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1

Spinal Loads during Post-Operative Physiotherapeutic Exercises  

PubMed Central

After spinal surgery, physiotherapeutic exercises are performed to achieve a rapid return to normal life. One important aim of treatment is to regain muscle strength, but it is known that muscle forces increase the spinal loads to potentially hazardous levels. It has not yet been clarified which exercises cause high spinal forces and thus endanger the surgical outcome. The loads on vertebral body replacements were measured in 5 patients during eleven physiotherapeutic exercises, performed in the supine, prone, or lateral position or on all fours (kneeling on the hands and knees). Low resultant forces on the vertebral body replacement were measured for the following exercises: lifting one straight leg in the supine position, abduction of the leg in the lateral position, outstretching one leg in the all-fours position, and hollowing the back in the all-fours position. From the biomechanical point of view, these exercises can be performed shortly after surgery. Implant forces similar or even greater than those for walking were measured during: lifting both legs, lifting the pelvis in the supine position, outstretching one arm with or without simultaneously outstretching the contralateral leg in the all-fours position, and arching the back in the all-fours position. These exercises should not be performed shortly after spine surgery.

Rohlmann, Antonius; Schwachmeyer, Verena; Graichen, Friedmar; Bergmann, Georg

2014-01-01

2

Proprioceptive neuropathy affects normalization of the H-reflex by exercise after spinal cord injury  

PubMed Central

The H-reflex habituates at relatively low frequency (10 Hz) stimulation in the intact spinal cord, but loss of descending inhibition resulting from spinal cord transection reduces this habituation. There is a return towards a normal pattern of low-frequency habituation in the reflex activity with cycling exercise of the affected hind limbs. This implies that repetitive passive stretching of the muscles in spinalized animals and the accompanying stimulation of large (Group I and II) proprioceptive fibers has modulatory effects on spinal cord reflexes after injury. To test this hypothesis, we induced pyridoxine neurotoxicity that preferentially affects large dorsal root ganglia neurons in intact and spinalized rats. Pyridoxine or saline injections were given twice daily (IP) for 6 weeks and half of the spinalized animals were subjected to cycling exercise during that period. After 6 weeks, the tibial nerve was stimulated electrically and recordings of M and H waves were made from interosseous muscles of the hind paw. Results show that pyridoxine treatment completely eliminated the H-reflex in spinal intact animals. In contrast, transection paired with pyridoxine treatment resulted in a reduction of the frequency-dependent habituation of the H-reflex that was not affected by exercise. These results indicate that normal Group I and II afferent input is critical to achieve exercise-based reversal of hyper-reflexia of the H-reflex after spinal cord injury.

Ollivier-Lanvin, Karen; Keeler, Benjamin E.; Siegfried, Rachel; Houle, John D.; Lemay, Michel A.

2009-01-01

3

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

NASA Astrophysics Data System (ADS)

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.

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

2012-12-01

4

Exercise awareness and barriers after spinal cord injury  

PubMed Central

Exercise is an essential element in managing several of the non-communicable diseases after spinal cord injury (SCI). Awareness of the importance of prescribing a customized exercise program that meets the goals of persons with SCI should be highly considered in the rehabilitation community. The barriers of implementing specific exercise program as well as the factors that may mask the outcomes of regular exercise regimen need to be continuously addressed as a part of patients’ rehabilitation care. The focus of this editorial is to encourage the medical community to consider routine physical activity as one of the necessary vital signs that needs to be routinely checked in patients with SCI. Providing education tips, nutritional counseling and engaging in recreational programs may provide motivational route to the community of SCI. This may result in reinforcing active lifestyle in survivors with SCI as well as to reduce the impact of chronic life threatening medical disorders.

Gorgey, Ashraf S

2014-01-01

5

Exercise awareness and barriers after spinal cord injury.  

PubMed

Exercise is an essential element in managing several of the non-communicable diseases after spinal cord injury (SCI). Awareness of the importance of prescribing a customized exercise program that meets the goals of persons with SCI should be highly considered in the rehabilitation community. The barriers of implementing specific exercise program as well as the factors that may mask the outcomes of regular exercise regimen need to be continuously addressed as a part of patients' rehabilitation care. The focus of this editorial is to encourage the medical community to consider routine physical activity as one of the necessary vital signs that needs to be routinely checked in patients with SCI. Providing education tips, nutritional counseling and engaging in recreational programs may provide motivational route to the community of SCI. This may result in reinforcing active lifestyle in survivors with SCI as well as to reduce the impact of chronic life threatening medical disorders. PMID:25035817

Gorgey, Ashraf S

2014-07-18

6

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

Microsoft Academic Search

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

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

2012-01-01

7

Nonsurgical treatment of thoracolumbar spinal fractures.  

PubMed

The transitional anatomy of the thoracolumbar spine makes it vulnerable to injury from high-energy vehicular crashes and falls. The definitive management of patients with thoracolumbar spinal fractures is dependent on the presence and extent of neurologic injury, the presence and magnitude of acute deformity, and an estimate concerning spinal stability. It is well established that neurologic deficits generally improve without surgery. Nonsurgical treatment leads to decreased pain and improved function. Although there is a dearth of high-quality studies comparing surgical with nonsurgical treatment, the natural course of thoracolumbar fractures usually is benign, and nonsurgical methods should be the standard treatment with few exceptions. PMID:19385572

Harris, Mitchel B; Shi, Lewis L; Vacarro, Alexander R; Zdeblick, Thomas A; Sasso, Rick C

2009-01-01

8

Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial  

PubMed Central

Background Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents. Methods/design This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment. Discussion This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents. Trial registration (ClinicalTrials.gov NCT01096628).

2014-01-01

9

Exercise Training after Spinal Cord Injury Selectively Alters Synaptic Properties in Neurons in Adult Mouse Spinal Cord  

PubMed Central

Abstract Following spinal cord injury (SCI), anatomical changes such as axonal sprouting occur within weeks in the vicinity of the injury. Exercise training enhances axon sprouting; however, the exact mechanisms that mediate exercised-induced plasticity are unknown. We studied the effects of exercise training after SCI on the intrinsic and synaptic properties of spinal neurons in the immediate vicinity (<2 segments) of the SCI. Male mice (C57BL/6, 9–10 weeks old) received a spinal hemisection (T10) and after 1 week of recovery, they were randomized to trained (treadmill exercise for 3 weeks) and untrained (no exercise) groups. After 3 weeks, mice were killed and horizontal spinal cord slices (T6–L1, 250??m thick) were prepared for visually guided whole cell patch clamp recording. Intrinsic properties, including resting membrane potential, input resistance, rheobase current, action potential (AP) threshold and after-hyperpolarization (AHP) amplitude were similar in neurons from trained and untrained mice (n=67 and 70 neurons, respectively). Neurons could be grouped into four categories based on their AP discharge during depolarizing current injection; the proportions of tonic firing, initial bursting, single spiking, and delayed firing neurons were similar in trained and untrained mice. The properties of spontaneous excitatory synaptic currents (sEPSCs) did not differ in trained and untrained animals. In contrast, evoked excitatory synaptic currents recorded after dorsal column stimulation were markedly increased in trained animals (peak amplitude 78.9±17.5 vs. 42.2±6.8 pA; charge 1054±376 vs. 348±75 pA·ms). These data suggest that 3 weeks of treadmill exercise does not affect the intrinsic properties of spinal neurons after SCI; however, excitatory synaptic drive from dorsal column pathways, such as the corticospinal tract, is enhanced.

Flynn, Jamie R.; Dunn, Lynda R.; Galea, Mary P.; Callister, Robin; Rank, Michelle M.

2013-01-01

10

Low-Grade Inflammation and Spinal Cord Injury: Exercise as Therapy?  

PubMed Central

An increase in the prevalence of obesity in people with spinal cord injury can contribute to low-grade chronic inflammation and increase the risk of infection in this population. A decrease in sympathetic activity contributes to immunosuppression due to the lower activation of immune cells in the blood. The effects of physical exercise on inflammatory parameters in individuals with spinal cord injury have not been well described. We conducted a review of the literature published from 1974 to 2012. This review explored the relationships between low-grade inflammation, spinal cord injury, and exercise to discuss a novel mechanism that might explain the beneficial effects of exercise involving an increase in catecholamines and cytokines in people with spinal cord injury.

da Silva Alves, Eduardo; de Aquino Lemos, Valdir; Ruiz da Silva, Francieli; Lira, Fabio Santos; dos Santos, Ronaldo Vagner Thomathieli; Rosa, Joao Paulo Pereira; Caperuto, Erico; Tufik, Sergio; de Mello, Marco Tulio

2013-01-01

11

Exercise induces cortical plasticity after neonatal spinal cord injury in the rat  

PubMed Central

Exercise-induced cortical plasticity is associated with improved functional outcome after brain or nerve injury. Exercise also improves functional outcomes after spinal cord injury, but its effects on cortical plasticity are not known. The goal of this investigation was to study the effect of moderate exercise (treadmill locomotion, 3 min/day, 5days/week) on the somatotopic organization of forelimb and hindlimb somatosensory cortex (SI) after neonatal thoracic transection. We used adult rats spinalized as neonates because some of these animals develop weight-supported stepping and, therefore, the relationship between cortical plasticity and stepping could also be examined. Acute, single-neuron mapping was used to determine the percentage of cortical cells responding to cutaneous forelimb stimulation in normal, spinalized, and exercised spinalized rats. Multiple single neuron recording from arrays of chronically implanted microwires examined the magnitude of response of these cells in normal and exercised spinalized rats. Our results show that exercise not only increased the percentage of responding cells in the hindlimb SI, but also increased the magnitude of the response of these cells. This increase in response magnitude was correlated with behavioral outcome measures. In the forelimb SI, neonatal transection reduced the percentage of responding cells to forelimb stimulation but exercise reversed this loss. This restoration in the percentage of responding cells after exercise was accompanied by an increase in their response magnitude. Therefore, the increase in responsiveness of hindlimb SI to forelimb stimulation after neonatal transection and exercise may be due, in part, to the effect of exercise on the forelimb SI.

Kao, T; Shumsky, JS; Murray, M; Moxon, KA

2009-01-01

12

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

PubMed

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

2013-03-26

13

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

PubMed Central

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 (6-fold increase), followed by swimming (3-fold increase) and voluntary running (2-fold 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 spinal cord is modulated by exercise.

McCullough, Monica J.; Gyorkos, Amy M.; Spitsbergen John, M.

2013-01-01

14

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

ERIC Educational Resources Information Center

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

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

2009-01-01

15

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

PubMed

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

2012-03-01

16

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

PubMed

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 T(13)-L(2) 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. PMID:23403764

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

2013-01-01

17

Treatment of symptomatic flatback after spinal fusion.  

PubMed

Fifty-five patients who had loss of lumbar lordosis after spinal fusion and subsequently had corrective osteotomies were studied. When they were first seen, fifty-two patients (95 per cent) were unable to stand erect and forty-nine (89 per cent) had back pain. The previous use of distraction instrumentation with a hook placed at the level of the lower lumbar spine or the sacrum was the factor that was most frequently identified as leading to the development of the flatback syndrome. Sixty-six extension osteotomies were performed in these fifty-five patients. Nineteen patients (35 per cent) had an associated anterior spinal fusion. Thirty-three patients (60 per cent) had one or more complications, including pseudarthrosis, a dural tear, failure of hardware, neurapraxia, and urinary tract infection. The results of the operation were evaluated at follow-up by review of clinical records, radiographs, and questionnaires. At an average follow-up of six years (range, two to fourteen years), most patients felt that they had benefited from the corrective osteotomies. However, twenty-six patients (47 per cent) continued to lean forward and twenty patients (36 per cent) continued to have moderate or severe back pain. The failure to restore sagittal plane balance led to a higher rate of pseudarthrosis, which was associated with recurrent deformity. Anterior spinal fusion combined with posterior osteotomy resulted in greater maintenance of correction. The prevention of flatback syndrome is important, since its treatment is difficult. When a spinal fusion must be extended to the level of the lower lumbar spine or the sacrum, the use of distraction instrumentation should be avoided in order to prevent this deformity. PMID:3356724

Lagrone, M O; Bradford, D S; Moe, J H; Lonstein, J E; Winter, R B; Ogilvie, J W

1988-04-01

18

THE EFFECTS OF EXERCISE TRAINING ON CARDIOVASCULAR REGULATION IN INDIVIUALS WITH SPINAL CORD INJURY  

Microsoft Academic Search

Introduction. Individuals with spinal cord injury (SCI) are prone to severe cardiovascular dysfunction and an increased risk of mortality from various cardiovascular diseases. The underlying mechanisms responsible for the increased cardiovascular risk are not precisely understood, however, the reduced activity levels that accompany SCI certainly contribute. Unfortunately, muscular paralysis (partial or complete) limits the exercise options for individuals with SCI

DAVID DITOR

2003-01-01

19

Thoracolumbar spinal manipulation and the immediate impact on exercise performance  

PubMed Central

Objective The purpose of this study was to determine if thoracolumbar chiropractic manipulative therapy (CMT) had an immediate impact on exercise performance by measuring blood lactate concentration, exercise heart rate, and rating of perceived exertion during a treadmill-based graded exercise test (GXT). Methods Ten healthy, asymptomatic male and 10 female college students (age = 27.5 ± 3.7 years, height = 1.68 ± 0.09 m, body mass = 71.3 ± 11.6 kg: mean ± SD) were equally randomized into an AB:BA crossover study design. Ten participants were in the AB group, and 10 were in the BA group. The study involved 1 week of rest in between each of the 2 conditions: A (prone Diversified T12-L1 CMT) vs B (no CMT). Participants engaged in a treadmill GXT 5 minutes after each week's condition (A or B). Outcome measures were blood lactate concentration, exercise heart rate, and rating of perceived exertion monitored at the conclusion of each 3-minute stage of the GXT. The exercise test continued until the participant achieved greater than 8 mmol/L blood lactate, which correlates with maximal to near-maximal exercise effort. A dependent-samples t test was used to make comparisons between A and B conditions related to exercise performance. Results No statistically significant difference was shown among any exercise response dependent variables in this study. Conclusions The results of this research preliminarily suggest that CMT to T12-L1 does not immediately impact exercise performance during a treadmill-based GXT using healthy college students.

Ward, John S.; Coats, Jesse; Ramcharan, Michael; Humphries, Kelley; Tong, Tammy; Chu, Cheuk

2012-01-01

20

Treatment Option Overview (Childhood Brain and Spinal Cord Tumors)  

MedlinePLUS

... symptoms that begin before diagnosis and continue for months or years. Childhood brain and spinal cord tumors ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. These are ...

21

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.

2013-01-01

22

Occupational therapy treatment time during inpatient spinal cord injury rehabilitation  

PubMed Central

Background Occupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously. Objective To describe the type and distribution of SCI rehabilitation OT activities, including the amount of time spent on evaluation and treatment, and to discuss predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities. Methods Six inpatient rehabilitation centers enrolled 600 patients with traumatic SCI in the first year of the SCIRehab. Occupational therapists documented 32 512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables. Results SCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time (individual and group sessions combined) were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of ‘therapeutic activities’ that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure (FIM) score, neurologic injury group, and the medical severity of illness score. Conclusion OT treatment patterns for patients with traumatic SCI show much variation in activity selection and time spent on activities, within and among neurologic level of injury groups. Some of the variation can be explained by patient and injury characteristics. Almost all patients with SCI participated in strengthening/endurance and ROM/stretching exercises during OT treatment and these two activities are where the most time was spent when therapy provided in individual and group settings was combined. ADL work consumed the most time in individual therapy sessions.

Foy, Teresa; Perritt, Ginger; Thimmaiah, Deepa; Heisler, Lauren; Offutt, Jennifer Lookingbill; Cantoni, Kara; Hseih, Ching-Hui; Gassaway, Julie; Ozelie, Rebecca; Backus, Deborah

2011-01-01

23

Differential brain and spinal cord cytokine and BDNF levels in experimental autoimmune encephalomyelitis are modulated by prior and regular exercise.  

PubMed

The interactions between a prior program of regular exercise and the development of experimental autoimmune encephalomyelitis (EAE)-mediated responses were evaluated. In the exercised EAE mice, although there was no effect on infiltrated cells, the cytokine and derived neurotrophic factor (BDNF) levels were altered, and the clinical score was attenuated. Although, the cytokine levels were decreased in the brain and increased in the spinal cord, BDNF was elevated in both compartments with a tendency of lesser demyelization volume in the spinal cord of the exercised EAE group compared with the unexercised. PMID:24054000

Bernardes, Danielle; Oliveira-Lima, Onésia Cristina; Silva, Thiago Vitarelli da; Faraco, Camila Cristina Fraga; Leite, Hércules Ribeiro; Juliano, Maria Aparecida; Santos, Daniel Moreira dos; Bethea, John R; Brambilla, Roberta; Orian, Jacqueline M; Arantes, Rosa Maria Esteves; Carvalho-Tavares, Juliana

2013-11-15

24

Exercise training as treatment in cancer cachexia.  

PubMed

Cachexia is a wasting syndrome that may accompany a plethora of diseases, including cancer, chronic obstructive pulmonary disease, aids, and rheumatoid arthritis. It is associated with central and systemic increases of pro-inflammatory factors, and with decreased quality of life, response to pharmacological treatment, and survival. At the moment, there is no single therapy able to reverse cachexia many symptoms, which include disruption of intermediary metabolism, endocrine dysfunction, compromised hypothalamic appetite control, and impaired immune function, among other. Growing evidence, nevertheless, shows that chronic exercise, employed as a tool to counteract systemic inflammation, may represent a low-cost, safe alternative for the prevention/attenuation of cancer cachexia. Despite the well-documented capacity of chronic exercise to counteract sustained disease-related inflammation, few studies address the effect of exercise training in cancer cachexia. The aim of the present review was hence to discuss the results of cachexia treatment with endurance training. As opposed to resistance exercise, endurance exercise may be performed devoid of equipment, is well tolerated by patients, and an anti-inflammatory effect may be observed even at low-intensity. The decrease in inflammatory status induced by endurance protocols is paralleled by recovery of various metabolic pathways. The mechanisms underlying the response to the treatment are considered. PMID:24797380

Lira, Fábio Santos; Neto, José Cesar Rosa; Seelaender, Marília

2014-06-01

25

Metabolic and cardiopulmonary responses to acute progressive resistive exercise in a person with C4 spinal cord injury  

Microsoft Academic Search

Study design: Single-subject (female, 38 years of age) case.Objectives: To describe metabolic and cardiopulmonary responses to progressive resistive exercise in an individual with C4 ASIA A tetraplegia, and to review the relationship between level of spinal cord injury (SCI) and exercise responses.Setting: Large, urban mid-western city rehabilitation hospital in United States of America.Methods: Bilateral shoulder elevation\\/depression (shoulder shrug) exercise with

TJ Birk; E Nieshoff; G Gray; J Steeby; K Jablonski

2001-01-01

26

Pathogenesis, presentation, and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities.  

PubMed

Sagittal- or coronal-plane deformity considerably complicates the diagnosis and treatment of lumbar spinal stenosis. Although decompressive laminectomy remains the standard operative treatment for uncomplicated lumbar spinal stenosis, the management of stenosis with concurrent deformity may require osteotomy, laminectomy, and spinal fusion with or without instrumentation. Broadly stated, the surgery-related goals in complex stenosis are neural decompression and a well-balanced sagittal and coronal fusion. Deformities that may present with concurrent stenosis are scoliosis, spondylolisthesis, and flatback deformity. The presentation and management of lumbar spinal stenosis associated with concurrent coronal or sagittal deformities depends on the type and extent of deformity as well as its impact on neural compression. Generally, clinical outcomes in complex stenosis are optimized by decompression combined with spinal fusion. The need for instrumentation is clear in cases of significant scoliosis or flatback deformity but is controversial in spondylolisthesis. With appropriate selection of technique for deformity correction, a surgeon may profoundly improve pain, quality of life, and functional capacity. The decision to undertake surgery entails weighing risk factors such as age, comorbidities, and preoperative functional status against potential benefits of improved neurological function, decreased pain, and reduced risk of disease progression. The purpose of this paper is to review the pathogenesis, presentation, and treatment of lumbar spinal stenosis complicated by scoliosis, spondylolisthesis, or flatback deformity. Specific attention is paid to surgery-related goals, decision making, techniques, and outcomes. PMID:15766223

Fraser, Justin F; Huang, Russel C; Girardi, Federico P; Cammisa, Frank P

2003-01-15

27

[Neurosurgical treatment of spinal dysraphism in children].  

PubMed

A tethered cord syndrome includes in its meaning all types of dysraphism in children. The syndrome is described in regard to its etiology, pathophysiology and clinical outcome. Next, the most prevalent types of dysraphism in children are presented. A surgical approach in myelocele--the most frequent defect--is discussed in detail. Reasons for taking a difficult decision not to operate are considered. The most important operative problems are also reviewed. It is reminded that myelocele often coexists with Arnold-Chiari malformation type II and hydrocephalus. Problems in selecting an appropriate surgical approach in this syndrome are shortly discussed. A rare syndrome of sacral agenesis, poorly amenable to surgical intervention, is presented. There are also some less frequent syndromes described, including:-sinus dermalis, potentially life-threatening in the case of recurrent meningitis;-lipomyelocele, needing early identification and prophylactic surgical treatment;-diastematomyelia, in half of the cases requiring surgery due to a bony spur;-retethered cord syndrome, an iatrogenic complication of neurosurgical interventions done on the spinal cord. PMID:9656749

Harasiewicz, M

1998-01-01

28

The Effects of Aquatic Exercise on Pulmonary Function in Patients with Spinal Cord Injury  

PubMed Central

[Purpose] The purpose of this study was to determine the effects of aquatic exercise on pulmonary function of patients with spinal cord injury. [Subjects] The subjects were randomly allocated to an aqua group (n=10) and a land group (n=10). [Methods] Both groups trained for 60 minutes, 3 times a week for 8 weeks. Pulmonary function was assessed by measuring the forced vital capacity (FVC), forced expiratory flow rate (FER), force expiratory volume at one second (FEV1) and force expiratory volume at one second/forced vital capacity (FEV1/FVC). [Results] Following the intervention, the aqua group showed significant changes in FVC, FER, FEV1, and FEV1/FVC. The land group showed only significant differences FER. [Conclusion] The results of this study suggest the effects on the aqua group were significantly higher than those on the land group in patients with spinal cord injury.

Jung, JaeHyun; Chung, EunJung; Kim, Kyoung; Lee, Byoung-Hee; Lee, JiYeun

2014-01-01

29

Conservative and Surgical Treatment Improves Pain and Ankle-Brachial Index in Patients with Lumbar Spinal Stenosis  

PubMed Central

Purpose The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. Materials and Methods One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. Results Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). Conclusion This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.

Yamashita, Masaomi; Murata, Yasuaki; Eguchi, Yawara; Aoki, Yasuchika; Ataka, Hiromi; Hirayama, Jiro; Ozawa, Tomoyuki; Morinaga, Tatsuo; Arai, Hajime; Mimura, Masaya; Kamoda, Hiroto; Orita, Sumihisa; Miyagi, Masayuki; Miyashita, Tomohiro; Okamoto, Yuzuru; Ishikawa, Tetsuhiro; Sameda, Hiroaki; Kinoshita, Tomoaki; Hanaoka, Eiji; Suzuki, Miyako; Suzuki, Munetaka; Aihara, Takato; Ito, Toshinori; Inoue, Gen; Yamagata, Masatsune; Toyone, Tomoaki; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Takahashi, Kazuhisa

2013-01-01

30

Preoperative embolization in the treatment of spinal metastasis.  

PubMed

Because of advances in the treatment of cancer, the average rate of patient survival is increasing. As patients with cancer live longer, the incidence of spinal metastasis also likely will increase. To help control pain and maintain function, some of these metastases will require surgical intervention. Because >60% of spinal metastases are hypervascular, preoperative embolization may be considered in order to decrease hemorrhage risk and improve outcomes. Embolization for spinal metastasis can be performed through the angiogram catheter. When such embolization is performed carefully, the complication rate is low. PMID:20675637

Truumees, Eeric; Dodwad, Shah-Nawaz; Kazmierczak, Chris D

2010-08-01

31

Acute exercise prevents the development of neuropathic pain and the sprouting of non-peptidergic (GDNF- and artemin-responsive) c-fibers after spinal cord injury.  

PubMed

Spinal cord injury (SCI) impaired sensory fiber transmission leads to chronic, debilitating neuropathic pain. Sensory afferents are responsive to neurotrophic factors, molecules that are known to promote survival and maintenance of neurons, and regulate sensory neuron transduction of peripheral stimuli. A subset of primary afferent fibers responds only to the glial cell-line derived neurotrophic factor (GDNF) family of ligands (GFLs) and is non-peptidergic. In peripheral nerve injury models, restoration of GDNF or artemin (another GFL) to pre-injury levels within the spinal cord attenuates neuropathic pain. One non-invasive approach to increase the levels of GFLs in the spinal cord is through exercise (Ex), and to date exercise training is the only ameliorative, non-pharmacological treatment for SCI-induced neuropathic pain. The purpose of this study was 3-fold: 1) to determine whether exercise affects the onset of SCI-induced neuropathic pain; 2) to examine the temporal profile of GDNF and artemin in the dorsal root ganglia and spinal cord dorsal horn regions associated with forepaw dermatomes after SCI and Ex; and 3) to characterize GFL-responsive sensory fiber plasticity after SCI and Ex. Adult, female, Sprague-Dawley rats received a moderate, unilateral spinal cord contusion at C5. A subset of rats was exercised (SCI+Ex) on automated running wheels for 20min, 5days/week starting at 5days post-injury (dpi), continuing until 9 or 37dpi. Hargreaves' and von Frey testing was performed preoperatively and weekly post-SCI. Forty-two percent of rats in the unexercised group exhibited tactile allodynia of the forepaws while the other 58% retained normal sensation. The development of SCI-induced neuropathic pain correlated with a marked decrease in the levels of GDNF and artemin in the spinal cord and DRGs. Additionally, a dramatic increase in the density and the distribution throughout the dorsal horn of GFL-responsive afferents was observed in rats with SCI-induced allodynia. Importantly, in SCI rats that received Ex, the incidence of tactile allodynia decreased to 7% (1/17) and there was maintenance of GDNF and artemin at normal levels, with a normal distribution of GFL-responsive fibers. These data suggest that GFLs and/or their downstream effectors may be important modulators of pain fiber plasticity, representing effective targets for anti-allodynic therapeutics. Furthermore, we highlight the potent beneficial effects of acute exercise after SCI. PMID:24560714

Detloff, Megan Ryan; Smith, Evan J; Quiros Molina, Daniel; Ganzer, Patrick D; Houlé, John D

2014-05-01

32

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

2012-01-01

33

Treatment of severe double spinal cord injuries  

Microsoft Academic Search

This is a case report describing an injury – sustained by a 25-year-old man during a car accident, and characterized by fracture dislocation of the spine at the level of C7 and T4 accompanied by pulmonary contusion. He had an incomplete spinal cord lesion at the level of C7 and a complete lesion at the level of T4 (T4 ASIA

A Csókay; T Pentelényi; CH Tator; TEP Barros; WS El Masry; PS Ramani

2001-01-01

34

Stereotactic radiosurgery for spinal metastases: update on treatment strategies.  

PubMed

Metastatic tumors are the most common tumors that affect the spinal column and are the source of significant pain and disability in cancer patients. The management of symptomatic spinal metastases presents unique challenges to surgeons as a number of considerations specific to the underlying tumor histology, extent of disease, the functional status of the patient and response to systemic therapy often affect the role, timing and effectiveness of any surgical intervention. As surgical techniques have evolved, the focus of therapy has shifted towards minimizing the morbidity associated with treatments for patients in whom limited nutrition and functional reserve impact their overall survival. As such, stereotactic spinal radiosurgery (SRS) has emerged as a powerful adjunct to surgery as well as a stand-alone treatment option for patients with metastatic disease. Recent technological innovations such as intensity-modulated radiation therapy, image-guidance, and non-invasive spine immobilization have made significant improvements to the delivery of highly conformal radiation to spinal tumors. In this article, current treatment strategies utilizing SRS in the multidisciplinary management of spinal metastases are discussed. PMID:21968584

Shin, J H; Chao, S T; Angelov, L

2011-09-01

35

Spinal cord response to laser treatment of injured peripheral nerve  

SciTech Connect

The authors describe the changes occurring in the spinal cord of rats subjected to crush injury of the sciatic nerve followed by low-power laser irradiation of the injured nerve. Such laser treatment of the crushed peripheral nerve has been found to mitigate the degenerative changes in the corresponding neurons of the spinal cord and induce proliferation of neuroglia both in astrocytes and oligodendrocytes. This suggests a higher metabolism in neurons and a better ability for myelin production under the influence of laser treatment.

Rochkind, S.; Vogler, I.; Barr-Nea, L. (Ichilov Hospital, Tel-Aviv Medical Center (Israel))

1990-01-01

36

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

PubMed

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

2013-08-01

37

Treatment of infertility in men with spinal cord injury  

Microsoft Academic Search

Most men with spinal cord injury (SCI) are infertile. Erectile dysfunction, ejaculatory dysfunction and semen abnormalities contribute to the problem. Treatments for erectile dysfunction include phosphodiesterase type 5 inhibitors, intracavernous injections of alprostadil, penile prostheses, and vacuum constriction devices. In anejaculatory patients who wish to father children, semen retrieval is necessary. Penile vibratory stimulation is recommended as the first line

Charles M. Lynne; Emad Ibrahim; Dana A. Ohl; Jens Sønksen; Nancy L. Brackett

2010-01-01

38

Effect of abdominal binding on respiratory mechanics during exercise in athletes with cervical spinal cord injury.  

PubMed

We asked whether elastic binding of the abdomen influences respiratory mechanics during wheelchair propulsion in athletes with cervical spinal cord injury (SCI). Eight Paralympic wheelchair rugby players with motor-complete SCI (C5-C7) performed submaximal and maximal incremental exercise tests on a treadmill, both with and without abdominal binding. Measurements included pulmonary function, pressure-derived indices of respiratory mechanics, operating lung volumes, tidal flow-volume data, gas exchange, blood lactate, and symptoms. Residual volume and functional residual capacity were reduced with binding (77 ± 18 and 81 ± 11% of unbound, P < 0.05), vital capacity was increased (114 ± 9%, P < 0.05), whereas total lung capacity was relatively well preserved (99 ± 5%). During exercise, binding introduced a passive increase in transdiaphragmatic pressure, due primarily to an increase in gastric pressure. Active pressures during inspiration were similar across conditions. A sudden, sustained rise in operating lung volumes was evident in the unbound condition, and these volumes were shifted downward with binding. Expiratory flow limitation did not occur in any subject and there was substantial reserve to increase flow and volume in both conditions. V?o2 was elevated with binding during the final stages of exercise (8-12%, P < 0.05), whereas blood lactate concentration was reduced (16-19%, P < 0.05). V?o2/heart rate slopes were less steep with binding (62 ± 35 vs. 47 ± 24 ml/beat, P < 0.05). Ventilation, symptoms, and work rates were similar across conditions. The results suggest that abdominal binding shifts tidal breathing to lower lung volumes without influencing flow limitation, symptoms, or exercise tolerance. Changes in respiratory mechanics with binding may benefit O2 transport capacity by an improvement in central circulatory function. PMID:24855136

West, Christopher R; Goosey-Tolfrey, Victoria L; Campbell, Ian G; Romer, Lee M

2014-07-01

39

Spinal epidural abscess: the importance of early diagnosis and treatment  

PubMed Central

OBJECTIVES—To remind clinicians of the dangers of delayed diagnosis and the importance of early treatment of spinal epidural abscess.?METHODS—A review of the literature on spinal epidural abscess and a comparison of the published literature with local experience.?RESULTS—Imaging with MRI or CT enables early diagnosis of spinal epidural abcess and optimal therapy is surgical evacuation combined with 6-12 weeks (median 8 weeks) of antimicrobial chemotherapy. Clinical features are fever, pain, and focal neurological signs and may be associated with preceding and pre-existing bone or joint disease. The commonest aetiological organism is S aureus.?CONCLUSION—Early diagnosis and appropriate early antimicrobial chemotherapy with surgery is associated with an excellent prognosis.??

Mackenzie, A; Laing, R; Smith, C; Kaar, G; Smith, F

1998-01-01

40

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

2012-01-01

41

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

2013-01-01

42

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

PubMed

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

1996-01-01

43

Intensive exercise program after spinal cord injury ("Full-On"): study protocol for a randomized controlled trial  

PubMed Central

Background Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise. Methods/Design A multicenter, parallel group, assessor-blinded randomized controlled trial will be conducted. One hundred eighty-eight participants with spinal cord injury, who have completed their primary rehabilitation at least 6 months prior, will be recruited from five SCI units in Australia and New Zealand. Participants will be randomized to an experimental or control group. Experimental participants will receive a 12-week program of intensive exercise for the whole body, including locomotor training, trunk exercises and functional electrical stimulation-assisted cycling. Control participants will receive a 12-week intensive upper body exercise program. The primary outcome is the American Spinal Injuries Association (ASIA) Motor Score. Secondary outcomes include measurements of sensation, function, pain, psychological measures, quality of life and cost effectiveness. All outcomes will be measured at baseline, 12 weeks, 6 months and 12 months by blinded assessors. Recruitment commenced in January 2011. Discussion The results of this trial will determine the effectiveness of a 12-week program of intensive exercise for the whole body in improving neurological recovery after spinal cord injury. Trial registration NCT01236976 (10 November 2010), ACTRN12610000498099 (17 June 2010).

2013-01-01

44

Treadmill exercise reduces spinal cord injury-induced apoptosis by activating the PI3K/Akt pathway in rats  

PubMed Central

Apoptosis occurring secondary to spinal cord injury (SCI) causes further neural damage and functional loss. In this study, a rat model was used to investigate the effect of treadmill exercise on SCI-induced apoptosis and expression of neurotrophic factors. To produce SCI, a contusion injury (10 g × 25 mm) was applied subsequent to laminectomy at the T9–T10 level. Following SCI, treadmill exercise was performed for six weeks. Hindlimb motor function was evaluated with a grid-walking test. The expression of neurotrophic factors and the level of apoptosis at the site of SCI were determined by western blotting. SCI reduced hindlimb motor function and suppressed expression of neurotrophin (NT)-3 and insulin-like growth factor (IGF)-1. Expression of phosphatidylinositol 3-kinase (PI3K), the ratio of phosphorylated Akt to Akt (pAkt/Akt) and the ratio of B-cell lymphoma 2 (Bcl-2) to Bax (Bcl-2/Bax) were decreased, and cleaved caspase-3 expression was increased by SCI. Treadmill exercise enhanced hindlimb motor function and increased expression of nerve growth factor (NGF), NT-3 and IGF-1 in the SCI rats. Treadmill exercise increased PI3K expression, the pAkt/Akt and the Bcl-2/Bax ratios, and suppressed cleaved caspase-3 expression in the injured spinal cord. This study demonstrated that treadmill exercise promotes the recovery of motor function by suppressing apoptosis in the injured spinal cord. The beneficial effect of exercise may be attributed to the increase in expression of neurotrophic factors via activation of the PI3K/Akt pathway.

JUNG, SUN-YOUNG; KIM, DAE-YOUNG; YUNE, TAE YOUNG; SHIN, DONG-HOON; BAEK, SANG-BIN; KIM, CHANG-JU

2014-01-01

45

Acute and prolonged hindlimb exercise elicits different gene expression in motoneurons than sensory neurons after spinal cord injury.  

PubMed

We examined gene expression in the lumbar spinal cord and the specific response of motoneurons, intermediate gray and proprioceptive sensory neurons after spinal cord injury and exercise of hindlimbs to identify potential molecular processes involved in activity dependent plasticity. Adult female rats received a low thoracic transection and passive cycling exercise for 1 or 4weeks. Gene expression analysis focused on the neurotrophic factors: brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), neurotrophin-3 (NT-3), neurotrophin-4 (NT-4), and their receptors because of their potential roles in neural plasticity. We also examined expression of genes involved in the cellular response to injury: heat shock proteins (HSP) -27 and -70, glial fibrillary acidic protein (GFAP) and caspases -3, -7, and -9. In lumbar cord samples, injury increased the expression of mRNA for TrkB, all three caspases and the HSPs. Acute and prolonged exercise increased expression of mRNA for the neurotrophic factors BDNF and GDNF, but not their receptors. It also increased HSP expression and decreased caspase-7 expression, with changes in protein levels complimentary to these changes in mRNA expression. Motoneurons and intermediate gray displayed little change in mRNA expression following injury, but acute and prolonged exercise increased levels of mRNA for BDNF, GDNF and NT-4. In large DRG neurons, mRNA for neurotrophic factors and their receptors were largely unaffected by either injury or exercise. However, caspase mRNA expression was increased by injury and decreased by exercise. Our results demonstrate that exercise affects expression of genes involved in plasticity and apoptosis in a cell specific manner and that these change with increased post-injury intervals and/or prolonged periods of exercise. PMID:22244304

Keeler, Benjamin E; Liu, Gang; Siegfried, Rachel N; Zhukareva, Victoria; Murray, Marion; Houlé, John D

2012-02-15

46

Acute and Prolonged Hindlimb Exercise Elicits Different Gene Expression in Motoneurons than Sensory Neurons after Spinal Cord Injury  

PubMed Central

We examined gene expression in the lumbar spinal cord and the specific response of motoneurons, intermediate gray and proprioceptive sensory neurons after spinal cord injury and exercise of hindlimbs to identify potential molecular processes involved in activity dependent plasticity. Adult female rats received a low thoracic transection and passive cycling exercise for 1 or 4 weeks. Gene expression analysis focused on the neurotrophic factors; brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), neurotrophin-3 (NT-3), neurotrophin-4 (NT-4), and their receptors because of their potential roles in neural plasticity. We also examined expression of genes involved in the cellular response to injury; heat shock proteins (HSP) -27 and -70, glial fibrillary acidic protein (GFAP) and caspases -3, -7, and -9. In lumbar cord samples, injury increased the expression of mRNA for TrkB, all three caspases and the HSPs. Acute and prolonged exercise increased expression of mRNA for the neurotrophic factors BDNF and GDNF, but not their receptors. It also increased HSP expression and decreased caspase-7 expression, with changes in protein levels complimentary to these changes in mRNA expression. Motoneurons and intermediate grey displayed little change in mRNA expression following injury, but acute and prolonged exercise increased levels of mRNA for BDNF, GDNF and NT-4. In large DRG neurons, mRNA for neurotrophic factors and their receptors were largely unaffected by either injury or exercise. However, caspase mRNA expression was increased by injury and decreased by exercise. Our results demonstrate that exercise affects expression of genes involved in plasticity and apoptosis in a cell specific manner and that these change with increased post-injury intervals and/or prolonged periods of exercise.

Keeler, Benjamin E.; Liu, Gang; Siegfried, Rachel N.; Zhukareva, Victoria; Murray, Marion; Houle, John D.

2011-01-01

47

Spontaneous spinal epidural haemorrhage: good results after early treatment.  

PubMed Central

Extravasation of blood in the spinal epidural space is an uncommon but often disastrous problem. Severe trauma, anticoagulants, bleeding diatheses, and intraspinal vascular malformations have been associated with such haemorrhage, but occasionally it occurs without apparent cause. It may then be confused with transverse myelopathy or vascular occlusion. Early diagnosis by myelography and treatment by surgery can result in good recovery, as illustrated by two cases.

Grollmus, J; Hoff, J

1975-01-01

48

Spontaneous spinal epidural haemorrhage: good results after early treatment.  

PubMed

Extravasation of blood in the spinal epidural space is an uncommon but often disastrous problem. Severe trauma, anticoagulants, bleeding diatheses, and intraspinal vascular malformations have been associated with such haemorrhage, but occasionally it occurs without apparent cause. It may then be confused with transverse myelopathy or vascular occlusion. Early diagnosis by myelography and treatment by surgery can result in good recovery, as illustrated by two cases. PMID:1117304

Grollmus, J; Hoff, J

1975-01-01

49

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

PubMed Central

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

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

2010-01-01

50

Clinical presentation and treatment considerations of a ruptured posterior spinal artery pseudoaneurysm.  

PubMed

Spinal artery pseudoaneurysms are rare vascular lesions with poorly defined natural history, diagnostic paradigms, and treatment strategies. We present a 68-year-old woman with severe back pain and left lower extremity weakness with spinal subarachnoid hemorrhage due to a ruptured T5 region posterior spinal artery pseudoaneurysm, and review issues related to radiologic diagnosis and endovascular and open neurosurgical interventions. PMID:24572933

Bell, Donnie L; Stapleton, Christopher J; Terry, Anna R; Stone, James R; Ogilvy, Christopher S

2014-07-01

51

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

2006-01-01

52

The role of exercise in cancer treatment: bridging the gap.  

PubMed

In recent years, there has been a burgeoning amount of evidence-based scientific data demonstrating the benefit of exercise during and following cancer treatment. This compelling evidence has resulted in major stakeholders in cancer management, including the American College of Sports Medicine, American Society of Clinical Oncology, National Comprehensive Cancer Network, American Cancer Society, Oncology Nursing Society, and the Commission on Cancer, advocating exercise as an integral component of cancer care. Despite the acknowledgment of exercise as an essential component, it remains virtually absent in routine cancer treatment. This article discusses the role of exercise in cancer treatment utilizing a community-based program. The rationale presented is that a scalable and replicable standard of care model is a plausible avenue to assimilate exercise into routine oncology practice. PMID:25014390

Kimmel, Gary T; Haas, Barbara K; Hermanns, Melinda

2014-01-01

53

Survival and Recurrence Rate after Treatment for Primary Spinal Sarcomas  

PubMed Central

Objective We have limited understanding on the presentation and survival of primary spinal sarcomas. The survival, recurrence rate, and related prognostic factors were investigated after treatment for primary sarcomas of the spine. Methods Retrospective analysis of medical records and radiological data was done for 29 patients in whom treatment was performed due to primary sarcoma of the spine from 2000 to 2010. As for treatment method, non-radical operation, radiation therapy, and chemotherapy were simultaneously or sequentially combined. Overall survival (OS), progression free survival (PFS), ambulatory function, and pain status were analyzed. In addition, factors affecting survival and recurrence were analyzed : age (?42 or ?43), gender, tumor histologic type, lesion location (mobile spine or rigid spine), weakness at diagnosis, pain at diagnosis, ambulation at diagnosis, initial treatment, radiation therapy, kind of irradiation, surgery, chemotherapy and distant metastasis. Results Median OS was 60 months, the recurrence rate was 79.3% and median PFS was 26 months. Patients with distant metastasis showed significantly shorter survival than those without metastasis. No factors were found to be significant relating to recurrence. Prognostic factor associated with walking ability was the presence of weakness at diagnosis. Conclusion Primary spinal sarcomas are difficult to cure and show high recurrence rate. However, the development of new treatment methods is improving survival.

Cho, Wonik

2013-01-01

54

Exercise as an Intervention During Breast Cancer Treatment  

Microsoft Academic Search

\\u000a Exercise is becoming an integral part of breast cancer rehabilitation. A growing body of evidence indicates that women experience\\u000a improved health-related physical fitness and reduced fatigue through exercise, not only after breast cancer treatment has\\u000a finished but during treatment. In this chapter, a systematic review is presented that summarises the findings of controlled\\u000a trials that have examined the effects of

Martina Markes

55

Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial  

PubMed Central

Background Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. Methods/design This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Discussion Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. Trial registration ClinicalTrials.gov identifier: NCT01943435

2014-01-01

56

Cycling Exercise Affects the Expression of Apoptosis-Associated microRNAs after Spinal Cord Injury in Rats  

PubMed Central

There are two major aspects to a spinal cord injury (SCI): an acute, primary mechanical trauma and a progressive phase of secondary tissue damage provoked by inflammation, excitotoxicity, apoptosis and demyelination. MicroRNAs (miRs) are small, ~22 nucleotide, non-protein-coding RNAs that function at the post-transcriptional level to regulate gene expression. They have important roles in homeostatic processes such as cell proliferation and programmed cell death. In the injured rat spinal cord we performed an expression analysis of miRs and their downstream targets involved in apoptotic pathways and used post-injury cycling exercise to test for activity dependent plasticity of miR expression. We show that SCI results in increased expression of miR Let-7a and miR16 while exercise leads to elevated levels of miR21 and decreased levels of miR15b. These changes in miR expression are correlated with changes in expression of their target genes: pro-apoptotic (decreased PTEN, PDCD4 and RAS mRNA) and anti-apoptotic (increased Bcl-2 mRNA) target genes. This is accompanied by a down regulation of mRNA for caspase-7 and caspase-9 and reduced levels of caspase-7 protein. These results indicates possible beneficial effects of exercise through action on multiple miRs and their targets that contribute to the functional regulation of apoptosis after SCI.

Liu, Gang; Keeler, Benjamin E.; Zhukareva, Victoria; Houle, John D.

2010-01-01

57

Onyx injection by direct puncture for the treatment of hypervascular spinal metastases close to the anterior spinal artery: initial experience.  

PubMed

Presurgical devascularization of hypervascular spinal metastases has been shown to be effective in preventing major blood loss during open surgery. Most often, embolization can be performed using polyvinyl alcohol (PVA) microparticles. However, in some cases, the close relationship between the feeders of the metastases and the feeders of the anterior spinal artery (ASA) poses a risk of spinal cord ischemia when PVA microparticle embolization is performed. The authors present their early experience in the treatment of spinal metastases close to the ASA; in 2 cases they injected Onyx-18, by direct puncture, into hypervascular posterior arch spinal metastases situated close to the ASA. Two women, one 36 and the other 55 years of age, who presented with spinal lesions (at the posterior arch of C-4 and T-6, respectively) from thyroid and a kidney tumors, were sent to the authors' department to undergo presurgical embolization. After having performed a complete spinal digital subtraction angiography study, a regular angiography catheter was positioned at the ostium of the artery that mainly supplied the lesion. Then, with the patient in the left lateral decubitus position, direct puncture with 18-gauge needles of the lesion was performed using roadmap guidance. Onyx-18 was injected through the needles under biplanar fluoroscopy. Satisfactory devascularization of the lesions was obtained; the ASA remained patent in both cases. The metastases were surgically removed in both cases within the 48 hours after the embolization and major blood loss did not occur. Presurgical devascularization of hypervascular spinal metastases close the ASA by direct puncture with Onyx-18 seems to be an effective technique and appears to be safe in terms of the preserving the ASA's patency. PMID:23600580

Clarençon, Frédéric; Di Maria, Federico; Cormier, Evelyne; Sourour, Nader-Antoine; Enkaoua, Eric; Sailhan, Frédéric; Iosif, Christina; Le Jean, Lise; Chiras, Jacques

2013-06-01

58

Silk peptide treatment can improve the exercise performance of mice  

PubMed Central

Background We previously reported that silk peptide (SP) treatment led to increased resting fat oxidation in exercised mice. However, it was not known whether SP treatment could effectively increase exercise capacity. Accordingly, this study aimed to examine whether SP treatment affected energy metabolism during exercise in addition to exercise performance. Methods We randomized 36 7-week-old male ICR mice into 2 groups: the control (n?=?18) and SP (n?=?18) groups. All mice were trained by treadmill running 5 times per week for 2 weeks. SP was dissolved in distilled water and daily 800-mg/kg body weight doses before the running exercise were oral administered intraperitoneally to the SP group for 2 weeks. V?O2max was measured before and after the 2 weeks training period. We also assessed energy metabolism during exercise for 1 h after the 2 week training period. In addition to blood samples, liver glycogen and gastrocnemius-white and gastrocnemius-red muscle was obtained at the following 3 time points: at rest, immediately after exercise, and 1-hour post exercise. Results The V?O2 max after 2 weeks of training was significantly increased (8%) in the SP group compared to the baseline; a similar result was not observed in the CON group. The sum of fat oxidation during a 1-h period tended to be 13% higher in the SP group than in the CON group (P?exercise but was significantly higher in the SP group than in the CON group during the recovery period (1 h post-exercise completion). Conclusions These results suggest that SP treatment can improve the exercise performance. Therefore, SP is considered to confer beneficial effects upon athletes, in whom exercise abilities are required.

2014-01-01

59

Exercise as an Effective Treatment for Type 2 Diabetes  

Microsoft Academic Search

With the increasing incidence of type 2 diabetes and the associated comorbidity of obesity, there has been increased demand\\u000a to develop effective treatment programs. Exercise has been traditionally associated with a number of health benefits, including\\u000a increased insulin sensitivity, but remains an underused modality. Although certain contraindications exist for those individuals\\u000a with health complications, exercise can be a safe and

Leslie A. Consitt; Kristen E. Boyle; Joseph A. Houmard

60

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.

2012-01-01

61

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

2012-01-01

62

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

2013-01-01

63

Treatment of urinary voiding dysfunction syndromes with spinal cord stimulation.  

PubMed

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

2010-03-01

64

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

PubMed Central

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 each of which was surveyed for content related to 'pathology' and related terms such as 'etiology,' 'inheritance,' 'pathomechanism,' 'signs and symptoms.' Additional resources included all books published on 'scoliosis' and available through the Arizona Health Sciences Library, Interlibrary Loan, or through direct contact with the authors or publishers. Results A lateral curvature of the spine–'scoliosis'–can develop in association with postural imbalance due to genetic defects and injury as well as pain and scarring from trauma or surgery. Irrespective of the factor that triggers its appearance, a sustained postural imbalance can result, over time, in establishment of a state of continuous asymmetric loading relative to the spinal axis. Recent studies support the longstanding hypothesis that spinal deformity results directly from such postural imbalance, irrespective of the primary trigger, because the dynamics of growth within vertebrae are altered by continuous asymmetric mechanical loading. These data suggest that, as long as growth potential remains, evolution of a spinal curvature into a spinal deformity can be prevented by reversing the state of continuous asymmetric loading. Conclusion Spinal curvatures can routinely be diagnosed in early stages, before pathological deformity of the vertebral elements is induced in response to asymmetric loading. Current clinical approaches involve 'watching and waiting' while mild reversible spinal curvatures develop into spinal deformities with potential to cause symptoms throughout life. Research to define patient-specific mechanics of spinal loading may allow quantification of a critical threshold at which curvature establishment and progression become inevitable, and thereby yield strategies to prevent development of spinal deformity. Even within the normal spine there is considerable flexibility with the possibility of producing many types of curves that can be altered during the course of normal movements. To create these curves during normal movement simply requires an imbalance of forces along the spine and, extending this concept a little further, a scoliotic curve is produced simply by a small but sustained imbalance of forces along the spine. In fact I would argue that no matter what you believe to be the cause of AIS, ultimately the problem can be reduced to the production of an imbalance of forces along the spine [1].

Hawes, Martha C; O'Brien, Joseph P

2006-01-01

65

Treatment and Prevention of Osteoarthritis through Exercise and Sports  

PubMed Central

Osteoarthritis (OA) is a degenerative joint disease with a high prevalence among older people. To date, the pathogenesis of the disease and the link between muscle function and OA is not entirely understood. As there is no known cure for OA, current research focuses on prevention and symptomatic treatment of the disorder. Recent research has indicated that muscle weakness precedes the onset of OA symptoms. Furthermore, several studies show a beneficial effect of land-based aerobic and strengthening exercises on pain relief and joint function. Therefore, current research focuses on the possibility to employ exercise and sports in the prevention and treatment of OA.

Valderrabano, Victor; Steiger, Christina

2011-01-01

66

Minimally invasive approaches for the treatment of intramedullary spinal tumors.  

PubMed

Intramedullary spinal cord tumors constitute 8% to 10% of all primary spinal cord tumors. The clinical presentation of primary spinal cord tumors is determined in part by the location of the tumor, and in nearly all clinical instances pain is the predominant presenting symptom. Motor disturbance is the next most common symptom, followed by sensory loss. Diagnosis of a primary spinal cord tumor requires a high index of suspicion based on clinical signs and symptoms, in addition to spine-directed magnetic resonance imaging. PMID:24703450

Tredway, Trent L

2014-04-01

67

Antisense oligonucleotides for the treatment of spinal muscular atrophy.  

PubMed

Spinal muscular atrophy (SMA) is an autosomal recessive disease affecting ?1 in 10,000 live births. The most striking component is the loss of ?-motor neurons in the ventral horn of the spinal cord, resulting in progressive paralysis and eventually premature death. There is no current treatment paradigm other than supportive care, though the past 15 years has seen a striking advancement in understanding of both SMA genetics and molecular mechanisms. A variety of disease-modifying interventions are rapidly bridging the translational gap from the laboratory to clinical trials, including the application of antisense oligonucleotide (ASO) therapy for the correction of aberrant RNA splicing characteristic of SMA. Survival motor neuron (SMN) is a ubiquitously expressed 38-kD protein. Humans have two genes that produce SMN, SMN1 and SMN2, the former of which is deleted or nonfunctional in the majority of patients with SMA. These two genes are nearly identical with one exception, a C to T transition (C6T) within exon 7 of SMN2. C6T disrupts a modulator of splicing, leading to the exclusion of exon 7 from ?90% of the mRNA transcript. The resultant truncated ?7SMN protein does not oligomerize efficiently and is rapidly degraded. SMA can therefore be considered a disease of too little SMN protein. A number of cis-acting splice modifiers have been identified in the region of exon 7, the steric block of which enhances the retention of the exon and a resultant full-length mRNA sequence. ASOs targeted to these splice motifs have shown impressive phenotype rescue in multiple SMA mouse models. PMID:23544870

Porensky, Paul N; Burghes, Arthur H M

2013-05-01

68

Predictive Ability of Pender's Health Promotion Model for Physical Activity and Exercise in People with Spinal Cord Injuries: A Hierarchical Regression Analysis  

ERIC Educational Resources Information Center

The main objective of this study was to validate Pender's Health Promotion Model (HPM) as a motivational model for exercise/physical activity self-management for people with spinal cord injuries (SCIs). Quantitative descriptive research design using hierarchical regression analysis (HRA) was used. A total of 126 individuals with SCI were recruited…

Keegan, John P.; Chan, Fong; Ditchman, Nicole; Chiu, Chung-Yi

2012-01-01

69

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

2012-01-01

70

Acute Treatment of Contusion Injury to the Spinal Cord.  

National Technical Information Service (NTIS)

A series of studies will test the effects of electric fields on recovery of function in acute contusion injuries of the spinal cord in laboratory guinea pigs and in naturally occurring clinical cases of acute spinal cord injury in dogs. In addition, the e...

R. B. Borgens

1993-01-01

71

Exercises  

MedlinePLUS

... PT Physical Therapist View full profile COPD: Lifestyle Management Exercise An exercise program is another very important ... BACK: Nutrition More Exercises Information Back to Lifestyle Management Print Page Email Page Add Page I want ...

72

Factors associated with treatment failure in vertebral osteomyelitis requiring spinal instrumentation.  

PubMed

Patients with vertebral osteomyelitis may require instrumentation for spinal stabilization. Determining the optimal duration and type of antimicrobial therapy for these patients is challenging. The aim of this study was to examine risk factors for treatment failure, in particular antimicrobial duration, in a cohort of patients requiring spinal instrumentation for vertebral osteomyelitis. We conducted a retrospective cohort study of all patients with vertebral osteomyelitis who had spinal instrumentation between January 2002 and January 2012 at the University of Maryland Medical Center. The primary outcome measure was treatment failure >4 weeks postoperatively. We identified 131 patients with vertebral osteomyelitis requiring spinal instrumentation, 94 of whom had >4 weeks of follow-up and were included in the primary analysis. Treatment failure occurred in 22 of the 94 patients (23%) at a median of 4 months after surgery. Among patients who failed therapy, 20 of 22 failed within 1 year of surgery. Cervical and thoracic infection sites and the presence of negative cultures were associated with fewer treatment failures. Addition of rifampin and the use of chronic suppressive antimicrobials did not affect treatment failure rate. Twenty-three percent of patients with spinal instrumentation for vertebral osteomyelitis experienced treatment failure. Treatment failure almost always occurred within the first year of spinal instrumentation. PMID:24277039

Arnold, Ryan; Rock, Clare; Croft, Lindsay; Gilliam, Bruce L; Morgan, Daniel J

2014-02-01

73

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy.  

PubMed

To evaluate the clinical results of the treatment and to assess the factors that influenced the rate of scoliosis progression, a retrospective study of spinal orthosis in 86 patients with spastic quadriplegic cerebral palsy was performed. The mean age of the patients was 13.8 years (range 5 to 33 years). Their scoliotic deformities were treated with custom-moulded, polypropylene thoraco-lumbar-sacral orthoses. Cobb angles were measured on radiographs taken in a sitting position before treatment, in orthosis, and during follow-up. The mean initial Cobb angle was 68.4 degrees (range 25 to 131 degrees). The mean correction in orthosis was 25 degrees (range 3 to 60 degrees). Seventy-two patients had a follow-up period of more than 2 years. At the latest follow-up, average 6.3 years (range 2 to 14 years) after the start of treatment, the mean Cobb angle without orthosis was 93.1 degrees (range 40 to 145 degrees). The mean progression per year was 4.2 degrees (range -3 to 21 degrees). Linear multiple regression revealed that age and initial correction in orthosis were the only variables that significantly influenced the rate of progression. Twenty-two patients had no progression or progression <1.0 degrees per year. Correction in orthosis was the only variable that predicted progression <1.0 degrees per year in both age groups (<15 years and > or =15 years). Of the 57 patients who were still alive and had not undergone surgical fusion, 72% used their orthoses at a mean age of 22 years. Parents and caregivers expressed satisfaction with the use of orthosis, mainly because of improved sitting stability which gave better overall function. PMID:10972416

Terjesen, T; Lange, J E; Steen, H

2000-07-01

74

Reproducibility of noninvasive cardiac output during arm exercise in spinal cord injury  

Microsoft Academic Search

The carbon dioxide (CO 2 ) rebreathing method is a noninvasive technique to estimate cardiac output during exer- cise, but few data are available on the validity and reliability of this measure in individuals with spinal cord injury (SCI). Six- teen male subjects with SCI (mean age 45 +\\/? 9, seven paraple- gic and nine tetraplegic) underwent three submaximal steady

Jonathan Myers; Heather Brown; Susan Smith; Inder Perkash; B. Jenny Kiratli

2007-01-01

75

Pain and spinal cysts in paraplegia: treatment by drainage and DREZ operation.  

PubMed

About 10% of paraplegics suffer from intractable pain. The onset of pain may be immediate or delayed for months to several years after the injury. The delayed onset of pain is highly suggestive of the development of a spinal cyst. This is a report of 18 paraplegics who developed a delayed onset of intractable pain who were found at the time of surgery to have associated spinal cord cysts. Treatment consisted of the dorsal root entry zone (DREZ) operation in addition to evacuation of the cyst. Burning pain was the most common complaint occurring years after the trauma. In this study we compared the relationship between the onset and character of the pain, the time of the spinal injury, the operative findings, and the results of the DREZ procedure and evacuation of the traumatic spinal cyst. We believe that the combination of paraplegia, pain and spinal cyst has not been emphasized in the neurosurgical literature although it is well known that cystic formation can follow spinal trauma. Two patients developed spinal cysts with nontraumatic lesions of the spinal cord. A single cyst was found in 14 patients while four had two separate cysts. The diagnosis was made on the basis of history and clinical examination with radiographic confirmation using delayed CT scan and myelography and more recently magnetic resonance imaging. Intraoperative ultrasound was employed in the study of some patients. All patients were treated with combined DREZ lesions and evacuation of the cysts with good pain relief in 77.7%. PMID:2222879

Nashold, B S; Vieira, J; el-Naggar, A O

1990-01-01

76

Minimally invasive lumbar decompression for the treatment of spinal stenosis of the lumbar spine.  

PubMed

SUMMARY Lumbar spinal stenosis is one of the most common degenerative diseases of the elderly population, and a major cause of debilitating pain and decreased function. Lumbar spinal stenosis is almost always associated with neurogenic claudication characterized as pain worsened by standing or walking and relieved by lumbar flexion or sitting. While initial treatment of lumbar spinal stenosis may involve conservative therapies, as patients become more symptomatic the traditional treatment path has generally led to open laminectomy and other invasive, potentially destabilizing, procedures. More recently, less invasive alternatives to wide laminectomy have been developed. This article describes a new method of percutaneous lumbar decompression for treatment of neurogenic claudication secondary to lumbar spinal stenosis, the minimally invasive lumbar decompression procedure. We review the steps of successfully decompressing the hypertrophic ligamentum flavum and lamina, thereby alleviating pressure on neural structures. This is a major innovation in patient care and a step to reduce risks while minimizing costs. PMID:24645862

Deer, Timothy

2012-09-01

77

Treatment of metastatic spinal cord compression: cepo review and clinical recommendations  

PubMed Central

Background Metastatic spinal cord compression (mscc) is an oncologic emergency that, unless diagnosed early and treated appropriately, can lead to permanent neurologic impairment. After an analysis of relevant studies evaluating the effectiveness of various treatment modalities, the Comité de l’évolution des pratiques en oncologie (cepo) made recommendations on mscc management. Method A review of the scientific literature published up to February 2011 considered only phase ii and iii trials that included assessment of neurologic function. A total of 26 studies were identified. Recommendations Considering the evidence available to date, cepo recommends that cancer patients with mscc be treated by a specialized multidisciplinary team.dexamethasone 16 mg daily be administered to symptomatic patients as soon as mscc is diagnosed or suspected.high-loading-dose corticosteroids be avoided.histopathologic diagnosis and scores from scales evaluating prognosis and spinal instability be considered before treatment.corticosteroids and chemotherapy with radiotherapy be offered to patients with spinal cord compression caused by myeloma, lymphoma, or germ cell tumour without sign of spinal instability or compression by bone fragment.short-course radiotherapy be administered to patients with spinal cord compression and short life expectancy.long-course radiotherapy be administered to patients with inoperable spinal cord compression and good life expectancy.decompressive surgery followed by long-course radiotherapy be offered to appropriate symptomatic mscc patients (including spinal instability, displacement of vertebral fragment); andpatients considered for surgery have a life expectancy of at least 3–6 months.

L'Esperance, S.; Vincent, F.; Gaudreault, M.; Ouellet, J.A.; Li, M.; Tosikyan, A.; Goulet, S.

2012-01-01

78

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

2008-01-01

79

Video-assisted thoracoscopic treatment of spinal lesions in the thoracolumbar junction  

Microsoft Academic Search

Background: The endoscopic treatment of spinal lesions in the thoracolumbar junction (T11–L2) poses a great challenge to the surgeon.\\u000a From November 1, 1995 to December 31, 1996, we successfully used a combination of video-assisted thoracoscopy and conventional\\u000a spinal instruments to treat 38 patients with anterior spinal lesions. Twelve of them had lesions in the thoracolumbar junction.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: The so-called extended

T. J. Huang; R. W. W. Hsu; H. P. Liu; K. Y. Hsu; Y. S. Liao; H. N. Shih; Y. J. Chen

1997-01-01

80

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.

2009-01-01

81

Incidence of Nocturnal Leg Cramps in Patients with Lumbar Spinal Stenosis before and after Conservative and Surgical Treatment  

PubMed Central

Purpose To examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. Materials and Methods The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. Results The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). Conclusion The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS.

Yamashita, Masaomi; Murata, Yasuaki; Eguchi, Yawara; Aoki, Yasuchika; Ataka, Hiromi; Hirayama, Jiro; Ozawa, Tomoyuki; Morinaga, Tatsuo; Arai, Hajime; Mimura, Masaya; Kamoda, Hiroto; Orita, Sumihisa; Miyagi, Masayuki; Miyashita, Tomohiro; Okamoto, Yuzuru; Ishikawa, Tetsuhiro; Sameda, Hiroaki; Kinoshita, Tomoaki; Hanaoka, Eiji; Suzuki, Miyako; Suzuki, Munetaka; Aihara, Takato; Ito, Toshinori; Inoue, Gen; Yamagata, Masatsune; Toyone, Tomoaki; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Yamauchi, Kazuyo; Takahashi, Kazuhisa

2014-01-01

82

The effects of exercise training on cardiovascular regulation in individuals with spinal cord injury  

Microsoft Academic Search

Individuals with SCI retain the ability to make positive changes in cardiovascular regulation with exercise training, as indicated by measures of HRV and BPV, as well as by Doppler ultrasound measures of arterial function. Individuals with less severe SCI (ASIA C and D injuries) may be particularly well suited for BWSTT as a means to promote cardiovascular improvement. Specifically, individuals

David Ditor

2004-01-01

83

Primary Spinal Germ Cell Tumors: A Case Analysis and Review of Treatment Paradigms  

PubMed Central

Objective. Primary intramedullary spinal germ cell tumors are exceedingly rare. As such, there are no established treatment paradigms. We describe our management for spinal germ cell tumors and a review of the literature. Clinical Presentation. We describe the case of a 45-year-old man with progressive lower extremity weakness and sensory deficits. He was found to have enhancing intramedullary mass lesions in the thoracic spinal cord, and pathology was consistent with an intramedullary germ cell tumor. A video presentation of the case and surgical approach is provided. Conclusion. As spinal cord germinomas are highly sensitive to radiation and chemotherapy, a patient can be spared radical surgery. Diverse treatment approaches exist across institutions. We advocate biopsy followed by local radiation, with or without adjuvant chemotherapy, as the optimal treatment for these tumors. Histological findings have prognostic value if syncytiotrophoblastic giant cells (STGCs) are found, which are associated with a higher rate of recurrence. The recurrence rate in STGC-positive spinal germinomas is 33% (2/6), whereas it is only 8% in STGC-negative tumors (2/24). We advocate limited volume radiotherapy combined with systemic chemotherapy in patients with high risk of recurrence. To reduce endocrine and neurocognitive side effects, cranio-spinal radiation should be used as a last resort in patients with recurrence.

Loya, Joshua J.; Jung, Henry; Temmins, Caroline; Cho, Nam; Singh, Harminder

2013-01-01

84

Endovascular treatment of intracranial dural arteriovenous fistulas with spinal perimedullary venous drainage.  

PubMed

Intracranial dural arteriovenous (AV) fistulas with spinal perimedullary venous drainage are rare lesions that have distinctive clinical, radiological, and therapeutic aspects. Five patients presented with an ascending myelopathy, which extended to involve the brain stem in three cases. Myelography and magnetic resonance imaging showed slightly dilated spinal perimedullary vessels. Spinal angiograms were normal in the arterial phase. Diagnosis was only possible after cerebral angiography, which demonstrated posterior fossa AV fistulas fed by meningeal arteries and draining into spinal perimedullary veins. Endovascular treatment alone resulted in angiographic obliteration of the lesion in three patients. Two patients required surgery in addition to endovascular therapy. One patient died postoperatively, and in one a transient complication of embolization was observed. Improvement after treatment was good in two cases and fair in two. Transverse sinus thrombosis was observed in three cases and was probably the cause of the aberrant venous drainage of the fistula into the spinal perimedullary veins. The pathophysiology is related to spinal cord venous hypertension. These lesions were classified as Type 5 in the Djindjian and Merland classification of dural intracranial AV fistulas. Endovascular therapy is a safe effective method in the treatment of these fistulas and should be tried first. PMID:1403113

Gobin, Y P; Rogopoulos, A; Aymard, A; Khayata, M; Reizine, D; Chiras, J; Merland, J J

1992-11-01

85

Limited effect of fly-wheel and spinal mobilization exercise countermeasures on lumbar spine deconditioning during 90 d bed-rest in the Toulouse LTBR study  

NASA Astrophysics Data System (ADS)

We examined the effect of high-load fly-wheel (targeting the lower-limb musculature and concurrent loading of the spine via shoulder restraints) and spinal movement countermeasures against lumbar spine muscle atrophy, disc and spinal morphology changes and trunk isokinetic torque loss during prolonged bed-rest. Twenty-four male subjects underwent 90 d head-down tilt bed-rest and performed either fly-wheel (FW) exercises every three days, spinal movement exercises in lying five times daily (SpMob), or no exercise (Ctrl). There was no significant impact of countermeasures on losses of isokinetic trunk flexion/extension ( p?0.65). Muscle volume change by day-89 of bed-rest in the psoas, iliacus, lumbar erector spinae, lumbar multifidus and quadratus lumborum, as measured via magnetic resonance imaging (MRI), was statistically similar in all three groups ( p?0.33). No significant effect on MRI-measures of lumbar intervertebral disc volume, spinal length and lordosis ( p?0.09) were seen either, but there was some impact ( p?0.048) on axial plane disc dimensions (greater reduction than in Ctrl) and disc height (greater increases than in Ctrl). MRI-data from subjects measured 13 and 90-days after bed-rest showed partial recovery of the spinal extensor musculature by day-13 after bed-rest with this process complete by day-90. Some changes in lumbar spine and disc morphology parameters were still persistent 90-days after bed-rest. The present results indicate that the countermeasures tested were not optimal to maintain integrity of the spine and trunk musculature during bed rest.

Belavý, Daniel L.; Ohshima, Hiroshi; Bareille, Marie-Pierre; Rittweger, Jörn; Felsenberg, Dieter

2011-09-01

86

Spinal deformity in neurofibromatosis type-1: diagnosis and treatment  

Microsoft Academic Search

Spinal deformity is the commonest orthopaedic manifestation in neurofibromatosis type-1 and is categorized into dystrophic and non-dystrophic types. Management should be based on a meticulous assessment of the spine with plain radiography and magnetic resonance imaging (MRI) to rule out the presence of dysplastic features that will determine prognosis and surgical planning. MRI of the whole spine should also be

Athanasios I. Tsirikos; Asif Saifuddin; M Hilali Noordeen

2005-01-01

87

Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning.  

PubMed

The surgical treatment of adult spinal deformity has been shown to offer superior clinical and radiographic outcomes compared with nonoperative approaches; furthermore, osteotomies are increasingly applied for treating spinal deformities. Establishing a plan for a patient suffering from marked spinal deformity is a matter of consideration of certain radiographic parameters which correlate with health-related quality of life scores, adherence to consistent principles of alignment and established formulas, and selecting the appropriate osteotomies. This is a review of the most recent work on vertebral osteotomies and includes a summary of a systematic and anatomically based osteotomy classification. A universal classification will facilitate communication, standardize outcomes research, and establish a framework upon which indications can be properly studied and described. Ongoing multicenter collaboration is certain to drive a more evidence-based approach to the complex clinical scenarios of patients suffering from spinal deformity. PMID:24816823

Diebo, Bassel; Liu, Shian; Lafage, Virginie; Schwab, Frank

2014-07-01

88

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

2001-01-01

89

Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy  

SciTech Connect

Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme, and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V{sub 4Gy}) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by {approx}20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.

Weksberg, David C.; Palmer, Matthew B.; Vu, Khoi N.; Rebueno, Neal C.; Sharp, Hadley J. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Luo, Dershan; Yang, James N.; Shiu, Almon S. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rhines, Laurence D. [Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); McAleer, Mary Frances; Brown, Paul D. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Eric L., E-mail: eric.L.chang@usc.edu [Department of Radiation Oncology, University of Southern California Keck School of Medicine, Norris Cancer Hospital, Los Angeles, California (United States)

2012-11-01

90

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

2009-01-01

91

Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review  

Microsoft Academic Search

BACKGROUND: Delayed onset muscle soreness (DOMS) is a frequent problem after unaccustomed exercise. No universally accepted treatment exists. Massage therapy is often recommended for this condition but uncertainty exists about its effectiveness. AIM: To determine whether post-exercise massage alleviates the symptoms of DOMS after a bout of strenuous exercise. METHOD: Various computerised literature searches were carried out and located seven

E. Ernst

1998-01-01

92

Comparing the Benefits of Diet and Exercise in the Treatment of Dyslipidemia  

Microsoft Academic Search

Background. Lifestyle changes are advocated as a first line of treatment for dyslipidemia. However, few studies have directly compared various combinations of diets and exercise.Methods. In a randomized controlled pilot study, we compared the standard lifestyle recommendations (NCEP step I diet with regular exercise) and more intense interventions including the NCEP step I diet with a supervised aerobic exercise program

Lyne Lalonde; Katherine Gray-Donald; Ilka Lowensteyn; Sylvie Marchand; Marc Dorais; George Michaels; Hilary A. Llewellyn-Thomas; Annette O'Connor; Steven A. Grover

2002-01-01

93

Comparing the Benefits of Diet and Exercise in the Treatment of Dyslipidemia1  

Microsoft Academic Search

Background. Lifestyle changes are advocated as a first line of treatment for dyslipidemia. However, few studies have directly compared various combinations of diets and exercise. Methods. In a randomized controlled pilot study, we compared the standard lifestyle recommendations (NCEP step I diet with regular exercise) and more intense interventions including the NCEP step I diet with a supervised aerobic exercise

Lyne Lalonde; Katherine Gray-Donald; Ilka Lowensteyn; Sylvie Marchand; Marc Dorais; George Michaels; Hilary A. Llewellyn-Thomas; Annette O'Connor; Steven A. Grover

94

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

2013-01-01

95

Spinal Cord Injury: A Systematic Review of Current Treatment Options  

Microsoft Academic Search

Background  Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an\\u000a understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary\\u000a mechanisms of injury, clinicians may be able to offer improved recovery after SCI.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  In this review, we highlight advances in the field of SCI

David W. Cadotte; Michael G. Fehlings

2011-01-01

96

Spinal cord tumours: advances in genetics and their implications for treatment  

PubMed Central

Tumours of the spinal cord, although rare, are associated with high morbidity. Surgical resection remains the primary treatment for patients with this disease, and offers the best chance for cure. Such surgical procedures, however, carry substantial risks such as worsening of neurological deficit, paralysis and death. New therapeutic avenues for spinal cord tumours are needed, but genetic studies of the molecular mechanisms governing tumourigenesis in the spinal cord are limited by the scarcity of high-quality human tumour samples. Many spinal cord tumours have intracranial counterparts that have been extensively studied, but emerging data show that the tumours are genetically and biologically distinct. The differences between brain and spine tumours make extrapolation of data from one to the other difficult. In this Review, we describe the demographics, genetics and current treatment approaches for the most commonly encountered spinal cord tumours—namely, ependymomas, astrocytomas, haemangioblastomas and meningiomas. We highlight advances in understanding of the biological basis of these lesions, and explain how the latest progress in genetics and beyond are being translated to improve patient care.

Zadnik, Patricia L.; Gokaslan, Ziya L.; Burger, Peter C.; Bettegowda, Chetan

2014-01-01

97

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors  

PubMed Central

Background. Spinal metastases frequently arise in patients with cancer. Modern oncology provides numerous treatment options that include effective systemic, radiation, and surgical options. We delineate and provide the evidence for the neurologic, oncologic, mechanical, and systemic (NOMS) decision framework, which is used at Memorial Sloan-Kettering Cancer Center to determine the optimal therapy for patients with spine metastases. Methods. We provide a literature review of the integral publications that serve as the basis for the NOMS framework and report the results of systematic implementation of the NOMS-guided treatment. Results. The NOMS decision framework consists of the neurologic, oncologic, mechanical, and systemic considerations and incorporates the use of conventional external beam radiation, spinal stereotactic radiosurgery, and minimally invasive and open surgical interventions. Review of radiation oncology and surgical literature that examine the outcomes of treatment of spinal metastatic tumors provides support for the NOMS decision framework. Application of the NOMS paradigm integrates multimodality therapy to optimize local tumor control, pain relief, and restoration or preservation of neurologic function and minimizes morbidity in this often systemically ill patient population. Conclusion. NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention.

Laufer, Ilya; Rubin, David G.; Lis, Eric; Cox, Brett W.; Stubblefield, Michael D.; Yamada, Yoshiya

2013-01-01

98

Significant predictive values for the life expectancy in patients with spinal metastasis following surgical treatment  

Microsoft Academic Search

Background  Spinal metastasis is a common manifestation of bony metastasis, but for surgeons involved in the treatment of individual patients,\\u000a it is not easy to choose optimal treatments. Various scoring systems have been designed to predict survival periods and to\\u000a select optimal treatments, but prognosis is still unpredictable. Objectives are to evaluate the efficiency of the predictive\\u000a value of preoperative Tokuhashi

In-Soo Oh; Sang-Il Kim; Kee-Yong Ha

99

A critical appraisal of the pain associated with iatrogenic adult spinal deformity, and treatment by spinal cord stimulation. A case report and review of the literature.  

PubMed

Objective. Over the past two decades, with the increasing use of spinal instrumentation to treat deformity, surgical restoration has become more frequent. A complication of surgical reconstruction for adult scoliosis, the iatrogenic flat back syndrome, has been described. Results of surgical realignment have been disappointing in terms of pain relief. The objective of this study is to examine a case of so-called flat back deformity and describe treatment via spinal cord stimulation. Materials and Methods. This is a case report of an individual who presented a spine center with the flat back deformity and pain. Results. Following exclusion of reversible compressive pathology, a 46 year-old male with the iatrogenic flat back deformity and lumbosacral and thigh pain was treated with implantation of a thoracic spinal cord stimulator. Significant pain relief was obtained without resorting to additional major reconstructive surgery. Conclusions. Literature on the pain associated with flat back deformity is incomplete regarding description and characterization of pain. Given the unpredictability of spinal osteotomy to address this pain, a possible alternative treatment strategy is presented. This involves the use of selective pharmaceutical therapy and spinal cord stimulation. Based on the response of this patient to spinal cord stimulation, it is a possible that a component of this persistent pain is neuropathic, despite the fact that preoperative imaging studies failed to disclose a significant compressive lesion. PMID:22151058

Wetzel, F T; Tansey, L P; Phillips, F M; Sinclair, D M

1999-01-01

100

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

2000-01-01

101

Early microsurgical treatment for spinal hemangioblastomas improves outcome in patients with von Hippel-Lindau disease  

PubMed Central

Background: Spinal hemangioblastomas (HB) are rare, histologically benign, highly vascularized tumors often associated with von Hippel–Lindau (VHL) disease. The aim of the current study is to demonstrate the benefit of early surgical resection of large spinal HBs in selected asymptomatic patients with VHL. Methods: Seventeen patients underwent microsurgical resection of 20 spinal HBs at the Department of Neurosurgery at Helsinki University Central Hospital (HUCH). Thirteen tumors were in the cervical spine, five in thoracic and one patient had two lumbar lesions. MRI tumor showed an associated syrinx in 16 patients (94%). Tumor volume ranged from 27 to 2730 mm3. Out of 17 patients, 11 (65%) tested positive for VHL in mutation analysis. Five of these patients with tumors ranging from 55 to 720 mm3 were treated prophylactically. Results: Complete tumor resection was performed in 16 patients (94%) who were followed up for a median of 57 months (range 2–165 months). No patient had neurological decline on long-term follow-up. Among the patients with VHL, five patients with preoperative sensorimotor deficits showed improvement of their symptoms but never regained full function. One patient who presented with tetraplegia remained the same. Otherwise, all five patients with prophylactic surgery remained neurologically intact. Conclusion: Although documented growth on serial MRIs and the need for pathological diagnosis have been suggested as indications for surgery in otherwise asymptomatic patients, our series showed that a potentially larger group of asymptomatic patients with spinal HB associated with VHL would benefit from microsurgical resection. Long-term results of the surgical management of spinal HB are generally favorable. Our results suggest staging and early treatment for spinal HB larger than 55 mm3, especially in patients with VHL. Small spinal HBs may be followed up.

Harati, Ali; Satopaa, Jarno; Mahler, Lydia; Billon-Grand, Romain; Elsharkawy, Ahmed; Niemela, Mika; Hernesniemi, Juha

2012-01-01

102

Exercise  

MedlinePLUS

Exercise - National Multiple Sclerosis Society Skip to navigation Skip to content Menu Navigation National Multiple Sclerosis Society Search v Make a Donation ... now Download now Publication Stretching for People with MS Illustrated manual showing range of motion, stretching, and ...

103

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

PubMed

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

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

2009-01-01

104

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

PubMed Central

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

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

2009-01-01

105

[Prophylaxis and treatment of arterial hypotension during caesarean with spinal anaesthesia].  

PubMed

Caesarean section is one of the most common surgical procedures worldwide. Arterial hypotension is the most prevalent adverse effect after spinal anaesthesia. Various methods have been used to prevent or treat hypotension. Since there is no treatment 100% effective by itself, a multimodal management is required to achieve an optimum balance and avoidance of hemodynamic imbalance. Strategies to avoid this side effect are analyzed on the basis of the best evidence available so far, summarized as mechanical factors, anesthetics, fluids and vasopressors. After spinal anaesthesia for caesarean section, the best strategy available for prevention of hypotension appears to be the combination of crystalloids along with an alpha 1 agonist vasopressor. PMID:23092743

Arias, J; Lacassie, H J

2013-11-01

106

Suloctidil treatment prevents the development of post-traumatic feline spinal cord ischemia.  

PubMed

The effects of suloctidil (1.0 mg/kg i.v.) on white matter spinal cord blood flow (SCBF) and somatosensory evoked potential (SEP) conduction were assessed in a feline lumbar spinal cord contusion model. SEP conduction ceased immediately after a 500 g-cm injury and did not recover. SCBF following suloctidil declined by only 12% from pre-injury levels over the 4 hr experiment as compared to a 42% decline observed following vehicle injection. Accordingly, 7/8 vehicle cats, but only 1/5 suloctidil-treated cats, had 4 hr SCBF values of less than 10 ml/100 g/min. Bradycardiac and hypotensive effects of suloctidil were also noted. The ability of suloctidil to prevent post-traumatic ischemia may be useful in the acute treatment of spinal cord injury. PMID:2990364

Wolf, D L; Hall, E D

1985-03-01

107

Opera?ní lé?ení infek?ního postižení páte?e Surgical Treatment of Spinal Infections  

Microsoft Academic Search

PURPOSE OF THE STUDY Although great advances have been made in both radiological diagnosis and antibiotic therapy of microbial infections, the treatment of spinal infections remains a major clinical challenge. Many of the patients affected are referred to spinal units with long delays. The general population is ageing and the number of immunocompromised patients, as well as the number of

Z. KLÉZL; J. ŠTULÍK; J. KRYL; P. ŠEBESTA; T. VYSKO?IL; R. BOMMIREDDY; D. CALTHORPE

2007-01-01

108

Do spinal cord injury patients always get the best treatment for neuropathic bladder after discharge from regional spinal injuries centre?  

Microsoft Academic Search

Objective: To draw attention to inadequate care received by some spinal cord injury patients after discharge from the regional spinal injury center.Setting: Regional Spinal Injuries Centre, Southport, UK.Methods: Presence of the urethral stricture was not recognised in a 69-year-old male with T-3 paraplegia, who attended a health-care facility with a urinary infection. A Foley catheter was inserted into the urethra

S Vaidyanathan; G Singh; B M Soni; P L Hughes; Paul Mansour; T Oo; J Bingley; P Sett

2004-01-01

109

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

PubMed

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

2010-08-01

110

Erythropoietin: Recent Developments in the Treatment of Spinal Cord Injury  

PubMed Central

Erythropoietin (EPO), originally identified for its critical function in regulating production and survival of erythrocytes, is a member of the type 1 cytokine superfamily. Recent studies have shown that EPO has cytoprotective effects in a wide variety of cells and tissues. Here is presented the analysis of EPO effects on spinal cord injury (SCI), considering both animal experiments concerning to mechanisms of neurodegeneration in SCI and EPO as a neuroprotective agent, and some evidences coming from ongoing clinical trials. The evidences underling that EPO could be a promising therapeutic agent in a variety of neurological insults, including trauma, are mounting. In particular, it is highlighted that administration of EPO or other recently generated EPO analogues such as asialo-EPO and carbamylated-EPO demonstrate interesting preclinical and clinical characteristics, rendering the evaluation of these tissue-protective agents imperative in human clinical trials. Moreover the demonstration of rhEPO and its analogues' broad neuroprotective effects in animal models of cord lesion and in human trial like stroke, should encourage scientists and clinicians to design clinical trials assessing the efficacy of these pharmacological compounds on SCI.

Carelli, Stephana; Marfia, Giovanni; Di Giulio, Anna Maria; Ghilardi, Giorgio; Gorio, Alfredo

2011-01-01

111

Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis  

PubMed Central

Background Lumbar spinal stenosis is a common cause of radicular and generalized back pain among older adults. Endoscopic minimally invasive surgery, in contrast to open decompression, may provide the opportunity for a less invasive surgical intervention. Thus, the purpose of this study is to evaluate the safety (operative complications, estimated blood loss, operative room time) and effectiveness (pre- versus postoperative level of disability and pain severity) of minimally invasive surgery using endoscopic laminotomy and foraminotomy among a large sample of patients with lumbar spinal stenosis. Methods This study is composed of 320 consecutive patients with lumbar spinal stenosis who underwent posterior lumbar laminotomy and foraminotomy between 2008 and 2011. Outcome measures consisted of perioperative complications, estimated blood loss, operative room time, level of disability, and pain severity. Pain severity and level of disability were prospectively analyzed to an average of 18 months (12–36 months) post-surgery. Results There was an average estimated blood loss of 39.3 cc and a mean operative room time of 74 min. Seven patients experienced minor operative complications. All patients were discharged the same day as surgery and reported a significantly lower level of disability (p = 0.00) and pain severity (p = 0.00) postoperative compared to preoperative. Conclusions Minimally invasive surgery using endoscopy for the treatment of lumbar spinal stenosis has a short operative time, a low operative complication rate, and minimal estimated blood loss. This study also indicates that MIS for the treatment of LSS can significantly reduce pain and disability level. Thus, minimally invasive surgery using endoscopic laminotomy and foraminotomy appears to be a safe and effective alternative surgical treatment for open decompression surgery in adult patients with lumbar spinal stenosis.

Polikandriotis, John A.; Hudak, Elizabeth M.; Perry, Michael W.

2013-01-01

112

Exploring exercise as an avenue for the treatment of anxiety disorders  

PubMed Central

Anxiety disorders constitute a significant public health problem. Current gold standard treatments are limited in their effectiveness, prompting the consideration of alternative approaches. In this review, we examine the evidence for exercise as an intervention for anxiety disorders. This evidence comes from population studies, studies of nonclinical anxiety reduction, as well as a limited number of studies of clinically anxious individuals. All of these studies provide converging evidence for consistent beneficial effects of exercise on anxiety, and are consistent with a variety of accounts of the mechanism of anxiety reduction with exercise. Further study of clinical populations is encouraged, as are studies of the mechanism of change of exercise interventions, which have the potential to help refine exercise intervention strategies. Likewise, studies that identify moderators of treatment efficacy will assist clinicians in deciding how and for whom to prescribe exercise.

DeBoer, Lindsey B; Powers, Mark B; Utschig, Angela C; Otto, Michael W; Smits, Jasper AJ

2012-01-01

113

Somatropin treatment of spinal muscular atrophy: a placebo-controlled, double-blind crossover pilot study.  

PubMed

In preclinical studies growth hormone and its primary mediator IGF-1 have shown potential to increase muscle mass and strength. A single patient with spinal muscular atrophy reported benefit after compassionate use of growth hormone. Therefore we evaluated the efficacy and safety of growth hormone treatment for spinal muscular atrophy in a multicenter, randomised, double-blind, placebo-controlled, crossover pilot trial. Patients (n = 19) with type II/III spinal muscular atrophy were randomised to receive either somatropin (0.03 mg/kg/day) or placebo subcutaneously for 3 months, followed by a 2-month wash-out phase before 3 months of treatment with the contrary remedy. Changes in upper limb muscle strength (megascore for elbow flexion and hand-grip in Newton) were assessed by hand-held myometry as the primary measure of outcome. Secondary outcome measures included lower limb muscle strength, motor function using the Hammersmith Functional Motor Scale and other functional tests for motor function and pulmonary function. Somatropin treatment did not significantly affect upper limb muscle strength (point estimate mean: 0.08 N, 95% confidence interval (CI:-3.79;3.95, p = 0.965), lower limb muscle strength (point estimate mean: 2.23 N, CI:-2.19;6.63, p = 0.302) or muscle and pulmonary function. Side effects occurring during somatropin treatment corresponded with well-known side effects of growth hormone substitution in patients with growth hormone deficiency. In this pilot study, growth hormone treatment did not improve muscle strength or function in patients with spinal muscular atrophy type II/III. PMID:24300782

Kirschner, J; Schorling, D; Hauschke, D; Rensing-Zimmermann, C; Wein, U; Grieben, U; Schottmann, G; Schara, U; Konrad, K; Müller-Felber, W; Thiele, S; Wilichowski, E; Hobbiebrunken, E; Stettner, G M; Korinthenberg, R

2014-02-01

114

Early diagnosis and treatment of spinal epidural metastasis in breast cancer: a prospective study.  

PubMed

This prospective study evaluated the usefulness of myelography in breast cancer patients who present with radiculopathy or myelopathy. A total of 124 consecutive myelograms were performed in 100 patients. Epidural metastasis (EM) was diagnosed in 67 myelograms (54%). Multiple epidural metastases were diagnosed in 15 (22%) of those, resulting in a total of 87 epidural lesions. A complete block was found in 13 EM (15%) and an incomplete block in 14 EM (16%). Clinical data could not predict the site of EM in 29 cases (33%). Fifteen asymptomatic EM were detected in myelograms with multiple EM. Plain radiographs were of no value in determining the site of EM in 29 cases (33%), including 13 cases (15%) without vertebral metastasis at the site of EM. Treatment consisted of radiotherapy (RT) with or without systemic treatment in 52 cases (80%), systemic treatment alone in 11 cases (17%) and surgery in two patients (3%). Clinical improvement was noticed in 72%, no change in 13%, and deterioration in 15%. No difference in response was noticed between RT and systemic therapy. Before treatment 21% and after treatment 15% of the patients could not walk. The one year survival was 42%. The ambulatory status at presentation was the most important prognostic factor. Examination of the spinal fluid, obtained at myelography, disclosed meningeal carcinomatosis in 9% of the patients. Imaging of the whole spinal canal with cytological examination of the spinal fluid is recommended in breast cancer patients suspected of epidural tumour with features of radiculopathy or myelopathy, irrespective of further clinical data and plain spinal radiographs. PMID:1479399

Boogerd, W; van der Sande, J J; Kröger, R

1992-12-01

115

Early diagnosis and treatment of spinal epidural metastasis in breast cancer: a prospective study.  

PubMed Central

This prospective study evaluated the usefulness of myelography in breast cancer patients who present with radiculopathy or myelopathy. A total of 124 consecutive myelograms were performed in 100 patients. Epidural metastasis (EM) was diagnosed in 67 myelograms (54%). Multiple epidural metastases were diagnosed in 15 (22%) of those, resulting in a total of 87 epidural lesions. A complete block was found in 13 EM (15%) and an incomplete block in 14 EM (16%). Clinical data could not predict the site of EM in 29 cases (33%). Fifteen asymptomatic EM were detected in myelograms with multiple EM. Plain radiographs were of no value in determining the site of EM in 29 cases (33%), including 13 cases (15%) without vertebral metastasis at the site of EM. Treatment consisted of radiotherapy (RT) with or without systemic treatment in 52 cases (80%), systemic treatment alone in 11 cases (17%) and surgery in two patients (3%). Clinical improvement was noticed in 72%, no change in 13%, and deterioration in 15%. No difference in response was noticed between RT and systemic therapy. Before treatment 21% and after treatment 15% of the patients could not walk. The one year survival was 42%. The ambulatory status at presentation was the most important prognostic factor. Examination of the spinal fluid, obtained at myelography, disclosed meningeal carcinomatosis in 9% of the patients. Imaging of the whole spinal canal with cytological examination of the spinal fluid is recommended in breast cancer patients suspected of epidural tumour with features of radiculopathy or myelopathy, irrespective of further clinical data and plain spinal radiographs.

Boogerd, W; van der Sande, J J; Kroger, R

1992-01-01

116

Evaluation and treatment of the asymptomatic patient with a positive exercise tolerance test  

SciTech Connect

A positive exercise study in an asymptomatic patient presents a clinical dilemma. Many of these asymptomatic positive studies are false-positive, but a subset of these patients have silent coronary artery disease. Other noninvasive tests can be used in conjunction with exercise testing to help identify this subset of patients, but coronary angiography is often ultimately necessary to ensure an accurate diagnosis. An algorithm for the evaluation and treatment of the patient with an asymptomatic positive exercise study is proposed.

Imperi, G.A.; Conti, C.R.

1986-11-01

117

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

2010-01-01

118

[Medical treatment of spinal cord injury during the acute phase. Effect of a calcium inhibitor].  

PubMed

Post traumatic ischemia appears to be largely involved for the extension of lesions in acute injury of the spinal cord. The present study evaluate the putative improvement of spinal cord blood flow (S.C.B.F.) by calcium channel blocker after acute spinal cord injury in baboons. S.C.B.F. measured by a scannographic technique with 133Xe were realised each thirty min for 4 hours and seven days later; somatosensory evoked potentials (S.E.P.) magnetic resonance imaging (M.R.I.) and histological study of the spine were realised at different time of the experimentation. Ten monkey were used. Acute trauma was achieved by compression of the cord at T1 by applying a 2.10(2) kPa (2 bar) pressure for 5 s with a balloon catheter inflated with Ringer's solution. Then, five monkeys received saline infusion for seven days and the other five received a nimodipine infusion (0.04 mg.kg-1.h-1) during the same time. Nimodipine improved significantly S.C.B.F. Two monkeys in the treated group showed improvement of axonal function as judged by S.E.P. Conversely no significant difference was noted by R.M.I. although the histological study showed smaller lesions in the treated group. Nimodipine could represent in the next years a new medical treatment in acute spinal cord injury in man. PMID:7802154

Pointillard, V; Petitjean, M E

1993-01-01

119

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

PubMed

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

2013-01-01

120

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

2013-01-01

121

Late effects of radiation on the lumbar spinal cord of guinea pigs: Re-treatment tolerance  

SciTech Connect

Using a guinea pig model of lumbar myelopathy, various factors affecting the tolerance of spinal cord to irradiation were assessed: (a) extent of initial injury; (b) time interval between priming and test doses; and (c) animal age at the time of initial radiation treatment. A 3 cm section of lumbar spinal cord of guinea pigs was irradiated with fractionated doses of 4.5 Gy gamma rays given as 9 fractions per week. Guinea pigs were primed with 9 x 4.5 Gy in 7 days which is 60% of the ED[sub 50] for a continuous course of treatment. After 28 or 40 weeks, animal were retreated with 6-14 fractions of 4.5 Gy. Animals were observed for 2 years following the priming dose and both the incidence and latency of myelopathy recorded. Young adult guinea pigs (8 wk old) showed both a decreased radiation tolerance and latency compared to old individuals (40 wk old). At 28 or 40 wk after 9 x 4.5 Gy, only about 8% of the initial injury was remembered in young adult guinea pigs. The amount of residual injury was dependent on the initial damage as a proportion of the tolerance dose. The spinal cord shows a greater capacity for long-term recovery than generally appreciated and re-treatment doses clinically prescribed may be lower than necessary. 8 refs., 3 figs., 2 tabs.

Mason, K.A. (Univ. of Texas M.D. Anderson Cancer Center, Houston, TX (United States)); Withers, H.R.; Chiang, Chi-Shiun (Univ. of California, Los Angeles, CA (United States))

1993-07-15

122

Sildenafil treatment in COPD does not affect stroke volume or exercise capacity  

Microsoft Academic Search

In chronic obstructive pulmonary disease (COPD) patients, stroke volume response to exercise is impaired. The aim of the present study was to investigate whether 3 months of sildenafil treatment improves stroke volume and, if so, whether this improvement is related to the pulmonary artery pressure and translated into an improved exercise capacity. A total of 15 stable COPD patients (Global

H. Rietema; S. Holverda; H. J. Bogaard; J. T. Marcus; H. J. Smit; N. Westerhof; P. E. Postmus; A. Boonstra; A. Vonk-Noordegraaf

2008-01-01

123

Problems of long-term spinal opioid treatment in advanced cancer patients.  

PubMed

Epidural and intrathecal techniques are well established techniques in cancer pain. However, several questions remain unresolved. The several problems of long-term spinal opioid treatment in advance cancer patients were reviewed. Indications for the use of spinal opioids include patients treated by systemic opioids with effective pain relief but with unacceptable side effects, or unsuccessful treatment with sequential strong opioid drug trials despite escalating doses. Therefore, the previous aggressive treatment with systemic opioids would leave as failures patients with difficult pain syndromes unresponsive to opioids. The choice of external or totally implanted delivery systems is based on different clinical considerations. The use of externalized tunneled intrathecal catheters has not been associated with higher rates of complications and is easier to place and use at home in debilitated patients late in the course of their disease. The intrathecal administration has a lower incidence of catheter occlusion, lower malfunctioning rate, lower dose requirement, and more effective pain control. Due to the lower daily doses and volumes, intrathecal treatment proved to be more suitable for treatment at home by a continuous infusion than the epidural treatment. Advantages of infusion techniques are more evident when using local anesthetics, since intermittent administration of bupivacaine often results in motor paralysis and hemodynamic instability. Morphine is the opioid of choice. An epidural dose of 10% of the systemic dose is often used. However, intrathecal administration of opioids and bupivacaine may substantially improve pain relief in patients unresponsive to high epidural doses of these drugs, Bupivacaine-induced adverse effects, including sensory deficits, motor complaints, signs of autonomic dysfunction or neurotoxicity have been reported to not occur with bupivacaine doses less than 30-60 mg/day. Adjuvant drugs may further improve analgesia. Different ranges of technical complication rates have been reported in the literature, most of them being associated with epidural catheters. Subcutaneous tunneling and fixation of the catheter, bacterial filters, minimum changes of tubings, careful exit site care weekly, site protection and monitoring of any sign of infection to prevent infection, and training for family under supervision, are recommended. Areas for additional research include the use of spinal adjuvants, the ideal spinal morphine-bupivacaine ratio. methods to improve spinal opioid responsiveness and long-term catheter management with appropriate home care programs. PMID:9928770

Mercadante, S

1999-01-01

124

Strategy in the Surgical Treatment of Primary Spinal Tumors  

PubMed Central

Primary spine tumors are rare, accounting for only 4% of all tumors of the spine. A minority of the more common primary benign lesions will require surgical treatment, and most amenable malignant lesions will proceed to attempted resection. The rarity of malignant primary lesions has resulted in a paucity of historical data regarding optimal surgical and adjuvant treatment and, although we now derive benefit from standardized guidelines of overall care, management of each neoplasm often proceeds on a case-by-case basis, taking into account the individual characteristics of patient operability, tumor resectability, and biological potential. This article aims to provide an overview of diagnostic techniques, staging algorithms and the authors' experience of surgical treatment alternatives that have been employed in the care of selected benign and malignant lesions. Although broadly a review of contemporary management, it is hoped that the case illustrations given will serve as additional “arrows in the quiver” of the treating surgeon.

Williams, Richard; Foote, Matthew; Deverall, Hamish

2012-01-01

125

What Are the Treatments for Spinal Cord Injury (SCI)?  

MedlinePLUS

... treatments, including prostheses and medications, which may promote regeneration of nerve cells or improve the function of the nerves that ... Scientists are pursuing research on how to halt cell death, control inflammation, and promote the repair or regeneration of nerves. 2 See " Is there a cure ...

126

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

PubMed Central

Previous RCTs 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, healthy, female smokers were randomized to an eight-week program consisting of brief baseline smoking cessation counseling and the nicotine patch plus either 150 min/week of moderate intensity exercise or contact control. Participants attended a median of 86.4% and 95.5% of prescribed exercise/control sessions, respectively. There was a moderate, though statistically non-significant, effect of exercise at post-treatment for objectively verified 7-day point prevalence abstinence (48.3% vs 23.3%; OR=3.07, 95% CI: 0.89-11.07) and prolonged abstinence (34.5% vs. 20.0%; OR=2.11, 95% CI: 0.56-8.32). Effects were attenuated when controlling for potential confounders, and following a one-month, no-treatment period. The findings provide a preliminary indication that—given adequate compliance—moderate intensity exercise may enhance short-term smoking cessation outcomes for women; however, a larger trial is warranted.

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

2013-01-01

127

Clinical trials for the treatment of spinal cord injury: not so simple.  

PubMed

The fast pace of research in stem cell biology and regenerative medicine is feeding hopes of the scientific community and the public that a new revolution in treatments is upon us. There are increasing numbers of examples of stem cell therapies that are effective in treating animal injuries and diseases. There is an expectation that stem cell transplantation will soon be commonplace in the human clinic, especially with the beginnings of clinical trials of embryonic stem cell transplantation for bone repair, spinal cord injury, macular degeneration, Stargardt's disease, and Batten's disease. This may be an appropriate point at which to review our experiences in moving from the lab to the clinic to initiate a Phase I clinical trial of autologous olfactory ensheathing cells in spinal cord injured humans. PMID:23934846

Mackay-Sim, Alan; Féron, François

2013-01-01

128

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

Cancer.gov

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.

129

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

1991-05-01

130

Red Ginseng Treatment for Two Weeks Promotes Fat Metabolism during Exercise in Mice  

PubMed Central

PURPOSE: Red ginseng (RG) has been reported to improve the blood and organ lipid profile when combined with exercise. However, the effect of RG on energy metabolism during exercise is poorly understood. Therefore, this study was designed to investigate whether RG treatment alters fat utilization during exercise; METHODS: We used seven-week-old ICR mice (n = 42). RG (1 g/kg) was administered orally daily during two weeks of endurance training. All mice were randomized into two groups: training only group (CON group) and training with RG group (RG group). Endurance training consisted of 20~25 m/min on a slope of 8° for one hour five times a week. After a two-week experimental period, we measured substrate utilization during exercise at the same intensity and duration of training using a respiratory calorimetry chamber. Mice were dissected for glycogen measurement of muscles and liver before, immediately after, and one hour after the exercise; RESULT: Fat oxidation during the initial 20 min of the one-hour exercise significantly increased in the RG group compared to the CON group. In addition, the liver glycogen stores significantly decreased immediately after the one-hour exercise compared to at rest in the RG group, but did not differ between immediately after the one-hour exercise and at rest in the RG group. The glycogen concentration in white and red gastrocnemius muscle did not differ between the groups immediately after the one-hour exercise; CONCLUSIONS: These results suggest that RG treatment for two weeks promotes fat oxidation and a glycogen-sparing effect during exercise. This might lead to a delay in peripheral fatigue during endurance exercise performance.

Hwang, Hyejung; Kim, Jisu; Park, Jonghoon; Yun, Heayeon; Cheon, Woo-Kwang; Kim, Bokyung; Lee, Chi-Ho; Suh, Heajung; Lim, Kiwon

2014-01-01

131

Transdermal monosialoganglioside with laser in the treatment of spinal cord lesion in rats  

PubMed Central

OBJECTIVES: To evaluate the effects of monosialoganglioside (GM1) administered transdermally with laser in the recovery of spinal cord injury in rats. METHODS: Forty male Wistar rats underwent spinal cord contusion using the NYU Impactor. In Group 1, the rats received 0,2 ml of saline intraperitoneally daily; in Group 2, GM1 was administered intraperitoneally at a concentration of 30 mg/kg per day; in Group 3, rats were treated daily with laser at low temperature on the skin, and in Group 4, the daily laser session also contained GM1. All the groups were treated for 42 days. The animals were evaluated by the Basso, Baettie and Bresnahan (BBB) functional scale on days 7, 14, 21, 28, 35 and 42 after the injury, and by histopathology and motor evoked potential after 42 days of injury. RESULTS: The animals in Group 4 had higher BBB scores compared with the other groups. There were no differences between the groups, or in the comparisons over time. Histological evaluation showed no differences, and no differences were found in the motor evoked potential tests either. CONCLUSION: GM1 associated with the use of low-temperature laser shows no superior functional, neurological or histological results in the treatment of spinal cord lesions in rats. Evidence Level I, Experimental, Controlled, Animal Study.

de Souza, Fabiano Inacio; Cristante, Alexandre Fogaca; Marcon, Raphael Martus; Ferreira, Ricardo; dos Santos, Gustavo Bispo; de Barros, Tarcisio Eloy Pessoa

2013-01-01

132

The role of exercise in the treatment of obesity.  

PubMed

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 (www.health.gov/paguidelines). 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

2012-11-01

133

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

1992-01-01

134

Treatment of combined spinal deformity in patient with ollier disease and abnormal vertebrae.  

PubMed

We report staged treatment of severe combined spinal deformity in an 11-year-old patient with Ollier disease and abnormal cervical vertebra. Combined scoliosis with systemic pathology and abnormal vertebrae is a rare condition and features atypical deformity location and rapid progression rate and frequently involves the rib cage and pelvis, disturbing the function of chest organs and skeleton. Progressive deformity resulted in cachexia and acute respiratory failure. A halo-pelvic distraction device assembled of Ilizarov components was employed for a staged surgical treatment performed for lifesaving indications. After vital functions stabilized, the scoliosis curve of the cervical spine was corrected and fixed with a hybrid system of transpedicular supporting points, connecting rods, and connectors that provided staged distraction during growth. The treatment showed good functional and cosmetic result. PMID:24436859

Ryabykh, S ?; Gubin, A V; Prudnikova, Capital O Cyrillic G; Kobyzev, Capital A Cyrillic ?

2013-06-01

135

Poor Responses to Interferon-Beta Treatment in Patients with Neuromyelitis Optica and Multiple Sclerosis with Long Spinal Cord Lesions  

PubMed Central

Interferon-beta (IFN-?) treatment may not be effective in neuromyelitis optica (NMO). Whether the poor response to IFN-? is related to long spinal cord lesions (LSCL) or the NMO disease entity itself is unclear. We evaluated the spinal cord involvement of patients with multiple sclerosis (MS) and NMO, as well as the response after receiving IFN-?. Forty-nine MS and 21 NMO patients treated with IFN-? for at least 2 years from 2002–2008 were enrolled in this study and the treatment response was analyzed 2 years post-treatment. In the study, spinal cord lesions were present in 57.1% (28/49) of the MS patients, of which 16.3% (8/49) presented spinal cord lesions longer than 3 vertebral segments (LSCL). Responses to IFN-? treatment were seen in 69.3% (34/49) of all the MS cases, of which the appropriate response rates were 76.1% (16/21) in MS patients without spinal cord lesions and 37.5% (3/8) in patients with LSCL. Only 14.2% (3/21) of NMO patients responded to IFN-? treatment. In conclusion, spinal cord lesion is common in MS patients in Taiwan. Both NMO and MS patients with LSCL had a poor response to IFN-? treatment. NMO patients had a worse response to IFN-? treatment than MS patients with LSCL, which shows that the crucial structural defect is something other than LSCL such as the elevated serum IL17 level in NMO compared to MS.

Lee, Tzu-Chi; Lee, Chao-Lin; Chen, Shao-Yuan; Chen, Shyi-Jou; Chin, Li-Te; Tsai, Ching-Piao

2014-01-01

136

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

2011-01-01

137

Exercise for prevention and treatment of cardiovascular disease, type 2 diabetes, and metabolic syndrome  

Microsoft Academic Search

A considerable number of observational and intervention studies support the role of exercise as a cornerstone in prevention\\u000a and treatment of cardiovascular disease (CVD), type 2 diabetes (T2D), and the metabolic syndrome. Physical activity and cardiorespiratory\\u000a fitness are also associated with reduced mortality rates among persons with CVD, T2D, and metabolic syndrome. Exercise has\\u000a definite acute effects on a number

Glenn A. Gaesser

2007-01-01

138

The Clinical Outcomes of Surgical Treatment of Noncontiguous Spinal Tuberculosis: A Retrospective Study in 23 Cases  

PubMed Central

Study design A retrospective clinical study. Objective To evaluate the clinical efficacy of the surgical treatment of noncontiguous spinal tuberculosis (NSTB), and to discuss its therapeutic strategies. Methods We performed a retrospective review of clinical and radiographic data that were prospectively collected on 550 consecutive spinal tubercular patients including 27 patients who were diagnosed and treated as NSTB in our institution from June 2005 to June 2011. Apart from 4 patients being treated conservatively, the remainder received surgery by posterior transforaminal debridement, interbody fusion with instrumentation, posterior instrumentation and anterior debridement with fusion in a single or two-stage operation. The clinical outcomes were evaluated before and after treatment in terms of hematologic and radiographic examinations, bone fusion and neurologic status. The Oswestry Disability Index score was determined before treatment and at the last follow-up visit. Results 23 patients (15 M/8F), averaged 44.6±14.2 years old (range, 19 to 70 yd), who received surgical treatment, were followed up after surgery for a mean of 52.5±19.5 months (range, 24 to 72 months). The kyphotic angle was changed significantly between pre- and postoperation (P<0.05). The mean amount of correction was 12.6±7.2 degrees, with a small loss of correction at last follow-up. All patients achieved solid bone fusion. No patients with neurological deficit deteriorated postoperatively. Neither mortalities nor any major complications were found. There was a significant difference of Oswestry Disability Index scores between preoperation and the final follow-up. Conclusion The outcomes of follow-up showed that posterior and posterior-anterior surgical treatment methods were both viable surgical options for NSTB. Posterior transforaminal debridement, interbody fusion and posterior instrumentation, as a less invasive technique, was feasible and effective to treat specific tubercular foci.

Huang, Jia; Zhang, Hongqi; Zeng, Kefeng; Gao, Qile

2014-01-01

139

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

2008-01-01

140

Analysis of Risk Factors and Management of Cerebrospinal Fluid Morbidity in the Treatment of Spinal Dysraphism  

PubMed Central

Objective Spinal dysraphism defects span wide spectrum. Wound dehiscence is a common postoperative complication, and is a challenge in the current management of cerebrospinal fluid (CSF) leaks and wound healing. The purpose of this study is to evaluate the risks of CSF-related morbidity in the surgical treatment of spinal dysraphism. Methods Ten patients with spinal dysraphism were included in this retrospective study. The median age of the cohort was 4.8 months. To assess the risk of CSF morbidity, we measured the skin lesion area and the percentage of the skin lesion area relative to the back surface for each patient. We then analyzed the relationship between morbidity and the measured skin lesion area or related factors. Results The overall median skin lesion area was 36.2 cm2 (n=10). The percentage of the skin lesion area relative to the back surface ranged from 0.6% to 18.1%. During surgical reconstruction, 4 patients required subsequent operations to repair CSF morbidity. The comparison of the mean area of skin lesions between the CSF morbidity group and the non-CSF morbidity group was statistically significant (average volume skin lesion of 64.4±32.5 cm2 versus 27.7±27.8 cm2, p<0.05). CSF morbidity tended to occur either when the skin lesion area was up to 44.2 cm2 or there was preexisting fibrosis before revision with an accompanying broad-based dural defect. Conclusion Measuring the lesion area, including the skin, dura, and related surgical parameters, offers useful information for predicting wound challenges and selecting appropriate reconstructive surgery methods.

Lee, Byung-Jou; Han, Seong-Rok; Choi, Chan-Young; Lee, Dong-Joon; Kang, Jae Heon

2013-01-01

141

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

PubMed

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. PMID:22414309

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

2012-05-01

142

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.

2012-01-01

143

The changing role for neurosurgeons and the treatment of spinal deformity  

Microsoft Academic Search

U Spinal deformity has classically and historically been studied by those in the discipline of orthopedic surgery. This may be attributable to the orthopedic interventionalists' experience with osseous fixation for long-bone and other skeletal fractures. Neurosurgeons have maintained a long-standing interest in complex cervical spinal disorders, and their interest in the larger field of complex spinal deformity has been expanding.

J. Patrick Johnson; Robert S. Pashman; Carl Lauryssen; Neel Anand; John J. Regan; Robert S. Bray

2005-01-01

144

Astrocytic and vascular remodeling in the injured adult rat spinal cord after chondroitinase ABC treatment.  

PubMed

Upregulation of extracellular chondroitin sulfate proteoglycans (CSPG) is a primary cause for the failure of axons to regenerate after spinal cord injury (SCI), and the beneficial effect of their degradation by chondroitinase ABC (ChABC) is widely documented. Little is known, however, about the effect of ChABC treatment on astrogliosis and revascularization, two important factors influencing axon regrowth. This was investigated in the present study. Immediately after a spinal cord hemisection at thoracic level 8-9, we injected ChABC intrathecally at the sacral level, repeated three times until 10 days post-injury. Our results show an effective cleavage of CSPG glycosaminoglycan chains and stimulation of axonal remodeling within the injury site, accompanied by an extended period of astrocyte remodeling (up to 4 weeks). Interestingly, ChABC treatment favored an orientation of astrocytic processes directed toward the injury, in close association with axons at the lesion entry zone, suggesting a correlation between axon and astrocyte remodeling. Further, during the first weeks post-injury, ChABC treatment affected the morphology of laminin-positive blood vessel basement membranes and vessel-independent laminin deposits: hypertrophied blood vessels with detached or duplicated basement membrane were more numerous than in lesioned untreated animals. In contrast, at later time points, laminin expression increased and became more directly associated with newly formed blood vessels, the size of which tended to be closer to that found in intact tissue. Our data reinforce the idea that ChABC injection in combination with other synergistic treatments is a promising therapeutic strategy for SCI repair. PMID:24380419

Milbreta, Ulla; von Boxberg, Ysander; Mailly, Philippe; Nothias, Fatiha; Soares, Sylvia

2014-05-01

145

X-STOP surgical implant for the treatment of lumbar spinal stenosis: clinical practice recommendations for neurosurgical nurse practitioners.  

PubMed

Lumbar spinal stenosis is a common condition that affects the aging population because of the natural degenerative changes the spine undergoes during the aging process. The symptoms cause decreased functionality and quality of life. Traditional surgical treatment has been a decompressive laminectomy with or without a fusion. However, a newer less-invasive surgical technique called X-STOP interspinous process device is available for the treatment of neurogenic intermittent claudication because of lumbar spinal stenosis. The main goal of this procedure is to allow the patient to restore functional ability and improve quality of life, which bears significant importance in the aging population. Knowledge of the X-STOP interspinous process device can assist neurosurgical advanced practice nurses in providing optimum care for patients with lumbar spinal stenosis when nonsurgical therapies have failed. PMID:23291871

Nielsen, Magan

2013-02-01

146

Use of Fidji Cervical Cage in the Treatment of Cervical Spinal Cord Injury without Radiographic Abnormality  

PubMed Central

Spinal cord injury without radiographic abnormality (SCIWORA) is a rare condition seen in adults. Many interbody fusion cages have been developed for its treatment, but clinical studies of Fidji cervical cage are still scarce. A total number of five patients (four male and one female) were reviewed. The ages of the patients ranged from 40 to 60 years. All the patients underwent neurological and radiological examinations. Neurological and functional outcomes were assessed on the basis of Frankel's grade. Three of the patients were Frankel B, and the rest two were Frankel C. Magnetic resonance imaging was also performed for the evaluation of spinal cord and intervertebral disc injury. Anterior cervical discectomy and Fidji cervical cage fusion were performed for all. The fusion status was evaluated on the basis of X-rays. After surgical intervention, the clinical symptoms improved for all the patients. The disc interspaces in all the patients achieved solid union at final follow-up. Fidji cervical cage is very efficient in achieving cervical fusion in patients with SCIWORA. There are few complications associated with the use of this cage, and the functional and neurological outcomes are satisfactory.

2013-01-01

147

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

PubMed

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

2012-07-01

148

Spinal stabilization in Duchenne muscular dystrophy: principles of treatment and record of 31 operative treated cases.  

PubMed

The aim of this study was to report results of prophylactic spinal stabilization in patients with Duchenne muscular dystrophy. There is still debate regarding the ideal instrumentation. A prospective study of a consecutive series of 31 patients stabilized with the ISOLA system from D2 to S1 will be presented. The mean follow-up was 22 months (range, 1-60 months). The evaluation of the Cobb angle and pelvic obliquity revealed the following: 1) Cobb angle: preoperation, 48.6 degrees (range, 22-82 degrees); postoperation, 12.5 degrees (range, 0-30 degrees); follow-up, 12.5 degrees (range, 0-42 degrees); and 2) pelvic obliquity: preoperation, 18.2 degrees (range, 3-40 degrees); postoperation, 3.8 degrees (range, 0-13 degrees); follow-up, 5.1 degrees (range, 0-14 degrees). Spinal stabilization with the ISOLA system was found to be a suitable treatment for scoliosis owing to Duchenne muscular dystrophy. It should be carried out after loss of ambulation as soon as a progressive curve of more than 20 degrees is documented. The complication rate was found to be high. PMID:11269806

Heller, K D; Wirtz, D C; Siebert, C H; Forst, R

2001-01-01

149

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.

1977-01-01

150

Treatment of spinal cord injury with intravenous immunoglobulin g: preliminary evidence and future perspectives.  

PubMed

Neuroinflammation plays an important role in the secondary pathophysiological mechanisms of spinal cord injury (SCI) and can exacerbate the primary trauma and thus worsen recovery. Although some aspects of the immune response are beneficial, it is thought that leukocyte recruitment and activation in the acute phase of injury results in the production of cytotoxic substances that are harmful to the nervous tissue. Therefore, suppression of excessive inflammation in the spinal cord could serve as a therapeutic strategy to attenuate tissue damage. The immunosuppressant methylprednisolone has been used in the setting of SCI, but there are complications which have attenuated the initial enthusiasm. Hence, there is interest in other immunomodulatory approaches, such as intravenous Immunoglobulin G (IVIg). Importantly, IVIg is used clinically for the treatment of several auto-immune neuropathies, such as Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy (CIPD) and Kawasaki disease, with a good safety profile. Thus, it is a promising treatment candidate for SCI. Indeed, IVIg has been shown by our team to attenuate the immune response and result in improved neurobehavioral recovery following cervical SCI in rats through a mechanism that involves the attenuation of neutrophil recruitment and reduction in the levels of cytokines and cytotoxic enzymes Nguyen et al. (J Neuroinflammation 9:224, 2012). Here we review published data in the context of relevant mechanisms of action that have been proposed for IVIg in other conditions. We hope that this discussion will trigger future research to provide supporting evidence for the efficiency and detailed mechanisms of action of this promising drug in the treatment of SCI, and to facilitate its clinical translation. PMID:24722853

Tzekou, Apostolia; Fehlings, Michael G

2014-07-01

151

A short-term arm-crank exercise program improved testosterone deficiency in adults with chronic spinal cord injury.  

PubMed

Purpose: To determine the influence of arm-crank exercise in reproductive hormone levels in adults with chronic SCI. Further objectives were to assess the influence of arm-crank exercise on muscle strength and body composition. Materials and Methods: Seventeen male adults with complete SCI at or below the 5th thoracic level (T5) volunteered for this study. Participants were randomly allocated to the intervention (n = 9) or control group (n = 8) using a concealed method. The participants in the intervention group performed a 12-week arm-crank exercise program, 3 sessions/week, consisting of warming-up (10-15 min) followed by a main part in arm-crank (20-30 min [increasing 2 min and 30 seconds each three weeks]) at a moderate work intensity of 50-65% of heart rate reserve (HRR) (starting at 50% and increasing 5% each three weeks) and by a cooling-down period (5-10 min). Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone and estradiol were determined by ELISA. Muscle strength (handgrip) and body composition (waist circumference [WC]) were assessed. Results: After the completion of the training program, testosterone level was significantly increased (p = 0.0166;d = 1.14). Furthermore, maximal handgrip and WC were significantly improved. Lastly, a significant inverse correlation was found between WC and testosterone (r =- 0.35; p = 0.0377). Conclusion: The arm-crank exercise improved reproductive hormone profile by increasing testosterone levels in adults with chronic SCI. A secondary finding was that it also significantly improved muscle strength and body composition in this group. PMID:25010302

Rosety-Rodriguez, Manuel; Rosety, Ignacio; Fornieles, Gabriel; Rosety, Jesus M; Elosegui, Sonia; Rosety, Miguel A; Ordonez, Francisco Javier

2014-01-01

152

Resistance exercise interventions during and following cancer treatment: a systematic review.  

PubMed

Findings from prior systematic reviews suggest that exercise results in meaningful improvements in many clinically relevant physiologic and quality of life (QOL) outcomes during and following cancer treatment. However, the majority of exercise-cancer studies have focused upon the benefits of aerobic exercise (AE) and knowledge of the efficacy of resistance exercise (RE) alone as a supportive care intervention for cancer patients and survivors remains limited. Consequently, the purpose of this review was to provide the first systematic evaluation of the effects of RE alone upon clinically relevant physiologic and QOL outcomes during and following cancer treatment. Literature searches were conducted to identify studies examining RE interventions in cancer patients and survivors. Data were extracted on physiologic (fitness, physical function, and body composition) and QOL (fatigue, psychological well-being, and cancer-specific and global QOL outcomes. Cohen's d effect sizes were calculated for each outcome. A total of 15 studies (6 in samples undergoing active cancer treatment and 9 in samples having completed cancer treatment) involving 1,077 participants met the inclusion criteria. Findings revealed that, on average, RE resulted in large effect-size improvements in muscular strength (d = 0.86), moderate effect-size improvements in physical function (d = 0.66), and small effect-size improvements in body composition (d = 0.28) and QOL (d = 0.25) outcomes. The effect sizes observed following RE are comparable in magnitude to the effects of exercise interventions reported in prior comprehensive reviews of the exercise-cancer literature which primarily focused upon AE. Additionally, the methodologic quality of the studies was generally strong. Taken collectively, results of this systematic review suggest that RE is a promising supportive care intervention that results in meaningful improvements in clinically relevant physiologic and QOL outcomes during and following cancer treatment. PMID:23967493

Focht, Brian C; Clinton, Steven K; Devor, Steven T; Garver, Matthew J; Lucas, Alexander R; Thomas-Ahner, Jennifer M; Grainger, Elizabeth

2013-06-01

153

Experimental Treatment of Neurogenic Detrusor Overactivity in Spinal Cord Injured Patients by Automatic Event Driven Electrical Stimulation  

Microsoft Academic Search

The aim of this study was to evaluate the feasibility and clinical relevance of automatic event driven electrical stimulation of the dorsal penile\\/clitoral nerve in treatment of neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI). Detrusor pressure (Pdet) was monitored during at least two sessions of natural bladder filling in each of the 16 patients examined. In

Hansen J; Fjorback MV; Nøhr M; Biering-Sørensen F

154

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

PubMed

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

2013-09-01

155

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

2013-01-01

156

EFFECTIVENESS OF PHYSICAL THERAPIST ADMINISTERED SPINAL MANIPULATION FOR THE TREATMENT OF LOW BACK PAIN: A SYSTEMATIC REVIEW OF THE LITERATURE  

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

2012-01-01

157

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

2009-01-01

158

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

1992-01-01

159

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

PubMed

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

1996-01-01

160

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

2003-01-01

161

The treatment of spinal cord ischemia following thoracic endovascular aortic repair  

Microsoft Academic Search

Introduction  Thoracic endovascular aortic repair (TEVAR) is a promising alternative to the traditional open surgical approach, though spinal\\u000a cord ischemia remains a challenging complication. Spinal cord ischemia has been treated using lumbar cerebral spinal fluid\\u000a (CSF) drainage.\\u000a \\u000a \\u000a \\u000a Methods  We report a case of delayed spinal cord ischemia that was successfully treated with vasopressor therapy alone, supporting\\u000a aggressive blood pressure augmentation as a

Michael L. McGarvey; Michael T. Mullen; Edward Y. Woo; Joseph E. Bavaria; Yanni G. Augoustides; Steven R. Messé; Albert T. Cheung

2007-01-01

162

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.

2012-01-01

163

Evaluation of Role of Anterior Debridement and Decompression of Spinal Cord and Instrumentation in Treatment of Tubercular Spondylitis  

PubMed Central

Study Design Prospective study with simple randomization. Purpose To evaluate the results of anterior spinal instrumentation, debridement and decompression of cord and compare it with results of a similar procedure done without the use of anterior instrumentation. Overview of Literature Use of anterior spinal instrumentation in treatment of tubercular spondylitis is still an infrequently followed modality of treatment and data regarding its usefulness are still emerging. Methods Thirty-two patients of tubercular paraplegia with involvement of dorsal and dorso-lumbar vertebrae were operated with anterior spinal cord decompression, autofibular strut grafting with anterior instrumentation in 18 patients and no implant in 14 patients. Results were compared on the basis of improvement in Frankel grade, correction of local kyphosis, decrease in canal compromise and further progression of kyphosis. Results The mean local kyphosis correction in the immediate postoperative period was 24.1° in the instrumented group and was 6.1° in the non instrumented group. The mean late loss of correction of local kyphosis at 3 years follow-up was 1.7° in the instrumented and 6.7° in the non instrumented group. The mean improvement in canal compression was 39.5% in the instrumented group and 34.8% in the non instrumented group. Conclusions In treatment of tubercular spondylitis by anterior debridement and decompression of the spinal cord and autofibular strut grafting, the use of instrumentation has no relation with the improvement in neurological status, however the correction of local kyphosis and prevention of further progression of local kyphosis was better with the use anterior spinal instrumentation.

Singh, Saurabh; Kumaraswamy, Vinay; Saraf, Shyam Kumar; Khare, Ghanshyam Narayan

2012-01-01

164

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

2011-01-01

165

Spinal fusion  

MedlinePLUS

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

166

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.

2012-01-01

167

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

2011-01-01

168

Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years  

PubMed Central

Background The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain. Objective To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis. Design Prospective cohort study. Data Sources Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants. Target Population Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis. Time Horizon 2 years. Perspective Societal. Intervention Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis). Outcome Measures Cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77 600 (CI, $49 600 to $120 000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus non-operative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115 600 (CI, $90 800 to $144 900) per QALY gained. Result of Sensitivity Analysis Surgery cost markedly affected the value of surgery. Limitation The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment non-adherence among randomly assigned participants. Conclusion The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon.

Tosteson, Anna N.A.; Lurie, Jon D.; Tosteson, Tor D.; Skinner, Jonathan S.; Herkowitz, Harry; Albert, Todd; Boden, Scott D.; Bridwell, Keith; Longley, Michael; Andersson, Gunnar B.; Blood, Emily A.; Grove, Margaret R.; Weinstein, James N.

2009-01-01

169

Small molecule protein tyrosine phosphatase inhibition as a neuroprotective treatment following spinal cord injury in adult rats  

PubMed Central

Spinal cord injury causes progressive secondary tissue degeneration leaving many injured people with neurological disabilities. There are no satisfactory neuroprotective treatments. Protein tyrosine phosphatases inactivate neurotrophic factor receptors and downstream intracellular signaling molecules. Thus, we tested whether the peroxovanadium compound bpV(phen), a stable, potent and selective protein tyrosine phosphatase inhibitor, would be neuroprotective following a thoracic spinal cord contusion in adult rats. Intrathecal bpV(phen) infusions through a lumbar puncture rescued dorsal column sensory axons innervating the nucleus gracilis and white matter at the injury epicenter. At the most effective dose, essentially all of these axons and most of the white matter at the epicenter were spared (vs. ~60% with control infusions). BpV(phen) treatments started 4 hours after contusion were fully effective. This treatment greatly improved and normalized sensory-motor function in a grid walking test and provided complete axonal protection over 6 weeks. The treatment rescued sensory evoked potentials which disappeared after dorsal column transection. BpV(phen) affected early degenerative mechanisms, as the main effects were seen at 7 days and lasted beyond the treatment period. The neuroprotection appeared to be mediated by rescue of blood vessels. BpV(phen) reduced apoptosis of cultured endothelial cells. These results show that a small molecule, used in a clinically relevant manner, reduces loss of long-projecting axons, myelin, blood vessels and function in a model relevant to the most common type of spinal cord injury in humans. They reveal a novel mechanism of spinal cord degeneration involving protein tyrosine phosphatases that can be targeted with therapeutic drugs.

Nakashima, Shojiro; Arnold, Sheila A.; Mahoney, Edward T.; Sithu, Srinivas D.; Zhang, Y. Ping; D'Souza, Stanley E.; Shields, Christopher B.; Hagg, Theo

2008-01-01

170

Human umbilical cord blood-derived mesenchymal stem cell transplantation for the treatment of spinal cord injury  

PubMed Central

The aim of the present study was to investigate the effects of human umbilical cord blood-derived mesenchymal stem cell (HUCB-MSC) transplantation on the functional restoration of spinal cord injury (SCI). A total of 46 adult Wistar rats were randomly divided into three groups: Injury (n=15), control (n=15) and transplantation (n=16). A SCI model was established using the modified Allen’s method (vulnerating energy, 25 g/cm). The rats in the control and transplantation groups were injected at the site of the injury with physiological saline and HUCB-MSC suspension, respectively. At week one, two and four following treatment, the behavior of the rats was evaluated using the Basso, Beattie, Bresnahan locomotor rating scale. In addition, immunohistochemistry (IHC) was performed on samples from the rats that had been sacrificed four weeks subsequent to the treatment. Recovery of the spinal cord nerve function was identified to be significantly different at week two and four following treatment (P<0.05), and IHC identified that at week four following treatment novel nerve cells were being produced. Thus, transplantation of HUCB-MSCs promoted the recovery of the damaged function of spinal cord nerves in rats with SCI.

CUI, BINGZHOU; LI, EN; YANG, BO; WANG, BO

2014-01-01

171

Eight Weeks of Exercise Training Improves Fitness Measures in Methamphetamine-Dependent Individuals in Residential Treatment  

PubMed Central

Objectives Physical exercise has been shown to benefit diverse medical and behavioral conditions. This study assesses the feasibility and efficacy of an 8-week endurance and resistance training program on fitness measures in individuals undergoing residential treatment for methamphetamine (MA) dependence. Methods A total of 39 MA-dependent individuals were randomized to 3 days/week of exercise training (ET, n=15) or health education without training (EA, n=14) over 8 weeks. Aerobic performance (VO2max) was measured by indirect calorimetry, body composition by skinfolds, muscle strength by 1-repetition maximum (1-RM) and endurance at 85% of 1-RM for both leg press (LP) and chest press (CP). Results A total of 29 individuals completed the study for a 74% adherence rate. Baseline characteristics (mean±SD) were balanced between groups: age 31±7 years; height=1.74±0.07 m; weight 82.0±15.0 kg. The ET group significantly improved VO2max by 0.63±0.22 L/min (+21%), LP strength by 24.4±5.6 kg (+40%) and CP strength by 20.6±5.7 kg (+49%). The ET group increased LP and CP endurance by 120% and 96%, respectively and showed significant reductions in body weight of 1.7±2.4 kg (?2%), % body fat of 2.8±1.3% (?15%) and fat weight 2.8±1.8 kg (?18%). All changes were significant (P<0.001) for ET, and no changes were seen for the EA group. Conclusions Individuals recovering from methamphetamine dependence showed substantial improvements in aerobic exercise performance, muscle strength and endurance, and body composition with exercise training. These findings demonstrate the feasibility of an exercise training intervention in these participants and also show excellent responsiveness to the exercise stimulus resulting in physiological changes that might enhance recovery from drug dependency.

Dolezal, Brett A.; Chudzynski, Joy; Storer, Thomas W.; Abrazado, Marlon; Penate, Jose; Mooney, Larissa; Dickerson, Daniel; Rawson, Richard A.; Cooper, Christopher B.

2013-01-01

172

Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A Randomized Controlled Trial  

Microsoft Academic Search

Background: Exercise training may be especially helpful for patients with generalized anxiety disorder (GAD). We conducted a randomized controlled trial to quantify the effects of 6 weeks of resistance (RET) or aerobic exercise training (AET) on remission and worry symptoms among sedentary patients with GAD. Methods: Thirty sedentary women aged 18–37 years, diagnosed by clinicians blinded to treatment allocation with

Matthew P. Herring; Marni L. Jacob; Cynthia Suveg; Rodney K. Dishman; Patrick J. O’Connor

2012-01-01

173

Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients?  

Microsoft Academic Search

Objective: To present and discuss treatment of severe spasms related to spinal cord injury with botulinum toxin type A.Design: A 2-year follow-up study of an incomplete T12 paraplegic patient, who was reluctant to undergo intrathecal baclofen therapy, presenting severe painful spasms in his lower limbs treated with intramuscular injections of botulinum toxin type A.Setting: Department of Physical Medicine and Rehabilitation,

A T Al-Khodairy; C Gobelet; A B Rossier

1998-01-01

174

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

2009-01-01

175

Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review  

Microsoft Academic Search

This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major\\u000a hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial\\u000a issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts)\\u000a are a rare

Efstathios J. Boviatsis; Lampis C. Staurinou; Andreas T. Kouyialis; Maria M. Gavra; Pantelis C. Stavrinou; Marios Themistokleous; Panayiotis Selviaridis; Damianos E. Sakas

2008-01-01

176

The effects of ice massage, ice massage with exercise, and exercise on the prevention and treatment of delayed onset muscle soreness.  

PubMed

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. PMID:16558163

Isabell, W K; Durrant, E; Myrer, W; Anderson, S

1992-01-01

177

A Systematic Review of Non-Invasive Pharmacologic Neuroprotective Treatments for Acute Spinal Cord Injury  

PubMed Central

Abstract 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.

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

2011-01-01

178

[Physical exercises in the rehabilitative treatment of patients in the acute phase of cerebral stroke].  

PubMed

The authors present new data on the results of rehabilitative treatment of 360 patients in the acute phase of cerebral stroke with the ischemic focus located in one of the carotid and vertebrobasiliar basins. They demonstrate the direct dependence of the success of restoration of locomotor activity on the early onset of remedial therapy and the significant correlation between the effect of physical exercises and the localization of the ischemic focus in the brain. PMID:21465773

Ponomarenko, G N; Anisimova, L N

2011-01-01

179

Exercise After Treatment for Breast Cancer: Effects on Quality of Life  

Microsoft Academic Search

\\u000a Whilst the incidence of breast cancer is high, survival is good and has improved significantly over the past 30 years. A diagnosis\\u000a of breast cancer can be a life-changing event for women and treatment can be intense and prolonged; this can have a detrimental\\u000a effect on QoL. Exercise may be a means by which the QoL of cancer survivors can

Helen Crank; Amanda Daley

180

Treatment of erectile dysfunction: can pelvic muscle exercises improve sexual function?  

PubMed

Erectile dysfunction, the inability to achieve or maintain an erection sufficient for satisfactory sexual performance, affects 10 to 20 million American men. The underlying causes of erectile dysfunction are commonly classified as neurogenic, arteriogenic, venogenic, or psychogenic. The perineal muscles, specifically the ischiocavernosus and bulbospongiosus, play a role in human penile erection. This article explores the role of pelvic muscle exercises, designed to strengthen the perineal muscles. In the treatment of erectile dysfunction secondary to venous leakage. PMID:9376901

Ballard, D J

1997-09-01

181

Treatment of hyperlipidemia in elderly persons with exercise training, nonpharmacologic therapy, and drug combinations.  

PubMed

Hyperlipidemia is a major modifiable risk factor for the primary and secondary prevention of cardiovascular diseases in the elderly population. Although statin therapy remains the mainstay of treatment for hyperlipidemia in the elderly, other therapies, including exercise training, plant stanols and sterols, soluble fiber, and drug combinations (especially ezetimibe, niacin, and/or fibrates alone or combined with statins) are also effective and important lipid therapies for the elderly population. PMID:15133427

Lavie, Carl J

2004-01-01

182

Treatment of Pulmonary Disease Following Cervical Spinal Cord Injury. Evidence Report/Technology Assessment Number 27.  

National Technical Information Service (NTIS)

Injuries at the cervical level of the spinal cord, depending on the completeness of the lesion, can lead to tetraplegia, loss of sensory function, and paralysis of the respiratory muscles. Patients with paralyzed respiratory muscles (principally the diaph...

B. B. Hamilton D. B. Matchar G. P. Samsa J. A. Govert J. T. Kolimaga R. E. Goslin

2001-01-01

183

Methyl Prednisolone in the Treatment of Acute Spinal Cord Decompression Sickness.  

National Technical Information Service (NTIS)

Sixteen anesthetized dogs undertook a chamber dive that was designed to induce decompression sickness. Somatosensory evoked potentials (SEP) were used to diagnose and quantify the outcome of spinal cord involvement in the disease. Following diagnosis, 8 a...

T. J. Francis A. J. Dutka

1989-01-01

184

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

2006-01-01

185

Applications of Medical Image Processing in the Diagnosis and Treatment of Spinal Deformity  

Microsoft Academic Search

\\u000a Spinal deformities are a group of disorders characterized by abnormal curvature of the spine. In the healthy spine, natural\\u000a curves occur in the sagittal plane, with a lordosis (concave curvature) in the lower back (lumbar) region and kyphosis (convex\\u000a curvature) in the upper back (thoracic) region. In some spinal deformities, these natural curves can be either suppressed\\u000a or amplified, as

Clayton Adam; Geoff Dougherty

186

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

2000-01-01

187

Motor function changes in the rat following severe spinal cord injury. Does treatment with moderate systemic hypothermia improve functional outcome?  

PubMed

Systemic hypothermia exerts neuroprotective effects following trauma and ischemia caused by vascular occlusion in the brain. In the spinal cord similar effects have been demonstrated following ischemia after aortic occlusion. We have previously presented protective effects on several morphological parameters in the early period after the injury, using an established spinal cord compression injury model and systemic hypothermia. In the present study we have evaluated the effects on motor function following severe spinal cord compression trauma and treatment with moderate systemic hypothermia. Thirty Sprague Dawley rats were randomized into three groups: In group 1 (n = 4), the animals underwent a hypothermic procedure, including a 2 h hypothermic period with a body temperature of 30 degrees C, following the initial laminectomy. In group 2 (n = 12) a 50 g compression was applied to the spinal cords for 5 min, after which the animals were kept under normothermic anesthesia for 3 h. In group 3 (n = 14), the animals underwent the same trauma procedure as in group 2 and the same hypothermic procedure as in group 1. The animals were allowed to survive for 14 days, during which the motor function was recorded. This degree of trauma results in a non-reversible paraplegia, and the addition of systemic hypothermia as described above did not alter the neurological recovery as measured by two different methods of recording the motor function up to two weeks after injury. All animals survived in group 1. However, the mortality rates in group 2 were 25% and in group 3, 50%, respectively, which mirrors the severity of the trauma. The application of systemic hypothermia and the lack of experimental therapeutic success highlight the difficulties of transferring experimental beneficial neuroprotective effects to a clinically useful treatment method. In this experimental set-up the effects of the severe primary injury may overshadow the effects of the secondary injury mechanisms, which limits the therapeutic possibilities of systemic hypothermic treatment. PMID:10898365

Westergren, H; Farooque, M; Olsson, Y; Holtz, A

2000-01-01

188

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

2005-01-01

189

Clinical improvement through nonoperative treatment of adult spinal deformity: who is likely to benefit?  

PubMed

Object The goal of this study was to determine the outcome and risk factors in patients with adult spinal deformity (ASD) who elected to receive nonoperative care. Methods In this retrospective study the authors reviewed a nonoperative branch of the International Spine Study Group database, derived from 10 sites across the US. Specific inclusion criteria included nonoperative treatment for ASD and the availability of Scoliosis Research Society (SRS)-22 scores and radiographic data at baseline (BL) and at 1-year (1Y) follow-up. Health-related quality of life measures were assessed using the SRS-22 and radiographic data. Changes in SRS-22 scores were evaluated by domain and expressed in number of minimum clinically important differences (MCIDs) gained or lost; BL and 1Y scores were also compared with age- and sex-matched normative references. Results One hundred eighty-nine patients (mean age 53 years, 86% female) met inclusion criteria. Pain was the domain with the largest offset for 43% of patients, followed by the Appearance (23%), Activity (18%), and Mental (15%) domains. On average, patients improved 0.3 MCID in Pain over 1Y, without changes in Activity or Appearance. Baseline scores significantly impacted 1Y outcomes, with up to 85% of patients in the mildest category of deformity being classified as < 1 MCID of normative reference at 1Y, versus 0% of patients with the most severe initial deformity. Baseline radiographic parameters did not correlate with outcome. Conclusions Patients who received nonoperative care are significantly more disabled than age- and sex-matched normative references. The likelihood for a patient to reach SRS scores similar to the normative reference at 1Y decreases with increased BL disability. Nonoperative treatment is a viable option for certain patients with ASD, and up to 24% of patients demonstrated significant improvement over 1Y with nonoperative care. PMID:24785484

Slobodyanyuk, Kseniya; Poorman, Caroline E; Smith, Justin S; Protopsaltis, Themistocles S; Hostin, Richard; Bess, Shay; Mundis, Gregory M; Schwab, Frank J; Lafage, Virginie

2014-05-01

190

The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence.  

PubMed

The aim of this study was to evaluate the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. A prospective comparison design of 99 matched pairs (n= 198) of mothers, a training group and a control group, was used. Eight weeks postpartum the training group attended an 8-week intensive pelvic floor muscle exercise course, training in groups led by a physical therapist for 45 minutes once a week. In addition they were asked to exercise at home at least three times per week. The control group followed the ordinary written postpartum instructions from the hospital. Pelvic floor muscle strength was measured pretreatment at the eighth, and post-treatment at the 16th week after delivery, using a vaginal balloon catheter connected to a pressure transducer. Vaginal palpation and observation of inward movement of the balloon catheter during contraction were used to test the ability to perform correct the pelvic floor muscle contraction. Urinary leakage was registered by interview, specially designed instruments to measure how women perceive SUI, and a standardized pad test. At baseline (8 weeks postpartum) there was no significant difference in the number of women with urinary incontinence in the training group compared to the control group. At 16 weeks postpartum, after the 8-week treatment period, there was a significant (P<0.01) difference in favor of the training group. In addition, a significantly greater improvement in pelvic floor muscle strength between test 1 and test 2 was found in the training group compared to the control group. The results show that a specially designed postpartum pelvic floor muscle exercise course is effective in increasing pelvic floor muscle strength and reducing urinary incontinence in the immediate postpartum period. PMID:9449300

Mørkved, S; Bø, K

1997-01-01

191

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

2011-01-01

192

Adipose tissue cellularity and lipolysis. Response to exercise and cortisol treatment.  

PubMed Central

Male rats a 5 wk of age were subjected to 13 wk of intensive treadmill running to study the effect of exercise on adipose tissue cellularity and lipolysis. Untrained controls of the same age remained sedentary in their cages for the duration of the experiment. Adipocyte numbers were similar in eqidiymal fat pads from trained and untrained rats (12.7 plus or minus 1.3 X 10(6) vs. 15.3 plus or minus 1.3 X 10(6) cells/pad), however trained rats had smaller fat pads containing smaller cells (0.09 plus of minus 0.01 vs. 0.20 plus or minus 0.04 mug triglyceride/cell). Adipocytes from trained rats possessed greater epinephrine-sensitive lipase activity than sedentary rats on a per cell, per milligram protein, per gram adipose tissue, or per fat pad basis. Although the smaller cells of the trained rats had greater epinephrine-sensitive lipase activity than the larger cells of the untrained rats, lipolysis was positively correlated with cell size within both treatment groups. Cortisol treatment of intact animals did not significantly affect in vitro adipose tissue lipolysis. The results of this study indicate that exercise training increased the potential of adipose tissue cells to release free fatty acids in response to epinephrine stimulation. Exercise training initiated at 5 wk of age had only a small effect on adipose tissue cell numbers but significantly decreased cell size.

Askew, E W; Huston, R L; Plopper, C G; Hecker, A L

1975-01-01

193

Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up.  

PubMed

Study design:Multi-center, cross-sectional study.Objectives:Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire.Setting:Turkey.Methods:Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management.Results:The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization (IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation (P>0.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders (P>0.05). The most common anticholinergic drug used was oxybutynin (40.3%), followed by trospium (32.6%), tolterodine (19.3%) darifenacin (3.3%), propiverine (3.3%) and solifenacin (1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists (76.2%), urologists (22.1%) and neurologists (1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients (77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital (15.3%) and monetary problems (7.7%). Of the patients, 42.7% did not experience urinary tract infections (UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had ?3 clinical UTIs. The clinical characteristics of patients with and without UTI (at least one symptomatic UTI during 1 year) were similar (P>0.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques (P>0.05).Conclusion:The most frequently used technique for bladder rehabilitation in patients with SCI was IC (77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs. PMID:24732167

Y?ld?z, N; Akkoç, Y; Erhan, B; Gündüz, B; Y?lmaz, B; Alaca, R; Gök, H; Köklü, K; Ersöz, M; C?nar, E; Karapolat, H; Catalba?, N; Bardak, A N; Turna, I; Demir, Y; Güne?, S; Alemdaro?lu, E; Tunç, H

2014-06-01

194

Percutaneous insertion of the spinal end of a cysto-peritoneal shunt as definitive treatment to relieve cord compression from a spinal arachnoid cyst  

Microsoft Academic Search

A case of myelopathy with both intradural and extradural spinal arachnoid cysts is reported treated by cysto-peritoneal shunt, the spinal end of which was inserted percutaneously under fluoroscopic control. The site of drainage was determined by findings at computed myelography. The case illustrates the value of the latter in demonstrating the pathological bio-mechanics producting myelopathy in this condition.

J. M. Stevens; B. E. Kendall; C. Davis; H. A. Crockard

1987-01-01

195

[Current role of methylprednisolone in the treatment of acute spinal cord injury].  

PubMed

High doses of methylprednisolone (MPSS) came into use as part of a therapeutic protocol for acute spinal cord injuries following the published results from the NASCIS II study in 1992; they soon became a standard of care around the world. However, the results of this study have been critically reviewed and questioned by many authors since the beginning. The major argument is based on the fact that its effectiveness in reducing post-injury neurological damage has not been conclusively proved; in addition, there has been increasing evidence of serious side effects of steroids administered at high doses. In the Czech Republic, as part of pre-hospital care, MPSS according to the NASCIS II (or NASCIS III) protocol is used in all regional centres of emergency medical service. In the Czech spinal surgery centres involved in treating acute spinal cord injuries, there are 19 of them, attitudes towards the use of MPSS vary. In 16% of the centres a certainty of its beneficial effect is still maintained, faith in its effect together with fear of a "non-lege artis" procedure is the reason for MSPP use in 21%, and the fear of sanctions only leads to its use in 63% of the centres. There is no standard practice in application of the NASCIS II and NASCIS III protocols and no standard exclusion criteria exist. The two protocols are used equally, and one institution has its own modification. The recommended MPSS dose is administered with no exception in 63% of the centres; dose adjustment is employed according to the form of spinal cord lesion in 11%, the level of spinal cord injury in 5%, associated diseases in 16% and patient age in 11% of the spinal surgery centres. After the results of studies on MPSS administration in acute spinal cord injury have been analysed, many medical societies have changed their recommendations. In view of later relevant publications it is no longer possible to regard MPSS administration as a standard of cure for acute spinal cord injury. Current evidence suggests that MPSS administration in a 24-hour regimen after an initial dose given within 8 hours of injury is the therapeutic procedure that needs individual consideration in each patient according to their state of health and potential complications. MPSS administration at an interval longer than 8 hours after injury and for more than 24 hours is not justified, nor is it justified to use a high MPSS dose at the place of injury by an emergency ambulance crew. Key words: corticosteroids, methylprednisolone, spinal cord trauma, neurological damage. PMID:21888840

Lukáš, R; Zýková, I; Barsa, P; Srám, J

2011-01-01

196

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

2012-01-01

197

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

2005-01-01

198

A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: Implications for treatment matching  

Microsoft Academic Search

Turner AP, Bombardier CH, Rimmele CT. A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching. Arch Phys Med Rehabil 2003;84:358-64. Objective: To describe empirically valid and clinically meaningful types of alcohol use among persons with recent traumatic brain or spinal cord injury. Design: Cross-sectional cohort survey. Setting: Acute

Aaron P. Turner; Charles H. Bombardier; Carl T. Rimmele

2003-01-01

199

The management of bilateral high hamstring tendinopathy with ASTYM® treatment and eccentric exercise: a case report.  

PubMed

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. PMID:23904753

McCormack, Joshua R

2012-08-01

200

Spinal Stenosis  

MedlinePLUS

... cord and allows you to stand and bend. Spinal stenosis causes narrowing in your spine. The narrowing puts ... nerves and spinal cord and can cause pain. Spinal stenosis occurs mostly in people older than 50. Younger ...

201

Computer assisted and patient interactive programming of dual octrode spinal cord stimulation in the treatment of chronic pain.  

PubMed

Objective. To evaluate the effectiveness of spinal cord stimulation using multiple independent programmable electrode selections compared to simple continuous stimulation. Design. Prospective case series 2 years. Setting. Ambulatory care center. Patients. All chronic pain patients who underwent spinal cord stimulation treatment at our center from February 1995 until October 1996 entered the study as a consecutive sample (n = 80). Interventions. Patients were evaluated in continuous stimulation mode (single stimulation program) vs. multi-stimulation mode, (patients activate a series of stimulation programs simultaneously to cover all of their pain) and patient-controlled stimulation mode (patients can select a program in response to their activities and pain level). Outcome measures. We collected visual analog pain scores, patient satisfaction scores by stimulation mode, and paresthesia maps. Results. Mean pain scores declined from 8.1 at baseline to 4.6 with continuous stimulation, and to 3.1 with multi-stimulation and with patient-controlled stimulation (p<0.05). Paresthesia overlap improved from 74% with continuous stimulation to 91% with multi-stimulation, and to 89% with patient-controlled stimulation (p<0.05). None of the patients selected continuous stimulation. Thirty-two patients preferred multi-stimulation, and 48 patients preferred patient-controlled stimulation. Lead revision rates declined from 15% in our previous experience using continuous stimulation to 3.8%. Conclusions. Continuous stimulation was not selected by any patient in favor of multi-stimulation or patient-controlled stimulation. This study indicates that in spinal cord stimulation the use of multiple electrodes together with advanced programmability increases paresthesia overlap, reduces pain scores, reduces revision rates, and improves patient satisfaction with spinal cord stimulation therapy. PMID:22150884

Alo, K M; Yland, M J; Kramer, D L; Charnov, J H; Redko, V

1998-01-01

202

Unusual Spinal Dysraphic Lesions  

PubMed Central

Human tail and multiple spinal dysraphism are unusual congenital malformations. Human tail appeared as a prominent lesion from the lumbosacrococcygeal region, generally without connection between the tail and the neurospinal axis. Spinal dysraphisms are usually isolated, reaching 0.038% of incidence of multiple spinal dysraphisms in the same child. There were three cases described of unusual spinal dysraphic lesions: two cases of human tail and a case of a multiple thoracic myelomeningocele. The literature about diagnosis and treatment was reviewed. Microsurgical technique was performed to provide better exploration of the lesions, and resection could be done in those congenital malformations, without morbidity.

Pacheco, Pollyana; Wanderley, Luiz Eduardo

2013-01-01

203

Spinal tuberculosis: A review  

PubMed Central

Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a ‘cold’ abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.

Garg, Ravindra Kumar; Somvanshi, Dilip Singh

2011-01-01

204

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

1994-01-01

205

Animal experiments and clinical application of olfactory ensheathing cell transplantation for treatment of spinal cord injury  

Microsoft Academic Search

BACKGROUND: The olfactory epithelium can still generate new neurons after arresting its growth and development in the human body. Axons can still be generated and pass through peripheral tissue to reach the olfactory bulb. Thus, olfactory cells have been widely used in the repair of spinal cord injury. OBJECTIVE: Using animal experiments in conjunction with a clinical study of olfactory

Nan Liu; Wei Liu; Baiyu Zhou; Jing Wang; Bing Li

206

Efficacy of interspinous device versus surgical decompression in the treatment of lumbar spinal stenosis: a modified network analysis  

PubMed Central

ABSTRACT Study design: Systematic review using a modified network analysis. Objectives: To compare the effectiveness and morbidity of interspinous-device placement versus surgical decompression for the treatment of lumbar spinal stenosis. Summary: Traditionally, the most effective treatment for degenerative lumbar spinal stenosis is through surgical decompression. Recently, interspinous devices have been used in lieu of standard laminectomy. Methods: A review of the English-language literature was undertaken for articles published between 1970 and March 2010. Electronic databases and reference lists of key articles were searched to identify studies comparing surgical decompression with interspinous-device placement for the treatment of lumbar spinal stenosis. First, studies making the direct comparison (cohort or randomized trials) were searched. Second, randomized controlled trials (RCTs) comparing each treatment to conservative management were searched to allow for an indirect comparison through a modified network analysis approach. Comparison studies involving simultaneous decompression with placement of an interspinous device were not included. Studies that did not have a comparison group were not included since a treatment effect could not be calculated. Two independent reviewers assessed the strength of evidence using the GRADE criteria assessing quality, quantity, and consistency of results. The strengths of evidence for indirect comparisons were downgraded. Disagreements were resolved by consensus. Results: We identified five studies meeting our inclusion criteria. No RCTs or cohort studies were identified that made the direct comparison of interspinous-device placement with surgical decompression. For the indirect comparison, three RCTs compared surgical decompression to conservative management and two RCTs compared interspinous-device placement to conservative management. There was low evidence supporting greater treatment effects for interspinous-device placement compared to decompression for disability and pain outcomes at 12 months. There was low evidence demonstrating little to no difference in treatment effects between the groups for walking distance and complication rates. Conclusion: The indirect treatment effect for disability and pain favors the interspinous device compared to decompression. The low evidence suggests that any further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. No significant treatment effect differences were observed for postoperative walking distance improvement or complication rates; however, findings should be considered with caution because of indirect comparisons and short follow-up periods.

Chou, Dean; Lau, Darryl; Hermsmeyer, Jeffrey; Norvell, Daniel

2011-01-01

207

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

2012-01-01

208

Adverse events after endovascular treatment of chronic cerebro-spinal venous insufficiency (CCSVI) in patients with multiple sclerosis.  

PubMed

Although it is debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients undergo endovascular treatment (ET) of CCSVI. A study is ongoing in Italy to evaluate the clinical outcome of ET. Severe adverse events (AEs) occurred in 15/462 subjects at a variable interval after ET: jugular thrombosis in seven patients, tetraventricular hydrocephalus, stroke, paroxysmal atrial fibrillation, status epilepticus, aspiration pneumonia, hypertension with tachicardia, or bleeding of bedsore in the remaining seven cases. One patient died because of myocardial infarction 10 weeks after ET. The risk of severe AEs related to ET for CCSVI must be carefully considered. PMID:23380649

Ghezzi, A; Annovazzi, P; Amato, M P; Capello, E; Cavalla, P; Cocco, E; Falcini, M; Gallo, A; Patti, F; Perini, P; Rodegher, M E; Rovaris, M; Rottoli, M R; Comi, G

2013-06-01

209

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

2006-01-01

210

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

PubMed

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

2013-11-01

211

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

PubMed

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

2013-11-01

212

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

2009-01-01

213

Is there a place for pudendal nerve maximal electrical stimulation for the treatment of detrusor hyperreflexia in spinal cord injury patients?  

Microsoft Academic Search

The aim of the study is to determine whether pudendal nerve maximal electrical stimulation (MES) could represent an alternative treatment for detrusor hyperreflexia in spinal cord injury (SCI) patients. Six suprasacral SCI patients participated in the study. The treatment consisted of daily stimulation periods of 20 min, repeated five times a week, during 4 weeks, with continuous electrical stimulation of

J G Prévinaire; J M Soler; M Perrigot

1998-01-01

214

Effect of Treatment by Nasal CPAP onCardiopulmonary Exercise Test in ObstructiveSleep Apnea Syndrome  

Microsoft Academic Search

This study was done to evaluate whether cardiac dysfunction or abnormal measurements on cardiopulmonary exercise testing (CPET) can be improved after 2 months of nasal CPAP treatment. Twenty patients with moderate or severe OSAS received nasal CPAP treatment. All subjects also underwent blood pressure, simple spirometric, and arterial blood gas (ABG) measurements; cardiac evaluation by radionuclide scanning and CPET; and

Ching-Chi Lin; Ching-Kai Lin; Kun-Ming Wu; Chon-Shin Chou

2004-01-01

215

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

2006-01-01

216

Impact of metformin treatment and swimming exercise on visfatin levels in high-fat-induced obesity rats.  

PubMed

Objective : Visfatin is a recently discovered adipocytokine that contributes to glucose and obesity-related conditions. Until now, its responses to the insulin-sensitizing agent metformin and to exercise are largely unknown. We aim to investigate the impact of metformin treatment and/or swimming exercise on serum visfatin and visfatin levels in subcutaneous adipose tissue (SAT), peri-renal adipose tissue (PAT) and skeletal muscle (SM) of high-fat-induced obesity rats. Materials and methods : Sprague-Dawley rats were fed a normal diet or a high-fat diet for 16 weeks to develop obesity model. The high-fat-induced obesity model rats were then randomized to metformin (MET), swimming exercise (SWI), or adjunctive therapy of metformin and swimming exercise (MAS), besides high-fat obesity control group and a normal control group, all with 10 rats per group. Zoometric and glycemic parameters, lipid profile, and serum visfatin levels were assessed at baseline and after 6 weeks of therapy. Visfatin levels in SAT, PAT and SM were determined by Western Blot. Results : Metformin and swimming exercise improved lipid profile, and increased insulin sensitivity and body weight reduction were observed. Both metformin and swimming exercise down-regulated visfatin levels in SAT and PAT, while the adjunctive therapy conferred greater benefits, but no changes of visfatin levels were observed in SM. Conclusion : Our results indicate that visfatin down-regulation in SAT and PAT may be one of the mechanisms by which metformin and swimming exercise inhibit obesity. PMID:24728163

Gao, Ya; Wang, Changjiang; Pan, Tianrong; Luo, Li

2014-02-01

217

Cervical Spinal Cord Injury and Deglutition Disorders  

Microsoft Academic Search

The association of cervical spinal cord injury and swallowing disorders is clinically well recognized. This study was performed to determine the clinical significance and the outcome of deglutition disorders observed in the initial treatment of cervical spinal cord injury in our tertiary care spinal cord injury unit. All patients with cervical spinal cord injury admitted to our facility for initial

Rainer Abel; Silke Ruf; Bernhard Spahn

2004-01-01

218

Ibuprofen treatment blunts early translational signaling responses in human skeletal muscle following resistance exercise.  

PubMed

Cyclooxygenase-1 and -2 pathway-derived prostaglandins (PGs) have been implicated in adaptive muscle responses to exercise, but the role of PGs in contraction-induced muscle signaling has not been determined. We investigated the effect of inhibition of cyclooxygenase-1 and -2 activities with the nonsteroidal anti-inflammatory drug ibuprofen on human muscle signaling responses to resistance exercise. Subjects orally ingested 1,200 mg ibuprofen (or placebo control) in three 400-mg doses administered ?30 min before and ?6 h and ?12 h following a bout of unaccustomed resistance exercise (80% one repetition maximum). Muscle biopsies were obtained at rest (preexercise), immediately postexercise (0 h), 3 h postexercise, and at 24 h of recovery. In the placebo (PLA) group, phosphorylation of ERK1/2 (Thr202/Tyr204), ribosomal protein S6 kinase (RSK, Ser380), mitogen-activated kinase 1 (Mnk1, Thr197/202), and p70S6 kinase (p70S6K, Thr421/Ser424) increased at both 0 and 3 h postexercise, with delayed elevation of phospho (p)-p70S6K (Thr389) and p-rpS6 (Ser235/S36 and Ser240/244) at 3 h postexercise. Only p-ERK1/2 (Thr202/Tyr204) remained significantly elevated in the 24-h postexercise biopsy. Ibuprofen treatment prevented sustained elevation of MEK-ERK signaling at 3 h (p-ERK1/2, p-RSK, p-Mnk1, p-p70S6K Thr421/Ser424) and 24 h (p-ERK1/2) postexercise, and this was associated with suppressed phosphorylation of ribosomal protein S6 (Ser235/236 and Ser240/244). Early contraction-induced p-Akt (Ser473) and p-p70S6K (Thr389) were not influenced by ibuprofen, but p-p70S6K (Thr389) remained elevated 24 h postexercise only in those receiving ibuprofen treatment. Early muscle signaling responses to resistance exercise are, in part, ibuprofen sensitive, suggesting that PGs are important signaling molecules during early postexercise recovery. PMID:24833778

Markworth, James F; Vella, Luke D; Figueiredo, Vandre C; Cameron-Smith, David

2014-07-01

219

Antisense-based therapy for the treatment of spinal muscular atrophy  

PubMed Central

One of the greatest thrills a biomedical researcher may experience is seeing the product of many years of dedicated effort finally make its way to the patient. As a team, we have worked for the past eight years to discover a drug that could treat a devastating childhood neuromuscular disease, spinal muscular atrophy (SMA). Here, we describe the journey that has led to a promising drug based on the biology underlying the disease.

Rigo, Frank; Hua, Yimin; Krainer, Adrian R.

2012-01-01

220

Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence  

Microsoft Academic Search

SummaryFunctional deficits of the striated anal sphincteric muscles without any apparent gross defect often result in a lack of ability to postpone defaecation by intention or in faecal incontinence in response to increased intra-abdominal or intra-rectal pressure.We applied electrostimulation to the sacral spinal nerves to increase function of the striated muscles of the anal sphincter. Of three patients followed for

K. E Matzel; U Stadelmaie; F. P Gall; M Hohenfellner

1995-01-01

221

Molecular genetic basis of proximal spinal muscular atrophy and experience in its pharmaceutical treatment  

Microsoft Academic Search

The review considers the original and published data on the molecular genetic basis of proximal spinal muscular atrophy (SMA),\\u000a the most common monogenic neuromuscular disease. The structures of the SMN1 gene and SMN2 pseudogene, mutations distorting the SMN1 function, the structure and functions of the Smn neurotrophic protein, its role in biogenesis of small nuclear ribonucleoproteins\\u000a (snRNPs), and the principles

V. S. Baranov; A. V. Kiselev; V. G. Vakharlovsky; G. Ju. Zheleznjakova; V. N. Komantzev; O. V. Malisheva; A. S. Glotov; T. E. Ivashchenko; A. N. Baranov

2008-01-01

222

Regenerative medicine for the treatment of spinal cord injury: more than just promises?  

PubMed

Spinal cord injury triggers a complex set of events that lead to tissue healing without the restoration of normal function due to the poor regenerative capacity of the spinal cord. Nevertheless, current knowledge about the intrinsic regenerative ability of central nervous system axons, when in a supportive environment, has made the prospect of treating spinal cord injury a reality. Among the range of strategies under investigation, cell-based therapies offer the most promising results, due to the multifactorial roles that these cells can fulfil. However, the best cell source is still a matter of debate, as are clinical issues that include the optimal cell dose as well as the timing and route of administration. In this context, the role of biomaterials is gaining importance. These can not only act as vehicles for the administered cells but also, in the case of chronic lesions, can be used to fill the permanent cyst, thus creating a more favourable and conducive environment for axonal regeneration in addition to serving as local delivery systems of therapeutic agents to improve the regenerative milieu. Some of the candidate molecules for the future are discussed in view of the knowledge derived from studying the mechanisms that facilitate the intrinsic regenerative capacity of central nervous system neurons. The future challenge for the multidisciplinary teams working in the field is to translate the knowledge acquired in basic research into effective combinatorial therapies to be applied in the clinic. PMID:22805417

Pêgo, Ana Paula; Kubinova, Sarka; Cizkova, Dasa; Vanicky, Ivo; Mar, Fernando Milhazes; Sousa, Mónica Mendes; Sykova, Eva

2012-11-01

223

Preventive roles of swimming exercise and pioglitazone treatment on hepatic dysfunction in a rat model of metabolic syndrome.  

PubMed

Pioglitazone (Pio) and swimming exercise (SE) are insulin sensitisers. This investigation was suggested because of the significant side effects associated with Pio treatment in metabolic syndrome (MetS). This study was, therefore, designed to investigate the preventive role of Pio treatment and SE in terms of efficiency and pathological changes in MetS in a rat model. Sixty male Sprague-Dawley rats were distributed equally among 6 groups: (i) control group (C), (ii) exercised control group (C+E), (iii) Pio-treated control group (C+Pio), (iv) group with MetS, (v) group with MetS treated with Pio (MetS+Pio), and (vi) exercised MetS group (MetS+E). Systolic blood pressure and heart rate were measured at the end of the experiments (16 weeks). Retro-orbital blood samples were used to determine the serum levels of glucose, insulin, lipids, gamma glutamyl transferase, alanine transaminase, aspartate transaminase, alkaline phosphatase, fetuin-A, and adiponectin. Semiquantitative reverse transcriptase - PCR insulin gene expression assays and hepatic histopathological examination were conducted. Swimming exercise significantly improved all of the aforementioned parameters, more so than the Pio treatment. In particular, the serum hepatic enzyme levels and hepatic histopathological changes were improved compared with the MetS group. These results suggested that swimming exercise might be an alternative physiological preventive tool against hepatic dysfunction to avoid the side effects associated with Pio treatment, and this could be demonstrated in a rat model of metabolic syndrome. PMID:24502640

Sakr, Hussein F; Al-Hashem, Fahaid H; El-Naby, Waffaa M Hassab; Alkhateeb, Mahmoud A; Zaki, Mohamed Samir A; Refaey, Hesham M El; Morsy, Mohamed D

2014-02-01

224

Exercise-mimicking treatment fails to increase Fndc5 mRNA & irisin secretion in primary human myotubes.  

PubMed

Irisin, myokine secreted by skeletal muscle, was suggested to mediate some of exercise health benefits via "browning" of white adipose tissue. However, mounting evidence contradicts the regulatory role of exercise for muscle irisin production/secretion in humans. Thus, we explored the direct effect of exercise-mimicking treatment on irisin in human primary muscle cells in vitro. Human primary muscle cell cultures were established from lean, obese prediabetic and type-2-diabetic individuals. Complex metabolic phenotyping included assessment of insulin sensitivity (euglycemic hyperinsulinemic clamp) and adiposity content&distribution (MRI&MRS). In vitro exercise-mimicking treatment (forskolin+ionomycin) was delivered in 1-h pulse/day during differentiation. Fndc5 mRNA (qRT-PCR) and secreted irisin (ELISA) were determined in cells and media. Exercise-mimicking treatment more than doubled Pgc1? mRNA in differentiated muscle cells. Nevertheless, Fndc5 mRNA was reduced by 18% and irisin in media by 20%. Moreover, Fncd5 mRNA was increased in myotubes derived from individuals with type-2-diabetes, independent on exercise-mimicking treatment. Fndc5 mRNA in cells was positively related to fasting glycemia (p=0.0001) and negatively to whole-body insulin sensitivity (p<0.05). Collectively, our data do not support the role of exercise-related signaling pathways in irisin regulation in human skeletal muscle and confirm our previous observations on increased Fndc5 expression in muscle cells from individuals with type-2-diabetes. PMID:24642356

Kurdiova, Timea; Balaz, Miroslav; Mayer, Alexander; Maderova, Denisa; Belan, Vitazoslav; Wolfrum, Christian; Ukropec, Jozef; Ukropcova, Barbara

2014-06-01

225

The effects of 4 weeks treatment with cisapride on cystometric parameters in spinal cord injury patients. A double-blind, placebo controlled study.  

PubMed

A group of 21 complete spinal cord injury patients, beyond the phase of spinal shock, were given a treatment of cisapride at random, 10 mg four times a day for 4 weeks. Cystometry was performed first before the start and during the following 4 weeks. No statistically significant difference could be found in the urodynamic parameters between the two groups at the first cystometry. No statistically significant change of the urodynamic parameters could be demonstrated with the treatment, although a non-statistically significant bladder stimulating effect was present in a majority of the patients in the cisapride group. PMID:8584295

Wyndaele, J J; Van Kerrebroeck, P

1995-11-01

226

Exercise prescription for the prevention and treatment of cardiovascular diseases: part I.  

PubMed

Epidemiological, clinical and laboratory studies have provided definitive evidence that physical activity is able to improve fitness and reduce cardiovascular morbidity and mortality. Moreover, physical exercise also seems to significantly reduce the risk of developing other chronic diseases such as obesity, osteoporosis, diabetes, tumours and depression. Promoting physical activity in the general population is therefore one of the primary objectives of our healthcare institutions. Although the benefits of an active lifestyle have been demonstrated by numerous scientific data, only a few numbers of Italians and Europeans take up regular physical exercise. To promote physical activity, both in the general population and in subjects affected by cardiovascular diseases, the Italian Federation of Sports Medicine, the Italian Society of Sports Cardiology, the Italian Association of Hospital Cardiologists, the Italian Society of Cardiology, the Italian Association of Out-of-Hospital Cardiologists and the Italian Group of Cardiac Rehabilitation have promoted the constitution of a Task Force made up of experts in the fields of sports cardiology. The document produced by the Task Force is intended for healthcare professionals and deals with the role of physical activity in the prevention and treatment of cardiovascular diseases. It examines the beneficial effects of physical activity on the cardiovascular system, while analysing the possible risks involved and how they can be avoided. The rational principles underlying the prescription of physical activity in the cardiologic setting are described, as are the modalities for prescribing such activity. PMID:18404008

Giada, Franco; Biffi, Alessandro; Agostoni, Piergiuseppe; Anedda, Alberto; Belardinelli, Romualdo; Carlon, Roberto; Carù, Bruno; D'Andrea, Luigi; Delise, Pietro; De Francesco, Antonino; Fattirolli, Francesco; Guglielmi, Riccardo; Guiducci, Umberto; Pelliccia, Antonio; Penco, Maria; Perticone, Francesco; Thiene, Gaetano; Vona, Margherita; Zeppilli, Paolo

2008-05-01

227

Exercise prescription for the prevention and treatment of cardiovascular diseases: part II.  

PubMed

Epidemiological, clinical and laboratory studies have provided definitive evidence that physical activity is able to improve fitness and reduce cardiovascular morbidity and mortality. Moreover, physical exercise also seems to significantly reduce the risk of developing other chronic diseases such as obesity, osteoporosis, diabetes, tumours and depression. Promoting physical activity in the general population is therefore one of the primary objectives of our healthcare institutions. Although the benefits of an active lifestyle have been demonstrated by numerous scientific data, only a few numbers of Italians and Europeans take up regular physical exercise. To promote physical activity, both in the general population and in subjects affected by cardiovascular diseases, the Italian Federation of Sports Medicine, the Italian Society of Sports Cardiology, the Italian Association of Hospital Cardiologists, the Italian Society of Cardiology, the Italian Association of Out-of-Hospital Cardiologists and the Italian Group of Cardiac Rehabilitation have promoted the constitution of a Task Force made up of experts in the fields of sports cardiology. The document produced by the Task Force is intended for healthcare professionals, and deals with the role of physical activity in the prevention and treatment of cardiovascular diseases. It examines the beneficial effects of physical activity on the cardiovascular system, while analysing the possible risks involved and how they can be avoided. The rational principles underlying the prescription of physical activity in the cardiologic setting are described, as are the modalities for prescribing such activity. PMID:18475138

Giada, Franco; Biffi, Alessandro; Agostoni, Piergiuseppe; Anedda, Alberto; Belardinelli, Romualdo; Carlon, Roberto; Carù, Bruno; D'Andrea, Luigi; Delise, Pietro; De Francesco, Antonino; Fattirolli, Francesco; Guglielmi, Riccardo; Guiducci, Umberto; Pelliccia, Antonio; Penco, Maria; Perticone, Francesco; Thiene, Gaetano; Vona, Margherita; Zeppilli, Paolo

2008-06-01

228

Treatment of spinal cord injury by transplantation of fetal neural precursor cells engineered to express BMP inhibitor  

Microsoft Academic Search

Spontaneous recovery after spinal cord injury is limited. Transplantation of neural precursor cells (NPCs) into lesioned adult rat spinal cord results in only partial functional recovery, and most transplanted cells tend to differentiate predominantly into astrocytes. In order to improve functional recovery after transplantation, it is important that transplanted neural precursor cells appropriately differentiate into cell lineages required for spinal

Takao Setoguchi; Kinichi Nakashima; Takumi Takizawa; Makoto Yanagisawa; Wataru Ochiai; Masaru Okabe; Kazunori Yone; Setsuro Komiya; Tetsuya Taga

2004-01-01

229

Development of Methods for Neurorrhaphy and the Treatment of Spinal Cord and Cauda Equina Injuries in Battle Casualties.  

National Technical Information Service (NTIS)

The role of free radical lipid peroxidation in spinal cord injury has been studied. A potentiating effect of ethanol was observed in both acute and chronic models of spinal cord injury. Lipid peroxidation following spinal cord injury was determined by mea...

J. Ransohoff

1978-01-01

230

The Outcomes of Manipulation or Mobilization Therapy Compared with Physical Therapy or Exercise for Neck Pain: A Systematic Review  

PubMed Central

Study Design?Systematic review. Study Rationale?Neck pain is a prevalent condition. Spinal manipulation and mobilization procedures are becoming an accepted treatment for neck pain. However, data on the effectiveness of these treatments have not been summarized. Objective?To compare manipulation or mobilization of the cervical spine to physical therapy or exercise for symptom improvement in patients with neck pain. Methods?A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database, and bibliographies of key articles, which compared spinal manipulation or mobilization therapy with physical therapy or exercise in patients with neck pain. Articles were included based on predetermined criteria and were appraised using a predefined quality rating scheme. Results?From 197 citations, 7 articles met all inclusion and exclusion criteria. There were no differences in pain improvement when comparing spinal manipulation to exercise, and there were inconsistent reports of pain improvement in subjects who underwent mobilization therapy versus physical therapy. No disability improvement was reported between treatment groups in studies of acute or chronic neck pain patients. No functional improvement was found with manipulation therapy compared with exercise treatment or mobilization therapy compared with physical therapy groups in patients with acute pain. In chronic neck pain subjects who underwent spinal manipulation therapy compared to exercise treatment, results for short-term functional improvement were inconsistent. Conclusion?The data available suggest that there are minimal short- and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain. This systematic review is limited by the variability of treatment interventions and lack of standardized outcomes to assess treatment benefit.

Schroeder, Josh; Kaplan, Leon; Fischer, Dena J.; Skelly, Andrea C.

2013-01-01

231

Continuous intrathecal baclofen treatment of severe spasms in two children with spinal-cord injury.  

PubMed

This study reports the use of intrathecal baclofen in two ventilator-dependent children with severe spasms secondary to spinal-cord injury. Baclofen was delivered via a subcutaneously implanted, programmable pump. The children were followed for 12 and 24 months. Baclofen dramatically reduced spasms, resulting in more stable ventilation, improved ease of care, reduced distress and better integration into the community. Although effective, intrathecal baclofen represents a significant intervention; careful consideration must be given to potential complications and the need for long-term management. Full effectiveness was dependent on free CSF flow. PMID:1644234

Armstrong, R W; Steinbok, P; Farrell, K; Cochrane, D; Norman, M G; Kube, S

1992-08-01

232

Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging  

PubMed Central

A rapidly growing literature strongly suggests that exercise, specifically aerobic exercise, may attenuate cognitive impairment and reduce dementia risk. We used PubMed (keywords exercise and cognition) and manuscript bibliographies to examine the published evidence of a cognitive neuroprotective effect of exercise. Meta-analyses of prospective studies documented a significantly reduced risk of dementia associated with midlife exercise; similarly, midlife exercise significantly reduced later risks of mild cognitive impairment in several studies. Among patients with dementia or mild cognitive impairment, randomized controlled trials (RCTs) documented better cognitive scores after 6 to 12 months of exercise compared with sedentary controls. Meta-analyses of RCTs of aerobic exercise in healthy adults were also associated with significantly improved cognitive scores. One year of aerobic exercise in a large RCT of seniors was associated with significantly larger hippocampal volumes and better spatial memory; other RCTs in seniors documented attenuation of age-related gray matter volume loss with aerobic exercise. Cross-sectional studies similarly reported significantly larger hippocampal or gray matter volumes among physically fit seniors compared with unfit seniors. Brain cognitive networks studied with functional magnetic resonance imaging display improved connectivity after 6 to 12 months of exercise. Animal studies indicate that exercise facilitates neuroplasticity via a variety of biomechanisms, with improved learning outcomes. Induction of brain neurotrophic factors by exercise has been confirmed in multiple animal studies, with indirect evidence for this process in humans. Besides a brain neuroprotective effect, physical exercise may also attenuate cognitive decline via mitigation of cerebrovascular risk, including the contribution of small vessel disease to dementia. Exercise should not be overlooked as an important therapeutic strategy.

Ahlskog, J. Eric; Geda, Yonas E.; Graff-Radford, Neill R.; Petersen, Ronald C.

2011-01-01

233

Multimodal cognitive-behavioural treatment for workers with chronic spinal pain: a matched cohort study with an 18-month follow-up  

Microsoft Academic Search

An outpatient multimodal cognitive-behavioural treatment program (MMCBT) for chronic spinal pain was evaluated during an 18-month follow-up period. The treatment included a 1-day course for the patients' work supervisors. The aim of the study was to evaluate the long-term effect of the treatment program as well as the effect of a work supervisor-training program on the patients' return to work.

I. B Jensen; L Bodin

1998-01-01

234

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.

1995-01-01

235

Early versus late treatment of spinal cord compression with long-term intrathecal enzyme replacement therapy in canine mucopolysaccharidosis type I.  

PubMed

Enzyme replacement therapy (ERT) with intravenous recombinant human alpha-l-iduronidase (IV rhIDU) is a treatment for patients with mucopolysaccharidosis I (MPS I). Spinal cord compression develops in MPS I patients due in part to dural and leptomeningeal thickening from accumulated glycosaminoglycans (GAG). We tested long-term and every 3-month intrathecal (IT) and weekly IV rhIDU in MPS I dogs age 12-15months (Adult) and MPS I pups age 2-23days (Early) to determine whether spinal cord compression could be reversed, stabilized, or prevented. Five treatment groups of MPS I dogs were evaluated (n=4 per group): IT+IV Adult, IV Adult, IT + IV Early, 0.58mg/kg IV Early and 1.57mg/kg IV Early. IT + IV rhIDU (Adult and Early) led to very high iduronidase levels in cervical, thoracic, and lumber spinal meninges (3600-29,000% of normal), while IV rhIDU alone (Adult and Early) led to levels that were 8.2-176% of normal. GAG storage was significantly reduced from untreated levels in spinal meninges of IT + IV Early (p<.001), IT+IV Adult (p=.001), 0.58mg/kg IV Early (p=.002) and 1.57mg/kg IV Early (p<.001) treatment groups. Treatment of dogs shortly after birth with IT+IV rhIDU (IT + IV Early) led to normal to near-normal GAG levels in the meninges and histologic absence of storage vacuoles. Lysosomal storage was reduced in spinal anterior horn cells in 1.57mg/kg IV Early and IT + IV Early animals. All dogs in IT + IV Adult and IV Adult groups had compression of their spinal cord at 12-15months of age determined by magnetic resonance imaging and was due to protrusion of spinal disks into the canal. Cord compression developed in 3 of 4 dogs in the 0.58mg/kg IV Early group; 2 of 3 dogs in the IT + IV Early group; and 0 of 4 dogs in the 1.57mg/kg IV Early group by 12-18months of age. IT + IV rhIDU was more effective than IV rhIDU alone for treatment of meningeal storage, and it prevented meningeal GAG accumulation when begun early. High-dose IV rhIDU from birth (1.57mg/kg weekly) appeared to prevent cord compression due to protrusion of spinal disks. PMID:20655780

Dickson, Patricia I; Hanson, Stephen; McEntee, Michael F; Vite, Charles H; Vogler, Carole A; Mlikotic, Anton; Chen, Agnes H; Ponder, Katherine P; Haskins, Mark E; Tippin, Brigette L; Le, Steven Q; Passage, Merry B; Guerra, Catalina; Dierenfeld, Ashley; Jens, Jackie; Snella, Elizabeth; Kan, Shih-Hsin; Ellinwood, N Matthew

2010-01-01

236

Surgical treatment for congenital kyphosis correction using both spinal navigation and a 3-dimensional model.  

PubMed

An 11 year-old girl had 66 degrees of kyphosis in the thoracolumbar junction. For the purpose of planning for kyphosis correction, we created a 3-D, full-scale model of the spine and consulted spinal navigation. Three-dimensional models are generally used as tactile guides to verify the surgical approach and portray the anatomic relations specific to a given patient. We performed posterior fusion from Th10 to L3, and vertebral column resection of Th12 and L1. Screw entry points, directions, lengths and diameters were determined by reference to navigation. Both tools were useful in the bone resection. We could easily detect the posterior element to be resected using the 3D model. During the anterior bony resection, navigation helped us to check the disc level and anterior wall of the vertebrae, which were otherwise difficult to detect due to their depth in the surgical field. Thus, the combination of navigation and 3D models helped us to safely perform surgery for a patient with complex spinal deformity. PMID:23254585

Sugimoto, Yoshihisa; Tanaka, Masato; Nakahara, Ryuichi; Misawa, Haruo; Kunisada, Toshiyuki; Ozaki, Toshifumi

2012-01-01

237

Usefulness of combining intermittent hypoxia and physical exercise in the treatment of obesity.  

PubMed

Obesity is an important public health problem worldwide and is a major risk factor for a number of chronic diseases such as type II diabetes, adverse cardiovascular events and metabolic syndrome-related features. Different treatments have been applied to tackle body fat accumulation and its associated clinical manifestations. Often, relevant weight loss is achieved during the first 6 months under different dietary treatments. From this point, a plateau is reached, and a gradual recovery of the lost weight may occur. Therefore, new research approaches are being investigated to assure weight maintenance. Pioneering investigations have reported that oxygen variations in organic systems may produce changes in body composition. Possible applications of intermittent hypoxia to promote health and in various pathophysiological states have been reported. The hypoxic stimulus in addition to diet and exercise can be an interesting approach to lose weight, by inducing higher basal noradrenalin levels and other metabolic changes whose mechanisms are still unclear. Indeed, hypoxic situations increase the diameter of arterioles, produce peripheral vasodilatation and decrease arterial blood pressure. Furthermore, hypoxic training increases the activity of glycolytic enzymes, enhancing the number of mitochondria and glucose transporter GLUT-4 levels as well as improving insulin sensitivity. Moreover, hypoxia increases blood serotonin and decreases leptin levels while appetite is suppressed. These observations allow consideration of the hypothesis that intermittent hypoxia induces fat loss and may ameliorate cardiovascular health, which might be of interest for the treatment of obesity. This new strategy may be useful and practical for clinical applications in obese patients. PMID:22045452

Urdampilleta, Aritz; González-Muniesa, Pedro; Portillo, María P; Martínez, J Alfredo

2012-06-01

238

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

National Technical Information Service (NTIS)

This study will test the effect of low-moderate intensity exercise on fatigue and physical functioning in women who have completed treatment for breast cancer. Sample: Subjects are 10-40 women, ages 20-80. Methods: Participants are randomly assigned to an...

K. L. Kemble

2004-01-01

239

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

2005-01-01

240

Spinal Stenosis  

MedlinePLUS

... you. Medications. Over-the-counter medications such as acetaminophen (Tylenol), or nonsteroidal anti-inflammatories (commonly called NSAIDS ) ... relief, it will not cure spinal stenosis or osteoarthritis and symptoms may recur. Broader health impacts Spinal ...

241

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

PubMed

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

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

2014-08-01

242

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

PubMed Central

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

Weiss, Hans-Rudolf; Werkmann, Mario

2009-01-01

243

Spinal shock.  

PubMed

The term "spinal shock" applies to all phenomena surrounding physiologic or anatomic transection of the spinal cord that results in temporary loss or depression of all or most spinal reflex activity below the level of the injury. Hypotension due to loss of sympathetic tone is a possible complication, depending on the level of the lesion. The mechanism of injury that causes spinal shock is usually traumatic in origin and occurs immediately, but spinal shock has been described with mechanisms of injury that progress over several hours. Spinal cord reflex arcs immediately above the level of injury may also be severely depressed on the basis of the Schiff-Sherrington phenomenon. The end of the spinal shock phase of spinal cord injury is signaled by the return of elicitable abnormal cutaneospinal or muscle spindle reflex arcs. Autonomic reflex arcs involving relay to secondary ganglionic neurons outside the spinal cord may be variably affected during spinal shock, and their return after spinal shock abates is variable. The returning spinal cord reflex arcs below the level of injury are irrevocably altered and are the substrate on which rehabilitation efforts are based. PMID:8637263

Atkinson, P P; Atkinson, J L

1996-04-01

244

Eccentric exercise induces chronic alterations in musculoskeletal nociception in the rat  

PubMed Central

Eccentric muscle exercise is a common cause of acute and chronic (lasting days to weeks) musculoskeletal pain. To evaluate mechanisms involved, we have employed a model in the rat, in which eccentric hind limb exercise produces both acute mechanical hyperalgesia as well as long-term changes characterized by enhanced hyperalgesia to subsequent exposure to an inflammatory mediator. Eccentric exercise of the hind limb produced mechanical hyperalgesia, measured in the gastrocnemius muscle, that returned to baseline 120 h post-exercise. When nociceptive thresholds had returned to baseline, intramuscular injection of prostaglandin E2 (PGE2) induced hyperalgesia that was unattenuated 240 h later, much longer than PGE2–induced hyperalgesia in unexercised rats (4 h). This marked prolongation of PGE2 hyperalgesia induced by eccentric exercise was prevented by spinal intrathecal injection of oligodeoxynucleotide antisense to protein kinase C?, a second messenger in nociceptors implicated in the induction of chronic pain. Exercise-induced hyperalgesia and prolongation of PGE2 hyperalgesia was inhibited by spinal intrathecal administration of antisense for the interleukin-6, but not the tumor necrosis factor-? type-1 receptor. These findings provide further insight into the mechanism underlying exercise-induced chronic muscle pain, which suggest novel approaches for the prevention and treatment of exercise or work-related chronic musculoskeletal pain syndromes.

Alvarez, Pedro; Levine, Jon D.; Green, Paul G.

2010-01-01

245

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

2006-01-01

246

Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review.  

PubMed

In addressing adult spinal deformities through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. The Ponte or Smith-Petersen osteotomy provides the least correction, but it can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies but carry increased technical demands, longer operative time, and greater blood loss and associated morbidity. Vertebral column resections serve as the most powerful method, providing the most correction in the coronal and sagittal planes, but posing both the greatest technical challenge and the greatest risk to the patient in terms of possible neurological injury, operative time, and potential morbidity. The authors reviewed the literature relating to these osteotomy methods. They also provided case illustrations and suggestions for their proper application. PMID:20192665

Dorward, Ian G; Lenke, Lawrence G

2010-03-01

247

Transrectal electroejaculation combined with in-vitro fertilization: effective treatment of anejaculatory infertility due to spinal cord injury.  

PubMed

Infertility due to spinal cord injury (SCI) in young men is a frequent complication of their injury. When the simpler methods of management of the erectile and ejaculatory dysfunction that invariably follow the more severe types of SCI are not effective, then semen production by transrectal electroejaculation (TREE) combined with in-vitro fertilization (IVF) and embryo transfer is effective. A retrospective analysis is presented of data on the treatment and outcome of 35 couples who wished to have a family but in whom the male partner had suffered SCI. These 35 couples had 71 attempts at IVF with spermatozoa obtained following TREE. Normal fertilization and cleavage of the embryos occurred in 48.2% of the oocytes. Fresh embryos were transferred in 54 cycles and frozen-thawed embryos in 14 cycles. In all, 18 clinical pregnancies were achieved in 54 fresh and 14 frozen embryo transfer cycles, with a live birth rate of 16.5% (14/85) per treatment cycle started, 20.6% (14/68) per transfer cycle and 40.0% (14/35) per couple who started treatment, in a mean of 1.9 transfer cycles. We conclude that TREE combined with IVF and embryo transfer is an effective treatment for the infertility problems associated with SCI. PMID:9455836

Brinsden, P R; Avery, S M; Marcus, S; Macnamee, M C

1997-12-01

248

The neuroprotective effect of treatment with curcumin in acute spinal cord injury: laboratory investigation.  

PubMed

The purpose of this study was investigating the effects of curcumin on the histological changes and functional recovery following spinal cord injury (SCI) in a rat model. Following either sham operation or SCI, 36 male Sprague-Dawley rats were distributed into three groups: sham group, curcumin-treated group, and vehicle-injected group. Locomotor function was assessed according to the Basso, Beattie, and Bresnahan (BBB) scale in rats who had received daily intraperitoneal injections of 200 mg/kg curcumin or an equivalent volume of vehicle for 7 days following SCI. The injured spinal cord was then examined histologically, including quantification of cavitation. BBB scores were significantly higher in rats receiving curcumin than receiving vehicle (P < 0.05). The cavity volume was significantly reduced in the curcumin group as compared to the control group (P = 0.039). Superoxide dismutase (SOD) activity was significantly elevated in the curcumin group as compared to the vehicle group but was not significantly different from the sham group (P < 0.05, P > 0.05, respectively) at one and two weeks after SCI. Malondialdehyde (MDA) levels were significantly elevated in the vehicle group as compared to the sham group (P < 0.05 at 1 and 2 weeks). MDA activity was significantly reduced in the curcumin group at 2 weeks after SCI when compared to the vehicle group (P = 0.004). The numbers of macrophage were significantly decreased in the curcumin group (P = 0.001). This study demonstrated that curcumin enhances early functional recovery after SCI by diminishing cavitation volume, anti-inflammatory reactions, and antioxidant activity. PMID:24477066

Kim, Kyoung-Tae; Kim, Myoung-Jin; Cho, Dae-Chul; Park, Seong-Hyun; Hwang, Jeong-Hyun; Sung, Joo-Kyung; Cho, Hee-Jung; Jeon, Younghoon

2014-05-15

249

An injectable, calcium responsive composite hydrogel for the treatment of acute spinal cord injury.  

PubMed

Immediately following spinal cord injury, further injury can occur through several secondary injury cascades. As a consequence of cell lysis, an increase in extracellular Ca(2+) results in additional neuronal loss by inducing apoptosis. Thus, hydrogels that reduce extracellular Ca(2+) concentration may reduce secondary injury severity. The goal of this study was to develop composite hydrogels consisting of alginate, chitosan, and genipin that interact with extracellular Ca(2+) to enable in situ gelation while maintaining an elastic modulus similar to native spinal cord (?1000 Pa). It was hypothesized that incorporation of genipin and chitosan would regulate hydrogel electrostatic characteristics and influence hydrogel porosity, degradation, and astrocyte behavior. Hydrogel composition was varied to create hydrogels with statistically similar mechanical properties (?1000 Pa) that demonstrated tunable charge characteristics (6-fold range in free amine concentration) and degradation rate (complete degradation between 7 and 28 days; some blends persist after 28 days). Hydrogels demonstrate high sensitivity to Ca(2+) concentration, as a 1 mM change during fabrication induced a significant change in elastic modulus. Additionally, hydrogels incubated in a Ca(2+)-containing solution exhibited an increased linear viscoelastic limit (LVE) and an increased elastic modulus above the LVE limit in a time dependent manner. An extension of the LVE limit implies a change in hydrogel cross-linking structure. Attachment assays demonstrated that addition of chitosan/genipin to alginate hydrogels induced up to a 4-fold increase in the number of attached astrocytes and facilitated astrocyte clustering on the hydrogel surface in a composition dependent manner. Furthermore, Western blots demonstrated tunable glial fibrillary acid protein (GFAP) expression in astrocytes cultured on hydrogel blends, with some hydrogel compositions demonstrating no significant increase in GFAP expression compared to astrocytes cultured on glass. Thus, alginate/chitosan/genipin hydrogel composites show promise as scaffolds that regulate astrocyte behavior and for the prevention of Ca(2+)-related secondary neuron damage during acute SCI. PMID:24397537

McKay, Christopher A; Pomrenke, Rebecca D; McLane, Joshua S; Schaub, Nicholas J; DeSimone, Elise K; Ligon, Lee A; Gilbert, Ryan J

2014-02-12

250

Web-based therapeutic exercise resource center as a treatment for knee osteoarthritis: a prospective cohort pilot study  

PubMed Central

Background Although beneficial effects of exercise in the management of knee osteoarthritis (OA) have been established, only 14 -18% of patients with knee OA receive an exercise from their primary care provider. Patients with knee OA cite lack of physician exercise advice as a major reason why they do not exercise to improve their condition. The purpose of this pilot study was to investigate use of a web-based Therapeutic Exercise Resource Center (TERC) as a tool to prescribe strength, flexibility and aerobic exercise as part of knee OA treatment. It was hypothesized that significant change in clinical outcome scores would result from patients’ use of the TERC. Methods Sixty five individuals diagnosed with mild/moderate knee OA based on symptoms and radiographs were enrolled through outpatient physician clinics. Using exercise animations to facilitate proper technique, the TERC assigned and progressed patients through multiple levels of exercise intensity based on exercise history, co-morbidities and a validated measure of pain and function. Subjects completed a modified short form WOMAC (mSF-WOMAC), World Health Organization Quality of Life (WHO-QOL) and Knee Self-Efficacy Scale (K-SES) at baseline and completion of the 8 week program, and a user satisfaction survey. Outcomes were compared over time using paired t-tests and effect sizes calculated using partial point biserial (pr). Results Fifty two participants completed the 8 week program with average duration of knee pain 8.0?±?11.0 yrs (25 females; 61.0?±?9.4 yrs; body mass index, 28.8?±?6.3 kg/m2). During the study period, all outcome measures improved: mSF-WOMAC scores decreased (better pain and function) (p?exercise animations were especially helpful). Conclusion This pilot study demonstrated the web-based TERC to be feasible and efficacious in improving clinical outcomes for patients with mild/moderate knee OA and supports future studies to compare TERC to current standard of care, such as educational brochures.

2014-01-01

251

Treatment of myofascial trigger-points with ultrasound combined with massage and exercise – a randomised controlled trial  

Microsoft Academic Search

The effect of treatment with ultrasound, massage and exercises on myofascial trigger-points (MTrP) in the neck and shoulder was assessed in a randomised controlled trial. The outcome measures were pain at rest and on daily function (Visual Analogue Scale, VAS), analgesic usage, global preference and index of MTrP. Long-term effect for treatment and control groups was assessed after 6 months

Arne N Gam; Lone Hørdum Larsen; Bente Jensen; Ola Høydalsmo; Ingelise Allon; Bente Andersen; Niels E Gøtzsche; Marelis Petersen; Birgitte Mathiesen

1998-01-01

252

Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial  

PubMed Central

The purpose of this double-blind, randomized controlled pilot study was to compare the effectiveness of four physical therapy interventions in the treatment of primary shoulder impingement syndrome: 1) supervised exercise only, 2) supervised exercise with glenohumeral mobilizations, 3) supervised exercise with a mobilization-with-movement (MWM) technique, or 4) a control group receiving only physician advice. Thirty-three subjects diagnosed with primary shoulder impingement were randomly assigned to one of these four groups. Main outcome measures included 24-hour pain (VAS), pain with the Neer and Hawkins-Kennedy tests, shoulder active range of motion (AROM), and shoulder function (SPADI). Repeated-measures analyses indicated significant decreases in pain, improved function, and increases in AROM. Univariate analyses on the percentage of change from pre- to post-treatment for each dependent variable found no statistically significant differences (P<0.05) between the four groups. Although not significant, the MWM and mobilization groups had a higher percentage of change from pre- to post-treatment on all three pain measures (VAS, Neer, Hawkins-Kennedy). The three intervention groups had a higher percentage of change on the SPADI. The MWM group had the highest percentage of change in AROM, and the mobilization group had the lowest. This pilot study suggests that performing glenohumeral mobilizations and MWM in combination with a supervised exercise program may result in a greater decrease in pain and improved function although studies with larger samples and discriminant sampling methods are needed.

Kachingwe, Aimie F.; Phillips, Beth; Sletten, Eric; Plunkett, Scott W.

2008-01-01

253

Clinical Assessment Of Stereotactic IGRT: Spinal Radiosurgery  

Microsoft Academic Search

The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited because of the availability of effective target immobilization devices. Recent advances in stereotactic IGRT have allowed for spinal applications. Large clinical experience with spinal radiosurgery to properly assess clinical outcomes has previously been limited. At

Peter C. Gerszten; Steven A. Burton

2008-01-01

254

Sodium bicarbonate treatment prevents gastric emptying delay caused by acute exercise in awake rats.  

PubMed

Physical exercise, mainly after vigorous activity, may induce gastrointestinal dysmotility whose mechanisms are still unknown. We hypothesized that physical exercise and ensuing lactate-related acidemia alter gastrointestinal motor behavior. In the present study, we evaluated the effects of short-term exercise on gastric emptying rate in awake rats subjected to 15-min swimming sessions against a load equivalent to 5% of their body weight. After 0, 10, or 20 min of exercise testing, the rats were gavage fed with 1.5 ml of a liquid test meal (0.5 mg/ml of phenol red in 5% glucose solution) and euthanized 10 min postprandially to measure fractional gastric dye recovery. In addition to inducing acidemia and increasing blood lactate levels, acute exercise increased (P < 0.05) gastric retention. Such a phenomenon presented a positive correlation (P < 0.001) between blood lactate levels and fractional gastric dye recovery. Gastric retention and other acidbase-related changes were all prevented by NaHCO3 pretreatment. Additionally, exercise enhanced (P < 0.05) the marker's progression through the small intestine. In anesthetized rats, exercise increased (P < 0.05) gastric volume, measured by a balloon catheter in a barostat system. Compared with sedentary control rats, acute exercise also inhibited (P < 0.05) the contractility of gastric fundus strips in vitro. In conclusion, acute exercise delayed the gastric emptying of a liquid test meal by interfering with the acid-base balance. PMID:24557800

Silva, Moisés T B; Palheta-Junior, Raimundo C; Sousa, Daniel F; Fonseca-Magalhães, Patrícia A; Okoba, Willy; Campos, Caio P S; Oliveira, Ricardo B; Magalhães, Pedro J C; Santos, Armenio A

2014-05-01

255

Resistance Versus Aerobic Exercise  

PubMed Central

OBJECTIVE In type 1 diabetes, small studies have found that resistance exercise (weight lifting) reduces HbA1c. In the current study, we examined the acute impacts of resistance exercise on glycemia during exercise and in the subsequent 24 h compared with aerobic exercise and no exercise. RESEARCH DESIGN AND METHODS Twelve physically active individuals with type 1 diabetes (HbA1c 7.1 ± 1.0%) performed 45 min of resistance exercise (three sets of seven exercises at eight repetitions maximum), 45 min of aerobic exercise (running at 60% of Vo2max), or no exercise on separate days. Plasma glucose was measured during and for 60 min after exercise. Interstitial glucose was measured by continuous glucose monitoring 24 h before, during, and 24 h after exercise. RESULTS Treatment-by-time interactions (P < 0.001) were found for changes in plasma glucose during and after exercise. Plasma glucose decreased from 8.4 ± 2.7 to 6.8 ± 2.3 mmol/L (P = 0.008) during resistance exercise and from 9.2 ± 3.4 to 5.8 ± 2.0 mmol/L (P = 0.001) during aerobic exercise. No significant changes were seen during the no-exercise control session. During recovery, glucose levels did not change significantly after resistance exercise but increased by 2.2 ± 0.6 mmol/L (P = 0.023) after aerobic exercise. Mean interstitial glucose from 4.5 to 6.0 h postexercise was significantly lower after resistance exercise versus aerobic exercise. CONCLUSIONS Resistance exercise causes less initial decline in blood glucose during the activity but is associated with more prolonged reductions in postexercise glycemia than aerobic exercise. This might account for HbA1c reductions found in studies of resistance exercise but not aerobic exercise in type 1 diabetes.

Yardley, Jane E.; Kenny, Glen P.; Perkins, Bruce A.; Riddell, Michael C.; Balaa, Nadia; Malcolm, Janine; Boulay, Pierre; Khandwala, Farah; Sigal, Ronald J.

2013-01-01

256

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 ClinicalTrials.gov: NCT00454792

2012-01-01

257

Pain Management Following Spinal Cord Injury  

MedlinePLUS

... Spinal Cord Injury InfoSheet 10 Level - Consumer Pain Management following Spinal Cord Injury coming from somewhere other ... is described as burning, cramping and constant. PAIN MANAGEMENT Pain management usually includes treatment with medications, modified ...

258

Questions and Answers about Spinal Stenosis (Revised).  

National Technical Information Service (NTIS)

This publication contains general information about spinal stenosis. It describes the conditions causes, symptoms, diagnosis, and treatments. At the end is a list of additional resources. Spinal stenosis is a narrowing of spaces in the spine (backbone) th...

2004-01-01

259

In vitro and ex vivo evaluation of second-generation histone deacetylase inhibitors for the treatment of spinal muscular atrophy.  

PubMed

Among a panel of histone deacetylase (HDAC) inhibitors investigated, suberoylanilide hydroxamic acid (SAHA) evolved as a potent and non-toxic candidate drug for the treatment of spinal muscular atrophy (SMA), an alpha-motoneurone disorder caused by insufficient survival motor neuron (SMN) protein levels. SAHA increased SMN levels at low micromolar concentrations in several neuroectodermal tissues, including rat hippocampal brain slices and motoneurone-rich cell fractions, and its therapeutic capacity was confirmed using a novel human brain slice culture assay. SAHA activated survival motor neuron gene 2 (SMN2), the target gene for SMA therapy, and inhibited HDACs at submicromolar doses, providing evidence that SAHA is more efficient than the HDAC inhibitor valproic acid, which is under clinical investigation for SMA treatment. In contrast to SAHA, the compounds m-Carboxycinnamic acid bis-Hydroxamide, suberoyl bishydroxamic acid and M344 displayed unfavourable toxicity profiles, whereas MS-275 failed to increase SMN levels. Clinical trials have revealed that SAHA, which is under investigation for cancer treatment, has a good oral bioavailability and is well tolerated, allowing in vivo concentrations shown to increase SMN levels to be achieved. Because SAHA crosses the blood-brain barrier, oral administration may allow deceleration of progressive alpha-motoneurone degeneration by epigenetic SMN2 gene activation. PMID:16805808

Hahnen, Eric; Eyüpoglu, Ilker Y; Brichta, Lars; Haastert, Kirsten; Tränkle, Christian; Siebzehnrübl, Florian A; Riessland, Markus; Hölker, Irmgard; Claus, Peter; Romstöck, Johann; Buslei, Rolf; Wirth, Brunhilde; Blümcke, Ingmar

2006-07-01

260

Somatic comorbidity and younger age are associated with life dissatisfaction among patients with lumbar spinal stenosis before surgical treatment  

PubMed Central

The objective of the study was to examine self-reported life satisfaction and associated factors in patients (n=100) with lumbar spinal stenosis (LSS) in secondary care level, selected for surgical treatment. Life satisfaction was assessed with the four-item Life Satisfaction scale. Depression was assessed with a 21-item Beck Depression Inventory (BDI). Psychological well-being was assessed with Toronto Alexithymia Scale and Sense of Coherence Scale. LSS related physical functioning and pain were assessed with Oswestry disability index, Stucki questionnaire, Visual Analogue Scale and pain drawings. All questionnaires were administered before surgical treatment of LSS. Results showed that 25% of the patients with LSS were found to be dissatisfied with life. In a univariate analysis, smoking, elevated subjective disability scores and extensive markings in the pain drawings were more common in the dissatisfied patients. The dissatisfied patients also showed lower coping resources, elevated alexithymia and depression scores, and were more often depressed. In multiple logistic regression analyses, only younger age and somatic comorbidity were associated with life dissatisfaction. This association remained significant even when the BDI score was added into the model. No other significant associations emerged. In conclusion, life dissatisfaction was rather common among preoperative LSS patients. Pain and constraints on everyday functioning were important correlates of life dissatisfaction. However, only younger age and somatic comorbidity were independently associated with life dissatisfaction. These results emphasize the importance of recognizing and assessing the effect of coexisting medical conditions and they need to be addressed in any treatment program.

Aalto, Timo; Airaksinen, Olavi; Herno, Arto; Kroger, Heikki; Savolainen, Sakari; Turunen, Veli; Viinamaki, Heimo

2006-01-01

261

Acetyl-L-carnitine treatment following spinal cord injury improves mitochondrial function correlated with remarkable tissue sparing and functional recovery.  

PubMed

We have recently documented that treatment with the alternative biofuel, acetyl-L-carnitine (ALC, 300 mg/kg), as late as 1 h after T10 contusion spinal cord injury (SCI), significantly maintained mitochondrial function 24 h after injury. Here we report that after more severe contusion SCI centered on the L1/L2 segments that are postulated to contain lamina X neurons critical for locomotion (the "central pattern generator"), ALC treatment resulted in significant improvements in acute mitochondrial bioenergetics and long-term hind limb function. Although control-injured rats were only able to achieve slight movements of hind limb joints, ALC-treated animals produced consistent weight-supported plantar steps 1 month after injury. Such landmark behavioral improvements were significantly correlated with increased tissue sparing of both gray and white matter proximal to the injury, as well as preservation of choline acetyltransferase (ChAT)-positive neurons in lamina X rostral to the injury site. These findings signify that functional improvements with ALC treatment are mediated, in part, by preserved locomotor circuitry rostral to upper lumbar contusion SCI. Based on beneficial effects of ALC on mitochondrial bioenergetics after injury, our collective evidence demonstrate that preventing mitochondrial dysfunction acutely "promotes" neuroprotection that may be associated with the milestone recovery of plantar, weight-supported stepping. PMID:22445934

Patel, S P; Sullivan, P G; Lyttle, T S; Magnuson, D S K; Rabchevsky, A G

2012-05-17

262

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

PubMed

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

2013-03-01

263

Repeated Baclofen treatment ameliorates motor dysfunction, suppresses reflex activity and decreases the expression of signaling proteins in reticular nuclei and lumbar motoneurons after spinal trauma in rats.  

PubMed

The interruption of supraspinal input to the spinal cord leads to motor dysfunction and the development of spasticity. Clinical studies have shown that Baclofen (a GABAB agonist), while effective in modulating spasticity is associated with side-effects and the development of tolerance. The aim of the present study was to assess if discontinued Baclofen treatment and its repeated application leads antispasticity effects, and whether such changes affect neuronal nitric oxide synthase (nNOS) in the brainstem, nNOS and parvalbumin (PV) in lumbar ?-motoneurons and glial fibrillary acidic protein in the ventral horn of the spinal cord. Adult male Wistar rats were exposed to Th9 spinal cord transection. Baclofen (30mg/b.w.) diluted in drinking water, was administered for 6 days, starting at week 1 after injury and then repeated till week 4 after injury. The behavior of the animals was tested (tail-flick test, BBB locomotor score) from 1 to 8 weeks. Our results clearly indicate the role of nitric oxide, produced by nNOS in the initiation and the maintenance of spasticity states 1, 6 and 8 weeks after spinal trauma. A considerable decrease of nNOS staining after Baclofen treatment correlates with improvement of motor dysfunction. The findings also show that parvalbumin and astrocytes participate in the regulation of ion concentrations in the sub-acute phase after the injury. PMID:24074748

Kucharíková, Andrea; Schreiberová, Andrea; Závodská, Monika; Gedrová, Štefánia; Hricová, ?udmila; Pavel, Jaroslav; Gálik, Ján; Maršala, Martin; Luká?ová, Nadežda

2014-03-01

264

Convex growth arrest in the treatment of congenital spinal deformities, revisited.  

PubMed

The authors studied 32 patients to delineate the reliability of well-defined but frequently extended indications to define the ideal patient who will benefit from convex growth arrest. Mean age at the time of convex growth arrest was 29 (range 6-72) months, and average follow-up was 40 (24-120) months. Mean Cobb angle was 55 degrees (31-105 degrees) before surgery and 50 degrees (13-107 degrees) at final follow-up. Thirteen patients (41%) had a true epiphysiodesis effect, while 15 (47%) had fusion and 4 (12%) had progression. The age at surgery, magnitude, length and location of the curve, presence of intraspinal anomaly, and presence of sagittal plane or rib deformity were investigated in terms of the outcome, but none of these parameters was found to have an effect on the outcome. In conclusion, convex growth arrest is a safe and effective method in the management of the young patients with congenital spinal deformities. It can be performed for the balanced and cosmetically acceptable deformities of patients younger than 5 years of age regardless of the type, length, magnitude, and location of the curve, the existence of associated rib fusion, or the presence of sagittal plane abnormality. PMID:15502567

Uzumcugil, Akin; Cil, Akin; Yazici, Muharrem; Acaroglu, Emre; Alanay, Ahmet; Aksoy, Cemalettin; Surat, Adil

2004-01-01

265

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

Microsoft Academic Search

Activation of spinal microglia contributes to aberrant pain responses associated with neuropathic pain states. Endocannabinoids (ECs) are present in the spinal cord, and inhibit nociceptive processing; levels of ECs may be altered by microglia which modulate the turnover of endocannabinoids in vitro. Here, we investigate the effect of minocycline, an inhibitor of activated microglia, on levels of the endocannabinoids anandamide

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

2009-01-01

266

Device-guided breathing exercises for the treatment of hypertension: An overview  

PubMed Central

The American Heart Association considers device-guided breathing as a reasonable treatment modality in their statement on non-pharmacological options for lowering blood pressure. This review discusses all randomized controlled trials that have investigated the effects of device-guided breathing on blood pressure in patients with hypertension. Thirteen studies were included in this review. In total, 627 patients were included, of which 365 patients were allocated to device-guided breathing. Only 6 studies used acceptable control groups: listening to music, meditative relaxation exercises, or a sham-device. Two sponsored trials showed beneficial effects of device-guided breathing, both used listening to music as a control group. The remaining 4 studies, which had no employees of the manufacturer listed as co-author, observed no beneficial effects on blood pressure. There is only 1 study that used a sham device as a control group. All other studies were to some extend methodologically flawed. Based on the studies with an acceptable methodological quality, there is no clear evidence supporting a short-term beneficial effect on blood pressure by using device-guided breathing.

van Hateren, Kornelis JJ; Landman, Gijs WD; Logtenberg, Susan JJ; Bilo, Henk JG; Kleefstra, Nanne

2014-01-01

267

Wilderness Medical Society practice guidelines for treatment of exercise-associated hyponatremia.  

PubMed

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

2013-09-01

268

Diabetic foot and exercise therapy: step by step the role of rigid posture and biomechanics treatment.  

PubMed

Lower extremity ulcers represent a serious and costly complication of diabetes mellitus. Many factors contribute to the development of diabetic foot. Peripheral neuropathy and peripheral vascular disease are the main causes of foot ulceration and contribute in turn to the growth of additional risk factors such as limited joint mobility, muscular alterations and foot deformities. Moreover, a deficit of balance, posture and biomechanics can be present, in particular in patients at high risk for ulceration. The result of this process may be the development of a vicious cycle which leads to abnormal distribution of the foot's plantar pressures in static and dynamic postural conditions. This review shows that some of these risk factors significantly improve after a few weeks of exercise therapy (ET) intervention. Accordingly it has been suggested that ET can be an important weapon in the prevention of foot ulcer. The aim of ET can relate to one or more alterations typically found in diabetic patients, although greater attention should be paid to the evaluation and possible correction of body balance, rigid posture and biomechanics. Some of the most important limitations of ET are difficult access to therapy, patient compliance and the transitoriness of the results if the training stops. Many proposals have been made to overcome such limitations. In particular, it is important that specialized centers offer the opportunity to participate in ET and during the treatment the team should work to change the patient's lifestyle by improving the execution of appropriate daily physical activity. PMID:24807636

Francia, Piergiorgio; Gulisano, Massimo; Anichini, Roberto; Seghieri, Giuseppe

2014-03-01

269

FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence.  

PubMed Central

We undertook this work to compare the treatment efficacies and the changes of quality of life after pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback treatment, both of which are being widely used as conservative treatment methods for female urinary incontinence. We randomly selected 60 female incontinence patients who visited our department and divided them evenly into two groups. They were treated for a period of 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of the questionnaire by Jackson. Objective changes of pelvic muscle contraction force were measured using a perineometer. Pre- and post-treatment maximal pelvic floor muscle contractile (PMC) pressure and changes in the severity of urinary incontinence and discomfort of the two groups showed statistically significant differences (p<0.001). In particular the FES-biofeedback group showed significantly increased maximal PMC pressure and a decreased severity of urinary incontinence and discomfort compared to the intensive PFM exercise group (p<0.001). In conclusion, FES-biofeedback proved more effective than simple PFM exercise.

Sung, M. S.; Hong, J. Y.; Choi, Y. H.; Baik, S. H.; Yoon, H.

2000-01-01

270

FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence.  

PubMed

We undertook this work to compare the treatment efficacies and the changes of quality of life after pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback treatment, both of which are being widely used as conservative treatment methods for female urinary incontinence. We randomly selected 60 female incontinence patients who visited our department and divided them evenly into two groups. They were treated for a period of 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of the questionnaire by Jackson. Objective changes of pelvic muscle contraction force were measured using a perineometer. Pre- and post-treatment maximal pelvic floor muscle contractile (PMC) pressure and changes in the severity of urinary incontinence and discomfort of the two groups showed statistically significant differences (p<0.001). In particular the FES-biofeedback group showed significantly increased maximal PMC pressure and a decreased severity of urinary incontinence and discomfort compared to the intensive PFM exercise group (p<0.001). In conclusion, FES-biofeedback proved more effective than simple PFM exercise. PMID:10895973

Sung, M S; Hong, J Y; Choi, Y H; Baik, S H; Yoon, H

2000-06-01

271

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.

2013-01-01

272

Control of work rate-driven exercise facilitates cardiopulmonary training and assessment during robot-assisted gait in incomplete spinal cord injury  

Microsoft Academic Search

Treadmill training is used for gait rehabilitation in various neurological conditions. Robot-assisted treadmill training automates repetition of the gait cycle and can reduce the load on therapists. Here we investigate the use of robot-assisted treadmill technology in cardiopulmonary rehabilitation and assessment.Using a new approach to exercise work rate estimation and volitional control, we propose cardiopulmonary assessment protocols for robot-assisted gait

K. J. Hunt; L. P. Jack; A. Pennycott; C. Perret; M. Baumberger; T. H. Kakebeeke

2008-01-01

273

Conventionally-fractionated image-guided intensity modulated radiotherapy (IG-IMRT): a safe and effective treatment for cancer spinal metastasis  

PubMed Central

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 positioning errors in the left-right (LR), superior-inferior (SI) and anterior-posterior (AP) axes were 0.3 ± 3.2, 0.4 ± 4.5 and -0.2 ± 3.9 mm, respectively. After repositioning, those errors were 0.1 ± 0.7, 0 ± 0.8 and 0 ± 0.7 mm, respectively. The systematic/random uncertainties ranged 1.4–2.3/3.0–4.1 before and 0.1–0.2/0.7–0.8 mm after online set-up correction. In the original IMRT plans, the average dose of the planning target volume (PTV) was 61.9 Gy, with the spinal cord dose less than 49 Gy. Compared to the simulated PTVs based on the pre-correction CBCT, the average volume reduction of PTVs was 42.3% after online correction. Also, organ at risk (OAR) all benefited from CBCT-based set-up correction and had significant dose reduction with IGRT technique. Clinically, most patients had prompt pain relief within one month of treatment. There was no radiation-induced toxicity detected clinically during a median follow-up of 15.6 months. Conclusion IG-IMRT provides a new approach to treat cancer spinal metastasis. The precise positioning ensures the implementation of optimal IMRT plan, satisfying both the dose escalation of tumor targets and the radiation tolerance of spinal cord. It might benefit the cancer patient with spinal metastasis.

Gong, Youling; Wang, Jin; Bai, Sen; Jiang, Xiaoqin; Xu, Feng

2008-01-01

274

Brain and Spinal Tumors  

MedlinePLUS

NINDS Brain and Spinal Tumors Information Page Synonym(s): Spinal Cord Tumors Condensed from Brain and Spinal Tumors: Hope Through ... Trials Organizations Additional resources from MedlinePlus What are Brain and Spinal Tumors? Brain and spinal cord tumors ...

275

Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes With Chronic Achilles Tendinopathy  

Microsoft Academic Search

Background: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset.Hypothesis: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups

Apostolos Stergioulas; Marianna Stergioula; Reidar Aarskog; Rodrigo A. B. Lopes-Martins; Jan M. Bjordal

2008-01-01

276

Complications in thoracoscopic spinal surgery  

Microsoft Academic Search

Background: The literature contains few reports on negative outcomes after thoracoscopic spinal surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: From November 1995 to February 1998, 90 patients underwent minimally invasive spinal surgery by thoracoscopic assistance\\u000a as treatment for their anterior spinal lesions. The diagnoses included 41 spinal metastases, 13 cases of scoliosis, 12 burst\\u000a fractures, 10 cases of tuberculous spondylitis, 8 cases of pyogenic spondylitis,

T.-J. Huang; R. W.-W. Hsu; C.-W. Sum; H.-P. Liu

1999-01-01

277

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

2012-01-01

278

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.

2012-01-01

279

Knee Exercises  

MedlinePLUS

... and Knee Replacement Rehabilitation News News Multimedia Resources Knee Exercises | If my knee hurts, why exercise? | How do I start exercising? | ... Exercises Print Article Text Size: + | - Next If my knee hurts, why exercise? Having strong, flexible muscles is ...

280

Modeling spinal cord biomechanics  

NASA Astrophysics Data System (ADS)

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

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

2012-02-01

281

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

PubMed

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

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

2014-06-01

282

Percutaneous surgical treatment in lumbar spinal stenosis with Aperius-PercLID: indications, surgical technique and results.  

PubMed

Interspinous spacers have recently been used in the treatment of lumbar spinal stenosis. In vitro studies have demonstrated a reduction in facet joint forces by 68% and annulus pressures by 63%. MRI studies have demonstrated increased canal and neural foraminal area after implantation of these devices. Previous studies by Zucherman et al. (Spine 30:1351-1358, 2005) demonstrated patient satisfaction rates of 71-73%.We carried out a multicentric retrospective study to assess the clinical outcomes following percutaneous posterior decompression using an interspinous spacer device (Aperius™-PercLID™ System; Kyphon-Medtronic). A total of 70 patients were included in the study. All of them had evidence of radiologically and clinically proven lumbar stenosis. The average age was 63.5 years. Patients completed the Zurich Claudication Questionnaire (ZCQ) and recorded pain levels on a Visual Analogue Scale (VAS). Average stay in hospital was 2 days. The average improvement in ZCQ included both symptomatic pain disappearance and functional ambulatory recovery. The average VAS pain score improved from 8.2 to 3.6 (scale of 1 to 10). The overall patient satisfaction rate was 76%. No complications were detected at 6 months' follow-up. PMID:21107956

Menchetti, P P M; Postacchini, F; Bini, W; Canero, G

2011-01-01

283

Efficacy of treatment with verbascoside, biotechnologically produced by Syringa vulgaris plant cell cultures in an experimental mice model of spinal cord trauma.  

PubMed

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

2010-10-01

284

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

2013-01-01

285

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

1972-01-01

286

Botulinum A toxin as a treatment of detrusor- sphincter dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections  

Microsoft Academic Search

OBJECTIVESTo correlate clinical and urodynamic findings with MRI in patients with spinal cord injury and detrusor-sphincter dyssynergia who were consecutively treated with transperineal injections of botulinum-A toxin (BTX-A) under EMG control.METHODSSix patients with spinal cord injury and upper motor neuron bladder dysfunction associated with detrusor- sphincter dyssynergia were prospectively analysed. One hundred international units (IU) BTX-A (Botox® in 1 ml

Brigitte Schurch; Juerg Hodler; Bilijana Rodic

1997-01-01

287

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

1999-01-01

288

Hypnotically assisted diaphragmatic exercises in the treatment of stuttering: a preliminary investigation.  

PubMed

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

2012-01-01

289

Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate  

PubMed Central

Background Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain, PGP, in pregnant women. However, the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition. The aim of the present work was to assess adverse effects of acupuncture on the pregnancy, mother, delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to standard treatment or standard treatment alone. Methods In all, 386 women with PGP entered this controlled, single-blind trial. They were randomly assigned to standard treatment plus acupuncture (n = 125), standard treatment plus specific stabilising exercises (n = 131) or to standard treatment alone (n = 130) for 6 weeks. Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy. Adverse effects were recorded during treatment and throughout the pregnancy. Influence on the fetus was measured with cardiotocography (CTG) before-during and after 43 acupuncture sessions in 43 women. A standardised computerized method to analyze the CTG reading numerically (Oxford 8000, Oxford, England) was used. After treatment, the women rated their overall experience of the treatment and listed adverse events if any in a questionnaire. Data of analgesia and oxytocin augmentation during labour, duration of labour, frequency of preterm birth, operative delivery, Apgar score, cord-blood gas/acid base balance and birth weight were also recorded. Results There were no serious adverse events after any of the treatments. Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this. The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal. Conclusion This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/neonate.

Elden, Helen; Ostgaard, Hans-Christian; Fagevik-Olsen, Monika; Ladfors, Lars; Hagberg, Henrik

2008-01-01

290

Spinal injuries.  

PubMed

The pre-hospital care of patients with suspected spinal injuries involves early immobilisation of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further mechanical disruption. Early ventilation and differentiation of haemorrhagic from neurogenic shock are the key elements of pre-hospital resuscitation specific to spinal injuries. Falls from a significant height, high-impact speed road accidents, blast injuries, direct blunt or penetrating injuries near the spine and other high energy injuries should all be regarded as high risk for spinal injury but clinical examination should determine whether the patient requires full, limited or no spinal immobilisation. Although there is little conclusive evidence in the literature that supports pre-hospital clinical clearance of the spine, the similarities between pre-hospital immobilisation decisions and in-hospital radiography decisions are such that it is likely that clinical clearance will be effective for selected patients. This decision can be made at the scene provided the patient has no evidence of: Altered level of consciousness or mental status Intoxication Neurological symptoms or signs A distracting painful injury (e.g. chest injuries, long bone fracture) Midline spinal pain or tenderness. Where there is evidence to support spinal immobilisation, then the full range of devices and techniques should be considered. In the remote or operational environment where pre-hospital times are prolonged, full immobilisation, analgesia and re-assessment may allow localisation of the injury and a reduction in the degree of immobilisation. Common reasons for missing significant spinal injuries include failing to consider the possibility of spinal injuries in patients who are either unconscious, intoxicated or uncooperative (54,55). The application of the decision rule discussed here will ensure that no clinically significant spinal injuries are missed in pre-hospital care. PMID:12174560

Mackenzie, R

2002-06-01

291

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

2012-01-01

292

[Variations of transpedicular screw fixation and spinal dura opening].  

PubMed

The paper presents modified treatment protocols for spinal trauma and degenerative disease--transpedicular screw fixation based upon biomechanical adjustment and spinal dura opening. Both methods help to improve results of surgical treatment and decrease complication rate. PMID:23033595

Tumakaev, R F

2012-01-01

293

[Spinal claudication].  

PubMed

Spinal claudication refers to symptoms caused by nerve compression in the spinal canal brought on during strain. The symptoms are felt as lower limb pain, numbness or fatigue, but back pain that becomes worse under stress is also common. The symptoms are usually associated with the erect position and relieved when sitting or laying down. The underlying condition is most commonly narrowing of the spinal canal. While the diagnosis is often clear, MRI imaging is worth conducting if the symptoms are atypical or cause a clear-cut disability or functional limitation. Most patients are treated conservatively. PMID:24159715

Osterman, Heikki

2013-01-01

294

Exercise and activity level in Alzheimer's disease: A potential treatment focus  

Microsoft Academic Search

This article provides information on the baseline health and physical function of 30 individuals with Alzheimer's disease (AD); describes a community-based program designed to increase balance, flexibility, strength, and endurance in these persons by the training of caregivers to facilitate and supervise exercise activity; and documents the adherence of these subjects and their caregivers to this intervention. Subjects were recruited

Linda Teri; Susan M. McCurry; David M. Buchner; Rebecca G. Logsdon; Andrea Z. LaCroix; Walter A. Kukull; William E. Barlow; Eric B. Larson

2004-01-01

295

Functional Endurance Capacity and Exercise Training in Long-Term Treatment after Heart Transplantation  

Microsoft Academic Search

Objective: The aim of this study was to investigate the influence of cardiac denervation on endurance exercise capacity in heart transplant recipients (HTR) in comparison to patients with coronary artery disease (CAD). Methods: We performed two successive incremental tests and a 30-min constant load test (CLT) in 20 HTR (55 ± 7 years old, 4.9 ± 2.2 years after transplantation)

Uwe Tegtbur; Klaus Pethig; Heike Machold; Axel Haverich; Martin Busse

2003-01-01

296

Spinal Drop Metastasis in Myxopapillary Ependymoma: A Case Report and a Review of Treatment Options  

PubMed Central

Myxopapillary ependymoma (MPE) is a World Health Organization grade I ependymoma that is quite rare and generally thought to be benign. Possible drop metastasis from MPE has been reported three times in the literature; in each case there were cotemporaneous additional MPE lesions. We report the case of a man who had a piecemeal gross total resection of a MPE at L1-L3 followed by adjuvant external beam radiotherapy (EBRT) who presented sixteen months later with a lesion in the thecal sac consistent with drop metastasis. A subtotal resection and adjuvant EBRT were performed. The patient has been disease-free in follow-up 27 months from the second surgery. A review of the literature regarding the treatment for MPE showed that gross total resection is optimal initial management. Several retrospective studies supported the role of adjuvant radiotherapy in enhancing local control and progression-free survival. Chemotherapy has a minimal role in the management of MPE.

Bates, James E.; Peterson, Carl R.; Yeaney, Gabrielle A.; Walter, Kevin A.; Lundquist, Thomas; Rosenzweig, Douglas; Milano, Michael T.

2014-01-01

297

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

298

Percutaneous vertebroplasty compared with conservative treatment in patients with chronic painful osteoporotic spinal fractures.  

PubMed

The efficacy of percutaneous vertebroplasty (PVP) for patients with chronic painful osteoporotic compression fractures remains unknown. The purpose of this study was to compare the efficacy of PVP and conservative treatment (CT) for pain relief and functional outcome in patients with chronic compression fractures and persistent pain. Ninety-six patients with chronic compression fractures confirmed by MRI and persistent severe pain for 3 months or longer were prospectively randomly assigned to undergo PVP (n=46, Group A) or CT (n=50, Group B). The primary outcome was pain relief and functional outcome at 1 week, 1 month, 3 months, 6 months and 1 year. A total of 89 patients (46 in Group A and 43 in Group B) completed the 1 year follow-up assessment. Pain relief and functional outcomes were significantly better in Group A than in Group B, as determined by visual analogue scale scores, Oswestry Disability Index scores, and Roland Morris Disability scores at 1 week, 1 month, 3 months, 6 months and 1 year (all p<0.001). The final clinical follow-up assessment indicated complete pain relief in 39 Group A patients and 15 Group B patients (p<0.001). PVP for patients with chronic compression fractures and persistent severe pain was associated with better pain relief and improved functional outcomes at 1 year compared to CT. PMID:24315046

Chen, Dong; An, Zhi-Quan; Song, Sa; Tang, Jian-Fei; Qin, Hui

2014-03-01

299

The clinic embraces all aspects of SEM from ‘exercise on prescription’ and ‘functional rehabilitation programmes’ to specialist image guided spinal injections  

Microsoft Academic Search

Simon is a Musculoskeletal and Sports physician and Director of the Blackberry Clinic in Milton Keynes. Simon has a special interest in prolotherapy injections as an adjunct to intense rehabilitation programmes for unremitting low back pain (LBP).This has culminated in successful treatment of many elite athletes and footballers.Most clinical trials on the treatment have shown significant benefits but no prominent

Simon Petrides

2011-01-01

300

Anti-Hypotensive Treatment and Endothelin Blockade Synergistically Antagonize Exercise Fatigue in Rats under Simulated High Altitude  

PubMed Central

Rapid ascent to high altitude causes illness and fatigue, and there is a demand for effective acute treatments to alleviate such effects. We hypothesized that increased oxygen delivery to the tissue using a combination of a hypertensive agent and an endothelin receptor A antagonist drugs would limit exercise-induced fatigue at simulated high altitude. Our data showed that the combination of 0.1 mg/kg ambrisentan with either 20 mg/kg ephedrine or 10 mg/kg methylphenidate significantly improved exercise duration in rats at simulated altitude of 4,267 m, whereas the individual compounds did not. In normoxic, anesthetized rats, ephedrine alone and in combination with ambrisentan increased heart rate, peripheral blood flow, carotid and pulmonary arterial pressures, breathing rate, and vastus lateralis muscle oxygenation, but under inspired hypoxia, only the combination treatment significantly enhanced muscle oxygenation. Our results suggest that sympathomimetic agents combined with endothelin-A receptor blockers offset altitude-induced fatigue in rats by synergistically increasing the delivery rate of oxygen to hypoxic muscle by concomitantly augmenting perfusion pressure and improving capillary conductance in the skeletal muscle. Our findings might therefore serve as a basis to develop an effective treatment to prevent high-altitude illness and fatigue in humans.

Radiloff, Daniel; Zhao, Yulin; Boico, Alina; Blueschke, Gert; Palmer, Gregory; Fontanella, Andrew; Dewhirst, Mark; Piantadosi, Claude A.; Noveck, Robert; Irwin, David; Hamilton, Karyn; Klitzman, Bruce; Schroeder, Thies

2014-01-01

301

Anti-Hypotensive Treatment and Endothelin Blockade Synergistically Antagonize Exercise Fatigue in Rats under Simulated High Altitude.  

PubMed

Rapid ascent to high altitude causes illness and fatigue, and there is a demand for effective acute treatments to alleviate such effects. We hypothesized that increased oxygen delivery to the tissue using a combination of a hypertensive agent and an endothelin receptor A antagonist drugs would limit exercise-induced fatigue at simulated high altitude. Our data showed that the combination of 0.1 mg/kg ambrisentan with either 20 mg/kg ephedrine or 10 mg/kg methylphenidate significantly improved exercise duration in rats at simulated altitude of 4,267 m, whereas the individual compounds did not. In normoxic, anesthetized rats, ephedrine alone and in combination with ambrisentan increased heart rate, peripheral blood flow, carotid and pulmonary arterial pressures, breathing rate, and vastus lateralis muscle oxygenation, but under inspired hypoxia, only the combination treatment significantly enhanced muscle oxygenation. Our results suggest that sympathomimetic agents combined with endothelin-A receptor blockers offset altitude-induced fatigue in rats by synergistically increasing the delivery rate of oxygen to hypoxic muscle by concomitantly augmenting perfusion pressure and improving capillary conductance in the skeletal muscle. Our findings might therefore serve as a basis to develop an effective treatment to prevent high-altitude illness and fatigue in humans. PMID:24960187

Radiloff, Daniel; Zhao, Yulin; Boico, Alina; Blueschke, Gert; Palmer, Gregory; Fontanella, Andrew; Dewhirst, Mark; Piantadosi, Claude A; Noveck, Robert; Irwin, David; Hamilton, Karyn; Klitzman, Bruce; Schroeder, Thies

2014-01-01

302

Treatment of a Patient with Cervical Radiculopathy Using Thoracic Spine Thrust Manipulation, Soft Tissue Mobilization, and Exercise  

PubMed Central

While there is currently little evidence to suggest which non-operative treatment approach is best for the management of patients with cervical radiculopathy, emerging evidence suggests that these patients benefit from a multimodal treatment approach. The purpose of this case report is to describe the physical therapy management of a patient with cervical radiculopathy. Diagnosis was based on the patient's meeting three of the four criteria in the diagnostic test cluster currently used to identify patients with cervical radiculopathy. Treatment included thrust manipulation of the thoracic spine, soft tissue mobilization, and therapeutic exercise. After three visits, patient-perceived disability, as measured by the Patient-Specific Functional Scale, improved from 5/10 to 10/10. The Numeric Pain Rating Score decreased from 4.66/10 to 0/10. The patient rated his improvement as a very great deal better on the Global Rating of Change Scale. These clinically meaningful improvements were maintained at the 14-week follow-up. While a cause-and-effect relationship may not be established from a case report, a multimodal approach including thoracic spine manipulation, soft tissue mobilization, and therapeutic exercise was associated with decreased pain and perceived disability in a patient with cervical radiculopathy. Further research is needed to investigate benefits of the components of this approach.

Costello, Michael

2008-01-01

303

The Felix-trial. Double-blind randomization of interspinous implant or bony decompression for treatment of spinal stenosis related intermittent neurogenic claudication  

PubMed Central

Background Decompressive laminotomy is the standard surgical procedure in the treatment of patients with canal stenosis related intermittent neurogenic claudication. New techniques, such as interspinous process implants, claim a shorter hospital stay, less post-operative pain and equal long-term functional outcome. A comparative (cost-) effectiveness study has not been performed yet. This protocol describes the design of a randomized controlled trial (RCT) on (cost-) effectiveness of the use of interspinous process implants versus conventional decompression surgery in patients with lumbar spinal stenosis. Methods/Design Patients (age 40-85) presenting with intermittent neurogenic claudication due to lumbar spinal stenosis lasting more than 3 months refractory to conservative treatment, are included. Randomization into interspinous implant surgery versus bony decompression surgery will take place in the operating room after induction of anesthesia. The primary outcome measure is the functional assessment of the patient measured by the Zurich Claudication Questionnaire (ZCQ), at 8 weeks and 1 year after surgery. Other outcome parameters include perceived recovery, leg and back pain, incidence of re-operations, complications, quality of life, medical consumption, absenteeism and costs. The study is a randomized multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 1 year. Discussion Currently decompressive laminotomy is the golden standard in the surgical treatment of lumbar spinal stenosis. Whether surgery with interspinous implants is a reasonable alternative can be determined by this trial. Trial register Dutch Trial register number: NTR1307

2010-01-01

304

Bortezomib Treatment Produces Nocifensive Behavior and Changes in the Expression of TRPV1, CGRP, and Substance P in the Rat DRG, Spinal Cord, and Sciatic Nerve  

PubMed Central

To investigate neurochemical changes associated with bortezomib-induced painful peripheral neuropathy (PN), we examined the effects of a single-dose intravenous administration of bortezomib and a well-established “chronic” schedule in a rat model of bortezomib-induced PN. The TRPV1 channel and sensory neuropeptides CGRP and substance P (SP) were studied in L4-L5 dorsal root ganglia (DRGs), spinal cord, and sciatic nerve. Behavioral measures, performed at the end of the chronic bortezomib treatment, confirmed a reduction of mechanical nociceptive threshold, whereas no difference occurred in thermal withdrawal latency. Western blot analysis showed a relative increase of TRPV1 in DRG and spinal cord after both acute and chronic bortezomib administration. Reverse transcriptase-polymerase chain reaction revealed a decrease of TRPV1 and CGRP mRNA relative levels after chronic treatment. Immunohistochemistry showed that in the DRGs, TRPV1-, CGRP-, and SP-immunoreactive neurons were mostly small- and medium-sized and the proportion of TRPV1- and CGRP-labeled neurons increased after treatment. A bortezomib-induced increase in density of TRPV1- and CGRP-immunoreactive innervation in the dorsal horn was also observed. Our findings show that bortezomib-treatment selectively affects subsets of DRG neurons likely involved in the processing of nociceptive stimuli and that neurochemical changes may contribute to development and persistence of pain in bortezomib-induced PN.

Quartu, M.; Carozzi, V. A.; Dorsey, S. G.; Serra, M. P.; Poddighe, L.; Picci, C.; Boi, M.; Melis, T.; Del Fiacco, M.; Meregalli, C.; Chiorazzi, A.; Renn, C. L.; Cavaletti, G.; Marmiroli, P.

2014-01-01

305

Clinical usefulness of the transobturator sub-urethral tape in the treatment of stress urinary incontinence in female patients with spinal cord lesion  

PubMed Central

Objectives To evaluate the clinical usefulness of transobturator sub-urethral tapes for the treatment of stress urinary incontinence in women with spinal cord injury. Method and subjects Chart review for all female patients with spinal cord injury who underwent implantation of a transobturator sub-urethral tape for treatment of stress urinary incontinence at our institution. Results Nine women, median age 45.1 years, received a sub-urethral transobturator tape in the period November 2007 to September 2010. Four patients had paraplegia and five had tetraplegia. Seven women performed intermittent catheterization. At follow up, three of the nine patients were either cured or vastly improved. One major late complication (urethral erosion) occurred. Five of the six patients without treatment success underwent second-line treatment (artificial sphincter or urinary diversion). Conclusion In our case series, implantation of transobturator sub-urethral tapes in women with stress urinary continence due to intrinsic sphincter deficiency and a low leak point pressure led to unfavorable results.

Pannek, Juergen; Bartel, Peter; Gocking, Konrad

2012-01-01

306

Bortezomib Treatment Produces Nocifensive Behavior and Changes in the Expression of TRPV1, CGRP, and Substance P in the Rat DRG, Spinal Cord, and Sciatic Nerve.  

PubMed

To investigate neurochemical changes associated with bortezomib-induced painful peripheral neuropathy (PN), we examined the effects of a single-dose intravenous administration of bortezomib and a well-established "chronic" schedule in a rat model of bortezomib-induced PN. The TRPV1 channel and sensory neuropeptides CGRP and substance P (SP) were studied in L4-L5 dorsal root ganglia (DRGs), spinal cord, and sciatic nerve. Behavioral measures, performed at the end of the chronic bortezomib treatment, confirmed a reduction of mechanical nociceptive threshold, whereas no difference occurred in thermal withdrawal latency. Western blot analysis showed a relative increase of TRPV1 in DRG and spinal cord after both acute and chronic bortezomib administration. Reverse transcriptase-polymerase chain reaction revealed a decrease of TRPV1 and CGRP mRNA relative levels after chronic treatment. Immunohistochemistry showed that in the DRGs, TRPV1-, CGRP-, and SP-immunoreactive neurons were mostly small- and medium-sized and the proportion of TRPV1- and CGRP-labeled neurons increased after treatment. A bortezomib-induced increase in density of TRPV1- and CGRP-immunoreactive innervation in the dorsal horn was also observed. Our findings show that bortezomib-treatment selectively affects subsets of DRG neurons likely involved in the processing of nociceptive stimuli and that neurochemical changes may contribute to development and persistence of pain in bortezomib-induced PN. PMID:24877063

Quartu, M; Carozzi, V A; Dorsey, S G; Serra, M P; Poddighe, L; Picci, C; Boi, M; Melis, T; Del Fiacco, M; Meregalli, C; Chiorazzi, A; Renn, C L; Cavaletti, G; Marmiroli, P

2014-01-01

307

Operational Applications of Autogenic Feedback Training Exercise as a Treatment for Airsickness in the Military  

NASA Technical Reports Server (NTRS)

Airsickness is experienced by about 50% of military aviators some time in their career. Aviators who suffer from recurrent episodes of airsickness are typically referred to the Naval Aerospace Medical Institute (NAMI) at Pensacola where they undergo extensive evaluation and 8 weeks of training in the Self-Paced Airsickness Desensitization (SPAD) program. Researchers at NASA Ames have developed an alternative mitigation training program, Autogenic Feedback Training Exercise (AFTE) that has demonstrated an 80% success rate for improving motion sickness tolerance.

Gebreyesus, Fiyore; Cowings, Patricia S.; Toscano, William B.

2012-01-01

308

Intradural spinal endoscopy in children.  

PubMed

Intracranial endoscopy in the treatment of hydrocephalus, arachnoid cysts, or brain tumors has gained wide acceptance, but the use of endoscopy for intradural navigation in the pediatric spine has received much less attention. The aim of the authors' present study was to analyze their experience in using spinal endoscopy to treat various pathologies of the spinal canal. The authors performed a retrospective review of intradural spinal endoscopic cases at their institution. They describe 4 representative cases, including an arachnoid cyst, intrinsic spinal cord tumor, holocord syrinx, and split cord malformation. Intradural spinal endoscopy was useful in treating the aforementioned lesions. It resulted in a more limited laminectomy and myelotomy, and it assisted in identifying a residual spinal cord tumor. It was also useful in the fenestration of a multilevel arachnoid cyst and in confirming communication of fluid spaces in the setting of a complex holocord syrinx. Endoscopy aided in the visualization of the spinal cord to ensure the absence of tethering in the case of a long-length Type II split spinal cord malformation. Conclusions Based on their experience, the authors found intradural endoscopy to be a useful surgical adjunct and one that helped to decrease morbidity through reduced laminectomy and myelotomy. With advances in technology, the authors believe that intradural endoscopy will begin to be used by more neurosurgeons for treating diseases of this anatomical region. PMID:21721897

Chern, Joshua J; Gordon, Amber S; Naftel, Robert P; Tubbs, R Shane; Oakes, W Jerry; Wellons, John C

2011-07-01

309

Comparative cost effectiveness of Coflex(R) interlaminar stabilization versus instrumented posterolateral lumbar fusion for the treatment of lumbar spinal stenosis and spondylolisthesis  

PubMed Central

Introduction Symptomatic chronic low back and leg pain resulting from lumbar spinal stenosis is expensive to treat and manage. A randomized, controlled, multicenter US Food and Drug Administration Investigational Device Exemption clinical trial assessed treatment-related patient outcomes comparing the Coflex® Interlaminar Stabilization Device, an interlaminar stabilization implant inserted following decompressive surgical laminotomy in the lumbar spine, to instrumented posterolateral fusion among patients with moderate to severe spinal stenosis. This study uses patient-reported outcomes and clinical events from the trial along with costs and expected resource utilization to determine cost effectiveness. Methods A decision-analytic model compared outcomes over 5 years. Clinical input parameters were derived from the trial. Oswestry Disability Index scores were converted to utilities. Treatment patterns over 5 years were estimated based on claims analyses and expert opinion. A third-party payer perspective was used; costs (in $US 2013) and outcomes were discounted at 3% annually. Sensitivity analyses examined the influence of key parameters. Analyses were conducted using Medicare payment rates and typical commercial reimbursements. Results Five-year costs were lower for patients implanted with Coflex compared to those undergoing fusion. Average Medicare payments over 5 years were estimated at $15,182 for Coflex compared to $26,863 for the fusion control, a difference of $11,681. Mean quality-adjusted life years were higher for Coflex patients compared to controls (3.02 vs 2.97). Results indicate that patients implanted with the Coflex device derive more utility, on average, than those treated with fusion, but at substantially lower costs. The cost advantage was greater when evaluating commercial insurance payments. Subgroup analyses found that the cost advantage for Coflex relative to fusion was even larger for two-level procedures compared to one-level procedures. Conclusion The Coflex Interlaminar Stabilization Device was found to be cost effective compared to instrumented posterolateral fusion for treatment of lumbar spinal stenosis. It provided higher utility at substantially lower cost.

Schmier, Jordana Kate; Halevi, Marci; Maislin, Greg; Ong, Kevin

2014-01-01

310

Inappropriate medical management of spinal epidural abscess  

PubMed Central

A 67 year old man with longstanding rheumatoid disease was referred to the regional spinal surgery unit with acute onset of paraparesis due to an extensive spinal epidural abscess of the lumbar spine. Ten months previously, he had started antibiotic treatment at another hospital for an epidural abscess arising at the level of the L2-3 disc space. Despite completing seven months of medical treatment with appropriate antibiotics, he had a recrudescence of acute back pain shortly after restarting methotrexate treatment. Urgent anterior spinal decompression with excision of the necrotic vertebral bodies of L1-3 was performed. The indications for the surgical management of spinal epidural abscess are reviewed.??

Harrington, P; Millner, P; Veale, D

2001-01-01

311

Combinatorial treatment of acute spinal cord injury with ghrelin, ibuprofen, C16, and ketogenic diet does not result in improved histologic or functional outcome.  

PubMed

Because of the complex, multifaceted nature of spinal cord injury (SCI), it is widely believed that a combination of approaches will be superior to individual treatments. Therefore, we employed a rat model of cervical SCI to evaluate the combination of four noninvasive treatments that individually have been reported to be effective for acute SCI during clinically relevant therapeutic time windows. These treatments included ghrelin, ibuprofen, C16, and ketogenic diet (KD). These were selected not only because of their previously reported efficacy in SCI models but also for their potentially different mechanisms of action. The administration of ghrelin, ibuprofen, C16, and KD several hours to days postinjury was based on previous observations by others that each treatment had profound effects on the pathophysiology and functional outcome following SCI. Here we showed that, with the exception of a modest improvement in performance on the Montoya staircase test at 8-10 weeks postinjury, the combinatorial treatment with ghrelin, ibuprofen, C16, and KD did not result in any significant improvements in the rearing test, grooming test, or horizontal ladder. Histologic analysis of the spinal cords did not reveal any significant differences in tissue sparing between treatment and control groups. Although single approaches of ghrelin, ibuprofen, C16, and KD have been reported to be beneficial after SCI, our results show that the combination of the four interventions did not confer significant functional or histological improvements in a cervical model of SCI. Possible interactions among the treatments may have negated their beneficial effects, emphasizing the challenges that have to be addressed when considering combinatorial drug therapies for SCI. PMID:24658967

Streijger, F; Lee, J H T; Duncan, G J; Ng, M T L; Assinck, P; Bhatnagar, T; Plunet, W T; Tetzlaff, W; Kwon, B K

2014-07-01

312

21 CFR 890.5350 - Exercise component.  

Code of Federal Regulations, 2010 CFR

...Devices § 890.5350 Exercise component. (a) Identification. An exercise component is a device that...conjunction with other forms of exercise and that is intended for...an adjunct treatment for obesity. Examples include...

2009-04-01

313

21 CFR 890.5350 - Exercise component.  

Code of Federal Regulations, 2010 CFR

...Devices § 890.5350 Exercise component. (a) Identification. An exercise component is a device that...conjunction with other forms of exercise and that is intended for...an adjunct treatment for obesity. Examples include...

2010-04-01

314

Effective Conservative Treatment for Chronic Low Back Pain  

PubMed Central

Evidence suggests that effective conservative treatment is available for chronic low back pain. The effectiveness of conservative treatment has recently received attention following publication of several randomized controlled trials (RCTs) that reported similar improvements in outcomes from cognitive intervention with exercise as from spinal fusion surgery. This paper will explore the conservative treatment arms of these RCTs with the goal of educating the reader about the principles of cognitive intervention with exercise. These principles can be incorporated into the care of chronic low back pain patients both as primary treatment and as a means of augmenting surgical outcomes.

Rainville, James; Nguyen, Rosalyn; Suri, Pradeep

2009-01-01

315

The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain.  

PubMed

Dysfunction of spinal stability seems to be one of the causes of low back pain (LBP). It is thought that a large number of muscles have a role in spinal stability including the pelvic floor muscle (PFM). The purpose of this study was to investigate the effect of PFM exercise in the treatment of chronic LBP. After ethical approval, a randomized controlled clinical trial was carried out on 20 women with chronic LBP. Patients were randomly allocated into two groups: an experimental and a control group. The control group was given routine treatment including electrotherapy and general exercises; and the experimental group received routine treatment and additional PFM exercise. Pain intensity, functional disability and PFM strength and endurance were measured before, immediately after intervention and at 3 months follow-up. In both groups pain and functional disability were significantly reduced following treatment (p<0.01), but no significant difference was found between the two groups (p>0.05). All measurements were improved in both groups (p<0.01) although patients in the experimental group showed greater improvement in PFM strength and endurance (p<0.01). It seems that the PFM exercise combined with routine treatment was not superior to routine treatment alone in patients with chronic LBP. PMID:21147422

Mohseni-Bandpei, Mohammad A; Rahmani, Nahid; Behtash, Hamid; Karimloo, Masoud

2011-01-01

316

A treatment-refractory spinal dural arteriovenous fistula sharing arterial origin with the Artery of Adamkiewicz: Repeated endovascular treatment after failed microsurgery  

PubMed Central

Background: Effective management of a spinal dural arteriovenous fistula (SDAVF) can be accomplished with either microsurgery or endovascular embolization, but there is a consensus that in patients in whom a radiculomedullary artery supplying the anterior spinal artery (ASA) originates from the same feeding artery as the SDAVF, the endovascular approach is to be avoided. Case Description: The patient was a 46-year-old woman with progressive lower limb paraparesis, sensory deficit, and sphincter dysfunction. Magnetic resonance imaging (MRI) and spinal angiography showed an SDAVF fed by a branch from the left second lumbar segmental artery, and the artery of Adamkiewicz (AA), a major ASA supplier, originating from the same segmental artery just proximal to the SDAVF. Microsurgical disconnection of the SDAVF was attempted, but failed. Embolization with cyanoacrylates was done in two occasions, the first time through a microcatheter placed just distal to the origin of the AA and the second time through another feeder coming from the same segmental artery that could not be visualized in the previous angiographies. All procedures were neurologically uncomplicated. Magnetic resonance imaging (MRI) 1 month after the last embolization showed resolution of the spinal cord edema. MRI scan taken 68 months after embolization revealed a slightly atrophic spinal cord with visible central canal and no recurrence of medullary edema. The patient presented good, but incomplete neurological improvement. Conclusion: Microsurgery is the first choice for an SDAVF branching off the same radiculomedullary artery supplying the ASA, but uncomplicated embolization can be feasible after failed surgery.

Eneling, Johanna; Karlsson, Per M.; Rossitti, Sandro

2014-01-01

317

Supported Exercise Improves Controlled Eating and Weight through Its Effects on Psychosocial Factors: Extending a Systematic Research Program Toward Treatment Development  

PubMed Central

Background: Behavioral weight-loss treatments have been overwhelmingly unsuccessful. Many inadequately address both behavioral theory and extant research—especially in regard to the lack of viability of simply educating individuals on improved eating and exercise behaviors. Objective: The aim was to synthesize research on associations of changes in exercise behaviors, psychosocial factors, eating behaviors, and weight; and then conduct further direct testing to inform the development of an improved treatment approach. Methods: A systematic program of health behavior-change research based on social cognitive theory, and extensions of that theory applied to exercise and weight loss, was first reviewed. Then, to extend this research toward treatment development and application, a field-based study of obese adults was conducted. Treatments incorporated a consistent component of cognitive-behaviorally supported exercise during 26 weeks that was paired with either standard nutrition education (n = 183) or cognitive-behavioral methods for controlled eating that emphasized self-regulatory methods such as goal setting and caloric tracking, cognitive restructuring, and eating cue awareness (n = 247). Results: Both treatment conditions were associated with improved self-efficacy, self-regulation, mood, exercise, fruit and vegetable consumption, weight, and waist circumference; with improvements in self-regulation for eating, fruit and vegetable consumption, weight, and waist circumference significantly greater in the cognitive-behavioral nutrition condition. Changes in exercise- and eating-related self-efficacy and self-regulation were associated with changes in exercise and eating (R2 = 0.40 and 0.17, respectively), with mood change increasing the explanatory power to R2 = 0.43 and 0.20. Improved self-efficacy and self-regulation for exercise carried over to self-efficacy and self-regulation for controlled eating (?= 0.53 and 0.68, respectively). Conclusions: Development and longitudinal testing of a new and different approach to behavioral treatment for sustained weight loss that emphasizes exercise program-induced psychosocial changes preceding the facilitation of improved eating and weight loss should be guided by our present research.

Annesi, James J

2012-01-01

318

Surgical treatment and intraoperative spinal cord monitoring in scoliosis associated with chronic inflammatory demyelinating polyneuropathy: A case report  

PubMed Central

There has been only one reported case of neuromuscular scoliosis following chronic inflammatory demyelinating polyneuropathy (CIDP). However, no cases of scoliosis that were treated with surgery secondary to CIDP have been previously described. A 16-year-old boy with CIDP was consultant due to the progression of scoliosis with the coronal curve of 86° from T8 to T12. Posterior correction and fusion with segmental pedicle screws were performed under intraoperative spinal cord monitoring with transcranial electric motor-evoked potentials. Although the latency period was prolonged and amplitude was low, the potential remained stable. Coronal curve was corrected from 86° to 34° without neurological complications. We here describe scoliosis associated with CIDP, which was successfully treated with surgery under intraoperative spinal cord monitoring.

Miyakoshi, Naohisa; Hongo, Michio; Kasukawa, Yuji; Ishikawa, Yoshinori; Misawa, Akiko; Shimada, Yoichi

2013-01-01

319

Microsurgical Treatment of Spontaneous and non-Spontaneous Spinal Epidural Haematomas: Neurological Outcome in Relation to Aetiology  

Microsoft Academic Search

Summary  ?Background. This retrospective study evaluated the neurological outcome of 26 patients with spontaneous and non-spontaneous spinal epidural\\u000a haematoma (SEH) who underwent microsurgical clot removal. It was the objective of the present study to investigate whether\\u000a the aetiology of the SEH has an influence on the neurological outcome.\\u000a \\u000a ?Methods. The medical records and radiological investigations of 26 patients with SEH were

V. Rohde; W. Küker; M. H. T. Reinges; J. M. Gilsbach

2000-01-01

320

Treatment of thoracolumbar vertebrate fracture by transpedicular morselized bone grafting in vertebrae for spinal fusion and pedicle screw fixation  

Microsoft Academic Search

Summary  To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment\\u000a pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with\\u000a thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment\\u000a pedicle screw fixation and were randomly divided into two groups. Fractures

Jinguo Wang; Hua Wu; Xiaolin Ding; Yutian Liu

2008-01-01

321

A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery  

PubMed Central

Background: In spinal surgery, cerebrospinal fluid (CSF) fistulas attributed to deliberate dural opening (e.g., for tumors, shunts, marsupialization of cysts) or inadvertent/traumatic dural tears (DTs) need to be readily recognized, and appropriately treated. Methods: During spinal surgery, the dura may be deliberately opened to resect intradural lesions/tumors, to perform shunts, or to open/marsupialize cysts. DTs, however, may inadvertently occur during primary, but are seen more frequently during revision spinal surgery often attributed to epidural scarring. Other etiologies of CSF fistulas/DTs include; epidural steroid injections, and resection of ossification of the posterior longitudinal ligament (OPLL) or ossification of the yellow ligament (OYL). Whatever the etiology of CSF fistulas or DTs, they must be diagnosed utilizing radioisotope cisternography (RIC), magnetic resonance imaging (MRI), computed axial tomography (CT) studies, and expeditiously repaired. Results: DTs should be repaired utilizing interrupted 7-0 Gore-Tex (W.L. Gore and Associates Inc., Elkton, MD, USA) sutures, as the suture itself is larger than the needle; the larger suture occludes the dural puncture site. Closure may also include muscle patch grafts, dural patches/substitutes (bovine pericardium), microfibrillar collagen (Duragen: Integra Life Sciences Holdings Corporation, Plainsboro, NJ), and fibrin glues or dural sealants (Tisseel: Baxter Healthcare Corporation, Deerfield, IL, USA). Only rarely are lumbar drains and wound-peritoneal and/or lumboperitoneal shunts warranted. Conclusion: DTs or CSF fistulas attributed to primary/secondary spinal surgery, trauma, epidural injections, OPLL, OYL, and other factors, require timely diagnosis (MRI/CT/Cisternography), and appropriate reconstruction.

Epstein, Nancy E.

2013-01-01

322

Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998–2006  

Microsoft Academic Search

Purpose: To characterize patterns in incidence, management, and costs of malignant spinal cord compression (MSCC) hospitalizations in the United States, using population-based data. Methods and Materials: Using the Nationwide Inpatient Sample, an all-payer healthcare database representative of all U.S. hospitalizations, MSCC-related hospitalizations were identified for the period 1998-2006. Cases were combined with age-adjusted Surveillance, Epidemiology and End Results cancer death

Kimberley S. Mak; Leslie K. Lee; Raymond H. Mak; Shuang Wang; John Pile-Spellman; Janet L. Abrahm; Holly G. Prigerson; Tracy A. Balboni

2011-01-01

323

Effect of low-load eccentric training before high-intensity eccentric exercise on delayed onset muscle soreness, revealed by c-fos expression in the spinal dorsal horn in rats  

Microsoft Academic Search

BackgroundDelayed onset muscle soreness (DOMS) occurs after unaccustomed exercise and is particularly associated with high-intensity eccentric exercise. Eccentric exercise is reported to have a protective effect against DOMS caused by subsequent eccentric exercise. Since objective assessment of pain is difficult, only limited experimental studies on DOMS and a few studies on pain prevention in DOMS have been performed.ObjectiveTo examine the

T Munehiro; K Kitaoka; H Tsuchiya

2011-01-01

324

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

PubMed

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 doses of L-Thyroxine for a medium of 5 years after removal of thyroid cancer; (B) those on L-Thyroxine treatment for a median of 9 years after being diagnosed with chronic lymphocytic thyroiditis (CLT); and (C) those with no thyroid disease or other known pathology and without any treatment. There were no differences in dietary calcium intake and daily activity between untreated and L-Thyroxine-treated women. Measurements of bone mineral density were performed at spine level L1-L4 using a dual X-ray densitometer and serum thyroid-stimulating hormone (TSH), thyroid hormones, and bone markers (serum osteocalcin, procollagen I, urinary calcium), and PTH levels were assayed and found to be within normal ranges. Women receiving L-Thyroxine after thyroid cancer had slightly higher FT4 levels compared with women who had CLT and lower TSH levels, with serum T4 and T3 levels normal and similar in both groups. No significant differences were found in spinal bone density after L-Thyroxine treatment between Groups A and B and compared with Group C. Bone loss according to 2 SD below reference standards (age and sex matched) was found in the 12.9% of L-Thyroxine-treated patients versus 22.6% of untreated women. No correlation was found between bone loss and thyroid hormone levels and duration of treatment.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8118747

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

1994-01-01

325

Exercise Treatment for Bipolar Disorder: Potential Mechanisms of Action Mediated through Increased Neurogenesis and Decreased Allostatic Load  

Microsoft Academic Search

Outcomes are frequently suboptimal for patients with bipolar disorder who are treated with pharmacotherapy alone. Adjunct exercise has the potential to substantially improve acute and long-term outcomes, although how exercise would improve the course of bipolar disorder needs to be elucidated. We propose that exercise may improve mood and functioning by increasing neurogenesis and reducing allostatic load. We review data

Louisa G. Sylvia; Rebecca M. Ametrano; Andrew A. Nierenberg

2010-01-01

326

The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease  

Microsoft Academic Search

Regular exercise reduces the risk of chronic metabolic and cardiorespiratory diseases, in part because exercise exerts anti-inflammatory effects. However, these effects are also likely to be responsible for the suppressed immunity that makes elite athletes more susceptible to infections. The anti-inflammatory effects of regular exercise may be mediated via both a reduction in visceral fat mass (with a subsequent decreased

Nicolette C. Bishop; David J. Stensel; Martin R. Lindley; Sarabjit S. Mastana; Myra A. Nimmo; Michael Gleeson

2011-01-01

327

Effect of treatment with 21-aminosteroid U-74389G and glucocorticoid steroid methylprednisolone on somatosensory evoked potentials in rat spinal cord during mild compression.  

PubMed

The purpose of this investigation was to compare the effects of treatment with glucocorticoid steroid methylprednisolone (MP) and the 21-aminosteroid U-74389G on the conduction of somatosensory evoked potentials (SEPs) during experimental spinal cord compression. Forty-five adult male Wistar rats were anesthetized and a laminectomy performed at the Th9-Th10 level. Animals with the same SEP patterns prior to and after laminectomy were randomly allocated to one of three groups (15 rats in each). A 14.8-g weight was applied to the dural surface of the spinal cord for 60 min. The SEPs were continually recorded during compression. The rats received a single intravenous bolus dose of three different agents two minutes after the start of compression. Animals in the first group received 0.5 ml of 0.9% NaCl, the second group received 30 mg/kg methylprednisolone and the third group received 3 mg/kg U-74389G. Following drug infusion the time period required for the SEPs to be completely suppressed was assessed. If the SEPs were not fully suppressed, the amplitude of the most stable and significant component of the SEPs was measured. The time taken to complete the SEPs suppression was significantly shorter in the control group (p < 0.001, Wilcoxon) than in the groups with either MP or U-74389G. However, the time taken to achieve full suppression was not significantly different between the MP and U-74389G groups. The proportional reduction of amplitude N1P1 was significantly different between the control and MP groups as well as between the control and U-74389G groups. The proportional reduction of amplitude N1P1 was not significant between the MP and the U-74389G groups. The present data indicate that both the glucocorticoid steroid MP and the 21-aminosteroid U-74389G protect spinal cord function to a similar extent during mild compression. PMID:10098963

Harat, M; Kochanowski, J

1999-02-01

328

Treatment of myogenic temporomandibular disorder: a prospective randomized clinical trial, comparing a mechanical stretching device (TheraBite®) with standard physical therapy exercise.  

PubMed

Aims: To compare in a randomized controlled clinical trial (RCT) the application of the TheraBite® (TB) Jaw Motion Rehabilitation System with a standard physical therapy (PT) exercise regimen for the treatment of myogenic temporomandibular disorder (TMD). Methodology: Myogenic TMD patients were randomized for the use of the TB device or for standard PT. Mandibular function was assessed with the mandibular function impairment questionnaire (MFIQ). Pain was evaluated using a visual analog scale, and maximum inter-incisor (mouth) opening (MIO) was measured using the disposable TB range of motion scale. Results: Of the 96 patients randomized (46 TB, 50 standard PT exercises), 38 actually started with the TB device and 41 with the standard PT exercises. After six-week follow-up, patients using the TB device reported a significantly greater functional improvement (MFIQ score) than the patients receiving regular PT exercises (P?=?0·0050). At 6 weeks, no significant differences in pain, and active or passive MIO were found between the two groups. At 3 months, patients in both treatment groups did equally well, and showed a significant improvement in all parameters assessed. Conclusions: This RCT on myogenic TMD treatment, comparing standard PT with passive jaw mobilization using the TheraBite Jaw Motion Rehabilitation System®, shows that both treatment modalities are equally effective in relieving myogenic TMD symptoms, but that the use of the TB device has the benefit of achieving a significantly greater functional improvement within the first week of treatment. PMID:25000163

Kraaijenga, Sophie; van der Molen, Lisette; van Tinteren, Harm; Hilgers, Frans; Smeele, Ludi

2014-07-01

329

How preventable are spinal cord injuries?  

PubMed

In order to determine how many spinal cord injuries are preventable in this country, and how effective a prevention campaign is likely to be, the causes of injury were analysed in 250 consecutive patients admitted to The Duke of Cornwall Spinal Treatment Centre in Salisbury. The results show that many spinal cord injuries are preventable, and the findings support the theory that a programme of prevention similar to that in Australia is urgently required. PMID:10116894

Peach, F; Grundy, D

1991-01-01

330

Pediatric spinal pilomyxoid astrocytoma.  

PubMed

Pediatric spinal pilomyxoid astrocytoma (PMA) is an extremely rare tumor that merits recognition as a specific, unique entity. The authors present the case of an intramedullary PMA in the thoracic spinal cord of an 11-year-old boy who presented with back pain, scoliosis, and multiple lung nodules. The patient underwent T5-11 laminoplasty and near-total resection of the spinal tumor. The final pathological diagnosis was WHO Grade II PMA. The patient did well for 14 months until the tumor progressed both clinically and radiographically. A literature review focusing on the clinical characteristics, histology, and treatment of PMAs provides a better understanding of these rare lesions. Because of the small number of cases optimal treatment guidelines have not been established, but gross-total resection and adjuvant chemotherapy with alkylating agents appear to confer a better long-term prognosis. Pediatric patients with PMAs can remain recurrence free at least 5 years after surgery, although these tumors may disseminate or dedifferentiate into more malignant gliomas. Recognition of intramedullary PMA as a unique entity in children is vital to the development of specific surgical and adjuvant treatment regimens. PMID:24053650

Garber, Sarah T; Bollo, Robert J; Riva-Cambrin, Jay K

2013-11-01

331

Acute spinal cord injury.  

PubMed

Acute spinal cord injury is a devastating disease with enormous repercussions, not only for the victims and their families but for society as a whole. Despite the advent of novel medical therapies for the treatment of these injuries, many patients with spinal cord injury remain severely incapacitated and dependent on their families and/or specialized nursing care. Much of the controversy in the treatment of these injuries stems from insufficient knowledge about the pathophysiology of the disease as well as the timing of certain treatments such as surgery. We discuss the diagnosis and management of these injuries as well as novel therapies on the horizon. The recent emphasis on evidence-based medicine has resulted in the creation of guidelines from the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, which will hopefully result in some standardization of care. It is our opinion that early recognition of spinal cord injury and careful management in an intensive care setting can prevent many of the medical complications that are the major source of morbidity and mortality in these patients. PMID:17298772

Cortez, Ricardo; Levi, Allan D

2007-03-01

332

Nonsurgical and surgical management of lumbar spinal stenosis.  

PubMed

The symptoms associated with lumbar spinal stenosis can decrease quality of life and may cause patients to seek treatment. Except in rare cases of rapid neurologic progression or cauda equina syndrome, nonsurgical modalities should be the initial treatment choice. Activity modification, a variety of medications, epidural steroid injections, and other methods are recommended for pain reduction. A formal physical therapy program, which focuses on flexion-based exercises, may lead to improved patientfunction. Surgery is indicated in patients who remain symptomatic despite a course of nonsurgical therapy and who have advanced imaging studies that correspond to existing .symptoms. Adequate decompression of the neural elements and maintenance of bony stability are necessary for a good surgical outcome for patients with spinal stenosis. Laminectomy has long been the method of choice for thorough lumbar decompression. Preserving at least the lateral half of the facet joints bilaterally and bone in the area of the pars interarticularis minimizes the potential for iatrogenic instability. Numerous other decompression techniques have been described, including multilevel laminotomies, fenestration, distraction laminoplasty, and microscopic decompression. Arthrodesis, either with or without instrumentation, is also indicated in some patients. Several studies report that surgical treatment produces better outcomes than nonsurgical treatment in the short term; however, the results tend to deteriorate with time. Lumbar decompressive surgery can be complicated by epidural hematoma, deep venous thrombosis, dural tear, infection, nerve root injury, and recurrence of symptoms. PMID:15948458

Yuan, Philip S; Booth, Robert E; Albert, Todd J

2005-01-01

333

Primary spinal epidural Hodgkin's lymphoma  

PubMed Central

Primary spinal epidural Hodgkin's lymphoma is very rare. We will discuss the clinical features and treatment of primary spinal epidural Hodgkin's lymphoma. In this paper, a 30-year-old male patient who presented with spinal epidural tumor at the T9–11 level is reported. Subtotal resection of the tumor was performed and the histological examination of the tumor specimen revealed Hodgkin's lymphoma. All other examinations were negative for an occult disease. Six courses of chemotheraphy containing adriamycin, bleomycin, vinblastine and dacarbazine were given to the patient. Surgery is the first therapeutic approach in malignancies compressing the spinal cord. Hodgkin's lymphoma is a very chemo- and radio-sensitive tumor. The indications for surgery were reduced and limited to laminectomy or even biopsy only, leaving the major role to chemo- and radiotheraphy.

Yaman, Onur; Ozdemir, Nail; Sevin, Ismail Ertan; Ozer, Fusun Demircivi; Unluoglu, Saime

2013-01-01

334

Spinal Cord Stimulation in the Treatment of Postherpetic Neuralgia in Patients with Chronic Kidney Disease: A Case Series and Review of the Literature  

PubMed Central

Background Postherpetic neuralgia (PHN) is usually managed pharmacologically. It is not uncommon for patients with chronic kidney disease (CKD) to suffer from PHN. It is difficult to prescribe a sufficient dose of anticonvulsants for intractable pain because of the decreased glomerular filtration rate. If the neural blockade and pulsed radiofrequency ablation provide only short-term amelioration of pain, spinal cord stimulation (SCS) with a low level of evidence may be used only as a last resort. This study was done to evaluate the efficacy of spinal cord stimulation in the treatment of PHN in patients with CKD. Methods PHN patients with CKD who needed hemo-dialysis who received insufficient relief of pain over a VAS of 8 regardless of the neuropathic medications were eligible for SCS trial. The follow-up period was at least 2 years after permanent implantation. Results Eleven patients received percutaneous SCS test trial from Jan 2003 to Dec 2007. Four patients had successfully received a permanent SCS implant with their pain being tolerable at a VAS score of less than 3 along with small doses of neuropathic medications. Conclusions SCS was helpful in managing tolerable pain levels in some PHN patients with CKD along with tolerable neuropathic medications for over 2 years.

Baek, In Yeob; Park, Ju Yeon; Kim, Hyae Jin; Yoon, Ji Uk; Byoen, Gyeong Jo

2011-01-01

335

Intradural approach to selective stimulation in the spinal cord for treatment of intractable pain: design principles and wireless protocol  

NASA Astrophysics Data System (ADS)

We introduce an intradural approach to spinal cord stimulation for the relief of intractable pain, and describe the biophysical rationale that underlies its design and performance requirements. The proposed device relies on wireless, inductive coupling between a pial surface implant and its epidural controller, and we present the results of benchtop experiments that demonstrate the ability to transmit and receive a frequency-modulated 1.6 MHz carrier signal between micro-coil antennae scaled to the ~ 1 cm dimensions of the implant, at power levels of about 5 mW. Plans for materials selection, microfabrication, and other aspects of future development are presented and discussed.

Howard, M. A.; Utz, M.; Brennan, T. J.; Dalm, B. D.; Viljoen, S.; Jeffery, N. D.; Gillies, G. T.

2011-08-01

336

Spinal injury - resources  

MedlinePLUS

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

337

Spinal Bracing  

NASA Technical Reports Server (NTRS)

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

1991-01-01

338

The development of an improved physical surrogate model of the human spinal cord—Tension and transverse compression  

Microsoft Academic Search

To prevent spinal cord injury, optimize treatments for it, and better understand spinal cord pathologies such as spondylotic myelopathy, the interaction between the spinal column and the spinal cord during injury and pathology must be understood. The spinal cord is a complex and very soft tissue that changes properties rapidly after death and is difficult to model. Our objective was

Shannon G. Kroeker; Philip L. Morley; Claire F. Jones; Lynne E. Bilston; Peter A. Cripton

2009-01-01

339

Spinal manipulative therapy versus Graston Technique in the treatment of non-specific thoracic spine pain: Design of a randomised controlled trial  

PubMed Central

Background The one year prevalence of thoracic back pain has been estimated as 17% compared to 64% for neck pain and 67% for low back pain. At present only one randomised controlled trial has been performed assessing the efficacy of spinal manipulative therapy (SMT) for thoracic spine pain. In addition no high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT), a soft tissue massage therapy using hand-held stainless steel instruments. The objective of this trial is to determine the efficacy of SMT and GT compared to a placebo for the treatment of non specific thoracic spine pain. Methods Eighty four eligible people with non specific thoracic pain mid back pain of six weeks or more will be randomised to one of three groups, either SMT, GT, or a placebo (de-tuned ultrasound). Each group will receive up to 10 supervised treatment sessions at the Murdoch University Chiropractic student clinic over a 4-week period. Treatment outcomes will be measured at baseline, one week after their first treatment, upon completion of the 4-week intervention period and at three, six and twelve months post randomisation. Outcome measures will include the Oswestry Back Pain Disability Index and the Visual Analogue Scale (VAS). Intention to treat analysis will be utilised in the statistical analysis of any group treatment effects. Trial Registration This trial was registered with the Australia and New Zealand Clinical Trials Registry on the 7th February 2008. Trial number: ACTRN12608000070336

Crothers, Amy; Walker, Bruce; French, Simon D

2008-01-01

340

Effective Therapy Using Voglibose for Nonalcoholic Steatohepatitis in a Patient with Insufficient Dietary and Exercise Therapy: Exploring Other Treatment Possibilities  

PubMed Central

A 56-year-old Japanese female with a 10-year history of thyroiditis presented to our institution. The laboratory data and clinical findings suggested that the patient had complicated nonalcoholic fatty liver disease or nonalcoholic steatohepatitis (NASH) with autoimmune hepatitis according to the criteria by the application of the International Autoimmune Hepatitis score. The patient could not manage by herself so dietary- and exercise-based treatment was difficult. Accordingly, ursodeoxycholic acid and ezetimibe therapy was started and continued until the performance of a liver needle biopsy to define the diagnosis. However, no improvement in liver function was observed. In addition, pathological findings indicated that the patient had NASH. The patient was finally diagnosed as having NASH. Therefore, voglibose was added to the ursodeoxycholic acid and ezetimibe therapy, and this addition of voglibose actually took effect. The patient's serum aspartate transaminase and alanine aminotransferase levels decreased dramatically. This report is the first to document other treatment possibilities of NASH in a case when dietary therapy is difficult.

Nagai, Kazuki; Matsumaru, Katsuhiko; Takahashi, Yutaka; Nakamura, Noriko

2011-01-01

341

Restoring walking after spinal cord injury  

Microsoft Academic Search

One of the most obvious deficits following a spinal cord injury is the difficulty in walking, forcing many patients to use wheelchairs for locomotion. Over the past decade considerable effort has been directed at promoting the recovery of walking and to find effective treatments for spinal cord injury. Advances in our knowledge of the neuronal control of walking have led

Karim Fouad; Keir Pearson

2004-01-01

342

LINAC-Based Spinal Stereotactic Radiosurgery  

Microsoft Academic Search

The authors' report on the use of a prototype spinal stereotactic radiosurgery frame which was employed for the treatment of 9 patients who presented with recurrent neoplastic involvement of the spinal column. All patients had failed standard therapy consisting of surgery, external fractionated radiation therapy, and\\/or chemotherapy. Eight of the lesions represented metastatic tumors in the vertebral column, one of

Allan J. Hamilton; Bruce A. Lulu; Helen Fosmire; Lynne Gosset

1996-01-01

343

Combined insulin treatment and intense exercise training improved basal cardiac function and Ca(2+)-cycling proteins expression in type 1 diabetic rats.  

PubMed

This study investigated the effects of 8 weeks of intense exercise training combined with insulin treatment on the Ca(2+)-cycling protein complex expression and their functional consequences on cardiac function in type 1 diabetic rat hearts. Diabetic Wistar rats were randomly assigned into the following groups: received no treatment, insulin-treated diabetic, trained diabetic, and trained insulin-treated diabetic. A control group was also included. Insulin treatment and (or) treadmill intense exercise training were conducted over 8 weeks. Basal cardiac function was evaluated by Langendorff technique. Cardiac expression of the main Ca(2+)-cycling proteins (RyR2, FKBP 12.6, SERCA2, PLB, NCX1) was assessed by Western blot. Diabetes altered basal cardiac function (±dP/dt) and decrease the expression of the main Ca(2+)-cycling proteins expression: RyR2, SERCA2, and NCX1 (p < 0.05). Whereas combined treatment was not able to normalize -dP/dt, it succeeded to normalize +dP/dt of diabetic rats (p < 0.05). Moreover, both insulin and intense exercise training, applied solely, increased the expression of the Ca(2+)-cycling proteins: RyR2, SERCA2, PLB. and NCX1 (p < 0.05). But this effect was higher when the 2 treatments were combined. These data are the first to show that combined insulin treatment and intense exercise training during diabetes synergistically act on the expression of the main Ca(2+)-cycling proteins, providing insights into mechanisms by which the dual treatment during diabetes improves cardiac function. PMID:22185592

Le Douairon Lahaye, Solène; Gratas-Delamarche, Arlette; Malardé, Ludivine; Zguira, Sami; Vincent, Sophie; Lemoine Morel, Sophie; Carré, François; Rannou Bekono, Françoise

2012-02-01

344

Low-Level Laser Therapy: A New Treatment Alternative Effective for Acute Exercise-Related Tendinitis.  

National Technical Information Service (NTIS)

The efficacy of low-level laser therapy for the treatment of acute iliotibial band syndrome was evaluated in a sample of Marine Corps recruits. A randomized, placebo-controlled, double-blind trial was conducted with 22 recruits receiving an active laser t...

S. Almeida S. G. Leichliter L. K. Hervig J. Streeter K. Maxwell-Williams

2002-01-01

345

Are they too old? Surgical treatment for metastatic epidural spinal cord compression in patients aged 65 years and older.  

PubMed

Objectives: We aimed to assess the efficacy of surgical decompression of metastatic epidural spinal cord compression (MESCC) in patients ?65 years and review our multidisciplinary surgical decision-making process. Methods: We identified all patients operated for MESCC from August 2008 to June 2012. Patients ?65 years, with a single area of cord compression, back/radicular pain, neurological signs of cord compression, surgery within 48 hours after onset of MESCC-related paraplegia, and follow-up for ?1 year or until death were included. Files were reviewed retrospectively. The requirement for informed consent was waived. Neurological status was assessed with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). Duration of ambulation and survival were assessed with Kaplan-Meier and Cox regression analysis. Results: Twenty-one patients met inclusion criteria (11 women/10 men; mean age 73 years, range 65-87). All presented with debilitating back/neck pain. Ten patients (48%) were not ambulatory before surgery and four suffered urinary incontinence/constipation (19%). Preoperative AIS was E in 5 patients (24%), D in 11 (62%), and C in 5 (24%). Motor symptoms had been present for a mean of 3·8 days (range 1-14). All patients regained ambulation. Overall, mean survival was 320 days (range 19-798) and mean ambulation was 302 days (range 18-747). On 31 March 2013, 7 patients (33%) were alive and ambulatory at a mean of 459 days (range 302-747); 14 patients had died (67%) at a mean of 251 days (range 19-798), with a mean ambulation of 223 days (range 18-730). Discussion: With careful patient selection, surgery may achieve long duration of ambulation in patients ?65 years with MESCC. PMID:24735349

Itshayek, Eyal; Or, Omer; Kaplan, Leon; Schroeder, Josh; Barzilay, Yair; Rosenthal, Guy; Shoshan, Yigal; Fraifeld, Shifra; Cohen, José E

2014-06-01

346

Spinal cord regeneration.  

PubMed

Three theories of regeneration dominate neuroscience today, all purporting to explain why the adult central nervous system (CNS) cannot regenerate. One theory proposes that Nogo, a molecule expressed by myelin, prevents axonal growth. The second theory emphasizes the role of glial scars. The third theory proposes that chondroitin sulfate proteoglycans (CSPGs) prevent axon growth. Blockade of Nogo, CSPG, and their receptors indeed can stop axon growth in vitro and improve functional recovery in animal spinal cord injury (SCI) models. These therapies also increase sprouting of surviving axons and plasticity. However, many investigators have reported regenerating spinal tracts without eliminating Nogo, glial scar, or CSPG. For example, many motor and sensory axons grow spontaneously in contused spinal cords, crossing gliotic tissue and white matter surrounding the injury site. Sensory axons grow long distances in injured dorsal columns after peripheral nerve lesions. Cell transplants and treatments that increase cAMP and neurotrophins stimulate motor and sensory axons to cross glial scars and to grow long distances in white matter. Genetic studies deleting all members of the Nogo family and even the Nogo receptor do not always improve regeneration in mice. A recent study reported that suppressing the phosphatase and tensin homolog (PTEN) gene promotes prolific corticospinal tract regeneration. These findings cannot be explained by the current theories proposing that Nogo and glial scars prevent regeneration. Spinal axons clearly can and will grow through glial scars and Nogo-expressing tissue under some circumstances. The observation that deleting PTEN allows corticospinal tract regeneration indicates that the PTEN/AKT/mTOR pathway regulates axonal growth. Finally, many other factors stimulate spinal axonal growth, including conditioning lesions, cAMP, glycogen synthetase kinase inhibition, and neurotrophins. To explain these disparate regenerative phenomena, I propose that the spinal cord has evolved regenerative mechanisms that are normally suppressed by multiple extrinsic and intrinsic factors but can be activated by injury, mediated by the PTEN/AKT/mTOR, cAMP, and GSK3b pathways, to stimulate neural growth and proliferation. PMID:24816452

Young, Wise

2014-01-01

347

Vertebral spinal osteophytes.  

PubMed

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

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

2011-03-01

348

Fitness and Spinal Cord Injuries  

PubMed Central

Activity for many disabled persons often begins as therapy, but the additional rewards derived from exercise must be appreciated. Public attitudes toward disabled persons have changed during the last few decades, recently focusing on abilities rather than on disabilities. The family physician of patients with spinal cord injuries will assist in managing acute medical problems and the association with loss of some degree of physical capacity. Physicians also can guide these individuals to choose a life that remains active and interesting over a “house-bound,” but safe, existence. Sensitivity and timing play key roles in establishing exercise as an intergral part of a disabled individuals' altered lifestyle. The physician can advocate increased access to wheelchairs and other facilities that make life easier for disabled individuals. ImagesFigure 1Figure 2Figure 3Figure 4

Mackie, J. William; McCormack, Rebecca; Campbell, Duncan

1989-01-01

349

Aerobic Exercise Prescription for Rheumatoid Arthritics.  

ERIC Educational Resources Information Center

The use of exercise as a general treatment for rheumatoid arthritics (RA) has included range of motion, muscular strength, water exercise and rest therapy while virtually ignoring possible benefits of aerobic exercise. The purposes of this project were to examine the guidelines for exercise prescription in relation to this special population and…

Evans, Blanche W.; Williams, Hilda L.

350

Enhancing Adherence in Clinical Exercise Trials.  

ERIC Educational Resources Information Center

Discusses exercise adherence from the perspective of adhering to an exercise treatment in a controlled trial, focusing on: adherence (to intervention and measurement); the development of randomized clinical trials; exemplary randomized clinical trials in exercise science (exercise training studies and physical activity interventions); and study…

O'Neal, Heather A.; Blair, Steven N.

2001-01-01

351

Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice.  

PubMed

Spinal manipulation for low back complaints is an intervention supported by randomized clinical trials and its use recommended by clinical practice guidelines. Physical therapists in this country and internationally have used thrust spinal manipulation at much lower-than-expected rates, despite evidence supporting its efficacy for the treatment of acute low back pain (LBP). The purpose of this clinical commentary is to describe a physical therapist professional degree curriculum in thrust spinal manipulation and outline a method of monitoring ongoing student performance during the clinical education experience. Increased emphasis on evidence-based decision making and on the psychomotor skills of thrust spinal manipulation was introduced into a physical therapist professional degree curriculum. As part of ongoing student performance monitoring, physical therapy students on their first full-time (8-week) clinical education experience, collected practice pattern and outcome data on individuals with low back complaints. Eight of 18 first-year students were in outpatient musculoskeletal clinical settings and managed 61 individuals with low back complaints. Patients were seen for an average (+/-SD) of 6.2 +/- 4.0 visits. Upon initial visit the student therapists employed spinal manipulation at a rate of 36.2% and spinal mobilization at 58.6%. At the final visit, utilization of manipulation and mobilization decreased (13% and 37.8%, respectively), while the utilization of exercise interventions increased, with 75% of patients receiving some form of lumbar stabilization training. Physical therapist students used thrust spinal manipulation at rates that are more consistent with clinical practice guidelines and substantially higher then previously reported by practicing physical therapists. Education within an evidence-based framework is thought to contribute to practice behaviors and outcomes that are more consistent with best practice guidelines. PMID:16915979

Flynn, Timothy W; Wainner, Robert S; Fritz, Julie M

2006-08-01

352

Which Treatment is More Effective for Functional Ankle Instability: Strengthening or Combined Muscle Strengthening and Proprioceptive Exercises?  

PubMed

[Purpose] The purpose of this study was to implement combined muscle strengthening and proprioceptive exercises to examine the effects of combined exercises on functional ankle instability. [Subjects and Methods] Experiments were conducted with 30 adult males and females. The study subjects were randomly assigned to either a control group (Group A), a muscle strengthening exercise group (Group B), or a combined muscle strengthening and proprioceptive exercise group (Group C) consisting of 10 subjects each. In Group A, measurements were only conducted before and after the experiment without any intervention, whereas the exercise programs for Group B and Group C were implemented three days per week for four weeks. [Results] Muscle strength showed significant increases in Groups B and C compared with the control group during plantar flexion, dorsiflexion, inversion, and eversion. The Cumberland ankle instability tool showed significant increases in Group B and Group C compared with Group A and significant increases in Group C compared with Group B. [Conclusion] Applying combined muscle strengthening and proprioceptive exercises to those who have functional ankle instability is more effective than applying only muscle strengthening exercises. PMID:24707089

Kim, Ki-Jong; Kim, Young-Eok; Jun, Hyun-Ju; Lee, Jin-Su; Ji, Sung-Ha; Ji, Sang-Goo; Seo, Tae-Hwa; Kim, Young-Ok

2014-03-01

353

Which Treatment is More Effective for Functional Ankle Instability: Strengthening or Combined Muscle Strengthening and Proprioceptive Exercises?  

PubMed Central

[Purpose] The purpose of this study was to implement combined muscle strengthening and proprioceptive exercises to examine the effects of combined exercises on functional ankle instability. [Subjects and Methods] Experiments were conducted with 30 adult males and females. The study subjects were randomly assigned to either a control group (Group A), a muscle strengthening exercise group (Group B), or a combined muscle strengthening and proprioceptive exercise group (Group C) consisting of 10 subjects each. In Group A, measurements were only conducted before and after the experiment without any intervention, whereas the exercise programs for Group B and Group C were implemented three days per week for four weeks. [Results] Muscle strength showed significant increases in Groups B and C compared with the control group during plantar flexion, dorsiflexion, inversion, and eversion. The Cumberland ankle instability tool showed significant increases in Group B and Group C compared with Group A and significant increases in Group C compared with Group B. [Conclusion] Applying combined muscle strengthening and proprioceptive exercises to those who have functional ankle instability is more effective than applying only muscle strengthening exercises.

Kim, Ki-Jong; Kim, Young-Eok; Jun, Hyun-Ju; Lee, Jin-Su; Ji, Sung-Ha; Ji, Sang-Goo; Seo, Tae-Hwa; Kim, Young-Ok

2014-01-01

354

Regression of pyuria during the treatment of symptomatic urinary tract infection in patients with spinal cord injury.  

PubMed

Pyuria is frequently present in patients who require bladder instrumentation. Using the hemocytometer chamber method, we prospectively studied the regression of pyuria in 29 spinal cord-injured (SCI) men with symptomatic urinary tract infection (UTI) who were grouped according to the method of bladder drainage: (a) Intermittent catheterization program (ICP; 10 patients); (b) Suprapubic tube (SPT; 10 patients); and (c) Indwelling foley catheters (IFC; 9 patients). All of the patients experienced relief of presenting symptoms within 3-4 days of receiving appropriate antibiotic therapy. The clinical response was associated with > or = 65% and > or = 87% reduction in the levels of pyuria at mid-therapy and after completion of antimicrobial therapy, respectively. Using a one-way analysis of variance, the group of patients who underwent ICP had significantly lower residual levels of pyuria at mid-therapy and after completion of therapy when compared to the other two groups (P < 0.05). The findings of relatively lower absolute levels of pyuria in the ICP group vs the SPT and IFC group of patients suggest that the response of pyuria to appropriate therapy for symptomatic UTI can be assessed better and earlier in patients who undergo ICP. PMID:8961433

Joshi, A; Darouiche, R O

1996-12-01

355

Efficacy and satisfaction rates of oral PDE5is in the treatment of erectile dysfunction secondary to spinal cord injury: A review of literature  

PubMed Central

Concept Decreased sexual function is a major concern of men with spinal cord injuries (SCIs). Treatment of erectile dysfunction (ED) through oral pharmacotherapies has been proven to be an effective way to address and treat this concern. Objective To find an efficacious and satisfactory treatment ED secondary to SCI through the compilation of studies that utilized the International Index of Erectile Function (IIEF) when testing phosphodiesterase V inhibitors (PDE5i). Method Ten articles, which used the IIEF to study satisfaction and/or efficacy of PDE5is sildenafil, tadalafil, and vardenafil in the treatment of ED were reviewed and analyzed. Through the use of a self-made grading scale the value of each article was determined for this research. Results Sildenafil, tadalafil, and vardenafil all have been proven to be effective in treating ED in men with SCI. While sildenafil is the most thoroughly studied ED treatment for patients with SCI, tadalafil has a longer time duration effectiveness, which allows for more spontaneity in the sexual experience. Minimal adverse effects have been noted in patients with SCI using these medications; headache, flushing, and mild hypotension are the most common. In articles that study satisfaction, patients show great improvement over baseline with the use of these medications. Conclusion Although there is a need for further research on the safety in long-term use of tadalafil and vardenafil, comparative studies done on all three medications show no statistically significant difference in effectiveness or satisfaction. New medications and treatment options, such as avanafil, are being studied in hope of continued improvement of sexual function in men with SCI.

Rizio, Nicole; Tran, Claire; Sorenson, Matthew

2012-01-01

356

Running training alters fiber type composition in spinal muscles  

Microsoft Academic Search

Summary  The issue of whether exercise can induce changes in muscle fiber types has been long debated. Knowledge about the alterations\\u000a in spinal muscle fiber types is scarce. In this study, the alterations initiated by long-distance running on spinal muscle\\u000a fiber type distribution was studied. Ten young dogs were run on a treadmill for 55 weeks, 5 days a week, and

K. Puustjärvi; M. Tammi; M. Reinikainen; H. J. Helminen; L. Paljärvi

1994-01-01

357

Disuse bone loss in hindquarter suspended rats: partial weightbearing, exercise and ibandronate treatment as countermeasures  

NASA Technical Reports Server (NTRS)

The purpose of this study was to evaluate potential countermeasures for bone loss during long-term space missions in the hindquarter suspended rat, including partial weight bearing (surrogate for artificial gravity) episodic full weight bearing (2 hour/day full weight bearing) and treatment with the third generation bisphosphonate ibandronate (Roche). Graded mechanical loading was studied by housing the animals on a novel servo controlled force plate system which permitted the titration of mechanical force at varying frequency and amplitude and different levels of weight bearing. The force plate, which forms the cage floor, is a glass platform supported by an 18" diameter speaker cone filled with expanding polyurethane foam. An infrared optical sensor attached to the speaker cone yields a voltage linearly related to vertical displacement of the glass platform. The dynamic force on the paw was computed as a product of the apparent mass of the animal on the platform at rest and the acceleration of the platform determined from the second derivative of the optical sensor output. The mass of the animal on the platform was varied by adjusting tension on the tether suspending the animal. Mechanical impact loading was titrated with the force plate resonating at different frequencies, including 3 Hz and 16 Hz.

Schultheis, L.; Ruff, C. B.; Rastogi, S.; Bloomfield, S.; Hogan, H. A.; Fedarko, N.; Thierry-Palmer, M.; Ruiz, J.; Bauss, F.; Shapiro, J. R.

2000-01-01

358

Successful Treatment of Intermittent Claudication Due to Spinal Canal Stenosis Using Beraprost Sodium, a Stable Prostaglandin I2 AnalogueA Case Report  

Microsoft Academic Search

The syndrome of intermittent claudication can be induced not only by vascular insuffi ciency of the lower limbs but also by diseases of the spinal cord and cauda equina. The authors describe a sixty-year-old man with intermittent claudication due to spinal canal stenosis who was successfully treated with beraprost sodium, a stable prostaglandin I2 analogue. This drug has a long

Hiroyuki Kato; Sei Emura; Kiyoko Ngashima; Hayato Kishikawa; Toshinobu Takashima; Keizo Ohmori

1997-01-01

359

Nanomedicine for treating spinal cord injury.  

PubMed

Spinal cord injury results in significant mortality and morbidity, lifestyle changes, and difficult rehabilitation. Treatment of spinal cord injury is challenging because the spinal cord is both complex to treat acutely and difficult to regenerate. Nanomaterials can be used to provide effective treatments; their unique properties can facilitate drug delivery to the injury site, enact as neuroprotective agents, or provide platforms to stimulate regrowth of damaged tissues. We review recent uses of nanomaterials including nanowires, micelles, nanoparticles, liposomes, and carbon-based nanomaterials for neuroprotection in the acute phase. We also review the design and neural regenerative application of electrospun scaffolds, conduits, and self-assembling peptide scaffolds. PMID:23945984

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

2013-10-01

360

RS-Glucoraphanin bioactivated with myrosinase treatment counteracts proinflammatory cascade and apoptosis associated to spinal cord injury in an experimental mouse model.  

PubMed

Spinal cord injury (SCI) is a highly debilitating pathology. Although innovative medical care has been improved, drug therapies to counteract neuronal damage and promote regeneration are limited. An experimental mouse model of SCI was designed to examine the possible neuroprotective role of the glucosinolate (RS)-glucoraphanin (RS-GRA), bioactivated with myrosinase enzyme (MYR-activated RS-GRA). Methodologically, the injury was induced by application of an aneurysm clip (force of 24 g) for 1 min via four-level T5-T8 after laminectomy. MYR-activated RS-GRA was administered in mice (10mg/kg i.p.) 1 and 6h after the trauma, identified as the therapeutic intervention window. The treatment with MYR-activated RS-GRA significantly decreased histological damage resulted by proinflammatory events as well as by apoptosis cascade. Overall, by quantitative analysis of immunohistochemical images, the neuroprotection has been quite evident. MYR-activated RS-GRA has given a histological quantification around zero in all determinations. Particularly, looking at the strongest data obtained, regarding the glial fibrillary acidic protein (GFAP), result the high tissue localization of this damage marker mediated by astrocyte activity, estimated as about 80% of positive staining, was shot down by MYR-activated RS-GRA treatment. Taken together, our results show that MYR-activated RS-GRA could represent an interesting approach for the management of secondary damage following SCI. PMID:23992921

Galuppo, Maria; Giacoppo, Sabrina; De Nicola, Gina Rosalinda; Iori, Renato; Mazzon, Emanuela; Bramanti, Placido

2013-11-15

361

Dietary Exercise as a Novel Strategy for the Prevention and Treatment of Metabolic Syndrome: Effects on Skeletal Muscle Function  

PubMed Central

A sedentary lifestyle can cause metabolic syndrome to develop. Metabolic syndrome is associated with metabolic function in the skeletal muscle, a major consumer of nutrients. Dietary exercise, along with an adequate diet, is reported to be one of the major preventive therapies for metabolic syndrome; exercise improves the metabolic capacity of muscles and prevents the loss of muscle mass. Epidemiological studies have shown that physical activity reduces the risk of various common diseases such as cardiovascular disease, diabetes, and cancer; it also helps in reducing visceral adipose tissue. In addition, laboratory studies have demonstrated the mechanisms underlying the benefits of single-bout and regular exercise. Exercise regulates the expression/activity of proteins associated with metabolic and anabolic signaling in muscle, leading to a change in phenotype. The extent of these changes depends on the intensity, the duration, and the frequency of the exercise. The effect of exercise is also partly due to a decrease in inflammation, which has been shown to be closely related to the development of various diseases. Furthermore, it has been suggested that several phytochemicals contained in natural foods can improve nutrient metabolism and prevent protein degradation in the muscle.

Aoi, Wataru; Naito, Yuji; Yoshikawa, Toshikazu

2011-01-01

362

L-Dopa effect on frequency-dependent depression of the H-reflex in adult rats with complete spinal cord transection.  

PubMed

This study investigated whether l-dopa (DOPA), locomotor-like passive exercise (Ex) using a motorized bicycle exercise trainer (MBET), or their combination in adult rats with complete spinal cord transection (Tx) preserves and restores low frequency-dependent depression (FDD) of the H-reflex. Adult Sprague-Dawley rats (n=56) transected at T8-9 had one of five treatments beginning 7 days after transection: Tx (transection only), Tx+Ex, Tx+DOPA, Tx+Ex+DOPA, and control (Ctl, no treatment) groups. After 30 days of treatment, FDD of the H-reflex was tested. Stimulation of the tibial nerve at 0.2, 1, 5, and 10Hz evoked an H-reflex that was recorded from plantar muscles of the hind paw. No significant differences were found at the stimulation rate of 1Hz. However, at 5Hz, FDD of the H-reflex in the Tx+Ex, Tx+DOPA and Ctl groups was significantly different from the Tx group (p<0.01). At 10Hz, all of the treatment groups were significantly different from the Tx group (p<0.01). No significant difference was identified between the Ctl and any of the treatment groups. These results suggest that DOPA significantly preserved and restored FDD after transection as effectively as exercise alone or exercise in combination with DOPA. Thus, there was no additive benefit when DOPA was combined with exercise. PMID:20637842

Liu, Hao; Skinner, Robert D; Arfaj, Ahmad; Yates, Charlotte; Reese, Nancy B; Williams, Keith; Garcia-Rill, Edgar

2010-10-30

363

L-dopa Effect on Frequency-Dependent Depression of the H-reflex in Adult Rats with Complete Spinal Cord Transection  

PubMed Central

This study investigated whether L-dopa (DOPA), locomotor-like passive exercise (Ex) using a Motorized Bicycle Exercise Trainer (MBET), or their combination in adult rats with complete spinal cord transection (Tx) preserves and restores low frequency-dependent depression (FDD) of the H-reflex. Adult Sprague Dawley rats (n=56) transected at T8-9 had one of five treatments beginning seven days after transection: Tx (transection only), Tx+Ex, Tx+DOPA, Tx+Ex+DOPA, and Control (Ctl, no treatment) groups. After 30 days of treatment, FDD of the H-reflex was tested. Stimulation of the tibial nerve at 0.2, 1, 5, and 10 Hz evoked an H-reflex that was recorded from plantar muscles of the hind paw. No significant differences were found at the stimulation rate of 1 Hz. However, at 5 Hz, FDD of the H-reflex in the Tx+Ex, Tx+DOPA and Ctl groups was significantly different from the Tx group (p<0.01). At 10 Hz, all of the treatment groups were significantly different from the Tx group (p<0.01). No significant difference was identified between the Ctl and any of the treatment groups. These results suggest that DOPA significantly preserved and restored FDD after transection as effectively as exercise alone or exercise in combination with DOPA. Thus, there was no additive benefit when DOPA was combined with exercise.

Liu, Hao; Skinner, Robert D.; Arfaj, Ahmad; Yates, Charlotte; Reese, Nancy B.; Williams, Keith; Garcia-Rill, Edgar

2012-01-01

364

Protective effects of hyperbaric oxygen treatment against spinal cord injury in rats via toll-like receptor 2/nuclear factor-?B signaling  

PubMed Central

Spinal cord injury (SCI) is a serious medical problem with high mortality and disability rates. Hyperbaric oxygen (HBO) treatment is beneficial for neurological recovery after SCI, but the underlying mechanisms await characterization. This study examined whether HBO treatment following SCI in rats exerts a neuroprotective effect through activation of the toll-like receptor (TLR) 2/nuclear factor (NF)-?B signaling pathway. The SC of rats was injured via T10 laminectomy. Experimental animals (n = 144) were divided into four groups: sham-operated (SH), SH + HBO, SCI, and SCI + HBO. Each group was subdivided into six subgroups (n = 6 per group) that were examined at 12 h, and 1, 2, 3, 7, and 14 days post-injury. Functional recovery in the hind limb was evaluated using the Basso, Beattie, and Bresnahan (BBB) scoring system. The expression of TLR2 and NF-?B was assessed by real-time polymerase chain reaction and Western blotting, while interleukin-1 (IL)-1? and tumor necrosis factor (TNF)-? levels were measured by enzyme-linked immunosorbent assay. TLR2 and NF-?B levels and histological scores were higher in the SCI than in the SH and SH + HBO groups at various time points. HBO treatment decreased TLR2 and NF-?B expression and histological scores as well as IL-1? and TNF-? levels compared to the SCI group at early post-injury stages. In addition, BBB scores were improved in the SCI + HBO relative to the SCI group at 7 and 14 days. HBO treatment may mitigate secondary injury to the SC by inhibiting inflammatory responses induced by TLR2/NF-?B signaling, thereby promoting functional recovery and improving neurological outcome.

Tan, Jiewen; Zhang, Fang; Liang, Fang; Wang, Yong; Li, Zhuo; Yang, Jing; Liu, Xuehua

2014-01-01

365

Can exercise ameliorate treatment toxicity during the initial phase of testosterone deprivation in prostate cancer patients? Is this more effective than delayed rehabilitation?  

PubMed Central

Background There has been substantial increase in use of androgen deprivation therapy as adjuvant management of prostate cancer. However, this leads to a range of musculoskeletal toxicities including reduced bone mass and increased skeletal fractures compounded with rapid metabolic alterations, including increased body fat, reduced lean mass, insulin resistance and negative lipoprotein profile, increased incidence of cardiovascular and metabolic morbidity, greater distress and reduced quality of life. Numerous research studies have demonstrated certain exercise prescriptions to be effective at preventing or even reversing these treatment toxicities. However, all interventions to date have been of rehabilitative intent being implemented after a minimum of 3 months since initiation of androgen deprivation, by which time considerable physical and psychological health problems have manifested. The pressing question is whether it is more efficacious to commence exercise therapy at the same time as initiating androgen deprivation, so treatment induced adverse effects can be immediately attenuated or indeed prevented. Methods/design We are proposing a multi-site randomized controlled trial with partial crossover to examine the effects of timing of exercise implementation (immediate or delayed) on preserving long-term skeletal health, reversing short- and long-term metabolic and cardiovascular risk factors, and supporting mental health in men receiving androgen deprivation therapy. 124 men who are about to initiate androgen deprivation for prostate cancer will be randomized to immediate or delayed groups. Immediate will commence a 6-month exercise program within 7–10 days of their first dose. Delayed will receive usual care for 6 months and then commence the exercise program for 6 months (partial cross-over). Immediate will be free to adopt the lifestyle of their choosing following the initial 6-month intervention. Measurements for primary and secondary endpoints will take place at baseline, 6 months and 12 months. Discussion This project is unique as it explores a fundamental question of when exercise implementation will be of most benefit and addresses both physical and psychological consequences of androgen deprivation initiation. The final outcome may be adjunct treatment which will reduce if not prevent the toxicities of androgen deprivation, ultimately resulting in reduced morbidity and mortality for men with prostate cancer. Trial registration ACTRN12612000097842

2012-01-01

366

The muscle mass, omega-3, diet, exercise and lifestyle (MODEL) study - a randomised controlled trial for women who have completed breast cancer treatment  

PubMed Central

Background Loss of lean body mass (LBM) is a common occurrence after treatment for breast cancer and is related to deleterious metabolic health outcomes [Clin Oncol, 22(4):281–288, 2010; Appl Physiol Nutr Metab, 34(5):950–956, 2009]. The aim of this research is to determine the effectiveness of long chain omega-3 fatty acids (LCn-3s) and exercise training alone, or in combination, in addressing LBM loss in breast cancer survivors. Methods/design A total of 153 women who have completed treatment for breast cancer in the last 12 months, with a Body Mass Index (BMI) of 20 to 35 kg/m2, will be randomly assigned to one of 3 groups: 3g/d LCn-3s (N-3), a 12-week nutrition and exercise education program plus olive oil (P-LC) or the education program plus LCn-3s (EX+N-3). Participants randomised to the education groups will be blinded to treatment, and will receive either olive oil placebo (OO+N-3) or LCn-3 provision, while the N-3 group will be open label. The education program includes nine 60-75min sessions over 12 weeks that will involve breast cancer specific healthy eating advice, plus a supervised exercise session run as a resistance exercise circuit. They will also be advised to conduct the resistance training and aerobic training 5 to 7 days per week collectively. Outcome measures will be taken at baseline, 12-weeks and 24-weeks. The primary outcome is % change in LBM as measured by the air displacement plethysmograhy. Secondary outcomes include quality of life (FACT-B?+?4) and inflammation (C-Reactive protein: CRP). Additional measures taken will be erythrocyte fatty acid analysis, fatigue, physical activity, menopausal symptoms, dietary intake, joint pain and function indices. Discussion This research will provide the first insight into the efficacy of LCn-3s alone or in combination with exercise in breast cancer survivors with regards to LBM and quality of life. In addition, this study is designed to improve evidence-based dietetic practice, and how specific dietary prescription may link with appropriate exercise interventions. Trials registration ACTRN12610001005044; and World Health Organisation Universal trial number: U1111-1116-8520.

2014-01-01

367

Pharmacological approaches to chronic spinal cord injury.  

PubMed

Although research on neural tissue repair has made enormous progress in recent years, spinal cord injury remains a devastating condition for which there is still no cure. In fact, recent estimates of prevalence in the United States reveal that spinal cord injury has undergone a five-fold increase in the last decades. Though, it has become the second most common neurological problem in North America after Alzheimer's disease. Despite modern trauma units and intensive care treatments, spinal cord injury remains associated with several comorbid conditions and unbearable health care costs. Regular administration of a plethora of symptomatic drug treatments aimed at controlling related-secondary complications and life-threatening problems in chronic spinal cord-injured patients has recently been reported. This article provides a thorough overview of the main drug classes and products currently used or in development for chronic spinal cord injury. Special attention is paid to a novel class of drug treatment designed to provide a holistic solution for several chronic complications and diseases related with spinal cord injury. There is clear evidence showing that new class can elicit 'on-demand' episodes of rhythmic and stereotyped walking activity in previously completely paraplegic animals and may consequently constitute a simple therapy against several physical inactivity-related comorbid problems. Understanding further pharmacological approaches to chronic spinal cord injury may improve both life expectancy and overall quality of life while reducing unsustainable cost increases associated with this debilitation condition. PMID:23360274

Steuer, Inge; Rouleau, Pascal; Guertin, Pierre A

2013-01-01

368

A comparison of the behavioral and anatomical outcomes in sub-acute and chronic spinal cord injury models following treatment with human mesenchymal precursor cell transplantation and recombinant decorin.  

PubMed

This study assessed the potential of highly purified (Stro-1(+)) human mesenchymal precursor cells (hMPCs) in combination with the anti-scarring protein decorin to repair the injured spinal cord (SC). Donor hMPCs isolated from spinal cord injury (SCI) patients were transplanted into athymic rats as a suspension graft, alone or after previous treatment with, core (decorin(core)) and proteoglycan (decorin(pro)) isoforms of purified human recombinant decorin. Decorin was delivered via mini-osmotic pumps for 14 days following sub-acute (7 day) or chronic (1 month) SCI. hMPCs were delivered to the spinal cord at 3 weeks or 6 weeks after the initial injury at T9 level. Behavioral and anatomical analysis in this study showed statistically significant improvement in functional recovery, tissue sparing and cyst volume reduction following hMPC therapy. The combination of decorin infusion followed by hMPC therapy did not improve these measured outcomes over the use of cell therapy alone, in either sub-acute or chronic SCI regimes. However, decorin infusion did improve tissue sparing, reduce spinal tissue cavitation and increase transplanted cell survivability as compared to controls. Immunohistochemical analysis of spinal cord sections revealed differences in glial, neuronal and extracellular matrix molecule expression within each experimental group. hMPC transplanted spinal cords showed the increased presence of serotonergic (5-HT) and sensory (CGRP) axonal growth within and surrounding transplanted hMPCs for up to 2 months; however, no evidence of hMPC transdifferentiation into neuronal or glial phenotypes. The number of hMPCs was dramatically reduced overall, and no transplanted cells were detected at 8 weeks post-injection using lentiviral GFP labeling and human nuclear antigen antibody labeling. The presence of recombinant decorin in the cell transplantation regimes delayed in part the loss of donor cells, with small numbers remaining at 2 months after transplantation. In vitro co-culture experiments with embryonic dorsal root ganglion explants revealed the growth promoting properties of hMPCs. Decorin did not increase axonal outgrowth from that achieved by hMPCs. We provide evidence for the first time that (Stro-1(+)) hMPCs provide: i) an advantageous source of allografts for stem cell transplantation for sub-acute and chronic spinal cord therapy, and (ii) a positive host microenvironment that promotes tissue sparing/repair that subsequently improves behavioral outcomes after SCI. This was not measurably improved by recombinant decorin treatment, but does provide important information for the future development and potential use of decorin in contusive SCI therapy. PMID:23867131

Hodgetts, Stuart I; Simmons, Paul J; Plant, Giles W

2013-10-01

369

Exercise at Home  

MedlinePLUS

... Health Information > Healthy Lifestyle > Exercise > Exercise at Home Exercise at Home Exercise and staying active are an ... plans to begin exercising with your doctor. Posture Exercises Better posture means better breathing and movement. Axial ...

370

21 CFR 890.5380 - Powered exercise equipment.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 false Powered exercise equipment. 890.5380... § 890.5380 Powered exercise equipment. (a) Identification. Powered exercise equipment consist of...an adjunct treatment for obesity. Examples include a...

2010-04-01

371

21 CFR 890.5370 - Nonmeasuring exercise equipment.  

Code of Federal Regulations, 2010 CFR

...890.5370 Nonmeasuring exercise equipment. (a) Identification. Nonmeasuring exercise equipment consist of...an adjunct treatment for obesity. Examples include a prone...mechanical treadmill, an exercise table, and a...

2010-04-01

372

21 CFR 890.5380 - Powered exercise equipment.  

Code of Federal Regulations, 2010 CFR

...2009-04-01 false Powered exercise equipment. 890.5380... § 890.5380 Powered exercise equipment. (a) Identification. Powered exercise equipment consist of...an adjunct treatment for obesity. Examples include a...

2009-04-01

373

21 CFR 890.5370 - Nonmeasuring exercise equipment.  

Code of Federal Regulations, 2010 CFR

...890.5370 Nonmeasuring exercise equipment. (a) Identification. Nonmeasuring exercise equipment consist of...an adjunct treatment for obesity. Examples include a prone...mechanical treadmill, an exercise table, and a...

2009-04-01

374

Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women  

PubMed Central

Objective To compare the effect of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment for genuine stress incontinence. Design Stratified, single blind, randomised controlled trial. Setting Multicentre. Participants 107 women with clinically and urodynamically proved genuine stress incontinence. Mean (range) age was 49.5 (24-70) years, and mean (range) duration of symptoms 10.8 (1-45) years. Interventions Pelvic floor exercise (n=25) comprised 8-12 contractions 3 times a day and exercise in groups with skilled physical therapists once a week. The electrical stimulation group (n=25) used vaginal intermittent stimulation with the MS 106 Twin at 50?Hz 30 minutes a day. The vaginal cones group (n=27) used cones for 20 minutes a day. The untreated control group (n=30) was offered the use of a continence guard. Muscle strength was measured by vaginal squeeze pressure once a month. Main outcome measures Pad test with standardised bladder volume, and self report of severity. Results Improvement in muscle strength was significantly greater (P=0.03) after pelvic floor exercises (11.0?cm H2O (95% confidence interval 7.7 to 14.3) before v 19.2?cm H2O (15.3 to 23.1) after) than either electrical stimulation (14.8?cm H2O (10.9 to 18.7) v 18.6 cm H2O (13.3 to 23.9)) or vaginal cones (11.8?cm H2O (8.5 to 15.1) v 15.4?cm H2O (11.1 to 19.7)). Reduction in leakage on pad test was greater in the exercise group (?30.2?g; ?43.3 to 16.9) than in the electrical stimulation group (?7.4?g; ?20.9 to 6.1) and the vaginal cones group (?14.7?g; ?27.6 to ?1.8). On completion of the trial one participant in the control group, 14 in the pelvic floor exercise group, three in the electrical stimulation group, and two in the vaginal cones group no longer considered themselves as having a problem. Conclusion Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence. Key messagesTraining to increase the strength of pelvic floor muscles was superior to electrical stimulation and vaginal cones in treatment of genuine stress incontinenceAdverse effects were reported with use of electrical stimulation and vaginal cones but not with exercisesPatients’ tolerance for electrical stimulation and vaginal cones was lowPelvic floor exercise should be first choice of treatment for genuine stress incontinence

B?, Kari; Talseth, Trygve; Holme, Ingar

1999-01-01

375

Can Exercise Help Women with PMS?  

ERIC Educational Resources Information Center

Various treatments for premenstrual syndrome (PMS) are described, focusing on the role of exercise. Some physicians prefer to try exercise and others, lifestyle changes before turning to such treatment as psychoactive drugs, vitamin B complex, dopamine agonists, and immunotherapy. Regular exercise has been shown to relieve symptoms of PMS. (SM)

Cowart, Virginia S.

1989-01-01

376

Spinal stenosis (image)  

MedlinePLUS

Spinal stenosis is a narrowing of the lumbar or cervical spinal canal. The narrowing can cause compression on nerve roots resulting in pain or weakness of the legs. Medications or steroid injections are ...

377

Spinal Cord Injury (SCI)  

MedlinePLUS

... 9,11 Sports: 12% 1,2,9,11 Demographics Males account for 80% of spinal cord injury ... AB, Dijkers M, DeVivo MJ, Poczatek RB. A demographic profile of new traumatic spinal cord injuries: change ...

378

Combined treatment of isoflavone supplementation and exercise restores the changes in hepatic protein expression in ovariectomized rats - a proteomics approach  

PubMed Central

Background Postmenopausal women experience adverse physiological changes caused by estrogen deprivation. Here, we hypothesized that the administration of isoflavone, a phytoestrogn, and/or physical exercise could reverse changes in the levels of hepatic enzymes disturbed by loss of estrogen to ameliorate postmenopause-related health problems. Methods Thirty-week-old female Sprague–Dawley rats were divided into five groups: a sham-operated (SHAM) group, ovariectomized groups on a regular diet with exercise (EXE) and without exercise (OVX), and ovariectomized groups on an isoflavone supplemented diet with (ISO?+?EXE) and without exercise (ISO). Proteomic tools were employed to identify candidate hepatic proteins that were differentially expressed among the five animal groups. Results INMT was detected in the SHAM but not in all of the ovariectomized rats. Seven proteins (PPIA, AKR1C3, ALDH2, PSME2, BUCS1, OTC, and GAMT) were identified to have differential expression among the groups. When compared to the SHAM group, the ovariectomy elevated the levels of PPIA, BUCS1, PSME2, AKR1C3, and GAMT while decreasing ALDH2 and OTC. Among these OVX-induced changes, OVX-increased BUCS1 and GAMT levels were noticeably decreased by ISO or EXE and further greatly down-regulated by ISO?+?EXE. In the case of PSME2, ISO and EXE further increased OVX-upregulated expression levels but ISO?+?EXE greatly reduced OVX-increased levels. On the other hand OVX-lowered OTC levels were elevated by ISO, EXE, or ISO?+?EXE. The protein levels of ALDH2, PPIA, and AKR1C3 were not significantly reverted by ISO, EXE or ISO?+?EXE. Conclusion The combination of an isoflavone diet and exercise partly reversed ovariectomy-induced changes in hepatic protein expression levels. Our data suggest that the combinatory regimen of isoflavone supplementation and exercise may be beneficial to menopausal women through modulating hepatic protein expression profiles.

2014-01-01

379

Diagnosis of important fixed coronary stenosis in patients with variant angina by exercise tests after treatment with calcium antagonists.  

PubMed Central

A 12 lead electrocardiogram was recorded during treadmill exercise in 57 patients with variant angina in whom coronary angiography was performed. Thirty six patients performed exercise tests with and without calcium antagonists, and 21 performed them only with calcium antagonists. In 55 patients calcium antagonists had prevented spontaneous attacks of variant angina for more than two days before the test. The other two patients were given a single dose of diltiazem (90 mg) two hours before the test. Exercise testing without calcium antagonists induced ST segment elevation with chest pain in nine patients, ST segment depression in 10 (nine with chest pain), and no important shift of the ST segment in 17. Five patients had severe coronary stenosis (greater than or equal to 75%) and all of them showed positive response. Thirty one patients had no important coronary stenosis and 14 of them showed positive response. The sensitivity of the exercise test in detecting a coronary stenosis greater than or equal to 75% was 100% without calcium antagonists but the specificity was low (55%). When the exercise test was done in patients taking calcium antagonists, only two (specificity 96%) of 48 patients without severe coronary stenosis showed positive response (elevation of ST segment in one and depression in another) whereas all nine patients with severe coronary stenosis had a positive response (depression of ST segment in six and elevation in three (sensitivity 100%). It is concluded that exercise testing with calcium antagonists may be a useful method for detecting severe coronary stenosis in patients with variant angina. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4

Araki, H; Hayata, N; Matsuguchi, T; Takeshita, A; Nakamura, M

1986-01-01

380

Spinal Cord Injuries  

MedlinePLUS

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

381

Acute spinal cord injury: current concepts.  

PubMed

Optimal treatment of acute spinal cord damage requires an effective emergency medical service at the scene of injury coordinated with a hospital-based multidisciplinary team of physicians and allied health professionals. A detailed protocol outlines the steps required for evaluation, supportive therapy and stabilization. Emphasis is placed on team work with equal attention directed to nervous tissue and spinal column lesions. Laboratory and clinical investigations regarding spinal cord injury are directed toward epidemiology, anti-inflammatory agents, biomechanics, physical therapy and reconstructive surgery. PMID:7471548

Green, B A; Callahan, R A; Klose, K J; de la Torre, J

1981-01-01

382