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Sample records for hypertrophica presenting spinal

  1. Spinal cysticercosis: an unusual presentation.

    PubMed

    Chaurasia, Rameshwar Nath; Mishra, Vijay Nath; Jaiswal, Shalini

    2015-01-01

    Spinal intramedullary cysticercosis is an uncommon clinical condition that may mimic an intramedullary tumour and can lead to irreversible neurological deficits if untreated. We report a case of a 35-year-old man who clinically presented as Brown-Sequard syndrome, having thoracic cord cysticercosis at T11 level. MRI of the spine revealed a well-defined round intramedullary inflammatory lesion with scolex and perilesional oedema at D11 level. PMID:25618884

  2. Intramedullary astrocytoma presenting as spinal muscular atrophy.

    PubMed

    Aysun, S; Cinbiş, M; Ozcan, O E

    1993-10-01

    We present a 6-year-old patient with a spinal cord tumor who had been followed with the diagnosis of spinal muscular atrophy since the age of 23 months. Reasons for reevaluating the diagnosis of spinal muscular atrophy were the early onset of scoliosis, the slight asymmetry in weakness of extremities, and the appearance of urinary retention in the last 3 days. Magnetic resonance imaging revealed a very long, intramedullary tumor extending from the level of the seventh cervical segment to the conus medullaris, later reported to be a grade I astrocytoma. We therefore recommend that magnetic resonance imaging, a noninvasive and sensitive technique for intraspinal pathologies, be performed in every patient with an atypical form of spinal muscular atrophy. PMID:8228031

  3. Melioidosis presenting as spinal epidural abscess.

    PubMed

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

    2003-12-01

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

  4. Spinal aneurysmal bone cyst presenting as acute paraparesis during pregnancy.

    PubMed

    Li, Luyuan; Tan, Lee A; Wewel, Joshua T; Kasliwal, Manish K; O'Toole, John E

    2016-06-01

    Aneurysmal bone cysts (ABC) are benign but locally aggressive osseous lesions characterized by blood-filled cystic cavities that account for 1-2% of all bone tumors. While pain remains the most common presenting symptom of spinal ABC, extensive anterior column involvement can result in vertebral fractures, spinal instability, and neurological deficits from compression of neural elements. An exceedingly rare case of thoracic ABC presenting as acute paraparesis in a 21-year-old pregnant woman, that was successfully treated with urgent surgical decompression and stabilization, is reported, with discussion of management strategies and review of the pertinent literature. PMID:26846358

  5. Lumbar spinal neurinoma presenting with nocturnal pain. A case report.

    PubMed

    Oelerich, M; Stögbauer, F; Schul, C

    1998-01-01

    Neurinomas are the most common intradural extramedullary tumors of the spine. Together with meningeoma they account for 80% to 90% of all tumors in this compartment. Radicular pain is the initial symptom in the majority of cases while motor disorders are less common and occur later in the course of the disease. We report a patient with spinal neurinoma and calf pain as the only presenting complaint. The differential diagnosis in this case required an interdisciplinary approach. PMID:9421658

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

    PubMed

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

    2016-03-01

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

  7. Spinal Cord InjuryPast, Present, and Future

    PubMed Central

    Donovan, William H

    2007-01-01

    Summary: This special report traces the path of spinal cord injury (SCI) from ancient times through the present and provides an optimistic overview of promising clinical trials and avenues of basic research. The spinal cord injuries of Lord Admiral Sir Horatio Nelson, President James A. Garfield, and General George Patton provide an interesting perspective on the evolution of the standard of care for SCI. The author details the contributions of a wide spectrum of professionals in the United States, Europe, and Australia, as well as the roles of various government and professional organizations, legislation, and overall advances in surgery, anesthesia, trauma care, imaging, pharmacology, and infection control, in the advancement of care for the individual with SCI. PMID:17591221

  8. ANCA-Associated Systemic Vasculitis Presenting With Hypertrophic Spinal Pachymeningitis

    PubMed Central

    Li, Xia; Zhao, Jiuliang; Wang, Qian; Fei, Yunyun; Zhao, Yan

    2015-01-01

    Abstract Reports of hypertrophic pachymeningitis associated with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) localized exclusively in the spine were quite rare. Two cases of ANCA-associated systemic vasculitis (AASV) presenting with hypertrophic spinal pachymeningitis (HSP) causing low back pain and numbness are described. Two patients showed prominent systemic and local inflammatory reactions manifested as fever, elevated levels of erythrocyte sedimentation rate and C-reactive protein, and markedly increased levels of total protein of cerebrospinal fluid. The gadolinium (Gd)-enhanced T1-weighted magnetic resonance imaging scan of spinal cord demonstrated diffuse spinal dura matter thickening. Additionally, simple microscopic hematuria was found in 1 case suggestive of renal involvement and the other 1 complicated with interstitial lung disease. Then, a diagnosis of HSP secondary to AASV was made. Combination therapy of corticosteroids and cyclophosphamide produced a rapid improvement in the clinical symptoms and laboratory parameters. Followed up for 6 months, 1 case relapsed when the dosage of prednisone was tapered to 10 mg daily. Since the patient refused rituximab-based regimen, an immunosuppressive triple-therapy (corticosteroid, cyclophosphamide, and azathioprine) was initiated and brought control of the disease during the subsequent 6 months of follow-up. HSP is a relatively rare form of central nervous system involvement of AASV. Early recognition and intervention are of great significance since the pathogenesis of HSP starts with an inflammatory and fibrosing process. PMID:26579814

  9. Neurobrucellosis presenting as an intra-medullary spinal cord abscess

    PubMed Central

    Vajramani, Girish V; Nagmoti, Mahantesh B; Patil, Chidanand S

    2005-01-01

    Background Of the diverse presentation of neurobrucellosis, intra-medullary spinal cord abscess is extremely rare. Only four other cases have been reported so far. We present a case of spinal cord intra-medullary abscess due to Brucella melitensis. Case presentation A forty-year-old female presented with progressive weakness of both lower limb with urinary incontinence of 6 months duration. She was febrile. Neurological examination revealed flaccid areflexic paraplegia with T10 below sensory impairment including perianal region. An intramedullary mass was diagnosed on Magnetic Resonance Image (MRI) scan extending from T12 to L2. At surgery, a large abscess was encountered at the conus medullaris, from which Brucella melitensis was grown on culture. She was started on streptomycin and doxycycline for 1 month, followed by rifampicin and doxycycline for 1 month. At 2-year follow-up, she had recovered only partially and continued to have impaired bladder function. Conclusion Neurobrucellosis, if not treated early, can result in severe neurological morbidity and sequale, which may be irreversible. Hence it is important to consider the possibility of neurobrucellosis in endemic region and treat aggressively. PMID:16168059

  10. Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

    PubMed Central

    Tanweer, Omar; Thomas, Cheddhi; Engler, John; Shapiro, Maksim; Becske, Tibor

    2016-01-01

    Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature. PMID:27114966

  11. [A Case of Spinal Epidural Hematoma Presenting with Transient Hemiplegia].

    PubMed

    Komai, Takanori; Nakashima, Kazuya; Tominaga, Takashi; Nogaki, Hidekazu

    2016-04-01

    We report a rare case of a patient with spinal epidural hematoma who presented with transient hemiplegia. A 90-year-old man awakened from sleep due to sudden neck pain. Fifteen minutes later, the man experienced progressively worsening weakness in his left hand, and was transported in an ambulance to our hospital. At the hospital, he presented with hemiplegia, and we suspected intracranial disease. Therefore, we performed magnetic resonance imaging(MRI), which revealed no intracranial lesions. Shortly after the MRI, the patient showed no signs of hemiplegia. However, since the severe neck pain persisted, we performed cervical MRI, which showed a high-intensity area at the C2-C5 level, predominantly on the left side. Despite recovery from hemiplegia, we performed a laminectomy of C3-C5 with evacuation of a hematoma at the C2-C6 level. After the surgery, the patient had no neck pain. PMID:27056873

  12. Giant intradural extramedullary spinal hydatid cyst--a rare presentation.

    PubMed

    Rashid, Muddassir; Kirmani, Sanna; Rashid, Mubashir

    2012-01-01

    The hydatidosis, or echinococcosis, has a characteristic geographic distribution, occurring most frequently in sheep-raising regions in Mediterranean, Central Asian, and South American countries and in Australia. Spinal hydatidosis is very rare, and intradural location is a rarer category of spinal hydatidosis. We report a case of intradural extramedullary spinal hydatid cyst in a 9-year-old boy. On magnetic resonance imaging, an intradural extramedullary giant cystic lesion was seen mimicking an arachnoid cyst. However, endemic origin of the patient and positive serology helped to make the diagnosis of hydatid cyst, which was confirmed on postoperative histopathology. PMID:23154030

  13. Abdominal pain and swelling as an initial presentation of spinal tuberculosis.

    PubMed

    Elgendy, Akram Y; Mahmoud, Ahmed; Elgendy, Islam Y

    2014-01-01

    Spinal tuberculosis (Pott's disease) is one of the common extra-pulmonary presentations of tuberculosis. Spinal tuberculosis commonly presents with back pain, fever and night sweats. In this report, we present a case of spinal tuberculosis complicated by bilateral large psoas abscesses. The patient presented with bilateral flank pain and swellings rather than the classic presentation of back pain. The aim of this report is to draw the attention of physicians to this uncommon presentation of spinal tuberculosis, as an early recognition of such condition may expedite diagnosis and treatment, thereby preventing future complications of the disease. PMID:24554681

  14. Abdominal pain and swelling as an initial presentation of spinal tuberculosis

    PubMed Central

    Elgendy, Akram Y; Mahmoud, Ahmed; Elgendy, Islam Y

    2014-01-01

    Spinal tuberculosis (Pott's disease) is one of the common extra-pulmonary presentations of tuberculosis. Spinal tuberculosis commonly presents with back pain, fever and night sweats. In this report, we present a case of spinal tuberculosis complicated by bilateral large psoas abscesses. The patient presented with bilateral flank pain and swellings rather than the classic presentation of back pain. The aim of this report is to draw the attention of physicians to this uncommon presentation of spinal tuberculosis, as an early recognition of such condition may expedite diagnosis and treatment, thereby preventing future complications of the disease. PMID:24554681

  15. Gliomatosis cerebri with spinal metastasis presenting with chronic meningitis in two boys.

    PubMed

    Lin, Yi-Heng; Chang, Yen-Wen; Yang, Shih-Hung; Chang, Hsiu-Hao; Lu, Meng-Yao; Fan, Pi-Chuan

    2015-09-01

    Spinal cord involvement in gliomatosis cerebri (GC) is uncommon. We report two patients with GC, who initially presented with chronic meningitis and were treated with antituberculous drugs. Although tumor meningitis was suspected, due to the intractable clinical course, a correct diagnosis was established after performing a biopsy examination of the metastatic spinal lesion which was detected by magnetic resonance imaging (MRI). Cerebrospinal fluid examination, including cytology, should be performed repetitively for patients with chronic meningitis refractory to antibiotic treatment. Spinal MRI is necessary for the complete neurological workup, even when the patients do not show spinal symptoms. PMID:26318497

  16. Spinal stenosis presenting as "the postpolio syndrome". Review of four cases.

    PubMed

    LaBan, M M; Sanitate, S S; Taylor, R S

    1993-12-01

    The diagnosis of postpolio syndrome is based primarily on a thorough history supported by both clinical and laboratory examination. Similarly, the presence of an occult spinal stenosis may be suspected initially by a history of progressive lumbar or cervical radicular pain, as well as concomitant extremity weakness and/or myelopathic signs. Appropriate electrodiagnostic examinations, including somatosensory spinal-evoked potentials and electroneuromyography, as well as imaging studies, computer-assisted tomography scan, magnetic resonance imaging and/or myelography are all useful in confirming the clinical diagnosis of either cervical spinal stenosis or lumbar spinal stenosis in patients who also may have had a history of poliomyelitis. Four patients (three men and one woman) previously diagnosed as having postpolio syndrome were referred with predominate complaints of spinal and extremity pain as well as associated motor weakness. It was subsequently recognized that these patients, ranging in age from 45-65 yr, were actually presenting with symptomatic spinal stenosis. It was discovered that two patients had cervical spinal stenosis; the other two had lumbar spinal stenosis. PMID:8260134

  17. Spinal dural arteriovenous malformation presented with intracranial hypertension in a young patient

    PubMed Central

    Inci, Mehmet Fatih; Senoğlu, Mehmet; Ozkan, Fuat; Yuksel, Murvet

    2012-01-01

    Spinal dural arteriovenous malformations (AVM), the most common type of spinal cord vascular malformation, can be a challenge to diagnosis and prompt treatment. The disorder is rare, and the presenting clinical symptoms and signs are non-specific and insidious at onset. Spinal dural AVMs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. İt may rarely present with symptoms of intracranial hypertension including headache and visual disorders. In this report, we present the radiological findings of a 19-year-old male patient with spinal dural AVM presenting with raised intracranial pressure symptoms including papilloedema and headache, and discuss with recent literature. PMID:23242102

  18. Post-hemorrhagic hydrocephalus presenting as cauda equina syndrome in a patient with spinal dysraphism.

    PubMed

    Bender, Matthew T; Colby, Geoffrey P; Huang, Judy

    2016-04-01

    Hydrocephalus has varied presentations in patients with a history of spinal dysraphism. This is a unique case of post-subarachnoid hemorrhage hydrocephalus presenting as cauda equina syndrome. We report on a 32-year-old woman with remotely repaired spinal defect who experienced subarachnoid hemorrhage and underwent anterior communicating artery aneurysm clipping. Post-operatively, she developed urinary and fecal incontinence as the sole presenting symptom of communicating post-hemorrhagic hydrocephalus. New neurological deficits in this population can also be attributed to recurrent cord tethering or syrinx, both of which were demonstrated on her lumbar spine MRI, but her incontinence resolved with external ventricular drain placement and cerebrospinal fluid diversion. There are few case reports of patients with closed neural tube defects and hydrocephalus and none in the adult population to our knowledge. Neurological change in patients with any history of spinal dysraphism may reflect altered cerebrospinal fluid dynamics affecting either end of the neuraxis. PMID:26675625

  19. Multicentric Spinal Tuberculosis with Sternoclavicular Joint Involvement: A Rare Presentation

    PubMed Central

    Meena, Umesh Kumar; Meena, Ramesh Chand

    2014-01-01

    Background. Tuberculosis is a chronic disease which may have varied presentations. Though pulmonary tuberculosis is the commonest, extrapulmonary tuberculosis involving skeletal system is often seen. Individuals with poor nourishment and immunological status are especially susceptible for disseminated and multicentric tuberculosis. Case Report. We here present a case of tuberculosis involving multiple anatomical locations in an immune-competent patient which was diagnosed with radiological studies and confirmed with histological examination. Patient was put on multidrug antitubercular therapy and responded well to the treatment with improvement in clinical and radiological picture. Clinical Relevance. This report of a rare case makes us aware of the varied presentations which tuberculosis can present with. It should be kept as a differential diagnosis in patients with cough and fever but not responding to conventional treatment. This is even more important in countries with poor socioeconomic conditions. PMID:25389505

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

    PubMed

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

    2016-04-01

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

  1. Light chain multiple myeloma presenting with spinal plasmacytoma: Unusual radiological appearance mimicking giant cell tumor.

    PubMed

    Satija, Bhawna; Gupta, Rajat; Kumar, Sanyal; Chandoke, Raj

    2015-01-01

    Plasmacytoma, an initial presentation of multiple myeloma, is extremely rare and an unusual cause of spinal cord compression in a young male. A 35-year-old man presented with complaints of progressive weakness and tingling of bilateral lower limbs, severe backache for 3 months, and bladder and bowel incontinence for 1 week duration. Imaging demonstrated lytic destruction of 10 th and 11 th dorsal vertebrae with large soft tissue component and compression of the spinal cord. Biopsy was performed under computed tomography guidance and the histopathology demonstrated presence of plasmacytoma. Serum electrophoresis and bone marrow examination confirmed the diagnosis of light chain multiple myeloma. Though the magnetic resonance imaging the appearance of spinal plasmacytoma is nonspecific, a minibrain appearance has been considered pathognomonic. This case is reported for the unusual radiological appearance of this entity mimicking giant cell tumor. PMID:26458612

  2. Acute Presentation of Lumbar Spinal Schwannoma Due to Torsion: A Case Report

    PubMed Central

    Khanna, Ryan; Ortmeier, Thomas C; Tapia-Zegarra, Gino G; Lindley, Timothy E; Smith, Zachary A; Dahdaleh, Nader S

    2016-01-01

    Although schwannomas are common spinal tumors with insidious presentations, acute neurological deterioration is an extremely rare manifestation that can occur in the setting of tumor torsion and infarction. The present case reports an unusual presentation of a spinal schwannoma that underwent torsion and infarction. A 65-year-old male presented initially with acute radicular pain progressing to cauda equina syndrome and confusion. MRI of the lumbar spine revealed an intradural extramedullary lesion at the level of L1/L2 measuring 1.1x0.9 cm. Intraoperatively, a reddish mass was seen caudally twisted around itself. Gross total resection was achieved with a final diagnosis of schwannoma with areas of infarction. At his six week follow up clinical visit, the patient was asymptomatic and his neurological exam was normal. The neurosurgeon should be aware of such atypical radiographic and clinical presentation amongst the spectrum of clinical manifestation of these nerve sheath tumors. 

  3. Ganglion cyst of the spinal anterior longitudinal ligament presenting as a retropharyngeal mass.

    PubMed

    Giger, Roland; Szalay-Quinodoz, Ildiko; Haenggeli, André; Dulguerov, Pavel

    2002-01-01

    Cervical spinal synovial and/or ganglion cysts can occur at various periarticular sites and should be considered in the differential diagnosis of intraspinal-extradural or paraspinal masses of the cervical spine. The first report of a ganglion cyst of the cervical anterior longitudinal ligament presenting as a retropharyngeal mass, is presented. The histopathology, etiology, and clinical aspects of synovial and ganglion cysts of the cervical spine are briefly reviewed. PMID:12430135

  4. Spinal Myeloid Sarcoma “Chloroma” Presenting as Cervical Radiculopathy: Case Report

    PubMed Central

    Hu, Xiaobang; Shahab, Imran; Lieberman, Isador H.

    2015-01-01

    Study Design Case report. Objective Myeloid sarcoma (also known as chloroma) is a rare, extramedullary tumor composed of immature granulocytic cells. It may occur early in the course of acute or chronic leukemia or myeloproliferative disorders. Spinal cord invasion by myeloid sarcoma is rare. The authors report a rare case of spinal myeloid sarcoma presenting as cervical radiculopathy. Methods A previously healthy 43-year-old man presented with progressive neck, right shoulder, and arm pain. Cervical magnetic resonance imaging (MRI) revealed a very large enhancing extradural soft tissue mass extending from C7 through T1, with severe narrowing of the thecal sac at the T1 level. The patient underwent posterior cervical open biopsy, laminectomy, and decompression. Histologic examination of the surgical specimen confirmed the diagnosis of myeloid sarcoma. Postoperatively, a bone marrow biopsy was done, which showed myeloproliferative neoplasm with eosinophilia. The patient then received systemic chemotherapy and radiotherapy. Results At the 10-month follow-up, the patient reported complete relief of arm pain and neck pain. X-rays showed that the overall cervical alignment was intact and there was no evidence of a recurrent lesion. MRI showed no evidence of compressive or remnant lesion. Conclusions Spinal myeloid sarcoma presenting as cervical radiculopathy is rare, and it may be easily misdiagnosed. Knowledge of its clinical presentation, imaging, and histologic characterization can lead to early diagnosis and appropriate treatment. PMID:26131394

  5. Donald Munro Lecture. Spinal cord injury--past, present, and future.

    PubMed

    Donovan, William H

    2007-01-01

    This special report traces the path of spinal cord injury (SCI) from ancient times through the present and provides an optimistic overview of promising clinical trials and avenues of basic research. The spinal cord injuries of Lord Admiral Sir Horatio Nelson, President James A. Garfield, and General George Patton provide an interesting perspective on the evolution of the standard of care for SCI. The author details the contributions of a wide spectrum of professionals in the United States, Europe, and Australia, as well as the roles of various government and professional organizations, legislation, and overall advances in surgery, anesthesia, trauma care, imaging, pharmacology, and infection control, in the advancement of care for the individual with SCI. PMID:17591221

  6. Clinical presentation, imaging findings, and prognosis of spinal dural arteriovenous fistula.

    PubMed

    Lee, Jookyung; Lim, Young-Min; Suh, Dae Chul; Rhim, Seung Chul; Kim, Sang Joon; Kim, Kwang-Kuk

    2016-04-01

    Spinal dural arteriovenous fistula (SDAVF) is a relatively common acquired vascular malformation of the spinal cord. Assessment of a SDAVF is often difficult because of non-specific findings on non-invasive imaging modalities. Diagnosis of a SDAVF is often delayed, and some patients receive unnecessary treatment and treatment delays, often resulting in a poor outcome. The aim of this study was to characterize the clinical presentation, typical imaging findings, and long-term outcome of SDAVF. Forty patients (13 women, 27 men; mean age 58.18±standard deviation 14.75years) who were treated at our hospital from June 1992 to March 2014 were retrospectively reviewed. We investigated the baseline characteristics, clinical presentation, imaging findings, treatment modalities, and outcome of the patients. The most common clinical presentation was a sensory symptom (80%), followed by motor weakness (70%), and sphincter dysfunction (62.5%). Roughly one-third (32.5%) of patients had a stepwise progression of fluctuating weakness and sensory symptoms, but the most common presentation was chronic progressive myelopathic symptoms (47.5%). Thirty-four patients (85%) had T2 signal change on the spinal cord MRI, indicative of cord edema. Thirty-eight patients had typical perimedullary vessel flow voids on T2-weighted MRI. Twenty-eight patients were treated with endovascular embolization, five patients underwent surgery, and four patients underwent both. Clinical outcome was determined by severity of initial deficit (p=0.008), extent of cord edema (p=0.010), treatment failure (p=0.004), and a residual fistula (p=0.017). SDAVF causes a treatable myelopathy, so early diagnosis and intervention is essential. PMID:26765752

  7. Spinal cord compression due to primary intramedullary tuberculoma of the spinal cord presenting as paraplegia: A case report and literature review

    PubMed Central

    Mishra, Sudhansu Sekhar; Das, Deepak; Das, Srikanta; Mohanta, Itibrata; Tripathy, Soubhagya Ranjan

    2015-01-01

    Background: Spinal cord compression can be due to various causes but spinal intramedullary tuberculoma is a rare cause. We report a case that had an intramedullary spinal cord tuberculomas in which the diagnosis was made histologically, without evidence of symptoms of systemic tuberculosis. This lesion, located in the thoracic region, mimicked as an intramedullary tumor radiologically. Case Description: The patient was a 25-year-old male who presented with a history of progressive paraparesis. Initial diagnosis was made as an intramedullary tumor by magnetic resonance imaging (MRI). The treatment of the patient involved is complete surgical excision of intramedullary lesion followed by appropriate antituberculous therapy. Postoperatively, his neurological symptoms were dramatically improved. With combination of both surgical and medical treatments, excellent clinical outcome was obtained. Conclusion: This case illustrates the risk of misdiagnosis and the importance of histological confirmation of a pathological lesion as spinal cord tuberculoma prior to surgical therapy, which should be kept in mind as a differential diagnosis of the intramedullary spinal cord tumors. PMID:25883834

  8. Tuberculous meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection

    PubMed Central

    Kobayashi, Kazuyoshi; Imagama, Shiro; Ito, Zenya; Ando, Kei; Yagi, Hideki; Shinjo, Ryuichi; Hida, Tetsuro; Ito, Kenyu; Ishikawa, Yoshimoto; Matsuyama, Yukihiro; Ishiguro, Naoki

    2015-01-01

    ABSTRACT Early-stage TB meningitis has no specific symptoms in patients, potentially leading to delayed diagnosis and consequently worsening prognosis. The authors present the fatal case with a delayed diagnosis of tuberculous (TB) meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection. The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. A 77-year-old man who underwent thoracic intramedullary hemangioblastoma resection for 2 times. The postoperative course was uneventful, but 1.5 months after surgery, the patient suffered from dementia with memory loss and diminished motivation and speech in the absence of a fever. No abnormalities were detected on blood test, brain computed tomography and cerebrospinal fluid (CSF) analysis. A sputum sample was negative for Mycobacterium tuberculosis in the QuantiFERON®-TB Gold (QFT-G) In-Tube Test and the tuberculin skin test was also negative. The patient was diagnosed with senile dementia by a psychiatrist. However, the patient’s symptoms progressively worsened. Despite the absence of TB meningitis findings, we suspected TB meningitis from the patient’s history, and administered a four-drug regimen. However the patient died 29 days after admission, subsequently M. tuberculosis was detected in the CSF sample. This case is a rare case of TB meningitis initially mistaken for dementia after intramedullary spinal cord tumor resection. Symptoms of dementia after intramedullary spinal cord tumor resection should first be suspected as one of TB meningitis, even if the tests for meningitis are negative. We propose that anti-tuberculosis therapy should be immediately initiated in cases of suspected TB meningitis prior to positive identification on culture. PMID:26663944

  9. Tuberculous meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection.

    PubMed

    Kobayashi, Kazuyoshi; Imagama, Shiro; Ito, Zenya; Ando, Kei; Yagi, Hideki; Shinjo, Ryuichi; Hida, Tetsuro; Ito, Kenyu; Ishikawa, Yoshimoto; Matsuyama, Yukihiro; Ishiguro, Naoki

    2015-11-01

    Early-stage TB meningitis has no specific symptoms in patients, potentially leading to delayed diagnosis and consequently worsening prognosis. The authors present the fatal case with a delayed diagnosis of tuberculous (TB) meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection. The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. A 77-year-old man who underwent thoracic intramedullary hemangioblastoma resection for 2 times. The postoperative course was uneventful, but 1.5 months after surgery, the patient suffered from dementia with memory loss and diminished motivation and speech in the absence of a fever. No abnormalities were detected on blood test, brain computed tomography and cerebrospinal fluid (CSF) analysis. A sputum sample was negative for Mycobacterium tuberculosis in the QuantiFERON®-TB Gold (QFT-G) In-Tube Test and the tuberculin skin test was also negative. The patient was diagnosed with senile dementia by a psychiatrist. However, the patient's symptoms progressively worsened. Despite the absence of TB meningitis findings, we suspected TB meningitis from the patient's history, and administered a four-drug regimen. However the patient died 29 days after admission, subsequently M. tuberculosis was detected in the CSF sample. This case is a rare case of TB meningitis initially mistaken for dementia after intramedullary spinal cord tumor resection. Symptoms of dementia after intramedullary spinal cord tumor resection should first be suspected as one of TB meningitis, even if the tests for meningitis are negative. We propose that anti-tuberculosis therapy should be immediately initiated in cases of suspected TB meningitis prior to positive identification on culture. PMID:26663944

  10. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

    PubMed Central

    2014-01-01

    Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

  11. Spontaneous Resolution of Non-traumatic Cervical Spinal Subdural Hematoma Presenting Acute Hemiparesis: A Case Report.

    PubMed

    Park, Yong Jin; Kim, Seok Won; Ju, Chang Il; Wang, Hui Sun

    2012-09-01

    Spontaneous cervical SDH with no underlying pathology is a very unusual condition. To the best of the authors' knowledge, only two cases have been previously reported. A 48-year-old female patient was admitted to our emergency room due to severe neck pain following standing up position with rapid onset of hemiparesis. MRI revealed a dorsolateral subdural hematoma from C3-C5 with cord compression. An emergency laminectomy was planned, but motor weakness gradually improved during surgical preparation. The patient showed substantial clinical improvement and complete recovery was confirmed after 7 days of conservative management without surgical treatment. To determine a differential diagnosis distinct from other conditions such as cervical epidural hematoma, a lumbar spinal puncture was performed. Follow-up MRI performed 10 days after admission revealed complete resolution of the hematoma. We report an extremely rare case of spontaneous cervical spinal subdural hematoma (SDH), present a review of relevant literature, and discuss the etiology, pathogenesis, and prognosis of this case. PMID:25983826

  12. Characteristics of Lumbar Disc Herniation With Exacerbation of Presentation Due to Spinal Manipulative Therapy

    PubMed Central

    Huang, Sheng-Li; Liu, Yan-Xi; Yuan, Guo-Lian; Zhang, Ji; Yan, Hong-Wei

    2015-01-01

    Abstract The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 4–15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 h. Magnetic resonance imaging showed that L4–L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging. PMID:25816037

  13. A giant spinal arterial aneurysm in a child presenting as quadriparesis.

    PubMed

    Santana-Ramírez, Adrian; Farias-Serratos, Felipe; Garzon-Muvdi, Tomas; Quiñones-Hinojosa, Alfredo

    2013-01-01

    A giant spinal aneurysm from anterior spinal artery not associated with arteriovenous (AV) malformations is unusual and no such cases have been reported in children. Few cases have been described as part of AV malformation complex and coarctation of the aorta. We report a case of anterior spinal aneurysm in a 1-year-old girl causing a subarachnoid haemorrhage and a cervical cord lesion. The diagnosis was confirmed with a multislice CT angiography. A microsurgical decompression was performed and excision of aneurysm was unsuccessful but neurological deficits were improved. No further approach was accepted by the parents. The mechanism for the development of spinal isolated aneurysms is not clear; it can be related to congenital vessel abnormalities and genetic origin. The multislice CT angiography is a very useful method to demonstrate the features of this entity. Previous reports of isolated spinal aneurysm are reviewed. PMID:23964047

  14. Onyx embolization of a thoracolumbar perimedullary spinal arteriovenous fistula in an infant presenting with subarachnoid and intraventricular hemorrhage.

    PubMed

    Kenning, Tyler J; Deshaies, Eric M; Adamo, Matthew A; Waldman, John B; Boulos, Alan S

    2009-03-01

    Identifying a source of spontaneous subarachnoid hemorrhage (SAH) or intraventricular hemorrhage (IVH) in patients with negative results on cranial angiographic imaging can be a diagnostic challenge. The authors present the case of a 14-month-old girl who presented with lethargy and spontaneous SAH and IVH, and later became acutely paraplegic. Except for the SAH and IVH, findings on neuroimages of the brain were normal. Magnetic resonance imaging revealed an intramedullary thoracolumbar spinal cord hemorrhage that was found to be associated with arterialized veins intraoperatively. Catheter-based diagnostic angiography identified a spinal perimedullary macroarteriovenous fistula (macro-AVF) that was completely embolized with Onyx, negating the need for further surgical intervention. The authors believe this to be the first reported case of a thoracolumbar perimedullary macro-AVF presenting with SAH and IVH. In addition, descriptions of Onyx embolization of a spinal AVF in the literature are rare, especially in pediatric patients. PMID:19338467

  15. Idiopathic Spinal Cord Herniation Presented as Brown-Sequard Syndrome : A Case Report and Surgical Outcome

    PubMed Central

    Ju, Min-Wook; Youm, Jin-Young; Kwon, Hyon-Jo

    2015-01-01

    Spinal cord herniation is a rare condition that has become increasingly recognised in the last few years. The authors report a case of idiopathic spinal cord herniation in a 33 year old woman performed with progressive Brown-Sequard syndrome. The diagnosis was made on MR imaging. After repairing the herniation, the patient made a gradual improvement. Potential causes are discussed, including a possible role of dural defect. In conclusion, idiopathic spinal cord herniation is a potentially treatable condition that should be more readily diagnosed that increasing awareness and improved imaging techniques. PMID:26539277

  16. Use of spinal manipulation in a rheumatoid patient presenting with acute thoracic pain: a case report

    PubMed Central

    Chung, Chadwick L. R.; Mior, Silvano A.

    2015-01-01

    Background: There is limited research related to spinal manipulation of uncomplicated thoracic spine pain and even less when pain is associated with comorbid conditions such as rheumatoid arthritis. In the absence of trial evidence, clinical experience and appropriate selection of the type of intervention is important to informing the appropriate management of these cases. Case presentation: We present a case of a patient with long standing rheumatoid arthritis who presented with acute thoracic pain. The patient was diagnosed with costovertebral joint dysfunction and a myofascial strain of the surrounding musculature. The patient was unresponsive to treatment involving a generalized manipulative technique; however, improved following the administration of a specific applied manipulation with modified forces. The patient was deemed recovered and discharged with ergonomic and home care recommendations. Discussion: This case demonstrates a clinical situation where there is a paucity of research to guide management, thus clinicians must rely on experience and patient preferences in the selection of an appropriate and safe therapeutic intervention. The case highlights the need to contextualize the apparent contraindication of manipulation in patients with rheumatoid arthritis and calls for further research. Finally the paper advances evidence based decision making that balances the available research, clinical experience, as well as patient preferences. PMID:26136606

  17. Subarachnoid Hemorrhage Presenting with Seizure due to Cerebrospinal Fluid Leakage after Spinal Surgery

    PubMed Central

    Yaman, Mesut Emre

    2016-01-01

    Cerebrospinal fluid leakage may commonly occur during spinal surgeries and it may cause dural tears. These tears may result in hemorrhage in the entire compartments of the brain. Most common site of such hemorrhages are the veins in the cerebellar region. We report a case of hemorrhage, mimicking aneurysmal subarachnoid hemorrhage due to a cerebrospinal fluid leakage following lumbar spinal surgery and discuss the possible mechanisms of action. PMID:26885288

  18. Acute spontaneous spinal subdural haematoma presenting as paraplegia and complete recovery with non-operative treatment

    PubMed Central

    Al, Behet; Yildirim, Cuma; Zengin, Suat; Genc, Sinan; Erkutlu, Ibrahim; Mete, Ahmet

    2009-01-01

    Spontaneous spinal subdural haematoma (SSDH) with no underlying pathology is a very rare condition. Only 20 cases have been previously reported. It can be caused by abnormalities of coagulation, blood dyscrasia, or trauma, underlying neoplasm, and arteriovenous malformation. It occurs most commonly in the thoracic spine and presents with sudden back pain radiating to the arms, legs or trunk, and varying degrees of motor, sensory, and autonomic disturbances. Although the main approach to management is surgical decompression, conservative management is used as well. We report the case of a 57-year-old man who presented with sudden severe low back pain followed by rapid onset of complete paraplegia. Magnetic resonance imaging (MRI) revealed an anterior subdural haematoma from T9 to L1 with cord compression. Corticosteroid treatment was administered. The patient showed substantial clinical improvement after 7 days of bed rest and an intense rehabilitation programme. An MRI scan and a computed tomography angiogram did not reveal any underlying pathology to account for the subdural haematoma. PMID:22065983

  19. [Spinal stenosis].

    PubMed

    Hashizume, Hiroshi; Yoshida, Munehito

    2014-10-01

    Spinal stenosis is an abnormal narrowing of the spinal canal that mainly occurs in the cervical and lumbar regions. The number of the patients of spinal stenosis is increasing in the aging society like Japan because the major reason for the stenosis is the degeneration of the spinal components including the intervertebral disc, facet, and ligamentum flavum. The development of the disease-concept is historically different between cervical spinal stenosis and lumbar spinal stenosis. Therefore, some confusion is still present in the definition and diagnosing criteria of these conditions. In this report, we mainly describe about the degenerative lumbar spinal stenosis, which is most common in the outpatient clinic, concerning the diagnosis, various options of conservative therapy, and the surgical indication. PMID:25509800

  20. Spinal meningiomas in dogs: description of 8 cases including a novel radiological and histopathological presentation.

    PubMed

    José-López, Roberto; de la Fuente, Cristian; Pumarola, Martí; Añor, Sonia

    2013-10-01

    Clinical, imaging, and histological features of 8 canine spinal meningiomas, including a cervical cystic meningioma with imaging and intraoperative features of an arachnoid cyst, are described. All meningiomas were histologically classified and graded following the international World Health Organization human classification for tumors. Six meningiomas were located in the cervical spinal cord. Myelography showed intradural/ extramedullary lesions in 3/4 cases. Magnetic resonance imaging revealed hyperintense intradural/extramedullary masses on pre-contrast T1-weighted and T2-weighted images with homogeneous contrast enhancement in 7/8 cases. One dog had a cerebrospinal fluid-filled subarachnoid cavity dorsal to the cervical spinal cord. A spinal arachnoid cyst was diagnosed on imaging, but the histopathological study of the resected tissue revealed a grade I meningothelial cystic meningioma. There were no differences in outcome associated with tumor grade and surgical treatment (6/8). Cystic meningioma should be considered in the differential diagnosis of intraspinal cystic lesions, and biopsy is necessary for definitive diagnosis. PMID:24155414

  1. Spontaneous Spinal Epidural Abscess Presenting in a Previously Healthy Young Adult Man

    PubMed Central

    McDonald, Andrew M.; Rollins, Jason L.

    2013-01-01

    We report a case of spontaneous spinal epidural abscess (SEA) with initial chief complaint of shoulder pain and no appreciable neurologic symptoms. Since outcomes of SEA appear to be related to the degree of neurologic deficit at the time of intervention, we explore opportunities for earlier diagnosis. PMID:24000285

  2. Clinical Trials in Spinal and Bulbar Muscular Atrophy-Past, Present, and Future.

    PubMed

    Weydt, Patrick; Sagnelli, Anna; Rosenbohm, Angela; Fratta, Pietro; Pradat, Pierre-François; Ludolph, Albert C; Pareyson, Davide

    2016-03-01

    Spinal and Bulbar Muscular Atrophy (SBMA), also known as Kennedy's disease, is a rare adult-onset lower motor neuron disorder with a classic X-linked inheritance pattern. It is caused by the abnormal expansion of the CAG-repeat tract in the androgen receptor gene. Despite important progress in the understanding of the molecular pathogenesis and the availability of a broad set of model organisms, successful translation of these insights into clinical interventions remains elusive. Here we review the available information on clinical trials in SBMA and discuss the challenges and pitfalls that impede therapy development. Two important factors are the variability of the complex neuro-endocrinological phenotype and the comparatively low incidence of the disease that renders recruitment for clinical trials demanding. We propose that these challenges can be and need to be overcome by fostering closer collaborations between clinical research centers, the patient communities and the industry and non-industry sponsors of clinical trials. PMID:26572537

  3. Hemorrhagic intramedullary hemangioblastoma of the cervical spinal cord presenting with acute-onset quadriparesis: Case report and review of the literature

    PubMed Central

    Gluf, Wayne M.; Dailey, Andrew T.

    2014-01-01

    Context Hemangioblastomas of the spinal cord are uncommon vascular tumors. Patients commonly present with subtle neurologic findings that are thought to represent growth of the lesion over time. Hemorrhage of an intramedullary hemangioblastoma presenting as acute neurologic deficit is an extremely rare occurrence. Although the cervical spine is the most common location for hemangioblastoma of the spinal cord, there have been no previously published cases in the literature of intramedullary hemorrhage from such a lesion. Findings A 22-year-old woman with a previously undiagnosed spinal cord hemangioblastoma presented with sudden-onset dense quadriparesis due to intramedullary hemorrhage in the cervical spinal cord. The patient did not have any clinical findings of von-Hippel Lindau disease. Laminoplasty from C5 to T2 and posterior midline myelotomy for resection of the intramedullary tumor with hematoma evacuation were completed without complication. Conclusion Intramedullary hemangioblastoma of the spinal cord is uncommon, and hemorrhage from a cervical spinal cord lesion has not previously been reported. Symptoms from these usually indolent lesions are commonly associated with tumor growth, edema, or associated syrinx, whereas devastating acute neurologic deficit from hemorrhage is exceedingly rare. Microsurgical resection should be done in cases of symptomatic lesions and considered in isolated symptomatic lesions without the known diagnosis of von Hippel-Lindau disease. PMID:25029412

  4. Diagnosis of a 64-year-old patient presenting with suspected lumbar spinal stenosis: an evidence-based case report

    PubMed Central

    Emary, Peter C.

    2015-01-01

    Objective: To present an evidence-based case report on the diagnosis of a patient with suspected lumbar spinal stenosis (LSS). Case: A 64-year-old man presented with signs and symptoms suggestive of LSS, but physical examination and diagnostic imaging findings were inconclusive. Other co-morbidities included diabetes, congestive heart failure, and left hip joint osteoarthritis. Outcome: PubMed was searched for systematic reviews of diagnostic studies on LSS. Two recent articles were found and appraised with respect to their validity, importance, and applicability in diagnosing the current patient. Copies of his magnetic resonance imaging were also obtained and used in combination with the appraised literature, including diagnostic test specificities and likelihood ratios, to confirm an LSS diagnosis. Summary: This case illustrates how research evidence can be used in clinical practice, particularly in the diagnosis of an individual patient. PMID:25729085

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

    PubMed

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

    2016-02-01

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

  6. Osteoporotic spinal burst fracture in a young adult as first presentation of systemic mastocytosis.

    PubMed

    Ble, Christina; Tsitsopoulos, Parmenion P; Anestis, Dimitrios M; Hadjileontiadou, Sofia; Koletsa, Triantafyllia; Papaioannou, Maria; Tsonidis, Christos

    2016-01-01

    Osteoporotic vertebral fractures are uncommon in young adults and usually indicate an underlying disease. Systemic mastocytosis is a myeloproliferative neoplasm, which can be associated with osteoporosis. A previously healthy 30-year-old man presented with an L4 burst fracture after lifting a heavy object. He was operated with laminectomy and posterior lumbar instrumentation. During surgery, abnormally soft bone was noted. Postoperatively, osteoporosis was confirmed with measurement of bone mineral density. Further investigation revealed elevated serum tryptase levels while bone marrow biopsy findings showed systemic mastocytosis. He was also tested positive for D816V KIT mutation. Treatment with biphosphonates and interferon was initiated. No extraskeletal involvement was noted up to the last checkup, 18 months after the first presentation. Abrupt vertebral fractures in apparently healthy young individuals should raise the suspicion of an underlying pathology. Prompt identification and treatment of systemic mastocytosis is crucial in order to avoid unexpected sequelae. PMID:27141048

  7. Osteoporotic spinal burst fracture in a young adult as first presentation of systemic mastocytosis

    PubMed Central

    Ble, Christina; Tsitsopoulos, Parmenion P.; Anestis, Dimitrios M.; Hadjileontiadou, Sofia; Koletsa, Triantafyllia; Papaioannou, Maria; Tsonidis, Christos

    2016-01-01

    Osteoporotic vertebral fractures are uncommon in young adults and usually indicate an underlying disease. Systemic mastocytosis is a myeloproliferative neoplasm, which can be associated with osteoporosis. A previously healthy 30-year-old man presented with an L4 burst fracture after lifting a heavy object. He was operated with laminectomy and posterior lumbar instrumentation. During surgery, abnormally soft bone was noted. Postoperatively, osteoporosis was confirmed with measurement of bone mineral density. Further investigation revealed elevated serum tryptase levels while bone marrow biopsy findings showed systemic mastocytosis. He was also tested positive for D816V KIT mutation. Treatment with biphosphonates and interferon was initiated. No extraskeletal involvement was noted up to the last checkup, 18 months after the first presentation. Abrupt vertebral fractures in apparently healthy young individuals should raise the suspicion of an underlying pathology. Prompt identification and treatment of systemic mastocytosis is crucial in order to avoid unexpected sequelae. PMID:27141048

  8. [Case of cerebellar and spinal cord infarction presenting with acute brachial diplegia due to right vertebral artery occlusion].

    PubMed

    Fujii, Takayuki; Santa, Yo; Akutagawa, Noriko; Nagano, Sukehisa; Yoshimura, Takeo

    2012-01-01

    A 73-year-old man was admitted for evaluation of sudden onset of dizziness, bilateral shoulder pain, and brachial diplegia. Neurological examination revealed severe bilateral weakness of the triceps brachii, wrist flexor, and wrist extensor muscles. There was no paresis of the lower limbs. His gait was ataxic. Pinprick and temperature sensations were diminished at the bilateral C6-C8 dermatomes. Vibration and position senses were intact. An MRI of the head revealed a right cerebellar infarction and occlusion of the right vertebral artery. An MRI of the cervical spine on T₂ weighted imaging (T₂WI) showed cord compression at the C3/4-C5/6 level secondary to spondylotic degeneration without any intramedullary signal changes of the cord. On the following day, however, high-signal lesions on T₂WI appeared in the C5-C6 spinal cord, suggesting cord infarction. Unilateral vertebral artery occlusion does not usually result in cervical cord infarction because of anastomosis of arteries. Because of the long-term mechanical compression in our case, it was likely that cervical cord ischemia was present before the onset of symptoms. On the basis of chronic cord compression, our case suggests that occlusion of a unilateral vertebral artery could cause cervical cord infarction. PMID:22790805

  9. Spinal stenosis.

    PubMed

    Melancia, João Levy; Francisco, António Fernandes; Antunes, João Lobo

    2014-01-01

    Narrowing of the spinal canal or foramina is a common finding in spine imaging of the elderly. Only when symptoms of neurogenic claudication and/or cervical myelopathy are present is a spinal stenosis diagnosis made, either of the lumbar spine, cervical spine or both (only very rarely is the thoracic spine involved). Epidemiological data suggest an incidence of 1 case per 100 000 for cervical spine stenosis and 5 cases per 100 000 for lumbar spine stenosis. Cervical myelopathy in patients over 50 years of age is most commonly due to cervical spine stenosis. Symptomatic spinal narrowing can be congenital, or, more frequently, acquired. The latter may be the result of systemic illneses, namely endocrinopathies (such as Cushing disease or acromegaly), calcium metabolism disorders (including hyporarthyroidism and Paget disease), inflammatory diseases (such as rheumathoid arthritis) and infectious diseases. Physical examination is more often abnormal in cervical spondylotic myeloptahy whereas in lumbar spinal stenosis it is typically normal. Therefore spinal stenosis diagnosis relies on the clinical picture corresponding to conspicuous causative changes identified by imaging techniques, most importantly CT and MRI. Other ancillary diagnostic tests are more likely to be yielding for establishing a differential diagnosis, namely vascular claudication. Most patients have a progressive presentation and are offered non operative management as first treatment strategy. Surgery is indicated for progressive intolerable symptoms or, more rarely, for the neurologically catastrophic initial presentations. Surgical strategy consists mainly of decompression (depending on the anatomical level and type of narrowing: laminectomy, foraminotomy, discectomy, corporectomy) with additional instrumentation should spinal stability and sagittal balance be at risk. For cervical spine stenosis the main objective of surgery is to halt disease progression. There is class 1b evidence that surgery is of benefit for lumbar stenosis at least in the short term. PMID:24365318

  10. G. Heiner Sell memorial lecture: neuronal plasticity after spinal cord injury: significance for present and future treatments.

    PubMed

    Dietz, Volker

    2006-01-01

    Recent progress in the understanding of movement control allows us to define more precisely the requirements for successful rehabilitation of patients with neurologic deficits after a spinal cord injury (SCI). Load- and hip joint position-related afferent input seems to be of crucial importance for the generation and success of locomotor training. In addition, there is accumulating evidence from animal experiments that axonal regeneration can be induced after a SCI. Consequently, in the near future, new therapeutic approaches will be developed for the treatment of subjects with SCI. Functional training and regeneration represent complimentary approaches. Regenerating spinal tract fibers needs functional training to make the appropriate connections, and training effects will be enhanced by regenerating fibers. A clinical basis for monitoring the effects of novel interventional therapies is needed. Refined and combined clinical and neurophysiologic measures are needed for a precise qualitative and quantitative assessment of spinal cord function in patients with SCI at an early stage. This is a basic requirement for predicting functional outcome, as well as for recognizing any improvement in the recovery of function caused by a new treatment. To this aim, 14 European spinal cord injury centers involved in the rehabilitation of patients with acute SCI have built a close clinical collaboration using a standardized protocol for the assessment of the outcome after SCI and the extent of recovery achieved by actually applied therapies in a larger population of patients with SCI. PMID:17274486

  11. Congenital neuroblastoma presenting with paraplegia following spinal puncture in a neonate. Case report and review of the literature.

    PubMed

    Kilani, M; Hammami, S; Darmoul, M; Haddad, S; Ben Nsir, A; Mnari, W; Hattab, M-N

    2016-03-01

    Neuroblastoma is the most common intraspinal solid tumor of childhood. Neurological deterioration due to an intratumoral hemorrhage following a spinal puncture is extremely rare. We report on the case of a 23-day-old neonate who was admitted to our institution for the onset of a paraplegia following a diagnostic lumbar puncture. The MRI showed an epidural tumor with massive intratumoral hemorrhage. Operatively and with histologic confirmation, the mass was determined to be a neuroblastoma. Following surgery, neurological function improved. PMID:26724980

  12. Spinal stenosis

    MedlinePlus

    ... Central spinal stenosis; Foraminal spinal stenosis; Degenerative spine disease; Back pain - spinal stenosis ... or pain in the back, buttocks, thighs, or calves, or in the neck, shoulders, or arms Weakness ...

  13. Multiple hypertrophic relapsing remitting cranial neuropathies as an initial presentation of primary CNS lymphoma without any brain or spinal cord lesion

    PubMed Central

    Watane, Gaurav V; Pandya, Saumil P; Atre, Isha D; Kothari, Foram N

    2016-01-01

    Cranial nerve thickening as an initial isolated presentation of CNS lymphoma is rare. Once an extremely rare neoplasm, primary lymphoma of the central nervous system (CNS) now ranks only next to meningiomas and low-grade astrocytomas in prevalence. Multiple cranial nerve thickening can be a feature of primary CNS lymphoma. Here we report a case of a 45-year-old immunocompetent female who presented with relapsing remitting multiple cranial nerve thickening as an initial feature of primary CNS lymphoma without any other brain or spinal cord lesions. PMID:27081238

  14. Spinal tumor

    MedlinePlus

    ... removed to relieve pressure on the spinal cord. Radiation therapy may be used with, or instead of, surgery. Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended ...

  15. Spinal Tuberculosis

    PubMed Central

    Ekinci, Safak; Tatar, Oner; Akpancar, Serkan; Bilgic, Serkan; Ersen, Omer

    2015-01-01

    Spinal tuberculosis (TB) is a significant form of TB, causing spinal deformity and paralysis. Early diagnosis and treatment are crucial for avoiding multivertebral destruction and are critical for improving outcomes in spinal TB. We believe that appropriate treatment method should be implemented at the early stage of this disease and that the Gulhane Askeri Tıp Akademisi classification system can be considered a practical guide for spinal TB treatment planning in all countries. PMID:26609247

  16. Spinal Infections

    MedlinePlus

    ... for spinal infections include poor nutrition, immune suppression, human immunodeficiency virus (HIV) infection, cancer, diabetes and obesity. Surgical risk factors include a long surgical time, instrumentation and re- ...

  17. Spinal Stenosis

    MedlinePlus

    ... diagnose spinal stenosis with a physical exam and imaging tests. Treatments include medications, physical therapy, braces, and surgery. NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

  18. Spinal fusion

    MedlinePlus

    ... the wound or vertebral bones Damage to a spinal nerve, causing weakness, pain, loss of sensation, problems with your bowels or bladder The vertebrae above and below the fusion are more likely to wear away, leading to more problems later

  19. Spinal orthoses.

    PubMed

    Agabegi, Steven S; Asghar, Ferhan A; Herkowitz, Harry N

    2010-11-01

    External orthoses are used in the management of a variety of spinal disorders. Many types of brace are available to support the cervical, thoracic, and lumbar spine as well as junctional regions, which have special mechanical considerations. Many prefabricated and custom-made devices are available, made by a variety of manufacturers in this unregulated area of medical practice. Despite the widespread use of spinal orthoses, evidence of their efficacy in managing many spinal conditions is lacking. The most compelling indication for their use is in the management of traumatic spine injury. However, studies evaluating the efficacy of spinal orthoses have several shortcomings; many have evaluated orthoses that are no longer used. Recent data provide general guidelines to help the clinician choose the appropriate device. PMID:21041800

  20. Spinal deformity.

    PubMed

    Bunnell, W P

    1986-12-01

    Spinal deformity is a relatively common disorder, particularly in teenage girls. Early detection is possible by a simple, quick visual inspection that should be a standard part of the routine examination of all preteen and teenage patients. Follow-up observation will reveal those curvatures that are progressive and permit orthotic treatment to prevent further increase in the deformity. Spinal fusion offers correction and stabilization of more severe degrees of scoliosis. PMID:3786010

  1. Primary Spinal Cord Melanoma

    PubMed Central

    Kim, Min Soo; Yoon, Do Heum

    2010-01-01

    Primary central nervous system (CNS) melanoma is a rare condition that accounts for only 1% of all melanomas. A 34-year-old Korean female presented with a two-month history of progressive weakness in both legs. Spinal magnetic resonance image (MRI) revealed a spinal cord tumor at the level of T4, which was hyperintense on T1-weighted imaging and hypointense on T2-weighted imaging. The intradural and extramedullary tumor was completely resected and diagnosed as melanoma. There were no metastatic lesions. At three years after surgery, the patient is still alive, with no evidence of tumor recurrence. We present the details of this case along with a comprehensive review of spinal cord melanoma. PMID:20856666

  2. Pediatric spinal trauma.

    PubMed

    Huisman, Thierry A G M; Wagner, Matthias W; Bosemani, Thangamadhan; Tekes, Aylin; Poretti, Andrea

    2015-01-01

    Pediatric spinal trauma is unique. The developing pediatric spinal column and spinal cord deal with direct impact and indirect acceleration/deceleration or shear forces very different compared to adult patients. In addition children are exposed to different kind of traumas. Moreover, each age group has its unique patterns of injury. Familiarity with the normal developing spinal anatomy and kind of traumas is essential to correctly diagnose injury. Various imaging modalities can be used. Ultrasound is limited to the neonatal time period; plain radiography and computer tomography are typically used in the acute work-up and give highly detailed information about the osseous lesions. Magnetic resonance imaging is more sensitive for disco-ligamentous and spinal cord injuries. Depending on the clinical presentation and timing of trauma the various imaging modalities will be employed. In the current review article, a summary of the epidemiology and distribution of posttraumatic lesions is discussed in the context of the normal anatomical variations due to progressing development of the child. PMID:25512255

  3. Spinal Claudication

    PubMed Central

    Bolton, Charles F.

    1983-01-01

    Spinal claudication is due to marked narrowing of the spinal canal with resulting pressure on the cauda equina. The characteristic symptoms are variable discomfort in the back and legs, brought on by exercise and/or extension movements of the hips and low back. The neurological examination may be normal or may reveal dysfunction of one or more lumbosacral nerve roots. Myelography and, particularly, body CT scanning are definitive diagnostic procedures. Most patients respond satisfactorily to extensive surgical decompression. ImagesFig. 2Fig. 3 PMID:21283326

  4. Retraining the injured spinal cord

    NASA Technical Reports Server (NTRS)

    Edgerton, V. R.; Leon, R. D.; Harkema, S. J.; Hodgson, J. A.; London, N.; Reinkensmeyer, D. J.; Roy, R. R.; Talmadge, R. J.; Tillakaratne, N. J.; Timoszyk, W.; Tobin, A.

    2001-01-01

    The present review presents a series of concepts that may be useful in developing rehabilitative strategies to enhance recovery of posture and locomotion following spinal cord injury. First, the loss of supraspinal input results in a marked change in the functional efficacy of the remaining synapses and neurons of intraspinal and peripheral afferent (dorsal root ganglion) origin. Second, following a complete transection the lumbrosacral spinal cord can recover greater levels of motor performance if it has been exposed to the afferent and intraspinal activation patterns that are associated with standing and stepping. Third, the spinal cord can more readily reacquire the ability to stand and step following spinal cord transection with repetitive exposure to standing and stepping. Fourth, robotic assistive devices can be used to guide the kinematics of the limbs and thus expose the spinal cord to the new normal activity patterns associated with a particular motor task following spinal cord injury. In addition, such robotic assistive devices can provide immediate quantification of the limb kinematics. Fifth, the behavioural and physiological effects of spinal cord transection are reflected in adaptations in most, if not all, neurotransmitter systems in the lumbosacral spinal cord. Evidence is presented that both the GABAergic and glycinergic inhibitory systems are up-regulated following complete spinal cord transection and that step training results in some aspects of these transmitter systems being down-regulated towards control levels. These concepts and observations demonstrate that (a) the spinal cord can interpret complex afferent information and generate the appropriate motor task; and (b) motor ability can be defined to a large degree by training.

  5. Clinical radiology of the spine and spinal cord

    SciTech Connect

    Banna, M.

    1985-01-01

    This book is a source of information about aspects of radiology of the spine and spinal column. It presents coverage of both normal and abnormal conditions. Contents: Spinal fractures and dislocations. Degenerative diseases of the spine. Gross anatomy of the spinal cord and meninges. Intraspinal mass lesions. Spinal dysraphism. Congenital anomalies. Tumors of the vertebral column, and more.

  6. Totally Ossified Metaplastic Spinal Meningioma

    PubMed Central

    Hida, Kazutoshi; Yamauchi, Tomohiro; Houkin, Kiyohiro

    2013-01-01

    A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma. PMID:24278660

  7. Motorcycle-related spinal injury: crash characteristics.

    PubMed

    Zulkipli, Zarir Hafiz; Abdul Rahmat, Abdul Manap; Mohd Faudzi, Siti Atiqah; Paiman, Noor Faradila; Wong, Shaw Voon; Hassan, Ahamedali

    2012-11-01

    This study presents an analysis of crash characteristics of motorcyclists who sustained spinal injuries in motorcycle crashes. The aim of the study is to identify the salient crash characteristics that would help explain spinal injury risks for motorcyclists. Data were retrospectively collected from police case reports that were archived at MIROS from year 2005 to 2007. The data were categorized into two subcategories; the first group was motorcycle crashes with spinal injury (case) and the second group was motorcycle crashes without spinal injury (control). A total of 363 motorcyclists with spinal injury and 873 motorcyclists without spinal injury were identified and analyzed. Descriptive analysis and multivariate analysis were performed in order to determine the odds of each characteristic in contributing to spinal injury. Single vehicle crash, collision with fixed objects and crash configuration were found to have significant influence on motorcyclists in sustaining spinal injury (p<0.05). Although relatively few than other impact configurations, the rear-end impacted motorcyclist shows the highest risk of spinal injury. Helmets have helped to reduce head injury but they did not seem to offer corresponding protection for the spine in the study. With a growing number of young motorcyclists, further efforts are needed to find effective measures to help reduce the crash incidents and severity of spinal injury. In sum, the study provides some insights on some vital crash characteristics associated with spinal injury that can be further investigated to determine the appropriate counter-measures and prevention strategies to reduce spinal injury. PMID:23036400

  8. Spinal Bracing

    NASA Technical Reports Server (NTRS)

    1991-01-01

    Dr. Arthur Copes of the Copes Foundation, Baton Rouge, LA, says that 35 percent of the 50 technical reports he received from the NASA/Southern University Industrial Applications Center in Baton Rouge and the Central Industrial Applications Center, Durant, OK, were vital to the development of his Copes Scoliosis Braces, which are custom designed and feature a novel pneumatic bladder that exerts constant corrective pressure to the torso to slowly reduce or eliminate the spinal curve.

  9. Spinal pain.

    PubMed

    Izzo, R; Popolizio, T; D'Aprile, P; Muto, M

    2015-05-01

    The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic pain, much more difficult to treat. The clinical assessment of pain source can be a challenge because of the complex anatomy and function of the spine; the advanced imaging methods are often not sufficient for a definitive diagnosis because similar findings could be present in either asymptomatic and symptomatic subjects: a clinical correlation is always mandatory and the therapy cannot rely uniquely upon any imaging abnormalities. Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. Special attention will be done to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. PMID:25824642

  10. Pathophysiology of spinal cord trauma.

    PubMed

    Anderson, D K; Hall, E D

    1993-06-01

    This article reviews the pathophysiology of spinal cord injury. The focus is on the role of post-traumatic membrane lipid changes, including lipid hydrolysis with enzymatic lipid peroxidation (ie, eicosanoid production) and nonenzymatic, free radical-induced lipid peroxidation in the secondary autodestruction of injured spinal cord tissue. A speculative etiopathogenesis of secondary injury is presented in an attempt to explain the importance and order of the pathophysiologic events that result in tissue death and the apparent effectiveness of diverse pharmacologic agents in the treatment of experimental spinal cord injury. PMID:8503537

  11. Spinal Cord Diseases

    MedlinePlus

    Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back ... of the spine, this can also injure the spinal cord. Other spinal cord problems include Tumors Infections such ...

  12. Spinal injury - resources

    MedlinePlus

    Resources - spinal injury ... The following organizations are good resources for information on spinal injury : National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov The National Spinal Cord Injury ...

  13. Acquired lumbar spinal stenosis.

    PubMed

    Deasy, JoAnn

    2015-04-01

    Lumbar spinal stenosis is the most frequent reason for spinal surgery in patients over age 65 years. In this condition, narrowing of the lumbar spinal canal and nerve root canals leads to painful, debilitating compression of spinal nerves and blood vessels. As the population ages, an increasing number of patients will be diagnosed and treated for lumbar spinal stenosis by primary care providers. This article reviews the pathophysiology, diagnosis, and management of lumbar spinal stenosis in adults over age 50 years. PMID:25763664

  14. Spinal cord contusion

    PubMed Central

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

    2014-01-01

    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. PMID:25206890

  15. Coexistence of amyotrophic lateral sclerosis with neuro-Behçet's disease presenting as a longitudinally extensive spinal cord lesion: clinicopathologic features of an autopsied patient.

    PubMed

    Sato, Tomoe; Ouchi, Haruka; Shimbo, Junsuke; Sato, Aki; Yamazaki, Motoyoshi; Hashidate, Hideki; Igarashi, Shuichi; Kakita, Akiyoshi

    2014-04-01

    We report the clinical and autopsy features of a 65-year-old Japanese man who clinically exhibited overlap of both neuro-Behçet's disease (NBD) and amyotrophic lateral sclerosis (ALS). The patient had a HLA-B51 serotype, a recent history of uveitis and had suffered paraparesis, sensory and autonomic disturbance, frontal signs and tremor. A brain and spine MRI study revealed a longitudinally extensive thoracic cord (Th) lesion, but no apparent intracranial abnormalities. The lesion extended ventrally from Th4 to Th9, exhibiting low intensity on T1-weighted images, high intensity on T2-weighted and fluid-attenuated inversion recovery images and gadolinium enhancement. The patient's upper and lower motor neuron signs and sensory disturbance worsened and he died 16 months after admission. At autopsy, the spinal cord and brain exhibited characteristic histopathological features of both NBD and ALS, including chronic destruction of the ventral thoracic white and gray matter, perivascular lymphocytic infiltration, binucleated neurons, lower and upper motor neuron degeneration, Bunina bodies and skein-like inclusions. Although incidental coexistence of these rare disorders could occur in an individual, this case raises the possibility of a pathomechanistic association between NBD and ALS. PMID:24118427

  16. Relationship between Spinal Cord Volume and Spinal Cord Injury due to Spinal Shortening

    PubMed Central

    Qiu, Feng; Yang, Jin-Cheng; Ma, Xiang-Yang; Xu, Jun-Jie; Yang, Qing-Lei; Zhou, Xin; Xiao, Yao-Sheng; Hu, Hai-Sheng; Xia, Li-Hui

    2015-01-01

    Vertebral column resection is associated with a risk of spinal cord injury. In the present study, using a goat model, we aimed to investigate the relationship between changes in spinal cord volume and spinal cord injury due to spinal shortening, and to quantify the spinal cord volume per 1-mm height in order to clarify a safe limit for shortening. Vertebral column resection was performed at T10 in 10 goats. The spinal cord was shortened until the somatosensory-evoked potential was decreased by 50% from the baseline amplitude or delayed by 10% relative to the baseline peak latency. A wake-up test was performed, and the goats were observed for two days postoperatively. Magnetic resonance imaging was used to measure the spinal cord volume, T10 height, disc height, osteotomy segment height, and spinal segment height pre- and postoperatively. Two of the 10 goats were excluded, and hence, only data from eight goats were analyzed. The somatosensory-evoked potential of these eight goats demonstrated meaningful changes. With regard to neurologic function, five and three goats were classified as Tarlov grades 5 and 4 at two days postoperatively. The mean shortening distance was 23.6 ± 1.51 mm, which correlated with the d-value (post-pre) of the spinal cord volume per 1-mm height of the osteotomy segment (r = 0.95, p < 0.001) and with the height of the T10 body (r = 0.79, p = 0.02). The mean d-value (post-pre) of the spinal cord volume per 1-mm height of the osteotomy segment was 142.87 ± 0.59 mm3 (range, 142.19–143.67 mm3). The limit for shortening was approximately 106% of the vertebral height. The mean volumes of the osteotomy and spinal segments did not significantly change after surgery (t = 0.310, p = 0.765 and t = 1.241, p = 0.255, respectively). Thus, our results indicate that the safe limit for shortening can be calculated using the change in spinal cord volume per 1-mm height. PMID:26001196

  17. Degenerative Spinal Deformity.

    PubMed

    Ailon, Tamir; Smith, Justin S; Shaffrey, Christopher I; Lenke, Lawrence G; Brodke, Darrel; Harrop, James S; Fehlings, Michael; Ames, Christopher P

    2015-10-01

    Degenerative spinal deformity afflicts a significant portion of the elderly and is increasing in prevalence. Recent evidence has revealed sagittal plane malalignment to be a key driver of pain and disability in this population and has led to a significant shift toward a more evidence-based management paradigm. In this narrative review, we review the recent literature on the epidemiology, evaluation, management, and outcomes of degenerative adult spinal deformity (ASD). ASD is increasing in prevalence in North America due to an aging population and demographic shifts. It results from cumulative degenerative changes focused in the intervertebral discs and facet joints that occur asymmetrically to produce deformity. Deformity correction focuses on restoration of global alignment, especially in the sagittal plane, and decompression of the neural elements. General realignment goals have been established, including sagittal vertical axis <50 mm, pelvic tilt <22°, and lumbopelvic mismatch <±9°; however, these should be tailored to the patient. Operative management, in carefully selected patients, yields satisfactory outcomes that appear to be superior to nonoperative strategies. ASD is characterized by malalignment in the sagittal and/or coronal plane and, in adults, presents with pain and disability. Nonoperative management is recommended for patients with mild, nonprogressive symptoms; however, evidence of its efficacy is limited. Surgery aims to restore global spinal alignment, decompress neural elements, and achieve fusion with minimal complications. The surgical approach should balance the desired correction with the increased risk of more aggressive maneuvers. In well-selected patients, surgery yields excellent outcomes. PMID:26378361

  18. Vertebral spinal osteophytes.

    PubMed

    Klaassen, Zachary; Tubbs, R Shane; Apaydin, Nihal; Hage, Robert; Jordan, Robert; Loukas, Marios

    2011-03-01

    Osteoarthritis is a common complication in the elderly and is often associated with osteophyte growth on vertebral bodies. The clinical presentation of vertebral osteophytes is related to anatomical structures adjacent to the spinal column. For instance, cervical osteophytes potentially involve the pharynx and esophagus, leading to dysphagic symptoms that may be accompanied by food aspiration, vocal fold paralysis and obstructive sleep apnea. In addition to anterior cervical osteophytes, posterior and uncinate process osteophytes may form, compressing the spinal cord and vertebral artery blood supply, respectively. Cervical osteophytes have also been shown to form an accessory median atlanto-occipital joint when the relationship between the atlas, dens and basiocciput is involved. In the thorax, the esophagus is often affected by osteophytes and may result in dysphagia. Traumatic and non-traumatic thoracic aorta pseudoaneurysm formation has been attributed to sharp osteophytes lacerating the aorta, a direct complication of the relationship between the aorta anterior vertebral column. Additionally, aspiration pneumonia was reported in patients with compression of a main stem bronchus, due to mechanical compression by thoracic osteophytes. In the lumbar spinal region, the two major structures in close proximity to the spine are the inferior vena cava and abdominal aorta, both of which have been reported to be affected by osteophytes. Treatment of osteophytes is initially conservative with anti-inflammatory medications, followed by surgical removal. Increasing obesity and geriatric populations will continue to result in an array of osteoarthritic degenerative changes such as osteophyte formation. PMID:20383671

  19. History of spinal osteotomy.

    PubMed

    Meredith, Dennis S; Vaccaro, Alexander R

    2014-07-01

    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

  20. Persistent paralysis after spinal anesthesia for cesarean delivery.

    PubMed

    Zaphiratos, Valerie; McKeen, Dolores M; Macaulay, Bruce; George, Ronald B

    2015-02-01

    Anterior spinal artery syndrome has rarely been reported as a cause of permanent neurologic complications after neuraxial anesthesia in obstetric patients. A parturient developed anterior spinal artery syndrome after spinal anesthesia for cesarean delivery. A healthy 32-year-old parturient presented at 41(2/7) weeks for primary elective caesarean delivery for breech presentation. Spinal anesthesia was easily performed with clear cerebrospinal fluid, and block height was T4 at 5 minutes. Intraoperative course was uneventful except for symptomatic bradycardia (37-40 beats per minute) and hypotension (88/44 mm Hg) 4 minutes postspinal anesthesia, treated with ephedrine and atropine. Dense motor block persisted 9 hours after spinal anesthesia, and magnetic resonance imaging of the lumbosacral region was normal, finding no spinal cord compression or lesion. Physical examination revealed deficits consistent with a spinal cord lesion at T6, impacting the anterior spinal cord while sparing the posterior tracts. PMID:25433726

  1. Spinal imaging in intracranial primary pleomorphic xanthoastrocytoma with anaplastic features.

    PubMed

    Nern, Christian; Hench, Jürgen; Fischmann, Arne

    2012-09-01

    We present a patient with an intracranial primary pleomorphic xanthoastrocytoma (PXA) with anaplastic features that recurred repeatedly after surgery. Late in the course, radiological follow-up revealed an unresectable spinal tumor. Very few patients with PXA associated with a spinal tumor have been reported. Earlier detection of the spinal lesion would have potentially improved the therapeutic options for the patient. PMID:22789631

  2. Central pattern generators of the mammalian spinal cord.

    PubMed

    Frigon, Alain

    2012-02-01

    Neuronal networks within the spinal cord of mammals are responsible for generating various rhythmic movements, such as walking, running, swimming, and scratching. The ability to generate multiple rhythmic movements highlights the complexity and flexibility of the mammalian spinal circuitry. The present review describes features of some rhythmic motor behaviors generated by the mammalian spinal cord and discusses how the spinal circuitry is able to produce different rhythmic movements with their own sets of goals and demands. PMID:21518815

  3. Solitary spinal dural syphilis granuloma mimicking a spinal meningioma.

    PubMed

    Zhou, Heng-Jun; Zhan, Ren-Ya; Chen, Man-Tao; Cao, Fei; Zheng, Xiu-Jue

    2014-01-01

    Dural granuloma is extremely rare. To our knowledge, there has no case reported solitary spinal dural syphilis granuloma worldwide so far. Here we report our findings in a 49-year-old woman, who presented with 10-year progressive left lower-limb numbness and two weeks of right lower-limb numbness. Magnetic resonance imaging (MRI) suggested a homogeneous enhanced spindle-shaped lesion, 2.9 × 1.5 cm in size, occupying the spinal intradural extramedullary space, at the level of Thoracic (T)-2/3, which mimicked the appearance of spinal meningioma. The Treponema pallidum particle agglutination (TPPA) test titer of 1:8, and the venereal diseases research laboratory of cerebral spinal fluid (VDRL-CSF) was reactive, so confirmed neurosyphilis was considered. After formal anti-syphilis treatment, posterior laminectomy surgery was performed, and the lesion was completely separated and extirpated. Final histopathologic diagnosis of the lesion was confirmed as chronic granulomatous inflammation, combined with the neurosyphilis history, spinal dural syphilis granuloma was finally diagnosed. Postoperatively, the patient recovered without any further treatment. PMID:24831378

  4. Spinal Cord Injury 101

    MedlinePlus Videos and Cool Tools

    ... Fertility After Spinal Cord Injury Coping with a New Injury Coping with a New Injury Adjusting to Social Life in a Wheelchair ... after an injury? What are the most promising new treatments for spinal cord injuries? What are the ...

  5. Tethered Spinal Cord Syndrome

    MedlinePlus

    ... If surgery is not advisable, spinal cord nerve roots may be cut to relieve pain. In adults, surgery to free (detether) the spinal cord can reduce the size and further development of cysts in the cord and may restore ...

  6. Spinal Cord Infarction

    MedlinePlus

    ... 800-225-0292 Fax: 973-912-9433 National Spinal Cord Injury Association 120-34 Queens Boulevard, #1320 Kew Gardens, ... 785-4452 Related NINDS Publications and Information NINDS Spinal Cord Injury Information Page Spinal cord injury information sheet compiled ...

  7. Brain and Spinal Tumors

    MedlinePlus

    ... Awards Enhancing Diversity Find People About NINDS NINDS Brain and Spinal Tumors Information Page Synonym(s): Spinal Cord ... en Español Additional resources from MedlinePlus What are Brain and Spinal Tumors? Tumors of the brain and ...

  8. Spinal Cord Injuries

    MedlinePlus

    ... your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures or ... bone disks that make up your spine. Most injuries don't cut through your spinal cord. Instead, ...

  9. Management of Spinal Meningiomas.

    PubMed

    Ravindra, Vijay M; Schmidt, Meic H

    2016-04-01

    Spinal meningiomas are the most common spinal tumors encountered in adults, and account for 6.5% of all craniospinal tumors. The treatment for these lesions is primarily surgical, but emerging modalities may include chemotherapy and radiosurgery. In this article, the current management of spinal meningiomas and the body of literature surrounding conventional treatment is reviewed and discussed. PMID:27012384

  10. Rehabilitation in spinal infection diseases

    PubMed Central

    Nas, Kemal; Karakoç, Mehmet; Aydın, Abdulkadir; Öneş, Kadriye

    2015-01-01

    Spinal cord infections were the diseases defined by Hypocrite yet the absence of modern medicine and there was not a real protocol in rehabilitation although there were many aspects in surgical treatment options. The patients whether surgically or conservatively treated had a lot of neurological, motor, and sensory disturbances. Our clinic has quite experience from our previous researchs. Unfortunately, serious spinal cord infections are still present in our region. In these patients the basic rehabilitation approaches during early, pre-operation, post-operation period and in the home environment will provide significant contributions to improve the patients’ sensory and motor skills, develop the balance and proriocaption, increase the independence of patients in daily living activities and minimize the assistance of other people. There is limited information in the literature related with the nature of the rehabilitation programmes to be applied for patients with spinal infections. The aim of this review is to share our clinic experience and summarise the publications about spinal infection rehabilitation. There are very few studies about the rehabilitation of spinal infections. There are still not enough studies about planning and performing rehabilitation programs in these patients. Therefore, a comprehensive rehabilitation programme during the hospitalisation and home periods is emphasised in order to provide optimal management and prevent further disability. PMID:25621205

  11. Acute thoracic epidural hematoma following spinal manipulative therapy: case report and review of the literature.

    PubMed

    Lee, Tsung-Han; Chen, Chih-Feng; Lee, Tao-Chen; Lee, Hsiang-Lin; Lu, Cheng-Hsien

    2011-09-01

    Spinal epidural hematoma is a rare complication of chiropractic manipulation. This study reports a case of thoracic spinal epidural hematoma following spinal manipulative therapy in the absence of predisposing factors. The effectiveness and safety of chiropractic treatment in chronic spinal pain and a literature review are also presented. PMID:21397387

  12. Management of infiltrating spinal epidural angiolipoma

    PubMed Central

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

    2015-01-01

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

  13. Acute Paraplegia as a Result of Hemorrhagic Spinal Ependymoma Masked by Spinal Anesthesia: Case Report and Review of Literature

    PubMed Central

    Lee, Sang-Hyo; Jeun, Sin-Soo

    2016-01-01

    Ependymomas are the most common intramedullary spinal cord tumors in adults. Although a hemorrhage within spinal ependymoma on imaging studies is not uncommon, it has rarely been reported to bea cause of acute neurological deficit. In the present report, we describe a case of a 24-year-old female patient who developed acute paraplegia as a result of hemorrhagic spinal ependymoma immediately after a cesarean delivery under spinal regional anesthesia. We review the literature of hemorrhagic spinal ependymomas presenting with acute neurological deficit and discuss the most appropriate treatment for a good neurological recovery. PMID:27195260

  14. Vascular malformations of the spinal cord (angiodysgenetic myelomalacia): a critique on its pathogenesis.

    PubMed

    Badejo, L; Sangalang, V E

    1979-02-01

    Two cases of angiodysgenetic myelomalacia are presented. Both patients had progressive weakness and sensory deficits in the lower extremities and vascular malformations of their spinal cords. The lesions were located on the dorsum of the spinal cord and the dorso-spinal roots. We believe the symptoms that developed later in life were due to spinal cord ischemia resulting from late degenerative changes in the vessels of the malformation and an ever increasing spinal "steal". PMID:424976

  15. Extradural spinal meningioma: Revisiting a rare entity

    PubMed Central

    Bettaswamy, Guruprasad; Ambesh, Paurush; Das, Kuntal Kanti; Sahu, Rabi; Srivastava, Arun; Mehrotra, Anant; Jaiswal, Awadhesh; Jaiswal, Sushila; Behari, Sanjay

    2016-01-01

    Spinal meningiomas are mostly intradural in location although at times these are associated with some extradural extensions. Purely extradural spinal meningiomas (EDSMs) are however, extremely rare and when present, may cause diagnostic dilemma preoperatively. Only seven cases of pure EDSM have been reported till date. In this paper, we describe two cases of EDSM affecting the cervical spine and present their clinical profiles, radiological findings, operative management, and follow-up data, along with a review of the literature.

  16. Post-traumatic recto-spinal fistula.

    PubMed

    Lantsberg, L; Laufer, L; Greenberg, G; Hertzanu, Y

    2000-01-01

    Acquired recto-spinal fistula has been described elsewhere as a rare complication of colorectal malignancy and Crohn's enterocolitis. We treated a young man who developed a recto-spinal fistula as a result of a high fall injury. The patient presented with meningeal signs, sepsis and perianal laceration. Computerized axial tomography revealed air in the supersellar cistern. Gastrografin enema showed that contrast material was leaking from the rectum into the spinal canal. Surgical management included a diverting sigmoid colostomy, sacral bone curettage and wide presacral drainage. To the best of our knowledge, rectospinal fistula of traumatic origin has not been previously reported in the English literature. PMID:10663732

  17. Genetically identified spinal interneurons integrating tactile afferents for motor control.

    PubMed

    Bui, Tuan V; Stifani, Nicolas; Panek, Izabela; Farah, Carl

    2015-12-01

    Our movements are shaped by our perception of the world as communicated by our senses. Perception of sensory information has been largely attributed to cortical activity. However, a prior level of sensory processing occurs in the spinal cord. Indeed, sensory inputs directly project to many spinal circuits, some of which communicate with motor circuits within the spinal cord. Therefore, the processing of sensory information for the purpose of ensuring proper movements is distributed between spinal and supraspinal circuits. The mechanisms underlying the integration of sensory information for motor control at the level of the spinal cord have yet to be fully described. Recent research has led to the characterization of spinal neuron populations that share common molecular identities. Identification of molecular markers that define specific populations of spinal neurons is a prerequisite to the application of genetic techniques devised to both delineate the function of these spinal neurons and their connectivity. This strategy has been used in the study of spinal neurons that receive tactile inputs from sensory neurons innervating the skin. As a result, the circuits that include these spinal neurons have been revealed to play important roles in specific aspects of motor function. We describe these genetically identified spinal neurons that integrate tactile information and the contribution of these studies to our understanding of how tactile information shapes motor output. Furthermore, we describe future opportunities that these circuits present for shedding light on the neural mechanisms of tactile processing. PMID:26445867

  18. Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis

    PubMed Central

    Hou, Zhong-jun; Huang, Yong; Fan, Zi-wen; Li, Xin-chun; Cao, Bing-yi

    2015-01-01

    Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging (DTI) for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy volunteers and 31 patients with lumbosacral stenosis. T2WI showed that the residual dural sac area was less than two-thirds that of the corresponding normal area in patients from L3 to S1 stenosis. On T1WI and T2WI, 74 lumbosacral spinal nerve roots from 31 patients showed compression changes. DTI showed thinning and distortion in 36 lumbosacral spinal nerve roots (49%) and abruption in 17 lumbosacral spinal nerve roots (23%). Moreover, fractional anisotropy values were reduced in the lumbosacral spinal nerve roots of patients with lumbosacral stenosis. These findings suggest that DTI can objectively and quantitatively evaluate the severity of lumbosacral spinal nerve root compression. PMID:26807125

  19. Posterior spinal artery syndrome showing marked swelling of the spinal cord: A clinico-pathological study

    PubMed Central

    Matsubayashi, Jun; Tsuchiya, Kuniaki; Shimizu, Soichiro; Kitagawa, Naoyuki; Wakabayashi, Yukari; Kuroda, Masahiko; Sakurai, Michio; Nagao, Toshitaka

    2013-01-01

    Objective To describe a rare autopsy case of posterior spinal artery syndrome with marked swelling of the spinal cord, an unusually subacute onset and short clinical course. Methods Case report. Findings An 84-year-old Japanese woman presented with bilateral muscle weakness of the lower legs and sensory disturbance 1 week after head contusion. Neurological findings worsened gradually. She developed phrenic nerve paralysis and died of respiratory failure 6 weeks after the onset of neurological symptoms. On pathological examination, the spinal cord was markedly swollen in the cervical and upper thoracic segments. Microscopically, there was loss of myelin sheath in the bilateral posterior columns and neuronal loss of the posterior horns in all of the spinal segments. However, findings were unremarkable in the bilateral anterior columns and bilateral anterior horns in most of the spinal segments. Posterior spinal arteries had no stenosis, occlusion, or thrombosis. We considered that pathogenesis was infarction associated with head injury. Conclusion To our knowledge, this is the first report of a case of posterior spinal artery syndrome with a markedly swollen spinal cord and poor prognosis. PMID:23433332

  20. Post-traumatic spinal deformity.

    PubMed

    Vaccaro, A R; Silber, J S

    2001-12-15

    There are approximately 50,000 fractures to the bony spinal column each year in the United States. The vast majority of unstable spinal injuries are recognized early and managed appropriately. Rarely, the initial treatment may have been inadequate, or in less obvious injuries, less aggressive immobilization techniques may have been chosen. This along with continued exposure to physiologic stresses may lead to a gradual post-traumatic deformity that may further impede the functional as well as emotional status of these often already compromised patients. The management of post-traumatic deformity can be extremely challenging. A post-traumatic kyphotic deformity may occur in the cervical, thoracic, thoracolumbar, or lumbar spine, and once appropriate imaging studies are obtained, careful surgical considerations must be undertaken. Surgical intervention is considered if the kyphotic deformity is progressive over time or there is new onset or progression of a neurologic deficit. Surgical procedures include either a posterior or anterior only approach or any variation of a combined anterior or posterior procedure. In most cases a posterior only fusion is often insufficient for optimal correction and stabilization. Although the majority of patients developing a post-traumatic deformity usually occur after spinal column trauma initially treated nonoperatively, several miscellaneous causes of post-traumatic deformity may occur after surgery. These include nonunion, implant failure, Charcot spine, and technical error. The overall outcome after the surgical management of post-traumatic deformity has been satisfactory with better outcomes in the patients treated earlier as opposed to later. Operative complications include the increased risk of neurologic injury because of the draping of the neural elements over the anterior vertebral elements, any pre-existing spinal cord injury, and possible scarring with cord tethering. Trauma to the spinal cord and column is a devastating injury that may be fraught with many complications including post-traumatic deformity. Certainly, the best treatment is prevention with close follow-up and early intervention when needed. Once present, the treatment of post-traumatic deformity follows basic biomechanical principles consisting of re-establishing the integrity of the compromised spinal columns so that spinal stability can be restored. PMID:11805617

  1. Spinal muscular atrophies.

    PubMed

    Darras, Basil T

    2015-06-01

    Spinal muscular atrophies (SMAs) are hereditary degenerative disorders of lower motor neurons associated with progressive muscle weakness and atrophy. Proximal 5q SMA is caused by decreased levels of the survival of motor neuron (SMN) protein and is the most common genetic cause of infant mortality. Its inheritance pattern is autosomal recessive, resulting from mutations involving the SMN1 gene on chromosome 5q13. Unlike other autosomal recessive diseases, the SMN gene has a unique structure (an inverted duplication) that presents potential therapeutic targets. Although there is currently no effective treatment of SMA, the field of translational research in this disorder is active and clinical trials are ongoing. Advances in the multidisciplinary supportive care of children with SMA also offer hope for improved life expectancy and quality of life. PMID:26022173

  2. [Spinal instrumentation and spinal fusion surgery].

    PubMed

    Futatsuki, Takahiro; Kakihana, Yasuyuki; Nakamura, Kentaro; Hirakawa, Ai; Yamaguchi, Keiji; Yasuda, Tomotsugu

    2014-05-01

    In this article, we review the potential complications of spinal instrumentation discussing various types of postoperative complications. Surgical implants in spinal surgeries are used to stabilize the spine, replace the defective parts and maintain anatomic reduction. Internal spinal instrumentation has undergone considerable advances during the last century. However, the spinal instrumentation is an invasive surgery, and postoperative complications occur frequently after the spinal deformity surgery. Elderly patients, who may have many histories of medical complications and osteoporosis, have a higher complication rate. Pulmonary complications are the most common life-threatening postoperative complications. The acute onset of neurologic symptoms in the immediate postoperative period should arouse clinical suspicion about the possible formation of a hematoma. Such occurrences require urgent surgical decompression. Better recognition of postoperative risk factors and early detection of urgent signs may lead to decrease complication rates and may improve outcomes. Although the latest monitoring system is very useful we should recognize that the observation of the patients by the five senses is the most important way to detect the postoperative medical complications early. PMID:24864573

  3. Spinal cord herniation with characteristic bone change: a case report

    PubMed Central

    Imai, Tasuku; Nakane, Yukimi; Tachibana, Eiji; Ogura, Koichiro

    2015-01-01

    ABSTRACT Spinal cord herniation (SCH) is a rare disease characterized by herniation of the thoracic spinal cord through an anterior dural defect, presenting with progressive myelopathy. A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented. The strangled spinal cord was released, and the defect was closed microsurgically using an artificial dural patch to prevent re-herniation. Postoperatively, the patient experienced gradual improvement in neurologic function. The SCH mechanism and surgical strategy are discussed. PMID:26412899

  4. Isolated and silent spinal neurocysticercosis associated with pseudotumor cerebri

    PubMed Central

    Pattanaik, Jaya K; Satpathy, Sanjoy K; Joshi, Sonia

    2008-01-01

    Incidence of spinal neurocysticercosis (NCC) is rare. Isolated spinal NCC is still rarer. We present here a case report where a young lady presented with all the clinical features of pseudotumor cerebri (PTC), where medical treatment for PTC failed and the presence of cysticercous in spinal canal was detected only on the operation table, while doing a lumbo- peritoneal shunt (LP shunt) to save her vision. Diagnosis could be confirmed only after the histopathology report was received. She did not have any direct evidence of spinal involvement, thereby eluding correct diagnosis. In English literature, we could not find any report of isolated and silent spinal NCC associated with PTC. In addition, we could not find any report of recovery of cysticercous larva through the Touhey′s needle injury, although this was an incidental finding. In endemic areas, isolated spinal NCC should be suspected in patients presenting with PTC. PMID:18417834

  5. Spinal Cord Injury Map

    MedlinePlus

    ... Short List Government Programs Family and Caregiver Support Financial Help Active Lifestyle Advocacy Employment and Education Adaptive Technology Recent Medical Research Good Things to Read Spinal Cord Injury Facts and Figures Model System Rehab Hospitals Pediatric Spinal Cord Injury Sex and ...

  6. Effects of asymmetric sitting on spinal balance

    PubMed Central

    Woo, Hee Soon; Oh, Jong Chi; Won, Sung Yoon

    2016-01-01

    [Purpose] To investigate the effects of two common asymmetric sitting positions on spinal balance. [Subjects and Methods] Thirty-seven healthy subjects in their twenties were enrolled and randomly divided into two groups. Asymmetric positions of resting the chin on a hand and crossing the legs were performed by each group for 1 hour. After 1 hour, the subjects lay in the supine position again and spinal imbalance was measured using a device. [Results] After 1 hour of resting with the chin on a hand, sagittal imbalance, coronal imbalance, pelvic obliquity and lordosis angle presented spinal imbalance worsening of 1 hour of crossing legs, sagittal imbalance, pelvic torsion showed in mainly learned spinal imbalance living. [Conclusion] Good posture could be an innate ability, however it through habits. So this study is meaningful from the perspective of the importance of good posture. PMID:27065291

  7. Multiple sclerosis of the spinal cord: Magnetic resonance appearance

    SciTech Connect

    Thielen, K.R.; Miller, G.M.

    1996-05-01

    To determine the MR appearance of spinal cord multiple sclerosis (MS) plaques in patients presenting with myclopathy by using a high-field (1.5 T) imager. We studied 119 patients who underwent high-field (1.5 T) MR studies of the spinal cord for evaluation of myelopathy. All 119 patients were thought to have possible findings of spinal cord MS at the time of the MRI interpretation. Sixty-four plaques were studied in 47 patients with clinically definite MS and adequate quality MRI. Of these patients 68% had a single spinal cord plaque, 19% had two plaques, and 13% had three or more plaques. Sixty-two percent of the plaques occurred in the cervical spinal cord and most frequently involved the posterior (41%) and lateral (25%) aspects of the spinal cord. None of the 64 lesions involved the entire thickness of the spinal cord. The lesion length varied from 2 to 60 mm, with 84% of the lesions <15 mm in length. The spinal cord diameter was unchanged in 84% of plaques, enlarged at the level of the lesion in 14%, and atrophic in 2%. Just over half (55%) of the plaques enhanced with intravenously administered gadolinium. Of the patients who received synchronous head and spinal cord examinations on the same day, 24% had normal findings on the MR study of the head. Follow-up spinal cord studies were available in nine patients. New lesions developed in two patients, while previously described lesions resolved. In three patients only new lesions developed. In four patients no change occurred in the existing number of cord plaques. Spinal cord demyelinating plaques present as well-circumscribed foci of increased T2 signal that asymmetrically involve the spinal cord parenchyma. Knowledge of their usual appearance may prevent unnecessary biopsy. An MR examination of the head may confirm the imaging suggestion of spinal cord demyelinating disease, because up to 76% of patients have abnormal intracranial findings. 15 refs., 7 figs.

  8. Spinal injuries in sports.

    PubMed

    Boden, Barry P; Jarvis, Christopher G

    2008-02-01

    Athletic competition has long been a known source of spinal injuries. Approximately 8.7% of all new cases of spinal cord injuries in the United States are related to sports activities. The sports activities that have the highest risk of catastrophic spinal injuries are football, ice hockey, wrestling, diving, skiing, snowboarding, rugby, and cheerleading. Axial compression forces to the top of the head can lead to cervical fracture and quadriplegia in any sport. It is critical for any medical personnel responsible for athletes in team sports to have a plan for stabilization and transfer of an athlete who sustains a cervical spine injury. PMID:18295084

  9. Spinal injuries in sports.

    PubMed

    Boden, Barry P; Jarvis, Christopher G

    2009-02-01

    Athletic competition has long been a known source of spinal injuries. Approximately 8.7% of all new cases of spinal cord injuries in the United States are related to sports activities. The sports activities that have the highest risk of catastrophic spinal injuries are football, ice hockey, wrestling, diving, skiing, snowboarding, rugby, and cheerleading. Axial compression forces to the top of the head can lead to cervical fracture and quadriplegia in any sport. It is critical for any medical personnel responsible for athletes in team sports to have a plan for stabilization and transfer of an athlete who sustains a cervical spine injury. PMID:19084763

  10. Segmentation of the human spinal cord.

    PubMed

    De Leener, Benjamin; Taso, Manuel; Cohen-Adad, Julien; Callot, Virginie

    2016-04-01

    Segmenting the spinal cord contour is a necessary step for quantifying spinal cord atrophy in various diseases. Delineating gray matter (GM) and white matter (WM) is also useful for quantifying GM atrophy or for extracting multiparametric MRI metrics into specific WM tracts. Spinal cord segmentation in clinical research is not as developed as brain segmentation, however with the substantial improvement of MR sequences adapted to spinal cord MR investigations, the field of spinal cord MR segmentation has advanced greatly within the last decade. Segmentation techniques with variable accuracy and degree of complexity have been developed and reported in the literature. In this paper, we review some of the existing methods for cord and WM/GM segmentation, including intensity-based, surface-based, and image-based methods. We also provide recommendations for validating spinal cord segmentation techniques, as it is important to understand the intrinsic characteristics of the methods and to evaluate their performance and limitations. Lastly, we illustrate some applications in the healthy and pathological spinal cord. One conclusion of this review is that robust and automatic segmentation is clinically relevant, as it would allow for longitudinal and group studies free from user bias as well as reproducible multicentric studies in large populations, thereby helping to further our understanding of the spinal cord pathophysiology and to develop new criteria for early detection of subclinical evolution for prognosis prediction and for patient management. Another conclusion is that at the present time, no single method adequately segments the cord and its substructure in all the cases encountered (abnormal intensities, loss of contrast, deformation of the cord, etc.). A combination of different approaches is thus advised for future developments, along with the introduction of probabilistic shape models. Maturation of standardized frameworks, multiplatform availability, inclusion in large suite and data sharing would also ultimately benefit to the community. PMID:26724926

  11. Spinal transection induces widespread proliferation of cells along the length of the spinal cord in a weakly electric fish

    PubMed Central

    Allen, Antiño R.; Smith, G. Troy

    2013-01-01

    The ability to regenerate spinal cord tissue after tail amputation has been well studied in several species of teleost fish. The present study examined proliferation and survival of cells following complete spinal cord transection rather than tail amputation in the weakly electric fish Apteronotus leptorhynchus. To quantify cell proliferation along the length of the spinal cord, fish were given a single bromodeoxyuridine (BrdU) injection immediately after spinal transection or sham surgery. Spinal transection significantly increased the density of BrdU+ cells along the entire length of the spinal cord at 1 day post transection (dpt), and most newly generated cells survived up to 14 dpt. To examine longer term survival of the newly proliferated cells, BrdU was injected for 5 days after the surgery, and fish were sacrificed 14 or 30 dpt. Spinal transection significantly increased proliferation and/or survival, as indicated by an elevated density of BrdU+ cells in the spinal cords of spinally transected compared to sham-operated and intact fish. At 14 dpt, BrdU+ cells were abundant at all levels of the spinal cord. By 30 dpt, the density of BrdU+ cells decreased at all levels of the spinal cord except at the tip of the tail. Thus, newly generated cells in the caudal-most segment of the spinal cord survived longer than those in more rostral segments. Our findings indicate that spinal cord transection stimulates widespread cellular proliferation; however, there were regional differences in the survival of the newly generated cells. PMID:23147638

  12. Large spinal intraosseous arteriovenous fistula: case report.

    PubMed

    Imajo, Yasuaki; Kanchiku, Tsukasa; Yoshida, Yuichiro; Nishida, Norihiro; Taguchi, Toshihiko

    2015-04-01

    Here the authors report the case of a fresh vertebral body fracture with a large spinal intraosseous arteriovenous fistula (AVF). A 74-year-old woman started to experience low-back pain following a rear-end car collision. Plain radiography showed diffuse idiopathic skeletal hyperostosis (DISH). Sagittal CT sections revealed a transverse fracture of the L-4 vertebral body with a bone defect. Sagittal fat-suppressed T2-weighted MRI revealed a flow void in the fractured vertebra. Spinal angiography revealed an intraosseous AVF with a feeder from the right L-4 segmental artery. A fresh fracture of the L-4 vertebral body with a spinal intraosseous AVF was diagnosed. Observation of a flow void in the vertebral body on fat-suppressed T2-weighted MRI was important for the diagnosis of the spinal intraosseous AVF. Because conservative treatment was ineffective, surgery was undertaken. The day before surgery, embolization through the right L-4 segmental artery was performed using 2 coils to achieve AVF closure. Posterolateral fusion with instrumentation at the T12-S2 vertebral levels was performed without L-4 vertebroplasty. The spinal intraosseous AVF had disappeared after 4 months. At 24 months after surgery, the bone defect was completely replaced by bone and the patient experienced no limitations in daily activities. Given their experience with the present case, the authors believe that performing vertebroplasty or anterior reconstruction may not be necessary in treating spinal intraosseous AVF. PMID:25635636

  13. Management of spinal fractures in patients with ankylosing spondylitis.

    PubMed

    El Tecle, Najib E; Abode-Iyamah, Kingsley O; Hitchon, Patrick W; Dahdaleh, Nader S

    2015-12-01

    Ankylosing spondlylitis is a seronegative spondyloarthropathy that primarily affects the spinal column and sacroiliac joints. With disease progression autofusion of the spinal column takes place. This combined with the brittle bone quality make patients prone to fractures and spinal cord injury. The typical fracture pattern is extension type and involves all three columns. These fractures and injuries may involve the craniovertebral junction, the subaxial cervical spine, and the thoracolumbar spine. While at times these fractures are challenging to manage especially when they affect the elderly, there is evidence that supports long segment fixation and fusion. This article presents a narrative review on managing spinal fractures in patients with ankylosing spondylitis. PMID:26513429

  14. What Is Spinal Stenosis?

    MedlinePlus

    ... To order the Sports Injuries Handout on Health full-text version, please contact NIAMS using the contact information ... publication. To order the Spinal Stenosis Q&A full-text version, please contact NIAMS using the contact information ...

  15. Spinal cord abscess

    MedlinePlus

    ... irritation (inflammation) and the collection of infected material (pus) in or around the spinal cord. ... occurs as a complication of an epidural abscess . Pus forms as a collection of: Destroyed tissue cells ...

  16. Spinal and epidural anesthesia

    MedlinePlus

    Intraspinal anesthesia; Subarachnoid anesthesia; Epidural; Peridural anesthesia ... Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). Patients usually recover their senses ...

  17. Spinal Cord Injury

    MedlinePlus

    ... Dramatically Improves Function After Spinal Cord Injury in Rats May 2004 press release on an experimental treatment ... NINDS). Signaling Molecule Improves Nerve Cell Regeneration in Rats August 2002 news summary on a signaling molecule ...

  18. Spinal Muscular Atrophy

    MedlinePlus

    ... it led to collaboration with several pharmaceutical and biotechnology companies. NIH Patient Recruitment for Spinal Muscular Atrophy ... From NINDS | Find People | Training | Research | Enhancing Diversity Careers@NINDS | FOIA | Accessibility Policy | Contact Us | Privacy Statement ...

  19. Spinal palpatory diagnostic procedures utilized by practitioners of spinal manipulation: annotated bibliography of content validity and reliability studies

    PubMed Central

    Seffinger, Michael; Adams, Alan; Najm, Wadie; Dickerson, Vivian; Mishra, Shiraz I; Reinsch, Sibylle; Murphy, Linda

    2003-01-01

    The diagnosis of spinal neuro-musculoskeletal dysfunction is a pre-requisite for application of spinal manual therapy. Different disciplines rely on palpatory procedures to establish this diagnosis and design treatment plans. Over the past 30 years, the osteopathic, chiropractic, physical therapy and allopathic professions have investigated the validity and reliability of spinal palpatory procedures. We explored the literature from all four disciplines looking for scientific papers studying the content validity and reliability of spinal palpatory procedures. Thirteen databases were searched for relevant papers between January 1966 and October 2001. An annotated bibliography of these articles is presented and organized by the type of test used.

  20. Recurrence of benign spinal neoplasms.

    PubMed

    Schick, U; Marquardt, G; Lorenz, R

    2001-03-01

    The outcome of surgical treatment of benign spinal neoplasms is considered to be excellent, with good improvement of neurological function. The risk of recurrence is estimated to be very low, except with subtotal resections. This retrospective study was designed to establish the course of illness, clinical outcome, and recurrence rate of benign spinal tumours. We present an overview of the clinical outcome and surgical treatment of 197 benign spinal tumours carried out in our centre from 1980 to 1999. Clinical history, signs, surgical approach, outcome, and radiological reports were obtained by reviewing patient charts. The most frequent benign tumour was meningeoma (41%), closely followed by neurinoma (33%) and neurofibroma (6.1%). Of all tumours, 79.7% were completely resected. Recurrence happened in 10.2% on an average of 4.3 years postoperatively. Only 2 patients suffered from neurofibromatosis. All neurinomas were completely resected at first operation, whereas three out of seven recurrent meningeomas and all ependymomas were classified as subtotally resected. Seventy per cent were treated by repeated surgical intervention. Benign tumours usually can be completely removed without adding to patients' neurological deficits. Benign tumours recur in 10.2% of cases, thus requiring long-term follow-up. Magnetic resonance imaging (MRI) studies are recommended up to 5 years postoperatively as a routine procedure. PMID:11339463

  1. Modeling spinal cord biomechanics

    NASA Astrophysics Data System (ADS)

    Luna, Carlos; Shah, Sameer; Cohen, Avis; Aranda-Espinoza, Helim

    2012-02-01

    Regeneration after spinal cord injury is a serious health issue and there is no treatment for ailing patients. To understand regeneration of the spinal cord we used a system where regeneration occurs naturally, such as the lamprey. In this work, we analyzed the stress response of the spinal cord to tensile loading and obtained the mechanical properties of the cord both in vitro and in vivo. Physiological measurements showed that the spinal cord is pre-stressed to a strain of 10%, and during sinusoidal swimming, there is a local strain of 5% concentrated evenly at the mid-body and caudal sections. We found that the mechanical properties are homogeneous along the body and independent of the meninges. The mechanical behavior of the spinal cord can be characterized by a non-linear viscoelastic model, described by a modulus of 20 KPa for strains up to 15% and a modulus of 0.5 MPa for strains above 15%, in agreement with experimental data. However, this model does not offer a full understanding of the behavior of the spinal cord fibers. Using polymer physics we developed a model that relates the stress response as a function of the number of fibers.

  2. Non-hepatocellular carcinoma spinal metastases.

    PubMed

    Goodwin, C Rory; Abu-Bonsrah, Nancy; Boone, Christine; Ruiz-Valls, Alejandro; Sankey, Eric W; Sarabia-Estrada, Rachel; Elder, Benjamin D; Kosztowski, Thomas; Sciubba, Daniel M

    2016-05-01

    Metastases to the spine from non-hepatocellular carcinomas, such as cholangiocarcinoma and angiosarcoma, occur rarely. With improvements in oncologic care, the number of patients diagnosed with metastatic cancer is expected to increase. We performed a systematic review of the literature to assess the clinical presentation, treatment, outcome and survival of patients diagnosed with non-hepatocellular carcinoma spinal metastasis using PubMed, Embase, CINAHL, Cochrane Library and Web of Science. We identified 19 cases of spinal metastases from non-hepatocellular carcinomas that fit our pre-specified criteria. The mean age at presentation was 62.3years and cholangiocarcinoma was the most common subtype. Patients frequently presented with pain, weakness or paraparesis and at the time of diagnosis, most of them had multi-level involvement of the spine. A majority of patients with spinal metastasis were treated either with radiation or chemotherapy or received no treatment. A minority of the reports included information on survival, which revealed a median survival of 1.5months following diagnosis of the spinal metastasis. Although there is a paucity of published literature on non-hepatocellular carcinoma spinal metastasis, this systematic review provides descriptive clinical characteristics of these patients. PMID:26778049

  3. Spinal osteosarcoma in a hedgehog with pedal self-mutilation.

    PubMed

    Rhody, Jeffrey L; Schiller, Chris A

    2006-09-01

    An African pygmy hedgehog (Atelerix albiventris) was diagnosed with osteosarcoma of vertebral origin with compression of the spinal cord and spinal nerves. The only presenting sign was a self-mutilation of rear feet. Additional diagnoses included a well-differentiated splenic hemangiosarcoma, an undifferentiated sarcoma of the ascending colon, and membranoproliferative glomerulonephritis. PMID:16931383

  4. Continuous spinal anesthesia.

    PubMed

    Moore, James M

    2009-01-01

    Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a somewhat unpredictable spread and duration of effect, CSA allows titration of the block level to the patient's needs, permits a spinal block of indefinite duration, and can provide greater hemodynamic stability than single-injection spinal anesthesia. PMID:19546804

  5. Imaging features of spinal tanycytic ependymoma.

    PubMed

    Tomek, Michal; Jayajothi, Anandapadmanabhan; Brandner, Sebastian; Jaunmuktane, Zane; Lee, Cheong Hung; Davagnanam, Indran

    2016-02-01

    Tanycytic ependymoma is an unusual morphological variant of WHO grade II ependymoma, typically arising from the cervical or thoracic spinal cord. Although the literature deals extensively with pathological features of this tumour entity, imaging features have not been well characterised. The purpose of this study was to review magnetic resonance imaging (MRI) features of spinal tanycytic ependymomas reported in the literature to date, exemplified by a case of a patient with tanycytic ependymoma of the conus medullaris presenting to our hospital. A Medline search of the English literature for all previously published cases of spinal tanycytic ependymoma was carried out and the reported MRI features reviewed. The tumours were found to be typically well-demarcated masses, predominantly showing isointensity on T1-weighted signal, and T2-weighted hyperintensity, with variable patterns of contrast enhancement. A cystic component was seen in half of the cases, and in a minority a mural nodule was present within the cyst wall. Associated syrinx formation was observed in one-third of the cases and haemorrhage was rare, which may be helpful pointers in differentiating the lesion from other ependymoma subtypes. In conclusion, MRI characteristics of spinal tanycytic ependymoma are variable and non-specific, and radiological diagnosis thus remains challenging, although certain predominant features are identified in this report. Knowledge of these is important in the diagnostic differentiation from other intramedullary and extramedullary spinal tumours in order to guide appropriate surgical management. PMID:26755489

  6. An interesting case of primary spinal arachnoiditis.

    PubMed

    Vaughan, Denis; Bolger, Ciaran; O'Brien, Donncha Finbar

    2012-08-01

    Spinal arachnoiditis describes inflammation of the meninges, subarachnoid space and, in most cases, also involve the pial layer. The vast majority of cases described are secondary and are preceded by a known event, for example,. trauma, infections or irritative substances. Here, we present the case of primary spinal arachnoiditis. A 35-year-old lady was referred to the neurosurgical services in Dublin, Ireland with a 15-month history of progressive, right lower limb weakness. Magnetic resonance imaging revealed cystic distortion of the lumbar spinal canal extending up to the conus. Initially, an L2-L4 laminectomy was performed revealing thickened and adherent arachnoid with a large cyst in the spinal canal. Four months after initial operation, the patient represented with bilateral lower limb weakness and loss of detrusor function. Repeat magnetic resonance imaging was performed, which showed the development of a syrinx in the patient's thoracic spine. We then performed a T9-T10 laminectomy, midline myelotomy and insertion of a syringe-arachnoid shunt. Post-operative imaging showed resolution of the syrinx and a vast improvement in lower limb power. The patient also regained bladder control. In conclusion, spinal arachnoiditis is a clearly defined pathological and radiological entity with a highly variable clinical presentation. It is exceedingly difficult to treat as there is no recognised treatment currently, with most interventions aimed at symptomatic relief. PMID:22369357

  7. Primary Multifocal Gliosarcoma of the Spinal Cord

    PubMed Central

    Kumar, Ramesh M.; Finn, Michael

    2016-01-01

    Gliosarcoma (GS) is a rare and exceedingly malignant neoplasm of the central nervous system. It displays clinical features similar to glioblastoma, yet is histologically unique as it harbors both gliomatous and sarcomatous cellular components. Involvement of the neuro-axis is predominantly limited to the cerebral parenchyma and meninges. Primary GS of the spinal cord is rarely encountered. We report a case of a 54 year old male who presented with 2 months of progressive, bilateral lower extremity sensory deficits. Magnetic resonance imaging of the neuro-axis revealed multiple intradural lesions involving the cervical and thoracic spinal cord without evidence of intracranial involvement. Surgical resection of a dural based, extramedullary cervical lesion and two exophytic, intramedullary thoracic lesions revealed gliosarcoma, WHO grade IV. The patient died approximately 11 months after presentation. This report confirms that GS is not limited to supratentorial involvement and can primarily affect the spinal cord.

  8. The tethered spinal cord: an overview.

    PubMed

    Patterson, P

    1989-12-01

    The growing child with a tethered spinal cord experiences serious neurological deficits as a result of traction on the conus medullaris. Children with tethered cords most commonly present with pain in the lower back, with motor or sensory loss in the lower limbs, with bowel or bladder dysfunction, or with scoliosis. Often, the neurological basis of these symptoms is overlooked. Surgical release of tethering arrests neurological deterioration. Without surgical intervention symptoms will progressively worsen and may become irreversible. Preoperatively the nurse must prepare the child and his family for neurological investigations and for surgery. Postoperatively the nurse must be skilled in assessing spinal cord function, providing pain management, and assisting in ambulation. This presentation will review the pathophysiology of the tethered spinal cord, the preparation of the school-aged child for surgery, and the postoperative nursing care of the pediatric laminectomy patient. PMID:2688738

  9. Spinal surgery -- cervical - series (image)

    MedlinePlus

    Cervical spine disease is usually caused by herniated intervertebral discs, abnormal growth of bony processes on the vertebral ... spinal column around the spinal cord. Symptoms of cervical spine problems include: pain that interferes with daily activities ...

  10. Neurosyphilis manifesting as spinal transverse myelitis.

    PubMed

    Matijosaitis, Vaidas; Vaitkus, Antanas; Pauza, Valius; Valiukeviciene, Skaidra; Gleizniene, Rymante

    2006-01-01

    Spinal myelitis caused by neurosyphilis is an extremely rare disease, and there are only few visual examples of magnetic resonance imaging scans. We present a clinical case of neurosyphilis, which is of great importance concerning diagnostic, differential diagnosis, and tactics of management. A patient complaining of progressive legs weakness, numbness, and shooting-like pain in the legs as well as pelvic dysfunction was admitted to the hospital. Neurological examination revealed spinal cord lesion symptoms: legs weakness, impairment of superficial and deep sensation together with pathological symptoms in the legs. Hernia of intervertebral disc or tumor was suspected, and myelography with computed tomography of the spine was performed. No pathological findings were observed. More precise examination of the patient (a small scar in the genitals and condylomata lata in anal region were noticed) pointed to possible syphilis-induced spinal cord lesion. Serologic syphilis diagnostic tests (Treponema pallidum hemagglutination assay, reagin plasma response, serum enzyme-linked immunosorbent assay) and cerebrospinal fluid tests (general cerebrospinal fluid test and Venereal Disease Research Laboratory test) confirmed the diagnosis of neurosyphilis. Spinal cord lesion determined by magnetic resonance imaging was evaluated as spinal syphilis or syphilis-induced myelitis. Conventional treatment showed a partial effect. PMID:16778468

  11. Beliefs and Practice Patterns in Spinal Manipulation and Spinal Motion Palpation Reported by Canadian Manipulative Physiotherapists

    PubMed Central

    Macdermid, Joy C.; Santaguida, P. Lina; Thabane, Lehana; Giulekas, Kevin; Larocque, Leo; Millard, James; Williams, Caitlin; Miller, Jack; Chesworth, Bert M.

    2013-01-01

    ABSTRACT Purpose: This practice survey describes how Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) use spinal manipulation and mobilization and how they perceive their competence in performing spinal assessment; it also quantifies relationships between clinical experience and use of spinal manipulation. Methods: A cross-sectional survey was designed based on input from experts and the literature was administered to a random sample of the FCAMPT mailing list. Descriptive (including frequencies) and inferential statistical analyses (including linear regression) were performed. Results: The response rate was 82% (278/338 eligible FCAMPTs). Most (99%) used spinal manipulation. Two-thirds (62%) used clinical presentation as a factor when deciding to mobilize or manipulate. The least frequently manipulated spinal region was the cervical spine (2% of patients); 60% felt that cervical manipulation generated more adverse events. Increased experience was associated with increased use of upper cervical manipulation among male respondents (14% more often for every 10 years after certification; ?, 95%CI=1.37, 0.891.85, p<0.001) but not among female respondents. Confidence in palpation accuracy decreased in lower regions of the spine. Conclusion: The use of spinal manipulation/mobilization is prevalent among FCAMPTs, but is less commonly used in the neck because of a perceived association with adverse events. PMID:24403681

  12. Spinal cord injury pain.

    PubMed

    Saulino, Michael

    2014-05-01

    Chronic pain associated with traumatic spinal cord injury (SCI) can be quite challenging to the physiatrist. This highly prevalent condition within the SCI population requires an appropriate evaluative approach including a thorough history, a targeted physical examination, and appropriate use of diagnostic testing. The International Spinal Cord Injury Pain Classification allows for a reasonable categorization of the various pain syndromes and may assist in selecting a reasoned treatment strategy. A multitude of management approaches exist including nonpharmacologic, pharmacologic, and interventional approaches. This article provides an overview of the epidemiology, classification, evaluation, and management of SCI-associated pain. PMID:24787340

  13. Spinal cord concussion.

    PubMed

    Parkinson, D; Del Bigio, M; Jell, R M

    1981-11-01

    A reliable experimental model using decerebrate frogs has been developed by which a measured cutaneous stimulus to the right forelimb produces a single electrical response from the left sciatic nerve. Using this model, the minimal concussing force necessary to abolish the propagation of the nerve impulse down the spinal cord was established by trial and error. The mean recovery time was 31.2 seconds, with a standard deviation of 1.32 seconds. Recovery of function of the spinal cord, as measured this method, was complete following single and multiple concussions. PMID:6977881

  14. Radiation-induced spinal cord hemorrhage (hematomyelia).

    PubMed

    Agarwal, Amit; Kanekar, Sangam; Thamburaj, Krishnamurthy; Vijay, Kanupriya

    2014-10-23

    Intraspinal hemorrhage is very rare and intramedullary hemorrhage, also called hematomyelia, is the rarest form of intraspinal hemorrhage, usually related to trauma. Spinal vascular malformations such intradural arteriovenous malformations are the most common cause of atraumatic hematomyelia. Other considerations include warfarin or heparin anticoagulation, bleeding disorders, spinal cord tumors. Radiation-induced hematomyelia of the cord is exceedingly rare with only one case in literature to date. We report the case of an 8 year old girl with Ewing's sarcoma of the thoracic vertebra, under radiation therapy, presenting with hematomyelia. We describe the clinical course, the findings on imaging studies and the available information in the literature. Recognition of the clinical pattern of spinal cord injury should lead clinicians to perform imaging studies to evaluate for compressive etiologies. PMID:25568739

  15. Spinal hemangioblastoma combined with pilocytic astrocytoma.

    PubMed

    Li, Wei-Qing; Wang, Xiang; Zhong, Nan-Zhe; Li, Yi-Ming

    2015-07-01

    The combination of vascular anomalies with gliomas is rarely seen in the CNS, and is defined as "angioglioma". However, the definition, category, and histopathogenesis of angiogliomas remain controversial. Here, we present an unusual case of spinal hemangioblastoma (HB) combined with pilocytic astrocytoma (PA). Spinal MRI revealed lesions extending from T9 to T12 segments, in a "sandwich-like" fashion. After resection of the tumor, histopathologic study confirmed the diagnosis of HB as well as PA. A comprehensive review of the literature was further conducted. We describe a case of spinal HB combined with PA, in addition we discuss the clinicopathological relationship between HB and PA under these conditions, which may facilitate the understanding of the histogenesis of an angioglioma and guide its diagnosis and treatment. PMID:26166599

  16. Spinal hemangioblastoma combined with pilocytic astrocytoma

    PubMed Central

    Li, Wei-Qing; Wang, Xiang; Zhong, Nan-Zhe; Yi-Li, Ming

    2015-01-01

    The combination of vascular anomalies with gliomas is rarely seen in the CNS, and is defined as ‘angioglioma’. However, the definition, category, and histopathogenesis of angiogliomas remain controversial. Here, we present an unusual case of spinal hemangioblastoma (HB) combined with pilocytic astrocytoma (PA). Spinal MRI revealed lesions extending from T9 to T12 segments, in a “sandwich-like” fashion. After resection of the tumor, histopathologic study confirmed the diagnosis of HB as well as PA. A comprehensive review of the literature was further conducted. We describe a case of spinal HB combined with PA, in addition we discuss the clinicopathological relationship between HB and PA under these conditions, which may facilitate the understanding of the histogenesis of an angioglioma and guide its diagnosis and treatment. PMID:26166599

  17. Primary extradural spinal ganglioneuroblastoma: a case report.

    PubMed

    Patnaik, Ashis; Mishra, Sudhansu S; Mishra, Sanjib; DAS, Srikanta; Deo, Rama C

    2014-01-01

    We report a case of ganglioneuroblastoma of the spinal cord in a 25-year-old man. Clinical history was short with paraparesis and bladder involvement. The MRI picture was that of an extradural solid tumor with extension to both intervertebral foramina, more suggestive of nerve sheath tumour rather than malignant embryonal tumour. Diagnosis was established by histopathological study. We could not find such a presentation of spinal ganglioneuroblastoma as an extradural, primary tumour in the literature. We discuss the radio-pathological features, surgical management and post-operative outcome. PMID:24831370

  18. Repeated early thrombolysis in cervical spinal cord ischemia.

    PubMed

    Etgen, Thorleif; Höcherl, Constanze

    2016-07-01

    Specific therapy of acute spinal ischemia is not established. We report the first case of an MRI-verified cervical spinal ischemia treated by thrombolysis and review the literature. A 72-year old woman with right-sided motor hemiparesis and trunk ataxia was treated by intravenous thrombolysis with full recovery. Three days later she developed again a severe right-sided sensorimotor hemiparesis and a second off-label intravenous thrombolysis was repeated. Magnetic resonance imaging revealed a right-sided posterior-lateral cervical spinal ischemia. Spinal ischemia may clinically present with a cerebral-stroke-like picture challenging diagnostic and therapeutic procedure. Systemic thrombolysis might be a treatment option in acute spinal ischemia. In addition, early repeated systemic thrombolysis may be considered in selected strokes. PMID:26762860

  19. Spinal muscular atrophy with respiratory distress type 1 (SMARD1).

    PubMed

    Kaindl, Angela M; Guenther, Ulf-Peter; Rudnik-Schneborn, Sabine; Varon, Raymonda; Zerres, Klaus; Schuelke, Markus; Hbner, Christoph; von Au, Katja

    2008-02-01

    Autosomal recessive spinal muscular atrophy with respiratory distress type 1 (SMARD1), recently referred to as distal spinal muscular atrophy 1 (DSMA1; MIM#604320) and also known as distal hereditary motor neuropathy type 6 (dHMN6 or HMN6), results from mutations in the IGHMBP2 gene on chromosome 11q13.3 encoding the immunoglobulin micro-binding protein 2. In contrast to the infantile spinal muscular atrophy type 1 (SMA1; Werdnig-Hoffmann disease) with weakness predominantly of proximal muscles and bell-shaped thorax deformities due to intercostal muscle atrophy, infants with distal spinal muscular atrophy 1 usually present with distal muscle weakness, foot deformities, and sudden respiratory failure due to diaphragmatic paralysis that often requires urgent intubation. In this article, the authors review the clinical, neuropathological, and genetic aspects of distal spinal muscular atrophy 1 and discuss differential diagnoses. PMID:18263757

  20. Cervical spinal intradural arachnoid cysts in related, young pugs.

    PubMed

    Rohdin, C; Nyman, H T; Wohlsein, P; Hultin Jäderlund, K

    2014-04-01

    Seven related young pugs were diagnosed with cervical spinal intradural arachnoid cysts by magnetic resonance imaging (n = 6) and myelography (n = 1). All dogs were presented with skin abrasions on their thoracic limbs and non-painful neurological deficits, indicating a C1-T2 myelopathy. In all six dogs examined by magnetic resonance imaging not only the spinal arachnoid cyst but also a concomitant, most likely secondary, syringohydromyelia was confirmed. Pedigree analysis suggested a genetic predisposition for spinal arachnoid cysts in this family of pugs. Generalised proprioceptive deficits more pronounced in the thoracic limbs suggesting a focal cervical spinal cord lesion, with concomitant skin abrasions on the dorsal aspect of the thoracic limbs in a young pug, should alert veterinarians to the possibility of cervical spinal arachnoid cysts. PMID:24372140

  1. Spinal epidural abscess.

    PubMed

    Miftode, E; Luca, V; Mihalache, D; Leca, D; Stefanidis, E; Anuţa, C; Sabadis, L

    2001-01-01

    In a retrospective study, 68 patients with Spinal Epidural Abscess (SEA) were reviewed. Of these, 66% had different predisposing factors such as staphylococcal skin infections, surgical procedures, rachicentesis, trauma, spondilodiscitis. Abscess had a lumbar region location in 53% of cases. Staphylococcus aureus was the most frequent etiological agent (81%). The overall rate of mortality in SEA patients was 13.2%. PMID:12092238

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

    PubMed Central

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

    2015-01-01

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

  3. A rare, high cervical traumatic spinal subdural hematoma.

    PubMed

    Berhouma, Moncef; Al Dahak, Nouman; Messerer, Rostom; Al Rammah, Mohamed; Vallee, Bernard

    2011-04-01

    Spinal subdural hematomas (SSDH) are rare lesions occurring in association with a wide variety of conditions, including anticoagulation, coagulation disorders, spinal anesthesia, lumbar puncture, spinal tumors and vascular malformations. SSDH resulting from trauma are the exception. We present a 62-year-old woman with a rare post-traumatic focal SSDH at C1 with bulbomedullary compression, treated successfully with surgery. A review of the literature revealed 26 patients with traumatic SSDH. The aim of this report is to describe the clinical presentation, imaging characteristics and management of traumatic SSDH. The controversial pathogenesis is also discussed. PMID:21277780

  4. Management of postoperative spinal infections

    PubMed Central

    Hegde, Vishal; Meredith, Dennis S; Kepler, Christopher K; Huang, Russel C

    2012-01-01

    Postoperative surgical site infection (SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention, diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories: (1) microbiological factors; (2) factors related to the patient and their spinal pathology; and (3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the organism causing the SSI can affect its presentation. SSI can be prevented by careful adherence to aseptic technique, prophylactic antibiotics, avoiding myonecrosis by frequently releasing retractors and preoperatively optimizing modifiable patient factors. Increasing pain is commonly the only symptom of a SSI and can lead to a delay in diagnosis. C-reactive protein and magnetic resonance imaging can help establish the diagnosis. Treatment requires acquiring intra-operative cultures to guide future antibiotic therapy and surgical debridement of all necrotic tissue. A SSI can usually be adequately treated without removing spinal instrumentation. A multidisciplinary approach to SSIs is important. It is useful to involve an infectious disease specialist and use minimum serial bactericidal titers to enhance the effectiveness of antibiotic therapy. A plastic surgeon should also be involved in those cases of severe infection that require repeat debridement and delayed closure. PMID:23330073

  5. Arachnoiditis ossificans after spinal surgery.

    PubMed

    Liu, Li-Di; Zhao, Song; Liu, Wan-Guo; Zhang, Shao-Kun

    2015-05-01

    This article presents an unusual case of arachnoiditis ossificans after spinal surgery. A case of arachnoiditis ossificans secondary to lumbar fixation and decompression surgery for the treatment of multilevel lumbar fractures is reported and the relevant literature is reviewed. A 29-year-old man who previously underwent posterior pedicle screw fixation and fusion for multiple lumbar spine fractures reported lower back stiffness and discomfort 23 months postoperatively. A laminectomy was performed at L2 and at L3-L4. At L2, bone fragments from the burst fracture had injured the dural sac and some nerve roots. A posterolateral fusion was performed using allogeneic bone. Postoperatively, there were no signs of fever, infection, or systemic inflammatory responses. Arachnoiditis ossificans of the thecal sac from L1-L5 was diagnosed by magnetic resonance imaging and computed tomography at the 2-year follow-up. His postoperative neurological status progressively improved and he regained motor and sensory functions. Because of neurological improvements, fixation hardware was removed without further decompression. The authors report a case of arachnoiditis ossificans secondary to lumbar fixation and decompression surgery, which involved a large region. Arachnoiditis ossificans is a relatively rare disorder with unclear etiologies and limited treatment options. Spinal surgical intervention of arachnoiditis ossificans should be carefully considered because it may lead to poor outcomes and multiple revision surgeries. PMID:25970374

  6. [Therapy progress of spinal cord compression by metastatic spinal tumor].

    PubMed

    Liu, Yao-sheng; He, Qi-zhen; Liu, Shu-bin; Jiang, Wei-gang; Lei, Ming-xing

    2016-01-01

    Metastatic epidural compression of the spinal cord is a significant source of morbidity in patients with systemic cancer. With improvment of oncotheray, survival period in the patients is improving and metastatic cord compression is en- countered increasingly often. Surgical management performed for early circumferential decompression for the spinal cord com- pression with spine instability, and spine reconstruction performed. Patients with radiosensitive tumours without spine instabili- ty, radiotherapy is an effective therapy. Spinal stereotactic radiosurgery and minimally invasive techniques, such as vertebro- plasty and kyphoplasty, percutaneous pedicle screw fixation, radiofrequency ablation are promising options for treatment of cer- tain selected patients with spinal metastases. PMID:27019908

  7. Cell Therapy Augments Functional Recovery Subsequent to Spinal Cord Injury under Experimental Conditions

    PubMed Central

    Sabapathy, Vikram; Tharion, George; Kumar, Sanjay

    2015-01-01

    The spinal cord injury leads to enervation of normal tissue homeostasis ultimately leading to paralysis. Until now there is no proper cure for the treatment of spinal cord injury. Recently, cell therapy in animal spinal cord injury models has shown some progress of recovery. At present, clinical trials are under progress to evaluate the efficacy of cell transplantation for the treatment of spinal cord injury. Different types of cells such as pluripotent stem cells derived neural cells, mesenchymal stromal cells, neural stem cells, glial cells are being tested in various spinal cord injury models. In this review we highlight both the advances and lacuna in the field of spinal cord injury by discussing epidemiology, pathophysiology, molecular mechanism, and various cell therapy strategies employed in preclinical and clinical injury models and finally we discuss the limitations and ethical issues involved in cell therapy approach for treating spinal cord injury. PMID:26240569

  8. Cell Therapy Augments Functional Recovery Subsequent to Spinal Cord Injury under Experimental Conditions.

    PubMed

    Sabapathy, Vikram; Tharion, George; Kumar, Sanjay

    2015-01-01

    The spinal cord injury leads to enervation of normal tissue homeostasis ultimately leading to paralysis. Until now there is no proper cure for the treatment of spinal cord injury. Recently, cell therapy in animal spinal cord injury models has shown some progress of recovery. At present, clinical trials are under progress to evaluate the efficacy of cell transplantation for the treatment of spinal cord injury. Different types of cells such as pluripotent stem cells derived neural cells, mesenchymal stromal cells, neural stem cells, glial cells are being tested in various spinal cord injury models. In this review we highlight both the advances and lacuna in the field of spinal cord injury by discussing epidemiology, pathophysiology, molecular mechanism, and various cell therapy strategies employed in preclinical and clinical injury models and finally we discuss the limitations and ethical issues involved in cell therapy approach for treating spinal cord injury. PMID:26240569

  9. Spinal cord stimulation.

    PubMed

    Costantini, A

    2005-01-01

    Spinal cord stimulation (SCS) is a neuromodulation technique using electricity, proposed for the first time by Shealy in 1967, as an alternative to neuroablation. Technological improvements in the last 20 years (percutaneous electrodes, single and dual leads, octopolar electrodes, high energy internal pulse generators) have allowed to obtain good results with SCS in various clinical situations of chronic pain. The main clinical indications to SCS are: vascular pain--refractory angina and peripheral vascular diseases (PVD); rachidian pain--failed back surgery syndrome (FBSS), degenerative low back leg pain (LBLP), nerve root lesions, incomplete spine lesions, spinal stenosis; neuropathic pain; chronic regional pain syndrome (CRPS) type 1 and type 2; perineal pain and urological diseases (urge-incontinence, interstitial cystitis). There are important differences between Europe and USA in the SCS use in various indications, especially about PVD. Really, in Europe this technique has been widely used and, finally, there are prospective studies establishing the utility of SCS in: limb survival; pain control; regression to Fontaine stage II; improvement of free interval of claudication. All of this is going to change the attitude towards SCS in USA, where the amputation incidence for critical ischaemia is considerably higher than in Europe. An indication to SCS not very mentioned in literature and that seems to have good results is LBLP due to acquired or mixed (constitutional-acquired) spinal stenosis. In this situation SCS seems to improve notably pain control and quality of life index of patients. PMID:16012421

  10. [Information analysis of spinal ganglia].

    PubMed

    Lobko, P I; Kovaleva, D V; Kovalchuk, I E; Pivchenko, P G; Rudenok, V V; Davydova, L A

    2000-01-01

    Information parameters (entropia and redundancy) of cervical and thoracic spinal ganglia of albino rat foetuses, mature animals (cat and dog) and human subjects were analysed. Information characteristics of spinal ganglia were shown to be level-specified and to depend on their functional peculiarities. Information parameters of thoracic spinal ganglia of man and different animals are specie specified and may be used in assessment of morphological structures as information systems. PMID:12629803

  11. 18F-FDG Hypermetabolism in Spinal Cord Schistosomiasis.

    PubMed

    Altinyay, Mustafa Erkan; Alharthi, Ashraf; Alassiri, Ali H; Syed, Ghulam Mustafa Shah

    2016-03-01

    A 24-year-old Saudi man presented with progressive lower-back pain for 3 months followed by lower-limb weakness, numbness, and urinary retention. Cerebrospinal fluid examination revealed high-protein, elevated white blood cell count with lymphocyte predominance. MRI scan of the spine demonstrated heterogeneously enhancing longitudinal spinal cord lesion from T6 through T9. FDG-PET/CT demonstrated prominently hypermetabolic lesion in the spinal cord. He had laminectomy and spinal cord (intramedullary) biopsy. Pathology revealed Schistosoma mansoni ova. PMID:26447373

  12. Complications in the management of metastatic spinal disease

    PubMed Central

    Dunning, Eilis Catherine; Butler, Joseph Simon; Morris, Seamus

    2012-01-01

    Metastatic spine disease accounts for 10% to 30% of new cancer diagnoses annually. The most frequent presentation is axial spinal pain. No treatment has been proven to increase the life expectancy of patients with spinal metastasis. The goals of therapy are pain control and functional preservation. The most important prognostic indicator for spinal metastases is the initial functional score. Treatment is multidisciplinary, and virtually all treatment is palliative. Management is guided by three key issues; neurologic compromise, spinal instability, and individual patient factors. Site-directed radiation, with or without chemotherapy is the most commonly used treatment modality for those patients presenting with spinal pain, causative by tumours which are not impinging on neural elements. Operative intervention has, until recently been advocated for establishing a tissue diagnosis, mechanical stabilization and for reduction of tumor burden but not for a curative approach. It is treatment of choice patients with diseaseadvancement despite radiotherapy and in those with known radiotherapy-resistant tumors. Vertebral resection and anterior stabilization with methacrylate or hardware (e.g., cages) has been advocated.Surgical decompression and stabilization, however, along with radiotherapy, may provide the most promising treatment. It stabilizes the metastatic deposited areaand allows ambulation with pain relief. In general, patients who are nonambulatory at diagnosis do poorly, as do patients in whom more than one vertebra is involved. Surgical intervention is indicated in patients with radiation-resistant tumors, spinal instability, spinal compression with bone or disk fragments, progressive neurologic deterioration, previous radiation exposure, and uncertain diagnosis that requires tissue diagnosis. The main goal in the management of spinal metastatic deposits is always palliative rather than curative, with the primary aim being pain relief and improved mobility. This however, does not come without complications, regardless of the surgical intervention technique used. These complication range from the general surgical complications of bleeding, infection, damage to surrounding structures and post operative DT/PE to spinal specific complications of persistent neurologic deficit and paralysis. PMID:22919567

  13. Pediatric primary intramedullary spinal cord glioblastoma

    PubMed Central

    Lober, Robert; Sharma, Suash; Bell, Beverly; Free, Alan; Figueroa, Ramon; Sheils, Chris W; Lee, Mark; Cowell, John

    2010-01-01

    Spinal cord tumors in pediatric patients are rare, representing less than 1% of all central nervous system tumors. Two cases of pediatric primary intramedullary spinal cord glioblastoma at ages 14 and 8 years are reported. Both patients presented with rapid onset paraparesis and quadraparesis. Magnetic resonance imaging in both showed heterogeneously enhancing solitary mass lesions localized to lower cervical and upper thoracic spinal cord parenchyma. Histopathologic diagnosis was glioblastoma. Case #1 had a small cell component (primitive neuroectodermal tumor-like areas), higher Ki67, and p53 labeling indices, and a relatively stable karyotype with only minimal single copy losses involving regions: Chr8;pter-30480019, Chr16;pter-29754532, Chr16;56160245–88668979, and Chr19;32848902-qter on retrospective comparative genomic hybridization using formalin-fixed, paraffin-embedded samples. Case #2 had relatively bland histomorphology and negligible p53 immunoreactivity. Both underwent multimodal therapy including gross total resection, postoperative radiation and chemotherapy. However, there was no significant improvement in neurological deficits, and overall survival in both cases was 14 months.This report highlights the broad histological spectrum and poor overall survival despite multi modality therapy. The finding of relatively unique genotypic abnormalities resembling pediatric embryonal tumors in one case may highlight the value of genome-wide profiling in development of effective therapy. The differences in management with intracranial and low-grade spinal cord gliomas and current management issues are discussed. PMID:21139963

  14. An Optimal Protocol to Analyze the Rat Spinal Cord Proteome

    PubMed Central

    Gil-Dones, F.; Alonso-Orgaz, S.; Avila, G.; Martin-Rojas, T.; Moral-Darde, V.; Barroso, G.; Vivanco, F.; Scott-Taylor, J.; Barderas, M.G.

    2009-01-01

    Since the function of the spinal cord depends on the proteins found there, better defing the normal Spinal Cord Proteome is an important and challenging task. Although brain and cerebrospinal fluid samples from patients with different central nervous system (CNS) disorders have been studied, a thorough examination of specific spinal cord proteins and the changes induced by injury or associated to conditions such as neurodegeneration, spasticity and neuropathies has yet to be performed. In the present study, we aimed to describe total protein content in the spinal cord of healthy rats, employing different proteomics tools. Accordingly, we have developed a fast, easy, and reproducible sequential protocol for protein extraction from rat spinal cords. We employed conventional two dimensional electrophoresis (2DE) in different pH ranges (eg. 4–7, 3–11 NL) combined with identification by mass spectrometry (MALDI-TOF/TOF), as well as first dimension protein separation combined with Liquid Chromatography Mass Spectrometry/Mass Spectrometry (LC-MS/MS) to maximise the benefits of this technology. The value of these techniques is demonstrated here by the identification of several proteins known to be associated with neuroglial structures, neurotransmission, cell survival and nerve growth in the central nervous system. Furthermore this study identified many spinal proteins that have not previously been described in the literature and which may play an important role as either sensitive biomarkers of dysfunction or of recovery after Spinal Cord Injury. PMID:20029654

  15. Hyperbaric oxygen therapy improves local microenvironment after spinal cord injury

    PubMed Central

    Wang, Yang; Zhang, Shuquan; Luo, Min; Li, Yajun

    2014-01-01

    Clinical studies have shown that hyperbaric oxygen therapy improves motor function in patients with spinal cord injury. In the present study, we explored the mechanisms associated with the recovery of neurological function after hyperbaric oxygen therapy in a rat model of spinal cord injury. We established an acute spinal cord injury model using a modification of the free-falling object method, and treated the animals with oxygen at 0.2 MPa for 45 minutes, 4 hours after injury. The treatment was administered four times per day, for 3 days. Compared with model rats that did not receive the treatment, rats exposed to hyperbaric oxygen had fewer apoptotic cells in spinal cord tissue, lower expression levels of aquaporin 4/9 mRNA and protein, and more NF-200 positive nerve fibers. Furthermore, they had smaller spinal cord cavities, rapid recovery of somatosensory and motor evoked potentials, and notably better recovery of hindlimb motor function than model rats. Our findings indicate that hyperbaric oxygen therapy reduces apoptosis, downregulates aquaporin 4/9 mRNA and protein expression in injured spinal cord tissue, improves the local microenvironment for nerve regeneration, and protects and repairs the spinal cord after injury. PMID:25657740

  16. Adaptation of motor function after spinal cord injury: novel insights into spinal shock.

    PubMed

    Boland, Robert A; Lin, Cindy S-Y; Engel, Stella; Kiernan, Matthew C

    2011-02-01

    The mechanisms underlying spinal shock have not been clearly defined. At present, clinical assessment remains the mainstay to describe progression through spinal shock following traumatic spinal cord injury. However, nerve excitability studies in combination with conventional nerve conduction and clinical assessments have the potential to investigate spinal shock at the level of the peripheral axon. Therefore, peripheral motor axon excitability was prospectively and systematically evaluated in more than 400 studies of 11 patients admitted to hospital after traumatic spinal cord injury, with cord lesions above T9 (nine cervical, two thoracic). Recordings commenced within 15 days of admission from the median nerve to abductor pollicis brevis in the upper limb and the common peroneal nerve to tibialis anterior in both lower limbs, and were continued until patient discharge from hospital. Excitability was assessed using threshold tracking techniques and recordings were compared with data from healthy controls. In addition, concurrent clinical measures of strength, serum electrolytes and nerve conduction were collected. High threshold stimulus-response relationships were apparent from the early phase of spinal shock that coincided with depolarization-like features that reached a peak on Day 16.9 (± 2.7 standard error) for the common peroneal nerve and Day 11.8 (± 2.0 standard error) for the median nerve. Overall, changes in the common peroneal nerve were of greater magnitude than for the median nerve. For both nerves, the most significant changes were in threshold electrotonus, which was 'fanned in', and during the recovery cycle superexcitability was reduced (P < 0.001). However, refractoriness was increased only for the common peroneal nerve (P < 0.05). Changes in the spinal injured cohort could not be explained on the basis of an isolated common peroneal nerve palsy. By the time patients with spinal injury were discharged from hospital between Days 68 and 215, excitability for upper and lower limbs had returned towards normative values, but not for all parameters. Electrolyte levels and results for nerve conduction studies remained within normal limits throughout the period of admission. Contrary to prevailing opinion, these data demonstrate that significant changes in peripheral motor axonal excitability occur early during spinal shock, with subsequent further deterioration in axonal function, before recovery ensues. PMID:20952380

  17. Spinal subdural abscess: a rare complication of decubitus ulcer.

    PubMed

    Usoltseva, Natalia; Medina-Flores, Rafael; Rehman, Ateeq; Samji, Swetha; D'Costa, Matthew

    2014-09-01

    Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not well-described, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a case of subacute onset of quadriplegia in a male patient, age 55 years, due to spinal cord compression from SSA and superimposed spinal subdural hematoma. The direct seeding from decubitus ulcers is thought to be the cause of infection in our patient. We present this case of SSA to elucidate and review the predisposing factors, pathogenesis, clinical presentation, diagnostic modalities, and treatment regarding management of this rare disorder. PMID:24667217

  18. Retroperitoneal spinal extradural arachnoid cyst combined with congenital hemivertebrae.

    PubMed

    Park, Se-Hwan; Kuh, Sung-Uk; Lim, Beom Jin

    2012-09-01

    Spinal extradural arachnoid cysts usually cause symptoms related to spinal cord or nerve root compression. Here, we report an atypical presentation of a spinal extradural arachnoid cyst combined with congenital hemivertebra which was presented as a retroperitoneal mass that exerted mass effects to the abdominal organs. On image studies, the communication between the cystic pedicle and the spinal arachnoid space was indistinct. Based on our experience and the literature of the pathogenesis, we planned anterior approach for removal of the arachnoid cyst in order to focus on mass removal rather than ligation of the fistulous channel. In our estimation this was feasible considering radiologic findings and also essential for the symptom relief. The cyst was totally removed with the clogged 'thecal sac-side' end of the cystic pedicle. The patient was free of abdominal discomfort by one month after the surgery. PMID:23115673

  19. Spontaneous thoracic spinal subarachnoid hemorrhage diagnosed with brain computed tomography.

    PubMed

    Sasaji, Tatsuro; Shinagawa, Kiyotsugu; Matsuya, Shigetsune

    2013-01-01

    Spontaneous thoracic spinal subarachnoid hemorrhage is rare, and thus no useful radiological findings for preoperative diagnosis have been reported. We experienced a patient with spontaneous thoracic spinal subarachnoid hemorrhage. A 37-year-old female presented with sudden-onset paraplegia and numbness in the trunk and bilateral lower extremities. The patient had no past history of trauma, lumbar puncture and bleeding disorder. T2-weighted sagittal magnetic resonance imaging (MRI) of the cervical and thoracic spines showed a mass occupied in the ventral space of spinal cord that was dorsally shifted. The mass extended from C6 to Th6 levels, with its largest size at Th2 level. Thoracic spine T2-weighted sagittal and axial MRI showed that the mass compressed spinal cord and was located in the intradural space. There was no spinal cord tumor and no spinal vascular malformation around the mass. Brain computed tomography (CT) showed a high-density area in the subarachnoid space, indicating the possibility of subarachnoid hemorrhage. Brain MRI showed no ruptured aneurysm. The patient was diagnosed as a spontaneous thoracic spinal subarachnoid hemorrhage and emergency surgery was selected. We performed right-side hemilaminectomy at Th1-Th6 and opened dura mater and arachnoid membrane. Hematoma was found in the ventral space of spinal cord and was removed. One year after surgery, numbness in the trunk and bilateral lower extremities had disappeared but paraplegia remained unchanged. Thoracic spine T2-weighted MRI confirmed no hematoma but showed a newly formed intradural cyst. Preoperative combination of brain CT and thoracic MRI is useful to diagnose thoracic spinal subarachnoid hemorrhage. PMID:24131866

  20. Sarcoidosis of the spinal cord: literature review and report of eight cases.

    PubMed Central

    Saleh, Samer; Saw, Chandan; Marzouk, Kamel; Sharma, Om

    2006-01-01

    Sarcoidosis, which affects African Americans more than it does other racial/ethnic groups, only rarely manifests initially as spinal cord dysfunction. This paper presents the findings of eight patients with spinal cord dysfunction as part of a presentation of sarcoidosis. After reviewing these cases, we devised an algorithm to diagnose and manage spinal cord sarcoidosis. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:16775923

  1. Update on treatment options for spinal brucellosis.

    PubMed

    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; Aydın, M; Horasan, E S; Gul, H C; Ceylan, B; Kadanalı, A; Karabay, O; Karagoz, G; Kayabas, U; Turhan, V; Engin, D; Gulsun, S; Elaldı, N; Alabay, S

    2014-02-01

    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

  2. Degenerative lumbar spinal stenosis and its imposters: three case studies

    PubMed Central

    Ammendolia, Carlo

    2014-01-01

    Degenerative lumbar spinal stenosis causing neurogenic claudicaton is a common condition impacting walking ability in older adults. There are other highly prevalent conditions in this patient population that have similar signs and symptoms and cause limited walking ability. The purpose of this study is to highlight the diagnostic challenges using three case studies of older adults who present with limited walking ability who have imaging evidence of degenerative lumbar spinal stenosis. PMID:25202160

  3. Quantifying the Nonlinear, Anisotropic Material Response of Spinal Ligaments

    NASA Astrophysics Data System (ADS)

    Robertson, Daniel J.

    Spinal ligaments may be a significant source of chronic back pain, yet they are often disregarded by the clinical community due to a lack of information with regards to their material response, and innervation characteristics. The purpose of this dissertation was to characterize the material response of spinal ligaments and to review their innervation characteristics. Review of relevant literature revealed that all of the major spinal ligaments are innervated. They cause painful sensations when irritated and provide reflexive control of the deep spinal musculature. As such, including the neurologic implications of iatrogenic ligament damage in the evaluation of surgical procedures aimed at relieving back pain will likely result in more effective long-term solutions. The material response of spinal ligaments has not previously been fully quantified due to limitations associated with standard soft tissue testing techniques. The present work presents and validates a novel testing methodology capable of overcoming these limitations. In particular, the anisotropic, inhomogeneous material constitutive properties of the human supraspinous ligament are quantified and methods for determining the response of the other spinal ligaments are presented. In addition, a method for determining the anisotropic, inhomogeneous pre-strain distribution of the spinal ligaments is presented. The multi-axial pre-strain distributions of the human anterior longitudinal ligament, ligamentum flavum and supraspinous ligament were determined using this methodology. Results from this work clearly demonstrate that spinal ligaments are not uniaxial structures, and that finite element models which account for pre-strain and incorporate ligament's complex material properties may provide increased fidelity to the in vivo condition.

  4. Spinal Injury Rehabilitation in Singapore.

    ERIC Educational Resources Information Center

    Yen, H. L.; Chua, K.; Chan, W.

    1998-01-01

    This study reviewed 231 cases of spinal cord injury treated in Singapore. Data on demographic characteristics, common causes (mostly falls and traffic accidents), types of spinal damage, and outcomes are reported. Following rehabilitation, 68 patients were able to ambulate independently and 45 patients achieved independence in activities of daily…

  5. Imaging modalities in spinal disorders

    SciTech Connect

    Kricun, M.E.

    1986-01-01

    This book provides an approach to the various imaging modalities used to view the spine. It discusses the indications, limitations and practical use of each in the diagnosis, work-up and staging of various spinal disorders, and compares each of them in various clinical settings. Topics covered include low back pain syndrome, disk disease, spinal cord lesions, congenital abnormalities, and trauma.

  6. Assessment of spinal pain.

    PubMed

    Braun, J; Baraliakos, X; Regel, A; Kiltz, U

    2014-12-01

    Spinal pain or back pain is a very common symptom that can have many reasons. The most studied location is low back pain, and it is considered to be nonspecific in the majority of cases. Only a small proportion of patients have axial inflammation as the major cause of their back complaints with chronic inflammatory back pain (IBP) as the most prominent clinical feature of spondyloarthritis (SpA). The recognition of IBP and patients with axial spondyloarthritis (axSpA) is challenging in primary care, and it is important to further facilitate the early diagnosis of SpA. Proposals for improving the referral of patients with a possible diagnosis of axSpA include clinical parameters, human leukocyte antigen (HLA) B27, and imaging parameters. Imaging is crucial for the visualization, objective validation, and understanding of back pain. Numerous diseases such as degenerative disk disease, degenerative changes in the intervertebral (facet) joints and the associated ligaments, spinal instability, herniation of the intervertebral disk, and spinal stenosis have to be differentiated in interpreting imaging of the spine. The sacroiliac joints and the spine are of major importance for the diagnosis and classification of axSpA. Conventional radiographs and magnetic resonance imaging (MRI) are the most important imaging technologies for visualization of structural changes such as syndesmophytes and axial inflammation such as sacroiliitis and spondylitis. The pathogenesis of axSpA is largely genetically determined. HLA B27 has the strongest contribution to the total genetic burden, but other major contributors such as endoplasmic reticulum aminopeptidase (ERAP)-1 and interleukin (IL)-23R have also been identified. PMID:26096091

  7. Distribution of Neuron Cell Bodies in the Intraspinal Portion of the Spinal Accessory Nerve in Humans.

    PubMed

    Boehm, Karl E; Kondrashov, Peter

    2016-01-01

    The spinal accessory nerve is often identified as a purely motor nerve innervating the trapezius and sternocleidomastoid muscles. Although it may contain proprioceptive neurons found in cervical spinal levels C2-C4, limited research has focused on the histology of the spinal accessory nerve. The objective of the present study was to examine the spinal accessory nerve to determine if there are neuronal cell bodies within the spinal accessory nerve in humans. Cervical spinal cords were dissected from eight cadavers that had previously been used for dissection in other body regions. The segmental rootlets were removed to quantify the neuron cell bodies present at each spinal level. Samples were embedded in paraffin; sectioned; stained with hematoxylin and eosin; and examined using a microscope at 4×, 10×, and 40× magnification. Digital photography was used to image the samples. Neuronal cell bodies were found in 100% of the specimens examined, with non-grossly visible ganglia found at spinal levels C1-C4. The C1 spinal level of the spinal accessory nerve had the highest number of neuron cell bodies. Anat Rec, 299:98-102, 2016. © 2015 Wiley Periodicals, Inc. PMID:26474532

  8. Spinal tumors in children.

    PubMed

    Binning, Mandy; Klimo, Paul; Gluf, Wayne; Goumnerova, Liliana

    2007-10-01

    Pediatric spine tumors encompass a diverse group of pathologic diagnoses that differ markedly based on the location and age of the child. Children can be affected by primary and metastatic tumors, making the differential diagnosis and treatment options extensive. This article discusses the features of spinal tumors in children based primarily on location: extradural, intradural-extramedullary, and intramedullary tumors. Because this article deals with such a broad topic, detailed descriptions and outcomes of surgical and nonsurgical treatments for each particular tumor are limited. Rather, the key clinical, diagnostic, and therapeutic features of each tumor are discussed. PMID:17991588

  9. Stereotactic Radiosurgery for Treatment of Spinal Metastases Recurring in Close Proximity to Previously Irradiated Spinal Cord

    SciTech Connect

    Choi, Clara Y.H.; Adler, John R.; Gibbs, Iris C.; Chang, Steven D.; Jackson, Paul S.; Minn, A. Yuriko; Lieberson, Robert E.; Soltys, Scott G.

    2010-10-01

    Purpose: As the spinal cord tolerance often precludes reirradiation with conventional techniques, local recurrence within a previously irradiated field presents a treatment challenge. Methods and Materials: We retrospectively reviewed 51 lesions in 42 patients treated from 2002 to 2008 whose spinal metastases recurred in a previous radiation field (median previous spinal cord dose of 40 Gy) and were subsequently treated with stereotactic radiosurgery (SRS). Results: SRS was delivered to a median marginal dose of 20 Gy (range, 10-30 Gy) in 1-5 fractions (median, 2), targeting a median tumor volume of 10.3 cm{sup 3} (range, 0.2-128.6 cm{sup 3}). Converting the SRS regimens with the linear quadratic model ({alpha}/{beta} = 3), the median spinal cord maximum single-session equivalent dose (SSED) was 12.1 Gy{sub 3} (range, 4.7-19.3 Gy{sub 3}). With a median follow-up of 7 months (range, 2-47 months), the Kaplan-Meier local control and overall survival rates at 6/12 months were 87%/73% and 81%/68%, respectively. A time to retreatment of {<=}12 months and the combination of time to retreatment of {<=}12 months with an SSED of <15 Gy{sub 10} were significant predictors of local failure on univariate and multivariate analyses. In patients with a retreatment interval of <12 months, 6/12 month local control rates were 88%/58%, with a SSED of >15 Gy{sub 10}, compared to 45%/0% with <15 Gy{sub 10}, respectively. One patient (2%) experienced Grade 4 neurotoxicity. Conclusion: SRS is safe and effective in the treatment of spinal metastases recurring in previously irradiated fields. Tumor recurrence within 12 months may correlate with biologic aggressiveness and require higher SRS doses (SSED >15 Gy{sub 10}). Further research is needed to define the partial volume retreatment tolerance of the spinal cord and the optimal target dose.

  10. Spinal hydatid with meralgia paresthetica in a female: A rare case report

    PubMed Central

    Lonkar, Yeshwant; Amale, Amar; Acharya, Sourya; Banode, Pankaj; Yeola, Meenakshi

    2012-01-01

    Meralgia paresthetica presents as tingling sensation in the antero-lateral aspect of thigh. It occurs due to compression of the lateral cutaneous nerve of thigh. Proximal spinal lesions may present as meralgia paresthetica due to radiculopathy. We present a rare case of spinal hydatid with meralgia paresthetica. PMID:24082690

  11. Posterior spinal artery aneurysm rupture after 'Ecstasy' abuse.

    PubMed

    Johnson, Jeremiah; Patel, Shnehal; Saraf-Lavi, Efrat; Aziz-Sultan, Mohammad Ali; Yavagal, Dileep R

    2015-07-01

    Posterior spinal artery (PSA) aneurysms are a rare cause of subarachnoid hemorrhage (SAH). The commonly abused street drug 3,4-methylenedioxymethamphetamine (MDMA) or 'Ecstasy' has been linked to both systemic and neurological complications. A teenager presented with neck stiffness, headaches and nausea after ingesting 'Ecstasy'. A brain CT was negative for SAH but a CT angiogram suggested cerebral vasculitis. A lumbar puncture showed SAH but a cerebral angiogram was negative. After a spinal MR angiogram identified abnormalities on the dorsal surface of the cervical spinal cord, a spinal angiogram demonstrated a left PSA 2 mm fusiform aneurysm. The patient underwent surgery and the aneurysmal portion of the PSA was excised without postoperative neurological sequelae. 'Ecstasy' can lead to neurovascular inflammation, intracranial hemorrhage, SAH and potentially even de novo aneurysm formation and subsequent rupture. PSA aneurysms may be treated by endovascular proximal vessel occlusion or open surgical excision. PMID:25006043

  12. Subarachnoid-subarachnoid bypass for spinal adhesive arachnoiditis.

    PubMed

    Tachibana, Toshiya; Moriyama, Tokuhide; Maruo, Keishi; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi

    2014-11-01

    The authors report a case of adhesive arachnoiditis (AA) and arachnoid cyst successfully treated by subarachnoid to subarachnoid bypass (S-S bypass). Arachnoid cysts or syringes sometimes compress the spinal cord and cause compressive myelopathy that requires surgical treatment. However, surgical treatment for AA is challenging. A 57-year-old woman developed leg pain and gait disturbance. A dorsal arachnoid cyst compressed the spinal cord at T7-9, the spinal cord was swollen, and a small syrinx was present at T9-10. An S-S bypass was performed from T6-7 to T11-12. The patient's gait disturbance resolved immediately after surgery. Two years later, a small arachnoid cyst developed. However, there was no neurological deterioration. The myelopathy associated with thoracic spinal AA, subarachnoid cyst, and syrinx improved after S-S bypass. PMID:25170651

  13. Biomaterial Design Strategies for the Treatment of Spinal Cord Injuries

    PubMed Central

    Straley, Karin S.; Po Foo, Cheryl Wong

    2010-01-01

    Abstract The highly debilitating nature of spinal cord injuries has provided much inspiration for the design of novel biomaterials that can stimulate cellular regeneration and functional recovery. Many experts agree that the greatest hope for treatment of spinal cord injuries will involve a combinatorial approach that integrates biomaterial scaffolds, cell transplantation, and molecule delivery. This manuscript presents a comprehensive review of biomaterial-scaffold design strategies currently being applied to the development of nerve guidance channels and hydrogels that more effectively stimulate spinal cord tissue regeneration. To enhance the regenerative capacity of these two scaffold types, researchers are focusing on optimizing the mechanical properties, cell-adhesivity, biodegradability, electrical activity, and topography of synthetic and natural materials, and are developing mechanisms to use these scaffolds to deliver cells and biomolecules. Developing scaffolds that address several of these key design parameters will lead to more successful therapies for the regeneration of spinal cord tissue. PMID:19698073

  14. Posterior spinal artery aneurysm rupture after 'Ecstasy' abuse.

    PubMed

    Johnson, Jeremiah; Patel, Shnehal; Saraf-Lavi, Efrat; Aziz-Sultan, Mohammad Ali; Yavagal, Dileep R

    2014-01-01

    Posterior spinal artery (PSA) aneurysms are a rare cause of subarachnoid hemorrhage (SAH). The commonly abused street drug 3,4-methylenedioxymethamphetamine (MDMA) or 'Ecstasy' has been linked to both systemic and neurological complications. A teenager presented with neck stiffness, headaches and nausea after ingesting 'Ecstasy'. A brain CT was negative for SAH but a CT angiogram suggested cerebral vasculitis. A lumbar puncture showed SAH but a cerebral angiogram was negative. After a spinal MR angiogram identified abnormalities on the dorsal surface of the cervical spinal cord, a spinal angiogram demonstrated a left PSA 2 mm fusiform aneurysm. The patient underwent surgery and the aneurysmal portion of the PSA was excised without postoperative neurological sequelae. 'Ecstasy' can lead to neurovascular inflammation, intracranial hemorrhage, SAH and potentially even de novo aneurysm formation and subsequent rupture. PSA aneurysms may be treated by endovascular proximal vessel occlusion or open surgical excision. PMID:24994748

  15. Senegenin inhibits neuronal apoptosis after spinal cord contusion injury

    PubMed Central

    Zhang, Shu-quan; Wu, Min-fei; Gu, Rui; Liu, Jia-bei; Li, Ye; Zhu, Qing-san; Jiang, Jin-lan

    2016-01-01

    Senegenin has been shown to inhibit neuronal apoptosis, thereby exerting a neuroprotective effect. In the present study, we established a rat model of spinal cord contusion injury using the modified Allen's method. Three hours after injury, senegenin (30 mg/g) was injected into the tail vein for 3 consecutive days. Senegenin reduced the size of syringomyelic cavities, and it substantially reduced the number of apoptotic cells in the spinal cord. At the site of injury, Bax and Caspase-3 mRNA and protein levels were decreased by senegenin, while Bcl-2 mRNA and protein levels were increased. Nerve fiber density was increased in the spinal cord proximal to the brain, and hindlimb motor function and electrophysiological properties of rat hindlimb were improved. Taken together, our results suggest that senegenin exerts a neuroprotective effect by suppressing neuronal apoptosis at the site of spinal cord injury. PMID:27212931

  16. Juxtafacet Spinal Synovial Cysts

    PubMed Central

    2016-01-01

    Study Design This was a retrospective study. Purpose To study the surgical outcome of synovial cysts of the lumbar spine through posterior laminectomy in combination with transpedicular screw fixation. Overview of Literature Synovial cysts of the lumbar spine contribute significantly to narrowing of the spinal canal and lateral thecal sac and nerve root compression. Cysts form as a result of arthrotic disruption of the facet joint, leading to degenerative spondylolisthesis in up to 40% of patients. Methods Retrospective data from 6 patients, treated during the period of March 2007 to February 2011, were analyzed. All preoperative and postoperative manifestations, extension/flexion radiographs, magnetic resonance imaging, and computed tomography records were reviewed. All underwent surgery for synovial cysts with excision and decompression combined with posterior fixation. The result of surgery was evaluated with Macnab's classification. An excellent or good outcome was considered as satisfactory. Japanese Orthopedic Association Scale was used for evaluation of back pain. Results All patients included in this study had excellent outcomes as regarding to improvement of all preoperative manifestations and returning to normal daily activities. Only 2 cases developed postoperative transient cerebro-spinal fluid leak and were treated conservatively and improved during the follow up period. Conclusions Although this study included a small number of cases and we could not have statistically significant results, the good outcome of decompression of synovial cysts combined with posterior fixation and fusion encouraged us to recommend this approach for patients with juxtafacet synovial cysts. PMID:26949457

  17. [Paranoid schizophrenic patient with unstable spinal fracture].

    PubMed

    Ydemann, Mogens

    2012-03-01

    The misdiagnosis of somatic illness in the psychiatric population can have grave consequences. Somatic symptoms are easily overseen or misinterpreted and a careful history and examination is essential when approaching this group of patients. We report a case of a patient with a history of paranoid schizophrenia, who had her somatic symptoms misinterpreted as being of psychiatric origin. This misinterpretation gave rise to an admission to a psychiatric ward of a patient who actually presented with an unstable spinal fracture. PMID:22395016

  18. Spinal Tuberculosis with Paraplegia in Pregnancy.

    PubMed

    Kaushal, S; Dora, S K; Thakur, S

    2015-01-01

    Spinal tuberculosis leading to paraplegia is uncommon in pregnancy and is a diagnostic and therapeutic challenge. We report a case of tubercular paraplegia presenting at 35 weeks of gestation. She was managed with Anti-tubercular drugs and did not require surgical intervention. Her neurological status improved and she was allowed to go in labour. She delivered a healthy term infant by cesarean. At three months follow-up, both mother and child are doing well. PMID:26994033

  19. Contact radiator burn subsequent to spinal anaesthesia.

    PubMed

    Sever, C; Aysal, B K; Sahin, C; Kulahci, Y

    2012-06-30

    An unusual case is reported in which a patient sustained a third-degree burn of the plantar surface of the right foot as the result of contact with a heating radiator. This occurred when the patient fell asleep in his hospital bed after knee surgery. Spinal anaesthesia is easy to perform, and the risk factors, though present, are not serious. Such accidents are not infrequent and care should be taken to prevent them. PMID:23233830

  20. Attitudes Towards Individuals with Spinal Cord Injuries

    ERIC Educational Resources Information Center

    Conway, Cassandra Sligh D.; Gooden, Randy; Nowell, Jennifer; Wilson, Navodda

    2010-01-01

    This paper will shed light on the lives of persons with spinal cord injuries by revealing the literature on spinal cord injuries that focuses on research that can shed light on attitudes towards persons with spinal cord injuries. The background literature related to incidences, the definition of spinal cord injury, and vocational opportunities are…

  1. Subdural hematoma following spinal cord stimulator implant.

    PubMed

    Chiravuri, Srinivas; Wasserman, Ronald; Chawla, Amit; Haider, Naeem

    2008-01-01

    Headache following interventional procedures is a diagnostic challenge due to the multitude of possible etiologies involved. Presentation can be simple (PDPH alone) or complex (exacerbation of pre-existing chronic headache along with PDPH) or headache associated with a new onset intracranial process. Subdural hematoma is a rare complication of cranio-spinal trauma. Cranial subdural hematoma may present in an acute, sub-acute, or chronic fashion. Diagnosis of a subdural hematoma in the wake of a PDPH is difficult, requiring a high level of suspicion. Delayed diagnosis of subdural hematoma is usually related to failure to consider it in the differential diagnosis. Thorough history, assessment of the evolution of symptoms, and imaging studies may identify the possible cause and help direct treatment. Change in the character of initial presenting symptoms may be a sign of resolution of the headache or the onset of a secondary process. We report a case of acute intracranial subdural hematoma secondary to unintentional dural puncture during placement of a permanent spinal cord stimulator lead for refractory angina. There is need for careful follow-up of patients with a known post-dural tear. Failure to identify uncommon adverse events in patients with complicated spinal cord stimulator implantation may lead to permanent injury. PMID:18196176

  2. Termination of vestibulospinal fibers arising from the spinal vestibular nucleus in the mouse spinal cord.

    PubMed

    Liang, H; Bácskai, T; Paxinos, G

    2015-05-21

    The present study investigated the vestibulospinal system which originates from the spinal vestibular nucleus (SpVe) with both retrograde and anterograde tracer injections. We found that fluoro-gold (FG) labeled neurons were found bilaterally with a contralateral predominance after FG injections into the upper lumbar cord. Anterogradely labeled fibers from the rostral SpVe traveled in the medial part of the ventral funiculus ipsilaterally and the dorsolateral funiculus bilaterally in the cervical cord. They mainly terminated in laminae 5-8, and 10 of the ipsilateral spinal cord. The contralateral side had fewer fibers and they were found in laminae 6-8, and 10. In the thoracic cord, fibers were also found to terminate in bilateral intermediolateral columns. In the lumbar and lower cord, fibers were mainly found in the dorsolateral funiculus bilaterally and they terminated predominantly in laminae 3-7 contralaterally. Anterogradely labeled fibers from the caudal SpVe did not travel in the medial part of the ventral funiculus but in the dorsolateral funiculus bilaterally. They mainly terminated in laminae 3-8 and 10 contralaterally. The present study is the first to describe the termination of vestibulospinal fibers arising from the SpVe in the spinal cord. It will lay the anatomical foundation for those who investigate the physiological role of vestibulospinal fibers and potentially target these fibers during rehabilitation after stroke, spinal cord injury, or vestibular organ injury. PMID:25791229

  3. Simultaneous Brain–Cervical Cord fMRI Reveals Intrinsic Spinal Cord Plasticity during Motor Sequence Learning

    PubMed Central

    Cohen-Adad, Julien; Marchand-Pauvert, Veronique; Benali, Habib; Doyon, Julien

    2015-01-01

    The spinal cord participates in the execution of skilled movements by translating high-level cerebral motor representations into musculotopic commands. Yet, the extent to which motor skill acquisition relies on intrinsic spinal cord processes remains unknown. To date, attempts to address this question were limited by difficulties in separating spinal local effects from supraspinal influences through traditional electrophysiological and neuroimaging methods. Here, for the first time, we provide evidence for local learning-induced plasticity in intact human spinal cord through simultaneous functional magnetic resonance imaging of the brain and spinal cord during motor sequence learning. Specifically, we show learning-related modulation of activity in the C6–C8 spinal region, which is independent from that of related supraspinal sensorimotor structures. Moreover, a brain–spinal cord functional connectivity analysis demonstrates that the initial linear relationship between the spinal cord and sensorimotor cortex gradually fades away over the course of motor sequence learning, while the connectivity between spinal activity and cerebellum gains strength. These data suggest that the spinal cord not only constitutes an active functional component of the human motor learning network but also contributes distinctively from the brain to the learning process. The present findings open new avenues for rehabilitation of patients with spinal cord injuries, as they demonstrate that this part of the central nervous system is much more plastic than assumed before. Yet, the neurophysiological mechanisms underlying this intrinsic functional plasticity in the spinal cord warrant further investigations. PMID:26125597

  4. DISCUSSION ON SPINAL INJURIES

    PubMed Central

    1928-01-01

    (1).Varieties of spinal injuries, the three groups of common usage: fractures, dislocations, fracture-dislocations. Shall not refer in detail to fractures of the spinous or transverse processes. (2) Mechanics of injury to vertebr. Two variables: (1) the nature of the bones; (2) the qualities of the force. Spinal injury usually caused by indirect violence. (3) The different results of injuries applied to the head; may break skull, failing that, the neck. Atlas fracture. Difference in qualities of the force causing atlas fracture and low cervical dislocation. (4) The compound nature of the vertebral body. The two columns, anterior, spongy; posterior, compact. The nature of wedge-compression of the vertebral body. Variations in the shape of the wedge. Reasons. Occur at all levels, including cervical spine. (5) Frequency of injury at different levels of vertebral column. Localization of injury. The two places of the graph of injury. The cervical at C. 5. Reason. The thoracic-lumbar peak at T. 12, L. 1 industrial. Is there a third peak at C. 2? (6) The effects of violent flexion of the spine: cervical flexion causes luxation at C. 5 or so. Extension causes fracture of odontoid. Violent flexion and extension therefore cause injury at very different levels. Thoracic region, why is there no peak of injury at T.6, 7? Lumbar region. (7) Displacement of fragments. Continuation of violence after the essential injury has been effected. Kmmell's disease, no inflammatory process involved. (8) Injury to the intervertebral discs, essential for displacement. Imperfect rupture a cause for difficulty in reducing luxations. The worst cases those in which it is most easily done, but most of these have cord damage. (9) Spinal injury from minimal violence. Examples of trivial cases, diving, brushing hair and so forth. Vertebral displacement in disease a much more serious thing. (10) Curious stability of many cervical luxations. Reasons. Locking of the inferior zygaphophyses. (11) Injury to nervous elements left principally to other speakers. Cord compression very rare. Immediate and irremediable damage. Root injuries. Falling mortality of modern statistics due to better diagnosis. (12) Primary operation for fractures of spine relegated to oblivion. Rarity of indications for open operation. Reduction the best treatment. ImagesFig. 5Fig. 6 PMID:19986314

  5. Spinal pleomorphic xanthoastrocytoma companied with periventricular tumor

    PubMed Central

    Zhao, Xintong; Jiang, Xiaochun; Wang, Xiangming

    2015-01-01

    Pleomorphic xanthoastrocytoma (PXA) is a low grade tumor that occurs in supratentorial area of children and young adult. In the previous reports, PXA of spinal cord or multicentre was extremely rare. A 60-year-old patient of spinal PXA and periventricular tumor presented with waist pain and weakness of double legs for one month. Neuroimaging showed that a lesion at the level of L2-L3 and periventricular tumor. Postoperative microscopy indicated that WHO grade II PXA. Photomicrograph of the lesion showed spindle cells, marked nuclear and cytoplasmic pleomorphism, with foamy cytoplasm. Immunohistochemical staining showed that GFAP and S-100 were positive. This is a rare case of synchronous multicentric PXA. Physicians should be realized multicentric dissemination by meninges or cerebrospinal fluid in PXA patients. It is important to describe the particular case in order to better understanding of clinical features. PMID:25755815

  6. Intraspinal microstimulation generates functional movements after spinal-cord injury.

    PubMed

    Saigal, Rajiv; Renzi, Costantino; Mushahwar, Vivian K

    2004-12-01

    Restoring locomotion after spinal-cord injury has been a difficult problem to solve with traditional functional electrical stimulation (FES) systems. Intraspinal microstimulation (ISMS) is a novel approach to FES that takes advantage of spinal-cord locomotor circuits by stimulating in the spinal cord directly. Previous studies in spinal-cord intact cats showed near normal recruitment order, reduced fatigue, and functional, synergistic movements induced by stimulation through a few microwires implanted over a 3-cm region in the lumbosacral cord. The present study sought to test the feasibility of ISMS for restoring locomotion after complete spinal-cord transection. In four adult male cats, the spinal cord was severed at T10, T11, or T12. Two to four weeks later, 30 wires (30 microm, stainless steel) were implanted, under anesthesia, in both sides of the lumbosacral cord. The cats were then decerebrated. Stimulus pulses (40-50 Hz, 200 micros, biphasic) with amplitudes ranging from 1-4x threshold (threshold = 32 +/- 19 microA) were delivered through each unipolar electrode. Kinetics, kinematics, and electromyographic (EMG) measurements were obtained with the cats suspended over a stationary treadmill with embedded force platforms for the hindlimbs. Phasic, interleaved stimulation through electrodes generating flexor or extensor movements produced bilateral weight-bearing stepping of the hindlimbs with ample foot clearance during swing. Minimal changes in kinematics and little fatigue were seen during episodes of 40 consecutive steps. The results indicate that ISMS is a promising technique for restoring locomotion after injury. PMID:15614999

  7. Evaluation and management of spinal epidural abscess.

    PubMed

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

    2016-02-01

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

  8. Spinal Traumas and their Treatments According to Avicenna's Canon of Medicine.

    PubMed

    Ghaffari, Farzaneh; Naseri, Mohsen; Movahhed, Mina; Zargaran, Arman

    2015-07-01

    Spinal Traumas have been categorized as disabling diseases that cause irretrievable personal and social problems. Having conducted a rather comprehensive diagnosis of the anatomy of the backbone and spinal cord as well as their functions, Avicenna (Ibn Sina, 980-1037) stated the levels and kinds of spinal impairments that are caused by spinal traumas in his great masterpiece Al-Qanun fi al-Tibb (The Canon of Medicine). He also based his treatment process on his etiological diagnosis of such impairments. Avicenna had used the following methods to treat spinal traumas: food and drug therapy and regimental therapies such as massage, phlebotomy, cupping, dry sauna, and surgery. The authors of the present article review the bases of Avicenna's viewpoints regarding spinal traumas and their treatment. PMID:25772611

  9. Spinal Cord Lesions in Congenital Toxoplasmosis Demonstrated with Neuroimaging, Including Their Successful Treatment in an Adult.

    PubMed

    Burrowes, Delilah; Boyer, Kenneth; Swisher, Charles N; Noble, A Gwendolyn; Sautter, Mari; Heydemann, Peter; Rabiah, Peter; Lee, Daniel; McLeod, Rima

    2012-03-01

    Neuroimaging studies for persons in the National Collaborative Chicago-Based Congenital Toxoplasmosis Study (NCCCTS) with symptoms and signs referable to the spinal cord were reviewed. Three infants had symptomatic spinal cord lesions, another infant a Chiari malformation, and another infant a symptomatic peri-spinal cord lipoma. One patient had an unusual history of prolonged spinal cord symptoms presenting in middle age. Neuroimaging was used to establish her diagnosis and response to treatment. This 43 year-old woman with congenital toxoplasmosis developed progressive leg spasticity, weakness, numbness, difficulty walking, and decreased visual acuity and color vision without documented re-activation of her chorioretinal disease. At 52 years of age, spinal cord lesions in locations correlating with her symptoms and optic atrophy were diagnosed with 3 Tesla MRI scan. Treatment with pyrimethamine and sulfadiazine decreased her neurologic symptoms, improved her neurologic examination, and resolved her enhancing spinal cord lesions seen on MRI. PMID:23487348

  10. Simulation in spinal diseases.

    PubMed

    Aso Escario, Jos; Martnez Quiones, Jos Vicente; Aso Vizn, Alberto; Arregui Calvo, Ricardo; Bernal Lafuente, Marta; Alczar Crevilln, Andrs

    2014-01-01

    Simulation is frequent in spinal disease, resulting in problems for specialists like Orthopedic Surgeons, Neurosurgeons, Reumathologists, etc. Simulation requires demonstration of the intentional production of false or exaggerated symptoms following an external incentive. The clinician has difficulties in demonstrating these criteria, resulting in misdiagnosis of simulation or misinterpretation of the normal patient as a simulator, with the possibility of iatrogenic distress and litigation. We review simulation-related problems in spine, proposing a terminological, as well as a diagnostic strategy including clinical and complementary diagnosis, as a way to avoid misinterpretation and minimize the iatrogenic distress and liability Based on the clinical-Forensic author's expertise, the literature is analyzed and the terminology readdressed to develop new terms (inconsistences, incongruences, discrepancies and contradictions). Clinical semiology and complementary test are adapted to the new scenario. Diagnostic strategy relies on anamnesis, clinical and complementary tests, adapting them to a uniform terminology with clear meaning of signs and symptoms. PMID:24913963

  11. Depression and Spinal Cord Injury

    MedlinePlus

    ... colleagues, with an educational grant from Pfizer Inc. University of Washington-operated SCI Clinics: Harborview Medical Center ... Spinal Cord Injury Clinic nurses: 206-744-5862 University of Washington Medical Center Rehabilitation Medicine Clinic 1959 ...

  12. Overview of Spinal Cord Disorders

    MedlinePlus

    ... temperature from the body to the spinal cord. Did You Know... Doctors can often tell where the ... on symptoms and results of a physical examination. Did You Know... Nerves from the lowest parts of ...

  13. Pacemaker neurons within newborn spinal pain circuits

    PubMed Central

    Li, Jie; Baccei, Mark L.

    2011-01-01

    Spontaneous activity driven by “pacemaker” neurons, defined by their intrinsic ability to generate rhythmic burst-firing, contributes to the development of sensory circuits in many regions of the immature CNS. However, it is unknown if pacemaker-like neurons are present within central pain pathways in the neonate. Here we provide evidence that a subpopulation of glutamatergic interneurons within lamina I of the rat spinal cord exhibits oscillatory burst-firing during early life, which occurs independently of fast synaptic transmission. Pacemaker neurons were distinguished by a higher ratio of persistent, voltage-gated Na+ conductance to leak membrane conductance (gNa,P / gleak) compared to adjacent, non-bursting lamina I neurons. The activation of high-threshold (N-type and L-type) voltage-gated Ca2+ channels also facilitated rhythmic burst-firing by triggering intracellular Ca2+ signaling. Bursting neurons received direct projections from high-threshold sensory afferents, but transmitted nociceptive signals with poor fidelity while in the bursting mode. The observation that pacemaker neurons send axon collaterals throughout the neonatal spinal cord raises the possibility that intrinsic burst-firing could provide an endogenous drive to the developing sensorimotor networks which mediate spinal pain reflexes. PMID:21677184

  14. Regulation of AMPA receptors in spinal nociception

    PubMed Central

    2010-01-01

    The functional properties of α-amino-3-hydroxy-5-methy-4-isoxazole propionate (AMPA) receptors in different brain regions, such as hippocampus and cerebellum, have been well studied in vitro and in vivo. The AMPA receptors present a unique characteristic in the mechanisms of subunit regulation during LTP (long-term potentiation) and LTD (long-term depression), which are involved in the trafficking, altered composition and phosphorylation of AMPA receptor subunits. Accumulated data have demonstrated that spinal AMPA receptors play a critical role in the mechanism of both acute and persistent pain. However, less is known about the biochemical regulation of AMPA receptor subunits in the spinal cord in response to painful stimuli. Recent studies have shown that some important regulatory processes, such as the trafficking of AMPA receptor subunit, subunit compositional changes, phosphorylation of AMPA receptor subunits, and their interaction with partner proteins may contribute to spinal nociceptive transmission. Of all these regulation processes, the phosphorylation of AMPA receptor subunits is the most important since it may trigger or affect other cellular processes. Therefore, these study results may suggest an effective strategy in developing novel analgesics targeting AMPA receptor subunit regulation that may be useful in treating persistent and chronic pain without unacceptable side effects in the clinics. PMID:20092646

  15. MRI Features of Spinal Epidural Angiolipomas

    PubMed Central

    Hu, Su; Hu, Xiao-yun; Wang, Xi-ming; Dai, Hui; Fang, Xiang-ming; Cui, Lei

    2013-01-01

    Objective To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. Materials and Methods Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. Results Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. Conclusion Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration. PMID:24043978

  16. Electronic bypass of spinal lesions: activation of lower motor neurons directly driven by cortical neural signals

    PubMed Central

    2014-01-01

    Background Lower motor neurons in the spinal cord lose supraspinal inputs after complete spinal cord injury, leading to a loss of volitional control below the injury site. Extensive locomotor training with spinal cord stimulation can restore locomotion function after spinal cord injury in humans and animals. However, this locomotion is non-voluntary, meaning that subjects cannot control stimulation via their natural “intent”. A recent study demonstrated an advanced system that triggers a stimulator using forelimb stepping electromyographic patterns to restore quadrupedal walking in rats with spinal cord transection. However, this indirect source of “intent” may mean that other non-stepping forelimb activities may false-trigger the spinal stimulator and thus produce unwanted hindlimb movements. Methods We hypothesized that there are distinguishable neural activities in the primary motor cortex during treadmill walking, even after low-thoracic spinal transection in adult guinea pigs. We developed an electronic spinal bridge, called “Motolink”, which detects these neural patterns and triggers a “spinal” stimulator for hindlimb movement. This hardware can be head-mounted or carried in a backpack. Neural data were processed in real-time and transmitted to a computer for analysis by an embedded processor. Off-line neural spike analysis was conducted to calculate and preset the spike threshold for “Motolink” hardware. Results We identified correlated activities of primary motor cortex neurons during treadmill walking of guinea pigs with spinal cord transection. These neural activities were used to predict the kinematic states of the animals. The appropriate selection of spike threshold value enabled the “Motolink” system to detect the neural “intent” of walking, which triggered electrical stimulation of the spinal cord and induced stepping-like hindlimb movements. Conclusion We present a direct cortical “intent”-driven electronic spinal bridge to restore hindlimb locomotion after complete spinal cord injury. PMID:24990580

  17. Significantly prolonged spinal anesthesia with the addition of dexamethasone: a case report.

    PubMed

    Abbas, Mostafa Samy; Asker, Omnia Ahmed

    2015-09-01

    The purpose of the study is to highlight that prolonged blocks with spinal anesthesia are not usually due to neurologic defects. Consent for data publication was obtained. A 35-year-old female patient with right upper tibial chondrosarcoma was planned to undergo excision and reconstruction with a free vascularized fibular graft. The patient had no significant medical history. We gave spinal anesthesia, which is to be continued with general anesthesia after regression of the sensory level. After 3 hours, we evaluated the patient for the second time to find sensory block at T10 level. It was decided to carry out these evaluations hourly and wait for general anesthesia. Ten hours after the spinal anesthesia, the sensory block was still at T10 level. After 13 hours, the surgical procedure was finished, and the sensory block was still at T10 level and the motor block according to the Bromage scale remained at grade 4. A computed tomography was performed and did not reveal signs of spinal compression, spinal canal stenosis, or other anomalies (magnetic resonance imaging was unavailable). A complete motor and sensory recovery from the spinal block was observed 20 hours after spinal anesthesia. We present a case of major microscopic surgery done over 13 hours with a single shot of spinal anesthesia in a 35-year-old female patient. Complete recovery of sensory and motor blocks has been after 20 hours. We also review other cases of unusually prolonged spinal blocks and the possible differential diagnosis for that. PMID:26142073

  18. Effect of spinal cord compression on local vascular blood flow and perfusion capacity.

    PubMed

    Alshareef, Mohammed; Krishna, Vibhor; Ferdous, Jahid; Alshareef, Ahmed; Kindy, Mark; Kolachalama, Vijaya B; Shazly, Tarek

    2014-01-01

    Spinal cord injury (SCI) can induce prolonged spinal cord compression that may result in a reduction of local tissue perfusion, progressive ischemia, and potentially irreversible tissue necrosis. Due to the combination of risk factors and the varied presentation of symptoms, the appropriate method and time course for clinical intervention following SCI are not always evident. In this study, a three-dimensional finite element fluid-structure interaction model of the cervical spinal cord was developed to examine how traditionally sub-clinical compressive mechanical loads impact spinal arterial blood flow. The spinal cord and surrounding dura mater were modeled as linear elastic, isotropic, and incompressible solids, while blood was modeled as a single-phased, incompressible Newtonian fluid. Simulation results indicate that anterior, posterior, and anteroposterior compressions of the cervical spinal cord have significantly different ischemic potentials, with prediction that the posterior component of loading elevates patient risk due to the concomitant reduction of blood flow in the arterial branches. Conversely, anterior loading compromises flow through the anterior spinal artery but minimally impacts branch flow rates. The findings of this study provide novel insight into how sub-clinical spinal cord compression could give rise to certain disease states, and suggest a need to monitor spinal artery perfusion following even mild compressive loading. PMID:25268384

  19. Effect of Spinal Cord Compression on Local Vascular Blood Flow and Perfusion Capacity

    PubMed Central

    Alshareef, Mohammed; Krishna, Vibhor; Ferdous, Jahid; Alshareef, Ahmed; Kindy, Mark; Kolachalama, Vijaya B.; Shazly, Tarek

    2014-01-01

    Spinal cord injury (SCI) can induce prolonged spinal cord compression that may result in a reduction of local tissue perfusion, progressive ischemia, and potentially irreversible tissue necrosis. Due to the combination of risk factors and the varied presentation of symptoms, the appropriate method and time course for clinical intervention following SCI are not always evident. In this study, a three-dimensional finite element fluid-structure interaction model of the cervical spinal cord was developed to examine how traditionally sub-clinical compressive mechanical loads impact spinal arterial blood flow. The spinal cord and surrounding dura mater were modeled as linear elastic, isotropic, and incompressible solids, while blood was modeled as a single-phased, incompressible Newtonian fluid. Simulation results indicate that anterior, posterior, and anteroposterior compressions of the cervical spinal cord have significantly different ischemic potentials, with prediction that the posterior component of loading elevates patient risk due to the concomitant reduction of blood flow in the arterial branches. Conversely, anterior loading compromises flow through the anterior spinal artery but minimally impacts branch flow rates. The findings of this study provide novel insight into how sub-clinical spinal cord compression could give rise to certain disease states, and suggest a need to monitor spinal artery perfusion following even mild compressive loading. PMID:25268384

  20. Spinal muscular atrophy

    PubMed Central

    2011-01-01

    Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by degeneration of alpha motor neurons in the spinal cord, resulting in progressive proximal muscle weakness and paralysis. Estimated incidence is 1 in 6,000 to 1 in 10,000 live births and carrier frequency of 1/40-1/60. This disease is characterized by generalized muscle weakness and atrophy predominating in proximal limb muscles, and phenotype is classified into four grades of severity (SMA I, SMAII, SMAIII, SMA IV) based on age of onset and motor function achieved. This disease is caused by homozygous mutations of the survival motor neuron 1 (SMN1) gene, and the diagnostic test demonstrates in most patients the homozygous deletion of the SMN1 gene, generally showing the absence of SMN1 exon 7. The test achieves up to 95% sensitivity and nearly 100% specificity. Differential diagnosis should be considered with other neuromuscular disorders which are not associated with increased CK manifesting as infantile hypotonia or as limb girdle weakness starting later in life. Considering the high carrier frequency, carrier testing is requested by siblings of patients or of parents of SMA children and are aimed at gaining information that may help with reproductive planning. Individuals at risk should be tested first and, in case of testing positive, the partner should be then analyzed. It is recommended that in case of a request on carrier testing on siblings of an affected SMA infant, a detailed neurological examination should be done and consideration given doing the direct test to exclude SMA. Prenatal diagnosis should be offered to couples who have previously had a child affected with SMA (recurrence risk 25%). The role of follow-up coordination has to be managed by an expert in neuromuscular disorders and in SMA who is able to plan a multidisciplinary intervention that includes pulmonary, gastroenterology/nutrition, and orthopedic care. Prognosis depends on the phenotypic severity going from high mortality within the first year for SMA type 1 to no mortality for the chronic and later onset forms. PMID:22047105

  1. Pathophysiology of primary spinal syringomyelia

    PubMed Central

    Heiss, John D.; Snyder, Kendall; Peterson, Matthew M.; Patronas, Nicholas J.; Butman, John A.; Smith, René K.; DeVroom, Hetty L.; Sansur, Charles A.; Eskioglu, Eric; Kammerer, William A.; Oldfield, Edward H.

    2013-01-01

    Object The pathogenesis of syringomyelia in patients with an associated spinal lesion is incompletely understood. The authors hypothesized that in primary spinal syringomyelia, a subarachnoid block effectively shortens the length of the spinal subarachnoid space (SAS), reducing compliance and the ability of the spinal theca to dampen the subarachnoid CSF pressure waves produced by brain expansion during cardiac systole. This creates exaggerated spinal subarachnoid pressure waves during every heartbeat that act on the spinal cord above the block to drive CSF into the spinal cord and create a syrinx. After a syrinx is formed, enlarged subarachnoid pressure waves compress the external surface of the spinal cord, propel the syrinx fluid, and promote syrinx progression. Methods To elucidate the pathophysiology, the authors prospectively studied 36 adult patients with spinal lesions obstructing the spinal SAS. Testing before surgery included clinical examination; evaluation of anatomy on T1-weighted MRI; measurement of lumbar and cervical subarachnoid mean and pulse pressures at rest, during Valsalva maneuver, during jugular compression, and after removal of CSF (CSF compliance measurement); and evaluation with CT myelography. During surgery, pressure measurements from the SAS above the level of the lesion and the lumbar intrathecal space below the lesion were obtained, and cardiac-gated ultrasonography was performed. One week after surgery, CT myelography was repeated. Three months after surgery, clinical examination, T1-weighted MRI, and CSF pressure recordings (cervical and lumbar) were repeated. Clinical examination and MRI studies were repeated annually thereafter. Findings in patients were compared with those obtained in a group of 18 healthy individuals who had already undergone T1-weighted MRI, cine MRI, and cervical and lumbar subarachnoid pressure testing. Results In syringomyelia patients compared with healthy volunteers, cervical subarachnoid pulse pressure was increased (2.7 ± 1.2 vs 1.6 ± 0.6 mm Hg, respectively; p = 0.004), pressure transmission to the thecal sac below the block was reduced, and spinal CSF compliance was decreased. Intraoperative ultrasonography confirmed that pulse pressure waves compressed the outer surface of the spinal cord superior to regions of obstruction of the subarachnoid space. Conclusions These findings are consistent with the theory that a spinal subarachnoid block increases spinal subarachnoid pulse pressure above the block, producing a pressure differential across the obstructed segment of the SAS, which results in syrinx formation and progression. These findings are similar to the results of the authors' previous studies that examined the pathophysiology of syringomyelia associated with obstruction of the SAS at the foramen magnum in the Chiari Type I malformation and indicate that a common mechanism, rather than different, separate mechanisms, underlies syrinx formation in these two entities. Clinical trial registration no.: NCT00011245. (http://thejns.org/doi/abs/10.3171/2012.8.SPINE111059) PMID:22958075

  2. The 'double tackle'--another cause of serious cervical spinal injury in rugby players. Case reports.

    PubMed

    Scher, A T

    1983-10-01

    The rugby player who is simultaneously tackled by 2 opponents is more susceptible to cervical spinal and spinal cord injury than the player tackled by a single opponent. The reasons for this increased susceptibility are described. Two illustrative case reports are presented. PMID:6623252

  3. Assessment of Spinal Curvature: An Evaluation of the Flexicurve and Associated Means of Analysis.

    ERIC Educational Resources Information Center

    Caine, M. P.; And Others

    1996-01-01

    Several interrelated issues pertaining to the measurement of spinal curvature are discussed, including the inherent limitations of the kyphotic index, the most widely used indicator in the evaluation of kyphosis. The paper suggests use of the Flexicurve to quantify spinal posture, suggests modifications to the Flexicurve, and presents results on…

  4. Ochronotic spondyloarthropathy: spinal involvement resembling ankylosing spondylitis.

    PubMed

    Balaban, Birol; Taskaynatan, Mehmet; Yasar, Evren; Tan, Kenan; Kalyon, Tunc

    2006-07-01

    Ochronotic spondyloarthropathy is a rare metabolic disease with the musculoskeletal manifestations of alkaptonuria. Ochronotic arthropathy patients may have spinal abnormalities similar to ankylosing spondylitis (AS). The proof of sacroiliac involvement or bamboo spine appearance is not sufficient either for diagnosis of ankylosing spondilitis or exclusion of ochronosis. In this report, the case of a 54-year-old woman having ochronosis, with clinically more recognizable axial arthropathy resembling AS, is presented, and the history, clinical presentation, diagnostic techniques, and distinctive diagnosis are reviewed. PMID:16267610

  5. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section.

    PubMed

    Shah, Tanmay H; Badve, Manasi S; Olajide, Kowe O; Skorupan, Havyn M; Waters, Jonathan H; Vallejo, Manuel C

    2011-07-01

    Patients with Klippel-Feil Syndrome (KFS) have congenital fusion of their cervical vertebrae due to a failure in the normal segmentation of the cervical vertebrae during the early weeks of gestation and also have myriad of other associated anomalies. Because of limited neck mobility, airway management in these patients can be a challenge for the anesthesiologist. We describe a unique case in which a dexmedetomidine infusion was used as sedation for an awake fiber-optic intubation in a parturient with Klippel-Feil Syndrome, who presented for elective cesarean delivery. A 36-year-old female, G2P1A0 with KFS (fusion of cervical vertebrae) who had prior cesarean section for breech presentation with difficult airway management was scheduled for repeat cesarean delivery. After obtaining an informed consent, patient was taken in the operating room and non-invasive monitors were applied. Dexmedetomidine infusion was started and after adequate sedation, an awake fiber-optic intubation was performed. General anesthetic was administered after intubation and dexmedetomidine infusion was continued on maintenance dose until extubation. Klippel-Feil Syndrome (KFS) is a rare congenital disorder for which the true incidence is unknown, which makes it even rare to see a parturient with this disease. Patients with KFS usually have other congenital abnormalities as well, sometimes including the whole thoraco-lumbar spine (Type III) precluding the use of neuraxial anesthesia for these patients. Obstetric patients with KFS can present unique challenges in administering anesthesia and analgesia, primarily as it relates to the airway and dexmedetomidine infusion has shown promising result to manage the airway through awake fiberoptic intubation without any adverse effects on mother and fetus. PMID:24765318

  6. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section

    PubMed Central

    Shah, Tanmay H.; Badve, Manasi S.; Olajide, Kowe O.; Skorupan, Havyn M.; Waters, Jonathan H.; Vallejo, Manuel C.

    2011-01-01

    Patients with Klippel-Feil Syndrome (KFS) have congenital fusion of their cervical vertebrae due to a failure in the normal segmentation of the cervical vertebrae during the early weeks of gestation and also have myriad of other associated anomalies. Because of limited neck mobility, airway management in these patients can be a challenge for the anesthesiologist. We describe a unique case in which a dexmedetomidine infusion was used as sedation for an awake fiber-optic intubation in a parturient with Klippel-Feil Syndrome, who presented for elective cesarean delivery. A 36-year-old female, G2P1A0 with KFS (fusion of cervical vertebrae) who had prior cesarean section for breech presentation with difficult airway management was scheduled for repeat cesarean delivery. After obtaining an informed consent, patient was taken in the operating room and non-invasive monitors were applied. Dexmedetomidine infusion was started and after adequate sedation, an awake fiber-optic intubation was performed. General anesthetic was administered after intubation and dexmedetomidine infusion was continued on maintenance dose until extubation. Klippel-Feil Syndrome (KFS) is a rare congenital disorder for which the true incidence is unknown, which makes it even rare to see a parturient with this disease. Patients with KFS usually have other congenital abnormalities as well, sometimes including the whole thoraco-lumbar spine (Type III) precluding the use of neuraxial anesthesia for these patients. Obstetric patients with KFS can present unique challenges in administering anesthesia and analgesia, primarily as it relates to the airway and dexmedetomidine infusion has shown promising result to manage the airway through awake fiberoptic intubation without any adverse effects on mother and fetus. PMID:24765318

  7. A huge ependymoma of the cervical spinal cord with subtle atypical manifestations and hyperhidrosis: Case report

    PubMed Central

    Haddadi, Kaveh

    2015-01-01

    Introduction Ependymomas are the most common neuroepithelial tumors of the spinal cord, accounting for 5060% of spinal cord gliomas. The nonspecific clinical presentation of a spinal cord tumor frequently results in delay of diagnosis with opposing outcomes. Presentation of case We report a 34-year-old man presented with abnormally enhanced sweating on the left side of his neck, upper extremity, and chest that had been occurring for 1 year. In the sagittal MRI there were a centrally localized mass lesion extending from medulla and C1 to T2 vertebra level and expanding the cord. Surgical elimination of the tumor was performed with posterior midline approach and near total resection of tumor was achieved. Conclusion Cervical intramedullary ependymal is a rare, slow growing spinal cord tumor. Attention to uncommon characteristics like hyperhidrosis might be an important key to early diagnosis of this rare spinal tumor. Surgical resection is the choice of treatment with infrequent recurrence. PMID:26741275

  8. Spinal extradural arachnoid cyst.

    PubMed

    Choi, Seung Won; Seong, Han Yu; Roh, Sung Woo

    2013-10-01

    Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy. PMID:24294463

  9. Spinal Extradural Arachnoid Cyst

    PubMed Central

    Choi, Seung Won; Seong, Han Yu

    2013-01-01

    Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy. PMID:24294463

  10. [Treatment of postoperative pain by balanced spinal analgesia].

    PubMed

    Polati, E; Finco, G; Bartoloni, A; Rigo, V; Gottin, L; Pinaroli, A M; Barzoi, G

    1995-01-01

    Postoperative pain relief has the aim to provide patient subjective comfort, to inhibit neuroendocrine and metabolic responses to surgical injury and to enhance restoration of function by allowing the patient to breathe, cough, move more easily and to begin enteral nutrition. Opioid analgesics, independently from the route of administration, are unable to provide all this. In addition to spinal opioids other drugs, such as local anesthetics, alpha 2-agonists and cholinergic drugs, may produce an antinociceptive effect when administered by spinal route. All these drugs may be administered in combination between them, realising the so called "balanced spinal analgesia". The aim of this study is to analyse the available methods for the evaluation of pharmacological interactions, the types of interaction among different spinal antinociceptive drugs and the role of balanced spinal analgesia in the treatment of postoperative pain. Analysis of the presented data shows that the spinal synergism between opioids-local anesthetics and opioids-alpha 2-agonists can be useful in the treatment of postoperative pain, because these drug combinations are able to provide a satisfactory pain control at low doses with a reduction of the adverse effects. Furthermore, the combined use of opioids-local anesthetics proved to be effective also in abolishing postoperative incident pain and in inhibiting neuroendocrine and metabolic responses to surgical injury. Especially in high risk patients this is related to a better outcome. Finally, even if the synergism between cholinergic drugs with opioids or a2-agonists have been proved, at the moment their use in man by spinal route in the treatment of postoperative pain is not advisable. PMID:9480192

  11. Modern concepts of therapy and management of spinal cord injuries.

    PubMed

    Woolsey, R M

    1988-01-01

    Trauma is the most common cause of spinal cord-related disability. There are approximately 52 new spinal cord injuries per million population per year in the U.S., and about 200,000 persons with post-traumatic paraplegia or quadriplegia require continuing medical care in this country at the present time. Management of the spinal cord-injured patient commences at the moment of injury and continues throughout the entire lifetime of the patient. While there is considerable consensus regarding the management of some problems related to traumatic myelopathy, other treatment concerns, mainly related to spinal fractures, are highly controversial, with a plethora of strongly held opinions, frequently supported by meager factual evidence or none at all. It is not generally recognized that whatever treatment the patient receives during the first days or weeks following injury is of considerably less importance, from a lifelong perspective, than that which occurs over subsequent months. Skillful physical rehabilitation to maximize the functional usefulness of remaining neurological function permits the return of most spinal cord-injured patients to their family and community able to function as an independent person. Paraplegic and quadriplegic patients acquire health risks unique to their condition, mainly related to pressure sore liability and altered bladder function, which requires continual, meticulous attention from the patient and his physician. The sudden transition from being an unimpaired to a permanently paralyzed person is a cataclysmic emotional experience. Unless psychic rehabilitation is undertaken in tandem with physical rehabilitation, a spinal cord-injured patient is likely to become an unhappy social recluse or denizen of a chronic care facility, rather than an independent productive member of his community. Centers dedicated to comprehensive spinal cord care have become generally available and provide optimal care for traumatic myelopathy. PMID:3063393

  12. [Gene expression profile of spinal ventral horn in ALS].

    PubMed

    Yamamoto, Masahiko; Tanaka, Fumiaki; Sobue, Gen

    2007-10-01

    The causative pathomechanism of sporadic amyotrophic lateral sclerosis (ALS) is not clearly understood. Using microarray technology combined with laser-captured microdissection, gene expression profiles of degenerating spinal motor neurons as well as spinal ventral horn from autopsied patients with sporadic ALS were examined. Spinal motor neurons showed a distinct gene expression profile from the whole spinal ventral horn. Three percent of genes examined were significantly downregulated, and 1% were upregulated in motor neurons. In contrast with motor neurons, the total spinal ventral horn homogenates demonstrated 0.7% and 0.2% significant upregulation and downregulation of gene expression, respectively. Downregulated genes in motor neurons included those associated with cytoskeleton/axonal transport, transcription and cell surface antigens/receptors, such as dynactin 1 (DCTN1) and early growth response 3 (EGR3). In particular, DCTN1 was markedly downregulated in most residual motor neurons prior to the accumulation of pNF-H and ubiquitylated protein. Promoters for cell death pathway, death receptor 5 (DR5), cyclins C (CCNC) and A1 (CCNA), and caspases were upregulated, whereas cell death inhibitors, acetyl-CoA transporter (ACATN) and NF-kappaB (NFKB) were also upregulated. In terms of spinal ventral horn, the expression of genes related to cell surface antigens/receptors, transcription and cell adhesion/ECM were increased. The gene expression resulting in neurodegenerative and neuroprotective changes were both present in spinal motor neurons and ventral horn. Moreover, Inflammation-related genes, such as belonging to the cytokine family were not, however, significantly upregulated in either motor neurons or ventral horn. The sequence of motor neuron-specific gene expression changes from early DCTN1 downregulation to late CCNC upregulation in sporadic ALS can provide direct information on the genes leading to neurodegeneration and neuronal death, and are helpful for developing new therapeutic strategies. PMID:17969353

  13. Genetics Home Reference: Spinal muscular atrophy

    MedlinePlus

    ... by a loss of specialized nerve cells, called motor neurons, in the spinal cord and the part ... the spinal cord (the brainstem). The loss of motor neurons leads to weakness and wasting (atrophy) of ...

  14. Spinal Cord Injury Model System Information Network

    MedlinePlus

    ... Contact the UAB-SCIMS UAB Spinal Cord Injury Model System Newly Injured Health Daily Living Consumer Groups ... University of Alabama at Birmingham Spinal Cord Injury Model System (UAB-SCIMS) maintains this Information Network as ...

  15. FAQs about Spinal Cord Injury (SCI)

    MedlinePlus

    ... the UAB-SCIMS UAB Spinal Cord Injury Model System Newly Injured Health Daily Living Consumer Groups Professional Groups Research Información En Español Information for the Newly Injured FAQs about Spinal Cord ...

  16. Phlyctenular conjunctivitis: a rare association with spinal intramedullary tuberculoma

    PubMed Central

    Bhandari, Aveg; Bhandari, Heena; Shukla, Rakesh; Giri, Prithvi

    2014-01-01

    We present a case of a 33-year-old woman who presented with phlyctenular conjunctivitis while on treatment for spinal intramedullary tuberculosis. She was treated with topical steroids along with continuation of antitubercular therapy, and improved on this treatment. PMID:24642174

  17. Why do spinal manipulation techniques take the form they do? Towards a general model of spinal manipulation.

    PubMed

    Evans, David W

    2010-06-01

    For centuries, techniques used to manipulate joints in the spine have been passed down from one generation of manipulators to the next. Today, spinal manipulation is in the curious position that positive clinical effects have now been demonstrated, yet the theoretical base underpinning every aspect of its use is still underdeveloped. An important question is posed in this masterclass: why do spinal manipulation techniques take the form they do? From the available literature, two factors appear to provide an answer: 1. Action of a force upon vertebrae. Any 'direct' spinal manipulation technique requires that the patient be orientated in such a way that force is applied perpendicular to the overlying skin surface so as to act upon the vertebrae beneath. If the vertebral motion produced by 'directly' applied force is insufficient to produce the desired effect (e.g. cavitation), then force must be applied 'indirectly', often through remote body segments such as the head, thorax, abdomen, pelvis, and extremities. 2. Spinal segment morphology. A new hypothesis is presented. Spinal manipulation techniques exploit the morphology of vertebrae by inducing rotation at a spinal segment, about an axis that is always parallel to the articular surfaces of the constituent zygapophysial joints. In doing so, the articular surfaces of one zygapophysial joint appose to the point of contact, resulting in migration of the axis of rotation towards these contacting surfaces, and in turn this facilitates gapping of the other (target) zygapophysial joint. Other variations in the form of spinal manipulation techniques are likely to depend upon the personal style and individual choices of the practitioner. PMID:19427809

  18. Overview of spinal interventions.

    PubMed

    Colonno, Daniel V; Harrast, Mark A; Herring, Stanley A

    2012-07-01

    Athletes represent a specific subgroup of highly motivated patients with a unique set of social and psychological incentives. Demands placed on the lumbosacral system are high, and athletes may be particularly prone to the pathology discussed above. For this reason, it is crucial to consider the athlete as a functional whole operating in concert with intrinsic and extrinsic factors and to consider the lumbosacral system within the context of the complete kinetic chain. Spinal interventions should never be considered in isolation but rather as part of a comprehensive rehabilitation program targeting psychosocial as well as biomechanical opportunities. When interventional procedures are warranted, they should be performed according to existing guidelines regarding indication, patient selection, and technique where possible and with systems in place to maximize patient safety and to consistently monitor for response. Each of the interventions discussed above should be performed with fluoroscopic guidance, given the lack of accuracy without fluoroscopy, and generally be reserved for athletes not responding to conservative care. When returning an athlete to play after ESI, we recommend careful serial evaluation as well as involvement of appropriate family members, athletic trainers, and coaches in the decision-making process. Athletes should not return to play with any significant objective neurologic deficits. In appropriate athletes, return to play should occur with graduated and comprehensive rehabilitation as discussed above. Because evidence concerning the interventions discussed in this article is often lacking, clinical judgment is paramount regarding their allocation. The interventions explored above likely do provide viable treatment adjuncts in the carefully selected athlete but are not without risk. Athlete safety and global well being should guide any decision to pursue interventional treatment options. PMID:22657992

  19. Synchronous and asynchronous electrically evoked motor activities during wind-up stimulation are differentially modulated following an acute spinal transection.

    PubMed

    Frigon, Alain; Hurteau, Marie-France; Johnson, Michael D; Heckman, C J; Telonio, Alessandro; Thibaudier, Yann

    2012-12-01

    In this study, we used a novel technique to study reflex wind-up when the spinal cord is intact and following an acute spinal transection. Specifically, we evaluated reflex responses evoked by a series of 10 electrical pulses to the tibial or superficial peroneal nerves in 9 decerebrate adult cats, before and after an acute spinal transection. Electromyograms were recorded in four hindlimb muscles (lateral gastrocnemius, tibialis anterior, semitendinosus, and sartorius) to evaluate reflex amplitude, duration, and the temporal summation of reflex responses, so-called wind-up. We identified two distinct reflex responses evoked by electrical stimulation of the tibial or superficial peroneal nerves on the basis of their pattern of change following acute spinal transection, a short-latency (∼10 ms) compound action potential (CAP) that was followed by a burst of sustained activity (SA). Wind-up of CAP and SA amplitudes was clearly present when the spinal cord was intact but was drastically reduced after acute spinalization in some muscles. Moreover, CAP and SA reflex responses were differentially modified by the acute spinalization. When the effects of acute spinal transection were significant, CAP responses were increased after acute spinalization, whereas SA responses were reduced, suggesting that the two signals are regulated by different neuronal mechanisms. The present results provide the first assessment of reflex wind-up before and after an acute spinal transection in the same animals and indicate that different reflex components must be considered separately when evaluating changes in neuronal excitability following SCI. PMID:22993264

  20. Evaluation of spinal cord injury animal models

    PubMed Central

    Zhang, Ning; Fang, Marong; Chen, Haohao; Gou, Fangming; Ding, Mingxing

    2014-01-01

    Because there is no curative treatment for spinal cord injury, establishing an ideal animal model is important to identify injury mechanisms and develop therapies for individuals suffering from spinal cord injuries. In this article, we systematically review and analyze various kinds of animal models of spinal cord injury and assess their advantages and disadvantages for further studies. PMID:25598784

  1. Blood supply to the thoracolumbar spinal cord in the laboratory mouse using corrosion and dissection techniques.

    PubMed

    Flesarova, Slavka; Mazensky, David; Teleky, Jana; Almasiova, Viera; Holovska, Katarina; Supuka, Peter

    2016-01-01

    Mice are used frequently as experimental models in the study of ischemic spinal cord injury. The aim of the present study was to describe the arterial blood supply to the thoracolumbar spinal cord in the mouse. The study was carried out on 20 adult mice using the corrosion and dissection technique. Dorsal intercostal arteries were found as branches of the thoracic aorta: as 7 pairs in 80% of cases, as 8 pairs in 15% of cases and as 9 pairs in 5% of cases. The paired lumbar arteries arising from the abdominal aorta were present as 5 pairs in all cases. Along the entire thoracic and lumbar spinal regions, we observed left-sided branches entering the ventral spinal artery in 64.2% and right-sided branches in 35.8% of cases. Along the entire thoracic and lumbar spinal regions, the branches entering the dorsal spinal arteries were left-sided in 60.8% of cases and right-sided in 39.2% of cases. We found some variations in the site of origin of the artery of Adamkiewicz and in the number of dorsal spinal arteries. Documenting the anatomical variations in spinal cord blood supply in the laboratory mouse will aid the planning of future experimental studies and in determining the clinical relevance of such studies. PMID:25636913

  2. Spinal mechanisms underlying potentiation of hindpaw responses observed after transient hindpaw ischemia in mice

    PubMed Central

    Watanabe, Tatsunori; Sasaki, Mika; Komagata, Seiji; Tsukano, Hiroaki; Hishida, Ryuichi; Kohno, Tatsuro; Baba, Hiroshi; Shibuki, Katsuei

    2015-01-01

    Transient ischemia produces postischemic tingling sensation. Ischemia also produces nerve conduction block that may modulate spinal neural circuits. In the present study, reduced mechanical thresholds for hindpaw-withdrawal reflex were found in mice after transient hindpaw ischemia, which was produced by a high pressure applied around the hindpaw for 30 min. The reduction in the threshold was blocked by spinal application of LY354740, a specific agonist of group II metabotropic glutamate receptors. Neural activities in the spinal cord and the primary somatosensory cortex (S1) were investigated using activity-dependent changes in endogenous fluorescence derived from mitochondrial flavoproteins. Ischemic treatment induced potentiation of the ipsilateral spinal and contralateral S1 responses to hindpaw stimulation. Both types of potentiation were blocked by spinal application of LY354740. The contralateral S1 responses, abolished by lesioning the ipsilateral dorsal column, reappeared after ischemic treatment, indicating that postischemic tingling sensation reflects a sensory modality shift from tactile sensation to nociception in the spinal cord. Changes in neural responses were investigated during ischemic treatment in the contralateral spinal cord and the ipsilateral S1. Potentiation already appeared during ischemic treatment for 30 min. The present findings suggest that the postischemic potentiation shares spinal mechanisms, at least in part, with neuropathic pain. PMID:26165560

  3. Spinal mechanisms underlying potentiation of hindpaw responses observed after transient hindpaw ischemia in mice.

    PubMed

    Watanabe, Tatsunori; Sasaki, Mika; Komagata, Seiji; Tsukano, Hiroaki; Hishida, Ryuichi; Kohno, Tatsuro; Baba, Hiroshi; Shibuki, Katsuei

    2015-01-01

    Transient ischemia produces postischemic tingling sensation. Ischemia also produces nerve conduction block that may modulate spinal neural circuits. In the present study, reduced mechanical thresholds for hindpaw-withdrawal reflex were found in mice after transient hindpaw ischemia, which was produced by a high pressure applied around the hindpaw for 30 min. The reduction in the threshold was blocked by spinal application of LY354740, a specific agonist of group II metabotropic glutamate receptors. Neural activities in the spinal cord and the primary somatosensory cortex (S1) were investigated using activity-dependent changes in endogenous fluorescence derived from mitochondrial flavoproteins. Ischemic treatment induced potentiation of the ipsilateral spinal and contralateral S1 responses to hindpaw stimulation. Both types of potentiation were blocked by spinal application of LY354740. The contralateral S1 responses, abolished by lesioning the ipsilateral dorsal column, reappeared after ischemic treatment, indicating that postischemic tingling sensation reflects a sensory modality shift from tactile sensation to nociception in the spinal cord. Changes in neural responses were investigated during ischemic treatment in the contralateral spinal cord and the ipsilateral S1. Potentiation already appeared during ischemic treatment for 30 min. The present findings suggest that the postischemic potentiation shares spinal mechanisms, at least in part, with neuropathic pain. PMID:26165560

  4. The validity of multimodal intraoperative monitoring (MIOM) in surgery of 109 spine and spinal cord tumors

    PubMed Central

    Eggspuehler, Andreas; Grob, Dieter; Jeszenszky, Dezsö; Benini, Arnaldo; Porchet, Francois; Mueller, Alfred; Dvorak, Jiri

    2007-01-01

    In a prospective study of 109 patients with tumor of the spine MIOM was performed during the surgical procedure between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during surgical procedure of spinal tumors. MIOM become an integrated procedure during surgical approach to intramedullar and extramedullar spine tumors. The combination of monitoring ascending and descending pathways may provide more sensitive and specific results than SEP alone giving immediate feedback information regarding any neurological deficit during the operation. Intraoperative sensory spinal and cerebral evoked potential combined with EMG recordings and motor evoked potential of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. One hundred and nine consecutive patients with spinal tumors of different aetiologies were monitored by the means of MIOM during the entire surgical procedure. Eighty-two patients presented true negative findings while two patients monitored false negative, one false positive and 24 patients true positive findings where neurological deficits after the operation were present. All patients with neurological deficit recovered completely or to pre-existing neurological situation. The sensitivity of MIOM applied during surgery of spinal tumors has been calculated of 92% and specificity 99%. Based upon the results of the study MIOM is an effective method of monitoring the spinal cord and nerve root function during surgical approach of spinal tumors and consequently can reduce or prevent the occurrence of postoperative neurological deficit. PMID:17661095

  5. Neurological outcome in road traffic accidents with spinal cord injury.

    PubMed

    Moslavac, Sasa; Dzidić, Ivan; Kejla, Zvonko

    2008-06-01

    The aim of the study was to investigate neurological outcome in road traffic accidents (RTA) with spinal cord injury (SCI). The study was undertaken in National Spinal Unit of Special Medical Rehabilitation Hospital, in Varazdinske Toplice, Croatia. Hospital records of 154 inpatient RTA SCI patients, in years 1991-2001 were reviewed. Six groups of patients were formed: car drivers, co-drivers, back seat passengers, motorcycle drivers, bicycle drivers and pedestrians. Neurological assessments at admission to rehabilitation and before discharge were done according to American Spinal Injury Association (ASIA) impairment scale. Methods of descriptive statistics were used. Overall 49% of RTA SCI patients presented with complete injury (ASIA A) at admission to rehabilitation, 93% of initially complete spinal cord injured patients remained complete at discharge and 72% previously non-ambulatory incomplete (ASIA B-E) patients achieved ambulation. Complete injury was acquired more often in motorcycle drivers and car drivers group (67% and 54%, respectively). Road traffic spinal cord injuries are, and will remain the leading cause of traumatic SCI, with high proportion of complete injury at rehabilitation onset, especially in motorcycle drivers and car drivers groups. PMID:18756914

  6. Two-photon imaging of spinal cord cellular networks.

    PubMed

    Johannssen, Helge C; Helmchen, Fritjof

    2013-04-01

    Two-photon microscopy enables high-resolution in vivo imaging of cellular morphology and activity, in particular of population activity in complex neuronal circuits. While two-photon imaging has been extensively used in a variety of brain regions in different species, in vivo application to the vertebrate spinal cord has lagged behind and only recently became feasible by adapting and refining the experimental preparations. A major experimental challenge for spinal cord imaging is adequate control of tissue movement, which meanwhile can be achieved by various means. One set of studies monitored structural dynamics of neuronal and glial cellular components in living animals using transgenic mice with specific expression of fluorescent proteins. Other studies employed in vivo calcium imaging for functional measurements of sensory-evoked responses in individual neurons of the dorsal horn circuitry, which at present is the only part of rodent spinal cord grey matter accessible for in vivo imaging. In a parallel approach, several research groups have applied two-photon imaging to sensorimotor circuits in the isolated spinal cord (in vitro) to provide complementary information and valuable new perspectives on the function of specific interneuron types in locomotor-related networks. In this review we summarize recent results from these types of high-resolution two-photon imaging studies in the spinal cord and provide experimental perspectives for improving and extending this approach in future applications. PMID:22849822

  7. Spinal axis irradiation with electrons: Measurements of attenuation by the spinal processes

    SciTech Connect

    Muller-Runkel, R.; Vijayakumar, S.

    1986-07-01

    Electrons may be used beneficially for spinal axis irradiation in medulloblastoma children to avoid some of the long-term sequelae induced by megavoltage photons. However, the attenuation by the intervening bone ought to be considered. Three-dimensional computer treatment planning with inhomogeneity correction for electron beams is not yet generally available, and alternate methods are needed to evaluate the attenuation by the complex bony structure of the spine. Here, we present our experimental data showing the alteration in the electron isodoses due to the intervening spinous processes. Film dosimetric measurements were made in the vertebral columns obtained from autopsies of a goat, a dog, and a child. Our results show that electron beam therapy for the spinal axis is a viable option.

  8. Electrophysiological Mapping of Rat Sensorimotor Lumbosacral Spinal Networks after Complete Paralysis

    PubMed Central

    Gad, Parag; Roy, Roland R.; Choe, Jaehoon; Zhong, Hui; Nandra, Mandheeraj Singh; Tai, Y.C.; Gerasimenko, Yury; Edgerton, V. Reggie

    2015-01-01

    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 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 use of a multisite electrode array in the spinal rat model to identify and stimulate specific sites of the spinal cord to produce discrete motor behaviors in spinal rats. The results demonstrate that spinal rats can stand and step when the spinal cord is stimulated tonically via electrodes located at specific sites on the spinal cord. The quality of stepping and standing was dependent on the location of the electrodes on the spinal cord, the specific stimulation parameters, and the orientation of the cathode and anode. The spinal motor evoked potentials (sMEP) in selected muscles during standing and stepping are shown to be critical tools to study selective activation of interneuronal circuits via responses of varying latencies. The present results provide further evidence that the assessment of functional networks in the background of behaviorally relevant functional states is likely to be a physiological tool of considerable importance in developing strategies to facilitate recovery of motor function after a number of neuromotor disorders. PMID:25890138

  9. Clinical analysis of 36 multiple myeloma patients with extramedullary plasmacytoma invasion of the spinal canal.

    PubMed

    Zhang, Jiajia; Zhong, Yuping

    2015-06-01

    Few physicians are familiar with extramedullary plasmacytoma (EMP) invasion of the spinal canal in multiple myeloma (MM) patients, and little information about this rare disease is available. The purpose of the present study was to investigate the clinical features, prognosis and treatment of MM patients with EMP invasion of the spinal canal. We evaluated 36 MM patients with EMP invasion of the spinal canal. EMP invasion was confirmed by magnetic resonance imaging, computed tomography and/or histopathological analysis of bone marrow biopsy samples. Patients underwent surgery followed by chemotherapy or received chemotherapy alone. Chemotherapy consisted of bortezomib-containing regimens and other combination therapies. The patients' median age was 58.6 years (range, 31-78 years). Eight patients had negative immunofixation electrophoresis results, and nine patients had a bone marrow plasma cell infiltration rate of less than 5%. Of the 36 MM patients with EMP invasion of the spinal canal that we identified, 19 had thoracic spinal cord involvement, 10 had lumbar spinal cord involvement, 2 had sacral spinal cord involvement and 5 had both lumbar and thoracic spinal cord involvement. The findings of our study, which is the largest study in MM patients with EMP spinal canal invasion conducted to date, suggest the importance of the early detection of spinal invasion in MM patients. Extramedullary disease was resistant to conventional treatments but responded well to regimens containing novel drugs such as bortezomib. In patients with symptoms of nerve root involvement, the tumour should be resected as soon as possible to relieve spinal cord compression. PMID:24395149

  10. Pantopaque mimicking spinal lipoma: MR pitfall.

    PubMed

    Suojanen, J; Wang, A M; Winston, K R

    1988-01-01

    We present a patient with an intraspinal, high-signal-intensity lesion in the lumbosacral region on T1-weighted magnetic resonance images and a thin line of signal void between this region and the CSF on T2-weighted images. These findings were interpreted initially as representing an extradural spinal lipoma. However, CT revealed an intrathecal collection of iophendylate (Pantopaque), which was subsequently removed via a lumbar puncture. The apparent separation of Pantopaque from the CSF (seen on T2-weighted images and interpreted as the dura) was probably caused by chemical shift artifact, chemical shift contour, and/or CSF motion artifact. PMID:3351056

  11. Natural polyphenols and spinal cord injury.

    PubMed

    Khalatbary, Ali Reza

    2014-07-01

    Polyphenols have been shown to have some of the neuroprotective effects against neurodegenerative diseases. These effects are attributed to a variety of biological activities, including free radical scavenging/antioxidant and anti-inflammatory and anti-apoptotic activities. In this regard, many efforts have been made to study the effects of various well-known dietary polyphenols on spinal cord injury (SCI) and to explore the mechanisms behind the neuroprotective effects. The aim of this paper is to present the mechanisms of neuroprotection of natural polyphenols used in animal models of SCI. PMID:24842137

  12. Natural Polyphenols and Spinal Cord Injury

    PubMed Central

    Khalatbary, Ali Reza

    2014-01-01

    Polyphenols have been shown to have some of the neuroprotective effects against neurodegenerative diseases. These effects are attributed to a variety of biological activities, including free radical scavenging/antioxidant and anti-inflammatory and anti-apoptotic activities. In this regard, many efforts have been made to study the effects of various well-known dietary polyphenols on spinal cord injury (SCI) and to explore the mechanisms behind the neuroprotective effects. The aim of this paper is to present the mechanisms of neuroprotection of natural polyphenols used in animal models of SCI. PMID:24842137

  13. [Spinal column: implants and revisions].

    PubMed

    Krieg, S M; Meyer, H S; Meyer, B

    2016-03-01

    Non-fusion spinal implants are designed to reduce the commonly occurring risks and complications of spinal fusion surgery, e.g. long duration of surgery, high blood loss, screw loosening and adjacent segment disease, by dynamic or movement preserving approaches. This principle could be shown for interspinous spacers, cervical and lumbar total disc replacement and dynamic stabilization; however, due to the continuing high rate of revision surgery, the indications for surgery require as much attention and evidence as comparative data on the surgical technique itself. PMID:26779646

  14. Radiculopathy as Delayed Presentations of Retained Spinal Bullet

    PubMed Central

    Ryu, Bang; Choi, Man Kyu; Kim, Kee D

    2015-01-01

    Bullet injuries to the spine may cause injury to the anatomical structures with or without neurologic deterioration. Most bullet injuries are acute, resulting from direct injury. However, in rare cases, delayed injury may occur, resulting in claudication. We report a case of intradural bullet at the L3-4 level with radiculopathy in a 30-year-old male. After surgical removal, radicular and claudicating pain were improved significantly, and motor power of the right leg also improved. We report the case of intradural bullet, which resulted in delayed radiculopathy. PMID:26587197

  15. Radiculopathy as Delayed Presentations of Retained Spinal Bullet.

    PubMed

    Ryu, Bang; Kim, Sung Bum; Choi, Man Kyu; Kim, Kee D

    2015-10-01

    Bullet injuries to the spine may cause injury to the anatomical structures with or without neurologic deterioration. Most bullet injuries are acute, resulting from direct injury. However, in rare cases, delayed injury may occur, resulting in claudication. We report a case of intradural bullet at the L3-4 level with radiculopathy in a 30-year-old male. After surgical removal, radicular and claudicating pain were improved significantly, and motor power of the right leg also improved. We report the case of intradural bullet, which resulted in delayed radiculopathy. PMID:26587197

  16. Ultra Long Construct Minimally Invasive Spinal Stabilization Using Percutaneous Pedicle Screws in the Treatment of Symptomatic Multicentric Spinal Metastasis

    PubMed Central

    Chan, Chris Yin Wei; Kwan, Mun Keong

    2015-01-01

    Managing multiple level spinal metastases is challenging. We report the case of a 58-year-old female with advanced lung cancer who presented with multiple pathological fractures of the thoracic spine (T5, T6, T7, and T8 vertebrae). She was treated with palliative radiotherapy. Her resting pain improved, but the instability pain persisted. One month later, she had a trivial fall leading to a pathological fracture of the L2 vertebra with cauda equine syndrome. The patient was treated surgically with minimally invasive decompression of the L2 and with percutaneous instrumented stabilization using an ultra-long construct from T3 to L5 (15 spinal levels), spanning the previously radiated zone and the decompression site. Postoperatively, she had significant improvements in pain and neurology. There were no surgical complications. Ultra long construct minimally invasive spinal stabilization is the ideal approach for symptomatic multicentric spinal metastasis with poor prognostic scores. Using this technique, the goals of spinal stabilization and direct neural decompression can be achieved with minimal morbidity. PMID:26713131

  17. Barriers to implementing intermittent catheterisation in spinal cord injury patients in Northwest Regional Spinal Injuries Centre, Southport, U.K.

    PubMed

    Vaidyanathan, Subramanian; Soni, Bakul M; Singh, Gurpreet; Oo, Tun; Hughes, Peter L

    2011-01-01

    Intermittent catheterisation is the preferred method of managing the neurogenic bladder in patients with spinal cord injury. However, spinal cord physicians experienced problems when trying to implement an intermittent catheterisation regime in some spinal cord injury patients in the northwest of England. We present illustrative cases to describe practical difficulties encountered by patients while trying to adopt an intermittent catheterisation regime. Barriers to intermittent catheterisation are (1) caregivers or nurses are not available to carry out five or six catheterisations a day; (2) lack of time to perform intermittent catheterisations; (3) unavailability of suitable toilet facilities in public places, including restaurants and offices; (4) redundant prepuce in a male patient, which prevents ready access to urethral meatus; (5) urethral false passage; (6) urethral sphincter spasm requiring the use of flexible-tip catheters and á-adrenoceptor-blocking drugs; (7) reluctance to perform intermittent catheterisation in patients >60 years by some health professionals; and (8) difficulty in accessing the urethral meatus for catheterisation while the patient is sitting up, especially in female patients. These cases demonstrate the urgent need for provision of trained caregivers who can perform intermittent catheterisation, and improvement in public facilities that are suitable for performing catheterisation in spinal cord injury patients. Further, vigilance should be exercised during each catheterisation in order to prevent complications, such as urethral trauma and consequent false passages. Health professionals should make additional efforts to implement intermittent catheterisation in female spinal cord injury patients and in those >60 years. PMID:21218264

  18. Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor-Incomplete Spinal Cord-Injured Individuals.

    PubMed

    Hofstoetter, Ursula S; Krenn, Matthias; Danner, Simon M; Hofer, Christian; Kern, Helmut; McKay, William B; Mayr, Winfried; Minassian, Karen

    2015-10-01

    The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor-incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to modulate this central state of excitability during voluntary treadmill stepping in three motor-incomplete spinal cord-injured individuals. Stimulation was applied at 30 Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill-stepping was essentially augmentative and step-phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3° ± 5.6° across all subjects. This preliminary work suggests that tSCS provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step-related feedback build upon the stimulation-induced increased state of excitability in the generation of locomotor activity. Thus, tSCS essentially works as an electrical neuroprosthesis augmenting remaining motor control. PMID:26450344

  19. Ultra Long Construct Minimally Invasive Spinal Stabilization Using Percutaneous Pedicle Screws in the Treatment of Symptomatic Multicentric Spinal Metastasis.

    PubMed

    Lee, Chee Kean; Chan, Chris Yin Wei; Kwan, Mun Keong

    2015-12-01

    Managing multiple level spinal metastases is challenging. We report the case of a 58-year-old female with advanced lung cancer who presented with multiple pathological fractures of the thoracic spine (T5, T6, T7, and T8 vertebrae). She was treated with palliative radiotherapy. Her resting pain improved, but the instability pain persisted. One month later, she had a trivial fall leading to a pathological fracture of the L2 vertebra with cauda equine syndrome. The patient was treated surgically with minimally invasive decompression of the L2 and with percutaneous instrumented stabilization using an ultra-long construct from T3 to L5 (15 spinal levels), spanning the previously radiated zone and the decompression site. Postoperatively, she had significant improvements in pain and neurology. There were no surgical complications. Ultra long construct minimally invasive spinal stabilization is the ideal approach for symptomatic multicentric spinal metastasis with poor prognostic scores. Using this technique, the goals of spinal stabilization and direct neural decompression can be achieved with minimal morbidity. PMID:26713131

  20. Primary Intradural Extramedullary Spinal Melanoma in the Lower Thoracic Spine

    PubMed Central

    Hering, Kathrin; Bresch, Anke; Lobsien, Donald; Mueller, Wolf; Kortmann, Rolf-Dieter; Seidel, Clemens

    2016-01-01

    Background Context. Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-term follow-up. Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation. Study Design. Case report. Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine. Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms. Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable. PMID:27127667

  1. Massive hematothorax after thoracic spinal manipulation for acute thoracolumbar pain.

    PubMed

    Struewer, Johannes; Frangen, Thomas Manfred; Ziring, Ewgeni; Hinterseher, Ulrike; Kiriazidis, Ilias

    2013-01-01

    Spinal manipulation usually represents a widely used and effective method for physicians in order to relieve acute patient pain and muscular dysbalance. Although life-threatening complications (e.g. pneumothorax, vertebral artery dissection, stroke) after manual treatment are reported with regard to actual medical literature millions of patients undergo manual treatment to manage thoracolumbar pain each year. The authors present the case of a 17 year old male patient with a life-threatening hematothorax after thoracic high velocity spinal manipulation for acute thoracolumbar pain. The patient required emergency chest tube thoracostomy and afterwards thoracoscopic haemostasis for an intercostal venous lesion. A massive hematothorax after spinal manipulation represents an extremely rare but life-threatening complication. Physicians are encouraged to promote the benefits of manual/chiropratic therapy on the one hand but on the other hand are obliged to educate about potential serious dangers and adverse events. PMID:24191187

  2. Clinical Applications of the Tubular Retractor on Spinal Disorders

    PubMed Central

    Hyun, Seung Jae

    2007-01-01

    Tubular retractor system as a minimally invasive surgery (MIS) technique has many advantages over other conventional MIS techniques. It offers direct visualization of the operative field, anatomical familiarity to spine surgeons, and minimizing tissue trauma. With technical advancement, many spinal pathologies are being treated using this system. Namely, herniated discs, lumbar and cervical stenosis, synovial cysts, lumbar instability, trauma, and even some intraspinal tumors have all been treated through tubular retractor system. Flexible arm and easy change of the tube direction are particularly useful in contralateral spinal decompression from an ipsilateral approach. Careful attention to surgical technique through narrow space will ensure that complications are minimized and will provide improved outcomes. However, understanding detailed anatomies and keeping precise surgical orientation are essential for this technique. Authors present the technical feasibility and initial results of use a tubular retractor system as a minimally invasive technique for variaties of spinal disorders with a review of literature. PMID:19096551

  3. Coexistence of Spinal Intramedullary Tuberculoma and Multiple Intracranial Tuberculomas

    PubMed Central

    Lee, Dong-Yoon; Kim, Sang-Pyo

    2015-01-01

    Spinal intramedullary tuberculoma remains a very rare entity of central nervous system tuberculosis. This is the same with the coexistence of spinal intramedullary and intracranial tuberculomas that remains extremely rare with less than 20 cases reported at present. Authors describe this uncommon case by analyzing a 65-year-old female patient who had past history of kidney transplantation due to stage 5 chronic kidney disease and pulmonary tuberculosis on medication. The patient experiences progressive paraplegia and numbness on both lower extremities. Magnetic resonance imaging demonstrated an intramedullary mass at T9-10 level and multiple intracranial enhancing nodules. Microsurgical resection of spinal intramedullary mass was performed and the lesion was histopathologically confirmed as Mycobacterium tuberculosis. Efficient diagnosis and management of this rare disease are reviewed along with previously reported cases. PMID:26217392

  4. Ogilvie's syndrome following posterior spinal instrumentation in thoraco lumbar trauma

    PubMed Central

    Krishnakumar, R.; Kuzhimattam, Mathew John; Kumar, Gaurav

    2015-01-01

    Objectives: To report unique cases of Ogilvie's syndrome (acute intestinal pseudo-obstruction) following posterior spinal instrumentation in thoraco lumbar trauma. Materials and Methods: A single centre retrospective study. We reviewed the surgical data of 420 patients who underwent thoracolumbar spinal surgery over a period of four years. Two patients who developed post operative Ogilvie's syndromes were identified. Results: The clinical presentation and blood investigations ruled out any infectious pathology. Computed tomography scans ruled out the mechanical obstruction. All patients improved with conservative management. Conclusion: Ogilvie's syndrome should be considered as a differential diagnosis in patients with postoperative significant abdominal distension who had undergone posterior instrumentation for spinal trauma. Early recognition and appropriate conservative treatment would be necessary to prevent complications such as bowel ischemia and perforation. PMID:26692695

  5. Spinal cord stimulation for neuropathic pain: current perspectives

    PubMed Central

    Wolter, Tilman

    2014-01-01

    Neuropathic pain constitutes a significant portion of chronic pain. Patients with neuropathic pain are usually more heavily burdened than patients with nociceptive pain. They suffer more often from insomnia, anxiety, and depression. Moreover, analgesic medication often has an insufficient effect on neuropathic pain. Spinal cord stimulation constitutes a therapy alternative that, to date, remains underused. In the last 10 to 15 years, it has undergone constant technical advancement. This review gives an overview of the present practice of spinal cord stimulation for chronic neuropathic pain and current developments such as high-frequency stimulation and peripheral nerve field stimulation. PMID:25429237

  6. Acute Management of Nutritional Demands after Spinal Cord Injury

    PubMed Central

    Thibault-Halman, Ginette; Casha, Steven; Singer, Shirley

    2011-01-01

    Abstract A systematic review of the literature was performed to address pertinent clinical questions regarding nutritional management in the setting of acute spinal cord injury (SCI). Specific metabolic challenges are present following spinal cord injury. The acute stage is characterized by a reduction in metabolic activity, as well as a negative nitrogen balance that cannot be corrected, even with aggressive nutritional support. Metabolic demands need to be accurately monitored to avoid overfeeding. Enteral feeding is the optimal route following SCI. When oral feeding is not possible, nasogastric, followed by nasojejunal, then by percutaneous endoscopic gastrostomy, if necessary, is suggested. PMID:20373845

  7. Posterior reversible leukoencephalopathy syndrome with spinal cord involvement in a 9-year-old girl.

    PubMed

    Yi?, Ulu; Karao?lu, Pakize; Kurul, Semra H?z; Soylu, Alper; akmaki, Handan; Kavuku, Salih

    2016-01-01

    We report the youngest pediatric case of posterior reversible leukoencephalopathy syndrome confined to brainstem and spinal cord. At presentation bicytopenia, renal derangement, visual disturbances, magnetic resonance imaging findings, increased protein content, IgG index and cell count in the cerebrospinal fluid led us to extensive search for myelitis. She received a short course of steroid treatment. The final diagnosis was hypertension due to reflux nephropathy. Severe hypertension that exceeds the range of autoregulation in anterior spinal territory may result in spinal posterior reversible leukoencephalopathy syndrome. Clinicians should be aware of spinal posterior reversible leukoencephalopathy syndrome when cases have extensive lesions in the brainstem and spinal cord with none or minimal clinical findings, so called "clinical radiologic dissociation". PMID:26220877

  8. 17-Year-Delayed Fistula Formation After Elective Spinal Instrumentation: A Case Report

    PubMed Central

    Etemadrezaei, Hamid; Zabihyan, Samira; Shakeri, Aidin; Ganjeifar, Babak

    2015-01-01

    Introduction A late-developing infection after an uneventful initial spinal instrumentation procedure is rare. Delayed infection and new fistula formation have been reported from a few months to 13 years. Here we report an unusual 17-year-delayed fistula formation after primary spinal instrumentation. The patient underwent hardware removal surgery with antibiotic therapy as a definitive treatment. Case Presentation Here we report an unusual 17-year delayed fistula formation after primary spinal instrumentation due to spinal trauma. He was admitted to Ghaem General Hospital, a chief referral center, Mashhad, North-East of Iran in August 2014. The patient underwent hardware removal surgery with antibiotic therapy as a definitive treatment. Conclusions Late inflammation may occur around spinal instruments and results in cutaneous fistula formation. After oral or intravenous antibiotic treatment, total device extraction is the cornerstone of treatment. PMID:26082855

  9. Clinical and genetic diversity of SMN1-negative proximal spinal muscular atrophies

    PubMed Central

    Jordanova, Albena

    2014-01-01

    Hereditary spinal muscular atrophy is a motor neuron disorder characterized by muscle weakness and atrophy due to degeneration of the anterior horn cells of the spinal cord. Initially, the disease was considered purely as an autosomal recessive condition caused by loss-of-function SMN1 mutations on 5q13. Recent developments in next generation sequencing technologies, however, have unveiled a growing number of clinical conditions designated as non-5q forms of spinal muscular atrophy. At present, 16 different genes and one unresolved locus are associated with proximal non-5q forms, having high phenotypic variability and diverse inheritance patterns. This review provides an overview of the current knowledge regarding the phenotypes, causative genes, and disease mechanisms associated with proximal SMN1-negative spinal muscular atrophies. We describe the molecular and cellular functions enriched among causative genes, and discuss the challenges in the post-genomics era of spinal muscular atrophy research. PMID:24970098

  10. Lumbosacral Plexopathy Caused by Presacral Recurrence of Colon Cancer Mimicking Degenerative Spinal Disease: A Case Report

    PubMed Central

    Jo, Se Yeong; Jeong, Je Hoon; Cha, Jang Gyu

    2015-01-01

    Radiculopathy triggered by degenerative spinal disease is the most common cause of spinal surgery, and the number of affected elderly patients is increasing. Radiating pain that is extraspinal in origin may distract from the surgical decision on how to treat a neurological presentation in the lower extremities. A 54-year-old man with sciatica visited our outpatient clinic. He had undergone laminectomy and discectomy to treat spinal stenosis at another hospital, but his pain remained. Finally, he was diagnosed with a plexopathy caused by late recurrence of colorectal cancer, which compressed the lumbar plexus in the presacral area. This case report illustrates the potential for misdiagnosis of extraspinal plexopathy and the value of obtaining an accurate history. Although the symptoms are similar, spinal surgeons should consider both spinal and extraspinal origins of sciatica. PMID:26217393

  11. Magnetic resonance imaging of spinal cord lesions in multiple sclerosis.

    PubMed Central

    Honig, L S; Sheremata, W A

    1989-01-01

    The clinical and pathological manifestations of multiple sclerosis are due to areas of demyelination which occur throughout the white matter of the central nervous system. MRI of the brain frequently shows abnormalities in the hemispheric subcortical white matter; these are demonstrable in the majority of patients and support the clinical diagnosis of multiple sclerosis. Our studies have shown that while MRI identifies such cerebral lesions in nearly all clinically definite multiple sclerosis patients with illness of duration greater than 10 years, these areas of abnormal T2 signal are present less often in the brains of patients studied within 3 years of disease onset. However, symptoms referable to the long tracts of the spinal cord are prominent in many of these patients. Imaging of the spinal cord has presented technical problems because of the small size of the cord, patient body, heart and respiratory movements, and limitations of surface coil technology. The spinal cord of 77 patients with multiple sclerosis have been imaged, revealing three types of abnormalities: (1) approximately half the cords show regions of abnormal T2 weighted signal; (2) during acute exacerbation, spinal cord enlargement (swelling) may be observed; (3) spinal cord atrophy (narrowing) is found particularly in patients with disease of longer duration and greater disability. Unlike the presence of brain lesions, the existence of spinal cord lesions of high T2 signal is not associated with increasing duration of disease but is correlated with disability status. Of patients with such lesions about one fifth did not exhibit brain lesions discernible by MRI. Images PMID:2738588

  12. [Balanced spinal analgesia in the treatment of oncologic pain. Review of the literature].

    PubMed

    Polati, E; Pinaroli, A M; Ischia, S

    1996-11-01

    Certain types of cancer pain fail to respond well either to systemic drug therapy or to spinal opioids because of the occurrence of intolerable adverse effects. In addition to spinal opioids other drugs may produce an antinociceptive effect when administered by the spinal route, such as local anesthetics, NSAID, alpha 2-agonists, calcium-channel blockers, NMDA antagonists, cholinergic drugs, peptides such as somatostatin, octreotide or calcitonin, adenosine agonists, benzodiazepines, neurokinin and cholecystokinin antagonists, nitric oxide synthase inhibitors, corticosteroids, and enkephalinase inhibitors. All these drugs may be administered in combination between them, realising the so called balanced spinal analgesia. The aim of this study is to analyse: the available methods for the evaluation of pharmacological interactions, the types of interaction between different spinal antinociceptive drugs and the role of balanced spinal analgesia in the treatment of cancer pain. Analysis of the presented data shows that the spinal synergism between opioids-local anesthetics and opioids-alpha 2-agonists can be useful in the treatment of opioid refractory cancer pain. Furthermore, the use of cholinergic drugs combined with opioids and alpha 2-agonists may be promising. Finally, even if the synergism between NSAID or NMDA antagonists with opioids or alpha 2-agonists have been proved, at the moment their use in man by the spinal route is not advisable because of the absence of adequate studies on their neurotoxicity and adverse effects. PMID:9102586

  13. Numerical model of the human cervical spinal cord--the development and validation.

    PubMed

    Czyż, Marcin; Scigała, Krzysztof; Jarmundowicz, Włodzimierz; Będziński, Romuald

    2011-01-01

    The influence of mechanical load on the extent of nervous tissue damage in the spinal cord at the time of trauma is presently incontestable. Although numerical modelling cannot fully replace physical testing, it seems to be the perfect complement to experiments in terms of the analysis of such a complex phenomenon as traumatic spinal cord injury. Previous numerical models of the human cervical spinal cord have been limited by several factors: two-dimensional modelling, spinal cord geometry simplification and incomplete reflection of specific anatomical and biomechanical relations of the objects being modelled. The objective of this study was to develop and validate an accurate and universal numerical Finite Element Method (FEM) model of the human cervical spinal cord. Our survey focuses mainly on geometric, constraint and material aspects. Experimental validation was carried out based on a controlled compression of the porcine spinal cord specimens. Each stage of compression was simulated using the FEM model of the compressed segment. Our 3D numerical simulation results compared with experimental results show a good agreement. It is possible to use the developed numerical model of the human cervical spinal cord in the biomechanical analysis of the spinal cord injury phenomenon. However, further clinical evaluation is clearly justified. PMID:22339282

  14. Macrophage activation and its role in repair and pathology after spinal cord injury.

    PubMed

    Gensel, John C; Zhang, Bei

    2015-09-01

    The injured spinal cord does not heal properly. In contrast, tissue repair and functional recovery occur after skin or muscle injuries. The reason for this dichotomy in wound repair is unclear but inflammation, and specifically macrophage activation, likely plays a key role. Macrophages have the ability to promote the repair of injured tissue by regulating transitions through different phase of the healing response. In the current review we compare and contrast the healing and inflammatory responses between spinal cord injuries and tissues that undergo complete wound resolution. Through this comparison, we identify key macrophage phenotypes that are inaptly triggered or absent after spinal cord injury and discuss spinal cord stimuli that contribute to this maladaptive response. Sequential activation of classic, pro-inflammatory, M1 macrophages and alternatively activated, M2a, M2b, and M2c macrophages occurs during normal healing and facilitates transitions through the inflammatory, proliferative, and remodeling phases of repair. In contrast, in the injured spinal cord, pro-inflammatory macrophages potentiate a prolonged inflammatory phase and remodeling is not properly initiated. The desynchronized macrophage activation after spinal cord injury is reminiscent of the inflammation present in chronic, non-healing wounds. By refining the role macrophages play in spinal cord injury repair we bring to light important areas for future neuroinflammation and neurotrauma research. This article is part of a Special Issue entitled SI: Spinal cord injury. PMID:25578260

  15. Causes of Spinal Cord Injury

    PubMed Central

    2013-01-01

    Background: Knowledge of the causes of spinal cord injury (SCI) and associated factors is critical in the development of successful prevention programs. Objective: This study analyzed data from the National SCI Database (NSCID) and National Shriners SCI Database (NSSCID) in the United States to examine specific etiologies of SCI by age, sex, race, ethnicity, day and month of injury, and neurologic outcomes. Methods: NSCID and NSSCID participants who had a traumatic SCI from 2005 to 2011 with known etiology were included in the analyses (N=7,834). Thirty-seven causes of injury documented in the databases were stratified by personal characteristics using descriptive analysis. Results: The most common causes of SCI were automobile crashes (31.5%) and falls (25.3%), followed by gunshot wounds (10.4%), motorcycle crashes (6.8%), diving incidents (4.7%), and medical/surgical complications (4.3%), which collectively accounted for 83.1% of total SCIs since 2005. Automobile crashes were the leading cause of SCI until age 45 years, whereas falls were the leading cause after age 45 years. Gunshot wounds, motorcycle crashes, and diving caused more SCIs in males than females. The major difference among race/ethnicity was in the proportion of gunshot wounds. More SCIs occurred during the weekends and warmer months, which seemed to parallel the increase of motorcycle- and diving-related SCIs. Level and completeness of injury are also associated with etiology of injury. Conclusions: The present findings suggest that prevention strategies should be tailored to the targeted population and major causes to have a meaningful impact on reducing the incidence of SCI. PMID:23678280

  16. Photochemically induced spinal ischaemia: a model of spinal cord trauma in the rat

    NASA Astrophysics Data System (ADS)

    Olby, Natasha J.; Blakemore, W. F.

    1995-05-01

    Focal thrombosis was induced in the dorsal funiculus of the rat spinal cord by exposing the cord to light following intravenous injection of the photoactive dye, rose bengal. The light source was a 599 standing wave dye laser, pumped by an Innova 70 - 4 argon ion laser (Coherent Ltd, Cambridge, UK) and the light was delivered to the operative site via an optical fiber. The histological characteristics of the development and resolution of the lesion have been studied. Forty rats were examined with light and electron microscopy at various time points between 30 minutes and one month after irradiation and the lesion length was measured. Platelet aggregation, increased extracellular space in the white matter and vacuolation of the neurones and glia of the grey matter were present 30 minutes after injury. Progressive necrosis of the white and grey matter developed over the subsequent 24 hours to produce a fusiform lesion that occupied the dorsal funiculus and dorsal horns of the spinal cord at its center and tapered cranially and caudally along the dorsal columns for a total distance of seven millimeters. By one month after injury the area of necrosis had become a cyst lined by astrocytes ventrolaterally and meningeal cells dorsally. Measurements of lesion length showed a variability of 26%. This model of spinal cord trauma produces a lesion that is sufficiently reproducible to be suitable for performing studies aimed at tissue preservation and repair.

  17. Vestibulo-spinal reflex mechanisms

    NASA Technical Reports Server (NTRS)

    Reschke, M. F.

    1981-01-01

    The specific objectives of experiments designed to investigate postural reflex behavior during sustained weightlessness are discussed. The first is to investigate, during prolonged weightlessness with Hoffmann response (H-reflex) measurement procedures, vestibulo-spinal reflexes associated with vestibular (otolith) responses evoked during an applied linear acceleration. This objective includes not only an evaluation of otolith-induced changes in a major postural muscle but also an investigation with this technique of the adaptive process of the vestibular system and spinal reflex mechanisms to this unique environment. The second objective is to relate space motion sickness to the results of this investigation. Finally, a return to the vestibulo-spinal and postural reflexes to normal values following the flight will be examined. The flight experiment involves activation of nerve tissue (tibial N) with electrical shock and the recording of resulting muscle activity (soleus) with surface electrodes. Soleus/spinal H-reflex testing procedures will be used in conjuction with linear acceleration through the subject's X-axis.

  18. SPINAL CORD INJURY (SCI) DATABASE

    EPA Science Inventory

    The National Spinal Cord Injury Database has been in existence since 1973 and captures data from SCI cases in the United States. Since its inception, 24 federally funded Model SCI Care Systems have contributed data to the National SCI Database. Statistics are derived from this da...

  19. MR imaging of spinal neurofibromatosis.

    PubMed

    Li, M H; Holtås, S

    1991-07-01

    The MR findings in 7 patients with neurofibromatosis involving the spine were evaluated. Six patients had paraspinal tumors at multiple levels. In 4 they were bilateral. Five patients had multiple intraspinal lesions, frequently with growth through the neural foramen. In one patient paraspinal tumors were found in the lumbar sacral plexus and in another bony dysplasia and meningoceles but no tumors were disclosed. In 2 patients the lesions were associated with bilateral acoustic neuromas and multiple intracranial meningeomas. In one of these a spinal meningeoma with signal characteristics close to spinal cord was found. The other tumors had a signal that was equal to or slightly lower than the spinal cord and slightly higher than muscle on T1-weighted images. On T2-weighted images the tumors had a markedly increased signal compared to surrounding tissue. In 3 patients with tumors larger than 4 cm the signal intensity was inhomogeneous with decreased signal in the center on T2-weighted images, indicating the presence of increased fibrous tissue. Gadolinium-DTPA was given to one patient with marked increase in intensity of small tumors on T1-weighted images. The study shows that MR imaging is the modality of choice for evaluating most aspects of spinal and paraspinal neurofibromatosis. PMID:1907470

  20. Endovascular treatment of spinal cord arteriovenous malformations.

    PubMed

    Veznedaroglu, Erol; Nelson, Peter K; Jabbour, Pascal M; Rosenwasser, Robert H

    2006-11-01

    Spinal cord arteriovenous malformations are rare lesions that represent one-tenth of the brain arteriovenous malformations. Depending on their location and relationship to the dura, these lesions are divided into four categories. Their clinical manifestations may vary from mild symptoms to severe motor deficits. Spinal angiography remains the "gold standard" for diagnosing spinal cord vascular lesions. Although the type of shunting remains difficult to determine by the magnetic resonance imaging, it is well analyzed by spinal angiography. The cure of the shunting is not by itself a therapeutic goal, but the objective is the creation of a new hemodynamic equilibrium between the lesion and the spinal cord to decrease the risk of hemorrhage and prevent the progression of the spinal cord ischemia. The endovascular tools seem to be a reasonable therapeutic option for the treatment of the majority of the spinal cord arteriovenous malformations. PMID:17053604

  1. Spinal arachnoiditis and cyst formation with subarachnoid haemorrhage.

    PubMed

    Abhinav, Kumar; Bradley, Marcus; Aquilina, Kristian; Patel, Nikunj K

    2012-08-01

    We present the case of a 58-year-old lady with p-ANCA vasculitis who suffered a WFNS grade 1 subarachnoid haemorrhage (Fisher grade 1) secondary to a ruptured left posterior inferior cerebellar artery aneurysm and then developed a rare complication of radiologically progressive spinal arachnoiditis despite maintained clinical response to definitive treatment measures. PMID:22299598

  2. Management of lumbar spinal stenosis.

    PubMed

    Lurie, Jon; Tomkins-Lane, Christy

    2016-01-01

    Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality. PMID:26727925

  3. Biomechanics of Degenerative Spinal Disorders.

    PubMed

    Iorio, Justin A; Jakoi, Andre M; Singla, Anuj

    2016-04-01

    The spine has several important functions including load transmission, permission of limited motion, and protection of the spinal cord. The vertebrae form functional spinal units, which represent the smallest segment that has characteristics of the entire spinal column. Discs and paired facet joints within each functional unit form a three-joint complex between which loads are transmitted. Surrounding the spinal motion segment are ligaments, composed of elastin and collagen, and joint capsules which restrict motion to within normal limits. Ligaments have variable strengths and act via different lever arm lengths to contribute to spinal stability. As a consequence of the longer moment arm from the spinous process to the instantaneous axis of rotation, inherently weaker ligaments (interspinous and supraspinous) are able to provide resistance to excessive flexion. Degenerative processes of the spine are a normal result of aging and occur on a spectrum. During the second decade of life, the intervertebral disc demonstrates histologic evidence of nucleus pulposus degradation caused by reduced end plate blood supply. As disc height decreases, the functional unit is capable of an increased range of axial rotation which subjects the posterior facet capsules to greater mechanical loads. A concurrent change in load transmission across the end plates and translation of the instantaneous axis of rotation further increase the degenerative processes at adjacent structures. The behavior of the functional unit is impacted by these processes and is reflected by changes in the stress-strain relationship. Back pain and other clinical symptoms may occur as a result of the biomechanical alterations of degeneration. PMID:27114783

  4. Biomechanics of Degenerative Spinal Disorders

    PubMed Central

    Iorio, Justin A.; Jakoi, Andre M.

    2016-01-01

    The spine has several important functions including load transmission, permission of limited motion, and protection of the spinal cord. The vertebrae form functional spinal units, which represent the smallest segment that has characteristics of the entire spinal column. Discs and paired facet joints within each functional unit form a three-joint complex between which loads are transmitted. Surrounding the spinal motion segment are ligaments, composed of elastin and collagen, and joint capsules which restrict motion to within normal limits. Ligaments have variable strengths and act via different lever arm lengths to contribute to spinal stability. As a consequence of the longer moment arm from the spinous process to the instantaneous axis of rotation, inherently weaker ligaments (interspinous and supraspinous) are able to provide resistance to excessive flexion. Degenerative processes of the spine are a normal result of aging and occur on a spectrum. During the second decade of life, the intervertebral disc demonstrates histologic evidence of nucleus pulposus degradation caused by reduced end plate blood supply. As disc height decreases, the functional unit is capable of an increased range of axial rotation which subjects the posterior facet capsules to greater mechanical loads. A concurrent change in load transmission across the end plates and translation of the instantaneous axis of rotation further increase the degenerative processes at adjacent structures. The behavior of the functional unit is impacted by these processes and is reflected by changes in the stress-strain relationship. Back pain and other clinical symptoms may occur as a result of the biomechanical alterations of degeneration. PMID:27114783

  5. Spinal extradural arachnoid cyst: a case report.

    PubMed

    Kong, Woo-Keun; Cho, Keun-Tae; Hong, Seung-Koan

    2013-03-01

    Spinal arachnoid cyst is a rare cause of myelopathy secondary to spinal cord compression. We report a case presenting extradural arachnoid cyst of probable traumatic origin leading to irreversible neurological deficits including paraparesis and neurogenic bladder. The patient presented progressive paraparesis and voiding difficulty. Magnetic resonance imaging (MRI) of the spine revealed long segmental cystic lesion of cerebrospinal fluid (CSF) signal intensity at dorsal extramedullary space of T11 to L3 level suggesting arachnoid cyst with diffuse cord compression. On the operation, an ovoid shaped dural defect was identified at right sided dorsolateral aspect of the dura mater between nerve root sleeves at T11 and T12 level. The patient was treated by microsurgical repair of the dural defect and intraoperative findings revealed no further leakage of CSF. The neurological status of the patient was stationary on follow-up examination postoperatively. We postulate that delayed-onset post-traumatic extradural arachnoid cyst should be taken into consideration on the differential diagnosis of intrapinal cysts. PMID:24757455

  6. Infarction of the unilateral posterior horn and lateral column of the spinal cord with sparing of posterior columns: demonstration by MRI.

    PubMed Central

    Kaneki, M; Inoue, K; Shimizu, T; Mannen, T

    1994-01-01

    Infarction of the spinal cord, particularly in the distribution of the posterior spinal arteries, is rare. Twenty seven cases of posterior spinal artery syndrome have been reported. In all cases, the posterior columns were affected, and in all but two, the lesions were bilateral. Here a 49-year-old woman is reported, who was affected with lumbar cord infarction in the distribution of the posterior spinal arteries, diagnosed by MRI and clinical presentation. This case is of special interest because of sparing of the posterior columns and the unilateral nature of the lesion, even though the infarction occurred in the distribution of the posterior spinal arteries. Images PMID:8201340

  7. Immunotherapy strategies for spinal cord injury.

    PubMed

    Wang, Yong-Tang; Lu, Xiu-Min; Chen, Kai-Ting; Shu, Ya-Hai; Qiu, Chun-Hong

    2015-01-01

    Regeneration in the central nervous system (CNS) of adult mammalian after traumatic injury is limited, which often causes permanent functional motor and sensory loss. After spinal cord injury (SCI), the lack of regeneration is mainly attributed to the presence of a hostile microenvironment, glial scarring, and cavitation. Besides, inflammation has also been proved to play a crucial role in secondary degeneration following SCI. The more prominent treatment strategies in experimental models focus mainly on drugs and cell therapies, however, only a few strategies applied in clinical studies and therapies still have only limited effects on the repair of SCI. Recently, the interests in immunotherapy strategies for CNS are increasing in number and breadth. Immunotherapy strategies have made good progresses in treating many CNS degenerative disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD), stroke, and multiple sclerosis (MS). However, the strategies begin to be considered to the treatment of SCI and other neurological disorders in recent years. Besides anti-inflamatory therapy, immunization with protein vaccines and DNA vaccines has emerged as a novel therapy strategy because of the simplicity of preparation and application. An inflammatory response followed by spinal cord injury, and is controled by specific signaling molecules, such as some cytokines playing a crucial role. As a result, appropriate immunoregulation, the expression of pro-inflammatory cytokines and anti-inflammatory cytokines may be an effective therapy strategy for earlier injury of spinal cord. In addition, myelinassociated inhibitors (MAIs) in the injured spinal cord, such as Nogo, myelin-associated glycoprotein (MAG) and oligodendrocyte- myelin glycoprotein (OMgp) are known to prevent axonal regeneration through their co-receptors, and to trigger demyelinating autoimmunity through T cell-mediated harmful autoimmune response. The antagonism of the MAIs through vaccinating with protein or DNA vaccines targeting Nogo, MAG, OMgp, and their co-receptors, may be an effective strategy for the treatment of SCI. However, immunotherapy such as anti-inflammtory therapy or vaccine targeting MAIs or their receptors, accompanied with the potential in risking autoimmune diseases. As a result, in order to optimize the anti-inflammtory therapy and design of protein or DNA vaccines for their use in the future clinical application, we need to further understand the possible mechanisms of neuroprotective immunity. This review presents recent advances in the development of immunotherapy strategies for the treatment of axonal degeneration and demyelination, and improvement of motor function after SCI. PMID:25860061

  8. Cytoarchitecture of the spinal cord of the postnatal (P4) mouse.

    PubMed

    Sengul, Gulgun; Puchalski, Ralph B; Watson, Charles

    2012-05-01

    Interpretation of the new wealth of gene expression and molecular mechanisms in the developing mouse spinal cord requires an accurate anatomical base on which data can be mapped. Therefore, we have assembled a spinal cord atlas of the P4 mouse to facilitate direct comparison with the adult specimens and to contribute to studies of the development of the mouse spinal cord. This study presents the anatomy of the spinal cord of the P4 C57Bl/6J mouse using Nissl and acetyl cholinesterase-stained sections. It includes a detailed map of the laminar organization of selected spinal cord segments and a description of named cell groups of the spinal cord such as the central cervical (CeCv), lateral spinal nucleus, lateral cervical, and dorsal nuclei. The motor neuron groups have also been identified according to the muscle groups they are likely to supply. General features of Rexed's laminae of the P4 spinal cord showed similarities to that of the adult (P56). However, certain differences were observed with regard to the extent of laminae and location of certain cell groups, such as the dorsal nucleus having a more dispersed structure and a more ventral and medial position or the CeCv being located in the medial part of lamina 5 in contrast to the adult where it is located in lamina 7. Motor neuron pools appeared to be more tightly packed in the P4 spinal cord. The dorsal horn was relatively larger and there was more white matter in the P56 spinal cord. PMID:22454209

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

    PubMed

    Langlet, C; Leblond, H; Rossignol, S

    2005-05-01

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

  10. Therapeutic approaches for spinal cord injury

    PubMed Central

    Cristante, Alexandre Fogaça; de Barros Filho, Tarcísio Eloy Pessoa; Marcon, Raphael Martus; Letaif, Olavo Biraghi; da Rocha, Ivan Dias

    2012-01-01

    This study reviews the literature concerning possible therapeutic approaches for spinal cord injury. Spinal cord injury is a disabling and irreversible condition that has high economic and social costs. There are both primary and secondary mechanisms of damage to the spinal cord. The primary lesion is the mechanical injury itself. The secondary lesion results from one or more biochemical and cellular processes that are triggered by the primary lesion. The frustration of health professionals in treating a severe spinal cord injury was described in 1700 BC in an Egyptian surgical papyrus that was translated by Edwin Smith; the papyrus reported spinal fractures as a “disease that should not be treated.” Over the last two decades, several studies have been performed to obtain more effective treatments for spinal cord injury. Most of these studies approach a patient with acute spinal cord injury in one of four manners: corrective surgery or a physical, biological or pharmacological treatment method. Science is unraveling the mechanisms of cell protection and neuroregeneration, but clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration. The combination of several therapeutic strategies should, at minimum, allow for partial functional recoveries for these patients, which could improve their quality of life. PMID:23070351

  11. Inflammatory cascades mediate synapse elimination in spinal cord compression

    PubMed Central

    2014-01-01

    Background Cervical compressive myelopathy (CCM) is caused by chronic spinal cord compression due to spondylosis, a degenerative disc disease, and ossification of the ligaments. Tip-toe walking Yoshimura (twy) mice are reported to be an ideal animal model for CCM-related neuronal dysfunction, because they develop spontaneous spinal cord compression without any artificial manipulation. Previous histological studies showed that neurons are lost due to apoptosis in CCM, but the mechanism underlying this neurodegeneration was not fully elucidated. The purpose of this study was to investigate the pathophysiology of CCM by evaluating the global gene expression of the compressed spinal cord and comparing the transcriptome analysis with the physical and histological findings in twy mice. Methods Twenty-week-old twy mice were divided into two groups according to the magnetic resonance imaging (MRI) findings: a severe compression (S) group and a mild compression (M) group. The transcriptome was analyzed by microarray and RT-PCR. The cellular pathophysiology was examined by immunohistological analysis and immuno-electron microscopy. Motor function was assessed by Rotarod treadmill latency and stride-length tests. Results Severe cervical calcification caused spinal canal stenosis and low functional capacity in twy mice. The microarray analysis revealed 215 genes that showed significantly different expression levels between the S and the M groups. Pathway analysis revealed that genes expressed at higher levels in the S group were enriched for terms related to the regulation of inflammation in the compressed spinal cord. M1 macrophage-dominant inflammation was present in the S group, and cysteine-rich protein 61 (Cyr61), an inducer of M1 macrophages, was markedly upregulated in these spinal cords. Furthermore, C1q, which initiates the classical complement cascade, was more upregulated in the S group than in the M group. The confocal and electron microscopy observations indicated that classically activated microglia/macrophages had migrated to the compressed spinal cord and eliminated synaptic terminals. Conclusions We revealed the detailed pathophysiology of the inflammatory response in an animal model of chronic spinal cord compression. Our findings suggest that complement-mediated synapse elimination is a central mechanism underlying the neurodegeneration in CCM. PMID:24589419

  12. [Chronic fibroplastic leptomeningitis of the spinal cord and cauda equina].

    PubMed

    Benini, A; Blanco, J

    1990-01-01

    Chronic (seldom subacute) low-grade spinal leptomeningitis, cystic and adhesive in natura, is a clinicopathologic condition known by several names in medical literature (arachnoiditis, arachnoditis adhesiva circumscripta, a.s.o.). The cystic structures are not cysts in the true sense of the word. They are in reality collections of cerebrospinal fluid walled off by meningeal adhesions. The extent of the leptomeningitis varies from a well-localized lesion to a diffused process involving the entire cereprospinal axis. In some cases the chronic proliferative changes lead to calcification and ossification of the leptomeninx. As well the circumscribed adhesive as the cystic form can produce a spinal cord compression syndrome similar to a tumor or a hydro-syringomyelia. Progressive paraparesis with difficulties of bladder and bowel function may nevertheless be arrested, or spontaneous remission may occur, perhaps due to temporary improvement of the local circulation of spinal fluid. An almost typical sciatic syndrome can be occasionally associated with a thickening of the leptomeninx and cystic spinal fluid collection in the region of the cauda equina. The lumbar adhesive and cystic form is as a rule a more benign disease then leptomeningitis occurring at thoracic or cervical levels. The etiological factors are trauma, spinal anesthesia, myelography, blood in the subarachnoid space, previous operations and infections. When the origin of the illness remains unidentified, low grade bacterial or viral infections can be presumed. We operated 2 patients with circumscribed severe leptomeningitis several segments far away from an intradural meningeoma. Such illness is uncommon, but not very rare. From 1970 until the end of 1986 we have carried out 33 laminectomies on 26 patients because of spinal leptomeningitis among 603 patients operated because of spinal cord compression (4.31%). Our cases are presented and literature is discussed. The dilemma what we have to do with a patient with symptomatic spinal leptomeningitis is open: the microsurgery can help the patient significantly, even if complete recovery is rare. In view of the extreme variety of these lesions a circumspect, sometime skeptical analysis of each patient must precede decision about surgery. We try to give some indications for microsurgery. PMID:1697979

  13. Toxocariasis Presenting as Encephalomyelitis

    PubMed Central

    Helsen, Gregory; Vandecasteele, Stefaan J.; Vanopdenbosch, Ludo J.

    2011-01-01

    We describe a farmer who presented with a clinical picture of a transverse thoracic myelitis. MRI showed inflammatory lesions in brain and thoracic spinal cord. Toxocariasis was suspected because of eosinophilia in blood and cerebrospinal fluid, and this diagnosis was confirmed immunologically. He was successfully treated with antihelminthics in combination with corticosteroids. Neurotoxocariasis is rare and diagnosis can be difficult because of the different and atypical clinical manifestations. It should be considered in every case of central neurological syndrome associated with eosinophilia. PMID:21629809

  14. Solitary C1 spinal osteochondroma causing vertebral artery compression and acute cerebellar infarct.

    PubMed

    Zhang, Yaxia; Ilaslan, Hakan; Hussain, Muhammad S; Bain, Mark; Bauer, Thomas W

    2015-02-01

    Osteochondroma is a common benign bone lesion, usually involving the long bones. Spinal involvement is rare. The clinical presentation of spinal osteochondroma varies according to the site of the lesion. The most common reported clinical presentation is secondary to encroachment of the lesion on the spinal canal or nerve roots. Less common presentations such as a palpable neck mass, dysphagia, sleep apnea, paralysis of left vocal cord or acute respiratory distress have been reported when the lesions compress the anatomic structures anteriorly. We describe a rare case of a young patient who presented with an emergent critical condition of acute cerebellar infarct as a result of vertebral artery compression caused by a solitary C1 spinal osteochondroma. PMID:25109381

  15. Spinal Dural Arteriovenous Fistula: A Review.

    PubMed

    Maimon, Shimon; Luckman, Yehudit; Strauss, Ido

    2016-01-01

    Spinal dural arteriovenous fistula (SDAVF) is a rare disease, the etiology of which is not entirely clear. It is the most common vascular malformation of the spinal cord, comprising 60-80 % of the cases. The clinical presentation and imaging findings may be nonspecific and misleading, often mistaking it for other entities like demyelinating or degenerative diseases of the spine.This chapter describes the imaging findings, clinical signs, and symptoms of this disease and also the available treatment options according to the current literature.Angiography is still considered the gold standard for diagnosis; however, MRI/MRA is increasingly used as a screening tool. Modern endovascular techniques are becoming increasingly more effective in treating SDAVF offering a less invasive treatment option; however, they still lag behind surgical success rates which approach 100 %. The outcome of both treatment options is similar if complete obliteration of the fistula is obtained and depends mainly on the severity of neurological dysfunction before treatment.Heightened awareness by radiologists and clinicians to this rare entity is essential to make a timely diagnosis of this treatable disease. A multidisciplinary treatment approach is required in order to make appropriate treatment decisions. PMID:26508408

  16. [Spinal stroke in the acute myeloblast leucosis].

    PubMed

    Kotova, N A; Klimovich, A V; Krasnoruzhskiĭ, A I; Skoromets, A A; Aliev, K T; Volkova, S A; Lalaian, T V

    2013-01-01

    Data of literature on the frequency of the nervous system lesions in different variants of leucosis are analyzed. A case of a man with petechial skin rash and bruises on the body, gingival hemorrhage and general sickness is described in details. The hematologic tests revealed acute myeloblast leucosis. A lumbar puncture revealed blood in the cerebrospinal fluid and MRI showed an epidural hematoma in lumbar segments 3 and 4. At this level, the hematoma compressed the dural bag and roots of the horse tail with accompanying vessels (the radicular medullar artery and large radicular veins). A paracentetic removal of the hematoma with the decompression of spinal roots was carried out. The blasts in the cerebrospinal fluid and symptoms of the left facial nerve lesion allowed to diagnose neuroleucosis. This case presented the mixed pathogenesis of myeloischemia. The epidural hematoma compressed not only the roots of the horse tail but the accompanying vessels (arteries and veins). The venous outflow obstruction along radicular veins worsened the microcirculation in the cross-sectional area of the spinal cord. Complex polychemotherapy in the combination with neuroprotectors (cortexin, gliatiline), antiaggregants and vitamins is recommended. PMID:23612398

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

    PubMed

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

    2016-01-01

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

  18. Thalassemia, extramedullary hematopoiesis, and spinal cord compression: A case report

    PubMed Central

    Bukhari, Syed Sarmad; Junaid, Muhammad; Rashid, Mamoon Ur

    2016-01-01

    Background: Extramedullary hematopoiesis (EMH) refers to hematopoiesis outside of the medulla of the bone. Chronic anemia states such as thalassemia can cause hematopoietic tissue to expand in certain locations. We report a case of spinal cord compression due to recurrent spinal epidural EMH, which was treated with a combination of surgery and radiotherapy. Pakistan has one of the highest incidence and prevalence of thalassemia in the world. We describe published literature on diagnosis and management of such cases. Case Description: An 18-year-old male presented with bilateral lower limb paresis. He was a known case of homozygous beta thalassemia major. He had undergone surgery for spinal cord compression due to EMH 4 months prior to presentation. Symptom resolution was followed by deterioration 5 days later. He was operated again at our hospital with complete resection of the mass. He underwent local radiotherapy to prevent recurrence. At 2 years follow-up, he showed complete resolution of symptoms. Follow-up imaging demonstrated no residual mass. Conclusion: The possibility of EMH should be considered in every patient with ineffective erythropoiesis as a cause of spinal cord compression. Treatment of such cases is usually done with blood transfusions, which can reduce the hematopoietic drive for EMH. Other options include surgery, hydroxyurea, radiotherapy, or a combination of these on a case to case basis. PMID:27069747

  19. Spinal dorsal dermal sinus tract: An experience of 21 cases

    PubMed Central

    Singh, Ishwar; Rohilla, Seema; Kumar, Prashant; Sharma, Saurabh

    2015-01-01

    Background: Spinal dorsal dermal sinus is a rare entity, which usually comes to clinical attention by cutaneous abnormalities, neurologic deficit, and/or infection. The present study was undertaken to know the clinical profile of these patients, to study associated anomalies and to assess the results of surgical intervention. Methods: Medical records of 21 patients treated for spinal dorsal dermal sinus from September 2007 to December 2013 were reviewed. Results: We had 21 patients with male: female ratio of 13:8. Only 2 patients were below 1-year of age, and most cases (15) were between 2 and 15 years (mean age = 8.2 years). Lumbar region (11 cases) was most frequently involved, followed by thoracic (4 cases), lumbosacral, and cervical region in 3 patients each. All of our patients presented with neurological deficits. Three patients were admitted with acute meningitis with acute onset paraplegia and had intraspinal abscess. The motor, sensory, and autonomic deficits were seen in 14, 6, and 8 patients, respectively. Scoliosis and congenital talipes equinovarus were the common associated anomalies. All patients underwent surgical exploration and repair of dysraphic state and excision of the sinus. Overall, 20 patients improved or neurological status stabilized and only 1 patient deteriorated. Postoperative wound infection was seen in 2 cases. Conclusions: All patients with spinal dorsal dermal sinuses should be offered aggressive surgical treatment in the form of total excision of sinus tract and correction of spinal malformation, as soon as diagnosed. PMID:26539316

  20. Surgical complications associated with spinal decompression surgery in a Japanese cohort.

    PubMed

    Takai, Keisuke; Matsumoto, Takahiro; Yabusaki, Hajime; Yokosuka, Junichi; Hatanaka, Ryo; Taniguchi, Makoto

    2016-04-01

    The aim of the present study was to identify risk factors for perioperative complications associated with spinal surgery for cervical, thoracic, and lumber spinal stenosis in a Japanese cohort. Patients with spinal stenosis who underwent spinal surgery between 2008 and 2012 were included. Neurological and/or surgical site complications within 30days of index surgery were retrospectively collected, and the rates of complications were calculated. Using univariate and multivariate logistic regression analyses, risk factors for complications were identified. A total of 364 patients underwent 407 spinal surgeries. Of the 407 surgeries performed, 236 were cervical, 28 were thoracic, and 143 were lumbar surgeries. Ossification of the ligamentum flavum was the most common diagnosis in patients with thoracic stenosis (85%), whereas spinal degenerative stenosis and disc herniation were the two most common diagnoses in patients with cervical and lumbar stenosis. Laminoplasty and laminectomy alone were the two most frequently performed procedures. The rate of complications was greater in patients with thoracic stenosis (36%) than in those with cervical (16%) or lumbar stenosis (13%, p=0.013). After a multivariate analysis, only thoracic stenosis (odds ratio 2.87) remained an independent risk factor for surgical complications. The novel result of the present study was that the level of stenosis in the spine had a significant impact on complications after spinal surgery in a Japanese cohort. The result can be explained by the fact that challenging ossified lesions are a common cause of thoracic stenosis in eastern Asia. PMID:26791473

  1. Ganglioglioma of the Spinal Cord

    PubMed Central

    Oppenheimer, Daniel C; Johnson, Mahlon D; Judkins, Alexander R

    2015-01-01

    Ganglioglioma is a rare tumor consisting of neoplastic glial and neuronal elements. It accounts for only 0.5% of all primary central nervous system (CNS) neoplasms. We report an unusual case of extensive intramedullary thoracic spinal cord ganglioglioma in a 14-month-old girl who underwent subtotal resection followed by adjuvant chemotherapy. The epidemiology, histopathologic features, imaging findings, treatment, and prognosis are subsequently reviewed. PMID:26605127

  2. The shortened spinal cord in tetraodontiform fishes.

    PubMed

    Uehara, Masato; Hosaka, Yoshinao Z; Doi, Hiroyuki; Sakai, Harumi

    2015-03-01

    In teleosts, the spinal cord generally extends along the entire vertebral canal. The Tetraodontiformes, in which the spinal cord is greatly reduced in length with a distinct long filum terminale and cauda equina, have been regarded as an aberration. The aims of this study are: 1) to elucidate whether the spinal cord in all tetraodontiform fishes shorten with the filum terminale, and 2) to describe the gross anatomical and histological differences in the spinal cord among all families of the Tetraodontiformes. Representative species from all families of the Tetraodontiformes, and for comparison the carp as a common teleost, were investigated. In the Triacanthodidae, Triacanthidae, and Triodontidae, which are the more ancestral taxa of the Tetraodontiformes, the spinal cord extends through the entire vertebral canal. In the Triacanthidae and Triodontidae, the caudal half or more spinal segments of the spinal cord, however, lack gray matter and consist largely of nerve fibers. In the other tetraodontiform families, the spinal cord is shortened forming a filum terminale with the cauda equina, which is prolonged as far as the last vertebra. The shortened spinal cord is divided into three groups. In the Ostraciidae and Molidae, the spinal cord tapers abruptly at the cranium or first vertebra forming a cord-like filum terminale. In the Monacanthidae, Tetraodontidae, and Diodontidae, it abruptly flattens at the rostral vertebrae forming a flat filum terminale. The spinal cord is relatively longer in the Monacanthidae than that in the other two families. It is suggested by histological features of the flat filum terminale that shortening of the spinal cord in this group progresses in order of the Monacanthidae, Tetraodontidae, and Diodontidae. In the Balistidae and Aracanidae, the cord is relatively long and then gradually decreased in dorso-ventral thickness. PMID:25388857

  3. Minocycline treatment inhibits microglial activation and alters spinal levels of endocannabinoids in a rat model of neuropathic pain

    PubMed Central

    Guasti, Leonardo; Richardson, Denise; Jhaveri, Maulik; Eldeeb, Khalil; Barrett, David; Elphick, Maurice R; Alexander, Stephen PH; Kendall, David; Michael, Gregory J; Chapman, Victoria

    2009-01-01

    Activation of spinal microglia contributes to aberrant pain responses associated with neuropathic pain states. Endocannabinoids (ECs) are present in the spinal cord, and inhibit nociceptive processing; levels of ECs may be altered by microglia which modulate the turnover of endocannabinoids in vitro. Here, we investigate the effect of minocycline, an inhibitor of activated microglia, on levels of the endocannabinoids anandamide and 2-arachidonoylglycerol (2-AG), and the related compound N-palmitoylethanolamine (PEA), in neuropathic spinal cord. Selective spinal nerve ligation (SNL) in rats resulted in mechanical allodynia and the presence of activated microglia in the ipsilateral spinal cord. Chronic daily treatment with minocycline (30 mg/kg, ip for 14 days) significantly reduced the development of mechanical allodynia at days 5, 10 and 14 post-SNL surgery, compared to vehicle-treated SNL rats (P < 0.001). Minocycline treatment also significantly attenuated OX-42 immunoreactivity, a marker of activated microglia, in the ipsilateral (P < 0.001) and contralateral (P < 0.01) spinal cord of SNL rats, compared to vehicle controls. Minocycline treatment significantly (P < 0.01) decreased levels of 2-AG and significantly (P < 0.01) increased levels of PEA in the ipsilateral spinal cord of SNL rats, compared to the contralateral spinal cord. Thus, activation of microglia affects spinal levels of endocannabinoids and related compounds in neuropathic pain states. PMID:19570201

  4. Histogram based quantification of spinal cord injury level using somatosensory evoked potentials.

    PubMed

    Mir, Hasan; Al-Nashash, Hasan; Kerr, Douglas; Thakor, Nitish; All, Angelo

    2010-01-01

    This paper uses an entropy based metric to study the somatosensory evoked potential (SEP) in rodents afflicted with focal demyelination spinal cord injury (SCI). It has been shown that amplitude characteristics of the SEP signal are a strong indicator of the integrity of the spinal cord sensory pathways. Compared to conventional correlation based metrics, the metric used in this paper exploits the amplitude histogram of SEP signals to provide a robust assessment of the different degrees of demyelination in the spinal cord. Results are presented using actual SEP signals collected on rodents with various levels of SCI. PMID:21096668

  5. Speckle variance optical coherence tomography of the rodent spinal cord: in vivo feasibility

    PubMed Central

    Cadotte, David W.; Mariampillai, Adrian; Cadotte, Adam; Lee, Kenneth K. C.; Kiehl, Tim-Rasmus; Wilson, Brian C.; Fehlings, Michael G.; Yang, Victor X. D.

    2012-01-01

    Optical coherence tomography (OCT) has the combined advantage of high temporal (µsec) and spatial (<10µm) resolution. These features make it an attractive tool to study the dynamic relationship between neural activity and the surrounding blood vessels in the spinal cord, a topic that is poorly understood. Here we present work that aims to optimize an in vivo OCT imaging model of the rodent spinal cord. In this study we image the microvascular networks of both rats and mice using speckle variance OCT. This is the first report of depth resolved imaging of the in vivo spinal cord using an entirely endogenous contrast mechanism. PMID:22567584

  6. Interfractional Displacement Analysis of the Spinal Cord for 21 Head & Neck Cases in Radiation Therapy Planning

    NASA Astrophysics Data System (ADS)

    Stoll, Armin; Giske, Kristina; Stoiber, Eva; Bendl, Rolf

    A monomodal slice-based displacement analysis of the spinal cord for three-dimensional computer tomography imaging in radiation therapy planning is presented. In total, 21 head and neck cases with tumor indications close to the spinal cord are studied and evaluated. Two-dimensional cross-correlation is applied to propagate manually segmented contours of the spinal cord from a high-resolution planning CT to subsequently acquired control CTs. The method and the fully automatic implementation turned out to be reliable and robust. A very few manual corrections on the resulting contours remained necessary in single transversal slices.

  7. Testosterone Plus Finasteride Treatment After Spinal Cord Injury

    ClinicalTrials.gov

    2016-01-29

    Spinal Cord Injury; Spinal Cord Injuries; Trauma, Nervous System; Wounds and Injuries; Central Nervous System Diseases; Nervous System Diseases; Spinal Cord Diseases; Gonadal Disorders; Endocrine System Diseases; Hypogonadism; Genital Diseases, Male

  8. Spine day 2012: spinal pain in Swiss school children– epidemiology and risk factors

    PubMed Central

    2013-01-01

    Background The key to a better understanding of the immense problem of spinal pain seems to be to investigate its development in adolescents. Based on the data of Spine Day 2012 (an annual action day where Swiss school children were examined by chiropractors on a voluntary basis for back problems), the aim of the present study was to gain systematic epidemiologic data on adolescent spinal pain in Switzerland and to explore risk factors per gender and per spinal area. Method Data (questionnaires and physical examinations) of 836 school children were descriptively analyzed for prevalence, recurrence and severity of spinal pain. Of those, 434 data sets were included in risk factor analysis. Using logistic regression analysis, psycho-social parameters (presence of parental back pain, parental smoking, media consumption, type of school bag) and physical parameters (trunk symmetry, posture, mobility, coordination, BMI) were analyzed per gender and per spinal area. Results Prevalence of spinal pain was higher for female gender in all areas apart from the neck. With age, a steep increase in prevalence was observed for low back pain (LBP) and for multiple pain sites. The increasing impact of spinal pain on quality of life with age was reflected in an increase in recurrence, but not in severity of spinal pain. Besides age and gender, parental back pain (Odds ratio (OR)=3.26, p=0.011) and trunk asymmetry (OR=3.36, p=0.027) emerged as risk factors for spinal pain in girls. Parental smoking seemed to increase the risk for both genders (boys: OR=2.39, p=0.020; girls: OR=2.19, p=0.051). Risk factor analysis per spinal area resulted in trunk asymmetry as risk factor for LBP (OR=3.15, p=0.015), while parental smoking increased the risk for thoracic spinal pain (TSP) (OR=2.83, p=0.036) and neck pain (OR=2.23, p=0.038). The risk for TSP was further enhanced by a higher BMI (OR=1.15, p=0.027). Conclusion This study supports the view of adolescent spinal pain as a bio-psycho-social problem that should be investigated per spinal area, age and gender. The role of trunk asymmetry and passive smoking as risk factors as well as the association between BMI and TSP should be further investigated, preferably in prospective studies. PMID:24094041

  9. Postoperative Spinal Wound Infections and Postprocedural Diskitis

    PubMed Central

    Chaudhary, Saad B; Vives, Michael J; Basra, Sushil K; Reiter, Mitchell F

    2007-01-01

    Background/Objective: Postprocedural infections are a significant cause of morbidity after spinal interventions. Methods: Literature review. An extensive literature review was conducted on postprocedural spinal infections. Relevant articles were reviewed in detail and additional case images were included. Results: Clinical findings, laboratory markers, and imaging modalities play important roles in the detection of postprocedural spinal infections. Treatment may range from biopsy and antibiotics to multiple operations with complex strategies for soft tissue management. Conclusions: Early detection and aggressive treatment are paramount in managing postprocedural spinal infections and limiting their long-term sequelae. PMID:18092559

  10. Spinal meningiomas: surgical management and outcome.

    PubMed

    Gottfried, Oren N; Gluf, Wayne; Quinones-Hinojosa, Alfredo; Kan, Peter; Schmidt, Meic H

    2003-06-15

    Advances in imaging and surgical technique have improved the treatment of spinal meningiomas; these include magnetic resonance imaging, intraoperative ultrasonography, neuromonitoring, the operative microscope, and ultrasonic cavitation aspirators. This study is a retrospective review of all patients treated at a single institution and with a pathologically confirmed diagnosis of spinal meningioma. Additionally the authors analyze data obtained in 556 patients reported in six large series in the literature, evaluating surgical techniques, results, and functional outcomes. Overall, surgical treatment of spinal meningiomas is associated with favorable outcomes. Spinal meningiomas can be completely resected, are associated with postoperative functional improvement, and the rate of recurrence is low. PMID:15669787

  11. Spinal cord astrocytoma mimicking multifocal myelitis

    PubMed Central

    Neutel, Dulce; Teodoro, Tiago; Coelho, Miguel; Pimentel, José; Albuquerque, Luísa

    2014-01-01

    Introduction Differential diagnosis of acute/subacute intrinsic spinal cord lesions can be challenging. In addition, intramedullary neoplasms typically show gadolinium enhancement, mass effect, and cord expansion. Case report We report a patient with spinal cord and brain stem lesions resembling multifocal myelitis. Magnetic resonance imaging showed no spinal cord enlargement or gadolinium enhancing. Treatment of myelitis was undertaken without stopping the progression of the disease. Biopsy was made and led to a histological diagnosis of astrocytoma. Discussion Astrocytoma must remain as a possible diagnosis of spinal cord lesions, even without typical characteristics of neoplasms. Furthermore, biopsy should always be considered when diagnosis is uncertain. PMID:24621037

  12. A SPINAL EPIDURAL HEMATOMA WITH SYMPTOMS MIMICKING CEREBRAL STROKE

    PubMed Central

    SHIMA, HIROSHI; YASUDA, MUNEYOSHI; NOMURA, MOTOHIRO; MORI, KENTARO; MIYASHITA, KATSUYOSHI; TAMASE, AKIRA; KITAMURA, YOSHIHISA; OSUKA, KOJI; TAKAYASU, MASAKAZU

    2012-01-01

    ABSTRACT A spontaneous cervical epidural hematoma (SCEH) is a rare condition, which usually requires urgent treatment. However, unusual manifestations, such as hemiparesis, may lead to a misdiagnosis. We herein report a case of SCEH that presented with pure motor hemiparesis to discuss the appropriate and prompt diagnosis and treatment of such cases. An 84-year-old female was brought to our emergency department complaining of nuchal pain, followed by right hemiparesis. A contrast-enhanced computed tomography (CT) scan of the neck demonstrated a spinal epidural hematoma right posterolateral to the spinal cord, extending from C2 to C3. She was managed conservatively and her symptoms improved significantly. The authors emphasize that cervical spinal lesions should be considered in the differential diagnosis for patients with acute onset of hemiparesis, when they are associated with neck pain. Even though magnetic resonance imaging is the gold standard, a CT scan is also useful for quick screening for SCEH. Key words: spinal epidural hematoma, hemiparesis, cerebrovascular stroke, diagnosis, spontaneous remission PMID:22515129

  13. Gastric dysreflexia after acute experimental spinal cord injury in rats

    PubMed Central

    Tong, M.; Holmes, G. M.

    2009-01-01

    Gastric reflexes are mediated mainly by vago-vagal reflex circuits in the caudal medulla. Despite the fact that brainstem vago-vagal circuitry remains intact after spinal cord injury (SCI), patients with SCI at the cervical level most often present gastric stasis with an increased risk of reflux and aspiration of gastric contents. Using a miniature strain gauge sutured to the gastric surface; we tested gastric motility and reflexive gastric relaxation following oesophageal distension (oesophageal-gastric relaxation reflex) in animals 3 days after a severe spinal contusion at either the third or ninth thoracic spinal segment (acute T3- or T9 SCI, respectively). Both basal gastric motility and the oesophageal-gastric relaxation reflex were significantly diminished in animals with T3 SCI. Conversely, both basal gastric motility and the oesophageal-gastric relaxation reflex were not significantly reduced in T9 SCI animals compared to controls. The reduced gastric motility and oesophageal-gastric reflex in T3 SCI rats was not ameliorated by celiac sympathectomy. Our results show that gastric stasis following acute SCI is independent of altered spinal sympathetic input to the stomach caudal to the lesion. Our data suggest that SCI may alter the sensitivity of vagal reflex function, perhaps by interrupting ascending spinosolitary input to brainstem vagal nuclei. PMID:19126185

  14. Craniospinal Irradiation With Spinal IMRT to Improve Target Homogeneity

    SciTech Connect

    Panandiker, Atmaram Pai; Ning, Holly; Likhacheva, Anna; Ullman, Karen; Arora, Barbara; Ondos, John C.; Karimpour, Shervin; Packer, Roger; Miller, Robert; Citrin, Deborah . E-mail: citrind@mail.nih.gov

    2007-08-01

    Purpose: To report a new technique for the spinal component of craniospinal irradiation (CSI) in the supine position, to describe a verification procedure for this method, and to compare this technique with conventional plans. Methods and Materials: Twelve patients were treated between 1998 and 2006 with CSI using a novel technique. Sixteen children were treated with a conventional field arrangement. All patients were followed for outcomes and toxicity. CSI was delivered using a posteroanterior (PA) intensity-modulated radiation therapy (IMRT) spinal field matched to conventional, opposed lateral cranial fields. Treatment plans were generated for each patient using the IMRT technique and a standard PA field technique. The resulting dosimetry was compared to determine target homogeneity, maximum dose to normal tissues, and total monitor units delivered. Results: Evaluation of the spinal IMRT technique compared with a standard PA technique reveals a 7% reduction in the target volume receiving {>=}110% of the prescribed dose and an 8% increase in the target volume receiving {>=}95% of the prescribed dose. Although target homogeneity was improved, the maximum dose delivered in the paraspinal muscles was increased by approximately 8.5% with spinal IMRT compared to the PA technique. Follow-up evaluations revealed no unexpected toxicity associated with the IMRT technique. Conclusions: A new technique of spine IMRT is presented in combination with a quality assurance method. This method improves target dose uniformity compared to the conventional CSI technique. Longer follow-up will be required to determine any benefit with regard to toxicity and disease control.

  15. Use of demineralized bone matrix in spinal fusion

    PubMed Central

    Tilkeridis, Konstantinos; Touzopoulos, Panagiotis; Ververidis, Athanasios; Christodoulou, Sotirios; Kazakos, Konstantinos; Drosos, Georgios I

    2014-01-01

    Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the gold-standard graft choice to promote spinal fusion; however, it is associated with significant donor site morbidity and a limited graft quantity. Therefore, several bone graft alternatives have been developed, to augment arthrodesis. The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix (DBM), alone or as a composite graft, in the spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key word “demineralized bone matrix”, “DBM”, “spinal fusion”, and “scoliosis”. Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer. Limited number of prospective randomized controlled trials (4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion. The majority of the clinical trials demonstrate comparable efficacy of DBM when it used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material. Additionally, high level of evidence studies are required, in order to optimize and clarify the indications of its use and the appropriate patient population that will benefit from DBM in spine arthrodesis. PMID:24649412

  16. Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette

    PubMed Central

    Matsuoka, Hidenori; Itoh, Yasunobu; Numazawa, Shinichi; Tomii, Masato; Watanabe, Kazuo; Hirano, Yoshitaka; Nakagawa, Hiroshi

    2012-01-01

    Objective: The authors present a novel method of the recapping hemilaminoplasty in a retrospective study of patients with spinal surgical disorders. This report describes the surgical technique and the results of hemilaminoplasty using an ultrasonic bone curette. The aim of this study was to examine the safety and effectiveness of the hemilaminoplasty technique with ultrasonic bone curette. Methods: Between April 2003 and July 2011, 33 patients with various spinal diseases (17 spinal tumors, 5 dural arteriovenous fistulas, 3 syringomyelia, 2 sacral perineural cysts, and 2 arachnoid cysts) were treated microsurgically by using an ultrasonic bone curette with scalpel blade and lightweight handpiece. The ultrasonic bone curette was used for division of lamina. After resection of the lesion, the excised lamina was replaced exactly in situ to its original anatomic position with a titanium plate and screw. Additional fusion technique was not required and the device was easy to handle. All patients were observed both neurologically and radiologically by dynamic plain radiographs and computed tomography (CT) scan. Results: The operation was performed successfully and there were no instrument-related complications such as dural laceration, nerve root injury, and vessels injury. The mean number of resected and restored lamina was 1.7. CT confirmed primary bone fusion in all patients by 12 months after surgery. Conclusion: The ultrasonic bone curette is a useful instrument for recapping hemilaminoplasty in various spinal surgeries. This method allows anatomical reconstruction of the excised bone to preserve the posterior surrounding tissues. PMID:22754735

  17. Spinal Cord Stimulation for Refractory Neuropathic Pain of Neuralgic Amyotrophy

    PubMed Central

    Kim, Jae-hun; Ha, Sang-woo

    2015-01-01

    The aim of this paper was to report the effect of temporary and chronic spinal cord stimulation for refractory neuropathic pain in neuralgic amyotrophy (NA). A 35-year-old female presented with two-months history of a severe, relentless neuropathic pain of the left shoulder, forearm, palm, and fingers. The neuropathic pain was refractory to various medical treatments, including nonsteroidal anti-inflammatory drugs, opiates, epidural and stellate ganglion blocks, and typically unrelenting. The diagnosis of NA was made with the characteristic clinical history and magnetic resonance imaging. The patient underwent a temporary spinal cord stimulation to achieve an adequate pain relief because her pain was notoriously difficult to control and lasted longer than the average duration (about 4 weeks on average) of a painful phase of NA. Permanent stimulation was given with paddle lead. The neuropathic pain in her NA persisted and she continued using the spinal cord stimulation with 12 months after development of NA. The temporary spinal cord stimulation was effective in a patient with an extraordinary prolonged, acute painful phase of NA attack, and the subsequent chronic stimulation was also useful in achieving an adequate analgesia during the chronic phase of NA. PMID:27169086

  18. Anterior spinal cord syndrome after initiation of treatment with atenolol.

    PubMed

    Schneider, Gregory S

    2010-06-01

    Anterior spinal cord syndrome is a rare condition with a variety of precipitating factors. Patients typically complain of weakness or paralysis of the extremities, often accompanied by pain, but frequently without a history of trauma. A 48-year-old man presented to the emergency department complaining of neck pain and inability to move his legs in the absence of trauma. Several hours prior he had seen his private physician and was given a dose of atenolol for elevated blood pressure. He had not previously been on medications for hypertension. His neurological examination revealed bilateral paralysis of the lower extremities. In the upper extremities he had weakness and sensory loss at the level of C6. Rectal tone was decreased and without sensation. Cervical and thoracic spine magnetic resonance imaging showed spondylotic disc disease, with disc herniation at C6-7 causing severe spinal canal stenosis. Despite i.v. methylprednisolone, pressors, and a prolonged intensive care unit course, the patient was discharged 5 weeks later with continued neurological deficits. Anterior spinal cord syndrome results from compression of the anterior spinal artery and often occurs in the absence of traumatic injury. The recognition, management, and prognosis of this condition are discussed. PMID:18597977

  19. Calpain inhibition prevents ethanol-induced alterations in spinal motoneurons.

    PubMed

    Samantaray, Supriti; Patel, Kaushal S; Knaryan, Varduhi H; Thakore, Nakul P; Roudabush, Stacy; Heissenbuttle, Jenna H; Becker, Howard C; Banik, Naren L

    2013-08-01

    Long-term exposure of ethanol (EtOH) alters the structure and function in brain and spinal cord. The present study addresses the mechanisms of EtOH-induced damaging effects on spinal motoneurons in vitro. Altered morphology and biochemical changes of such damage were demonstrated by in situ Wright staining and DNA ladder assay. EtOH at low to moderate (25-50mM) concentrations induced damaging effects in the motoneuronal scaffold which involved activation of proteases like ?-calpain and caspase-3. Caspase-8 was seen only at higher (100mM) EtOH concentration. Further, pretreatment with calpeptin, a potent calpain inhibitor, confirmed the involvement of active proteases in EtOH-induced damage to motoneurons. The lysosomal enzyme cathepsin D was also elevated in the motoneurons by EtOH, and this effect was significantly attenuated by inhibitor treatment. Overall, EtOH exposure rendered spinal motoneurons vulnerable to damage, and calpeptin provided protection, suggesting a critical role of calpain activation in EtOH-induced alterations in spinal motoneurons. PMID:23690229

  20. Cardio Respiratory Adaptations with Long Term Personalized Exercise Program in a T12 Spinal Cord Injured Person

    ERIC Educational Resources Information Center

    Vasiliadis, Angelo; Christoulas, Kosmas; Evaggelinou, Christina; Vrabas, Ioannis

    2009-01-01

    The purpose of this study was to investigate the physiological adaptations in cardio respiratory endurance with a personalized exercise program with arm-cranking exercise in a paraplegic person (incomplete T12 spinal cord injury). A 32 year-old man with spinal cord injury (T12) participated in the present study performing 30 minutes arm cranking…

  1. Survival and neurite growth of chick embryo spinal cord cells in serum-free culture.

    PubMed

    Tanaka, H; Obata, K

    1982-07-01

    Cell survival and neurite growth were investigated in serum-free spinal cord cell cultures on polyornithine coating (PORN). Cells were obtained from 6- or 7-day-old chick embryos. Isolated spinal cord cells required promoting factors for their survival and neurite growth. The survival-promoting factors were initially present in spinal cord cells. High density cultures, co-cultures with spinal cord explants, and spinal cord extract promoted survival of isolated spinal cord cells in MEM with no additives. Other tissue extracts (brain, liver, heart and skeletal muscle), serum, and serum-free conditioned medium (SF-CM) of muscle or glioma C6 cells also promoted survival. The active substances in the brain extract and SF-CM were shown to be protein and were separated into 3 fractions (approximately molecular weight 150,000, 70,000, 40,000) by gel filtration chromatography. Survival and neurite growth were suggested to be promoted by different factors because: (1) survival was promoted by both tissue extract and SF-CM, but neurite growth was promoted only by SF-CM; (2) the neurite growth-stimulating activity of SF-CM was lost following dialysis and heat (100 degrees C, 2 min) treatment; however, the survival-promoting activity was not. It was also suggested that spinal cord cells produce neurite growth promoting factors, but did not initially contain these factors. PMID:7104764

  2. Sensory and spinal inhibitory dorsal midline crossing is independent of Robo3.

    PubMed

    Comer, John D; Pan, Fong Cheng; Willet, Spencer G; Haldipur, Parthiv; Millen, Kathleen J; Wright, Christopher V E; Kaltschmidt, Julia A

    2015-01-01

    Commissural neurons project across the midline at all levels of the central nervous system (CNS), providing bilateral communication critical for the coordination of motor activity and sensory perception. Midline crossing at the spinal ventral midline has been extensively studied and has revealed that multiple developmental lineages contribute to this commissural neuron population. Ventral midline crossing occurs in a manner dependent on Robo3 regulation of Robo/Slit signaling and the ventral commissure is absent in the spinal cord and hindbrain of Robo3 mutants. Midline crossing in the spinal cord is not limited to the ventral midline, however. While prior anatomical studies provide evidence that commissural axons also cross the midline dorsally, little is known of the genetic and molecular properties of dorsally-crossing neurons or of the mechanisms that regulate dorsal midline crossing. In this study, we describe a commissural neuron population that crosses the spinal dorsal midline during the last quarter of embryogenesis in discrete fiber bundles present throughout the rostrocaudal extent of the spinal cord. Using immunohistochemistry, neurotracing, and mouse genetics, we show that this commissural neuron population includes spinal inhibitory neurons and sensory nociceptors. While the floor plate and roof plate are dispensable for dorsal midline crossing, we show that this population depends on Robo/Slit signaling yet crosses the dorsal midline in a Robo3-independent manner. The dorsally-crossing commissural neuron population we describe suggests a substrate circuitry for pain processing in the dorsal spinal cord. PMID:26257608

  3. Diffusion tensor imaging of lumbar spinal nerve in subjects with degenerative lumbar disorders.

    PubMed

    Oikawa, Yasuhiro; Eguchi, Yawara; Inoue, Gen; Yamauchi, Kazuyo; Orita, Sumihisa; Kamoda, Hiroto; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Go; Inage, Kazuhide; Saino, Takeshi; Sato, Hirotaka; Ando, Hiroki; Kojima, Masatoshi; Okumura, Kenichiro; Masuda, Yoshitada; Watanabe, Atsuya; Takahashi, Kazuhisa; Ohtori, Seiji

    2015-10-01

    Recently several authors have reported that diffusion tensor imaging (DTI) might provide a new understanding of sciatica. The purpose of this study was to investigate the clinical feasibility of DTI for the evaluation of lumbar spinal nerve of patients with sciatica associated with lumbar degenerative disorders. Thirty-four patients (25men, mean age63. 3years) with degenerated lumbar disease, 14 patients with lumbar spinal stenosis with foraminal stenosis, 12 with lumbar spinal stenosis without foraminal stenosis, five with lumbar disc herniation, two with discogenic low back pain, and one with spondylolysis who underwent 3.0T magnetic resonance (MR) imaging and surgical treatment were included in the present study. Fractional anisotropy (FA) was calculated from an FA map, and tractography was investigated. In asymptomatic nerves, tractography showed all L3-S1 spinal nerve roots clearly. Abnormalities of tractography were classified into three types by shape; "Disrupted", "Narrowing", and "Tapering". More abnormalities of tractography were found in patients with lumbar spinal stenosis, and especially in patients with foraminal stenosis. The disrupted type was the most common. The mean FA of entrapped symptomatic nerves was less than seen on the intact side. This study demonstrates that tractography shows abnormal findings for nerve roots in lumbar spinal degeneration and that FA decreases in symptomatic roots. DTI may offer not only morphological evaluation, but also quantitative evaluation. We believe that DTI can be used as a tool for the diagnosis of lumbar spinal degenerative disease. PMID:25979227

  4. Computer-assisted scheme for automated determination of imaging planes in cervical spinal cord MRI

    NASA Astrophysics Data System (ADS)

    Tsurumaki, Masaki; Tsai, Du-Yih; Lee, Yongbum; Sekiya, Masaru; Kazama, Kiyoko

    2009-02-01

    This paper presents a computerized scheme to assist MRI operators in accurate and rapid determination of sagittal sections for MRI exam of cervical spinal cord. The algorithm of the proposed scheme consisted of 6 steps: (1) extraction of a cervical vertebra containing spinal cord from an axial localizer image; (2) extraction of spinal cord with sagittal image from the extracted vertebra; (3) selection of a series of coronal localizer images corresponding to various, involved portions of the extracted spinal cord with sagittal image; (4) generation of a composite coronal-plane image from the obtained coronal images; (5) extraction of spinal cord from the obtained composite image; (6) determination of oblique sagittal sections from the detected location and gradient of the extracted spinal cord. Cervical spine images obtained from 25 healthy volunteers were used for the study. A perceptual evaluation was performed by five experienced MRI operators. Good agreement between the automated and manual determinations was achieved. By use of the proposed scheme, average execution time was reduced from 39 seconds/case to 1 second/case. The results demonstrate that the proposed scheme can assist MRI operators in performing cervical spinal cord MRI exam accurately and rapidly.

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

    PubMed

    Seo, Eunjeong; Choi, Jihye; Choi, Mincheol; Yoon, Junghee

    2014-01-01

    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

  6. The change tendency of PI3K/Akt pathway after spinal cord injury

    PubMed Central

    Zhang, Peixun; Zhang, Luping; Zhu, Lei; Chen, Fangmin; Zhou, Shuai; Tian, Ting; Zhang, Yuqiang; Jiang, Xiaorui; Li, Xuekun; Zhang, Chuansen; Xu, Lin; Huang, Fei

    2015-01-01

    Spinal cord injury (SCI) refers to the damage of spinal cord’s structure and function due to a variety of causes. At present, many scholars have confirmed that apoptosis is the main method of secondary injury in spinal cord injury. In view of understanding the function of PI3K/Akt pathway on spinal cord injury, this study observed the temporal variation of key molecules (PI3K, Akt, p-Akt) in the PI3K/Akt pathway after spinal cord injury by immunohistochemistry and Western-blot. The results showed that the expression of PI3K, Akt and p-Akt display a sharp increase one day after the spinal cord injury, and then it decreased gradually with the time passing by, but the absolute expression was certainly higher than the normal group. These results indicate that the PI3K/Akt signaling pathway is involved in the spinal cord injury and the mechanism may be related to apoptosis. PMID:26807170

  7. Spinal cord injuries in older children: is there a role for high-dose methylprednisolone?

    PubMed

    Arora, Bhawana; Suresh, Srinivasan

    2011-12-01

    We present a retrospective case series of 15 children (aged 8-16 years) with blunt traumatic spinal cord injury who were treated with methylprednisolone as per the National Acute Spinal Cord Injury Study protocol. Of all patients, 12 (80%) were male. Causes were sports injuries (n = 9), motor vehicle crashes (n = 2), and falls (n = 4). Most injuries were nonskeletal (n = 14), and all patients had incomplete injury of the spinal cord. The most common location of tenderness was cervical (n = 7). Of the 15 patients, methylprednisolone was initiated within 3 hours in 13 patients and between 3 and 8 hours in 2 patients. All patients received the medication for 23 hours as per the National Acute Spinal Cord Injury Study protocol. Of the 15 patients, 13 recovered completely by 24 hours and were discharged with a diagnosis of spinal cord concussion. One patient had compression fracture of T5 and T3-T5 spinal contusion but no long-term neurological deficit. One patient was discharged with diagnosis of C1-C3 spinal cord contusion (by magnetic resonance imaging) and had partial recovery at 2 years after injury. All patients with a diagnosis of cord concussion had normal plain films of the spine and computed tomographic and magnetic resonance imaging findings. None of the patients had any associated major traumatic injuries to other organ systems. The high-dose steroid therapy did not result in any serious bacterial infections. PMID:22158284

  8. Spinal cord-muscle relations: their role in neuro-muscular development in birds.

    PubMed

    Gardahaut, M F; Fontaine-Perus, J; Le Douarin, G H

    1990-03-01

    In the present study we focused our attention on the role of spinal cord-muscle interactions in the development of muscle and spinal cord cells. Four experimental approaches were used: 1) muscle fiber-spinal cord co-culture; 2) chronic spinal cord stimulation in chick embryos; 3) direct electrical stimulation of the denervated chick muscle; 4) skeletal muscle transplantation in close apposition to the spinal cord in chick embryos. The characteristics of mATPase and energetic metabolism enzyme activities and of myosin isoform expression were used as markers for fiber types in two peculiar muscles, the fast-twitch PLD and the slow-tonic ALD. In vitro, in the absence of neurons, myoblasts can express some characteristics of either slow or fast muscle types according to their origin, while in the presence of neurons, muscle fiber differentiation seems to be related to the spontaneous rhythm delivered by the neurons. The in ovo experiments of chronic spinal cord stimulation demonstrate that the differentiation of the fast and slow muscle features appears to be rhythm dependent. In the chick, direct stimulation of denervated muscles shows that the rhythm of the muscle activity is also involved in the control of muscle properties. In chick embryos developing ALD, the changes induced by modifications of muscle tension demonstrate that this factor also influences muscle development. Other experiments show that muscle back-transplantation can alter the early spinal cord development. PMID:2203457

  9. Sensory and spinal inhibitory dorsal midline crossing is independent of Robo3

    PubMed Central

    Comer, John D.; Pan, Fong Cheng; Willet, Spencer G.; Haldipur, Parthiv; Millen, Kathleen J.; Wright, Christopher V. E.; Kaltschmidt, Julia A.

    2015-01-01

    Commissural neurons project across the midline at all levels of the central nervous system (CNS), providing bilateral communication critical for the coordination of motor activity and sensory perception. Midline crossing at the spinal ventral midline has been extensively studied and has revealed that multiple developmental lineages contribute to this commissural neuron population. Ventral midline crossing occurs in a manner dependent on Robo3 regulation of Robo/Slit signaling and the ventral commissure is absent in the spinal cord and hindbrain of Robo3 mutants. Midline crossing in the spinal cord is not limited to the ventral midline, however. While prior anatomical studies provide evidence that commissural axons also cross the midline dorsally, little is known of the genetic and molecular properties of dorsally-crossing neurons or of the mechanisms that regulate dorsal midline crossing. In this study, we describe a commissural neuron population that crosses the spinal dorsal midline during the last quarter of embryogenesis in discrete fiber bundles present throughout the rostrocaudal extent of the spinal cord. Using immunohistochemistry, neurotracing, and mouse genetics, we show that this commissural neuron population includes spinal inhibitory neurons and sensory nociceptors. While the floor plate and roof plate are dispensable for dorsal midline crossing, we show that this population depends on Robo/Slit signaling yet crosses the dorsal midline in a Robo3-independent manner. The dorsally-crossing commissural neuron population we describe suggests a substrate circuitry for pain processing in the dorsal spinal cord. PMID:26257608

  10. Transection of Spinal Cord

    PubMed Central

    Shulman, Stanford T.; Madden, John D.; Esterly, John R.; Shanklin, Douglas R.

    1971-01-01

    A newborn infant, delivered following mid-forceps rotation, presented with apnoea, anaesthesia below the level of the mid-neck, and flaccid quadriplegia. At necropsy there was transection of the cord, and atlanto-occipital and atlantoaxial dislocations. Cord injury usually follows breech presentation, the lesion is in the lower cervical or upper thoracic segments, and results from excessive traction. By contrast, in the rare cases following cephalic delivery, the lesion is most often in the upper cervical cord and probably results from rotational forces. PMID:5104538

  11. Thermoelectric device for treatment of radiculitis and spinal massage

    NASA Astrophysics Data System (ADS)

    Anatychuk, L. I.; Kobylyansky, R. R.

    2012-06-01

    Results of development of a thermoelectric device that enables controlled cyclic temperature impact on the damaged area of human organism are presented. Unlike the existing medical devices employing direct supply current for thermoelectric module, the present device controls supply current according to time dependence of temperature change assigned by doctor. It is established that such a device is an efficient means of therapy at herniation of intervertebral disks with marked radiculitis and tunicary syndromes, at meningitis, other spinal diseases and back traumas.

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

    PubMed

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

    2015-03-10

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

  13. High yield extraction of pure spinal motor neurons, astrocytes and microglia from single embryo and adult mouse spinal cord

    PubMed Central

    Beaudet, Marie-Josée; Yang, Qiurui; Cadau, Sébastien; Blais, Mathieu; Bellenfant, Sabrina; Gros-Louis, François; Berthod, François

    2015-01-01

    Extraction of mouse spinal motor neurons from transgenic mouse embryos recapitulating some aspects of neurodegenerative diseases like amyotrophic lateral sclerosis has met with limited success. Furthermore, extraction and long-term culture of adult mouse spinal motor neurons and glia remain also challenging. We present here a protocol designed to extract and purify high yields of motor neurons and glia from individual spinal cords collected on embryos and adult (5-month-old) normal or transgenic mice. This method is based on mild digestion of tissue followed by gradient density separation allowing to obtain two millions motor neurons over 92% pure from one E14.5 single embryo and more than 30,000 from an adult mouse. These cells can be cultured more than 14 days in vitro at a density of 100,000 cells/cm2 to maintain optimal viability. Functional astrocytes and microglia and small gamma motor neurons can be purified at the same time. This protocol will be a powerful and reliable method to obtain motor neurons and glia to better understand mechanisms underlying spinal cord diseases. PMID:26577180

  14. Treatment of Acute Tuberculous Spondylitis by the Spinal Shortening Osteotomy: A Technical Notes and Case Illustrations

    PubMed Central

    Chanplakorn, Pongsthorn; Chanplakorn, Niramol; Kraiwattanapong, Chaiwat; Laohacharoensombat, Wichien

    2011-01-01

    Surgical treatment for spinal tuberculosis is necessary in particular cases that a large amount of necrotic tissue is encountered and there is spinal cord compression. A spinal shortening osteotomy procedure has previously been described for the correction of the sagittal balance in a late kyphotic deformity, but there have been no reports on this as a surgical treatment in the acute stage. Thus, the aim of this report is to present the surgical techniques and clinical results of 3 patients who were treated with this procedure. Three patients with tuberculous spondylitis at the thoracic spine were surgically treated with this procedure. All the patients presented with severe progressive back pain, kyphotic deformity and neurological deficit. The patients recovered uneventfully from surgery without further neurological deterioration. Their pain was improved and the patients remained free of pain during the follow-up period. In conclusion, posterior spinal shortening osteotomy is an alternative method for the management of tuberculous spondylitis. PMID:22164318

  15. Spinal plasticity in robot-mediated therapy for the lower limbs.

    PubMed

    Stevenson, Andrew Jt; Mrachacz-Kersting, Natalie; van Asseldonk, Edwin; Turner, Duncan L; Spaich, Erika G

    2015-01-01

    Robot-mediated therapy can help improve walking ability in patients following injuries to the central nervous system. However, the efficacy of this treatment varies between patients, and evidence for the mechanisms underlying functional improvements in humans is poor, particularly in terms of neural changes in the spinal cord. Here, we review the recent literature on spinal plasticity induced by robotic-based training in humans and propose recommendations for the measurement of spinal plasticity using robotic devices. Evidence for spinal plasticity in humans following robotic training is limited to the lower limbs. Body weight-supported (BWS) robotic-assisted step training of patients with spinal cord injury (SCI) or stroke patients has been shown to lead to changes in the amplitude and phase modulation of spinal reflex pathways elicited by electrical stimulation or joint rotations. Of particular importance is the finding that, among other changes to the spinal reflex circuitries, BWS robotic-assisted step training in SCI patients resulted in the re-emergence of a physiological phase modulation of the soleus H-reflex during walking. Stretch reflexes elicited by joint rotations constitute a tool of interest to probe spinal circuitry since the technology necessary to produce these perturbations could be integrated as a natural part of robotic devices. Presently, ad-hoc devices with an actuator capable of producing perturbations powerful enough to elicit the reflex are available but are not part of robotic devices used for training purposes. A further development of robotic devices that include the technology to elicit stretch reflexes would allow for the spinal circuitry to be routinely tested as a part of the training and evaluation protocols. PMID:26377324

  16. Unique Imaging Features of Spinal Neurenteric Cyst

    PubMed Central

    Jung, Hyoung-Seok; Park, Sang-Min; Kim, Gang-Un; Kim, Mi Kyung

    2015-01-01

    A 50-year-old male presented with acutely progressed paraplegia. His magnetic resonance imaging demonstrated two well-demarcated components with opposite signals in one cystic lesion between the T1- and T2-weighted images at the T1 spine level. The patient showed immediately improved neurological symptoms after surgical intervention and the histopathological exam was compatible with a neurenteric cyst. On operation, two different viscous drainages from the cyst were confirmed. A unique similarity of image findings was found from a review of the pertinent literature. The common findings of spinal neurenteric cyst include an isointense or mildly hyperintense signal relative to cerebrospinal fluid for both T1- and T2-weighted images. However, albeit rarer, the signals of some part of the cyst could change into brightly hyperintensity on T1-weighted images and hypointensity on T2-weighted images due to the differing sedimentation of the more viscous contents in the cyst. PMID:26640637

  17. [Diagnostics and therapy of spinal disc herniation].

    PubMed

    Zimmer, A; Reith, W

    2014-11-01

    Degenerative processes in a movement segment of the vertebral column, which can potentially give rise to herniation of elements of the nucleus pulposus, are complex and of variable clinical and radiological dimensions; however the mere assumption that degenerative changes precede disc herniation remains a matter of debate. By definition, spinal disc herniation (SDH) refers to components of the gelatinous nucleus pulposus protruding beyond the dorsal level of the vertebral body margin through tears in the annulus fibrosus. Clinical presentation may include pain, paresis and sensory disturbances. Magnetic resonance imaging (MRI) is considered the gold standard in the diagnosis of SDH. In the majority of patients a conservative approach with physical therapy exercises and adequate analgesic and antiphlogistic medical treatment results in a substantial improvement of symptoms. PMID:25398570

  18. Epidural Cystic Spinal Meningioma: A Case Report.

    PubMed

    Zhang, Ji; Chen, Zheng-He; Wang, Zi-Feng; Sun, Peng; Jin, Jie-Tian; Zhang, Xiang-Heng; Zhao, Yi-Ying; Wang, Jian; Mou, Yong-Gao; Chen, Zhong-Ping

    2016-03-01

    Cystic spinal meningioma (CSM) is an uncommon meningioma variant. Extradural CSMs are particularly rare and difficult to distinguish from other intraaxial tumors. This study presents a case of a 36-year-old woman with intraspinal extradual CSM at the thoracolumbar spine. She experienced persistent weakness, progressive numbness, and sensory disturbance in the right lower limb. Magnetic resonance imaging (MRI) of the patient revealed an irregular cystic mass at the thoracic 11 to lumbar 3 levels dorsally. This case was misdiagnosed as other neoplasms prior to surgery because of the atypical radiographic features and location of the tumor.Extradural CSMs should be considered in the differential diagnosis of intraspinal extradural cystic neoplasms. Complete removal of cystic wall provides an optimal outcome, rendering the lesion curable. PMID:26986119

  19. 'Crashing' the rugby scrum -- an avoidable cause of cervical spinal injury. Case reports.

    PubMed

    Scher, A T

    1982-06-12

    Deliberate crashing of the opposing packs prior to a rugby scrum is an illegal but commonly practised manoeuvre which can lead to abnormal flexion forces being applied to players in the front row, with resultant cervical spine and spinal cord injury. Two cases of cervical spinal cord injury sustained in this manner are presented. The mechanism of injury, the forces involved and preventive measures are discussed. PMID:7089756

  20. Ruptured spinal dermoid cyst with chemical arachnoiditis and disseminated intracranial lipid droplets.

    PubMed

    Roeder, M B; Bazan, C; Jinkins, J R

    1995-02-01

    A 33-year-old man presented with a 3-month history of gradually progressive leg weakness. Spinal MRI and myelography with CT demonstrated an extensive intradural abnormality suggesting a diffuse inflammatory or neoplastic process. Only after cranial CT and MRI demonstrated lipid droplets was the diagnosis of a ruptured spinal dermoid cyst suggested. Subsequent laminectomy revealed a ruptured intradural dermoid cyst in the lumbar spine, with chemical arachnoiditis. PMID:7761002

  1. Chronic spinal cord injury in the cervical spine of a young soccer player.

    PubMed

    Kato, Yoshihiko; Koga, Michiaki; Taguchi, Toshihiko

    2010-05-01

    A 17-year-old male soccer player presented with numbness in the upper- and lower-left extremities of 6 months' duration. He had no apparent history of trauma but experienced neck pain during heading of the ball 5 years prior. A high-signal intensity area was seen on T2-weighted magnetic resonance imaging (MRI) of the cervical spine. No muscle weakness was observed. Hypoesthesia was observed in bilateral forearms, hands, and extremities below the inguinal region. Plain radiographs in the neutral position showed local kyphosis at C3/4. A small protrusion of the C3/4 disk was observed on T1-weighted MRI. A high-signal area in the spinal cord at the C3/4 level was observed on T2-weighted MRI, but this was not enhanced by gadolinium. Multiple sclerosis, intramedullary spinal cord tumor, sarcoidosis and malignant lymphoma, and spinal cord injury were all considered in the differential diagnosis. However, in view of the clinical, laboratory, and radiological investigations, we concluded that repeated impacts to the neck caused by heading of the ball during soccer induced a chronic, minor spinal cord injury. This contributed to the high-signal intensity change of the spinal cord in T2-weighted MRI. The present case demonstrates that repeated impact may cause chronic spinal cord injury. Soccer, American football, or rugby players presenting with neck or extremity symptoms should not be overlooked for the possibility of latent spinal cord injury, as this could present later development of more severe or unrecoverable spinal cord injuries. PMID:20506942

  2. Therapeutic approaches for spinal cord injury.

    PubMed

    Cristante, Alexandre Fogaça; Barros Filho, Tarcísio Eloy Pessoa de; Marcon, Raphael Martus; Letaif, Olavo Biraghi; Rocha, Ivan Dias da

    2012-10-01

    This study reviews the literature concerning possible therapeutic approaches for spinal cord injury. Spinal cord injury is a disabling and irreversible condition that has high economic and social costs. There are both primary and secondary mechanisms of damage to the spinal cord. The primary lesion is the mechanical injury itself. The secondary lesion results from one or more biochemical and cellular processes that are triggered by the primary lesion. The frustration of health professionals in treating a severe spinal cord injury was described in 1700 BC in an Egyptian surgical papyrus that was translated by Edwin Smith; the papyrus reported spinal fractures as a "disease that should not be treated." Over the last biological or pharmacological treatment method. Science is unraveling the mechanisms of cell protection and neuroregeneration, but clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration. The combination of several therapeutic strategies should, at minimum, allow for partial functional recoveries for these patients, which could improve their quality of life. PMID:23070351

  3. Nutrition of People with Spinal Cord Injuries

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This conference proceeding summarizes current knowledge about the nutritional status and needs of the spinal cord injured patient. Topics covered include the aspects of spinal cord injury that influence nutrient intakes and status, and the nutrients most likely to be problematic in this diverse gro...

  4. Psychological Aspects of Spinal Cord Injury

    ERIC Educational Resources Information Center

    Cook, Daniel W.

    1976-01-01

    Reviewing literature on the psychological impact of spinal cord injury suggests: (a) depression may not be a precondition for injury adjustment; (b) many persons sustaining cord injury may have experienced psychological disruption prior to injury; and (c) indexes of rehabilitation success need to be developed for the spinal cord injured. (Author)

  5. Intraoperative neurophysiological monitoring in spinal surgery

    PubMed Central

    Park, Jong-Hwa; Hyun, Seung-Jae

    2015-01-01

    Recently, many surgeons have been using intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials (MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome. PMID:26380823

  6. Spinal arteriovenous malformations: Is surgery indicated?

    PubMed Central

    Singh, Bikramjit; Behari, Sanjay; Jaiswal, Awadhesh K.; Sahu, Rabi Narayan; Mehrotra, Anant; Mohan, B. Madan; Phadke, Rajendra V.

    2016-01-01

    Purpose: To identify clinico-radiological distinguishing features in various types of spinal arteriovenous malformations (AVM) with an aim to define the role of surgical intervention. Materials and Methods: Hero's modified Di Chiro classification differentiated four types of spinal AVMs on digital subtraction angiogram (DSA) in 74 patients: I. Dural arteriovenous fistulae (n = 35, 47.3%); II. Glomus/intramedullary (n = 13, 17.6%); III. Juvenile/metameric (n = 4, 5.4%); and, IV. Ventral perimedullary fistula (n = 21, 28.4%). A patient with extradural AVM remained unclassified. Demographic profiles, DSA features and reason for surgical referral were recorded. Statistical comparison of discrete variables like gender, spinal cord level, presentation and outcome was made using Chi-square test; and, continuous variables like age, feeder number, duration of symptoms and number of staged embolizations by one way analysis of variance with Boneferoni post hoc comparison. Embolization alone (n = 39, 52.7%), surgery alone (n = 16, 21.6%), and combined approach (n = 4, 5.4%) were the treatments offered (15 were treated elsewhere). Results: Type I-AVM occurred in significantly older population than other types (P = 0.01). Mean duration of symptoms was 13.18 ± 12.8 months. Thoracic cord involvement predominated in type-I and III AVMs (P = 0.01). Number of feeding arteries were 1 in 59.7%; 2 in 29.0%; and, multiple in 11.3% patients, respectively. Staged embolization procedures in type-III AVM were significant (P < 0.01). Surgical referral was required due to: Vessel tortuosity/insufficient parent vessel caliber (n = 7); residual AVM (n = 4); low flow AVM (n = 3); and, multiple feeders (n = 2). Check DSA (n = 34) revealed complete AVM obliteration in 26 and minor residual lesion in eight patients. Neurological status improved in 26 and stabilized in 25 patients. Conclusions: Differentiating between Type I-IV AVMs has a significant bearing on their management. Surgical intervention should be considered as an important adjunct/alternative to therapeutic embolization. PMID:27057219

  7. Cooling athletes with a spinal cord injury.

    PubMed

    Griggs, Katy E; Price, Michael J; Goosey-Tolfrey, Victoria L

    2015-01-01

    Cooling strategies that help prevent a reduction in exercise capacity whilst exercising in the heat have received considerable research interest over the past 3 decades, especially in the lead up to a relatively hot Olympic and Paralympic Games. Progressing into the next Olympic/Paralympic cycle, the host, Rio de Janeiro, could again present an environmental challenge for competing athletes. Despite the interest and vast array of research into cooling strategies for the able-bodied athlete, less is known regarding the application of these cooling strategies in the thermoregulatory impaired spinal cord injured (SCI) athletic population. Individuals with a spinal cord injury (SCI) have a reduced afferent input to the thermoregulatory centre and a loss of both sweating capacity and vasomotor control below the level of the spinal cord lesion. The magnitude of this thermoregulatory impairment is proportional to the level of the lesion. For instance, individuals with high-level lesions (tetraplegia) are at a greater risk of heat illness than individuals with lower-level lesions (paraplegia) at a given exercise intensity. Therefore, cooling strategies may be highly beneficial in this population group, even in moderate ambient conditions (~21 °C). This review was undertaken to examine the scientific literature that addresses the application of cooling strategies in individuals with an SCI. Each method is discussed in regards to the practical issues associated with the method and the potential underlying mechanism. For instance, site-specific cooling would be more suitable for an athlete with an SCI than whole body water immersion, due to the practical difficulties of administering this method in this population group. From the studies reviewed, wearing an ice vest during intermittent sprint exercise has been shown to decrease thermal strain and improve performance. These garments have also been shown to be effective during exercise in the able-bodied. Drawing on additional findings from the able-bodied literature, the combination of methods used prior to and during exercise and/or during rest periods/half-time may increase the effectiveness of a strategy. However, due to the paucity of research involving athletes with an SCI, it is difficult to establish an optimal cooling strategy. Future studies are needed to ensure that research outcomes can be translated into meaningful performance enhancements by investigating cooling strategies under the constraints of actual competition. Cooling strategies that meet the demands of intermittent wheelchair sports need to be identified, with particular attention to the logistics of the sport. PMID:25119157

  8. Sheaths of the spinal nerve roots. Permeability and structural characteristics of dorsal and ventral spinal nerve roots of the rat.

    PubMed

    Pettersson, C A

    1993-01-01

    The present study was carried out to investigate the permeability of normal spinal nerve root sheaths around dorsal and ventral roots in the rat. In vivo studies were performed using Evans blue-albumin and lanthanum chloride as tracers. The Evans blue-albumin complex is macromolecular in size and lanthanum ions are small and easily visible in the electron microscope. Both tracers were injected into the subarachnoid space and 15 min later samples were taken and further processed for detection of tracer. Postmortem studies with lanthanum was also performed. Following fixation by cardiac perfusion with fixative without tracer, lanthanum chloride was added to the fixative and applied directly to exposed spinal cord including the spinal nerve roots. Macroscopical examination showed Evans blue staining of the superficial blood vessels of the spinal cord, but no staining of the parenchyma of either spinal cord or nerve roots. Fluorescence microscopy revealed, in addition to a bright red fluorescence of root sheaths, a faint longitudinally orientated red fluorescence in the endoneurium of the nerve roots, indicating the presence of the dye-albumin complex. In both in vivo and post-mortem lanthanum studies, the tracer was detected between cell layers of the nerve root sheath and in invaginations of the plasma membrane of these cells, as well as inside the nerve root parenchyma. Some of the cells of the sheaths in post-mortem animals were diffusely marked with intracellular tracer. The endo-radicular lanthanum was most often seen superficially, but lanthanum could occasionally be detected deeper in the parenchyma in the post mortem studies.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7680181

  9. A database of lumbar spinal mechanical behavior for validation of spinal analytical models.

    PubMed

    Stokes, Ian A F; Gardner-Morse, Mack

    2016-03-21

    Data from two experimental studies with eight specimens each of spinal motion segments and/or intervertebral discs are presented in a form that can be used for comparison with finite element model predictions. The data include the effect of compressive preload (0, 250 and 500N) with quasistatic cyclic loading (0.0115Hz) and the effect of loading frequency (1, 0.1, 0.01 and 0.001Hz) with a physiological compressive preload (mean 642N). Specimens were tested with displacements in each of six degrees of freedom (three translations and three rotations) about defined anatomical axes. The three forces and three moments in the corresponding axis system were recorded during each test. Linearized stiffness matrices were calculated that could be used in multi-segmental biomechanical models of the spine and these matrices were analyzed to determine whether off-diagonal terms and symmetry assumptions should be included. These databases of lumbar spinal mechanical behavior under physiological conditions quantify behaviors that should be present in finite element model simulations. The addition of more specimens to identify sources of variability associated with physical dimensions, degeneration, and other variables would be beneficial. Supplementary data provide the recorded data and Matlab® codes for reading files. Linearized stiffness matrices derived from the tests at different preloads revealed few significant unexpected off-diagonal terms and little evidence of significant matrix asymmetry. PMID:26900035

  10. Thoracic Nerve Root Schwannoma Filling the Spinal Canal Almost Entirely Without any Neurological Deficits

    PubMed Central

    Godlewski, Bartosz; Klauz, Grzegorz; Czepko, Ryszard

    2016-01-01

    Introduction Spinal tumours may be classified in three groups: 1) extradural, 2) intradural extramedullary and 3) intramedullary spinal cord tumours. Intradural extramedullary tumours arise from the leptomeninges or nerve roots and include schwannomas. A schwannoma is usually a firm grey-whitish tumour growing near a nerve trunk or ramus. It can be separated from the nerve without damaging neural tissue. Schwannomas are usually solitary tumours. Case Presentation We present the case of a 37-year-old male who underwent surgery for a tumour in the upper thoracic segment of the spinal canal. Although the tumour filled the spinal canal almost entirely, the patient did not manifest any neurological deficits. During the surgery, the tumour was removed completely. A histological examination confirmed a benign schwannoma lesion (WHO G1). Conclusions The question whether doctors are keen to order more diagnostic investigations (including both laboratory and imaging studies) than are necessary is often asked in clinical practice. The cost factor is also important. Not every patient with back pain is referred for an MRI study in the absence of characteristic neurological signs. The case of our patient, however, speaks in favour of early referral for such diagnostic modalities. Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability. A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk. PMID:27110539

  11. Spontaneous ventral spinal epidural hematoma in a child: A case report and review of literature.

    PubMed

    Ratre, Shailendra; Yadav, Yadram; Choudhary, Sushma; Parihar, Vijay

    2016-01-01

    Spontaneous spinal epidural hematoma is very uncommon cause of spinal cord compression. It is extremely rare in children and is mostly located in dorsal epidural space. Ventral spontaneous spinal epidural hematoma (SSEH) is even rarer, with only four previous reports in childrens. We are reporting fifth such case in a 14 year old male child. He presented with history of sudden onset weakness and sensory loss in both lower limbs with bladder bowel involvment since 15 days. There was no history of trauma or bleeding diasthesis. On clinical examination he had spastic paraplegia. Magnetic resonance imaging (MRI) of dorsal spine was suggestive of ventral spinal epidural hematoma extending from first to sixth dorsal vertebrae. Laminectomy of fourth and fifth dorsal vertebrae and complete evacuation of hematoma was done on the same day of admission. Postoperatively the neurological status was same. PMID:27114667

  12. Perfusion assessment in rat spinal cord tissue using photoplethysmography and laser Doppler flux measurements

    NASA Astrophysics Data System (ADS)

    Phillips, Justin P.; Cibert-Goton, Vincent; Langford, Richard M.; Shortland, Peter J.

    2013-03-01

    Animal models are widely used to investigate the pathological mechanisms of spinal cord injury (SCI), most commonly in rats. It is well known that compromised blood flow caused by mechanical disruption of the vasculature can produce irreversible damage and cell death in hypoperfused tissue regions and spinal cord tissue is particularly susceptible to such damage. A fiberoptic photoplethysmography (PPG) probe and instrumentation system were used to investigate the practical considerations of making measurements from rat spinal cord and to assess its suitability for use in SCI models. Experiments to assess the regional perfusion of exposed spinal cord in anesthetized adult rats using both PPG and laser Doppler flowmetry (LDF) were performed. It was found that signals could be obtained reliably from all subjects, although considerable intersite and intersubject variability was seen in the PPG signal amplitude compared to LDF. We present results from 30 measurements in five subjects, the two methods are compared, and practical application to SCI animal models is discussed.

  13. Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma

    PubMed Central

    Oh, Jung-Hwan; Jwa, Seung-Joo; Yang, Tae Ki; Lee, Chang Sub; Oh, Kyungmi

    2015-01-01

    Spontaneous spinal subdural hematoma (SDH) is very rare. Furthermore, intracranial vasospasm (ICVS) associated with spinal hemorrhage has been very rarely reported. We present an ICVS case without intracranial hemorrhage following SDH. A 41-year-old woman was admitted to our hospital with a complaint of severe headache. Multiple intracranial vasospasms were noted on a brain CT angiogram and transfemoral cerebral angiography. However, intracranial hemorrhage was not revealed by brain MRI or CT. On day 3 after admission, weakness of both legs and urinary incontinence developed. Spine MRI showed C7~T6 spinal cord compression due to hyperacute stage of SDH. After hematoma evacuation, her symptoms gradually improved. We suggest that spinal cord evaluation should be considered in patients with headache who have ICVS, although intracranial hemorrhage would not be visible in brain images. PMID:26713084

  14. Rapamycin plays a neuroprotective effect after spinal cord injury via anti-inflammatory effects.

    PubMed

    Song, Yu; Xue, Hui; Liu, Ting-ting; Liu, Jia-mei; Chen, Dong

    2015-01-01

    Whether rapamycin has neuroprotective effects in spinal cord injury remains controversial. The present study shows that rapamycin protects neurons from death after spinal cord injury by inhibiting the secondary inflammatory response. The effects of rapamycin were tested using a myeloperoxidase assay, Western blotting, immunohistochemistry, and the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The experimental results showed that after spinal cord injury, rapamycin reduced the numbers of activated microglia and neutrophils in the damage zone, lowered the expression levels of TNF-? and IL-1?, reduced the apoptotic cells, and increased the survival of neurons. The above data proved that rapamycin diminishes inflammatory cell activation and proliferation, downregulates the expression of inflammatory factors, reduces the microenvironmental damage effects on neurons in the acute injury phase, and thus promotes the survival of neurons. Therefore, we believe that rapamycin has neuroprotective effects in spinal cord injury. PMID:25171343

  15. Intramedullary spinal cord damage associated with intervertebral disk material in a dog.

    PubMed

    Sanders, Sean G; Bagley, Rodney S; Gavin, Patrick R

    2002-12-01

    Intervertebral disk extrusions into the spinal cord are rarely reported in veterinary medicine, and only necropsy findings are described in previous reports. It is hypothesized that a disk lesion results in forceful injection of disk material into the spinal cord. In the 3-year-old Miniature Doberman Pinscher of our report, acute clinical signs and results of magnetic resonance imaging were consistent with this disease and helped determine the extent and character of the lesions. Alteration in the appearance of the nucleus pulposus was important in determining that intervertebral disk disease may have been present in this dog. However, a definitive diagnosis of intramedullary disk extrusion can be made only via histologic examination of a biopsy specimen or at necropsy. The dog improved substantially after surgical decompression of the spinal cord, and histologic findings in a biopsy specimen of material found within the spinal cord were consistent with mature degenerate intervertebral disk material. PMID:12479331

  16. Melanotic cyst of L5 spinal root: A case report and review of literature.

    PubMed

    Chakravarthy, Hariprakash

    2012-10-01

    Till date, 85 cases of melanotic schwannoma and 11 cases of spinal root melanoma have been reported in literature. We are reporting a case of a 45-year-old lady who presented with primary low back pain, and magnetic resonance imaging of lumbo-sacral spine showed at left L5-S1 foraminal lesion extending to the para-spinal compartment. Hemi-laminectomy, facetectomy, and excision of the lesion were done. It was primarily a cystic lesion with attachment to the exiting spinal nerve root. Histopathology of the cyst wall showed a fibro-collagenous stroma with no specific cell lining containing melanin pigment suggestive of a melanotic cyst. The patient was completely relieved of the back pain, and had no recurrence over a follow-up period of one and half years. This case is probably the first reported predominantly cystic, pigmented lesion, affecting the spinal root. PMID:23559992

  17. An unusual cause of spinal cord ischemia after thoracic endovascular repair.

    PubMed

    Koleilat, Issam; Moore, Erin; Hanover, Tod; Eidt, John

    2016-04-01

    A 59-year-old left-handed man presented with chest pain and hypertension and was found to have an acute descending aortic dissection on imaging. After thoracic endovascular repair of the dissection, he developed left arm weakness and ischemia. Despite carotid-subclavian transposition, the patient was found to have persistent left triceps weakness as well as bilateral leg paresis. An urgent spinal drain was placed that improved his lower extremity deficit but did not greatly change his arm symptoms. Magnetic resonance imaging of the spine revealed previously undiagnosed severe multilevel spinal stenosis requiring operative decompression. To our knowledge, this is the first report of the contribution of cervical spinal stenosis to post-thoracic endovascular repair spinal ischemia. PMID:25564598

  18. Spontaneous ventral spinal epidural hematoma in a child: A case report and review of literature

    PubMed Central

    Ratre, Shailendra; Yadav, Yadram; Choudhary, Sushma; Parihar, Vijay

    2016-01-01

    Spontaneous spinal epidural hematoma is very uncommon cause of spinal cord compression. It is extremely rare in children and is mostly located in dorsal epidural space. Ventral spontaneous spinal epidural hematoma (SSEH) is even rarer, with only four previous reports in childrens. We are reporting fifth such case in a 14 year old male child. He presented with history of sudden onset weakness and sensory loss in both lower limbs with bladder bowel involvment since 15 days. There was no history of trauma or bleeding diasthesis. On clinical examination he had spastic paraplegia. Magnetic resonance imaging (MRI) of dorsal spine was suggestive of ventral spinal epidural hematoma extending from first to sixth dorsal vertebrae. Laminectomy of fourth and fifth dorsal vertebrae and complete evacuation of hematoma was done on the same day of admission. Postoperatively the neurological status was same. PMID:27114667

  19. Propagation of sinusoidal electrical waves along the spinal cord during a fictive motor task.

    PubMed

    Cuellar, Carlos A; Tapia, Jesus A; Juárez, Victoria; Quevedo, Jorge; Linares, Pablo; Martínez, Lourdes; Manjarrez, Elias

    2009-01-21

    We present for the first time direct electrophysiological evidence of the phenomenon of traveling electrical waves produced by populations of interneurons within the spinal cord. We show that, during a fictive rhythmic motor task, scratching, an electrical field potential of spinal interneurons takes the shape of a sinuous wave, "sweeping" the lumbosacral spinal cord rostrocaudally with a mean speed of approximately 0.3 m/s. We observed that traveling waves and scratching have the same cycle duration and that duration of the flexor phase, but not of the extensor phase, is highly correlated with the cycle duration of the traveling waves. Furthermore, we found that the interneurons from the deep dorsal horn and the intermediate nucleus can generate the spinal traveling waves, even in the absence of motoneuronal activity. These findings show that the sinusoidal field potentials generated during fictive scratching could be a powerful tool to disclose the organization of central pattern generator networks. PMID:19158305

  20. Acquired cervical spinal arachnoid diverticulum in a cat.

    PubMed

    Adams, R J; Garosi, L; Matiasek, K; Lowrie, M

    2015-04-01

    A one-year-old, female entire, domestic, shorthair cat presented with acute onset non-ambulatory tetraparesis. Magnetic resonance imaging was consistent with a C3-C4 acute non-compressive nucleus pulposus extrusion and the cat was treated conservatively. The cat was able to walk after 10 days and was normal 2 months after presentation. The cat was referred five and a half years later for investigation of an insidious onset 3-month history of ataxia and tetraparesis. Magnetic resonance imaging of the cervical spine was repeated, demonstrating a spinal arachnoid diverticulum at C3 causing marked focal compression of the spinal cord. This was treated surgically with hemilaminectomy and durectomy. The cat improved uneventfully and was discharged 12 days later. PMID:25482364

  1. A description of spinal fatigue strength.

    PubMed

    Huber, Gerd; Nagel, Katrin; Skrzypiec, Daniel M; Klein, Anke; Püschel, Klaus; Morlock, Michael M

    2016-04-11

    Understanding fatigue failure of the spine is important to establish dynamic loading limits for occupational health and safety. In this study experimental data were combined with published data to develop a description of the predictive parameters for spinal fatigue failure. 41 lumbar functional spinal units (FSUs) from cadaveric spines (age 49.0±11.9yr) where cyclically loaded. Three different levels of sinusoidal axial compression (0-3kN, 0-2kN or 1-3kN) were applied for 300,000 cycles. Further, published data consisted of 70 thoracic and lumbar FSUs loaded in axial compression for 5000 cycles. Cyclic forces ranged from lower peaks (Fmin) of 0.7-1kN to upper peaks (Fmax) of 1.2-7.1kN. Based on Wöhler analysis, a fatigue model was developed accounting for three parameters: I) specimen-specific scaling based on the endplate area, II) specimen-specific strength dependency on age or bone mineral density, III) load-specific correction factors based on Fmax and Fmin. The most predictive model was achieved for a combination of Fmax, endplate area and bone mineral density; this model explained 61% of variation (p<0.001). A model including Fmax, endplate area and age explained only 28% of variation (p<0.001). Inclusion of a load-specific correction factor did not significantly improve model prediction of fatigue failure. This analysis presents the basis for the prediction of specimen-specific fatigue failure of the lumbar spine, provided the endplate area and bone mineral density can be derived. PMID:26948575

  2. Rehabilitation of spinal cord injuries

    PubMed Central

    Nas, Kemal; Yazmalar, Levent; Şah, Volkan; Aydın, Abdulkadir; Öneş, Kadriye

    2015-01-01

    Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients’ family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary. PMID:25621206

  3. Rehabilitation of spinal cord injuries.

    PubMed

    Nas, Kemal; Yazmalar, Levent; Şah, Volkan; Aydın, Abdulkadir; Öneş, Kadriye

    2015-01-18

    Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients' family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary. PMID:25621206

  4. Spinal Cord Stimulation and Augmentative Control Strategies for Leg Movement after Spinal Paralysis in Humans.

    PubMed

    Minassian, Karen; Hofstoetter, Ursula S

    2016-04-01

    Severe spinal cord injury is a devastating condition, tearing apart long white matter tracts and causing paralysis and disability of body functions below the lesion. But caudal to most injuries, the majority of neurons forming the distributed propriospinal system, the localized gray matter spinal interneuronal circuitry, and spinal motoneuron populations are spared. Epidural spinal cord stimulation can gain access to this neural circuitry. This review focuses on the capability of the human lumbar spinal cord to generate stereotyped motor output underlying standing and stepping, as well as full weight-bearing standing and rhythmic muscle activation during assisted treadmill stepping in paralyzed individuals in response to spinal cord stimulation. By enhancing the excitability state of the spinal circuitry, the stimulation can have an enabling effect upon otherwise "silent" translesional volitional motor control. Strategies for achieving functional movement in patients with severe injuries based on minimal translesional intentional control, task-specific proprioceptive feedback, and next-generation spinal cord stimulation systems will be reviewed. The role of spinal cord stimulation can go well beyond the immediate generation of motor output. With recently developed training paradigms, it can become a major rehabilitation approach in spinal cord injury for augmenting and steering trans- and sublesional plasticity for lasting therapeutic benefits. PMID:26890324

  5. Virchow's Triad and spinal manipulative therapy of the cervical spine

    PubMed Central

    Symons, Bruce P; Westaway, Michael

    2001-01-01

    The objective of this review paper is to borrow Virchow's Triad as a conceptual framework to examine the state of the art in research on thrombosis, specifically in the vertebrobasilar system as a consequence of high velocity, low amplitude spinal manipulation of the cervical spine. A revised Virchow's Triad is presented which emphasizes the interactions between various risk factors, as a tool for clinicians and researchers to use in their analyses of vertebrobasilar stroke. Endothelial injury, abnormal blood flow and hypercoagulability are discussed.

  6. Isolated thoracic (D5) intramedullary epidermoid cyst without spinal dysraphism: A rare case report

    PubMed Central

    Mishra, Sudhansu Sekhar; Satapathy, Mani Charan; Deo, Rama Chandra; Tripathy, Soubhagya Ranjan; Senapati, Satya Bhusan

    2015-01-01

    Spinal epidermoid cyst, congenital or acquired, is mainly congenital associated with spinal dysraphism, rarely in isolation. Intramedullary epidermoid cysts (IECs) are rare with less than 60 cases reported so far; isolated variety (i.e., without spinal dysraphism) is still rarer. Complete microsurgical excision is the dictum of surgical treatment. A 14-year-old boy presented with 4-month history of upper backache accompanied with progressive descending paresthesia with paraparesis with early bladder and bowel involvement. His condition deteriorated rapidly making him bedridden. Neurological examination revealed upper thoracic myeloradiculopathy probably of neoplastic origin with sensory localization to D5 spinal level. Digital X-ray revealed no feature suggestive of spinal dysraphism. Contrast magnetic resonance imaging (MRI) characteristics clinched the presumptive diagnosis. Near-total microsurgical excision was done leaving behind a small part of the calcified capsule densely adhered to cord. Histopathological features were confirmative of an epidermoid cyst. Postoperatively, he improved significantly with a gain of motor power sufficient to walk without support within a span of 6 months. Spinal IECs, without any specific clinical presentation, are often diagnosed based upon intraoperative and histopathological findings, however early diagnosis is possible on complete MRI valuation. Complete microsurgical excision, resulting in cessation of clinical progression and remission of symptoms, has to be limited to sub-total or near-total excision if cyst is adherent to cord or its confines. PMID:26167216

  7. Spinal epidural abscess following glossectomy and neck dissection: A case report

    PubMed Central

    Cheng, Esther; Thorpe, Eric; Borrowdale, Richard

    2016-01-01

    Introduction Spinal epidural abscess is an uncommon but potentially life threatening entity that rarely occurs after otolaryngology procedures. Presentation of case We report a case of a diabetic patient who presented with a lumbar spinal epidural abscess eight days after head and neck oncologic surgery. Magnetic resonance imaging revealed an L4 spinal epidural abscess. Cultures from the spinal epidural abscess, blood, urine, and the previous neck incision grew Klebsiella pneumoniae. The patient recovered neurologic function after surgical decompression and drainage, long-term intravenous antibiotics, and physical therapy. Discussion The development of postoperative spinal epidural abscess is rare after otolaryngology procedures but has been reported in the cervical epidural space. To our knowledge, lumbar spinal epidural abscess has not yet been reported after head and neck oncologic surgery. Even more unique is the presence of the pathogen K. pneumoniae. Conclusion A high index of suspicion of this potential outcome is paramount as early recognition and intervention are keys to recovery of neurologic function. PMID:26799413

  8. Ruptured anterior spinal artery aneurysm from a herniated cervical disc. A case report and review of the literature

    PubMed Central

    Nakhla, Jonathan; Nasser, Rani; Yassari, Reza; Pasquale, David; Altschul, David

    2016-01-01

    Background: Subarachnoid hemorrhage (SAH) caused by a ruptured cervical anterior spinal artery aneurysm is extremely rare and in the setting of cervical spondylosis. This case presentation reviews the diagnosis, management, and treatment of such aneurysms. Case Presentation: An 88-year-old female presented with the worst headache of her life without focal deficits. She was found to have diffuse SAH in the basal cisterns extending inferiorly down the spinal canal. Review of the neurodiagnostic images revealed an anterior spinal artery aneurysm in the setting of cervical spondylosis. Conclusions: Clinicians should be suspicious of cervical spondylosis as a rare etiology for an SAH when cerebral angiograms prove negative for intracranial aneurysms. PMID:26862449

  9. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... column fluid space, to connect the spinal fluid to a graduated column so that the pressure can be... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500... Devices 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device...

  10. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... column fluid space, to connect the spinal fluid to a graduated column so that the pressure can be... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500... Devices 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device...

  11. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... column fluid space, to connect the spinal fluid to a graduated column so that the pressure can be... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500... Devices 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device...

  12. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... column fluid space, to connect the spinal fluid to a graduated column so that the pressure can be... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500... Devices 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device...

  13. Pneumomediastinum, subcutaneous emphysema, and tracheal tear in the early postoperative period of spinal surgery in a paraplegic achondroplastic dwarf.

    PubMed

    Kahraman, Sinan; Enercan, Meriç; Demirhan, Ozkan; Sengül, Türker; Dalar, Levent; Hamzaoğlu, Azmi

    2013-01-01

    Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20-25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period. PMID:24455372

  14. Dystrophic Spinal Deformities in a Neurofibromatosis Type 1 Murine Model

    PubMed Central

    Yang, Dalong; Yang, Hao; Chen, Shi; Wu, Xiaohua; Li, Xiaohong; Yang, Xianlin; Mohammad, Khalid S.; Guise, Theresa A.; Bergner, Amanda L.; Stevenson, David A.; Yang, Feng-Chun

    2015-01-01

    Despite the high prevalence and significant morbidity of spinal anomalies in neurofibromatosis type 1 (NF1), the pathogenesis of these defects remains largely unknown. Here, we present two murine models: Nf1flox/?;PeriCre and Nf1flox/?;Col.2.3Cre mice, which recapitulate spinal deformities seen in the human disease. Dynamic histomorphometry and microtomographic studies show recalcitrant bone remodeling and distorted bone microarchitecture within the vertebral spine of Nf1flox/?;PeriCre and Nf1flox/?;Col2.3Cre mice, with analogous histological features present in a human patient with dystrophic scoliosis. Intriguingly, 3660% of Nf1flox/?;PeriCre and Nf1flox/?;Col2.3Cre mice exhibit segmental vertebral fusion anomalies with boney obliteration of the intervertebral disc (IVD). While analogous findings have not yet been reported in the NF1 patient population, we herein present two case reports of IVD defects and interarticular vertebral fusion in patients with NF1. Collectively, these data provide novel insights regarding the pathophysiology of dystrophic spinal anomalies in NF1, and provide impetus for future radiographic analyses of larger patient cohorts to determine whether IVD and vertebral fusion defects may have been previously overlooked or underreported in the NF1 patient population. PMID:25786243

  15. Post-surgical thoracic pseudomeningocele causing spinal cord compression.

    PubMed

    Macki, Mohamed; Lo, Sheng-fu L; Bydon, Mohamad; Kaloostian, Paul; Bydon, Ali

    2014-03-01

    Pseudomeningoceles are extradural cerebrospinal fluid collections categorized into three groups: traumatic, congenital, and iatrogenic. Iatrogenic pseudomeningoceles occur after durotomy, usually after cervical or lumbar spine surgery. Although many remain asymptomatic, pseudomeningoceles can compress or herniate the spinal cord and nerve roots. We present a 57-year-old woman who had a thoracic laminectomy and discectomy. Two weeks after surgery, she presented with lower extremity weakness and gait difficulty. Physical examination revealed hyperreflexia and a T11 sensory level. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The patient underwent surgical drainage of the cyst. On follow-up, she had complete resolution of her symptoms, and MRI did not show a residual lesion. To our knowledge, this is the second documented post-operative pseudomeningocele causing symptomatic spinal cord compression of the thoracic spine. In this article, a review of the literature is presented, including four reported patients with post-traumatic pseudomeningocele causing myelopathic symptoms and 20 patients with iatrogenic pseudomeningocele that resulted in neurological decline due to herniation or compression of neural tissue. Treatment options for these lesions include conservative management, epidural blood patch, lumbar subarachnoid drainage, and lumbo-peritoneal shunt placement. Surgical repair, usually by primary dural closure, remains the definitive treatment modality for iatrogenic symptomatic pseudomeningoceles. PMID:24210805

  16. Fifth lumbar spinal nerve injury causes neurochemical changes in corresponding as well as adjacent spinal segments: a possible mechanism underlying neuropathic pain.

    PubMed

    Shehab, Safa Al-Deen Saudi

    2014-01-01

    Previous investigations of the anatomical basis of the neuropathic-like manifestations in the spinal nerve ligation animal model have shown that the central terminations of the unmyelinated primary afferents of L5 spinal nerve are not restricted to the corresponding L5 spinal segment, and rather extend to two spinal segments rostrally and one segment caudally where they intermingle with primary afferents of the adjacent L4 spinal nerve. The aim of the present study was to investigate the neurochemical changes in the dorsal horn of the spinal cord and DRGs after L5 nerve injury in rats. In the first experiment, the right L5 nerve was ligated and sectioned for 14 days, and isolectin B4 (IB4, a tracer for unmyelinated primary afferents) was injected into the left L5 nerve. The results showed that the vasoactive intestinal peptide (VIP) was up-regulated in laminae I-II of L3-L6 spinal segments on the right side in exactly the same areas where IB4 labelled terminals were revealed on the left side. In the second experiment, L5 was ligated and sectioned and the spinal cord and DRGs were stained immunocytochemically with antibodies raised against various peptides known to be involved in pain transmission and hyperalgesia. The results showed that L5 nerve lesion caused down-regulation of substance P, calcitonin-gene related peptide and IB4 binding and up-regulation of neuropeptide Y and neurokinin-1 receptor in the dorsal horn of L4 and L5 spinal segments. Similar neurochemical changes were observed only in the corresponding L5 DRG with minimal effects observed in L3, L4 and L6 DRGs. Although, L5 nerve injury caused an up-regulation in NPY, no change in SP and CGRP immunoreactivity was observed in ipsilateral garcile nucleus. These neuroplastic changes in the dorsal horn of the spinal cord, in the adjacent uninjured territories of the central terminations of the adjacent uninjured nerves, might explain the mechanism of hyperalgesia after peripheral nerve injury. PMID:24394408

  17. Magnetic resonance imaging of spinal injury.

    PubMed

    Tracy, P T; Wright, R M; Hanigan, W C

    1989-03-01

    Magnetic resonance imaging (MRI) was performed on 30 patients following spinal injury (SI). Spin-echo sequences and surface coils were used for all patients. Plain radiographs, high-resolution computed tomography (CT), and MRI were compared for the delineation of bone, disc, and ligament injury, measurement of sagittal spinal canal diameter and subluxation, epidural hematoma, and spinal cord structure. Myelography or intrathecal contrast-enhanced CT were not performed on any of these patients. Magnetic resonance imaging accurately delineated intraspinal pathology in two of four patients with acute penetrating SI, and was normal in the other two patients. In 16 patients with acute nonpenetrating SI, MRI was superior to CT for visualizing injuries to discs, ligaments, and the spinal cord, while CT was superior to MRI in characterizing bony injury. Computed tomography and MRI provided similar measurements of subluxation in six of six patients and of sagittal spinal canal diameter in three of four patients. In ten patients with chronic SI, MRI demonstrated post-traumatic cysts, myelomalacia, spinal cord edema, and the presence or absence of spinal cord compression. In patients with acute penetrating SI and chronic SI, MRI provided comprehensive clinical information. In patients with acute nonpenetrating SI, the information obtained by MRI complemented the data given by plain radiographs and CT, allowing clinical decisions to be made without the need of invasive imaging modalities. PMID:2711244

  18. Stem cell therapy for the spinal cord

    PubMed Central

    2012-01-01

    Injury and disease of the spinal cord are generally met with a poor prognosis. This poor prognosis is due not only to the characteristics of the diseases but also to our poor ability to deliver therapeutics to the spinal cord. The spinal cord is extremely sensitive to direct manipulation, and delivery of therapeutics has proven a challenge for both scientists and physicians. Recent advances in stem cell technologies have opened up a new avenue for the treatment of spinal cord disease and injury. Stem cells have proven beneficial in rodent models of spinal cord disease and injury. In these animal models, stem cells have been shown to produce their effect by the dual action of cell replacement and the trophic support of the factors secreted by these cells. In this review we look at the main clinical trials involving stem cell transplant into the spinal cord, focusing on motor neuron diseases and spinal cord injury. We will also discuss the major hurdles in optimizing stem cell delivery methods into the spinal cord. We shall examine current techniques such as functional magnetic resonance imaging guidance and cell labeling and will look at the current research striving to improve these techniques. With all caveats and future research taken into account, this is a very exciting time for stem cell transplant into the spinal cord. We are only beginning to realize the huge potential of stem cells in a central nervous system setting to provide cell replacement and trophic support. Many more trials will need to be undertaken before we can fully exploit the attributes of stem cells. PMID:22776143

  19. Spinal cord evolution in early Homo.

    PubMed

    Meyer, Marc R; Haeusler, Martin

    2015-11-01

    The discovery at Nariokotome of the Homo erectus skeleton KNM-WT 15000, with a narrow spinal canal, seemed to show that this relatively large-brained hominin retained the primitive spinal cord size of African apes and that brain size expansion preceded postcranial neurological evolution. Here we compare the size and shape of the KNM-WT 15000 spinal canal with modern and fossil taxa including H. erectus from Dmanisi, Homo antecessor, the European middle Pleistocene hominins from Sima de los Huesos, and Pan troglodytes. In terms of shape and absolute and relative size of the spinal canal, we find all of the Dmanisi and most of the vertebrae of KNM-WT 15000 are within the human range of variation except for the C7, T2, and T3 of KNM-WT 15000, which are constricted, suggesting spinal stenosis. While additional fossils might definitively indicate whether H. erectus had evolved a human-like enlarged spinal canal, the evidence from the Dmanisi spinal canal and the unaffected levels of KNM-WT 15000 show that unlike Australopithecus, H. erectus had a spinal canal size and shape equivalent to that of modern humans. Subadult status is unlikely to affect our results, as spinal canal growth is complete in both individuals. We contest the notion that vertebrae yield information about respiratory control or language evolution, but suggest that, like H. antecessor and European middle Pleistocene hominins from Sima de los Huesos, early Homo possessed a postcranial neurological endowment roughly commensurate to modern humans, with implications for neurological, structural, and vascular improvements over Pan and Australopithecus. PMID:26553817

  20. Cell death in developing human spinal cord.

    PubMed

    Vilović, Katarina; Ilijić, Ema; Glamoclija, Violeta; Kolić, Kresimir; Bocina, Ivana; Sapunar, Damir; Saraga-Babić, Mirna

    2006-01-01

    Cell death in the developing human spinal cord was investigated in 5-12 week human conceptuses using immunohistochemical and TUNEL methods. Expression of pro-apoptotic (Fas-receptor, caspase-3) and anti-apoptotic (bcl-2) markers and marker for internucleosomal fragmentation (TUNEL) were analysed in the cranial and caudal parts of the human spinal cord. In early developmental stages (5-6 weeks) of the cranial spinal cord, bcl-2 positive cells were seen in the ventricular zone and in the roof plate, while in the caudal part they were seen surrounding the central lumen. Subsequently, bcl-2 expression appeared in the basal plates of the grey matter and in the spinal ganglia, and from the seventh week on they also appeared in the intermediate horn of the grey matter. In the fetal period, bcl-2 expression appeared in the dorsal horns of the grey matter (9 weeks) but ceased in the ventricular zone (12 weeks) . In the trunk region, TUNEL-positive cells were found in ventricular and mantle zones along the whole length of the spinal cord. Caspase-3 positive cells and Fas-receptor positive cells appeared only in the grey matter of the cranial segments (head and trunk) of the spinal cord, but they were missing in the caudal parts. Caspase-3 dependant pathway, probably activated by Fas-receptor, seems to operate only in the cranial part of the human spinal cord. In the caudal (sacrococcygeal and tail) parts, cells seem to die by caspase-3 independent pathway. The interplay of pro-apoptotic and anti-apoptotic factors may be associated with cranial spinal cord morphogenesis, adjustment of cells number and selective survival of neurons, while in the caudal regions these factors cause massive cell death associated with regression of the caudal spinal cord. PMID:16315061

  1. Spinal shock revisited: a four-phase model.

    PubMed

    Ditunno, J F; Little, J W; Tessler, A; Burns, A S

    2004-07-01

    Spinal shock has been of interest to clinicians for over two centuries. Advances in our understanding of both the neurophysiology of the spinal cord and neuroplasticity following spinal cord injury have provided us with additional insight into the phenomena of spinal shock. In this review, we provide a historical background followed by a description of a novel four-phase model for understanding and describing spinal shock. Clinical implications of the model are discussed as well. PMID:15037862

  2. Spinal Manipulation in the Treatment of Low-Back Pain

    PubMed Central

    Kirkaldy-Willis, W. H.; Cassidy, J. D.

    1985-01-01

    Spinal manipulation, one of the oldest forms of therapy for back pain, has mostly been practiced outside of the medical profession. Over the past decade, there has been an escalation of clinical and basic science research on manipulative therapy, which has shown that there is a scientific basis for the treatment of back pain by manipulation. Most family practitioners have neither the time nor inclination to master the art of manipulation and will wish to refer their patients to a skilled practitioner of this therapy. Results of spinal manipulation in 283 patients with low back pain are presented. The physician who makes use of this resource will provide relief for many patients. PMID:21274223

  3. Photoplethysmographic sensors for perfusion measurements in spinal cord tissue

    NASA Astrophysics Data System (ADS)

    Phillips, J. P.; Kyriacou, P. A.

    2011-08-01

    Sensors for recording photoplethysmographic signals from the nervous tissue of the spinal cord are described. The purpose of these sensors is to establish whether perfusion is compromised in various states of injury which occur in certain animal models of spinal cord injury, for example compression injury. Various measures of perfusion are applicable such as the amplitude of the photoplethysmograph signal and the oxygen saturation, measured using a dual wavelength configuration. Signals are usually compared to baseline measurements made in uninjured subjects. This paper describes two types of probe, one based on optical fibres, and one in which optotes are placed in direct contact with the tissue surface. Results from a study based on a compression model utilising a fibreoptic sensor are presented.

  4. Assessment of hyperactive reflexes in patients with spinal cord injury.

    PubMed

    Xu, Dali; Guo, Xin; Yang, Chung-Yong; Zhang, Li-Qun

    2015-01-01

    Hyperactive reflexes are commonly observed in patients with spinal cord injury (SCI) but there is a lack of convenient and quantitative characterizations. Patellar tendon reflexes were examined in nine SCI patients and ten healthy control subjects by tapping the tendon using a hand-held instrumented hammer at various knee flexion angles, and the tapping force, quadriceps EMG, and knee extension torque were measured to characterize patellar tendon reflexes quantitatively in terms of the tendon reflex gain (G tr), contraction rate (R c ), and reflex loop time delay (t d ). It was found that there are significant increases in G tr and R c and decrease in t d in patients with spinal cord injury as compared to the controls (P < 0.05). This study presented a convenient and quantitative method to evaluate reflex excitability and muscle contraction dynamics. With proper simplifications, it can potentially be used for quantitative diagnosis and outcome evaluations of hyperreflexia in clinical settings. PMID:25654084

  5. Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

    PubMed Central

    Hasankhani, Ebrahim Ghayem; Ashjazadeh, Amir

    2014-01-01

    Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome. PMID:25187873

  6. Phantom limb pain from spinal sarcoma: a case report.

    PubMed

    Cruz, Ernesto; Dangaria, Harsh T

    2013-07-01

    Phantom limb pain is a frequent sequela of amputation. A high prevalence of residual limb pain and back pain also exists among amputees. We present a case of a new-onset severe phantom limb pain resulting from a metastatic spinal mass in an 81-year-old patient with a history of malignant sarcoma and an old hip disarticulation amputation. The metastatic lesion, upon imaging, was found to involve the L3 vertebra and caused moderate compression of the thecal sac on the right and severe right lateral recess stenosis. After the mass was resected, the patient's phantom limb pain resolved. Our case report demonstrates that spinal metastatic pathologies may be a cause of phantom limb pain and should be included in the differential diagnosis of new-onset phantom limb pain or a change in phantom limb pain. PMID:23880049

  7. Spinal interneurones involved in presynaptic controls of supraspinal origin†

    PubMed Central

    Besson, J. M.; Rivot, J. P.

    1973-01-01

    1. Interneurones presenting heterotopic and heterosensory convergence have been identified in laminae VI-VII of the lumbar dorsal horn in the cat. Stimulation of the hind limbs sometimes induced a bimodal response, but we considered only the late convergent discharge. 2. The fact that response latencies are longer to hind limb than to forelimb stimulation at this level suggests the intervention of a supraspinal loop in the activation of spinal convergent units. This hypothesis is supported by the relationship between the excitability of supraspinal structures and the discharge intensity of convergent cells as well as by the absence of long latency responses in the spinal preparation. 3. Electrophysiological and pharmacological evidence discloses a strong relationship between convergent unit discharges and the occurrence of dorsal root potentials to cortical, heterosegmental and heterosensory stimulation. 4. It is suggested that convergent units receive information of supraspinal origin and exert control over sensory input to the cord via primary afferent depolarization. PMID:4702428

  8. In Vivo Reprogramming for Brain and Spinal Cord Repair.

    PubMed

    Chen, Gong; Wernig, Marius; Berninger, Benedikt; Nakafuku, Masato; Parmar, Malin; Zhang, Chun-Li

    2015-01-01

    Cell reprogramming technologies have enabled the generation of various specific cell types including neurons from readily accessible patient cells, such as skin fibroblasts, providing an intriguing novel cell source for autologous cell transplantation. However, cell transplantation faces several difficult hurdles such as cell production and purification, long-term survival, and functional integration after transplantation. Recently, in vivo reprogramming, which makes use of endogenous cells for regeneration purpose, emerged as a new approach to circumvent cell transplantation. There has been evidence for in vivo reprogramming in the mouse pancreas, heart, and brain and spinal cord with various degrees of success. This mini review summarizes the latest developments presented in the first symposium on in vivo reprogramming glial cells into functional neurons in the brain and spinal cord, held at the 2014 annual meeting of the Society for Neuroscience in Washington, DC. PMID:26730402

  9. Assessment of Hyperactive Reflexes in Patients with Spinal Cord Injury

    PubMed Central

    Yang, Chung-Yong

    2015-01-01

    Hyperactive reflexes are commonly observed in patients with spinal cord injury (SCI) but there is a lack of convenient and quantitative characterizations. Patellar tendon reflexes were examined in nine SCI patients and ten healthy control subjects by tapping the tendon using a hand-held instrumented hammer at various knee flexion angles, and the tapping force, quadriceps EMG, and knee extension torque were measured to characterize patellar tendon reflexes quantitatively in terms of the tendon reflex gain (Gtr), contraction rate (Rc), and reflex loop time delay (td). It was found that there are significant increases in Gtr and Rc and decrease in td in patients with spinal cord injury as compared to the controls (P < 0.05). This study presented a convenient and quantitative method to evaluate reflex excitability and muscle contraction dynamics. With proper simplifications, it can potentially be used for quantitative diagnosis and outcome evaluations of hyperreflexia in clinical settings. PMID:25654084

  10. Serotonin affects movement gain control in the spinal cord.

    PubMed

    Wei, Kunlin; Glaser, Joshua I; Deng, Linna; Thompson, Christopher K; Stevenson, Ian H; Wang, Qining; Hornby, Thomas George; Heckman, Charles J; Kording, Konrad P

    2014-09-17

    A fundamental challenge for the nervous system is to encode signals spanning many orders of magnitude with neurons of limited bandwidth. To meet this challenge, perceptual systems use gain control. However, whether the motor system uses an analogous mechanism is essentially unknown. Neuromodulators, such as serotonin, are prime candidates for gain control signals during force production. Serotonergic neurons project diffusely to motor pools, and, therefore, force production by one muscle should change the gain of others. Here we present behavioral and pharmaceutical evidence that serotonin modulates the input-output gain of motoneurons in humans. By selectively changing the efficacy of serotonin with drugs, we systematically modulated the amplitude of spinal reflexes. More importantly, force production in different limbs interacts systematically, as predicted by a spinal gain control mechanism. Psychophysics and pharmacology suggest that the motor system adopts gain control mechanisms, and serotonin is a primary driver for their implementation in force production. PMID:25232107

  11. Nanomedicine for treating spinal cord injury

    NASA Astrophysics Data System (ADS)

    Tyler, Jacqueline Y.; Xu, Xiao-Ming; Cheng, Ji-Xin

    2013-09-01

    Spinal cord injury results in significant mortality and morbidity, lifestyle changes, and difficult rehabilitation. Treatment of spinal cord injury is challenging because the spinal cord is both complex to treat acutely and difficult to regenerate. Nanomaterials can be used to provide effective treatments; their unique properties can facilitate drug delivery to the injury site, enact as neuroprotective agents, or provide platforms to stimulate regrowth of damaged tissues. We review recent uses of nanomaterials including nanowires, micelles, nanoparticles, liposomes, and carbon-based nanomaterials for neuroprotection in the acute phase. We also review the design and neural regenerative application of electrospun scaffolds, conduits, and self-assembling peptide scaffolds.

  12. Chronic spinal muscular atrophy of facioscapulohumeral type.

    PubMed Central

    Furukawa, T; Toyokura, Y

    1976-01-01

    Chronic spinal muscular atrophy of FSH type affecting a mother and her son and daughter is reported. The relevant literature is reviewed and the relation between this conditon and Kugelberg-Welander (K-W) disease is discussed. Chronic spinal muscular atrophy of FSH type is considered to be a different entity from the eponymous K-W disease. Each type of muscular dystrophy, e.g. limb-girdle, FSH, distal, ocular, or oculopharyngeal type, has its counterpart of nuclear origin. A classification of the chronic spinal muscular atrophies is suggested following the classification of muscular dystrophy. Images PMID:957378

  13. The changing pattern of spinal arachnoiditis.

    PubMed Central

    Shaw, M D; Russell, J A; Grossart, K W

    1978-01-01

    Spinal arachnoiditis is a rare condition. Eighty cases, diagnosed during a period when 7600 spinal contrast investigations were undertaken, have been reviewed. The majority had suffered a previous spinal condition, the most common being lumbar disc disease. There has been a change in the distribution of arahnoiditis with the lumbar region now most frequently involved. This accounts for the persistence of radicular symptoms and the relatively low incidence of paraplegia when compared with earlier series. Surgery does not appear to have any role in the treatment. Images PMID:632824

  14. Spinal cord monitoring in neuromuscular scoliosis.

    PubMed

    Tucker, S K; Noordeen, M H; Pitt, M C

    2001-01-01

    This article reviews the use of spinal cord monitoring in neuromuscular scoliosis, a condition having a higher incidence of true positive results than idiopathic scoliosis. While somatosensory cortical evoked potentials (SCEP) are unreliable, somatosensory spinal evoked potentials (SSEP) are possible to obtain in most cases and a method using an epidural electrode is described. The '50% rule' is satisfactory having good specificity and sensitivity with it rare for post-operative paralysis to have occurred undetected. The spinal cord in these cases appears to have increased susceptibility particularly during the passage of sublaminar wires with the incidence of complications reduced using modern instrumentation. PMID:11269804

  15. Pain and spinal cord imaging measures in children with demyelinating disease

    PubMed Central

    Barakat, Nadia; Gorman, Mark P.; Benson, Leslie; Becerra, Lino; Borsook, David

    2015-01-01

    Pain is a significant problem in diseases affecting the spinal cord, including demyelinating disease. To date, studies have examined the reliability of clinical measures for assessing and classifying the severity of spinal cord injury (SCI) and also to evaluate SCI-related pain. Most of this research has focused on adult populations and patients with traumatic injuries. Little research exists regarding pediatric spinal cord demyelinating disease. One reason for this is the lack of reliable and useful approaches to measuring spinal cord changes since currently used diagnostic imaging has limited specificity for quantitative measures of demyelination. No single imaging technique demonstrates sufficiently high sensitivity or specificity to myelin, and strong correlation with clinical measures. However, recent advances in diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) measures are considered promising in providing increasingly useful and specific information on spinal cord damage. Findings from these quantitative imaging modalities correlate with the extent of demyelination and remyelination. These techniques may be of potential use for defining the evolution of the disease state, how it may affect specific spinal cord pathways, and contribute to the management of pediatric demyelination syndromes. Since pain is a major presenting symptom in patients with transverse myelitis, the disease is an ideal model to evaluate imaging methods to define these regional changes within the spinal cord. In this review we summarize (1) pediatric demyelinating conditions affecting the spinal cord; (2) their distinguishing features; and (3) current diagnostic and classification methods with particular focus on pain pathways. We also focus on concepts that are essential in developing strategies for the detection, monitoring, treatment and repair of pediatric myelitis. PMID:26509120

  16. Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion level.

    PubMed

    Brommer, Benedikt; Engel, Odilo; Kopp, Marcel A; Watzlawick, Ralf; Müller, Susanne; Prüss, Harald; Chen, Yuying; DeVivo, Michael J; Finkenstaedt, Felix W; Dirnagl, Ulrich; Liebscher, Thomas; Meisel, Andreas; Schwab, Jan M

    2016-03-01

    Pneumonia is the leading cause of death after acute spinal cord injury and is associated with poor neurological outcome. In contrast to the current understanding, attributing enhanced infection susceptibility solely to the patient's environment and motor dysfunction, we investigate whether a secondary functional neurogenic immune deficiency (spinal cord injury-induced immune deficiency syndrome, SCI-IDS) may account for the enhanced infection susceptibility. We applied a clinically relevant model of experimental induced pneumonia to investigate whether the systemic SCI-IDS is functional sufficient to cause pneumonia dependent on spinal cord injury lesion level and investigated whether findings are mirrored in a large prospective cohort study after human spinal cord injury. In a mouse model of inducible pneumonia, high thoracic lesions that interrupt sympathetic innervation to major immune organs, but not low thoracic lesions, significantly increased bacterial load in lungs. The ability to clear the bacterial load from the lung remained preserved in sham animals. Propagated immune susceptibility depended on injury of central pre-ganglionic but not peripheral postganglionic sympathetic innervation to the spleen. Thoracic spinal cord injury level was confirmed as an independent increased risk factor of pneumonia in patients after motor complete spinal cord injury (odds ratio = 1.35, P < 0.001) independently from mechanical ventilation and preserved sensory function by multiple regression analysis. We present evidence that spinal cord injury directly causes increased risk for bacterial infection in mice as well as in patients. Besides obvious motor and sensory paralysis, spinal cord injury also induces a functional SCI-IDS ('immune paralysis'), sufficient to propagate clinically relevant infection in an injury level dependent manner. PMID:26754788

  17. Increasing Incidence of Degenerative Spinal Diseases in Japan during 25 Years: The Registration System of Spinal Surgery in Tohoku University Spine Society.

    PubMed

    Aizawa, Toshimi; Kokubun, Shoichi; Ozawa, Hiroshi; Kusakabe, Takashi; Tanaka, Yasuhisa; Hoshikawa, Takeshi; Hashimoto, Ko; Kanno, Haruo; Morozumi, Naoki; Koizumi, Yutaka; Sato, Tetsuro; Hyodo, Hironori; Kasama, Fumio; Ogawa, Shinji; Murakami, Eiichi; Kawahara, Chikashi; Yahata, Jun-Ichiro; Ishii, Yushin; Itoi, Eiji

    2016-01-01

    Spinal disorders affect mainly older people and cause pain, paralysis and/or deformities of the trunk and/or extremities, which could eventually disturb locomotive functions. For ensuring safe and high-quality treatment of spinal disorders, in 1987, the Tohoku University Spine Society (TUSS) was established by orthopedic departments in Tohoku University School of Medicine and its affiliated hospitals in and around Miyagi Prefecture. All spine surgeries have been enrolled in the TUSS Spine Registry since 1988. Using the data from this registration system between 1988 and 2012, we demonstrate here the longitudinal changes in surgical trends for spinal disorders in Japan that has rushed into the most advanced "aging society" in the world. In total, data on 56,744 surgeries were retrieved. The number of spinal surgeries has annually increased approximately 4-fold. There was a particular increase among patients aged ≥ 70 years and those aged ≥ 80 years, with a 20- to 90-fold increase. Nearly 90% of the spinal operations were performed for degenerative disorders, with their number increasing approximately 5-fold from 705 to 3,448. The most common disease for surgery was lumbar spinal stenosis (LSS) (35.9%), followed by lumbar disc herniation (27.7%) and cervical myelopathy (19.8%). In 2012, approximately half of the patients with LSS and cervical myelopathy were ≥ 70 years of age. In conclusion, the number of spinal operations markedly increased during the 25-year period, particularly among older patients. As Japan has a notably aged population, the present study could provide a near-future model for countries with aging population. PMID:26876801

  18. Human Neural Stem Cell Replacement Therapy for Amyotrophic Lateral Sclerosis by Spinal Transplantation

    PubMed Central

    Hefferan, Michael P.; Galik, Jan; Kakinohana, Osamu; Sekerkova, Gabriela; Santucci, Camila; Marsala, Silvia; Navarro, Roman; Hruska-Plochan, Marian; Johe, Karl; Feldman, Eva; Cleveland, Don W.; Marsala, Martin

    2012-01-01

    Background Mutation in the ubiquitously expressed cytoplasmic superoxide dismutase (SOD1) causes an inherited form of Amyotrophic Lateral Sclerosis (ALS). Mutant synthesis in motor neurons drives disease onset and early disease progression. Previous experimental studies have shown that spinal grafting of human fetal spinal neural stem cells (hNSCs) into the lumbar spinal cord of SOD1G93A rats leads to a moderate therapeutical effect as evidenced by local α-motoneuron sparing and extension of lifespan. The aim of the present study was to analyze the degree of therapeutical effect of hNSCs once grafted into the lumbar spinal ventral horn in presymptomatic immunosuppressed SOD1G93A rats and to assess the presence and functional integrity of the descending motor system in symptomatic SOD1G93A animals. Methods/Principal Findings Presymptomatic SOD1G93A rats (60–65 days old) received spinal lumbar injections of hNSCs. After cell grafting, disease onset, disease progression and lifespan were analyzed. In separate symptomatic SOD1G93A rats, the presence and functional conductivity of descending motor tracts (corticospinal and rubrospinal) was analyzed by spinal surface recording electrodes after electrical stimulation of the motor cortex. Silver impregnation of lumbar spinal cord sections and descending motor axon counting in plastic spinal cord sections were used to validate morphologically the integrity of descending motor tracts. Grafting of hNSCs into the lumbar spinal cord of SOD1G93A rats protected α-motoneurons in the vicinity of grafted cells, provided transient functional improvement, but offered no protection to α-motoneuron pools distant from grafted lumbar segments. Analysis of motor-evoked potentials recorded from the thoracic spinal cord of symptomatic SOD1G93A rats showed a near complete loss of descending motor tract conduction, corresponding to a significant (50–65%) loss of large caliber descending motor axons. Conclusions/Significance These data demonstrate that in order to achieve a more clinically-adequate treatment, cell-replacement/gene therapy strategies will likely require both spinal and supraspinal targets. PMID:22916141

  19. Spinal Hydatid as a Rare Cause of Posterior Mediastinal Lesion: Understanding Cervicothoracic Sign on Chest Radiography

    PubMed Central

    Aswani, Yashant; Hira, Priya

    2015-01-01

    Summary Background Location of an intrathoracic lesion on chest radiograph is facilitated by application of ‘silhouette sign’. This helps narrow down the differential diagnoses. The list of probable diagnoses reduces further on determination of the density of the lesion. A spinal hydatid presents as a fluid-density posterior mediastinal lesion on chest radiograph with destruction of the vertebral body and preservation of the disc space. Spinal hydatid is, however, rare. Case Report We describe a case of a 30-year-old female with gradual-onset paraperesis since six months. Chest radiograph was suggestive of a posterior mediastinal lesion with fluid density and destruction of D4 vertebra. MRI findings were consistent with spinal hydatid. The patient was started on perioperative benzimidazole therapy with resection of the hydatid cyst. The drug therapy was continued for six months post-operatively. Conclusions A chest radiograph helps localise the site and possible contents of the lesion. It also guides further investigations. MRI is the imaging modality of choice for spinal pathologies causing cord compression including spinal hydatid. Echinococcal involvement of the spine is a rarity but needs to be considered in the differential diagnoses for spinal causes of gradual-onset paraperesis. PMID:26692911

  20. Sensorimotor event-related desynchronization represents the excitability of human spinal motoneurons.

    PubMed

    Takemi, M; Masakado, Y; Liu, M; Ushiba, J

    2015-06-25

    Amplitudes of mu and beta (7-26Hz) oscillations measured by electroencephalography over the sensorimotor areas are suppressed during motor imagery as well as during voluntary movements. This phenomenon is referred to as event-related desynchronization (ERD) and is known to reflect motor cortical excitability. The increased motor cortical excitability associated with ERD during hand motor imagery would induce a descending cortical volley to spinal motoneurons, resulting in facilitation of spinal motoneuronal excitability. Therefore, in the present study, we tested the association of ERD during motor imagery with the excitability of spinal motoneurons in 15 healthy participants. Spinal excitability was tested using the F-wave recorded from the right abductor pollicis brevis muscle. The F-wave results from antidromic activation of spinal motoneurons and is induced by peripheral nerve stimulation. Participants performed 5s of motor imagery of right thumb abduction following 7s of rest. The right median nerve was stimulated at wrist level when the ERD magnitude of the contralateral hand sensorimotor area exceeded predetermined thresholds during motor imagery. The results showed ERD magnitude during hand motor imagery was associated with an increase in F-wave persistence, but not with the response average of F-wave amplitude or F-wave latency. These findings suggest that the ERD magnitude may be a biomarker representing increases in the excitability of both cortical and spinal levels. PMID:25839147

  1. Cryptic organisation within an apparently irregular rostrocaudal distribution of interneurons in the embryonic zebrafish spinal cord

    SciTech Connect

    Wells, Simon; The Special Research Centre for the Molecular Genetics of Development, University of Adelaide, Adelaide, South Australia 5005 ; Conran, John G.; Tamme, Richard; Gaudin, Arnaud; Webb, Jonathan; Lardelli, Michael; The Special Research Centre for the Molecular Genetics of Development, University of Adelaide, Adelaide, South Australia 5005

    2010-11-15

    The molecules and mechanisms involved in patterning the dorsoventral axis of the developing vertebrate spinal cord have been investigated extensively and many are well known. Conversely, knowledge of mechanisms patterning cellular distributions along the rostrocaudal axis is relatively more restricted. Much is known about the rostrocaudal distribution of motoneurons and spinal cord cells derived from neural crest but there is little known about the rostrocaudal patterning of most of the other spinal cord neurons. Here we report data from our analyses of the distribution of dorsal longitudinal ascending (DoLA) interneurons in the developing zebrafish spinal cord. We show that, although apparently distributed irregularly, these cells have cryptic organisation. We present a novel cell-labelling technique that reveals that DoLA interneurons migrate rostrally along the dorsal longitudinal fasciculus of the spinal cord during development. This cell-labelling strategy may be useful for in vivo analysis of factors controlling neuron migration in the central nervous system. Additionally, we show that DoLA interneurons persist in the developing spinal cord for longer than previously reported. These findings illustrate the need to investigate factors and mechanisms that determine 'irregular' patterns of cell distribution, particularly in the central nervous system but also in other tissues of developing embryos.

  2. The Organotypic Longitudinal Spinal Cord Slice Culture for Stem Cell Study

    PubMed Central

    Sypecka, Joanna; Koniusz, Sylwia; Kawalec, Maria

    2015-01-01

    The objective of this paper is to describe in detail the method of organotypic longitudinal spinal cord slice culture and the scientific basis for its potential utility. The technique is based on the interface method, which was described previously and thereafter was modified in our laboratory. The most important advantage of the presented model is the preservation of the intrinsic spinal cord fiber tract and the ventrodorsal polarity of the spinal cord. All the processes occurring during axonal growth, regeneration, synapse formation, and myelination could be visualized while being cultured in vitro for up to 4-5 weeks after the slices had been isolated. Both pups and adult animals can undergo the same, equally efficient procedures when going by the protocol in question. The urgent need for an appropriate in vitro model for spinal cord regeneration results from a greater number of clinical trials concerning regenerative medicine in the spinal cord injury and from still insufficient knowledge of the molecular mechanisms involved in the neuroreparative processes. The detailed method of organotypic longitudinal spinal cord slice culture is accompanied by examples of its application to studying biological processes to which both the CNS inhabiting and grafted cells are subjected. PMID:25802530

  3. Cerebral and spinal vascular involvement in Hereditary Hemorrhagic Telengiectasia: Report of two cases

    PubMed Central

    Sivasankar, Rajeev; Saraf, Rashmi; Pawal, Sambhaji; Limaye, Uday S

    2014-01-01

    Introduction We present two cases of Hereditary Hemmorhagic Telengiectasia (HHT), one pediatric and the other adult, with a view to highlight the myriad cerebral and spinal vascular manifestations of this disease. The syndrome and its various findings will be reviewed including the utility of angiography in assessing the various vascular abnormalities of the cerebral and spinal vasculature. Methods A review of literature regarding various developmental abnormalities including brain and spinal cord arterio-venous malformations (AVMs), arterio-venous fistulae (AVFs), micro AVMs, micro-fistulae, aneurysms and cavernomas that occur in pediatric and adult population subsets of HHT. Both patients underwent thorough clinical and laboratory evaluation. The pediatric patient underwent a contrast enhanced computed tomography (CECT) of the chest; cerebral, Pulmonary & celiac angiography. The adult patient underwent cerebral and spinal angiography. Conclusion The spectrum of vascular malformations in Hereditary Hemorrhagic Telengiectasia (HHT) is varied.The incidence and manifestations of brain and spinal cord AVMs, AVFs, micro AVMs, micro-fistulae, aneurysms and cavernomas are different in the pediatric and adults affected by the disease. Cerebral and spinal angiography are necessary in characterising the various developmental vascular abnormalities in order to guide further management. PMID:25422703

  4. Intrathecal delivery of a polymeric nanocomposite hydrogel after spinal cord injury.

    PubMed

    Baumann, M Douglas; Kang, Catherine E; Tator, Charles H; Shoichet, Molly S

    2010-10-01

    Major traumatic spinal cord injury (SCI) results in permanent paralysis below the site of injury. The effectiveness of systemically delivered pharmacological therapies against SCI can be limited by the blood-spinal cord barrier and side effects. Local drug delivery to the injured spinal cord can be achieved using a minimally invasive biopolymer matrix of hyaluronan and methylcellulose injected into the intrathecal space, bypassing the blood-spinal cord barrier and overcoming limitations of existing strategies. Composite hydrogels of drug-loaded poly(lactide-co-glycolide) (PLGA) nanoparticles dispersed in this biopolymer matrix meet the in vitro design criteria for prolonged local release. Using a blank (without drug) composite designed for 28-day sustained release, we presently explore the mechanism of particle-mediated hydrogel stabilization in vitro and aspects of biocompatibility and safety in vivo. The composite hydrogel is well tolerated in the intrathecal space of spinal cord injured rats, showing no increase in inflammation, scarring, or cavity volume relative to controls, and no significant effect on locomotor function up to 28 days. Furthermore, there was no effect on locomotor function in healthy animals which received the composite hydrogel, although a qualitative increase in ED-1 staining was apparent. These data support the further development of composite hydrogels of hyaluronan and methylcellulose containing PLGA nanoparticles for sustained local delivery to the injured spinal cord, an application for which there are no approved alternatives. PMID:20656347

  5. Air gun impactor--a novel model of graded white matter spinal cord injury in rodents.

    PubMed

    Marcol, Wiesław; Slusarczyk, Wojciech; Gzik, Marek; Larysz-Brysz, Magdalena; Bobrowski, Michał; Grynkiewicz-Bylina, Beata; Rosicka, Paulina; Kalita, Katarzyna; Węglarz, Władysław; Barski, Jarosław J; Kotulska, Katarzyna; Labuzek, Krzysztof; Lewin-Kowalik, Joanna

    2012-10-01

    Understanding mechanisms of spinal cord injury and repair requires a reliable experimental model. We have developed a new device that produces a partial damage of spinal cord white matter by means of a precisely adjusted stream of air applied under high pressure. This procedure is less invasive than standard contusion or compression models and does not require surgical removal of vertebral bones. We investigated the effects of spinal cord injury made with our device in 29 adult rats, applying different experimental parameters. The rats were divided into three groups in respect to the applied force of the blast wave. Functional outcome and histopathological effects of the injury were analyzed during 12-week follow-up. The lesions were also examined by means of magnetic resonance imaging (MRI) scans. The weakest stimulus produced transient hindlimb paresis with no cyst visible in spinal cord MRI scans, whereas the strongest was associated with permanent neurological deficit accompanied by pathological changes resembling posttraumatic syringomyelia. Obtained data revealed that our apparatus provided a spinal cord injury animal model with structural changes very similar to that present in patients after moderate spinal cord trauma. PMID:22711195

  6. Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity

    PubMed Central

    D'Amico, Jessica M.; Condliffe, Elizabeth G.; Martins, Karen J. B.; Bennett, David J.; Gorassini, Monica A.

    2014-01-01

    The state of areflexia and muscle weakness that immediately follows a spinal cord injury (SCI) is gradually replaced by the recovery of neuronal and network excitability, leading to both improvements in residual motor function and the development of spasticity. In this review we summarize recent animal and human studies that describe how motoneurons and their activation by sensory pathways become hyperexcitable to compensate for the reduction of functional activation of the spinal cord and the eventual impact on the muscle. Specifically, decreases in the inhibitory control of sensory transmission and increases in intrinsic motoneuron excitability are described. We present the idea that replacing lost patterned activation of the spinal cord by activating synaptic inputs via assisted movements, pharmacology or electrical stimulation may help to recover lost spinal inhibition. This may lead to a reduction of uncontrolled activation of the spinal cord and thus, improve its controlled activation by synaptic inputs to ultimately normalize circuit function. Increasing the excitation of the spinal cord with spared descending and/or peripheral inputs by facilitating movement, instead of suppressing it pharmacologically, may provide the best avenue to improve residual motor function and manage spasticity after SCI. PMID:24860447

  7. Continuous spinal anesthesia for lower limb surgery: a retrospective analysis of 1212 cases

    PubMed Central

    Lux, Eberhard Albert

    2012-01-01

    Background Continuous spinal anesthesia is a very reliable and versatile technique for providing effective anesthesia and analgesia. However, the incidence of possible complications, including postdural puncture headache or neurological impairment, remains controversial. Therefore, the aim of the present retrospective study was to analyze a large number of patients for the incidence of adverse events after continuous spinal anesthesia with a microcatheter. Methods This retrospective study was conducted on 1212 patients who underwent surgery of the lower extremities with continuous spinal anesthesia, which was administered with 22-gauge Quincke spinal needles and 28-gauge microcatheters. Sociodemographic and clinical data were available from the patient records, and data on headaches and patient satisfaction were drawn from a brief postoperative patient questionnaire. Results The patient population included 825 females (68%) and 387 males; the median age was 61 (56–76). The types of operations performed were 843 hip prostheses, 264 knee prostheses, and 105 other leg operations. No major complications were observed in any of these patients. Tension headaches were experienced by 190 (15.7%) patients, but postdural puncture headaches were reported by only 18 (1.5%) patients. Nearly all patients (98.4%) were satisfied with continuous spinal anesthesia and confirmed that they would choose this kind of anesthesia again. Conclusion Based on the findings of this large data analysis, continuous spinal anesthesia using a 28-gauge microcatheter appears to be a safe and appropriate anesthetic technique in lower leg surgery for aged patients. PMID:23204868

  8. Cecal bascule after spinal cord injury: A case series report

    PubMed Central

    Ishida, Yuichi; McLean, Susan F.; Tyroch, Alan H.

    2016-01-01

    Introduction Cecal bascule is a rare cause of intestinal obstruction associated with upward and anterior folding of the ascending colon. We report three patients who presented with spinal cord injury complicated with a cecal bascule. Diagnosis and management of cecal bascule is discussed. Presentation of cases Patient 1: 59-year-old male sustained a traumatic brain injury and cervical spinal cord injury after a motorcycle crash. He had abdominal distension and the diagnosis of cecal bascule was made. Cecopexy was performed. Patient 2: 51-year-old male sustained an unstable C7 vertebral fracture with a cord contusion and quadriplegia after a diving incident. After an unsuccessful medical management of the colonic distension, the patient was taken for a laparotomy and cecal bascule was found. A cecostomy and a cecopexy were performed. Patient 3: 63-year-old male was transferred after a fall. He had diffuse degenerative changes in the thoracic and lumbar spine. He was found to have a perforated cecal bascule. He had a right hemicolectomy with an ileocolic anastomosis. Discussion We suggest the possibility of spinal cord injury being a risk factor for cecal bascule. Currently, right hemicolectomy is recommended for the treatment of cecal bascule. Cecopexy is also acceptable treatment option for a case in which the patient will be undergoing an operation with an insertion of hardware. Conclusion The diagnosis of cecal bascule should be considered for trauma patients with cecal distention without delay in order to prevent disastrous complications. PMID:27077698

  9. Arterial peculiarities of the thoracolumbar spinal cord in rabbit.

    PubMed

    Mazensky, D; Danko, J; Petrovova, E; Mechirova, E; Prokes, M

    2014-10-01

    The aim of this study was to investigate the arterial blood supply of the thoracolumbar spinal cord in rabbit. The study was carried out on twenty adult New Zealand white rabbits. Ten rabbits were used in the corrosion technique and ten rabbits in the dissection technique. After the killing, the vascular network was perfused with saline. Batson's corrosion casting kit no. 17 © was used as a casting medium. After polymerisation of the medium, in ten rabbits the maceration was carried out in KOH solution, and in ten other rabbits, formaldehyde was injected by the dissection technique into the vertebral canal. We found high variability of segmental arteries supplying blood to the spinal cord. There are 12 intercostal arteries and 1 costo-abdominal artery. Dorsal branches arising from the dorsal surface of the aorta thoracica were found as follows: in 70% of the cases, 9 pairs were present; in 20% of the cases 8 pairs; and in 10% of the cases 10 pairs. The paired arteriae lumbales were present in 6 pairs in 90% of the cases and in 5 pairs in 10% of the cases. On the dorsal surface of spinal cord, we found two irregular longitudinal arteries in 70% of the cases, no longitudinal arteries in 20% of the cases and three irregular longitudinal arteries in 10% of the cases receiving dorsal branches of rami spinales. Among the dorsal branches observed in the thoracic region, 60.5% were left-sided, 39.5% right-sided and in the lumbar region, 52.5% were left-sided and 47.5% right-sided. PMID:23952724

  10. Migration of the Anterior Spinal Rod to the Right Thigh, a Rare Complication of Anterior Spinal Instrumentations: A Case Report and a Literature Review

    PubMed Central

    Gaston, Camino Willhuber; Danilo, Taype Zamboni; Guido, Carabelli; Jorge, Barla; Carlos, Sancineto

    2015-01-01

    Posterior and anterior fusion procedures with instrumentation are well-known surgical treatments for scoliosis. Rod migration has been described as unusual complication in anterior spinal instrumentations; migration beyond pelvis is a rare complication. A 32-year-old female presented to the consultant with right thigh pain, rod migration was diagnosed, rod extraction by minimal approach was performed, and spinal instrumentation after nonunion diagnosis was underwent. A rod migration case to the right thigh is presented; this uncommon complication of spinal instrumentation should be ruled out as unusual cause of sudden pain without any other suspicions, and long-term follow-up is important to prevent and diagnose this problem. PMID:26613058

  11. Spinal epidural abscess in brucellosis.

    PubMed

    Boyaci, Ahmet; Boyaci, Nurefsan; Tutoglu, Ahmet; Dokumaci, Dilek Sen

    2013-01-01

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

  12. Spinal Epidural Lipomatosis in Korean

    PubMed Central

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

    2014-01-01

    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. PMID:25237435

  13. Malignancies of the spinal cord.

    PubMed

    Waters, J Dawn; Peran, Encarnacion Maria Navarro; Ciacci, Joseph

    2012-01-01

    The management of intramedullary spinal cord tumors (IMSCT) is primarily concerned with the preservation of existing neurologic function. To this end, clinical scientists are continually seeking tools and techniques to improve the safety and efficacy of tumor resection and control. Further advances in safety and efficacy can be proposed at each phase of management, from pre-operative screening to post-treatment monitoring. Innovations within the areas of molecular biology and genetics, intraoperative imaging and stereotactic radiosurgery offer exciting new options to explore in the management of IMSCT. This section will review the pathophysiology and epidemiology of IMSCT and the state-of-the-art management before delving into the promising new tools and techniques for each phase of management. PMID:23281516

  14. Fitness and Spinal Cord Injuries

    PubMed Central

    Mackie, J. William; McCormack, Rebecca; Campbell, Duncan

    1989-01-01

    Activity for many disabled persons often begins as therapy, but the additional rewards derived from exercise must be appreciated. Public attitudes toward disabled persons have changed during the last few decades, recently focusing on abilities rather than on disabilities. The family physician of patients with spinal cord injuries will assist in managing acute medical problems and the association with loss of some degree of physical capacity. Physicians also can guide these individuals to choose a life that remains active and interesting over a “house-bound,” but safe, existence. Sensitivity and timing play key roles in establishing exercise as an intergral part of a disabled individuals' altered lifestyle. The physician can advocate increased access to wheelchairs and other facilities that make life easier for disabled individuals. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:21248871

  15. Spinal cord injury in youth.

    PubMed

    Apple, D F; Anson, C A; Hunter, J D; Bell, R B

    1995-02-01

    To identify special characteristics of the pediatric spinal cord-injured (SCI) population, we analyzed a database of 1,770 traumatic SCI patients; 88 (5%) fell into the two pediatric subgroups: 0-12 years (n = 26) and 13-15 years (n = 62) at time of injury. Differences between age groups were identified with regard to demographics, neurologic characteristics, associated injuries and complications, and management. Mode level of bony injury was C2 in preteens, C4 in teens, and C4-C5 in adults. Scoliosis developed far more frequently in children, particularly preteens (23%), than in adults (5%). Violent etiologies, predominantly gunshots, accounted for a disproportionate share of injuries to preteens (19%) and African-Americans (28%), as compared with adults (12%) and Caucasians (7%). This last finding underscores the urgent need to mount a response to the nationwide proliferation of gunshot-related SCI in children and minorities. PMID:7729113

  16. Remote Astrocytic and Microglial Activation Modulate Neuronal Hyperexcitability and Below-Level Neuropathic Pain after Spinal Injury in Rat

    PubMed Central

    Gwak, Young Seob; Hulsebosch, Claire E.

    2010-01-01

    In this study, we evaluated whether astrocytic and microglial activation mediates below-level neuropathic pain following spinal cord injury. Male Sprague-Dawley (225–250 g) rats were given low thoracic (T13) spinal transverse hemisection and behavioral, electrophysiological and immunohistochemical methods were used to examine the development and maintenance of below-level neuropathic pain. On post operation day 28, both hindlimbs showed significantly decreased paw withdrawal thresholds and thermal latencies as well as hyperexcitability of lumbar (L4-5) spinal wide dynamic range (WDR) neurons on both sides of spinal dorsal horn compared to sham controls (*p<0.05). Intrathecal treatment with propentofylline (PPF, 10 mM) for 7 consecutive days immediately after spinal injury attenuated the development of mechanical allodynia and thermal hyperalgesia in both hindlimbs in a dose related reduction compared to vehicle treatments (*p<0.05). Intrathecal treatment with single injections of PPF at 28 days after spinal injury, attenuated the existing mechanical allodynia and thermal hyperalgesia in both hindlimbs in a dose related reduction (*p<0.05). In electrophysiological studies, topical treatment of 10 mM PPF onto the spinal surface attenuated the neuronal hyperexcitability in response to mechanical stimuli. In immunohistochemical studies, astrocytes and microglia in rats with spinal hemisection showed significantly increased GFAP and OX-42 expression in both superficial and deep dorsal horns in the lumbar spinal dorsal horn compared to sham controls (*p<0.05) that was prevented in a dose related manner by PPF. In conclusion, our present data support astrocytic and microglial activation that contributes to below-level central neuropathic pain following spinal cord injury. PMID:19332108

  17. Experimental Strategies to Bridge Large Tissue Gaps in the Injured Spinal Cord after Acute and Chronic Lesion.

    PubMed

    Brazda, Nicole; Estrada, Veronica; Voss, Christian; Seide, Klaus; Trieu, Hoc Khiem; Müller, Hans Werner

    2016-01-01

    After a spinal cord injury (SCI) a scar forms in the lesion core which hinders axonal regeneration. Bridging the site of injury after an insult to the spinal cord, tumor resections, or tissue defects resulting from traumatic accidents can aid in facilitating general tissue repair as well as regenerative growth of nerve fibers into and beyond the affected area. Two experimental treatment strategies are presented: (1) implantation of a novel microconnector device into an acutely and completely transected thoracic rat spinal cord to readapt severed spinal cord tissue stumps, and (2) polyethylene glycol filling of the SCI site in chronically lesioned rats after scar resection. The chronic spinal cord lesion in this model is a complete spinal cord transection which was inflicted 5 weeks before treatment. Both methods have recently achieved very promising outcomes and promoted axonal regrowth, beneficial cellular invasion and functional improvements in rodent models of spinal cord injury. The mechanical microconnector system (mMS) is a multi-channel system composed of polymethylmethacrylate (PMMA) with an outlet tubing system to apply negative pressure to the mMS lumen thus pulling the spinal cord stumps into the honeycomb-structured holes. After its implantation into the 1 mm tissue gap the tissue is sucked into the device. Furthermore, the inner walls of the mMS are microstructured for better tissue adhesion. In the case of the chronic spinal cord injury approach, spinal cord tissue - including the scar-filled lesion area - is resected over an area of 4 mm in length. After the microsurgical scar resection the resulting cavity is filled with polyethylene glycol (PEG 600) which was found to provide an excellent substratum for cellular invasion, revascularization, axonal regeneration and even compact remyelination in vivo. PMID:27077921

  18. Investigation of spinal pathology in notalgia paresthetica.

    PubMed

    Savk, Oner; Savk, Ekin

    2005-06-01

    A possible association of spinal pathology with notalgia paresthetica (NP) was investigated through clinical and radiographic evaluation. Forty-three NP patients underwent dermatologic and orthopedic examination accompanied by radiography of the spine. Sixty-one lesions in 43 patients were evaluated. In 34 patients, various vertebral pathologies were observed radiographically by a blinded investigator, and in 28 of these cases these changes were most prominent in the vertebrae which corresponded to a lesional dermatome. Thirty-seven lesions were accompanied by spinal changes decided to be relevant (60.7%). The striking correlation of NP localization with spinal pathology suggests that spinal nerve impingement may contribute to the pathogenesis of this entity. PMID:15928634

  19. Spinal Manipulation for Low-Back Pain

    MedlinePlus

    ... Research Spotlight . NCCIH-Funded Research Recent NCCIH-supported projects have been investigating: The biomechanisms of spinal manipulation— ... information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of ...

  20. Simulation and resident education in spinal neurosurgery

    PubMed Central

    Bohm, Parker E.; Arnold, Paul M.

    2015-01-01

    Background: A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. Methods: We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. Results: A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. Conclusion: The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education. PMID:25745588

  1. Tracheostomy in Spinal Cord Injured Patients

    PubMed Central

    Ganuza, Javier-Romero; Oliviero, Antonio

    2011-01-01

    Patients with cervical spinal cord injury frequently need prolonged mechanical ventilation as a result of worsening pulmonary vital capacity due to paralysis of respiratory muscles, severe impairment of tracheobronchial secretions clearance and high incidence of respiratory complications like pneumonia or atelectasis. Patients with thoracic spinal cord injury may need mechanical ventilation due to associate injuries. For these reasons, tracheostomy is frequently performed in these patients, more frequently when the spinal cord injury is at cervical level. Percutaneous technique, performed in the ICU, should be considered the preferred procedure for performing elective tracheostomies in spinal cord injured patients. Tracheostomy should be implemented as soon as possible in SCI patients they require prolonged mechanical ventilation. Tracheostomy can be performed just after anterolateral cervical spine fixation surgery. Tracheostomy can be removed when no longer needed without major complications. PMID:23905031

  2. Lumbar Puncture (Spinal Tap) (For Parents)

    MedlinePlus

    ... anesthesia medication is given, a numbing cream is applied to the skin to minimize discomfort. The spinal ... Collected samples are sent to a lab for analysis and testing. Sometimes doctors also measure the amount ...

  3. Genetics Home Reference: spinal muscular atrophy

    MedlinePlus

    ... Florence J, Pestronk A, Al-Lozi M, Baloh RH. Dominant spinal muscular atrophy with lower extremity predominance: ... A, Shy ME, Muntoni F, Vallee RB, Baloh RH. Mutations in the tail domain of DYNC1H1 cause ...

  4. Spinal Cord Injury: Hope through Research

    MedlinePlus

    ... chronic pain in people with spinal cord injury. Robotic-assisted therapy Most recovery following SCI takes place ... the safety and efficacy of a type of robotic therapy device known as the AMES device. The ...

  5. Brain and Spinal Cord Tumors in Adults

    MedlinePlus

    ... saved articles window. My Saved Articles » My ACS » Brain and Spinal Cord Tumors in Adults Download Printable ... the topics below to get started. What Is Brain/CNS Tumors In Adults? What are adult brain ...

  6. Bone Morphogenic Proteins: Applications in Spinal Surgery

    PubMed Central

    Jeong, Gerard K.; Sandhu, Harvinder S.

    2005-01-01

    The prospect of predictable and reliable oseteogenesis without the need for secondary bone grafting to treat a wide spectrum of spinal disorders is tremendously appealing. Recombinant human bone morphogenic proteins (rhBMP) have been the subject of extensive basic science, animal, and clinical research as a potential therapeutic modality to promote bony fusion. Animal studies and prospective, randomized clinical trials have demonstrated the efficacy of rhBMPs as an adjunct or substitute to autogenous bone graft in the specific treatment of certain spinal conditions. The future role of rhBMPs in spinal surgery applications remains to be determined and will be dependent upon future investigations evaluating 1) the efficacy in a variety of spinal conditions and environments, 2) the optimal dose and delivery system, 3) the long-term safety profile (immunogenicity, antibody formation), and 4) the cost effectiveness of these therapeutic growth factors. PMID:18751819

  7. Staging Childhood Brain and Spinal Cord Tumors

    MedlinePlus

    ... before the cancer is diagnosed and continue for months or years. Childhood brain and spinal cord tumors ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. These are ...

  8. Hyphenated history: Knight-Taylor spinal orthosis.

    PubMed

    Mehlman, C T; Schwegmann, J P

    2000-06-01

    This paper offers some interesting biographic information on the two men from whom the Knight-Taylor spinal orthosis takes its name. James Knight and Charles Taylor were two orthopedists from New York City who were interested in spinal care. They prescribed and fashioned their distinctive braces, aspects of which were combined by others, thus linking these two men in orthopedic hyphenated history. PMID:10890464

  9. Bowel Management in Spinal Cord Injury Patients

    PubMed Central

    Hughes, Matthew

    2014-01-01

    Spinal cord injuries are common in the United States, affecting approximately 12,000 people per year. Most of these patients lack normal bowel function. The pattern of dysfunction varies with the spinal level involved. Most patients use a bowel management program, and elements of successful programs are discussed. Surgical treatment, when indicated, could include sacral nerve stimulation, Malone antegrade continence enema, and colostomy. PMID:25320571

  10. Skin vasomotor hemiparesis followed by overactivity: characteristic thermography findings in a patient with Horner syndrome due to spinal cord infarction.

    PubMed

    Kobayashi, Makoto

    2016-04-01

    We present a 21-year-old female with Horner syndrome due to spinal cord infarction. In this patient, infrared thermography revealed a hemibody skin temperature increase followed by excessive focal decreases, indicating skin vasomotor hemiparesis and overactivity. PMID:26811085

  11. The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches.

    PubMed

    McKenzie, Christine P; Carvalho, Brendan; Riley, Edward T

    2016-01-01

    Intrathecal catheter devices using a catheter-over-needle design and softer flexible material have been introduced to clinical practice with the aim of reducing some of the complications such as postdural puncture headaches and paresthesias seen with previous versions of intrathecal catheters. We present a case series of 5 cesarean deliveries using the Wiley Spinal intrathecal system (Epimed, Johnstown, New York), which was recently approved by the US Food and Drug Administration. The intrathecal catheter system consists of a flexible 23-gauge intrathecal cannula over a 27-gauge pencil-point spinal needle. The placement of the intrathecal catheter was successful in all 5 cases; however, paresthesias in 3 cases and postdural puncture headaches in 2 cases complicated the placement and use of the device. Although the unique catheter-over-needle design facilitates the use of smaller-gauge spinal needles for dural puncture and larger-gauge catheters for medication administration, this case series using the Wiley Spinal suggests that paresthesias and postdural puncture headaches may still limit its widespread utilization. Future studies are needed to determine the true incidence of complications and to determine the role of continuous spinal anesthesia in the obstetric population. PMID:26909488

  12. Intraspinal microstimulation for the recovery of function following spinal cord injury

    PubMed Central

    Bamford, Jeremy A.; Mushahwar, Vivian K.

    2011-01-01

    Spinal cord injury is a devastating neurological trauma, often resulting in the impairment of bladder, bowel, and sexual function as well as the loss of voluntary control of muscles innervated by spinal cord segments below the lesion site. Research is ongoing into several classes of therapies to restore lost function. These include the encouragement of neural sparing and regeneration of the affected tissue, and the intervention with pharmacological and rehabilitative means to improve function. This review will focus on the application of electrical current in the spinal cord in order to reactivate extant circuitry which coordinates and controls smooth and skeletal muscle below the injury. We first present a brief historical review of intraspinal microstimulation (ISMS) focusing on its use for restoring bladder function after spinal cord injury as well as its utilization as a research tool for mapping spinal cord circuits that coordinate movements. We then present a review of our own results related to the use of ISMS for restoring standing and walking movements after spinal cord injury. We discuss the mechanisms of action of ISMS and how they relate to observed functional outcomes in animal models. These include the activation of fibers-in-passage which lead to the transsynaptic spread of activation through the spinal cord and the ability of ISMS to produce fatigue-resistant, weight-bearing movements. We present our thoughts on the clinical potential for ISMS with regard to implantation techniques, stability, and damage induced by mechanical and electrical factors. We conclude by suggesting improvements in materials and techniques that are needed in preparation for a clinical proof-of-principle and review our current attempts to achieve these. PMID:21867807

  13. Spontaneous spinal epidural haematoma mimicking acute coronary syndrome

    PubMed Central

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

    2015-01-01

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

  14. Spinal gas accumulation causing lumbar discogenic disease: a case report.

    PubMed

    Ayberk, Giyas; Özveren, Mehmet Faik; Yıldırım, Timur

    2015-01-01

    Vacuum disc phenomenon is seen frequently with degenerative disc disease and is characterized by the collection of gas in the disc space. Although the accumulation of gas within the disc space does not have clinical significance, symptoms may develop when occurring within the spinal canal. We present a 60-year-old female patient with low back and left leg pain occurring for 3 months before admission to our clinic. Straight leg raise test was 50 degrees in the left leg. Magnetic resonance imaging showed a narrowing of the L5-S1 disc space with vacuum disc phenomenon and hypointense cystic mass in T1 and T2-weighted images. The decision for surgery was made and left L5-S1 hemilaminectomy and foraminotomy was performed. The cyst wall was adherent to the root and dura mater and was partially excised. The patient was pain-free on the first postoperative day. In cases of gas accumulation in the spinal canal, discogenic pain may occur. Surgical therapy is still an acceptable method for the treatment of vacuum disc phenomenon and accumulation of gas within the spinal canal. PMID:25803262

  15. Aspirin and spinal haematoma after neuraxial anaesthesia: Myth or reality?

    PubMed

    Vela Vásquez, R S; Peláez Romero, R

    2015-11-01

    The safety of aspirin therapy in neuraxial anaesthesia has been historically questioned, and the current recommendations are still heterogeneous. A comprehensive review of clinical evidence and a comparative analysis of European and American guidelines were performed. Low-dose aspirin produces a selective, complete and irreversible cyclooxygenase-1 blockade, and higher doses do not increase the antiplatelet effect. Additional cyclooxygenase-2 blockade by high-dose aspirin might decrease the antithrombotic efficacy by inhibiting endothelial prostacyclin synthesis. Different doses of aspirin have been shown to be safe in a broad population subjected to neuraxial anaesthesia or analgesia. In the few case reports of spinal haematoma involving aspirin therapy, additional complicating factors were present. Considering the available evidence, the majority of national scientific societies agree that the isolated use of aspirin does not increase the risk of spinal haematoma and does not represent a contraindication to neuraxial blocks. The precautions regarding higher doses do not seem to be justified. Although aspirin alone is considered to be safe in neuraxial anaesthesia, the concurrent administration of other antithrombotic drugs significantly increases the risk of spinal haematoma and the recommended safety times for each of these other drugs must be strictly followed. An individualized assessment of the risks and benefits should be performed, before performing a neuraxial technique or catheter removal in a patient receiving aspirin. PMID:26475800

  16. Robust local intervertebral disc alignment for spinal MRI

    NASA Astrophysics Data System (ADS)

    Reisman, James; Höppner, Jan; Huang, Szu-Hao; Zhang, Li; Lai, Shang-Hong; Odry, Benjamin; Novak, Carol L.

    2006-03-01

    Magnetic resonance (MR) imaging is frequently used to diagnose abnormalities in the spinal intervertebral discs. Owing to the non-isotropic resolution of typical MR spinal scans, physicians prefer to align the scanner plane with the disc in order to maximize the diagnostic value and to facilitate comparison with prior and follow-up studies. Commonly a planning scan is acquired of the whole spine, followed by a diagnostic scan aligned with selected discs of interest. Manual determination of the optimal disc plane is tedious and prone to operator variation. A fast and accurate method to automatically determine the disc alignment can decrease examination time and increase the reliability of diagnosis. We present a validation study of an automatic spine alignment system for determining the orientation of intervertebral discs in MR studies. In order to measure the effectiveness of the automatic alignment system, we compared its performance with human observers. 12 MR spinal scans of adult spines were tested. Two observers independently indicated the intervertebral plane for each disc, and then repeated the procedure on another day, in order to determine the inter- and intra-observer variability associated with manual alignment. Results were also collected for the observers utilizing the automatic spine alignment system, in order to determine the method's consistency and its accuracy with respect to human observers. We found that the results from the automatic alignment system are comparable with the alignment determined by human observers, with the computer showing greater speed and consistency.

  17. Spinal muscular atrophy with respiratory distress type 1 (SMARD1)

    PubMed Central

    San Millan, Beatriz; Fernandez, Jose M.; Navarro, Carmen; Reparaz, Alfredo; Teijeira, Susana

    2016-01-01

    Background: Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a clinically and genetically distinct and uncommon variant of SMA that results from irreversible degeneration of α-motor neurons in the anterior horns of the spinal cord and in ganglion cells on the spinal root ganglia. Aims: To describe the clinical, electrophysiological, neuropathological, and genetic findings, at different stages from birth to death, of a Spanish child diagnosed with SMARD1. Patient and methods: We report the case of a 3-month-old girl with severe respiratory insufficiency and, later, intense hypotonia. Paraclinical tests included biochemistry, chest X-ray, and electrophysiological studies, among others. Muscle and nerve biopsies were performed at 5 and 10 months and studied under light and electron microscopy. Post-mortem examination and genetic investigations were performed. Results: Pre- and post-mortem histopathological findings demonstrated the disease progression over time. Muscle biopsy at 5 months of age was normal, however a marked neurogenic atrophy was present in post-mortem samples. Peripheral motor and sensory nerves were severely involved likely due to a primary axonal disorder. Automatic sequencing of IGHMBP2 revealed a compound heterozygous mutation. Conclusions: The diagnosis of SMARD1 should be considered in children with early respiratory insufficiency or in cases of atypical SMA. Direct sequencing of the IGHMBP2 gene should be performed. PMID:26709713

  18. Complication with Removal of a Lumbar Spinal Locking Plate

    PubMed Central

    Crawford, Brooke; Lenarz, Christopher; Watson, J. Tracy; Alander, Dirk

    2015-01-01

    Introduction. The use of locking plate technology for anterior lumbar spinal fusion has increased stability of the vertebral fusion mass over traditional nonconstrained screw and plate systems. This case report outlines a complication due to the use of this construct. Case. A patient with a history of L2 corpectomy and anterior spinal fusion presented with discitis at the L4/5 level and underwent an anterior lumbar interbody fusion (ALIF) supplemented with a locking plate placed anterolaterally for stability. Fifteen months after the ALIF procedure, he returned with a hardware infection. He underwent debridement of the infection site and removal of hardware. Results. Once hardware was exposed, removal of the locking plate screws was only successful in one out of four screws using a reverse thread screw removal device. Three of the reverse thread screw removal devices broke in attempt to remove the subsequent screws. A metal cutting drill was then used to break hoop stresses associated with the locking device and the plate was removed. Conclusion. Anterior locking plates add significant stability to an anterior spinal fusion mass. However, removal of this hardware can be complicated by the inherent properties of the design with significant risk of major vascular injury. PMID:25838956

  19. Complication with removal of a lumbar spinal locking plate.

    PubMed

    Crawford, Brooke; Lenarz, Christopher; Watson, J Tracy; Alander, Dirk

    2015-01-01

    Introduction. The use of locking plate technology for anterior lumbar spinal fusion has increased stability of the vertebral fusion mass over traditional nonconstrained screw and plate systems. This case report outlines a complication due to the use of this construct. Case. A patient with a history of L2 corpectomy and anterior spinal fusion presented with discitis at the L4/5 level and underwent an anterior lumbar interbody fusion (ALIF) supplemented with a locking plate placed anterolaterally for stability. Fifteen months after the ALIF procedure, he returned with a hardware infection. He underwent debridement of the infection site and removal of hardware. Results. Once hardware was exposed, removal of the locking plate screws was only successful in one out of four screws using a reverse thread screw removal device. Three of the reverse thread screw removal devices broke in attempt to remove the subsequent screws. A metal cutting drill was then used to break hoop stresses associated with the locking device and the plate was removed. Conclusion. Anterior locking plates add significant stability to an anterior spinal fusion mass. However, removal of this hardware can be complicated by the inherent properties of the design with significant risk of major vascular injury. PMID:25838956

  20. The role of extracellular matrix in spinal cord development.

    PubMed

    Wiese, Stefan; Faissner, Andreas

    2015-12-01

    The development of the spinal cord represents one of the most complex structure developments of the central nervous system (CNS) as it has to unfold along the longitudinal axis and within segmental cues. There it has to cope with on the one hand connection to the periphery (skeletal muscle, dermomyotome, smooth muscles) and connect it to the higher midbrain and cortical regions of the CNS. Major studies have been performed to analyze the specific subset of transcription factors of the different types of cells within the different segments of the spinal cord. But transcription factor expression is always a result of cellular positioning as the environment defines the intracellular changes during differentiation and in adulthood. The surrounding composed of mainly extracellular matrix does not only provide a "glue" to attach cells to each other but also provides signals with special domains docking to cell surface receptors and presents soluble molecules such as basic fibroblast growth factors (bFGFs) or Wnt-proteins. The availability of these molecules depends on the matrix composition and influences the transcription factor code of each cell. Recent research has also provided strong evidence that depletion of single matrix molecules like Tenascin C (TnC) can lead to developmental changes within the progenitor pools. Therefore beyond the transcription factor code that defines cellular properties we want to focus on the role of the extracellular matrix in the development of the spinal cord. PMID:26028310

  1. Spinal cord damage in Machado-Joseph disease.

    PubMed

    Fahl, Camila N; Branco, Lucas Melo T; Bergo, Felipe P G; D'Abreu, Anelyssa; Lopes-Cendes, Iscia; França, Marcondes C

    2015-04-01

    Machado-Joseph disease (SCA3) is the most frequent spinocerebellar ataxia worldwide and characterized by remarkable phenotypic heterogeneity. MRI-based studies in SCA3 focused in the cerebellum and connections, but little is known about cord damage in the disease and its clinical relevance. To evaluate the spinal cord damage in SCA3 through quantitative analysis of MRI scans. A group of 48 patients with SCA3 and 48 age and gender-matched healthy controls underwent MRI on a 3T scanner. We used T1-weighted 3D images to estimate the cervical spinal cord area (CA) and eccentricity (CE) at three C2/C3 levels based on a semi-automatic image segmentation protocol. The scale for assessment and rating of ataxia (SARA) was employed to quantify disease severity. The two groups-SCA3 and controls-were significantly different regarding CA (49.5 ± 7.3 vs 67.2 ± 6.3 mm(2), p < 0.001) and CE values (0.79 ± 0.06 vs 0.75 ± 0.05, p = 0.005). In addition, CA presented a significant correlation with SARA scores in the patient group (p = 0.010). CE was not associated with SARA scores (p = 0.857). In the multiple variable regression, we found that disease duration was the only variable associated with CA (coefficient = -0.629, p = 0.025). SCA3 is characterized by cervical cord atrophy and antero-posterior flattening. In addition, the spinal cord areas did correlate with disease severity. This suggests that quantitative analyses of the spinal cord MRI might be a useful biomarker in SCA3. PMID:25370748

  2. Dendritic spine dysgenesis contributes to hyperreflexia after spinal cord injury

    PubMed Central

    Bandaru, Samira P.; Liu, Shujun; Waxman, Stephen G.

    2014-01-01

    Hyperreflexia and spasticity are chronic complications in spinal cord injury (SCI), with limited options for safe and effective treatment. A central mechanism in spasticity is hyperexcitability of the spinal stretch reflex, which presents symptomatically as a velocity-dependent increase in tonic stretch reflexes and exaggerated tendon jerks. In this study we tested the hypothesis that dendritic spine remodeling within motor reflex pathways in the spinal cord contributes to H-reflex dysfunction indicative of spasticity after contusion SCI. Six weeks after SCI in adult Sprague-Dawley rats, we observed changes in dendritic spine morphology on α-motor neurons below the level of injury, including increased density, altered spine shape, and redistribution along dendritic branches. These abnormal spine morphologies accompanied the loss of H-reflex rate-dependent depression (RDD) and increased ratio of H-reflex to M-wave responses (H/M ratio). Above the level of injury, spine density decreased compared with below-injury spine profiles and spine distributions were similar to those for uninjured controls. As expected, there was no H-reflex hyperexcitability above the level of injury in forelimb H-reflex testing. Treatment with NSC23766, a Rac1-specific inhibitor, decreased the presence of abnormal dendritic spine profiles below the level of injury, restored RDD of the H-reflex, and decreased H/M ratios in SCI animals. These findings provide evidence for a novel mechanistic relationship between abnormal dendritic spine remodeling in the spinal cord motor system and reflex dysfunction in SCI. PMID:25505110

  3. Spinal injuries in the 2012 twin earthquakes, northwest iran.

    PubMed

    Ghabili, Kamyar; Golzari, Samad E J; Salehpour, Firooz; Imani, Taghi; Bazzazi, Amir Mohammad; Ghaffari, Alireza; Khanli, Hadi Mohammad; Tizro, Parastou; Taghizade, Shabnam; Shakouri, Seyed Kazem

    2013-01-01

    On 11 August 2012, twin earthquakes measured 6.3 and 6.4 on the Richter scale hit three towns (Ahar, Varzaqan, and Heris) in East Azerbaijan Province, Iran resulting in tragic loss of three hundred lives and leaving thousands of injured. The aim of the present study was to report the spinal injuries during recent earthquake in northwest Iran, its consequences and management. Of the 923 hospitalized patients, 26 (2.8%) had neurosurgical complications. The imaging and clinical data of the patients were retrospectively studied regarding the anatomical location of the injury, the severity of spinal injury and associated neurological deficit. To further analyze the findings, Magerl (AO) and Frankel's classifications were used. The injuries without any fracture were considered as minor spinal injuries. The mean age of the patients was 44.5422.52 (range: 5-88) years. We detected a total of 38 vertebral injuries including 24 major (63.15%) and 14 minor injuries (36.85%). The most common injuries were observed in the lumbar spine (19 injuries, 50%). The 24 major injuries chiefly included Magerl type A (14 injuries, 58.3%). According to the Frankel's classification, majority of the patients (88.46%) had no neurological deficit. In this study, three patients had nerve injuries. In conclusion, the number and proportion of spinal fractures patients in the recent twin earthquakes, northwest Iran was limited and caused less nerve injuries compared to the previous similar disasters. This might be due to the milder earthquake consequences since the incident happened in the middle of the day when men were working their fields. Potential complications in patients traumatized in earthquake incidents should be monitored for and early assessment of the neurological function is required to prioritize care for the victims. PMID:23568085

  4. Spinal cord ischemia after cardiac arrest.

    PubMed

    Imaizumi, H; Ujike, Y; Asai, Y; Kaneko, M; Chiba, S

    1994-01-01

    Subsequent to cardiac arrest, a 58-year-old man with intractable dysrhythmia and severe arteriosclerosis developed flaccid paraplegia, depressed deep tendon reflexes, and showed no pain or temperature sensation caudal to Th-7 in spite of completely intact proprioception and vibration sensation. An echocardiogram showed no clots or vegetation on the prosthetic valve and no thrombus in the left atrium or left ventricle. The patient's paraplegia was permanent, at least through a follow-up period of 2 years. These findings suggest that the etiology was spinal cord ischemia due to blood supply in the area of the anterior spinal artery (ASA); however, magnetic resonance T2-weighted imaging demonstrated signal abnormalities throughout the gray matter and in the adjacent center white matter. Somatosensory-evoked potentials (SEP) measure neural transmission in the afferent spinal cord pathway, which is located in the lateral and posterior columns of the white matter; these showed a delay in latency between Th-6 and Th-7. The spinal cord is as vulnerable to transient ischemia as the brain. Spinal cord ischemia after cardiac arrest results from principal damage in the anterior horn of the gray matter, the so-called ASA syndrome; however, the pathways of SEP and pathogenesis of the spinal cord ischemia need further investigation. PMID:7884198

  5. Targeting endothelin receptors A and B attenuates the inflammatory response and improves locomotor function following spinal cord injury in mice.

    PubMed

    Guo, Jian; Li, Yiqiao; He, Zhennian; Zhang, Bin; Li, Yonghuan; Hu, Jianghua; Han, Mingyuan; Xu, Yuanlin; Li, Yongfu; Gu, Jie; Dai, Bo; Chen, Zhong

    2014-07-01

    After spinal cord injury (SCI), the disruption of blood-spinal cord barrier by activation of the endothelin (ET) system is a critical event leading to leukocyte infiltration, inflammatory response and oxidative stress, contributing to neurological disability. In the present study, we showed that blockade of ET receptor A (ETAR) and/or ET receptor B (ETBR) prevented early inflammatory responses directly via the inhibition of neutrophil and monocyte diapedesis and inflammatory mediator production following traumatic SCI in mice. Long-term neurological improvement, based on a series of tests of locomotor performance, occurred only in the spinal cord‑injured mice following blockade of ETAR and ETBR. We also examined the post‑traumatic changes of the micro-environment within the injured spinal cord of mice following blockade of ET receptors. Oxidative stress reflects an imbalance between malondialdehyde and superoxide dismutase in spinal cord‑injured mice treated with vehicle, whereas blockade of ETAR and ETBR reversed the oxidation state imbalance. In addition, hemeoxygenase-1, a protective protease involved in early SCI, was increased in spinal cord‑injured mice following the blockade of ETAR and ETBR, or only ETBR. Matrix metalloproteinase-9, a tissue-destructive protease involved in early damage, was decreased in the injured spinal cord of mice following blockade of ETAR, ETBR or a combination thereof. The findings of the present study therefore suggested an association between ETAR and ETBR in regulating early pathogenesis of SCI and determining the outcomes of long‑term neurological recovery. PMID:24756152

  6. Targeting endothelin receptors A and B attenuates the inflammatory response and improves locomotor function following spinal cord injury in mice

    PubMed Central

    GUO, JIAN; LI, YIQIAO; HE, ZHENNIAN; ZHANG, BIN; LI, YONGHUAN; HU, JIANGHUA; HAN, MINGYUAN; XU, YUANLIN; LI, YONGFU; GU, JIE; DAI, BO; CHEN, ZHONG

    2014-01-01

    After spinal cord injury (SCI), the disruption of blood-spinal cord barrier by activation of the endothelin (ET) system is a critical event leading to leukocyte infiltration, inflammatory response and oxidative stress, contributing to neurological disability. In the present study, we showed that blockade of ET receptor A (ETAR) and/or ET receptor B (ETBR) prevented early inflammatory responses directly via the inhibition of neutrophil and monocyte diapedesis and inflammatory mediator production following traumatic SCI in mice. Long-term neurological improvement, based on a series of tests of locomotor performance, occurred only in the spinal cord-injured mice following blockade of ETAR and ETBR. We also examined the post-traumatic changes of the microenvironment within the injured spinal cord of mice following blockade of ET receptors. Oxidative stress reflects an imbalance between malondialdehyde and superoxide dismutase in spinal cord-injured mice treated with vehicle, whereas blockade of ETAR and ETBR reversed the oxidation state imbalance. In addition, hemeoxygenase-1, a protective protease involved in early SCI, was increased in spinal cord-injured mice following the blockade of ETAR and ETBR, or only ETBR. Matrix metalloproteinase-9, a tissue-destructive protease involved in early damage, was decreased in the injured spinal cord of mice following blockade of ETAR, ETBR or a combination thereof. The findings of the present study therefore suggested an association between ETAR and ETBR in regulating early pathogenesis of SCI and determining the outcomes of long-term neurological recovery. PMID:24756152

  7. “No Clinical Puzzles More Interesting”: Harvey Cushing and Spinal Trauma, The Johns Hopkins Hospital 1896-1912

    PubMed Central

    Dasenbrock, Hormuzdiyar H.; Pendleton, Courtney; Cohen-Gadol, Aaron A.; Witham, Timothy F.; Gokaslan, Ziya L.; Quinones-Hinojosa, Alfredo; Bydon, Ali

    2015-01-01

    Although Harvey Cushing played a central role in the establishment of neurosurgery in the United States, his work on the spine remains largely unknown. This article is not only the first time that Cushing's spinal cases while he was at Johns Hopkins have been reported, but also the first time his management of spinal trauma has been described. We report on 12 patients that Cushing treated from 1898 to 1911 who have never been reported before, including blunt and penetrating injuries, complete and incomplete spinal cord lesions, and both immediate and delayed presentations. Cushing performed laminectomies within 24 hours on patients with immediate presentations—both complete and incomplete spinal cord lesions. Among those with delayed presentations, Cushing did laminectomies on patients with incomplete spinal cord injuries. By the end of his tenure at Hopkins, Cushing advocated nonoperative treatment for all patients with complete spinal cord lesions. Four patients died while an inpatient, with meningitis and cystitis leading to the death of 1 and 3 patients, respectively. Cystitis was treated with intravesicular irrigation; an indwelling catheter was placed by a suprapubic cystostomy in four. Cushing was one of the first to report the use of x-ray in a spine patient, in a case that may have been one factor leading to his interest in the nervous system; Cushing also routinely obtained radiographs in those with spinal trauma. These cases illustrate Cushing's dedication to and rapport with his patients, even in the face of a dismal prognosis. PMID:21135734

  8. In vivo two-photon imaging of structural dynamics in the spinal dorsal horn in an inflammatory pain model.

    PubMed

    Matsumura, Shinji; Taniguchi, Wataru; Nishida, Kazuhiko; Nakatsuka, Terumasa; Ito, Seiji

    2015-04-01

    Two-photon microscopy imaging has recently been applied to the brain to clarify functional and structural synaptic plasticity in adult neural circuits. Whereas the pain system in the spinal cord is phylogenetically primitive and easily exhibits behavioral changes such as hyperalgesia in response to inflammation, the structural dynamics of dendrites has not been analysed in the spinal cord mainly due to tissue movements associated with breathing and heart beats. Here we present experimental procedures to prepare the spinal cord sufficiently to follow morphological changes of neuronal processes in vivo by using two-photon microscopy and transgenic mice expressing fluorescent protein specific to the nervous system. Structural changes such as the formation of spine-like structures and swelling of dendrites were observed in the spinal dorsal horn within 30 min after the multiple-site injections of complete Freund's adjuvant (a chemical irritant) to a leg, and these changes continued for 5 h. Both AMPA and N-methyl-D-aspartate receptor antagonists, and gabapentin, a presynaptic Ca(2+) channel blocker, completely suppressed the inflammation-induced structural changes in the dendrites in the spinal dorsal horn. The present study first demonstrated by in vivo two-photon microscopy imaging that structural synaptic plasticity occurred in the spinal dorsal horn immediately after the injection of complete Freund's adjuvant and may be involved in inflammatory pain. Furthermore, acute inflammation-associated structural changes in the spinal dorsal horn were shown to be mediated by glutamate receptor activation. PMID:25645012

  9. Spinal anaesthesia for caesarean section in the presence of respiratory failure and spinal metastases from a soft tissue clear cell sarcoma.

    PubMed

    Miskovic, A M; Dob, D P

    2013-07-01

    Spinal metastases occur in up to 70% of all patients with cancer. However, only 10% are symptomatic. Before considering central neuraxial blockade in patients with malignancy, a history of back pain should be excluded. Anaesthetists should be aware that intrathecal and epidural injections could cause paraplegia if metastases are impinging on the spinal cord. Failure to achieve adequate sensory anaesthesia after central neuraxial blockade or presentation with postoperative paraplegia may indicate the presence of asymptomatic vertebral canal metastases. In this report, the anaesthetic management of a patient with respiratory failure and spinal metastases from a soft tissue sarcoma, requiring caesarean section is described. Sensory anaesthesia extending above a level of imminent cord compression was achieved despite loss of cerebrospinal fluid signal on magnetic resonance imaging. PMID:23809016

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

    PubMed

    Vaught, Kevin A

    2009-01-01

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

  11. Groupwise multi-atlas segmentation of the spinal cord's internal structure.

    PubMed

    Asman, Andrew J; Bryan, Frederick W; Smith, Seth A; Reich, Daniel S; Landman, Bennett A

    2014-04-01

    The spinal cord is an essential and vulnerable component of the central nervous system. Differentiating and localizing the spinal cord internal structure (i.e., gray matter vs. white matter) is critical for assessment of therapeutic impacts and determining prognosis of relevant conditions. Fortunately, new magnetic resonance imaging (MRI) sequences enable clinical study of the in vivo spinal cord's internal structure. Yet, low contrast-to-noise ratio, artifacts, and imaging distortions have limited the applicability of tissue segmentation techniques pioneered elsewhere in the central nervous system. Additionally, due to the inter-subject variability exhibited on cervical MRI, typical deformable volumetric registrations perform poorly, limiting the applicability of a typical multi-atlas segmentation framework. Thus, to date, no automated algorithms have been presented for the spinal cord's internal structure. Herein, we present a novel slice-based groupwise registration framework for robustly segmenting cervical spinal cord MRI. Specifically, we provide a method for (1) pre-aligning the slice-based atlases into a groupwise-consistent space, (2) constructing a model of spinal cord variability, (3) projecting the target slice into the low-dimensional space using a model-specific registration cost function, and (4) estimating robust segmentation susing geodesically appropriate atlas information. Moreover, the proposed framework provides a natural mechanism for performing atlas selection and initializing the free model parameters in an informed manner. In a cross-validation experiment using 67 MR volumes of the cervical spinal cord, we demonstrate sub-millimetric accuracy, significant quantitative and qualitative improvement over comparable multi-atlas frameworks, and provide insight into the sensitivity of the associated model parameters. PMID:24556080

  12. Groupwise Multi-Atlas Segmentation of the Spinal Cord’s Internal Structure

    PubMed Central

    Asman, Andrew J.; Bryan, Frederick W.; Smith, Seth A.; Reich, Daniel S.; Landman, Bennett A.

    2014-01-01

    The spinal cord is an essential and vulnerable component of the central nervous system. Differentiating and localizing the spinal cord internal structure (i.e., gray matter vs. white matter) is critical for assessment of therapeutic impacts and determining prognosis of relevant conditions. Fortunately, new magnetic resonance imaging (MRI) sequences enable clinical study of the in vivo spinal cord’s internal structure. Yet, low contrast-to-noise ratio, artifacts, and imaging distortions have limited the applicability of tissue segmentation techniques pioneered elsewhere in the central nervous system. Additionally, due to the inter-subject variability exhibited on cervical MRI, typical deformable volumetric registrations perform poorly, limiting the applicability of a typical multi-atlas segmentation framework. Thus, to date, no automated algorithms have been presented for the spinal cord’s internal structure. Herein, we present a novel slice-based groupwise registration framework for robustly segmenting cervical spinal cord MRI. Specifically, we provide a method for (1) pre-aligning the slice-based atlases into a groupwise-consistent space, (2) constructing a model of spinal cord variability, (3) projecting the target slice into the low-dimensional space using a model-specific registration cost function, and (4) estimating robust segmentations using geodesically appropriate atlas information. Moreover, the proposed framework provides a natural mechanism for performing atlas selection and initializing the free model parameters in an informed manner. In a cross-validation experiment using 67 MR volumes of the cervical spinal cord, we demonstrate sub-millimetric accuracy, significant quantitative and qualitative improvement over comparable multi-atlas frameworks, and provide insight into the sensitivity of the associated model parameters. PMID:24556080

  13. Targeting Lumbar Spinal Neural Circuitry by Epidural Stimulation to Restore Motor Function After Spinal Cord Injury.

    PubMed

    Minassian, Karen; McKay, W Barry; Binder, Heinrich; Hofstoetter, Ursula S

    2016-04-01

    Epidural spinal cord stimulation has a long history of application for improving motor control in spinal cord injury. This review focuses on its resurgence following the progress made in understanding the underlying neurophysiological mechanisms and on recent reports of its augmentative effects upon otherwise subfunctional volitional motor control. Early work revealed that the spinal circuitry involved in lower-limb motor control can be accessed by stimulating through electrodes placed epidurally over the posterior aspect of the lumbar spinal cord below a paralyzing injury. Current understanding is that such stimulation activates large-to-medium-diameter sensory fibers within the posterior roots. Those fibers then trans-synaptically activate various spinal reflex circuits and plurisegmentally organized interneuronal networks that control more complex contraction and relaxation patterns involving multiple muscles. The induced change in responsiveness of this spinal motor circuitry to any residual supraspinal input via clinically silent translesional neural connections that have survived the injury may be a likely explanation for rudimentary volitional control enabled by epidural stimulation in otherwise paralyzed muscles. Technological developments that allow dynamic control of stimulation parameters and the potential for activity-dependent beneficial plasticity may further unveil the remarkable capacity of spinal motor processing that remains even after severe spinal cord injuries. PMID:26843089

  14. Diagnostic Inefficiency of Nonselective Spinal Angiography (Flush Aortography) in the Evaluation of the Normal and Pathological Spinal Vasculature.

    PubMed

    Gailloud, Philippe

    2016-01-01

    Selective spinal angiography was introduced in the 1960s to palliate the poor sensitivity of nonselective techniques for the evaluation of the spinal cord vasculature. Recent advances made in the field of angiography seem to have prompted a renewed interest for nonselective spinal angiography, or flush aortograms. This pictorial essay, illustrated with 2 cases of presurgical evaluation of the spinal cord supply and 2 cases of spinal vascular malformation, suggests that nonselective techniques remain insufficient to properly document the normal or pathological spinal vasculature. While flush aortography can play a role as a complement to spinal angiography, for example, to locate vessels eluding selective catheterization, relying on nonselective studies to rule out the presence of a spinal vascular malformation or to identify the normal spinal cord supply before surgical interventions may lead to false-negative investigations with potentially devastating consequences. PMID:26489792

  15. Symptomatic spinal cord compression from an intradural arachnoid cyst with associated syrinx in a child: case report.

    PubMed

    Su, David K; Ebenezer, Sudesh; Avellino, Anthony M

    2012-01-01

    Symptomatic intradural extramedullary arachnoid cysts in children are rare, and of the previously reported pediatric cases in the current literature, none to our knowledge were associated with a spinal cord syrinx. We describe an 8-year-old child who presented with paraparesis and regression of bowel and bladder control. An intradural extramedullary arachnoid cyst was identified on preoperative magnetic resonance imaging, with an associated spinal cord syrinx. We describe the preoperative imaging, surgical management, and clinical course of this patient, who had improvement in his paraparesis. This paper reviews relevant pediatric literature and the etiology of arachnoid cysts and associated spinal cord syrinx formation. PMID:23615079

  16. Distribution of nitric oxide-producing cells along spinal cord in urodeles

    PubMed Central

    Mahmoud, Mayada A.; Fahmy, Gehan H.; Moftah, Marie Z.; Sabry, Ismail

    2014-01-01

    Nitric oxide is a unique neurotransmitter, which participates in many physiological and pathological processes in the organism. There are little data about the neuronal nitric oxide synthase immunoreactivity in the spinal cord of amphibians. In this respect, the present study aims to investigate the distribution of nitric oxide producing cells in the spinal cord of urodele and to find out the possibility of a functional locomotory role to this neurotransmitter. The results of the present study demonstrate a specific pattern of NADPH-d labeling in the selected amphibian model throughout the spinal cord length as NADPH-d-producing cells and fibers were present in almost all segments of the spinal cord of the salamander investigated. However, their number, cytological characteristics and labeling intensity varied significantly. It was noticed that the NO-producing cells (NO-PC) were accumulated in the ventral side of certain segments in the spinal cord corresponding to the brachial and sacral plexuses. In addition, the number of NO-PC was found to be increased also at the beginning of the tail and this could be due to the fact that salamanders are tetrapods having bimodal locomotion, namely swimming and walking. PMID:25309330

  17. Clinical Assessment Of Stereotactic IGRT: Spinal Radiosurgery

    SciTech Connect

    Gerszten, Peter C. Burton, Steven A.

    2008-07-01

    The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited because of the availability of effective target immobilization devices. Recent advances in stereotactic IGRT have allowed for spinal applications. Large clinical experience with spinal radiosurgery to properly assess clinical outcomes has previously been limited. At our institution, we have developed a successful multidisciplinary spinal radiosurgery program in which 542 spinal lesions (486 malignant and 56 benign lesions) were treated with a single-fraction radiosurgery technique. Patient ages ranged from 18 to 85 years (mean 56 years). Lesion location included 92 cervical, 234 thoracic, 130 lumbar, and 86 sacral. The most common metastatic tumors were renal cell (89 cases), breast (74 cases), and lung (71 cases). The most common benign tumors were neurofibroma (24 cases), schwannoma (13 cases), and meningioma (7 cases). Eighty-nine cervical lesions were treated using skull tracking. Thoracic, lumbar, and sacral tumors were tracked relative to either gold or stainless steel fiducial markers. The maximum intratumoral dose ranged from 12.5 to 30 Gy (mean 20 Gy). Tumor volume ranged from 0.16 to 298 mL (mean 47 mL). Three hundred thirty-seven lesions had received prior external beam irradiation with spinal cord doses precluding further conventional irradiation. The primary indication for radiosurgery was pain in 326 cases, as a primary treatment modality in 70 cases, for tumor radiographic tumor progression in 65 cases, for post-surgical treatment in 38 cases, for progressive neurological deficit in 35 cases, and as a radiation boost in 8 cases. Follow-up period was at least 3 to 49 months. Axial and/or radicular pain improved in 300 of 326 cases (92%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Thirty of 35 patients (85%) with progressive neurological deficits experienced at least some improvement after treatment. Spinal stereotactic radiosurgery is now a feasible, safe, and clinically effective technique for the treatment of a variety of spinal lesions. The potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with essentially no recovery time and excellent symptomatic response. This technique offers a new therapeutic modality for the primary treatment of a variety of spinal lesions, including the treatment of neoplasms in medically inoperable patients, previously irradiated sites, for lesions not amenable to open surgical techniques, and as an adjunct to surgery.

  18. A case of spinal epidural haematoma during breath-hold diving.

    PubMed

    Tremolizzo, Lucio; Patassini, Mirko; Malpieri, Massimo; Ferrarese, Carlo; Appollonio, Ildebrando

    2012-06-01

    Spinal epidural haematoma (SEH) is a rare condition usually the result of bleeding of the epidural venous plexus that might present with acute spinal cord compression. It is often due to traumatic events, but 'spontaneous' cases have been described, usually related to different predisposing conditions, such as coagulopathies. A 47-year-old male presented with severe frontal headache and intense cervical pain which developed during a protracted breath-hold spearfishing session. A cervical spine MRI performed 12 days after symptom onset showed a small epidural blood collection on the left side of the spinal canal, at the C7-T1 level. One week later, blood was no longer present and the asymptomatic patient was discharged. Protracted minor trauma (neck flexion) and repeated Valsalva manoeuvres might have played a role in the genesis of this event. The role of decompression sickness is discussed as well. PMID:22828819

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

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

    2015-01-01

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

  1. Recovery of control of posture and locomotion after a spinal cord injury: solutions staring us in the face

    PubMed Central

    Fong, Andy J.; Roy, Roland R.; Ichiyama, Ronaldo M.; Lavrov, Igor; Courtine, Grégoire; Gerasimenko, Yury; Tai, Y.C.; Burdick, Joel; Edgerton, V. Reggie

    2010-01-01

    Over the past 20 years, tremendous advances have been made in the field of spinal cord injury research. Yet, consumed with individual pieces of the puzzle, we have failed as a community to grasp the magnitude of the sum of our findings. Our current knowledge should allow us to improve the lives of patients suffering from spinal cord injury. Advances in multiple areas have provided tools for pursuing effective combination of strategies for recovering stepping and standing after a severe spinal cord injury. Muscle physiology research has provided insight into how to maintain functional muscle properties after a spinal cord injury. Understanding the role of the spinal networks in processing sensory information that is important for the generation of motor functions has focused research on developing treatments that sharpen the sensitivity of the locomotor circuitry and that carefully manage the presentation of proprioceptive and cutaneous stimuli to favor recovery. Pharmacological facilitation or inhibition of neurotransmitter systems, spinal cord stimulation, and rehabilitative motor training, which all function by modulating the physiological state of the spinal circuitry, have emerged as promising approaches. Early technological developments, such as robotic training systems and high-density electrode arrays for stimulating the spinal cord, can significantly enhance the precision and minimize the invasiveness of treatment after an injury. Strategies that seek out the complementary effects of combination treatments and that efficiently integrate relevant technical advances in bioengineering represent an untapped potential and are likely to have an immediate impact. Herein, we review key findings in each of these areas of research and present a unified vision for moving forward. Much work remains, but we already have the capability, and more importantly, the responsibility, to help spinal cord injury patients now. PMID:19660669

  2. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

    PubMed Central

    Kim, Terrence T.; Johnson, J. Patrick; Pashman, Robert; Drazin, Doniel

    2016-01-01

    We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

  3. Pyogenic spinal osteomyelitis: a review of 61 cases.

    PubMed

    Silverthorn, K G; Gillespie, W J

    1986-02-12

    The presentation and outcome of 61 cases of nontuberculous spinal osteomyelitis were reviewed. Although the commonest presentation was subacute, with back pain predominating, 10% had septicaemia and 7% paraperesis or paraplegia. Most infections were caudal to the fourth thoracic vertebra. One third were associated with preceding urinary, respiratory, dental or abdominal sepsis. Staphylococcus aureus was the infecting organism in 85% of isolates. Delay in diagnosis was frequent. There were four deaths, and seven individuals remained severely disabled: outcome was otherwise satisfactory. An algorithm for the investigation and management of this uncommon but serious condition is proposed. PMID:3456113

  4. Correlation of thermography with spinal dysfunction: preliminary results

    PubMed Central

    Diakow, Peter RP; Ouellet, Sandra; Lee, Selina; Blackmore, Edward J

    1988-01-01

    The results of a blinded pilot study researching the correlation of thermographic abnormalities and spinal segmental dysfunction are presented. The highest agreement resulted between focal increases in thermal emission and fixation (64.7%). Other parameters studied were tenderness and textural skin changes which agreed with thermographic findings 63.7% and 59.9% respectively. Correlation coefficients were calculated for each subject and reasons for the wide range (r = .14 to .77) were discussed. Discussion of this research design and suggestions for future study were also presented.

  5. Intracranial hypotension secondary to spinal pathology: Diagnosis and treatment.

    PubMed

    Sartip, Kamyar; McKenna, Gregory; Spina, Michael; Grahovac, Stephen

    2016-04-01

    Spinal pathology resulting in cerebrospinal fluid (CSF) leak and intracranial hypotension is an infrequently reported and a potentially severe cause of headaches. We present a case of cerebrospinal fluid (CSF) leak caused by a thoracic disk herniation successfully treated with two targeted epidural blood patches. Although patients typically present with orthostatic headaches, the imaging findings of intracranial hypotension should prompt investigation of the spine for site and cause of the CSF leakage. Treatment includes autologous blood patch and surgery in refractory cases. PMID:26914140

  6. Effect of a single dose of pamidronate administered at the time of surgery in a rabbit posterolateral spinal fusion model

    PubMed Central

    Briceno, Jorge; Carmona, Maximiliano; Olavarria, Fernando; Hodgson, Felipe

    2010-01-01

    Spinal fusion is usually performed on patients who receive bisphosphonates (BP); however, limited data on their action on spinal fusion are available. Previous studies in animal models have shown that chronic administrations of BP reduced spinal fusion rates, and only one study has shown that a single dose administration of zolendronic acid increased fusion rate. The objective of the present study was to evaluate if pamidronate (PA), which was previously demonstrated to reduce spinal fusion rate when administered continuously for 8 weeks, would increase the spinal fusion rate if administered in a single dose at the time of surgery in a rabbit model. Thirty-two New Zealand rabbits underwent an L5–L6 posterolateral intertransverse fusion with iliac crest autograft. Animals were randomized to receive either PA 3 mg/kg in a single dose immediately after surgery, or normal saline. Animals were killed 8 weeks after surgery and fusion was determined by manual palpation and radiographic analysis. Fusion healing was obtained in eight rabbits (50%) in the PA group and in four animals (25%) in the control group, p = 0.137. In a rabbit model, a single dose of PA did not decrease lumbar spinal arthrodesis consolidation rates, but it obtained a nonsignificant higher spinal fusion rate. PMID:20127496

  7. Adiposity and spinal cord injury

    PubMed Central

    Gorgey, Ashraf S; Wells, Kathryn M; Austin, Timothy L

    2015-01-01

    The drastic changes in body composition following spinal cord injury (SCI) have been shown to play a significant role in cardiovascular and metabolic health. The pattern of storage and distribution of different types of adipose tissue may impact metabolic health variables similar to carbohydrate, lipid and bone metabolism. The use of magnetic resonance imaging provides insights on the interplay among different regional adipose tissue compartments and their role in developing chronic diseases. Regional adipose tissue can be either distributed centrally or peripherally into subcutaneous and ectopic sites. The primary ectopic adipose tissue sites are visceral, intramuscular and bone marrow. Dysfunction in the central nervous system following SCI impacts the pattern of distribution of adiposity especially between tetraplegia and paraplegia. The current editorial is focused primarily on introducing different types of adipose tissue and establishing scientific basis to develop appropriate dietary, rehabilitation or pharmaceutical interventions to manage the negative consequences of increasing adiposity after SCI. We have also summarized the clinical implications and future recommendations relevant to study adiposity after SCI. PMID:26396933

  8. Spinal Hydatid Disease: A Case Series

    PubMed Central

    Prabhakar, Mukund M; Acharya, Apurv J; Modi, Dhaval R; Jadav, Bhavin

    2005-01-01

    Background: Over the past 10 years, 4 cases of spinal hydatid disease (3 men, 1 woman) were diagnosed and treated at our institution, with an average follow-up of 4 years. Hydatid disease of the spine is a rare condition with a poor prognosis that presents diagnostic and therapeutic challenges. Methods: The patients were evaluated clinically, using the latest imaging modalities available in our institution. Decompressive surgeries were performed and the diagnosis was confirmed by histopathologic examination. All patients received long-term antihelminthic therapy with 400 mg of albendazole 3 times daily for 1 year. Results: After surgery, all patients improved; however, over time, recurrence and residual disease were observed. Two patients had complete neurologic recovery at follow-up at 2 to 3 years, although there were radiographic signs of recurrence. The other 2 patients did not achieve complete neurologic recovery despite anterior decompression; they developed recurrent disease and the neurologic status deteriorated to spastic paraplegia. All patients refused further surgeries for recurrences and 2 patients died of complications of paraplegia. Conclusion: Diagnosis was challenging, eradication was difficult, and hydatid disease recurred in all 4 patients. In our experience, morbidity and mortality were high and prognosis was poor. PMID:16869090

  9. Proximal spinal muscular atrophy: current orthopedic perspective.

    PubMed

    Haaker, Gerrit; Fujak, Albert

    2013-01-01

    Spinal muscular atrophy (SMA) is a hereditary neuromuscular disease of lower motor neurons that is caused by a defective "survival motor neuron" (SMN) protein that is mainly associated with proximal progressive muscle weakness and atrophy. Although SMA involves a wide range of disease severity and a high mortality and morbidity rate, recent advances in multidisciplinary supportive care have enhanced quality of life and life expectancy. Active research for possible treatment options has become possible since the disease-causing gene defect was identified in 1995. Nevertheless, a causal therapy is not available at present, and therapeutic management of SMA remains challenging; the prolonged survival is increasing, especially orthopedic, respiratory and nutritive problems. This review focuses on orthopedic management of the disease, with discussion of key aspects that include scoliosis, muscular contractures, hip joint disorders, fractures, technical devices, and a comparative approach of conservative and surgical treatment. Also emphasized are associated complications including respiratory involvement, perioperative care and anesthesia, nutrition problems, and rehabilitation. The SMA disease course can be greatly improved with adequate therapy with established orthopedic procedures in a multidisciplinary therapeutic approach. PMID:24399883

  10. Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature

    PubMed Central

    Sasani, Mehdi; Ozer, Ali F; Vural, Metin; Sarioglu, Ali C

    2009-01-01

    Background: Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy frequently present in Brown-Séquard syndrome. Preoperative diagnosis can be made with magnetic resonance imaging (MRI). Many surgical techniques have been applied by various authors and are usually reversible by surgical treatment. Methods: Case report and review of the literature. Findings: A 45-year-old woman with Brown-Séquard syndrome underwent thoracic MRI, which revealed transdural spinal cord herniation at T8 vertebral body level. During surgery the spinal cord was reduced and the ventral dural defect was restorated primarily and reinforced with a thin layer of subdermal fat. The dural defect was then closed with interrupted stitches. Results: Although neurologic status improved postoperatively, postsurgical MRI demonstrated swelling and abnormal T2-signal intensity in the reduced spinal cord. Review of the English language literature revealed 100 ISCH cases. Conclusions: ISCH is a rare clinical entity that should be considered in differential diagnosis of Brown-Séquard syndrome, especially among women in their fifth decade of life. Outcome for patients who initially had Brown-Séquard syndrome was significantly better than for patients who presented with spastic paralysis. Although progression of neurologic deficits can be very slow, reduction of the spinal cord and repair of the defect are crucial in stopping or reversing the deterioration. PMID:19264054

  11. Lumbar spinal epidural arteriovenous fistula with perimedullary venous drainage after endoscopic lumbar surgery

    PubMed Central

    Murakami, Toshiharu; Wada, Takeshi; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2015-01-01

    Spinal epidural arteriovenous fistulas (AVFs) with perimedullary venous drainage are rare. This report describes a case of lumbar epidural AVF in a patient with a history of endoscopic lumbar discectomy at the same level 8 years prior to presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. A 69-year-old man presented with progressive lower extremity weakness and sensory disturbance and loss of sphincter control 8 years after endoscopic lumbar discectomy for a disc herniation at L4–5 level. Magnetic resonance imaging showed spinal cord edema and dilated intradural perimedullary vessels. Spinal angiography revealed an epidural AVF at the site of the previous endoscopic lumbar surgery with intradural perimedullary venous drainage. The fistula was successfully occluded via endovascular transarterial embolization, and the patient had stabilization of his neurological deficits. Lumbar spinal epidural AVFs, especially those associated with iatrogenic trauma, are rare. Endoscopic surgical procedure can occlude the epidural venous plexus and disturb venous drainage, thereby inducing local venous hypertension and leading to epidural AVF with perimedullary venous drainage. This type of pathology should be considered within the differential diagnosis of delayed neurological deterioration after spinal surgery. PMID:25948114

  12. Effects of polarization in low-level laser therapy of spinal cord injury in rats

    NASA Astrophysics Data System (ADS)

    Ando, Takahiro; Sato, Shunichi; Kobayashi, Hiroaki; Nawashiro, Hiroshi; Ashida, Hiroshi; Hamblin, Michael R.; Obara, Minoru

    2012-03-01

    Low-level laser therapy (LLLT) is a promising approach to treat the spinal cord injury (SCI). Since nerve fibers have optical anisotropy, propagation of light in the spinal tissue might be affected by its polarization direction. However, the effect of polarization on the efficacy of LLLT has not been elucidated. In the present study, we investigated the effect of polarization on the efficacy of near-infrared LLLT for SCI. Rat spinal cord was injured with a weight-drop device. The lesion site was irradiated with an 808-nm diode laser beam that was transmitted through a polarizing filter immediately after injury and daily for five consecutive days. The laser power at the injured spinal cord surface was 25 mW, and the dosage per day was 9.6 J/cm2 (spot diameter, 2 cm; irradiation duration, 1200 s). Functional recovery was assessed daily by an open-field test. The results showed that the functional scores of the SCI rats that were treated with 808-nm laser irradiation were significantly higher than those of the SCI alone group (Group 1) from day 5 after injury, regardless of the polarization direction. Importantly, as compared to the locomotive function of the SCI rats that were treated with the perpendicularly-polarized laser parallel to the spinal column (Group 2), that of the SCI rats that were irradiated with the linearly aligned polarization (Group 3) was significantly improved from day 10 after injury. In addition, the ATP contents in the injured spinal tissue of Group 3, which were measured immediately after laser irradiation, were moderately higher than those of Group 2. These observations are attributable to the deeper penetration of the parallelpolarized light in the anisotropic spinal tissue, suggesting that polarization direction significantly affects the efficacy of LLLT for SCI.

  13. Matrix Metalloproteinases Limit Functional Recovery after Spinal Cord Injury by Modulation of Early Vascular Events

    PubMed Central

    Noble, Linda J.; Donovan, Frances; Igarashi, Takuji; Goussev, Staci; Werb, Zena

    2009-01-01

    Inflammation in general and proteinases generated as a result are likely mediators of early secondary pathogenesis after spinal cord injury. We report that matrix metalloproteinase-9 (MMP-9) plays an important role in blood–spinal cord barrier dysfunction, inflammation, and locomotor recovery. MMP-9 was present in the meninges and neurons of the uninjured cord. MMP-9 increased rapidly after a moderate contusion spinal cord injury, reaching a maximum at 24 hr, becoming markedly reduced by 72 hr, and not detectable at 7 d after injury. It was seen in glia, macrophages, neutrophils, and vascular elements in the injured spinal cord at 24 hr after injury. The natural tissue inhibitors of MMPs were unchanged over this time course. MMP-9-null mice exhibited significantly less disruption of the blood–spinal cord barrier, attenuation of neutrophil infiltration, and significant locomotor recovery compared with wild-type mice. Similar findings were observed in mice treated with a hydroxamic acid MMP inhibitor from 3 hr to 3 d after injury, compared with the vehicle controls. Moreover, the area of residual white matter at the lesion epicenter was significantly greater in the inhibitor-treated group. This study provides evidence that MMP-9 plays a key role in abnormal vascular permeability and inflammation within the first 3 d after spinal cord injury, and that blockade of MMPs during this critical period attenuates these vascular events and leads to improved locomotor recovery. Our findings suggest that early inhibition of MMPs may be an efficacious strategy for the spinal cord-injured patient. PMID:12196576

  14. Locomotor impact of beneficial or nonbeneficial H-reflex conditioning after spinal cord injury.

    PubMed

    Chen, Yi; Chen, Lu; Liu, Rongliang; Wang, Yu; Chen, Xiang Yang; Wolpaw, Jonathan R

    2014-03-01

    When new motor learning changes neurons and synapses in the spinal cord, it may affect previously learned behaviors that depend on the same spinal neurons and synapses. To explore these effects, we used operant conditioning to strengthen or weaken the right soleus H-reflex pathway in rats in which a right spinal cord contusion had impaired locomotion. When up-conditioning increased the H-reflex, locomotion improved. Steps became longer, and step-cycle asymmetry (i.e., limping) disappeared. In contrast, when down-conditioning decreased the H-reflex, locomotion did not worsen. Steps did not become shorter, and asymmetry did not increase. Electromyographic and kinematic analyses explained how H-reflex increase improved locomotion and why H-reflex decrease did not further impair it. Although the impact of up-conditioning or down-conditioning on the H-reflex pathway was still present during locomotion, only up-conditioning affected the soleus locomotor burst. Additionally, compensatory plasticity apparently prevented the weaker H-reflex pathway caused by down-conditioning from weakening the locomotor burst and further impairing locomotion. The results support the hypothesis that the state of the spinal cord is a "negotiated equilibrium" that serves all the behaviors that depend on it. When new learning changes the spinal cord, old behaviors undergo concurrent relearning that preserves or improves their key features. Thus, if an old behavior has been impaired by trauma or disease, spinal reflex conditioning, by changing a specific pathway and triggering a new negotiation, may enable recovery beyond that achieved simply by practicing the old behavior. Spinal reflex conditioning protocols might complement other neurorehabilitation methods and enhance recovery. PMID:24371288

  15. Tolerance of the Spinal Cord to Stereotactic Radiosurgery: Insights From Hemangioblastomas

    SciTech Connect

    Daly, Megan E.; Choi, Clara Y.H.; Gibbs, Iris C.; Adler, John R.; Chang, Steven D.; Lieberson, Robert E.; Soltys, Scott G.

    2011-05-01

    Purpose: To evaluate spinal cord dose-volume effects, we present a retrospective review of stereotactic radiosurgery (SRS) treatments for spinal cord hemangioblastomas. Methods and Materials: From November 2001 to July 2008, 27 spinal hemangioblastomas were treated in 19 patients with SRS. Seventeen tumors received a single fraction with a median dose of 20 Gy (range, 18-30 Gy). Ten lesions were treated using 18-25 Gy in two to three sessions. Cord volumes receiving 8, 10, 12, 14, 16, 18, 20, 22, and 24 Gy and dose to 10, 100, 250, 500, 1000, and 2000 mm{sup 3} of cord were determined. Multisession treatments were converted to single-fraction biologically effective dose (SFBED). Results: Single-fraction median cord D{sub max} was 22.7 Gy (range, 17.8-30.9 Gy). Median V10 was 454 mm{sup 3} (range, 226-3543 mm{sup 3}). Median dose to 500 mm{sup 3} cord was 9.5 Gy (range, 5.3-22.5 Gy). Fractionated median SFBED{sub 3} cord D{sub max} was 14.1 Gy{sub 3} (range, 12.3-19.4 Gy{sub 3}). Potential toxicities included a Grade 2 unilateral foot drop 5 months after SRS and 2 cases of Grade 1 sensory deficits. The actuarial 3-year local tumor control estimate was 86%. Conclusions: Despite exceeding commonly cited spinal cord dose constraints, SRS for spinal hemangioblastomas is safe and effective. Consistent with animal experiments, these data support a partial-volume tolerance model for the human spinal cord. Because irradiated cord volumes were generally small, application of these data to other clinical scenarios should be made cautiously. Further prospective studies of spinal radiosurgery are needed.

  16. New software applications for interchangeable instrumentation in spinal stereotaxis.

    PubMed

    Kim, K D; Johnson, J P; Bloch, O; Masciopinto, J E; Saracen, M J; Villablanca, J P

    1999-01-01

    Computer image-guided surgery has been widely accepted because it allows the surgeon to track an instrument through unvisualized critical structures of a patient in real-time, thus minimizing the risk of injury. Current spinal and cranial image-guided surgery is, however, limited by the lack of surgical instruments and software applications that would allow rapid interchange of useful instruments to perform the procedures. Most image-guided systems utilize a single standard probe or a few pre-defined instruments that are not necessarily useful for performing the actual surgical procedure. Present image-guided technology for screw placement in spinal surgery utilizes the standard probe only to confirm the entry point location and view the planned trajectory of the screw. The surgeon then resumes the procedure using standard surgical instruments to drill, tap and place screws without the benefit of image guidance. Our clinical laboratory experience with spinal image-guided surgery indicates that there is potential for error between each of these procedural steps of screw placement. Despite accurately locating an entry point, any deviation in the trajectory during drilling of a pilot hole, tapping or screw placement may result in significant errors in screw placement and potential neurovascular injury. We have developed custom software applications and universal hardware adaptation devices for spinal image-guided surgery that allow the use of standard instruments for intraoperative guidance. Utilizing universal dynamic registration hardware and software, standard surgical instruments are adapted for real-time image guided surgery. An array of light emitting diodes can be attached to essentially any rigid instrument with a definable tip and then calibrated to the system for intraoperative use. Laboratory tests using a cadaveric model indicate a difference in accuracy of less than 1.0 mm between the standard probe and a dynamically registered custom instrument and an absolute mean error of less than 2.0 mm for the image-guided system which is clinically insignificant in most cases. This technology is a significant step forward as it allows the surgeon to use a full array of instruments with image guidance and will ultimately make spinal and intracranial surgery safer and more accurate. PMID:10538351

  17. Transient Ischemic Attacks of Spinal Cord due to Abdominal Aortic Aneurysm Thrombus.

    PubMed

    Ates, Ihsan; Kaplan, Mustafa; Özçalık, Merve; Yılmaz, Nisbet

    2016-01-01

    Thrombosis due to abdominal aortic aneurysm is a rare condition that causes high mortality. Transient ischemic attack of the spinal cord can occur as a result of trash emboli from thrombus in abdominal aortic aneurysm. This condition generally occurs during operation of abdominal aortic aneurysm; very rarely, it can also be seen in laminated abdominal aortic aneurysm. Here, we present a case of a patient presenting with bilateral lower extremity paralysis resulting from transient ischemic attack of the spinal cord due to infrarenal abdominal aortic aneurysm. PMID:26520423

  18. [Glioblastoma multiforme with intra- and extramedullary dissemination to the spinal cord].

    PubMed

    Hansson, Karin; Gutte, Henrik; Idris, Fadi

    2013-04-15

    Metastases to the spinal cord from glioblastoma multiforme (GBM) are uncommon, but important to have in mind when patients with a history of GBM present with symptoms that do not correlate with the primary disease pattern. We report a rare case, where a male with GBM, six months after tumour excision followed by concomitant radio- and chemotherapy, presented with gait disturbance and unspecific neurological symptoms of the lower right limb. Magnetic resonance imaging of columna totalis revealed both intra- and extramedullary metastases in the spinal cord. The patient died one month later. PMID:23651753

  19. Anaplastic pleomorphic xanthoastrocytoma with spinal leptomeningeal spread at the time of diagnosis in an adult.

    PubMed

    Benjamin, Carolina; Faustin, Arline; Snuderl, Matija; Pacione, Donato

    2015-08-01

    We describe the first patient, to our knowledge, with anaplastic pleomorphic xanthoastrocytoma (PXA) with spinal leptomeningeal spread at the time of diagnosis and present a review of the literature. PXA is a tumor that typically has an indolent course but occasionally, when anaplastic features are present, behaves in a more aggressive manner. We found that PXA with spinal leptomeningeal spread at the time of diagnosis confers a worse prognosis. Craniospinal imaging should be obtained at time of diagnosis of PXA and the presence of leptomeningeal spread may be indicative of a more aggressive disease process. PMID:25934112

  20. Afferent pathway and neuromodulation of superficial and deeper thoracic spinal neurons receiving noxious pulmonary inputs in rats.

    PubMed

    Qin, Chao; Foreman, Robert D; Farber, Jay P

    2007-01-30

    The occurrence of vagally mediated afferent signaling by lung irritants is well known. However, spinal visceral afferent pathways also might be relevant to pulmonary irritation. In the present study, responses and modulation of superficial and deep T3 spinal neurons were examined using inhaled ammonia, and the peripheral afferent fibers were also characterized in part. Extracellular potentials of single thoracic (T3) spinal neurons were recorded in pentobarbital anesthetized, paralyzed, and ventilated male rats. Ammonia vapor (0.5, 1.0, 2.0 ml) was injected into the inspiratory line of the ventilator for 20 s. Inhaled ammonia (IA, 1.0 ml) excited 5/6 neurons and inhibited one spinal neuron recorded in superficial laminae, whereas deeper neurons responded with excitatory (E, n = 20), inhibitory (I, n = 4) or biphasic patterns (6 E-I, 3 I-E). Electrical and chemical stimulation of C1-C2 spinal neurons primarily suppressed T3 neuronal responses to IA. Resiniferatoxin (2 microg/kg, i.v.), which desensitizes afferent fibers containing transient receptor potential vanilloid receptor-1 (TRPV-1), abolished excitatory responses of 8/8 neurons to IA. Bilateral cervical vagotomy did not affect IA responses in 5 superficial neurons while 7 deeper neurons showed variable responses. 82% (32/39) of the spinal neurons responding to IA also received convergent noxious inputs from somatic fields in the chest and back areas. These results suggested that superficial and deeper spinal neuronal activation by inhaled ammonia mainly depended upon pulmonary sympathetic afferent fibers expressing TRPV-1. Additionally, C1-C2 spinal neurons, supraspinal sites and vagal afferents modulated the thoracic spinal neuronal responses to lower airway irritation. PMID:16935568

  1. Techniques for precision irradiation of the lateral half of the rat cervical spinal cord using 150 MeV protons

    NASA Astrophysics Data System (ADS)

    van Luijk, P.; Bijl, H. P.; Coppes, R. P.; van der Kogel, A. J.; Konings, A. W. T.; Pikkemaat, J. A.; Schippers, J. M.

    2001-11-01

    Techniques for high precision irradiation experiments with protons, to investigate the volume dependence of the tolerance dose of the rat cervical spinal cord are described. In the present study, 50% of the lateral cross section of the spinal cord was irradiated. The diameter of the cross section of this part of the rat spinal cord is at maximum 3.5 mm. Therefore, a dedicated procedure was developed to comply with the needs for a very high positioning accuracy and high spatial resolution dosimetry. By using 150 MeV protons a steep dose gradient (20-80% = 1 mm) in the centre of the spinal cord was achieved. This yields a good dose contrast between the left and right halves of the cord. A home-made digital x-ray imager with a pixel resolution of 0.18 mm/pixel was used for position verification of the spinal cord. A positioning accuracy of 0.09 mm was obtained by using information of multiple pixels. The average position stability during the irradiation was found to be 0.08 mm (1 SD) without significant systematic deviations. Profiles of the dose distribution were measured with a 2D dosimetry system consisting of a scintillating screen and a CCD camera. Dose volume histograms of the whole spinal cord as well as separately of the white and grey matters were calculated using MRI imaging of the cross section of the rat cervical spinal cord. From the irradiation of 20 animals a dose-response curve has been established. MRI showed radiation-induced damage at the high dose side of the spinal cord. Analysis of the preliminary dose-response data shows a significant dose-volume effect. With the described procedure and equipment it is possible to perform high precision irradiations on selected parts of the spinal cord.

  2. Effects of Local Administration of Boric Acid on Posterolateral Spinal Fusion with Autogenous Bone Grafting in a Rodent Model.

    PubMed

    Kömürcü, Erkam; Özyalvaçlı, Gülzade; Kaymaz, Burak; Gölge, Umut Hatay; Göksel, Ferdi; Cevizci, Sibel; Adam, Gürhan; Ozden, Raif

    2015-09-01

    Spinal fusion is among the most frequently applied spinal surgical procedures. The goal of the present study was to evaluate whether the local administration of boric acid (BA) improves spinal fusion in an experimental spinal fusion model in rats. Currently, there is no published data that evaluates the possible positive effects if the local administration of BA on posterolateral spinal fusion. Thirty-two rats were randomly divided into four independent groups: no material was added at the fusion area for group 1; an autogenous morselized corticocancellous bone graft was used for group 2; an autogenous morselized corticocancellous bone graft with boric acid (8.7 mg/kg) for group 3; and only boric acid was placed into the fusion area for group 4. The L4-L6 spinal segments were collected at week 6, and the assessments included radiography, manual palpation, and histomorphometry. A statistically significant difference was determined between the groups with regard to the mean histopathological scores (p = 0.002), and a paired comparison was made with the Mann-Whitney U test to detect the group/groups from which the difference originated. It was determined that only the graft + BA practice increased the histopathological score significantly with regard to the control group (p = 0.002). Whereas, there was no statistically significant difference between the groups in terms of the manual assessment of fusion and radiographic analysis (respectively p = 0.328 and p = 0.196). This preliminary study suggests that BA may clearly be useful as a therapeutic agent in spinal fusion. However, further research is required to show the most effective dosage of BA on spinal fusion, and should indicate whether BA effects spinal fusion in the human body. PMID:25728510

  3. Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis

    PubMed Central

    Al-Shaar, Hussam Abou; AbouAl-Shaar, Iyad; Al-Kawi, Mohammed Z.

    2015-01-01

    Acute infarction of the cervical segment of the spinal cord is extremely uncommon. Patients may present with signs and symptoms mimicking that of acute myelitis. On imaging, both conditions may present as a hyperintense area on T-2 weighted MRI. History of sudden onset is essential in establishing the diagnosis. We report a case of cervical spinal cord infarction in a 40-year-old man who was diagnosed with acute transverse myelitis, and was treated with high dose intravenous corticosteroids followed by 5 sessions of plasma exchange. An MRI of the spine revealed abnormal high T2 signal intensity extending from the C2 to C7 level involving the anterior two-thirds of the cord with more central involvement. The findings were consistent with anterior spinal artery territory cervical cord infarction. PMID:26492118

  4. Agmatine reverses pain induced by inflammation, neuropathy, and spinal cord injury

    PubMed Central

    Fairbanks, Carolyn A.; Schreiber, Kristin L.; Brewer, Kori L.; Yu, Chen-Guang; Stone, Laura S.; Kitto, Kelley F.; Nguyen, H. Oanh; Grocholski, Brent M.; Shoeman, Don W.; Kehl, Lois J.; Regunathan, Soundararajan; Reis, Donald J.; Yezierski, Robert P.; Wilcox, George L.

    2000-01-01

    Antagonists of glutamate receptors of the N-methyl-d-aspartate subclass (NMDAR) or inhibitors of nitric oxide synthase (NOS) prevent nervous system plasticity. Inflammatory and neuropathic pain rely on plasticity, presenting a clinical opportunity for the use of NMDAR antagonists and NOS inhibitors in chronic pain. Agmatine (AG), an endogenous neuromodulator present in brain and spinal cord, has both NMDAR antagonist and NOS inhibitor activities. We report here that AG, exogenously administered to rodents, decreased hyperalgesia accompanying inflammation, normalized the mechanical hypersensitivity (allodynia/hyperalgesia) produced by chemical or mechanical nerve injury, and reduced autotomy-like behavior and lesion size after excitotoxic spinal cord injury. AG produced these effects in the absence of antinociceptive effects in acute pain tests. Endogenous AG also was detected in rodent lumbosacral spinal cord in concentrations similar to those previously detected in brain. The evidence suggests a unique antiplasticity and neuroprotective role for AG in processes underlying persistent pain and neuronal injury. PMID:10984543

  5. Spontaneous rupture of spinal dermoid cyst with disseminated lipid droplets in central canal and ventricles.

    PubMed

    Goyal, A; Singh, D; Singh, A K; Gupta, V; Sinha, S

    2004-06-01

    Free fat in the ventricular space is a rare but well recognized complication of ruptured tumour of dermal origin. However, only 1 patient of spontaneous rupture of spinal dermoid tumour with disseminated fat in the central canal and ventricles has been described in the literature. The authors report an extremely rare case of ruptured intraspinal dermoid and passage of free fatty droplets via the patent central canal to the intracranial CSF space. The detailed clinical presentation, radiological findings, and review of the literature are presented. Despite being rarely reported, spinal dermoid cyst can rupture spontaneously, and free fat disseminate into the ventricles, and in extremely rare cases, fat can enter into the central canal. It is underlinerd that a prompt detection, with the help of MRI is essential in cases of spinal dermoid tumour cyst, with sudden deterioration in neurological condition, keeping in mind, the possibility of free fat in the central canal. PMID:15550900

  6. Diagnosis and treatment of a patient with isolated spinal granulocytic sarcoma: A case report

    PubMed Central

    XIAO, RUO-ZHI; LONG, ZI-JIE; XIONG, MU-JUN; WANG, WEN-WEN; LIN, DONG-JUN

    2013-01-01

    A previously healthy 34-year-old female presented with a 5-month history of progressive backache and weakness in the left fingers. Magnetic resonance imaging (MRI) showed soft tissue masses in the spinal canal distributed along the nerve course. The patient’s baseline laboratory data were normal. Surgical intervention was performed and histological examination identified isolated spinal granulocytic sarcoma (GS). A bone marrow biopsy also presented normal findings. However, the patient developed numbness and pain in the right lower limb two months later. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed FDG uptake in the left trapezius muscle, cervix uteri, iliac bone, lymphadenectasis of the pelvic wall and left axillary fossa. Cerebrospinal fluid (CSF) examination allowed a diagnosis of central nervous system leukemia (CNSL). The patient underwent chemotherapy and intrathecal injection, resulting in the elimination of the residual lesion. Correct diagnosis and adequate treatment are essential to achieve optimal results in patients with isolated spinal GS. PMID:23599768

  7. Diagnosis and treatment of a patient with isolated spinal granulocytic sarcoma: A case report.

    PubMed

    Xiao, Ruo-Zhi; Long, Zi-Jie; Xiong, Mu-Jun; Wang, Wen-Wen; Lin, Dong-Jun

    2013-04-01

    A previously healthy 34-year-old female presented with a 5-month history of progressive backache and weakness in the left fingers. Magnetic resonance imaging (MRI) showed soft tissue masses in the spinal canal distributed along the nerve course. The patient's baseline laboratory data were normal. Surgical intervention was performed and histological examination identified isolated spinal granulocytic sarcoma (GS). A bone marrow biopsy also presented normal findings. However, the patient developed numbness and pain in the right lower limb two months later. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed FDG uptake in the left trapezius muscle, cervix uteri, iliac bone, lymphadenectasis of the pelvic wall and left axillary fossa. Cerebrospinal fluid (CSF) examination allowed a diagnosis of central nervous system leukemia (CNSL). The patient underwent chemotherapy and intrathecal injection, resulting in the elimination of the residual lesion. Correct diagnosis and adequate treatment are essential to achieve optimal results in patients with isolated spinal GS. PMID:23599768

  8. Radiation tolerance of the cervical spinal cord

    SciTech Connect

    McCunniff, A.J.; Liang, M.J.

    1989-03-01

    The incidence of permanent injury to the spinal cord as a complication of radiation therapy generally correlates positively with total radiation dosage. However, several reports in the literature have indicated that fraction size is also an important factor in the development or nondevelopment of late injuries in normal tissue. To determine the effect of fraction size on the incidence of radiation-induced spinal cord injuries, we reviewed 144 cases of head and neck cancer treated at our institution between 1971 and 1980 with radiation greater than 5600 cGy to a portion of the cervical spinal cord. Most of these patients received greater than or equal to 6000 cGy, with fraction sizes ranging from 133 cGy to 200 cGy. Fifty-three of the 144 patients have been followed up for 2 years or more. Nearly half of these (26 patients) received greater than 6000 cGy with fraction sizes of 133 cGy to 180 cGy. Only 1 of the 53 (1.9%) has sustained permanent spinal cord injury; 20 months after completion of radiation treatments he developed Brown-Sequard syndrome. Our experience suggests that radiation injuries to the spinal cord correlate not only with total radiation dosage, but also with fraction size; low fraction sizes appear to decrease the incidence of such injuries.

  9. Rehabilitation and treatment of spinal cord tumors

    PubMed Central

    Raj, Vishwa S.; Lofton, LaTanya

    2013-01-01

    Context Due to advances in acute oncological treatment, patients with spinal cord tumors exhibit improved survival. However, these patients have not received the full benefits of rehabilitation services to address their neurological deficits and rehabilitation goals. Objective To evaluate the epidemiology and pathophysiology of spinal cord tumors, address methods of acute oncological management, review treatment for neurological sequelae, and understand the implications as they relate to rehabilitation. Methods An extensive literature review was performed regarding the epidemiology, pathophysiology, acute oncological management, neurological sequelae, and rehabilitation for patients with spinal cord tumors. Databases used included pubmed.gov and OVID, as well as individual journal and textbook articles. Results Access to treatment should be increased given improved survival and functional deficits for patients with spinal cord tumors. Individuals can benefit from inpatient rehabilitation programs, in spite of increased medical co-morbidity and neurological deficits. Specific areas of improvement include functionality, mood, quality of life, and survival. Adjustments to treatment plans must incorporate medical complications from cancer and its treatment, perceived quality of life, and prognosis. Conclusions Patients with spinal cord tumors who participate in rehabilitation programs show general improvement in function, mood, quality of life, and survival. Adaptations to care plans should be made to accommodate medical co-morbidities from cancer and its treatment, patient perceptions, and prognosis. PMID:23433329

  10. Developing therapies for spinal muscular atrophy.

    PubMed

    Wertz, Mary H; Sahin, Mustafa

    2016-02-01

    Spinal muscular atrophy is an autosomal-recessive pediatric neurodegenerative disease characterized by loss of spinal motor neurons. It is caused by mutation in the gene survival of motor neuron 1 (SMN1), leading to loss of function of the full-length SMN protein. SMN has a number of functions in neurons, including RNA splicing and snRNP biogenesis in the nucleus, and RNA trafficking in neurites. The expression level of full-length SMN protein from the SMN2 locus modifies disease severity. Increasing full-length SMN protein by a small amount can lead to significant improvements in the neurological phenotype. Currently available interventions for spinal muscular atrophy patients are physical therapy and orthopedic, nutritional, and pulmonary interventions; these are palliative or supportive measures and do not address the etiology of the disease. In the past decade, there has been a push for developing therapeutics to improve motor phenotypes and increase life span of spinal muscular atrophy patients. These therapies are aimed primarily at restoration of full-length SMN protein levels, but other neuroprotective treatments have been investigated as well. Here, we discuss recent advances in basic and clinical studies toward finding safe and effective treatments of spinal muscular atrophy using gene therapy, antisense oligonucleotides, and other small molecule modulators of SMN expression. PMID:26173388

  11. Vocational Rehabilitation of Persons with Spinal Cord Injuries

    ERIC Educational Resources Information Center

    Poor, Charles R.

    1975-01-01

    Reviews historical development of organized vocational rehabilitation programming for the spinal cord injured in the United States. Significant factors that affect vocational rehabilitation outcomes with spinal cord injured persons are listed and discussed. (Author)

  12. What Are Brain and Spinal Cord Tumors in Children?

    MedlinePlus

    ... as depression A change in personality Weakness or paralysis in part of the body Changes in vision, ... bowel control. Spinal cord tumors can cause weakness, paralysis, or numbness. The spinal cord is a narrow ...

  13. Genetics Home Reference: spinal muscular atrophy with progressive myoclonic epilepsy

    MedlinePlus

    ... myoclonic epilepsy spinal muscular atrophy with progressive myoclonic epilepsy Enable Javascript to view the expand/collapse boxes. ... All Description Spinal muscular atrophy with progressive myoclonic epilepsy (SMA-PME) is a neurological condition that causes ...

  14. Spinal Cord Tolerance in the Age of Spinal Radiosurgery: Lessons From Preclinical Studies

    SciTech Connect

    Medin, Paul M.; Boike, Thomas P.

    2011-04-01

    Clinical implementation of spinal radiosurgery has increased rapidly in recent years, but little is known regarding human spinal cord tolerance to single-fraction irradiation. In contrast, preclinical studies in single-fraction spinal cord tolerance have been ongoing since the 1970s. The influences of field length, dose rate, inhomogeneous dose distributions, and reirradiation have all been investigated. This review summarizes literature regarding single-fraction spinal cord tolerance in preclinical models with an emphasis on practical clinical significance. The outcomes of studies that incorporate uniform irradiation are surprisingly consistent among multiple small- and large-animal models. Extensive investigation of inhomogeneous dose distributions in the rat has demonstrated a significant dose-volume effect while preliminary results from one pig study are contradictory. Preclinical spinal cord dose-volume studies indicate that dose distribution is more critical than the volume irradiated suggesting that neither dose-volume histogram analysis nor absolute volume constraints are effective in predicting complications. Reirradiation data are sparse, but results from guinea pig, rat, and pig studies are consistent with the hypothesis that the spinal cord possesses a large capacity for repair. The mechanisms behind the phenomena observed in spinal cord studies are not readily explained and the ability of dose response models to predict outcomes is variable underscoring the need for further investigation. Animal studies provide insight into the phenomena and mechanisms of radiosensitivity but the true significance of animal studies can only be discovered through clinical trials.

  15. MRI Evaluation of Spinal Length and Vertebral Body Angle During Loading with a Spinal Compression Harness

    NASA Technical Reports Server (NTRS)

    Campbell, James A.; Hargens, Alan R.; Murthy, G.; Ballard, R. E.; Watenpaugh, D. E.; Hargens, Alan, R.; Sanchez, E.; Yang, C.; Mitsui, I.; Schwandt, D.; Fechner, K. P.; Holton, Emily M. (Technical Monitor)

    1998-01-01

    Weight bearing by the spinal column during upright posture often plays a role in the common problem of low back pain. Therefore, we developed a non-ferromagnetic spinal compression harness to enable MRI investigations of the spinal column during axial loading. Human subjects were fitted with a Nest and a footplate which were connected by adjustable straps to an analog load cell. MRI scans of human subjects (5 males and 1 female with age range of 27-53 yrs) during loaded and unloaded conditions were accomplished with a 1.5 Tesla GE Signa scanner. Studies of two subjects undergoing sequentially increasing spinal loads revealed significant decreases (r(sup 2) = 0.852) in spinal length between T4 and L5 culminating in a 1.5 to 2% length decrease during loading with 75% body weight. Sagittal vertebral body angles of four subjects placed under a constant 50% body weight load for one hour demonstrated increased lordotic and kyphotic curvatures. In the lumbar spine, the L2 vertebral body experienced the greatest angular change (-3 deg. to -5 deg.) in most subjects while in the thoracic spine, T4 angles increased from the unloaded state by +2 deg. to +9 deg. Overall, our studies demonstrate: 1) a progressive, although surprisingly small, decrease in spinal length with increasing load and 2) relatively large changes in spinal column angulation with 50% body weight.

  16. Ruptured spinal dermoid cyst with disseminated intracranial fat droplets.

    PubMed

    Cha, J G; Paik, S-H; Park, J-S; Park, S-J; Kim, D-H; Lee, H-K

    2006-02-01

    Fat droplets in the cerebrospinal fluid (CSF) is a well-known complication of ruptured intracranial dermoid tumours. We report an unusual case of a ruptured spinal dermoid tumour. MR images showed a tethered spinal cord and an intramedullary fat-containing mass. Fat droplets were revealed in the ventricles and the cisternal spaces on brain CT and brain MR. In the English literature, a ruptured spinal dermoid tumour accompanying a tethered spinal cord is extremely rare. PMID:16489200

  17. Intractable Pruritus After Traumatic Spinal Cord Injury

    PubMed Central

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

    2009-01-01

    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

  18. Percutaneous endoscopic decompression for lumbar spinal stenosis.

    PubMed

    Ahn, Yong

    2014-11-01

    Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery. PMID:25033889

  19. Vascular anatomy of the spinal cord

    SciTech Connect

    Thron, A.K.

    1988-01-01

    The book summarizes the anatomic guidelines of external blood supply to the spinal cord. The basic principles of arterial supply and venous drainage are illustrated by explicit schemes for quick orientation. In the first part of the book, systematic radiologic-anatomic investigations of the superficial and deep vessels of all segments of the spinal cord are introduced. The microvascular morphology is portrayed by numerous microradiographic sections in all three dimensions without overshadowing. The three-dimensional representation of the vascular architecture illustrates elementary outlines and details of arterial territories, anastomotic cross-linking as well as the capillary system, particularly the hitherto unknown structure of the medullary venous system with its functionally important anastomoses and varying regional structures. These often now radiologic-anatomic findings are discussed as to their functional and pathophysiologic impact and constitute the basic on which to improve one's understanding of vascular syndromes of the spinal cord.

  20. Surgical Strategies for Cervical Spinal Neurinomas

    PubMed Central

    ITO, Kiyoshi; AOYAMA, Tatsuro; MIYAOKA, Yoshinari; HORIUCHI, Tetsuyoshi; HONGO, Kazuhiro

    Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis. PMID:26119900

  1. Cannabinoids to treat spinal cord injury.

    PubMed

    Arevalo-Martin, Angel; Molina-Holgado, Eduardo; Garcia-Ovejero, Daniel

    2016-01-01

    Spinal cord injury (SCI) is a devastating condition for which there is no standard treatment beyond rehabilitation strategies. In this review, we discuss the current knowledge on the use of cannabinoids to treat this condition. The endocannabinoid system is expressed in the intact spinal cord, and it is dramatically upregulated after lesion. Endogenous activation of this system counteracts secondary damage following SCI, and treatments with endocannabinoids or synthetic cannabinoid receptor agonists promote a better functional outcome in experimental models. The use of cannabinoids in SCI is a new research field and many questions remain open. Here, we discuss caveats and suggest some future directions that may help to understand the role of cannabinoids in SCI and how to take advantage of this system to regain functions after spinal cord damage. PMID:25805333

  2. Turkish Adaptation of Spinal Cord Independence Measure--Version III

    ERIC Educational Resources Information Center

    Kesiktas, Nur; Paker, Nurdan; Bugdayci, Derya; Sencan, Sureyya; Karan, Ayse; Muslumanoglu, Lutfiye

    2012-01-01

    Various rating scales have been used to assess ability in individuals with spinal cord injury. There is no specific functional assessment scale for Turkish patients with spinal cord injury. The Spinal Cord Independence Measure (SCIM) is a specific test, which has become popular in the last decade. A study was conducted to validate and evaluate the…

  3. Sexuality Counseling with Clients Who Have Spinal Cord Injuries.

    ERIC Educational Resources Information Center

    Farrow, Jeff

    1990-01-01

    Examines effects of spinal cord injury on sexuality. Discusses areas of sexual concern. Provides suggestions for treating clients with spinal cord injuries experiencing sexual difficulties. Concludes that major goal in working with clients with spinal cord injuries who have sexual difficulties should be the facilitation of a creative and…

  4. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the...; spinal tumor; and failed previous fusion (pseudarthrosis). These pedicle screw spinal systems must comply... with significant mechanical instability or deformity requiring fusion with instrumentation....

  5. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the...; spinal tumor; and failed previous fusion (pseudarthrosis). These pedicle screw spinal systems must comply... with significant mechanical instability or deformity requiring fusion with instrumentation....

  6. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the...; spinal tumor; and failed previous fusion (pseudarthrosis). These pedicle screw spinal systems must comply... with significant mechanical instability or deformity requiring fusion with instrumentation....

  7. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the...; spinal tumor; and failed previous fusion (pseudarthrosis). These pedicle screw spinal systems must comply... with significant mechanical instability or deformity requiring fusion with instrumentation....

  8. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pedicle screw spinal system. 888.3070 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3070 Pedicle screw spinal system. (a) Identification. Pedicle screw spinal systems are multiple component devices, made from a variety of...

  9. Co-Ultramicronized Palmitoylethanolamide/Luteolin Promotes Neuronal Regeneration after Spinal Cord Injury

    PubMed Central

    Crupi, Rosalia; Impellizzeri, Daniela; Bruschetta, Giuseppe; Cordaro, Marika; Paterniti, Irene; Siracusa, Rosalba; Cuzzocrea, Salvatore; Esposito, Emanuela

    2016-01-01

    Spinal cord injury (SCI) stimulates activation of astrocytes and infiltration of immune cells at the lesion site; however, the mechanism that promotes the birth of new neurons is still under debate. Neuronal regeneration is restricted after spinal cord injury, but can be stimulated by experimental intervention. Previously we demonstrated that treatment co-ultramicronized palmitoylethanolamide and luteolin, namely co-ultraPEALut, reduced inflammation. The present study was designed to explore the neuroregenerative properties of co-ultraPEALut in an estabished murine model of SCI. A vascular clip was applied to the spinal cord dura at T5–T8 to provoke injury. Mice were treated with co-ultraPEALut (1 mg/kg, intraperitoneally) daily for 72 h after SCI. Co-ultraPEALut increased the numbers of both bromodeoxyuridine-positive nuclei and doublecortin-immunoreactive cells in the spinal cord of injured mice. To correlate neuronal development with synaptic plasticity a Golgi method was employed to analyze dendritic spine density. Co-ultraPEALut administration stimulated expression of the neurotrophic factors brain-derived neurotrophic factor, glial cell-derived neurotrophic factor, nerve growth factor, and neurotrophin-3. These findings show a prominent effect of co-ultraPEALut administration in the management of survival and differentiation of new neurons and spine maturation, and may represent a therapeutic treatment for spinal cord and other traumatic diseases. PMID:27014061

  10. [Spinal circuit motor plasticity mechanisms in long-term sports activity adaptation].

    PubMed

    Andriianova, E Iu; Lanskaia, O V

    2014-01-01

    Man interacts with the environment through motor activities getting considerable sensor information from numerous internal and external sources. There is significant evidence of I-a afferents sensor information being critical in initiating of functional and morphological transformations in the periods of both development and maturation of cortex and spinal cord. Ia fibers ability to transmit sensor information, generated by muscle and motor activities, causes plastic changes in the central nervous system, enabling man to acquire new skills and movements and develop them. Therefore, understanding of activity-dependent neural plasticity mechanisms is of great importance in developing methods to perfect motor function, for example, in doing sports. This article presents the results of investigation of activity-dependent changes in spinal cord circuits in athletes. There are new data of cervical and lumbosacral motor spinal system plasticity as a result of various longterm sports activities. It is shown, in particular, that, in comparison with non-athletes, in the spinal cord of ski-racers and basketball-players the representation area of upper and lower extremities muscles alpha-motorneurons with high reflex excitability is extended. Moreover,.the direction of the extension was specified by the upper segments activity. Besides, the volume of some revealed signs of cervical and lumbosacral spinal cord plasticity in the ski-racers, involved into moderate cyclic activity, was higher than that in the basketball-players, whose movements are more various. PMID:25702462

  11. Idiopathic Ventral Spinal Cord Herniation: An Increasingly Recognized Cause of Thoracic Myelopathy

    PubMed Central

    Berg-Johnsen, Jon; Ilstad, Eivind; Kolstad, Frode; Züchner, Mark; Sundseth, Jarle

    2014-01-01

    Idiopathic spinal cord herniation (ISCH), where a segment of the spinal cord has herniated through a ventral defect in the dura, is a rarely encountered cause of thoracic myelopathy. The purpose of our study was to increase the clinical awareness of this condition by presenting our experience with seven consecutive cases treated in our department since 2005. All the patients developed pronounced spastic paraparesis or Brown-Séquard syndrome for several years (mean, 4.7 years) prior to diagnosis. MRI was consistent with a transdural spinal cord herniation in the mid-thoracic region in all the cases. The patients underwent surgical reduction of the herniated spinal cord and closure of the dural defect using an artificial dural patch. At follow-up, three patients experienced considerable clinical improvement, one had slight improvement, one had transient improvement, and two were unchanged. Two of the four patients with sphincter dysfunction regained sphincter control. MRI showed realignment of the spinal cord in all the patients. ISCH is probably a more common cause of thoracic myelopathy than previously recognized. The patients usually develop progressive myelopathy for several years before the correct diagnosis is made. Early diagnosis is important in order to treat the patients before the myelopathy has become advanced. PMID:25336997

  12. In vivo imaging of spinal cord in contusion injury model mice by multi-photon microscopy

    NASA Astrophysics Data System (ADS)

    Oshima, Y.; Horiuchi, H.; Ogata, T.; Hikita, A.; Miura, H.; Imamura, T.

    2014-03-01

    Fluorescent imaging technique is a promising method and has been developed for in vivo applications in cellular biology. In particular, nonlinear optical imaging technique, multi-photon microscopy has make it possible to analyze deep portion of tissues in living animals such as axons of spinal code. Traumatic spinal cord injuries (SCIs) are usually caused by contusion damages. Therefore, observation of spinal cord tissue after the contusion injury is necessary for understanding cellular dynamics in response to traumatic SCI and development of the treatment for traumatic SCI. Our goal is elucidation of mechanism for degeneration of axons after contusion injuries by establishing SCI model and chronic observation of injured axons in the living animals. Firstly we generated and observed acute SCI model by contusion injury. By using a multi-photon microscope, axons in dorsal cord were visualized approximately 140 micron in depth from the surface. Immediately after injury, minimal morphological change of spinal cord was observed. At 3 days after injury, spinal cord was swelling and the axons seem to be fragmented. At 7 days after injury, increased degradation of axons could be observed, although the image was blurred due to accumulation of the connective tissue. In the present study, we successfully observed axon degeneration after the contusion SCI in a living animal in vivo. Our final goal is to understand molecular mechanisms and cellular dynamics in response to traumatic SCIs in acute and chronic stage.

  13. Noninvasive detection of brainstem and spinal cord axonal degeneration in an amyotrophic lateral sclerosis mouse model.

    PubMed

    Kim, Joong Hee; Wu, Tzy-Haw; Budde, Matthew D; Lee, Jin-Moo; Song, Sheng-Kwei

    2011-02-01

    Degeneration of motor neurons and their associated axons is a hallmark of amyotrophic lateral sclerosis, but reliable noninvasive lesion detection is lacking. In vivo diffusion tensor imaging was performed to evaluate neurodegeneration in the brainstem and cervical spinal cord of wild-type and G93A-SOD1 transgenic mice, an animal model of amyotrophic lateral sclerosis. A statistically significant reduction in the apparent diffusion coefficient was observed in the motor nuclei VII and XII of G93A-SOD1 transgenic mice relative to wild-type mice. No significant difference in diffusion anisotropy was observed in dorsal white or gray matter in cervical and lumbar segments of the spinal cord. In contrast, statistically significant decreases in axial diffusivity (diffusivity parallel to the axis of the spinal cord) and apparent diffusion coefficient were found in the ventrolateral white matter of G93A-SOD1 mice in both the cervical and lumbar spinal cord. The reduction in axial diffusivity, suggestive of axonal injury, in the white matter of the spinal cord of G93A-SOD1 mice was verified by immunostaining with nonphosphorylated neurofilament. The present study demonstrates that in vivo diffusion tensor imaging-derived axial diffusivity may be used to accurately evaluate axonal degeneration in an animal model of amyotrophic lateral sclerosis. PMID:21344532

  14. Neuroprotective Effect of Ulinastatin on Spinal Cord Ischemia-Reperfusion Injury in Rabbits

    PubMed Central

    Liu, Bingbing; Huang, Weihua; Xiao, Xiaoshan; Xu, Yao; Ma, Songmei; Xia, Zhengyuan

    2015-01-01

    Ulinastatin (UTI), a trypsin inhibitor, is isolated and purified from human urine and has been shown to exert protective effect on myocardial ischemia reperfusion injury in patients. The present study was aimed at investigating the effect of ulinastatin on neurologic functions after spinal cord ischemia reperfusion injury and the underlying mechanism. The spinal cord IR model was achieved by occluding the aorta just caudal to the left renal artery with a bulldog clamp. The drugs were administered immediately after the clamp was removed. The animals were terminated 48 hours after reperfusion. Neuronal function was evaluated with the Tarlov Scoring System. Spinal cord segments between L2 and L5 were harvested for pathological and biochemical analysis. Ulinastatin administration significantly improved postischemic neurologic function with concomitant reduction of apoptotic cell death. In addition, ulinastatin treatment increased SOD activity and decreased MDA content in the spinal cord tissue. Also, ulinastatin treatment suppressed the protein expressions of Bax and caspase-3 but enhanced Bcl-2 protein expression. These results suggest that ulinastatin significantly attenuates spinal cord ischemia-reperfusion injury and improves postischemic neuronal function and that this protection might be attributable to its antioxidant and antiapoptotic properties. PMID:26161241

  15. Co-Ultramicronized Palmitoylethanolamide/Luteolin Promotes Neuronal Regeneration after Spinal Cord Injury.

    PubMed

    Crupi, Rosalia; Impellizzeri, Daniela; Bruschetta, Giuseppe; Cordaro, Marika; Paterniti, Irene; Siracusa, Rosalba; Cuzzocrea, Salvatore; Esposito, Emanuela

    2016-01-01

    Spinal cord injury (SCI) stimulates activation of astrocytes and infiltration of immune cells at the lesion site; however, the mechanism that promotes the birth of new neurons is still under debate. Neuronal regeneration is restricted after spinal cord injury, but can be stimulated by experimental intervention. Previously we demonstrated that treatment co-ultramicronized palmitoylethanolamide and luteolin, namely co-ultraPEALut, reduced inflammation. The present study was designed to explore the neuroregenerative properties of co-ultraPEALut in an estabished murine model of SCI. A vascular clip was applied to the spinal cord dura at T5-T8 to provoke injury. Mice were treated with co-ultraPEALut (1 mg/kg, intraperitoneally) daily for 72 h after SCI. Co-ultraPEALut increased the numbers of both bromodeoxyuridine-positive nuclei and doublecortin-immunoreactive cells in the spinal cord of injured mice. To correlate neuronal development with synaptic plasticity a Golgi method was employed to analyze dendritic spine density. Co-ultraPEALut administration stimulated expression of the neurotrophic factors brain-derived neurotrophic factor, glial cell-derived neurotrophic factor, nerve growth factor, and neurotrophin-3. These findings show a prominent effect of co-ultraPEALut administration in the management of survival and differentiation of new neurons and spine maturation, and may represent a therapeutic treatment for spinal cord and other traumatic diseases. PMID:27014061

  16. Heterosynaptic long-term potentiation at GABAergic synapses of spinal lamina I neurons.

    PubMed

    Fenselau, Henning; Heinke, Bernhard; Sandkühler, Jürgen

    2011-11-30

    Neurons in spinal dorsal horn lamina I play a pivotal role for nociception that critically depends on a proper balance between excitatory and inhibitory inputs. Any modification in synaptic strength may challenge this delicate balance. Long-term potentiation (LTP) at glutamatergic synapses between nociceptive C-fibers and lamina I neurons is an intensively studied cellular model of pain amplification. In contrast, nothing is presently known about long-term changes of synaptic strength at inhibitory synapses in the spinal dorsal horn. Using a spinal cord-dorsal root slice preparation from rats, we show that conditioning stimulation of primary afferent fibers with a stimulating protocol that induces LTP at C-fiber synapses also triggered LTP at GABAergic synapses (LTP(GABA)). This LTP(GABA) was heterosynaptic in nature and was mediated by activation of group I metabotropic glutamate receptors. Opening of ionotropic glutamate receptor channels of the AMPA/KA or NMDA subtype was not required for LTP(GABA). Paired-pulse ratio, coefficient of variation, and miniature IPSCs analysis revealed that LTP(GABA) was expressed presynaptically. Nitric oxide as a retrograde messenger signal mediated this increase of GABA release at spinal inhibitory synapses. This novel form of synaptic plasticity in spinal nociceptive circuits may be an essential mechanism to maintain the relative balance between excitation and inhibition and to improve the signal-to-noise ratio in nociceptive pathways. PMID:22131400

  17. An experimental spinal cord injury rat model using customized impact device: A cost-effective approach.

    PubMed

    Vijayaprakash, K M; Sridharan, N

    2013-07-01

    Till date, NYU MASCIS (New York University, Multicenter Animal Spinal Cord Injury Study) impactor and Ohio State University electromagnetic spinal cord injury device impactor were under use for simulating an experimental spinal cord injury in rodents; functional recovery being assessed through Basso, Beattie and Bresnahan (BBB) scoring method which is an open field behavior based scoring system. Although, the cited impactors are state-of-art devices, affordability to scientists in developing and under developed countries is questionable. Since the acquisition of these impact devices are expensive, we designed a customized impact device based on the requirement, satisfying all the parameters to withstand a standard animal model for contusion type of spinal cord injury at the thoracic level without compromising the lesion reproducibility. Here, a spinal cord contusion is created using a blunt-force impactor in male Wistar rats. Our method gave consistent lesion effects as evaluated by behavior scoring methods. All the animals showed equal degree of performance in tests like narrow beam, inclined plane and horizontal ladder and in BBB scores (open field locomotor test). The aim of presenting our experience is to reinstate the fact that lack of affordability to get sophisticated instrumentation need not be a hurdle in the pursuit of science. PMID:23960429

  18. Arterial circulation of the spinal cord and brain in the Monodontidae (order Cetacea).

    PubMed

    Vogl, A W; Fisher, H D

    1981-11-01

    In this paper we document retial supply of the spinal cord and describe the arterial vascular pattern of the brain in the whale family Monodontidae. Observations are based on gross dissections of four brains, two each of Monodon monoceros and Delphinapterus leucas, and one spinal cord from M. monoceros. Vessels of the spinal cord arise from extradural retia in the neural canal. Arteries originating from the retia penetrate the dura between successive spinal roots (mainly ventral) and not in association with them, unlike radicular arteries of other mammals. Also, these vessels are uniformly distributed and contribute equally to a plexus surrounding the cord. An A. radicularis magna is not present, and neither are distinct anterior or posterior spinal arteries. Circulation to the brain is effected by two pairs of arteries originating from intracranial retia. The rostral pair supplies most of the forebrain (prosencephalon), whereas the more caudal pair supplies mainly the midbrain (mesencephalon) and hindbrain (rhombencephalon). The circulatory pattern is characterized by 1) complete independence of anterior cerebral arteries (no anastomoses); 2) extensive cortical supply by the anterior choroidal arteries; 3) absence of subdural communicating vessels between rostral and caudal trunks; 4) union of caudal trunks to form a small basilar artery; and 5) absence of vertebral arteries and hence of a vertebral basilar system. There are some obvious differences between subdural arteries in the Monodontidae and those in other mammals; however, their general patterns of distribution are similar, and we suggest that most of the vessels, at least in the cranium, are homologous. PMID:7299826

  19. Injection of ropivacaine into the subarachnoid changes the ultrastructure and proteome of the rat spinal cord.

    PubMed

    Li, Lin; Zhang, Tiezheng; Diao, Yugang; Wang, Junke

    2013-10-01

    1. In the present study, we investigated the impact of 1.0% ropivacaine on the ultrastructure and proteome of the rat spinal cord. 2. Rats received three injections (90-min intervals, 0.2 mL/kg) of 0.9% NaCl, 0.5% ropivacaine or 1.0% ropivacaine via an implanted intrathecal catheter. Transmission electron microscopy was performed to exam the ultrastructure of the spinal cord. Two-dimensional electrophoresis followed by mass spectrometry identification were carried out to investigate the proteome. 3. In the rats administered 1.0% ropivacaine, deformed organelles, detached myelinated nerve fiber layer, and incomplete inner and outer shaft membranes were observed in the spinal cord and posterior root shrunken nuclei. Furthermore, in the rat spinal cord 1.0% ropivacaine induced the down-regulation of voltage-dependent anion channel 2 (VDAC2) and mitochondrial pyruvate dehydrogenase subunit alpha (ODPA), the upregulation of myelin basic protein (MBP), the disappearance of myelin transcription factor 1 (MYT1) and the appearance of heat shock protein 25 (HSP25). Little change was observed in the 0.5% ropivacaine or control groups. 4. Our results suggest that 1.0% ropivacaine treatment led to neurotoxicity, as shown by ultrastructural and proteomic changes in the rat spinal cord. Specific proteins were identified that are implicated in 1.0% ropivacaine-induced neurotoxicity. PMID:23536973

  20. Spinal mu and delta opioids inhibit both thermal and mechanical pain in rats

    PubMed Central

    Normandin, Audrey; Luccarini, Philippe; Molat, Jean-Louis; Gendron, Louis; Dallel, Radhouane

    2013-01-01

    The expression and contribution of mu (MOPR) and delta opioid receptors (DOPR) in polymodal nociceptors have been recently challenged. Indeed, MOPR and DOPR were shown to be expressed in distinct subpopulation of nociceptors where they respectively inhibit pain induced by noxious heat and mechanical stimuli. In the present study, we used electrophysiological measurements to assess the effect of spinal MOPR and DOPR activation on heat- and mechanically-induced diffuse noxious inhibitory controls (DNIC). We recorded from wide-dynamic range neurons in the spinal trigeminal nucleus of anesthetized rats. Trains of 105 electrical shocks were delivered to the excitatory cutaneous receptive field. DNIC were triggered either by immersion of the hindpaw in 49°C water or application of 300 g of mechanical pressure. To study the involvement of peptidergic primary afferents in the activation of DNIC by noxious heat and mechanical stimulations, substance P release was measured in the spinal cord by visualizing neurokinin type 1 (NK1) receptor internalization. We found that the activation of spinal MOPR and DOPR similarly attenuates the DNIC and NK1 receptor internalization induced either by heat or mechanical stimuli. Our results therefore reveal that the activation of spinal MOPR and DOPR relieves both heat- and mechanically-induced pain with similar potency and suggest that these receptors are expressed on polymodal, substance P-expressing neurons. PMID:23843537