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Sample records for adult spinal deformity

  1. Current Status of Adult Spinal Deformity

    PubMed Central

    Youssef, J. A.; Orndorff, D. O.; Patty, C. A.; Scott, M. A.; Price, H. L.; Hamlin, L. F.; Williams, T. L.; Uribe, J. S.; Deviren, V.

    2012-01-01

    Purpose To review the current literature for the nonoperative and operative treatment for adult spinal deformity. Recent Findings With more than 11 million baby boomers joining the population of over 60 years of age in the United States, the incidence of lumbar deformity is greatly increasing. Recent literature suggests that a lack of evidence exists to support the effectiveness of nonoperative treatment for adult scoliosis. In regards to operative treatment, current literature reports a varying range of improved clinical outcomes, curve correction, and complication rates. The extension of fusion to S1 compared with L5 and lower thoracic levels compared with L1 remains a highly controversial topic among literature. Summary Most adult deformity patients never seek nonoperative or operative treatment. Of the few that seek treatment, many can benefit from nonoperative treatment. However, in selected patients who have failed nonoperative treatment and who are candidates for surgical intervention, the literature reflects positive outcomes related to surgical intervention as compared with nonoperative treatment despite varying associated ranges in morbidity and mortality rates. If nonoperative therapy fails in addressing a patient's complaints, then an appropriate surgical procedure that relieves neural compression, corrects excessive sagittal or coronal imbalance, and results in a solidly fused, pain-free spine is warranted. PMID:24436852

  2. Spinal deformity.

    PubMed

    Bunnell, W P

    1986-12-01

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

  3. Management of adult spinal deformity with combined anterior-posterior arthrodesis and Luque-Galveston instrumentation.

    PubMed

    Boachie-Adjei, O; Dendrinos, G K; Ogilvie, J W; Bradford, D S

    1991-06-01

    Twenty-five consecutive adult women with nonparalytic spinal deformity were treated with fusion to the sacrum. Two patients were lost to follow-up and one patient died, leaving 22 patients for review. All patients underwent a first-stage anterior spinal fusion without instrumentation followed by a second-stage posterior spinal fusion with Luque-Galveston instrumentation. The average age of the patients was 47 years (range, 25-64 years). The average follow-up was 39 months (range, 24-60 months). Ten patients had had previous surgery in the area of the instrumentation. The main indications were pain (22 patients), loss of sagittal plane balance (17 patients), and progression of the deformity (13 patients). Additional procedures included anterior corpectomies (five patients), anterior and posterior osteotomies (two patients), posterior osteotomies (eight patients), and posterior decompression (five patients). The average curve correction was 27% for thoracic scoliosis and 44% for lumbar scoliosis. Physiologic sagittal plane realignment was obtained in four patients who presented preoperatively with sagittal plane deformities. Pain improvement was reported in 14 of 22 (63%) patients. Nineteen (82%) patients had 34 complications. Pseudarthrosis occurred in nine patients (41%) and was successfully repaired in four; hence the fusion rate was 77% at follow-up. Of the 23 patients, one died from pulmonary embolism, 15 (66%) were in good condition, one (4%) was in fair condition, and seven (30%) were in poor condition. Previous surgery and additional procedures such as vertebrectomies or osteotomies did not adversely affect the outcome. There were no permanent neurologic deficits related to the instrumentation or the passage of sublaminar wires. The Luque-Galveston method provided correction of sagittal plane deformities and flatback syndrome.

  4. Surgical Treatment for Adult Spinal Deformity: Projected Cost Effectiveness at 5-Year Follow-Up

    PubMed Central

    Terran, Jamie; McHugh, Brian J.; Fischer, Charla R.; Lonner, Baron; Warren, Daniel; Glassman, Steven; Bridwell, Keith; Schwab, Frank; Lafage, Virginie

    2014-01-01

    Background In the United States, expenditures related to spine care are estimated to account for $86 billion annually. Policy makers have set a cost-effectiveness benchmark of less than $100,000/quality adjusted life year (QALY), forcing surgeons to defend their choices economically. This study projects the cost/QALY for surgical treatment of adult spinal deformity at 5-year follow-up based on 2-year cost- and health-related quality-of-life (HRQOL) data. Methods In a review of 541 patients with adult spinal deformity, the patients who underwent revision or were likely to undergo revision were identified and cost of surgery was doubled to account for the second procedure; all other patients maintained the cost of the initial surgery. Oswestry Disability Index (ODI) was modeled by revision status based on literature findings. Total surgical cost was based on Medicare reimbursement. Chi square and student t tests were utilized to compare cost-effective and non–cost-effective patients. Results The average cost/QALY at 5-year follow-up was $120,311.73. A total of 40.7% of patients fell under the threshold of a cost/QALY <$100,000. Cost-effective patients had higher baseline ODI scores (45% vs 34% [P=0.001]), lower baseline total Scoliosis Research Society scores (2.89 vs 3.00 [P=0.04]), and shorter fusions (8.23 vs 9.87 [P=0.0001]). Conclusion We found 40.7% of patients to be below the threshold of cost effectiveness. Factors associated with reaching the threshold <$100,000/QALY were greater preoperative disability, diagnosis of idiopathic scoliosis, poor preoperative HRQOL scores, and fewer fusion levels. PMID:24688328

  5. Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity

    PubMed Central

    Moal, Bertrand; Bronsard, Nicolas; Raya, José G; Vital, Jean Marc; Schwab, Frank; Skalli, Wafa; Lafage, Virginie

    2015-01-01

    AIM: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity (ASD) with magnetic resonance imaging (MRI) and 3D reconstructions. METHODS: Nineteen female ASD patients (mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle (fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl’X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle’s contour on a limited number of axial images [Deformation of parametric specific objects (DPSO) Method]. Musclar volume (Vmuscle), infiltrated fat volume (Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 × (Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated. RESULTS: Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fat-water ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability (Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2nd in terms of Pfat (14% ± 8%), and were significantly greater than those of the knee extensor (P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat (12% ± 8%). They were also the only group with a significant correlation

  6. The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases

    PubMed Central

    Bess, Shay; Line, Breton; Fu, Kai-Ming; McCarthy, Ian; Lafage, Virgine; Schwab, Frank; Shaffrey, Christopher; Ames, Christopher; Akbarnia, Behrooz; Jo, Han; Kelly, Michael; Burton, Douglas; Hart, Robert; Klineberg, Eric; Kebaish, Khaled; Hostin, Richard; Mundis, Gregory; Mummaneni, Praveen; Smith, Justin S.

    2016-01-01

    Study Design. A retrospective analysis of a prospective, multicenter database. Objective. The aim of this study was to evaluate the health impact of symptomatic adult spinal deformity (SASD) by comparing Standard Form Version 2 (SF-36) scores for SASD with United States normative and chronic disease values. Summary of Background Data. Recent data have identified radiographic parameters correlating with poor health-related quality of life for SASD. Disability comparisons between SASD patients and patients with chronic diseases may provide further insight to the disease burden caused by SASD. Methods. Consecutive SASD patients, with no history of spine surgery, were enrolled into a multicenter database and evaluated for type and severity of spinal deformity. Baseline SF-36 physical component summary (PCS) and mental component summary (MCS) values for SASD patients were compared with reported U.S. normative and chronic disease SF-36 scores. SF-36 scores were reported as normative-based scores (NBS) and evaluated for minimally clinical important difference (MCID). Results. Between 2008 and 2011, 497 SASD patients were prospectively enrolled and evaluated. Mean PCS for all SASD was lower than U.S. total population (ASD = 40.9; US = 50; P < 0.05). Generational decline in PCS for SASD patients with no other reported comorbidities was more rapid than U.S. norms (P < 0.05). PCS worsened with lumbar scoliosis and increasing sagittal vertical axis (SVA). PCS scores for patients with isolated thoracic scoliosis were similar to values reported by individuals with chronic back pain (45.5 vs 45.7, respectively; P > 0.05), whereas patients with lumbar scoliosis combined with severe sagittal malalignment (SVA >10 cm) demonstrated worse PCS scores than values reported by patients with limited use of arms and legs (24.7 vs 29.1, respectively; P < 0.05). Conclusions. SASD is a heterogeneous condition that, depending upon the type and severity of the deformity

  7. The effect of July admission on inpatient morbidity and mortality after adult spinal deformity surgery

    PubMed Central

    De la Garza-Ramos, Rafael; Passias, Peter G.; Schwab, Frank J.; Lafage, Virginie

    2016-01-01

    Background Some studies have suggested patients who undergo surgery in July have worse outcomes compared to patients treated during other months. The purpose of this study is to compare inpatient morbidity and mortality among patients who underwent adult spinal deformity (ASD) surgery in July with those who underwent surgery in other months. Methods Admission data for patients who underwent ASD surgery were extracted from the Nationwide Inpatient Sample for the years 2002 to 2011. Only adult patients (over 21 years of age) and elective admissions to teaching hospitals were included. A multivariable regression analysis was performed to examine the independent effect of July admissions on overall complications, major complications, and inpatient mortality. Results A total of 27,794 patients were identified, with 2,023 (7.8%) admitted in July and 25,771 (92.2%) in other months. Overall complication rates in July (43.1%) were not different from rates in other months (44.9%, p=0.468). Similarly, major complication rates were similar; 12.9% in July and 12.4% in other months (p=0.764). Mortality was not different between groups (p=0.807). After multivariable analysis, July admissions were not found to increase the odds of developing any complication (OR 0.94; 95% CI, 0.77 - 1.12; p=0.403), major complications (OR 1.04; 95% CI, 0.76 - 1.41; p=0.788) or inpatient mortality (OR 1.35; 95% CI, 0.31 - 5.84; p=0.684). Conclusion In this study of a nationwide database, patients who underwent ASD surgery in July did not have increased odds of developing a complication or inpatient mortality compared to patients admitted in other months. PMID:26913223

  8. Lateral interbody fusion combined with open posterior surgery for adult spinal deformity.

    PubMed

    Strom, Russell G; Bae, Junseok; Mizutani, Jun; Valone, Frank; Ames, Christopher P; Deviren, Vedat

    2016-12-01

    OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and

  9. Development of a preoperative predictive model for major complications following adult spinal deformity surgery.

    PubMed

    Scheer, Justin K; Smith, Justin S; Schwab, Frank; Lafage, Virginie; Shaffrey, Christopher I; Bess, Shay; Daniels, Alan H; Hart, Robert A; Protopsaltis, Themistocles S; Mundis, Gregory M; Sciubba, Daniel M; Ailon, Tamir; Burton, Douglas C; Klineberg, Eric; Ames, Christopher P

    2017-03-24

    OBJECTIVE The operative management of patients with adult spinal deformity (ASD) has a high complication rate and it remains unknown whether baseline patient characteristics and surgical variables can predict early complications (intraoperative and perioperative [within 6 weeks]). The development of an accurate preoperative predictive model can aid in patient counseling, shared decision making, and improved surgical planning. The purpose of this study was to develop a model based on baseline demographic, radiographic, and surgical factors that can predict if patients will sustain an intraoperative or perioperative major complication. METHODS This study was a retrospective analysis of a prospective, multicenter ASD database. The inclusion criteria were age ≥ 18 years and the presence of ASD. In total, 45 variables were used in the initial training of the model including demographic data, comorbidities, modifiable surgical variables, baseline health-related quality of life, and coronal and sagittal radiographic parameters. Patients were grouped as either having at least 1 major intraoperative or perioperative complication (COMP group) or not (NOCOMP group). An ensemble of decision trees was constructed utilizing the C5.0 algorithm with 5 different bootstrapped models. Internal validation was accomplished via a 70/30 data split for training and testing each model, respectively. Overall accuracy, the area under the receiver operating characteristic (AUROC) curve, and predictor importance were calculated. RESULTS Five hundred fifty-seven patients were included: 409 (73.4%) in the NOCOMP group, and 148 (26.6%) in the COMP group. The overall model accuracy was 87.6% correct with an AUROC curve of 0.89 indicating a very good model fit. Twenty variables were determined to be the top predictors (importance ≥ 0.90 as determined by the model) and included (in decreasing importance): age, leg pain, Oswestry Disability Index, number of decompression levels, number of

  10. Mini-Open Anterior Lumbar Interbody Fusion Combined with Lateral Lumbar Interbody Fusion in Corrective Surgery for Adult Spinal Deformity

    PubMed Central

    Lee, Chong-Suh; Chung, Sung-Soo; Lee, Jun-Young; Yum, Tae-Hoon; Shin, Seong-Kee

    2016-01-01

    Study Design Prospective observational study. Purpose To introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformity Overview of Literature Although LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal. Methods Thirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5–S1 or L4–S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded. Results No major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p <0.001). Four patients (12.5%) had lumbar lordosis with a pelvic incidence of ±9° preoperatively, whereas this outcome was achieved postoperatively in 30 patients (93.8%). The total increase in lumbar lordosis was 14.7° in the percutaneous group, 35.3° in the open group, and 57.0° in the PSO group. The ranges of potential lumbar lordosis increase were estimated as 4°–25°, 23°–42°, and 45°–65°, respectively. Conclusions Mini-open ALIF combined with LLIF followed by posterior fixation may be a feasible technique for achieving optimal sagittal balance and reducing the necessity of more extensive surgery. PMID:27994777

  11. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery.

    PubMed

    Smith, Justin S; Klineberg, Eric; Lafage, Virginie; Shaffrey, Christopher I; Schwab, Frank; Lafage, Renaud; Hostin, Richard; Mundis, Gregory M; Errico, Thomas J; Kim, Han Jo; Protopsaltis, Themistocles S; Hamilton, D Kojo; Scheer, Justin K; Soroceanu, Alex; Kelly, Michael P; Line, Breton; Gupta, Munish; Deviren, Vedat; Hart, Robert; Burton, Douglas C; Bess, Shay; Ames, Christopher P

    2016-07-01

    OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82

  12. Predictive parameters for the antecedent development of hip pathology associated with long segment fusions to the pelvis for the treatment of adult spinal deformity

    PubMed Central

    Kinon, Merritt D.; Nasser, Rani; Nakhla, Jonathan P.; Adogwa, Owoicho; Moreno, Jessica R.; Harowicz, Michael; Verla, Terence; Yassari, Reza; Bagley, Carlos A.

    2016-01-01

    Background: The surgical treatment of adult scoliosis frequently involves long segment fusions across the lumbosacral joints that redistribute tremendous amounts of force to the remaining mobile spinal segments as well as to the pelvis and hip joints. Whether or not these forces increase the risk of femoral bone pathology remains unknown. The aim of this study is to determine the correlation between long segment spinal fusions to the pelvis and the antecedent development of degenerative hip pathologies as well as what predictive patient characteristics, if any, correlate with their development. Methods: A retrospective chart review of all long segment fusions to the pelvis for adult degenerative deformity operated on by the senior author at the Duke Spine Center from February 2008 to March 2014 was undertaken. Enrolment criteria included all available demographic, surgical, and clinical outcome data as well as pre and postoperative hip pathology assessment. All patients had prospectively collected outcome measures and a minimum 2-year follow-up. Multivariable logistic regression analysis was performed comparing the incidence of preoperative hip pain and antecedent postoperative hip pain as a function of age, gender, body mass index (BMI), and number of spinal levels fused. Results: In total, 194 patients were enrolled in this study. Of those, 116 patients (60%) reported no hip pain prior to surgery. Eighty-three patients (71.6%) remained hip pain free, whereas 33 patients (28.5%) developed new postoperative hip pain. Age, gender, and BMI were not significant among those who went on to develop hip pain postoperatively (P < 0.0651, 0.3491, and 0.1021, respectively). Of the 78 patients with preoperative hip pain, 20 patients (25.6%) continued to have hip pain postoperatively, whereas 58 patients reported improvement in the hip pain after long segment fusion for correction of their deformity, a 74.4% rate of reduction. Age, gender, and BMI were not significant among

  13. Spinal deformity in children treated for neuroblastoma

    SciTech Connect

    Mayfield, J.K.; Riseborough, E.J.; Jaffe, N.; Nehme, M.E.

    1981-02-01

    Of seventy-four children who were treated at a mean age of seventeen months for neuroblastoma and survived more than five years, fifty-six had spinal deformity due either to the disease or to the treatment after a mean follow-up of 12.9 years. Of these fifty-six, 50 per cent had post-radiation scoliosis, and 16 per cent had post-radiation kyphosis, most frequently at the thoracolumbar junction, at the time of follow-up. Two kyphotic thoracolumbar curve patterns were identified: an angular kyphosis with a short radius of curvature and its apex at the twelfth thoracic and first lumbar vertebrae, and a thoracic kyphosis with a long radius of curvature that extended into the lumbar spine. The post-radiation deformity - both the scoliosis and the kyphosis - progressed with growth, the scoliosis at a rate of 1 degree per year and the kyphosis at a rate of 3 degrees per year. Epidural spread of the neuroblastoma was associated with most of the cases of severe scoliosis and kyphosis. The deformity was due either to the laminectomy or to the paraplegia acting in conjunction with the radiation. Eighteen per cent of 419 children with this malignant disease survived more than five years, and of the survivors, 20 per cent had spinal deformity severe enough to warrant treatment. The factors associated with the development of spinal deformity in patient treated for neuroblastoma were: orthovoltage radiation exceeding 3000 rads, asymmetrical radiation of the spine, thoracolumbar kyphosis, and epidural spread of the tumor.

  14. Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up.

    PubMed

    Bakhsheshian, Joshua; Scheer, Justin K; Gum, Jeffrey L; Hostin, Richard; Lafage, Virginie; Bess, Shay; Protopsaltis, Themistocles S; Burton, Douglas C; Keefe, Malla Kate; Hart, Robert A; Mundis, Gregory M; Shaffrey, Christopher I; Schwab, Frank; Smith, Justin S; Ames, Christopher P

    2017-01-01

    OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores ≤ 25th percentile for matched norms; however, the low mental health (LMH) group consisted of patients with an MCS score ≤ 25th percentile, and the high mental health (HMH) group included patients with an MCS score ≥ 75th percentile. RESULTS Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression

  15. Brain and Spinal Cord Tumors in Adults

    MedlinePlus

    ... Search Search En Español Category Cancer A-Z Brain and Spinal Cord Tumors in Adults If you have a brain or spinal cord tumor or are close to ... cope. Here you can find out all about brain and spinal cord tumors in adults, including risk ...

  16. Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up.

    PubMed

    Smith, Justin S; Shaffrey, Christopher I; Klineberg, Eric; Lafage, Virginie; Schwab, Frank; Lafage, Renaud; Kim, Han Jo; Hostin, Richard; Mundis, Gregory M; Gupta, Munish; Liabaud, Barthelemy; Scheer, Justin K; Diebo, Bassel G; Protopsaltis, Themistocles S; Kelly, Michael P; Deviren, Vedat; Hart, Robert; Burton, Doug; Bess, Shay; Ames, Christopher P

    2017-02-17

    OBJECTIVE Although 3-column osteotomy (3CO) can provide powerful alignment correction in adult spinal deformity (ASD), these procedures are complex and associated with high complication rates. The authors' objective was to assess complications associated with ASD surgery that included 3CO based on a prospectively collected multicenter database. METHODS This study is a retrospective review of a prospectively collected multicenter consecutive case registry. ASD patients treated with 3CO and eligible for 2-year follow-up were identified from a prospectively collected multicenter ASD database. Early (≤ 6 weeks after surgery) and delayed (> 6 weeks after surgery) complications were collected using standardized forms and on-site coordinators. RESULTS Of 106 ASD patients treated with 3CO, 82 (77%; 68 treated with pedicle subtraction osteotomy [PSO] and 14 treated with vertebral column resection [VCR]) had 2-year follow-up (76% women, mean age 60.7 years, previous spine fusion in 80%). The mean number of posterior fusion levels was 12.9, and 17% also had an anterior fusion. A total of 76 early (44 minor, 32 major) and 66 delayed (13 minor, 53 major) complications were reported, with 41 patients (50.0%) and 45 patients (54.9%) affected, respectively. Overall, 64 patients (78.0%) had at least 1 complication, and 50 (61.0%) had at least 1 major complication. The most common complications were rod breakage (31.7%), dural tear (20.7%), radiculopathy (9.8%), motor deficit (9.8%), proximal junctional kyphosis (PJK, 9.8%), pleural effusion (8.5%), and deep wound infection (7.3%). Compared with patients who did not experience early or delayed complications, those who had these complications did not differ significantly with regard to age, sex, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, smoking status, history of previous spine surgery or spine fusion, or whether the 3CO performed was a PSO or VCR (p ≥ 0.06). Twenty-seven (33

  17. Historical overview of spinal deformities in ancient Greece

    PubMed Central

    Vasiliadis, Elias S; Grivas, Theodoros B; Kaspiris, Angelos

    2009-01-01

    Little is known about the history of spinal deformities in ancient Greece. The present study summarizes what we know today for diagnosis and management of spinal deformities in ancient Greece, mainly from the medical treatises of Hippocrates and Galen. Hippocrates, through accurate observation and logical reasoning was led to accurate conclusions firstly for the structure of the spine and secondly for its diseases. He introduced the terms kyphosis and scoliosis and wrote in depth about diagnosis and treatment of kyphosis and less about scoliosis. The innovation of the board, the application of axial traction and even the principle of trans-abdominal correction for correction of spinal deformities have their origin in Hippocrates. Galen, who lived nearly five centuries later impressively described scoliosis, lordosis and kyphosis, provided aetiologic implications and used the same principles with Hippocrates for their management, while his studies influenced medical practice on spinal deformities for more than 1500 years. PMID:19243609

  18. Historical overview of spinal deformities in ancient Greece.

    PubMed

    Vasiliadis, Elias S; Grivas, Theodoros B; Kaspiris, Angelos

    2009-02-25

    Little is known about the history of spinal deformities in ancient Greece. The present study summarizes what we know today for diagnosis and management of spinal deformities in ancient Greece, mainly from the medical treatises of Hippocrates and Galen. Hippocrates, through accurate observation and logical reasoning was led to accurate conclusions firstly for the structure of the spine and secondly for its diseases. He introduced the terms kyphosis and scoliosis and wrote in depth about diagnosis and treatment of kyphosis and less about scoliosis. The innovation of the board, the application of axial traction and even the principle of trans-abdominal correction for correction of spinal deformities have their origin in Hippocrates. Galen, who lived nearly five centuries later impressively described scoliosis, lordosis and kyphosis, provided aetiologic implications and used the same principles with Hippocrates for their management, while his studies influenced medical practice on spinal deformities for more than 1500 years.

  19. In-vivo spinal cord deformation in flexion

    NASA Astrophysics Data System (ADS)

    Yuan, Qing; Dougherty, Lawrence; Margulies, Susan S.

    1997-05-01

    Traumatic mechanical loading of the head-neck complex results cervical spinal cord injury when the distortion of the cord is sufficient to produce functional or structural failure of the cord's neural and/or vascular components. Characterizing cervical spinal cord deformation during physiological loading conditions is an important step to defining a comprehensive injury threshold associated with acute spinal cord injury. In this study, in vivo quasi- static deformation of the cervical spinal cord during flexion of the neck in human volunteers was measured using magnetic resonance (MR) imaging of motion with spatial modulation of magnetization (SPAMM). A custom-designed device was built to guide the motion of the neck and enhance more reproducibility. the SPAMM pulse sequence labeled the tissue with a series of parallel tagging lines. A single- shot gradient-recalled-echo sequence was used to acquire the mid-sagittal image of the cervical spine. A comparison of the tagged line pattern in each MR reference and deformed image pair revealed the distortion of the spinal cord. The results showed the cervical spinal cord elongates during head flexion. The elongation experienced by the spinal cord varies linearly with head flexion, with the posterior surface of the cord stretching more than the anterior surface. The maximal elongation of the cord is about 12 percent of its original length.

  20. Mini-open pedicle subtraction osteotomy as a treatment for severe adult spinal deformities: case series with initial clinical and radiographic outcomes.

    PubMed

    Wang, Michael Y; Bordon, Gerd

    2016-05-01

    lumbar Cobb angle improved from a mean of 41.2° ± 18.4° to 15.4° ± 9.6°, and lumbar lordosis improved from 23.1° ± 15.9° to 48.6° ± 11.7°. Pelvic tilt improved from a mean of 33.7° ± 8.6° to 24.4° ± 6.5°, and the sagittal vertical axis improved from 102.4 ± 73.4 mm to 42.2 ± 39.9 mm. The final lumbar lordosis-pelvic incidence difference averaged 8.4° ± 12.1°. There were 4 patients who failed to achieve less than or equal to a 10° mismatch on this parameter. Ten of the 16 patients underwent delayed postoperative CT, and 8 of these had developed a solid arthrodesis at all levels treated. A total of 6 complications occurred in this series. There were no cases of symptomatic proximal junction kyphosis. CONCLUSIONS Advancements in minimally invasive technique have resulted in the ability to manage increasingly complex deformities with hybrid approaches. In this limited series, the authors describe the results of utilizing a tissue-sparing mini-open PSO to correct severe spinal deformities. This method was technically feasible in all cases with acceptable radiographic outcomes similar to open surgery. However, high complication rates associated with these deformity corrections remain problematic.

  1. Spinal dysraphism and cavovarus foot deformity: a case report

    PubMed Central

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

    1992-01-01

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

  2. Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction.

    PubMed

    Scheer, Justin K; Smith, Justin S; Clark, Aaron J; Lafage, Virginie; Kim, Han Jo; Rolston, John D; Eastlack, Robert; Hart, Robert A; Protopsaltis, Themistocles S; Kelly, Michael P; Kebaish, Khaled; Gupta, Munish; Klineberg, Eric; Hostin, Richard; Shaffrey, Christopher I; Schwab, Frank; Ames, Christopher P

    2015-05-01

    OBJECT Back and leg pain are the primary outcomes of adult spinal deformity (ASD) and predict patients' seeking of surgical management. The authors sought to characterize changes in back and leg pain after operative or nonoperative management of ASD. Outcomes were assessed according to pain severity, type of surgical procedure, Scoliosis Research Society (SRS)-Schwab spine deformity class, and patient satisfaction. METHODS This study retrospectively reviewed data in a prospective multicenter database of ASD patients. Inclusion criteria were the following: age > 18 years and presence of spinal deformity as defined by a scoliosis Cobb angle ≥ 20°, sagittal vertical axis length ≥ 5 cm, pelvic tilt angle ≥ 25°, or thoracic kyphosis angle ≥ 60°. Patients were grouped into nonoperated and operated subcohorts and by the type of surgical procedure, spine SRS-Schwab deformity class, preoperative pain severity, and patient satisfaction. Numerical rating scale (NRS) scores of back and leg pain, Oswestry Disability Index (ODI) scores, physical component summary (PCS) scores of the 36-Item Short Form Health Survey, minimum clinically important differences (MCIDs), and substantial clinical benefits (SCBs) were assessed. RESULTS Patients in whom ASD had been operatively managed were 6 times more likely to have an improvement in back pain and 3 times more likely to have an improvement in leg pain than patients in whom ASD had been nonoperatively managed. Patients whose ASD had been managed nonoperatively were more likely to have their back or leg pain remain the same or worsen. The incidence of postoperative leg pain was 37.0% at 6 weeks postoperatively and 33.3% at the 2-year follow-up (FU). At the 2-year FU, among patients with any preoperative back or leg pain, 24.3% and 37.8% were free of back and leg pain, respectively, and among patients with severe (NRS scores of 7-10) preoperative back or leg pain, 21.0% and 32.8% were free of back and leg pain, respectively

  3. Craniofacial features of children with spinal deformities

    PubMed Central

    Segatto, Emil; Lippold, Carsten; Végh, András

    2008-01-01

    Background The objective of this epidemiological study is to map the dentofacial anomalies that can be correlated to the two most frequent spinal diseases responsible for postural abnormalities and that can be clinically identified by the orthodontic examination. Methods Twenty-three children with Scheuermann's disease participated in the study (mean age: 14Y8M; SD: 1Y8M), 28 with Scoliosis (mean age: 14Y7M; SD: 2Y3M) and a control group of 68 orthopedically healthy children (mean age: 14Y8M; SD: 0Y11M). Standardized orthodontic screening protocols were used to map the occlusal relations in the sagittal, vertical, and transversal dimensions, space relations of the maxillary and mandibular frontal segment, and the TMJ status and function. The examinations for the children with orthopedic disorders were supplemented by the evaluation of routine orthodontic radiograms – lateral cephalograms and panoramic X-rays. Results The majority of the dentofacial features examined revealed more and greater abnormalities among patients in the Scheuermann's disease group than in the scoliosis group. In the latter group the proportion of the TMJ symptoms and the consecutive functional deviations were greater. When comparing the values of the two spinal-disorder groups and the control group, statistically significant differences (p < .05) occurred for the following measurements: frequency of unilateral Cl.II. molar occlusion, overjet and extreme overjet mean value (Scheuermann's disease group), as well as the frequency of TMJ pathological symptoms (scoliosis group). The evaluation of the panoramic X-rays showed significant differences among the mandibular measurements of the two spinal-disorder groups. Within the framework of the evaluation of the cephalograms significant differences (p < .05) were found only in the case of dental relations. However, several values differed significantly from the Ricketts' norms, none of the indices strictly characterized any of the groups with

  4. Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

    PubMed Central

    Choi, Ho Yong; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2017-01-01

    Objective Spinal deformity surgery has the potential risk of massive blood loss. To reduce surgical bleeding, the use of tranexamic acid (TXA) became popular in spinal surgery, recently. The purpose of this study was to determine the effectiveness of intra-operative TXA use to reduce surgical bleeding and transfusion requirements in spinal deformity surgery. Methods A total of 132 consecutive patients undergoing multi-level posterior spinal segmental instrumented fusion (≥5 levels) were analyzed retrospectively. Primary outcome measures included intraoperative estimated blood loss (EBL), transfusion amount and rate of transfusion. Secondary outcome measures included postoperative transfusion amount, rate of transfusion, and complications associated with TXA or allogeneic blood transfusions. Results The number of patients was 89 in TXA group and 43 in non-TXA group. There were no significant differences in demographic or surgical traits between the groups except hypertension. The EBL was significantly lower in TXA group than non-TXA group (841 vs. 1336 mL, p=0.002). TXA group also showed less intra-operative and postoperative transfusion requirements (544 vs. 812 mL, p=0.012; 193 vs. 359 mL, p=0.034). Based on multiple regression analysis, TXA use could reduce surgical bleeding by 371 mL (37 % of mean EBL). Complication rate was not different between the groups. Conclusion TXA use can effectively reduce the amount of intra-operative bleeding and transfusion requirements in spinal deformity surgery. Future randomized controlled study could confirm the routine use of TXA in major spinal surgery. PMID:28061495

  5. Genetics Underlying an Individualized Approach to Adult Spinal Disorders

    PubMed Central

    Walker, Corey T.; Bonney, Phillip A.; Martirosyan, Nikolay L.; Theodore, Nicholas

    2016-01-01

    Adult spinal disorders are a significant cause of morbidity across the world and carry significant health and economic burdens. Genetic predispositions are increasingly considered for these conditions and are becoming understood. Advances in molecular technologies since the mid-1990s have made possible genetic characterizations of these diseases in many populations, and recent findings have provided insight into the underlying pathophysiologic mechanisms. These studies have made clear the genetic heterogeneity producing clinical phenotypes and suggest that individualized treatments are possible in the future. We review the genetics and heritability of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament and perform a systematic review of the genetics of adult lumbar degenerative scoliotic deformity, highlighting recent discoveries and the potential for personalized future therapeutics for these patients. PMID:27921035

  6. Corticosteroid Treatment Impact on Spinal Deformity in Duchenne Muscular Dystrophy

    PubMed Central

    Sanzarello, Ilaria; Merlini, Luciano; Traina, Francesco; Rosa, Michele Attilio; Faldini, Cesare

    2014-01-01

    Duchenne muscular dystrophy is a progressive disease with loss of ambulation at around 9-10 years of age, followed, if untreated, by development of scoliosis, respiratory insufficiency, and death in the second decade of life. This review highlights the natural history of the disease, in particular, with regard to the development of the spinal deformity and how this complication has been modified by surgical interventions and overall by corticosteroid treatment. The beneficial effect of corticosteroids may have also an impact on the clinical trial design of the new emerging causative therapies. PMID:27382620

  7. [Calculation of the strain-deformation condition of the spinal motor segment during loading].

    PubMed

    Chumachenko, E N; Logashina, I V

    2014-01-01

    A mathematical model is proposed to analyze the spinal strain-deformation condition resulting from axial and lateral g-loads generated by changes in the gravity field and/or pilot's maneuvering high-performance aircraft. The solution algorithm takes into account changes in the intervertebral disk pressure and the fibrous ring shape at the time of close-to-critical g values. Calculation of the spinal strain-deformation condition was implemented by the instrumentality of computer system SPLEN (KOMMEK ltd., Russia). Analysis of the spinal strain-deformation condition was made for 2 types of external loads, i.e. normal and unilateral with a bending moment. Maximum permissible loads on a spinal segment were evaluated, as well as distribution of strain intensity, mean strains, spinal deformation and destruction field was described. The constructed computer models could be used as a basis for developing a technique of predicting characteristic spinal injuries in consequence of specific extreme loads and pathologies.

  8. In Vivo Measurement of Cervical Spinal Cord Deformation During Traumatic Spinal Cord Injury in a Rodent Model.

    PubMed

    Bhatnagar, Tim; Liu, Jie; Yung, Andrew; Cripton, Peter A; Kozlowski, Piotr; Oxland, Thomas

    2016-04-01

    The spinal cord undergoes physical deformation during traumatic spinal cord injury (TSCI), which results in biological damage. This study demonstrates a novel approach, using magnetic resonance imaging and image registration techniques, to quantify the three-dimensional deformation of the cervical spinal cord in an in vivo rat model. Twenty-four male rats were subjected to one of two clinically relevant mechanisms of TSCI (i.e. contusion and dislocation) inside of a MR scanner using a novel apparatus, enabling imaging of the deformed spinal cords. The displacement fields demonstrated qualitative differences between injury mechanisms. Three-dimensional Lagrangian strain fields were calculated, and the results from the contusion injury mechanism were deemed most reliable. Strain field error was assessed using a Monte Carlo approach, which showed that simulated normal strain error experienced a bias, whereas shear strain error did not. In contusion injury, a large region of dorso-ventral compressive strain was observed under the impactor which extended into the ventral region of the spinal cord. High tensile lateral strains under the impactor and compressive lateral strains in the lateral white matter were also observed in contusion. The ability to directly observe and quantify in vivo spinal cord deformation informs our knowledge of the mechanics of TSCI.

  9. Complications after spinal anesthesia in adult tethered cord syndrome

    PubMed Central

    Liu, Jing-Jie; Guan, Zheng; Gao, Zhen; Xiang, Li; Zhao, Feng; Huang, Sheng-Li

    2016-01-01

    Abstract Since little has been reported about complications of spinal anesthesia in adult tethered cord syndrome (TCS), we sought to delineate the characteristics of the condition. A total of 4 cases of adult TCS after spinal anesthesia were reviewed. The medical charts of the patients were obtained. Anesthesia, which was combined spinal and epidural anesthesia or spinal anesthesia was performed, and follow-up were carried out in all patients. The most common neurological symptom of adult TCS before surgery was occasional severe pain in back, perineal region, or legs. Frequent micturition, diminished knee and ankle reflexes, and difficulty in bending were exhibited in partial patients. Paraesthesia of perineal region or/and lower extremities existed 2 to 3 days after spinal anesthesia in all the cases. Weakness of lower extremities existed in 1 case. Lumbar magnetic resonance imaging showed the low location of conus medullaris. At follow-up, 3 cases recovered completely within 3 weeks, and 1 case underwent permanent disability. These cases suggest anesthesiologists and surgeons alert to the association of adult TCS and spinal anesthesia. Spinal anesthesia should be prohibited in patients with adult TCS to prevent neurological damages. PMID:27442670

  10. Spinal pedicle screw planning using deformable atlas registration

    NASA Astrophysics Data System (ADS)

    Goerres, J.; Uneri, A.; De Silva, T.; Ketcha, M.; Reaungamornrat, S.; Jacobson, M.; Vogt, S.; Kleinszig, G.; Osgood, G.; Wolinsky, J.-P.; Siewerdsen, J. H.

    2017-04-01

    Spinal screw placement is a challenging task due to small bone corridors and high risk of neurological or vascular complications, benefiting from precision guidance/navigation and quality assurance (QA). Implicit to both guidance and QA is the definition of a surgical plan—i.e. the desired trajectories and device selection for target vertebrae—conventionally requiring time-consuming manual annotations by a skilled surgeon. We propose automation of such planning by deriving the pedicle trajectory and device selection from a patient’s preoperative CT or MRI. An atlas of vertebrae surfaces was created to provide the underlying basis for automatic planning—in this work, comprising 40 exemplary vertebrae at three levels of the spine (T7, T8, and L3). The atlas was enriched with ideal trajectory annotations for 60 pedicles in total. To define trajectories for a given patient, sparse deformation fields from the atlas surfaces to the input (CT or MR image) are applied on the annotated trajectories. Mean value coordinates are used to interpolate dense deformation fields. The pose of a straight trajectory is optimized by image-based registration to an accumulated volume of the deformed annotations. For evaluation, input deformation fields were created using coherent point drift (CPD) to perform a leave-one-out analysis over the atlas surfaces. CPD registration demonstrated surface error of 0.89  ±  0.10 mm (median  ±  interquartile range) for T7/T8 and 1.29  ±  0.15 mm for L3. At the pedicle center, registered trajectories deviated from the expert reference by 0.56  ±  0.63 mm (T7/T8) and 1.12  ±  0.67 mm (L3). The predicted maximum screw diameter differed by 0.45  ±  0.62 mm (T7/T8), and 1.26  ±  1.19 mm (L3). The automated planning method avoided screw collisions in all cases and demonstrated close agreement overall with expert reference plans, offering a potentially valuable tool in support

  11. Endogenous neurogenesis in adult mammals after spinal cord injury.

    PubMed

    Duan, Hongmei; Song, Wei; Zhao, Wen; Gao, Yudan; Yang, Zhaoyang; Li, Xiaoguang

    2016-12-01

    During the whole life cycle of mammals, new neurons are constantly regenerated in the subgranular zone of the dentate gyrus and in the subventricular zone of the lateral ventricles. Thanks to emerging methodologies, great progress has been made in the characterization of spinal cord endogenous neural stem cells (ependymal cells) and identification of their role in adult spinal cord development. As recently evidenced, both the intrinsic and extrinsic molecular mechanisms of ependymal cells control the sequential steps of the adult spinal cord neurogenesis. This review introduces the concept of adult endogenous neurogenesis, the reaction of ependymal cells after adult spinal cord injury (SCI), the heterogeneity and markers of ependymal cells, the factors that regulate ependymal cells, and the niches that impact the activation or differentiation of ependymal cells.

  12. Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients

    PubMed Central

    Sutter, Martin A.; Grob, Dieter; Jeszenszky, Dezsö; Dvorak, Jiri

    2007-01-01

    A prospective study was performed on 217 patients who received MIOM during corrective surgery of spinal deformities between March 2000 and December 2005. Aim is to determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during corrective spine surgery. MIOM is becoming an increasingly used method of monitoring function during corrective spine surgery. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information regarding any neurological deficits during the operation. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 217 consecutive patients with spinal deformities of different aetiologies were monitored by means of MIOM during the surgical procedure. Out of which 201 patients presented true negative findings while one patient presented false negative and three patients presented false positive findings. Twelve patients presented true positive findings where neurological deficit after the operation was predicted. All neurological deficits in those 12 patients recovered completely. The sensitivity of MIOM applied during surgery of spinal deformities has been calculated of 92.3% and the specificity 98.5%. Based upon the results of this study MIOM is an effective method of monitoring the spinal cord and nerve root function during corrective surgery of spinal deformities and consequently improves postoperative results. The Wake-up test for surgical procedure of spinal deformities became obsolete in our institution. PMID:17632737

  13. The 100 most cited papers in spinal deformity surgery: a bibliometric analysis.

    PubMed

    O'Neill, Shane C; Butler, Joseph S; McGoldrick, Niall; O'Leary, Robert; Synnott, Keith

    2014-10-27

    Spinal deformity is a condition that has been recognized for many millennia. There have been major advances in the treatment of spinal deformity in recent years and studies outlining new ideas can inspire others to further advance the speciality. The number of citations a paper receives may indicate the influence of that paper. It is therefore important that we evaluate and analyze the most cited works in our field. The aim of this study is to identify the 100 most cited papers relevant to spinal deformity surgery in the literature. A search through the Thomson Reuters Web of Science™ for citations related to spinal deformity surgery was performed. The number of citations, mean citation number (total number citations/years since publication), journal, authors, year of publication and country of origin of the top 100 papers was recorded. The top 100 papers were cited a combined 17,646 times, ranging from 453 to 112. The majority of papers originated from the United States (71) and were published in 20 different journals. The decade 1990-1999 was the most prolific, with 36 of the 100 papers published during this time. Papers pertaining to the management of scoliosis (49) were the most common. This study identifies the top 100 most cited papers in the field of spinal deformity surgery. While citation is not a specific marker of the scientific quality of a paper, it is a surrogate for the influence a paper has had on the orthopedic community. This list of papers provides an invaluable resource for both those in training and those actively practicing and involved in the further development of spinal deformity surgery.

  14. Modern induced skull deformity in adults.

    PubMed

    Gump, William

    2010-12-01

    The practice of induced skull deformity has long existed in numerous disparate cultures, but for the first time in history it can be applied to adults. While extremely limited in application, some ideas have persisted in the far fringes of modern Western culture with remarkable tenacity. Practitioners of extreme body modification undergo procedures, outside the sphere of traditional medical practice, to make striking, permanent, nontraditional esthetic tissue distortions with the goal of transgressing societal norms. The International Trepanation Advocacy Group represents another example of a fringe cultural movement, whose goal, rather than being purely aesthetic in nature, is to promote elective trepanation as a method for achieving a heightened level of consciousness. Both movements have relatively short and well-defined histories. Despite their tiny numbers of adherents, neurosurgeons may be called on to address relevant patient concerns preprocedurally, or complications postprocedurally, and would benefit from awareness of these peculiar subcultures.

  15. The results of preoperative halo-gravity traction in children with severe spinal deformity.

    PubMed

    Garabekyan, Tigran; Hosseinzadeh, Pooya; Iwinski, Henry J; Muchow, Ryan D; Talwalkar, Vishwas R; Walker, Janet; Milbrandt, Todd A

    2014-01-01

    Halo-gravity traction has been used preoperatively for patients with severe spinal deformity but there are limited data in the literature on the results and complications. We studied the outcomes of perioperative halo-gravity traction in children with severe spinal deformity. A retrospective study was carried out on patients who were treated at our center. Twenty-one patients were included in the study. Radiographic and pulmonary function parameters showed significant improvement during the course of traction and at the final follow-up. The overall complication rate was 19%, including two patients with pin loosening and two patients with superficial pin-site infections treated with oral antibiotics.

  16. Automatic 3D segmentation of spinal cord MRI using propagated deformable models

    NASA Astrophysics Data System (ADS)

    De Leener, B.; Cohen-Adad, J.; Kadoury, S.

    2014-03-01

    Spinal cord diseases or injuries can cause dysfunction of the sensory and locomotor systems. Segmentation of the spinal cord provides measures of atrophy and allows group analysis of multi-parametric MRI via inter-subject registration to a template. All these measures were shown to improve diagnostic and surgical intervention. We developed a framework to automatically segment the spinal cord on T2-weighted MR images, based on the propagation of a deformable model. The algorithm is divided into three parts: first, an initialization step detects the spinal cord position and orientation by using the elliptical Hough transform on multiple adjacent axial slices to produce an initial tubular mesh. Second, a low-resolution deformable model is iteratively propagated along the spinal cord. To deal with highly variable contrast levels between the spinal cord and the cerebrospinal fluid, the deformation is coupled with a contrast adaptation at each iteration. Third, a refinement process and a global deformation are applied on the low-resolution mesh to provide an accurate segmentation of the spinal cord. Our method was evaluated against a semi-automatic edge-based snake method implemented in ITK-SNAP (with heavy manual adjustment) by computing the 3D Dice coefficient, mean and maximum distance errors. Accuracy and robustness were assessed from 8 healthy subjects. Each subject had two volumes: one at the cervical and one at the thoracolumbar region. Results show a precision of 0.30 +/- 0.05 mm (mean absolute distance error) in the cervical region and 0.27 +/- 0.06 mm in the thoracolumbar region. The 3D Dice coefficient was of 0.93 for both regions.

  17. Effect of unilateral exercise on spinal and pelvic deformities, and isokinetic trunk muscle strength.

    PubMed

    Jeon, Kyoungkyu; Kim, Soonyoung

    2016-03-01

    [Purpose] The purpose of this study was to collect basic data regarding the prevention of spinal and pelvic deformities by investigating the spinal shape and muscular function characteristics of imbalance reduction and functional improvement following asymmetric activities. [Subjects and Methods] The subjects were 14 archery athletes who mostly perform unilateral motion with spinal and pelvic pain, and 19 healthy subjects. All the participants were evaluated using spinal structure analysis and for 60°/sec isokinetic muscular strength of the trunk. [Results] Between the two groups, there were significant differences in the interaction effect of trunk inclination deformities, and flexor and extensor 60°/sec isokinetic muscular strength of the trunk. Also, the main effects of gender comparison showed significant differences in the trunk inclination deformities, pelvic rotation deformities, lordosis angles, and flexor and extensor 60 ˚/sec isokinetic muscular strengths of the trunk. [Conclusion] The basic data obtained in this study can be used to help develop a strategic exercise program for improving unilateral movement and malalignment of the spine and pelvis.

  18. Effect of unilateral exercise on spinal and pelvic deformities, and isokinetic trunk muscle strength

    PubMed Central

    Jeon, Kyoungkyu; Kim, Soonyoung

    2016-01-01

    [Purpose] The purpose of this study was to collect basic data regarding the prevention of spinal and pelvic deformities by investigating the spinal shape and muscular function characteristics of imbalance reduction and functional improvement following asymmetric activities. [Subjects and Methods] The subjects were 14 archery athletes who mostly perform unilateral motion with spinal and pelvic pain, and 19 healthy subjects. All the participants were evaluated using spinal structure analysis and for 60°/sec isokinetic muscular strength of the trunk. [Results] Between the two groups, there were significant differences in the interaction effect of trunk inclination deformities, and flexor and extensor 60°/sec isokinetic muscular strength of the trunk. Also, the main effects of gender comparison showed significant differences in the trunk inclination deformities, pelvic rotation deformities, lordosis angles, and flexor and extensor 60 ˚/sec isokinetic muscular strengths of the trunk. [Conclusion] The basic data obtained in this study can be used to help develop a strategic exercise program for improving unilateral movement and malalignment of the spine and pelvis. PMID:27134369

  19. [Scoliotic spinal deformity in pilot personnel from aviation physical examination's point of view].

    PubMed

    Churilov, Iu K; Moiseev, Iu B; Imenovskiĭ, I É; Radchenko, S N

    2013-11-01

    According to results of performed examinations scoliotic spinal deformity in flight personnel has a low impact on professional health. This is proved by: oligosymptomatic course of disease - lack of complaints of pain, moderate pain, which is revealed only in case of loading tests and palpation; preservation of supporting and movement spinal function; lack of worsening of deformity during the flight service. At the same time in flight personnel suffering from scoliosis was registered a low tolerance to ergometri; robe, which point to insufficient muscle reserve of lower extremities, abdominals and dorsum. This insufficient may have an adverse effect on G-tolerance of pilots serving in maneuvering aviation. According to this fact authors came to conclusion that first-degree scoliotic deformity is of importance for expert examination of pilots of high-performance aircraft. Scoliotic deformity in pilots of other branches of aviation is of importance only in case of clinical implications (pain syndrome, restraint of movement). From there, it is not necessary to make a record in regulatory documents of flight medical board about functional-compensatory spinal deformity (first- and second degree scoliosis) in flight personnel, except flight personnel of high-performance aircraft.

  20. Expression of Lymphatic Markers in the Adult Rat Spinal Cord

    PubMed Central

    Kaser-Eichberger, Alexandra; Schroedl, Falk; Bieler, Lara; Trost, Andrea; Bogner, Barbara; Runge, Christian; Tempfer, Herbert; Zaunmair, Pia; Kreutzer, Christina; Traweger, Andreas; Reitsamer, Herbert A.; Couillard-Despres, Sebastien

    2016-01-01

    Under physiological conditions, lymphatic vessels are thought to be absent from the central nervous system (CNS), although they are widely distributed within the rest of the body. Recent work in the eye, i.e., another organ regarded as alymphatic, revealed numerous cells expressing lymphatic markers. As the latter can be involved in the response to pathological conditions, we addressed the presence of cells expressing lymphatic markers within the spinal cord by immunohistochemistry. Spinal cord of young adult Fisher rats was scrutinized for the co-expression of the lymphatic markers PROX1 and LYVE-1 with the cell type markers Iba1, CD68, PGP9.5, OLIG2. Rat skin served as positive control for the lymphatic markers. PROX1-immunoreactivity was detected in many nuclei throughout the spinal cord white and gray matter. These nuclei showed no association with LYVE-1. Expression of LYVE-1 could only be detected in cells at the spinal cord surface and in cells closely associated with blood vessels. These cells were found to co-express Iba1, a macrophage and microglia marker. Further, double labeling experiments using CD68, another marker found in microglia and macrophages, also displayed co-localization in the Iba1+ cells located at the spinal cord surface and those apposed to blood vessels. On the other hand, PROX1-expressing cells found in the parenchyma were lacking Iba1 or PGP9.5, but a significant fraction of those cells showed co-expression of the oligodendrocyte lineage marker OLIG2. Intriguingly, following spinal cord injury, LYVE-1-expressing cells assembled and reorganized into putative pre-vessel structures. As expected, the rat skin used as positive controls revealed classical lymphatic vessels, displaying PROX1+ nuclei surrounded by LYVE-1-immunoreactivity. Classical lymphatics were not detected in adult rat spinal cord. Nevertheless, numerous cells expressing either LYVE-1 or PROX1 were identified. Based on their localization and overlapping expression with

  1. Expression of Lymphatic Markers in the Adult Rat Spinal Cord.

    PubMed

    Kaser-Eichberger, Alexandra; Schroedl, Falk; Bieler, Lara; Trost, Andrea; Bogner, Barbara; Runge, Christian; Tempfer, Herbert; Zaunmair, Pia; Kreutzer, Christina; Traweger, Andreas; Reitsamer, Herbert A; Couillard-Despres, Sebastien

    2016-01-01

    Under physiological conditions, lymphatic vessels are thought to be absent from the central nervous system (CNS), although they are widely distributed within the rest of the body. Recent work in the eye, i.e., another organ regarded as alymphatic, revealed numerous cells expressing lymphatic markers. As the latter can be involved in the response to pathological conditions, we addressed the presence of cells expressing lymphatic markers within the spinal cord by immunohistochemistry. Spinal cord of young adult Fisher rats was scrutinized for the co-expression of the lymphatic markers PROX1 and LYVE-1 with the cell type markers Iba1, CD68, PGP9.5, OLIG2. Rat skin served as positive control for the lymphatic markers. PROX1-immunoreactivity was detected in many nuclei throughout the spinal cord white and gray matter. These nuclei showed no association with LYVE-1. Expression of LYVE-1 could only be detected in cells at the spinal cord surface and in cells closely associated with blood vessels. These cells were found to co-express Iba1, a macrophage and microglia marker. Further, double labeling experiments using CD68, another marker found in microglia and macrophages, also displayed co-localization in the Iba1+ cells located at the spinal cord surface and those apposed to blood vessels. On the other hand, PROX1-expressing cells found in the parenchyma were lacking Iba1 or PGP9.5, but a significant fraction of those cells showed co-expression of the oligodendrocyte lineage marker OLIG2. Intriguingly, following spinal cord injury, LYVE-1-expressing cells assembled and reorganized into putative pre-vessel structures. As expected, the rat skin used as positive controls revealed classical lymphatic vessels, displaying PROX1+ nuclei surrounded by LYVE-1-immunoreactivity. Classical lymphatics were not detected in adult rat spinal cord. Nevertheless, numerous cells expressing either LYVE-1 or PROX1 were identified. Based on their localization and overlapping expression with

  2. Use of vacuum assisted closure in instrumented spinal deformities for children with postoperative deep infections

    PubMed Central

    Canavese, Federico; Krajbich, Joseph I

    2010-01-01

    Background: Postoperative deep infections are relatively common in children with instrumented spinal deformities, whose healing potential is somewhat compromised. Children with underlying diagnosis of cerebral palsy, spina bifida and other chronic debilitating conditions are particularly susceptible. Vacuum-assisted closure (VAC) is a newer technique to promote healing of wounds resistant to treatment by established methods. This article aims to review the efficacy of the VAC system in the treatment of deep spinal infections following spinal instrumentation and fusion in children and adolescents. Materials and Methods: We reviewed 33 patients with deep postoperative surgical site infection treated with wound VAC technique. We reviewed clinical and laboratory data, including the ability to retain the spinal hardware, loss of correction and recurrent infections. Results: All patients successfully completed their wound VAC treatment regime. None had significant loss of correction and one had persistent infection requiring partial hardware removal. The laboratory indices normalized in all but three patients. Conclusions: Wound VAC technique is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for retention of the instrumentation and maintenance of the spinal correction. It is reliable and easy to use. PMID:20419005

  3. Wnt/β-catenin signaling promotes regeneration after adult zebrafish spinal cord injury.

    PubMed

    Strand, Nicholas S; Hoi, Kimberly K; Phan, Tien M T; Ray, Catherine A; Berndt, Jason D; Moon, Randall T

    2016-09-02

    Unlike mammals, zebrafish can regenerate their injured spinal cord and regain control of caudal tissues. It was recently shown that Wnt/β-catenin signaling is necessary for spinal cord regeneration in the larval zebrafish. However, the molecular mechanisms of regeneration may or may not be conserved between larval and adult zebrafish. To test this, we assessed the role of Wnt/β-catenin signaling after spinal cord injury in the adult zebrafish. We show that Wnt/β-catenin signaling is increased after spinal cord injury in the adult zebrafish. Moreover, overexpression of Dkk1b inhibited Wnt/β-catenin signaling in the regenerating spinal cord of adult zebrafish. Dkk1b overexpression also inhibited locomotor recovery, axon regeneration, and glial bridge formation in the injured spinal cord. Thus, our data illustrate a conserved role for Wnt/β-catenin signaling in adult and larval zebrafish spinal cord regeneration.

  4. Posterior Vertebral Column Resection for VATER/VACTERL Associated Spinal Deformity: A Case Report

    PubMed Central

    Cunningham, Matthew E.; Charles, Gina

    2006-01-01

    The VATER/VACTERL association is a syndrome notable for congenital vertebral malformations, anal atresia, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, and renal or limb malformations. Vertebral malformations may include the entire spectrum of congenital spinal deformities, including kyphosis, as was seen in this case. A 14-year-old girl presented to our institution with severe rigid sagittal deformity in the thoracolumbar spine that had recurred following three prior spinal fusion surgeries: the first posterior only, the second anterior and posterior, and the third a posterior only proximal extension. These surgeries were performed to control progressive kyphosis from a complex failure of segmentation that resulted in a 66° kyphosis from T11 to L3 by the time she was 9 years old. Our evaluation revealed solid arthrodesis from the most recent procedures with resultant sagittal imbalance, and surgical options to restore balance included anterior and posterior revision spinal fusion with osteotomies, multiple posterior extension osteotomies with circumferential spine fusion, and posterior vertebral column resection with circumferential spine fusion. She was advised that multiple posterior extension osteotomies would likely be insufficient to restore sagittal balance in the setting of solid arthrodesis from anterior and posterior surgery, and that the posterior-only vertebral column resection would provide results equivalent to revision anterior and posterior surgery, without the morbidity of the anterior approach. She successfully underwent posterior vertebrectomy and circumferential spinal fusion with instrumentation and is doing well 2 years postoperatively. Severe rigid sagittal deformity can be effectively managed with a posterior-only surgical approach, vertebrectomy, and circumferential spinal fusion with instrumentation. PMID:18751773

  5. Pulmonary function in patients with hereditary motor and sensory neuropathy: a comparison of patients with and without spinal deformity.

    PubMed

    Horacek, Ondrej; Chlumsky, Jan; Mazanec, Radim; Kolar, Pavel; Andel, Ross; Kobesova, Alena

    2012-12-01

    We assessed pulmonary function in hereditary motor and sensory neuropathy. Fourteen neuropathy patients without spinal deformity (group 1), 14 with spinal deformity (group 2), and 16 individuals with idiopathic spinal deformity (group 3) matched to group 2 for age, height and Cobb angle, were included. Hereditary motor and sensory neuropathy severity was measured with Charcot-Marie-Tooth Neuropathy Score. All participants exhibited mild decrease in maximal inspiratory pressure at the mouth. One-way analysis of variance yielded significant main effects for lung volumes - slow vital capacity, forced expiratory volume in 1s, and total lung capacity (p's<.01), attributable to greater volumes in group 1 compared to groups with spinal deformity - and transfer factor for carbon monoxide (p=.013), reflecting differences between groups 1 vs. 2. Slow vital capacity and total lung capacity correlated with maximal inspiratory pressure at the mouth in group 2, whereas slow vital capacity correlated with muscle work in group 3 (p's<.05). Decreased lung volume may be due to impaired respiratory muscle strength in hereditary motor and sensory neuropathy with spinal deformity and due to spinal deformity in idiopathic patients.

  6. Treatment of Combined Spinal Deformity in Patient with Ollier Disease and Abnormal Vertebrae

    PubMed Central

    Ryabykh, S. О.; Gubin, A. V.; Prudnikova, О. G.; Kobyzev, А. Е.

    2012-01-01

    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

  7. Spinal deformity in a sandtiger shark, Carcharias taurus Rafinesque: a clinical-pathological study.

    PubMed

    Preziosi, R; Gridelli, S; Borghetti, P; Diana, A; Parmeggiani, A; Fioravanti, M L; Marcer, F; Bianchi, I; Walsh, M; Berzins, I

    2006-01-01

    The present study investigated spinal deformity in a captive sandtiger shark and describes the clinical and histopathological features of the lesion. Clinically, the shark presented a marked spinal curvature in the region between the pectoral girdle and cranial dorsal fin. Radiographic studies revealed scoliosis and kyphosis of the vertebral column with a modification of the basic structure of five vertebrae. Post-mortem examination confirmed the results of radiographic studies and histological examination showed remodelling and cartilaginous proliferation of the vertebral bodies together with necrosis, haemorrhage and signs of a local chronic inflammatory response extending to the surrounding muscle. Different aetiologies are proposed and discussed but nutritional imbalance (dietary vitamin deficiency) and/or traumatic injury are considered the most likely contributing factors.

  8. Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis

    PubMed Central

    Anwer, Shahnawaz; Alghadir, Ahmad; Abu Shaphe, Md.; Anwar, Dilshad

    2015-01-01

    Objectives. This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS). Data Sources. Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words “exercise,” “postural correction,” “posture,” “postural curve,” “Cobb's angle,” “quality of life,” and “spinal deformities,” combined with the Medical Subject Heading “scoliosis.” Study Selection. This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaboration's tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). Data Extraction. Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life. Data Synthesis. A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life. Conclusions. A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS. PMID:26583083

  9. Spinal deformities in a wild line of Poecilia wingei bred in captivity: report of cases and review of the literature

    PubMed Central

    Arbuatti, Alessio; Salda, Leonardo Della; Romanucci, Mariarita

    2013-01-01

    Objective To describe the occurrence of various spinal deformations in a captive-bred wild line of Poecilia wingei (P. wingei). Methods Fish belonging to a wild line of P. wingei caught from Laguna de Los Patos, Venezuela, were bred in an aquarium home-breeding system during a period of three years (2006-2009). The spinal curvature was observed to study spinal deformities in P. wingei. Results Out of a total of 600 fish, 22 showed different types of deformities (scoliosis, lordosis, kyphosis), with a higher incidence in females. Growth, swimming and breeding of deformed fish were generally normal. Conclusions Possible causes for spinal curvature in fish are discussed on the basis of the current literature. While it is not possible to determine the exact cause(s) of spinal deformities observed in the present study, traumatic injuries, nutritional imbalances, genetic defects or a combination of these factors can be supposed to be involved in the pathogenesis of such lesions. PMID:23620835

  10. Review of Advances in Cobb Angle Calculation and Image-Based Modelling Techniques for Spinal Deformities

    NASA Astrophysics Data System (ADS)

    Giannoglou, V.; Stylianidis, E.

    2016-06-01

    Scoliosis is a 3D deformity of the human spinal column that is caused from the bending of the latter, causing pain, aesthetic and respiratory problems. This internal deformation is reflected in the outer shape of the human back. The golden standard for diagnosis and monitoring of scoliosis is the Cobb angle, which refers to the internal curvature of the trunk. This work is the first part of a post-doctoral research, presenting the most important researches that have been done in the field of scoliosis, concerning its digital visualisation, in order to provide a more precise and robust identification and monitoring of scoliosis. The research is divided in four fields, namely, the X-ray processing, the automatic Cobb angle(s) calculation, the 3D modelling of the spine that provides a more accurate representation of the trunk and the reduction of X-ray radiation exposure throughout the monitoring of scoliosis. Despite the fact that many researchers have been working on the field for the last decade at least, there is no reliable and universal tool to automatically calculate the Cobb angle(s) and successfully perform proper 3D modelling of the spinal column that would assist a more accurate detection and monitoring of scoliosis.

  11. Changes in spinal alignment.

    PubMed

    Veintemillas Aráiz, M T; Beltrán Salazar, V P; Rivera Valladares, L; Marín Aznar, A; Melloni Ribas, P; Valls Pascual, R

    2016-04-01

    Spinal misalignments are a common reason for consultation at primary care centers and specialized departments. Misalignment has diverse causes and is influenced by multiple factors: in adolescence, the most frequent misalignment is scoliosis, which is idiopathic in 80% of cases and normally asymptomatic. In adults, the most common cause is degenerative. It is important to know the natural history and to detect factors that might predict progression. The correct diagnosis of spinal deformities requires specific imaging studies. The degree of deformity determines the type of treatment. The aim is to prevent progression of the deformity and to recover the flexibility and balance of the body.

  12. Identification of spinal deformity classification with total curvature analysis and artificial neural network.

    PubMed

    Lin, Hong

    2008-01-01

    In this paper, a multilayer feed-forward, back-propagation (MLFF/BP) artificial neural network (ANN) was implemented to identify the classification patterns of the scoliosis spinal deformity. At the first step, the simplified 3-D spine model was constructed based on the coronal and sagittal X-ray images. The features of the central axis curve of the spinal deformity patterns in 3-D space were extracted by the total curvature analysis. The discrete form of the total curvature, including the curvature and the torsion of the central axis of the simplified 3-D spine model was derived from the difference quotients. The total curvature values of 17 vertebrae from the first thoracic to the fifth lumbar spine formed a Euclidean space of 17 dimensions. The King classification model was tested on this MLFF/BP ANN identification system. The 17 total curvature values were presented to the input layer of MLFF/BP ANN. In the output layer there were five neurons representing five King classification types. A total of 37 spinal deformity patterns from scoliosis patients were selected. These 37 patterns were divided into two groups. The training group had 25 patterns and testing group had 12 patterns. The 25-pattern training group was further divided into five subsets. Based on the definition of King classification system, each subset contained all five King types. The network training was conducted on these five subsets by the hold-out method, one of cross-validation variants, and the early stop method. In each one of the five cross-validation sessions, four subsets were alternatively used for estimation learning and one subset left was used for validation learning. Final network testing was conducted with remaining 12 patterns in testing group after the MLFF/BP ANN was trained by all five subsets in training group. The performance of the neural network was evaluated by comparing between two network topologies, one with one hidden layer and another with two hidden layers. The

  13. Impact of post-manipulation corrective core exercises on the spinal deformation and lumbar strength in golfers: a case study

    PubMed Central

    Shin, Chul-ho; Kim, Minjeong; Park, Gi Duck

    2015-01-01

    [Purpose] This study examined spinal shape in professional golfers with chronic back pain, and analyzed the effects of a 4-week regimen of semi-weekly manipulation and corrective core exercises on spinal shape. [Subjects] Two golfers with chronic back pain. [Methods] The pelvis and spinal vertebrae were corrected using the Thompson “drop” technique. Angle and force were adjusted to place the pelvis, lumbar spine, and thoracic vertebrae in neutral position. The technique was applied twice weekly after muscle massage in the back and pelvic areas. The golfers performed corrective, warmup stretching exercises, followed by squats on an unstable surface using the Togu ball. They then used a gym ball for repetitions of hip rotation, upper trunk extension, sit-ups, and pelvic anterior-posterior, pelvic left-right, and trunk flexion-extension exercises. The session ended with cycling as a cool-down exercise. Each session lasted 60 minutes. [Results] The difference in height was measured on the left and right sides of the pelvic bone. The pelvic tilt changed significantly in both participants after the 4-week program. [Conclusion] In golfers, core muscles are critical and are closely related to spinal deformation. Core strengthening and spinal correction play a pivotal role in the correction of spinal deformation. PMID:26504350

  14. Impact of post-manipulation corrective core exercises on the spinal deformation and lumbar strength in golfers: a case study.

    PubMed

    Shin, Chul-Ho; Kim, Minjeong; Park, Gi Duck

    2015-09-01

    [Purpose] This study examined spinal shape in professional golfers with chronic back pain, and analyzed the effects of a 4-week regimen of semi-weekly manipulation and corrective core exercises on spinal shape. [Subjects] Two golfers with chronic back pain. [Methods] The pelvis and spinal vertebrae were corrected using the Thompson "drop" technique. Angle and force were adjusted to place the pelvis, lumbar spine, and thoracic vertebrae in neutral position. The technique was applied twice weekly after muscle massage in the back and pelvic areas. The golfers performed corrective, warmup stretching exercises, followed by squats on an unstable surface using the Togu ball. They then used a gym ball for repetitions of hip rotation, upper trunk extension, sit-ups, and pelvic anterior-posterior, pelvic left-right, and trunk flexion-extension exercises. The session ended with cycling as a cool-down exercise. Each session lasted 60 minutes. [Results] The difference in height was measured on the left and right sides of the pelvic bone. The pelvic tilt changed significantly in both participants after the 4-week program. [Conclusion] In golfers, core muscles are critical and are closely related to spinal deformation. Core strengthening and spinal correction play a pivotal role in the correction of spinal deformation.

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

    PubMed Central

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

    2015-01-01

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

  16. Dopamine from the brain promotes spinal motor neuron generation during development and adult regeneration.

    PubMed

    Reimer, Michell M; Norris, Anneliese; Ohnmacht, Jochen; Patani, Rickie; Zhong, Zhen; Dias, Tatyana B; Kuscha, Veronika; Scott, Angela L; Chen, Yu-Chia; Rozov, Stanislav; Frazer, Sarah L; Wyatt, Cameron; Higashijima, Shin-ichi; Patton, E Elizabeth; Panula, Pertti; Chandran, Siddharthan; Becker, Thomas; Becker, Catherina G

    2013-06-10

    Coordinated development of brain stem and spinal target neurons is pivotal for the emergence of a precisely functioning locomotor system. Signals that match the development of these far-apart regions of the central nervous system may be redeployed during spinal cord regeneration. Here we show that descending dopaminergic projections from the brain promote motor neuron generation at the expense of V2 interneurons in the developing zebrafish spinal cord by activating the D4a receptor, which acts on the hedgehog pathway. Inhibiting this essential signal during early neurogenesis leads to a long-lasting reduction of motor neuron numbers and impaired motor responses of free-swimming larvae. Importantly, during successful spinal cord regeneration in adult zebrafish, endogenous dopamine promotes generation of spinal motor neurons, and dopamine agonists augment this process. Hence, we describe a supraspinal control mechanism for the development and regeneration of specific spinal cell types that uses dopamine as a signal.

  17. Complete sternal cleft associated with right clavicular, manubrial, and thyroid hypoplasia, pectus deformity, and spinal anomalies.

    PubMed

    Golden, Eleza T; Alazraki, Adina; Loewen, Jonathan; Braithwaite, Kiery

    2016-01-01

    Sternal cleft anomalies are rare. Associated anomalies include pentalogy of Cantrell and posterior fossa abnormalities, hemangiomas, arteriopathy, cardiac anomalies, eye abnormalities, and sternal defects syndrome. There is only a single report of complete sternal cleft, pectus excavatum, and right clavicular hypoplasia in an adult. Thyroid hemiagenesis is also very rare. To our knowledge, this is the first case of complete sternal cleft, pectus deformity, and right clavicular hypoplasia in a child and the first case with right thyroid hemiagenesis.

  18. Fully automatic measurements of axial vertebral rotation for assessment of spinal deformity in idiopathic scoliosis

    NASA Astrophysics Data System (ADS)

    Forsberg, Daniel; Lundström, Claes; Andersson, Mats; Vavruch, Ludvig; Tropp, Hans; Knutsson, Hans

    2013-03-01

    Reliable measurements of spinal deformities in idiopathic scoliosis are vital, since they are used for assessing the degree of scoliosis, deciding upon treatment and monitoring the progression of the disease. However, commonly used two dimensional methods (e.g. the Cobb angle) do not fully capture the three dimensional deformity at hand in scoliosis, of which axial vertebral rotation (AVR) is considered to be of great importance. There are manual methods for measuring the AVR, but they are often time-consuming and related with a high intra- and inter-observer variability. In this paper, we present a fully automatic method for estimating the AVR in images from computed tomography. The proposed method is evaluated on four scoliotic patients with 17 vertebrae each and compared with manual measurements performed by three observers using the standard method by Aaro-Dahlborn. The comparison shows that the difference in measured AVR between automatic and manual measurements are on the same level as the inter-observer difference. This is further supported by a high intraclass correlation coefficient (0.971-0.979), obtained when comparing the automatic measurements with the manual measurements of each observer. Hence, the provided results and the computational performance, only requiring approximately 10 to 15 s for processing an entire volume, demonstrate the potential clinical value of the proposed method.

  19. Mechanical properties of sand tiger shark (Carcharias taurus) vertebrae in relation to spinal deformity.

    PubMed

    Huber, Daniel R; Neveu, Danielle E; Stinson, Charlotte M; Anderson, Paul A; Berzins, Ilze K

    2013-11-15

    Approximately 35% of sand tiger sharks (Carcharias taurus) in public aquaria exhibit spinal deformities ranging from compressed vertebrae and loss of intervertebral space to dislocated spines with vertebral degeneration and massive spondylosis caused by excessive mineralization both within vertebrae and outside the notochordal sheath. To identify the mechanical basis of these deformities, vertebral centra from affected (N=12) and non-affected (N=9) C. taurus were subjected to axial compression tests on an MTS 858 Bionix material testing system, after which mineral content was determined. Vertebral centra from affected sharks had significantly lower mineral content and material behavior in nearly all variables characterizing elasticity, plasticity and failure. These mechanical deficiencies are correlated with size at capture, capture method, vitamin C and zinc deficiency, aquarium size and swimming behavior in public aquaria. Non-affected C. taurus had greater stiffness and toughness even though these properties are generally incompatible in mineralized structures, suggesting that the biphasic (mineralized, unmineralized phases) nature of chondrichthyan vertebrae yields material behavior not otherwise observed in vertebrate skeletons. However, vertebral centra from non-affected sharks had lower mineral content (33%), stiffness (167 MPa), yield strain (14%) and ultimate strength (16 MPa) than other species of sharks and bony vertebrates, indicating that biomechanical precautions must be taken in the husbandry of this species.

  20. Effect of Surgical Curve Correction on Exercise Tolerance and Physical Capacities in Patients of Severe Spinal Deformity

    PubMed Central

    Rathod, Ashok K; Borde, Mandar; Singh, Vishwajeet; Singh, Hemant U

    2016-01-01

    Introduction Traditionally, surgical intervention for patients with a spinal deformity has been considered for cosmetic benefits, but surgical intervention can alter the lung physiology or volumes and in turn leads to increase in physical capacity and exercise tolerance. Therefore, we conducted this to determine whether a surgical correction would restore the lung physiology, physical capacity and exercise tolerance in patients with kyphoscoliosis. Aim To evaluate the usage of six-minute walk test scores and modified Borg scores as tools/measures for exercise tolerance in patients with spinal deformity and to study the effects of surgical correction of spinal deformity on exercise tolerance with above parameters as the measures. Materials and Methods Thirty patients with spinal deformity, who had undergone surgery for deformity correction, were evaluated. All patients were investigated pre-operatively with x-rays of the spine (anteroposterior and lateral views). Clinical tests like breath holding time (after full inspiration) in number of seconds, modified Borg scores, six-minute walk test scores (heart rate, respiratory rate, maximum distance walked); were recorded as measures of exercise tolerance. The patients were followed up on the first, third, sixth and twelfth month post-operatively and tested clinically for breath holding time, modified Borg scores, six-minute walk test scores (heart rate, respiratory rate, maximum distance walked) and x-rays of the spine (anteroposterior and lateral views). Results In our study, breath holding time (p-value = 0.001) and modified Borg scores (p-value = 0.012) showed a significant improvement at 12 months post-operatively. We noted similar findings with heart rate, respiratory rate and maximum distance walked after a six-minute walk test. Improvements were noted in all the parameters, especially in the group of patients with greater than 60 degrees of cobb angle. However, the differences between the two groups (pre

  1. The surgical management of spinal deformity in children with a Fontan circulation: The development of an algorithm for treatment.

    PubMed

    Evans, S; Ramasamy, A; Marks, D S; Spilsbury, J; Miller, P; Tatman, A; Gardner, A C

    2014-01-01

    The management of spinal deformity in children with univentricular cardiac pathology poses significant challenges to the surgical and anaesthetic teams. To date, only posterior instrumented fusion techniques have been used in these children and these are associated with a high rate of complications. We reviewed our experience of both growing rod instrumentation and posterior instrumented fusion in children with a univentricular circulation. Six children underwent spinal corrective surgery, two with cavopulmonary shunts and four following completion of a Fontan procedure. Three underwent growing rod instrumentation, two had a posterior fusion and one had spinal growth arrest. There were no complications following surgery, and the children undergoing growing rod instrumentation were successfully lengthened. We noted a trend for greater blood loss and haemodynamic instability in those whose surgery was undertaken following completion of a Fontan procedure. At a median follow-up of 87.6 months (interquartile range (IQR) 62.9 to 96.5) the median correction of deformity was 24.2% (64.5° (IQR 46° to 80°) vs 50.5° (IQR 36° to 63°)). We believe that early surgical intervention with growing rod instrumentation systems allows staged correction of the spinal deformity and reduces the haemodynamic insult to these physiologically compromised children. Due to the haemodynamic changes that occur with the completed Fontan circulation, the initial scoliosis surgery should ideally be undertaken when in the cavopulmonary shunt stage.

  2. Adult spinal cord ependymal layer: a promising pool of quiescent stem cells to treat spinal cord injury.

    PubMed

    Panayiotou, Elena; Malas, Stavros

    2013-11-28

    Spinal cord injury (SCI) is a major health burden and currently there is no effective medical intervention. Research performed over the last decade revealed that cells surrounding the central canal of the adult spinal cord and forming the ependymal layer acquire stem cell properties either in vitro or in response to injury. Following SCI activated ependymal cells generate progeny cells which migrate to the injury site but fail to produce the appropriate type of cells in sufficient number to limit the damage, rendering this physiological response mainly ineffective. Research is now focusing on the manipulation of ependymal cells to produce cells of the oligodendrocyte lineage which are primarily lost in such a situation leading to secondary neuronal degeneration. Thus, there is a need for a more focused approach to understand the molecular properties of adult ependymal cells in greater detail and develop effective strategies for guiding their response during SCI.

  3. Transspinal direct current stimulation modulates migration and proliferation of adult newly born spinal cells in mice.

    PubMed

    Samaddar, Sreyashi; Vazquez, Kizzy; Ponkia, Dipen; Toruno, Pedro; Sahbani, Karim; Begum, Sultana; Abouelela, Ahmed; Mekhael, Wagdy; Ahmed, Zaghloul

    2017-02-01

    Direct current electrical fields have been shown to be a major factor in the regulation of cell proliferation, differentiation, migration, and survival, as well as in the maturation of dividing cells during development. During adulthood, spinal cord cells are continuously produced in both animals and humans, and they hold great potential for neural restoration following spinal cord injury. While the effects of direct current electrical fields on adult-born spinal cells cultured ex vivo have recently been reported, the effects of direct current electrical fields on adult-born spinal cells in vivo have not been characterized. Here, we provide convincing findings that a therapeutic form of transspinal direct current stimulation (tsDCS) affects the migration and proliferation of adult-born spinal cells in mice. Specifically, cathodal tsDCS attracted the adult-born spinal cells, while anodal tsDCS repulsed them. In addition, both tsDCS polarities caused a significant increase in cell number. Regarding the potential mechanisms involved, both cathodal and anodal tsDCS caused significant increases in expression of brain-derived neurotrophic factor, while expression of nerve growth factor increased and decreased, respectively. In the spinal cord, both anodal and cathodal tsDCS increased blood flow. Since blood flow and angiogenesis are associated with the proliferation of neural stem cells, increased blood flow may represent a major factor in the modulation of newly born spinal cells by tsDCS. Consequently, we propose that the method and novel findings presented in the current study have the potential to facilitate cellular, molecular, and/or bioengineering strategies to repair injured spinal cords.NEW & NOTEWORTHY Our results indicate that transspinal direct current stimulation (tsDCS) affects the migratory pattern and proliferation of adult newly born spinal cells, a cell population which has been implicated in learning and memory. In addition, our results suggest a

  4. Adult Primary Spinal Epidural Extraosseous Ewing's Sarcoma: A Case Report and Review of the Literature

    PubMed Central

    Thomas, Cheddhi; Modrek, Aram S.; Bayin, N. Sumru; Snuderl, Matija; Schiff, Peter B.

    2016-01-01

    Background. Extraosseous Ewing's sarcoma in the spinal epidural space is a rare malignancy, especially in adults. Case Presentation. A 40-year-old male presented with back pain and urinary hesitancy. MRI revealed a thoracic extradural mass with no osseous involvement. He underwent surgery for gross total resection of the mass, which was diagnosed as Ewing's sarcoma. He was subsequently treated with chemoradiotherapy. He remains disease-free 1 year after surgery. Review of the literature indicated only 45 previously reported cases of spinal epidural extraosseous Ewing's sarcoma in adults. Conclusions. Extraosseous Ewing's sarcoma in the spinal epidural space is a rare clinical entity that should be included in the differential for spinal epidural masses. Its treatment is multidisciplinary but frequently requires surgical intervention due to compressive neurologic symptoms. Gross total resection appears to correlate with improved outcomes. PMID:27610254

  5. Complications and Outcomes of Complex Spine Reconstructions in Poliomyelitis-Associated Spinal Deformities: A Single Institution Experience

    PubMed Central

    Godzik, Jakub; Lenke, Lawrence G.; Holekamp, Terrence; Sides, Brenda; Kelly, Michael P.

    2014-01-01

    Study Design Retrospective case-series Objective Share our institutional experience with spinal reconstruction for deformity correction in patients with a history of poliomyelitis. Background Data Polio and post-polio syndrome are not uncommonly related to a paralytic spinal deformity. Limited modern data exists regarding outcomes and complications following spinal reconstruction in this population. Methods A clinical database was reviewed for patients undergoing spinal reconstruction for polio-associated spinal deformity at our institution from 1985 to 2012. Relevant demographic, medical, surgical and postoperative information were collected from medical records and analyzed. Preoperative and last follow-up SRS-22 scores were recorded. Results A total of 22 patients with polio who underwent surgical deformity correction were identified. Mean age was 49 years (Range, 12–74), and 15 patients (68%) were female. Preoperative motor deficit was present in 14/22 (64%). All patients underwent instrumented spinal fusion (Mean 13 vertebral levels, Range, 3–18). Ten (10/22, 45%) patients developed major complications, and four patients (4/22, 18%) developed new postoperative neurological deficits. Neurological monitoring yielded a 13% false negative rate. At 2-year follow-up (20/22), patients maintained an average coronal correction of 25 degrees (33%, p = 0.001) and sagittal correction of 25 degrees (34%, p = 0.003). Minimum 2-year follow-up data were available for 11/22 (50%) of patients. At an average of 72 months of follow-up (Range, 28 – 134 months), the mean SRS22 pain subscore improved from a mean of 2.75 to 3.6 (p = 0.012); self-image from 2.8 to 3.7 (p = 0.041); function from 3.1 to 3.8 (p = 0.036); satisfaction from 2.1 to 3.9 (p = 0.08); mental health from 3.7 to 4.5 (p = 0.115). Conclusion Spine reconstruction for poliomyelitis-associated deformity was associated with high complication rates (54%) and sometimes unreliable neurologic monitoring data. Despite

  6. Fetal grafts alter chronic behavioral outcome after contusion damage to the adult rat spinal cord.

    PubMed

    Stokes, B T; Reier, P J

    1992-04-01

    In the present experiments, we have examined the capacity of intraspinal transplants to effect alterations in certain locomotor behaviors after spinal contusion injuries. An electromechanical impactor that was sensitive to tissue biomechanical characteristics was used to produce rapid (20 ms) compression injuries to the thoracic spinal cord (T8). Suspensions of fetal spinal tissue (14-day) were placed at 10 days postinjury into the intraspinal cavity created by these reproducible spinal injuries. In the pre- and postinjury period, a number of general and sensitive motor behaviors were used to characterize the immediate and long-term progress of hindlimb behavioral recovery over an extended period of time (73 days). Our data reveal that a lasting alteration in some motor behaviors can be achieved by suspension grafts. While little improvement in some generalized motor tasks (inclined plane analysis, grid walking) takes place, fetal transplants precipitate a rapid and enduring change in certain motivated fine motor behaviors (gait analysis). The base of support and stride length of the hindlimbs were improved by 7 days post-transplantation and the effect was stable over time. The angle of rotation was, however, not altered. The lasting effect in two gait parameters noted was accompanied by the presence of well-developed spinal grafts that often fused with the host spinal parenchyma. These results provide the first documentation of an influence of fetal transplants on motivated locomotor capacity in a well-characterized spinal injury model that mimics lesions seen in the contused adult human spinal cord.

  7. Spinal Deformity in Aged Zebrafish Is Accompanied by Degenerative Changes to Their Vertebrae that Resemble Osteoarthritis

    PubMed Central

    Hayes, Anthony J.; Reynolds, Scott; Nowell, Mari A.; Meakin, Lee B.; Habicher, Judith; Ledin, Johan; Bashford, Andrew; Caterson, Bruce; Hammond, Chrissy L.

    2013-01-01

    Age-related degenerative changes within the vertebral column are a significant cause of morbidity with considerable socio-economic impact worldwide. An improved understanding of these changes through the development of experimental models may lead to improvements in existing clinical treatment options. The zebrafish is a well-established model for the study of skeletogenesis with significant potential in gerontological research. With advancing age, zebrafish frequently develop gross deformities of their vertebral column, previously ascribed to reduced trunk muscle tone. In this study, we assess degenerative changes specifically within the bone and cartilage of the vertebral column of zebrafish at 1, 2 and 3-years of age. We show increased frequency and severity of spinal deformities/curvatures with age. Underlying the most severe phenotypes are partial or complete vertebral dislocations and focal thickening of the vertebral bone at the joint margins. MicroCT examination demonstrates small defects, fractures and morphological evidence suggestive of bone erosion and remodeling (i.e. osteophytes) within the vertebrae during aging, but no significant change in bone density. Light and electron microscopic examination reveal striking age-related changes in cell morphology, suggestive of chondroptosis, and tissue remodelling of the vertebral cartilage, particularly within the pericellular micro-environment. Glycosaminoglycan analysis of the vertebral column by HPLC demonstrates a consistent, age-related increase in the yield of total chondroitin sulfate disaccharide, but no change in sulfation pattern, supported by immunohistochemical analysis. Immunohistochemistry strongly identifies all three chondroitin/dermatan sulphate isoforms (C-0-S, C-4-S/DS and C-6-S) within the vertebral cartilage, particularly within the pericellular micro-environment. In contrast, keratan sulfate immunolocalises specifically with the notochordal tissue of the intervertebral disc, and its

  8. Spinal deformity in aged zebrafish is accompanied by degenerative changes to their vertebrae that resemble osteoarthritis.

    PubMed

    Hayes, Anthony J; Reynolds, Scott; Nowell, Mari A; Meakin, Lee B; Habicher, Judith; Ledin, Johan; Bashford, Andrew; Caterson, Bruce; Hammond, Chrissy L

    2013-01-01

    Age-related degenerative changes within the vertebral column are a significant cause of morbidity with considerable socio-economic impact worldwide. An improved understanding of these changes through the development of experimental models may lead to improvements in existing clinical treatment options. The zebrafish is a well-established model for the study of skeletogenesis with significant potential in gerontological research. With advancing age, zebrafish frequently develop gross deformities of their vertebral column, previously ascribed to reduced trunk muscle tone. In this study, we assess degenerative changes specifically within the bone and cartilage of the vertebral column of zebrafish at 1, 2 and 3-years of age. We show increased frequency and severity of spinal deformities/curvatures with age. Underlying the most severe phenotypes are partial or complete vertebral dislocations and focal thickening of the vertebral bone at the joint margins. MicroCT examination demonstrates small defects, fractures and morphological evidence suggestive of bone erosion and remodeling (i.e. osteophytes) within the vertebrae during aging, but no significant change in bone density. Light and electron microscopic examination reveal striking age-related changes in cell morphology, suggestive of chondroptosis, and tissue remodelling of the vertebral cartilage, particularly within the pericellular micro-environment. Glycosaminoglycan analysis of the vertebral column by HPLC demonstrates a consistent, age-related increase in the yield of total chondroitin sulfate disaccharide, but no change in sulfation pattern, supported by immunohistochemical analysis. Immunohistochemistry strongly identifies all three chondroitin/dermatan sulphate isoforms (C-0-S, C-4-S/DS and C-6-S) within the vertebral cartilage, particularly within the pericellular micro-environment. In contrast, keratan sulfate immunolocalises specifically with the notochordal tissue of the intervertebral disc, and its

  9. Forebrain GABAergic neuron precursors integrate into adult spinal cord and reduce injury-induced neuropathic pain

    PubMed Central

    Bráz, JM; Sharif-Naeini, R; Vogt, D; Kriegstein, A; Alvarez-Buylla, A; Rubenstein, JL; Basbaum, AI

    2012-01-01

    Neuropathic pain is a chronic debilitating disease characterized by mechanical allodynia and spontaneous pain. Because symptoms are often unresponsive to conventional methods of pain treatment, new therapeutic approaches are essential. Here, we describe a strategy that not only ameliorates symptoms of neuropathic pain, but is also potentially disease modifying. We show that transplantation of immature telencephalic GABAergic interneurons from the mouse medial ganglionic eminence (MGE) into the adult mouse spinal cord completely reverses the mechanical hypersensitivity produced by peripheral nerve injury. Underlying this improvement is a remarkable integration of the MGE transplants into the host spinal cord circuitry, in which the transplanted cells make functional connections with both primary afferent and spinal cord neurons. By contrast, MGE transplants were not effective against inflammatory pain. Our findings suggest that MGE-derived GABAergic interneurons overcome the spinal cord hyperexcitability that is a hallmark of nerve-injury induced neuropathic pain. PMID:22632725

  10. Expectations of life and health among spinal cord injured adults.

    PubMed

    McColl, M A; Walker, J; Stirling, P; Wilkins, R; Corey, P

    1997-12-01

    While our understanding of aging and mortality in spinal cord injury is evolving, precise estimates are still not available for expectations of life and health following a spinal cord injury. In order to derive these estimates, information about mortality and health must be combined into a single estimate. Health expectancy estimates have been widely used in the literature of the last decade to try to understand the relationship between population health and survival, both in the general population and in special populations. This study brought the benefit of this methodology to the question of long-term survival following spinal cord injury. Specifically, the study aimed to calculate life and health expectancy in a population of spinal cord injured individuals; and to estimate the effect of factors associated with survival and health. The study involved a retrospective cohort, all of whom sustained a spinal cord injury between the ages of 25 and 34 years, and between 1945 and 1990. The study predicted a median survival time of 38 years post-injury, with 43% surviving at least 40 years. These findings suggest an increase in life expectancy of about 5 years over previous research on the same cohort. Factors affecting survival were age at injury, level and completeness of lesion. Expectations of health found in the present study are similar to those found in studies of the general population. This study showed seven remaining years of poor health expected at injury, and five remaining years expected at 40 years post injury, presumably occurring at the end of life.

  11. Prevalence and Consequences of the Proximal Junctional Kyphosis After Spinal Deformity Surgery

    PubMed Central

    Yan, Chunda; Li, Yong; Yu, Zhange

    2016-01-01

    Abstract The aim of this study was to estimate the prevalence and patient outcomes of proximal junctional kyphosis (PJK) in pediatric patients and adolescents who received surgical interventions for the treatment of a spinal deformity. Literature was searched in electronic databases, and studies were selected by following précised eligibility criteria. Percent prevalence values of the PJK in individual studies were pooled to achieve a weighted effect size under the random effects model. Subgroup and meta-regression analyses were performed to appraise the factors affecting PJK prevalence. Twenty-six studies (2024 patients) were included in this meta-analysis. Average age of the patients was 13.8 ± 2.75 years of which 32 ± 20 % were males. Average follow-up was 51.6 ± 38.8 (range 17 ± 13 to 218 ± 60) months. Overall, the percent prevalence of PJK (95% confidence interval) was 11.02 (10.5, 11.5) %; P < 0.00001 which was inversely associated with age (meta-regression coefficient: –1.607 [–2.86, –0.36]; 0.014). Revision surgery rate in the patients with PJK was 10%. The prevalence of PJK was positively associated with the proximal junctional angle at last follow-up (coefficient: 2.248; P = 0.012) and the change in the proximal junctional angle from surgery to last follow-up (coefficient: 2.139; P = 0.014) but not with preoperative proximal junctional angle. The prevalence of PJK in the children and adolescent patients is 11%. About 10% of those affected require revision surgery. PMID:27196453

  12. Epidural Stimulation Induced Modulation of Spinal Locomotor Networks in Adult Spinal Rats

    PubMed Central

    Lavrov, Igor; Dy, Christine J.; Fong, Andy J.; Gerasimenko, Yury; Courtine, Grégoire; Zhong, Hui; Roy, Roland R.; Edgerton, V. Reggie

    2010-01-01

    The importance of the in vivo dynamic nature of the circuitries within the spinal cord that generate locomotion is becoming increasingly evident. We examined the characteristics of hindlimb EMG activity evoked in response to epidural stimulation at the S1 spinal cord segment in complete mid-thoracic spinal cord transected rats at different stages of post-lesion recovery. A progressive and phase-dependent modulation of monosynaptic (middle) and long latency (late) stimulation-evoked EMG responses was observed throughout the step cycle. During the first three weeks after injury the amplitude of the middle response was potentiated during the EMG bursts, whereas after 4 weeks both the middle and late responses were phase-dependently modulated. The middle and late response magnitudes were closely linked to the amplitude and duration of the EMG bursts during locomotion facilitated by epidural stimulation. The optimum stimulation frequency that maintained consistent activity of the long latency responses ranged from 40 to 60 Hz, whereas the short latency responses were consistent from 5 to 130 Hz. These data demonstrate that both middle and late evoked potentials within a motor pool are strictly gated during in vivo bipedal stepping as a function of the general excitability of the motor pool and, thus as a function of the phase of the step cycle. These data demonstrate that spinal cord epidural stimulation can facilitate locomotion in a time-dependent manner post-lesion. The long latency responses to epidural stimulation are correlated with the recovery of weight-bearing bipedal locomotion and may reflect activation of interneuronal central pattern-generating circuits. PMID:18524907

  13. Epidural stimulation induced modulation of spinal locomotor networks in adult spinal rats.

    PubMed

    Lavrov, Igor; Dy, Christine J; Fong, Andy J; Gerasimenko, Yury; Courtine, Grégoire; Zhong, Hui; Roy, Roland R; Edgerton, V Reggie

    2008-06-04

    The importance of the in vivo dynamic nature of the circuitries within the spinal cord that generate locomotion is becoming increasingly evident. We examined the characteristics of hindlimb EMG activity evoked in response to epidural stimulation at the S1 spinal cord segment in complete midthoracic spinal cord-transected rats at different stages of postlesion recovery. A progressive and phase-dependent modulation of monosynaptic (middle) and long-latency (late) stimulation-evoked EMG responses was observed throughout the step cycle. During the first 3 weeks after injury, the amplitude of the middle response was potentiated during the EMG bursts, whereas after 4 weeks, both the middle and late responses were phase-dependently modulated. The middle- and late-response magnitudes were closely linked to the amplitude and duration of the EMG bursts during locomotion facilitated by epidural stimulation. The optimum stimulation frequency that maintained consistent activity of the long-latency responses ranged from 40 to 60 Hz, whereas the short-latency responses were consistent from 5 to 130 Hz. These data demonstrate that both middle and late evoked potentials within a motor pool are strictly gated during in vivo bipedal stepping as a function of the general excitability of the motor pool and, thus, as a function of the phase of the step cycle. These data demonstrate that spinal cord epidural stimulation can facilitate locomotion in a time-dependent manner after lesion. The long-latency responses to epidural stimulation are correlated with the recovery of weight-bearing bipedal locomotion and may reflect activation of interneuronal central pattern-generating circuits.

  14. Spinal rehabilitative exercise or manual treatment for the prevention of tension-type headache in adults.

    PubMed

    Leininger, Brent; Brønfort, Gert; Haas, Mitchell; Schmitt, John; Evans, Roni L; Levin, Morris; Westrom, Kristine; Goldsmith, Charles H

    2016-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the short- and long-term effects of manual treatment and spinal rehabilitative exercise for the prevention of tension-type headache in adults.

  15. New developments in the treatment of early-onset spinal deformity: role of the Shilla growth guidance system

    PubMed Central

    Morell, Sean M; McCarthy, Richard E

    2016-01-01

    Early-onset scoliosis is a complex condition with multiple facets. The goal of treating any spinal deformity is to improve the condition of the patient with the least intervention necessary. A system that allows for continuation of natural spinal growth while correcting the deformity should be the goal of treating this complex condition. The SHILLA growth guidance system allows for continued growth of the pediatric spine while correcting and guiding the apex and guiding the future growth of the curvature. The system involves selective fusion across the apex of the curvature, and minimally invasive instrumentation is then used above and below the apex to allow for continued growth of the spine. A review of recent literature on the SHILLA growth guidance system shows promising results. Early animal models showed continued growth across unfused levels with minimal facet articular damage. Comparative studies to traditional growing rods showed significantly less total surgeries along with comparable correction and longitudinal growth. The SHILLA growth guidance system is a good option for this complex patient group. Results are comparable with other growing constructs with significantly less operative interventions. The SHILLA system allows for natural growth of the pediatric spine while correcting the scoliotic deformity in a minimally invasive method. The goal of this article is to present a comprehensive review of the SHILLA system surgical technique and the associated literature concerning this topic. PMID:27499651

  16. Functional Synaptic Integration of Forebrain GABAergic Precursors into the Adult Spinal Cord

    PubMed Central

    Etlin, Alex; Bráz, Joao M.; Kuhn, Julia A.; Wang, Xidao; Hamel, Katherine A.; Llewellyn-Smith, Ida J.

    2016-01-01

    Spinal cord transplants of embryonic cortical GABAergic progenitor cells derived from the medial ganglionic eminence (MGE) can reverse mechanical hypersensitivity in the mouse models of peripheral nerve injury- and paclitaxel-induced neuropathic pain. Here, we used electrophysiology, immunohistochemistry, and electron microscopy to examine the extent to which MGE cells integrate into host circuitry and recapitulate endogenous inhibitory circuits. Whether the transplants were performed before or after nerve injury, the MGE cells developed into mature neurons and exhibited firing patterns characteristic of subpopulations of cortical and spinal cord inhibitory interneurons. Conversely, the transplanted cells preserved cortical morphological and neurochemical properties. We also observed a robust anatomical and functional synaptic integration of the transplanted cells into host circuitry in both injured and uninjured animals. The MGE cells were activated by primary afferents, including TRPV1-expressing nociceptors, and formed GABAergic, bicuculline-sensitive, synapses onto host neurons. Unexpectedly, MGE cells transplanted before injury prevented the development of mechanical hypersensitivity. Together, our findings provide direct confirmation of an extensive, functional synaptic integration of MGE cells into host spinal cord circuits. This integration underlies normalization of the dorsal horn inhibitory tone after injury and may be responsible for the prophylactic effect of preinjury transplants. SIGNIFICANCE STATEMENT Spinal cord transplants of embryonic cortical GABAergic interneuron progenitors from the medial ganglionic eminence (MGE), can overcome the mechanical hypersensitivity produced in different neuropathic pain models in adult mice. Here, we examined the properties of transplanted MGE cells and the extent to which they integrate into spinal cord circuitry. Using electrophysiology, immunohistochemistry, and electron microscopy, we demonstrate that MGE cells

  17. Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity

    PubMed Central

    He, Zhaohui; Zhang, Caixia; Zeng, Guohua

    2016-01-01

    ABSTRACT Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis. PMID:27509373

  18. Auto-catalytic Ceria Nanoparticles Offer Neuroprotection to Adult Rat Spinal Cord Neurons

    PubMed Central

    Das, Mainak; Patil, Swanand; Bhargava, Neelima; Kang, Jung-Fong; Riedel, Lisa M.; Seal, Sudipta; Hickman, James J.

    2007-01-01

    This paper describes the evaluation of the auto-catalytic anti-oxidant behavior and biocompatibility of Cerium oxide nanoparticles for applications in spinal cord repair and other diseases of the CNS. The application of a single dose of nano-Ceria at a nano-molar concentration is biocompatible, regenerative and provides a significant neuroprotective effect on adult rat spinal cord neurons. Retention of neuronal function is demonstrated from electrophysiological recordings and the possibility of its application to prevent ischemic insult is suggested from an oxidative injury assay. A mechanism is proposed to explain the auto-catalytic properties of these nanoparticles. PMID:17222903

  19. Potent spinal parenchymal AAV9-mediated gene delivery by subpial injection in adult rats and pigs

    PubMed Central

    Miyanohara, Atsushi; Kamizato, Kota; Juhas, Stefan; Juhasova, Jana; Navarro, Michael; Marsala, Silvia; Lukacova, Nada; Hruska-Plochan, Marian; Curtis, Erik; Gabel, Brandon; Ciacci, Joseph; Ahrens, Eric T; Kaspar, Brian K; Cleveland, Don; Marsala, Martin

    2016-01-01

    Effective in vivo use of adeno-associated virus (AAV)-based vectors to achieve gene-specific silencing or upregulation in the central nervous system has been limited by the inability to provide more than limited deep parenchymal expression in adult animals using delivery routes with the most clinical relevance (intravenous or intrathecal). Here, we demonstrate that the spinal pia membrane represents the primary barrier limiting effective AAV9 penetration into the spinal parenchyma after intrathecal AAV9 delivery. We develop a novel subpial AAV9 delivery technique and AAV9-dextran formulation. We use these in adult rats and pigs to show (i) potent spinal parenchymal transgene expression in white and gray matter including neurons, glial and endothelial cells after single bolus subpial AAV9 delivery; (ii) delivery to almost all apparent descending motor axons throughout the length of the spinal cord after cervical or thoracic subpial AAV9 injection; (iii) potent retrograde transgene expression in brain motor centers (motor cortex and brain stem); and (iv) the relative safety of this approach by defining normal neurological function for up to 6 months after AAV9 delivery. Thus, subpial delivery of AAV9 enables gene-based therapies with a wide range of potential experimental and clinical utilizations in adult animals and human patients. PMID:27462649

  20. Gonadotropin-releasing hormone receptor in spinal cord neurons of embryos and adult rats.

    PubMed

    Quintanar, J Luis; Salinas, Eva; González, Rodolfo

    2009-09-11

    Mammalian gonadotropin-releasing hormone (GnRH) and its receptor have been found in the neuroendocrine reproductive axis. However, they can be localized in other extra-pituitary tissues as well including the central nervous system. The present study reports the expression of GnRH receptor and its mRNA in spinal cord neurons of rat embryos and adult rats, using immunohistochemistry and reverse transcriptase polymerase chain reaction (RT-PCR). Immunohistochemistry showed that the spinal cord neurons of rat embryos and adult rats expressed the GnRH receptor. The study of GnRH receptor mRNAs revealed that both cultured spinal cord neurons of rat embryos and adult rats expressed the GnRH receptor mRNA. Additional in vitro experiments showed that the expression of GnRH receptor mRNA was less in the spinal cord neurons exposed to GnRH compared to unexposed ones. These results raise the possibility that GnRH may play other roles independently from its participation in reproductive function.

  1. Implanting Glass Spinal Cord Windows in Adult Mice with Experimental Autoimmune Encephalomyelitis

    PubMed Central

    Fenrich, Keith K.; Weber, Pascal; Rougon, Genevieve; Debarbieux, Franck

    2013-01-01

    Experimental autoimmune encephalomyelitis (EAE) in adult rodents is the standard experimental model for studying autonomic demyelinating diseases such as multiple sclerosis. Here we present a low-cost and reproducible glass window implantation protocol that is suitable for intravital microscopy and studying the dynamics of spinal cord cytoarchitecture with subcellular resolution in live adult mice with EAE. Briefly, we surgically expose the vertebrae T12-L2 and construct a chamber around the exposed vertebrae using a combination of cyanoacrylate and dental cement. A laminectomy is performed from T13 to L1, and a thin layer of transparent silicone elastomer is applied to the dorsal surface of the exposed spinal cord. A modified glass cover slip is implanted over the exposed spinal cord taking care that the glass does not directly contact the spinal cord. To reduce the infiltration of inflammatory cells between the window and spinal cord, anti-inflammatory treatment is administered every 2 days (as recommended by ethics committee) for the first 10 days after implantation. EAE is induced only 2-3 weeks after the cessation of anti-inflammatory treatment. Using this approach we successfully induced EAE in 87% of animals with implanted windows and, using Thy1-CFP-23 mice (blue axons in dorsal spinal cord), quantified axonal loss throughout EAE progression. Taken together, this protocol may be useful for studying the recruitment of various cell populations as well as their interaction dynamics, with subcellular resolution and for extended periods of time. This intravital imaging modality represents a valuable tool for developing therapeutic strategies to treat autoimmune demyelinating diseases such as EAE. PMID:24378439

  2. Implanting glass spinal cord windows in adult mice with experimental autoimmune encephalomyelitis.

    PubMed

    Fenrich, Keith K; Weber, Pascal; Rougon, Genevieve; Debarbieux, Franck

    2013-12-21

    Experimental autoimmune encephalomyelitis (EAE) in adult rodents is the standard experimental model for studying autonomic demyelinating diseases such as multiple sclerosis. Here we present a low-cost and reproducible glass window implantation protocol that is suitable for intravital microscopy and studying the dynamics of spinal cord cytoarchitecture with subcellular resolution in live adult mice with EAE. Briefly, we surgically expose the vertebrae T12-L2 and construct a chamber around the exposed vertebrae using a combination of cyanoacrylate and dental cement. A laminectomy is performed from T13 to L1, and a thin layer of transparent silicone elastomer is applied to the dorsal surface of the exposed spinal cord. A modified glass cover slip is implanted over the exposed spinal cord taking care that the glass does not directly contact the spinal cord. To reduce the infiltration of inflammatory cells between the window and spinal cord, anti-inflammatory treatment is administered every 2 days (as recommended by ethics committee) for the first 10 days after implantation. EAE is induced only 2-3 weeks after the cessation of anti-inflammatory treatment. Using this approach we successfully induced EAE in 87% of animals with implanted windows and, using Thy1-CFP-23 mice (blue axons in dorsal spinal cord), quantified axonal loss throughout EAE progression. Taken together, this protocol may be useful for studying the recruitment of various cell populations as well as their interaction dynamics, with subcellular resolution and for extended periods of time. This intravital imaging modality represents a valuable tool for developing therapeutic strategies to treat autoimmune demyelinating diseases such as EAE.

  3. Finite element method-based study for effect of adult degenerative scoliosis on the spinal vibration characteristics.

    PubMed

    Xu, Ming; Yang, James; Lieberman, Isador; Haddas, Ram

    2017-03-22

    Finite element analysis was used to investigate the responses of five healthy subjects and five adult degenerative scoliosis (ADS) subjects to cyclic vibration. The dynamic responses of the healthy and scoliotic spines to the sinusoidal cyclic vibrations have been investigated in previous studies by simulation or experimental approaches. However, no simulation or experimental results were available for the ADS subjects. The effect of the ADS on the vibrational characteristics of spines remained unknown. The objective of this study was to compare differences of the dynamic responses to the cyclic vibration input between the healthy subjects and subjects with ADS. Based on the simulations results in this study, the scoliotic spines are more sensitive to the cyclic vibrations than the healthy spines. More resonant frequencies were predicted in the scoliotic spines than the healthy spines. The scoliotic deformity in the spine was to make the vibrational response of the spine significantly more complex at the apical scoliotic region. This study suggested that ADS could severely increase spinal response to the cyclic vibrations, which could potentially lead to further scoliotic deformity in the spine.

  4. Characterization of Proliferating Neural Progenitors after Spinal Cord Injury in Adult Zebrafish

    PubMed Central

    Hui, Subhra Prakash; Nag, Tapas Chandra; Ghosh, Sukla

    2015-01-01

    Zebrafish can repair their injured brain and spinal cord after injury unlike adult mammalian central nervous system. Any injury to zebrafish spinal cord would lead to increased proliferation and neurogenesis. There are presences of proliferating progenitors from which both neuronal and glial loss can be reversed by appropriately generating new neurons and glia. We have demonstrated the presence of multiple progenitors, which are different types of proliferating populations like Sox2+ neural progenitor, A2B5+ astrocyte/ glial progenitor, NG2+ oligodendrocyte progenitor, radial glia and Schwann cell like progenitor. We analyzed the expression levels of two common markers of dedifferentiation like msx-b and vimentin during regeneration along with some of the pluripotency associated factors to explore the possible role of these two processes. Among the several key factors related to pluripotency, pou5f1 and sox2 are upregulated during regeneration and associated with activation of neural progenitor cells. Uncovering the molecular mechanism for endogenous regeneration of adult zebrafish spinal cord would give us more clues on important targets for future therapeutic approach in mammalian spinal cord repair and regeneration. PMID:26630262

  5. The effects of age on the morphometry of the cervical spinal cord and spinal column in adult rats: an MRI-based study.

    PubMed

    Laing, Andrew C; Brenneman, Elora C; Yung, Andrew; Liu, Jie; Kozlowski, Piotr; Oxland, Thomas

    2014-10-01

    Rat models are commonly used to investigate the pathophysiological pathways and treatment outcomes after spinal cord injury (SCI). The high incidence of fall-induced SCI in older adults has created a need for aging models of SCI in rats to investigate potential age-related differences in SCI severity and outcomes. The aims of this study were to determine the influences of age and vertebral level on the geometries of the cervical spinal cord and spinal column in a rat model. Three young (3 months) and three aged (12 months) Fischer 344 rats were imaged in a high field (7 T) small-animal magnetic resonance imaging system. All spinal cord geometry variables (including depth, width, and axial cross-sectional area) and one spinal canal variable (depth) were significantly larger in the aged specimens by an average of 8.1%. There were main effects of vertebral level on all spinal cord variables and four spinal canal variables with values generally larger at C4 as compared to C6 (average increases ranged from 5.7% to 12.9% in spinal cord measures and 5.4% to 6.8% in spinal canal measures). High inter-rater reliability between two measurers was observed with a mean intraclass correlation of 0.921 and percent difference of 0.9% across all variables measured. This study clearly demonstrates that cervical spinal cord geometry changes between the ages of 3 and 12 months in Fischer 344 rats. This information can aid in the planning and interpretation of studies that use a rat model to investigate the influence of age on cervical SCI.

  6. Correlations of capture, transport, and nutrition with spinal deformities in sandtiger sharks, Carcharias taurus, in public aquaria.

    PubMed

    Anderson, Paul A; Huber, Daniel R; Berzins, Ilze K

    2012-12-01

    A number of captive sandtiger sharks (Carcharias taurus) in public aquaria have developed spinal deformities over the past decade, ranging in severity from mild curvature to spinal fracture and severe subluxation. To determine the frequency and etiologic basis of this disease, U.S. public aquaria participated in a two-stage epidemiologic study of resident sharks: 1) a history and husbandry survey and 2) hematology, clinical chemistry, and radiography conducted during health exams. Eighteen aquaria submitted data, samples, or both from 73 specimens, including 19 affected sharks (26%). Sharks caught off the Rhode Island coast or by pound net were smaller at capture and demonstrated a higher prevalence of deformity than did larger sharks caught from other areas via hook and line. Relative to healthy sharks, affected sharks were deficient in zinc, potassium, and vitamins C and E. Capture and transport results lead to two likely etiologic hypotheses: 1) that the pound-net capture process induces spinal trauma that becomes exacerbated over time in aquarium environments or 2) that small (and presumably young) sharks caught by pound net are exposed to disease-promoting conditions (including diet or habitat deficiencies) in aquaria during the critical growth phase of their life history. The last hypothesis is further supported by nutrient deficiencies among affected sharks documented in this study; potassium, zinc, and vitamin C play critical roles in proper cartilage-collagen development and maintenance. These correlative findings indicate that public aquaria give careful consideration to choice of collection methods and size at capture and supplement diets to provide nutrients required for proper development and maintenance of cartilaginous tissue.

  7. Adult Spinal Cord Injury without Radiographic Abnormalities (SCIWORA): Clinical and Radiological Correlations

    PubMed Central

    Sharma, Siddhartha; Singh, Manjeet; Wani, Iftikhar H; Sharma, Sushil; Sharma, Narendra; Singh, Dara

    2009-01-01

    Background This study is aimed to determine the clinical and radiological corellations of adult patients with Spinal Cord Injury Without Radiographic Abnormalities (SCIWORA). Methods The study population consisted of all adult patients with suspected cervical spine injury. SCIWORA was defined as the presence of either no injury or a neural injury on Magnetic Resonance Imaging (MRI) in the absence of radiographic or Computed Tomographic (CT) Scan findings suggestive of trauma in patients with neurological deficit. Purely extra neural compressive lesions were excluded from the study. Results Twelve of ninety seven (12.4%) patients had a neural injury on MRI with normal radiographs and CT scan. These included cord contusion in five cases, cord edema in five cases and cord hemorrhage in two cases. Ten patients were managed conservatively and two patients with disc prolapse were managed surgically. All patients showed at least one ASIA Impairment Scale (AIS) grade improvement and three patients (25%) recovered completely. Conclusions Parenchymal spinal cord injury is the single most important determinant in the long term outcome of adult SCIWORA patients. Cord hemorrhage has the worst prognosis and cord edema has the best. Longitudinal signal extension and associated extra neural injuries are also associated with poorer outcomes. Cases with purely neural injuries can be managed conservatively, but associated extra neural injuries, especially disc prolapse and ligamentous instability, warrant surgical management. Keywords Post Traumatic Myelopathy; Spinal Cord Trauma; Computed tomography; Magnetic resonance imaging; SCIWORA PMID:22493651

  8. CB1 cannabinoid receptor enrichment in the ependymal region of the adult human spinal cord

    PubMed Central

    Paniagua-Torija, Beatriz; Arevalo-Martin, Angel; Ferrer, Isidro; Molina-Holgado, Eduardo; Garcia-Ovejero, Daniel

    2015-01-01

    Cannabinoids are involved in the regulation of neural stem cell biology and their receptors are expressed in the neurogenic niches of adult rodents. In the spinal cord of rats and mice, neural stem cells can be found in the ependymal region, surrounding the central canal, but there is evidence that this region is largely different in adult humans: lacks a patent canal and presents perivascular pseudorosettes, typically found in low grade ependymomas. Using Laser Capture Microdissection, Taqman gene expression assays and immunohistochemistry, we have studied the expression of endocannabinoid system components (receptors and enzymes) at the human spinal cord ependymal region. We observe that ependymal region is enriched in CB1 cannabinoid receptor, due to high CB1 expression in GFAP+ astrocytic domains. However, in human spinal cord levels that retain central canal patency we found ependymal cells with high CB1 expression, equivalent to the CB1HIGH cell subpopulation described in rodents. Our results support the existence of ependymal CB1HIGH cells across species, and may encourage further studies on this subpopulation, although only in cases when central canal is patent. In the adult human ependyma, which usually shows central canal absence, CB1 may play a different role by modulating astrocyte functions. PMID:26634814

  9. CB1 cannabinoid receptor enrichment in the ependymal region of the adult human spinal cord.

    PubMed

    Paniagua-Torija, Beatriz; Arevalo-Martin, Angel; Ferrer, Isidro; Molina-Holgado, Eduardo; Garcia-Ovejero, Daniel

    2015-12-04

    Cannabinoids are involved in the regulation of neural stem cell biology and their receptors are expressed in the neurogenic niches of adult rodents. In the spinal cord of rats and mice, neural stem cells can be found in the ependymal region, surrounding the central canal, but there is evidence that this region is largely different in adult humans: lacks a patent canal and presents perivascular pseudorosettes, typically found in low grade ependymomas. Using Laser Capture Microdissection, Taqman gene expression assays and immunohistochemistry, we have studied the expression of endocannabinoid system components (receptors and enzymes) at the human spinal cord ependymal region. We observe that ependymal region is enriched in CB1 cannabinoid receptor, due to high CB1 expression in GFAP+ astrocytic domains. However, in human spinal cord levels that retain central canal patency we found ependymal cells with high CB1 expression, equivalent to the CB1(HIGH) cell subpopulation described in rodents. Our results support the existence of ependymal CB1(HIGH) cells across species, and may encourage further studies on this subpopulation, although only in cases when central canal is patent. In the adult human ependyma, which usually shows central canal absence, CB1 may play a different role by modulating astrocyte functions.

  10. Results of Single-Staged Posterior Decompression and Circumferential Fusion Using a Transpedicular Approach to Correct a Kyphotic Deformity due to Thoracolumbar Spinal Tuberculosis

    PubMed Central

    Modi, Jayprakash; Soman, Shardul; Patel, Harshil; Dhanani, Shrikant

    2016-01-01

    Study Design This is a prospective study. Purpose The aim of this study was to investigate the results of single-staged posterior decompression and circumferential fusion using a transpedicular approach to correct a kyphotic deformity due to thoracolumbar spinal tuberculosis. Overview of Literature Surgical management is frequently an imperative choice to achieve spinal decompression and deformity correction due to tuberculosis to relieve pain, improve neurology, and reconstruct the spine stability. Since the time anterior radical debridement and noninstrumented fusion was described, it has become apparent that even anterior debridement and bone grafting was often unsatisfactory in correcting or preventing the progression of kyphosis deformity. With the advent of modern segmental spinal instrumentation systems, isolated posterior instrumentation; combined anterior and posterior fusion; and single-staged posterior decompression and circumferential fusion have been described by many authors for correcting angular deformity and stabilizing the spine; however, there is a lack of consensus regarding the most effective means of correcting the deformity due to thoracolumbar spinal tuberculosis. Methods This is a prospective study of 20 patients with thoracolumbar spinal tuberculosis who underwent surgery at our institute. Results Twenty patients who were started on antituberculosis treatment underwent surgery using a single-staged posterior approach involving fixation, decompression, and kyphosis correction. Preoperatively, all patients had varying degrees of neurological deficit and a 27.45° average kyphotic angle, which improved. At the 1-year follow-up, correction was maintained at 6.9°, and 55% of patients showed neurological improvement. None of the patients experienced neurological deterioration. Two patients with lumbar spine tuberculosis underwent revision surgery because of nonunion. Conclusions The procedure of posterior decompression, fixation, and

  11. Abundance of gap junctions at glutamatergic mixed synapses in adult Mosquitofish spinal cord neurons.

    PubMed

    Serrano-Velez, Jose L; Rodriguez-Alvarado, Melanie; Torres-Vazquez, Irma I; Fraser, Scott E; Yasumura, Thomas; Vanderpool, Kimberly G; Rash, John E; Rosa-Molinar, Eduardo

    2014-01-01

    "Dye-coupling", whole-mount immunohistochemistry for gap junction channel protein connexin 35 (Cx35), and freeze-fracture replica immunogold labeling (FRIL) reveal an abundance of electrical synapses/gap junctions at glutamatergic mixed synapses in the 14th spinal segment that innervates the adult male gonopodium of Western Mosquitofish, Gambusia affinis (Mosquitofish). To study gap junctions' role in fast motor behavior, we used a minimally-invasive neural-tract-tracing technique to introduce gap junction-permeant or -impermeant dyes into deep muscles controlling the gonopodium of the adult male Mosquitofish, a teleost fish that rapidly transfers (complete in <20 mS) spermatozeugmata into the female reproductive tract. Dye-coupling in the 14th spinal segment controlling the gonopodium reveals coupling between motor neurons and a commissural primary ascending interneuron (CoPA IN) and shows that the 14th segment has an extensive and elaborate dendritic arbor and more gap junctions than do other segments. Whole-mount immunohistochemistry for Cx35 results confirm dye-coupling and show it occurs via gap junctions. Finally, FRIL shows that gap junctions are at mixed synapses and reveals that >50 of the 62 gap junctions at mixed synapses are in the 14th spinal segment. Our results support and extend studies showing gap junctions at mixed synapses in spinal cord segments involved in control of genital reflexes in rodents, and they suggest a link between mixed synapses and fast motor behavior. The findings provide a basis for studies of specific roles of spinal neurons in the generation/regulation of sex-specific behavior and for studies of gap junctions' role in regulating fast motor behavior. Finally, the CoPA IN provides a novel candidate neuron for future studies of gap junctions and neural control of fast motor behaviors.

  12. Abundance of gap junctions at glutamatergic mixed synapses in adult Mosquitofish spinal cord neurons

    PubMed Central

    Serrano-Velez, Jose L.; Rodriguez-Alvarado, Melanie; Torres-Vazquez, Irma I.; Fraser, Scott E.; Yasumura, Thomas; Vanderpool, Kimberly G.; Rash, John E.; Rosa-Molinar, Eduardo

    2014-01-01

    “Dye-coupling”, whole-mount immunohistochemistry for gap junction channel protein connexin 35 (Cx35), and freeze-fracture replica immunogold labeling (FRIL) reveal an abundance of electrical synapses/gap junctions at glutamatergic mixed synapses in the 14th spinal segment that innervates the adult male gonopodium of Western Mosquitofish, Gambusia affinis (Mosquitofish). To study gap junctions’ role in fast motor behavior, we used a minimally-invasive neural-tract-tracing technique to introduce gap junction-permeant or -impermeant dyes into deep muscles controlling the gonopodium of the adult male Mosquitofish, a teleost fish that rapidly transfers (complete in <20 mS) spermatozeugmata into the female reproductive tract. Dye-coupling in the 14th spinal segment controlling the gonopodium reveals coupling between motor neurons and a commissural primary ascending interneuron (CoPA IN) and shows that the 14th segment has an extensive and elaborate dendritic arbor and more gap junctions than do other segments. Whole-mount immunohistochemistry for Cx35 results confirm dye-coupling and show it occurs via gap junctions. Finally, FRIL shows that gap junctions are at mixed synapses and reveals that >50 of the 62 gap junctions at mixed synapses are in the 14th spinal segment. Our results support and extend studies showing gap junctions at mixed synapses in spinal cord segments involved in control of genital reflexes in rodents, and they suggest a link between mixed synapses and fast motor behavior. The findings provide a basis for studies of specific roles of spinal neurons in the generation/regulation of sex-specific behavior and for studies of gap junctions’ role in regulating fast motor behavior. Finally, the CoPA IN provides a novel candidate neuron for future studies of gap junctions and neural control of fast motor behaviors. PMID:25018700

  13. Single-stage management of a neglected radial club hand deformity in an adult

    PubMed Central

    Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul; Mancha, David Ghorau

    2015-01-01

    Radial club hand is an intercalary congenital deformity involving the forearm, wrist and hand. A congenital absence of radius (partial or complete) and ulnar bowing are classical radiographic abnormalities seen in this condition. This deformity is usually treated surgically in infants and young children but the management of this problem in an adult is complex and challenging. We present a neglected case of an adult with severe and rigid deformity that was successfully treated by one-stage correction involving ulnar osteotomy and wrist arthrodesis, simultaneously. PMID:25670786

  14. Cervical Spinal Cord Atrophy Profile in Adult SMN1-Linked SMA

    PubMed Central

    El Mendili, Mohamed-Mounir; Lenglet, Timothée; Stojkovic, Tanya; Behin, Anthony; Guimarães-Costa, Raquel; Salachas, François; Meininger, Vincent; Bruneteau, Gaelle; Le Forestier, Nadine; Laforêt, Pascal; Lehéricy, Stéphane; Benali, Habib; Pradat, Pierre-François

    2016-01-01

    Purpose The mechanisms underlying the topography of motor deficits in spinal muscular atrophy (SMA) remain unknown. We investigated the profile of spinal cord atrophy (SCA) in SMN1-linked SMA, and its correlation with the topography of muscle weakness. Materials and Methods Eighteen SMN1-linked SMA patients type III/V and 18 age/gender-matched healthy volunteers were included. Patients were scored on manual muscle testing and functional scales. Spinal cord was imaged using 3T MRI system. Radial distance (RD) and cord cross-sectional area (CSA) measurements in SMA patients were compared to those in controls and correlated with strength and disability scores. Results CSA measurements revealed a significant cord atrophy gradient mainly located between C3 and C6 vertebral levels with a SCA rate ranging from 5.4% to 23% in SMA patients compared to controls. RD was significantly lower in SMA patients compared to controls in the anterior-posterior direction with a maximum along C4 and C5 vertebral levels (p-values < 10−5). There were no correlations between atrophy measurements, strength and disability scores. Conclusions Spinal cord atrophy in adult SMN1-linked SMA predominates in the segments innervating the proximal muscles. Additional factors such as neuromuscular junction or intrinsic skeletal muscle defects may play a role in more complex mechanisms underlying weakness in these patients. PMID:27089520

  15. Regulation of neuropilin 1 by spinal cord injury in adult rats.

    PubMed

    Agudo, Marta; Robinson, Michelle; Cafferty, William; Bradbury, Elizabeth J; Kilkenny, Carol; Hunt, Stephen P; McMahon, Stephen B

    2005-03-01

    Using RT-PCR, in situ hybridization, Western blotting, and immunofluorescence, we have analyzed the expression of neuropilin 1 (Np1) in two models of spinal cord injury (spinal cord hemisection and dorsal column crush) and following dorsal root rhizotomy in adult rats. Our results show that Np1 RNA and protein are up-regulated in the spinal cord after all these lesions but remain unaltered in the adjacent dorsal root ganglia. In control animals, Np1 levels in the spinal cord are low and appear to be localized mainly in blood vessels, motoneurons, and in the superficial layers of the dorsal horn. After DCC and rhizotomy, Np1 is expressed de novo around the injury and in the deafferentated dorsal horn, respectively, mainly by OX42-positive microglial cells. Both lesions affect the sensory projections, and interestingly a consistent increase of Np1 signal is additionally seen in the dorsal horn where these projections terminate. Unexpectedly, this increase is bilateral after unilateral rhizotomy.

  16. Adult spinal V2a interneurons show increased excitability and serotonin-dependent bistability.

    PubMed

    Husch, Andreas; Dietz, Shelby B; Hong, Diana N; Harris-Warrick, Ronald M

    2015-02-15

    In mice, most studies of the organization of the spinal central pattern generator (CPG) for locomotion, and its component neuron classes, have been performed on neonatal [postnatal day (P)2-P4] animals. While the neonatal spinal cord can generate a basic locomotor pattern, it is often argued that the CPG network is in an immature form whose detailed properties mature with postnatal development. Here, we compare intrinsic properties and serotonergic modulation of the V2a class of excitatory spinal interneurons in behaviorally mature (older than P43) mice to those in neonatal mice. Using perforated patch recordings from genetically tagged V2a interneurons, we revealed an age-dependent increase in excitability. The input resistance increased, the rheobase values decreased, and the relation between injected current and firing frequency (F/I plot) showed higher excitability in the adult neurons, with almost all neurons firing tonically during a current step. The adult action potential (AP) properties became narrower and taller, and the AP threshold hyperpolarized. While in neonates the AP afterhyperpolarization was monophasic, most adult V2a interneurons showed a biphasic afterhyperpolarization. Serotonin increased excitability and depolarized most neonatal and adult V2a interneurons. However, in ∼30% of adult V2a interneurons, serotonin additionally elicited spontaneous intrinsic membrane potential bistability, resulting in alternations between hyperpolarized and depolarized states with a dramatically decreased membrane input resistance and facilitation of evoked plateau potentials. This was never seen in younger animals. Our findings indicate a significant postnatal development of the properties of locomotor-related V2a interneurons, which could alter their interpretation of synaptic inputs in the locomotor CPG.

  17. Temporal changes in the level of neurotrophins in the spinal cord and associated precentral gyrus following spinal hemisection in adult Rhesus monkeys.

    PubMed

    Zhang, Hong-Tian; Gao, Zhi-Yu; Chen, Yi-Zhao; Wang, Ting-Hua

    2008-12-01

    Neurotrophins (NTs) appear to be crucial for the survival and potential regeneration of injured neurons. However, their temporal changes and remote regulations following spinal cord injury (SCI) have been only partially determined, especially in primates. In this study, ELISA was performed on the extracts of injured spinal cord and the associated precentral gyrus contralateral to the site of spinal cord hemisection to investigate the temporal changes in the levels of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3) and neurotrophin-4 (NT-4) in adult rhesus monkeys subjected to T8 spinal hemisection. Animals were allowed to survive 3, 7, 14, 30 and 90 days post-operation (dpo). In the spinal cord, the levels of NGF, BDNF and NT-3 sharply decreased between 3 and 7dpo. Thereafter, the levels of NGF and BDNF were transiently elevated while NT-3 level continuously increased and recovered to normal level at 30dpo. In the contralateral precentral gyrus (cPG), only the NT-3 level was altered and in fact elevated above the normal value. No obvious changes were observed in NT-4 level in any of the regions studied. Taken together, the present findings indicated that intrinsic NGF, BDNF and NT-3 may play a local role in the responses to the SCI in primates. Especially, the increase of NT-3 level occurred continuously in both the cPG and the spinal cord pointed to a possible transportation of NT-3 to the cord following SCI.

  18. Hindlimb Stretching Alters Locomotor Function Post-Spinal Cord Injury in the Adult Rat

    PubMed Central

    Caudle, Krista L.; Atkinson, Darryn A.; Brown, Edward H.; Donaldson, Katie; Seibt, Erik; Chea, Tim; Smith, Erin; Chung, Karianne; Shum-Siu, Alice; Cron, Courtney C.; Magnuson, David S. K.

    2014-01-01

    Background Stretching is a widely accepted standard-of-care therapy following spinal cord injury that has not been systematically studied in animal models. Objective To investigate the influence of a daily stretch-based physical therapy program on locomotor recovery in adult rats with moderate T9 contusive SCI. Methods A randomized treatment and control study of stretching in an animal model of acute spinal cord injury (SCI). Moderate spinal cord injuries were delivered with the NYU Impactor. Daily stretching (30 min./day, 5 days/wk for 8 wks) was provided by a team of animal handlers. Hindlimb function was assessed using the BBB Open Field Locomotor Scale and kinematically. Passive range-of-motion for each joint was determined weekly using a goniometer. Results Declines in hindlimb function during overground stepping were observed for the first 4 weeks. BBB scores improved weeks 5–10 but remained below the control group. Stretched animals had significant deficits in knee passive ROM starting at week 4 and for the duration of the study. Kinematic assessment showed decreased joint excursion during stepping that partially recovered beginning at week 5. Conclusion Stretch-based therapy significantly impaired functional recovery in adult rats with a moderate contusive SCI at T10. The negative impact on function was greatest acutely, but persisted even after the stretching ceased at 8 weeks post-injury. PMID:25106555

  19. Intravenous multipotent adult progenitor cell treatment decreases inflammation leading to functional recovery following spinal cord injury

    PubMed Central

    DePaul, Marc A.; Palmer, Marc; Lang, Bradley T.; Cutrone, Rochelle; Tran, Amanda P.; Madalena, Kathryn M.; Bogaerts, Annelies; Hamilton, Jason A.; Deans, Robert J.; Mays, Robert W.; Busch, Sarah A.; Silver, Jerry

    2015-01-01

    Following spinal cord injury (SCI), immune-mediated secondary processes exacerbate the extent of permanent neurological deficits. We investigated the capacity of adult bone marrow-derived stem cells, which exhibit immunomodulatory properties, to alter inflammation and promote recovery following SCI. In vitro, we show that human multipotent adult progenitor cells (MAPCs) have the ability to modulate macrophage activation, and prior exposure to MAPC secreted factors can reduce macrophage-mediated axonal dieback of dystrophic axons. Using a contusion model of SCI, we found that intravenous delivery of MAPCs one day, but not immediately, after SCI significantly improves urinary and locomotor recovery, which was associated with marked spinal cord tissue sparing. Intravenous MAPCs altered the immune response in the spinal cord and periphery, however biodistribution studies revealed that no MAPCs were found in the cord and instead preferentially homed to the spleen. Our results demonstrate that MAPCs exert their primary effects in the periphery and provide strong support for the use of these cells in acute human contusive SCI. PMID:26582249

  20. Novel application of pre-operative vertebral body embolization to reduce intraoperative blood loss during a three-column spinal osteotomy for non-oncologic spinal deformity.

    PubMed

    Tuchman, Alexander; Mehta, Vivek A; Mack, William J; Acosta, Frank L

    2015-04-01

    Three column osteotomies (3CO) of the lumbar spine are powerful corrective procedures used in the treatment of kyphoscoliosis. Their efficacy comes at the cost of high reported complication rates, notably significant estimated blood loss (EBL). Previously reported techniques to reduce EBL have had modest efficacy. Here we describe a potential technique to decrease EBL during pedicle subtraction osteotomy (PSO) of the lumbar spine by means of pre-operative vertebral body embolization - a technique traditionally used to reduce blood loss prior to spinal column tumor resection. We present a 62-year-old man with iatrogenic kyphoscoliosis who underwent staged deformity correction. Stage 1 involved thoracolumbar instrumentation followed by transarterial embolization of the L4 vertebral body through bilateral segmental arteries. A combination of polyvinyl alcohol particles and Gelfoam (Pfizer, New York, NY, USA) were used. Following embolization there was decreased angiographic blood flow to the small vessels of the L4 vertebral body, while the segmental arteries remained patent. Stage 2 consisted of an L4 PSO and fusion. The EBL during the PSO procedure was 1L, which compared favorably to that during previous PSO at this institution as well as to quantities reported in previous literature. There have been no short term (5 month follow-up) complications attributable to the vertebral body embolization or surgical procedure. Although further investigation into this technique is required to better characterize its safety and efficacy in reducing EBL during 3CO, we believe this patient illustrates the potential utility of pre-operative vertebral embolization in the setting of non-oncologic deformity correction surgery.

  1. Spinal cord deformation due to nozzle gas flow effects using optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Wong, Ronnie J.; Jivraj, Jamil; Vuong, Barry; Ramjist, Joel; Sun, Cuiru; Huang, Yize; Yang, Victor X. D.

    2015-03-01

    The use of gas assistance in laser machining hard materials is well established in manufacturing but not in the context of surgery. Laser cutting of osseous tissue in the context of neurosurgery can benefit from gas-assist but requires an understanding of flow and pressure effects to minimize neural tissue damage. In this study we acquire volumetric flow rates through a gas nozzle on the spinal cord, with dura and without dura.

  2. Adult-onset intradural spinal teratoma in the lumbar spine: A case report.

    PubMed

    Arai, Yasuhisa; Takahashi, Masaki; Takeda, Koutarou; Shitoto, Katsuo

    2000-12-01

    Intradural spinal teratoma is a very rare tumour that can be associated with dysraphic defects. We report a case of adult-onset intradural spinal teratoma in the lumbar spine. The patient was a 54-year-old female who had chief complaints of a gait disturbance. X-rays showed an enlargement of the interpedicular distance at L3/L4 and spina bifida distal to L4. MRI showed a spindle-shaped tumour between L2 and L5. We performed laminotomy using an ultrasonic surgical knife. Pathological diagnosis of the resected tumour was matured teratoma. The diagnosis of matured teratoma was made because the tumour had no epithelium and a layered structure including prostate tissue, matured fat, cartilage and sweat gland.

  3. Correction of neglected vertical talus deformity in an adult.

    PubMed

    Lui, Tun Hing

    2015-02-18

    Congenital vertical talus is an uncommon foot deformity that is characterised by a fixed dorsal dislocation of the navicular on the talar head and neck. Left untreated, a congenital vertical talus causes significant long-term disability. We present a case of neglected vertical talus in a middle-aged woman who was successfully treated with resection of the talar head and tendon transfers.

  4. Response of ependymal progenitors to spinal cord injury or enhanced physical activity in adult rat.

    PubMed

    Cizkova, Dasa; Nagyova, Miriam; Slovinska, Lucia; Novotna, Ivana; Radonak, Jozef; Cizek, Milan; Mechirova, Eva; Tomori, Zoltan; Hlucilova, Jana; Motlik, Jan; Sulla, Igor; Vanicky, Ivo

    2009-09-01

    Ependymal cells (EC) in the spinal cord central canal (CC) are believed to be responsible for the postnatal neurogenesis following pathological or stimulatory conditions. In this study, we have analyzed the proliferation of the CC ependymal progenitors in adult rats processed to compression SCI or enhanced physical activity. To label dividing cells, a single daily injection of Bromo-deoxyuridine (BrdU) was administered over a 14-day-survival period. Systematic quantification of BrdU-positive ependymal progenitors was performed by using stereological principles of systematic, random sampling, and optical Dissector software. The number of proliferating BrdU-labeled EC increased gradually with the time of survival after both paradigms, spinal cord injury, or increased physical activity. In the spinal cord injury group, we have found 4.9-fold (4 days), 7.1-fold (7 days), 4.9-fold (10 days), and 5.6-fold (14 days) increase of proliferating EC in the rostro-caudal regions, 4 mm away from the epicenter. In the second group subjected to enhanced physical activity by running wheel, we have observed 2.1-2.6 fold increase of dividing EC in the thoracic spinal cord segments at 4 and 7 days, but no significant progression at 10-14 days. Nestin was rapidly induced in the ependymal cells of the CC by 2-4 days and expression decreased by 7-14 days post-injury. Double immunohistochemistry showed that dividing cells adjacent to CC expressed astrocytic (GFAP, S100beta) or nestin markers at 14 days. These data demonstrate that SCI or enhanced physical activity in adult rats induces an endogenous ependymal cell response leading to increased proliferation and differentiation primarily into macroglia or cells with nestin phenotype.

  5. Electrophysiological properties of newborn and adult rat spinal cord glycine receptors expressed in Xenopus oocytes.

    PubMed Central

    Morales, A; Nguyen, Q T; Miledi, R

    1994-01-01

    The properties of glycine receptors (GlyRs) from newborn and adult rat spinal cord were studied in Xenopus oocytes injected with whole mRNA or the heavy (H) or light (L) mRNA fractions encoding their respective GlyRs. Mean open times and conductances of channels gated by H- or L-GlyRs were determined by noise analysis or voltage jumps. We found that adult H- and L-GlyRs opened channels that differed in their mean open time but had the same channel conductance. Both H- and L-GlyRs gated Cl- currents that displayed a similarly strong outward rectification. Nevertheless, single channels of adult H- and L-GlyRs did not rectify and their mean open times were only slightly altered by voltage. It follows that the outward rectification of adult GlyRs is due mainly to a reduction in the number of open channels. In contrast to H-GlyRs, whose characteristics seem to remain essentially unchanged with age, L-GlyRs from newborn and adult rats have different properties. Channels of newborn L-GlyRs have a higher conductance, longer open time, and greater voltage dependency than those from the adult. Interestingly, properties of newborn GlyRs expressed by whole mRNA were markedly different from those encoded by newborn or adult L or H mRNA. These results demonstrate that the functional heterogeneity of GlyRs is developmentally regulated. PMID:8159710

  6. Lessons for spinal cord injury rehabilitation taken from adult developmental psychology: 2011 Essie Morgan Lecture

    PubMed Central

    Rose, Jon

    2012-01-01

    Background/objective Developmental phases affect how individuals cope with and challenge threats to self-concept, health and functioning. Understanding prominent models of adult psychological development can help spinal cord injury/disease (SCI/D) rehabilitation professionals facilitate positive change and growth. Design Author's theoretical model informed by literature review and personal experience. Setting Veterans administration (VA) medical center interdisciplinary outpatient clinic providing primary and specialty care to veterans with spinal cord injuries and disorders. Conclusion Threats to life expectations, health, well-being, identity, and other aspects of self create crises that can result in psychopathology or psychological growth. SCI/D can present multiple threats across the lifespan. For example, self-image, ability to perform various activities, ability to feel attractive, and even life itself may be challenged by SCI/D or its complications. Threats may be perceived at the time of injury or onset of symptoms. Also, as the injured body declines further over time, complications can cause significant temporary or permanent functional decline. Individuals interpret each of these threats in the context of current developmental needs. How people cope is influenced by developmental factors and personality traits. An integrated model of adult psychological development based on the works of Erikson, Gutmann, and Baltes is related to the literature on coping with SCI/D. This model provides insights that interdisciplinary rehabilitation teams may use to facilitate personal growth, optimal functioning, and physical health as adults with SCI negotiate normal developmental challenges throughout their lifetimes. PMID:22507022

  7. Wnts Are Expressed in the Ependymal Region of the Adult Spinal Cord.

    PubMed

    Gonzalez-Fernandez, Carlos; Arevalo-Martin, Angel; Paniagua-Torija, Beatriz; Ferrer, Isidro; Rodriguez, Francisco J; Garcia-Ovejero, Daniel

    2016-10-08

    The Wnt family of proteins plays key roles during central nervous system development and in several physiological processes during adulthood. Recently, experimental evidence has linked Wnt-related genes to regulation and maintenance of stem cells in the adult neurogenic niches. In the spinal cord, the ependymal cells surrounding the central canal form one of those niches, but little is known about their Wnt expression patterns. Using microdissection followed by TaqMan® low-density arrays, we show here that the ependymal regions of young, mature rats and adult humans express several Wnt-related genes, including ligands, conventional and non-conventional receptors, co-receptors, and soluble inhibitors. We found 13 genes shared between rats and humans, 4 exclusively expressed in rats and 9 expressed only in humans. Also, we observed a reduction with age on spontaneous proliferation of ependymal cells in rats paralleled by a decrease in the expression of Fzd1, Fzd8, and Fzd9. Our results suggest a role for Wnts in the regulation of the adult spinal cord neurogenic niche and provide new data on the specific differences in this region between humans and rodents.

  8. Spinal Injuries in Children

    PubMed Central

    Basu, Saumyajit

    2012-01-01

    About 5% of spinal injuries occur in children – however the consequences to the society are devastating, all the more so because the cervical spine is more commonly affected. Anatomical differences with adults along with the inherent elasticity of the pediatric spine, makes these injuries a biomechanically separate entity. Hence clinical manifestations are unique, one of which is the Spinal Cord Injury Without Radiological Abnormality. With the advent of high quality MRI and CT scan along with digital X-ray, it is now possible to exactly delineate the anatomical location, geometrical configuration, and the pathological extent of the injury. This has improved the management strategies of these unfortunate children and the role of surgical stabilization in unstable injuries can be more sharply defined. However these patients should be followed up diligently because of the recognized long term complications of spinal deformity and syringomyelia. PMID:22855681

  9. Posterior vertebral column resection with 360-degree osteosynthesis in osteoporotic kyphotic deformity and spinal cord compression.

    PubMed

    Dreimann, Marc; Hempfing, Axel; Stangenberg, Martin; Viezens, Lennart; Weiser, Lukas; Czorlich, Patrick; Eicker, Sven Oliver

    2017-03-09

    Osteoporotic fractures with severe kyphosis and neurologic deficits often require decompression and stabilisation. To reduce the risk of procedure-related complications, single-stage posterolateral vertebrectomy and a 360-degree fusion can be performed. An adequate reduction of kyphotic deformity through this approach has not been reported. The aim of this study is to investigate the efficacy of kyphotic deformity reduction by this approach in osteoporotic situation. A retrospective analysis and chart review was performed for 10 consecutive patients who underwent posterolateral decompression and posterior vertebrectomy with dorsal mesh stabilisation and reduction of kyphotic deformity. Preoperative back pain was 8.6 on a visual analogue scale; it was reduced to 5.5 at discharge and 3.7 at the latest follow-up (18 months). The Frankel score improved from D to E (three patients) or was equal (E). Radiological segmental kyphosis was corrected from a mean of 25° to 5° (p < 0.008) postoperatively with a loss of 3° at follow-up (p < 0.005). Single-stage posterolateral vertebrectomy allow for a fast and safe reconstitution/preservation of neurological function in patients with osteoporotic fracture and kyphotic deformity. A significant correction of often-accompanied hyperkyphosis is possible without neurological deterioration and with an improved sagittal profile and good pain reduction.

  10. Nestin- and doublecortin-positive cells reside in adult spinal cord meninges and participate in injury-induced parenchymal reaction.

    PubMed

    Decimo, Ilaria; Bifari, Francesco; Rodriguez, Francisco Javier; Malpeli, Giorgio; Dolci, Sissi; Lavarini, Valentina; Pretto, Silvia; Vasquez, Sandra; Sciancalepore, Marina; Montalbano, Alberto; Berton, Valeria; Krampera, Mauro; Fumagalli, Guido

    2011-12-01

    Adult spinal cord has little regenerative potential, thus limiting patient recovery following injury. In this study, we describe a new population of cells resident in the adult rat spinal cord meninges that express the neural stem/precursor markers nestin and doublecortin. Furthermore, from dissociated meningeal tissue a neural stem cell population was cultured in vitro and subsequently shown to differentiate into functional neurons or mature oligodendrocytes. Proliferation rate and number of nestin- and doublecortin-positive cells increased in vivo in meninges following spinal cord injury. By using a lentivirus-labeling approach, we show that meningeal cells, including nestin- and doublecortin-positive cells, migrate in the spinal cord parenchyma and contribute to the glial scar formation. Our data emphasize the multiple roles of meninges in the reaction of the parenchyma to trauma and indicate for the first time that spinal cord meninges are potential niches harboring stem/precursor cells that can be activated by injury. Meninges may be considered as a new source of adult stem/precursor cells to be further tested for use in regenerative medicine applied to neurological disorders, including repair from spinal cord injury.

  11. Effects of mechanical horseback riding velocity on spinal alignment in young adults

    PubMed Central

    Lim, Jae-Heon; Cho, Woon-Su; Lee, Seong-Jin; Park, Chi-Bok; Park, Jang-Sung

    2016-01-01

    [Purpose] This study aimed to determine if the velocity of mechanical horseback-riding training can improve spinal alignment in young adults. [Subjects and Methods] Thirty-six subjects were enrolled in this study. The subjects were randomly allocated into high-, moderate-, and low-velocity mechanical horseback-riding training groups. All participants completed one 20-minute session per day, 3 days per week, for 6 weeks. The evaluation was performed before and 6 weeks after the training intervention. The spinal alignment was measured by a Formetric III device. The measurement items were kyphotic angle, lordotic angle, trunk inclination, pelvic torsion, pelvic rotation, and lateral deviation. The data were analyzed using analysis of covariance to determine the statistical significance. [Results] The kyphotic angle and trunk inclination were significantly different among the groups. The kyphotic angles of the high- and moderate-velocity groups were significantly lower than that of the low-velocity group after the intervention. The trunk inclination of the high-velocity group was significantly lower than that of the low-velocity group after intervention. [Conclusion] Higher-velocity mechanical horseback-riding training is more effective than lower-velocity mechanical horseback-riding training for improving spinal alignment. PMID:27390428

  12. Effects of enriched housing on functional recovery after spinal cord contusive injury in the adult rat.

    PubMed

    Lankhorst, A J; ter Laak, M P; van Laar, T J; van Meeteren, N L; de Groot, J C; Schrama, L H; Hamers, F P; Gispen, W H

    2001-02-01

    To date, most research performed in the area of spinal cord injury focuses on treatments designed to either prevent spreading lesion (secondary injury) or to enhance outgrowth of long descending and ascending fiber tracts around or through the lesion. In the last decade, however, several authors have shown that it is possible to enhance locomotor function after spinal cord injury in both animals and patients using specific training paradigms. As a first step towards combining such training paradigms with pharmacotherapy, we evaluated recovery of function in adult rats sustaining a spinal cord contusion injury (MASCIS device, 12.5 mm at T8), either housed in an enriched environment or in standard cages (n = 15 in both groups). The animals in the enriched environment were stimulated to increase their locomotor activity by placing water and food on opposite sides of the cage. As extra stimuli, a running wheel and several other objects were added to the cage. We show that exposure to the enriched environment improves gross and fine locomotor recovery as measured by the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale, the BBB subscale, the Gridwalk, and the Thoracolumbar height test. However, no group differences were found on our electrophysiological parameters nor on the amount of spared white matter. These data justify further studies on enriched housing and more controlled exercise training, with their use as potential additive to pharmacological intervention.

  13. Expression of some neurotrophins in the spinal motoneurons after cord hemisection in adult rats.

    PubMed

    Qin, Dan Xia; Zou, Xiao Li; Luo, Wei; Zhang, Wei; Zhang, Hong Tian; Li, Xiao Li; Zhang, Han; Wang, Xu Yang; Wang, Ting-Hua

    2006-12-27

    There are numerous studies reporting on the crucial roles of neurotrophins (NTFs) in neuronal survival and sprouting after spinal cord injury (SCI). But studies on endogenous changes of neurotrophins after SCI are few. In this study we explored by means of immunohistochemistry the localization of NGF, BDNF and NT-3 in the normal adult spinal cord (SC) and the changes in the expression of these chemicals in the ventral horn after right cord hemisection at T9-10. The results showed an obvious increase in the numbers of NGF, BDNF and NT-3-immunoreactive neurons in the ventral horn and also an increase in their intracellular optical density (O.D.) at 3, 7 and 21 days after cord hemisection, when compared with sham-operated rats. The expression of NGF peaked at 7 days postoperation (dpo), while BDNF and NT-3 expressions peaked at 3 dpo. Evaluation of hindlimb functions by Basso Beattie Bresnahan (BBB) scoring showed that the hindlimb support and stepping function improved very quickly at 7 dpo. This study indicated that NGF, BDNF and NT-3 could play important but different roles in the mechanisms of spinal neuroplasticity at different times after SCI.

  14. Effects of mechanical horseback riding velocity on spinal alignment in young adults.

    PubMed

    Lim, Jae-Heon; Cho, Woon-Su; Lee, Seong-Jin; Park, Chi-Bok; Park, Jang-Sung

    2016-06-01

    [Purpose] This study aimed to determine if the velocity of mechanical horseback-riding training can improve spinal alignment in young adults. [Subjects and Methods] Thirty-six subjects were enrolled in this study. The subjects were randomly allocated into high-, moderate-, and low-velocity mechanical horseback-riding training groups. All participants completed one 20-minute session per day, 3 days per week, for 6 weeks. The evaluation was performed before and 6 weeks after the training intervention. The spinal alignment was measured by a Formetric III device. The measurement items were kyphotic angle, lordotic angle, trunk inclination, pelvic torsion, pelvic rotation, and lateral deviation. The data were analyzed using analysis of covariance to determine the statistical significance. [Results] The kyphotic angle and trunk inclination were significantly different among the groups. The kyphotic angles of the high- and moderate-velocity groups were significantly lower than that of the low-velocity group after the intervention. The trunk inclination of the high-velocity group was significantly lower than that of the low-velocity group after intervention. [Conclusion] Higher-velocity mechanical horseback-riding training is more effective than lower-velocity mechanical horseback-riding training for improving spinal alignment.

  15. Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes.

    PubMed

    Liu, Ning; Wood, Kirkham B

    2017-03-01

    OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

  16. Comparison of expression of inflammatory cytokines in the spinal cord between young adult and aged beagle dogs.

    PubMed

    Lee, Dae Hwan; Ahn, Ji Hyeon; Park, Joon Ha; Yan, Bing Chun; Cho, Jeong-Hwi; Kim, In Hye; Lee, Jae-Chul; Jang, Sang-Hun; Lee, Myoung Hyo; Hwang, In Koo; Moon, Seung Myung; Lee, Bonghee; Cho, Jun Hwi; Shin, Hyung-Cheul; Kim, Jin Sang; Won, Moo-Ho

    2013-07-01

    Aging is an inevitable process that occurs in the whole body system accompanying with many functional and morphological changes. Inflammation is known as one of age-related factors, and inflammatory changes could enhance mortality risk. In this study, we compared immunoreactivities of inflammatory cytokines, such as interleukin (IL)-2 (a pro-inflammatory cytokine), its receptor (IL-2R), IL-4 (an anti-inflammatory cytokine), and its receptor (IL-4R) in the cervical and lumbar spinal cord of young adult (2-3 years old) and aged (10-12 years old) beagle dogs using immunohistochemistry and western blotting. IL-2 and IL-2R-immunoreactive nerve cells were found throughout the gray matter of the cervical and lumbar spinal cord of young adult and aged dogs. In the spinal cord neurons of the aged dog, immunoreactivity and protein levels were apparently increased compared with those in the young adult dog. Change patterns of IL-4- and IL-4R-immunoreactive cells and their protein levels were also similar to those in IL-2 and IL-2R; however, IL-4 and IL-4R immunoreactivity in the periphery of the neuronal cytoplasm in the aged dog was much stronger than that in the young adult dog. These results indicate that the increase of inflammatory cytokines and their receptors in the aged spinal cord might be related to maintaining a balance of inflammatory reaction in the spinal cord during normal aging.

  17. Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults.

    PubMed

    Aldave, Guillermo; Hansen, Daniel; Hwang, Steven W; Moreno, Amee; Briceño, Valentina; Jea, Andrew

    2017-03-31

    OBJECTIVE Tethered cord syndrome is the clinical manifestation of an abnormal stretch on the spinal cord, presumably causing mechanical injury, a compromised blood supply, and altered spinal cord metabolism. Tethered cord release is the standard treatment for tethered cord syndrome. However, direct untethering of the spinal cord carries potential risks, such as new neurological deficits from spinal cord injury, a CSF leak from opening the dura, and retethering of the spinal cord from normal scar formation after surgery. To avoid these risks, the authors applied spinal column shortening to children and transitional adults with primary and secondary tethered cord syndrome and report treatment outcomes. The authors' aim with this study was to determine the safety and efficacy of spinal column shortening for tethered cord syndrome by analyzing their experience with this surgical technique. METHODS The authors retrospectively reviewed the demographic and procedural data of children and young adults who had undergone spinal column shortening for primary or secondary tethered cord syndrome. RESULTS Seven patients with tethered cord syndrome caused by myelomeningocele, lipomyelomeningocele, and transitional spinal lipoma were treated with spinal column shortening. One patient with less than 24 months of follow-up was excluded from further analysis. There were 3 males and 4 females; the average age at the time was surgery was 16 years (range 8-30 years). Clinical presentations for our patients included pain (in 5 patients), weakness (in 4 patients), and bowel/bladder dysfunction (in 4 patients). Spinal column osteotomy was most commonly performed at the L-1 level, with fusion between T-12 and L-2 using a pedicle screw-rod construct. Pedicle subtraction osteotomy was performed in 6 patients, and vertebral column resection was performed in 1 patient. The average follow-up period was 31 months (range 26-37 months). Computed tomography-based radiographic outcomes showed solid

  18. 3D Morphology Prediction of Progressive Spinal Deformities from Probabilistic Modeling of Discriminant Manifolds.

    PubMed

    Kadoury, Samuel; Mandel, William; Roy-Beaudry, Marjolaine; Nault, Marie-Lyne; Parent, Stefan

    2017-01-23

    We introduce a novel approach for predicting the progression of adolescent idiopathic scoliosis from 3D spine models reconstructed from biplanar X-ray images. Recent progress in machine learning have allowed to improve classification and prognosis rates, but lack a probabilistic framework to measure uncertainty in the data. We propose a discriminative probabilistic manifold embedding where locally linear mappings transform data points from high-dimensional space to corresponding lowdimensional coordinates. A discriminant adjacency matrix is constructed to maximize the separation between progressive and non-progressive groups of patients diagnosed with scoliosis, while minimizing the distance in latent variables belonging to the same class. To predict the evolution of deformation, a baseline reconstruction is projected onto the manifold, from which a spatiotemporal regression model is built from parallel transport curves inferred from neighboring exemplars. Rate of progression is modulated from the spine flexibility and curve magnitude of the 3D spine deformation. The method was tested on 745 reconstructions from 133 subjects using longitudinal 3D reconstructions of the spine, with results demonstrating the discriminatory framework can identify between progressive and non-progressive of scoliotic patients with a classification rate of 81% and prediction differences of 2.1o in main curve angulation, outperforming other manifold learning methods. Our method achieved a higher prediction accuracy and improved the modeling of spatiotemporal morphological changes in highly deformed spines compared to other learning methods.

  19. Design and evaluation of an MRI compatible axial compression device for 3D assessment of spinal deformity and flexibility in AIS.

    PubMed

    Adam, Clayton; Izatt, Maree; Askin, Geoffrey

    2010-01-01

    Magnetic Resonance Imaging (MRI) offers a valuable research tool for the assessment of 3D spinal deformity in AIS, however the horizontal patient position imposed by conventional scanners removes the axial compressive loading on the spine. The objective of this study was to design, construct and test an MRI compatible compression device for research into the effect of axial loading on spinal deformity using supine MRI scans. The device was evaluated by performing unloaded and loaded supine MRI scans on a series of 10 AIS patients. The patient group had a mean initial (unloaded) major Cobb angle of 43+/-7 degrees, which increased to 50+/-9 degrees on application of the compressive load. The 7 degrees increase in mean Cobb angle is consistent with that reported by a previous study comparing standing versus supine posture in scoliosis patients (Torell et al, 1985. Spine 10:425-7).

  20. Performance evaluation of MIND demons deformable registration of MR and CT images in spinal interventions

    NASA Astrophysics Data System (ADS)

    Reaungamornrat, S.; De Silva, T.; Uneri, A.; Goerres, J.; Jacobson, M.; Ketcha, M.; Vogt, S.; Kleinszig, G.; Khanna, A. J.; Wolinsky, J.-P.; Prince, J. L.; Siewerdsen, J. H.

    2016-12-01

    Accurate intraoperative localization of target anatomy and adjacent nervous and vascular tissue is essential to safe, effective surgery, and multimodality deformable registration can be used to identify such anatomy by fusing preoperative CT or MR images with intraoperative images. A deformable image registration method has been developed to estimate viscoelastic diffeomorphisms between preoperative MR and intraoperative CT using modality-independent neighborhood descriptors (MIND) and a Huber metric for robust registration. The method, called MIND Demons, optimizes a constrained symmetric energy functional incorporating priors on smoothness, geodesics, and invertibility by alternating between Gauss-Newton optimization and Tikhonov regularization in a multiresolution scheme. Registration performance was evaluated for the MIND Demons method with a symmetric energy formulation in comparison to an asymmetric form, and sensitivity to anisotropic MR voxel-size was analyzed in phantom experiments emulating image-guided spine-surgery in comparison to a free-form deformation (FFD) method using local mutual information (LMI). Performance was validated in a clinical study involving 15 patients undergoing intervention of the cervical, thoracic, and lumbar spine. The target registration error (TRE) for the symmetric MIND Demons formulation (1.3  ±  0.8 mm (median  ±  interquartile)) outperformed the asymmetric form (3.6  ±  4.4 mm). The method demonstrated fairly minor sensitivity to anisotropic MR voxel size, with median TRE ranging 1.3-2.9 mm for MR slice thickness ranging 0.9-9.9 mm, compared to TRE  =  3.2-4.1 mm for LMI FFD over the same range. Evaluation in clinical data demonstrated sub-voxel TRE (<2 mm) in all fifteen cases with realistic deformations that preserved topology with sub-voxel invertibility (0.001 mm) and positive-determinant spatial Jacobians. The approach therefore appears robust against realistic

  1. Neonatal local noxious insult affects gene expression in the spinal dorsal horn of adult rats.

    PubMed

    Ren, Ke; Novikova, Svetlana I; He, Fang; Dubner, Ronald; Lidow, Michael S

    2005-09-22

    Neonatal noxious insult produces a long-term effect on pain processing in adults. Rats subjected to carrageenan (CAR) injection in one hindpaw within the sensitive period develop bilateral hypoalgesia as adults. In the same rats, inflammation of the hindpaw, which was the site of the neonatal injury, induces a localized enhanced hyperalgesia limited to this paw. To gain an insight into the long-term molecular changes involved in the above-described long-term nociceptive effects of neonatal noxious insult at the spinal level, we performed DNA microarray analysis (using microarrays containing oligo-probes for 205 genes encoding receptors and transporters for glutamate, GABA, and amine neurotransmitters, precursors and receptors for neuropeptides, and neurotrophins, cytokines and their receptors) to compare gene expression profiles in the lumbar spinal dorsal horn (LDH) of adult (P60) male rats that received neonatal CAR treatment within (at postnatal day 3; P3) and outside (at postnatal 12; P12) of the sensitive period. The data were obtained both without inflammation (at baseline) and during complete Freund's adjuvant induced inflammation of the neonatally injured paw. The observed changes were verified by real-time RT-PCR. This study revealed significant basal and inflammation-associated aberrations in the expression of multiple genes in the LDH of adult animals receiving CAR injection at P3 as compared to their expression levels in the LDH of animals receiving either no injections or CAR injection at P12. In particular, at baseline, twelve genes (representing GABA, serotonin, adenosine, neuropeptide Y, cholecystokinin, opioid, tachykinin and interleukin systems) were up-regulated in the bilateral LDH of the former animals. The baseline condition in these animals was also characterized by up-regulation of seven genes (encoding members of GABA, cholecystokinin, histamine, serotonin, and neurotensin systems) in the LDH ipsilateral to the neonatally-injured paw. The

  2. Dietary fatty acids and inflammation in the vertebral column of Atlantic salmon, Salmo salar L., smolts: a possible link to spinal deformities.

    PubMed

    Gil Martens, L; Lock, E J; Fjelldal, P G; Wargelius, A; Araujo, P; Torstensen, B E; Witten, P E; Hansen, T; Waagbø, R; Ørnsrud, R

    2010-12-01

    Vegetable oils (Vo) are an alternative to fish oil (Fo) in aquaculture feeds. This study aimed to evaluate the effect of dietary soybean oil (Vo diet), rich in linoleic acid, and of dietary fish oil (Fo diet) on the development of spinal deformities under bacterial lipopolysaccharide (LPS)-induced chronic inflammation conditions in Atlantic salmon, Salmo salar L. Fish [25 g body weight (BW)] were fed the experimental diets for 99 days. On day 47 of feeding (40 g BW), fish were subjected to four experimental regimes: (i) intramuscular injections with LPS, (ii) sham-injected phosphate-buffered saline (PBS), (iii) intraperitoneally injected commercial oil adjuvant vaccine, or (iv) no treatment. The fish continued under a common feeding regime in sea water for 165 more days. Body weight was temporarily higher in the Vo group than in the Fo group prior to immunization and was also affected by the type of immunization. At the end of the trial, no differences were seen between the dietary groups. The overall prevalence of spinal deformities was approximately 14% at the end of the experiment. The Vo diet affected vertebral shape but did not induce spinal deformities. In groups injected with LPS and PBS, spinal deformities ranged between 21% and 38%, diet independent. Deformed vertebrae were located at or in proximity to the injection point. Assessment of inflammatory markers revealed high levels of plasma prostaglandin E₂ (PGE₂) in the Vo-fed and LPS-injected groups, suggesting an inflammatory response to LPS. Cyclooxigenase 2 (COX-2) mRNA expression in bone was higher in fish fed Fo compared to Vo-fed fish. Gene expression of immunoglobulin M (IgM) was up-regulated in bone of all LPS-injected groups irrespective of dietary oil. In conclusion, the study suggests that Vo is not a risk factor for the development of inflammation-related spinal deformities. At the same time, we found evidence that localized injection-related processes could trigger the development of

  3. Assessing Function and Endurance in Adults with Spinal and Bulbar Muscular Atrophy: Validity of the Adult Myopathy Assessment Tool

    PubMed Central

    Harris-Love, Michael O.; Fernandez-Rhodes, Lindsay; Joe, Galen; Shrader, Joseph A.; Kokkinis, Angela; La Pean Kirschner, Alison; Auh, Sungyoung; Chen, Cheunju; Li, Li; Levy, Ellen; Davenport, Todd E.; Di Prospero, Nicholas A.; Fischbeck, Kenneth H.

    2014-01-01

    Purpose. The adult myopathy assessment tool (AMAT) is a performance-based battery comprised of functional and endurance subscales that can be completed in approximately 30 minutes without the use of specialized equipment. The purpose of this study was to determine the construct validity and internal consistency of the AMAT with a sample of adults with spinal and bulbar muscular atrophy (SBMA). Methods. AMAT validity was assessed in 56-male participants with genetically confirmed SBMA (mean age, 53 ± 10 years). The participants completed the AMAT and assessments for disease status, strength, and functional status. Results. Lower AMAT scores were associated with longer disease duration (r = −0.29; P < 0.03) and lower serum androgen levels (r = 0.49–0.59; P < 0.001). The AMAT was significantly correlated with strength and functional status (r = 0.82–0.88; P < 0.001). The domains of the AMAT exhibited good internal consistency (Cronbach's α = 0.77–0.89; P < 0.001). Conclusions. The AMAT is a standardized, performance-based tool that may be used to assess functional limitations and muscle endurance. The AMAT has good internal consistency, and the construct validity of the AMAT is supported by its significant associations with hormonal, strength, and functional characteristics of adults with SBMA. This trial is registered with Clinicaltrials.gov identifier NCT00303446. PMID:24876969

  4. [3-dimensional approach to spinal deformities. Application to the study of the prognosis of pediatric scoliosis].

    PubMed

    Graf, H; Hecquet, J; Dubousset, J

    1983-01-01

    The authors have utilized a computer for a spatial analysis of deformities of the spine using antero-posterior and lateral radiographs. The posterior limits of the sacral plateau and the centre of each vertebral plateau was demarcated on the antero-posterior radiograph. The posterior margin of each vertebra was demarcated on the lateral radiograph. With this information, the computer can make a picture as if the spine were seen from above and vertebral rotation can be assessed. The vertebrae are of different colours according to their level. Thirty cases have been studied and six types of infantile scoliosis defined - scoliosis with a localised hyper-rotation like a hairpin, scoliosis with rotary dislocation at the junction of two rotational levels, infantile scoliosis with a moderate curve, progressive scoliosis, benign scoliosis and spontaneously regressive scoliosis of the newborn. This study was shown that prognostic features were in accordance with classical assessments.

  5. The International Research Society of Spinal Deformities (IRSSD) and its contribution to science

    PubMed Central

    2009-01-01

    From the time of its initial, informal meetings starting in 1980 to its formal creation in 1990, the IRSSD has met on a bi-annual basis to discuss all aspects of the spine and associated deformities. It has encouraged open discussion on all topics and, in particular, has tried to be the seed-bed for new ideas. The members are spread around the world and include people from all areas of academia as well as the most important people, the patients themselves. Most notably, application of the ideas and results of the research has always been at the forefront of the discussions. This paper was conceived with the idea of evaluating the impact made by the IRSSD over the last 30 years in the various areas and is intended to create discussion for the upcoming meeting in Montreal regarding future focus: "We are lost over the Atlantic Ocean but we are making good time." PMID:20025783

  6. The impact of patient self assessment of deformity on HRQL in adults with scoliosis

    PubMed Central

    Tones, Megan J; Moss, Nathan D

    2007-01-01

    Background Body image and HRQL are significant issues for patients with scoliosis due to cosmetic deformity, physical and psychological symptoms, and treatment factors. A selective review of scoliosis literature revealed that self report measures of body image and HRQL share unreliable correlations with radiographic measures and clinician recommendations for surgery. However, current body image and HRQL measures do not indicate which aspects of scoliosis deformity are the most distressing for patients. The WRVAS is an instrument designed to evaluate patient self assessment of deformity, and may show some promise in identifying aspects of deformity most troubling to patients. Previous research on adolescents with scoliosis supports the use of the WRVAS as a clinical tool, as the instrument shares strong correlations with radiographic measures and quality of life instruments. There has been limited use of this instrument on adult populations. Methods The WRVAS and the SF-36v2, a HRQL measure, were administered to 71 adults with scoliosis, along with a form to report age and gender. Preliminary validation analyses were performed on the WRVAS (floor and ceiling effects, internal consistency and collinearity, correlations with the SF-36v2, and multiple regression with the WRVAS total score as the predictor, and SF-36v2 scores as outcomes). Results The psychometric properties of the WRVAS were acceptable. Older participants perceived their deformities as more severe than younger participants. More severe deformities were associated with lower scores on the Physical Component Summary Score of the SF-36v2. Total WRVAS score also predicted Physical Component Summary scores. Conclusion The results of the current study indicate that the WRVAS is a reliable tool to use with adult patients, and that patient self assessment of deformity shared a relationship with physical rather than psychological aspects of HRQL. The current and previous studies concur that revision of the

  7. Characterization of a Graded Cervical Hemicontusion Spinal Cord Injury Model in Adult Male Rats

    PubMed Central

    Dunham, Kelly A.; Siriphorn, Akkradate; Chompoopong, Supin

    2010-01-01

    Abstract Most experimental models of spinal cord injury (SCI) in rodents induce damage in the thoracic cord and subsequently examine hindlimb function as an indicator of recovery. In these models, functional recovery is most attributable to white-matter preservation and is less influenced by grey-matter sparing. In contrast, most clinical cases of SCI occur at the lower cervical levels, a region in which both grey-matter and white-matter sparing contribute to functional motor recovery. Thus experimental cervical SCI models are beginning to be developed and used to assess protective and pharmacological interventions following SCI. The objective of this study was to characterize a model of graded cervical hemicontusion SCI with regard to several histological and behavioral outcome measures, including novel forelimb behavioral tasks. Using a commercially available rodent spinal cord impactor, adult male rats received hemicontusion SCI at vertebral level C5 at 100, 200, or 300 kdyn force, to produce mild, moderate, or severe injury severities. Tests of skilled and unskilled forelimb and locomotor function were employed to assess functional recovery, and spinal cord tissue was collected to assess lesion severity. Deficits in skilled and unskilled forelimb function and locomotion relating to injury severity were observed, as well as decreases in neuronal numbers, white-matter area, and white-matter gliosis. Significant correlations were observed between behavioral and histological data. Taken together, these data suggest that the forelimb functional and locomotor assessments employed here are sensitive enough to measure functional changes, and that this hemicontusion model can be used to evaluate potential protective and regenerative therapeutic strategies. PMID:21087156

  8. Early metabolic reactivation versus antioxidant therapy after a traumatic spinal cord injury in adult rats.

    PubMed

    Torres, Sergio; Salgado-Ceballos, Hermelinda; Torres, José Luis; Orozco-Suarez, Sandra; Díaz-Ruíz, Araceli; Martínez, Angelina; Rivera-Cruz, Mario; Ríos, Camilo; Lara, Alicia; Collado, Carlos; Guizar-Sahagún, Gabriel

    2010-02-01

    Disability after traumatic spinal cord injury (TSCI) results from physical trauma and from "secondary mechanisms of injury" such as low metabolic energy levels, oxidative damage and lipid peroxidation. In order to prove if early metabolic reactivation is a better therapeutic option than antioxidant therapy in the acute phase of TSCI, spinal cord contusions were performed in adult rats using a well-characterized weight drop technique at thoracic 9 level. After TSCI, pyrophosphate of thiamine or non-degradable cocarboxylase (NDC) enzyme was used to maintain energy levels, antioxidants such as superoxide dismutase and catalase (ANT) were used to decrease oxidative damage and methylprednisolone (MP), which has both therapeutic properties, was used as a control. Rats were divided into one sham group and six with TSCI; one of them received no treatment, and the rest were treated with NDC, MP, NDC + MP, NDC + ANT or ANT. The ANT group decreased lactate and creatine phosphokinase levels and increased the amount of preserved tissue (morphometric analysis) as well as functional recovery (Basso, Beattie and Bresnahan or BBB motor scale). In contrast, NDC treatment increased lipid peroxidation, measured through thiobarbituric acid reactive substances (TBARS) levels, as well as spinal cord tissue destruction and functional deficit. Early metabolic reactivation after a TSCI may be deleterious, while natural early metabolic inhibition may not be a "secondary mechanism of injury" but a "secondary neuroprotective response". While increased antioxidant defence after a TSCI may currently be an ideal therapeutic strategy, the usefulness of metabolic reactivation should be tested in the sub-acute or chronic phases of TSCI and new strategies must continue to be tested for the early ones.

  9. Disseminated spinal myxopapillary ependymoma in an adult at initial presentation: a case report and review of the literature.

    PubMed

    Straus, David; Tan, Lee A; Takagi, Ippei; O'Toole, John E

    2014-10-01

    Disseminated spinal myxopapillary ependymoma (MPE) is extremely rare in adults. We report a 63-year-old man with chronic low-back pain found to have multiple MPEs in the thoracic, lumbar and sacral spine. Diagnostic and management strategies of disseminated MPE are discussed with a review of pertinent literature.

  10. Cervical Pre-Phrenic Interneurons in the Normal and Lesioned Spinal Cord of the Adult Rat

    PubMed Central

    Lane, Michael A.; White, Todd E.; Coutts, Marcella A.; Jones, Alex L.; Sandhu, Milapjit S.; Bloom, David C.; Bolser, Donald C.; Yates, Bill J.; Fuller, David D.; Reier, Paul J.

    2008-01-01

    While monosynaptic bulbospinal projections to phrenic motoneurons have been extensively described, little is known about the organization of phrenic premotor neurons in the adult rat spinal cord. As interneurons may play an important role in normal breathing and recovery following spinal cord injury, the present study has used anterograde and transneuronal retrograde tracing to study their distribution and synaptic relations. Exclusive unilateral, first-order labeling of the phrenic motoneuron pool with pseudorabies virus demonstrated a substantial number of second-order, bilaterally-distributed cervical interneurons predominantly in the dorsal horn and around the central canal. Combined transneuronal and anterograde tracing revealed ventral respiratory column projections to pre-phrenic interneurons suggesting some propriospinal relays exist between medullary neurons and the phrenic nucleus. Dual-labeling studies with pseudorabies virus recombinants also showed pre-phrenic interneurons integrated with either contralateral phrenic or intercostal motoneuron pools. The stability of interneuronal pseudorabies virus labeling patterns following lateral cervical hemisection was then addressed. Except for fewer infected contralateral interneurons at the level of the central canal, the number and distribution of phrenic-associated interneurons was not significantly altered two weeks post-hemisection (i.e. when the earliest post-injury recovery of phrenic activity has been reported). These results demonstrate a heterogeneous population of phrenic-related interneurons. Their connectivity and relative stability after cervical hemisection raises speculation for potentially diverse roles in modulating phrenic function normally and post-injury. PMID:18924146

  11. PRDM5 Expression and Essential Role After Acute Spinal Cord Injury in Adult Rat.

    PubMed

    Liu, Jie; Wu, Weijie; Hao, Jie; Yu, Mingchen; Liu, Jin; Chen, Xinlei; Qian, Rong; Zhang, Feng

    2016-12-01

    PR (PRDI-BF1 and RIZ) domain proteins (PRDM) are a subfamily of the kruppel-like zinc finger gene products that modulate cellular processes such as differentiation, cell growth and apoptosis. PRDM5 is a recently identified family member that functions as a transcriptional repressor and behaves as a putative tumor suppressor in different types of cancer. However, the expression and function of PRDM5 in spinal cord injury (SCI) are still unknown. In the present study, we have performed an acute SCI model in adult rats and investigated the dynamic changes of PRDM5 expression in the spinal cord. We found that PRDM5 protein levels gradually increased, reaching a peak at day 5 and then gradually declined to a normal level at day 14 after SCI with Western blot analysis. Double immunofluorescence staining showed that PRDM5 immunoreactivity was found in neurons, astrocytes and microglia. However, the expression of PRDM5 was increased predominantly in neurons. Additionally, colocalization of PRDM5/active caspase-3 was been respectively detected in neurons. In vitro, we found that depletion of PRDM5 by short interfering RNA, obviously decreases neuronal apoptosis. In summary, this is the first description of PRDM5 expression in SCI. Our results suggested that PRDM5 might play crucial roles in CNS pathophysiology after SCI and this research will provide new drug targets for clinical treatment of SCI.

  12. The effects of cyclosporin-A on functional outcome and axonal regrowth following spinal cord injury in adult rats.

    PubMed

    Roozbehi, Amrollah; Joghataie, Mohammad Taghi; Mehdizadeh, Mehdi; Mirzaei, Ali; Delaviz, Hamdollah

    2012-01-01

    It has been shown that the immunophilin ligands have the special advantage in spinal cord repair. In this study, the effects of cyclosporine A (CsA) on functional recovery and histological outcome were evaluated following spinal cord injury in rats. After spinal cord hemisection in thirty six adult female Sprague-Dawley rats (200- 250 g), treatment groups received CsA (2.5 mg/kg i.p.) at 15min and 24h after lesion (CsA 15min group and CsA 24h group) daily, for 8 weeks. Control and sham groups received normal saline and in sham operated animals the spinal cord was exposed in the same manner as treatment groups, but was not hemisected. Hindlimb motor function was assessed in 1, 3, 5 and 7 weeks after lesion, using locomotive rating scale developed by Basso, Bresnahan and Beattie (BBB). Motor neurons were counted within the lamina IX of ventral horn and lesion size was measured in 5 mm of spinal lumbar segment with the epicenter of the lesion site. The mean number of motor neurons and the mean BBB scale in 3, 5 and 7 weeks in CsA 15min groups significantly increased compared to the control group. Although, the lesion size reduced in rats with CsA treatment compared to the control group, no significant difference was observed. Thus, it can be concluded that CsA can improve locomotor function and histological outcome in the partial spinal cord injury.

  13. Biomechanical analysis of forces sustained by iliac screws in spinal instrumentation for deformity treatment: preliminary results.

    PubMed

    Perrault, Frederique D; Aubin, Carl-Eric; Wang, Xiaoyu; Schwend, Richard M

    2012-01-01

    Iliac screws used in long instrumentation for deformity treatment are subject to large forces, which may sometimes lead to fixation failures (intra- and postoperatively). The objective of this study was to analyze the biomechanics of iliac screw fixations. The study was based on a patient-specific simulation of a neuromuscular scoliosis case with a long instrumentation to the pelvis. A multi body flexible model was created using a preoperative 3D reconstructed spine and pelvis. The side bending radiographs were used to personalize the mechanical properties. The instrumentation construct was modeled as rigid bodies and flexible beams connected by kinematic joints. Three instrumentation parameters were studied: the connector length, the inter rod connectors and the use of sacral screws. The simulations showed that the forces and torques at the iliac screws were lowered by 9% and 25% respectively by reducing the lateral connector length (from 20 to 10 mm). An inter rod connector did not significantly reduce the iliac screw loads. Sacral screws reduced the functional loads on the iliac screws, but hardware related problems may be shifted onto the sacral screws. Sacral screws in conjunction with inter rod connectors reduced the loads at iliac screws without overloading the sacral screws. The preliminary results showed that the forces at the iliac screws could be lowered through different instrumentation parameters. In the next step of the study, the model validation will be further completed and used to evaluate other instrumentation factors by means of an experimental design framework. The knowledge of loading biomechanics at the iliac screw fixation is important for finding solutions to reduce the risk of failure, such as improving preoperative planning, instrumentation techniques and iliac screw construct design.

  14. The ependymal region of the adult human spinal cord differs from other species and shows ependymoma-like features.

    PubMed

    Garcia-Ovejero, Daniel; Arevalo-Martin, Angel; Paniagua-Torija, Beatriz; Florensa-Vila, José; Ferrer, Isidro; Grassner, Lukas; Molina-Holgado, Eduardo

    2015-06-01

    Several laboratories have described the existence of undifferentiated precursor cells that may act like stem cells in the ependyma of the rodent spinal cord. However, there are reports showing that this region is occluded and disassembled in humans after the second decade of life, although this has been largely ignored or interpreted as a post-mortem artefact. To gain insight into the patency, actual structure, and molecular properties of the adult human spinal cord ependymal region, we followed three approaches: (i) with MRI, we estimated the central canal patency in 59 control subjects, 99 patients with traumatic spinal cord injury, and 26 patients with non-traumatic spinal cord injuries. We observed that the central canal is absent from the vast majority of individuals beyond the age of 18 years, gender-independently, throughout the entire length of the spinal cord, both in healthy controls and after injury; (ii) with histology and immunohistochemistry, we describe morphological properties of the non-lesioned ependymal region, which showed the presence of perivascular pseudorosettes, a common feature of ependymoma; and (iii) with laser capture microdissection, followed by TaqMan® low density arrays, we studied the gene expression profile of the ependymal region and found that it is mainly enriched in genes compatible with a low grade or quiescent ependymoma (53 genes); this region is enriched only in 14 genes related to neurogenic niches. In summary, we demonstrate here that the central canal is mainly absent in the adult human spinal cord and is replaced by a structure morphologically and molecularly different from that described for rodents and other primates. The presented data suggest that the ependymal region is more likely to be reminiscent of a low-grade ependymoma. Therefore, a direct translation to adult human patients of an eventual therapeutic potential of this region based on animal models should be approached with caution.

  15. The ependymal region of the adult human spinal cord differs from other species and shows ependymoma-like features

    PubMed Central

    Arevalo-Martin, Angel; Paniagua-Torija, Beatriz; Florensa-Vila, José; Ferrer, Isidro; Grassner, Lukas; Molina-Holgado, Eduardo

    2015-01-01

    Several laboratories have described the existence of undifferentiated precursor cells that may act like stem cells in the ependyma of the rodent spinal cord. However, there are reports showing that this region is occluded and disassembled in humans after the second decade of life, although this has been largely ignored or interpreted as a post-mortem artefact. To gain insight into the patency, actual structure, and molecular properties of the adult human spinal cord ependymal region, we followed three approaches: (i) with MRI, we estimated the central canal patency in 59 control subjects, 99 patients with traumatic spinal cord injury, and 26 patients with non-traumatic spinal cord injuries. We observed that the central canal is absent from the vast majority of individuals beyond the age of 18 years, gender-independently, throughout the entire length of the spinal cord, both in healthy controls and after injury; (ii) with histology and immunohistochemistry, we describe morphological properties of the non-lesioned ependymal region, which showed the presence of perivascular pseudorosettes, a common feature of ependymoma; and (iii) with laser capture microdissection, followed by TaqMan® low density arrays, we studied the gene expression profile of the ependymal region and found that it is mainly enriched in genes compatible with a low grade or quiescent ependymoma (53 genes); this region is enriched only in 14 genes related to neurogenic niches. In summary, we demonstrate here that the central canal is mainly absent in the adult human spinal cord and is replaced by a structure morphologically and molecularly different from that described for rodents and other primates. The presented data suggest that the ependymal region is more likely to be reminiscent of a low-grade ependymoma. Therefore, a direct translation to adult human patients of an eventual therapeutic potential of this region based on animal models should be approached with caution. PMID:25882650

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

    PubMed Central

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

    2013-01-01

    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 μm 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. PMID:23320512

  17. Supracondylar Osteotomies of Posttraumatic Distal Humeral Deformities in Young Adults - Technique and Results

    PubMed Central

    Buß, Fokko Richard; Schulz, Arndt-Peter; Lill, Helmut; Voigt, Christine

    2011-01-01

    Background: Cubitus varus deformity is the most common late complication after distal humeral fractures in children. Typical symptoms are increasing instability especially the posterolateral rotatory instability (POLRI), lateral elbow pain and cosmetic problems. Different ways of correction have been described but a gold standard has not yet been established. Methods: In this study the clinical outcome 6,5 months after supracondylar closed wedge osteotomy stabilized with locking plates in four young adults was investigated: three with a posttraumatic varus deformity and one with a posttraumatic valgus deformity of the distal humerus. Results: All patients showed good or excellent results in the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand score (DASH). In one case, a revision because of a delayed union was necessary, in another case a preexisting pseudarthrosis of the radial epicondyle remained. Neither a residual instability of the elbow joint, nor any significant prominence of the lateral epicondyle was observed. Conclusion: The supracondylar closed wedge osteotomy stabilized by a locking plate is an effective procedure for the correction of posttraumatic distal humerus deformities in young adults with good final functional results. PMID:22276080

  18. Spinal infections.

    PubMed

    Tay, Bobby K-B; Deckey, Jeffrey; Hu, Serena S

    2002-01-01

    Spinal infections can occur in a variety of clinical situations. Their presentation ranges from the infant with diskitis who is unwilling to crawl or walk to the adult who develops an infection after a spinal procedure. The most common types of spinal infections are hematogenous bacterial or fungal infections, pediatric diskitis, epidural abscess, and postoperative infections. Prompt and accurate diagnosis of spinal infections, the cornerstone of treatment, requires a high index of suspicion in at-risk patients and the appropriate evaluation to identify the organism and determine the extent of infection. Neurologic function and spinal stability also should be carefully evaluated. The goals of therapy should include eradicating the infection, relieving pain, preserving or restoring neurologic function, improving nutrition, and maintaining spinal stability.

  19. Potential of adult mammalian lumbosacral spinal cord to execute and acquire improved locomotion in the absence of supraspinal input

    NASA Technical Reports Server (NTRS)

    Edgerton, V. R.; Roy, R. R.; Hodgson, J. A.; Prober, R. J.; de Guzman, C. P.; de Leon, R.

    1992-01-01

    The neural circuitry of the lumbar spinal cord can generate alternating extension and flexion of the hindlimbs. The hindlimbs of adult cats with complete transection of the spinal cord at a low thoracic level (T12-T13) can perform full weight-supporting locomotion on a treadmill belt moving at a range of speeds. Some limitations in the locomotor capacity can be associated with a deficit in the recruitment level of the fast extensors during the stance phase and the flexors during the swing phase of a step cycle. The level of locomotor performance, however, can be enhanced by daily training on a treadmill while emphasizing full weight-support stepping and by providing appropriately timed sensory stimulation, loading, and/or pharmacologic stimulation of the hindlimb neuromuscular apparatus. Furthermore, there appears to be an interactive effect of these interventions. For example, the maximum treadmill speed that a spinal adult cat can attain and maintain is significantly improved with daily full weight-supporting treadmill training, but progressive recruitment of fast extensors becomes apparent only when the hindlimbs are loaded by gently pulling down on the tail during the stepping. Stimulation of the sural nerve at the initiation of the flexion phase of the step cycle can likewise markedly improve the locomotor capability. Administration of clonidine, in particular in combination with an elevated load, resulted in the most distinct and consistent alternating bursts of electromyographic activity during spinal stepping. These data indicate that the spinal cord has the ability to execute alternating activation of the extensor and flexor musculature of the hindlimbs (stepping) and that this ability can be improved by several interventions such as training, sensory stimulation, and use of some pharmacologic agents. Thus, it appears that the spinal cord, without supraspinal input, is highly plastic and has the potential to "learn," that is, to acquire and improve its

  20. Neuroprotective effects of N-acetyl-cysteine and acetyl-L-carnitine after spinal cord injury in adult rats.

    PubMed

    Karalija, Amar; Novikova, Liudmila N; Kingham, Paul J; Wiberg, Mikael; Novikov, Lev N

    2012-01-01

    Following the initial acute stage of spinal cord injury, a cascade of cellular and inflammatory responses will lead to progressive secondary damage of the nerve tissue surrounding the primary injury site. The degeneration is manifested by loss of neurons and glial cells, demyelination and cyst formation. Injury to the mammalian spinal cord results in nearly complete failure of the severed axons to regenerate. We have previously demonstrated that the antioxidants N-acetyl-cysteine (NAC) and acetyl-L-carnitine (ALC) can attenuate retrograde neuronal degeneration after peripheral nerve and ventral root injury. The present study evaluates the effects of NAC and ALC on neuronal survival, axonal sprouting and glial cell reactions after spinal cord injury in adult rats. Tibial motoneurons in the spinal cord were pre-labeled with fluorescent tracer Fast Blue one week before lumbar L5 hemisection. Continuous intrathecal infusion of NAC (2.4 mg/day) or ALC (0.9 mg/day) was initiated immediately after spinal injury using Alzet 2002 osmotic minipumps. Neuroprotective effects of treatment were assessed by counting surviving motoneurons and by using quantitative immunohistochemistry and Western blotting for neuronal and glial cell markers 4 weeks after hemisection. Spinal cord injury induced significant loss of tibial motoneurons in L4-L6 segments. Neuronal degeneration was associated with decreased immunostaining for microtubular-associated protein-2 (MAP2) in dendritic branches, synaptophysin in presynaptic boutons and neurofilaments in nerve fibers. Immunostaining for the astroglial marker GFAP and microglial marker OX42 was increased. Treatment with NAC and ALC rescued approximately half of the motoneurons destined to die. In addition, antioxidants restored MAP2 and synaptophysin immunoreactivity. However, the perineuronal synaptophysin labeling was not recovered. Although both treatments promoted axonal sprouting, there was no effect on reactive astrocytes. In contrast, the

  1. Bone marrow stromal cell-mediated tissue sparing enhances functional repair after spinal cord contusion in adult rats.

    PubMed

    Ritfeld, Gaby J; Nandoe Tewarie, Rishi D S; Vajn, Katarina; Rahiem, Sahar T; Hurtado, Andres; Wendell, Dane F; Roos, Raymund A C; Oudega, Martin

    2012-01-01

    Bone marrow stromal cell (BMSC) transplantation has shown promise for repair of the spinal cord. We showed earlier that a BMSC transplant limits the loss of spinal nervous tissue after a contusive injury. Here, we addressed the premise that BMSC-mediated tissue sparing underlies functional recovery in adult rats after a contusion of the thoracic spinal cord. Our results reveal that after 2 months BMSCs had elicited a significant increase in spared tissue volumes and in blood vessel density in the contusion epicenter. A strong functional relationship existed between spared tissue volumes and blood vessel density. BMSC-transplanted rats exhibited significant improvements in motor, sensorimotor, and sensory functions, which were strongly correlated with spared tissue volumes. Retrograde tracing revealed that rats with BMSCs had twice as many descending brainstem neurons with an axon projecting beyond the contused spinal cord segment and these correlated strongly with the improved motor/sensorimotor functions but not sensory functions. Together, our data indicate that tissue sparing greatly contributes to BMSC-mediated functional repair after spinal cord contusion. The preservation/formation of blood vessels and sparing/regeneration of descending brainstem axons may be important mediators of the BMSC-mediated anatomical and functional improvements.

  2. Mechanism of Forelimb Motor Function Restoration after Cervical Spinal Cord Hemisection in Rats: A Comparison of Juveniles and Adults.

    PubMed

    Hasegawa, Atsushi; Takahashi, Masahito; Satomi, Kazuhiko; Ohne, Hideaki; Takeuchi, Takumi; Sato, Shunsuke; Ichimura, Shoichi

    2016-01-01

    The aim of this study was to investigate forelimb motor function after cervical spinal cord injury in juvenile and adult rats. Both rats received a left segmental hemisection of the spinal cord after C3-C4 laminectomy. Behavioral evaluation of motor function was monitored and assessed using the New Rating Scale (NRS) and Forelimb Locomotor Scale (FLS) and by measuring the range of motion (ROM) of both the elbow and wrist. Complete left forelimb motor paralysis was observed in both rats. The NRS showed motor function recovery restored to 50.2 ± 24.7% in juvenile rats and 34.0 ± 19.8% in adult rats. FLS was 60.4 ± 26.8% in juvenile rats and 46.5 ± 26.9% in adult rats. ROM of the elbow and wrist were 88.9 ± 20.6% and 44.4 ± 24.1% in juvenile rats and 70.0 ± 29.2% and 40.0 ± 21.1% in adult rats. Thus, the NRS and ROM of the elbow showed a significant difference between age groups. These results indicate that left hemisection of the cervical spinal cord was not related to right-sided motor functions. Moreover, while motor paralysis of the left forelimb gradually recovered in both groups, the improvement was greater in juvenile rats.

  3. Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up.

    PubMed

    Oh, Taemin; Scheer, Justin K; Eastlack, Robert; Smith, Justin S; Lafage, Virginie; Protopsaltis, Themistocles S; Klineberg, Eric; Passias, Peter G; Deviren, Vedat; Hostin, Richard; Gupta, Munish; Bess, Shay; Schwab, Frank; Shaffrey, Christopher I; Ames, Christopher P

    2015-06-01

    OBJECT Alignment changes in the cervical spine that occur following surgical correction for thoracic deformity remain poorly understood. The purpose of this study was to evaluate such changes in a cohort of adults with thoracic deformity treated surgically. METHODS The authors conducted a multicenter retrospective analysis of consecutive patients with thoracic deformity. Inclusion criteria for this study were as follows: corrective osteotomy for thoracic deformity, upper-most instrumented vertebra (UIV) between T-1 and T-4, lower-most instrumented vertebra (LIV) at or above L-5 (LIV ≥ L-5) or at the ilium (LIV-ilium), and a minimum radiographic follow-up of 2 years. Sagittal radiographic parameters were assessed preoperatively as well as at 3 months and 2 years postoperatively, including the C-7 sagittal vertical axis (SVA), C2-7 cervical lordosis (CL), C2-7 SVA, T-1 slope (T1S), T1S minus CL (T1S-CL), T2-12 thoracic kyphosis (TK), apical TK, lumbar lordosis (LL), pelvic incidence (PI), PI-LL, pelvic tilt (PT), and sacral slope (SS). RESULTS Fifty-seven patients with a mean age of 49.1 ± 14.6 years met the study inclusion criteria. The preoperative prevalence of increased CL (CL > 15°) was 48.9%. Both 3-month and 2-year apical TK improved from baseline (p < 0.05, statistically significant). At the 2-year follow-up, only the C2-7 SVA increased significantly from baseline (p = 0.01), whereas LL decreased from baseline (p < 0.01). The prevalence of increased CL was 35.3% at 3 months and 47.8% at 2 years, which did not represent a significant change. Postoperative cervical alignment changes were not significantly different from preoperative values regardless of the LIV (LIV ≥ L-5 or LIV-ilium, p > 0.05 for both). In a subset of patients with a maximum TK ≥ 60° (35 patients) and 3-column osteotomy (38 patients), no significant postoperative cervical changes were seen. CONCLUSION Increased CL is common in adult spinal deformity patients with thoracic deformities

  4. The effect of treadmill training on motor recovery after a partial spinal cord compression-injury in the adult rat.

    PubMed

    Multon, Sylvie; Franzen, Rachelle; Poirrier, Anne-Lise; Scholtes, Felix; Schoenen, Jean

    2003-08-01

    Locomotor training on a treadmill is a therapeutic strategy used for several years in human paraplegics in whom it was shown to improve functional recovery mainly after incomplete spinal cord lesions. The precise mechanisms underlying its effects are not known. Experimental studies in adult animals were chiefly performed after complete spinal transections. The objective of this experiment was to assess the effects of early treadmill training on recovery of spontaneous walking capacity after a partial spinal cord lesion in adult rats. Following a compression-injury by a subdurally inflated microballoon, seven rats were trained daily on a treadmill with a body weight support system, whereas six other animals were used as controls and only handled. Spontaneous walking ability in an open field was compared weekly between both groups by two blinded observers, using the Basso, Beattie and Bresnahan (BBB) locomotor rating scale. Mean BBB score during 12 weeks was globally significantly greater in the treadmill-trained animals than in the control group, the benefit of training appearing as early as the 2nd week. At week 7, locomotor recovery reached a plateau in both animal groups, but remained superior in trained rats. Daily treadmill training started early after a partial spinal cord lesion in adult rats, which accelerates recovery of locomotion and produces a long-term benefit. These findings in an animal model mimicking the closed spinal cord injury occurring in most human paraplegics are useful for future studies of optimal locomotor training programs, their neurobiologic mechanisms, and their combination with other treatment strategies.

  5. SOX2 expression is upregulated in adult spinal cord after contusion injury in both oligodendrocyte lineage and ependymal cells.

    PubMed

    Lee, Hyun Joon; Wu, Junfang; Chung, Jumi; Wrathall, Jean R

    2013-02-01

    The upregulation of genes normally associated with development may occur in the adult after spinal cord injury (SCI). To test this, we performed real-time RT-PCR array analysis of mouse spinal cord mRNAs comparing embryonic day (E)14.5 spinal cord with intact adult and adult cord 1 week after a clinically relevant standardized contusion SCI. We found significantly increased expression of a large number of neural development- and stem cell-associated genes after SCI. These included Sox2 (sex determining region Y-box 2), a transcription factor that regulates self-renewal and potency of embryonic neural stem cells and is one of only a few key factors needed to induce pluripotency. In adult spinal cord of Sox2-EGFP mice, Sox2-EGFP was found mainly in the ependymal cells of the central canal. After SCI, both mRNA and protein levels of Sox2 were significantly increased at and near the injury site. By 1 day, Sox2 was upregulated in NG2(+) oligodendrocyte progenitor cells (OPC) in the spared white matter. By 3 days, Sox2-EGFP ependymal cells had increased proliferation and begun to form multiple layers and clusters of cells in the central lesion zone of the cord. Expression of Sox2 by NG2(+) cells had declined by 1 week, but increased numbers of other Sox2-expressing cells persisted for at least 4 weeks after SCI in both mouse and rat models. Thus, SCI upregulates many genes associated with development and neural stem cells, including the key transcription factor Sox2, which is expressed in a pool of cells that persists for weeks after SCI.

  6. Combining Adult Learning Theory with Occupational Therapy Intervention for Bladder and Bowel Management after Spinal Cord Injury: A Case Report.

    PubMed

    Gallagher, Gina; Bell, Alison

    2016-01-01

    Bladder and bowel management is an important goal of rehabilitation for clients with spinal cord injury. Dependence is these areas have been linked to a variety of secondary complications, including decreased quality of life, urinary tract infections and pressure ulcers (Hammell, 2010; Hicken et al, 2001). Occupational therapists have been identified as important members of the health care team in spinal cord injury rehabilitation; however, specific roles and interventions have not been clearly described. This case report will describe occupational therapy interventions embedded with principles of adult learning theory to address bladder and bowel management with an adult client who sustained an incomplete thoracic level spinal cord injury.

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

    PubMed Central

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

    2012-01-01

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

  8. Cervical spinal cord dimensions and clinical outcomes in adults with klippel-feil syndrome: a comparison with matched controls.

    PubMed

    Cho, Woojin; Lee, Dong-Ho; Auerbach, Joshua D; Sehn, Jennifer K; Nabb, Colin E; Riew, K Daniel

    2014-12-01

    Study Design Retrospective case-control study. Objectives To confirm the fact that spinal cord dimensions are smaller in adults with Klippel-Feil syndrome (KFS) than in pediatric patients with KFS and to compare the clinical characteristics and outcomes of neurologic complications in patients with KFS with matched controls. Methods We performed an independent 1:2 case-control retrospective radiographic and chart review of a consecutive series of adults with KFS who underwent surgical intervention. The control group consisted of consecutive non-KFS surgical patients. Patients were matched in 1:2 case-control manner. Their charts were reviewed and the clinical characteristics were compared. Axial T2-weighted magnetic resonance imaging (MRI) was used to measure the anteroposterior and mediolateral axial spinal cord and spinal canal at the operative levels and measurements were compared. Results A total of 22 patients with KFS and 44 controls were identified. The KFS group had a tendency of more myeloradiculopathy, and the control group had a tendency toward more radiculopathy. Both tendencies, however, were not significantly different. MRIs of 10 patients from the KFS group and 22 controls were available. There was no difference in the area of both spinal cord and canal at the operative levels. Conclusion Contrary to the finding in previous reports on pediatric patients, there were no differences between KFS and well-matched control groups in terms of age of onset, presentation, revision rate, complication rate, surgical outcome, and cross-sectional spinal cord and canal dimensions at the operative level.

  9. Altered Cerebellar Circuitry following Thoracic Spinal Cord Injury in Adult Rats

    PubMed Central

    2016-01-01

    Cerebellar function is critical for coordinating movement and motor learning. However, events occurring in the cerebellum following spinal cord injury (SCI) have not been investigated in detail. We provide evidence of SCI-induced cerebellar synaptic changes involving a loss of granule cell parallel fiber input to distal regions of the Purkinje cell dendritic tree. This is accompanied by an apparent increase in synaptic contacts to Purkinje cell proximal dendrites, presumably from climbing fibers originating in the inferior olive. We also observed an early stage injury-induced decrease in the levels of cerebellin-1, a synaptic organizing molecule that is critical for establishing and maintaining parallel fiber-Purkinje cell synaptic integrity. Interestingly, this transsynaptic reorganizational pattern is consistent with that reported during development and in certain transgenic mouse models. To our knowledge, such a reorganizational event has not been described in response to SCI in adult rats. Regardless, the novel results of this study are important for understanding SCI-induced synaptic changes in the cerebellum, which may prove critical for strategies focusing on promoting functional recovery. PMID:27504204

  10. Diagnostic accuracy of evoked potentials for functional impairment after contusive spinal cord injury in adult rats.

    PubMed

    Thirumala, Parthasarathy; Zhou, James; Krishnan, Rohan; Manem, Nihita; Umredkar, Shreya; Hamilton, D K; Balzer, Jeffrey R; Oudega, Martin

    2016-03-01

    Iatrogenic spinal cord injury (SCI) is a cause of potentially debilitating post-operative neurologic complications. Currently, intra-operative neurophysiological monitoring (IONM) via somatosensory evoked potentials and motor-evoked potentials is used to detect and prevent impending SCI. However, no empirically validated interventions exist to halt the progression of iatrogenic SCI once it is detected. This is in part due to the lack of a suitable translational model that mimics the circumstances surrounding iatrogenic SCI detected via IONM. Here, we evaluate a model of simulated contusive iatrogenic SCI detected via IONM in adult female Sprague-Dawley rats. We show that transient losses of somatosensory evoked potentials responses are 88.24% sensitive (95% confidence interval [CI] 63.53-98.20) and 80% specific (95% CI 51.91-95.43) for significant functional impairment following simulated iatrogenic SCI. Similarly, we show that transient losses in motor-evoked potentials responses are 70.83% sensitive (95% CI 48.91-87.33) and 100% specific (95% CI 62.91-100.00) for significant functional impairment following simulated iatrogenic SCI. These results indicate that our model is a suitable replica of the circumstances surrounding clinical iatrogenic SCI.

  11. Plantar measurements to determine success of surgical correction of Stage IIb adult acquired flatfoot deformity.

    PubMed

    Matheis, Erika A; Spratley, E Meade; Hayes, Curtis W; Adelaar, Robert S; Wayne, Jennifer S

    2014-01-01

    Adult acquired flatfoot deformity is a degenerative disease causing medial arch dysfunction. Surgical correction has typically involved tendon reconstruction with calcaneal osteotomy; however, the postoperative changes have not been fully characterized. The present study assessed the success of surgical correction of Stage IIb adult acquired flatfoot deformity through changes in plantar pressures and patient-generated outcome scores. With Institutional Review Board approval, 6 participants were evaluated before and after surgery using pedobarography, the Foot and Ankle Outcome Score, and the Medical Outcomes Study 36-item short-form questionnaire. The plantar pressures were recorded using a TekScan HRMat(®) during walking and in a 1- and 2-foot stance. The resulting contour maps were segmented into 9 regions, with the peak pressure, normalized force, and arch index calculated. Surgical effects were analyzed using paired t tests. Postoperatively, the Foot and Ankle Outcome Score and Medical Outcomes Study 36-item short-form questionnaire scores increased significantly from 180 ± 78 to 360 ± 136 (p < .03) and 47 ± 18 to 71 ± 19 (p = .06), respectively. During the 2-foot stance, the normalized force had increased significantly in the lateral midfoot (p < .03), although no significant differences were found in peak pressures. No significant differences were observed in the 1-foot stance. During walking, the normalized force increased significantly in the lateral mid- and forefoot (p < .05). The peak pressure increased significantly in the lateral forefoot (p < .01). The arch index values demonstrated no significant changes. The increased questionnaire scores indicated that surgical correction improved the self-perceived health of the participants. Lateral shifts in the peak pressure and normalized force suggest that forefoot and midfoot loading is altered postoperatively, consistent with the goal of offloading the dysfunctional arch. Thus, the present study has

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

    PubMed

    Yang, Xi; Song, Yueming; Kong, Qingquan

    2013-12-01

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

  13. Longitudinal changes in medical complications in adults with pediatric-onset spinal cord injury

    PubMed Central

    Hwang, Miriam; Zebracki, Kathy; Chlan, Kathleen M.; Vogel, Lawrence C.

    2014-01-01

    Objectives To determine longitudinal changes in the occurrence of medical complications in adults with pediatric-onset spinal cord injury (SCI). Design Longitudinal study of long-term outcomes. Setting Community. Participants Individuals who had sustained an SCI before age 19, were 23 years of age or older at initial interview, and followed annually between 1996 and 2011. They were classified into four American Spinal Injury Association (ASIA) Impairment Scale (AIS) severity groups: C1–4 AIS ABC, C5–8 AIS ABC, T1–S5 AIS ABC, AIS D. Outcome measures Generalized estimating equation (GEE) models were formulated to obtain the odds ratio (OR) of having a medical complication over time. Results A total of 1793 interviews were conducted among 226 men and 125 women (86% Caucasian; age at baseline, 26.7 ± 3.6 years; time since injury at baseline, 12.9 ± 5.2 years). Odds of complication occurrence over time varied among severity groups, with increased ORs of severe urinary tract infection (1.05, confidence interval (CI) 1.02–1.09), autonomic dysreflexia (AD) (1.09, CI 1.05–1.14), spasticity (1.06, CI 1.01–1.11), pneumonia/respiratory failure (1.09, CI 1.03–1.16), and hypertension/cardiac disease (1.07, CI 1.01–1.15) in the C1-4 ABC group; AD (1.08, CI 1.04–1.13) and pneumonia/respiratory failure (1.09, CI 1.02–1.16) in the C5–8 ABC group; and hypertension/cardiac disease (1.08, CI 1.02–1.14) in the T1–S5 ABC group. Upper extremity joint pain had increased odds of occurrence in all injury severity groups. Conclusion The significantly increased odds of having medical complications over time warrants awareness of risk factors and implementation of preventive measures to avoid adverse consequences of complications and to maintain independence in individuals with pediatric-onset SCI. PMID:24090490

  14. Teaching Adult Rats Spinalized as Neonates to Walk Using Trunk Robotic Rehabilitation: Elements of Success, Failure, and Dependence

    PubMed Central

    Udoekwere, Ubong I.; Oza, Chintan S.

    2016-01-01

    Robot therapy promotes functional recovery after spinal cord injury (SCI) in animal and clinical studies. Trunk actions are important in adult rats spinalized as neonates (NTX rats) that walk autonomously. Quadrupedal robot rehabilitation was tested using an implanted orthosis at the pelvis. Trunk cortical reorganization follows such rehabilitation. Here, we test the functional outcomes of such training. Robot impedance control at the pelvis allowed hindlimb, trunk, and forelimb mechanical interactions. Rats gradually increased weight support. Rats showed significant improvement in hindlimb stepping ability, quadrupedal weight support, and all measures examined. Function in NTX rats both before and after training showed bimodal distributions, with “poor” and “high weight support” groupings. A total of 35% of rats initially classified as “poor” were able to increase their weight-supported step measures to a level considered “high weight support” after robot training, thus moving between weight support groups. Recovered function in these rats persisted on treadmill with the robot both actuated and nonactuated, but returned to pretraining levels if they were completely disconnected from the robot. Locomotor recovery in robot rehabilitation of NTX rats thus likely included context dependence and/or incorporation of models of robot mechanics that became essential parts of their learned strategy. Such learned dependence is likely a hurdle to autonomy to be overcome for many robot locomotor therapies. Notwithstanding these limitations, trunk-based quadrupedal robot rehabilitation helped the rats to visit mechanical states they would never have achieved alone, to learn novel coordinations, and to achieve major improvements in locomotor function. SIGNIFICANCE STATEMENT Neonatal spinal transected rats without any weight support can be taught weight support as adults by using robot rehabilitation at trunk. No adult control rats with neonatal spinal

  15. Spring Ligament Complex and Posterior Tibial Tendon: MR Anatomy and Findings in Acquired Adult Flatfoot Deformity.

    PubMed

    Mengiardi, Bernard; Pinto, Clinton; Zanetti, Marco

    2016-02-01

    The spring ligament complex is an important stabilizer of the medial ankle, together with the posterior tibial tendon (PTT) and the deltoid ligament complex. Lesions in these stabilizers result in acquired adult flatfoot deformity. The spring ligament complex includes three ligaments: the superomedial calcaneonavicular ligament, the medioplantar oblique calcaneonavicular ligament, and the inferoplantar longitudinal calcaneonavicular ligament. Normal MR imaging anatomy of the spring ligament complex and the PTT are described and illustrated in detail. Isolated lesions of the spring ligament complex are rare. In most cases, spring ligament complex lesions are secondary to PTT dysfunction. The best criteria for an injury of the clinically relevant superomedial calcaneonavicular ligament are increased signal on proton-density or T2-weighted sequences with thickening (> 5 mm), thinning (< 2 mm), or partial or complete discontinuity. A thickened ligament can be simulated by the gliding layer between the PTT and the superomedial calcaneonavicular ligament (thickness: 1-3 mm). The most common location of injury is the superior and distal portion of the superomedial calcaneonavicular ligament. A lesion seen by the orthopedic foot surgeon at the junction between the tibiospring ligament and the superomedial portion of the calcaneonavicular ligament is commonly classified as a spring ligament injury. In addition, an overview of MR imaging findings in different stages of the acquired adult flatfoot deformity is provided.

  16. Mats made from fibronectin support oriented growth of axons in the damaged spinal cord of the adult rat.

    PubMed

    King, Von R; Henseler, Manuel; Brown, Robert A; Priestley, John V

    2003-08-01

    A variety of biological as well as synthetic implants have been used to attempt to promote regeneration into the damaged spinal cord. We have implanted mats made from fibronectin (FN) into the damaged spinal cord to determine their effectiveness as a substrate for regeneration of axons. These mats contain oriented pores and can take up and release growth factors. Lesion cavities 1 mm in width and depth and 2 mm in length were created on one side of the spinal cord of adult rats. FN mats containing neurotrophins or saline were placed into the lesion. Mats were well integrated into surrounding tissue and showed robust well-oriented growth of calcitonin gene-related peptide, substance P, GABAergic, cholinergic, glutamatergic, and noradrenergic axons into FN mats. Transganglionic tracing using cholera toxin B indicated large-diameter primary afferents had grown into FN implants. Schwann cells had also infiltrated FN mats. Electron microscopy confirmed the presence of axons within implants sites, with most axons either ensheathed or myelinated by Schwann cells. Mats incubated in brain-derived neurotrophic factor and neurotrophin-3 showed significantly more neurofilament-positive and glutamatergic fibers compared to saline- and nerve growth factor-incubated mats, while mats incubated with nerve growth factor showed more calcitonin gene-related peptide-positive axons. In contrast, neurotrophin treatment had no effect on PGP 9.5-positive axons. In addition, in some animals with neurotrophin-3-incubated mats, cholera toxin B-labelled fibers had grown from the mat into adjoining intact areas of spinal cord. The results indicate that FN mats provide a substrate that is permissive for robust oriented axonal growth in the damaged spinal cord, and that this growth is supported by Schwann cells.

  17. ADAM8 is selectively upregulated in endothelial cells and is associated with angiogenesis after spinal cord injury in adult mice

    PubMed Central

    Mahoney, Edward T.; Benton, Richard L.; Maddie, Melissa A.; Whittemore, Scott R.; Hagg, Theo

    2009-01-01

    Endothelial cell (EC) loss and subsequent angiogenesis occurs over the first week after spinal cord injury (SCI). To identify molecular mechanisms that could be targeted with intravenous (i.v.) treatments we determined whether transmembrane A Disintegrin And Metalloprotease (ADAM) proteins are expressed in ECs of the injured spinal cord. ADAMs bind to integrins which are important for EC survival and angiogenesis. Female adult C57Bl/6 mice with a spinal cord contusion had progressively more ADAM8 (CD156) immunostaining in blood vessels and individual ECs between 1 and 28 days following injury. Uninjured spinal cords had little ADAM8 staining. The increase in ADAM8 mRNA and protein was confirmed in spinal cord lysates, and ADAM8 mRNA was present in FACS-enriched ECs. ADAM8 co-localized extensively and exclusively with the EC marker PECAM and also with i.v. injected lectins. I.v. injected isolectin B4 (IB4) labels a subpopulation of blood vessels at and within the injury epicenter 3-7 days after injury, coincident with angiogenesis. Both ADAM8 and the proliferation marker Ki-67 were present in IB4-positive microvessels. ADAM8-positive proliferating cells were seen at the leading end of IB4-positive blood vessels. Angiogenesis was confirmed by BrdU incorporation, binding of i.v. injected nucleolin antibodies, and MT1-MMP immunostaining in a subset of blood vessels. These data suggest that ADAM8 is vascular-selective and plays a role in proliferation and/or migration of ECs during angiogenesis following SCI. PMID:19003792

  18. Delayed intervention with transplants and neurotrophic factors supports recovery of forelimb function after cervical spinal cord injury in adult rats.

    PubMed

    Lynskey, James V; Sandhu, Faheem A; Sandhu, Faheen A; Dai, Hai-Ning; Dai, Hail-Ning; McAtee, Marietta; Slotkin, Jonathan R; Slotkin, Jon R; MacArthur, Linda; Bregman, Barbara S

    2006-05-01

    The adult central nervous system is capable of considerable anatomical reorganization and functional recovery after injury. Functional outcomes, however, vary greatly, depending upon size and location of injury, type and timing of intervention, and type of recovery and plasticity evaluated. The present study was undertaken to assess the recovery of skilled and unskilled forelimb function in adult rats after a C5/C6 spinal cord over-hemisection and delayed intervention with fetal spinal cord transplants and neurotrophins. Recovery of forelimb function was evaluated during both target reaching (a skilled behavior) and vertical exploration (an unskilled behavior). Anatomical tracing and immunohistochemistry were used to assess the growth of descending raphespinal, corticospinal, and rubrospinal fibers at the injury site, tracts that normally confer forelimb function. Delayed intervention with transplants and either brain-derived neurotrophic factor (BDNF) or neurotrophin-3 (NT-3) restored skilled left forelimb reaching to pre-injury levels. Animals showed recovery of normal reaching movements rather than compensation with abnormal movements. Transplants and NT-3 also improved right forelimb use during an unskilled vertical exploration, but not skilled right reaching. Intervention with fetal transplant tissue supported the growth of descending serotonergic, corticospinal, and rubrospinal fibers into the transplant at the lesion site. The addition of neurotrophins, however, did not significantly increase axonal growth at the lesion site. These studies suggest that the recovery of skilled and unskilled forelimb use is possible after a large cervical spinal cord injury following delayed intervention with fetal spinal cord and neurotrophins. Plasticity of both spared and axotomized descending pathways likely contributes to the functional recovery observed.

  19. Dwarf with dual spinal kyphotic deformity at the cervical and dorsal spine unassociated with odontoid hypoplasia: Surgical management

    PubMed Central

    Satyarthee, Guru Dutta; Mankotia, Dipanker Singh

    2016-01-01

    Morquio's syndrome is associated with systemic skeletal hypoplasia leading to generalized skeletal deformation. The hypoplasia of odontoid process is frequent association, which is responsible for atlantoaxial dislocation causing compressive myelopathy. However, development of sub-axial cervical kyphotic deformity unassociated with odontoid hypoplasia is extremely rare, and coexistence of dorsal kyphotic deformity is not reported in the western literature till date and represents first case. Current case is 16-year-old boy, who presented with severe kyphotic deformity of cervical spine with spastic quadriparesis. Interestingly, he also had additional asymptomatic kyphotic deformity of dorsal spine; however, odontoid proves hypoplasia was not observed. He was only symptomatic for cervical compression, accordingly surgery was planned. The patient was planned for correction of cervical kyphotic deformity under general anesthesia, underwent fourth cervical corpectomy with resection of posterior longitudinal ligament and fusion with autologous bone graft derived from right fibula, which was refashioned approximating to the width of the corpectomy size after harvesting and fixed between C3 and C5 vertebral bodies and further secured with anterior cervical plating. He tolerated surgical procedure well with improvement in power with significant reduction in spasticity. Postoperative X-ray, cervical spine revealed complete correction of kyphotic deformity cervical spine. At follow-up 6 months following surgery, he is doing well. Successful surgical correction of symptomatic cervical kyphotic deformity can be achieved utilizing anterior cervical corpectomy, autologous fibular bone graft, and anterior cervical plating. PMID:27857796

  20. Recombinant DNA vaccine against inhibition of neurite outgrowth promotes functional recovery associated with endogeous NGF expression in spinal cord hemisected adult rats.

    PubMed

    Zhang, Yi; Hao, Chun-Guang; Hu, Li-Qun; Dong, Jian; Wei, Peng; Xu, Dan; Xiao, Zhi-Cheng; Wang, Ting-Hua

    2009-09-01

    Axonal regeneration across the site of spinal cord lesion is often aborted in adult mammalian species. The use of DNA vaccine to nullify the inhibitory molecules has been shown to be effective in promoting axonal regeneration in injured spinal cord. The possible molecular mechanisms, however, remain to be elucidated. The present study showed that the administration of recombinant DNA vaccine encoding multiple domains, Nogo-66, Nogo-N, TnR, and MAG, significantly improved hindlimb locomotor functions in rats subjected to ablation of the dorsal halves of the cord. Western blot analysis demonstrated that nerve growth factor (NGF) levels in the spinal cord of immunized rats were significantly upregulated than those of control rats. Immunohistochemistry as well as in situ hybridization confirmed that NGF was expressed in neurons of the spinal cord. These findings indicated that functional recovery in immunized rats could be correlated with endogeous NGF expression in hemisected rat spinal cords.

  1. [Causal analysis and management strategies of 30-day unplanned revision surgery following single-stage posterior vertebral column resection for severe spinal deformity].

    PubMed

    Tao, Y P; Wu, J G; Ma, H S; Shao, S L; Zhang, L L; Gao, B; Li, H X

    2017-03-01

    Objective: To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection (PVCR) for severe spinal deformity and the methods of prevention and management. Methods: A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306(th) Hospital of People's Liberation Army from May 2010 to December 2015 were retrospectively reviewed. Six patients required reoperation within 30 days after PVCR, including 2 males and 4 females with average age of 21 years (ranging from 12 to 38 years). Four cases were congenital kyphoscoliosis, 1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis. Three cases associated with preoperative neurologic deficit (Frankel C in 1 patient and D in 2 patients). The causes, management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded. Results: The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4% (6/112). There was 1 case due to cerebrospinal fluid leak, 5 cases with varying degrees of new neurologic deficits, the causes were as followed: dural buckling in 1 case, residual bone compression in 1 case, epidural hematoma compression in 2 cases, spinal subdural hematoma in 1 case. All the 6 cases underwent surgical exploration again, including further dural repair, decompression and hematoma clearance. After unplanned reoperation, 6 cases recovered completely. The average follow-up time after surgery was 30.8 months (ranging from 10 to 60 months). The major curve at coronal plane was improved from preoperative 87.7° to 34.2°, with a mean correction of 61.0% at final follow-up; the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°, with a mean correction of 61.9% at final follow-up. Two patients' neurological status improved from Frankel D to Frankel E, one patient's neurological status improved from Frankel C to Frankel E. Conclusions: One

  2. Sustaining intrinsic growth capacity of adult neurons promotes spinal cord regeneration

    NASA Astrophysics Data System (ADS)

    Neumann, Simona; Skinner, Kate; Basbaum, Allan I.

    2005-11-01

    The peripheral axonal branch of primary sensory neurons readily regenerates after peripheral nerve injury, but the central branch, which courses in the dorsal columns of the spinal cord, does not. However, if a peripheral nerve is transected before a spinal cord injury, sensory neurons that course in the dorsal columns will regenerate, presumably because their intrinsic growth capacity is enhanced by the priming peripheral nerve lesion. As the effective priming lesion is made before the spinal cord injury it would clearly have no clinical utility, and unfortunately, a priming lesion made after a spinal cord injury results in an abortive regenerative response. Here, we show that two priming lesions, one made at the time of a spinal cord injury and a second 1 week after a spinal cord injury, in fact, promote dramatic regeneration, within and beyond the lesion. The first lesion, we hypothesize, enhances intrinsic growth capacity, and the second one sustains it, providing a paradigm for promoting CNS regeneration after injury. primary afferents | dorsal columns | neurite outgrowth | sprouting | priming

  3. Deformation-induced changeable Young's modulus with high strength in β-type Ti-Cr-O alloys for spinal fixture.

    PubMed

    Liu, Huihong; Niinomi, Mitsuo; Nakai, Masaaki; Hieda, Junko; Cho, Ken

    2014-02-01

    In order to meet the requirements of the patients and surgeons simultaneously for spinal fixation applications, a novel biomedical alloy with a changeable Young's modulus, that is, with a low Young's modulus to prevent the stress-shielding effect for patients and a high Young's modulus to suppress springback for surgeons, was developed. In this study, the chromium and oxygen contents in ternary Ti(11, 12 mass%)Cr-(0.2, 0.4, 0.6 mass%)O alloys were optimized in order to achieve a changeable Young's modulus via deformation-induced ω-phase transformation with good mechanical properties. The Young's moduli of all the examined alloys increase after cold rolling, which is attributed to the deformation-induced ω-phase transformation. This transformation is suppressed by oxygen but enhanced with lower chromium content, which is related to the β(bcc)-lattice stability. Among the examined alloys, the Ti-11Cr-0.2O alloy shows a low Young's modulus of less than 80GPa in the solution-treated (ST) condition and a high Young's modulus of more than 90GPa in the cold rolled (CR) condition. The Ti-11Cr-0.2O alloy also exhibits a high tensile strength, above 1000MPa, with an acceptable elongation of ~12% in the ST condition. Furthermore, the Ti-11Cr-0.2O alloy exhibits minimal springback. This value of springback is the closest to that of Ti64 ELI alloy among the compared alloys. Therefore, the Ti-11Cr-0.2O alloy, which has a good balance between large changeable Young's modulus, high tensile strength, good plasticity, and minimal springback, is considered to be a potential candidate for spinal fixation applications.

  4. How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up.

    PubMed

    Protopsaltis, Themistocles S; Scheer, Justin K; Terran, Jamie S; Smith, Justin S; Hamilton, D Kojo; Kim, Han Jo; Mundis, Greg M; Hart, Robert A; McCarthy, Ian M; Klineberg, Eric; Lafage, Virginie; Bess, Shay; Schwab, Frank; Shaffrey, Christopher I; Ames, Christopher P

    2015-08-01

    OBJECT Regional cervical sagittal alignment (C2-7 sagittal vertical axis [SVA]) has been shown to correlate with health-related quality of life (HRQOL). The study objective was to examine the relationship between cervical and thoracolumbar alignment parameters with HRQOL among patients with operative and nonoperative adult thoracolumbar deformity. METHODS This is a multicenter prospective data collection of consecutive patients with adult thoracolumbar spinal deformity. Clinical measures of disability included the Oswestry Disability Index (ODI), Scoliosis Research Society-22 Patient Questionnaire (SRS-22), and 36-Item Short-Form Health Survey (SF-36). Cervical radiographic parameters were correlated with global sagittal parameters within the nonoperative and operative cohorts. A partial correlation analysis was performed controlling for C-7 SVA. The operative group was subanalyzed by the magnitude of global deformity (C-7 SVA ≥ 5 cm vs < 5 cm). RESULTS A total of 318 patients were included (186 operative and 132 nonoperative). The mean age was 55.4 ± 14.9 years. Operative patients had significantly worse baseline HRQOL and significantly larger C-7 SVA, pelvic tilt (PT), mismatch between pelvic incidence and lumbar lordosis (PI-LL), and C2-7 SVA. The operative patients with baseline C-7 SVA ≥ 5 cm had significantly larger C2-7 lordosis (CL), C2-7 SVA, C-7 SVA, PI-LL, and PT than patients with a normal C-7 SVA. For all patients, baseline C2-7 SVA and CL significantly correlated with baseline ODI, Physical Component Summary (PCS), SRS Activity domain, and SRS Appearance domain. Baseline C2-7 SVA also correlated with SRS Pain and SRS Total. For the operative patients with baseline C-7 SVA ≥ 5 cm, the 2-year C2-7 SVA significantly correlated with 2-year Mental Component Summary, SRS Mental, SRS Satisfaction, and decreases in ODI. Decreases in C2-7 SVA at 2 years significantly correlated with lower ODI at 2 years. Using partial correlations while controlling for

  5. Transplantation of mesenchymal stem cells exerts anti-apoptotic effects in adult rats after spinal cord ischemia-reperfusion injury.

    PubMed

    Yin, Fei; Guo, Li; Meng, Chun-yang; Liu, Ya-juan; Lu, Ri-feng; Li, Peng; Zhou, Yu-bo

    2014-05-02

    It is unknown whether transplantation of bone marrow mesenchymal stem cells (BM-MSCs) can repair spinal cord ischemia-reperfusion injury (SCII) in a rat model through an anti-apoptotic effect. Adult rats were divided into untreated or sham-operated controls, untreated models of SCII (uSCII) and BM-MSC-transplanted models of SCII (tSCII; labeled with CM-Dill transplanted at 1 h and 24 h after reperfusion). According to evaluation of hind-limb motor function, the motor functions of tSCII rats were significantly better than those of uSCII rats by the seventh day. H&E and TUNEL staining showed that the spinal cords of uSCII rats contained damaged neural cells with nuclear pyknosis and congestion of blood vessels, with a high percentage of apoptotic neural cells, while the spinal cords of tSCII rats were nearly normal with significantly fewer apoptotic neural cells. Immunohistochemistry and double immunofluorescence staining revealed that in tSCII rats CASP3 and neurofilament-H (NF-H) levels were 14.57% and 174% those of uSCII rats, respectively, and in tSCII rats the ratio of BAX to BCL2 was reduced by nearly 50%. The differentiation of transplanted CM-Dil-labeled BM-MSCs into neurons and astrocytes was observed in the spinal cords of the tSCII rats under laser scanning confocal microscopy. These results showed that transplantation of BM-MSCs improved functional recovery after SCII via anti-apoptosis.

  6. Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?

    PubMed Central

    Suri, Pradeep; Rainville, James; Kalichman, Leonid; Katz, Jeffrey N.

    2012-01-01

    Context The clinical syndrome of lumbar spinal stenosis (LSS) is a common diagnosis in older adults presenting with lower extremity pain. Objective To systematically review the accuracy of the clinical examination for the diagnosis of the clinical syndrome of LSS. Data Sources MEDLINE, EMBASE, and CINAHL searches of articles published from January 1966 to September 2010. Study Selection Studies were included if they contained adequate data on the accuracy of the history and physical examination for diagnosing the clinical syndrome of LSS, using a reference standard of expert opinion with radiographic or anatomic confirmation. Data Extraction Two authors independently reviewed each study to determine eligibility, extract data, and appraise levels of evidence. Data Synthesis Four studies evaluating 741 patients were identified. Among patients with lower extremity pain, the likelihood of the clinical syndrome of LSS was increased for individuals older than 70 years (likelihood ratio [LR], 2.0; 95% confidence interval [CI], 1.6–2.5), and was decreased for those younger than 60 years (LR, 0.40; 95% CI, 0.29–0.57). The most useful symptoms for increasing the likelihood of the clinical syndrome of LSS were having no pain when seated (LR, 7.4; 95% CI, 1.9–30), improvement of symptoms when bending forward (LR, 6.4; 95% CI, 4.1–9.9), the presence of bilateral buttock or leg pain (LR, 6.3; 95% CI, 3.1–13), and neurogenic claudication (LR, 3.7; 95% CI, 2.9–4.8). Absence of neurogenic claudication (LR, 0.23; 95% CI, 0.17–0.31) decreased the likelihood of the diagnosis. A wide-based gait (LR, 13; 95% CI, 1.9–95) and abnormal Romberg test result (LR, 4.2; 95% CI, 1.4–13) increased the likelihood of the clinical syndrome of LSS. A score of 7 or higher on a diagnostic support tool including history and examination findings increased the likelihood of the clinical syndrome of LSS (LR, 3.3; 95% CI, 2.7–4.0), while a score lower than 7 made the diagnosis much less

  7. Development of an integrated optical coherence tomography-gas nozzle system for surgical laser ablation applications: preliminary findings of in situ spinal cord deformation due to gas flow effects.

    PubMed

    Wong, Ronnie; Jivraj, Jamil; Vuong, Barry; Ramjist, Joel; Dinn, Nicole A; Sun, Cuiru; Huang, Yize; Smith, James A; Yang, Victor X D

    2015-01-01

    Gas assisted laser machining of materials is a common practice in the manufacturing industry. Advantages in using gas assistance include reducing the likelihood of flare-ups in flammable materials and clearing away ablated material in the cutting path. Current surgical procedures and research do not take advantage of this and in the case for resecting osseous tissue, gas assisted ablation can help minimize charring and clear away debris from the surgical site. In the context of neurosurgery, the objective is to cut through osseous tissue without damaging the underlying neural structures. Different inert gas flow rates used in laser machining could cause deformations in compliant materials. Complications may arise during surgical procedures if the dura and spinal cord are damaged by these deformations. We present preliminary spinal deformation findings for various gas flow rates by using optical coherence tomography to measure the depression depth at the site of gas delivery.

  8. Development of an integrated optical coherence tomography-gas nozzle system for surgical laser ablation applications: preliminary findings of in situ spinal cord deformation due to gas flow effects

    PubMed Central

    Wong, Ronnie; Jivraj, Jamil; Vuong, Barry; Ramjist, Joel; Dinn, Nicole A.; Sun, Cuiru; Huang, Yize; Smith, James A.; Yang, Victor X.D.

    2014-01-01

    Gas assisted laser machining of materials is a common practice in the manufacturing industry. Advantages in using gas assistance include reducing the likelihood of flare-ups in flammable materials and clearing away ablated material in the cutting path. Current surgical procedures and research do not take advantage of this and in the case for resecting osseous tissue, gas assisted ablation can help minimize charring and clear away debris from the surgical site. In the context of neurosurgery, the objective is to cut through osseous tissue without damaging the underlying neural structures. Different inert gas flow rates used in laser machining could cause deformations in compliant materials. Complications may arise during surgical procedures if the dura and spinal cord are damaged by these deformations. We present preliminary spinal deformation findings for various gas flow rates by using optical coherence tomography to measure the depression depth at the site of gas delivery. PMID:25657873

  9. Differential regulation of proliferation and neuronal differentiation in adult rat spinal cord neural stem/progenitors by ERK1/2, Akt, and PLCγ

    PubMed Central

    Chan, Wai Si; Sideris, Alexandra; Sutachan, Jhon J.; Montoya G, Jose V.; Blanck, Thomas J. J.; Recio-Pinto, Esperanza

    2013-01-01

    Proliferation of endogenous neural stem/progenitor cells (NSPCs) has been identified in both normal and injured adult mammalian spinal cord. Yet the signaling mechanisms underlying the regulation of adult spinal cord NSPCs proliferation and commitment toward a neuronal lineage remain undefined. In this study, the role of three growth factor-mediated signaling pathways in proliferation and neuronal differentiation was examined. Adult spinal cord NSPCs were enriched in the presence of fibroblast growth factor 2 (FGF2). We observed an increase in the number of cells expressing the microtubule-associated protein 2 (MAP2) over time, indicating neuronal differentiation in the culture. Inhibition of the mitogen-activated protein kinase or extracellular signal-regulated kinase (ERK) kinase 1 and 2/ERK 1 and 2 (MEK/ERK1/2) or the phosphoinositide 3-kinase (PI3K)/Akt pathways suppressed active proliferation in adult spinal cord NSPC cultures; whereas neuronal differentiation was negatively affected only when the ERK1/2 pathway was inhibited. Inhibition of the phospholipase Cγ (PLCγ) pathway did not affect proliferation or neuronal differentiation. Finally, we demonstrated that the blockade of either the ERK1/2 or PLCγ signaling pathways reduced neurite branching of MAP2+ cells derived from the NSPC cultures. Many of the MAP2+ cells expressed synaptophysin and had a glutamatergic phenotype, indicating that over time adult spinal cord NSPCs had differentiated into mostly glutamatergic neurons. Our work provides new information regarding the contribution of these pathways to the proliferation and neuronal differentiation of NSPCs derived from adult spinal cord cultures, and emphasizes that the contribution of these pathways is dependent on the origin of the NSPCs. PMID:23986655

  10. Deformable adult human phantoms for radiation protection dosimetry: anthropometric data representing size distributions of adult worker populations and software algorithms

    NASA Astrophysics Data System (ADS)

    Hum Na, Yong; Zhang, Binquan; Zhang, Juying; Caracappa, Peter F.; Xu, X. George

    2010-07-01

    Computational phantoms representing workers and patients are essential in estimating organ doses from various occupational radiation exposures and medical procedures. Nearly all existing phantoms, however, were purposely designed to match internal and external anatomical features of the Reference Man as defined by the International Commission on Radiological Protection (ICRP). To reduce uncertainty in dose calculations caused by anatomical variations, a new generation of phantoms of varying organ and body sizes is needed. This paper presents detailed anatomical data in tables and graphs that are used to design such size-adjustable phantoms representing a range of adult individuals in terms of the body height, body weight and internal organ volume/mass. Two different sets of information are used to derive the phantom sets: (1) individual internal organ size and volume/mass distribution data derived from the recommendations of the ICRP in Publications 23 and 89 and (2) whole-body height and weight percentile data from the National Health and Nutrition Examination Survey (NHANES 1999-2002). The NHANES height and weight data for 19 year old males and females are used to estimate the distributions of individuals' size, which is unknown, that corresponds to the ICRP organ and tissue distributions. This paper then demonstrates the usage of these anthropometric data in the development of deformable anatomical phantoms. A pair of phantoms—modeled entirely in mesh surfaces—of the adult male and female, RPI-adult male (AM) and RPI-adult female (AF) are used as the base for size-adjustable phantoms. To create percentile-specific phantoms from these two base phantoms, organ surface boundaries are carefully altered according to the tabulated anthropometric data. Software algorithms are developed to automatically match the organ volumes and masses with desired values. Finally, these mesh-based, percentile-specific phantoms are converted into voxel-based phantoms for Monte

  11. Deformable adult human phantoms for radiation protection dosimetry: anthropometric data representing size distributions of adult worker populations and software algorithms.

    PubMed

    Na, Yong Hum; Zhang, Binquan; Zhang, Juying; Caracappa, Peter F; Xu, X George

    2010-07-07

    Computational phantoms representing workers and patients are essential in estimating organ doses from various occupational radiation exposures and medical procedures. Nearly all existing phantoms, however, were purposely designed to match internal and external anatomical features of the Reference Man as defined by the International Commission on Radiological Protection (ICRP). To reduce uncertainty in dose calculations caused by anatomical variations, a new generation of phantoms of varying organ and body sizes is needed. This paper presents detailed anatomical data in tables and graphs that are used to design such size-adjustable phantoms representing a range of adult individuals in terms of the body height, body weight and internal organ volume/mass. Two different sets of information are used to derive the phantom sets: (1) individual internal organ size and volume/mass distribution data derived from the recommendations of the ICRP in Publications 23 and 89 and (2) whole-body height and weight percentile data from the National Health and Nutrition Examination Survey (NHANES 1999-2002). The NHANES height and weight data for 19 year old males and females are used to estimate the distributions of individuals' size, which is unknown, that corresponds to the ICRP organ and tissue distributions. This paper then demonstrates the usage of these anthropometric data in the development of deformable anatomical phantoms. A pair of phantoms--modeled entirely in mesh surfaces--of the adult male and female, RPI-adult male (AM) and RPI-adult female (AF) are used as the base for size-adjustable phantoms. To create percentile-specific phantoms from these two base phantoms, organ surface boundaries are carefully altered according to the tabulated anthropometric data. Software algorithms are developed to automatically match the organ volumes and masses with desired values. Finally, these mesh-based, percentile-specific phantoms are converted into voxel-based phantoms for Monte Carlo

  12. Anaplastic pleomorphic xanthoastrocytoma with spinal leptomeningeal spread at the time of diagnosis in an adult.

    PubMed

    Benjamin, Carolina; Faustin, Arline; Snuderl, Matija; Pacione, Donato

    2015-08-01

    We describe the first patient, to our knowledge, with anaplastic pleomorphic xanthoastrocytoma (PXA) with spinal leptomeningeal spread at the time of diagnosis and present a review of the literature. PXA is a tumor that typically has an indolent course but occasionally, when anaplastic features are present, behaves in a more aggressive manner. We found that PXA with spinal leptomeningeal spread at the time of diagnosis confers a worse prognosis. Craniospinal imaging should be obtained at time of diagnosis of PXA and the presence of leptomeningeal spread may be indicative of a more aggressive disease process.

  13. Effects of Adult Romantic Attachment and Social Support on Resilience and Depression in Individuals with Spinal Cord Injuries

    PubMed Central

    Dodd, Zane; Warren, Ann Marie; Riggs, Shelley; Clark, Mike

    2015-01-01

    Background: Spinal cord injury (SCI) can cause psychological consequences that negatively affect quality of life. It is increasingly recognized that factors such as resilience and social support may produce a buffering effect and are associated with improved health outcomes. However the influence of adult attachment style on an individual’s ability to utilize social support after SCI has not been examined. Objective: The purpose of this study was to examine relationships between adult romantic attachment perceived social support depression and resilience in individuals with SCI. In addition we evaluated potential mediating effects of social support and adult attachment on resilience and depression. Methods: Participants included 106 adults with SCI undergoing inpatient rehabilitation. Individuals completed measures of adult attachment (avoidance and anxiety) social support resilience and depression. Path analysis was performed to assess for presence of mediation effects. Results: When accounting for the smaller sample size support was found for the model (comparative fit index = .927 chi square = 7.86 P = .01 β = -0.25 standard error [SE] = -2.93 P < .05). The mediating effect of social support on the association between attachment avoidance and resilience was the only hypothesized mediating effect found to be significant (β = -0.25 SE = -2.93 P < .05). Conclusion: Results suggest that individuals with SCI with higher levels of attachment avoidance have lower perceived social support which relates to lower perceived resilience. Assessing attachment patterns during inpatient rehabilitation may allow therapists to intervene to provide greater support. PMID:26364285

  14. Spinal Muscular Atrophy (SMA)

    MedlinePlus

    ... children with SMA develop spinal deformities, such as scoliosis (sideways curvature of the spine) and kyphosis (front- ... Magnetic Resonance Imaging (MRI) Brain and Nervous System Scoliosis Contact Us Print Resources Send to a friend ...

  15. Spinal rehabilitative exercise or manual treatment for the prevention of cervicogenic headache in adults.

    PubMed

    Haas, Mitchell; Brønfort, Gert; Evans, Roni L; Leininger, Brent; Schmitt, John; Levin, Morris; Westrom, Kristine; Goldsmith, Charles H

    2016-05-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To quantify and compare the short- and long-term effects of manual treatment and spinal rehabilitative exercise for cervicogenic headache, classified according to the International Headache Society's (IHS) diagnostic criteria, with an active or placebo/sham comparison or wait-list control.

  16. Spontaneous spinal epidural abscess presenting in a previously healthy young adult man.

    PubMed

    McDonald, Andrew M; Rollins, Jason L

    2013-01-01

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

  17. Constituent ratio of motor fibers from the C5-C7 spinal nerves in the radial nerve is greater in pup rats than in adult rats.

    PubMed

    Nie, Mingbo; Chen, Liang; Gu, Yudong

    2012-06-01

    Clinically, injuries of C5-C7 of the brachial plexus cause falling of the wrist and fingers in infants but not in adults unless 4 consecutive spinal nerves are injured. The purpose of this study was to compare the constituent difference of spinal nerves in the radial nerve between pup and adult rats.A group of 16 pup rats and a group of 16 adult rats were each divided into 2 groups of 8 (P1 and A1 groups, C5-C6 were divided; P2 and A2 groups, C5-C7 were divided]). A nerve conduction study and histological examination were performed to evaluate radial nerve innervation to the extensor digitorum communis muscle after dividing the spinal nerves. Retrograde tracing with 5% cholera toxin B for anterior horn motoneurons of the spinal cord innervating the radial nerve was performed in 8 pup rats and 8 adult rats. Results showed that the division of C5-C7 caused more significant damage to radial nerve innervation to the extensor digitorum communis in pups than in adults, although the division of C5-C6 did not. In pups, the percentages (median with interquartile) of anterior horn motoneurons of the spinal cord innervating the radial nerve were 36.4 (28.3-38.5) in C5-C6, 28.1 (24.5-32.5) in C7, and 37.5 (36.5-39.3) in C8-T1. In adults, they were 24.2 (23.6-27.8) in C5-C6, 21.8 (19.5-26.3) in C7, and 50.7 (48.7-55.5) C8-T1.This study implies that C7 innervation in the radial nerve in humans may be more critical to the function of this nerve in infants than in adults.

  18. Expression patterns of Slit and Robo family members in adult mouse spinal cord and peripheral nervous system.

    PubMed

    Carr, Lauren; Parkinson, David B; Dun, Xin-Peng

    2017-01-01

    The secreted glycoproteins, Slit1-3, are classic axon guidance molecules that act as repulsive cues through their well characterised receptors Robo1-2 to allow precise axon pathfinding and neuronal migration. The expression patterns of Slit1-3 and Robo1-2 have been most characterized in the rodent developing nervous system and the adult brain, but little is known about their expression patterns in the adult rodent peripheral nervous system. Here, we report a detailed expression analysis of Slit1-3 and Robo1-2 in the adult mouse sciatic nerve as well as their expression in the nerve cell bodies within the ventral spinal cord (motor neurons) and dorsal root ganglion (sensory neurons). Our results show that, in the adult mouse peripheral nervous system, Slit1-3 and Robo1-2 are expressed in the cell bodies and axons of both motor and sensory neurons. While Slit1 and Robo2 are only expressed in peripheral axons and their cell bodies, Slit2, Slit3 and Robo1 are also expressed in satellite cells of the dorsal root ganglion, Schwann cells and fibroblasts of peripheral nerves. In addition to these expression patterns, we also demonstrate the expression of Robo1 in blood vessels of the peripheral nerves. Our work gives important new data on the expression patterns of Slit and Robo family members within the peripheral nervous system that may relate both to nerve homeostasis and the reaction of the peripheral nerves to injury.

  19. A retinoic acid receptor beta agonist (CD2019) overcomes inhibition of axonal outgrowth via phosphoinositide 3-kinase signalling in the injured adult spinal cord.

    PubMed

    Agudo, Marta; Yip, Ping; Davies, Meirion; Bradbury, Elizabeth; Doherty, Patrick; McMahon, Stephen; Maden, Malcolm; Corcoran, Jonathan P T

    2010-01-01

    After spinal cord injury in the adult mammal, axons do not normally regrow and this commonly leads to paralysis. Retinoic acid (RA) can stimulate neurite outgrowth in vitro of both the embryonic central and peripheral nervous system, via activation of the retinoic acid receptor (RAR) beta2. We show here that regions of the adult CNS, including the cerebellum and cerebral cortex, express RARbeta2. We show that when cerebellar neurons are grown in the presence of myelin-associated glycoprotein (MAG) which inhibits neurite outgrowth, RARbeta can be activated in a dose dependent manner by a RARbeta agonist (CD2019) and neurite outgrowth can occur via phosphoinositide 3-kinase (PI3K) signalling. In a model of spinal cord injury CD2019 also acts through PI3K signalling to induce axonal outgrowth of descending corticospinal fibres and promote functional recovery. Our data suggest that RARbeta agonists may be of therapeutic potential for human spinal cord injuries.

  20. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery

    PubMed Central

    Balaji, V.; Kaila, R.; Wilson, L.

    2016-01-01

    Objectives We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. Methods The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion. Results A total of six studies (three prospective and three retrospective) reporting on the use of BMP2 met the inclusion criteria (203 patients). Of these, four provided a comparison of BMP2 and bone graft whereas the other two solely investigated the use of BMP2. The primary outcome was seen in 92.3% (108/117) of patients following surgery with BMP2. Although none of the studies showed superiority of BMP2 to bone graft for fusion, its use was associated with a statistically quicker time to achieving fusion. BMP2 did not appear to increase the risk of complication. Conclusion The use of BMP2 is both safe and effective within the revision setting, ideally in cases where bone graft is unavailable or undesirable. Further research is required to define its optimum role. Cite this article: Mr P. Bodalia. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery: A systematic review. Bone Joint Res 2016;5:145–152. DOI: 10.1302/2046-3758.54.2000418. PMID:27121215

  1. Neonatal Tissue Damage Promotes Spike Timing-Dependent Synaptic Long-Term Potentiation in Adult Spinal Projection Neurons

    PubMed Central

    Li, Jie

    2016-01-01

    Mounting evidence from both humans and rodents suggests that tissue damage during the neonatal period can “prime” developing nociceptive pathways such that a subsequent injury during adulthood causes an exacerbated degree of pain hypersensitivity. However, the cellular and molecular mechanisms that underlie this priming effect remain poorly understood. Here, we demonstrate that neonatal surgical injury relaxes the timing rules governing long-term potentiation (LTP) at mouse primary afferent synapses onto mature lamina I projection neurons, which serve as a major output of the spinal nociceptive network and are essential for pain perception. In addition, whereas LTP in naive mice was only observed if the presynaptic input preceded postsynaptic firing, early tissue injury removed this temporal requirement and LTP was observed regardless of the order in which the inputs were activated. Neonatal tissue damage also reduced the dependence of spike-timing-dependent LTP on NMDAR activation and unmasked a novel contribution of Ca2+-permeable AMPARs. These results suggest for the first time that transient tissue damage during early life creates a more permissive environment for the production of LTP within adult spinal nociceptive circuits. This persistent metaplasticity may promote the excessive amplification of ascending nociceptive transmission to the mature brain and thereby facilitate the generation of chronic pain after injury, thus representing a novel potential mechanism by which early trauma can prime adult pain pathways in the CNS. SIGNIFICANCE STATEMENT Tissue damage during early life can “prime” developing nociceptive pathways in the CNS, leading to greater pain severity after repeat injury via mechanisms that remain poorly understood. Here, we demonstrate that neonatal surgical injury widens the timing window during which correlated presynaptic and postsynaptic activity can evoke long-term potentiation (LTP) at sensory synapses onto adult lamina I

  2. Soft Tissue Deformations Contribute to the Mechanics of Walking in Obese Adults

    PubMed Central

    Fu, Xiao-Yu; Zelik, Karl E.; Board, Wayne J.; Browning, Raymond C.; Kuo, Arthur D.

    2014-01-01

    Obesity not only adds to the mass that must be carried during walking, but also changes body composition. Although extra mass causes roughly proportional increases in musculoskeletal loading, less well understood is the effect of relatively soft and mechanically compliant adipose tissue. Purpose To estimate the work performed by soft tissue deformations during walking. The soft tissue would be expected to experience damped oscillations, particularly from high force transients following heel strike, and could potentially change the mechanical work demands for walking. Method We analyzed treadmill walking data at 1.25 m/s for 11 obese (BMI > 30 kg/m2) and 9 non-obese (BMI < 30 kg/m2) adults. The soft tissue work was quantified with a method that compares the work performed by lower extremity joints as derived using assumptions of rigid body segments, with that estimated without rigid body assumptions. Results Relative to body mass, obese and non-obese individuals perform similar amounts of mechanical work. But negative work performed by soft tissues was significantly greater in obese individuals (p= 0.0102), equivalent to about 0.36 J/kg vs. 0.27 J/kg in non-obese individuals. The negative (dissipative) work by soft tissues occurred mainly after heel strike, and for obese individuals was comparable in magnitude to the total negative work from all of the joints combined (0.34 J/kg vs. 0.33 J/kg for obese and non-obese adults, respectively). Although the joints performed a relatively similar amount of work overall, obese individuals performed less negative work actively at the knee. Conclusion The greater proportion of soft tissues in obese individuals results in substantial changes in the amount, location, and timing of work, and may also impact metabolic energy expenditure during walking. PMID:25380475

  3. Regeneration of the Adult Rat Spinal Cord in Response to Ensheathing Cells and Methylprednisolone

    DTIC Science & Technology

    2002-01-01

    me in academics and research, and also as my friend. I thank Dr. Linda L. Porter, for her continuous efforts on my behalf as the Chairperson of...and Spinal Cord Injury Program. We are grateful to Drs. Barbara S. Bregman and Linda L. Porter for their wonderful suggestions and guidance; to Anna...ES, Pietronigro DD, Seligman ML (1980) The free radical pathology and the microcirculation in the major central nervous system disorders. Acta

  4. Antinociceptive Effects of Spinal Manipulative Therapy on Nociceptive Behavior of Adult Rats during the Formalin Test

    PubMed Central

    Onifer, Stephen M.; Reed, William R.; Sozio, Randall S.; Long, Cynthia R.

    2015-01-01

    Optimizing pain relief resulting from spinal manipulative therapies, including low velocity variable amplitude spinal manipulation (LVVA-SM), requires determining their mechanisms. Pain models that incorporate simulated spinal manipulative therapy treatments are needed for these studies. The antinociceptive effects of a single LVVA-SM treatment on rat nociceptive behavior during the commonly used formalin test were investigated. Dilute formalin was injected subcutaneously into a plantar hindpaw. Licking behavior was video-recorded for 5 minutes. Ten minutes of LVVA-SM at 20° flexion was administered with a custom-made device at the lumbar (L5) vertebra of isoflurane-anesthetized experimental rats (n = 12) beginning 10 minutes after formalin injection. Hindpaw licking was video-recorded for 60 minutes beginning 5 minutes after LVVA-SM. Control rats (n = 12) underwent the same methods except for LVVA-SM. The mean times spent licking the formalin-injected hindpaw of both groups 1–5 minutes after injection were not different. The mean licking time during the first 20 minutes post-LVVA-SM of experimental rats was significantly less than that of control rats (P < 0.001). The mean licking times of both groups during the second and third 20 minutes post-LVVA-SM were not different. Administration of LVVA-SM had a short-term, remote antinociceptive effect similar to clinical findings. Therefore, mechanistic investigations using this experimental approach are warranted. PMID:26693243

  5. Differential Activation of TRP Channels in the Adult Rat Spinal Substantia Gelatinosa by Stereoisomers of Plant-Derived Chemicals

    PubMed Central

    Kumamoto, Eiichi; Fujita, Tsugumi

    2016-01-01

    Activation of TRPV1, TRPA1 or TRPM8 channel expressed in the central terminal of dorsal root ganglion (DRG) neuron increases the spontaneous release of l-glutamate onto spinal dorsal horn lamina II (substantia gelatinosa; SG) neurons which play a pivotal role in regulating nociceptive transmission. The TRP channels are activated by various plant-derived chemicals. Although stereoisomers activate or modulate ion channels in a distinct manner, this phenomenon is not fully addressed for TRP channels. By applying the whole-cell patch-clamp technique to SG neurons of adult rat spinal cord slices, we found out that all of plant-derived chemicals, carvacrol, thymol, carvone and cineole, increase the frequency of spontaneous excitatory postsynaptic current, a measure of the spontaneous release of l-glutamate from nerve terminals, by activating TRP channels. The presynaptic activities were different between stereoisomers (carvacrol and thymol; (−)-carvone and (+)-carvone; 1,8-cineole and 1,4-cineole) in the extent or the types of TRP channels activated, indicating that TRP channels in the SG are activated by stereoisomers in a distinct manner. This result could serve to know the properties of the central terminal TRP channels that are targets of drugs for alleviating pain. PMID:27483289

  6. Spinal Headaches

    MedlinePlus

    ... undergo a spinal tap (lumbar puncture) or spinal anesthesia. Both procedures require a puncture of the tough ... is withdrawn from your spinal canal. During spinal anesthesia, medication is injected into your spinal canal to ...

  7. Regeneration of lumbar dorsal root axons into the spinal cord of adult frogs (Rana pipiens), an HRP study.

    PubMed

    Liuzzi, F J; Lasek, R J

    1985-02-22

    Lumbar dorsal roots of adult frogs were crushed or cut and reanastomosed. Following survival times of up to 75 days, the regenerating dorsal roots were recut and anterogradely injury-filled with horseradish peroxidase. This revealed that in the adult frog, regenerating axons re-enter the spinal cord. Comparison of the distribution of these axons with that of normal dorsal root axons showed that there is a partial restoration of the segmental distribution in the gray matter. However, the long ascending sensory tract of the dorsal funiculus was not restored. The dorsal funiculus was markedly gliotic and had relatively few labelled, regenerated axons. The labelled axons that were seen in the dorsal funiculus either extended longitudinally for a distance just beneath the pia, apparently in association with the glia limitans, or traversed the region to enter the dorsal gray matter. Most of the large and small diameter axons that entered the gray matter did so by passing through the region of the dorsolateral fasciculus. Within the gray matter, small diameter, regenerated axons arborized in the region of the dorsal terminal field, a region that has been shown in the normal frog to receive cutaneous afferents only. Many large diameter axons, presumably muscle afferents, arborized in the ventral terminal field, a region shown in the normal frog to receive muscle afferents exclusively. However, many of these large diameter axons had arborizations that extended to both terminal fields, thus suggesting that some abberant connections are made during dorsal root regeneration in the adult frog.

  8. Effects of mechanical loading on the expression of pleiotrophin and its receptor protein tyrosine phosphatase beta/zeta in a rat spinal deformity model.

    PubMed

    Kaspiris, Angelos; Chronopoulos, Efstathios; Grivas, Theodoros B; Vasiliadis, Elias; Khaldi, Lubna; Lamprou, Margarita; Lelovas, Pavlos P; Papaioannou, Nikolaos; Dontas, Ismene A; Papadimitriou, Evangelia

    2016-02-01

    Mechanical loading of the spine is a major causative factor of degenerative changes and causes molecular and structural changes in the intervertebral disc (IVD) and the vertebrae end plate (EP). Pleiotrophin (PTN) is a growth factor with a putative role in bone remodeling through its receptor protein tyrosine phosphatase beta/zeta (RPTPβ/ζ). The present study investigates the effects of strain on PTN and RPTPβ/ζ protein expression in vivo. Tails of eight weeks old Sprague-Dawley rats were subjected to mechanical loading using a mini Ilizarov external apparatus. Rat tails untreated (control) or after 0 degrees of compression and 10°, 30° and 50° of angulation (groups 0, I, II and III respectively) were studied. PTN and RPTPβ/ζ expression were evaluated using immunohistochemistry and Western blot analysis. In the control group, PTN was mostly expressed by the EP hypertrophic chondrocytes. In groups 0 to II, PTN expression was increased in the chondrocytes of hypertrophic and proliferating zones, as well as in osteocytes and osteoblast-like cells of the ossification zone. In group III, only limited PTN expression was observed in osteocytes. RPTPβ/ζ expression was increased mainly in group 0, but also in group I, in all types of cells. Low intensity RPTPβ/ζ immunostaining was observed in groups II and III. Collectively, PTN and RPTPβ/ζ are expressed in spinal deformities caused by mechanical loading, and their expression depends on the type and severity of the applied strain.

  9. Effects of Surgical Correction for the Treatment of Adult Acquired Flatfoot Deformity: A Computational Investigation

    PubMed Central

    Iaquinto, Joseph M; Wayne, Jennifer S

    2011-01-01

    Computational models of the foot/ankle complex were developed to predict the biomechanical consequences of surgical procedures that correct for Stage II adult acquired flatfoot deformity. Cadaveric leg and foot bony anatomy was captured by CT imaging in neutral flexion and imported to the modeling software. Ligaments were approximated as tension only springs attached at insertion sites. Muscle contraction of the gastrocnemius/soleus complex was simulated through force vectors and desired external loads applied to the model. Ligament stiffnesses were modified to reflect Stage II flatfoot damage, followed by integration of corrective osteotomies—medializing calcaneal osteotomy (MCO) and Evans and calcaneocuboid distraction arthrodesis (CCDA)—to treat flatfoot. Joint angles, tissue strains, calcaneocuboid contact force, and plantar loads were analyzed. The flatfoot simulation demonstrated clinical signs of disease evidenced by degradation of joint alignment. Repair states corrected these joint misalignments with MCO having greatest impact in the hindfoot, and Evans/CCDA having greatest effect in the mid- and forefoot. The lateral procedures unevenly strained plantar structures, while offloading the medial forefoot, and increased loading on the lateral forefoot, which was amplified by combining with MCO. The Evans procedure raised calcaneocuboid joint contact force to twice intact levels. Computational results are in agreement with clinical and experimental findings. The model demonstrated potential precursors to such complications as lateral tightness and arthritic development and may thus be useful as a predictor of surgical outcomes. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29: 1047–1054, 2011 PMID:21319218

  10. Expression patterns of Slit and Robo family members in adult mouse spinal cord and peripheral nervous system

    PubMed Central

    Carr, Lauren; Parkinson, David B.; Dun, Xin-peng

    2017-01-01

    The secreted glycoproteins, Slit1-3, are classic axon guidance molecules that act as repulsive cues through their well characterised receptors Robo1-2 to allow precise axon pathfinding and neuronal migration. The expression patterns of Slit1-3 and Robo1-2 have been most characterized in the rodent developing nervous system and the adult brain, but little is known about their expression patterns in the adult rodent peripheral nervous system. Here, we report a detailed expression analysis of Slit1-3 and Robo1-2 in the adult mouse sciatic nerve as well as their expression in the nerve cell bodies within the ventral spinal cord (motor neurons) and dorsal root ganglion (sensory neurons). Our results show that, in the adult mouse peripheral nervous system, Slit1-3 and Robo1-2 are expressed in the cell bodies and axons of both motor and sensory neurons. While Slit1 and Robo2 are only expressed in peripheral axons and their cell bodies, Slit2, Slit3 and Robo1 are also expressed in satellite cells of the dorsal root ganglion, Schwann cells and fibroblasts of peripheral nerves. In addition to these expression patterns, we also demonstrate the expression of Robo1 in blood vessels of the peripheral nerves. Our work gives important new data on the expression patterns of Slit and Robo family members within the peripheral nervous system that may relate both to nerve homeostasis and the reaction of the peripheral nerves to injury. PMID:28234971

  11. Utility of multilevel lateral interbody fusion of the thoracolumbar coronal curve apex in adult deformity surgery in combination with open posterior instrumentation and L5-S1 interbody fusion: a case-matched evaluation of 32 patients.

    PubMed

    Theologis, Alexander A; Mundis, Gregory M; Nguyen, Stacie; Okonkwo, David O; Mummaneni, Praveen V; Smith, Justin S; Shaffrey, Christopher I; Fessler, Richard; Bess, Shay; Schwab, Frank; Diebo, Bassel G; Burton, Douglas; Hart, Robert; Deviren, Vedat; Ames, Christopher

    2017-02-01

    OBJECTIVE The aim of this study was to evaluate the utility of supplementing long thoracolumbar posterior instrumented fusion (posterior spinal fusion, PSF) with lateral interbody fusion (LIF) of the lumbar/thoracolumbar coronal curve apex in adult spinal deformity (ASD). METHODS Two multicenter databases were evaluated. Adults who had undergone multilevel LIF of the coronal curve apex in addition to PSF with L5-S1 interbody fusion (LS+Apex group) were matched by number of posterior levels fused with patients who had undergone PSF with L5-S1 interbody fusion without LIF (LS-Only group). All patients had at least 2 years of follow-up. Percutaneous PSF and 3-column osteotomy (3CO) were excluded. Demographics, perioperative details, radiographic spinal deformity measurements, and HRQoL data were analyzed. RESULTS Thirty-two patients were matched (LS+Apex: 16; LS: 16) (6 men, 26 women; mean age 63 ± 10 years). Overall, the average values for measures of deformity were as follows: Cobb angle > 40°, sagittal vertical axis (SVA) > 6 cm, pelvic tilt (PT) > 25°, and mismatch between pelvic incidence (PI) and lumbar lordosis (LL) > 15°. There were no significant intergroup differences in preoperative radiographic parameters, although patients in the LS+Apex group had greater Cobb angles and less LL. Patients in the LS+Apex group had significantly more anterior levels fused (4.6 vs 1), longer operative times (859 vs 379 minutes), and longer length of stay (12 vs 7.5 days) (all p < 0.01). For patients in the LS+Apex group, Cobb angle, pelvic tilt (PT), lumbar lordosis (LL), PI-LL (lumbopelvic mismatch), Oswestry Disability Index (ODI) scores, and visual analog scale (VAS) scores for back and leg pain improved significantly (p < 0.05). For patients in the LS-Only group, there were significant improvements in Cobb angle, ODI score, and VAS scores for back and leg pain. The LS+Apex group had better correction of Cobb angles (56% vs 33%, p = 0.02), SVA (43% vs 5%, p = 0

  12. Transplantation of Adult Monkey Neural Stem Cells into A Contusion Spinal Cord Injury Model in Rhesus Macaque Monkeys

    PubMed Central

    Hajinasrollah, Mostafa; Zare Mehrjerdi, Nargess; Azizi, Hossein; Hemmesi, Katayoun; Moghiminasr, Reza; Azhdari, Zahra; Talebi, Ardeshir; Mohitmafi, Soroush; Vosough Taqi Dizaj, Ahmad; Sharifi, Giuve; Baharvand, Hossein; Rezaee, Omidvar; Kiani, Sahar

    2014-01-01

    Objective Currently, cellular transplantation for spinal cord injuries (SCI) is the subject of numerous preclinical studies. Among the many cell types in the adult brain, there is a unique subpopulation of neural stem cells (NSC) that can self-renew and differentiate into neurons. The study aims, therefore, to explore the efficacy of adult monkey NSC (mNSC) in a primate SCI model. Materials and Methods In this experimental study, isolated mNSCs were analyzed by flow cytometry, immunocytochemistry, and RT-PCR. Next, BrdU-labeled cells were transplanted into a SCI model. The SCI animal model was confirmed by magnetic resonance imaging (MRI) and histological analysis. Animals were clinically observed for 6 months. Results Analysis confirmed homing of mNSCs into the injury site. Transplanted cells expressed neuronal markers (TubIII). Hind limb performance improved in trans- planted animals based on Tarlov’s scale and our established behavioral tests for monkeys. Conclusion Our findings have indicated that mNSCs can facilitate recovery in contusion SCI models in rhesus macaque monkeys. Additional studies are necessary to determine the im- provement mechanisms after cell transplantation. PMID:24567941

  13. Novel concept of motor functional analysis for spinal cord injury in adult mice.

    PubMed

    Shinozaki, Munehisa; Takahashi, Yuichiro; Mukaino, Masahiko; Saito, Nobuhito; Toyama, Yoshiaki; Okano, Hideyuki; Nakamura, Masaya

    2011-01-01

    In basic research on spinal cord injury (SCI), behavioral evaluation of the SCI animal model is critical. However, it is difficult to accurately evaluate function in the mouse SCI model due to the small size of mice. Although the open-field scoring scale is an outstanding appraisal method, supplementary objective tests are required. Using a compact SCANET system, in which a mouse carries out free movement for 5 min, we developed a novel method to detect locomotor ability. A SCANET system samples the horizontal coordinates of a mouse every 0.1 s, and both the speed and acceleration of its motion are calculated at each moment. It was found that the maximum speed and acceleration of motion over 5 min varied by injury severity. Moreover, these values were significantly correlated with open-field scores. The maximum speed and acceleration of SCI model mice using a SCANET system are objective, easy to obtain, and reproducible for evaluating locomotive function.

  14. Function of Sox2 in ependymal cells of lesioned spinal cords in adult zebrafish.

    PubMed

    Ogai, Kazuhiro; Nakatani, Kumi; Hisano, Suguru; Sugitani, Kayo; Koriyama, Yoshiki; Kato, Satoru

    2014-11-01

    The sex-determining region Y-box 2 (Sox2) is related not only to pluripotency, but also to cell proliferation. Zebrafish can regain their motor function after spinal cord injury (SCI). Following SCI, new motor neurons are produced from proliferating ependymal cells. Here, we investigated the expression and function of Sox2 after SCI in zebrafish. Sox2 was upregulated as early as 1 day post-lesion (dpl) in ependymal cells, which was followed by cell proliferation. Sox2 knockdown significantly decreased the number of proliferating cells at 5dpl. The results of this study suggest a role of Sox2 as one of the proliferation initiators in ependymal cells after SCI.

  15. Combining an autologous peripheral nervous system "bridge" and matrix modification by chondroitinase allows robust, functional regeneration beyond a hemisection lesion of the adult rat spinal cord.

    PubMed

    Houle, John D; Tom, Veronica J; Mayes, Debra; Wagoner, Gail; Phillips, Napoleon; Silver, Jerry

    2006-07-12

    Chondroitinase-ABC (ChABC) was applied to a cervical level 5 (C5) dorsal quadrant aspiration cavity of the adult rat spinal cord to degrade the local accumulation of inhibitory chondroitin sulfate proteoglycans. The intent was to enhance the extension of regenerated axons from the distal end of a peripheral nerve (PN) graft back into the C5 spinal cord, having bypassed a hemisection lesion at C3. ChABC-treated rats showed (1) gradual improvement in the range of forelimb swing during locomotion, with some animals progressing to the point of raising their forelimb above the nose, (2) an enhanced ability to use the forelimb in a cylinder test, and (3) improvements in balance and weight bearing on a horizontal rope. Transection of the PN graft, which cuts through regenerated axons, greatly diminished these functional improvements. Axonal regrowth from the PN graft correlated well with the behavioral assessments. Thus, many more axons extended for much longer distances into the cord after ChABC treatment and bridge insertion compared with the control groups, in which axons regenerated into the PN graft but growth back into the spinal cord was extremely limited. These results demonstrate, for the first time, that modulation of extracellular matrix components after spinal cord injury promotes significant axonal regeneration beyond the distal end of a PN bridge back into the spinal cord and that regenerating axons can mediate the return of useful function of the affected limb.

  16. Activation of TRPA1 channel facilitates excitatory synaptic transmission in substantia gelatinosa neurons of the adult rat spinal cord.

    PubMed

    Kosugi, Masafumi; Nakatsuka, Terumasa; Fujita, Tsugumi; Kuroda, Yasuo; Kumamoto, Eiichi

    2007-04-18

    TRPA1 is expressed in primary sensory neurons and hair cells, and it is proposed to be activated by cold stimuli, mechanical stimuli, or pungent ingredients. However, its role in regulating synaptic transmission has never been documented yet. In the present study, we examined whether activation of the TRPA1 channels affects synaptic transmission in substantia gelatinosa (SG) neurons of adult rat spinal cord slices by using the whole-cell patch-clamp technique. A chief ingredient of mustard oil, allyl isothiocyanate (AITC), superfused for 2 min markedly increased the frequency and amplitude of spontaneous EPSCs (sEPSCs), which was accompanied by an inward current. Similar actions were produced by cinnamaldehyde and allicin. The AITC-induced increases in sEPSC frequency and amplitude were resistant to tetrodotoxin (TTX) and La3+, whereas being significantly reduced in extent in a Ca2+-free bath solution. In the presence of glutamate receptor antagonists CNQX and AP5, AITC did not generate any synaptic activities. The AITC-induced increases in sEPSC frequency and amplitude were reduced by ruthenium red, whereas being unaffected by capsazepine. AITC also increased the frequency and amplitude of spontaneous inhibitory postsynaptic currents; this AITC action was abolished in the presence of TTX or glutamate receptor antagonists. These results indicate that TRPA1 appears to be localized not only at presynaptic terminals on SG neurons to enhance glutamate release, but also in terminals of primary afferents innervating onto spinal inhibitory interneurons, which make synapses with SG neurons. This central modulation of sensory signals may be associated with physiological and pathological pain sensations.

  17. Connexin36 identified at morphologically mixed chemical/electrical synapses on trigeminal motoneurons and at primary afferent terminals on spinal cord neurons in adult mouse and rat.

    PubMed

    Bautista, W; McCrea, D A; Nagy, J I

    2014-03-28

    Morphologically mixed chemical/electrical synapses at axon terminals, with the electrical component formed by gap junctions, is common in the CNS of lower vertebrates. In mammalian CNS, evidence for morphologically mixed synapses has been obtained in only a few locations. Here, we used immunofluorescence approaches to examine the localization of the neuronally expressed gap junction forming protein connexin36 (Cx36) in relation to the axon terminal marker vesicular glutamate transporter-1 (vglut1) in the spinal cord and the trigeminal motor nucleus (Mo5) of rat and mouse. In adult rodents, immunolabeling for Cx36 appeared exclusively as Cx36-puncta, and was widely distributed at all rostro-caudal levels in most spinal cord laminae and in the Mo5. A high proportion of Cx36-puncta was co-localized with vglut1, forming morphologically mixed synapses on motoneurons, in intermediate spinal cord lamina, and in regions of medial lamina VII, where vglut1-containing terminals associated with Cx36 converged on neurons adjacent to the central canal. Unilateral transection of lumbar dorsal roots reduced immunolabeling of both vglut1 and Cx36 in intermediate laminae and lamina IX. Further, vglut1-terminals displaying Cx36-puncta were contacted by terminals labeled for glutamic acid decarboxylase65, which is known to be contained in presynaptic terminals on large-diameter primary afferents. Developmentally, mixed synapses begin to emerge in the spinal cord only after the second to third postnatal week and thereafter increase to adult levels. Our findings demonstrate that axon terminals of primary afferent origin form morphologically mixed synapses containing Cx36 in broadly distributed areas of adult rodent spinal cord and Mo5.

  18. Methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities - 6th SOSORT consensus paper

    PubMed Central

    2009-01-01

    Background Comprehensive evaluation of the morphology of the spine and of the whole body is essential in order to correctly manage patients suffering from progressive idiopathic scoliosis. Although methodology of clinical and radiological examination is well described in manuals of orthopaedics, there is deficit of data which clinical and radiological parameters are considered in everyday practise. Recently, an increasing tendency to extend scoliosis examination beyond the measure of the Cobb angle can be observed, reflecting a more patient-oriented approach. Such evaluation often involves surface parameters, aesthetics, function and quality of life. Aim of the study To investigate current recommendations of experts on methodology of evaluation of the patient with spinal deformity, essentially idiopathic scoliosis. Methods Structured Delphi procedure for collecting and processing knowledge from a group of experts with a series of questionnaires and controlled opinion feedback was performed. Experience and opinions of the professionals - physicians and physiotherapists managing scoliosis patients - were studied. According to Delphi method a Meeting Questionnaire (MQ) has been developed, resulting from a preliminary Pre-Meeting Questionnaire (PMQ) which had been previously discussed and approved on line. The MQ was circulated among the SOSORT experts during Consensus Session on "Measurements" which took place at the Annual Meeting of the Society, totally 23 panellists being engaged. Clinical, radiological and surface topography parameters were checked for agreement. Results 90% agreement or more was reached in 35 items and superior than 75% agreement was reached in further 25 items. An evaluation form was proposed to be used by clinicians and researchers. Conclusion The consensus was reached on evaluation of the morphology of the patient with idiopathic scoliosis, comprising clinical, radiological and, to less extend, surface topography assessment. Considering the

  19. Trends, Major Medical Complications, and Charges Associated with Surgery for Lumbar Spinal Stenosis in Older Adults

    PubMed Central

    Deyo, Richard A.; Mirza, Sohail K.; Martin, Brook I.; Kreuter, William; Goodman, David C.; Jarvik, Jeffrey G.

    2010-01-01

    Context In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over non-operative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in elderly patients, so benefits and risks must be carefully weighed in the choice of surgical procedure. Objective Examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity. Design, Setting, and Patients Retrospective cohort analysis of Medicare claims for 2002–2007, focusing on 2007 to assess complications and resource use in U.S. hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n=32,152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (one or two disc levels, single surgical approach) or complex fusion (more than 2 disc levels or combined anterior and posterior approach). Main Outcome Measures Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use. Results Overall, surgical rates declined slightly from 2002–2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100,000 beneficiaries. Life-threatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared to decompression alone was 2.95 (95% CI 2.50–3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR 1.94; 95% CI 1.74–2.17). Adjusted mean hospital

  20. Cleft deformities in adults and children aged over six years in Nigeria: Reasons for late presentation and management challenges

    PubMed Central

    Adeyemo, Wasiu L; Ogunlewe, Mobolanle O; Desalu, Ibironke; Ladeinde, Akinola L; Mofikoya, Bolaji O; Adeyemi, Michael O; Adepoju, Adegbenga A; Hassan, Olufemi O

    2009-01-01

    In developing countries, untreated cleft lips and palates are found with increasing frequency and patients often present to the surgeon far past the optimal time for closure of the cleft deformities. A prospective study was conducted between March 2007 and September 2009, to identify the reasons and treatment challenges of delayed presentation of cleft lip and palate deformities at the Lagos University Teaching Hospital, Nigeria. Out of a total of 150 patients with cleft defects during the period, 43 (28.7%) were adults and children aged over six years. The mean age of these patients at the time of presentation was 17.3 years. The most common reasons for late presentation were lack of money (56.7%), lack of health care services nearby (18.4%), and lack of awareness of treatment availability (13.3%). Common challenges in these patients included surgical, orthodontic, speech, anesthetic, and psychological. Although adult clefts were significantly enlarged in three dimensions the anatomic landmarks were easier to discern than in an infant. However, extensive soft tissue dissection in adult cleft lip repair resulted in significant postoperative edema. Closure of wide palatal cleft often required the use of adjunct intraoral flaps. Despite late presentation, surgical outcome of these patients was satisfactory and comparable to cleft repair in infants. PMID:23674906

  1. Postural and dynamic balance while walking in adults with incomplete spinal cord injury.

    PubMed

    Lemay, Jean-François; Duclos, Cyril; Nadeau, Sylvie; Gagnon, Dany; Desrosiers, Émilie

    2014-10-01

    The purpose of this study was to characterize balance in individuals with and without an incomplete spinal cord injury (ISCI) during the single support phase of gait. Thirty-four individuals (17 with a ISCI, 17 able-bodied) walked at their self-selected walking speed. Among those, eighteen individuals (9 with ISCI, 9 able-bodied) with a similar walking speed were also analyzed. Stabilizing and destabilizing forces quantified balance during the single support phase of gait. The biomechanical factors included in the equation of the stabilizing and destabilizing forces served as explanatory factors. Individuals with ISCI had a lower stabilizing force and a higher destabilizing force compared to able-bodied individuals. The main explanatory factors of the forces extracted from the equations were the speed of the center of mass (maximal stabilizing force) and the distance between the center of pressure and the base of support (minimal destabilizing force). Only the minimal destabilizing force was significantly different among subgroups with a similar walking speed. The stabilizing and destabilizing forces suggest that individuals with ISCI were more stable than able-bodied, which was achieved by walking more slowly - which decrease the speed of the center of mass - and keeping the center of pressure away from the margin of the base of support in order to maintain balance within their range of physical ability.

  2. Rapid functional reorganization of the forelimb cortical representation after thoracic spinal cord injury in adult rats.

    PubMed

    Sydekum, Esther; Ghosh, Arko; Gullo, Miriam; Baltes, Christof; Schwab, Martin; Rudin, Markus

    2014-02-15

    Thoracic spinal cord injured rats rely largely on forelimbs to walk, as their hindlimbs are dysfunctional. This increased limb use is accompanied by expansion of the cortical forelimb sensory representation. It is unclear how quickly the representational changes occur and whether they are at all related to the behavioral adaptation. Using blood oxygenation level dependent functional mangetic resonance imaging (BOLD-fMRI) we show that major plastic changes of the somato-sensory map can occur as early as one day after injury. The extent of map increase was variable between animals, and some animals showed a reduction in map size. However, at three or seven days after injury a significant enhancement of the forelimb representation was evident in all the animals. In a behavioral test for precise limb control, crossing of a horizontal ladder, the injured rats relied almost entirely on their forelimbs; they initially made more mistakes than at 7 days post injury. Remarkably, in the individual animals the behavioral performance seen at seven days was proportional to the physiological change present at one day after injury. The rapid increase in cortical representation of the injury-spared body part may provide the additional neural substrate necessary for high level behavioral adaptation.

  3. Lifestyle Changes and Pressure Ulcer Prevention in Adults With Spinal Cord Injury in the Pressure Ulcer Prevention Study Lifestyle Intervention

    PubMed Central

    Ghaisas, Samruddhi; Pyatak, Elizabeth A.; Blanche, Erna; Clark, Florence

    2015-01-01

    Pressure ulcers (PrUs) are a major burden to patients with spinal cord injury (SCI), affecting their psychological, physical, and social well-being. Lifestyle choices are thought to contribute to the risk of developing PrUs. This article focuses on the interaction between lifestyle choices and the development of PrUs in community settings among participants in the University of Southern California–Rancho Los Amigos National Rehabilitation Center Pressure Ulcer Prevention Study (PUPS II), a randomized controlled trial of a lifestyle intervention for adults with SCI. We conducted a secondary cross-case analysis of treatment notes of 47 PUPS II participants and identified four patterns relating PrU development to lifestyle changes: positive PrU changes (e.g., healing PrUs) with positive lifestyle changes, negative or no PrU changes with positive lifestyle changes, positive PrU changes with minor lifestyle changes, and negative or no PrU changes with no lifestyle changes. We present case studies exemplifying each pattern. PMID:25553751

  4. Comparison of pulmonary function and back muscle strength according to the degree of spinal curvature of healthy adults.

    PubMed

    You, Jae Eung; Lee, Hye Young; Kim, Kyoung

    2015-06-01

    [Purpose] Degree of curvature on the spine is known to affect respiratory function and back muscle activation. We compared pulmonary function and back muscle strength according to the degree of curvature of the spine of healthy adults. [Subjects and Methods] Twenty-three healthy volunteers were enrolled. They were divided into two groups according to the degree of curvature of the spine: the below 2° group, and the above 2° group. The degree of curvature was assessed using the Adams forward bending test and a scoliometer. A pulmonary function test (PFT) was conducted, and back muscle strength was measured. [Results] No significant differences in PFT were found between the below 2° group and the above 2° group, in terms of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), or peak expiratory flow (PEF). However, back muscle strength in the below 2 group was significantly higher than that of the above 2 group. [Conclusion] Our findings indicate that the degree of curvature of the spine is associated with back muscle strength in subjects who have spinal curvature within the normal range. Therefore, evaluation and treatment of back muscle strength might be helpful for preventing the progress of curvature of the spine in adolescents with potential scoliosis.

  5. Understanding Quality of Life in Adults with Spinal Cord Injury Via SCI-Related Needs and Secondary Complications

    PubMed Central

    Noreau, Luc; Leblond, Jean; Dumont, Frédéric S.

    2014-01-01

    Background: Understanding the factors that can predict greater quality of life (QoL) is important for adults with spinal cord injury (SCI), given that they report lower levels of QoL than the general population. Objectives: To build a conceptual model linking SCI-related needs, secondary complications, and QoL in adults with SCI. Prior to testing the conceptual model, we aimed to develop and evaluate the factor structure for both SCI-related needs and secondary complications. Methods: Individuals with a traumatic SCI (N = 1,137) responded to an online survey measuring 13 SCI-related needs, 13 secondary complications, and the Life Satisfaction Questionnaire to assess QoL. The SCI-related needs and secondary complications were conceptualized into factors, tested with a confirmatory factor analysis, and subsequently evaluated in a structural equation model to predict QoL. Results: The confirmatory factor analysis supported a 2-factor model for SCI related needs, χ2(61, N = 1,137) = 250.40, P <.001, comparative fit index (CFI) = .93, root mean square error of approximation (RMSEA) = .05, standardized root mean square residual (SRMR) = .04, and for 11 of the 13 secondary complications, χ2(44, N = 1,137) = 305.67, P < .001, CFI = .91, RMSEA = .060, SRMR = .033. The final 2 secondary complications were kept as observed constructs. In the structural model, both vital and personal development unmet SCI-related needs (β = -.22 and -.20, P < .05, respectively) and the neuro-physiological systems factor (β = -.45, P < .05) were negatively related with QoL. Conclusions: Identifying unmet SCI-related needs of individuals with SCI and preventing or managing secondary complications are essential to their QoL. PMID:25477745

  6. Rupture Following Biceps-to-Triceps Tendon Transfer in Adolescents and Young Adults With Spinal Cord Injury:

    PubMed Central

    Merenda, Lisa A.; Rutter, Laure; Curran, Kimberly; Kozin, Scott H.

    2012-01-01

    Background: Tendon transfer surgery can restore elbow extension in approximately 70% of persons with tetraplegia and often results in antigravity elbow extension strength. However, we have noted an almost 15% rupture/attenuation rate. Objective: This investigation was conducted to analyze potential causes in adolescents/young adults with spinal cord injury (SCI) who experienced tendon rupture or attenuation after biceps-to-triceps transfer. Methods: Medical charts of young adults with SCI who underwent biceps-to-triceps transfer and experienced tendon rupture or attenuation were reviewed. Data collected by retrospective chart review included general demographics, surgical procedure(s), use and duration of antibiotic treatment, time from tendon transfer surgery to rupture/attenuation, and method of diagnosis. Results: Twelve subjects with tetraplegia (mean age, 19 years) who underwent biceps-to-triceps reconstruction with subsequent tendon rupture or attenuation were evaluated. Mean age at time of tendon transfer was 18 years (range, 14-21 years). A fluoroquinolone was prescribed for 42% (n=5) of subjects. Tendon rupture was noted in 67% (n=8), and attenuation was noted in 33% (n=4). Average length of time from surgery to tendon rupture/attenuation was 5.7 months (range, 3-10 months). Conclusion: Potential contributing causes of tendon rupture/attenuation after transfer include surgical technique, rehabilitation, co-contraction of the transfer, poor patient compliance, and medications. In this cohort, 5 subjects were prescribed fluoroquinolones that have a US Food and Drug Administration black box concerning tendon ruptures. Currently, all candidates for upper extremity tendon transfer reconstruction are counseled on the effects of fluoroquinolones and the potential risk for tendon rupture. PMID:23459326

  7. Mental Health and Risk of Secondary Medical Complications in Adults With Pediatric-Onset Spinal Cord Injury

    PubMed Central

    Zebracki, Kathy

    2014-01-01

    Objective: To investigate mental health problems in adults with pediatric-onset spinal cord injury (SCI) and explore how these problems relate to the risk of negative outcomes over time. Method: The study included 466 adults who sustained an SCI prior to age 19 years and had been injured for at least 1 year. Participants were interviewed on an approximately annual basis using a study-specific questionnaire and standardized measures of depression, anxiety, substance use, and community involvement. Generalized estimating equations were used to assess the risk of negative outcomes across time as a function of depression, anxiety, and substance misuse. Results: Of the participants who reported on each domain of mental health, 26% reported misuse of alcohol or drugs (122/466), 21% reported problems with depression (78/360), and 29% reported problems with anxiety (49/168). Depression was associated with increased odds of pressure ulcers, urinary tract infections, hospitalizations, pain, and smoking and lower levels of economic independence and mobility. Anxiety was associated with increased odds of hospitalization, pain, and smoking. Substance misuse predicted an increased risk of pressure ulcers, pain, and smoking and decreased odds of occupational involvement. When examining the effect of mental health with time, results showed that depression accelerated the risk of urinary tract infections, respiratory complications, and hospitalizations and anxiety and depression accelerated risk for lower occupational independence. Conclusions: The added burden that mental health difficulties pose for medical and psychosocial outcomes highlight the importance of monitoring and treating mental health symptoms in pediatric-onset SCI. PMID:24574817

  8. Spinal Cord Repair with Engineered Nervous Tissue

    DTIC Science & Technology

    2014-04-01

    in order to minimize scarring and injected dissociated adult DRGs rostral to a dorsal column transection of the spinal cord. From the sensory... columns were dissected and post-fixed overnight in 4% paraformaldehyde, and then spinal cords were dissected from spinal columns and cryoprotected...AD______________ Award Number: W81XWH-10-1-0941 TITLE: Spinal Cord Repair with Engineered Nervous Tissue

  9. Spinal arteriovenous shunts in children.

    PubMed

    Davagnanam, Indran; Toma, Ahmed K; Brew, Stefan

    2013-11-01

    Pediatric spinal arteriovenous shunts are rare and, in contrast to those in adults, are often congenital or associated with underlying genetic disorders. These are thought to be a more severe and complete phenotypic spectrum of all spinal arteriovenous shunts seen in the overall spinal shunt population. The pediatric presentation thus accounts for its association with significant morbidity and, in general, a more challenging treatment process compared with the adult presentation.

  10. Effects of underwater treadmill training on leg strength, balance, and walking performance in adults with incomplete spinal cord injury

    PubMed Central

    Stevens, Sandra L.; Caputo, Jennifer L.; Fuller, Dana K.; Morgan, Don W.

    2015-01-01

    Objective To document the effects of underwater treadmill training (UTT) on leg strength, balance, and walking performance in adults with incomplete spinal cord injury (iSCI). Design Pre-test and post-test design. Setting Exercise physiology laboratory. Participants Adult volunteers with iSCI (n = 11). Intervention Participants completed 8 weeks (3 × /week) of UTT. Each training session consisted of three walks performed at a personalized speed, with adequate rest between walks. Body weight support remained constant for each participant and ranged from 29 to 47% of land body weight. Increases in walking speed and duration were staggered and imposed in a gradual and systematic fashion. Outcome measures Lower-extremity strength (LS), balance (BL), preferred and rapid walking speeds (PWS and RWS), 6-minute walk distance (6MWD), and daily step activity (DSA). Results Significant (P < 0.05) increases were observed in LS (13.1 ± 3.1 to 20.6 ± 5.1 N·kg−1), BL (23 ± 11 to 32 ± 13), PWS (0.41 ± 0.27 to 0.55 ± 0.28 m·s−1), RWS (0.44 ± 0.31 to 0.71 ± 0.40 m·s−1), 6MWD (97 ± 80 to 177 ± 122 m), and DSA (593 ± 782 to 1310 ± 1258 steps) following UTT. Conclusion Physical function and walking ability were improved in adults with iSCI following a structured program of UTT featuring individualized levels of body weight support and carefully staged increases in speed and duration. From a clinical perspective, these findings highlight the potential of UTT in persons with physical disabilities and diseases that would benefit from weight-supported exercise. PMID:24969269

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

    PubMed Central

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

    2016-01-01

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

  12. Spinal tuberculosis: diagnosis and management.

    PubMed

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

    2012-12-01

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

  13. Repetitive transcranial magnetic stimulation improves open field locomotor recovery after low but not high thoracic spinal cord compression-injury in adult rats.

    PubMed

    Poirrier, Anne-Lise; Nyssen, Yves; Scholtes, Felix; Multon, Sylvie; Rinkin, Charline; Weber, Géraldine; Bouhy, Delphine; Brook, Gary; Franzen, Rachelle; Schoenen, Jean

    2004-01-15

    Electromagnetic fields are able to promote axonal regeneration in vitro and in vivo. Repetitive transcranial magnetic stimulation (rTMS) is used routinely in neuropsychiatric conditions and as an atraumatic method to activate descending motor pathways. After spinal cord injury, these pathways are disconnected from the spinal locomotor generator, resulting in most of the functional deficit. We have applied daily 10 Hz rTMS for 8 weeks immediately after an incomplete high (T4-5; n = 5) or low (T10-11; n = 6) thoracic closed spinal cord compression-injury in adult rats, using 6 high- and 6 low-lesioned non-stimulated animals as controls. Functional recovery of hindlimbs was assessed using the BBB locomotor rating scale. In the control group, the BBB score was significantly better from the 7th week post-injury in animals lesioned at T4-5 compared to those lesioned at T10-11. rTMS significantly improved locomotor recovery in T10-11-injured rats, but not in rats with a high thoracic injury. In rTMS-treated rats, there was significant positive correlation between final BBB score and grey matter density of serotonergic fibres in the spinal segment just caudal to the lesion. We propose that low thoracic lesions produce a greater functional deficit because they interfere with the locomotor centre and that rTMS is beneficial in such lesions because it activates this central pattern generator, presumably via descending serotonin pathways. The benefits of rTMS shown here suggest strongly that this non-invasive intervention strategy merits consideration for clinical trials in human paraplegics with low spinal cord lesions.

  14. Carvacrol presynaptically enhances spontaneous excitatory transmission and produces outward current in adult rat spinal substantia gelatinosa neurons.

    PubMed

    Luo, Qing-Tian; Fujita, Tsugumi; Jiang, Chang-Yu; Kumamoto, Eiichi

    2014-12-10

    Carvacrol, which is abundantly contained in oregano essential oils, has various pharmacological actions including antinociception. Although the oral administration of carvacrol results in antinociception, cellular mechanisms for this action have not been examined yet. We investigated the action of carvacrol on glutamatergic spontaneous excitatory transmission in substantia gelatinosa neurons which play a pivotal role in regulating nociceptive transmission from the periphery by using the patch-clamp technique in adult rat spinal cord slices. Carvacrol superfused for 2 min produced either spontaneous excitatory postsynaptic current frequency increase or outward current at −70 mV, or both of them in many of the neurons tested. The frequency increase and outward current had the EC(50) values of 0.69 mM and 0.55 mM, respectively. The former action was inhibited by a selective TRPA1 antagonist HC-030031 but not a selective TRPV1 antagonist capsazepine, while the latter action was unaffected by their antagonists. The current–voltage relationship for the outward current indicated an involvement in the current of a change in the membrane permeability of K(+) and its outward rectification. The outward current was inhibited in 10 mM-K((+) 0but not K(+)-channel blockers [tetraethylammonium and Ba(2+)]-containing and 11.0 mM-Cl- Krebs solution. These results indicate that carvacrol increases the spontaneous release of l-glutamate from nerve terminals by activating TRPA1 but not TRPV1 channels and produces membrane hyperpolarization, which is possibly mediated by tetraethylammonium- and Ba(2+)-insensitive K(+) channels, in substantia gelatinosa neurons. It is suggested that the hyperpolarizing effect of carvacrol could contribute to its antinociceptive action.

  15. Transplantation of human bone marrow stromal cell-derived Schwann cells reduces cystic cavity and promotes functional recovery after contusion injury of adult rat spinal cord.

    PubMed

    Kamada, Takahito; Koda, Masao; Dezawa, Mari; Anahara, Reiko; Toyama, Yoshiro; Yoshinaga, Katsunori; Hashimoto, Masayuki; Koshizuka, Shuhei; Nishio, Yutaka; Mannoji, Chikato; Okawa, Akihiko; Yamazaki, Masashi

    2011-02-01

    The aim of this study was to evaluate whether transplantation of human bone marrow stromal cell-derived Schwann cells (hBMSC-SC) promotes functional recovery after contusive spinal cord injury of adult rats. Human bone marrow stromal cells (hBMSC) were cultured from bone marrow of adult human patients and induced into Schwann cells (hBMSC-SC) in vitro. Schwann cell phenotype was confirmed by immunocytochemistry. Growth factors secreted from hBMSC-SC were detected using cytokine antibody array. Immunosuppressed rats were laminectomized and their spinal cords were contused using NYU impactor (10 g, 25 mm). Nine days after injury, a mixture of Matrigel and hBMSC-SC (hBMSC-SC group) was injected into the lesioned site. Five weeks after transplantation, cresyl-violet staining revealed that the area of cystic cavity was smaller in the hBMSC-SC group than that in the control group. Immunohistochemistry revealed that the number of anti-growth-associated protein-43-positive nerve fibers was significantly larger in the hBMSC-SC group than that in the control group. At the same time, the number of tyrosine hydroxylase- or serotonin-positive fibers was significantly larger at the lesion epicenter and caudal level in the hBMSC-SC group than that in the control group. In electron microscopy, formation of peripheral-type myelin was recognized near the lesion epicenter in the hBMSC-SC group. Hind limb function recovered significantly in the hBMSC-SC group compared with the control group. In conclusion, the functions of hBMSC-SC are comparable to original Schwann cells in rat spinal cord injury models, and are thus potentially useful treatments for patients with spinal cord injury.

  16. Activation of the Wnt/{beta}-catenin signaling pathway is associated with glial proliferation in the adult spinal cord of ALS transgenic mice

    SciTech Connect

    Chen, Yanchun; Guan, Yingjun; Liu, Huancai; Wu, Xin; Yu, Li; Wang, Shanshan; Zhao, Chunyan; Du, Hongmei; Wang, Xin

    2012-04-06

    Highlights: Black-Right-Pointing-Pointer Wnt3a and Cyclin D1 were upregulated in the spinal cord of the ALS mice. Black-Right-Pointing-Pointer {beta}-catenin translocated from the cell membrane to the nucleus in the ALS mice. Black-Right-Pointing-Pointer Wnt3a, {beta}-catenin and Cyclin D1 co-localized for astrocytes were all increased. Black-Right-Pointing-Pointer BrdU/Cyclin D1 double-positive cells were increased in the spinal cord of ALS mice. Black-Right-Pointing-Pointer BrdU/Cyclin D1/GFAP triple-positive cells were detected in the ALS mice. -- Abstract: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the progressive and fatal loss of motor neurons. In ALS, there is a significant cell proliferation in response to neurodegeneration; however, the exact molecular mechanisms of cell proliferation and differentiation are unclear. The Wnt signaling pathway has been shown to be involved in neurodegenerative processes. Wnt3a, {beta}-catenin, and Cyclin D1 are three key signaling molecules of the Wnt/{beta}-catenin signaling pathway. We determined the expression of Wnt3a, {beta}-catenin, and Cyclin D1 in the adult spinal cord of SOD1{sup G93A} ALS transgenic mice at different stages by RT-PCR, Western blot, and immunofluorescence labeling techniques. We found that the mRNA and protein of Wnt3a and Cyclin D1 in the spinal cord of the ALS mice were upregulated compared to those in wild-type mice. In addition, {beta}-catenin translocated from the cell membrane to the nucleus and subsequently activated transcription of the target gene, Cyclin D1. BrdU and Cyclin D1 double-positive cells were increased in the spinal cord of these mice. Moreover, Wnt3a, {beta}-catenin, and Cyclin D1 were also expressed in both neurons and astrocytes. The expression of Wnt3a, {beta}-catenin or Cyclin D1 in mature GFAP{sup +} astrocytes increased. Moreover, BrdU/Cyclin D1/GFAP triple-positive cells were detected in the ALS mice. Our findings suggest that

  17. Acquired dorsal intraspinal epidermoid cyst in an adult female

    PubMed Central

    Singh, Kulwant; Pandey, Sharad; Gupta, Praveen Kumar; Sharma, Vivek; Santhosh, Deepa; Ghosh, Amrita

    2016-01-01

    Background: Epidermoid and dermoid cyst comprise <1% of spinal tumors and may be congenital (hamartoma) or acquired (iatrogenic) in origin. Epidermoid cysts within the neuraxis are rare benign neoplasms that are most commonly located in the intracranial region. Case Description: Here, we report the a case of an acquired intradural extramedullary epidermoid cyst involving the thoracic region in an adult female who had no associated history of an accompanying congenital spinal deformity. Conclusion: Early diagnosis and immediate surgical intervention reduce patient morbidity. Near complete or subtotal excision of the cyst wall is warranted to prevent inadvertent injury to the spinal cord thus minimizing neurological morbidity. PMID:26904369

  18. What Are the Key Statistics about Brain and Spinal Cord Cancers?

    MedlinePlus

    ... in Adults What Are the Key Statistics About Brain and Spinal Cord Tumors? The American Cancer Society’s ... Spinal Cord Tumor Research and Treatment? More In Brain And Spinal Cord Tumors In Adults About Brain ...

  19. Skin incision induces expression of axonal regeneration-related genes in adult rat spinal sensory neurons

    PubMed Central

    Hill, Caitlin E.; Harrison, Benjamin J.; Rau, Kris K.; Hougland, M. Tyler; Bunge, Mary Bartlett; Mendell, Lorne M.; Petruska, Jeffrey C.

    2010-01-01

    Skin incision and nerve injury both induce painful conditions. Incisional and post-surgical pain is believed to arise primarily from inflammation of tissue and the subsequent sensitization of peripheral and central neurons. The role of axonal regeneration-related processes in development of pain has only been considered when there has been injury to the peripheral nerve itself, even though tissue damage likely induces injury of resident axons. We sought to determine if skin incision would affect expression of regeneration-related genes such as activating transcription factor 3 (ATF3) in dorsal root ganglion (DRG) neurons. ATF3 is absent from DRG neurons of the normal adult rodent, but is induced by injury of peripheral nerves and modulates the regenerative capacity of axons. Image analysis of immunolabeled DRG sections revealed that skin incision led to an increase in the number of DRG neurons expressing ATF3. RT-PCR indicated that other regeneration-associated genes (galanin, GAP-43, Gadd45a) were also increased, further suggesting an injury-like response in DRG neurons. Our finding that injury of skin can induce expression of neuronal injury/regeneration-associated genes may impact how clinical post-surgical pain is investigated and treated. Perspective Tissue injury, even without direct nerve injury, may induce a state of enhanced growth capacity in sensory neurons. Axonal regeneration-associated processes should be considered alongside nerve signal conduction and inflammatory/sensitization processes as possible mechanisms contributing to pain, particularly the transition from acute to chronic pain. PMID:20627820

  20. Spinal Stenosis

    MedlinePlus

    ... center of the column of bones (vertebral or spinal column) through which the spinal cord and nerve roots ... be acquired at birth. Poor alignment of the spinal column when a vertebra slips forward onto the one ...

  1. Reduction in deformed wing virus infection in larval and adult honey bees (Apis mellifera L.) by double-stranded RNA ingestion.

    PubMed

    Desai, S D; Eu, Y-J; Whyard, S; Currie, R W

    2012-08-01

    Deformed wing virus (DWV) is a serious pathogen of the honey bee, Apis mellifera L., vectored by the parasitic mite Varroa destructor. The virus is associated with wing deformity in symptomatic bees, and premature death and reduced colony performance in asymptomatic bees. In the present study we reduced DWV infection by feeding both first instar larvae and adult A. mellifera with a double-stranded (ds) RNA construct, DWV-dsRNA, which is specific to DWV in DWV-inoculated bees, by mixing it with their food. We showed that feeding DWV to larvae causes wing deformity in adult bees in the absence of varroa mites and decreases survival rates of adult bees relative to bees not fed DWV. Feeding larvae with DWV-dsRNA in advance of inoculation with virus reduced the DWV viral level and reduced wing deformity relative to larvae fed DWV or DWV with green fluorescent protein-dsRNA (probably a result of RNA silencing), but did not affect survival to the adult stage. Feeding DWV-dsRNA did not affect larval survival rates, which suggests that dsRNA is non-toxic to larvae. Feeding adult workers with DWV-dsRNA in advance of inoculation with virus increased their longevity and reduced DWV concentration relative to controls.

  2. Passive immunization with myelin basic protein activated T cells suppresses axonal dieback but does not promote axonal regeneration following spinal cord hemisection in adult rats.

    PubMed

    Wang, Hong-Ju; Hu, Jian-Guo; Shen, Lin; Wang, Rui; Wang, Qi-Yi; Zhang, Chen; Xi, Jin; Zhou, Jian-Sheng; Lü, He-Zuo

    2012-08-01

    The previous studies suggested that some subpopulations of T lymphocytes against central nervous system (CNS) antigens, such as myelin basic protein (MBP), are neuroprotective. But there were few reports about the effect of these T cells on axon regeneration. In this study, the neonatally thymectomied (Tx) adult rats which contain few T lymphocytes were subjected to spinal cord hemisection and then passively immunized with MBP-activated T cells (MBP-T). The regeneration and dieback of transected axons of cortico-spinal tract (CST) were detected by biotin dextran amine (BDA) tracing. The behavioral assessments were performed using the Basso, Beattie, and Bresnahan locomotor rating scale. We found that passive transferring of MBP-T could attenuate axonal dieback. However, no significant axon regeneration and behavioral differences were observed among the normal, Tx and sham-Tx (sTx) rats with or without MBP-T passive immunization. These results indicate that passive transferring of MBP-T cells can attenuate axonal dieback and promote neuroprotection following spinal cord injury (SCI), but may not promote axon regeneration.

  3. Griffonia simplicifolia isolectin B4 identifies a specific subpopulation of angiogenic blood vessels following contusive spinal cord injury in the adult mouse.

    PubMed

    Benton, Richard L; Maddie, Melissa A; Minnillo, Danielle R; Hagg, Theo; Whittemore, Scott R

    2008-03-01

    After traumatic spinal cord injury (SCI), disruption and plasticity of the microvasculature within injured spinal tissue contribute to the pathological cascades associated with the evolution of both primary and secondary injury. Conversely, preserved vascular function most likely results in tissue sparing and subsequent functional recovery. It has been difficult to identify subclasses of damaged or regenerating blood vessels at the cellular level. Here, adult mice received a single intravenous injection of the Griffonia simplicifolia isolectin B4 (IB4) at 1-28 days following a moderate thoracic (T9) contusion. Vascular binding of IB4 was maximally observed 7 days following injury, a time associated with multiple pathologic aspects of the intrinsic adaptive angiogenesis, with numbers of IB4 vascular profiles decreasing by 21 days postinjury. Quantitative assessment of IB4 binding shows that it occurs within the evolving lesion epicenter, with affected vessels expressing a temporally specific dysfunctional tight junctional phenotype as assessed by occludin, claudin-5, and ZO-1 immunoreactivities. Taken together, these results demonstrate that intravascular lectin delivery following SCI is a useful approach not only for observing the functional status of neovascular formation but also for definitively identifying specific subpopulations of reactive spinal microvascular elements.

  4. Parachute deformity of both atrioventricular valves with congenitally corrected transposition in an adult

    PubMed Central

    Mohan, Jagdish C.; Shukla, Madhu; Sethi, Arvind

    2015-01-01

    A 23-year-young female presented with mild exertional dyspnoea and palpitation since early childhood. By deploying 2D- and 3D echocardiography, she was detected to have situs solitus, atrioventricular and ventriculoarterial discordance with L-malposition of great vessels, valvular pulmonary stenosis, large secundum atrial septal defect, bicuspid aortic valve, right-sided aortic arch, and moderately severe mitral and tricuspid valve regurgitation. Typical parachute deformities of the morphologically mitral and tricuspid valves were observed. 3D echocardiography revealed a single papillary muscle in the morphologically left ventricle placed anteriorly and providing insertion to tendinous cords and only a moderator band with no other muscle bundles in the morphologically right ventricle placed posteriorly and providing attachment to two strings of cords. Considering the minimal symptoms, conservative treatment was pursued. PMID:26702687

  5. Cellular organization of the central canal ependymal zone, a niche of latent neural stem cells in the adult mammalian spinal cord.

    PubMed

    Hamilton, L K; Truong, M K V; Bednarczyk, M R; Aumont, A; Fernandes, K J L

    2009-12-15

    A stem cell's microenvironment, or "niche," is a critical regulator of its behaviour. In the adult mammalian spinal cord, central canal ependymal cells possess latent neural stem cell properties, but the ependymal cell niche has not yet been described. Here, we identify important similarities and differences between the central canal ependymal zone and the forebrain subventricular zone (SVZ), a well-characterized niche of neural stem cells. First, direct immunohistochemical comparison of the spinal cord ependymal zone and the forebrain SVZ revealed distinct patterns of neural precursor marker expression. In particular, ependymal cells in the spinal cord were found to be bordered by a previously uncharacterized sub-ependymal layer, which is relatively less elaborate than that of the SVZ and comprised of small numbers of astrocytes, oligodendrocyte progenitors and neurons. Cell proliferation surrounding the central canal occurs in close association with blood vessels, but unlike in the SVZ, involves mainly ependymal rather than sub-ependymal cells. These proliferating ependymal cells typically self-renew rather than produce transit-amplifying progenitors, as they generate doublets of progeny that remain within the ependymal layer and show no evidence of a lineage relationship to sub-ependymal cells. Interestingly, the dorsal pole of the central canal was found to possess a sub-population of tanycyte-like cells that express markers of both ependymal cells and neural precursors, and their presence correlates with higher numbers of dorsally proliferating ependymal cells. Together, these data identify key features of the spinal cord ependymal cell niche, and suggest that dorsal ependymal cells possess the potential for stem cell activity. This work provides a foundation for future studies aimed at understanding ependymal cell regulation under normal and pathological conditions.

  6. Differential Expression of Adenosine A1 and A2A Receptors After Upper Cervical (C2) Spinal Cord Hemisection in Adult Rats

    PubMed Central

    Petrov, Theodor; Kreipke, Christian; Alilain, Warren; Nantwi, Kwaku D

    2007-01-01

    Background: In an animal model of spinal cord injury, a latent respiratory motor pathway can be pharmacologically activated via adenosine receptors to restore respiratory function after cervical (C2) spinal cord hemisection that paralyzes the hemidiaphragm ipsilateral to injury. Although spinal phrenic motoneurons immunopositive for adenosine receptors have been demonstrated (C3–C5), it is unclear if adenosine receptor protein levels are altered after C2 hemisection and theophylline administration. Objective: To assess the effects of C2 spinal cord hemisection and theophylline administration on the expression of adenosine receptor proteins. Methods: Adenosine A1 and A2A receptor protein levels were assessed in adult rats classified as (a) noninjured and theophylline treated, (b) C2 hemisected, (c) C2 hemisected and administered theophylline orally (3× daily) for 3 days only, and (d) C2 hemisected and administered theophylline (3× daily for 3 days) and assessed 12 days after drug administration. Assessment of A1 protein levels was carried out via immunohistochemistry and A2A protein levels by densitometry. Results: Adenosine A1 protein levels decreased significantly (both ipsilateral and contralateral to injury) after C2 hemisection; however, the decrease was attenuated in hemisected and theophylline-treated animals. Attenuation in adenosine A1 receptor protein levels persisted when theophylline administration was stopped for 12 days prior to assessment. Adenosine A2A protein levels were unchanged by C2 hemisection; however, theophylline reduced the levels within the phrenic motoneurons. Furthermore, the decrease in A2A levels persisted 12 days after theophylline was withdrawn. Conclusion: Our findings suggest that theophylline mitigates the effects of C2 hemisection by attenuating the C2 hemisection–induced decrease in A1 protein levels. Furthermore, A2A protein levels are unaltered by C2 hemisection but decrease after continuous or interrupted theophylline

  7. Temporal changes in the expression of TGF-beta 1 and EGF in the ventral horn of the spinal cord and associated precentral gyrus in adult Rhesus monkeys subjected to cord hemisection.

    PubMed

    Li, Xiao-Li; Liu, Jia; Wang, Xu-Yang; Li, Li-Yan; Ni, Wei; Zheng, Rong-Yuan; Yang, Hui-Juan; Lu, Yong-Chao; Qi, Jian-Guo; Wang, Ting-Hua

    2008-05-15

    It is well known that some growth factors can not only rescue neurons from death, but also improve motor functions following spinal cord injury. However, their cellular distribution in situ and temporal expressions following spinal cord injury have not been determined, especially in primates. This study investigated the temporal changes in the expression of two growth factors--epidermal growth factor (EGF) and transforming growth factor-beta 1 (TGF-beta1) in the injured motoneurons of the spinal cord and the associated precentral gyrus in adult Rhesus monkeys subjected to spinal cord hemisection. Animals were allowed to survive 7, 14, 30 and 90 days post operation (dpo). Functional recovery of the hindlimbs was assessed using Tarlov scale. The immunohistological expressions of EGF and TGF-beta1 in the ventral horn motoneurons decreased sharply at 7 dpo in the cord segments caudal to the lesion site, which was followed by an increase and a peak between 14 and 30 dpo for EGF and at 90 dpo for TGF-beta1. Changes in the expression of EGF in the precentral gyrus were similar to that in the spinal cord. No TGF-beta1 immunoreactive neurons were detected in the precentral gyrus. In the spinal segments rostral to the lesion, the expressions of EGF and TGF-beta1 peaked at 30 dpo. The mRNA of EGF was detected in both spinal motoneurons and the precentral gyrus, while that of TGF-beta1, only in the spinal motoneuons, suggesting that the spinal motoneurons themselves could synthesize both the growth factors. Partial locomotor recovery in hindlimbs was seen, especially after 14 dpo. It was concluded that a possible association existed between the modulation of EGF and TGF-beta1 and the recovery of locomotor function, and their roles differed somewhat in the neuroplasticity observed after spinal cord injury in primates.

  8. Immunogold evidence that neuronal gap junctions in adult rat brain and spinal cord contain connexin-36 but not connexin-32 or connexin-43

    PubMed Central

    Rash, J. E.; Staines, W. A.; Yasumura, T.; Patel, D.; Furman, C. S.; Stelmack, G. L.; Nagy, J. I.

    2000-01-01

    Physiological and ultrastructural evidence indicates that gap junctions link many classes of neurons in mammalian central nervous system (CNS), allowing direct electrical and metabolic communication. Among at least six gap junction-forming connexin proteins in adult rat brain, connexin- (Cx) 32, Cx36, and Cx43 have been reported to occur in neurons. However, no connexin has been documented at ultrastructurally defined neuronal gap junctions. To address this question directly, freeze-fracture replica immunogold labeling (FRIL) and immunofluorescence (IF) were used to visualize the subcellular and regional localization of Cx36 in rat brain and spinal cord. Three antibodies were generated against different sequences in Cx36. By Western blotting, these antibodies detected protein at 36 and 66 kDa, corresponding to Cx36 monomer and dimer forms, respectively. After double-labeling for Cx36 and Cx43 by FRIL, neuronal gap junctions in inferior olive, spinal cord, and retina were consistently immunogold-labeled for Cx36, but none were labeled for Cx43. Conversely, Cx43 but not Cx36 was detected in astrocyte and ependymocyte gap junctions. In >250 Cx32/Cx43 single- and double-labeled replicas from 10 CNS regions, no neuronal gap junctions were labeled for either Cx32 or Cx43. Instead, Cx32 and Cx43 were restricted to glial gap junctions. By IF, Cx36 labeling was widely distributed in neuropil, including along dendritic processes and within neuronal somata. On the basis of FRIL identification of Cx36 in neuronal gap junctions and IF imaging of Cx36 throughout rat brain and spinal cord, neuronal gap junctions containing Cx36 appear to occur in sufficient density to provide widespread electrical and metabolic coupling in adult CNS. PMID:10861019

  9. Repair of spinal cord injury by chitosan scaffold with glioma ECM and SB216763 implantation in adult rats.

    PubMed

    Jian, Rao; Yixu, Yang; Sheyu, Lin; Jianhong, Shen; Yaohua, Yan; Xing, Su; Qingfeng, Huang; Xiaojian, Lu; Lei, Zhang; Yan, Zhen; Fangling, Xiong; Huasong, Gao; Yilu, Gao

    2015-10-01

    The loss of spinal cord tissue and the cavity formation are major obstacles to the repair of spinal cord injury (SCI). In the study, the scaffold of chitosan+ECM+SB216763 was fabricated and used for the repair of injured spinal cord injury. First, the biocompatibility of the scaffold was analyzed and results showed that the scaffold had a good compatibility with the neural stem cells. Especially, the processes of differentiated neural stem cell embedded in the scaffold were found in the experiment. At the same time, we also investigated the effect of scaffold on the differentiation of neural stem cell. The results showed that the scaffold of chitosan+ECM+SB216763 could significantly promote the differentiation of neural stem cells into neurons, astrocytes, and oligodendrocytes relative to those in other groups. In order to probe the application of scaffold in vivo, the rat models of spinal cord hemisection were set up and scaffolds were implanted into transected gap. Then the electrophysiology and BBB score were evaluated and results showed that the amplitude, latency period and BBB score in chitosan+ECM+SB216763 group were dramatically better than those in other groups. In addition, the differentiation of neural stem cells into nerve cells was also assayed and the results revealed that the number of neural stem cells differentiating into neuron, astrocytes and oligodendrocytes in chitosan+ECM+SB216763 group was significantly bigger than those in other groups. All these data suggested that the scaffold of chitosan+ECM+SB216763 would be a promising medium for the repair of injured spinal cord.

  10. [The influence of metabolic disturbances present in diabetes mellitus type I on vestibulo-spinal reflexes in children and young adults].

    PubMed

    Gawron, Wojciech; Pośpiech, Lucyna; Orendorz-Fraczkowska, Krystyna; Noczyńska, Anna

    2002-01-01

    Diabetic neuropathy encompasses various disturbances concerning somatic and autonomic nervous system and has significant impact on prognosis and course of diabetes mellitus. The aim of the work is an evaluation of vestibulo-spinal reflexes in children and young adults suffering from diabetes mellitus type 1. Material--95 children and young adults aged from 6 to 28 years with diabetes mellitus type 1 diagnosed. The control group consisted of 44 otoneurologically healthy subjects aged from 6 to 28 years. After detailed medical history collection and physical ENT examination stato-posturography was performed in each case. Posturographer PE 62 Model 04 was applied in the studies. Static posturography as well as dynamic one (one leg standing test) was performed in each case. 6 patients belonging to diabetic group complained about vertigo or dizziness. There were worse stabilograms parameters in diabetic group in comparison to control one, statistically significant in younger children. There were better stabilogram parameters in diabetic patients with longer history of the disease. The parameters analysed were significantly worse in the subgroup with not compensated diabetes. The parameters were slightly better in relation to the presence of hypoglycaemic incidents. No apparent differences in stabilograms parameters were present in relation to the presence of diabetic complications. Diabetes mellitus type 1 with slight or without complications does not have significant influence on vestibulo-spinal reflexes and posture stability of the patients. Balance organ disturbances in diabetes mellitus type 1 in children and young adults despite their presence have subclinical course. Perhaps one should consider monitoring of those disturbances in the course of the disease.

  11. Surgical Treatment Guidelines for Digital Deformity Associated With Intrinsic Muscle Spasticity (Intrinsic Plus Foot) in Adults With Cerebral Palsy.

    PubMed

    Boffeli, Troy J; Collier, Rachel C

    2015-01-01

    Intrinsic plus foot deformity has primarily been associated with cerebral palsy and involves spastic contracture of the intrinsic musculature with resultant toe deformities. Digital deformity is caused by a dynamic imbalance between the intrinsic muscles in the foot and extrinsic muscles in the lower leg. Spastic contracture of the toes frequently involves curling under of the lesser digits or contracture of the hallux into valgus or plantarflexion deformity. Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers. Four different patterns of intrinsic plus foot deformity have been observed by the authors that likely relate to the different patterns of muscle involvement. Case examples are provided of the 4 patterns of intrinsic plus foot deformity observed, including global intrinsic plus lesser toe deformity, isolated intrinsic plus lesser toe deformity, intrinsic plus hallux valgus deformity, and intrinsic plus hallux flexus deformity. These case examples are presented to demonstrate each type of deformity and our approach for surgical management according to the contracture pattern. The surgical approach has typically involved tenotomy, capsulotomy, or isolated joint fusion. The main goals of surgical treatment are to relieve pain and reduce pressure points through digital realignment in an effort to decrease the risk of pressure sores and allow more effective bracing to ultimately improve the patient's mobility.

  12. The aetiology of spinal deformity in Atlantic salmon, Salmo salar L.: influence of different commercial diets on the incidence and severity of the preclinical condition in salmon parr under two contrasting husbandry regimes.

    PubMed

    Sullivan, M; Reid, S W J; Ternent, H; Manchester, N J; Roberts, R J; Stone, D A J; Hardy, R W

    2007-12-01

    A large-scale trial of the effect of different commercial diets on the incidence of preclinical spinal deformation, as assessed by radiography, and the influence of two contrasting rearing systems was carried out. Two sets of three populations of Atlantic salmon, each of 20 000 first feeding fry of identical hatchery origin, created from equal numbers of eggs from 15 different families, were reared under commercial conditions on two different farms. Three commercial (closed formula) extruded fish meal-based diets were used in this study (diets A, B & C). Each diet was fed to one population of 20 000 fish at each site. Fish were fed a percentage of their body weight per day, with feeding rates set at commercial levels, based on water temperature, day length and fish biomass. Additional hand feeding was used to ensure satiation in all tanks. Fish in each tank were bulk-weighed and counted at the beginning and at 2-week intervals throughout the study. The fish were grown for 30 weeks. In addition, phosphorus (P) digestibility was evaluated by in-feed absorption testing in rainbow trout. The morphology of the radiographic lesions conformed to those described previously. Statistical analysis using multivariate regression analysis showed that date of sampling, site and diet were all statistically significant (P < 0.001) on univariable analysis. Farm A had significantly more affected fish than farm B (P < 0.001), which may have been attributable to variation in dissolved oxygen levels. The available dietary P levels were low in each diet. The number of fish affected in the group of fish being fed diet B was significantly lower than in the groups being fed diets A or C (P < 0.001). It appears most likely that the occurrence of preclinical radiographically apparent defects in parr which are believed to lead to the condition known as 'spinal deformity' is predominantly caused by a deficiency of available dietary P in first-feeding fry. The availability of dietary P may also

  13. Effect of neural stem cell transplantation combined with erythropoietin injection on axon regeneration in adult rats with transected spinal cord injury.

    PubMed

    Zhao, Y; Zuo, Y; Wang, X L; Huo, H J; Jiang, J M; Yan, H B; Xiao, Y L

    2015-12-22

    We investigated the effect of neural stem cells (NSC) and erythropoietin (EPO) on axon regeneration in adult rats with transected spinal cord injury, and provided an experimental basis for clinical treatment. Forty Wistar rats with T10-transected spinal cord injury were randomly divided into four groups of ten rats: a control group (group A), an NSC-transplant group (group B), an NSC-transplant and EPO group (group C), and an EPO group (group D). Biotinylated dextran amines (BDA) anterograde corticospinal cord neuronal tracing and Fluoro-Gold (FG) retrograde tracing were carried out at the 8th week after operation to observe the regeneration of nerve fibers. The Basso, Beattie, and Bresnahan (BBB) locomotor score was used to evaluate restoration. 1) BDA and FG immunofluorescence staining: in group C, a large number of regenerated axons were observed and some penetrated the injured area. In group B, only a small number of regenerated axons were observed and none penetrated the injured area. In group D, only sporadic regenerated nerve fibers were observed occasionally, while in group A, no axonal regeneration was observed. In group C, a small number of cones and axons emitted yellow fluorescence, and no FG-labeled cells were observed in the other groups. 2) The BBB scores for group C were higher than those for the other groups, and the differences were statistically significance (P < 0.05). NSC transplantation combined with EPO intraperitoneal injection may benefit axon regeneration in rats with transected spinal cord injury, and accelerate the functional recovery of the hindlimb locomotor.

  14. TRPA1-expressing primary afferents synapse with a morphologically identified subclass of substantia gelatinosa neurons in the adult rat spinal cord.

    PubMed

    Uta, Daisuke; Furue, Hidemasa; Pickering, Anthony E; Rashid, Md Harunor; Mizuguchi-Takase, Hiroko; Katafuchi, Toshihiko; Imoto, Keiji; Yoshimura, Megumu

    2010-06-01

    The TRPA1 channel has been proposed to be a molecular transducer of cold and inflammatory nociceptive signals. It is expressed on a subset of small primary afferent neurons both in the peripheral terminals, where it serves as a sensor, and on the central nerve endings in the dorsal horn. The substantia gelatinosa (SG) of the spinal cord is a key site for integration of noxious inputs. The SG neurons are morphologically and functionally heterogeneous and the precise synaptic circuits of the SG are poorly understood. We examined how activation of TRPA1 channels affects synaptic transmission onto SG neurons using whole-cell patch-clamp recordings and morphological analyses in adult rat spinal cord slices. Cinnamaldehyde (TRPA1 agonist) elicited a barrage of excitatory postsynaptic currents (EPSCs) in a subset of the SG neurons that responded to allyl isothiocyanate (less specific TRPA1 agonist) and capsaicin (TRPV1 agonist). Cinnamaldehyde evoked EPSCs in vertical and radial but not islet or central SG cells. Notably, cinnamaldehyde produced no change in inhibitory postsynaptic currents and nor did it produce direct postsynaptic effects. In the presence of tetrodotoxin, cinnamaldehyde increased the frequency but not amplitude of miniature EPSCs. Intriguingly, cinnamaldehyde had a selective inhibitory action on monosynaptic C- (but not Adelta-) fiber-evoked EPSCs. These results indicate that activation of spinal TRPA1 presynaptically facilitates miniature excitatory synaptic transmission from primary afferents onto vertical and radial cells to initiate action potentials. The presence of TRPA1 channels on the central terminals raises the possibility of bidirectional modulatory action in morphologically identified subclasses of SG neurons.

  15. Differentiation and migration of astrocytes in the spinal cord following dorsal root injury in the adult rat.

    PubMed

    Kozlova, Elena N

    2003-02-01

    Nerve fibre degeneration in the spinal cord is accompanied by astroglial proliferation. It is not known whether these cells proliferate in situ or are recruited from specific regions harbouring astroglial precursors. We found cells expressing nestin, characteristic of astroglial precursors, at the dorsal surface of the spinal cord on the operated side from 30 h after dorsal root injury. Nestin-expressing cells dispersed to deeper areas of the dorsal funiculus and dorsal horn on the operated side during the first few days after injury. Injection of bromodeoxyuridine (BrdU) 2 h before the end of the experiment, at 30 h after injury, revealed numerous BrdU-labelled, nestin-positive cells in the dorsal superficial region. In animals surviving 20 h after BrdU injection at 28 h postlesion, cells double-labelled with BrdU and nestin were also found in deeper areas. Labeling with BrdU 2 h before perfusion showed proliferation of microglia and radial astrocytes in the ventral and lateral funiculi on both sides of the spinal cord 30 h after injury. Nestin-positive cells coexpressed the calcium-binding protein Mts1, a marker for white matter astrocytes, in the dorsal funiculus, and were positive for glial fibrillary acidic protein (GFAP), but negative for Mts1 in the dorsal horn. One week after injury the level of nestin expression decreased and was undetectable after 3 months. Taken together, our data indicate that after dorsal root injury newly formed astrocytes in the degenerating white and grey matter first appear at the dorsal surface of the spinal cord from where some of them subsequently migrate ventrally, and differentiate into white- or grey-matter astrocytes.

  16. Remyelination of the nonhuman primate spinal cord by transplantation of H-transferase transgenic adult pig olfactory ensheathing cells

    PubMed Central

    Radtke, Christine; Akiyama, Yukinori; Brokaw, Jane; Lankford, Karen L.; Wewetzer, Konstantin; Fodor, William L.; Kocsis, Jeffery D.

    2008-01-01

    Olfactory ensheathing cells (OECs) have been shown to mediate remyelination and to stimulate axonal regeneration in a number of in vivo rodent spinal cord studies. However, whether OECs display similar properties in the primate model has not been tested so far. In the present study, we thus transplanted highly-purified OECs isolated from transgenic pigs expressing the α1,2 fucosyltransferase gene (H-transferase or HT) gene into a demyelinated lesion of the African green monkey spinal cord. Four weeks posttransplantation, robust remyelination was found in 62.5% of the lesion sites, whereas there was virtually no remyelination in the nontransplanted controls. This together with the immunohistochemical demonstration of the grafted cells within the lesioned area confirmed that remyelination was indeed achieved by OECs. Additional in vitro assays demonstrated 1) that the applied cell suspension consisted of >98% OECs, 2) that the majority of the cells expressed the transgene, and 3) that expression of the HT gene reduced complement activation more than twofold compared with the nontransgenic control. This is the first demonstration that xenotransplantation of characterized OECs into the primate spinal cord results in remyelination. PMID:14657003

  17. Recurrence of spinal schwannoma: Is it preventable?

    PubMed Central

    Senapati, Satya B.; Mishra, Sudhansu S.; Dhir, Manmath K.; Patnaik, Ashis; Panigrahi, Souvagya

    2016-01-01

    Spinal schwannomas account for about 25% of primary intradural spinal cord tumors in adult. The prognosis for spinal schwannomas is excellent in most cases. Complete resection is curative. However following subtotal removal, recurrence develops after several years. We describe a case of recurrent spinal schwannoma who had been operated twice before for same disease. The possible cause of recurrence and difficulties in reoperation are discussed. PMID:27695564

  18. Spinal Stenosis

    MedlinePlus

    ... Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on ... stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. Many people ...

  19. Spinal stenosis

    MedlinePlus

    ... stenosis; Foraminal spinal stenosis; Degenerative spine disease; Back pain - spinal stenosis; Low back pain - stenosis; LBP - stenosis ... involve both legs. Symptoms include: Numbness , cramping, or pain in the back, buttocks, thighs, or calves, or ...

  20. Spinal injury

    MedlinePlus

    ... and drive. Do not dive into pools, lakes, rivers, and other bodies of water, particularly if you cannot determine the depth of the ... Central nervous system Spinal cord injury Spinal anatomy Two person roll - ...

  1. Alterations of action potentials and the localization of Nav1.6 sodium channels in spared axons after hemisection injury of the spinal cord in adult rats.

    PubMed

    Hunanyan, Arsen S; Alessi, Valentina; Patel, Samik; Pearse, Damien D; Matthews, Gary; Arvanian, Victor L

    2011-03-01

    Previously, we reported a pronounced reduction in transmission through surviving axons contralateral to chronic hemisection (HX) of adult rat spinal cord. To examine the cellular and molecular mechanisms responsible for this diminished transmission, we recorded intracellularly from lumbar lateral white matter axons in deeply anesthetized adult rats in vivo and measured the propagation of action potentials (APs) through rubrospinal/reticulospinal tract (RST/RtST) axons contralateral to chronic HX at T10. We found decreased excitability in these axons, manifested by an increased rheobase to trigger APs and longer latency for AP propagation passing the injury level, without significant differences in axonal resting membrane potential and input resistance. These electrophysiological changes were associated with altered spatial localization of Nav1.6 sodium channels along axons: a subset of axons contralateral to the injury exhibited a diffuse localization (>10 μm spread) of Nav1.6 channels, a pattern characteristic of demyelinated axons (Craner MJ, Newcombe J, Black JA, Hartle C, Cuzner ML, Waxman SG. Proc Natl Acad Sci USA 101: 8168-8173, 2004b). This result was substantiated by ultrastructural changes seen with electron microscopy, in which an increased number of large-caliber, demyelinated RST axons were found contralateral to the chronic HX. Therefore, an increased rheobase, pathological changes in the distribution of Nav1.6 sodium channels, and the demyelination of contralateral RST axons are likely responsible for their decreased conduction chronically after HX and thus may provide novel targets for strategies to improve function following incomplete spinal cord injury.

  2. Regulation of DM-20 mRNA expression and intracellular translocation of glutathione-S-transferase pi isoform during oligodendrocyte differentiation in the adult rat spinal cord.

    PubMed

    Kitada, Masaaki; Takeda, Kazuya; Dezawa, Mari

    2016-07-01

    We previously demonstrated that NG2-positive oligodendrocyte precursor cells (OPCs) do not express DM-20 mRNA and identified a distinct DM-20 mRNA-positive cell population expressing glutathione-S-transferase pi isoform (GST-pi) in the nucleus (GST-pi(Nuc)) of the adult rat spinal cord. As GST-pi intranuclear localization correlates with progenitor cell properties, we examined the differentiation status of this cell population under the intensive 5-bromo-2'-deoxyuridine (BrdU) administration method, consisting of intraperitoneal BrdU injections every 2 h for 48 h. We observed that a certain population of proliferating/proliferated cells expressed DM-20 mRNA, and sometimes two proliferating/proliferated cells were observed still attached to each other. We performed triple staining for BrdU, DM-20 mRNA, and NG2 and found pairs of neighboring BrdU-positive cells, which were considered to originate from the same progenitor cells and where both cells expressed DM-20 mRNA. Triple staining for BrdU, DM-20 mRNA, and GST-pi detected proliferating/proliferated cells exhibiting the GST-pi(Nuc)/DM-20 mRNA-positive expression pattern. These findings suggested the presence of a GST-pi(Nuc)/DM-20 mRNA-positive oligodendrocyte-lineage progenitor cell population in the adult rat spinal cord. However, we did not find any pair of neighboring BrdU-positive cells with this expression pattern. These observations collectively support the idea that GST-pi(Nuc)/DM-20 mRNA-expressing cells are the progeny of NG2-positive OPCs rather than a novel type of oligodendrocyte-lineage progenitor cells and that DM-20 mRNA expression is dynamically regulated during differentiation of OPCs into oligodendrocytes.

  3. Automated Assessment of Left Ventricular Function and Mass Using Heart Deformation Analysis: Initial Experience in 160 older adults

    PubMed Central

    Lin, Kai; Collins, Jeremy D.; Lloyd-Jones, Donald M.; Jolly, Marie-Pierre; Li, Debiao; Markl, Michael; Carr, James C.

    2016-01-01

    Objective To assess the performance of automated quantification of left ventricular function and mass based on heart deformation analysis (HDA) in asymptomatic older adults Materials and methods This study complied with HIPAA regulations. Following the approval of the institutional review board (IRB), 160 asymptomatic older participants were recruited for cardiac MRI including two-dimensional (2D) cine images covering the entire left ventricle (LV) in short-axis view. Data analysis included the calculation of left ventricular ejection fraction (LVEF), mass (LVM) and cardiac output (CO) using HDA and standard global cardiac function analysis (delineation of end systolic and diastolic LV epi- and endo-cardial borders). The agreement between methods was evaluated using intra-class correlation coefficient (ICC) and coefficient of variation (CoV). Results HDA had a shorter processing time than standard method (1.5 ± 0.3 minute/case vs. 5.8 ± 1.4 minute/case, p < 0.001). There was good agreement for LVEF (ICC = 0.552, CoV = 10.5%), CO (ICC = 0.773, CoV = 13.5%) and LVM (ICC = 0.859, CoV = 14.5%) acquired with standard method and HDA. There was a systemic bias towards lower LVEF (62.8% ± 8.3% vs.69.3% ± 6.7%, p < 0.001) and CO (4.4 ± 1.0 L/minute vs. 4.8 ± 1.3 L/minute, p < 0.001) by HDA compared to the standard technique. Conversely, HDA overestimated LVM (114.8 ± 30.1g vs. 100.2 ± 29.0g, p < 0.001) as compared to the reference method. Conclusion HDA has the potential to measure LVEF, CO, and LVM without the need for user interaction based on standard cardiac 2D Cine images. PMID:26749328

  4. TRP Channels Involved in Spontaneous l-Glutamate Release Enhancement in the Adult Rat Spinal Substantia Gelatinosa

    PubMed Central

    Kumamoto, Eiichi; Fujita, Tsugumi; Jiang, Chang-Yu

    2014-01-01

    The spinal substantia gelatinosa (SG) plays a pivotal role in modulating nociceptive transmission through dorsal root ganglion (DRG) neurons from the periphery. TRP channels such as TRPV1 and TRPA1 channels expressed in the SG are involved in the regulation of the nociceptive transmission. On the other hand, the TRP channels located in the peripheral terminals of the DRG neurons are activated by nociceptive stimuli given to the periphery and also by plant-derived chemicals, which generates a membrane depolarization. The chemicals also activate the TRP channels in the SG. In this review, we introduce how synaptic transmissions in the SG neurons are affected by various plant-derived chemicals and suggest that the peripheral and central TRP channels may differ in property from each other. PMID:24785347

  5. Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center.

    PubMed

    Artenstein, Andrew W; Friderici, Jennifer; Holers, Adam; Lewis, Deirdre; Fitzgerald, Jan; Visintainer, Paul

    2016-10-01

    Background.  Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005-2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA. Methods.  Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05. Results.  We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups. Conclusions.  Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA.

  6. Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center

    PubMed Central

    Artenstein, Andrew W.; Friderici, Jennifer; Holers, Adam; Lewis, Deirdre; Fitzgerald, Jan; Visintainer, Paul

    2016-01-01

    Background. Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005–2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA. Methods. Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05. Results. We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups. Conclusions. Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA. PMID:28018923

  7. Transplants of cells genetically modified to express neurotrophin-3 rescue axotomized Clarke's nucleus neurons after spinal cord hemisection in adult rats.

    PubMed

    Himes, B T; Liu, Y; Solowska, J M; Snyder, E Y; Fischer, I; Tessler, A

    2001-09-15

    To test the idea that genetically engineered cells can rescue axotomized neurons, we transplanted fibroblasts and immortalized neural stem cells (NSCs) modified to express neurotrophic factors into the injured spinal cord. The neurotrophin-3 (NT-3) or nerve growth factor (NGF) transgene was introduced into these cells using recombinant retroviral vectors containing an internal ribosome entry site (IRES) sequence and the beta-galactosidase or alkaline phosphatase reporter gene. Bioassay confirmed biological activity of the secreted neurotrophic factors. Clarke's nucleus (CN) axons, which project to the rostral spinal cord and cerebellum, were cut unilaterally in adult rats by T8 hemisection. Rats received transplants of fibroblasts or NSCs genetically modified to express NT-3 or NGF and a reporter gene, only a reporter gene, or no transplant. Two months postoperatively, grafted cells survived at the hemisection site. Grafted fibroblasts and NSCs expressed a reporter gene and immunoreactivity for the NGF or NT-3 transgene. Rats receiving no transplant or a transplant expressing only a reporter gene showed a 30% loss of CN neurons in the L1 segment on the lesioned side. NGF-expressing transplants produced partial rescue compared with hemisection alone. There was no significant neuron loss in rats receiving grafts of either fibroblasts or NSCs engineered to express NT-3. We postulate that NT-3 mediates survival of CN neurons through interaction with trkC receptors, which are expressed on CN neurons. These results support the idea that NT-3 contributes to long-term survival of axotomized CN neurons and show that genetically modified cells rescue axotomized neurons as efficiently as fetal CNS transplants.

  8. Endogenous Nkx2.2+/Olig2+ oligodendrocyte precursor cells fail to remyelinate the demyelinated adult rat spinal cord in the absence of astrocytes

    PubMed Central

    Talbott, Jason F.; Loy, David N.; Liu, Ying; Qiu, Mengsheng S.; Bunge, Mary Bartlett; Rao, Mahendra S.; Whittemore, Scott R.

    2010-01-01

    Chronic demyelination is a pathophysiologic component of compressive spinal cord injury (SCI) and a characteristic finding in demyelinating diseases including multiple sclerosis (MS). A better characterization of endogenous cells responsible for successful remyelination is essential for designing therapeutic strategies aimed at restoring functional myelin. The present study examined the spatiotemporal response of endogenous oligodendrocyte precursor cells (OPCs) following ethidium bromide (EB)-induced demyelination of the adult rat spinal cord. Beginning at 2 days post-EB injection (dpi), a robust mobilization of highly proliferative NG2+ cells within the lesion was observed, none of which expressed the oligodendrocyte lineage-associated transcription factor Nkx2.2. At 7 dpi, a significant up-regulation of Nkx2.2 by OPCs within the lesion was observed, 90% of which coexpressed NG2 and virtually all of which coexpressed the bHLH transcription factor Olig2. Despite successful recruitment of Nkx2.2+/Olig2+ OPCs within the lesion, demyelinated axons were not remyelinated by these OPCs in regions lacking astrocytes. Rather, Schwann cell remyelination predominated throughout the central core of the lesion, particularly around blood vessels. Oligodendrocyte remyelination was observed in the astrogliotic perimeter, suggesting a necessary role for astrocytes in oligodendrocyte maturation. In addition, reexpression of the radial glial antigen, RC-1, by reactive astrocytes and ependymal cells was observed following injury. However, these cells did not express the neural stem cell (NSC)-associated transcription factors Sox1 or Sox2, suggesting that the endogenous response is primarily mediated by glial progenitors. In vivo electrophysiology demonstrated a limited and unsustained functional recovery concurrent with endogenous remyelination following EB-induced lesions. PMID:15698615

  9. Proliferation, migration, and differentiation of endogenous ependymal region stem/progenitor cells following minimal spinal cord injury in the adult rat.

    PubMed

    Mothe, A J; Tator, C H

    2005-01-01

    Ependymal cells of the adult mammalian spinal cord exhibit stem/progenitor cell properties following injury. In the present study, we utilized intraventricular injection of 1,1'-dioctadecyl-6,6'-di(4-sulfophenyl)-3,3,3',3'-tetramethylindocarbocyanine (DiI) to label the ependyma lining the central canal to allow tracking of the migration of endogenous ependymal cells and their progeny after spinal cord injury (SCI). We developed a minimal injury model that preserved the integrity of the central canal and did not interfere with ependymal cell labeling. Three days following SCI, there was an 8.6-fold increase in the proliferative labeling index of the ependymal cells at the level of the needle track based on bromodeoxyuridine labeling, compared with 1 day post-injury. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) positive cells were not detected in the ependyma or surrounding gray matter, indicating that ependymal cells do not undergo apoptosis in response to minimal injury. Nestin was rapidly induced in the ependyma by 1 day and expression peaked by 7 days post-injury. We quantitated the number and distance of ependymal cell migration following minimal injury. The number of ependymal cells migrating from the region of the central canal increased by 3 days following minimal injury and DiI-labeled glial fibrillary acidic protein expressing cells were detected 14 days post-SCI, most of which migrated within 70 microm of the region of the central canal. These results show that a minimal SCI adjacent to the ependyma is sufficient to induce an endogenous ependymal cell response where ependymal stem/progenitor cells proliferate and migrate from the region of the central canal, differentiating primarily into astrocytes.

  10. Spinal brucellosis.

    PubMed

    Tali, E Turgut; Koc, A Murat; Oner, A Yusuf

    2015-05-01

    Spinal involvement in human brucellosis is a common condition and a significant cause of morbidity and mortality, particularly in endemic areas, because it is often associated with therapeutic failure. Most chronic brucellosis cases are the result of inadequate treatment of the initial episode. Recognition of spinal brucellosis is challenging. Early diagnosis is important to ensure proper treatment and decrease morbidity and mortality. Radiologic evaluation has gained importance in diagnosis and treatment planning, including interventional procedures and monitoring of all spinal infections.

  11. The Oropharyngeal Airway in Young Adults with Skeletal Class II and Class III Deformities: A 3-D Morphometric Analysis

    PubMed Central

    Jayaratne, Yasas Shri Nalaka; Zwahlen, Roger Arthur

    2016-01-01

    Objectives 1) To determine the accuracy and reliability of an automated anthropometric measurement software for the oropharyngeal airway and 2) To compare the anthropometric dimensions of the oropharyngeal airway in skeletal class II and III deformity patients. Methods Cone-beam CT (CBCT) scans of 62 patients with skeletal class II or III deformities were used for this study. Volumetric, linear and surface area measurements retroglossal (RG) and retropalatal (RP) compartments of the oropharyngeal airway was measured with the 3dMDVultus software. Accuracy of automated anthropometric pharyngeal airway measurements was assessed using an airway phantom. Results The software was found to be reasonably accurate for measuring dimensions of air passages. The total oropharyngeal volume was significantly greater in the skeletal class III deformity group (16.7 ± 9.04 mm3) compared with class II subjects (11.87 ± 4.01 mm3). The average surface area of both the RG and RP compartments were significantly larger in the class III deformity group. The most constricted area in the RG and RP airway was significantly larger in individuals with skeletal class III deformity. The anterior-posterior (AP) length of this constriction was significantly greater in skeletal class III individuals in both compartments, whereas the width of the constriction was not significantly different between the two groups in both compartments. The RP compartment was larger but less uniform than the RG compartment in both skeletal deformities. Conclusion Significant differences were observed in morphological characteristics of the oropharyngeal airway in individuals with skeletal class II and III deformities. This information may be valuable for surgeons in orthognathic treatment planning, especially for mandibular setback surgery that might compromise the oropharyngeal patency. PMID:26901313

  12. Single pellet grasping following cervical spinal cord injury in adult rat using an automated full-time training robot

    PubMed Central

    Fenrich, Keith K.; May, Zacincte; Torres-Espín, Abel; Forero, Juan; Bennett, David J.; Fouad, Karim

    2016-01-01

    Task specific motor training is a common form of rehabilitation therapy in individuals with spinal cord injury (SCI). The single pellet grasping (SPG) task is a skilled forelimb motor task used to evaluate recovery of forelimb function in rodent models of SCI. The task requires animals to obtain food pellets located on a shelf beyond a slit at the front of an enclosure. Manually training and testing rats in the SPG task requires extensive time and often yields results with high outcome variability and small therapeutic windows (i.e., the difference between pre- and post-SCI success rates). Recent advances in automated SPG training using automated pellet presentation (APP) systems allow rats to train ad libitum 24 h a day, 7 days a week. APP trained rats have improved success rates, require less researcher time, and have lower outcome variability compared to manually trained rats. However, it is unclear whether APP trained rats can perform the SPG task using the APP system after SCI. Here we show that rats with cervical SCI can successfully perform the SPG task using the APP system. We found that SCI rats with APP training performed significantly more attempts, had slightly lower and less variable final score success rates, and larger therapeutic windows than SCI rats with manual training. These results demonstrate that APP training has clear advantages over manual training for evaluating reaching performance of SCI rats and represents a new tool for investigating rehabilitative motor training following CNS injury. PMID:26611563

  13. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    PubMed

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2017-02-24

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  14. Cortical PKC inhibition promotes axonal regeneration of the corticospinal tract and forelimb functional recovery after cervical dorsal spinal hemisection in adult rats.

    PubMed

    Wang, Xiaofei; Hu, Jianguo; She, Yun; Smith, George M; Xu, Xiao-Ming

    2014-11-01

    Our previous study shows that conventional protein kinases C (cPKCs) are key signaling mediators that are activated by extracellular inhibitory molecules. Inhibition of cPKC by intrathecal infusion of a cPKC inhibitor, GÖ6976, into the site of dorsal hemisection (DH) induces regeneration of lesioned dorsal column sensory, but not corticospinal tract (CST), axons. Here, we investigated whether a direct cortical delivery of GÖ6976 into the soma of corticospinal neurons promotes regeneration of CST and the recovery of forelimb function in rats with cervical spinal cord injuries. We report that cortical delivery of GÖ6976 reduced injury-induced activation of conventional PKCα and PKCβ1 in CST neurons, promoted regeneration of CST axons through and beyond a cervical DH at C4, formed new synapses on target neurons caudal to the injury, and enhanced forelimb functional recovery in adult rats. When combined with lenti-Chondroitinase ABC treatment, cortical administration of GÖ6976 promoted even greater CST axonal regeneration and recovery of forelimb function. Thus, this study has demonstrated a novel strategy that can promote anatomical regeneration of damaged CST axons and partial recovery of forelimb function. Importantly, such an effect is critically dependent on the efficient blockage of injury-induced PKC activation in the soma of layer V CST neurons.

  15. Expression of Wnt5a and its receptor Fzd2 is changed in the spinal cord of adult amyotrophic lateral sclerosis transgenic mice

    PubMed Central

    Li, Xiaojin; Guan, Yingjun; Chen, Yanchun; Zhang, Caixia; Shi, Caixing; Zhou, Fenghua; Yu, Li; Juan, Juan; Wang, Xin

    2013-01-01

    Wnt5a, a member of the Wnt gene family, encodes a cysteine-rich growth factor involved in signal transduction during growth and differentiation. The Fzd2 gene codes for a cell membrane receptor called Frizzled-2 have a structure similar to G protein coupled receptors. The extracellular N-terminal of the Fzd2 receptor has a cysteine-rich domain (CRD) that binds Wnt ligands and thus primes the Wnt signal pathway. Downregulation of the Wnt signal pathway occurs in neurodegenerative diseases including Amyotrophic Lateral Sclerosis (ALS). However, little is known about Wnt5a/Fzd2 signaling in mammalian nerve cells, and it is not clear whether Wnt5a or Fzd2 functioning are changed in ALS. The influence of Wnt5a and Fzd2 signal transduction pathway on ALS was investigated in adult SOD1G93A transgenic mice. Changes in Wnt5a and Fzd2 expression in the spinal cord of SOD1G93A transgenic mice (ALS), SOD1G93A transfected NSC-34 cells, and primary cultures of astrocytes from SOD1G93A transgenic mice were detected by immunofluorescent staining, Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and Western blotting. The results provide further insight into the role of Wnt5a and Fzd2 in the pathogenesis of ALS transgenic mice, which provides evidence that should help in the search for treatments of ALS. PMID:23826406

  16. Co-existing spinal intradural ependymal cyst and sacral Tarlov cyst in adult-onset tethered cord syndrome with syringomyelia: Case report and literature review

    PubMed Central

    Rai, Hamid H.; Khan, Muhammad F.; Enam, Syed Ather; Hashmi, Imtiaz

    2016-01-01

    Background: Synchronous spinal intradural ependymal cysts and sacral Tarlov cysts in adult onset tethered cord syndrome are extremely rare. Case Description: A 23-year-old male presented with back pain radiating into both lower extremities, accompanied by acute onset of gait difficulty and sphincter dysfunction. Magnetic resonance imaging identified a low lying conus medullaris, syringomyelia with septations extending from T12 to S1, a tethered cord, and a thickened filum terminale with a sacral Tarlov cyst. The patient underwent a L3-4 laminectomy for decompression of syringomyelia and excision/biopsy of a space occupying lesion along with S1-2 laminectomy for cord untethering and Tarlov cyst fenestration. Postoperative histopathology confirmed that the lesion was an ependymal cyst. Clinically, patient showed marked improvement in the neurological status. Conclusion: Simultaneous decompressive laminectomy of L3-4 and S1-2 effectively decompressed the syringomyelia while allowing for excision/biopsy of a space occupying lesion at the former and untethering and Tarlov cyst fenestration at the latter levels. PMID:27843691

  17. Effects of depressant amino acids and antagonists on an in vitro spinal cord preparation from the adult rat.

    PubMed

    Long, S K; Evans, R H; Krijzer, F

    1989-07-01

    A mature sacrococcygeal in vitro spinal preparation from the rat has been used to demonstrate effects of neutral amino acids and their antagonists. gamma-Aminobutanoate (GABA), glycine and taurine (0.5-5 mM) produced dose-dependent depression of spontaneous paroxysmal activity generated in Mg2+ -free medium. The depressant effect of GABA was antagonised selectively by picrotoxin (25-50 microM) and the depressant effects of glycine and taurine were antagonised selectively by strychnine (0.2 microM). Glycine (0.5-5 mM) had a dose-dependent depolarizing action which was present at the central ends of isolated ventral roots. gamma-Aminobutanoate and taurine, had only weak depolarizing actions on ventral root fibres. Depolarizing responses to glycine showed a marked fading. Reduction in the fading appeared to be responsible for a paradoxical potentiation of glycine-induced depolarizations, which occurred in the presence of strychnine (0.2-2 microM). Strychnine (2-10 microM), picrotoxin (10-50 microM) or bicuculline (10 microM) had little or no effect on the amplitude, duration or latency of the monosynaptic component of ventral root reflexes evoked by supramaximal stimulation of dorsal roots (DR-VRP). However all three antagonists introduced slow, NMDA receptor mediated, components to these ventral root potentials. Picrotoxin and bicuculline, but not strychnine, reversibly depressed the dorsal root potential evoked from an adjacent dorsal root (DR-DRP). The depressant actions of 2-amino-5-phosphonopentanoate (AP5), kynurenate and 3-((+/-)-2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP) revealed both NMDA and non-NMDA receptor mediated components in the dorsal root potential.

  18. Anterior column realignment following lateral interbody fusion for sagittal deformity correction.

    PubMed

    Pimenta, Luiz; Fortti, Fernanda; Oliveira, Leonardo; Marchi, Luis; Jensen, Rubens; Coutinho, Etevaldo; Amaral, Rodrigo

    2015-07-01

    Degenerative and iatrogenic diseases may lead to loss of lordosis or even kyphotic thoracolumbar deformity and sagittal misalignment. Traditional surgery with three-column osteotomies is associated with important neurologic risks and postoperative morbidity. In a novel technique, the lateral transpsoas interbody fusion (LTIF) is complemented with the sacrifice of the anterior longitudinal ligament and anterior portion of the annulus followed by the insertion of a hyperlordotic interbody cage. This is a less invasive lateral technique named anterior column realignment (ACR) and aims to correct sagittal misalignment in adult spinal deformity (ASD), with or without the addition of minor posterior osteotomies. In this article, we provide an account of the evolution to the ACR technique, the literature, and the Brazilian experience in the treatment of adult spinal deformity with this novel advanced application of LTIF. In the presence of ASD, the risk-to-benefit ratio of a surgical correction must be evaluated. Less invasive surgical strategies can be alternatives to treat the deformity and provide better quality of life to the patient. ACR is an advanced application of lateral transpsoas approach, up to date has shown to be reliable and effective when used for ASD, and may minimize complications and morbidity from traditional surgical procedures. Long-term follow-up and comparative studies are needed to evaluate real benefit.

  19. Spinal Fusion

    MedlinePlus

    ... concept of fusion is similar to that of welding in industry. Spinal fusion surgery, however, does not ... bone taken from the patient has a long history of use and results in predictable healing. Autograft ...

  20. Spinal tumor

    MedlinePlus

    ... Livingstone; 2014:chap 49. Read More Brain tumor - children Hodgkin lymphoma Metastasis Spinal cord trauma Review Date 8/15/2016 Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review ...

  1. Spinal Infections

    MedlinePlus

    ... spinal infection include fever, chills, headache, neck stiffness, pain, wound redness and tenderness, and wound drainage. In some cases, patients may notice new weakness, numbness or tingling sensations in the arms and/or legs. The symptoms ...

  2. Short term treatment versus long term management of neck and back disability in older adults utilizing spinal manipulative therapy and supervised exercise: a parallel-group randomized clinical trial evaluating relative effectiveness and harms

    PubMed Central

    2014-01-01

    Background Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability. The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability. Methods/Design Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area. Participants Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200). Interventions 12 weeks SMT + SRE or 36 weeks SMT + SRE. Randomization Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes. Blinding Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment. Primary endpoint 36 weeks post-randomization. Data collection Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs

  3. Spinal dorsal horn cell receptive field size is increased in adult rats following neonatal hindpaw skin injury.

    PubMed

    Torsney, Carole; Fitzgerald, Maria

    2003-07-01

    Local tissue damage in newborn rats can lead to changes in skin sensitivity that last into adulthood and this is likely to be due to plasticity of developing peripheral and central sensory connections. This study examines the functional connections of dorsal horn neurons in young and adult rats that have undergone local skin damage at birth. Newborn rat pups were halothane anaesthetised and received either a unilateral subcutaneous plantar injection of 1 % lambda-carrageenan or a unilateral plantar foot injury made by removal of 2 mm x 2 mm of skin. At 3 weeks, (postnatal day (P) 19-23) and 6 weeks (P40-44) in vivo extracellular recordings of single dorsal horn cells with plantar cutaneous receptive fields were made under urethane anaesthesia (2 g kg-1) and responses to mechanical and electrical stimulation of the skin were assessed. Following neonatal carrageenan inflammation, dorsal horn neuron properties and receptive field sizes at 3 weeks were the same as those of controls. In contrast, following neonatal skin injury, dorsal horn cell receptive field sizes were significantly greater than those of controls at 3 weeks (2.5-fold) and at 6 weeks (2.2-fold). Mechanical thresholds, mechanical response magnitudes and evoked responses to single and repeated A and C fibre stimulation remained unaffected. These results show that early skin injury can cause prolonged changes in central sensory connections that persist into adult life, long after the skin has healed. Enlarged dorsal horn neuron receptive field sizes provide a physiological mechanism for the persistent behavioural hypersensitivity that follows neonatal skin injury in rats and for the prolonged sensory changes reported in human infants after early pain and injury.

  4. Negative correlation between Nosema ceranae spore loads and deformed wing virus infection levels in adult honey bee workers.

    PubMed

    Costa, Cecilia; Tanner, Gina; Lodesani, Marco; Maistrello, Lara; Neumann, Peter

    2011-11-01

    Interactions between pathogens might contribute to honey bee colony losses. Here we investigated if there is an association between the microsporidian Nosema ceranae and the deformed wing virus (DWV) in different body sections of individual honey bee workers (Apis mellifera ligustica) under exclusion of the vector Varroa destructor. Our data provide correlational evidence for antagonistic interactions between the two pathogens in the midgut of the bees.

  5. Spinal fusion - series (image)

    MedlinePlus

    ... vertebrae are the bones that make up the spinal column, which surrounds and protects the spinal cord. The ... cushions between vertebrae, and absorb energy while the spinal column flexes, extends, and twists. Nerves from the spinal ...

  6. Spinal Cord Tumor

    MedlinePlus

    Spinal cord tumor Overview By Mayo Clinic Staff A spinal tumor is a growth that develops within your ... as vertebral tumors. Tumors that begin within the spinal cord itself are called spinal cord tumors. There are ...

  7. Effects of baclofen on mechanical noxious and innocuous transmission in the spinal dorsal horn of the adult rat: in vivo patch-clamp analysis.

    PubMed

    Fukuhara, Kaori; Katafuchi, Toshihiko; Yoshimura, Megumu

    2013-11-01

    The effects of a GABAB agonist, baclofen, on mechanical noxious and innocuous synaptic transmission in the substantia gelatinosa (SG) were investigated in adult rats with the in vivo patch-clamp technique. Under current-clamp conditions, perfusion with baclofen (10 μm) on the surface of the spinal cord caused hyperpolarisation of SG neurons and a decrease in the number of action potentials elicited by pinch and touch stimuli applied to the receptive field of the ipsilateral hindlimb. The suppression of action potentials was preserved under blockade of postsynaptic G-proteins, although baclofen-induced hyperpolarisation was completely blocked. These findings suggest presynaptic effects of baclofen on the induced action potentials. Under voltage-clamp conditions, application of baclofen reduced the frequency, but not the amplitude, of miniature excitatory postsynaptic currents (mEPSCs), whereas the GABAB receptor antagonist CGP55845 increased the frequency of mEPSCs without affecting the amplitude. Furthermore, application of a GABA uptake inhibitor, nipecotic acid, decreased the frequency of mEPSCs; this effect was blocked by CGP55845, but not by the GABAA antagonist bicuculline. Both the frequency and the amplitude of the pinch-evoked barrage of excitatory postsynaptic currents (EPSCs) were suppressed by baclofen in a dose-dependent manner. The frequency and amplitude of touch-evoked EPSCs was also suppressed by baclofen, but the suppression was significantly smaller than that of pinch-evoked EPSCs. We conclude that mechanical noxious transmission is presynaptically blocked through GABAB receptors in the SG, and is more effectively suppressed than innocuous transmission, which may account for a part of the mechanism of the efficient analgesic effects of baclofen.

  8. Clinical and molecular cross-sectional study of a cohort of adult type III spinal muscular atrophy patients: clues from a biomarker study

    PubMed Central

    Tiziano, Francesco D; Lomastro, Rosa; Di Pietro, Lorena; Barbara Pasanisi, Maria; Fiori, Stefania; Angelozzi, Carla; Abiusi, Emanuela; Angelini, Corrado; Sorarù, Gianni; Gaiani, Alessandra; Mongini, Tiziana; Vercelli, Liliana; Vasco, Gessica; Vita, Giuseppe; Luca Vita, Gian; Messina, Sonia; Politano, Luisa; Passamano, Luigia; Di Gregorio, Grazia; Montomoli, Cristina; Orsi, Chiara; Campanella, Angela; Mantegazza, Renato; Morandi, Lucia

    2013-01-01

    Proximal spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by mutations of the SMN1 gene. Based on severity, three forms of SMA are recognized (types I–III). All patients usually have 2–4 copies of a highly homologous gene (SMN2), which produces insufficient levels of functional survival motor neuron (SMN) protein due to the alternative splicing of exon 7. The availability of potential candidates to the treatment of SMA has raised a number of issues, including the availability of biomarkers. This study was aimed at evaluating whether the quantification of SMN2 products in peripheral blood is a suitable biomarker for SMA. Forty-five adult type III patients were evaluated by Manual Muscle Testing, North Star Ambulatory Assessment scale, 6-min walk test, myometry, forced vital capacity, and dual X-ray absorptiometry. Molecular assessments included SMN2 copy number, levels of full-length SMN2 (SMN2-fl) transcripts and those lacking exon 7 and SMN protein. Clinical outcome measures strongly correlated to each other. Lean body mass correlated inversely with years from diagnosis and with several aspects of motor performance. SMN2 copy number and SMN protein levels were not associated with motor performance or transcript levels. SMN2-fl levels correlated with motor performance in ambulant patients. Our results indicate that SMN2-fl levels correlate with motor performance only in patients preserving higher levels of motor function, whereas motor performance was strongly influenced by disease duration and lean body mass. If not taken into account, the confounding effect of disease duration may impair the identification of potential SMA biomarkers. PMID:23073312

  9. Anti-NGF Local Therapy for Autonomic Dysreflexia in Spinal Cord Injury

    DTIC Science & Technology

    2013-10-01

    pathophysiological basis of neurogenic detrusor overactivity with spinal cord injury (SCI). However, the... bladder distention after SCI. Using adult female rats with chronic spinal cord injury induced by Th4 spinal cord transection, we will investigate: (1...autonomic dysreflexia during bladder distention in rats with spinal cord injury . 111th Annual Meeting AUA, Abstract No. 34, San Diego, May 4-8, 2013.

  10. Spinal fixation. Part 3. Complications of spinal instrumentation.

    PubMed

    Slone, R M; MacMillan, M; Montgomery, W J

    1993-07-01

    Spinal fixation devices can be used to form a rigid construct with the spine to replace bone, restore alignment, maintain position, and prevent motion in the treatment of fractures, degenerative disease, neoplasm, and congenital deformities. Because most spinal constructs will eventually fail if bone fusion does not occur, bone graft material is often used along with the implant to promote fusion. Conventional radiographs, obtained in two projections, remain the mainstay of implant evaluation, demonstrating the position of the spinal elements, hardware, graft material, and evidence of complication. Possible complications connected with use of fixation devices include intraoperative soft-tissue injuries, postoperative hematomas, and infection. The components (through incorrect use, malpositioning at surgery, and later dislodgment or fracture) may also contribute to complications such as instability; failure of fusion; or pain, with possible resultant neurologic damage. Bone graft material can migrate or hypertrophy, resulting in impingement on the spinal canal or neural foramen. Radiologists should be familiar with the various spinal fixation devices and techniques to better identify evolving complications.

  11. Spinal and Limb Abnormalities in Adolescents with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Lin, Pei-Ying; Lin, Lan-Ping; Lai, Chia-Im; Leu, Yii-Rong; Yen, Chia-Feng; Hsu, Shang-Wei; Chu, Chi-Ming; Wu, Chia-Ling; Chu, Cordia M.

    2010-01-01

    There are not many studies pertaining to the spinal or limb abnormalities in people with intellectual disabilities, without a clear profile of these deformities of them, efforts to understand its characters and improve their quality of life will be impossible. Therefore, this paper aims to describe the prevalence and related factors of spinal and…

  12. Surgeon-driven neurophysiologic monitoring in a spinal surgery population

    PubMed Central

    Pickell, Michael; Mann, Stephen M.; Chakravertty, Rajesh

    2016-01-01

    Background This is a prospective observational study examining the use of a surgeon-driven intraoperative neurophysiologic monitoring system. Intraoperative neurophysiologic monitoring is becoming the standard of care for spinal surgeries with potential post-operative neurologic deficits. This standard applies to both adult and pediatric spinal surgery, but a shortage of appropriately trained and certified technologists and physiologists can compromise monitoring capabilities in some centers. A surgeon-driven, intra-operative monitoring system in the absence of a technologist or physiologist was examined for safety and efficacy. Methods One hundred thirty-five patients undergoing a variety of spinal procedures were monitored intra-operatively using a surgeon-driven neuro-monitoring system over a period of 80 months. Intraoperative monitoring included serial motor evoked potentials via an automated system that provided visual and audible feedback directly to the operative surgeon. Changes in monitoring and any corresponding surgical responses were evaluated and compared with postoperative neurological status. Results Of the 135 patients studied, intraoperative adjustments based on neuro-monitoring took place in four patients (3.0%): following reduction in spondylolisthesis, during instrumentation and fusion for a large kyphoscoliosis deformity, due to low hemoglobin, and because of traction. In all cases, surgical and/or anaesthetic modification restored MEPs toward baseline values. The accuracy of the neuro-monitoring results was sensitive to narcotics, benzodiazepines and changes in haemoglobin concentrations. No new postoperative deficits were observed in any patients in the cohort. Conclusions The authors concluded that surgeon-driven neuro-monitoring was a safe and effective means of intraoperative neuro-monitoring during spinal surgery. It reliably detected intraoperative insults, which could potentially have resulted in postoperative neurologic compromise

  13. Distribution of the neuronal gap junction protein Connexin36 in the spinal cord enlargements of developing and adult opossums, Monodelphis domestica.

    PubMed

    Lemieux, Maxime; Cabana, Thérèse; Pflieger, Jean-François

    2010-01-01

    We use opossums Monodelphis domestica to study the development of mammalian motor systems. The immature forelimbs of the newborn perform rhythmic and alternating movements that are likely under spinal control. The hindlimbs start moving in the second week. Chemical synapses are scant in the spinal enlargements of neonatal opossums and the presence of electrochemical synapses has not been evaluated in this species or in other marsupials. As a first step aiming at evaluating the existence of such synapses in the neonatal spinal cord, we have investigated the presence of the exclusively neuronal gap junction protein connexin36 (Cx36) by immunohistochemistry in light microscopy. At birth, Cx36 immunoreactivity is moderate in the presumptive gray matter in both enlargements. Thereafter, it decreases gradually, except in the superficial dorsal horn where it increases to a plateau between P10 and P20. Cx36 labeling is detected in the presumptive white matter at birth, but then decreases except in the dorsal part of the lateral funiculus, where it is dense between P10 and P20. Cx36 has become virtually undetectable by P52. The presence of Cx36 in the spinal enlargements of postnatal opossums suggests that neurons might be linked by gap junctions at a time when chemical synapses are only beginning to form. The greater abundance of Cx36 observed transiently in the superficial dorsal horn suggests a stronger involvement of this protein in spinal sensory systems than in direct motor control of the limbs.

  14. Spinal cord transection in the larval zebrafish.

    PubMed

    Briona, Lisa K; Dorsky, Richard I

    2014-05-21

    Mammals fail in sensory and motor recovery following spinal cord injury due to lack of axonal regrowth below the level of injury as well as an inability to reinitiate spinal neurogenesis. However, some anamniotes including the zebrafish Danio rerio exhibit both sensory and functional recovery even after complete transection of the spinal cord. The adult zebrafish is an established model organism for studying regeneration following spinal cord injury, with sensory and motor recovery by 6 weeks post-injury. To take advantage of in vivo analysis of the regenerative process available in the transparent larval zebrafish as well as genetic tools not accessible in the adult, we use the larval zebrafish to study regeneration after spinal cord transection. Here we demonstrate a method for reproducibly and verifiably transecting the larval spinal cord. After transection, our data shows sensory recovery beginning at 2 days post-injury (dpi), with the C-bend movement detectable by 3 dpi and resumption of free swimming by 5 dpi. Thus we propose the larval zebrafish as a companion tool to the adult zebrafish for the study of recovery after spinal cord injury.

  15. Effect of locomotor training in completely spinalized cats previously submitted to a spinal hemisection.

    PubMed

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

    2012-08-08

    After a spinal hemisection in cats, locomotor plasticity occurring at the spinal level can be revealed by performing, several weeks later, a complete spinalization below the first hemisection. Using this paradigm, we recently demonstrated that the hemisection induces durable changes in the symmetry of locomotor kinematics that persist after spinalization. Can this asymmetry be changed again in the spinal state by interventions such as treadmill locomotor training started within a few days after the spinalization? We performed, in 9 adult cats, a spinal hemisection at thoracic level 10 and then a complete spinalization at T13, 3 weeks later. Cats were not treadmill trained during the hemispinal period. After spinalization, 5 of 9 cats were not trained and served as control while 4 of 9 cats were trained on the treadmill for 20 min, 5 d a week for 3 weeks. Using detailed kinematic analyses, we showed that, without training, the asymmetrical state of locomotion induced by the hemisection was retained durably after the subsequent spinalization. By contrast, training cats after spinalization induced a reversal of the left/right asymmetries, suggesting that new plastic changes occurred within the spinal cord through locomotor training. Moreover, training was shown to improve the kinematic parameters and the performance of the hindlimb on the previously hemisected side. These results indicate that spinal locomotor circuits, previously modified by past experience such as required for adaptation to the hemisection, can remarkably respond to subsequent locomotor training and improve bilateral locomotor kinematics, clearly showing the benefits of locomotor training in the spinal state.

  16. Spinal Osteosarcoma

    PubMed Central

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

    2013-01-01

    Although osteosarcoma represents the second most common primary bone tumor, spinal involvement is rare, accounting for 3%–5% of all osteosarcomas. The most frequent symptom of osteosarcoma is pain, which appears in almost all patients, whereas more than 70% exhibit neurologic deficit. At a molecular level, it is a tumor of great genetic complexity and several genetic disorders have been associated with its appearance. Early diagnosis and careful surgical staging are the most important factors in accomplishing sufficient management. Even though overall prognosis remains poor, en-block tumor removal combined with adjuvant radiotherapy and chemotherapy is currently the treatment of choice. This paper outlines histopathological classification, epidemiology, diagnostic procedures, and current concepts of management of spinal osteosarcoma. PMID:24179411

  17. Spinal Bracing

    NASA Technical Reports Server (NTRS)

    1991-01-01

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

  18. Spinal Cord Injury

    MedlinePlus

    ... Types of illnesses and disabilities Spinal cord injury Spinal cord injury Read advice from Dr. Jeffrey Rabin , a ... your health on a daily basis. Living with spinal cord injury — your questions answered top What are pediatric ...

  19. Tethered Spinal Cord Syndrome

    MedlinePlus

    ... the movement of the spinal cord within the spinal column. Attachments may occur congenitally at the base of ... or may be due to narrowing of the spinal column (stenosis) with age. Tethering may also develop after ...

  20. Spinal Cord Injury Map

    MedlinePlus

    ... Counseling About Blog Facing Disability Jeff Shannon Donate Spinal Cord Injury Map Loss of function depends on what ... control. Learn more about spinal cord injuries. A spinal cord injury affects the entire family FacingDisability is designed ...

  1. Spinal injury - resources

    MedlinePlus

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

  2. Coadministration of Dexamethasone and Melissa officinalis Has Neuroprotective Effects in Rat Animal Model with Spinal Cord Injury

    PubMed Central

    Hosseini, Seyed Ruhollah; Kaka, Gholamreza; Joghataei, Mohammad Taghi; Hooshmandi, Mehdi; Sadraie, Seyed Homayoon; Yaghoobi, Kayvan; Mansoori, Korosh; Mohammadi, Alireza

    2017-01-01

    Objective Spinal cord injury (SCI) causes inflammation, deformity and cell loss. It has been shown that Melissa officinalis (MO), as herbal medicine, and dexamethasone (DEX) are useful in the prevention of various neurological diseases. The present study evaluated combinational effects of DEX and MO on spinal cord injury. Materials and Methods Thirty six adult male Wistar rats were used in this experimental study. The weight-drop contusion method was employed to induce spinal cord injury in rats. DEX and MO were administrated alone and together in different treatment groups. Intra-muscular injection of DEX (1 mg/kg) was started three hours after injury and continued once a day for seven days after injury. Intra-peritoneal (I.P) injection of MO (150 mg/ kg) was started one day after injury and continued once a day for 14 days. Results Our results showed motor and sensory functions were improved significantly in the group received a combination of DEX and MO, compared to spinal cord injury group. Mean cavity area was decreased and loss of lower motor neurons and astrogliosis in the ventral horn of spinal cord was significantly prevented in the group received combination of DEX and Melissa officinalis, compared to spinal cord injury group. Furthermore, the findings showed a significant augmentation of electromyography (EMG) recruitment index, increase of myelin diameter, and up-regulation of myelin basic protein in the treated group with combination of DEX and MO. Conclusion Results showed that combination of DEX and MO could be considered as a neuroprotective agent in spinal cord injury. PMID:28367421

  3. Rehabilitation of Disabled Children Following Spinal Fusion.

    ERIC Educational Resources Information Center

    Jaffe, Kenneth M.; Hays, Ross M.

    1986-01-01

    Records of 16 patients (ages 6-19) who had undergone surgery for severe spinal deformity were retrospectively analyzed to document ten aspects of rehabilitation intervention, including mobility skills, patient and family training and education, daily living activities, ongoing medical problems, planning for school reentry, and management of…

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

    MedlinePlus

    The cervical spinal column is made up of vertebral bodies which protect the spinal cord. ... spinal nerves, trauma, and narrowing (stenosis) of the spinal column around the spinal cord. Symptoms of cervical spine ...

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

    PubMed

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

    2013-06-01

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

  6. Proximal junctional vertebral fracture-subluxation after adult spine deformity surgery. Does vertebral augmentation avoid this complication? A case report

    PubMed Central

    2012-01-01

    Background To report to the orthopedic community a case of vertebral fracture and adjacent vertebral subluxation through the upper instrumented vertebra after thoracolumbar fusion with augmentation of the cranial level. Methods This report reviewed the patient`s medical record, her imaging studies and related literature. The possible factors contributing to this fracture are hypothesized. Results A 70-year-old woman underwent decompressive surgery and posterolateral fusion for adult lumbar scoliosis. We used pedicular screws from T10 to S1 and iliac screw at the right side, augmented with cement at T10, T11, L1, L5 and S1; and prophylactic vertebroplasty at T9 to avoid the "topping-off syndrome". Thirty days after discharge, without recognizable inciting trauma, the patient complained of pain in the lower thoracic area. The exam revealed overall neurological deficit below the level of fracture. CT scan and MRI demonstrated a T10 vertebral collapse and T9 vertebral subluxation with morphologic features of flexion-distraction fracture through the upper edge of the screw. At this point, the authors performed posterior decompression at T9 to T10 and extended posterolateral arthrodesis from T2 to T10. To our knowledge, this is an unreported fracture. Conclusions Augmentation of the cranial level in a long thoracolumbar fusion has been developed to avoid the junctional kyphosis and compression fractures at that level. We alert the orthopedic community that this augmentation may lead to further and more severe fractures, although this opinion requires investigation for confirmation. PMID:22947422

  7. The adult scoliosis.

    PubMed

    Aebi, Max

    2005-12-01

    Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Adult scoliosis can be separated into four major groups: Type 1: Primary degenerative scoliosis, mostly on the basis of a disc and/or facet joint arthritis, affecting those structures asymmetrically with predominantly back pain symptoms, often accompanied either by signs of spinal stenosis (central as well as lateral stenosis) or without. These curves are often classified as "de novo" scoliosis. Type 2: Idiopathic adolescent scoliosis of the thoracic and/or lumbar spine which progresses in adult life and is usually combined with secondary degeneration and/or imbalance. Some patients had either no surgical treatment or a surgical correction and fusion in adolescence in either the thoracic or thoracolumbar spine. Those patients may develop secondary degeneration and progression of the adjacent curve; in this case those curves belong to the type 3a. Type 3: Secondary adult curves: (a) In the context of an oblique pelvis, for instance, due to a leg length discrepancy or hip pathology or as a secondary curve in idiopathic, neuromuscular and congenital scoliosis, or asymmetrical anomalies at the lumbosacral junction; (b) In the context of a metabolic bone disease (mostly osteoporosis) combined with asymmetric arthritic disease and/or vertebral fractures. Sometimes it is difficult to decide, what exactly the primary cause of the curve was, once it has significantly progressed. However, once an asymmetric load or degeneration occurs, the pathomorphology and pathomechanism in adult scoliosis predominantly located in the lumbar or thoracolumbar spine is quite predictable. Asymmetric degeneration leads to increased asymmetric load and therefore to a progression of the degeneration and deformity, as either scoliosis and/or kyphosis. The progression of a curve is further supported by osteoporosis, particularly in post-menopausal female

  8. Cutaneous inputs from the back abolish locomotor-like activity and reduce spastic-like activity in the adult cat following complete spinal cord injury.

    PubMed

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

    2012-06-01

    Spasticity is a condition that can include increased muscle tone, clonus, spasms, and hyperreflexia. In this study, we report the effect of manually stimulating the dorsal lumbosacral skin on spontaneous locomotor-like activity and on a variety of reflex responses in 5 decerebrate chronic spinal cats treated with clonidine. Cats were spinalized 1 month before the terminal experiment. Stretch reflexes were evoked by stretching the left triceps surae muscles. Crossed reflexes were elicited by electrically stimulating the right tibial or superficial peroneal nerves. Wind-up of reflex responses was evoked by electrically stimulating the left tibial or superficial peroneal nerves. We found that pinching the skin of the back abolished spontaneous locomotor-like activity. We also found that back pinch abolished the rhythmic activity observed during reflex testing without eliminating the reflex responses. Some of the rhythmic episodes of activity observed during reflex testing were consistent with clonus with an oscillation frequency greater than 3 Hz. Pinching the skin of the back effectively abolished rhythmic activity occurring spontaneously or evoked during reflex testing, irrespective of oscillation frequency. The results are consistent with the hypothesis that locomotion and clonus are produced by common central pattern-generators. Stimulating the skin of the back could prove helpful in managing undesired rhythmic activity in spinal cord-injured humans.

  9. Multiple Spinal Revision Surgery in a Patient with Parkinson's Disease

    PubMed Central

    Malla, Hridayesh Pratap; Kim, Min Ki; Kim, Tae Sung

    2016-01-01

    Parkinson's disease (PD) patients frequently have several spinal deformities leading to postural instabilities including camptocormia, myopathy-induced postural deformity, Pisa syndrome, and progressive degeneration, all of which adversely affect daily life activities. To improve these postural deformities and relieve the related neurologic symptoms, patients often undergo spinal instrumentation surgery. Due to progressive degenerative changes related to PD itself and other complicating factors, patients and surgeons are faced with instrument failure-related complications, which can ultimately result in multiple revision surgeries yielding various postoperative complications and morbidities. Here, we report a representative case of a 70-year-old PD patient with flat back syndrome who had undergone several revision surgeries, including anterior and posterior decompression and fusion for a lumbosacral spinal deformity. The patient ultimately benefitted from a relatively short segment fixation and corrective fusion surgery. PMID:27847583

  10. 2014 Leonard Goldner Award Winner: Correlation of Postoperative Midfoot Position with Patient Outcomes Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity

    PubMed Central

    Conti, Matthew S.; Chan, Jeremy Y.; Do, Huong T.; Ellis, Scott J.; Deland, Jonathan T.

    2016-01-01

    Background No studies investigating the effect of midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from AP radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). Methods Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors’ institution that underwent flatfoot reconstruction for stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with two or more measurements in the abduction category were classified as the abduction group (n=30); those with one or fewer measurements in the abduction category were placed in the adduction group (n=25). Preoperative FAOS and postoperative FAOS with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. Results Patients corrected to a position of adduction showed a significantly lower improvement in the FAOS daily activities (p=0.012) and quality of life subscales (p=0.046). Mean improvement in subscale score for the adducted group was lower for pain (p=0.052) and sports activities (p=0.085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (p=0.372) between groups was found. Conclusions Correction of the talonavicular joint to a position of adduction following stage II AAFD is associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in the

  11. Lateral column lengthening for acquired adult flatfoot deformity caused by posterior tibial tendon dysfunction stage II: a retrospective comparison of calcaneus osteotomy with calcaneocuboid distraction arthrodesis.

    PubMed

    Haeseker, Guus A; Mureau, Marc A; Faber, Frank W M

    2010-01-01

    In this study, clinical and radiological results after lateral column lengthening by calcaneocuboid distraction arthrodesis and calcaneus osteotomy were compared. Thirty-three patients (35 feet) treated with lateral column lengthening by distraction arthrodesis (14 patients, 16 feet; group I) or by calcaneus osteotomy (19 patients, 19 feet; group II) for adult-acquired flatfoot deformity caused by stage II posterior tibial tendon dysfunction were compared retrospectively. Mean follow-up was 42.4 months (range, 6-78 months) for group I and 15.8 months (range, 6-32 months) for group II (P < .001). The American Orthopaedic Foot & Ankle Society ankle-hindfoot score was determined, 4 variables were measured on preoperative and postoperative weight-bearing radiographs, and a number of independent and outcome variables, including patient satisfaction, were recorded. Group 2 had a significantly higher American Orthopaedic Foot & Ankle Society score compared with group I (mean, 85 vs. 72, respectively; P < .02) at time of last follow-up, and there were no dissatisfied patients in group I, whereas 2 patients in group II were dissatisfied with the result of the operation. All radiological results were significantly better at time of follow-up in both groups (except for talocalcaneal angle in group I), although no significant differences were noted in the amount of change in radiographic measurements between the groups. No significant correlation was found between follow-up time and radiographic improvement, indicating stable radiographic measurements over time. In group II, 13 mild calcaneocuboid subluxations were observed. In both groups, 1 nonunion and 1 wound complication occurred. Based on our experience with the patients described in this report, we recommend lateral column lengthening by means of calcaneus osteotomy rather than distraction arthrodesis of the calcaneocuboid joint, for correction of stage II posterior tibial tendon dysfunction.

  12. Corticospinal and Reticulospinal Contacts on Cervical Commissural and Long Descending Propriospinal Neurons in the Adult Rat Spinal Cord; Evidence for Powerful Reticulospinal Connections

    PubMed Central

    Mitchell, Emma J.; McCallum, Sarah; Dewar, Deborah; Maxwell, David J.

    2016-01-01

    Descending systems have a crucial role in the selection of motor output patterns by influencing the activity of interneuronal networks in the spinal cord. Commissural interneurons that project to the contralateral grey matter are key components of such networks as they coordinate left-right motor activity of fore and hind-limbs. The aim of this study was to determine if corticospinal (CST) and reticulospinal (RST) neurons make significant numbers of axonal contacts with cervical commissural interneurons. Two classes of commissural neurons were analysed: 1) local commissural interneurons (LCINs) in segments C4-5; 2) long descending propriospinal neurons (LDPNs) projecting from C4 to the rostral lumbar cord. Commissural interneurons were labelled with Fluorogold and CST and RST axons were labelled by injecting the b subunit of cholera toxin in the forelimb area of the primary somatosensory cortex or the medial longitudinal fasciculus respectively. The results show that LCINs and LDPNs receive few contacts from CST terminals but large numbers of contacts are formed by RST terminals. Use of vesicular glutamate and vesicular GABA transporters revealed that both types of cell received about 80% excitatory and 20% inhibitory RST contacts. Therefore the CST appears to have a minimal influence on LCINs and LDPNs but the RST has a powerful influence. This suggests that left-right activity in the rat spinal cord is not influenced directly via CST systems but is strongly controlled by the RST pathway. Many RST neurons have monosynaptic input from corticobulbar pathways therefore this pathway may provide an indirect route from the cortex to commissural systems. The cortico-reticulospinal-commissural system may also contribute to functional recovery following damage to the CST as it has the capacity to deliver information from the cortex to the spinal cord in the absence of direct CST input. PMID:26999665

  13. Pediatric spinal cord injury: a review by organ system.

    PubMed

    Powell, Aaron; Davidson, Loren

    2015-02-01

    In this article, an overview is provided of pediatric spinal cord injury, organized by effects of this injury on various organ systems. Specific management differences between children and adults with spinal cord injury are highlighted. A detailed management approach is offered for particularly complex topics, such as spasticity and upper extremity reconstruction.

  14. Primary osseous tumors of the pediatric spinal column: review of pathology and surgical decision making.

    PubMed

    Ravindra, Vijay M; Eli, Ilyas M; Schmidt, Meic H; Brockmeyer, Douglas L

    2016-08-01

    Spinal column tumors are rare in children and young adults, accounting for only 1% of all spine and spinal cord tumors combined. They often present diagnostic and therapeutic challenges. In this article, the authors review the current management of primary osseous tumors of the pediatric spinal column and highlight diagnosis, management, and surgical decision making.

  15. [Spinal instrumentation, source of progress, but also revealing pitfalls].

    PubMed

    Dubousset, Jean

    2003-01-01

    The second half of the XXo century and especially the last 30 years have been the source of a great improvement for surgical treatment of spinal pathology essentially in 3 directions:--First, for the patient himself and his comfort by suppression for most of the cases of any post operative external support thanks to the rigidity, security and strength of segmental fixation given by the hooks, screws and rods systems, as well for posterior as anterior instrumentation. In addition, these new techniques allow the patient to return quickly to standing and walking activity and subsequently the surgery for adult people increased dramatically especially for all kind of degenerative diseases and more and more extended spinal deformities.--The second major improvement came from the real and new understanding of the 3 dimensions for all the physiology and pathology of the spine leading to practical applications for the design and surgical strategies for correction. The exploding expansion of the era of computer technology brought a lot of help in such understanding as well as for the development of spinal instrumentation.--Finally the impressive development of medical imaging with CT scan and less and less invasive techniques like MRI allow a much better vision of spinal cord and roots (a major concern for the spinal surgeon). All this occurs also because simultaneous revolution occurred in the field of anesthesia and intensive care especially post operatively, but also because the big progress for monitoring of vital function as well as neurological monitoring during surgery. The consequence of that was an improvement for the results concerning the patient for functional quality of life as well as for cosmesis. The subsequent failures resulting of these improvements came from various fields even if we exclude infection or neurological complications more and more controlled now.--At the level of the indications because of these lack of post operative external immobilization

  16. Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review.

    PubMed

    Henderson, Fraser C; Henderson, Fraser C; Wilson, William A; Mark, Alexander S; Koby, Myles

    2017-03-03

    There is growing recognition of the kyphotic clivo-axial angle (CXA) as an index of risk of brainstem deformity and craniocervical instability. This review of literature and prospective pilot study is the first to address the potential correlation between correction of the pathological CXA and postoperative clinical outcome. The CXA is a useful sentinel to alert the radiologist and surgeon to the possibility of brainstem deformity or instability. Ten adult subjects with ventral brainstem compression, radiographically manifest as a kyphotic CXA, underwent correction of deformity (normalization of the CXA) prior to fusion and occipito-cervical stabilization. The subjects were assessed preoperatively and at one, three, six, and twelve months after surgery, using established clinical metrics: the visual analog pain scale (VAS), American Spinal InjuryAssociation Impairment Scale (ASIA), Oswestry Neck Disability Index, SF 36, and Karnofsky Index. Parametric and non-parametric statistical tests were performed to correlate clinical outcome with CXA. No major complications were observed. Two patients showed pedicle screws adjacent to but not deforming the vertebral artery on post-operative CT scan. All clinical metrics showed statistically significant improvement. Mean CXA was normalized from 135.8° to 163.7°. Correction of abnormal CXA correlated with statistically significant clinical improvement in this cohort of patients. The study supports the thesis that the CXA maybe an important metric for predicting the risk of brainstem and upper spinal cord deformation. Further study is feasible and warranted.

  17. VOLUNTARY EXERCISE INCREASES OLIGODENDROGENESIS IN SPINAL CORD

    PubMed Central

    Krityakiarana, W.; Espinosa-Jeffrey, A.; Ghiani, C.A.; Zhao, P. M.; Gomez-Pinilla, F.; Yamaguchi, M.; Kotchabhakdi, N.; de Vellis, J.

    2009-01-01

    Exercise has been shown to increase hippocampal neurogenesis, but the effects of exercise on oligodendrocyte generation have not yet been reported. In this study, we evaluated the hypothesis that voluntary exercise may affect neurogenesis, and more in particular, oligodendrogenesis, in the thoracic segment of the intact spinal cord of adult nestin-GFP transgenic mice. Voluntary exercise for 7 and 14 days increased nestin-GFP expression around the ependymal area. In addition, voluntary exercise for 7 days significantly increased nestin-GFP expression in both the white and gray matter of the thoracic segment of the intact spinal cord, whereas, 14 days-exercise decreased nestin-GFP expression. Markers for immature oligodendrocytes (Transferrin and CNPase) were significantly increased after 7 days of voluntary exercise. These results suggest that voluntary exercise positively influences oligodendrogenesis in the intact spinal cord, emphasizing the beneficial effect of voluntary exercise as a possible co-treatment for spinal cord injury. PMID:20374076

  18. Exposure to ELF- magnetic field promotes restoration of sensori-motor functions in adult rats with hemisection of thoracic spinal cord.

    PubMed

    Das, Suman; Kumar, Suneel; Jain, Suman; Avelev, Valery D; Mathur, Rashmi

    2012-09-01

    Clinically effective modalities of treatment for spinal cord injury (SCI) still remain unsatisfactory and are largely invasive in nature. There are reports of accelerated regeneration in injured peripheral nerves by extremely low-frequency pulsed electromagnetic field (ELF-EMF) in the rat. In the present study, the effect of (50 Hz), low-intensity (17.96 μT) magnetic field (MF) exposure of rats after-hemisection of T13 spinal cord (hSCI) was investigated on sensori-motor and locomotor functions. Rats were divided into hSCI (sham-exposed) and hSCI+MF (MF: 2 h/d X 6 weeks) groups. Besides their general conditions, locomotor function by Basso, Beattie, and Brenahan (BBB) score; motor responses to noxious stimuli by threshold of tail flick (TTF), simple vocalization (TSV), tail flick latency (TFL), and neuronal excitability by H-reflex were noted. It is found that, in the hSCI+MF group, a statistically significant improvement over the hSCI control group was noted in BBB score from post-SCI wk2 and TFL and TTF by post-hSCI wk1 and wk3, respectively. Correspondingly, TSV gradually restored by post-hSCI wk5.The threshold of H-reflex was reduced on ipsilateral side vs. contralateral side in hSCI and hSCI+MF group. A complete bladder control was dramatically restored on post-hSCI day4 (vs. day7 of hSCI group) and the survival rate was 100% in the hSCI+MF group (vs. 90% of hSCI group). The results of our study suggest that extremely low-frequency (50 Hz), low-intensity (17.96 μT) MF exposure for 2 h/d x 6wks promotes recovery of sensori-motor behavior including locomotion and bladder control both in terms of temporal pattern and magnitude in hemisection injury of (T13) spinal cord rats.

  19. Prospectively isolated CD133/CD24-positive ependymal cells from the adult spinal cord and lateral ventricle wall differ in their long-term in vitro self-renewal and in vivo gene expression.

    PubMed

    Pfenninger, Cosima V; Steinhoff, Christine; Hertwig, Falk; Nuber, Ulrike A

    2011-01-01

    In contrast to ependymal cells located above the subventricular zone (SVZ) of the adult lateral ventricle wall (LVW), adult spinal cord (SC) ependymal cells possess certain neural stem cell characteristics. The molecular basis of this difference is unknown. In this study, antibodies against multiple cell surface markers were applied to isolate pure populations of SC and LVW ependymal cells, which allowed a direct comparison of their in vitro behavior and in vivo gene expression profile. Isolated CD133(+)/CD24(+)/CD45(-)/CD34(-) ependymal cells from the SC displayed in vitro self-renewal and differentiation capacity, whereas those from the LVW did not. SC ependymal cells showed a higher expression of several genes involved in cell division, cell cycle regulation, and chromosome stability, which is consistent with a long-term self-renewal capacity, and shared certain transcripts with neural stem cells of the embryonic forebrain. They also expressed several retinoic acid (RA)-regulated genes and responded to RA exposure. LVW ependymal cells showed higher transcript levels of many genes regulated by transforming growth factor-β family members. Among them were Dlx2, Id2, Hey1, which together with Foxg1 could explain their potential to turn into neuroblasts under certain environmental conditions.

  20. Segmentation of the human spinal cord.

    PubMed

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

    2016-04-01

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

  1. Robust, accurate and fast automatic segmentation of the spinal cord.

    PubMed

    De Leener, Benjamin; Kadoury, Samuel; Cohen-Adad, Julien

    2014-09-01

    Spinal cord segmentation provides measures of atrophy and facilitates group analysis via inter-subject correspondence. Automatizing this procedure enables studies with large throughput and minimizes user bias. Although several automatic segmentation methods exist, they are often restricted in terms of image contrast and field-of-view. This paper presents a new automatic segmentation method (PropSeg) optimized for robustness, accuracy and speed. The algorithm is based on the propagation of a deformable model and is divided into three parts: firstly, an initialization step detects the spinal cord position and orientation using a circular Hough transform on multiple axial slices rostral and caudal to the starting plane and builds an initial elliptical tubular mesh. Secondly, a low-resolution deformable model is propagated along the spinal cord. To deal with highly variable contrast levels between the spinal cord and the cerebrospinal fluid, the deformation is coupled with a local contrast-to-noise adaptation at each iteration. Thirdly, a refinement process and a global deformation are applied on the propagated mesh to provide an accurate segmentation of the spinal cord. Validation was performed in 15 healthy subjects and two patients with spinal cord injury, using T1- and T2-weighted images of the entire spinal cord and on multiecho T2*-weighted images. Our method was compared against manual segmentation and against an active surface method. Results show high precision for all the MR sequences. Dice coefficients were 0.9 for the T1- and T2-weighted cohorts and 0.86 for the T2*-weighted images. The proposed method runs in less than 1min on a normal computer and can be used to quantify morphological features such as cross-sectional area along the whole spinal cord.

  2. Activation of Akt/FKHR in the medulla oblongata contributes to spontaneous respiratory recovery after incomplete spinal cord injury in adult rats.

    PubMed

    Felix, M S; Bauer, S; Darlot, F; Muscatelli, F; Kastner, A; Gauthier, P; Matarazzo, V

    2014-09-01

    After incomplete spinal cord injury (SCI), patients and animals may exhibit some spontaneous functional recovery which can be partly attributed to remodeling of injured neural circuitry. This post-lesion plasticity implies spinal remodeling but increasing evidences suggest that supraspinal structures contribute also to the functional recovery. Here we tested the hypothesis that partial SCI may activate cell-signaling pathway(s) at the supraspinal level and that this molecular response may contribute to spontaneous recovery. With this aim, we used a rat model of partial cervical hemisection which injures the bulbospinal respiratory tract originating from the medulla oblongata of the brainstem but leads to a time-dependent spontaneous functional recovery of the paralyzed hemidiaphragm. We first demonstrate that after SCI the PI3K/Akt signaling pathway is activated in the medulla oblongata of the brainstem, resulting in an inactivation of its pro-apoptotic downstream target, forkhead transcription factor (FKHR/FOXO1A). Retrograde labeling of medullary premotoneurons including respiratory ones which project to phrenic motoneurons reveals an increased FKHR phosphorylation in their cell bodies together with an unchanged cell number. Medulla infusion of the PI3K inhibitor, LY294002, prevents the SCI-induced Akt and FKHR phosphorylations and activates one of its death-promoting downstream targets, Fas ligand. Quantitative EMG analyses of diaphragmatic contractility demonstrate that the inhibition of medulla PI3K/Akt signaling prevents spontaneous respiratory recovery normally observed after partial cervical SCI. Such inhibition does not however affect either baseline contractile frequency or the ventilatory reactivity under acute respiratory challenge. Together, these findings provide novel evidence of supraspinal cellular contribution to the spontaneous respiratory recovery after partial SCI.

  3. Spinal Cord Injury

    MedlinePlus

    ... care for people with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the ... care for people with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the ...

  4. Spinal Cord Diseases

    MedlinePlus

    ... diseases Autoimmune diseases Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy Symptoms vary but might include pain, numbness, loss of sensation and muscle weakness. These symptoms can occur around the spinal ...

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

    PubMed Central

    Ammendolia, Carlo

    2014-01-01

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

  6. 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, ...

  7. Employment Outcomes Following Spinal Cord Injury.

    ERIC Educational Resources Information Center

    Engel, S.; Murphy, G. S.; Athanasou, J. A.; Hickey, L.

    1998-01-01

    A study of 83 Australian adults with spinal cord injuries found that at least 56% had worked at some time post-injury and those who were working when surveyed had done so for an average of close to 10 years. Clerical, office, and administrative occupations proved to be the most suitable. (Author/CR)

  8. Supratentorial glioblastoma multiforme with spinal metastases

    PubMed Central

    Shah, Abhidha; Redhu, Rakesh; Nadkarni, Trimurti; Goel, Atul

    2010-01-01

    Glioblastoma multiforme is the most common malignant brain tumor in adults. Metastasis of intracranial glioblastoma via the cerebrospinal fluid to the spine is a rare occurrence. We present two cases of glioblastoma multiforme with spinal leptomeningeal spread who presented with back pain and paraparesis. PMID:21572635

  9. Spinal cord injury in youth.

    PubMed

    Apple, D F; Anson, C A; Hunter, J D; Bell, R B

    1995-02-01

    To identify special characteristics of the pediatric spinal cord-injured (SCI) population, we analyzed a database of 1,770 traumatic SCI patients; 88 (5%) fell into the two pediatric subgroups: 0-12 years (n = 26) and 13-15 years (n = 62) at time of injury. Differences between age groups were identified with regard to demographics, neurologic characteristics, associated injuries and complications, and management. Mode level of bony injury was C2 in preteens, C4 in teens, and C4-C5 in adults. Scoliosis developed far more frequently in children, particularly preteens (23%), than in adults (5%). Violent etiologies, predominantly gunshots, accounted for a disproportionate share of injuries to preteens (19%) and African-Americans (28%), as compared with adults (12%) and Caucasians (7%). This last finding underscores the urgent need to mount a response to the nationwide proliferation of gunshot-related SCI in children and minorities.

  10. Spinal infections in children: A review.

    PubMed

    Tyagi, Rahul

    2016-12-01

    Spinal infections are uncommon but significant causes of morbidity and hospitalization in the paediatric population. These infections encompass a broad range of conditions, from discitis to osteomyelitis and spinal epidural and intramedullary abscesses. Paediatric spinal infections can be caused by a range of bacterial, viral, fungal and parasitic agents. Ultrastructural differences of the vertebrae and associated structures result in distinct mechanisms of pathogenesis of spinal infections in children compared to adults. The non-specific nature of symptoms produced by them can cause considerable diagnostic delays. Magnetic Resonance (MR) imaging can facilitate early identification of the disease, and distinguish it from other spinal pathologies. The association of antimicrobial resistant bacterial strains from some of the cases appears worrisome; as is the increasing incidence of Kingella kingae infections causing spinal infections. Rest and immobilization are the general treatment, and prompt initiation of antimicrobial therapy is warranted to ensure optimal clinical outcome. Most patients generally have a good prognosis; however, early identification and prompt initiation of antimicrobial therapy is essential to achieve the best therapeutic response.

  11. AAVshRNA-Mediated Suppression of PTEN in Adult Rats in Combination with Salmon Fibrin Administration Enables Regenerative Growth of Corticospinal Axons and Enhances Recovery of Voluntary Motor Function after Cervical Spinal Cord Injury

    PubMed Central

    2014-01-01

    Conditional genetic deletion of phosphatase and tensin homolog (PTEN) in the sensorimotor cortex of neonatal mice enables regeneration of corticospinal tract (CST) axons after spinal cord injury (SCI). The present study addresses three questions: (1) whether PTEN knockdown in adult rats by nongenetic techniques enables CST regeneration, (2) whether interventions to enable CST regeneration enhance recovery of voluntary motor function, and (3) whether delivery of salmon fibrin into the injury site further enhances CST regeneration and motor recovery. Adult rats were trained in a staircase-reaching task and then received either intracortical injections of AAVshPTEN to delete PTEN or a control vector expressing shRNA for luciferase (AAVshLuc). Rats then received cervical dorsal hemisection injuries and salmon fibrin was injected into the injury site in half the rats, yielding four groups (AAVshPTEN, AAVshLuc, AAVshPTEN + fibrin, and AAVshLuc + fibrin). Forepaw function was assessed for 10 weeks after injury and CST axons were traced by injecting biotin-conjugated dextran amine into the sensorimotor cortex. Rats that received AAVshPTEN alone did not exhibit improved motor function, whereas rats that received AAVshPTEN and salmon fibrin had significantly higher forelimb-reaching scores. Tract tracing revealed that CST axons extended farther caudally in the group that received AAVshPTEN and salmon fibrin versus other groups. There were no significant differences in lesion size between the groups. Together, these data suggest that the combination of PTEN deletion and salmon fibrin injection into the lesion can significantly improve voluntary motor function after SCI by enabling regenerative growth of CST axons. PMID:25057197

  12. AAVshRNA-mediated suppression of PTEN in adult rats in combination with salmon fibrin administration enables regenerative growth of corticospinal axons and enhances recovery of voluntary motor function after cervical spinal cord injury.

    PubMed

    Lewandowski, Gail; Steward, Oswald

    2014-07-23

    Conditional genetic deletion of phosphatase and tensin homolog (PTEN) in the sensorimotor cortex of neonatal mice enables regeneration of corticospinal tract (CST) axons after spinal cord injury (SCI). The present study addresses three questions: (1) whether PTEN knockdown in adult rats by nongenetic techniques enables CST regeneration, (2) whether interventions to enable CST regeneration enhance recovery of voluntary motor function, and (3) whether delivery of salmon fibrin into the injury site further enhances CST regeneration and motor recovery. Adult rats were trained in a staircase-reaching task and then received either intracortical injections of AAVshPTEN to delete PTEN or a control vector expressing shRNA for luciferase (AAVshLuc). Rats then received cervical dorsal hemisection injuries and salmon fibrin was injected into the injury site in half the rats, yielding four groups (AAVshPTEN, AAVshLuc, AAVshPTEN + fibrin, and AAVshLuc + fibrin). Forepaw function was assessed for 10 weeks after injury and CST axons were traced by injecting biotin-conjugated dextran amine into the sensorimotor cortex. Rats that received AAVshPTEN alone did not exhibit improved motor function, whereas rats that received AAVshPTEN and salmon fibrin had significantly higher forelimb-reaching scores. Tract tracing revealed that CST axons extended farther caudally in the group that received AAVshPTEN and salmon fibrin versus other groups. There were no significant differences in lesion size between the groups. Together, these data suggest that the combination of PTEN deletion and salmon fibrin injection into the lesion can significantly improve voluntary motor function after SCI by enabling regenerative growth of CST axons.

  13. Spinal and limb abnormalities in adolescents with intellectual disabilities.

    PubMed

    Lin, Jin-Ding; Lin, Pei-Ying; Lin, Lan-Ping; Lai, Chia-Im; Leu, Yii-Rong; Yen, Chia-Feng; Hsu, Shang-Wei; Chu, Chi-Ming; Wu, Chia-Ling; Chu, Cordia M

    2010-01-01

    There are not many studies pertaining to the spinal or limb abnormalities in people with intellectual disabilities, without a clear profile of these deformities of them, efforts to understand its characters and improve their quality of life will be impossible. Therefore, this paper aims to describe the prevalence and related factors of spinal and limb abnormalities in adolescents with intellectual disabilities. The participants who participated in health examinations as they enrolled into special schools at the first year, a total of 822 aged 15-18 years adolescents with ID were recruited to this study. The results showed that there were 14.5% and 8.5% cases had spinal and limb abnormalities based on the physician's observation and X-ray test. Factors of BMI level and limb abnormalities were significantly predicted the spinal abnormality occurrence in those adolescents with ID. Gender, disability level and have a spinal abnormality were variables that can statistically correlate to limb abnormality condition. The study highlights that in order to ensure people with intellectual disabilities receive an appropriate quality of care, it is important to have a precise understanding of the ways in which the needs of them who have spinal or limb deformities differ from the sole intellectual disability and the general population as a whole.

  14. Intranasal nerve growth factor bypasses the blood-brain barrier and affects spinal cord neurons in spinal cord injury

    PubMed Central

    Aloe, Luigi; Bianchi, Patrizia; De Bellis, Alberto; Soligo, Marzia; Rocco, Maria Luisa

    2014-01-01

    The purpose of this work was to investigate whether, by intranasal administration, the nerve growth factor bypasses the blood-brain barrier and turns over the spinal cord neurons and if such therapeutic approach could be of value in the treatment of spinal cord injury. Adult Sprague-Dawley rats with intact and injured spinal cord received daily intranasal nerve growth factor administration in both nostrils for 1 day or for 3 consecutive weeks. We found an increased content of nerve growth factor and enhanced expression of nerve growth factor receptor in the spinal cord 24 hours after a single intranasal administration of nerve growth factor in healthy rats, while daily treatment for 3 weeks in a model of spinal cord injury improved the deficits in locomotor behaviour and increased spinal content of both nerve growth factor and nerve growth factor receptors. These outcomes suggest that the intranasal nerve growth factor bypasses blood-brain barrier and affects spinal cord neurons in spinal cord injury. They also suggest exploiting the possible therapeutic role of intranasally delivered nerve growth factor for the neuroprotection of damaged spinal nerve cells. PMID:25206755

  15. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities.

    PubMed

    Bakaloudis, Georgios; Lolli, Francesco; Di Silvestre, Mario; Greggi, Tiziana; Astolfi, Stefano; Martikos, Konstantinos; Vommaro, Francesco; Barbanti-Brodano, Giovanni; Cioni, Alfredo; Giacomini, Stefano

    2011-05-01

    The traditional surgical treatment of severe spinal deformities, both in adult and pediatric patients, consisted of a 360° approach. Posterior-based spinal osteotomy has recently been reported as a useful and safe technique in maximizing kyphosis and/or kyphoscoliosis correction. It obviates the deleterious effects of an anterior approach and can increase the magnitude of correction both in the coronal and sagittal plane. There are few reports in the literature focusing on the surgical treatment of severe spinal deformities in large pediatric-only series (age <16 years old) by means of a posterior-based spinal osteotomy, with no consistent results on the use of a single posterior-based thoracic pedicle subtraction osteotomy in the treatment of such challenging group of patients. The purpose of the present study was to review our operative experience with pediatric patients undergoing a single level PSO for the correction of thoracic kyphosis/kyphoscoliosis in the region of the spinal cord (T12 and cephalad), and determine the safety and efficacy of posterior thoracic pedicle subtraction osteotomy (PSO) in the treatment of severe pediatric deformities. A retrospective review was performed on 12 consecutive pediatric patients (6 F, 6 M) treated by means of a posterior thoracic PSO between 2002 and 2006 in a single Institution. Average age at surgery was 12.6 years (range, 9-16), whereas the deformity was due to a severe juvenile idiopathic scoliosis in seven cases (average preoperative main thoracic 113°; 90-135); an infantile idiopathic scoliosis in two cases (preoperative main thoracic of 95° and 105°, respectively); a post-laminectomy kypho-scoliosis of 95° (for a intra-medullar ependimoma); an angular kypho-scoliosis due to a spondylo-epiphisary dysplasia (already operated on four times); and a sharp congenital kypho-scoliosis (already operated on by means of a anterior-posterior in situ fusion). In all patients a pedicle screws instrumentation was used

  16. Astrocytoma with involvement of medulla oblongata, spinal cord and spinal nerves in a raccoon (Procyon lotor)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Neoplasms affecting the central and peripheral nervous systems of wild animals are extremely rare. Described are clinical signs, pathologic and immunohistochemical findings in an adult female raccoon (Procyon lotor) with an astrocytoma which involved brainstem, cervical spinal cord and roots of the ...

  17. The association of congenital spinal anomalies with imperforate anus.

    PubMed

    Denton, J R

    1982-01-01

    Ninety-four patients with congenital imperforate anus were studied to investigate: (1) the incidence of congenital spinal anomalies; (2) the orthopedic significance of these anomalies; (3) the incidence of other musculoskeletal disorders; and (4) the incidence of anomalies in other organ systems in the anal-spine anomaly group. There was a 38% incidence of spinal anomalies in 94 patients with congenital imperforate anus. Most of these abnormalities were sacral, and there were no related or progressive spinal deformities. The incidence of other musculoskeletal anomalies was much lower than of the spine (only 9% of the total). The triad of caudal regression-imperforate anus, spinal anomalies, and genitourinary tract anomalies-was present in 19 (53%) of the 36 cases, much more than any other combination of major system abnormalities such as the VATER of VACTEL syndromes.

  18. Spinal Muscular Atrophy (SMA)

    MedlinePlus

    ... Lessons? Visit KidsHealth in the Classroom What Other Parents Are Reading Your Child's Development (Birth to 3 Years) Feeding Your 1- to 3-Month-Old Feeding Your 4- to 7-Month-Old Feeding Your 8- to 12-Month-Old Feeding Your 1- to 2-Year-Old Spinal ... > For Parents > Spinal Muscular Atrophy (SMA) Print A A A ...

  19. What Is Spinal Stenosis?

    MedlinePlus

    ... and problems with joints. Rheumatoid arthritis:  Affects most people at a younger age than osteoarthritis.  Causes the soft tissues of the joints to swell and can affect the internal organs and systems.  Is not a common cause of spinal ... Conditions Some people are born with conditions that cause spinal stenosis. ...

  20. Spinal Myoclonus After Spinal Cord Injury

    PubMed Central

    Calancie, Blair

    2006-01-01

    Background/Objective: In the course of examining spinal motor function in many hundreds of people with traumatic spinal cord injury, we encountered 6 individuals who developed involuntary and rhythmic contractions in muscles of their legs. Although there are many reports of unusual muscle activation patterns associated with different forms of myoclonus, we believe that certain aspects of the patterns seen with these 6 subjects have not been previously reported. These patterns share many features with those associated with a spinal central pattern generator for walking. Methods: Subjects in this case series had a history of chronic injury to the cervical spinal cord, resulting in either complete (ASIA A; n = 4) or incomplete (ASIA D; n = 2) quadriplegia. We used multi-channel electromyography recordings of trunk and leg muscles of each subject to document muscle activation patterns associated with different postures and as influenced by a variety of sensory stimuli. Results: Involuntary contractions spanned multiple leg muscles bilaterally, sometimes including weak abdominal contractions. Contractions were smooth and graded and were highly reproducible in rate for a given subject (contraction rates were 0.3–0.5 Hz). These movements did not resemble the brief rapid contractions (ie, "jerks") ascribed to some forms of spinal myoclonus. For all subjects, the onset of involuntary muscle contraction was dependent upon hip angle; contractions did not occur unless the hips (and knees) were extended (ie, subjects were supine). In the 4 ASIA A subjects, contractions occurred simultaneously in all muscles (agonists and antagonists) bilaterally. In sharp contrast, contractions in the 2 ASIA D subjects were reciprocal between agonists and antagonists within a limb and alternated between limbs, such that movements in these 2 subjects looked just like repetitive stepping. Finally, each of the 6 subjects had a distinct pathology of their spinal cord, nerve roots, distal trunk

  1. Identification of Skeletal Deformities in Far Eastern Catfish, Silurus asotus under Indoor Aquaculture Condition

    PubMed Central

    Yang, Won Seok; Gil, Hyun Woo; Yoo, Gwang Yeol; Park, In-Seok

    2015-01-01

    For the 2 years of farming, at the indoor circulating aquaculture system, four kinds of skeletal deformities were found among 60 Far Eastern catfish, Silurus asotus. Deformities saw jawbone’s luxation, abnormality of upper lip and malocclusion. Spinal deformity was most fatal deformities with low weight and small length. Jawbone’s luxation had 1 maxilla and 2 mandibles. Abnormality of upper lip had just lip was back over. Malocclusion’s left maxilla and right maxilla were not balanced. This experiment was any deformities in this species through the deformity can grasp how it affects. PMID:27004272

  2. The Therapeutic Effectiveness of Delayed Fetal Spinal Cord Tissue Transplantation on Respiratory Function Following Mid-Cervical Spinal Cord Injury.

    PubMed

    Lin, Chia-Ching; Lai, Sih-Rong; Shao, Yu-Han; Chen, Chun-Lin; Lee, Kun-Ze

    2017-01-17

    Respiratory impairment due to damage of the spinal respiratory motoneurons and interruption of the descending drives from brainstem premotor neurons to spinal respiratory motoneurons is the leading cause of morbidity and mortality following cervical spinal cord injury. The present study was designed to evaluate the therapeutic effectiveness of delayed transplantation of fetal spinal cord (FSC) tissue on respiratory function in rats with mid-cervical spinal cord injury. Embryonic day-14 rat FSC tissue was transplanted into a C4 spinal cord hemilesion cavity in adult male rats at 1 week postinjury. The histological results showed that FSC-derived grafts can survive, fill the lesion cavity, and differentiate into neurons and astrocytes at 8 weeks post-transplantation. Some FSC-derived graft neurons exhibited specific neurochemical markers of neurotransmitter (e.g., serotonin, noradrenalin, or acetylcholine). Moreover, a robust expression of glutamatergic and γ-aminobutyric acid-ergic fibers was observed within FSC-derived grafts. Retrograde tracing results indicated that there was a connection between FSC-derived grafts and host phrenic nucleus. Neurophysiological recording of the phrenic nerve demonstrated that phrenic burst amplitude ipsilateral to the lesion was significantly greater in injured animals that received FSC transplantation than in those that received buffer transplantation under high respiratory drives. These results suggest that delayed FSC transplantation may have the potential to repair the injured spinal cord and promote respiratory functional recovery after mid-cervical spinal cord injury.

  3. Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection.

    PubMed

    Jain, Amit; Hassanzadeh, Hamid; Strike, Sophia A; Menga, Emmanuel N; Sponseller, Paul D; Kebaish, Khaled M

    2015-09-16

    Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially. Indications for spinopelvic fixation as a means to achieve lumbosacral arthrodesis include a long arthrodesis (five or more vertebral levels) or use of three-column osteotomies in the lower thoracic or lumbar spine, surgical treatment of high-grade spondylolisthesis, and correction of lumbar deformity and pelvic obliquity. A variety of techniques have been described over the years, including Galveston iliac rods, Jackson intrasacral rods, the Kostuik transiliac bar, iliac screws, and S2-alar-iliac screws. Modern iliac screws and S2-alar-iliac screws are associated with relatively low rates of pseudarthrosis. S2-alar-iliac screws have the advantages of less implant prominence and inline placement with proximal spinal anchors. Collectively, these techniques provide powerful methods for obtaining control of the pelvis in facilitating lumbosacral arthrodesis.

  4. Spinal cordectomy: A new hope for morbid spinal conditions.

    PubMed

    Konar, Subhas K; Maiti, Tanmoy K; Bir, Shyamal C; Nanda, Anil

    2017-01-01

    A spinal cordectomy is a treatment option for several disorders of the spinal cord like post-traumatic syringomyelia, spinal cord tumor and myelomeningocele. We have done a systematic analysis of all reported cases of spinal cordectomy to investigate the possible outcomes and complications. A PubMed search was performed for literature published from 1949 to 2015 with search words "spinal cordectomy", "spinal cord transection" and "cordectomy for malignant spinal cord tumors" to select articles containing information about the indication, outcome and complication of spinal cordectomy performed for diverse etiologies. Spinal cordectomy was performed for post-traumatic syrinx (76 cases), SPAM (2 cases), Central pain of spinal cord origin (22 cases), Spasticity (8 cases), Spinal tumors (16 cases) and Myelomeningocele (30 cases). Among the 76 cases, 60 cases fulfilled the inclusion criteria for our outcome analysis in terms of improvement, stabilization or deterioration after spinal cordectomy. The results showed 78.3% excellent improvement, 13.4% stable and 8.3% (5 cases) deterioration. The reported causes of failure of spinal cordectomy for post-traumatic syrinx were scarring of a proximal stump and severe arachnoid adhesion. Sixteen cases of spinal cordectomy related with spinal cord tumors have been reported. Also reported were seven cases of GBM, two cases of AA and one each case of anaplastic tanycytic ependymoma, schwanoma, neurofibroma, atypical meningioma and malignant ganglioglioma. Cordectomy shouldbe strongly considered in patients having malignant spinal cord tumors with complete motor loss and sensory loss below the level of the lesion as a means of preventing the spread of disease from the original tumor focus. Spinal cordectomy is a treatment option with a good outcome for post-traumatic spinal morbidity, spinal cord tumors and myelomeningocele. However, since it is an invasive and irreversible procedure, it is only considered when other options have

  5. Spinal epidural abscess.

    PubMed

    Johnson, Katherine G

    2013-09-01

    Spinal epidural abscess is a rare bacterial infection located within the spinal canal. Early diagnosis and rapid treatment are important because of its potential to cause rapidly progressive spinal cord compression and irreversible paralysis. A staphylococcus bacterial infection is the cause in most cases. Treatment includes antibiotics and possible surgical drainage of the abscess. A favorable neurologic outcome correlates with the severity and duration of neurologic deficits before surgery and the timeliness of the chosen intervention. It is important for the critical care nurse to monitor the patient's neurologic status and provide appropriate interventions.

  6. Bunionette deformity.

    PubMed

    Cohen, Bruce E; Nicholson, Christopher W

    2007-05-01

    The bunionette, or tailor's bunion, is a lateral prominence of the fifth metatarsal head. Most commonly, bunionettes are the result of a widened 4-5 intermetatarsal angle with associated varus of the metatarsophalangeal joint. When symptomatic, these deformities often respond to nonsurgical treatment methods, such as wider shoes and padding techniques. When these methods are unsuccessful, surgical treatment is based on preoperative radiographs and associated lesions, such as hyperkeratoses. In rare situations, a simple lateral eminence resection is appropriate; however, the risk of recurrence or overresection is high with this technique. Patients with a lateral bow to the fifth metatarsal are treated with a distal chevron-type osteotomy. A widened 4-5 intermetatarsal angle often requires a diaphyseal osteotomy for correction.

  7. Generation of electromotor neurons in Sternarchus albifrons: differences between normally growing and regenerating spinal cord.

    PubMed

    Waxman, S G; Anderson, M J

    1985-12-01

    This study examines the regulation of the number of electromotor neurons during postnatal growth of the spinal cord in the gymnotiform teleost Sternarchus albifrons. It specifically asks whether a large overproduction of electromotor neurons and a wave of cell death, similar to those occurring during spinal cord regeneration in this species, play a role in the on-going growth at the caudal tip of the normal spinal cord. Neurons are produced from ependymal precursors at the caudal end of the spinal cord during both normal growth in the adult and regeneration of the spinal cord in this species. Previous studies have demonstrated that during spinal cord regeneration after amputation of the tail in Sternarchus, there is an initial massive (up to fivefold) overproduction of electromotor neurons, followed by a wave of cell death which reduces the number of these neurons to the normal level. In the present study, transverse sections through the caudalmost spinal segment of normal adult Sternarchus were examined. Proceeding rostrally from the caudal tip of the cord, the number of electromotor neurons increases monotonically to reach the normal number at a site 4-5 mm rostral to the caudal tip. Neither a massive overproduction of electromotor neurons nor a wave of neuronal death are observed during on-going growth of the normal spinal cord. The mechanisms by which the neuronal number is modulated are therefore different in the on-going normal growth of spinal cord versus regeneration of spinal cord in this species.

  8. Role of DSCAM in the development of the spinal locomotor and sensorimotor circuits.

    PubMed

    Thiry, Louise; Lemieux, Maxime; D Laflamme, Olivier; Bretzner, Frédéric

    2016-03-01

    Locomotion is controlled by spinal circuits that generate rhythm and coordinate left-right and flexor-extensor motoneuronal activities. The outputs of motoneurons and spinal interneuronal circuits are shaped by sensory feedback, relaying peripheral signals that are critical to the locomotor and postural control. Several studies in invertebrates and vertebrates have argued that the Down syndrome cell adhesion molecule (DSCAM) would play an important role in the normal development of neural circuits through cell spacing and targeting, axonal and dendritic branching, and synapse establishment and maintenance. Although there is evidence that DSCAM is important for the normal development of neural circuits, little is known about its functional contribution to spinal motor circuits. We show here that adult DSCAM(2J) mutant mice, lacking DSCAM, exhibit a higher variability in their locomotor pattern and rhythm during treadmill locomotion. Retrograde tracing studies in neonatal isolated spinal cords show an increased number of spinal commissural interneurons, which likely contributes to reducing the left-right alternation and to increasing the flexor/swing duration during neonatal and adult locomotion. Moreover, our results argue that, by reducing the peripheral excitatory drive onto spinal motoneurons, the DSCAM mutation reduces or abolishes spinal reflexes in both neonatal isolated spinal cords and adult mice, thus likely impairing sensorimotor control. Collectively, our functional, electrophysiological, and anatomical studies suggest that the mammalian DSCAM protein is involved in the normal development of spinal locomotor and sensorimotor circuits.

  9. What Is Spinal Stenosis?

    MedlinePlus

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

  10. Spinal cord trauma

    MedlinePlus

    ... Oh's Intensive Care Manual . 7th ed. Philadelphia, PA: Elsevier; 2014:chap 78. Bryce TN. Spinal cord injury. ... Physical Medicine and Rehabilitation . 5th ed. Philadelphia, PA: Elsevier; 2016:chap 49. Dalzell K, Nouri A, Fehlings ...

  11. Spinal Cord Injury 101

    MedlinePlus Videos and Cool Tools

    ... is "Braingate" research? What is the status of stem-cell research? How would stem-cell therapies work in the treatment of spinal cord injuries? What does stem-cell research on animals tell us? When can we ...

  12. [Meningitis after spinal anesthesia].

    PubMed

    Mouchrif, Issam; Berdaii, Adnane; Labib, Ismail; Harrandou, Moustapha

    2016-01-01

    Meningitis is a rare but serious complication of epidural and spinal anesthesia. Bacterial meningitis is mainly caused by Gram-positive cocci, implying an exogenous contamination which suggests a lack of asepsis. The evolution is usually favorable after treatment, but at the expense of increased health care costs and, sometimes, of significant neurological sequelae. We report a case of bacterial meningitis after spinal anesthesia for caesarean section.

  13. Influence of Fatigue in Neuromuscular Control of Spinal Stability

    PubMed Central

    Granata, Kevin P.; Slota, Greg P.; Wilson, Sara E.

    2006-01-01

    Lifting-induced fatigue may influence neuromuscular control of spinal stability. Stability is primarily controlled by muscle recruitment, active muscle stiffness, and reflex response. Fatigue has been observed to affect each of these neuromuscular parameters and may therefore affect spinal stability. A biomechanical model of spinal stability was implemented to evaluate the effects of fatigue on spinal stability. The model included a 6-degree-of-freedom representation of the spine controlled by 12 deformable muscles from which muscle recruitment was determined to simultaneously achieve equilibrium and stability. Fatigue-induced reduction in active muscle stiffness necessitated increased antagonistic cocontraction to maintain stability resulting in increased spinal compression with fatigue. Fatigueinduced reduction in force-generating capacity limited the feasible set of muscle recruitment patterns, thereby restricting the estimated stability of the spine. Electromyographic and trunk kinematics from 21 healthy participants were recorded during sudden-load trials in fatigued and unfatigued states. Empirical data supported the model predictions, demonstrating increased antagonistic cocontraction during fatigued exertions. Results suggest that biomechanical factors including spinal load and stability should be considered when performing ergonomic assessments of fatiguing lifting tasks. Potential applications of this research include a biomechanical tool for the design of administrative ergonomic controls in manual materials handling industries. PMID:15151156

  14. Modeling spinal cord biomechanics

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

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

  15. Canine spinal cord glioma.

    PubMed

    Rissi, Daniel R; Barber, Renee; Burnum, Annabelle; Miller, Andrew D

    2017-01-01

    Spinal cord glioma is uncommonly reported in dogs. We describe the clinicopathologic and diagnostic features of 7 cases of canine spinal cord glioma and briefly review the veterinary literature on this topic. The median age at presentation was 7.2 y. Six females and 1 male were affected and 4 dogs were brachycephalic. The clinical course lasted from 3 d to 12 wk, and clinical signs were progressive and associated with multiple suspected neuroanatomic locations in the spinal cord. Magnetic resonance imaging of 6 cases revealed T2-weighted hyperintense lesions with variable contrast enhancement in the spinal cord. All dogs had a presumptive clinical diagnosis of intraparenchymal neoplasia or myelitis based on history, advanced imaging, and cerebrospinal fluid analysis. Euthanasia was elected in all cases because of poor outcome despite anti-inflammatory or immunosuppressive treatment or because of poor prognosis at the time of diagnosis. Tumor location during autopsy ranged from C1 to L6, with no clear predilection for a specific spinal cord segment. The diagnosis was based on histopathology and the immunohistochemistry expression of glial fibrillary acidic protein, oligodendrocyte lineage transcription factor 2, 2',3'-cyclic-nucleotide 3'-phosphodiesterase, neuron-specific enolase, synaptophysin, and Ki-67. Diagnoses consisted of 4 cases of oligodendroglioma, 2 cases of gliomatosis cerebri, and 1 astrocytoma. This case series further defines the clinicopathologic features of canine spinal glioma and highlights the need for comprehensive immunohistochemistry in addition to routine histopathology to confirm the diagnosis of these tumors.

  16. 1989 Volvo Award in basic science. Device-related osteoporosis with spinal instrumentation.

    PubMed

    McAfee, P C; Farey, I D; Sutterlin, C E; Gurr, K R; Warden, K E; Cunningham, B W

    1989-09-01

    An animal model of anterior and posterior column instability was developed to allow in vivo observation of bone remodeling and arthrodesis after spinal instrumentation. After an initial anterior and posterior destabilizing lesion was created at the L5-L6 vertebral levels in 42 adult beagles, various spinal reconstructive surgical procedures were performed--with or without bilateral posterolateral bone grafting, and with or without spinal instrumentation (Harrington distraction; Luque rectangular, or Cotrel-Dubousset transpedicular methods). After 6 months' postoperative observation, there was a significantly improved probability of achieving a spinal fusion if spinal instrumentation had been used (P = 0.058). Nondestructive mechanical testing after removal of all metal instrumentation in torsion, axial compression, and flexion revealed that the fusions performed in conjunction with spinal instrumentation were more rigid (P less than 0.05). Quantitative histomorphometry showed that the volumetric density of bone was significantly lower (ie, device-related osteoporosis occurred) for fused versus unfused spines; and Harrington- and Cotrel-Dubousset-instrumented dogs became more osteoporotic than the other three groups. The rigidity of spinal instrumentation led to device-related osteoporosis (stress shielding) of the vertebra. However, as the rigidity of spinal instrumentation increased, there was an increased probability of achieving a successful spinal fusion. The improved mechanical properties of spinal instrumentation on spinal arthrodesis more than compensate for the occurrence of device-related osteoporosis in the spine.

  17. Sexual and Reproductive Function in Spinal Cord Injury and Spinal Surgery Patients

    PubMed Central

    Albright, Theodore H.; Grabel, Zachary; DePasse, J. Mason; Palumbo, Mark A.

    2015-01-01

    Sexual and reproductive health is important quality of life outcomes, which can have a major impact on patient satisfaction. Spinal pathology arising from trauma, deformity, and degenerative disease processes may be detrimental to sexual and reproductive function. Furthermore, spine surgery may impact sexual and reproductive function due to post-surgical mechanical, neurologic, and psychological factors. The aim of this paper is to provide a concise evidence-based review on the impact that spine surgery and pathology can have on sexual and reproductive function. A review of published literature regarding sexual and reproductive function in spinal injury and spinal surgery patients was performed. We have found that sexual and reproductive dysfunction can occur due to numerous etiological factors associated with spinal pathology. Numerous treatment options are available for those patients, depending on the degree of dysfunction. Spine surgeons and non-operative healthcare providers should be aware of the issues surrounding sexual and reproductive function as related to spine pathology and spine surgery. It is important for spine surgeons to educate their patients on the operative risks that spine surgery encompasses with regard to sexual dysfunction, although current data examining these topics largely consists of level IV data. PMID:26605025

  18. Tapping into spinal circuits to restore motor function.

    PubMed

    Barbeau, H; McCrea, D A; O'Donovan, M J; Rossignol, S; Grill, W M; Lemay, M A

    1999-07-01

    Motivated by the challenge of improving neuroprosthetic devices, the authors review current knowledge relating to harnessing the potential of spinal neural circuits, such as reflexes and pattern generators. If such spinal interneuronal circuits could be activated, they could provide the coordinated control of many muscles that is so complex to implement with a device that aims to address each participating muscle individually. The authors' goal is to identify candidate spinal circuits and areas of research that might open opportunities to effect control of human limbs through electrical activation of such circuits. David McCrea's discussion of the ways in which hindlimb reflexes in the cat modify motor activity may help in developing optimal strategies for functional neuromuscular stimulation (FNS), by using knowledge of how reflex actions can adapt to different conditions. Michael O'Donovan's discussion of the development of rhythmogenic networks in the chick embryo may provide clues to methods of generating rhythmic activity in the adult spinal cord. Serge Rossignol examines the spinal pattern generator for locomotion in cats, its trigger mechanisms, modulation and adaptation, and suggests how this knowledge can help guide therapeutic approaches in humans. Hugues Barbeau applies the work of Rossignol and others to locomotor training in human subjects who have suffered spinal cord injury (SCI) with incomplete motor function loss (IMFL). Michel Lemay and Warren Grill discuss some of the technical challenges that must be addressed by engineers to implement a neuroprosthesis using electrical stimulation of the spinal cord, particularly the control issues that would have to be resolved.

  19. Molecular and cellular development of spinal cord locomotor circuitry

    PubMed Central

    Lu, Daniel C.; Niu, Tianyi; Alaynick, William A.

    2015-01-01

    The spinal cord of vertebrate animals is comprised of intrinsic circuits that are capable of sensing the environment and generating complex motor behaviors. There are two major perspectives for understanding the biology of this complicated structure. The first approaches the spinal cord from the point of view of function and is based on classic and ongoing research in electrophysiology, adult behavior, and spinal cord injury. The second view considers the spinal cord from a developmental perspective and is founded mostly on gene expression and gain-of-function and loss-of-function genetic experiments. Together these studies have uncovered functional classes of neurons and their lineage relationships. In this review, we summarize our knowledge of developmental classes, with an eye toward understanding the functional roles of each group. PMID:26136656

  20. Spinal epidural abscess in a young girl without risk factors.

    PubMed

    Mantadakis, Elpis; Birbilis, Theodosios; Michailidis, Lambros; Souftas, Vasileios; Chatzimichael, Athanassios

    2011-07-01

    Spinal epidural abscess (SEA) is a rare infection associated with well-established risk factors mainly in adults. We describe an 11-year-old girl without any known risk factors who presented with fever and localized spinal tenderness in the lumbar area and was diagnosed with spinal MRI as suffering from a posterior SEA extending between T11 and L4. She was successfully managed with sequential intravenous and oral antibiotics along with minimally invasive surgery without laminectomy. Methicillin-sensitive Staphylococcus aureus was the responsible pathogen isolated at surgery. Immediate institution of antibiotics, spinal MRI, and well-timed neurosurgical consultation are mandatory for a favorable outcome in cases of SEA in children.

  1. The treatment for multilevel noncontiguous spinal fractures

    PubMed Central

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

    2006-01-01

    We report the outcome of 30 patients with multilevel noncontiguous spinal fractures treated between 2000 and 2005. Ten cases were treated conservatively (group A), eight cases were operated on at only one level (group B), and 12 cases were treated surgically at both levels (group C). All cases were followed up for 14–60 months (mean 32 months). Initial mobilisation with a wheelchair or crutches in group A was 9.2±1.1 weeks, which was significantly longer than groups B and C with 6.8±0.7 weeks and 3.1±0.4 weeks, respectively. Operative time and blood loss in group C were significantly more than group B. The neurological deficit improved in six cases in group A (60%), six in group B (75%) and eight in group C (80%). Correction of kyphotic deformity was significantly superior in groups C and B at the operated level, and increasing deformity occurred in groups A and B at the non-operated level. From the results we believe that three treatment strategies were suitable for multilevel noncontiguous spinal fractures, and individualised treatment should be used in these patients. In the patients treated surgically, the clinical and radiographic outcomes are much better. PMID:17043863

  2. Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only.

    PubMed

    Tang, Ming-xing; Zhang, Hong-qi; Wang, Yu-xiang; Guo, Chao-feng; Liu, Jin-yang

    2016-02-01

    Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting

  3. Epidural Injections for Spinal Pain

    MedlinePlus

    ... back or leg pain after spinal surgery) Other injuries to spinal nerves, vertebrae and surrounding tissues Bone ... Bleeding if a blood vessel is inadvertently damaged. Injury to the nerves at the injection site. Temporary ...

  4. Living with Spinal Cord Injury

    MedlinePlus

    ... to send and receive messages to and from the brain. About 200,000 people in the United States have spinal cord injuries. Most injuries occur from a traumatic event, according to the National Spinal Cord Injury ...

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

    PubMed

    Frigon, Alain; Johnson, Michael D; Heckman, C J

    2011-10-01

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

  6. Transformation of nonfunctional spinal circuits into functional states after the loss of brain input

    PubMed Central

    Courtine, Grégoire; Gerasimenko, Yury; van den Brand, Rubia; Yew, Aileen; Musienko, Pavel; Zhong, Hui; Song, Bingbing; Ao, Yan; Ichiyama, Ronaldo M; Lavrov, Igor; Roy, Roland R; Sofroniew, Michael V; Edgerton, V Reggie

    2010-01-01

    After complete spinal cord transections that removed all supraspinal inputs in adult rats, combinations of serotonergic agonists and epidural electrical stimulation were able to acutely transform spinal networks from nonfunctional to highly functional and adaptive states as early as 1 week after injury. Using kinematics, physiological and anatomical analyses, we found that these interventions could recruit specific populations of spinal circuits, refine their control via sensory input and functionally remodel these locomotor pathways when combined with training. The emergence of these new functional states enabled full weight-bearing treadmill locomotion in paralyzed rats that was almost indistinguishable from voluntary stepping. We propose that, in the absence of supraspinal input, spinal locomotion can emerge from a combination of central pattern-generating capability and the ability of these spinal circuits to use sensory afferent input to control stepping. These findings provide a strategy by which individuals with spinal cord injuries could regain substantial levels of motor control. PMID:19767747

  7. Transformation of nonfunctional spinal circuits into functional states after the loss of brain input.

    PubMed

    Courtine, Grégoire; Gerasimenko, Yury; van den Brand, Rubia; Yew, Aileen; Musienko, Pavel; Zhong, Hui; Song, Bingbing; Ao, Yan; Ichiyama, Ronaldo M; Lavrov, Igor; Roy, Roland R; Sofroniew, Michael V; Edgerton, V Reggie

    2009-10-01

    After complete spinal cord transections that removed all supraspinal inputs in adult rats, combinations of serotonergic agonists and epidural electrical stimulation were able to acutely transform spinal networks from nonfunctional to highly functional and adaptive states as early as 1 week after injury. Using kinematics, physiological and anatomical analyses, we found that these interventions could recruit specific populations of spinal circuits, refine their control via sensory input and functionally remodel these locomotor pathways when combined with training. The emergence of these new functional states enabled full weight-bearing treadmill locomotion in paralyzed rats that was almost indistinguishable from voluntary stepping. We propose that, in the absence of supraspinal input, spinal locomotion can emerge from a combination of central pattern-generating capability and the ability of these spinal circuits to use sensory afferent input to control stepping. These findings provide a strategy by which individuals with spinal cord injuries could regain substantial levels of motor control.

  8. Lumbar spinal stenosis.

    PubMed Central

    Ciricillo, S F; Weinstein, P R

    1993-01-01

    Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful initially, surgical decompression by wide laminectomy or an intralaminar approach should be done in patients with serious or progressive pain or neurologic dysfunction. Because the early diagnosis and treatment of lumbar spinal stenosis may prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment, all physicians should be aware of the different neurologic presentations and the treatment options for patients with spinal stenosis. Images PMID:8434469

  9. Effects of diet and/or exercise in enhancing spinal cord sensorimotor learning.

    PubMed

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

    2012-01-01

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

  10. Activity of platelet hemostasis in children with spinal deformities.

    PubMed

    Medvedev, I N; Lapshina, E V; Zavalishina, S Yu

    2010-10-01

    An increase of adhesion and aggregation functions of platelets in vivo and in vitro was detected in 5-6-year-old children with scoliosis. These disorders were caused by hyperproduction of von Willebrand's factor in the vascular wall and intensification of thromboxane production in blood platelets. Activation of thromboxane formation is the main cause of platelet hyperactivity in children with scoliosis. Correction of platelet hemostasis may include pathogenetically substantiated complex of therapeutic exercises, swimming, and massage.

  11. Development of catecholaminergic systems in the spinal cord of the dogfish Scyliorhinus canicula (Elasmobranchs).

    PubMed

    Sueiro, Catalina; Carrera, Iván; Rodríguez-Moldes, Isabel; Molist, Pilar; Anadón, Ramón

    2003-05-14

    The development of catecholamine-synthesizing cells and fibers in the spinal cord of dogfish (Scyliorhinus canicula L.) was studied by means of immunohistochemistry using antibodies against tyrosine hydroxylase (TH). The only TH-immunoreactive (TH-ir) cells already present in the spinal cord of stage 26 embryos were of cerebrospinal fluid-contacting (CSF-c) type. These cells were the first catecholaminergic neurons of the dogfish CNS. The number of these TH-ir cells increased very considerably in later embryos and adult dogfish. In later embryos (stage 33; prehatching), faintly TH-ir non-CSF-contacting neurons were observed in the ventral horn throughout most of the spinal cord. In adult dogfish, some non-CSF-contacting TH-ir cells were observed ventral or lateral to the central canal. In the rostral spinal cord, the catecholaminergic neurons observed in dorsal regions were continuous with caudal rhombencephalic populations. Numerous TH-ir fibers were observed in the spinal cord of later embryos and in adults, both intrinsic and descending from the brain, innervating many regions of the cord including the dorsal and ventral horns. In addition, some TH-ir fibers innervated the marginal nucleus of the spinal cord. The early appearance of catecholaminergic cells and fibers in the embryonic spinal cord of the dogfish, and the large number of these elements observed in adults, suggests an important role for catecholamines through development and adulthood in sensory and motor functions.

  12. Idiopathic normal pressure hydrocephalus: theoretical concept of a spinal etiology.

    PubMed

    Hamlat, Abderrahmane; Abderrahmane, Hamlat; Sid-Ahmed, Seddik; Seddik, Sid-Ahmed; Adn, Mahmoudreza; Mahmoudreza, Adn; Askar, Brahim; Brahim, Askar; Pasqualini, Edouardo; Edouardo, Pasqualini

    2006-01-01

    Normal pressure hydrocephalus (NPH) is an adult syndrome characterised by a combination of gait disturbance, varying degrees of cognitive decline, urinary incontinence, ventricular enlargement and normal mean intracranial pressure. Since this syndrome was first described, its pathophysiology has been a matter of great debate, although it is now considered that NPH could be divided into two groups: cases with unknown etiology (idiopathic normal pressure hydrocephalus, or INPH) and those which develop from several known causes (such as trauma, meningitis or subarachnoid haemorrhage). The pathophysiology of INPH is still unclear and a matter of debate. In this manuscript, the current pathophysiological conditions of INPH are analysed and the authors put forward the theory that the disease is a dynamic syndrome which occurs in patients who have suffered a significant loss of spinal compliance over time. Consequently, intracranial pressure increases more during systole in INPH patients because it cannot be compensated for by the escape of CSF into the spinal canal as effectively, due to the reduced volume or lack of distension of the spinal canal. This leads to an increase in ventricular size and causes cumulative brain damage over a long period of time and accounts for the slow, progressive nature of NPH. The loss of spinal compliance with age is fundamental to the proposed theory which provides a theoretical justification for studying the spinal canal in INPH and investigating the relationship between the progressive narrowing of the spinal canal and the compensating ability of the craniospinal system.

  13. Spinal epidural abscess.

    PubMed

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

    2001-01-01

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

  14. A Review of Complications and Outcomes following Vertebral Column Resection in Adults.

    PubMed

    Iyer, Sravisht; Nemani, Venu M; Kim, Han Jo

    2016-06-01

    The correction of rigid spinal deformities in adult patients can require a three-column osteotomy (pedicle subtraction osteotomy [PSO] or vertebral column resection [VCR]) to obtain spinal balance. Unfortunately, the existing adult deformity literature frequently reports the outcomes and complications of these procedures together even though VCR is a more extensive procedure with potentially higher rates of complications. We sought to address this shortcoming and provide clinicians with an overview of the existing literature regarding VCR in adult patients. The goals of this review are: to determine the rate of overall and neurologic complications following VCR, the rate of complications with VCR compared to PSO, and the impact of VCR on clinical and radiographic outcomes. An electronic literature search was used to identify studies reporting outcomes or complications following VCR in adult patients. Raw data on patient demographics, case information, radiographic outcomes, complications and clinical outcomes were extracted. Data were pooled to report a rate of overall complications and neurologic complications. A pooled relative risk of complications following PSO vs. VCR was also calculated. Eleven retrospective studies (Level IV) met our inclusion criteria. The overall rate of complications was 69.2%. The reoperation rate was 9.6%. The rate of neurologic complications was 13.3% (range, 6.3% to 15.8%) with most cases being transient. The rate of permanent neurologic deficits was 2.0%. We found a significantly higher rate of all complications with VCR compared to PSO (relative risk, 1.36; 95% confidence interval, 1.24-1.49; p<0.001). All studies reporting clinical outcomes showed significant improvements in functional outcome postoperatively.

  15. A Review of Complications and Outcomes following Vertebral Column Resection in Adults

    PubMed Central

    Iyer, Sravisht; Nemani, Venu M.

    2016-01-01

    The correction of rigid spinal deformities in adult patients can require a three-column osteotomy (pedicle subtraction osteotomy [PSO] or vertebral column resection [VCR]) to obtain spinal balance. Unfortunately, the existing adult deformity literature frequently reports the outcomes and complications of these procedures together even though VCR is a more extensive procedure with potentially higher rates of complications. We sought to address this shortcoming and provide clinicians with an overview of the existing literature regarding VCR in adult patients. The goals of this review are: to determine the rate of overall and neurologic complications following VCR, the rate of complications with VCR compared to PSO, and the impact of VCR on clinical and radiographic outcomes. An electronic literature search was used to identify studies reporting outcomes or complications following VCR in adult patients. Raw data on patient demographics, case information, radiographic outcomes, complications and clinical outcomes were extracted. Data were pooled to report a rate of overall complications and neurologic complications. A pooled relative risk of complications following PSO vs. VCR was also calculated. Eleven retrospective studies (Level IV) met our inclusion criteria. The overall rate of complications was 69.2%. The reoperation rate was 9.6%. The rate of neurologic complications was 13.3% (range, 6.3% to 15.8%) with most cases being transient. The rate of permanent neurologic deficits was 2.0%. We found a significantly higher rate of all complications with VCR compared to PSO (relative risk, 1.36; 95% confidence interval, 1.24–1.49; p<0.001). All studies reporting clinical outcomes showed significant improvements in functional outcome postoperatively. PMID:27340543

  16. Posterior spinal cord infarction due to fibrocartilaginous embolization in a 16-year-old athlete.

    PubMed

    Bansal, Seema; Brown, Wendy; Dayal, Anuradha; Carpenter, Jessica L

    2014-07-01

    Spinal cord infarction is extremely rare in children, and, similar to cerebrovascular infarcts, the pathogenesis is different from adults. Spinal cord infarcts are most commonly reported in adults in the context of aortic surgery; in children, the etiology is frequently unknown. Fibrocartilaginous embolization is a potential cause of spinal cord infarct in both populations. It is a process that occurs when spinal injury has resulted in disc disease, and subsequently disc fragments embolize to the cord, resulting in ischemia and/or infarction. In this report, we present a 16-year-old athlete who presented with symptoms of acute myelopathy after a period of intense exercise. Our original concern was for an inflammatory process of the spinal cord; however, given her history of competitive tumbling and degenerative disc changes on her initial spine magnetic resonance imaging scan, diffusion-weighted imaging was performed, which demonstrated acute spinal cord infarction. Unlike many cases of spinal cord infarction, our patient was fortunate to make a near-complete recovery. This case highlights the importance of recognizing rare causes of spinal cord pathology and considering infarction in the differential diagnosis of acute myelopathy because management and prognosis varies.

  17. Early radiation-induced endothelial cell loss and blood-spinal cord barrier breakdown in the rat spinal cord.

    PubMed

    Li, Yu-Qing; Chen, Paul; Jain, Vipan; Reilly, Raymond M; Wong, C Shun

    2004-02-01

    Using a rat spinal cord model, this study was designed to characterize radiation-induced vascular endothelial cell loss and its relationship to early blood-brain barrier disruption in the central nervous system. Adult rats were given a single dose of 0, 2, 8, 19.5, 22, 30 or 50 Gy to the cervical spinal cord. At various times up to 2 weeks after irradiation, the spinal cord was processed for histological and immunohistochemical analysis. Radiation-induced apoptosis was assessed by morphology and TdT-mediated dUTP nick end labeling combined with immunohistochemical markers for endothelial and glial cells. Image analysis was performed to determine endothelial cell and microvessel density using immunohistochemistry with endothelial markers, namely endothelial barrier antigen, glucose transporter isoform 1, laminin and zonula occludens 1. Blood-spinal cord barrier permeability was assessed using immunohistochemistry for albumin and (99m)Tc-diethylenetriamine pentaacetic acid as a vascular tracer. Endothelial cell proliferation was assessed using in vivo BrdU labeling. During the first 24 h after irradiation, apoptotic endothelial cells were observed in the rat spinal cord. The decrease in endothelial cell density at 24 h after irradiation was associated with an increase in albumin immunostaining around microvessels. The decrease in the number of endothelial cells persisted for 7 days and recovery of endothelial density was apparent by day 14. A similar pattern of blood-spinal cord barrier disruption and recovery of permeability was observed over the 2 weeks, and an increase in BrdU-labeled endothelial cells was seen at day 3. These results are consistent with an association between endothelial cell death and acute blood-spinal cord barrier disruption in the rat spinal cord after irradiation.

  18. Thoracic rat spinal cord contusion injury induces remote spinal gliogenesis but not neurogenesis or gliogenesis in the brain.

    PubMed

    Franz, Steffen; Ciatipis, Mareva; Pfeifer, Kathrin; Kierdorf, Birthe; Sandner, Beatrice; Bogdahn, Ulrich; Blesch, Armin; Winner, Beate; Weidner, Norbert

    2014-01-01

    After spinal cord injury, transected axons fail to regenerate, yet significant, spontaneous functional improvement can be observed over time. Distinct central nervous system regions retain the capacity to generate new neurons and glia from an endogenous pool of progenitor cells and to compensate neural cell loss following certain lesions. The aim of the present study was to investigate whether endogenous cell replacement (neurogenesis or gliogenesis) in the brain (subventricular zone, SVZ; corpus callosum, CC; hippocampus, HC; and motor cortex, MC) or cervical spinal cord might represent a structural correlate for spontaneous locomotor recovery after a thoracic spinal cord injury. Adult Fischer 344 rats received severe contusion injuries (200 kDyn) of the mid-thoracic spinal cord using an Infinite Horizon Impactor. Uninjured rats served as controls. From 4 to 14 days post-injury, both groups received injections of bromodeoxyuridine (BrdU) to label dividing cells. Over the course of six weeks post-injury, spontaneous recovery of locomotor function occurred. Survival of newly generated cells was unaltered in the SVZ, HC, CC, and the MC. Neurogenesis, as determined by identification and quantification of doublecortin immunoreactive neuroblasts or BrdU/neuronal nuclear antigen double positive newly generated neurons, was not present in non-neurogenic regions (MC, CC, and cervical spinal cord) and unaltered in neurogenic regions (dentate gyrus and SVZ) of the brain. The lack of neuronal replacement in the brain and spinal cord after spinal cord injury precludes any relevance for spontaneous recovery of locomotor function. Gliogenesis was increased in the cervical spinal cord remote from the injury site, however, is unlikely to contribute to functional improvement.

  19. Thoracic Rat Spinal Cord Contusion Injury Induces Remote Spinal Gliogenesis but Not Neurogenesis or Gliogenesis in the Brain

    PubMed Central

    Pfeifer, Kathrin; Kierdorf, Birthe; Sandner, Beatrice; Bogdahn, Ulrich; Blesch, Armin; Winner, Beate; Weidner, Norbert

    2014-01-01

    After spinal cord injury, transected axons fail to regenerate, yet significant, spontaneous functional improvement can be observed over time. Distinct central nervous system regions retain the capacity to generate new neurons and glia from an endogenous pool of progenitor cells and to compensate neural cell loss following certain lesions. The aim of the present study was to investigate whether endogenous cell replacement (neurogenesis or gliogenesis) in the brain (subventricular zone, SVZ; corpus callosum, CC; hippocampus, HC; and motor cortex, MC) or cervical spinal cord might represent a structural correlate for spontaneous locomotor recovery after a thoracic spinal cord injury. Adult Fischer 344 rats received severe contusion injuries (200 kDyn) of the mid-thoracic spinal cord using an Infinite Horizon Impactor. Uninjured rats served as controls. From 4 to 14 days post-injury, both groups received injections of bromodeoxyuridine (BrdU) to label dividing cells. Over the course of six weeks post-injury, spontaneous recovery of locomotor function occurred. Survival of newly generated cells was unaltered in the SVZ, HC, CC, and the MC. Neurogenesis, as determined by identification and quantification of doublecortin immunoreactive neuroblasts or BrdU/neuronal nuclear antigen double positive newly generated neurons, was not present in non-neurogenic regions (MC, CC, and cervical spinal cord) and unaltered in neurogenic regions (dentate gyrus and SVZ) of the brain. The lack of neuronal replacement in the brain and spinal cord after spinal cord injury precludes any relevance for spontaneous recovery of locomotor function. Gliogenesis was increased in the cervical spinal cord remote from the injury site, however, is unlikely to contribute to functional improvement. PMID:25050623

  20. Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia

    PubMed Central

    Argyrakis, Nikolaos; Matis, Georgios K.; Mpata-Tshibemba, Stephanie

    2014-01-01

    A case of an iatrogenic spinal arteriovenous fistula with progressive paraplegia in a young woman is reported. The fistula was eventually created after repetitive lumbar punctures performed in the process of spinal anaesthesia. Her symptoms were progressed to paraplegia over a period of 2 years. The digital subtraction angiography demonstrated a single-hole fistula, involving the anterior spinal artery and vein. The lesion was occluded by embolization with immediate improvement. The potential mechanism is discussed. PMID:24653807

  1. Carbohydrate and lipid disorders and relevant considerations in persons with spinal cord injury.

    PubMed Central

    Wilt, Timothy J; Carlson, Kathleen F; Goldish, Gary D; MacDonald, Roderick; Niewoehner, Catherine; Rutks, Indulis; Shamliyan, Tatyana; Tacklind, James; Taylor, Brent C; Kane, Robert L

    2008-01-01

    OBJECTIVES To assess the prevalence of carbohydrate and lipid disorders in adults with chronic spinal cord injury and evaluate their risk contribution to cardiovascular diseases and the potential impact of exercise and pharmacologic and dietary therapies to alter these disorders and reduce cardiovascular disease risk. DATA SOURCES MEDLINE (PubMed), Cochrane Database and Web sites of the American Spinal Injury Association, American Paraplegia Society, Paralyzed Veterans of America, Consortium of Spinal Cord Medicine, and WorldCat through August 2007. REVIEW METHODS English language observational studies addressing prevalence of carbohydrate and lipid disorders were included if they evaluated at least 100 adults with chronic spinal cord injury or a total of 100 subjects if using a control group. Epidemiologic investigations of more than 50 adults with spinal cord injury that were published in English after 1990 and reported cardiovascular morbidity and mortality were abstracted. Intervention studies from 1996-2007 were included regardless of design or size if they assessed exercise, diet, or pharmacologic therapies and reported carbohydrate, lipid, or cardiovascular outcomes. RESULTS The quality of evidence regarding the prevalence, impact, and outcomes of carbohydrate and lipid disorders in adults with chronic spinal cord injuries is weak. Evidence is limited by relatively few studies, small sample size, lack of appropriate control groups, failure to adjust for known confounding variables, and variation in reported outcomes. However, the existing evidence does not indicate that adults with spinal cord injuries are at markedly greater risk for carbohydrate and lipid disorders or subsequent cardiovascular morbidity and mortality than able-bodied adults. Body mass index is not reliable for assessing body composition, especially percent body fat, in adults with spinal cord injury. There are no high quality studies evaluating the impact of exercise, diet, or

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

    PubMed

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

    2016-01-01

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

  3. Spinal epidural abscess.

    PubMed

    Krishnamohan, Prashanth; Berger, Joseph R

    2014-11-01

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

  4. Deformations in VLBI antennas

    NASA Technical Reports Server (NTRS)

    Clark, T. A.; Thomsen, P.

    1988-01-01

    A study is presented of deformations in antennas with the emphasis on their influence on VLBI measurements. The GIFTS structural analysis program has been used to model the VLBI antenna in Fairbanks (Alaska). The report identifies key deformations and studies the effect of gravity, wind, and temperature. Estimates of expected deformations are given.

  5. Aspergillus spinal epidural abscess

    SciTech Connect

    Byrd, B.F. III; Weiner, M.H.; McGee, Z.A.

    1982-12-17

    A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.

  6. Spontaneous spinal epidural abscess.

    PubMed

    Ellanti, P; Morris, S

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

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

    PubMed Central

    2014-01-01

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

  8. The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes.

    PubMed

    Blizzard, Daniel J; Nickel, Brian T; Seyler, Thorsten M; Bolognesi, Michael P

    2016-01-01

    Concurrent spine and hip disease is common. Spinal deformities can restrict lumbar range of motion and lumbar lordosis, leading to pelvic obliquity and increased pelvic tilt. A comprehensive preoperative workup and component templating ensure appropriate compensation for altered pelvic parameters for implantation of components according to functional positioning. Pelvic obliquity from scoliosis must be measured to calculate appropriate leg length. Cup positioning should be templated on standing radiograph to limit impingement from cup malposition. In spinal deformity, the optimal position of the cup that accommodates pelvic parameters and limits impingement may lie outside the classic parameters of the safe zone.

  9. Sagittal plane deformity: an overview of interpretation and management.

    PubMed

    Roussouly, Pierre; Nnadi, Colin

    2010-11-01

    The impact of sagittal plane alignment on the treatment of spinal disorders is of critical importance. A failure to recognise malalignment in this plane can have significant consequences for the patient not only in terms of pain and deformity, but also social interaction due to deficient forward gaze. A good understanding of the principles of sagittal balance is vital to achieve optimum outcomes when treating spinal disorders. Even when addressing problems in the coronal plane, an awareness of sagittal balance is necessary to avoid future complications. The normal spine has lordotic curves in the cephalad and caudal regions with a kyphotic curve in between. Overall, there is a positive correlation between thoracic kyphosis and lumbar lordosis. There are variations on the degree of normal curvature but nevertheless this shape allows equal distribution of forces across the spinal column. It is the disruption of this equilibrium by pathological processes or, as in most cases, ageing that results in deformity. This leads to adaptive changes in the pelvis and lower limbs. The effects of limb alignment on spinal posture are well documented. We now also know that changes in pelvic posture also affect spinal alignment. Sagittal malalignment presents as an exaggeration or deficiency of normal lordosis or kyphosis. Most cases seen in clinical practise are due to kyphotic deformity secondary to inflammatory, degenerative or post-traumatic disorders. They may also be secondary to infection or tumours. There is usually pain and functional disability along with concerns about self-image and social interaction due to inability to maintain a horizontal gaze. The resultant pelvic and lower limb posture is an attempt to restore normal alignment. Addressing this complex problem requires detailed expertise and awareness of the potential pitfalls surrounding its treatment.

  10. Sagittal plane deformity: an overview of interpretation and management

    PubMed Central

    Roussouly, Pierre

    2010-01-01

    The impact of sagittal plane alignment on the treatment of spinal disorders is of critical importance. A failure to recognise malalignment in this plane can have significant consequences for the patient not only in terms of pain and deformity, but also social interaction due to deficient forward gaze. A good understanding of the principles of sagittal balance is vital to achieve optimum outcomes when treating spinal disorders. Even when addressing problems in the coronal plane, an awareness of sagittal balance is necessary to avoid future complications. The normal spine has lordotic curves in the cephalad and caudal regions with a kyphotic curve in between. Overall, there is a positive correlation between thoracic kyphosis and lumbar lordosis. There are variations on the degree of normal curvature but nevertheless this shape allows equal distribution of forces across the spinal column. It is the disruption of this equilibrium by pathological processes or, as in most cases, ageing that results in deformity. This leads to adaptive changes in the pelvis and lower limbs. The effects of limb alignment on spinal posture are well documented. We now also know that changes in pelvic posture also affect spinal alignment. Sagittal malalignment presents as an exaggeration or deficiency of normal lordosis or kyphosis. Most cases seen in clinical practise are due to kyphotic deformity secondary to inflammatory, degenerative or post-traumatic disorders. They may also be secondary to infection or tumours. There is usually pain and functional disability along with concerns about self-image and social interaction due to inability to maintain a horizontal gaze. The resultant pelvic and lower limb posture is an attempt to restore normal alignment. Addressing this complex problem requires detailed expertise and awareness of the potential pitfalls surrounding its treatment. PMID:20567858

  11. [Information analysis of spinal ganglia].

    PubMed

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

    2000-01-01

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

  12. [Galveston technique in treatment of paralytic spine deformities].

    PubMed

    Kaczmarczyk, Jacek; Nowakowski, Andrzej; Balcerkiewicz, Karol; Szulc, Paweł

    2003-01-01

    The author's present their own experiences with the Galveston technique in treatment of paralytic spine deformities. Nineteen patients (6 boys and 13 girls) were treated (between 1996 and 2002) at the Swiebodzin Spine Centre and the Special Spine Surgery Unit in Poznań. All patients were unable to sit straight without external support, due to neurologic muscle weakness and pelvic obliquity. Surgical treatment lead to a marked improvement of the spinal deformity and also allowed the patients to sit-straight, without need of any support.

  13. Beta type Ti-Mo alloys with changeable Young's modulus for spinal fixation applications.

    PubMed

    Zhao, Xingfeng; Niinomi, Mitsuo; Nakai, Masaaki; Hieda, Junko

    2012-05-01

    To develop a novel biomedical titanium alloy with a changeable Young's modulus via deformation-induced ω phase transformation for the spinal rods in spinal fixation devices, a series of metastable β type binary Ti-(15-18)Mo alloys were prepared. In this study, the microstructures, Young's moduli and tensile properties of the alloys were systemically examined to investigate the effects of deformation-induced ω phase transformation on their mechanical properties. The springback of the optimal alloy was also examined. Ti-(15-18)Mo alloys subjected to solution treatment comprise a β phase and a small amount of athermal ω phase, and they have low Young's moduli. All the alloys investigated in this study show an increase in the Young's modulus owing to deformation-induced ω phase transformation during cold rolling. The deformation-induced ω phase transformation is accompanied with {332}(β) mechanical twinning. This resulted in the maintenance of acceptable ductility with relatively high strength. Among the examined alloys, the Ti-17Mo alloy shows the lowest Young's modulus and the largest increase in the Young's modulus. This alloy exhibits small springback and could be easily bent to the required shape during operation. Thus, Ti-17Mo alloy is considered to be a potential candidate for the spinal rods in spinal fixation devices.

  14. Primary spinal primitive neuroectodermal tumour: report of two cases mimicking neurofibroma and review of the literature.

    PubMed

    Patnaik, Ashis; Mishra, Sudhansu; Mishra, Sanjib; Deo, Rama

    2012-01-01

    Primary spinal primitive neuroectodermal tumours (PNETs) are a rare entity. Most of them occur in children and young adults. To date, 47 cases of primary spinal PNET have been reported in the literature. We present two cases of primary spinal PNET. In both cases, the tumours were thoracic extradural ones with intrathoracic extension through intervertebral foramina resembling neurofibroma. These tumours are highly aggressive with rapid growth as evidenced by the short history in both of our cases. Both cases underwent gross total removal of the intraspinal and thoracic components. Postoperatively, both patients underwent cranio-spinal radiotherapy. A review of the literature shows that the overall prognosis of PNETs of the spinal cord is very poor even with adequate surgery, radiotherapy and chemotherapy. One patient died after 4 months and the other one is still alive 8 months after surgery, radiotherapy and chemotherapy.

  15. Syringomyelia associated with spinal arachnoiditis treated by partial arachnoid dissection and syrinx-far distal subarachnoid shunt.

    PubMed

    Iwatsuki, Koichi; Yoshimine, Toshiki; Ohnishi, Yu-Ichiro; Ninomiya, Koshi; Moriwaki, Takashi; Ohkawa, Toshika

    2014-01-01

    The authors describe a new modified surgical approach to minimize the postoperative recurrence of a syrinx after surgery to treat syringomyelia associated with spinal adhesive arachnoiditis in two cases. Both patients presented with progressive gait disturbance without any remarkable history, and spinal magnetic resonance imaging revealed a syrinx and broad irregular disappearance of the subarachnoid space and/or deformity of the cord. We successfully performed a partial arachnoid dissection and syrinx-far distal subarachnoid shunt for both cases.

  16. Syringomyelia Associated with Spinal Arachnoiditis Treated by Partial Arachnoid Dissection and Syrinx-Far Distal Subarachnoid Shunt

    PubMed Central

    Iwatsuki, Koichi; Yoshimine, Toshiki; Ohnishi, Yu-Ichiro; Ninomiya, Koshi; Moriwaki, Takashi; Ohkawa, Toshika

    2014-01-01

    The authors describe a new modified surgical approach to minimize the postoperative recurrence of a syrinx after surgery to treat syringomyelia associated with spinal adhesive arachnoiditis in two cases. Both patients presented with progressive gait disturbance without any remarkable history, and spinal magnetic resonance imaging revealed a syrinx and broad irregular disappearance of the subarachnoid space and/or deformity of the cord. We successfully performed a partial arachnoid dissection and syrinx-far distal subarachnoid shunt for both cases. PMID:25232285

  17. A Neonatal Mouse Spinal Cord Compression Injury Model

    PubMed Central

    Züchner, Mark; Glover, Joel C.; Boulland, Jean-Luc

    2016-01-01

    Spinal cord injury (SCI) typically causes devastating neurological deficits, particularly through damage to fibers descending from the brain to the spinal cord. A major current area of research is focused on the mechanisms of adaptive plasticity that underlie spontaneous or induced functional recovery following SCI. Spontaneous functional recovery is reported to be greater early in life, raising interesting questions about how adaptive plasticity changes as the spinal cord develops. To facilitate investigation of this dynamic, we have developed a SCI model in the neonatal mouse. The model has relevance for pediatric SCI, which is too little studied. Because neural plasticity in the adult involves some of the same mechanisms as neural plasticity in early life1, this model may potentially have some relevance also for adult SCI. Here we describe the entire procedure for generating a reproducible spinal cord compression (SCC) injury in the neonatal mouse as early as postnatal (P) day 1. SCC is achieved by performing a laminectomy at a given spinal level (here described at thoracic levels 9-11) and then using a modified Yasargil aneurysm mini-clip to rapidly compress and decompress the spinal cord. As previously described, the injured neonatal mice can be tested for behavioral deficits or sacrificed for ex vivo physiological analysis of synaptic connectivity using electrophysiological and high-throughput optical recording techniques1. Earlier and ongoing studies using behavioral and physiological assessment have demonstrated a dramatic, acute impairment of hindlimb motility followed by a complete functional recovery within 2 weeks, and the first evidence of changes in functional circuitry at the level of identified descending synaptic connections1. PMID:27078037

  18. Surgery for spinal tuberculosis: a multi-center experience of 582 cases

    PubMed Central

    Phan, Kevin; Karim, Rezaul; Jonayed, Sharif Ahmed; Munir, Hasan Khalid Md.; Chakraborty, Shubhendu; Alam, Tashfique

    2015-01-01

    Background Tuberculosis (TB) of the spine is a common site of osseous TB, accounting for 50%-60% of cases. Spinal TB still occurs in both developed and developing countries. The diagnosis of spinal TB is difficult and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity. Methods A total of 582 patients with TB of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January, 2003 to July, 2014. Thoracotomy along with anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were performed in 113 cases. Posterior decompression, posterior interbody and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods were done in the remaining 469 cases. Appropriate anti-TB drugs were given to all patients for 18-24 months. The follow-up period was 3 months to 10 years. Results The average age was 32.5 years. All patients survived surgery. There were 7 cases of superficial infections (1.2%) whilst there were 4 cases (0.7%) of deep infections. Revision surgery was performed in 6 patients (1.0%). Implant failure occurred in 4 cases (0.7%) whilst malposition of screws occurred in 12 cases (2.1%). Perioperative bleeding complications were reported for 4 patients (0.7%). Neurological improvement occurred in all patients except for 2 cases (0.3%). Preoperatively, the majority of patients (n=221, 38%) were classified with Class A on the American Spinal Injury Association (ASIS) neurological impairment scale. This was significantly reduced postoperatively to 0.4%. Conclusions For patients with spinal TB anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining

  19. Relating Histopathology and Mechanical Strain in Experimental Contusion Spinal Cord Injury in a Rat Model

    PubMed Central

    Liu, Jie; Yung, Andrew; Cripton, Peter; Kozlowski, Piotr; Tetzlaff, Wolfram; Oxland, Thomas

    2016-01-01

    Abstract During traumatic spinal cord injury (SCI), the spinal cord is subject to external displacements that result in damage of neural tissues. These displacements produce complex internal deformations, or strains, of the spinal cord parenchyma. The aim of this study is to determine a relationship between these internal strains during SCI and primary damage to spinal cord gray matter (GM) in an in vivo rat contusion model. Using magnetic resonance imaging and novel image registration methods, we measured three-dimensional (3D) mechanical strain in in vivo rat cervical spinal cord (n = 12) during an imposed contusion injury. We then assessed expression of the neuronal transcription factor, neuronal nuclei (NeuN), in ventral horns of GM (at the epicenter of injury as well as at intervals cranially and caudally), immediately post-injury. We found that minimum principal strain was most strongly correlated with loss of NeuN stain across all animals (R2 = 0.19), but varied in strength between individual animals (R2 = 0.06–0.52). Craniocaudal distribution of anatomical damage was similar to measured strain distribution. A Monte Carlo simulation was used to assess strain field error, and minimum principal strain (which ranged from 8% to 36% in GM ventral horns) exhibited a standard deviation of 2.6% attributed to the simulated error. This study is the first to measure 3D deformation of the spinal cord and relate it to patterns of ensuing tissue damage in an in vivo model. It provides a platform on which to build future studies addressing the tolerance of spinal cord tissue to mechanical deformation. PMID:26729511

  20. Relating Histopathology and Mechanical Strain in Experimental Contusion Spinal Cord Injury in a Rat Model.

    PubMed

    Bhatnagar, Tim; Liu, Jie; Yung, Andrew; Cripton, Peter; Kozlowski, Piotr; Tetzlaff, Wolfram; Oxland, Thomas

    2016-09-15

    During traumatic spinal cord injury (SCI), the spinal cord is subject to external displacements that result in damage of neural tissues. These displacements produce complex internal deformations, or strains, of the spinal cord parenchyma. The aim of this study is to determine a relationship between these internal strains during SCI and primary damage to spinal cord gray matter (GM) in an in vivo rat contusion model. Using magnetic resonance imaging and novel image registration methods, we measured three-dimensional (3D) mechanical strain in in vivo rat cervical spinal cord (n = 12) during an imposed contusion injury. We then assessed expression of the neuronal transcription factor, neuronal nuclei (NeuN), in ventral horns of GM (at the epicenter of injury as well as at intervals cranially and caudally), immediately post-injury. We found that minimum principal strain was most strongly correlated with loss of NeuN stain across all animals (R(2) = 0.19), but varied in strength between individual animals (R(2) = 0.06-0.52). Craniocaudal distribution of anatomical damage was similar to measured strain distribution. A Monte Carlo simulation was used to assess strain field error, and minimum principal strain (which ranged from 8% to 36% in GM ventral horns) exhibited a standard deviation of 2.6% attributed to the simulated error. This study is the first to measure 3D deformation of the spinal cord and relate it to patterns of ensuing tissue damage in an in vivo model. It provides a platform on which to build future studies addressing the tolerance of spinal cord tissue to mechanical deformation.

  1. Medicolegal cases for spinal epidural hematoma and spinal epidural abscess.

    PubMed

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

    2013-01-01

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

  2. Spinal cord regeneration in a tail autotomizing urodele.

    PubMed

    Dawley, Ellen M; O Samson, Shoji; Woodard, Kenton T; Matthias, Kathryn A

    2012-02-01

    Adult urodele amphibians possess extensive regenerative abilities, including lens, jaws, limbs, and tails. In this study, we examined the cellular events and time course of spinal cord regeneration in a species, Plethodon cinereus, that has the ability to autotomize its tail as an antipredator strategy. We propose that this species may have enhanced regenerative abilities as further coadaptations with this antipredator strategy. We examined the expression of nestin, vimentin, and glial fibrillary acidic protein (GFAP) after autotomy as markers of neural precursor cells and astroglia; we also traced the appearance of new neurons using 5-bromo-2'-deoxyuridine/neuronal nuclei (BrdU/NeuN) double labeling. As expected, the regenerating ependymal tube was a major source of new neurons; however, the spinal cord cranial to the plane of autotomy showed significant mitotic activity, more extensive than what is reported for other urodeles that cannot autotomize their tails. In addition, this species shows upregulation of nestin, vimentin, and GFAP within days after tail autotomy; further, this expression is upregulated within the spinal cord cranial to the plane of autotomy, not just within the extending ependymal tube, as reported in other urodeles. We suggest that enhanced survival of the spinal cord cranial to autotomy allows this portion to participate in the enhanced recovery and regeneration of the spinal cord.

  3. Spinal neuronal activation during locomotor-like activity enabled by epidural stimulation and 5-HT agonists in spinal rats

    PubMed Central

    Duru, Paul O.; Tillakaratne, Niranjala J.K.; Kim, Jung A.; Zhong, Hui; Stauber, Stacey M.; Pham, Trinh T.; Xiao, Mei S.; Edgerton, V. Reggie; Roy, Roland R.

    2015-01-01

    The neural networks that generate stepping in complete spinal adult rats remain poorly defined. To address this problem we used c-fos (an activity-dependent marker) to identify active interneurons and motoneurons in the lumbar spinal cord of adult spinal rats during a 30-minute bout of bipedal stepping. Spinal rats were either step trained (30 min/day, 3 days/week for 7.5 weeks) or not step-trained. Stepping was enabled by epidural stimulation and the administration of the serotonergic agonists quipazine and 8-OHDPAT. A third group of spinal rats served as untreated (no stimulation, drugs, or stepping) controls. The number of activated cholinergic central canal cluster cells and partition neurons was higher in both step-trained and non-trained than untreated rats, and higher in non-trained than step-trained rats. The latter finding suggests that daily treatment with epidural stimulation plus serotonergic agonist treatment without step training enhanced the excitability of a broader cholinergic interneuronal population than step training. The number of activated interneurons in laminae II-VI of lumbar cross sections was higher in both step-trained and non-trained than untreated rats, and highest in step-trained rats. This finding suggests that this population of interneurons was responsive to epidural stimulation plus serotonergic treatment and that load-bearing induced when stepping had an additive effect. The number of activated motoneurons of all size categories was higher in the step-trained than the other two groups, reflecting a strong effect of loading on motoneuron recruitment. In general, these results indicate that the spinal networks for locomotion are similar with and without brain input. PMID:25789848

  4. Imaging modalities in spinal disorders

    SciTech Connect

    Kricun, M.E.

    1986-01-01

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

  5. Use of quadrupedal step training to re-engage spinal interneuronal networks and improve locomotor function after spinal cord injury.

    PubMed

    Shah, Prithvi K; Garcia-Alias, Guillermo; Choe, Jaehoon; Gad, Parag; Gerasimenko, Yury; Tillakaratne, Niranjala; Zhong, Hui; Roy, Roland R; Edgerton, V Reggie

    2013-11-01

    Can lower limb motor function be improved after a spinal cord lesion by re-engaging functional activity of the upper limbs? We addressed this issue by training the forelimbs in conjunction with the hindlimbs after a thoracic spinal cord hemisection in adult rats. The spinal circuitries were more excitable, and behavioural and electrophysiological analyses showed improved hindlimb function when the forelimbs were engaged simultaneously with the hindlimbs during treadmill step-training as opposed to training only the hindlimbs. Neuronal retrograde labelling demonstrated a greater number of propriospinal labelled neurons above and below the thoracic lesion site in quadrupedally versus bipedally trained rats. The results provide strong evidence that actively engaging the forelimbs improves hindlimb function and that one likely mechanism underlying these effects is the reorganization and re-engagement of rostrocaudal spinal interneuronal networks. For the first time, we provide evidence that the spinal interneuronal networks linking the forelimbs and hindlimbs are amenable to a rehabilitation training paradigm. Identification of this phenomenon provides a strong rationale for proceeding toward preclinical studies for determining whether training paradigms involving upper arm training in concert with lower extremity training can enhance locomotor recovery after neurological damage.

  6. Behavioral recovery induced by applied electric fields after spinal cord hemisection in guinea pig

    SciTech Connect

    Borgens, R.B.; Blight, A.R.; McGinnis, M.E.

    1987-10-16

    Applied electric fields were used to promote axonal regeneration in spinal cords of adult guinea pigs. A propriospinal intersegmental reflex (the cutaneous trunci muscle reflex) was used to test lateral tract function after hemisection of the thoracic spinal cord. An electrical field (200 microvolts per millimeter, cathode rostral) applied across the lesion led to functional recovery of the cutaneous trunci muscle reflex in 25 percent of experimental animals, whereas the functional deficit remained in control animals, which were implanted with inactive stimulators.

  7. Responsiveness of a Neuromuscular Recovery Scale for Spinal Cord Injury: Inpatient and Outpatient Rehabilitation

    DTIC Science & Technology

    2013-10-01

    adults post-stroke, examining adaptive locomotor training in animal models and the human condition of SCI, and examining responsiveness of the...Proposal No. SC090246, Award No. W81XWH-10-1-0959 Responsiveness of a Neuromuscular Recovery Scale for Spinal Cord Injury: Inpatient and...AD_________________ Award Number: W81XWH-10-1-0959 TITLE: Responsiveness of a Neuromuscular Recovery Scale for Spinal Cord Injury: Inpatient and

  8. Spinal adhesive arachnoiditis.

    PubMed

    Dolan, R A

    1993-06-01

    Forty-one cases of spinal adhesive arachnoiditis are presented. The key points are, first, that lumbar disc lesions, their investigations and surgical treatment and the use of nonabsorbable contrast materials are the most common etiological factors and, secondly, that operation is the best treatment. It is our contention that the majority of patients so treated do experience some improvement in what otherwise can be an unbearable amount of pain and disability. The use of adsorbable, nonirritative contrast materials such as Iohexol Parenteral will result in a marked reduction in the frequency of occurrence of arachnoiditis.

  9. CNS and spinal tumors.

    PubMed

    Furtado, Andre D; Panigrahy, Ashok; Fitz, Charles R

    2016-01-01

    Primary CNS tumors consist of a diverse group of neoplasms originating from various cell types in the CNS. Brain tumors are the most common solid malignancy in children under the age of 15 years and the second leading cause of cancer death after leukemia. The most common brain neoplasms in children differ consistently from those in older age groups. Pediatric brain tumors demonstrate distinct patterns of occurrence and biologic behavior according to sex, age, and race. This chapter highlights the imaging features of the most common tumors that affect the child's CNS (brain and spinal cord).

  10. Totally Ossified Metaplastic Spinal Meningioma

    PubMed Central

    Hida, Kazutoshi; Yamauchi, Tomohiro; Houkin, Kiyohiro

    2013-01-01

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

  11. Deformity in the "Boxing Boys".

    PubMed

    Ferrence, Susan; Bendersky, Gordon

    2005-01-01

    The late Bronze Age wall painting the Boxing Boys (c. 17th-16th century BCE) was excavated in the ancient town of Akrotiri on the Greek island of Thera. This article considers a medical interpretation for the spinal-pelvic anomaly in the anatomy of one of the boys. The artist has depicted a combination of structural anatomical adjustments diagnostic of spondylolisthesis, a forward slippage of one of the lumbar vertebrae. The accurate portrayal of the surface appearance of this condition suggests that the artist painted directly from a live subject. Thus, the Boxing Boys mural may be the earliest visual record of a sports-induced injury. Although the meaning of the wall paintings is unclear, the wild goats (agrimia) on the adjoining walls simulate swayback as a reflection of the boy's torso deformity and share other features with the boxers, adding to the unifying characteristics of the room. The abnormal morphology appears to be the earliest achievement of transforming disease into aesthetic charm on a monumental scale.

  12. Retraining the injured spinal cord

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  13. Spinal cord regeneration in Xenopus tadpoles proceeds through activation of Sox2-positive cells

    PubMed Central

    2012-01-01

    Background In contrast to mammals, amphibians, such as adult urodeles (for example, newts) and anuran larvae (for example, Xenopus) can regenerate their spinal cord after injury. However, the cellular and molecular mechanisms involved in this process are still poorly understood. Results Here, we report that tail amputation results in a global increase of Sox2 levels and proliferation of Sox2+ cells. Overexpression of a dominant negative form of Sox2 diminished proliferation of spinal cord resident cells affecting tail regeneration after amputation, suggesting that spinal cord regeneration is crucial for the whole process. After spinal cord transection, Sox2+ cells are found in the ablation gap forming aggregates. Furthermore, Sox2 levels correlated with regenerative capabilities during metamorphosis, observing a decrease in Sox2 levels at non-regenerative stages. Conclusions Sox2+ cells contribute to the regeneration of spinal cord after tail amputation and transection. Sox2 levels decreases during metamorphosis concomitantly with the lost of regenerative capabilities. Our results lead to a working hypothesis in which spinal cord damage activates proliferation and/or migration of Sox2+ cells, thus allowing regeneration of the spinal cord after tail amputation or reconstitution of the ependymal epithelium after spinal cord transection. PMID:22537391

  14. Intracranial Somatosensory Responses with Direct Spinal Cord Stimulation in Anesthetized Sheep

    PubMed Central

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

    2013-01-01

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

  15. Deformations of superconformal theories

    NASA Astrophysics Data System (ADS)

    Córdova, Clay; Dumitrescu, Thomas T.; Intriligator, Kenneth

    2016-11-01

    We classify possible supersymmetry-preserving relevant, marginal, and irrelevant deformations of unitary superconformal theories in d ≥ 3 dimensions. Our method only relies on symmetries and unitarity. Hence, the results are model independent and do not require a Lagrangian description. Two unifying themes emerge: first, many theories admit deformations that reside in multiplets together with conserved currents. Such deformations can lead to modifications of the supersymmetry algebra by central and non-central charges. Second, many theories with a sufficient amount of supersymmetry do not admit relevant or marginal deformations, and some admit neither. The classification is complicated by the fact that short superconformal multiplets display a rich variety of sporadic phenomena, including supersymmetric deformations that reside in the middle of a multiplet. We illustrate our results with examples in diverse dimensions. In particular, we explain how the classification of irrelevant supersymmetric deformations can be used to derive known and new constraints on moduli-space effective actions.

  16. Segmental spinal dysgenesis with caudal agenesis in a Holstein calf

    PubMed Central

    TOKUDOME, Kaori; ITO, Shuichi; KATO, Tomoko; YANASE, Tohru; KAWARASAKI, Tatsuo; MORITOMO, Yasuo

    2016-01-01

    A rare complex dysraphic malformation, comprising segmental spinal dysgenesis with caudal agenesis, was found in a Holstein calf that was unable to stand and was slightly short at the lumbosacral spine with taillessness. The thoracolumbar and sacrococcygeal regions of the midline axial segments showed severe deformities. In the spinal cord, the thoracolumbar region showed severe constriction with myelodysplastic changes, and the sacrococcygeal region showed dorsoventral separation with connection to a neural mass. In the spine, vertebral anomalies according to the degree of the segmentation error were confirmed. The cervical and thoracic segments also showed milder dysraphic changes. These changes suggest a multisegmental causal insult impairing the early embryonic notochord. This represents the first bovine case definitively confirmed morphologically. PMID:27980290

  17. Juxtafacet Spinal Synovial Cysts

    PubMed Central

    2016-01-01

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

  18. [Surgical anatomy of spinal cord tumors].

    PubMed

    Peltier, J; Chenin, L; Hannequin, P; Page, C; Havet, É; Foulon, P; Le Gars, D

    2015-08-03

    In this article, we respectively describe the morphology of the spinal cord, spinal meningeal layers, main fiber tracts, and both arterial and venous distribution in order to explain signs of spinal cord compression. We will then describe a surgical technique for spinal cord tumor removal.

  19. Attitudes Towards Individuals with Spinal Cord Injuries

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  20. Potential Clinical Applications for Spinal Functional MRI

    PubMed Central

    Kornelsen, Jennifer; Mackey, Sean

    2010-01-01

    Functional MRI (fMRI) of the spinal cord is a noninvasive technique for obtaining information regarding spinal cord neuronal function. This article provides a brief overview of recent developments in spinal cord fMRI and outlines potential applications, as well as the limitations that must be overcome, for using spinal fMRI in the clinic. This technique is currently used for research purposes, but significant potential exists for spinal fMRI to become an important clinical tool. PMID:17504642

  1. DISCUSSION ON SPINAL INJURIES

    PubMed Central

    1928-01-01

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

  2. Pediatric spine and spinal cord trauma. State of the art for the third millennium.

    PubMed

    Rekate, H L; Theodore, N; Sonntag, V K; Dickman, C A

    1999-11-01

    The purpose of this work was to analyze the literature published in English and to review the experience of the Barrow Neurological Institute (BNI) with spine and spinal cord injury (SCI) in children. Standard computerized data bases were queried for information regarding SCI, spinal injury, spinal instability, and spinal cord regeneration to produce a review of the epidemiology, diagnosis, treatment, outcome and directions for future research. We also reviewed our experiences in the management of infants and children with spine injuries and SCIs and with spinal instability from all causes. A total of 132 articles were identified and obtained from the Medical Library at St. Joseph's Hospital and Medical Center in Phoenix, Ariz. and through interlibrary loan. All these articles were read, although not all were used in the final review. A review of all children with SCIs revealed that fractures treated over the past 20 years at the BNI were very rare in preadolescent children, who suffered mostly from ligamentous injury or SCI without radiographic abnormality. A total of 68 children aged 16 years or younger who had been treated over the past 15 years and who had undergone spinal fusions for trauma, congenital anomalies, or tumor resection were identified. Occipitocervical fusion is well tolerated in children as young as 11 months when internal stabilization with a threaded titanium rod is used. Posterior instrumentation, including pedicle screw fixation, is feasible in children as young as 4 years. Fusion techniques derived from the adult spinal instrumentation experience were found appropriate except for the youngest patients. Fusion in the newborn period was futile in our experience. The adolescent spine does not differ from the adult spine in terms of sensitivity or response to fixation. Children past the neonatal period can be successfully instrumented for spinal stability without apparent long-term sequelae. Related advances are needed in the area of prevention

  3. Spinal tuberculosis in an infant associated with maternal urinary tuberculosis.

    PubMed

    Peterson, Rachel Ranitha; Agarwal, Indira; Gibikote, Sridhar

    2012-07-01

    A ten-month-old infant who presented with regression of milestones and seizures was noted to have a gibbus deformity in the upper thoracic region. She was diagnosed to have spine and central nervous system tuberculosis by culture of pus from the paravertebral abcess which showed a growth of Mycobacterium tuberculosis. The mother, who had been having recurrent episodes of Urinary tract infection, was diagnosed to have Urinary TB proven by culture. Spinal tuberculosis, though rare, can be encountered in infancy and should be kept in mind while treating infants presenting with related symptoms.

  4. Deformation mechanisms in experimentally deformed Boom Clay

    NASA Astrophysics Data System (ADS)

    Desbois, Guillaume; Schuck, Bernhard; Urai, Janos

    2016-04-01

    Bulk mechanical and transport properties of reference claystones for deep disposal of radioactive waste have been investigated since many years but little is known about microscale deformation mechanisms because accessing the relevant microstructure in these soft, very fine-grained, low permeable and low porous materials remains difficult. Recent development of ion beam polishing methods to prepare high quality damage free surfaces for scanning electron microscope (SEM) is opening new fields of microstructural investigation in claystones towards a better understanding of the deformation behavior transitional between rocks and soils. We present results of Boom Clay deformed in a triaxial cell in a consolidated - undrained test at a confining pressure of 0.375 MPa (i.e. close to natural value), with σ1 perpendicular to the bedding. Experiments stopped at 20 % strain. As a first approximation, the plasticity of the sample can be described by a Mohr-Coulomb type failure envelope with a coefficient of cohesion C = 0.117 MPa and an internal friction angle ϕ = 18.7°. After deformation test, the bulk sample shows a shear zone at an angle of about 35° from the vertical with an offset of about 5 mm. We used the "Lamipeel" method that allows producing a permanent absolutely plane and large size etched micro relief-replica in order to localize and to document the shear zone at the scale of the deformed core. High-resolution imaging of microstructures was mostly done by using the BIB-SEM method on key-regions identified after the "Lamipeel" method. Detailed BIB-SEM investigations of shear zones show the following: the boundaries between the shear zone and the host rock are sharp, clay aggregates and clastic grains are strongly reoriented parallel to the shear direction, and the porosity is significantly reduced in the shear zone and the grain size is smaller in the shear zone than in the host rock but there is no evidence for broken grains. Comparison of microstructures

  5. The dura causes spinal cord compression after spinal cord injury.

    PubMed

    Saadoun, Samira; Werndle, Melissa C; Lopez de Heredia, Luis; Papadopoulos, Marios C

    2016-10-01

    MR scans from 65 patients with traumatic spinal cord injury were analysed; on admission 95% had evidence of cord compression - in 26% due to the dura, and in the remaining 74% due to extradural factors. Compression due to dural factors resolved with a half-life of 5.5 days. These findings suggest that bony decompression alone may not relieve spinal cord compression in the quarter of patients in whom dural factors are significant.

  6. Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate.

    PubMed

    Hospach, Toni; Langendoerfer, Micha; von Kalle, Tekla; Maier, Jan; Dannecker, Guenther E

    2010-09-01

    There are only a few studies that address the frequency and type of spinal involvement in patients with chronic recurrent multifocal osteomyelitis (CRMO) as well as the outcome of these patients treated with pamidronate (PAM). We performed a retrospective study on patients with CRMO and analyzed clinical and pain assessments as well as regional and whole body MRI findings and compared with posttreatment findings. Of 102 children and adolescents with CRMO, 27 (26%) had involvement of the spine. Vertebral deformities were seen in 14 of these 27 patients, scoliosis or kyphosis in 6. After routine whole body MRI, 19 complained of back pain, whereas eight were asymptomatic with spinal lesions detected incidentally. A total of 72 spinal lesions were detected, thoracic vertebrae being the most commonly affected. Seven patients were treated with PAM; all of whom had vertebral deformities and ongoing back pain. Pain resolution was achieved within 3 months of PAM treatment in every case. One patient subsequently developed a pain amplification syndrome. Repeat MRI performed at a mean interval of 13 months revealed partial or complete resolution of vertebral hyperintensities in every patient. Improvement of vertebral height was seen in a total of three vertebrae in two patients. Severe side effects were not observed. In conclusion, we demonstrated that spinal involvement and associated vertebral deformities with or without kyphoscoliosis are not rare in CRMO, and PAM appears to be an effective and safe treatment for this condition. Although controlled studies are urgently needed, the use of PAM for refractory CRMO with extended spinal involvement (vertebral deformities, kyphosis, and scoliosis) should be considered, especially after failing of conventional therapy.

  7. Forelimb EMG-based trigger to control an electronic spinal bridge to enable hindlimb stepping after a complete spinal cord lesion in rats

    PubMed Central

    2012-01-01

    Background A complete spinal cord transection results in loss of all supraspinal motor control below the level of the injury. The neural circuitry in the lumbosacral spinal cord, however, can generate locomotor patterns in the hindlimbs of rats and cats with the aid of motor training, epidural stimulation and/or administration of monoaminergic agonists. We hypothesized that there are patterns of EMG signals from the forelimbs during quadrupedal locomotion that uniquely represent a signal for the “intent” to step with the hindlimbs. These observations led us to determine whether this type of “indirect” volitional control of stepping can be achieved after a complete spinal cord injury. The objective of this study was to develop an electronic bridge across the lesion of the spinal cord to facilitate hindlimb stepping after a complete mid-thoracic spinal cord injury in adult rats. Methods We developed an electronic spinal bridge that can detect specific patterns of EMG activity from the forelimb muscles to initiate electrical-enabling motor control (eEmc) of the lumbosacral spinal cord to enable quadrupedal stepping after a complete spinal cord transection in rats. A moving window detection algorithm was implemented in a small microprocessor to detect biceps brachii EMG activity bilaterally that then was used to initiate and terminate epidural stimulation in the lumbosacral spinal cord. We found dominant frequencies of 180–220 Hz in the EMG of the forelimb muscles during active periods, whereas these frequencies were between 0–10 Hz when the muscles were inactive. Results and conclusions Once the algorithm was validated to represent kinematically appropriate quadrupedal stepping, we observed that the algorithm could reliably detect, initiate, and facilitate stepping under different pharmacological conditions and at various treadmill speeds. PMID:22691460

  8. Simulation in spinal diseases.

    PubMed

    Aso Escario, José; Martínez Quiñones, José Vicente; Aso Vizán, Alberto; Arregui Calvo, Ricardo; Bernal Lafuente, Marta; Alcázar Crevillén, Andrés

    2014-01-01

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

  9. Glycine receptor heterogeneity in rat spinal cord during postnatal development.

    PubMed Central

    Becker, C M; Hoch, W; Betz, H

    1988-01-01

    Two different isoforms of the inhibitory glycine receptor were identified during postnatal development of rat spinal cord. A neonatal form characterized by low strychnine binding affinity, altered antigenicity, and a ligand binding subunit differing in mol. wt (49 kd) from that of the adult receptor (48 kd) predominates at birth (70% of the total receptor protein). Separation from the adult form could be achieved by either use of a selective antibody or glycine gradient elution of 2-aminostrychnine affinity columns. Both isoforms co-purify with the mol. wt 93 kd peripheral membrane protein of the postsynaptic glycine receptor complex. Images PMID:2850172

  10. Effects of iloprost on vasospasm after experimental spinal cord injury: an electron and light microscopic study.

    PubMed

    Attar, A; Tuna, H; Ugur, H C; Sargon, M F; Egemen, N

    2001-12-01

    It has been increasingly reported that traumatic and ischemic insults to the spinal cord may produce tissue damage through both direct and indirect mechanisms. In spite of many theories about post-traumatic spinal cord injury, there is still no satisfactory account of the exact mechanism. Vasospasm may be related to the trauma and release of vasoconstrictor or vasoactive amines. This study aims at studying the possible protective mechanisms of iloprost, a stable analogue of prostacyclin, after spinal cord injury on the rabbit. Forty-two adult male rabbits (New Zealand albino) were inflicted injuries by epidural application of an aneurysm clip to the spinal cord. Twenty-one rabbits received an i.v. infusion of 25 microg kg(-1) x h(-1) iloprost. The remaining twenty-one rabbits received an i.v. infusion of saline as the control group. Intravenous treatment started immediately after the infliction of the spinal cord injury and lasted for 1 h. Iloprost treatment had no side effects on the general physiological parameters in the rabbits. Control and iloprost treatment groups were divided into three sub-groups. The first group of animals was deeply anesthetized and spinal cords were removed 15 min after treatment. Second and third group animals were sacrificed in the 3rd and 24th hours respectively. All spinal cords were removed for light and electron microscopic examination. The width of anteriolar smooth muscle cells and the ultrastructural analysis of sulcal arterioles and venules in the ventral median fissure of spinal cords treated by iloprost revealed less thickening in all groups especially on the 24th hour group (p < 0.01), but less thickening was observed on the 3rd hour group. Iloprost-treated groups had limited edema and moderate protection of myelin and axons. These results suggest that iloprost treatment after spinal cord injury has a highly protective effect, and the possible protective effect of iloprost is resolution of vasospasm due to spinal cord injury.

  11. [A rare cause of spinal cord compression: osteochondroma of the thoracic spine. A case report].

    PubMed

    Nassar, I; Semlali, S; El Quessar, A; Kacemi, L; Mahi, M; Chakir, N; El Hassani, My R; Jiddane, M

    2003-09-01

    Osteochondroma or exostosis is the most common benign tumor of bone, but vertebral involvement is rare. The authors report the case of a 16 years old male with a family history of hereditary multiple exostoses who presented with spinal cord compression. MR examination showed an intraspinal extradural bone lesion at the T1-T2 level, hyperintense on T1 weighted and hypointense on T2 weighted images, causing marked cord deformity. The CT scan showed a tumor of the body and left pedicle of T2 with severe narrowing of the spinal canal.

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

    PubMed Central

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

    2015-01-01

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

  13. Currarino syndrome and spinal dysraphism.

    PubMed

    Kole, Matthew J; Fridley, Jared S; Jea, Andrew; Bollo, Robert J

    2014-06-01

    Currarino syndrome is a rare constellation of congenital anomalies characterized by the triad of sacral dysgenesis, presacral mass, and anorectal malformation. It is frequently associated with other congenital anomalies, often including occult spinal dysraphism. Mutations in the MNX1 gene are identified in the majority of cases. The authors report a rare case of Currarino syndrome in an infant with tethered cord syndrome and a dorsal lipomyelomeningocele continuous with a presacral intradural spinal lipoma, in addition to an imperforate anus and a scimitar sacrum. They review the literature to highlight patterns of occult spinal dysraphism in patients with Currarino syndrome and their relationship to tethered cord syndrome. Approximately 60% of the patients with Currarino syndrome reported in the literature have an occult spinal dysraphism. Published studies suggest that the risk of tethered cord syndrome may be higher among patients with a lipoma and lower among those with a teratoma or anterior meningocele.

  14. Overview of Spinal Cord Disorders

    MedlinePlus

    ... cord consists of gray matter shaped like a butterfly: The front "wings" (anterior or motor horns) contain ... In the center of the spinal cord, a butterfly-shaped area of gray matter helps relay impulses ...

  15. Depression and Spinal Cord Injury

    MedlinePlus

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

  16. Increase in Trx2/Prx3 redox system immunoreactivity in the spinal cord and hippocampus of aged dogs.

    PubMed

    Ahn, Ji Hyeon; Choi, Jung Hoon; Song, Ju Min; Lee, Choong Hyun; Yoo, Ki-Yeon; Hwang, In Koo; Kim, Jin Sang; Shin, Hyung-Cheul; Won, Moo-Ho

    2011-11-01

    We previously reported that no distinct neuronal loss occurred in the aged dog spinal cord, although oxidative stress was increased in the aged dog spinal cord. Thioredoxin 2 (Trx2)/peroxiredoxin 3 (Prx3) redox system is a major route for removing H(2)O(2) in the central nervous system. In the present study, we compared the distribution and immunoreactivity of thioredoxin reductase 2 (TrxR2), Trx2 and Prx3 and their protein levels in the spinal cord and hippocampus between the adult (2-3 years) and aged (10-12 years) dogs. The number of TrxR2-immunoreactive neurons was slightly increased; however, its immunoreactivity was significantly increased in the aged spinal cord compared to that in the adult spinal cord. On the other hand, the number and immunoreactivity of both Trx2- and Prx3-immunoreactive neurons were significantly increased in the spinal cord of the aged dog. Similarly, in the hippocampus of the aged dog, TrxR2, Trx2 and Prx3 immunoreactivity and protein levels were markedly increased compared to those in the adult dog. These results indicate that the increases of TrxR2, Trx2 and Prx3 immunoreactivity and their protein levels in the aged spinal cord and hippocampus may contribute to reducing neuronal damage against oxidative stresses during normal aging.

  17. Spinal anomalies in Pfeiffer syndrome.

    PubMed

    Moore, M H; Lodge, M L; Clark, B E

    1995-05-01

    Review of the spinal radiographs of a consecutive series of 11 patients with Pfeiffer syndrome presenting to the Australian Craniofacial Unit was performed. The prevalence of cervical spine fusions was high, and the pattern of fusion complex. Isolated anomalies were evident at lower levels, including two cases of sacrococcygeal eversion. Spinal anomalies occur more frequently in the more severely involved cases of Pfeiffer syndrome emphasizing the generalized dysostotic nature of this condition.

  18. Development of Surrogate Spinal Cords for the Evaluation of Electrode Arrays Used in Intraspinal Implants

    PubMed Central

    Cheng, Cheng; Kmech, Jonn; Mushahwar, Vivian K.

    2013-01-01

    We report the development of a surrogate spinal cord for evaluating the mechanical suitability of electrode arrays for intraspinal implants. The mechanical and interfacial properties of candidate materials (including silicone elastomers and gelatin hydrogels) for the surrogate cord were tested. The elastic modulus was characterized using dynamic mechanical analysis, and compared with values of actual human spinal cords from the literature. Forces required to indent the surrogate cords to specified depths were measured to obtain values under static conditions. Importantly, to quantify surface properties in addition to mechanical properties normally considered, interfacial frictional forces were measured by pulling a needle out of each cord at a controlled rate. The measured forces were then compared to those obtained from rat spinal cords. Formaldehyde-crosslinked gelatin, 12 wt% in water, was identified as the most suitable material for the construction of surrogate spinal cords. To demonstrate the utility of surrogate spinal cords in evaluating the behavior of various electrode arrays, cords were implanted with two types of intraspinal electrode arrays (one made of individual microwires and another of microwires anchored with a solid base), and cord deformation under elongation was evaluated. The results demonstrate that the surrogate model simulates the mechanical and interfacial properties of the spinal cord, and enables in vitro screening of intraspinal implants. PMID:23358939

  19. Calcaneo-valgus deformity.

    PubMed

    Evans, D

    1975-08-01

    A discussion of the essential deformity in calcaneo-valgus feet develops a theme originally put forward in 1961 on the relapsed club foot (Evans 1961). Whereas in the normal foot the medial and lateral columns are about equal in length, in talipes equino-varus the lateral column is longer and in calcaneo-valgus shorter than the medial column. The suggestion is that in the treatment of both deformities the length of the columns be made equal. A method is described of treating calcaneo-valgus deformity by inserting cortical bone grafts taken from the tibia to elongate the anterior end of the calcaneus.

  20. Fas and FasL expression in the spinal cord following cord hemisection in the monkey.

    PubMed

    Jia, Liu; Yu, Zou; Hui, Li; Yu-Guang, Guan; Xin-Fu, Zhou; Chao, You; Yanbin, Xiyang; Xi, Zhan; Jun, Wang; Xin-Hua, Heng; Xin-Hua, Hen; Ting-Hua, Wang

    2011-03-01

    The changes of endogenous Fas/FasL in injured spinal cord, mostly in primates, are not well known. In this study, we investigated the temporal changes in the expression of Fas and FasL and explored their possible roles in the ventral horn of the spinal cord and associated precentral gyrus following T(11) spinal cord hemisection in the adult rhesus monkey. A significant functional improvement was seen with the time going on in monkeys subjected to cord hemisection. Apoptotic cells were also seen in the ventral horn of injured spinal cord with TUNEL staining, and a marked increase presents at 7 days post operation (dpo). Simultaneously, the number of Fas and FasL immunoreactive neurons in the spinal cords caudal and rostral to injury site and their intracellular optical density (OD) in the ipsilateral side of injury site at 7 dpo increased significantly more than that of control group and contralateral sides. This was followed by a decrease and returned to normal level at 60 dpo. No positive neurons were observed in precentral gyrus. The present results may provide some insights to understand the role of Fas/FasL in the spinal cord but not motor cortex with neuronal apoptosis and neuroplasticity in monkeys subjected to hemisection spinal cord injury.

  1. Tumor Necrosis Factor-stimulated Gene-6 (TSG-6) Is Constitutively Expressed in Adult Central Nervous System (CNS) and Associated with Astrocyte-mediated Glial Scar Formation following Spinal Cord Injury*

    PubMed Central

    Coulson-Thomas, Vivien J.; Lauer, Mark E.; Soleman, Sara; Zhao, Chao; Hascall, Vincent C.; Day, Anthony J.; Fawcett, James W.

    2016-01-01

    Tumor necrosis factor (TNF)-stimulated gene-6 (TSG-6) binds to hyaluronan and can reorganize/stabilize its structure, also enhancing the binding of this glycosaminoglycan to its cell surface receptor, CD44. TSG-6 is rapidly up-regulated in response to inflammatory cytokines protecting tissues from the damaging effects of inflammation. Despite TSG-6 treatment having been shown to improve outcomes in an experimental model of traumatic brain injury, TSG-6 expression has not been extensively studied in the central nervous system (CNS). We hereby analyzed the expression profile of TSG-6 in the developing CNS and following injury. We show that TSG-6 is expressed in the rat CNS by GFAP+ and CD44+ astrocytes, solely in the mature brain and spinal cord, and is not present during the development of the CNS. TSG-6−/− mice present a reduced number of GFAP+ astrocytes when compared with the littermate TSG-6+/− mice. TSG-6 expression is drastically up-regulated after injury, and the TSG-6 protein is present within the glial scar, potentially coordinating and stabilizing the formation of this hyaluronan-rich matrix. This study shows that TSG-6 is expressed in the CNS, suggesting a role for TSG-6 in astrocyte activation and tissue repair. We hypothesize that within this context TSG-6 could participate in the formation of the glial scar and confer anti-inflammatory properties. Further studies are required to elucidate the therapeutic potential of targeting TSG-6 after CNS injury to promote its protective effects while reducing the inhibitory properties of the glial scar in axon regeneration. PMID:27435674

  2. Tumor Necrosis Factor-stimulated Gene-6 (TSG-6) Is Constitutively Expressed in Adult Central Nervous System (CNS) and Associated with Astrocyte-mediated Glial Scar Formation following Spinal Cord Injury.

    PubMed

    Coulson-Thomas, Vivien J; Lauer, Mark E; Soleman, Sara; Zhao, Chao; Hascall, Vincent C; Day, Anthony J; Fawcett, James W

    2016-09-16

    Tumor necrosis factor (TNF)-stimulated gene-6 (TSG-6) binds to hyaluronan and can reorganize/stabilize its structure, also enhancing the binding of this glycosaminoglycan to its cell surface receptor, CD44. TSG-6 is rapidly up-regulated in response to inflammatory cytokines protecting tissues from the damaging effects of inflammation. Despite TSG-6 treatment having been shown to improve outcomes in an experimental model of traumatic brain injury, TSG-6 expression has not been extensively studied in the central nervous system (CNS). We hereby analyzed the expression profile of TSG-6 in the developing CNS and following injury. We show that TSG-6 is expressed in the rat CNS by GFAP(+) and CD44(+) astrocytes, solely in the mature brain and spinal cord, and is not present during the development of the CNS. TSG-6(-/-) mice present a reduced number of GFAP(+) astrocytes when compared with the littermate TSG-6(+/-) mice. TSG-6 expression is drastically up-regulated after injury, and the TSG-6 protein is present within the glial scar, potentially coordinating and stabilizing the formation of this hyaluronan-rich matrix. This study shows that TSG-6 is expressed in the CNS, suggesting a role for TSG-6 in astrocyte activation and tissue repair. We hypothesize that within this context TSG-6 could participate in the formation of the glial scar and confer anti-inflammatory properties. Further studies are required to elucidate the therapeutic potential of targeting TSG-6 after CNS injury to promote its protective effects while reducing the inhibitory properties of the glial scar in axon regeneration.

  3. Adult cavovarus foot.

    PubMed

    Younger, Alastair S E; Hansen, Sigvard T

    2005-09-01

    Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.

  4. Spinal muscular atrophy

    PubMed Central

    2011-01-01

    Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by degeneration of alpha motor neurons in the spinal cord, resulting in progressive proximal muscle weakness and paralysis. Estimated incidence is 1 in 6,000 to 1 in 10,000 live births and carrier frequency of 1/40-1/60. This disease is characterized by generalized muscle weakness and atrophy predominating in proximal limb muscles, and phenotype is classified into four grades of severity (SMA I, SMAII, SMAIII, SMA IV) based on age of onset and motor function achieved. This disease is caused by homozygous mutations of the survival motor neuron 1 (SMN1) gene, and the diagnostic test demonstrates in most patients the homozygous deletion of the SMN1 gene, generally showing the absence of SMN1 exon 7. The test achieves up to 95% sensitivity and nearly 100% specificity. Differential diagnosis should be considered with other neuromuscular disorders which are not associated with increased CK manifesting as infantile hypotonia or as limb girdle weakness starting later in life. Considering the high carrier frequency, carrier testing is requested by siblings of patients or of parents of SMA children and are aimed at gaining information that may help with reproductive planning. Individuals at risk should be tested first and, in case of testing positive, the partner should be then analyzed. It is recommended that in case of a request on carrier testing on siblings of an affected SMA infant, a detailed neurological examination should be done and consideration given doing the direct test to exclude SMA. Prenatal diagnosis should be offered to couples who have previously had a child affected with SMA (recurrence risk 25%). The role of follow-up coordination has to be managed by an expert in neuromuscular disorders and in SMA who is able to plan a multidisciplinary intervention that includes pulmonary, gastroenterology/nutrition, and orthopedic care. Prognosis depends on the phenotypic

  5. Rock Deformation Meeting

    NASA Astrophysics Data System (ADS)

    Green, Harry

    The Third Rock Deformation Colloquium was held December 4, 1989, at the AGU Fall Meeting in San Francisco. Steve Kirby of the U.S. Geological Survey, Menlo Park, Calif., reported on actions taken by the rock deformation steering committee. Brian Wernicke of Harvard University, Cambridge, Mass., talked on the structural geology of the Great Basin.The steering committee voted for “Committee on Deformation of Earth Materials” as the name for the AGU technical committee on rock deformation, Kirby said. Considerable discussion has occurred in the steering committee over our relationship to the AGU Mineral Physics Committee. Indeed, Kirby will become chairman of that committee in 1990, underlining the overlap of the two groups. It was agreed that we will pursue closer association with Mineral Physics.

  6. Wrist deformities after fracture.

    PubMed

    Vanheest, Ann

    2006-02-01

    Wrist deformities can occur after fracture because of malunion of the fracture or injury to the growth plate leading to imbalance of growth. Prevention of malunion is paramount by early recognition with proper reduction and casting or fixation with casting. If a mal-union occurs, an osteotomy may be necessary if anticipated growth will not correct the deformity. Injury of the growth plate may lead to wrist deformity in two ways: angular growth or growth arrest. Angular growth deformities are corrected most commonly by osteotomy. Growth arrest of the radius or the ulna leads to an ulnar-positive or an ulnar-negative variance at the wrist. If the ulnar variance is symptomatic, treatment is centered on achieving a level joint. Options for joint leveling procedures include epiphysiodesis or physeal stapling of the longer bone, lengthening osteotomy of the shorter bone, or shortening osteotomy of the longer bone.

  7. Spinal trauma. Pathophysiology and management of traumatic spinal injuries.

    PubMed

    Shores, A

    1992-07-01

    Spinal trauma can originate from internal or external sources. Injuries to the spinal cord can be classified as either concussive or compressive and concussive. The pathophysiologic events surrounding spinal cord injury include the primary injury (compression, concussion) and numerous secondary injury mechanisms (vascular, biochemical, electrolyte), which are mediated by excessive oxygen free radicles, neurotransmitter and electrolyte alterations in cell membrane permeability, excitotoxic amino acids, and various other biochemical factors that collectively result in reduced SCBF, ischemia, and eventual necrosis of the gray and white matter. Management of acute spinal cord injuries includes the use of a high-dose corticosteroid regimen within the initial 8 hours after trauma. Sodium prednisolone and methylprednisolone, at recommended doses, act as oxygen radical scavengers and are anti-inflammatory. Additional considerations are the stability of the vertebral column, other conditions associated with trauma (i.e., pneumothorax), and the presence or absence of spinal cord compression, which may warrant surgical therapy. Vertebral fractures or luxations can occur in any area of the spine but most commonly occur at the junction of mobile and immobile segments. Dorsal and dorsolateral surgical approaches are applicable to the lumbosacral and thoracolumbar spine and dorsal and ventral approaches to the cervical spine. Indications for surgical intervention include spinal cord compression and vertebral instability. Instability can be determined from the type of fracture, how many of the three compartments of the vertebrae are disrupted, and on occasion, by carefully positioned stress studies of fluoroscopy. Decompression (dorsal laminectomy, hemilaminectomy, or ventral cervical slot) is employed when compression of the spinal cord exists. The hemilaminectomy (unilateral or bilateral) causes less instability than dorsal laminectomy and therefore should be used when practical

  8. [Acute spinal subdural hematoma after attempted spinal anesthesia].

    PubMed

    Likar, R; Mathiaschitz, K; Spendel, M; Krumpholz, R; Martin, E

    1996-01-01

    This is a report of a case of a subdural haematoma with resulting paraplegia after attempted spinal anaesthesia. Epidural and subdural haematomas are rare complications after central neural blockade. The complication described here was the result of an unsuccessful attempt to puncture the spinal channel. The patient was a 72-year-old woman with a fracture of the left femoral neck, which it was intended to stabilize operatively. Findings that made lumbar spinal puncture difficult were severe overweight, and lordosis and scoliosis of the lumbar spine resulting from degenerative changes. Spinal anaesthesia was suggested because the patient had eaten shortly before and because she suffered from asthma. From the aspect of haemostasis no contraindications were present, and the anaesthesist was experienced in spinal anaesthesia even under difficult anatomical conditions. Several unsuccessful attempts were made to puncture the lumbar spinal channel while the patient was lying on her right side. It was also impossible to reach the spinal channel from a median or left paramedian approach. We used atraumatic pencil-point needles (Sprotte gauge 24, 90 mm). No blood was aspirated during any of the attempts. The surgical intervention was finally performed under a general anaesthetic in view of the urgency. No significant complications occurred during the operation, and no neurological abnormalities were observed immediately after or in the next 8 h after the operation. At 12 h after the operation a paraparesis was found caudal to L3. After this had been verified by radiological and neurological tests, neurosurgical decompression was carried out as quickly as possible. During the operation a distinct subdural haematoma without any detectable source of bleeding was discovered. Even after surgical revision and evacuation of the remaining haematoma it was not possible to reverse the paraplegia, in spite of rehabilitation measures. Despite a certain fragility of the vessel and

  9. Principles of rock deformation

    SciTech Connect

    Nicolas, A.

    1987-01-01

    This text focuses on the recent achievements in the analysis of rock deformation. It gives an analytical presentation of the essential structures in terms of kinetic and dynamic interpretation. The physical properties underlying the interpretation of rock structures are exposed in simple terms. Emphasized in the book are: the role of fluids in rock fracturing; the kinematic analysis of magnetic flow structures; the application of crystalline plasticity to the kinematic and dynamic analysis of the large deformation imprinted in many metamorphic rocks.

  10. Polygonal deformation bands

    NASA Astrophysics Data System (ADS)

    Antonellini, Marco; Mollema, Pauline Nella

    2015-12-01

    We report for the first time the occurrence of polygonal faults in sandstone, which is compelling given that layer-bound polygonal fault systems have been observed so far only in fine-grained sediments such as clay and chalk. The polygonal faults are shear deformation bands that developed under shallow burial conditions via strain hardening in dm-wide zones. The edges of the polygons are 1-5 m long. The shear deformation bands are organized as conjugate faults along each edge of the polygon and form characteristic horst-like structures. The individual deformation bands have slip magnitudes ranging from a few mm to 1.5 cm; the cumulative average slip magnitude in a zone is up to 10 cm. The deformation bands heaves, in aggregate form, accommodate a small isotropic horizontal extension (strain <0.005). The individual shear deformation bands show abutting T-junctions, veering, curving, and merging where they mechanically interact. Crosscutting relationships are rare. The interactions of the deformation bands are similar to those of mode I opening fractures. The documented fault networks have important implications for evaluating the geometry of km-scale polygonal fault systems in the subsurface, top seal integrity, as well as constraining paleo-tectonic stress regimes.

  11. Acute sports-related spinal cord injury: contemporary management principles.

    PubMed

    Kim, David H; Vaccaro, Alexander R; Berta, Scott C

    2003-07-01

    Improvements in helmet and equipment design have led to significant decreases in overall injury incidence, but no available helmet can prevent catastrophic injury to the neck and cervical spine. The most effective strategy for preventing this type of injury appears to be careful instruction, training, and regulations designed to eliminate head-first contact. The incidence of football-related quadriplegia has decreased from a peak of 13 cases per one million players between 1976 and 1980 to 3 per million from 1991 to 1993, mostly as a result of systematic research and an organized effort to eliminate high-risk behavior. An episode of transient quadriparesis does not appear to be a risk factor for catastrophic spinal cord injury. Torg reported that 0 of 117 quadriplegics in the National Football Head and Neck Injuries Registry recalled a prior episode of transient quadriparesis, and 0 of the 45 patients originally studied in his transient quadriparesis cohort have subsequently suffered quadriplegia. The significance of developmental spinal stenosis is unclear. Plain radiographic identification of a narrow spinal canal in a player sustaining cervical cord neurapraxia warrants further evaluation by MRI to rule out functional stenosis. The presence of actual cord deformation or compression on MRI should preclude participation in high-risk contact or collision sports.

  12. Establishing a standardized therapeutic testing protocol for spinal muscular atrophy.

    PubMed

    Tsai, Li-Kai; Tsai, Ming-Shung; Lin, Tzer-Bin; Hwu, Wuh-Liang; Li, Hung

    2006-11-01

    Several mice models have been created for spinal muscular atrophy (SMA); however, there is still no standard preclinical testing system for the disease. We previously generated type III-specific SMA model mice, which might be suitable for use as a preclinical therapeutic testing system for SMA. To establish such a system and test its applicability, we first created a testing protocol and then applied it as a means to investigate the use of valproic acid (VPA) as a possible treatment for SMA. These SMA mice revealed tail/ear/foot deformity, muscle atrophy, poorer motor performances, smaller compound muscle action potential and lower spinal motoneuron density at the age of 9 to 12 months in comparison with age-matched wild-type littermate mice. In addition, VPA attenuates motoneuron death, increases spinal SMN protein level and partially normalizes motor function in SMA mice. These results suggest that the testing protocol developed here is well suited for use as a standardized preclinical therapeutic testing system for SMA.

  13. Spinal primitive neuroectodermal tumor mimicking as chronic inflammatory demyelination polyneuropathy: a case report and review of literature.

    PubMed

    Chan, Sophelia H S; Tsang, Dickson S F; Wong, Virginia C N; Chan, Godfrey C F

    2015-02-01

    We report a young boy who presented with progressive weakness of lower extremities associated with areflexia and abnormal electrophysiological findings initially suggestive of chronic inflammatory demyelinating polyneuropathy. Initial lumbosacral spinal magnetic resonance imaging (MRI) showed thickened descending spinal nerve roots only. Immunomodulating therapy was given but with limited clinical response. Repeated spine magnetic resonance imaging showed cauda equina and also new spinal cord extramedullary contrast enhancement. The initial extensive investigations including open biopsy did not point to any specific diagnosis. Only through pursuing a repeated biopsy, the diagnosis of the spinal peripheral primitive neuroectodermal tumor was confirmed. This case highlights the diagnostic challenges of the spinal peripheral primitive neuroectodermal tumor that could have an initial chronic inflammatory demyelinating polyneuropathy-like presentation. The literature review confirms that this is a rare condition and cauda equina origin has only been reported in adults and teenagers, and this is the first reported case in a young child.

  14. Spinal Extradural Arachnoid Cyst

    PubMed Central

    Woo, Joon Bum; Kang, Kyung Taek; Lee, Jun Seok; Song, Geun Seong; Sung, Soon Ki; Lee, Sang Weon

    2016-01-01

    A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient’s symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy. PMID:27857934

  15. Spinal Extradural Arachnoid Cyst

    PubMed Central

    Choi, Seung Won; Seong, Han Yu

    2013-01-01

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

  16. Orofacial characteristics of adolescents with diagnosed spinal disorders.

    PubMed

    Végh, András; Fábian, Gábor; Jianu, Rodica; Segatto, Emil

    2012-01-10

    The objective of the current epidemiological study is to show the correlation of various postural abnormalities and spinal deformities and the clinically identifiable dentofacial anomalies by orthodontic examination. Twenty-three children with Scheuermann's disease [mean age: 14 years 8 months; standard deviation (SD): 1 year 8 months] and 28 with scoliosis (mean age: 14 years 7 months; SD: 2 years 3 months) participated in the study. Standardized orthodontic screening protocols were used to map the occlusal relations in the sagittal, vertical, and horizontal dimensions; the space relations of the maxillary and mandibular frontal segment; the temporomandibular joint (TMJ) status; and the facial asymmetries. Statistically significant differences (p<0.05) were found between the values of the examined groups of patients for the following measurements: incisal overjet and overbite, upper and lower midline deviation, mandibular frontal spacing, TMJ pathological symptoms and functional characteristics, and frequency of facial asymmetries. A large percentage of patients with pre-pubertal developments of spinal deformities have various dentofacial anomalies. The majority of these anomalies are present in patients with Scheuermann's disease. Early treatment of the malocclusions closely correlated to postural disorders should minimize the progression of the dentofacial anomalies, making necessary performing orthodontic screening of these patients as early as possible.

  17. The use of physical biomodelling in complex spinal surgery

    PubMed Central

    Izatt, Maree T.; Thorpe, Paul L. P. J.; Thompson, Robert G.; D’Urso, Paul S.; Earwaker, John W. S.; Labrom, Robert D.; Askin, Geoffrey N.

    2007-01-01

    Prior studies have suggested that biomodels enhance patient education, preoperative planning and intra-operative stereotaxy; however, the usefulness of biomodels compared to regular imaging modalities such as X-ray, CT and MR has not been quantified. Our objective was to quantify the surgeon’s perceptions on the usefulness of biomodels compared to standard visualisation modalities for preoperative planning and intra-operative anatomical reference. Physical biomodels were manufactured for a series of 26 consecutive patients with complex spinal pathologies using a stereolithographic technique based on CT data. The biomodels were used preoperatively for surgical planning and customising implants, and intra-operatively for anatomical reference. Following surgery, a detailed biomodel utility survey was completed by the surgeons, and informal telephone interviews were conducted with patients. Using biomodels, 21 deformity and 5 tumour cases were performed. Surgeons stated that the anatomical details were better visible on the biomodel than on other imaging modalities in 65% of cases, and exclusively visible on the biomodel in 11% of cases. Preoperative use of the biomodel led to a different decision regarding the choice of osteosynthetic materials used in 52% of cases, and the implantation site of osteosynthetic material in 74% of cases. Surgeons reported that the use of biomodels reduced operating time by a mean of 8% in tumour patients and 22% in deformity procedures. This study supports biomodelling as a useful, and sometimes essential tool in the armamentarium of imaging techniques used for complex spinal surgery. PMID:17846803

  18. Development and characterization of pathways descending to the spinal cord in the embryonic chick.

    PubMed

    Sholomenko, G N; O'Donovan, M J

    1995-03-01

    1. We used an isolated preparation of the embryonic chick brain stem and spinal cord to examine the origin, trajectory, and effects of descending supraspinal pathways on lumbosacral motor activity. The in vitro preparation remained viable for < or 24 h and was sufficiently stable for electrophysiological, pharmacological, and neuroanatomic examination. In this preparation, as in the isolated spinal cord, spontaneous episodes of both forelimb and hindlimb motor activity occur in the absence of phasic afferent input. Motor activity can also be evoked by brain stem electrical stimulation or modulated by the introduction of neurochemicals to the independently perfused brain stem. 2. At embryonic day (E)6, lumbosacral motor activity could be evoked by brain stem electrical stimulation. At E5, neither brain stem nor spinal cord stimulation evoked activity in the lumbosacral spinal cord, although motoneurons did express spontaneous activity. 3. Lesion and electrophysiological studies indicated that axons traveling in the ventral cord mediated the activation of lumbosacral networks by brain stem stimulation. 4. Partition of the preparation into three separately perfused baths, using a zero-Ca2+ middle bath that encompassed the cervical spinal cord, demonstrated that the brain stem activation of spinal networks could be mediated by long-axoned pathways connecting the brain stem and lumbosacral spinal cord. 5. Using retrograde tracing from the spinal cord combined with brain stem stimulation, we found that the brain stem regions from which spinal activity could be evoked lie in the embryonic reticular formation close to neurons that send long descending axons to the lumbosacral spinal cord. The cells giving rise to these descending pathways are found in the ventral pontine and medullary reticular formation, a region that is the source of reticulospinal neurons important for motor activity in adult vertebrates. 6. Electrical recordings from this region revealed that the

  19. Novel spinal instrumentation to enhance osteogenesis and fusion: a preliminary study.

    PubMed

    MacEwan, Matthew R; Talcott, Michael R; Moran, Daniel W; Leuthardt, Eric C

    2016-09-01

    OBJECTIVE Instrumented spinal fusion continues to exhibit high failure rates in patients undergoing multilevel lumbar fusion or pseudarthrosis revision; with Grade II or higher spondylolisthesis; or in those possessing risk factors such as obesity, tobacco use, or metabolic disorders. Direct current (DC) electrical stimulation of bone growth represents a unique surgical adjunct in vertebral fusion procedures, yet existing spinal fusion stimulators are not optimized to enhance interbody fusion. To develop an advanced method of applying DC electrical stimulation to promote interbody fusion, a novel osteogenic spinal system capable of routing DC through rigid instrumentation and into the vertebral bodies was fabricated. A pilot study was designed to assess the feasibility of osteogenic instrumentation and compare the ability of osteogenic instrumentation to promote successful interbody fusion in vivo to standard spinal instrumentation with autograft. METHODS Instrumented, single-level, posterior lumbar interbody fusion (PLIF) with autologous graft was performed at L4-5 in adult Toggenburg/Alpine goats, using both osteogenic spinal instrumentation (plus electrical stimulation) and standard spinal instrumentation (no electrical stimulation). At terminal time points (3 months, 6 months), animals were killed and lumbar spines were explanted for radiographic analysis using a SOMATOM Dual Source Definition CT Scanner and high-resolution Microcat II CT Scanner. Trabecular continuity, radiodensity within the fusion mass, and regional bone formation were examined to determine successful spinal fusion. RESULTS Quantitative analysis of average bone density in pedicle screw beds confirmed that electroactive pedicle screws used in the osteogenic spinal system focally enhanced bone density in instrumented vertebral bodies. Qualitative and quantitative analysis of high-resolution CT scans of explanted lumbar spines further demonstrated that the osteogenic spinal system induced solid

  20. Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on Functional Recovery after Spinal Cord Injury

    DTIC Science & Technology

    2014-10-01

    AWARD NUMBER: W81XWH-12-1-0587 TITLE: Directing Spinal Cord Plasticity: The Impact of Stretch ...Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on Functional Recovery after Spinal Cord Injury. 5b. GRANT NUMBER W81XWH-12-1...ABSTRACT Essentially all spinal cord injured patients receive stretching therapies beginning within the first few weeks post-injury. Despite

  1. Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia

    PubMed Central

    Maddali, Prasanthi; Walker, Blake; Fisahn, Christian; Page, Jeni; Diaz, Vicki; Zwillman, Michael E; Oskouian, Rod J; Tubbs, R. Shane

    2017-01-01

    Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation. PMID:28357164

  2. Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia.

    PubMed

    Maddali, Prasanthi; Walker, Blake; Fisahn, Christian; Page, Jeni; Diaz, Vicki; Zwillman, Michael E; Oskouian, Rod J; Tubbs, R Shane; Moisi, Marc

    2017-02-16

    Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.

  3. Structural Femoral Shaft Allografts for Anterior Spinal Column Reconstruction in Osteoporotic Spines

    PubMed Central

    Chang, Bong-Soon; Jung, Jong-Hun; Park, Sang-Min; Lee, Seung Hoo; Lee, Choon-Ki

    2016-01-01

    This study was to investigate the clinical and radiographical outcomes of anterior spinal column reconstruction using structural femoral shaft allografts in osteoporotic patients. Retrospective analyses of medical records, radiographic parameters, and postoperative complications were performed in twenty-one patients who underwent anterior spinal column reconstruction surgery for osteoporotic vertebral collapse or nonunion. Surgical invasiveness, clinical outcomes, postoperative complications, and radiographic outcomes were evaluated. Ambulatory status and back pain significantly improved. The Cobb's angle of segmental kyphosis significantly improved immediately after surgery with slight progression at the final follow-up. There were two cases of failed reconstruction with marked progression of kyphosis; both were related to loosening of screws rather than subsidence of the graft. Anterior spinal column reconstruction using femoral shaft allografts improved kyphosis and resulted in minimal subsidence and therefore is recommended as an effective treatment option for dealing with osteoporotic vertebral collapse and kyphotic deformity. PMID:27995144

  4. Structural Femoral Shaft Allografts for Anterior Spinal Column Reconstruction in Osteoporotic Spines.

    PubMed

    Chang, Bong-Soon; Jung, Jong-Hun; Park, Sang-Min; Lee, Seung Hoo; Lee, Choon-Ki; Kim, Hyoungmin

    2016-01-01

    This study was to investigate the clinical and radiographical outcomes of anterior spinal column reconstruction using structural femoral shaft allografts in osteoporotic patients. Retrospective analyses of medical records, radiographic parameters, and postoperative complications were performed in twenty-one patients who underwent anterior spinal column reconstruction surgery for osteoporotic vertebral collapse or nonunion. Surgical invasiveness, clinical outcomes, postoperative complications, and radiographic outcomes were evaluated. Ambulatory status and back pain significantly improved. The Cobb's angle of segmental kyphosis significantly improved immediately after surgery with slight progression at the final follow-up. There were two cases of failed reconstruction with marked progression of kyphosis; both were related to loosening of screws rather than subsidence of the graft. Anterior spinal column reconstruction using femoral shaft allografts improved kyphosis and resulted in minimal subsidence and therefore is recommended as an effective treatment option for dealing with osteoporotic vertebral collapse and kyphotic deformity.

  5. FAQs about Spinal Cord Injury (SCI)

    MedlinePlus

    ... spinal cord injury? Where is the nearest SCI Model System of Care? Emergency Medical Services Hospital (Acute) Care Rehabilitation More ... spinal cord injury? Where is the nearest SCI Model System of Care? Follow Us! Get Email Updates Questions & Comments Suggest ...

  6. Genetics Home Reference: spinal muscular atrophy

    MedlinePlus

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

  7. Rehabilitation in spinal infection diseases

    PubMed Central

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

    2015-01-01

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

  8. Rehabilitation in spinal infection diseases.

    PubMed

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

    2015-01-18

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

  9. Cerebellar and Spinal Direct Current Stimulation in Children: Computational Modeling of the Induced Electric Field

    PubMed Central

    Fiocchi, Serena; Ravazzani, Paolo; Priori, Alberto; Parazzini, Marta

    2016-01-01

    Recent studies have shown that the specific application of transcranial direct current stimulation (tDCS) over the cerebellum can modulate cerebellar activity. In parallel, transcutaneous spinal DC stimulation (tsDCS) was found to be able to modulate conduction along the spinal cord and spinal cord functions. Of particular interest is the possible use of these techniques in pediatric age, since many pathologies and injuries, which affect the cerebellar cortex as well as spinal cord circuits, are diffuse in adults as well as in children. Up to now, experimental studies of cerebellar and spinal DC stimulation on children are completely missing and therefore there is a lack of information about the safety of this technique as well as the appropriate dose to be used during the treatment. Therefore, the knowledge of electric quantities induced into the cerebellum and over the spinal cord during cerebellar tDCS and tsDCS, respectively, is required. This work attempts to address this issue by estimating through computational techniques, the electric field distributions induced in the target tissues during the two stimulation techniques applied to different models of children of various ages and gender. In detail, we used four voxel child models, aged between 5- and 8-years. Results revealed that, despite inter-individual differences, the cerebellum is the structure mainly involved by cerebellar tDCS, whereas the electric field generated by tsDCS can reach the spinal cord also in children. Moreover, it was found that there is a considerable spread toward the anterior area of the cerebellum and the brainstem region for cerebellar tDCS and in the spinal nerve for spinal direct current stimulation. Our study therefore predicts that the electric field spreads in complex patterns that strongly depend on individual anatomy, thus giving further insight into safety issues and informing data for pediatric investigations of these stimulation techniques. PMID:27799905

  10. Cerebellar and Spinal Direct Current Stimulation in Children: Computational Modeling of the Induced Electric Field.

    PubMed

    Fiocchi, Serena; Ravazzani, Paolo; Priori, Alberto; Parazzini, Marta

    2016-01-01

    Recent studies have shown that the specific application of transcranial direct current stimulation (tDCS) over the cerebellum can modulate cerebellar activity. In parallel, transcutaneous spinal DC stimulation (tsDCS) was found to be able to modulate conduction along the spinal cord and spinal cord functions. Of particular interest is the possible use of these techniques in pediatric age, since many pathologies and injuries, which affect the cerebellar cortex as well as spinal cord circuits, are diffuse in adults as well as in children. Up to now, experimental studies of cerebellar and spinal DC stimulation on children are completely missing and therefore there is a lack of information about the safety of this technique as well as the appropriate dose to be used during the treatment. Therefore, the knowledge of electric quantities induced into the cerebellum and over the spinal cord during cerebellar tDCS and tsDCS, respectively, is required. This work attempts to address this issue by estimating through computational techniques, the electric field distributions induced in the target tissues during the two stimulation techniques applied to different models of children of various ages and gender. In detail, we used four voxel child models, aged between 5- and 8-years. Results revealed that, despite inter-individual differences, the cerebellum is the structure mainly involved by cerebellar tDCS, whereas the electric field generated by tsDCS can reach the spinal cord also in children. Moreover, it was found that there is a considerable spread toward the anterior area of the cerebellum and the brainstem region for cerebellar tDCS and in the spinal nerve for spinal direct current stimulation. Our study therefore predicts that the electric field spreads in complex patterns that strongly depend on individual anatomy, thus giving further insight into safety issues and informing data for pediatric investigations of these stimulation techniques.

  11. Experimental Deformation of Magnetite

    NASA Astrophysics Data System (ADS)

    Till, J. L.; Rybacki, E.; Morales, L. F. G.

    2015-12-01

    Magnetite is an important iron ore mineral and the most prominent Fe-oxide phase in the Earth's crust. The systematic occurrence of magnetite in zones of intense deformation in oceanic core complexes suggests that it may play a role in strain localization in some silicate rocks. We performed a series of high-temperature deformation experiments on synthetic magnetite aggregates and natural single crystals to characterize the rheological behavior of magnetite. As starting material, we used fine-grained magnetite powder that was hot isostatically pressed at 1100°C for several hours, resulting in polycrystalline material with a mean grain size of around 40 μm and containing 3-5% porosity. Samples were deformed to 15-20% axial strain under constant load (approximating constant stress) conditions in a Paterson-type gas apparatus for triaxial deformation at temperatures between 900 and 1100°C and 300 MPa confining pressure. The aggregates exhibit typical power-law creep behavior. At high stresses, samples deformed by dislocation creep exhibit stress exponents close to 3, revealing a transition to near-Newtonian creep with stress exponents around 1.3 at lower stresses. Natural magnetite single crystals deformed at 1 atm pressure and temperatures between 950°C and 1150 °C also exhibit stress exponents close to 3, but with lower flow stresses and a lower apparent activation energy than the aggregates. Such behavior may result from the different oxygen fugacity buffers used. Crystallographic-preferred orientations in all polycrystalline samples are very weak and corroborate numerical models of CPO development, suggesting that texture development in magnetite may be inherently slow compared with lower symmetry phases. Comparison of our results with experimental deformation data for various silicate minerals suggests that magnetite should be weaker than most silicates during ductile creep in dry igneous rocks.

  12. Regenerative Potential of Ependymal Cells for Spinal Cord Injuries Over Time.

    PubMed

    Li, Xiaofei; Floriddia, Elisa M; Toskas, Konstantinos; Fernandes, Karl J L; Guérout, Nicolas; Barnabé-Heider, Fanie

    2016-11-01

    Stem cells have a high therapeutic potential for the treatment of spinal cord injury (SCI). We have shown previously that endogenous stem cell potential is confined to ependymal cells in the adult spinal cord which could be targeted for non-invasive SCI therapy. However, ependymal cells are an understudied cell population. Taking advantage of transgenic lines, we characterize the appearance and potential of ependymal cells during development. We show that spinal cord stem cell potential in vitro is contained within these cells by birth. Moreover, juvenile cultures generate more neurospheres and more oligodendrocytes than adult ones. Interestingly, juvenile ependymal cells in vivo contribute to glial scar formation after severe but not mild SCI, due to a more effective sealing of the lesion by other glial cells. This study highlights the importance of the age-dependent potential of stem cells and post-SCI environment in order to utilize ependymal cell's regenerative potential.

  13. Timing of Surgery After Spinal Cord Injury.

    PubMed

    Piazza, Matthew; Schuster, James

    2017-01-01

    Although timing for surgical intervention after spinal cord injury remains controversial, there is accumulating evidence suggesting that early surgery may improve neurologic outcomes, particularly with incomplete spinal cord injury, and may reduce non-neurologic complications and health care resource utilization. Moreover, even in patients with complete spinal cord injury, minor improvement in neurologic function can lead to significant changes in quality of life. This article reviews the experimental and clinical data examining surgical timing after spinal cord injury.

  14. Navigation and Robotics in Spinal Surgery: Where Are We Now?

    PubMed

    Overley, Samuel C; Cho, Samuel K; Mehta, Ankit I; Arnold, Paul M

    2017-03-01

    Spine surgery has experienced much technological innovation over the past several decades. The field has seen advancements in operative techniques, implants and biologics, and equipment such as computer-assisted navigation and surgical robotics. With the arrival of real-time image guidance and navigation capabilities along with the computing ability to process and reconstruct these data into an interactive three-dimensional spinal "map", so too have the applications of surgical robotic technology. While spinal robotics and navigation represent promising potential for improving modern spinal surgery, it remains paramount to demonstrate its superiority as compared to traditional techniques prior to assimilation of its use amongst surgeons.The applications for intraoperative navigation and image-guided robotics have expanded to surgical resection of spinal column and intradural tumors, revision procedures on arthrodesed spines, and deformity cases with distorted anatomy. Additionally, these platforms may mitigate much of the harmful radiation exposure in minimally invasive surgery to which the patient, surgeon, and ancillary operating room staff are subjected.Spine surgery relies upon meticulous fine motor skills to manipulate neural elements and a steady hand while doing so, often exploiting small working corridors utilizing exposures that minimize collateral damage. Additionally, the procedures may be long and arduous, predisposing the surgeon to both mental and physical fatigue. In light of these characteristics, spine surgery may actually be an ideal candidate for the integration of navigation and robotic-assisted procedures.With this paper, we aim to critically evaluate the current literature and explore the options available for intraoperative navigation and robotic-assisted spine surgery.

  15. Intramedullary spinal metastasis of a carcinoid tumor.

    PubMed

    Kumar, Jay I; Yanamadala, Vijay; Shin, John H

    2015-12-01

    We report an intramedullary spinal cord metastasis from a bronchial carcinoid, and discuss its mechanisms and management. Intramedullary spinal cord metastases from any cancer are rare, and bronchial carcinoids account for only a small fraction of lung cancers. To our knowledge, an intramedullary spinal cord metastasis from a bronchial carcinoid has been described only once previously.

  16. Cervical epidural hematoma after chiropractic spinal manipulation.

    PubMed

    Heiner, Jason D

    2009-10-01

    Spinal epidural hematoma is a rare but potentially devastating complication of spinal manipulation therapy. This is a case report of a healthy pregnant female who presented to the emergency department with a cervical epidural hematoma resulting from chiropractic spinal manipulation therapy that responded to conservative treatment rather than the more common route of surgical management.

  17. Evaluation of spinal cord injury animal models

    PubMed Central

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

    2014-01-01

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

  18. Motorcycle-related spinal injury: crash characteristics.

    PubMed

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

    2012-11-01

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

  19. Aquaporins in the Spinal Cord

    PubMed Central

    Oklinski, Michal K.; Skowronski, Mariusz T.; Skowronska, Agnieszka; Rützler, Michael; Nørgaard, Kirsten; Nieland, John D.; Kwon, Tae-Hwan; Nielsen, Søren

    2016-01-01

    Aquaporins (AQPs) are water channel proteins robustly expressed in the central nervous system (CNS). A number of previous studies described the cellular expression sites and investigated their major roles and function in the brain and spinal cord. Among thirteen different mammalian AQPs, AQP1 and AQP4 have been mainly studied in the CNS and evidence has been presented that they play important roles in the pathogenesis of CNS injury, edema and multiple diseases such as multiple sclerosis, neuromyelitis optica spectrum disorders, amyotrophic lateral sclerosis, glioblastoma multiforme, Alzheimer’s disease and Parkinson’s disease. The objective of this review is to highlight the current knowledge about AQPs in the spinal cord and their proposed roles in pathophysiology and pathogenesis related to spinal cord lesions and injury. PMID:27941618

  20. Spinal reflexes in brain death.

    PubMed

    Beckmann, Yesim; Çiftçi, Yeliz; Incesu, Tülay Kurt; Seçil, Yaprak; Akhan, Galip

    2014-12-01

    Spontaneous and reflex movements have been described in brain death and these unusual movements might cause uncertainties in diagnosis. In this study we evaluated the presence of spinal reflexes in patients who fulfilled the criteria for brain death. Thirty-two (22 %) of 144 patients presented unexpected motor movements spontaneously or during examinations. These patients exhibited the following signs: undulating toe, increased deep tendon reflexes, plantar responses, Lazarus sign, flexion-withdrawal reflex, facial myokymia, neck-arm flexion, finger jerks and fasciculations. In comparison, there were no significant differences in age, sex, etiology of brain death and hemodynamic laboratory findings in patients with and without reflex motor movement. Spinal reflexes should be well recognized by physicians and it should be born in mind that brain death can be determined in the presence of spinal reflexes.

  1. Syringomyelia associated with adhesive spinal arachnoiditis: MRI.

    PubMed

    Inoue, Y; Nemoto, Y; Ohata, K; Daikokuya, H; Hakuba, A; Tashiro, T; Shakudo, M; Nagai, K; Nakayama, K; Yamada, R

    2001-04-01

    We reviewed the MRI of seven patients with syringomyelia associated with surgically proven adhesive spinal arachnoiditis to describe clinical and MRI findings in this condition. Using 0.5, 1.0 or 1.5 tesla units, we obtained sagittal T1- and T2-weighted spin-echo and axial T1-weighted images. Additional sagittal T2-weighted images were obtained without using motion-artefact suppression. Contrast medium was given intravenously to five patients. The syrinx cavities were thoracic in five cases, cervicothoracic in one, and extended from C4 to L1 in one. No Chiari malformation or craniovertebral junction anomaly was demonstrated. Meningeal thickening was seen on T2-weighted sagittal images only in one case. Cord deformity due to adhesion or displacement due to an associated arachnoid cyst was seen in all cases best demonstrated on axial images. Focal blurring of the syrinx wall on axial images was seen in six patients. Flow voids were seen in the syrinx fluid in all cases on T2-weighted images obtained without motion-artefact suppression. No abnormal contrast enhancement was demonstrated.

  2. The spinal cord in rheumatoid arthritis with clinical myelopathy: a computed myelographic study.

    PubMed Central

    Stevens, J M; Kendall, B E; Crockard, H A

    1986-01-01

    Thirty one patients with suspected myelopathy due to rheumatoid arthritis were examined by plain radiography and 27 had computed myelography. Clinical features and radiological findings were compared. Deformity of the spinal cord could occur in the absence of combined anterior and posterior compression and correlated closely with clinical features only when considered in combination with skeletal and adjacent soft tissue abnormalities. The best surgical results were achieved by transoral odontoidectomy. Images PMID:3950633

  3. Muscle Activity Adaptations to Spinal Tissue Creep in the Presence of Muscle Fatigue

    PubMed Central

    Nougarou, François

    2016-01-01

    Aim The aim of this study was to identify adaptations in muscle activity distribution to spinal tissue creep in presence of muscle fatigue. Methods Twenty-three healthy participants performed a fatigue task before and after 30 minutes of passive spinal tissue deformation in flexion. Right and left erector spinae activity was recorded using large-arrays surface electromyography (EMG). To characterize muscle activity distribution, dispersion was used. During the fatigue task, EMG amplitude root mean square (RMS), median frequency and dispersion in x- and y-axis were compared before and after spinal creep. Results Important fatigue-related changes in EMG median frequency were observed during muscle fatigue. Median frequency values showed a significant main creep effect, with lower median frequency values on the left side under the creep condition (p≤0.0001). A significant main creep effect on RMS values was also observed as RMS values were higher after creep deformation on the right side (p = 0.014); a similar tendency, although not significant, was observed on the left side (p = 0.06). A significant creep effects for x-axis dispersion values was observed, with higher dispersion values following the deformation protocol on the left side (p≤0.001). Regarding y-axis dispersion values, a significant creep x fatigue interaction effect was observed on the left side (p = 0.016); a similar tendency, although not significant, was observed on the right side (p = 0.08). Conclusion Combined muscle fatigue and creep deformation of spinal tissues led to changes in muscle activity amplitude, frequency domain and distribution. PMID:26866911

  4. Enhanced UV-B radiation during pupal stage reduce body mass