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Biological basis of exercise-based treatments: spinal cord injury.  


Despite intensive neurorehabilitation, extensive functional recovery after spinal cord injury is unattainable for most individuals. Optimal recovery will likely depend on activity-based, task-specific training that personalizes the timing of intervention with the severity of injury. Exercise paradigms elicit both beneficial and deleterious biophysical effects after spinal cord injury. Modulating the type, intensity, complexity, and timing of training may minimize risk and induce greater recovery. This review discusses the following: (a) the biological underpinning of training paradigms that promote motor relearning and recovery, and (b) how exercise interacts with cellular cascades after spinal cord injury. Clinical implications are discussed throughout. PMID:21703584

Michele Basso, D; Hansen, Christopher N



A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation, and neuro emotional technique for the treatment of pregnancy-related low back pain  

PubMed Central

Background This pilot randomized controlled trial evaluated the feasibility of conducting a full scale study and compared the efficacy of exercise, spinal manipulation, and a mind-body therapy called Neuro Emotional Technique for the treatment of pregnancy-related low back pain, a common morbidity of pregnancy. Methods Healthy pregnant women with low back pain of insidious onset were eligible to enroll in the study at any point in their pregnancy. Once enrolled, they remained in the study until they had their babies. Women were randomly allocated into one of three treatment groups using opaque envelopes. The treatment schedule paralleled the prenatal care schedule and women received individualized intervention. Our null hypothesis was that spinal manipulation and Neuro Emotional Technique would perform no better than exercise in enhancing function and decreasing pain. Our primary outcome measure was the Roland Morris Disability Questionnaire and our secondary outcome measure was the Numeric Pain Rating Scale. Intention to treat analysis was conducted. For the primary analysis, regression was conducted to compare groups on the outcome measure scores. In a secondary responder analysis, difference in proportions of participants in attaining 30% and 50% improvement were calculated. Feasibility factors for conducting a future larger trial were also evaluated such as recruitment, compliance to study protocols, cost, and adverse events. Results Fifty-seven participants were randomized into the exercise (n?=?22), spinal manipulation (n?=?15), and Neuro Emotional Technique (n?=?20) treatment arms. At least 50% of participants in each treatment group experienced clinically meaningful improvement in symptoms for the Roland Morris Disability Questionnaire. At least 50% of the exercise and spinal manipulation participants also experienced clinically meaningful improvement for the Numeric Pain Rating Scale. There were no clinically meaningful or statistically significant differences between groups in any analysis. Conclusions This pilot study demonstrated feasibility for recruitment, compliance, safety, and affordability for conducting a larger study in the future. Spinal manipulation and exercise generally performed slightly better than did Neuro Emotional Technique for improving function and decreasing pain, but the study was not powered to detect the between-group differences as statistically significant. Trial registration (Identifier: NCT00937365).



The effects of McKenzie and Brunkow exercise program on spinal mobility comparative study.  


This study encompassed 64 participants with symptoms of low back pain, 33 in McKenzie group and 31 in Brunkow group. Patients attended exercise program daily and they were asked to do the same exercise at home--five times a day in series of 5 to 10 repetition each time, depending of stage of disease and pain intensity. All patients were assessed for the spinal motion, before and after the treatment. All parameters for spinal movements showed improvement after exercising McKenzie program for lower back pain with a significant difference of p<0.01 for all motions. Also, in Brunkow group, all of the parameters showed statistically significant improvement at the end of treatment in relation to pre-treatment values, with significant difference of p<0.01 for all motions. Statistically comparison between McKenzie and Brunkow difference in score at the end of the treatment showed statistically significant improvement in McKenzie group, for extension, right and left side flexion, while flexion score didn't show statistically significant difference. McKenzie exercises seemed to be more effective than Brunkow exercises for improvement in spinal motion. Both, McKenzie and Brunkow exercises can be used for spinal mobility improvement in patients with lower back pain, but is preferable to use McKenzie exercises first, to decrease the pain and increase spinal mobility, and then Brunkow exercises to strengthen the paravertebral muscles. PMID:15628984

Muji? Skiki?, Emela; Trebinjac, Suad; Sakota, Slavica; Avdi?, Dijana



Effects of Diet and/or Exercise in Enhancing Spinal Cord Sensorimotor Learning  

PubMed Central

Given that the spinal cord is capable of learning sensorimotor tasks and that dietary interventions can influence learning involving supraspinal centers, we asked whether the presence of omega-3 fatty acid docosahexaenoic acid (DHA) and the curry spice curcumin (Cur) by themselves or in combination with voluntary exercise could affect spinal cord learning in adult spinal mice. Using an instrumental learning paradigm to assess spinal learning we observed that mice fed a diet containing DHA/Cur performed better in the spinal learning paradigm than mice fed a diet deficient in DHA/Cur. The enhanced performance was accompanied by increases in the mRNA levels of molecular markers of learning, i.e., BDNF, CREB, CaMKII, and syntaxin 3. Concurrent exposure to exercise was complementary to the dietary treatment effects on spinal learning. The diet containing DHA/Cur resulted in higher levels of DHA and lower levels of omega-6 fatty acid arachidonic acid (AA) in the spinal cord than the diet deficient in DHA/Cur. The level of spinal learning was inversely related to the ratio of AA?DHA. These results emphasize the capacity of select dietary factors and exercise to foster spinal cord learning. Given the non-invasiveness and safety of the modulation of diet and exercise, these interventions should be considered in light of their potential to enhance relearning of sensorimotor tasks during rehabilitative training paradigms after a spinal cord injury.

Joseph, M. Selvan; Ying, Zhe; Zhuang, Yumei; Zhong, Hui; Wu, Aiguo; Bhatia, Harsharan S.; Cruz, Rusvelda; Tillakaratne, Niranjala J. K.; Roy, Roland R.; Edgerton, V. Reggie; Gomez-Pinilla, Fernando



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



Assessing small-volume spinal cord dose for repeat spinal stereotactic body radiotherapy treatments.  


Spinal cord biologically effective dose (BED) limits are critical to safe spine stereotactic body radiotherapy (SBRT) delivery. In particular, when repeating SBRT to the same site, the problem of adding non-uniform BED distributions within small volumes of spinal cord has yet to be solved. We report a probability-based generalized BED (gBED) model to guide repeat spine SBRT treatment planning. The gBED was formulated by considering the sequential damaging probabilities of repeat spine SBRT treatments. Parameters from the standard linear-quadratic model, such as ?/? = 2 Gy for the spinal cord, were applied. We tested the model based on SBRT specific spinal cord tolerance using a simulated and ten clinical repeat SBRT cases. The gBED provides a consistent solution for superimposing non-uniform dose distributions from different fractionation schemes, analogous to the BED for uniform dose distributions. Based on ten clinical cases, the gBED was observed to eliminate discrepancies in the cumulative BED of approximately 5% to 20% within small volumes (e.g. 0.1-2.0 cc) of spinal cord, as compared to a conventional calculation method. When assessing spinal cord tolerance for repeat spinal SBRT treatments, caution should be exercised when applying conventional BED calculations for small volumes of spinal cord irradiated, and the gBED potentially provides more conservative and consistently derived dose surrogates to guide safe treatment planning and treatment outcome modeling. PMID:23135285

Ma, Lijun; Kirby, Neil; Korol, Renee; Larson, David A; Sahgal, Arjun



Combined effects of acrobatic exercise and magnetic stimulation on the functional recovery after spinal cord lesions.  


The objective of the study was to determine whether physical exercise combined with epidural spinal cord magnetic stimulation could improve recovery after injury of the spinal cord. Spinal cord lesioning in mice resulted in reduced locomotor function and negatively affected the muscle strength tested in vitro. Acrobatic exercise attenuated the behavioral effects of spinal cord injury. The exposure to magnetic fields facilitated further this improvement. The progress in behavioral recovery was correlated with reduced muscle degeneration and enhanced muscle contraction. The acrobatic exercise combined with stimulation with magnetic fields significantly facilitates behavioral recovery and muscle physiology in mice following spinal cord injury. PMID:18986227

Ahmed, Zaghloul; Wieraszko, Andrzej



The Efficacy of Spinal Stabilization Exercises as Intervention for Insidious Onset Lumbar and Sacroiliac Pain  

Microsoft Academic Search

Overall Clinical Bottom Line: After a thorough examination of ten articles, we conclude that the addition of spinal stabilization exercises (SSEs) to a conventional physical therapy program (modalities, traction, manual therapy, and general exercises to increase strength and range of motion) clinically improved pain and function in patients with clinical sacroiliac\\/lumbar spinal instability (CSI). SSEs did not provide additional, clinically

Sylvia R. Sisto; Jeff A. Soulia



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 Exercise: The Backbone of Spine Treatment  


North American Spine Society Public Education Series Cervical Exercise: The Backbone of Spine Treatment How important is ... physician before starting any exercises. The Importance of Exercise for the Neck Spine experts agree that physical ...


Effects of an exercise program on the rehabilitation of patients with spinal cord injury  

Microsoft Academic Search

Salinas Dur[aacute]n F, Lugo L, Ram[iacute]rez L, Eusse E. Effects of an exercise program on the rehabilitation of patients with spinal cord injury. Arch Phys Med Rehabil 2001;82:1349-54. Objectives: To evaluate the impact of directed physical exercise in patients with spinal cord injury (SCI) and to measure functional independence before and after an exercise program. Design: Case series. Setting: Tertiary

Luz Lugo; Edgar Eusse Lic



Regenerative treatment in spinal cord injury.  


Spinal cord injury is a devastating, traumatic event, and experienced mainly among young people. Until the modern era, spinal cord injury was so rapidly fatal that no seriously injured persons would survive long enough for regeneration to occur. Treatment of spinal cord injury can be summarized as follows: prevent further cord injury, maintain blood flow, relieve spinal cord compression, and provide secure vertebral stabilization so as to allow mobilization and rehabilitation, none of which achieves functional recovery. Previous studies have focused on analyzing the pathogenesis of secondary injury that extends from the injury epicenter to the periphery, as well as the tissue damage and neural cell death associated with secondary injury. Now, there are hundreds of current experimental and clinical regenerative treatment studies. One of the most popular treatment method is cell transplantation in injured spinal cord. For this purpose bone marrow stromal cells, mononuclear stem cells, mesenchymal stem cells, embryonic stem cells, neural stem cells, and olfactory ensheathing cells can be used. As a result, cell transplantation has become a promising therapeutic option for spinal cord injury patients. In this paper we discuss the effectiveness of stem cell therapy in spinal cord injury. PMID:22849699

Ozdemir, Mevci; Attar, Ayhan; Kuzu, Isinsu



Nogo Receptor Deletion and Multimodal Exercise Improve Distinct Aspects of Recovery in Cervical Spinal Cord Injury  

PubMed Central

Abstract We tested the ability of two plasticity-promoting approaches to enhance recovery in a mouse model of incomplete spinal cord injury (SCI). Genetically, we reduced myelin-mediated inhibition of neural plasticity through Nogo66-receptor (NgR) gene deletion. Behaviorally, we utilized a novel multimodal exercise training paradigm. Adult mice of wild-type or NgR-null genotype were subjected to partial lateral hemisection (LHx) at C3-C4 with the intent of producing anatomically and functionally mild deficits. Exercise training or control treatment proceeded for 14 weeks. Behavioral outcomes were assessed prior to tract tracing and histological analysis. Genotype and training exerted differing effects on performance; training improved performance on a test related to the training regimen (task-specific benefit), whereas genotype also improved performance on more generalized behaviors (task-non-specific benefit). There were no significant histological differences across genotype or training assignment with regard to lesion size or axonal tract staining. Thus either NgR gene deletion or exercise training benefits mice with mild cervical spinal injury. In this lesion model, the effects of NgR deletion and training were not synergistic for the tasks assessed. Further work is required to optimize the interaction between pharmacological and physical interventions for SCI.

Song, Kang-Ho; Tang, Xin; Strittmatter, Stephen M.



Foot Cooling Reduces Exercise-Induced Hyperthermia in Men with Spinal Cord Injury  

Microsoft Academic Search

HAGOBIAN, T. A., K. A. JACOBS, B. J. KIRATLI, and A. L. FRIEDLANDER. Foot Cooling Reduces Exercise-Induced Hyperthermia in Men with Spinal Cord Injury. Med. Sci. Sports Exerc., Vol. 36, No. 3, pp. 411- 417, 2004. The number of individuals with spinal cord injury (SCI) participating in sports at recreational and elite levels is on the rise. However, loss of




[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



Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury.  


We asked whether specific inspiratory muscle training (IMT) improves respiratory structure and function and peak exercise responses in highly trained athletes with cervical spinal cord injury (SCI). Ten Paralympic wheelchair rugby players with motor-complete SCI (C5-C7) were paired by functional classification then randomly assigned to an IMT or placebo group. Diaphragm thickness (B-mode ultrasonography), respiratory function [spirometry and maximum static inspiratory (PI ,max ) and expiratory (PE ,max ) pressures], chronic activity-related dyspnea (Baseline and Transition Dyspnea Indices), and physiological responses to incremental arm-crank exercise were assessed before and after 6 weeks of pressure threshold IMT or sham bronchodilator treatment. Compared to placebo, the IMT group showed significant increases in diaphragm thickness (P?=?0.001) and PI ,max (P?=?0.016). There was a significant increase in tidal volume at peak exercise in IMT vs placebo (P?=?0.048) and a strong trend toward an increase in peak work rate (P?=?0.081, partial eta-squared?=?0.33) and peak oxygen uptake (P?=?0.077, partial eta-squared?=?0.34). No other indices changed post-intervention. In conclusion, IMT resulted in significant diaphragmatic hypertrophy and increased inspiratory muscle strength in highly trained athletes with cervical SCI. The strong trend, with large observed effect, toward an increase in peak aerobic performance suggests IMT may provide a useful adjunct to training in this population. PMID:23530708

West, C R; Taylor, B J; Campbell, I G; Romer, L M



The effect of exercise and oxidant–antioxidant intervention on the levels of neurotrophins and free radicals in spinal cord of rats  

Microsoft Academic Search

Study design:This study was designed to investigate the effects of oxidant and antioxidant treatment, as well as regular exercise, on neurotrophin levels in the spinal cord of rats.Objectives:Reactive oxygen species (ROS) play a role in neurodegenerative diseases, but ROS at moderate levels could stimulate biochemical processes through redox-sensitive transcription.Methods:Exercised or sedentary animals were injected subcutaneously with hydrogen peroxide (H2O2), N-tert

S Siamilis; J Jakus; C Nyakas; A Costa; B Mihalik; A Falus; Z Radak



Renal function and endocrine responses to arm exercise in euhydrated individuals with spinal cord injury.  


This study investigated the renal and endocrine responses to arm exercise in persons with spinal cord injury (SCI) under euhydration conditions (ad libitum drinking of water) and determined the physiological effects of exercise on renal function in these subjects. Eleven SCI (spinal lesions between T6 and L1, American Spinal Injury Association impairment scale A) and 14 able-bodied (AB) persons first rested for 1 h in a sitting position, before undergoing 2-h arm-crank ergometer exercise at 60% of maximum oxygen consumption followed by a 2-h recovery period. On another day, all subjects participated in a time control study (5 h of rest condition in sitting position). Urine and blood samples were collected hourly. There were no differences in mean blood pressure between the two groups. SCI patients showed attenuated increase in plasma adrenaline and increase in plasma aldosterone compared with AB controls, but similar changes in human atrial natriuretic polypeptide, plasma renin activity and plasma antidiuretic hormone following the exercise. Creatinine clearance, osmolal clearance, free water clearance and fractional excretion of Na(+) did not change during exercise in any of the subjects. These findings suggested that activated aldosterone and attenuated adrenaline responses during exercise in SCI could be due to adaptation to disordered sympathetic nervous system triggered to maintain renal function. The results showed no exercise-related adverse effects on renal function in hydrated subjects with SCI. PMID:21850517

Kawasaki, Takashi; Nakamura, Takeshi; Sasaki, Yusuke; Sakamoto, Keiko; Ito, Tomoyuki; Goto, Masaki; Shimomatsu, Tomoya; Tajima, Fumihiro



Lipid profiles are influenced by arm cranking exercise and training in individuals with spinal cord injury  

Microsoft Academic Search

Study design:A prospective, two-group comparative intervention study.Objective:To determine the acute and training effects of arm cranking exercise on blood lipid profiles in wheel chair bound individuals with spinal cord injury (SCI) and normal able-bodied subjects.Setting:Faculty of Science, School of Sport and Exercise Science, Liverpool John Moores University, England.Methods:Total cholesterol, triglyceride and high-density lipoprotein cholesterol (HDL-C) at rest and in response

M S El-Sayed; A Younesian



Plasma IL6 levels during arm exercise in persons with spinal cord injury  

Microsoft Academic Search

Study design:Non-randomized study.Objectives:Previous studies indicated that at least 2-h leg exercise at more than 60% maximum oxygen consumption (VO2max) increased plasma interleukin (IL)-6 in able-bodied (AB) subjects. The purpose of the present study was to compare IL-6 response to arm exercise in AB subjects and persons with spinal cord injury (SCI).Setting:Wakayama Medical University in Japan.Methods:Six subjects with SCI between T6

Y Umemoto; K Furusawa; K Kouda; Y Sasaki; N Kanno; D Kojima; F Tajima



Cardiovascular determinants of exercise capacity in the Paralympic athlete with spinal cord injury.  


This report briefly summarizes the cardiovascular factors that influence exercise physiology and, eventually, sports performance of athletes with a spinal cord injury (SCI). The consequences of an SCI are numerous and concern voluntary muscle function, deep and superficial sensitivity, and autonomic function to a degree determined by the level and completeness of the spinal lesion. Athletes with SCI perform with their upper body, which limits their maximal exercise capacity and puts them at a disadvantage compared with leg exercise in terms of mechanical efficiency and physiological adaptations to exercise. Studies generally find that maximal oxygen consumption and mechanical power output are inversely related to spinal lesion level. Athletes with cervical or dorsal lesions down to Th6 have limited maximal heart rates owing to a lack of sympathetic drive to the heart. Blood redistribution from body areas lacking autonomic control is impaired, thus reducing venous return and limiting cardiac stroke volume during exercise. Thermoregulatory function is affected through a lack of afferent neural feedback and limited efferent vasomotor and sudomotor control below the lesion. Strategies to support venous return and to promote body cooling potentially improve physiological responses and athletic performance, especially in individuals with high lesion levels. The latter are subject to autonomic dysreflexia, a generalized sympathetic vasoconstriction below the lesion resulting from nociceptive stimulations in insensate body regions. Acute episodes induce high blood pressure, may enhance exercise performance and must be treated as a clinical emergency. Deliberate triggering of this reflex is prohibited by the International Paralympic Committee. PMID:22090064

Theisen, Daniel



Exercise pressor reflex function following acute hemi-section of the spinal cord in cats  

PubMed Central

Cardiovascular disease is a leading cause of morbidity and mortality in patients post spinal cord injury (SCI). The prescription of exercise as a therapeutic modality for disease prevention in this population is promising. It is logical to suggest that the sooner an exercise program can begin the more benefit the patient will receive from the therapy. However, the time point after injury at which the requisite circulatory responses needed to support exercise are viable remains largely unknown. The skeletal muscle exercise pressor reflex (EPR) significantly contributes to cardiovascular control during exercise in healthy individuals. Experiments in patients with a chronic lateral hemi-section of the spinal cord (Brown-Séquard syndrome) suggest that the EPR, although blunted, is operational when examined months to years post injury. However, whether this critically important reflex remains functional immediately after lateral SCI or, in contrast, experiences a period of reduced capacity due to spinal shock has not been established. This study was designed to assess EPR function after acute lateral transection of the spinal cord. The EPR was selectively activated in seven decerebrate cats via electrically stimulated static contraction of the triceps surae muscles of each hindlimb before and after lateral hemi-section of the T13–L2 region of the spinal cord. Compared to responses prior to injury, increases in mean arterial pressure (MAP) were significantly decreased when contracting the hindlimb either ipsilateral to the lesion (MAP = 17 ± 3 mmHg before and 9 ± 2 mmHg after) or contralateral to the lesion (MAP = 22 ± 5 mmHg before and 12 ± 4 mmHg after). The heart rate (HR) response to stimulation of the EPR was largely unaffected by induction of acute SCI. The findings suggest that the EPR maintains the ability to importantly contribute to cardiovascular regulation during exercise immediately following a Brown-Séquard-like injury.

Murphy, Megan N.; Ichiyama, Ronaldo M.; Iwamoto, Gary A.; Mitchell, Jere H.; Smith, Scott A.





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Is Exercise a Viable Treatment for Depression?  

PubMed Central

Depression is a common disorder that is associated with compromised quality of life, increased health care costs, and greater risk for a variety of medical conditions, particularly coronary heart disease. This review examines methods for assessing depression and discusses current treatment approaches. Traditional treatments include psychotherapy and antidepressant medications, but such treatments are not effective for all patients and alternative approaches have recently received increased attention, especially the use of aerobic exercise. This review examines evidence that exercise is effective in improving depressive symptoms among patients with major depression and offers practical suggestions for helping patients initiate and maintain exercise in their daily lives.

Blumenthal, James A.; Smith, Patrick J.; Hoffman, Benson M.



Spinal Recurrence From Intracranial Germinoma: Risk Factors and Treatment Outcome for Spinal Recurrence  

SciTech Connect

Purpose: To analyze retrospectively the risk factors of spinal recurrence in patients with intracranial germinoma and clinical outcomes of patients who developed spinal recurrence. Methods and Materials: Between 1980 and 2007, 165 patients with no evidence of spinal metastases at diagnosis were treated with cranial radiotherapy without spinal irradiation. The median follow-up in all 165 patients was 61.2 months (range, 1.2-260.1 months). Results: After the initial treatment, 15 patients (9.1%) developed spinal recurrences. Multivariate analysis revealed that large intracranial disease ({>=}4 cm) and multifocal intracranial disease were independent risk factors for spinal recurrence. Radiation field, total radiation dose, and the use of chemotherapy did not affect the occurrence of spinal recurrences. Of the 15 patients who experienced spinal recurrence, the 3-year actuarial overall survival and disease-free survival (DFS) rates from the beginning of salvage treatments were 65% and 57%, respectively. In the analysis, presence of intracranial recurrence and salvage treatment modality (radiotherapy with chemotherapy vs. radiotherapy alone) had a statistically significant impact on DFS. The 3-year DFS rate in patients with no intracranial recurrence and treated with both spinal radiotherapy and chemotherapy was 100%, whereas only 17% in patients with intracranial recurrence or treated with radiotherapy alone (p = 0.001). Conclusion: Large intracranial disease and multifocal intracranial disease were risk factors for spinal recurrence in patients with intracranial germinoma with no evidence of spinal metastases at diagnosis. For patients who developed spinal recurrence alone, salvage treatment combined with spinal radiotherapy and chemotherapy was effective in controlling the recurrent disease.

Ogawa, Kazuhiko [Department of Radiology, University of the Ryukyus, Okinawa (Japan)], E-mail:; Yoshii, Yoshihiko [Department of Neurosurgery, University of the Ryukyus, Okinawa (Japan); Shikama, Naoto [Department of Radiology, Shinshu University, Fukuoka (Japan); Nakamura, Katsumasa [Department of Radiology, Kyushu University, Nagano (Japan); Uno, Takashi [Department of Radiology, Chiba University, Chiba (Japan); Onishi, Hiroshi [Department of Radiology, Yamanashi University, Yamanashi (Japan); Itami, Jun [Department of Radiology, International Medical Center of Japan, Tokyo (Japan); Shioyama, Yoshiyuki [Department of Radiology, Shinshu University, Fukuoka (Japan); Iraha, Shiro [Department of Radiology, University of the Ryukyus, Okinawa (Japan); Hyodo, Akio [Department of Neurosurgery, University of the Ryukyus, Okinawa (Japan); Toita, Takafumi; Kakinohana, Yasumasa; Tamaki, Wakana [Department of Radiology, University of the Ryukyus, Okinawa (Japan); Ito, Hisao [Department of Radiology, Chiba University, Chiba (Japan); Murayama, Sadayuki [Department of Radiology, University of the Ryukyus, Okinawa (Japan)



Spinal manipulation for low-back pain: a treatment package agreed by the UK chiropractic, osteopathy and physiotherapy professional associations  

Microsoft Academic Search

Trials of manipulative treatment have been compromised by, amongst other things, different definitions of the therapeutic procedures involved. This paper describes a spinal manipulation package agreed by the UK professional bodies that represent chiropractors, osteopaths and physiotherapists. It was devised for use in the UK Back pain Exercise And Manipulation (UK BEAM) trial—a national study of physical treatments in primary

E. Harvey; A. K. Burton; J. K. Moffett; A. Breen



Passive Exercise of the Hind Limbs after Complete Thoracic Transection of the Spinal Cord Promotes Cortical Reorganization  

PubMed Central

Physical exercise promotes neural plasticity in the brain of healthy subjects and modulates pathophysiological neural plasticity after sensorimotor loss, but the mechanisms of this action are not fully understood. After spinal cord injury, cortical reorganization can be maximized by exercising the non-affected body or the residual functions of the affected body. However, exercise per se also produces systemic changes – such as increased cardiovascular fitness, improved circulation and neuroendocrine changes – that have a great impact on brain function and plasticity. It is therefore possible that passive exercise therapies typically applied below the level of the lesion in patients with spinal cord injury could put the brain in a more plastic state and promote cortical reorganization. To directly test this hypothesis, we applied passive hindlimb bike exercise after complete thoracic transection of the spinal cord in adult rats. Using western blot analysis, we found that the level of proteins associated with plasticity – specifically ADCY1 and BDNF – increased in the somatosensory cortex of transected animals that received passive bike exercise compared to transected animals that received sham exercise. Using electrophysiological techniques, we then verified that neurons in the deafferented hindlimb cortex increased their responsiveness to tactile stimuli delivered to the forelimb in transected animals that received passive bike exercise compared to transected animals that received sham exercise. Passive exercise below the level of the lesion, therefore, promotes cortical reorganization after spinal cord injury, uncovering a brain-body interaction that does not rely on intact sensorimotor pathways connecting the exercised body parts and the brain.

Knudsen, Eric B.; Shumsky, Jed; Moxon, Karen A.



The treatment for multilevel noncontiguous spinal fractures  

PubMed Central

We report the outcome of 30 patients with multilevel noncontiguous spinal fractures treated between 2000 and 2005. Ten cases were treated conservatively (group A), eight cases were operated on at only one level (group B), and 12 cases were treated surgically at both levels (group C). All cases were followed up for 14–60 months (mean 32 months). Initial mobilisation with a wheelchair or crutches in group A was 9.2±1.1 weeks, which was significantly longer than groups B and C with 6.8±0.7 weeks and 3.1±0.4 weeks, respectively. Operative time and blood loss in group C were significantly more than group B. The neurological deficit improved in six cases in group A (60%), six in group B (75%) and eight in group C (80%). Correction of kyphotic deformity was significantly superior in groups C and B at the operated level, and increasing deformity occurred in groups A and B at the non-operated level. From the results we believe that three treatment strategies were suitable for multilevel noncontiguous spinal fractures, and individualised treatment should be used in these patients. In the patients treated surgically, the clinical and radiographic outcomes are much better.

Lian, Xiao Feng; Hou, Tie Sheng; Yuan, Jian Dong; Jin, Gen Yang; Li, Zhong Hai



Functional role of exercise-induced cortical organization of sensorimotor cortex after spinal transection.  


Spinal cord transection silences neuronal activity in the deafferented cortex to cutaneous stimulation of the body and untreated animals show no improvement in functional outcome (weight-supported stepping) with time after lesion. However, adult rats spinalized since neonates that receive exercise therapy exhibit greater functional recovery and exhibit more cortical reorganization. This suggests that the change in the somatotopic organization of the cortex may be functionally relevant. To address this issue, we chronically implanted arrays of microwire electrodes into the infragranular layers of the hindlimb somatosensory cortex of adult rats neonatally transected at T8/T9 that received exercise training (spinalized rats) and of normal adult rats. Multiple, single neuron activity was recorded during passive sensory stimulation, when the animals were anesthetized, and during active sensorimotor stimulation during treadmill-induced locomotion when the animal was awake and free to move. Our results demonstrate that cortical neurons recorded from the spinalized rats that received exercise 1) had higher spontaneous firing rates, 2) were more likely to respond to both sensory and sensorimotor stimulations of the forelimbs, and also 3) responded with more spikes per stimulus than those recorded from normal rats, suggesting expansion of the forelimb map into the hindlimb map. During treadmill locomotion the activity of neurons recorded from neonatally spinalized rats was greater during weight-supported steps on the treadmill compared with the neuronal activity during nonweight supported steps. We hypothesize that this increased activity is related to the ability of the animal to take weight supported steps and that, therefore, these changes in cortical organization after spinal cord injury are relevant for functional recovery. PMID:21865438

Kao, T; Shumsky, J S; Knudsen, E B; Murray, M; Moxon, K A



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


[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



Excess post-exercise oxygen consumption in spinal cord-injured men  

Microsoft Academic Search

This study examined excess post-exercise oxygen consumption (EPOC) following arm cranking in men who had a traumatic spinal cord injury (SCI). Six physically active SCI men with a lesion level between T10 and T12 and six able-bodied (AB) men who were matched according to upper body peak VO 2 performed 30 min of arm-cranking at 65–70% peak VO 2. Baseline measurements

Darlene A. Sedlock; Donald A. Schneider; Elizabeth Gass; Greg Gass



Spinal extension exercises prevent natural progression of kyphosis  

Microsoft Academic Search

Introduction  The angle of kyphosis increases with age with the most rapid increase occurring between 50 and 60 years. The progression of\\u000a kyphosis was prevented in women ages 50–59 years who performed extension exercises three times a week for one year.\\u000a \\u000a \\u000a \\u000a Introduction  The purpose of this study was to (1) measure the progression of the angle of kyphosis with age and (2)

J. M. Ball; P. Cagle; B. E. Johnson; C. Lucasey; B. P. Lukert



Effects of Exercise Training and Inspiratory Muscle Training in Spinal Cord Injury: A Systematic Review  

PubMed Central

Objective: To provide a systematic review of the studies assessing exercise training and inspiratory muscle training (IMT) in individuals for the improved respiratory function of patients with spinal cord injury (SCI). Methods: Thirteen studies (5 exercise training, 8 IMT) were identified. Articles were scored for their methodological quality using the Physiotherapy Evidence Database scores and Downs and Black tools for randomized and nonrandomized studies, respectively. Conclusions were based on the most rigorously executed studies using Sackett's levels of evidence. Results: Study comparison was compromised by diverse research designs; small sample sizes; and heterogeneity of studied populations, protocols, and outcome measures. Based on current literature, there is level 2 evidence supporting exercise training as an intervention to improve respiratory strength and endurance and level 4 evidence to support exercise training as an intervention that might improve resting and exercising respiratory function in people with SCI. There is level 4 evidence to support IMT as an intervention that might decrease dyspnea and improve respiratory function in people with SCI. Conclusions: There are insufficient data to strongly support the use of exercise training or IMT for improved respiratory function in people with SCI. There is some evidence of efficacy of both regimens; however, the evidence is not of the best possible quality.

Sheel, A. William; Reid, Wendy Darlene; Townson, Andrea F; Ayas, Najib T; Konnyu, Kristin J



Impact of exercise on neuroplasticity-related proteins in spinal cord injured humans.  


The present study investigated the effects of exercise on the serum concentrations of brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), prolactin (PRL) and cortisol (COR) in 11 chronically spinal cord-injured athletes. In these subjects BDNF concentration at rest was sixfold higher compared with the concentrations reported earlier in able-bodied persons, while IGF-1, PRL and COR were within normal range. Ten minutes of moderate intensity handbiking (54% of the maximal heart rate) during a warm-up period (W) induced an increase (P<0.05) of BDNF of approximately 1.5-fold from basal level at rest, while a decrease to basal level was found after an immediately succeeding handbiking time trial (89% of the maximal heart rate) over the marathon distance of 42 km (M). An increase (P<0.01) of serum IGF-1 was found after W and this levels remained elevated (P<0.01) until the end of M. W had no significant effects on the serum PRL and COR, however, M induced an increase (P<0.01) of both hormones. This is the first study showing elevated BDNF concentrations at rest in spinal cord-injured athletes. Furthermore, short moderate intensity handbiking but not immediately following long lasting high intensity handbiking further increases serum BDNF concentrations. IGF-1 response to exercise differs to BDNF response as this neuroplasticity-related protein remains elevated during the long lasting physical demand with high intensity. The augmented PRL concentration suggests that a possible mechanism by which exercise promotes neuroplasticity might be the activation of neural serotonergic pathways as 5-HT is the main PRL releasing factor. Elevated COR concentrations after M are unlikely to be deleterious to neuroplasticity as COR concentrations remain within the physiological range. The present study suggests that exercise might be beneficial to enhance neuroprotection and neuroplasticity, thereby improving recovery after spinal cord injury. PMID:18440711

Rojas Vega, S; Abel, T; Lindschulten, R; Hollmann, W; Bloch, W; Strüder, H K



Treatment of spinal neoplasms using frameless stereotactic radiosurgery  

Microsoft Academic Search

Purpose of study: The use of stereotactic radiosurgery for the treatment of spinal lesions has been limited by the availability of effective target immobilization devices. Thi?s study evaluated the feasibility of treating spinal neoplasms with a single-fraction radiosurgical technique using the CyberKnife Image-Guided Radiosurgery System. During treatment, a real-time image-guidance system tracks the patient's tumor. Information about tumor position is

Peter C. Gerszten; Stephen A. Burton; Ronald J. Lalonde; Paula M. McGrath; Shalom Kalnicki; Cihat Ozhasoglu; William C. Welch



The Role of Physical Exercise in Alcoholism Treatment and Recovery  

Microsoft Academic Search

A growing body of literature has demonstrated that physical exercise is associated with favorable mental health outcomes. Exercise has the potential to be an accessible and affordable adjunct treatment option for persons with alcohol use disorders (AUD); however, exercise-based interventions have rarely been applied to this population. The authors examine the potential role of physical exercise in the process of

Jennifer P. Read; Richard A. Brown



Comparison of intradiscal pressures and spinal fixator loads for different body positions and exercises.  


Loading of the spine is still not well understood. The most reliable results seemed to come from the intradiscal pressure measurements from studies by Nachemson, 1966. A new similar study by Wilke et al. (1999) complemented the present study and confirmed some of the earlier data, although it contradicted others. The new data did not confirm that the load on the spine is higher in sitting compared with standing and did not find distinct differences between positions in which subjects were lying down. The objective of this paper was to compare results from two independent in vivo studies (applying different methods) to provide information about spinal loading. In one of these studies (Wilke 1999), intradiscal pressure was measured in one volunteer in different postures and exercises, and in the other study (Rohlmann et al. 1994) the loads on an internal spinal fixation device (an implant for stabilising unstable spines) were determined in 10 patients. The absolute values of the results from both studies were normalized and compared for many body positions and dynamic exercises. The relative differences in intradiscal pressure and flexion bending moments in the fixators corresponded in most cases. Both studies showed slightly lower loads for sitting than for standing and comparatively low loads in all lying positions. High loads were measured for jogging, jumping on a trampoline and skipping. Differences between trends for intradiscal pressure and for flexion bending moments in the fixators were found when the load was predominantly carried by the anterior spinal column, as during flexion of the upper part of the body or when lifting and carrying weights. The combination of the results from these two methods may improve the understanding of the biomechanical behaviour of the lumbar spine and may be used to validate models and theories of spinal loading. PMID:11450876

Rohlmannt, A; Claes, L E; Bergmannt, G; Graichen, F; Neef, P; Wilke, H J



Short-term exercise increases GDNF protein levels in the spinal cord of young and old rats.  


Neurotrophic factors may play a role in exercise-induced neuroprotective effects, however it is not known if exercise mediates changes in glial cell line-derived neurotrophic factor (GDNF) protein levels in the spinal cord. The aim of the current study was to determine if 2 weeks of exercise alters GDNF protein content in the lumbar spinal cord of young and old rats. GDNF protein was quantified via an enzyme-linked immunosorbent assay and Western blot. Immunohistochemical analysis localized GDNF in choline acetyltransferase (ChAT)-positive motor neurons and cell body areas were measured. Involuntary running in the young animals appeared to elicit the greatest increase in GDNF protein content (sixfold increase), followed by swimming (threefold increase) and voluntary running (twofold increase); however there was no significant difference between the modalities of exercise. Low-intensity running of the old animals significantly increased GDNF protein content in the spinal cord. Both young and old exercised animals showed a doubling in ChAT-positive motor neuron cell body areas. These results suggest that GDNF protein content in the spinal cord is modulated by exercise. PMID:23500094

McCullough, M J; Gyorkos, A M; Spitsbergen, J M



Functional Outcome of Bone Marrow Stem Cells (CD45 +\\/CD34 ?) After Cell Therapy in Acute Spinal Cord Injury: In Exercise Training and in Sedentary Rats  

Microsoft Academic Search

BackgroundCell therapy and exercise training may be options for spinal cord regeneration. Our objective was to evaluate the functional effects of autologous bone marrow stem cell (CD45+\\/CD34?) transplantation in acute spinal cord injury in exercise training and in sedentary rats.

K. A. T. Carvalho; R. C. Cunha; E. N. Vialle; R. Osiecki; G. H. G. Moreira; R. B. Simeoni; J. C. Francisco; L. C. Guarita-Souza; L. Oliveira; L. Zocche; M. Olandoski



[Lumbar spinal stenosis: scientific evidence of surgical treatment].  


In 2000, Nachemson and coll. published a book about modern treatment of spine related pathologies. They concluded that evidence regarding efficiency of surgical and non surgical treatments of lumbar spinal stenosis was poor. Despite this and the fact that the precise mechanism of pain is still unknown, surgical treatment of spinal stenosis, mainly consisting in a laminectomy, has made it through the years. More recently, higher quality scientific publications have brought significant evidence that surgery yields better short and long term functional results, than non surgical conservative treatment. This advantage might also compensate for possible internistic complications in a usually older and fragile population. PMID:19405274

Faundez, Antonio Arturo



The Effects of Glucocorticoid and Voluntary Exercise Treatment on the Development of Thoracolumbar Kyphosis in Dystrophin-Deficient Mice  

PubMed Central

The development of spinal curvature deformities is a hallmark of muscular dystrophy. While glucocorticoid treatment has been shown to prolong muscle function in dystrophic mice, its effects on the development of dystrophinopathic spinal deformation are poorly understood. In this study, we test the effects of glucocorticoid treatment on the onset of thoracolumbar kyphosis in the dystrophin-deficient mdx mouse using voluntary running exercise to exacerbate muscle fibrosis. We measure the kyphotic index, erector spinae muscle fibrosis, and vertebral bone histomorphometry in 4-month-old mdx mice in four groups: sedentary control, exercise-treated (continuous voluntary access to an activity wheel), glucocorticoid-treated, and glucocorticoid + exercise-treated. Exercise treated mice were found to have significantly lower kyphotic index (i.e., greater kyphosis) and greater muscle fibrosis relative to controls (p < 0.05). However, the deleterious effect of exercise on KI and muscle fibrosis was prevented by glucocorticoid treatment. Some differences in bone histological parameters were observed between treatment groups, suggesting there is a complex relationship between dystrophic muscular changes and vertebral bone mass. Our findings indicate glucocorticoid treatment delays the onset of thoracodorsal spinal deformation in mdx mice.

Brereton, Daniel; Plochocki, Jeffrey; An, Daniel; Costas, Jeffrey; Simons, Erin



Excess post-exercise oxygen consumption in spinal cord-injured men.  


This study examined excess post-exercise oxygen consumption (EPOC) following arm cranking in men who had a traumatic spinal cord injury (SCI). Six physically active SCI men with a lesion level between T10 and T12 and six able-bodied (AB) men who were matched according to upper body peak VO(2) performed 30 min of arm-cranking at 65-70% peak VO(2). Baseline measurements were recorded during the last 10 min of a 40-min seated rest. Subjects remained seated during recovery for 40 min or until VO(2) returned to baseline, whichever was longer. Plasma lactate concentration was measured at rest, at the end of exercise, and at 10, 20 and 40 min of recovery. EPOC duration was not significantly different ( P>0.05) between SCI [23.2 (7.9) min; mean (SE)] and AB [35.0 (15.4) min] men, nor was there a significant group difference in EPOC magnitude [36.8 (7.8) kJ for SCI and 53.0 (22.8) kJ for AB]. There was no significant difference in recovery heart rate (HR) or respiratory exchange ratio (RER) between SCI and AB. However, HR measured at the end of the EPOC period was significantly elevated ( P<0.001) and RER significantly lower ( P<0.03) for both groups when compared to baseline. Lactate concentration was not significantly different between the groups at any sampling period. The findings suggest that physically active SCI men have a similar energy expenditure and time frame for recovery from arm crank exercise as their AB counterparts. Similar to what has been reported following lower body exercise, arm crank exercise elicits a higher HR and lower RER at end-EPOC when compared to pre-exercise values. PMID:15349783

Sedlock, Darlene A; Schneider, Donald A; Gass, Elizabeth; Gass, Greg



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



Treatment of Charcot spinal arthropathy following traumatic paraplegia.  


Four cases of Charcot's spinal arthropathy in patients with complete traumatic paraplegia were diagnosed an average of 12 years (range, 4-22 years) postinjury. Each patient had previous posterior spinal fusion with Harrington instrumentation. The Charcot joint occurred just below the fusion near the thoracolumbar junction and well below the level of spinal cord injury. All four patients experienced progressive kyphosis, flexion instability, and loss of height. Each underwent a treatment protocol that included anterior fusion with partial resection of the Charcot joint and staged posterior spinal fusion and stabilization with Cotrel-Dubousset (CD) rods. At follow-up evaluation 18-30 months postoperatively, three of four patients showed complete healing with kyphosis correction. One patient developed loosening of his lower hooks at 6 months postoperatively and required posterior revision with ultimate healing. Resection of the involved segments along with two-stage fusion with segmental instrumentation provides excellent management of this difficult problem. PMID:1806086

McBride, G G; Greenberg, D



[Tuberculous spondylitis complicated by spinal disorders: diagnosis and treatment].  


Complex diagnosis using additional radiation procedures (computed tomography and magnetic resonance imaging) for tuberculous spondylitis complicated by spinal disorders was made in 52 patients. It made the genesis of spinal cord disorders more clear. The genesis was due to epidural abscess, necrotic osseous tissue and bony compression of destroyed vertebrae. Spinal cord structural changes were detectable in the postoperative period. Hemosorption in combination with blood ultraviolet radiation was used in 25 (40%) patients for their indications, which allowed all the patients to be operated on. Surgical treatment of 60 patients by using radical interventions into the target site and extended corporolateral decompression of the spinal cord, by employing autograft spondylolodesis resulted in rehabilitation in 95% of cases. PMID:10900983

Akhmetov, A A; Amanzholova, L K; Tutkyshbaev, S O



Does 20-min arm crank ergometer exercise increase plasma interleukin-6 in individuals with cervical spinal cord injury?  

Microsoft Academic Search

Interleukin-6 (IL-6) is produced by contracting skeletal muscles and then released into the circulation and considered to\\u000a mediate the health benefits of exercise against chronic diseases. Individuals with spinal cord injury (SCI) are reported to\\u000a be at higher risk of developing metabolic diseases. We investigated the IL-6 responses to 20-min arm crank ergometer exercise\\u000a at 60% of maximum oxygen consumption

Ken Kouda; Kazunari Furusawa; Hiroyuki Sugiyama; Tadashi Sumiya; Tomoyuki Ito; Fumihiro Tajima; Katsuji Shimizu


Peripheral fatigue limits endurance exercise via a sensory feedback-mediated reduction in spinal motoneuronal output.  


This study sought to determine whether afferent feedback associated with peripheral muscle fatigue inhibits central motor drive (CMD) and thereby limits endurance exercise performance. On two separate days, eight men performed constant-load, single-leg knee extensor exercise to exhaustion (85% of peak power) with each leg (Leg1 and Leg2). On another day, the performance test was repeated with one leg (Leg1) and consecutively (within 10 s) with the other/contralateral leg (Leg2-post). Exercise-induced quadriceps fatigue was assessed by reductions in potentiated quadriceps twitch-force from pre- to postexercise (?Qtw,pot) in response to supramaximal magnetic femoral nerve stimulation. The output from spinal motoneurons, estimated from quadriceps electromyography (iEMG), was used to reflect changes in CMD. Rating of perceived exertion (RPE) was recorded during exercise. Time to exhaustion (?9.3 min) and exercise-induced ?Qtw,pot (?51%) were similar in Leg1 and Leg2 (P > 0.5). In the consecutive leg trial, endurance performance of the first leg was similar to that observed during the initial trial (?9.3 min; P = 0.8); however, time to exhaustion of the consecutively exercising contralateral leg (Leg2-post) was shorter than the initial Leg2 trial (4.7 ± 0.6 vs. 9.2 ± 0.4 min; P < 0.01). Additionally, ?Qtw,pot following Leg2-post was less than Leg2 (33 ± 3 vs 52 ± 3%; P < 0.01). Although the slope of iEMG was similar during Leg2 and Leg2-post, end-exercise iEMG following Leg2-post was 26% lower compared with Leg2 (P < 0.05). Despite a similar rate of rise, RPE was consistently ?28% higher throughout Leg2-post vs. Leg2 (P < 0.05). In conclusion, this study provides evidence that peripheral fatigue and associated afferent feedback limits the development of peripheral fatigue and compromises endurance exercise performance by inhibiting CMD. PMID:23722705

Amann, Markus; Venturelli, Massimo; Ives, Stephen J; McDaniel, John; Layec, Gwenael; Rossman, Matthew J; Richardson, Russell S



Health and fitness in pediatric spinal cord injury: medical issues and the role of exercise.  


Children with spinal cord injury (SCI) are at risk for the same health related complications experienced by adults with SCI; however, children are likely at increased risk due to the young age at which the injury was sustained. Common health related complications impact the cardiovascular, respiratory, and musculoskeletal systems, increasing the risk of cardiovascular disease, metabolic syndrome, and fractures, as well as impacting the ability to complete everyday tasks. The available literature shows that children and adults with SCI have a high prevalence of metabolic syndrome and decreased muscle mass, resting energy expenditure, peak oxygen consumption, and bone mineral density. Exercise may have an impact on these complications, thus increasing overall health and fitness. Some literature is available on the effects of exercise for adults with SCI, but few studies have examined these effects for children. Pediatric and adult studies have shown some positive effects on muscle mass, resting energy expenditure, peak oxygen consumption, and bone mineral density. However, more research is needed to develop optimal exercise programs that adequately address long-term health in children who have a long lifetime ahead. PMID:23481890

Johnston, Therese E; McDonald, Craig M



Experimental Studies on Surgical Treatment of Avulsed Spinal Nerve Roots in Brachial Plexus Injury  

Microsoft Academic Search

This review summarises studies aiming at a surgical treatment of spinal nerve root avulsions from the spinal cord in brachial plexus lesions. After dorsal root injury, regrowth of nerve fibres into the spinal cord occurs only in the immature animal. After ventral root avulsion and subsequent implantation into the spinal cord, neuroanatomical and neurophysiological data show that motoneurons are capable




Forced exercise as a rehabilitation strategy after unilateral cervical spinal cord contusion injury.  


Evaluation of locomotor training after spinal cord injury (SCI) has primarily focused on hind limb recovery, with evidence of functional and molecular changes in response to exercise. Since trauma at a cervical (C) level is common in human SCI, we used a unilateral C4 contusion injury model in rats to determine whether forced exercise (Ex) would affect spinal cord biochemistry, anatomy, and recovery of fore and hind limb function. SCI was created with the Infinite Horizon spinal cord impactor device at C4 with a force of 200 Kdyne and a mean displacement of 1600-1800 microm in adult female Sprague-Dawley rats that had been acclimated to a motorized exercise wheel apparatus. Five days post-operatively, the treated group began Ex on the wheel for 20 min per day, 5 days per week for 8 weeks. Wheel speed was increased daily according to the abilities of each animal up to 14 m/min. Control rats were handled daily but were not exposed to Ex. In one set of animals experiencing 5 days of Ex, there was a moderate increase in brain-derived neurotrophic factor (BDNF) and heat shock protein-27 (HSP-27) levels in the lesion epicenter and surrounding tissue. Long-term (8 weeks) survival groups were exposed to weekly behavioral tests to assess qualitative aspects of fore limb and hind limb locomotion (fore limb scale, FLS and BBB [Basso, Beattie, and Bresnahan locomotor rating scale]), as well as sensorimotor (grid) and motor (grip) skills. Biweekly assessment of performance during wheel walking examined gross and fine motor skills. The FLS indicated a significant benefit of Ex during weeks 2-4. The BBB test showed no change with Ex at the end of the 8-week period, however hind limb grid performance was improved during weeks 2-4. Lesion size was not affected by Ex, but the presence of phagocytic and reactive glial cells was reduced with Ex as an intervention. These results suggest that Ex alone can influence the evolution of the injury and transiently improve fore and hind limb function during weeks 2-4 following a cervical SCI. PMID:19489718

Sandrow-Feinberg, Harra R; Izzi, Jessica; Shumsky, Jed S; Zhukareva, Victoria; Houle, John D



Spinal cord GABA receptors modulate the exercise pressor reflex in decerebrate rats.  


Neurotransmitters and neuromodulators released by contraction-activated skeletal muscle afferents into the dorsal horn of the spinal cord initiate the central component of the exercise pressor reflex (EPR). Whether ?-aminobutyric acid (GABA), a major inhibitory neurotransmitter within the mammalian central nervous system, is involved in the modulation of the EPR at the level of dorsal horn remains to be determined. We performed local microinjection of either the GABA(A) antagonist bicuculline or the GABA(B) antagonist CGP 52432 into the ipisilateral L4/L5 dorsal horns to investigate the effect of GABA receptor blockade on the pressor response to either static contraction induced by stimulation of the peripheral end of L4/L5 ventral roots, passive stretch, or hindlimb arterial injection of capsaicin (0.1 ?g/0.2 ml) in decerebrate rats. Microinjection of either bicuculline (1 mM, 100 nl) or CGP 52432 (10 mM, 100 nl) into the L4/5 dorsal horns significantly increased the pressor and cardioaccelerator responses to all stimuli. Microinjection of either bicuculline or CGP 52432 into the L5 dorsal horn significantly increased the pressor and cardioaccelerator responses to direct microinjection of l-glutatmate (10 mM, 100 nl) into this spinal segment. The disinhibitory effect of both GABA receptor antagonists on the EPR was abolished by microinjection of the broad-spectrum glutamate receptor antagonist kynurenate (10 mM/100 nl). These data suggest that 1) GABA exerts a tonic inhibition of the EPR at the level of dorsal horn; and 2) that an interaction between glutamatergic and GABAergic inputs exist at the level of dorsal horn, contributing to spinal control of the EPR. PMID:23637133

Wang, Han-Jun; Wang, Wei; Patel, Kaushik P; Rozanski, George J; Zucker, Irving H



Acute Leptin Treatment Enhances Functional Recovery after Spinal Cord Injury  

PubMed Central

Background Spinal cord injury is a major cause of long-term disability and has no current clinically accepted treatment. Leptin, an adipocyte-derived hormone, is best known as a regulator of food intake and energy expenditure. Interestingly, several studies have demonstrated that leptin has significant effects on proliferation and cell survival in different neuropathologies. Here, we sought to evaluate the role of leptin after spinal cord injury. Findings Based on its proposed neuroprotective role, we have evaluated the effects of a single, acute intraparenchymal injection of leptin in a clinically relevant animal model of spinal cord injury. As determined by quantitative Real Time-PCR, endogenous leptin and the long isoform of the leptin receptor genes show time-dependent variations in their expression in the healthy and injured adult spinal cord. Immunohistochemical analysis of post-injury tissue showed the long isoform of the leptin receptor expression in oligodendrocytes and, to a lesser extent, in astrocytes, microglia/macrophages and neurons. Moreover, leptin administered after spinal cord injury increased the expression of neuroprotective genes, reduced caspase-3 activity and decreased the expression of pro-inflammatory molecules. In addition, histological analysis performed at the completion of the study showed that leptin treatment reduced microglial reactivity and increased caudal myelin preservation, but it did not modulate astroglial reactivity. Consequently, leptin improved the recovery of sensory and locomotor functioning. Conclusions Our data suggest that leptin has a prominent neuroprotective and anti-inflammatory role in spinal cord damage and highlights leptin as a promising therapeutic agent.

Fernandez-Martos, Carmen Maria; Gonzalez, Pau; Rodriguez, Francisco Javier



Development and Treatments of Inflammatory Cells and Cytokines in Spinal Cord Ischemia-Reperfusion Injury  

PubMed Central

During aortic surgery, interruption of spinal cord blood flow might cause spinal cord ischemia-reperfusion injury (IRI). The incidence of spinal cord IRI after aortic surgery is up to 28%, and patients with spinal cord IRI might suffer from postoperative paraplegia or paraparesis. Spinal cord IRI includes two phases. The immediate spinal cord injury is related to acute ischemia. And the delayed spinal cord injury involves both ischemic cellular death and reperfusion injury. Inflammation is a subsequent event of spinal cord ischemia and possibly a major contributor to spinal cord IRI. However, the development of inflammatory mediators is incompletely demonstrated. And treatments available for inflammation in spinal cord IRI are insufficient. Improved understanding about spinal cord IRI and the development of inflammatory cells and cytokines in this process will provide novel therapeutic strategies for spinal cord IRI. Inflammatory cytokines (e.g., TNF-? and IL-1) may play an important role in spinal cord IRI. For treatment of several intractable autoimmune diseases (e.g., rheumatoid arthritis), where inflammatory cytokines are involved in disease progression, anti-inflammatory cytokine antagonist is now available. Hence, there is great potential of anti-inflammatory cytokine antagonist for therapeutic use of spinal cord IRI. We here review the mediators and several possibilities of treatment in spinal cord IRI.

Zhu, Ping; Li, Jia-xin; Fujino, Masayuki; Zhuang, Jian; Li, Xiao-Kang



[Maximal exercise in spinal cord injured subjects: effects of an antigravity suit].  


Paraplegics have low aerobic capacity because of the spinal cord injury. Their functional muscle mass is reduced and usually untrained. They have to use upperbody muscles for displacements and daily activities. Sympathic nervous system injury is responsible of vasomotricity disturbances in leg vessels and possible abdominal vessels, proportionally to level injury. If cord injury level is higher than T5, then sympathic cardiac efferences may be damaged. Underbody muscles atrophy and vasomotricity disturbances contribute to phlebostasis. This stasis may decrease venous return, preload and stroke volume (Starling). To maintain appropriate cardiac output, tachycardia is necessary, especially during exercise. Low stroke volume, all the more since it is associated with cardio-acceleration disturbances, may reduce cardiac output reserve, and so constitutes a limiting factor for adaptation to exercise. The aim of this study was to verify if use of an underlesional pressure suit may increase cardiac output reserve because of lower venous stasis, and increase performance. We studied 10 able-bodied and 14 traumatic paraplegic subjects. Able-bodied subjects were 37 +/- 6 years old, wellbeing, not especially trained with upperbody muscles: there were 2 women and 8 men. Paraplegics were 27 +/- 7 years old, wellbeing except paraplegia, five of them practiced sport regularly (athletism or basket for disabled), and the others just daily propelled their wheelchair; there were 5 women and 9 men. For 8 of them, cord injury levels were located below T7, between T1 and T6 for the others. The age disability varied from 6 months to 2 years for 9 of them, it was approximately five years for 4 of them, and 20 years for one. We used a maximal triangular arm crank exercise with an electro-magnetic ergocycle Gauthier frame. After five minutes warm up, it was proceeded in one minute successive stages until maximal oxygen consumption is raised. VO2, VCO2, RER were measured by direct method with an Ergostar analyser every 30 seconds. Heart rate was registered continuously using a cardio-frequence-meter Baumann, and ECG was observed on a Cardiovit electro-cardiograph. Each subject reached maximal exercises on different days: one without any contention, and the other one with abdomen and legs contention using an antigravity suit, inflated to 45-50 mm Hg for legs and 30-40 mm Hg for abdomen. The able-bodied subjects VO2 peak was 24 +/- 5.8 mL min-1 kg-1, without any change on peak VO2 and on cardiac frequency when pressure suit was used. Results were different for paraplegics: peak VO2 was significantly higher (21.5 +/- 6.5 mL min-1 kg-1 without contention and 23.8 +/- 6.3 mL min-1 kg-1 with contention), heart rate was significantly lower at all stages of exercise with antigravity suit and comfort was better during exercise and rest. In our study, contention contributed to increase paraplegics's performances, but responses depend also on spinal cord level, injury age, spasticity. Therefore, testing paraplegics using an antigravity suit may be useful to determine if neurovegetative disturbances significantly modify their cardiac adaptation and capability. If gravity suit is efficient, contention tights might be prescribed, with respect to subject's legs measurements. But, because these tights are very difficult to put on, their efficiency has to be proved before, the motivation of the subject is essential too. PMID:11541516

Bazzi-Grossin, C; Bonnin, P; Bailliart, O; Bazzi, H; Kedra, A W; Martineaud, J P



Staying physically active after spinal cord injury: a qualitative exploration of barriers and facilitators to exercise participation  

PubMed Central

Background While enhancing physical activity has been an essential goal of public health officials, people with physical impairments such as spinal cord injury (SCI) are more likely to live a sedentary lifestyle. Exercise has been shown to decrease the risk for many of the secondary conditions associated with SCI, including osteoporosis, cardiovascular disease, pressure ulcers, urinary tract infections, diabetes and arthritis, yet this population is rarely a target for health promotion efforts. This paper examines the self-reported exercise experiences of people with SCI using a qualitative-exploratory design. Methods We enrolled 26 individuals with SCI (15 self-described 'exercisers' and 11 'non-exercisers') from a non-random pool of survey responders. Semi-structured phone interviews were conducted to record participants' experiences with exercise pre/post injury, barriers and facilitators to being active and perceived health impact. Results Regardless of exercise status, all participants reported physical activity prior to injury and expressed interest in becoming active or maintaining an active lifestyle. Participants identified a range of both motivational and socio-environmental factors that were either facilitating or constraining of such a lifestyle. Non-exercisers identified barriers to exercise, including a perceived low return on physical investment, lack of accessible facilities, unaffordable equipment, no personal assistance and fear of injury. Exercisers identified facilitators, including personal motivation, independence, availability of accessible facilities and personal assistants, fear of health complications, and weight management. Exercisers associated a greater range of specific health benefits with being active than non-exercisers. Conclusion Despite motivation and interest in being exercise active, people with SCI face many obstacles. Removal of barriers coupled with promotion of facilitating factors, is vital for enhancing opportunities for physical activity and reducing the risk of costly secondary conditions in this population.

Kehn, Matthew; Kroll, Thilo



Exercise performance during captopril and atenolol treatment in hypertensive patients.  

PubMed Central

1. Maximal aerobic exercise capacity, submaximal endurance exercise performance, and exercise haemodynamics have been studied in sixteen patients with mild to moderate essential hypertension during treatment with captopril and atenolol. 2. Administration of atenolol (1 x 100 mg day-1) or captopril (1 x 100 mg day-1) for 6 weeks resulted in similar supine and erect systolic and diastolic blood pressures. Heart rate was significantly lower during atenolol treatment. 3. Exercise heart rate and systolic blood pressure were significantly lower during atenolol than during captopril treatment, exercise diastolic blood pressure (at 100W) did not differ significantly. With atenolol exercise cardiac output was significantly lower and exercise stroke volume significantly higher than with captopril. 4. Maximal work rate, maximal oxygen consumption and maximal heart rate were significantly lower during atenolol than during captopril treatment (respectively 6%, 8% and 25%). Maximal respiratory exchange ratio and lactate concentration did not differ. 5. No statistically significant difference in submaximal endurance time between atenolol and captopril was found. Endurance time was reduced by 19% during atenolol and by 13% during captopril as compared with placebo. No difference in rating of perceived exertion between atenolol and captopril was present. 6. The results indicate that atenolol will reduce blood pressure during exercise more effectively than captopril in patients with hypertension. The limitation of submaximal endurance exercise performance by both agents is of similar magnitude. This may be regarded as an unwanted side effect in certain physically active patients with hypertension.

Van Baak, M A; Koene, F M; Verstappen, F T; Tan, E S



Return to Full Functioning after Graded Exercise Assessment and Progressive Exercise Treatment of Postconcussion Syndrome  

PubMed Central

Exercise assessment and aerobic exercise training for postconcussion syndrome (PCS) may reduce concussion-related physiological dysfunction and symptoms by restoring autonomic balance and improving cerebral blood flow autoregulation. In a descriptive pilot study of 91 patients referred to a university clinic for treatment of PCS, a subset of 63 patients were contacted by telephone for assessment of symptoms and return to full daily functioning. Those who experienced symptoms during a graded exercise treadmill test (physiologic PCS, n = 40) were compared to those who could exercise to capacity (PCS, n = 23). Both groups had been offered progressive exercise rehabilitation. Overall 41 of 57 (72%) who participated in the exercise rehabilitation program returned to full daily functioning. This included 27 of 35 (77%) from the physiologic PCS group, and 14 of 22 (64%) from the PCS group. Only 1 of the 6 patients who declined exercise rehabilitation returned to full functioning. Interpretation of these results is limited by the descriptive nature of the study, the small sample size, and the relatively few patients who declined exercise treatment. Nonetheless, exercise assessment indicates that approximately one third of those examined did not have physiologic PCS.

Baker, John G.; Freitas, Michael S.; Leddy, John J.; Kozlowski, Karl F.; Willer, Barry S.



Outcomes in Treatment for Intradural Spinal Cord Ependymomas  

SciTech Connect

Purpose: Spinal cord ependymomas are rare tumors, accounting for <2% of all primary central nervous system tumors. This study assessed the treatment outcomes for patients diagnosed with spinal cord ependymomas within the Southern California Kaiser Permanente system. Methods and Materials: We studied 23 patients treated with surgery with or without external beam radiotherapy (EBRT). The local and distant control rates and overall survival rates were determined. Results: The overall local control, overall recurrence, and 9-year overall survival rate was 96%, 17.4%, and 63.9%, respectively. Conclusions: The results of our study indicate that en bloc gross total resection should be the initial treatment, with radiotherapy reserved primarily for postoperative cases with unfavorable characteristics such as residual tumor, anaplastic histologic features, or piecemeal resection. Excellent local control and overall survival rates can be achieved using modern microsurgical techniques, with or without local radiotherapy.

Volpp, P. Brian [Department of Radiation Oncology, Kaiser Permanente, Los Angeles, CA (United States)], E-mail:; Han, Khanh [Huntington Memorial Medical Center, Pasadena, CA (United States); Kagan, A. Robert; Tome, Michael [Department of Radiation Oncology, Kaiser Permanente, Los Angeles, CA (United States)



Potential impact of orthotic gait exercise on natural killer cell activities in thoracic level of spinal cord-injured patients  

Microsoft Academic Search

Study design: Prospective before–after trial.Objective: To examine the changes of natural killer (NK) cell activity in response to orthotic gait exercise in thoracic level of spinal cord-injured (SCI) patients.Setting: National Rehabilitation Center for Persons with Disabilities, Japan.Methods: In all, 10 thoracic level of SCI patients (ranging Th5–Th12), who experienced orthotic gait training, participated in this study. NK cell activity at

N Kawashima; K Nakazawa; N Ishii; M Akai; H Yano



Acute Leptin Treatment Enhances Functional Recovery after Spinal Cord Injury  

Microsoft Academic Search

BackgroundSpinal cord injury is a major cause of long-term disability and has no current clinically accepted treatment. Leptin, an adipocyte-derived hormone, is best known as a regulator of food intake and energy expenditure. Interestingly, several studies have demonstrated that leptin has significant effects on proliferation and cell survival in different neuropathologies. Here, we sought to evaluate the role of leptin

Carmen María Fernández-Martos; Pau González; Francisco Javier Rodriguez



Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation  

Microsoft Academic Search

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

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



Evaluation and treatment of spinal injuries in the obese patient.  


Given the increasing incidence and severity of obesity in the adult population, orthopaedic surgeons are evaluating and treating more acutely injured obese patients. Management of obese patients is complicated given their body habitus and associated medical comorbidities. Although evaluation and treatment are almost the same as for nonobese patients, some special considerations are necessary to prevent errors in diagnosis and treatment of obese trauma patients. This article focuses on spine injuries in obese patients. Predisposition to spinal injury, effective evaluation and early management, principles of treatment planning, operative technical pearls, and postoperative management are discussed. PMID:21095437

Greenleaf, Robert M; Altman, Daniel T



Detraining from total body exercise ergometry in individuals with spinal cord injury.  


This study was designed to investigate the effects of detraining that occurred during an 8 week period of muscular inactivity following a 12 week training program of artificial computerized functional electrical stimulation cycle ergometry (CFES LE) and arm ergometry. Six spinal cord injured male individuals were followed through an 8 week detraining period that was preceded by a 12 week exercise program including CFES LE and arm ergometry. Maximal graded exercise tests were completed and measurements of peak oxygen consumption (VO2), heart rate (HR), ventilation (VE) workload, and creatine kinase were taken. Testing occurred at initial training (0T), after 12 weeks of training (12T), and after 8 weeks of detraining (DT). After the training program, peak VO2 increased significantly from 0.562 +/- 0.126 (0T) to 1.021 +/- 0.247 l/min (12T, P < 0.05). After DT, peak VO2 decreased to 0.791 +/- 0.216 l/min, which was lower than 12T (P < 0.05), yet higher than 0T (P < 0.05). After DT, peak workoad had decreased from 0.675 +/- 0.203 (12T) to 0.32 +/- 0.203 kp (P < 0.05), which was not different than 0T. Creatine kinase levels were significantly lower both at 12T and DT compared to 0T (P < 0.05). In addition, this training program induced linear increases in both VO2 and HR with workload, which were retained after DT. These increases did not reach statistical significance. however. No apparent relationship existed between these values at baseline. There were no significant differences in submaximal or peak HR of VE between the three testing periods. The results indicate that both peripheral muscular adaptations and central distribution adaptations in SCI individuals are partially maintained following 8 weeks of DT from CFES LE and arm ergometry. PMID:9848487

Gurney, A B; Robergs, R A; Aisenbrey, J; Cordova, J C; McClanahan, L



Physical Exercise as complementary treatment in prostate cancer  

Microsoft Academic Search

This article presents how physical exercise can be considered as a complementary treatment in prostate cancer. The article presents the design and implementation of a strength-endurance physical exercise program adapted to prostate cancer. The initial model corresponds to the guidelines of the American College of Sports Medicine (ACSM 1998). Adapting and transforming the program included the most common symptoms relating

Bernat Carles Serdà Ferrer; Pilar Monreal Bosch; Arantza Del Valle



Exercise-Induced Anaphylaxis: An Update on Diagnosis and Treatment  

PubMed Central

Exercise-induced anaphylaxis (EIA) and food-dependent, exercise-induced anaphylaxis (FDEIA) are rare but potentially life-threatening clinical syndromes in which association with exercise is crucial. The range of triggering physical activities is broad, including as mild an effort as a stroll. EIA is not fully repeatable (ie, the same exercise may not always result in anaphylaxis in a given patient). In FDEIA, the combined ingestion of sensitizing food and exercise is necessary to precipitate symptoms. Clinical features and management do not differ significantly from other types of anaphylaxis. The pathophysiology of EIA and FDEIA is not fully understood. Different hypotheses concerning the possible influence of exercise on the development of anaphylactic symptoms are taken into consideration. These include increased gastrointestinal permeability, blood flow redistribution, and most likely increased osmolality. This article also describes current diagnostic and therapeutic possibilities, including changes in lifestyle and preventive properties of antiallergic drugs as well as acute treatment of these dangerous syndromes.

Barg, Wojciech; Medrala, Wojciech



Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation  

PubMed Central

Pyogenic vertebral osteomyelitis responds well to conservative treatment at early stage, but more complicated and advanced conditions, including mechanical spinal instability, epidural abscess formation, neurologic deficits, and refractoriness to antibiotic therapy, usually require surgical intervention. The subject of using metallic implants in the setting of infection remains controversial, although more and more surgeons acknowledge that instrumentation can help the body to combat the infection rather than to interfere with it. The combination of radical debridement and instrumentation has lots of merits such as, restoration and maintenance of the sagittal alignment of the spine, stabilization of the spinal column and reduction of bed rest period. This issue must be viewed in the context of the overall and detailed health conditions of the subjecting patient. We think the culprit for the recurrence of infection is not the implants itself, but is the compromised general health condition of the patients. In this review, we focus on surgical treatment of pyogenic vertebral osteomyelitis with special attention to the role of spinal instrumentation in the presence of pyogenic infection.

Chen, Wei-Hua; Jiang, Lei-Sheng



Complications of surgical treatment of pediatric spinal deformities.  


Surgery in a child with spinal deformity is challenging. Although current orthopedic practice ensures good long-term surgical results, complications occur. Idiopathic scoliosis represents the most extensively investigated deformity of the pediatric spine. Nonidiopathic deformities of the spine are at higher risk for perioperative and long-term complications, mainly because of underlying comorbidities. A multidisciplinary treatment strategy is helpful to assure optimization of medical conditions before surgery. Awareness of complications that occur during or after spine surgery is essential to avoid a poor outcome and for future surgical decision making. This article summarizes the complications of surgical treatment of the growing spine. PMID:23827838

Lykissas, Marios G; Crawford, Alvin H; Jain, Viral V



Does 20-min arm crank ergometer exercise increase plasma interleukin-6 in individuals with cervical spinal cord injury?  


Interleukin-6 (IL-6) is produced by contracting skeletal muscles and then released into the circulation and considered to mediate the health benefits of exercise against chronic diseases. Individuals with spinal cord injury (SCI) are reported to be at higher risk of developing metabolic diseases. We investigated the IL-6 responses to 20-min arm crank ergometer exercise at 60% of maximum oxygen consumption in eight trained individuals with cervical SCI (CSCI) between C6 and C7, and eight able-bodied trained healthy subjects. The plasma concentrations of IL-6, adrenaline, prostaglandin E(2) and cortisol were measured before, immediately after the exercise, 1 and 2 h after exercise. At rest, the plasma adrenaline concentration was significantly lower in individuals with CSCI than in able-bodied subjects (P < 0.01). On the other hand, the concentration of IL-6 was significantly higher at rest in individuals with CSCI (2.18 ± 0.44 pg/ml, mean ± SEM) than the control (1.02 ± 0.22 pg/ml, P < 0.05). In able-bodied subjects, the plasma adrenaline concentration increased significantly immediately after the exercise (P < 0.01) and returned to the baseline level at 1 h after exercise, and the plasma IL-6 level increased significantly at 1 h after exercise (1.91 ± 0.28 pg/ml, P < 0.05) and returned to the baseline level at 2 h after exercise. In contrast, adrenaline and IL-6 levels were steady throughout the study in individuals with CSCI. The lack of exercise-related IL-6 response in individuals with CSCI could be due to muscle atrophy and sympathetic nervous system dysfunction. PMID:21617884

Kouda, Ken; Furusawa, Kazunari; Sugiyama, Hiroyuki; Sumiya, Tadashi; Ito, Tomoyuki; Tajima, Fumihiro; Shimizu, Katsuji



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

Microsoft Academic Search

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

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



The Practice and Process of Healthy Exercise: An Investigation of the Treatment of Exercise Abuse in Women with Eating Disorders  

Microsoft Academic Search

This study investigates the effectiveness of an exercise program designed to reduce exercise abuse in women who are in residential treatment for eating disorders. One hundred and twenty-seven women who participated in the exercise program were compared to 127 non-participants on weight gain and self-reported obligatory attitudes and beliefs about exercise. The exercise participants were women who were medically cleared




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



Review of Harrington rod treatment of spinal trauma.  


Harrington rod treatment for spinal trauma has become the gold standard against which other treatment modalities are judged. A review of the results of Harrington rod treatment is essential to establish a baseline level of efficiency in terms of rehabilitation time, correction of deformity, canal decompression, motion segment loss, and device-related complications. With economic concerns becoming more important in medical treatment, the value of newer techniques must be clearly superior to established methods. Harrington rod-augmented spine fusion is reliable and cost-effective in the thoracic and thoracolumbar spine. The risks of rod failure and late complications related to lost motion segments in the lumbar spine make pedicle screw systems a better option in this region. PMID:8470010

Riebel, G D; Yoo, J U; Fredrickson, B E; Yuan, H A



Evidence for prescribing exercise as treatment in pediatric rheumatic diseases.  


There has been an increasing recognition of adverse short-, mid-, or long-term effects associated with the treatment as well as the disease itself that impair the health-related quality of life and functional capacity of children and adolescents with rheumatic diseases. Interestingly, cumulative evidence has suggested that exercise training may benefit patients with juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile dermatomyositis and juvenile fibromyalgia, attenuating several clinical symptoms related to physical disability. Remarkably, recent evidence also suggests that exercise may have direct effects on the pathogenesis of autoimmune diseases by attenuating chronic low-grade systemic inflammation. It is also important to emphasize that no exercise-related adverse effects have been reported. This short review provides the evidence for physical training as a treatment of pediatric rheumatic diseases, introducing a novel concept that exercise is a treatment for these populations. PMID:20388559

Gualano, Bruno; Sá Pinto, Ana Lucia; Perondi, Beatriz; Leite Prado, Danilo Marcelo; Omori, Clarissa; Almeida, Roberta Tavares; Sallum, Adriana Maluf Elias; Silva, Clovis Artur Almeida



Results of surgical treatment for patients with a spinal angioma  

PubMed Central

The clinical, angiographic, and operative findings in 16 patients with a spinal angioma are reviewed, and the results of surgery are assessed. The surgical procedure employed in 15 patients consisted of excision of the fistulous portion of the malformation, achieved by intradural ligation of its feeding vessels and excision of its draining veins throughout the limits of the exposure. In 14 patients, a previously progressive deterioration in their clinical condition was arrested by surgical correction of the malformation and in 12 of these patients there was worthwhile improvement in functional capacity. The optimal time for surgical treatment is considered and suggestions are made for the manner in which patients should be investigated. Images

Logue, Valentine; Aminoff, M. J.; Kendall, B. E.



Contemporary treatment strategy for spinal metastasis: the "LMNOP" system.  


The choice of treatment for spinal metastasis is complex because (1) it depends on several inter-related clinical and radiologic factors, and (2) a wide range of management options has evolved in recent years. While radiation therapy and surgery remain the cornerstones of treatment, radiosurgery and percutaneous vertebral augmentation have also established a role. Classification systems have been developed to aid in the decision-making process, and each has different strengths and weaknesses. The comprehensive scoring systems developed to date provide an estimate of life expectancy, but do not provide much advice on the choice of treatment. We propose a new decision model that describes the key factors in formulating the management plan, while recognizing that the care of each patient remains highly individualized. The system also incorporates the latest changes in technology. The LMNOP system evaluates the number of spinal Levels involved and the Location of disease in the spine (L), Mechanical instability (M), Neurology (N), Oncology (O), Patient fitness, Prognosis and response to Prior therapy (P). PMID:21515496

Paton, Gillian R; Frangou, Evan; Fourney, Daryl 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.




A Clinical Analysis of Surgical Treatment for Spontaneous Spinal Infection  

PubMed Central

Objective The purpose of the study was to determine the clinical effects of anterior radical debridement on a series of patients with spontaneous spinal infection. Methods We retrospectively analyzed the clinical characteristics of 32 patients who underwent surgical treatment from January 2000 to December 2005 in our department. The average follow-up Period was 33.4 months (range, 6 to 87 months). Thirty-two patients presented with the following : 23 cases with pyogenic spondylitis, eight with tuberculous spondylitis and one with fungal spondylitis. The indications for surgery were intractable pain, failure of medical management, neurological impairment with or without an associated abscess, vertebral destruction causing spinal instability and/or segmental kyphosis. Results The study included 15 (46.9%) males and 17 (53.1%) females ranging in age from 26 to 75 years (mean, 53.1 years). Diabetes mellitus (DM) and pulmonary Tbc were the most common predisposing factors for pyogenic spondylitis and tuberculous spondylitis. Staphylococcus aureus (13%) was the main organism isolated. The most prevalent location was the lumbar spine (75%). Changes in the pain score, Frankel's classification, and laboratory parameters demonstrated a significant clinical improvement in all patients. However, there were recurrent infections in two patients with tuberculous spondylitis and inappropriate debridement and intolerance of medication and noncompliance. Autologous rib, iliac bone and allograft (fibular) were performed in most patients. However, 10 patients were grafted using a titanium mesh cage after anterior radical debridement. There were no recurrent infections in the 10 cases using the mesh cage with radical debridement. Conclusion The findings of this study indicate that surgery based on appropriate surgical indications is effective for the control of spinal infection and prevention of recurrence with anterior radical debridement, proper drug use and abscess drainage.

Lee, Dong-Geun; Kang, Dong-Ho; Hwang, Soo Hyun; Jung, Jin Myung; Han, Jong Woo



Spinal dural arteriovenous fistulas: a plea for neurosurgical treatment  

Microsoft Academic Search

Summary  Spinal dural arteriovenous fistulas are the most common type of arteriovenous malformation involving the spinal cord, especially\\u000a in middle-aged men. We report 21 patients with this malformation who had signs and symptoms of myelopathy. The diagnosis was\\u000a established by selective spinal angiography in patients whose neurological deficits, myelograms or magnetic resonance tomographies\\u000a suggested the presence of a spinal arteriovenous fistula.

B. C. Huffmann; J. M. Gilsbach; A. Thron



Surgical treatment of syringomyelia associated with spinal dysraphism  

Microsoft Academic Search

Clinical and radiological features of syringomyelia in 15 patients with spinal dysraphism are reported. There were 8 patients\\u000a with occult spinal dysraphism (lumbosacral lipoma) and 7 with spina bifida aperta (meningomyelocele). Syringomyelia with spinal\\u000a dysraphism can be radiologically divided into two types according to the dysraphic state. The syrinx in the patients with\\u000a occult spinal dysraphism occurred immediately rostral to

Izumi Koyanagi; Yoshinobu Iwasaki; Kazutoshi Hida; Hiroshi Abe; Toyohiko Isu; Minoru Akino



Exercise Intervention Research in Stroke: Optimizing Outcomes Through Treatment Fidelity  

PubMed Central

Demonstrating the treatment fidelity of an intervention is a key methodological requirement of any trial testing the impact of the intervention. The purpose of this report, therefore, was to serve as a model for evaluating treatment fidelity in stroke exercise intervention studies, and to provide evidence for treatment fidelity in the Exercise Training for Hemiparetic Stroke Intervention Development Study (The Treadmill Study) at the University of Maryland Claude D. Pepper Older Americans Independence Center. Treatment fidelity was evaluated based on study design, training of interventionists, delivery of the intervention and receipt of the intervention. There were some concerns about design fidelity as the control group and intervention group traveled to the study location together and received different exercise programs in the same facility. With regard to training of interventionists, observations were utilized to help maintain adherence to the protocol. There was strong support for the delivery and receipt of the intervention with participants exposed to the anticipated number of exercise sessions, although participants did not, overall, achieve the ultimate goal of 45 minutes of continuous walking at 60–70% predicted heart rate maximum. As per study protocol, there was evidence that progress toward that goal was made. In addition to assurance of true testing of the intervention in this study, treatment fidelity of this work provides critically important information to better understand the type, dose, and length of exposure to exercise interventions that is needed to optimize stroke recovery.

Resnick, Barbara; Michael, Kathleen; Shaughnessy, Marianne; Nahm, Eun Shim; Sorkin, John D.; Macko, Richard



A Systematic Review of Exercise Training To Promote Locomotor Recovery in Animal Models of Spinal Cord Injury  

PubMed Central

Abstract In the early 1980s experiments on spinalized cats showed that exercise training on the treadmill could enhance locomotor recovery after spinal cord injury (SCI). In this review, we summarize the evidence for the effectiveness of exercise training aimed at promoting locomotor recovery in animal models of SCI. We performed a systematic search of the literature using Medline, Web of Science, and Embase. Of the 362 studies screened, 41 were included. The adult female rat was the most widely used animal model. The majority of studies (73%) reported that exercise training had a positive effect on some aspect of locomotor recovery. Studies employing a complete SCI were less likely to have positive outcomes. For incomplete SCI models, contusion was the most frequently employed method of lesion induction, and the degree of recovery depended on injury severity. Positive outcomes were associated with training regimens that involved partial weight-bearing activity, commenced within a critical period of 1–2 weeks after SCI, and maintained training for at least 8 weeks. Considerable heterogeneity in training paradigms and methods used to assess or quantify recovery was observed. A 13-item checklist was developed and employed to assess the quality of reporting and study design; only 15% of the studies had high methodological quality. We recommend that future studies include control groups, randomize animals to groups, conduct blinded assessments, report the extent of the SCI lesion, and report sample size calculations. A small battery of objective assessment methods including assessment of over-ground stepping should also be developed and routinely employed. This would allow future meta-analyses of the effectiveness of exercise interventions on locomotor recovery.

Callister, Robert J.; Callister, Robin; Galea, Mary P.



A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain  

PubMed Central

Background Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program. Methods Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire. Results Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase. Conclusions This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP. Trial registration NCT00566930



Does Supervised Exercise Offer Adjuvant Benefit Over Exercise Advice Alone for the Treatment of Intermittent Claudication? A Randomised Trial  

Microsoft Academic Search

Objective. Exercise advice is the main treatment for symptom relief in the UK for patients with mild to moderate Intermittent Claudication (IC). Would a weekly exercise and motivation class for 6 months offer adjuvant benefit over written and verbal exercise advice alone?Patients and methods. Fifty-nine patients attending a regional vascular centre for whom IC was the main factor affecting mobility

D. R Cheetham; L Burgess; M Ellis; A Williams; R. M Greenhalgh; A. H Davies



Current Status of Treatment of Spinal and Bulbar Muscular Atrophy  

PubMed Central

Spinal and bulbar muscular atrophy (SBMA) is the first member identified among polyglutamine diseases characterized by slowly progressive muscle weakness and atrophy of the bulbar, facial, and limb muscles pathologically associated with motor neuron loss in the spinal cord and brainstem. Androgen receptor (AR), a disease-causing protein of SBMA, is a well-characterized ligand-activated transcription factor, and androgen binding induces nuclear translocation, conformational change and recruitment of coregulators for transactivation of AR target genes. Some therapeutic strategies for SBMA are based on these native functions of AR. Since ligand-induced nuclear translocation of mutant AR has been shown to be a critical step in motor neuron degeneration in SBMA, androgen deprivation therapies using leuprorelin and dutasteride have been developed and translated into clinical trials. Although the results of these trials are inconclusive, renewed clinical trials with more sophisticated design might prove the effectiveness of hormonal intervention in the near future. Furthermore, based on the normal function of AR, therapies targeted for conformational changes of AR including amino-terminal (N) and carboxy-terminal (C) (N/C) interaction and transcriptional coregulators might be promising. Other treatments targeted for mitochondrial function, ubiquitin-proteasome system (UPS), and autophagy could be applicable for all types of polyglutamine diseases.

Tanaka, Fumiaki; Katsuno, Masahisa; Banno, Haruhiko; Suzuki, Keisuke; Adachi, Hiroaki; Sobue, Gen



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



Dosimetric comparison of metastatic spinal photon treatment techniques  

SciTech Connect

Traditional palliative treatment of metastatic cancer to the vertebral bodies often results in doses to the spinal cord that are higher than the dose prescribed to the target, or gross tumor volume (GTV). This study compares traditional techniques of spine palliation with intensity-modulated radiation therapy (IMRT). The purpose of the study is 2-fold: first, the study demonstrates the benefits of using IMRT to lower the dose to the organs at risk (OAR), particularly for the spinal cord and other nonspecified normal tissues; second, the article provides information regarding the advantages and disadvantages of commonly used conventional techniques for treating the vertebral bodies based on patient anatomy. Because the use of IMRT or other advanced techniques may be prohibitive because of insurance issues, treatment plans were created that compared optimal coverage vs. optimal sparing for single-field, wedged-pair, and opposed-beam arrangements. Fifty-five patients were selected and divided by location of target (cervical, thoracic, and lumbar spine) and also by the measured separation between the anterior and posterior surface of the patient at the level of mid-GTV. Within each anatomic category the patients again were divided into the categories of small, medium, and large based on separation. The patient dataset that most closely represented the average separation within each category was selected, resulting in a total of 9 patients, and the appropriate treatment plan techniques were calculated for each of the 9 patients. The results of the study do show that the use of IMRT is far superior when compared with other techniques, both for coverage and for sparing of the surrounding tissue, regardless of patient size and the section of spine being treated. Based on a combination of both target coverage and sparing of normal tissues, the conventional plan of choice may vary by both the section of spine to be treated and by the size of the patient.

Ewing, Marvene M., E-mail: [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN (United States); Carnes, Samuel M.; Henderson, Mark A.; Das, Indra J. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN (United States)



Stereotactic radiosurgery for spinal metastases: case report and review of treatment options.  


The spine is the most common site for bone metastases. Spinal metastases can impact quality of life by causing severe pain, limitation of motion, and increased requirements for pain medication. Radiation therapy is a common form of treatment reserved for palliation of pain and for prevention or treatment of spinal cord compression. Newer approaches such as stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) have a more precise ability to customize the radiation dose to the target tissues adjacent to critical structures, thus increasing the local control of spinal column metastases. In this report, we examine the efficacy and possible advantages of single fraction SRS using a state-of-the-art tomotherapy machine in the treatment of a patient with spinal metastases from breast cancer. We also review the literature on treatment of spinal metastases using SRS, SBRT, and other modalities. PMID:19540375

Chawla, Sheema; Abu-Aita, Rami; Philip, Abraham; Lundquist, Tom; Okunieff, Paul; Milano, Michael T



The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review  

Microsoft Academic Search

Study design:Systematic review.Objectives:To conduct a systematic review of evidence surrounding the effects of exercise on physical fitness in people with spinal cord injury (SCI).Setting:Canada.Methods:The review was limited to English-language studies (published prior to March 2010) of people with SCI that evaluated the effects of an exercise intervention on at least one of the four main components of physical fitness (physical

A L Hicks; K A Martin Ginis; C A Pelletier; D S Ditor; B Foulon; D L Wolfe; AL Hicks



Treatment of Urinary Voiding Dysfunction Syndromes With Spinal Cord Stimulation  

PubMed Central

This case report presents the use of spinal cord stimulation (SCS) in a patient with urinary incontinence who had previously undergone trial and implantation of InterStim therapy (Medtronic Neurological, Minneapolis, MN). The patient also experienced bilateral lower extremity pain and low back pain related to post-laminectomy syndrome. Having failed all conservative treatment, the patient underwent SCS trial and subsequent implantation. In the postoperative period using SCS therapy, the patient had excellent relief of urinary incontinence symptoms, along with relief of low back pain and bilateral lower extremity pain and was able to discontinue use of InterStim therapy. For this patient, SCS was effective in controlling the urinary voiding dysfunction symptoms, bilateral lower extremity pain and back pain. The use of SCS to treat urinary incontinence problems deserves further study to explore its therapeutic potentials.

Yakovlev, Alexander E.; Resch, Beth E.



Treatment of urinary voiding dysfunction syndromes with spinal cord stimulation.  


This case report presents the use of spinal cord stimulation (SCS) in a patient with urinary incontinence who had previously undergone trial and implantation of InterStim therapy (Medtronic Neurological, Minneapolis, MN). The patient also experienced bilateral lower extremity pain and low back pain related to post-laminectomy syndrome. Having failed all conservative treatment, the patient underwent SCS trial and subsequent implantation. In the postoperative period using SCS therapy, the patient had excellent relief of urinary incontinence symptoms, along with relief of low back pain and bilateral lower extremity pain and was able to discontinue use of InterStim therapy. For this patient, SCS was effective in controlling the urinary voiding dysfunction symptoms, bilateral lower extremity pain and back pain. The use of SCS to treat urinary incontinence problems deserves further study to explore its therapeutic potentials. PMID:20305146

Yakovlev, Alexander E; Resch, Beth E



Comparisons of Exercise Dose and Symptom Severity Between Exercisers and Nonexercisers in Women During and After Cancer Treatment  

PubMed Central

Context Although numerous studies of the efficacy of exercise are reported, few studies have evaluated changes in characteristics of exercise dose in women with cancer both during and after cancer treatment. Objectives To describe the characteristics of exercise dose (i.e., frequency, duration, and intensity), and to evaluate for differences in symptom severity (i.e., fatigue, sleep disturbance, depression, pain) between women who did and did not exercise during and after cancer treatment. Methods In a sample of 119 women, two groups were classified: exercisers and nonexercisers. Exercisers were defined as women who met specific criteria for frequency (three times per week), duration (20 minutes per session), intensity (moderate), and mode (aerobic). Nonexercisers were defined as women who did not meet all of these criteria. Evaluation of exercise dose was completed at baseline (T1: the week before chemotherapy cycle two), at the end of cancer treatment (T2), and at the end of the study (T3: approximately one year after the T1 assessment) using self-report exercise questionnaires. Results Approximately 50% of the participants exercised during and 70% exercised after treatment. At T1, exercisers had lower total fatigue, lower behavioral and sensory subscale fatigue scores, and lower depression scores (P =0.038) than nonexercisers. No significant differences in sleep disturbance or pain were found between groups. At T2, exercisers had lower cognitive/mood subscale fatigue and depression scores than nonexercisers (P =0.047). At T3, no significant differences were found between groups in any symptom severity scores. Conclusion Both during and after cancer treatment, achieving or maintaining exercise guideline levels were met by most patients. Further study is needed to examine the link between exercise dose and symptom severity.

Cho, Maria H.; Dodd, Marylin J.; Cooper, Bruce A.; Miaskowski, Christine



Effectiveness of an Upper Extremity Exercise Device Integrated With Computer Gaming for Aerobic Training in Adolescents With Spinal Cord Dysfunction  

PubMed Central

Background/Objective: To determine whether a new upper extremity exercise device integrated with a video game (GameCycle) requires sufficient metabolic demand and effort to induce an aerobic training effect and to explore the feasibility of using this system as an exercise modality in an exercise intervention. Design: Pre-post intervention. Setting: University-based research facility. Subject Population: A referred sample of 8 adolescent subjects with spina bifida (4 girls, 15.5 ± 0.6 years; 4 boys, 17.5 ± 0.9 years) was recruited to participate in the project. All subjects had some level of mobility impairment that did not allow them to participate in mainstream sports available to their nondisabled peers. Five subjects used a wheelchair full time, one used a wheelchair occasionally, but walked with forearm crutches, and 2 were fully ambulatory, but had impaired gait. Main Outcome Measures: Peak oxygen uptake, maximum work output, aerobic endurance, peak heart rate, rating of perceived exertion, and user satisfaction. Results: Six of the 8 subjects were able to reach a Vo2 of at least 50% of their Vo2 reserve while using the GameCycle. Seven of the 8 subjects reached a heart rate of at least 50% of their heart rate reserve. One subject did not reach either 50% of Vo2 reserve or 50% of heart rate reserve. Seven of the 8 subjects increased their maximum work capability after training with the GameCycle at least 3 times per week for 16 weeks. Conclusions: The data suggest that the GameCycle seems to be adequate as an exercise device to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction. The subjects in this study reported that the video game component was enjoyable and provided a motivation to exercise.

Widman, Lana M; McDonald, Craig M; Abresch, R. Ted



Immunoendocrine responses of male spinal cord injured athletes to 1-hour self-paced exercise: pilot study.  


This study examined the effect of a 1 h, self-paced handcycling time trial on blood leukocytes, mucosal immunity, and markers of stress in paraplegic athletes. Nine male paraplegic athletes (spinal injury level thoracic 4-lumbar 2) performed 1 h of handcycling exercise on a standard 400 m athletics track. Heart rate (HR) was measured continuously during exercise, and a retrospective rating of perceived exertion (RPE) was obtained immediately after. Venous blood and saliva samples were collected immediately before exercise (Pre-Ex), after exercise (End-Ex), and 1 h postexercise (1-h Post). The athletes completed mean +/- standard error of mean 22.4 +/- 1.1 km cycling at HR 165 +/- 2 beats/min, RPE 15 +/- 1, and blood lactate 7.9 +/- 2.5 mmol/L. Total leukocytes increased 72% and neutrophils increased 74% End-Ex; both remained elevated at 1-h Post (both p < 0.05). Lymphocytes increased 53% and natural killer cells increased 175% End-Ex (both p < 0.05), but returned to near baseline levels 1-h Post. Increases (p < 0.05) were observed End-Ex in alpha-amylase activity (p < 0.05), which returned to baseline at 1-h Post, but there was no significant change in saliva flow rate, salivary immunoglobulin A, or cortisol. These data confirm that 1 h of handcycling exercise elevated circulating leukocytes but had a minimal effect on mucosal immunity. These changes appear to be associated with alpha-amylase rather than cortisol. PMID:23299262

Allgrove, Judith E; Chapman, Mark; Christides, Tatiana; Smith, Paul M



A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain  

PubMed Central

Summary Background A number of studies have evaluated exercise interventions compared with other treatment strategies for subjects with recurrent low back pain (LBP); however, subject pain level and balance were not carefully considered. The purpose of this study was to investigate the effectiveness of spinal stabilization exercises (SSE) for managing pain and increasing balance strategy changes following unexpected perturbations in patients diagnosed with recurrent LBP. Material/Methods Twenty-one age- and gender-matched patients participated in a supervised SSE or control exercise program 5 times a week over a 4-week period. The Million Visual Analogue Scale (MVAS) and Oswestry Disability Index (ODI) were used to measure each patient’s level of pain and disability. Balance measurements were derived from recordings of the anterior-posterior (A/P) and medio-lateral (M/L) center of pressure (COP) displacements during 3 consecutive, unexpected random perturbations. Results The level of reported pain and disability significantly decreased following treatment for both groups. Although the M/L sway was not significantly different in either group (p=0.86), there was a significant difference between group and measurement time during A/P sway (p=0.04). The A/P displacement of the SSE group significantly decreased compared with the control group. The decreased A/P displacement can be linked to the SSE intervention, which helps prevent further injury by limiting an individual’s response rate to external perturbations. Conclusions Clinicians might consider SSE for LBP patients as a possible rehabilitation strategy to reduce A/P displacement.

Rhee, Hyun Sill; Kim, Yoon Hyuk; Sung, Paul S.



Moderate Intensity Exercise as an Adjunct to Standard Smoking Cessation Treatment for Women: A Pilot Study  

Microsoft Academic Search

Previous randomized controlled trials have not supported moderate intensity exercise as an efficacious adjunct to smoking cessation treatments for women; however, compliance with exercise programs in these studies has been poor. The purpose of this pilot study was to estimate the effects of moderate intensity exercise on smoking cessation outcomes under optimal conditions for exercise program compliance. Sixty previously sedentary,

David M. Williams; Jessica A. Whiteley; Shira Dunsiger; Ernestine G. Jennings; Anna E. Albrecht; Michael H. Ussher; Joseph T. Ciccolo; Alfred F. Parisi; Bess H. Marcus



Locomotor recovery after spinal cord contusion injury in rats is improved by spontaneous exercise  

Microsoft Academic Search

We have recently shown that enriched environment (EE) housing significantly enhances locomotor recovery following spinal cord contusion injury (SCI) in rats. As the type and intensity of locomotor training with EE housing are rather poorly characterized, we decided to compare the effectiveness of EE housing with that of voluntary wheel running, the latter of which is both well characterized and

W. H. Gispen; N. L. van Meeteren; L. Eggers; A. J. Lankhorst; Frank P. T. Hamers



Osteopathic manipulative treatment is effective on pain control associated to spinal cord injury  

Microsoft Academic Search

Study design:This study was designed as an experimental study (trial).Objectives:To verify the effects of the association between conventional pharmacological treatment and osteopathic manipulative treatment (OMT) for chronic pain management in spinal cord injury (SCI).Setting:This study was carried out at Spinal Unit, Ospedale Niguarda Ca’ Granda, Milan, Italy. Istituto Superiore di Osteopatia, Milan, Italy.Methods:We enrolled 47 patients with SCI, 26 with

C Arienti; S Daccò; I Piccolo; T Redaelli



Magnesium sulfate treatment in experimental spinal cord injury: emphasis on vascular changes and early clinical results.  


Injury to the spinal cord results in disruption of neurons, cell membranes, axons, myelin, and endothelial cells. The aim of this study was to demonstrate the protective effect of magnesium sulfate on the blood-spinal cord barrier after acute spinal cord injury (SCI). This experiment was conducted in two parts. In the first, rats were injected intravenously with Evans blue 2 h after SCI. The laminectomy-only group had no trauma. Contusion injury (50 g-cm) was applied to the trauma and treatment groups. Magnesium sulfate (600 mg/kg) was given to the treatment group immediately after injury. For the second part, clinical evaluations were performed 24 h post surgery. Then, following Evans blue injection, spinal cord samples were obtained from the laminectomy-only, trauma, and treatment groups. For the control group, nontraumatized spinal cord samples were taken after Evans blue injection following clinical examination. Laminectomy did not affect the spinal cord Evans blue content in 2-h and 24-h groups. The trauma increased tissue Evans blue content, and 24-h samples showed more remarkable tissue Evans blue content, suggesting secondary injury. Application of 600 mg/kg of magnesium resulted in lower Evans blue content in the spinal cord than with injury. Remarkable clinical neuroprotection was observed in the treatment groups. Magnesium sulfate showed vaso- and neuroprotective properties after contusion injury to the rat spinal cord. The authors also demonstrated secondary injury of the blood-spinal cord barrier with the Evans blue clearance technique for the first time. PMID:12783273

Kaptanoglu, Erkan; Beskonakli, Etem; Solaroglu, Ihsan; Kilinc, Asuman; Taskin, Yamac



Exercise Tests and BBB Method for Evaluation of Motor Disorders in Rats after Contusion Spinal Injury  

Microsoft Academic Search

Contusion spinal injury of different severity was induced by the weight drop method in male rats by dropping standard weight\\u000a from the heights of 6.5, 12.5, 25, and 50 mm on the spine after laminectomy at the Th9 level. The dynamics of recovery of\\u000a voluntary movements was evaluated over 8 weeks after the operation by comparing the traditional semiquantitative BBB score\\u000a with

S. V. Lebedev; S. V. Timofeyev; A. V. Zharkov; V. G. Schipilov; J. A. Chelyshev; G. A. Masgutova; V. P. Chekhonin



Increasing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program  

Microsoft Academic Search

Objective: To determine the magnitude of changes in muscle mass and lower extremity body composition that could be induced with a regular regimen of functional electrical stimulation (FES)-induced lower-extremity cycling, as well as the distribution of changes in muscle mass among the thigh muscles in persons with spinal cord injury (SCI).Study Design: Thirteen men with neurologically complete motor sensory SCI

A. M. Erika Scremin; Lyvia Kurta; Amilcare Gentili; Barbara Wiseman; Karen Perell; Charles Kunkel; Oscar U. Scremin



Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: A pilot randomized clinical trial  

Microsoft Academic Search

Background: To date, no substantiated studies have been performed to investigate the efficacy of spinal manipulative therapy on thoracic spinal syndromes. Objective: To investigate the effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain. Study Design: A single-blind, randomized, comparative, controlled pilot study. Setting: Technikon Natal Chiropractic Clinic in Durban, South Africa. Participants: Thirty subjects selected

Linda Schiller



The Effectiveness of Spinal Manipulation for the Treatment of Headache Disorders: A Systematic Review of Randomized Clinical Trials  

Microsoft Academic Search

To carry out a systematic review of the literature examining the effectiveness of spinal manipulation for the treatment of headache disorders, computerized literature searches were carried out in Medline, Embase, Amed and CISCOM. Studies were included only if they were randomized trials of (any type of) spinal manipulation for (any type of) headache in human patients in which spinal manipulation

J A Astin; E Ernst



Exercise \\  

Microsoft Academic Search

FOCUS POINTS • Exercise behavior occurs commonly in anorexia nervosa (AN) and appears to be highly reinforcing to individuals with this disorder. • Authors adapted a clinical survey used to mea- sure dependence to drugs of abuse to assess exercise behavior among subjects with AN. • Forty-eight percent of individuals assessed endorsed symptoms consistent with exercise dependence in the previous

Diane A. Klein; Andrew S. Bennett; Janet Schebendach; Richard W. Foltin; Michael J. Devlin; B. Timothy Walsh



Shortening osteotomy for the treatment of spinal neuroarthropathy following spinal cord injury. A case report and literature review  

PubMed Central

The development of Charcot’s arthropathy of the spine secondary to spinal cord injury is rare and reports in the literature concerning it’s surgical management are limited. Arthrodesis is the recommended treatment for painful and unstable neuropathic joints. Traditionally this involves extensive debridement of the affected joint with anterior and posterior instrumented fusion and autograft to bridge the defect. This paper reviews the reported surgical management of post-traumatic spinal neuroarthropathy in the recent literature and presents a case where sound fusion was achieved by a shortening osteotomy and end-to-end apposition of the fresh bleeding bony surfaces of the adjacent vertebral bodies. The patient reported marked improvement of symptoms post-operatively without any complications of surgery. CT scan at 13 months confirmed successful bony union. Clinical follow up was completed to 3 years. This technique eliminated the need for anterior surgery and extensive autograft thus reducing surgical morbidity.

Thomason, Katharine; Chan, Daniel



Vertebral Column Resection for the Treatment of Severe Spinal Deformity  

PubMed Central

Abstract The ability to treat severe pediatric and adult spinal deformities through an all-posterior vertebral column resection (VCR) has obviated the need for a circumferential approach in primary and revision surgery, but there is limited literature evaluating this new approach. Our purpose was therefore to provide further support of this technique. We reviewed 43 patients who underwent a posterior-only VCR using pedicle screws, anteriorly positioned cages, and intraoperative spinal cord monitoring between 2002 and 2006. Diagnoses included severe scoliosis, global kyphosis, angular kyphosis, or kyphoscoliosis. Forty (93%) procedures were performed at L1 or cephalad in the spinal cord (SC) territory. Seven patients (18%) lost intraoperative neurogenic monitoring evoked potentials (NMEPs) data during correction with data returning to baseline after prompt surgical intervention. All patients after surgery were at their baseline or showed improved SC function, whereas no one worsened. Two patients had nerve root palsies postoperatively, which resolved spontaneously at 6 months and 2 weeks. Spinal cord monitoring (specifically NMEP) is mandatory to prevent neurologic complications. Although technically challenging, a single-stage approach offers dramatic correction in both primary and revision surgery of severe spinal deformities. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Electronic supplementary material The online version of this article (doi:10.1007/s11999-009-1037-x) contains supplementary material, which is available to authorized users.

Sides, Brenda A.; Koester, Linda A.; Hensley, Marsha; Blanke, Kathy M.



EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries.  


INTRODUCTION: Exercise programmes are used in the prevention and treatment of adductor-related groin injuries in soccer; however, there is a lack of knowledge concerning the intensity of frequently used exercises. OBJECTIVE: Primarily to investigate muscle activity of adductor longus during six traditional and two new hip adduction exercises. Additionally, to analyse muscle activation of gluteals and abdominals. MATERIALS AND METHODS: 40 healthy male elite soccer players, training >5 h a week, participated in the study. Muscle activity using surface electromyography (sEMG) was measured bilaterally for the adductor longus during eight hip adduction strengthening exercises and peak EMG was normalised (nEMG) using an isometric maximal voluntary contraction (MVC) as reference. Furthermore, muscle activation of the gluteus medius, rectus abdominis and the external abdominal obliques was analysed during the exercises. RESULTS: There were large differences in peak nEMG of the adductor longus between the exercises, with values ranging from 14% to 108% nEMG (p<0.0001). There was a significant difference between legs in three of the eight exercises (35-48%, p<0.0001). The peak nEMG results for the gluteals and the abdominals showed relatively low values (5-48% nEMG, p<0.001). CONCLUSIONS: Specific hip adduction exercises can be graded by exercise intensity providing athletes and therapists with the knowledge to select appropriate exercises during different phases of prevention and treatment of groin injuries. The Copenhagen Adduction and the hip adduction with an elastic band are dynamic high-intensity exercises, which can easily be performed at any training facility and could therefore be relevant to include in future prevention and treatment programmes. PMID:23511698

Serner, Andreas; Jakobsen, Markus Due; Andersen, Lars Louis; Hölmich, Per; Sundstrup, Emil; Thorborg, Kristian



Predictors of weight loss success. Exercise vs. dietary self-efficacy and treatment attendance.  


Pre-treatment diet and exercise self-efficacies can predict weight loss success. Changes in diet self-efficacy across treatment appear to be even stronger predictors than baseline levels, but research on changes in exercise self-efficacy is lacking. Using data from a pilot study evaluating tangible reinforcement for weight loss (N=30), we examined the impact of changes in diet and exercise self-efficacy on outcomes. Multiple regression analyses indicated that treatment attendance and changes in exercise self-efficacy during treatment were the strongest predictors of weight loss. Developing weight loss programs that foster the development of exercise self-efficacy may enhance participants' success. PMID:22248709

Byrne, Shannon; Barry, Danielle; Petry, Nancy M



Radiation Therapy of Metastatic Spinal Cord Compression. Multidisciplinary team diagnosis and treatment  

Microsoft Academic Search

Purpose: To evaluate the effectiveness of a multidisciplinary approach to spinal cord compression (SCC) in accordance with prospective protocol, providing a uniform approach to diagnosis, decision making concerning optimal treatment modality in any particular case of SCC, treatment performance and evaluation of treatment results. The SCC patients treated by radiation therapy are described.

Felix Kovner; Shulem Spigel; Irit Rider; Itzhak Otremsky; Ilan Ron; Eliezer Shohat; Jose Martin Rabey; Jose Avram; Ofer Merimsky; Nely Wigler; Samario Chaitchik; Moshe Inbar



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



Stem cells for the treatment of spinal cord injury  

Microsoft Academic Search

This article reviews stem cell-based strategies for spinal cord injury repair, and practical issues concerning their translation to the clinic. Recent progress in the stem cell field includes clinically compliant culture conditions and directed differentiation of both embryonic stem cells and somatic stem cells. We provide a brief overview of the types of stem cells under evaluation, comparing their advantages

Margaret Coutts; Hans S. Keirstead



Pediatric spinal cord injury: Approach for urological rehabilitation and treatment  

Microsoft Academic Search

PurposeAs proposed in this report, early urological rehabilitative management of patients with spinal cord injuries (SCIs) is mandatory, in order to prevent a poorly compliant bladder with related upper urinary tract complications and secondary renal failure. Moreover, the approach to treating this traumatic condition in children must be as much rapid as appropriate.

M. Silveri; L. Salsano; M. M. Pierro; G. Mosiello; M. L. Capitanucci; M. De Gennaro



Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency  

Microsoft Academic Search

Study design:Prospective clinical study of two treatments.Objective:To compare mechanical ventilation (MV) with phrenic nerve stimulation (PNS) for treatment of respiratory device-dependent (RDD) spinal cord-injured (SCI) patients.Setting:Department for spinal cord-injured patients of an insurance-company-run trauma hospital in Hamburg, Germany.Methods:Prospective data collection of treatment-related data over 20 years.Results:In total, 64 SCI-RDD patients were treated during the study period. Of these, 32 of

S Hirschfeld; G Exner; T Luukkaala; G A Baer



Facilitation of pain in the human spinal cord by nocebo treatment.  


Nocebo hyperalgesia is an increase in subjective pain perception after a patient or subject underwent an inert treatment without any active ingredient. For example, verbal suggestion of increased pain can enhance both pain experience and responses in pain-related cortical brain areas. However, changes in cortical pain responses may be secondary to earlier amplification of incoming pain signals within the spinal cord. To test for a potential early enhancement of pain signals in the dorsal horn of the spinal cord, we combined a nocebo heat pain paradigm with spinal functional magnetic resonance imaging in healthy volunteers. We found that local application of an inert nocebo cream on the forearm increased pain ratings compared with a control cream, and also reduced pain thresholds on the nocebo-treated skin patch. On the neurobiological level, pain stimulation induced a strong activation in the spinal cord at the level of the stimulated dermatomes C5/C6. Comparing pain stimulation under nocebo to a control pain stimulation of the same physical intensity revealed enhanced pain-related activity in the ipsilateral dorsal horn of the spinal cord. Importantly, the activation of the main effect of pain and the nocebo effect spatially overlapped. The current study thus provides direct evidence for a pain-facilitating mechanism in the human spinal cord before cortical processing, which can be activated by cognitive manipulations such as nocebo treatments. PMID:23966699

Geuter, Stephan; Büchel, Christian



Exercise and Cancer Treatment Symptoms in 408 Newly Diagnosed Older Cancer Patients  

PubMed Central

While the benefits of exercise for managing cancer-and treatment-related side effects has been shown among various populations of cancer survivors, a relative dearth of information exists among older cancer patients. Objectives To determine the prevalence of exercise participation during and after primary cancer treatment in older (?65 years) and the oldest (?80 years) cancer patients and to examine the relationships between exercise, symptoms, and self-rated health (SRH). Materials and Methods 408 newly diagnosed older cancer patients (mean age=73, range=65-92) scheduled to receive chemotherapy and/or radiation therapy reported symptoms and SRH prior to, during, and 6 months after treatment, and exercise participation during and following treatment. Results Forty-six percent of older and 41% of the oldest patients reported exercising during treatment. Sixty percent of older and 68% of the oldest patients reported exercising in the 6 months thereafter. Older patients who exercised during treatment reported less shortness of breath and better SRH during treatment, and better SRH following treatment. The oldest patients who exercised during treatment reported less memory loss and better SRH during treatment and less fatigue and better SRH following treatment. The oldest patients who exercised following treatment reported less fatigue, skin problems, and total symptom burden following treatment. Conclusion These data suggest a willingness of older cancer patients to attempt exercise during and after treatment. Exercise during these times is associated with less severe symptoms; further clinical research examining the efficacy of formal exercise interventions to reduce symptoms and improve SRH in older cancer patients is needed.

Sprod, Lisa K.; Mohile, Supriya G.; Demark-Wahnefried, Wendy; Janelsins, Michelle C.; Peppone, Luke J.; Morrow, Gary R.; Lord, Raymond; Gross, Howard; Mustian, Karen M.



Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States  

PubMed Central

Background Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States. Methods A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests were used to analyze the reported usage of each item. The effect of gender was analyzed using Mann-Whitney tests. Results One hundred seventy-one osteopathic physicians completed the survey (22%). For the assessment of spinal somatic dysfunction, paraspinal tissue texture (98%), transverse process asymmetry (89%), and tenderness (85%) were most commonly reported. Myofascial release (78%), soft tissue technique (77%), and patient self-stretches (71%) were most commonly used for treatment of the spine. For assessment of pelvic landmark asymmetry, the anterior superior iliac spine (ASIS, 87%), sacral base (82%), posterior superior iliac spine (81%), sacral sulci (78%), iliac crests (77%), and inferior lateral angle of the sacrum (74%) were commonly palpated. For assessment of sacroiliac joint motion, ASIS compression (68%) was most commonly used. Sacroiliac pain provocation tests were also employed although their use was less common than asymmetry or motion tests. Muscle energy (70%), myofascial release (67%), patient self-stretches (66%), osteopathy in the cranial field (59%), muscle strengthening exercises (58%), soft tissue technique (58%), and articulatory technique (53%) were most commonly used for treatment of the pelvis and sacroiliac. The effect of gender was significant for many of the treatment procedures, with females using more soft tissue and muscle energy and males more high-velocity techniques. The majority of respondents document the types of osteopathic manipulative techniques used (83%), document somatic dysfunction with Fryette nomenclature (64%), and bill for osteopathic manipulative treatment (92%). Conclusion Respondents reported the use of a broad range of assessment and treatment approaches. Results suggest a higher use of myofascial release and cranial technique and lower use of high-velocity techniques in this group of physicians compared to previous studies.

Fryer, Gary; Morse, Christopher M; Johnson, Jane C



Treatment of severe peripheral arterial and vasospastic disease of the upper extremity by spinal cord stimulation  

Microsoft Academic Search

Spinal cord stimulation (SCS) has been successfully introduced for treatment of severe peripheral arterial disease of the lower limbs. However, the effect of SCS for treatment of severe vasospastic disease (VD) and peripheral arterial disease (PAD) of the upper extremities remains uncertain. Therefore, the efficacy of SCS for pain reduction and increase of blood supply was studied in four patients

Claus Bartels; Luc Claeys; Kiriakos Ktenidis; Christiane Pastrik; Svante Horsch



Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience  

Microsoft Academic Search

Study design: Male infertility caused by anejaculation is common among patients with spinal cord injury (SCIP). The fertility options for SCIP have improved impressively over the past 10 years. We present the Israeli experience in the treatment of infertility in a large series of SCIP. The issues which are addressed include the treatment of ejaculatory dysfunction, seminal quality and fertility

RJ Heruti; H Katz; Y Menashe; R Weissenberg; G Raviv; I Madjar; A Ohry; Heruti RJ



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



Alternative Treatments of Breakthrough Pain in Patients Receiving Spinal Analgesics for Cancer Pain  

Microsoft Academic Search

Patients who experience a poor response to different systemic opioid trials (oral and intravenous) are candidates for spinal treatment. Breakthrough pain occurring in this group of patients is challenging for physicians. This phenomenon has never been described in this context and the treatment is quite difficult, as patients already demonstrated a poor response to systemic opioids. We report a preliminary

Sebastiano Mercadante; Edoardo Arcuri; Patrizia Ferrera; Patrizia Villari; Salvatore Mangione



Effect and safety of spinal cord stimulation for treatment of chronic pain caused by diabetic neuropathy  

Microsoft Academic Search

AimSpinal cord stimulation (SCS) has been shown effective as a therapy for different chronic painful conditions, but the effectiveness of this treatment for pain as a result of peripheral diabetic neuropathy is not well established. The primary objectives of this study were to evaluate the effect and safety of SCS for treatment of pain and the effects on microcirculatory blood

Cecile C. de Vos; Vinayakrishnan Rajan; Wiendelt Steenbergen; Hans E. van der Aa; Hendrik P. J. Buschman



Balloon kyphoplasty for the treatment of painful spinal deformity resulting from osteoporotic vertebral compression fractures  

Microsoft Academic Search

Purpose of study: Treatments for vertebral compression fractures (VCFs) have historically focused on pain control, but the kyphotic deformity as a result of VCF is also a cause of significant medical morbidity. The ideal treatment of VCFs should thus address both the fracture-related pain and associated spinal deformity. Balloon kyphoplasty is a recently developed minimally invasive procedure that aims to

Frank Phillips; Erling Ho; Marion Campbell-Hupp; Euby Kerr; F. Todd Wetzel; Purnendu Gupta



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.



Controversies over spinal treatment in advanced cancer patients  

Microsoft Academic Search

About 10% of patients with cancer pain do not obtain pain relief or experience unacceptable side effects with systemic opioids.\\u000a In some cases a change of the route of administration can improve the balance of analgesia and adverse effects. In this paper\\u000a the use of spinal opioids in such patients is discussed from various aspects: patient selection, epidural vs intrathecal

Sebastiano Mercadante



Pelvic floor muscle exercise for the treatment of stress urinary incontinence: An exercise physiology perspective  

Microsoft Academic Search

The aim of this article is to give an overview of the exercise science related to pelvic floor muscle (PFM) strength training, and to assess the effect of PFM exercises to treat stress urinary incontinence (SUI). Sixteen articles addressing the effect of PFM exercise alone on SUI were compiled by computerized search or found in other review articles. Studies with

K. Bø



Exercise in the treatment of major depression: A systematic review grading the quality of evidence.  


Objective: To examine the quality of evidence for exercise in the treatment of major depression, comparing specific study types; aerobic exercise vs. antidepressants, aerobic exercise vs. any physical activity, and aerobic exercise as augmentation therapy to treatment as usual vs. treatment as usual. Methods: Electronic searches for randomized controlled studies, reporting on treatment outcome in adults with major depression confirmed by a clinical interview. Quality of evidence was assessed using the Grading and Recommendations Assessment, Development and Evaluation and an additional risk of bias-protocol. Results: Fourteen eligible studies were retrieved, of which nine had low risk of bias. We found moderate quality of evidence that aerobic exercise has no significant effect compared to antidepressants. We found moderate quality of evidence that aerobic exercise at a moderate to high intensity has no significant effect compared to other forms of physical activity. We found low quality of evidence that exercise as augmentation to treatment as usual has a small effect - depression scores were on average 0.44 of a standard deviation lower - compared to treatment as usual. Conclusion: In general, exercise appears to be beneficial in the treatment of depression when used in combination with medication. A significant issue that is not well addressed in previous studies is the risks associated with exercise. Further, this review indicates that aerobic exercise is not more effective than other types of physical activity, pointing to a need to further investigate active components. PMID:23521569

Danielsson, Louise; Noras, Anna Maria; Waern, Margda; Carlsson, Jane



Exercise-induced motor improvement after complete spinal cord transection and its relation to expression of brain-derived neurotrophic factor and presynaptic markers  

PubMed Central

Background It has been postulated that exercise-induced activation of brain-derived neurotrophic factor (BDNF) may account for improvement of stepping ability in animals after complete spinal cord transection. As we have shown previously, treadmill locomotor exercise leads to up-regulation of BDNF protein and mRNA in the entire neuronal network of intact spinal cord. The questions arise: (i) how the treadmill locomotor training, supplemented with tail stimulation, affects the expression of molecular correlates of synaptic plasticity in spinal rats, and (ii) if a response is related to BDNF protein level and distribution. We investigated the effect of training in rats spinalized at low thoracic segments on the level and distribution of BDNF immunoreactivity (IR) in ventral quadrants of the lumbar segments, in conjunction with markers of presynaptic terminals, synaptophysin and synaptic zinc. Results Training improved hindlimb stepping in spinal animals evaluated with modified Basso-Beattie-Bresnahan scale. Grades of spinal trained animals ranged between 5 and 11, whereas those of spinal were between 2 and 4. Functional improvement was associated with changes in presynaptic markers and BDNF distribution. Six weeks after transection, synaptophysin IR was reduced by 18% around the large neurons of lamina IX and training elevated its expression by over 30%. The level of synaptic zinc staining in the ventral horn was unaltered, whereas in ventral funiculi it was decreased by 26% postlesion and tended to normalize after the training. Overall BDNF IR levels in the ventral horn, which were higher by 22% postlesion, were unchanged after the training. However, training modified distribution of BDNF in the processes with its predominance in the longer and thicker ones. It also caused selective up-regulation of BDNF in two classes of cells (soma ranging between 100-400 ?m2 and over 1000 ?m2) of the ventrolateral and laterodorsal motor nuclei. Conclusion Our results show that it is not BDNF deficit that determines lack of functional improvement in spinal animals. They indicate selectivity of up-regulation of BDNF in distinct subpopulations of cells in the motor nuclei which leads to changes of innervation targeting motoneurons, tuned up by locomotor activity as indicated by a region-specific increase of presynaptic markers.



TREAD: TReatment with Exercise Augmentation for Depression: study rationale and design  

Microsoft Academic Search

Background Despite recent advancements in the pharmacological treatment of major depressive disorder (MDD), over half of patients who receive treatment with antidepressant medication do not achieve full remission of symptoms. There is evidence that exercise can reduce depressive symptomatology when used as a treatment for MDD. However, no randomized controlled trials have evaluated exercise as an augmentation strategy for patients

Madhukar H Trivedi; Tracy L Greer; Bruce D Grannemann; Timothy S Church; Daniel I Galper; Prabha Sunderajan; Stephen R Wisniewski; Heather O Chambliss; Alexander N Jordan; Carrie Finley; Thomas J Carmody



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





... better bladder and bowel function, less fatigue and depression, a more positive attitude, and increased participation in social activities. Since 1996, several additional studies have confirmed the benefits of exercise. Inactivity in people with or without MS can ...




... part of any spondylitis program, along with good posture habits and medication to reduce pain and stiffness. ... spondylitis exercise program will help you maintain good posture, flexibility and eventually help to lessen pain. In ...


Histone deacetylase inhibitors as potential treatment for spinal muscular atrophy  

PubMed Central

Histone acetylation plays an important role in regulation of transcription in eukaryotic cells by promoting a more relaxed chromatin structure necessary for transcriptional activation. Histone deacetylases (HDACs) remove acetyl groups and suppress gene expression. HDAC inhibitors (HDACIs) are a group of small molecules that promote gene transcription by chromatin remodeling and have been extensively studied as potential drugs for treating of spinal muscular atrophy. Various drugs in this class have been studied with regard to their efficacy in increasing the expression of survival of motor neuron (SMN) protein. In this review, we discuss the current literature on this topic and summarize the findings of the main studies in this field.

Mohseni, Jafar; Zabidi-Hussin, Z.A.M.H.; Sasongko, Teguh Haryo



Endovascular treatment of iatrogenic aortic injury after spinal surgery.  


A 59-year-old female presented to our institution with paraparesis caused by medullar compression secondary to multiple myeloma. Spinal cord decompression and transpedicular spine fixation were performed. A month later, the patient complained of sudden pain in her middle back. A CT scan revealed screw impingement on the aortic wall at T8 level. A thoracic stent-graft was deployed before removing the fixation. The patient had an uneventful postoperative course, without complications during the four-year follow-up. In this case report, stent-graft placement proved to be safe and effective in avoiding bleeding during screw removal. PMID:23134443

Rabellino, Martin; Garcia-Monaco, Ricardo; Cesareo, Vicente; Rostagno, Roman; Sola, Carlos



Percutaneous disc decompression for the treatment of lumbar spinal stenosis.  


Percutaneous disc decompression was used to treat three patients with severe spinal stenosis using Nucleoplasty. Access to the disc was obtained bilaterally using a paramedian approach. Channels were created bilaterally using Coblation and stabilized using coagulation. The patients were reassessed at 1 week, 2 weeks, 4 weeks, 6 weeks, 6 months, and 1 year. MRI was obtained on the first two patients at 6 weeks. All three patients demonstrated significant reduction in pain scores as well as increased functionality for various periods of time. The use of analgesics was also reduced in each of the three patients during the period of diminished pain. PMID:16871306

Pace, Charles; Reyna, Jose; Schlicht, Christian



Effect of antioxidant treatment on spinal GABA neurons in a neuropathic pain model in the mouse.  


One feature of neuropathic pain is a reduced spinal gamma-aminobutyric acid (GABA)-ergic inhibitory function. However, the mechanisms behind this attenuation remain to be elucidated. This study investigated the involvement of reactive oxygen species in the spinal GABA neuron loss and reduced GABA neuron excitability in spinal nerve ligation (SNL) model of neuropathic pain in mice. The importance of spinal GABAergic inhibition in neuropathic pain was tested by examining the effects of intrathecally administered GABA receptor agonists and antagonists in SNL and naïve mice, respectively. The effects of SNL and antioxidant treatment on GABA neuron loss and functional changes were examined in transgenic GAD67-enhanced green fluorescent protein positive (EGFP+) mice. GABA receptor agonists transiently reversed mechanical hypersensitivity of the hind paw in SNL mice. On the other hand, GABA receptor antagonists made naïve mice mechanically hypersensitive. Stereological analysis showed that the numbers of enhanced green fluorescent protein positive (EGFP+) GABA neurons were significantly decreased in the lateral superficial laminae (I-II) on the ipsilateral L5 spinal cord after SNL. Repeated antioxidant treatments significantly reduced the pain behaviors and prevented the reduction in EGFP+ GABA neurons. The response rate of the tonic firing GABA neurons recorded from SNL mice increased with antioxidant treatment, whereas no change was seen in those recorded from naïve mice, which suggested that oxidative stress impaired some spinal GABA neuron activity in the neuropathic pain condition. Together the data suggest that neuropathic pain, at least partially, is attributed to oxidative stress, which induces both a GABA neuron loss and dysfunction of surviving GABA neurons. PMID:23880056

Yowtak, June; Wang, Jigong; Kim, Hee Young; Lu, Ying; Chung, Kyungsoon; Chung, Jin Mo



Interleukin 2-regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects  

Microsoft Academic Search

BACKGROUND: Our recent investigations have demonstrated that cell cultures from subjects, who received a single spinal manipulative treatment in the upper thoracic spine, show increased capacity for the production of the key immunoregulatory cytokine, interleukin-2. However, it has not been determined if such changes influence the response of the immune effector cells. Thus, the purpose of the present study was

Julita A Teodorczyk-Injeyan; Marion McGregor; Richard Ruegg; H Stephen Injeyan



Sildenafil in the Treatment of Sexual Dysfunction in Spinal Cord–Injured Male Patients  

Microsoft Academic Search

Objectives: The aim of this study was to evaluate the efficacy and safety of sildenafil in the treatment of erectile dysfunction (ED) in spinal cord–injury (SCI) patients. Moreover, we looked for neurological conditions permitting therapeutic success and for the ideal dose needed to achieve sufficient erections.Methods: 41 SCI patients were prospectively examined. Sexual dysfunction was assessed by means of anamnesis,

Daniel Max Schmid; Brigitte Schurch; Dieter Hauri



In vivo longitudinal studies of spinal cord injury and vascular endothelial growth factor treatment  

Microsoft Academic Search

Approximately 12,000 new cases of spinal cord injury (SCI) are added each year to the estimated 259,000 Americans living with SCI. The majority of these patients return to society, their lives forever changed by permanent loss of sensory and motor function. While there are no FDA approved drugs for the treatment of SCI or a universally accepted standard therapy, the

Laura Michelle Sundberg



Proportional treatment effects for count response panel data: effects of binary exercise on health care demand  

Microsoft Academic Search

We define conditional and marginal treatment effects appropriate for count data, and then conduct an empirical analysis for the effects of exercise on health care demand using panel data from the Health Retirement Study. The response variables are office visits to doctors and hospitalization days, and the treatments of interest are light and vigorous exercises. We found that short-run light

Myoung-Jae Lee; Satoru Kobayashi



Diagnosis and treatment of a patient with isolated spinal granulocytic sarcoma: A case report  

PubMed Central

A previously healthy 34-year-old female presented with a 5-month history of progressive backache and weakness in the left fingers. Magnetic resonance imaging (MRI) showed soft tissue masses in the spinal canal distributed along the nerve course. The patient’s baseline laboratory data were normal. Surgical intervention was performed and histological examination identified isolated spinal granulocytic sarcoma (GS). A bone marrow biopsy also presented normal findings. However, the patient developed numbness and pain in the right lower limb two months later. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed FDG uptake in the left trapezius muscle, cervix uteri, iliac bone, lymphadenectasis of the pelvic wall and left axillary fossa. Cerebrospinal fluid (CSF) examination allowed a diagnosis of central nervous system leukemia (CNSL). The patient underwent chemotherapy and intrathecal injection, resulting in the elimination of the residual lesion. Correct diagnosis and adequate treatment are essential to achieve optimal results in patients with isolated spinal GS.




Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials  

PubMed Central

Background The aim of this paper was undertake a systematic review and meta-analysis of the use of spinal cord stimulation (SCS) in the management of refractory angina. Methods We searched a number of electronic databases including Medline, Embase and Cochrane Library up to February 2008 to identify randomised controlled trials (RCTs) reporting exercise capacity, ischemic burden, functional class, quality of life, usage of anti-anginal medication, costs and adverse events including mortality. Results were reported both descriptively for each study and using random effects meta-analysis. Given the variety in outcomes reported, some outcome results were pooled as standardised mean differences (SMD) and reported in standard deviation units. Results Seven RCTs were identified in a total of 270 refractory angina patients. The outcomes of SCS were found to be similar when directly compared to coronary artery bypass grafting (CABG) and percutaneous myocardial laser revascularisation (PMR). Compared to a 'no stimulation' control, there was some evidence of improvement in all outcomes following SCS implantation with significant gains observed in pooled exercise capacity (SMD: 0.76, 0.07 to 1.46, p = 0.03) and health-related quality of life (SMD: 0.83, 95% CI: 0.32 to 1.34, p = 0.001). Trials were small and were judged to range considerably in their quality. The healthcare costs of SCS appeared to be lower than CABG at 2-years follow up. Conclusion SCS appears to be an effective and safe treatment option in the management of refractory angina patients and of similar efficacy and safety to PMR, a potential alternative treatment. Further high quality RCT and cost effectiveness evidence is needed before SCS can be accepted as a routine treatment for refractory angina.

Taylor, Rod S; De Vries, Jessica; Buchser, Eric; DeJongste, Mike JL




Microsoft Academic Search

Many athletes, especially female athletes and participants in endurance and aesthetic sports and sports with weight classes, are chronically energy deficient. This energy deficiency impairs performance, growth and health. Reproductive disorders in female athletes are caused by low energy availability (defined as dietary energy intake minus exercise energy expenditure), perhaps specifically by low carbohydrate availability, and not by the stress

F A Hellebrandt



Treatment for “Helpless” Women Suffering from Chronic Spinal Pain: A Randomized Controlled 18Month Follow-Up Study  

Microsoft Academic Search

This prospective randomized controlled outcome study was designed to evaluate whether a MultiModal Cognitive—Behavioral Treatment for chronic spinal pain (MMCBT) specifically designed for women has an increased effect on well being and return to work compared to a regular MMCBT regimen. In Sweden, spinal pain is most prevalent among women. A tremendous amount of money is spent on secondary prevention

Irene B. Jensen; Catarina Dahlquist; Åke Nygren; Eva Royen; Monica Stenberg



Partial functional recovery after complete spinal cord transection by combined chondroitinase and clenbuterol treatment.  


Spinal cord injury not only disrupts axonal tracts but also causes gliotic, fibrotic, and Schwannotic scarring with resulting deposition of chondroitin sulfate proteoglycans (CSPGs) which prevent axonal reconnection and recovery of locomotor function. Here, we determined whether recovery of locomotor function could be promoted after complete transection, by degrading CSPGs enzymatically within the injury site with chondroitinase ABC (chABC) together with treatment with the beta(2)-adrenoceptor agonist, clenbuterol, a neuroprotective agent which can promote regrowth of lower motoneurons. Partial recovery of locomotor function was observed 8-12 weeks postinjury only after combined chABC and clenbuterol treatment. The recovery of locomotor function coincided with the presence of axons caudal to the injury site arising from neurons of the reticular, vestibular, and red nuclei also only with combined chABC and clenbuterol treatment. Axons myelinated by Schwann cells were most prominent in the transection site in the combined treatment group. Clenbuterol treatment activated cAMP response element binding protein within retrogradely traced neurons which has been associated with axonal regrowth. ChABC treatment decreased scarring due to both CSPG and collagen deposition as well as the gap between intact regions of the spinal cord. ChABC also increased numbers of phagocytic cells which remove myelin debris as well as populations of astrocytes thereby aiding blood-spinal cord barrier reformation. Together the results suggest that chABC and clenbuterol can act synergistically to promote recovery of locomotor function. PMID:20552220

Bai, Fusheng; Peng, Hong; Etlinger, Joseph D; Zeman, Richard J



Driven Exercise Among Treatment-Seeking Youth with Eating Disorders  

PubMed Central

Purpose This study evaluated the prevalence and clinical significance of driven exercise (DE) in treatment-seeking youth. Methods Participants were 380 consecutive referrals to a pediatric eating disorder program (90.8% female; M age=14.9±2.2). Spearman’s rho correlations examined the relation between DE frequency, and Beck Depression Inventory (BDI) and Eating Disorders Examination (EDE) Global Severity scores. ANOVA compared those reporting only DE, only vomiting, or both DE and vomiting on the aforementioned measures. Results 51.3% of participants (n=193) reported DE in the past 3 months, with an average of 21.8 (SD=32.6) episodes. Frequency of DE was related to EDE global severity score (Spearman’s rho=.46; p<.001) and BDI Total Score (Spearman’s rho=.33; p<.001). Participants reporting both vomiting and DE had the highest EDE global severity and BDI total scores. Conclusions DE is associated with greater eating disorder and depressive symptomatology, especially when paired with vomiting. The findings highlight the importance of assessing for DE in youth presenting for eating disorder treatment.

Stiles-Shields, E. Colleen; Goldschmidt, Andrea B.; Boepple, Leah; Glunz, Catherine; Le Grange, Daniel



Effects of Spinal Flexion and Extension Exercises and Their Associated Postures in Patients With Acute Low Back Pain.  

National Technical Information Service (NTIS)

Study Design. A prospective randomized clinical trial compared the effects of flexion and extension back - - -- exercises and postures among soldiers with acute low back pain. Objective. To compare the immediate effects of back exercise on functional stat...

J. R. Dettori S. H. Bullock T. G. Sutlive R. J. Franklin T. Patience



Leptomeningeal spinal metastases from glioblastoma multiforme: treatment and management of an uncommon manifestation of disease.  


Glioblastoma multiforme (GBM) is one of the most common and aggressive primary brain tumors, composing 12%-20% of all intracranial tumors in adults. Average life expectancy is merely 12-14 months following initial diagnosis. Patients with this neoplasm have one of the worst 5-year survival rates among all cancers despite aggressive multimodal treatment consisting of maximal tumor resection, radiation therapy, and adjuvant chemotherapy. With recent advancements in management strategies, there has been improvement in the overall trend in patient outcomes; however, recurrence remains nearly inevitable. While most tumors recur locally, metastases to distal locations have become more common. Specifically, the last decade has seen an increased incidence of spinal metastases, representing an emerging complication in patients with intracranial GBM. However, the literature regarding prevention strategies and the presentation of spinal metastases has remained scarce. As local control of primary lesions continues to improve, more cases of spinal metastases are likely to be seen. In this review the authors present a new case of metastatic GBM to the L-5 nerve root, and they summarize previous cases of intracranial GBM with leptomeningeal spinal metastatic disease. They also characterize key features of this disease presentation and discuss areas of future investigation necessary for enhanced prevention and treatment of this complication. PMID:22958073

Lawton, Cort D; Nagasawa, Daniel T; Yang, Isaac; Fessler, Richard G; Smith, Zachary A



Hippocampal Brain-Derived Neurotrophic Factor Expression Following Treatment with Reboxetine, Citalopram, and Physical Exercise  

Microsoft Academic Search

The antidepressants, reboxetine and citalopram, were used in conjunction with voluntary physical exercise (wheel running) in order to assess the contribution of noradrenergic and serotonergic activation to enhancements in hippocampal brain-derived neurotrophic factor (BDNF) expression resulting from antidepressant treatment and exercise. Reboxetine (40 mg\\/kg\\/day), citalopram (10 mg\\/kg\\/day), voluntary physical activity, and the combination of antidepressants with exercise were applied to

Amelia A Russo-Neustadt; Hilda Alejandre; Celithelma Garcia; Autumn S Ivy; Michael J Chen



Thermoregulatory responses of spinal cord injured and able-bodied athletes to prolonged upper body exercise and recovery  

Microsoft Academic Search

Study design: Single trial, two factor repeated measures design. Setting: England, Cheshire. Objectives: To examine the thermoregulatory responses of able-bodied (AB) athletes, paraplegic (PA) athletes and a tetraplegic (TP) athlete at rest, during prolonged upper body exercise and recovery. Methods: Exercise was performed on a Monark cycle ergometer (Ergomedic 814E) adapted for arm exercise at 60% VO2 peak for 60

MJ Price; IG Campbell



U.S. Army Battlefield Exercise and Combat Related Spinal Cord Injury Research: Neuroprotection and Repair After Spinal Cord Injury. Addendum.  

National Technical Information Service (NTIS)

The purpose of this research program is to use a multidisciplinary approach to investigate the pathophysiology of spinal cord injury (SCI) with the major goal of developing therapies targeted at both the acute and more chronic injury setting. We are testi...

W. D. Dietrich



UK Back pain Exercise And Manipulation (UK BEAM) trial--national randomised trial of physical treatments for back pain in primary care: objectives, design and interventions [ISRCTN32683578].  


BACKGROUND: Low back pain has major health and social implications. Although there have been many randomised controlled trials of manipulation and exercise for the management of low back pain, the role of these two treatments in its routine management remains unclear. A previous trial comparing private chiropractic treatment with National Health Service (NHS) outpatient treatment, which found a benefit from chiropractic treatment, has been criticised because it did not take treatment location into account. There are data to suggest that general exercise programmes may have beneficial effects on low back pain. The UK Medical Research Council (MRC) has funded this major trial of physical treatments for back pain, based in primary care. It aims to establish if, when added to best care in general practice, a defined package of spinal manipulation and a defined programme of exercise classes (Back to Fitness) improve participant-assessed outcomes. Additionally the trial compares outcomes between participants receiving the spinal manipulation in NHS premises and in private premises. DESIGN: Randomised controlled trial using a 3 x 2 factorial design. METHODS: We sought to randomise 1350 participants with simple low back pain of at least one month's duration. These came from 14 locations across the UK, each with a cluster of 10-15 general practices that were members of the MRC General Practice Research Framework (GPRF). All practices were trained in the active management of low back pain. Participants were randomised to this form of general practice care only, or this general practice care plus manipulation, or this general practice care plus exercise, or this general practice care plus manipulation followed by exercise. Those randomised to manipulation were further randomised to receive treatment in either NHS or private premises. Follow up was by postal questionnaire one, three and 12 months after randomisation. The primary analysis will consider the main treatment effects before interactions between the two treatment packages. Economic analysis will estimate the cost per unit of health utility gained by adding either or both of the treatment packages to general practice care. PMID:12892566

Brealey, S; Burton, K; Coulton, S; Farrin, A; Garratt, A; Harvey, E; Letley, L; Martin, J; Klaber, Moffett J; Russell, I; Torgerson, D; Underwood, M; Vickers, M; Whyte, K; Williams, M



[Analysis of FIM-values during the hospital treatment of patients with acute spinal cord injury].  


The cost pressures in the German health care system continue to rise. In the context of the introduction of the DRG system, adequate treatment of paraplegic and tetraplegic patients within the financial limits will become even more difficult. In dispute with health care insurance companies, scientifically sound studies have been lacking to justify a treatment lasting up to six months as an in-patient of individuals with acute spinal cord injury or disease. The FIM (Functional Independence Measurement), established as a reliable tool in the evaluation of the functional development of patients presenting with acute spinal cord lesions, has been used as the basic tool in our study. Under the conditions of a specialized spinal cord injury centre the FIM showed a statistically highly significant increase of functional independence during the entire course of treatment. No therapeutic standstill could be detected in order to determine a point of discharge. Even in the last six weeks of treatment significant progress in functional independence can be observed. PMID:15202036

Meiners, T; Böhm, V; Schlüter, E



Evidence on the effects of exercise therapy in the treatment of chronic disease  

Microsoft Academic Search

Evidence on the effects of exercise in the treatment of patients with chronic diseases should be based on well designed randomised controlled trials. The most consistent finding of the meta-analyses summarised in the present work is that aerobic\\/functional capacity and muscle strength can be improved by exercise training among patients with different diseases without having detrimental effects on disease progression.

U M Kujala



Treatment of minor depression in older adults: A pilot study comparing sertraline and exercise  

Microsoft Academic Search

The purpose of this study was to conduct a pilot clinical trial to test the feasibility and efficacy of an exercise program and anti-depressant treatment compared with usual care in improving the emotional and physical functioning of older adults with minor depression. Participants were 37 older adults with minor depression who were randomized to exercise, sertraline, or usual care; 32

G. A. Brenes; J. D. Williamson; S. P. Messier; W. J. Rejeski; M. Pahor; E. Ip; B. W. J. H. Penninx



Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment  

Microsoft Academic Search

Background: Fatigue is a relevant problem of cancer patients during and after treatment. Several studies have shown that exercise can improve quality of life and functional status of cancer patients undergoing chemo- or radiotherapy. However, there is a lack of information about the effects of this intervention on persistent cancer-related fatigue. Therefore, we assessed the effects of an exercise program

F. Dimeo; S. Schwartz; N. Wesel; A. Voigt; E. Thiel



Development and treatment of spinal deformity in patients with cerebral palsy  

PubMed Central

Scoliosis is a common deformity in children and adolescents with cerebral palsy. This is usually associated with pelvic obliquity due to extension of the curve to the sacrum. Sagittal plane deformity is less common and often develops along with scoliosis. Spinal deformity in patients with severe neurological handicaps can affect their ability to sit and cause significant back pain or pain due to rib impingement against the elevated side of the pelvis on the concavity of the curvature. Surgical correction followed by spinal arthrodesis is indicated in patients with progressive deformities which interfere with their level of function and quality of life. Spinal deformity correction is a major task in children with multiple medical co-morbidities and can be associated with a high risk of complications including death. A well-coordinated multidisciplinary approach is required in the assessment and treatment of this group of patients with the aim to minimize the complication rate and secure a satisfactory surgical outcome. Good knowledge of the surgical and instrumentation techniques, as well as the principles of management is needed to achieve optimum correction of the deformity and balancing of the spine and pelvis. Spinal fusion has a well-documented positive impact even in children with quadriplegia or total body involvement and is the only surgical procedure which has such a high satisfaction rate among parents and caregivers.

Tsirikos, Athanasios I



Fluoxetine treatment promotes functional recovery in a rat model of cervical spinal cord injury.  


Spinal cord injury (SCI) is a severe condition leading to enduring motor deficits. When lesions are incomplete, promoting spinal cord plasticity might be a useful strategy to elicit functional recovery. Here we investigated whether long-term fluoxetine administration in the drinking water, a treatment recently demonstrated to optimize brain plasticity in several pathological conditions, promotes motor recovery in rats that received a C4 dorsal funiculus crush. We show that fluoxetine administration markedly improved motor functions compared to controls in several behavioral paradigms. The improved functional effects correlated positively with significant sprouting of intact corticospinal fibers and a modulation of the excitation/inhibition balance. Our results suggest a potential application of fluoxetine treatment as a non invasive therapeutic strategy for SCI-associated neuropathologies. PMID:23860568

Scali, Manuela; Begenisic, Tatjana; Mainardi, Marco; Milanese, Marco; Bonifacino, Tiziana; Bonanno, Giambattista; Sale, Alessandro; Maffei, Lamberto



Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease  

Microsoft Academic Search

We studied the efficacy of endoscopic injection of Botulinum A toxin (150 I.U. Dysport®) in the treatment of detrusor-sphincter dyssynergia in 17 patients with spinal cord disease. One month after the injection, the postvoiding residual urine volume (?176 ml, P<0.001), the bladder pressure on voiding (?19 cm water, P<0.01), and the urethral pressure (?24 cm water, P<0.001) were significantly decreased.

H Petit; L Wiart; E Gaujard; F Le Breton; J M Ferrière; A Lagueny; P A Joseph; M Barat



Latest Approaches for the Treatment of Spasticity and Autonomic Dysreflexia in Chronic Spinal Cord Injury  

Microsoft Academic Search

Summary  Two of the most prevalent secondary complications following spinal cord injury (SCI), besides loss of function and\\/or sensation\\u000a below the level of injury, are uncontrolled muscle spasticity and hypertensive autonomic dysreflexia. Despite the desires\\u000a of the SCI community, there have been few advances in the treatment and\\/or management of these fundamental impediments to\\u000a the quality of life associated with chronic

Alexander G. Rabchevsky; Patrick H. Kitzman



Spinal cord stimulation in the treatment of chronic critical limb ischemia  

Microsoft Academic Search

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

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


Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients  

Microsoft Academic Search

Objective:To analyze factors with impact on the functional outcome for patients with surgically treated intramedullary spinal cord tumors (IMSCT) and to point out characteristics of the different histological entities.Setting:Neurosurgical Department, University of Essen, Germany.Methods:Between 1990 and 2000, a consecutive series of 78 patients were referred to our institution and underwent surgical treatment. There were 46 (59%) male and 32 (41%)

I E Sandalcioglu; T Gasser; S Asgari; A Lazorisak; T Engelhorn; T Egelhof; D Stolke; H Wiedemayer



Spinal Cystic Echinococcosis - A Systematic Analysis and Review of the Literature: Part 2. Treatment, Follow-up and Outcome.  


Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques, surgical treatment and introduction of pharmacological therapy, spinal echinococcosis remains associated with a high degree of morbidity, disability and mortality. We systematically reviewed the published literature of the last five decades to update and summarize the currently existing data on treatment, follow-up and outcome of spinal CE. PMID:24069501

Neumayr, Andreas; Tamarozzi, Francesca; Goblirsch, Sam; Blum, Johannes; Brunetti, Enrico



Spinal Cystic Echinococcosis - A Systematic Analysis and Review of the Literature: Part 2. Treatment, Follow-up and Outcome  

PubMed Central

Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques, surgical treatment and introduction of pharmacological therapy, spinal echinococcosis remains associated with a high degree of morbidity, disability and mortality. We systematically reviewed the published literature of the last five decades to update and summarize the currently existing data on treatment, follow-up and outcome of spinal CE.

Neumayr, Andreas; Tamarozzi, Francesca; Goblirsch, Sam; Blum, Johannes; Brunetti, Enrico



A Pilot Study of Aerobic Exercise as an Adjunctive Treatment for Drug Dependence  

PubMed Central

Intervention to increase exercise in drug dependent patients represents a potentially useful yet unexplored strategy for preventing relapse. However, there are currently no established exercise interventions for use with this population. The purpose of this pilot study was to examine the feasibility of aerobic exercise as an adjunct to substance abuse treatment among drug dependent patients. Participants included 16 (31% female, 38.3 years old) drug dependent patients who participated in a 12-week, moderate-intensity aerobic exercise intervention. Participants attended a mean of 8.6 sessions (out of 12). Participants demonstrated a significant increase in percent days abstinent for both alcohol and drugs at the end of treatment, and those who attended at least 75% of the exercise sessions had significantly better substance use outcomes than those who did not. In addition, participants showed a significant increase in their cardiorespiratory fitness by the end of treatment. While preliminary, this study is one of the first to demonstrate the feasibility of incorporating aerobic exercise during drug abuse treatment. Future randomized control trials are a necessary next step to test the efficacy of a moderate-intensity aerobic exercise intervention as an adjunct to drug abuse treatment in this patient population.

Brown, Richard A.; Abrantes, Ana M.; Read, Jennifer P.; Marcus, Bess H.; Jakicic, John; Strong, David R.; Oakley, Julie R.; Ramsey, Susan E.; Kahler, Christopher W.; Stuart, Gregory G.; Dubreuil, Mary Ella; Gordon, Alan A.



Estradiol Treatment Prevents Injury Induced Enhancement in Spinal Cord Dynorphin Expression  

PubMed Central

Administration of the ovarian steroid estradiol in male and female animals has been shown to have neuromodulatory and neuroprotective effects in a variety of experimental models. In the present study, spinal tissues from dermatomes just above (T5–T7, at level) a severe chronic spinal cord injury (SCI) at T8 were analyzed for expression levels of prodynorphin (PRDN) and phospho-(serine 369) ?-opioid receptor (KOR-P) in 17 ? estradiol (EB)- and placebo-treated adult male rats. Dynorphin was targeted since (1) it has previously been shown to be elevated post-SCI, (2) intrathecal injection of dynorphin produces several of the same adverse effects seen with a SCI, and (3) its increased expression is known to occur in a variety of different experimental models of central neuropathic pain. A significant elevation of extracellular levels of both PRDN and KOR-P in the placebo-treated SCI group relative to uninjured surgical sham controls was found in spinal tissues above the injury level, indicating increased dynorphin levels. Importantly, the EB-treated SCI group did not show elevations of PRDN levels at 6?weeks post-injury. Immunohistochemical analysis of at level tissues revealed that EB treatment significantly prevented a post-SCI increase in expression of PRDN puncta co-labeling synapsin I, a nerve terminal marker. The dynorphin-containing terminals co-labeled vesicular glutamate receptor-2 (a marker of glutamatergic terminals), a finding consistent with a non-opioid basis for the adverse effects of dynorphin. These results support a beneficial role for EB treatment post-SCI through a reduction in excessive spinal cord levels of dynorphin. Studies manipulating the timing of the EB treatment post-injury along with specific functional assessments will address whether the beneficial effects are due to EB’s potential neuromodulatory or neuroprotective action.

Gupta, Daya S.; Hubscher, Charles H.



Prolonged Minocycline Treatment Impairs Motor Neuronal Survival and Glial Function in Organotypic Rat Spinal Cord Cultures  

PubMed Central

Background Minocycline, a second-generation tetracycline antibiotic, exhibits anti-inflammatory and neuroprotective effects in various experimental models of neurological diseases, such as stroke, Alzheimer’s disease, amyotrophic lateral sclerosis and spinal cord injury. However, conflicting results have prompted a debate regarding the beneficial effects of minocycline. Methods In this study, we analyzed minocycline treatment in organotypic spinal cord cultures of neonatal rats as a model of motor neuron survival and regeneration after injury. Minocycline was administered in 2 different concentrations (10 and 100 µM) at various time points in culture and fixed after 1 week. Results Prolonged minocycline administration decreased the survival of motor neurons in the organotypic cultures. This effect was strongly enhanced with higher concentrations of minocycline. High concentrations of minocycline reduced the number of DAPI-positive cell nuclei in organotypic cultures and simultaneously inhibited microglial activation. Astrocytes, which covered the surface of the control organotypic cultures, revealed a peripheral distribution after early minocycline treatment. Thus, we further analyzed the effects of 100 µM minocycline on the viability and migration ability of dispersed primary glial cell cultures. We found that minocycline reduced cell viability, delayed wound closure in a scratch migration assay and increased connexin 43 protein levels in these cultures. Conclusions The administration of high doses of minocycline was deleterious for motor neuron survival. In addition, it inhibited microglial activation and impaired glial viability and migration. These data suggest that especially high doses of minocycline might have undesired affects in treatment of spinal cord injury. Further experiments are required to determine the conditions for the safe clinical administration of minocycline in spinal cord injured patients.

Pinkernelle, Josephine; Fansa, Hisham; Ebmeyer, Uwe; Keilhoff, Gerburg



Spinal extradural metastasis: review of current treatment options  

Microsoft Academic Search

Bone metastases, especially to the spine, are frequently encountered during the course of a malignancy. Due to a worldwide increase of cancer incidence and to a longer life expectancy of patients with cancer, a rise in incidence of bone metastases is observed. A brief historical overview is the base of a review of current treatment options. Despite new developments in

R. H. M. A. Bartels; Y. M. van der Linden



Spinal Extradural Metastasis: Review of Current Treatment Options  

Microsoft Academic Search

Bone metastases, especially to the spine, are frequently encountered during the course of a malignancy. Due to a worldwide increase of cancer incidence and to a longer life expectancy of patients with cancer, a rise in incidence of bone metastases is observed. A brief historical overview is the base of a review of current treatment options. Despite new develop- ments

M. A. Bartels; Yvette M. van der Linden


Exercise, Behavioral Therapy Reduce Menopausal Symptoms Caused by Breast Cancer Treatment

Women with breast cancer who were suffering from treatment-related menopausal symptoms experienced symptom relief with cognitive behavioral therapy, physical exercise, or both, according to a Dutch study published October 8, 2012, in the Journal of Clinical Oncology.


Burr Hole Drainage : Could Be Another Treatment Option for Cerebrospinal Fluid Leakage after Unidentified Dural Tear during Spinal Surgery?  

PubMed Central

Authors report a rare case of acute intracranial subdural and intraventricular hemorrhage that were caused by intracranial hypotension resulted from cerebrospinal fluid leakage through an unidentified dural tear site during spinal surgery. The initial brain computed tomography image showed acute hemorrhages combined with preexisting asymptomatic chronic subdural hemorrhage. One burr hole was made over the right parietal skull to drain intracranial hemorrhages and subsequent drainage of cerebrospinal fluid induced by closure of the durotomy site. Among various methods to treat cerebrospinal fluid leakage through unidentified dural injury site, primary repair and spinal subarachnoid drainage are well known treatment options. The brain imaging study to diagnose intracranial hemorrhage should be taken before selecting the treatment method, especially for spinal subarachnoid drainage. Similar mechanism to its spinal counterpart, cranial cerebrospinal fluid drainage has not been mentioned in previous article and could be another treatment option to seal off an unidentified dural tear in particular case of drainage of intracranial hemorrhage is needed.



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



Exercise barrier and task self-efficacy in breast cancer patients during treatment  

Microsoft Academic Search

Understanding exercise self-efficacy in breast cancer patients during treatment is important for enhancing physical activity adherence. Therefore, the primary study purpose was to determine, among breast cancer patients during treatment, the psychometric properties of scales to measure exercise barrier and task self-efficacy. The study also aimed to determine the following: (1) level of self-efficacy, (2) associations between barrier and task

Laura Q. Rogers; Kerry S. Courneya; Steve Verhulst; Steve Markwell; Victor Lanzotti; Prabodh Shah



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 ...


The role of exercise in the treatment of obesity.  


The United States is in the midst of a significant public health problem that relates to obesity and inactivity. This epidemic has far-ranging consequences for our workforce and our children and shows no signs of slowing in the near future. Significant research has been performed on the effects of exercise for the reduction of body weight; results of most studies indicate that exercise alone has a small effect on body-weight reduction independent of caloric restriction. However, when combined with dietary restriction, exercise has a synergistic effect and enhances weight loss beyond the effect of diet alone. In addition, exercise has been shown to have significant beneficial effects on cardiovascular and metabolic risk factors independent of actual weight loss, and losing just a small amount of weight can have a significant beneficial effect on these parameters. Genetic factors related to obesity have been found to be positively modified when persons incorporate physical activity into their lifestyle. Sitting time appears to be an independent risk factor for the development of metabolic risk factors; persons who spend more time sitting and watching television have worse metabolic profiles, even if they achieve the recommended amount of physical activity per week, than do those who move about throughout the day. Exercise also is essential for the prevention of weight gain over a life span, although the amount required to prevent weight gain may be closer to twice the amount of exercise recommended by the current Physical Activity Guidelines for Americans ( In many ways, the physiatrist is the most well prepared of all the specialists to address the complex, multidimensional problems of obesity and inactivity. PMID:23174547

Laskowski, Edward R



Intraoperative clinical use of low-power laser irradiation following surgical treatment of the tethered spinal cord  

NASA Astrophysics Data System (ADS)

Based on previous experimental investigations which indicated that low-power laser irradiation has a significant therapeutic effect and treatment potential on the injured nerve tissue, the authors began using this method in clinical practice. This data represents the first clinical results in the treatment of four patients with tethered spinal cord resulting from fibrous adhesions at the site of previous myelomeningocele and lypomyelomeningocele repair, thickened filum terminale and spinal lipoma. After surgical release of the tethered spinal cord, stable evoked responses were recorded and the conus medullaris was subjected to direct laser irradiation (CW He-Ne laser, 632.8nm, 7Jcm 2). The findings show intraoperative laser treatment increases evoked responses from 15-52% (mean 26.7%). In a previous work, it was shown that direct laser irradiation promotes restoration of the electrophysiological activity of the severely injured peripheral nerve, prevents degenerative changes in neurons of the spinal cord and induces proliferation of astrocytes and oligodendrocytes. This suggested a higher metabolism in neurons and improved ability for myelin production under the influence of laser treatment. It is well known that tethering of the spinal cord causes mechanical damage to neuronal cell membranes leading to metabolic disturbances in the neurons. For this reason, the authors believe that using low-power laser irradiation may improve neuronal metabolism, prevent neuronal degeneration and promote improved spinal cord function and repair.

Rochkind, S.; Alon, M.; Ouaknine, G. E.; Weiss, S.; Avram, J.; Razon, N.; Lubart, Rachel; Friedmann, Harry



Efficacy of directly observed treatment short-course intermittent regimen in spinal tuberculosis  

PubMed Central

Background: Most important cause of treatment failure and emergence of drug resistance in the treatment of tuberculosis is noncompliance. Compliance can be improved by direct observation of drug intake, intermittent therapy, and short-course treatment. The efficacy of Directly Observed Treatment Short Course (DOTS) strategy advocated by World Health Organization (WHO) in spinal tuberculosis is not yet proven. We conducted a prospective clinical study on a consecutive series of patients with spinal tuberculosis treated by Category I Revised National Tuberculosis Control Programme (RNTCP) regimen based on DOTS strategy of WHO from 2004 to 2007 to evaluate the efficacy. Materials and Methods: Forty-nine consecutive patients of spinal tuberculosis were treated with short-course intermittent chemotherapy under Category I RNTCP/DOTS strategy. Patients were followed up for a minimum period of 2 years. Surgery was done if the patient presented with significant neurologic deficit or when the drug treatment failed. Outcome was assessed by clinical, radiologic, and laboratory criteria, and graded into excellent, good, fair, and poor based on various parameters. Results: 63.4% (n=26) of the patients had excellent results. 14.6% (n=6) of the patients had good and fair results. Three patients (7.3%) had poor results 48.7% (n=20) of the patients had but only one of them was severe enough to warrant change of drug. Conclusions: Efficacy of DOTS was comparable with other standard regimens. There was a significant reduction in adverse side effects when compared with daily regimens. Study showed that the outcome was better in those treated early.

Valsalan, Rejith; Purushothaman, Rajesh; Raveendran, MK; Zacharia, Balaji; Surendran, Sibin



Aerobic exercise in the adjunctive treatment of depression: a randomized controlled trial.  

PubMed Central

Two clinical trials have been conducted in a sample of depressed patients to determine whether the addition of an aerobic exercise programme to their usual treatment improved outcome after 12 weeks. In the first trial, an aerobic exercise group had a superior outcome compared with a control group in terms of trait anxiety and a standard psychiatric interview. A second trial was then conducted to compare an aerobic exercise programme with low intensity exercise. Both groups showed improvement but there were no significant differences between the groups. In neither trial was there any correlation between the extent of change in the subjects' physical fitness due to aerobic exercise and the extent of the improvement of psychiatric scores.

Veale, D; Le Fevre, K; Pantelis, C; de Souza, V; Mann, A; Sargeant, A



Surgical Treatment of Primary Spinal Tumors in the Conus Medullaris  

PubMed Central

Objective The objective of this study was to evaluate the characteristics and surgical outcome of the conus medullaris tumors. Methods We retrospectively reviewed 26 patients who underwent surgery for conus medullaris tumor from August 1986 to July 2007. We analyzed clinical manifestation, preoperative MRI findings, extent of surgical resection, histopathologic type, adjuvant therapy, and outcomes. Results There were ependymoma (13), hemangioblastoma (3), lipoma (3), astrocytoma (3), primitive neuroectodermal tumor (PNET) (2), mature teratoma (1), and capillary hemangioma (1) on histopathologic type. Leg pain was the most common symptom and was seen in 80.8% of patients. Pain or sensory change in the saddle area was seen in 50% of patients and 2 patients had severe pain in the perineum and genitalia. Gross total or complete tumor resection was obtained in 80.8% of patients. On surgical outcome, modified JOA score worsened in 26.9% of patients, improved in 34.6%, and remained stable in 38.5%. The mean VAS score was improved from 5.4 to 1.8 among 21 patients who had lower back pain and leg pain. Conclusion The surgical outcome of conus medullaris tumor mainly depends on preoperative neurological condition and pathological type. The surgical treatment of conus medullaris tumor needs understanding the anatomical and functional characteristics of conus meudllaris tumor for better outcome.

Han, In-Ho; Chin, Dong-Kyu; Kim, Keun-Su; Jin, Byung-Ho; Cho, Yong-Eun



Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial  

Microsoft Academic Search

Summary Background The standard treatment for spinal cord compression caused by metastatic cancer is corticosteroids and radiotherapy. The role of surgery has not been established. We assessed the efficacy of direct decompressive surgery. Methods In this randomised, multi-institutional, non-blinded trial, we randomly assigned patients with spinal cord compression caused by metastatic cancer to either surgery followed by radiotherapy (n=50) or

Roy A Patchell; Phillip A Tibbs; William F Regine; Richard Payne; Stephen Saris; Richard J Kryscio; Mohammed Mohiuddin; Byron Young



Prescribed Exercise Behavior in the Treatment of Spouse Abuse.  

ERIC Educational Resources Information Center

|This presentation by a practicing marital therapist describes how exercise behavior can be used as a preventive measure against spouse abuse. This crisis intervention approach is intended to help couples develop stopgap techniques to prevent physical violence; it is one segment of a more comprehensive approach which might include contingency…

Doyle, William W., Jr.


Biomechanical analysis of pedicle screw density in spinal instrumentation for scoliosis treatment: first results.  


Clinical studies reveal remarkable variation in screw patterns, or screw density in spinal instrumentation. Screw density may have a great impact on blood loss, operative time, radiation, risk of screw malposition, and cost. Thus, there is a need to understanding of the biomechanical effects of screw density so as to minimize the number of pedicle screws while ensuring safe and effective instrumentation. The objective of this study was to compare the deformity correction effects and bone-screw loadings of different pedicle screw densities in spinal instrumentation for scoliosis treatment. Spinal instrumentation simulations were performed on three scoliosis patients using 3 screw density patterns (low, preferred, and high screw density) proposed by two experienced surgeons and basic correction techniques: concave rod attachment, rod derotation, apical vertebral derotation, and convex side rod attachment. Simulation results showed that all tested screw densities generated quite similar correction, with differences between the achieved corrections all below 3°. The average bone-screw forces were 244±67N, 214±66 N, and 210±71 N, respectively for low, preferred, and high densities. It remains a complex challenge balancing the benefit of load sharing between more implants with the overconstraints and limited degrees of freedom introduced by the increased number of implants. Studies on additional screw densities and patterns proposed by more surgeons for a variety of cases, and using more diverse correction techniques are necessary to draw stronger conclusions and to recommend the optimal screw density. PMID:22744515

Wang, Xiaoyu; Aubin, Carl-Eric; Larson, A Noelle; Labelle, Hubert; Parent, Stefan



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 ...


Treatment of Chronic Lower Back Pain with Lumbar Extension and Whole-Body Vibration Exercise  

Microsoft Academic Search

Study Design. A randomized controlled trial with a 6-month follow-up period was conducted. Objective. To compare lumbar extension exercise and whole-body vibration exercise for chronic lower back pain. Summary of Background Data. Chronic lower back pain involves muscular as well as connective and neural systems. Different types of physiotherapy are applied for its treatment. Industrial vibration is regarded as a

A Randomized Controlled Trial; Jorn Rittweger; Karsten Just; Katja Kautzsch; Peter Reeg; Dieter Felsenberg


Cognitive Group Therapy and Aerobic Exercise in the Treatment of Anxiety  

Microsoft Academic Search

Our purpose was to examine the effects of cognitive group therapy, aerobic exercise, or their combination on anxiety reduction. Seventy participants were divided into four groups: cognitive group therapy, aerobic exercise, both treatments, or control. Participants were administered the State-Trait Anxiety Inventory (STAI) before and after the study, and at a two-month follow-up. Results indicate that all interventions were equally

Derek J. McEntee; Richard P. Halgin



Path analysis of exercise treatment-induced changes in psychological factors leading to weight loss  

Microsoft Academic Search

Physical activity may affect weight loss largely through psychological pathways associated with eating changes, especially in obese individuals whose caloric expenditure through exercise is typically small. Direct testing of this is, however, lacking. Previously sedentary adults (N?=?114; 77% female; Mage?=?43.3 years), with a minimum body mass index (BMI) of 35?kg\\/m (MBMI?=?42.0?kg\\/m), participated in a 24-week treatment of cognitive-behavioural exercise support

James J. Annesi; C. Nathan Marti



The Use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Chronic Low-Back Pain  

Microsoft Academic Search

Objectives: To determine the effect of a series of electro-acupuncture (EA) treatment in con- junction with exercise on the pain, disability, and functional improvement scores of patients with chronic low-back pain (LBP). Design: A blinded prospective randomized controlled study. Subjects and interventions: A total of 52 patients were randomly allocated to an exercise group (n 5 26) or an exercise

Cecilia K. N. Yeung; Mason C. P. Leung; Daniel H. K. Chow



Effects of a Supervised Exercise Intervention on Recovery From Treatment Regimens in Breast Cancer Survivors  

PubMed Central

Purpose/Objectives To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments. Design Pretest and post-test quasiexperimental. Setting Outpatient oncology rehabilitation center. Sample 96 breast cancer survivors undergoing various clinical treatments. Methods Subjects were divided into four groups based on the specific type of clinical treatment: surgery alone (n = 22); surgery and chemotherapy (n = 30); surgery and radiation (n = 17); and surgery, chemotherapy, and radiation (n = 27). Following a comprehensive screening and medical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed, leading to the development of an individualized exercise prescription and a six-month exercise intervention. Repeated-measures analysis of variance and covariance were used to compare the effectiveness of the intervention and differences among treatment groups. Main Research Variables Systolic and diastolic blood pressure, resting heart rate, forced vital capacity, forced expiratory volume, predicted oxygen consumption, time on treadmill, and fatigue. Findings Cardiopulmonary function (predicted maximal oxygen consumption and time on treadmill) significantly increased in all groups after exercise training. In addition, resting heart rate and forced vital capacity significantly improved in those receiving surgery, chemotherapy, and radiation. Psychologically, the exercise intervention resulted in significant reductions in behavioral, affective, sensory, cognitive and mood, and total fatigue scale scores in all three groups who received treatment with surgery. The breast cancer survivors in the surgery-alone group showed significant reductions in behavioral, affective, and total fatigue scale scores but not in sensory and cognitive and mood fatigue scale scores. Conclusions The results suggest that moderate intensity, individualized, prescriptive exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue regardless of treatment type. Moreover, cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention. Implications for Nursing Clinicians need to be aware of adjuvant therapies such as moderate exercise that attenuate negative side effects of cancer treatments. Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum and the importance of participating in a cancer rehabilitation exercise program.

Hsieh, City C.; Sprod, Lisa K.; Hydock, David S.; Carter, Susan D.; Hayward, Reid; Schneider, Carole M.



The objective evaluation of effectiveness of manual treatment of spinal function disturbances  

PubMed Central

Summary Background The aim of this paper is the evaluation of effectiveness of manual therapy in the treatment of functional disturbances of the spine. Material/Methods The study subjects were 40 persons aged 45–60 years, in whom degenerative changes in intervertebral discs and physical limitations within the spine were found (NMR), which were manifested as pain. Subjects were randomly divided into 2 groups of 20 persons each. The first group went on a monthly rehabilitation tour, where the manual therapy methods were applied. The second group was treated by means of physical methods. In order to verify the results of effectiveness of the therapies, the examination of the sectional mobility and the evaluation of the spinal curvatures before and after the completion of the therapy were made by means of a tensiometric electrogoniometer. Results The percentage differences in significance result from the lower value of parameter t1 in the group of persons treated physically. The dynamics of changes in the parameters in the sectional mobility in both tested groups was highest in the cervical and lumbar spine. The manually treated group had greater dynamics of changes in functional parameters of the spine. Conclusions Manual therapy is an effective method for treatment of functional changes and early structural changes within the spine, and may be used as supplementary therapy in relation to the standard model of treatment of spinal pain.

Szulc, Pawel; Lewandowski, Jacek; Boch-Kmieciak, Joanna; Berski, Pawel; Matusiak, Marta



Effect of vibration treatment on symptoms associated with eccentric exercise-induced muscle damage  

Microsoft Academic Search

Unaccustomed eccentric exercise results in delayed onset of muscle soreness (DOMS), loss of muscle strength, reduced range of motion (ROM) and swelling. Vibration treatment has been used in physiotherapy to reduce pain and oedema, and to facilitate the repair of injured tissue. This study tested the hypothesis that vibration treatment would reduce the symptoms of muscle damage such as DOMS

Wing Y. Lau



Effect of diet and exercise treatment for obese Japanese children on abdominal fat distribution.  


The purpose of this study was to investigate the combined effect of dietary treatment and exercise treatment on abdominal fat distribution and the risk factors for chronic disease in obese Japanese children. The subjects were 33 obese children. The areas of subcutaneous and visceral fat were measured using CT images at the level of the umbilicus. Blood samples were taken to measure risk factors for chronic disease such as triglycerides (TG), total cholesterol (T-Cho), high-density lipoprotein cholesterol (HDL-C), insulin, asparate amino-transferase (AST), alanine aminotransferase (ALT) and uric acid (UA). Supervised exercise treatment at 50% Vo(2)max for about 60 min/day was performed 5 or 7 days/week for 3 months. The dietary treatment was varied with daily calorie intake between 1400 and 1900 kcal depending on the degree of obesity. After dietary treatment combined with exercise treatment, the areas of subcutaneous and visceral fat decreased significantly, and such risk factors as TG, T-Cho, insulin, AST, ALT, and UA were noticeably reduced. These data suggest that dietary treatment combined with exercise treatment in obese children normalizes the distribution of abdominal fat and reduces the risk factors for chronic disease. PMID:20391247

Togashi, Kenji; Masuda, Hidenari; Iguchi, Kousei



Reducing resistance and denial by exercising ambivalence during the treatment of addiction  

Microsoft Academic Search

Stage change models and motivational enhancement therapies have significantly influenced the therapeutic tactics clinicians employ in the treatment of addictive behaviors. While motivational enhancement strategies have addressed client ambivalence to increase motivation to change, this article suggests that focusing on ambivalence during treatment has even wider clinical utility than previously thought. Resistance reduction concentrates on exercising ambivalence without an investment

Howard J Shaffer; Gary Simoneau



Responses of brown adipose tissue to diet-induced obesity, exercise, dietary restriction and ephedrine treatment.  


Drug-induced weight loss in humans has been associated with undesirable side effects not present in weight loss from lifestyle interventions (caloric restriction or exercise). To investigate the mechanistic differences of weight loss by drug-induced and lifestyle interventions, we examined the gene expression (mRNA) in brown adipose tissue (BAT) and conducted histopathologic assessments in diet-induced obese (DIO) mice given ephedrine (18 mg/kg/day orally), treadmill exercise (10 m/min, 1-h/day), and dietary restriction (DR: 26% dietary restriction) for 7 days. Exercise and DR mice lost more body weight than controls and both ephedrine and exercise reduced percent body fat. All treatments reduced BAT and liver lipid accumulation (i.e., cytoplasmic lipids in brown adipocytes and hepatocytes) and increased oxygen consumption (VO2 ml/kg/h) compared with controls. Mitochondrial biogenesis/function-related genes (TFAM, NRF1 and GABPA) were up-regulated in the BAT of all groups. UCP-1 was up-regulated in exercise and ephedrine groups, whereas MFSD2A was up-regulated in ephedrine and DR groups. PGC-1? up-regulation was observed in exercise and DR groups but not in ephedrine group. In all experimental groups, except for ephedrine, fatty acid transport and metabolism genes were up-regulated, but the magnitude of change was higher in the DR group. PRKAA1 was up-regulated in all groups but not significantly in the ephedrine group. ADRß3 was slightly up-regulated in the DR group only, whereas ESRRA remained unchanged in all groups. Although our data suggest a common pathway of BAT activation elicited by ephedrine treatment, exercise or DR, mRNA changes were indicative of additional nutrient-sensing pathways in exercise and DR. PMID:22542811

Slocum, Nikki; Durrant, Jessica R; Bailey, David; Yoon, Lawrence; Jordan, Holly; Barton, Joanna; Brown, Roger H; Clifton, Lisa; Milliken, Tula; Harrington, Wallace; Kimbrough, Carie; Faber, Catherine A; Cariello, Neal; Elangbam, Chandikumar S



Treatment of obesity by exercise in the cold.  

PubMed Central

Six obese men aged 25 to 46 years exercised vigorously for 3 1/2 hours in a cold chamber (-34 degrees C) on 10 successive days. There was an early water loss of about 1 kg, probably due to mobilization of glycogen stores, and a subsequent fat loss of about 4 kg (as estimated from readings of skinfold thickness and confirmed by underwater weighing). The total fat loss was much greater than the calculated external energy deficit (as estimated from dietary records, an activity diary and use of a Kofranyi-Michaelis respirometer). Although some energy was "wasted" through ketosis, much of the additional energy was apparently used for synthesis of additional muscle protein. Both readings of skinfold thickness and underwater weighing indicated that the loss of adipose tissue was well sustained in the first 2 months after the exercise program. Further experiments are recommended to determine whether cold exposure makes a specific contribution to the observed weight loss, and whether this approach would be equally effective in a larger and less selected sample of obese patients.

O'Hara, W. J.; Allen, C.; Shephard, R. J.



Salmon fibrin treatment of spinal cord injury promotes functional recovery and density of serotonergic innervation  

PubMed Central

The neural degeneration caused by spinal cord injury leaves a cavity at the injury site that greatly inhibits repair. One approach to promoting repair is to fill the cavity with a scaffold to limit further damage and encourage regrowth. Injectable materials are advantageous scaffolds because they can be placed as a liquid in the lesion site then form a solid in vivo that precisely matches the contours of the lesion. Fibrin is one type of injectable scaffold, but risk of infection from blood borne pathogens has limited its use. We investigated the potential utility of salmon fibrin as an injectable scaffold to treat spinal cord injury since it lacks mammalian infectious agents and encourages greater neuronal extension in vitro than mammalian fibrin or Matrigel®, another injectable material. Female rats received a T9 dorsal hemisection injury and were treated with either salmon or human fibrin at the time of injury while a third group served as untreated controls. Locomotor function was assessed using the BBB scale, bladder function was analyzed by measuring residual urine, and sensory responses were tested by mechanical stimulation (von Frey hairs). Histological analyses quantified the glial scar, lesion volume, and serotonergic fiber density. Rats that received salmon fibrin exhibited significantly improved recovery of both locomotor and bladder function and a greater density of serotonergic innervation caudal to the lesion site without exacerbation of pain. Rats treated with salmon fibrin also exhibited less autophagia than those treated with human fibrin, potentially pointing to amelioration of sensory dysfunction. Glial scar formation and lesion size did not differ significantly among groups. The pattern and timing of salmon fibrin’s effects suggest that it acts on neuronal populations but not by stimulating long tract regeneration. Salmon fibrin clearly has properties distinct from those of mammalian fibrin and is a beneficial injectable scaffold for treatment of spinal cord injury.

Sharp, Kelli G.; Dickson, Amanda R.; Marchenko, Steve A.; Yee, Kelly M.; Emery, Pauline N.; Laidmae, Ivo; Uibo, Raivo; Sawyer, Evelyn S.; Steward, Oswald; Flanagan, Lisa A.



miR-124 regulates neural stem cells in the treatment of spinal cord injury.  


Several studies demonstrated that the overexpression of miR-124 in neural stem cells (NSCs) could lead the NSCs to differentiate into neurons and astrocytes, which may be important for functional recovery in spinal cord injury. The present study attempted to explore the potential repairing effect of the NSCs transfected with miR-124 for the rats with spinal cord injury (SCI). NSCs transfected with miR-124 were transplanted into rats by intravenous injection after SCI. The effects of miR-124 on the differentiation of NSCs and the treatment for the SCI-model rats were experimentally investigated. The reduction of cavity volume in focal lesions and Basso-Beattie-Bresnahan (BBB) scores were used as the criteria of functional recovery of the SCI-model rats. Up-regulation of miR-124 promoted the differentiation of NSCs. Transfection of miR-124 in NSCs dramatically increased the percentage of NeuN-positive cells, and reduced the percentage of GFAP-positive cells in vitro and in vivo respectively. All of the rats treated with NSCs transfected with miR-124 achieved the better functional recovery than the ones in NSCs and sham control groups. Furthermore, the systemic delivery of the NSCs transfected with miR-124 resulted in a reduction of lesion cavity volume of SCI-model rats. Thus, Overexpression of miR-124 can promote the differentiation of NSCs and play an important role in the repair of SCI. The utility of intravenous delivery of stem cells regulated with miR-124 to target lesion areas as a prospective therapeutic approach in acute spinal cord injury is very promising in the future. PMID:22999930

Xu, Weiwei; Li, Peng; Qin, Kun; Wang, Xiangyu; Jiang, Xiaodan



Prevention and Treatment of Bone Loss after a Spinal Cord Injury: A Systematic Review  

PubMed Central

Preserving and maintaining bone mass after a spinal cord injury (SCI) is crucial to decrease the risk of fragility or low trauma fractures— significant health events that occur as a result of minimal trauma such as falling during transfers or from a standing height or less. There is an increased risk for low trauma fractures after a SCI especially in the lower extremity. Therefore, purpose of this systematic review was to appraise the literature to provide clinical guidance for the optimization of bone health after SCI. The key research questions focused on prevention of acute bone loss and effective treatment of established low bone mass with long-standing SCI (? 1year). We report moderate evidence for the treatment of bone loss using pharmacology; however, non-pharmacological evidence for preventing and treating bone loss is limited.

Ashe, Maureen C.; Craven, Cathy; Eng, Janice J.; Krassioukov, Andrei



Comparison of transdermal nitroglycerin and intracavernous injection of papaverine in the treatment of erectile dysfunction in patients with spinal cord lesions  

Microsoft Academic Search

This study was done to evaluate the effectiveness of transdermal nitroglycerin in the treatment of erectile dysfunction in males with spinal cord lesions as compared to the treatment with intracavernous injection of papaverine. The study design used was an open, randomized, cross over trial of intracavernous injection papaverine versus transdermal nitroglycerin. Twenty eight male patients with spinal cord lesions with

R Renganathan; B Suranjan; T Kurien



Melatonin treatment protects against spinal cord injury induced functional and biochemical changes in rat urinary bladder.  


Oxidative stress induced by spinal cord injury (SCI) has deleterious effects on the function of several organ systems including the urinary bladder. In this study, we investigated the possible protective actions of melatonin on SCI-induced oxidative damage and urinary bladder dysfunction. Wistar albino rats (n = 24) were divided randomly as control, vehicle- or melatonin (10 mg/kg, ip)-treated SCI groups. To induce SCI, a standard weight-drop method that induced a moderately severe injury at T10 was used. Injured animals were given either vehicle or melatonin 15 min postinjury. One week postinjury, each rat was neurologically examined and then decapitated; blood samples were taken to evaluate neuron-specific enolase (NSE) and soluble protein 100? (S-100?). Spinal cord (SC) and urinary bladder samples were taken for functional studies and histological examination or stored for the measurement of malondialdehyde (MDA), glutathione (GSH) and nerve growth factor (NGF) levels and caspase-3 activity. Isometric contractions in bladder strips were induced by carbachol. In the SCI rats, decreased contractile responses of the bladder strips were found to be restored by melatonin treatment. Serum S-100? levels and NSE activities and tissue MDA levels and caspase-3 activities, all of which were elevated in the vehicle-treated SCI animals as compared to the control values, were reversed by melatonin treatment. On the other hand, reduced GSH and NGF levels due to SCI were restored by melatonin treatment. Furthermore, melatonin treatment improved histological findings. These findings suggest that melatonin reduces SCI-induced tissue injury and improves bladder functions through its effects on oxidative stress and NGF. PMID:22220508

Er?ahin, Mehmet; Özdemir, Zarife; Özsavc?, Derya; Akak?n, Dilek; Ye?en, Berrak Ç; Reiter, Russel J; Sener, Göksel



Exercise Therapy for Depression in Middle-Aged and Older Adults: Predictors of Early Dropout and Treatment Failure  

Microsoft Academic Search

Psychosocial factors predicting treatment dropout or failure to benefit from treatment were identified in a randomized trial of exercise therapy and pharmacotherapy for major depression. One hundred fifty-six men and women over age 50 diagnosed with major depressive disorder were assigned to a 16-week program of aerobic exercise, medication (sertraline), or a combination of exercise and medication. Thirty-two patients (21%)

Steve Herman; James A. Blumenthal; Michael Babyak; Parinda Khatri; W. Edward Craighead; K. Ranga Krishnan; P. Murali Doraiswamy



Exercise as a novel treatment for drug addiction: A neurobiological and stage-dependent hypothesis.  


Physical activity, and specifically exercise, has been suggested as a potential treatment for drug addiction. In this review, we discuss clinical and preclinical evidence for the efficacy of exercise at different phases of the addiction process. Potential neurobiological mechanisms are also discussed focusing on interactions with dopaminergic and glutamatergic signaling and chromatin remodeling in the reward pathway. While exercise generally produces an efficacious response, certain exercise conditions may be either ineffective or lead to detrimental effects depending on the level/type/timing of exercise exposure, the stage of addiction, the drug involved, and the subject population. During drug use initiation and withdrawal, its efficacy may be related to its ability to facilitate dopaminergic transmission, and once addiction develops, its efficacy may be related to its ability to normalize glutamatergic and dopaminergic signaling and reverse drug-induced changes in chromatin via epigenetic interactions with brain-derived neurotrophic factor (BDNF) in the reward pathway. We conclude with future directions, including the development of exercise-based interventions alone or as an adjunct to other strategies for treating drug addiction. PMID:23806439

Lynch, Wendy J; Peterson, Alexis B; Sanchez, Victoria; Abel, Jean; Smith, Mark A



Recent therapeutic strategies for spinal cord injury treatment: possible role of stem cells.  


Spinal cord injury (SCI) often results in significant dysfunction and disability. A series of treatments have been proposed to prevent and overcome the formation of the glial scar and inhibitory factors to axon regrowth. In the last decade, cell therapy has emerged as a new tool for several diseases of the nervous system. Stem cells act as minipumps providing trophic and immunomodulatory factors to enhance axonal growth, to modulate the environment, and to reduce neuroinflammation. This capability can be boosted by genetical manipulation to deliver trophic molecules. Different types of stem cells have been tested, according to their properties and the therapeutic aims. They differ from each other for origin, developmental stage, stage of differentiation, and fate lineage. Related to this, stem cells differentiating into neurons could be used for cell replacement, even though the feasibility that stem cells after transplantation in the adult lesioned spinal cord can differentiate into neurons, integrate within neural circuits, and emit axons reaching the muscle is quite remote. The timing of cell therapy has been variable, and may be summarized in the acute and chronic phases of disease, when stem cells interact with a completely different environment. Even though further experimental studies are needed to elucidate the mechanisms of action, the therapeutic, and the side effects of cell therapy, several clinical protocols have been tested or are under trial. Here, we report the state-of-the-art of cell therapy in SCI, in terms of feasibility, outcome, and side effects. PMID:22539011

Garbossa, D; Boido, M; Fontanella, M; Fronda, C; Ducati, A; Vercelli, A



Factors in neurological deterioration and role of surgical treatment in lumbosacral spinal lipoma.  


The purpose of this study was to determine factors that might be involved in neurological deterioration and the role of surgical treatment in patients with lumbosacral spinal lipoma. Pre- and postoperative courses of 34 patients were retrospectively analyzed. The age at surgery ranged from 1 month to 47 years. The records of preoperative neurological status indicated that older patients had more severe deficits, while all 8 asymptomatic patients were under 5 years of age. Motor deficits were noted in 9 patients, in 7 of whom the lipoma extended cranially beyond the L5 level. Transitional-type lipomas were accompanied by more severe deficits (asymptomatic 1, symptomatic 17) than other types (asymptomatic 7, symptomatic 9). Postoperative follow-up periods ranged from 5 months to 13 years. During these periods, 7 of the 8 asymptomatic patients remained neurologically intact. Nine of the 26 symptomatic patients improved. Age, extension of the lipoma in the spinal canal and type of lipoma will influence the preoperative neurological status of the patients. Early untethering surgery is recommended in patients with large lipomas extending beyond the L5 level. PMID:10804049

Koyanagi, I; Iwasaki, Y; Hida, K; Abe, H; Isu, T; Akino, M; Aida, T



Effects of acute agonist treatment on subcellular distribution of kappa opioid receptor in rat spinal cord.  


We investigated whether acute treatment with agonists affected the subcellular distribution of kappa opioid receptor (KOPR) in the dorsal horn of the rat lumbar spinal cord by using immunoelectron microscopy. Rats were injected intrathecally (i.t.) with U50,488H (100 nmole), dynorphin A(1-17) (15 nmole), or vehicle. The doses chosen have been shown to induce antinociception. Rats were perfused transcardially 30 min later, and lumbar spinal cords were removed and processed for electron microscopic analysis. KOPR was stained with KT-2, a specific polyclonal antibody against the rat/mouse KOPR(371-380) peptide, followed by gold-labeled secondary antibody and silver intensification. The silver grains were present in axons, terminals, dendrites, and somata, and the association with plasma membranes was quantified in dendrites, because KOPR immunoreactivity was most frequently observed in these profiles. In vehicle-treated rats, approximately 27% of KOPR immunoreactivity was associated with plasma membranes. U50,488H, i.t., did not cause a significant change in the percentage of KOPR present on plasma membranes, whereas dynorphin A, i.t., significantly decreased cell surface KOPR to approximately 19%. In summary, these data indicate that U50,488H and dynorphin A differentially regulate the subcellular distribution of endogenous KOPR. PMID:19130621

Wang, Yulin; Xu, Wei; Huang, Peng; Chavkin, Charles; Van Bockstaele, Elisabeth J; Liu-Chen, Lee-Yuan



Exercise therapy is evidence-based treatment of shoulder impingement syndrome. Current practice or recommendation only.  


Background: Subacromial impingement syndrome is the most common indication for shoulder operation. However, exercise therapy for the conservative treatment is recommended in the first instance. Aim: To evaluate the implementation of exercise therapy in impingement syndrome. Design: Retrospective study using structured postal questionnaire and data collected from hospital archive. Methods: A total of 104 consecutive patients who had undergone shoulder surgery due to impingement syndrome. Patients were asked about therapy modalities that they had received before and after the operation as well as pain (VAS) and functional impairment (ASES) at one-year follow-up. Results: Before surgery 49% of patients had not received advice for shoulder muscle exercises. After operation all patients had received mobility exercises, but one quarter of patients still reported that they had not received instructions about shoulder strength exercises. At the follow-up the means of the ASES index was 85 and use of NSAID had decreased by 75%. However, 15% of patients had moderate functional impairment (ASES under 60). Conclusion: About half of patients reported that they had not received advice for rotator cuff exercise therapy before surgery even though with it surgery would probably have been avoided in many cases. Although symptoms in most patients had decreased after operation, several patients still suffered from pain and decreased function. Still several patients had not received advice for shoulder strengthening exercises that are important to recovery. Clinical Rehabilitation Impact: The adherence to the current recommendations about exercise therapy is insufficient in clinical practice. Thus we recommend that it should be monitored in all institutions in which shoulder pain is treated. PMID:23480979

Ylinen, J; Vuorenmaa, M; Paloneva, J; Kiviranta, I; Kautiainen, H; Oikari, M; Häkkinen, A



Dosimetry of a single ''hockey stick'' portal for treatment of tumors of the cranio-spinal axis  

SciTech Connect

Conventional treatment of tumors of the cranio-spinal axis portal usually involves multiple-field, moving junction treatments to avoid overlapping fields over the spinal cord. To avoid these problems, we irradiate the cranio-spinal axis using a single ''hockey stick'' portal and the 25-MV x-ray beam from a Varian Clinac-35/sup X/ linear accelerator. Patients are positioned prone on the floor 229 cm from the radiation source and the collimators are rotated 45/sup 0/ so the maximum diagonal dimension of the field 116 cm at 229 cm is coincident with the cranio-spinal axis. The head is alternately rotated to treat the right-hand side one day and the left-hand side the next day. Thermoluminescent dosimetry in an anatomical phantom reveals that, relative to the 100% dose delivered at 4-cm depth on the central axis of the blocked field, the midline posterior fossa dose is about 100%, with a maximum dose of about 105% to the extreme posterior portion of the skull. The midline neck dose is about 95% and the dose to the inferior portion of the spinal cord is about 105%. The doses to other critical organs are also presented.

Glasgow, G.P.; Marks, J.E.



Exercise stage of change, barriers, expectations, values and preferences among breast cancer patients during treatment: a pilot study.  


With increasing evidence supporting physical activity benefits during breast cancer treatment, addressing exercise adherence with consideration of the unique exercise barriers, outcome expectations and preferences of cancer patients is needed. Our pilot study aimed to determine the following during breast cancer treatment: (1) exercise barriers, outcome expectations/values and associations with exercise stage of change and (2) exercise preferences. A cross-sectional survey was administered to 23 breast cancer patients during treatment. Participants were primarily aged 50-60 years (52%), Caucasian (91%), with stage I (30%), II (44%) or III (26%) disease. A total of 48% were receiving chemotherapy. In total, 50% were in the pre-contemplation/contemplation stage of change, with 34% in action/maintenance. Common exercise adherence barriers (i.e. lack of priority, self-discipline, procrastination and fatigue) demonstrated statistically significant negative associations with exercise. Frequent outcome expectations included improving heart/lungs, reducing disease risk, building muscle strength and losing weight. Important outcomes included improving state of mind, reducing fatigue and avoiding injury. Outcome expectations (i.e. less depression, boredom and nausea) were positively associated with exercise. The majority preferred walking (100%), moderate-intensity (61%), home-based (78%) exercise. Among breast cancer patients during treatment, exercise adherence barriers are general and disease specific. Outcome expectations are physical benefits, with the most important outcomes being psychological or avoidance of risk (i.e. injury). PMID:17227354

Rogers, L Q; Courneya, K S; Shah, P; Dunnington, G; Hopkins-Price, P



[Usefulness of exercise tests in the evaluation of the effects of treatment in chronic cardiac insufficiency].  


Before it reaches the decompensation stage, heart failure is characterized by symptoms which occur only during exercise. It is therefore rational to believe that the effectiveness of treatments of heart failure should be evaluated by the improvement they produce in tolerance to stress. This tolerance can be evaluated by exercise tests which may take different forms. The most common is a progressive load test on bicycle ergometer or treadmill. Among the indices used to assess tolerance to stress, the total duration of the exercise test until symptoms develop is a variable subject to fluctuations which may be independent of the patient's cardiovascular state. Measurement of oxygen consumption at peak exercise level is usually preferred, being unrelated to the nature of the stress and much more reproducible and sensitive to changes. Among the pharmacological treatments of heart failure, only chronic vasodilator therapy, notably with angiotensin-converting enzyme inhibitors, has proved constantly effective on the various ergometric indices. In the literature, the effects of digitalis compounds, dihydralazine and alpha-blockers are inconstant. Among the new treatments of heart failure, phosphodiesterase inhibitors may improve tolerance to stress, as does Corwin which may prolong the total duration of exercise. Its effect on oxygen consumption has not yet been evaluated. Performance at exercise is almost never improved by acute treatment with any pharmacological agent, and the same remarks applies to short-term heart transplantation. The reason for this is that heart failure is associated with a physical deconditioning syndrome due to abnormalities of the arterial dilatation capacity in skeletal muscles, and with muscular metabolic abnormalities due to a defective oxygen utilization by these muscles.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2267563

Zannad, F



Brunkow exercises and low back pain.  


Brunkow exercises starting with dynamic contraction of hands and feet with fixed point on the wrist or/and heal. Dynamic contraction from the beginning, transferring through kinetic chain, leads to isometric contraction of the group of muscles, which has to be included in the exercise. Starting positions determine the group of muscles to be trained. The purpose of this study is to investigate influence of Brunkow exercises on spinal motion improvement and pain relief and to evaluate use of Brunkow exercises, as a routine method for lower back pain in Physical Medicine and Rehabilitation Centres. Thirty-four patients with symptoms of low back pain were included in study. Patients received a mean of 14.9 treatments with standard deviation of 8.96. All patients were assessed before and after the treatment for spinal mobility and flexibility as well as pain intensity. All parameters for spinal movements showed statistically significant improvement in patients with low back pain who practiced Brunkow exercise program at the end of treatment in relations to pre-treatment values, with significant difference of p<0.01 for all motions. Pain was reduced on VAS for X=1.,7 with S.D. 1.97. Difference Test was t=6.020 with significant difference p<0.01. Flexibility of spine increased, so average difference in values before and after treatment for Shober test was 0.5 cm with SD 0.65. Difference test was t=3.794 with significant difference p<0.01. Brunkow exercises for low back pain are beneficial treatment for increasing flexibility and mobility of spine and improving the pain. PMID:15628994

Skiki?, Emela Muji?; Trebinjac, Suad; Sakota, Slavica; Avdi?, Dijana; Deli?, Aida



Exercise-related activities are associated with positive outcome in contingency management treatment for substance use disorders  

Microsoft Academic Search

Exercise has been proposed as an adjunct intervention for substance use disorders due to its many benefits in terms of mental and physical health. This study investigated the association between completion of exercise-related activities and substance use disorders treatment outcome in a sample of 187 participants undergoing intensive outpatient treatment with contingency management. The sample was divided into two groups

Jeremiah Weinstock; Danielle Barry; Nancy M. Petry



High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis  

Microsoft Academic Search

The X-Stop interspinous distraction device has shown to be an attractive alternative to conventional surgical procedures in\\u000a the treatment of symptomatic degenerative lumbar spinal stenosis. However, the effectiveness of the X-Stop in symptomatic\\u000a degenerative lumbar spinal stenosis caused by degenerative spondylolisthesis is not known. A cohort of 12 consecutive patients\\u000a with symptomatic lumbar spinal stenosis caused by degenerative spondylolisthesis were

Olaf J. Verhoof; Johannes L. Bron; Frits H. Wapstra; Barend J. van Royen



Holistic Treatment Approaches to ADHD: Nutrition, Sleep,and Exercise, Part 7  

ERIC Educational Resources Information Center

|This article is part of a series exploring Attention Deficit Hyperactivity Disorder (ADHD). In this seventh installment, the author discusses three holistic treatments for children and adults with ADHD: diet and nutrition, sleep, and exercise. These approaches focus and improve the overall health of ADHD patients. (For Part 6 of this series, see…

Lavoie, Theresa



Evaluation of Enalapril+Losartan Treatment with Cardiopulmonary Exercise Test in Patients with Left Ventricular Dysfunction  

Microsoft Academic Search

The aim of this study was to evaluate the effects of the combination of enalapril and losartan in patients with left ventricular systolic dysfunction by means of cardiopulmonary exercise test (CPET). Patients with left-ventricular systolic dysfunction and ejection fractions of 40% or less were included to the study. All patients were under the treatment of enalapril 20 mg once daily.

Tamer Akbulut; Haldun Akgöz; Seden Erten Çelik; Ufuk Gürkan



Effect of Erythropoietin Treatment on Physical Exercise Capacity and on Renal Function in Predialytic Uremic Patients  

Microsoft Academic Search

Anemia is already present in patients with moderate renal failure and is a major cause of the decline in exercise capacity seen in these patients. We examined the effects of erythropoietin (EPO) treatment in 12 predialytic uremic patients (EPO group: mean age 46 ± 12 years; 6 men, 6 women) with a mean glomerular filtration rate (GFR) of 10 ±

Naomi Clyne; Tomas Jogestrand



Role of Leukotriene Receptor Antagonists in the Treatment of Exercise-Induced Bronchoconstriction: A Review  

PubMed Central

Asthma is a very common disorder that still causes significant morbidity and mortality. A high percentage of individuals with asthma also experience exercise-induced bronchoconstriction (EIB). This article reviews the current literature and updates the reader on the safety, efficacy, and clinical applications of leukotriene modifiers in the treatment of EIB.



SMN-inducing compounds for the treatment of spinal muscular atrophy  

PubMed Central

Spinal muscular atrophy (SMA) is a leading genetic cause of infant mortality. A neurodegenerative disease, it is caused by loss of SMN1, although low, but essential, levels of SMN protein are produced by the nearly identical gene SMN2. While no effective treatment or therapy currently exists, a new wave of therapeutics has rapidly progressed from cell-based and preclinical animal models to the point where clinical trials have initiated for SMA-specific compounds. There are several reasons why SMA has moved relatively rapidly towards novel therapeutics, including: SMA is monogenic; the molecular understanding of SMN gene regulation has been building for nearly 20 years; and all SMA patients retain one or more copies of SMN2 that produces low levels of full-length, fully functional SMN protein. This review primarily focuses upon the biology behind the disease and examines SMN1- and SMN2-targeted therapeutics.

Lorson, Monique A; Lorson, Christian L



Efficacy of biofeedback, when included with pelvic floor muscle exercise treatment, for genuine stress incontinence.  


We performed a randomized clinical trial on the efficacy of physical therapy on genuine stress incontinence. Study objective: "Is a physical therapeutical training program (pelvic floor muscle training) combined with biofeedback, more effective than the same program without biofeedback in patients with mild or moderate stress incontinence?" Forty-four patients were referred by a general practitioner or a urologist. After informed consent, 40 patients were randomized in an exercises and biofeedback group (BF), or treated with exercises exclusively (pelvic floor muscle training = PFMT). After a diagnostic phase of 1 week every patient received twelve treatment sessions, three times weekly. The primary measure of effect, the quantity of involuntary urine loss, was measured with the 48 hours PAD test (Inco-test Mölnlycke). Before every treatment session the Symptoms questionnaire was filed out by the patient and the Patient dairy was controlled. The data of the trial were analysed according to the principal of intention to treat. During the trial there was 100% compliance. There were no drop-outs. Both treatment modalities appeared to be effective. After twelve treatment sessions there was a mean improvement of +/- 55% (P = 0.00) in both treatment groups, measured by the primary measure of effect. In the group with BF this improvement was already realized after six treatment sessions (P = 0.01). Yet, the difference between BF and PFMT faded to reach significance at six treatment sessions (P = 0.08). Although differences in treatment effects between both groups were not significant, our findings suggest that adding biofeedback to pelvic floor muscle exercises might be more effective than pelvic floor muscle exercises alone after six treatments. PMID:8696355

Berghmans, L C; Frederiks, C M; de Bie, R A; Weil, E H; Smeets, L W; van Waalwijk van Doorn, E S; Janknegt, R A



Radiological evaluation of treatment with SpineCor brace in children with idiopathic spinal scoliosis.  


INTRODUCTION. This paper reports on a radiological evaluation of the outcomes of treatment with the SpineCor brace in children with idiopathic spinal scoliosis vs. a control group who had only received 24 months of rehabilitation. The compliance of the SpineCor-treated patients with medical instructions was also assessed. MATERIAL AND METHODS. A prospective evaluation encompassed a group of forty (40) children, treated with a SpineCor brace for idiopathic scoliosis. A control group included forty (40) children who were followed up. The mean age of the children was 12.0 years and sixty-six (66) of the patients were girls. The study group and the control group were comparable in terms of demographic data and radiological parameters of scoliosis. The mean scoliosis angle was 25.3? and 26.1? in the thoracic and lumbar spine, respectively. RESULTS. In the (SpineCor-treated) study group, stabilisation or improvement of the scoliosis was obtained in 31 (78%) patients, while progression was noted in 9 (22%). In the control group, stabilisation was found in 21 (53%) patients and progression in 19 (47%), while none of the children met improvement criteria. In the brace-treated group, a smaller change in the thoracic curvature angle was observed (R=0.34, p=0.0001) than in the control group, while no such difference was identified at the lumbar spine level (R=0.15, p=0.18). Out of the 40 treated children, 38 used the brace regularly. Four of the children were active in sports above recreation level. CONCLUSIONS. The treatment of idiopathic spinal scoliosis in children by means of the SpineCor dynamic brace solution significantly more frequently led to stabilisation or correction of scoliosis as measured by Cobb's angle. A high compliance of the children and their parents was also observed. PMID:23897999

Plewka, Barbara; Sibi?ski, Marcin; Synder, Marek; Wito?ski, Dariusz; Ko?odziejczyk-Klimek, Katarzyna; Plewka, Micha?



Detrimental effects of anti-apoptotic treatments in spinal cord injury  

PubMed Central

Long term functional impairments due to spinal cord injury (SCI) in the rat result from secondary apoptotic death regulated, in part, by SCI-induced decreases in protein levels of the anti-apoptotic protein Bcl-xL. We have shown that exogenous administration of Bcl-xL spares neurons 24h after SCI. However, long term effects of chronic application of Bcl-xL have not been characterized. To counteract SCI-induced decreases in Bcl-xL and resulting apoptosis, we used the TAT protein transduction domain fused to the Bcl-xL protein (Tat-Bcl-xL), or its anti-apoptotic domain BH4 (Tat-BH4). We used intrathecal delivery of Tat-Bcl-xL, or Tat-BH4, into injured spinal cords for 24h or 7 days, and apoptosis, neuronal death and locomotor recovery were assessed up to 2 months after injury. Both, Tat-Bcl-xL and Tat-BH4, significantly decreased SCI-induced apoptosis in thoracic segments containing the site of injury (T10) at 24h or 7 days after SCI. However, the 7 day delivery of Tat-Bcl-xL, or Tat-BH4, also induced a significant impairment of locomotor recovery that lasted beyond the drug delivery time. We found that the 7 day administration of Tat-Bcl-xL, or Tat-BH4, significantly increased non-apoptotic neuronal loss and robustly augmented microglia/macrophage activation. These results indicate that the anti-apoptotic treatment targeting Bcl-xL shifts neuronal apoptosis to necrosis, increases the inflammatory response and impairs locomotor recovery. Our results suggest that a combinatorial treatment consisting of anti-apoptotic and anti-inflammatory agents may be necessary to achieve tissue preservation and significant improvement in functional recovery after SCI.

Cittelly, Diana M; Nesic, Olivera; Johnson, Kathia; Hulsebosch, Claire; Perez-Polo, J. Regino



Reducing resistance and denial by exercising ambivalence during the treatment of addiction.  


Stage change models and motivational enhancement therapies have significantly influenced the therapeutic tactics clinicians employ in the treatment of addictive behaviors. While motivational enhancement strategies have addressed client ambivalence to increase motivation to change, this article suggests that focusing on ambivalence during treatment has even wider clinical utility than previously thought. Resistance reduction concentrates on exercising ambivalence without an investment in clients changing, thereby strengthening client tolerance for ambivalent thoughts and feelings. Exercising ambivalence reduces resistance to treatment and change by validating a wide array of possible outcomes through detailed exploration of how a behavior pattern works for a client. Since resistance reduction does not require clients to want to change for therapy to progress, exploring the decision-making process becomes paramount. A general discussion of the resistance reduction model, ambivalence, and how clients present for treatment precedes clinical case examples. PMID:11239735

Shaffer, H J; Simoneau, G




PubMed Central

Background Context: Low back pain (LBP) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses. A common intervention for LBP is spinal manipulation, a technique that is not specific to one scope of practice or profession. Purpose: The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain. Methods: A search of the current literature was conducted using PubMed, CINAHL, SPORTDiscus, Pro Quest Nursing and Allied Health Source, Scopus, and Cochrane Controlled Trials Register. Studies were included if each involved: 1) individuals with LBP; 2) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations; 3) measurable clinical outcomes or efficiency of treatment measures, and 4) randomized control trials. The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Database (PEDro). Results: Six randomized control trials met the inclusion criteria of this systematic review. The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes. Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events resulting from this intervention. Additionally, the manipulation group in one study reported statistically significantly less medication use, health care utilization, and lost work time. Conclusion: Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice. Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain.

Kuczynski, John J.; Schwieterman, Braun; Columber, Kirby; Knupp, Darren; Shaub, Lauren



Spinal cord stimulation for treatment of pain in a patient with post thoracotomy pain syndrome.  


Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area of the thoracotomy incision for at least 2 months following the initial procedure.  The true incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5% to 90%.  Thoracotomy is associated with a high risk of severe chronic postoperative pain.  Presenting symptoms include both neuropathic pain in the area of the incision, as well as myofascial pain commonly in the ipsilateral scapula and shoulder.  Pain management can be challenging in these patients.  Multiple treatments have been described including conservative treatments with oral nonsteroidal anti-inflammatory drugs (NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physical therapy; transcutaneous electrical nerve stimulation as well as more invasive treatments including intercostal nerve blocks, trigger point steroid injections, epidural steroid injections, radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation.  Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatment modalities, and in some cases will experience worsening of pain. This case report describes the novel utility and complete resolution of symptoms with spinal cord stimulation (SCS) in treatment of a patient with persistent PTPS. In the operating room, a percutaneous octet electrode lead was placed using sterile technique under fluoroscopic guidance and loss-of-resistance technique.  The octet electrode lead was subsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplate just right of midline.  The patient's pain distribution was captured optimally with stimulation at this level.  With the assistance of a neurosurgeon, the lead was anchored, tunneled, and connected to a generator, which was implanted over the right iliac crest.  The patient tolerated the procedure well with no complications. We report the successful use of SCS as well as complete resolution of symptoms at 4 months follow-up, in a patient with persistent PTPS, which was resistant to other modalities. In conclusion, studies designed to evaluate the effectiveness of SCS for PTPS may be warranted. PMID:21927048

Graybill, Jordan; Conermann, Till; Kabazie, Abraham J; Chandy, Sunil


Manual therapy and therapeutic exercise in the treatment of osteoarthritis of the hip: a systematic review.  


This systematic review aimed at investigating the role of therapeutic exercise and/or manual therapy in the treatment of hip osteoarthritis (OA). Two independent reviewers (AR, CV) searched PubMed, Cinahl, Cochrane Library, PEDro and Scopus databases and a third one (SP) was consulted in case of disagreement. The research criteria were publication period (from May 2007 to April 2012) and publication language (English or Italian). Ten randomized controlled trials matched inclusion criteria, eight of which concerning therapeutic exercise and two manual therapy. Few good quality studies were found. At mid- and long-term follow-up land-based exercises showed insufficient evidence of effectiveness with respect to pain and quality of life, but positive results were found for physical function. Water exercises significantly reduced fall risk when combined with functional exercises. Programs containing progressive and gradual exposure of difficult activities, education and exercises promoted better outcomes, higher adherence to home program and increased amount of physical activity, especially walking. Manual therapy seemed to reduce pain and decrease disability at short-term. Less use of nonsteroidal anti-inflammatory drugs was statistically significant at long-term follow-up in patients treated with manual therapy. The relationship between clinical results and radiological grade of OA was not investigated. Encouraging results were found in recent literature for manual therapy and functional training. Further research is needed to elucidate this issue through high-quality trials, especially addressing the aspects that have not been thoroughly explored yet, for instance type, amount and scheduling of conservative treatment. PMID:23877410

Romeo, A; Parazza, S; Boschi, M; Nava, T; Vanti, C



Magnesium sulfate treatment in experimental spinal cord injury: emphasis on vascular changes and early clinical results  

Microsoft Academic Search

Injury to the spinal cord results in disruption of neurons, cell membranes, axons, myelin, and endothelial cells. The aim\\u000a of this study was to demonstrate the protective effect of magnesium sulfate on the blood-spinal cord barrier after acute spinal\\u000a cord injury (SCI). This experiment was conducted in two parts. In the first, rats were injected intravenously with Evans blue\\u000a 2 h

Erkan Kaptanoglu; Etem Beskonakli; Ihsan Solaroglu; Asuman Kilinc; Yamac Taskin



Aerobic Exercise Training Reduces Cannabis Craving and Use in Non-Treatment Seeking Cannabis-Dependent Adults  

Microsoft Academic Search

BackgroundCannabis dependence is a significant public health problem. Because there are no approved medications for this condition, treatment must rely on behavioral approaches empirically complemented by such lifestyle change as exercise.AimsTo examine the effects of moderate aerobic exercise on cannabis craving and use in cannabis dependent adults under normal living conditions.DesignParticipants attended 10 supervised 30-min treadmill exercise sessions standardized using

Maciej S. Buchowski; Natalie N. Meade; Evonne Charboneau; Sohee Park; Mary S. Dietrich; Ronald L. Cowan; Peter R. Martin; Antonio Verdejo García



A biomechanical analysis of exercise in standing, supine, and seated positions: Implications for individuals with spinal cord injury  

PubMed Central

Context/objective The distal femur is the primary fracture site in patients with osteoporosis after spinal cord injury (SCI). Objective To mathematically compare the compression and shear forces at the distal femur during quadriceps stimulation in the standing, supine, and seated positions. A force analysis across these positions may be a consideration for people with SCI during neuromuscular electrical stimulation of the quadriceps. Design A biomechanical model. Setting Research laboratory. Outcome measures Compression and shear forces from the standing, supine, and seated biomechanical models at the distal femur during constant loads generated by the quadriceps muscles. Results The standing model estimated the highest compressive force at 240% body weight and the lowest shear force of 24% body weight at the distal femur compared with the supine and seated models. The supine model yielded a compressive force of 191% body weight with a shear force of 62% body weight at the distal femur. The seated model yielded the lowest compressive force of 139% body weight and the highest shear force of 215% body weight. Conclusions When inducing a range of forces in the quadriceps muscles, the seated position yields the highest shear forces and lowest compressive forces when compared with the supine and standing positions. Standing with isometric contractions generates the highest compressive loads and lowest shear forces. Early active resistive standing may provide the most effective means to prevent bone loss after SCI.

McHenry, Colleen L.; Shields, Richard K.



Microsurgical treatment and functional outcomes of multi-segment intramedullary spinal cord tumors.  


We aimed to prospectively analyze correlations between clinical features and histological classification of multi-segment intramedullary spinal cord tumors (MSICTs), and the extent of microsurgical resection and functional outcomes. Fifty-six patients with MSICTs underwent microsurgery for tumor removal using a posterior approach. The tumor was exposed through a dorsal myelotomy. Pre-operative and post-operative nervous function was scored using the Improved Japanese Orthopaedic Association (IJOA) grading system. Correlation analyses were performed between functional outcome (IJOA score) and histological features, age, tumor location, and the longitudinal extent of spinal cord involvement. The most frequently involved levels were the medullo cervical and the cervicothoracic regions (51.8%, 29/56) followed by the conus terminalis (26.8%, 15/56) and the thoracic region (14.3%, 8/56). Ependymoma was the most frequent MSICT type, seen in 22 of 56 patients (39%), followed by low grade astrocytoma (17 patients, 30%) and glioblastoma multiforme (3 patients, 5%). Gross total tumor removal was achieved in 33 cases (58%), subtotal resection in 4 (7%), and partial resection in 16 (28%). The histological classification of the tumor was the most important factor influencing the extent of surgical removal (chi2=22.17, p=0.00). The overall difference between pre-operative and post-operative neurological state was not significant (chi2=5.44, p=0.61). Thus, MSICTs were most commonly seen in the medullo cervical and cervicothoracic regions, with ependymoma and low grade astrocytoma the most common tumour types. We stress the importance of early microsurgical treatment for MSICTs while the patients do not have severe dysfunction. PMID:19303302

Sun, Jianjun; Wang, Zhenyu; Li, Zhendong; Liu, Bin



Antinociception induced by chronic glucocorticoid treatment is correlated to local modulation of spinal neurotransmitter content  

PubMed Central

Background While acute effects of stress on pain are well described, those produced by chronic stress are still a matter of dispute. Previously we demonstrated that chronic unpredictable stress results in antinociception in the tail-flick test, an effect that is mediated by increased levels of corticosteroids. In the present study, we evaluated nociception in rats after chronic treatment with corticosterone (CORT) and dexamethasone (DEX) in order to discriminate the role of each type of corticosteroid receptors in antinociception. Results Both experimental groups exhibited a pronounced antinociceptive effect after three weeks of treatment when compared to controls (CONT); however, at four weeks the pain threshold in CORT-treated animals returned to basal levels whereas in DEX-treated rats antinociception was maintained. In order to assess if these differences are associated with altered expression of neuropeptides involved in nociceptive transmission we evaluated the density of substance P (SP), calcitonin gene-related peptide (CGRP), somatostatin (SS) and B2-?-aminobutiric acid receptors (GABAB2) expression in the spinal dorsal horn using light density measurements and stereological techniques. After three weeks of treatment the expression of CGRP in the superficial dorsal horn was significantly decreased in both CORT and DEX groups, while GABAB2 was significantly increased; the levels of SP for both experimental groups remained unchanged at this point. At 4 weeks, CGRP and SP are reduced in DEX-treated animals and GABAB2 unchanged, but all changes were restored to CONT levels in CORT-treated animals. The expression of SS remained unaltered throughout the experimental period. Conclusion These data indicate that corticosteroids modulate nociception since chronic corticosteroid treatment alters the expression of neuropeptides involved in nociceptive transmission at the spinal cord level. As previously observed in some supraspinal areas, the exclusive GR activation resulted in more profound and sustained behavioural and neurochemical changes, than the one observed with a mixed ligand of corticosteroid receptors. These results might be of relevance for the pharmacological management of certain types of chronic pain, in which corticosteroids are used as adjuvant analgesics.

Pinto-Ribeiro, Filipa; Moreira, Vitor; Pego, Jose M; Leao, Pedro; Almeida, Armando; Sousa, Nuno



Behavioral Weight Control Treatment Combined with Supervised Exercise or Peer Enhanced Adventure for Overweight Adolescents  

PubMed Central

Objectives To evaluate the efficacy of behavioral weight control intervention combined with a peer-enhanced activity intervention versus structured aerobic exercise in decreasing BMI and z-BMI in overweight adolescents. Study design Participants were randomized to one of two group-based treatment conditions: 1) cognitive behavioral treatment combined with peer enhanced adventure therapy (CBT+PEAT) or 2) cognitive behavioral weight control treatment combined with supervised aerobic exercise (CBT+EXER). Participants included 118 overweight adolescents, ages 13 – 16 years, and a primary caregiver. Changes in body mass index (BMI), standardized BMI, percent over BMI, and waist circumference were examined. Results Analysis of variance based on intent to treat (ITT) indicated significant decreases in all weight change outcomes at end of treatment, with significant decreases maintained at 12-month follow-up. No differences between treatment conditions were observed. Secondary analyses indicated that adherence with attendance and completion of weekly diet records contributed significantly to reductions in BMI. Conclusions A cognitive behavioral weight control intervention combined with supervised aerobic exercise or peer-enhanced adventure therapy is equally effective in short-term reduction of BMI and z-BMI among overweight adolescents. Adherence, as measured by session attendance and self-monitoring, is a key dimension of weight change.

Jelalian, Elissa; Lloyd-Richardson, Elizabeth E.; Mehlenbeck, Robyn S.; Hart, Chantelle N.; Flynn-O'Brien, Katherine; Kaplan, Jamie; Neill, Meghan; Wing, Rena R.



Scoliosis in patients with Prader Willi Syndrome – comparisons of conservative and surgical treatment  

Microsoft Academic Search

: In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits

Hans-Rudolf Weiss; Deborah Goodall



Exercise as a Time-conditioning Effector in Chronic Disease: a Complementary Treatment Strategy  

PubMed Central

Exercise has been widely believed to be a preventive and therapeutic aid in the treatment of various pathophysiological conditions such as cardiovascular disease and cancer. A common problem associated with such pathologies is cachexia, characterized by progressive weight loss and depletion of lean and fat body mass, and is linked to poor prognosis. As this syndrome comprises changes in many physiological systems, it is tempting to assume that the modulation of the psychoneuroimmunoendocrine axis could attenuate or even prevent cachexia progression in cancer patients. Cancer cachexia is characterized by a disruption in the rhythmic secretion of melatonin, an important time-conditioning effector. This hormone, secreted by the pineal gland, transmits circadian and seasonal information to all organs and cells of the body, synchronizing the organism with the photoperiod. Considering that exercise modulates the immune response through at least two different mechanisms—metabolic and neuroendocrine—we propose that the adoption of a regular exercise program as a complementary strategy in the treatment of cancer patients, with the exercise bouts regularly performed at the same time of the day, will ameliorate cachexia symptoms and increase survival and quality of life.



Diagnosis and surgical treatment of progressive pseudorheumatoid dysplasia in an adult with severe spinal disorders and polyarthropathy.  


Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal-recessive disorder. The polyarthritis of PPD has been detailed before. However, the spinal disorder and surgical treatment been rarely mentioned. A 44-year-old patient who has been misdiagnosed as juvenile rheumatoid arthritis (JRA) and given unilateral total hip replacement yet, suffers mainly from severe spinal disorder this time. The platyspondyly, Scheuermann-like lesions of the spine and JRA-like features of the peripheral joints were found on radiographic films, combining negative inflammatory and rheumatoid factors, which most suggested the diagnosis of PPD. As the homozygous nucleotide deletion was found in WISP3 gene, diagnosis of PPD was definite. Neurological examination and further imaging examination indicated severe compression of thoracic and lumbar spinal cord which might lead to his conspicuous spinal disorder. Decompressive laminectomy, posterior fusion and fixation were performed. And an excellent clinical outcome was achieved 1year after the decompression and fusion: leg pain and hypoesthesia resolved and osseous fusion performed. This is the first reported decompression in the adult spine of PPD. Surgical treatment could receive satisfactory result in PPD, however, it is a palliative therapy which has less help to prevent the development of this disease. Early diagnosis and rehabilitation interventions remain the most important. Clinical, radiographic and genetic features in PPD are crucial in the differential diagnosis. PMID:23618803

Yang, Xi; Song, Yueming; Kong, Qingquan



Neuropathic Pain Post Spinal Cord Injury Part 1: Systematic Review of Physical and Behavioral Treatment  

PubMed Central

Background: Neuropathic pain has various physiologic and psychosocial aspects. Hence, there is a growing use of adjunct nonpharmacological therapy with traditional pharmacotherapy to reduce neuropathic pain post spinal cord injury (SCI). Objective: The purpose of this study was to conduct a systematic review of published research on nonpharmacological treatment of neuropathic pain after SCI. Methods: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing nonpharmacological treatment of pain post SCI. Articles were restricted to the English language. Article selection was conducted by 2 independent reviewers with the following inclusion criteria: the subjects participated in a treatment or intervention for neuropathic pain; at least 50% of the subjects had an SCI; at least 3 subjects had an SCI; and a definable intervention was being studied. Data extracted included study design, study type, subject demographics, inclusion and exclusion criteria, sample size, outcome measures, and study results. Randomized controlled trials (RCTs) were assessed for quality using the Physiotherapy Evidence Database (PEDro) assessment scale. Levels of evidence were assigned to each intervention using a modified Sackett scale. Results: The 16 articles selected for this review fell into 1 of 2 categories of nonpharmacological management of pain after SCI: physical and behavioral treatments. The pooled sample size of all studies included 433 participants. Of the 16 studies included, 7 were level 1, 3 were level 2, and 6 were level 4 studies. Conclusions: Physical interventions demonstrated the strongest evidence based on quality of studies and numbers of RCTs in the nonpharmacological treatment of post-SCI pain. Of these interventions, transcranial electrical stimulation had the strongest evidence of reducing pain. Despite a growing body of literature, there is still a significant lack of research on the use of nonpharmacological therapies for SCI pain.



Evoked potentials and contingent negative variation during treatment of multiple sclerosis with spinal cord stimulation  

Microsoft Academic Search

Cervical somatosensory evoked potentials, brainstem evoked potentials, visual evoked potentials, and the cerebral contingent negative variation were recorded in patients with definite multiple sclerosis before, during, and after spinal cord stimulation. Improvements were seen in the cervical somatosensory and brainstem evoked potentials but neither the visual evoked potential nor the contingent negative variation changed in association with spinal cord stimulation.

E M Sedgwick; L S Illis; R C Tallis; A R Thornton; P Abraham; E El-Negamy; T B Docherty; J S Soar; S C Spencer; F M Taylor



Magnitude of spinal muscle damage is not statistically associated with exercise-induced low back pain intensity  

PubMed Central

BACKGROUND CONTEXT Findings on imaging of noncontractile anatomic abnormalities and the intensity of low back pain have weak associations because of false-positive rates among asymptomatic individuals. This association might be stronger for contractile tissues. PURPOSE The purpose of this study was to examine the relationship between location and reports of pain intensity in the low back and exercise-induced muscle damage to the lumbar paraspinal muscles. STUDY DESIGN Nondiagnostic observational study in a laboratory setting. METHODS Delayed onset muscle soreness was induced in the low back of healthy pain-free volunteers. Measures of pain intensity (100-mm visual analog scale [VAS]) and location (area on the pain diagram) were taken before and 48 hours after exercise. Muscle damage was quantified using mechanical pain thresholds, motor performance deficits, and transverse relaxation time (T2)–weighted magnetic resonance imaging (MRI). Changes pre- to postexercise in signal intensity on T2-weighted imaging within the erector spinae, pain intensity, pain area, mechanical pain threshold, and isometric torque were assessed using paired t tests. Bivariate correlations were conducted to assess associations among muscle damage, pain intensity, and pain drawing area. RESULTS Twenty participants volunteered (11 women; average age, 22.3 years; average body mass index, 23.5) for study participation. Reports of pain intensity at 48 hours ranged from 0 to 59 mm on the VAS. Muscle damage was confirmed by reductions in mechanical threshold (p=.011) and motor performance (p<.001) and by changes in T2-weighted MRI (p=.007). This study was powered to find an association of at least r=0.5 to be statistically significant. Correlations of continuous variables revealed no significant correlations between pain intensity and measures of muscle damage (ranging between ?0.075 and 0.151). There was a significant association between the remaining torque deficit at 48 hours and pain area. CONCLUSIONS The results of this study indicate that there was no association between the magnitude of muscle damage in the lumbar erector spinae and reported pain intensity in the low back. In future studies, larger cohorts may report statistically significant associations, but our data suggest that there will be low magnitude potentially indicating limited clinical relevance.

Bishop, Mark D.; Horn, Maggie E.; Lott, Donovan J.; Arpan, Ishu; George, Steven Z.



Effect of VEGF Treatment on the Blood-Spinal Cord Barrier Permeability in Experimental Spinal Cord Injury: Dynamic Contrast-Enhanced Magnetic Resonance Imaging  

PubMed Central

Abstract Compromised blood-spinal cord barrier (BSCB) is a factor in the outcome following traumatic spinal cord injury (SCI). Vascular endothelial growth factor (VEGF) is a potent stimulator of angiogenesis and vascular permeability. The role of VEGF in SCI is controversial. Relatively little is known about the spatial and temporal changes in the BSCB permeability following administration of VEGF in experimental SCI. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies were performed to noninvasively follow spatial and temporal changes in the BSCB permeability following acute administration of VEGF in experimental SCI over a post-injury period of 56 days. The DCE-MRI data was analyzed using a two-compartment pharmacokinetic model. Animals were assessed for open field locomotion using the Basso-Beattie-Bresnahan score. These studies demonstrate that the BSCB permeability was greater at all time points in the VEGF-treated animals compared to saline controls, most significantly in the epicenter region of injury. Although a significant temporal reduction in the BSCB permeability was observed in the VEGF-treated animals, BSCB permeability remained elevated even during the chronic phase. VEGF treatment resulted in earlier improvement in locomotor ability during the chronic phase of SCI. This study suggests a beneficial role of acutely administered VEGF in hastening neurobehavioral recovery after SCI.

Patel, Chirag B.; Cohen, David M.; Ahobila-Vajjula, Pallavi; Sundberg, Laura M.; Chacko, Tessy



The use of stem cells for the treatment of spinal surgical conditions.  


Spinal pathologies are a major burden on society and individuals. Recent years have seen a large number of studies dedicated to the use of stem cells in spinal surgery. This review focuses on recent advances and controversies regarding the applications of stem cells in spinal fusion surgery, spinal cord injury and intervertebral disc degeneration. There are significant concerns regarding the ethics and risks of stem cell use. Animal models do not always accurately depict the human condition. While a great deal has been achieved, successful translation into clinical practice is needed. However there is no doubt that stem cells have a major role to play in the future management of spinal conditions. PMID:24016321

Aftab, Syed; Chimutengwende-Gordon, Mukai; Malik, Atif; Lee, Robert



Radioactive bone cement for the treatment of spinal metastases: a dosimetric analysis of simulated clinical scenarios  

NASA Astrophysics Data System (ADS)

Vertebral metastases are a common manifestation of many cancers, potentially leading to vertebral collapse and neurological complications. Conventional treatment often involves percutaneous vertebroplasty/kyphoplasty followed by external beam radiation therapy. As a more convenient alternative, we have introduced radioactive bone cement, i.e. bone cement incorporating a radionuclide. In this study, we used a previously developed Monte Carlo radiation transport modeling method to evaluate dose distributions from phosphorus-32 radioactive cement in simulated clinical scenarios. Isodose curves were generally concentric about the surface of bone cement injected into cadaveric vertebrae, indicating that dose distributions are relatively predictable, thus facilitating treatment planning (cement formulation and dosimetry method are patent pending). Model results indicated that a therapeutic dose could be delivered to tumor/bone within ?4 mm of the cement surface while maintaining a safe dose to radiosensitive tissue beyond this distance. This therapeutic range should be sufficient to treat target volumes within the vertebral body when tumor ablation or other techniques are used to create a cavity into which the radioactive cement can be injected. With further development, treating spinal metastases with radioactive bone cement may become a clinically useful and convenient alternative to the conventional two-step approach of percutaneous strength restoration followed by radiotherapy.

Kaneko, T. S.; Sehgal, V.; Skinner, H. B.; Al-Ghazi, M. S. A. L.; Ramsinghani, N. S.; Marquez Miranda, M.; Keyak, J. H.



The Effects of Ice Massage, Ice Massage with Exercise, and Exercise on the Prevention and Treatment of Delayed Onset Muscle Soreness  

PubMed Central

We investigated the effects of ice massage, ice massage with exercise, and exercise on the prevention and treatment of delayed onset muscle soreness (DOMS). Twenty-two subjects were randomly assigned to one of four groups. Preexercise measures were recorded for range of motion (ROM), strength, perceived soreness, and serum creatine kinase (CK) levels. Subjects performed up to 300 concentric/eccentric contractions of the elbow flexors with 90% of their 10 repetition maximum to induce muscle soreness. Dependent variables were assessed at 2, 4, 6, 24, 48, 72, 96, and 120 hours postexercise. Significant differences occurred in all variables with respect to time (ANOVA(p<.05)). However, no significant mode of treatment, or mode of treatment/assessment time interaction was present. Decreases in range of motion and flexion strength correspond with increases in perceived soreness. The nonsignificant mode of treatment/assessment time interaction suggests that the use of ice massage, ice massage with exercise, or exercise alone is not effective in significantly reducing the symptoms of delayed onset muscle soreness. In fact, though not statistically significant, the pattern of the data suggested the use of ice in the treatment of DOMS may be contraindicated. Further investigation is recommended.

Isabell, William Kirk; Durrant, Earlene; Myrer, William; Anderson, Shauna



Minimally invasive treatment of lumbar spinal stenosis with a novel interspinous spacer  

PubMed Central

Purpose To assess the safety and effectiveness of a novel, minimally invasive interspinous spacer in patients with moderate lumbar spinal stenosis (LSS). Methods A total of 53 patients (mean age, 70 ± 11 years; 45% female) with intermittent neurogenic claudication secondary to moderate LSS, confirmed on imaging studies, were treated with the Superion® Interspinous Spacer (VertiFlex, Inc, San Clemente, CA) and returned for follow-up visits at 6 weeks, 1 year, and 2 years. Study endpoints included axial and extremity pain severity with an 11-point numeric scale, Zurich Claudication Questionnaire (ZCQ), back function with the Oswestry Disability Index (ODI), health-related quality of life with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-12, and adverse events. Results Axial and extremity pain each decreased 54% (both P < 0.001) over the 2-year follow-up period. ZCQ symptom severity scores improved 43% (P < 0.001) and ZCQ physical function improved 44% (P < 0.001) from pre-treatment to 2 years post-treatment. A statistically significant 50% improvement (P < 0.001) also was noted in back function. PCS and MCS each improved 40% (both P < 0.001) from pre-treatment to 2 years. Clinical success rates at 2 years were 83%–89% for ZCQ subscores, 75% for ODI, 78% for PCS, and 80% for MCS. No device infection, implant breakage, migration, or pull-out was observed, although two (3.8%) patients underwent explant with subsequent laminectomy. Conclusion Moderate LSS can be effectively treated with a minimally invasive interspinous spacer. This device is appropriate for select patients who have failed nonoperative treatment measures for LSS and meet strict anatomical criteria.

Shabat, Shay; Miller, Larry E; Block, Jon E; Gepstein, Reuven



Do exercise motives predict obligatory exercise?  


Few studies have examined whether factors predicting obligatory exercise differ by gender. 303 participants completed the Obligatory Exercise Questionnaire and the Reason for Exercise Inventory. All variables correlated significantly. However, the correlation between exercising for fitness and obligatory exercise was significantly stronger in women than men. In women, obligatory exercise was predicted by exercising to improve body tone, fitness, and to enhance mood; in men, obligatory exercise was predicted by exercising to improve body tone, enjoyment, and perceived attractiveness. Implications for treatment are discussed. PMID:22365798

Pritchard, Mary E; Beaver, Jessica L



Neurobiology of Exercise  

Microsoft Academic Search

Voluntary physical activity and exercise training can favorably influence brain plasticity by facilitating neurogenerative, neuroadaptive, and neuroprotective processes. At least some of the processes are mediated by neurotrophic factors. Motor skill training and regular exercise enhance executive functions of cognition and some types of learning, including motor learning in the spinal cord. These adaptations in the central nervous system have

Rod K. Dishman; Hans-Rudolf Berthoud; Frank W. Booth; Carl W. Cotman; V. Reggie Edgerton; Monika R. Fleshner; Simon C. Gandevia; Fernando Gomez-Pinilla; Benjamin N. Greenwood; Charles H. Hillman; Arthur F. Kramer; Barry E. Levin; Timothy H. Moran; Amelia A. Russo-Neustadt; John D. Salamone; Jacqueline D. Van Hoomissen; Charles E. Wade; David A. York; Michael J. Zigmond



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



Can Surgery Improve Neurological Function in Penetrating Spinal Injury. A Review of the Military and Civilian Literature and Treatment Recommendations for Military Neurosurgeons.  

National Technical Information Service (NTIS)

Penetrating spinal injury (PSI), although an infrequent injury in the civilian population, is not an infrequent injury in military conflicts. Throughout military history, the role of surgery in the treatment of PSI has been controversial. The US is curren...

B. T. Ragel J. P. Klimo M. Rosner R. McCafferty W. Gluf



Stem cells in the treatment of chronic spinal cord injury: evaluation of somatosensitive evoked potentials in 39 patients  

Microsoft Academic Search

Study design:A prospective, non-randomized clinical series trial.Objective:To evaluate the effect of autogenous undifferentiated stem cell infusion for the treatment of patients with chronic spinal cord injury (SCI) on somatosensory evoked potentials (SSEPs).Setting:A public tertiary hospital in São Paulo, Brazil.Methods:Thirty-nine consecutive patients with diagnosed complete cervical and thoracic SCI for at least 2 years and with no cortical response in the

A F Cristante; T E P Barros-Filho; N Tatsui; A Mendrone; J G Caldas; A Camargo; A Alexandre; W G J Teixeira; R P Oliveira; R M Marcon



High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression  

Microsoft Academic Search

Twenty-eight consecutive patients were given high-dose dexamethasone (96 mg i.v. loading dose, decreasing doses to zero in 14 days) and radiotherapy for epidural spinal cord compression due to malignant disease. There were eight events classified as side effects of the dexamethasone treatment. Four of these were considered as serious (one fatal ulcer with haemmorhage, one rectal bleeding and one gastrointestinal

Ketil Heimdal; Henry Hirschberg; Haldor Slettebø; Kjell Watne I; Ole Nome



The surgical treatment of the osteoporotic vertebral compression fracture in the elderly patients with the spinal instrumentation.  


The study was to present the results of the surgical treatment using the spinal instrumentation toe resolve the osteoporotic vertebral compression fracture in the elderly patients having the clinical symptoms of pain and the neurological compromise. Sixty elderly patients who underwent the surgical treatment of the osteoporotic vertebral compression fracture were retrospectively reviewed. Their average age was 72 years; the range was 60-90. The average follow-up period for these patients was 4.2 years; the range was 3-7. Twenty-four patients were performed by the posterior stabilization enhanced by the pedicle screws and rods with the transpedicular bone grafting. Thirty-two patients were performed by the anterior corpectomy with the interbody fusion and the anterior spinal instrumentation. Four patients were performed by two-step surgical treatment: firstly the posterior stabilization enhanced by pedicle screws and rods, and finally, the anterior corpectomy with the interbody fusion. The sagittal Cobb angle and the back pain were improved in all patients. The neurological deficits were improved in 14 patients out of the 16 patients. Twelve patients had the post operative complications: late implants loosening in 5 patients, subcutaneous wound infections in 4 patients, painful neuromas at thoracic cage in 2 patients and incisional hernia in one patient. Although the surgical treatment with spinal implants in the osteoporotic compression fracture was performed in the selected patients, the complication rate was still high, i.e. twenty percent. All of them, nevertheless, were not the mortal complications. The anterior column support could maintain the sagittal alignment better than the posterior spinal fusion alone in the long-term follow up period while the VAS of pain was improved in the similar results. PMID:19891385

Chotigavanich, Chatupon; Sanpakit, Sanyapong; Wantthanaapisith, Thanet; Thanapipatsiri, Surin; Chotigavanich, Charoen



Splicing regulation of the Survival Motor Neuron genes and implications for treatment of spinal muscular atrophy  

PubMed Central

Proximal spinal muscular atrophy (SMA) is a neuromuscular disease caused by low levels of the survival motor neuron (SMN) protein. The reduced SMN levels are due to loss of the survival motor neuron-1 (SMN1) gene. Humans carry a nearly identical SMN2 gene that generates a truncated protein, due to a C to T nucleotide alteration in exon 7 that leads to inefficient RNA splicing of exon 7. This exclusion of SMN exon 7 is central to the onset of the SMA disease, however, this offers a unique therapeutic intervention in which corrective splicing of the SMN2 gene would restore SMN function. Exon 7 splicing is regulated by a number of exonic and intronic splicing regulatory sequences and trans-factors that bind them. A better understanding of the way SMN pre-mRNA is spliced has lead to the development of targeted therapies aimed at correcting SMN2 splicing. As therapeutics targeted toward correction of SMN2 splicing continue to be developed available SMA mouse models can be utilized in validating their potential in disease treatment.

Bebee, Thomas W.; Gladman, Jordan T.; Chandler, Dawn S.



Concise review: human pluripotent stem cells in the treatment of spinal cord injury.  


Spinal cord injury (SCI) results in neural loss and consequently motor and sensory impairment below the injury. There are currently no effective therapies for the treatment of traumatic SCI in humans. Different kinds of cells including embryonic, fetal, and adult stem cells have been transplanted into animal models of SCI resulting in sensorimotor benefits. Transplantation of human embryonic stem cell (hESC)- or induced pluripotent stem cell (hiPSC)-derived neural cells is nowadays a promising therapy for SCI. This review updates the recent progress in preclinical studies and discusses the advantages and flaws of various neural cell types derived from hESCs and hiPSCs. Before introducing the stem cell replacement strategies in clinical practice, this complex field needs to advance significantly in understanding the lesion itself, the animal model adequacy, and improve cell replacement source. This knowledge will contribute to the successful translation from animals to humans and lead to established guidelines for rigorous safety screening in order to be implemented in clinical practice. PMID:22736576

Lukovic, Dunja; Moreno Manzano, Victoria; Stojkovic, Miodrag; Bhattacharya, Shom Shanker; Erceg, Slaven



[Clinical results of infertility treatment to male patients with spinal cord injury].  


It is difficult for male patients with spinal cord injury (SCI) to have children because of an ejaculation and dysfunction of spermatogenesis. However, owing to progress of assisted reproduction technology in recent years, it has become possible to have children even if the male has SCI, and the rate of success is improving gradually. During the 8 years from 1994 to 2002, infertility treatment was performed on 16 male patients with SCI consulting our hospital for acquistion of a child. We extracted their sperm by electroejaculation (EE) or testicular excision sperm extraction (TESE), and the sperm was artificially inseminated by the techniques such as artificial insemination with husband's semen (AIH), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). Consequently, it was successful in 14 pregnancies on 10 couples, and resulted in 11 healthy live births on 7 couples. Four cases resulted in abortion. Two spouses are pregnant at present. There were no remarkable differences between the success group and the failure group in the quality of sperm such as concentration and motility. The mean age of the spouses who became pregnant was slightly lower than that of those who did not. Assisted reproduction techniques as EE and ICSI were useful techniques for patients with SCI wishing to have children. PMID:15032010

Komiya, Atsushi; Sato, Kazuhiko; Ishidoh, Tetsuo; Tanaka, Katsuyuki; Tomoda, Takeshi



A systematic review of non-invasive pharmacologic neuroprotective treatments for acute spinal cord injury.  


An increasing number of therapies for spinal cord injury (SCI) are emerging from the laboratory and seeking translation into human clinical trials. Many of these are administered as soon as possible after injury with the hope of attenuating secondary damage and maximizing the extent of spared neurologic tissue. In this article, we systematically review the available pre-clinical research on such neuroprotective therapies that are administered in a non-invasive manner for acute SCI. Specifically, we review treatments that have a relatively high potential for translation due to the fact that they are already used in human clinical applications, or are available in a form that could be administered to humans. These include: erythropoietin, NSAIDs, anti-CD11d antibodies, minocycline, progesterone, estrogen, magnesium, riluzole, polyethylene glycol, atorvastatin, inosine, and pioglitazone. The literature was systematically reviewed to examine studies in which an in-vivo animal model was utilized to assess the efficacy of the therapy in a traumatic SCI paradigm. Using these criteria, 122 studies were identified and reviewed in detail. Wide variations exist in the animal species, injury models, and experimental designs reported in the pre-clinical literature on the therapies reviewed. The review highlights the extent of investigation that has occurred in these specific therapies, and points out gaps in our knowledge that would be potentially valuable prior to human translation. PMID:20146558

Kwon, Brian K; Okon, Elena; Hillyer, Jessica; Mann, Cody; Baptiste, Darryl; Weaver, Lynne C; Fehlings, Michael G; Tetzlaff, Wolfram



Effect of Spinal Cord Injury on the Respiratory System: Basic Research and Current Clinical Treatment Options  

PubMed Central

Summary: Spinal cord injury (SCI) often leads to an impairment of the respiratory system. The more rostral the level of injury, the more likely the injury will affect ventilation. In fact, respiratory insufficiency is the number one cause of mortality and morbidity after SCI. This review highlights the progress that has been made in basic and clinical research, while noting the gaps in our knowledge. Basic research has focused on a hemisection injury model to examine methods aimed at improving respiratory function after SCI, but contusion injury models have also been used. Increasing synaptic plasticity, strengthening spared axonal pathways, and the disinhibition of phrenic motor neurons all result in the activation of a latent respiratory motor pathway that restores function to a previously paralyzed hemidiaphragm in animal models. Human clinical studies have revealed that respiratory function is negatively impacted by SCI. Respiratory muscle training regimens may improve inspiratory function after SCI, but more thorough and carefully designed studies are needed to adequately address this issue. Phrenic nerve and diaphragm pacing are options available to wean patients from standard mechanical ventilation. The techniques aimed at improving respiratory function in humans with SCI have both pros and cons, but having more options available to the clinician allows for more individualized treatment, resulting in better patient care. Despite significant progress in both basic and clinical research, there is still a significant gap in our understanding of the effect of SCI on the respiratory system.

Zimmer, M. Beth; Nantwi, Kwaku; Goshgarian, Harry G



Exercise and side effects among 749 patients during and after treatment for cancer: a University of Rochester Cancer Center Community Clinical Oncology Program Study  

Microsoft Academic Search

Goals  Despite advances in cancer treatment and symptom management, many patients experience side effects from cancer treatments that cause suffering and impair quality of life (QOL). Exercise is a method for enhancing QOL among cancer patients that shows promise in reducing side effects. However, patient participation in exercise is not well defined. We report on exercise participation during and within 6 months

Karen M. Mustian; Jennifer J. Griggs; Gary R. Morrow; Anne McTiernan; Joseph A. Roscoe; Christopher W. Bole; James N. Atkins; Brian F. Issell



Electric Spinal Cord Stimulation (SCS) in the Treatment of Angina Pectoris: A Cost-Utility Analysis.  


For the last 15 years electric spinal cord stimulation (SCS) has been employed in patients with confirmed ischemic heart disease who suffer from refractory angina pectoris despite maximum medical/surgical treatment. The purpose of this investigation was to assess not only the economic consequences of SCS treatment (cost-utility analysis) but also altered quality of life in SCS patients. The retrospective study includes 18 consecutive patients, six women and 12 men, with an average age of 56.5 years (range 50-68), submitted to implantation of a SCS system at Odense University Hospital. Before implantation of the SCS system, the patients were in a transcutaneous electric nerve stimulation (TENS) treatment 2-11 months. At the submission all patients were in New York Heart Association functional group III/IV. The results are based on cost data from the year prior to start of TENS treatment compared with the year after implantation of the SCS system. Medical records of the patients were examined and data concerning use of general practitioners and emergency services were collected from a nationwide database. Quality of life data were collected using identical questionnaires (perception of pain, mobility, function in daily life, and physical activity) related to the period immediately before start of the TENS treatment and one year after SCS implant. Savings were found at hospital level (reduction in number of admissions) and for non-hospital related expenses (such as medication and visits at general practitioners). In addition, improvements were registered in all respects which constituted assessment of the quality of life of the patients. The study is a repetition of a similar analysis with identical results made in 1990 and including the 16 first angina pectoris patients treated with SCS at Odense University Hospital. SCS is effective in reducing hospital and non-hospital related expenses and improving quality of life of the patients. SCS is a simple treatment for the patient to use. The implantation technique is not more invasive than permanent cardiac pacing. The decisive part of the procedure is the insertion of the electrode and follow-up with support and adjustments of the stimulation. PMID:22151189

Rasmussen, Malene Bladt; Hole, Peter; Andersen, Claus



[Expression of neurotrophin and IL-1 beta mRNAs following spinal cord injury and the effects of methylprednisolone treatment].  


Glucocorticoid has been clinically used for the treatment of acute spinal cord injury (SCI) to enhance the neurological recovery, but the relevance of the use of steroid is not fully discussed. Neurotrophins play important roles in normal development of central and peripheral nervous system. It is reported that traumatic insults to the brain alter the expression of these neurotrophins. These responses are considered to trigger a cascade of cellular protection and repair. First, we investigated the temporal and spatial expression patterns of neurotrophin and IL-1 beta mRNAs in the area of spinal cord lesion. Second, we examined if methylprednisolone (MP) affects the expression of these genes in SCI. Male Sprague-Dawley rats (250-300 gms) were laminectomized at T10. Spinal cord was crushed by clipping (holding force 60 gms, 1 sec). Rats were killed at 1, 6, 12, 24 h, and 72 h after the injury and the spinal cord was rapidly removed and frozen sections were cut. Second, the other group of rats were treated with MP (165 mg/kg) just after SCI and sacrificed at 6 h. The levels of neurotrophins and IL-1 beta mRNAs were evaluated by in situ hybridization histochemistry. IL-1 beta mRNA level was elevated at 1 h and 6 h and attenuated at 12 h. The increased level of BDNF and NT3 mRNAs were first observed at 6 h and the labeling was enhanced at 24 h and 72 h. In MP treated group, the levels of IL-1 beta, BDNF and NT3 mRNAs were attenuated compared with those of MP-untreated SCI group. Steroid hormone therapy diminishes the post-traumatic inflammatory cascades which produce edema and swelling and worsen neuronal injury. However, glucocorticoid may hinder the endogenous repair mechanism. Our data show that MP depress the production of BDNF and NT3 following SCI, which might be disadvantageous to the survival of spinal neurons. PMID:9251297

Hayashi, M; Ueyama, T; Tamaki, T; Senba, E



Risk factors and treatment outcome in scuba divers with spinal cord decompression sickness  

Microsoft Academic Search

PurposeThis study was designed to determine the recompression strategy and the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS).

Emmanuel Gempp; Jean-Eric Blatteau



Innovative Preventive and Treatment Techniques in Spinal Cord Injury Urologic Complications.  

National Technical Information Service (NTIS)

This project demonstrated the effectiveness and practicality of a new classification for neurogenic bladder following spinal cord injury and an algorithm for bladder care. By grouping the same type of bladder according to the 'residual ability' to achieve...

J. B. Nanninga Y. Wu



Outcome of late surgical treatment in patients with incomplete paraplegia due to spinal degenerative diseases  

Microsoft Academic Search

Study design:Retrospective analysis.Objective:To assess the outcome of late surgical intervention in patients with incomplete paraplegia due to spinal degenerative diseases.Setting:Three men and four women with cervical or thoracic spinal degenerative diseases, who preoperatively were unable to walk for more than 6 months in Mie prefecture, Japan.Methods:Review of clinical records and questionnaire survey regarding the walking ability of patients 2 years

Y Kasai; D Shi; T Sugimoto; K Takegami; A Uchida



Antegrade continence enema for the treatment of neurogenic constipation and fecal incontinence after spinal cord injury  

Microsoft Academic Search

Objective: To describe the effects of an antegrade continence enema stoma formed in a paraplegic man with intractable constipation and fecal incontinence.Design: Case report.Setting: Spinal cord injury unit, Veterans Affairs hospital.Participants: Spinal cord injury (SCI) patient with T12 paraplegia.Intervention: Surgical formation of antegrade continence enema stoma.Main Outcome Measures: Time of bowel program care, ease of fecal elimination, safety of procedure.Results:

Claire C. Yang; Steven A. Stiens



Plasticity of the spinal cord contributes to neurological improvement after treatment by cervical decompression  

Microsoft Academic Search

To investigate the relationship between morphological plasticity of the spinal cord and neurological outcome after surgery\\u000a for compressive lesions, we correlated the transverse area of the cervical spinal cord measured by transaxial magnetic resonance\\u000a imaging (MRI) obtained during the early postoperative period (1–6 months) with neurological function assessed at a median\\u000a postoperative follow-up period of 2.5 years. Measurements on MRI

Hisatoshi Baba; Yasuhisa Maezawa; Kenzo Uchida; Nobuaki Furusawa; Makoto Wada; Shinichi Imura



Chronic treatment with lithium does not improve neuromuscular phenotype in a mouse model of severe spinal muscular atrophy.  


Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by defective levels of the survival motor neuron (SMN) protein. SMA causes spinal motoneuron (MN) loss, and progressive muscle weakness and paralysis. Currently, there is no effective therapy to cure this disease. Although different strategies focused on increasing the expression of functional SMN protein have been assayed, numerous SMN-independent therapeutic approaches have been demonstrated to have potential effectiveness in improving the SMA phenotype in mouse models and clinical trials. Recent works have shown that compounds which inhibit GSK-3? activity are effective in promoting MN survival and ameliorating lifespan in models of MN diseases including SMA. Taking into account the reported neuroprotective actions of lithium (Li) through the inhibition of GSK-3? in different studies, we tested here its potential efficiency as a therapeutic agent in a mouse model of severe SMA (SMN?7 mice). We show that the chronic treatment with Li initiated before the appearance of disease symptoms, although inhibited GSK-3?, did not improve the median survival, motor behavior, and spinal MN loss linked to SMA. Li administration did not either ameliorate the microglial and astroglial reaction in the spinal cord or the depletion of glutamatergic synapses on MNs observed in SMN?7 animals. Moreover, Li treatment did not mitigate muscle atrophy or calcitonin gene-related peptide (CGRP) downregulation in the neuromuscular junctions linked to the disease. However, a significant reduction in apoptotic cell death found in the skeletal muscle of SMA mice was observed after Li treatment. PMID:23876328

Dachs, E; Piedrafita, L; Hereu, M; Esquerda, J E; Calderó, J



Treatment of spinal cord injury with co-grafts of genetically modified schwann cells and fetal spinal cord cell suspension in the rat  

Microsoft Academic Search

Epub ahead of print: December 2004 Fetal spinal cord cells, Schwann cells and neurotrophins all have the capacity to promote\\u000a repair of injured spinal cord in animal models. To explore the possibility of using these approaches to treat clinical patients,\\u000a we have examined whether a combination of these protocols produces functional and anatomical improvement. The spinal cords\\u000a of adult rats

Shi-Qing Feng; Xiao-Hong Kong; Shi-Fu Guo; Pei Wang; Li Li; Jin-Hua Zhong; Xin-Fu Zhou



Radiation-induced spinal cord glioblastoma with cerebrospinal fluid dissemination subsequent to treatment of lymphoblastic lymphoma  

PubMed Central

Background: Radiation-induced glioma arising in the spinal cord is extremely rare. We report a case of radiation-induced spinal cord glioblastoma with cerebrospinal fluid (CSF) dissemination 10 years after radiotherapy for T-cell lymphoblastic lymphoma. Case Description: A 32-year-old male with a history of T-cell lymphoblastic lymphoma presented with progressive gait disturbance and sensory disturbance below the T4 dermatome 10 years after mediastinal irradiation. Gadolinium-enhanced magnetic resonance (MR) imaging revealed an intramedullary tumor extending from the C6 to the T6 level, corresponding to the previous radiation site, and periventricular enhanced lesions. In this case, the spinal lesion was not directly diagnosed because the patient refused any kind of spinal surgery to avoid worsening of neurological deficits. However, based on a biopsy of an intracranial disseminated lesion and repeated immmunocytochemical examination of CSF cytology, we diagnosed the spinal tumor as a radiation-induced glioblastoma. The patient was treated with radiotherapy plus concomitant and adjuvant temozolomide. Then, the spinal tumor was markedly reduced in size, and the dissemination disappeared. Conclusion: We describe our detailed diagnostic process and emphasize the diagnostic importance of immunocytochemical analysis of CSF cytology.

Kikkawa, Yuichiro; Suzuki, Satoshi O; Nakamizo, Akira; Tsuchimochi, Ryosuke; Murakami, Nobuya; Yoshitake, Tadamasa; Aishima, Shinichi; Okubo, Fumihiko; Hata, Nobuhiro; Amano, Toshiyuki; Yoshimoto, Koji; Mizoguchi, Masahiro; Iwaki, Toru; Sasaki, Tomio



Spinal balloon nucleoplasty: a hypothetical minimally invasive treatment for herniated nucleus pulposus.  


Low back pain is the most common cause of disability under the age of 45. The annual incidence of back pain is estimated to be 5% and the lifetime prevalence is 80%. Majority of the patients with persistent symptoms are suffering from radiculopathy that is mainly caused by a herniated nucleus pulposus (HNP). HNP can heal spontaneously due to spontaneous resorption. Besides pressure nucleus pulposus, without any compression, may induce similar changes when applied epidurally to the nerve roots. Nevertheless, combination of chronic mechanical compression and application of nucleus pulposus causes a more pronounced nerve injury. When dual pathophysiology (pressure and inflammatory reaction), spontaneous resorption, and natural course of HNP are taken into account, any treatment modality that eliminates both the pressure and contact of the nucleus pulposus with the nerve root via creating extra time for healing to take place might prove beneficial. These requirements can be provided by spinal balloon nucleoplasty (SBN), which can be used in combination with other treatment modalities such as chymopapain injection. In this hypothetical method, epidural access to the subarachnoid space is established via epidural needles, thereafter a specially designed balloon tipped catheter is advanced. When the catheter is ideally placed with the help of CT or MRI, the balloon at the tip is inflated to relieve pressure and to prevent contact of the nerve root with HNP. The answer to the question, will SBN find a place in clinical practice? is obscure. But a homology can be established with uterine fibroid embolization, which has found clinical use in a period of 30 years approximately. PMID:18096323

Basaran, Ahmet; Topatan, Sena



Spinal cord compression in two related Ursus arctos horribilis.  


Two 15-yr-old grizzly bear littermates were evaluated within 9 mo of each other with the symptom of acute onset of progressive paraparesis and proprioceptive ataxia. The most significant clinical examination finding was pelvic limb paresis in both bears. Magnetic resonance examinations of both bears showed cranial thoracic spinal cord compression. The first bear had left-sided extradural, dorsolateral spinal cord compression at T3-T4. Vertebral canal stenosis was also observed at T2-T3. Images of the second bear showed lateral spinal cord compression from T2-T3 to T4-T5. Intervertebral disk disease and associated spinal cord compression was also observed at T2-T3 and T3-T4. One grizzly bear continued to deteriorate despite reduced exercise, steroid, and antibiotic therapy. The bear was euthanized, and a necropsy was performed. The postmortem showed a spinal ganglion cyst that caused spinal cord compression at the level of T3-T4. Wallerian-like degeneration was observed from C3-T6. The second bear was prescribed treatment that consisted of a combination of reduced exercise and steroid therapy. He continued to deteriorate with these medical therapies and was euthanized 4 mo after diagnosis. A necropsy showed hypertrophy and protrusion of the dorsal longitudinal ligament at T2-T3 and T3-T4, with resulting spinal cord compression in this region. Wallerian-like degeneration was observed from C2-L1. This is one of few case reports that describes paresis in bears. It is the only case report, to the authors' knowledge, that describes spinal magnetic resonance imaging findings in a grizzly bear and also the only report that describes a cranial thoracic myelopathy in two related grizzly bears with neurologic signs. PMID:23082524

Thomovsky, Stephanie A; Chen, Annie V; Roberts, Greg R; Schmidt, Carrie E; Layton, Arthur W



Combination Treatment of Rosuvastatin or Atorvastatin, with Regular Exercise Improves Arterial Wall Stiffness in Patients with Coronary Artery Disease  

PubMed Central

Objective Statin- and exercise-therapy are both clinically beneficial by preventing cardiovascular events in patients with coronary artery disease (CAD). However, there is no information on the vascular effects of the combination of statins and exercise on arterial wall stiffness in CAD patients. Methods The present study is a sub-analysis of PRESET study that determined the effects of 20-week treatment with statins (rosuvastatin, n?=?14, atorvastatin, n?=?14) combined with regular exercise on arterial wall stiffness assessed by measurement of brachial and ankle pulse wave velocity (baPWV) in CAD patients. Results The combination of statins and regular exercise significantly improved exercise capacity, lipid profile, including low- and high-density lipoprotein cholesterol, and high-sensitivity C-reactive protein (hs-CRP), baPWV (baseline: 1747±355, at 20 weeks of treatment: 1627±271 cm/s, p?=?0.008), and basophil count (baseline: 42±32, 20 weeks: 26±15 cells/µL, p?=?0.007), but had no effect on blood pressure (baseline: 125±22, 20 weeks: 121±16 mmHg). Changes in baPWV correlated significantly with changes in basophil count (r?=?0.488, p?=?0.008), but not with age, lipids profile, exercise capacity, or hs-CRP. Conclusion In CAD patients, the combination treatment with statins and exercise resulted in significant amelioration of arterial wall stiffness, at least in part, through reduction of circulating basophils.

Toyama, Kensuke; Sugiyama, Seigo; Oka, Hideki; Iwasaki, Yuri; Sumida, Hitoshi; Tanaka, Tomoko; Tayama, Shinji; Jinnouchi, Hideaki; Ogawa, Hisao



Spinal Cord Stimulation for the Treatment of Upper and Lower Extremity Neuropathic Pain due to Lyme Disease.  


Background.? Lyme disease is caused by Borrelia, a bacterium transmitted by the bite of a deer tick. A slow developing encephalopathy or an axonal polyneuropathy with distal paresthesia and spinal or radicular pain rarely occurs and can be hard to treat. Materials and Methods.? We report here the case of a 44-year-old woman with four-limb, intolerable, neuropathic pain as sequelae to Lyme disease, which was resistant to conservative measures and was treated successfully with concurrent, thoracic, and cervical percutaneous spinal cord stimulation (SCS). Results.? After 18 months of therapy and follow-up, this patient's analgesia, as a result of SCS, continues to be excellent, with almost complete subjective pain relief and cessation of adjuvant analgesic medication. Conclusions.? SCS may be efficacious for the treatment of neuropathic pain due to Lyme disease. PMID:22151863

Mearini, Massimo; Podetta, Stefano; Catenacci, Emanuela; d'Auria, Patrizia; Cornali, Claudio; Mortini, Pietro



A Systematic Review of Pharmacological Treatments of Pain Following Spinal Cord Injury  

PubMed Central

Objective To conduct a systematic review of published research on the pharmacological treatment of pain after spinal cord injury (SCI). Data Sources Medline, CINAHL, EMBASE and PsycINFO databases were searched for articles published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized controlled trials (RCTs) were assessed for methodological quality using the PEDro assessment scale, while non-RCTs were assessed using the Downs and Black evaluation tool. A level of evidence was assigned to each intervention using a modified Sackett scale. Study Selection The review included randomized controlled trials and non-randomized controlled trials which included prospective controlled trials, cohort, case series, case-control, pre-post and post studies. Case studies were included only when there were no other studies found. Data Extraction Data extracted included the PEDro or Downs and Black score, the type of study, a brief summary of intervention outcomes, type of pain, type of pain scale and the study findings.. Data Synthesis Articles selected for this particular review evaluated different interventions in the pharmacological management of pain post SCI. 28 studies met inclusion criteria: there were 21 randomized controlled trials of these 19 had Level 1 evidence. Treatments were divided into five categories: anticonvulsants, antidepressants, analgesics, cannabinoids and antispasticity medications. Conclusions Most studies did not specify participants’ types of pain; hence making it difficult to identify the type of pain being targeted by the treatment. Anticonvulsant and analgesic drugs had the highest levels of evidence and were the drugs most often studied. Gabapentin and pregabalin had strong evidence (five Level 1 RCTs) for effectiveness in treating post-SCI neuropathic pain, as did intravenous analgesics (lidocaine, ketamine and morphine) but the latter only had short term benefits. Tricyclic antidepressants only showed benefit for neuropathic pain in depressed individuals. Intrathecal baclofen reduced musculoskeletal pain associated with spasticity; however there was conflicting evidence for the reduction in neuropathic pain. Studies assessing the effectiveness of opioids were limited and revealed only small benefits. Cannabinoids showed conflicting evidence in improving spasticity related pain. Clonidine and morphine, when given together, had a significant synergistic neuropathic pain-relieving effect.

Teasell, Robert W.; Mehta, Swati; Aubut, Jo-Anne L.; Foulon, Brianne; Wolfe, Dalton L.; Hsieh, Jane T.C.; Townson, Andrea F.; Short, Christine



Influence of recombinant human erythropoietin treatment on pulmonary O2 uptake kinetics during exercise in humans  

PubMed Central

We hypothesized that 4 weeks of recombinant human erythropoietin (RhEPO) treatment would result in a significant increase in haemoglobin concentration ([Hb]) and arterial blood O2-carrying capacity and that this would (1) increase peak pulmonary oxygen uptake V?O2 during ramp incremental exercise, and (2) speed V?O2 kinetics during ‘severe’-, but not ‘moderate’- or ‘heavy’-intensity, step exercise. Fifteen subjects (mean ±s.d. age 25 ± 4 years) were randomly assigned to either an experimental group which received a weekly subcutaneous injection of RhEPO (150 IU kg?1; n = 8), or a control group (CON) which received a weekly subcutaneous injection of sterile saline (10 ml; n = 7) as a placebo, for four weeks. The subjects and the principal researchers were both blind with respect to the group assignment. Before and after the intervention period, all subjects completed a ramp test for determination of the gas exchange threshold (GET) and V?O2,peak, and a number of identical ‘step’ transitions from ‘unloaded’ cycling to work rates requiring 80% GET (moderate), 70% of the difference between the GET and V?O2,peak (heavy), and 105% V?O2,peak (severe) as determined from the initial ramp test. Pulmonary gas exchange was measured breath-by-breath. There were no significant differences between the RhEPO and CON groups for any of the measurements of interest ([Hb], V?O2,peak V?O2 kinetics) before the intervention. Four weeks of RhEPO treatment resulted in a 7% increase both in [Hb] (from 15.8 ± 1.0 to 16.9 ± 0.7 g dl?1; P < 0.01) and V?O2,peak (from 47.5 ± 4.2 to 50.8 ± 10.7 ml kg?1·min?1; P < 0.05), with no significant change in CON. RhEPO had no significant effect on V?O2 kinetics for moderate (Phase II time constant, from 28 ± 8 to 28 ± 7 s), heavy (from 37 ± 12 to 35 ± 11 s), or severe (from 33 ± 15 to 35 ± 15 s) step exercise. Our results indicate that enhancing blood O2-carrying capacity and thus the potential for muscle O2 delivery with RhEPO treatment enhanced the peak V?O2 but did not influence V?O2 kinetics, suggesting that the latter is principally regulated by intracellular (metabolic) factors, even during exercise where the V?O2 requirement is greater than the V?O2,peak, at least in young subjects performing upright cycle exercise.

Wilkerson, Daryl P; Rittweger, Jorn; Berger, Nicolas JA; Naish, Patrick F; Jones, Andrew M



Minimally invasive surgical treatment of lumbar spinal stenosis: Two-year follow-up in 54 patients  

PubMed Central

Objective: Minimally invasive surgery has seen increasing application in the treatment of spinal disorders. Treatment of degenerative spinal stenosis, with or without spondylolisthesis, with minimally invasive technique preserves stabilizing ligaments, bone, and muscle. Satisfactory results can be achieved without the need for fusion in most cases. Methods: Fifty-four consecutive patients underwent bilateral decompressions from a unilateral approach for spinal stenosis using METRx instrumentation. Visual Analog Scale (VAS) pain scores were recorded preoperatively and patients were interviewed, in person or by phone, by our office nurse practitioner (LD) to assess postoperative VAS scores, and patient satisfaction with the clinical results 21-39 months postoperatively (median 27 months). Results: Fifty-four patients underwent decompression at 77 levels (L4/5 = 43, L3/4 = 22, L5/S1 = 8, L1/2 = 4, L2/3 = 4), (single = 35, double = 16, triple = 2, quadruple = 1). There were 39 females and 15 males. The average age was 67 years. The average operative time was 78 minutes and the average blood loss was 37 ml per level. Twenty-seven patients had preoperative degenerative spondylolisthesis (Grade 1 = 26, Grade 2 = 1). Eight patients had discectomies and four had synovial cysts. Patient satisfaction was high. Use of pain medication for leg and back pain was low, and VAS scores improved by more than half. There were three dural tears. There were no deaths or infections. One patient with an unrecognized dural tear required re-exploration for repair of a pseudomeningocele and one patient required a lumbar fusion for pain associated with progression of her spondylolisthesis. Conclusions: Minimally invasive bilateral decompression of acquired spinal stenosis from a unilateral approach can be successfully accomplished with reasonable operative times, minimal blood loss, and acceptable morbidity. Two-year outcomes in this series revealed high patient satisfaction and only one patient progressed to lumbar fusion.

Palmer, Sylvain; Davison, Lisa



Treatment of digit ulcers in a patient with Buerger's disease by using cervical spinal cord stimulation -a case report-  

PubMed Central

Buerger's disease (thromboangiitis obliterans) is known as a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. Most effective treatment for Buerger's disease is smoking cessation. Except for the cessation of tobacco use, surgical revascularization is available in severe ischemia and a distal target vessel. Amputation has been used as the last treatment option of the disease up to the present. Increasing limb survival and decreasing amputation rate is important. This case describes the use of spinal cord stimulation (SCS) in patient with Buerger's disease and its effect is not only the complete healing of ulcers but also amputation is not performed.

Ryu, Sang-Wook; Jeon, Hee-Jung; Cho, Sam-Soon; Choi, Rak-Min; Yoon, Jin-Sun; Ko, Hong-Seok



Treatment of digit ulcers in a patient with Buerger's disease by using cervical spinal cord stimulation -a case report-.  


Buerger's disease (thromboangiitis obliterans) is known as a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. Most effective treatment for Buerger's disease is smoking cessation. Except for the cessation of tobacco use, surgical revascularization is available in severe ischemia and a distal target vessel. Amputation has been used as the last treatment option of the disease up to the present. Increasing limb survival and decreasing amputation rate is important. This case describes the use of spinal cord stimulation (SCS) in patient with Buerger's disease and its effect is not only the complete healing of ulcers but also amputation is not performed. PMID:24024002

Ryu, Sang-Wook; Jeon, Hee-Jung; Cho, Sam-Soon; Choi, Rak-Min; Yoon, Jin-Sun; Ko, Hong-Seok; Lee, Jae-Do



Antisense oligonucleotide knockdown of mGlu? receptor attenuates the antinociceptive tolerance and up-regulated expression of spinal protein kinase C associated with chronic morphine treatment.  


Spinal metabotropic glutamate receptor 5 (mGlu? receptor) is known to influence the development of intrathecal morphine antinociceptive tolerance. However, the signaling mechanisms remain unknown. We carried out intrathecal administration of an antisense oligodeoxynucleotide (ODN), which results in reduced expression of spinal mGlu? receptor, to determine its effects on morphine tolerance and spinal protein kinase C (PKC) expression. Rats were treated intrathecally with saline, morphine, mGlu5 receptor antisense ODN or mGlu5 receptor mismatched ODN. Behavioral tests were used to test the thermal and mechanical pain thresholds. Eight days later, rats were sacrificed and spinal cords were harvested to assess the expression of spinal PKC (?, ? and ?) by Western blotting and real-time polymerase chain reaction (PCR). Compared to control, intrathecal mGlu? receptor antisense ODN resulted in a ~53.9% reduction of spinal mGlu? receptor after 8days treatment. The mGlu5 receptor antisense ODN prevented the development of morphine tolerance. Expression of spinal PKC (?, ? and ?) was up-regulated at the mRNA and protein levels during the development of tolerance. Meanwhile, antisense ODN but not mismatched ODN reduced the spinal dorsal horn levels of PKC (?, ? and ?) which had been up-regulated after morphine exposure. We conclude that mGlu? receptor participates in the development of morphine tolerance. Expression of spinal PKC (?, ? and ?) at the mRNA and protein levels increased during morphine tolerance. Antisense ODN of mGlu? receptor prevented the tolerance and inhibited the altered expression of spinal PKC (?, ? and ?) during the development of tolerance. PMID:22429573

Xu, Tao; Chen, Moxi; Zhou, Quanhong; Xue, Ying; Wang, Li; Bil De Arce, Vida J; Zhang, Xiaoli; Jiang, Wei



Surgical treatment of spinal vascular malformations performed using intraoperative indocyanine green videoangiography.  


This study aims to evaluate the benefits of intraoperative indocyanine green (ICG) videoangiography and associated surgical outcomes of patients with spinal vascular malformations. ICG videoangiography was used during 24 surgical interventions to treat spinal vascular malformations at the Beijing Tiantan Hospital from August 2009 to May 2011. The vascular malformations were removed or the fistulae were occluded with the assistance of ICG videoangiography. The completeness of fistula clipping or nidus extirpation and each patient's neurological status were evaluated. Among these 24 patients, there were seven with spinal dural arteriovenous fistulae, five glomus arteriovenous malformations, one juvenile arteriovenous malformation, nine perimedullary arteriovenous fistulae, and two perimedullary arteriovenous fistulae in combination with perimedullary arteriovenous malformations. Intraoperative ICG videoangiography confirmed the definite clipping of the fistulous points and complete removal of intramedullary arteriovenous malformations in all but one patient. All patients had satisfactory preservation of spinal cord blood supply and venous return. No adverse effects or complications related to ICG videoangiography occurred. Three patients were lost to follow up; 21 patients were followed clinically with a mean follow up of 7.5 months. The neurological deficits completely resolved in six patients, improved significantly in 10, remained stable in two, and were aggravated in three patients. Our experience shows that intraoperative ICG videoangiography offers useful information on the pathological and physiological vascular anatomy encountered during surgery for spinal vascular malformations. PMID:23632289

Wang, Guihuai; Ma, Guangshuo; Ma, Jun; Hao, Shuyu; Li, Dezhi; Han, Lijiang; Wang, Tao; Su, Wei; Han, Bo; Yen, Chun-Po; Kwan, Aij-Lie



Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study  

PubMed Central

Objective To compare the effectiveness of radial extracorporeal shockwave treatment with that of supervised exercises in patients with shoulder pain. Design Single blind randomised study. Setting Outpatient clinic of physical medicine and rehabilitation department in Oslo, Norway. Participants 104 patients with subacromial shoulder pain lasting at least three months. Interventions Radial extracorporeal shockwave treatment: one session weekly for four to six weeks. Supervised exercises: two 45 minute sessions weekly for up to 12 weeks. Primary outcome measure Shoulder pain and disability index. Results A treatment effect in favour of supervised exercises at 6, 12, and 18 weeks was found. The adjusted treatment effect was ?8.4 (95% confidence interval ?16.5 to ?0.6) points. A significantly higher proportion of patients in the group treated with supervised exercises improved—odds ratio 3.2 (1.3 to 7.8). More patients in the shockwave treatment group had additional treatment between 12 and 18 weeks—odds ratio 5.5 (1.3 to 26.4). Conclusion Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain. Trial registration Clinical trials NCT00653081.



Follow-up of an exercise-based treatment for children with reading difficulties.  


This study reports the results of a long-term follow-up of an exercise-based approach to dyslexia-related disorders (Reynolds, Nicolson, & Hambly, Dyslexia, 2003; 9(1): 48-71). In the initial study, children at risk of dyslexia were identified in 3 years of a junior school. One half then undertook a 6 month, home-based exercise programme. Evaluation after 6 months indicated that the exercise group improved significantly more than the controls on a range of cognitive and motor skills. Critics had suggested that the improvement might be attributable to artifactual issues including Hawthorne effects; an initial literacy imbalance between the groups; and inclusion of non-dyslexic participants. The present study evaluated the issue of whether the gains were maintained over the following 18 months, and whether they were in some sense artifactual as postulated by critics of the original study. Comparison of (age-adjusted) initial and follow-up performance indicated significant gains in motor skill, speech/language fluency, phonology, and working memory. Both dyslexic and non-dyslexic low achieving children benefited. There was also a highly significant reduction in the incidence of symptoms of inattention. Interestingly there were no significant changes in speeded tests of reading and spelling, but there was a significant improvement in (age-adjusted) reading (NFER). It is concluded that the gains were indeed long-lasting, and that the alternative hypotheses based on potential artifacts were untenable, and that the exercise treatment therefore achieved its applied purpose. Further research is needed to determine the underlying reasons for the benefits. Possible (and potentially synergistic) explanations include: improved cerebellar function (neural level); improved learning ability and/or attentional ability (cognitive level); improved self-esteem and self-efficacy (affective level); and improved parental/familial support (social level). PMID:17557685

Reynolds, David; Nicolson, Roderick I



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

PubMed Central

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

Mailis, Angela; Taenzer, Paul



The application of electron beam delivery using dose rate variation and dynamic couch motion in conformal treatment of the cranial-spinal axis  

SciTech Connect

Radiation therapy to the cranial-spinal axis is typically targeted to the spinal cord and to the cerebrospinal fluid (CSF) in the subarachnoid space adjacent to the spinal cord and brain. Standard techniques employed in the treatment of the whole central nervous system do little to compensate for the varying depths of spinal cord along the length of the spinal field. Lateral simulation films, sagittal magnetic resonance imaging (MRI), or computerized tomography (CT) are used to estimate an average prescription depth for treatment along the spine field. However, due to the varying depth of the target along the spinal axis, even with the use of physical compensators, there can be considerable dose inhomogeneity along the spine field. With the advent of treatment machines that have full dynamic capabilities, a technique has been devised that will allow for more conformal dose distribution along the full length of the spinal field. This project simulates this technique utilizing computer-controlled couch motion to deliver multiple small electron beams of differing energies and intensities. CT planning determines target depth along the entire spine volume. The ability to conform dose along the complete length of the treatment field is investigated through the application of superpositioning of the fields as energies and intensities change. The positioning of each beam is registered with the treatment couch dynamic motion. This allows for 1 setup in the treatment room rather than multiple setups for each treatment position, which would have been previously required. Dose-volume histograms are utilized to evaluate the dose delivered to structures in the beam exit region. This technique will allow for precise localization and delivery of a homogeneous dose to the entire CSF space.

Chapek, Julie; Watson, Gordon; Smith, Lynn M.; Leavitt, Dennis



The application of electron beam delivery using dose rate variation and dynamic couch motion in conformal treatment of the cranial-spinal axis.  


Radiation therapy to the cranial-spinal axis is typically targeted to the spinal cord and to the cerebrospinal fluid (CSF) in the subarachnoid space adjacent to the spinal cord and brain. Standard techniques employed in the treatment of the whole central nervous system do little to compensate for the varying depths of spinal cord along the length of the spinal field. Lateral simulation films, sagittal magnetic resonance imaging (MRI), or computerized tomography (CT) are used to estimate an average prescription depth for treatment along the spine field. However, due to the varying depth of the target along the spinal axis, even with the use of physical compensators, there can be considerable dose inhomogeneity along the spine field. With the advent of treatment machines that have full dynamic capabilities, a technique has been devised that will allow for more conformal dose distribution along the full length of the spinal field. This project simulates this technique utilizing computer-controlled couch motion to deliver multiple small electron beams of differing energies and intensities. CT planning determines target depth along the entire spine volume. The ability to conform dose along the complete length of the treatment field is investigated through the application of superpositioning of the fields as energies and intensities change. The positioning of each beam is registered with the treatment couch dynamic motion. This allows for I setup in the treatment room rather than multiple setups for each treatment position, which would have been previously required. Dose-volume histograms are utilized to evaluate the dose delivered to structures in the beam exit region. This technique will allow for precise localization and delivery of a homogeneous dose to the entire CSF space. PMID:12521071

Chapek, Julie; Watson, Gordon; Smith, Lynn M; Leavitt, Dennis D



Exercise addiction.  


This article examines the nature of exercise addiction. It presents a broad, congruent and discerning narrative literature review with the aim of providing a deeper understanding of the condition 'exercise addiction', including symptoms and options for treatment. In addition, guidelines are provided with respect to 'healthy' levels of exercise. Criteria used for determining the eligibility of studies evaluated in the review included the provision of relevant information in studies identified using pertinent search terms. The review highlights some of the key distinctions between healthy levels of exercise and exercise addiction. The findings suggest that an individual who is addicted to exercise will continue exercising regardless of physical injury, personal inconvenience or disruption to other areas of life including marital strain, interference with work and lack of time for other activities. 'Addicted' exercisers are more likely to exercise for intrinsic rewards and experience disturbing deprivation sensations when unable to exercise. In contrast, 'committed' exercisers engage in physical activity for extrinsic rewards and do not suffer severe withdrawal symptoms when they cannot exercise. Exercisers must acquire a sense of life-balance while embracing an attitude conducive to sustainable long-term physical, psychological and social health outcomes. Implementation of recommendations by the Canadian Society for Exercise Physiology, which states that all apparently healthy adults between 18 and 64 years of age should accumulate at least 150 minutes of moderate (5 or 6 on a scale of 0-10) to vigorous (7 or 8 on a scale of 0-10) intensity aerobic physical activity per week in bouts of 10 minutes or more, also expressed as 30 minutes per day distributed over 5 days per week, would be a good start. PMID:23329605

Landolfi, Emilio



Rationale, design and clinical performance of the Superion® Interspinous Spacer: a minimally invasive implant for treatment of lumbar spinal stenosis.  


Lumbar spinal stenosis is a progressive degenerative condition that manifests as low back pain with neurogenic claudication as a cardinal clinical feature. Although mild radicular symptoms can often be successfully treated with conservative care, management of lumbar spinal stenosis grows increasingly difficult as symptoms worsen. No satisfactory nonsurgical treatments exist to manage moderate radicular symptoms and, therefore, these patients are faced with the decision of continuing ineffective conservative options or opting to undergo invasive decompressive spine surgery. The Superion(®) Interspinous Spacer (Vertiflex, Inc., CA, USA) was developed specifically to fill the therapeutic void between conservative care and surgical decompression. The Superion device is a titanium implant that is delivered percutaneously and deployed between the spinous processes at the symptomatic vertebral levels. The Superion device improves radicular symptoms by limiting spinal extension and, consequently, minimizing impingement of neural and vascular elements. This article describes the rationale for and the design of the Superion device and summarizes initial clinical results with this novel, minimally invasive interspinous spacer. PMID:21728727

Loguidice, Vito; Bini, Walter; Shabat, Shay; Miller, Larry E; Block, Jon E



Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life  

Microsoft Academic Search

Objectives: To study the effect of a combination of thalassotherapy, exercise and patient education in people with fibromyalgia. -\\u000aMethods: Patients with fibromyalgia, selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association, were pre-randomized to receive either 2 weeks of treatment in a Tunisian spa resort, including thalassotherapy, supervised exercise and group education (active

T. R. Zijlstra; Laar van de M. A. F. J; H. J. Bernelot Moens; E. Taal; L. Zakraoui; J. J. Rasker



Combination Treatment of Rosuvastatin or Atorvastatin, with Regular Exercise Improves Arterial Wall Stiffness in Patients with Coronary Artery Disease  

Microsoft Academic Search

ObjectiveStatin- and exercise-therapy are both clinically beneficial by preventing cardiovascular events in patients with coronary artery disease (CAD). However, there is no information on the vascular effects of the combination of statins and exercise on arterial wall stiffness in CAD patients.MethodsThe present study is a sub-analysis of PRESET study that determined the effects of 20-week treatment with statins (rosuvastatin, n

Kensuke Toyama; Seigo Sugiyama; Hideki Oka; Yuri Iwasaki; Hitoshi Sumida; Tomoko Tanaka; Shinji Tayama; Hideaki Jinnouchi; Hisao Ogawa



Long-term treatment with eicosapentaenoic acid improves exercise-induced vasodilation in patients with coronary artery disease.  


We have previously shown that long-term treatment with eicosapentaenoic acid (EPA) improves endothelium-dependent vasodilation of the atherosclerotic arteries in both animals and humans. The aim of the present study was to examine whether EPA treatment also improves metabolic vasodilation evoked by exercise in patients with coronary artery disease (CAD). Forearm blood flow (FBF) was measured by strain gauge plethysmography in 10 patients with stable CAD, before and 3 months after oral treatment with EPA (1,800 mg/kg). FBF was measured at rest and during intra-arterial infusion of acetylcholine or sodium nitroprusside, before and after intra-arterial infusion of NG-monomethyl-L-arginine (L-NMMA, an inhibitor of nitric oxide (NO) synthesis). A rhythmic handgrip exercise was also performed for 3 min before and after L-NMMA, and FBF was measured for 3 min just after the handgrip exercise. These protocols were repeated after the long-term treatment with EPA for 3 months. The long-term treatment with EPA significantly improved the FBF responses to acetylcholine (p < 0.01), which was significantly reduced by acute administration of L-NMMA (p < 0.01). By contrast, the EPA treatment did not affect the endothelium-independent responses to sodium nitroprusside. Metabolic increases in FBF caused by the handgrip exercise were not significantly decreased by L-NMMA before the EPA treatment. The EPA treatment significantly augmented the exercise-induced increases in FBF (p < 0.05) and L-NMMA acutely abolished this augmentation (p < 0.01). These results indicate that long-term treatment with EPA improves both endothelium-dependent and exercise-induced forearm vasodilations in patients with CAD and that NO is substantially involved in the EPA-induced improvement of the FBF responses in patients with CAD. PMID:12484504

Tagawa, Tatsuya; Hirooka, Yoshitaka; Shimokawa, Hiroaki; Hironaga, Kiyoshi; Sakai, Koji; Oyama, Jun-ichi; Takeshita, Akira



Recent Developments in Conservative Surgical Treatment of Lumbar Spinal Stenosis in the Elderly  

Microsoft Academic Search

1. Edith Cavell Clinic and 2. Hôpital Molière Longchamp Lumbar spinal stenosis in the elderly is mostly an acquired condition and is a result of a combination of factors. Disc space narrowing with annular bulging and buckling of the ligamenta flava, combined with a degenerative hypertrophy of the facet joints, compresses the neural structures to such a degree that their

Robert Gunzburg; Marek Szpalski



Treatment of Type I Spinal Muscular Atrophy With Noninvasive Ventilation and Gastrostomy Feeding  

Microsoft Academic Search

Type I spinal muscular atrophy (SMA) is a rapidly progressive, degenerative neuromuscular disease of infancy. In severe SMA, weakness, hypotonia, and bulbar involvement lead to progressive respiratory insufficiency and swallowing dysfunction, which are frequently complicated by aspirations. There are few studies reported in the literature that address the respiratory management of type I SMA. This article reports the results of

David J Birnkrant; John F Pope; James E Martin; Anthony H Repucci; Robert M Eiben



Epidural spinal cord stimulation in the treatment of severe peripheral arterial occlusive disease  

Microsoft Academic Search

Epidural spinal cord stimulation (ESCS) has been suggested to improve microcirculatory blood flow and reduce amputation rates in patients with severe peripheral arterial occlusive disease (PAOD). Pain relief, limb salvage, and skin circulation were studied in 177 patients with ischemic pain caused by nonreconstructible PAOD who were receiving ESCS. Medical or surgical therapy had failed and vascular reconstruction was impossible

Svante Horsch; Luc Claeys



Conservative surgery and radiotherapy in the treatment of spinal cord astrocytoma  

Microsoft Academic Search

Spinal cord astrocytomas are rare neoplasms, and optimaltreatment guidelines are undefined. 23 patients with spinalcord astrocytomas were treated between 1984 and 1993with conservative surgery and postoperative radiotherapy. The meanage was 31 years. Twelve patients were maleand eleven female. All patients presented with neurologicdeficits. Cervical cord was involved in five patients,cervicothoracic in four, thoracic in eight and thoracolumbarin six. Five patients

Rema Jyothirmayi; Jayaprakash Madhavan; Madhavan Krishnan Nair; Balakrishnan Rajan



Chronic Pain Following Spinal Cord Injury: The Role of Immunogenetics and Time of Injury Pain Treatment.  

National Technical Information Service (NTIS)

We are one-year into the three-years of our research program into the immunogenetic and drug exposure factors that contribute to chronic pain following spinal cord injury. Owing to the planned data collection timeline of the 2 studies in this program we h...

J. Clark J. Coller J. Middleton M. Hutchinson R. Marshall



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.



Nucleus retroambiguus-spinal pathway in the mouse: Localization, gender differences, and effects of estrogen treatment.  


Nucleus retroambiguus (NRA)-motoneuronal projections are species-specific and serve expiration, Valsalva maneuvers, vocalization, and sexual behavior. In cat and monkey, estrogen induces sprouting of NRA-spinal axons. This pathway may thus serve as a model to study mechanisms through which estrogen induces neuronal plasticity. In this study, NRA-spinal projections are described in adult mice by using anterograde and retrograde tracing techniques, with attention to gender, strain (CD-1 and C57BL/6), and estrogen-induced changes (in ovariectomized females). Labeled NRA-spinal neurons at the level of the decussation of the corticospinal tract were most numerous after tracer injections into the thoracic and upper lumbar cord. They were medium-sized and had axons that descended through the contralateral cord. A group of small neurons was labeled in the NRA immediately rostral to the decussation of the corticospinal tract after cervical and thoracic, but not after lumbar injections. This group projected mainly via an ipsilateral pathway. The main projections from the caudal NRA involved motoneurons in the thoracic and upper-lumbar cord that supply abdominal wall and cremaster muscles. Pelvic floor motoneurons did not receive substantial input. NRA-spinal projections, especially those involving the upper lumbar cord, were sexually dimorphic, being more extensive in males than in females. Moreover, they were more distinct in estrogen-treated females than in control females. Strain differences were not observed. The unique features of the caudal NRA-spinal pathway in the mouse are discussed in the framework of possible functions of this system, such as mating behavior and related social behaviors, parturition, thermoregulation, and control of balance. PMID:15924340

Vanderhorst, Veronique G J M



Effects of Low to Moderate Intensity Aerobic Exercise on Fatigue in Breast Cancer Patients Following Clinical Treatment.  

National Technical Information Service (NTIS)

To test the effects of a low to moderate intensity exercise on fatigue and overall QOL, both physiologically and psychologically in women who completed breast cancer treatment. Methods: Twenty-two women, ages 43-79, who had completed treatment for breast ...

K. L. Kemble



Electroversion in treatment of arrhythmia in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury.  


We report electroversion in treatment of atrial fibrillation (AF) and atrioventricular nodal reentry tachycardia (AVNRT) in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury. At first, the patient sustained respiratory failure and weak cough reflex, thereafter repeated bronchoscopy was used to aspirate the sputum as well as control the pneumonia, which resulted in arrhythmia (AF and AVNRT). Two doses of intravenous amiodarone failed to correct the arrhythmia. After restoration of sinus rhythm by electroversion, he was successfully weaned from mechanical ventilation and discharged from the intensive care unit without recurrent arrhythmia. PMID:23735553

Shen, Peng; Luo, Ru-Bin; Cai, Si-Yu; Zhang, Mao



Spinal cord stimulation in the treatment of complex regional pain syndrome (CRPS) of the lower extremity: a case report.  


Complex regional pain syndrome (CRPS) is a condition that is often associated with the extremities. This chronic pain syndrome, when localized to the lower extremity, includes peripheral changes such as edema, temperature alterations, limited range of motion, loss of or excessive perspiration, pain out of proportion to any stimulus, and trophic alterations of the skin, hair, and nails. In this report, we describe the case of a patient who developed complex regional pain syndrome following an ankle injury and surgery. This case report highlights treatment options that are available to patients experiencing complex regional pain, including the use of a spinal cord stimulator. Level of Clinical Evidence: 4. PMID:19110160

Saranita, Julie; Childs, Douglas; Saranita, Anthony D


Effect of Vascular Endothelial Growth Factor Treatment in Experimental Traumatic Spinal Cord Injury: In Vivo Longitudinal Assessment  

PubMed Central

Abstract Vascular endothelial growth factor (VEGF) is thought to provide neuroprotection to the traumatically injured spinal cord. We examined whether supplementing the injured environment with VEGF165 via direct intraspinal injection into the lesion epicenter during the acute phase of spinal cord injury (SCI) results in improved outcome. The effect of treatment was investigated using longitudinal multi-modal magnetic resonance imaging (MRI), neurobehavioral assays, and end-point immunohistochemistry. We observed on MRI that rats treated with VEGF165 after SCI had increased tissue sparing compared to vehicle-treated animals at the earlier time points. However, these favorable effects were not maintained into the chronic phase. Histology revealed that VEGF165 treatment resulted in increased oligodendrogenesis and/or white matter sparing, and therefore may eventually lead to improved functional outcome. The increase in spared tissue as demonstrated by MRI, coupled with the possible remyelination and increased neurosensory sensitivity, suggests that VEGF165 treatment may play a role in promoting plasticity in the sensory pathways following SCI. However, VEGF-treated animals also demonstrated an increased incidence of persistent allodynia, as indicated on the von Frey filament test.

Sundberg, Laura M.; Herrera, Juan J.



Memokath® stents for the treatment of detrusor sphincter dyssynergia (DSD) in men with spinal cord injury: The Princess Royal Spinal Injuries Unit 10-year experience  

Microsoft Academic Search

Study design:Medical records review.Objective:To assess the effectiveness of the Memokath (Engineers & Doctors A\\/S, Denmark) thermosensitive stent as a ‘nondestructive’ means of reducing bladder outlet resistance by treating detrusor sphincter dyssynergia (DSD) of neurogenic bladder dysfunction associated with spinal cord injury.Setting:Spinal Injuries Unit, Sheffield, England.Methods:A medical records review was performed to examine our experience of Memokaths over the last 10

S S Mehta; P R Tophill



Treatment of spinal deformity associated with myelomeningocele in young children with the use of the four-rib construct.  


Surgery for myelomeningocele spinal deformity is accompanied by a high rate of complications. These include infection, pathological skin breakage, instrumentation failure, and neurological deterioration. The four-rib construct associated with the percutaneous technique in immature children with myelomeningocele and spinal deformity is introduced. The four-rib construct serves to correct for deformity and to allow for growth, with minimal complications. The study was small and retrospective, a level four case series. The results of four patients who underwent the four-rib construct surgery in 2008 and 2009 was revised. All four were nonambulatory, skeletally immature children, not previously corrected by bracing, with the progressive spinal deformity associated with myelomeningocele affecting their sitting position. Furthermore, the research protocol was approved by our institutional review board. Three patients were females and one was male. Two cases of kyphoscoliosis, one of kyphosis, and one of scoliosis. Age at the time of the initial procedure ranged between 64 and 82 months, with a mean age of 70 months. Follow-up time after surgery ranged from 24 to 39 months, with a mean of 31 months. Preoperatively, deformity angles were severe, averaging 55° for thoracic scoliosis, 67° for thoracolumbar scoliosis, and 85° for thoracolumbar kyphosis. Surgery mitigated the deformities markedly. Postoperative angles measured were 42° for thoracic scoliosis, 21° for thoracolumbar scoliosis, and 45° for thoracolumbar kyphosis. These observations indicate significant reductions in spinal deformity, by 24, 69, and 48%, respectively. In total, 14 procedures were performed: four initial implants and 10 lengthening and exchange procedures. There were no intraoperative complications. The postoperative complications that did arise consisted of two instances of skin breakage, one distal iliac screw dislodgement, and one shunt displacement. Significantly, no proximal fixation dislodgement, deep-seated infection, or damage in the pathological skin were detected. The four-rib construct technique can be considered as a potential surgical option in (powered by Editorial Manager and Preprint Manager; Aries Systems Corporation) treating spinal deformity associated with myelomeningocele, but still more patients with long term follow-up are needed to prove the efficacy of this procedure. The four-rib construct is simple, minimally invasive, and does not exclude alternative treatment. Moreover, the incidence of complications associated with the four-rib construct compares favorably with other growth techniques. PMID:23787773

Ahmad, Alaaeldin A



MRI evaluation of topical heat and static stretching as therapeutic modalities for the treatment of eccentric exercise-induced muscle damage  

Microsoft Academic Search

The aim of this study was to monitor the effects of topical heat and\\/or static stretch treatments on the recovery of muscle damage by eccentric exercise. For this purpose, 32 untrained male subjects performed intense eccentric knee extension exercise, followed by 2 weeks of treatment (heat, stretch, heat plus stretch) or no treatment (control, n=8\\/group). Isometric strength testing, pain ratings,

R. C. Jayaraman; R. W. Reid; J. M. Foley; B. M. Prior; G. A. Dudley; K. W. Weingand; R. A. Meyer



The effect of pressure pad location of spinal orthosis on the treatment of adolescent idiopathic scoliosis (AIS).  


Patient with moderate AIS is usually prescribed with spinal orthosis aiming to mechanically support and prevent the spine from further deterioration. In the conventional fitting method, pre-brace X-ray is the main reference, thus, the pressure pad of spinal orthosis may not be accurately located to the strategic areas because the spinal deformities could change 3-dimensionally once pressure pad is applied. A high correlation (r > 0.98) between Cobb's angle and spinous process angle (SPA) was found in the recent studies. With the advancements of 3D clinical ultrasound (3D CUS), tracing SPA along a scoliotic spine becomes possible and this can be used to estimate Cobb's angle. This study aimed to evaluate the effect of pressure pad location of spinal orthosis in the treatment of AIS and 3D CUS was used to trace SPA for estimation of Cobb's angle. The in-brace X-rays were assessed for confirmation of treatment effectiveness. The subjects were divided into ultrasound-guided fitting group A (n=21) and conventional fitting group B (n=22). In the group A, pressure pads were tested at 5 locations - the prescribed location as in the conventional fitting (referred to the pre-brace X-ray), and 1 cm and 2 cm above and below the prescribed location, and 3D CUS was applied to trace the SPA in these 5 pad locations, and the pad location with the lowest estimated Cobb's angle was selected in the final fitting. The assessments of in-brace X-rays showed that the mean Cobb's angle of group A decreased from 28.9° (pre-brace) to 18.6° (immediate in-brace) while the mean Cobb's angle of group B decreased from 27.1° (pre-brace) to 22.5° (immediate in-brace). There was a significant difference (p < 0.05) in the correction of Cobb's angle between the two groups. The results showed that accurate pressure pad location does play an important role in the reduction of Cobb's angle and 3D CUS can be considered as a non-invasive and effective assessment tool to improve orthotic treatment of AIS. PMID:22744533

Wong, M S; Li, M; Ng, B; Lam, T P; Ying, M; Wong, A; Cheng, J



Surgical treatment options and management strategies of metastatic renal cell carcinoma to the lumbar spinal nerve roots.  


Spinal nerve root metastasis of renal cell carcinoma is a rare occurrence. In addition to treatment of the primary lesion, surgical resection of the nerve root metastasis, occasionally with sacrifice of the involved nerve, is the accepted standard of treatment. Resection often resolves presenting motor and pain symptoms due to relief of neural compression. We describe two patients with nerve root metastasis of renal cell carcinoma and their management. While locally advanced and metastatic renal cell carcinoma has been shown to be chemo- and radio-resistant, immunotherapy is a promising treatment. Given the high prevalence of systemic disease in patients with intradural metastases, systemic (and possibly intracranial) imaging can be used to identify other potential areas of disease. PMID:23931936

Strong, Christian; Yanamadala, Vijay; Khanna, Arjun; Walcott, Brian P; Nahed, Brian V; Borges, Lawrence F; Coumans, Jean-Valery C E



Influence of setup errors on spinal cord dose and treatment plan quality for cervical spine tumours: a phantom study for photon IMRT and heavy charged particle radiotherapy  

NASA Astrophysics Data System (ADS)

Tumours partly surrounding the cervical spine may be treated by conformal radiotherapy (RT) using intensity-modulated RT (IMRT) with photons or heavy charged particle RT. For both, a high setup accuracy is required to spare the radiosensitive spinal cord, if a high dose is to be delivered. A phantom study was performed to determine the variation of the dose to the spinal cord surface by predefined setup errors. The measured doses were compared to those calculated by the treatment planning programme. The influence of systematic setup errors on characteristic parameters of the treatment plan quality was quantified. The largest variation of the mean and maximum doses to the spinal cord due to setup errors was significantly larger for carbon ions than for IMRT (mean: 11.9% versus 3.9%, max: 29.2% versus 10.8% of the prescribed dose). For the comparison of measured and calculated doses, mean deviations of 3% (IMRT) and 6% (carbon ions) of the prescribed dose were obtained. These deviations have to be considered, when the spinal cord dose is assessed from the treatment plan and they may also influence the dose prescription. Carbon ions yield better values for coverage (99.9% versus 93.1%) and conformality (110% versus 126%) of the PTV as compared to IMRT, while the spinal cord is better spared. Dose distributions produced with carbon ions, however, are more sensitive to setup errors, which have to be considered during treatment.

Karger, Christian P.; Schulz-Ertner, Daniela; Didinger, Bernd H.; Debus, Jürgen; Jäkel, Oliver



Midodrine for the treatment of organic anejaculation but not spinal cord injury: a prospective randomized placebo-controlled double-blind clinical study  

Microsoft Academic Search

Anejaculation is a rare cause of infertility and adversely affects the general sense of well-being and perception of sexual life satisfaction. Evidence to support effective and noninvasive treatment for this ejaculatory disorder is lacking. This study aimed to evaluate the efficacy and safety of midodrine (?1-adrenergic receptor agonist) for the treatment of organic anejaculation but not spinal cord injury (SCI).

M R Safarinejad; Safarinejad



Minimally invasive treatment of spinal dural arteriovenous fistula with the use of intraoperative indocyanine green angiography.  


Spinal dural arteriovenous fistula (dAVF) is the most common vascular malformation of the spinal cord. Traditionally it is treated by the standard muscle-splitting midline approach with bilateral laminectomies extending from one level above to one level below the dAVF. We present a minimally invasive approach for ligation of dAVF with concurrent use of intraoperative indocyanine green (ICG) angiography. Minimally invasive watertight dural closure technique is also demonstrated and discussed. The minimally invasive approach with intraoperative ICG results in quicker recovery, early mobilization and shorter hospital stay compared to traditional open approach. The video can be found here: PMID:23829854

Fontes, Ricardo B; Tan, Lee A; O'Toole, John E




PubMed Central

Prior work has shown that d-amphetamine (AMPH) treatment or voluntary exercise improves cognitive functions after traumatic brain injury (TBI). In addition, voluntary exercise increases levels of brain-derived neurotrophic factor (BDNF). The current study was conducted to determine how AMPH and exercise treatments, either alone or in combination, affect molecular events that may underlie recovery following controlled cortical impact (CCI) injury in rats. We also determined if these treatments reduced injury-induced oxidative stress. Following a CCI or sham injury, rats received AMPH (1 mg/kg/day) or saline treatment via an ALZET® pump and were housed with or without access to a running wheel for 7 days. CCI rats ran significantly less than sham controls, but exercise level was not altered by drug treatment. On day 7 the hippocampus ipsilateral to injury was harvested and BDNF, synapsin I and phosphorylated (P) -synapsin I proteins were quantified. Exercise or AMPH alone significantly increased BDNF protein in sham and CCI rats, but this effect was lost with the combined treatment. In sham-injured rats synapsin I increased significantly after AMPH or exercise, but did not increase after combined treatment. Synapsin levels, including the P-synapsin/total synapsin ratio, were reduced from sham controls in the saline-treated CCI groups, with or without exercise. AMPH treatment significantly increased the P-synapsin/total synapsin ratio after CCI, an effect that was attenuated by combining AMPH with exercise. Exercise or AMPH treatment alone significantly decreased hippocampal carbonyl groups on oxidized proteins in the CCI rats, compared with saline-treated sedentary counterparts, but this reduction in a marker of oxidative stress was not found with the combination of exercise and AMPH treatment. These results indicate that, whereas exercise or AMPH treatment alone may induce plasticity and reduce oxidative stress after TBI, combining these treatments may cancel each other’s therapeutic effects.




Microsurgical treatment and functional outcomes of multi-segment intramedullary spinal cord tumors  

Microsoft Academic Search

We aimed to prospectively analyze correlations between clinical features and histological classification of multi-segment intramedullary spinal cord tumors (MSICTs), and the extent of microsurgical resection and functional outcomes. Fifty-six patients with MSICTs underwent microsurgery for tumor removal using a posterior approach. The tumor was exposed through a dorsal myelotomy. Pre-operative and post-operative nervous function was scored using the Improved Japanese

Jianjun Sun; Zhenyu Wang; Zhendong Li; Bin Liu



Transplantation of Predifferentiated Adipose-Derived Stromal Cells for the Treatment of Spinal Cord Injury  

Microsoft Academic Search

Adipose-derived stromal cells (ASCs) are an alternative source of stem cells for cell-based therapies of neurological disorders\\u000a such as spinal cord injury (SCI). In the present study, we predifferentiated ASCs (pASCs) and compared their behavior with\\u000a naïve ASCs in vitro and after transplantation into rats with a balloon-induced compression lesion. ASCs were predifferentiated\\u000a into spheres before transplantation, then pASCs or

David Arboleda; Serhiy Forostyak; Pavla Jendelova; Dana Marekova; Takashi Amemori; Helena Pivonkova; Katarina Masinova; Eva Sykova


Intraurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury  

Microsoft Academic Search

Objectives. To assess the efficacy of intraurethral prostaglandin E1 (alprostadil, MUSE) in treating erectile dysfunction in patients with spinal cord injury (SCI).Methods. Intraurethral alprostadil was tested in 15 patients with SCI to evaluate its effectiveness in treating SCI-associated erectile dysfunction. All patients were at least 1 year after injury, and all had previously used intracavernosal injections successfully (Schramek’s grade 5

Donald R Bodner; Christopher A Haas; Beverle Krueger; Allen D Seftel



Treatment of spinal cord impact injury in the rat with transforming growth factor-?  

Microsoft Academic Search

To investigate the contribution of cytokines, proinflammatory TNF-? and inhibitory TGF-?, to spinal cord injury (SCI) in a rat model, two studies were performed using adult Sprague–Dawley rats which were injured at T9\\/T10. In the first study, rats were sacrificed at 1, 6, 24, 96 and 168 h after SCI for immunocytochemistry of coronal sections for the presence of mononuclear

William R Tyor; Nicholas Avgeropoulos; George Ohlandt; Edward L Hogan



Partial functional recovery after complete spinal cord transection by combined chondroitinase and clenbuterol treatment  

Microsoft Academic Search

Spinal cord injury not only disrupts axonal tracts but also causes gliotic, fibrotic, and Schwannotic scarring with resulting\\u000a deposition of chondroitin sulfate proteoglycans (CSPGs) which prevent axonal reconnection and recovery of locomotor function.\\u000a Here, we determined whether recovery of locomotor function could be promoted after complete transection, by degrading CSPGs\\u000a enzymatically within the injury site with chondroitinase ABC (chABC) together

Fusheng Bai; Hong Peng; Joseph D. Etlinger; Richard J. Zeman



Interspinous Process Implant for Treatment of Lateral and Central Spinal Stenosis  

Microsoft Academic Search

The clinical syndrome of spinal stenosis is usually seen in middle-aged or elderly individuals who complain of leg pain, weakness,\\u000a paresthesia, or sensory changes that generally develop on standing or walking and are relieved, typically, by sitting and\\u000a lying down. Often patients stoop forward to ease the symptoms when standing or walking. The condition can be extremely disabling,\\u000a making the

Douglas Wardlaw


Synergic Effect of Compression Therapy and Controlled Active Exercises Using a Facilitating Device in the Treatment of Arm Lymphedema  

PubMed Central

Trial design: A randomized controlled trial was performed to evaluate the effect of the combination of compression therapy with active exercising using a facilitating apparatus on arm lymphedema. Method: Twenty women with a mean age of 63.3 years were evaluated; all had lymphedema resulting from breast cancer treatment. The inclusion criterion was a difference of 200 mL in size between arms. The apparatus used, called 'pulley system', is a vertical iron wheel fixed on a support at a distance of 10 cm from the patient's body. Participants were submitted to two series of active exercises using this facilitating device, one series using a compression sleeve and the other without. Each series consisted of four 12-minute sessions of exercises separated by 3-minute rest intervals. Volumetry was performed before and after each series of exercises. The paired t-test was utilized for statistical analysis (p-value < 0.05). Results: A significant mean reduction (p-value < 0.007) and non-significant mean increase (p-value < 0.2) in volumes were observed during exercising with and without compression, respectively. Conclusion: Controlled active exercising utilizing a facilitating apparatus while wearing a compression sleeve reduces the size of lymphedematous arms.

Godoy, Maria de Fatima Guerreiro; Pereira, Maria Regina; Oliani, Antonio Helio; de Godoy, Jose Maria Pereira



Metoprolol treatment for two years after coronary bypass grafting: effects on exercise capacity and signs of myocardial ischaemia.  

PubMed Central

OBJECTIVE--To evaluate whether prophylactic treatment with metoprolol for two years after coronary artery bypass grafting improves working capacity and reduces the occurrence of myocardial ischaemia in patients with coronary artery disease. METHODS--After coronary artery bypass grafting, patients were randomised to treatment with metoprolol or placebo for two years. Two years after randomisation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise test in 618 patients (64% of all those randomised). RESULTS--The median exercise capacity was 140 W in the metoprolol group (n = 307) and 130 W in the placebo group (n = 311) (P > 0.20). An ST depression of > or = 1 mm at maximum exercise was present in 34% of the patients in the metoprolol group and 38% in the placebo group (P > 0.20) and an ST depression of > or = 2 mm at maximum exercise was present in 11% in the metoprolol group and 16% in the placebo group (P = 0.09). The median values for maximum systolic blood pressure were 200 mm Hg in the metoprolol group and 210 mm Hg in the placebo group (P < 0.0001), while the median values for maximum heart rate were 126 beats/min in the metoprolol group and 143 beats/min in the placebo group (P < 0.0001). The occurrence of cardiac and neurological clinical events two years postoperatively among exercised patients was comparable in the treatment groups. CONCLUSIONS--Treatment with metoprolol for two years after coronary artery bypass grafting did not significantly change exercise capacity or electrocardiographic signs of myocardial ischaemia.

Sjoland, H.; Caidahl, K.; Lurje, L.; Hjalmarson, A.; Herlitz, J.



A non-pharmacologic approach to the treatment of exercise-induced bronchospasm.  

PubMed Central

We investigated the effects of breathing air warmed and fully saturated to body temperature (AWS) before, during, and after exercise in asthmatic subjects. Airway responses to submaximal exercise on a cycloergometer were measured on four separate days in 14 asthmatic volunteers. On day 1 the subjects exercised breathing ambient air (AA). On the subsequent three days exercise was performed with the subjects breathing AWS, (1) for five minutes preceding, (2) during, and (3) for five minutes following exercise. We showed complete protection against EIB by AWS during exercise, but no protection by AWS before or after exercise. On two subsequent days we examined the effects of partially warming and humidifying the subjects' inspired air by having them wear a mask during exercise. We found that with such protection bronchospasm was significantly but not completely blunted. We conclude that the physiologic changes initiated during exercise can be prevented by breathing AWS during exercise, but are not by AWS inhaled before or after exercise. Furthermore, these studies demonstrate the possibility of using masks as a non-pharmacologic means of controlling EIB.

Schachter, E. N.; Lee, M.; Gerhard, H.; Brown, S.



Analysis of Exercise-Induced R-Wave-Amplitude Changes in Detection of Coronary Artery Disease in Patients with Typical or Atypical Chest Pain under Digitalis Treatment  

Microsoft Academic Search

Specificity and sensitivity of exercise ECG were compared to exercise stress thallium 201 scanning and coronary arteriograms in 70 male patients with typical or atypical chest pain complaints, without previous myocardial infarction. 50 patients (group I) did not receive any treatment; 20 patients (group II) received digitalis as preventive treatment of atrial arrythmias or for no particular reason. Only subjects

S. Degre; B. Longo; M. Thirion; E. Stoupel; J. Sobolski; G. Berkenboom; P. Vandermoten; J. C. Brion



The Effect of Physical Exercise on Cancer-related Fatigue during Cancer Treatment: a Meta-analysis of Randomised Controlled Trials  

Microsoft Academic Search

The aim of this meta-analysis was to evaluate the effects of different exercise prescription parameters during cancer treatment on cancer-related fatigue (CRF). We also aimed to gain insight into the safety and feasibility of exercise during adjuvant cancer treatment. A systematic search of CINAHL, Cochrane Library, Embase, Medline, Scopus and PEDro was carried out. Randomised controlled trials studying the effects

M. J. Velthuis; S. C. Agasi-Idenburg; G. Aufdemkampe; H. M. Wittink



Recent developments in the treatment of Duchenne muscular dystrophy and spinal muscular atrophy  

PubMed Central

Pediatric neuromuscular disorders comprise a large variety of disorders that can be classified based on their neuroanatomical localization, patterns of weakness, and laboratory test results. Over the last decade, the field of translational research has been active with many ongoing clinical trials. This is particularly so in two common pediatric neuromuscular disorders: Duchenne muscular dystrophy and spinal muscular atrophy. Although no definitive therapy has yet been found, numerous active areas of research raise the potential for novel therapies in these two disorders, offering hope for improved quality of life and life expectancy for affected individuals.

Liew, Wendy K. M.



[Treatment of radiculo-spinal complications of cervic arthrosis with Cloward's method. Results concerning 370 patients].  


370 patients exhibiting a brachial radiculalgia or a spinal cord disease due to cervicarthrosis were submitted to surgery according to Cloward's technique; freeing or grafting were performed in 682 levels. A study of this surgical management is made and compared with the other therapeutical modalities. A consensus of the results leads to offer this kind of mangement to the initial stage of the disease before the appearing of definitive sclerotic or atrophic lesions. The arthrosic lesions interesting numerous levels, the anatomic-clinical discrepancies concerning the injured level, the misknowledge of the exact physiopathogenesis of the nervous lesions, plead in favour of anterior cervical grafts interesting numerous levels. PMID:1102999

Jomin, J; Bousquet, C; Delandsheer, J M; Laine, E


Discontinuous Myelotomy: An Alternative to Standard Myelotomy in the Surgical Treatment of Intramedullary Spinal Cord Tumours  

Microsoft Academic Search

Summary.\\u000a Summary.  \\u000a ?\\u000a \\u000a \\u000a \\u000a \\u000a Background:   Myelotomy is an essential step for the removal of intramedullary tumours. Often, this manoeuvre requires division of large\\u000a vessels surfacing the midline, contributing to the development of postoperative sensory deficits. We developed a technique\\u000a of discontinuous myelotomy to preserve the integrity of these large spinal cord vessels.\\u000a \\u000a ?\\u000a \\u000a \\u000a \\u000a \\u000a Methods:   Over a three-year period, we approached 20

G. Cantore; P. Ciappetta; A. Santoro; S. Paolini



The Ethics of the Treatment of Spinal Cord Injury: Stem Cell Transplants, Motor Neuroprosthetics, and Social Equity  

PubMed Central

The intense desire for a “cure” in individuals with spinal cord injury (SCI) has resulted in the transplantation of stem cells and embryonic and other cell types into the injured spinal cord to enable limb function. We review the ethical issues concerning the procurement and use of embryonic stem cells. A brief survey of the current state of human SCI transplantation is presented. We explore the interface between basic science and the clinical management of SCI and discuss the ethical issues of therapy. At what point is it ethical to conduct human experiments when the experimental data is still at an early stage of development? Is it ethical to perform these operations on a vulnerable group of patients without adequate scientific controls and analysis of the results? Motor neuroprosthetics is developing rapidly and will enable limb movement controlled by the paralyzed patient and other device control such as wheelchairs and communication boards. How can there be a more equitable distribution of such expensive technology and other treatments of SCI? Both clinicians and scientists should be mindful of these complex ethical issues when undertaking pioneering therapies for patients with SCI.

Rosenfeld, Jeffrey V.; Bandopadhayay, Prateek; Goldschlager, Tony; Brown, Douglas J.



A Series of Systematic Reviews on the Treatment of Acute Spinal Cord Injury: A Foundation for Best Medical Practice  

PubMed Central

Abstract The treatment of acute spinal cord injury (SCI) is a multidisciplinary effort that spans from the time of injury through to an acute care center, and in some cases the remainder of the individual's life. Recovery from SCI depends on the care received at each point along this spectrum in time. In order to facilitate the practice of evidence-based medicine and best clinical practices, a multidisciplinary team of clinicians and researchers systematically reviewed the literature on SCI and set out to answer pertinent clinical questions and establish evidence-based recommendations. This article introduces the series of systematic reviews, summarizes the most notable findings, and gives an overview of the questions asked in each review and the evidence-based recommendations for care. Some of the most important recommendations are as follows: (1) Patients should be immobilized before transport to a hospital using a cervical collar, head immobilization, and a spinal board; (2) MRI is strongly recommended for the prognostication of acute SCI; (3) early surgical intervention (from 8–24?h) should be considered following acute traumatic SCI; (4) SCI patients are at significant risk of cardiovascular and respiratory problems and management should proactively anticipate these potential complications; and (5) outcomes can be improved by management in specialized centers with access to intensive care.

Cadotte, David W.; Fehlings, Lauren N.



Translating Empirically Supported Strategies into Accessible Interventions: The Potential Utility of Exercise for the Treatment of Panic Disorder  

ERIC Educational Resources Information Center

|Many patients suffering from panic disorder do not receive adequate care. Advances in the conceptualization and treatment of panic disorder encourage innovative strategies for targeting core fears (fears of anxiety sensations) that underlie this disorder. In this article, we discuss the use of exercise as a potential strategy for therapeutic…

Smits, Jasper A. J.; Powers, Mark B.; Berry, Angela C.; Otto, Michael W.



Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials  

Microsoft Academic Search

PURPOSE: To systematically review the methodologic quality of, and summarize the evidence from trials examining the effectiveness of physical exercise in improving the level of physical functioning and psychological well-being of cancer patients during and after medical treatment. METHODS: Thirty-four randomized clinical trials (RCTs) and controlled clinical trials were identified, reviewed for substantive results, and assessed for methodologic quality. RESULTS:

R. H. Knols; N. K. Aaronson; D. Uebelhart; J. Fransen; G. Aufdemkampe



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


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

Vallejo, Ricardo; Kramer, Jeffery; Benyamin, Ramsin



Gait analysis on the treadmill – monitoring exercise in the treatment of paraplegia  

Microsoft Academic Search

Study design: A prospective study was performed to evaluate the gait training of seven consecutive spinal cord injured patients and 10 controls on a treadmill using instrumented gait analysis and video documentation.Objectives: To determine whether it is possible to maintain gait motion within physiological limits during treadmill training.Setting: Primary and secondary care unit for spinal cord injury, Heidelberg, Germany.Methods: Treadmill

R Abel; M Schablowski; R Rupp; HJ Gerner



A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer  

PubMed Central

Background Androgen deprivation therapy (ADT) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass compromising physical functioning, independence, and quality of life. The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. Specifically, we aim to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints: 1) bone mineral density; 2) cardiorespiratory function and maximal oxygen capacity; 3) body composition (lean mass and fat mass); 4) blood pressure and cardiovascular function; 5) lipids and glycemic control; and 6) quality of life and psychological distress. Methods/Design Multi-site randomized controlled trial of 195 men (65 subjects per arm) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia. Participants will be randomized to (1) resistance/impact loading exercise, (2) resistance/cardiovascular exercise groups and (3) usual care/delayed exercise. Participants will then undergo progressive training for 12 months. Measurements for primary and secondary endpoints will take place at baseline, 6 and 12 months (end of the intervention). Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal, cardiovascular and insulin metabolism side effects of androgen deprivation in prostate cancer patients. As this project is much longer term than previous investigations in the area of exercise and cancer, we will gain knowledge as to the continuing effects of exercise in this patient population specifically targeting bone density, cardiovascular function, lean and fat mass, physical function and falls risk as primary study endpoints. In terms of advancement of prostate cancer care, we expect dissemination of the knowledge gained from this project to reduce fracture risk, improve physical and functional ability, quality of life and ultimately survival rate in this population. Clinical Trial Registry A Phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer; ACTRN12609000200280



High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis  

PubMed Central

The X-Stop interspinous distraction device has shown to be an attractive alternative to conventional surgical procedures in the treatment of symptomatic degenerative lumbar spinal stenosis. However, the effectiveness of the X-Stop in symptomatic degenerative lumbar spinal stenosis caused by degenerative spondylolisthesis is not known. A cohort of 12 consecutive patients with symptomatic lumbar spinal stenosis caused by degenerative spondylolisthesis were treated with the X-Stop interspinous distraction device. All patients had low back pain, neurogenic claudication and radiculopathy. Pre-operative radiographs revealed an average slip of 19.6%. MRI of the lumbosacral spine showed a severe stenosis. In ten patients, the X-Stop was placed at the L4–5 level, whereas two patients were treated at both, L3–4 and L4–5 level. The mean follow-up was 30.3 months. In eight patients a complete relief of symptoms was observed post-operatively, whereas the remaining 4 patients experienced no relief of symptoms. Recurrence of pain, neurogenic claudication, and worsening of neurological symptoms was observed in three patients within 24 months. Post-operative radiographs and MRI did not show any changes in the percentage of slip or spinal dimensions. Finally, secondary surgical treatment by decompression with posterolateral fusion was performed in seven patients (58%) within 24 months. In conclusion, the X-Stop interspinous distraction device showed an extremely high failure rate, defined as surgical re-intervention, after short term follow-up in patients with spinal stenosis caused by degenerative spondylolisthesis. We do not recommend the X-Stop for the treatment of spinal stenosis complicating degenerative spondylolisthesis.

Verhoof, Olaf J.; Bron, Johannes L.; Wapstra, Frits H.



Treatment of Rat Spinal Cord Injury with the Neurotrophic Factor Albumin-Oleic Acid: Translational Application for Paralysis, Spasticity and Pain  

Microsoft Academic Search

Sensorimotor dysfunction following incomplete spinal cord injury (iSCI) is often characterized by the debilitating symptoms of paralysis, spasticity and pain, which require treatment with novel pleiotropic pharmacological agents. Previous in vitro studies suggest that Albumin (Alb) and Oleic Acid (OA) may play a role together as an endogenous neurotrophic factor. Although Alb can promote basic recovery of motor function after

Gerardo Avila-Martin; Iriana Galan-Arriero; Julio Gómez-Soriano; Julian Taylor



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: ...


Rest versus exercise as treatment for patients with low back pain and Modic changes. a randomized controlled clinical trial  

PubMed Central

Background Clinical experience suggests that many patients with Modic changes have relatively severe and persistent low back pain (LBP), which typically appears to be resistant to treatment. Exercise therapy is the recommended treatment for chronic LBP, however, due to their underlying pathology, Modic changes might be a diagnostic subgroup that does not benefit from exercise. The objective of this study was to compare the current state-of-the art treatment approach (exercise and staying active) with a new approach (load reduction and daily rest) for people with Modic changes using a randomized controlled trial design. Methods Participants were patients from an outpatient clinic with persistent LBP and Modic changes. They were allocated using minimization to either rest therapy for 10 weeks with a recommendation to rest for two hours daily and the option of using a flexible lumbar belt or exercise therapy once a week for 10 weeks. Follow-up was at 10 weeks after recruitment and 52 weeks after intervention and the clinical outcome measures were pain, disability, general health and global assessment, supplemented by weekly information on low back problems and sick leave measured by short text message (SMS) tracking. Results In total, 100 patients were included in the study. Data on 87 patients at 10 weeks and 96 patients at one-year follow-up were available and were used in the intention-to-treat analysis. No statistically significant differences were found between the two intervention groups on any outcome. Conclusions No differences were found between the two treatment approaches, 'rest and reduced load' and 'exercise and staying active', in patients with persistent LBP and Modic changes. Trial Registration NCT00454792



Total haemoglobin mass but not cardiac volume adapts to long-term endurance exercise in highly trained spinal cord injured athletes  

Microsoft Academic Search

The oxygen transport system is an important component in the limitation of endurance performance in able-bodied and paraplegic\\u000a athletes. The aim of the present study was to investigate the total haemoglobin mass (tHb, carbon monoxide rebreathing method)\\u000a and cardiac volume (HV, echocardiography) in 25 highly endurance trained male spinal cord injured (mainly paraplegic) athletes\\u000a (SCI-TRAINED) and to compare the results

Yorck Olaf Schumacher; Sebastian Ruthardt; Michael Schmidt; Christoph Ahlgrim; Kai Roecker; Torben Pottgiesser



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


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



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 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



Physical exercise down-regulated locomotor side effects induced by haloperidol treatment in Wistar rats.  


Extra-pyramidal symptoms (EPS) such as akinesia, dystonia, gait alteration and tremors are observed when dopamine D2-receptors are blocked by pharmacological agents such as haloperidol. These alterations produce a Parkinson disease-like state (PLS). Physical exercise has been proven to improve gait and locomotor symptoms in Parkinson's disease; we sought to elucidate the effects of physical exercise on PLS induced by chronic administration of haloperidol in rats. We used 48 rats distributed into four groups: Control, Exercise, Haloperidol, and Hal+Exe. All the animals received a daily injection of saline or haloperidol for 30 days, and the exercise groups underwent a daily 30-minute exercise protocol for 20 days. The animals were subjected to the ink-paw test, bar test and open-field test throughout the training period. The haloperidol-induced akinesia increased throughout the days of injections, but exercise was shown to alleviate it. The assessment showed shortened stride length and increased stance width with the use of haloperidol, which were significantly alleviated by exercise. These results indicate that exercise could be an interesting approach towards reducing unwanted EPS caused by haloperidol. PMID:23290938

Baptista, Pedro Porto Alegre; de Senna, Priscylla Nunes; Paim, Mariana Fontoura; Saur, Lisiani; Blank, Martina; do Nascimento, Patricia; Ilha, Jocemar; Vianna, Mônica Ryff Moreira; Mestriner, Régis Gemerasca; Achaval, Matilde; Xavier, Léder Leal



The effects of alkaline treatment on short?term maximal exercise  

Microsoft Academic Search

The effects of alkalosis on submaximal and maximal exercise performance of a relatively long duration have been investigated previously. The present study examined the effects of sodium bicarbonate ingestion on cycling performance of the 30 s Wingate Anaerobic Test using 13 male physical education students. Three hours prior to exercise, subjects ingested either table salt (control) or sodium bicarbonate (alkalosis)

O. Inbar; A. Rotstein; I. Jacobs; P. Kaiser; R. Dlin; R. Dotan



Enhanced regeneration in spinal cord injury by concomitant treatment with granulocyte colony-stimulating factor and neuronal stem cells  

Microsoft Academic Search

Granulocyte colony-stimulating factor (G-CSF) inhibits programmed cell death and stimulates neuronal progenitor differentiation. Neuronal stem cells transplanted into injured spinal cord can survive, differentiating into astroglia and oligodendroglia, and supporting axon growth and myelination. Herein, we evaluate the combined effects of G-CSF and neuronal stem cells on spinal cord injury. For 40 Sprague-Dawley rats (n=10 in each group) transverse spinal

Hung-Chuan Pan; Fu-Chou Cheng; Shu-Zhen Lai; Dar-Yu Yang; Yeou-Chih Wang; Maw-Sheng Lee



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



Spinal bone mass after long-term treatment with L-Thyroxine in postmenopausal women with thyroid cancer and chronic lymphocytic thyroiditis  

Microsoft Academic Search

This study investigated the effect of long-term treatment upon bone density with L-Thyroxine in postmenopausal women compared with untreated postmenopausal women with climacteric symptoms. We measured spinal bone density in three groups (n=84) of postmenopausal women: (A) those treated with TSH-suppressive dosis of L-Thyroxine for a medium of 5 years after removal of thyroid cancer; (B) those on L-Thyroxine treatment

F. Hawkins; D. Rigopoulou; K. Papapietro; M. B. Lopez



Wilderness medical society practice guidelines for treatment of exercise-associated hyponatremia.  


Exercise-associated hyponatremia (EAH) typically occurs during or up to 24 hours after prolonged physical activity, and is defined by a serum or plasma sodium concentration below the normal reference range of 135 mEq/L. It is also reported to occur in individual physical activities or during organized endurance events conducted in austere environments in which medical care is limited or often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to ensure a positive outcome. Failure in this regard is a recognized cause of event-related fatality. In an effort to produce best practice guidelines for EAH in the austere environment, the Wilderness Medical Society convened an expert panel. The panel was charged with the development of evidence-based guidelines for management of EAH. Recommendations are made regarding the situations when sodium concentration can be assessed in the field and when these values are not known. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. PMID:23590928

Bennett, Brad L; Hew-Butler, Tamara; Hoffman, Martin D; Rogers, Ian R; Rosner, Mitchell H



Cognitive-behavioural treatment for workers with chronic spinal pain: a matched and controlled cohort study in Sweden.  

PubMed Central

An ambulatory multimodal cognitive-behavioural treatment programme (MMCBT) for Swedish workers with chronic spinal pain was formally evaluated. The design was a matched cohort study with three repeated measures done in two groups of 35 referred patients (one exposed to MMCBT and controls exposed to usual care). The MMCBT package includes standardised modules of physical treatment, cognitive-behavioural treatment, education of worker patients, and education of subjects' supervisors. The primary outcome variables assessed were absenteeism, disability, pain, and depression. Because of a change in Swedish sick leave compensation laws affecting records of absence during the study period, absenteeism could not be reliably measured among controls. The trend, however, suggested a reduction of absenteeism among the subjects in the MMCBT cohort. The findings for disability, pain, and depression all showed clinically important and significant beneficial changes (ANOVA for repeated measures: disability p = 0.05; pain p = 0.001; depression p = 0.01). The direction of the improvements and the size of effect were coherent and clinically plausible. The benefits were only among the women in the study. These comprised 74% of each group. Further research on larger sample sizes and in cohorts more representative of the whole country are needed to confirm these encouraging findings and to explore how the benefits might be extended to men.

Jensen, I B; Nygren, A; Lundin, A



Biomechanical Evaluation of the X-Stop Device for Surgical Treatment of Lumbar Spinal Stenosis  

PubMed Central

Study Design Controlled experimental study. Objective To evaluate the kinematical effects of X-Stop device on the spinal process at the operated and the adjacent segments before and after X-Stop surgeries during various weight-bearing postures in elderly patients with lumbar spine stenosis. Summary of Background Data The mechanism of interspinous process (ISP) devices is to directly distract the ISP of the implanted level to indirectly decompress the intervertebra foramen and spinal canal. Few studies have investigated the changes of ISP gap caused by X-Stop implantation using magnetic resonance imaging or radiography, but the effect of X-Stop surgery on the kinematics of spinous processes during functional activities is still unclear. Methods Eight patients were tested before and, on average, 7 months after surgical implantation of the X-Stop devices using a combined computed tomography/magnetic resonance imaging and dual fluoroscopic imaging system during weight-bearing standing, flexion-extension, left-right bending, and left-right twisting positions of the torso. The shortest distances of the ISPs at the operated and the adjacent levels were measured using iterative closest point method and was dissected into vertical (gap) and horizontal (lateral translation) components. Results At the operated levels, the shortest vertical ISP distances (gap) significantly (P <0.05) increased by 1.5mm during standing, 1.2mm during left twist, 1.3mm during extension, and 1.1mm during flexion, whereas they also increased yet not significantly (P>0.05) in right twist, left bend, and right bend after the X-Stop implantation. The lateral translations were not significantly affected. At both cephalad and caudad adjacent levels, the ISP distances (vertical and horizontal) were not significantly affected during all postures after X-Stop implantation. Conclusion The findings of this study indicate that implantation of the X-Stop devices can effectively distract the ISP space at the diseased level without causing apparent kinematic changes at the adjacent segments during the studied postures.

Wan, Zongmiao; Wang, Shaobai; Kozanek, Michal; Passias, Peter G.; Mansfield, Frederick L.; Wood, Kirkham B.; Li, Guoan



A randomized trial investigating an exercise program to prevent reduction of bone mineral density and impairment of motor performance during treatment for childhood acute lymphoblastic leukemia  

Microsoft Academic Search

BACKGROUND: Reduced bone mineral density (BMD), altered body composition, impaired motor performance and passive ankle dorsiflexion are side effects of acute lymphoblastic leukemia (ALL) treatment. We performed a randomized study investigating whether an exercise program could prevent these side effects. PROCEDURE: At diagnosis we randomized 51 ALL patients (median age: 5.4 years) into a group receiving a 2-year exercise program

A. Hartman; M. L. te Winkel; R. D. van Beek; S. M. P. F. de Muinck Keizer-Schrama; H. C. G. Kemper; W. C. J. Hop; M. M. van den Heuvel-Eibrink; R. Pieters



Mesenchymal cells in the treatment of spinal cord injury: current & future perspectives.  


Nearly 1.5 million people in the US live with a spinal cord injury (SCI). The cost to the healthcare system is estimated at over $10 billion annually likely because over 65% of SCIs occur at the cervical level. Despite medical advances, many SCI patients still experience substantial neurological disability and high dependency with severe loss of motor, sensory and autonomic function. The consensus from a combination of in vivo studies and in vivo models is that mesenchymal or stromal cells, and possibly even neural progenitors, regardless of derivation act through the provision of trophic support and inflammatory modulation. Indeed, they have been found to secrete a wide spectrum of diffusible factors with known roles in both. As such, mesenchymal cells, obtainable from multiple tissues, are ideally suited to addressing many pathophysiological consequences of SCI. Advances in understanding the latter, structural and functional magnetic resonance imaging, image-guided microneurosurgical techniques and transplantable cell biology have enabled the clinical use of cell-based therapies. Of the twenty most recent cell therapy clinical trials for SCI, seven involve adult bone marrow mesenchymal cells and six others umbilical cord cells. This reflects the growing recognition of the clinical potential of perinatal cells. However, a limited understanding of how best to exploit the capabilities of these cells impedes a full-scale clinical deployment. This mini-review focuses on recent developments that are likely to facilitate the targeted application of these cells to treat specific secondary pathophysiological processes. PMID:23270635

Vawda, Reaz; Fehlings, Michael G



Treatment Of Intractable Discogenic Low Back Pain. A Systematic Review Of Spinal Fusion And Intradiscal Electrothermal Therapy (Idet)  

Microsoft Academic Search

Background: A growing number of pa- tients suffer from severe low back pain of discogenic origin that is not responsive to conservative medical management. These patients must consider the option of surgi- cal spinal fusion or minimally-invasive in- tradiscal electrothermal therapy (IDET). Objective: To conduct a systemat- ic review of clinical outcomes in patients undergoing spinal fusion or the intradiscal

Gunnar B. J. Andersson; Nagy A. Mekhail; Jon E. Block



Hypnotically Assisted Diaphragmatic Exercises in the Treatment of Stuttering: A Preliminary Investigation  

Microsoft Academic Search

This preliminary study investigates the combined effect of intensive hypnotherapy and diaphragmatic exercises in the management of stuttering. Fifty-nine clients with stuttering were trained to practice abdominal weightlifting to strengthen their respiratory muscles and to improve their diaphragmatic movements. The weightlifting exercises involved lifting a dumbbell (2.0–4.0 kg) with the abdomen for 2 hours daily for 8 consecutive days. Hypnotherapy

Yalcin Kaya; Assen Alladin



Follow-up of an Exercise-Based Treatment for Children with Reading Difficulties  

ERIC Educational Resources Information Center

|This study reports the results of a long-term follow-up of an exercise-based approach to dyslexia-related disorders (Reynolds, Nicolson, & Hambly, "Dyslexia," 2003; 9(1): 48-71). In the initial study, children at risk of dyslexia were identified in 3 years of a junior school. One half then undertook a 6 month, home-based exercise programme.…

Reynolds, David; Nicolson, Roderick I.



Lack of robust neurologic benefits with simvastatin or atorvastatin treatment after acute thoracic spinal cord contusion injury.  


Although much progress has been made in the clinical care of patients with acute spinal cord injuries, there are no reliably effective treatments, which minimize secondary damage and improve neurologic outcome. The time and expense needed to establish de novo pharmacologic or biologic therapies for acute SCI has encouraged the development of neuroprotective treatments based on drugs that are already in clinical use and, therefore, have the advantage of a well-characterized safety and pharmacokinetic profile in humans. Statins are the most commonly prescribed class of lipid-lowering drugs, and recently, it has been recognized that statins also have powerful immunomodulatory and anti-inflammatory effects. This paper describes a series of experiments that were performed to evaluate the comparative neuroprotective effects of simvastatin and atorvastatin. We observed a promising signal of neurologic benefit with simvastatin in our first experiment, but in repeated attempts to replicate that effect in three subsequent experiments, we failed to reveal any behavioral or histologic improvements. We would conclude that simvastatin given orally or subcutaneously at doses previously reported by other investigators to be effective in different neurologic conditions does not confer a significant neurologic benefit in a thoracic contusion injury model (OSU Impactor) when administered with a 1-h delay in intervention. We contend that further preclinical investigation of atorvastatin and simvastatin is warranted before considering their translation into human SCI. PMID:19931252

Mann, Cody M; Lee, Jae H T; Hillyer, Jessica; Stammers, Anthea M T; Tetzlaff, Wolfram; Kwon, Brian K



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


Exercise as a potential treatment for drug abuse: evidence from preclinical studies.  


Epidemiological studies reveal that individuals who engage in regular aerobic exercise are less likely to use and abuse illicit drugs. Until recently, very few studies had examined the causal influences that mediate this relationship, and it was not clear whether exercise was effective at reducing substance use and abuse. In the past few years, several preclinical studies have revealed that exercise reduces drug self-administration in laboratory animals. These studies have revealed that exercise produces protective effects in procedures designed to model different transitional phases that occur during the development of, and recover from, a substance use disorder (e.g., acquisition, maintenance, escalation, and relapse/reinstatement of drug use). Moreover, recent studies have revealed several behavioral and neurobiological consequences of exercise that may be responsible for its protective effects in these assays. Collectively, these studies have provided convincing evidence to support the development of exercise-based interventions to reduce compulsive patterns of drug intake in clinical and at-risk populations. PMID:22347866

Smith, Mark A; Lynch, Wendy J



Exercise as a Potential Treatment for Drug Abuse: Evidence from Preclinical Studies  

PubMed Central

Epidemiological studies reveal that individuals who engage in regular aerobic exercise are less likely to use and abuse illicit drugs. Until recently, very few studies had examined the causal influences that mediate this relationship, and it was not clear whether exercise was effective at reducing substance use and abuse. In the past few years, several preclinical studies have revealed that exercise reduces drug self-administration in laboratory animals. These studies have revealed that exercise produces protective effects in procedures designed to model different transitional phases that occur during the development of, and recover from, a substance use disorder (e.g., acquisition, maintenance, escalation, and relapse/reinstatement of drug use). Moreover, recent studies have revealed several behavioral and neurobiological consequences of exercise that may be responsible for its protective effects in these assays. Collectively, these studies have provided convincing evidence to support the development of exercise-based interventions to reduce compulsive patterns of drug intake in clinical and at-risk populations.

Smith, Mark A.; Lynch, Wendy J.



The future of spine surgery: New horizons in the treatment of spinal disorders  

PubMed Central

Background and Methods: As with any evolving surgical discipline, it is difficult to predict the future of the practice and science of spine surgery. In the last decade, there have been dramatic developments in both the techniques as well as the tools employed in the delivery of better outcomes to patients undergoing such surgery. In this article, we explore four specific areas in spine surgery: namely the role of minimally invasive spine surgery; motion preservation; robotic-aided surgery and neuro-navigation; and the use of biological substances to reduce the number of traditional and revision spine surgeries. Results: Minimally invasive spine surgery has flourished in the last decade with an increasing amount of surgeries being performed for a wide variety of degenerative, traumatic, and neoplastic processes. Particular progress in the development of a direct lateral approach as well as improvement of tubular retractors has been achieved. Improvements in motion preservation techniques have led to a significant number of patients achieving arthroplasty where fusion was the only option previously. Important caveats to the indications for arthroplasty are discussed. Both robotics and neuro-navigation have become further refined as tools to assist in spine surgery and have been demonstrated to increase accuracy in spinal instrumentation placement. There has much debate and refinement in the use of biologically active agents to aid and augment function in spine surgery. Biological agents targeted to the intervertebral disc space could increase function and halt degeneration in this anatomical region. Conclusions: Great improvements have been achieved in developing better techniques and tools in spine surgery. It is envisaged that progress in the four focus areas discussed will lead to better outcomes and reduced burdens on the future of both our patients and the health care system.

Kazemi, Noojan; Crew, Laura K.; Tredway, Trent L.



Transplantation of predifferentiated adipose-derived stromal cells for the treatment of spinal cord injury.  


Adipose-derived stromal cells (ASCs) are an alternative source of stem cells for cell-based therapies of neurological disorders such as spinal cord injury (SCI). In the present study, we predifferentiated ASCs (pASCs) and compared their behavior with naïve ASCs in vitro and after transplantation into rats with a balloon-induced compression lesion. ASCs were predifferentiated into spheres before transplantation, then pASCs or ASCs were injected intraspinally 1 week after SCI. The cells' fate and the rats' functional outcome were assessed using behavioral, histological, and electrophysiological methods. Immunohistological analysis of pASCs in vitro revealed the expression of NCAM, NG2, S100, and p75. Quantitative RT-PCR at different intervals after neural induction showed the up-regulated expression of the glial markers NG2 and p75 and the neural precursor markers NCAM and Nestin. Patch clamp analysis of pASCs revealed three different types of membrane currents; however, none were fast activating Na(+) currents indicating a mature neuronal phenotype. Significant improvement in both the pASC and ASC transplanted groups was observed in the BBB motor test. In vivo, pASCs survived better than ASCs did and interacted closely with the host tissue, wrapping host axons and oligodendrocytes. Some transplanted cells were NG2- or CD31-positive, but no neuronal markers were detected. The predifferentiation of ASCs plays a beneficial role in SCI repair by promoting the protection of denuded axons; however, functional improvements were comparable in both the groups, indicating that repair was induced mainly through paracrine mechanisms. PMID:21630007

Arboleda, David; Forostyak, Serhiy; Jendelova, Pavla; Marekova, Dana; Amemori, Takashi; Pivonkova, Helena; Masinova, Katarina; Sykova, Eva



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



Efficacy of ?yurvedic treatment using Pañcakarma combined with balance exercises for disability and balance in progressive supranuclear palsy.  


A 55-year-old female presented at Department of Pañcakarma with diagnosis of progressive supranuclear palsy (PSP). For assessing disability, progressive supranuclear palsy rating scale (PSPRS) was used and balance was assessed by using Tetrax Interactive Balance System (IBS) posturography. ?yurvedic treatment was given along with Pañcakarma and balance exercises for 3 months. As part of ?yurvedic treatment, first Virecana karma was done with classical method and then M?tr? basti, ?irobasti, and other palliative treatment was given for 3 months. Amanatidine was not continued during Virecana karma but started thereafter. On comparison with pre-intervention scores, there was a significant improvement in the patient post-treatment. The features which mainly showed improvement were: Eye movements, spontaneous episodes of laughing, dysphagia, dysarthria, double vision, and neck rigidity. Balance showed significant improvement and there was a remarkable decrease in the postural sway. This case study may present new possibilities for treatment of neurodegenerative diseases by ?yurveda. PMID:23929996

Jindal, Nitin; Shamkuwar, Manoj K; Kaur, Jaskirat; Berry, Sadhan



Efficacy of ?yurvedic treatment using Pañcakarma combined with balance exercises for disability and balance in progressive supranuclear palsy  

PubMed Central

A 55-year-old female presented at Department of Pañcakarma with diagnosis of progressive supranuclear palsy (PSP). For assessing disability, progressive supranuclear palsy rating scale (PSPRS) was used and balance was assessed by using Tetrax Interactive Balance System (IBS) posturography. ?yurvedic treatment was given along with Pañcakarma and balance exercises for 3 months. As part of ?yurvedic treatment, first Virecana karma was done with classical method and then M?tr? basti, ?irobasti, and other palliative treatment was given for 3 months. Amanatidine was not continued during Virecana karma but started thereafter. On comparison with pre-intervention scores, there was a significant improvement in the patient post-treatment. The features which mainly showed improvement were: Eye movements, spontaneous episodes of laughing, dysphagia, dysarthria, double vision, and neck rigidity. Balance showed significant improvement and there was a remarkable decrease in the postural sway. This case study may present new possibilities for treatment of neurodegenerative diseases by ?yurveda.

Jindal, Nitin; Shamkuwar, Manoj K.; Kaur, Jaskirat; Berry, Sadhan



Conventionally-fractionated image-guided intensity modulated radiotherapy (IG-IMRT): a safe and effective treatment for cancer spinal metastasis  

Microsoft Academic Search

BACKGROUND: Treatments for cancer spinal metastasis were always palliative. This study was conducted to investigate the safety and effectiveness of IG-IMRT for these patients. METHODS: 10 metastatic lesions were treated with conventionally-fractionated IG-IMRT. Daily kilovoltage cone-beam computed tomography (kV-CBCT) scan was applied to ensure accurate positioning. Plans were evaluated by the dose-volume histogram (DVH) analysis. RESULTS: Before set-up correction, the

Youling Gong; Jin Wang; Sen Bai; Xiaoqin Jiang; Feng Xu



Improved Antisense Oligonucleotide Design to Suppress Aberrant SMN2 Gene Transcript Processing: Towards a Treatment for Spinal Muscular Atrophy  

PubMed Central

Spinal muscular atrophy (SMA) is caused by loss of the Survival Motor Neuron 1 (SMN1) gene, resulting in reduced SMN protein. Humans possess the additional SMN2 gene (or genes) that does produce low level of full length SMN, but cannot adequately compensate for loss of SMN1 due to aberrant splicing. The majority of SMN2 gene transcripts lack exon 7 and the resultant SMN?7 mRNA is translated into an unstable and non-functional protein. Splice intervention therapies to promote exon 7 retention and increase amounts of full-length SMN2 transcript offer great potential as a treatment for SMA patients. Several splice silencing motifs in SMN2 have been identified as potential targets for antisense oligonucleotide mediated splice modification. A strong splice silencer is located downstream of exon 7 in SMN2 intron 7. Antisense oligonucleotides targeting this motif promoted SMN2 exon 7 retention in the mature SMN2 transcripts, with increased SMN expression detected in SMA fibroblasts. We report here systematic optimisation of phosphorodiamidate morpholino oligonucleotides (PMO) that promote exon 7 retention to levels that rescued the phenotype in a severe mouse model of SMA after intracerebroventricular delivery. Furthermore, the PMO gives the longest survival reported to date after a single dosing by ICV.

Mitrpant, Chalermchai; Porensky, Paul; Zhou, Haiyan; Price, Loren; Muntoni, Francesco; Fletcher, Sue; Wilton, Steve D.; Burghes, Arthur H. M.



Improved antisense oligonucleotide design to suppress aberrant SMN2 gene transcript processing: towards a treatment for spinal muscular atrophy.  


Spinal muscular atrophy (SMA) is caused by loss of the Survival Motor Neuron 1 (SMN1) gene, resulting in reduced SMN protein. Humans possess the additional SMN2 gene (or genes) that does produce low level of full length SMN, but cannot adequately compensate for loss of SMN1 due to aberrant splicing. The majority of SMN2 gene transcripts lack exon 7 and the resultant SMN?7 mRNA is translated into an unstable and non-functional protein. Splice intervention therapies to promote exon 7 retention and increase amounts of full-length SMN2 transcript offer great potential as a treatment for SMA patients. Several splice silencing motifs in SMN2 have been identified as potential targets for antisense oligonucleotide mediated splice modification. A strong splice silencer is located downstream of exon 7 in SMN2 intron 7. Antisense oligonucleotides targeting this motif promoted SMN2 exon 7 retention in the mature SMN2 transcripts, with increased SMN expression detected in SMA fibroblasts. We report here systematic optimisation of phosphorodiamidate morpholino oligonucleotides (PMO) that promote exon 7 retention to levels that rescued the phenotype in a severe mouse model of SMA after intracerebroventricular delivery. Furthermore, the PMO gives the longest survival reported to date after a single dosing by ICV. PMID:23630626

Mitrpant, Chalermchai; Porensky, Paul; Zhou, Haiyan; Price, Loren; Muntoni, Francesco; Fletcher, Sue; Wilton, Steve D; Burghes, Arthur H M



Hypnotically assisted diaphragmatic exercises in the treatment of stuttering: a preliminary investigation.  


This preliminary study investigates the combined effect of intensive hypnotherapy and diaphragmatic exercises in the management of stuttering. Fifty-nine clients with stuttering were trained to practice abdominal weightlifting to strengthen their respiratory muscles and to improve their diaphragmatic movements. The weightlifting exercises involved lifting a dumbbell (2.0-4.0 kg) with the abdomen for 2 hours daily for 8 consecutive days. Hypnotherapy was utilized to alleviate anxiety, to boost self-confidence, and to increase motivation for weightlifting exercise. The pre- and postmeasures were statistically significant (p < .001). Results of the study provide support for the effectiveness of hypnotically assisted diaphragmatic training in the management of stuttering but should be further studied in controlled trials. PMID:22443525

Kaya, Yalcin; Alladin, Assen



Efficacy of treatment with verbascoside, biotechnologically produced by Syringa vulgaris plant cell cultures in an experimental mice model of spinal cord trauma.  


In this study we evaluated the effect of glycosylated phenylpropanoid verbascoside (VB), isolated from cultured cells of the medicinal plant Syringa vulgaris (Oleaceae) in experimental animal model of spinal cord injury (SCI). SCI was induced by the application of vascular clips to the dura via a four-level T5-T8 laminectomy. SCI in mice resulted in severe trauma characterized by edema, tissue damage, and apoptosis. At 1 and 6 h after injury, the mice were treated with VB extract, administered at the dose of 2 mg/kg with intraperitoneal administration. Immunohistochemical examination demonstrated a marked increase on expression for nitrotyrosine, inducible nitric oxide synthase, poly(ADP-ribose), and apoptosis events (increase of Bax and Bcl-2 expression) in the spinal cord tissue. Additionally, we demonstrate that these inflammatory events were associated with the cytokines expression (TNF-? and IL-1?), neutrophil infiltration (myeloperoxidase), and activation of NF-?B. In contrast, all of these parameters of inflammation were attenuated by treatment with VB. In a separate set of experiment, we have clearly demonstrated that VB treatment significantly ameliorated the recovery of function (evaluated by motor recovery score). Taken together, our results clearly demonstrate that treatment with VB extract reduces the development of inflammation and tissue injury events associated with spinal cord trauma. PMID:20799028

Genovese, Tiziana; Paterniti, Irene; Mazzon, Emanuela; Esposito, Emanuela; Di Paola, Rosanna; Galuppo, Maria; Bramanti, Placido; Cuzzocrea, Salvatore



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



Optimal treatment for Spinal Cord Injury associated with cervical canal Stenosis (OSCIS): a study protocol for a randomized controlled trial comparing early versus delayed surgery  

PubMed Central

Background The optimal management of acute cervical spinal cord injury (SCI) associated with preexisting canal stenosis remains to be established. The objective of this study is to examine whether early surgical decompression (within 24 hours after admission) would result in greater improvement in motor function compared with delayed surgery (later than two weeks) in cervical SCI patients presenting with canal stenosis, but without bony injury. Methods/design OSCIS is a randomized, controlled, parallel-group, assessor-blinded, multicenter trial. We will recruit 100 cervical SCI patients who are admitted within 48 hours of injury (aged 20 to 79 years; without fractures or dislocations; American Spinal Injury Association (ASIA) grade C; preexisting spinal canal stenosis). Patients will be enrolled from 36 participating hospitals across Japan and randomly allocated in a 1:1 ratio to either early surgical decompression (within 24 hours after admission) or delayed surgery following at least two weeks of conservative treatment. The primary outcomes include: 1) the change from baseline to one year in the ASIA motor score; 2) the total score of the Spinal Cord Independence Measure and 3) the proportion of patients who are able to walk without human assistance. The secondary outcomes are: 1) the health-related quality of life as measured by the Medical Outcomes Study Short Form 36 and the EuroQol 5 Dimension; 2) the Neuropathic Pain Symptom Inventory and 3) the walking status as evaluated with the Walking Index for Spinal Cord Injury II. The analysis will be on an intention-to-treat basis. The primary analysis will be a comparison of the primary and secondary outcomes one year after the injury. Discussion The results of this study will provide evidence of the potential benefit of early surgical decompression compared to the current ‘watch and wait’ strategy. Trial registration UMIN000006780; NCT01485458



The effect of an extended source-to-skin distance in the treatment of the spinal field in children receiving craniospinal irradiation  

SciTech Connect

In this study, we compared a single extended source-to-skin difference (SSD) spinal field and the alternative 2-field gapped approach at 100 SSD on dose to surrounding normal tissues. Five female patients ranging in age from 3 to 20 years underwent computed tomography (CT) simulation for treatment planning of the craniospinal axis, which was treated in its entirety to 36 Gy. For each slice, the clinical target volume (thecal sac and contents), mandible, thyroid gland, esophagus, heart, lungs, liver, and ovaries were contoured. Technique A employed the use of a single posterior spinal field delivered at SSD = 140 cm (140 SSD), and Technique B employed the use of 2 gapped spinal fields using a traditional SSD of 100 cm (100 SSD). Dose-volume histograms (DVHs) were obtained for each organ contoured and for each technique used. In all patients, the average mean dose to all surrounding structures was increased with the use of a single extended SSD (Technique A) when compared to the 2 spinal fields prescribed at 100 SSD (Technique B). The average mean doses to the mandible, thyroid gland, esophagus, and heart were 78%, 19%, 6%, and 16%, respectively, higher with Technique A as compared to Technique B. In addition, the average mean doses to the lungs, liver, and ovaries were 53%, 33% and 69%, respectively, higher as compared to Technique B. However, the clinical target volume at the spinal junction site received a less homogenous dose with Technique B as compared to Technique A. We conclude that although the use of a single-field extended SSD delivered a more homogenous dose to the spine, a higher dose to the ovaries, thyroid gland, mandible, lungs, liver, and heart was seen.

Koshy, Mary; Paulino, Arnold C.; Marcus, Robert B.; Ting, Joseph



Development of Methods for Neurorrhaphy and the Treatments of Spinal Cord and Cauda Equina Injuries in Battle Casualties.  

National Technical Information Service (NTIS)

A 400 gm-cm force exerted on the exposed feline spinal cord leads to its destruction by hemorrhage and edema approximately four hours after impact. One hour after trauma, simultaneous intravenous administration of Epsilon aminocaproic acid and methyl pred...

J. B. Campbell



Treatment of Rat Spinal Cord Injury with the Neurotrophic Factor Albumin-Oleic Acid: Translational Application for Paralysis, Spasticity and Pain  

PubMed Central

Sensorimotor dysfunction following incomplete spinal cord injury (iSCI) is often characterized by the debilitating symptoms of paralysis, spasticity and pain, which require treatment with novel pleiotropic pharmacological agents. Previous in vitro studies suggest that Albumin (Alb) and Oleic Acid (OA) may play a role together as an endogenous neurotrophic factor. Although Alb can promote basic recovery of motor function after iSCI, the therapeutic effect of OA or Alb-OA on a known translational measure of SCI associated with symptoms of spasticity and change in nociception has not been studied. Following T9 spinal contusion injury in Wistar rats, intrathecal treatment with: i) Saline, ii) Alb (0.4 nanomoles), iii) OA (80 nanomoles), iv) Alb-Elaidic acid (0.4/80 nanomoles), or v) Alb-OA (0.4/80 nanomoles) were evaluated on basic motor function, temporal summation of noxious reflex activity, and with a new test of descending modulation of spinal activity below the SCI up to one month after injury. Albumin, OA and Alb-OA treatment inhibited nociceptive Tibialis Anterior (TA) reflex activity. Moreover Alb-OA synergistically promoted early recovery of locomotor activity to 50±10% of control and promoted de novo phasic descending inhibition of TA noxious reflex activity to 47±5% following non-invasive electrical conditioning stimulation applied above the iSCI. Spinal L4–L5 immunohistochemistry demonstrated a unique increase in serotonin fibre innervation up to 4.2±1.1 and 2.3±0.3 fold within the dorsal and ventral horn respectively with Alb-OA treatment when compared to uninjured tissue, in addition to a reduction in NR1 NMDA receptor phosphorylation and microglia reactivity. Early recovery of voluntary motor function accompanied with tonic and de novo phasic descending inhibition of nociceptive TA flexor reflex activity following Alb-OA treatment, mediated via known endogenous spinal mechanisms of action, suggests a clinical application of this novel neurotrophic factor for the treatment of paralysis, spasticity and pain.

Avila-Martin, Gerardo; Galan-Arriero, Iriana; Gomez-Soriano, Julio; Taylor, Julian



Effects of Combinatorial Treatment with Pituitary Adenylate Cyclase Activating Peptide and Human Mesenchymal Stem Cells on Spinal Cord Tissue Repair  

Microsoft Academic Search

The aim of this study is to understand if human mesenchymal stem cells (hMSCs) and neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP) have synergistic protective effect that promotes functional recovery in rats with severe spinal cord injury (SCI). To evaluate the effect of delayed combinatorial therapy of PACAP and hMSCs on spinal cord tissue repair, we used the immortalized hMSCs that

Kuan-Min Fang; Jen-Kun Chen; Shih-Chieh Hung; Mei-Chun Chen; Yi-Ting Wu; Tsung-Jung Wu; Hsin-I. Lin; Chia-Hua Chen; Henrich Cheng; Chung-Shi Yang; Shun-Fen Tzeng; Dimas Tadeu Covas



Lactobacillus farciminis treatment attenuates stress-induced overexpression of Fos protein in spinal and supraspinal sites after colorectal distension in rats.  


Abstract Irritable bowel syndrome (IBS), frequently associated with psychological distress, is characterized by hypersensitivity to gut wall distension. Some probiotics are able to alleviate IBS symptoms and reduce visceromotor response to mechanical stimuli in animals. Moreover, we have previously shown that Lactobacillus farciminis treatment abolished the hyperalgesia to colorectal distension (CRD) induced by acute stress. The aims of the present study were to determine whether (i) stress-induced visceral hyperalgesia modifies the expression of Fos, a marker of general neuronal activation, induced by CRD, (ii) this activation can be modulated by L. farciminis treatment. Female rats were treated by L. farciminis and CRD was performed after partial restraint stress (PRS) or sham-PRS. The expression of Fos protein was measured by immunohistochemistry. After CRD or PRS, Fos expression was increased in spinal cord section (S1), nucleus tractus solitarius (NTS), paraventricular nucleus (PVN) of the hypothalamus, and in the medial nucleus of the amygdala (MeA). The combination of both stimuli, PRS and CRD, markedly increased this Fos overexpression in the sacral spinal cord section, PVN and MeA, but not in NTS. By contrast, a pretreatment with L. farciminis significantly reduced the number of Fos positive cells in these area. This study shows that PRS enhances Fos protein expression induced by CRD at the spinal and supraspinal levels in rats. Lactobacillus farciminis treatment inhibited this enhancing effect, suggesting that the antinociceptive effect of this probiotic strain results from a decrease of the stress-induced activation/sensitization of sensory neurons at the spinal and supraspinal level. PMID:19309441

Ait-Belgnaoui, A; Eutamene, H; Houdeau, E; Bueno, L; Fioramonti, J; Theodorou, V



Radioactive bone cement for the treatment of spinal metastases: a dosimetric analysis of simulated clinical scenarios  

Microsoft Academic Search

Vertebral metastases are a common manifestation of many cancers, potentially leading to vertebral collapse and neurological complications. Conventional treatment often involves percutaneous vertebroplasty\\/kyphoplasty followed by external beam radiation therapy. As a more convenient alternative, we have introduced radioactive bone cement, i.e. bone cement incorporating a radionuclide. In this study, we used a previously developed Monte Carlo radiation transport modeling method

T S Kaneko; V Sehgal; H B Skinner; M S A L Al-Ghazi; N S Ramsinghani; M Marquez Miranda; J H Keyak



Cost Analysis of the Treatment of Severe Spinal Spasticity With a Continuous Intrathecal Baclofen Infusion System  

Microsoft Academic Search

Objective: The purpose of our study was to analyse and evaluate the costs of continuous intrathecal baclofen administration as a modality in the treatment of severe spasticity in the Netherlands. Design: A cost analysis was conducted as part of a prospective, multicentre, multidisciplinary, randomised and placebo-controlled clinical trial. The study covered the period from December 1991 to September 1995. The

M. Postma; Dettie Oenema; Symon Terpstra; Jelte Bouma; Hannah Kuipers-Upmeijer; Michiel J. Staal; Berry J. Middel



The management of bilateral high hamstring tendinopathy with ASTYM(R) treatment and eccentric exercise: a case report  

PubMed Central

High hamstring tendinopathy (HHT) is an overuse injury that occurs most commonly in runners. The management of HHT is often challenging and the research supporting many interventions is limited. Eccentric exercise has been proven effective in the treatment of various tendinopathies but has not been thoroughly studied with HHT. Soft tissue mobilization, including ASTYM, is often utilized in the treatment of tendinopathies, though there is limited evidence supporting this approach. The purpose of this paper is to present the case of a patient referred to physical therapy with bilateral HHT. The patient was a 41-year-old recreational runner that had an insidious onset of right buttock pain 12 months prior to initiating therapy and left buttock pain 9 months prior. Her primary complaints included an inability to run, pain with prolonged or brisk walking, and pain with sitting on hard surfaces. The patient was treated in physical therapy two times per week for 16 visits with treatment focused on eccentric hamstring strengthening and ASTYM. By her eighth visit, the patient was able to walk 2·5 miles without pain and by her 12 visit, she was able to jog 1 mile before the onset of pain. After 16 visits, the patient reported that she was approximately 95% improved, was able to run 2·5 miles without pain, and had no pain with sitting on hard surfaces. This case suggests that eccentric exercise combined with ASTYM may be an effective treatment for HHT.

McCormack, Joshua R



Attitudes About Treatment of Coronary Heart Disease Among Women and Men Presenting for Exercise Testing  

Microsoft Academic Search

To assess attitudes that could contribute to gender differences in the use of coronary procedures, we surveyed 322 patients presenting for exercise testing at a major teaching hospital. Adjusting for sociodemographic and clinical factors, women and men did not differ significantly in their willingness to seek a second opinion, reduce physical activity, or take drugs to avoid major cardiac surgery,

John Z. Ayanian; Arnold M. Epstein



The psychological benefits of exercise and the treatment of delinquent adolescents.  


The conviction that athletic participation imparts desirable educational, social and personal values has been the basis for including recreational sports in the remedial programme for juvenile delinquents. More recently, the psychological benefits of aerobic exercise and increased fitness have been investigated. Changes following intensive exercise include reductions in anxiety, tension and depression, and increased self-esteem. These effects have been variously hypothesised as due to a sense of increased control or mastery, a meditative effect or to alterations in neurotransmitter-levels. Delinquent adolescents comprise a heterogeneous population characterised by clusters of risk factors, handicapping conditions and psychopathology, with a prevalence of depression and low self-esteem far exceeding that of the population at large. Intervention which can benefit these characteristics may be especially useful in preventive or therapeutic programmes in this group. While less intensive recreational play or physically challenging 'Outward Bound' programmes can be effective in improving social attitudes and self-esteem, intensive aerobic exercise may produce greater improvements in self-esteem and depression. Future research must identify the mechanisms by which exercise confers these benefits, whether it enhances other areas, such as social skills or academic performance, and which populations are benefitted by such programmes. PMID:2192424

MacMahon, J R



Behavioural treatments for chronic systemic inflammation: effects of dietary weight loss and exercise training.  


Persistent low-grade inflammation, as indicated by higher circulating levels of inflammatory mediators such as C-reactive protein, interleukin-6 and tumour necrosis factor-alpha, is a strong risk factor for several chronic diseases. There are data indicating that decreasing energy intake and increasing physical activity may be effective therapies for reducing overall inflammation. Evidence is strong that circulating levels of inflammatory markers are elevated with total and abdominal obesity, possibly owing to a higher secretion rate of cytokines by adipose tissue in obese people. Moreover, very-low-energy dietary weight loss reduces both circulating markers of inflammation and adipose-tissue cytokine production. Data from several large population-based cohorts show an inverse association between markers of systemic inflammation and physical activity or fitness status; small-scale intervention studies support that exercise training diminishes inflammation. Dietary weight loss plus exercise is likely more effective than weight reduction alone in reducing inflammation. To date, data from randomized, controlled trails designed to definitively test the effects of weight loss or exercise training, or both, on inflammation are limited. Future studies are required to define the amount of weight loss needed for clinically meaningful reductions of inflammation; in addition, fully powered and controlled studies are necessary to clarify the effect of exercise training on chronic, systemic inflammation. PMID:15851714

Nicklas, Barbara J; You, Tongjian; Pahor, Marco



Prognostic value of predischarge low-level exercise thallium testing after thrombolytic treatment of acute myocardial infarction  

SciTech Connect

Low-level exercise thallium testing is useful in identifying the high-risk patient after acute myocardial infarction (AMI). To determine whether this use also applies to patients after thrombolytic treatment of AMI, 64 patients who underwent early thrombolytic therapy for AMI and 107 patients without acute intervention were evaluated. The ability of both the electrocardiogram and thallium tests to predict future events was compared in both groups. After a mean follow-up of 374 days, there were 25 and 32% of cardiac events in the 2 groups, respectively, with versus without acute intervention. These included death, another AMI, coronary artery bypass grafting or angioplasty with 75% of the events occurring in the 3 months after the first infarction. The only significant predictors of outcome were left ventricular cavity dilatation in the intervention group and ST-segment depression and increased lung uptake in the nonintervention group. The sensitivity of exercise thallium was 55% in the intervention group and 81% in the nonintervention group (p less than 0.05). Therefore, in patients having thrombolytic therapy for AMI, nearly half the events after discharge are not predicted by predischarge low-level exercise thallium testing. The relatively weak correlation of outcome with unmasking ischemia in the laboratory before discharge may be due to an unstable coronary lesion or rapid progression of disease after the test. Tests considered useful for prognostication after AMI may not necessarily have a similar value if there has been an acute intervention, such as thrombolytic therapy.

Tilkemeier, P.L.; Guiney, T.E.; LaRaia, P.J.; Boucher, C.A. (Massachusetts General Hospital, Boston (USA))



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



Long-term exercise treatment reduces oxidative stress in the hippocampus of aging rats.  


Exercise can exert beneficial effects on cognitive functions of older subjects and it can also play an important role in the prevention of neurodegenerative diseases. At the same time it is perceivable that limited information is available on the nature of molecular pathways supporting the antioxidant effects of exercise in the brain. In this study 12-month old, middle-aged female Wistar rats were subjected to daily moderate intensity exercise on a rodent treadmill for a period of 15weeks which covered the early aging period unmasking already some aging-related molecular disturbances. The levels of reactive oxygen species (ROS), the amount of protein carbonyls, the levels of antioxidant intracellular enzymes superoxide dismutases (SOD-1, SOD-2) and glutathione peroxidase (GPx) were determined in the hippocampus. In addition, to identify the molecular pathways that may be involved in ROS metabolism and mitochondrial biogenesis, the activation of 5'-AMP-activated protein kinase (AMPK), the protein level of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1?), nuclear respiratory factor 1 (NRF-1) and mitochondrial transcription factor A (mtTFA) were measured. Our results revealed a lower level of ROS associated with a reduced amount of protein carbonyls in the hippocampus of physically trained rats compared to sedentary controls. Furthermore, exercise induced an up-regulation of SOD-1 and GPx enzymes, p-AMPK and PGC-1?, that can be related to an improved redox balance in the hippocampus. These results suggest that long-term physical exercise can comprises antioxidant properties and by this way protect neurons against oxidative stress at the early stage of aging. PMID:22982624

Marosi, K; Bori, Z; Hart, N; Sárga, L; Koltai, E; Radák, Z; Nyakas, C



Task-oriented aerobic exercise in chronic hemiparetic stroke: training protocols and treatment effects.  


Stroke is the leading cause of disability in older Americans. Each year 750,000 Americans suffer a stroke, two thirds of whom are left with neurological deficits that persistently impair function. Principal among them is hemiparetic gait that limits mobility and increases fall risk, promoting a sedentary lifestyle. These events propagate disability by physical deconditioning and "learned non-use," with further functional declines accelerated by the sarcopenia and fitness decrements of advancing age. Conventional rehabilitation care typically provides little or no structured therapeutic exercise beyond the subacute stroke recovery period, based on natural history studies showing little or no further functional motor recovery beyond 6 months after stroke. Emerging evidence suggests that new models of task-oriented exercise have the potential to improve motor function even years after stroke. This article presents treadmill as a task-oriented training paradigm to optimize locomotor relearning while eliciting cardiovascular conditioning in chronic stroke patients. Protocols for exercise testing and longitudinal aerobic training progression are presented that provide fundamental formulas that safely approach the complex task of customizing aerobic training to gait deficit severity in the high CVD risk stroke population. The beneficial effects of 6 months task-oriented treadmill exercise on cardiovascular-metabolic fitness, energy cost of hemiparetic gait, ADL mobility task performance, and leg strength are discussed with respect to the central and peripheral neuromuscular adaptations targeted by the training. Collectively, these findings constitute one initial experience in a much broader neuroscience and exercise rehabilitation development of task-oriented training paradigms that offer a multisystems approach to improving both neurological and cardiovascular health outcomes in the chronic stroke population. PMID:15736000

Macko, R F; Ivey, F M; Forrester, L W



Successful truncated osteomyelitis treatment for chronic osteomyelitis secondary to pressure ulcers in spinal cord injury patients.  


Time-tested treatments for chronic osteomyelitis involve prolonged courses of costly antibiotic treatment. Although such treatment remains unquestioned in acute osteomyelitis, it is an excessive regiment for chronic osteomyelitis. With appropriate surgical debridement and careful operative care, antibiotic treatment can be truncated in diagnoses of chronic osteomyelitis. This study represents the clinical practice of the pressure ulcer management program at Rancho Los Amigos National Rehabilitation Center in dealing with this difficult problem. One hundred fifty-seven patients with similar pressure ulcer wounds were studied retrospectively. Three groups of patients with pathologic diagnoses of acute osteomyelitis, chronic osteomyelitis, and negative osteomyelitis were compared for (1) postoperative stay, (2) wound infection, (3) wound breakdown requiring reoperation, and (4) same-site ulcer recurrence. In all cases, shallow bone shavings were sent for diagnosis via histologic study, and deep shavings were also sent to ensure adequate bone debridement and microbiologic study. All ulcers were subsequently closed with muscle and/or myocutaneous flaps. The negative and chronic osteomyelitis groups were treated with 5 to 7 days of IV antibiotics, whereas the acute group underwent a full 6-week course according to bone bacteriological culture and sensitivity. There was no statistical difference between the chronic osteomyelitis group and the control (negative) osteomyelitis group with respect to postoperative stay (70 days for chronic group, 72.4 for control), wound breakdown rate (10.7% for chronic, 10.2% for control), or ulcer recurrence (1.8% for chronic, 4.1 for control). The acute osteomyelitis group incurred longer hospital stays, greater incidence of wound breakdown, and statistically significantly greater ulcer recurrence (78.6 days, 13.2% and 17.0%, respectively). In cases of pressure ulcer management with bony involvement, bone pathologic diagnosis of chronic osteomyelitis allows for a shorter antibiotic course with better results when the offending tissue has been adequately debrided and closed with viable tissue flap coverage, than simple long-term (4-6 weeks) antibiotic treatment. Because of the extreme contaminated nature of these wounds, if such therapy works in these patients, it may be applicable to chronic osteomyelitis in more varied contaminated surgical cases involving bone. PMID:18812715

Marriott, Robert; Rubayi, Salah



Titanium Expandable Pedicle Screw for the Treatment of Degenerative and Traumatic Spinal Diseases in Osteoporotic Patients: Preliminary Experience.  


Osteoporosis is a major global health problem, with over 10 million people currently diagnosed with the disease. Although 80% of osteoporotic patients are women, a considerable number of men are also affected. Also, due to increasing life expectancy, the number of elderly patients with osteoporosis affected by degenerative and traumatic spinal diseases will increase further. Osteoporosis reduces bone quality through negative bone remodelling. Low bone quality can reduce the pull-out strength of pedicle screw, and negative bone remodelling can cause delayed bone fusion. However, pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pull-out, and fixation failure. Our preliminary study aims to investigate the efficiency of expandable pedicle screws (OsseoScrew-Zodiac,® Scient'x® Alphatec Spine Inc, Carlsbad, CA) in osteoporotic spinal patients. All osteoporotic patients with degenerative and traumatic spinal diseases admitted in our department underwent a pre-operative spinal x-Ray and MRI or CT. Pre-operative clinical assesment of patients was based on the visual analog scale (VAS) and Owestry Disability (ODI) questionnaire-a disease-specific outcome measure. Ten osteoporotic patients were treated with expandable pedicle screws (OsseoScrew®). Post-operative clinical assessment of patients was based on the VAS and ODI questionnaire at 3 months and 1 year of follow-up. Post-operative radiologic follow-up was performed after 3 days (CT, x-ray); 3 months (xray); 6 months (spinal CT); and 1 year (spinal CT). Expandable pedicle screws improved pull-out strength as compared to standard pedicle screws in steoporotic patients with degenerative and traumatic spinal diseases. PMID:23023577

Gazzeri, Roberto; Roperto, Raffaelino; Fiore, Claudio



Acute reserpine treatment alters the catecholamine, glucocorticoid and opioid response to walking exercise in sheep.  


The aim of the study was to examine the effects of reserpine on the plasma levels of adrenaline, noradrenaline, cortisol and alpha-neoendorphin in sheep under control conditions and during walking exercise. One hour of walking (5 km/h) caused a significant increase in both catecholamines and cortisol between 10 and 30 min of stress, and transiently decreased the level of alpha-neoendorphin at the same time. Reserpine at the dose of 0.3 mg/kg i.v. given before stress significantly lowered the basal levels of all tested parameters. A combination of the reserpine and walking exercise significantly attenuated the stress-induced changes in the plasma level of measured hormones. PMID:10077362

Pierzcha?a-Koziec, K; Niezgoda, J; Wro?ska-Fortuna, D; Bobek, S; Wieczorek, E



Treatment of the Metabolic Syndrome with Weight Loss, Exercise, Hormones, and Surgery  

Microsoft Academic Search

\\u000a Weight reduction improves all components of the metabolic syndrome. This is seen with calorie-reduced diets as well as weight-loss\\u000a Mediterranean-type diets. Exercise is also an effective strategy, but less so than diets usually because the weight loss is\\u000a less. Sibutramine, xenical, and rimonabant are effective strategies to lower body weight and improve the metabolic syndrome.\\u000a Surgery is more effective than

George A. Bray


Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures.  


Cement augmentation is a controversial treatment for painful vertebral compression fractures (VCF). Our research questions for the meta-analysis were: Is there a clinical and statistical difference in pain relief, functional improvement, and quality of life between conservative care and cement augmentation for VCF and, if so, are they maintained at longer time points? We conducted a search of MEDLINE from January 1980 to July 2011 using PubMed, Cochrane Database of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE. Searches were performed from medical subject headings. Terms "vertebroplasty" and "compression fracture" were used. The outcome variables of pain, functional measures, health-related quality of life (HRQOL), and new fracture risk were analyzed. A random effects model was chosen. Continuous variables were calculated using the standardized mean difference comparing improvement from baseline of the experimental group with the control group. New vertebral fracture risk was calculated using log odds ratio. Six studies met the criteria. The pain visual analog scale (VAS) mean difference was 0.73 (confidence interval [CI] 0.35, 1.10) for early (<12 weeks) and 0.58 (CI 0.19, 0.97) for late time points (6 to 12 months), favoring vertebroplasty (p?treatment of symptomatic VCF fractures. PMID:22991246

Anderson, Paul A; Froyshteter, Alexander B; Tontz, William L



Neural stem cells & supporting cells--the new therapeutic tools for the treatment of spinal cord injury.  


Stem cells play important role in the development and in the maintenance of specific tissues. They have been identified in majority of the organs like liver, blood, skin and intestine. Role of stem cells in regenerative medicine have been implicated in many chronic diseases. Stem cell research is a new opportunity to those patients whose organs are damaged or diseased. The discovery of stem cells in central and peripheral nervous system is relatively recent. Spinal cord injury is one of the major neurological disaster affecting mostly young lives. Stem cell transplantation in spinal cord injury patients have shown encouraging results. Different sources of stem cells are being exploited for spinal cord injury as well as other neurological disorders. PMID:19942740

Paspala, Syed Ameer Basha; Balaji, Avvari Bhaskara; Nyamath, Parveen; Ahmed, Khawaja Shakeel; Khan, Aleem Ahmed; Khaja, Mohammed Nane; Narsu, M Lakshmi; Devi, Y Prameela; Murthy, T V R K; Habibullah, C M



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



Minimally Invasive Treatment of Moderate Lumbar Spinal Stenosis with the Superion® Interspinous Spacer  

PubMed Central

Purpose: We evaluated the safety and effectiveness of the minimally invasive Superion® Interspinous Spacer (VertiFlex, Inc., San Clemente, CA) in patients with moderate LSS. Methods: This single-arm prospective study enrolled 121 patients with moderate LSS between February 2008 and August 2009 and were followed up at 1 (n=111), 3 (n=96), 6 (n=81), and 12 (n=52) months. All patients were treated with the Superion Interspinous Spacer. Main outcomes were back function with the Oswestry Disability Index (ODI), extremity and axial pain severity with an 11-point scale, health-related quality of life with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36, and adverse events through 12 months. Results: ODI improved 64% (p<0.001) through 12 months and clinical success was 92%. Extremity and axial pain improved 53% and 49% (both p<0.001), respectively, through 12 months with clinical success of 76% for axial pain and 86% for extremity pain. Health-related quality of life improved 41% for PCS and 22% for MCS (both p<0.001) through 12 months. PCS clinical success was 81% and MCS clinical success was 62% at 12 months. Four (5.9%) explants were performed although 3 were unrelated to the device. Eight procedure-related adverse events, observed in 6 (5.0%) patients, included superficial incision seroma (n=5), minor wound pain (n=2), and infection (n=1). Conclusions: Preliminary results with the Superion Interspinous Spacer suggest that it is an effective and safe treatment option for patients with moderate LSS who are unresponsive to conservative care.

Bini, Walter; Miller, Larry E; Block, Jon E



Electro-Acupuncture Treatment Improves Neurological Function Associated with Downregulation of PDGF and Inhibition of Astrogliosis in Rats with Spinal Cord Transection.  


The aim of the current study was to determine the effects of electro-acupuncture (EA) on the improvement of locomotor function in injured spinal cord and underlying mechanism. Forty-five female Sprague-Dawley rats (180?200 g) were randomly divided into three groups, sham operation control group (sham), spinal cord transection group (SCT) and EA group. The Basso, Beattie, and Bresnahan (BBB) Locomotor Rating Scale was used to evaluate functional recovery of rats in hindlimbs at 1, 3, 5 weeks after injury and EA therapy. The gene and protein expression of glial fibrillary acidic protein (GFAP) and platelet derived growth factor (PDGF) were measured by reverse transcription-polymerase chain reaction and Western blot analysis, respectively, and the number of GFAP-positive cells was counted, also. Compared with SCT group, the locomotor function in hindlimbs of rats was improved after 1, 3, 5 weeks following EA therapy. EA treatment not only decreased effectively the number of GFAP immunostaining and GFAP expression, but also downregulated the PDGF expression both gene and protein, in addition decreased the number of PDGF immunostaining in injured spinal cord of rats with transection. It therefore concluded that EA therapy can significantly promote the recovery of locomotor function, and this may be linked to the inhibition of astrogliosis, together with the downregulation of PDGF. PMID:23749676

Liu, Fen; Zou, Yu; Liu, Sujuan; Liu, Jia; Wang, Tinghua



Surgical versus Non-Operative Treatment for Lumbar Spinal Stenosis Four-Year Results of the Spine Patient Outcomes Research Trial (SPORT)  

PubMed Central

Study Design Randomized trial and concurrent observational cohort study Objective To compare 4 year outcomes of surgery to non-operative care for spinal stenosis. Summary of Background Data Surgery for spinal stenosis has been shown to be more effective compared to non-operative treatment over two years, but longer-term data have not been analyzed. Methods Surgical candidates from 13 centers in 11 U.S. states with at least 12 weeks of symptoms and confirmatory imaging were enrolled in a randomized cohort (RC) or observational cohort (OC). Treatment was standard decompressive laminectomy or standard non-operative care. Primary outcomes were SF-36 bodily pain (BP) and physical function (PF) scales and the modified Oswestry Disability index (ODI) assessed at 6 weeks, 3 months, 6 months and yearly up to 4 years. Results 289 patients enrolled in the RC and 365 patients enrolled in the OC. An as-treated analysis combining the RC and OC and adjusting for potential confounders found that the clinically significant advantages for surgery previously reported were maintained through 4 years, with treatment effects (defined as mean change in surgery group minus mean change in non-op group) for BP 12.6 (95% CI, 8.5 to 16.7); PF 8.6 (95% CI, 4.6 to 12.6); and ODI ?9.4 (95% CI, ?12.6, to ?6.2). Early advantages for surgical treatment for secondary measures such as bothersomeness, satisfaction with symptoms and self-rated progress also were maintained. Conclusions Patients with symptomatic spinal stenosis treated surgically compared to those treated non-operatively maintain substantially greater improvement in pain and function through four years.

Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna; Blood, Emily; Herkowitz, Harry; Cammisa, Frank; Albert, Todd; Boden, Scott D.; Hilibrand, Alan; Goldberg, Harley; Berven, Sigurd; An, Howard



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


Effect of simvastatin versus placebo on treadmill exercise time until the onset of intermittent claudication in older patients with peripheral arterial disease at six months and at one year after treatment.  


Simvastatin significantly increased treadmill exercise time until onset of intermittent claudication from baseline by 54 seconds (a 24% increase, p <0.0001) at 6 months after treatment and by 95 seconds (a 42% increase, p <0.0001) at 1 year after treatment. At 6 months and 1 year after treatment with placebo, treadmill exercise time until onset of intermittent claudication was not significantly different from baseline exercise time. PMID:12972114

Aronow, Wilbert S; Nayak, Devraj; Woodworth, Steven; Ahn, Chul



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 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 ...


The effects on depression of Internet-administered behavioural activation and physical exercise with treatment rationale and relapse prevention: study protocol for a randomised controlled trial  

PubMed Central

Background Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioural activation and physical exercise have not yet been directly compared. This study will examine the effects of these interventions, administered via the Internet. The added effect of providing a treatment rationale will also be studied, as well as a relapse prevention program featuring cognitive behavioural therapy components. Methods/Design This randomised controlled trial will include 500 participants meeting the diagnostic criteria for major depression, recruited in multiple cycles and randomised to either a waiting list control group with delayed treatment, or one of the four treatment groups: (1) physical exercise without a clear treatment rationale; (2) physical exercise with treatment rationale; (3) behavioural activation with treatment rationale; or (4) behavioural activation without a clear treatment rationale. Post treatment, half of the participants will be offered a relapse prevention program. Primary outcome measure will be the Patient Health Questionnaire 9-item. Secondary measures include diagnostic criteria for depression, as well as self-reported anxiety, physical activity and quality of life. Measurements - done via telephone and the Internet - will be collected pre-treatment, weekly during treatment period, immediately post treatment and then monthly during a 24-month follow-up period. Discussion The results of this study will constitute an important contribution to the body of knowledge of the respective interventions. Limitations are discussed. Trial registration NCT01619930



Peroral treatment with ciprofloxacin of patients with spinal cord lesion and bacteriuria caused by multiply resistant bacteria  

Microsoft Academic Search

Eleven patients, median age 38 years, with spinal cord lesion (SCL) and urinary tract infection (UTI) caused by multiply resistant bacteria entered an open clinical trial of peroral ciprofloxacin 250 mg b.i.d. for 6 days. P. aeruginosa was the most prevalent bacteria. Ciprofloxacin was clinically effective in all patients who had symptoms of UTI at entry. Bacterial eradication was achieved

S S Pedersen; S Hørbov; F Biering-Sørensen; N Høiby



An experimental electro-acupuncture study in treatment of the rat demyelinated spinal cord injury induced by ethidium bromide  

Microsoft Academic Search

Oligodendrocyte precursor cells (OPCs) are one of the potential treating tools for multiple sclerosis (MS). Therefore, the cell number and differentiation of OPCs in a demyelinated spinal cord are crucial for improvement of reparative process. In the present study, we investigated whether “Governor Vessel (GV)” electro-acupuncture (EA) could efficiently promote increase in cell number and differentiation of OPCs into oligodendrocytes,

Si-Fan Huang; Ying Ding; Jing-Wen Ruan; Wei Zhang; Jin-Lang Wu; Bing He; Yu-Jiao Zhang; Yan Li; Yuan-Shan Zeng



810 NM Light Treatment of Acute Spinal Cord Injury Alters the Immune Response and Improves Axonal Regeneration and Functional Recovery.  

National Technical Information Service (NTIS)

Spinal cord injury (SCI) results in substantial and often permanent impairment of function due to the lack of regeneration of damaged axons. Despite vigorous research, no cure for SCI has been found. Light therapy (LT), through the absorption of light by ...

K. R. Byrnes


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