These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

Chronic spontaneous lumbar epidural hematoma simulating extradural spinal tumor: a case report.  

PubMed

Spinal epidural hematoma (SEH) is an uncommon disorder, and chronic SEHs are rarer than acute SEHs. However, there is few reported involving the bone change of the vertebral body in chronic SEHs. We present a case report of lumbar epidural hematoma that required differentiation from extramedullary spinal tumors by a long process because the CT scan revealed scalloping of the vertebral body and review the relevant literature. A 78-year-old man had experienced a gradual onset of low back pain and excruciating pain in both legs. Lumbar MRI on T1-weighted images revealed a space-occupying lesion with a hyperintense signal relative to the spinal cord with no enhancement on gadolinium adminisration. Meanwhile, T2-weighted images revealed a heterogeneous intensity change, accompanying a central area of hyperintense signals with a hypointense peripheral border at the L4 vertebra. Moreover, the CT scan demonstrated scalloping of the posterior wall of the L4 vertebral body which is generally suspected as the CT finding of spainal tumor. During the epidural space exploration, we found a dark red-colored mass surrounded by a capsular layer, which was fibrous and adhered to the flavum and dura mater. Microscopic histological examination of the resected mass revealed a mixture of the relatively new hematoma and the hematoma that was moving into the connective tissue. Accordingly, the hematoma was diagnosed as chronic SEH. The particular MRI findings of chronic SEHs are helpful for making accurate preoperative diagnoses of this pathology. PMID:25130006

Matsui, Hiroki; Imagama, Shiro; Ito, Zenya; Ando, Kei; Hirano, Kenichi; Tauchi, Ryoji; Muramoto, Akio; Matsumoto, Tomohiro; Ishiguro, Naoki

2014-02-01

2

Holocord spinal epidural abscess.  

PubMed

Spinal epidural abscess is rare in infants and leads to major permanent neurological deficits if the condition is left untreated. Holocord epidural abscess is extremely rare. We report a patient with methicillin-resistant Staphylococcus aureus septicemia presenting with pneumonia, retroperitoneal abscess, and epidural abscess. A 7-month-old previously healthy girl presented with fever, irritability, tachypnea for 4 days and decreased movement of the right lower limb for 1 day. Magnetic resonance imaging of the spine demonstrated an extensive epidural abscess from second cervical to fifth lumbar vertebrae without osteomyelitis or discitis. The epidural abscess was treated with intravenous antibiotics for 6 weeks. At 3 months follow-up, no neurological deficits were present. Only a few case reports of holocord epidural abscess in children have been published. We present a case of conservatively treated holocord spinal abscess in an infant. PMID:19491119

Ghosh, Partha Sekhar; Loddenkemper, Tobias; Blanco, Manuel Buitrago; Marks, Michelle; Sabella, Camille; Ghosh, Debabrata

2009-06-01

3

Epidural ketamine in post spinal cord injury-related chronic pain  

PubMed Central

Aim: This study was to identify the safety and efficacy of adding epidural N-methyl-D-aspartate receptor antagonists (ketamine) to oral gabapentin for the treatment of post spinal cord injury-related chronic pain. Materials and Methods: Forty patients in the age range of 18–50 years with a diagnosis of neuropathic pain secondary to spinal cord injury were randomized into two equal groups. Group I received 0.2 mg/Kg of preservative-free ketamine (2 ml) single bolus epidural injection and gabapentin 300 mg three times daily. Group II received isotonic saline 0.9% (2 ml) single bolus epidural injection and gabapentin 300 mg three times daily. Pain scores were evaluated pre-injection, 7, 15, 30,45 and 60 days post injection. Patients were asked about any side-effects occurred during follow-up period. Results: At all time points examined, pain scores were significantly lower in both groups than pre-injection values (P < 0.0001). Pain scores were significantly lower in Group I than in Group II at 7, 15, 30 days after injection (P 0.02, < 0.0001, =0.0001 respectively), but no statistically significant difference was detected between groups at 45, 60 days post injection (P = 0.54, =0.25), there was no statistically significant difference regarding incidence of side-effects in both groups. Conclusion: Epidurally administrated ketamine seems to be a safe adjunct to gabapentin in post spinal cord injury-related chronic pain. However, its analgesic efficacy was limited to 30 days after injection.

Amr, Yasser Mohamed

2011-01-01

4

Dorsal epidural spinal lipomatosis  

Microsoft Academic Search

The authors report a case of a thoracic epidural spinal lipomatosis causing severe neurological deficits along the review of pertinent literature. The patient is a 56-year-old woman who presented with acute onset of severe paraparesis; she was investigated with cervical and thoracic MRI and then surgically managed because of an intraspinal mass compressing the cord. The operation consisted in the

S Chibbaro; G Mirone; M Nouri; P Di Emidio; M Polivka; M Marsella; B George

2011-01-01

5

Spinal cord stimulation with implanted epidural paddle lead relieves chronic axial low back pain  

PubMed Central

Introduction Spinal cord stimulation (SCS) provides significant relief for lumbosacral radiculopathy refractory to both medical and surgical treatment, but historically only offers limited relief for axial low back pain (LBP). We aim to evaluate the response of chronic axial LBP treated with SCS using a surgically implanted epidural paddle lead. Materials and methods This is a retrospective review of a consecutive series of patients with exclusive LBP or predominant LBP associated with lower extremity (LE) pain evaluated and treated with SCS using an implanted paddle lead within the dorsal thoracic epidural space. Baseline LBP, and if present LE pain, were recorded using the visual analogue scale (VAS) at an initial evaluation. At a follow-up visit (a minimum of 12 months later), LBP and LE pain after a spinal cord stimulator implantation were again recorded using the VAS. Patients were also asked to estimate total LBP pain relief achieved. Results Patients with either exclusive (n=7) or predominant (n=2) axial LBP were treated with SCS by implantation of a paddle lead at an average spine level of T9. The baseline VAS score for LBP was 7.2; after a follow-up of 20 months, the score decreased to 2.3 (P=0.003). The LE pain VAS score decreased from 7.5 to 0.0 (P=0.103). Patients also reported a subjective 66.4% decrease of their LBP at follow-up. There were no surgical complications. Conclusions Axial LBP is refractory to many treatments, including SCS. SCS using a surgically implanted paddle electrode provides significant pain relief for chronic axial LPB, and is a safe treatment modality. PMID:25143753

Stidd, David A; Rivero, Sergio; Weinand, Martin E

2014-01-01

6

Spinal epidural abscess.  

PubMed

Spinal epidural abscess (SEA) remains a relatively infrequent diagnosis. Staphylococcus aureus is the most common organism identified, and the infectious source in SEA emanates from skin and soft tissue infections in about 20 % of instances. The thoracic spine is most often involved followed by the lumbar spine. The classic triad of fever, spinal pain, and neurological deficit is present in but a minority of patients. The appearance of neurological deficits with SEA has a significant impact on the prognosis; therefore, early diagnosis is imperative. Magnetic resonance imaging has permitted earlier diagnosis, although significant delays in diagnosis are common due to the nonspecific symptoms that frequently attend the disorder. Due to the rarity of this condition, there have been few randomized controlled trials to evaluate new treatment strategies, and most recommendations regarding treatment are based on case series studies often derived from the experiences at a single center. PMID:25230605

Krishnamohan, Prashanth; Berger, Joseph R

2014-11-01

7

Dorsal epidural spinal lipomatosis.  

PubMed

The authors report a case of a thoracic epidural spinal lipomatosis causing severe neurological deficits along the review of pertinent literature. The patient is a 56-year-old woman who presented with acute onset of severe paraparesis; she was investigated with cervical and thoracic MRI and then surgically managed because of an intraspinal mass compressing the cord. The operation consisted in the excision of the mass confirmed to be a fibrolipoma by pathological analysis. The patient attained complete neurological recovery and at 18 months follow-up she reported a generalised well-being. Thoracic lipomas are rare lesions that presenting mostly with back pain; however, in rare instances they may cause progressive and/or abrupt neurological dysfunction. Appropriate imaging can help in the diagnosis and management of such cases. PMID:22707370

Chibbaro, S; Mirone, G; Nouri, M; Di Emidio, P; Polivka, M; Marsella, M; George, B

2011-01-01

8

Dorsal epidural spinal lipomatosis  

PubMed Central

The authors report a case of a thoracic epidural spinal lipomatosis causing severe neurological deficits along the review of pertinent literature. The patient is a 56-year-old woman who presented with acute onset of severe paraparesis; she was investigated with cervical and thoracic MRI and then surgically managed because of an intraspinal mass compressing the cord. The operation consisted in the excision of the mass confirmed to be a fibrolipoma by pathological analysis. The patient attained complete neurological recovery and at 18 months follow-up she reported a generalised well-being. Thoracic lipomas are rare lesions that presenting mostly with back pain; however, in rare instances they may cause progressive and/or abrupt neurological dysfunction. Appropriate imaging can help in the diagnosis and management of such cases. PMID:22707370

Chibbaro, S; Mirone, G; Nouri, M; Di Emidio, P; Polivka, M; Marsella, M; George, B

2011-01-01

9

Whole Spontaneous Spinal Epidural Hematoma  

PubMed Central

A 26-year-old male who had no underlying disease, including coagulopathy, underwent thoracotomy and bleeding control due to hemothorax. On the fifth postoperative day, paralysis of both lower limbs occurred. Urgent spine magnetic resonance imaging showed a massive anterior spinal epidural hematoma from C2 to L1 level with different signal intensities, which was suspected to be staged hemorrhage. Hematoma evacuation with decompressive laminectomy was performed. The patient's neurologic deterioration was recovered immediately, and he was discharged without neurological deficits. A drug history of naftazone, which could induce a drug-induced platelet dysfunction, was revealed retrospectively. To our knowledge, this is the first report of whole spontaneous spinal epidural hematoma in a young patient, with a history of hemorrhoid medication. PMID:24967052

Yoon, Kyeong-Wook; Song, Jae Gyok; Ryu, Jae-Wook

2014-01-01

10

Epidural spinal cord stimulation for treatment of chronic pain—some predictors of success. A 15-year experience  

Microsoft Academic Search

BACKGROUND We have used epidural spinal cord stimulation (SCS) for pain control for the past 15 years. An analysis of our series of 235 patients has clarified the value of specific prognostic parameters in the prediction of successful SCS.METHODS Patients were followed up for periods ranging from 6 months to 15 years with a mean follow-up of 66 months. The

Krishna Kumar; Cory Toth; RahulK Nath; Patricia Laing

1998-01-01

11

Spinal epidural angiolipoma: A rare cause of spinal cord compression  

PubMed Central

Spinal epidural angiolipomas are rare, benign tumors composed of mature lipocytes admixed with abnormal blood vessels. Only 128 cases of spinal epidural angiolipomas have been reported in literature till now. Spinal angiolipomas are predominantly located in the mid-thoracic region. We report a case of dorsal epidural angiolipoma in a 56-year-old male who presented with paraparesis and was diagnosed to have D4-5 epidural angiolipoma. Total surgical excision of the epidural angiolipoma was done and his paraparesis gradually improved. PMID:23188989

Ghanta, Rajesh K; Koti, Kalyan; Dandamudi, Srinivas

2012-01-01

12

Epidural Injections for Spinal Pain  

MedlinePLUS

... An epidural injection is delivered into the epidural space of the spine to provide temporary or prolonged relief from pain or inflammation. The epidural space is located outside the dural membrane. Steroids, anesthetics ...

13

Spinal epidural extramedullary haematopoiesis in ?-thalassaemia intermedia.  

PubMed

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

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

2014-01-01

14

Epidural anesthesia for obstetrics after spinal surgery.  

PubMed

The experience of 18 patients with previous spinal surgery who requested epidural anesthesia for obstetric pain was reviewed. Three received epidural anesthetics in two separate pregnancies, producing a total of 21 attempts at epidural anesthesia. All were initiated during labor and three were later extended for Cesarean delivery. Continuous lumbar epidural anesthesia was successfully established in 20 of 21 attempts. Ten were performed easily on the first attempt. There were excessive local anesthetic requirements and/or a patchy block for the remaining 11 attempts. The only complication that could be attributed to the attempts at epidural anesthesia was temporary low back pain in two patients with multiple attempts. No complications were noted on long-term follow-up. Our data, therefore, suggest that epidural anesthesia is safe and generally effective in obstetric patients with previous spinal surgery. PMID:2291882

Daley, M D; Rolbin, S H; Hew, E M; Morningstar, B A; Stewart, J A

1990-01-01

15

Epidural spinal myelolipoma in a dog.  

PubMed

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

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

2007-01-01

16

Spinal Epidural Lipomatosis in Korean  

PubMed Central

Spinal epidural lipomatosis (SEL) is a rare disorder, regarded in literature as a consequence of administration of exogenous steroids, associated with a variety of systemic diseases, endocrinopathies and the Cushing's syndrome. Occasionally, SEL may occur in patients not exposed to steroids or suffering from endocrinopathies, namely, idiopathic SEL. Thus far, case studies of SEL among Korean have been published rather sporadically. We reviewed the clinical features of SEL cases, among Koreans with journal review, including this report of three operated cases. According to this study, there were some differences between Korean and western cases. Koreans had higher incidences of idiopathic SEL, predominant involvement in the lumbar segments, very few thoracic involvement and lower MBI, as opposed to westerners.

Yoo, Je Chul; Choi, Jeong Jae; Lee, Dong Woo

2014-01-01

17

Idiopathic Spinal Epidural Lipomatosis - Two Cases Report and Review of Literature  

Microsoft Academic Search

Spinal epidural lipomatosis (SEL), an abnormal localized or tumor-like accumulation of fat in the epidural space, is an infrequent complication of chronic steroid usage and an uncommon cause of spinal cord compression. During the period of 1990 to 2006, we have two cases of medically heath SEL patients without history of steroid administration. Their initial clinical manifestations were low back

Jun-Yeen Chan; Chih-Ju Chang; Chin-Ming Jeng; Shih-Hung Huang; Yuan-Kai Liu; Jing-Shan Huang

18

[Case of spinal epidural abscess after continuous epidural block to manage the pain of herpes zoster].  

PubMed

A woman in her 90's received continuous epidural block for the pain of herpes zoster. Four days after epidural catheterization, she was found with cellutitis. Fourteen days after epidural catheterization, spinal epidural abscess was pointed out on MRI. Since there were no neurological symptoms, we performed conservative medical management with antibiotics. She recovered without sequela When the symptoms of cellutitis appeared after epidural block (even if there are neither neurological symptoms nor infectious signs), there is a possibility of progressing into spinal epidural abscess. PMID:24724451

Miyamoto, Tatsuhito; Nakatani, Toshihiko; Narai, Yasuhiro; Sakakibara, Manabu; Hashimoto, Tatsuya; Saito, Youji

2014-03-01

19

Metastasis to nervous system: spinal epidural and intramedullary metastases  

Microsoft Academic Search

Summary Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer with an increasing incidence. Prostate, breast and lung cancer are the most common offenders. Metastasis usually arises in the posterior aspect of vertebral body with later invasion of epidural space. Pathophysiologically, vascular insufficiency is more important than direct spinal cord compression. The most common complaint is pain,

Melike Mut; David Schiff; Mark E. Shaffrey

2005-01-01

20

Injecting saline through the epidural needle decreases the iv epidural catheter placement rate during combined spinal-epidural labour analgesia  

Microsoft Academic Search

Purpose  To determine if injecting 10 mL saline before epidural catheter threading (pre-cannulation epidural fluid injection) can decrease\\u000a the incidence ofiv epidural catheter placement during combined spinal-epidural (CSE) labour analgesia.\\u000a \\u000a \\u000a \\u000a Methods  One hundred healthy women requesting CSE labour analgesia with either fentanyl 20 ?g or sufentanil 10 ?g were prospectively\\u000a randomized to receive either no epidural injection (dry group,n = 50) or

Farida Gadalla; Sung-Hee Rhim Lee; Kue C. Choi; Jill Fong; Matthew C. Gomillion; Barbara L. Leighton

2003-01-01

21

Case report of spinal epidural abscess caused by Haemophilus paraphrophilus.  

PubMed Central

Haemophilus paraphrophilus was recovered in pure culture from purulent material collected at surgery from a patient presenting with a spinal epidural abscess and a severe neurological deficit. This is the first report of such an occurrence. PMID:8150977

Scerpella, E G; Wu, S; Oefinger, P E

1994-01-01

22

Risks from Epidural, Spinal Anesthesia Very Low, Study Says  

MedlinePLUS

... Tuesday, October 14, 2014 Related MedlinePlus Pages Anesthesia Childbirth TUESDAY, Oct. 14 2014 (HealthDay News) -- The risks of using epidural and spinal anesthesia during childbirth are extremely low, according to a new study. ...

23

Spinal Epidural Arteriovenous Hemangioma Mimicking Lumbar Disc Herniation  

PubMed Central

A spinal epidural hemangioma is rare. In this case, a 51 year-old female patient had low back pain and right thigh numbness. She was initially misdiagnosed as having a ruptured disc with possible sequestration of granulation tissue formation due to the limited number of spinal epidural hemangiomas and little-known radiological findings. Because there are no effective diagnostic tools to verify the hemangioma, more effort should be put into preoperative imaging tests to avoid misdiagnosis and poor decisions). PMID:23133733

Kim, Kyung Hyun; Song, Sang Woo; Lee, Soo Eon

2012-01-01

24

Idiopathic spinal epidural lipomatosis - two cases report and review of literature.  

PubMed

Spinal epidural lipomatosis (SEL), an abnormal localized or tumor-like accumulation of fat in the epidural space, is an infrequent complication of chronic steroid usage and an uncommon cause of spinal cord compression. During the period of 1990 to 2006, we have two cases of medically heath SEL patients without history of steroid administration. Their initial clinical manifestations were low back pain, progressive lower extremities weakness, numbness, followed by rapid deterioration of neurogenic intermittent claudication. They were misdiagnosed and treated as degenerative spinal disease for a long time. Due to prominent neurological deficit, lumbar magnetic resonance image (MRI) was obtained and showed SEL. These 2 patients all underwent laminectomy and removal of epidural fat. Postoperatively, they both showed improvement. We reviewed the literature and discussed the current concept in the management of SEL. PMID:20035646

Chan, Jun-Yeen; Chang, Chih-Ju; Jeng, Chin-Ming; Huang, Shih-Hung; Liu, Yuan-Kai; Huang, Jing-Shan

2009-01-01

25

Imaging diagnosis--Spinal epidural hemangiosarcoma in a dog.  

PubMed

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

de la Fuente, Cristian; Pumarola, Martí; Añor, Sònia

2014-01-01

26

[The clinical usefulness and problem of combined spinal epidural needle].  

PubMed

The clinical usefulness of combined spinal-epidural needles, Portex Spinal/Epidural set (Pencil point tip type and Lancet point tip type), was evaluated on 30 patients undergoing orthopedic lower limb surgeries, hysterectomies or transurethral surgeries. In all the patients, the spinal-epidural needles were successfully inserted with paramedian approach without any problem. The time to appearance of cerebrospinal fluid in the spinal needle hub after removal of the stylet was 15-40 seconds, and no patient in both groups had postspinal headache. Following spinal anesthesia, the local anesthetics injected through the epidural catheter extended the analgesia in the range of 1-2 dermatomes higher in the Lancet point type group in comparison with Pencil point type group. It is possible that the hole in the dura may allow a transfer of local anesthetics into the subarachnoid space. The present study shows that combined spinal-epidural block is clinically useful, and the Pencil point type is safer than the Lancet point type. PMID:8544292

Kitamura, A; Kon, T; Kamiyama, M; Ogawa, R

1995-11-01

27

[Clinico-roentgenologic diagnosis of spinal arachnoiditis and epiduritis].  

PubMed

The clinico-radiological picture of spinal arachnoiditis and epiduritis was studied in 135 patients. The disorders were expressed in the form of radicular pain, paresthesia, hyperesthesia, pareses, paralyses and pelvic disturbances. The most informative of radiological methods were pneumomyelography, myelography with myodile, sacral and transdural epidurography. Contrast radiological examinations of the membranous spaces of the spinal cord make it possible to determine the localization, severity and nature of pathological changes. Spinal arachnoiditis and epiduritis are associated with non-filling or non-uniform filling of the membranous spaces, their narrowing and deformation, non-filling and deformation of radicular pockets. The diagnosis is made by correlating clinical, laboratory and radiological findings. PMID:4090836

Sipukhin, Ia M; Galin, Iu M; Khmaruk, L P

1985-01-01

28

Spinal Epidural Abscess: Common Symptoms of an Emergency Condition  

PubMed Central

Summary Spinal epidural abscess (SEA) is a severe pyogenic infection of the epidural space that leads to devastating neurological deficits and may be fatal. SEA is usually located in the thoracic and lumbar parts of the vertebral column and injures the spine by direct compression or local ischemia. Spinal injury may be prevented if surgical and medical interventions are implemented early. The diagnosis is difficult, because clinical symptoms are not specific and can mimic many benign conditions. The classical triad of symptoms includes back pain, fever and neurological deterioration. The gold standard in the diagnostic evaluation is magnetic resonance imaging with gadolinium enhancement, which determines the location and extent of the abscess. Increased awareness of the disease is essential for rapid recognition and immediate implementation of treatment. Here we describe the case of a 26-year-old woman with SEA with fever, back pain in the thoracic region and delayed symptoms of a transverse spinal cord injury. PMID:24007734

Rosc-Bereza, K.; Arkuszewski, M.; Ciach-Wysocka, E.; Boczarska-Jedynak, M.

2013-01-01

29

Spontaneous spinal epidural hemorrhage from intense piano playing.  

PubMed

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

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

2014-06-01

30

Steroid-induced Spinal Epidural Lipomatosis after Suprasella Tumor Resection  

PubMed Central

Spinal epidural lipomatosis (SEL) is an abnormal localized accumulation of fat tissues in the epidural space. It is strongly related with steroid administration. The symptoms of SEL are various and range from back pain to paraplegia. In severe cases, decompressive laminectomy is the choice of treatment. A 32-year-old woman who had been under long-term steroid administration after suprasellar tumor resection was admitted for both leg radiating pain and weakness. She was diagnosed with SEL and had a decompressive laminectomy. During the operation, we found the nerve roots were compressed by epidural fat tissues and engorged vessels. After the operation, her radiating pain was relieved and motor weakness was improved. PMID:24757466

Kim, Si On; Park, Keuk Kyu; Kwon, Young Jun; Shin, Hyun Chul

2013-01-01

31

Postoperative spinal epidural hematoma resulting in cauda equina syndrome: a case report and review of the literature  

PubMed Central

Spinal epidural hematoma is a well known complication of spinal surgery. Clinically insignificant small epidural hematomas develop in most spinal surgeries following laminectomy. However, the incidence of clinically significant postoperative spinal epidural hematomas that result in neurological deficits is extremely rare. In this report, we present a 33-year-old female patient whose spinal surgery resulted in postoperative spinal epidural hematoma. She was diagnosed with lumbar disc disease and underwent hemipartial lumbar laminectomy and discectomy. After twelve hours postoperation, her neurologic status deteriorated and cauda equina syndrome with acute spinal epidural hematoma was identified. She was immediately treated with surgical decompression and evacuation of the hematoma. The incidence of epidural hematoma after spinal surgery is rare, but very serious complication. Spinal epidural hematomas can cause significant spinal cord and cauda equina compression, requiring surgical intervention. Once diagnosed, the patient should immediately undergo emergency surgical exploration and evacuation of the hematoma. PMID:19830087

Sasani, Mehdi; Oktenoglu, Tunc; Cirak, Bayram; Ozer, Ali Fahir

2009-01-01

32

Spinal Mechanisms Contribute to Analgesia Produced by Epidural Sufentanil Combined with Bupivacaine for Postoperative Analgesia  

Microsoft Academic Search

When used alone, lipid-soluble epidural opioids are thought to produce analgesia supraspinally via systemic absorption. However, spinal opioids and local anesthetics have been shown to act synergistically at the spinal level in animal studies. We, therefore, tested the hypothesis that sufentanil requirements will be less when given epi- durally than IV in patients simultaneously given epidural bupivacaine after major abdominal

Jean L. Joris; Eric A. Jacob; Daniel I. Sessler; Abdourahamane Kaba; Maurice L. Lamy

2003-01-01

33

Neurogenic claudication without spinal stenosis arising as a result of lumbar epidural varices.  

PubMed

Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. We describe a patient with lumbar epidural varices secondary to obstruction of the inferior vena cava by pathological lymph nodes presenting with this syndrome. Following a diagnosis of follicular lymphoma, successful chemotherapy led to the resolution of the varices and the symptoms of neurogenic claudication. The lumbar epidural venous plexus may have an important role in the pathogenesis of spinal stenosis. Although rare, epidural venous engorgement can induce neurogenic claudication without spinal stenosis. Further investigations should be directed at identifying an underlying cause. PMID:22933506

Dabasia, H; Rahim, N; Marshall, R

2012-09-01

34

Sensory nerve conduction in the human spinal cord: epidural recordings made during scoliosis surgery  

Microsoft Academic Search

This report describes the waveform and properties of somatosensory evoked potentials recorded from various levels of the human spinal cord, with electrodes inserted into the epidural space and the stimulus delivered to the posterior tibial nerve at the knee. The object was to provide a means of monitoring spinal cord function during surgery for the correction of spinal deformities. The

S J Jones; M A Edgar; A O Ransford

1982-01-01

35

Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised  

Microsoft Academic Search

Objectives To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality. Design Systematic review of all trials with randomisation to intraoperative neuraxial blockade or not.

Anthony Rodgers; Natalie Walker; S Schug; A McKee; H Kehlet; A van Zundert; D Sage; M Futter; G Saville; T Clark; S MacMahon

2000-01-01

36

Percutaneous Transforaminal Epidural Injection Method in an Experimental Rat: Minimally Invasive Drug Delivery Method to Spinal Epidural Space  

PubMed Central

Objective To compare a newly developed minimally-invasive method for percutaneous transforaminal epidural injection (INJ group) with the existing method for lumbar epidural catheterization (CATH group). Method Through anatomical review of experimental rats, the cephalic one fourth of the neural foramen was selected as the target point for drug delivery. After the rats had undergone lumbar epidural catheterization, lidocaine, and 1% methylene blue were injected through the unilateral or bilateral L5/6 neural foramen in the INJ group, and through an epidural catheter in the CATH group. Measurement of body weight and the mechanical allodynia test before and after injection of lidocaine, and fine dissection after injection were performed. Results Results of the mechanical allodynia test of 1.0% lidocaine 50 µl injection in the CATH group were statistically similar to those of 0.5% lidocaine 100 µl injection in the INJ group. The results of 2.0% lidocaine 50 µl injection in the CATH group were statistically similar to those of 1.0% lidocaine 100 µl injection in the INJ group. After dissection, only one distal partial spinal nerve was stained by methylene blue 50 µl through the transforaminal pathway. However, the dorsal root ganglion, nerve root, and adjacent hemi-partial spinal cord were stained by methylene blue 100 µl through the transforaminal pathway. Conclusion The percutaneous transforaminal epidural injection is practical, easy, and safe, and, in particular, does not cause significant pain compared to the existing lumbar epidural catheterization. We expect this method to be effective in an animal study showing that drug delivery to the spinal epidural space is necessary. PMID:23185728

Kim, Nack Hwan; Lee, Sang Heon

2012-01-01

37

Pure spinal epidural cavernous hemangioma with intralesional hemorrhage: a rare cause of thoracic myelopathy.  

PubMed

Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors. PMID:25110490

Jang, Donghwan; Kim, Choonghyo; Lee, Seung Jin; Ryu, Young-Joon; Kim, Jiha

2014-06-01

38

Epidural lipomatosis and congenital small spinal canal in spinal anaesthesia: a case report and review of the literature  

PubMed Central

Introduction Complications after lumbar anaesthesia and epidural blood patch have been described in patients with congenital small spinal canal and increased epidural fat or epidural lipomatosis. These conditions, whether occurring separately or in combination, require magnetic resonance imaging for diagnosis and grading, but their clinical significance is still unclear. Case presentation A 35-year-old Caucasian woman who was undergoing a Caesarean section developed a longstanding L4-L5 unilateral neuropathy after the administration of spinal anaesthesia. There were several attempts to correctly position the needle, one of which resulted in paraesthesia. A magnetic resonance image revealed that the patient's bony spinal canal was congenitally small and had excess epidural fat. The cross-sectional area of the dural sac was then reduced, which left practically no free cerebrospinal fluid space. Conclusion The combination of epidural lipomatosis of varying degrees and congenital small spinal canal has not been previously discussed with spinal anaesthesia. Due to the low cerebrospinal fluid content of the small dural sac, the cauda equina becomes a firm system with a very limited possibility for the nerve roots to move away from the puncture needle when it is inserted into the dural sac. This constitutes risks of technical difficulties and neuropathies with spinal anaesthesia. PMID:20062767

2009-01-01

39

Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases  

SciTech Connect

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.

Mahadevan, Anand, E-mail: amahadev@bidmc.harvard.edu [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Floyd, Scott [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Wong, Eric; Jeyapalan, Suriya [Department of Neuro-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Groff, Michael; Kasper, Ekkehard [Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel)

2011-12-01

40

Stepping-like movements in humans with complete spinal cord injury induced by epidural stimulation of the lumbar cord: electromyographic study of compound muscle action potentials  

Microsoft Academic Search

Study design: It has been previously demonstrated that sustained nonpatterned electric stimulation of the posterior lumbar spinal cord from the epidural space can induce stepping-like movements in subjects with chronic, complete spinal cord injury. In the present paper, we explore physiologically related components of electromyographic (EMG) recordings during the induced stepping-like activity.Objectives: To examine mechanisms underlying the stepping-like movements activated

K Minassian; B Jilge; F Rattay; M M Pinter; H Binder; F Gerstenbrand; M R Dimitrijevic

2004-01-01

41

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

PubMed Central

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

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

2014-01-01

42

Endovascular treatment for acute paraplegia after epidural steroid injection in a patient with spinal dural arteriovenous malformation.  

PubMed

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations. Type 1 spinal arteriovenous malformations are defined by the presence of radiculomeningeal feeders that drain into intradural veins. Patients with these lesions frequently present with chronic myelopathy, which is most often caused by venous hypertension. The authors present the case of a 69-year-old man with acute paraparesis following a lumbar epidural injection, resulting from a previously undiagnosed SDAVF. The patient initially reported right lower-extremity weakness and paresthesias and was referred to an orthopedic practice. His pain and weakness were exacerbated with ambulation. Reevaluation at 4 months was remarkable for groin, mild low-back, and buttock pain. The patient received a right L5-S1 interlaminar epidural steroid injection and became acutely weak. He presented to the emergency department 3 hours after the injection. Once MRI of the lumbar and thoracic spine had been performed, the neurosurgery service was consulted, and it was decided to proceed with emergent spinal angiography with the intent to embolize the fistula. An emergent spinal angiogram was obtained, revealing 2 arterial pedicles emanating from the right T-5 and T-6 radicular arteries. Transarterial embolization was thought to be the most rapid way to potentially obliterate the fistula. The patient exhibited immediate improvement in neurological function, and by 6 hours postprocedure, his neurological function was near normal. He was ambulatory and released to home 3 days after the embolization procedure. PMID:22769730

Oliver, T Adam; Sorensen, Michael; Arthur, Adam S

2012-09-01

43

Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study  

Microsoft Academic Search

Purpose  Failed conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum Cesarean delivery\\u000a (CD) has been observed in clinical practice. However, spinal anesthesia (SA) in parturients experiencing failed conversion\\u000a of ELA to ESA has been associated with an increased incidence of serious side effects. In this retrospective cohort analysis,\\u000a we examined our routine clinical practice of removing

W. Anton Visser; Annemieke Dijkstra; Mustafa Albayrak; Mathieu J. M. Gielen; Eric Boersma; Henk J. Vonsée

2009-01-01

44

"Dry tap" during spinal anaesthesia turns out to be epidural abscess  

PubMed Central

We report a case of “dry tap” during spinal anaesthesia in a patient posted for incision and drainage of lower limb with cellulitis. When the patient was being given sub-arachnoid block (SAB) for regional anaesthesia, it turned out to be a case of pyogenic ilio-psoas abscess extended up to the paravertebral and epidural spaces. The causative organism was Staphylococcus aureus. This is probably the first case reported when epidural abscess is diagnosed during SAB. PMID:22923830

Sahu, Dinesh Kumar; Kaul, Vinca; Parampill, Reena

2012-01-01

45

Hemiparesis Caused by Cervical Spontaneous Spinal Epidural Hematoma: A Report of 3 Cases  

PubMed Central

We report three cases of spontaneous spinal epidural hematoma (SSEH) with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis. PMID:21991415

Nakanishi, Kinya; Nakano, Naoki; Uchiyama, Takuya; Kato, Amami

2011-01-01

46

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

PubMed

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

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

2014-06-01

47

Primary spinal epidural lymphoma: Patients’ profile, outcome, and prognostic factors: A multicenter Rare Cancer Network study  

Microsoft Academic Search

Purpose To assess the clinical profile, treatment outcome, and prognostic factors in primary spinal epidural lymphoma (PSEL). Methods and Materials Between 1982 and 2002, 52 consecutive patients with PSEL were treated in nine institutions of the Rare Cancer Network. Forty-eight patients had an Ann Arbor stage IE and four had a stage IIE. Forty-eight patients underwent decompressive laminectomy, all received

Virginie Monnard; Alex Sun; Ron Epelbaum; Philip Poortmans; Robert C. Miller; Tom Verschueren; Luciano Scandolaro; Salvador Villa; Sabine Balmer Majno; Sandrine Ostermann; Mahmut Ozsahin; Rene-Olivier. Mirimanoff

2006-01-01

48

Continuous spinal anesthesia with epidural catheters: An experience in the periphery  

PubMed Central

Background and Aim: Continuous spinal anesthesia (CSA) offers considerable advantages over “singleshot” spinal or epidural anesthesia since it allows administration of well-controlled anesthesia using small doses of local anesthetics and a definite end point with less failure rate. There are described technical difficulties with introduction of spinal micro catheters and hence this study was undertaken by using epidural catheters. Materials and Methods: Sixty patients of ASA grade II to III were selected and they were administered continuous spinal anesthesia with Portex 18-G epidural catheters. Results: The introduction was done in first attempt and was easy in all cases. The intraoperative period was uneventful in all cases. Early postoperative analgesia was achieved in all cases. Only two patients (3%) had postdural puncture headache controlled with simple analgesics. In a 3 month postoperative followup, the incidence of neurological complication is nil. Conclusion: We conclude CSA with epidural catheters is a simple and safe alternative for prolonged procedures with negligible failure rate especially in high-risk patients and in patients with possible difficulties in administration of general anesthesia.

Parthasarathy, S.; Ravishankar, M.

2011-01-01

49

Post-operative spinal epidural hematoma causing American Spinal Injury Association B spinal cord injury in patients with suction wound drains  

PubMed Central

Background Subfascial wound suction drains are commonly used after spinal surgery to decrease the incidence of post-operative hematoma. However, there is a paucity of literature regarding their effectiveness. Objective To report four cases of post-operative spinal epidural hematoma causing massive neurological deficit in patients who had subfascial suction wound drains. Methods During an 8-year period, a retrospective review of 1750 consecutive adult spinal surgery cases was performed to determine the incidence, commonalities, and outcomes of catastrophic neurological deficit caused by post-operative spinal epidural hematoma. Findings Epidural hematoma causing major neurological deficit (American Spinal Injury Association B) was identified in 4 out of 1750 patients (0.23%). All four patients in this series had subfascial wound suction drains placed prophylactically at the conclusion of their initial procedure. Results Three patients developed massive neurological deficits with the drain in place; one patient had the drain removed at 24 hours and subsequently developed neurological symptoms during the following post-operative day. Significant risk factors for the development of hematoma were identified in two of the four patients. Average time to return to the operating room for hematoma evacuation was 6 hours (range 3–12 hours). Neurological status significantly improved in all four patients after hematoma evacuation. Conclusions Post-operative epidural hematoma causing catastrophic neurological deficit is a rare complication after spinal surgery. The presence of suction wound drains does not appear to prevent the occurrence of this devastating complication. PMID:23809591

Chimenti, Peter; Molinari, Robert

2013-01-01

50

Epidural hematoma associated with spinal fracture in diffuse idiopathic skeletal hyperostosis.  

PubMed

The authors describe the clinical findings, radiographic appearance and surgical treatment of a spinal epidural hematoma (SEH) associated with spinal fracture in diffuse idiopathic skeletal hyperostosis (DISH). An 81-year-old male patient injured after falling from a 2.5 m tree presented with severe back pain. On plain radiographs and CT images, DISH with anterolateral osteophytes and fused thoracolumbar vertebrae was found along with a T12 fracture. Patient was initially treated with bed rest followed by placement into a body cast. Three weeks later, he presented with incomplete paraplegia of his lower limbs. CT images did not reveal any fracture displacement, but MRI images showed an epidural hematoma compressing the dura mater. The patient was successfully treated by posterior fixation surgery using pedicle screws and rod with vertebroplasty. We aimed to report a unique case of a SEH complicating a spinal fracture in DISH. PMID:24535802

Tauchi, Ryoji; Imagama, Shiro; Satake, Kotaro; Iwase, Toshiki; Ishiguro, Naoki

2014-01-01

51

[Combined spinal-epidural anesthesia for caesarean section in a parturient with scoliosis].  

PubMed

An emergency caesarean section was performed in a 38-year-old parturient with pregnancy-induced hypertension at week 31 of gestation because of nonreassuring fetal status. A chest X-ray revealed mild spinal scoliosis. We attempted a combined spinal-epidural anesthesia in the parturient because the Cobb angle was only 28 degrees. However, we failed to achieve epidural puncture at the T12-L1 and L1-2 interspaces using a paramedian approach. In addition, we failed to achieve the puncture of the subarachnoid spaces at L3-4 and L4-5 using medial and paramedian approaches. Finally, we succeeded in puncturing the subarachnoid space at L5-S1 using the median approach, and injected 11 mg of hyperbaric bupivacaine. Analgesia was achieved from the T6 to S regions, and the caesarean section was completed uneventfully. A postoperative X-ray and computed tomography scan revealed that the rotation of the lumbar spine was so severe that the spaces between the laminae of the lumbar regions were shifted to the left and narrowed. Therefore, the puncture of the epidural and subarachnoid spaces was difficult, suggesting that the degree of lumbar spine rotation is more important than the thoracic spine curvature for successful epidural and spinal anesthesia in parturients with scoliosis. PMID:23905412

Kiyosawa, Kenkichi; Kawamata, Tomoyuki; Yamamoto, Katsumi; Kawamata, Mikito

2013-07-01

52

Subarachnoid and Intraventricular Hemorrhage due to Ruptured Aneurysm after Combined Spinal-Epidural Anesthesia  

PubMed Central

A patient received combined spinal-epidural anesthesia for a scheduled total knee arthroplasty. After an injection of spinal anesthetic and ephedrine due to a decrease in blood pressure, the patient developed a severe headache. The patient did not respond to verbal command at the completion of the operation. A brain CT scan revealed massive subarachnoid and intraventricular hemorrhages, and a CT angiogram showed a ruptured aneurysm. Severe headaches should not be overlooked in an uncontrolled hypertensive patient during spinal anesthesia because it may imply an intracranial and intraventricular hemorrhage due to the rupture of a hidden aneurysm. PMID:20376909

Chun, Duk-Hee; Kim, Na-Young

2010-01-01

53

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

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 1–100 Hz and 1–10 V 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 (40 Hz). 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 1 Hz 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

2013-01-01

54

Epidural Dexamethasone Decreased Inflammatory Hyperalgesia and Spinal cPLA2 Expression in a Rat Formalin Test  

PubMed Central

Purpose The aim of this study was to investigate the effect of epidural dexamethasone on analgesia and cytosolic phospholipase A2 (cPLA2) expression in the spinal cord in a rat formalin test. Materials and Methods Epidural dexamethasone injection was performed to Sprague-Dawley rats with a 25 gauge needle under fluoroscopy. Following the epidural injection, a formalin induced pain behavior test was performed. Next, the spinal cords corresponding to L4 dorsal root ganglion was extracted to observe the cPLA2 expression. Results There were no differences in pain response during phase I among the groups. The phase II pain response in 300 µg of epidural dexamethasone group decreased as compared to control, 30 µg of epidural dexamethasone, 100 µg of epidural dexamethasone, and 300 µg of systemic dexamethasone groups. The expression of cPLA2 decreased in Rexed laminae I-II in 300 µg of the epidural dexamethasone group compared with the ones in the control group. Conclusion Taken together, these results suggest that 300 µg of epidural dexamethasone has an attenuating effect on the peripheral inflammatory tissue injury induced hyperalgesia and this effect is mediated through the inhibition of intraspinal cPLA2 expression and the primary site of action is the laminae I-II of the spinal cord. PMID:25323902

Min, Sam-Hong; Soh, Jung-Sub; Park, Ji-Yong; Choi, Sung-Uk; Lee, Hye-Won; Lee, Jae-Jin

2014-01-01

55

Midline trough corpectomies for the evacuation of an extensive ventral cervical and upper thoracic spinal epidural abscess.  

PubMed

The author reports on a 59-year-old woman with a history of a chronic, nonhealing skin ulcer who presented with sepsis, neck pain, and rapidly progressive quadriparesis. Precontrast and postcontrast MR imaging studies revealed a multifocal ventral cervical and upper thoracic spinal epidural abscess. Compression of the spinal cord from the abscess was greatest behind the disc space of C2-3 and C7-T1. Because of the patient's tenuous medical status, the author elected to apply a technique that would allow expeditious decompression without necessitating concomitant fusion and instrumentation. Multilevel, contiguous trough corpectomies were performed for evacuation of the compressive lesions. A high-speed matchstick bur was used to create a 5- to 7-mm midline trough in the vertebrae and intervening disc spaces from C-2 to T-3. Rapid and successful decompression of the entire ventral cervical and upper thoracic epidural space was achieved using this technique. Understanding that the surgical treatment of discitis or osteomyelitis can often result in a kyphotic deformity or frank instability, the patient was immobilized in a cervical collar following surgery and underwent vigilant monitoring with serial plain radiographs, CT scans, and MR images. These neuroimaging studies confirmed complete resolution of the abscess and the slow development of a mild, stable kyphotic deformity. At the 1-year follow-up, the patient was ambulating and had returned to work. A trough corpectomy is a viable surgical approach that allows for rapid decompression of ventral cervical and upper thoracic epidural abscesses while obviating the need for same-setting fusion and fixation. PMID:20672959

Deshmukh, Vinay R

2010-08-01

56

[Combined spinal-epidural anesthesia for a patient with HTLV-1 associated myelopathy].  

PubMed

An 81-year-old female with HTLV-1 associated myelopathy (HAM) was scheduled for transurethral lithotomy. She had had paresthesia and spastic paresis in the lower extremities for the past 15 years. The preoperative respiratory function test revealed a vital capacity of 1.3 l (58% of the predicted value). We selected combined spinal-epidural anesthesia (CSEA) for her to avoid postoperative respiratory complications due to general anesthesia. After placement of a thoracic epidural catheter, spinal anesthesia was achieved by administration of bupivacaine 7.5 mg, resulting in the sensory block level to T 6, five min later. The intraoperative blood pressure remained high at 150-200 mmHg, in spite of the administration of nicardipine. Postoperatively, neither the deterioration in the neurological findings of HAM nor the exacerbation of respiratory function was observed. The present report suggests that CSEA can be one of the choices of anesthesia for a patient with HAM. PMID:25199333

Yokomizo, Taishi; Hiraki, Teruyuki; Mishima, Yasunori; Ushijima, Kazuo

2014-08-01

57

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

SciTech Connect

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.

Han, Young-Min, E-mail: ymhan@chonbuk.ac.kr; Kwak, Ho-Sung; Jin, Gong-Young; Chung, Gyung-Ho [Chonbuk National University Medical School, Departments of Radiology (Korea, Republic of); Song, Kyung-Jin [Chonbuk National University Medical School, Departments of Orthopedic Surgery (Korea, Republic of)

2006-06-15

58

Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation  

PubMed Central

Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recognized by the appearance of acute asymmetric focal motor and sensory involvement. In infants, the initial presenting symptoms are very non-specific and irritability is often the only initial manifestation. Appearance of other neurological signs may be delayed up to hours or even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies, the diagnosis is usually delayed until the full picture of severe cord compression is developed. The diagnosis is finally made by performing magnetic resonance imaging. We report a 5-month-old infant with spinal epidural hematoma who presented with symmetrical upper limb weakness and diaphragmatic involvement to highlight the importance of recognizing the atypical manifestations for early diagnosis and intervention. PMID:24665297

ABBAS, Asad; AFZAL, Kamran; MUJEEB, Athar Abdul; SHAHAB, Tabassum; KHALID, Mohammad

2013-01-01

59

Spontaneous spinal epidural hematoma in infancy: review of the literature and the "seventh" case report.  

PubMed

Spontaneous spinal epidural hematomas (SSEH) are a rare cause of spinal cord compression in childhood and especially in infancy. We reviewed the literature and describe a case of an 8-month-old boy with a large spontaneous cervico-thoracic epidural hematoma. With this review we want to detail the importance of early investigation, diagnosis and treatment in infants with SSEH. In our case the infant presented with irritability and crying and an ascending paralysis within four days. Magnetic resonance imaging (MRI) of the spine demonstrated an extensive epidural hematoma between C5 and L1, serious medullar compression and secondary cervical and thoracic medullar edema and hydromyelia. An emergency laminectomy was performed with evacuation of a well organized hematoma. There was a partial recuperation of the neurologic symptoms. Based on the scarce literature which only concerns seven case reports, SSEH is a rare cause of spinal compression in infancy. The presentation is often not specific and neurological symptoms are often lacking in the beginning. However early diagnosis with MRI and prompt neurosurgical intervention are important to improve outcome. PMID:23786707

Schoonjans, An-Sofie; De Dooy, Jozef; Kenis, Sandra; Menovsky, Tomas; Verhulst, Stijn; Hellinckx, Johan; Van Ingelghem, Ingrid; Parizel, Paul M; Jorens, Philippe G; Ceulemans, Berten

2013-11-01

60

Omental transposition in chronic spinal cord injury  

Microsoft Academic Search

The results of omental transposition in chronic spinal cord injury have been reported in 160 patients operated upon in the United States, Great Britain, China, Japan, India and Mexico, with detailed outcomes reported in few studies. Recovery of function to a greater degree than expected by natural history has been reported. In this series, 15 patients with chronic traumatic spinal

G L Clifton; W H Donovan; M M Dimitrijevic; S J Allen; A Ku; J R Potts; F G Moody; C Boake; A M Sherwood; J V Edwards

1996-01-01

61

[Venospondylography in the diagnosis of epidural abscesses in spinal osteomyelitis].  

PubMed

Venospondilography following a modified method in combination with pneumomyelotomography was fulfilled in 1,5 patients with osteomyelitis of spine. Venospondilography was found to be more informative as compared with pneumomyelography and liquor dynamic tests. It can be used among other methods of preoperative diagnosis in patients with spine osteomyelitis complicated by spinal disorders. PMID:6474735

Tikhodeev, S A; Sovetova, N A

1984-07-01

62

Spinal epidural hematoma after intravenous thrombolysis for acute ischemic stroke  

Microsoft Academic Search

Intracranial bleeding is an important and dangerous complication associated with thrombolytic therapy for acute ischemic stroke. Spinal hemorrhage has been reported after systemic thrombolysis for various conditions other than acute ischemic stroke. Our patient presented with an acute ischemic stroke and showed significant clinical recovery during intravenous thrombolysis. CT scan of the brain, performed about 6 h later due to neurological

Leonard L. L. Yeo; Joline Si Jing Lim; Vijay K. Sharma

2009-01-01

63

Comparison of low doses of intrathecal bupivacaine in combined spinal epidural anaesthesia with epidural volume extension for caesarean delivery  

PubMed Central

Aims and Objectives: This study aims to compare relative efficacy of three different doses of intrathecal bupivacaine in combined spinal epidural anaesthesia (CSEA) for caesarean delivery. Materials and Methods: In a double blinded manner, 204 cases were randomized into three groups: I, II, and III to receive a dose of 4, 5.5, and 7 mg of hyperbaric bupivacaine with a fixed dose of 25 ?g fentanyl intrathecally, and Dextran 40 w/v 10 mL given for epidural volume extension (EVE), in CSEA. Our primary outcome was the number of effective doses. The block characteristics and side effects were also monitored. Results: Out of 198 patients completing the study, 53, 63, and 65 in group I, II and III had effective doses. Mean Pi (probability of an effective dose) in group I, II, and III, was 0.81, 0.95, and 0.97, respectively. The Pb (superiority of one group over the other) of group II and III was higher than group I. The maximal sensory block height in group II and III (T2) was higher than group I (T3), with a shorter time required to achieve the same. Group I and II exhibited lesser motor blockade, lesser hypotension with early recovery as compared to group III. No significant adverse effects were observed between the groups. Conclusion: The intermediate dose of bupivacaine (5.5 mg) provided safe and effective anaesthesia for caesarean delivery with an additional advantage of lesser episodes of hypotension and partial motor blockade in CSEA.

Jain, Gaurav; Singh, Dinesh K.; Bansal, Pranav; Ahmed, Bashir; Dhama, Satyavir S.

2012-01-01

64

Spinal epidural granulocytic sarcoma in non-leukemic patient.  

PubMed

A previously healthy 24-year-old male presented with a 3-month history of progressive backache and weakness in both legs. Magnetic resonance imaging of the spine showed a large soft tissue mass infiltrating paraspinal musculature of lumbosacral area, sacral laminas, last lumbar and all sacral vertebra, protruding into the spinal canal, and with propagation into pelvis. Baseline laboratory data were normal. Decompressive laminectomy and tumor removal were performed resulting in neurological improvement. Histological examination identified granulocytic sarcoma (GS). Bone marrow biopsy showed normal findings. The patient underwent adjuvant chemotherapy and radiotherapy, resulting in the elimination of residual lesion, followed by autologous transplant. Immediate diagnosis and adequate systematic treatment are essential to achieve optimal results in patients with isolated GS. The patient is alive and free of the disease 14 months from the diagnosis. PMID:19109732

Antic, Darko; Verstovsek, Srdan; Elezovic, Ivo; Grujicic, Dana; Gotic, Mirjana; Bila, Jelena; Perunicic, Maja; Jakovic, Ljubomir

2009-01-01

65

Spinal Cord Stimulation for Chronic Pain Management  

Microsoft Academic Search

This article outlines the role of spinal cord stimulation in contemporary chronic pain management. The anatomical and neurophysiological correlates of stimulation of the intraspinal structures are discussed. The most common indications are presented, including failed back syndrome, reflex sympathetic dystrophy, neurogenic thoracic outlet syndrome, and spinal cord injury, etc. The most common complications are presented, including paralysis, infection, electrode migration,

Giancarlo Barolat

2000-01-01

66

Primary spinal epidural lymphoma: Patients' profile, outcome, and prognostic factors: A multicenter Rare Cancer Network study  

SciTech Connect

Purpose To assess the clinical profile, treatment outcome, and prognostic factors in primary spinal epidural lymphoma (PSEL). Methods and Materials Between 1982 and 2002, 52 consecutive patients with PSEL were treated in nine institutions of the Rare Cancer Network. Forty-eight patients had an Ann Arbor stage IE and four had a stage IIE. Forty-eight patients underwent decompressive laminectomy, all received radiotherapy (RT) with (n = 32) or without chemotherapy (n = 20). Median RT dose was 36 Gy (range, 6-50 Gy). Results Six (11%) patients progressed locally and 22 (42%) had a systemic relapse. At last follow-up, 28 patients were alive and 24 had died. The 5-year overall survival, disease-free survival, and local control were 69%, 57%, and 88%, respectively. In univariate analyses, favorable prognostic factors were younger age and complete neurologic response. Multivariate analysis showed that combined modality treatment, RT volume, total dose more than 36 Gy, tumor resection, and complete neurologic response were favorable prognostic factors. Conclusions Primary spinal epidural lymphoma has distinct clinical features and outcome, with a relatively good prognosis. After therapy, local control is excellent and systemic relapse occurs in less than half the cases. Combined modality treatment appears to be superior to RT alone.

Monnard, Virginie [Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Sun, Alex [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario (Canada); Epelbaum, Ron [Department of Oncology, Rambam Medical Centre, Haifa (Israel); Poortmans, Philip [Department of Radiotherapy, Dr. Bernard Verbeeten Instituut, Tilburg (Netherlands); Miller, Robert C. [Division of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Verschueren, Tom [Department of Radiation Oncology MAASTRO, University Hospital, Maastricht (Netherlands); Scandolaro, Luciano [Department of Radiation Oncology, Ospedale Sant'Anna, Como (Italy); Villa, Salvador [Department of Radiation Oncology, Institut Catala d'Oncologia, Barcelona (Spain); Majno, Sabine Balmer [Hopital Cantonal Universitaire de Geneve (HCUGE), Geneva (Switzerland); Ostermann, Sandrine [Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Ozsahin, Mahmut [Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Mirimanoff, Rene-Olivier [Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland)]. E-mail: rene-olivier.mirimanoff@chuv.ch

2006-07-01

67

Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases  

Microsoft Academic Search

Summary Objective. To identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH). Methods. The literature was reviewed reguarding non-operative cases of SSEH (SSEH cons). Sixty-two cases from the literature and 2 of our own cases were collected, focusing on sex, age, medical history, position of the hematoma, segmental distribution and length of the

R. J. M. Groen

2004-01-01

68

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

PubMed

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

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

2013-10-01

69

Suspected epidural morphine analgesia induced chronic urinary and bowel dysfunction in a cat.  

PubMed

A 12-year-old male castrated domestic shorthair developed chronic urinary retention, constipation and a decreased perineal reflex following a single lumbo-sacral epidural injection of morphine during general anesthesia. Similar adverse effects have been reported in humans following epidural analgesia, but this is the first reported case of both urinary and bowel dysfunction in a cat purportedly from an epidural. The cat was medically managed with manual bladder expressions, intermittent enemas, and various medications including bethanechol, cisapride and stool softeners. The cat continues to have long-term neurologic dysfunction 15 months post-onset. This case report describes a rare but serious potential risk of lumbo-sacral epidural injections in cats. PMID:21571562

Song, Rachel B; Cross, Johnny R; Golder, Francis J; Callan, Mary Beth

2011-08-01

70

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

PubMed

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

Kim, Young Sung; Park, Ji Hye; Lee, Shin Young; Lim, Byung Gun; Kim, Heezoo; Lee, Il-Ok; Kong, Myoung-Hoon

2014-08-01

71

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

PubMed Central

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.

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

2014-01-01

72

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

PubMed Central

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 C5–6 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

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

2012-01-01

73

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

PubMed Central

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

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

1988-01-01

74

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

PubMed

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

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

1988-03-01

75

Extensive long-segment cervicothoracic traumatic spinal epidural hematoma with avulsion of C7, C8, and T1 nerve roots.  

PubMed

Traumatic spinal epidural hematoma (TSEH) is of rare clinical occurrence. We report a case of a young man with posttraumatic long-segment spinal epidural hematoma. Evacuation of the hematoma led to complete neurologic recovery in our patient. Our case highlights the importance of early diagnosis and prompt surgical intervention for the evacuation of hematoma in preservation or maximum recovery of neurologic function. Imaging findings, management options, and the relevant literature are reviewed. PMID:25288853

Garg, Kanwaljeet; Satyarthee, Guru Dutta; Singla, Raghav; Sharma, Bhawani Shankar

2014-10-01

76

Extensive long-segment cervicothoracic traumatic spinal epidural hematoma with avulsion of C7, C8, and T1 nerve roots  

PubMed Central

Traumatic spinal epidural hematoma (TSEH) is of rare clinical occurrence. We report a case of a young man with posttraumatic long-segment spinal epidural hematoma. Evacuation of the hematoma led to complete neurologic recovery in our patient. Our case highlights the importance of early diagnosis and prompt surgical intervention for the evacuation of hematoma in preservation or maximum recovery of neurologic function. Imaging findings, management options, and the relevant literature are reviewed.

Garg, Kanwaljeet; Satyarthee, Guru Dutta; Singla, Raghav; Sharma, Bhawani Shankar

2014-01-01

77

Corticosteroid-induced spinal epidural lipomatosis in the pediatric age group: report of a new case and updated analysis of the literature  

PubMed Central

Spinal epidural lipomatosis is a rare complication of chronic corticosteroid treatment. We report a new pediatric case and an analysis of this and 19 pediatric cases identified in the international literature. The youngest of these combined 20 patients was 5 years old when lipomatosis was diagnosed. Lipomatosis manifested after a mean of 1.3 (+/- 1.5) years (SD) (median, 0.8 years; range, 3 weeks - 6.5 years) of corticosteroid treatment. The corticosteroid dose at the time of presentation of the lipomatosis ranged widely, between 5 and 80 mg of prednisone/day. Back pain was the most common presenting symptom. Imaging revealed that lipomatosis almost always involved the thoracic spine, extending into the lumbosacral region in a subset of patients. Predominantly lumbosacral involvement was documented in only two cases. Although a neurological deficit at presentation was documented in about half of the cases, surgical decompression was not performed in the cases reported after 1996. Instead, reducing the corticosteroid dose (sometimes combined with dietary restriction to mobilize fat) sufficed to induce remission. In summary, pediatric spinal epidural lipomatosis remains a potentially serious untoward effect of corticosteroid treatment, which, if recognized in a timely manner, can have a good outcome with conservative treatment. PMID:21284882

2011-01-01

78

Spinal epidural abscess penetrating into retroperitoneal space in patient with diabetes mellitus type 2: early diagnosis and treatment requirement.  

PubMed

Spinal epidural abscess (SEA) is a rare condition with very serious prognosis. Predisposing factors for SEA include bacterial infections, immunocompromised states such as diabetes mellitus, intravenous drug abuse, alcoholism, AIDS, as well as spinal surgery and modern techniques of epidural anesthesia. The most common causative agent for SEA is Staphylococcus aureus. The typical clinical signs of SEA are back pain, fever and neurologic dysficit. Magnetic resonance (MR) of the spine and vertebral column is the best imaging diagnostic method in suspected cases. Emergency surgical decompression combined with intravenous antibiotics is the therapeutic method of choice. Conservative treatment may be appropriate in selected patients. Unless the typical presentation of SEA correct diagnosis of this illness is often overlooked and not considered initially. It delays suitable management and leads to poor outcome. We report a classic case of SEA in a woman with a history of diabetes mellitus. PMID:18405176

Grabysa, Rados?aw; Moczulska, Beata

2008-01-01

79

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

PubMed

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

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

2013-09-01

80

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

PubMed Central

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

Akeda, Koji; Tsujii, Masaya; Sudo, Akihiro

2013-01-01

81

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

PubMed Central

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.

Epstein, Nancy E.

2014-01-01

82

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

PubMed

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

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

83

Cervical epidural steroid injections for the treatment of cervical spinal (neck) pain.  

PubMed

Cervical epidural steroid injections (CESI) are an accepted treatment for neck pain with a radicular component, and may be accomplished by using either transforaminal (CTFESI) or interlaminar (CILESI) approaches. CESIs are routinely performed using real-time fluoroscopic-guidance in conjunction with the injection of water soluble, iodine-based contrast media to enhance visualization of intravascular injections. Digital subtraction angiography (DSA) imaging is an adjuvant to fluoroscopic methods for visualizing blood vessels while performing spinal injections. However, as with any neuraxial procedure, various complications associated with CESIs have been reported. Complications are directly associated with the technical procedures of CESIs. Particulate steroids may have a prolonged duration of action but non-particulate steroids are safer for CESIs. Blunt-beveled needles are less likely than sharp-beveled needles to penetrate blood vessels to cause bleeding complications during CTFESI procedures. Small doses of local anesthetics appear to be safe and assist in identifying intravascular injections previously overlooked by conventional techniques. PMID:23315021

Candido, Kenneth D; Knezevic, Nebojsa 'nick'

2013-02-01

84

[Paradigm shift in the management of metastatic epidural spinal cord compression: the importance of preserving ambulation].  

PubMed

In 2005, a Landmark study showed that direct decompressive surgery, followed by postoperative external beam radiotherapy (EBRT) is superior to EBRT alone in patients with metastatic epidural spinal cord compression (MESCC). Patients undergoing both surgery and EBRT had similar median survival but experienced longer ambulation than with EBRT alone. Additional studies have shown improvements in quality-of-life, higher cost-effectiveness, improved pain control, and higher functional status with surgery plus EBRT. Improved neurological outcome also improved the patients' ability to undergo postoperative adjuvant therapy. According to our experience, even patients over 65 or patients with aggressive primary tumors and additional metastases have benefited from surgical intervention, living longer than expected with preservation of ambulation and sphincter control until death or shortly before. Preserving ambulation is critical. With current surgical devices and techniques, patients with MESCC who present with a single area of cord compression, back pain, neurological deficit, or progressive deformity, may benefit from surgery prior to adjuvant radiation-based treatment or chemotherapy. PMID:24482995

Itshayek, Eyal

2013-12-01

85

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

PubMed

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

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

2014-01-01

86

Anesthetic Management of Chronic Spinal Cord Injury  

Microsoft Academic Search

\\u000a As longevity increases for patients with spinal cord injuries (SCI), operative procedures are often necessary to further rehabilitation,\\u000a control pain, evaluate urinary dysfunction, maintain skin integrity and reverse further neurologic degeneration. Increasingly,\\u000a SCI women are completing pregnancies. Considerations for anesthetic management of patients with chronic SCI include avoiding\\u000a autonomic hyperreflexia and hyperkalemia-related to succinylcholine, preventing exacerbations of pulmonary dysfunction and

Patricia H. Petrozza

87

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

PubMed Central

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

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

2012-01-01

88

Does diffusion tensor data reflect pathological changes in the spinal cord with chronic injury  

PubMed Central

Magnetic resonance diffusion tensor imaging has been shown to quantitatively measure the early pathological changes in chronic cervical spondylotic myelopathy. In this study, a novel spongy polyurethane material was implanted in the rat C3–5 epidural space to establish a rat model of chronic cervical spondylotic myelopathy. Diffusion tensor data were used to predict pathological changes. Results revealed that the fractional anisotropy value gradually decreased at 4, 24, and 72 hours and 1 week after injury in rat spinal cord, showing a time-dependent manner. Average diffusion coefficient increased at 72 hours and 1 week after implantation. Hematoxylin-eosin staining and Luxol-fast-blue staining exhibited that the number of neurons in the anterior horn of the spinal cord gray matter and the nerve fiber density of the white matter gradually reduced with prolonged compression time. Neuronal loss was most significant at 1 week after injury. Results verified that the fractional anisotropy value and average diffusion coefficient reflected the degree of pathological change in the site of compression in rat models at various time points after chronic spinal cord compression injury, which potentially has a reference value in the early diagnosis of chronic cervical spondylotic myelopathy.

Lin, Erjian; Long, Houqing; Li, Guangsheng; Lei, Wanlong

2013-01-01

89

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

PubMed

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. PMID:25358531

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

2014-12-01

90

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

PubMed Central

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

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

2012-01-01

91

Post-traumatic venous and systemic air embolism associated with spinal epidural emphysema: multi-slice computed tomography diagnosis.  

PubMed

A 30-year-old man was admitted with chest trauma after a road traffic accident. The patient was paraplegic and suffered from transient monoparesia of the left arm. The chest X-ray revealed a severe right tension pneumothorax and thoracic spine fractures. Emergency right thoracic drainage was carried out followed by angiography. Unfortunately the patient died and an autopsy was not permitted. Consequently post-mortem multi-slice computed tomography (MSCT) was performed, revealing presence of air inside the right cerebral arteries, bilateral pneumothorax accompanied by a severe right tension pneumothorax, bilateral haematic pleural effusion, pneumomediastinum and bilateral lung contusions. Air was also observed within the right coronary artery, ascending aorta and right ventricle. Thoracic and cervical spinal epidural emphysema were diagnosed. Venous air embolism followed by arterial air embolism producing paradoxical embolism was diagnosed. To the best of our knowledge, this is the first case illustrating by post-mortem MSCT such simultaneous complications after chest trauma as spinal epidural emphysema and cerebral and coronary air embolism. PMID:16153795

Dedouit, Fabrice; Otal, Philippe; Loubes-Lacroix, Florence; Rousseau, Hervé; Costagliola, Rémi; Telmon, Norbert; Joffre, Francis; Rouge, Daniel

2006-05-10

92

Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques.  

PubMed

Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects. Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient. PMID:25081960

Smith, Gabriel A; Kochar, Arshneel S; Manjila, Sunil; Onwuzulike, Kaine; Geertman, Robert T; Anderson, James S; Steinmetz, Michael P

2014-08-01

93

Classification of chronic pain associated with spinal cord injuries  

Microsoft Academic Search

Cardenas DD, Turner JA, Warms CA, Marshall HM. Classification of chronic pain associated with spinal cord injuries. Arch Phys Med Rehabil 2002;83:1708-14. Objectives: To determine interrater reliability of a classification system for chronic pain in persons with spinal cord injury (SCI) and to determine the frequency and characteristics of various pain types as categorized by this system. Design: Independent categorization

Diana D. Cardenas; Judith A. Turner; Catherine A. Warms; Helen M. Marshall

2002-01-01

94

Case report Spontaneous spinal epidural haematoma during pregnancy: case report and review of the literature  

Microsoft Academic Search

Spontaneous epidural haematoma is rare in pregnancy and only five cases have been reported. We present a case of a 31-year-old female G2P1 who at 32 weeks of gestation developed progressive ascending paralysis and numbness to a level of approximately T4. An urgent MRI of the spine was performed, which demonstrated a posterior epidural lesion at T1-T4 level. The lesion

P SZKUP; G STONEHAM

95

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

PubMed Central

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

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

96

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

SciTech Connect

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.

Fitzpatrick, David [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada) [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada); St Luke's Hospital, Dublin (Ireland); Grabarz, Daniel [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada) [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada); Centro Oncologia Mendel and Associados, Sao Paulo (Brazil); Wang, Lisa [Department of Biostatistics, Princess Margaret Hospital, University Health Network, University of Toronto (Canada)] [Department of Biostatistics, Princess Margaret Hospital, University Health Network, University of Toronto (Canada); Bezjak, Andrea [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada)] [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada); Fehlings, Michael G. [Division of Neurosurgery, Krembil Neuroscience Center, Spinal Program, Toronto Western Hospital, University Health Network, University of Toronto (Canada)] [Division of Neurosurgery, Krembil Neuroscience Center, Spinal Program, Toronto Western Hospital, University Health Network, University of Toronto (Canada); Fosker, Christopher [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada)] [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada); Rampersaud, Raja [Division of Orthopaedic Surgery, Krembil Neuroscience Center, Spinal Program, Toronto Western Hospital, University Health Network, University of Toronto (Canada)] [Division of Orthopaedic Surgery, Krembil Neuroscience Center, Spinal Program, Toronto Western Hospital, University Health Network, University of Toronto (Canada); Wong, Rebecca K.S., E-mail: rebecca.wong@rmp.uhn.on.ca [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada)

2012-10-01

97

Holospinal epidural abscess.  

PubMed

Holospinal epidural abscess (HEA) is an extremely rare condition in which spinal epidural abscesses extend from the cervical to the sacral spine. We report two patients who presented with myelopathy secondary to HEA. Both patients underwent urgent surgical decompression and abscess drainage, and had significant improvement in neurological function. We discuss the surgical management strategies and briefly review the literature regarding HEA. PMID:24128769

Lau, Darryl; Maa, John; Mummaneni, Praveen V; Chou, Dean

2014-03-01

98

Time-Dependent Effect of Epidural Steroid on Pain Behavior Induced by Chronic Compression of Dorsal Root Ganglion in Rats  

PubMed Central

Although epidural steroid injection has been commonly used to treat radicular pain, its clinical efficacy remains controversial. In a rat model of radicular pain induced by chronic compression of lumbar dorsal root ganglion (CCD), we examined the effect of epidural steroid on CCD-induced pain behavior. Triamcinolone [a glucocorticoid receptor (GR) agonist] or RU38486 (a GR antagonist) was given epidurally once either on day 3 (early treatment) or day 10 (late treatment) after CCD. The results showed that 1) early treatment with triamcinolone and RU38486 alone, respectively, reduced and exacerbated mechanical allodynia and thermal hyperalgesia, 2) late treatment with triamcinolone alone failed to improve mechanical allodynia and only transiently attenuated thermal hyperalgesia, and 3) late treatment with RU38486 alone improved mechanical allodynia and thermal hyperalgesia in CCD rats. Moreover, a second dose of triamcinolone given on day 10 paradoxically exacerbated pain behavior in CCD rats that received a first dose of triamcinolone on day 3. These results indicate that the effect of epidural steroid on radicular pain may be time-dependent. Clinical implications for epidural steroid treatment are discussed in light of these preclinical findings. PMID:17869229

Gu, Xiaoping; Wang, Shuxing; Yang, Liling; Sung, Backil; Lim, Grewo; Mao, Ji; Zeng, Qing; Chang, Yang; Mao, Jianren

2012-01-01

99

In utero Spontaneous Cervical Thoracic Epidural Hematoma Imitating Spinal Cord Birth Injury  

Microsoft Academic Search

A neonate male born cesarian due to a breech presentation was noted to have no spontaneous movements of the limbs after delivery. Radiographs were not demonstrative of pathology. However, MRI revealed a large intraspinal mass with significant distortion of the cervicothoracic spinal cord. At operation, a brown, fibro-gelatinous, moderately adherent mass was evident extradurally dorsal to the spinal cord. It

Jeffrey Blount; Kyle Doughty; R. Shane Tubbs; John C. Wellons; Alyssa Reddy; Charlie Law; Virginia Karle; W. Jerry Oakes

2004-01-01

100

Enhanced suppression of hormonal and metabolic responses to stress by application of combined spinal-epidural and general anaesthesia compared with combined spinal general anaesthesia during colorectal surgery.  

PubMed

The aim of the study was to determine the impact of combined spinal-epidural and general anesthesia (CSEGA) on the suppression of the hormonal and metabolic response to surgical stress and to compare it with the technique of combined spinal and general anesthesia (CSGA). Sixteen patients referred for elective colorectal surgery randomly divided into two groups on the basis of anesthesia (CSEGA and CSGA). Mean arterial blood pressure, heart rate, haemoglobin saturation, serum glucose, serum cortisol and urinary catecholamines (adrenaline, noradrenaline and dopamine) were determined at four distinct peri-operative time points. During the peri-operative period the overall haemodynamic and respiratory functions in patients that received CSEGA were superior compared to those in patients that received CSGA. Biochemical analysis revealed that in the sera of patients that received CSEGA the concentration of both glucose and cortisol was elevated to a lesser degree than that observed in the sera of patients that received CSGA. Furthermore, a significant reduction in post-operative urinary catecholamine (adrenaline and noradrenaline) excretion was apparent in the CSEGA group. We conclude that CSEGA is a more suitable form of combined anaesthesia for colorectal surgery with a clear advantage of a blunted surgery-mediated neuro-endocrine stress response. PMID:18457100

Malenkovi?, Vesna; Baricevi?, Ivona; Jones, D R; Nedi?, Olgica; Bilanovi?, D

2008-01-01

101

Interlaminar Epidural Steroid Injection for Degenerative Lumbar Spinal Canal Stenosis: Does the Intervertebral Level of Performance Matter?  

PubMed Central

Background Interlaminar epidural steroid injections (ILESIs) are commonly employed in the management of patients with symptomatic degenerative lumbar spinal canal stenosis despite little experimental evidence to guide technique optimization. One untested performance parameter is the intervertebral level at which the ILESI should be performed for maximum patient relief. Methods This study randomized patients with symptomatic degenerative lumbar spinal canal stenosis to receive an ILESI at the level of maximal spinal canal stenosis or at a normal/less stenotic intervertebral site 2 intervertebral levels cephalad to the level of maximal stenosis. Pain with ambulation and Roland Morris Disability Questionnaire scores were collected prior to the procedure and at 1-, 4-, and 12-week follow-ups. Results Fifty-seven patients were enrolled. Thirty patients (Group 1) received an ILESI at the level of maximal stenosis; 27 patients (Group 2) received an ILESI at a less stenotic level. The mean baseline preprocedural maximal pain with ambulation and disability scores for the 2 groups were not significantly different (P=0.94 and P=0.13, respectively). Patients' pain with ambulation scores were significantly lower in Group 1 compared to Group 2 at 1 and 4 weeks postinjection, but they were not significantly lower at 12 weeks (1 week, P=0.045; 4 weeks, P=0.049; 12 weeks, P=0.08). The mean Roland Morris Disability Questionnaire scores at 1, 4, and 12 weeks postinjection were significantly lower in Group 1 as compared to Group 2 (P=0.001, P=0.009, P=0.003, respectively). Conclusion Results suggest that patient symptom improvement is optimized when the ILESI is performed at the intervertebral level of maximal stenosis. PMID:24688335

Milburn, James; Freeman, Jeffrey; Steven, Andrew; Altmeyer, Wilson; Kay, Dennis

2014-01-01

102

Efficacy of Spinal Manipulation for Chronic Headache: A Systematic Review  

Microsoft Academic Search

Background: Chronic headache is a preva- lent condition with substantial socioeco- nomic impact. Complementary or alterna- tive therapies are increasingly being used by patients to treat headache pain, and spinal manipulative therapy (SMT) is among the most common of these. Objective: To assess the efficacy\\/effectiveness of SMT for chronic headache through a systematic review of randomized clinical trials. Study Selection:

Gert Bronfort; Willem J. J. Assendelft; Roni Evans; Lex Bouter

103

Gait ataxia as a presenting symptom of malignant epidural spinal cord compression.  

PubMed Central

A 68 year old man with prostatic carcinoma developed spinal cord compression. The sole presenting feature was painless gait ataxia indistinguishable from cerebellar ataxia. He was investigated for cerebellar disease but the correct diagnosis was made when he subsequently presented with paraplegia and classical signs of spinal cord compression. Surgical decompression failed to produce neurological recovery. We discuss the importance of recognizing this unusual presentation of spinal cord compression, its possible mechanism and evidence that it may be under-reported. Images Figure 1 Figure 2 PMID:3774706

Karp, S. J.; Ho, R. T.

1986-01-01

104

Efficacy of spinal manipulation for chronic headache: A systematic review  

Microsoft Academic Search

Background: Chronic headache is a prevalent condition with substantial socioeconomic impact. Complementary or alternative therapies are increasingly being used by patients to treat headache pain, and spinal manipulative therapy (SMT) is among the most common of these.Objective: To assess the efficacy\\/effectiveness of SMT for chronic headache through a systematic review of randomized clinical trials.Study Selection: Randomized clinical trials on chronic

Gert Bronfort; Willem J. J. Assendelft; Roni Evans; Mitchell Haas; Lex Bouter

2001-01-01

105

Epidural Spinal Cord Electrical Stimulation in Diabetic Critical Lower Limb Ischemia  

Microsoft Academic Search

Spinal cord stimulation (SCS) has been suggested to improve microcirculatory blood flow to relieve ischemic pain and to reduce amputation rate in patients with peripheral arterial occlusive disease (PAOD). The aim of this study was to evaluate the specific prognostic parameters in the prediction of successful SCS, in diabetic patients, performing a retrospective data analysis. To perform this evaluation, 64

Ioannis E Petrakis; Vincenzo Sciacca

1999-01-01

106

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

PubMed Central

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

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

2012-01-01

107

Spinal cord stimulation and the relief of chronic pain  

Microsoft Academic Search

Twenty six patients who had received spinal cord stimulation for chronic pain were evaluated by videotaped structured interviews with staff not directly involved in the patients' care. In addition estimates of pain relief were obtained from clinicians involved in the patients' care and from close relatives and friends. Information about lifestyles and drug usage was also collected and correlated with

T H Koeze; A C Williams; S Reiman

1987-01-01

108

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

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.

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

2013-01-01

109

Dietary therapy to promote neuroprotection in chronic spinal cord injury  

PubMed Central

Object The pathogenesis of cervical spondylotic myelopathy (CSM) is related to both primary mechanical and secondary biological injury. The authors of this study explored a novel, noninvasive method of promoting neuroprotection in myelopathy by using curcumin to minimize oxidative cellular injury and the capacity of omega-3 fatty acids to support membrane structure and improve neurotransmission. Methods An animal model of CSM was created using a nonresorbable expandable polymer placed in the thoracic epidural space, which induced delayed myelopathy. Animals that underwent placement of the expandable polymer were exposed to either a diet rich in docosahexaenoic acid and curcumin (DHA-Cur) or a standard Western diet (WD). Twenty-seven animals underwent serial gait testing, and spinal cord molecular assessments were performed after the 6-week study period. Results At the conclusion of the study period, gait analysis revealed significantly worse function in the WD group than in the DHA-Cur group. Levels of brain-derived neurotrophic factor (BDNF), syntaxin-3, and 4-hydroxynonenal (4-HNE) were measured in the thoracic region affected by compression and lumbar enlargement. Results showed that BDNF levels in the DHA-Cur group were not significantly different from those in the intact animals but were significantly greater than in the WD group. Significantly higher lumbar enlargement syntaxin-3 in the DHA-Cur animals combined with a reduction in lipid peroxidation (4-HNE) indicated a possible healing effect on the plasma membrane. Conclusions Data in this study demonstrated that DHA-Cur can promote spinal cord neuroprotection and neutralize the clinical and biochemical effects of myelopathy. PMID:22735048

Holly, Langston T.; Blaskiewicz, Donald; Wu, Aiguo; Feng, Cameron; Ying, Zhe; Gomez-Pinilla, Fernando

2013-01-01

110

Spinal cord stimulation: Current applications for treatment of chronic pain  

PubMed Central

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.

Vannemreddy, Prasad; Slavin, Konstantin V.

2011-01-01

111

Unusual presentation of spinal lipomatosis  

PubMed Central

Spinal epidural lipomatosis (SEL) is a rare condition characterized by overgrowth of normal adipose tissue in the extradural space within the spinal canal that can lead to significant spinal cord compression. It is most commonly reported in patients receiving chronic glucocorticoid therapy. Other causes can include obesity and hypercortisolism. Occasionally, idiopathic SEL will occur in patients with no known risk factors, but cases are more generally reported in obesity and males. We present the case of a 35 year-old non-obese woman found to have rapidly progressive SEL that was not associated with any of the common causes of the disorder.

Stephenson, William; Kauflin, Matthew J

2014-01-01

112

Psychological distress in chronic craniomandibular and cervical spinal pain patients.  

PubMed

Recent studies to chronic pain have shown that the number of painful body areas is related to the level of psychological distress. Therefore, the first aim of this study was to analyse differences in level of psychological distress between craniomandibular pain patients with or without cervical spinal pain. In this analysis, the number of painful body areas below the cervical spine was also taken into account. The second aim was to determine psychological differences between subgroups of craniomandibular pain patients. In this study, 103 out of 250 persons with or without craniomandibular pain were included in the final analyses. Patients who suffered from both craniomandibular and cervical spinal pain showed higher levels of psychological distress, as measured with the Symptom Checklist 90 (SCL-90) than patients with local craniomandibular pain and persons without pain. Further, a positive relationship was found between the number of painful body areas below the cervical spine, as measured on a body drawing, and the SCL-90 scores. No psychological differences were found between myogenous and arthrogenous craniomandibular pain patients. In conclusion, chronic craniomandibular pain patients with a coexistent cervical spinal pain showed more psychological distress compared to patients with only a local craniomandibular pain and asymptomatic persons. PMID:11456346

Visscher, C M; Lobbezoo, F; de Boer, W; van der Meulen, M; Naeije, M

2001-06-01

113

Disseminated Cunninghamella bertholletiae infection with spinal epidural abscess in a kidney transplant patient: case report and literature review.  

PubMed

Cunninghamella bertholletiae is a rare cause of invasive mucormycosis. We report the case of a 42-year-old Thai woman who suffered from disseminated C. bertholletiae infection. The patient developed dry cough, sharp shooting pain in the left buttock referred to the left leg, and fever 1 month after undergoing deceased-donor kidney transplantation. Radiographic studies exhibited multiple pulmonary cavities, osteomyelitis of the sacral spine, epidural abscess along the lumbrosacral spine, and paravertebral soft tissue involvement. Surgical debridement of the epidural abscess concurrent with prolonged intravenous administration of amphotericin B resulted in a good outcome. PMID:24962170

Navanukroh, O; Jitmuang, A; Chayakulkeeree, M; Ngamskulrungroj, P

2014-08-01

114

A Perioperative strategy for the placement of a thoracic epidural in a pediatric patient on high dose enoxaprin  

Microsoft Academic Search

Introduction: Thoracic epidurals are the gold standard for the management of postoperative pain in a patient having a thoracotomy. The placement of neuraxial anesthesia in a patient on chronic anticoagulants requires a clearly defined perioperative plan that balances the risk of a thrombotic event with the obvious and potentially devastating risk of a spinal hematoma. It is critical that the

EH Jooste

115

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

PubMed Central

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

Bhakta, Pradipta; Bakshi, Anamika; Langer, Vijay

2011-01-01

116

MR-imaging of chronic spinal cord injury. Association with neurologic function  

Microsoft Academic Search

Twenty-two para- and tetraplegic patients with chronic spinal cord injuries were examined with magnetic resonance imaging (MRI). The clinical course in the entire rehabilitation period was recorded and an attempt was made to associate the functional status of the patients with the morphologic findings on MRI. Small and large spinal cord cysts and syringomyelia, cord atrophy, and spinal stenosis were

Andreas Nidecker; Michel Kocher; Marc Maeder; Othmar Gratzl; Guido A. Zäch; Ulrich F. Benz; Bernhard Burckhardt

1991-01-01

117

Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement  

Microsoft Academic Search

Objective. Initial presentation with primary spinal involvement in chronic recurrent multifocal osteomyelitis of childhood (CRMO) is rare. Our objective was to review the imaging appearances of three patients who had CRMO who initially presented with isolated primary spinal involvement.Design and patients. The imaging, clinical, laboratory and histology findings of the three patients were retrospectively reviewed. Imaging included seven spinal MR

S. E. Anderson; P. Heini; M. J. Sauvain; E. Stauffer; L. Geiger; J. O. Johnston; A. Roggo; D. Kalbermatten; L. S. Steinbach

2003-01-01

118

Primary Thoracic Epidural Melanoma : A Case Report  

PubMed Central

A 68-year-old woman with progressive paraparesis and altered sensation lasting approximately five days was admitted to our clinic. Magnetic resonance imaging (MRI) revealed an advanced stage T7-8 epidural mass ventral to the spinal cord, which was believed to be a metastatic tumor considering the patient's age. A highly enhanced epidural mass and pedicle appeared during the MR scan. However, the pathologic findings were compatible with the diagnosis of a primary meningeal melanocytic tumor. Primary epidural melanomas are extremely rare lesions. This case was finally diagnosed as a primary thoracic spinal epidural melanoma. PMID:20622955

Jo, Kwang-Wook; Kim, Sang-Don; Park, Ik-Seong

2010-01-01

119

Study of quality and extent of intrathecal bupivacaine block by extradural injection of bupivacaine or normal saline in combined spinal epidural technique  

PubMed Central

Aims: The aim of the present study is to substantiate and compare the quality and extent of nerve block by using intrathecal bupivacaine or extradural bupivacaine alone and in combined spinal-epidural (CSE) technique using smaller dose of intrathecal bupivacaine and extradural injection of a smaller dose of bupivacaine or normal saline. Setting and Design: A prospective study design was set up with 60 adult patients scheduled for vaginal and lower abdominal operation under CSE technique and single spinal or epidural technique. Materials and Methods: 60 patients undergoing infra-umbilical surgery were divided into three groups (Group). Group A1 (control) 10 patients received 3 ml of intrathecal heavy bupivacaine. A2-10 patients received 16 ml isobaric bupivacaine extradurally Group B (n = 20) patients received 2 ml intrathecal heavy bupivacaine and 10 ml normal saline extradurally. Group C patients (n = 20) received 2 ml heavy bupivacaine intrathecally and 10 ml isobaric bupivacaine extradurally. A total duration of this study was 18 months. Duration of motor block, sensory block, analgesia, onset of sensory block and cephaloid extent of sensory block and side-effects noted among patients. Visual analog scale in the post-operative period was recorded. Statistical Analysis: The results were analyzed statistically by applying analysis of variable, odds ratio and Chi-square test. Results: Patients were comparable regarding the onset time and height and duration of sensory block with a significant difference, though there was no difference in duration of motor block and analgesia. The side-effects in the control group are higher than the other two groups. Conclusion: Quality of nerve block in combined technique using bupivacaine both intrathecally and extradurally is better and associated with lower side-effect compared with intrathecal heavy bupivacaine or extradural isobaric bupivacaine alone.

Guha (Banerjee), Sarmila; Bandyopadhyay, Ujjwal; Pan, Pradyut Kumar; Sinha, Arijit

2014-01-01

120

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

PubMed

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 inflammation and immunity exert both beneficial (plasticity enhancing) and detrimental (e.g. glia- and neurodegenerative; secondary damage) effects and these functions change over time. Moreover, "compartimentalized" 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 are 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 context 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

Schwab, Jan M; Zhang, Yi; Kopp, Marcel A; Brommer, Benedikt; Popovich, Phillip G

2014-08-01

121

Chronic spinal infusion of loperamide alleviates postsurgical pain in rats.  

PubMed

Plantar incision in rat generates spontaneous pain behaviour. The opioid drug, morphine used to treat postsurgical pain produces tolerance after long-term administration. Loperamide, a potent mu-opioid agonist, has documented analgesic action in various pain conditions. However, loperamide analgesia and associated tolerance following continuous spinal administration in postsurgical pain has not been reported. Chronic spinal infusion of drugs was achieved using intrathecal catheters connected to osmotic minipump. Coinciding with the onset of spinal infusion of loperamide or morphine, rats were subjected to plantar incision. Pain-related behaviour was assessed by Hargreaves apparatus (thermal hyperalgesia) and von Frey filaments (mechanical allodynia). Morphine and loperamide (0.5, 1 and 2 microL/h) induced analgesia was observed until 7th day post-plantar incision in Sprague-Dawley rats. Morphine and loperamide produced dose-dependent analgesia. Loperamide, in the highest dose, produced analgesia till 7th day. However, the highest dose of morphine produced inhibition of thermal hyperalgesia till 5th day and mechanical allodynia only till 3rd day post-plantar incision. Morphine and loperamide produced analgesia in postsurgical pain, which may be mediated through different mechanisms. Longer duration of analgesia with loperamide could probably be due sustained blockade of calcium channels. PMID:24772934

Kumar, Rakesh; Reeta, K H; Ray, Subrata Basu

2014-04-01

122

Mechanical and thermal allodynia in chronic central pain following spinal cord injury  

Microsoft Academic Search

Spinal cord injury (SCI) results in variable motor recoveries and chronic central pain syndromes develop in the majority of SCI patients. To provide a basis for further studies, we report a new rodent model of chronic central pain following spinal cord trauma. Male Sprague-Dawley rats (N = 10) were hemisectioned at T13 and were tested both preoperatively and postoperatively and

Marc D Christensen; Alex W Everhart; Jason T Pickelman; Claire E Hulsebosch

1996-01-01

123

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

MedlinePLUS

... the Optimal Number of Spinal Manipulation Sessions for Chronic Low-Back Pain Findings from the largest and most rigorous, randomized ... response study of spinal manipulative therapy (SMT) for chronic low-back pain suggest that 12 sessions (SMT) may be the ...

124

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

PubMed Central

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 37–39 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

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

2012-01-01

125

[Estimates of life expectancy for individuals with chronic spinal diseases in Brazil].  

PubMed

Chronic spinal diseases, including deformities and muscular pain, are significant causes of morbidity among adults and the elderly. The scope of this study is to assess the life expectancy of Brazilians with chronic spinal diseases by sex and age between 2003 and 2008. The Sullivan method was used, combining the mortality/actuarial table with the prevalence of chronic spinal diseases. The mortality/actuarial tables published by the Brazilian Institute of Geography and Statistics (IBGE) were used and the prevalence of chronic spinal diseases was taken from the Brazilian Household Sample Survey (PNAD) for the years under scrutiny. The main results indicate that a man born in Brazil in 2008 could expect to live for 69.1 years, of which 15% with chronic spinal diseases. However, women born in the same year had a life expectancy of 76.7 years and could expect to live a fifth of their lives with chronic spinal diseases. Over the period under analysis, concurrently with gains in life expectancy, there was an increase in healthy life expectancy, or length of life lived without chronic spinal diseases, both in absolute and relative terms. PMID:24897480

Camargos, Mirela Castro Santos

2014-06-01

126

Two chronic motor training paradigms differentially influence acute instrumental learning in spinally transected rats  

Microsoft Academic Search

The effect of two chronic motor training paradigms on the ability of the lumbar spinal cord to perform an acute instrumental learning task was examined in neonatally (postnatal day 5; P5) spinal cord transected (i.e., spinal) rats. At ?P30, rats began either unipedal hindlimb stand training (Stand-Tr; 20–25min\\/day, 5days\\/week), or bipedal hindlimb step training (Step-Tr; 20min\\/day; 5days\\/week) for 7 weeks.

Allison J. Bigbee; Eric D. Crown; Adam R. Ferguson; Roland R. Roy; Niranjala J. K. Tillakaratne; James W. Grau; V. Reggie Edgerton

2007-01-01

127

Responses of the flexor reflex to LSD, tryptamine, 5-hydroxytryptophan, methoxamine, and d -amphetamine in acute and chronic spinal rats  

Microsoft Academic Search

The flexor reflex of acute (40–48 h after mid-thoracic spinal transection) and chronic (at least 2 months after transection) spinal rats was evoked by tetanic electrical stimulation of both hindfeet and recorded on a polygraph using a transducer connected to the left hindfoot. The flexor reflex in the chronic spinal rat was more responsive to electrical stimulation and to the

M. Nozaki; J. A. Bell; D. B. Vaupel; W. R. Martin

1977-01-01

128

Interventional Techniques: Evidence-based Practice Guidelines in the Management of Chronic Spinal Pain  

Microsoft Academic Search

Background: The evidence-based practice guidelines for the management of chronic spinal pain with interventional techniques were developed to provide recommendations to clinicians in the United States. Objective: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain, utilizing all types of evidence and to apply an evidence-based approach, with broad representation of

Mark V. Boswell; Andrea M. Trescot; Sukdeb Datta; David M. Schultz; Hans C. Hansen; Salahadin Abdi; Nalini Sehgal; Rinoo V. Shah; Vijay Singh; Ramsin M. Benyamin; Vikram B. Patel; Ricardo M. Buenaventura; James D. Colson; Harold J. Cordner; Richard S. Epter; Joseph F. Jasper; Elmer E. Dunbar; Sairam L. Atluri; Richard C. Bowman; Timothy R. Deer; John Swicegood; Peter S. Staats; Howard S. Smith; Allen W. Burton; David S. Kloth; James Giordano; Laxmaiah Manchikanti

2007-01-01

129

Takayasu's arteritis: Anesthetic significance and management of a patient for cesarean section using the epidural volume extension technique  

PubMed Central

Takayasu's arteritis (TA) is a rare, chronic progressive pan-endarteritis involving the aorta and its main branches. Anesthesia for patients with TA is complicated by severe uncontrolled hypertension, end-organ dysfunction, stenosis of major blood vessels, and difficulties in monitoring arterial blood pressure. We present the successful anesthetic management of a 23-year-old woman having TA with bilateral subclavian and renal artery stenosis posted for emergency cesarean section by using the epidural volume extension technique, which offers the combined advantage of both spinal and epidural anesthesia and, at the same time, also avoids the need of sophisticated neurological monitors like EEG and transcranial Doppler.

Tiwari, Akhilesh Kumar; Tomar, Gaurav Singh; Chadha, Madhur; Kapoor, Mukul C.

2011-01-01

130

A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease  

PubMed Central

Radiotherapy has been the primary therapy for managing metastatic spinal disease; however, surgery that decompresses the spinal cord circumferentially, followed by reconstruction and immediate stabilization, has also proven effective. We provide a quantitative comparison between the “new” surgery and radiotherapy, based on articles that report on ambulatory status before and after treatment, age, sex, primary neoplasm pathology, and spinal disease distribution. Ambulation was categorized as “success” or “rescue” (proportion of patients ambulatory after treatment and proportion regaining ambulatory function, respectively). Secondary outcomes were also analyzed. We calculated cumulative success and rescue rates for our ambulatory measurements and quantified heterogeneity using a mixed-effects model. We investigated the source of the heterogeneity in both a univariate and multivariate manner with a meta-regression model. Our analysis included data from 24 surgical articles (999 patients) and 4 radiation articles (543 patients), mostly uncontrolled cohort studies (Class III). Surgical patients were 1.3 times more likely to be ambulatory after treatment and twice as likely to regain ambulatory function. Overall ambulatory success rates for surgery and radiation were 85% and 64%, respectively. Primary pathology was the principal factor determining survival. We present the first known formal meta-analysis using data from nonrandomized clinical studies. Although we attempted to control for imbalances between the surgical and radiation groups, significant heterogeneity undoubtedly still exists. Nonetheless, we believe the differences in the outcomes indicate a true difference resulting from treatment. We conclude that surgery should usually be the primary treatment with radiation given as adjuvant therapy. Neurologic status, overall health, extent of disease (spinal and extraspinal), and primary pathology all impact proper treatment selection. PMID:15701283

Klimo, Paul; Thompson, Clinton J.; Kestle, John R.W.; Schmidt, Meic H.

2005-01-01

131

Sleep Disordered Breathing in Chronic Spinal Cord Injury  

PubMed Central

Study Objectives: Spinal cord injury (SCI) is associated with 2-5 times greater prevalence of sleep disordered breathing (SDB) than the general population. The contribution of SCI on sleep and breathing at different levels of injury using two scoring methods has not been assessed. The objectives of this study were to characterize the sleep disturbances in the SCI population and the associated physiological abnormalities using quantitative polysomnography and to determine the contribution of SCI level on the SDB mechanism. Methods: We studied 26 consecutive patients with SCI (8 females; age 42.5 ± 15.5 years; BMI 25.9 ± 4.9 kg/m2; 15 cervical and 11 thoracic levels) by spirometry, a battery of questionnaires and by attended polysomnography with flow and pharyngeal pressure measurements. Inclusion criteria for SCI: chronic SCI (> 6 months post injury), level T6 and above and not on mechanical ventilation. Ventilation, end-tidal CO2 (PETCO2), variability in minute ventilation (VI-CV) and upper airway resistance (RUA) were monitored during wakefulness and NREM sleep in all subjects. Each subject completed brief history and exam, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire (BQ) and fatigue severity scale (FSS). Sleep studies were scored twice, first using standard 2007 American Academy of Sleep Medicine (AASM) criteria and second using new 2012 recommended AASM criteria. Results: Mean PSQI was increased to 10.3 ± 3.7 in SCI patients and 92% had poor sleep quality. Mean ESS was increased 10.4 ± 4.4 in SCI patients and excessive daytime sleepiness (ESS ? 10) was present in 59% of the patients. Daytime fatigue (FSS > 20) was reported in 96% of SCI, while only 46% had high-risk score of SDB on BQ. Forced vital capacity (FVC) in SCI was reduced to 70.5% predicted in supine compared to 78.5% predicted in upright positions (p < 0.05). Likewise forced expiratory volume in first second (FEV1) was 64.9% predicted in supine compared to 74.7% predicted in upright positions (p < 0.05). Mean AHI in SCI patients was 29.3 ± 25.0 vs. 20.0 ± 22.8 events/h using the new and conventional AASM scoring criteria, respectively (p < 0.001). SCI patients had SDB (AHI > 5 events/h) in 77% of the cases using the new AASM scoring criteria compared to 65% using standard conventional criteria (p < 0.05). In cervical SCI, VI decreased from 7.2 ± 1.6 to 5.5 ± 1.3 L/min, whereas PETCO2 and VI-CV, increased during sleep compared to thoracic SCI. Conclusion: The majority of SCI survivors have symptomatic SDB and poor sleep that may be missed if not carefully assessed. Decreased VI and increased PETCO2 during sleep in patients with cervical SCI relative to thoracic SCI suggests that sleep related hypoventilation may contribute to the pathogenesis SDB in patients with chronic cervical SCI. Citation: Sankari A; Bascom A; Oomman S; Badr MS. Sleep disordered breathing in chronic spinal cord injury. J Clin Sleep Med 2014;10(1):65-72. PMID:24426822

Sankari, Abdulghani; Bascom, Amy; Oomman, Sowmini; Badr, M. Safwan

2014-01-01

132

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

PubMed Central

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

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

2013-01-01

133

Effect of capsaicin on micturition and associated reflexes in chronic spinal rats  

Microsoft Academic Search

The role of capsaicin-sensitive bladder afferents in micturition was studied in unanesthetized chronic spinal rats. Reflex voiding in response to tactile stimulation of the perigenital region appeared 5–9 days after spinal cord injury (SCI) whereas voiding induced by bladder distension occurred 2–3 weeks after SCI. The frequency and amplitude of reflex bladder contractions recorded under isovolumetric conditions were similar in

Chen-Li Cheng; Cheng-Ping Ma; William C. de Groat

1995-01-01

134

Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different Approaches  

PubMed Central

Background Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom. PMID:25317285

Singh, Saru; Kaur, Sukhdeep; Singh, Kulvinder; Aujla, Kuljeet

2014-01-01

135

Lumbar Epidural Varix Mimicking Perineural Cyst  

PubMed Central

Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent

2013-01-01

136

Spinal distribution of c-Fos activated neurons expressing enkephalin in acute and chronic pain models.  

PubMed

The endogenous opioid enkephalin is known to inhibit spinal nociceptive transmission. Here we investigated activation of spinal enkephalinergic neurons by determining the proportions of c-Fos expressing (activated) spinal neurons that were enkephalinergic after different acute and chronic peripheral nociceptive stimuli. The number of c-Fos-activated neurons in the dorsal horn was increased after hind paw injection of capsaicin, formalin or complete Freund's adjuvant (CFA, 1.5 hrs - 4 days). The numbers of these neurons that were enkephalinergic increased after paraformaldehyde, and at 20 hrs, but not 1.5 hrs or 4 days post-CFA as compared to saline. In the spared nerve injury (SNI) model of neuropathic pain, c-Fos expression was increased acutely (2 hrs) and chronically (2 weeks), and a greater number of these were enkephalinergic in the nerve-injured animals acutely compared to controls (sham-SNI). Combining all acute (=2 hrs) versus chronic (?20 hrs) treatment groups, there was a significant decrease in the percentage of activated neurons that were enkephalinergic in superficial layers, but a significant increase in the deeper layers of the dorsal horn in the chronic treatment group. It is concluded that the overall percentage of c-Fos activated neurons that contained enkephalin was not significantly different between acute and chronic pain phases. However, the shift in localization of these neurons within the spinal dorsal horn indicates a noxious stimulus directed activation pattern. PMID:24231552

Hossaini, Mehdi; Duraku, Liron S; Kohli, Somesh K; Jongen, Joost L M; Holstege, Jan C

2014-01-16

137

Chronic inflammatory demyelinating polyneuropathy in a child: clinical-spinal MR imaging correlation  

Microsoft Academic Search

Spinal magnetic resonance (MR) imaging of a 3-year-old girl with chronic inflammatory demyelinating polyneuropathy (CIDP) showed thickened and marked enhancement of the lumbosacral nerve roots. These abnormalities resolved after steroid treatment. MR imaging of the cauda equina may be helpful in the diagnosis of CIDP.

S Likasitwattanakul; P Visrutaratna

138

Autonomic Dysreflexia Causes Chronic Immune Suppression after Spinal Cord Injury  

PubMed Central

Autonomic dysreflexia (AD), a potentially dangerous complication of high-level spinal cord injury (SCI) characterized by exaggerated activation of spinal autonomic (sympathetic) reflexes, can cause pulmonary embolism, stroke, and, in severe cases, death. People with high-level SCI also are immune compromised, rendering them more susceptible to infectious morbidity and mortality. The mechanisms underlying postinjury immune suppression are not known. Data presented herein indicate that AD causes immune suppression. Using in vivo telemetry, we show that AD develops spontaneously in SCI mice with the frequency of dysreflexic episodes increasing as a function of time postinjury. As the frequency of AD increases, there is a corresponding increase in splenic leucopenia and immune suppression. Experimental activation of spinal sympathetic reflexes in SCI mice (e.g., via colorectal distension) elicits AD and exacerbates immune suppression via a mechanism that involves aberrant accumulation of norepinephrine and glucocorticoids. Reversal of postinjury immune suppression in SCI mice can be achieved by pharmacological inhibition of receptors for norepinephrine and glucocorticoids during the onset and progression of AD. In a human subject with C5 SCI, stimulating the micturition reflex caused AD with exaggerated catecholamine release and impaired immune function, thus confirming the relevance of the mouse data. These data implicate AD as a cause of secondary immune deficiency after SCI and reveal novel therapeutic targets for overcoming infectious complications that arise due to deficits in immune function. PMID:23926252

Zhang, Yi; Guan, Zhen; Reader, Brenda; Shawler, Todd; Mandrekar-Colucci, Shweta; Huang, Kun; Weil, Zachary; Bratasz, Anna; Wells, Jonathan; Powell, Nicole D.; Sheridan, John F.; Whitacre, Caroline C.; Rabchevsky, Alexander G.; Nash, Mark S.

2013-01-01

139

Genetic homogeneity between acute and chronic forms of spinal muscular atrophy  

Microsoft Academic Search

THE childhood-onset spinal muscular atrophies (SMAs) describe a heterogeneous group of disorders that selectively affect the alpha motoneuron. We have shown that chronic childhood-onset SMA (SMA II and III) maps to a single locus on chromosome 5q (ref. 1). Acute SMA (SMA Type I\\/Werdnig-Hoffmann\\/severe\\/infantile) is the main cause of heritable infant mortality. Mapping the acute SMA locus by conventional methods

T. C. Gilliam; L. M. Brzustowicz; L. H. Castilla; T. Lehner; G. K. Penchaszadeh; R. J. Daniels; B. C. Byth; J. Knowles; J. E. Hislop; Y. Shapira; V. Dubowitz; T. L. Munsat; J. Ott; K. E. Davies

1990-01-01

140

Spinal cord stimulation in the treatment of chronic critical limb ischemia  

Microsoft Academic Search

This paper reviews the clinical experience and proposed working mechanisms of spinal cord stimulation (SCS) in the treatment\\u000a of chronic critical limb ischemia (CCLI). SCS appears to provide a significant long-term relief of ischemic pain and to improve\\u000a healing of small ulcers, most likely due to effects on the nutritional skin blood flow. Despite these observations, randomized\\u000a trials were not

Luc G. Y. Claeys; W. Berg; S. Jonas

141

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

PubMed Central

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 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

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

142

Spinal opioid bioavailability in postoperative pain.  

PubMed

Opioids have been used for spinal analgesia for more than a century, and their injection epidurally and intrathecally has a key role in the control of postoperative pain. Since the discovery of the endogenous opioid system, 3 decades ago, their use has become more generalized in obstetric analgesia, the management of chronic pain, and acute postoperative pain. To use opioids effectively for this type of analgesia, it is important to understand the pharmacokinetics and clinical pharmacology of these drugs, specifically those that produce analgesia by an intrinsic spinal mechanism. Evidence from animal and human experiments indicates that hydrophilic opioids (such as hydromorphone and morphine) bind more strongly to specific receptors within the dorsal horn of the spinal cord than lipophilic opioids (such as alfentanil, fentanyl, and sufentanil). This can be understood by considering the spinal cord selectivity and bioavailability of these opioids. This difference is attributable to differences in the pharmacokinetic and pharmacodynamic properties of the 2 groups. It is more difficult for lipophilic opioids to reach and remain at sufficiently high concentrations at the site of action due to their sequestration in epidural fat and rapid plasma clearance from both epidural and intrathecal spaces, resulting in analgesia with a limited spread and duration, as well as the appearance of early supraspinal side effects. In contrast, morphine has very different properties, including greater spinal bioavailability and therefore administered neuraxially, it is suitable choice for the treatment of acute postoperative pain. However, when using morphine, a greater incidence of adverse effects can be expected, and it requires careful patient selection. PMID:23834413

Bujedo, Borja Mugabure

2014-04-01

143

Influence of Season, Ethnicity, and Chronicity on Vitamin D Deficiency in Traumatic Spinal Cord Injury  

PubMed Central

Background: Inadequate levels of vitamin D increase the risk of osteoporosis, a highly prevalent condition in patients with traumatic spinal cord injury (SCI). Reduced sunlight and dark skin further contribute to low vitamin D levels. Objectives: To compare serum 25-hydroxy vitamin D [vitamin D25(OH)] levels in acute and chronic SCI and to explore seasonal and ethnic differences among patients with acute and chronic SCI. Patients/Methods: Patients (N ?=? 96) aged 19 to 55 years with C3-T10 motor complete SCI participated. Acute SCI was 2 to 6 months after injury, whereas chronic SCI was at least 1 year from injury. Serum vitamin D25(OH), calcium, and parathyroid hormone were drawn during summer or winter months. Vitamin D deficiency (<13 ng/mL), insufficiency (<20 ng/mL), and subtherapeutic (<32 ng/mL) levels were compared for all groups. A 3-way analysis of covariance was adopted to determine significant main effects of season, chronicity, and ethnicity. Interactions between season and chronicity, season and ethnicity, and chronicity and ethnicity were evaluated. Evaluation of a 3-way interaction among season, chronicity, and ethnicity was completed. Results: In summer, 65% of patients with acute SCI and 81% of patients with chronic SCI had subtherapeutic vitamin D levels, whereas in winter, 84% with acute SCI and 96% with chronic SCI had vitamin D25(OH) (<32ng/mL). Lower vitamin D25(OH) levels were observed in African Americans relative to whites. Significant main effects were noted for season (P ?=? 0.017), chronicity (P ?=? 0.003), and ethnicity (P < 0.001). However, interactions between 2 or more factors were not found. Conclusions: Vitamin D insufficiency and deficiency are found in the majority of patients with chronic SCI and in many with acute SCI. Initial screening for serum vitamin D25(OH) levels should be performed early in rehabilitation. Periodic monitoring in the chronic setting is highly recommended. PMID:20737793

Oleson, Christina V; Patel, Payal H; Wuermser, Lisa-Ann

2010-01-01

144

Intractable Pruritus After Traumatic Spinal Cord Injury  

PubMed Central

Background: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. Method: Case report. Findings: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. Conclusions: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective. PMID:19777867

Crane, Deborah A; Jaffee, Kenneth M; Kundu, Anjana

2009-01-01

145

Chronic Spinal Cord Electrical Stimulation Protects Against 6-hydroxydopamine Lesions  

NASA Astrophysics Data System (ADS)

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.

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

2014-01-01

146

Epidural steroid warning controversy still dogging FDA.  

PubMed

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

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

147

BDNF regulates atypical PKC at spinal synapses to initiate and maintain a centralized chronic pain state  

PubMed Central

Background Chronic pain is an important medical problem affecting hundreds of millions of people worldwide. Mechanisms underlying the maintenance of chronic pain states are poorly understood but the elucidation of such mechanisms have the potential to reveal novel therapeutics capable of reversing a chronic pain state. We have recently shown that the maintenance of a chronic pain state is dependent on an atypical PKC, PKM?, but the mechanisms involved in controlling PKM? in chronic pain are completely unknown. Here we have tested the hypothesis that brain derived neurotrophic factor (BDNF) regulates PKM?, and possibly other aPKCs, to maintain a centralized chronic pain state. Results We first demonstrate that although other kinases play a role in the initiation of persistent nociceptive sensitization, they are not involved in the maintenance of this chronic pain state indicating that a ZIP-reversible process is responsible for the maintenance of persistent sensitization. We further show that BDNF plays a critical role in initiating and maintaining persistent nociceptive sensitization and that this occurs via a ZIP-reversible process. Moreover, at spinal synapses, BDNF controls PKM? and PKC? nascent synthesis via mTORC1 and BDNF enhances PKM? phosphorylaton. Finally, we show that BDNF signaling to PKM? and PKC? is conserved across CNS synapses demonstrating molecular links between pain and memory mechanisms. Conclusions Hence, BDNF is a key regulator of aPKC synthesis and phosphorylation and an essential mediator of the maintenance of a centralized chronic pain state. These findings point to BDNF regulation of aPKC as a potential therapeutic target for the permanent reversal of a chronic pain state. PMID:23510079

2013-01-01

148

Activated spinal astrocytes are involved in the maintenance of chronic widespread mechanical hyperalgesia after cast immobilization  

PubMed Central

Background In the present study, we examined spinal glial cell activation as a central nervous system mechanism of widespread mechanical hyperalgesia in rats that experienced chronic post-cast pain (CPCP) 2 weeks after cast immobilization. Activated spinal microglia and astrocytes were investigated immunohistologically in lumbar and coccygeal spinal cord segments 1 day, 5 weeks, and 13 weeks following cast removal. Results In the lumbar cord, astrocytes were activated after microglia. Astrocytes also were activated after microglia in the coccygeal cord, but with a delay that was longer than that observed in the lumbar cord. This activation pattern paralleled the observation that mechanical hyperalgesia occurred in the hindleg or the hindpaw before the tail. The activating transcription factor 3 (ATF3) immune response in dorsal root ganglia (DRG) on the last day of cast immobilization suggested that nerve damage might not occur in CPCP rats. The neural activation assessed by the phosphorylated extracellular signal-regulated kinase (pERK) immune response in DRG arose 1 day after cast removal. In addition, L-?-aminoadipate (L-?-AA), an inhibitor of astrocyte activation administered intrathecally 5 weeks after cast removal, inhibited mechanical hyperalgesia in several body parts including the lower leg skin and muscles bilaterally, hindpaws, and tail. Conclusions These findings suggest that activation of lumbar cord astrocytes is an important factor in widespread mechanical hyperalgesia in CPCP. PMID:24456903

2014-01-01

149

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

PubMed

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 10 days 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

Goecks, Cristina S B; Horst, Andréa; Moraes, Maira S; Scheid, Taína; Kolberg, Carolina; Belló-Klein, Adriane; Partata, Wania A

2012-09-01

150

Clinical Experience and Management of Cervico-Thoracic Epidural Hematoma  

PubMed Central

Spinal epidural hematoma (SEH) causing acute myelopathy is rare. The usual clinical presentation of a SEH is sudden severe neck or back pain that progresses toward paraparesis or quadriparesis, depending on the level of the lesion. Recent studies have shown that early decompressive surgery is very important for patient's recovery. We experienced five patients of cervico-thoracic epidural hematomas associated with neurologic deficits that were treated successfully with surgical intervention. PMID:20539799

Ahn, Sang-Soak

2010-01-01

151

Conduction failure following spinal cord injury: functional and anatomical changes from acute to chronic stages.  

PubMed

In the majority of spinal cord injuries (SCIs), some axonal projections remain intact. We examined the functional status of these surviving axons since they represent a prime therapeutic target. Using a novel electrophysiological preparation, adapted from techniques used to study primary demyelination, we quantified conduction failure across a SCI and studied conduction changes over time in adult rats with a moderate severity spinal contusion (150 kdyn; Infinite Horizon impactor). By recording antidromically activated single units from teased dorsal root filaments, we demonstrate complete conduction block in ascending dorsal column axons acutely (1-7 d) after injury, followed by a period of restored conduction over the subacute phase (2-4 weeks), with no further improvements in conduction at chronic stages (3-6 months). By cooling the lesion site, additional conducting fibers could be recruited, thus revealing a population of axons that are viable but unable to conduct under normal physiological conditions. Importantly, this phenomenon is still apparent at the most chronic (6 month) time point. The time course of conduction changes corresponded with changes in behavioral function, and ultrastructural analysis of dorsal column axons revealed extensive demyelination during the period of conduction block, followed by progressive remyelination. A proportion of dorsal column axons remained chronically demyelinated, suggesting that these are the axons recruited with the cooling paradigm. Thus, using a clinically relevant SCI model, we have identified a population of axons present at chronic injury stages that are intact but fail to conduct and are therefore a prime target for therapeutic strategies to restore function. PMID:22171053

James, Nicholas D; Bartus, Katalin; Grist, John; Bennett, David L H; McMahon, Stephen B; Bradbury, Elizabeth J

2011-12-14

152

Functional Recovery in Chronic Stage of Spinal Cord Injury by Neurorestorative Approach: A Case Report  

PubMed Central

Spinal cord injury (SCI) at an early age can be debilitating for the child's growth. Current treatments show a level of stagnancy, after which the recovery is minimal. Cellular therapy is an emerging area of research and has been found to possess many benefits in the previous studies. Transplantation of autologous bone marrow mononuclear cells (BMMNCs) has demonstrated therapeutic potential for many neurological conditions, including spinal cord injury. Here we report a case of 6-year-old girl with traumatic SCI at the level of C7-D1 4 years back, who underwent 2 doses of cell transplantation with autologous BMMNCs with an interval of 6 months along with standard rehabilitation. The patient did not have any major or minor side effects. The patient showed clinical improvements throughout the 6 months after transplantation, which was assessed using Functional Independence Measure (before: 82, after: 101 out of 126). There were patchy areas of sensory gain in bilateral feet recorded, with improvements in the bladder sensation and control. Improved gait was seen as a result of better strength in abdominals and back extensors. The fact that there was functional improvement in the chronic plateau phase indicates the potential of cell therapy in chronic SCI. Further clinical studies are warranted. PMID:24744950

Sharma, Alok; Sane, Hemangi; Khopkar, Dipti; Gokulchandran, Nandini; Jacob, V. C.; Joseph, Joji; Badhe, Prerna

2014-01-01

153

Restoring Voluntary Grasping Function in Individuals with Incomplete Chronic Spinal Cord Injury: Pilot Study  

PubMed Central

Background: Functional electrical stimulation (FES) therapy has been shown to be one of the most promising approaches for improving voluntary grasping function in individuals with subacute cervical spinal cord injury (SCI). Objective: To determine the effectiveness of FES therapy, as compared to conventional occupational therapy (COT), in improving voluntary hand function in individuals with chronic (?24 months post injury), incomplete (American Spinal Injury Association Impairment Scale [AIS] B-D), C4 to C7 SCI. Methods: Eight participants were randomized to the intervention group (FES therapy; n = 5) or the control group (COT; n = 3). Both groups received 39 hours of therapy over 13 to 16 weeks. The primary outcome measure was the Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT), and the secondary outcome measures were Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Functional Independence Measure (FIM) self-care subscore, and Spinal Cord Independence Measure (SCIM) self-care subscore. Outcome assessments were performed at baseline, after 39 sessions of therapy, and at 6 months following the baseline assessment. Results: After 39 sessions of therapy, the intervention group improved by 5.8 points on the TRI-HFT’s Object Manipulation Task, whereas the control group changed by only 1.17 points. Similarly, after 39 sessions of therapy, the intervention group improved by 4.6 points on the FIM self-care subscore, whereas the control group did not change at all. Conclusion: The results of the pilot data justify a clinical trial to compare FES therapy and COT alone to improve voluntary hand function in individuals with chronic incomplete tetraplegia. PMID:24244093

2013-01-01

154

Determination of epidural catheter placement using nerve stimulation in obstetric patients  

Microsoft Academic Search

Background and Objectives. Peripheral nerve and spinal cord stimulation techniques have been used for many years. However, electrical stimulation methods rarely have been used to confirm epidural catheter placement. This study examines the practicality of this technique to confirm epidural catheter placement in obstetric patients. Methods. Thirty-nine obstetric patients in labor were studied. An electrocardiography (ECG) adapter (Arrow-Johans) was attached

Ban C. H. Tsui; Sunil Gupta; Brendan Finucane

1999-01-01

155

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

PubMed Central

Objective The purpose of this study was to determine whether long-term electrical stimulation training of the paralyzed soleus could change this muscle’s 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

Shields, Richard K.; Dudley-Javoroski, Shauna

2012-01-01

156

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

PubMed

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 Sprague-Dawley rats (200-235 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

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

2013-02-19

157

Interventional spinal procedures in the presence of a Chiari malformation: a potential contraindication.  

PubMed

Although Chiari malformations are much more prevalent than once believed, no study has described treatment with an interventional spinal procedure. The purpose of this report was to discuss the clinical course of a patient who was diagnosed with a Chiari malformation and treated with three cervical epidural injections. In 2012, a 50-yr-old woman presented to a neurology clinic with chronic suboccipital headaches, diplopia, and increasing numbness/tingling in her upper extremities. Magnetic resonance imaging confirmed a type I Chiari malformation and a cervical syrinx. The patient was treated with three cervical epidural injections, after which her symptoms exacerbated. Consequently, a posterior fossa suboccipital craniectomy with C1 laminectomy and excision of extradural and intradural adhesions was performed. After surgical intervention, notable neurologic improvements were observed. Given the marked worsening of symptoms, the present report suggests that interventional spinal procedures may be a contraindication in the presence of a Chiari malformation with a syrinx. PMID:24743463

Smith, Jason A; Cuccurullo, Sara J; Protzman, Nicole M; Kooch, Jason E

2014-08-01

158

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

PubMed

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

Hoffmann, Marina Verena; Ludwig, Davina Claudia; Lempp, Charlotte; Haist, Verena; Stein, Veronika Maria

2013-01-01

159

Epidural myelolipoma in a Husky-cross: a case report  

PubMed Central

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

2013-01-01

160

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

PubMed Central

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

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

2014-01-01

161

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

PubMed

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 (mean ± SD), 52.0 ± 14.9 years old, and ?4 years post SCI (20.5 ± 12.5 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 =1.25-3.70 per each pack per day increase), chronic obstructive pulmonary disease (COPD) (3.52; 1.79-6.92), and heart disease (2.18; 1.14-4.16). Adjusting for age, subjects reporting previous chest illness had a non-significantly increased hazard ratio (HR) for mortality (1.30; 0.88-1.91). 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; 0.77-1.73). 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

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

2014-11-01

162

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

PubMed Central

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

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

2012-01-01

163

The influence of postoperative epidural analgesia on postoperative pain and stress response after major spine surgery--a randomized controlled double blind study.  

PubMed

Major spinal surgery is associated with severe postoperative pain and stress response, bowel dysfunction, and a potential for chronic pain development. Epidural analgesia has been shown to be advantageous compared to intravenous analgesia alone. The aim of the study was to investigate whether postoperative addition of epidural levobupivacaine to intravenous opioid analgesia offers advantage over intravenous opioid analgesia alone. Eighty-one patients scheduled for spinal fusion were enrolled in the study and randomized into two groups. Postoperatively, group A received 0.125% epidural levobupivacaine and group B received saline. Both groups also received intravenous piritramide as a rescue analgesic. Pain intensity, rescue analgesic consumption, blood glucose, cholesterol and cortisol levels, postoperative blood loss, paresthesia, time to first postoperative defecation, and length of hospital stay were recorded. Sixty-eight patients completed the study. The visual analog scale score (mean 2 vs. 4, p = 0.01), consumption ofpiritramide (25 mg vs. 51.5 mg, p = 0.01) and metamizole (1400 vs. 1875 mg, p < 0.01), incidence of nausea (6% vs. 28% p = 0.02) and blood loss (450 mL vs. 650 mL, p < 0.05) were significantly lower in group A. Bowel recovery and first postoperative defecation also occurred earlier in group A (6% vs. 45%, p < 0.01). Blood cortisol, glucose and cholesterol levels and the incidence of paresthesia did not differ between the groups. In conclusion, after spinal fusion, postoperative epidural administration of levobupivacaine provides better analgesia and fewer side effects with no impact on stress response. PMID:25163233

Servicl-Kuchler, Darja; Maldini, Branka; Borgeat, Alain; Bili?, Nada; Kosak, Robert; Mavcic, Blaz; Novak-Jankovic, Vesna

2014-06-01

164

Fatigue properties of human thenar motor units paralysed by chronic spinal cord injury  

PubMed Central

Human muscles paralysed chronically by spinal cord injury (SCI) fatigue excessively. Whether these reductions in force reflect a decrease in the fatigue resistance of the motor units is unknown. Our aim was to determine the fatigability of thenar motor units paralysed chronically (10 ± 2 years) by cervical SCI. Surface electromyographic activity (EMG) and force were recorded from 17 paralysed motor units (n = 7 subjects) in response to intraneural motor axon stimulation (13 pulses at 40 Hz, 1 s?1 for 2 min). Unit force decreased progressively, reaching 8–60% of initial after 2 min, whereas both the amplitude and area of the first EMG potentials in the trains increased significantly (both P < 0.05). Thus, transmission of neural signals to the sarcolemma was effective and the reduction in force must reflect impaired processes in the muscle fibres. The median fatigue index for paralysed units (0.31), the ratio of the force at 2 min compared to the initial force, was significantly lower than that for units from control subjects (0.85, P < 0.05), but the distribution of fatigue indices for each population had a similar shape (ranges: 0.08–0.60 and 0.41–0.95, respectively). Hence, chronic paralysis did not limit the range of fatigability typically found for thenar units, only its magnitude. These findings suggest that all paralysed units underwent similar reductions in fatigue resistance. After fatigue, paralysed unit forces were reduced at all frequencies (1–100 Hz, P < 0.05). Twitch contraction and half-relaxation times were increased, as was the frequency needed to produce half maximal force (P < 0.05). Thus, stimulation protocols used to produce functional movements in paralysed muscles need to accommodate the significant and rapid fatigue of the motor units. PMID:16513673

Klein, C S; Hager-Ross, C K; Thomas, C K

2006-01-01

165

Treatment of spinal cord tumors  

Microsoft Academic Search

Opinion statement  Tumors associated with the spinal cord can have devastating effects on patient function and quality of life. Most of these\\u000a tumors are from metastatic disease, usually to the epidural space. Less frequently, the tumors are intrinsic to the spinal\\u000a cord itself (ie, primary tumor). Regardless of the etiology, spinal cord tumors often present first with progressive local\\u000a or radicular

Brian Vaillant; Monica Loghin

2009-01-01

166

Epidural hematoma secondary to a rupture of a synovial cyst  

Microsoft Academic Search

Background contentWith modern advances in imaging studies, synovial cysts are becoming more evident as a common component of erosive lumbar degenerative disc disease causing spinal stenosis and radiculopathy. Whereas hemorrhage can occur inside the cyst and is reported, rupture causing epidural hematoma is a rare complication and finding of this disorder.

Christopher Brown; Jeffery L. Stambough

2005-01-01

167

Locomotor step training with body weight support improves respiratory motor function in individuals with chronic spinal cord injury  

PubMed Central

This prospective case-controlled clinical study was undertaken to investigate to what extent the manually assisted treadmill stepping Locomotor Training with body weight support (LT) can change respiratory function in individuals with chronic Spinal Cord Injury (SCI). Pulmonary function outcomes (Forced Vital Capacity /FVC/, Forced Expiratory Volume one second /FEV1/, Maximum Inspiratory Pressure /PImax/, Maximum Expiratory Pressure /PEmax/) and surface electromyographic (sEMG) measures of respiratory muscles activity during respiratory taskswere obtained from eight individuals with chronic C3-T12 SCI before and after 62±10 (Mean ± SD) sessions of the LT. FVC, FEV1, PImax, PEmax, amount of overall sEMG activity and rate of motor unit recruitment were significantly increased after LT (p<0.05) These results suggest that these improvements induced by the LT are likely the result of neuroplastic changes in spinal neural circuitry responsible for the activation of respiratory muscles preserved after injury. PMID:23999001

de Paleville, Daniela Terson; McKay, William; Aslan, Sevda; Folz, Rodney; Sayenko, Dimitry; Ovechkin, Alexander V.

2013-01-01

168

Epidural steroid injections for radicular lumbosacral pain: a systematic review.  

PubMed

Most clinical guidelines do not recommend routine use of epidural steroid injections for the management of chronic low back pain. However, many clinicians do not adhere to these guidelines. This comprehensive evidence overview concluded that off-label epidural steroid injections provide small short-term but not long- term leg-pain relief and improvement in function; injection of steroids is no more effective than injection of local anesthetics alone; post-procedural complications are uncommon, but the risk of contamination and serious infections is very high. The evidence does not support routine use of off-label epidural steroid injections in adults with benign radicular lumbosacral pain. PMID:24787344

Shamliyan, Tatyana A; Staal, J Bart; Goldmann, David; Sands-Lincoln, Megan

2014-05-01

169

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

PubMed Central

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

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

2012-01-01

170

Chronic-pain-associated astrocytic reaction in the spinal cord dorsal horn of HIV-infected patients  

PubMed Central

Studies with animal models have suggested that reactivation of glia, including microglia and astrocytes, critically contributes to the development and maintenance of chronic pain. However, the involvement of glial reactivation in human chronic pain is unclear. We performed analyses to compare the glial reactivation profiles in the spinal dorsal horn (SDH) from three cohorts of sex- and age-matched human postmortem tissues: (i) HIV-negative patients, (ii) HIV-positive patients without chronic pain, and (iii) HIV patients with chronic pain. Our results indicate that the expression levels of CD11b and Iba1, commonly used for labeling microglial cells, did not differ in the three patient groups. On the other hand, GFAP and S100?, often used for labeling astrocytes, were specifically up-regulated in the spinal dorsal horn (SDH) of the ‘pain-positive’ HIV patients but not in the ‘pain-negative’ HIV patients. In addition, pro-inflammatory cytokines, TNF? and IL-1?, were specifically increased in the SDH of ‘pain-positive’ HIV patients. Our findings suggest that reactivation of astrocytes in the SDH may play a role during the maintenance phase of HIV-associated chronic pain. PMID:22875918

Shi, Yuqiang; Gelman, Benjamin B.; Lisinicchia, Joshua G.; Tang, Shao-Jun

2012-01-01

171

Acceptance of chronic neuropathic pain in spinal cord injured persons: a qualitative approach.  

PubMed

Chronic neuropathic pain (CNP) in spinal cord injury (SCI) is a significant problem that has physical, functional, and psychosocial repercussions beyond the consequences of SCI. The notion that acceptance may be a viable alternative to suffering when resolution of pain is unattainable was explored. Studies indicate that acceptance of pain is associated with lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily active time, and improved work status in patients who have other types of chronic pain. This exploratory qualitative study examined acceptance of pain in SCI individuals who have CNP. Grounded theory was used to develop a conceptual framework to describe acceptance in people with CNP and SCI. Data were obtained from in-depth interviews with seven SCI individuals. Six phases were identified, including: "comprehending the perplexity of CNP," "seeking pain resolution," "acknowledging pain permanence," "redefining core values," "learning to live with the pain," and "integrating pain." Two driving forces, "increasing independence" and "evolving pain view," were noted to move the process of acceptance forward. The findings in this study suggest that acceptance of pain appeared to be beneficial in terms of reducing suffering and facilitating a more satisfying and fulfilling life in these SCI individuals. A decreased emphasis on continued searching for a cure for CNP and movement toward a self-management approach was associated with increased pain coping for these SCI individuals. Clinical implications suggest that early intervention to facilitate effective coping and an exploration of the notion of acceptance could be beneficial. PMID:23158703

Henwood, Penelope; Ellis, Jacqueline; Logan, Jo; Dubouloz, Claire-Jehanne; D'Eon, Joyce

2012-12-01

172

Respiratory motor function in seated and supine positions in individuals with chronic spinal cord injury  

PubMed Central

This case-controlled clinical study was undertaken to investigate to what extent pulmonary function in individuals with chronic Spinal Cord Injury (SCI) is affected by posture. Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Maximal Inspiratory Pressure (PImax) and Maximal Expiratory Pressure (PEmax) were obtained from 27 individuals with chronic motor-complete (n=13, complete group) and motor-incomplete (n=14, incomplete group) C2-T12 SCI in both seated and supine positions. Seated-to-supine changes in spirometrical (FVC and FEV1) and airway pressure (PImax and PEmax) outcome measures had different dynamics when compared in complete and incomplete groups. Patients with motor-complete SCI had tendency to increase spirometrical outcomes in supine position showing significant increase in FVC (p=.007), whereas patients in incomplete group exhibited decrease in these values with significant decreases in FEV1 (p=.002). At the same time, the airway pressure values were decreased in supine position in both groups with significant decrease in PEmax (p=.031) in complete group and significant decrease in PImax (p=.042) in incomplete group. In addition, seated-to-supine percent change of PImax was strongly correlated with neurological level of motor-complete SCI (?= ?.77, p=.002). These results indicate that postural effects on respiratory performance in patients with SCI can depend on severity and neurological level of SCI, and that these effects differ depending on respiratory tasks. Further studies with adequate sample size are needed to investigate these effects in clinically specific groups and to study the mechanisms of such effects on specific respiratory outcome measures. PMID:25169115

Terson de Paleville, Daniela; Sayenko, Dimitry G.; Aslan, Sevda C.; Folz, Rodney J.; McKay, William B.; Ovechkin, Alexander V.

2014-01-01

173

Chronic At- and Below-Level Pain after Moderate Unilateral Cervical Spinal Cord Contusion in Rats  

PubMed Central

Abstract Chronic neuropathic pain is a significant consequence of spinal cord injury (SCI) that is associated with evoked pain, including allodynia and/or hyperalgesia. Allodynia is defined as a painful response to normally innocuous stimuli, and hyperalgesia occurs when there is an amplified pain response to normally noxious stimuli. We describe a model of a unilateral cervical level (C5) contusion injury where sensory recovery was assessed weekly for 6 weeks in 32 adult, female, Sprague-Dawley rats. Bilateral thermal hyperalgesia and tactile allodynia are detectable in the fore- and hindpaws as early as 7 days post-injury (dpi) and persist for at least 42 days. Paw withdrawal latency in response to a noxious thermal stimulus significantly intra-animal pre-operative values. Change in paw withdrawal latency plateaued at 21?dpi. Interestingly, bilateral forepaw allodynia develops in fewer than 40% of rats as measured by von Frey monofilament testing. Similar results occur in the hindpaws, where bilateral allodynia occurs in 46% of rats with SCI. The contralesional forepaw and both hindpaws of rats showed a slight increase in paw withdrawal threshold to tactile stimuli acutely after SCI, corresponding to ipsilesional forelimb motor deficits that resolve over time. That there is no difference among allodynic and non-allodynic groups in overall spared tissue or specifically of the dorsal column or ventrolateral white matter where ascending sensory tracts reside suggests that SCI-induced pain does not depend solely on the size or extent of the lesion, but that other mechanisms are in play. These observations provide a valid model system for future testing of therapeutic interventions to prevent the onset or to reduce the debilitating effects of chronic neuropathic pain after SCI. PMID:23216008

Wade, Rodel E.; Houle, John D.

2013-01-01

174

Respiratory motor function in seated and supine positions in individuals with chronic spinal cord injury.  

PubMed

This case-controlled clinical study was undertaken to investigate to what extent pulmonary function in individuals with chronic spinal cord injury (SCI) is affected by posture. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) were obtained from 27 individuals with chronic motor-complete (n=13, complete group) and motor-incomplete (n=14, incomplete group) C2-T12 SCI in both seated and supine positions. Seated-to-supine changes in spirometrical (FVC and FEV1) and airway pressure (PImax and PEmax) outcome measures had different dynamics when compared in complete and incomplete groups. Patients with motor-complete SCI had tendency to increase spirometrical outcomes in supine position showing significant increase in FVC (p=.007), whereas patients in incomplete group exhibited decrease in these values with significant decreases in FEV1 (p=.002). At the same time, the airway pressure values were decreased in supine position in both groups with significant decrease in PEmax (p=.031) in complete group and significant decrease in PImax (p=.042) in incomplete group. In addition, seated-to-supine percent change of PImax was strongly correlated with neurological level of motor-complete SCI (?=-.77, p=.002). These results indicate that postural effects on respiratory performance in patients with SCI can depend on severity and neurological level of SCI, and that these effects differ depending on respiratory tasks. Further studies with adequate sample size are needed to investigate these effects in clinically specific groups and to study the mechanisms of such effects on specific respiratory outcome measures. PMID:25169115

Terson de Paleville, Daniela G L; Sayenko, Dimitry G; Aslan, Sevda C; Folz, Rodney J; McKay, William B; Ovechkin, Alexander V

2014-11-01

175

Does Standing Protect Bone Density in Patients With Chronic Spinal Cord Injury  

PubMed Central

Background/Objective: To compare the t-scores of proximal femur and lumbar spine of patients with spinal cord injury (SCI) with different levels of weight bearing. Methods: Cross-sectional study comparing 3 groups of patients with SCI: patients with daily standing times of more than 1 hour, patients with daily standing times of less than 1 hour, and nonstanding patients. Seventy-one patients with chronic SCI were recruited. They were assigned to 1 of 3 groups according to their reported daily standing time. The bone density of lumbar and proximal femoral regions was measured with dual-energy x-ray absorptiometry. Results: The 3 groups were similar in terms of demographics and clinical variables. No significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups. However, the patients in the group that stood more than 1 hour daily had a slight tendency to have higher t-scores than those in the control group. Conclusions: There was no significant difference among the 3 groups. However, standing might be partially helpful in protecting the bone density in SCI by opposing the effects of immobilization. PMID:18581668

Goktepe, Ahmet Salim; Tugcu, Ilknur; Yilmaz, Bilge; Alaca, Ridvan; Gunduz, Sukru

2008-01-01

176

An examination of dietary intakes and nutritional status of chronic healthy spinal cord injured individuals.  

PubMed

To examine the nutritional composition of the dietary intake of chronic healthy spinal cord injured (SCI) individuals, 33 subjects affiliated with 3 SCI rehabilitation centers logged their food consumption for 7 days. Prior to record keeping, subjects were trained by a registered dietitian on the accurate recording of their standard food choices and portion size, and were provided with scales to weigh food accurately. Dietary macro and micronutrients were analyzed with a computer software package, with nutritional analysis compared to the recommended daily allowances (RDA) of the Food and Nutrition Board of the National Academy of Sciences. Analysis showed caloric intake to be 75% of that recommended for able bodies persons, with a high reliance on fat for calories. Fat intake accounted for 37.9% of calories, well above the recommended level of 30%, but typical of the American diet. The ratio of polyunsaturated to saturated fat was approximately one half the recommended level, with carbohydrate calories averaging 16.5% below optimal RDA. Protein consumption was within normal range, but average dietary fiber was only 25% of recommended levels. Micronutrient analysis showed deficiencies in both water and fat-soluble vitamins, with suboptimal intake of multiple minerals. Given the apparent reliance on a high-fat and low-carbohydrate diet, this research shows that nutritional intervention and education of SCI persons are needed, and that a registered dietitian should be included in the SCI health care team. PMID:1287542

Levine, A M; Nash, M S; Green, B A; Shea, J D; Aronica, M J

1992-12-01

177

Altered synaptophysin expression in the rat spinal cord after chronic constriction injury of sciatic nerve.  

PubMed

Injury to the peripheral nervous system can lead to spontaneous pain, hyperalgesia and allodynia. Previous studies have shown sprouting of Abeta-fibres into lamina II of the spinal cord dorsal horn after nerve injury and the formation of new synapses by these sprouts. Synaptophysin is a presynaptic vesicle protein, useful in the identification of synaptogenesis. Here we investigated whether synaptogenesis as measured by the expression of synaptophysin protein correlates with symptoms of neuropathic pain in rats with a chronic constriction injury (CCI) of the sciatic nerve. We used immunohistochemistry, Western immunoblotting and densitometry to study the distribution of synaptophysin and to quantify relative protein. Synaptophysin was increased in the ipsilateral dorsal horn with a peak level on day 14 and returned to baseline on day 21 post-CCI. Synaptophysin levels temporally correlated with thermal hyperalgesia but not with tactile allodynia. Our results indicate that thermal hyperalgesia in CCI significantly correlates with synaptogenesis within the superficial layers of the dorsal horn. PMID:12429371

Chou, An-Kuo; Muhammad, Rania; Huang, Shu-Min; Chen, Jing-Tsang; Wu, Chao-Liang; Lin, Chung-Ren; Lee, Tsung-Hsing; Lin, Sheng-Han; Lu, Cheng-Yan; Yang, Lin-Cheng

2002-11-29

178

Idiopathic Hypertrophic Spinal Pachymeningitis with an Osteolytic Lesion  

PubMed Central

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

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

2014-01-01

179

Tissue reaction of morphine applied to the epidural space of dogs  

Microsoft Academic Search

Epidural morphine has found increasing popularity in clinical trials for the relief of chronic and postoperative pain relief.\\u000a This study was conducted to determine if there was any adverse tissue reaction when morphine was applied to the epidural space\\u000a of dogs. Sixteen dogs were given 0.07 mg·kg-1of morphine in a volume of 2 cc of normal saline into the epidural

F. G. King; A. D. Baxter; G. Mathieson

1984-01-01

180

Alteration of capsaicin-induced pulmonary chemoreflex following chronic cervical spinal cord injury.  

E-print Network

??High cervical spinal cord injury usually changes the respiratory pattern, which may influence the pulmonary vagal afferent activity. Previous study revealed that pulmonary chemoreflex cannot… (more)

Chang, Yu-Shuo

2014-01-01

181

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

PubMed Central

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

2014-01-01

182

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

PubMed Central

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 ? 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 ? 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

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

183

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

SciTech Connect

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.

Kitsou, Maria-Chrysanthi; Kostopanagiotou, Georgia; Kalimeris, Konstantinos [University of Athens, 2nd Department of Anesthesiology-Pain Unit, School of Medicine, Attikon University Hospital (Greece); Vlachodimitropoulos, Demetrios [University of Athens, Department of Forensic Medicine, School of Medicine (Greece); Soultanis, Konstantinos [University of Athens, 1st Department of Orthopaedics, School of Medicine, Attikon University Hospital (Greece); Batistaki, Chrysanthi [University of Athens, 2nd Department of Anesthesiology-Pain Unit, School of Medicine, Attikon University Hospital (Greece); Kelekis, Alexis, E-mail: akelekis@med.uoa.gr [University of Athens, 2nd Radiology Department, Attikon University Hospital (Greece)

2011-12-15

184

Chronic spinal cord injury: management of patients in acute hospital settings  

Microsoft Academic Search

Spinal cord injury (SCI) is a lifelong condition affecting over 40,000 people in the UK. When an individual with established SCI is admitted to hospital for a procedure or because of illness, hospital teams need to manage both the acute condition and the spinal cord injury. These guidelines aim to assist in their assessment and management to avoid the common

Angela Gall; Lynne Turner; Stokes FRCP

2008-01-01

185

Clinical observation of fetal olfactory ensheathing glia transplantation (OEGT) in patients with complete chronic spinal cord injury.  

PubMed

This study was designed to observe the functional changes after fetal olfactory ensheathing glia transplantation (OEGT) into the spinal cord of patients with chronic spinal cord injury (SCI). Patients whose recovery had plateaued for longer than 6 months were enrolled. Six thoracic patients were tested for safety and five cervical patients for efficacy. OEGT was performed according to the method developed by Huang. Average follow-up was 14 months (range 1.0-1.5 years). Sensation improved moderately (light touch 14.2, pin prick 13.6); as did spasticity (1-2 modified Ashworth scale down). Locomotion recovery was minimal (1.6). Useful reticular formation functions were observed, but due to a lack of appropriate outcome measure, they were not recorded and reported. PMID:22507678

Wu, Jun; Sun, Tiansheng; Ye, Chaoqun; Yao, Jianhua; Zhu, Bing; He, Hongying

2012-01-01

186

Spinal Cord Stimulation in Deafferentation Pain  

Microsoft Academic Search

Spinal cord stimulation (SCS) was used in 49 cases to control resistant deafferentation pain resulting from causalgia, phantom limb, plexus and nerve root avulsion, postherpetic neuralgia, reflex sympathetic dystrophy and amputation. In all cases, one or two Standard percutaneous leads were introduced into the epidural space and manipulated until the spinal segment at which external stimulation provoked paresthesic sensation in

M. J. Sánchez-Ledesma; G. García-March; P. Diaz-Cascajo; J. Gómez-Moreta; J. Broseta

1989-01-01

187

Influence of chronic and acute spinal cord injury on skeletal muscle Na+-K+-ATPase and phospholemman expression in humans.  

PubMed

Na(+)-K(+)-ATPase is an integral membrane protein crucial for the maintenance of ion homeostasis and skeletal muscle contractibility. Skeletal muscle Na(+)-K(+)-ATPase content displays remarkable plasticity in response to long-term increase in physiological demand, such as exercise training. However, the adaptations in Na(+)-K(+)-ATPase function in response to a suddenly decreased and/or habitually low level of physical activity, especially after a spinal cord injury (SCI), are incompletely known. We tested the hypothesis that skeletal muscle content of Na(+)-K(+)-ATPase and the associated regulatory proteins from the FXYD family is altered in SCI patients in a manner dependent on the severity of the spinal cord lesion and postinjury level of physical activity. Three different groups were studied: 1) six subjects with chronic complete cervical SCI, 2) seven subjects with acute, complete cervical SCI, and 3) six subjects with acute, incomplete cervical SCI. The individuals in groups 2 and 3 were studied at months 1, 3, and 12 postinjury, whereas individuals with chronic SCI were compared with an able-bodied control group. Chronic complete SCI was associated with a marked decrease in [(3)H]ouabain binding site concentration in skeletal muscle as well as reduced protein content of the ?(1)-, ?(2)-, and ?(1)-subunit of the Na(+)-K(+)-ATPase. In line with this finding, expression of the Na(+)-K(+)-ATPase ?(1)- and ?(2)-subunits progressively decreased during the first year after complete but not after incomplete SCI. The expression of the regulatory protein phospholemman (PLM or FXYD1) was attenuated after complete, but not incomplete, cervical SCI. In contrast, FXYD5 was substantially upregulated in patients with complete SCI. In conclusion, the severity of the spinal cord lesion and the level of postinjury physical activity in patients with SCI are important factors controlling the expression of Na(+)-K(+)-ATPase and its regulatory proteins PLM and FXYD5. PMID:22275761

Boon, Hanneke; Kostovski, Emil; Pirkmajer, Sergej; Song, Moshi; Lubarski, Irina; Iversen, Per O; Hjeltnes, Nils; Widegren, Ulrika; Chibalin, Alexander V

2012-04-01

188

Thoracic epidural analgesia in lung transplantation.  

PubMed

Achieving optimal pain relief after lung transplantation (LT) is often difficult, because both systemic analgesics and regional techniques have specific advantages and disadvantages. Uncontrolled pain impedes repeated powerful coughs and hinders valid respiratory excursions and graft expansion; these consequences markedly increase the risk of pulmonary complications. Thoracic epidural analgesia (TEA) is a universally accepted method of pain management after unilateral or bilateral thoracotomy, and in clinical experience it has proven to be the best option after LT. The combination of epidural local anesthetic plus opioid is associated with significant reduction in pain scores and/or supplementary analgesic requirement compared with parenteral opioid analgesia. Even though the benefits of epidural techniques in reduction of respiratory morbidity and protection from stress response to surgery have to be weighted against the risk of spinal bleeding, a well functioning thoracic sensory blockade provides satisfactory pain control and avoids the excessive sedation associated with systemic opiates. Multiple factors determine the quality of postoperative assistance, and a clear relationship between "adequate" or "high-quality" postoperative analgesia and improved outcome is difficult to establish. However, an individualized perimedullary analgesic regimen may certainly contribute to greater cooperation with physical maneuvers, avoid noxious limitations to graft expansion, and possibly decrease overall morbidity. PMID:20534277

Feltracco, P; Barbieri, S; Milevoj, M; Serra, E; Michieletto, E; Carollo, C; Rea, F; Marulli, G; Ori, C

2010-05-01

189

COMPARABLE EFFECTIVENESS OF CAUDAL VS. TRANS-FORAMINAL EPIDURAL STEROID INJECTIONS  

Microsoft Academic Search

Study Design: Retrospective case-control study. Objective: To compare the effectiveness between caudal and trans-foraminal epidural steroid injec- tions for the treatment of primary lumbar radicu- lopathy. Summary of Background Data: Spinal injec- tions with steroids play an important role in non-operative care of lumbar radiculopathy. The trans-foraminal epidural steroid injection (TESI) theoretically has a higher success rate based on targeted

Sergio Mendoza-Lattes; Andrew Weiss; Ernest Found; Bridget Zimmerman; Yubo Gao

190

Decorin blocks scarring and cystic cavitation in acute and induces scar dissolution in chronic spinal cord wounds.  

PubMed

In the injured central nervous system (CNS), transforming growth factor (TGF)-?1/2-induced scarring and wound cavitation impede axon regeneration implying that a combination of both scar suppression and axogenic treatments is required to achieve functional recovery. After treating acute and chronic dorsal funicular spinal cord lesions (DFL) in adult rats with the pan-TGF-?1/2 antagonist Decorin, we report that in: (1), acute DFL, the development of all injury parameters was significantly retarded e.g., wound cavity area by 68%, encapsulation of the wound by a glia limitans accessoria (GLA) by 65%, GLA basal lamina thickness by 94%, fibronectin, NG2 and Sema-3A deposition by 87%, 48% and 48%, respectively, and both macrophage and reactive microglia accumulations by 60%; and (2), chronic DFL, all the above parameters were attenuated to a lesser extent e.g., wound cavity area by 11%, GLA encapsulation by 25%, GLA basal lamina thickness by 31%, extracellular fibronectin, NG2 and Sema-3A deposition by 58%, 22% and 29%, respectively, and macrophage and reactive microglia accumulations by 44%. Moreover, in acute and chronic DFL, levels of tissue plasminogen activator (tPA) were raised (by 236% and 482%, respectively), as were active-MMP-2 (by 64% and 91%, respectively) and active-MMP-9 (by 122% and 18%, respectively), while plasminogen activator inhibitor-1 (PAI-1) was suppressed (by 56% and 23%, respectively) and active-TIMP-1 and active TIMP-2 were both lower but only significantly suppressed in acute DFL (by 56 and 21%, respectively). These findings demonstrate that both scar tissue mass and cavitation are attenuated in acute and chronic spinal cord wounds by Decorin treatment and suggest that the dominant effect of Decorin during acute scarring is anti-fibrogenic through suppression of inflammatory fibrosis by neutralisation of TGF-?1/2 whereas, in chronic lesions, Decorin-induction of tPA and MMP (concomitant with reduced complimentary levels of TIMP and PAI-1) leads to dissolution of the mature established scar by fibrolysis. Decorin also promoted the regeneration of similar numbers of axons through acute and chronic wounds. Accordingly, intrathecal delivery of Decorin offers a potential translatable treatment for scar tissue attenuation in patients with spinal cord injury. PMID:24384090

Ahmed, Zubair; Bansal, Daljeet; Tizzard, Katie; Surey, Sarina; Esmaeili, Maryam; Gonzalez, Ana Maria; Berry, Martin; Logan, Ann

2014-04-01

191

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

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.

Rades, Dirk [Department of Radiation Oncology, University Hospital Lubeck, Lubeck (Germany)], E-mail: Rades.Dirk@gmx.net; Lange, Marisa [Department of Radiation Oncology, University Hospital Lubeck, Lubeck (Germany); Veninga, Theo [Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg (Netherlands); Rudat, Volker [Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar (Saudi Arabia); Bajrovic, Amira [Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf (Germany); Stalpers, Lukas J.A. [Department of Radiotherapy, Academic Medical Center, Amsterdam (Netherlands); Dunst, Juergen [Department of Radiation Oncology, University Hospital Lubeck, Lubeck (Germany); Schild, Steven E. [Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ (United States)

2009-01-01

192

Long-term changes of c-Fos expression in the rat spinal cord following chronic constriction injury.  

PubMed

The expression of c-Fos protein has been used as a relative marker of nociceptive neuronal activity in the spinal cord following various noxious stimuli. Experiments were conducted to examine c-Fos expression in lumbar spinal cord (L3-L6) following chronic constriction injury (CCI) in relation to nociceptive behavior over longer survival period up to 28 days. Development of mechanical allodynia was observed in the ipsilateral hind paw of CCI rats at day 3 and lasted up to 28 days. In contrast, the spinal c-Fos expression in CCI rats appeared in a biphasic manner. The highest number of c-Fos positive neurons occurred during the first week, followed by a decline at 7 and 14 days and reappearance at day 28 following injury. The early increase of c-Fos expression correlated with allodynia development, however, at longer survival period (28 days) c-Fos positivity become comparable in both CCI and sham groups despite their obvious behavior differences. Our results suggest that, at least in the CCI model, the c-Fos protein expression should not be considered as a reliable index of pain sensation disorders. PMID:15862484

Jergova, Stanislava; Cizkova, Dasa

2005-06-01

193

Recovery of the pulmonary chemoreflex and functional role of bronchopulmonary C-fibers following chronic cervical spinal cord injury.  

PubMed

Persistent impairment of pulmonary defense reflexes is a critical factor contributing to pulmonary complications in patients with spinal cord injuries. The pulmonary chemoreflex evoked by activation of bronchopulmonary C-fibers has been reported to be abolished in animals with acute cervical hemisection (C2Hx). The present study examined whether the pulmonary chemoreflex can recover during the chronic injury phase and investigated the role of bronchopulmonary C-fibers on the altered breathing pattern after C2Hx. In the first protocol, bronchopulmonary C-fibers were excited by intrajugular capsaicin administration in uninjured and complete C2Hx animals 8 wk postsurgery. Capsaicin evoked pulmonary chemoreflexes in both groups, but the reflex intensity was significantly weaker in C2Hx animals. To examine whether spared spinal white matter tissue contributes to pulmonary chemoreflex recovery, the reflex was evaluated in animals with different extents of lateral injury. Linear regression analyses revealed that tidal volume significantly correlated with the extent of spared tissue; however, capsaicin-induced apnea was not related to injury severity when the ipsilateral-to-contralateral white matter ratio was <50%. In the second protocol, the influence of background bronchopulmonary C-fiber activity on respiration was investigated by blocking C-fiber conduction via perivagal capsaicin treatment. The rapid shallow breathing of C2Hx animals persisted after perivagal capsaicin treatment despite attenuation of pulmonary chemoreflexes. These results indicate that the pulmonary chemoreflex can recover to some extent following spinal injury, but remains attenuated even when there is moderate spinal tissue sparing, and that altered breathing pattern of C2Hx animals cannot be attributed to endogenous activation of bronchopulmonary C-fibers. PMID:25257870

Lee, Kun-Ze; Chang, Yu-Shuo

2014-11-15

194

Piriformis pyomyositis mimicking epidural abscess in a parturient  

Microsoft Academic Search

A case is presented of a patient who developed fever, leukocytosis, severe back pain, local overlying spinal tenderness, and\\u000a left leg weakness on the fifth day postpartum. The patient had epidural anaesthesia for ten hours duration, before and during\\u000a a forceps delivery. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) of the pelvis and lumbar spine\\u000a revealed swelling of

Anna M. Kinahan; M. Joanne Douglas; Kari G. Smedstad; Terrance W. Breen

1995-01-01

195

Shivering during epidural anesthesia.  

PubMed

The authors tested the hypothesis that during epidural anesthesia: 1) shivering-like tremor is primarily normal thermoregulatory shivering; 2) hypothermia does not produce a subjective sensation of cold; and 3) injectate temperature does not influence tremor intensity. An epidural catheter was inserted into ten healthy, nonpregnant volunteers randomly assigned to skin-surface warming below the T10 dermatome (warmed group) or no extra warming (unwarmed group). Each volunteer was given two 30-ml epidural injections of 1% lidocaine (16.0 +/- 4.7 degrees C and 40.6 +/- 0.7 degrees C at the catheter tip), in random order separated by at least 3 h. Skin-temperature gradients (forearm-fingertip) and tympanic membrane and average skin temperatures were recorded; significant vasoconstriction was prospectively defined as a gradient greater than or equal to 4 degrees C. Integrated electromyographic (EMG) intensity was recorded from four upper-body muscles. Overall thermal comfort was evaluated using a visual analog scale. Tympanic membrane temperatures decreased significantly in the unwarmed group (n = 6). Tremor occurred following ten of 12 injections in unwarmed volunteers, but only following one of eight injections in the warmed group. Integrated EMG intensity did not differ significantly following epidural injection of warm and cold lidocaine: tremor started when tympanic membrane temperature decreased about 0.5 degrees C and continued until central temperature returned to within 0.5 degrees C of control. Tremor always was preceded by hypothermia and vasoconstriction in the arms. Thermal comfort increased in both groups after epidural injection, with maximal comfort occurring at the lowest tympanic temperatures.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2339797

Sessler, D I; Ponte, J

1990-05-01

196

Spinal cord stimulation exerts analgesia effects in chronic constriction injury rats via suppression of the TLR4/NF-?B pathway.  

PubMed

Spinal cord stimulation (SCS) is an established method for treating chronic neuropathic pain. However, the mechanisms underlying the pain relieving effect of SCS on neuropathic pain remain unclear. Evidence shows that the toll-like receptor 4 (TLR4)/nuclear factor (NF)-?B signal transduction pathway plays a key role in chronic neuropathic pain. We investigated changes in the TLR4/NF-?B pathway and downstream pro-inflammatory cytokine expression in L4-6 spinal cord following SCS. Neuropathic pain was induced through chronic constriction injury (CCI) of the sciatic nerve in rats. Mechanical withdrawal threshold (MWT) was assessed before surgery and on days 1, 4, 7, and 14 after CCI. During days 11-14, the nerve-injured rats were treated with SCS for 30min per day. Compared with the control group, the CCI rats displayed a significantly decreased MWT. After SCS for 3 days, the expression of TLR4/NF-?B and the levels of interleukin(IL)-1?, IL-6, and tumor necrosis factor (TNF)-? in the spinal cord were lower in the SCS group compared to those in the CCI and sham spinal cord stimulation (S-SCS) groups. These results indicate that SCS could effectively attenuate neuropathic pain in CCI rats by inhibiting the activation of the TLR4/NF-?B signaling pathway and by inhibiting the up-regulation of pro-inflammatory cytokines in the spinal cord. PMID:25153517

Yuan, Baohong; Liu, Danyan; Liu, Xiaonan

2014-10-01

197

Human Neural Stem Cells Differentiate and Promote Locomotor Recovery in an Early Chronic Spinal coRd Injury NOD-scid Mouse Model  

Microsoft Academic Search

BackgroundTraumatic spinal cord injury (SCI) results in partial or complete paralysis and is characterized by a loss of neurons and oligodendrocytes, axonal injury, and demyelination\\/dysmyelination of spared axons. Approximately 1,250,000 individuals have chronic SCI in the U.S.; therefore treatment in the chronic stages is highly clinically relevant. Human neural stem cells (hCNS-SCns) were prospectively isolated based on fluorescence-activated cell sorting

Desirée L. Salazar; Nobuko Uchida; Frank P. T. Hamers; Brian J. Cummings; Aileen J. Anderson; Fabrizio Gelain

2010-01-01

198

Imaging of Spinal Metastatic Disease  

PubMed Central

Metastases to the spine can involve the bone, epidural space, leptomeninges, and spinal cord. The spine is the third most common site for metastatic disease, following the lung and the liver. Approximately 60–70% of patients with systemic cancer will have spinal metastasis. Materials/Methods. This is a review of the imaging techniques and typical imaging appearances of spinal metastatic disease. Conclusions. Awareness of the different manifestations of spinal metastatic disease is essential as the spine is the most common site of osseous metastatic disease. Imaging modalities have complimentary roles in the evaluation of spinal metastatic disease. CT best delineates osseous integrity, while MRI is better at assessing soft tissue involvement. Physiologic properties, particularly in treated disease, can be evaluated with other imaging modalities such as FDG PET and advanced MRI sequences. Imaging plays a fundamental role in not only diagnosis but also treatment planning of spinal metastatic disease. PMID:22312523

Shah, Lubdha M.; Salzman, Karen L.

2011-01-01

199

Persistent At-Level Thermal Hyperalgesia and Tactile Allodynia Accompany Chronic Neuronal and Astrocyte Activation in Superficial Dorsal Horn following Mouse Cervical Contusion Spinal Cord Injury  

PubMed Central

In humans, sensory abnormalities, including neuropathic pain, often result from traumatic spinal cord injury (SCI). SCI can induce cellular changes in the CNS, termed central sensitization, that alter excitability of spinal cord neurons, including those in the dorsal horn involved in pain transmission. Persistently elevated levels of neuronal activity, glial activation, and glutamatergic transmission are thought to contribute to the hyperexcitability of these dorsal horn neurons, which can lead to maladaptive circuitry, aberrant pain processing and, ultimately, chronic neuropathic pain. Here we present a mouse model of SCI-induced neuropathic pain that exhibits a persistent pain phenotype accompanied by chronic neuronal hyperexcitability and glial activation in the spinal cord dorsal horn. We generated a unilateral cervical contusion injury at the C5 or C6 level of the adult mouse spinal cord. Following injury, an increase in the number of neurons expressing ?FosB (a marker of chronic neuronal activation), persistent astrocyte activation and proliferation (as measured by GFAP and Ki67 expression), and a decrease in the expression of the astrocyte glutamate transporter GLT1 are observed in the ipsilateral superficial dorsal horn of cervical spinal cord. These changes have previously been associated with neuronal hyperexcitability and may contribute to altered pain transmission and chronic neuropathic pain. In our model, they are accompanied by robust at-level hyperaglesia in the ipsilateral forepaw and allodynia in both forepaws that are evident within two weeks following injury and persist for at least six weeks. Furthermore, the pain phenotype occurs in the absence of alterations in forelimb grip strength, suggesting that it represents sensory and not motor abnormalities. Given the importance of transgenic mouse technology, this clinically-relevant model provides a resource that can be used to study the molecular mechanisms contributing to neuropathic pain following SCI and to identify potential therapeutic targets for the treatment of chronic pathological pain. PMID:25268642

Watson, Jaime L.; Hala, Tamara J.; Putatunda, Rajarshi; Sannie, Daniel; Lepore, Angelo C.

2014-01-01

200

Enzymatic plasticity of medial gastrocnemius fibers in the adult chronic spinal cat.  

PubMed

The metabolic plasticity of single fibers in adult cat medial gastrocnemius (MG) 6 mo after complete spinal cord transection (Sp) at T12-T13 was studied. Some Sp cats were trained to weight support (Sp-WS) 30 min/day beginning 1 mo posttransection. Cross-sectional area, succinate dehydrogenase (SDH), alpha-glycerophosphate dehydrogenase (GPD), and myofibrillar adenosinetriphosphatase (ATPase) activities were determined in fibers identified in frozen serial sections. Fibers were categorized as light or dark based on myosin ATPase staining, alkaline preincubation. The percentage of dark ATPase fibers was higher in Sp and Sp-WS (approximately 85%) than in control (approximately 60%). All dark ATPase fibers reacted positively to a fast myosin heavy chain monoclonal antibody. In both spinal groups, a higher percentage of dark ATPase fibers reacted to both fast and slow myosin heavy chain antibodies than in controls. Neither Sp nor Sp-WS cats showed fiber atrophy. Compared with control, SDH activity was decreased in both fiber types of Sp cats. Daily weight-support training ameliorated this adaptation. There were no differences among the three groups in mean GPD and ATPase activities for either fiber type. There was a slight tendency, however, for spinal cats to have higher GPD and ATPase activities (independent of type) than control, probably reflecting the larger proportion of dark ATPase fibers in these cats. These observations indicate that 6 mo after spinalization in adult cats, some of the fibers of a fast muscle became "faster" and developed oxidative and glycolytic enzyme profiles that normally are exhibited in fast fatigable motor units.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2144712

Jiang, B; Roy, R R; Edgerton, V R

1990-09-01

201

Epidural steroid injections are useful for the treatment of low back pain and radicular symptoms: pro.  

PubMed

Epidural steroid injection has been used to treat low back pain for many decades. Numerous randomized trials have examined the efficacy of this approach. This review details the findings of older systematic reviews, newer randomized controlled trials, and two recent systematic reviews that examine the effectiveness of this treatment. Collectively, studies in acute radicular pain due to herniated nucleus pulposus have failed to show that epidural steroid injection reduces long-term pain or obviates the need for surgery. Similarly, there is scant evidence that epidural steroids have any beneficial effect in those with acute low back pain without leg pain or in those with chronic low back or leg pain. However, most studies have demonstrated more rapid resolution of leg pain in those who received epidural steroid injections versus those who did not. The role of epidural steroid injections in the management of acute radicular pain due to herniated nucleus pulposus is simply to provide earlier pain relief. PMID:19126368

Sethee, Jai; Rathmell, James P

2009-02-01

202

Cardiac myxosarcoma with thoracic spinal metastasis.  

PubMed

Echocardiography revealed a left atrial tumor in a 59-year-old man with back pain that concurrently worsened with left foot drop and loss of the left ankle reflex soon after admission to our hospital. Magnetic resonance imaging of the spine revealed an epidural tumor extending from Th5 with spinal cord compression. The patient was immediately treated by emergency Th4-5 laminectomy and epidural decompression. One month later, a cardiac tumor excised via the left atrial approach was histopathologically diagnosed as myxosarcoma, and the Th5 tumor was consistent with this finding. This is the first report to describe spinal metastasis of cardiac myxosarcoma. PMID:23677508

Kimura, Mitsuhiro; Kikuchi, Chizuo; Takahashi, Yoshiki; Kanazawa, Hiroshi; Nakazawa, Satoshi

2014-07-01

203

Digital subtraction angiography does not reliably prevent paraplegia associated with lumbar transforaminal epidural steroid injection.  

PubMed

Digital subtraction angiography (DSA) has been touted as a radiologic adjunct to interventional neuraxial procedures where it is imperative to identify vascular compromise during the injection. Transforaminal epidural steroid injections (TFESI) are commonly performed interventions for treating acute and chronic radicular spine pain. We present a case of instantaneous and irreversible paraplegia following lumbar TFESI wherein a local anesthetic test dose, as well as DSA, were used as adjuncts to fluoroscopy. An 80-year-old man with severe lumbar spinal stenosis and chronic L5 radiculopathic pain was evaluated at a university pain management center seeking symptomatic pain relief. Two prior lumbar interlaminar epidural steroid injections (LESI) provided only transient pain relief, and a decision was made to perform right-sided L5-S1 TFESI. A 5-inch, 22-gauge Quincke-type spinal needle with a curved tip was used. Foraminal placement of the needle tip was confirmed with anteroposterior, oblique, and lateral views on fluoroscopy. Aspiration did not reveal any blood or cerebrospinal fluid. Digital subtraction angiography was performed twice to confirm the absence of intravascular contrast medium spread. Subsequently, a 0.5 mL of 1% lidocaine test dose was performed without any changes in neurological status. Two minutes later, a mixture of one mL of 1% lidocaine with 80 mg triamcinolone acetonide was injected. Immediately following the completion of the injection, the patient reported extreme bilateral lower extremity pain. He became diaphoretic, followed by marked weakness in his bilateral lower extremities and numbness up to his lower abdomen. The patient was transferred to the emergency department for evaluation. Magnetic resonance imaging (MRI) of the lumbar and thoracic spine was completed 5 hours postinjection. It showed a small high T2 signal focus in the thoracic spinal cord at the T7-T8 level. The patient was admitted to the critical care unit for neurological observation and treatment with intravenous methylprednisolone. Follow-up MRI revealed a hyper-intense T2 and short-tau inversion recovery signal in the central portion of the spinal cord beginning at the level of the T6 superior endplate and extending caudally to the T9-T10 level with accompanying development of mild spinal cord expansion. The patient was diagnosed with paraplegia from acute spinal cord infarction. At discharge to an acute inpatient rehabilitation program, the patient had persistent bilateral lower extremity paralysis, and incontinence of bowel and bladder functions. In the present patient, DSA performed twice and an anesthetic test dose did not prevent a catastrophic spinal cord infarction and resulting paraplegia. DSA use is clearly not foolproof and may not be sufficient to identify potentially life-or-limb threatening consequences of lumbar TFESI. We believe that this report should open further discussion regarding adding the possibility of these catastrophic events in the informed consent process for lumbar TFESIs, as it has for cervical TFESI. Utilizing blunt needles or larger bevel needles in place of sharp, cutting needles may minimize the chances of this event occurring. Considering eliminating use of particulate steroids for TFESI should be evaluated, although the use of nonparticulate agents remains controversial due to the perception that their respective duration of action is less than that of particulate steroids. PMID:23159970

Chang Chien, George C; Candido, Kenneth D; Knezevic, Nebojsa Nick

2012-01-01

204

Acute and chronic phases of complex regional pain syndrome in mice are accompanied by distinct transcriptional changes in the spinal cord  

PubMed Central

Background CRPS is a painful, debilitating, and often-chronic condition characterized by various sensory, motor, and vascular disturbances. Despite many years of study, current treatments are limited by our understanding of the underlying mechanisms. Little is known on the molecular level concerning changes in gene expression supporting the nociceptive sensitization commonly observed in CRPS limbs, or how those changes might evolve over time. Results We used a well-characterized mouse tibial fracture/cast immobilization model of CRPS to study molecular, vascular and nociceptive changes. We observed that the acute (3 weeks after fracture) and chronic (7 weeks after fracture) phases of CRPS-like changes in our model were accompanied by unique alterations in spinal gene expression corresponding to distinct canonical pathways. For the acute phase, top regulated pathways were: chemokine signaling, glycogen degradation, and cAMP-mediated signaling; while for the chronic phase, the associated pathways were: coagulation system, granzyme A signaling, and aryl hydrocarbon receptor signaling. We then focused on the role of CcL2, a chemokine that we showed to be upregulated at the mRNA and protein levels in spinal cord tissue in our model. We confirmed its association with the nociceptive sensitization displayed in this model by demonstrating that the spinal but not peripheral administration of a CCR2 antagonist (RS504393) in CRPS animals could decrease mechanical allodynia. The spinal administration of CcL2 itself resulted in mechanical allodynia in control mice. Conclusions Our data provide a global look at the transcriptional changes in the spinal cord that accompany the acute and chronic phases of CRPS as modeled in mice. Furthermore, it follows up on one of the top-regulated genes coding for CcL2 and validates its role in regulating nociception in the fracture/cast model of CRPS. PMID:23924076

2013-01-01

205

The Prevalence and Phenotype of Activated Microglia/Macrophages within the Spinal Cord of the Hyperostotic Mouse (twy/twy) Changes in Response to Chronic Progressive Spinal Cord Compression: Implications for Human Cervical Compressive Myelopathy  

PubMed Central

Background Cervical compressive myelopathy, e.g. due to spondylosis or ossification of the posterior longitudinal ligament is a common cause of spinal cord dysfunction. Although human pathological studies have reported neuronal loss and demyelination in the chronically compressed spinal cord, little is known about the mechanisms involved. In particular, the neuroinflammatory processes that are thought to underlie the condition are poorly understood. The present study assessed the localized prevalence of activated M1 and M2 microglia/macrophages in twy/twy mice that develop spontaneous cervical spinal cord compression, as a model of human disease. Methods Inflammatory cells and cytokines were assessed in compressed lesions of the spinal cords in 12-, 18- and 24-weeks old twy/twy mice by immunohistochemical, immunoblot and flow cytometric analysis. Computed tomography and standard histology confirmed a progressive spinal cord compression through the spontaneously development of an impinging calcified mass. Results The prevalence of CD11b-positive cells, in the compressed spinal cord increased over time with a concurrent decrease in neurons. The CD11b-positive cell population was initially formed of arginase-1- and CD206-positive M2 microglia/macrophages, which later shifted towards iNOS- and CD16/32-positive M1 microglia/macrophages. There was a transient increase in levels of T helper 2 (Th2) cytokines at 18 weeks, whereas levels of Th1 cytokines as well as brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and macrophage antigen (Mac) ?2 progressively increased. Conclusions Spinal cord compression was associated with a temporal M2 microglia/macrophage response, which may act as a possible repair or neuroprotective mechanism. However, the persistence of the neural insult also associated with persistent expression of Th1 cytokines and increased prevalence of activated M1 microglia/macrophages, which may lead to neuronal loss and demyelination despite the presence of neurotrophic factors. This understanding of the aetiopathology of chronic spinal cord compression is of importance in the development of new treatment targets in human disease. PMID:23717624

Hirai, Takayuki; Uchida, Kenzo; Nakajima, Hideaki; Guerrero, Alexander Rodriguez; Takeura, Naoto; Watanabe, Shuji; Sugita, Daisuke; Yoshida, Ai; Johnson, William E. B.; Baba, Hisatoshi

2013-01-01

206

Spontaneous Cervical Epidural Hematoma with Hemiparesis Mimicking Cerebral Stroke  

PubMed Central

Aim. Spontaneous cervical epidural hematoma (SCEH) is defined as an epidural hematoma that does not have an etiological explanation. The most common site for SCEH is cervicothoracic area. Early diagnosis and treatment are important for prognosis and good results. In this paper, we aimed to present a case who complains of sudden weakness on right extremities imitating cerebral stroke and that neuroimaging reveals spontaneous cervical epidural hematoma. Case. A 72-year-old woman was admitted to our hospital with acute neck pain and loss of strength on right extremities. On neurological examination, the patient had right hemiparesis. PT, aPTT, and INR results were 50.5, 42.8, and 4.8, respectively. Cranial MRI was in normal limits. Spinal MRI revealed a lesion that extends from C4 to C7 located on the right side and compatible with epidural hematoma. The patient was operated after normalization of INR values. Conclusion. Even though SCEH is a rare condition, it can cause severe morbidity and mortality. Early diagnosis and treatment are quiet important for prognosis. SCEH can easily be mistaken for stroke as with other pathologies and this diagnosis should come to mind especially in patients who have diathesis of bleeding. PMID:25371831

Tiryaki, Mehmet; Aydin, Serdar Onur; Efendioglu, Mustafa; Balak, Naci

2014-01-01

207

Adiponectin is a candidate biomarker of lower extremity bone density in men with chronic spinal cord injury.  

PubMed

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

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

2014-01-01

208

The pig model of chronic paraplegia: a challenge for experimental studies in spinal cord injury.  

PubMed

The regenerative medicine techniques that are beginning to be applied to the nervous system have led to increased hope in the treatment of diseases that have been considered incurable and that require experimental models on which to test new therapeutic strategies. We present our experience with adult pigs (minipigs) that have undergone a traumatic spinal cord injury (SCI) experimental model, and that have been followed for 1 year. We describe the surgical aspects of our SCI model by acute compression and also describe protocols for daily care and rehabilitation that are necessary to maintain the paraplegic pigs in good health during the months following the injury. Furthermore, we provide in detail the main complications that arise with this experimental model and the treatments used to address these complications. Suitable housing conditions, daily rehabilitation and prevention of complications (i.e., taking the same care applied to patients following SCI) are essential for achieving the absence of mortality and long-term maintenance of the animals. We consider the model that is described here to be feasible and useful for preliminary testing of novel therapeutic strategies aimed at regeneration of the injured spinal cord in paraplegic patients. PMID:22564435

Zurita, Mercedes; Aguayo, Concepción; Bonilla, Celia; Otero, Laura; Rico, Miguel; Rodríguez, Alicia; Vaquero, Jesús

2012-06-01

209

Total vertebrectomy for stabilisation of chronic spinal lumbar luxation in a paraplegic dog without nociception.  

PubMed

An adult male crossbred dog was referred with a history of a road traffic accident that took place 1 month earlier. Neurological examination revealed paraplegia with absent nociception in the pelvic limbs. On epaxial palpation, significant curvature of the anatomical axis of the spine between the third and fourth lumbar vertebrae was observed, with the presence of a bone end almost piercing the dog's skin. Survey radiographs of the lumbar spine revealed severe dislocation between L3 and L4 vertebrae. During surgery, the spinal cord was not visible between the dislocated segments. Because of difficulties in reducing the lumbar luxation during surgery, vertebrectomy and vertebral shortening were performed. After alignment between vertebrae L3 and L5, eight cortical orthopaedic screws and bone cement were used for fixation. After 30 days, the dog started to use a wheelchair and was considered by its owner to have a good quality of life with no evidence of pain. To the authors' knowledge, this is the first case of severe luxation treated by total vertebrectomy and spine shortening in a dog. This surgery can be considered as an option in the management of severe spine luxation when the spinal cord is physically transected. PMID:24962201

Tertuliano Marinho, P V; Zani, C C; De Biasi, F; Bahr Arias, M V

2014-10-01

210

Unusual form of spinal tuberculosis: involvement of atlantoaxial joint  

Microsoft Academic Search

A 40-year-old woman who had neck pain and weakness in her extremities for 3 months was investigated. Anterior dislocation of atlantoaxial joint was detected on plain film. Epidural soft tissue mass leading spinal cord compression was found at the atlantoaxial joint on MR examination. The odontoid process was destructed as well. The soft tissue mass was isointense with spinal cord

Kutsi Koseoglu; Can Z. Karaman; Alev Akdilli; Yelda Ozsunar Dayanir

2003-01-01

211

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

PubMed Central

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

2010-01-01

212

MicroRNA-mediated GABAA?-1 receptor subunit downregulation in adult spinal cord following neonatal cystitis-induced chronic visceral pain in rats  

PubMed Central

The nociceptive transmission under pathological chronic pain conditions involves transcriptional and/or translational alteration in spinal neurotransmitters and receptors expression, and modification of neuronal function. Studies indicate the involvement of MicroRNA (miRNA)-mediated transcriptional deregulation in pathophysiology of acute and chronic pain. In the present study, we tested the hypothesis that long-term cross-organ colonic hypersensitivity in neonatally zymosan-induced cystitis is due to miRNA-mediated posttranscriptional suppression of the developing spinal GABAergic system. Cystitis was produced by intravesicular injection of zymosan (1% in saline) into the bladder during postnatal (P) days P14 through P16 and spinal dorsal horns (L6-S1) were collected either on P60 (unchallenge groups) or on P30 following a zymosan re-challenge on P29 (re-challenge groups). miRNA arrays and Real-time reverse transcription polymerase chain reaction revealed significant, but differential, upregulation of mature miR-181a in the L6-S1 spinal dorsal horns from zymosan-treated rats compared with saline controls in both unchallenge and re-challenge groups. The target gene analysis demonstrated multiple complementary binding sites in miR-181a for GABAA receptor subunit GABAA??1 gene with a miRSVR score of ?1.83. Increase in miR-181a concomitantly resulted in significant downregulation of GABAA??1 receptor subunit gene and protein expression in adult spinal cords from neonatal cystitis rats. Intrathecal administration of GABAA receptor agonist muscimol failed to attenuate viscero-motor response (VMR) to colon distension in neonatal cystitis rats, whereas, in adult zymosan-treated rats the drug produced significant decrease in VMR. These results support an integral role for miRNA-mediated transcriptional deregulation of GABAergic system in neonatal cystitis-induced chronic pelvic pain. PMID:23273104

Sengupta, JN; Pochiraju, S; Kannampalli, P; Bruckert, M; Addya, S; Yadav, P; Miranda, A; Shaker, R; Banerjee, B

2012-01-01

213

Spinal infections: clinical and imaging features.  

PubMed

Spinal infections represent a group of rare conditions affecting vertebral bodies, intervertebral discs, paraspinal soft tissues, epidural space, meninges, and spinal cord. The causal factors, clinical presentations, and imaging features are a challenge because the difficulty to differentiate them from other conditions, such as degenerative and inflammatory disorders and spinal neoplasm. They require early recognition because delay diagnosis, imaging, and intervention may have devastating consequences especially in children and the elderly. This article reviews the most common spinal infections, their pathophysiologic, clinical manifestation, and their imaging findings. PMID:25296275

Arbelaez, Andres; Restrepo, Feliza; Castillo, Mauricio

2014-10-01

214

Relief of Postherpetic Neuralgia with Transforaminal Epidural Injection of Magnesium  

E-print Network

Although postherpetic neuralgia (PHN) is a common chronic pain syndrome, the pathophysiology of this disorder is not well known and management is often very difficult. N-methyl-D-Aspartate (NMDA) receptor antagonists are known to be effective in PHN, and magnesium, a physiological blocker of NMDA receptors, is widely used to treat various chronic pain disorders. Here, we present a case of the PHN refractory to conventional treatment, which was treated successfully with transforaminal epidural injection of magnesium sulphate at the affected dermatome. (Korean J Pain 2011; 24: 53-56) Key Words: epidural injections, magnesium sulphate, N-Methyl-D-Aspartate receptor, postherpetic neuralgia. Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome that occurs after reactivation of varicella zoster virus infection with damage to sensory ganglia in nerve roots [1]. Numerous treatment strategies for PHN, including topical lidocaine patches, antidepressants, anticonvulsants, corticosteroids, opioids and nerve blocks, have shown some degree of efficacy [2], but the effects

unknown authors

2010-01-01

215

Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings  

Microsoft Academic Search

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI

Berna Oguz; Kader Karli Oguz; Aysenur Cila; Ersin Tan

2003-01-01

216

SPINAL CORD STIMULATION FOR CHRONIC PAIN MANAGEMENT: TOWARDS AN EXPERT SYSTEM  

E-print Network

of the low sugar count until it may be life­threatening, so they must contin­ uously monitor their sugar methods to get rid of the pain. Easing Chronic Pain: a Brief History Since pain signals are simply

Kreinovich, Vladik

217

[Inadvertent epidural infusion of paracetamol].  

PubMed

A 45-year-old woman was accidentally administered an epidural infusion of paracetamol instead of levobupivacaine for postoperative pain therapy during the postoperative period of abdominal hysterectomy under general anesthesia combined with epidural analgesia. The patient had no neurological symptoms at any time, although a slight tendency to arterial hypotension that did not require treatment was observed. No rescue analgesia was necessary until 8h after the start of epidural infusion. The incidence of these types of errors is probably underestimated, although there are several cases reported with various drugs. PMID:24332361

Charco Roca, L M; Ortiz Sánchez, V E; Del Pino Moreno, A L

2014-10-01

218

Characterization of time course of spinal amino acids, citrulline and PGE 2 release after carrageenan\\/kaolin-induced knee joint inflammation: a chronic microdialysis study  

Microsoft Academic Search

Pharmacological studies have implicated the spinal activation of excitatory amino acids, nitric oxide, and prostaglandins systems in the development of tactile and thermal hypersensitivity and central sensitization after peripheral inflammation. In the present study, using a chronically placed loop dialysis catheter, we examined in the unanesthetized rat the effect of carrageenan\\/kaolin (C\\/K)-induced knee joint inflammation on the time course of

Lin Ch. Yang; Martin Marsala; Tony L. Yaksh

1996-01-01

219

Association of Shoulder Pain With the Use of Mobility Devices in Persons With Chronic Spinal Cord Injury  

PubMed Central

Objective To assess the prevalence of shoulder pain and its association with the use of assistive devices for mobility in persons with chronic spinal cord injury (SCI). Design Cross-sectional analysis conducted within a cohort study. Setting SCI service in a hospital and the community. Participants Between August 2005 and January 2008, 93 participants with chronic SCI completed a standardized health questionnaire and pain questionnaire. Main Outcome Measures Shoulder pain in last 6 months elicited by use of the McGill Pain Questionnaire pain diagram. Results Of the 93 participants, 65 (69.9%) reported pain at any site in the 6 months before testing. Shoulder pain, reported by 39.8% of participants, was the third most common site of pain after the legs and back. When stratified by the use of assistive mobility devices, shoulder pain was reported by 46.7% of motorized wheelchair users, 35.4% of manual wheelchair users, 47.6% of participants using aids such as crutch(es) or canes, and 33.3% of participants walking without assistance (P = .7 for comparison of 4 groups). Conclusions Shoulder pain is highly prevalent in SCI. The authors of previous studies have largely attributed shoulder pain in SCI to manual wheelchair use. However, our results provide evidence for similarly elevated prevalence of shoulder pain among motorized wheelchair users and those patients using crutches or canes. This finding suggests that in addition to overuse injury from cyclic wheelchair propulsion, the assessment of other mechanical and nonmechanical factors that lead to shoulder pain in SCI is an unmet research need that may have treatment implications. PMID:20970758

Jain, Nitin B.; Higgins, Laurence D.; Katz, Jeffrey N.; Garshick, Eric

2011-01-01

220

Factors Associated with the Success of Trial Spinal Cord Stimulation in Patients with Chronic Pain from Failed Back Surgery Syndrome  

PubMed Central

Objective Spinal cord stimulation (SCS) is an effective means of treatment of chronic neuropathic pain from failed back surgery syndrome (FBSS). Because the success of trial stimulation is an essential part of SCS, we investigated factors associated with success of trial stimulation. Methods Successful trial stimulation was possible in 26 of 44 patients (63.6%) who underwent insertion of electrodes for the treatment of chronic pain from FBSS. To investigate factors associated with successful trial stimulation, patients were classified into two groups (success and failure in trial). We investigated the following factors : age, sex, predominant pain areas (axial, limb, axial combined with limbs), number of operations, duration of preoperative pain, type of electrode (cylindrical/paddle), predominant type of pain (nociceptive, neuropathic, mixed), degree of sensory loss in painful areas, presence of motor weakness, and preoperative Visual Analogue Scale. Results There were no significant differences between the two groups in terms of age, degree of pain, number of operations, and duration of pain (p>0.05). Univariate analysis revealed that the type of electrode and presence of severe sensory deficits were significantly associated with the success of trial stimulation (p<0.05). However, the remaining variable, sex, type of pain, main location of pain, degree of pain duration, degree of sensory loss, and presence of motor weakness, were not associated with the trial success of SCS for FBSS. Conclusion Trial stimulation with paddle leads was more successful. If severe sensory deficits occur in the painful dermatomes in FBSS, trial stimulation were less effective. PMID:24527193

Son, Byung-chul; Kim, Deok-ryeong; Lee, Sang-won

2013-01-01

221

Chronic thoracic spinal cord injury impairs CD8+ T-cell function by up-regulating programmed cell death-1 expression  

PubMed Central

Background Chronic spinal cord injury (SCI) induces immune depression in patients, which contributes to their higher risk of developing infections. While defects in humoral immunity have been reported, complications in T-cell immunity during the chronic phase of SCI have not yet been explored. Methods To assess the impact of chronic SCI on peripheral T-cell number and function we used a mouse model of severe spinal cord contusion at thoracic level T9 and performed flow cytometry analysis on the spleen for T-cell markers along with intracellular cytokine staining. Furthermore we identified alterations in sympathetic activity in the spleen of chronic SCI mice by measuring splenic levels of tyrosine hydroxylase (TH) and norepinephrine (NE). To gain insight into the neurogenic mechanism leading to T-cell dysfunction we performed in vitro NE stimulation of T-cells followed by flow cytometry analysis for T-cell exhaustion marker. Results Chronic SCI impaired both CD4+ and CD8+ T-cell cytokine production. The observed T-cell dysfunction correlated with increased expression of programmed cell death 1 (PD-1) exhaustion marker on these cells. Blocking PD-1 signaling in vitro restored the CD8+ T-cell functional defect. In addition, we showed that chronic SCI mice had higher levels of splenic NE, which contributed to the T-cell exhaustion phenotype, as PD-1 expression on both CD4+ and CD8+ T-cells was up-regulated following sustained exposure to NE in vitro. Conclusions These studies indicate that alteration of sympathetic activity following chronic SCI induces CD8+ T-cell exhaustion, which in turn impairs T-cell function and contributes to immune depression. Inhibition of the exhaustion pathway should be considered as a new therapeutic strategy for chronic SCI-induced immune depression. PMID:24690491

2014-01-01

222

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

PubMed Central

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

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

2011-01-01

223

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

PubMed Central

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

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

2014-01-01

224

Lumbosacral epidural lipomatosis: MRI grading  

Microsoft Academic Search

.  \\u000a Lumbosacral epidural lipomatosis (LEL) is characterized by excessive deposition of epidural fat (EF). The purpose of our retrospective\\u000a study was to quantify normal and pathologic amounts of EF in order to develop a reproducible MRI grading of LEL. In this study\\u000a of 2528 patients (1095 men and 1433 women; age range 18–84 years, mean age 47.3 years) we performed a retrospective

Daniel G. Borré; Guillermo E. Borré; Flavio Aude; Gladys N. Palmieri

2003-01-01

225

Body composition modifications in people with chronic spinal cord injury after supervised physical activity  

PubMed Central

Background Quantification of body composition variables is important for planning of better activities in relation to individuals with spinal cord injury (SCI). Objectives (1) To evaluate changes in body composition in patients with SCI after a supervised physical activity process; (2) To correlate total body fat with time since injury. Design Pre-post intervention. Setting Sarah Rehabilitation Hospital Network, Brazil. Participants Fifty-three men with SCI aged 18–52 years with duration of injury >3 years. Interventions The subjects were divided into three groups: tetraplegia (TT) (C5–C8), high paraplegia (HP) (T1–T6), and low paraplegia (LP) (T7–L2). Body composition was estimated in the first and last weeks of hospitalization. Outcome measures Body weight (kg), skinfolds sum (mm), absolute (kg), and relative (%) fat and lean body mass. Results Body weight increased in TT and decreased in HP (0.8 kg, 95%CI 0.1–1.5; and ?1.0 kg, 95%CI ?2.0 to 0.0, respectively; P < 0.05). Skinfolds sum decreased only in HP (?13.1 mm, 95%CI ?20.7 to ?5.5; P < 0.05). Absolute and relative body fat decreased significantly in the paraplegia groups. Lean body mass (LBM) percentage increased significantly in the paraplegia groups. Absolute LBM increased in TT and LP (0.8 kg, 95%CI 0.3–1.3; and 1.3 kg, 95%CI 0.8 to 1.8, respectively; P < 0.05). There was no correlation between time since injury and skinfolds sum for the three groups (P < 0.05). Conclusion TT, HP, and LP demonstrated favorable changes in body composition after 29 days of supervised physical activity. However, these changes were different in direction and magnitude. PMID:22330114

Neto, Frederico Ribeiro; Lopes, Guilherme Henrique

2011-01-01

226

Spontaneous resolution of paraparesis because of acute spontaneous thoracolumbar epidural hematoma  

PubMed Central

Background Symptomatic spontaneous spinal epidural hematoma(SSEH) is an uncommon cause of cord compression that commonly is considered an indication for emergent surgical decompression. We aimed to investigate a patient with a SSEH that completely resolved clinically and radiographically, without surgical treatment. The patient presented three days after the sudden onset of back pain, numbness, and weakness. Magnetic Resonance Imaging (MRI) revealed a posterior thoracolumbar epidural hematoma extending from the level of T10 to L2 with significant cord compression. Decompression was recommended but he refused surgery and was managed conservatively. One month later weakness totally recovered and hematoma was absent on MRI. PMID:23115720

Gundag, M; Hakan, M; Dogan, K; Kitis, S; Ozkan, N

2012-01-01

227

Are gender, marital status or parenthood risk factors for outcome of treatment for chronic disabling spinal disorders?  

PubMed

Recent clinical research has suggested that single working mothers may differ in their response to health treatment and outcomes, relative to their married female or male counterparts. The present study explored, on an a priori basis, the existence and extent of differences in chronic pain rehabilitation outcomes of pain report, return-to-work and future health utilization for single working mothers, relative to other patients. A cohort of 1,679 consecutive chronically disabled work related spinal disorder (CDWRSD) patients were placed into one of eight groups as a function of gender, marital status (single/married), and parenthood (with/without children). All patients completed an assessment battery measuring psychosocial variables at pre- and post-treatment, and a structured clinical interview evaluating socioeconomic outcomes at 1 year following completion of a 5-7 week functional restoration program. Results revealed that single females with children differed from all other groups in racial representation, with 57.1% of these individuals being African American, widely disparate from the prevailing local ethnicity. Single females and males with children were represented by a higher incidence of cervical injuries (25.0% and 26.7%, respectively) than all other groups (5.4-16.6%, p < .001). Contrary to expectation, the 8 groups did not differ significantly in program completion rate, work return, work retention, health utilization, recurrent injury or case settlement rates at one-year follow-up. The single females with children group did display greater levels of depression pre-treatment compared to the other groups. However, at post-treatment, these differences no longer existed. This investigation is one of the first to examine if the combination of gender and parenthood distinguishes significantly among CDWRSD patients. Overall, contrary to expectation, the single mothers did not show any significant differences in CDWRSD outcome at one-year post-rehab follow-up, and the single mothers and fathers showed no differences in depression or pain severity post-treatment. Thus, in spite of the societal belief to the contrary, it seems that single parent patients can show similar chronic pain rehabilitation outcomes, relative to other CDWRSD patients, after a prescribed course of tertiary functional restoration rehabilitation. PMID:15844676

Gatchel, Robert J; Mayer, Tom G; Kidner, Cindy L; McGeary, Donald D

2005-06-01

228

Analgesia after Epidural Dexamethasone is Further Enhanced by IV Dipyrone, but Not IV Parecoxibe Following Minor Orthopedic Surgery  

PubMed Central

Background Epidural administration of dexamethasone has been suggested for pain control after minor orthopedic surgery. This study was conducted to assess its efficacy after such surgery, combined or not to IV dipyrone, IV parecoxibe or their combination. Methods 91 patients were randomly assigned to seven groups. Patients were submitted to spinal bupivacaine anesthesia combined to epidural administration of either 10 ml saline or 10 mg dexamethasone diluted to 10-ml volume. Patients also received 10 ml IV saline or 1 gr dipyrone and/or 40 mg parecoxibe diluted to 10 ml with saline. Control group (CG) received epidural and IV saline. Dexamethasone group (DexG) received epidural dexamethasone and IV saline. Dipyrone group (DipG) received epidural saline and IV dipyrone. Dex-Dip G received epidural dexamethasone and IV dipyrone. Parecoxibe group (ParG) received epidural saline and IV parecoxibe. Dex-ParG received epidural dexamethasone and IV parecoxibe. Finally, Dex-Dip-ParG received epidural dexamethasone and IV dipyrone plus IV parecoxibe. Results The CG expressed 4h of analgesia and sooner requested pain killer. DexG was similar to DipG or ParG or Dex-ParG (7-hours), and they requested less ketoprofen compared to the CG (P < 0.05). However, the Dex-DipG and the Dex-Dip-ParG resulted in longer time to demand pain killer (17-hours) and less ketoprofen consumption in 24-hours (P < 0.002). Adverse effects were similar among groups. Conclusions The analgesia secondary to epidural dexamethasone was enhanced by IV dipyrone, while no effects were observed by the addition of IV parecoxibe.

Righeti, Claudia CF; Kitayama, Antonio T

2014-01-01

229

[A case of acromegaly associated with variegated spinal disorders].  

PubMed

A case of acromegaly associated with variegated spinal disorders was reported. The spinal disorders were multiple cervical disc herniations, spinal epidural cavernous angioma, multiple ossification of the spinal ligament and lumbar canal stenosis. A 51-year-old woman with acromegaly, complaining of disturbances of delicate hand movement and gate, consulted our department. Her past history included diabetes mellitus, hypertension and progressing enlargement of her extremities. Serum growth hormone level was 65.7 ng/ml and somatomedin-c level was 746 ng/ml. Brain MRI showed a pituitary tumor extending to the right cavernous sinus. Cervical MRI revealed disc herniations at C5/6 and C6/7. Thoracic MRI revealed osteoporosis, ossification of the posterior longitudinal ligament and multiple ossification of yellow ligament. Lumbar MRI disclosed ossification of yellow ligament and canal stenosis. Anterior fusion of C5-C7 and an intracapsular removal of the pituitary tumor were performed. Its pathology was that of eosinophilic adenoma. After 3 months, she suffered from paraparesis. On repeating MRI examination with Gd-DTPA, a spinal epidural mass was found at T4. Under laminectomy of Th3-5 and Th8-11, the epidural mass and ossified yellow ligament were removed. The epidural mass was cavernous angioma. She was able to walk without any assistance. An association of spinal canal stenosis with acromegaly is well known. But the association of disc herniation and with the ossification of spinal ligaments is rather rare in the literature. Spinal epidural cavernous angioma is very rare. We discussed the etiological aspects and the management of spinal disorders with acromegaly. PMID:8914152

Suga, T; Murakami, E; Ishizuka, M; Fang, S N; Yoshioka, K; Sano, M; Hsoya, T

1996-10-01

230

Acupuncture's Effects in Treating the Sequelae of Acute and Chronic Spinal Cord Injuries: A Review of Allopathic and Traditional Chinese Medicine Literature  

PubMed Central

Each year, there are an estimated 12?000 individuals who sustain a spinal cord injury (SCI) in the United States. Improved understanding of the pathophysiology of SCI and its sequelae has over the past 50 years led to the development of medical treatments (especially urologic) that have enhanced short- and long-term survival from these injuries. The prevalence of individuals with SCI in this country is ~250?000 individuals; and beyond the incalculable personal consequences of these devastating neurologic injuries, substantial direct and indirect societal costs result from the sequelae of SCI including paralysis, sensory loss, chronic pain, decubiti and bladder and/or bowel incontinence. The purpose of this treatise is to review the allopathic and traditional Chinese medicine (TCM) literature available through MEDLINE, PubMed and eCAM search engines that discuss the potential uses of acupuncture to treat acute and chronic spinal cord injuries and their sequelae, and present the neurophysiologic mechanisms for acupuncture's beneficial effects. There is evidence that use of electroacupuncture in acute SCI may significantly improve long-term neurologic recovery from these injuries both in terms of motor, sensory and bowel/bladder function with essentially no risk. Acupuncture may even improve neurourologic function in individuals with chronic SCI, and help with management with chronic pain associated with these injuries. PMID:19244295

Dorsher, Peter T.; McIntosh, Peter M.

2011-01-01

231

Spinal Fusion in the Treatment of Chronic Low Back Pain: Rationale for Improvement  

PubMed Central

Results following fusion for chronic low back pain (CLBP) are unpredictable and generally not very satisfying. The major reason is the absence of a detailed description of the symptoms of patients with pain, if present, in a motion segment of the spine. Various radiological findings have been attributed to discogenic pain, but if these radiological signs were really true signs of such pain, fusion would have been very successful. If discogenic pain exists, it should be possible to select these patients from all others within the CLBP population. Even if this selection were 100% perfect, however, identification of the painful segment would remain, and at present there is no reliable test for doing so. Regardless of whether an anterior or posterior type of fusion is performed, or even if artificial discs are used, solving the puzzle of pain associated with the presumed segmental disorder must be the primary goal. PMID:23166576

Nystrom, Bo

2012-01-01

232

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

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

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

233

Reactive oxygen species and lipid peroxidation inhibitors reduce mechanical sensitivity in a chronic neuropathic pain model of spinal cord injury in rats.  

PubMed

Chronic neuropathic pain is a common consequence of spinal cord injury (SCI), develops over time and negatively impacts quality of life, often leading to substance abuse and suicide. Recent evidence has demonstrated that reactive oxygen species (ROS) play a role in contributing to neuropathic pain in SCI animal models. This investigation examines four compounds that reduce ROS and the downstream lipid peroxidation products, apocynin, 4-oxo-tempo, U-83836E, and tirilazad, and tests if these compounds can reduce nocioceptive behaviors in chronic SCI animals. Apocynin and 4-oxo-tempo significantly reduced abnormal mechanical hypersensitivity measured in forelimbs and hindlimbs in a model of chronic SCI-induced neuropathic pain. Thus, compounds that inhibit ROS or lipid peroxidation products can be used to ameliorate chronic neuropathic pain. We propose that the application of compounds that inhibit reactive oxygen species (ROS) and related downstream molecules will also reduce the behavioral measures of chronic neuropathic pain. Injury or trauma to nervous tissue leads to increased concentrations of ROS in the surviving tissue. Further damage from ROS molecules to dorsal lamina neurons leads to membrane excitability, the physiological correlate of chronic pain. Chronic pain is difficult to treat with current analgesics and this research will provide a novel therapy for this disease. PMID:25051888

Hassler, Shayne N; Johnson, Kathia M; Hulsebosch, Claire E

2014-11-01

234

Epidural Local Anesthetics: A Novel Treatment for Fetal Growth Retardation?  

Microsoft Academic Search

Background: Chronically compromised uterine perfusion may lead to placental insufficiency and subsequent intrauterine growth restriction (IUGR). Various therapeutic approaches (e.g. vasodilators, low-dose aspirin, intravenous glucose infusion, and hemodilution) are often of limited efficacy. Local anesthetics have been shown to improve placental blood flow in pre-eclamptic women. We hypothesized that epidural administration of local anesthetics might improve outcome in IUGR independent

D. Strümper; F. Louwen; M. E. Durieux; H. F. Gramke; J. Stuessel; D. Marcus-Soekarman; H. Van Aken; M. A. E. Marcus

2005-01-01

235

A comparison of epidural tramadol and epidural morphine for postoperative analgesia  

Microsoft Academic Search

The present study compared epidural tramadol with epidural morphine for postoperative analgesia in 20 patients undergoing\\u000a major abdominal surgery. Intraoperatively, the patients were anaesthetized by a balanced technique of general anaesthesia\\u000a combined with lumbar epidural lidocaine. In ten of the patients 100 mg tramadol diluted in 10 ml normal saline was also injected\\u000a epidurally, while 4 mg epidural morphine was

Anis Baraka; Samar Jabbour; Maroun Ghabash; Antoun Nader; Ghattas Khoury; Abla Sibai

1993-01-01

236

Spinal Cord Stimulation for Neuropathic Pain  

PubMed Central

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 exclus

2005-01-01

237

Granulocytic Sarcoma with Compressive Myelopathy: A Rare Presentation of Chronic Myelogenous Leukemia  

PubMed Central

Granulocytic sarcoma occurs most commonly in acute myelogenous leukemia. The appearance of granulocytic sarcoma in chronic myelogenous leukemia signals accelerated phase/ blast transformation. This is a rare case of undiagnosed chronic myelogenous leukemia with granulocytic sarcoma causing cord compression, which went into tumour lysis syndrome requiring dialysis after starting of steroids and radiotherapy. A 43-year-old male presented in emergency department with acute onset of flaccid paralysis. On clinical examination, there was hepatosplenomegaly and lower motor neuron paralysis in the lower limbs. The peripheral smear was consistent with chronic myelogenous leukemia in chronic phase. The MRI spine revealed para-spinal and epidural masses causing cord compression and the biopsy from the paraspinal mass was consistent with granulocytic sarcoma. PMID:25177619

Viswabandya, Auro; Jasper, Anita; Patel, Palak; Kokil, Gautami

2014-01-01

238

Epidural Opioid Analgesia and Neonatal Respiratory Depression  

Microsoft Academic Search

Epidural opioid analgesia is commonly employed as a therapeutic modality in the management of pain during labor. The general perception among health-care providers is that administered drugs remain in the maternal epidural space and do not compromise the respiratory status of newborns. We describe the clinical course of two newborns who developed respiratory depression following epidural fentanyl analgesia requiring administration

Manoj Kumar; Bosco Paes

2003-01-01

239

Soma size and oxidative enzyme activity in normal and chronically stimulated motoneurones of the cat's spinal cord.  

PubMed

In normal adult cats we measured the density of staining for the activity of succinate dehydrogenase (SDH staining) in ventral horn cells of different sizes. The measurements were restricted to that part of the lumbar ventral horn (L6-L7) which is known to contain motoneurones of the peroneal nerve. A statistically significant tendency was found for the SDH staining to be denser in smaller than in larger neurones within the size range of a motoneurones (soma diameter greater than 40 microns). These results are consistent with recently published evidence for ventral horn cells of rats and qualitatively similar relationships between size and SDH staining have also been observed among skeletal muscle fibres (confirmed for mixed muscle of cat in present study). In hindlimb muscles, size as well as SDH staining are known to be markedly activity-dependent. We tested whether this is the case for peroneal motoneurones as well by analyzing the effects of chronic nerve stimulation on the properties of neurones within the appropriate region of the ventral horn. Prior to the final acute experiment, these cats had been subjected to a left-side dorsal rhizotomy and hemispinalization. By aid of a portable mini-stimulator, the left-side common peroneal nerve was activated by repetitive pulses during 50% of total time per day (intra-activity rate: 10, 20 or 40 Hz). After 8 weeks of such treatment, cell sizes as well as the densities of SDH staining showed hardly any differences between peroneal ventral horn cells of the experimental and control sides of the spinal cord.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3768720

Donselaar, Y; Kernell, D; Eerbeek, O

1986-10-15

240

Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection  

PubMed Central

Serious complications following cervical epidural steroid injection are rare. Subdural injection of local anesthetic and steroid represents a rare but potentially life threatening complication. A patient presented with left sided cervical pain radiating into the left upper extremity with motor deficit. MRI showed absent lordosis with a broad left paramedian disc-osteophyte complex impinging the spinal cord at C5-6. During C5-6 transforaminal epidural steroid injection contrast in AP fluoroscopic view demonstrated a subdural contrast pattern. The needle was withdrawn slightly and repositioned. Normal lateral epidural and nerve root contrast pattern was subsequently obtained and injection followed with immediate improvement in radicular symptoms. There were no postoperative complications on subsequent clinic follow-up. The subdural space is a potential space between the arachnoid and dura mater. As the subdural space is larger in the cervical region, there may be an elevated potential for inadvertent subdural injection. Needle placement in the cervical subdural space during transforaminal injection is uncommon. Failure to identify aberrant needle entry within the cervical subdural space may result in life threatening complications. We recommend initial injection of a limited volume of contrast agent to detect inadvertent subdural space placement. PMID:24490089

Sadacharam, Kesavan; Petersohn, Jeffrey D.; Green, Michael S.

2013-01-01

241

Sterile epidural and bilateral psoas abscesses in a patient with Crohn's disease.  

PubMed

Crohn's disease primarily affects the distal gastrointestinal tract, yet it is a systemic disease that can involve nearly any organ. A psoas abscess complicating Crohn's disease is uncommon and usually originates from a fistulous communication with an adherent bowel. Spinal epidural abscess, an extremely rare complication, also appears to arise by fistulization from another organ involved with Crohn's disease. Previous reports indicate that abscesses in these two areas usually contain bacterial organisms, often mixed flora, consistent with seeding from a diseased bowel. This report represents the first case of Crohn's disease complicated by both bilateral sterile psoas abscesses and a coexistent sterile epidural abscess without evidence of a fistulous communication from the bowel. We report this case because psoas and epidural abscesses can present without typical signs and symptoms. Once suspected, aggressive diagnostic workup and definitive operative intervention is indicated. Failure to promptly diagnose and treat these abscesses may result in considerable morbidity. PMID:8017369

Lamport, R D; Cheskin, L J; Moscatello, S A; Nikoomanesh, P

1994-07-01

242

MicroRNA-mediated GABA A?-1 receptor subunit down-regulation in adult spinal cord following neonatal cystitis-induced chronic visceral pain in rats.  

PubMed

The nociceptive transmission under pathological chronic pain conditions involves transcriptional and/or translational alteration in spinal neurotransmitters, receptor expressions, and modification of neuronal functions. Studies indicate the involvement of microRNA (miRNA) - mediated transcriptional deregulation in the pathophysiology of acute and chronic pain. In the present study, we tested the hypothesis that long-term cross-organ colonic hypersensitivity in neonatal zymosan-induced cystitis is due to miRNA-mediated posttranscriptional suppression of the developing spinal GABAergic system. Cystitis was produced by intravesicular injection of zymosan (1% in saline) into the bladder during postnatal (P) days P14 through P16 and spinal dorsal horns (L6-S1) were collected either on P60 (unchallenged groups) or on P30 after a zymosan re-challenge on P29 (re-challenged groups). miRNA arrays and real-time reverse transcription-polymerase chain reaction (RT-PCR) revealed significant, but differential, up-regulation of mature miR-181a in the L6-S1 spinal dorsal horns from zymosan-treated rats compared with saline-treated controls in both the unchallenged and re-challenged groups. The target gene analysis demonstrated multiple complementary binding sites in miR-181a for GABA(A) receptor subunit GABA(A?-1) gene with a miRSVR score of -1.83. An increase in miR-181a concomitantly resulted in significant down-regulation of GABA(A?-1) receptor subunit gene and protein expression in adult spinal cords from rats with neonatal cystitis. Intrathecal administration of the GABA(A) receptor agonist muscimol failed to attenuate the viscero-motor response (VMR) to colon distension in rats with neonatal cystitis, whereas in adult zymosan-treated rats the drug produced significant decrease in VMR. These results support an integral role for miRNA-mediated transcriptional deregulation of the GABAergic system in neonatal cystitis-induced chronic pelvic pain. PMID:23273104

Sengupta, Jyoti N; Pochiraju, Soumya; Pochiraju, Soumiya; Kannampalli, Pradeep; Bruckert, Mitchell; Addya, Sankar; Yadav, Priyanka; Miranda, Adrian; Shaker, Reza; Banerjee, Banani

2013-01-01

243

Limb compressive load does not inhibit post activation depression of soleus H-reflex in indiviudals with chronic spinal cord injury  

PubMed Central

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

Tseng, Shih-Chiao; Shields, Richard K.

2013-01-01

244

5-HT2 and 5-HT7 receptor agonists facilitate plantar stepping in chronic spinal rats through actions on different populations of spinal neurons  

PubMed Central

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.

Slawinska, Urszula; Miazga, Krzysztof; Jordan, Larry M.

2014-01-01

245

Depth of the thoracic epidural space in children  

Microsoft Academic Search

Thoracic epidural anaesthesia in anaesthetized children requires a meticulous technique and may have an increased success rate when the distance between skin and epidural space is known. The objective of this observational study was to measure the skin to epidural distance (SED) during thoracic epidural puncture in 61 children. The epidural puncture was performed using the loss of resistance technique

F. Masir; J. J. Driessen; K. C. Thies; M. H. W. A. Wijnen; J. van Egmond

2006-01-01

246

Decreased Immune Reactivity and Neuroendocrine Alterations Related to Chronic Stress in Spinal Cord Injury and Stroke Patients  

Microsoft Academic Search

Both natural and adaptive immune responses were found to be strikingly decreased 2 weeks after injury in 54 spinal cord injury and stroke patients, i.e., 28 quadriplegics, 21 paraplegics and 5 stroke patients, compared with those of age-matched controls. All values are expressed as means. Natural-killer (NK)-cell function decreased to 21.0% 2 weeks after spinal cord injury compared with 48.6%

Julius M. Cruse; Reid Bishop; William F. Kliesch; Eduardo Gaitan; Robert Britt

1993-01-01

247

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 ...

248

Spinal fusion  

MedlinePLUS

Vertebral interbody fusion; Posterior spinal fusion; Arthrodesis; Anterior spinal fusion; Spine surgery - spinal fusion ... Spinal fusion is most often done along with other surgical procedures of the spine. It may be done: With ...

249

Improvement of spinal non-viral IL-10 gene delivery by D-mannose as a transgene adjuvant to control chronic neuropathic pain  

PubMed Central

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

2014-01-01

250

Effect of yogic colon cleansing (Laghu Sankhaprakshalana Kriya) on pain, spinal flexibility, disability and state anxiety in chronic low back pain  

PubMed Central

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

Haldavnekar, Richa Vivek; Tekur, Padmini; Nagarathna, Raghuram; Nagendra, Hongasandra Ramarao

2014-01-01

251

Volitional Muscle Strength in the Legs Predicts Changes in Walking Speed Following Locomotor Training in People With Chronic Spinal Cord Injury  

PubMed Central

Background It is unclear which individuals with incomplete spinal cord injury best respond to body-weight–supported treadmill training. Objective The purpose of this study was to determine the factors that predict whether a person with motor incomplete spinal cord injury will respond to body-weight–supported treadmill training. Design This was a prognostic study with a one-group pretest-posttest design. Methods Demographic, clinical, and electrophysiological measurements taken prior to training were examined to determine which measures best predicted improvements in walking speed in 19 individuals with chronic (>7 months postinjury), motor-incomplete spinal cord injuries (ASIA Impairment Scale categories C and D, levels C1–L1). Results Two initial measures correlated significantly with improvements in walking speed: (1) the ability to volitionally contract a muscle, as measured by the lower-extremity manual muscle test (LE MMT) (r=.72), and (2) the peak locomotor electromyographic (EMG) amplitude in the legs (r=.56). None of the demographics (time since injury, age, body mass index) were significantly related to improvements in walking speed, nor was the clinical measure of balance (Berg Balance Scale). Further analysis of LE MMT scores showed 4 key muscle groups were significantly related to improvements in walking speed: knee extensors, knee flexors, ankle plantar flexors, and hip abductors (r=.82). Prediction using the summed MMT scores from those muscles and peak EMG amplitude in a multivariable regression indicated that peak locomotor EMG amplitude did not add significantly to the prediction provided by the LE MMT alone. Change in total LE MMT scores from the beginning to the end of training was not correlated with a change in walking speed over the same period. Limitations The sample size was limited, so the results should be considered exploratory. Conclusions The results suggest that preserved muscle strength in the legs after incomplete spinal cord injury, as measured by MMT, allows for improvements in walking speed induced by locomotor training. PMID:21511993

Norton, Jonathan; Nevett-Duchcherer, Jennifer; Roy, Francois D.; Gross, Douglas P.; Gorassini, Monica A.

2011-01-01

252

Bilateral Bulbospinal Projections to Pudendal Motoneuron Circuitry after Chronic Spinal Cord Hemisection Injury as Revealed by Transsynaptic Tracing with Pseudorabies Virus  

PubMed Central

Abstract Complications of spinal cord injury in males include losing brainstem control of pudendal nerve–innervated 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 (1–2 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

Chadha, Harpreet K.; Dugan, Victoria P.; Gupta, Daya S.; Ferrero, Sunny L.; Hubscher, Charles H.

2011-01-01

253

Intraoperative Forced Air-Warming During Cesarean Delivery Under Spinal Anesthesia Does Not Prevent Maternal Hypothermia  

Microsoft Academic Search

BACKGROUND: Prewarming and intraoperative warming with forced air-warming systems prevent perioperative hypothermia and shivering in patients undergoing elective cesarean delivery with epidural anesthesia. We tested the hypothesis that intraoperative lower body forced air-warming prevents hypothermia in patients undergoing elective cesarean delivery with spinal anesthesia. METHODS: Thirty healthy patients undergoing cesarean delivery with spinal anes- thesia were randomly assigned to forced

Alexander J. Butwick; Steven S. Lipman; Brendan Carvalho

2007-01-01

254

Parturient's posture during epidural puncture affects the distance from skin to epidural space  

Microsoft Academic Search

Study Objective: To assess the factors affecting the distance from skin to epidural space.Design: Prospective observational study of consecutive cases over a 2-year period.Setting: Inpatient obstetric unit in a French university hospital.Patients: 2,123 consecutive term parturients who received epidural anesthesia for cesarean section or epidural analgesia for labor and vaginal delivery.Interventions: At the time of epidural puncture, the interspace used

Jamil Hamza; Mohammed Smida; Dan Benhamou; Sheila E. Cohen

1995-01-01

255

Self-sustained motor activity triggered by interlimb reflexes in chronic spinal cord injury, evidence of functional ascending propriospinal pathways.  

PubMed

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

McNulty, Penelope A; Burke, David

2013-01-01

256

Self-Sustained Motor Activity Triggered by Interlimb Reflexes in Chronic Spinal Cord Injury, Evidence of Functional Ascending Propriospinal Pathways  

PubMed Central

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

McNulty, Penelope A.; Burke, David

2013-01-01

257

Lumbar spinal angiolipoma: case report and review of the literature.  

PubMed

Spinal angiolipomas are extremely rare benign tumors composed of mature lipomatous and angiomatous elements. Most are symptomatic due to progressive spinal cord or root compression. This article describes the case of a 60-year-old woman who presented with a 6-month history of low back pain radiating to her right leg. The pain was multisegmental. The condition had worsened with time. Lumbar magnetic resonance imaging revealed a dorsal epidural mass at L5 and erosion of the lamina of the L5 vertebra. Laminectomy was performed, and an extradural tumor was totally excised. Neuropathologic examination identified it as a lumbar spinal angiolipoma. There was no evidence of recurrence in follow-up 12 months later. This rare clinical entity must be considered in the differential diagnosis for any spinal epidural lesion. PMID:16172903

Konya, Deniz; Ozgen, Serdar; Kurtkaya, Ozlem; Pamir, Necmettin M

2006-06-01

258

Thoracic epidural anaesthesia in infants and children  

Microsoft Academic Search

When compared with conventional analgesic techniques, epidural anaesthesia not only provides improved analgesia, but also\\u000a has several beneficial effects on the postoperative respiratory, cardiovascular, and metabolic status of the patient. Although\\u000a the efficacy and safety of caudal and lumbar epidural anaesthesia in children has been demonstrated, there is little information\\u000a concerning the use of thoracic epidural anaesthesia. The purpose of

Joseph D. Tobias; Sandra Lowe; Nancy O’Dell; George W. Holcomb III

1993-01-01

259

Cluster Analysis and Chronic Pain: An Empirical Classification of Pain Subgroups in a Spinal Cord Injury Sample  

Microsoft Academic Search

Objective: To determine the existence of homogeneous spinal cord injury (SCI) pain subgroups. Design: Prospective longitudinal design. Participants: Persons with traumatic onset SCI (N = 1,334) with self-reported pain, pain interference, and depression. Outcome Measures: Pain (Numerical Rating Scale); pain interference (item from the Short Form-12); and depression (Brief Patient Health Questionnaire). Results: Multivariate clustering revealed 4 SCI pain subgroups:

Michael W. Wilson; J. Scott Richards; Joshua C. Klapow; Michael J. DeVivo

2005-01-01

260

Differential distribution of activated spinal neurons containing glycine and/or GABA and expressing c-fos in acute and chronic pain models.  

PubMed

The inhibitory transmitters GABA and glycine play an important role in modulating pain transmission, both in normal and in pathological situations. In the present study we have combined in situ hybridization for identifying spinal neurons that use the transmitter(s) glycine and/or GABA (Gly/GABA neurons) with immunohistochemistry for c-fos, a marker for neuronal activation. This procedure was used with acute pain models induced by the injection of capsaicin or formalin; and chronic pain models using Complete Freund's Adjuvant (CFA, chronic inflammation), and the spared nerve injury (SNI) model (neuropathic pain). In all models Gly/GABA neurons were activated as indicated by their expression of c-fos. The pattern of Gly/GABA neuronal activation was different for every model, both anatomically and quantitatively. However, the averaged percentage of activated neurons that were Gly/GABA in the chronic phase (?20h survival, 46%) was significantly higher than in the acute phase (?2h survival, 34%). In addition, the total numbers of activated Gly/GABA neurons were similar in both phases, showing that the activation of non-Gly/GABA (presumed excitatory) neurons in the chronic phase decreased. Finally, morphine application equally decreased the total number of activated neurons and activated Gly/GABA neurons. This showed that morphine did not specifically activate Gly/GABA neurons to achieve nociceptive inhibition. The present study shows an increased activity of Gly/GABA neurons in acute and chronic models. This mechanism, together with mechanisms that antagonize the effects of GABA and glycine at the receptor level, may determine the sensitivity of our pain system during health and disease. PMID:20727678

Hossaini, Mehdi; Duraku, Liron S; Saraç, Ci?dem; Jongen, Joost L M; Holstege, Jan C

2010-11-01

261

Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain.  

PubMed

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

Soegaard, Rikke; Christensen, Finn Bjarke; Christiansen, Terkel; Bünger, Cody

2007-05-01

262

Low back pain (chronic)  

PubMed Central

Introduction Over 70% of people in resource-rich countries develop low back pain (LBP) at some time. But recovery is not always favourable: 82% of non-recent-onset patients still experience pain one year later. Many chronic patients 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? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ 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 74 systematic reviews, RCTs, or observational studies 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 steroid injections, facet joint injections, local injections), intensive multidisciplinary treatment programmes, lumbar supports, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), spinal manipulative therapy, traction, and transcutaneous electrical nerve stimulation (TENS). PMID:19445791

2008-01-01

263

Relationship of Spasticity to Soft Tissue Body Composition and the Metabolic Profile in Persons With Chronic Motor Complete Spinal Cord Injury  

PubMed Central

Background/Objective: To determine the effects of spasticity on anthropometrics, body composition (fat mass [FM] and fat-free mass [FFM]), and metabolic profile (energy expenditure, plasma glucose, insulin concentration, and lipid panel) in individuals with motor complete spinal cord injury (SCI). Methods: Ten individuals with chronic motor complete SCI (age, 33 ± 7 years; BMI, 24 ± 4 kg/m2; level of injury, C6–T11; American Spinal Injury Association A and B) underwent waist and abdominal circumferences to measure trunk adiposity. After the first visit, the participants were admitted to the general clinical research center for body composition (FFM and FM) assessment using dual energy x-ray absorptiometry. After overnight fasting, resting metabolic rate (RMR) and metabolic profile (plasma glucose, insulin, and lipid profile) were measured. Spasticity of the hip, knee, and ankle flexors and extensors was measured at 6 time points over 24 hours using the Modified Ashworth Scale. Results: Knee extensor spasticity was negatively correlated to abdominal circumferences (r ?=? ?0.66, P ?=? 0.038). After accounting for leg or total FFM, spasticity was negatively related to abdominal circumference (r ?=? ?0.67, P ?=? 0.03). Knee extensor spasticity was associated with greater total %FFM (r ?=? 0.64; P ?=? 0.048), lower %FM (r ?=? ?0.66; P ?=? 0.03), and lower FM to FFM ratio. Increased FFM (kg) was associated with higher RMR (r ?=? 0.89; P ?=? 0.0001). Finally, spasticity may indirectly influence glucose homeostasis and lipid profile by maintaining FFM (r ?=? ?0.5 to ?0.8, P < 0.001). Conclusion: Significant relationships were noted between spasticity and variables of body composition and metabolic profile in persons with chronic motor complete SCI, suggesting that spasticity may play a role in the defense against deterioration in these variables years after injury. The exact mechanism is yet to be determined. PMID:20397439

Gorgey, Ashraf S; Chiodo, Anthony E; Zemper, Eric D; Hornyak, Joseph E; Rodriguez, Gianna M; Gater, David R

2010-01-01

264

Safety and efficacy of postoperative epidural analgesia  

Microsoft Academic Search

Effective analgesia for postoperative pain relief after major surgery has been a practical proposition with epidural administration of local anaesthetic (LA) and opioid drugs since the early 1980s. Although epidural administration is perceived by 80% of UK anaesthetists as the ideal analgesic technique for upper abdominal surgery,34 there are many patients undergoing major surgery who do not receive this form

R. G. Wheatley; S. A. Schug; D. Watson

2001-01-01

265

Epidural magnesium reduces postoperative analgesic requirement  

Microsoft Academic Search

Background. Magnesium has antinociceptive effects in animal and human models of pain. Our hypothesis was that the addition of magnesium to postoperative epidural infusion of fentanyl may decrease the need for fentanyl. Methods. Fifty patients undergoing hip surgery were enrolled to receive either fentanyl (Group F) or fentanyl plus magnesium sulphate (Group FM) for 24 h for epidural analgesia. All

A. Bilir; S. Gulec; A. Erkan; A. Ozcelik

2007-01-01

266

Vision Loss After Lumbar Epidural Steroid Injection  

Microsoft Academic Search

'isual loss associated with retinal hemorrhages after laparoscopy performed under general an- esthesia has been previously reported in the an- esthesiology literature (1). This complication has been reported only once after an epidural steroid injection in the anesthesia literature (2). We report a case of acute monocular vision loss secondary to multiple retinal hemorrhages after a lumbar epidural steroid injection.

ERIG P. PURDY; GURJIT S. AJIMAL

1998-01-01

267

Epidural catheterization with a subcutaneous injection port for the long-term administration of opioids and local anesthetics to treat zoster-associated pain -a report of two cases-  

PubMed Central

Continuous epidural analgesia has been used for decades to treat acute herpes zoster pain and to prevent postherpetic neuralgia. However, many technical problems can arise during chronic treatment with epidural medications. These complications include catheter dislodgement, infection, injection pain, leakage, and occlusion. Epidural catheter placement utilizing subcutaneous injection port implantation has gained widespread acceptance as a method to overcome such complications. The technique reduces the risk of infection, the most feared complication, compared to the use of a percutaneous epidural catheter. Herein, we present 2 cases in which the continuous thoracic epidural administration of opioids and local anesthetics through an implantable subcutaneous injection port for over 2 months successfully treated zoster-associated pain without any technique- or medication-related complications in patients with risk factors for epidural abscess. PMID:24363852

Min, Bo Mi

2013-01-01

268

A difficult case to swallow: herpes esophagitis after epidural steroid injection.  

PubMed

Herpes esophagitis due to infection with herpes simplex virus typically occurs in immunocompromised patients such as those with human immunodeficiency virus, malignancy, and those undergoing immunosuppressive therapy. Albeit rare, herpes esophagitis can occur in immunocompetent patients as a primary infection. We present a case of herpes esophagitis after corticosteroid treatment for back pain including epidural steroid injections. Corticosteroids, especially local injections, are a common treatment for chronic back pain, but they are not without risk. Epidural steroid injections can have systemic effects, which may go unrecognized and underappreciated. Although local infections have been reported after administering these injections, systemic immune suppression may allow for unexpected infections such as herpes esophagitis. Given the widespread use of epidural steroid injections, physicians should reevaluate the potential for harm when considering this treatment. PMID:21768868

Davis, Kelli; Prater, Adam; Fluker, Shelly-Ann; Klein, Robin

2014-01-01

269

Ultrasound-guided transversus abdominis plane block: A technically easier analgesic option in obese compared to epidural  

PubMed Central

Ultrasound-guided transversus abdominis plane (TAP) block is an extremely attractive alternative to the technically difficult epidural in obese patients. It provides adequate perioperative analgesia and reduces the opioid requirement. The use of ultrasound has enhanced the accuracy of local anaesthetic deposition in the plane between internal oblique and transversus abdominis, thereby blocking the spinal nerves more effectively and hence enhancing the efficacy of analgesia. We present a case of 65-year-old male patient weighing 96 kg who underwent umbilical hernia repair and had adequate perioperative pain relief after the ultrasound-guided TAP block. Epidural analgesia planned for him was abandoned after we faced technical difficulty in securing the epidural, but the TAP block administered under ultrasound guidance ensured adequate pain relief perioperatively.

Chaudhuri, Souvik; Goyal, Sham Sunder

2012-01-01

270

Meralgia paresthetica-like symptoms following epidural analgesia after total knee arthroplasty.  

PubMed

Meralgia paresthetica (MP) is generally caused by entrapment of the lateral femoral cutaneous nerve (LFCN), and presents with pain and paresthesia in the anterolateral thigh. This paper describes a patient who had MP-like symptoms as a result of continuous epidural analgesia after total knee arthroplasty. The patient with pre-existing left foraminal stenosis at L3-L4 and disc herniations at L4-5 did not complain of paresthesia or pain during the combined spinal-epidural anesthetic procedure. However, during epidural analgesia on the second post-operative day, he complained of paresthesia and pain in the anterolateral thigh of the contralateral leg. Electromyography showed a neurogenic lesion at the level of L3. Although an ultrasound-guided diagnostic block of the LFCN was performed twice post-operatively, the patient's symptoms persisted. The symptoms gradually resolved 12 months after the surgery. In our case, we suggest that the continuous epidural infusate caused neural ischemia of the L3 nerve root by a compressive effect. PMID:25307713

Shin, H J; Kim, Y H; Lee, H W

2014-11-01

271

Epidural anesthesia and analgesia in liver resection and living donor hepatectomy.  

PubMed

Parenteral analgesics are still diffusely administered for postoperative pain after major liver resection, while epidural analgesia is widely criticized because of possible changes in the postoperative coagulation profile. The safety of regional anesthesia in liver resections is based on appropriate timing of needle placement and catheter removal and on the individual's skill in performing both the puncture and the catheterization. In the absence of liver failure or in cases of only moderate hepatic dysfunction, the risk of neurologic complications and spinal hematomas does not appear greater than when an epidural is performed for routine abdominal or thoracic surgery. Various anesthetic strategies have been adopted to prevent bleeding during liver resection, such as fluid restriction, diuretic administration, and vasodilator drugs. Lowering central venous pressure (CVP) seems to play a prominent role in prevention of bleeding since an elevated CVP may be associated with increased blood loss at various phases of liver resection. However, a low CVP may not be tolerated by all patients: intraoperative hemodynamic instability may, in fact, easily ensue because of the cardiovascular depressant effects of anesthetics, surgical blood losses, and manipulation of the inferior vena cava. We suggest combining intraoperative epidural anesthesia with general (light) anesthesia as a useful strategy to keep the CVP low during liver resection without vasodilators or diuretics. Epidural anesthesia does not lead to changes in intravascular volume, but only promotes redistribution of blood, decreasing both venous return and portal vein pressure, thus contributing to reduced hepatic congestion and surgical blood loss. PMID:18555139

Feltracco, P; Brezzi, M L; Barbieri, S; Serra, E; Milevoj, M; Ori, C

2008-05-01

272

[Case of pyogenic spondylitis and epidural abscess after chemoradiotherapy for hypopharyngeal cancer].  

PubMed

Osteomyelitis is one of the most severe late complications of radiation therapy. The condition can arise from osteoradionecrosis and can be fatal if it occurrs in vertebrae. A 71-year-old woman, who had undergone chemoradiotherapy for hypopharyngeal cancer 6 months previously, presented with severe neck pain. An MRI examination revealed pyogenic spondylitis and an epidural abscess of the neck. Neurological disturbance in the extremities developed despite the administration of antibiotics for 5 days. Drainage and a laminectomy were performed to control the infection and to relieve spinal cord compression. The patient had no postoperative complications at 15 months after surgery. Previous case reports of osteomyelitis and epidural abscess following radiation therapy for head and neck cancer with surgical treatment tended to have a good clinical course. Severe neck pain and a limitation in the range of motion of the neck are considered to be serious clinical features of osteomyelitis. Since infection in the necrotic mucosa leads to pyogenic spondylitis, a repeated cultivation survey of the mucosa is nessesary for adequate antibiotics therapy. For osteomyelitis and epidural abscess following radiation therapy, immediate specific surgical treatment of the involved region is strongly suggested if antibiotics are not effective or spinal cord compression develops. PMID:24558949

Kuba, Kiyomi; Inoue, Hitoshi; Matsumura, Satoko; Minami, Kazuhiko; Takajo, Fumihiko; Morita, Kei; Nakahira, Mitsuhiko; Sugasawa, Masashi

2013-12-01

273

Botulinum toxin type A normalizes alterations in urothelial ATP and NO release induced by chronic spinal cord injury  

PubMed Central

The purpose of this paper was to simultaneously examine changes in urothelial ATP and NO release in normal and spinal cord injured animals as well as in spinal cord injured animals treated with botulinum toxin type A (BoNT-A). Furthermore we correlated changes in transmitter release with functional changes in bladder contraction frequency, and determined the effects of BoNT-A on bladder efferent nerve function. Normal and spinal cord injured rat bladders were injected on day 0 with either vehicle (saline containing bovine serum albumin) or BoNT-A. On day 2, in vitro neurotransmitter release and bladder strip contractility studies as well as in vivo cystometrographic studies were conducted. Resting ATP release was significantly enhanced following spinal cord injury (i.e. 57% increase, p<0.05) and was unaffected by BoNT-A treatment. SCI increased hypo-osmotic evoked urothelial ATP release by 377% (p<0.05). BoNT-A treatment reduced evoked ATP release in SCI bladders by 83% (p<0.05). In contrast, hypo-osmotic stimulation induced NO release was significantly inhibited following SCI (i.e. 50%, p<0.05) but recovered in SCI rats treated with BoNT-A (i.e. 195% increase in NO release in SCI-BTX treated rats compared to SCI controls, p<0.01). Changes in urothelial transmitter release coincided with a significant decrease in non-voiding bladder contraction frequency (i.e. 71%, p<0.05) in SCI-BTX rats compared to SCI rats. While no difference was measured between neurally evoked contractile amplitude between SCI and SCI-BTX animals, atropine (1µM) inhibited contractile amplitude to a greater extent (i.e. 76%, p<0.05) in the SCI-BTX group compared to the SCI group. We hypothesize that alterations in the ratio of excitatory (i.e. ATP) and inhibitory (i.e. NO) urothelial transmitters promote bladder hyperactivity in rat bladders following SCI that can be reversed, to a large extent, by treatment with BoNT-A. PMID:18187233

Smith, Christopher P.; Gangitano, David A.; Munoz, Alvaro; Salas, Nilson A.; Boone, Timothy B.; Aoki, K. Roger; Francis, Joseph; Somogyi, George T.

2008-01-01

274

Combination of lumbar kyphosis, epidural lipomatosis, and perineural cyst as a cause of neurological deficit: a case report.  

PubMed

We describe the rare simultaneous occurrence of epidural lipomatosis and a perineural cyst at the same level, lumbar kyphosis, osteoporotic vertebral fractures, and neurological deficits. A 75-year-old corticosteroid-dependent female farmer presented with severe low back pain, progressive lumbar kyphosis, and inability to stand because of numbness and muscle weakness of both legs. Plain radiographs displayed markedly decreased bone density, significant lumbar kyphosis, and vertebral compression fractures of L2, L3, and L4. Magnetic resonance imaging of the lumbar spine revealed a perineural cyst at the L2-3 level, extensive epidural lipomatosis, and spinal canal stenosis. Laminectomy from L3 to L5 with resection of epidural fatty tissue restored her walking ability. We postulate that the osteoporotic fractures and epidural lipomatosis were induced by corticosteroid therapy. Preexisting degenerative lumbar kyphosis of the type commonly seen in elderly farmers could have promoted osteoporotic lumbar vertebral fractures at points where bending stress had been strongly exerted. The combination of a perineural cyst and epidural lipomatosis at the same level has not been reported previously. PMID:12486480

Miyakoshi, Naohisa; Shimada, Yoichi; Murai, Hajime; Suzuki, Tetsuya; Hongo, Michio; Itoi, Eiji

2002-01-01

275

Bionic epidural stimulation restores arterial pressure regulation during orthostasis.  

PubMed

A bionic baroreflex system (BBS) is a computer-assisted intelligent feedback system to control arterial pressure (AP) for the treatment of baroreflex failure. To apply this system clinically, an appropriate efferent neural (sympathetic vasomotor) interface has to be explored. We examined whether the spinal cord is a candidate site for such interface. In six anesthetized and baroreflex-deafferentiated cats, a multielectrode catheter was inserted into the epidural space to deliver epidural spinal cord stimulation (ESCS). Stepwise changes in ESCS rate revealed a linear correlation between ESCS rate and AP for ESCS rates of 2 pulses/s and above (r2, 0.876-0.979; slope, 14.3 +/- 5.8 mmHg.pulses(-1).s; pressure axis intercept, 35.7 +/- 25.9 mmHg). Random changes in ESCS rate with a white noise sequence revealed dynamic transfer function of peripheral effectors. The transfer function resembled a second-order, low-pass filter with a lag time (gain, 16.7 +/- 8.3 mmHg.pulses(-1).s; natural frequency, 0.022 +/- 0.007 Hz; damping coefficient, 2.40 +/- 1.07; lag time, 1.06 +/- 0.41 s). On the basis of the transfer function, we designed an artificial vasomotor center to attenuate hypotension. We evaluated the performance of the BBS against hypotension induced by 60 degrees head-up tilt. In the cats with baroreflex failure, head-up tilt dropped AP by 37 +/- 5 mmHg in 5 s and 59 +/- 11 mmHg in 30 s. BBS with optimized feedback parameters attenuated hypotension to 21 +/- 2 mmHg in 5 s (P < 0.05) and 8 +/- 4 mmHg in 30 s (P < 0.05). These results indicate that ESCS-mediated BBS prevents orthostatic hypotension. Because epidural stimulation is a clinically feasible procedure, this BBS can be applied clinically to combat hypotension associated with various pathophysiologies. PMID:15133002

Yanagiya, Yusuke; Sato, Takayuki; Kawada, Toru; Inagaki, Masashi; Tatewaki, Teiji; Zheng, Can; Kamiya, Atsunori; Takaki, Hiroshi; Sugimachi, Masaru; Sunagawa, Kenji

2004-09-01

276

Neuroendocrine and cardiac metabolic dysfunction and NLRP3 inflammasome activation in adipose tissue and pancreas following chronic spinal cord injury in the mouse  

PubMed Central

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

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

2013-01-01

277

Paraplegia by spinal cord compression as the initial manifestation of Hodgkin's disease: a case report.  

PubMed

The 90% of Hodgkin's disease (HD) cases are originated by lymphnodes whereas 10% by extranodal regions as epidural space. Neurologic complications of HD can be classified as directly resulting from the disease or indirectly originated from the disease or from its treatment. Patients very rarely present with spinal cord compression (SCC)  due to epidural HD. Few cases of HD with such presentation have been reported in the literature. Primary spinal extradural HD with no further organ involvement is extremely rare. We report a case of a child with SCC as initial and unique presentation of HD. PMID:25245654

Baroni, Lorenza; Fornaciari, Sara; Predieri, Barbara; Bergonzini, Patrizia; Guerra, Azzurra; Paolucci, Paolo; Iughetti, Lorenzo

2014-01-01

278

The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature  

PubMed Central

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

Epstein, Nancy E.

2013-01-01

279

Block-Dependent Sedation during Epidural Anaesthesia is Associated with Delayed Brainstem Conduction  

PubMed Central

Neuraxial anaesthesia produces a sedative and anesthetic-sparing effect. Recent evidence suggests that spinal cord anaesthesia modifies reticulo-thalamo-cortical arousal by decreasing afferent sensory transmission. We hypothesized that epidural anaesthesia produces sensory deafferentation-dependent sedation that is associated with impairment of brainstem transmission. We used brainstem auditory evoked potentials (BAEP) to evaluate reticular function in 11 volunteers. Epidural anaesthesia was induced with 2% 2-chloroprocaine. Hemodynamic and respiratory responses, sensory block level, sedation depth and BAEP were assessed throughout induction and resolution of epidural anaesthesia. Sedation was evaluated using verbal rating score (VRS), observer's assessment alertness/sedation (OAA/S) score, and bispectral index (BIS). Prediction probability (PK) was used to associate sensory block with sedation, as well as BIS with other sedation measures. Spearman rank order correlation was used to associate block level and sedation with the absolute and interpeak BAEP latencies. Sensory block level significantly predicted VRS (PK = 0.747), OAA/S score (PK = 0.748) and BIS. Bispectral index predicted VRS and OAA/S score (PK = 0.728). The latency of wave III of BAEP significantly correlated with sedation level (rho = 0.335, P < 0.01) and sensory block (rho = 0.394, P < 0.01). The other BAEP parameters did not change during epidural anaesthesia. Hemodynamic and respiratory responses remained stable throughout the study. Sedation during epidural anaesthesia depends on sensory block level and is associated with detectable block-dependent alterations in the brainstem auditory evoked responses. Sensory deafferentation may reduce CNS alertness through mechanisms related to brainstem neural activity. PMID:15220178

Wadhwa, Anupama; Shah, Yunus M.; Lin, Chum-Ming; Haugh, Gilbert S.; Sessler, Daniel I.

2005-01-01

280

Spontaneous intracranial hypotension from calcified thoracic disc protrusions causing CSF leak successfully treated with targeted epidural blood patch.  

PubMed

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

Allmendinger, Andrew M; Lee, Thomas C

2013-01-01

281

Fibrin glue to treat spinal fluid leaks associated with intrathecal drug systems.  

PubMed

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

Freeman, Eric D; Hoelzer, Bryan C; Eldrige, Jason S; Moeschler, Susan M

2014-07-01

282

Postoperative epidural hematoma contributes to delayed upper cord tethering after decompression of Chiari malformation type I  

PubMed Central

Background: Symptomatic arachnoiditis after posterior fossa surgical procedures such as decompression of Chiari malformation is a possible complication. Clinical presentation is generally insidious and delayed by months or years. It causes disturbances in the normal flow of cerebrospinal fluid and enlargement of a syrinx cavity in the upper spinal cord. Surgical de-tethering has favorable results with progressive collapse of the syrinx and relief of the associated symptoms. Case Description: A 30-year-old male with Chiari malformation type I was treated by performing posterior fossa bone decompression, dura opening and closure with a suturable bovine pericardium dural graft. Postoperative period was uneventful until the fifth day in which the patient suffered intense headache and progressive loose of consciousness caused by an acute posterior fossa epidural hematoma. It was quickly removed with complete clinical recovering. One year later, the patient experienced progressive worsened of his symptoms. Upper spinal cord tethering was diagnosed and a new surgery for debridement was required. Conclusions: The epidural hematoma compressing the dural graft against the neural structures contributes to the upper spinal cord tethering and represents a nondescribed cause of postoperative fibrosis, adhesion formation, and subsequent recurrent hindbrain compression.

Lopez-Gonzalez, Antonio; Plaza, Estela; Marquez-Rivas, Francisco Javier

2014-01-01

283

Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome  

Microsoft Academic Search

Exercise rehabilitation is one of the few evidence-based treatments for chronic non-specific low back pain (cLBP), but individual\\u000a success is notoriously variable and may depend on the patient’s adherence to the prescribed exercise regime. This prospective\\u000a study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic\\u000a spine stabilisation exercises. A total of

Anne F. Mannion; Daniel Helbling; Natascha Pulkovski; Haiko Sprott

2009-01-01

284

Longitudinal study of diffusion tensor imaging properties of affected cortical spinal tracts in acute and chronic hemorrhagic stroke.  

PubMed

This study investigated the clinical value of diffusion tensor imaging (DTI) in predicting the motor outcome in patients with basal ganglia hemorrhage. This prospective study included 23 patients assessed with DTI to measure the fractional anisotropy (FA) value in affected cortical spinal tract (CST) at three time points: day 0, day 30 and day 90 after onset. The motor function score (MFS) was applied to evaluate motor function and patients were divided into good and poor outcome groups according to the MFS on day 90. The mean FA value on day 0 was significantly lower in the poor outcome group than in the good outcome group (p<0.01). FA value gradually decreased in the poor outcome group until day 90 after onset, while it continuously increased in the good outcome group. The MFS obtained at day 90 after onset was significantly correlated with the initial FA value in the affected cerebral peduncle (r=-0.926, p<0.01). Receiver operating characteristic curve analysis showed that the FA value on day 0 could predict motor function outcome with a sensitivity of 88.89% and specificity of 92.86% at the initial FA value of 0.45. The FA value of affected CST in acute cerebral hemorrhage may valuably predict the motor function outcome and its dynamic change may represent the Wallerian degeneration in motor tracts after hemorrhagic stroke. PMID:24746110

Ma, Chicheng; Liu, Aijun; Li, Zhenzuo; Zhou, Xueying; Zhou, Shengnian

2014-08-01

285

Predifferentiated Embryonic Stem Cells Prevent Chronic Pain Behaviors and Restore Sensory Function Following Spinal Cord Injury in Mice  

PubMed Central

Embryonic stem (ES) cells have been investigated in repair of the CNS following neuronal injury and disease; however, the efficacy of these cells in treatment of postinjury pain is far from clear. In this study, we evaluated the therapeutic potential of predifferentiated mouse ES cells to restore sensory deficits following spinal cord injury (SCI) in mice. The pain model used unilateral intraspinal injection of quisqualic acid (QUIS) into the dorsal horn between vertebral levels T13 and L1. Seven days later, 60,000 predifferentiated ES cells or media were transplanted into the site of the lesion. Histological analysis at 7, 14, and 60 days post-transplantation revealed that animals receiving ES cell transplants suffered significantly less tissue damage than animals receiving media alone. Transplanted cells provided immediate effects on both spontaneous and evoked pain behaviors. Treatment with ES cells resulted in 0% (n = 28) excessive grooming behavior versus 60% (18 of 30) in media-treated animals. In the acetone test (to assess thermal allodynia), mice recovered to preinjury levels by 12 days after ES cell transplant, whereas control animals injected with media after SCI did not show any improvement up to 60 days. Similarly, the von Frey test (to assess mechanical allodynia) and the formalin test (to assess nociceptive hyperalgesia) showed that transplantation of predifferentiated ES cells significantly reduced these pain behaviors following injury. Here we show that predifferentiated ES cells act in a neuroprotective manner and provide antinociceptive and therapeutic effects following excitotoxic SCI. PMID:16838066

Hendricks, Wesley A; Pak, Elena S; Owensby, J Paul; Menta, Kristie J; Glazova, Margarita; Moretto, Justin; Hollis, Sarah; Brewer, Kori L; Murashov, Alexander K

2006-01-01

286

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

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 Freund’s 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

Cady, Ryan J.; Denson, Jennifer E.; Durham, Paul L.

2013-01-01

287

A comparison of bupivacaine and tetracaine in epidural analgesia for surgery  

Microsoft Academic Search

\\u000a Summary  The new long-acting local anaesthetic, bupivacaine, has been compared with tetracaine using a 0.5 per cent solution for epidural\\u000a analgesia in 103 surgical patients.\\u000a \\u000a Both agents had almost identical latency of action and dose requirements. Analgesia commenced in 5.8–6.6 minutes and took\\u000a about 18 minutes to spread to the first sacral segment. Dose requirements in milligrams per spinal segment at

Philip R. Bromage

1969-01-01

288

Intraoperative phosphorus-32 brachytherapy plaque for multiply recurrent high-risk epidural neuroblastoma.  

PubMed

Achieving local control is a crucial component in the management of neuroblastoma, but this may be complicated in the setting of prior radiation treatment, especially when the therapeutic target is in proximity to critical structures such as the spinal cord. The authors describe a pediatric patient with multiply recurrent neuroblastoma and prior high-dose radiation therapy to the spine who presented with progressive epidural disease. The patient was managed with resection and intraoperative high-dose-rate brachytherapy using a phosphorus-32 ((32)P) plaque previously developed for the treatment of brain and spine lesions. PMID:24483253

Tong, William Y; Folkert, Michael R; Greenfield, Jeffrey P; Yamada, Yoshiya; Wolden, Suzanne L

2014-04-01

289

Epidural Hematoma Related with Low-Dose Aspirin : Complete Recovery without Surgical Treatment  

PubMed Central

Hemorrhagic complications associated with aspirin use occur primarily at skin or gastrointestinal sites but can occasionally occur in the central nervous system. In particular, spontaneous spinal epidural hemorrhage (SSEH) associated with aspirin is very rare. We report a case of low-dose (100 mg daily) aspirin-related SSEH that was successfully treated with medical management. Our case indicates that low-dose aspirin could induce SSEH and that conservative treatment with close observation and repeated imaging studies should be considered in cases with neurological improvement or mild deficits. PMID:22792431

Kim, Kyoung-Tae; Cho, Dae-Chul; Ahn, Suk-Won

2012-01-01

290

Epidural Anesthesia for Caesarean Section in a Pregnant Patient with Pituitary Macroadenoma  

PubMed Central

Anaesthesia for patient with pituitary adenoma posted for non-neurosurgical surgeries is a challenge to the anaesthesiologist with the risk of sudden change in intracranial dynamics during administration of spinal anaesthesia or during stress response of general anaesthesia. There is a chance of increase in tumour size during antenatal period. A careful assessment of pituitary function and a screening of visual field and fundus examination are essential to rule out any mass effect. We are presenting the anaesthetic management of patient with pituitary macroadenoma posted for elective caesarean section done under epidural anaesthesia due to its rarity.

Babu, D. Dinesh; Sureshkumar, K; Patil, Shubhada A.

2014-01-01

291

Overtreating Chronic Back Pain: Time to Back Off?  

PubMed Central

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 – over approximately a decade - 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 MRIs 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

Deyo, Richard A.; Mirza, Sohail K.; Turner, Judith A.; Martin, Brook I.

2009-01-01

292

Accidental epidural injection of thiopental in a dog  

PubMed Central

A 3-year-old Labrador retriever was presented to the Western College of Veterinary Medicine for a tibial plateau levelling osteotomy. While performing a pre-operative epidural, thiopental was inadvertently administered into the epidural space. Treatment included epidural saline flushing and intravenous methylprednisolone sodium succinate. No neurologic deficits were detected. PMID:20514256

O'Kell, Allison L.; Ambros, Barbara

2010-01-01

293

Accidental epidural injection of thiopental in a dog.  

PubMed

A 3-year-old Labrador retriever was presented to the Western College of Veterinary Medicine for a tibial plateau levelling osteotomy. While performing a pre-operative epidural, thiopental was inadvertently administered into the epidural space. Treatment included epidural saline flushing and intravenous methylprednisolone sodium succinate. No neurologic deficits were detected. PMID:20514256

O'Kell, Allison L; Ambros, Barbara

2010-03-01

294

Epidural anesthesia and analgesia in the neonate: a review of current evidences.  

PubMed

The role of single shot spinal anesthesia has been established in ex-premature infants at risk of apnea. However, use of epidural anesthesia in neonates is on the rise. In this systematic analysis, we have reviewed the current evidence on the safety and efficacy of the use of single shot and continuous epidural anesthesia/analgesia in neonates. Current clinical practice is guided by evidence based mostly on non-randomized studies, prospective/retrospective case series and surveys. Single shot caudal blockade as a sole technique has been used in neonates mainly for inguinal hernia repair and circumcision. Use of continuous epidural anesthesia through the caudal route or caudo-thoracic advancement of the catheter for major thoracic and abdominal surgery offers good perioperative analgesia. Other observed benefits are early extubation, attenuation of stress response, early return of bowel function and reduction of general anesthesia-related postoperative complications. However, risk of procedure-related and drug-related complications to the developing neural structure remains a serious concern. PMID:24522812

Maitra, Souvik; Baidya, Dalim Kumar; Pawar, Dilip K; Arora, Mahesh Kumar; Khanna, Puneet

2014-10-01

295

Prevention of epidural scarring after microdiscectomy: a randomized clinical trial comparing gel and expanded polytetrafluoroethylene membrane  

PubMed Central

A randomized clinical trial compared two materials used to prevent epidural scarring after microdiscectomy. To determine whether ADCON®-L Gel (ALG) or Preclude Spinal Membrane® (PSM) was more effective in preventing scarring, reducing pain, and improving quality of life postoperatively. Postdiscectomy syndrome may result from epidural scarring. Various materials have been used in attempts to prevent this problem, but none have provided optimal results. Previous laboratory and clinical studies have found ALG and PSM to be effective, but none compared the two materials. Thirty-one patients undergoing primary microdiscectomy were randomly assigned to receive either ALG or PSM. Postoperatively, patients were evaluated by magnetic resonance imaging (MRI), with contrast, for volume and rostral–caudal extent of scar tissue and nerve root involvement. Back and leg pain and quality of life were assessed by neurologic examinations and standardized patient surveys. Findings at any reoperations were recorded. Results in the PSM (n = 18) and ALG (n = 13) groups were compared statistically. No operative or postoperative complications occurred. Two patients in each group required reoperation. MRI at 6 months showed no, mild or mild-moderate scarring in most patients, with no significant differences between the ALG and PSM groups in scar volume and extent or nerve root involvement. Neurologic examinations and patient surveys showed substantial reductions in pain over time in both groups but no significant differences between groups. PSM was easy to see and remove at reoperation. PSM and ALG are equally effective in preventing epidural scarring associated with postdiscectomy syndrome. PMID:16763848

Pink, Peter T.; Schneider, Frank; Stuecker, Markus; Homann, Nicolaus C.; Preidler, Klaus W.

2006-01-01

296

A Novel Balloon-Inflatable Catheter for Percutaneous Epidural Adhesiolysis and Decompression  

PubMed Central

Epidural adhesions cause pain by interfering with the free movement of the spinal nerves and increasing neural sensitivity as a consequence of neural compression. To remove adhesions and deliver injected drugs to target sites, percutaneous epidural adhesiolysis (PEA) is performed in patients who are unresponsive to conservative treatments. We describe four patients who were treated with a newly developed inflatable balloon catheter for more effective PEA and relief of stenosis. In the present patients, treatments with repetitive epidural steroid injection and/or PEA with the Racz catheter or the NaviCath did not yield long-lasting effects or functional improvements. However, PEA and decompression with the inflatable balloon catheter led to maintenance of pain relief for more than seven months and improvements in the functional status with increases in the walking distance. The present case series suggests that the inflatable balloon catheter may be an effective alternative to performing PEA when conventional methods fail to remove adhesions or sufficiently relieve stenosis. PMID:24748948

Choi, Seong Soo; Joo, Eun Young; Hwang, Beom Sang; Lee, Jong Hyuk; Lee, Gunn; Suh, Jeong Hun; Leem, Jeong Gill

2014-01-01

297

Spinal hematoma: a literature survey with meta-analysis of 613 patients  

Microsoft Academic Search

.   Spinal hematoma has been described in autopsies since 1682 and as a clinical diagnosis since 1867. It is a rare and usually\\u000a severe neurological disorder that, without adequate treatment, often leads to death or permanent neurological deficit. Epidural\\u000a as well as subdural and subarachnoid hematomas have been investigated. Some cases of subarachnoid spinal hematoma may present\\u000a with symptoms similar

D. Kreppel; G. Antoniadis; W. Seeling

2003-01-01

298

Lumbar spinal stenosis.  

PubMed Central

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

Ciricillo, S F; Weinstein, P R

1993-01-01

299

Transplants of Adrenal Medullary Chromaffin Cells Reduce Forelimb and Hindlimb Allodynia in a Rodent Model of Chronic Central Pain after Spinal Cord Hemisection Injury  

Microsoft Academic Search

In the majority of patients, spinal cord injury (SCI) results in abnormal pain syndromes in which nonnoxious stimuli become noxious (allodynia). To reduce allodynia, it would be desirable to implant a permanent biological pump such as adrenal medullary chromaffin cells (AM), which secrete catecholamines and opioid peptides, both antinociceptive substances, near the spinal cord. We tested this approach using a

Bryan C. Hains; Kathy M. Chastain; Alex W. Everhart; David J. McAdoo; Claire E. Hulsebosch

2000-01-01

300

Epidural vs intramuscular administration of lecirelin, a GnRH analogue, for the resolution of follicular cysts in dairy cows.  

PubMed

Bovine follicular cysts are an ovarian disorder of dairy cows associated with abnormal estrous behaviour and infertility. The treatment of choice is intramuscular administration of a GnRH analogue, which acts by triggering pituitary release of LH. However, the presence of GnRH and GnRH receptors on spinal cord and ovary in some species, and the kind of innervation of the ovary, let us hypothesize that GnRH and its analogues may also act when administered by epidural route, as happens for other drugs. Therefore the aim of this study was to compare the effects of epidural vs intramuscular administration of lecirelin (a GnRH analogue) on FC regression, estrus detection and pregnancy outcomes. The study was conducted on 220 Friesian cows affected by follicular cysts, divided among 4 groups: Group L(epid) and Group L(im) received, respectively 50 ?g of lecirelin in the epidural space and intramuscular; Group C(epid) and Group C(im) were used as control groups. In Group L(epid), estrus induction and pregnancy rates were significantly higher than in Group L(im). The results of this study show that the epidural administration of lecirelin promoted the remission of follicular cysts and an improvement of reproductive parameters compared to intramuscular administration. Thus, an alternative therapeutical approach is available for FC treatment, in order to obtain an easier restoration of the ovarian activity, especially in those cases refractory to classical therapeutic approaches. PMID:21571459

Rizzo, Annalisa; Annalisa, Rizzo; Campanile, Debora; Debora, Campanile; Mutinati, Maddalena; Maddalena, Mutinati; Minoia, Giuseppe; Giuseppe, Minoia; Spedicato, Massimo; Massimo, Spedicato; Sciorsci, Raffaele Luigi; Luigi, Sciorsci Raffaele

2011-06-01

301

Extracranial epidural emphysema: pathway, aetiology, diagnosis and management  

PubMed Central

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

Cloran, F; Bui-Mansfield, L T

2011-01-01

302

Sciatica caused by lumbar epidural gas  

PubMed Central

Gas production as a part of disc degeneration can occur but rarely causes nerve compression syndromes. The clinical features are similar to those of common sciatica. CT is very useful in the detection of epidural gas accumulation and nerve root compression. We report a case of symptomatic epidural gas accumulation originating from vacuum phenomenon in the intervertebral disc, causing lumbo-sacral radiculopathy. A 45-year-old woman suffered from sciatica for 9 months. The condition worsened in recent days. Computed tomography (CT) demonstrated intradiscal vacuum phenomenon, and accumulation of gas in the lumbar epidural space compressing the dural sac and S1 nerve root. After evacuation of the gas, her pain resolved without recurrence.

Belfquih, Hatim; El Mostarchid, Brahim; Akhaddar, Ali; Gazzaz, Miloudi; Boucetta, Mohammed

2014-01-01

303

Ocular Infection Preceding Major Epidural Abscess  

PubMed Central

Staphylococcal bacteremia is an important clinical entity. A 74-year-old lady presented with an isolated staphylococcal ocular infection; this was treated with a short course of antibiotics, a prolonged course of steroids, and discharge from hospital with outpatient clinic followup. She represented three weeks later to the emergency department with back pain, raised inflammatory markers, and positive blood cultures. On magnetic resonance imaging (MRI), an extensive epidural collection was seen. This was surgically decompressed, and she was treated with appropriate intravenous antibiotics. Despite a complicated postoperative course, she made an excellent recovery. This case reviews the important clinical and radiological features of the presentation of a major epidural abscess and it also suggests a potentially unusual primary source. The clinician is reminded to always have a high index of suspicion regarding staphylococcal bacteremia and the potential for seeding to the epidural space.

Johnstone, Ryan

2014-01-01

304

The role of spinal serotonin receptor and alpha adrenoceptor on the antiallodynic effects induced by intrathecal milnacipran in chronic constriction injury rats.  

PubMed

Milnacipran, a reuptake inhibitor of noradrenaline (NA) and serotonin (5-HT), elicits an antiallodynic effect in rats with neuropathic pain; however, the role of NA and 5-HT receptors in the induction of the antiallodynic effect of milnacipran remains unclear. Thus, we examined the effects of prazosin as an ?1 adrenoceptor antagonist, yohimbine as an ?2 adrenoceptor antagonist, metergoline as a 5-HT1, 5-HT2 and 5-HT7 receptor antagonist, cyanopindolol as a 5-HT1A/1B receptor antagonist, ketanserin as a 5-HT2 receptor antagonist, and ondansetoron as a 5-HT3 receptor antagonist on the antiallodynic effect of milnacipran in neuropathic rats with chronic constriction injury (CCI). The CCI rats expressed mechanical and thermal allodynia, which was attenuated by intrathecal injection of milnacipran. Yohimbine, but not prazosin, reversed the milnacipran-induced antiallodynic effect. The antiallodynic effect of milnacipran was also reversed by metergoline, ketanserin and ondansetron, while cyanopindolol reversed the antiallodynic effect on mechanical, but not thermal stimulation. Furthermore, c-Fos expression in lamina I/II of the spinal dorsal horn was enhanced by thermal stimulation and the enhanced expression of c-Fos was suppressed by milnacipran. This effect of milnacipran was reversed by yohimbine, metergoline, katanserin and ondansetron, but not prazosin. These results indicate that the effect of milnacipran on mechanical and thermal allodynia and c-Fos expression is elicited through the ?2 adrenoceptor, but not ?1 adrenoceptor, and 5-HT2 and 5-HT3 receptors; furthermore, the 5-HT1A/1B receptor is involved in mechanical allodynia, but not thermal allodynia. PMID:24876059

Nakamura, Takehiro; Ikeda, Tetsuya; Takeda, Ryuichiro; Igawa, Kaori; Naono-Nakayama, Rumi; Sakoda, Sumio; Nishimori, Toshikazu; Ishida, Yasushi

2014-09-01

305

Dietary intake and adherence to the 2010 Dietary Guidelines for Americans among individuals with chronic spinal cord injury: A pilot study.  

PubMed

Objective To investigate dietary intake and adherence to the 2010 Dietary Guidelines for Americans in individuals with chronic spinal cord injury (SCI) and able-bodied individuals. Design A pilot study of dietary intake among a sample of individuals with SCI >1 year ago from a single site compared with able-bodied individuals. Participants/methods One hundred black or white adults aged 38-55 years old with SCI >1 year and 100 age-, sex-, and race-matched adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary intake was assessed by the CARDIA dietary history. Linear regression analysis was used to compare dietary intake between the subjects with SCI and those enrolled in the CARDIA study. Further, adherence to the 2010 Dietary Guidelines for dairy, fruits, and vegetables, and whole-grain foods was assessed. Results Compared with CARDIA participants, participants with SCI consumed fewer daily servings of dairy (2.10 vs. 5.0, P < 0.001), fruit (2.01 vs. 3.64, P = 0.002), and whole grain foods (1.20 vs. 2.44 P = 0.007). For each food group, fewer participants with SCI met the recommended servings compared with the CARDIA participants. Specifically, the participants with SCI and in CARDIA who met the guidelines were, respectively: dairy, 22% vs. 54% (P < 0.001), fruits and vegetables 39% vs. 70% (P = 0.001), and whole-grain foods 8% vs. 69.6% (P = 0.001). Conclusions Compared with able-bodied individuals, SCI participants consumed fewer daily servings of fruit, dairy, and whole grain foods than proposed by the 2010 Dietary Guideline recommendations. Nutrition education for this population may be warranted. PMID:24621049

Lieberman, Jesse; Goff, David; Hammond, Flora; Schreiner, Pamela; Norton, H James; Dulin, Michael; Zhou, Xia; Steffen, Lyn

2014-11-01

306

Predictors of Pain Relief Following Spinal Cord Stimulation in Chronic Back and Leg Pain and Failed Back Surgery Syndrome: A Systematic Review and Meta-Regression Analysis  

PubMed Central

We sought to assess the extent to which pain relief in chronic back and leg pain (CBLP) following spinal cord stimulation (SCS) is influenced by patient-related factors, including pain location, and technology factors. A number of electronic databases were searched with citation searching of included papers and recent systematic reviews. All study designs were included. The primary outcome was pain relief following SCS, we also sought pain score (pre- and post-SCS). Multiple predictive factors were examined: location of pain, history of back surgery, initial level of pain, litigation/worker's compensation, age, gender, duration of pain, duration of follow-up, publication year, continent of data collection, study design, quality score, method of SCS lead implant, and type of SCS lead. Between-study association in predictive factors and pain relief were assessed by meta-regression. Seventy-four studies (N = 3,025 patients with CBLP) met the inclusion criteria; 63 reported data to allow inclusion in a quantitative analysis. Evidence of substantial statistical heterogeneity (P < 0.0001) in level of pain relief following SCS was noted. The mean level of pain relief across studies was 58% (95% CI: 53% to 64%, random effects) at an average follow-up of 24 months. Multivariable meta-regression analysis showed no predictive patient or technology factors. SCS was effective in reducing pain irrespective of the location of CBLP. This review supports SCS as an effective pain relieving treatment for CBLP with predominant leg pain with or without a prior history of back surgery. Randomized controlled trials need to confirm the effectiveness and cost-effectiveness of SCS in the CLBP population with predominant low back pain. PMID:23834386

Taylor, Rod S; Desai, Mehul J; Rigoard, Philippe; Taylor, Rebecca J

2014-01-01

307

Comparative short-term effects of two thoracic spinal manipulation techniques in subjects with chronic mechanical neck pain: a randomized controlled trial.  

PubMed

Spinal Manipulation (SM) has been purported to decrease pain and improve function in subjects with non-specific neck pain. Previous research has investigated which individuals with non-specific neck pain will be more likely to benefit from SM. It has not yet been proven whether or not the effectiveness of thoracic SM depends on the specific technique being used. This double-blind randomized trial has compared the short-term effects of two thoracic SM maneuvers in subjects with chronic non-specific neck pain. Sixty participants were distributed randomly into two groups. One group received the Dog technique (n = 30), with the subject in supine position, and the other group underwent the Toggle-Recoil technique (n = 30), with the participant lying prone, T4 being the targeted area in both cases. Evaluations were made of self-reported neck pain (Visual Analogue Scale); neck mobility (Cervical Range of Motion); and pressure pain threshold at the cervical and thoracic levels (C4 and T4 spinous process) and over the site described for location of tense bands of the upper trapezius muscle. Measurements were taken before intervention, immediately afterward, and 20 min later. Both maneuvers improved neck mobility and mechanosensitivity and reduced pain in the short term. No major or clinical differences were found between the groups. In the between-groups comparison slightly better results were observed in the Toggle-Recoil group only for cervical extension (p = 0.009), right lateral flexion (p = 0.004) and left rotation (p < 0.05). PMID:24679838

Casanova-Méndez, Amaloha; Oliva-Pascual-Vaca, Angel; Rodriguez-Blanco, Cleofás; Heredia-Rizo, Alberto Marcos; Gogorza-Arroitaonandia, Kristobal; Almazán-Campos, Ginés

2014-08-01

308

Low back pain (chronic)  

PubMed Central

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

2010-01-01

309

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation  

Microsoft Academic Search

Pyogenic vertebral osteomyelitis responds well to conservative treatment at early stage, but more complicated and advanced\\u000a conditions, including mechanical spinal instability, epidural abscess formation, neurologic deficits, and refractoriness to\\u000a antibiotic therapy, usually require surgical intervention. The subject of using metallic implants in the setting of infection\\u000a remains controversial, although more and more surgeons acknowledge that instrumentation can help the body

Wei-Hua Chen; Lei-Sheng Jiang; Li-Yang Dai

2007-01-01

310

Pregnancy following spinal cord injury.  

PubMed Central

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

Cross, L. L.; Meythaler, J. M.; Tuel, S. M.; Cross, A. L.

1991-01-01

311

Metastatic spinal abscesses from diabetic foot osteomyelitis.  

PubMed

A 66-year-old man with long-standing type 2 diabetes, nephropathy and neuropathy was admitted acutely with an infected left big toe neuropathic ulcer, with underlying osteomyelitis. His condition rapidly deteriorated with sepsis and right lobar pneumonia. Microbiology grew methicillin-sensitive Staphylococcus aureus. Shortly into his admission, he developed flaccid paraparesis, and an MRI showed multiple epidural abscesses with likely cord infarction, not amenable to surgical intervention. His sepsis resolved, but his paraparesis remained severe, requiring spinal rehabilitation. PMID:24920514

Shaho, Shang; Khan, Shaila; Huda, M S Bobby; Chowdhury, Tahseen Ahmad

2014-01-01

312

Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome.  

PubMed

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 patient's 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 Roland-Morris disability scale and back pain intensity with a 0-10 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 patient's 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 "adherence-outcome" 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

Mannion, Anne F; Helbling, Daniel; Pulkovski, Natascha; Sprott, Haiko

2009-12-01

313

Spinal Anesthesia with Isobaric Tetracaine in Patients with Previous Lumbar Spinal Surgery  

PubMed Central

Purpose Previous lumbar spinal surgery (PLSS) is not currently considered as a contraindication for regional anesthesia. However, there are still problems that make spinal anesthesia more difficult with a possibility of worsening the patient's back pain. Spinal anesthesia using combined spinal-epidural anesthesia (CSEA) in elderly patients with or without PLSS was investigated and the anesthetic characteristics, success rates, and possible complications were evaluated. Materials and Methods Fifty patients without PLSS (Control group) and 45 patients with PLSS (PLSS group) who were scheduled for total knee arthroplasty were studied prospectively. A CSEA was performed with patients in the left lateral position, and 10 mg of 0.5% isobaric tetracaine was injected through a 27 G spinal needle. An epidural catheter was then inserted for patient controlled analgesia. Successful spinal anesthesia was defined as adequate sensory block level more than T12. The number of skin punctures and the onset time were recorded, and maximal sensory block level (MSBL), time to 2-segment regression, success rate and complications were observed. Results The success rate of CSEA in Control group and PLSS group was 98.0%, and 93.3%, respectively. The median MSBL in PLSS group was higher than Control group [T4 (T2-L1) vs. T6 (T3-T12)] (p < 0.001). There was a significant difference in the number of patients who required ephedrine for the treatment of hypotension in PLSS group (p = 0.028). Conclusion The success rate of CSEA in patients with PLSS was 93.3%, and patients experienced no significant neurological complications. The MSBL can be higher in PLSS group than Control group. PMID:19430559

Kim, Soo Hwan; Jeon, Dong-Hyuk; Chang, Chul Ho; Lee, Sung-Jin

2009-01-01

314

Continous epidural butorphanol decreases the incidence of intrathecal morphine-related pruritus after cesarean section: a randomized, double-blinded, placebo-controlled trial: epidural butorphanol decreases the incidence of intrathecal morphine-related pruritus.  

PubMed

This randomized, double-blinded, placebo-controlled trial investigated the effect of continuous epidural butorphanol on intrathecal morphine-related pruritus in patients undergoing cesarean section. Eighty-three patients undergoing elective cesarean section under spinal anesthesia (1.5 mL of isobaric bupivacaine 0.5 % and 0.1 mg of preservative-free morphine) were enrolled in this study. Subjects were randomized to receive epidural butorphanol (n = 43) or normal saline combined bupivacaine (n = 40). In the study group, after the umbilical cord was clamped, patients were administered an epidural loading dose of 1 mg followed by a 48-h infusion of 0.004 % butorphanol with 0.1 % bupivacaine at a rate of 2 mL/h. In the normal saline group, saline was used for the loading dose and the infusion 0.1 % bupivacaine at a same rate. Postoperatively, a blinded observer recorded the incidence/severity of pruritus, visual analog pain scores and sedation level at 1, 3, 6, 9, 12, 24 and 48 h. The 48-h consumption of breakthrough analgesic (tramadol) was also noted. The primary outcome was the incidence of pruritus at 48 h. At 48 h, the incidence of pruritus was significantly lower in the butorphanol group (16.3 vs. 52.5 %; P < 0.001). Furthermore, compared with the normal saline group, the intensity of pruritus was also decreased with epidural butorphanol at 3, 6 and 9 h (all P ? 0.008). The pain scores were significantly lower at 12, 24 and 48 h (all P < 0.05) in the butorphanol groups. Patients only receiving bupivacaine required a higher cumulative dose of tramadol (37.5 ± 62.8 vs. 9.3 ± 36.6; P = 0.014). In patients undergoing elective cesarean section, continuous epidural butorphanol with bupivacaine decreases the incidence and severity of intrathecal morphine-related pruritus without adversely affecting the quality of postoperative analgesia. PMID:24639106

Wu, Zhen; Kong, Mingjian; Chen, Jianqing; Wen, Laiyou; Wang, Jing; Tan, Jie

2014-09-01

315

Exogenous BDNF enhances the integration of chronically injured axons that regenerate through a peripheral nerve grafted into a chondroitinase-treated spinal cord injury site.  

PubMed

Although axons lose some of their intrinsic capacity for growth after their developmental period, some axons retain the potential for regrowth after injury. When provided with a growth-promoting substrate such as a peripheral nerve graft (PNG), severed axons regenerate into and through the graft; however, they stop when they reach the glial scar at the distal graft-host interface that is rich with inhibitory chondroitin sulfate proteoglycans. We previously showed that treatment of a spinal cord injury site with chondroitinase (ChABC) allows axons within the graft to traverse the scar and reinnervate spinal cord, where they form functional synapses. While this improvement in outgrowth was significant, it still represented only a small percentage (<20%) of axons compared to the total number of axons that regenerated into the PNG. Here we tested whether providing exogenous brain-derived neurotrophic factor (BDNF) via lentivirus in tissue distal to the PNG would augment regeneration beyond a ChABC-treated glial interface. We found that ChABC treatment alone promoted axonal regeneration but combining ChABC with BDNF-lentivirus did not increase the number of axons that regenerated back into spinal cord. Combining BDNF with ChABC did increase the number of spinal cord neurons that were trans-synaptically activated during electrical stimulation of the graft, as indicated by c-Fos expression, suggesting that BDNF overexpression improved the functional significance of axons that did reinnervate distal spinal cord tissue. PMID:23022460

Tom, Veronica J; Sandrow-Feinberg, Harra R; Miller, Kassi; Domitrovich, Cheryl; Bouyer, Julien; Zhukareva, Victoria; Klaw, Michelle C; Lemay, Michel A; Houlé, John D

2013-01-01

316

Spinal Stenosis  

MedlinePLUS

... stenosis most often results from a gradual, degenerative aging process. Either structural changes or inflammation can begin ... spinal cord or nerve roots at that place. Aging with secondary changes is the most common cause ...

317

Spinal Stenosis  

MedlinePLUS

... legs (the hip adductors and abductors, quadriceps and hamstrings). This will improve your balance, ability to walk, ... the tissue around the spinal cord; infection; and injury to the nerve root. While surgery may bring ...

318

Wind-up of stretch reflexes as a measure of spasticity in chronic spinalized rats: The effects of passive exercise and modafinil  

Microsoft Academic Search

Spasticity is a common disorder following spinal cord injury that can impair function and quality of life. While a number of mechanisms are thought to play a role in spasticity, the role of motoneuron persistent inward currents (PICs) is emerging as pivotal. The presence of PICs can be evidenced by temporal summation or wind-up of reflex responses to brief afferent

M. Kevin Garrison; Charlotte C. Yates; Nancy B. Reese; Robert D. Skinner; Edgar Garcia-Rill

2011-01-01

319

Surgical Treatment of Spinal Tuberculosis Complicated with Extensive ABSCESS  

PubMed Central

Purpose Tuberculosis can be responsible for extensive spinal lesions. Despite the efficacy of medical treatment, surgery is indicated to avoid or correct significant deformity, treat spinal instability, prevent neurological compromise, and to eradicate an extensive tuberculous abscess. In this paper we present our experience in the surgical management of spinal tuberculosis complicated with large abscess. Patients and Methods Fifteen patients with spinal tuberculosis complicated with extensive abscess were identified; and nine of those patients had extension of the infection into the epidural space. The average age at treatment was 34 years old. Seven patients had thoracic infection, seven patients had lumbar infection and one had thoracolumbar infection. Six patients had neurological deficit at presentation. All patients were surgically treated with abscess debridement, spinal stabilization and concurrent antituberculous chemotherapy. A single anterior surgical approach was used in three cases, a posterior approach was used in four others and a combined approach was performed in eight patients. Results Surgical management allowed for effective abscess debridement and sspinal stabilization in this cohort. In combination with antituberculous drugs, surgical treatment resulted in infection eradication and bone fusion in all patients at 24 month average follow-up. Satisfactory neurological outcomes with improved American Spinal Injury Association (ASIA) scores were observed in 100% of patients. Conclusion Surgical treatment for spinal tuberculosis abscess can lead to satisfactory clinical outcomes.

Brito, Joaquim Soares Do; Tirado, Antonio; Fernandes, Pedro

2014-01-01

320

Limited Upper Thoracic Epidural Block and Splanchnic Perfusion in Dogs  

Microsoft Academic Search

Epidural blockade leads to a sympathetic block in af- fected segments and an increase of sympathetic out- flow from various unblocked segments. A limited up- per thoracic epidural block (LUTEB) is used during coronary artery surgery affecting the cardiac sympa- thetic fibers cephalad to the fifth thoracic segment. This block does not extend to the sympathetic fibers inner- vating the

A. Meissner; T. P. Weber; H. Van Aken; N. Rolf

1999-01-01

321

Spontaneous spinal subdural hematoma concurrent with cranial subdural hematoma.  

PubMed

A 39-year old female presented with chronic spinal subdural hematoma manifesting as low back pain and radiating pain from both legs. Magnetic resonance imaging (MRI) showed spinal subdural hematoma (SDH) extending from L4 to S2 leading to severe central spinal canal stenosis. One day after admission, she complained of nausea and severe headache. Computed tomography of the brain revealed chronic SDH associated with midline shift. Intracranial chronic SDH was evacuated through two burr holes. Back pain and radiating leg pain derived from the spinal SDH diminished about 2 weeks after admission and spinal SDH was completely resolved on MRI obtained 3 months after onset. Physicians should be aware of such a condition and check the possibility of concurrent cranial SDH in patients with spinal SDH, especially with non-traumatic origin. PMID:24044087

Moon, Wonjun; Joo, Wonil; Chough, Jeongki; Park, Haekwan

2013-07-01

322

Over-expression of P2X7 receptors in spinal glial cells contributes to the development of chronic postsurgical pain induced by skin/muscle incision and retraction (SMIR) in rats.  

PubMed

Many patients suffer from chronic postsurgical pain (CPSP) following surgery, and the underlying mechanisms are poorly understood. In the present work, with use of the skin/muscle incision and retraction (SMIR) model, the role of P2X7 receptors (P2X7Rs) in spinal glial cells in the development of CPSP was evaluated. Consistent with previous reports, we found that SMIR decreased the ipsilateral 50% paw withdrawal threshold (PWT), lasting for at least 2weeks. No injury was done to L3 dorsal root ganglia (DRG) neurons and no axonal or Schwann cell damage at the retraction site in the saphenous nerve was observed 7days after SMIR. The results of immunofluorescence showed that both microglia and astrocytes were activated in the spinal dorsal horn following SMIR. In addition, both P2X7Rs and tumor necrosis factor-alpha (TNF-?) were up-regulated following SMIR. Double immunofluorescence staining revealed that the up-regulated P2X7R immunoreactivity was mainly located in microglia, and to a lesser extent in astrocytes, but not in neurons. Intrathecal delivery of specific P2X7R antagonist BBG (10?M in 10?l volume) or A438079 (10?M in 10?l volume), started 30min before the surgery and once daily thereafter for 7days, prevented the mechanical allodynia. Intrathecal injection of BBG inhibited the activation of microglia and astrocytes, and the up-regulation of TNF-? induced by SMIR. These data suggest that P2X7Rs in the spinal dorsal horn might mediate the development of CPSP via activation of glial cells and up-regulation of TNF-?. PMID:25242211

Ying, Yan-Lu; Wei, Xu-Hong; Xu, Xue-Bing; She, Shou-Zhang; Zhou, Li-Jun; Lv, Jing; Li, Dai; Zheng, Bin; Liu, Xian-Guo

2014-11-01

323

Directional preference following epidural steroid injection in three patients with acute cervical radiculopathy.  

PubMed

Cervical radiculopathy is typically characterized by neurologic symptoms that are traced to disturbances of discrete spinal nerve root(s) due to inflammatory or mechanical etiologies. Here we present three patients diagnosed with cervical radiculopathy, whose directional preference only surfaced after either a cervical transforaminal or intralaminar nerve root epidural steroid injection. This retrospective observational case series describes three men who presented with cervical radiculopathy with 7-9/10 neck pain, neck disability index (NDI) ranging between 44% and 90%, and an irreducible derangement upon McKenzie mechanical diagnosis and therapy (MMDT) evaluation. These patients demonstrated weaknesses, sensory changes, and/or decreased reflexes in the C5, C6, or C7 distributions. They each underwent a cervical transforaminal or intralaminar epidural injections at one or two levels, which uncovered their directional preference and facilitated further conservative treatment. These three patients experienced drastic improvements with each postinjection physical therapy session. They demonstrated decreased pain scores, centralization of pain, and a decreasing NDI trends throughout their treatments. They were all discharged with stable 0-3/10 pain severity after four physical therapy sessions and NDI scores of 0%. These cases suggest an interplay between inflammatory and mechanical contributors to spine-mediated pain and the treatment challenge this presents. Dissecting the components of spine pain can be challenging; however, delivery of skilled multidisciplinary care in an algorithmic fashion may be beneficial and provide the future framework for the management of cervical radiculopathy and other spine-related conditions. PMID:23113937

Desai, Mehul J; Padmanabhan, Girish; Simbasivan, Ajai; Kamanga-Sollo, Gladys G; Dharmappa, Ajay

2013-09-01

324

A Spinal Arteriovenous Fistula in a 3-Year Old Boy  

PubMed Central

We present a case of a 3-year-old boy with neurodegeneration. Family history reveals Rendu-Osler-Weber disease. Magnetic resonance imaging (MRI) of the spinal cord and spinal angiography showed a spinal arteriovenous fistula with venous aneurysm, causing compression of the lumbar spinal cord. Embolisation of the fistula was executed, resulting in clinical improvement. A week after discharge he was readmitted with neurologic regression. A second MRI scan revealed an intraspinal epidural haematoma and increase in size of the aneurysm with several new arterial feeders leading to it. Coiling of the aneurysm and fistulas was performed. Postoperative, the spinal oedema increased despite corticoids, causing more extensive paraplegia of the lower limbs and a deterioration of his mental state. A laminectomy was performed and the aneurysm was surgically removed. Subsequently, the boy recovered gradually. A new MRI scan after two months showed less oedema and a split, partly affected spinal chord. This case shows the importance of excluding possible arteriovenous malformations in a child presenting with progressive neurodegeneration. In particular when there is a family history for Rendu-Osler-Weber disease, scans should be performed instantly to rule out this possibility. The case also highlights the possibility of good recovery of paraplegia in paediatric Rendu-Osler-Weber patients. PMID:24707424

Crijnen, Thomas E. M.; Voormolen, Maurits H. J.; Robert, Dominique; Jorens, Philippe G.; Ramet, Jose

2014-01-01

325

Epidural Use and Clinical Chorioamnionitis among Women Who Delivered Vaginally.  

PubMed

Objective?Chorioamnionitis, an important cause of maternal and neonatal morbidity, is influenced by epidural use and the occurrence of epidural fever. We evaluated the association between chorioamnionitis, histologic placental findings, and intrapartum factors focusing on epidural use. Materials and Methods?We conducted a secondary analysis of a randomized controlled trial of different doses of oxytocin to prevent postpartum hemorrhage among women who delivered vaginally. The primary outcome was clinical diagnosis of chorioamnionitis leading to antibiotic therapy. Intrapartum factors examined included epidural use, parity, labor induction, gestational age, maternal age, ethnicity, body mass index, cervical dilatation at admission, preeclampsia/eclampsia, preterm labor, and duration of labor. Results?Of the 1,798 women randomized, we excluded 13 multifetal births leaving 1,785 for analysis: 1,491 had an epidural and 294 did not. Of those with epidural, 8.0% had clinically diagnosed chorioamnionitis compared with only 1.0% without epidural: unadjusted odds ratio (OR)?=?8.3 (95% confidence interval [CI]: 2.63-26.40); p?epidural use (adjusted OR: 5.80; 95% CI: 1.77-19.11), increasing parity (0.42; 0.32-0.55), and preeclampsia (0.31; 0.14-0.66) were significantly associated with chorioamnionitis. Conclusion?Epidural use is statistically associated with an increase in clinical diagnosis of chorioamnionitis. A cause and effect relationship cannot be confirmed from this study. Independently of labor duration and increasing parity, preeclampsia appeared protective. PMID:24705965

Abramovici, Adi; Szychowski, Jeff M; Biggio, Joseph R; Sakawi, Yasser; Andrews, William W; Tita, Alan T N

2014-11-01

326

The spinal cord dura mater reaction to nitinol and titanium alloy particles: a 1-year study in rabbits  

PubMed Central

This investigation was undertaken to simulate in an animal model the particles released from a porous nitinol interbody fusion device and to evaluate its consequences on the dura mater, spinal cord and nerve roots, lymph nodes (abdominal para-aortic), and organs (kidneys, spleen, pancreas, liver, and lungs). Our objective was to evaluate the compatibility of the nitinol particles with the dura mater in comparison with titanium alloy. In spite of the great use of metallic devices in spine surgery, the proximity of the spinal cord to the devices raised concerns about the effect of the metal debris that might be released onto the neural tissue. Forty-five New Zealand white female rabbits were divided into three groups: nitinol (treated: N = 4 per implantation period), titanium (treated: N = 4 per implantation period), and sham rabbits (control: N = 1 per observation period). The nitinol and titanium alloy particles were implanted in the spinal canal on the dura mater at the lumbar level L2–L3. The rabbits were sacrificed at 1, 4, 12, 26, and 52 weeks. Histologic sections from the regional lymph nodes, organs, from remote and implantation sites, were analyzed for any abnormalities and inflammation. Regardless of the implantation time, both nitinol and titanium particles remained at the implantation site and clung to the spinal cord lining soft tissue of the dura mater. The inflammation was limited to the epidural space around the particles and then reduced from acute to mild chronic during the follow-up. The dura mater, sub-dural space, nerve roots, and the spinal cord were free of reaction. No particles or abnormalities were found either in the lymph nodes or in the organs. In contact with the dura, the nitinol elicits an inflammatory response similar to that of titanium. The tolerance of nitinol by a sensitive tissue such as the dura mater during the span of 1 year of implantation demonstrated the safety of nitinol and its potential use as an intervertebral fusion device. PMID:17334794

Rhalmi, Souad; Charette, Sylvie; Assad, Michel; Coillard, Christine

2007-01-01

327

Therapy of Acute and Delayed Spinal Infections after Spinal Surgery Treated with Negative Pressure Wound Therapy in Adult Patients  

PubMed Central

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

Zwolak, Pawel; Konig, Matthias Alexander; Osterhoff, Georg; Wilzeck, Verena; Simmen, Hans-Peter; Jukema, Gerrolt Nico

2013-01-01

328

Degenerative spinal disease in large felids.  

PubMed

Degenerative spinal disorders, including intervertebral disc disease and spondylosis, seldom occur in domestic cats. In contrast, a retrospective study of 13 lions (Panthera leo), 16 tigers (Panthera tigris), 4 leopards (Panthera pardis), 1 snow leopard (Panthera uncia), and 3 jaguars (Panthera onca) from the Knoxville Zoo that died or were euthanatized from 1976 to 1996 indicated that degenerative spinal disease is an important problem in large nondomestic felids. The medical record, radiographic data, and the necropsy report of each animal were examined for evidence of intervertebral disc disease or spondylosis. Eight (three lions, four tigers, and one leopard) animals were diagnosed with degenerative spinal disease. Clinical signs included progressively decreased activity, moderate to severe rear limb muscle atrophy, chronic intermittent rear limb paresis, and ataxia. The age at onset of clinical signs was 10-19 yr (median = 18 yr). Radiographic evaluation of the spinal column was useful in assessing the severity of spinal lesions, and results were correlated with necropsy findings. Lesions were frequently multifocal, included intervertebral disc mineralization or herniation with collapsed intervertebral disc spaces, and were most common in the lumbar area but also involved cervical and thoracic vertebrae. Marked spondylosis was present in the cats with intervertebral disc disease, presumably subsequent to vertebral instability. Six of the animals' spinal cords were examined histologically, and five had acute or chronic damage to the spinal cord secondary to disc protrusion. Spinal disease should be suspected in geriatric large felids with decreased appetite or activity. Radiographic evaluation of the spinal column is the most useful method to assess the type and severity of spinal lesions. PMID:10884118

Kolmstetter, C; Munson, L; Ramsay, E C

2000-03-01

329

Spinal Bracing  

NASA Technical Reports Server (NTRS)

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.

1991-01-01

330

Spinal Metastases  

Microsoft Academic Search

Spinal cord metastases are a common complication of systemic malignancy, most commonly from lung, breast, and prostate cancer.\\u000a Patients may present with a variety of symptoms, most notably pain and weakness. The ultimate goals in managing these patients\\u000a include maximizing neurologic function, length of survival, and quality of life. These goals can best be reached via early,\\u000a accurate diagnosis followed

Jonathan H. Sherman; Dawit G. Aregawi; Mark E. Shaffrey; David Schiff

331

Update on treatment options for spinal brucellosis.  

PubMed

We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular. PMID:24118178

Ulu-Kilic, A; Karakas, A; Erdem, H; Turker, T; Inal, A S; Ak, O; Turan, H; Kazak, E; Inan, A; Duygu, F; Demiraslan, H; Kader, C; Sener, A; Dayan, S; Deveci, O; Tekin, R; Saltoglu, N; Ayd?n, M; Horasan, E S; Gul, H C; Ceylan, B; Kadanal?, A; Karabay, O; Karagoz, G; Kayabas, U; Turhan, V; Engin, D; Gulsun, S; Elald?, N; Alabay, S

2014-02-01

332

Effect of epidural blockade on indicators of splanchnic perfusion and gut function in critically ill patients with peritonitis: a randomised comparison of epidural bupivacaine with systemic morphine  

Microsoft Academic Search

Objectives: (a) To measure gastric tonometry values in critically ill patients with peritonitis and to assess the impact of epidural analgesia on these values. (b) To assess the impact of epidural analgesia on gastro-intestinal motility by abdominal ultrasound and paracetamol absorption. (c) To observe any change in clinical outcome that may result from the use of epidural analgesia in such

David R. Spackman; Andrew D. M. McLeod; Steven N. Prineas; Richard M. Leach; F. Reynolds

2000-01-01

333

Low-pressure/spinal fluid leak headache.  

PubMed

Low cerebrospinal fluid (CSF) pressure results in neurologic deficits, of which the most common manifestation is headache. Typically, the headache is postural - and specifically, orthostatic - in presentation. There are three hypotheses to explain the occurrence of headache associated with low CSF fluid. The first is traction on pain-sensitive intracranial and meningeal structures; the second is CSF hypovolemia; and the third is spinal loss of CSF resulting in increased compliance at the caudal end of the CSF space. Spontaneous intracranial hypotension (SIH), once believed to be rare, is now more commonly recognized. It is typically associated with orthostatic headache (although initially it may not be) and one or more other symptoms such as alterations in hearing, nausea, vomiting, neck stiffness, diplopia, and visual field cuts. Magnetic resonance imaging (MRI) of the brain with gadolinium is the first study of choice, which typically reveals diffuse pachymeningeal enhancement and, frequently, cerebellar tonsillar descent and posterior fossa crowding. Epidural blood patch (EBP) is the treatment of choice. Surgery and epidural fibrin glue injection are options for those who fail conservative therapy and/or EBP. PMID:24760494

Spears, Roderick C

2014-06-01

334

Spinal cord contusion  

PubMed Central

Spinal cord injury is a major cause of disability with devastating neurological outcomes and limited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result.

Ju, Gong; Wang, Jian; Wang, Yazhou; Zhao, Xianghui

2014-01-01

335

Complications of continuous epidural infusions for postoperative analgesia in children  

Microsoft Academic Search

To determine the incidences of side effects and complications associated with the use of epidural analgesia for infants and\\u000a children at the Alberta Children’s Hospital, we reviewed our experience over a two-year period. A database was established\\u000a for recording management, side effects and complications of each epidural, and this is a retrospective review ofthat database.\\u000a Problems were identified as complications

Catherine E. Wood; Gerald V. Goresky; Kimberly A. Klassen; Brian Kuwahara; Stuart G. Neil

1994-01-01

336

The Efficacy of Thoracic Epidural Neostigmine Infusion After Thoracotomy  

Microsoft Academic Search

Few anesthesia studies have explored perioperative con- tinuous epidural infusion of neostigmine. We examined such a regimen in thoracotomy patients. Ninety patients were randomized to one of three groups in this double- blind trial. Before anesthesia induction, an epidural cath- eter was inserted in all patients at T5-8 levels under local anesthesia. Pre-neo patients received bolus 500-g epi- dural neostigmine

Yuan-Yi Chia; Ting-Hang Chang; Kang Liu; Huang-Chou Chang; Nai-Hua Ko; Ying-Ming Wang

2006-01-01

337

Small-Dose Fentanyl in Intravenous Versus Epidural Preemptive Analgesia  

Microsoft Academic Search

In this randomized, double-blinded study, the preemptive effects of intravenous and epidural fentanyl analgesia were compared with post-incisional analgesia in 40 patients undergoing orthophedic surgery of the lower extremities. Patients were randomly allocated to one of two groups; intravenous or epidural analgesia, with twenty patients in each group. General anesthesia was induced with thiopentone 5-6 mgkg-1 and maintained with 0.8-1.0%

Binnur SARIHASAN; Deniz KARAKAYA; Fuat GÜLDO; Ayla TÜR

2000-01-01

338

Epidural Meperidine After Cesarean Section: The Effect of Diluent Volume  

Microsoft Academic Search

We investigated the effect of diluent volume on analge- sia and systemic absorption from epidural meperidine after cesarean section in a randomized, double-blind study. At the first request for postoperative analgesia, 36 parturients were given epidural meperidine 25 mg diluted with saline to either 2 mL (12.5 mg\\/mL), 5 mL (5 mg\\/mL), or 10 mL (2.5 mg\\/mL). Visual analog pain

Warwick D. Ngan Kee; Kwok K. Lam; Tony Gin; FRCA FANZCA

339

Seizures after epidural blood patch with undiagnosed subdural hematoma  

Microsoft Academic Search

Objective: We present a case of new-onset seizures in a parturient who received an epidural blood patch (EBP) in the presence of an undiagnosed cerebral subdural hematoma. We review the relevant literature and examine the implications for management. Case Report: A 33-year-old parturient developed symptoms of postdural puncture headache 16 hours after initiation of epidural analgesia for labor. On the

Kenneth Kardash; Farrah Morrow

2002-01-01

340

Postoperative Epidural Morphine for Postpartum Tubal Ligation Analgesia  

Microsoft Academic Search

Womenundergoingpostoperativepostpartumtuballiga- tion (PPTL) often experience considerable pain. We hy- pothesized that epidural morphine, as part of a multi- modal analgesic regimen, would decrease postoperative pain and the need for systemic analgesia after PPTL. In a double-blinded study, patients were randomized to re- ceiveepiduralsalineormorphine2mg,3mg,or4mgafter epidural anesthesia for PPTL. Postoperatively, ibuprofen 600 mg was administered every 6 h and patients could requestacetaminophen325mg\\/hydrocodone10mg.The

R-Jay L. Marcus; Cynthia A. Wong; Amy Lehor; Robert J. McCarthy; Edward Yaghmour; Meltem Yilmaz

2005-01-01

341

Clinical evaluation of a new epidural pressure monitor  

Microsoft Academic Search

Summary Comparative measuring of epidural pressure using the Spiegelberg probe 1 and ventricular fluid pressure was carried out in 15 neurosurgical intensive-care patients. Deviations in both directions were established, with a trend toward overestimating ventricular pressure in epidural pressure measuring (r=0.77). Individual pulsations, spontaneous wave courses and therapy-induced pressure changes were reflected without delays. There were no complications observed with

Th. Czech; A. Korn; A. Reinprecht; W. Schramm; Th. Kimla; C. K. Spiss

1993-01-01

342

Thoracic epidural anesthesia decreases endotoxin-induced endothelial injury  

PubMed Central

Background The sympathetic nervous system is considered to modulate the endotoxin-induced activation of immune cells. Here we investigate whether thoracic epidural anesthesia with its regional symapathetic blocking effect alters endotoxin-induced leukocyte-endothelium activation and interaction with subsequent endothelial injury. Methods Sprague Dawley rats were anesthetized, cannulated and hemodynamically monitored. E. coli lipopolysaccharide (Serotype 0127:B8, 1.5 mg x kg-1 x h-1) or isotonic saline (controls) was infused for 300 minutes. An epidural catheter was inserted for continuous application of lidocaine or normal saline in endotoxemic animals and saline in controls. After 300 minutes we measured catecholamine and cytokine plasma concentrations, adhesion molecule expression, leukocyte adhesion, and intestinal tissue edema. Results In endotoxemic animals with epidural saline, LPS significantly increased the interleukin-1? plasma concentration (48%), the expression of endothelial adhesion molecules E-selectin (34%) and ICAM-1 (42%), and the number of adherent leukocytes (40%) with an increase in intestinal myeloperoxidase activity (26%) and tissue edema (75%) when compared to healthy controls. In endotoxemic animals with epidural infusion of lidocaine the values were similar to those in control animals, while epinephrine plasma concentration was 32% lower compared to endotoxemic animals with epidural saline. Conclusions Thoracic epidural anesthesia attenuated the endotoxin-induced increase of IL-1? concentration, adhesion molecule expression and leukocyte-adhesion with subsequent endothelial injury. A potential mechanism is the reduction in the plasma concentration of epinephrine. PMID:24708631

2014-01-01

343

Top Spinal Cord Inj Rehabil 2013;19(4):279287 2013 Thomas Land Publishers, Inc.  

E-print Network

279 Top Spinal Cord Inj Rehabil 2013;19(4):279­287 © 2013 Thomas Land Publishers, Inc. www Voluntary Grasping Function in Individuals with Incomplete Chronic Spinal Cord Injury: Pilot Study Naaz Kapadia, MSc (PT),1 Vera Zivanovic, MD,1 and Milos R. Popovic, PhD2 1 Spinal Cord Injury Research Program

Popovic, Milos R.

344

Effects of Intrathecal Glutamatergic Drugs on Locomotion I. NMDA in Short-Term Spinal Cats  

E-print Network

Effects of Intrathecal Glutamatergic Drugs on Locomotion I. NMDA in Short-Term Spinal Cats CONNIE, and Serge Rossignol. Effects of intrathecal glutamatergic drugs on locomotion. I. NMDA in short-term spinal within the first week after spinalization. Five cats chronically implanted with an intrathecal cannula

Manitoba, University of

345

Experiences of Living with Pain after a Spinal Cord Injury.  

National Technical Information Service (NTIS)

Persistent chronic pain is prevalent after a spinal cord injury (SCI), with about two-thirds of persons with SCI reporting persistent pain despite available treatments. There is a risk for a significant psychosocial impact and a substantially reduced qual...

E. G. Widerstrom-Noga

2013-01-01

346

Advanced therapy learning algorithm for spinal cord stimulation  

E-print Network

Spinal Cord Stimulation (SCS) is a technique used to treat chronic pain and has been shown to be an effective method of treatment, both financially and socioeconomically. Stimulating electrodes are surgically implanted ...

Gaudreau Balderrama, Amanda Dawn

2010-01-01

347

Design and development of an epidural needle puncture and retraction device  

E-print Network

Over 2 million epidural procedures are performed every year in the United States, but many result in complications caused by over puncture, where the needle punctures farther than the epidural space. A usable model of a ...

Xu, Alan K

2013-01-01

348

Plasticity of the Injured Human Spinal Cord: Insights Revealed by Spinal Cord Functional MRI  

PubMed Central

Introduction While numerous studies have documented evidence for plasticity of the human brain there is little evidence that the human spinal cord can change after injury. Here, we employ a novel spinal fMRI design where we stimulate normal and abnormal sensory dermatomes in persons with traumatic spinal cord injury and perform a connectivity analysis to understand how spinal networks process information. Methods Spinal fMRI data was collected at 3 Tesla at two institutions from 38 individuals using the standard SEEP functional MR imaging techniques. Thermal stimulation was applied to four dermatomes in an interleaved timing pattern during each fMRI acquisition. SCI patients were stimulated in dermatomes both above (normal sensation) and below the level of their injury. Sub-group analysis was performed on healthy controls (n?=?20), complete SCI (n?=?3), incomplete SCI (n?=?9) and SCI patients who recovered full function (n?=?6). Results Patients with chronic incomplete SCI, when stimulated in a dermatome of normal sensation, showed an increased number of active voxels relative to controls (p?=?0.025). There was an inverse relationship between the degree of sensory impairment and the number of active voxels in the region of the spinal cord corresponding to that dermatome of abnormal sensation (R2?=?0.93, p<0.001). Lastly, a connectivity analysis demonstrated a significantly increased number of intraspinal connections in incomplete SCI patients relative to controls suggesting altered processing of afferent sensory signals. Conclusions In this work we demonstrate the use of spinal fMRI to investigate changes in spinal processing of somatosensory information in the human spinal cord. We provide evidence for plasticity of the human spinal cord after traumatic injury based on an increase in the average number of active voxels in dermatomes of normal sensation in chronic SCI patients and an increased number of intraspinal connections in incomplete SCI patients relative to healthy controls. PMID:23029097

Cadotte, David W.; Bosma, Rachael; Mikulis, David; Nugaeva, Natalia; Smith, Karen; Pokrupa, Ronald; Islam, Omar; Stroman, Patrick W.; Fehlings, Michael G.

2012-01-01

349

Intracranial Somatosensory Responses with Direct Spinal Cord Stimulation in Anesthetized Sheep  

PubMed Central

The efficacy of spinal cord stimulators is dependent on the ability of the device to functionally activate targeted structures within the spinal cord, while avoiding activation of near-by non-targeted structures. In theory, these objectives can best be achieved by delivering electrical stimuli directly to the surface of the spinal cord. The current experiments were performed to study the influence of different stimulating electrode positions on patterns of spinal cord electrophysiological activation. A custom-designed spinal cord neurostimulator was used to investigate the effects of lead position and stimulus amplitude on cortical electrophysiological responses to spinal cord stimulation. Brain recordings were obtained from subdural grids placed in four adult sheep. We systematically varied the position of the stimulating lead relative to the spinal cord and the voltage delivered by the device at each position, and then examined how these variables influenced cortical responses. A clear relationship was observed between voltage and electrode position, and the magnitude of high gamma-band oscillations. Direct stimulation of the dorsal column contralateral to the grid required the lowest voltage to evoke brain responses to spinal cord stimulation. Given the lower voltage thresholds associated with direct stimulation of the dorsal column, and its possible impact on the therapeutic window, this intradural modality may have particular clinical advantages over standard epidural techniques now in routine use. PMID:23457542

Flouty, Oliver E.; Oya, Hiroyuki; Kawasaki, Hiroto; Reddy, Chandan G.; Fredericks, Douglas C.; Gibson-Corley, Katherine N.; Jeffery, Nicholas D.; Gillies, George T.; Howard, Matthew A.

2013-01-01

350

Wind-up of stretch reflexes as a measure of spasticity in chronic spinalized rats: The effects of passive exercise and modafinil.  

PubMed

Spasticity is a common disorder following spinal cord injury that can impair function and quality of life. While a number of mechanisms are thought to play a role in spasticity, the role of motoneuron persistent inward currents (PICs) is emerging as pivotal. The presence of PICs can be evidenced by temporal summation or wind-up of reflex responses to brief afferent inputs. In this study, a combined neurophysiological and novel biomechanical approach was used to assess the effects of passive exercise and modafinil administration on hyper-reflexia and spasticity following complete T-10 transection in the rat. Animals were divided into 3 groups (n=8) and provided daily passive cycling exercise, oral modafinil, or no intervention. After 6weeks, animals were tested for wind-up of the stretch reflex (SR) during repeated dorsiflexion stretches of the ankle. H-reflexes were tested in a subset of animals. Both torque and gastrocnemius electromyography showed evidence of SR wind-up in the transection only group that was significantly different from both treatment groups (p<0.05). H-reflex frequency dependent depression was also restored to normal levels in both treatment groups. The results provide support for the use of passive cycling exercise and modafinil in the treatment of spasticity and provide insight into the possible contribution of PICs. PMID:20932828

Garrison, M Kevin; Yates, Charlotte C; Reese, Nancy B; Skinner, Robert D; Garcia-Rill, Edgar

2011-01-01

351

Subacute combined degeneration mimicking traumatic spinal cord injury.  

PubMed

Subacute combined degeneration (SCD) of the spinal cord is the most common neurologic manifestation of vitamin B12 (cobalamin) deficiency and is usually secondary to autoimmune gastritis, but may also be seen in malnutrition syndromes such as chronic alcoholism, strict vegetarianism, gastrectomy, and also in nitrous oxide abuse. Although traumatic spinal cord injury is routinely encountered in the medical examiner's office, medical causes of spinal cord abnormalities such as SCD should be considered in the appropriate clinical setting. We report a case of alcohol-associated SCD mimicking traumatic spinal cord injury. PMID:19237854

Paul, Ian; Reichard, R Ross

2009-03-01

352

Ephedrine, but Not Phenylephrine, Increases Bispectral Index Values During Combined General and Epidural Anesthesia  

Microsoft Academic Search

Ephedrine and phenylephrine are used to treat hypo- tension during combined general and epidural anesthe- sia, and they may change anesthetic depth. In the cur- rent study, we evaluated the effects of ephedrine versus phenylephrine on bispectral index (BIS) during com- bined general and epidural anesthesia. After injection of ropivacaine through the epidural catheter, general anesthesia was induced with propofol

Tadahiko Ishiyama; Takeshi Oguchi; Tetsuya Iijima; Takashi Matsukawa; Satoshi Kashimoto; Teruo Kumazawa

2003-01-01

353

Thoracic Epidural Over 1,000 lung transplants occur across the United States every  

E-print Network

was the main driving force behind "Thoracic Epidural Impact on Postoperative Pain Control in Lung Transplant epidural analgesia (TEA) on postoperative lung transplant patients in providing both adequate pain control of hospitalization · Bleeding/ Infection Risk ·Epidural anticoagulation placement and removal ·Most intensive

Connor, Ed

354

A randomized trial of epidural anesthesia to improve external cephalic version success  

Microsoft Academic Search

Objective: This study was designed to determine whether epidural anesthesia would improve external cephalic version success in a safe and effective manner. Study Design: All women >37 weeks' gestation with breech presentation scheduled for external cephalic version at the medical center from Dec. 1, 1993, to July 31, 1996, were randomized to receive an epidural or no epidural anesthesia. Under

Stephen J. Schorr; Steven E. Speights; Elaine L. Ross; James A. Bofill; Orion A. Rust; Patricia F. Norman; John C. Morrison

1997-01-01

355

The influence of epidural analgesia on cesarean delivery rates: A randomized, prospective clinical trial  

Microsoft Academic Search

Objective: The effects of epidural analgesia on the progress of labor are controversial. The objective of this study was to determine the effect of epidural analgesia on cesarean delivery rates in a population of patients randomly assigned to receive either epidural analgesia or intravenous opioids for intrapartum pain relief. Study Design: From January 1995 to May 1996, 318 spontaneously laboring,

Ann Clark; Darcy Carr; Gary Loyd; Vernon Cook; Joseph Spinnato

1998-01-01

356

Delayed posttraumatic unilateral occipital epidural hygroma in early childhood.  

PubMed

An extremely rare case of posttraumatic epidural hygroma in the left occipital supratentorial and infratentorial region is reported. A year and five months old child was admitted to the Clinic of Neurosurgery with sustained occipital head injury. She presented with drowsiness and vomiting due to intracranial hypertension. Initial computed tomography scan revealed left-sided fracture of the squamous part of the occipital bone without associated traumatic changes to the brain. A second spiral computed tomography scan was obtained two days later because of persisting symptoms of increased intracranial pressure. It demonstrated a newly formed left-sided epidural hygroma adjacent to the skull fracture in the left supratentorial and infratentorial occipital region. The case is discussed with emphasis on the mechanism of formation of epidural hygroma and an attempt has been made to outline the major predisposing factors leading to the development of this traumatic disease. Necessity for computed tomography follow-up is pointed out in order to diagnose delayed posttraumatic hygromas. The recommended surgical approach should include craniotomy centered at the site of the epidural hygroma and obligatory dural elevation by means of traction sutures to eliminate the posttraumatic epidural cavity. PMID:21644408

Kehayov, Ivo I; Batakliev, Ivan V; Kitov, Borislav D; Dichev, Alexander D

2011-01-01

357

Epidural temperature and possible intracerebral temperature gradients in man.  

PubMed

Although it has been known for a long time that pronounced hypothermia has a protective effect on the brain during ischemia, and that severe hyperthermia damages neuronal tissue, knowledge of human brain temperature is very limited. The recent findings by two independent research groups, that even small differences in brain temperature significantly influence the degree of neuronal damage following cerebral ischemia, became the incentive for measuring brain temperature in neurosurgical patients. The temperature of the lateral ventricle, epidural space, membrana tympani and rectum were measured with copper-constantan thermocouples. During the implantation of an intraventricular catheter for measuring intracranial pressure, a temperature gradient of 0.4-1.0 degrees C between the lateral ventricle and the epidural space was noted. Continuous measurements for 1-5 days showed that the rectal temperature usually adequately reflects the temperature of the epidural space, although the temperature of the membrana tympani followed changes in epidural temperature more closely. However, at times, and in one patient during most of the time, the temperature of the epidural space was up to 1 degree C above rectal temperature. The relevance of these findings for the care of neurosurgical patients is discussed in relationship to what is known about brain temperature from animal experiments. PMID:2334525

Mellergård, P; Nordström, C H

1990-01-01

358

History of spinal osteotomy.  

PubMed

Spinal deformity is one of the oldest known diseases with descriptions documented many of the earliest civilizations. Historical treatments have had little efficacy, especially in adults. However, in the modern era, there has been a rapid expansion of new technologies and surgical techniques aided by advances in supportive care that now allow the spinal surgeon to have powerful tools to correct spinal deformity. In this manuscript, we review the origins of spinal deformity surgery and the development of spinal instrumentation. The focus of the manuscript is to review the relationship of these developments to the implementation of spinal osteotomies for deformity correction. PMID:24390043

Meredith, Dennis S; Vaccaro, Alexander R

2014-07-01

359

Symptomatic air trapped in the spine after lumbar epidural corticosteroid injection. Case report.  

PubMed

The authors report the first case involving trapped epidural air in the spine that mimicked a mass lesion and caused neurological symptoms after epidural corticosteroid injection in the lumbar region. New neurological symptoms developed immediately after injection, and magnetic resonance (MR) imaging demonstrated trapped air displacing the dural sac. After the patient underwent conservative treatment, the new symptoms resolved, and follow-up MR imaging and computed tomography demonstrated resorption of the epidural air in the lumbar region. To limit this problem, the clinician should decrease the amount of air injected in the epidural space or substitute nitrous oxide for air when injecting steroid agents epidurally. PMID:17048774

Ammirati, Mario; Perino, Florence

2006-10-01

360

Surgical treatment of supra- and infratentorial epidural hematoma.  

PubMed

Supra- and infratentorial acute epidural hematoma (SIEDH) is a common type of posterior fossa epidural hematoma (PFEDH), representing 11- 64% of all PFEDHs. Although SIEDH is associated with typical characteristics, it might be difficult to diagnose when presenting as infratentorial acute epidural hematoma, which is clinically silent and has nonspecific symptoms. However, this type of hematoma can often be rapidly deteriorating, causing a sharp rise in intracranial pressure that leads to a life-threatening foramen magnum herniation. Early diagnosis and management of SIEDH are imperative. Traditional surgical management has always required relatively large craniotomies, larger than the hematoma itself, to expose its edge, and then tack up the dura matter). It usually opens the window and emphasizes retention of the bone bridge outside the transverse sinus. This method can effectively eliminate the hematoma, but it is associated with larger postoperative wound, longer operation time, larger skull defect, and more complications. Hence, exploration into a better surgical method is direly needed. PMID:23756966

Xiaoyu, Wang; Guoping, Li

2013-01-01

361

Differentiation of idiopathic spinal cord herniation from CSF-isointense intraspinal extramedullary lesions displacing the cord.  

PubMed

Focal spinal cord displacement can be caused by idiopathic spinal cord herniation (ISCH), in which the cord protrudes through a dural defect into the epidural space, causing cord displacement and tethering. ISCH is uncommon and often is misdiagnosed initially, which results in delayed management. ISCH can be mimicked by space-occupying cerebrospinal fluid (CSF)-isointense intraspinal extramedullary lesions, such as epidermoid cysts or teratomas, intradural arachnoid cysts, epidural hematomas or abscesses, cystic nerve sheath tumors, synovial or Tarlov cysts, meningoceles, and pseudomeningoceles. Initial computed tomography (CT) and unenhanced magnetic resonance (MR) imaging studies may depict focal cord displacement and a widened CSF space but often are not sufficient to identify the underlying cause. High-resolution thin-section MR imaging can delineate the exact location of the dural defect and the protrusion of the herniated cord through this defect into the epidural space. At imaging, unimpeded CSF pulsation artifacts seen within a widened CSF space exclude a space-occupying lesion. A filling defect seen at conventional or CT myelography can help confirm a CSF-isointense space-occupying lesion; intravenous contrast agent administration can help exclude a rim-enhancing cystic extramedullary lesion. The clinical presentation usually is nonspecific, but symptom acuity, fever, and trauma can guide the imaging evaluation and help narrow the differential diagnosis. A multimodality imaging approach is essential to differentiate ISCH from space-occupying CSF-isointense intraspinal extramedullary lesions. PMID:24617681

Haber, Marc D; Nguyen, Dustin D; Li, Shan

2014-01-01

362

Prognostic Parameters and Spinal Metastases: A Research Study  

PubMed Central

Object To identify pre-operative prognostic parameters for survival in patients with spinal epidural neoplastic metastasis when the primary tumour is unknown. Methods This study was a retrospective chart review of patients who underwent surgery for spinal epidural neoplastic metastases between February 1997 and January 2011. The inclusion criteria were as follows: known post-operative survival period, a Karnofsky Performance Score equal to or greater than 30 points and a post-operative neoplastic metastasis histological type. The Kaplan-Meier method was used to estimate post-operative survival, and the Log-Rank test was used for statistical inference. Results A total of 52 patients who underwent 52 surgical procedures were identified. The mean age at the time of spinal surgery was 53.92 years (std. deviation, 19.09). The median survival after surgery was 70 days (95% CI 49.97–90.02), and post-operative mortality occurred within 6 months in 38 (73.07%) patients. Lung cancer, prostate cancer, myeloma and lymphoma, the 4 most common primary tumour types, affected 32 (61.53%) patients. The three identified prognostic parameters were the following: pre-operative walking incapacity (American Spinal Injury Association, A and B), present in 86.53% of the patients (p-value?=?0.107); special care dependency (Karnofsky Performance Score, 10–40 points), present in 90.38% of the patients (p-value?=?0.322); and vertebral epidural neoplastic metastases that were in contact with the thecal sac (Weinstein-Boriani-Biagini, sector D), present in 94.23% of the patients (p-value?=?0.643). When the three secondary prognostic parameters were combined, the mean post-operative survival was 45 days; when at least one was present, the survival was 82 days (p-value?=?0.175). Conclusions Walking incapacity, special care dependency and contact between the neoplastic metastases and the thecal sac can help determine the ultimate survival of this patient population and, potentially, which patients would benefit from surgery versus palliation alone. A 2- to 3-month post-operative survival period justified surgical treatment. PMID:25310095

Daniel, Jefferson W.; Veiga, Jose C. E.

2014-01-01

363

Thoracic epidural anesthesia improves functional recovery from myocardial stunning in conscious dogs.  

PubMed

The effects of thoracic epidural anesthesia (TEA) on the contractile performance of ischemic and postischemic myocardium have not been well investigated. The purpose of this investigation was to examine the effects of TEA on severity and duration of myocardial stunning in an experimental model for sublethal acute myocardial ischemia. Seven dogs were chronically instrumented for measurement of heart rate (HR), left atrial (LAP), aortic and left ventricular pressure (LVP), LV dP/dtmax' and myocardial wall-thickening fraction (WTF). An occluder around the left anterior descending artery (LAD) allowed induction of reversible LAD ischemia. TEA was performed with lidocaine 4 mg/kg through a chronically implanted epidural catheter at the second thoracic level. Regional myocardial blood flow was determined with colored microspheres. Two experiments were performed in a cross-over design on separate days: Experiment 1, induction of 10 min of LAD ischemia without TEA; and Experiment 2, induction of 10 min of LAD ischemia with TEA. WTF was measured at baseline (BL) and predetermined time points until complete recovery from ischemic dysfunction occurred. LAD ischemia caused a significant decrease of LAD-WTF with (-28% +/- 5.1% versus BL) and without TEA (-15.5% +/- 5.3% versus BL). After 3 h of reperfusion, WTF as percent of BL values was significantly higher with TEA (P < 0.001). BL values of WTF were reached after 24 h with TEA and after more than 48 h without TEA (P < 0.05). There were no significant differences for mean arterial pressure (MAP), heart rate (HR), LVP, LAP, and LVdP/dtmax between the groups during ischemia and reperfusion. In nonischemic myocardium TEA caused an increase of subendocardial blood flow. During ischemia neither the subendocardial/subepicardial nor the occluded/ normal zone blood flow was affected by TEA. TEA attenuates myocardial stunning in conscious dogs. This finding is consistent with data regarding a reduction of infarct size due to TEA. PMID:8895266

Rolf, N; Van de Velde, M; Wouters, P F; Möllhoff, T; Weber, T P; Van Aken, H K

1996-11-01

364

Efficacy of epidural dexamethasone versus fentanyl on postoperative analgesia  

Microsoft Academic Search

Purpose  Dexamethasone has analgesic, anti-inflammatory, and antiemetic effects. This prospective, randomized, double-blind, controlled\\u000a study was designed to evaluate the efficacy of adding dexamethasone versus fentanyl to epidural bupivacaine on postoperative\\u000a analgesia.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Ninety patients ASA I–II scheduled for lower abdominal surgeries were randomly allocated into three groups to receive a total\\u000a of 10 mL epidural plain bupivacaine 0.25% in the control group (group

Hanan F. Khafagy; Ahmed I. Refaat; Hossam H. El-sabae; Maha A. Youssif

2010-01-01

365

[Contribution of spiral CT scan and MRI in spinal tuberculosis].  

PubMed

Spinal tuberculosis is the most frequent skeletal involvement in tuberculosis. The purpose of this study was to demonstrate the importance of the MRI and the helicoidal CT scan in the diagnosis of spinal tuberculosis. A retrospective study was conducted in 23 patients with spinal tuberculosis. The methods of investigation were helicoidal CT scan in 15 patients and MRI in the other eight patients. In the all cases with helicoidal CT scan, the features of the spinal tuberculosis were seen as an anterior vertebral body destruction with a paraspinal or epidural extension in 12 cases and a sequestrum formation in 5 cases. The analysis with helicoidal CT scan showed a gibbous deformity in 5 cases, a disk space narrowing in 14 cases and evaluated the extension very well. The MR imaging features showed one case in an early stage without features on the plain radiographs, and detected 3 cases of intramedullary lesions. A disruption of the longitudinal posterior vertebral ligament was found in one case and skip lesions at the granulomatous stage in 2 cases. MRI is superior to CT scan even helicoidal CT at the early lesion stage, skip lesions and the ligamentous or medullary lesions. For other lesions (bone, disk, extension), the MRI and CT scan are the same with an advantage for CT scan in osseous lesions. PMID:10363440

Zamiati, W; Jiddane, M; el Hassani, M R; Chakir, N; Boukhrissi, N

1999-03-01

366

Model of Induced Leakage of Polymethylmethacrilate Inside Epidural Space and Prevertebral Muscles During Vertebroplasty in Pigs: Clinical, Macroscopical, and Histological Study  

PubMed Central

Study Design Experimental study in animals. Purpose Study the clinical behavior of animals after an induced leakage of cement during vertebroplasty in pigs. Study the distribution of polymethylmetacrilate inside the epidural space and prevertebral muscle. Study the histological findings of the spinal cord and muscles, which contact with cement. Overview of Literature Although vertebroplasty has a low rate of complication, leakage of cement is highly frequent. There is paucity, in how cement is distributed inside the spinal canal and what occurs when soft tissue comes into contact with polymethylmetacrilate. Methods We performed vertebroplasty on six pigs. We performed a leakage of cement into the epidural space and into prevertebral muscles. Two weeks later we performed an anatomic evaluation regarding the spreading of polymethylmetacrilate and a histological analysis of soft tissues that came into contact with it. Results No clinical alterations were observed. We observed a laminar distribution of the cement surrounding dura mater, and creating a fusiform cavity inside muscles. Spinal cord was normal in all the animals. In dura mater, we observed: synovialmetaplasia, inflammatory reaction, crystal deposits, and giant-cell-reaction. In muscles, we observed: inflammatory reaction, crystal deposits, giant-cell-reaction, muscular atrophy, fibrosis, and synovial metaplasia. Conclusions The spinal cord was normal; it is likely that dura mater and cerebrospinal fluid are responsible to isolate neural structures from cement. Dura mater and muscle showed similar histological changes than other publications. Synovial metaplasia was observed in dura mater and muscles that came into contact with cement. The pulsatile rubbing between the tissue and cement could be responsible of this phenomenon. PMID:24066209

Alfonso Olmos, Matias; Villas Tome, Carlos; Angulo, Marcela Gallegos

2013-01-01

367

Computed tomographic evaluation of cervical vertebral canal and spinal cord morphometry in normal dogs  

PubMed Central

The height, width, and cross-sectional area of the vertebral canal and spinal cord along with the area ratio of spinal cord to vertebral canal in the cervical vertebra were evaluated in images obtained using computed tomography (CT). Measurements were taken at the cranial, middle, and caudal point of each cervical vertebra in eight clinically normal small breed dogs (two shih tzu, two miniature schnauzers, and four mixed breed), 10 beagles, and four German shepherds. CT myelography facilitated the delineation of the epidural space, subarachnoid space, and spinal cord except at the caudal portion of the 7th cervical vertebra. The spinal cord had a tendency to have a clear ventral border in the middle portion of the vertebral canal and lateral borders near both end plates. The height, width, and area of the vertebral canal and spinal cord in the cervical vertebra were increased as the size of dog increased. However, the ratio of the spinal cord area to vertebral canal area in the small dogs was higher than that of the larger dogs. Results of the present study could provide basic and quantitative information for CT evaluation of pathologic lesions in the cervical vertebra and spinal cord. PMID:24136210

Seo, Eunjeong; Choi, Jihye; Choi, Mincheol

2014-01-01

368

Paddle versus cylindrical leads for percutaneous implantation in spinal cord stimulation for failed back surgery syndrome: a single-center trial.  

PubMed

Objective?Spinal cord stimulation is an interventional treatment for chronic pain syndromes such as failed back surgery syndrome (FBSS), and it utilizes either cylindrical or paddle electrodes placed percutaneously into the epidural space. This prospective nonrandomized single-center study investigated the specific advantages and disadvantages of percutaneously implanted paddle and cylindrical leads in patients with FBSS. Methods?Over a 2-year period, 100 patients with FBSS (43 men; 57 women; mean age: 56.3 years) were included. Paddle leads were placed percutaneously under local anesthesia in 50 patients; conventional percutaneous cylindrical lead implantation was performed in the other 50 patients (one lead permitted per patient). Follow-up included the Visual Analog Scale (VAS) assessment of pain and administration of the Oswestry Disability Questionnaire. Results?Similar significant pain reduction (69%) was demonstrated in both groups (VAS pre/post: paddle: 8.8/3.7; cylindrical: 8.5/3.8). Using the same perioperative protocol for each group, we observed higher dislocation and infection rates for the cylindrical group (14% and 10%, respectively) than for the paddle group (6% and 2%, respectively). Conclusion?Minimally invasive percutaneous paddle and cylindrical leads are safe and effective, have low complication rates, and perform well in patients with FBSS. Both devices can be implanted using a local anesthetic, so that intraoperative and reproducible testing stimulation can be performed for sufficient paresthesia overlap prior to permanent device fixation. PMID:24793061

Kinfe, Thomas M; Quack, Florian; Wille, Christian; Schu, Stefan; Vesper, Jan

2014-11-01

369

Spinal cord, hypothalamic, and air temperature: interaction with arousal states in the marmot.  

PubMed

Yellow-bellied marmots, Marmota flaviventris, prepared with U-shaped thermodes in the epidural space of the thoracic vertebral canal, a thermode in the preoptic hypothalamus, and cortical surface and hippocampal electrodes, were used to investigate the interaction of arousal states with temperature regulation. It was found that arousal state of the animal influences the thermoregulatory responses initiated in either the spinal cord or hypothalamus. Further, changes in ambient temperature affected both the gain and the threshold of these responses. The interaction of the hypothalamus and spinal cord was not an additive function, however the threshold for shivering of each could be altered by temperature manipulation of the other. Future studies in modeling of temperature regulation should consider the contributions of temperature receptors of the spinal cord and the arousal state of the animal during the stimulation period. PMID:434182

Miller, V M; South, F E

1979-01-01

370

Dynamic lumbar spinal stenosis : the usefulness of axial loaded MRI in preoperative evaluation.  

PubMed

Two cases of dynamic lumbar spinal stenosis were identified by the authors using axial loaded magnetic resonance image (MRI). In both cases, the patients presented with neurogenic claudication but MRI in decumbency showed no definite pathologic condition associated with their symptoms. In contrast, axial loaded MRI demonstrated constrictive spinal stenosis and a significantly decreased dural sac caused by epidural fat buckling and thickening of the ligamentum flavum in both cases. In the second case, a more prominent disc protrusion was also demonstrated compared with decumbent MRI. After decompressive surgery, both patients had satisfactory outcomes. Axial loaded MRI can therefore give decisive information in dynamic spinal disorders by allowing simulation of an upright position. PMID:19844630

Choi, Kyung-Chul; Kim, Jin-Sung; Jung, Byungjoo; Lee, Sang-Ho

2009-09-01

371

Advances in spinal instrumentation  

Microsoft Academic Search

New approaches to the spinal column and the use of spinal fixation have vastly improved our ability to treat spinal pathology. Over the last several decades there has been a rapid expansion in the availability of implants for use in the spine. The empetus behind these advancements is a combination of the ingenuity of surgeons in the drive for better

Warren D. Yu

2003-01-01

372

Advances in Imaging of Vertebral and Spinal Cord Injury  

PubMed Central

Background/Objectives: Imaging technology is an important part of the diagnosis and management of spinal trauma. Indications and findings in post-traumatic imaging of the vertebral column and spinal cord are reviewed. Methods: An extensive literature review was performed on the imaging of vertebral and spinal cord injury. Relevant images from a Level I trauma center were included as examples. Results: Imaging plays an important role in the evaluation of acute and chronic spinal injury. Spinal cord and soft-tissue injuries are best evaluated by magnetic resonance imaging (MRI), whereas spinal fractures are better characterized by computed tomography (CT). Vascular injuries can be evaluated using CT or MR angiography. Conclusions: Imaging using CT and MRI is essential in the management of spinal cord injuries, both in the acute and in the chronic settings. MRI shows the status of ligamentous integrity and visualizes internal derangement of the spinal cord. Vascular compromise can be diagnosed by MR and CT angiography. Plain radiography now has a more limited, adjunctive role, and the need for higher risk myelography has been minimized. PMID:20486529

Goldberg, Andrew L; Kershah, Sharif M

2010-01-01

373

Do we need cephalic spread of spinal anaesthesia for caesarean section? A different approach to CSE-EVE for reducing hypotension.  

PubMed

Spinal anaesthesia is the most preferred anaesthetic technique for elective as well as for unplanned Caesarean sections. Spinal-induced hypotension remains the most important side effect with a reported incidence between 20% and 100%. It can cause -maternal discomfort (nausea and vomiting) and impaired utero-placental perfusion. The present study was designed to examine the influence of epidural volume effect on the spread and duration of low-dose hyperbaric levobupivacaine. The aim of this study was to evaluate the influence of epidural restriction (injection of saline) on the distribution of anaesthesia as well as the incidence of hypotension during the spinal anaesthesia.After the approval by the ethics committee, 60 full-term parturient women (ASA I or II) with uncomplicated pregnancies were prospectively randomized into 2 groups: the SA group (single shot spinal anaesthesia) included 37 patients and the CSE-EVR group (combined spinal-epidural anaesthesia) included 39 patients in whom we induced the restriction of the spinal space by epidural volume compression. The blocks were performed at the L2/3 or L3/4 level in a sitting position, in the CSE-EVR group using the needle-through-needle technique. The initial dose for CSE-EVR was exactly half of the SA dose (0.5 mg per 10 cm height of hyperbaric levobupivacaine and 20 microg fentanyl). After spinal injection, an epidural catheter was located in the CSE-EVR and a volume of 20 mL saline solution injected. After injection, the women were turned supine with a left uterine displacement. Surgery was allowed when a sensory block at or above the T8 dermatome was established. We evaluated the height of the block by the pinprick method and the motor block by the Bromage scale, 10 min after spinal injection, during the operation time and at the end of surgery. Haemodynamic monitoring (NIBP, HR) was assessed every 2 min until the childbirth, then every 5 min during operative time. Anaesthetic efficacy was evaluated for breakthrough pain by visual analogue pain score (VAPS), Apgar score at birth, umbilical artery pH, and epinephrine consumption.The level of anaesthesia 10 min after the induction was significantly higher in the spinal group (SA) than in the CSE-EVR T5 (T4-T7) vs. T7 (T6-T8) group.The SA group experienced complete motor block during the time of anaesthesia, while the CSE-EVR group demonstrated significantly faster motor recovery. The incidence of hypotension and ephedrine supplementation was significantly lower in the CSE-EVR group (19 vs. 35 patients) than in the SA group (p<0.05).The neonatal outcome and umbilical artery pH were higher in the CSE-EVR group. Both groups were comparable in demographic data, VAS scores, preloading and infusion volume, atropine or ephedrine use, and adverse effects such as nausea or skin pruritus.We demonstrated a possible restriction of the spread of spinal anaesthesia by using epidural volume restriction with 20 mL saline as part of a combined spinal epidural technique. The study shows that CSE with EVR using only 50% of the levobupivacaine dose provided adequate anaesthesia for elective Caesarean delivery, as well as better maternal haemodynamic stability. PMID:23982939

Fabris, L K; Belci, D; Zdrav?evi?, K Š; Hrgovi?, Z; Sacic, L

2013-08-01

374

Oral Clonidine Premedication Enhances Postoperative Analgesia by Epidural Morphine  

Microsoft Academic Search

This study was designed to evaluate the effects of oral clonidine premedication on postoperative analgesia by epidural morphine in a prospective, randomized, double- blinded design. Sixty consenting patients, scheduled for total abdominal hysterectomy, were randomly assigned to one of three groups (n 5 20 each); the clonidine- morphine group received oral clonidine 5 mg\\/kg 90 min before arriving in the

Toru Goyagi; Makoto Tanaka; Toshiaki Nishikawa

1999-01-01

375

Effects of epidural anaesthesia on intestinal oxygenation in pigs  

Microsoft Academic Search

Background. Perioperative intestinal hypoperfusion is a major contributing factor leading to organ dysfunction. It can be caused by stress as a result of surgical manipulation or hypoxia. Additionally, anaesthesia can affect intestinal oxygenation. This animal study was designed to assess the effects of reduced regional sympathetic nervous activity induced by thoracic epidural anaesthesia on intestinal oxygenation. Methods. After ethical approval,

D. A. Vagts; T. Iber; B. Szabo; J. Haberstroh; K. Reising; M. Puccini; K. Geiger; G. F. E. Noldge-Schomburg

2003-01-01

376

[Trapped epidural catheter: reconstruction of computed tomography images].  

PubMed

A trapped epidural catheter without a knot is a rare complication. During placement of an epidural catheter for analgesia during labor, resistance made it impossible to position the catheter within the epidural space. A second catheter was inserted to provide the required analgesia. When the second catheter was removed, computed tomography (CT) revealed that the tip of the first catheter was close to the the right facet joint space. A second attempt to extract the catheter failed. In light of this situation, the patient was seated with the spine slightly bent to one side, a guidewire was inserted through the catheter lumen, and the catheter and guidewire were gently pulled; the catheter was extracted without causing the tip to break up. Three-dimensional CT reconstruction allowed the catheter tip and characteristics of the joint surfaces to be observed. We discuss protcols and alternative strategies that can be followed when an epidural catheter is difficult to remove, including the most appropriate images to use for guidance. PMID:19177867

Román, J A; Reina, M A; López, A; De Luis, E; Fernández, M S; Escobar, J M

2008-12-01

377

Solitary Epidural Lipoma with Ipsilateral Facet Arthritis Causing Lumbar Radiculopathy  

PubMed Central

A 55-year-old obese man (body mass index, 31.6 kg/m2) presented radiating pain and motor weakness in the left leg. Magnetic resonance imaging showed an epidural mass posterior to the L5 vertebral body, which was isosignal to subcutaneous fat and it asymmetrically compressed the left side of the cauda equina and the exiting left L5 nerve root on the axial T1 weighted images. Severe arthritis of the left facet joint and edema of the bone marrow regarding the left pedicle were also found. As far as we know, there have been no reports concerning a solitary epidural lipoma combined with ipsilateral facet arthorsis causing lumbar radiculopathy. Solitary epidural lipoma with ipsilateral facet arthritis causing lumbar radiculopathy was removed after the failure of conservative treatment. After decompression, the neurologic deficit was relieved. At a 2 year follow-up, motor weakness had completely recovered and the patient was satisfied with the result. We recommend that a solitary epidural lipoma causing neurologic deficit should be excised at the time of diagnosis. PMID:22977701

Kim, Hong Kyun; Koh, Sung Hye

2012-01-01

378

Use of thoracic epidural anaesthesia for coronary artery bypass grafting  

Microsoft Academic Search

Cardiac sympathetic blockade in experimental settings show beneficial effects on blood flow redistribution after myocardial infarction and functional recovery following myocardial ischaemia. This aim can be achieved by TEA without jeopardizing systemic haemodynamics.In patients, thoracic epidural anaesthesia (TEA) demonstrates potential benefit for the perioperative management for coronary artery bypass grafting (CABG). Perioperative sympathetic blockade of the cardiac nerves and an

Heinz Michael Loick; Thomas Möllhoff; Norbert Rolf; Hugo Van Aken

1999-01-01

379

Ischemic pain mandating unconventional position for epidural placement  

PubMed Central

Positioning has always been a special and important concern for any regional anesthetic technique. The standard positions recommended for epidural anesthesia include lateral decubitus, sitting and prone. We report a special situation where we employed the standing position for placing epidural catheter. A 40-year-old man presented with severe ischemic pain of right lower limb due to near total thrombosis of right common iliac artery. He was scheduled for peripheral angiogram and referred to us for pain management as his pain was not permitting him to sit or lie down. Epidural analgesia was planned for managing the pain in the catheterization laboratory and for any other possible management intervention later. As the patient was not tolerating any position other than standing because of severe pain, we placed the lumbar epidural catheter in the standing position and quickly activated the analgesia in the supine position. Patient had good pain relief immediately and an infusion was commenced. Safety and comfort are the major issues to be addressed, while positioning for any procedure. Standing position was chosen for this particular case as it was the only comfortable position for the patient and the safety was not compromised.

Yallapragada, Srivishnu Vardhan; Vemuri, Nagendra Nath; Saheb, Shaik Mastan

2014-01-01

380

[Epidural anesthesia in obstetrics: an accidentally placed intrathecal catheter--remove it or use it?].  

PubMed

Epidural anesthesia is an established method in obstetrics. Despite constant practical experiences and established techniques, accidental penetrations of the dura and therefore malpositioning of the catheter in the intrathecal space are still present. This can result in post spinal headaches, a higher dispersion of the local anesthetic followed by life-threatening respiratory insufficiency and loss of overall conscious delivery. In consideration of these risks removal of the misplaced catheter and proper reinsertion in a higher position is standard. Thus significant emotional stress and re-exposure to the risks of the procedure for the parturient is accepted. We report of a 30-year-old primipara with secondary realized intrathecal placement. In due consideration of the current state of labor, we decided to leave the catheter in place and initiate a pain therapy applying bupivacain via this catheter immediately after the motor block had ceased. Within the first stage of labor sufficient pain relief was established. There was no change in tonicity. It resulted in a normal unproblematic vaginal birth. After an initial irritation due to the high dispersion the patient described a noticeable alleviation of pain during the adequate controlled labor. PMID:21207326

Aust, H; Plöger, B; Frietsch, T

2010-12-01

381

Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch.  

PubMed

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disease. It is characterised by an orthostatic headache in the absence of a past history of a trauma or a dural puncture. SIH is caused by a spontaneous spinal cerebrospinal fluid (CSF) leakage demonstrated by neuroradiological studies in most of the patients. Conservative treatment usually includes bed rest, hydration and administration of caffeine or steroids. However, when the patient is refractory to the conservative treatment, an epidural blood patch (EBP) is performed. We report a 34-year-old woman with SIH and no neuroradiologically demonstrable clear point of CSF leakage, who was treated with a double EBP at two different levels (lumbar and thoracic) in the same procedure. The patient was successfully managed, and she was still asymptomatic at the 18 months follow-up. After review of literature, we observed that execution of a double EBP at the same time is not a common procedure for treatment of SIH. We consider that simultaneous use of two EBP could be useful as a novel treatment in those cases of SIH without demonstration of CSF leakage. PMID:22834896

Beleña, J M; Nuñez, M; Yuste, J; Plaza-Nieto, J F; Jiménez-Jiménez, F J; Serrano, S

2012-11-01

382

Cervical transforaminal epidural steroid injections: a proposal for optimizing the preprocedural evaluation with available imaging.  

PubMed

Cervical transforaminal epidural steroid injection (CTFESI) has been used to treat cervical radicular pain; however, rare but serious complications such as cerebellar or spinal cord infarction have been reported. The most probable causes of the serious complications include vertebral artery trauma, spasm, or accidental arterial injection of particulate steroid. Several recommendations have been made to improve the safety of CTFESI; however, evaluation and risk assessment of the patient's anatomy by the interventionist have not been sufficiently emphasized. Significant correlations between foraminal narrowing and proximity of the vertebral artery to the target of needle have been reported. This correlation is particularly problematic for interventionists because patients considered or referred for CTFESI are more likely to have foraminal narrowing at the level concerned. Without knowing the patient's anatomy, a common practice of rotating the C-arm obliquely to obtain a full view of the target foramen may carry significant risk of needle's encounter with the vertebral artery. Risk assessment through careful preprocedural review of the patient's magnetic resonance imaging by the interventionist is a worthwhile practice to optimize safety. Special attention should be paid to the vital structures such as the vertebral artery, neural foramen, and carotid artery. A preprocedural roadmap for the safest predicted needle trajectory can be created by simulation using the patient's available magnetic resonance imaging scans. These considerations may guide and help the interventionist to minimize the risk of inadvertent needle placement involving vital structures such as the vertebral artery or carotid artery. PMID:25304477

Nishio, Isuta

2014-01-01

383

Rotational thromboelastometry and multiple electrode platelet aggregometry in four patients with abnormal routine coagulation studies before removal of epidural catheters after major surgery: a case series and research study  

PubMed Central

Introduction Routine coagulation tests have a low predictability for perioperative bleeding complications, and spinal hematoma after removal of epidural catheters is very infrequent. Thromboelastometry and point-of-care platelet aggregometry may improve hemostatic monitoring but have not been studied in the context of safety around epidural removal. Methods Twenty patients who received an epidural catheter for major thoracoabdominal and abdominal surgery were included prospectively. In addition to routine coagulation tests, rotational thromboelastometry and multiple electrode platelet aggregometry were carried out. Results A coagulation deficit was suggested by routine coagulation tests on the intended day of epidural catheter removal in four out of 20 patients. Prothrombin time-international normalized ratio was elevated to 1.5 in one patient (normal range: 0.9 to 1.2) while rotational thromboelastometry and multiple electrode platelet aggregometry parameters were within normal limits. Activated partial thromboplastin time was elevated to 47 to 50 seconds in the remaining three patients (normal range 28 to 45 seconds). Rotational thromboelastometry showed that one of the patients’ results was due to heparin effect: the clotting time with the HEPTEM® activator was 154 seconds as compared to 261 seconds with INTEM. The three remaining patients with prolonged routine coagulation test results had all received over 1L of hydroxyethyl starch (Venofundin®) and thrombosis prophylaxis with low-molecular-weight heparin (enoxaparin). Rotational thromboelastometry and multiple electrode platelet aggregometrygave normal or hypercoagulative signals in most patients. Conclusions This case series is new in that it examines rotational thromboelastometry and multiple electrode platelet aggregometry postoperatively in the context of epidural analgesia and shows that they may be clinically useful. These methods should be validated before they can be used for standard patient care. PMID:24377397

2013-01-01

384

Effectiveness of rehabilitation for spinal pain.  

PubMed

The evidence for effectiveness of different approaches is often diluted by the inclusion of heterogeneous groups and, in this case, lack of agreement over what constitutes 'acute' and 'chronic' back pain is a clear confounding factor. Although there are undoubtedly common issues in the approach to these problems, there are also clear differences. Closer definition of the problem and the development of specific and targeted outcome measures is required. In common with other areas of musculoskeletal rehabilitation, the evidence strongly supports exercise (except possibly in the rare case of true radicular back pain) and a cognitive behavioural approach to pain management. The variability of evidence in support of manipulation suggests that patient selection is important, but as yet those selection criteria are not clear. As is often the case, medical interventions are rarely submitted to evaluation in terms of functional outcome so, for procedures such as epidurals and facet joint injections, the jury is still out at the current time. PMID:10685624

Haigh, R; Clarke, A K

1999-01-01

385

Evaluation of Epidural Morphine for Postoperative Analgesia in Ferrets (Mustela putorius furo)  

Microsoft Academic Search

We evaluated the analgesic efficacy of epidural morphine for relieving postoperative pain in domestic ferrets by evaluating behavior and fecal cortisol concentrations. The 12 laboratory-reared, intact, female, domestic ferrets were anesthetized then underwent ovariohysterectomy and bilateral anal sacculectomy. Using a double-blind procedure, we provided epidural mor- phine (0.1 mg\\/kg) to six ferrets and epidural saline (0.1 mL\\/ferret) to the remaining

KURT K. SLADKY; WILLIAM A. HORNE; KAREN L. GOODROWE; MICHAEL K. STOSKOPF; MICHAEL R. LOOMIS; CRAIG A. HARMS

2000-01-01

386

[Epidural-sacral anesthesia in radical surgical treatment of acute paraproctitis].  

PubMed

The epidural-sacral anesthesia was used in 242 patients operated upon for different forms of acute paraproctitis. No complications resulting from the anesthesia were noted. The incidence of failures in performing epidural-sacral anesthesia was 3.6%. The epidural-sacral anesthesia has advantages over other kinds of anesthesia, is safe and not technically difficult and practically has no contraindications. PMID:3250074

Georgadze, A K; Vasiukov, S M; Kuznetsov, E V

1988-12-01

387

Current Evidence for Spinal Opioid Selection in Postoperative Pain  

PubMed Central

Background Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one. Methods The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic. Results Recent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil. Conclusions Results obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security. PMID:25031805

2014-01-01

388

Accuracy of pulse oximeter perfusion index in thoracic epidural anesthesia under basal general anesthesia  

PubMed Central

Objective: To observe the change of PVI after thoracic epidural block on the basis of general anesthesia. Methods: In 26 patients undergoing elective upper abdominal operations, changes of SVI, PVI, SVV, PPV and CVP were monitored immediately before and 10 minutes after T8-9 thoracic epidural anesthesia on the basis of general anesthesia. The definition was that patients with ?SVI greater than 10% belonged to response group to epidural block. Results: Before epidural block, the PVI, SVV and PPV baseline values in patients of response group were significantly higher than those in patients of non-response group. PVI, SVV and PPV after epidural block were significantly higher than immediately before epidural block (P < 0.001). PVI, SVV and PPV baseline values immediately before epidural block were positively correlated with ?SVI; the correlation coefficients were 0.70, 0.71 and 0.63, respectively, P ? 0.001. The optimal critical values for PVI, SVV and PPV to predict response to T8-9 gap epidural block under general anesthesia were 16% (sensitivity 80%, specificity 92%), 13% (sensitivity 90%, specificity 62%) and 12% (sensitivity 90%, specificity 77%), respectively. Conclusion: PVI can be used as a noninvasive indictor to monitor volume change after thoracic epidural block on the basis of general anesthesia. PMID:25126171

Xu, Zifeng; Zhang, Jianhai; Xia, Yunfei; Deng, Xiaoming

2014-01-01

389

Evaluation of epidural morphine and incisional bupivacaine for analgesia following hemilaminectomy in the dog.  

E-print Network

??A blind, placebo â controlled clinical trial was performed to evaluate the postoperative analgesic effect of topically administered, intraoperative, epidural morphine (Duramorphâ¢) and intramuscular infiltration… (more)

Horowitz, Farrah B

2009-01-01

390

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation  

PubMed Central

Pyogenic vertebral osteomyelitis responds well to conservative treatment at early stage, but more complicated and advanced conditions, including mechanical spinal instability, epidural abscess formation, neurologic deficits, and refractoriness to antibiotic therapy, usually require surgical intervention. The subject of using metallic implants in the setting of infection remains controversial, although more and more surgeons acknowledge that instrumentation can help the body to combat the infection rather than to interfere with it. The combination of radical debridement and instrumentation has lots of merits such as, restoration and maintenance of the sagittal alignment of the spine, stabilization of the spinal column and reduction of bed rest period. This issue must be viewed in the context of the overall and detailed health conditions of the subjecting patient. We think the culprit for the recurrence of infection is not the implants itself, but is the compromised general health condition of the patients. In this review, we focus on surgical treatment of pyogenic vertebral osteomyelitis with special attention to the role of spinal instrumentation in the presence of pyogenic infection. PMID:17106664

Chen, Wei-Hua; Jiang, Lei-Sheng

2006-01-01

391

MRI and MRA of spinal cord arteriovenous shunts.  

PubMed

The purpose of this review is to describe the diagnostic criteria for spinal cord arteriovenous shunts (SCAVSs) when using magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), and to discuss the extent to which the different MRI and MRA sequences and technical parameters provide the information that is required to diagnose these lesions properly. SCAVSs are divided into four groups according to location (paraspinal, epidural, dural, or intradural) and type (fistula or nidus); each type of lesion is described. SCAVSs are responsible for neurological symptoms due to spinal cord or nerve root involvement. MRI is usually the first examination performed when a spinal cord lesion is suspected. Recognition of the image characteristics of vascular lesions is mandatory if useful sequences are to be performed-especially MRA sequences. Because the treatment of SCAVSs relies mainly on endovascular therapies, MRI and MRA help with the planning of the angiographic procedure. We explain the choice of MRA sequences and parameters, the advantages and pitfalls to be aware of in order to obtain the best visualization, and the analysis of each lesion.J. Magn. Reson. Imaging 2014;40:1253-1266. © 2014 Wiley Periodicals, Inc. PMID:24591106

Condette-Auliac, Stéphanie; Boulin, Anne; Roccatagliata, Luca; Coskun, Oguzhan; Guieu, Stéphanie; Guedin, Pierre; Rodesch, Georges

2014-12-01

392

Intramedullary spinal cord tumors  

Microsoft Academic Search

Opinion statement  The three most common types of intramedullary spinal cord tumors are low-grade astrocytomas, ependymomas, and high-grade astrocytomas.\\u000a Surgical extirpation is the necessary and sufficient primary treatment for most intramedullary spinal cord tumors. Radiation\\u000a therapy may also have a role in the management of persistent, recurrent, or progressive low-grade astrocytomas and ependymomas.\\u000a The current treatment of spinal cord high-grade astrocytomas,

Daniel C. Bowers; Bradley E. Weprin

2003-01-01

393

The Collateral Network Concept: A Reassessment of the Anatomy of Spinal Cord Perfusion  

PubMed Central

OBJECTIVE Prevention of paraplegia following repair of thoracoabdominal aortic aneurysms (TAAA) requires understanding the anatomy and physiology of the blood supply to the spinal cord. Recent laboratory studies and clinical observations suggest that a robust collateral network must exist to explain preservation of spinal cord perfusion when segmental vessels are interrupted. An anatomical study was undertaken. METHODS Twelve juvenile Yorkshire pigs underwent a