increased crossover to surgical treatment in the ESI patients (ESI 58% vs. No ESI 32%, p=0.003). Conclusion Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT. Furthermore, ESI were associated with longer duration of surgery and longer hospital stay. There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically. PMID:23238485

  18. Spinal cord stimulation: Current applications for treatment of chronic pain.

    PubMed

    Vannemreddy, Prasad; Slavin, Konstantin V

    2011-01-01

    Spinal cord stimulation (SCS) is thought to relieve chronic intractable pain by stimulating nerve fibers in the spinal cord. The resulting impulses in the fibers may inhibit the conduction of pain signals to the brain, according to the pain gate theory proposed by Melzack and Wall in 1965 and the sensation of pain is thus blocked. Although SCS may reduce pain, it will not eliminate it. After a period of concern about safety and efficacy, SCS is now regaining popularity among pain specialists for the treatment of chronic pain. The sympatholytic effect of SCS is one of its most interesting therapeutic properties. This effect is considered responsible for the effectiveness of SCS in peripheral ischemia, and at least some cases of complex regional pain syndrome. The sympatholytic effect has also been considered part of the management of other chronic pain states such as failed back surgery syndrome, phantom pain, diabetic neuropathy, and postherpetic neuralgia. In general, SCS is part of an overall treatment strategy and is used only after the more conservative treatments have failed. The concept of SCS has evolved rapidly following the technological advances that have produced leads with multiple contact electrodes and battery systems. The current prevalence of patients with chronic pain requiring treatment other than conventional medical management has significantly increased and so has been the need for SCS. With the cost benefit analysis showing significant support for SCS, it may be appropriate to offer this as an effective alternative treatment for these patients. PMID:25885295

  19. Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans

    PubMed Central

    Angeli, Claudia A.; Edgerton, V. Reggie; Gerasimenko, Yury P.

    2014-01-01

    Previously, we reported that one individual who had a motor complete, but sensory incomplete spinal cord injury regained voluntary movement after 7 months of epidural stimulation and stand training. We presumed that the residual sensory pathways were critical in this recovery. However, we now report in three more individuals voluntary movement occurred with epidural stimulation immediately after implant even in two who were diagnosed with a motor and sensory complete lesion. We demonstrate that neuromodulating the spinal circuitry with epidural stimulation, enables completely paralysed individuals to process conceptual, auditory and visual input to regain relatively fine voluntary control of paralysed muscles. We show that neuromodulation of the sub-threshold motor state of excitability of the lumbosacral spinal networks was the key to recovery of intentional movement in four of four individuals diagnosed as having complete paralysis of the legs. We have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury. PMID:24713270

  20. Neurocontrol of Movement in Humans With Spinal Cord Injury.

    PubMed

    Dimitrijevic, Milan R; Danner, Simon M; Mayr, Winfried

    2015-10-01

    In this review of neurocontrol of movement after spinal cord injury, we discuss neurophysiological evidences of conducting and processing mechanisms of the spinal cord. We illustrate that external afferent inputs to the spinal cord below the level of the lesion can modify, initiate, and maintain execution of movement in absence or partial presence of brain motor control after chronic spinal cord injury. We review significant differences between spinal reflex activity elicited by single and repetitive stimulation. The spinal cord can respond with sensitization, habituation, and dis-habituation to regular repetitive stimulation. Therefore, repetitive spinal cord reflex activity can contribute to the functional configuration of the spinal network. Moreover, testing spinal reflex activity in individuals with motor complete spinal cord injury provided evidences for subclinical residual brain influence, suggesting the existence of axons traversing the injury site and influencing the activities below the level of lesion. Thus, there are two motor control models of chronic spinal cord injury in humans: "discomplete" and "reduced and altered volitional motor control." We outline accomplishments in modification and initiation of altered neurocontrol in chronic spinal cord injury people with epidural and functional electrical stimulation. By nonpatterned electrical stimulation of lumbar posterior roots, it is possible to evoke bilateral extension as well as rhythmic motor outputs. Epidural stimulation during treadmill stepping shows increased and/or modified motor activity. Finally, volitional efforts can alter epidurally induced rhythmic activities in incomplete spinal cord injury. Overall, we highlight that upper motor neuron paralysis does not entail complete absence of connectivity between cortex, brain stem, and spinal motor cells, but there can be altered anatomy and corresponding neurophysiological characteristics. With specific input to the spinal cord below the level of the lesion, the clinical status of upper motor neuron paralysis without structural modification can be modified, and movements can be initiated. Thus, external afferent input can partially replace brain control. PMID:26471132

  1. [ENMG-assessment of efficiency of temporal epidural electroneurostimulation in combined with robotic kinesotherapy in the treatment of patients with spinal cord injury consequences].

    PubMed

    Shein, A P; Krivoruchko, G A; Prudnikova, O G

    2015-01-01

    The goal of this study was to ENMG-assess effectiveness of the short combined neurorehabilitation course (temporal epidural stimulation of the spinal cord combined with a robotic kinesotherapy) in the restorative treatment of patients with traumatic spinal cord disease. Before and after completion of the combined instrumental neurorehabilitation (course duration--2-3 weeks) were tested 75 patients with spinal cord injury consequences. The authors used global and stimulation (H-reflex, M-response) electromyography methods. On the ENMG-data basis were calculated indices of sensorimotor deficit (ISD) and their postrehabilitation trends. ENMG-signs of sensorimotor deficit regression in the lower extremities were observed in 46.6% of events, in the upper extremities (if damaged cervical spine)--in 78.6% of events. The stabilizing effect of the used neurorehabilitation technology was identified an average of 24.0% of events. In 18.8% of events, the using of the combined neurorehabilitation technology has been ineffective. As indications for the use of combined neurorehabilitation courses series may be employed ENMG-signs of the partial corticospinal tracts conduction safety and a positive ISD trend after the each course completion. PMID:26027339

  2. Case Report and Mini Literature Review: Anesthetic Management for Severe Peripartum Cardiomyopathy Complicated with Preeclampsia Using Sufetanil in Combined Spinal Epidural Anesthesia

    PubMed Central

    Bhakta, Pradipta; Bakshi, Anamika; Langer, Vijay

    2011-01-01

    Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in the anesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases. PMID:21155028

  3. [Epidural long-term local pharmacotherapy in patients with degenerative dystrophic spinal diseases during combined rehabilitation therapy].

    PubMed

    Likhachev, M Iu; Razumov, A N; Sidorov, V D

    2002-01-01

    Epidural long-term local pharmacotherapy in degenerative-dystrophic diseases of the lumbar spine proved most effective in combination with rehabilitation procedures. Such combined treatment can be used in cases with long-standing disease resistant to conservative treatment. PMID:12532592

  4. An unusual posterior mediastinal lipoblastoma with spinal epidural extension presenting as a painful suprascapular swelling: case report and a brief review of the literature.

    PubMed

    Raman Sharma, Rewati; Mahapatra, Ashok K; Pawar, Sanjay J; Sousa, Jesus; Musa, Mohammed M

    2002-03-01

    Lipoblastoma is a rare benign pediatric neoplasm of fetal-embryonal fat with little risk of recurrence following total microsurgical excision, but it may progress to local invasion or infiltration if not treated surgically. No adjuvant therapies are usually necessary once the tumor is excised. It is best diagnosed on histopathological studies following excision. An unusual posterior mediastinal lipoblastoma in a 2-year-old Omani girl with spinal epidural extension clinically manifested as a progressive painful suprascapular swelling is reported. It was initially construed to be a benign lipoma, but progressively increasing pain and mild imbalance whilst walking with a tendency to fall on the right side prompted neurosurgical referral and eventual total excision without any added morbidity. Interesting clinical and neuroimaging (CT & MRI) findings are presented and discussed, with a brief review of the literature. PMID:11922718

  5. Spinal fluid abnormalities in patients with chronic fatigue syndrome.

    PubMed

    Natelson, Benjamin H; Weaver, Shelley A; Tseng, Chin-Lin; Ottenweller, John E

    2005-01-01

    Arguments exist as to the cause of chronic fatigue syndrome (CFS). Some think that it is an example of symptom amplification indicative of functional or psychogenic illness, while our group thinks that some CFS patients may have brain dysfunction. To further pursue our encephalopathy hypothesis, we did spinal taps on 31 women and 13 men fulfilling the 1994 case definition for CFS and on 8 women and 5 men serving as healthy controls. Our outcome measures were white blood cell count, protein concentration in spinal fluid, and cytokines detectable in spinal fluid. We found that significantly more CFS patients had elevations in either protein levels or number of cells than healthy controls (30 versus 0%), and 13 CFS patients had protein levels and cell numbers that were higher than laboratory norms; patients with abnormal fluid had a lower rate of having comorbid depression than those with normal fluid. In addition, of the 11 cytokines detectable in spinal fluid, (i) levels of granulocyte-macrophage colony-stimulating factor were lower in patients than controls, (ii) levels of interleukin-8 (IL-8) were higher in patients with sudden, influenza-like onset than in patients with gradual onset or in controls, and (iii) IL-10 levels were higher in the patients with abnormal spinal fluids than in those with normal fluid or controls. The results support two hypotheses: that some CFS patients have a neurological abnormality that may contribute to the clinical picture of the illness and that immune dysregulation within the central nervous system may be involved in this process. PMID:15642984

  6. Foetal heart rate deceleration with combined spinal-epidural analgesia during labour: a maternal haemodynamic cardiac study.

    PubMed

    Valensise, Herbert; Lo Presti, Damiano; Tiralongo, Grazia Maria; Pisani, Ilaria; Gagliardi, Giulia; Vasapollo, Barbara; Frigo, Maria Grazia

    2016-06-01

    To understand the mechanisms those are involved in the appearance of foetal heart rate decelerations (FHR) after the combined epidural analgesia in labour. Observational study done at University Hospital for 86-term singleton pregnant women with spontaneous labour. Serial bedside measurement of the main cardiac maternal parameters with USCOM technique; stroke volume (SV), heart rate (HR), cardiac output (CO) and total vascular resistances (TVR) inputting systolic and diastolic blood pressure before combined epidural analgesia and after 5', 10', 15' and 20 min. FHR was continuously recorded though cardiotocography before and after the procedure. Correlation between the appearance of foetal heart rate decelerations and the modification of maternal haemodynamic parameters. Fourteen out of 86 foetuses showed decelerations after the combined spino epidural procedure. No decelerations occurred in the women with low TVR (<1000 dyne/s/cm(-5)) at the basal evaluation. FHR abnormalities were concentrated in 39 women who presented elevated TVR values at the basal evaluation (>1200 dyne/s/cm(-5)). Soon after the epidural procedure, the absence of increase in SV and CO was observed in these women. No variations in systolic and diastolic blood pressure values were found. The level of TVR before combined epidural analgesia in labour may indicate the risk of FHR abnormalities after the procedure. Low TVR (<1000 dyne/s/cm(-5)) showed a reduced risk of FHR abnormalities. FHR decelerations seem to occur in women without the ability to upregulate SV and CO in response to the initial effects of analgesia. PMID:26333691

  7. Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature.

    PubMed

    Vallejo, Ricardo; Kramer, Jeffery; Benyamin, Ramsin

    2007-03-01

    Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70-90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain. PMID:17387353

  8. Epidural angiomatous meningioma of the thoracic spine: A case report

    PubMed Central

    YANG, TAO; WU, LIANG; YANG, CHENLONG; XU, YULUN

    2016-01-01

    Spinal epidural angiomatous meningiomas (AMs) are extremely rare lesions. Here, we report on a case of an epidural AM of the thoracic spine with chronic but severe cord compression. The patient underwent a T6-T8 laminectomy through the posterior approach. En bloc resection was achieved, and histopathological examination demonstrated an AM. Delayed paraplegia occurred 4 h postoperatively. The patient was treated with methylprednisolone, hyperbaric oxygen and rehabilitation. Gradually, over the next six months, the bilateral leg strength was improved compared with the preoperative status, and no tumor recurrence was noted. Although epidural AM is extremely rare, it should be included in the differential diagnosis of spinal epidural lesions. A definitive diagnosis is difficult based on magnetic resonance imaging alone due to the nonspecific characteristics of the tumor. Since AM is a histologically benign and highly vascularized tumor, timely gross total resection (GTR) is the most effective treatment. A good clinical outcome may be expected following GTR (Simpson grade I and II resection).

  9. Altered activation patterns by triceps surae stretch reflex pathways in acute and chronic spinal cord injury

    PubMed Central

    Johnson, Michael D.; Heckman, C. J.

    2011-01-01

    Spinal reflexes are modified by spinal cord injury (SCI) due the loss of excitatory inputs from supraspinal structures and changes within the spinal cord. The stretch reflex is one of the simplest pathways of the central nervous system and was used presently to evaluate how inputs from primary and secondary muscle spindles interact with spinal circuits before and after spinal transection (i.e., spinalization) in 12 adult decerebrate cats. Seven cats were spinalized and allowed to recover for 1 mo (i.e., chronic spinal state), whereas 5 cats were evaluated before (i.e., intact state) and after acute spinalization (i.e., acute spinal state). Stretch reflexes were evoked by stretching the left triceps surae (TS) muscles. The force evoked by TS muscles was recorded along with the activity of several hindlimb muscles. Stretch reflexes were abolished in the acute spinal state due to an inability to activate TS muscles, such as soleus (Sol) and lateral gastrocnemius (LG). In chronic spinal cats, reflex force had partly recovered but Sol and LG activity remained considerably depressed, despite the fact that injecting clonidine could recruit these muscles during locomotor-like activity. In contrast, other muscles not recruited in the intact state, most notably semitendinosus and sartorius, were strongly activated by stretching TS muscles in chronic spinal cats. Therefore, stretch reflex pathways from TS muscles to multiple hindlimb muscles undergo functional reorganization following spinalization, both acute and chronic. Altered activation patterns by stretch reflex pathways could explain some sensorimotor deficits observed during locomotion and postural corrections after SCI. PMID:21734111

  10. A thin film polyimide mesh microelectrode for chronic epidural electrocorticography recording with enhanced contactability

    NASA Astrophysics Data System (ADS)

    Baek, Dong-Hyun; Lee, Jeyeon; Byeon, Hang jin; Choi, Hoseok; Kim, In Young; Lee, Kyoung-Min; Jungho Pak, James; Jang, Dong Pyo; Lee, Sang-Hoon

    2014-08-01

    Objective. Epidural electrocorticography (ECoG) activity may be more reliable and stable than single-unit-activity or local field potential. Invasive brain computer interface (BCI) devices are limited by mechanical mismatching and cellular reactive responses due to differences in the elastic modulus and the motion of stiff electrodes. We propose a mesh-shaped electrode to enhance the contactability between surface of dura and electrode. Approach. We designed a polyimide (PI) electrode with a mesh pattern for more conformal contact with a curved surface. We compared the contact capability of mesh PI electrodes with conventionally used sheet PI electrode. The electrical properties of the mesh PI electrode were evaluated for four weeks. We recorded the epidural ECoG (eECoG) activity on the surface of rhesus monkey brains while they performed a saccadic task for four months. Main results. The mesh PI electrode showed good contact with the agarose brain surface, as evaluated by visual inspection and signal measurement. It was about 87% accurate in predicting the direction of saccade eye movement. Significance. Our results indicate that the mesh PI electrode was flexible and good contact on the curved surface and can record eECoG activity maintaining close contact to dura, which was proved by in vivo and in vitro test.

  11. Thoracic epidural analgesia for off-pump coronary artery bypass surgery in patients with chronic obstructive pulmonary disease.

    PubMed

    Mehta, Yatin; Vats, Mayank; Sharma, Munish; Arora, Reetesh; Trehan, Naresh

    2010-01-01

    The benefits of thoracic epidural analgesia in patients undergoing coronary artery bypass grafting are well documented. However, the literature available on the role of high thoracic epidural analgesia (HTEA) in patients with chronic obstructive pulmonary disease undergoing off-pump coronary artery bypass graft (OPCAB) surgery is scarce. We conducted a randomized clinical trial to establish whether HTEA is beneficial in patients with chronic obstructive pulmonary disease undergoing elective OPCAB surgery. After institutional ethics board approval and informed consent, 62 chronic obstructive pulmonary disease patients undergoing elective OPCAB were randomly grouped into two (n = 31 each). Both groups received general anesthesia (GA), but in the HTEA group patients, TEA was also administered. Standardized surgical and anesthetic techniques were used for both the groups. Pulmonary function tests were performed pre-operatively, 6 h and 24 h post-extubation and on days 2, 3, 4 and 5 along with arterial blood gas analysis (ABG) analysis. Time for extubation (h) and time for oxygen withdrawal (h) were recorded. Pain score was assessed by the 10-cm visual analogue scale. All hemodynamic/oxygenation parameters were noted. Any complications related to the TEA were also recorded. Patients in the HTEA group were extubated earlier (10.8 h vs. 13.5 h, P < 0.01) and their oxygen withdrawal time was also significantly lower (26.26 h vs. 29.87 h, P < 0.01). The VAS score, both at rest and on coughing, was significantly lower in the HTEA group at all times, post-operatively (P < 0.01). The forced vital capacity improved significantly at 6 h post-operatively in the HTEA group (P = 0.026) and remained significantly higher thereafter. A similar trend was observed in forced expiratory volume in the first second on day 2 in the HTEA group (P = 0.024). We did not observe any significant side-effects/mortality in either group. In chronic obstructive pulmonary disease patients undergoing elective OPCAB surgery, HTEA is a good adjunct to GA for early extubation, faster recovery of pulmonary function and better analgesia. PMID:20826963

  12. Chronic spinal cord stimulation in medically intractable orthostatic tremor

    PubMed Central

    Krauss, J K; Weigel, R; Blahak, C; Bzner, H; Capelle, H?H; Grips, E; Rittmann, M; Whrle, J C

    2006-01-01

    Background Orthostatic tremor with its sense of unsteadiness when standing may have a devastating effect on affected persons. Currently, there are no other treatment options in those who do not respond or who do not tolerate medical treatment. Objectives To report on a pilot study on spinal cord stimulation in medically intractable orthostatic tremor. Methods Chronic spinal cord stimulation (SCS) was performed in two patients with medically?intractable orthostatic tremor via quadripolar plate electrodes implanted at the lower thoracic spine. The electrodes were connected to implantable pulse generators. Results Subjective and objective improvement of unsteadiness was achieved within a frequency range of 50 to 150?Hz, and occurred in the presence of stimulation?induced paraesthesia. With optimized stimulation settings polygraphic electromyelogram (EMG) recordings continued to show the typical 1416?Hz EMG activity. The beneficial effect of SCS was maintained at long?term follow?up. Conclusions The results of this pilot study indicate that SCS may be an option in patients with otherwise intractable orthostatic tremor. PMID:16735398

  13. Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Malla, Yogesh

    2012-01-01

    Background While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Methods A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain. Results One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1) or local anesthetic mixed with nonparticulate betamethasone (group 2). The primary outcome of significant pain relief and improvement in functional status (?50%) was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 3739 weeks in the successful group over a period of 52 weeks. Conclusion Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain. PMID:22826642

  14. Successful Neuraxial Analgesia After Recent Epidural Blood Patch.

    PubMed

    Whitwell, Trevor A; Li, Dongchen; Le, Vanny; Gonzalez-Fiol, Antonio J

    2015-08-15

    Epidural blood patch is a frequently successful treatment for postdural puncture headache. It is not clear whether a recent epidural blood patch affects subsequent neuraxial analgesia. We describe the case of a patient who received an epidural blood patch for postdural puncture headache and returned 3 days later in active labor, requesting epidural analgesia. The patient successfully received analgesia from a combined spinal epidural without further complications. We discuss the anesthetic considerations for providing neuraxial analgesia after a recent epidural blood patch. PMID:26275305

  15. Epidural narcotics: mechanism of action and nursing implications.

    PubMed

    McShane, F J

    1992-06-01

    Patients who receive narcotics by epidural injection or infusion have the potential to develop pharmacological side effects. Theories of epidural pain control and a brief review of spinal anatomy and pain physiology are presented in this article. Narcotic medications used for epidural infusion are pharmacologically distinguished by their hydrophilic or lipophilic character. Important side effects of epidurally administered narcotics, clinical presentation, manifestations, and appropriate nursing interventions are discussed. PMID:1351099

  16. The paradox of chronic neuroinflammation, systemic immune suppression and autoimmunity after traumatic chronic spinal cord injury

    PubMed Central

    Kopp, Marcel A.; Brommer, Benedikt; Popovich, Phillip G.

    2014-01-01

    During the transition from acute to chronic stages of recovery after spinal cord injury (SCI), there is an evolving state of immunologic dysfunction that exacerbates the problems associated with the more clinically obvious neurologic deficits. Since injury directly affects cells embedded within the “immune privileged/specialized” milieu of the spinal cord, maladaptive or inefficient responses are likely to occur. Collectively, these responses qualify as part of the continuum of “SCI disease” and are important therapeutic targets to improve neural repair and neurological outcome. Generic immune suppressive therapies have been largely unsuccessful, mostly because nflammation and immunity exert both beneficial (plasticity enhancing) and detrimental (e.g. glia- and neurodegenerative; secondary damage) effects and these functions change over time. Moreover, “compartmentalized” investigations, limited to only intraspinal inflammation and associated cellular or molecular changes in the spinal cord, neglect the reality that the structure and function of the CNS is influenced by systemic immune challenges and that the immune system is hardwired into the nervous system. Here, we consider this interplay during the progression from acute to chronic SCI. Specifically, we survey impaired/non-resolving intraspinal inflammation and the paradox of systemic inflammatory responses in the face of ongoing chronic immune suppression and autoimmunity. The concepts of systemic inflammatory response syndrome (SIRS), compensatory anti-inflammatory response syndrome (CARS) and ‘neurogenic’ spinal cord injury-induced immune depression syndrome (SCI-IDS) are discussed as determinants of impaired ‘host-defense’ and trauma-induced autoimmunity. PMID:25017893

  17. Effects of ozone applied by spinal endoscopy in patients with chronic pain related to failed back surgery syndrome: a pilot study

    PubMed Central

    de Nêuton, Francisco; Magalhães, Oliveira; Soares, Sandra Correia; Torres, Jaqueline Melo; Ungaretti, Arthur; Cacciacarro, Mariana Fillipi; Teixeira, Manoel Jacobsen; Fonoff, Erich Talamoni

    2013-01-01

    Introduction In the last two decades, ozone has emerged as a treatment for low back pain, applied by means of minimally invasive techniques. Objective The aim of this study is to assess the effect and safety of ozone therapy applied in the epidural space for chronic pain related to failed back surgery syndrome. Methods The investigators studied 13 sequential patients of both sexes, between 18 and 70 years old, with persistent chronic pain (more than six months) in the lumbar region and in the lower limbs related to failed back surgery syndrome (FBSS). Pain was classified as neuropathic and non-neuropathic regarding the topography (lumbar and lower limb), based on the DN4 (Douleur Neuropathique 4) questionnaire. The patients received the ozone gas in the lumbar epidural space via spinal-sacral endoscopy. Clinical evaluation was performed before, immediately after (24 hours), and 1, 3, and 6 months after intervention with visual analog scale and Oswestry Disability Index (ODI). Results Overall, the patients had 43.7% reduction of lumbar pain, 60.9% reduction in leg pain in six months followed by 44.0% of improvement in ODI. The reduction of pain and in the disability index was markedly greater in patients with non-neuropathic predominant pain, 95.2%, 80.6%, and 75.3% improvement in lumbar, leg pain, and ODI respectively, while neuropathic predominant pain patients experienced only 12.5%, 42.4%, and 20.9% improvement, also respectively. No neurological or infectious complications were observed acutely or during the follow-up. The present data suggests that epidural ozone might be a therapeutic option for persistent low back pain, especially in non-neuropathic predominant pain patients, but double-blind controlled studies are still required to prove its efficacy. PMID:24259984

  18. Transplantation of neural progenitor cells in chronic spinal cord injury.

    PubMed

    Jin, Y; Bouyer, J; Shumsky, J S; Haas, C; Fischer, I

    2016-04-21

    Previous studies demonstrated that neural progenitor cells (NPCs) transplanted into a subacute contusion injury improve motor, sensory, and bladder function. In this study we tested whether transplanted NPCs can also improve functional recovery after chronic spinal cord injury (SCI) alone or in combination with the reduction of glial scar and neurotrophic support. Adult rats received a T10 moderate contusion. Thirteen weeks after the injury they were divided into four groups and received either: 1. Medium (control), 2. NPC transplants, 3. NPC+lentivirus vector expressing chondroitinase, or 4. NPC+lentivirus vectors expressing chondroitinase and neurotrophic factors. During the 8weeks post-transplantation the animals were tested for functional recovery and eventually analyzed by anatomical and immunohistochemical assays. The behavioral tests for motor and sensory function were performed before and after injury, and weekly after transplantation, with some animals also tested for bladder function at the end of the experiment. Transplant survival in the chronic injury model was variable and showed NPCs at the injury site in 60% of the animals in all transplantation groups. The NPC transplants comprised less than 40% of the injury site, without significant anatomical or histological differences among the groups. All groups also showed similar patterns of functional deficits and recovery in the 12weeks after injury and in the 8weeks after transplantation using the Basso, Beattie, and Bresnahan rating score, the grid test, and the Von Frey test for mechanical allodynia. A notable exception was group 4 (NPC together with chondroitinase and neurotrophins), which showed a significant improvement in bladder function. This study underscores the therapeutic challenges facing transplantation strategies in a chronic SCI in which even the inclusion of treatments designed to reduce scarring and increase neurotrophic support produce only modest functional improvements. Further studies will have to identify the combination of acute and chronic interventions that will augment the survival and efficacy of neural cell transplants. PMID:26852702

  19. A comparison of femoral/sciatic nerve block with lateral femoral cutaneous nerve block and combined spinal epidural anesthesia for total knee replacement arthroplasty

    PubMed Central

    Kim, Jong Hae; Cho, Myoung Rae; Kim, Si Oh; Kim, Jung Eun; Lee, Dong Keun

    2012-01-01

    Background Several factors, such as compromised cardiopulmonary function, anticoagulative therapy, or anatomical deformity in the elderly, prevent general anesthesia and neuraxial blockade from being conducted for total knee replacement arthroplasty (TKRA). We investigated the efficacy of femoral/sciatic nerve block with lateral femoral cutaneous nerve block (FSNB) as an alternative procedure in comparison with combined spinal epidural nerve block (CSE) in patients undergoing TKRA. Methods In this observational study, 80 American Society of Anesthesiologists physical status I-III patients scheduled for elective unilateral TKRA underwent CSE (n = 40) or FSNB (n = 40). Perioperative side effects, intraoperative medications, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale pain scores were assessed. Statistical analysis was done using Chi-square test, Student's t-test, and repeated-measures analysis of variances. Results There was significantly more use of antihypertensives, analgesics, and sedatives in the FSNB group. There were no significant differences of perioperative side effects, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale scores between the two groups. Conclusions FSNB with a sophisticated use of antihypertensives, analgesics, and sedatives to supplement insufficient block offers a practical alternative to CSE for TKRAs. PMID:22679542

  20. Determining the Optimal Number of Spinal Manipulation Sessions for Chronic Low-Back Pain

    MedlinePLUS

    ... Number of Spinal Manipulation Sessions for Chronic Low-Back Pain Share: holding_lower_back_pain.jpg © Matthew Lester ... print. Additional Resources Spinal Manipulation for Low-Back Pain Low-Back Pain Information Publication Date: October 16, 2013 Sign ...

  1. Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids

    PubMed Central

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Benyamin, Ramsin M.; Boswell, Mark V.

    2015-01-01

    Study Design: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain. Objective: To assess the comparative efficacy of caudal and lumbar interlaminar approaches of epidural injections in managing axial or discogenic low back pain. Summary of Background Data: Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or discogenic pain, which is pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar pain of presumed discogenic origin is limited. Methods: The present analysis is based on 2 randomized controlled trials of chronic axial low back pain not caused by disc herniation, radiculitis, or facet joint pain, utilizing either a caudal or lumbar interlaminar approach, with a total of 240 patients studied, and a 24-month follow-up. Patients were assigned to receive either local anesthetic only or local anesthetic with a steroid in each 60 patient group. Results: The primary outcome measure was significant improvement, defined as pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months. Conclusion: This assessment shows that in patients with axial or discogenic pain in the lumbar spine after excluding facet joint and SI Joint pain, epidural injections of local anesthetic by the caudal or lumbar interlaminar approach may be effective in managing chronic low back pain with a potential superiority for a lumbar interlaminar approach over a caudal approach. PMID:25678838

  2. Targeted epidural patch with n-butyl cyanoacrylate (n-BCA) through a single catheter access site for treatment of a cerebral spinal fluid leak causing spontaneous intracranial hypotension.

    PubMed

    Woolen, Sean; Gemmete, Joseph J; Pandey, Aditya S; Chaudhary, Neeraj

    2015-01-01

    Spontaneous intracranial hypotension (SIH) usually occurs in the setting of a spontaneous cerebral spinal fluid (CSF) leak. We report the first description of a case of SIH caused by a CSF leak which improved after a targeted epidural patch with n-butyl cyanoacrylate (n-BCA) at the right T1-T2 level. An 81-year-old woman presented with an orthostatic headache for 6?days. MRI of the brain with contrast demonstrated low lying cerebellar tonsils, an engorged transverse sinus flow void, bifrontal small subdural fluid collections, and diffuse dural enhancement. CT myelography showed extravasation of intrathecal contrast at the right T1-T2 level. A targeted epidural patch was performed by injection of n-BCA through a catheter at the right T1-T2 level. After treatment, the patient's symptoms immediately improved and she was without a headache at 1-year follow-up. PMID:26038380

  3. Management of chronic severe pain: spinal neuromodulatory and neuroablative approaches.

    PubMed

    Raslan, A M; McCartney, S; Burchiel, K J

    2007-01-01

    The spinal cord is the target of many neurosurgical procedures used to treat pain. Compactness and well-defined tract separation in addition to well understood dermatomal cord organization make the spinal cord an ideal target for pain procedures. Moreover, the presence of opioid and other receptors involved in pain modulation at the level of the dorsal horn increases the suitability of the spinal cord. Neuromodulative approaches of the spinal cord are either electrical or pharmacological. Electrical spinal cord modulation is used on a large scale for various pain syndromes including; failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), neuropathic pain, angina, and ischemic limb pain. Intraspinal delivery of medications e.g. opioids is used to treat nociceptive and neuropathic pains due to malignant and cancer pain etiologies. Neuroablation of the spinal cord pain pathway is mainly used to treat cancer pain. Targets involved include; the spinothalamic tract, the midline dorsal column visceral pain pathway and the trigeminal tract in the upper spinal cord. Spinal neuroablation can also involve cellular elements such as with trigeminal nucleotomy and the dorsal root entry zone (DREZ) operation. The DREZ operation is indicated for phantom type pain and root avulsion injuries. Due to its reversible nature spinal neuromodulation prevails, and spinal neuroablation is performed in a few select cases. PMID:17691354

  4. Exacerbation of chronic pain following spinal cord injury.

    PubMed

    Widerstrm-Noga, Eva G; Turk, Dennis C

    2004-10-01

    Because of the high prevalence and the refractory nature of pain following spinal cord injury (SCI), it is important to increase the understanding of what factors aggravate different types of pain. This information is related to pain generating mechanisms and may thus be useful in the diagnosis and management of these difficult pain conditions. The aims of the present study were to (1) identify variables (factors) that exacerbate chronic pain associated with SCI and (2) define the relationships among these patterns of pain exacerbation, specific pain characteristics, and psychological features. A sample out of 159 (75.5%) people with SCI and chronic pain, volunteered to participate in a mail survey. Over 50% of the sample indicated that prolonged sitting, infections, fatigue, muscle spasms, cold weather, and sudden movements exacerbated their pain. A principal components analysis detected five sets of factors that were reported to magnify pain: negative mood, prolonged afferent activity (bowel, bladder, somatic), weather, voluntary physical activity, and transient somatic afferent activity. Negative mood and prolonged afferent activity were frequently and significantly associated with both pain characteristics and psychosocial issues. A multiple regression analysis revealed that a combination of decreased activity levels due to pain (t = 3.54; p < 0.001), pain located in the frontal aspects of torso (including genitals) (t = 2.29; p < 0.05), "burning" (t = 2.26; p < 0.05), or "electric" (t = 2.09; p < 0.05) pain, and a limited perception of life control (t = -2.16; p < 0.05) was significantly associated with a high extent of pain aggravation (R2 = 0.39; p < 0.000). PMID:15672629

  5. Licofelone modulates neuroinflammation and attenuates mechanical hypersensitivity in the chronic phase of spinal cord injury

    PubMed Central

    Dulin, Jennifer N.; Karoly, Edward D.; Wang, Ying; Strobel, Henry W.; Grill, Raymond J.

    2013-01-01

    Inflammation is a major factor shaping outcome during the early, acute phase of traumatic spinal cord injury (SCI). It is known that pro-inflammatory signaling within the injured spinal cord drives pathological alterations in neurosensory processing and shapes functional outcome early after injury. However, it is unclear whether inflammation persists into the chronic phase of injury or shapes sensory processing long after injury. In order to investigate these possibilities, we have performed biochemical and behavioral assessments 9 months after moderate thoracic spinal contusion injury in the rat. We have found that levels of the pro-inflammatory lipid mediators leukotriene B4 and prostaglandin E2 are elevated in the chronic spinal cord lesion site. Additionally, using metabolomic profiling, we have detected elevated levels of pro-oxidative and inflammatory metabolites, along with alterations in multiple biological pathways within the chronic lesion site. We found that 28-day treatment of chronically-injured rats with the dual COX/5-LOX inhibitor licofelone elevated levels of endogenous anti-oxidant and anti-inflammatory metabolites within the lesion site. Furthermore, licofelone treatment reduced hypersensitivity of hindpaws to mechanical, but not thermal, stimulation, indicating that mechanical sensitivity is modulated by pro-inflammatory signaling in the chronic phase of injury. Together, these findings provide novel evidence of inflammation and oxidative stress within spinal cord tissue far into the chronic phase of SCI, and demonstrate a role for inflammatory modulation of mechanical sensitivity in the chronic phase of injury. PMID:23303944

  6. Acute Cervical Subdural Hematoma with Quadriparesis after Cervical Transforaminal Epidural Block

    PubMed Central

    Lee, Jun Kyu; Chae, Ki Whan; Kim, Byoung Wook

    2015-01-01

    Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block. PMID:26713152

  7. Effects of Combined Spinal-Epidural Analgesia during Labor on Postpartum Electrophysiological Function of Maternal Pelvic Floor Muscle: A Randomized Controlled Trial

    PubMed Central

    Xiong, Xiao-Ming; Huang, Li; Lao, Cheng-Yi; Yang, Mei; Gao, Shan; Huang, Qiong-Yan; Yang, Wei; Zhu, Yun-Feng; Zhang, Di-Hua

    2015-01-01

    Objective Combined spinal-epidural analgesia (CSEA) is sometimes used for difficult births, but whether it contributes to postpartum pelvic muscle disorder is unclear. This randomized controlled trial examined whether CSEA given during labor affects the electrophysiological index of postpartum pelvic floor muscle function. Methods A consecutive sample of primiparous women who delivered vaginally at term were randomly assigned to a CSEA group (n = 143) and control group (n = 142) between June 2013 and June 2014. All were assessed 68 weeks later for electrophysiological function of pelvic floor muscle. Results The two groups were similar in the degree of muscle strength, muscle fatigue, and pelvic dynamic pressure of pelvic floor muscle. The CSEA and control groups showed similar proportions of women with normal muscle strength (score ?4) in type I pelvic fibers (23.1% vs. 14.1%, P = 0.051) and type II pelvic fibers (28.0% vs. 24.6%, P = 0.524). The groups also contained similar proportions of women who showed no fatigue in type I fibers (54.5% vs. 48.6%, P = 0.315) or type II fibers (88.8% vs. 87.3%, P = 0.699). Similarly low proportions of women in the CSEA group and control group showed normal pelvic dynamic pressure (11.2% vs. 7.7%, P = 0.321). However, women in the CSEA group spent significantly less time in labor than those in the control group (7.25 vs. 9.52 h, P <0.001). Conclusions CSEA did not affect the risk of postpartum pelvic muscle disorder in this cohort of primiparous women who gave birth vaginally. A significant shorter duration of labour was observed in the CSEA-group. Trial Registration ClinicalTrials.gov NCT02334150 PMID:26340002

  8. Epidural steriods.

    PubMed

    Fishman, Scott M

    2005-01-01

    The use of steroids administered into the epidural space to manage low back pain is described in a manner that a clinician might use to explain this intervention to a patient or care-giver. PMID:16219614

  9. Spontaneous epidural hematoma due to cervico-thoracic angiolipoma.

    PubMed

    Eap, C; Bannwarth, M; Jazeron, J-F; Kleber, J-C; Theret, ; Duntze, J; Litre, C-F

    2015-12-01

    Epidural angiolipomas are uncommon benign tumors of the spine. Their clinical presentation is usually a progressive spinal cord compression. We report the case of a 22-year-old patient who presented with an acute paraparesis and a spontaneous epidural hematoma, which revealed a epidural angiolipoma which extended from C7 to T3. The patient underwent a C7-T3 laminectomy, in emergency, with evacuation of the hematoma and extradural complete resection of a fibrous epidural tumor bleeding. The postoperative course was favorable with regression of neurological symptoms. Epidural angiolipomas can be revealed by spontaneous intratumoral hemorrhage without traumatism. The standard treatment is total removal by surgery. PMID:26597606

  10. Sleep onset hypoventilation in chronic spinal cord injury

    PubMed Central

    Bascom, Amy T; Sankari, Abdulghani; Goshgarian, Harry G; Badr, M Safwan

    2015-01-01

    A high prevalence of sleep-disordered breathing (SDB) after spinal cord injury (SCI) has been reported in the literature; however, the underlying mechanisms are not well understood. We sought to determine the effect of the withdrawal of the wakefulness drive to breathe on the degree of hypoventilation in SCI patients and able-bodied controls. We studied 18 subjects with chronic cervical and thoracic SCI (10 cervical, 8 thoracic SCI; 11 males; age 42.417.1years; body mass index 26.34.8kg/m2) and 17 matched able-bodied subjects. Subjects underwent polysomnography, which included quantitative measurement of ventilation, timing, and upper airway resistance (RUA) on a breath-by-breath basis during transitions from wake to stage N1 sleep. Compared to able-bodied controls, SCI subjects had a significantly greater reduction in tidal volume during the transition from wake to N1 sleep (from 0.510.21 to 0.320.10L vs. 0.470.13 to 0.430.12L; respectively, P<0.05). Moreover, end-tidal CO2 and end-tidal O2 were significantly altered from wake to sleep in SCI (38.92.7mmHg vs. 40.63.4mmHg; 94.17.1mmHg vs. 91.28.3mmHg; respectively, P<0.05), but not in able-bodied controls (39.53.2mmHg vs. 39.93.2mmHg; 99.45.4mmHg vs. 98.96.1mmHg; respectively, P=ns). RUA was not significantly altered in either group. In conclusion, individuals with SCI experience hypoventilation at sleep onset, which cannot be explained by upper airway mechanics. Sleep onset hypoventilation may contribute to the development SDB in the SCI population. PMID:26290534

  11. Phrenic motoneuron discharge patterns following chronic cervical spinal cord injury

    PubMed Central

    Lee, Kun-Ze; Dougherty, Brendan J.; Sandhu, Milapjit S.; Lane, Michael A.; Reier, Paul J.; Fuller, David D.

    2013-01-01

    Cervical spinal cord injury (SCI) dramatically disrupts synaptic inputs and triggers biochemical, as well as morphological, plasticity in relation to the phrenic motor neuron (PhMN) pool. Accordingly, our primary purpose was to determine if chronic SCI induces fundamental changes in the recruitment profile and discharge patterns of PhMNs. Individual PhMN action potentials were recorded from the phrenic nerve ipsilateral to lateral cervical (C2) hemisection injury (C2Hx) in anesthetized adult male rats at 2, 4 or 8 wks post-injury and in uninjured controls. PhMNs were phenotypically classified as early (Early-I) or late inspiratory (Late-I), or silent according to discharge patterns. Following C2Hx, the distribution of PhMNs was dominated by Late-I and silent cells. Late-I burst parameters (e.g., spikes per breath, burst frequency and duration) were initially reduced but returned towards control values by 8 wks post-injury. In addition, a unique PhMN burst pattern emerged after C2Hx in which Early-I cells burst tonically during hypocapnic inspiratory apnea. We also quantified the impact of gradual reductions in end-tidal CO2 partial pressure (PETCO2) on bilateral phrenic nerve activity. Compared to control rats, as PETCO2 declined, the C2Hx animals had greater inspiratory frequencies (breaths*min?1) and more substantial decreases in ipsilateral phrenic burst amplitude. We conclude that the primary physiological impact of C2Hx on ipsilateral PhMN burst patterns is a persistent delay in burst onset, transient reductions in burst frequency, and the emergence of tonic burst patterns. The inspiratory frequency data suggest that plasticity in brainstem networks is likely to play an important role in phrenic motor output after cervical SCI. PMID:23954215

  12. Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A.; Pampati, Vidyasagar; Malla, Yogesh

    2014-01-01

    Study Design: A randomized, double-blind, active-controlled trial. Objective: To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or discogenic pain in patients without disc herniation, radiculitis, or facet joint pain. Summary of Background Data: Cervical discogenic pain without disc herniation is a common cause of suffering and disability in the adult population. Once conservative management has failed and facet joint pain has been excluded, cervical epidural injections may be considered as a management tool. Despite a paucity of evidence, cervical epidural injections are one of the most commonly performed nonsurgical interventions in the management of chronic axial or disc-related neck pain. Methods: One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain as determined by means of controlled diagnostic medial branch blocks were randomly assigned to one of the 2 treatment groups. Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL), whereas Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL or 6 mg of nonparticulate betamethasone. The primary outcome measure was ? 50% improvement in pain and function. Outcome assessments included numeric rating scale (NRS), Neck Disability Index (NDI), opioid intake, employment, and changes in weight. Results: Significant pain relief and functional improvement (? 50%) was present at the end of 2 years in 73% of patients receiving local anesthetic only and 70% receiving local anesthetic with steroids. In the successful group of patients, however, defined as consistent relief with 2 initial injections of at least 3 weeks, significant improvement was illustrated in 78% in the local anesthetic group and 75% in the local anesthetic with steroid group at the end of 2 years. The results reported at the one-year follow-up were sustained at the 2-year follow-up. Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and functioning in patients with chronic discogenic or axial pain that is function-limiting and not related to facet joint pain. PMID:24578607

  13. Motoneuron Intrinsic Properties, but Not Their Receptive Fields, Recover in Chronic Spinal Injury

    PubMed Central

    Kajtaz, Elma; Cain, Charlette M.; Heckman, C.J.

    2013-01-01

    Proper movement execution relies on precise input processing by spinal motoneurons (MNs). Spinal MNs are activated by limb joint rotations. Typically, their movement-related receptive fields (MRRFs) are sharply focused and joint-specific. After acute spinal transection MRRFs become wide, but their manifestation is not apparent, as intrinsic excitability, primarily resulting from the loss of persistent inward currents (PICs), dramatically decreases. PICs undergo a remarkable recovery with time after injury. Here we investigate whether MRRFs undergo a recovery that parallels that of the PIC. Using the chronic spinal cat in acute terminal decerebrate preparations, we found that MRRFs remain expanded 1 month after spinal transaction, whereas PICs recovered to >80% of their preinjury amplitudes. These recovered PICs substantially amplified the expanded inputs underlying the MRRFs. As a result, we show that single joint rotations lead to the activation of muscles across the entire limb. These results provide a potential mechanism for the propagation of spasms throughout the limb. PMID:24285887

  14. The Emerging Role of Spinal Dynorphin in Chronic Pain: A Therapeutic Perspective.

    PubMed

    Podvin, Sonia; Yaksh, Tony; Hook, Vivian

    2016-01-01

    Notable findings point to the significance of the dynorphin peptide neurotransmitter in chronic pain. Spinal dynorphin neuropeptide levels are elevated during development of chronic pain and sustained during persistent chronic pain. Importantly, knockout of the dynorphin gene prevents development of chronic pain in mice, but acute nociception is unaffected. Intrathecal (IT) administration of opioid and nonopioid dynorphin peptides initiates allodynia through a nonopioid receptor mechanism; furthermore, antidynorphin antibodies administered by the IT route attenuate chronic pain. Thus, this review presents the compelling evidence in the field that supports the role of dynorphin in facilitating the development of a persistent pain state. These observations illustrate the importance of elucidating the control mechanisms responsible for the upregulation of spinal dynorphin in chronic pain. Also, spinal dynorphin regulation of downstream signaling molecules may be implicated in hyperpathic states. Therapeutic strategies to block the upregulation of spinal dynorphin may provide a nonaddictive approach to improve the devastating condition of chronic pain that occurs in numerous human diseases. PMID:26738478

  15. Spinal fusion

    MedlinePLUS

    ... Anterior spinal fusion; Spine surgery - spinal fusion; Low back pain - fusion; Herniated disk - fusion ... If you had chronic back pain before surgery, you will likely still have some pain afterward. Spinal fusion is unlikely to take away all your pain ...

  16. STAT3-dependent reactive astrogliosis in the spinal dorsal horn underlies chronic itch.

    PubMed

    Shiratori-Hayashi, Miho; Koga, Keisuke; Tozaki-Saitoh, Hidetoshi; Kohro, Yuta; Toyonaga, Honami; Yamaguchi, Chiharu; Hasegawa, Ayumi; Nakahara, Takeshi; Hachisuka, Junichi; Akira, Shizuo; Okano, Hideyuki; Furue, Masutaka; Inoue, Kazuhide; Tsuda, Makoto

    2015-08-01

    Chronic itch is an intractable symptom of inflammatory skin diseases, such as atopic and contact dermatitis. Recent studies have revealed neuronal pathways selective for itch, but the mechanisms by which itch turns into a pathological chronic state are poorly understood. Using mouse models of atopic and contact dermatitis, we demonstrate a long-term reactive state of astrocytes in the dorsal horn of the spinal segments that corresponds to lesioned, itchy skin. We found that reactive astrogliosis depended on the activation of signal transducer and activator of transcription 3 (STAT3). Conditional disruption of astrocytic STAT3 suppressed chronic itch, and pharmacological inhibition of spinal STAT3 ameliorated the fully developed chronic itch. Mice with atopic dermatitis exhibited an increase in scratching elicited by intrathecal administration of the itch-inducer gastrin-releasing peptide (GRP), and this enhancement was normalized by suppressing STAT3-mediated reactive astrogliosis. Moreover, we identified lipocalin-2 (LCN2) as an astrocytic STAT3-dependent upregulated factor that was crucial for chronic itch, and we demonstrated that intrathecal administration of LCN2 to normal mice increased spinal GRP-evoked scratching. Our findings indicate that STAT3-dependent reactive astrocytes act as critical amplifiers of itching through a mechanism involving the enhancement of spinal itch signals by LCN2, thereby providing a previously unrecognized target for treating chronic itch. PMID:26193341

  17. Delayed Onset of Subdural Hematoma following Epidural Catheter Breakage

    PubMed Central

    Ishikawa, Yoshimoto; Imagama, Shiro; Ito, Zenya; Ando, Kei; Gotoh, Momokazu; Nishiwaki, Kimitoshi; Nagao, Yoshimasa; Ishiguro, Naoki

    2015-01-01

    Study Design?Case report. Objectives?To describe a case of delayed-onset spinal hematoma following the breakage of a spinal epidural catheter. Methods?The authors describe the clinical case review. Results?A 64-year-old woman had undergone epidural anesthesia 18 years before she was referred to our hospital because of lower-back pain and lower neurologic deficit with leg pain. The clinical examination showed the presence of a fragment of an epidural catheter in the thoracolumbar canal, as assessed by computed tomography, and a spinal hematoma that compressed the spinal cord at the same spinal level, as assessed by magnetic resonance imaging. Surgical removal of the epidural catheter and decompression surgery were performed. The patient exhibited substantial clinical improvement 1?month after surgery; she achieved a steady gait without the need for a cane and had no leg pain. Conclusion?This is the first report of delayed onset of spinal hematoma following the breakage of an epidural catheter. Generally, when the breakage of an epidural catheter occurs without symptoms, follow-up alone is recommended. However, because spinal hematoma might exhibit a late onset, the possibility of this complication should be considered when deciding whether to remove the catheter fragment. We believe that in our patient, there could be a relationship between the catheter fragment and subdural hematoma, and catheter breakage could have been a risk factor for the spinal hematoma.

  18. Spinal translocator protein alleviates chronic neuropathic pain behavior and modulates spinal astrocyte-neuronal function in rats with L5 spinal nerve ligation model.

    PubMed

    Liu, Xiaoming; Liu, Hongjun; Xu, Shuangshuang; Tang, Zongxiang; Xia, Weiliang; Cheng, Zhuqiang; Li, Weiyan; Jin, Yi

    2016-01-01

    Recent studies reported the translocator protein (TSPO) to play critical roles in several kinds of neurological diseases including the inflammatory and neuropathic pain. However, the precise mechanism remains unclear. This study was undertaken to explore the distribution and possible mechanism of spinal TSPO against chronic neuropathic pain (CNP) in a rat model of L5 spinal nerve ligation (SNL). Our results showed that TSPO was upregulated in a time-related manner in the spinal dorsal horn after SNL. Spinal TSPO was predominately expressed in astrocytes. A single intrathecal injection of TSPO agonist Ro5-4864, but not TSPO antagonist PK11195, alleviated the mechanical allodynia in a dose-dependent manner. A single intraspinal injection of TSPO overexpression lentivirus (LV-TSPO), but not TSPO inhibited lentivirus (LV-shTSPO), also relieved the development of CNP. Intrathecal administration of 2 ?g Ro5-4864 on day 3 induced a significant increase of TSPO protein content at the early stage (days 5-7) while inhibited the TSPO activation during the chronic period (days 14-21) compared with the control group. Ro5-4864 suppressed the astrocytes and p-JNK1 activation and decreased the CXCL1 expression in both in vivo and in vitro studies. Ro5-4864 also attenuated the spinal CXCR2 and p-ERK expressions. These results suggested that early upregulation of TSPO could elicit potent analgesic effects against CNP, which might be partly attributed to the inhibition of CXCL1-CXCR2-dependent astrocyte-to-neuron signaling and central sensitization. TSPO signaling pathway may present a novel strategy for the treatment of CNP. PMID:26307860

  19. Single-Fraction Versus 5-Fraction Radiation Therapy for Metastatic Epidural Spinal Cord Compression in Patients With Limited Survival Prognoses: Results of a Matched-Pair Analysis

    SciTech Connect

    Rades, Dirk; Huttenlocher, Stefan; Šegedin, Barbara; Perpar, Ana; Conde, Antonio J.; Garcia, Raquel; Veninga, Theo; Stalpers, Lukas J.A.; Cacicedo, Jon; Rudat, Volker; Schild, Steven E.

    2015-10-01

    Purpose: This study compared single-fraction to multi-fraction short-course radiation therapy (RT) for symptomatic metastatic epidural spinal cord compression (MESCC) in patients with limited survival prognosis. Methods and Materials: A total of 121 patients who received 8 Gy × 1 fraction were matched (1:1) to 121 patients treated with 4 Gy × 5 fractions for 10 factors including age, sex, performance status, primary tumor type, number of involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MESCC, pre-RT ambulatory status, and time developing motor deficits prior to RT. Endpoints included in-field repeated RT (reRT) for MESCC, overall survival (OS), and impact of RT on motor function. Univariate analyses were performed with the Kaplan-Meier method and log-rank test for in-field reRT for MESCC and OS and with the ordered-logit model for effect of RT on motor function. Results: Doses of 8 Gy × 1 fraction and 4 Gy × 5 fractions were not significantly different with respect to the need for in-field reRT for MESCC (P=.11) at 6 months (18% vs 9%, respectively) and 12 months (30% vs 22%, respectively). The RT regimen also had no significant impact on OS (P=.65) and post-RT motor function (P=.21). OS rates at 6 and 12 months were 24% and 9%, respectively, after 8 Gy × 1 fraction versus 25% and 13%, respectively, after 4 Gy × 5 fractions. Improvement of motor function was observed in 17% of patients after 8 Gy × 1 fraction and 23% after 4 Gy × 5 fractions, respectively. Conclusions: There were no significant differences with respect to need for in-field reRT for MESCC, OS, and motor function by dose fractionation regimen. Thus, 8 Gy × 1 fraction may be a reasonable option for patients with survival prognosis of a few months.

  20. Cervical epidural abscess following an Escherichia coli urinary tract infection

    PubMed Central

    O'Neill, Shane C; Baker, Joseph F; Ellanti, Prasad; Synnott, Keith

    2014-01-01

    A previously healthy 64-year-old man developed an Escherichia coli spinal epidural abscess (SEA) isolated to the cervical vertebrae posturinary tract infection 9?days previously. He subsequently underwent emergent surgical decompression followed by a prolonged course of intravenous antibiotics. He is symptom free at 1-year follow-up. SEA is an uncommon condition. Even with modern surgical techniques and antimicrobial agents, the mortality remains significant. Intravenous drug use, spinal procedures and medical conditions such as diabetes, Crohn's disease and chronic renal failure are all known risk factors for SEA and the majority of cases are associated with at least one of these risk factors. The case report highlights the importance of maintaining a high index of suspicion for this condition even in patients without established risk factors who present with red flag symptoms: back pain, fever and neurological deficit, as the consequences of a delayed diagnosis can be severe. PMID:24473426

  1. Recombinant neural progenitor transplants in the spinal dorsal horn alleviate chronic central neuropathic pain.

    PubMed

    Jergova, Stanislava; Gajavelli, Shyam; Pathak, Nirmal; Sagen, Jacqueline

    2016-04-01

    Neuropathic pain induced by spinal cord injury (SCI) is clinically challenging with inadequate long-term treatment options. Partial pain relief offered by pharmacologic treatment is often counterbalanced by adverse effects after prolonged use in chronic pain patients. Cell-based therapy for neuropathic pain using GABAergic neuronal progenitor cells (NPCs) has the potential to overcome untoward effects of systemic pharmacotherapy while enhancing analgesic potency due to local activation of GABAergic signaling in the spinal cord. However, multifactorial anomalies underlying chronic pain will likely require simultaneous targeting of multiple mechanisms. Here, we explore the analgesic potential of genetically modified rat embryonic GABAergic NPCs releasing a peptidergic NMDA receptor antagonist, Serine-histogranin (SHG), thus targeting both spinal hyperexcitability and reduced inhibitory processes. Recombinant NPCs were designed using either lentiviral or adeno-associated viral vectors (AAV2/8) encoding single and multimeric (6 copies of SHG) cDNA. Intraspinal injection of recombinant cells elicited enhanced analgesic effects compared with nonrecombinant NPCs in SCI-induced pain in rats. Moreover, potent and sustained antinociception was achieved, even after a 5-week postinjury delay, using recombinant multimeric NPCs. Intrathecal injection of SHG antibody attenuated analgesic effects of the recombinant grafts suggesting active participation of SHG in these antinociceptive effects. Immunoblots and immunocytochemical assays indicated ongoing recombinant peptide production and secretion in the grafted host spinal cords. These results support the potential for engineered NPCs grafted into the spinal dorsal horn to alleviate chronic neuropathic pain. PMID:26761378

  2. Contributions of spinal D-amino acid oxidase to chronic morphine-induced hyperalgesia.

    PubMed

    Ma, Shuai; Li, Xin-Yan; Gong, Nian; Wang, Yong-Xiang

    2015-12-10

    Spinal D-amino acid oxidase (DAAO) is an FAD-dependent peroxisomal flavoenzyme which mediates the conversion of neutral and polar D-amino acids (including D-serine) to the corresponding ?-keto acids, and simultaneously produces hydrogen peroxide and ammonia. This study has aimed to explore the potential contributions of spinal DAAO and its mediated hydrogen peroxide/D-serine metabolism to the development of morphine-induced hyperalgesia. Bi-daily subcutaneous injections of morphine to mice over 7 days induced thermal hyperalgesia as measured by both the hot-plate and tail-immersion tests, and spinal astroglial activation with increased spinal gene expression of DAAO, glial fibrillary acidic protein (GFAP) and pro-inflammatory cytokines (interleukin-1? (IL-1?), interleukin-6 (IL-6) and tumor necrosis factor-? (TNF-?)). Subcutaneous injections of the potent DAAO inhibitor CBIO (5-chloro-benzo[D]isoxazol-3-ol) prevented and reversed the chronic morphine-induced hyperalgesia. CBIO also inhibited both astrocyte activation and the expression of pro-inflammatory cytokines. Intrathecal injection of the hydrogen peroxide scavenger PBN (phenyl-N-tert-butylnitrone) and of catalase completely reversed established morphine hyperalgesia, whereas subcutaneous injections of exogenous D-serine failed to alter chronic morphine-induced hyperalgesia. These results provided evidence that spinal DAAO and its subsequent production of hydrogen peroxide rather than the D-serine metabolism contributed to the development of morphine-induced hyperalgesia. PMID:25850373

  3. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection.

    PubMed

    Lee, Yujin; Kim, Joon-Sung; Kim, Ji Yeon

    2015-06-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  4. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection

    PubMed Central

    Kim, Joon-Sung; Kim, Ji Yeon

    2015-01-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  5. Role of MK2 signaling pathway in the chronic compression of cervical spinal cord

    PubMed Central

    Song, Hongxing; Fang, Xiutong; Wen, Mingjie; Yu, Fang; Gao, Kai; Sun, Chenli; Wang, Zhenwei

    2015-01-01

    Objective: In this study, chronic compression of cervical spinal cord was introduced into twy/twy mice and the role of MK2 signaling pathway was investigated in this disease. Methods: twy/twy mice aged 6-24 weeks were used and the inflammatory response in the cervical spinal cord was observed. The Institute of Cancer Research (ICR) mice were used as controls. MK2 inhibitor (PF-3644022, 30 mg/kg) was administered intragastrically to twy/twy mice. The motor behavior was firstly observed in these three groups by Catwalk gait analysis. And the cervical spinal cord between C2 and C3 of vertebral segments was analyzed by MRI and Western blot assay. Results: The stride length of paws and interlimb coordination reduced in twy/twy mice. However, at 4 weeks after PF-3644022 treatment, a marked improvement was observed in the motor function. The expressions of inflammation related factors (such as IL-1?, NF-?B, TNF-?, MK2 and p-MK2) and apoptosis related proteins (such as cleaved caspase-8 and bax/bcl-2) in the spinal cord of twy/twy mice significantly increased as compared to controls, but 4-week treatment with PF-3644022 markedly reduced the expressions of these factors and apoptotic proteins in the cervical spinal cord. Conclusion: MK2 signaling pathway is involved in the chronic compression induced inflammation of the cervical spinal cord. Thus, to inhibit the MK2 pathway may used to improve the outcome and prevent the deterioration of neurological dysfunction. PMID:26807183

  6. The maternal and fetal cardiovascular effects of epidural morphine in the sheep model.

    PubMed

    Craft, J B; Bolan, J C; Coaldrake, L A; Mondino, M; Mazel, P; Gilman, R M; Shokes, L K; Woolf, W A

    1982-04-01

    Interest in the use of epidural narcotics for analgesia has been widespread since the demonstration of opiate receptors in the spinal cord in the mid nineteen-seventies. Recently, several studies have attempted to evaluate the effectiveness of epidural narcotics for the relief of pain in labor and after cesarean section. Using the chronically catheterized maternal-fetal sheep model, we injected 5 mg of preservative-free morphine into the epidural space. No statistically significant changes were observed, neither in maternal or fetal arterial pressure and acid-base status, nor in maternal central venous pressure, systemic and pulmonary vascular resistance, cardiac output, or intrauterine pressure (p greater than 0.05). There was a significant, although small, decrease in maternal heart rate (8%) and uterine blood flow (9%) at 120 minutes (p less than 0.05), and then a return to control values. The maternal levels of morphine peaked at 15 minutes (29 ng/ml) and the fetal levels of morphine peaked at 90 minutes (3 to 4 ng/ml). We conclude that the injection of 5 mg of morphine into the maternal epidural space has no adverse effect on mother or fetus in the sheep model. PMID:7065061

  7. Spinal cord microstimulation generates functional limb movements in chronically implanted cats.

    PubMed

    Mushahwar, V K; Collins, D F; Prochazka, A

    2000-06-01

    Spinal cord injuries disrupt the communication between the brain and peripheral nerves, but leave motoneurons and networks of interneurons below the level of the lesion intact. It is therefore possible to restore some function following injury by providing an artificial stimulus to the surviving neurons below the level of the lesion. We report here on a novel approach for generating functional movements by electrically stimulating the spinal cord through chronically implanted ultrafine, hair-like electrodes. Six to 12 microwires were implanted in the lumbar enlargement of intact cats for 6 months. Twice a week, trains of stimuli were delivered through each microwire and the evoked electromyographic and torque responses were recorded. Strong coordinated hindlimb movements were obtained by stimulating through individual electrodes. The joint torques elicited were capable of supporting the animals' hindquarters. The responses were stable over time and the contractions caused no apparent discomfort to the animals. No obvious motor deficits were seen throughout the 6-month duration of implantation. The results demonstrate that microwires implanted in the spinal cord remain stably in place and stimulation through these electrodes produces strong, controllable movements. This provides a promising basis for the use of spinal cord neuroprostheses in restoring mobility following spinal cord injury. PMID:10833317

  8. Spinal blocks.

    PubMed

    Kokki, Hannu

    2012-01-01

    Every anesthetist should have the expertise to perform lumbar puncture that is the prerequisite to induce spinal anesthesia. Spinal anesthesia is easy and effective technique: small amount of local anesthetic injected in the lumbar cerebrospinal fluid provides highly effective anesthesia, analgesia, and sympathetic and motor block in the lower part of the body. The main limitation of spinal anesthesia is a variable and relatively short duration of the block with a single-injection of local anesthetic. With appropriate use of adjuvant or combining spinal anesthesia with epidural anesthesia, the analgesic action can be controlled in case of early recovery of initial block or in patients with prolonged procedures. Contraindications are rare. Bleeding disorders and any major dysfunction in coagulation system are rare in children, but spinal anesthesia should not be used in children with local infection or increased intracranial pressure. Children with spinal anesthesia may develop the same adverse effects as has been reported in adults, but in contrast to adults, cardiovascular deterioration is uncommon in children even with high blocks. Most children having surgery with spinal anesthesia need sedation, and in these cases, close monitoring of sufficient respiratory function and protective airway reflexes is necessary. Postdural puncture headache and transient neurological symptoms have been reported also in pediatric patients, and thus, guardians should be provided instructions for follow-up and contact information if symptoms appear or persist after discharge. Epidural blood patch is effective treatment for prolonged, severe headache, and nonopioid analgesic is often sufficient for transient neurological symptoms. PMID:21899656

  9. Therapeutic activities of engrafted neural stem/precursor cells are not dormant in the chronically injured spinal cord.

    PubMed

    Kumamaru, Hiromi; Saiwai, Hirokazu; Kubota, Kensuke; Kobayakawa, Kazu; Yokota, Kazuya; Ohkawa, Yasuyuki; Shiba, Keiichiro; Iwamoto, Yukihide; Okada, Seiji

    2013-08-01

    The transplantation of neural stem/precursor cells (NSPCs) is a promising therapeutic strategy for many neurodegenerative disorders including spinal cord injury (SCI) because it provides for neural replacement or trophic support. This strategy is now being extended to the treatment of chronic SCI patients. However, understanding of biological properties of chronically transplanted NSPCs and their surrounding environments is limited. Here, we performed temporal analysis of injured spinal cords and demonstrated their multiphasic cellular and molecular responses. In particular, chronically injured spinal cords were growth factor-enriched environments, whereas acutely injured spinal cords were enriched by neurotrophic and inflammatory factors. To determine how these environmental differences affect engrafted cells, NSPCs transplanted into acutely, subacutely, and chronically injured spinal cords were selectively isolated by flow cytometry, and their whole transcriptomes were compared by RNA sequencing. This analysis revealed that NSPCs produced many regenerative/neurotrophic molecules irrespective of transplantation timing, and these activities were prominent in chronically transplanted NSPCs. Furthermore, chronically injured spinal cords permitted engrafted NSPCs to differentiate into neurons/oligodendrocytes and provided more neurogenic environment for NSPCs than other environments. Despite these results demonstrate that transplanted NSPCs have adequate capacity in generating neurons/oligodendrocytes and producing therapeutic molecules in chronic SCI microenvironments, they did not improve locomotor function. Our results indicate that failure in chronic transplantation is not due to the lack of therapeutic activities of engrafted NSPCs but the refractory state of chronically injured spinal cords. Environmental modulation, rather modification of transplanting cells, will be significant for successful translation of stem cell-based therapies into chronic SCI patients. PMID:23606608

  10. Analgesic action of suspended moxibustion in rats with chronic visceral hyperalgesia correlates with enkephalins in the spinal cord.

    PubMed

    Yi, Tao; Qi, Li; Wu, Huangan; Ma, Xiaopeng; Liu, Huirong; Wang, Xiaomei

    2012-01-25

    Rats that modeled chronic visceral hyperalgesia received suspended moxibustion at bilateral Tianshu (ST25) and Shangjuxu (ST37) once daily over a period of 7 days. Results show that suspended moxibustion significantly depressed abdominal withdrawal reflex scores and increased enkephalin concentration in the spinal cord. The experimental findings suggest that spinal enkephalins contributed to the analgesic effect of suspended moxibustion in rats with chronic visceral hyperalgesia. PMID:25767503

  11. Heterotopic inputs facilitate poststimulus afterdischarges of spinal WDR neurons in rats with chronic nerve constriction.

    PubMed

    Sotgiu, Maria Luisa; Valente, Maurizio; Caramenti, Gian Carlo; Biella, Gabriele Eliseo Mario

    2006-07-12

    Heterotopic inputs activate spinal wide dynamic range (WDR) neurons in rats with chronic constriction of one sciatic nerve (CCI rats). A possible contribution from these inputs, to long-lasting afterdischarges (ADs) of noxious evoked responses, was investigated during reversible input blockade from adjacent saphenous nerve and contralateral peripheral nerve territories. The results show significant AD reduction or suppression, indicating that heterotopic afferences contribute to mechanisms underlying prolonged ADs. PMID:16797491

  12. [Spinal electrostimulation in the treatment of advanced chronic obliterating arteriopathies].

    PubMed

    Visconti, W; Fontana, P; Buonocore, P; Grillo, N; Seno, S

    1996-01-01

    From 1989 to 1992 83 patients suffering from peripheral vascular disease without medical or surgical possibilities, were treated by spinal cord stimulation (SCS). We studied claudicatio intermittens, rest pain and ischemic lesion behaviour in all the patients. We also studied microcirculation behaviour of 21 patients, by oxygen transcutaneous tension (vasodilatation index VI = TcPO2 42 degrees C: TcPO2 45 degrees C) and laser Doppler flowmetry (resting flow RF, standing flow SF, venoarteriolar reflex VAR = RF - SF, flow temperature increase FTI = F 40 degrees C 15'-RF). The clinical follow-up at 2 years showed an improvement of walking distance in 85.7% of 7 controls, a complete rest pain control in 82.35% of 17 controls, an improvement and healing of ischemic lesions respectively in 27.07% and 53.86% of 18 controls. In arteriosclerotic arteriopathy with or without diabetes but without neuropathy VI increased and FTI decreased, after SCS, showing a sympathetic tone decrease. In arteriosclerotic arteriopathy with diabetic neuropathy V.I. decreased and FTI increased, after SCS, showing a sympathetic tone reappearance. VAR improved or reappeared, in arteriosclerotic arteriopathy with or without diabetes, showing improvement of tissue perfusion as regards a better efficiency of "paramicrovessels" and "microvascular unit". We believe that SCS, as regards favourable clinical results represents a useful and effective treatment in peripheral vascular disease treatment. PMID:8767618

  13. Epidural abscess

    MedlinePLUS

    ... infections Boils especially on the back or scalp Bone infections of the spine (vertebral osteomyelitis) People who inject ... Complications may include: Brain abscess Brain damage Bone ... Meningitis Nerve damage Return of infection Spinal cord abscess

  14. Thoracic Extraosseous Epidural Cavernous Hemangioma

    PubMed Central

    Asil, Kiyasettin; Ceylan, Davut; Erdem, Sahin

    2015-01-01

    Cavernous hemangiomas were first reported in 1929 by Globus and Doshay, and are defined as benign vascular structures developed between the neural tissues occurring in the central nervous system, consisting of a dilated vascular bed. Cavernous hemangiomas comprise nearly 5-12% of all spinal vascular malformations; however, existence in the epidural space without bone involvement is rare. Only 4% of all cavernous hemangiomas (0.22/1.000.000) are purely epidural cavernous hemangiomas. In this case report, we removed a hemorrhagic thoracic mass presenting with progressive neurological deficits in a 55-year-old male patient. We found this case to be appropriate for presentation due to the rare occurrence of this type of cavernous hemangioma. PMID:25674348

  15. Chronic spinal compression model in minipigs: a systematic behavioral, qualitative, and quantitative neuropathological study.

    PubMed

    Navarro, Roman; Juhas, Stefan; Keshavarzi, Sassan; Juhasova, Jana; Motlik, Jan; Johe, Karl; Marsala, Silvia; Scadeng, Miriam; Lazar, Peter; Tomori, Zoltan; Schulteis, Gery; Beattie, Michael; Ciacci, Joseph D; Marsala, Martin

    2012-02-10

    The goal of the present study was to develop a porcine spinal cord injury (SCI) model, and to describe the neurological outcome and characterize the corresponding quantitative and qualitative histological changes at 4-9 months after injury. Adult Gottingen-Minnesota minipigs were anesthetized and placed in a spine immobilization frame. The exposed T12 spinal segment was compressed in a dorso-ventral direction using a 5-mm-diameter circular bar with a progressively increasing peak force (1.5, 2.0, or 2.5?kg) at a velocity of 3?cm/sec. During recovery, motor and sensory function were periodically monitored. After survival, the animals were perfusion fixed and the extent of local SCI was analyzed by (1) post-mortem MRI analysis of dissected spinal cords, (2) qualitative and quantitative analysis of axonal survival at the epicenter of injury, and (3) defining the presence of local inflammatory changes, astrocytosis, and schwannosis. Following 2.5-kg spinal cord compression the animals demonstrated a near complete loss of motor and sensory function with no recovery over the next 4-9 months. Those that underwent spinal cord compression with 2 kg force developed an incomplete injury with progressive partial neurological recovery characterized by a restricted ability to stand and walk. Animals injured with a spinal compression force of 1.5?kg showed near normal ambulation 10 days after injury. In fully paralyzed animals (2.5?kg), MRI analysis demonstrated a loss of spinal white matter integrity and extensive septal cavitations. A significant correlation between the magnitude of loss of small and medium-sized myelinated axons in the ventral funiculus and neurological deficits was identified. These data, demonstrating stable neurological deficits in severely injured animals, similarities of spinal pathology to humans, and relatively good post-injury tolerance of this strain of minipigs to spinal trauma, suggest that this model can successfully be used to study therapeutic interventions targeting both acute and chronic stages of SCI. PMID:22029501

  16. Chronic Spinal Compression Model in Minipigs: A Systematic Behavioral, Qualitative, and Quantitative Neuropathological Study

    PubMed Central

    Navarro, Roman; Juhas, Stefan; Keshavarzi, Sassan; Juhasova, Jana; Motlik, Jan; Johe, Karl; Marsala, Silvia; Scadeng, Miriam; Lazar, Peter; Tomori, Zoltan; Schulteis, Gery; Beattie, Michael; Ciacci, Joseph D.

    2012-01-01

    Abstract The goal of the present study was to develop a porcine spinal cord injury (SCI) model, and to describe the neurological outcome and characterize the corresponding quantitative and qualitative histological changes at 49 months after injury. Adult Gottingen-Minnesota minipigs were anesthetized and placed in a spine immobilization frame. The exposed T12 spinal segment was compressed in a dorso-ventral direction using a 5-mm-diameter circular bar with a progressively increasing peak force (1.5, 2.0, or 2.5?kg) at a velocity of 3?cm/sec. During recovery, motor and sensory function were periodically monitored. After survival, the animals were perfusion fixed and the extent of local SCI was analyzed by (1) post-mortem MRI analysis of dissected spinal cords, (2) qualitative and quantitative analysis of axonal survival at the epicenter of injury, and (3) defining the presence of local inflammatory changes, astrocytosis, and schwannosis. Following 2.5-kg spinal cord compression the animals demonstrated a near complete loss of motor and sensory function with no recovery over the next 49 months. Those that underwent spinal cord compression with 2?kg force developed an incomplete injury with progressive partial neurological recovery characterized by a restricted ability to stand and walk. Animals injured with a spinal compression force of 1.5?kg showed near normal ambulation 10 days after injury. In fully paralyzed animals (2.5?kg), MRI analysis demonstrated a loss of spinal white matter integrity and extensive septal cavitations. A significant correlation between the magnitude of loss of small and medium-sized myelinated axons in the ventral funiculus and neurological deficits was identified. These data, demonstrating stable neurological deficits in severely injured animals, similarities of spinal pathology to humans, and relatively good post-injury tolerance of this strain of minipigs to spinal trauma, suggest that this model can successfully be used to study therapeutic interventions targeting both acute and chronic stages of SCI. PMID:22029501

  17. Unusual cervical spine epidural abscess.

    PubMed

    Liou, Jr-Han; Su, Yu-Jang

    2015-10-01

    A 48-year-old man presented to the emergency department with complain of severe neck pain and anterior chest pain. Intermittent fever in the recent 2 days was also noted. There is a track maker over his left side of neck. The laboratory examination showed leukocytosis and high C-reactive protein level. Urine drug screen was positive for opiate. Empirical antibiotic administration was given. Blood culture grew gram-positive cocci in chain, and there was no vegetation found by heart echocardiogram. However, progressive weakness of four limbs was noted, and patient even cannot stand up and walk. The patient also complained of numbness sensation over bilateral hands and legs, and lower abdomen. Acute urine retention occurred. We arranged magnetic resonance imaging survey, which showed evidence of inflammatory process involving the retropharyngeal spaces and epidural spaces from the skull base to the bony level of T5. Epidural inflammatory process resulted in compression of the spinal cord and bilateral neural foramen narrowing. Neurosurgeon was consulted. Operation with laminectomy and posterior fusion with bone graft and internal fixation was done. Culture of epidural abscess and 2 sets of blood culture all yielded methicillin-sensitive Staphylococcus aureus. For epidural abscess, the most common involved spine is lumbar followed by thoracic and cervical spine. Diagnosis and treatment in the drug abusers are still challenging because they lack typical presentation, drug compliance, and adequate follow-up and because it is hard to stop drug abuser habit. Significant improvement of neurological deficit can be expected in most spinal abscess in drug abusers after treatment. PMID:26298050

  18. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions

    PubMed Central

    Manchikanti, Laxmaiah; Boswell, Mark V; Singh, Vijay; Pampati, Vidyasagar; Damron, Kim S; Beyer, Carla D

    2004-01-01

    Background Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Methods Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting. Results The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% 61%), with thoracic spine pain was 42% (95% CI, 30% 53%), and in with lumbar spine pain was 31% (95% CI, 27% 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% 72%) in the cervical spine, 55% (95% CI, 39% 78%) in the thoracic spine, and 27% (95% CI, 22% 32%) in the lumbar spine. Conclusion This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain. PMID:15169547

  19. Spontaneous thoracic epidural hematoma: a case report and literature review.

    PubMed

    Babayev, Rasim; Ek?i, Murat ?akir

    2016-01-01

    Spinal epidural hematoma is a rare neurosurgical emergency in respect of motor and sensory loss. Identifiable reasons for spontaneous hemorrhage are vascular malformations and hemophilias. We presented a case of spontaneous epidural hematoma in an 18-year-old female patient who had motor and sensory deficits that had been present for 1day. On MRI, there was spinal epidural hematoma posterior to the T2-T3 spinal cord. The hematoma was evacuated with T2 hemilaminectomy and T3 laminectomy. Patient recovered immediately after the surgery. Literature review depicted 112 pediatric cases (including the presented one) of spinal epidural hematoma. The female/male ratio is 1.1:2. Average age at presentation is 7.09years. Clinical presentations include loss of strength, sensory disturbance, bowel and bladder disturbances, neck pain, back pain, leg pain, abdominal pain, meningismus, respiratory difficulty, irritability, gait instability, and torticollis. Most common spinal level was cervicothoracic spine. Time interval from symptom onset to clinical diagnosis varied from immediate to 18months. Spinal epidural hematoma happened spontaneously in 71.8% of the cases, and hemophilia was the leading disorder (58%) in the cases with a definable disorder. Partial or complete recovery is possible after surgical interventions and factor supplementations. PMID:26033378

  20. Epidural injection with or without steroid in managing chronic low back and lower extremity pain: ameta-analysis of ten randomized controlled trials

    PubMed Central

    Zhai, Jinshuai; Zhang, Long; Li, Mengya; Tian, Yiren; Zheng, Wang; Chen, Jia; Huang, Teng; Li, Xicheng; Tian, Zhi

    2015-01-01

    Background: Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the two interventions in managing various chronic low and lower extremity pain. Methods: A systematic literature search was conducted to identify randomized controlled trials (RCTs) which compared the effect of local anesthetic with or without steroids. The outcomes included pain relief, functional improvement, opioid intake, and therapeutic procedural characteristics. Pooled estimates were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies. Results: 10 RCTs (involving 1111 patients) were included in this meta-analysis. The pooled results showed that 41.7% of patients who received local anesthetic with steroid (group 1) and 40.2% of patients who received local anesthetic alone (group 2) had significant improvement in pain relief. And the Numeric Rating Scale pain scales were significantly reduced by 4.09 scores (95% CI: -4.26, -3.91), and 4.12 (95% CI: -4.35, -3.89) scores, respectively. Similarly, 39.8% of patients in group 1 and 40.7% of patients in group 2 achieved significantly improved functional status. The Oswestry Disability Index in the two groups were reduced by 14.5 (95% CI: -15.24, -13.75) and 12.37 (95% CI: -16.13, -8.62), respectively. The average procedures per year in group 1 was 3.68 1.17 and 3.68 1.26 in group 2 with an average total relief per year of 31.67 13.17 weeks and 32.64 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI: -12.24, -5.38) and 16.92 mg (95% CI: -22.71, -11.12) in the two groups, respectively. Conclusion: This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have beneficial but similar effects in the treatment of patients with chronic low back and lower extremity pain. PMID:26309483

  1. Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report.

    PubMed

    Chae, Yun Jeong; Han, Kyung Ream; Park, Hyung Bae; Kim, Chan; Nam, Si Gweon

    2016-02-01

    We report a case of paraplegia without neurologic deficit of upper extremities following cervical epidural catheterization using air during the loss of resistance technique. A 41-year-old woman diagnosed with complex regional pain syndrome had upper and lower extremity pain. A thoracic epidural lead was inserted for a trial spinal cord stimulation for treating lower extremity pain and cervical epidural catheterization was performed for treating upper extremity pain. Rapidly progressive paraplegia developed six hours after cervical epidural catheterization. Spine CT revealed air entrapment in multiple thoracic intervertebral foraminal spaces and surrounding epidural space without obvious spinal cord compression before the decompressive operation, which disappeared one day after the decompressive operation. Her paraplegia symptoms were normalized immediately after the operation. The presumed cause of paraplegia was transient interruption of blood supply to the spinal cord through the segmental radiculomedullary arteries feeding the spinal cord at the thoracic level of the intervertebral foramen caused by the air. PMID:26885305

  2. Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report

    PubMed Central

    Chae, Yun Jeong; Park, Hyung Bae; Kim, Chan; Nam, Si Gweon

    2016-01-01

    We report a case of paraplegia without neurologic deficit of upper extremities following cervical epidural catheterization using air during the loss of resistance technique. A 41-year-old woman diagnosed with complex regional pain syndrome had upper and lower extremity pain. A thoracic epidural lead was inserted for a trial spinal cord stimulation for treating lower extremity pain and cervical epidural catheterization was performed for treating upper extremity pain. Rapidly progressive paraplegia developed six hours after cervical epidural catheterization. Spine CT revealed air entrapment in multiple thoracic intervertebral foraminal spaces and surrounding epidural space without obvious spinal cord compression before the decompressive operation, which disappeared one day after the decompressive operation. Her paraplegia symptoms were normalized immediately after the operation. The presumed cause of paraplegia was transient interruption of blood supply to the spinal cord through the segmental radiculomedullary arteries feeding the spinal cord at the thoracic level of the intervertebral foramen caused by the air. PMID:26885305

  3. Circulating T cell subsets are altered in individuals with chronic spinal cord injury.

    PubMed

    Monahan, Rachel; Stein, Adam; Gibbs, Katie; Bank, Matthew; Bloom, Ona

    2015-12-01

    Traumatic spinal cord injury (SCI) induces changes in the immune system, both acutely and chronically. To better understand changes in the chronic phase of SCI, we performed a prospective, observational study in a research institute and Department of Physical Medicine and Rehabilitation of an academic medical center to examine immune system parameters, including peripheral immune cell populations, in individuals with chronic SCI as compared to uninjured individuals. Here, we describe the relative frequencies of T cell populations in individuals with chronic SCI as compared to uninjured individuals. We show that the frequency of CD3+ and CD3+ CD4+ T cells are decreased in individuals with chronic SCI, although activated (HLA-DR+) CD4+ T cells are elevated in chronic SCI. We also examined regulatory T cells (Tregs), defined as CD3+ CD4+ CD25+ CD127lo and CCR4+, HLA-DR+ or CCR4+ HLA-DR+. To our knowledge, we provide the first evidence that CCR4+, HLA-DR+ or CCR4+ HLA-DR+ Tregs are expanded in individuals with SCI. These data support additional functional studies of T cells isolated from individuals with chronic SCI, where alterations in T cell homeostasis may contribute to immune dysfunction, such as immunity against infections or the persistence of chronic inflammation. PMID:26440591

  4. [History and Technique of Epidural Anaesthesia].

    PubMed

    Waurick, Katrin; Waurick, René

    2015-07-01

    In 1901, the first Epidural anesthesia via a caudal approach was independently described by two FrenchmanJean-Anthanase Sicard and Fernand Cathelin.. The Spanish military surgeon, Fidel Pagés Miravé, completed the lumbar approach successfully in 1921. The two possibilities for identification of the epidural space the "loss of resistance" technique and the technique of the "hanging drop" were developed by Achille Mario Dogliotti, an Italian, and Alberto Gutierrez, an Argentinean physician, at the same time. In 1956 John J. Bonica published the paramedian approach to the epidural space. As early as 1931 Eugene Aburel, a Romanian obstetrician, injected local anaesthetics via a silk catheter to perform lumbar obstetric Epidural analgesia. In 1949 the first successful continuous lumbar Epidural anaesthesia was reported by Manuel Martinez Curbelo, a Cuban. Epidural anaesthesia can be performed in sitting or lateral position in all segments of the spinal column via the median or paramedian approach. Different off-axis angles pose the challenge in learning the technique. PMID:26230893

  5. Chronic Spinal Cord Electrical Stimulation Protects Against 6-hydroxydopamine Lesions

    PubMed Central

    Yadav, Amol P.; Fuentes, Romulo; Zhang, Hao; Vinholo, Thais; Wang, Chi-Han; Freire, Marco Aurelio M.; Nicolelis, Miguel A. L.

    2014-01-01

    Although L-dopa continues to be the gold standard for treating motor symptoms of Parkinson's disease (PD), it presents long-term complications. Deep brain stimulation is effective, but only a small percentage of idiopathic PD patients are eligible. Based on results in animal models and a handful of patients, dorsal column stimulation (DCS) has been proposed as a potential therapy for PD. To date, the long-term effects of DCS in animal models have not been quantified. Here, we report that DCS applied twice a week in rats treated with bilateral 6-OHDA striatal infusions led to a significant improvement in symptoms. DCS-treated rats exhibited a higher density of dopaminergic innervation in the striatum and higher neuronal cell count in the substantia nigra pars compacta compared to a control group. These results suggest that DCS has a chronic therapeutical and neuroprotective effect, increasing its potential as a new clinical option for treating PD patients. PMID:24452435

  6. Chronic Spinal Cord Electrical Stimulation Protects Against 6-hydroxydopamine Lesions

    NASA Astrophysics Data System (ADS)

    Yadav, Amol P.; Fuentes, Romulo; Zhang, Hao; Vinholo, Thais; Wang, Chi-Han; Freire, Marco Aurelio M.; Nicolelis, Miguel A. L.

    2014-01-01

    Although L-dopa continues to be the gold standard for treating motor symptoms of Parkinson's disease (PD), it presents long-term complications. Deep brain stimulation is effective, but only a small percentage of idiopathic PD patients are eligible. Based on results in animal models and a handful of patients, dorsal column stimulation (DCS) has been proposed as a potential therapy for PD. To date, the long-term effects of DCS in animal models have not been quantified. Here, we report that DCS applied twice a week in rats treated with bilateral 6-OHDA striatal infusions led to a significant improvement in symptoms. DCS-treated rats exhibited a higher density of dopaminergic innervation in the striatum and higher neuronal cell count in the substantia nigra pars compacta compared to a control group. These results suggest that DCS has a chronic therapeutical and neuroprotective effect, increasing its potential as a new clinical option for treating PD patients.

  7. Microglial polarization dynamics in dorsal spinal cord in the early stages following chronic sciatic nerve damage.

    PubMed

    Xu, Fangting; Huang, Juan; He, Zhenghua; Chen, Jia; Tang, Xiaoting; Song, Zongbin; Guo, Qulian; Huang, Changsheng

    2016-03-23

    Peripheral nerve injury can lead to activation of spinal microglia, which can mediate neuroinflammation and contribute to neuropathic pain following nerve injury. Activated microglia may manifest with either pro-inflammatory M1 phenotype or anti-inflammatory M2 phenotype, which may lead to detrimental or beneficial roles in the nervous system. In this study, microglia numbers, morphology and gene profiles were examined in the dorsal spinal cord of rats over 14 days following sciatic nerve chronic constriction injury (CCI). The morphology of some microglia changed from a surveying to an activated state within 1 day of CCI. Neuropathic pain developed within seven to 14 days following injury and microglia numbers were increased, with almost all in the dorsal spinal cord morphologically defined as activated. At day one after CCI, both M1 and M2 microglia-related genes were increased but only M1 microglia-related genes remained elevated at day seven and 14 thereafter. These results indicate that both M1 and M2 microglia were activated in the dorsal spinal cord one day after CCI but the microglia skewed towards M1 phenotype during the following seven and 14 days. PMID:26820376

  8. Hypoxia triggers short term potentiation of phrenic motoneuron discharge after chronic cervical spinal cord injury.

    PubMed

    Lee, Kun-Ze; Sandhu, Milapjit S; Dougherty, Brendan J; Reier, Paul J; Fuller, David D

    2015-01-01

    Repeated exposure to hypoxia can induce spinal neuroplasticity as well as respiratory and somatic motor recovery after spinal cord injury (SCI). The purpose of the present study was twofold: to define the capacity for a single bout of hypoxia to trigger short-term plasticity in phrenic output after cervical SCI and to determine the phrenic motoneuron (PhrMN) bursting and recruitment patterns underlying the response. Hypoxia-induced short term potentiation (STP) of phrenic motor output was quantified in anesthetized rats 11 weeks following lateral spinal cord hemisection at C2 (C2Hx). A 3-min hypoxic episode (12-14% O2) always triggered STP of inspiratory burst amplitude, the magnitude of which was greater in phrenic bursting ipsilateral vs. contralateral to C2Hx. We next determined if STP could be evoked in recruited (silent) PhrMNs ipsilateral to C2Hx. Individual PhrMN action potentials were recorded during and following hypoxia using a "single fiber" approach. STP of bursting activity did not occur in cells initiating bursting at inspiratory onset, but was robust in recruited PhrMNs as well as previously active cells initiating bursting later in the inspiratory effort. We conclude that following chronic C2Hx, a single bout of hypoxia triggers recruitment of PhrMNs in the ipsilateral spinal cord with bursting that persists beyond the hypoxic exposure. The results provide further support for the use of short bouts of hypoxia as a neurorehabilitative training modality following SCI. PMID:25448009

  9. No evidence for chronic demyelination in spared axons following spinal cord injury in a mouse

    PubMed Central

    Lasiene, Jurate; Shupe, Larry; Perlmutter, Steve; Horner, Philip

    2008-01-01

    The pattern of remyelination after traumatic spinal cord injury remains elusive, with animal and human studies reporting partial to complete demyelination followed by incomplete remyelination. In the present study, we found that spared rubrospinal tract (RST) axons of passage traced with actively transported dextrans and examined caudally to the lesion twelve weeks after mouse spinal cord contusion injury were fully remyelinated. Spared axons exhibited a marginally reduced myelin thickness and significantly shorter internodes. Contactin-associated protein (CASPR) and Kv1.2 channels were used to identify internodes and paranodal protein distribution properties were used as an index of myelin integrity. This is the first time the CNS myelin internode length was measured in a mouse. To better understand the significance of shortened internodes and thinner myelin in spared axons, we modeled conduction properties using McIntyres et al. model of myelinated axons. Mathematical modeling predicted a 21% decrease in the conduction velocity of remyelinated RST axons due to shortened internodes. To determine whether demyelination could be present on axons exhibiting a pathological transport system we utilized the retroviral reporter system. Virally delivered GFP unveiled a small population of dystrophic RST axons that persist chronically with evident demyelination or abnormal remyelination. Collectively these data show that lasting demyelination in spared axons is rare and that remyelination of axons of passage occurs in the chronically injured mouse spinal cord. PMID:18400887

  10. Epidural steroid warning controversy still dogging FDA.

    PubMed

    Manchikanti, Laxmaiah; Candido, Kenneth D; Singh, Vijay; Gharibo, Christopher G; Boswell, Mark V; Benyamin, Ramsin M; Falco, Frank J E; Grider, Jay S; Diwan, Sudhir; Hirsch, Joshua A

    2014-01-01

    On April 23, 2014, the Food and Drug Administration (FDA) issued a letter of warning that injection of corticosteroids into the epidural space of the spine may result in rare, but serious adverse events, including "loss of vision, stroke, paralysis, and death." The advisory also advocated that patients should discuss the benefits and risks of epidural corticosteroid injections with their health care professionals, along with the benefits and risks associated with other possible treatments. In addition, the FDA stated that the effectiveness and safety of the corticosteroids for epidural use have not been established, and the FDA has not approved corticosteroids for such use. To raise awareness of the risks of epidural corticosteroid injections in the medical community, the FDA's Safe Use Initiative convened a panel of experts including pain management experts to help define the techniques for such injections with the aim of reducing preventable harm. The panel was unable to reach an agreement on 20 proposed items related to technical aspects of performing epidural injections. Subsequently, the FDA issued the above referenced warning and a notice that a panel will be convened in November 2014. This review assesses the inaccuracies of the warning and critically analyzes the available literature. The literature has been assessed in reference to alternate techniques and an understanding of the risk factors when performing transforaminal epidural injections in the cervical, thoracic, and lumbar regions, ultimately resulting in improved safety. The results of this review show the efficacy of epidural injections, with or without steroids, in a multitude of spinal ailments utilizing caudal, cervical, thoracic, and lumbar interlaminar approaches as well as lumbar transforaminal epidural injections . The evidence also shows the superiority of steroids in managing lumbar disc herniation utilizing caudal and lumbar interlaminar approaches without any significant difference as compared to transforaminal approaches, either with local anesthetic alone or local anesthetic and steroids combined. In conclusion, the authors request that the FDA modify the warning based on the evidence. PMID:25054397

  11. Consensus of clinical neurorestorative progress in patients with complete chronic spinal cord injury.

    PubMed

    Huang, Hongyun; Sun, Tiansheng; Chen, Lin; Moviglia, Gustavo; Chernykh, Elena; von Wild, Klaus; Deda, Haluk; Kang, Kyung-Sun; Kumar, Anand; Jeon, Sang Ryong; Zhang, Shaocheng; Brunelli, Giorgio; Bohbot, Albert; Soler, Maria Dolors; Li, Jianjun; Cristante, Alexandre Fogaa; Xi, Haitao; Onose, Gelu; Kern, Helmut; Carraro, Ugo; Saberi, Hooshang; Sharma, Hari Shanker; Sharma, Alok; He, Xijing; Muresanu, Dafin; Feng, Shiqing; Otom, Ali; Wang, Dajue; Iwatsu, Koichi; Lu, Jike; Al-Zoubi, Adeeb

    2014-01-01

    Currently, there is a lack of effective therapeutic methods to restore neurological function for chronic complete spinal cord injury (SCI) by conventional treatment. Neurorestorative strategies with positive preclinical results have been translated to the clinic, and some patients have gotten benefits and their quality of life has improved. These strategies include cell therapy, neurostimulation or neuromodulation, neuroprosthesis, neurotization or nerve bridging, and neurorehabilitation. The aim of this consensus by 31 experts from 20 countries is to show the objective evidence of clinical neurorestoration for chronic complete SCI by the mentioned neurorestorative strategies. Complete chronic SCI patients are no longer told, "nothing can be done." The clinical translation of more effective preclinical neurorestorative strategies should be encouraged as fast as possible in order to benefit patients with incurable CNS diseases. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation. PMID:25302689

  12. Epidural block

    MedlinePLUS

    ... back. The needle is placed into a small space outside your spinal cord A small soft tube (catheter) is placed into your back, next to your spine. The needle is removed. The numbing medicine is given through the tube for as long ...

  13. Chronic Tissue Response to Untethered Microelectrode Implants in the Rat Brain and Spinal Cord

    PubMed Central

    ERSEN, Ali; ELKABES, Stella; FREEDMAN, David S.; SAHIN, Mesut

    2015-01-01

    Objective Microelectrodes implanted in the central nervous system (CNS) often fail in long term implants due to the immunological tissue response caused by tethering forces of the connecting wires. In addition to the tethering effect, there is a mechanical stress that occurs at the device-tissue interface simply because the microelectrode is a rigid body floating in soft tissue and it cannot reshape itself to comply with changes in the surrounding tissue. In the current study we evaluated the scar tissue formation to tetherless devices with two significantly different geometries in the rat brain and spinal cord in order to investigate the effects of device geometry. Approach One of the implant geometries resembled the wireless, floating microstimulators that we are currently developing in our laboratory and the other was a (shank only) Michigan probe for comparison. Both electrodes were implanted into either the cervical spinal cord or the motor cortices, one on each side. Main Results The most pronounced astroglial and microglial reactions occurred within 20 ?m from the device and decreased sharply at larger distances. Both cell types displayed the morphology of non-activated cells past the 100 ?m perimeter. Even though the aspect ratios of the implants were different, the astroglial and microglial responses to both microelectrode types were very mild in the brain, stronger and yet limited in the spinal cord. Significance These observations confirm previous reports and further suggest that tethering may be responsible for most of the tissue response in chronic implants and that the electrode size has a smaller contribution with floating electrodes. The electrode size may be playing primarily an amplifying role to the tethering forces in the brain whereas the size itself may induce chronic response in the spinal cord where the movement of surrounding tissues is more significant. PMID:25605679

  14. Chronic tissue response to untethered microelectrode implants in the rat brain and spinal cord

    NASA Astrophysics Data System (ADS)

    Ersen, Ali; Elkabes, Stella; Freedman, David S.; Sahin, Mesut

    2015-02-01

    Objective. Microelectrodes implanted in the central nervous system (CNS) often fail in long term implants due to the immunological tissue response caused by tethering forces of the connecting wires. In addition to the tethering effect, there is a mechanical stress that occurs at the device-tissue interface simply because the microelectrode is a rigid body floating in soft tissue and it cannot reshape itself to comply with changes in the surrounding tissue. In the current study we evaluated the scar tissue formation to tetherless devices with two significantly different geometries in the rat brain and spinal cord in order to investigate the effects of device geometry. Approach. One of the implant geometries resembled the wireless, floating microstimulators that we are currently developing in our laboratory and the other was a (shank only) Michigan probe for comparison. Both electrodes were implanted into either the cervical spinal cord or the motor cortices, one on each side. Main results. The most pronounced astroglial and microglial reactions occurred within 20 μm from the device and decreased sharply at larger distances. Both cell types displayed the morphology of non-activated cells past the 100 μm perimeter. Even though the aspect ratios of the implants were different, the astroglial and microglial responses to both microelectrode types were very mild in the brain, stronger and yet limited in the spinal cord. Significance. These observations confirm previous reports and further suggest that tethering may be responsible for most of the tissue response in chronic implants and that the electrode size has a smaller contribution with floating electrodes. The electrode size may be playing primarily an amplifying role to the tethering forces in the brain whereas the size itself may induce chronic response in the spinal cord where the movement of surrounding tissues is more significant.

  15. Assessment of oxidative parameters in rat spinal cord after chronic constriction of the sciatic nerve.

    PubMed

    Goecks, Cristina S B; Horst, Andra; Moraes, Maira S; Scheid, Tana; Kolberg, Carolina; Bell-Klein, Adriane; Partata, Wania A

    2012-09-01

    Although reactive oxygen species (ROS) are involved in neuropathic pain, the direct relationship between these species and chronic constriction of sciatic nerve (CCI) has not been studied in spinal cord. Thus, this study induced CCI in rats and these animals were sacrificed 3 and 10days after the surgical procedure to determine the superoxide dismutase (SOD) and catalase activities, as well as ascorbic acid, hydrogen peroxide (H(2)O(2)) and lipid hydroperoxide levels in lumbosacral spinal cord. Von Frey Hair and hot plate tests were performed to assess the degree of mechanical and thermal hyperalgesia at days 0, 3 and 10. The results showed that CCI significantly induced mechanical and thermal hyperalgesia at days 3 and 10. Parallel there was increase in spinal cord lipid hydroperoxide at days 3 and 10 in rats submitted to CCI. In Sham rats a significant increase in this parameter occurred at day 10. H(2)O(2) decreased at day 10 only in CCI group. SOD activity was decreased in Sham and CCI groups at day 3, while catalase activity was increased in CCI rats at days 3 and 10. Ascorbic acid levels were reduced only in CCI rats at day 3. Although the role of such changes is unclear, many were not specific to neuropathic pain and the differences could be related to different degrees of central sensitization in Sham and CCI rats. PMID:22674084

  16. Modulation of Spinal GABAergic Inhibition and Mechanical Hypersensitivity following Chronic Compression of Dorsal Root Ganglion in the Rat

    PubMed Central

    Lee, Moon Chul; Nam, Taick Sang; Jung, Se Jung; Gwak, Young S.; Leem, Joong Woo

    2015-01-01

    Chronic compression of dorsal root ganglion (CCD) results in neuropathic pain. We investigated the role of spinal GABA in CCD-induced pain using rats with unilateral CCD. A stereological analysis revealed that the proportion of GABA-immunoreactive neurons to total neurons at L4/5 laminae I–III on the injured side decreased in the early phase of CCD (post-CCD week 1) and then returned to the sham-control level in the late phase (post-CCD week 18). In the early phase, the rats showed an increase in both mechanical sensitivity of the hind paw and spinal WDR neuronal excitability on the injured side, and such increase was suppressed by spinally applied muscimol (GABA-A agonist, 5 nmol) and baclofen (GABA-B agonist, 25 nmol), indicating the reduced spinal GABAergic inhibition involved. In the late phase, the CCD-induced increase in mechanical sensitivity and neuronal excitability returned to pre-CCD levels, and such recovered responses were enhanced by spinally applied bicuculline (GABA-A antagonist, 15 nmol) and CGP52432 (GABA-B antagonist, 15 nmol), indicating the regained spinal GABAergic inhibition involved. In conclusion, the alteration of spinal GABAergic inhibition following CCD and leading to a gradual reduction over time of CCD-induced mechanical hypersensitivity is most likely due to changes in GABA content in spinal GABA neurons. PMID:26451259

  17. Safety of Human Neural Stem Cell Transplantation in Chronic Spinal Cord Injury

    PubMed Central

    Piltti, Katja M.; Salazar, Desiree L.; Uchida, Nobuko; Cummings, Brian J.

    2013-01-01

    The spinal cord injury (SCI) microenvironment undergoes dynamic changes over time, which could potentially affect survival or differentiation of cells in early versus delayed transplantation study designs. Accordingly, assessment of safety parameters, including cell survival, migration, fate, sensory fiber sprouting, and behavioral measures of pain sensitivity in animals receiving transplants during the chronic postinjury period is required for establishing a potential therapeutic window. The goal of the study was assessment of safety parameters for delayed transplantation of human central nervous system-derived neural stem cells (hCNS-SCns) by comparing hCNS-SCns transplantation in the subacute period, 9 days postinjury (DPI), versus the chronic period, 60 DPI, in contusion-injured athymic nude rats. Although the number of surviving human cells after chronic transplantation was lower, no changes in cell migration were detected between the 9 and 60 DPI cohorts; however, the data suggest chronic transplantation may have enhanced the generation of mature oligodendrocytes. The timing of transplantation did not induce changes in allodynia or hyperalgesia measures. Together, these data support the safety of hCNS-SCns transplantation in the chronic period post-SCI. PMID:24191264

  18. Chronic spinal cord stimulation modifies intrinsic cardiac synaptic efficacy in the suppression of atrial fibrillation

    PubMed Central

    Ardell, Jeffrey L.; Cardinal, Ren; Beaumont, Eric; Vermeulen, Michel; Smith, Frank M.; Armour, J. Andrew

    2014-01-01

    We sought to determine whether spinal cord stimulation (SCS) therapy, when applied chronically to canines, imparts long-lasting cardio-protective effects on neurogenic atrial tachyarrhythmia induction and, if so, whether its effects can be attributable to i) changes in intrinsic cardiac (IC) neuronal transmembrane properties vs ii) modification of their interneuronal stochastic interactivity that initiates such pathology. Data derived from canines subjected to long-term SCS [(group 1 studied after 34 weeks SCS; n=5) (group 2: studied 5 weeks SCS; n=11)] were compared to data derived from 10 control animals (including 4 sham SCS electrode implantations). During terminal studies conducted under anesthesia, chronotropic and inotropic responses to vagal nerve or stellate ganglion stimulation were similar in all 3 groups. Chronic SCS suppressed atrial tachyarrhythmia induction evoked by mediastinal nerve stimulation. When induced, arrhythmia durations were shortened (controls: median of 27s; SCS 34 weeks: median of 16s; SCS 5 weeks: median of 7s). Phasic and accommodating right atrial neuronal somata displayed similar passive and active membrane properties in vitro, whether derived from sham or either chronic SCS groups. Synaptic efficacy was differentially enhanced in accommodating (not phasic) IC neurons by chronic SCS. Taken together these data indicate that chronic SCS therapy modifies IC neuronal stochastic inter-connectivity in atrial fibrillation suppression by altering synaptic function without directly targeting the transmembrane properties of individual IC neuronal somata. PMID:25301713

  19. Inducing Chronic Excitotoxicity in the Mouse Spinal Cord to Investigate Lower Motor Neuron Degeneration

    PubMed Central

    Blizzard, Catherine A.; Lee, K. M.; Dickson, Tracey C.

    2016-01-01

    We report the methodology for the chronic delivery of an excitotoxin to the mouse spinal cord via surgically implanted osmotic mini-pumps. Previous studies have investigated the effect of chronic application of excitotoxins in the rat, however there has been little translation of this model to the mouse. Using mice that express yellow fluorescent protein (YFP), motor neuron and neuromuscular junction alterations can be investigate following targeted, long-term (28 days) exposure to the α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor excitotoxin, kainic acid. By targeting the L3-4 region of the lumbar spinal cord, with insertion of an intrathecal catheter into the subarachnoid space at L5, chronic application of the kainic acid results in slow excitotoxic death in the anterior ventral horn, with a significant (P < 0.05) reduction in the number of SMI-32 immunopositive neurons present after 28 days infusion. Use of the Thy1-YFP mice provides unrivaled visualization of the neuromuscular junction and enables the resultant distal degeneration in skeletal muscle to be observed. Both neuromuscular junction retraction at the gastrocnemius muscle and axonal fragmentation in the sciatic nerve were observed after chronic infusion of kainic acid for 28 days. Lower motor neuron, and distal neuromuscular junction, degeneration are pathological hallmarks of the devastating neurodegenerative disease Amyotrophic Lateral Sclerosis (ALS). This mouse model will be advantageous for increasing our understanding of how the pathophysiological phenomena associated with this disease can lead to lower motor neuron loss and distal pathology, as well as providing a robust in vivo platform to test therapeutic interventions directed at excitotoxic mechanisms. PMID:26973454

  20. Alternative approach for lumbar transforaminal epidural steroid injections.

    PubMed

    Zhu, Jie; Falco, Frank J E; Formoso, Ferdinand; Onyewu, Obi; Irwin, Franklin L

    2011-01-01

    The traditional superoanterior approach for transforaminal epidural steroid injection (TFESI) carries a risk of complication by obstructing arterial flow to the anterior portion of the spinal cord by puncturing the spinal radicular artery that passes through the superoanterior foraminal zone or "safe triangle" zone, which does not describe vascular safety, but rather describes neural safety. Consequently, multiple disasters have been described in recent years with transforaminal epidural injections. They are utilized extensively even though their effectiveness has been debated. Here we describe a dorsal technique through transforaminal epidural injections to place the tip of the needle immediately dorsal to the dorsal root ganglion. Multiple different techniques have been discussed and described in recent years, the majority of them to avoid the radicular artery injection. The primary goal of this paper is to describe another posterior approach to place the tip of spinal needle directly toward the posterior epidural space to avoid puncturing the spinal radicular artery and minimize nerve root penetrations while delivering medication into the epidural space through the foramen. PMID:21785476

  1. The maternal and fetal cardiovascular effects of epidural fentanyl in the sheep model.

    PubMed

    Craft, J B; Robichaux, A G; Kim, H S; Thorpe, D H; Mazel, P; Woolf, W A; Stolte, A

    1984-04-15

    Since the demonstration of opiate receptors in the spinal cord in the mid-1970s, investigators have been looking for the most effective epidural narcotic. With the use of the chronically catheterized maternal sheep model, we injected two different doses of preservative-free fentanyl (50 and 100 micrograms) into the epidural space. No statistically significant changes were observed, either in maternal or fetal arterial pressure and acid-base status or in maternal central venous pressure, systemic and pulmonary vascular resistance, cardiac output, and intrauterine pressure (p greater than 0.05). With a dose of 50 micrograms of fentanyl, maternal levels of fentanyl peaked at 60 minutes (50 pg/ml) and the fetal levels of fentanyl peaked at 45 minutes (20 pg/ml). With the 100 micrograms dose of fentanyl, maternal levels of fentanyl peaked at 45 minutes (230 pg/ml) and the fetal levels peaked at 15 minutes (110 pg/ml). We conclude that the injection of 50 and 100 micrograms of fentanyl into the maternal epidural space has no adverse effects on mother or fetus in the sheep model. PMID:6711645

  2. Epidural myelolipoma in a Husky-cross: a case report

    PubMed Central

    2013-01-01

    Epidural spinal myelolipoma was diagnosed in an 11.5-year-old castrated male Husky-cross that was evaluated at the veterinary teaching hospital due to progressive thoracolumbar spinal hyperaesthesia and mild proprioceptive pelvic limb ataxia. A focal, ill-defined mildly inhomogenous extradural mass lesion was detected by MRI. The dog was euthanized. At necropsy an extradurally located reddish mass of about 2.5 cm in diameter was present in the vertebral canal. The mass was identified histopathologically as an epidural myelolipoma. PMID:23557489

  3. Alleviation of chronic pain following rat spinal cord compression injury with multimodal actions of huperzine A

    PubMed Central

    Yu, Dou; Thakor, Devang K.; Han, Inbo; Ropper, Alexander E.; Haragopal, Hariprakash; Sidman, Richard L.; Zafonte, Ross; Schachter, Steven C.; Teng, Yang D.

    2013-01-01

    Diverse mechanisms including activation of NMDA receptors, microglial activation, reactive astrogliosis, loss of descending inhibition, and spasticity are responsible for ?40% of cases of intractable neuropathic pain after spinal cord injury (SCI). Because conventional treatments blocking individual mechanisms elicit only short-term effectiveness, a multimodal approach with simultaneous actions against major pain-related pathways may have value for clinical management of chronic pain. We hypothesize that [-]-huperzine A (HUP-A), an alkaloid isolated from the club moss Huperzia serrata, that is a potent reversible inhibitor of acetylcholinesterase and NMDA receptors, could mitigate pain without invoking drug tolerance or dependence by stimulating cholinergic interneurons to impede pain signaling, inhibiting inflammation via microglial cholinergic activation, and blocking NMDA-mediated central hypersensitization. We tested our hypothesis by administering HUP-A i.p. or intrathecally to female SpragueDawley rats (200235 g body weight) after moderate static compression (35 g for 5 min) of T10 spinal cord. Compared with controls, HUP-A treatment demonstrates significant analgesic effects in both regimens. SCI rats manifested no drug tolerance following repeated bolus i.p. or chronic intrathecal HUP-A dosing. The pain-ameliorating effect of HUP-A is cholinergic dependent. Relative to vehicle treatment, HUP-A administration also reduced neural inflammation, retained higher numbers of calcium-impermeable GluR2-containing AMPA receptors, and prevented Homer1a up-regulation in dorsal horn sensory neurons. Therefore, HUP-A may provide safe and effective management for chronic postneurotrauma pain by reestablishing homeostasis of sensory circuits. PMID:23386718

  4. Musculoskeletal Adaptations in Chronic Spinal Cord Injury: Effects of Long-term Soleus Electrical Stimulation Training

    PubMed Central

    Shields, Richard K.; Dudley-Javoroski, Shauna

    2012-01-01

    Objective The purpose of this study was to determine whether long-term electrical stimulation training of the paralyzed soleus could change this muscles physiological properties (torque, fatigue index, potentiation index, torque-time integral) and increase tibia bone mineral density. Methods Four men with chronic (>2 years) complete spinal cord injury (SCI; American Spinal Injury Association classification A) trained 1 soleus muscle using an isometric plantar flexion electrical stimulation protocol. The untrained limb served as a within-subject control. The protocol involved ~30 minutes of training each day, 5 days a week, for a period of 6 to 11 months. Mean compliance over 11 months of training was 91% for 3 subjects. A fourth subject achieved high compliance after only 5 months of training. Mean estimated compressive loads delivered to the tibia were ~110% of body weight. Over the 11 months of training, the muscle plantar flexion torque, fatigue index, potentiation index, and torque-time integral were evaluated periodically. Bone mineral density (dual-energy x-ray absorptiometry) was evaluated before and after the training program. Results The trained limb fatigue index, potentiation index, and torque-time integral showed rapid and robust training effects (P < .05). Soleus electrical stimulation training yielded no changes to the proximal tibia bone mineral density, as measured by dual-energy x-ray absorptiometry. The subject with low compliance experienced fatigue index and torque-time integral improvements only when his compliance surpassed 80%. In contrast, his potentiation index showed adaptations even when compliance was low. Conclusions These findings highlight the persistent adaptive capabilities of chronically paralyzed muscle but suggest that preventing musculoskeletal adaptations after SCI may be more effective than reversing changes in the chronic condition. PMID:17312092

  5. Chronic spinal nerve ligation induces changes in response characteristics of nociceptive spinal dorsal horn neurons and in their descending regulation originating in the periaqueductal gray in the rat.

    PubMed

    Pertovaara, A; Kontinen, V K; Kalso, E A

    1997-10-01

    We studied whether a chronic neuropathy induced by unilateral spinal nerve ligation changes the response characteristics of spinal dorsal horn wide-dynamic range (WDR) neurons or their periaqueductal gray (PAG)-induced descending modulation. Experiments were performed in rats with behaviorally demonstrated allodynia induced by spinal nerve ligation and in a group of nonneuropathic control rats. The stimulus-response functions of WDR neurons for mechanical and thermal stimuli and the modulation of their peripherally evoked responses by electrical stimulation of the PAG were determined under pentobarbital anesthesia. The results showed that neuropathy caused a significant leftward shift in stimulus-response functions for mechanical stimuli. In contrast, stimulus-response functions for noxious heat stimuli in the neuropathic limb were, if anything, shifted rightward, although this shift was short of statistical significance. In neuropathic rats, PAG stimulation produced a significantly stronger attenuation of spinal neuronal responses induced by noxious heat in the unoperated than in the operated side. At the intensity that produced attenuation of noxious heat stimuli, PAG stimulation did not produce any significant change in spinal neuronal responses evoked by mechanical stimuli either from the operated or the nonoperated hindlimb of the neuropathic rats. Spontaneous activity of WDR neurons was higher in the operated side of neuropathic rats than in control rats. Afterdischarges evoked by peripheral stimuli were observed in 1/16 of the WDR neurons ipsilateral to spinal nerve ligation and not at all in other experimental groups. The WDR neurons studied were not activated by innocuous or noxious cold stimuli. The results indicate that spinal nerve ligation induces increased spontaneous activity and enhanced responses to mechanical stimuli in the spinal dorsal horn WDR neurons, whereas noxious heat-evoked responses are not significantly changed or if anything, attenuated. Moreover, the inhibition of noxious heat stimuli by PAG stimulation is attenuated in the neuropathic side. It is proposed that the observed changes in the response characteristics of the spinal dorsal horn WDR neurons and in their descending modulation may contribute to the neuropathic symptoms in these animals. PMID:9344567

  6. [Spinal cord stimulation - evidence and personal experience].

    PubMed

    Klein-Weigel, P

    2010-08-01

    Spinal cord stimulation (SCS) has been successfully used to treat chronic pain syndromes for decades. For this purpose, an electrode is implanted into the epidural space under local anaesthesia and connected to a neurostimulator which applies a weak direct current to the dorsal roots of the spinal column. Besides pain control, SCS increases the blood supply in the stimulated area. This effect is mediated by a sympathicolytic effect and the liberation of vasodilatators within the stimulated skin area. A Cochrane meta-analysis has revealed a significantly increased limb salvage rate in patients with non-reconstructable critical limb ischaemia (CLI) treated with SCS. The effect of SCS in CLI might be predicted by the measurement of forefoot transcutaneous pO (2) in supine and dependent positions, which renders trial stimulation unnecessary in many cases. PMID:20806142

  7. Caudal epidural steroid injections.

    PubMed

    Ogoke, B A

    2000-07-01

    The caudal approach to the epidural space was first reported in 1901. Injection of steroids to treat low back pain was introduced in 1952. Caudal epidural steroid injection is a safe, effective technique when performed with appropriate care under fluoroscopic visualization. Caudal epidural injections are associated with inaccurate needle placement when performed blindly in a substantial number of patients, resulting in intravascular injections as well as other complications. This review will discuss anatomic and technical considerations of caudal epidural injections, along with advantages, disadvantages, complications, and indications. PMID:16906188

  8. Cellular Transplants in China: Observational Study from the Largest Human Experiment in Chronic Spinal Cord Injury

    PubMed Central

    Dobkin, Bruce H.; Curt, Armin; Guest, James

    2014-01-01

    Background In China, fetal brain tissue has been transplanted into the lesions of more than 400 patients with spinal cord injury (SCI). Anecdotal reports have been the only basis for assuming that the procedure is safe and effective. Objective To compare available reports to the experiences and objective findings of patients who received preoperative and postoperative assessments before and up to 1 year after receiving cellular implants. Methods Independent observational study of 7 chronic SCI subjects undergoing surgery by Dr Hongyun Huang in Beijing. Assessments included lesion location by magnetic resonance imaging, protocol of the American Spinal Injury Association (ASIA), change in disability, and detailed history of the perioperative course. Results Inclusion and exclusion criteria were not clearly defined, as subjects with myelopathies graded ASIA A through D and of diverse causes were eligible. Cell injection sites did not always correlate with the level of injury and included the frontal lobes of a subject with a high cervical lesion. Complications, including meningitis, occurred in 5 subjects. Transient postoperative hypotonicity may have accounted for some physical changes. No clinically useful sensorimotor, disability, or autonomic improvements were found. Conclusions The phenotype and the fate of the transplanted cells, described as olfactory ensheathing cells, are unknown. Perioperative morbidity and lack of functional benefit were identified as the most serious clinical shortcomings. The procedures observed did not attempt to meet international standards for either a safety or efficacy trial. In the absence of a valid clinical trials protocol, physicians should not recommend this procedure to patients. PMID:16467274

  9. Plasticity of interneuronal networks of the functionally isolated human spinal cord.

    PubMed

    Harkema, Susan J

    2008-01-01

    The loss of walking after human spinal cord injury has been attributed to the dominance of supraspinal over spinal mechanisms. The evidence for central pattern generation in humans is limited due to the inability to conclusively isolate the circuitry from descending and afferent input. However, studying individuals following spinal cord injury with no detectable influence on spinal networks from supraspinal centers can provide insight to their interaction with afferent input. The focus of this article is on the interaction of sensory input with human spinal networks in the generation of locomotor patterns. The functionally isolated human spinal cord has the capacity to generate locomotor patterns with appropriate afferent input. Locomotor Training is a rehabilitative strategy that has evolved from animal and humans studies focused on the neural plasticity of the spinal cord and has been successful for many people with acute and chronic incomplete spinal cord injury. However, even those individuals with clinically complete spinal cord injury that generate appropriate locomotor patterns during stepping with assistance on a treadmill with body weight support cannot sustain overground walking. This suggests that although a significant control of locomotion can occur at the level of spinal interneuronal networks the level of sustainable excitability of these circuits is still compromised. Future studies should focus on approaches to increase the central state of excitability and may include neural repair strategies, pharmacological interventions or epidural stimulation in combination with Locomotor Training. PMID:18042493

  10. Plasticity of interneuronal networks of the functionally isolated human spinal cord

    PubMed Central

    Harkema, Susan J.

    2009-01-01

    The loss of walking after human spinal cord injury has been attributed to the dominance of supraspinal over spinal mechanisms. The evidence for central pattern generation in humans is limited due to the inability to conclusively isolate the circuitry from descending and afferent input. However, studying individuals following spinal cord injury with no detectable influence on spinal networks from supraspinal centers can provide insight to their interaction with afferent input. The focus of this article is on the interaction of sensory input with human spinal networks in the generation of locomotor patterns. The functionally isolated human spinal cord has the capacity to generate locomotor patterns with appropriate afferent input. Locomotor Training is a rehabilitative strategy that has evolved from animal and humans studies focused on the neural plasticity of the spinal cord and has been successful for many people with acute and chronic incomplete spinal cord injury. However, even those individuals with clinically complete spinal cord injury that generate appropriate locomotor patterns during stepping with assistance on a treadmill with body weight support cannot sustain overground walking. This suggests that although a significant control of locomotion can occur at the level of spinal interneuronal networks the level of sustainable excitability of these circuits is still compromised. Future studies should focus on approaches to increase the central state of excitability and may include neural repair strategies, pharmacological interventions or epidural stimulation in combination with Locomotor Training. PMID:18042493

  11. Possible role of spinal astrocytes in maintaining chronic pain sensitization: review of current evidence with focus on bFGF/JNK pathway

    PubMed Central

    JI, RU-RONG; KAWASAKI, YASUHIKO; ZHUANG, ZHI-YE; WEN, YEONG-RAY; DECOSTERD, ISABELLE

    2007-01-01

    Although pain is regarded traditionally as neuronally mediated, recent progress shows an important role of spinal glial cells in persistent pain sensitization. Mounting evidence has implicated spinal microglia in the development of chronic pain (e.g. neuropathic pain after peripheral nerve injury). Less is known about the role of astrocytes in pain regulation. However, astrocytes have very close contact with synapses and maintain homeostasis in the extracellular environment. In this review, we provide evidence to support a role of spinal astrocytes in maintaining chronic pain. In particular, c-Jun N-terminal kinase (JNK) is activated persistently in spinal astrocytes in a neuropathic pain condition produced by spinal nerve ligation. This activation is required for the maintenance of neuropathic pain because spinal infusion of JNK inhibitors can reverse mechanical allodynia, a major symptom of neuropathic pain. Further study reveals that JNK is activated strongly in astrocytes by basic fibroblast growth factor (bFGF), an astroglial activator. Intrathecal infusion of bFGF also produces persistent mechanical allodynia. After peripheral nerve injury, bFGF might be produced by primary sensory neurons and spinal astrocytes because nerve injury produces robust bFGF upregulation in both cell types. Therefore, the bFGF/JNK pathway is an important signalling pathway in spinal astrocytes for chronic pain sensitization. Investigation of signaling mechanisms in spinal astrocytes will identify new molecular targets for the management of chronic pain. PMID:17710215

  12. Targeted, activity-dependent spinal stimulation produces long-lasting motor recovery in chronic cervical spinal cord injury.

    PubMed

    McPherson, Jacob G; Miller, Robert R; Perlmutter, Steve I

    2015-09-29

    Use-dependent movement therapies can lead to partial recovery of motor function after neurological injury. We attempted to improve recovery by developing a neuroprosthetic intervention that enhances movement therapy by directing spike timing-dependent plasticity in spared motor pathways. Using a recurrent neural-computer interface in rats with a cervical contusion of the spinal cord, we synchronized intraspinal microstimulation below the injury with the arrival of functionally related volitional motor commands signaled by muscle activity in the impaired forelimb. Stimulation was delivered during physical retraining of a forelimb behavior and throughout the day for 3 mo. Rats receiving this targeted, activity-dependent spinal stimulation (TADSS) exhibited markedly enhanced recovery compared with animals receiving targeted but open-loop spinal stimulation and rats receiving physical retraining alone. On a forelimb reach and grasp task, TADSS animals recovered 63% of their preinjury ability, more than two times the performance level achieved by the other therapy groups. Therapeutic gains were maintained for 3 additional wk without stimulation. The results suggest that activity-dependent spinal stimulation can induce neural plasticity that improves behavioral recovery after spinal cord injury. PMID:26371306

  13. Single-Shot Epidural Injections in the Management of Radicular Pain.

    PubMed

    Zarghooni, Kourosh; Rashidi, Ali; Siewe, Jan; Rllinghoff, Marc; Bredow, Jan; Eysel, Peer; Scheyerer, Max J

    2015-12-28

    Epidural injections are commonly used in the treatment of chronic low back pain due to symptomatic lumbar spinal disorders. The aim of the present investigation was to study their therapeutic value for different age subgroups. A consecutive series of 356 patients were treated with at least one injection, and assessed before and after injection. Significant pain reduction was observed in all age groups following a series of injections with the greatest reduction after the first one. Especially in patients younger than 50 years, pain medication could be reduced substantially. Surgery was performed in 19.4% of patients (n=69) following a series of SSPDA injections. In the current study, interlaminar steroid injections for treatment of chronic low back and radicular pain caused sufficient improvement and significant reduction of medication especially in younger patients. PMID:26793292

  14. Single-Shot Epidural Injections in the Management of Radicular Pain

    PubMed Central

    Zarghooni, Kourosh; Rashidi, Ali; Siewe, Jan; Röllinghoff, Marc; Bredow, Jan; Eysel, Peer

    2015-01-01

    Epidural injections are commonly used in the treatment of chronic low back pain due to symptomatic lumbar spinal disorders. The aim of the present investigation was to study their therapeutic value for different age subgroups. A consecutive series of 356 patients were treated with at least one injection, and assessed before and after injection. Significant pain reduction was observed in all age groups following a series of injections with the greatest reduction after the first one. Especially in patients younger than 50 years, pain medication could be reduced substantially. Surgery was performed in 19.4% of patients (n=69) following a series of SSPDA injections. In the current study, interlaminar steroid injections for treatment of chronic low back and radicular pain caused sufficient improvement and significant reduction of medication especially in younger patients. PMID:26793292

  15. Cervical Epidural Abscess: Rare Complication of Bacterial Endocarditis with Streptococcus Viridans: A Case Report

    PubMed Central

    Oh, Jae-Sang; Shim, Jai-Joon; Lee, Kyeong-Seok

    2015-01-01

    Although many patients with infective endocarditis (IE) complain of joint, muscle, and back pain, infections at these sights are rare. The incidence of spinal abscess in cervical spine complicating endocarditis is very rare. Although the surgical management is the mainstay of treatment, conservative treatment can get success in selected patients. We report a patient with cervical epidural abscess due to Streptococcus viridans endocarditis. Both epidural abscess and IE were managed conservatively with intravenous antibiotics for 8 weeks, with recovery. It is important to remind spinal epidural abscess can occur in those patients with bacterial endocarditis. PMID:25883665

  16. CT contrast evidence of injectate encapsulation after long-term epidural administration.

    PubMed

    Cherry, D A; Gourlay, G K

    1992-06-01

    This case report provides radiographic evidence (CT scan with Iopamidol) to support the development of epidural injectate encapsulation in response to long-term epidural morphine injections via an implanted polyurethane catheter. The patient complained of intense low interscapular pain when the catheter was used for administration of epidural morphine for control of angina. The patient had previously enjoyed 3 months of excellent pain relief following the initiation of epidural morphine via an implanted portal device. The CT scan, with contrast dye injected via the epidural catheter, clearly showed loculation of the injectate and associated indentation of the spinal cord. It is significant to note that the dye in the encapsulated sheath occupied a significant proportion of the spinal canal extending from T7 to T9. PMID:1408303

  17. Associations with chest illness and mortality in chronic spinal cord injury

    PubMed Central

    Danilack, Valery A.; Stolzmann, Kelly L.; Gagnon, David R.; Brown, Robert; Tun, Carlos G.; Morse, Leslie R.; Garshick, Eric

    2014-01-01

    Objective Identify factors associated with chest illness and describe the relationship between chest illness and mortality in chronic spinal cord injury (SCI). Design Cross-sectional survey assessing chest illness and a prospective assessment of mortality. Methods Between 1994 and 2005, 430 persons with chronic SCI (meanSD), 52.014.9 years old, and ?4 years post SCI (20.512.5 years) underwent spirometry, completed a health questionnaire, and reported any chest illness resulting in time off work, indoors, or in bed in the preceding 3 years. Deaths through 2007 were identified. Outcome measures Logistic regression assessing relationships with chest illness at baseline and Cox regression assessing the relationship between chest illness and mortality. Results Chest illness was reported by 139 persons (32.3%). Personal characteristics associated with chest illness were current smoking (odds ratio =2.15; 95% confidence interval =1.253.70 per each pack per day increase), chronic obstructive pulmonary disease (COPD) (3.52; 1.796.92), and heart disease (2.18; 1.144.16). Adjusting for age, subjects reporting previous chest illness had a non-significantly increased hazard ratio (HR) for mortality (1.30; 0.881.91). In a multivariable model, independent predictors of mortality were greater age, SCI level and completeness of injury, diabetes, a lower %-predicted forced expiratory volume in 1 second, heart disease, and smoking history. Adjusting for these covariates, the effect of a previous chest illness on mortality was attenuated (HR=1.15; 0.771.73). Conclusion In chronic SCI, chest illness in the preceding 3 years was not an independent risk factor for mortality and was not associated with level and completeness of SCI, but was associated with current smoking, physician-diagnosed COPD, and heart disease history. PMID:24090450

  18. Nocardia brasiliensis vertebral osteomyelitis and epidural abscess.

    PubMed

    Johnson, Philip; Ammar, Hussam

    2013-01-01

    Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature. PMID:23585503

  19. Nocardia brasiliensis vertebral osteomyelitis and epidural abscess

    PubMed Central

    Johnson, Philip; Ammar, Hussam

    2013-01-01

    Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature. PMID:23585503

  20. Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain

    PubMed Central

    Kuo, Yi-Liang; Huang, Kuo-Yuan; Chiang, Pei-Tzu; Lee, Pei-Yun; Tsai, Yi-Ju

    2015-01-01

    The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis) during single-leg standing including relative holding time (RHT) and relative standstill time (RST), and clinical balance tests (timed up and go test and 5-repetition sit to stand test). The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests. PMID:26024534

  1. Chronic spinal cord injury impairs primary antibody responses, but spares existing humoral immunity in mice

    PubMed Central

    Oropallo, Michael A.; Held, Katherine S.; Goenka, Radhika; Ahmad, Sifat A.; ONeill, Patrick J.; Steward, Oswald; Lane, Thomas E.; Cancro, Michael P.

    2012-01-01

    Spinal cord injury (SCI) results in immune depression. To better understand how injury inhibits humoral immunity, the effects of chronic thoracic SCI on B cell development and immune responses to thymus-independent (TI) type-2 and thymus-dependent (TD) antigens were determined. Mice received complete crush injury or control laminectomy at either thoracic level 3 (T3), which disrupts descending autonomic control of the spleen, or at T9, which conserves most splenic sympathetic activity. Although mature B cell numbers were only mildly reduced, bone marrow B cell production was transiently but profoundly depressed immediately after injury. Despite the return of normal B cell production four weeks after SCI, mice receiving T3-injury showed a significant reduction in their ability to mount primary TI-2 or TD immune responses. The latter were marked by decreases in germinal center B cells as well as class switched high-affinity antibody secreting cells. Importantly, injury did not affect affinity maturation per se, pre-existing B cell memory, or secondary humoral immune responses. Together, these findings show that chronic high thoracic SCI impairs the ability to mount optimal antibody responses to new antigenic challenges, but spares previously established humoral immunity. PMID:22523388

  2. Maternal Position and Development of Hypotension in Patients undergoing Cesarean Section under Combined Spinal-Epidural Anesthesia of Intrathecal Hyperbaric Ropivacaine

    PubMed Central

    Wang, Xin; Xu, Jun-Mei; Zhou, Fan; He, Liang; Cui, Yu-Long; Li, Zhi-Jian

    2015-01-01

    Background Spinal anesthesia (SA) is usually associated with hypotension in pregnant women. We sought to assess the influence of various maternal positions on SA-induced hypotension. Material/Methods The study population comprised 99 women at full-term gestation scheduled for elective cesarean section. They were randomized into 3 equal groups: the LL group, in which the patient was placed in the full left-lateral position until the start of surgery with the Whitacre needle bevel oriented laterally; the LS group, in which the patient was placed in the full left-lateral position initially and then shifted to the left-tilt supine position with the needle bevel oriented laterally; and the CS group, in which the patient was initially placed in the full left-lateral position and then shifted to the left-tilt supine position with the needle oriented in the cephalad direction. Results The incidences of hypotension in the LL, LS, and CS groups were 9.7%, 54.8%, and 56.3%, respectively. Ephedrine requirements were lower in the LL group than in the LS group (P<0.01). Conclusions The maternal position during the induction of anesthesia played an important role in the development of hypotension during cesarean delivery. PMID:25557016

  3. Isolated spinal cord contusion in rats induces chronic brain neuroinflammation, neurodegeneration, and cognitive impairment

    PubMed Central

    Wu, Junfang; Stoica, Bogdan A; Luo, Tao; Sabirzhanov, Boris; Zhao, Zaorui; Guanciale, Kelsey; Nayar, Suresh K; Foss, Catherine A; Pomper, Martin G; Faden, Alan I

    2014-01-01

    Cognitive dysfunction has been reported in patients with spinal cord injury (SCI), but it has been questioned whether such changes may reflect concurrent head injury, and the issue has not been addressed mechanistically or in a well-controlled experimental model. Our recent rodent studies examining SCI-induced hyperesthesia revealed neuroinflammatory changes not only in supratentorial pain-regulatory sites, but also in other brain regions, suggesting that additional brain functions may be impacted following SCI. Here we examined effects of isolated thoracic SCI in rats on cognition, brain inflammation, and neurodegeneration. We show for the first time that SCI causes widespread microglial activation in the brain, with increased expression of markers for activated microglia/macrophages, including translocator protein and chemokine ligand 21 (CC motif). Stereological analysis demonstrated significant neuronal loss in the cortex, thalamus, and hippocampus. SCI caused chronic impairment in spatial, retention, contextual, and fear-related emotional memoryevidenced by poor performance in the Morris water maze, novel objective recognition, and passive avoidance tests. Based on our prior work implicating cell cycle activation (CCA) in chronic neuroinflammation after SCI or traumatic brain injury, we evaluated whether CCA contributed to the observed changes. Increased expression of cell cycle-related genes and proteins was found in hippocampus and cortex after SCI. Posttraumatic brain inflammation, neuronal loss, and cognitive changes were attenuated by systemic post-injury administration of a selective cyclin-dependent kinase inhibitor. These studies demonstrate that chronic brain neurodegeneration occurs after isolated SCI, likely related to sustained microglial activation mediated by cell cycle activation. PMID:25483194

  4. Precise Delivery Into Chronic Spinal Cord Injury Syringomyelic Cysts with Magnetic Nanoparticles MRI Visualization

    PubMed Central

    Zhang, Chao; Morozova, Anna Y.; Abakumov, Maxim A.; Gubsky, Ilya L.; Douglas, Patricia; Feng, Shiqing; Bryukhovetskiy, Andrey S.; Chekhonin, Vladimir P.

    2015-01-01

    Background Traumatic spinal cord injury (SCI) often results in the deficiency of glia and neurons in cystic cavities. These syringomyelic cysts can prevent axonal regeneration and sprouting. Details of the mechanism of syringomyelic cyst formation are unknown and an effective treatment for overcoming syringomyelic cysts is not available. Material/Methods Ten adult female Wistar rats underwent contusion SCI modeling resulting in syringomyelic cyst formation. A novel method for locating the cysts was developed and employed. MRI safe silver needles were inserted through the erector spinae of anesthetized rats to create a stable reference point. MRI images of the rodent spine were taken with the needles in situ. This information was used to accurately locate the cyst and determine the 3-dimensional entry point coordinates for nanoparticle delivery. Nanoparticles were injected into the cyst during a primary injection of 8 ul and a secondary injection of 8 ul, to prove the procedure can be accurately repeated. Results None of the rats died intra- or post-operatively. The syringomyelic cysts were accurately located with the 3-dimensional entry point coordinates. After nanoparticle delivery twice into each rat, the visualized syringomyelic cyst volume significantly decreased from 5.71±0.21 mm3 to 3.23±0.364 mm3 and to 1.48±0.722 mm3. Conclusions The present study describes a novel strategy for precise nanoparticle delivery into a syringomyelic cyst, using measurements obtained from MRI images. This strategy may aid in developing a new method for studying chronic spinal cord injury and a novel treatment for syringomyelic cysts. PMID:26486048

  5. Correlation Between Health-Related Quality of Life in Veterans With Chronic Spinal Cord Injury and Their Caregiving Spouses

    PubMed Central

    Ebrahimzadeh, Mohammad Hosein; Golhasani-Keshtan, Farideh; Shojaee, Bibi Soheila

    2014-01-01

    Background: Recently, investigations have indicated that caring of a chronically ill family member strongly influences the health status and the quality of life (QOL) of the caregiving family members. Objectives: The purpose of this study was to examine the relationship between health-related QOL of veterans with chronic spinal cord injury and their caregiving spouses. Patients and Methods: We designed a cross-sectional study including two groups; veterans with chronic spinal cord injury and their caregiving wives who were living in the city of Mashhad, Iran. The patients with spinal cord injury were veterans from the Iran-Iraq war (1980-1988). All the participants filled out the short form 36 (SF-36) health survey questionnaire. A Pearson correlation coefficient was calculated for the scales of the two groups. Results: The mean age and standard deviation of veterans and their spouses were 48.5 5.9 and 44.8 7.2, respectively and their number of children ranged between 0-6. Our data analysis showed that there was a significant difference between the two groups in some domains of the SF-36, including PF, MH, PCS, MCS, BP and GH (P < 0.05), but there was no significant difference in RP, VT, SF and RE between the two groups. Conclusions: The results indicate that a decrease in health status level of veterans, physically and mentally, can affect the health-related QOL of their caregiving spouses. PMID:25738130

  6. Idiopathic hypertrophic spinal pachymeningitis with an osteolytic lesion.

    PubMed

    Jee, Tae Keun; Lee, Sun-Ho; Kim, Eun-Sang; Eoh, Whan

    2014-08-01

    Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic, progressive, inflammatory disorder characterized by marked fibrosis of the spinal dura mater with unknown etiology. According to the location of the lesion, it might induce neurologic deficits by compression of spinal cord and nerve root. A 58-year old female with a 3-year history of progressive weakness in both lower extremities was referred to our institute. Spinal computed tomography (CT) scan showed an osteolytic lesion involving base of the C6 spinous process with adjacent epidural mass. Magnetic resonance imaging (MRI) revealed an epidural mass involving dorsal aspect of cervical spinal canal from C5 to C7 level, with low signal intensity on T1 and T2 weighted images and non-enhancement on T1 weighted-enhanced images. We decided to undertake surgical exploration. At the operation field, there was yellow colored, thickened fibrous tissue over the dura mater. The lesion was removed totally, and decompression of spinal cord was achieved. Symptoms improved partially after the operation. Histopathologically, fibrotic pachymeninges with scanty inflammatory cells was revealed, which was compatible with diagnosis of idiopathic hypertrophic pachymeningitis. Six months after operation, motor power grade of both lower extremities was normal on physical examination. However, the patient still complained of mild weakness in the right lower extremity. Although the nature of IHSP is generally indolent, decompressive surgery should be considered for the patient with definite or progressive neurologic symptoms in order to prevent further deterioration. In addition, IHSP can present as an osteolytic lesion. Differential diagnosis with neoplastic disease, including giant cell tumor, is important. PMID:25328657

  7. Alterations in Mouse Hypothalamic Adipokine Gene Expression and Leptin Signaling following Chronic Spinal Cord Injury and with Advanced Age

    PubMed Central

    Bigford, Gregory E.; Bracchi-Ricard, Valerie C.; Nash, Mark S.; Bethea, John R.

    2012-01-01

    Chronic spinal cord injury (SCI) results in an accelerated trajectory of several cardiovascular disease (CVD) risk factors and related aging characteristics, however the molecular mechanisms that are activated have not been explored. Adipokines and leptin signaling are known to play a critical role in neuro-endocrine regulation of energy metabolism, and are now implicated in central inflammatory processes associated with CVD. Here, we examine hypothalamic adipokine gene expression and leptin signaling in response to chronic spinal cord injury and with advanced age. We demonstrate significant changes in fasting-induced adipose factor (FIAF), resistin (Rstn), long-form leptin receptor (LepRb) and suppressor of cytokine-3 (SOCS3) gene expression following chronic SCI and with advanced age. LepRb and Jak2/stat3 signaling is significantly decreased and the leptin signaling inhibitor SOCS3 is significantly elevated with chronic SCI and advanced age. In addition, we investigate endoplasmic reticulum (ER) stress and activation of the uncoupled protein response (UPR) as a biological hallmark of leptin resistance. We observe the activation of the ER stress/UPR proteins IRE1, PERK, and eIF2alpha, demonstrating leptin resistance in chronic SCI and with advanced age. These findings provide evidence for adipokine-mediated inflammatory responses and leptin resistance as contributing to neuro-endocrine dysfunction and CVD risk following SCI and with advanced age. Understanding the underlying mechanisms contributing to SCI and age related CVD may provide insight that will help direct specific therapeutic interventions. PMID:22815920

  8. Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans

    PubMed Central

    Karuza, Jurgis; Dunn, Andrew S.; Savino, Dorian; Katz, Paul

    2014-01-01

    Introduction: Chronic lower back pain (CLBP) is problematic in older veterans. Spinal manipulative therapy (SMT) is commonly utilized for CLBP in older adults, yet there are few randomized placebo-controlled trials evaluating SMT. Methods: The purpose of the study was to compare the effectiveness of SMT to a sham intervention on pain (Visual Analogue Scale, SF-36 pain subscale), disability (Oswestry Disability Index), and physical function (SF-36 subscale, Timed Up and Go) by performing a randomized placebo-controlled trial at 2 Veteran Affairs Clinics. Results: Older veterans (? 65 years of age) who were naive to chiropractic were recruited. A total of 136 were included in the study with 69 being randomly assigned to SMT and 67 to sham intervention. Patients were treated 2 times per week for 4 weeks assessing outcomes at baseline, 5, and 12 weeks postbaseline. Both groups demonstrated significant decrease in pain and disability at 5 and 12 weeks. At 12 weeks, there was no significant difference in pain and a statistically significant decline in disability scores in the SMT group when compared to the sham intervention group. There were no significant differences in adverse events between the groups. Conclusions: The SMT did not result in greater improvement in pain when compared to our sham intervention; however, SMT did demonstrate a slightly greater improvement in disability at 12 weeks. The fact that patients in both groups showed improvements suggests the presence of a nonspecific therapeutic effect. PMID:26246937

  9. Epidural Steroid Injections

    MedlinePLUS

    ... cycle of pain and inflammation and allow the body to compensate for the condition. In this way, the injections can provide benefits that outlast the effects of the steroid itself. How Are Epidural Steroid Injections Performed? There ...

  10. THERAPEUTIC EFFECTS OF ENDOTHELIN-A RECEPTOR ANTAGONIST ON BLADDER OVERACTIVITY IN RATS WITH CHRONIC SPINAL CORD INJURY

    PubMed Central

    Ogawa, Teruyuki; Sasatomi, Kurumi; Hiragata, Shiro; Seki, Satoshi; Nishizawa, Osamu; Chermansky, Christopher J; Pflug, Beth R.; Nelson, Joel B.; Chancellor, Michael B.; Yoshimura, Naoki

    2008-01-01

    Objectives We investigated the effects of suppression of ETA receptors on bladder function and ET-1 levels in the bladder in rats with chronic spinal cord injury (SCI). Methods The spinal cord of female Spraque-Dawley rats was transected at the level of Th 89. Awake cystometrograms were performed 4 weeks after spinal cord transection. Cystometric parameters such as mean amplitudes of non-voiding contractions (NVCs), the number of NVCs, voided volume, voiding efficiency, and micturition pressure were evaluated before and after intravenous (i.v.) injection of ABT-627, an ETA antagonist, or A-19261, an ETB antagonist, in SCI animals. Four weeks after spinalization, the protein and mRNA levels of ET-1 in the bladder were also measured using enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qRT-PCR). Results ABT-627 (1 mg/kg, i.v.), but not A-192621 (10 mg/kg, i.v.), significantly decreased the amplitude of NVCs and the number of NVCs in SCI rats. There were no significant changes in pressure threshold, maximum voiding pressure, voided volume or voiding efficiency. ELISA analysis for ET-1 showed significantly elevated protein concentrations in SCI rats compared with spinal cord intact rats. Significant upregulation of the ET-1 mRNA was also noted in SCI bladders. Conclusions These results suggest that upregulation of ET-1 is involved in the mechanism inducing bladder overactivity in chronic SCI rats and that an ETA receptor antagonist can suppress SCI-induced bladder overactivity as indicated by a reduction in NVCs. Thus, ETA receptor inhibition could be an effective treatment for neurogenic bladder overactivity in pathological conditions such as SCI. PMID:18308116

  11. Antinociceptive effects of low dose lumbosacral epidural ropivacaine in healthy ponies.

    PubMed

    van Loon, Johannes P A M; Menke, Eveline S; Doornenbal, Arie; Back, Willem; Hellebrekers, Ludo J

    2012-07-01

    The objective of this study was to evaluate the safety and efficacy of low dose lumbosacral epidural ropivacaine in ponies. Antinociceptive effects of epidural ropivacaine were evaluated by means of mechanical nociceptive thresholds (MNTs) at several spinal levels in conscious ponies. The effects of ropivacaine on nociceptive afferent transmission to the spinal cord were also assessed by measuring spinal cord somatosensory evoked potentials (SSEPs) in anaesthetised ponies. Ataxia scores were determined in conscious ponies to assess the effects on motor function. A randomised, placebo controlled, double blind cross-over design was used. Low dose lumbosacral epidural ropivacaine led to increases in MNTs at various anatomical locations with a maximum effect at the lumbosacral and sacrococcygeal regions, both with respect to increase in threshold and duration of effect. Analysis of SSEPs showed that epidural ropivacaine influenced both A?- and A?-mediated afferent transmission to the spinal cord at the level of the lumbosacral junction. Ponies showed mild ataxia after low dose lumbosacral epidural ropivacaine, but all ponies remained standing. Application of low dose lumbosacral epidural ropivacaine provided safe and efficacious antinociceptive effects in conscious and anaesthetised ponies, and could therefore be a valuable addition to multimodal analgesic protocols in Equidae. PMID:22398129

  12. Chronic Ingestion of Advanced Glycation End Products Induces Degenerative Spinal Changes and Hypertrophy in Aging Pre-Diabetic Mice

    PubMed Central

    Illien-Jünger, Svenja; Lu, Young; Qureshi, Sheeraz A.; Hecht, Andrew C.; Cai, Weijing; Vlassara, Helen; Striker, Gary E.; Iatridis, James C.

    2015-01-01

    Intervertebral disc (IVD) degeneration and pathological spinal changes are major causes of back pain, which is the top cause of global disability. Obese and diabetic individuals are at increased risk for back pain and musculoskeletal complications. Modern diets contain high levels of advanced glycation end products (AGEs), cyto-toxic components which are known contributors to obesity, diabetes and accelerated aging pathologies. There is little information about potential effects of AGE rich diet on spinal pathology, which may be a contributing cause for back pain which is common in obese and diabetic individuals. This study investigated the role of specific AGE precursors (e.g. methylglyoxal-derivatives (MG)) on IVD and vertebral pathologies in aging C57BL6 mice that were fed isocaloric diets with standard (dMG+) or reduced amounts of MG derivatives (dMG-; containing 60-70% less dMG). dMG+ mice exhibited a pre-diabetic phenotype, as they were insulin resistant but not hyperglycemic. Vertebrae of dMG+ mice displayed increased cortical-thickness and cortical-area, greater MG-AGE accumulation and ectopic calcification in vertebral endplates. IVD morphology of dMG+ mice exhibited ectopic calcification, hypertrophic differentiation and glycosaminoglycan loss relative to dMG- mice. Overall, chronic exposure to dietary AGEs promoted age-accelerated IVD degeneration and vertebral alterations involving ectopic calcification which occurred in parallel with insulin resistance, and which were prevented with dMG- diet. This study described a new mouse model for diet-induced spinal degeneration, and results were in support of the hypothesis that chronic AGE ingestion could be a factor contributing to a pre-diabetic state, ectopic calcifications in spinal tissues, and musculoskeletal complications that are more generally known to occur with chronic diabetic conditions. PMID:25668621

  13. Spinal cord brain-derived neurotrophic factor levels increase after dexamethasone treatment in male rats with chronic inflammation.

    PubMed

    Laste, Gabriela; Ripoll Rozisky, Joanna; de Macedo, Isabel Cristina; Souza Dos Santos, Vinicius; Custdio de Souza, Izabel Cristina; Caumo, Wolnei; Torres, Iraci L S

    2013-01-01

    Dexamethasone is widely used in the therapy of chronic inflammatory diseases for its pain-modulating effects. The objective of this study was to evaluate the effect of dexamethasone on nociception and local inflammation, and the levels of brain-derived neurotrophic factor (BDNF) in the spinal cord in male rats with chronic inflammation induced by complete Freund's adjuvant (CFA). Rats were randomly divided into a control group (not manipulated) and 2 CFA-induced chronic inflammation groups (in the 15th post-CFA injection): 1 injected with vehicle (saline solution) and 1 received dexamethasone (0.25 mg/kg) for 8 days. The hot-plate and electronic von Frey tests were performed 24 h after the end of treatment. BDNF spinal cord levels were determined by enzyme-linked immunosorbent assay (ELISA). The level of inflammation in the tibiotarsal joint (the ankle region) was evaluated histologically at the end of treatment. Dexamethasone produced significantly increased latency in the hot-plate test (one-way ANOVA, p < 0.05) and withdrawal threshold in the electronic von Frey test (p < 0.005). The dexamethasone group showed increased spinal cord BDNF levels compared to the other groups (one-way ANOVA p, < 0.05). Histological analysis showed a local inflammatory response only in animals treated with vehicle, which demonstrated that the dexamethasone treatment decreased the inflammatory process. Our findings corroborate the antinociceptive and anti-inflammatory properties of dexamethasone. In addition, we showed that the dexamethasone treatment increased BDNF levels in the spinal cord; its pain- modulating effects can be attributed to this effect. PMID:23328256

  14. Histopathological Alterations after Single Epidural Injection of Ropivacaine, Methylprednizolone Acetate, or Contrast Material in Swine

    SciTech Connect

    Kitsou, Maria-Chrysanthi; Kostopanagiotou, Georgia; Kalimeris, Konstantinos; Vlachodimitropoulos, Demetrios; Soultanis, Konstantinos; Batistaki, Chrysanthi; Kelekis, Alexis

    2011-12-15

    Purpose: The consequences from the injection of different types of drugs in the epidural space remains unknown. Increasing evidence suggests that localized inflammation, fibrosis, and arachnoiditis can complicate sequential epidural blockades, or even epidural contrast injection. We investigate the in vivo effect of epidural injections in the epidural space in an animal model. Materials and Methods: A group of ten male adult pigs, five punctures to each at distinct vertebral interspaces under general anesthesia, were examined, testing different drugs, used regularly in the epidural space (iopamidol, methylprednisolone acetate, ropivacaine). Each site was marked with a percutaneous hook wire marker. Histological analysis of the epidural space, the meninges, and the underlying spinal cord of the punctured sites along with staining for caspase-3 followed 20 days later. Results: The epidural space did not manifest adhesions or any other pathology, and the outer surface of the dura was not impaired in any specimen. The group that had the contrast media injection showed a higher inflammation response compared to the other groups (P = 0.001). Positive staining for caspase-3 was limited to <5% of neurons with all substances used. Conclusion: No proof of arachnoiditis and/or fibrosis was noted in the epidural space with the use of the above-described drugs. A higher inflammation rate was noted with the use of contrast media.

  15. Preclinical evidence supporting the clinical development of central pattern generator-modulating therapies for chronic spinal cord-injured patients

    PubMed Central

    2014-01-01

    Ambulation or walking is one of the main gaits of locomotion. In terrestrial animals, it may be defined as a series of rhythmic and bilaterally coordinated movement of the limbs which creates a forward movement of the body. This applies regardless of the number of limbs—from arthropods with six or more limbs to bipedal primates. These fundamental similarities among species may explain why comparable neural systems and cellular properties have been found, thus far, to control in similar ways locomotor rhythm generation in most animal models. The aim of this article is to provide a comprehensive review of the known structural and functional features associated with central nervous system (CNS) networks that are involved in the control of ambulation and other stereotyped motor patterns—specifically Central Pattern Generators (CPGs) that produce basic rhythmic patterned outputs for locomotion, micturition, ejaculation, and defecation. Although there is compelling evidence of their existence in humans, CPGs have been most studied in reduced models including in vitro isolated preparations, genetically-engineered mice and spinal cord-transected animals. Compared with other structures of the CNS, the spinal cord is generally considered as being well-preserved phylogenetically. As such, most animal models of spinal cord-injured (SCI) should be considered as valuable tools for the development of novel pharmacological strategies aimed at modulating spinal activity and restoring corresponding functions in chronic SCI patients. PMID:24910602

  16. Warming Moxibustion Relieves Chronic Visceral Hyperalgesia in Rats: Relations to Spinal Dynorphin and Orphanin-FQ System.

    PubMed

    Qi, Li; Liu, Hui-Rong; Yi, Tao; Wu, Lu-Yi; Liu, Xi-Ru; Zhao, Chen; Shi, Yin; Ma, Xiao-Peng; Wu, Huan-Gan

    2013-01-01

    As a twin therapy of acupuncture in traditional Chinese medicine, moxibustion has shown its effects in relieving abdominal pain in irritable bowel syndrome (IBS) patients and IBS rat models, but its mechanisms are largely unknown. In this paper, we determined the role of spinal dynorphin and orphanin-FQ system in analgesic effect of warming moxibustion (WM) on chronic visceral hyperalgesia (CVH) in IBS-like rat model. Here, we show that (1) repeated WM at bilateral ST25 and ST37 acupoints markedly attenuated the abdominal withdrawal reflex scores in CVH rats; (2) intrathecal administration of κ receptor antagonist prior to WM significantly attenuated the WM analgesia and dynorphinA (1-17) enhanced the WM analgesia. WM significantly reinforced the upregulation of spinal dynorphin mRNA/protein and κ receptor mRNA levels in CVH rats; (3) intrathecal administration of orphanin-FQ receptor antagonist prior to WM significantly attenuated the WM analgesia and orphanin-FQ enhanced the WM analgesia. WM reinforced the upregulation of spinal orphanin-FQ mRNA/protein and orphanin-FQ receptor mRNA levels in CVH rats. These results suggest that moxibustion may relieve CVH at least in part by activating spinal dynorphin and orphanin-FQ system. PMID:23573158

  17. Temporary homonymous hemianopsia after epidural blood patch

    PubMed Central

    Yeon, Hyeonkyeong; Shin, Young-Ok; Lee, Oh-Young; Kwon, Eunjeong

    2013-01-01

    We describe a case in which homonymous hemianopsia developed abruptly following an epidural blood patch procedure. The procedure was performed in a patient complaining of post-dural puncture headache after an emergency Cesarean section under spinal anesthesia. Computed tomography and magnetic resonance imaging demonstrated that air bubbles had moved from the prepontine and premedullar cisterns toward the left retrochiasmal region. The homonymous hemianopsia resolved rapidly with conservative management including oxygen, intravenous fluid, and antibiotics. We report on this case with a brief review of the related literature. PMID:24327992

  18. Patterns of chronic adhesive arachnoiditis following Myodil myelography: the significance of spinal canal stenosis and previous surgery.

    PubMed

    Laitt, R; Jackson, A; Isherwood, I

    1996-08-01

    109 patients who had undergone Myodil myelography on at least one occasion were identified. The patterns of lumbar nerve root distribution in this group were examined using magnetic resonance imaging. The relationship between these patterns and the presence of spinal stenosis or previous surgery was investigated. Chronic adhesive arachnoiditic nerve root patterns were seen in 68 patients and were classified into three groups according to Delemarter et al. Central clumping of nerve roots (type 1) and complete opacification of the thecal sac (type 3), extending over at least one vertebral level, were significantly related to spinal stenosis at an adjacent level (p < 0.0001). Peripheral adhesion of nerve roots to the theca (type 2) was significantly related to previous surgery at the level of abnormality (p < 0.00005). Only a single case of arachnoiditic nerve root patterns was seen in the absence of stenosis or previous surgery. We conclude that chronic adhesive arachnoiditis is significantly related to previous Myodil myelography in the presence of spinal stenosis or previous surgery but that Myodil alone rarely produces these changes. PMID:8949669

  19. Chronic infection of a Brindley sacral nerve root stimulator.

    PubMed

    Bramall, Alexa; Chaudhary, Bednash; Ahmad, Jamil; Shamji, Mohammed F

    2016-01-01

    The Finetech-Brindley sacral anterior root stimulator (SARS) is implanted for the treatment of bladder dysfunction following spinal cord injury (SCI) and has been successful in improving micturition in many patients with SCI. This case describes a 62-year-old man who presented with a chronic Staphylococcus aureus infection of a Brindley SARS 26?years after implantation following a T5 American Spinal Injury Association A spinal cord injury (T5 ASIA A SCI). He presented with chronic sacral osteomyelitis with a history of periodic implant erosion through the skin. Following a series of interventions, definitive management involved removal of the intradural electrodes and epidural and intradural phlegmon, ligation of the thecal sac and flap reconstruction. In the case of delayed infection of a Brindley SARS, removal of the entire system should be considered, especially if extension of the infection to the intradural compartment is suspected. PMID:26917791

  20. Ascending central canal dilation and progressive ependymal disruption in a contusion model of rodent chronic spinal cord injury

    PubMed Central

    Radojicic, Milan; Nistor, Gabriel; Keirstead, Hans S

    2007-01-01

    Background Chronic spinal cord injury (SCI) can lead to an insidious decline in motor and sensory function in individuals even years after the initial injury and is accompanied by a slow and progressive cytoarchitectural destruction. At present, no pathological mechanisms satisfactorily explain the ongoing degeneration. Methods Adult female Sprague-Dawley rats were anesthetized laminectomized at T10 and received spinal cord contusion injuries with a force of 250 kilodynes using an Infinite Horizon Impactor. Animals were randomly distributed into 5 groups and killed 1 (n = 4), 28 (n = 4), 120 (n = 4), 450 (n = 5), or 540 (n = 5) days after injury. Morphometric and immunohistochemical studies were then performed on 1 mm block sections, 6 mm cranial and 6 mm caudal to the lesion epicenter. The SPSS 11.5 t test was used to determine differences between quantitative measures. Results Here, we document the first report of an ascending central canal dilation and progressive ependymal disruption cranial to the epicenter of injury in a contusion model of chronic SCI, which was characterized by extensive dural fibrosis and intraparenchymal cystic cavitation. Expansion of the central canal lumen beyond a critical diameter corresponded with ependymal cell ciliary loss, an empirically predictable thinning of the ependymal region, and a decrease in cell proliferation in the ependymal region. Large, aneurysmal dilations of the central canal were accompanied by disruptions in the ependymal layer, periependymal edema and gliosis, and destruction of the adjacent neuropil. Conclusion Cells of the ependymal region play an important role in CSF homeostasis, cellular signaling and wound repair in the spinal cord. The possible effects of this ascending pathology on ependymal function are discussed. Our studies suggest central canal dilation and ependymal region disruption as steps in the pathogenesis of chronic SCI, identify central canal dilation as a marker of chronic SCI and provide novel targets for therapeutic intervention. PMID:17822568

  1. Mid-lumbar segments are needed for the expression of locomotion in chronic spinal cats.

    PubMed

    Langlet, C; Leblond, H; Rossignol, S

    2005-05-01

    In acute experiments performed in decerebrated and spinalized (T13) cats, an intraspinal injection of clonidine, a noradrenergic agonist, restricted to mid-lumbar segments L3-L4, can induce hindlimb locomotion, whereas yohimbine, a noradrenergic antagonist, can block spinal locomotion, and a second spinal lesion at L4 can abolish all locomotor activity. In the present study, we investigated whether the abolition of locomotion after this second spinal lesion was due to an acute spinal shock or to the functional disconnection of the rostral and caudal lumbar segments. In seven cats, first spinalized at T13 and having recovered treadmill locomotion, a second transection was performed at lower lumbar levels. Video and electromyographic recordings were used to evaluate locomotor performance. Results show that after a second transection at L2 or rostral L3 levels, spinal locomotion was maintained; when the second lesion was performed at caudal L3 or L4, all locomotor activity was abolished even after several weeks of attempted locomotor training; vigorous fast paw shakes (FPS) were observed in all cases; and after an intraperitoneal injection of clonidine in cats with a second transection below L4, perineal stimulation induced hyperextension of the hindlimbs but no locomotion. Considering that the main motoneuron pools of the hindlimbs are caudal to L4 and are still functional after the second spinal transection, as evidenced by the presence of FPS, we conclude that the mid-lumbar spinal segments are essential for the specific expression of spinal locomotion but not necessarily for other rhythmic motor patterns. PMID:15647400

  2. Spinal cord stimulation for intractable chronic upper abdominal pain: a case report of the first patient in New Zealand.

    PubMed

    Al-Mahrouqi, Haitham; Munro, Zea; Acland, Richard H; MacFarlane, Martin R

    2012-12-14

    We present the first patient in New Zealand to undergo Spinal Cord Stimulation (SCS) for intractable upper abdominal pain. The patient was a 53-year-old man with a 20-year history of debilitating upper abdominal pain associated with chronic pancreatitis secondary to pancreatic divisum. Prior to the SCS, he was prescribed 680 mg of morphine sulphate equi-analgesia a day. Despite the intense analgesia, he still suffered monthly attacks of upper abdominal pain requiring hospitalisation. Nine months after implanting a Spinal Cord Stimulator, the monthly attacks ceased, his background pain was effectively controlled and the need for opioids decreased to 510 mg of morphine sulphate equi-analgesia a day. PMID:23321890

  3. Role of spinal microglia in visceral hyperalgesia and NK1R upregulation in a rat model of chronic stress

    PubMed Central

    Bradesi, S; Svensson, CI; Steinauer, J; Pothoulakis, C; Yaksh, TL; Mayer, EA

    2010-01-01

    Background & Aims Chronic psychological stress is associated with visceral hyperalgesia and increased expression of spinal NK1 receptors (NK1R). We aimed to identify the role of spinal microglia in this process. Methods Male Wistar rats were exposed to water avoidance (WA) or sham stress 1 hour each day for 10 days and given daily injections of minocycline, the p38 inhibitor SB203580, or saline. Phosphorylation levels of the kinase p38 (P-p38), the microglia marker OX42, NK1R, and I?B? were assessed by immunoblotting and/or immunostaining of spinal samples collected at Day 11. The visceromotor response (VMR) to colorectal distension at baseline and following WA were also assayed in rats given injections of minocycline, SB203580 or vehicle. The effects of fractalkine were assessed on the VMR in rats exposed to minocycline or vehicle. Results P-p38 protein levels and immunoreactivity were increased in stressed rats and co-localized with OX42-positive cells and neurons in the dorsal horn. This increase was reversed by minocycline or SB203580 exposure. Stress-induced increased NK1R expression was blocked by minocycline but not SB203580. WA-induced decreased I?B? expression was blocked by minocycline and SB203580. WA-induced hyperalgesia was blocked by minocycline and SB203580 IT. Fractalkine-induced hyperalgesia was blocked by minocycline. Conclusions This is the first demonstration that stress-induced activation of spinal microglia has a key role in visceral hyperalgesia and associated spinal NK1R upregulation. PMID:19249394

  4. Preliminary Results of Spinal Cord Compression Recurrence Evaluation (Score-1) Study Comparing Short-Course Versus Long-Course Radiotherapy for Local Control of Malignant Epidural Spinal Cord Compression

    SciTech Connect

    Rades, Dirk Lange, Marisa; Veninga, Theo; Rudat, Volker; Bajrovic, Amira; Stalpers, Lukas J.A.; Dunst, Juergen; Schild, Steven E.

    2009-01-01

    Purpose: To compare the results of short-course vs. long-course radiotherapy (RT) for metastatic spinal cord compression. Methods and Materials: A total of 231 patients who underwent RT between January 2006 and August 2007 were included in this two-arm prospective nonrandomized study. Patients received short-course (n = 114) or long-course (n = 117) RT. The primary endpoint was progression-free survival (PFS). The secondary endpoints were local control (LC), functional outcome, and overall survival (OS). An additional 10 potential prognostic factors were investigated for outcomes. PFS and LC were judged according to motor function, not pain control. Results: The PFS rate at 12 months was 72% after long-course and 55% after short-course RT (p = 0.034). These results were confirmed in a multivariate analysis (relative risk, 1.33; 95% confidence interval, 1.01-1.79; p = 0.046). The 12-month LC rate was 77% and 61% after long-course and short-course RT, respectively (p = 0.032). These results were also confirmed in a multivariate analysis (relative risk, 1.49; 95% confidence interval, 1.03-2.24; p = 0.035). The corresponding 12-month OS rates were 32% and 25% (p = 0.37). Improvement in motor function was observed in 30% and 28% of patients undergoing long-course vs. short-course RT, respectively (p = 0.61). In addition to radiation schedule, PFS was associated with the interval to developing motor deficits before RT (relative risk, 1.99; 95% confidence interval, 1.10-3.55; p = 0.024). LC was associated only with the radiation schedule. Post-RT motor function was associated with performance status (p = 0.031), tumor type (p = 0.013), interval to developing motor deficits (p = 0.001), and bisphosphonate administration (p = 0.006). OS was associated with performance status (p < 0.001), number of involved vertebrae (p = 0.007), visceral metastases (p < 0.001), ambulatory status (p < 0.001), and bisphosphonate administration (p < 0.001). Conclusion: Short-course and long-course RT resulted in similar functional outcome and OS. Long-course RT was significant for improved PFS and improved LC.

  5. Resilience as a Possible Predictor for Psychological Distress in Chronic Spinal Cord Injured Patients Living in the Community

    PubMed Central

    Shin, Jung-In; Min, Jung-Ah; Lee, Chang-Uk; Hwang, Sung-Il; Lee, Bum-Suk; Han, Sang-Hoon; Ju, Hye-In; Lee, Cha-Yeon

    2012-01-01

    Objective To investigate whether higher resilience level predicts low levels of psychological distress in chronic SCI patients living in the community. Method Thirty seven patients (mean age 41.5±10.9, male : female=28 : 9) with chronic spinal cord injury (duration 8.35±7.0 years) living in the community are included, who were hospitalized for annual checkups from November, 2010 to May, 2011. First, their spinal cord injury level, completeness and complications were evaluated. The patients completed questionnaires about their educational status, religion, employment status, marital status, medical and psychological history and also the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Connor-Davidson Resilience Scale (CD-RISC), Alcohol Use Disorders Identification Test-alcohol consumption questions (AUDIT-C) and Health-related quality of life (EQ-5D). The patients were divided into two subgroups: patients with HADS ≥13 are classified as high psychological distress group and others as low psychological distress group. We compared the two groups to find statistically significant differences among the variables. Results CD-RISC, EQ-5D and employment status are significantly different between two groups (p<0.05). In a forward stepwise regression, we found that EQ-5D had a greater contribution than CD-RISC to the psychological distress level. Conclusion In addition to health-related quality of life, resilience can be suggested as a possible predictor of psychological distress in chronic SCI patients. PMID:23342314

  6. Bilateral supratentorial epidural hematomas: a rare complication in adolescent spine surgery.

    PubMed

    Li, Zhao-Jian; Sun, Peng; Dou, Yi-He; Lan, Xiao-Lei; Xu, Jian; Zhang, Chun-Yong; Wang, Jian-Peng

    2012-01-01

    A 14-year-old girl presented with a rare case of spontaneous bilateral supratentorial epidural hematomas which developed rapidly following cervical surgery. The hematomas presumably resulted from dural dynamics changes secondary to cerebrospinal fluid loss and intracranial hypotension. Intracranial epidural hemorrhage after spinal surgery is extremely uncommon with only one previous case report. Spontaneous intracranial epidural hematoma is an extremely rare complication, but should be considered as a possible complication of spine surgery, especially in adolescents complicated by delayed consciousness and breathing restoration from anesthesia. This case report expands the presently known clinical spectrum of this uncommon complication. PMID:23006878

  7. Myelopathy-mimicking symptoms of epidural venous engorgement and syringomyelia due to inferior vena cava stenosis at the thoracolumbar junction in a patient with Budd-Chiari syndrome.

    PubMed

    Lee, Jung-Hee; Song, Wook-Jae; Kang, Kyung-Chung

    2015-10-01

    Epidural venous engorgement can result from various lesions, such as arteriovenous malformation, thrombosis or occlusion of the inferior vena cava (IVC), or an abdominal masslike lesion. Most patients with these problems complain of low-back pain, radicular pain, or neurogenic claudication, which are symptoms suggestive of disc herniation or spinal stenosis. However, these patients rarely exhibit neurological deficits or cauda equina syndrome. The authors encountered a case of a 60-year-old man presenting with lower-extremity weakness and voiding difficulty for a period of 1 year. To investigate the patient's myelopathy-mimicking symptoms, a lumbar spine MRI scan was performed. The MR images exhibited tortuous and dilated spinal vessels compressing the spinal cord and thecal sac at the T11-L3 level, which were concurrent with syringomyelia evidenced by a 22 2.5-mm cyst at the T11-12 level. 3D CT scanning of the whole aorta revealed total occlusion and regression of the IVC in the intrahepatic region 3 cm inferior to the right atrium and dilation of multiple collateral veins. The patient was diagnosed with chronic Budd-Chiari syndrome Type I. The authors performed venography, followed by intrahepatic IVC recanalization via stent placement under fluoroscopic and ultra sonographic guidance and without surgical exploration. After this treatment, there was a marked decrease in epidural venous engorgement and the patient's symptoms resolved almost completely. This case indicates that epidural venous engorgement at thoracolumbar levels may cause symptoms suggestive of myelopathy and can be successfully treated by minimally invasive procedures to eliminate the underlying causes. PMID:26140407

  8. Epidural capsaicin produces prolonged segmental analgesia in the rat.

    PubMed

    Eimerl, D; Papir-Kricheli, D

    1987-07-01

    The effect of epidural capsaicin injections on the thermal nociceptive threshold of unrestrained freely moving adult rats was examined. Capsaicin solution (1% 0.05 ml, 0.1 ml) was injected in a single dose or in two consecutive doses through an indwelling lumbar epidural catheter. Effects were compared with 1 ml 1% capsaicin injected intraperitoneally. Twelve rats served as sham-treated and vehicle controls. Nociceptive thermal stimuli were brief pulses of CO2 laser radiation directed at three body areas, hind limb, forelimb, and pinna. Capsaicin caused prolonged, segmental thermal analgesia. Maximal nociceptive threshold values in the hind limbs, attained within 24 h of epidural injection, were 2.5 (P less than or equal to 0.006) and 5.3 (P less than or equal to 0.0005) time control values for the 0.05-ml and 0.1-ml doses, respectively. Response thresholds in the forelimbs and pinna were unaffected. Two-stage epidural injection of capsaicin led to a roughly twofold elevation of threshold, as well as prolongation of the analgesia to about 14 days. Intraperitoneal injection of capsaicin resulted in elevation of nociceptive threshold which included all body areas tested. These results indicate that epidural application of capsaicin at the lumbar spinal level produced a profound and long-lasting segmental analgesia. PMID:3582561

  9. Testretest reliability of pulse wave velocity in individuals with chronic spinal cord injury

    PubMed Central

    Miyatani, Masae; Masani, Kei; Moore, Cameron; Szato, Maggie; Oh, Paul; Craven, Catharine

    2012-01-01

    Background Pulse wave velocity (PWV), which reflects arterial stiffness, is an important predictor of future coronary artery disease. The testretest reliability of PWV has not been investigated in people with spinal cord injury (SCI). Purpose To report the testretest (day-to-day) reliability of PWV measurements among people with SCI, and to determine the smallest real difference (SRD) of PWV values. Participants Twenty men (n=19) and a woman (n=1) with SCI (C4-T10; AIS A-D; ?1-year post-injury; 10 with paraplegia and 10 with tetraplegia; time post-injury: 11.88.7 years; age: 43.012.6 years). Methods On two occasions within a 2-week period, aortic PWV (between the common carotid and femoral artery), arm PWV (between the brachial and radial artery), and leg PWV (between femoral and posterior tibial artery) were assessed at the same time of day using Doppler flowmeters. Results No statistically significant differences were found between days 1 and 2 in aortic PWV (day 1: 941185cm/seconds, day 2: 917160cm/seconds, P=0.257), leg PWV (day 1: 1088141cm/seconds, day 2: 1122165cm/seconds, P=0.099) and arm PWV (day 1: 1283185cm/seconds, day 2: 1358256cm/seconds, P=0.180). The aortic and leg PWVs had high testretest reliability (intraclass correlation coefficient: ICC=0.920 and 0.913, respectively; P<0.001 for both) and arm PWV had moderate testretest reliability (ICC=0.598, P=0.03). SRDs for each PWV were 104cm/seconds (aortic PWV), 97cm/seconds (leg PWV) and 143cm/seconds (arm PWV). Conclusion The testretest reliability of PWV assessment is high among patients with chronic SCI. Changes in aortic PWV values above 104cm/seconds with repeated testing like represent true changes in health status. PMID:23031177

  10. Transient bladder and fecal incontinence following epidural blood patch

    PubMed Central

    Palomero-Rodrguez, Miguel Angel; Palacio-Abinzada, Francisco J.; Campollo, Sara Chacn; Laporta-Bez, Yolanda; Mendez Cendn, Jose Carlos; Lpez-Garca, Andres

    2015-01-01

    Epidural blood patch (EBP) is the currently accepted treatment of choice for postdural puncture headache because of its high initial success rates and infrequent complications. Many authors recommended a small volume (10-20 mL) of blood to be delivered for an effective EBP. Here, we report an obstetric patient who developed a transient bladder and fecal incontinence after 19 mL of blood EBP at L1 -L2 level. Since the magnetic resonance image did not demonstrate any definitive spinal cord lesion, the exact mechanism remains unclear. We suggest that accumulation of blood performed at L1 to L2 level in a closed relationship with the sacral cord, may have trigger a significant pressure elevation of the epidural space at this level, resulting in a temporal spinal cord-related injury in the sacral cord. PMID:26543470

  11. Transient bladder and fecal incontinence following epidural blood patch.

    PubMed

    Palomero-Rodrguez, Miguel Angel; Palacio-Abinzada, Francisco J; Campollo, Sara Chacn; Laporta-Bez, Yolanda; Mendez Cendn, Jose Carlos; Lpez-Garca, Andres

    2015-01-01

    Epidural blood patch (EBP) is the currently accepted treatment of choice for postdural puncture headache because of its high initial success rates and infrequent complications. Many authors recommended a small volume (10-20 mL) of blood to be delivered for an effective EBP. Here, we report an obstetric patient who developed a transient bladder and fecal incontinence after 19 mL of blood EBP at L1 -L2 level. Since the magnetic resonance image did not demonstrate any definitive spinal cord lesion, the exact mechanism remains unclear. We suggest that accumulation of blood performed at L1 to L2 level in a closed relationship with the sacral cord, may have trigger a significant pressure elevation of the epidural space at this level, resulting in a temporal spinal cord-related injury in the sacral cord. PMID:26543470

  12. Autologous bone marrow-derived cell therapy combined with physical therapy induces functional improvement in chronic spinal cord injury patients.

    PubMed

    El-Kheir, Wael Abo; Gabr, Hala; Awad, Mohamed Reda; Ghannam, Osama; Barakat, Yousef; Farghali, Haithem A M A; El Maadawi, Zeinab M; Ewes, Ibrahim; Sabaawy, Hatem E

    2014-04-01

    Spinal cord injuries (SCI) cause sensory loss and motor paralysis. They are normally treated with physical therapy, but most patients fail to recover due to limited neural regeneration. Here we describe a strategy in which treatment with autologous adherent bone marrow cells is combined with physical therapy to improve motor and sensory functions in early stage chronic SCI patients. In a phase I/II controlled single-blind clinical trial (clinicaltrials.gov identifier: NCT00816803), 70 chronic cervical and thoracic SCI patients with injury durations of at least 12 months were treated with either intrathecal injection(s) of autologous adherent bone marrow cells combined with physical therapy or with physical therapy alone. Patients were evaluated with clinical and neurological examinations using the American Spinal Injury Association (ASIA) Impairment Scale (AIS), electrophysiological somatosensory-evoked potential, magnetic resonance imaging (MRI), and functional independence measurements. Chronic cervical and thoracic SCI patients (15 AIS A and 35 AIS B) treated with autologous adherent bone marrow cells combined with physical therapy showed functional improvements over patients in the control group (10 AIS A and 10 AIS B) treated with physical therapy alone, and there were no long-term cell therapy-related side effects. At 18 months posttreatment, 23 of the 50 cell therapy-treated cases (46%) showed sustained functional improvement. Compared to those patients with cervical injuries, a higher rate of functional improvement was achieved in thoracic SCI patients with shorter durations of injury and smaller cord lesions. Therefore, when combined with physical therapy, autologous adherent bone marrow cell therapy appears to be a safe and promising therapy for patients with chronic SCI of traumatic origin. Randomized controlled multicenter trials are warranted. PMID:23452836

  13. Management of cardiovascular disease risk factors in individuals with chronic spinal cord injury: an evidence-based review.

    PubMed

    Cragg, Jacquelyn J; Stone, James A; Krassioukov, Andrei V

    2012-07-20

    Clinical scenario: A 37-year-old man suffered a complete spinal cord injury (C8, American Spinal Injury Association Impairment Scale [ASIA] score A) 10 years ago in a car accident. Should primary prevention of cardiovascular disease be a priority in this patient? In order to answer this question, we performed a systematic review of the literature to inform an evidence-based clinical review. The objective was to provide a comprehensive and up-to-date review of the clinical management of cardiovascular disease (CVD) and risk factors for individuals with spinal cord injury (SCI). Comprehensive literature searches were performed. The quality of each study was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials, and the Downs and Black Scale for all other studies. Levels of evidence were assigned using a modified version of Sackett's scale. Our findings indicate that CVD is a critical issue in individuals with chronic SCI. Almost all risk factors for CVD are amplified in individuals with SCI, including physical inactivity, dyslipidemia, blood pressure irregularities, abnormal glycemic control, and chronic inflammation. However, there is a paucity of high-quality literature with respect to treatment outcomes in SCI-specific study populations (a total of 22 intervention studies in all of these categories combined) that allow for the development of evidence-informed clinical practice recommendations. These limitations notwithstanding, we present a series of contemporary practice suggestions with regard to CVD event risk modification in SCI patients. For optimal outcomes, health care providers should be cognizant of these heightened CVD risk factors and the resultant increased CVD morbidity and mortality in SCI patients. Despite the absence of high-quality evidence-based treatment strategies, clinicians should re-examine their own CVD risk factor treatment strategies to better reflect contemporary practice in similar high-CVD-event-risk patients and populations. PMID:22738320

  14. Salmonella Typhi Vertebral Osteomyelitis and Epidural Abscess

    PubMed Central

    Chua, Ying Ying; Chen, John L. T.

    2016-01-01

    Salmonella vertebral osteomyelitis is an uncommon complication of Salmonella infection. We report a case of a 57-year-old transgender male who presented with lower back pain for a period of one month following a fall. Physical examination only revealed tenderness over the lower back with no neurological deficits. MRI of the thoracic and lumbar spine revealed a spondylodiscitis at T10-T11 and T12-L1 and right posterior epidural collection at the T9-T10 level. He underwent decompression laminectomy with segmental instrumentation and fusion of T8 to L3 vertebrae. Intraoperatively, he was found to have acute-on-chronic osteomyelitis in T10 and T11, epidural abscess, and discitis in T12-L1. Tissue and wound culture grew Salmonella Typhi and with antibiotics susceptibility guidance he was treated with intravenous ceftriaxone for a period of six weeks. He recovered well with no neurological deficits.

  15. Subdural Hematoma as a Consequence of Epidural Anesthesia

    PubMed Central

    Bishop, Tracy M.; Elsayed, Kareem S.; Kane, Kathleen E.

    2015-01-01

    Regional spinal and epidural anesthesia are used commonly in operative procedures. While the most frequent complication, postdural puncture headache (PDPH), is a clinically diagnosed positional headache that is usually self-limited, subdural hemorrhage (SDH) is a potentially fatal complication that cannot be missed. We report a case of an otherwise healthy female who presented with persistent positional headache and was ultimately found to have a large subdural hematoma with midline shift requiring surgical evacuation. PMID:26697237

  16. Primary lumbar epidural abscess without spondylodiscitis caused by Fusobacterium necrophorum diagnosed by 16S rRNA PCR.

    PubMed

    Sanmilln, Jose Luis; Pelegrn, Ivn; Rodrguez, David; Ardanuy, Carmen; Cabellos, Carmen

    2013-10-01

    We report the case of a 71-year-old woman who presented a primary spinal epidural abscess caused by Fusobacterium necrophorum. This is the second report in the medical literature to associate this organism with a primary spinal epidural abscess without spondylodiscitis. After treatment with emergency laminectomy followed by 8 weeks of antibiotic treatment the patient was cured. Oral metronidazole (500mg every 8h) was the definitive choice of treatment. F.necrophorum spinal epidural abscess is rare, although samples for anaerobic culture should be collected in order to improve detection of anaerobic spinal infections. PCR amplification and sequencing of the 16S rRNA permits early diagnosis in anaerobic infections. PMID:23845584

  17. Regulation of Neurotrophin-3 and Interleukin-1β and Inhibition of Spinal Glial Activation Contribute to the Analgesic Effect of Electroacupuncture in Chronic Neuropathic Pain States of Rats

    PubMed Central

    Tu, Wenzhan; Wang, Wansheng; Xi, Haiyan; He, Rong; Gao, Liping; Jiang, Songhe

    2015-01-01

    Growing evidence indicates that neurotrophin-3, interleukin-1β, and spinal glia are involved in neuropathic pain derived from dorsal root ganglia to spinal cord. Electroacupuncture is widely accepted to treat chronic pain, but the precise mechanism underlying the analgesic effect of EA has not been fully demonstrated. In this study, the mechanical withdrawal threshold and thermal withdrawal latency were recorded. We used immunofluorescence and western blots methods to investigate the effect of EA on the expression of NT-3 and IL-1β in DRG and spinal cord of CCI rats; we also examined the expression of spinal GFAP and OX-42 in spinal cord. In present study, the MWT and TWL of CCI group rats were lower than those in the Sham CCI group rats, but EA treatment increased the pain thresholds. Furtherly, we found that EA upregulates the expression of NT-3 in DRG and spinal cord of CCI rats, while EA downregulates the expression of IL-1β. Additionally, immunofluorescence exhibited that CCI-induced activation of microglia and astrocytes was inhibited significantly by EA treatment. These results demonstrated that the analgesic effect of EA may be achieved through promoting the neural protection of NT-3 as well as the inhibition of IL-1β production and spinal glial activity. PMID:26161124

  18. Intraspinal stimulation for bladder voiding in cats before and after chronic spinal cord injury

    NASA Astrophysics Data System (ADS)

    Pikov, Victor; Bullara, Leo; McCreery, Douglas B.

    2007-12-01

    The long-term objective of this study is to develop neural prostheses for people with spinal cord injuries who are unable to voluntarily control their bladder. This feasibility study was performed in 22 adult cats. We implanted an array of microelectrodes into locations in the sacral spinal cord that are involved in the control of micturition reflexes. The effect of microelectrode stimulation was studied under light Propofol anesthesia at monthly intervals for up to 14 months. We found that electrical stimulation in the sacral parasympathetic nucleus at S2 level or in adjacent ventrolateral white matter produced bladder contractions insufficient for inducing voiding, while stimulation at or immediately dorsal to the dorsal gray commissure at S1 level produced strong (at least 20 mmHg) bladder contractions as well as strong (at least 40 mm Hg) external urethral sphincter relaxation, resulting in bladder voiding in 14 animals. In a subset of three animals, spinal cord transection was performed. For several months after the transection, intraspinal stimulation continued to be similarly or even more effective in inducing the bladder voiding as before the transection. We speculate that in the absence of the supraspinal connections, the plasticity in the local spinal circuitry played a role in the improved responsiveness to intraspinal stimulation.

  19. Effects of Therapy in Patients Suffering from Chronic Back Pain Treated with Spinal Cord Stimulation.

    PubMed

    Mosiewicz, Anna; Rutkowska, Elżbieta; Matacz, Monika; Mosiewicz, Barbara; Kaczmarczyk, Robert; Trojanowski, Tomasz

    2015-10-01

    Pain in the lumbosacral part of the spine in the course of degenerative disease is the most common cause of physical activity limitation in adults. Treatment includes pharmacotherapy, physiotherapy, psychotherapy, health promotion, and sometimes surgery. Surgical treatment is not always successful, and the various clinical and psychosomatic symptoms that result from surgical treatment failure are known as failed back surgery syndrome. For some patients with this condition, spinal cord stimulation can provide relief. The aim of the work was to define subjective and objective spinal cord stimulation effects by assessing chosen disability and physical activity limitation ratios. Pain intensity, level of disability, and presence of neurological symptoms were assessed. The examination was performed twice: before the stimulator implantation and at least 6 months postimplantation. The study was conducted at the Department of Neurosurgery and Paediatric Neurosurgery in Lublin. Thirty-six patients suffering from failed back surgery syndrome were recruited for this study. The Visual Analog Scale, modified Laitinen's pain questionnaire, and Oswestry Disability Index were used in this work. The study showed that spinal cord stimulation was effective in treating spinal and lower limb pain in 64% of patients, similar to results obtained in other departments. Although back pain and neuropathic pain radiating to the lower limbs decreased, moderate physical activity impairment was still observed according to the Oswestry Disability Index scale. The decrease in neuropathic pain radiating to the lower limbs had the most significant influence on reducing physical activity impairment. PMID:26187548

  20. Longitudinal study of bone loss in chronic spinal cord injury patients

    PubMed Central

    Karapolat, Inanc; Karapolat, Hale Uzumcugil; Kirazli, Yesim; Capaci, Kazim; Akkoc, Yesim; Kumanlioglu, Kamil

    2015-01-01

    [Purpose] This prospective longitudinal study evaluated the changes in bone metabolism markers and bone mineral density of spinal cord injury patients over 3?years. We also assessed the relationships among the bone mineral density, bone metabolism, and clinical data of spinal cord injury patients. [Subjects and Methods] We assessed the clinical data (i.e., immobilization due to surgery, neurological status, neurological level, and extent of lesion) in 20 spinal cord injury patients. Bone mineral density, and hormonal and biochemical markers of the patients were measured at 0, 6, 12, and 36 months. [Results] Femoral neck T score decreased significantly at 36 months (p < 0.05). Among the hormonal markers, parathyroid hormone and vitamin D were significantly elevated, while bone turnover markers (i.e., deoxypyridinoline and osteocalcin) were significantly decreased at 12 and 36 months (p < 0.05). [Conclusion] Bone mineral density of the femoral neck decreases significantly during the long-term follow-up of patients with spinal cord injury due to osteoporosis. This could be due to changes in hormonal and bone turnover markers. PMID:26157234

  1. Chronic Expression of PPAR-? by Oligodendrocyte Lineage Cells in the Injured Rat Spinal Cord

    PubMed Central

    Almad, Akshata; McTigue, Dana M.

    2014-01-01

    The transcription factor peroxisome proliferator-activated receptor (PPAR)-? promotes oligodendrocyte differentiation and myelin formation in vitro and is prevalent throughout the brain and spinal cord. Its expression after injury, however, has not been examined. Thus, we used a spinal contusion model to examine the spatiotemporal expression of PPAR-? in nave and injured spinal cords from adult rats. As previously reported, PPAR-? was expressed by neurons and oligodendrocytes in uninjured spinal cords; PPAR-? was also detected in NG2 cells (potential oligodendrocyte progenitors) within the white matter and gray matter. After spinal cord injury (SCI), PPAR-? mRNA and protein were present early and increased over time. Overall PPAR-?+ cell numbers declined at 1 day post injury (dpi), likely reflecting neuron loss, and then rose through 14 dpi. A large proportion of NG2 cells expressed PPAR-? after SCI, especially along lesion borders. PPAR-?+ NG2 cell numbers were significantly higher than naive by 7 dpi and remained elevated through at least 28 dpi. PPAR-?+ oligodendrocyte numbers declined at 1 dpi and then increased over time such that >20% of oligodendrocytes expressed PPAR-? after SCI compared with ~10% in uninjured tissue. The most prominent increase in PPAR-?+ oligodendrocytes was along lesion borders where at least a portion of newly generated oligodendrocytes (bromode-oxyuridine +) were PPAR-?+. Consistent with its role in cellular differentiation, the early rise in PPAR-?+ NG2 cells followed by an increase in new PPAR-?+ oligodendrocytes suggests that this transcription factor may be involved in the robust oligodendrogenesis detected previously along SCI lesion borders. PMID:20058304

  2. Suspended moxibustion at Tianshu (ST25) inhibits prokineticin 1 and prokineticin receptor 1 expression in the spinal cord of rats with chronic visceral hypersensitivity.

    PubMed

    Zhao, Chen; Qi, Li; Wu, Luyi; Yi, Tao; Wu, Huangan; Guo, Xinxin; Zhou, Cili; Liu, Huirong; Wang, Xiaomei

    2012-05-25

    Suspended moxibustion can decrease the expression of prokineticin 1 and its receptor in colonic tissue from rats modeling chronic visceral hyperalgesia. This study aimed to verify if rat spinal cord prokineticin 1 and its receptor contribute to the analgesic effect of suspended moxibustion in a rat model of irritable bowel syndrome where rats display chronic visceral hypersensitivity. Results showed that suspended moxibustion at Tianshu (ST25) point significantly decreased visceral sensitivity to colorectal distention in a chronic visceral hyperalgesia rat model; also protein and mRNA expression of prokineticin 1 and prokineticin receptor 1 in the spinal cord of rats was significantly decreased. Experimental findings indicate that prokineticin 1 and prokineticin receptor 1 are involved in the analgesia using suspended moxibustion in rats with chronic visceral hyperalgesia. PMID:25722707

  3. Bilateral assymetric epidural hematoma

    PubMed Central

    Pereira, Edmundo Luis Rodrigues; Rodrigues, Daniella Brito; Lima, Lorena Oliveira; Sawada, Luis Armando; Hermes, Mário de Nazareth

    2015-01-01

    Background: Acute bilateral extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5–10% of all extradural hematomas. However, higher mortality rates have been reported in previous series. Case Description: The authors described the case of a 28-year-old male presenting head injury, comatose, Glasgow Coma Scale of 6, anisocoric pupils without puppilary light reflex. Computed tomography showed asymmetric bilateral epidural hematomas, effacement of the lateral ventricles and sulci, midline shift and a bilateral skull fracture reaching the vertex. Surgical evacuation was performed with simultaneous hematoma drainage. Patient was discharged on the 29th postoperative day with no neurological deficit. Conclusion: The correct approach on bilateral epidural hematomas depends on the volume, moment of diagnosis, and neurological deficit level. Simultaneous drainage of bilateral hematomas has been demonstrated to be an effective technique for it, which soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage. PMID:25657867

  4. The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases

    PubMed Central

    Bess, Shay; Line, Breton; Fu, Kai-Ming; McCarthy, Ian; Lafage, Virgine; Schwab, Frank; Shaffrey, Christopher; Ames, Christopher; Akbarnia, Behrooz; Jo, Han; Kelly, Michael; Burton, Douglas; Hart, Robert; Klineberg, Eric; Kebaish, Khaled; Hostin, Richard; Mundis, Gregory; Mummaneni, Praveen; Smith, Justin S.

    2016-01-01

    Study Design. A retrospective analysis of a prospective, multicenter database. Objective. The aim of this study was to evaluate the health impact of symptomatic adult spinal deformity (SASD) by comparing Standard Form Version 2 (SF-36) scores for SASD with United States normative and chronic disease values. Summary of Background Data. Recent data have identified radiographic parameters correlating with poor health-related quality of life for SASD. Disability comparisons between SASD patients and patients with chronic diseases may provide further insight to the disease burden caused by SASD. Methods. Consecutive SASD patients, with no history of spine surgery, were enrolled into a multicenter database and evaluated for type and severity of spinal deformity. Baseline SF-36 physical component summary (PCS) and mental component summary (MCS) values for SASD patients were compared with reported U.S. normative and chronic disease SF-36 scores. SF-36 scores were reported as normative-based scores (NBS) and evaluated for minimally clinical important difference (MCID). Results. Between 2008 and 2011, 497 SASD patients were prospectively enrolled and evaluated. Mean PCS for all SASD was lower than U.S. total population (ASD = 40.9; US = 50; P < 0.05). Generational decline in PCS for SASD patients with no other reported comorbidities was more rapid than U.S. norms (P < 0.05). PCS worsened with lumbar scoliosis and increasing sagittal vertical axis (SVA). PCS scores for patients with isolated thoracic scoliosis were similar to values reported by individuals with chronic back pain (45.5 vs 45.7, respectively; P > 0.05), whereas patients with lumbar scoliosis combined with severe sagittal malalignment (SVA >10 cm) demonstrated worse PCS scores than values reported by patients with limited use of arms and legs (24.7 vs 29.1, respectively; P < 0.05). Conclusions. SASD is a heterogeneous condition that, depending upon the type and severity of the deformity, can have a debilitating impact on health often exceeding the disability of more recognized chronic diseases. Health care providers must be aware of the types of SASD that correlate with disability to facilitate appropriate diagnosis, treatment, and research efforts. Level of Evidence: 3. PMID:26571174

  5. Ectopic extramedullary hematopoiesis: evaluation and treatment of a rare and benign paraspinal/epidural tumor.

    PubMed

    Mattei, Tobias A; Higgins, Michael; Joseph, Flynn; Mendel, Ehud

    2013-03-01

    Ectopic extramedullary hematopoiesis (EMH), defined as the formation of blood cells outside the bone marrow, usually occurs in a scenario of chronic anemia when, even after conversion of the bony yellow marrow to red marrow, the body is still unable to meet the demand for red blood cells. Ectopic extramedullary hematopoiesis most commonly occurs in the liver and spleen but may, in fact, occur almost anywhere in the body. Although previous reports have documented EMH presenting as paraspinal masses, such lesions have almost always been associated with a predisposing hematological disorder such as hemolytic anemia, myelofibrosis or myelodysplastic syndromes, thalassemia, polycythemia vera, leukemia, or lymphoma. The authors of this report describe the first reported instance of EMH in a patient presenting with a symptomatic epidural and paraspinal cervical lesion arising from the posterior spinal elements and no known predisposing hematological disease. Initial radiographs revealed a bony lesion arising posteriorly from the C2-3 laminae and spinous processes. Subsequent imaging suggested the diagnosis, which was confirmed by CT-guided biopsy, peripheral blood smears, and bone marrow aspirate. Despite epidural compression and slight displacement of the cervical cord and thecal sac, the patient's symptoms were limited to pain and diminished cervical range of motion. Therefore, surgery was deferred in favor of nonsurgical therapy. Several alternative modalities for the treatment of EMH have been suggested in the literature, including cytotoxic agents and radiotherapy. The authors opted for an approach utilizing directed low-dose radiotherapy of a total of 25 Gy divided in 2.5-Gy fractions. At the 3-month follow-up, the patient continued to be asymptomatic, and MRI demonstrated a significant reduction in the dimensions of the lesion. Extramedullary hematopoiesis with spinal cord compression in the absence of a preexisting hematological disorder has not been described in the context of clinical neurosurgical practice. Recognizing that EMH may present as an epidural or paraspinal lesion is important since chemotherapy and radiotherapy are effective therapeutic options in the majority of patients who suffer few if any symptoms. Extensive evaluation for underlying hematological disorders is necessary before undertaking directed therapy. Inadvertent resection of these highly vascularized masses may risk catastrophic intraoperative hemorrhage with no proven benefit as compared with medical treatment, which usually provides excellent long-term outcomes. PMID:23330877

  6. Bilateral oscillatory hip movements induce windup of multijoint lower extremity spastic reflexes in chronic spinal cord injury.

    PubMed

    Onushko, Tanya; Hyngstrom, Allison; Schmit, Brian D

    2011-10-01

    After spinal cord injury (SCI), alterations in intrinsic motoneuron properties have been shown to be partly responsible for spastic reflex behaviors in human SCI. In particular, a dysregulation of voltage-dependent depolarizing persistent inward currents (PICs) may permit sustained muscle contraction after the removal of a brief excitatory stimulus. Windup, in which the motor response increases with repeated activation, is an indicator of PICs. Although windup of homonymous stretch reflexes has been shown, multijoint muscle activity is often observed following imposed limb movements and may exhibit a similar windup phenomenon. The purpose of this study was to identify and quantify windup of multijoint reflex responses to repeated imposed hip oscillations. Ten chronic SCI subjects participated in this study. A custom-built servomotor apparatus was used to oscillate the legs about the hip joint bilaterally and unilaterally from 10 of extension to 40 flexion for 10 consecutive cycles. Surface electromyograms (EMGs) and joint torques were recorded from both legs. Consistent with a windup response, hip and knee flexion/extension and ankle plantarflexion torque and EMG responses varied according to movement cycle number. The temporal patterns of windup depended on the muscle groups that were activated, which may suggest a difference in the response of neurons in different spinal pathways. Furthermore, because windup was seen in muscles that were not being stretched, these results imply that changes in interneuronal properties are also likely to be associated with windup of spastic reflexes in human SCI. PMID:21753029

  7. Plasticity in ascending long propriospinal and descending supraspinal pathways in chronic cervical spinal cord injured rats

    PubMed Central

    Ct, Marie-Pascale; Detloff, Megan R.; Wade, Rodel E.; Lemay, Michel A.; Houl, John D.

    2012-01-01

    The high clinical relevance of models of incomplete cervical spinal cord injury (SCI) creates a need to address the spontaneous neuroplasticity that underlies changes in functional activity that occur over time after SCI. There is accumulating evidence supporting long projecting propriospinal neurons as suitable targets for therapeutic intervention after SCI, but focus has remained primarily oriented toward study of descending pathways. Long ascending axons from propriospinal neurons at lower thoracic and lumbar levels that form inter-enlargement pathways are involved in forelimb-hindlimb coordination during locomotion and are capable of modulating cervical motor output. We used non-invasive magnetic stimulation to assess how a unilateral cervical (C5) spinal contusion might affect transmission in intact, long ascending propriospinal pathways, and influence spinal cord plasticity. Our results show that transmission is facilitated in this pathway on the ipsilesional side as early as 1 week post-SCI. We also probed for descending magnetic motor evoked potentials (MMEPs) and found them absent or greatly reduced on the ipsilesional side as expected. The frequency-dependent depression (FDD) of the H-reflex recorded from the forelimb triceps brachii was bilaterally decreased although Hmax/Mmax was increased only on the ipsilesional side. Behaviorally, stepping recovered, but there were deficits in forelimbhindlimb coordination as detected by BBB and CatWalk measures. Importantly, epicenter sparing correlated to the amplitude of the MMEPs and locomotor recovery but it was not significantly associated with the inter-enlargement or segmental H-reflex. In summary, our results indicate that complex plasticity occurs after a C5 hemicontusion injury, leading to differential changes in ascending vs. descending pathways, ipsi- vs. contralesional sides even though the lesion was unilateral as well as cervical vs. lumbar local spinal networks. PMID:22934078

  8. Treatment of chronic low back pain in patients with spinal deformities using a sagittal re-alignment brace

    PubMed Central

    Weiss, Hans-Rudolf; Werkmann, Mario

    2009-01-01

    Background For adult scoliosis patients with chronic low back pain bracing is initially indicated before spinal surgery is considered. Until recently there has been a lack of research into the effect upon pain reductions in the mid and long-term. Promising results have been documented in short-term studies for the application of a sagittal re-alignment brace in patients with spinal deformities and along with pain; however mid-term and long-term results are not yet available. The purpose of this study is to investigate the mid-term effects of this brace with respect to pain control. Materials and methods 67 patients (58 females and 9 males) with chronic low back pain (> 24 months) and the diagnosis of scoliosis or hyperkyphosis were treated with a sagittal re-alignment brace (physio-logic brace) between January 2006 and July 2007. The indication for this kind of brace treatment was derived from a positive sagittal re-alignment test (SRT) and the exclusion of successful conservative treatment during the last 24 months. The aim of this type of conservative intervention was to avoid surgery for chronic low back pain. Results The average pain intensity was measured on the Roland and Morris VRS (5 steps) before treatment. This was 3.3 (t1), at the time of brace adjustment it was 2.7 (t2) and after at an average observation time of 18 months it was 2.0 (t3). The differences were highly significant in the Wilcoxon test. Discussion Short-term measurements showed that a significant pain reduction is possible in chronic postural low back pain using a sagittal re-alignment brace inducing lumbar re-lordosation. In a preliminary report at adjustment (t2), highly significant improvements of pain intensity have also been demonstrated. At 6 months of treatment however, no improvement was measured. The improvement of the mid-term effects (18 months) found in this study compared to the preliminary report may be due to the changed approach to compliance: whilst the bracing standard was not changed; the patients in this study were obligated to wear the brace for a minimum of 20 hrs per day for the first 6 months of treatment. Conclusion The effect of the sagittal re-alignment brace leads to promising short-term improvements in patients with chronic low back pain and spinal deformities. Contrary to unspecific orthoses, which after a short period without persistent pain reduction are omitted by the patients, the sagittal re-alignment brace (physio-logic brace) leads to an effective reduction of pain intensity in mid-term even in patients who have stopped brace treatment after the initial 6 months of treatment. In conservative treatment of chronic low back pain specific approaches such as the sagittal re-alignment brace are indicated prior to considering the surgical options. PMID:19272146

  9. Dose-Response and Efficacy of Spinal Manipulation for Care of Chronic Low Back Pain: A Randomized Controlled Trial

    PubMed Central

    Haas, Mitchell; Vavrek, Darcy; Peterson, David; Polissar, Nayak; Neradilek, Moni B.

    2013-01-01

    BACKGROUND CONTEXT There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation. PURPOSE To identify the dose-response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes; to determine the efficacy of manipulation by comparison to a light-massage control. STUDY DESIGN/SETTING Practice-based randomized controlled trial. PATIENT SAMPLE Four hundred participants with cLBP. OUTCOME MEASURES The primary cLBP outcomes were the100-point Modified Von Korff pain intensity and functional disability scales evaluated at the 12 and 24-week primary endpoints. Secondary outcomes included days with pain and functional disability, pain unpleasantness, global perceived improvement, medication use, and general health status. METHODS One hundred participants with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for six weeks. At sessions when manipulation was not assigned, they received a focused light massage control. Covariate-adjusted linear dose effects and comparisons to the no-manipulation control group were evaluated at 6, 12, 18, 24, 39, and 52 weeks. RESULTS For the primary outcomes, mean pain and disability improvement in the manipulation groups was 20 points by 12 weeks and sustainable to 52 weeks. Linear dose-response effects were small, reaching about two points per six manipulation sessions at 12 and 52 weeks for both variables (P < .025). At 12 weeks, the greatest differences from the no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability points, P < .025); at 24 weeks, differences were negligible. At 52 weeks, the greatest group differences were seen for 18 visits (5.9 pain and 8.8 disability points, P < .025). CONCLUSIONS The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results, but was not well distinguished from other dose levels. PMID:24139233

  10. Reversal of tetraplegia in a patient with haematogenous cervical epidural abscess.

    PubMed

    Katonis, Pavlos; Souvatzis, Xenia; Tsavalas, Nikolaos; Alpantaki, Kalliopi

    2011-08-01

    Pyogenic haematogenous cervical epidural abscess complicated by tetraplegia is an uncommon entity, but its clinical importance overshadows its rarity. Predisposing risk factors for spinal epidural abscess include diabetes, intravenous drug abuse, liver disease, renal failure, malignancy, HIV, infection elsewhere, rheumatoid conditions, trauma and a number of spinal interventions. Lack of recovery and death are much more frequent when complete paralysis exists since more than 24 to 48 hours. Most authors combine decompressive laminectomy and antibiotics. Anterior decompression and needle aspiration are rarely used, the former more specifically in case of anterior abscess formation. A high index of suspicion along with reliance on gadolinium-enhanced MRI is essential to diagnose the pathology and institute appropriate treatment on an individual basis. The authors report on a diabetic male patient who developed a cervical epidural abscess with tetraplegia after dental extraction. He was treated within six hours by one stage anterior/posterior decompression and fusion, with complete recovery. PMID:21954768

  11. Extended Pneumocephalus after Drainage of Chronic Subdural Hematoma Associated with Intracranial Hypotension : Case Report with Pathophysiologic Consideration

    PubMed Central

    Shin, Hee Sup; Ko, Hak Cheol; Koh, Jun Seok

    2016-01-01

    Chronic subdural hematoma (SDH) is a well-known disease entity and is traditionally managed with surgery. However, when associated with spontaneous intracranial hypotension (SIH), the treatment strategy ought to be modified, as classical treatment could lead to unwanted consequences. A 59-year-old man presented with a case of SIH that manifested as a bilateral chronic SDH. He developed fatal extensive pneumocephalus and SDH re-accumulation as a complication of burr-hole drainage. Despite application of an epidural blood patch, the spinal cerebrospinal fluid leak continued, which required open spinal surgery. Chronic SDH management should not be overlooked, especially if the exact cause has not been determined. When chronic SDH assumed to be associated with SIH, the neurosurgeon should determine the exact cause of SIH in order to effectively correct the cause. PMID:26885290

  12. An Active Learning Algorithm for Control of Epidural Electrostimulation.

    PubMed

    Desautels, Thomas A; Choe, Jaehoon; Gad, Parag; Nandra, Mandheerej S; Roy, Roland R; Zhong, Hui; Tai, Yu-Chong; Edgerton, V Reggie; Burdick, Joel W

    2015-10-01

    Epidural electrostimulation has shown promise for spinal cord injury therapy. However, finding effective stimuli on the multi-electrode stimulating arrays employed requires a laborious manual search of a vast space for each patient. Widespread clinical application of these techniques would be greatly facilitated by an autonomous, algorithmic system which choses stimuli to simultaneously deliver effective therapy and explore this space. We propose a method based on GP-BUCB, a Gaussian process bandit algorithm. In n = 4 spinally transected rats, we implant epidural electrode arrays and examine the algorithm's performance in selecting bipolar stimuli to elicit specified muscle responses. These responses are compared with temporally interleaved intra-animal stimulus selections by a human expert. GP-BUCB successfully controlled the spinal electrostimulation preparation in 37 testing sessions, selecting 670 stimuli. These sessions included sustained autonomous operations (ten-session duration). Delivered performance with respect to the specified metric was as good as or better than that of the human expert. Despite receiving no information as to anatomically likely locations of effective stimuli, GP-BUCB also consistently discovered such a pattern. Further, GP-BUCB was able to extrapolate from previous sessions' results to make predictions about performance in new testing sessions, while remaining sufficiently flexible to capture temporal variability. These results provide validation for applying automated stimulus selection methods to the problem of spinal cord injury therapy. PMID:25974925

  13. Spinal tumor

    MedlinePLUS

    Tumor - spinal cord ... spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other ... gene mutations. Spinal tumors can occur: Inside the spinal cord (intramedullary) In the membranes (meninges) covering the spinal ...

  14. Human spinal locomotor control is based on flexibly organized burst generators.

    PubMed

    Danner, Simon M; Hofstoetter, Ursula S; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank; Minassian, Karen

    2015-03-01

    Constant drive provided to the human lumbar spinal cord by epidural electrical stimulation can cause local neural circuits to generate rhythmic motor outputs to lower limb muscles in people paralysed by spinal cord injury. Epidural spinal cord stimulation thus allows the study of spinal rhythm and pattern generating circuits without their configuration by volitional motor tasks or task-specific peripheral feedback. To reveal spinal locomotor control principles, we studied the repertoire of rhythmic patterns that can be generated by the functionally isolated human lumbar spinal cord, detected as electromyographic activity from the legs, and investigated basic temporal components shared across these patterns. Ten subjects with chronic, motor-complete spinal cord injury were studied. Surface electromyographic responses to lumbar spinal cord stimulation were collected from quadriceps, hamstrings, tibialis anterior, and triceps surae in the supine position. From these data, 10-s segments of rhythmic activity present in the four muscle groups of one limb were extracted. Such samples were found in seven subjects. Physiologically adequate cycle durations and relative extension- and flexion-phase durations similar to those needed for locomotion were generated. The multi-muscle activation patterns exhibited a variety of coactivation, mixed-synergy and locomotor-like configurations. Statistical decomposition of the electromyographic data across subjects, muscles and samples of rhythmic patterns identified three common temporal components, i.e. basic or shared activation patterns. Two of these basic patterns controlled muscles to contract either synchronously or alternatingly during extension- and flexion-like phases. The third basic pattern contributed to the observed muscle activities independently from these extensor- and flexor-related basic patterns. Each bifunctional muscle group was able to express both extensor- and flexor-patterns, with variable ratios across the samples of rhythmic patterns. The basic activation patterns can be interpreted as central drives implemented by spinal burst generators that impose specific spatiotemporally organized activation on the lumbosacral motor neuron pools. Our data thus imply that the human lumbar spinal cord circuits can form burst-generating elements that flexibly combine to obtain a wide range of locomotor outputs from a constant, repetitive input. It may be possible to use this flexibility to incorporate specific adaptations to gait and stance to improve locomotor control, even after severe central nervous system damage. PMID:25582580

  15. Adiponectin Is a Candidate Biomarker of Lower Extremity Bone Density in Men With Chronic Spinal Cord Injury

    PubMed Central

    Doherty, Ashley L; Battaglino, Ricardo A; Donovan, Jayne; Gagnon, David; Lazzari, Antonio A; Garshick, Eric; Zafonte, Ross; Morse, Leslie R

    2014-01-01

    Adipose tissue is a major regulator of bone metabolism and in the general population obesity is associated with greater bone mineral density (BMD). However, bone-fat interactions are multifactorial, and may involve pathways that influence both bone formation and resorption with competing effects on the skeleton. One such pathway involves adipocyte production of adipokines that regulate bone metabolism. In this study we determined the association between BMD, walking status, and circulating adipokines (adiponectin and leptin) in 149 men with chronic spinal cord injury (SCI). Although adipokine levels did not vary significantly based on walking status, there was a significant inverse association between adiponectin and BMD in wheelchair users independent of body composition. We found no association between adiponectin and BMD in the walkers and no association between leptin and BMD in either group. These findings suggest that for subjects with chronic SCI, walking may mitigate the effect of adiponectin mediated bone loss. For wheelchair users, adipose-derived adiponectin may contribute to SCI-induced osteoporosis because the osteoprotective benefits of obesity appear to require mechanical loading during ambulation. PMID:23787489

  16. Accidental dural puncture, postdural puncture headache, intrathecal catheters, and epidural blood patch: revisiting the old nemesis.

    PubMed

    Kaddoum, Roland; Motlani, Faisal; Kaddoum, Romeo N; Srirajakalidindi, Arvi; Gupta, Deepak; Soskin, Vitaly

    2014-08-01

    One of the controversial management options for accidental dural puncture in pregnant patients is the conversion of labor epidural analgesia to continuous spinal analgesia by threading the epidural catheter intrathecally. No clear consensus exists on how to best prevent severe headache from occurring after accidental dural puncture. To investigate whether the intrathecal placement of an epidural catheter following accidental dural puncture impacts the incidence of postdural puncture headache (PDPH) and the subsequent need for an epidural blood patch in parturients. A retrospective chart review of accidental dural puncture was performed at Hutzel Women's Hospital in Detroit, MI, USA for the years 2002-2010. Documented cases of accidental dural punctures (N = 238) were distributed into two groups based on their management: an intrathecal catheter (ITC) group in which the epidural catheter was inserted intrathecally and a non-intrathecal catheter (non-ITC) group that received the epidural catheter inserted at different levels of lumbar interspaces. The incidence of PDPH as well as the necessity for epidural blood patch was analyzed using two-tailed Fisher's exact test. In the non-ITC group, 99 (54 %) parturients developed PDPH in comparison to 20 (37 %) in the ITC [odds ratio (OR), 1.98; 95 % confidence interval (CI), 1.06-3.69; P = 0.03]. Fifty-seven (31 %) of 182 patients in the non-ITC group required an epidural blood patch (EBP) (data for 2 patients of 184 were missing). In contrast, 7 (13 %) of parturients in the ITC group required an EBP. The incidence of EBP was calculated in parturients who actually developed headache to be 57 of 99 (57 %) in the non-ITC group versus 7 of 20 (35 %) in the ITC group (OR, 2.52; 95 % CI, 0.92-6.68; P = 0.07). The insertion of an intrathecal catheter following accidental dural puncture decreases the incidence of PDPH but not the need for epidural blood patch in parturients. PMID:24347033

  17. Delayed expression of cell cycle proteins contributes to astroglial scar formation and chronic inflammation after rat spinal cord contusion

    PubMed Central

    2012-01-01

    Background Traumatic spinal cord injury (SCI) induces secondary tissue damage that is associated with astrogliosis and inflammation. We previously reported that acute upregulation of a cluster of cell-cycle-related genes contributes to post-mitotic cell death and secondary damage after SCI. However, it remains unclear whether cell cycle activation continues more chronically and contributes to more delayed glial change. Here we examined expression of cell cycle-related proteins up to 4 months following SCI, as well as the effects of the selective cyclin-dependent kinase (CDKs) inhibitor CR8, on astrogliosis and microglial activation in a rat SCI contusion model. Methods Adult male rats were subjected to moderate spinal cord contusion injury at T8 using a well-characterized weight-drop model. Tissue from the lesion epicenter was obtained 4 weeks or 4 months post-injury, and processed for protein expression and lesion volume. Functional recovery was assessed over the 4 months after injury. Results Immunoblot analysis demonstrated a marked continued upregulation of cell cycle-related proteins − including cyclin D1 and E, CDK4, E2F5 and PCNA − for 4 months post-injury that were highly expressed by GFAP+ astrocytes and microglia, and co-localized with inflammatory-related proteins. CR8 administrated systemically 3 h post-injury and continued for 7 days limited the sustained elevation of cell cycle proteins and immunoreactivity of GFAP, Iba-1 and p22PHOX − a key component of NADPH oxidase − up to 4 months after SCI. CR8 treatment significantly reduced lesion volume, which typically progressed in untreated animals between 1 and 4 months after trauma. Functional recovery was also significantly improved by CR8 treatment after SCI from week 2 through week 16. Conclusions These data demonstrate that cell cycle-related proteins are chronically upregulated after SCI and may contribute to astroglial scar formation, chronic inflammation and further tissue loss. PMID:22784881

  18. Combination of acupuncture and spinal manipulative therapy: management of a 32-year-old patient with chronic tension-type headache and migraine

    PubMed Central

    Ohlsen, Bahia A.

    2012-01-01

    Objective The purpose of this case study is to describe the treatment using acupuncture and spinal manipulation for a patient with a chronic tension-type headache and episodic migraines. Clinical Features A 32-year-old woman presented with headaches of 5 months' duration. She had a history of episodic migraine that began in her teens and had been controlled with medication. She had stopped taking the prescription medications because of gastrointestinal symptoms. A neurologist diagnosed her with mixed headaches, some migrainous and some tension type. Her headaches were chronic, were daily, and fit the International Classification of Headache Disorders criteria of a chronic tension-type headache superimposed with migraine. Intervention and Outcome After 5 treatments over a 2-week period (the first using acupuncture only, the next 3 using acupuncture and chiropractic spinal manipulative therapy), her headaches resolved. The patient had no recurrences of headaches in her 1-year follow-up. Conclusion The combination of acupuncture with chiropractic spinal manipulative therapy was a reasonable alternative in treating this patient's chronic tension-type headaches superimposed with migraine. PMID:23449932

  19. Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial

    PubMed Central

    Alexeeva, Natalia; Sames, Carol; Jacobs, Patrick L.; Hobday, Lori; DiStasio, Marcello M.; Mitchell, Sarah A.; Calancie, Blair

    2011-01-01

    Objective To compare two forms of device-specific training – body-weight-supported (BWS) ambulation on a fixed track (TRK) and BWS ambulation on a treadmill (TM) – to comprehensive physical therapy (PT) for improving walking speed in persons with chronic, motor-incomplete spinal cord injury (SCI). Methods Thirty-five adult subjects with a history of chronic SCI (>1 year; AIS ‘C’ or ‘D’) participated in a 13-week (1 hour/day; 3 days per week) training program. Subjects were randomized into one of the three training groups. Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert. For each training session, performance values and heart rate were monitored. Pre- and post-training maximal 10-m walking speed, balance, muscle strength, fitness, and quality of life were assessed in each subject. Results All three training groups showed significant improvement in maximal walking speed, muscle strength, and psychological well-being. A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group. In all groups, post-training measures of fitness, functional independence, and perceived health and vitality were unchanged. Conclusions Our results demonstrate that persons with chronic, motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy, regardless of training method. Improvement in walking speed was associated with improved balance and muscle strength. In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups, these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength. It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training. PMID:21903010

  20. Robotically assisted treadmill exercise training for improving peak fitness in chronic motor incomplete spinal cord injury: A randomized controlled trial.

    PubMed

    Gorman, Peter H; Scott, William; York, Henry; Theyagaraj, Melita; Price-Miller, Naomi; McQuaid, Jean; Eyvazzadeh, Megan; Ivey, Frederick M; Macko, Richard F

    2016-01-01

    Objective To assess the effectiveness of robotically assisted body weight supported treadmill training (RABWSTT) for improving cardiovascular fitness in chronic motor incomplete spinal cord injury (CMISCI). Design Pilot prospective randomized, controlled clinical trial. Setting Outpatient rehabilitation specialty hospital. Participants Eighteen individuals with CMISCI with American Spinal Injury Association (ASIA) level between C4 and L2 and at least one-year post injury. Interventions CMISCI participants were randomized to RABWSTT or a home stretching program (HSP) three times per week for three months. Those in the home stretching group were crossed over to three months of RABWSTT following completion of the initial three month phase. Outcome measures Peak oxygen consumption (peak VO2) was measured during both robotic treadmill walking and arm cycle ergometry: twice at baseline, once at six weeks (mid-training) and twice at three months (post-training). Peak VO2 values were normalized for body mass. Results The RABWSTT group improved peak VO2 by 12.3% during robotic treadmill walking (20.27.4 to 22.77.5ml/kg/min, P=0.018), compared to a non-significant 3.9% within group change observed in HSP controls (P=0.37). Neither group displayed a significant change in peak VO2 during arm cycle ergometry (RABWSTT, 8.5% (P=0.25); HSP, 1.76% (P=0.72)). A repeated measures analysis showed statistically significant differences between treatments for peak VO2 during both robotic treadmill walking (P=0.002) and arm cycle ergometry (P=0.001). Conclusion RABWSTT is an effective intervention model for improving peak fitness levels assessed during robotic treadmill walking in persons with CMISCI. PMID:25520035

  1. A multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury: the protocol of the CONECSI trial

    PubMed Central

    2010-01-01

    Background Most people with a spinal cord injury rate neuropathic pain as one of the most difficult problems to manage and there are no medical treatments that provide satisfactory pain relief in most people. Furthermore, psychosocial factors have been considered in the maintenance and aggravation of neuropathic spinal cord injury pain. Psychological interventions to support people with spinal cord injury to deal with neuropathic pain, however, are sparse. The primary aim of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial is to evaluate the effects of a multidisciplinary cognitive behavioural treatment programme on pain intensity and pain-related disability, and secondary on mood, participation in activities, and life satisfaction. Methods/Design CONECSI is a multicentre randomised controlled trial. A sample of 60 persons with chronic neuropathic spinal cord injury pain will be recruited from four rehabilitation centres and randomised to an intervention group or a waiting list control group. The control group will be invited for the programme six months after the intervention group. Main inclusion criteria are: having chronic (> 6 months) neuropathic spinal cord injury pain as the worst pain complaint and rating the pain intensity in the last week as 40 or more on a 0-100 scale. The intervention consists of educational, cognitive, and behavioural elements and encompasses 11 sessions over a 3-month period. Each meeting will be supervised by a local psychologist and physical therapist. Measurements will be perfomed before starting the programme/entering the control group, and at 3, 6, 9, and 12 months. Primary outcomes are pain intensity and pain-related disability (Chronic Pain Grade questionnaire). Secondary outcomes are mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Pain coping and pain cognitions will be assessed with three questionnaires (Coping Strategy Questionnaire, Pain Coping Inventory, and Pain Cognition List). Discussion The CONECSI trial will reveal the effects of a multidisciplinary cognitive behavioural programme for people with chronic neuropathic spinal cord injury pain. This intervention is expected to contribute to the rehabilitation treatment possibilities for this population. Trial Registration Dutch Trial Register NTR1580. PMID:20961406

  2. Spinal cord compression due to extramedullary hematopoiesis associated with polycythemia vera--case report.

    PubMed

    Ohta, Yuzuru; Shichinohe, Hideo; Nagashima, Kazuo

    2002-01-01

    A 69-year-old woman with a 14-year history of polycythemia vera suffered progressive paraparesis due to epidural involvement of hematopoietic tissue. Magnetic resonance (MR) imaging demonstrated extensive epidural masses. Decompressive surgery and radiotherapy were performed and she made an almost complete clinical recovery. Serial MR imaging showed no regrowth of the other epidural masses. Extramedullary hematopoiesis occurs in patients with various hematologic disorders involving a chronic increase in the production of red blood cells, and is often associated with thalassemia, but is less common with polycythemia vera. The most frequent sites are the spleen, liver, and kidney. Extramedullary hematopoietic tissue occurring within the spinal canal and causing cord compression is very rare. Total surgical excision is not usually feasible because of the diffuse nature of extramedullary hematopoietic tissue and the possibility of recurrence, but acute neurological deterioration does require emergency surgery. Extramedullary hematopoiesis is radiosensitive and displays a rapid response to low dosages, so radiation therapy is recommended for residual tumors. Considering the possibility of central nervous system extramedullary hematopoiesis in patients with polycythemia vera, an early diagnosis is necessary for a favorable prognosis. PMID:11902077

  3. Cauda Equina Syndrome Caused by Idiopathic Epidural Lipomatosis

    PubMed Central

    Kim, Yun Seong; Ju, Chang Il; Kim, Hyeun Sung

    2015-01-01

    Spinal epidural lipomatosis (SEL) is a rare condition that presents as a back pain with progressive neurologic symptoms. Most affected patients are obese and receiving steroid therapy, or have an endocrinopathies. We report a rare case of cauda equina syndrome caused by SEL in a non-obese healthy young man without any evident traumatic episode. A healthy 19-year-old man, who had experienced lower back pain for two months, visited our emergency room because of the sudden development of motor weakness and voiding difficulty. Lumbar magnetic resonance image revealed extradural fat compressing the cauda equina. Urgent decompression via posterior laminectomy and excision of excess epidural fat resulted in an immediate symptom improvement. PMID:26834816

  4. Combination strategies for repair, plasticity, and regeneration using regulation of gene expression during the chronic phase after spinal cord injury.

    PubMed

    Gerin, Christine G; Madueke, Ikenna C; Perkins, Tina; Hill, Seritta; Smith, Kristin; Haley, Benjamin; Allen, Shannon A; Garcia, Richard P; Paunesku, Tanjana; Woloschak, Gayle

    2011-12-01

    Although recovery after spinal cord injury (SCI) is rare in humans, recent literature indicates that some patients do recover sensorimotor function years after the trauma. This study seeks to elucidate the genetic underpinnings of SCI repair through the investigation of neurodegenerative and regenerative associated genes involved in the response to SCI during the chronic phase in adult rats. Intervention on the level of gene regulation focused on enhancing naturally attempting SCI regenerative genes has the potential to promote SCI repair. Our aim was to analyze gene expression characteristics of candidate genes involved in the neuro-degenerative and -regenerative processes following various animal models of SCI. We compiled data showing gene expression changes after SCI in adult rats and created a chronological time-line of candidate genes differentially expressed during the chronic phase of SCI. Compiled data showed that SCI induced a transient upregulation of endogenous neuro-regenerative genes not only within a few hours but also within a few days, weeks, and months after SCI. For example, gene controlling growth-associated protein-43 (GAP-43), brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and others, showed significant changes in mRNA accumulation in SCI animals, from 48 hours to 12 weeks after SCI. Similarly, inhibitory genes, such as RhoA, LINGO-1, and others, were upregulated as late as 4 to 14 days after injury. This indicates that gene specific regulation changes, corresponding to repair and regenerative attempts, are naturally orchestrated over time after injury. These delayed changes after SCI give ample time for therapeutic gene modulation through upregulation or silencing of specific genes responsible for the synthesis of the corresponding biogenic proteins. By following the examination of differential gene regulation during the chronic phase, we have determined times, successions, co-activations, interferences, and dosages for potential therapeutic synchronized interventions. Finally, local cellular specificities and their neuropathophysiologies have been taken into account in the elaboration of the combination treatment strategy we propose. The interventions we propose suggest the delivery of exogenous therapeutic agents to upregulate or downregulate chosen genes or the expression of the downstream proteins to revert the post-traumatic stage of SCI during the chronic phase. The proposed combination and schedule of local cell-specific treatment should enhance intrinsic regenerative machinery and provide a promising strategy for treating patients sustaining chronic SCI. PMID:21308793

  5. Differences in Supraspinal and Spinal Excitability during Various Force Outputs of the Biceps Brachii in Chronic- and Non-Resistance Trained Individuals

    PubMed Central

    Pearcey, Gregory E. P.; Power, Kevin E.; Button, Duane C.

    2014-01-01

    Motor evoked potentials (MEP) and cervicomedullary evoked potentials (CMEP) may help determine the corticospinal adaptations underlying chronic resistance training-induced increases in voluntary force production. The purpose of the study was to determine the effect of chronic resistance training on corticospinal excitability (CE) of the biceps brachii during elbow flexion contractions at various intensities and the CNS site (i.e. supraspinal or spinal) predominantly responsible for any training-induced differences in CE. Fifteen male subjects were divided into two groups: 1) chronic resistance-trained (RT), (n = 8) and 2) non-RT, (n = 7). Each group performed four sets of ∼5 s elbow flexion contractions of the dominant arm at 10 target forces (from 10%–100% MVC). During each contraction, subjects received 1) transcranial magnetic stimulation, 2) transmastoid electrical stimulation and 3) brachial plexus electrical stimulation, to determine MEP, CMEP and compound muscle action potential (Mmax) amplitudes, respectively, of the biceps brachii. All MEP and CMEP amplitudes were normalized to Mmax. MEP amplitudes were similar in both groups up to 50% MVC, however, beyond 50% MVC, MEP amplitudes were lower in the chronic RT group (p<0.05). CMEP amplitudes recorded from 10–100% MVC were similar for both groups. The ratio of MEP amplitude/absolute force and CMEP amplitude/absolute force were reduced (p<0.012) at all contraction intensities from 10–100% MVC in the chronic-RT compared to the non-RT group. In conclusion, chronic resistance training alters supraspinal and spinal excitability. However, adaptations in the spinal cord (i.e. motoneurone) seem to have a greater influence on the altered CE. PMID:24875495

  6. [Aseptic precautions in epidural catheterization for surgery].

    PubMed

    Haraga, Isao; Shono, Shinjiro; Abe, Shintarou; Higa, Kazuo

    2010-05-01

    We describe aseptic precautions in epidural catheterization for surgery. Every patient has to be checked for immunodeficiency, atopic dermatitis, preoperative use of antibiotics, and local infection of the epidural puncture site. Physicians who perform epidural catheterization should wear a mask and a cap and take off a wrist watch and rings on the fingers before an epidural kit is opened. Fingers and hands should be disinfected before wearing surgical gloves. The skin for epidural puncture site should be disinfected with 0.5% chlorhexidine in 80% ethanol. A micropore filter should be used when epidural catheterization is expected to remain over 24 hours. PMID:20486569

  7. Initiation of Bladder Voiding with Epidural Stimulation in Paralyzed, Step Trained Rats

    PubMed Central

    Gad, Parag N.; Roy, Roland R.; Zhong, Hui; Lu, Daniel C.; Gerasimenko, Yury P.; Edgerton, V. Reggie

    2014-01-01

    The inability to control timely bladder emptying is one of the most serious challenges among the several functional deficits that occur after a complete spinal cord injury. Having demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis, we hypothesized that a similar approach could be used to recover bladder function after paralysis. Also knowing that posture and locomotion can be initiated immediately with a specific frequency-dependent stimulation pattern and that with repeated stimulation-training sessions these functions can improve even further, we reasoned that the same two strategies could be used to regain bladder function. Recent evidence suggests that rats with severe paralysis can be rehabilitated with a multisystem neuroprosthetic training regime that counteracts the development of neurogenic bladder dysfunction. No data regarding the acute effects of locomotion on bladder function, however, were reported. In this study we show that enabling of locomotor-related spinal neuronal circuits by epidural stimulation also influences neural networks controlling bladder function and can play a vital role in recovering bladder function after complete paralysis. We have identified specific spinal cord stimulation parameters that initiate bladder emptying within seconds of the initiation of epidural stimulation. The clinical implications of these results are substantial in that this strategy could have a major impact in improving the quality of life and longevity of patients while simultaneously dramatically reducing ongoing health maintenance after a spinal cord injury. PMID:25264607

  8. Epidural infection: Is it really an abscess?

    PubMed Central

    Avilucea, Frank R.; Patel, Alpesh A.

    2012-01-01

    Background: We reviewed the literature regarding the pathogenesis, clinical presentation, diagnosis, and management of spinal epidural abscess (SEA). Methods: Utilizing PubMed, we performed a comprehensive review of the literature on SEAs. Results: SEA remains a difficult infectious process to diagnose. This is particularly true in the early stages, when patients remain neurologically intact, and before the classic triad of fever, back pain, and neurologic deficit develop. However, knowledge of risk factors, obtaining serologic markers, and employing magnetic resonance scans facilitate obtaining a prompt and accurate diagnosis. In patients without neurologic deficits, lone medical therapy may prove effective. Conclusions: More prevalent over the previous three decades, SEA remains a rare but deleterious infectious process requiring prompt identification and treatment. Historically, identification of SEA is often elusive, diagnosis is delayed, and clinicians contend that surgical debridement is the cornerstone of treatment. Early surgery leads to more favorable outcomes and preserves neurologic function, particularly in the early stages of disease when minimal or no neurologic deficits are present. The advent of improved imaging modalities, diagnostic techniques, and multidrug antimicrobial agents has enabled medical/spinal surgical consultants to more rapidly diagnose SEA and institute more effective early medical treatment (e.g., data suggest that lone medical therapy may prove effective in the early management of SEA). PMID:23248757

  9. Infected epidural hematoma of the lumbar spine associated with invasive pneumococcal disease.

    PubMed

    Inamasu, Joji; Shizu, Naoyuki; Tsutsumi, Yutaka; Hirose, Yuichi

    2015-01-01

    Spinal epidural abscess (SEA) and spinal epidural hematoma (SEH) are neurologic emergencies with distinct etiologies and treatment. Despite similarities on magnetic resonance imaging (MRI), their differentiation is usually possible with meticulous history taking and neurologic examinations. We report an unusual case of SEA that developed from preceding SEH, posing a diagnostic challenge to physicians. A 65-year-old diabetic man suddenly experienced back pain and weakness of both legs when he lifted heavy luggage. He was afebrile, and his laboratory tests were mostly unremarkable. Spinal MRI consisting of T1-weighted, T2-weighted, and fat-suppressed T2-weighted images revealed an epidural mass over the L2-L4 spinous process. He was diagnosed with SEH based on his symptoms and MRI findings, and was treated conservatively using steroid pulse therapy. Despite initial improvement, he suddenly developed into septic shock and coma on the 10(th) hospital day, and died shortly thereafter. An autopsy revealed massive pus accumulation in the lumbar epidural space and brain, and a postmortem diagnosis of infected SEH associated with invasive pneumococcal disease was established. Serial MRI studies, including diffusion-weighted and/or gadolinium-enhanced T1-weighted images are warranted in patients with a presumed diagnosis of SEH receiving steroid therapy to detect such infectious transformation. PMID:25767594

  10. Tumor necrosis factor-alpha is a potential diagnostic biomarker for chronic neuropathic pain after spinal cord injury.

    PubMed

    Xu, Jun; E, Xiaoqiang; Liu, Huiyong; Li, Feng; Cao, Yanhui; Tian, Jun; Yan, Jinglong

    2015-05-19

    Neuropathic pain (NP) is one of the most common complications after spinal cord injury (SCI), but no protein biomarkers has ever been introduced into clinical diagnosis. Previous studies implicated that toll-like receptor (TLR) 4 played a critical role in the development of NP in animal SCI models. Here, a total of 140 participants were recruited, 70 of them were SCI-NP subject and the rest 70 controls did not show neuropathic symptoms. TLR4 was upregulated significantly in SCI-NP patients compared with SCI-noNP subjects. Furthermore, we measured the concentrations of tumor necrosis factor-alpha (TNF-?) and interleukin-6 (IL-6), two TLR4 downstream pro-inflammatory cytokines, to assess their diagnostic values. Receiver operating characteristics (ROC) analysis revealed that TNF-? had great potential advantages to predict the progression of neuropathy, the risks of NP were strongly increased in SCI subjects with higher levels of TNF-? (odds ratio: 4.92; 95% confidence interval: 1.89-12.32). These results suggested neuro-immune activation contributed to the development of neuropathic disorder after SCI, and TNF-? could be a potential sensitive diagnostic biomarker for chronic neuropathic pain in SCI patients. PMID:25847150

  11. A calcific pelvic mass in a woman with chronic spinal pain: a case of mature cystic teratoma

    PubMed Central

    Kaeser, Martha A.; McDonald, Jennifer K.; Kettner, Norman W.

    2011-01-01

    Objective The purpose of this case is to describe findings of a mature cystic teratoma and to further provide differential diagnoses for ovarian pelvic masses and calcifications. Clinical Features A 27-year-old woman presented to a chiropractic teaching clinic with a chief complaint of chronic multilevel spinal pain. During a full spine radiographic examination, radiopaque densities were incidentally identified in the pelvic bowl visualized through a gonad shield. Follow-up pelvic radiography revealed several radiopacities of uniform density localized in the pelvic bowl. Intervention/Outcomes Medical (gynecological) consultation led to ultrasonography of the pelvis that revealed a mature cystic teratoma. The patient underwent complete excision of the mass through a laparotomy procedure. The patient continued to receive chiropractic treatment of her original cervical and lumbar spine complaints, further suggesting that the pelvic mass was not a source of her musculoskeletal complaints. Conclusion This case demonstrates the detection and proper referral of a patient with a calcific mass. The presence of a pelvic mass, suspected of arising from the ovary, requires additional diagnostic imaging and careful clinical correlation. PMID:22654694

  12. Chronic Indwelling Urinary Catheter Increase the Risk of Bladder Cancer, Even in Patients Without Spinal Cord Injury.

    PubMed

    Ho, Chung-Han; Sung, Kuan-Chin; Lim, Sher-Wei; Liao, Chien-Hwa; Liang, Fu-Wen; Wang, Jhi-Joung; Wu, Chia-Chun

    2015-10-01

    Chronic indwelling urinary catheters (CIDCs) are known as a risk factor for bladder cancer in patients with spinal cord injury (SCI). This study examined the potential risk of bladder cancer from CIDCs in patients without SCI.The National Health Insurance Research Database in Taiwan was used to identify SCI patients (N?=?1816). This group was compared against a control CIDC cohort without SCI (N?=?1816) and a reference cohort with normal individuals without SCI and a record of CIDC (N?=?7264). Comparisons were made based on age and gender matching over a maximum of 11 follow-up years. The incidence risk and hazard ratio (HR) of bladder cancer were estimated in all 3 groups.During the follow-up period, the bladder cancer incidence rates were 68.90 and 102.53 per 100,000 person-years in the SCI and CIDC-non-SCI groups, respectively. These values were both higher than that of the reference cohort (12.00 per 100,000 person-years). Patients who had history of SCI (HR: 6.51; 95% CI, 2.56-16.52) or CIDC without SCI (HR: 9.11; 95% CI, 3.9-21.29) had a higher risk of bladder cancer compared with the reference cohort.Patients with CIDCs may have an increased risk of bladder cancer development, especially in older aged and male patients compared with general population. PMID:26512566

  13. Spontaneous intracranial hypotension and single entry multi-site epidural blood patch

    PubMed Central

    Murphy, David; Chandna, Arjun; Laing, Andrew; MacFarlane, Martin

    2015-01-01

    The syndrome of spontaneous intracranial hypotension is often difficult to treat. Unfortunately, cerebrospinal fluid leaks are often numerous and difficult to detect radiologically. Multiple entries to the spinal epidural space, in an effort to alleviate symptoms, are therefore sometimes necessary. This case report details two patients treated successfully with a single lumbar entry point and the administration of a continuous multi-site epidural blood patch via a mobile catheter and their subsequent follow-up. These procedures are based on that first published by Ohtonari et al. in 2012. It is, to our knowledge, the first undertaken in Australasia. PMID:26396625

  14. GLT1 overexpression reverses established neuropathic pain-related behavior and attenuates chronic dorsal horn neuron activation following cervical spinal cord injury.

    PubMed

    Falnikar, Aditi; Hala, Tamara J; Poulsen, David J; Lepore, Angelo C

    2016-03-01

    Development of neuropathic pain occurs in a major portion of traumatic spinal cord injury (SCI) patients, resulting in debilitating and often long-term physical and psychological burdens. Following SCI, chronic dysregulation of extracellular glutamate homeostasis has been shown to play a key role in persistent central hyperexcitability of superficial dorsal horn neurons that mediate pain neurotransmission, leading to various forms of neuropathic pain. Astrocytes express the major CNS glutamate transporter, GLT1, which is responsible for the vast majority of functional glutamate uptake, particularly in the spinal cord. In our unilateral cervical contusion model of mouse SCI that is associated with ipsilateral forepaw heat hypersensititvity (a form of chronic at-level neuropathic pain-related behavior), we previously reported significant and long-lasting reductions in GLT1 expression and functional GLT1-mediated glutamate uptake in cervical spinal cord dorsal horn. To therapeutically address GLT1 dysfunction following cervical contusion SCI, we injected an adeno-associated virus type 8 (AAV8)-Gfa2 vector into the superficial dorsal horn to increase GLT1 expression selectively in astrocytes. Compared to both contusion-only animals and injured mice that received AAV8-eGFP control injection, AAV8-GLT1 delivery increased GLT1 protein expression in astrocytes of the injured cervical spinal cord dorsal horn, resulting in a significant and persistent reversal of already-established heat hypersensitivity. Furthermore, AAV8-GLT1 injection significantly reduced expression of the transcription factor and marker of persistently increased neuronal activation, ΔFosB, in superficial dorsal horn neurons. These results demonstrate that focal restoration of GLT1 expression in the superficial dorsal horn is a promising target for treating chronic neuropathic pain following SCI. GLIA 2016;64:396-406. PMID:26496514

  15. EPIDURAL ANALGESIA IN LABOR - CONTROVERSIES.

    PubMed

    Bilić, Nada; Djaković, Ivka; Kličan-Jaić, Katarina; Rudman, Senka Sabolović; Ivanec, Željko

    2015-09-01

    Labor pain is one of the most severe pains. Labor is a complex and individual process with varying maternal requesting analgesia. Labor analgesia must be safe and accompanied by minimal amount of unwanted consequences for both the mother and the child, as well as for the delivery procedure. Epidural analgesia is the treatment that best meets these demands. According to the American Congress of Obstetrics and Gynecology and American Society of Anesthesiologists, mother's demand is a reason enough for the introduction of epidural analgesia in labor, providing that no contraindications exist. The application of analgesics should not cease at the end of the second stage of labor, but it is recommended that lower concentration analgesics be then applied. Based on the latest studies, it can be claimed that epidural analgesia can be applied during the major part of the first and second stage of labor. According to previous investigations, there is no definitive conclusion about the incidence of instrumental delivery, duration of second stage of labor, time of epidural analgesia initiation, and long term outcomes for the newborn. Cooperation of obstetric and anesthesiology personnel, as well as appropriate technical equipment significantly decrease the need of instrumental completion of a delivery, as well as other complications encountered in the application of epidural analgesia. Our hospital offers 24/7 epidural analgesia service. The majority of pregnant women in our hospital were aware of the advantages of epidural analgesia for labor, however, only a small proportion of them used it, mainly because of inadequate level of information. PMID:26666104

  16. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections.

    PubMed

    Furman, Michael B; Giovanniello, Michael T; O'Brien, Erin M

    2003-01-01

    STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target. A recently published study demonstrates a high incidence of intravascular injections in transforaminal lumbosacral epidural injections. No studies so far have evaluated the incidence of vascular injections in transforaminal cervical epidural steroid injections, nor have they calculated the ability of observed blood in the needle hub to predict a vascular injection in the cervical spine.METHODS The incidence of fluoroscopically confirmed intravascular uptake of contrast was prospectively observed in 337 patients treated with cervical transforaminal epidural steroid injections. The ability of observed blood in the needle hub to predict intravascular injection was also investigated. For each subject, the injection level was chosen on the basis of the clinical scenario including history, physical examination, and review of imaging studies. Some patients had multilevel injections. Using fluoroscopic guidance, the authors placed a 25-gauge needle into the epidural space using a transforaminal approach according to accepted standard technique. Needle tip location was confirmed with biplanar imaging. The presence or absence of blood in the needle hub spontaneously ("flash") and after attempted aspiration by pulling back on the syringe's plunger was documented. Contrast then was injected under real-time fluoroscopy to determine whether the location of the needle tip was intravascular. The results were recorded in a prospective manner indicating the presence or absence of blood in the needle hub and whether a vascular pattern was noted with contrast injection, and these were correlated. Relevant epidemiologic data also were recorded. RESULTS The study included 504 transforaminal epidural steroid injections. The overall rate of fluoroscopically confirmed intravascular contrast injections was 19.4%. Use of observed blood in the needle hub to predict intravascular injections was 97% specific, but only 45.9% sensitive. There was no significant difference in intravascular rates related to age or gender. CONCLUSIONS As compared with a previous study of lumbosacral epidural steroid injections, there is an overall higher incidence of intravascular injections with cervical transforaminal epidural steroid injections. Use of observed blood in the needle hub to predict an intravascular injection is not sensitive, and therefore the absence of blood in the needle hub despite aspiration is not reliable. The reported sensitivity and specificity rates are similar to lumbar data. Fluoroscopically guided procedures without contrast confirmation instill medications intravascularly, and therefore not in the desired epidural location. This study confirms that there is a need not only for fluoroscopic guidance, but also for contrast instillation in cervical transforaminal epidural steroid injections. PMID:12544950

  17. Another cause of headache after epidural injection.

    PubMed

    Anwari, Jamil S; Hazazi, Abdulaziz A

    2015-04-01

    Headache is a potential complication of epidural injection. We report a patient who developed headache 5 days after a lumbar epidural steroid injection, which was not related to the epidural procedure, but caused by Duloxetine induced hyponatremia. Antidepressant drug induced headache should be considered in the differential diagnosis of post dural puncture headache. PMID:25864071

  18. Another cause of headache after epidural injection

    PubMed Central

    Anwari, Jamil S.; Hazazi, Abdulaziz A.

    2015-01-01

    Headache is a potential complication of epidural injection. We report a patient who developed headache 5 days after a lumbar epidural steroid injection, which was not related to the epidural procedure, but caused by Duloxetine induced hyponatremia. Antidepressant drug induced headache should be considered in the differential diagnosis of post dural puncture headache. PMID:25864071

  19. Extruded lumbar disc associated with epidural hematoma. Case report.

    PubMed

    Giri, Pramod Janardhan; Sharma, Manish Singh; Jaiswal, Awadhesh Kumar; Behari, Sanjay; Jain, Vijendra Kumar

    2006-04-01

    Lumbar disc herniation and spinal epidural hematomas (SEHs) are highly unusual causes of secondary lumbar canal stenosis in the adolescent population. The authors report a unique concomitant occurrence in a 16-year-old boy who presented with left-sided L-5 radiculopathy. Magnetic resonance imaging T1-weighted sequences revealed a left-sided posterolateral prolapsed L4-5 disc with an isointense extruded fragment lying behind the L-5 body. On T2-weighted sequences a hyperintense area was seen in the region of the extruded disc fragment with thecal compression. At surgery the extradural encapsulated hematoma was removed, together with the extruded disc fragment and the L4-5 disc. The characteristics of the biopsy specimen from the epidural collection were consistent with those of a hematoma. At 6 months' follow up, the patient had returned to his normal activities. An SEH may result from tearing of delicate epidural veins following disc extrusion. It can occur at any age, regardless of whether there is a history of significant trauma. Magnetic resonance imaging allows preoperative characterization of the lesion. Results after surgical evacuation are excellent. Distinguishing between a solitary SEH and one caused by a lumbar disc extrusion has significant implications, as the former may resolve completely with conservative management. PMID:16619642

  20. Caudalized human iPSC-derived neural progenitor cells produce neurons and glia but fail to restore function in an early chronic spinal cord injury model

    PubMed Central

    Nutt, Samuel E.; Chang, Eun-Ah; Suhr, Steven T.; Schlosser, Laura O.; Mondello, Sarah E.; Moritz, Chet T.; Cibelli, Jose B.; Horner, Philip J.

    2014-01-01

    Neural progenitor cells (NPCs) have shown modest potential and some side effects (e.g. allodynia) for treatment of spinal cord injury (SCI). In only a few cases, however, have NPCs shown promise at the chronic stage. Given the 1.275 million people living with chronic paralysis, there is a significant need to rigorously evaluate the cell types and methods for safe and efficacious treatment of this devastating condition. For the first time, we examined the pre-clinical potential of NPCs derived from human induced pluripotent stem cells (hiPSCs) to repair chronic SCI. hiPSCs were differentiated into region-specific (i.e. caudal) NPCs, then transplanted into a new, clinically relevant model of early chronic cervical SCI. We established the conditions for successful transplantation of caudalized hiPSC-NPCs and demonstrate their remarkable ability to integrate and produce multiple neural lineages in the early chronic injury environment. In contrast to prior reports in acute and sub-acute injury models, survival and integration of hiPSC-derived neural cells in the early chronic cervical model did not lead to significant improvement in forelimb function or induce allodynia. These data indicate that while hiPSCs show promise, future work needs to focus on the specific hiPSC-derivatives or co-therapies that will restore function in the early chronic injury setting. PMID:23891888

  1. Management of postdural puncture headache with epidural saline patch in a 10-year-old child after inguinal hernia repair: a case report.

    PubMed

    Kara, Inci; Ciftci, Ilhan; Apiliogullari, Seza; Arun, Oguzhan; Duman, Ates; Celik, Jale Bengi

    2012-10-01

    Spinal anesthesia (SA) is becoming increasingly popular among pediatric anesthetists. Postdural puncture headache (PDPH) has been reported in children. PDPH generally spontaneously resolves within a few days with bed rest and nonopioid analgesics, but it may last for several days. If the symptoms persist, an epidural blood patch is considered as an effective treatment. We describe the successful use of an epidural saline patch in a 10 year-old child with PDPH who did not respond to conservative treatment. PMID:23084234

  2. Effect of Amniotic Membrane to Reduce Postlaminectomy Epidural Adhesion on a Rat Model

    PubMed Central

    Choi, Hyu Jin; Kim, Kyoung Beom

    2011-01-01

    Objective Epidural fibrosis and adhesion are the main reasons for post-laminectomy sustained pain and functional disability. In this study, the authors investigate the effect of irradiated freeze-dried human amniotic membrane on reducing epidural adhesion after laminectomy on a rat model. Methods A total of 20 rats were divided into two groups. The group A did not receive human amniotic membrane implantation after laminectomy and group B underwent human amniotic membrane implantation after laminectomy. Gross and microscopic findings were evaluated and compared at postoperative 1, 3 and 8 weeks. Results The amount of scar tissue and tenacity were reduced grossly in group of rats with human amniotic membrane implantation (group B). On a microscopic evaluation, there were less inflammatory cell infiltration and fibroblast proliferation in group B. Conclusion This experimental study shows that implantation of irradiated freeze-dried human amniotic membrane reduce epidural fibrosis and adhesion after spinal laminectomy in a rat model. PMID:21887388

  3. Spinal cord monitoring in neuromuscular scoliosis.

    PubMed

    Tucker, S K; Noordeen, M H; Pitt, M C

    2001-01-01

    This article reviews the use of spinal cord monitoring in neuromuscular scoliosis, a condition having a higher incidence of true positive results than idiopathic scoliosis. While somatosensory cortical evoked potentials (SCEP) are unreliable, somatosensory spinal evoked potentials (SSEP) are possible to obtain in most cases and a method using an epidural electrode is described. The '50% rule' is satisfactory having good specificity and sensitivity with it rare for post-operative paralysis to have occurred undetected. The spinal cord in these cases appears to have increased susceptibility particularly during the passage of sublaminar wires with the incidence of complications reduced using modern instrumentation. PMID:11269804

  4. Effect of chronic activity-based therapy on bone mineral density and bone turnover in persons with spinal cord injury

    PubMed Central

    Harness, Eric T.; Witzke, Kara A.

    2014-01-01

    Purpose Osteoporosis is a severe complication of spinal cord injury (SCI). Many exercise modalities are used to slow bone loss, yet their efficacy is equivocal. This study examined the effect of activity-based therapy (ABT) targeting the lower extremities on bone health in individuals with SCI. Methods Thirteen men and women with SCI (age and injury duration = 29.7 ± 7.8 and 1.9 ± 2.7 years) underwent 6 months of ABT. At baseline and after 3 and 6 months of training, blood samples were obtained to assess bone formation (serum procollagen type 1 N propeptide (PINP) and bone resorption (serum C-terminal telopeptide of type I collagen (CTX), and participants underwent dual-energy X-ray absorptiometry scans to obtain total body and regional estimates of bone mineral density (BMD). Results Results demonstrated significant increases (p < 0.05) in spine BMD (+4.8 %; 1.27 ± 0.22–1.33 ± 0.24 g/cm2) and decreases (p < 0.01) in total hip BMD (−6.1 %; 0.98 ± 0.18–0.91 ± 0.16 g/cm2) from 0 to 6 months of training. BMD at the bilateral distal femur (−7.5 to −11.0 %) and proximal tibia (− 8.0 to −11.2 %) declined but was not different (p > 0.05) versus baseline. Neither PINP nor CTX was altered (p> 0.05) with training. Conclusions Chronic activity-based therapy did not reverse bone loss typically observed soon after injury, yet reductions in BMD were less than the expected magnitude of decline in lower extremity BMD in persons with recent SCI. PMID:24097172

  5. Somatosensory inputs by application of KinesioTaping: effects on spasticity, balance, and gait in chronic spinal cord injury

    PubMed Central

    Tamburella, Federica; Scivoletto, Giorgio; Molinari, Marco

    2014-01-01

    Introduction: Leg paralysis, spasticity, reduced interlimb coordination, and impaired balance are the chief limitations to overground ambulation in subjects with incomplete spinal cord injury (SCI). In recent years, the application of KinesioTaping (KT) has been proposed to enhance sensory inputs, decreasing spasticity by proprioception feedback and relieving abnormal muscle tension. Because no studies have examined KT-based techniques in SCI subjects, our goal was to analyze the effects of ankle joint KT on spasticity, balance, and gait. Materials and Methods: A randomized crossover case control design was used to compare the effects of KT and conventional nonelastic silk tape (ST) in 11 chronic SCI subjects, AIS level D, with soleus/gastrocnemius (S/G) muscle spasticity and balance and gait impairments. Treatment: 48 h of treatment with KT or ST was followed by 48 h with the other technique after 1 week. A single Y-strip of Cure© tape (KT) and ST was to the S and G muscles with 0% stretch. Before and 48 h after of application of KT and ST, clinical data on the range of motion (ROM), spasticity, clonus, pain, balance, and gait were collected. Stabilometric platform assessment of center of pressure (COP) movements; bidimensional gait analysis; and recording of electromyographic (EMG) activity of the S, G, and tibialis anterior and extensor hallucis lungus muscles were also performed. Results: Only KT had significant effects on spasticity (p < 0.05), clonus (p < 0.001) and COP movements (p < 0.05), kinematic gait parameters (p < 0.001), and EMG activity (p < 0.001). Comparison between ST and KT improvements pointed out significant differences as concerns ROM (p < 0.001), spasticity (p < 0.001), clonus (p < 0.001), pain (p < 0.001), COP parameters (p < 0.05), and most kinematic gait data (p < 0.05). Discussion: Short-term application of KT reduces spasticity and pain and improves balance and gait in chronic SCI subjects. Although these data are promising, they require confirmation in a larger cohort of patients. PMID:24910607

  6. Determining the reliability of a custom built seated stadiometry set-up for measuring spinal height in participants with chronic low back pain.

    PubMed

    Steele, James; Bruce-Low, Stewart; Smith, Dave; Jessop, David; Osborne, Neil

    2016-03-01

    Indirect measurement of disc hydration can be obtained through measures of spinal height using stadiometry. However, specialised stadiometers for this are often custom-built and expensive. Generic wall-mounted stadiometers alternatively are common in clinics and laboratories. This study examined the reliability of a custom set-up utilising a wall-mounted stadiometer for measurement of spinal height using custom built wall mounted postural rods. Twelve participants with non-specific chronic low back pain (CLBP; females n = 5, males n = 7) underwent measurement of spinal height on three separate consecutive days at the same time of day where 10 measurements were taken at 20 s intervals. Comparisons were made using repeated measures analysis of variance for 'trial' and 'gender'. There were no significant effects by trial or interaction effects of trial x gender. Intra-individual absolute standard error of measurement (SEM) was calculated for spinal height using the first of the 10 measures, the average of 10 measures, the total shrinkage, and the rate of shrinkage across the 10 measures examined as the slope of the curve when a linear regression was fitted. SEMs were 3.1 mm, 2.8 mm, 2.6 mm and 0.212, respectively. Absence of significant differences between trials and the reported SEMs suggests this custom set-up for measuring spinal height changes is suitable use as an outcome measure in either research or clinical practice in participants with CLBP. PMID:26493099

  7. Chronic Treatment with the AMPK Agonist AICAR Prevents Skeletal Muscle Pathology but Fails to Improve Clinical Outcome in a Mouse Model of Severe Spinal Muscular Atrophy.

    PubMed

    Cerveró, Clàudia; Montull, Neus; Tarabal, Olga; Piedrafita, Lídia; Esquerda, Josep E; Calderó, Jordi

    2016-01-01

    Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder characterized by spinal and brainstem motor neuron (MN) loss and skeletal muscle paralysis. Currently, there is no effective treatment other than supportive care to ameliorate the quality of life of patients with SMA. Some studies have reported that physical exercise, by improving muscle strength and motor function, is potentially beneficial in SMA. The adenosine monophosphate-activated protein kinase agonist 5-aminoimidazole-4-carboxamide-1-β-D-ribofuranoside (AICAR) has been reported to be an exercise mimetic agent that is able to regulate muscle metabolism and increase endurance both at rest and during exercise. Chronic AICAR administration has been shown to ameliorate the dystrophic muscle phenotype and motor behavior in the mdx mouse, a model of Duchenne muscular dystrophy. Here, we investigated whether chronic AICAR treatment was able to elicit beneficial effects on motor abilities and neuromuscular histopathology in a mouse model of severe SMA (the SMNΔ7 mouse). We report that AICAR improved skeletal muscle atrophy and structural changes found in neuromuscular junctions of SMNΔ7 animals. However, although AICAR prevented the loss of glutamatergic excitatory synapses on MNs, this compound was not able to mitigate MN loss or the microglial and astroglial reaction occurring in the spinal cord of diseased mice. Moreover, no improvement in survival or motor performance was seen in SMNΔ7 animals treated with AICAR. The beneficial effects of AICAR in SMA found in our study are SMN-independent, as no changes in the expression of this protein were seen in the spinal cord and skeletal muscle of diseased animals treated with this compound. PMID:26582176

  8. Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis.

    PubMed

    Akinduro, Oluwaseun O; Miller, Brandon A; Haussen, Diogo C; Pradilla, Gustavo; Ahmad, Faiz U

    2015-10-01

    OBJECT The authors' aim in this paper was to review the intraoperative use of epidural steroids in lumbar discectomy surgery with a focus on surgical complications. METHODS A comprehensive literature search was done using PubMed, MEDLINE, and the Cochrane Central Registry of Controlled Trials. Relevant papers were retrieved and analyzed. The authors performed a meta-analysis of all available data. Search terms included epidural, steroids, discectomy, lumbar disc surgery, herniated lumbar disc, methylprednisolone, and perioperative.The primary outcome was surgical complications such as wound infection or need for reoperation. Secondary outcomes were pain and postoperative narcotic usage. RESULTS Sixteen trials and 1 retrospective study (a total of 1933 patients) were eligible for inclusion in this study. In all studies, steroids were added epidurally over the nerve root before closure in cases, and control patients underwent discectomy alone. The mean age (42.7 years vs 42.4 years; RR 0.30 [95% CI -0.30 to 0.90], p = 0.32), overall complication rates (2.69% vs 1.18%; RR 1.94 [95% CI 0.72-5.26], p = 0.19), and infectious complication rates (0.94% vs 0.08%; RR 4.58 [95% CI 0.75-27.95], p = 0.10) were similar between the steroid group and control group, respectively. CONCLUSIONS There is good evidence that epidural steroids can decrease pain in the short term and decrease the usage of postoperative narcotics after lumbar spinal surgery for degenerative spinal disease. The authors' results demonstrate a trend toward increased infection with epidural steroid use, but there was not a statistically significant difference. More studies are needed to validate the long-term risk/benefit ratio of epidural steroids in lumbar discectomy. PMID:26424336

  9. Continuous spinal anesthesia.

    PubMed

    Moore, James M

    2009-01-01

    Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a somewhat unpredictable spread and duration of effect, CSA allows titration of the block level to the patient's needs, permits a spinal block of indefinite duration, and can provide greater hemodynamic stability than single-injection spinal anesthesia. PMID:19546804

  10. Spinal stenosis

    MedlinePLUS

    ... spinal stenosis; Foraminal spinal stenosis; Degenerative spine disease; Back pain - spinal stenosis ... help your pain during flare-ups. Treatments for back pain caused by spinal stenosis include: Medicines that may ...

  11. Limb compressive load does not inhibit post activation depression of soleus H-reflex in indiviudals with chronic spinal cord injury

    PubMed Central

    Tseng, Shih-Chiao; Shields, Richard K.

    2013-01-01

    Objective We investigated the effect of various doses of limb compressive load on soleus H-reflex amplitude and post activation depression in individuals with/without chronic SCI. We hypothesized that SCI reorganization changes the typical reflex response to an external load. Methods Ten healthy adults and 10 individuals with SCI received three doses of compressive load to the top of their knee (10%, 25%, and 50% of the body weight, BW). Soleus H-reflexes were measured before (baseline) and during the loading phase. Results With persistent background muscle activity across all testing sessions, segment compressive load significantly decreased post activation depression in the control group, but did not change the post activation ratio in the SCI group. Normalized H2 amplitude significantly increased according to load (50% > 25% > 10%) in the control group whereas was minimally modulated to load in those with SCI. Conclusions Segment compressive load inhibits post activation depression in humans without SCI, but minimally modulates the reflex circuitry in people with chronic SCI. These findings suggest that spinal cord reorganization mitigates the typical response to load in people with chronic SCI. Significance Early limb load training may impact the reorganization of the spinal cord in humans with acute SCI. PMID:23168355

  12. 5-HT? and 5-HT? receptor agonists facilitate plantar stepping in chronic spinal rats through actions on different populations of spinal neurons.

    PubMed

    S?awi?ska, Urszula; Miazga, Krzysztof; Jordan, Larry M

    2014-01-01

    There is considerable evidence from research in neonatal and adult rat and mouse preparations to warrant the conclusion that activation of 5-HT2 and 5-HT1A/7 receptors leads to activation of the spinal cord circuitry for locomotion. These receptors are involved in control of locomotor movements, but it is not clear how they are implicated in the responses to 5-HT agonists observed after spinal cord injury. Here we used agonists that are efficient in promoting locomotor recovery in paraplegic rats, 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OHDPAT) (acting on 5-HT1A/7 receptors) and quipazine (acting on 5-HT2 receptors), to examine this issue. Analysis of intra- and interlimb coordination confirmed that the locomotor performance was significantly improved by either drug, but the data revealed marked differences in their mode of action. Interlimb coordination was significantly better after 8-OHDPAT application, and the activity of the extensor soleus muscle was significantly longer during the stance phase of locomotor movements enhanced by quipazine. Our results show that activation of both receptors facilitates locomotion, but their effects are likely exerted on different populations of spinal neurons. Activation of 5-HT2 receptors facilitates the output stage of the locomotor system, in part by directly activating motoneurons, and also through activation of interneurons of the locomotor central pattern generator (CPG). Activation of 5-HT7/1A receptors facilitates the activity of the locomotor CPG, without direct actions on the output components of the locomotor system, including motoneurons. Although our findings show that the combined use of these two drugs results in production of well-coordinated weight supported locomotion with a reduced need for exteroceptive stimulation, they also indicate that there might be some limitations to the utility of combined treatment. Sensory feedback and some intraspinal circuitry recruited by the drugs can conflict with the locomotor activation. PMID:25191231

  13. Epidural nalbuphine for postoperative analgesia in orthopedic surgery

    PubMed Central

    Chatrath, Veena; Attri, Joginder Pal; Bala, Anju; Khetarpal, Ranjana; Ahuja, Deepti; Kaur, Sawinder

    2015-01-01

    Background: The challenging task of postoperative pain relief comes within the realm of the anesthesiologist. Combined spinal epidural (CSE) anesthesia can be used as the sole technique for carrying out surgical procedures and managing postoperative pain using various drug regimes. Epidural administration of opioids in combination with local anesthetic agents in low dose offers new dimensions in the management of postoperative pain. Aims: Comparative evaluation of bupivacaine hydrochloride with nalbuphine versus bupivacaine with tramadol for postoperative analgesia in lower limb orthopedic surgeries under CSE anesthesia to know the quality of analgesia, incidence of side effects, surgical outcome and level of patient satisfaction. Settings and Design: A prospective, randomized and double-blind study was conducted involving 80 patients of American Society of Anesthesiologists physical status I and II coming for elective lower limb orthopedic surgeries carried under spinal anesthesia. Materials and Methods: Anesthesia was given with 0.5% of 2.5 ml bupivacaine intrathecally in both the groups. Epidurally 0.25% bupivacaine along with 10 mg nalbuphine (group A) or tramadol 100 mg (group B) diluted to 2 ml to make a total volume of 10 ml was administered at sensory regression to T10. Statistical Analysis: The data were collected, compiled and statistically analyzed with the help of MS Excel, EPI Info 6 and SPSS to draw the relative conclusions. Results and Conclusions: The mean duration of analgesia in group A was 380 11.49 min and in group B was 380 9.8 min. The mean sedation score was found to be more in group B than group A. The mean patient satisfaction score in group A was 4.40 0.871 and in group B was 3.90 1.150 which was found to be statistically significant (P < 0.05). We concluded that the addition of nalbuphine with bupivacaine was effective for postoperative analgesia in terms of quality of analgesia and patient satisfaction score as compared to tramadol. PMID:26712968

  14. Nonoperative Management of a Multi-Regional Epidural Abscess with Neurological Dysfunction

    PubMed Central

    Hernandez, Miguel; Berg, Andrew; Bhatia, Chandra

    2015-01-01

    Spinal epidural abscesses are uncommon, but their incidence is increasing. They represent a collection of purulent material in the epidural space and most commonly occur in the lumbar spine, where they remain localised. Abscesses that affect all three spinal levels (holospinal or multiregional abscesses) are extremely rare, with only a few cases published in the literature. Epidural abscesses are particularly high risk infections as progressive neurological dysfunction can occur rapidly; early diagnosis and treatment is therefore essential to avoid long term neurological complications and reduce potential mortality. Given the uncommon nature of this condition, the treatment remains controversial with no definitive guidance on conservative versus surgical management. The literature mostly recommends surgical decompression along with intravenous antibiotics in patients with neurological abnormalities. We describe a case of a 77-year-old patient presenting with a delayed diagnosis of a multi-regional epidural abscess with associated upper motor neurone signs. The patient was successfully treated nonoperatively with a course of antibiotics resulting in complete radiological resolution of the abscess and full neurological recovery. PMID:26512341

  15. Upper Cervical Epidural Abscess in a Patient With Parkinson Disease: A Case Report and Review.

    PubMed

    Al-Hourani, Khalid; Frost, Chelsea; Mesfin, Addisu

    2015-12-01

    To our knowledge, there are no reports in the literature of patients with Parkinson disease (PD) developing upper cervical spine infections. Our objective is to present a case of upper cervical epidural abscess in a patient with PD and to review upper cervical spine infection. We present the patient's presentation, physical examination, imaging findings, and management as well a review of the literature. A 66-year-old male with PD presented to the emergency department (ED) following referral by a neurologist for a presumed C2 fracture. The preceding history was 1 week of severe neck pain requiring a magnetic resonance imaging (MRI), which was initially interpreted as a C2 fracture. On admission from the ED, further review of the MRI appeared to show anterior prevertebral abscess and an epidural abscess. The patient's neurological examination was at baseline. In the span of 2 days, the patient developed significant motor weakness. A repeat MRI demonstrated expansion of the epidural collection and spinal cord compression. Surgical management consisting of C1 and C2 laminectomy, irrigation, and debridement from anterior and posterior approaches was performed. Postoperatively, the patient did not recover any motor strength and elected to withdraw care and died. Spinal epidural abscess requires a high index of suspicion and needs prompt recognition to prevent neurological impairment. Upper cervical spine infections are rare but can lead to lethal consequences. PMID:26623170

  16. Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain

    PubMed Central

    Chu, Andrew; Aung, Thu Thu; Shankar, Uday

    2015-01-01

    Paraspinal and epidural abscesses are rare conditions often diagnosed later in the disease process that can have significant morbidity and mortality. Predisposing risk factors include diabetes, human immunodeficiency virus, intravenous drug abuse, and previous history of spinal surgery or injection. They can threaten the spinal cord by compressive effect, leading to sensory motor deficits and ultimately paralysis and death. Diagnosis may be a challenge due to the delayed presentation of nonspecific back pain or radicular pain such as chest pain or abdominal pain. We present a rare case on a patient with periumbilical pain, constipation, and urinary retention who was ultimately diagnosed with a paraspinal abscess extending into the epidural space from T1 to S2. He underwent decompressive laminectomy with incision and drainage of the abscesses. The patient made an excellent recovery postoperatively, and repeat magnetic resonance imaging at six weeks showed resolution of the abscess. PMID:26770847

  17. Sciatica and epidural corticosteroid injections.

    PubMed

    2015-02-01

    According to trials conducted in hundreds of patients with sciatica, epidural corticosteroid injections have no demonstrated efficacy beyond the placebo effect, either in the short-term or the long-term. However, they expose patients to a risk of sometimes serious neurological adverse effects. PMID:25802923

  18. The Morphofunctional Effect of the Transplantation of Bone Marrow Stromal Cells and Predegenerated Peripheral Nerve in Chronic Paraplegic Rat Model via Spinal Cord Transection.

    PubMed

    Buzoianu-Anguiano, Vinnitsa; Orozco-Surez, Sandra; Garca-Vences, Elisa; Caballero-Chacn, Sara; Guizar-Sahagn, Gabriel; Chavez-Sanchez, Luis; Grijalva, Israel

    2015-01-01

    Functional recovery following spinal cord injury (SCI) is limited by poor axonal and cellular regeneration as well as the failure to replace damaged myelin. Employed separately, both the transplantation of the predegenerated peripheral nerve (PPN) and the transplantation of bone marrow stromal cells (BMSCs) have been shown to promote the regrowth and remyelination of the damaged central axons in SCI models of hemisection, transection, and contusion injury. With the aim to test the effects of the combined transplantation of PPN and BMSC on regrowth, remyelination, and locomotor function in an adult rat model of spinal cord (SC) transection, 39 Fischer 344 rats underwent SC transection at T9 level. Four weeks later they were randomly assigned to traumatic spinal cord injury (TSCI) without treatment, TSCI + Fibrin Glue (FG), TSCI + FG + PPN, and TSCI + FG + PPN + BMSCs. Eight weeks after, transplantation was carried out on immunofluorescence and electron microscope studies. The results showed greater axonal regrowth and remyelination in experimental groups TSCI + FG + PPN and TSCI + FG + PPN + BMSCs analyzed with GAP-43, neuritin, and myelin basic protein. It is concluded that the combined treatment of PPN and BMSCs is a favorable strategy for axonal regrowth and remyelination in a chronic SC transection model. PMID:26634157

  19. The role of spinal manipulation, soft-tissue therapy, and exercise in chronic obstructive pulmonary disease: a review of the literature and proposal of an anatomical explanation.

    PubMed

    Engel, Roger; Vemulpad, Subramanyam

    2011-09-01

    The premise that lung function can regulate chest wall mobility is an accepted concept. Descriptions of the primary and accessory respiratory structures do not usually include spinal components as a part of these classifications. The case for including these components as a part of the respiratory mechanism and their role in the development of dyspnea and chest wall rigidity in chronic obstructive pulmonary disease (COPD) is reviewed. Mechanical impairment of the chest wall is a contributing factor in the prognosis of COPD. Reducing this impairment improves prognosis. Because spinal manipulation and soft-tissue therapy increase joint mobility and decrease muscle hypertonicity, respectively, applying these interventions to the chest wall in COPD could reduce chest wall rigidity, thereby improving breathing mechanics. Improvements in breathing mechanics reduce the work of the respiratory muscles and delay the onset of dyspnea. Exercise capacity is reliant on the ability to overcome activity-limiting dyspnea, which usually occurs prior to maximum exercise capacity being reached. Delaying the onset of dyspnea permits more exercise to be performed before dyspnea develops. Spinal manipulation and soft-tissue therapy have the potential to deliver such a delay. Because exercise tolerance is considered to be a strong predictor of quality of life and survival in COPD, any increase in exercise capacity would therefore improve prognosis for the disease. PMID:21838523

  20. The Morphofunctional Effect of the Transplantation of Bone Marrow Stromal Cells and Predegenerated Peripheral Nerve in Chronic Paraplegic Rat Model via Spinal Cord Transection

    PubMed Central

    Buzoianu-Anguiano, Vinnitsa; Orozco-Suárez, Sandra; García-Vences, Elisa; Caballero-Chacón, Sara; Guizar-Sahagún, Gabriel; Chavez-Sanchez, Luis; Grijalva, Israel

    2015-01-01

    Functional recovery following spinal cord injury (SCI) is limited by poor axonal and cellular regeneration as well as the failure to replace damaged myelin. Employed separately, both the transplantation of the predegenerated peripheral nerve (PPN) and the transplantation of bone marrow stromal cells (BMSCs) have been shown to promote the regrowth and remyelination of the damaged central axons in SCI models of hemisection, transection, and contusion injury. With the aim to test the effects of the combined transplantation of PPN and BMSC on regrowth, remyelination, and locomotor function in an adult rat model of spinal cord (SC) transection, 39 Fischer 344 rats underwent SC transection at T9 level. Four weeks later they were randomly assigned to traumatic spinal cord injury (TSCI) without treatment, TSCI + Fibrin Glue (FG), TSCI + FG + PPN, and TSCI + FG + PPN + BMSCs. Eight weeks after, transplantation was carried out on immunofluorescence and electron microscope studies. The results showed greater axonal regrowth and remyelination in experimental groups TSCI + FG + PPN and TSCI + FG + PPN + BMSCs analyzed with GAP-43, neuritin, and myelin basic protein. It is concluded that the combined treatment of PPN and BMSCs is a favorable strategy for axonal regrowth and remyelination in a chronic SC transection model. PMID:26634157

  1. Bilateral Heel Numbness due to External Compression during Obstetric Epidural Analgesia

    PubMed Central

    Kamphuis, Vivian P.; Zegers, Marie P.A.; Koppen, Hille

    2015-01-01

    We describe the case of a 32-year-old woman who developed bilateral heel numbness after obstetric epidural analgesia. We diagnosed her with bilateral neuropathy of the medial calcaneal nerve, most likely due to longstanding pressure on both heels. Risk factors for the development of this neuropathy were prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy. Padded footrests decrease pressure and can possibly prevent this neuropathy. PMID:25802500

  2. Improvement of spinal non-viral IL-10 gene delivery by D-mannose as a transgene adjuvant to control chronic neuropathic pain

    PubMed Central

    2014-01-01

    Background Peri-spinal subarachnoid (intrathecal; i.t.) injection of non-viral naked plasmid DNA encoding the anti-inflammatory cytokine, IL-10 (pDNA-IL-10) suppresses chronic neuropathic pain in animal models. However, two sequential i.t. pDNA injections are required within a discrete 5 to 72-hour period for prolonged efficacy. Previous reports identified phagocytic immune cells present in the peri-spinal milieu surrounding the i.t injection site that may play a role in transgene uptake resulting in subsequent IL-10 transgene expression. Methods In the present study, we aimed to examine whether factors known to induce pro-phagocytic anti-inflammatory properties of immune cells improve i.t. IL-10 transgene uptake using reduced naked pDNA-IL-10 doses previously determined ineffective. Both the synthetic glucocorticoid, dexamethasone, and the hexose sugar, D-mannose, were factors examined that could optimize i.t. pDNA-IL-10 uptake leading to enduring suppression of neuropathic pain as assessed by light touch sensitivity of the rat hindpaw (allodynia). Results Compared to dexamethasone, i.t. mannose pretreatment significantly and dose-dependently prolonged pDNA-IL-10 pain suppressive effects, reduced spinal IL-1? and enhanced spinal and dorsal root ganglia IL-10 immunoreactivity. Macrophages exposed to D-mannose revealed reduced proinflammatory TNF-?, IL-1?, and nitric oxide, and increased IL-10 protein release, while IL-4 revealed no improvement in transgene uptake. Separately, D-mannose dramatically increased pDNA-derived IL-10 protein release in culture supernatants. Lastly, a single i.t. co-injection of mannose with a 25-fold lower pDNA-IL-10 dose produced prolonged pain suppression in neuropathic rats. Conclusions Peri-spinal treatment with D-mannose may optimize naked pDNA-IL-10 transgene uptake for suppression of allodynia, and is a novel approach to tune spinal immune cells toward pro-phagocytic phenotype for improved non-viral gene therapy. PMID:24884664

  3. [Anesthetic Management of Three Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy].

    PubMed

    Maruyama, Naoko; Wakimoto, Mayuko; Inamori, Noriko; Nishimura, Shinya; Mori, Takahiko

    2015-08-01

    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronically progressing or relapsing disease caused by immune-mediated peripheral neuropathy. We report the anesthetic management of three CIDP patients who underwent elective orthopedic surgeries. Owing to the risk of neuraxial anesthetics triggering demyelination, general anesthesia was selected to avoid epidural or spinal anesthesia or other neuraxial blockade. It was also judged prudent to avoid prolonged perioperative immobilization, which might compress vulnerable peripheral nerves. For Patient 1, general anesthesia was induced with propofol, remifentanil, and sevoflurane, and was maintained with sevoflurane and remifentanil. For Patients 2 and 3, general anesthesia was induced and maintained with propofol and remifentanil. For tracheal intubation, under careful monitoring with peripheral nerve stimulators, minimal doses of rocuronium (0.6-0.7 mg x kg(-1)) were administered. When sugammadex was administered to reverse the effect of rocuronium, all patients rapidly regained muscular strength. Postoperative courses were satisfactory without sequelae. PMID:26442423

  4. Labor analgesia for the parturient with prior spinal surgery: what does an obstetrician need to know?

    PubMed

    Kuczkowski, Krzysztof M

    2006-10-01

    Administration of lumbar epidural analgesia in a parturient with previous spinal surgery presents a unique challenge to the anesthesiologist. These challenges (difficulties) range from inability to identify the epidural space, multiple attempts before catheter insertion, vascular trauma, and/or subdural local anesthetic injection to accidental dural puncture. The literature documenting management of labor analgesia in pregnant women with prior spinal surgery is limited to a handful of case reports. This author is not aware of any other review articles in English literature discussing special considerations for labor analgesia in parturients presenting with history of prior spinal instrumentation. PMID:16547684

  5. Bilateral Bulbospinal Projections to Pudendal Motoneuron Circuitry after Chronic Spinal Cord Hemisection Injury as Revealed by Transsynaptic Tracing with Pseudorabies Virus

    PubMed Central

    Chadha, Harpreet K.; Dugan, Victoria P.; Gupta, Daya S.; Ferrero, Sunny L.; Hubscher, Charles H.

    2011-01-01

    Abstract Complications of spinal cord injury in males include losing brainstem control of pudendal nerveinnervated perineal muscles involved in erection and ejaculation. We previously described, in adult male rats, a bulbospinal pathway originating in a discrete area within the medullary gigantocellularis (GiA/Gi), and lateral paragigantocellularis (LPGi) nuclei, which when electrically microstimulated unilaterally, produces a bilateral inhibition of pudendal motoneuron reflex circuitry after crossing to the contralateral spinal cord below T8. Microstimulation following a long-term lateral hemisection, however, revealed reflex inhibition from both sides of the medulla, suggesting the development or unmasking of an injury-induced bulbospinal pathway crossing the midline cranial to the spinal lesion. In the present study, we investigated this pathway anatomically using the transsynaptic neuronal tracer pseudorabies virus (PRV) injected unilaterally into the bulbospongiosus muscle in uninjured controls, and ipsilateral to a chronic (12 months) unilateral lesion of the lateral funiculus. At 4.75 days post-injection, PRV-labeled cells were found bilaterally in the GiA/Gi/LPGi with equal side-to-side labeling in uninjured controls, and with significantly greater labeling contralateral to the lesion/injection in lesioned animals. The finding of PRV-labeled neurons on both sides of the medulla after removing the mid-thoracic spinal pathway on one side provides anatomical evidence for the bilaterality in both the brainstem origin and the lumbosacral pudendal circuit termination of the spared lateral funicular bulbospinal pathway. This also suggests that this bilaterality may contribute to the quick functional recovery of bladder and sexual functions observed in animals and humans with lateral hemisection injury. PMID:21265606

  6. Effect of yogic colon cleansing (Laghu Sankhaprakshalana Kriya) on pain, spinal flexibility, disability and state anxiety in chronic low back pain

    PubMed Central

    Haldavnekar, Richa Vivek; Tekur, Padmini; Nagarathna, Raghuram; Nagendra, Hongasandra Ramarao

    2014-01-01

    Background: Studies have shown that Integrated Yoga reduces pain, disability, anxiety and depression and increases spinal flexibility and quality-of-life in chronic low back pain (CLBP) patients. Objective: The objective of this study was to compare the effect of two yoga practices namely laghu shankha prakshalana (LSP) kriya, a yogic colon cleansing technique and back pain specific asanas (Back pain special technique [BST]) on pain, disability, spinal flexibility and state anxiety in patients with CLBP. Materials and Methods: In this randomized control (self as control) study, 40 in-patients (25 were males, 15 were females) between 25 and 70 years (44.05 13.27) with CLBP were randomly assigned to receive LSP or BST sessions. The measurements were taken immediately before and after each session of either of the practices (30 min) in the same participant. Randomization was used to decide the day of the session (3rd or 5th day after admission) to ensure random distribution of the hang over effect of the two practices. Statistical analysis was performed using the repeated measures analysis of variance. Results: Significant group * time interaction (P < 0.001) was observed in 11 point numerical rating scale, spinal flexibility (on Leighton type Goniometer) and (straight leg raise test in both legs), Oswestry Disability Index, State Anxiety (XI component of Spieldberger's state and trait anxiety inventory. There was significantly (P < 0.001, between groups) better reduction in LSP than BST group on all variables. No adverse effects were reported by any participant. Conclusion: Clearing the bowel by yoga based colon cleansing technique (LSP) is safe and offers immediate analgesic effect with reduced disability, anxiety and improved spinal flexibility in patients with CLBP. PMID:25035620

  7. Safety Concerns About an Epidural Blood Patch in a Patient with Extensive Epidural Fluid Accumulation.

    PubMed

    Droog, Wouter; Zuidgeest, Dick M H; de Jonge, Leenoud C W; van Oort, Cas J

    2015-10-01

    We present a case of postdural puncture headache in a patient with extensive epidural fluid accumulation. An initial epidural blood patch was aborted because of concern about increased risk of complications. After magnetic resonance imaging, we proceeded with epidural blood patch with a good therapeutic result. We discuss the imaging results and safety concerns we considered when assessing the benefits and risks of epidural blood patch in this patient. PMID:26402022

  8. A study of pethidine kinetics and analgesia in women in labour following intravenous, intramuscular and epidural administration.

    PubMed Central

    Husemeyer, R P; Cummings, A J; Rosankiewicz, J R; Davenport, H T

    1982-01-01

    1 Epidural administration of opiates for analgesia has recently generated widespread interest and would theoretically be advantageous as a method for relief of pain in labour. 2 Plasma pethidine concentrations were measured after intravenous, intramuscular and epidural administration of pethidine to women in labour and after epidural administration to non-pregnant female surgical patients. 3 Kinetic parameters were derived from the plasma concentration data in each group of subjects and the relationship between plasma kinetics and analgesia in labour were examined. 4 Absorption of pethidine from the epidural space in pregnant women in rapid and excepting the lower initial values, the average plasma concentration and area under the plasma concentration v time curve did not differ significantly (P less than 0.01) from those obtained with intravenous dosage, but were significantly higher (P less than 0.01) during the first 2 h after dosage than the results after intramuscular administration. The analgesia provided by the epidural route of administration was greater than with intravenous or intramuscular administration. 5 It is postulated that the analgesic efficacy of epidural pethidine in women in labour is due to a combination of systemic and local effects and that the local effect is attributable to the local anaesthetic properties of pethidine rather than a selective anti-nociceptive action on the spinal cord. PMID:7059414

  9. Neurological complications associated with epidural steroid injections.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2015-05-01

    Multiple case reports of neurological complications resulting from intraarterial injection of corticosteroids have led the Food and Drug Administration (FDA) to issue a warning, requiring label changes, warning of serious neurological events, some resulting in death. The FDA has identified 131 cases of neurological adverse events, including 41 cases of arachnoiditis. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, of which cervical transforaminal epidural injections constituted the majority of neurological complications. Utilization data of epidural injections in the Medicare population revealed that cervical transforaminal epidural injections constitute only 2.4% of total epidural injections and <5% of all transforaminal epidural injections. Multiple theories have been proposed as the cause of neurological injury including particulate steroid, arterial intimal flaps, arterial dissection, dislodgement of plaque causing embolism, arterial muscle spasm, and embolism of a fresh thrombus following disruption of the intima. PMID:25795154

  10. A Clinical Perspective and Definition of Spinal Cord Injury.

    PubMed

    Kretzer, Ryan M

    2016-04-01

    Spinal cord injury (SCI) can be complete or incomplete. The level of injury in SCI is defined as the most caudal segment with motor function rated at greater than or equal to 3/5, with pain and temperature preserved. The standard neurological classification of SCI provided by the American Spinal Injury Association (ASIA) assigns grades from ASIA A (complete SCI) through ASIA E (normal sensory/motor), with B, C, and D representing varying degrees of injury between these extremes. The most common causes of SCI include trauma (motor vehicle accidents, sports, violence, falls), degenerative spinal disease, vascular injury (anterior spinal artery syndrome, epidural hematoma), tumor, infection (epidural abscess), and demyelinating processes (). (SDC Figure 1, http://links.lww.com/BRS/B91)(Figure is included in full-text article.). PMID:27015067

  11. Self-Sustained Motor Activity Triggered by Interlimb Reflexes in Chronic Spinal Cord Injury, Evidence of Functional Ascending Propriospinal Pathways

    PubMed Central

    McNulty, Penelope A.; Burke, David

    2013-01-01

    The loss or reduction of supraspinal inputs after spinal cord injury provides a unique opportunity to examine the plasticity of neural pathways within the spinal cord. In a series of nine experiments on a patient, quadriplegic due to spinal cord injury, we investigated interlimb reflexes and self-sustained activity in completely paralyzed and paretic muscles due to a disinhibited propriospinal pathway. Electrical stimuli were delivered over the left common peroneal nerve at the fibular head as single stimuli or in trains at 2–100 Hz lasting 1 s. Single stimuli produced a robust interlimb reflex twitch in the contralateral thumb at a mean latency 69 ms, but no activity in other muscles. With stimulus trains the thumb twitch occurred at variable subharmonics of the stimulus rate, and strong self-sustained activity developed in the contralateral wrist extensors, outlasting both the stimuli and the thumb reflex by up to 20 s. Similar behavior was recorded in the ipsilateral wrist extensors and quadriceps femoris of both legs, but not in the contralateral thenar or peroneal muscles. The patient could not terminate the self-sustained activity voluntarily, but it was abolished on the left by attempted contractions of the paralyzed thumb muscles of the right hand. These responses depend on the functional integrity of an ascending propriospinal pathway, and highlight the plasticity of spinal circuitry following spinal cord injury. They emphasize the potential for pathways below the level of injury to generate movement, and the role of self-sustained reflex activity in the sequelae of spinal cord injury. PMID:23936543

  12. Identification of Spinal Cord MicroRNA and Gene Signatures in a Model of Chronic Stress-Induced Visceral Hyperalgesia in Rat

    PubMed Central

    Bradesi, Sylvie; Karagiannides, Iordanes; Bakirtzi, Kyriaki; Joshi, Swapna Mahurkar; Koukos, Georgios; Iliopoulos, Dimitrios; Pothoulakis, Charalabos; Mayer, Emeran A.

    2015-01-01

    Introduction Animal studies have shown that stress could induce epigenetic and transcriptomic alterations essential in determining the balance between adaptive or maladaptive responses to stress. We tested the hypothesis that chronic stress in rats deregulates coding and non-coding gene expression in the spinal cord, which may underline neuroinflammation and nociceptive changes previously observed in this model. Methods Male Wistar rats were exposed to daily stress or handled, for 10 days. At day 11, lumbar spinal segments were collected and processed for mRNA/miRNA isolation followed by expression profiling using Agilent SurePrint Rat Exon and Rat miRNA Microarray platforms. Differentially expressed gene lists were generated using the dChip program. Microarrays were analyzed using the Ingenuity Pathways Analysis (IPA) tool from Ingenuity Systems. Multiple methods were used for the analysis of miRNA-mRNA functional modules. Quantitative real time RT-PCR for Interleukin 6 signal transducer (gp130), the Signal Transducer And Activator Of Transcription 3 (STAT3), glial fibrillary acidic protein and mir-17-5p were performed to confirm levels of expression. Results Gene network analysis revealed that stress deregulated different inflammatory (IL-6, JAK/STAT, TNF) and metabolic (PI3K/AKT) signaling pathways. MicroRNA array analysis revealed a signature of 39 deregulated microRNAs in stressed rats. MicroRNA-gene network analysis showed that microRNAs are regulators of two gene networks relevant to inflammatory processes. Specifically, our analysis of miRNA-mRNA functional modules identified miR-17-5p as an important regulator in our model. We verified miR-17-5p increased expression in stress using qPCR and in situ hybridization. In addition, we observed changes in the expression of gp130 and STAT3 (involved in intracellular signaling cascades in response to gp130 activation), both predicted targets for miR-17-5p. A modulatory role of spinal mir17-5p in the modulation of visceral sensitivity was confirmed in vivo. Conclusion Using an integrative high throughput approach, our findings suggest a link between miR-17-5p increased expression and gp130/STAT3 activation providing new insight into the possible mechanisms mediating the effect of chronic stress on neuroinflammation in the spinal cord. PMID:26222740

  13. Glutaminase 1 is a potential biomarker for chronic post-surgical pain in the rat dorsal spinal cord using differential proteomics.

    PubMed

    Wang, Haitang; Liu, Wei; Cai, Yehua; Ma, Lulu; Ma, Chao; Luo, Ailun; Huang, Yuguang

    2016-02-01

    Chronic post-surgical pain (CPSP) is a normal and significant symptom in clinical surgery, such as breast operation, biliary tract operation, cesarean operation, uterectomy and thoracic operation. Severe chronic post-surgical pain could increase post-surgical complications, including myocardial ischemia, respiratory insufficiency, pneumonia and thromboembolism. However, the underlying mechanism is still unknown. Herein, a rat CPSP model was produced via thoracotomy. After surgery, in an initial study, 5 out of 12 rats after surgery showed a significant decrease in mechanical withdrawal threshold and/or increase in the number of acetone-evoked responses, and therefore classified as the CPSP group. The remaining seven animals were classified as non-CPSP. Subsequently, open-chest operation was performed on another 30 rats and divided into CPSP and non-CPSP groups after 21-day observation. Protein expression levels in the dorsal spinal cord tissue were determined by 12.5 % SDS-PAGE. Finally, differently expressed proteins were identified by LC MS/MS and analyzed by MASCOT software, followed by Gene Ontology cluster analysis using PANTHER software. Compared with the non-CPSP group, 24 proteins were only expressed in the CPSP group and another 23 proteins expressed differentially between CPSP and non-CPSP group. Western blot further confirmed that the expression of glutaminase 1 (GLS1) was significantly higher in the CPSP than in the non-CPSP group. This study provided a new strategy to identify the spinal proteins, which may contribute to the development of chronic pain using differential proteomics, and suggested that GLS1 may serve as a potential biomarker for CPSP. PMID:26427714

  14. Chronic treatment with the opioid antagonist naltrexone favours the coupling of spinal cord ?-opioid receptors to G?z protein subunits.

    PubMed

    Valdizn, Elsa M; Daz, Alvaro; Pilar-Cullar, Fuencisla; Lantero, Aquilino; Mostany, Ricardo; Villar, Ana V; Laorden, Mara L; Hurl, Mara A

    2012-02-01

    Sustained administration of opioid antagonists to rodents results in an enhanced antinociceptive response to agonists. We investigated the changes in spinal ?-opioid receptor signalling underlying this phenomenon. Rats received naltrexone (120 ?g/h; 7 days) via osmotic minipumps. The antinociceptive response to the ?-agonist sufentanil was tested 24 h after naltrexone withdrawal. In spinal cord samples, we determined the interaction of ?-receptors with G? proteins (agonist-stimulated [(35)S]GTP?S binding and immunoprecipitation of [(35)S]GTP?S-labelled G? subunits) as well as ?-opioid receptor-dependent inhibition of the adenylyl cyclase (AC) activity. Chronic naltrexone treatment augmented DAMGO-stimulated [(35)S]GTP?S binding, potentiated the inhibitory effect of DAMGO on the AC/cAMP pathway, and increased the inverse agonist effect of naltrexone on cAMP accumulation. In control rats, the inhibitory effect of DAMGO on cAMP production was antagonized by pertussis toxin (PTX) whereas, after chronic naltrexone, the effect became resistant to the toxin, suggesting a coupling of ?-receptors to PTX-insensitive G?(z) subunits. Immunoprecipitation assays confirmed the transduction switch from G?(i/o) to G?(z) proteins. The consequence was an enhancement of the antinociceptive response to sufentanil that, in consonance with the neurochemical data, was prevented by G?(z)-antisense oligodeoxyribonucleotides but not by PTX. Such changes in opioid receptor signalling can be a double-edged sword. On the one hand, they may have potential applicability to the optimisation of the analgesic effects of opioid drugs for the control of pain. On the other hand, they represent an important homeostatic dysregulation of the endogenous opioid system that might account for undesirable effects in patients chronically treated with opioid antagonists. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'. PMID:21903117

  15. Effect of chronic undernourishment on the cord dorsum potentials and the primary afferent depolarization evoked by cutaneous nerves in the rat spinal cord.

    PubMed

    Gonzlez, Salvador Quirz; Alegra, Bertha Segura; Olmos, Jos Carlos Guadarrama; Jimnez-Estrada, Ismael

    2011-04-25

    The effect of chronic undernourishment on the cord dorsum potentials (CDPs) and the dorsal root potential (DRP), closely related to primary afferent depolarization (PAD) and presynaptic inhibition in the spinal cord of the rat, was analyzed in this study. Single electrical pulses applied to the sural nerve (SU) of control (n=14) and chronically undernourished (n=16) Wistar rats produced CDPs, which are composed of four components: afferent volley (AV), two negative components (N(1) and N(2)), and one positive component (P wave) and negative DRPs recorded in a small rootlet of the L6 segment of the rat. The CDPs of the control and undernourished rats with AV components of comparable amplitude (U(AV)/C(AV)=0.96), showed N(1) components of similar amplitude (U(N1)/C(N1)=0.94), but smaller P wave (U(PW)/C(PW)=0.23). A comparable reduction in the amplitude of the DRPs was obtained in the undernourished rats (U(DRP)/C(DRP)=0.36). When normalized as a function of the body mass of the animals, the CDPs and DRPs produced in undernourished rats were of significantly smaller normalized amplitude than those evoked in the control. According to these results, it is suggested that chronic undernourishment induce a depressive effect on the mechanisms generating the P wave component in the CDP and the DRPs either by decreasing the sensory input and/or the excitability of the dorsal horn neurones involved in the generation of PAD and presynaptic inhibition in the spinal cord of the rat. PMID:21354275

  16. Rapidly calcified epidural hematoma in a neonate.

    PubMed

    Yu, Dong Kun; Heo, Dong Hwa; Cho, Sung Min; Cho, Yong Jun

    2008-08-01

    We report a very rare case of a rapidly calcified chronic epidural hematoma (EDH) in a neonate. A 26-day-old female infant was referred to us from a regional hospital because of drowsy mentality and a seizure attack. She was delivered through caesarian section because normal spontaneous vaginal delivery was prolonged and failed. At birth, mild scalp swelling was found on the right frontal area. Scalp swelling was spontaneously resolved and she was discharged without any problems. On the 25th day after her birth, the baby presented with drowsiness and hypotonia following a generalized tonic-clonic seizure. Magnetic resonance imaging (MRI) and a computed tomography (CT) scan revealed a chronic EDH that had a thick layer of calcification. A small burr-hole trephination was performed and a single silastic drainage catheter was inserted. After the operation, a total of 12 ml of liquefied hematoma was drained, and the patient's mentality improved from drowsiness to alertness. The patient was asymptomatic when discharged. PMID:19096702

  17. Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain.

    PubMed

    Soegaard, Rikke; Christensen, Finn Bjarke; Christiansen, Terkel; Bnger, Cody

    2007-05-01

    Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar spinal fusion. We hypothesized a positive correlation between costs and effects, that determinants of effects would also determine cost-effectiveness, and that posterolateral instrumentation and anterior intervertebral support are cost-effective adjuncts in posterolateral lumbar fusion. A cohort of 136 consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator's perspective, by means of Activity-Based-Costing. Clinical effects were measured by means of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted analysis (for non-random allocation of patients) was performed in order to reveal the incremental cost-effectiveness ratios of (a) posterior instrumentation and (b) anterior support. The costs of non-instrumented posterolateral spinal fusion were estimated at DKK 88,285(95% CI 81,369;95,546), instrumented posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited, whereas the probability of anterior intervertebral support being cost-effective escalates as willingness-to-pay per effect unit increases. This study reveals useful and hitherto unknown information both about cost-patterns at the patient-level and determinants of cost-effectiveness. The overall conclusion of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself--at least from an administrator's perspective. PMID:16871387

  18. Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion.

    PubMed

    Willems, Paul

    2013-02-01

    Chronic low back pain (CLBP) is one of the main causes of disability in the western world with a huge economic burden to society. As yet, no specific underlying anatomic cause has been identified for CLBP. Imaging often reveals degenerative findings of the disc or facet joints of one or more lumbar motion segments. These findings, however, can also be observed in asymptomatic people. It has been suggested that pain in degenerated discs may be caused by the ingrowth of nerve fibers into tears or clefts of the annulus fibrosus or nucleus pulposus, and by reported high levels of pro-inflammatory mediators. As this so-called discogenic pain is often exacerbated by mechanical loading, the concept of relieving pain by spinal fusion to stabilise a painful spinal segment, has been developed. For some patients lumbar spinal fusion indeed is beneficial, but its results are highly variable and hard to predict for the individual patient. To identify those CLBP patients who will benefit from fusion, many surgeons rely on tests that are assumed to predict the outcome of spinal fusion. The three most commonly used prognostic tests in daily practice are immobilization in a lumbosacral orthosis, provocative discography and trial immobilization by temporary external transpedicular fixation. Aiming for consensus on the indications for lumbar fusion and in order to improve its results by better patient selection, it is essential to know the role and value of these prognostic tests for CLBP patients in clinical practice. The overall aims of the present thesis were: 1) to evaluate whether there is consensus among spine surgeons regarding the use and appreciation of prognostic tests for lumbar spinal fusion; 2) to verify whether a thoracolumbosacral orthosisis (TLSO) truly minimises lumbosacral motion; 3) to verify whether a TLSO can predict the clinical outcome of fusion for CLBP; 4) to assess whether provocative discography of adjacent segments actually predicts the long-term clinical outcome fusion; 5) to determine the incidence of postdiscography discitis, and whether there is a need for routine antibiotic prophylaxis; 6) to assess whether temporary external transpedicular fixation (TETF) can help to predict the outcome of spinal fusion; 7) to determine the prognostic accuracy of the most commonly used tests in clinical practice to predict the outcome of fusion for CLBP. The results of a national survey among spine surgeons in the Netherlands were presented in Study I. The surgeons were questioned about their opinion on prognostic factors and about the use of predictive tests for lumbar fusion in CLBP patients. The comments were compared with findings from the prevailing literature. The survey revealed a considerable lack of uniformity in the use and appreciation of predictive tests. Prognostic factors known from the literature were not consistently incorporated in the surgeons' decision making process either. This heterogeneity in strategy is most probably caused by the lack of sound scientific evidence for current predictive tests and it was concluded that currently there is not enough consensus among spine surgeons in the Netherlands to create national guidelines for surgical decision making in CLBP. In Study II, the hypothesized working mechanism of a pantaloon cast (i.e., minimisation of lumbosacral joint mobility) was studied. In patients who were admitted for a temporary external transpedicular fixation test (TETF), infrared light markers were rigidly attached to the protruding ends of Steinman pins that were fixed in two spinal levels. In this way three-dimensional motion between these levels could be analysed opto-electronically. During dynamic test conditions such as walking, a plaster cast, either with or without unilateral hip fixation, did not significantly decrease lumbosacral joint motion. Although not substantiated by sound scientific support, lumbosacral orthoses or pantaloon casts are often used in everyday practice as a predictor for the outcome of fusion. A systematic review of the literature supplemented with a prospec

  19. Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

    PubMed Central

    Hashemi, Seyed Masoud; Aryani, Mohamad Reza; Momenzadeh, Sirus; Razavi, Seyed Sajad; Mohseni, Gholamreza; Mohajerani, Seyed Amir; Esmilijah, Ali Akbar

    2015-01-01

    Background: Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF. Objectives: This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain. Patients and Methods: This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0 - 10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI). Results: Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67?90.5%) of patients in PIL group and 74.2% (95% CI: 62.4 - 89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients. Conclusions: The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration. PMID:26587400

  20. Spinal Cord Stimulation and Augmentative Control Strategies for Leg Movement after Spinal Paralysis in Humans.

    PubMed

    Minassian, Karen; Hofstoetter, Ursula S

    2016-04-01

    Severe spinal cord injury is a devastating condition, tearing apart long white matter tracts and causing paralysis and disability of body functions below the lesion. But caudal to most injuries, the majority of neurons forming the distributed propriospinal system, the localized gray matter spinal interneuronal circuitry, and spinal motoneuron populations are spared. Epidural spinal cord stimulation can gain access to this neural circuitry. This review focuses on the capability of the human lumbar spinal cord to generate stereotyped motor output underlying standing and stepping, as well as full weight-bearing standing and rhythmic muscle activation during assisted treadmill stepping in paralyzed individuals in response to spinal cord stimulation. By enhancing the excitability state of the spinal circuitry, the stimulation can have an enabling effect upon otherwise "silent" translesional volitional motor control. Strategies for achieving functional movement in patients with severe injuries based on minimal translesional intentional control, task-specific proprioceptive feedback, and next-generation spinal cord stimulation systems will be reviewed. The role of spinal cord stimulation can go well beyond the immediate generation of motor output. With recently developed training paradigms, it can become a major rehabilitation approach in spinal cord injury for augmenting and steering trans- and sublesional plasticity for lasting therapeutic benefits. PMID:26890324

  1. The Zarit Caregiver Burden Interview Short Form (ZBI-12) in spouses of Veterans with Chronic Spinal Cord Injury, Validity and Reliability of the Persian Version

    PubMed Central

    Rajabi-Mashhadi, Mohammad T; Mashhadinejad, Hosein; Ebrahimzadeh, Mohammad H; Golhasani-Keshtan, Farideh; Ebrahimi, Hanieh; Zarei, Zahra

    2015-01-01

    Background: To test the psychometric properties of the Persian version of Zarit Burden Interview (ZBI-12) in the Iranian population. Methods: After translating and cultural adaptation of the questionnaire into Persian, 100 caregiver spouses of Iran- Iraq war (1980-88) veterans with chronic spinal cord injury who live in the city of Mashhad, Iran, invited to participate in the study. The Persian version of ZBI-12 accompanied with the Persian SF-36 was completed by the caregivers to test validity of the Persian ZBI-12.A Pearson`s correlation coefficient was calculated for validity testing. In order to assess reliability of the Persian ZBI-12, we administered the ZBI-12 randomly in 48 caregiver spouses again 3 days later. Results: Generally, the internal consistency of the questionnaire was found to be strong (Cronbach's alpha 0.77). Intercorrelation matrix between the different domains of ZBI-12 at test-retest was 0.78. The results revealed that majority of questions the Persian ZBI_12 have a significant correlation to each other. In terms of validity, our results showed that there is significant correlations between some domains of the Persian version the Short Form Health Survey -36 with the Persian Zarit Burden Interview such as Q1 with Role Physical (P=0.03),General Health (P=0.034),Social Functional (0.037), Mental Health (0.023) and Q3 with Physical Function (P=0.001),Viltality (0.002), Socil Function (0.001). Conclusions: Our findings suggest that the Zarit Burden Interview Persian version is both a valid and reliable instrument for measuring the burden of caregivers of individuals with chronic spinal cord injury. PMID:25692171

  2. Spinal cord stimulation reduces mechanical hyperalgesia and glial cell activation in animals with neuropathic pain

    PubMed Central

    Sato, Karina L.; Johanek, Lisa M.; Sanada, Luciana S.; Sluka, Kathleen A.

    2015-01-01

    Spinal cord stimulation (SCS) is used to manage chronic intractable neuropathic pain. We examined parameters of SCS in rats with spared nerve injury by modulating frequency (4Hz vs. 60Hz), duration (30m vs. 6h), or intensity (50%, 75%, or 90% MT). To elucidate potential mechanisms modulated by SCS, we examined immunoreactivity glial markers in the spinal cord after SCS). An epidural SCS lead was implanted in the upper lumbar spinal cord. Animals were tested for mechanical withdrawal threshold (MWT) of the paw before and 2 weeks after SNI, before and after SCS daily for 4 days, and for 9 days after SCS. Seperate groups of animals were tested for glial immunoreactivity after 4 days of 6h SCS. All rats showed a decrease in MWT 2 weeks after nerve injury and an increase in glial activation. For frequency, 4Hz or 60Hz SCS reversed the MWT when compared to sham SCS. For duration, 6h of SCS showed a greater reduction in MWT when compared to 30 min. For intensity, 90% MT was greater than 75% MT and both were greater than 50% MT or sham SCS. SCS decreased glial activation (GFAP, MCP-1 and OX-42) in the spinal cord dorsal horn when compared to sham. In conclusion, 4Hz and 60Hz SCS for a 6h at 90% MT were the most effective parameters for reducing hyperalgesia, suggesting parameters of stimulation are important for effectiveness of SCS. SCS reduced glial activation at the level of the spinal cord suggesting reduction in central excitability. PMID:24361846

  3. Systemic effects of epidural methylprednisolone injection on glucose tolerance in diabetic patients

    PubMed Central

    2011-01-01

    Background Several studies have shown that in diabetic patients, the glycemic profile was disturbed after intra-articular injection of corticosteroids. Little is known about the impact of epidural injection in such patients. The goal of this study was double, at first comparing the glycaemic profile in diabetic patients after a unique injection of 80 mg of acetate methylprednisolone either intra-articular or epidural and secondly to compare the amount of systemic diffusion of the drug after both procedures. Methods Seventeen patients were included. Glycemic changes were compared in 9 diabetic patients following intra-articular (4 patients) and epidural injections (5 patients). Epidural injections were performed using the sacral route under fluoroscopic control in patients with lumbar spinal stenosis. Diabetes control had to stable for more than 10 days and the renal function to be preserved. Blood glucose was monitored using a validated continuous measuring device (GMS, Medtronic) the day before and for two days following the injection. Results were expressed in the form of daily glycemic profiles and as by mean, peak and minimal values +/- SD. The urinary excretion of methylprednisolone after the 2 routes of injection was analyzed in 8 patients (4 in each group). Urine samples were cropped one hour before the injections, then 4 times during the first day and 3 times a week for 2 weeks. The measurements included the free and conjugated fraction Results The glycaemic profile remains unchanged with no significant changes in the group of the 5 diabetic patients receiving epidural injections. On the other end, the average peak and and mean values were enhanced up to 3 mmol/l above baseline two days after the infiltration in the groups of the 4 diabetic patients infiltrated intra-articular. The mean urinary excretion of the steroid was about ten times higher in the intra-articular versus epidural group: 7000 ng/ml versus 700 ng/ml. Looking at each individual there were marked differences especially after intra-articular injections. Conclusion This is the first study to show that a single epidural steroid injection of 80 mg depot methylprednisolone had no effect on the glycemic control in diabetic patients. The absence of glycemic control changes correlated well with the very low urinary excretion of the drug after epidural injection. Trial registration NCT01420497 PMID:22185681

  4. Spontaneously Resolved Recurrent Cervical Epidural Hematoma in a 37-Week Primigravida.

    PubMed

    Iwatsuki, Katsuyuki; Deguchi, Masao; Hirata, Hitoshi; Kanamono, Toshihisa

    2015-10-01

    Study Design Case report. Objective To describe a patient with a recurrent spontaneous spinal epidural hematoma (SSEH) during pregnancy that had spontaneous remission. Methods A 27-year-old primigravida at 37 weeks' gestation suddenly felt a strong left shoulder pain without any trauma. She had a history of fenestration for a spontaneous cervical hematoma when she was 18 years old. An emergency magnetic resonance imaging revealed a recurrence of the cervical epidural hematoma at the C4-T1 level, but she had no paralysis. Results The patient subsequently underwent a cesarean section and delivered a healthy male infant. Her spinal epidural hematoma disappeared. Multislice computed tomography showed no evidence for a vascular malformation or tumor. Three years after the initial cesarean section, she underwent a second one and delivered another male infant. Conclusions We report on a rare case of recurrent SSEH during pregnancy with no neurologic deficits that was treated nonoperatively with close observation and resulted in spontaneous resolution. In such patients with no neurologic deficits, nonoperative management with close observation may be a reasonable alternative. PMID:26430600

  5. Lumbar vertebral hemangioma mimicking lateral spinal canal stenosis: case report and review of literature.

    PubMed

    Syrimpeis, Vasileios; Vitsas, Vasileios; Korovessis, Panagiotis

    2014-03-01

    Context Hemangiomas are the commonest benign tumors of the spine. Most occur in the thoracolumbar spine and the majority are asymptomatic. Rarely, hemangiomas cause symptoms through epidural expansion of the involved vertebra, resulting in spinal canal stenosis, spontaneous epidural hemorrhage, and pathological burst fracture. Findings We report a rare case of a 73-year-old woman, who had been treated for two months for degenerative neurogenic claudication. On admission, magnetic resonance imaging and computed tomographic scans revealed a hemangioma of the third lumbar vertebra protruding to the epidural space producing lateral spinal stenosis and ipsilateral nerve root compression. The patient underwent successful right hemilaminectomy for decompression of the nerve root, balloon kyphoplasty with poly-methyl methacrylate (PMMA) and pedicle screw segmental stabilization. Postoperative course was uneventful. Conclusion In the elderly, this rare presentation of spinal stenosis due to hemangiomas may be encountered. Decompression and vertebral augmentation by means balloon kyphoplasty with PMMA plus segmental pedicle screw fixation is recommended. PMID:24090267

  6. Cost analysis related to dose-response of spinal manipulative therapy for chronic low back pain: outcomes from a randomized controlled trial

    PubMed Central

    Vavrek, Darcy A; Sharma, Rajiv; Haas, Mitchell

    2014-01-01

    Objective The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP). Methods We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits over 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year following study enrollment were estimated using patient reports of healthcare utilization and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data. Results Lost productivity accounts for a majority of societal costs of chronic LBP. Cost of treatment and lost productivity ranged from $3398 for 12 SMT sessions to $3815 for 0 SMT sessions with no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age (P=0.03), greater disability (P=0.01), lower QALY scores (P=0.01), and higher costs in the period preceding enrollment (P<0.01). Pain-free and disability-free days were greater for all SMT doses compared to control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days (P=0.03) and 19.8 disability-free days (P=0.04). No statistically significant group differences in QALYs were noted. Conclusions A dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity. PMID:24928639

  7. A Systematic Review of Experimental Strategies Aimed at Improving Motor Function after Acute and Chronic Spinal Cord Injury.

    PubMed

    Gomes-Osman, Joyce; Cortes, Mar; Guest, James; Pascual-Leone, Alvaro

    2016-03-01

    While various approaches have been proposed in clinical trials aimed at improving motor function after spinal cord injury in humans, there is still limited information regarding the scope, methodological quality, and evidence associated with single-intervention and multi-intervention approaches. A systematic review performed using the PubMed search engine and the key words "spinal cord injury motor recovery" identified 1973 records, of which 39 were selected (18 from the search records and 21 from reference list inspection). Study phase ( clinicaltrials.org criteria) and methodological quality (Cochrane criteria) were assessed. Studies included proposed a broad range of single-intervention (encompassing cell therapies, pharmacology, electrical stimulation, rehabilitation) (encompassing cell therapies, pharmacology, electrical stimulation, rehabilitation) and multi-intervention approaches (that combined more than one strategy). The highest evidence level was for Phase III studies supporting the role of multi-intervention approaches that contained a rehabilitation component. Quality appraisal revealed that the percentage of selected studies classified with high risk of bias by Cochrane criteria was as follows: random sequence generation = 64%; allocation concealment = 77%; blinding of participants and personnel = 69%; blinding of outcome assessment = 64%; attrition = 44%; selective reporting = 44%. The current literature contains a high proportion of studies with a limited ability to measure efficacy in a valid manner because of low methodological strength in all items of the Cochrane risk of bias assessment. Recommendations to decrease bias are discussed and include increased methodological rigor in the study design and recruitment of study participants, and the use of electrophysiological and imaging measures that can assess functional integrity of the spinal cord (and may be sufficiently sensitive to detect changes that occur in response to therapeutic interventions). PMID:26415105

  8. Randomized trial demonstrates that extended-release epidural morphine may provide safe pain control for lumbar surgery patients

    PubMed Central

    Offley, Sarah C.; Coyne, Ellen; Horodyski, MaryBeth; Rubery, Paul T.; Zeidman, Seth M; Rechtine, Glenn R.

    2013-01-01

    Background: Safe and effective postoperative pain control remains an issue in complex spine surgery. Spinal narcotics have been used for decades but have not become commonplace because of safety or re-dosing concerns. An extended release epidural morphine (EREM) preparation has been used successfully in obstetric, abdominal, thoracic, and extremity surgery done with epidural anesthesia. This has not been studied in open spinal surgery. Methods: Ninety-eight patients having complex posterior lumbar surgery were enrolled in a partially randomized clinical trial (PRCT) of low to moderate doses of EREM. Surgery included levels from L3 to S1 with procedures involving combinations of decompression, instrumented arthrodesis, and interbody grafting. The patients were randomized to receive either 10 or 15 mg of EREM through an epidural catheter placed under direct vision at the conclusion of surgery. Multiple safety measures were employed to prevent or detect respiratory depression. Postoperative pain scores, narcotic utilization, and adverse events were recorded. Results: There were no significant differences between the two groups as to supplemental narcotic requirements, pain scores, or adverse events. There were no cases of respiratory depression. The epidural narcotic effect persisted from 3 to 36 hours after the injection. Conclusion: By utilizing appropriate safety measures, EREM can be used safely for postoperative pain control in lumbar surgery patients. As there was no apparent advantage to the use of 15 mg, the lower 10 mg dose should be used. PMID:23646274

  9. Intraoperative neurophysiological monitoring in spinal surgery.

    PubMed

    Park, Jong-Hwa; Hyun, Seung-Jae

    2015-09-16

    Recently, many surgeons have been using intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials (MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome. PMID:26380823

  10. Intraoperative neurophysiological monitoring in spinal surgery

    PubMed Central

    Park, Jong-Hwa; Hyun, Seung-Jae

    2015-01-01

    Recently, many surgeons have been using intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials (MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome. PMID:26380823

  11. Mechanisms Underlying the Neuromodulation of Spinal Circuits for Correcting Gait and Balance Deficits after Spinal Cord Injury.

    PubMed

    Moraud, Eduardo Martin; Capogrosso, Marco; Formento, Emanuele; Wenger, Nikolaus; DiGiovanna, Jack; Courtine, Grgoire; Micera, Silvestro

    2016-02-17

    Epidural electrical stimulation of lumbar segments facilitates standing and walking in animal models and humans with spinal cord injury. However, the mechanisms through which this neuromodulation therapy engages spinal circuits remain enigmatic. Using computer simulations and behavioral experiments, we provide evidence that epidural electrical stimulation interacts with muscle spindle feedback circuits to modulate muscle activity during locomotion. Hypothesis-driven strategies emerging from simulations steered the design of stimulation protocols that adjust bilateral hindlimb kinematics throughout gait execution. These stimulation strategies corrected subject-specific gait and balance deficits in rats with incomplete and complete spinal cord injury. The conservation of muscle spindle feedback circuits across mammals suggests that the same mechanisms may facilitate motor control in humans. These results provide a conceptual framework to improve stimulation protocols for clinical applications. PMID:26853304

  12. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries

    PubMed Central

    Khetarpal, Ranjana; Bali, Kusum; Chatrath, Veena; Bansal, Divya

    2016-01-01

    The aim of this study was to review the various anesthetic options which can be considered for laparoscopic surgeries in the patients with the chronic obstructive pulmonary disease. The literature search was performed in the Google, PubMed, and Medscape using key words “analgesia, anesthesia, general, laparoscopy, lung diseases, obstructive.” More than thirty-five free full articles and books published from the year 1994 to 2014 were retrieved and studied. Retrospective data observed from various studies and case reports showed regional anesthesia (RA) to be valid and safer option in the patients who are not good candidates of general anesthesia like patients having obstructive pulmonary diseases. It showed better postoperative patient outcome with respect to safety, efficacy, postoperative pulmonary complications, and analgesia. So depending upon disease severity RA in various forms such as spinal anesthesia, paravertebral block, continuous epidural anesthesia, combined spinal epidural anesthesia (CSEA), and CSEA with bi-level positive airway pressure should be considered. PMID:26957682

  13. Spinal nerve root stimulation.

    PubMed

    Kellner, Christopher P; Kellner, Michael A; Winfree, Christopher J

    2011-01-01

    Spinal nerve root stimulation (SNRS) is a neuromodulation technique that is used to treat chronic pain. This modality places stimulator electrode array(s) along the spinal nerve roots, creating stimulation paresthesias within the distribution of the target nerve root(s), thereby treating pain in that same distribution. There are several different forms of spinal nerve root stimulation, depending upon the exact electrode positioning along the nerve roots. SNRS combines the minimally invasive nature, central location, and ease of placement of spinal cord stimulation with the focal targeting of stimulation paresthesias of peripheral nerve stimulation. This hybrid technique may be an effective alternative for patients in whom other forms of neurostimulation are either ineffective or inappropriate. PMID:21422788

  14. The Usefulness of Spinal Cord Stimulation for Chronic Pain Due to Combined Vasospastic Prinzmetal Angina and Diabetic Neuropathic Pain of the Lower Limbs.

    PubMed

    Kinfe, Thomas M; Pintea, Bogdan

    2016-03-01

    Objective?To describe an unusual case of combined neuropathic and ischemia-induced chronic pain in a patient who was treated with one high thoracic paddle lead. Background?To the best of our knowledge, the use of spinal cord stimulation (SCS) utilizing a single lead as a treatment strategy for combined Prinzmetal angina, a cardiac ischemia-induced disturbance of nociceptive perception, and diabetic neuropathy of the lower limbs has rarely been described. Case Report?The underlying pain conditions and SCS technique used to treat both types of pain-Prinzmetal angina and lower-limb diabetic neuropathy-in a 73-year-old patient experiencing medical or interventional refractory complex pain syndrome are described. The SCS electrode was placed in the anatomical midline with a T2- to T3-level laminotomy and externalized for postoperative trial stimulation with systemic antibiotic administration. Results?After 8 months, stable pain control was achieved. No complications occurred. Conclusion?We present a chronic pain syndrome due to combined Prinzmetal angina and diabetic neuropathy of the lower limbs with sustained pain relief utilizing a single SCS lead. PMID:26238940

  15. Postoperative Epidural Hematomas in the Lumbar Spine.

    PubMed

    Schroeder, Gregory D; Kurd, Mark F; Kepler, Christopher K; Arnold, Paul M; Vaccaro, Alexander R

    2015-11-01

    Postoperative epidural hematomas are rare complications following lumbar spine surgery, but if they are not quickly identified and treated they can lead to permanent neurological deficits. Epidural hematomas occur in approximately 0.10%-0.24% of all spine surgeries, and despite the fact that multiple large studies have been performed attempting to identify risk factors for this complication, there is still significant debate about the effect of subfascial drains, postoperative anticoagulation, and antiplatelet medication on the incidence of postoperative hematoma. The purpose of this manuscript is to review the epidemiology, etiology, diagnosis, and treatment of patients who develop a postoperative lumbar epidural hematoma. PMID:26484502

  16. Cervical myelopathy due to chronic overshunting in a pediatric patient: case report and review of the literature.

    PubMed

    Ulrich, Nils Harry-Bert; Maier, Matthias; Bernays, Rene-Ludwig; Krayenbuhl, Niklaus; Kollias, Spyros

    2013-01-01

    We present a rare cause of cervical myelopathy produced by an engorged suboccipital epidural venous plexus due to chronic cerebrospinal fluid (CSF) overdrainage. A 17-year-old boy with obstructive hydrocephalus due to a retrocerebellar cyst and secondary implantation of a ventricloperitoneal shunt (VP-shunt) presented with progressive spastic tetraparesis. MRI imaging revealed myelopathy due to significant compression of the cervical spinal cord by engorged epidural veins. Further assessment at a low-pressure setting revealed a broken shunt valve. The VP-shunt valve was changed with an additional anti-siphon device leading to a gradual increase of the intracranial pressure (ICP). After intensive physiotherapy, the patient showed slight clinical improvement. Follow-up imaging within nine days showed distinct regression of the dilated venous plexus at the cranial-cervical junction (CCJ) with the resolution of cord compression. Engorgement of the epidural venous plexus should always be considered in the differential diagnosis of myelopathy in long-term shunt patients even when classical clinical and radiological signs of overshunting are missing. PMID:23756987

  17. The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature

    PubMed Central

    Epstein, Nancy E.

    2013-01-01

    Background: Multiple type of spinal injections, whether epidural/translaminar or transforaminal, facet injections, are offered to patients with/without surgical spinal lesions by pain management specialists (radiologists, physiatrists, and anesthesiologists). Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications. Methods: For many patients with spinal pain alone and no surgical lesions, the success of epidural injections may simply reflect the self-limited course of the disease. Alternatively, although those with surgical pathology may experience transient or no pain relief, undergoing these injections (typically administered in a series of three) unnecessarily exposes them to the inherent risks, while also delaying surgery and potentially exposing them to more severe/permanent neurological deficits. Results: Multiple recent reports cite contaminated epidural steroid injections resulting in meningitis, stroke, paralysis, and death. The Center for Disease Control (CDC) specifically identified 25 deaths (many due to Aspergillosis), 337 patients sickened, and 14,000 exposed to contaminated steroids. Nevertheless, many other patients develop other complications that go unreported/underreported: Other life-threatening infections, spinal fluid leaks (0.4-6%), positional headaches (28%), adhesive arachnoiditis (6-16%), hydrocephalus, air embolism, urinary retention, allergic reactions, intravascular injections (7.9-11.6%), stroke, blindness, neurological deficits/paralysis, hematomas, seizures, and death. Conclusions: Although the benefits for epidural steroid injections may include transient pain relief for those with/without surgical disease, the multitude of risks attributed to these injections outweighs the benefits. PMID:23646278

  18. Neuroendocrine and cardiac metabolic dysfunction and NLRP3 inflammasome activation in adipose tissue and pancreas following chronic spinal cord injury in the mouse.

    PubMed

    Bigford, Gregory E; Bracchi-Ricard, Valerie C; Keane, Robert W; Nash, Mark S; Bethea, John R

    2013-01-01

    CVD (cardiovascular disease) represents a leading cause of mortality in chronic SCI (spinal cord injury). Several component risk factors are observed in SCI; however, the underlying mechanisms that contribute to these risks have not been defined. Central and peripheral chronic inflammation is associated with metabolic dysfunction and CVD, including adipokine regulation of neuroendocrine and cardiac function and inflammatory processes initiated by the innate immune response. We use female C57 Bl/6 mice to examine neuroendocrine, cardiac, adipose and pancreatic signaling related to inflammation and metabolic dysfunction in response to experimentally induced chronic SCI. Using immuno-histochemical, -precipitation, and -blotting analysis, we show decreased POMC (proopiomelanocortin) and increased NPY (neuropeptide-Y) expression in the hypothalamic ARC (arcuate nucleus) and PVN (paraventricular nucleus), 1-month post-SCI. Long-form leptin receptor (Ob-Rb), JAK2 (Janus kinase)/STAT3 (signal transducer and activator of transcription 3)/p38 and RhoA/ROCK (Rho-associated kinase) signaling is significantly increased in the heart tissue post-SCI, and we observe the formation and activation of the NLRP3 (NOD-like receptor family, pyrin domain containing 3) inflammasome in VAT (visceral adipose tissue) and pancreas post-SCI. These data demonstrate neuroendocrine signaling peptide alterations, associated with central inflammation and metabolic dysfunction post-SCI, and provide evidence for the peripheral activation of signaling mechanisms involved in cardiac, VAT and pancreatic inflammation and metabolic dysfunction post-SCI. Further understanding of biological mechanisms contributing to SCI-related inflammatory processes and metabolic dysfunction associated with CVD pathology may help to direct therapeutic and rehabilitation countermeasures. PMID:23924318

  19. Neuroendocrine and cardiac metabolic dysfunction and NLRP3 inflammasome activation in adipose tissue and pancreas following chronic spinal cord injury in the mouse

    PubMed Central

    Bigford, Gregory E.; Bracchi-Ricard, Valerie C.; Keane, Robert W.; Nash, Mark S.; Bethea, John R.

    2013-01-01

    CVD (cardiovascular disease) represents a leading cause of mortality in chronic SCI (spinal cord injury). Several component risk factors are observed in SCI; however, the underlying mechanisms that contribute to these risks have not been defined. Central and peripheral chronic inflammation is associated with metabolic dysfunction and CVD, including adipokine regulation of neuroendocrine and cardiac function and inflammatory processes initiated by the innate immune response. We use female C57 Bl/6 mice to examine neuroendocrine, cardiac, adipose and pancreatic signaling related to inflammation and metabolic dysfunction in response to experimentally induced chronic SCI. Using immuno-histochemical, -precipitation, and -blotting analysis, we show decreased POMC (proopiomelanocortin) and increased NPY (neuropeptide-Y) expression in the hypothalamic ARC (arcuate nucleus) and PVN (paraventricular nucleus), 1-month post-SCI. Long-form leptin receptor (Ob-Rb), JAK2 (Janus kinase)/STAT3 (signal transducer and activator of transcription 3)/p38 and RhoA/ROCK (Rho-associated kinase) signaling is significantly increased in the heart tissue post-SCI, and we observe the formation and activation of the NLRP3 (NOD-like receptor family, pyrin domain containing 3) inflammasome in VAT (visceral adipose tissue) and pancreas post-SCI. These data demonstrate neuroendocrine signaling peptide alterations, associated with central inflammation and metabolic dysfunction post-SCI, and provide evidence for the peripheral activation of signaling mechanisms involved in cardiac, VAT and pancreatic inflammation and metabolic dysfunction post-SCI. Further understanding of biological mechanisms contributing to SCI-related inflammatory processes and metabolic dysfunction associated with CVD pathology may help to direct therapeutic and rehabilitation countermeasures. PMID:23924318

  20. Endovascular treatment of chronic cerebro spinal venous insufficiency in patients with multiple sclerosis modifies circulating markers of endothelial dysfunction and coagulation activation: a prospective study.

    PubMed

    Napolitano, Mariasanta; Bruno, Aldo; Mastrangelo, Diego; De Vizia, Marcella; Bernardo, Benedetto; Rosa, Buonagura; De Lucia, Domenico

    2014-10-01

    We performed a monocentric observational prospective study to evaluate coagulation activation and endothelial dysfunction parameters in patients with multiple sclerosis undergoing endovascular treatment for cerebro-spinal-venous insufficiency. Between February 2011 and July 2012, 144 endovascular procedures in 110 patients with multiple sclerosis and chronical cerebro-spinal venous insufficiency were performed and they were prospectively analyzed. Each patient was included in the study according to previously published criteria, assessed by the investigators before enrollment. Endothelial dysfunction and coagulation activation parameters were determined before the procedure and during follow-up at 1, 3, 6, 9, 12, 15 and 18 months after treatment, respectively. After the endovascular procedure, patients were treated with standard therapies, with the addition of mesoglycan. Fifty-five percent of patients experienced a favorable outcome of multiple sclerosis within 1 month after treatment, 25% regressed in the following 3 months, 24.9% did not experience any benefit. In only 0.1% patients, acute recurrence was observed and it was treated with high-dose immunosuppressive therapy. No major complications were observed. Coagulation activation and endothelial dysfunction parameters were shown to be reduced at 1 month and stable up to 12-month follow-up, and they were furthermore associated with a good clinical outcome. Endovascular procedures performed by a qualified staff are well tolerated; they can be associated with other currently adopted treatments. Correlations between inflammation, coagulation activation and neurodegenerative disorders are here supported by the observed variations in plasma levels of markers of coagulation activation and endothelial dysfunction. PMID:24806325

  1. Tyrosine Phosphorylation of Kir3.1 in Spinal Cord Is Induced by Acute Inflammation, Chronic Neuropathic Pain, and Behavioral Stress*

    PubMed Central

    Ippolito, Danielle L.; Xu, Mei; Bruchas, Michael R.; Wickman, Kevin; Chavkin, Charles

    2008-01-01

    Tyrosine phosphorylation is an important means of regulating ion channel function. Our previous gene expression studies using the Xenopus laevis oocyte system suggested that tyrosine phosphorylation of G-protein-gated inwardly rectifying potassium channels (Kir3 or GIRK) suppressed basal channel conductance and accelerated channel deactivation. To assess whether similar mechanisms regulate Kir3 function in mammalian cells, we developed and characterized a phosphoselective antibody recognizing Kir3.1 phosphorylated at tyrosine 12 in the N-terminal domain and then probed for evidence of Kir3.1 phosphorylation in cultured mammalian cells and spinal cord. The antibody was found to discriminate between the phospho-Tyr12 of Kir3.1 and the native state in transfected cell lines and in primary cultures of mouse atria. Following either mouse hindpaw formalin injection or sciatic nerve ligation, pY12-Kir3.1 immunoreactivity was enhanced unilaterally in the superficial layers of the spinal cord dorsal horn, regions previously described as expressing Kir3.1 channels. Mice lacking Kir3.1 following targeted gene disruption did not show specific pY12-Kir3.1 immunoreactivity after sciatic nerve ligation. Further, mice exposed to repeatedly forced swim stress showed bilateral enhancement in pY12-Kir3.1 in the dorsal horn. This study provides evidence that Kir3 tyrosine phosphorylation occurred during acute and chronic inflammatory pain and under behavioral stress. The reduction in Kir3 channel activity is predicted to enhance neuronal excitability under physiologically relevant conditions and may mediate a component of the adaptive physiological response. PMID:16223722

  2. Tyrosine phosphorylation of K(ir)3.1 in spinal cord is induced by acute inflammation, chronic neuropathic pain, and behavioral stress.

    PubMed

    Ippolito, Danielle L; Xu, Mei; Bruchas, Michael R; Wickman, Kevin; Chavkin, Charles

    2005-12-16

    Tyrosine phosphorylation is an important means of regulating ion channel function. Our previous gene expression studies using the Xenopus laevis oocyte system suggested that tyrosine phosphorylation of G-protein-gated inwardly rectifying potassium channels (K(ir)3 or GIRK) suppressed basal channel conductance and accelerated channel deactivation. To assess whether similar mechanisms regulate K(ir)3 function in mammalian cells, we developed and characterized a phosphoselective antibody recognizing K(ir)3.1 phosphorylated at tyrosine 12 in the N-terminal domain and then probed for evidence of K(ir)3.1 phosphorylation in cultured mammalian cells and spinal cord. The antibody was found to discriminate between the phospho-Tyr(12) of K(ir)3.1 and the native state in transfected cell lines and in primary cultures of mouse atria. Following either mouse hindpaw formalin injection or sciatic nerve ligation, pY12-K(ir)3.1 immunoreactivity was enhanced unilaterally in the superficial layers of the spinal cord dorsal horn, regions previously described as expressing K(ir)3.1 channels. Mice lacking K 3.1 following targeted gene disruption did not show specific pY12-K(ir)3.1 immunoreactivity after sciatic nerve ligation. Further, mice exposed to repeatedly forced swim stress showed bilateral enhancement in pY12-K(ir)3.1 in the dorsal horn. This study provides evidence that K(ir)3 tyrosine phosphorylation occurred during acute and chronic inflammatory pain and under behavioral stress. The reduction in K(ir)3 channel activity is predicted to enhance neuronal excitability under physiologically relevant conditions and may mediate a component of the adaptive physiological response. PMID:16223722

  3. Plasticity of non-adrenergic non-cholinergic bladder contractions in rats after chronic spinal cord injury

    PubMed Central

    Lai, H. Henry; Munoz, Alvaro; Smith, Christopher P.; Boone, Timothy B.; Somogyi, George T.

    2011-01-01

    The purpose of this study was to examine the pharmacologic plasticity of cholinergic, non-adrenergic non-cholinergic (NANC), and purinergic contractions in neurogenic bladder strips from spinal cord injured (SCI) rats. Bladder strips were harvested from female rats three to four weeks after T9–T10 spinal cord transection. The strips were electrically stimulated using two experimental protocols to compare the contribution of muscarinic and NANC/purinergic contractions in the presence and the absence of carbachol or muscarine. The endpoints of the study were: (1) percent NANC contraction that was unmasked by the muscarinic antagonist 4-DAMP, and (2) P2X purinergic contraction that was evoked by α,β–methylene ATP. NANC contraction accounted for 78.5% of the neurally evoked contraction in SCI bladders. When SCI bladder strips were treated with carbachol (10 µM) prior to 4-DAMP (500 nM), the percent NANC contraction decreased dramatically to only 13.1% of the neurally evoked contraction (p=0.041). This was accompanied by a substantial decrease in α,β–methylene ATP evoked P2X contraction, and desensitization of purinergic receptors (the ratio of subsequent over initial P2X contraction decreased from 97.2% to 42.1%, p=0.0017). Sequential activation of the cholinergic receptors with carbachol (or with muscarine in neurally intact bladders) and unmasking of the NANC response with 4-DAMP switched the neurally evoked bladder contraction from predominantly NANC to predominantly cholinergic. We conclude that activation of muscarinic receptors (with carbachol or muscarine) blocks NANC and purinergic contractions in neurally intact or in SCI rat bladders. The carbachol-induced inhibition of the NANC contraction is expressed more in SCI bladders compared to neurally intact bladders. Along with receptor plasticity, this change in bladder function may involve P2X-independent mechanisms. PMID:21689735

  4. Plasticity of non-adrenergic non-cholinergic bladder contractions in rats after chronic spinal cord injury.

    PubMed

    Lai, H Henry; Munoz, Alvaro; Smith, Christopher P; Boone, Timothy B; Somogyi, George T

    2011-08-10

    The purpose of this study was to examine the pharmacologic plasticity of cholinergic, non-adrenergic non-cholinergic (NANC), and purinergic contractions in neurogenic bladder strips from spinal cord injured (SCI) rats. Bladder strips were harvested from female rats three to four weeks after T(9)-T(10) spinal cord transection. The strips were electrically stimulated using two experimental protocols to compare the contribution of muscarinic and NANC/purinergic contractions in the presence and the absence of carbachol or muscarine. The endpoints of the study were: (1) percent NANC contraction that was unmasked by the muscarinic antagonist 4-DAMP, and (2) P2X purinergic contraction that was evoked by α,β-methylene ATP. NANC contraction accounted for 78.5% of the neurally evoked contraction in SCI bladders. When SCI bladder strips were treated with carbachol (10 μM) prior to 4-DAMP (500 nM), the percent NANC contraction decreased dramatically to only 13.1% of the neurally evoked contraction (P=0.041). This was accompanied by a substantial decrease in α,β-methylene ATP evoked P2X contraction, and desensitization of purinergic receptors (the ratio of subsequent over initial P2X contraction decreased from 97.2% to 42.1%, P=0.0017). Sequential activation of the cholinergic receptors with carbachol (or with muscarine in neurally intact bladders) and unmasking of the NANC response with 4-DAMP switched the neurally evoked bladder contraction from predominantly NANC to predominantly cholinergic. We conclude that activation of muscarinic receptors (with carbachol or muscarine) blocks NANC and purinergic contractions in neurally intact or in SCI rat bladders. The carbachol-induced inhibition of the NANC contraction is expressed more in SCI bladders compared to neurally intact bladders. Along with receptor plasticity, this change in bladder function may involve P2X-independent mechanisms. PMID:21689735

  5. Bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells: Case series of 14 patients

    PubMed Central

    Amr, Sherif M.; Gouda, Ashraf; Koptan, Wael T.; Galal, Ahmad A.; Abdel-Fattah, Dina Sabry; Rashed, Laila A.; Atta, Hazem M.; Abdel-Aziz, Mohammad T.

    2014-01-01

    Objective To investigate the effect of bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells. Methods In 14 patients with chronic paraplegia caused by spinal cord injury, cord defects were grafted and stem cells injected into the whole construct and contained using a chitosan-laminin paste. Patients were evaluated using the International Standards for Classification of Spinal Cord Injuries. Results Chitosan disintegration leading to post-operative seroma formation was a complication. Motor level improved four levels in 2 cases and two levels in 12 cases. Sensory-level improved six levels in two cases, five levels in five cases, four levels in three cases, and three levels in four cases. A four-level neurological improvement was recorded in 2 cases and a two-level neurological improvement occurred in 12 cases. The American Spinal Impairment Association (ASIA) impairment scale improved from A to C in 12 cases and from A to B in 2 cases. Although motor power improvement was recorded in the abdominal muscles (2 grades), hip flexors (3 grades), hip adductors (3 grades), knee extensors (2–3 grades), ankle dorsiflexors (1–2 grades), long toe extensors (1–2 grades), and plantar flexors (0–2 grades), this improvement was too low to enable them to stand erect and hold their knees extended while walking unaided. Conclusion Mesenchymal stem cell-derived neural stem cell-like cell transplantation enhances recovery in chronic spinal cord injuries with defects bridged by sural nerve grafts combined with a chitosan-laminin scaffold. PMID:24090088

  6. Observational study of changes in epidural pressure and elastance during epidural blood patch in obstetric patients

    PubMed Central

    Pratt, S.D.; Kaczka, D.W.; Hess, PE

    2014-01-01

    Background During an epidural blood patch, we inject blood until the patient describes mild back pressure, often leading to injection of more than 20 mL of blood. We undertook this study to measure the epidural pressures generated during an epidural blood patch and to identify the impact of volume on epidural elastance in obstetric patients. Methods This study was performed in postpartum patients who presented for an epidural blood patch with symptoms consistent with a postdural puncture headache. After identification of the epidural space using loss of resistance to air or saline, we measured static epidural pressure after each 5-mL injection of blood. Models were then fitted to the data and the epidural elastance and compliance calculated. Results Eighteen blood patches were performed on 17 patients. The mean final volume injected was 18.9 7.8 mL [range 6 to 38 mL]. The mean final pressure generated was 13.1 13.4 mmHg [range 2 to 56 mmHg]. A curvilinear relationship existed between volume injected and pressure, which was described by two models: (1) pressure = 0.0254 (mL injected)2 + 0.0297 mL, or (2) pressure = 0.0679 mL1.742. The value for r2 was approximately 0.57 for both models. We found no correlation between the final pressure generated and the success of the EBP. Conclusions We found a curvilinear relationship between the volume of blood injected during an epidural blood patch and the pressure generated in the epidural space. However, there was a large variation in both the volume of blood and the epidural pressure generated. The clinical importance of this finding is not known. A larger study would be required to demonstrate whether pressure is a predictor of success. PMID:24631062

  7. Bilateral Acute Epidural Hematoma with Good Outcome

    PubMed Central

    Paiva, Wellingson Silva; Andrade, Almir Ferreira De; Alves, Aderaldo Costa Junior; Ribeiro, Iuri Neville; Teixeira, Manoel Jacobsen

    2013-01-01

    Epidural haematomas are one of the most common complicated closed-head injuries, but they, rarely show any bilateral localization. We are reporting here a case of a man found unconscious with Glasgow Coma Scale score; 8/15. Computed tomography of skull revealed bilateral epidural hematoma. Two emergency craniotomies were performed simultaneously, with satisfactory radiological control and neurological outcome. We discussed the aspects of a etiology and treatment about this unusual condition. PMID:24392414

  8. Spontaneous intracranial hypotension from calcified thoracic disc protrusions causing CSF leak successfully treated with targeted epidural blood patch.

    PubMed

    Allmendinger, Andrew M; Lee, Thomas C

    2013-01-01

    Spontaneous spinal cerebrospinal fluid (CSF) leaks are increasingly recognized in patients presenting with orthostatic headache and ultimately diagnosed with intracranial hypotension. While the precise cause of these spontaneous leaks is unknown, it is thought to result from underlying weakness in the spinal meninges and may be associated with meningeal diverticula or Tarlov cysts. Rarely, calcified intervertebral discs or bony osteophytes can result in CSF leakage, which has been described in the surgery literature but not well recognized in the radiology literature. The authors present three cases of patients presenting with CSF leaks from calcified thoracic disc protrusions that were successfully treated with epidural blood patches. PMID:23395554

  9. Fibrin glue to treat spinal fluid leaks associated with intrathecal drug systems.

    PubMed

    Freeman, Eric D; Hoelzer, Bryan C; Eldrige, Jason S; Moeschler, Susan M

    2014-07-01

    Intrathecal drug delivery systems (IDDSs) are used to treat resistant pain states as well as intractable spasticity via medication delivery into the spinal fluid. Risks associated with implantation of these devices include infection, bleeding, intrathecal granuloma formation, and neurologic sequelae similar to other neuraxial procedures. Intrathecal catheter placement creates the additional risk of persistent spinal fluid leak, which can lead to postdural puncture headaches as well as seroma formation and may require subsequent surgical exploration or explantation. This retrospective case series examines 3 patients at a single institution with persistent spinal fluid leak after IDDS placement (and explantation in one case) resulting in headache and/or seroma formation that were treated with epidural fibrin glue. Three patients underwent IDDS implantation with baclofen for spasticity. In 1 patient, a cerebral spinal fluid leak developed at 1-week postoperatively. After several unsuccessful epidural blood patches and surgical exploration with a catheter revision, she was ultimately treated successfully with a fibrin glue patch. The second patient received an IDDS and did well until a seroma developed 1 year later. He was likewise treated with an epidural fibrin glue patch after 2 failed blood patches. In a third patient, a spinal fluid leak developed after explantation of an IDDS and was treated with an epidural fibrin glue patch as initial therapy. PMID:24256213

  10. Spinal infection: a case report

    PubMed Central

    Quesnele, Jairus; Dufton, John; Stern, Paula

    2012-01-01

    Objective: To present a case of a patient with spinal infection (SI) and highlight the chiropractors role in the prevention or minimization of devastating complications of SI. Background: Recent literature trends suggest an increasing prevalence of SI. Patients with SI most commonly present with unremitting progressive back pain and may or may not have fever or neurological signs. To avoid negative post-infection sequelae, establishing an early diagnosis and treatment is crucial. Clinical Features: A 29-year-old female diagnosed with L5-S1 disc herniation with impingement of the right S1 nerve root opted for surgical management. Iatrogenic bowel perforation during her spinal surgery resulted in contamination of the spinal surgical site, and findings in keeping with disco-osteomyelitis with epidural and paraspinal phlegmon formation were visualized on contrast enhanced MRI. Conclusion: Recent trends of increased spinal infection urge a heightened awareness by the chiropractor. The chiropractor can provide early diagnosis and supportive multidisciplinary care for such patients. PMID:22997471

  11. Intracortical and Thalamocortical Connections of the Hand and Face Representations in Somatosensory Area 3b of Macaque Monkeys and Effects of Chronic Spinal Cord Injuries.

    PubMed

    Chand, Prem; Jain, Neeraj

    2015-09-30

    Brains of adult monkeys with chronic lesions of dorsal columns of spinal cord at cervical levels undergo large-scale reorganization. Reorganization results in expansion of intact chin inputs, which reactivate neurons in the deafferented hand representation in the primary somatosensory cortex (area 3b), ventroposterior nucleus of the thalamus and cuneate nucleus of the brainstem. A likely contributing mechanism for this large-scale plasticity is sprouting of axons across the hand-face border. Here we determined whether such sprouting takes place in area 3b. We first determined the extent of intrinsic corticocortical connectivity between the hand and the face representations in normal area 3b. Small amounts of neuroanatomical tracers were injected in these representations close to the electrophysiologically determined hand-face border. Locations of the labeled neurons were mapped with respect to the detailed electrophysiological somatotopic maps and histologically determined hand-face border revealed in sections of the flattened cortex stained for myelin. Results show that intracortical projections across the hand-face border are few. In monkeys with chronic unilateral lesions of the dorsal columns and expanded chin representation, connections across the hand-face border were not different compared with normal monkeys. Thalamocortical connections from the hand and face representations in the ventroposterior nucleus to area 3b also remained unaltered after injury. The results show that sprouting of intrinsic connections in area 3b or the thalamocortical inputs does not contribute to large-scale cortical plasticity. Significance statement: Long-term injuries to dorsal spinal cord in adult primates result in large-scale somatotopic reorganization due to which chin inputs expand into the deafferented hand region. Reorganization takes place in multiple cortical areas, and thalamic and medullary nuclei. To what extent this brain reorganization due to dorsal column injuries is related to axonal sprouting is not known. Here we show that reorganization of primary somatosensory area 3b is not accompanied with either an increase in intrinsic cortical connections between the hand and face representations, or any change in thalamocortical inputs to these areas. Axonal sprouting that causes reorganization likely takes place at subthalamic levels. PMID:26424892

  12. Spinal Tuberculosis

    PubMed Central

    Ekinci, Safak; Tatar, Oner; Akpancar, Serkan; Bilgic, Serkan; Ersen, Omer

    2015-01-01

    Spinal tuberculosis (TB) is a significant form of TB, causing spinal deformity and paralysis. Early diagnosis and treatment are crucial for avoiding multivertebral destruction and are critical for improving outcomes in spinal TB. We believe that appropriate treatment method should be implemented at the early stage of this disease and that the Gulhane Askeri T?p Akademisi classification system can be considered a practical guide for spinal TB treatment planning in all countries. PMID:26609247

  13. Intrapartum epidural fixation methods: a randomised controlled trial of three different epidural catheter securement devices.

    PubMed

    Odor, P M; Bampoe, S; Hayward, J; Chis Ster, I; Evans, E

    2016-03-01

    This randomised controlled trial investigated the efficacy of Epi-Fix() , LockIt Plus() and Tegaderm() as fixation devices for intrapartum epidural catheters. One hundred and sixty-five women requesting intrapartum epidural analgesia were randomised to receive different fixation devices to secure their epidural catheter. The amount of epidural catheter migration (measured to the nearest 0.5 cm) was analysed for three devices: Epi-Fix (n = 55); LockIt Plus (n = 54); and Tegaderm dressing (n = 51). Median (IQR [range]) catheter migration for Epi-Fix was 1.0 cm (0.0-2.0 [-2.0 to 9.5]), vs 0.0 cm (0.0-0.5 [-1.0 to 5.5]) for LockIt Plus and 0.5 cm (0.0-1.8 [-1.5 to 8.0]) for Tegaderm (p = 0.003). Thirty-eight (69.1%) epidural catheters secured with Epi-Fix migrated < 2.0 cm, compared with 49 (90.7%) with LockIt Plus and 40 (78.4%) with Tegaderm. Sixteen epidural catheters required resiting due to failure of analgesia of which 12 (75.0%) occurred in patients with epidural catheters that had migrated ? 2.0 cm. This study shows that intrapartum epidural catheters secured with the LockIt Plus device exhibit less catheter migration compared with fixation with Epi-Fix and Tegaderm. PMID:26712088

  14. Spinal Myoclonus After Spinal Cord Injury

    PubMed Central

    Calancie, Blair

    2006-01-01

    Background/Objective: In the course of examining spinal motor function in many hundreds of people with traumatic spinal cord injury, we encountered 6 individuals who developed involuntary and rhythmic contractions in muscles of their legs. Although there are many reports of unusual muscle activation patterns associated with different forms of myoclonus, we believe that certain aspects of the patterns seen with these 6 subjects have not been previously reported. These patterns share many features with those associated with a spinal central pattern generator for walking. Methods: Subjects in this case series had a history of chronic injury to the cervical spinal cord, resulting in either complete (ASIA A; n = 4) or incomplete (ASIA D; n = 2) quadriplegia. We used multi-channel electromyography recordings of trunk and leg muscles of each subject to document muscle activation patterns associated with different postures and as influenced by a variety of sensory stimuli. Results: Involuntary contractions spanned multiple leg muscles bilaterally, sometimes including weak abdominal contractions. Contractions were smooth and graded and were highly reproducible in rate for a given subject (contraction rates were 0.30.5 Hz). These movements did not resemble the brief rapid contractions (ie, "jerks") ascribed to some forms of spinal myoclonus. For all subjects, the onset of involuntary muscle contraction was dependent upon hip angle; contractions did not occur unless the hips (and knees) were extended (ie, subjects were supine). In the 4 ASIA A subjects, contractions occurred simultaneously in all muscles (agonists and antagonists) bilaterally. In sharp contrast, contractions in the 2 ASIA D subjects were reciprocal between agonists and antagonists within a limb and alternated between limbs, such that movements in these 2 subjects looked just like repetitive stepping. Finally, each of the 6 subjects had a distinct pathology of their spinal cord, nerve roots, distal trunk, or thigh; in 4 of these subjects, treatment of the pathology eliminated the involuntary movements. Conclusion: The timing, distribution, and reliance upon hip angle suggest that these movement patterns reflect some elements of a central pattern generator for stepping. Emergence of these movements in persons with chronic spinal cord injury is extremely rare and appears to depend upon a combination of the more rostrally placed injury and a pathologic process leading to a further enhancement of excitability in the caudal spinal cord. PMID:17044393

  15. Spinal Stenosis

    MedlinePLUS

    ... and spinal cord. Afterwards, doctors often perform a spinal fusion to connect two or more vertebrae and better support for the spine. Several recent studies have found that surgery ... the tissue around the spinal cord; infection; and injury to the nerve root. ...

  16. A comparison of the behavioral and anatomical outcomes in sub-acute and chronic spinal cord injury models following treatment with human mesenchymal precursor cell transplantation and recombinant decorin.

    PubMed

    Hodgetts, Stuart I; Simmons, Paul J; Plant, Giles W

    2013-10-01

    This study assessed the potential of highly purified (Stro-1(+)) human mesenchymal precursor cells (hMPCs) in combination with the anti-scarring protein decorin to repair the injured spinal cord (SC). Donor hMPCs isolated from spinal cord injury (SCI) patients were transplanted into athymic rats as a suspension graft, alone or after previous treatment with, core (decorin(core)) and proteoglycan (decorin(pro)) isoforms of purified human recombinant decorin. Decorin was delivered via mini-osmotic pumps for 14 days following sub-acute (7 day) or chronic (1 month) SCI. hMPCs were delivered to the spinal cord at 3 weeks or 6 weeks after the initial injury at T9 level. Behavioral and anatomical analysis in this study showed statistically significant improvement in functional recovery, tissue sparing and cyst volume reduction following hMPC therapy. The combination of decorin infusion followed by hMPC therapy did not improve these measured outcomes over the use of cell therapy alone, in either sub-acute or chronic SCI regimes. However, decorin infusion did improve tissue sparing, reduce spinal tissue cavitation and increase transplanted cell survivability as compared to controls. Immunohistochemical analysis of spinal cord sections revealed differences in glial, neuronal and extracellular matrix molecule expression within each experimental group. hMPC transplanted spinal cords showed the increased presence of serotonergic (5-HT) and sensory (CGRP) axonal growth within and surrounding transplanted hMPCs for up to 2 months; however, no evidence of hMPC transdifferentiation into neuronal or glial phenotypes. The number of hMPCs was dramatically reduced overall, and no transplanted cells were detected at 8 weeks post-injection using lentiviral GFP labeling and human nuclear antigen antibody labeling. The presence of recombinant decorin in the cell transplantation regimes delayed in part the loss of donor cells, with small numbers remaining at 2 months after transplantation. In vitro co-culture experiments with embryonic dorsal root ganglion explants revealed the growth promoting properties of hMPCs. Decorin did not increase axonal outgrowth from that achieved by hMPCs. We provide evidence for the first time that (Stro-1(+)) hMPCs provide: i) an advantageous source of allografts for stem cell transplantation for sub-acute and chronic spinal cord therapy, and (ii) a positive host microenvironment that promotes tissue sparing/repair that subsequently improves behavioral outcomes after SCI. This was not measurably improved by recombinant decorin treatment, but does provide important information for the future development and potential use of decorin in contusive SCI therapy. PMID:23867131

  17. Chronic ibuprofen administration reduces neuropathic pain but does not exert neuroprotection after spinal cord injury in adult rats.

    PubMed

    Redondo-Castro, Elena; Navarro, Xavier

    2014-02-01

    Ibuprofen is commonly used as an anti-inflammatory analgesic drug, although it is not amongst the first-line treatments for neuropathic pain. Its main effects are mediated by non-specific inhibition of COX enzymes, but it also exerts some COX-independent effects, such as the inhibition of RhoA signaling and the modulation of glial activity. These effects have boosted the use of ibuprofen as a tool to promote axonal regeneration and to increase functional recovery after neural injuries, although with controversial results showing positive and negative outcomes of ibuprofen treatment in several experimental models. We have evaluated the effects of ibuprofen administered at 60 mg/kg twice a day to rats subjected to a mild spinal cord contusion. Our results indicate that ibuprofen ameliorates mechanical hyperalgesia in rats by reducing central hyperexcitability, but failed to produce improvements in the recovery of locomotion. Despite an early effect on reducing microglial reactivity, the ibuprofen treatment did not provide histological evidence of neuroprotection; indeed the volume of cord tissue spared rostral to the lesion was decreased in ibuprofen treated rats. In summary, the early modulation of neuroinflammation produced by the administration of ibuprofen seems to eventually lead to a worse resolution of detrimental events occurring in the secondary injury phase, but also to reduce the development of neuropathic pain. PMID:24246280

  18. A PARYLENE-BASED MICROELECTRODE ARRAY IMPLANT FOR SPINAL CORD STIMULATION IN RATS

    PubMed Central

    Nandra, Mandheerej. S.; Lavrov, Igor A.; Edgerton, V. Reggie; Tai, Yu-Chong

    2011-01-01

    The design and fabrication of an epidural spinal cord implant using a parylene-based microelectrode array is presented. Rats with hindlimb paralysis from a complete spinal cord transection were implanted with the device and studied for up to eight weeks, where we have demonstrated recovery of hindlimb stepping functionality through pulsed stimulation. The microelectrode array allows for a high degree of freedom and specificity in selecting the site of stimulation compared to wire-based implants, and triggers varied biological responses that can lead to an increased understanding of the spinal cord and locomotion recovery for victims of spinal cord injury. PMID:21841938

  19. Spinal cord injury pain.

    PubMed

    Saulino, Michael

    2014-05-01

    Chronic pain associated with traumatic spinal cord injury (SCI) can be quite challenging to the physiatrist. This highly prevalent condition within the SCI population requires an appropriate evaluative approach including a thorough history, a targeted physical examination, and appropriate use of diagnostic testing. The International Spinal Cord Injury Pain Classification allows for a reasonable categorization of the various pain syndromes and may assist in selecting a reasoned treatment strategy. A multitude of management approaches exist including nonpharmacologic, pharmacologic, and interventional approaches. This article provides an overview of the epidemiology, classification, evaluation, and management of SCI-associated pain. PMID:24787340

  20. Inclusion of Cocoa as a Dietary Supplement Represses Expression of Inflammatory Proteins in Spinal Trigeminal Nucleus in Response to Chronic Trigeminal Nerve Stimulation

    PubMed Central

    Cady, Ryan J.; Denson, Jennifer E.; Durham, Paul L.

    2013-01-01

    Scope Central sensitization is implicated in the pathology of temporomandibular joint disorder (TMD) and other types of orofacial pain. We investigated the effects of dietary cocoa on expression of proteins involved in the development of central sensitization in the spinal trigeminal nucleus (STN) in response to inflammatory stimulation of trigeminal nerves. Methods and results Male Sprague Dawley rats were fed either a control diet or an isocaloric diet consisting of 10% cocoa powder 14 days prior to bilateral injection of complete Freunds adjuvant (CFA) into the temporomandibular joint to promote prolonged activation of trigeminal ganglion neurons and glia. While dietary cocoa stimulated basal expression of GLAST and MKP-1 when compared to animals on a normal diet, cocoa suppressed basal calcitonin gene-related peptide levels in the STN. CFA-stimulated levels of protein kinase A, P2X3, P-p38, GFAP, and OX-42, whose elevated levels in the STN are implicated in central sensitization, were repressed to near control levels in animals on a cocoa enriched diet. Similarly, dietary cocoa repressed CFA-stimulated inflammatory cytokine expression. Conclusion Based on our findings, we speculate that cocoa enriched diets could be beneficial as a natural therapeutic option for TMD and other chronic orofacial pain conditions. PMID:23576361

  1. Calcium and vitamin D plasma concentration and nutritional intake status in patients with chronic spinal cord injury: A referral center report

    PubMed Central

    Javidan, Abbas Norouzi; Sabour, Hadis; Latifi, Sahar; Vafa, Mohammadreza; Shidfar, Farzad; Khazaeipour, Zahra; Shahbazi, Fatemeh; Rahimi, Abbas; Razavi, Seyed-Hassan Emami

    2014-01-01

    Background: Nutritional status influences bone health spinal cord injury (SCI). This study evaluates serum levels of 25-hydroxy-vitamin-D and calcium along with dietary intakes in patients with chronic SCI. Materials and Methods: Total of 160 patients participated in this investigation. Dietary intakes were assessed by semi-quantitative food-frequency questionnaire. Serum calcium, phosphorus and 25(OH)-vitamin-D level were measured. Results: Mean of serum calcium and 25(OH)-vitamin-D were 9.54 0.64 mg/dl (standard error of the mean [SE]: 0.05) and 13.6 10.99 ?g/dl (SE: 0.9), respectively. Dairy intake was below recommended amount (1.8 0.74 per serving (SE: 0.06), recommended: 4). A high prevalence (53.1%) of Vitamin D deficiency (25(OH) Vitamin D <13 ng/ml) was found. Conclusion: This study shows below adequate intake of calcium and Vitamin D in Iranian patients with SCI. These results insist on the importance of dietary modifications among these patients. PMID:25535504

  2. Examining the effectiveness of intrathecal baclofen on spasticity in individuals with chronic spinal cord injury: A systematic review

    PubMed Central

    McIntyre, Amanda; Mays, Rachel; Mehta, Swati; Janzen, Shannon; Townson, Andrea; Hsieh, Jane; Wolfe, Dalton; Teasell, Robert

    2014-01-01

    Objective To review the available evidence on the effectiveness of intrathecal baclofen in the treatment of spasticity in individuals with spinal cord injuries (SCIs) at least 6 months post-injury or diagnosis. Data sources A literature search of multiple databases (Pub Med, CINAHL, EMBASE) was conducted to identify articles published in the English language. Study selection Studies were included for review if: (1) more than 50% of the sample size had suffered a traumatic or non-traumatic SCI; (2) there were more than three subjects; (3) subjects received continuous intrathecal baclofen via an implantable pump aimed at improving spasticity; and (4) all subjects were ≥6 months post-SCI, at the time of the intervention. Data extraction Data extracted from the studies included patient and treatment characteristics, study design, method of assessment, and outcomes of the intervention. Data synthesis Methodological quality was assessed using the PEDro for randomized-controlled trials (RCTs) and the Downs and Black (D&B) tool for non-RCTs. A level of evidence was assigned to each intervention using a modified Sackett scale. Conclusion The literature search resulted in 677 articles. No RCTs and eight non-RCTs (D&B scores 13–24) met criteria for inclusion, providing a pooled sample size of 162 individuals. There was substantial level 4 evidence that intrathecal baclofen is effective in reducing spasticity. Mean Ashworth scores reduced from 3.1–4.5 at baseline to 1.0–2.0 (P < 0.005) at follow-up (range 2–41 months). Average dosing increased from 57–187 µg/day at baseline to 218.7–535.9 µg/day at follow-up. Several complications from the use of intrathecal baclofen or pump and catheter malfunction were reported. PMID:24089997

  3. Spinal Cord Stimulation for Neuropathic Pain

    PubMed Central

    2005-01-01

    Executive Summary Objective The objective of this health technology policy assessment was to determine the effectiveness of spinal cord stimulation (SCS) to manage chronic intractable neuropathic pain and to evaluate the adverse events and Ontario-specific economic profile of this technology. Clinical Need SCS is a reversible pain therapy that uses low-voltage electrical pulses to manage chronic, intractable neuropathic pain of the trunk or limbs. Neuropathic pain begins or is caused by damage or dysfunction to the nervous system and can be difficult to manage. The prevalence of neuropathic pain has been estimated at about 1.5% of the population in the United States and 1% of the population in the United Kingdom. These prevalence rates are generalizable to Canada. Neuropathic pain is extremely difficult to manage. People with symptoms that persist for at least 6 months or who have symptoms that last longer than expected for tissue healing or resolution of an underlying disease are considered to have chronic pain. Chronic pain is an emotional, social, and economic burden for those living with it. Depression, reduced quality of life (QOL), absenteeism from work, and a lower household income are positively correlated with chronic pain. Although the actual number is unknown, a proportion of people with chronic neuropathic pain fail to obtain pain relief from pharmacological therapies despite adequate and reasonable efforts to use them. These people are said to have intractable neuropathic pain, and they are the target population for SCS. The most common indication for SCS in North America is chronic intractable neuropathic pain due to failed back surgery syndrome (FBSS), a term that describes persistent leg or back and leg pain in patients who have had back or spine surgery. Neuropathic pain due to complex regional pain syndrome (CRPS), which can develop in the distal aspect of a limb a minor injury, is another common indication. To a lesser extent, chronic intractable pain of postherpetic neuralgia, which is a persistent burning pain and hyperesthesia along the distribution of a cutaneous nerve after an attack of herpes zoster, is also managed with SCS. For each condition, SCS is considered as a pain management therapy only after conventional pain therapies, including pharmacological, nonpharmacological, and surgical treatments, if applicable, have been attempted and have failed. The Technology The SCS technology consists of 3 implantable components: a pulse generator, an extension cable, and a lead (a small wire). The pulse generator is the power source for the spinal cord stimulator. It generates low-voltage electrical pulses. The extension cable connects the pulse generator to the lead. The lead is a small, insulated wire that has a set of electrodes at one end. The lead is placed into the epidural space on the posterior aspect of the spinal cord, and the electrodes are positioned at the level of the nerve roots innervating the painful area. An electrical current from the electrodes induces a paresthesia, or a tingling sensation that masks the pain. Before SCS is initiated, candidates must have psychological testing to rule out major psychological illness, drug habituation, and issues of secondary gain that can negatively influence the success of the therapy. Successful candidates will have a SCS test stimulation period (trial period) to assess their responsiveness to SCS. The test stimulation takes about 1 week to complete, and candidates who obtain at least 50% pain relief during this period are deemed suitable to receive a permanent implantation of a spinal cord stimulator Review Strategy The Medical Advisory Secretariat (MAS) reviewed all published health technology assessments of spinal cord stimulation. Following this, a literature search was conducted from 2000 to January, 2005 and a systematic review of the literature was completed. The primary outcome for the systematic review was pain relief. Secondary outcomes included functional status and quality of life. After applying the predetermined inclusion and exclusion criteria, 2 randomized controlled trials (MAS level 2 evidence), and 2 prospective non-randomized controlled trials with a before-and-after-treatment study design (MAS level 3a evidence) were retrieved and reviewed. Summary of Findings The authors of 6 health technology assessments concluded that evidence exists to support the effectiveness of SCS to decrease pain in various neuropathic pain syndromes. However, the quality of this evidence varied among reports from weak to moderate. The systematic review completed by MAS found high quality level 2 evidence that SCS decreases pain and level 3a evidence that it improves functional status and quality of life in some people with neuropathic pain conditions. The rate of technical failures was approximately 11%, which included electrode lead migration and/or malposition. Procedural complications included infection and dural puncture; each occurred at a rate of 1.2%. Conclusions SCS may be considered for patients with chronic, neuropathic pain for whom standard pain treatments have failed and when there is no indication for surgical intervention to treat the underlying condition. PMID:23074473

  4. Effects of Radiation on Spinal Dura Mater and Surrounding Tissue in Mice

    PubMed Central

    Yokogawa, Noriaki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Yamamoto, Miyuki; Iseki, Shoichi; Tsuchiya, Hiroyuki

    2015-01-01

    Purpose Spinal surgery in a previously irradiated field carries increased risk of perioperative complications, such as delayed wound healing or wound infection. In addition, adhesion around the dura mater is often observed clinically. Therefore, similar to radiation-induced fibrosisa major late-stage radiation injury in other tissueepidural fibrosis is anticipated to occur after spinal radiation. In this study, we performed histopathologic assessment of postirradiation changes in the spinal dura mater and peridural tissue in mice. Materials and Methods The thoracolumbar transition of ddY mice was irradiated with a single dose of 10 or 20 Gy. After resection of the irradiated spine, occurrence of epidural fibrosis and expression of transforming growth factor beta 1 in the spinal dura mater were evaluated. In addition, microstructures in the spinal dura mater and peridural tissue were assessed using an electron microscope. Results In the 20-Gy irradiated mice, epidural fibrosis first occurred around 12 weeks postirradiation, and was observed in all cases from 16 weeks postirradiation. In contrast, epidural fibrosis was not observed in the nonirradiated mice. Compared with the nonirradiated mice, the 10- and 20-Gy irradiated mice had significantly more overexpression of transforming growth factor beta 1 at 1 week postirradiation and in the late stages after irradiation. In microstructural assessment, the arachnoid barrier cell layer was thinned at 12 and 24 weeks postirradiation compared with that in the nonirradiated mice. Conclusion In mice, spinal epidural fibrosis develops in the late stages after high-dose irradiation, and overexpression of transforming growth factor beta 1 occurs in a manner similar to that seen in radiation-induced fibrosis in other tissue. Additionally, thinning of the arachnoid barrier cell layer was observed in the late stages after irradiation. Thus, consideration should be given to the possibility that these phenomena can occur as radiation-induced injuries of the spine. PMID:26214850

  5. Relationships between spinal mobility, physical performance tests, pain intensity and disability assessments in chronic low back pain patients.

    PubMed

    Grönblad, M; Hurri, H; Kouri, J P

    1997-03-01

    Correlations between the Oswestry Disability Questionnaire (ODQ), the Pain Disability Index (PDI), PDI subscales PDI factor 1 (PDI 1), PDI factor 2 (PDI 2) and visual analogue scale (VAS) pain intensity on the one hand and spine range of motion measures and static and dynamic functional performance tests on the other, were studied in 52 chronic low back pain patients. Comparable groups of male and female patients were studied. A moderately significant (p < 0.01) inverse correlation was observed between the ODQ and rotation to the left even after correction for age, but not when men and women were studied separately. A significant (r = -0.480, p < 0.001) inverse correlation was observed between the repeated squatting test and pain intensity and in men both pain intensity and disability correlated (r = -0.607, p < 0.001) with this particular test. Only for the women were there moderately significant (p < 0.01) inverse correlations between disability assessments and all the physical performance tests with the exception of the static back muscle test. In the women only the isometric lifting test showed a moderately significant inverse correlation (r = -0.504, p < 0.01) with pain intensity. Such apparent gender differences in the overlap between physical performance tests and self-report disability assessments and pain intensity may be clinically relevant. The results will, however, require confirmation on larger groups of chronic low back pain patients. PMID:9084101

  6. Epidural cortical stimulation and aphasia therapy

    PubMed Central

    Cherney, Leora R.; Harvey, Richard L.; Babbitt, Edna M.; Hurwitz, Rosalind; Kaye, Rosalind C.; Lee, Jaime B.; Small, Steven. L.

    2013-01-01

    Background There are several methods of delivering cortical brain stimulation to modulate cortical excitability and interest in their application as an adjuvant strategy in aphasia rehabilitation after stroke is growing. Epidural cortical stimulation, although more invasive than other methods, permits high frequency stimulation of high spatial specificity to targeted neuronal populations. Aims First, we review evidence supporting the use of epidural cortical stimulation for upper limb recovery after focal cortical injury in both animal models and human stroke survivors. These data provide the empirical and theoretical platform underlying the use of epidural cortical stimulation in aphasia. Second, we summarize evidence for the application of epidural cortical stimulation in aphasia. We describe the procedures and primary outcomes of a safety and feasibility study (Cherney, Erickson & Small, 2010), and provide previously unpublished data regarding secondary behavioral outcomes from that study. Main Contribution In a controlled study comparing epidural cortical stimulation plus language treatment (CS/LT) to language treatment alone (LT), eight stroke survivors with nonfluent aphasia received intensive language therapy for 6 weeks. Four of these participants also underwent surgical implantation of an epidural stimulation device which was activated only during therapy sessions. Behavioral data were collected before treatment, immediately after treatment, and at 6 and 12 weeks following the end of treatment. The effect size for the primary outcome measure, the Western Aphasia Battery Aphasia Quotient, was benchmarked as moderate from baseline to immediately post-treatment, and large from baseline to the 12-week follow-up. Similarly, effect sizes obtained at the 12-week follow-up for the Boston Naming Test, the Communicative Effectiveness Index, and for correct information units on a picture description task were greater than those obtained immediately post treatment. When effect sizes were compared for individual subject pairs on discourse measures of content and rate, effects were typically larger for the investigational subjects receiving CS/LT than for the control subjects receiving LT alone. These analyses support previous findings regarding therapeutic efficacy of CS/LT compared to LT i.e. epidural stimulation of ipsilesional premotor cortex may augment behavioral speech-language therapy, with the largest effects after completion of therapy. Conclusions Continued investigation of epidural cortical stimulation in combination with language training in post-stroke aphasia should proceed cautiously. Carefully planned studies that customize procedures to individual profiles are warranted. Information from research on non-invasive methods of CS/LT may also inform future studies of epidural cortical stimulation. PMID:23667287

  7. Lumbar spinal stenosis.

    PubMed Central

    Ciricillo, S F; Weinstein, P R

    1993-01-01

    Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful initially, surgical decompression by wide laminectomy or an intralaminar approach should be done in patients with serious or progressive pain or neurologic dysfunction. Because the early diagnosis and treatment of lumbar spinal stenosis may prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment, all physicians should be aware of the different neurologic presentations and the treatment options for patients with spinal stenosis. Images PMID:8434469

  8. [Spinal cord ischaemia and preoperative clopidogrel withdrawal in an arteriosclerotic patient].

    PubMed

    Murat, O; Durand, E; Delpine, G; Nguyen, P; Malinovsky, J-M

    2008-04-01

    We report the case of a motor impairment associated with bladder dysfunction several days after clopidogrel withdrawal in an arteriosclerotic woman scheduled for thoracotomy under general and thoracic epidural anaesthesia. Even if spinal artery syndrome may have a lot of aetiologies, we believe in a direct link between clopidogrel withdrawal and medulla ischaemia. PMID:18378112

  9. Primary Dural Spinal Lymphoma Presentation of a Rare Spinal Tumor Case

    PubMed Central

    een, Dilber Ayiek; Tatarl?, Necati; Turan Ssl, Hikmet; zdo?an, Seluk; Bar???k, Nagehan zdemir

    2015-01-01

    Background. Primary spinal dural lymphomas (PSDL) are tumors with characteristic histopathology of a lymphoma, which are completely in the spinal epidural space without any other systemic involvement. Extranodal primary lymphoma involving nervous system prefers thalamus/basal ganglia, periventricular region, cerebellum, eyes, meninges/dura, and cranial nerves or spinal cord. Rare spinal localization with acute spinal cord compression is worth attention. Case Presentation. A 48-year-old male presented with a several-month-long history of upper back pain. Lately, he had numbness and weakness at both lower extremities and was unable to walk for one week. A spinal MRI showed a thoracic lesion with cord compression at T2T4 levels. The patient underwent surgical decompression, with his final histopathology showing diffuse large B-cell lymphoma. Systemic work-up was negative for nodal disease. Following surgery, he received radiotherapy combined with chemotherapy. He experienced a good outcome after four years. Conclusion. The upper thoracic cord is a rare location for primary spinal lesions/metastases, both of which prefer the lower thoracic and upper lumbar regions. In cases of progressive paraparesis, there should be immediate surgical intervention in the case of denovo disease, followed by combined radiotherapy and chemotherapy procedures. PMID:26199784

  10. Effective Dose of CT-Guided Epidural and Periradicular Injections of the Lumbar Spine: A Retrospective Study

    PubMed Central

    Artner, Juraj; Lattig, Friederike; Reichel, Heiko; Cakir, Balkan

    2012-01-01

    Spinal injection procedures can be performed blindly or, more accurately, with fluoroscopic or computed tomography (CT) guidance. Radiographic guidance for selective nerve root blocks and epidural injections allows an accurate needle placement, reduces the procedure time and is more secure for the patient, especially in patients with marked degenerative changes and scoliosis, resulting in a narrowing of the interlaminar space. Limiting factors remain the availability of scanners and the radiation dose. Interventional CT scan protocols in axial CT-acquisition mode for epidural and periradicular injections help to limit the radiation dose without a significant decrease of image quality. The purpose of this retrospective study was to analyze the effective radiation dosage patients are exposed during CT-guided epidural lumbar and periradicular injections. A total amount of n=1870 datasets from 18 months were analyzed after multiplying the dose length product with conversion factor k for each lumbar segment. For lumbar epidural injections (n=1286), a mean effective dose of 1.34 mSv (CI 95%, 1.30-1.38), for periradicular injections (n=584) a mean effective dose of 1.38 mSv (CI 95%, 1.32-1.44) were calculated. PMID:22942924

  11. Overtreating chronic back pain: time to back off?

    PubMed

    Deyo, Richard A; Mirza, Sohail K; Turner, Judith A; Martin, Brook I

    2009-01-01

    Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain. PMID:19124635

  12. Epidural abscess secondary to acute appendicitis.

    PubMed

    Carter, Marguerite; Meshkat, Babek; El-Masry, Sherif

    2014-01-01

    A 62-year-old man presented via the emergency department with a 1-week history of back pain, on a background of non-insulin-dependent diabetes mellitus and rectal carcinoma for which he had undergone abdominoperineal resection, chemotherapy and radiotherapy. He exhibited signs of sepsis, midline lumbar spine tenderness and reduced hip flexion. CT of the abdomen and pelvis showed a presacral collection contiguous with the tip of the appendix, and MRI lumbar spine revealed abscess invation into the epidural space extending to T9. He underwent a laparotomy with washout of the presacral abscess and appendicectomy and prolonged course intravenous antibiotic therapy. At 3 months after initial presentation he had made a full clinical recovery with progressive radiological resolution of the epidural abscess. The objective of the case report is to highlight a unique and clinically significant complication of a very common pathology (appendicitis) and to briefly discuss other intra-abdominal sources of epidural abscess. PMID:25527687

  13. Extracranial epidural emphysema: pathway, aetiology, diagnosis and management

    PubMed Central

    Cloran, F; Bui-Mansfield, L T

    2011-01-01

    Extracranial epidural emphysema is an uncommon phenomenon that refers to the presence of gas within the epidural space. As an isolated finding, it is typically benign, but it can be a secondary sign of more ominous disease processes, such as pneumothorax, pneumoperitoneum and epidural abscess. Although the phenomenon has been cited in case reports, a comprehensive review of this topic is lacking in the radiology literature. The authors' aim is to report our experience with extracranial epidural emphysema, illustrating the spectrum of its clinical presentation. We also review the aetiology, pathophysiology, diagnosis and management of extracranial epidural emphysema. PMID:21343323

  14. Postpartum septic sacroiliitis coincident with labour epidural analgesia.

    PubMed

    Mulvey, J M

    2008-11-01

    A 22-year-old woman presented to hospital 10 days after emergency caesarean section with severe back pain, fever tachycardia and a raised C-reactive protein. She had received labour epidural analgesia and was investigated for an epidural abscess. After repeat magnetic resonance imaging she was ultimately diagnosed with septic sacroiliitis. Although an uncommon cause of back pain, pregnancy-associated sacroiliitis should be considered in the differential diagnosis of post-epidural back pain, as the presentation and symptoms of an epidural infection and sacroiliitis are similar. We recommend imaging to include the sacroiliac joints when considering the diagnosis of an epidural collection. PMID:19115661

  15. Paraplegia Following Intercostal Nerve Neurolysis with Alcohol and Thoracic Epidural Injection in Lung Cancer Patient

    PubMed Central

    Kim, Byoung Ho; No, Min Young; Han, Sang Ju; Park, Cheol Hwan

    2015-01-01

    The goal of cancer treatment is generally pain reduction and function recovery. However, drug therapy does not treat pain adequately in approximately 43% of patients, and the latter may have to undergo a nerve block or neurolysis. In the case reported here, a 42-year-old female patient with lung cancer (adenocarcinoma) developed paraplegia after receiving T8-10 and 11th intercostal nerve neurolysis and T9-10 interlaminar epidural steroid injections. An MRI results revealed extensive swelling of the spinal cord between the T4 spinal cord and conus medullaris, and T5, 7-11, and L1 bone metastasis. Although steroid therapy was administered, the paraplegia did not improve. PMID:25852838

  16. Pregnancy following spinal cord injury.

    PubMed Central

    Cross, L. L.; Meythaler, J. M.; Tuel, S. M.; Cross, A. L.

    1991-01-01

    Each year about 2,000 women of childbearing age in the United States have a spinal cord injury. Only a few mostly anecdotal reports describe pregnancy after such an injury. In a retrospective study of 16 women with a spinal cord injury, half of whom have a complete injury and about half quadriplegia, 25 pregnancies occurred, with 21 carried to full term. The women delayed pregnancy an average of 6.5 years after their injury, with an average age at first pregnancy of 26.8 years. Cesarean section was necessary in 4 patients because of inadequate progress of labor. In 5 deliveries an episiotomy and local anesthesia were required, 7 required epidural anesthesia, including all cesarean sections, and 10 did not require anesthesia. Several complications have been identified in the antepartum, intrapartum, and postpartum periods including autonomic hyperreflexia, premature labor, pressure sores, urinary tract infections, abnormal presentation, and failure to progress. Ultrasonography and amniocentesis were used selectively. Women with spinal cord injuries can have healthy children, although there are significant risks and these women have special needs. PMID:1866960

  17. Spinal Stenosis

    MedlinePLUS

    ... diagnose spinal stenosis with a physical exam and imaging tests. Treatments include medications, physical therapy, braces, and surgery. NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

  18. [Postoperative epidural bupivacaine infusion in pediatric oncology].

    PubMed

    Matinian, N V; Saltanov, A I; Illarionov, Iu V; Ordukhanian, Z S

    2006-01-01

    The paper presents the results of use of continuous epidural bupivacaine infusion for postoperative anesthesia in 88 children operated on for malignant tumors. Two groups of patients differing in the procedure of epidural bupivacaine infusion are compared. The use of bupivacaine at a higher concentration (0.25%) within the first 12 hours of the early postoperative period can provide a more effective anesthesia than that at a concentration of 0.125%. The efficacy and tolerability of the above procedures for injecting the local anesthetic are studied and their after-effects are analyzed. PMID:16613036

  19. Epidural Catheter Placement in Morbidly Obese Parturients with the Use of an Epidural Depth Equation prior to Ultrasound Visualization

    PubMed Central

    Singh, Sukhdip; Wirth, Keith M.; Phelps, Amy L.; Badve, Manasi H.; Shah, Tanmay H.; Vallejo, Manuel C.

    2013-01-01

    Background. Previously, Balki determined the Pearson correlation coefficient with the use of ultrasound (US) was 0.85 in morbidly obese parturients. We aimed to determine if the use of the epidural depth equation (EDE) in conjunction with US can provide better clinical correlation in estimating the distance from the skin to the epidural space in morbidly obese parturients. Methods. One hundred sixty morbidly obese (?40?kg/m2) parturients requesting labor epidural analgesia were enrolled. Before epidural catheter placement, EDE was used to estimate depth to the epidural space. This estimation was used to help visualize the epidural space with the transverse and midline longitudinal US views and to measure depth to epidural space. The measured epidural depth was made available to the resident trainee before needle insertion. Actual needle depth (ND) to the epidural space was recorded. Results. Pearson's correlation coefficients comparing actual (ND) versus US estimated depth to the epidural space in the longitudinal median and transverse planes were 0.905 (95% CI: 0.873 to 0.929) and 0.899 (95% CI: 0.865 to 0.925), respectively. Conclusion. Use of the epidural depth equation (EDE) in conjunction with the longitudinal and transverse US views results in better clinical correlation than with the use of US alone. PMID:23983645

  20. Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome

    PubMed Central

    Helbling, Daniel; Pulkovski, Natascha; Sprott, Haiko

    2009-01-01

    Exercise rehabilitation is one of the few evidence-based treatments for chronic non-specific low back pain (cLBP), but individual success is notoriously variable and may depend on the patients adherence to the prescribed exercise regime. This prospective study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic spine stabilisation exercises. A total of 32/37 patients with cLBP completed the study (mean age, 44.0 (SD=12.3) years; 11/32 (34%) male). Adherence to the 9-week programme was documented as: percent attendance at therapy, percent adherence to daily home exercises (patient diary) and percent commitment to rehabilitation (Sports Injury Rehabilitation Adherence Scale (SIRAS)). The average of these three measures formed a multidimensional adherence index (MAI). Psychological disturbance, fear-avoidance beliefs, catastrophising, exercise self-efficacy and health locus of control were measured by questionnaire; disability in everyday activities was scored with the RolandMorris disability scale and back pain intensity with a 010 graphic rating scale. Overall, adherence to therapy was very good (average MAI score, 85%; median (IQR), 89 (15)%). The only psychological/beliefs variable showing a unique significant association with MAI was exercise self-efficacy (Rho=0.36, P=0.045). Pain intensity and self-rated disability decreased significantly after therapy (each P<0.01). Adherence to home exercises showed a moderate, positive correlation with the reduction in average pain (Rho=0.54, P=0.003) and disability (Rho=0.38, P=0.036); higher MAI scores were associated with greater reductions in average pain (Rho=0.48, P=0.008) and a (n.s.) tendency for greater reductions in disability (Rho=0.32, P=0.07) Neither attendance at therapy nor SIRAS were significantly related to any of the outcomes. The benefits of rehabilitation depended to a large extent on the patients exercise behaviour outside of the formal physiotherapy sessions. Hence, more effort should be invested in finding ways to improve patients motivation to take responsibility for the success of their own therapy, perhaps by increasing exercise self-efficacy. Whether the adherenceoutcome interaction was mediated by improvements in function related to the specific exercises, or by a more global effect of the programme, remains to be examined. PMID:19609785

  1. Low back pain (chronic)

    PubMed Central

    2010-01-01

    Introduction Over 70% of people in developed countries develop low back pain (LBP) at some time. But recovery is not always favourable: 82% of non recent-onset patients still experience pain 1 year later. Many patients with chronic LBP who were initially told that their natural history was good spend months or years seeking relief. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatments? What are the effects of injection therapy? What are the effects of non-drug treatments? What are the effects of non-surgical and surgical treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 64 systematic reviews or RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture, analgesics, antidepressants, back schools, behavioural therapy, electromyographic biofeedback, exercise, injections (epidural corticosteroid injections, facet joint injections, local injections), intensive multidisciplinary treatment programmes, lumbar supports, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), non-surgical interventional therapies (intradiscal electrothermal therapy, radiofrequency denervation), spinal manipulative therapy, surgery, traction, and transcutaneous electrical nerve stimulation (TENS). PMID:21418678

  2. Occult spinal dysraphism: a challenge in pain management.

    PubMed

    Gerges, Frederic J; Manchanda, Chhavi; Novak, Gordon; Al-Kimawi, Magid; Semenovski, Michael; Williams, Stephen

    2015-01-01

    Spina bifida is a common birth defect affecting the central nervous system and represents a group of neural tube defects caused by congenital dysraphic malformations of the vertebral column and/or spinal cord. The anatomy in these patients is challenging and includes structural and vascular abnormalities including arteriovenous malformation or fistulae, and fatty substitution of paravertebral tissues. A magnetic resonance image (MRI) is needed for management of patients with lumbar radiculopathy and clinical features suspicious of occult spinal dysraphism. Risks and benefits of lumbar epidural steroids should be discussed comprehensively with those patients and in the best case scenario be avoided. Occult spinal dysraphism poses a clinical dilemma for interventional pain specialists managing those patients with lumbar radiculopathy. We report a case of occult spinal dysraphism discovered following the development of post-traumatic radicular symptoms. PMID:25794223

  3. Primary dumbbell-shaped epidural myxoid liposarcoma of the thoracic spine: A case report and review of the literature

    PubMed Central

    KANEUCHI, YOICHI; HAKOZAKI, MICHIYUKI; YAMADA, HITOSHI; TAJINO, TAKAHIRO; WATANABE, KAZUYUKI; OTANI, KOJI; HOJO, HIROSHI; HASEGAWA, TADASHI; KONNO, SHINICHI

    2016-01-01

    Myxoid liposarcoma frequently occurs in the deep soft tissue of the extremities, particularly in the thigh. The present study describes an extremely rare case of primary dumbbell-shaped epidural myxoid liposarcoma of the thoracic spine occurring in a 22-year-old woman. Although preoperative magnetic resonance imaging findings were thought to be compatible with schwannoma, the pathological diagnosis of the resected tumor was myxoid liposarcoma. The patient underwent three courses of adjuvant chemotherapy with doxorubicin and ifosfamide, and exhibited no symptoms or signs of local recurrence or metastasis for 18 months post surgery. The present case suggests that, when radiologically diagnosing spinal epidural tumors, clinicians should consider the possibility of myxoid liposarcoma. PMID:26893754

  4. Lumbar laminectomy with segmental continuous epidural anesthesia

    PubMed Central

    Kiran, Lakkam Vamsee; Radhika, Kusuma Srividhya; Parthasarathy, S.

    2014-01-01

    Lumbar laminectomies are usually performed under general anesthesia in the prone position. We report a case of lumbar laminectomy done under segmental continuous epidural anesthesia, so that direct visual intra-operative monitoring of the motor and sensory component of the lower extremities was possible. PMID:25886233

  5. Electrophysiological biomarkers of neuromodulatory strategies to recover motor function after spinal cord injury.

    PubMed

    Gad, Parag; Roy, Roland R; Choe, Jaehoon; Creagmile, Jack; Zhong, Hui; Gerasimenko, Yury; Edgerton, V Reggie

    2015-05-01

    The spinal cord contains the circuitry to control posture and locomotion after complete paralysis, and this circuitry can be enabled with epidural stimulation [electrical enabling motor control (eEmc)] and/or administration of pharmacological agents [pharmacological enabling motor control (fEmc)] when combined with motor training. We hypothesized that the characteristics of the spinally evoked potentials after chronic administration of both strychnine and quipazine under the influence of eEmc during standing and stepping can be used as biomarkers to predict successful motor performance. To test this hypothesis we trained rats to step bipedally for 7 wk after paralysis and characterized the motor potentials evoked in the soleus and tibialis anterior (TA) muscles with the rats in a non-weight-bearing position, standing and stepping. The middle responses (MRs) to spinally evoked stimuli were suppressed with either or both drugs when the rat was suspended, whereas the addition of either or both drugs resulted in an overall activation of the extensor muscles during stepping and/or standing and reduced the drag duration and cocontraction between the TA and soleus muscles during stepping. The administration of quipazine and strychnine in concert with eEmc and step training after injury resulted in larger-amplitude evoked potentials [MRs and late responses (LRs)] in flexors and extensors, with the LRs consisting of a more normal bursting pattern, i.e., randomly generated action potentials within the bursts. This pattern was linked to more successful standing and stepping. Thus it appears that selected features of the patterns of potentials evoked in specific muscles with stimulation can serve as effective biomarkers and predictors of motor performance. PMID:25695648

  6. Further evidence of olfactory ensheathing glia facilitating axonal regeneration after a complete spinal cord transection

    PubMed Central

    Ziegler, Matthias D.; Hsu, Derek; Takeoka, Aya; Zhong, Hui; Ramn-Cueto, Almudena; Phelps, Patricia E.; Roy, Roland R.; Edgerton, V. Reggie

    2011-01-01

    Spinal Wistar Hannover rats injected with olfactory ensheathing glia (OEG) have been shown to recover some bipedal stepping and climbing abilities. Given the intrinsic ability of the spinal cord to regain stepping with pharmacological agents or epidural stimulation after a complete mid-thoracic transection, we asked if functional recovery after OEG injections is due to changes in the caudal stump or facilitation of functional regeneration of axons across the transection site. OEG were injected rostral and caudal to the transection site immediately after transection. Robotically assisted step training in the presence of intrathecal injections of a 5-HT2A receptor agonist (quipazine) was used to facilitate recovery of stepping. Bipedal stepping as well as climbing abilities were tested over a 6-month period post-transection to determine any improvement in hindlimb functional due to OEG injections and/or step training. The ability for OEG to facilitate regeneration was analyzed electrophysiologically by transcranially stimulating the brainstem and recording motor evoked potentials (MEP) with chronically implanted intramuscular EMG electrodes in the soleus and tibalis anterior with and without intrathecal injections of noradrenergic, serotonergic, and glycinergic receptor antagonists. Analyses confirmed that along with improved stepping ability and increased use of the hindlimbs during climbing, only OEG rats showed recovery of MEP. In addition the MEP signals were eliminated after a re-transection of the spinal cord rostral to the original transection and were modified in the presence of receptor antagonists. These data indicate that improved hindlimb function after a complete transection was coupled with OEG-facilitated functional regeneration of axons. PMID:21272578

  7. [High level thoracic epidural analgesia as a special component of anesthesia during thoracic surgeries].

    PubMed

    Kurilova, O A; Vyzhigina, M A; Titov, V A; Kozlov, S P; Zhukova, S G; Parshin, V D

    2011-01-01

    This article is devoted to assessing the adequacy and safety of total intravenous anesthesia based on constant dosed infusion of propofol and high thoracic epidural analgesia in thoracic surgical procedures requiring an artificial one-lung ventilation in patients with concomitant chronic cardiorespiratory disorders compared to TIVA without a high thoracic epidural analgesia. Comparative analysis of gas exchange, metabolic rate, pressor, resistance and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics was conducted. We used high technology invasive monitoring system PICCOplus for transpulmonary thermodilution in combination with VoLEF for pulmonary thermodilution in changing modes of ventilation MV-MSL V-MV. MSL V lasted more than 1.5 hours. PMID:21688654

  8. Spinal pain.

    PubMed

    Izzo, R; Popolizio, T; D'Aprile, P; Muto, M

    2015-05-01

    The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic pain, much more difficult to treat. The clinical assessment of pain source can be a challenge because of the complex anatomy and function of the spine; the advanced imaging methods are often not sufficient for a definitive diagnosis because similar findings could be present in either asymptomatic and symptomatic subjects: a clinical correlation is always mandatory and the therapy cannot rely uniquely upon any imaging abnormalities. Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. Special attention will be done to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. PMID:25824642

  9. Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study

    PubMed Central

    Kaur, Jasleen; Bajwa, Sukhminder Jit Singh

    2014-01-01

    Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine (B). Materials and Methods: A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol (BB) and bupivacaine + fentanyl (BF). B (0.5%) 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 ?g fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher's exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant. Results: The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group. Conclusions: Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory anesthesia. Butorphanol provides a significantly prolonged post-operative analgesia. PMID:24843326

  10. Spinal Cord Injury: Hope through Research

    MedlinePLUS

    ... chronic pain in people with spinal cord injury. Robotic-assisted therapy Most recovery following SCI takes place ... the safety and efficacy of a type of robotic therapy device known as the AMES device. The ...

  11. A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain

    PubMed Central

    2011-01-01

    Background Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program. Methods Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire. Results Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase. Conclusions This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP. Trial registration ClinicalTrials.gov: NCT00566930 PMID:21303529

  12. Motor Cortex Stimulation Suppresses Cortical Responses to Noxious Hindpaw Stimulation after Spinal Cord Lesion in Rats

    PubMed Central

    Jiang, Li; Ji, Yadong; Voulalas, Pamela; Keaser, Michael; Xu, Su; Gullapalli, Rao P.; Greenspan, Joel; Masri, Radi

    2014-01-01

    Background Motor cortex stimulation (MCS) is a potentially effective treatment for chronic neuropathic pain. The neural mechanisms underlying the reduction of hyperalgesia and allodynia after MCS are not completely understood. Objective To investigate the neural mechanisms responsible for analgesic effects after MCS. We test the hypothesis that MCS attenuates evoked blood oxygen-level dependent signals in cortical areas involved in nociceptive processing in an animal model of chronic neuropathic pain. Methods We used adult female Sprague-Dawley rats (n = 10) that received unilateral electrolytic lesions of the right spinal cord at the level of C6 (SCL animals). In these animals, we performed magnetic resonance imaging (fMRI) experiments to study the analgesic effects of MCS. On the day of fMRI experiment, 14 days after spinal cord lesion, the animals were anesthetized and epidural bipolar platinum electrodes were placed above the left primary motor cortex. Two 10-minute sessions of fMRI were performed before and after a session of MCS (50 μA, 50 Hz, 300 μs, for 30 min.). During each fMRI session, the right hindpaw was electrically stimulated (noxious stimulation: 5 mA, 5 Hz, 3 ms) using a block design of 20 s stimulation off and 20 s stimulation on. A general linear model-based statistical parametric analysis was used to analyze whole brain activation maps. Region of interest (ROI) analysis and paired t-test were used to compare changes in activation before and after MCS in these ROI. Results MCS suppressed evoked blood oxygen dependent signals significantly (Family-wise error corrected p < 0.05) and bilaterally in 2 areas heavily implicated in nociceptive processing. These areas consisted of the primary somatosensory cortex and the prefrontal cortex. Conclusions These findings suggest that, in animals with SCL, MCS attenuates hypersensitivity by suppressing activity in the primary somatosensory cortex and prefrontal cortex. PMID:24468093

  13. Presumed Group B Streptococcal Meningitis After Epidural Blood Patch.

    PubMed

    Beilin, Yaakov; Spitzer, Yelena

    2015-06-15

    Bacterial meningitis after epidural catheter placement is rare. We describe a case in which a parturient received labor epidural analgesia for vaginal delivery complicated by dural puncture. The patient developed postdural puncture headache and underwent 2 separate epidural blood patch procedures. She subsequently developed a headache with fever and focal neurologic deficits. She was treated with broad spectrum antibiotics for presumed meningitis, and she made a full recovery. Blood cultures subsequently grew group B streptococcus. PMID:26050248

  14. Spinal deformity.

    PubMed

    Bunnell, W P

    1986-12-01

    Spinal deformity is a relatively common disorder, particularly in teenage girls. Early detection is possible by a simple, quick visual inspection that should be a standard part of the routine examination of all preteen and teenage patients. Follow-up observation will reveal those curvatures that are progressive and permit orthotic treatment to prevent further increase in the deformity. Spinal fusion offers correction and stabilization of more severe degrees of scoliosis. PMID:3786010

  15. Spinal Cord Hemisection Facilitates Aromatic L-Amino Acid Decarboxylase Cells to Produce Serotonin in the Subchronic but Not the Chronic Phase

    PubMed Central

    Azam, Bushra; Wienecke, Jacob; Jensen, Dennis Bo; Azam, Aleena; Zhang, Mengliang

    2015-01-01

    Neuromodulators, such as serotonin (5-hydroxytryptamine, 5-HT) and noradrenalin, play an essential role in regulating the motor and sensory functions in the spinal cord. We have previously shown that in the rat spinal cord the activity of aromatic L-amino acid decarboxylase (AADC) cells to produce 5-HT from its precursor (5-hydroxytryptophan, 5-HTP) is dramatically increased following complete spinal cord transection. In this study, we investigated whether a partial loss of 5-HT innervation could similarly increase AADC activity. Adult rats with spinal cord hemisected at thoracic level (T11/T12) were used with a postoperation interval at 5 days or 60 days. Using immunohistochemistry, first, we observed a significant reduction in the density of 5-HT-immunoreactive fibers in the spinal cord below the lesion on the injured side for both groups. Second, we found that the AADC cells were similarly expressed on both injured and uninjured sides in both groups. Third, increased production of 5-HT in AADC cells following 5-HTP was seen in 5-day but not in 60-day postinjury group. These results suggest that plastic changes of the 5-HT system might happen primarily in the subchronic phase and for longer period its function could be compensated by plastic changes of other intrinsic and/or supraspinal modulation systems. PMID:26504602

  16. Key safety considerations when administering epidural steroid injections.

    PubMed

    Manchikanti, Laxmaiah; Benyamin, Ramsin M

    2015-01-01

    Neurological and other complications of epidural steroid injections have been widely discussed in recent years. Consequently, the US FDA issued a warning about serious neurological events, some resulting in death, and consequently is requiring label changes. Neurological adverse events numbering 131, including 41 cases of arachnoiditis, have been identified by the FDA, and 700 cases of fungal meningitis following injection of contaminated steroids. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, with the majority of them to cervical transforaminal epidural injections. This perspective describes the prevalence of administering epidural injections, complications, pathoanatomy, mechanism of injury and various preventive strategies. PMID:26059467

  17. Meningeal Infiltration of the Spinal Cord by Non-Classically Activated B Cells is Associated with Chronic Disease Course in a Spontaneous B Cell-Dependent Model of CNS Autoimmune Disease

    PubMed Central

    Dang, Amy K.; Tesfagiorgis, Yodit; Jain, Rajiv W.; Craig, Heather C.; Kerfoot, Steven M.

    2015-01-01

    We characterized B cell infiltration of the spinal cord in a B cell-dependent spontaneous model of central nervous system (CNS) autoimmunity that develops in a proportion of mice with mutant T and B cell receptors specific for myelin oligodendrocyte glycoprotein. We found that, while males are more likely to develop disease, females are more likely to have a chronic rather than monophasic disease course. B cell infiltration of the spinal cord was investigated by histology and FACs. CD4+ T cell infiltration was pervasive throughout the white and in some cases gray matter. B cells were almost exclusively restricted to the meninges, often in clusters reminiscent of those described in human multiple sclerosis. These clusters were typically found adjacent to white matter lesions and their presence was associated with a chronic disease course. Extensive investigation of these clusters by histology did not identify features of lymphoid follicles, including organization of T and B cells into separate zones, CD35+ follicular dendritic cells, or germinal centers. The majority of cluster B cells were IgD+ with little evidence of class switch. Consistent with this, B cells isolated from the spinal cord were of the naïve/memory CD38hi CD95lo phenotype. Nevertheless, they were CD62Llo and CD80hi compared to lymph node B cells suggesting that they were at least partly activated and primed to present antigen. Therefore, if meningeal B cells contribute to CNS pathology in autoimmunity, follicular differentiation is not necessary for the pathogenic mechanism. PMID:26441975

  18. Spinal cord trauma

    MedlinePLUS

    Spinal cord injury; Compression of spinal cord; SCI; Cord compression ... them more likely to fall may also have spinal cord injury. ... vary depending on the location of the injury. Spinal cord injury causes weakness and loss of feeling at, and ...

  19. Spinal fusion - series (image)

    MedlinePLUS

    ... vertebrae are the bones that make up the spinal column, which surrounds and protects the spinal cord. The ... cushions between vertebrae, and absorb energy while the spinal column flexes, extends, and twists. Nerves from the spinal ...

  20. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

    PubMed Central

    Kim, J; Capizzano, A A; Kirby, P; Kademian, J; Sato, Y

    2014-01-01

    The incidence of spinal infections has increased in the past two decades, owing to the increasing number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use. Conventional MRI is the gold standard for diagnostic imaging; however, there are still a significant number of misdiagnosed cases. Diffusion-weighted imaging (DWI) with a b-value of 1000 and apparent diffusion coefficient (ADC) maps provide early and accurate detection of abscess and pus collection. Pyogenic infections are classified into four types of extension based on MRI and DWI findings: (1) epidural/paraspinal abscess with spondylodiscitis, (2) epidural/paraspinal abscess with facet joint infection, (3) epidural/paraspinal abscess without concomitant spondylodiscitis or facet joint infection and (4) intradural abscess (subdural abscess, purulent meningitis and spinal cord abscess). DWI easily detects abscesses and demonstrates the extension, multiplicity and remote disseminated infection. DWI is often a key image in the differential diagnosis. Important differential diagnoses include epidural, subdural or subarachnoid haemorrhage, cerebrospinal fluid leak, disc herniation, synovial cyst, granulation tissue, intra- or extradural tumour and post-surgical fluid collections. DWI and the ADC values are affected by susceptibility artefacts, incomplete fat suppression and volume-averaging artefacts. Recognition of artefacts is essential when interpreting DWI of spinal and paraspinal infections. DWI is not only useful for the diagnosis but also for the treatment planning of pyogenic and non-pyogenic spinal infections. PMID:24999081

  1. Spinal stenosis.

    PubMed

    Melancia, Joo Levy; Francisco, Antnio Fernandes; Antunes, Joo Lobo

    2014-01-01

    Narrowing of the spinal canal or foramina is a common finding in spine imaging of the elderly. Only when symptoms of neurogenic claudication and/or cervical myelopathy are present is a spinal stenosis diagnosis made, either of the lumbar spine, cervical spine or both (only very rarely is the thoracic spine involved). Epidemiological data suggest an incidence of 1 case per 100 000 for cervical spine stenosis and 5 cases per 100 000 for lumbar spine stenosis. Cervical myelopathy in patients over 50 years of age is most commonly due to cervical spine stenosis. Symptomatic spinal narrowing can be congenital, or, more frequently, acquired. The latter may be the result of systemic illneses, namely endocrinopathies (such as Cushing disease or acromegaly), calcium metabolism disorders (including hyporarthyroidism and Paget disease), inflammatory diseases (such as rheumathoid arthritis) and infectious diseases. Physical examination is more often abnormal in cervical spondylotic myeloptahy whereas in lumbar spinal stenosis it is typically normal. Therefore spinal stenosis diagnosis relies on the clinical picture corresponding to conspicuous causative changes identified by imaging techniques, most importantly CT and MRI. Other ancillary diagnostic tests are more likely to be yielding for establishing a differential diagnosis, namely vascular claudication. Most patients have a progressive presentation and are offered non operative management as first treatment strategy. Surgery is indicated for progressive intolerable symptoms or, more rarely, for the neurologically catastrophic initial presentations. Surgical strategy consists mainly of decompression (depending on the anatomical level and type of narrowing: laminectomy, foraminotomy, discectomy, corporectomy) with additional instrumentation should spinal stability and sagittal balance be at risk. For cervical spine stenosis the main objective of surgery is to halt disease progression. There is class 1b evidence that surgery is of benefit for lumbar stenosis at least in the short term. PMID:24365318

  2. Diagnostic use of magnetic resonance imaging (MRI) of a cervical epidural abscess and spondylodiscitis in an infant – case report

    PubMed Central

    RAUS, IULIAN; TATAR, SIMONA; COROIU, ROXANA ELENA

    2015-01-01

    Epidural abscess in infancy is very rare and has non-specific features, requiring very careful attention and early diagnosis. We present a case of a 3-month-old girl in which the diagnosis of spontaneous cervical epidural abscess developed after an initial episode of acute enterocolitis and was subsequently identified at a later visit to the emergency department for right-upper extremity hypotonia. Endoscopy revealed slightly domed retro pharynx and magnetic resonance imaging (MRI) scan showed cervical spondylodiscitis at the level of intervertebral disc C5–C6 with right-sided epidural abscess that compressed the spinal cord and right C6 nerve root, without extension into superior mediastinum. The systemic antibiotic treatment with meropenem and clindamycin solved the symptoms but the spondylodiscitis complicated with vertebral body fusion which can be symptomatic or not in the future and needs follow-up. Cervical spontaneous spondylodiscitis with abscess is very rare, especially in this age group. This case emphasizes the importance of investigating an upper extremity motor deficiency in infancy and diagnosing any potential spondylodiscitis complication. PMID:26733756

  3. Spinal Claudication

    PubMed Central

    Bolton, Charles F.

    1983-01-01

    Spinal claudication is due to marked narrowing of the spinal canal with resulting pressure on the cauda equina. The characteristic symptoms are variable discomfort in the back and legs, brought on by exercise and/or extension movements of the hips and low back. The neurological examination may be normal or may reveal dysfunction of one or more lumbosacral nerve roots. Myelography and, particularly, body CT scanning are definitive diagnostic procedures. Most patients respond satisfactorily to extensive surgical decompression. ImagesFig. 2Fig. 3 PMID:21283326

  4. Spinal Cord Stimulation for Refractory Angina Pectoris -A Case Report-

    PubMed Central

    Lee, Seong Heon; Jeong, Hye Jin; Jeong, Sin Ho; Lee, Hyung Gon; Choi, Jeong Il; Yoon, Myung Ha

    2012-01-01

    Refractory angina pectoris is defined as angina refractory to optimal medical treatment and standard coronary revascularization procedures. Despite recent therapeutic advances, patients with refractory angina pectoris are not adequately treated. Spinal cord stimulation is a minimally invasive and reversible technique which utilizes electrical neuromodulation by means of an electrode implanted in the epidural space. It has been reported to be an effective and safe treatment for refractory angina pectoris. We report a case of spinal cord stimulation which has effectively relieved chest pain due to coronary artery disease in a 40-year-old man. This is the first report of spinal cord stimulation for treatment of refractory angina pectoris in South Korea. PMID:22514782

  5. Spinal cord stimulation for complex regional pain syndrome type 1 with dystonia: a case report and discussion of the literature

    PubMed Central

    Voet, Caroline; le Polain de Waroux, Bernard; Forget, Patrice; Deumens, Ronald; Masquelier, Etienne

    2014-01-01

    Background: Complex Regional Pain Syndrome type 1 (CRPS-1) is a debilitating chronic pain disorder, the physiopathology of which can lead to dystonia associated with changes in the autonomic, central and peripheral nervous system. An interdisciplinary approach (pharmacological, interventional and psychological therapies in conjunction with a rehabilitation pathway) is central to progress towards pain reduction and restoration of function. Aim: This case report aims to stimulate reflection and development of mechanism-based therapeutic strategies concerning CRPS associated with dystonia. Case description: A 31 year old female CRPS-1 patient presented with dystonia of the right foot following ligamentoplasty for chronic ankle instability. She did not have a satisfactory response to the usual therapies. Multiple anesthetic blocks (popliteal, epidural and intrathecal) were not associated with significant anesthesia and analgesia. Mobilization of the foot by a physiotherapist was not possible. A multidisciplinary approach with psychological support, physiotherapy and spinal cord stimulation (SCS) brought pain relief, rehabilitation and improvement in the quality of life. Conclusion: The present case report demonstrates the occurrence of multilevel (peripheral and central) pathological modifications in the nervous system of a CRPS-1 patient with dystonia. This conclusion is based on the patient’s pain being resistant to anesthetic blocks at different levels and the favourable, at least initially, response to SCS. The importance of the bio-psycho-social model is also suggested, permitting behavioural change. PMID:25254100

  6. Spinal deformity in children treated for neuroblastoma

    SciTech Connect

    Mayfield, J.K.; Riseborough, E.J.; Jaffe, N.; Nehme, M.E.

    1981-02-01

    Of seventy-four children who were treated at a mean age of seventeen months for neuroblastoma and survived more than five years, fifty-six had spinal deformity due either to the disease or to the treatment after a mean follow-up of 12.9 years. Of these fifty-six, 50 per cent had post-radiation scoliosis, and 16 per cent had post-radiation kyphosis, most frequently at the thoracolumbar junction, at the time of follow-up. Two kyphotic thoracolumbar curve patterns were identified: an angular kyphosis with a short radius of curvature and its apex at the twelfth thoracic and first lumbar vertebrae, and a thoracic kyphosis with a long radius of curvature that extended into the lumbar spine. The post-radiation deformity - both the scoliosis and the kyphosis - progressed with growth, the scoliosis at a rate of 1 degree per year and the kyphosis at a rate of 3 degrees per year. Epidural spread of the neuroblastoma was associated with most of the cases of severe scoliosis and kyphosis. The deformity was due either to the laminectomy or to the paraplegia acting in conjunction with the radiation. Eighteen per cent of 419 children with this malignant disease survived more than five years, and of the survivors, 20 per cent had spinal deformity severe enough to warrant treatment. The factors associated with the development of spinal deformity in patient treated for neuroblastoma were: orthovoltage radiation exceeding 3000 rads, asymmetrical radiation of the spine, thoracolumbar kyphosis, and epidural spread of the tumor.

  7. The Epidural Treatment of Sciatica: Its Origin and Evolution.

    PubMed

    Ter Meulen, Bastiaan C; Weinstein, Henry; Ostelo, Raymond; Koehler, Peter J

    2016-01-01

    Epidural injection with corticosteroids is a common treatment option for patients with lower back pain or sciatica. In this paper we review its origin and evolution. The first injections were given around 1900 in Paris by Jean Sicard (1872-1929) and Fernand Cathelin (1873-1945), who worked independently. They both injected small volumes of cocaine into the sacral hiatus. After a slow start, the epidural treatment of back pain and sciatica gradually spread to other parts of Europe and Northern America. In the early 1950s, corticosteroids were introduced for epidural use. Since the 1970s, there have been numerous clinical trials that show a significant, although small, effect of epidural corticosteroid injections compared with placebo for leg pain in the short term. Despite an ongoing debate about effectiveness and safety, epidural injections remain popular. PMID:26820578

  8. Case Report:Pneumocephalus after labor epidural anesthesia

    PubMed Central

    Nistal-Nuo, Beatriz; Gmez-Ros, Manuel ngel

    2014-01-01

    Lumbar epidural anesthesia is commonly used for labor analgesia. The 'loss-of- resistance' to air technique (LORA) is generally employed for recognition of the epidural space. One of the rare complications of this technique is pneumocephalus (PC). Here we describe the case of a parturient who developed a frontal headache when locating the epidural space using LORA. On the second day after epidural injection, the patient exhibited occipital headaches with gradual worsening. Computed tomography scans of the brain indicated PC. Following symptomatic treatment, our patient was discharged on the 13th day. We concluded that the amount of air used to identify the epidural space in LORA should be minimized, LORA should not be used after dural puncture and the use of saline avoids PC complications. PMID:25210618

  9. Postoperative pain relief with epidural buprenorphine versus epidural butorphanol in laparoscopic hysterectomies: A comparative study

    PubMed Central

    Jose, Dona Elsa; Ganapathi, P.; Anish Sharma, N. G.; Shankaranarayana, P.; Aiyappa, D. S.; Nazim, Mohammed

    2016-01-01

    Background: The purpose of this study was to compare the safety and efficacy of postoperative analgesia with epidural buprenorphine and butorphanol tartrate. Methods: Sixty patients who were scheduled for elective laparoscopic hysterectomies were randomly enrolled in the study. At the end of the surgery, in study Group A 1 ml (0.3 mg) of buprenorphine and in Group B 1 ml (1 mg) of butorphanol tartrate both diluted to 10 ml with normal saline was injected through the epidural catheter. Visual analog pain scales (VAPSs) were assessed every hour till the 6th h, then 2nd hourly till the 12th h. To assess sedation, Ramsay sedation score was used. The total duration of postoperative analgesia was taken as the period from the time of giving epidural drug until the patients first complain of pain and the VAPS is more than 6. Patients were observed for any side effects such as respiratory depression, nausea, vomiting, hypotension, bradycardia, pruritus, and headache. Results: Buprenorphine had a longer duration of analgesia when compared to butorphanol tartrate (586.17 ± 73.64 vs. 342.53 ± 47.42 [P < 0.001]). Nausea, vomiting (13% vs. 10%), and headache (20% vs. 13%) were more in buprenorphine group; however, sedation score and pruritus (3% vs. 6%) were found to be more with butorphanol. Conclusion: Epidural buprenorphine significantly reduced pain and increased the quality of analgesia with a longer duration of action and was a better alternative to butorphanol for postoperative pain relief. PMID:26957696

  10. Forelimb EMG-based trigger to control an electronic spinal bridge to enable hindlimb stepping after a complete spinal cord lesion in rats

    PubMed Central

    2012-01-01

    Background A complete spinal cord transection results in loss of all supraspinal motor control below the level of the injury. The neural circuitry in the lumbosacral spinal cord, however, can generate locomotor patterns in the hindlimbs of rats and cats with the aid of motor training, epidural stimulation and/or administration of monoaminergic agonists. We hypothesized that there are patterns of EMG signals from the forelimbs during quadrupedal locomotion that uniquely represent a signal for the intent to step with the hindlimbs. These observations led us to determine whether this type of indirect volitional control of stepping can be achieved after a complete spinal cord injury. The objective of this study was to develop an electronic bridge across the lesion of the spinal cord to facilitate hindlimb stepping after a complete mid-thoracic spinal cord injury in adult rats. Methods We developed an electronic spinal bridge that can detect specific patterns of EMG activity from the forelimb muscles to initiate electrical-enabling motor control (eEmc) of the lumbosacral spinal cord to enable quadrupedal stepping after a complete spinal cord transection in rats. A moving window detection algorithm was implemented in a small microprocessor to detect biceps brachii EMG activity bilaterally that then was used to initiate and terminate epidural stimulation in the lumbosacral spinal cord. We found dominant frequencies of 180220 Hz in the EMG of the forelimb muscles during active periods, whereas these frequencies were between 010 Hz when the muscles were inactive. Results and conclusions Once the algorithm was validated to represent kinematically appropriate quadrupedal stepping, we observed that the algorithm could reliably detect, initiate, and facilitate stepping under different pharmacological conditions and at various treadmill speeds. PMID:22691460

  11. Spinal Tap

    MedlinePLUS

    ... minutes. When it's done, the doctor takes the needle out and puts a small bandage over the area. The sample is sent to a lab for analysis and testing. Your doctor might ask you to lie on your back for a few hours after the procedure. Safety A spinal tap is considered a safe procedure ...

  12. Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch

    PubMed Central

    Correia, Inês; Marques, Inês Brás; Ferreira, Rogério; Cordeiro, Miguel; Sousa, Lívia

    2016-01-01

    Spontaneous intracranial hypotension (SIH) is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF) leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery. PMID:26981128

  13. Chronic inflammatory polyneuropathy

    MedlinePLUS

    ... nerves outside the brain or spinal cord ( peripheral neuropathy ). Polyneuropathy means several nerves are involved. It usually ... demyelinating polyneuropathy (CIDP) is the most common chronic neuropathy caused by an abnormal immune response. CIDP occurs ...

  14. What is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion

    PubMed Central

    Staats, Peter S.; Nampiaparampil, Devi E.; Hirsch, Joshua A.

    2015-01-01

    Background Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing discogenic pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery. Methods A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar discogenic pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V. Results Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar. Conclusions The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity pain for patients with lumbar discogenic pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments. PMID:25852828

  15. Low-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy.

    PubMed

    Zeng, X Z; Xu, Y M; Cui, X G; Guo, Y P; Li, W Z

    2014-03-01

    Thoracic epidural anaesthesia alone is an applied technique of anaesthesia for nephrectomy which has both advantages and limitations. Dexmedetomidine is a highly selective alpha2-adrenoreceptor agonist which has both central and peripheral analgesic properties. Forty patients undergoing nephrectomy were enrolled in this clinical trial and allocated randomly to two groups, a control group (C group) and a dexmedetomidine group (D group). The C group received epidural 0.75% levobupivacaine 12 ml with 1 ml of isotonic sodium chloride solution, while the D group received epidural 0.75% levobupivacaine 12 ml with 1 ml (0.5 g/kg) of dexmedetomidine. Haemodynamic changes, onset time and duration of sensory and motor block, muscle relaxation score, verbal rating score for pain, sedation score and the total postoperative analgesic consumption were evaluated. Sensory blockade duration was longer in the D group than in the C group (P=0.01). The incidence of motor block and the muscle relaxation score were significantly higher in the D group compared with the C group (P=0.01). Compared with the C group, pain scores were signi?cantly lower in the ?rst four postoperative hours in the D group (two hours rest P=0.038; two hours activity P=0.009; four hours rest P=0.044; four hours activity P=0.003). The total amount of flurbiprofen analgesic was signi?cantly lower in the D group compared with the C group (P=0.03). Epidural dexmedetomidine 0.5 g/kg appears to intensify thoracic epidural anaesthesia with levobupivacaine. PMID:24580383

  16. Low-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy.

    TOXLINE Toxicology Bibliographic Information

    Zeng XZ; Xu YM; Cui XG; Guo YP; Li WZ

    2014-03-01

    Thoracic epidural anaesthesia alone is an applied technique of anaesthesia for nephrectomy which has both advantages and limitations. Dexmedetomidine is a highly selective alpha2-adrenoreceptor agonist which has both central and peripheral analgesic properties. Forty patients undergoing nephrectomy were enrolled in this clinical trial and allocated randomly to two groups, a control group (C group) and a dexmedetomidine group (D group). The C group received epidural 0.75% levobupivacaine 12 ml with 1 ml of isotonic sodium chloride solution, while the D group received epidural 0.75% levobupivacaine 12 ml with 1 ml (0.5 g/kg) of dexmedetomidine. Haemodynamic changes, onset time and duration of sensory and motor block, muscle relaxation score, verbal rating score for pain, sedation score and the total postoperative analgesic consumption were evaluated. Sensory blockade duration was longer in the D group than in the C group (P=0.01). The incidence of motor block and the muscle relaxation score were significantly higher in the D group compared with the C group (P=0.01). Compared with the C group, pain scores were signi?cantly lower in the ?rst four postoperative hours in the D group (two hours rest P=0.038; two hours activity P=0.009; four hours rest P=0.044; four hours activity P=0.003). The total amount of flurbiprofen analgesic was signi?cantly lower in the D group compared with the C group (P=0.03). Epidural dexmedetomidine 0.5 g/kg appears to intensify thoracic epidural anaesthesia with levobupivacaine.

  17. Real-time two-dimensional and three-dimensional echocardiographic imaging of the thoracic spinal cord: a possible new window into the central neuraxis.

    PubMed

    Feinglass, Neil G; Clendenen, Steven R; Shine, Timothy S J; Martin, Archer K; Greengrass, Roy A

    2015-02-01

    Transesophageal echocardiography of the spine has been difficult to perform, and high-quality images have been difficult to obtain with earlier available technology. New capabilities in hardware and software reconstruction may allow more reliable clinical data to be obtained. We describe an initial successful attempt to image the adult spinal canal, its contents, and in situ instrumentation. This report is a retrospective review of two patients in whom transesophageal echocardiography (TEE) was used to image the thoracic spine. The thoracic spine was identified and imaged with real-time 2-D and 3-D technology with location of the thoracic aorta and slight insertion and withdrawal of the TEE probe until the intervertebral discs alignment was optimized. Images of the spinal cord anatomy and its vascular supply, as well as indwelling epidural catheters were easily identified. 2-D and 3-D imaging was performed and images were recorded in digital imaging and communications in medicine format. 3-D reconstruction of images was possible with instantaneous 3-D imaging from multiple 2-D electrocardiogram-gated image acquisitions using the Phillips TEE IE-33 imaging platform. The central neuraxial cavity, including the spinal cord and the spinal nerve roots, was easily visualized, and motion of the cord was seen in a phasic pattern (with respiratory variation); cerebrospinal fluid surrounding the spinal cord was documented. The epidural space and local anesthetic drug administration through the epidural catheter were visualized, with the epidural catheter seen lying adjacent to the epidural tissue as a bright hyperechoic line. Pulsed-wave Doppler determined a biphasic pattern of blood flow in the anterior spinal artery through pulse mapping of the anatomic area. New, advanced imaging hardware and software generate clinically useful imaging of the thoracic spine in 2-D and 3-D using TEE. We believe this technology holds promise for future diagnostic and therapeutic interventions in the operating room that were previously unavailable. PMID:24748550

  18. Transient Glaucoma after an Epidural Steroid Injection: A Case Report

    PubMed Central

    Manjiani, Deepak; Said, Salam; Kaye, Alan David

    2015-01-01

    Background Steroids are recognized as a beneficial treatment for various medical conditions, yet clinically relevant side effects of steroids are common and problematic, ranging from a minor case of acne to a potentially life-threatening Addisonian crisis. In anesthetic medicine, the use of epidural steroid injections (ESIs) for chronic low back pain and other radicular pain-related conditions has become standard practice in interventional pain management. Case Report We report the case of a patient who experienced sudden bilateral blurred vision after receiving an ESI and required urgent ophthalmic interventions and follow-up care. The main clinical findings from this case showed that the patient had high intraocular pressure (IOP) that caused unexpected short-term vision loss. The symptom resolved after 3 months without ophthalmic treatment. Conclusion Clinicians should inform patients about the possibility of visual complications associated with pain procedures involving steroids. Among the high-risk groups with predisposing factors, such as uncontrolled hypertension and diabetes mellitus, routine eye tests that include measuring IOP prior to ESI should be recommended as a preventive measure. Alternative pain management therapies should be considered if possible. Comprehensive planning of patient care will also ensure safety and prevent unwanted outcomes, particularly with high-risk patients receiving steroids for pain procedures. PMID:25829885

  19. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    PubMed Central

    Isoyama-Shirakawa, Yuko; Nakamura, Katsumasa; Abe, Madoka; Kunitake, Naonobu; Matsumoto, Keiji; Ohga, Saiji; Sasaki, Tomonari; Uehara, Satoru; Okushima, Kazuhiro; Shioyama, Yoshiyuki; Honda, Hiroshi

    2015-01-01

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 2.97, significantly lower than that of the control group's 6.80 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. PMID:25852151

  20. Solitary spinal dural syphilis granuloma mimicking a spinal meningioma.

    PubMed

    Zhou, Heng-Jun; Zhan, Ren-Ya; Chen, Man-Tao; Cao, Fei; Zheng, Xiu-Jue

    2014-01-01

    Dural granuloma is extremely rare. To our knowledge, there has no case reported solitary spinal dural syphilis granuloma worldwide so far. Here we report our findings in a 49-year-old woman, who presented with 10-year progressive left lower-limb numbness and two weeks of right lower-limb numbness. Magnetic resonance imaging (MRI) suggested a homogeneous enhanced spindle-shaped lesion, 2.9 × 1.5 cm in size, occupying the spinal intradural extramedullary space, at the level of Thoracic (T)-2/3, which mimicked the appearance of spinal meningioma. The Treponema pallidum particle agglutination (TPPA) test titer of 1:8, and the venereal diseases research laboratory of cerebral spinal fluid (VDRL-CSF) was reactive, so confirmed neurosyphilis was considered. After formal anti-syphilis treatment, posterior laminectomy surgery was performed, and the lesion was completely separated and extirpated. Final histopathologic diagnosis of the lesion was confirmed as chronic granulomatous inflammation, combined with the neurosyphilis history, spinal dural syphilis granuloma was finally diagnosed. Postoperatively, the patient recovered without any further treatment. PMID:24831378

  1. Extraosseous, Epidural Cavernous Hemangioma with Back Pain

    PubMed Central

    Ozkal, Birol; Yaldiz, Can; Yaman, Onur; Ozdem?r, Nail; Dalbayrak, Sedat

    2015-01-01

    Summary Background Cavernous malformations are characterized by enlarged vascular structures located in benign neural tissues within the cerebellum and spinal cord of the central nervous system. Cavernous hemangiomas (CHs) account for 5% to 12% of all spinal vascular malformations. Case Report We removed a hemorrhagic thoracic mass in a 40-year-old male patient who presented with progressive neurological deficits. Conclusions We found it appropriate to present this case due to its rarity. PMID:25960818

  2. Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients.

    PubMed

    Zwolak, Pawel; Knig, Matthias Alexander; Osterhoff, Georg; Wilzeck, Verena; Simmen, Hans-Peter; Jukema, Gerrolt Nico

    2013-01-01

    We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland) nine patients (three women and six men; mean age 68.6, range 43-87 years) were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30). The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy. PMID:24416474

  3. Spinal biomechanics.

    PubMed

    Pope, M H; Novotny, J E

    1993-11-01

    The lumbar spine is a source of disability due to low back pain (LBP), yet the precise diagnosis is unknown in 80-90 percent of patients. The lifetime prevalence is 75 percent with a cost to the U.S. economy as high as 80 billion dollars. The problem is partly caused by mechanical overloading of the tissues and thus, there is some potential for both primary and secondary prevention. Biomechanical techniques have been effective in improving our understanding of the loading conditions leading to LBP, and in developing techniques for improved diagnosis and more effectual methods of treatment. Much progress has been made through the use of biomechanical models. Most models assume that the external moments are balanced by trunk musculature. Multiple muscle system models, employing agonist and antagonists, now are available to define 3D spine reaction forces. The static indeterminacy is taken care of either by simplification of the model or by linear or nonlinear optimization. Dynamic analysis has shown that vibrational and impact conditions (such as vehicle driving) can excite the natural frequency of the spine and lead to high spinal loadings. In vivo measurements have shown the resonant frequency of the lumbar spine to be 4-5 Hz and many vehicles excite those frequencies. New biomechanical techniques employing electromyography can estimate muscle load and muscle fatigue. Stereo photogrammetric techniques for establishing segmental kinematics have great potential for improving the diagnosis of spinal problems. These techniques are solidly based on prior in-vitro measurements of spinal kinematics. Mechanical fixation techniques, such as pedicle fixation, show great promise in improving the treatment of spinal problems. These have been extensively analyzed by both finite element techniques and in-vitro simulation so as to improve design as well as surgical technique. PMID:8302043

  4. Spinal Bracing

    NASA Technical Reports Server (NTRS)

    1991-01-01

    Dr. Arthur Copes of the Copes Foundation, Baton Rouge, LA, says that 35 percent of the 50 technical reports he received from the NASA/Southern University Industrial Applications Center in Baton Rouge and the Central Industrial Applications Center, Durant, OK, were vital to the development of his Copes Scoliosis Braces, which are custom designed and feature a novel pneumatic bladder that exerts constant corrective pressure to the torso to slowly reduce or eliminate the spinal curve.

  5. A rare case of pneumocephalus and pneumorrhachis after epidural anesthesia.

    PubMed

    Hsieh, Xhang-Xian; Hsieh, Sun-Wung; Lu, Chueng-He; Wu, Zhi-Fu; Ju, Da-Tong; Huh, Billy; Wang, Jia-Chang; Kuo, Chan-Yang

    2015-03-01

    Both pneumocephalus and pneumorrhachis are rare but serious complications following epidural anesthesia. We report a rare case of simultaneous pneumocephalus and pneumorrhachis in a patient after undergoing epidural anesthesia. The patient lost consciousness and received emergent external ventricular drainage for pneumocephalus in another medical center. The patient was clear after external ventricular drain placement until 4 days later, when sudden onset of subdural hemorrhage occurred and an emergent craniectomy was performed. The patient passed away 2 days after craniectomy, due to multiorgan failure. Pneumocephalus with or without pneumorrhachis should be kept in mind when there is a sudden change of consciousness or persistent convulsions after epidural anesthesia. PMID:25702950

  6. Fever following an Epidural Blood Patch in a Child

    PubMed Central

    Hunyady, Agnes I.; Anderson, Corrie T. M.; Kuratani, John D.; Kundu, Anjana

    2012-01-01

    There is increasing evidence that children suffer from the consequences of spontaneous or iatrogenic intracranial hypotension. Pediatric epidural blood patch is gaining popularity because of its ability to alter cerebrospinal fluid dynamics and to alleviate headaches attributed to low cerebrospinal fluid pressure. There is, however, still not enough data to document the safety profile of an epidural blood patch. Here we describe a case of a fever in a child temporally related to the administration of an epidural blood patch. This case depicts the dilemmas in making the diagnosis and instituting treatment for complications of this procedure in the pediatric population. PMID:23029626

  7. Spinal cord abscess

    MedlinePLUS

    ... infection often begins in the bone ( osteomyelitis ). The bone infection may cause an epidural abscess to form. This ... pressure. It involves removing part of the spine bone and ... treat the infection. They are usually given through a vein (IV).

  8. Spinal Cord Injury Map

    MedlinePLUS

    ... Counseling About Blog Facing Disability Jeff Shannon Donate Spinal Cord Injury Map Loss of function depends on what part ... control. Learn more about spinal cord injuries. A spinal cord injury affects the entire family FacingDisability is designed to ...

  9. Spinal Cord Injury

    MedlinePLUS

    ... Types of illnesses and disabilities Spinal cord injury Spinal cord injury Read advice from Dr. Jeffrey Rabin , a pediatric ... your health on a daily basis. Living with spinal cord injury — your questions answered top What are pediatric rehabilitation ...

  10. Spinal Cord Diseases

    MedlinePLUS

    Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back ... of the spine, this can also injure the spinal cord. Other spinal cord problems include Tumors Infections such ...

  11. Tethered Spinal Cord Syndrome

    MedlinePLUS

    ... Enhancing Diversity Find People About NINDS NINDS Tethered Spinal Cord