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Unusual presentation of a primary spinal Burkitt's lymphoma  

PubMed Central

Primary CNS lymphomas are detected with increasing frequency in immunocompetent and immunodeficient persons. Primary involvement of the spinal roots has only rarely been reported. The unusual history is described of a patient with a primary spinal Burkitt's lymphoma initially presenting as an S1 syndrome showing lymphocytic pleocytosis in the CSF, leading to the misdiagnosis of meningoradiculitis. Repeated spinal MRI disclosed a spinal mass lesion and histological and immunohistological examination of the tumour confirmed the diagnosis of spinal Burkitt's lymphoma.??

Wilkening, A; Brack, M; Brandis, A; Heidenreich, F; Dengler, R; Weibenborn, K



Transient Spinal Cord Ischemia as Presenting Manifestation of Polycythemia Vera  

PubMed Central

Spinal arterial vascularization is supplied by a large anastomotic net, making spinal ischemic events far less common than ischemic cerebral strokes. Polycythemia vera, due to blood hyperviscosity and activated platelet aggregation, is associated with a higher risk of arterial and venous thrombotic events. We report a patient with spinal cord transient ischemic attacks, a rarely presenting manifestation, and polycythemia vera, which highlights the thrombotic potential of this disease, and the requirement of exhaustive diagnostic workout of a spinal ischemic event.

Costa, Sonia; Marques, Joana; Barradas, Anabela; Valverde, Ana



Intramedullary Spinal Neurocysticercosis Presenting as Brown-Sequard Syndrome  

PubMed Central

Cysticercosis is an emerging disease in the United States. Neurocysticercosis may rarely cause disease within the spinal cord, but the occurrence of such pathology can produce debilitating symptoms for patients. We present the second report in the literature of intramedullary spinal neurocysticercosis presenting with a Brown-Sequard syndrome.

Rice, Brian; Perera, Phillips



Spinal congenital dermal sinus presenting as a diagnostic conundrum.  


Spinal congenital dermal sinus is a rare entity. Still rarer is its location over the thoracic and cervical spine. Secondary to congenital dermal sinus, intramedullary abscesses of the spinal cord are uncommon. Only few cases of such an association have been reported in the literature. We report such an interesting case of thoracic spinal congenital dermal sinus associated with intramedullary abscess in an 18-month-old boy who presented with a diagnostic conundrum. The pathogenesis, clinical presentation, neuroimaging and management of such cases are discussed. Awareness, detection, timely referral and definitive operative intervention for a better neurological outcome are emphasized. PMID:23257833

Chopra, Abhisek; Patra, Bijoy; Aneja, Satinder; Mukherjee, Sharmilla; Maheswari, Anu; Seth, Anju



Spontaneous spinal epidural hematoma as the initial presentation of leukemia  

PubMed Central

We present a case of a 55-year-old male with progressive neurological deficits that appeared dramatically. MRI detected a spinal epidural hematoma at the cervicothoracic junction and blood tests showed leukocytosis, mild anemia, and thrombocytosis. Spontaneous spinal epidural hematoma (SSEH) as the initial presentation of leukemia was diagnosed. Urgent posterior decompression was performed after 28 h from acute onset of backache, and the patient experienced remarkable improvement in neurological findings.

Kim, Sungdo; Tsuji, Takaaki; Uta, Soichi



Multiple myeloma presenting as spinal cord compression: a case report  

PubMed Central

Introduction Spinal cord compression is a potentially devastating condition that demands immediate attention. Efforts must be divided between addressing the symptoms of cord compression and identifying the precise etiology of the condition. Case presentation A 76-year-old Peruvian man presented to our emergency department for evaluation of the gradual onset of lower extremity weakness over one month, resulting in falls and a two day history of bladder and bowel incontinence. Surprisingly, the etiology of this case of spinal cord compression was found to be multiple myeloma presenting as a solid tumor. Conclusion We report a case of a spinal cord mass resulting in symptoms of cord compression that was diagnosed when aspects of our patient's initial magnetic resonance imaging scan did not correlate with disc herniation, which was the diagnosis with the greatest pretest probability.



Multiple myeloma presenting as spinal cord compression: a case report  

Microsoft Academic Search

INTRODUCTION: Spinal cord compression is a potentially devastating condition that demands immediate attention. Efforts must be divided between addressing the symptoms of cord compression and identifying the precise etiology of the condition. CASE PRESENTATION: A 76-year-old Peruvian man presented to our emergency department for evaluation of the gradual onset of lower extremity weakness over one month, resulting in falls and

Chayan Chakraborti; Kristen L Miller



Asymptomatic spherocytosis presenting with spinal cord compression: case report.  


Extramedullary hematopoiesis (EMH) is a compensatory mechanism occurring in patients with chronic anemia, which occurs most frequently with thalassemia. The authors report the case of a 57-year-old man, with no history of clinical or hematological disease, presenting with spinal cord compression. Magnetic resonance (MR) imaging demonstrated a homogeneous posterior epidural mass extending from T-3 to T-6. Following decompressive surgery, the patient's symptoms improved. Histological analysis showed features consistent with a diagnosis of EMH. Subsequent workup was remarkable for an asymptomatic spherocytosis without anemia. There was no family history of anemia. An EMH-related presentation of mild spherocytosis has been described in the literature, but its epidural location led to spinal cord compression. The MR imaging features were suggestive of EMH, but in the presence of spinal cord compression and in the absence of a history of chronic anemia, the authors did not believe that nonsurgical management would have been reasonable. PMID:15871492

Jalbert, Florian; Chaynes, Patrick; Lagarrigue, Jacques



Spinal dural arteriovenous fistula presenting with paraplegia following lumbar puncture.  


Spinal dural arteriovenous fistulas are rare lesions with an annual incidence of 1 per 100,000 population. In patients with this disease, an abnormal vascular dural shunt exists between a dural branch of a segmental artery and a subdural radicular vein that drains the perimedullary venous system, leading to venous hypertension and secondary congestive myelopathy. Generally, patients present with progressive paraparesis, urinary disturbances, and gait ataxia. In this report the authors describe a 61-year-old woman with a spinal dural arteriovenous fistula who developed an acute paraplegia after a nontraumatic lumbar puncture. The possible underlying mechanisms and treatment options are discussed. PMID:23641674

Koerts, Guus; Vanthuyne, Vincent; Delavallee, Maxime; Rooijakkers, Herbert; Raftopoulos, Christian



Spinal Cord Injury--Past, Present, and Future  

PubMed Central

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.

Donovan, William H



Neurobrucellosis presenting as an intra-medullary spinal cord abscess  

PubMed Central

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.

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



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

Microsoft Academic Search

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

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



Lumbar Disk Pseudotumor: An Unusual Presentation of Lumbar Spinal Fracture and Stenosis  

Microsoft Academic Search

Summary: We present an unusual case of a primary lumbar disk-space mass that presumably developed secondary to a chronic hyperextension spinal fracture associated with spinal stenosis. This injury resulted in the appearance of a lumbar intervertebral disk-space mass or pseudotumor. The pseudo- tumor most likely resulted from a prior spinal fracture, lead- ing to a fused hyperextension deformity in a

Robert A. Koenigsberg; Perry Black; Scott H. Faro; Jeffrey Rykken


Thoracic Disc Herniation Presenting with Transient Anterior Spinal Artery Syndrome  

PubMed Central

Summary This report is a clinical and radiologic correlation of anterior spinal arterial distribution ischemia with a thoracic disc herniation affecting the artery of Adamkiewicz. We could only find one other similar reported case. A 38-year-old woman developed sudden onset of severe back pain and radiculopathy, followed by rapidly evolving paraparesis. The neurological examination was consistent with a deficit caused by anterior spinal artery ischemia. MRI revealed T2 signal change in the thoracolumbar spinal cord and a laterally placed, non-calcified disc herniation. Selective spinal angiography performed 30 hours after onset revealed displacement of the left T9 radicular feeding artery by the disc herniation; at this time the artery was patent. The patient experienced some resolution of symptoms within the first 24 hours and was managed conservatively and made a significant recovery within two weeks. Appropriately located thoracic disc herniations can disturb the blood supply to the thoracolumbar spinal cord.

Guest, J.D.; Griesdale, D.E.; Marotta, T.



[Two cases of spinal arteriovenous malformation presenting with subarachnoid hemorrhage].  


Two cases of spinal arteriovenous malformation (AVM) with subarachnoid hemorrhage (SAH) are reported. The first case is that of a 14-year-old boy who was transferred to our hospital with a sudden onset of headache. Neurological examination revealed no motosensory deficit, but a brain CT showed a slight diffuse SAH. A left vertebral angiogram demonstrated intramedullary AVM in the cervical region of the spinal cord. This AVM was therefore occluded using a solid embolization material. The patient was then discharged without neurological deficit. The second case is that of a 67-year-old man who visited our hospital with a sudden onset of headache. Neurological examination revealed no motor or sensory deficit, but a brain CT showed SAH, which was dominant in the posterior fossa. Initial cerebral angiography demonstrated no abnormality such as cerebral aneurysm or AVM except for laterality of the C1 radiculo-meningeal artery. A second angiogram on day 11 demonstrated spinal arteriovenous fistula (AVF), which was fed by the left radiculo-meningeal artery and drained to the posterior spinal vein. Embolization for the AVF was performed using liquid material. He was then discharged without neurological deficit. These two cases revealed non-specific SAH symptoms and were indistinguishable from other ruptured aneurysms. Although the brain CT can show a slight SAH or posterior fossa dominant SAH, repeated angiography may be necessary to verify and conclude the diagnosis of spinal AVM. PMID:15352630

Hayashi, Kentaro; Takahata, Hideaki; Nakamura, Minoru



Atypical presentations of spinal muscular atrophy type III (Kugelberg–Welander disease)  

Microsoft Academic Search

Spinal muscular atrophy type III (SMA III, Kugelberg–Welander disease) typically presents with symmetric proximal weakness, areflexia, and hypotonia. We present four children with spinal muscular atrophy type III who had atypical phenotypes. Three patients clearly had asymmetric weakness at presentation and two had upper motor neuron signs in the lower extremities (one patient had both features). Two of the patients

P. B. Kang; K. S. Krishnamoorthy; R. M. Jones; F. D. Shapiro; B. T. Darras



Pain as a presenting feature of acute abdomen in spinal injuries.  


The diagnosis of acute abdomen can be difficult in patients with spinal injuries. We reviewed all the 1039 case records of patients admitted with spinal injuries to the Queen Elizabeth National Spinal Injuries Unit, Glasgow over a 7-year-period and found 5 (0.48%) cases of acute abdomen that required surgical intervention and were not caused by original injury. Their presenting signs and symptoms were analysed. Pain was found to be an unreliable symptom in these patients. PMID:12531374

Deep, Kamal; Bhalaik, Vijay



Multiple sclerosis presenting as a spinal cord tumor  

Microsoft Academic Search

Multiple sclerosis, a disorder of central nervous system demyelination, is a leading cause of disability in young people. Lesions of the spinal cord are usually less than two vertebral body segments long, peripherally located, and found in the cervical region. A 30-year-old woman had a 2-month history of back pain, urinary incontinence, and bilateral lower extremity weakness. Magnetic resonance imaging

Debra L. Braverman; Elisabeth A. Lachmann; Richard Tunkel; Willibald Nagler



Central neuraxial anaesthesia presenting with spinal myoclonus in the perioperative period: a case series  

Microsoft Academic Search

INTRODUCTION: Perioperative spinal myoclonus is extremely rare. Many anaesthetists and perioperative practitioners may not diagnose or manage this complication appropriately when it occurs. This case report of unusual acute spinal myoclonus following regional anaesthesia highlights certain aspects of this rare complication that have not previously been published. CASE PRESENTATIONS: A series of four consecutive patients who developed acute lower-limb myoclonus

Olumuyiwa A Bamgbade; John A Alfa; Wael M Khalaf; Andrew P Zuokumor



Anterior sacral pyocele with meningitis: a rare presentation of occult spinal dysraphism with congenital dermal sinus.  


The authors describe an interesting case of a hitherto asymptomatic occult spinal defect with a congenital sacral dermal sinus which proved to be the entry point for bacterial meningitis in an otherwise healthy 9-year-old female child. The patient presented with fever and neck stiffness, and a dermal sinus in the lumbosacral region was identified on examination. Cerebrospinal fluid analysis confirmed bacterial meningitis and a spinal magnetic resonance imaging scan revealed a dermal sinus tract with an anterior spinal meningocele, caudal regression syndrome, and a tethered spinal cord. In addition to administration of intravenous antimicrobial agents, surgical exploration of the sacral dermal sinus tract was performed and an anterior sacral pyocele was drained. The pyocele cavity was disconnected from the thecal sac, and the thickened and fatty filum terminale was sectioned. Although congenital sacral dermal sinus manifesting as bacterial meningitis is known, the occurrence of an anterior sacral pyocele has not yet been described in children. PMID:20363962

Bhatia, Sonal; Tullu, Milind S; Date, Nitin B; Muzumdar, Dattatraya; Muranjan, Mamta N; Lahiri, Keya R



Intramedullary spinal cord ganglioglioma presenting as hyperhidrosis: unique symptoms and magnetic resonance imaging findings: case report.  


Hyperhidrosis is caused by a sympathetic dysfunction of the central or peripheral nervous system. Intramedullary spinal cord lesions can be a cause of hyperhidrosis. The authors report a rare case of intramedullary thoracic spinal cord ganglioglioma presenting as hyperhidrosis. This 16-year-old boy presented with abnormal sweating on the right side of the neck, chest, and the right arm that had been occurring for 6 years. Neurological examination revealed mild motor weakness of the right lower extremity and slightly decreased sensation in the left lower extremity. Hyperhidrosis was observed in the right C3-T8 dermatomes. Magnetic resonance imaging showed an intramedullary tumor at the right side of the spinal cord at the T2-3 level. The tumor showed partial enhancement after Gd administration. The patient underwent removal of the tumor via hemilaminectomy of T2-3. Only subtotal resection was achieved because the margins of the tumor were unclear. Histopathological examination revealed ganglioglioma. Hyperhidrosis gradually improved after surgery. Hyperhidrosis is a rare clinical manifestation of intramedullary spinal cord tumors, and only a few cases have been reported in the literature. The location of the tumor origin, around the right gray matter of the lateral spinal cord, may account for the hyperhidrosis as the initial symptom in this patient. Physicians should examine the spinal cord using MRI studies when a patient has hyperhidrosis with some motor or sensory symptoms of the extremities. PMID:23198806

Murakami, Tomohiro; Koyanagi, Izumi; Kaneko, Takahisa; Yoneta, Akihiro; Keira, Yoshiko; Wanibuchi, Masahiko; Hasegawa, Tadashi; Mikuni, Nobuhiro



Aortic dissection presenting primarily as acute spinal cord damage: a case report and literature review.  


Acute aortic dissection is a rare, life-threatening condition. Clinical manifestations generally include the acute onset of severe chest or back pain. Aortic dissection presenting with signs and symptoms of acute spinal cord damage is the most severe complication and is particularly rare. This paper reports a case of aortic dissection in a 50-year-old man with a 10-year history of hypertension manifesting as acute spinal cord damage (bilateral lower extremity weakness and loss of all types of sensation), acute skeletal muscle ischaemic necrosis with increased levels of creatine kinase, and acute kidney failure with increased levels of serum creatinine and decreased glomerular filtration rate. The patient refused surgical treatment. His clinical condition progressively worsened and he died 3 days later. This case indicates the importance of considering aortic dissection in patients presenting with acute spinal cord damage, acute skeletal muscle necrosis or acute kidney failure, which may allow early diagnosis and reduce the mortality rate. PMID:23206486

Sui, R-B; Zhang, L; Liu, K



The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery  

Microsoft Academic Search

STUDY DESIGN: Descriptive, retrospective cohort analysis. OBJECTIVE: To evaluate the presentation, etiology, and treatment of surgical site infections (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA: SSI after spine surgery is frequently seen. Small case control studies have been published reporting the results of treatment options of SSI. We performed this study to identify the most common clinical and laboratory

Albert F. Pull ter Gunne; Ahmed S. Mohamed; Richard L. Skolasky; Cees J. H. M. van Laarhoven; David B. Cohen



Spontaneous spinal epidural hematoma: an uncommon presentation of a rare disease  

Microsoft Academic Search

Introduction: Spontaneous spinal epidural hematoma is rare in children. The presenting symptoms are usually pain, either local or radicular, followed by progressive bilateral weakness, and sensory loss hours and even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies the diagnosis is usually delayed, and it is not until the full picture

Sarit Ravid; Steven Schneider; Joseph Maytal



Solitary spinal epidural cavernous angiomas in children presenting with acute neurological symptoms caused by hemorrhage.  


Spinal solitary epidural cavernous angiomas are rare benign vascular malformations, which occur even less frequently in children than in adults. It is uncommon to find such lesions without adjacent vertebral involvement. Occasionally, these lesions can lead to neurological symptoms through growth or due to intralesional hemorrhage. In this report the authors describe 2 children presenting with acute symptoms and neurological deficits caused by hemorrhage within solitary spinal epidural cavernous angiomas. A 13-year-old girl and a 9-year-old girl, previously healthy, were admitted to the authors' department due to acute radicular pain and neurological deficits. In both cases MR imaging revealed a solitary epidural mass with signs of bleeding and compression of the spinal cord. Complete resection of the lesion via a dorsal approach was performed in both patients. The histological examination of the lesions revealed the characteristic structures of a cavernous angioma with hemosiderin deposits and acute hemorrhage. Both patients recovered fully after surgical removal of the lesions. Review of the literature confirmed that spinal epidural cavernous angiomas are extremely rare in the pediatric patient population, described currently in only 2 instances, but without acute hemorrhage. These cases suggest that epidural cavernous angiomas also have to be considered in the pediatric patient population in the differential diagnosis of intraspinal lesions with acute or progressive neurological symptoms. Microsurgical resection of these cavernous malformations is an effective and curative treatment option. PMID:20043742

Sarikaya-Seiwert, Sevgi; Gierga, Kristin; Wessalowski, Rüdiger; Steiger, Hans-Jakob; Hänggi, Daniel



A Case Report of Cerebral Venous Thrombosis in Polycythemia Vera Presenting with Intracranial and Spinal Subdural Hematoma.  


Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed concomitant cranial and spinal SDH related to cerebral venous thrombosis (CVT) associated with hemorrhagic venous infarct. Laboratory examinations were consistent with polycythemia vera. There was no history of trauma and previous cranial surgery. Brain angiography did not reveal any evidence of arteriovenous fistula or vascular malformation. Since lower back pain occurred shortly after the headache and there was no other reasonable explanation for spinal hemorrhage, we suppose that the mechanism of spinal SDH is the migration of blood from the intracranial compartment. Therefore, this is the first report of concomitant spinal SDH and cerebral hemorrhage associated with CVT in a patient with myeloproliferative disease. PMID:20671855

Sirin, Nermin Görkem; Yesilot, Nilufer; Ekizoglu, Esme; Keles, Nur; Tuncay, Rezzan; Coban, Oguzhan; Bahar, Sara Zarko



A Case Report of Cerebral Venous Thrombosis in Polycythemia Vera Presenting with Intracranial and Spinal Subdural Hematoma  

PubMed Central

Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed concomitant cranial and spinal SDH related to cerebral venous thrombosis (CVT) associated with hemorrhagic venous infarct. Laboratory examinations were consistent with polycythemia vera. There was no history of trauma and previous cranial surgery. Brain angiography did not reveal any evidence of arteriovenous fistula or vascular malformation. Since lower back pain occurred shortly after the headache and there was no other reasonable explanation for spinal hemorrhage, we suppose that the mechanism of spinal SDH is the migration of blood from the intracranial compartment. Therefore, this is the first report of concomitant spinal SDH and cerebral hemorrhage associated with CVT in a patient with myeloproliferative disease.

Sirin, Nermin Gorkem; Yesilot, Nilufer; Ekizoglu, Esme; Keles, Nur; Tuncay, Rezzan; Coban, Oguzhan; Bahar, Sara Zarko



MRI features of spinal cord decompression sickness presenting as a Brown-Sequard syndrome.  


Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of spinal cord decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical cord at the level of C2-C3. A second MRI at 10 days post-injury showed signal abnormalities corresponding to an infarction in the posterior spinal artery territory. After two weeks of intensive treatment with various HBOT regimens, the clinical outcome was still poor, but at six months after the injury her neurological condition was greatly improved, with only slight impairment of proprioception on the left when walking remaining. PMID:22828817

Louge, Pierre; Gempp, Emmanuel; Hugon, Michel



Spinal cord stimulation: principles of past, present and future practice: a review.  


Electric energy have been in use for the treatment of various ailments, including pain, since the time of Pharaohs. The theoretical basis of electrotherapy of pain was provided by the Gate Control Theory of Melzak and Wall. In 1965, Shealey et al. first introduced electrical stimulation of spinal cord for treating pain. At present spinal cord stimulation (SCS) is a well established form of treatment for failed back surgery syndrome, complex regional pain syndrome and refractory pain due to ischemia. The indications for SCS is growing and the technology involved in this is rapidly advancing, however, high level of scientific evidence is still lacking to support this form of therapy due to difficulties in blinding and comparing with control groups. Future developments in SCS could include, combined SCS-drug delivery system, bio feedback and closed loop systems. PMID:19728120

Kunnumpurath, Sreekumar; Srinivasagopalan, Ravi; Vadivelu, Nalini



Intracranial Dural Arteriovenous Fistulas with Spinal Venous Drainage: Relation between Clinical Presentation and Angiographic Findings  

Microsoft Academic Search

PURPOSE: To investigate why some patients with an intracranial dural arteriovenous fistula (DAVF) with spinal venous drainage have myelopathy and others do not.METHODS:We reviewed the clinical and radiologic data for 12 patients who had a DAVF with spinal venous drainage diagnosed at our institutions from 1982 to 1995. RESULTS: Six patients had progressive spinal cord indications of disease (patients with

Laurent Brunereau; Y. Pierre Gobin; Jean-Francois Meder; Christophe Cognard; Jean-Michel Tubiana; Jean-Jacques Merland


Thoracic spinal cord (T3-T4) transection in a breech-presenting, cesarean-section-delivered preterm infant.  


Thoracic spinal cord transection below the origin of the brachial plexus is a rare event among breech-presenting infants delivered by cesarean section. A case of a thoracic (T3-T4) spinal cord injury with paravertebral hemorrhage mimicking catastrophic intracranial bleeding is presented to illustrate the value of careful application of traction or any longitudinal stretching forces during fetal head extraction. PMID:3606755

Ilagan, N B; Liang, K C; Piligian, J; Poland, R



A 19-year-old man with sickle cell disease presenting with spinal infarction: a case report  

PubMed Central

Introduction Vasculopathy of the large vessels commonly occurs in sickle cell disease, and as a result cerebral infarction is a well characterized complication of this condition. However, spinal infarction appears to be rare. Spinal infarct is infrequent in the non-sickle cell population as well, and accounts for only about 1 percent of all central nervous system infarcts. Case presentation In the present work, we report the case of a 19-year-old African-American man with sickle cell disease who experienced an anterior spinal infarct and subsequent quadriplegia. He was incidentally noted to be a heterozygote for factor V Leiden. We also reviewed the literature and found two previous cases of spinal cord infarction and sickle hemoglobin. Our literature search did not demonstrate that heterozygocity for factor V Leiden plays an important role in spinal cord infarction. Conclusions The paucity of cases associated with sickle hemoglobin does not allow us to postulate any particular risk factors with sickle cell disease that might predispose patients to spinal cord infarction. Our patient’s case raises the question as to whether spinal cord infarction is being missed in individuals with sickle cell disease and neurologic symptoms.



Lumbar spinal dural arteriovenous fistula presenting with brainstem symptomatology: A case report.  


This report is about a rare case of a lumbar spinal dural arteriovenous fistula (DAVF) with distant brainstem symptoms of vertigo and ataxia. Brain magnetic resonance imaging (MRI) demonstrated a high signal abnormality in the lower pons, medulla, and cervico-medullary junction, presumably related to venous hypertension. Spinal MRI revealed markedly dilated veins along the dorsal aspect of the cord, while spinal angiography confirmed the presence of a lumbar spinal DAVF. Because lumbar DAVF may cause remote brainstem symptoms, spinal DAVF should be considered in the differential diagnosis of high signal MRI abnormalities localized in the brainstem. Properly extending the scanning range is essential in the diagnosis. PMID:16950713

Wu, S-L; Tsui, H-W; Chuang, Y-C; Kuo, H-C; Chen, C-J



Divergence Paresis Without Positional Headache: An Unusual Presentation of Cerebrospinal Fluid Hypovolemia After Spinal Anesthesia  

Microsoft Academic Search

We report a rare complication of spinal anesthesia— divergence paresis—which is characterized by an ac- quired horizontal diplopia at distance without evi- dence for abducens palsy. A 64-yr-old man underwent prostatectomy under spinal anesthesia with2.5mLofdibucainehydrochloride0.3%injected through a 20-gauge cutting-tip spinal needle. Seven- teen days after the operation, the patient noticed hor- izontal diplopia for distant objects. Although cranial magnetic resonance

Motomi Arai; Satoko Matsushima; Hiroshi Terada



Central and Extrapontine Myelinolysis Affecting the Brain and Spinal Cord. An Unusual Presentation of Pancreatic Encephalopathy  

PubMed Central

Pancreatic encephalopathy refers to a gamut of neuropsychiatric symptoms complicating acute pancreatitis. Osmotic myelinolysis is a known complication of pancreatic encephalopathy. We evaluated a 58-year-old woman with pancreatic encephalopathy associated to pontine and extrapontine myelinolysis involving the brain and spinal cord. To our knowledge, this is the first clinic pathological case report of pancreatic encephalopathy involving the spinal cord.

Hornik, Alejandro; Rodriguez Porcel, Federico J.; Agha, Caroline; Flaster, Murray; Morales Vidal, Sarkis; Schneck, Michael J.; Lee, John; Biller, Jose



Spinal cord compression injury in the mouse: presentation of a model including assessment of motor dysfunction  

Microsoft Academic Search

The purpose of this study was to develop a spinal cord injury model in the mouse. Various degrees of extradural compression\\u000a were used to induce mild, moderate or severe compression injuries. Furthermore, a locomotor rating scale was developed by\\u000a which the functional outcome of the spinal cord injury could be assessed. The introduction of such a model will be useful

Mohammad Farooque



Unusual presentation of congenital dermal sinus: tethered spinal cord with intradural epidermoid and dual paramedian cutaneous ostia.  


The authors present the first report of spinal congenital dermal sinus with paramedian dual ostia leading to 2 intradural epidermoid cysts. This 7-year-old girl had a history of recurrent left paramedian lumbosacral subcutaneous abscesses, with no chemical or pyogenic meningitis. Admission MRI studies demonstrated bilateral lumbar dermal sinus tracts and a tethered spinal cord. At surgery to release the tethered spinal cord the authors encountered paramedian dermal sinus tracts with dual ostia, as well as 2 intradural epidermoid cysts that were not readily apparent on MRI studies. Congenital dermal sinus should be considered in the differential diagnosis of lumbar subcutaneous abscesses, even if the neurocutaneous signatures are located off the midline. PMID:23025446

Cox, Efrem M; Knudson, Kathleen E; Manjila, Sunil; Cohen, Alan R



Spinal Cord  

Microsoft Academic Search

The spinal cord is a relatively understudied target of diabetes. In this chapter an overview of the anatomy of the spinal\\u000a cord and its associated structures is presented before reviewing the published literature describing evidence for structural\\u000a damage to the spinal cord reported in both diabetic patients and animal models of diabetes. Spinal cord pathology is accompanied\\u000a by functional disorders

Andrew P. Mizisin; Corinne G. Jolivalt; Nigel A. Calcutt


Multipotent CNS Stem Cells Are Present in the Adult Mammalian Spinal Cord and Ventricular Neuroaxis  

Microsoft Academic Search

Neural stem cells in the lateral ventricles of the adult mouse CNS participate in repopulation of forebrain structures in vivo and are amenable to in vitro expansion by epidermal growth factor (EGF). There have been no reports of stem cells in more caudal brain regions or in the spinal cord of adult mammals. In this study we found that although

Samuel Weiss; Christine Dunne; Jennifer Hewson; Cheryl Wohl; Matt Wheatley; Alan C. Peterson; Brent A. Reynolds


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

PubMed Central

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.

McDonald, Andrew M.; Rollins, Jason L.



[Failed back surgery, spinal cord stimulation and pregnancy: presentation of a case].  


Spinal cord stimulation is increasingly used to manage chronic pain syndromes, such as complex regional pain syndrome, chronic back pain, refractory angina pectoris or peripheral vascular diseases, which are unresponsive to other common less aggressive treatment methods. The early use of this technique in the aforementioned diseases makes it suitable in young women of childbearing age and who wish to become pregnant. We report the case of a 33-year-old woman who became pregnant 4 months after having undergone posterior cord stimulation, and we review the approach to this situation and the perioperative management during the perinatal period. PMID:22683272

Gredilla, E; Abejón, D; Del Pozo, C; Del Saz, J; Gilsanz, F



Spinal tumor  


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


Scoliosis treatment using spinal manipulation and the Pettibon Weighting System™: a summary of 3 atypical presentations  

Microsoft Academic Search

BACKGROUND: Given the relative lack of treatment options for mild to moderate scoliosis, when the Cobb angle measurements fall below the 25–30° range, conservative manual therapies for scoliosis treatment have been increasingly investigated in recent years. In this case series, we present 3 specific cases of scoliosis. CASE PRESENTATION: Patient presentation, examination, intervention and outcomes are detailed for each case.

Mark W Morningstar; Timothy Joy



Scoliosis treatment using spinal manipulation and the Pettibon Weighting System(TM): a summary of 3 atypical presentations  

PubMed Central

Background Given the relative lack of treatment options for mild to moderate scoliosis, when the Cobb angle measurements fall below the 25–30° range, conservative manual therapies for scoliosis treatment have been increasingly investigated in recent years. In this case series, we present 3 specific cases of scoliosis. Case presentation Patient presentation, examination, intervention and outcomes are detailed for each case. The types of scoliosis presented here are left thoracic, idiopathic scoliosis after Harrington rod instrumentation, and a left thoracic scoliosis secondary to Scheuermann's Kyphosis. Each case carries its own clinical significance, in relation to clinical presentation. The first patient presented for chiropractic treatment with a 35° thoracic dextroscoliosis 18 years following Harrington Rod instrumentation and fusion. The second patient presented with a 22° thoracic levoscoliosis and concomitant Scheuermann's Disease. Finally, the third case summarizes the treatment of a patient with a primary 37° idiopathic thoracic levoscoliosis. Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system. Following a course of treatment, consisting of clinic and home care treatments, post-treatment radiographs and examinations were conducted. Improvement in symptoms and daily function was obtained in all 3 cases. Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13°, 8°, and 16° over a maximum of 12 weeks of treatment. Conclusion Although mild to moderate reductions in Cobb angle measurements were achieved in these cases, these improvements may not be related to the symptomatic and functional improvements. The lack of a control also includes the possibility of a placebo effect. However, this study adds to the growing body of literature investigating methods by which mild to moderate cases of scoliosis can be treated conservatively. Further investigation is necessary to determine whether curve reduction and/or manipulation and/or placebo was responsible for the symptomatic and functional improvements noted in these cases.

Morningstar, Mark W; Joy, Timothy



Multidisciplinary Management of Spinal Dural Arteriovenous Fistulas Clinical Presentation and Long-Term Follow-Up in 49 Patients  

Microsoft Academic Search

Background and Purpose—In the early 1980s, it was demonstrated that surgical intradural division of the shunting vein to the medullary venous plexus cures a spinal dural arteriovenous fistula (DAVF) at low morbidity. There is, however, growing literature to support endovascular therapy. Methods—The clinical features of 49 consecutive patients with a spinal DAVF treated at a single institution between 1986 and

J. Marc; C. van Dijk; Karel G. TerBrugge; Robert A. Willinsky; Richard I. Farb; M. Christopher Wallace


Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients  

Microsoft Academic Search

Tuberculosis (TB) of the spine (Pott’s disease) is both the most common and most dangerous form of TB infection. Delay in\\u000a establishing diagnosis and management cause spinal cord compression and spinal deformity. This study investigated the data\\u000a on all cases of Pott’s disease reported in Turkey from 1985 to 1996. A total of 694 cases were included. Out of the

Mehmet Turgut



[Spinal cord infarction presenting Brown-Séquard syndrome with impaired position sense].  


A 79-year-old hypertensive man presented left hemiplegia of sudden onset. Neurological examination revealed weakness of the left extremities, with hypoalgesia on the opposite side below the level C 4. He also showed Horner syndrome, facial hypoalgesia, weakness of sternocleidmastoid and trapezius muscles on the paralyzed side. The position and vibration senses were impaired on the left extremities. The position sense was more disturbed on his upper limb, to the extent that the patient was not able to recognize where his wrist was located. The cervical MRI exhibited a high signal intensity on the left half of the cord between C 2-C 5 vertebral level on T 2 WI. Bilateral vertebral arteries were patent, though severe stenosis of internal-external carotid artery bifurcation was observed on MRA. Asymmetrical distribution of upper cervical cord arteries, severe atherosclerotic change of cervical and intracranial vessels, and spondylotic cervical canal stenosis were suggested to contribute to cause the lateralized infarction of the cord, involving not only the anterior, but also posterior part, where Burdach's fascicle were probably more affected. PMID:11064867

Yoshimura, M; Ono, H; Takahashi, Y; Takatsu, M



Fungal Smn and Spf30 homologues are mainly present in filamentous fungi and genomes with many introns: Implications for spinal muscular atrophy  

Microsoft Academic Search

Spinal muscular atrophy is an important rare genetic disease characterized by the loss of motor neurons, where the main gene responsible is smn1. Orthologous genes have only been characterized in a single fungal genome: Schizosaccharomyces pombe. We have searched for putative SMN orthologues in publically available fungal genomes, finding that they are predominately present in filamentous fungi. SMN binding partners

Pablo Mier; Antonio J. Pérez-Pulido


An unusual manifestation of a rare pleuropulmonary blastoma presenting with spinal cord compression and its neurosurgical implications.  


Pleuropulmonary blastomas (PPB) are rare and biologically aggressive paediatric tumours. Although central nervous system metastatic dissemination is a recognised complication of PPB, to our knowledge, spinal cord compression has been described only in six patients. We report a 5-year-old boy with a diagnosis of recurrent type III PPB that was initially thought to be an empyema, who developed features of thoracic spinal cord compression secondary to local tumour infiltration. Although PPB demonstrate significant biologically aggressive behaviour, aggressive surgical resections together with adjuvant chemotherapy can help limit disease progression without impacting on the quality of life. Spinal metastatic disease should also be treated vigorously. In this paper we discuss the treatment strategies available in the management of PPB. PMID:23639617

Fayeye, O; Volpon, M; George, J; Hobin, D; Solanki, G



Spinal extradural arachnoid cyst  

Microsoft Academic Search

Summary  Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. They usually present with progressive signs\\u000a and symptoms caused by spinal cord compression if they enlarge. A comprehensive review about spinal extradural arachnoid cyst\\u000a is made including the author’s own case of a 59-year-old woman with a 6-month history of progressive back pain radiating to\\u000a both legs. Key

J. Y. Choi; S. H. Kim; W. S. Lee; K. H. Sung



Release of Neurotransmitters in the CNS by Spinal Cord Stimulation: Survey of Present State of Knowledge and Recent Experimental Studies  

Microsoft Academic Search

Electric Stimulation applied to the posterior surface of the spinal cord (SCS) is an established treatment in certain chronic pain syndromes resistant to con-ventional therapeutic procedures. Despite the clinical value of SCS, the mechanisms behind the efficacy of the method are largely unknown. Several neurotransmitters in the CNS (e.g. Opioids, serotonin, noradrenaline, substance P, GABA), have been pro-posed to be

B. Linderoth; C. O. Stiller; L. Gunasekera; W. T. OConnor; J. Franck; B. Gazelius; E. Brodin



Mechanical strain induces Cx43 expression in spinal ligament fibroblasts derived from patients presenting ossification of the posterior longitudinal ligament  

Microsoft Academic Search

Ossification of the posterior longitudinal ligament (OPLL) is characterized by ectopic bone formation in spinal ligaments.\\u000a Some evidence indicates that mechanical strain can lead to the development of OPLL, although the signaling mechanism is not\\u000a fully understood. Connexin43 (Cx43), a gap-junction protein, has been shown to be of particular importance in bone formation.\\u000a We hypothesized that Cx43 may play an

Hai-song Yang; Xu-hua Lu; De-yu Chen; Wen Yuan; Li-li Yang; Yu Chen; Hai-long He


Encephalomyelitis due to Cryptococcus neoformans var gattii presenting as spinal tumour: case report and review of the literature  

PubMed Central

A 24 year old immunocompetent German resident is described who developed multifocal encephalomyelitis due to infection with Cryptococcus neoformans var gatti, commonly considered a disease of tropical regions. In the light of current knowlege on the epidemiology of C neoformans var gatti and the travel history of the patient it is assumed that the infection was aquired outside Europe. As exclusive intramedullary involvement is an outstandingly rare manifestation in spinal cryptococcosis, the particular diagnostic procedure and the therapeutic stratagies are discussed??

Grosse, P; Tintelnot, K; Sollner, O; Schmitz, B



Spinal Stenosis  


... in the treatment of this disease. What is spinal stenosis? Spinal stenosis is a narrowing of one ... and not to the narrowing itself. What causes spinal stenosis? The image above shows the narrowing of ...


Spinal Metastases  

Microsoft Academic Search

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

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



Presentations Name Position Presentation (ppt) Sudhir Srivastava, PhD, MPH Chief, Cancer Biomarkers Research Group Metabolomics: An Untapped Frontier (ppt, 161kb) John Milner, PhD Chief, Nutritional Sciences research Group Can Metabolomics


Spinal arteriovenous malformation  

Microsoft Academic Search

An 11-year-old girl presented with acute onset of paraplegia with bowel and bladder incontinence. She had spinal tenderness\\u000a and a sensory level at mid thoracic region. MRI spine revealed an intradural extramedullary arterio-venous malformation with\\u000a hemorrhage into the intramedullary region. Hence a diagnosis of spinal arterio-venous malformation was entertained.

S. Balasubramanian; So. Shivbalan; Sandeep D. Jaipurkar



Spinal Stenosis  


Spinal stenosis Basics In-Depth Multimedia Expert Answers Resources Reprints A single copy of this article may be reprinted for personal, noncommercial use only. Spinal stenosis By Mayo Clinic staff Original Article: http:// ...


Spinal Tumor  


... the diagnosis and pinpoint the tumor's location: Spinal magnetic resonance imaging (MRI). MRI uses a powerful magnet ... and staging of spine tumors. Orthopedic Clinics of North America. 2009;40:1. Brain and spinal tumors: ...


Tethered Spinal Cord with Double Spinal Lipomas  

PubMed Central

Although lumbosacral lipoma is reported to occur in 4-8 of 100,000 patients, and 66% of lipomyelomeningoceles in young patients are accompanied by hypertrophic filum terminale, it is very rare to find two isolated spinal lipomas simultaneously. A 3 month-old baby girl was admitted to the hospital for a protruding, non-tender, soft, subcutaneous 2.5 cm mass of the lumbosacral area that had been present since birth. Simple radiography showed a spinal posterior arch defect from L3 to L5, and magnetic resonance imaging (MRI) demonstrated two isolated spinal lipomas, a transitional type from L3 to L5, and a terminal type below S1 without dural defect. The cornus medullaris was severely tethered descending to the S1, but there was no cerebellar or brain stem herniation on the MRI. We suggest that the presence of a combined spinal lipoma should be a point for careful differentiation in an infant with spinal lipoma.

Kim, Myeong Jin; Cho, Ki Hong; Won, Geun Soo



Spinal infections  

Microsoft Academic Search

Spinal infections can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, epidural infections, meningitis, polyradiculopathy and myelitis. Radiological evaluations have gained importance in the diagnosis, treatment planning, treatment and treatment monitoring of the spinal infections. Conventional radiographs are usually the initial imaging study. The sensitivity and specificity of the plain radiographs are very

E. Turgut Tali



Endovascular management of spinal dural arteriovenous fistulas  

Microsoft Academic Search

Spinal dural arteriovenous fistulas (SDAVFs) represent the most frequent spinal arteriovenous malformation and have an ominous natural history if left untreated. In the present review, we describe the spinal vascular anatomy, pathophysiology and clinical manifestations of SDAVFs, and the current role of endovascular embolization in this type of lesion.

Athos Patsalides; Alejandro Santillan; Jared Knopman; Apostolos J Tsiouris; Howard A Riina; Y Pierre Gobin



Spinal Cord Injury Map  


Spinal Cord Injury Map Loss of function depends on what part of the spinal cord is damaged, ... control. Learn more about spinal cord injuries. A spinal cord injury affects the entire family FacingDisability is ...


Lumbar spinal stenosis.  

PubMed Central

Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful initially, surgical decompression by wide laminectomy or an intralaminar approach should be done in patients with serious or progressive pain or neurologic dysfunction. Because the early diagnosis and treatment of lumbar spinal stenosis may prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment, all physicians should be aware of the different neurologic presentations and the treatment options for patients with spinal stenosis. Images

Ciricillo, S F; Weinstein, P R



Medicolegal cases for spinal epidural hematoma and spinal epidural abscess.  


Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider. The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control. All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases. PMID:23276337

French, Keisha L; Daniels, Eldra W; Ahn, Uri M; Ahn, Nicholas U



Spinal epidural angiolipoma: A rare cause of spinal cord compression  

PubMed Central

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

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



The effects of a polyphenol present in olive oil, oleuropein aglycone, in an experimental model of spinal cord injury in mice.  


Several olive oil phenolic compounds, such us oleuropein have attracted considerable attention because of their antioxidant activity, anti-atherosclerotic and anti-inflammatory properties. The aim of this experimental study was to determine the effect of oleuropein aglycone, a hydrolysis product of oleuropein, in the inflammatory response, in particular in the secondary injury associated with the mouse model of spinal cord trauma. The injury was induced by application of vascular clips to the dura via a four-level T5-T8 laminectomy in mice. Oleuropein aglycone was administered in mice (100 ?g/kg, 40 ?g/kg, 20 ?g/kg, 10% ethanol, i.p.) 1h and 6h after the trauma. The treatment with oleuropein aglycone significantly decreased: (1) histological damage, (2) motor recovery, (3) nuclear factor (NF)-?B expression and IKB-? degradation, (4) protein kinase A (PKA) activity and expression, (5) pro-inflammatory cytokines production such as tumor necrosis factor (TNF-?) and interleukin-1? (IL-1?), 6) inducible nitric oxide synthase (iNOS) expression, (7) neutrophil infiltration, (8) lipid peroxidation, (9) nitrotyrosine and poly-ADP-ribose (PAR) formation, (10) glial cell-derived neurotrophic factor (GDNF) levels, (11) apoptosis (TUNEL staining, FAS ligand expression, Caspase 3, Bax and Bcl-2 expression). Thus, we propose that olive oil phenolic constituents such as oleuropein aglycone may be useful in the treatment of various inflammatory diseases. PMID:22342994

Impellizzeri, Daniela; Esposito, Emanuela; Mazzon, Emanuela; Paterniti, Irene; Di Paola, Rosanna; Bramanti, Placido; Morittu, Valeria Maria; Procopio, Antonio; Perri, Enzo; Britti, Domenico; Cuzzocrea, Salvatore



Syringomyelia Associated with a Spinal Arachnoid Cyst  

PubMed Central

While syringomyelia is not a rare spinal disorder, syringomyelia associated with a spinal arachnoid cyst is very unusual. Here, we report a 62-year-old man who suffered from gait disturbance and numbness of bilateral lower extremities. Spinal magnetic resonance imaging (MRI) showed the presence of a spinal arachnoid cyst between the 7th cervical and 3rd thoracic vertebral segment and syringomyelia extending between the 6th cervical and 1st thoracic vertebral segment. The cyst had compressed the spinal cord anteriorly. Syringomyelia usually results from lesions that partially obstruct cerebrospinal fluid flow. Therefore, we concluded that the spinal arachnoid cyst was causing the syringomyelia. After simple excision of the arachnoid cyst, the symptoms were relieved. A follow-up MRI demonstrated that the syringomyelia had significantly decreased in size after removal of the arachnoid cyst. This report presents an unusual case of gait disturbance caused by syringomyelia associated with a spinal arachnoid cyst.

Kim, Min-Su



Spinal Osteosarcoma  

PubMed Central

Although osteosarcoma represents the second most common primary bone tumor, spinal involvement is rare, accounting for 3%–5% of all osteosarcomas. The most frequent symptom of osteosarcoma is pain, which appears in almost all patients, whereas more than 70% exhibit neurologic deficit. At a molecular level, it is a tumor of great genetic complexity and several genetic disorders have been associated with its appearance. Early diagnosis and careful surgical staging are the most important factors in accomplishing sufficient management. Even though overall prognosis remains poor, en-block tumor removal combined with adjuvant radiotherapy and chemotherapy is currently the treatment of choice. This paper outlines histopathological classification, epidemiology, diagnostic procedures, and current concepts of management of spinal osteosarcoma.

Katonis, P.; Datsis, G.; Karantanas, A.; Kampouroglou, A.; Lianoudakis, S.; Licoudis, S.; Papoutsopoulou, E.; Alpantaki, K.



Spinal Cord Injuries  


Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals ... forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries ...


Spinal Cord Diseases  


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


Spinal Cord Infarction  


... Contact NINDS Adobe Reader Microsoft Word Viewer NINDS Spinal Cord Infarction Information Page Table of Contents (click ... is being done? Clinical Trials Organizations What is Spinal Cord Infarction? Spinal cord infarction is a stroke ...


Spinal Infarcts  

Microsoft Academic Search

In the last decade typical signs of spinal cord ischemia have been reported. Confirming and supporting signs of acute ischemic\\u000a myelomalacia are vertebral body infarction and the pathognomonic contrast enhancement of the cauda equina in the course of\\u000a the disease. Moreover, bone infarction strongly indicates the proximal occlusion and the level of the affected segmental artery.\\u000a Cartilaginous disc embolism, embolism

Michael Mull; Armin Thron


Primary intramedullary spinal cord germinoma.  


Primary intramedullary spinal cord germinoma (PISCG) is an exceedingly rare diagnosis, with fewer than 30 cases reported in the literature. It is even less common in the pediatric population. Usually, initial imaging at patient presentation reveals a mass. The authors describe the unique case of a child whose initial imaging showed only focal spinal cord atrophy, which was the earliest sign of a slowly growing intramedullary lesion that was eventually proven via biopsy to represent a PISCG. The authors outline this child's diagnostically challenging presentation, review the events leading up to a diagnosis, briefly discuss PISCG, and summarize their recommendations for other physicians who may encounter a similar case. They assert that PISCG should be considered as a rare entity in the differential diagnosis of progressive spinal cord dysfunction even in the absence of an MRI abnormality of an intrinsic spinal cord mass, especially if there is unexplained focal atrophy of the cord. PMID:23432481

Madhukar, Megha; Maller, Vinod G; Choudhary, Arabinda K; Iantosca, Mark R; Specht, Charles S; Dias, Mark S



Understanding Spinal Muscular Atrophy  


... Ask the Expert »Understanding SMA »Newly Diagnosed »Chapters »Spinal Muscular Atrophy Medical Issues »Publications »Daily Life »Spinal Muscular Atrophy Conference »SMA Networking »Legislative »Grief and ...


Isolated Terminal Myelocystocele: A Rare Spinal Dysraphism  

PubMed Central

Terminal myelocystocele is a rare spinal dysraphism that present as lumbosacral mass. Magnetic resonance imaging (MRI) is the modality of choice for preoperative diagnosis. A 2.5 months old female baby presented with lumbosacral skin covered mass. There were no associated neurological deficits. MRI of the lesion suggested two cysts, one of which was continuous with the central canal of the spinal cord. At operation terminal myelocystocele was found with tethering of the spinal cord. Untethering of the spinal cord and repair of the myelocystocele performed with uneventful recovery.

Mahmood, Nasir; Ijaz, Lubna; Khawaja, Tariq; Aslam, Imaran; Sheikh, Afzal



Spinal epidural hemangioma related to pregnancy  

Microsoft Academic Search

We report the case of a 39-year-old woman with adolescent idiopathic scoliosis presenting with myelopathy secondary to a spinal\\u000a epidural hemangioma. MRI showed an epidural soft tissue mass within the spinal canal between T5 and T9 with severe spinal\\u000a cord compression. Symptoms had a temporal relationship to her pregnancy. Surgical removal of the epidural hemangioma rapidly\\u000a relieved her symptoms and

Gary S. Shapiro; Peter J. Millett; Edward F. DiCarlo; Douglas N. Mintz; Francis W Gamache; Bernard A. Rawlins



Vascular diseases of the spinal cord.  


Vascular disease affecting the spinal can cause substantial neurologic morbidity. Several vascular spinal cord ailments present as neurologic emergencies, and should thus be recognizable to the practicing neurologist. We review the epidemiology, presentation, management strategies, and prognosis of various pathologies, including infarction, dural arteriovenous fistula, arteriovenous malformation, cavernous malformation, compressive epidural hematoma, vasculitis, and genetic abnormalities. PMID:23186899

Rubin, Mark N; Rabinstein, Alejandro A



Spinal manifestation of neurolisteriosis  

Microsoft Academic Search

Spinal symptoms in acute bacterial meningitis are rare. In a series of 10 cases of neurolisteriosis, we observed 2 spinal complications, one due to an acute intramedullary abscess, the other caused by chronic spinal arachnoiditis. Therefore, if spinal symptoms develop in acute bacterial meningitis,Listeria monocytogenes infection should be considered and early adequate antibiotic treatment be implemented.

Karl Pfadenhauer; Tilman Rossmanith



Synergistic antiallodynic effects of spinal morphine with ketorolac and selective COX 1- and COX 2-inhibitors in nerve-injured rats 1 An abstract of this study was presented at the 1997 APS Meeting (New Orleans). 1  

Microsoft Academic Search

The possible role of spinal prostanoids in the tactile allodynia and thermal hyperalgesia associated with an experimental model of neuropathic pain was investigated. Neuropathic pain was induced by tight ligation of the L5 and L6 spinal nerves. Tactile allodynia was assessed 7 days after the surgery by measuring hindpaw withdrawal threshold to probing with von Frey filaments. Thermal hyperalgesia and

Jason M Lashbrook; Michael H Ossipov; John C Hunter; Robert B Raffa; Ronald J Tallarida; Frank Porreca



Spinal syringomyelia following subarachnoid hemorrhage.  


Subarachnoid blood has been reported as a cause of chronic spinal arachnoiditis. Although syringomyelia has been thought to be caused by spinal arachnoiditis, reports of syringomyelia following aneurysmal subarachnoid hemorrhage (SAH) are very rare. We describe two patients with syringomyelia associated with chronic spinal arachnoiditis following SAH. From January 2001 to December 2010, 198 patients with aneurysmal SAH were treated at Kinki University School of Medicine. Two of the 198 patients had syringomyelia following aneurysmal SAH; thus the rate of syringomyelia associated with aneurysmal SAH was 1.0%. Patient 1 was a 54-year-old woman who presented with back pain, back numbness and gait disturbance 20 months after SAH. Her MRI revealed syringomyelia of the spinal cord from C2 to T10. She underwent shunting of the syrinx to the subarachnoid space. Patient 2 was a 49-year-old man, who was admitted to the hospital with headache, diplopia, hoarseness, dysphagia and ataxia five months after SAH. MRI revealed syringomyelia from the medulla oblongata to C6, and an enlargement of the lateral and fourth ventricles. After foramen magnum decompression and C1 laminectomy, a fourth ventricle-subarachnoid shunt was placed by insertion of a catheter. Spinal arachnoiditis and spinal syringomyelia are rare but important chronic complications after SAH. PMID:22285478

Nakanishi, Kinya; Uchiyama, Takuya; Nakano, Naoki; Fukawa, Norihito; Yamada, Kimito; Yabuuchi, Tomonari; Kato, Amami



Spinal anesthesia in children: pro.  


Spinal anaesthesia, first introduced in children at beginning of 20th century, offers adequate intraoperative anaesthetic conditions (analgesia and muscle relaxation). The technique is easy to perform even if lumbar puncture is more difficult when the children is smaller. It has not been observed haemodynamic modifications especially in patients under 5 year of age; duration of spinal anaesthesia is shorter if compared to adults and post dural puncture headache (PDPH) after spinal anaesthesia is as common in children as it is in adults, but was usually mild and very short lasting. PDPH has not been correlated with the type of spinal needle used. Hyperbaric solution of local anaesthetics like bupivacaine and tetracaine are preferable. The only adjuvant used for spinal anesthesia in children is morphine, which should be administered only in patients admitted to high dependency unit in the postoperative period. Spinal anaesthesia is indicated mainly in sub umbilical surgical procedures lasting no more than 90 minutes and particularly in the surgical treatment of former premature infants who present an higher risk with regional anaesthesia. PMID:11778106

De Negri, P; Perrotta, F; Tirri, T; De Vivo, P; Ivani, G



Spinal Cord Neurosarcoidosis.  


BACKGROUND:: Spinal cord neurosarcoidosis (SN) is problematic to diagnose because it mimics other inflammatory neurologic diseases. The authors report the clinical features of 29 SN cases. METHODS:: They retrospectively reviewed the medical records of 29 histologically proven sarcoidosis patients with spinal cord involvement seen at 3 university medical centers. They collected clinical data including laboratory and radiological findings. Clinical outcomes were assessed retrospectively using the modified Rankin scale. RESULTS:: The cohort included high number of African Americans (16/29, 55%). The lung and intrathoracic lymph nodes were the most common confirmatory biopsy sites (18/29, 62%), whereas the spinal cord was a relatively uncommon one (4/29, 14%). The most common presenting symptoms were lower extremity weakness and paresthesias. Thoracic segment was most frequently involved (21/27, 78%). Lesions were mostly intramedullary (22/27, 81%), although nearly half involved the leptomeninges (13/27, 48%). The average size of a lesion spanned 3.9 spine segments (range, 1-9); 17 of 22 (77%) intramedullary patients had ?3 spine segments involved. Angiotensin-converting enzyme levels in cerebrospinal fluid were elevated in only 2 of 11 (18%) patients. All patients received glucocorticosteroids. Additional immune-modulating agents were used in 24 of 29 (83%) patients. Scores on the modified Rankin scale at the final follow-up visit were improved. CONCLUSIONS:: Most SN cases were diagnosed indirectly based on extraneural tissue biopsy. Extended spinal cord lesion (?3 spine segments) may be useful to distinguish SN from multiple sclerosis. Cerebrospinal fluid analysis was of limited value. Most patients experienced clinical improvement with immunosuppressive treatment, but many required combination therapy. PMID:23364469

Sohn, Mimi; Culver, Daniel A; Judson, Marc A; Scott, Thomas F; Tavee, Jinny; Nozaki, Kenkichi



Spinal cord stroke in a ballet dancer.  


Fibrocartilaginous embolism of the intervertebral disc represents an uncommon cause of spinal cord infarction. We present the case of a previously healthy 30-year old ballet dancer who noted acute severe neck pain shortly after an intensive training session and developed weakness and numbness of both arms, as well as difficulties in emptying the bladder and bowel. Her clinical presentation and neuroimaging studies including diffusion weighted imaging were consistent with a spinal cord infarction in the anterior spinal territory at the C3-C6 spinal cord level. Although no histological confirmation was obtained, lack of evidence of other plausible diagnoses in the setting of the patient's clinical presentation and neuroimaging findings made fibrocartilaginous embolism the most likely etiopathogenetic mechanism of spinal stroke. PMID:16460761

Spengos, Konstantinos; Tsivgoulis, Georgios; Toulas, Panagiotis; Sameli, Sofia; Vassilopoulou, Sofia; Zakopoulos, Nikolaos; Sfagos, Konstantinos



Spinal surgery -- cervical - series (image)  


The cervical spinal column is made up of vertebral bodies which protect the spinal cord. ... processes on the vertebral bodies (osteophytes), which compress spinal nerves, trauma, and narrowing (stenosis) of the spinal ...


Intramedullary lumbar lesion mimicking spinal cord tumor: a case of non-neoplastic intramedullary spinal cord lesion.  


Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed. PMID:20049487

Solmaz, Ilker; Onal, Mehmet B; Civelek, Erdinç; Sirin, Sait; Kahraman, Serdar



Intramedullary lumbar lesion mimicking spinal cord tumor: a case of non-neoplastic intramedullary spinal cord lesion  

PubMed Central

Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed.

Solmaz, Ilker; Civelek, Erdinc; Sirin, Sait; Kahraman, Serdar



Treadmill training promotes spinal changes leading to locomotor recovery after partial spinal cord injury in cats.  


After a spinal hemisection at thoracic level in cats, the paretic hindlimb progressively recovers locomotion without treadmill training but asymmetries between hindlimbs persist for several weeks and can be seen even after a further complete spinal transection at T13. To promote optimal locomotor recovery after hemisection, such asymmetrical changes need to be corrected. In the present study we determined if the locomotor deficits induced by a spinal hemisection can be corrected by locomotor training and, if so, whether the spinal stepping after the complete spinal cord transection is also more symmetrical. This would indicate that locomotor training in the hemisected period induces efficient changes in the spinal cord itself. Sixteen adult cats were first submitted to a spinal hemisection at T10. One group received 3 wk of treadmill training, whereas the second group did not. Detailed kinematic and electromyographic analyses showed that a 3-wk period of locomotor training was sufficient to improve the quality and symmetry of walking of the hindlimbs. Moreover, after the complete spinal lesion was performed, all the trained cats reexpressed bilateral and symmetrical hindlimb locomotion within 24 h. By contrast, the locomotor pattern of the untrained cats remained asymmetrical, and the hindlimb on the side of the hemisection was still deficient. This study highlights the beneficial role of locomotor training in facilitating bilateral and symmetrical functional plastic changes within the spinal circuitry and in promoting locomotor recovery after an incomplete spinal cord injury. PMID:23554433

Martinez, Marina; Delivet-Mongrain, Hugo; Rossignol, Serge



Spinal Cord Injury Medicine. 6. Economic and Societal Issues in Spinal Cord Injury  

Microsoft Academic Search

Priebe MM, Chiodo AE, Scelza WM, Kirshblum SC, Wuermser LA, Ho CH. Spinal cord injury medicine. 6. Economic and societal issues in spinal cord injury.This self-directed learning module presents a variety of social and economic issues facing people with spinal cord injury (SCI). It is part of the study guide on SCI medicine in the Self-Directed Physiatric Education Program for

Michael M. Priebe; Anthony E. Chiodo; William M. Scelza; Steven C. Kirshblum; Lisa-Ann Wuermser; Chester H. Ho



Spinal Muscular Atrophy  


Spinal muscular atrophy (SMA) is a genetic disease that attacks nerve cells, called motor neurons, in the spinal cord. These cells communicate with ... crawling, breathing, swallowing, and head and neck control. SMA runs in families. Parents usually have no symptoms, ...


Effects of systemic carbamazepine and gabapentin on spinal neuronal responses in spinal nerve ligated rats  

Microsoft Academic Search

There are few pharmacological studies of central neuronal measures in animal models of neuropathic pain. In the present study we have compared the effects of two anticonvulsants, carbamazepine and gabapentin, on spinal neuronal responses of nerve injured rats (selective ligation of spinal nerves L5 and L6, SNL) and sham-operated rats. The development and maintenance of cooling and mechanical allodynia of

Victoria Chapman; Rie Suzuki; Holly L. C Chamarette; Lars J Rygh; Anthony H Dickenson



Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured  

Microsoft Academic Search

Design: This paper describes a treatment paradigm to facilitate functional gait in a quadriplegic, ASIA C spinal cord injured (SCI), wheelchair-dependent subject who presented with some large fiber sensation, sub-functional motor strength in all lower limb muscles, and moderate spasticity. The study utilizes partial weight bearing therapy (PWBT) followed by epidural spinal cord stimulation (ESCS) with the assumption that both

R Herman; J He; S D'Luzansky; W Willis; S Dilli



Thoracoscopic Spinal Fusion Compared with Posterior Spinal Fusion for the Treatment of Thoracic Adolescent Idiopathic Scoliosis  

Microsoft Academic Search

BACKGROUND: Posterior spinal fusion with segmental instrumentation is the gold standard for the surgical treatment of tho- racic adolescent idiopathic scoliosis. More recently, an- terior surgery and video-assisted thoracoscopic surgery with spinal instrumentation have become an option. The purpose of the present study was to compare the radio- graphic and clinical outcomes as well as pulmonary function in patients managed

Baron S. Lonner; Dimitry Kondrachov; Farhan Siddiqi; Victor Hayes; Carrie Scharf


Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI  

Microsoft Academic Search

Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia\\u000a presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary\\u000a haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural\\u000a mass and gradual resolution of spinal cord oedema.

Ü. Ayd?ngöz; A. Oto; A. Cila



Spinal Chondrosarcoma: A Review  

PubMed Central

Chondrosarcoma is the third most common primary malignant bone tumor. Yet the spine represents the primary location in only 2% to 12% of these tumors. Almost all patients present with pain and a palpable mass. About 50% of patients present with neurologic symptoms. Chemotherapy and radiotherapy are generally unsuccessful while surgical resection is the treatment of choice. Early diagnosis and careful surgical staging are important to achieve adequate management. This paper provides an overview of the histopathological classification, clinical presentation, and diagnostic procedures regarding spinal chondrosarcoma. We highlight specific treatment modalities and discuss which is truly the most suitable approach for these tumors. Abstracts and original articles in English investigating these tumors were searched and analyzed with the use of the PubMed and Scopus databases with “chondrosarcoma and spine” as keywords.

Katonis, Pavlos; Alpantaki, Kalliopi; Michail, Konstantinos; Lianoudakis, Stratos; Christoforakis, Zaharias; Tzanakakis, George; Karantanas, Apostolos



Spinal infection: a case report  

PubMed Central

Objective: To present a case of a patient with spinal infection (SI) and highlight the chiropractor’s role in the prevention or minimization of devastating complications of SI. Background: Recent literature trends suggest an increasing prevalence of SI. Patients with SI most commonly present with unremitting progressive back pain and may or may not have fever or neurological signs. To avoid negative post-infection sequelae, establishing an early diagnosis and treatment is crucial. Clinical Features: A 29-year-old female diagnosed with L5-S1 disc herniation with impingement of the right S1 nerve root opted for surgical management. Iatrogenic bowel perforation during her spinal surgery resulted in contamination of the spinal surgical site, and findings in keeping with disco-osteomyelitis with epidural and paraspinal phlegmon formation were visualized on contrast enhanced MRI. Conclusion: Recent trends of increased spinal infection urge a heightened awareness by the chiropractor. The chiropractor can provide early diagnosis and supportive multidisciplinary care for such patients.

Quesnele, Jairus; Dufton, John; Stern, Paula



Pediatric spinal tumors.  


Although tumors of the central nervous system in children constitute the second most prevalent tumor type of childhood, spinal cord tumors account for less than 10% of pediatric central nervous system tumors. The most common are intramedullary, although they can be found in the extradural compartment or as intradural extramedullary masses. Extradural tumors can arise from bony elements, the meninges, or soft tissues. Neuroblastomas and sarcomas are frequently encountered along with bone tumors. Intradural extramedullary tumors can be meningeal or from distant sites and include meningiomas and schwannomas; most tend to be benign. Intradural intramedullary tumors, neuronal or glial, can be derived from neuroepithelial tissues. For the intramedullary tumors, astrocytomas represent around 60% of tumors, ependymomas 30%, and developmental tumors 4%. Such tumors require a multidisciplinary approach to ensure optimal patient outcomes. Spinal cord tumors most often present with pain followed by motor regression, gait disturbance, sphincter dysfunction or sensory loss, torticollis, and kyphoscoliosis. Treatment is based on tumor type, but surgical resection is the mainstay. Predictors of outcome include the histological grading, extent of resection, and neurological status at the time of surgery. PMID:23622304

Hsu, Wesley; Jallo, George I



[Spinal epidural abscess].  


The aspecific spinal epidural abscess is an uncommon cause of the spinal cord compression. Forty eight patients presented with epidural abscess were operated on during the last 37-year-period in the National Institute of Neurosurgery Budapest. Experiences with the diagnostic methods and the results of the treatment of these patients are analysed. Based on the case history data, preoperative symptoms and operative findings 31 male and 17 female patients (their age ranged from 15-64 years) have been selected in acute, subacute and chronic groups. Localized backpain, acceleration of the blood sedimentation, leukocytosis and fever were significant findings which were followed by sings of radicular or medullary compression. This clinical picture developed rapidly in the acute group. Aspecific abscess most commonly appeared in thoracal or lumbal localisation and was rarely found in the ventral area. Staphylococcus aureus was the causative organism in nearly 100 percent of the cases. Surgery carried out before the onset of the neurological deficits according to proper CSF examination and myelography, proved to be favourable. Early diagnosis and emergency operation led to a significant improvement of the outcome. PMID:7651713

Vidovszky, T



Spinal dural arteriovenous fistulas: a review.  


Spinal dural arteriovenous fistulas (SDAVF) are a rare pathologic entity with a diverse and often misleading clinical presentation. While digital subtraction spinal angiography remains the gold standard, recent advances in noninvasive vascular imaging have improved the diagnosis of SDAVF. As this condition can result in permanent spinal cord injury, all patients require treatment, which consists of surgical or endovascular occlusion of the fistula. Failure to recognize and treat SDAVF in a timely fashion can result in irreversible neurologic disability, including myelopathy, lower extremity weakness and bowel, bladder and sexual dysfunction. This article reviews the clinical features, pathogenesis, radiographic features and current treatment strategies for these complex lesions. PMID:23666862

Marcus, Joshua; Schwarz, Justin; Singh, I Paul; Sigounas, Dimitri; Knopman, Jared; Gobin, Y Pierre; Patsalides, Athos



Thrombolysis in anterior spinal artery syndrome.  


Anterior spinal artery syndrome (ASAS) is often a devastating spinal stroke occurring when the anterior spinal artery or one of its supplying anterior medullary arteries are occluded. The most common causes are arteriosclerosis, dissection of the abdominal aorta, cardiac embolism and degenerative spine disease, and the major risk factors are smoking, hypertension, diabetes and hypercholesterolaemia. The treatment has generally been supportive. We believe thrombolysis should be considered in the acute phase of this condition, and present a case with ASAS who experienced partial recovery after treatment given 4.5 h after symptom onset. PMID:22962400

Müller, Kai Ivar; Steffensen, Linn Hofsøy; Johnsen, Stein Harald



Spinal Cord Ring Enhancement in Multiple Sclerosis  

PubMed Central

Objective Describe the clinical and imaging characteristics of spinal cord ring enhancement in multiple sclerosis (MS). Design Clinical case series. Setting Academic referral center. Patients Twenty MS subjects with spinal cord ring enhancement were retrospectively identified from 322 cervical and thoracic spinal cord MRI studies over a 3 year period. Main Outcome Measures Demographics, disability, pattern of enhancement on spinal cord imaging, and concomitant brain magnetic resonance imaging (MRI) were determined. Results Ring enhancement was seen in 20 subjects with spinal cord enhancement, most commonly in the cervical cord. Incomplete or ‘open’ ring enhancement was the dominant pattern in 19 of 20 (95%) subjects. Concurrent ring enhancing brain lesions were present in 40% of subjects. At the time of the MRI, the Expanded Disability Status Scale (EDSS) ranged from 1.0–7.0 (median 3.0). Conclusion Ring enhancement is not an uncommon pattern for MS spinal cord lesions, occurring with a prevalence of 6.2% (20/322). The most common pattern was incomplete ring enhancement in the cervical spinal cord. Recognition of this pattern may improve and expedite the diagnosis of MS and preclude need for invasive diagnostic interventions.

Klawiter, Eric C; Benzinger, Tammie; Roy, Abhik; Naismith, Robert T; Parks, Becky J; Cross, Anne H



Spinal Cord Ischemia  

Microsoft Academic Search

\\u000a Despite many advances and an improved understanding of spinal cord anatomy and the pathogenesis of spinal ischemia, the rates\\u000a of debilitating postoperative paraparesis or paraplegia are still not negligible after an open procedure for treatment of\\u000a thoracic or thoraco-abdominal pathology. Individual studies have demonstrated the role of different treatment modalities to\\u000a prevent or treat spinal cord ischemia; however, a multimodal

Germano Melissano; Luca Bertoglio; Efrem Civilini; Roberto Chiesa


Intramedullary spinal cord tumors  

Microsoft Academic Search

Opinion statement  The three most common types of intramedullary spinal cord tumors are low-grade astrocytomas, ependymomas, and high-grade astrocytomas.\\u000a Surgical extirpation is the necessary and sufficient primary treatment for most intramedullary spinal cord tumors. Radiation\\u000a therapy may also have a role in the management of persistent, recurrent, or progressive low-grade astrocytomas and ependymomas.\\u000a The current treatment of spinal cord high-grade astrocytomas,

Daniel C. Bowers; Bradley E. Weprin



Skimboarding: a new cause of water sport spinal cord injury  

Microsoft Academic Search

Study design:Case series.Objective:To present three cases of spinal cord injuries associated with skimboarding and to suggest aspects of the sport that may be associated with spinal cord injury.Setting:Shepherd Center, Atlanta, GA, USA. Spinal cord injury rehabilitation facility.Methods:Three males, aged 17–23 years, sustained cervical spine fractures resulting in tetraplegia after skimboarding accidents.Results:The patients admitted from Florida hospitals presented with tetraplegia resulting

T R Collier; M L Jones; H H Murray



Pulmonary Function in Spinal Muscular Atrophy  

Microsoft Academic Search

We present the first prospective study on pulmonary function in spinal muscular atrophy patients. Seventy-seven spinal muscular atrophy patients, ages 5 to 18 years, from three centers, were studied with regard to forced vital capacity, using height as a predictor. Patients were categorized into four motor function categories. The highest-functioning group had normal or near-normal values, and those who sat

F. J. Samaha; C. R. Buncher; B. S. Russman; M. L. White; S. T. Iannaccone; L. Barker; K. Burhans; C. Smith; B. Perkins; L. Zimmerman



Spinal Dysraphism: Trends in Northern India  

Microsoft Academic Search

Objective: To evaluate the clinical profiles, image findings and surgical outcome of 155 cases of spinal dysraphism. Methods: 155 patients were studied prospectively (143) or retrospectively (12). The male to female ratio was 1.5:1. Mean age at presentation was 5.7 years. Out of 155 cases of spinal dysraphism, 119 had open spina bifida [meningomyelocele (MMC) in 113 (72%), meningocele in

Raj Kumar; S. N. Singh



[Spontaneous spinal subdural hematoma].  


Spontaneous spinal subdural hematomas are rare and may be caused by vascular malformations or bleeding disorders. The diagnosis is based on the conjunction of clinical examination with imaging studies, being MRI the gold standard in detection and surgical planning. The authors report the case of a patient on anticoagulant therapy in the context of atrial fibrillation and mechanical prosthetic mitral and tricuspid valves, presenting with sudden onset of dorsal pain radiated to both lower limbs, paresthesias and progressive paraparesis. The impossibility to perform MRI (because the mechanical valve prostheses) hindered the diagnosis of acute spontaneous subdural hematoma. After reversal of the anticoagulation and surgical treatment, clinical course was favorable with neurological recovery. PMID:22856422

Alpoim, Bruno; Rodrigues, Maria; Silva, Pedro; Carvalho, Bruno; Pereira, Paulo; Vaz, Rui



Spinal Deformities  

Microsoft Academic Search

\\u000a The spine is normally straight in the frontal (coronal) plane. If it is not, a lateral curvature or scoliosis is present.\\u000a Scolioses are subdivided into structural and non-structural, according to whether the spine is additionally twisted [1]. Thus\\u000a structural scoliosis is defined as a lateral curvature with rotation. The important attribute of a structural scoliosis is\\u000a that it is intrinsic

Robert A. Dickson


Symptomatic Spinal Intradural Arachnoid Cysts in the Pediatric Age Group: Description of Three New Cases and Review of the Literature  

Microsoft Academic Search

Spinal arachnoid cysts are a relatively uncommon lesion that may be either intra- or extradural, and intradural spinal arachnoid cysts are even less common. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots suddenly or progressively. We present three cases in the pediatric age group with spinal intradural arachnoid cysts without a

H.-J. Lee; D.-Y. Cho



Spinal injury in sports  

Microsoft Academic Search

Nowadays, the scene of sports has changed as it involves not only money but prestige for self and country. Hence, sports has become aggressive. Any sport which involves movement and momentum can cause spinal injury, like football, water sports, wrestling, rugby, transpoling and ice hockey.Spinal injury can be simple to serious leading to paralysis or death.The team physician should: Identify

R C Mishra



Spinal surgery in spinal muscular atrophy.  


Fifteen patients with surgical treatment of spinal muscular atrophy were reviewed. The curve pattern was thoracic in 3, thoracolumbar in 11, and double thoracic and thoracolumbar in 1. Follow-up averaged 31 months. Eleven patients underwent posterior spinal fusion with Harrington instrumentation, with segmental wiring in four, and two had Luque instrumentation. The average age at time of surgery was 14.4 years. The average curve correction was 48%; that with the pelvic obliquity corrected, 63%. Surgery is best done when the curve is approximately 50-60 degrees, and Luque sublaminar wiring of Harrington or Luque rods with no external support appears to be the procedure of choice. PMID:4019750

Daher, Y H; Lonstein, J E; Winter, R B; Bradford, D S


Entrapped spinal nerve roots in a pseudomeningocoele as a complication of previous spinal surgery  

Microsoft Academic Search

Summary  Pseudomeningocele is a rare but well recognised complication of lumbar surgery (microdiscectomy and laminectomy). Most of\\u000a the patients tolerate the presence of the cyst well, however some present with back pain and spinal claudication, presumably\\u000a due to neural compression. We report a case who presented following three operations (microdiscectomy, laminectomy and excision\\u000a of a pseudomeningocele) with symptoms of spinal claudication

G. Pavlou; S. D. Bucur; P. T. van Hille



Proceedings of Annual Clinical Spinal Cord Injury Conference (16th), September 27-29, 1967.  

National Technical Information Service (NTIS)

The forty-five papers, illustrations, references and discussion are reproduced. Presentations were made on spinal injuries centers in Victoria and Perth, Australia and in California. EEG patterns in sleep and wakefulness, properties of deafferented spinal...



Purine Receptor Inhibition as a Therapeutic Strategy in Spinal Cord and Brain.  

National Technical Information Service (NTIS)

The present invention is directed to a method of treating a subject with acute spinal cord injury by administering a purine receptor antagonist to the subject under conditions effective to treat spinal cord injury. The purine receptor antagonist inhibits ...

M. Nedergaard S. A. Goldman



Angiography in the investigation of spinal dural arteriovenous fistula  

Microsoft Academic Search

The authors present their protocol for spinal angiography in their investigation of dural arteriovenous fistula (DAVF). The protocol has been used in approximately 120 patients from 1983 to the present at Bicetre Hospital. The approach is based on the fact that venous congestion is responsible for the myelopathy of DAVF. If the venous phase of the spinal circulation is normal,

R. Willinsky; P. Lasjaunias; K. Terbrugge; M. Hurth



Case report: diffusion-weighted MRI in anterior spinal artery stroke of the cervical spinal cord.  


The authors present a case of anterior spinal artery stroke demonstrated by diffusion-weighted MRI (DWI) using single-shot echo-planar imaging. DWI clearly demonstrated hyperintensity with a decreased apparent diffusion coefficient (ADC) at 26 hours after onset. At 28 days, there was persistent hyperintensity with an increased ADC, corresponding to T2-weighted hyperintensity in the whole spinal gray matter at the C2-C7 vertebral level. DWI provided satisfactory images and was helpful for diagnosing and evaluating anterior spinal artery stroke. PMID:12794607

Sagiuchi, Takao; Iida, Hideo; Tachibana, Shigekuni; Kusumi, Mari; Kan, Shinichi; Fujii, Kiyotaka


Spontaneous spinal subdural hematoma concurrent with cranial subdural hematoma.  


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

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



Spontaneous Spinal Subdural Hematoma Concurrent with Cranial Subdural Hematoma  

PubMed Central

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

Moon, Wonjun; Chough, Jeongki; Park, Haekwan



Spinal respiratory motoneurons and interneurons.  


Maintenance of life among higher vertebrates depends on permanent, rhythmic and coordinated activity of respiratory muscles. Fundamental to our understanding of breathing is an appreciation for the neural components involved in the generation, maintenance and modulation of respiratory rhythm. Multidisciplinary studies have revealed important perspectives about the spinal and supraspinal components contributing to breathing, but a complete understanding of respiratory pathways and their interconnectivity remains unknown. Definition of these pathways is essential for understanding how respiratory processes may be affected by injury or disease. The present review highlights our current understanding of the distribution of spinal motoneurons and interneurons involved in mammalian respiratory activity and how they are affected by injury or disease in the central nervous system. PMID:21782981

Lane, Michael A



Spinal astrocytes produce and secrete dynorphin neuropeptides.  


Dynorphin peptide neurotransmitters (neuropeptides) have been implicated in spinal pain processing based on the observations that intrathecal delivery of dynorphin results in proalgesic effects and disruption of extracellular dynorphin activity (by antisera) prevents injury evoked hyperalgesia. However, the cellular source of secreted spinal dynorphin has been unknown. For this reason, this study investigated the expression and secretion of dynorphin-related neuropeptides from spinal astrocytes (rat) in primary culture. Dynorphin A (1-17), dynorphin B, and ?-neoendorphin were found to be present in the astrocytes, illustrated by immunofluorescence confocal microscopy, in a discrete punctate pattern of cellular localization. Measurement of astrocyte cellular levels of these dynorphins by radioimmunoassays confirmed the expression of these three dynorphin-related neuropeptides. Notably, BzATP (3'-O-(4-benzoyl)benzoyl adenosine 5'-triphosphate) and KLA (di[3-deoxy-D-manno-octulosonyl]-lipid A) activation of purinergic and toll-like receptors, respectively, resulted in stimulated secretion of dynorphins A and B. However, ?-neoendorphin secretion was not affected by BzATP or KLA. These findings suggest that dynorphins A and B undergo regulated secretion from spinal astrocytes. These findings also suggest that spinal astrocytes may provide secreted dynorphins that participate in spinal pain processing. PMID:23290538

Wahlert, Andrew; Funkelstein, Lydiane; Fitzsimmons, Bethany; Yaksh, Tony; Hook, Vivian



Spinal injuries in sports.  


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

Boden, Barry P; Jarvis, Christopher G



Spinal injuries in sports.  


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

Boden, Barry P; Jarvis, Christopher G



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

PubMed Central

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.

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



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

PubMed Central

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

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



Pregnancy following spinal cord injury.  

PubMed Central

Each year about 2,000 women of childbearing age in the United States have a spinal cord injury. Only a few mostly anecdotal reports describe pregnancy after such an injury. In a retrospective study of 16 women with a spinal cord injury, half of whom have a complete injury and about half quadriplegia, 25 pregnancies occurred, with 21 carried to full term. The women delayed pregnancy an average of 6.5 years after their injury, with an average age at first pregnancy of 26.8 years. Cesarean section was necessary in 4 patients because of inadequate progress of labor. In 5 deliveries an episiotomy and local anesthesia were required, 7 required epidural anesthesia, including all cesarean sections, and 10 did not require anesthesia. Several complications have been identified in the antepartum, intrapartum, and postpartum periods including autonomic hyperreflexia, premature labor, pressure sores, urinary tract infections, abnormal presentation, and failure to progress. Ultrasonography and amniocentesis were used selectively. Women with spinal cord injuries can have healthy children, although there are significant risks and these women have special needs.

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



What Is Spinal Stenosis?  


... Public 3 One type of spinal stenosis, cauda equine syndrome, is very serious. This type occurs when ... Limits on your activity. ? Exercises and/or physical therapy. ? A brace for your lower back. What Is ...


Spinal Cord Injury  


... which then crush and destroy axons -- extensions of nerve cells that carry signals up and down the spinal ... drug methylprednisolone appears to reduce the damage to nerve cells if it is given within the first 8 ...


Applications in spinal imbalance.  


The pelvis may be seen as a single vertebra, between the spine and the femurs. The anatomy of this pelvic vertebra has changed with the evolution of species, notably with the transition to bipedalism, with the consequent appearance of lumbar lordosis. The lumbosacral angle, almost non-existent in other mammals, is at its greatest in humans. Pelvic and spinal radiological parameters reflect the sagittal balance of the spine in bipedal humanity. Applications in the management of spinal imbalance are numerous. Arthrogenic or degenerative kyphosis is the stereotypic example of spinal aging. Postoperative flat back following spine surgery is hard to prevent. Scoliosis surgery in adults should now take greater account of the patient's individual sagittal balance, by analyzing the pelvic and spinal parameters. The extent of arthrodeses performed during adolescence to manage idiopathic scoliosis may also induce problems of balance in adulthood if these elements are not taken into account. PMID:20447889

Husson, J-L; Mallet, J-F; Parent, H; Cavagna, R; Vital, J-M; Blamoutier, A; Violas, P



Congenital spinal cord anomalies: a pictorial review.  


Development of spinal canal and its contents occurs in a much regulated fashion. Aberration at any stage of development namely gastrulation, primary neurulation, secondary neurulation, and retrogressive differentiation can result in a specific abnormality. Spinal cord anomalies or spinal dysraphism is a heterogeneous group containing some entities that are obvious at birth and many that are discovered only after imaging for neurological symptoms or signs. Congenital spinal tumors are closely related and present either as an external mass or imaging abnormalities. Radiological imaging plays a crucial role in both diagnosis and postoperative evaluation of these patients. Magnetic resonance imaging is the modality of choice. Computed tomography is used in a limited fashion. Plain radiographs are the initial imaging in patients presenting with abnormal curvatures of spine. No other central nervous system abnormality requires as systematic an approach as spinal dysraphism. The authors present a review of both common and rare anomalies that they encountered for a 3-year period in their institute, a tertiary care level hospital. PMID:23332138

Gupta, Pankaj; Kumar, Atin; Kumar, Avneesh; Goel, Sandeep


Cutaneous silent periods in intramedullary spinal cord lesions  

Microsoft Academic Search

Objective: The neurophysiological assessment of intramedullary spinal cord lesions has been unsatisfactory. Previous studies in patients with syringomyelia suggest that testing of cutaneous silent periods (CSPs) may be useful to assess centromedullary lesions. Methods: The authors studied nine patients with intramedullary spinal cord lesions of different etiologies. Eight patients with cervical lesions presented with hypalgesia, hypothermesthesia, or pain in at

Markus Kofler; Martina F Kronenberg; Christian Brenneis; Alexandra Felber; Leopold Saltuari



Hypothalamic Hypocretin (Orexin): Robust Innervation of the Spinal Cord  

Microsoft Academic Search

Hypocretin (orexin) is synthesized by neurons in the lateral hypothalamus and has been reported to increase food intake and regulate the neuroendocrine system. In the present paper, long descending axonal projections that contain hypocretin were found that innervate all levels of the spinal cord from cervical to sacral segments, as studied in mouse, rat, and human spinal cord and not

Anthony N. van den Pol



Gait Analysis of Adult Paraplegic Rats after Spinal Cord Repair  

Microsoft Academic Search

This study presents a novel detailed method of analysis of rat gait and uses this method to demonstrate recovery of forward locomotion patterns in adult rats made paraplegic by surgical spinal cord transection and subjected to a novel strategy for spinal cord repair. Six normal rats were compared to five animals in which the cord was transected at T8–T9, and

Henrich Cheng; Susanne Almström; Lydia Giménez-Llort; Robert Chang; Sven Ove Ögren; Barry Hoffer; Lars Olson



MRI of the Spinal Cord in Vitamin B12 Deficiency  

Microsoft Academic Search

Vitamin B12 deficiency causes hematological and neurological diseases. Subacute combined degeneration (SCD) of the spinal cord characterized by degeneration of the lateral and posterior columns is often found due to vitamin B 12 deficiency. We described three patients with SCD presenting with cervical and thoracic myelopathy. Laboratory data revealed vitamin B 12 deficiency and MRI of the spinal cord demonstrated

Chin-Hua Fu; Hui-Ching Chen; Wen-Long Tsao


[Congenital defects of the spinal cord and canal in neuroimaging].  


Authors present the clinical classification of spinal dysraphisms and discuss all imaging modalities useful in the diagnosis: conventional X-rays, myelography, computed tomography, myelo-CT and magnetic resonance imaging. They precise the place of ultrasound in the prenatal and postnatal imaging of spinal dysraphisms. PMID:9656741

Urbanik, A; Herman-Sucharska, I; Podsiad?o-Kleinrok, B; Chojnacka, I; Kleinrok, K; Ku?miderski, J



Effect of Temporary Visceral Ischemia on Spinal Cord Ischemic Damage in the Rabbit  

Microsoft Academic Search

Background. Spinal cord ischemia and visceral ischemia may occur simultaneously during thoracoabdominal aortic aneurysm repair. The present rabbit study investigated the effect of a temporary interruption of the visceral perfusion on the development of ischemia-reperfusion injury of the spinal cord. Methods. Spinal cord ischemia was induced by occlusion of the infrarenal aorta for variable durations (6 to 20 minutes) in

Paul W. G. Elbers; Peter de Haan; Ivo Vanicky; Dink Legemate; Misa Dzoljic



Noninvasive assessment of the injured human spinal cord by means of functional magnetic resonance imaging  

Microsoft Academic Search

Study design: A magnetic resonance imaging technique that enables indirect detection of neuronal activity has been developed for the spinal cord. In the present study, this method, spinal functional magnetic resonance imaging (fMRI), is applied to the first study of the injured spinal cord, with the goal of better clinical assessment of the entire cord.Objectives: The objectives of this project

P W Stroman; J Kornelsen; A Bergman; V Krause; K Ethans; K L Malisza; B Tomanek



Disseminated Tuberculosis of Central Nervous System : Spinal Intramedullary and Intracranial Tuberculomas  

PubMed Central

As a cause of spinal cord compression, intramedullary spinal tuberculoma with central nervous system (CNS) involvement is rare. Aurthors report a 66-year-old female presented with multiple CNS tuberculomas including spinal intramedullary tuberculoma manifesting paraparesis and urinary dysfunction. We review the clinical menifestation and experiences of previous reported literature.

Lim, Yu Seok; Kim, Min Ki; Lim, Young Jin



Clenbuterol, a ? 2Adrenoceptor Agonist, Improves Locomotor and Histological Outcomes after Spinal Cord Contusion in Rats  

Microsoft Academic Search

An important goal of rehabilitation following spinal cord injury is recovery of locomotor function and muscular strength. In the present studies, we determined whether the ?2-agonist, clenbuterol, can improve recovery of locomotor function following spinal cord injury. A model of spinal cord injury was examined in which four graded levels of contusion injury were produced in rats at the level

Richard J. Zeman; Yong Feng; Hong Peng; Joseph D. Etlinger



Spinal arachnoiditis as a consequence of aneurysm-related subarachnoid haemorrhage.  


Only a few case reports currently exist regarding symptomatic spinal arachnoiditis following aneurysm-related subarachnoid haemorrhage. We present three patients who developed symptomatic spinal arachnoiditis following spontaneous aneurysm rupture. Following initial aneurysm and subarachnoid haemorrhage management (including ventriculo-peritoneal shunt placement), all three patients developed gradually worsening neurological abnormalities, and subsequent imaging demonstrated spinal arachnoiditis. Despite spinal decompression, all three patients experienced progressively worsening neurological decline. PMID:23374556

van Heerden, Jolandi; McAuliffe, William



Conus Medullaris Spinal Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome  

PubMed Central

Summary We describe a 24-year-old woman who presented with twice previously unverified subarachnoid hemorrhages from the conus me-dullaris spinal arteriovenous malformation with Parkes-Weber-syndrome. Spinal MRI examination is considered to be necessary for the diagnosis of Klippel-Trenaunay-Weber syndro-me. For diagnosis of the spinal cord arteriovenous malformation, it is indispensable to search carefully for the presence of accompanying lesions. Transarterial glue embolization is effective for the management of the spinal vascular lesion.

Iizuka, Y.; Suzuki, M.; Komura, S.; Takada, T.; Shimoji, K.



Characteristics of Human Fetal Spinal Cord Grafts in the Adult Rat Spinal Cord: Influences of Lesion and Grafting Conditions  

Microsoft Academic Search

The present study evaluated the growth potential and differentiation of human fetal spinal cord (FSC) tissue in the injured adult rat spinal cord under different lesion and grafting conditions. Donor tissue at 6–9 weeks of gestational age was obtained through elective abortions and transplanted either immediately into acute resection (solid grafts) or into chronic contusion (suspension and solid grafts) lesions

Mark A. Giovanini; Paul J. Reier; Thomas A. Eskin; Edward Wirth; Douglas K. Anderson



The association of tethered cord, syringomyelia, diastometamyelia, spinal epidermoid, spinal lipoma and dermal sinus tract in a child.  


We report on a 5-year-old boy presenting with tethered cord, diastometamyelia, spinal dysraphism, terminal lipoma, spinal epidermoid, and dermal sinus tract with CT, conventional MRI, and diffusion-weighted MRI findings. To the best of our knowledge, our case has the property to be the first case in the literature showing the association of these pathologies all together. PMID:21381528

Avcu, S; Köseo?lu, M Necat; Bulut, M Deniz; Ozen, O; Unal, O


Spinal-cord compression in myeloma.  

PubMed Central

Clinical records of 47 patients in whom spinal-cord compression was the presenting feature of plasma-cell myeloma were analysed retrospectively. Patients were referred during 1954-78. Median survival was 30 months and prognosis was best for those in whom the site of cord compression was the thoracic region. Early laminectomy and decompression followed by adequate radiotherapy resulted in complete or good partial response in over a third of patients who presented with complete paraplegia. Improvements in supportive care and more effective chemotherapy allow spinal-cord compression in myeloma to be treated promptly and vigorously, thus improving duration and quality of survival in a substantial proportion of patients.

Benson, W J; Scarffe, J H; Todd, I D; Palmer, M; Crowther, D



An interesting case of primary spinal arachnoiditis.  


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

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



Type III spinal muscular atrophy mimicking muscular dystrophies.  


Types III and IV spinal muscular atrophy represent a diagnostic challenge due to the great variability in their presentation. We report a series of eight patients with type III spinal muscular atrophy who were followed for a long time for possible muscular dystrophy or myopathy, confirming its clinical heterogeneity and propensity to delayed diagnosis. Clinical examination revealed heterogeneous findings, where the diagnosis of type III spinal muscular atrophy was not immediately apparent in many patients as their clinical and laboratory abnormalities were consistent with muscular dystrophy or myopathy. The presence of dystrophic features such as hypertrophy of the calves, weakness of the limb girdle, high serum creatine kinase levels, and myopathic histopathology should not divert attention from the possibility of spinal muscular atrophy. It is strongly recommended to give variable presentations enough thought and to consider the autosomal recessive type III spinal muscular atrophy in the diagnostic evaluation. PMID:23583053

Alsaman, Abdulaziz S; Alshaikh, Nahla M



What Is Spinal Cord Injury?  


... NICHD Research Information Clinical Trials Resources and Publications Spinal Cord Injury (SCI): Condition Information Page Content What ... back. Generally speaking, SCI is damage to the spinal nerves, the body's central and most important nerve ...


Pediatric Spinal Cord Injury 101  

MedlinePLUS Videos and Cool Tools

Experts \\ Pediatric Spinal Cord Injury 101 Topics Adult Injuries Spinal Cord Injury 101 The Basics of SCI Rehabilitation Preventing Pressure Sores Transition from Hospital to Home Spasticity, Physical Therapy- ...


Overview of Spinal Cord Disorders  


... about such things as touch, pain, temperature, and vibration from the skin to the spinal cord.) Spinal ... to feel a light touch, pain, temperature, or vibration) Changes in reflexes Loss of bladder control (urinary ...


Lumbar puncture (spinal tap) (image)  


... A spinal needle is inserted, usually between the 3rd and 4th lumbar vertebrae in the lower spine. Once the needle is properly positioned in the subarachnoid space (the space between the spinal cord and its ...


A novel rodent model of spinal metastasis and spinal cord compression  

PubMed Central

Background Spinal cord metastatic lesions affect a high number of cancer patients usually resulting in spinal cord compression syndrome. A major obstacle in the research of spinal metastatic disease is the lack of a simple reproducible animal model that mimics the natural course of the disease. In this study, we present a highly reproducible rodent model that can be used for different types of cancers while mimicking the natural course of human metastatic spinal cord compression syndrome. Results All sixteen Fisher 344 rats survived the dorsal approach intraosseous implantation of CRL-1666 adenocarcinoma cells and both rats survived the sham control surgery. By Day 13 functional analysis via the modified Basso-Beattie-Bresnahan (BBB) locomotor rating scale showed significant decrease in motor function; median functional score was 3 for the tumor group (p = 0.0011). Median time to paresis was 8.7 days post-operatively. MR imaging illustrated repeated and consistent tumor formation, furthermore, onset of neurological sequale was the result of tumor formation and cord compression as confirmed by histological examination. Conclusions Analysis of these findings demonstrates a repeatable and consistent tumor growth model for cancer spinal metastases in rats. This novel rat model requires a less intricate surgical procedure, and as a result minimizes procedure time while subsequently increasing consistency. Therefore, this model allows for the preclinical evaluation of therapeutics for spinal metastases that more closely replicates physiological findings.



Spinal dysraphism and cavovarus foot deformity: a case report  

PubMed Central

Neurological impairment secondary to spinal dysraphism most commonly presents as unilateral cavovarus foot in children. The deformity usually develops in the growing child around the age of five or six. The presence of a cavovarus foot of unknown origin in a child should lead to a complete neurological examination, including an assessment of the spine for spinal dysraphism. The early recognition of pathology may prevent severe neurological sequelae. A case of lipomyelomeningocele is presented to illustrate that cord damage in children with spinal dysraphism can present initially as a cavovarus foot. ImagesFigure 1 (a, b and c)Figure 2Figure 3Figure 4

Hains, Francois; Dzus, Ann K; Cassidy, J David



Neurophysiological effects of spinal manipulation  

Microsoft Academic Search

Background context: Despite clinical evidence for the benefits of spinal maniputation and the apparent wide usage of it, the biological mechanisms underlying the effects of spinal manipulation are not known. Although this does not negate the clinical effects of spinal manipulation, it hinders acceptance by the wider scientific and health-care communities and hinders rational strategies for improving the delivery of

Joel G Pickar



Spinal syringomyelia following subarachnoid hemorrhage  

Microsoft Academic Search

Subarachnoid blood has been reported as a cause of chronic spinal arachnoiditis. Although syringomyelia has been thought to be caused by spinal arachnoiditis, reports of syringomyelia following aneurysmal subarachnoid hemorrhage (SAH) are very rare. We describe two patients with syringomyelia associated with chronic spinal arachnoiditis following SAH. From January 2001 to December 2010, 198 patients with aneurysmal SAH were treated

Kinya Nakanishi; Takuya Uchiyama; Naoki Nakano; Norihito Fukawa; Kimito Yamada; Tomonari Yabuuchi; Amami Kato


Neurophysiological effects of spinal manipulation  

Microsoft Academic Search

Background context: Despite clinical evidence for the benefits of spinal maniputation and the appar- ent wide usage of it, the biological mechanisms underlying the effects of spinal manipulation are not known. Although this does not negate the clinical effects of spinal manipulation, it hinders acceptance by the wider scientific and health-care communities and hinders rational strategies for improving the delivery

Joel G. Pickar



Metastatic Spinal Tumor  

PubMed Central

In accordance with extending survival periods of cancer patients, number of consecutively developing metastatic spinal tumor is also increasing. There have been improvements in the treatment results of metastatic spine tumor by virtue of the developments in diagnostic radiology, chemotherapy, adjuvant treatment, operative device and technique, discrete preoperative plan, and standardized operation. Accordingly, surgical indication has also increased. Clinically, in case of metastatic spine tumor, treatment of tumor itself should be focused on pain relief, preservation of neurologic function, prevention of pathologic fracture, prevention of pathologic fracture, and correction of spinal instability for improving quality of life, rather than for extension of survival. Additionally, etiology of spinal tumor, correct diagnosis and subsequent treatment principles should be thoroughly understood before establishing treatment plans for effective treatments.

Jung, Chul-Hee



Spinal Injuries in Children  

PubMed Central

About 5% of spinal injuries occur in children – however the consequences to the society are devastating, all the more so because the cervical spine is more commonly affected. Anatomical differences with adults along with the inherent elasticity of the pediatric spine, makes these injuries a biomechanically separate entity. Hence clinical manifestations are unique, one of which is the Spinal Cord Injury Without Radiological Abnormality. With the advent of high quality MRI and CT scan along with digital X-ray, it is now possible to exactly delineate the anatomical location, geometrical configuration, and the pathological extent of the injury. This has improved the management strategies of these unfortunate children and the role of surgical stabilization in unstable injuries can be more sharply defined. However these patients should be followed up diligently because of the recognized long term complications of spinal deformity and syringomyelia.

Basu, Saumyajit



Cocaine-induced vasospasm causing spinal cord transient ischemia.  


A 25-year-old woman developed a spinal cord infarction leading to quadriplegia and respiratory insufficiency after consuming cocaine and vodka for several days. Within five months, she regained full motor and respiratory function. A literature review revealed 11 cases of cocaine-induced spinal cord infarction. A complete recovery from quadriplegia and respiratory failure following cocaine abuse has never been reported to date. The value of diffusion-weighted imaging in cocaine-induced spinal cord infarction is here presented and discussed. The literature proposes several mechanisms for cocaine-induced infarction including vasospasm, arteritis, and thrombosis. In this case, the imaging studies and the full recovery suggest that the spinal cord ischemia was secondary to a transient vasospasm of the anterior spinal artery. PMID:24028991

Gorelik, N; Tampieri, D



Spinal cord concussion.  


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

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



Spinal manipulative therapy.  


Spinal manipulative therapy is growing in popularity and acceptance, as judged by the increasing number of practitioners in physical therapy and medicine and by the results of clinical trials. Manipulation is the skilled, gentle, passive movement of a joint (or spinal segment) either within or beyond its active range of motion. This definition is broad enough to encompass a great variety of techniques, ranging from the more traditional thrust to oscillation and distraction. Manipulation is rendered effective by a combination of mechanical, neurophysiologic, and biomechanical mechanisms. PMID:6225596

Paris, S V



Spinal dural ossification causing neurological signs in a cat.  


A six-year-old Ragdoll cat underwent examination due to a six-month history of slowly progressive gait abnormalities. The cat presented with an ambulatory tetraparesis with a neurological examination indicating a C1-T2 myelopathy. Radiographs of the spine showed a radiopaque irregular line ventrally in the vertebral canal dorsal to vertebral bodies C3-C5. In this area, magnetic resonance imaging revealed an intradural extramedullary/extradural lesion compressing the spinal cord. The spinal cord was surgically decompressed. The cause of the spinal cord compression was dural ossification, a diagnosis confirmed by histopathological examination of the surgically dissected sample of dura mater. The cat gradually improved after the procedure and was ambulating better than prior to the surgery. The cat's locomotion later worsened again due to ossified plaques in the dura causing spinal cord compression on the same cervical area as before. Oral prednisolone treatment provided temporary remission. Ten months after surgery, the cat was euthanized due to severe worsening of gait abnormalities, non-ambulatory tetraparesis. Necropsy confirmed spinal cord compression and secondary degenerative changes in the spinal cord on cervical and lumbar areas caused by dural ossification. To our knowledge, this is the first report of spinal dural ossification in a cat. The reported cat showed neurological signs associated with these dural changes. Dural ossification should be considered in the differential diagnosis of compressive spinal cord disorders in cats. PMID:23777582

Antila, Johanna M; Jeserevics, Janis; Rakauskas, Mindaugas; Anttila, Marjukka; Cizinauskas, Sigitas



Cranial and spinal tumors with meningitic onset  

Microsoft Academic Search

We review the literature on cases of cranial or spinal tumor presenting with meningitic symptoms. Embryonal tumors — dermoid cysts, epidermoid, epidermoid cysts, craniopharyngiomas, teratomas - and malignant gliomas were the cause of most of the episodes of chemical meningitis, single or multiple in patients with no neurological symptoms. Differential diagnosis from aseptic meningitis, especially from Mollaret aseptic meningitis, is

P. Lunardi; P. Missori



Sildenafil-induced cervical spinal cord infarction.  


We present a patient with an acute cervical spinal cord infarction resulting from the use of sildenafil (Viagra) in combination with his hypertension medication. Symptoms were acute and rapidly progressive, and MR imaging with DWI was crucial in confirming the diagnosis. PMID:21903916

Walden, J E; Castillo, M



Spinal Cord Infarction in Chinese Patients  

Microsoft Academic Search

Background: The clinical presentations, MRI findings and outcomes for spinal cord infarction (SCI) are well documented in the West but scarce in the East. We investigated the clinical characteristics of SCI patients and further analyzed etiologies and prognostic factors in Chinese subjects. Methods: We reviewed all SCI patients from March 1993 to March 2007. Clinical symptoms, laboratory and imaging findings

Mei-Yun Cheng; Rong-Kuo Lyu; Yeu-Jhy Chang; Rou-Shayn Chen; Chin-Chang Huang; Tony Wu; Tsong-Hai Lee; Chin-Song Lu; Long-Sun Ro



Transient Neurologic Symptoms After Spinal Anesthesia  

Microsoft Academic Search

- We recently reported several cases consistent with tran- sient radicular irritation after spinal anesthesia with hy- perbaric 5% lidocaine. The present prospective, blind, nonrandomized study was performed to determine the incidence of these transient neurologic symptoms and to identify factors that might be associated with their occurrence. We studied 270 patients scheduled for gy- necologic or obstetric procedures under

Karl F. Hampl; Markus C. Schneider; Wolfgang Ummenhofer; Jurgen Drewe



Spinal cord compression due to vertebral hemangioma.  


This article presents a case of multiple vertebral hemangiomas in a 58-year-old man with pain in the dorsal region and bilateral progressive foot numbness. Magnetic resonance imaging revealed multiple vertebral hemangiomas. One hemangioma at the T7 level demonstrated epidural extension, causing spinal cord compression. After treatment with radiotherapy, the patient's symptoms improved significantly. PMID:19292199

Aksu, Gorkem; Fayda, Merdan; Saynak, Mert; Karadeniz, Ahmet



Adult spinal cord injury without radiological abnormality  

Microsoft Academic Search

Spinal cord injury without radiological abnormality is rare in adults. A case is described of a 61 year old man who fell 15 feet from a ladder striking his head on a wall who presented with neck pain and with motor and sensory neurological abnormalities in his limbs. Plain radiographs of the neck revealed no fractures or dislocations. Further imaging

Sarah Crawford; Tony Bleetman



Spinal Epidural Abscess in a Young Child  

Microsoft Academic Search

This is a case report of a spinal epidural abscess, caused by Staphylococcus aureus, in a 3-year-old girl. The child presented with fever and hip pain, but without any neurologic deficit. After normal plain films and a normal bone scan were obtained, the diagnosis was made via magnetic resonance imaging (MRI). The neu- rosurgery and pediatric infectious disease teams evalu-

Megan H. Bair-Merritt; Charles Chung; Albert Collier


Sheaths of the spinal nerve roots  

Microsoft Academic Search

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 bluealbumin 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

C. Å. V. Pettersson



Subacute myelopathy caused by spinal venous infarction.  

PubMed Central

A 44 year old female presented with a subacute myelopathy in association with pelvic venous thrombosis. It is inferred from the temporal relationship of these events that the patient suffered a subacute spinal venous infarction. This is discussed along with the aetiology, anatomical distribution and management of the condition. Images Figure 1

Clarke, C. E.; Cumming, W. J.



Spinal canal narrowing during simulated frontal impact  

Microsoft Academic Search

Between 23 and 70% of occupants involved in frontal impacts sustain cervical spine injuries, many with neurological involvement. It has been hypothesized that cervical spinal cord compression and injury may explain the variable neurological profile described by frontal impact victims. The goals of the present study, using a biofidelic whole cervical spine model with muscle force replication, were to quantify

Paul C. Ivancic; Manohar M. Panjabi; Yasuhiro Tominaga; Adam M. Pearson; S. Elena Gimenez; Travis G. Maak



Stimulus-sensitive spinal myoclonus.  

PubMed Central

Two cases of spinal myoclonus are described; in both patients myoclonus was responsive to stimuli and absent during sleep. The first patient was considered to have viral neuronitis and the condition resolved spontaneously. The second patient had spinal cord ischaemia; there was electro-physiological evidence of abnormal alpha motor neurone activity and histological study of the spinal cord revealed a severe reduction in small and intermediate neurones. This supports the theory that spinal myoclonus may result from abnormal activity of alpha motor neurones released from control by spinal internuncial neurones. Images

Davis, S M; Murray, N M; Diengdoh, J V; Galea-Debono, A; Kocen, R S



Assessment of autonomic dysfunction following spinal cord injury: Rationale for additions to International Standards for Neurological Assessment  

Microsoft Academic Search

We present a preliminary report of the discussion of the joint committee of the American Spinal Injury Associa- tion (ASIA) and the International Spinal Cord Society concern- ing the development of assessment criteria for general autonomic function testing following spinal cord injury (SCI). Elements of this report were presented at the 2005 annual meeting of the ASIA. To improve the

Andrei V. Krassioukov; Ann-Katrin Karlsson; Jill M. Wecht; Lisa-Anne Wuermser; Christopher J. Mathias; Ralph J. Marino



Paraplegia due to Spinal Cord Infarction After Lifting Heavy Objects  

PubMed Central

Spinal cord infarction is uncommon and usually presents with sudden onset of motor and sensory disturbances. We report a case of a 64-year-old women without previous medical history, who presented with acute onset of paraplegia after lifting. However, radiologic examinations did not show any abnormal lesion in the spinal cord. And, cerebrospinal fluid studies also showed no remarkable findings. This case illustrates the cause of spontaneous paraplegia after lifting injury and we consider the presumptive cause of paraplegia as spinal cord infarction.

Lee, Sung-Ho; Choi, Seok-Geun; Lim, Young-Jin



Spinal Tuberculosis: Diagnosis and Management  

PubMed Central

The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions.

Rasouli, Mohammad R.; Mirkoohi, Maryam; Vaccaro, Alexander R.; Yarandi, Kourosh Karimi



Spinal tuberculosis: diagnosis and management.  


The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions. PMID:23275816

Rasouli, Mohammad R; Mirkoohi, Maryam; Vaccaro, Alexander R; Yarandi, Kourosh Karimi; Rahimi-Movaghar, Vafa



Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury  

PubMed Central

Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI). Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. A mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain) pathways in the spinal cord may emerge in response to various noxious inputs, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord below the level of SCI. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Prior work from our group has shown that stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after SCI. We review these basic phenomena, how these findings relate to the broader spinal plasticity literature, discuss the cellular and molecular mechanisms, and finally discuss implications of these and other findings for improved rehabilitative therapies after SCI.

Ferguson, Adam R.; Huie, J. Russell; Crown, Eric D.; Baumbauer, Kyle M.; Hook, Michelle A.; Garraway, Sandra M.; Lee, Kuan H.; Hoy, Kevin C.; Grau, James W.



Pediatric Extradural Spinal Tumors  

Microsoft Academic Search

We have reviewed 16 children with extradural spinal tumors, both benign and malignant, treated from 1998 to 2006 in Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. The duration of symptomatology, clinical signs, radiological investigations, surgical approach, outcome and histopathological variation from the Western world was noted and evaluated. The age of these children ranged from 3 to 20

Raj Kumar; Pramod J. Giri



Bilateral psoas abscess during pregnancy presenting as an acute abdomen: atypical presentation.  


Nearly half of skeletal tuberculosis patients have spinal tuberculosis, but psoas abscess develops in only 5% of spinal tuberculosis cases. However, bilateral psoas abscess is a rarity. Psoas abscess occurring in pregnancy could be a clinical dilemma and is hardly reported. We report an unusual presentation of bilateral psoas abscess in pregnancy presenting as an acute abdomen and adnexal mass. PMID:24148941

Nigam, Aruna; Prakash, Anupam; Pathak, Puja; Abbey, Pooja



Malignant spinal cord compression in cancer patients may be mimicked by a primary spinal cord tumour.  


Although it is quite rare, second primary neoplasms in cancer patients may present with the signs and symptoms of malignant spinal cord compression. Primary spinal cord tumours in the cancer patients may be deceptive and considered as the recurrent first cancer. Therefore, it should be precisely differentiated and appropriately managed. We report such a case of intramedullary ependymoma of the cervical spinal cord mimicking metatstatic recurrent lymphoma and causing cord compression. A 50-year-old man developed intramedullary ependymoma of the cervical spinal cord 1.5 years following chemoradiation for Waldeyer's ring lymphoma. He presented with a 2-month history of neck pain, progressive upper- and lower-extremity numbness and weakness, and bowel and bladder dysfunction. Magnetic resonance imaging revealed an intramedullary expansive lesion extending from C4 to C6 levels of the cervical spinal cord. The clinical and radiological findings were suggestive of malignant process. A comprehensive investigation failed to detect another site of disease. He underwent operation, and the tumour was subtotally resected. The patient's neurological deficits improved subsequently. The development of the intramedullary ependymoma following treating lymphoma has not been reported. We describe the clinical, radiological and pathological findings of this case and review the literature. PMID:17177910

Mohammadianpanah, M; Vasei, M; Mosalaei, A; Omidvari, S; Ahmadloo, N



Glycyrrhizin protects spinal cord and reduces inflammation in spinal cord ischemia-reperfusion injury.  


Objective: Inflammation, which is detrimental to the neurologic defect after ischemia-reperfusion, provides a potential target for therapeutic approach for spinal cord ischemia-reperfusion injury. High mobility group box 1 (HMGB-1) was recently discovered to be a crucial cytokine that mediates the response to infection, injury and inflammation. The present study aimed to gain a deep insight into the neuroprotective effect of glycyrrhizin in the process of ischemia and reperfusion injury in spinal cord of mice. Methods: Spinal cord ischemia was induced in male C57BL/6 mice by occlusion of the thoracic aorta. The experimental groups (n = 6 per group) included sham operation, control (receiving phosphate buffered saline (PBS)) and glycyrrhizin (10 mg/kg, when cross-clamped). Neurologic function was assessed by the motor function score of the hind limbs at 72 hours after reperfusion. Histologic changes were studied using hematoxylin and eosin staining. Expression changes of inflammatory cytokines or their receptors at messenger RNA level or protein level were determined by real-time transcription polymerase chain reaction or enzyme-linked immunosorbent assay at different time points post reperfusion. Nuclear factor ?B (NF-?B) activity was examined with Western blotting. Results: Compared with the control group, the glycyrrhizin group showed significantly improved neurologic outcome, reduced apoptosis of motoneurons of spinal anterior horn, decreased the activation of NF-?B and subsequent inflammatory cytokines expression [tumor necrosis factor (TNF) and interleukin 1? (IL-1?)], and alleviated neutrophil infiltration in ischemic spinal cord. HMGB-1 treatment also reduced the expressions of itself. Conclusions: Treatment with glycyrrhizin exerted a neuroprotective effect against spinal cord ischemia-reperfusion injury. The anti-inflammatory effect was believed to be one of the contributing mechanisms. Our findings provided experimental and therapeutic options for the treatment of spinal cord ischemia-reperfusion injury. PMID:23594088

Ni, Bin; Cao, Zhenyu; Liu, Yan



Acute paraplegia due to an extradural spinal lipoma: Case report  

Microsoft Academic Search

We describe a 20 year old man, who presented with an acute onset of transverse myelopathy evolving over 24 h at T6 spinal level; as yet, an unreported presenting symptom from a mid-thoracic intraspinal lipoma. The C.S.F findings suggested a spinal block. MRI, imaging was not practical. Urgent myelography revealed extradural compression at the T5-6 vertebral level. The patient underwent

Y V Meisheri; S Mehta; K Chattopadhyay



The Animal Model of Spinal Cord Injury as an Experimental Pain Model  

PubMed Central

Pain, which remains largely unsolved, is one of the most crucial problems for spinal cord injury patients. Due to sensory problems, as well as motor dysfunctions, spinal cord injury research has proven to be complex and difficult. Furthermore, many types of pain are associated with spinal cord injury, such as neuropathic, visceral, and musculoskeletal pain. Many animal models of spinal cord injury exist to emulate clinical situations, which could help to determine common mechanisms of pathology. However, results can be easily misunderstood and falsely interpreted. Therefore, it is important to fully understand the symptoms of human spinal cord injury, as well as the various spinal cord injury models and the possible pathologies. The present paper summarizes results from animal models of spinal cord injury, as well as the most effective use of these models.

Nakae, Aya; Nakai, Kunihiro; Yano, Kenji; Hosokawa, Ko; Shibata, Masahiko; Mashimo, Takashi



Management of postoperative spinal infections  

PubMed Central

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.

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



Spinal intradural extraosseous Ewing's sarcoma  

PubMed Central

Extraosseous Ewing's sarcoma (EES) involving the central nervous system is rare, but can be diagnosed and distinguished from other primitive neuroectodermal tumors (PNET) by identification of the chromosomal translocation (11;22)(q24;q12). We report EES arising from the spinal intradural extramedullary space, based on imaging, histopathological, and molecular data in two men, ages 50 and 60 years old and a review of the literature using PubMed (1970–2009). Reverse transcriptase polymerase chain reaction (RT-PCR) identified the fusion product FL1-EWS. Multimodal therapy, including radiation and alternating chemotherapy including vincristine, cyclophosphamide, doxorubicin and ifosfamide and etoposide led to local tumor control and an initial, favorable therapeutic response. No systemic involvement was seen from the time of diagnosis to the time of last follow-up (26 months) or death (4 years). This report confirms that EES is not confined to the earliest decades of life, and like its rare occurrence as an extra-axial meningeal based mass intracranially, can occasionally present as an intradural mass in the spinal canal without evidence of systemic tumor. Gross total resection followed by multimodal therapy may provide for extended progression free and overall survival.

Mateen, Farrah J.; Nassar, Aziza; Bardia, Aditya; Jatoi, Aminah; Haddock, Michael G.; Buckner, Jan C.; Lachance, Daniel H.



Irreversible damage to the spinal cord following spinal anesthesia.  


The authors report five patients with damage to the distal spinal cord following spinal anesthesia. The patients developed leg weakness and sensory disturbance. MRI of the lumbosacral spine showed an abnormal area of high signal within the conus medullaris in all patients. Symptoms and signs persisted at 1- to 2.5-year follow-ups. Incorrect needle placement and type of needle used are possible factors leading to spinal cord injury. PMID:12196664

Hamandi, K; Mottershead, J; Lewis, T; Ormerod, I C; Ferguson, I T



A Unique Case of Intradural Communicating Branches between the Accessory Nerve and the Dorsal Roots of the Cervical Spinal Nerves.  


Objective The accessory nerve has cranial and spinal roots. The cranial roots emerge from the medulla, whereas the spinal roots arise from motor cells within the ventral horn of C1-C7 segments of the spinal cord. Communications have been described between the spinal accessory nerve rootlets and the dorsal rootlets of cervical spinal nerves. In the present case, we report a communication that has not been reported before and discuss the functional anatomy.Materials and Methods During the dissection of the craniovertebral junction of a 67-year-old formalin-fixed adult male cadaver, a connection between the spinal accessory nerve rootlets and the dorsal rootlets of the cervical spinal nerves was observed.Results A communication between the spinal rootlets of the accessory nerve and the dorsal roots of cervical spinal nerves was present on the right and left side. On the right, a communication between the accessory nerve spinal rootlet and the dorsal rootlet of the fourth cervical spinal nerve existed. On the left, there were two branches from the lowest accessory nerve spinal rootlet, one run ventrally and the other dorsally to the spinal rootlet and reached the dorsal root of third cervical spinal nerve. The dorsal root of C1 did not exist on either the right or the left side. Further, an unusual spinal accessory nerve formation was also observed.Discussion This case does not fit into any of the previously described classifications in the literature. Therefore, the different variations concerning the communications between the spinal rootlets of the accessory nerve and the cervical spinal nerves should be kept in mind during both surgical, especially radical neck dissections, and nonsurgical evaluations. PMID:23397124

Seker, A?k?n; Ceylan, Davut; Tatarl?, Necati; Abdullaev, Tuychiboy; Gülbar, Seda; Konya, Deniz; Bayri, Yasar; Kele?, Evren; K?l?ç, Türker; Cavdar, Safiye



Development of AMPA receptor and GABA B receptor-sensitive spinal hyper-reflexia after spinal air embolism in rat: a systematic neurological, electrophysiological and qualitative histopathological study  

PubMed Central

Decompression sickness results from formation of bubbles in the arterial and venous system, resulting in spinal disseminated neurodegenerative changes and may clinically be presented by motor dysfunction, spinal segmental stretch hyper-reflexia (i.e., spasticity) and muscle rigidity. In our current study, we describe a rat model of spinal air embolism characterized by the development of similar spinal disseminated neurodegenerative changes and functional deficit. In addition, the anti-spastic potency of systemic AMPA receptor antagonist (NGX424) or GABA B receptor agonist (baclofen) treatment was studied. To induce spinal air embolism, animals received an intra-aortic injection of air (50–200 ?l/kg). After embolism, the development of spasticity was measured using computer-controlled ankle rotation. Animals receiving 150 or 200 ?l of intra-aortic air injections displayed motor dysfunction with developed spastic (50–60% of animals) or flaccid (25–35% of animals) paraplegia at 5–7 days. MRI and spinal histopathological analysis showed disseminated spinal cord infarcts in the lower thoracic to sacral spinal segments. Treatment with NGX424 or baclofen provided a potent anti-spasticity effect (i.e., stretch hyper-reflexia inhibition). This model appears to provide a valuable experimental tool to study the pathophysiology of air embolism-induced spinal injury and permits the assessment of new treatment efficacy targeted to modulate neurological symptoms resulting from spinal air embolism.

Kakinohana, Osamu; Scadeng, Miriam; Corleto, Jose A.; Sevc, Juraj; Lukacova, Nadezda; Marsala, Martin



Transection method for shortening the rat spine and spinal cord.  


Previous studies have presented evidence which indicates that the regeneration of axons in the spinal cord occurs following spinal cord transection in young rats. However, in a transection-regeneration model, the completeness of the transection is often a matter of dispute. We established a method for shortening the rat spine and spinal cord to provide a spinal cord injury (SCI) model in which there was no doubt about whether the axonal transection was complete. In the future, this model may be applied to the chronic period of complete paralysis following SCI. Adult, female Wistar rats (220-250g) were used in the study. The spinal cord was exposed and a 4-mm-long segment of the spinal cord was removed at Th8. Subsequently, the Th7/8 and Th8/9 discs were cut between the stumps of the spinal cord to remove the Th8 vertebra. The stitches which had been passed through the 7th and 9th ribs bilaterally were tied gradually to bring together the stumps of the spinal cord. Almost all the rats survived until the end of the experiment. Uncoordinated movements of the hind limbs in locomotion were observed at 4 weeks after surgery. However coordinated movements of the hind limbs in locomotion were not observed until the end of the experiment. After 12 weeks, an intracardiac perfusion was performed to remove the thoracic spine and the spinal cord. There were no signs of infection. The bone fusion of the Th7 and Th9 vertebrae was observed to be complete in all specimens and the alignment of the thoracic spine was maintained. The spinal canal was also correctly reconstituted. The stumps of the spinal cord were connected. Light microscopy of the cord showed that scar tissue intervened at the connection site. Cavitation inhibiting the axonal regeneration was also observed. This model was also made on the assumption that glial scar tissue inhibits axonal regeneration in chronic SCI. Axonal regeneration was not observed across the transected spinal cord in this model. Attempts should be made to minimize the damage to the spinal cord and the surgery time for successful axonal regeneration to occur. The model developed in this study may be useful in the study of axonal regeneration in SCI. PMID:23403404

Yoshida, Yuichiro; Kataoka, Hideo; Kanchiku, Tsukasa; Suzuki, Hidenori; Imajyo, Yasuaki; Kato, Hidetoyo; Taguchi, Toshihiko



Long-term changes in expressions of spinal glutamate transporters after spinal cord injury.  


Glutamate is a major excitatory transmitter in the central nervous system that may produce cellular injury when its concentration is abnormally increased in the synaptic cleft. Glial glutamate transporters GLAST and GLT-1, which are responsible for clearing synaptic glutamate into glial cells, play an important role in the regulation of the glutamate concentration in the synaptic cleft. However, there has been no report on long-term changes in the levels of glutamate transporters following spinal cord injury. Spinal cord injury (SCI) was induced at T12 by a New York University (NYU) impactor. Segments of the spinal cord at T9-10, L1-2, L4-5 and at the epicenter were removed after SCI, and Western blots for GLAST, GLT-1 and EAAC1 were performed. GLAST and GLT-1 were significantly decreased in the epicenter from 1day up to 8weeks after SCI. GLT-1 was significantly decreased in the spinal segments rostral to the injury site, and GLAST expression was significantly increased in the L4-5 region of the spinal cord for 8weeks. Because strategies to modulate the regulation of glutamate transporters may be applied, the present data serve as a reference for further research, although the long-term roles of glutamate transporters in pathological processes caused by SCI are not clear. PMID:21439271

Kim, Youngkyung; Park, Young-Keun; Cho, Hwi-Young; Kim, Junesun; Yoon, Young Wook



Spinal trauma in children  

Microsoft Academic Search

.   Evaluation of the child with suspected spinal injury can be a difficult task for the radiologist. Added to the problems posed\\u000a by lack of familiarity with the normal appearances of the paediatric spine is anxiety about missing a potentially significant\\u000a injury resulting in neurological damage. Due to differences in anatomy and function, the pattern of injury in the paediatric

Claire Roche; H. Carty



Management of Spinal Tumors  

Microsoft Academic Search

\\u000a This chapter describes the treatment approach to patients with intradural spinal tumors, with the most common being nerve\\u000a sheath tumors and meningiomas, representing a combined 55%. The remaining 45% of intradural tumors are intramedullary. Surgical\\u000a management of these tumors may include the application of the Cavitron ultrasonic aspirator and the laser. Many intramedullary\\u000a tumors are amenable to gross total resection

Karl F. Kothbauer; George I. Jallo; Fred J. Epstein


Microdiscectomy: spinal anesthesia offers optimal results in general patient population.  


Spinal anesthesia provides a safe and highly satisfactory alternative to general anesthesia in patients undergoing limited lumbar surgery. Nevertheless, it is not commonly used for spinal surgery, and in some centers it is not even considered as an option for spinal procedures. This study presents the current anesthetic technique for patients undergoing microdiscectomy and compares the peri- and postoperative outcomes in 76 patients drawn from a case-controlled study group. Patients underwent microdiscectomy for herniated nucleus pulposus under spinal (43 patients) or general anesthesia (33 patients). Patients ranged from 18 to 40 years, and all were anesthesia class 1. Surgical and anesthesia times were longer for the general anesthetic group, as was total anesthetic time. Urinary retention was more common in the general anesthesia group (p = .035). Postanesthetic care unit admission times were significantly shorter among general anesthetic patients compared with spinal anesthetic patients (p < .001). Spinal anesthesia patients required less pain medication and experienced less nausea and emesis. Even among young, medically fit patients, spinal anesthesia provided specific advantages over general anesthesia, including decreased anesthesia time, decreased nausea and antiemetic requirements, reduced analgesic requirements, and a trend toward lower complication rates and shorter hospital stay. Both surgeon and patient satisfaction with this anesthetic approach is high. PMID:17371640

McLain, Robert F; Tetzlaff, John E; Bell, Gordon R; Uwe-Lewandrowski, Kai; Yoon, Helen J; Rana, Maunak



Pediatric primary intramedullary spinal cord glioblastoma  

PubMed Central

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.

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



Sexuality and spinal cord injury.  


Spinal cord injury may have a profound effect on the patient's sexuality. In order to maximize the patient's potential, concern and support from health care professionals is needed. This article reviews normal sexual function and changes occurring following spinal cord injury. The PLISSIT model is described and is used to describe nursing interventions designed to deal with the sexual concerns of spinal cord-injured patients. PMID:2973501

Goddard, L R



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


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

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



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

PubMed Central

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

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



Living with Spinal Cord Injury  


... available through spinal injury centers, most rehabilitation hospitals, medical centers, and clinics. Occupational therapists and occupational therapy assistants are trained in helping both adults and children ...


[Spinal cord compression by testicular germ cell tumor: case report].  


Malignant spinal cord compression occurs in 2.5% - 5% cancer patients. Early diagnosis and therapeutic intervention are critical for pain control and improvement of any neurological deficit. Treatment should be directed to the underlying disease together with appropriate symptom management. The case of a man with tetraparesis of 24 hours duration is presented. He had surgery five days earlier because of a testicular tumor and spinal magnetic resonance imaging (MRI) showed spinal cord compression by a soft tissue mass between C7 and D2. After confirming the diagnosis of mixed germ cell tumor, stage IIIC, the patient began chemotherapy with progressive neurological improvement. Two years after diagnosis the patient presents a slight reduction of strength in the right hand and remains without any evidence of disease. This case illustrates the importance of early diagnosis of spinal cord compression and one of the main indications for the use of chemotherapy as the treatment for an oncologic emergency. PMID:23534600

Estevinho, Fernanda; Sousa, Nuno; Rodrigues, Ângelo; Carneiro, Eduarda; Souto, João; Begonha, Rosa; Maurício, Joaquina



Retroperitoneal Spinal Extradural Arachnoid Cyst Combined with Congenital Hemivertebrae  

PubMed Central

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.

Park, Se-Hwan; Lim, Beom Jin



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

PubMed Central

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

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



Ossified ligamentum flavum causing spinal cord compression in a patient with acromegaly.  


Acromegaly is a relatively rare neuroendocrine disorder associated with diffuse hypertrophy of bony and soft tissues due to growth hormone hypersecretion from a pituitary adenoma. Acromegaly can also cause numerous pathological changes in the spine, including degenerative osteoarticular disease, axial arthropathy, spinal stenosis, vertebral fracture and diffuse idiopathic skeletal hyperostosis (Forestier's disease). Ossified ligamentum flavum (OLF) is a rare disorder that often presents as thoracic spinal stenosis, but to our knowledge has never been described in patients with acromegaly. Previously, no link has been established between these two entities. We present, to our knowledge, the first reported case of OLF in a patient with acromegaly who presented with thoracic spinal cord compression. OLF is a potential spinal manifestation of acromegaly and should be considered in the differential diagnosis of spinal stenosis or spinal cord compression in the context of growth hormone hypersecretion. PMID:23706185

Schmidt, Richard F; Goldstein, Ira M; Liu, James K



Cauda equina lesions as a complication of spinal surgery  

Microsoft Academic Search

Although the most common aetiology of cauda equina lesions is lumbar intervertebral disc herniation, iatrogenic lesions may\\u000a also be the cause. The aim of this study was to identify and present patients in whom cauda equina lesions occurred after\\u000a spinal surgery. From the author’s series of patients with cauda equina lesions, those with the appearance of sacral symptoms\\u000a after spinal

Simon Podnar



Mechanisms of chronic central neuropathic pain after spinal cord injury  

Microsoft Academic Search

Not all spinal contusions result in mechanical allodynia, in which non-noxious stimuli become noxious. The studies presented use the NYU impactor at 12.5 mm drop or the Infinite Horizons Impactor (150 kdyn, 1 s dwell) devices to model spinal cord injury (SCI). Both of these devices and injury parameters, if done correctly, will result in animals with above level (forelimb), at level (trunk)

Claire E. Hulsebosch; Bryan C. Hains; Eric D. Crown; Susan M. Carlton



Spinal sagittal mobility and joint laxity in young ballet dancers  

Microsoft Academic Search

The present study compares spinal configuration, spinal range of motion and joint mobility in first-year students of the Swedish Ballet School and in nondancing students of corresponding age and sex in a state school. The study comprises all the first-year (fourth grade) students (n=23) at the Swedish Ballet School: 11 boys and 12 girls. Their dance practice time was 10

C. Nilsson; A. Wykman; J. Leanderson



Work related spinal cord injury, Australia 1986–97  

Microsoft Academic Search

Objectives—Little has been published before on the epidemiology and prevention of work related spinal cord injury (SCI). This study is the first national population based epidemiological analysis of this type of injury. It presents that largest case series ever reported.Setting—The study utilises information from the Australian Spinal Cord Injury Register, which has full coverage of the population.Methods—All newly incident cases

P OConnor



Interspinous implant in lumbar spinal stenosis: a prospective cohort  

Microsoft Academic Search

Lumbar spinal stenosis is a narrowing of spinal canal or neural foramina producing root ischaemia and neurogenic claudication[1–3].\\u000a Both the neural canal and foramen are narrowed with the spine in extension and opened in flexion. Patients are usually sixty\\u000a years or over and present with unilateral or bilateral leg pain with or without back pain. The pain is worse on

A. K. Bhadra; A. S. Raman; S. Tucker; H. H. Noordeen



Addressing issues of sexuality with spinal cord injured persons.  


For many years society viewed the spinal cord injured person as an asexual being. Within the past 10 years health care providers have recognized the need to incorporate information sexuality into the care of this population. This article reviews the physiologic and psychologic changes experienced by the spinal cord injured person, explores methods of enhancing the physiologic function inherent in the sexual experience, and presents nursing's role in sexual counseling. PMID:7630662

Hodge, A L


[Spinal and spinal cord injuries. Therapeutic approach in Gabon].  


The authors present their experience with 81 cases (66.4%) of acute cervical spine injuries (C.S.I.) and 41 cases (33.6%) of acute thoracolumbar spine injuries (T.L.S.I.) treated by a multidisciplinary approach, at Jeanne Ebori Hospital (Libreville, Gabon) between the years 1981 and 1987. Traffic accidents were the leading cause of injury. The largest group consisted of patients in their third decade. The anatomic localizations were: upper cervical spine: 22 cases (27%); lower cervical spine: 56 (69%); upper thoracic spine: 11 (26.8%); lower thoracic spine or thoracolumbar area: 19 (46.3%); lumbar spine: 7 (17%). There were osteoligamental lesions in 3 cases (3.7%) of C.S.I. and 4 (9.7%) of T.L.S.I. Clinically, 44 patients (54.3%) with C.S.I. and 37 (90.2%) with T.L.S.I. had neurological deficits. Surgical indications depended upon the osseous as well as neurologic lesions. There were five important steps in the treatment of spinal injuries associated with neurological deficit: (1) immobilization, (2) medical stabilization, (3) spinal alignment (skeletal traction), (4) operative decompression if there was proven cord compression, and (5) spinal stabilization. Twenty patients (24.6%) with cervical injuries were treated conservatively (traction, collar, kinesitherapy); 53 (65.4%) underwent a surgical intervention (anterior approach - 21, posterior fusion - 30, combined approach - 2); and in 8 patients (9.8%) refraining from surgery seemed the best alternative. After lengthy multidisciplinary discussion, the authors elected not to operate on tetraplegic patients with respiratory problems that necessitated assisted ventilation, because of its fatal outcome. Of injuries to the thoracolumbar spine, 13 (31.7%) were treated conservatively (bedrest, orthopedic treatment). Twenty-eight patients (68.2%) with unstable thoracic and lumbar fractures associated with neurologic deficit required acute surgical intervention (stabilization with or without decompression of the neural elements). Laminectomy alone was performed in 5 cases, laminectomy with graft in 2, stabilization by Roy-Camille plates in 16 and by Harrington rods in 5. Most upper thoracic spine fractures were treated conservatively. Surgical intervention was increasingly possible with the availability of more material and qualified staff. There were 17 patients (21%) who died from C.S.I. (15 were tetraplegic), and 6 (14.6%) from T.L.S.I. In general, osteoligamental consolidation was satisfactory. Neurological recovery was observed only in patients with partial deficits. Most cases posed socioeconomic problems. PMID:2038942

Loembe, P M; Bouger, D; Dukuly, L; Ndong-Launay, M



Hereditary canine spinal muscular atrophy is phenotypically similar but molecularly distinct from human spinal muscular atrophy  

Microsoft Academic Search

Hereditary canine spinal muscular atrophy (HCSMA) is an autosomal dominant mo- tor neuron disease that is similar in pathology and clinical presentation to various forms of human motor neuron disease. We have tested the hypothesis that the canine survival motor neuron (SMN) gene is responsible for HCSMA by genetic and molecular analysis of a colony of mixed breed dogs, all

R. G. Blazej; C. S. Mellersh; L. C. Cork; E. A. Ostrander



Spinal nerve ligation increases ? 2-adrenergic receptor G-protein coupling in the spinal cord  

Microsoft Academic Search

Intrathecal and epidural administration of the ?2-adrenergic receptor agonist clonidine in humans results in analgesia to both acute nociceptive and chronic neuropathic pain. The potency of clonidine increases with hypersensitivity to mechanical stimuli after nerve injury, although the reasons for this change are unknown. In the present study, we tested the hypothesis that peripheral nerve injury alters either spinal ?2-adrenergic

Carsten Bantel; James C. Eisenach; Frederic Duflo; Joseph R. Tobin; Steven R. Childers



Occult spinal dysraphism: neuroradiological study.  


We present a retrospective study of occult spinal dysraphism in 47 children aged 0 to 14 years, all studied with plain X-rays, 60% with CT and myelo-CT, and 40% with MR. We consider the classification and grading of these malformations, clinical, neuroradiological patterns, and indications for surgery. In the light of our findings and of the published data MR emerges as the key investigation. Only in a few cases of great anatomical complexity is it now necessary to perform CT and myelo-CT as well. A case in point is when the conus and thickened filum terminale are inextricably bound together and can no longer be considered separate structures. We propose the term "neurofibrous structure" to define the conus-thickened-filum-terminale unit when these structure are no longer distinguishable. PMID:2191246

Tortori-Donati, P; Cama, A; Rosa, M L; Andreussi, L; Taccone, A



Microscopic clusters of sensory neurons in c1 spinal nerve roots and in the c1 level of the spinal accessory nerve in adult humans.  


This study examined C1 spinal nerve roots and their anastomotic connections with the spinal accessory nerve for histological evidence of sensory neurons in adult humans. C1 spinal nerves and roots with the adjacent segments of the spinal accessory nerve and the spinal cord were dissected en bloc from cadaveric specimens, and prepared for histological study. Results show that in 39.3% of specimens studied, no sensory component to the C1 spinal nerve could be identified. The C1 dorsal root was present 35.7% of the time, and when present it always contained neuronal cell bodies. In the remaining specimens, the sensory contribution to the C1 spinal nerve came through an anastomotic connection with the spinal accessory nerve. The investigators were able to identify clusters of neuronal cell bodies along the spinal accessory nerve at the level of C1 in 100% of the specimens examined. Anat Rec, 296:1588-1593, 2013. © 2013 Wiley Periodicals, Inc. PMID:23929774

Hovorka, Michelle S; Uray, Nandor J



Separation of radiolabelled protein from brain and spinal cord of spinal hemisected rats on SDS polyacrylamide slab gels.  


After hemisection of the spinal cord in rats, alterations in amino acid incorporation into protein have been observed in brain and spinal cord. Proteins mediating these changes have been studied in the present experiment. Male, Long-Evans hooded rats were given either a laminectomy and dura incision (sham) at spinal segment T2, a left spinal cord hemisection, or no operative procedures. One hour prior to utilization at 1, 3 and 14 days postoperation, amimals were injected subcutaneously with 200 microCi of [3H]-L-lysine and 200 microCi of [3H]-L-amino acid mixture. Samples were prepared for electrophoresis and proteins separated on linear gradient SDS polyacrylamide slab gels (7.5-20% acrylamide). The Gel slabs were cut into slices and processed for scintillation counting. In right somatomotor cortex, there was evidence for a general stimulation of amino acid incorporation at one day postoperation in animals which received surgery. At other postoperation intervals, significant increases in proteins in the regions of 90-150,000, 50-65,000 and 35-45,000 molecular weight (MW) were observed. In spinal cord, significant increases in proteins in the regions of 55-65,000, 30-45,000 and 15,000 MW were observed over postoperation time in all animals receiving surgery compared to normals. A large, significant increase in the radioactivity of proteins in the region of 18-20,000 MW were observed in the spinal cord lesion site of spinal hemisected animals alone at three days postoperation. These results indicate that increases in amino acid incorporation into the brain and spinal cord of laminectomized and spinal hemisected animals observed previously are theresult of both specific and nonspecific changes in protein incorporation of precursors. PMID:6770100

Wells, M R



Immunohistochemical studies on the effect of capsaicin on spinal and medullary peptide and monoamine neurons using antisera to substance P, gastrin\\/CCK, somatostatin, VIP, enkephalin, neurotensin and 5-hydroxytryptamine  

Microsoft Academic Search

Summary After neonatal treatment of rats with capsaicin, the spinal cord, the spinal trigeminal nucleus and spinal and trigeminal ganglia were analysed with immunohistochemistry using antisera to several peptides and 5-hydroxytryptamine. A marked decrease was observed in substance P-, cholecystokinin-, somatostatin- and VIP-like immunoreactivity present in the central branches of primary sensory neurons in the spinal cord and in substance

G. Jancsó; T. Hökfelt; J. M. Lundberg; E. Kiraly; N. Halász; G. Nilsson; L. Terenius; J. Rehfeld; H. Steinbusch; A. Verhofstad; R. Elde; S. Said; M. Brown



Spinal magnetic resonance imaging manifestations at neurological onset in Japanese patients with spinal cord sarcoidosis.  


Objective We retrospectively investigated spinal magnetic resonance imaging (MRI) manifestations at neurological onset in Japanese patients with spinal cord sarcoidosis. Methods Between July 2000 and April 2012, we reviewed our database and recruited patients with spinal cord sarcoidosis. On spinal MRI performed at neurological onset, the following items were evaluated: the vertebral-segment distribution and length of intramedullay T2-elongated lesions, abnormal enhancement patterns and distributions and the concomitant presence of spondylosis and associated extraspinal lesions. If available, brain MRI scans were concomitantly assessed. Results Nine patients were enrolled (four men and five women; median, 49 years). Reflecting Japanese epidemiological backgrounds, a predilection for occurrence was observed in young men and middle-aged women. Intramedullary T2-elongated lesions were present in eight patients, peaking at the C5 level, with a mean length of 3.7±2.6 vertebral segments. Spondylosis coexisted in the middle-aged patients. Abnormal intramedullary enhancement with concomitantly involved the nerve roots was observed in six patients, comprised of two types reflecting the disease progression: linear- and/or nodular enhancement along the surface of the spinal cord and intramedullary enhancement consisting of patchy, broad-based enhancement adjacent to the cord surface. Five patients had associated extraspinal lesions, including lymphadenopathy in four patients and brain involvement in four patients. Conclusion Spinal cord sarcoidosis exhibits a predilection for young men and middle-aged women among Japanese individuals and is characterized by intramedullary T2-elongated lesions spreading more than three vertebral segments peaking at the C5 level, two types of abnormal intramedullary enhancement reflecting disease progression, frequent nerve root involvement and lymphadenopathy. PMID:24042510

Kobayashi, Shigeru; Nakata, Waka; Sugimoto, Hideharu



Biomaterial design strategies for the treatment of spinal cord injuries.  


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

Straley, Karin S; Foo, Cheryl Wong Po; Heilshorn, Sarah C



Kümmell's disease, an uncommon and complicated spinal disorder: a review.  


Kümmell's disease is an uncommon and complicated spinal condition first described in 1891. Patients develop a kyphosis in the lower thoracolumbar spinal region months to years after sustaining an otherwise asymptomatic minor spinal trauma. The patho physiology, clinical presentation, imaging and treatment options of this disease remain controversial. The most widely accepted hypothetical patho physiology is avascular osteonecrosis. The intravertebral vacuum cleft phenomenon is considered a radiographic sign of avascular osteonecrosis of the vertebral body and is highly suggestive of Kümmell's disease. Treatment options include nonsurgical and surgical treatment, and percutaneous vertebral augmentation. The primary aims of surgical treatment of Kümmell's disease are neural decompression and stabilization of the spinal column. Surgery can involve an anterior, posterior, or combined anterior and posterior approach. Surgery and percutaneous vertebral augmentation provide significant symptomatic relief, functional improvement and deformity correction. Treatment of this disease must be individualized according to the stage of disease and the experience and preference of the surgeon. PMID:22613401

Li, H; Liang, C-Z; Chen, Q-X



Spinal cord injury I: A synopsis of the basic science  

PubMed Central

Substantial knowledge has been gained in the pathological findings following naturally occurring spinal cord injury (SCI) in dogs and cats. The molecular mechanisms involved in failure of neural regeneration within the central nervous system, potential therapeutics including cellular transplantation therapy, neural plasticity, and prognostic indicators of recovery from SCI have been studied. This 2-part review summarizes 1) basic science perspectives regarding treating and curing spinal cord injury, 2) recent studies that shed light on prognosis and recovery from SCI, 3) current thinking regarding standards of care for dogs with SCI, 4) experimental approaches in the laboratory setting, and 5) current clinical trials being conducted in veterinary medicine. Part I presents timely information on the pathophysiology of spinal cord injury, challenges associated with promoting regeneration of neurons of the central nervous system, and experimental approaches aimed at developing treatments for spinal cord injury.

Webb, Aubrey A.; Ngan, Sybil; Fowler, J. David



Depression following spinal cord injury  

Microsoft Academic Search

Although depression has been widely studied among persons with spinal cord injury, the ubiquitous and unsophisticated use of the term and presumtions about its manifestations in the rehabilitation setting have needlessly encumbered the understanding and treatment of depression. Major themes and issues in the study, measurement, and treatment of depression among persons with spinal cord injury are reviewed. Greater precision

Timothy R. Elliott; Robert G. Frank



Toxicity of new spinal agents.  

PubMed Central

The clinical success of perispinal administration of opiates for pain relief has demonstrated the power of manipulating the neurochemistry of the spinal cord. This article briefly discussed reasons for increased interest in new spinal agents and some of the issues associated with determining their clinical safety.

Collins, J. G.



Medication-assisted Spinal Manipulation  

Microsoft Academic Search

Background context: The acceptance of spinal manipulation as a reasonable method of treating certain patients with spinal pain over the past decade has led to a renewed interest and increased use of these techniques performed in conjunction with commonly used medications and procedures. Manual therapy is increasingly being used in conjunction with anesthetics, sedatives or analgesics as well as local,

Frank J Kohlbeck; Scott Haldeman



Hydrogels in Spinal Cord Injury Repair Strategies  

PubMed Central

Nowadays there are at present no efficient therapies for spinal cord injury (SCI), and new approaches have to be proposed. Recently, a new regenerative medicine strategy has been suggested using smart biomaterials able to carry and deliver cells and/or drugs in the damaged spinal cord. Among the wide field of emerging materials, research has been focused on hydrogels, three-dimensional polymeric networks able to swell and absorb a large amount of water. The present paper intends to give an overview of a wide range of natural, synthetic, and composite hydrogels with particular efforts for the ones studied in the last five years. Here, different hydrogel applications are underlined, together with their different nature, in order to have a clearer view of what is happening in one of the most sparkling fields of regenerative medicine.



Spinal Radiotherapy for the Pediatric Patient  

Microsoft Academic Search

Radiation therapy (RT) in the pediatric population presents challenging dilemmas to the clinician. Some of the pediatric malignancies\\u000a are treated according to multi-institutional multimodality trials that guide the indications and techniques within specific\\u000a parameters. Because of the extremely low incidence of primary spinal malignancies, multi-institutional trials have not been\\u000a implemented. Most experience has been gained through the retrospective single institution

Adir Ludin


Spinal cord avulsion in the pediatric population: case study and review.  


Spinal cord injury without radiographic abnormality (SCIWORA) is a rare phenomenon, but with advances in imaging and improvements in magnetic resonance imaging more cases are being identified. Even more uncommon is the finding of spinal cord avulsion as a type of SCIWORA with only single case reports in the literature. We present the case reports of 2 patients both experiencing spinal cord avulsion as a type of SCIWORA, secondary to improper lap-belt restraint during a motor vehicle accident. PMID:24084611

Phillips, Blake C; Pinckard, Heather; Pownall, Ambre'; Ocal, Eylem



Enhanced cervical MRI in identifying intracranial dural arteriovenous fistulae with spinal perimedullary venous drainage  

Microsoft Academic Search

Diagnosis of an intracranial dural arteriovenous fistula (DAVF) with spinal perimedullary venous drainage is challenging\\u000a because the presenting symptoms are usually related to dysfunction of the spine, not of the brain. Repeated spinal angiograms\\u000a are usually performed before the diagnosis is finally made by cerebral angiography. We report two cases of intracranial DAVFs\\u000a with spinal perimedullary venous drainage. In both

C. J. Chen; C. M. Chen; T. K. Lin



Spinal cord herniation: a misdiagnosed and treatable cause of thoracic myelopathy  

Microsoft Academic Search

This study is a case report and review of the literature. Spinal cord herniation is a rare, although increasingly recognized,\\u000a cause of spinal cord dysfunction. It is due to an anterior dural defect, through which the spinal cord herniates. The purpose\\u000a of this article is to report the authors’ experience and to provide insight on clinical presentation and radiological signs

Fahed Zairi; Laurent Thines; Philippe Bourgeois; Olivier Dereeper; Richard Assaker



Dual pathology as a result of spinal stenosis and vitamin B12 deficiency  

Microsoft Academic Search

Vitamin B12 deficiency can confound the clinical assessment of patients presenting with features of spinal disorders. Speciality\\u000a practice within spinal surgery may lead the clinician to a focus upon spinal explanations for symptoms and that belief may\\u000a be reinforced by supporting imaging. In the presence of mainly sensory symptoms consideration and exclusion of non surgical\\u000a causes needs to occur. This

Mohammed Shakil Patel; Zurqa Rasul; Philip Sell


Multiple subpial lipomas with dumb-bell extradural extension through the intervertebral foramen without spinal dysraphism  

Microsoft Academic Search

BACKGROUNDIntradural subpial lipomas not associated with spinal dysraphism, account for less than 1% of spinal cord tumors. The simultaneous existence of multiple intradural subpial lipomas with dumb-bell extradural extension through the intervertebral foramen in the same patient without any evidence of spinal dysraphism has not been previously reported.CASE DESCRIPTIONA 38-year-old man presented with progressive spastic paraparesis, and weakness of right

Pappu Subramaniam; Sanjay Behari; Satyanarayan Singh; Vijendra Kumar Jain; Devendra Kumar Chhabra



Extradural tumor causing spinal cord compression in Klippel-Trenaunay-weber syndrome  

Microsoft Academic Search

BACKGROUNDMyelopathy in Klippel-Trenaunay-Weber syndrome is uncommon but has been reported secondary to spinal vascular malformations.REPORTA patient with Klippel-Trenaunay-Weber syndrome who presented with spinal cord compression from a spinal extradural mass lesion (angiomyolipoma) is described.DISCUSSIONThis association has not been reported previously but is consistent with the segmental vascular abnormalities observed in Klippel-Trenaunay-Weber syndrome.

David A Carter; Kitai Kim; Ray A Brinker



Spinal and Paraspinal Ewing Tumors  

SciTech Connect

Purpose: To perform a review of the 40-year University of Florida experience treating spinal and paraspinal Ewing tumors. Patients and Methods: A total of 27 patients were treated between 1965 and 2007. For local management, 21 patients were treated with radiotherapy (RT) alone and 6 with surgery plus RT. All patients with metastatic disease were treated with RT alone. The risk profiles of each group were otherwise similar. The median age was 17 years, and the most frequent subsite was the sacral spine (n = 9). The median potential follow-up was 16 years. Results: The 5-year actuarial overall survival, cause-specific survival, and local control rate was 62%, 62%, and 90%, respectively. For the nonmetastatic subset (n = 22), the 5-year overall survival, cause-specific survival, and local control rate was 71%, 71%, and 89%, respectively. The local control rate was 84% for patients treated with RT alone vs. 100% for those treated with surgery plus RT. Patients who were >14 years old and those who were treated with intensive therapy demonstrated superior local control. Of 9 patients in our series with Frankel C or greater neurologic deficits at presentation, 7 experienced a full recovery with treatment. Of the 27 patients, 37% experienced Common Toxicity Criteria Grade 3 or greater toxicity, including 2 deaths from sepsis. Conclusion: Aggressive management of spinal and paraspinal Ewing tumors with RT with or without surgery results in high toxicity but excellent local control and neurologic outcomes. Efforts should be focused on identifying disease amenable to combined modality local therapy and improving RT techniques.

Indelicato, Daniel J., E-mail: dindelicato@floridaproton.or [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Keole, Sameer R. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Shahlaee, Amir H. [Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL (United States); Morris, Christopher G. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Gibbs, C. Parker; Scarborough, Mark T. [Department of Orthopedic Surgery, University of Florida College of Medicine, Gainesville, FL (United States); Pincus, David W. [Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL (United States); Marcus, Robert B. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States)



Pediatric Spinal Cord Tumors and Masses  

PubMed Central

Background/Objective: Spinal cord tumors are a relatively rare diagnosis, accounting for 1% to 10% of all pediatric central nervous system tumors. Understanding the etiology and clinical outcomes of these tumors is therefore very important. This study presents detailed information regarding clinical presentation, histological findings, outcomes, functional assessment, and management of a series of patients with this diagnosis. Method: Retrospective, descriptive study. Subjects: Thirty-five children with a final diagnosis of spinal cord tumor or mass, excluding dysraphism. Results: Neurodevelopmental tumors (dermoid tumors, epidermoid tumors, and teratomas) were the most common tumor type (31%), followed by astrocytomas (29%) and neuroblastomas (14%). Other types included schwannomas, meningiomas, giant cell tumors, extradural cystic masses, leukemic-related masses, and masses related to neurofibromatosis. Mean age at diagnosis was 6.6 years (SD = 5.5 y) and did not vary significantly by tumor type except for children with neuroblastoma (mean = 0.4 y, SD = 0.5 y). More boys (57%) were identified in the series than girls (43%); however, there was no association between tumor type and sex. Presenting complaints of pain were noted in 57% and were localized to the back, neck, or extremities. Extremity weakness was reported as an initial presenting symptom in 46%. Three children had scoliosis as a presenting issue and 14 had gait abnormalities. Regardless of treatment modality, mobility was retained in 83% of children with or without gait aids. Neurogenic bowel and/or bladder were present in 23% of the population. Conclusions: This study corroborates other studies indicating that intramedullary tumors are the predominant form of pediatric spinal cord tumor. This population, however, presented with an unusually large number of developmental tumors, contrary to several published studies. The disparity may be the result of this institution acting as a regional referral center, thus increasing the number of this type of patient. The population is too small to make any other conjecture. The predominance of astrocytomas and neuroblastomas among those patients with poor outcomes and the prevalence of developmental tumors suggest the need for broader investigation. Although, in general, spinal cord tumors are relatively rare, this preliminary study supports the need to further evaluate associations between tumor type, presenting symptoms, treatment, and functional outcome in children with spinal cord tumors.

Wilson, Pamela E; Oleszek, Joyce L; Clayton, Gerald H



Subdural hematoma following spinal cord stimulator implant.  


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

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



Cardiovascular Control After Spinal Cord Injury  

Microsoft Academic Search

Spinal cord injury (SCI) leads to profound haemodynamic changes. Constant outflows from the central autonomic pattern generators modulate the activity of the spinal sympathetic neurons. Sudden loss of communication between these centers and the sympathetic neurons in the intermediolateral thoracic and lumbar spinal cord leads to spinal shock. After high SCI, experimental data demonstrated a brief hypertensive peak followed by

F. A. A. Gondim; A. C. A. Lopes Jr.; G. R. Oliveira; C. L. Rodrigues; P. R. L. Leal; A. A. Santos; F. H. Rola



Spinal segmental maldevelopment with a dermal sinus  

Microsoft Academic Search

Segmental spinal dysgenesis is a rare form of spinal dysraphism. We report a case of segmental hypoplasia of the spinal cord\\u000a extending from T6 to L1 vertebral levels, with a dorsal dermal sinus, diagnosed by spinal sonography and MRI and confirmed\\u000a at surgery. The probable pathogenesis is suggested.

H. Rastogi; S. Behari; R. V. Phadke; R. K. Gupta; S. Kumar; P. Mittal



[Spinal neuronavigation. Our experience].  


The spinal column has been considered ideal for guided surgery due to its stable anatomical structure and notable reference points which are perfectly distinguishable both in computer tomography (C.T.) images and in the surgical field. Our main objective was to apply this technique to the conventional transpedicular fusion surgery. During the last year (1999), 13 males and 26 females, with an average of 47.1, + 14.1 years were operated because of degenerative discopathy (9 cases) degenerative discopathy associated to listhesis (7 cases) and spinal canal stenosis (8 cases). All of them were operated according to a preestablished protocol using the Brain Lab Image Guided System. The preestablished protocol could not be applied in 3 patients. Of the 36 patients, only in 22 cases (61%), a properly navigation was obtained. In these cases 116 screws were used: 108 (93%) strictly intrapediculars. In the other 14 patients, without Guided Surgery, it was used 76 screws: 65 (86%) were strictly intrapediculars. In our opinion Guided Spine Surgery, offers an accuracy and reliability to reduce the margin of error in the Transpedicular location of the Spine Fusion Systems. PMID:11787397

de la Torre-Gutiérrez, M; Martínez-Quiñones, J V; Escobar-Solís, R; de la Torre-Gutiérrez, S



Nerve root enhancement on spinal MRI in pediatric Guillain-Barré syndrome.  


Guillain-Barré syndrome diagnosis is based on clinical presentation and supportive diagnostic testing. In its early stage, no single, reliable diagnostic test is available. However, a finding of nerve root enhancement on spinal magnetic resonance imaging may be useful. We evaluated the frequency of nerve root enhancement on spinal magnetic resonance imaging in children with Guillain-Barré syndrome. At a single tertiary pediatric center, we conducted a retrospective chart review of children with Guillain-Barré syndrome who had complete spinal or lumbosacral spinal magnetic resonance imaging with gadolinium administration from January 2002-January 2009. Twenty-four consecutive patients were identified. Spinal nerve root enhancement with gadolinium was present in 92% (22/24) of children with Guillain-Barré syndrome on initial spinal magnetic resonance imaging (95% confidence interval, 0.745-0.978). This finding increased to 100% of patients, after two patients underwent repeat spinal magnetic resonance imaging that did reveal nerve root enhancement. Patterns of enhancement were variable, but involved the thoracolumbar nerve roots in all patients. Enhancement of nerve roots with gadolinium on initial spinal magnetic resonance imaging was frequently present in these children with Guillain-Barré syndrome. Spinal magnetic resonance imaging is a sensitive diagnostic test and should be considered an additional diagnostic tool in select cases. PMID:20837305

Mulkey, Sarah B; Glasier, Charles M; El-Nabbout, Bassem; Walters, William D; Ionita, Christian; McCarthy, Michael H; Sharp, Gregory B; Shbarou, Rolla M



Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions.  


The authors present a review of spinal cord blood supply, discussing the anatomy of the vascular system and physiological aspects of blood flow regulation in normal and injured spinal cords. Unique anatomical functional properties of vessels and blood supply determine the susceptibility of the spinal cord to damage, especially ischemia. Spinal cord injury (SCI), for example, complicating thoracoabdominal aortic aneurysm repair is associated with ischemic trauma. The rate of this devastating complication has been decreased significantly by instituting physiological methods of protection. Traumatic SCI causes complex changes in spinal cord blood flow, which are closely related to the severity of injury. Manipulating physiological parameters such as mean arterial blood pressure and intrathecal pressure may be beneficial for patients with an SCI. Studying the physiopathological processes of the spinal cord under vascular compromise remains challenging because of its central role in almost all of the body's hemodynamic and neurofunctional processes. PMID:21663407

Martirosyan, Nikolay L; Feuerstein, Jeanne S; Theodore, Nicholas; Cavalcanti, Daniel D; Spetzler, Robert F; Preul, Mark C



Novel surgical management of spinal adhesive arachnoiditis by arachnoid microdissection and ventriculo-subarachnoid shunting.  


Spinal cord tethering and cerebrospinal fluid (CSF) flow disturbance are two major features in the pathophysiology of spinal adhesive arachnoiditis. We hypothesized that insufficient CSF supply to the surgically untethered spinal cord may be one of the causes of the typical post-operative recurrent extensive lesion. We report a patient with extensive spinal adhesive arachnoiditis, who was successfully treated using a novel surgical technique consisting of two procedures. First, microdissection of the thickened adherent arachnoid was performed to resolve spinal cord tethering. Next, a ventriculo-subarachnoid shunt was placed to provide sufficient flow of CSF. Clinical improvement was sustained for at least 22 months after surgery. The present surgical procedure may improve clinical outcome in patients with longitudinally extensive spinal adhesive arachnoiditis. PMID:22019435

Mitsuyama, Tetsuryu; Asamoto, Shunji; Kawamata, Takakazu



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


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

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



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

PubMed Central

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.

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



Changes in expiratory muscle function following spinal cord section.  


Following spinal cord injury, muscles below the level of injury develop variable degrees of disuse atrophy. The present study assessed the physiological changes of the expiratory muscles in a cat model of spinal cord injury. Muscle fiber typing, cross-sectional area, muscle weight, and changes in pressure-generating capacity were assessed in five cats spinalized at the T(6) level. Airway pressure (P)-generating capacity was monitored during lower thoracic spinal cord stimulation before and 6 mo after spinalization. These parameters were also assessed in five acute animals, which served as controls. In spinalized animals, P fell from 41 +/- l to 28 +/- 3 cm H2O (means +/- SE; P < 0.001). Muscle weight of the external oblique, internal oblique, transversus abdominis, and internal intercostal muscles decreased significantly (P < 0.05 for each). Muscle weight of the external oblique, internal oblique, transversus abdominis, and internal intercostal, but not rectus abdominis (RA), correlated linearly with P (r > 0.7 for each; P < 0.05 for each). Mean muscle fiber cross-sectional area of these muscles was significantly smaller (P < 0.05 for each; except RA) and also correlated linearly with P (r > 0.55 for each; P < 0.05 for each, except RA). In spinalized animals, the expiratory muscles demonstrated a significant increase in the population of fast muscle fibers. These results indicate that, following spinalization, 1) the expiratory muscles undergo significant atrophy and fiber-type transformation and 2) the P-generating capacity of the expiratory muscles falls significantly secondary to reductions in muscle mass. PMID:17158247

Kowalski, Krzysztof E; Romaniuk, Jaroslaw R; DiMarco, Anthony F



Arylsulfatase B Improves Locomotor Function after Mouse Spinal Cord Injury  

PubMed Central

Bacterial chondroitinase ABC (ChaseABC) has been used to remove the inhibitory chondroitin sulfate chains from chondroitin sulfate proteoglycans to improve regeneration after rodent spinal cord injury. We hypothesized that the mammalian enzyme arylsulfatase B (ARSB) would also enhance recovery after mouse spinal cord injury. Application of the mammalian enzyme would be an attractive alternative to ChaseABC because of its more robust chemical stability and reduced immunogenicity. A one-time injection of human ARSB into injured mouse spinal cord eliminated immunoreactivity for chondroitin sulfates within five days, and up to 9 weeks after injury. After a moderate spinal cord injury, we observed improvements of locomotor recovery assessed by the Basso Mouse Scale (BMS) in ARSB treated mice, compared to the buffer-treated control group, at 6 weeks after injection. After a severe spinal cord injury, mice injected with equivalent units of ARSB or ChaseABC improved similarly and both groups achieved significantly more locomotor recovery than the buffer-treated control mice. Serotonin and tyrosine hydroxylase immunoreactive axons were more extensively present in mouse spinal cords treated with ARSB and ChaseABC, and the immunoreactive axons penetrated further beyond the injury site in ARSB or ChaseABC treated mice than in control mice. These results indicate that mammalian ARSB improves functional recovery after CNS injury. The structural/molecular mechanisms underlying the observed functional improvement remain to be elucidated.

Yoo, Myungsik; Khaled, Muntasir; Gibbs, Kurt M.; Kim, Jonghun; Kowalewski, Bjorn; Dierks, Thomas; Schachner, Melitta



Clinical Results of Cyberknife(R) Radiosurgery for Spinal Metastases  

PubMed Central

Objective Primary treatment of spinal metastasis has been external beam radiotherapy. Recent advance of technology enables radiosurgery to be extended to extracranial lesions. The purpose of this study was to determine the clinical effectiveness and safety of stereotactic radiosurgery using Cyberknife in spinal metastasis. Methods From June, 2002 to December, 2007, 129 patients with 167 spinal metastases were treated with Cyberknife. Most of the patients (94%) presented with pain and nine patients suffered from motor deficits. Twelve patients were asymptomatic. Fifty-three patients (32%) had previous radiation therapy. Using Cyberknife, 16-39 Gy in 1-5 fractions were delivered to spinal metastatic lesions. Radiation dose was not different regarding the tumor pathology or tumor volume. Results After six months follow-up, patient evaluation was possible in 108 lesions. Among them, significant pain relief was seen in 98 lesions (91%). Radiological data were obtained in 83 lesions. The mass size was decreased or stable in 75 lesions and increased in eight lesions. Radiological control failure cases were hepatocellular carcinoma (5 cases), lung cancer (1 case), breast cancer (1 case) and renal cell carcinoma (1 case). Treatment-related radiation injury was not detected. Conclusion Cyberknife radiosurgery is clinically effective and safe for spinal metastases. It is true even in previously irradiated patients. Compared to conventional radiation therapy, Cyberknife shows higher pain control rate and its treatment process is more convenient for patients. Thus, it can be regarded as a primary treatment modality for spinal metastases.

Youn, Sang Min; Park, Sukh Que; Rhee, Chang Hun



Potential Clinical Applications for Spinal Functional MRI  

PubMed Central

Functional MRI (fMRI) of the spinal cord is a noninvasive technique for obtaining information regarding spinal cord neuronal function. This article provides a brief overview of recent developments in spinal cord fMRI and outlines potential applications, as well as the limitations that must be overcome, for using spinal fMRI in the clinic. This technique is currently used for research purposes, but significant potential exists for spinal fMRI to become an important clinical tool.

Kornelsen, Jennifer; Mackey, Sean



Placental abruption occurring soon after labor combined spinal-epidural analgesia.  


We present a case of placental abruption necessitating emergency cesarean section in an otherwise uncomplicated patient soon after initiation of combined spinal-epidural analgesia in labor. Administration of spinal opioids has the potential to cause fetal bradycardia due to uterine hypertonicity following rapid onset of analgesia. In this case, a previously bloody show before placement of combined spinal-epidural analgesia may have been evidence of a small abruption. We hypothesize that uterine hypertonicity following administration of spinal opioids may have hastened the development of an existing placental abruption. PMID:22940265

Jaime, F; Degani, J; Lam, N; Allen, G



Reirradiation of Spinal Column Metastases  

Microsoft Academic Search

\\u000a \\u000a Background:\\u000a   For reirradiation of spinal column metastases, intensity-modulated radiation therapy (IMRT) reduces the dose to the spinal\\u000a cord, while allowing longer treatment times. We analyzed the potential of volumetric modulated arc therapy (VMAT) to reduce\\u000a treatment time and number of monitor units (MU).\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a   In CT datasets of 9 patients with spinal column metastases, the planned target volume

Florian Stieler; Dirk Wolff; Linda Bauer; Hans-Jörg Wertz; Frederik Wenz; Frank Lohr



Bladder dysfunction and neurological disability at presentation in closed spina bifida  

Microsoft Academic Search

Congenital closed spinal anomalies are associated with distortion of the spinal cord, the spinal nerve roots or both, and can result in neurological abnormalities of the lower limbs and neuropathic bladder dysfunction. This study reports clinical and videourodynamic findings in a group of 51 patients with closed spina bifida. The mean age at presentation to a specialist neurourological clinic was

L B Johnston; M Borzyskowski



Spinal Cord Stimulation in a Patient with Spinal Epidural Lipomatosis  

Microsoft Academic Search

Background and ObjectiveSpinal cord stimulation is the most commonly used implantable neurostimulation modality for management of pain syndromes. For treatment of lower extremity pain, the spinal cord stimulator lead is typically placed in the thoracic epidural space, at the T10–T12 levels. Typically, satisfactory stimulation can be obtained relatively easily. Anatomical variability in the epidural space, such as epidural scarring, has

Yi Zhang; Monica J. Wood; Christopher Gilligan



Spinal robotics: current applications and future perspectives.  


Even though robotic technology holds great potential for performing spinal surgery and advancing neurosurgical techniques, it is of utmost importance to establish its practicality and to demonstrate better clinical outcomes compared with traditional techniques, especially in the current cost-effective era. Several systems have proved to be safe and reliable in the execution of tasks on a routine basis, are commercially available, and are used for specific indications in spine surgery. However, workflow, usability, interdisciplinary setups, efficacy, and cost-effectiveness have to be proven prospectively. This article includes a short description of robotic structures and workflow, followed by preliminary results of a randomized prospective study comparing conventional free-hand techniques with routine spine navigation and robotic-assisted procedures. Additionally, we present cases performed with a spinal robotic device, assessing not only the accuracy of the robotic-assisted procedure but also other factors (eg, minimal invasiveness, radiation dosage, and learning curves). Currently, the use of robotics in spinal surgery greatly enhances the application of minimally invasive procedures by increasing accuracy and reducing radiation exposure for patients and surgeons compared with standard procedures. Second-generation hardware and software upgrades of existing devices will enhance workflow and intraoperative setup. As more studies are published in this field, robot-assisted therapies will gain wider acceptance in the near future. PMID:23254800

Roser, Florian; Tatagiba, Marcos; Maier, Gottlieb



MRI Features of Spinal Epidural Angiolipomas  

PubMed Central

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.

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



Pacemaker neurons within newborn spinal pain circuits  

PubMed Central

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.

Li, Jie; Baccei, Mark L.



Backpacks and spinal disorders in school children.  


The interest on backpacks, particularly with regard to their potential unfavourable effect on spinal disorders in school children, has dramatically increased during the last years. The aim of the present study was to look critically at the recent publications and to qualify some ''common sense-based rules''. In recent studies no or weak associations between spinal disorders in children and backpack use could be identified, which is related to the methodology of the studies. From reviewing the biomechanical and physiological effects of backpack use, it was concluded that there is evidence that carrying a heavy backpack results in trunk forward lean and that there are indications that backpack use can increase metabolic cost and alter gait kinetics in youngsters. However there is no evidence that postural, metabolic or kinetic adaptations to backpack use, cause back disorders at young age. Spinal forces based on the above mentioned postural responses can be presumed. However, the amount of work represented by the school backpacks should be compared with the physical activities performed by the same youngsters during their leisure time and is probably not as dangerous as claimed in some media. Therefore the uproar in medical and educational societies and in the media, to sensitize children, parents and educators, with weight cut-off limitations and other backpack use safety guidelines can not be justified and overmedicalizing this issue should be avoided. PMID:16030489

Cardon, G; Balagué, F



The human tail and spinal dysraphism.  


Recent publications have endeavoured to differentiate between the true, or vestigial tail, and the pseudotail by clinical and pathological examination, and have indicated the benign nature of the true tail. The true tail arises from the most distal remnant of the embryonic tail, contains adipose, connective, muscle, and nerve tissue, and is covered by skin. Pseudotails represent a variety of lesions having in common a lumbosacral protrusion and a superficial resemblance to vestigial tails. A review of the case reports indicates spina bifida to be the most frequent coexisting anomaly with both. A review of occult spinal dysraphism shows it to be associated with cutaneous signs in more than 50% of instances. Three cases of spinal dysraphism with tail-like cutaneous structures are described and their radiological, operative, and pathological findings presented. The classification of each of the appendages into true tail or pseudotail remains obscure. Although the finding of these three tails was the subject of much curiosity, surgical treatment was clearly designed to adequately deal with the associated dysraphic state. The presence of a tail-like appendage in the lumbosacral region should alert the clinician to the possibility of underlying spinal dysraphism. Preoperative assessment must include a complete neurological history and examination as well as computed tomographic or magnetic resonance imaging. PMID:1779337

Belzberg, A J; Myles, S T; Trevenen, C L



Overview of Spinal Cord Disorders  


... The front "wings" (anterior or motor horns) contain nerve cells that carry signals from the brain or spinal ... muscles. The back (posterior or sensory) horns contain nerve cells that receive signals about pain, temperature, and other ...


Instrumented stabilization in spinal tuberculosis  

Microsoft Academic Search

Spinal tuberculosis (TB) produces neurological complications and grotesque spinal deformity, which in children increases even\\u000a with treatment and after achieving healing. Long-standing, severe deformity leads to painful costo-pelvic impingement, respiratory\\u000a distress, risk of developing late-onset paraplegia and consequent reduction in quality and longevity of life. The treatment\\u000a objective is to avoid the sequelae of neural complications and achieve the healed

Anil Kumar Jain; Saurabh Jain


Spinal cord stimulation for radicular pain following retained bullet in the spinal canal.  


We are reporting on the implantation of a spinal cord stimulator to treat intractable radicular pain following a retained bullet fragment in the spinal canal. Such retained fragments are associated with risks including pain, neurological deficit, infection, toxic effects, and migration. Our patient was a young man with radicular pain and history of a gunshot entering the abdomen. Computed tomography of the spine had revealed a nearly complete bullet in the right paracentral canal at L4, partially extending into the lateral recess. He presented 17 months after his injury with gradually worsening pain and parasthesias radiating from the back to the whole right leg and foot. There was no weakness. As the patient had failed conservative therapy, procedural options were considered. In this case, the potential benefits of epidural steroid injection by any approach might not have outweighed risks of infection, related to foreign body and local steroid, or possible migration due to mechanical forces during injection. As he may well need repeated epidural steroid injections to manage his pain, this increases his risk for infection. A percutaneous trial spinal cord stimulation lead was placed, with epidural entry well away from the bullet. After good results, a permanent system was implanted. There was no evidence of infection or migration, and excellent pain relief was achieved. Bullets and other foreign bodies retained in the spinal canal can cause progressive neurologic symptoms through reactive tissue formation and compression. Spinal cord stimulation can relieve radicular pain while avoiding risks associated with altering the location of the offending foreign body. PMID:23511684

Keel, John C; Lau, Mary E; Gulur, Padma


Spinal nerve ligation increases alpha2-adrenergic receptor G-protein coupling in the spinal cord.  


Intrathecal and epidural administration of the alpha2-adrenergic receptor agonist clonidine in humans results in analgesia to both acute nociceptive and chronic neuropathic pain. The potency of clonidine increases with hypersensitivity to mechanical stimuli after nerve injury, although the reasons for this change are unknown. In the present study, we tested the hypothesis that peripheral nerve injury alters either spinal alpha2-adrenergic receptor-mediated G-protein activity or alpha2-adrenergic receptor number. Rats were randomized to left spinal nerve ligation (SNL) or sham surgery. Tactile hypersensitivity in the hindpaw was confirmed and lumbar spinal cords were removed for binding assays. To examine agonist-induced G-protein coupling, [35S]GTP gamma S binding experiments were performed in spinal cord membranes and sections using norepinephrine as an alpha2-adrenergic agonist. SNL was associated with an increase in maximal efficacy, but not potency, of norepinephrine-stimulated [35S]GTP gamma S binding in dorsal horn. SNL had no effect on basal [35S]GTP gamma S binding or on muscarinic cholinergic-stimulated [35S]GTP gamma S binding. [35S]GTP gamma S autoradiography showed that this increase in alpha2-adrenergic-activated G-proteins occurred both ipsilateral and contralateral to SNL surgery. SNL did not alter total alpha2-adrenergic receptor number or affinity to [3H]-rauwolscine binding, and displacement studies with the alpha2A-adrenergic antagonist BRL44408 revealed that most of the binding was associated with the alpha2A-adrenergic subtype. These data suggest that the increased potency of clonidine in neuropathic pain could reflect increased efficiency of G-protein coupling from spinal alpha2-adrenergic receptors. PMID:15748875

Bantel, Carsten; Eisenach, James C; Duflo, Frederic; Tobin, Joseph R; Childers, Steven R



Combined treatment with FK506 and nerve growth factor for spinal cord injury in rats  

PubMed Central

Following spinal cord injury in rats, FK506 is able to protect local nerve tissue, promote neural regeneration, reduce neuronal apoptosis and accelerate the recovery of spinal cord functions. Nerve growth factor (NGF) is important in the regulation of central and peripheral nerve cell regeneration, growth differentiation and functions. Previous studies have shown that FK506 and NGF exhibit a synergistic effect in the treatment of peripheral nerve injury; however, it remains unclear whether the synergistic effect is present in the treatment of spinal cord injury. In this study, we combined FK506 and NGF for the treatment of spinal cord injury in rats. The NF200 protein expression in rats with spinal cord injury was determined using immunohistochemical staining and NF200 mRNA expression levels were observed using the reverse transcription-polymerase chain reaction method. The restoration of spinal cord functions was evaluated using the Basso, Beattie and Bresnahan score. The results demonstrated that the combined treatment significantly enhanced the expression of NF200 and improved spinal cord functions compared with the results of the single treatment. Our experimental observations indicated that FK506 and NGF exhibit a synergistic effect in the treatment of spinal cord injury in rats and that the combined treatment may effectively promote neural regeneration and functional recovery in rats following spinal cord injury.




Thoracolumbar spinal ligaments exhibit negative and transverse pre-strain.  


The present work represents the first reported bi-axial spinal ligament pre-strain data for the thoracic and lumbar spine. Ligament pre-strain (in-situ strain) is known to significantly alter joint biomechanics. However, there is currently a lack of comprehensive data with regards to spinal ligament pre-strain. The current work determined the pre-strain of 71 spinal ligaments (30 anterior longitudinal ligaments, 27 supraspinous ligaments and 14 interspinous ligaments). The interspinous ligament and the anterior longitudinal ligament exhibited bi-axial pre-strain distributions, demonstrating they are not uniaxial structures. The supraspinous ligament frequently exhibited large amounts of negative pre-strain or laxity suggesting it makes no mechanical contribution to spinal stability near the neutral posture. Upon implementing multi-axial pre-strain results into a finite element model of the lumbar spine, large differences in spinal biomechanics were observed. These results demonstrate the necessity of accounting for ligament pre-strain in biomechanical models. In addition, the authors present a unique experimental method for obtaining ligament pre-strain that presents a number of advantages when compared to standard techniques. PMID:23660304

Robertson, Daniel J; Von Forell, Gregory A; Alsup, Jeremy; Bowden, Anton E



Transcutaneous spinal direct current stimulation.  


In the past 10?years renewed interest has centered on non-invasive transcutaneous weak direct currents applied over the scalp to modulate cortical excitability ("brain polarization" or transcranial direct current stimulation, tDCS). Extensive literature shows that tDCS induces marked changes in cortical excitability that outlast stimulation. Aiming at developing a new, non-invasive, approach to spinal cord neuromodulation we assessed the after-effects of thoracic transcutaneous spinal DC stimulation (tsDCS) on somatosensory potentials (SEPs) evoked in healthy subjects by posterior tibial nerve (PTN) stimulation. Our findings showed that thoracic anodal tsDCS depresses the cervico-medullary PTN-SEP component (P30) without eliciting adverse effects. tsDCS also modulates post-activation H-reflex dynamics. Later works further confirmed that transcutaneous electric fields modulate spinal cord function. Subsequent studies in our laboratory showed that tsDCS modulates the flexion reflex in the human lower limb. Besides influencing the laser evoked potentials (LEPs), tsDCS increases pain tolerance in healthy subjects. Hence, though the underlying mechanisms remain speculative, tsDCS modulates activity in lemniscal, spinothalamic, and segmental motor systems. Here we review currently available experimental evidence that non-invasive spinal cord stimulation (SCS) influences spinal function in humans and argue that, by focally modulating spinal excitability, tsDCS could provide a novel therapeutic tool complementary to drugs and invasive SCS in managing various pathologic conditions, including pain. PMID:22783208

Cogiamanian, Filippo; Ardolino, Gianluca; Vergari, Maurizio; Ferrucci, Roberta; Ciocca, Matteo; Scelzo, Emma; Barbieri, Sergio; Priori, Alberto



Spinal neuronal dysfunction after stroke.  


Central nervous system lesions, such as stroke or spinal cord injury (SCI), are followed by both cortical and spinal neuronal reorganization. In a severe chronic SCI a spinal neuronal dysfunction develops which is reflected in an exhaustion of leg muscle electromyographic (EMG) activity during assisted locomotion and a change in the dominance from an early to a late polysynaptic spinal reflex (SR) component. The aim of this study was to investigate the course of spinal neuronal function after a severe stroke, i.e., a unilateral deprivation of supraspinal input. In 30 hemiparetic stroke subjects locomotor and SR behavior were assessed. SR responses in the tibialis anterior muscle were evoked by non-noxious tibial nerve stimulation on both, the affected and the unaffected leg. In nine stroke subjects EMG activity of the leg muscles was recorded during assisted locomotion. In a similar way to SCI subjects, in severely affected chronic (>12 months post-incidence) stroke subjects a late SR component was prominent in the affected leg, while an early one dominated in the unaffected leg. The late SR component correlated with muscle paresis (rho=0.714) and walking ability (rho=0.493). In contrast to SCI subjects, no exhaustion of the EMG activity was observed in the affected leg muscles during prolonged assisted locomotion. It is concluded that spinal neuronal circuits undergo functional changes also after a stroke which have common as well as divergent features compared to SCI subjects. As a consequence, different rehabilitative strategies might be required. PMID:22226596

Hubli, Michèle; Bolliger, Marc; Limacher, Esther; Luft, Andreas R; Dietz, Volker



Presentation of occult Chiari I malformation following spinal anesthesia  

PubMed Central

Chiari I malformation (CM-I) manifests with tonsillar herniation below foramen magnum. These patients are at high risk of respiratory depression and bulbar dysfunction in the perioperative period with underlying obstructive sleep apnea. However, the safe use of both general and regional anaesthesia has been documented in a known CM-I parturients. We describe the successful management of a patient who had hypercapnic respiratory failure in the post-anaesthetic care unit following an uneventful subarachnoid block for left knee replacement surgery. This patient was retrospectively diagnosed with occult CM-I and moderate to severe obstructive sleep apnea in the postoperative period.

Ankichetty, Saravanan P; Khunein, Saleh; Venkatraghavan, Lashmi



Guillain-Barre Syndrome Following Spinal Fusion for Thoracic Vertebral Fracture  

PubMed Central

There have been very few reports in the literature of Guillain-Barré syndrome (GBS) after spinal surgery. We present a unique case of GBS following spinal fusion for thoracic vertebral fracture. The aim of this report is to illustrate the importance of early neurological assessment and determining the exact cause of a new neurological deficit that occurs after an operation.

Son, Dong Wuk; Sung, Sun Ki; Kim, Sung Hoon



Spinal lymphoma and pulmonary filariasis in a pet domestic rabbit (Oryctolagus cuniculus domesticus)  

Microsoft Academic Search

Spinal lymphoma and concurrent pulmonary filariasis are reported in a pet rabbit. The rabbit presented for pelvic limb paralysis resulting from extradural spinal lymphoma, presumably rising from the body of the sixth lumbar vertebra. The neoplasm was subsequently immunophenotyped as a B-cell lymphoma. Pulmonary filariasis was an incidental finding at necropsy.

Scott D. Reed; Shannon Shaw; Dawn E. Evans


Spinal injury considerations in the competitive diver: a case report and review of the literature  

Microsoft Academic Search

Background contextDespite significant literature associated with spinal injuries and recreational diving, few articles exist regarding competitive diving injuries, with no reports pertaining specifically to spinal injuries. As a result, a case report of a collegiate diver with C5–C6 ligamentous instability requiring operative stabilization is currently presented in addition to a review of the literature.

Brian L. Badman; Glenn R. Rechtine



Measurement of spinal cord area in clinically isolated syndromes suggestive of multiple sclerosis  

Microsoft Academic Search

Atrophy of the spinal cord is known to occur in multiple sclerosis but the cause and the timing of its onset are not clear. Recent evidence suggests that atrophy may start to occur early in the disease. The aim was to determine whether atrophy of the spinal cord could be detected in vivo using MRI techniques, in patients presenting with

P A Brex; S M Leary; J I ORiordan; K A Miszkiel; G T Plant; A J Thompson; D H Miller



Appropriateness of Spinal Manipulation for Low-Back Pain: Project Overview and Literature Review.  

National Technical Information Service (NTIS)

The report presents results from one part of the RAND Appropriateness of Spinal Manipulation for Low-Back-Pain Study. The study is designed to ascertain the clinical criteria for the appropriate use of spinal manipulation for low-back pain from chiropract...

P. G. Shekelle A. H. Adams M. R. Chassin E. L. Hurwitz R. B. Phillips



Cerebellar hemorrhage after spinal surgery: case report and review of the literature  

Microsoft Academic Search

Recent reports indicate that cerebellar hemorrhage after spinal surgery is infrequent, but it is an important and preventable problem. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanisms are unknown. This report details the case of a 48-year-old woman who developed remote cerebellar hemorrhage after spinal surgery. The patient presented with a

Deniz Konya; Serdar Ozgen; M. Necmettin Pamir



Labor analgesia for the parturient with prior spinal surgery: what does an obstetrician need to know?  

Microsoft Academic Search

Administration of lumbar epidural analgesia in a parturient with previous spinal surgery presents a unique challenge to the anesthesiologist. These challenges (difficulties) range from inability to identify the epidural space, multiple attempts before catheter insertion, vascular trauma, and\\/or subdural local anesthetic injection to accidental dural puncture. The literature documenting management of labor analgesia in pregnant women with prior spinal surgery

Krzysztof M. Kuczkowski



Inhibition of tolerance to spinal morphine antinociception by low doses of opioid receptor antagonists  

Microsoft Academic Search

Ultra-low doses of opioid receptor antagonists inhibit development of chronic spinal morphine tolerance. As this phenomenon mechanistically resembles acute tolerance, the present study examined actions of opioid receptor antagonists on acute spinal morphine tolerance. In adult rats, administration of three intrathecal injections of morphine (15 ?g) at 90 min intervals produced a significant decline of the antinociceptive effect and loss of agonist

Benjamin McNaull; Tuan Trang; Maaja Sutak; Khem Jhamandas



Anaplastic ganglioglioma in the spinal cord: case report and literature review.  


Anaplastic ganglioglioma (AGG) is a rare tumor. A PubMed database search yielded only a few case reports and fewer case series. An even rarer entity is AGG arising in the spinal cord. We present a case of a pediatric patient with a pathological diagnosis of spinal AGG. PMID:23689037

Kuten, Jonathan; Kaidar-Person, Orit; Vlodavsky, Eugene; Postovsky, Sergey; Billan, Salem; Kuten, Abraham; Bortnyak-Abdah, Roxolyana



Rudimentary third lower limb in association with spinal dysraphism: Two cases  

PubMed Central

Spinal dysraphism is a common congenital anomaly with many associated variants. One of the rarest associated findings is a full grown or rudimentary third limb, collectively called Tripagus. We present two cases of spinal dysraphism with rudimentary third limb arising from the ilium.

Wasnik, Ashish P; Shinagare, Atul; Lalchandani, Usha R; Gujrathi, Rahul; Pai, Bhujang U



Human Tail with Noncontiguous Intraspinal Lipoma and Spinal Cord Tethering:Case Report and Embryologic Discussion  

Microsoft Academic Search

Children born with a tail-like appendage have a rare malformation that is frequently associated with abnormalities of the spine and spinal cord. A contiguous fibrolipoma is usually seen extending from the subcutaneous portion of the tail into the inferior spinal cord, resulting in tethered cord syndrome. We present the case of a child born with a tail and intraspinal lipoma

Daniel J. Donovan; Robert C. Pedersen



Prophylactic ephedrine and hypotension associated with spinal anesthesia for cesarean delivery  

Microsoft Academic Search

Hypotension commonly accompanies induction of spinal anesthesia for cesarean section. To determine whether intravenous ephedrine prophylaxis would benefit prehydrated obstetrical patients presenting for elective cesarean section, we studied 30 patients randomly assigned to one of three experimental groups. All patients were preloaded with crystalloid (15 ml\\/kg), given spinal anesthesia and positioned with left uterine displacement (LUD). During induction, all patients

S. W. King; M. A. Rosen



Depletion of Hematogenous Macrophages Promotes Partial Hindlimb Recovery and Neuroanatomical Repair after Experimental Spinal Cord Injury  

Microsoft Academic Search

Traumatic injury to the spinal cord initiates a series of destructive cellular processes which accentuate tissue damage at and beyond the original site of trauma. The cellular inflammatory response has been implicated as one mechanism of secondary degeneration. Of the various leukocytes present in the spinal cord after injury, macrophages predominate. Through the release of chemicals and enzymes involved in

Phillip G. Popovich; Zhen Guan; Ping Wei; Inge Huitinga; Nico van Rooijen; Bradford T. Stokes




PubMed Central

Transient spinal cord ischemia in humans can lead to the development of permanent paraplegia with prominent spasticity and rigidity. Histopathological analysis of spinal cords in animals with ischemic spastic paraplegia show a selective loss of small inhibitory interneurons in previously ischemic segments but with a continuing presence of ventral ?-motoneurons and descending cortico-spinal and rubro-spinal projections. The aim of the present study was to examine the effect of human spinal stem cells (hSSCs) implanted spinally in rats with fully developed ischemic paraplegia on the recovery of motor function and corresponding changes in motor evoked potentials. In addition the optimal time frame for cell grafting after ischemia and the optimal dosing of grafted cells were also studied. Spinal cord ischemia was induced for 10 min using intra-aortic balloon and systemic hypotension. In the functional recovery study, hSSCs (10 000–30 000 cells/0.5 ?l/injection) were grafted into spinal central gray matter of L2-L5 segments at 21 days after ischemia. Animals were immunosuppressed with Prograf (1mg/kg or 3mg/kg) for the duration of the study. After cell grafting the recovery of motor function was assessed periodically using BBB scoring system and correlated with the recovery of motor evoked potentials. At predetermined times after grafting (2–12 weeks), animals were perfusion-fixed and the survival, and maturation of implanted cells were analyzed using antibodies recognizing human-specific antigens: nuclear protein (hNUMA), neural cell adhesion molecule (hMOC), neuron-specific enolase (hNSE) and synapthophysin (hSYN) as well as the non-human specific antibodies TUJ1, GFAP, GABA, GAD65 and GLYT2. After cell grafting a time-dependent improvement in motor function and suppression of spasticity and rigidity was seen and this improvement correlated with the recovery of motor evoked potentials. Immunohistochemical analysis of grafted lumbar segments at 8 and 12 weeks after grafting revealed intense hNSE immunoreactivity, an extensive axo-dendritic outgrowth as well as rostrocaudal and dorsoventral migration of implanted NUMA-positive cells. An intense hSYN immunoreactivity was identified within the grafts and in the vicinity of persisting ?-motoneurons. On average, 64% of hSYN terminals were GAD65 immunoreactive which corresponded to GABA immunoreactivity identified in 40–45% of NUMA-positive grafted cells. The most robust survival of grafted cells was seen when cells were grafted 21 days after ischemia. As defined by cell survival and laminar distribution, the optimal dose of injected cells was 10 000–30 000 cells per injection. These data indicate that spinal grafting of hSSCs can represent an effective therapy for patients with spinal ischemic paraplegia.

Cizkova, Dasa; Kakinohana, Osamu; Kucharova, Karolina; Marsala, Silvia; Johe, Karl; Hazel, Thomas; Hefferan, Michael P.; Marsala, Martin



Pathways mediating descending control of spinal nociceptive transmission from the nuclei locus coeruleus (LC) and raphe magnus (NRM) in the cat  

Microsoft Academic Search

We have previously reported that electrical stimulation in LC or NRM when tested on the activity of a multireceptive neurone in the spinal cord produced similar inhibitory actions. The present study aimed to define the pathways that mediate this descending inhibitory action in the spinal cord by pharmacological means and by making surgical lesions in the spinal cord or NRM.

S. S. Mokha; J. A. McMillan; A. Iggo



The Diagnosis of Spinal Dural Arteriovenous Fistulas.  


Study Design. Retrospective consecutive case series.Objective. To review and analyze clinical presentations and radiological imaging of 326 consecutive spinal dural arteriovenous fistula (SDAVF) patients from two institutions.Summary of Background Data. The clinical presentations of SDAVF are nonspecific. Patients may be initially diagnosed with other spinal diseases. MRI can reveal spinal cord changes associated with the disorder, but neurosurgeons often overlook these changes.Methods. From 1989 to 2009, 326 patients were diagnosed with SDAVF and treated in the two institutions. We retrospectively reviewed the clinical records and radiological imaging of all patients, and collected and analyzed the related data.Results. 282 men and 44 women (men/women ratio 6.4:1, mean age 53.9 years, SD 12.1) were included in the study. Fistulas were located at the T7 spinal segment (41, 12.6%) but were more typically found at T5 to L5 (273, 82.5%). The most common initial symptoms were lower extremity weakness (234, 71.8%), sensory disturbance (229, 70.2%) and sphincter disturbance (87, 26.7%). These percentages increased, 85.6%, 80.8% and 52.5% respectively, until patients were properly diagnosed. The mean diagnostic time to SDAVF was 19.9 months (SD 25.2). Two major changes on MRI were intramedullary T2-weighted signal hyperintensity (284, 87.1%) and perimedullary dilated vessels (251, 77%). Fistulas were often located outside of the vertebral segments of T2-weighted signal change (P = 0.005). Magnetic Resonance Angiography (MRA) and Computed Tomography angiography (CTA) of 33 (71.7%) patients revealed perimedullary dilated vessels and precisely located fistulas in 19 (41.3%) patients. MRA and CTA studies of the perimedullary vessels also led to identification of a second fistula through angiography. Degenerative disc disease and myelitis were the most common misdiagnoses, and the patients were often treated incorrectly.Conclusion. "Worsening" and "Symptoms Combination" are progression characteristics of SDAVF. Patients should undergo spinal MRI when they are first suspected to have SDAVF. MRA and CTA as non-invasive angiography are helpful for diagnosis. PMID:23380827

Wang, Donghai; Yang, Ning; Zhang, Peng; Xu, Shuo; Li, Xueen; Zhao, Peng; Huang, Bin; Li, Xingang



Baicalin ameliorates neuropathic pain by suppressing HDAC1 expression in the spinal cord of spinal nerve ligation rats.  


BACKGROUND/PURPOSE: In a recent study, we found that baicalin exhibited a potent analgesic effect on carrageenan-evoked thermal hyperalgesia. The underlining mechanisms may be associated with inhibition of inflammatory mediator overproduction, including proinflammatory cytokines, nitric oxide (NO), and prostaglandin E2 (PGE2). In the present study, we examined the effect of baicalin on the antinociceptive effect of morphine and histone deacetylase 1 (HDAC1) expression in the spinal cord dorsal horn in neuropathic pain rats. METHODS: Neuropathic pain was induced by tight ligation of the left L5 spinal nerve of the rats. An intrathecal catheter was implanted for drug administration. Nociception was assessed by using the plantar test with the Hargreaves radiant heat apparatus, and the von Frey test with the dynamic plantar anesthesiometer. Spinal cords were removed for histone acetyl-H3 and HDAC1 western blot analysis at the end of the nociceptive assessment. RESULTS: The results showed that hyperalgesia and allodynia were observed in the spinal nerve ligated (SNL) left hindlimb; it was companied by histone-H3 deacetylation and HDAC1 overexpression on the ipsilateral side of the spinal cord dorsal horn. Intrathecal injection of baicalin (10 ?g) significantly attenuated the allodynia and hyperalgesia, and enhanced the antinociceptive effect of morphine (15 ?g). Moreover, baicalin reversed the histone-H3 acetylation and suppressed HDAC1 expression on the ipsilateral side of the spinal cord dorsal horn of SNL rats. CONCLUSION: The present findings suggest that baicalin can ameliorate neuropathic pain by suppressing HDAC1 expression and preventing histone-H3 acetylation in the spinal cord dorsal horn of SNL rats. PMID:23684218

Cherng, Chen-Hwan; Lee, Kwong-Chiu; Chien, Chih-Cheng; Chou, Kuang-Yi; Cheng, Yu-Che; Hsin, Shih-Tai; Lee, Sing-Ong; Shen, Ching-Hui; Tsai, Ru-Yin; Wong, Chih-Shung



Care of post-traumatic spinal cord injury patients in India: An analysis  

PubMed Central

Background: The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup. Materials and Methods: Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed. Results: Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years). Twenty-nine (48.33%) of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days) of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5%) cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33%) patients were given injection solumedrol with conservative treatment, 35 (60%) patients were given only conservative treatment and seven patients were operated (11.66%) upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42%) and two (28.57%) were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance. Conclusion: Awareness on the part of the general population, attendants of the patients, clinical and paraclinical team regarding spinal cord injury needs to be addressed. Safe mode of transportation of spinal cord injured patient and early presentation at tertiary spinal care center with comprehensive spinal trauma care team should be stressed upon.

Pandey, VK; Nigam, V; Goyal, T D; Chhabra, HS



Spinal cord herniation into pseudomeningocele after traumatic nerve root avulsion: case report and review of the literature  

Microsoft Academic Search

We present an extremely rare case of traumatic spinal cord herniation due to a brachial plexus avulsion injury and provide\\u000a a review of the literature of spinal cord herniation. Spinal cord herniation is an uncommon condition that can occur spontaneously\\u000a or as a result of surgery or trauma. This condition often presents with symptoms and signs as Brown-Séquard syndrome. Traumatic

Masato Tanaka; Hisanori Ikuma; Kazuo Nakanishi; Yoshihisa Sugimoto; Haruo Misawa; Tomoaki Takigawa; Toshifumi Ozaki



Spinal manipulation or mobilization for radiculopathy: a systematic review.  


In this systematic review, we present a comprehensive and up-to-date systematic review of the literature as it relates to the efficacy and effectiveness of spinal manipulation or mobilization in the management of cervical, thoracic, and lumbar-related extremity pain. There is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. The quality of evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low. At present, no evidence exists for the treatment of thoracic radiculopathy. Future high-quality studies should address these conditions. PMID:21292148

Leininger, Brent; Bronfort, Gert; Evans, Roni; Reiter, Todd



Pathophysiology of primary spinal syringomyelia  

PubMed Central

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. (

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



Diplopia from Subacute Bilateral Subdural Hematoma after Spinal Anesthesia  

PubMed Central

Subdural hematoma (SDH) is a rare, but life-threatening complication of spinal anesthesia. Subdural hematoma resulting from this procedure could present with vague symptoms such as chronic headache and could easily be missed. Chronic headache is one of the symptoms of chronic SDH in postpartum women. Diplopia as the presenting complaint in SDH secondary to peripartum spinal anesthesia has not, to our knowledge, been previously reported. Here, we report a case of diplopia secondary to postpartum subacute bilateral SDHs with transtentorial herniation after spinal anesthesia in a healthy primagravid 25-year-old woman. SDH can expand gradually and the initial symptoms might be subtle as in our case, despite critically high intracranial pressure.

Hassen, Getaw Worku; Kalantari, Hossein



Muscle after spinal cord injury.  


The morphological and contractile changes of muscles below the level of the lesion after spinal cord injury (SCI) are dramatic. In humans with SCI, a fiber-type transformation away from type I begins 4-7 months post-SCI and reaches a new steady state with predominantly fast glycolytic IIX fibers years after the injury. There is a progressive drop in the proportion of slow myosin heavy chain (MHC) isoform fibers and a rise in the proportion of fibers that coexpress both the fast and slow MHC isoforms. The oxidative enzymatic activity starts to decline after the first few months post-SCI. Muscles from individuals with chronic SCI show less resistance to fatigue, and the speed-related contractile properties change, becoming faster. These findings are also present in animals. Future studies should longitudinally examine changes in muscles from early SCI until steady state is reached in order to determine optimal training protocols for maintaining skeletal muscle after paralysis. PMID:19705475

Biering-Sørensen, Bo; Kristensen, Ida Bruun; Kjaer, Michael; Biering-Sørensen, Fin



Lumbar Spinal Stenosis  

PubMed Central

Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. LSS is being more commonly diagnosed and may relate to better access to advanced imaging and to an aging population. This review focuses on radicular symptoms related to degenerative central and lateral stenosis and updates knowledge of LSS pathophysiology, diagnosis and management. Since patients with anatomic LSS can range from asymptomatic to severely disabled, the clinical diagnosis focuses on symptoms and examination findings associated with LSS. Imaging findings are helpful for patients with persistent, bothersome symptoms in whom invasive treatments are being considered. There is limited information from high quality studies about the relative benefits and harms of commonly used treatments. Interpreting and comparing results of available research is limited by a lack of consensus about the definition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent and bothersome symptoms. Recommendations favor a shared decision making approach due to important trade-offs between alternative therapies and differences among patients in their preferences and values.

Genevay, Stephane



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


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

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



Asymptomatic spinal cord lesions in clinically isolated optic nerve, brain stem, and spinal cord syndromes suggestive of demyelination  

PubMed Central

OBJECTIVES—Conventional T2 weighted MRI studies have highlighted the fact that the presence of clinically silent brain lesions increases the risk of developing clinically definite multiple sclerosis after an isolated syndrome of the optic nerve, brain stem, or spinal cord. The objectives of the present study are: (1) to show whether or not these patients also have asymptomatic abnormalities of the spinal cord, and (2) to recruit a new cohort of such patients using high resolution MRI of both brain and spinal cord.?METHODS—The brain was imaged in the axial plane with 3 mm thick contiguous slices using a proton density and T2 weighted fast spin echo (FSE) sequence; a T1 weighted sequence after the injection of gadolinium-DTPA; and a fast fluid attenuated inversion recovery (fFLAIR) sequence. The spinal cord was imaged in the sagittal plane with 3 mm thick slices using a T2 weighted FSE and a T1 weighted gadolinium enhanced sequence.?RESULTS—Thirty three patients, mean age 31 (16-46) were recruited. There were 14 men and 19 women. Brain MRI was abnormal in 22 (67%); no patient was seen with abnormalities on only one or other sequence. Six patients (18%) displayed one or more gadolinium enhancing lesions on brain MRI. In the spinal cord, nine (27%) patients displayed one or more clinically silent lesions on FSE. Two patients showed one and two gadolinium enhancing lesions in the spinal cord respectively.?CONCLUSION—This high incidence of spinal cord lesions emphasises that asymptomatic demyelinating lesions may also involve clinically eloquent pathways. Follow up studies are required to determine their prognostic importance.??

O'Riordan, J; Losseff, N; Phatouros, C; Thompson, A; Moseley, I; MacManus, D; McDonald, W; Miller, D



Concurrent intracranial and spinal arteriovenous malformations: Report of two pediatric cases and literature review  

PubMed Central

Background: Concurrent intracranial and spinal arteriovenous malformations (AVMs) are very rare with only a few cases being reported in literature. Two of the rare concurrent intracranial and spinal AVM cases are presented. Case Description: Case 1 is a 12-year-old girl with headache and motor disturbances in the lower limbs. Her spinal and brain angiogram was done and she was diagnosed to have a spinal AVM at level T8–T9 and an intracranial AVM in the left mesial temporal lobe. Her spinal AVM was embolized, while no treatment was given for her intracranial AVM. Case 2 is a 10-year-old girl who presented with headache and quadriparesis. Her brain and spinal angiogram revealed an intracranial AVM in the left parietal lobe and a spinal AVM at level C2, respectively. Craniotomy and excision was done for her intracranial AVM and embolization for the spinal AVM. Conclusion: It is proposed that multiple AVMs may be a result of yet unrevealed pathogenesis or strong embryogenetic anomaly, which may be different from that involved in single AVM. With lack of consensus over the best therapeutic strategy, multimodality treatment based on the individual's needs is suggested.

Shallwani, Hussain; Tahir, Muhammad Z.; Bari, Muhammad E.; Tanveer-ul-Haq



Lumbar Puncture (Spinal Tap) (For Parents)  


... Is A lumbar puncture (LP), often called a spinal tap, is a common medical test that involves ... that delivers nutrients and "cushions" the brain and spinal cord, or central nervous system. In a lumbar ...


Visceral responses to spinal manipulation.  


While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. This controversy is due in part to the perception that there is no robust neurobiological rationale to justify using a biomechanical treatment of the spine to address a disorder of visceral function. This paper therefore looks at the physiological evidence that spinal manipulation can impact visceral function. A structured search was conducted, using PubMed and the Index to Chiropractic Literature, to construct of corpus of primary data studies in healthy human subjects of the effects of spinal manipulation on visceral function. The corpus of literature is not large, and the greatest number of papers concerns cardiovascular function. Authors often attribute visceral effects of spinal manipulation to somato-autonomic reflexes. While this is not unreasonable, little attention is paid to alternative mechanisms such as somato-humoural pathways. Thus, while the literature confirms that mechanical stimulation of the spine modulates some organ functions in some cohorts, a comprehensive neurobiological rationale for this general phenomenon has yet to appear. PMID:22440554

Bolton, Philip S; Budgell, Brian



Two-photon imaging of spinal cord cellular networks.  


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

Johannssen, Helge C; Helmchen, Fritjof



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

SciTech Connect

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.

Muller-Runkel, R.; Vijayakumar, S.



Stem Cells for Spinal Cord Repair  

Microsoft Academic Search

The spinal cord is the main relay for signals between the brain and the body. Spinal cord injury completely or partially deprives the individual of mobility and sensory input as well as autonomic nervous system control below the level of the lesion. The major- ity of spinal cord injuries affect the cervical segments, leaving the patient para- or tetraplegic depending

Fanie Barnabe; Jonas Frisen



Dystonic Movement Disorders and Spinal Degenerative Disease  

Microsoft Academic Search

The occurrence of degenerative spinal disease subsequent to dystonic movement disorders has been neglected and has received more attention only recently. Spinal surgery is challenging with regard to continuous mechanical stress when treatment of the underlying movement disorder is insufficient. To characterize better the particular features of degenerative spinal disease in patients with dystonia and to analyze operative strategies, we

Thomas J. Loher; Christian B. Bärlocher; Joachim K. Krauss



The changing pattern of spinal arachnoiditis  

Microsoft Academic Search

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

M D Shaw; J A Russell; K W Grossart



Electrophysiology of mammalian spinal cord in vitro  

Microsoft Academic Search

MAMMLIAN spinal cord has often been used in electrophysiological studies where the experiments were carried out exclusively on the spinal cord in situ1. An obvious disadvantage of such experiments is that the concentrations of ions or drugs studied cannot be controlled precisely in the extracellular medium. To overcome that disadvantage, we have developed an isolated spinal cord preparation of the

Masanori Otsuka; Shiro Konishi



Spinal application of ?-conotoxin GVIA, an N-type calcium channel antagonist, attenuates enhancement of dorsal spinal neuronal responses caused by intra-articular injection of mustard oil in the rat  

Microsoft Academic Search

Administration of the N-type calcium channel antagonist ?-conotoxin GVIA to the spinal cord reduces spinal neuronal responses\\u000a to innocuous and noxious pressure applied to the knee, both in rats with normal knees and in rats in which a knee inflammation\\u000a has induced a state of hyperexcitability in spinal neurons (Neugebauer et al. 1996, J Neurophysiol 76: 3740–3749). In the\\u000a present

Johannes Nebe; Horacio Vanegas; Hans-Georg Schaible



Citrobocter kasori spinal epidural abscess: a rare occurrence.  


Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. MRI pointed towards an epidural abscess extending from T12 vertebral level to S1 vertebral level. Surgical decompression in the form of laminectomy and evacuation of pus was done and antibiotics were given according to culture and sensitivity. Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented. PMID:24000517

Kumar, Ashok; Jain, Pramod; Singh, Pritish; Divthane, Rupam; Badole, C M



Enrichment of spinal cord cell cultures with motoneurons  

Microsoft Academic Search

ABSTRACT Spinal cord,cell cultures,contain,several,types,of neurons.,Two,methods,are described,for enriching,such,cultures,with,motoneurons,(defined here,simply,as cholinergic,cells that are capable,of innervating,muscle). In the first method, 7-day embryonic chick spinal cord neurons were separated according,to size by,1 g,velocity,sedimentation.,It is assumed,that cholinergic motoneurons,are among,the largest cells present,at this stage. The spinal cords were,dissociated,vigorously,so that 95-98% of the ceils in the initial suspension were,isolated,from,one,another.,Cells in leading,fractions,(large cell fractions: LCFs) contain,about,seven,times as

Darwin K. Berg; Gerald D. Fischbach



Exophytic intramedullary meningioma of the cervical spinal cord.  


Intramedullary spinal cord neoplasms are relatively uncommon. The most common intramedullary tumors are astrocytomas and ependymomas. Meningiomas can occur as an intradural tumor; however, they are typically in the extramedullary compartment. A 42-year-old male presented with progressive sensory loss in the upper extremities and lower extremity weakness. Pre-operative imaging suggested an intramedullary cervical lesion. To treat the progressive neurological abnormality, surgical resection was planned. At surgery, it was noted that the tumor originated in the cervical spinal cord and extended into the extramedullary region. Histology confirmed the lesion to be a meningioma. This meningioma variant has not previously been described. Spinal meningiomas may occur in locations other than intradural, extramedullary locations, and should be included in the differential diagnosis of intramedullary lesions. Intramedullary meningiomas can be successfully treated with surgery. PMID:18710810

Sahni, D; Harrop, J S; Kalfas, I H; Vaccaro, A R; Weingarten, D



Aberrant extradural spinal migration of Spirocerca lupi: four dogs.  


Spirocerca lupi is a nematode mainly affecting dogs but has been found in other animals, particularly carnivores. Anatomical areas of typical and aberrant migration vary. This report describes four cases of Spirocerca lupi causing neurological symptoms, similar to thoracolumbar disc syndrome, as a result of aberrant migration of the nematode into the spinal canal. In two of the cases, the nematode could be demonstrated intraoperatively. The third was discovered on post-mortem examination, while the fourth case displayed compelling evidence of Spirocerca lupi involvement. Surgical removal of the Spirocerca lupi nematode would be the treatment of choice in cases of spinal migration, with therapeutic and preventive treatment with doramectin instituted to treat remote sites and prevent re-infection. In areas endemic for spirocercosis, Spirocerca lupi should be considered as an important differential diagnosis in cases that are presented with clinical signs suggestive of a spinal cord lesion. PMID:17425698

Du Plessis, C J; Keller, N; Millward, I R



Epidemiology, demographics, and pathophysiology of acute spinal cord injury.  


Spinal cord injury occurs through various countries throughout the world with an annual incidence of 15 to 40 cases per million, with the causes of these injuries ranging from motor vehicle accidents and community violence to recreational activities and workplace-related injuries. Survival has improved along with a greater appreciation of patterns of presentation, survival, and complications. Despite much work having been done, the only treatment to date known to ameliorate neurologic dysfunction that occurs at or below the level of neurologic injury has been intravenous methylprednisolone therapy. Much research over the past 30 to 40 years has focused on elucidating the mechanisms of spinal cord injury, with the complex pathophysiologic processes slowly being unraveled. With a greater understanding of both primary and secondary mechanisms of injury, the roles of calcium, free radicals, sodium, excitatory amino acids, vascular mediators, and apoptosis have been elucidated. This review examines the epidemiology, demographics, and pathophysiology of acute spinal cord injury. PMID:11805601

Sekhon, L H; Fehlings, M G



[Spinal epidural angiolipomas: a rare cause of spinal cord compression. A report of 8 cases and review of the literature].  


Extradural spinal angiolipomas are rare benign tumors containing vascular and mature adipose elements. We report 8 cases of spinal epidural angiolipomas in 6 females and 2 males. In 7 cases, the clinical manifestation was a progressive spinal cord compression and one case had a regressive paraparesis mimicking a multiple sclerosis. In the 8 cases, the localization was thoracic with an extradural complete type of contrast block in 2 cases and partial in 5 cases. The myelo-CT achieved in 7 cases and the magnetic resonance imaging done at our last case revealed a fat-containing epidural tumor. The tumors were removed in all cases through a laminectomy with a successful outcome after an average of 9 years (range: 6 months-12 years). Sixty-seven similar cases in the international literature are reviewed. A total of 75 cases have been studied: 45 women and 30 men with a mean age of 46.3 years (range: 6-73), presenting a progressive spinal cord compression in 68 cases and in 7 cases a regressive paraparesis mimicking a multiple sclerosis. Myelography shows an extradural compression of the thecal sac. MRI is nowadays the imaging modality of choice for the diagnosis of these lesions. The surgical removal often easy of the epidural spinal angiolipomas permit a fast recovery. The etiopathogenesis of this process is still controversial between the dysembryogenetic and malformative hypothesis. PMID:11148405

Akhaddar, A; Gazzaz, M; Derraz, S; Rifi, L; Amarti, A; Aghzadi, A; El Ouahabi A; El Khamlichi A



Exploring positive adjustment in people with spinal cord injury.  


This study explored adjustment in people with spinal cord injury; data from four focus groups are presented. Thematic analysis revealed four themes, managing goals and expectations, comparison with others, feeling useful and acceptance, showing participants positively engaged in life, positively interpreted social comparison information and set realistic goals and expectations. These positive strategies show support for adjustment theories, such as the Cognitive Adaptation Theory, the Control Process Theory and Response Shift Theory. These results also provide insight into the adjustment process of a person with spinal cord injury and may be useful in tailoring support during rehabilitation. PMID:23682061

Dibb, Bridget; Ellis-Hill, Caroline; Donovan-Hall, Maggie; Burridge, Jane H; Rushton, David



The immunological response to spinal cord injury: helpful or harmful?  


The role of the immune response in spinal cord injury has become a frequent object of debate. Evidence exists to suggest that autoimmunity following neurotrauma can be either beneficial or detrimental to recovery. The following commentary examines the recent findings indicating that mice lacking mature B- and T-lymphocytes have improved behavioral and histological outcomes following thoracic spinal cord injury. These data, presented in the October issue of Experimental Neurology are discussed within the context of previous findings and differing viewpoints in the field of neuroimmunology. Limitations on the translation of immune modulation therapeutics, and clinical perspectives on their future potential are also examined. PMID:23333564

Laliberte, A M; Fehlings, M G



Neonatal hind-paw injury disrupts acquisition of an instrumental response in adult spinal rats.  


The present study was designed to evaluate the impact of neonatal injury on adult spinal plasticity in rats. Subjects were randomly assigned to 1 of 4 experimental conditions: (a) hind-paw injury at Postnatal Day (PD) 2, (b) hind-paw injury at PD 5, (c) anesthesia exposure only on PD 2, or (d) anesthesia exposure only on PD 5. Subjects receiving a unilateral neonatal hind-paw injury showed decreased mechanical threshold (hyperalgesia) on the previously injured hind paw throughout development. This decrease in threshold survived spinal transection (at T2) at 12 weeks of age. Injured subjects also showed significant impairment in a spinal instrumental learning task performed by the previously injured hind paw. This disruption of learning indicates a disruption of spinal plasticity that may be due to induction of long-term changes in nociceptive processing within the spinal cord. PMID:17907840

Young, Erin E; Baumbauer, Kyle M; Elliot, Audrea; Joynes, Robin L



Solitary ruptured aneurysm of the spinal artery of adamkiewicz with subarachnoid hemorrhage.  


Spinal subarachnoid hemorrhage (SAH) due to solitary spinal aneurysm is extremely rare. A 45-year-old female patient visited the emergency department with severe headache and back pain. Imaging studies showed cerebral SAH in parietal lobe and spinal SAH in thoracolumbar level. Spinal angiography revealed a small pearl and string-like aneurysm of the Adamkiewicz artery at the T12 level. One month after onset, her back pain aggravated, and follow-up imaging study showed arachnoiditis. Two months after onset, her symptoms improved, and follow-up imaging study showed resolution of SAH. The present case of spinal SAH due to rupture of dissecting aneurysm of the Adamkiewicz artery underwent subsequent spontaneous resolution, indicating that the wait-and-see strategy may provide adequate treatment option. PMID:24044082

Son, Seong; Lee, Sang-Gu; Park, Cheol-Wan




PubMed Central

Despite extensive gray matter loss following spinal cord injury (SCI), little attention has been given to neuronal replacement strategies and their effects on specific functional circuits in the injured spinal cord. In the present study, we assessed breathing behavior and phrenic nerve electrophysiological activity following transplantation of microdissected dorsal or ventral pieces of rat fetal spinal cord tissue (FSCD or FSCV, respectively) into acute, cervical (C2) spinal hemisections. Transneuronal tracing demonstrated connectivity between donor neurons from both sources and the host phrenic circuitry. Phrenic nerve recordings revealed differential effects of dorsally- vs. ventrally-derived neural progenitors on ipsilateral phrenic nerve recovery and activity. These initial results suggest that local gray matter repair can influence motoneuron function in targeted circuits following spinal cord injury and that outcomes will be dependent on the properties and phenotypic fates of the donor cells employed.

White, Todd E.; Lane, Michael A.; Sandhu, Milapjit S.; O'Steen, Barbara E.; Fuller, David D.; Reier, Paul J.



Neuropathic bladder and spinal dysraphism.  

PubMed Central

The association between spinal dysraphism and a neuropathic bladder is well known, but the diagnosis of the spinal lesion and the associated renal problems is often delayed. Four children referred with orthopaedic problems and in whom the bladder abnormally proved to be the major disability are described. Despite widely differing vertebral involvement, all had lower motor neurone neurological deficits confined to lumbar and upper sacral segments. All had unstable, variably thickened, small bladders, and it is proposed that the bladder abnormality is the result of a partial lesion of lumbosacral innervation, and not of an upper motor neurone lesion. Images Fig. 1a Fig. 1b Fig. 2 Fig. 3 Fig. 4

Borzyskowski, M; Neville, B G



Granulocyte colony-stimulating factor improves alternative activation of microglia under microenvironment of spinal cord injury.  


Granulocyte colony-stimulating factor (G-CSF) was investigated in the present study to examine whether it could affect the activation status of microglia under microenvironment of spinal cord injury and provide a potential therapeutic treatment for spinal cord injury. We established mouse spinal cord hemisection model and injected recombinant human G-CSF (rhG-CSF) subcutaneously. The results demonstrated that G-CSF could recruit microglia to the injury site in the first 72h after spinal cord injury. Moreover, G-CSF inhibits the expression of pro-inflammatory factors and promotes the expression of neurotrophic factors. Additionally, G-CSF also increases the expression of markers of M2 macrophage and inhibits the expression of markers of M1 macrophage in BV2 microglia in vitro model, favoring the M2 polarization of microglia under the microenvironment of spinal cord hemisection. NF?B signal pathway was involved in G-CSF-induced polarization of BV2 microglia. As a conclusion, we suggested that administration of G-CSF within the first 72h after spinal cord injury might reduce early inflammation-induced detrimental effect and promote an anti-inflammatory response that favors repair via improving alternative activation of microglia. Administration of G-CSF in the acute phase of spinal cord injury may be a promising strategy in restorative therapy after spinal cord injury. PMID:23419550

Guo, Y; Zhang, H; Yang, J; Liu, S; Bing, L; Gao, J; Hao, A



New canine spinal cord injury model free from laminectomy  

Microsoft Academic Search

The present report details the successful development of a model for spinal cord injury (SCI). This model is simple, reproducible, and requires no laminectomy. Development of the model was carried out using fourteen dogs. A balloon catheter was inserted into the extradural space via the intervertebral foramen of each dog, then the balloon was inflated at the L1 level by

Seijun Fukuda; Tatsuo Nakamura; Yoshihiro Kishigami; Katsuaki Endo; Takashi Azuma; Takamitsu Fujikawa; Sadami Tsutsumi; Yasuhiko Shimizu



Radicular Compression by extradural spinal endometriosis. Case report  

Microsoft Academic Search

Summary The case of a 35 years old woman affected by endometriosis located inside the spinal canal in the extradural space at the level of the third left lumbar root, and developing through the corresponding foramen into the paraspinal muscles, is presented. The clinical aspect, radiological picture and surgical treatment are described. Pathogenesis is discussed on the basis of the

F. Carta; G. Guiducci; E. Fulcheri; C. Bernucci; C. Rivano



Mechanical airway obstruction due to dislodged spinal hardware.  


A difficult airway caused by mechanical obstruction from dislodged spinal hardware in a patient undergoing revision surgery for a cervical chordoma is presented. Due to the logical, sequential multidisciplinary airway and patient management by the anesthesiology, neurosurgery, and otolaryngology teams working together in an environment of clear communication, a potential life-threatening crisis was averted with successful outcome for the patient. PMID:23101773

Petrovic, Michelle A; Kretzer, Ryan; Simon, Brett A; Berkow, Lauren C



Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.  


The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts. PMID:23596239

Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia



Spinal dural arteriovenous fistula with perimesencephalic subarachnoid haemorrhage  

Microsoft Academic Search

A case is reported of a 66 year old woman presenting with perimesencephalic subarachnoid haemorrhage (SAH) which was caused by a spinal dural arteriovenous fistula at the C1 level. The fistula drained into the venous system of the posterior cranial fossa through a perimedullary vein. The bleeding was thought to result from venous hypertension induced by the fistula. This case

Hiroyuki Hashimoto; Jun-ichi Iida; Yasushi Shin; Yasuo Hironaka; Toshisuke Sakaki



Computed tomography in spinal hemangioma with cord compression  

Microsoft Academic Search

Two teenagers with spinal cord compression due to a thoracic vertebral hemangioma are presented. Myelography showed a complete block in both patients. Selective intercostal arteriography was normal or non-conclusive. Only computed tomography (CT) gave precise information about the extent and nature of the compressive lesion. In the first case it showed angiomatous involvement of the body and all parts of

P. Schnyder; H. Fankhauser; B. Mansouri



Unrecognised spinal cord compression as a cause of morbidity.  

PubMed Central

Predicting outcomes is important in planning patient management and rehabilitation. Two cases, one with illustrative radiology, are described. Each presented with potentially preventable morbidity, secondary to unrecognised compression of the spinal cord. Detailed history and examination may have revealed the underlying problem: a condition with potential associated long-term morbidity. Images Fig 1 Fig 2

O'Neill, S. B.; McCann, J. P.



Spinal cord compression in thalassemia major: value of MR imaging  

Microsoft Academic Search

A 17 year old Iranian girl presented with thalassemia major, complicated by acute compression of the cauda equina caused by extramedullary haemopoiesis. The advantages of MRI in confirming the spinal space-occupying lesion and involvement of liver and pancreas are discussed in the context of treatment decision analysis and follow-up.

L. Ziegler; M. Lange; W. Feiden; T. Vogl



The clinical significance of spinal anomalies: A case report  

PubMed Central

A case with multiple block vertebrae is presented. The clinical significance of congenital anomalies is discussed with reference to spinal manipulative therapy. ImagesFigure 1a-1dFigure 2 (a) and (b)Figure 2 (c)Figure 3

Steiman, Igor



Degenerative and regenerative mechanisms governing spinal cord injury  

Microsoft Academic Search

Spinal cord injury (SCI) is a major cause of disability, and at present, there is no universally accepted treatment. The functional decline following SCI is contributed to both direct mechanical injury and secondary pathophysiological mechanisms that are induced by the initial trauma. These mechanisms initially involve widespread haemorrhage at the site of injury and necrosis of central nervous system (CNS)

Christos Profyris; Surindar S Cheema; DaWei Zang; Michael F Azari; Kristy Boyle; Steven Petratos



Spinal arachnoiditis and cyst formation with subarachnoid haemorrhage.  


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

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



Epidemiology of Spinal Cord Injury in New Zealand  

Microsoft Academic Search

Spinal cord injury (SCI) is a catastrophic and costly result of both intentional and unintentional injury. We present data from the Health Statistics Services files of New Zealand for the year 1988 on the epidemiology of SCI resulting in morbidity. New Zealand has one of the highest rates of SCI in the western world and since 1979 this has been

Graeme S. Dixon; John N. Danesh; Tudor H. Caradoc-Davies



Postpartum spinal cord injury in a woman with HELLP syndrome  

Microsoft Academic Search

OBJECTIVE: To report a rare cause of spinal cord injury. STUDY DESIGN: Case report. CASE REPORT: A 36-year-old woman presented with acute onset of paresis of the upper and lower extremity (level C5, ASIA B) the day after delivering a healthy daughter (39 weeks' gestation). Prior to giving birth, she was admitted with gestational hypertension. Directly postpartum, blood pressure increased

J. T. Groothuis; DH van Kuppevelt



Spinal cord stimulation revisited.  


The proportion of patients with intractable pain successfully managed with spinal cord stimulation (SCS) remains disputed. We analyze 27 consecutive patients with intractable pain treated with SCS using identical hardware (Itrel II System; Medtronic Neurological, Inc Minneapolis, MN, USA) by a single satisfactory diagnosis 1992 through 1995. A rigid selection protocol was used: 1. A satisfactory diagnosis of the pathologic process resulting in pain was made. 2. A corrective surgical procedure was judged not feasible by surgeons experienced in the particular pathology, e.g., vascular peripheral nerve, spine. 3. Lack of satisfactory response to noninterventional pain management modalities by an interdisciplinary pain clinic. 4. Independent psychological evaluation, including a structured interview was performed by a psychologist specialized in chronic pain management. In the last eight cases, a battery of self-report tests designed to assess psychosocial and behavioral consequences of the chronic pain problem were administered as well. All cases were of nonmalignant pain, except for one patient. Thirteen cases were diagnosed with failed back surgery syndrome (FBSS), one older patient with lumbosacral radiculopathy who refused decompression, one cervical radiculopathy and Klippel-Feil syndrome, six with reflex sympathetic dystrophy (RSD), two with peripheral vascular ischemic disease, one with post-thoracotomy pain syndrome, one with leg pain following resection of angiolipoma, one with traumatic superficial peroneal neuropathy, and one with Pancoast's tumor. Fifteen patients were female and twelve were male. All were Caucasian. Their ages ranged from 27 to 84 years (mean:48). The average follow-up was 21 months (range: 48-6). All patients underwent a three day trial screening with Pisces-Quad/Resume epidural leads connected to a temporary external stimulator. An Itrel II System pulse-generator was internalized in each of the 24 patients who had successful trial (three cervical and twenty-one thoracic-lumbar). There was no morbidity. Pain reduction was sustained in 22 out of the 24 patients who continue to use the stimulator. The same number would choose to receive in an electrical stimulator again. Normalization or improvement in Quantitative Sudomotor Axon Reflex Test (Q-SART) and Thermography was documented in the patients with RSD. We conclude that rigid selection protocol can maximize the proportion of patients with intractable pain who are successfully treated with SCS. Strict neurosurgical technique eliminates infection risk. Hardware selection minimizes incidence of malfunction. PMID:9664583

Segal, R; Stacey, B R; Rudy, T E; Baser, S; Markham, J



Functional corticotropin-releasing factor receptors in neonatal rat spinal cord  

SciTech Connect

The present study localized corticotropin-releasing factor (CRF) receptors and studied the action of CRF in the neonatal rat spinal cord preparation. Lumbar CRF receptors were present in highest concentrations in laminae I and II with progressively lower concentrations in lamina IX and intermediate and central zones respectively. CRF directly and indirectly depolarized lumbar motoneurons in a concentration-related manner and the putative receptor antagonist, alpha helical oCRF(9-41), partially blocked the depolarizing response to CRF. The electrophysiological responses to CRF and the distribution of receptors within the spinal cord suggest that CRF may play a physiological role in regulating spinal cord reflex function.

Bell, J.A.; de Souza, E.B.



Hox genes and spinal cord development.  


The spinal cord is differentiated along the rostrocaudal axis into large domains with regional distinctions reflected in the position and projection of specific cell types. Spinal cord patterning is likely to be mediated by the local expression and activity of transcription factors. This review will examine the expression of one class of transcription factors, encoded by the Hox genes, that are active in spinal cord patterning. Hox genes encode homeodomain-containing proteins with overlapping rostrocaudal domains of expression in the developing spinal cord. Rostrally expressed Ant-p/Ubx/Abd-D-related Hox genes may function in patterning the cervical spinal cord, while Abd-D-related, caudally expressed Hox genes may pattern the lumbar spinal cord. Changes in spinal cord patterning are apparent following Hox gene inactivation, supporting a role for these genes in defining or establishing this pattern. PMID:12145408

Carpenter, Ellen M



Spinal metastasis in the elderly  

Microsoft Academic Search

Bony metastases are a frequent problem in elderly patients affected by cancer, and those with bony metastases involve the spine in approx. 50%. The most frequent spinal metastases (60%) are from breast, lung, or prostate cancer. The chance that an elderly patient (60–79 years old) is affected by bony metastases is four times higher in men and three times higher in

Max Aebi



Hyperpyrexia in spinal injury patients  

Microsoft Academic Search

We studied 13 spinal injury patients who had hyperpyrexia during an 18 month period (September 1984—March 1986) to discover if differences existed in the core temperature of patients with tetraplegia and those with paraplegia, and the contribution of these differences to the final outcome. Children were excluded from this study as well as patients with any sign of infection on

A Essiet; O Onuba



Controlled hypotension for spinal surgery.  


Controlled, deliberate hypotension during anesthesia for major spinal surgery reduces intraoperative blood loss and transfusion requirement. Hypotension may be achieved with increased doses of volatile anesthetic agents or by continuous infusion of vasodilating drugs. Safe application of this technique requires knowledge of the physiology of hemorrhagic shock and close intraoperative monitoring to avoid vasoconstriction and end-organ ischemia. PMID:15197633

Dutton, Richard P




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...


Suckling-induced oxytocin increase in the spinal cord of the rat.  


Oxytocin (OT) is essential for parturition and milk ejection, and OT-containing fibers are present in several regions of the brain and in the spinal cord. During lactation, activation of spinal cord neurons by suckling stimulation involves deep laminae III-X including sympathetic preganglionic neurons of the intermedio-medial cell column. In the present study, experiments were designed to determine if the suckling provided by the litter increased OT levels in the spinal cord of dams, as determined by competitive immunoassay. In addition, we investigated if OT fibers reach neurons of the spinal cord that are known to respond to suckling. The OT content was higher in the hypothalamus than in the spinal cord in animals from all experimental groups. After 6 h of pup separation, OT levels decreased and suckling for 5 min induced a significant increase of OT levels in the spinal cord. Double immunostaining for Fos and OT showed OT-positive fibers adjacent to neurons that had Fos-positive nuclei, located mostly in laminae III, IV, and X. The present data support the notion that OT is released within the spinal cord in response to suckling, suggesting a role for this peptide in modulating the afferent and/or efferent responses generated by suckling. PMID:18755161

Ramos, Eugenia; Castilla, Alejandra; Navarro, Nilda; Monasterio, Nela; Mena, Flavio; Morales, Teresa



Intramedullary spinal cord metastasis from prostate carcinoma: a case report  

PubMed Central

Introduction Although vertebral and epidural metastases are common, intradural metastases and intramedullary spinal cord metastases are rare. The indications for the treatment of intramedullary spinal cord metastases remain controversial. We present the first biopsy-proven case of an intramedullary spinal cord metastasis from adenocarcinoma of the prostate. Case presentation Our patient was a 68-year-old right-handed Caucasian man with a Gleason grade 4?+?3 prostate adenocarcinoma who had previously undergone a prostatectomy, androgen blockade and transurethral debulking. He presented with new-onset saddle anesthesia and fecal incontinence. Magnetic resonance imaging demonstrated a spindle-shaped intramedullary lesion of the conus medullaris. Our patient underwent decompression and an excisional biopsy; the lesion’s pathology was consistent with metastatic adenocarcinoma of the prostate. Postoperatively, our patient received CyberKnife® radiosurgery to the resection cavity at a marginal dose of 27Gy to the 85% isodose line. At three months follow-up, our patient remains neurologically stable with no new deficits or lesions. Conclusions We review the literature and discuss the indications for surgery and radiosurgery for intramedullary spinal cord metastases. We also report the novel use of stereotactic radiosurgery to sterilize the resection cavity following an excisional biopsy of the metastasis.



Neuromodulation of thoracic intraspinal visceroreceptive transmission by electrical stimulation of spinal dorsal column and somatic afferents in rats  

PubMed Central

Clinical studies have shown that neuromodulation therapies, such as spinal cord stimulation (SCS) and transcutaneous electrical nerve stimulation (TENS), reduce symptoms of chronic neuropathic and visceral pain. The neural mechanisms underlying SCS and TENS therapy are poorly understood. The present study was designed to compare the effects of SCS and TENS on spinal neuronal responses to noxious stimuli applied to the heart and esophagus. Direct stimulation of an intercostal nerve (ICNS) was used to simulate the effects of TENS. Extracellular potentials of left thoracic (T3) spinal neurons were recorded in pentobarbital anesthetized, paralyzed and ventilated male rats. SCS (50 Hz, 0.2 ms, 3–5 min) at a clinical relevant intensity (90% of motor threshold) was applied on the C1–C2 or C8-T1 ipsilateral spinal segments. Intercostal nerve stimulation (ICNS) at T3 spinal level was performed using the same parameters as SCS. Intrapericardial injection of bradykinin (IB, 10 ?g/ml, 0.2 ml, 1 min) was employed as the noxious cardiac stimulus. Noxious thoracic esophageal distension (ED, 0.4 ml, 20 s) was produced by water inflation of a latex balloon. C1–C2 SCS suppressed excitatory responses of 16/22 T3 spinal neurons to IB and 25/30 neurons to ED. C8-T1 SCS suppressed excitatory responses of 10/15 spinal neurons to IB and 17/23 neurons to ED. ICNS suppressed excitatory responses of 9/12 spinal neurons to IB and 17/22 neurons to ED. These data showed that SCS and ICNS modulated excitatory responses of T3 spinal neurons to noxious stimulation of the heart and esophagus. Perspective: Neuromodulation of noxious cardiac and esophageal inputs onto thoracic spinal neurons by spinal cord and intercostal nerves stimulation observed in the present study may help account for therapeutic effects on thoracic visceral pain by activating the spinal dorsal column or somatic afferents.

Qin, Chao; Farber, Jay P.; Linderoth, Bengt; Shahid, Abdul; Foreman, R. D.



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


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

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



Lumbar spinal cord stimulation for cervical-originated central pain: a case report  

Microsoft Academic Search

This case presents a patient with neuropathic pain in a lower extremity, which appeared subsequent to the removal of a C1 meningioma and which was successfully treated by lower thoracic spinal cord stimulation.

Elon Eisenberg; Clara Brecker



Longitudinal Change in FEV1 and FVC in Chronic Spinal Cord Injury  

Microsoft Academic Search

Presented in abstract form at the annual meeting of the American Spinal Injury Association, Tampa, Florida (June, 2007). Correspondence: Eric Garshick, MD, MOH VA Boston Healthcare System Pulmonary and Critical Care Medicine Section 1400 VFW Parkway West Roxbury, MA 02132

Kelly L Stolzmann; David R. Gagnon; Robert Brown; Carlos G. Tun; Eric Garshick



Ankylosing spinal hyperostosis (ASH) and ossification of the posterior longitudinal ligament (OPLL)  

Microsoft Academic Search

The clinical and radiological features of 70 patients with ankylosing spinal hyperostosis are presented. Pain in some region of the back was found in 49 patients. No significant deviations were found in HLA typing.

H. Mitsui; H. Sonozaki; T. Juji; K. Kabata



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

Microsoft Academic Search

Spinal epidural angiolipoma is a rare benign tumor containing vascular and mature adipose elements. A slow progressive clinical\\u000a course was mostly presented and rarely a fluctuating course during pregnancy. The authors report the original case of spontaneous\\u000a spinal epidural bleeding resulting from thoracic epidural angiolipoma who presented with hyperacute onset of paraplegia, simulating\\u000a an extradural hematoma. The patient was admitted

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



Transient spinal cord injuries in the young athlete.  


Spinal cord injuries are be potentially devastating. Despite initial presentation, they may be permanent or transient. A small percentage of spinal cord patients with motor or sensory dysfunction recover rapidly and completely with no neurological sequelae. Cervical cord neurapraxia is a frequent cause of transient neurologic symptoms. This transient neurological phenomenon involves bilateral motor paralysis and/or sensory manifestations that appear in the absence of any structural deficiencies of the cervical spine as evidence by negative diagnostic imaging. All patients with any history of neurologic deficits should be assessed thoroughly and rendered care appropriately to avoid secondary injury. This article will present a case study of a 15-year-old high school football player who complained of motor and sensory deficits after tackling another player. Treatment was provided and his neurological symptoms resolved completely. The pathophysiology of cellular injury related to the spinal cord and cervical cord neurapraxia is reviewed. In addition treatment modalities such as high dose steroids to reduce secondary spinal cord injury are discussed. PMID:16602338

Perks, Diane H


Therapeutic approaches for spinal cord injury  

PubMed Central

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.

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



Intramedullary Spinal Cord Metastasis of Choriocarcinoma  

PubMed Central

The authors describe a case of choriocarcinoma that metastasized to the cerebral cortex, vertebral body, and intramedullary spinal cord. A 21-year-old woman presented with sudden headache, vomiting and a visual field defect. Brain computed tomography and magnetic resonance examinations revealed an intracranial hemorrhage in the left temporo-parietal lobe and two enhancing nodules in the left temporal and right frontal lobe. After several days, the size of the hemorrhage increased, and a new hemorrhage was identified in the right frontal lobe. The hematoma and enhancing mass in the left temporo-parietal lobe were surgically removed. Choriocarcinoma was diagnosed after histological examination. At 6 days after the operation, her consciousness had worsened and she was in a state of stupor. The size of the hematoma in the right frontal lobe was enlarged. We performed an emergency operation to remove the hematoma and enhancing mass. Her mental status recovered slowly. Two months thereafter, she complained of paraplegia with sensory loss below the nipples. Whole spine magnetic resonance imaging revealed a well-enhancing mass in the thoracic intramedullary spinal cord and L2 vertebral body. Despite chemotherapy and radiotherapy, the patient died 13 months after the diagnosis.

Ko, Jun Kyeung; Cha, Seung Heon; Lee, Jung Hwan



Intramedullary spinal cord metastasis of choriocarcinoma.  


The authors describe a case of choriocarcinoma that metastasized to the cerebral cortex, vertebral body, and intramedullary spinal cord. A 21-year-old woman presented with sudden headache, vomiting and a visual field defect. Brain computed tomography and magnetic resonance examinations revealed an intracranial hemorrhage in the left temporo-parietal lobe and two enhancing nodules in the left temporal and right frontal lobe. After several days, the size of the hemorrhage increased, and a new hemorrhage was identified in the right frontal lobe. The hematoma and enhancing mass in the left temporo-parietal lobe were surgically removed. Choriocarcinoma was diagnosed after histological examination. At 6 days after the operation, her consciousness had worsened and she was in a state of stupor. The size of the hematoma in the right frontal lobe was enlarged. We performed an emergency operation to remove the hematoma and enhancing mass. Her mental status recovered slowly. Two months thereafter, she complained of paraplegia with sensory loss below the nipples. Whole spine magnetic resonance imaging revealed a well-enhancing mass in the thoracic intramedullary spinal cord and L2 vertebral body. Despite chemotherapy and radiotherapy, the patient died 13 months after the diagnosis. PMID:22639709

Ko, Jun Kyeung; Cha, Seung Heon; Lee, Jung Hwan; Choi, Chang Hwa



Congenital spinal lipomas: Role of prophylactic surgery  

PubMed Central

Introduction: Congenital spinal lipomas constitute an important group of lesions causing tethered cord syndrome. Management of these lesions is challenging and role of prophylactic surgery for these lesions is still controversial. Hence, current study was undertaken with the aim to evaluate the role of prophylactic surgery in the management of these lesions. Materials and Methods: A total of 147 consecutive patients, treated over a period of 10 years (January 2001–December 2010), are retrospectively analyzed. Results: In our study, 93 patients had conus lipomas, 26 had filum lipomas and 28 had only lipomeningomyelocele. Boys and girls were almost equally represented. The age of patients at the time of surgery ranged from 15 days to 34 years with an average of 62 months (5.2 years). Neurological deficits were present in 101 (68) patients. The patients with neurological deficits were older in comparison to those neurologically intact (average age 6.2 versus 2.8 years, respectively). Difference in age between the two groups was statistically significant (P value 0.03). Neurological deterioration was observed in 8 (5) patients following surgery, out of which six patients developed transient deterioration and only two, had persisting deficits. None of the neurologically asymptomatic patients developed persistent neurological deficits. In the symptomatic group, nine patients (9) showed improvement in neurological status after surgery. Conclusions: In author's view, prophylactic surgery for congenital spinal lipomas is safe and effective. However, a well designed randomized controlled trial, to definitely and objectively prove the usefulness of prophylactic surgery is needed.

Kumar, Amandeep; Mahapatra, Ashok K.; Satyarthee, Guru D.



[Spinal stroke in the acute myeloblast leucosis].  


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

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



An update on spinal cord injury research.  


Spinal cord injury (SCI) can have a range of debilitating effects and permanently alter the capabilities and quality of life of survivors. The first specialized centers of care for SCI were established in 1944 and since then an increasing amount of research has been carried out in this area. Despite this, the present treatment and care levels for SCI are not comparable to those in other areas of medicine. In the clinic, the aim of SCI treatment is primarily to limit secondary damage by reducing compression in trauma spots and stabilizing the spinal column. Currently, no effective strategy for functional recovery is offered. In this review, we focus on research progress on the molecular mechanisms underlying SCI, and assess the treatment outcomes of SCI in animal models, i.e., neurotrophins and stem cells are discussed as pre-clinical therapies in animal models. We also assess the resources available and national research projects carried out on SCI in China in recent years, as well as making recommendations for the future allocation of funds in this area. PMID:23124646

Cao, He-Qi; Dong, Er-Dan



Hartshill spinal fixation in vertebral metastasis.  


Spinal fusion by Hartshill rectangle frame was used in 10 patients with spinal cord compression secondary to vertebral metastasis in the thoracic and lumbar spine, occupying mainly the posterior elements. All patients presented with pain, bone collapse, and neurologic deficit. The procedure is built on a system of sublaminar wires passed under two to three lamina above and below the decompressed area and tightened to a prebent metal frame. This procedure was relatively simple, and the immediate stabilization achieved in our patients was good. All patients experienced immediate pain relief. While only two patients were able to walk before surgery, seven were able to do so at follow-up. During a follow-up period of at least 2 years in two patients, or until death in the other eight patients, one patient had a broken wire that did not affect the correction achieved at surgery. Partial loss of correction in the sagittal plane was found in two patients who had metastasis in the lumbar spine and in another patient who had metastasis in the ninth thoracic vertebra. PMID:10401900

Mirovsky, Y; Tamir, L; Pollak, L; Gur, R; Halperin, N; Schiffer, J



Extramedullary intradural spinal tumors: a pictorial review.  


Defining the location of tumors and mass lesions of the spine in relation to the spinal cord and the dura is of the utmost importance as certain types of lesions tend to occur in certain locations. The differential diagnostic considerations will vary according to location of the mass lesion as will the treatment and prognosis of these various lesions. The category of extramedullary intradural masses includes a variety of lesions from meningiomas and nerve sheath tumors (neurofibromas, schwannomas) to less common tumors (hemangiopericytoma), metastases, benign tumors (lipoma, dermoid, epidermoid), inflammatory disorders (arachnoid adhesions, sarcoidosis), vascular lesions (spinal-dural arteriovenous fistula), and cystic lesions (perineural or Tarlov cysts). Characteristic magnetic resonance imaging findings are helpful for localization and characterization of these lesions before treatment, as well as for follow-up after treatment. We present a pictorial review of the various extramedullary intradural lesions of the spine, with pathologic correlation. We discuss imaging features that are typical for the various entities and describe various therapeutic options that are important considerations for surgical treatment of these lesions. PMID:17765798

Beall, Douglas P; Googe, David J; Emery, Robert L; Thompson, Darin B; Campbell, Scot E; Ly, Justin Q; DeLone, David; Smirniotopoulos, James; Lisanti, Chris; Currie, T Jenks


Spinal reflex excitability changes after cervical and lumbar spinal manipulation  

Microsoft Academic Search

Background context: Spinal manipulation (SM) is a commonly employed nonoperative treatment modality in the management of patients with neck, low back or pelvic pain. One basic physiologic response to SM is a transient decrease in motoneuron activity as assessed using the Hoffmann reflex (H-reflex) technique. Previous research from our laboratory indicates that both SM with a high-velocity, low-amplitude thrust and

J. Donald Dishman; Jeanmarie Burke



Upper limbs dysmetria caused by cervical spinal cord injury: a case report  

PubMed Central

Background Upper limbs dysmetria caused by spinal cord injury is very rare. We will discuss the associated mechanism in our articles. Case presentation A 51-year-old male had sudden onset of weakness, dysmetria over bilateral upper limbs and ataxia after he fell accidentally. Brain magnetic resonance imaging (MRI) revealed no specific findings. C-spine MRI revealed C1 myelopathy and C4-6 spinal cord compression by bulged disc. The symptoms subsided after surgical intervention. Conclusion Sudden onset of upper limbs dysmetria is a sign of dysfunction in cerebellum and its associated pathway. However, lesion in spinal cord can also cause cerebellar signs such as dysmetria.

Lin, Hsun-Chang; Chen, Chun-Hung; Khor, Gim-Thean; Huang, Poyin



Glutamate circuits in selected medullo-spinal areas regulating cardiovascular function.  


1. The importance of the medullo-spinal neuronal pools in the regulation of cardiovascular function has been known for a long time. However, important groups of these neurons, interconnections between them and the neurotransmitters released at their projections have been identified with certainty only during the past two decades. 2. Some of the medullo-spinal neuronal pools mediating cardiovascular function include the nucleus tractus solitarius, caudal ventrolateral medullary depressor area, rostral ventrolateral medullary pressor area, nucleus ambiguus and intermediolateral cell column of the thoracolumbar spinal cord. Interactions between these selected neuronal groups and neurotransmitters in the pathways connecting them are discussed in the present short review. PMID:12010197

Sapru, H N


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


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

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



An intradural-extramedullary gas-forming spinal abscess in a patient with diabetes mellitus.  


Spinal infections are commonly reported to be located in the extradural or intramedullary spaces. Infection involving the intradural-extramedullary space are uncommon. We report a patient with uncontrolled diabetes mellitus and an infected foot ulcer who presented with a cervical cord abscess and intradural gas. Early diagnosis and aggressive treatment are necessary for a favourable outcome in gas-forming intradural spinal abscesses. To our knowledge, a gas-forming intradural spinal abscess has not been reported previously and we discuss the relevant literature. PMID:20036548

Nadkarni, Trimurti; Shah, Abhidha; Kansal, Ritesh; Goel, Atul



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

NASA Astrophysics Data System (ADS)

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.

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


Spinal cord infarction following minor trauma in children: fibrocartilaginous embolism as a putative cause.  


Spinal cord infarctions following seemingly innocuous trauma in children are rare, devastating events. In the majority of these cases, the pathophysiology is enigmatic. The authors present 3 cases of pediatric spinal cord infarction that followed minor trauma. An analysis of the clinical, radiographic, and laboratory features of these cases suggests that thromboembolism of the nucleus pulposus into the spinal cord microcirculation is the likely mechanism. A review of the human and veterinary literature supports this notion. To the authors' knowledge, this is the largest pediatric series of myelopathy due to thromboembolism of the nucleus pulposus reported to date, and it is the first report of this condition occurring in an infant. PMID:23414133

Reisner, Andrew; Gary, Matthew F; Chern, Joshua J; Grattan-Smith, J Damien



Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report  

PubMed Central

Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.



[Primary amyloidosis of the spine presenting with acute paraplegia].  


Primary amylosis is rarely located in bone, exceptionally in the spine. The radiographic presentation is polymorphous. Magnetic resonance imaging is currently the best imaging technique. Spinal amyloidosis can exceptionally lead to cord compression requiring rapid surgical release. PMID:18774025

Ajlani, H; Zaouia, K; Chtourou, A; Elleuch, M; Bellil, S; Sellami, S



Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel.  

National Technical Information Service (NTIS)

The report presents results from one part of the RAND Appropriateness of Spinal Manipulation for Low-Back-Pain Study. The study is designed to ascertain the clinical criteria for the appropriate use of spinal manipulation for low-back pain from chiropract...

P. G. Shekelle A. H. Adams M. R. Chassin E. L. Hurwitz R. E. Park



Mosaic evolution of neural development in anurans: acceleration of spinal cord development in the direct developing frog Eleutherodactylus coqui  

Microsoft Academic Search

Previous studies have shown that spinal cord development in direct developing frogs of the genus Eleutherodactylus, which have evolutionarily lost the tadpole stage, differs from that in biphasically developing anurans (with the larval and the adult stage separated by metamorphosis). The present study of spinal cord development in Eleutherodactylus coqui provides additional information about neurogenesis, neuronal differentiation and growth analyzed

Gerhard Schlosser



Gait analysis does not correlate with clinical and MR imaging parameters in patients with symptomatic lumbar spinal stenosis  

Microsoft Academic Search

BACKGROUND: Parameters of MR imaging play a pivotal role in diagnosing lumbar spinal stenosis (LSS), and serve as an important tool in clinical decision-making. Despite the importance of MR imaging, little is known about the correlation between MRI parameters, objective gait analysis, and clinical presentation of patients with lumbar spinal stenosis. METHODS: Sixty-three patients from our clinic with symptomatic lumbar

Felix Zeifang; Marcus Schiltenwolf; Rainer Abel; Babak Moradi



Functional Recovery of Paraplegic Rats and Motor Axon Regeneration in Their Spinal Cords by Olfactory Ensheathing Glia  

Microsoft Academic Search

Axonal regeneration in the lesioned mammalian central nervous system is abortive, and this causes permanent disabilities in individuals with spinal cord injuries. In adult rats, olfactory ensheathing glia (OEG) transplants successfully led to functional and structural recovery after complete spinal cord transection. From 3 to 7 months post surgery, all OEG-transplanted animals recovered locomotor functions and sensorimotor reflexes. They presented

Almudena Ramón-Cueto; M. Isabel Cordero; Fernando F. Santos-Benito; Jesús Avila



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

Microsoft Academic Search

BACKGROUND: Chronic spinal cord injury (SCI) can lead to an insidious decline in motor and sensory function in individuals even years after the initial injury and is accompanied by a slow and progressive cytoarchitectural destruction. At present, no pathological mechanisms satisfactorily explain the ongoing degeneration. METHODS: Adult female Sprague-Dawley rats were anesthetized laminectomized at T10 and received spinal cord contusion

Milan Radojicic; Gabriel Nistor; Hans S Keirstead



Reinnervation of the denervated adult spinal cord of rats by intraspinal transplants of embryonic brain stem neurons  

Microsoft Academic Search

Previous studies have revealed a remarkable capacity of intracerebral grafts of embryonic brain tissue to establish extensive axonal connections with denervated areas in the brains of adult rats. In the present study we have explored the possibilities of using grafts in the spinal cord to substitute for the loss of noradrenergic brain-stem inputs to the severed spinal cord. Intraspinal grafts

Howard Nornes; Anders Björklund; Ulf Stenevi



The Sir Ludwig Guttmann lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries.  


This Ludwig Guttmann Lecture was presented at the 2012 meeting of the International Spinal Cord Society in London. It describes the contribution of Stoke Mandeville Hospital to the field of spinal cord injuries. Dr Ludwig Guttmann started the Spinal Unit at Stoke Mandeville Hospital in 1944 and introduced a novel, comprehensive method of care, which included early admission, prevention and treatment of spinal cord injury related complications, active rehabilitation and social reintegration. Soon a dedicated specialist team was assembled and training of visitors was encouraged, some of whom went on to start their own spinal units. Research went hand in hand with clinical work, and over the years more than 500 scientific contributions from Stoke Mandeville have been published in peer reviewed journals and books. Guttmann introduced sport as a means of physical therapy, which soon lead to organised Stoke Mandeville Games, first national in 1948, then international in 1952 and finally the Paralympic Games in 1960. Stoke Mandeville is regarded as the birthplace of the Paralympic movement, and Guttmann was knighted in 1966. Stoke Mandeville is also the birthplace of the International Medical Society of Paraplegia, later International Spinal Cord Society, which was formed during the International Stoke Mandeville Games in 1961, and of the Society's medical journal Paraplegia, later Spinal Cord, first published in 1963. Guttmann's followers have continued his philosophy and, with some new developments and advances, the present day National Spinal Injuries Centre at Stoke Mandeville Hospital provides comprehensive, multidisciplinary acute care, rehabilitation and life-long follow-up for patient with spinal cord injuries of all ages. PMID:23045299

Frankel, H L



Segmental and laminar organization of the spinal neurons projecting to the periaqueductal gray (PAG) in the cat suggests the existence of at least five separate clusters of spino-PAG neurons  

Microsoft Academic Search

The present retrograde tracing study in the cat describes the spinal cord projections to the periaqueductal gray (PAG), taking into account different regions of the PAG and all spinal segments. Results show that injecting different parts of the PAG leads to different laminar and segmental distributions of labeled spinal neurons. The impression was gained that at least five separate clusters

Leonora J. Mouton; Gert Holstege



Missed injuries of the spinal cord.  

PubMed Central

Damage to the spinal cord had not been recognised initially in 15 patients out of a consecutive series of 353 admitted over a decade to the National Spinal Injuries Centre with paralysis due to trauma to the cord. In some patients the missed diagnosis led to mismanagement and a greater neurological deficit. Missed injuries of the spinal cord are seen in patients with multiple injuries and head injuries and in those without any paralysis. Various radiological errors contribute to the failure to recognise the vertebral injury. In addition to causing severe disability to the victim these missed and mismanaged injuries of the spinal cord cost the National Health Service large sums in compensation. A careful evaluation of the history of each accident, with greater awareness of the potential of certain types of accidents to cause spinal cord injury, should reduce the incidence of missed injuries of the spinal cord. Images p955-a

Ravichandran, G; Silver, J R



Spinal Cord Injury Medicine. 4. Community Reintegration After Spinal Cord Injury  

Microsoft Academic Search

Scelza WM, Kirshblum SC, Wuermser LA, Ho CH, Priebe MM, Chiodo AE. Spinal cord injury medicine. 4. Community reintegration after spinal cord injury.This self-directed learning module highlights community reintegration after spinal cord injury (SCI). It is part of the study guide on spinal cord injury medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and

William M. Scelza; Steven C. Kirshblum; Lisa-Ann Wuermser; Chester H. Ho; Michael M. Priebe; Anthony E. Chiodo



[Spinal stenosis: diagnosis and treatment].  


Spondylotic cervical myelopathy (SCM) is a radiologic entity that can match a clinical syndrome of varying degree of severity, and results from spinal canal narrowing due to physiological degeneration of the cervical spine. Clinically, cervical spinal canal narrowing can produce minimal symptoms such as non-specific neck pain, foraminal entrapment of nerve roots, or more severe, chronic myelopathy. SCM initially manifests by signs of posterior medullary tract dysfunction with subsequent pallesthesia, resulting in gait and balance disturbance. Spasticity due to lower motoneurone impairment and incontinence may appear in later stages. Once the symptoms of myelopathy occur, functional deterioration will take place sooner or later. Surgery can then be recommended and scheduled according to the severity of functional impairment and imaging. PMID:22872937

Faundez, Antonio; Genevay, Stéphane



21 CFR 888.3070 - Pedicle screw spinal system.  

Code of Federal Regulations, 2010 CFR

...or deformities of the thoracic, lumbar, and sacral...fracture; dislocation; scoliosis; kyphosis; spinal...or deformity of the thoracic, lumbar, and sacral...fracture, dislocation, scoliosis, kyphosis, spinal tumor...spinal segments in the thoracic, lumbar, and...



21 CFR 888.3070 - Pedicle screw spinal system.  

Code of Federal Regulations, 2010 CFR

...or deformities of the thoracic, lumbar, and sacral...fracture; dislocation; scoliosis; kyphosis; spinal...or deformity of the thoracic, lumbar, and sacral...fracture, dislocation, scoliosis, kyphosis, spinal tumor...spinal segments in the thoracic, lumbar, and...



21 CFR 888.3070 - Pedicle screw spinal system.  

Code of Federal Regulations, 2010 CFR

...or deformities of the thoracic, lumbar, and sacral...fracture; dislocation; scoliosis; kyphosis; spinal...or deformity of the thoracic, lumbar, and sacral...fracture, dislocation, scoliosis, kyphosis, spinal tumor...spinal segments in the thoracic, lumbar, and...



21 CFR 888.3070 - Pedicle screw spinal system.  

Code of Federal Regulations, 2010 CFR

...or deformities of the thoracic, lumbar, and sacral...fracture; dislocation; scoliosis; kyphosis; spinal...or deformity of the thoracic, lumbar, and sacral...fracture, dislocation, scoliosis, kyphosis, spinal tumor...spinal segments in the thoracic, lumbar, and...



21 CFR 888.3070 - Pedicle screw spinal system.  

Code of Federal Regulations, 2010 CFR

...or deformities of the thoracic, lumbar, and sacral...fracture; dislocation; scoliosis; kyphosis; spinal...or deformity of the thoracic, lumbar, and sacral...fracture, dislocation, scoliosis, kyphosis, spinal tumor...spinal segments in the thoracic, lumbar, and...



21 CFR 888.3070 - Pedicle screw spinal system.  

Code of Federal Regulations, 2010 CFR

...or deformities of the thoracic, lumbar, and sacral...fracture; dislocation; scoliosis; kyphosis; spinal...or deformity of the thoracic, lumbar, and sacral...fracture, dislocation, scoliosis, kyphosis, spinal tumor...spinal segments in the thoracic, lumbar, and...



21 CFR 888.3070 - Pedicle screw spinal system.  

Code of Federal Regulations, 2010 CFR

...or deformities of the thoracic, lumbar, and sacral...fracture; dislocation; scoliosis; kyphosis; spinal...or deformity of the thoracic, lumbar, and sacral...fracture, dislocation, scoliosis, kyphosis, spinal tumor...spinal segments in the thoracic, lumbar, and...



21 CFR 888.3070 - Pedicle screw spinal system.  

Code of Federal Regulations, 2010 CFR

...or deformities of the thoracic, lumbar, and sacral...fracture; dislocation; scoliosis; kyphosis; spinal...or deformity of the thoracic, lumbar, and sacral...fracture, dislocation, scoliosis, kyphosis, spinal tumor...spinal segments in the thoracic, lumbar, and...



Genetics Home Reference: Spinal and bulbar muscular atrophy  


... PubMed Recent literature OMIM Genetic disorder catalog Conditions > Spinal and bulbar muscular atrophy On this page: Description ... names Glossary definitions Reviewed December 2012 What is spinal and bulbar muscular atrophy? Spinal and bulbar muscular ...


21 CFR 880.2500 - Spinal fluid manometer.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500...Monitoring Devices § 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device used to measure...



Paragangliomas of the spinal canal  

Microsoft Academic Search

We report the clinical MRI and histopathological features of five consecutive cases of spinal paraganglioma. Three intradural\\u000a tumours were found in the typical location (two at the L4, one at the S2 level); one intradural extramedullary tumour arose\\u000a at an unusual level, from the ventral C2 root, and one extradural tumour growing along the L5 nerve root sheath had an

P. Sundgren; M. Annertz; E. Englund; L. G. Strömblad; ?. Holtås



Assessing suspected spinal cord compression  

Microsoft Academic Search

The object of this work was to evaluate the assessment and document the outcomes of cancer patients with suspected spinal\\u000a cord compression (SCC). In a retrospective cohort study of 342 episodes of suspected SCC in cancer patients evaluated by computed\\u000a tomography (CT) of the spine, a multidisciplinary team of neurologists, radiologists, and oncologists assessed the impact\\u000a of varying the anatomical

James A. Talcott; Paul C. Stomper; Frank W. Drislane; Patrick Y. Wen; Caroline C. Block; Charles C. Humphrey; Charles Lu; Ferenc Jolesz



Respiratory depression and spinal opioids  

Microsoft Academic Search

Administration of epidural and intrathecal opioids may provide excellent postoperative analgesia, but a minority of patients\\u000a will suffer dangerous respiratory depression. This review discusses the detection and measurement of respiratory depression\\u000a and summarizes the relevant literature as it pertains to epidural and intrathecal opioid administration. The respiratory depressant\\u000a effects and pharmacokinetics of spinal opioids are reviewed. The clinical implications and

Richard C. Etches; Alan N. Sandler; M. Denise Daley



Why variability facilitates spinal learning.  


Spinal Wistar Hannover rats trained to step bipedally on a treadmill with manual assistance of the hindlimbs have been shown to improve their stepping ability. Given the improvement in motor performance with practice and the ability of the spinal cord circuitry to learn to step more effectively when the mode of training allows variability, we examined why this intrinsic variability is an important factor. Intramuscular EMG electrodes were implanted to monitor and compare the patterns of activation of flexor (tibialis anterior) and extensor (soleus) muscles associated with a fixed-trajectory and assist-as-needed (AAN) step training paradigms in rats after a complete midthoracic (T8-T9) spinal cord transection. Both methods involved a robotic arm attached to each ankle of the rat to provide guidance during stepping. The fixed trajectory allowed little variance between steps, and the AAN provided guidance only when the ankle deviated a specified distance from the programmed trajectory. We hypothesized that an AAN paradigm would impose fewer disruptions of the control strategies intrinsic to the spinal locomotor circuitry compared with a fixed trajectory. Intrathecal injections of quipazine were given to each rat to facilitate stepping. Analysis confirmed that there were more corrections within a fixed-trajectory step cycle and consequently there was less coactivation of agonist and antagonist muscles during the AAN paradigm. These data suggest that some critical level of variation in the specific circuitry activated and the resulting kinematics reflect a fundamental feature of the neural control mechanisms even in a highly repetitive motor task. PMID:20702702

Ziegler, Matthias D; Zhong, Hui; Roy, Roland R; Edgerton, V Reggie



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


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

Tanaka, H; Obata, K



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


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

Arora, Bhawana; Suresh, Srinivasan



The risk of spinal deformity after selective dorsal rhizotomy.  


To define the risk of spinal deformity after selective dorsal rhizotomy (SDR) for the treatment of spasticity due to cerebral palsy, 43 patients were reviewed before and after the procedure. The average length of follow-up was 5.3 years with a range of 2-9 years. Scoliosis was present in three patients before rhizotomy. One patient had a thoracic hyperkyphosis, and another, a lumbar hyperlordosis deformity preoperatively. Wide laminectomies were performed in 46 patients, and none had laminoplasties. Twenty-eight significant spinal deformities developed in 19 patients; 15 cases of scoliosis, seven instances of lumbar hyperlordosis, five thoracic hyperkyphosis, and one L4-5 spondylolisthesis. Five patients were placed in braces, and three patients went on to have surgical stabilization of their deformities. For the entire group, the risk of developing a structural spinal deformity was 36%, with 6% requiring stabilization at an average of 4.9 years after SDR. Older age, more severe neurologic impairment, and preexisting spinal deformity seems to increase this risk. PMID:10641698

Turi, M; Kalen, V


Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette  

PubMed Central

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.

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



Gastric dysreflexia after acute experimental spinal cord injury in rats  

PubMed Central

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.

Tong, M.; Holmes, G. M.



Craniospinal Irradiation With Spinal IMRT to Improve Target Homogeneity  

SciTech Connect

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.

Panandiker, Atmaram Pai [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Ning, Holly [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Likhacheva, Anna [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Ullman, Karen [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Arora, Barbara [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Ondos, John C. [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Karimpour, Shervin [Memorial Regional Cancer Center, Radiation Oncology, Hollywood, FL (United States); Packer, Roger [Division of Neurology and Pediatrics, Children's National Medical Center, Departments of Neurology and Pediatrics, George Washington University, Washington, D.C. (United States); Miller, Robert [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Citrin, Deborah [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States)]. E-mail:



Neurogenic positional pedal neuritis. Common pedal manifestations of spinal stenosis.  


Neurogenic positional pedal neuritis is a presentation of neuritic symptoms in one or both feet usually affected by body position, specifically, the position of the spine. Its etiology is similar to that of neurogenic-induced claudication caused by spinal stenosis in that the symptoms are caused by compression or irritation of nerves of the lower lumbosacral spine, usually the fifth lumbar and first sacral nerve roots. Burning, stabbing, a cold feeling, aching, numbness, paresthesia, or a weak or tired feeling of the feet (during some part of the disease process) depend on spinal position and may occur during standing, walking, or even lying in bed. Symptoms may be severe and are often eliminated by lumbosacral spine flexion, such as by walking with wheeled support such as a grocery cart or walker; less frequently by negative-heel shoe modification, which can change the position of the lumbosacral spine in stance; or by alteration of sleeping position. This condition, which can include loss of protective sensation, is often misdiagnosed as neuropathy (especially in diabetic patients) or less frequently as biomechanical in origin. In diabetic patients, this condition is frequently the cause of failure of monochromatic infrared energy therapy for diabetic peripheral neuropathy. Treatment is aimed at reducing the spinal nerve or nerve root irritation. Clear definition of the pedal symptoms of spinal nerve compression within a single diagnostic category should facilitate identification and treatment. PMID:12756307

Goldman, Stuart M


Antioxidant Therapies for Acute Spinal Cord Injury  

Microsoft Academic Search

Summary  One of the most investigated molecular mechanisms involved in the secondary pathophysiology of acute spinal cord injury (SCI)\\u000a is free radical-induced, iron-catalyzed lipid peroxidation (LP) and protein oxidative\\/nitrative damage to spinal neurons,\\u000a glia, and microvascular cells. The reactive nitrogen species peroxynitrite and its highly reactive free radicals are key initiators\\u000a of LP and protein nitration in the injured spinal cord,

Edward D. Hall



Intracranial metastasis of spinal intramedullary anaplastic astrocytoma  

PubMed Central

Meningeal spread of spinal intramedullary astrocytoma into the cranium is rare. Only few case reports are available so far in the literature. We report a case of intramedullary high grade astrocytoma of the conus, developing intracranial metastasis after three months of partial excision of the spinal mass. The need for radical surgery, entire neuroaxis radiation, and adjuvant chemotherapy is suggested in the management of malignant spinal cord astrocytoma to prevent dissemination.

Kataria, Rashim; Bhasme, Vishal; Chopra, Sanjeev; Sinha, V. D.; Singhvi, Shashi



[Osteoporosis associated with spinal cord lesion].  


One of the complications caused by spinal lesion is osteoporosis which development is induced by lesion itself, and its mechanism is not explained enough. Risk factor of this kind of osteoporosis is fracture which management is difficult and is cause of further complications which aggravate already damaged quality of life of patients with spinal cord injury, and demand additional health insurance expenses. Importance of prevention and treatment of spinal cord injury induced osteoporosis is enlightened by case report. PMID:18232288

Miladinovi?, Ksenija; Vavra-Hadziahmetovi?, Narcisa; Mufti?, Mirsad; Sakota, Slavica



Cervical spinal cord injury in sapho syndrome.  


Cervical spinal fracture and pseudarthrosis are previously described causes of spinal cord injury (SCI) in patients with spondylarthropathy. SAPHO (Synovitis Acne Pustulosis Hyperostosis Osteitis) syndrome is a recently recognized rheumatic condition characterized by hyperostosis and arthro-osteitis of the upper anterior chest wall, spinal involvement similar to spondylarthropathies and skin manifestations including palmoplantar pustulosis and pustular psoriasis. We report the first case of SAPHO syndrome disclosed by SCI related to cervical spine ankylosis. PMID:10338354

Deltombe, T; Nisolle, J F; Boutsen, Y; Gustin, T; Gilliard, C; Hanson, P



Emotional modulation of pain and spinal nociception in fibromyalgia.  


Fibromyalgia (FM) is characterized by widespread pain, as well as affective disturbance (eg, depression). Given that emotional processes are known to modulate pain, a disruption of emotion and emotional modulation of pain and nociception may contribute to FM. The present study used a well-validated affective picture-viewing paradigm to study emotional processing and emotional modulation of pain and spinal nociception. Participants were 18 individuals with FM, 18 individuals with rheumatoid arthritis (RA), and 19 healthy pain-free controls (HC). Mutilation, neutral, and erotic pictures were presented in 4 blocks; 2 blocks assessed only physiological-emotional reactions (ie, pleasure/arousal ratings, corrugator electromyography, startle modulation, skin conductance) in the absence of pain, and 2 blocks assessed emotional reactivity and emotional modulation of pain and the nociceptive flexion reflex (NFR, a physiological measure of spinal nociception) evoked by suprathreshold electric stimulations over the sural nerve. In general, mutilation pictures elicited displeasure, corrugator activity, subjective arousal, and sympathetic activation, whereas erotic pictures elicited pleasure, subjective arousal, and sympathetic activation. However, FM was associated with deficits in appetitive activation (eg, reduced pleasure/arousal to erotica). Moreover, emotional modulation of pain was observed in HC and RA, but not FM, even though all 3 groups evidenced modulation of NFR. Additionally, NFR thresholds were not lower in the FM group, indicating a lack of spinal sensitization. Together, these results suggest that FM is associated with a disruption of supraspinal processes associated with positive affect and emotional modulation of pain, but not brain-to-spinal cord circuitry that modulates spinal nociceptive processes. PMID:23622762

Rhudy, Jamie L; DelVentura, Jennifer L; Terry, Ellen L; Bartley, Emily J; Olech, Ewa; Palit, Shreela; Kerr, Kara L



Complications of spinal opioid therapy: myoclonus, spastic muscle tone and spinal jerking  

Microsoft Academic Search

This study was made in order to define risk factors for patients requiring spinal opioid therapy developing painful spastic muscle tone together with myoclonus and spinal jerking (MSJ). The case histories of 75 patients, all receiving morphine spinally, were retrospectively analysed and, of these, 10 suffered from the MSJ syndrome. The following were taken as evaluation criteria: age, sex, performance

Marianne Kloke; Ulrich Bingel; Siegfried Seeber



Brain and Spinal Cord Interaction: Protective Effects of Exercise Prior to Spinal Cord Injury  

PubMed Central

We have investigated the effects of a spinal cord injury on the brain and spinal cord, and whether exercise provided before the injury could organize a protective reaction across the neuroaxis. Animals were exposed to 21 days of voluntary exercise, followed by a full spinal transection (T7–T9) and sacrificed two days later. Here we show that the effects of spinal cord injury go beyond the spinal cord itself and influence the molecular substrates of synaptic plasticity and learning in the brain. The injury reduced BDNF levels in the hippocampus in conjunction with the activated forms of p-synapsin I, p-CREB and p-CaMK II, while exercise prior to injury prevented these reductions. Similar effects of the injury were observed in the lumbar enlargement region of the spinal cord, where exercise prevented the reductions in BDNF, and p-CREB. Furthermore, the response of the hippocampus to the spinal lesion appeared to be coordinated to that of the spinal cord, as evidenced by corresponding injury-related changes in BDNF levels in the brain and spinal cord. These results provide an indication for the increased vulnerability of brain centers after spinal cord injury. These findings also imply that the level of chronic activity prior to a spinal cord injury could determine the level of sensory-motor and cognitive recovery following the injury. In particular, exercise prior to the injury onset appears to foster protective mechanisms in the brain and spinal cord.

Gomez-Pinilla, Fernando; Ying, Zhe; Zhuang, Yumei



The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment  

Microsoft Academic Search

BACKGROUND: This review summarizes what is known about the pathological processes (e.g. structural and functional changes), by which spinal curvatures develop and evolve into spinal deformities. METHODS: Comprehensive review of articles (English language only) published on 'scoliosis,' whose content yielded data on the pathological changes associated with spinal curvatures. Medline, Science Citation Index and other searches yielded > 10,000 titles

Martha C Hawes; Joseph P O'Brien



Regeneration of descending projections to the spinal motor neurons after spinal hemisection in the goldfish  

Microsoft Academic Search

Following spinal transection, descending spinal projections from goldfish brainstem neurons spontaneously regenerate beyond the lesion site. The nucleus of the medial longitudinal fasciculus (nFLM), which has a critical role in swimming, also sends regenerated axons over a long distance to the ipsilateral spinal cord. To examine whether regenerated axons re-innervate the appropriate targets, we injected rhodamine dextran amine (RDA) into

Akihito Takeda; Richard C. Goris; Kengo Funakoshi



Gastroschisis Associated with Lower Limb and Spinal Congenital Anomalies  

PubMed Central

Gastroschisis is not a very rare congenital deformity, but extragastrointestinal association is rare, if any present, in that condition, an alternative diagnosis should be considered, like Pentalogy of Cantrell, Limb-body wall complex, etc., Other birth defects are always associated with gastroschisis, most commonly, abnormalities of the cardiac and genitourinary. The present case is one of the gastroschisis to highlight the associations of spinal and lower limbs anomalies, with two-vessel short umbilical cord and severe oligohydramnios in primiparous.

Dharmraj, Meena; Verma, Anand Prakash



Thermoelectric device for treatment of radiculitis and spinal massage  

NASA Astrophysics Data System (ADS)

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.

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



Focused review: spinal anesthesia in severe preeclampsia.  


Spinal anesthesia is widely regarded as a reasonable anesthetic option for cesarean delivery in severe preeclampsia, provided there is no indwelling epidural catheter or contraindication to neuraxial anesthesia. Compared with healthy parturients, those with severe preeclampsia experience less frequent, less severe spinal-induced hypotension. In severe preeclampsia, spinal anesthesia may cause a higher incidence of hypotension than epidural anesthesia; however, this hypotension is typically easily treated and short lived and has not been linked to clinically significant differences in outcomes. In this review, we describe the advantages and limitations of spinal anesthesia in the setting of severe preeclampsia and the evidence guiding intraoperative hemodynamic management. PMID:23868886

Henke, Vanessa G; Bateman, Brian T; Leffert, Lisa R



Ultrastructure of the leptomeninx of the fetal ferret spinal cord and cerebrum.  


The ultrastructures of the leptomeninx of the spinal cord and cerebrum was examined in the 32 d post-conception fetal ferret. Leptomeningeal cells of the fetal ferret spinal cord have a moderately electron dense cytoplasm and nucleoplasm. The cisternae of endoplasmic reticulum are filled with an amorphous material and are more numerous in cells covering the lateral part of the cord. Collagen fibrils are also abundant in this region. Glycogen granules are only rarely present and then only in arachnoid cells. Cells of the cerebral leptomenix have a much less electron dense cytoplasm and nucleoplasm and glycogen is present in most cells, sparsely scattered in pial cells, but more plentiful in arachnoid cells. Collagen fibrils are much less numerous and of a finer diameter than those found in the spinal leptomeninx. Cells of the spinal leptomeninx are therefore at a more advanced stage of differentiation than those of the cerebral leptomeninx. PMID:2088147

Sturrock, R R



Presumed intramedullary spinal cord sarcoidosis in a healthy young adult woman.  


Sarcoidosis is an inflammatory disease of unknown etiology associated with the development of granulomatous nodules in various organs, most commonly the lungs, eyes, and skin. It rarely affects the central nervous system, with the spinal cord being least common area of involvement. However, when sarcoidosis does affect the central nervous system, it is often the first presentation of the disease, making diagnosis more difficult. Physical examination findings are consistent with spinal cord pathology, and imaging often suggests spinal cord tumor. We present a case of an otherwise healthy young woman with a granulomatous mass in her cervico-thoracic spinal cord presumed to be sarcoid and review the clinical findings, diagnosis, treatment, and prognosis associated with this rare disease. PMID:22257972

Eby, Sarah A; Buchner, Eric J; Bryant, Mary G



Delivery presentations  


... Malpresentations; Breech birth; Cephalic presentation; Fetal lie; Fetal attitude ... is described in terms of fetal station, lie, attitude, and presentation. Fetal station: This is the relationship ...


A contusive model of unilateral cervical spinal cord injury using the infinite horizon impactor.  


While the majority of human spinal cord injuries occur in the cervical spinal cord, the vast majority of laboratory research employs animal models of spinal cord injury (SCI) in which the thoracic spinal cord is injured. Additionally, because most human cord injuries occur as the result of blunt, non-penetrating trauma (e.g. motor vehicle accident, sporting injury) where the spinal cord is violently struck by displaced bone or soft tissues, the majority of SCI researchers are of the opinion that the most clinically relevant injury models are those in which the spinal cord is rapidly contused.(1) Therefore, an important step in the preclinical evaluation of novel treatments on their way to human translation is an assessment of their efficacy in a model of contusion SCI within the cervical spinal cord. Here, we describe the technical aspects and resultant anatomical and behavioral outcomes of an unilateral contusive model of cervical SCI that employs the Infinite Horizon spinal cord injury impactor. Sprague Dawley rats underwent a left-sided unilateral laminectomy at C5. To optimize the reproducibility of the biomechanical, functional, and histological outcomes of the injury model, we contused the spinal cords using an impact force of 150 kdyn, an impact trajectory of 22.5° (animals rotated at 22.5°), and an impact location off of midline of 1.4 mm. Functional recovery was assessed using the cylinder rearing test, horizontal ladder test, grooming test and modified Montoya's staircase test for up to 6 weeks, after which the spinal cords were evaluated histologically for white and grey matter sparing. The injury model presented here imparts consistent and reproducible biomechanical forces to the spinal cord, an important feature of any experimental SCI model. This results in discrete histological damage to the lateral half of the spinal cord which is largely contained to the ipsilateral side of injury. The injury is well tolerated by the animals, but does result in functional deficits of the forelimb that are significant and sustained in the weeks following injury. The cervical unilateral injury model presented here may be a resource to researchers who wish to evaluate potentially promising therapies prior to human translation. PMID:22871686

Lee, Jae H T; Streijger, Femke; Tigchelaar, Seth; Maloon, Michael; Liu, Jie; Tetzlaff, Wolfram; Kwon, Brian K



Ganglioglioma of the thoracolumbar spinal cord in a patient with neurofibromatosis type 1: a case report and literature review.  


Gangliogliomas of the spinal cord are rare, and the conus medullaris is an extremely rare site for their occurrence. The authors present a case in which a ganglioglioma was found in the thoracolumbar spinal cord, including the conus medullaris, of a 5-year-old female patient with neurofibromatosis type 1 (NF1) who presented with paraparesis and urinary disturbance. MRI revealed an intramedullary lesion within the thoracolumbar spinal cord, including the conus medullaris, which was surgically removed. Pathological investigation showed a ganglioglioma consisting of glioneuronal tumor cells. This is the first report to provide a pathological description of a spinal cord ganglioglioma in a patient with NF1. Because gangliogliomas usually have a good prognosis following resection, it is important to clearly distinguish them from other NF1-associated lesions, even though ganglioglioma of the thoracolumbar spinal cord, including the conus medullaris, is an extremely rare condition. PMID:22041518

Hayashi, Yutaka; Nakada, Mitsutoshi; Mohri, Masanao; Murakami, Hideki; Kawahara, Norio; Hamada, Jun-Ichiro



Pitfall in insertion of suprapubic catheter in patients with spinal cord injuries  

Microsoft Academic Search

Objective: To report an unusual presentation of a misplaced suprapubic catheter (SPC) in a spinal cord injury (SCI) patient.Design: A case report of a SCI patient in whom a SPC was `partially misplaced' in an emergency.Setting: London Spinal Injuries Unit, Stanmore, UK.Subject: A 33-year-old man who sustained a C5 SCI in a road traffic accident 6 months ago. He had

R Hamid; J Peters; PJR Shah



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


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

Scher, A T



Role of electrical stimulation for rehabilitation and regeneration after spinal cord injury: an overview  

Microsoft Academic Search

Structural discontinuity in the spinal cord after injury results in a disruption in the impulse conduction resulting in loss\\u000a of various bodily functions depending upon the level of injury. This article presents a summary of the scientific research\\u000a employing electrical stimulation as a means for anatomical or functional recovery for patients suffering from spinal cord\\u000a injury. Electrical stimulation in the

Samar Hamid; Ray Hayek



A comparative study of methionine adenosyltransferase activity and regional distribution in mammalian spinal cord  

Microsoft Academic Search

To provide a background for future studies on neurodegenerative changes in the spinal cord, the present study analysed the distribution of the activity of methionine adenosyltransferase (ATP:l-methionine S-adenosyltransferase, EC, MAT), an enzyme that catalyses the synthesis of the biological methyl group donor S-adenosylmethionine (AdoMet), in spinal cords from bovine and pig, and compared the results with those from human

Titti Ekegren; Sten-Magnus Aquilonius; Cecilia Gomes-Trolin



Coherent Anti-Stokes Raman Scattering Imaging of Axonal Myelin in Live Spinal Tissues  

Microsoft Academic Search

We present a vibrational imaging study of axonal myelin under physiological conditions by laser-scanning coherent anti-Stokes Raman scattering (CARS) microscopy. We use spinal cord white matter strips that are isolated from guinea pigs and kept alive in oxygen bubbled Krebs’ solution. Both forward- and epi-detected CARS are used to probe the parallel axons in the spinal tissue with a high

Haifeng Wang; Yan Fu; Phyllis Zickmund; Riyi Shi; Ji-Xin Cheng



Pharmacologically evoked fictive motor patterns in the acutely spinalized marmoset monkey (Callithrix jacchus)  

Microsoft Academic Search

The existence of a spinal network capable of generating rhythmic alternating activity resembling locomotion still has not\\u000a been firmly established in primates, including man, although evidence for one is accumulating. The present study investigated\\u000a whether it is possible to activate such a network by administration of a variety of pharmacological agents to acutely spinalized\\u000a marmoset monkeys (Callithrix jacchus) in the

B. Fedirchuk; J. Nielsen; N. Petersen; H. Hultborn



Development in a biologically inspired spinal neural network for movement control  

Microsoft Academic Search

In two phases, we develop increasingly complex neural network models of spinal circuitry that self-organizes into networks with opponent channels for the control of an antagonistic muscle pair. The self-organization is enabled by a Hebbian learning rule operating during spontaneous activity present in the spinal cord. After the self-organized development, the networks enable independent control of the length and tension

Jacob J. Van Heijst; Johan E. Vos; Daniel Bullock



Evidence for the involvement of spinal cord glia in subcutaneous formalin induced hyperalgesia in the rat  

Microsoft Academic Search

Subcutaneous (s.c.) injection of formalin induces a rapid and prolonged hyperalgesia across widespread areas of the body. This hyperalgesic state involves a brain-to-spinal cord pathway, likely arising from the nucleus raphe magnus. The present study examined whether subsequent activation of spinal cord glia may be critical for the hyperalgesic state to be observed in rats. Glia were considered candidates as

L. R Watkins; D Martin; P Ulrich; K. J Tracey; S. F Maier



[Mature lumbar multi-tissue dysembryoma of the spinal cord with sacral spina bifida occulta].  


The authors report the case of a 28-year-old woman who presented with L5 bilateral sciatica associated with perineal sensory disorders. During surgery, a mature pluritissular dysembryoma originating in a tethered spinal cord was discovered at the level of the L2-L3 intervertebral space. Following removal of the lesion, all symptoms disappeared. Mature pluritissular dysembryomas of the spinal cord result from the inclusion of neuroectodermal and mesodermal tissue which has not followed normal evolutive embryonic organization. PMID:2234262

Borne, G; Cristino, G; Bedou, G; Schaefer, J P; Pinaudeau, M



The human tail: rare lesion with occult spinal dysraphism—a case report  

Microsoft Academic Search

Human tail or tail-like caudal cutaneous appendage is a rare fingerlike, midline protrusion at the lumbosacrococcygeal region, often associated with occult spinal dysraphism. A 2-month-old male child presented here had a lumbosacral tail-like appendage with underlying spinal dysraphism without any appreciable neurological deficit. In contradiction to a previous report, true vestigial tails are not benign because they may be associated

Deepak Kumar Singh; Basant Kumar; V. D. Sinha; H. R. Bagaria



Spinal manipulation and mobilisation for back and neck pain: a blinded review  

Microsoft Academic Search

OBJECTIVE--To assess the efficacy of spinal manipulation for patients with back or neck pain. DESIGN--Computer aided search for published papers and blinded assessment of the methods of the studies. SUBJECTS--35 randomised clinical trials comparing spinal manipulation with other treatments. MAIN OUTCOME MEASURES--Score for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation

B. W. Koes; W. J. J. Assendelft; Heijden van der G. J. M. G; L. M. Bouter; P. G. Knipschild



3D spinal motion analysis during staircase walking using an ambulatory inertial and magnetic sensing system  

Microsoft Academic Search

Previous research on spinal motion during walking has been restricted to the level walking condition in a gait lab although\\u000a staircase walking (i.e., stair ascent and descent) exhibits unique biomechanical characteristics. A major difficulty in spinal\\u000a motion capture during staircase walking is the in-the-lab limitation of measurement techniques. The purpose of this article\\u000a is twofold: (i) to present an ambulatory

Jung Keun Lee; Edward J. Park



Depletion of endogenous noradrenaline does not prevent spinal cord plasticity following peripheral nerve injury  

Microsoft Academic Search

The present study examined the role of endogenous noradrenaline on glial and neuronal plasticity in the spinal cord in rats after peripheral nerve injury. An intrathecal injection of dopamine-?-hydroxylase antibody conjugated to saporin (D?H-saporin) completely depleted noradrenergic axons in the spinal cord and also reduced noradrenergic neurons in the locus coeruleus (A6) and A5 noradrenergic nucleus in the brainstem and

Ken-ichiro Hayashida; Christopher M. Peters; Silvia Gutierrez; James C. Eisenach


Progression of spinal cord atrophy by traumatic or inflammatory myelopathy in the pediatric patients: case series  

Microsoft Academic Search

Study design:Case series.Objective:To present spinal cord atrophy in pediatric patients who had spinal cord injury developed after trauma or acute transverse myelitis, and had no motor recovery later.Setting:Department of Rehabilitation Medicine, Tertiary National University Children's Hospital, Seoul, Korea.Methods:Case series.Results:Two pediatric patients with paraplegia due to acute transverse myelitis and one pediatric patient with paraplegia due to traumatic myelopathy were included

M S Bang; S J Kim



Multiple spinal arteriovenous fistulas in Klippel-Trenaunay-Weber syndrome treated with platinum fibre coils  

Microsoft Academic Search

A 13-year-old girl with Klippel-Trenaunay-Weber syndrome and intradural extramedullary spinal arteriovenous fistulas is presented. Pre-embolization balloon test occlusions and embolization with platinum fibre coils were carried out in three sessions, after which the myelopathy and the intense back pain disappeared. Our conclusion is that spinal fistulas can be safely and effectively treated with fibre coils in combination with balloon testing.

P. H. Nakstad; J. K. Hald; S. J. Bakke



Surgical outcome after spinal fractures in patients with ankylosing spondylitis  

PubMed Central

Background Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine. The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned. Methods Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge. Results Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries. Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed. Conclusion The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.

Sapkas, George; Kateros, Konstantinos; Papadakis, Stamatios A; Galanakos, Spyros; Brilakis, Emmanuel; Machairas, George; Katonis, Pavlos



Gait analysis of adult paraplegic rats after spinal cord repair.  


This study presents a novel detailed method of analysis of rat gait and uses this method to demonstrate recovery of forward locomotion patterns in adult rats made paraplegic by surgical spinal cord transection and subjected to a novel strategy for spinal cord repair. Six normal rats were compared to five animals in which the cord was transected at T8-T9, and a 5-mm segment of the spinal cord removed, and to seven animals in which, following spinal cord transection and removal of a spinal cord segment, multiple intercostal peripheral nerve bridges were implanted, rerouting pathways from white to gray matter in both directions. The implanted area was filled with fibrin glue containing acidic fibroblast growth factor. Details of the repair strategy have been published (H. Cheng, Y. Cao, and L. Olson, 1996, Science 273: 510-513). Gait analysis was carried out 3 and 4 months after surgery and once in the normal animals. Animals were allowed to walk across a runway with a transparent floor. Each test consisted of five trials, and each trial was videorecorded from underneath. Using frame-by-frame playback, individual footprints were then recorded regarding location and order of limb use, as well as step quality (degree of weight bearing, etc.). These data allowed measuring runway transit time, five different measures of step numbers, all possible temporal patterns of limb use, stride length, and base of support. Transected controls remained paralyzed in the hindlimbs with only occasional reflex hindlimb movements without weight bearing. Animals subjected to the full repair procedure were significantly faster than the controls, used their hindlimbs for 25-30% of the movements, and regained several of the specific limb recruitment patterns used by normal rats. Taken together, the gait analysis data demonstrate remarkable recovery of coordinated gait in the repaired animals, which was significantly better than controls for all relevant parameters, while at the same time clearly inferior to normal rats for most of the examined parameters. We conclude that normal rats use a multitude of interchangeable step sequence patterns, and that our spinal cord repair strategy leads to recovery of some of these patterns following complete spinal cord transection. These data suggest functionally relevant neuronal communication across the lesion. PMID:9417831

Cheng, H; Almström, S; Giménez-Llort, L; Chang, R; Ove Ogren, S; Hoffer, B; Olson, L



[Lumbar spinal stenosis: diagnosis and conservative treatment].  


Lumbar Spinal Stenosis is a typical disease of the elderly patient that mainly originates in degenerative multisegmental changes of the lumbar vertebral column. The classical symptom of pain irradiation into the legs whilst walking and relief with standing is similar to peripheral arterial disease presentation but differs in the sense that symptoms can be triggered through lumbar extension and relieved with lumbar flexion whereas arterial disease is correlated with pathological arteriovascular findings. Diagnosis is usually confirmed through magnetic resonance imaging (MRI) and response to conservative treatment (analgetics, physiotherapy, epidural injections) is usually good in the majority of cases. Only a minority of about 20% of all cases show progressive disease and may necessitate surgical interventions. PMID:23531906

Nydegger, Alexander; Brühlmann, Pius; Steurer, Johann



History of the spinal cord localization.  


The first reference to spinal cord injury is recorded in the Edwin Smith papyrus. Little was known of the function of the cord before Galen's experiments conducted in the second century AD. Galen described the protective coverings of the spinal cord: the bone, posterior longitudinal ligament, dura mater, and pia mater. He gave a detailed account of the gross anatomy of the spinal cord. During the medieval period (AD 700-1500) almost nothing of note was added to Galen's account of spinal cord structure. The first significant work on the spinal cord was that of Blasius in 1666. He was the first to differentiate the gray and white matter of the cord and demonstrated for the first time the origin of the anterior and posterior spinal nerve roots. The elucidation of the various tracts in the spinal cord actually began with demonstrations of pyramidal decussation by Mistichelli (1709) and Pourfoir du Petit (1710). Huber (1739) recorded the first detailed account of spinal roots and the denticulate ligaments. In 1809, Rolando described the substantia gelatinosa. The microtome, invented in 1824 by Stilling, proved to be one of the fundamental tools for the study of spinal cord anatomy. Stilling's technique involved slicing frozen or alcohol-hardened spinal cord into very thin sections and examining them unstained by using the naked eye or a microscope. With improvements in histological and experimental techniques, modern studies of spinal cord anatomy and function were initiated by Brown-Sequard. In 1846, he gave the first demonstration of the decussation of the sensory tracts. The location and direction of fiber tracts were uncovered by the experimental studies of Burdach (1826), Turck (1849), Clarke (1851), Lissauer (1855), Goll (1860), Flechsig (1876), and Gowers (1880). Bastian (1890) demonstrated that in complete transverse lesions of the spinal cord, reflexes below the level of the lesion are lost and muscle tone is abolished. Flatau (1894) observed the laminar nature of spinal pathways. The 20th century ushered in a new era in the evaluation of spinal cord function and localization; however, the total understanding of this remarkable organ remains elusive. Perhaps the next century will provide the answers to today's questions about spinal cord localization. PMID:15264793

Naderi, Sait; Türe, U?ur; Pait, T Glenn



Acute Spinal Rigidity  

Microsoft Academic Search

A 69-year-old woman presented with a 1-year history of low back and leg pain accompanied by progressive difficulty walking.\\u000a Lumbar surgery was undertaken for spondylolisthesis and canal stenosis. Postoperatively, the pain improved but her walking\\u000a continued to deteriorate. She then developed spasms of the back and right leg causing flexion of the trunk, hip, and knee.\\u000a Her mobility deteriorated further.

P. D. Thompson


[Acute ischemic spinal cord disease. Spinal cord infarction. A clinical study and MRI in 8 cases].  


Acute spinal cord infarction (ASCI) occurs infrequently and may have diverse causes. The diagnosis of ASCI, and particularly of an anterior spinal artery syndrome (ASAS) can be confirmed nowadays by MRI, whereas in the past only necropsy confirmation was possible. Pathophysiology and long-term prognosis may be better known at present and treatments more consistent. We present the longitudinal study and clinical features of 8 patients suffering from ASCI. All of them were personally studied and had MRI examinations, often with sequential studies. three groups must be considered: one included 4 cases of ASAS at cervical level, the second 2 cases of ASAS at thoracic level and the third group with infarction of the conus medullaris (ICM), one of them developed during surgical repair of an infrarenal aortic aneurysm. Motor and sensory sequelae were assessed in each case together with possible etiological factors. In conclusion, recovery after ASAS tends to be dependent on the severity of the initial deficit. At cervical level, clinical and morphological findings argue in favour of an extrinsic selective compression of the C7 right radiculo-medullary artery as responsible for the ASA. At thoracic level, the artery preferentially occluded seems to be the sulco-commisural artery as a consequence of disc compression. Finally, an underlying peculiarity of the pattern of arterial supply is a probable predisposing factor for ICM. Generally, the long-term prognosis of ASCI is not necessarily bad. PMID:7801036

Pau Serradell, A



The protective effect of salvianolic Acid B on blood-spinal cord barrier after compression spinal cord injury in rats.  


Salvianolic acid B (Sal B), a bioactive compound isolated from the Chinese medicinal herb danshen, is commonly used for the prevention and treatment of cardiovascular disease. The present study was performed to investigate the effect of Sal B on the blood-spinal cord barrier (BSCB) after spinal cord injury (SCI) in a rat model. Sal B (1, 10, and 50 mg/kg i.v.) was administered to rats immediately following SCI. The permeability of the BSCB and spinal cord tissue water content were evaluated. Additionally, the expression levels of tight junction proteins and heme oxygenase-1 (HO-1) were monitored by Western blot analysis. Enzyme-linked immunosorbent assay analysis of spinal cord tissue homogenates was performed 24 h post-SCI to evaluate the expression of inflammation-related cytokines. In addition, the motor recovery of SCI rats was assessed using the Basso, Beattie, and Bresnahan scoring system. Compared to the SCI group, rats treated with Sal B (10, 50 mg/kg) exhibited significantly reduced spinal cord tissue water content and BSCB permeability. Further, the motor function of rats was also greatly improved by Sal B administration. The expression of pro-inflammatory factors TNF-? and NF-?B was found to be greatly increased 24 h post-SCI, and this upregulation was significantly attenuated by Sal B treatment. The expression of ZO-1 and occludin was upregulated by Sal B (10 mg/kg) treatment after SCI, and this effect was blocked by the HO-1 inhibitor ZnPP. Taken together, our results clearly indicate that Sal B attenuates SCI by promoting the repair of the damaged BSCB, demonstrating that this molecule is a novel and promising therapeutic agent for human SCI. PMID:23943397

Fan, Zhong-Kai; Lv, Gang; Wang, Yan-Feng; Li, Gang; Yu, De-Shui; Wang, Yan-Song; Zhang, Yu-Qiang; Mei, Xi-Fan; Cao, Yang



Spinal Cord Infarction Caused by Non-dissected and Unruptured Thoracoabdominal Aortic Aneurysm with Intraluminal Thrombus  

PubMed Central

Spinal cord infarction, especially anterior spinal artery syndrome, is a relatively rare disease. We report a case of spinal cord infarction caused by thoracoabdominal aortic aneurysm with intraluminal thrombus. A 52-year-old man presented with sudden onset paraplegia. At first, he was diagnosed with cervical myelopathy due to a C6-7 herniated intervertebral disc, and had an operation for C6-7 discetomy and anterior interbody fusion. Approximately 1 month after the operation, he was transferred to the department of rehabilitation in our hospital. Thoracoabdominal aortic aneurysm with intraluminal thrombus was found incidentally on an enhanced computed tomography scan, and high signal intensities were detected at the anterior horns of gray matter from the T8 to cauda equina level on T2-weighted magnetic resonance imaging. There was no evidence of aortic rupture, dissection, or complete occlusion of the aorta. We diagnosed his case as a spinal cord infarction caused by thoracoabdominal aortic aneurysm with intraluminal thrombus.

Ki, Young Jin; Jeon, Byoung Hyun



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


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

Chakravarthy, Hariprakash



Spontaneous Intracranial Hypotension: Spinal MR Findings  

Microsoft Academic Search

Summary: We report three patients with spontaneous in- tracranial hypotension in whom spinal MR imaging re- vealed ventral extradural fluid collections that were cen- tered at the cervicothoracic junction in two patients and extended throughout the entire spine in the third patient. These spinal fluid collections most likely resulted from the accumulation of CSF at the site of dural leakage.

Barry M. Rabin; Sudipta Roychowdhury; Joel R. Meyer; Bruce A. Cohen; Kenneth D. LaPat; Eric J. Russell



Microsoft Academic Search

Abstract Altered sexual function is one of the most devastating consequences,of spinal cord trauma (SCT). Despite this fact, current knowledge of the neural circuitry regulating sexual response in the spinal cord (SC) in healthy humans,is remarkably incomplete. In order to better understand the changes that occur to sexual responses following SCT, we must elucidate the neural transmission of sexual function

Natalie Kozyrev



Spinal Muscular Atrophy Infantile and Juvenile Type.  

National Technical Information Service (NTIS)

This book reflects over 18 years of research at the Warsaw Department of Neurology on spinal muscular atrophy. Since Brandt's monograph was published in 1950, many papers on different aspects of spinal atrophies have appeared in journals and in the procee...

I. Hausmanowa-Petrusewicz



Risk factors for spinal surgical site infection  

Microsoft Academic Search

Background. Surgical site infections (SSI) are one of the most common nosocomial infections in the United States. This study was conducted following an increase in the rate of SSI following spinal procedures at the study hospital. ^ Methods. This study examined patient and hospital associated risk factors for SSI using existing data on patients who had spinal surgery performed at

Kelley M Boston



Depression Following a Spinal Cord Injury  

Microsoft Academic Search

Elliott TR, Frank RG. Depression following spinal cord injury. Arch Phys Med Rehabil 1996;77:816-23. Although depression has been widely studied among persons with spinal cord injury, the ubiquitous and unsophisticated use of the term and presumtions about its manifestations in the rehabilitation setting have needlessly encumbered the under- standing and treatment of depression. Major themes and issues in the study,

Robert G. Frank



Outcome Measures for Pediatric Spinal Muscular Atrophy  

Microsoft Academic Search

Background: Spinal muscular atrophy (SMA) is a ge- netic disease of the anterior horn cell with a frequency of 8 per 100000 live births and a high rate of mortality during infancy. The American Spinal Muscular Atrophy Randomized Trials (AmSMART) Group is an organiza- tion of 5 centers formed to perform clinical trials in chil- dren with SMA. Objective: To

Susan T. Iannaccone



An unusual spinal intradural arachnoid cyst  

Microsoft Academic Search

Spinal intradural arachnoid cysts are seen most frequently in the thoracic region, particularly near the midline posteriorly. A thoracic intradural arachnoid cyst in this typical location is reported, with the additional unusual finding of herniation of the spinal cord through an anterior defect in the dura mater. The MRI findings are described.

J. P. Slavotinek; M. R. Sage; B. P. Brophy



Spinal Cord Involvement in Uncomplicated Herpes Zoster  

Microsoft Academic Search

We prospectively evaluated herpes zoster patients during the acute phase of the disease for central nervous system involvement. Of 24 patients with spinal zoster, 13 (54%) had spinal cord abnormality, which was asymptomatic in 12 of the 13. Age but not lack of acyclovir treatment was associated with such involvement. In all but 2, neurological involvement resolved within 6 months.





Microsoft Academic Search

Degenerative spinal disorders, including intervertebral disc disease and spondylosis, seldom occur in domestic cats. In contrast, a retrospective study of 13 lions ( Panthera leo), 16 tigers (Panthera tigris), 4 leopards (Panthera pardis), 1 snow leopard (Panthera uncia), and 3 jaguars (Panthera onca) from the Knoxville Zoo that died or were euthanatized from 1976 to 1996 indicated that degenerative spinal

Christine Kolmstetter; Linda Munson; Edward C. Ramsay


Presumed Venous Infarction in Spinal Decompression Sickness  

Microsoft Academic Search

Summary: We describe the serial MR imaging findings in a patient with spinal decompression sickness. In the acute phase, the spinal cord was swollen, with increased T2 sig- nal in the posterior part of the column; 1 month later, marked contrast enhancement was noted in the same loca- tion; and 2 months later, the swelling and T2 signal had decreased.

Yasuhiro Manabe; Kenichi Sakai; Kenichi Kashihara; Toshikiyo Shohmori


Therapeutic approaches for spinal cord injury.  


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

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



Bilateral spinal accessory nerve palsy after rhytidectomy  

Microsoft Academic Search

A 64-year-old patient experienced palsy of the right spinal accessory nerve after rhytidectomy. She was evaluated 6 months after surgery for unexplained shoulder pain and weakness since the procedure. Electrophysiological testing showed bilateral spinal nerve palsy without abnormalities in the other shoulder nerves. The electrophysiological findings supported entrapment as the mechanism, rather than nerve section or pure axonal disease due to

Paul Seror; Henri Lellouche



Neural Plasticity After Spinal Cord Injury  

Microsoft Academic Search

Spinal cord injury (SCI) has devastating physical and socioeconomical impact. However, some degree of functional recovery is frequently observed in patients after SCI. There is considerable evidence that functional plasticity occurs in cerebral cortical maps of the body, which may account for functional recovery after injury. Additionally, these plasticity changes also occur at multiple levels including the brainstem, spinal cord,

Yuemin Ding; Abba J. Kastin; Weihong Pan



Minimally Invasive Treatment of Spinal Metastases: Techniques  

PubMed Central

With improved treatments and increasingly life expectancy, the burden of metastatic disease in the spine is expected to rise. The role of conventional surgery for spinal metastases is well established but often involves procedures of large magnitude. We describe minimally invasive techniques for spinal stabilization and decompression in patients with symptomatic metastatic disease of the spine.

Rose, Peter S.; Clarke, Michelle J.; Dekutoski, Mark B.



Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment  

Microsoft Academic Search

Age-related changes in the spinal column result in a degenerative cascade known as spondylosis. Genetic, environmental, and\\u000a occupational influences may play a role. These spondylotic changes may result in direct compressive and ischemic dysfunction\\u000a of the spinal cord known as cervical spondylotic myelopathy (CSM). Both static and dynamic factors contribute to the pathogenesis.\\u000a CSM may present as subclinical stenosis or

Darren R. Lebl; Alex Hughes; Frank P. Cammisa; Patrick F. O’Leary



Extraosseous epidural multiple myeloma presenting with thoracic spine compression  

Microsoft Academic Search

Multiple myeloma is a hematopoetic disorder and multicentric disease, with the most common localisation being the spine. A 47-year-old male presented with progressive paraplegia, superficial and deep sensory disturbance below the level of T4. Spinal magnetic resonance image showed an epidural mass compressing the spinal cord at the level of T4–T6 with intact bone structure. The patient underwent surgical T4–T6

Naama Okacha; Elasri Chrif; Elmostarchid Brahim; Akhaddar Ali; Elbouzidi Abderrahman; Miloudi Gazzaz; Belhachmi Adil; Kadiri Bouchaib; Boucetta Mohamed



Effective Presentations  

PubMed Central

Where the purpose of presentations is to inform, effective delivery is important to ensure that audiences receive the educational message. We offer six suggestions: introduce the topic in an interesting way; speak loudly enough; do not read; involve the audience actively; respect the attention span of the audience; and limit the amount of content. We conclude that the skills of live public presentation can be learned, but that the art of presentation is innate. Imagesp2063-ap2064-a

Spooner, H. James; Swanson, Richard W.



Poster Presentation  

NSDL National Science Digital Library

To prepare their presentations students do background reading on a topic of their choosing. They are required to prepare a visual poster presentation of their topic that incorporates graphic elements and a short written summary of their topic. In class students are required to give a five minute oral presentation using their poster to illustrate their talk. They must then answer questions from their classmate and instructor. The final element of this assignment requires students to evaluate the work of their classmates and to ask questions about the topics other students present.

Hoppe, Kathryn A.


Spinal deformity in young athletes.  


Young athletes may have a spinal deformity incidentally or potentially related to their sport. These athletes should be encouraged to continue sports participation in many instances. Brace wear is commonly used for kyphotic and scoliosis deformities. Many sports can be played in the brace. Even with sports that cannot practically be played in the brace, most bracing protocols have enough time out of brace during the day for the athlete to continue participation. However, good physical therapy for flexibility and strengthening of the spine should be continued. Even sports that potentially aggravate the deformity may be continued in these circumstances. PMID:22657994

d'Hemecourt, Pierre A; Hresko, M Timothy



Directional spinals in obstetric analgesia.  


Directional characteristics of spinal injections delivered via a 22 gauge Whitacre needle were confirmed in twenty-one obstetric patients undergoing elective Caesarean section. Caudad injection was inadequate for elective Caesarean section, while cephalad or lateral injection provided good sensory levels for the duration of the surgery. It is speculated that along with the low incidence of postspinal headache and ease of administering the block with a more rigid 22 gauge needle, low dose caudally directed injections may provide a superior means of administering saddle block analgesia for obstetric patients. PMID:637277

Graham, C W; Sutton, L; Cozen, H J



Malignant autonomic dysreflexia in spinal cord injured men  

Microsoft Academic Search

Study design:Case reports.Objectives:To present a series of cases of protracted and severe autonomic dysreflexia (AD) in men with spinal cord injury (SCI), who sustained damage to their descending autonomic pathways.Settings:GF Strong Rehabilitation Centre, Sexual Health Rehabilitation Service, Vancouver Sperm Retrieval Clinic, Vancouver Coastal Health Authority, Vancouver, BC, Canada.Case report:AD is a serious complication of SCI triggered by a variety of

S Elliott; A Krassioukov



A patient with Parkinson's disease benefits from spinal cord stimulation.  


We present a case of a 43-year-old woman with a history of Parkinson's disease and chronic neuropathic pain secondary to trauma. She was implanted with a spinal cord simulator to relieve her persistent intractable pain. After the implantation of the device the patient not only was relieved of her neuropathic pain but also found significant improvement in her Parkinson symptoms. PMID:23453160

Hassan, Syed; Amer, Syed; Alwaki, Abdulrehman; Elborno, Ahmed



Spinal cord compression of primary extragonadal giant yolk sac tumor  

Microsoft Academic Search

Study design:Case report.Objective:To report an adult male patient with a primary extragonadal giant yolk sac tumor presenting with acute spinal cord compression.Setting:Faculty of Medicine, University of Dicle, Diyarbakir, Turkey.Method:A 31-year-old man was referred to our department with a diagnosis of Pott's disease, a complaint of back pain and gait difficulty for 2 weeks. Neurological examination showed spastic paraparesis and hypoesthesia

A Guzel; M Tatli; D Belen; H Seckin



Activity-based Therapies in Spinal Cord Injury:  

PubMed Central

This article summarizes presentations of a symposium examining the potential impact of activity-based therapies (ABT) in promoting neurological and functional recovery after spinal cord injury (SCI). The symposium addressed 3 key questions concerning activity-based therapy in SCI: (1) What clinical approaches are used? (2) Is there empirical evidence supporting efficacy of ABT in promoting neurological recovery and improving overall function, health, and quality of life? (3) What are the issues related to long-term viability of ABT?

Jones, Michael L.; Harness, Eric; Denison, Paula; Tefertiller, Candy; Evans, Nicholas; Larson, Cathy A.



Cerebral and spinal air embolism following percutaneous nephrolithotomy.  


We present a case report of cerebral and spinal air embolism following percutaneous nephrolithotomy in a patient without evidence of intra-cardiac defects or prepulmonary A-V shunts. The position of the patient during the incidence determined the site of eventual lodgement of air emboli in the arterial circulation. We suspect that the time of onset of symptoms following the procedure may be the clue to the path followed by air emboli. PMID:21755765

Kachalia, Amit Girish; Savant, Charulata Sankhla; Patil, Suhas; Gupta, Santosh; Kapadia, Farhad N



Trauma of the spine and spinal cord: imaging strategies  

Microsoft Academic Search

Traumatic injuries of the spine and spinal cord are common and potentially devastating lesions. We present a comprehensive\\u000a overview of the classification of vertebral fractures, based on morphology (e.g., wedge, (bi)concave, or crush fractures)\\u000a or on the mechanism of injury (flexion-compression, axial compression, flexion-distraction, or rotational fracture-dislocation\\u000a lesions). The merits and limitations of different imaging techniques are discussed, including plain

P. M. Parizel; T. van der Zijden; S. Gaudino; M. Spaepen; M. H. J. Voormolen; C. Venstermans; F. De Belder; L. van den Hauwe; J. Van Goethem



Endocrine pathology in spinal cord injured patients on maintenance dialysis  

Microsoft Academic Search

We studied the histopathological changes of the thyroid, adrenal and parathyroid glands, testes and pancreata in 15 patients with end-stage renal disease associated with long-standing spinal cord injury. All patients were males aged 42.7 ± 9.4 years and were treated with maintenance haemodialysis for 20.4 ± 17.7 months. Thyroid amyloidosis was present in eight of 12 glands and was extensive

C H Barton; N D Vaziri; S Gordon; I Eltorai



Extradural spinal arachnoid cysts associated with spina bifida occulta  

Microsoft Academic Search

Summary  Introduction. Spinal extradural arachnoid cysts are an uncommon cause of neural compression in children. Even more uncommon is the association\\u000a of such cysts with spina bifida occulta.\\u000a \\u000a Material. Two girls, 12 and 8-years-old, presented with left leg pain, deteriorating gait, clinical signs of left L5 and S1 root compression,\\u000a without bladder or bowel symptoms. The first patient had left foot

K. Apel; S. Sgouros



Vestibular stimulation can relieve central pain of spinal origin  

Microsoft Academic Search

Study design:Single-blind, placebo-controlled case report.Setting:Center for Brain and Cognition, University of California, San Diego, CA, USA.Objective and results:We present the case of a 64-year-old woman with right-sided central pain following transverse myelitis of her cervical spinal cord in 2002. We investigated whether her pain could be improved beyond a placebo response by cold caloric vestibular stimulation. She had very little

P D McGeoch; V S Ramachandran



Oncocytoma of the spinal cord causing paraplegia – a case report  

Microsoft Academic Search

Study design:Case report.Objectives:To describe a rare case of oncocytoma arising from the spinal cord in a 40-year old woman.Setting:Republic of Korea.Methods:The patient's history, physical examination, radiological and pathological findings were reviewed.Results:A 40-year-old woman presented with 3-month history of low back pain. Magnetic resonance imaging revealed an intradural extramedullary mass located between L1 and L4. She refused any surgical treatment and

H S Park; K Y Jang; M J Kang; K J Song; K B Lee



Notch1 control of oligodendrocyte differentiation in the spinal cord  

Microsoft Academic Search

e have selectively inhibited Notch1 signaling in oligodendrocyte precursors (OPCs) using the Cre\\/loxP system in transgenic mice to investigate the role of Notch1 in oligodendrocyte (OL) development and differentiation. Early development of OPCs appeared normal in the spinal cord. However, at embryonic day 17.5, premature OL differentiation was observed and ectopic immature OLs were present in the gray matter. At

Stéphane Genoud; Corinna Lappe-Siefke; Sandra Goebbels; Freddy Radtke; Michel Aguet; Steven S. Scherer; Ueli Suter; Klaus-Armin Nave; Ned Mantei



Hereditary distal spinal muscular atrophy with vocal cord paralysis.  

PubMed Central

A large kindred is described in which an unusual form of spinal muscular atrophy is segregating in an autosomal dominant manner. The disease presents most commonly in the teens with small muscle wasting in the hands, particularly involving median nerve musculature. Subsequently distal muscle wasting and weakness occur in the lower limbs. Vocal cord paralysis is a characteristic and potentially hazardous feature. No previous report of this condition has been found. Images

Young, I D; Harper, P S



A rare case of spinal dural arteriovenous fistula  

PubMed Central

Spinal dural arteriovenous fistula (SDAVF) is a rare vascular malformation of the spine. Only a limited number of cases of SDAVF have been reported in the current literature. We describe the case of a 74 year old male who presented with gradually progressive bilateral lower extremity weakness and bladder dysfunction and was subsequently diagnosed with SDAVF affecting both the thoracic and lumbar spine. The patient later underwent embolization with some improvement in his neurologic symptoms.

Apostolova, Mariya; Nasser, Samer; Kodsi, Samir



Topical application of dynorphin A (1–17) antiserum attenuates trauma induced alterations in spinal cord evoked potentials, microvascular permeability disturbances, edema formation and cell injury  

Microsoft Academic Search

Summary.  ?Dynorphin is a neuropeptide that is present in high quantities in the dorsal horn of the spinal cord. The peptide is actively\\u000a involved in pain processing pathways. However, its involvement in spinal cord injury is not well known. Alteration in dynorphin\\u000a immunoreactivity occurs following a focal trauma to the rat spinal cord. Infusion of dynorphin into the intrathecal space\\u000a of

T. Winkler; H. S. Sharma; T. Gordh; R. D. Badgaiyan; E. Stålberg; J. Westman



Combinational Spinal GAD65 Gene Delivery and Systemic GABA-Mimetic Treatment for Modulation of Spasticity  

PubMed Central

Background Loss of GABA-mediated pre-synaptic inhibition after spinal injury plays a key role in the progressive increase in spinal reflexes and the appearance of spasticity. Clinical studies show that the use of baclofen (GABAB receptor agonist), while effective in modulating spasticity is associated with major side effects such as general sedation and progressive tolerance development. The goal of the present study was to assess if a combined therapy composed of spinal segment-specific upregulation of GAD65 (glutamate decarboxylase) gene once combined with systemic treatment with tiagabine (GABA uptake inhibitor) will lead to an antispasticity effect and whether such an effect will only be present in GAD65 gene over-expressing spinal segments. Methods/Principal Findings Adult Sprague-Dawley (SD) rats were exposed to transient spinal ischemia (10 min) to induce muscle spasticity. Animals then received lumbar injection of HIV1-CMV-GAD65 lentivirus (LVs) targeting ventral ?-motoneuronal pools. At 2–3 weeks after lentivirus delivery animals were treated systemically with tiagabine (4, 10, 20 or 40 mg/kg or vehicle) and the degree of spasticity response measured. In a separate experiment the expression of GAD65 gene after spinal parenchymal delivery of GAD65-lentivirus in naive minipigs was studied. Spastic SD rats receiving spinal injections of the GAD65 gene and treated with systemic tiagabine showed potent and tiagabine-dose-dependent alleviation of spasticity. Neither treatment alone (i.e., GAD65-LVs injection only or tiagabine treatment only) had any significant antispasticity effect nor had any detectable side effect. Measured antispasticity effect correlated with increase in spinal parenchymal GABA synthesis and was restricted to spinal segments overexpressing GAD65 gene. Conclusions/Significance These data show that treatment with orally bioavailable GABA-mimetic drugs if combined with spinal-segment-specific GAD65 gene overexpression can represent a novel and highly effective anti-spasticity treatment which is associated with minimal side effects and is restricted to GAD65-gene over-expressing spinal segments.

Kakinohana, Osamu; Hefferan, Michael P.; Miyanohara, Atsushi; Nejime, Tetsuya; Marsala, Silvia; Juhas, Stefan; Juhasova, Jana; Motlik, Jan; Kucharova, Karolina; Strnadel, Jan; Platoshyn, Oleksandr; Lazar, Peter; Galik, Jan; Vinay, Laurent; Marsala, Martin



Cerebral Vasospasm with Ischemia following a Spontaneous Spinal Subarachnoid Hemorrhage  

PubMed Central

Cerebral vasospasm is a well-known consequence of aneurysmal subarachnoid hemorrhage (SAH) triggered by blood breakdown products. Here, we present the first case of cerebral vasospasm with ischemia following a spontaneous spinal SAH. A 67-year-old woman, who was on Coumadin for atrial fibrillation, presented with chest pain radiating to the back accompanied by headache and leg paresthesias. The international normalized ratio (INR) was 4.5. Ten hours after presentation, she developed loss of movement in both legs and lack of sensation below the umbilicus. Spine MRI showed intradural hemorrhage. Her coagulopathy was reversed, and she underwent T2 to T12 laminectomies. A large subarachnoid hematoma was evacuated. Given her complaint of headache preoperatively and the intraoperative finding of spinal SAH, a head CT was done postoperatively that displayed SAH in peripheral sulci. On postoperative day 5, she became obtunded. Brain MRI demonstrated focal restricted diffusion in the left frontoparietal area. Formal angiography revealed vasospasm in anterior cerebral arteries bilaterally and right middle cerebral artery. Vasospasm was treated, and she returned to baseline within 48 hours. Spontaneous spinal SAH can result in the same sequelae typically associated with aneurysmal SAH, and the clinician must have a degree of sus