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Sample records for cervical spinal canal

  1. Cervical spinal canal narrowing and cervical neurologi-cal injuries

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    ZHANG Ling

    2012-04-01

    Full Text Available 【Abstract】Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms in-cluding neck pain, headache, weakness and parasthesisas. According to previous and recent clinical researches, we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio. The mean sagittal diameter of cervical spinal canal at C 1 to C 7 ranges from 15.33 mm to 20.46 mm, the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96. With respect to narrow cervical spinal canal, the following charaterstics are found: firstly, extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly, females sustain cervical spinal canal narrowing more easily than males; finally, the consistent narrowest cervical canal level is at C 4 for all ethnicity, but there is a slight variation in the sagittal diameter of cervical spinal stenosis (≤14 mm in Whites, ≤ 12 mm in Japanese, ≤13.7 mm in Chinese. Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic, degenerative and inflam-matory conditions and is related with extension of cervical spine, gender, as well as ethnicity. It is hoped that this re-view will be helpful in diagnosing spinal cord and neuro-logical injuries with the geometric parameters of cervical spine in the future. Key words: Spinal cord injuries; Spinal stenosis; Trauma, nervous system

  2. Cervical spinal canal narrowing and cervical neurological injuries

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ling; CHEN Hai-bin; WANG Yi; ZHANG Li-ying; LIU Jing-cheng; WANG Zheng-guo

    2012-01-01

    Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms including neck pain,headache,weakness and parasthesisas.According to previous and recent clinical researches,we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio.The mean sagittal diameter of cervical spinal canal at C1 to C7 ranges from 15.33 mm to 20.46 mm,the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96.With respect to narrow cervical spinal canal,the following charaterstics are found:firstly,extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly,females sustain cervical spinal canal narrowing more easily than males;finally,the consistent narrowest cervical canal level is at C4 for all ethnicity,but there is a slight variation in the sagittal diameter of cervical spinal stenosis(≤ 14 mm in Whites,≤12 mm in Japanese,≤ 13.7 mm in Chinese).Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic,degenerative and inflammatory conditions and is related with extension of cervical spine,gender,as well as ethnicity.It is hoped that this review will be helpful in diagnosing spinal cord and neurological injuries with the geometric parameters of cervical spine in the future.

  3. Cervical spinal canal narrowing in idiopathic syringomyelia

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    Struck, Aaron F. [Massachusetts General Hospital, Department of Neurology, Boston, MA (United States); Carr, Carrie M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shah, Vinil [University of California San Francisco, Department of Radiology, San Francisco, CA (United States); Hesselink, John R. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Haughton, Victor M. [University of Wisconsin, Department of Radiology, Madison, WI (United States)

    2016-08-15

    The cervical spine in Chiari I patient with syringomyelia has significantly different anteroposterior diameters than it does in Chiari I patients without syringomyelia. We tested the hypothesis that patients with idiopathic syringomyelia (IS) also have abnormal cervical spinal canal diameters. The finding in both groups may relate to the pathogenesis of syringomyelia. Local institutional review boards approved this retrospective study. Patients with IS were compared to age-matched controls with normal sagittal spine MR. All subjects had T1-weighted spin-echo (500/20) and T2-weighted fast spin-echo (2000/90) sagittal cervical spine images at 1.5 T. Readers blinded to demographic data and study hypothesis measured anteroposterior diameters at each cervical level. The spinal canal diameters were compared with a Mann-Whitney U test. The overall difference was assessed with a Friedman test. Seventeen subjects were read by two reviewers to assess inter-rater reliability. Fifty IS patients with 50 age-matched controls were studied. IS subjects had one or more syrinxes varying from 1 to 19 spinal segments. Spinal canal diameters narrowed from C1 to C3 and then enlarged from C5 to C7 in both groups. Diameters from C2 to C4 were narrower in the IS group (p < 0.005) than in controls. The ratio of the C3 to the C7 diameters was also smaller (p = 0.004) in IS than controls. Collectively, the spinal canal diameters in the IS were significantly different from controls (Friedman test p < 0.0001). Patients with IS have abnormally narrow upper and mid cervical spinal canal diameters and greater positive tapering between C3 and C7. (orig.)

  4. Upper cervical spinal cord compression due to bony stenosis of the spinal canal.

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    Benitah, S; Raftopoulos, C; Balériaux, D; Levivier, M; Dedeire, S

    1994-04-01

    Compression of the upper cervical spinal cord due to stenosis of the bony spinal canal is infrequent. In the first case reported here, stenosis was due to acquired extensive, unilateral osteophytes centered on the left apophyseal joints of C1-C2 in an elderly professional violinist. In the second case, stenosis was secondary to isolated congenital hypertrophy of the laminae of C1 and C2.

  5. +Gz associated stenosis of the cervical spinal canal in fighter pilots.

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    Hämäläinen, O; Toivakka-Hämäläinen, S K; Kuronen, P

    1999-04-01

    Previous magnetic resonance imaging (MRI) studies have shown that repeated exposure to +Gz forces can cause premature degenerative changes of the cervical spine (i.e. a work-related disease). This paper reports on two clinical cases of +Gz-associated degenerative cervical spinal stenosis caused by dorsal osteophytes in fighter pilots. Conventional x-rays and MRI were used to demonstrate narrowing of the cervical spinal canal. The first case was complicated by a C6-7 intervertebral disk prolapse and a congenitally narrow spinal canal. The second case involved progressive degenerative spinal stenosis in the C5-6 disk space which required surgery. The findings in this case were confirmed by surgery which showed posterior osteophytes and thickened ligaments compressing the cervical medulla. These two cases suggest that +Gz forces can cause degenerative spinal stenosis of the cervical spine. Flight safety may be jeopardized if symptoms and signs of medullar compression occur during high +Gz stress. It is recommended that student fighter pilots undergo conventional x-rays and MRI studies in order to screen out and reject candidates with a congenitally narrow spinal canal. These examination methods might be useful in fighter pilots' periodic medical check-ups in order to reveal acquired degenerative spinal stenosis.

  6. Unusual magnetic resonance characteristics of a cerebellopontine angle epidermoid cyst with upper cervical spinal canal extension.

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    Teo, Beng-Tiong; Lin, Chao-chun; Chiou, Tsung-Lang; Chen, Shang-Chi; Yen, Pao-Sheng

    2006-08-01

    We present a 27-year-old woman with an epidermoid cyst at the cerebellopontine (CP) angle with caudal extension into the upper cervical spinal canal. The lesion showed unusual hyperintensity on T1-weighted images, and hypointensity on T2-weighted images. We used microneurosurgical techniques for tumour dissection and excision. To our knowledge, this is the fifth example in Index Medicus/MEDLINE of histopathologically proven CP angle epidermoid with cervical spine extension.

  7. Comparative evaluation of surgical alternatives in the treatment of acute cervical myelopathy and in the decompression of cervical spinal canal

    Institute of Scientific and Technical Information of China (English)

    Gbor Cziglczki; Zoltn Papp; Csaba Padnyi; Pter Banczerowski

    2014-01-01

    Symptoms of cervical myelopathy are caused by the compression of the cervical spinal cord in the narrowed spinal canal.Several techniques including less invasive and minimally invasive methods have been developed with the aim of decompressing the cervical spinal canal, preserving posterior motion segments and paraspinal muscles as much as possible, reducing iatrogenic consequences and promoting faster recoveries of patients.The purpose of this article is to summarize these procedures and evaluate their efficacy with comparing them to each other. The applicable methods are presented shortly but the differences between them are discussed in details.Comprehensive examination did not reveal the proven superiority of any techniques and in most cases the less invasive or minimally invasive treatment choices should be individually determined, considering the location and extension of pathology and the familiarity of surgeon with techniques.

  8. Comparative evaluation of surgical alternatives in the treatment of acute cervical myelopathy and in the decompression of cervical spinal canal

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    Gábor Czigléczki

    2014-01-01

    Full Text Available Symptoms of cervical myelopathy are caused by the compression of the cervical spinal cord in the narrowed spinal canal. Several techniques including less invasive and minimally invasive methods have been developed with the aim of decompressing the cervical spinal canal, preserving posterior motion segments and paraspinal muscles as much as possible, reducing iatrogenic consequences and promoting faster recoveries of patients. The purpose of this article is to summarize these procedures and evaluate their efficacy with comparing them to each other. The applicable methods are presented shortly but the differences between them are discussed in details. Comprehensive examination did not reveal the proven superiority of any techniques and in most cases the less invasive or minimally invasive treatment choices should be individually determined, considering the location and extension of pathology and the familiarity of surgeon with techniques.

  9. Effective lordosis: analysis of sagittal spinal canal alignment in cervical spondylotic myelopathy.

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    Gwinn, David E; Iannotti, Christopher A; Benzel, Edward C; Steinmetz, Michael P

    2009-12-01

    Analysis of cervical sagittal deformity in patients with cervical spondylotic myelopathy (CSM) requires a thorough clinical and radiographic evaluation to select the most appropriate surgical approach. Angular radiographic measurements, which are commonly used to define sagittal deformity, may not be the most appropriate to use for surgical planning. The authors present a simple straight-line method to measure effective spinal canal lordosis and analyze its reliability. Furthermore, comparisons of this measurement to traditional angular measurements of sagittal cervical alignment are made in regards to surgical planning in patients with CSM. Twenty preoperative lateral cervical digital radiographs of patients with CSM were analyzed by 3 independent observers on 3 separate occasions using a software measurement program. Sagittal measurements included C2-7 angles utilizing the Cobb and posterior tangent methods, as well as a straight-line method to measure effective spinal canal lordosis from the dorsal-caudal aspect of the C2-7 vertebral bodies. Analysis of variance for repeated measures or Cohen 3-way (kappa) correlation coefficient analysis was performed as appropriate to calculate the intra- and interobserver reliability for each parameter. Discrepancies in angular and effective lordosis measurements were analyzed. Intra- and interobserver reliability was excellent (intraclass coefficient > 0.75, kappa > 0.90) utilizing all 3 techniques. Four discrepancies between angular and effective lordotic measurements occurred in which images with a lordotic angular measurement did not have lordosis within the ventral spinal canal. These discrepancies were caused by either spondylolisthesis or dorsally projecting osteophytes in all cases. Although they are reliable, traditional methods used to make angular measurements of sagittal cervical spine alignment do not take into account ventral obstructions to the spinal cord. The effective lordosis measurement method provides a

  10. MULTIPLE SPINAL CANAL MENINGIOMAS

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    Nandigama Pratap Kumar

    2016-10-01

    Full Text Available BACKGROUND Meningiomas of the spinal canal are common tumours with the incidence of 25 percent of all spinal cord tumours. But multiple spinal canal meningiomas are rare in compare to solitary lesions and account for 2 to 3.5% of all spinal meningiomas. Most of the reported cases are both intra cranial and spinal. Exclusive involvement of the spinal canal by multiple meningiomas are very rare. We could find only sixteen cases in the literature to the best of our knowledge. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for single lesion. We analysed the literature, with illustration of our case. MATERIALS AND METHODS In September 2016, we performed a literature search for multiple spinal canal meningiomas involving exclusively the spinal canal with no limitation for language and publication date. The search was conducted through http://pubmed.com, a wellknown worldwide internet medical address. To the best of our knowledge, we could find only sixteen cases of multiple meningiomas exclusively confined to the spinal canal. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for solitary intradural extra medullary spinal canal meningioma at D4-D6 level, again presented with spastic quadriparesis of two years duration and MRI whole spine demonstrated multiple intradural extra medullary lesions, which were excised completely and the histopathological diagnosis was transitional meningioma. RESULTS Patient recovered from his weakness and sensory symptoms gradually and bladder and bowel symptoms improved gradually over a period of two to three weeks. CONCLUSION Multiple

  11. MRI Findings in Spinal Canal Stenosis

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    Maryam Barzin

    2010-05-01

    Full Text Available Spinal canal stenosis results from progressive narrowing of the central spinal canal and the lateral recesses. Primary (congenital lumbar spinal stenosis is associated with achondroplastic dwarfism. The spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposus posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the facet joints, hypertrophy of the ligamentum flavum, epidural fat deposition, spondylosis of the intervertebral disc margins and uncovertebral joint hypertrophy in the neck. The central canal and the neurorecess may be compromised by tumor infiltration, such as metastatic disease, or by infectious spondylitis."nAP diameter of the normal adult cervical canal has a mean value of 17-18 mm at vertebral levels C3-5. The lower cervical canal measures 12-14 mm. Cervical stenosis is associated with an AP diameter of less than 10 mm. The thoracic spinal canal varies from 12 to 14 mm in diameter in the adult. The diameter of the normal lumbar spinal canal varies from 15 to 27 mm. Lumbar stenosis results from a spinal canal diameter of less than 12 mm in some patients; a diameter of 10 mm is definitely stenotic."nSpinal MRI is the most suitable technique for the diagnosis of spinal stenosis. The examination should be performed using thin sections (3 mm and high resolution, including the axial and sagittal planes using T1-weighted, proton-density, and T2-weighted techniques. The bony and osteophytic components are seen best using a T2-weighted gradient-echo technique."nOn MRI, findings of spinal stenosis have a variable presentation depending on the specific disease. The goal of spinal imaging is to localize the site and level of disease and to help differentiate between conditions in which patients require surgery or conservative treatment."nIn this presentation, different kinds of spinal canal stenosis and their MRI findings would be discussed.

  12. 颈椎管容积和脊髓体积的MRI测量及其动态变化%Dynamic measurement of cervical spinal canal and cervical spinal cord volume

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    钱军; 申才良; 荆珏华; 田大胜

    2009-01-01

    目的 利用核磁共振测量正常人的颈椎管容积及脊髓的体积,并探讨其动态变化趋势.方法 选取正常人20名,排除退变、畸形和对扫描发生恐惧者4名,利用MRI无间隔梯度扰像回波序列方式分别扫描并测量过屈、中立、过伸位下各颈椎椎管容积和脊髓的体积,并进行统计学分析.结果 过屈、中立、过伸三种体位下正常人的颈椎管容积改变趋势为V过屈V中立V过伸,且三个体位下的容积差异有显著性(P0.05);过屈、中立和过伸位下脊髓的体积差异均无统计学意义(P>0.05),颈段脊髓的体积约10.69±0.56cm3.结论 颈椎由过屈向过伸动态变化过程中,颈椎管的容积是逐渐减小的,且颈椎管容积的改变主要发生在颈3~颈7节段;但颈段脊髓的体积是固定不变的,脊髓的形态和在椎管内的位置是变化的.%Objectives To measure the cervical spinal canal and cervical spinal cord volume of healthy people during MRI,and also to evaluate the dynamic changes of the cervical spinal canal and cervical spinal cord volume with the angle change of the cervical vertebrae. Methods Twenty healthy people are chosen to experiment,and four individuals of all are excluded because of degeneration,deformity or in fear of the scan. The remaining 16 individuals are conducted MRI scan. Last,we analyze the conclusions and evaluate their dynamic changes. Results The volume of the cervical spinal canal reduced gradually. The volume was larger in flexion position than in the central position,and the volume was larger in central position than in the extension position,and al-so they had a significant difference (P0.05),the mean volume of cer-vical spinal cord were about 10.69±0.56cm3. Conclusion The volume of the cervical spinal canal decreases gradually with increasing extension angle,but the volume of the spinal cord is always the same size with changing the angle of cervical vertebrae,and the shape and location of the spinal

  13. A PET/CT-based Morphometric Study of Spinal Canal in Korean Young Adults: Anteroposterior Diameter from Cervical Vertebra to Sacrum

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    Kang, Moo Sung; Park, Jeong Yoon; Chin, Dong Kyu; Kim, Kyung Hyun; Kuh, Sung Uk; Kim, Keun Su; Cho, Yong Eun

    2012-01-01

    Objective To establish normative data for spinal canal AP diameter from cervical vertebra to sacrum in the Korean young and to assess the exposed spinal canal after laminectomy which was related with restenosis by post-laminectomy membrane formation. Methods From PET/CT, axial bone-window CT of 83 young adults (20-29 years) were obtained, and we measured AP diameters of C3, C5, C7, T1, T4, T8, T12, L1, L3, L5 and S1. We also measured exposed AP diameter of C3, C5, C7, T1 and T2 above imaginar...

  14. Spinal canal stenosis; Spinalkanalstenose

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    Papanagiotou, P.; Boutchakova, M. [Klinikum Bremen-Mitte/Bremen-Ost, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Bremen (Germany)

    2014-11-15

    Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which can lead to mechanical compression of spinal nerve roots or the dural sac. The lumbal spinal compression of these nerve roots can be symptomatic, resulting in weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain or atypical leg pain and neurogenic claudication. The anatomical presence of spinal canal stenosis is confirmed radiologically with computerized tomography, myelography or magnetic resonance imaging and play a decisive role in optimal patient-oriented therapy decision-making. (orig.) [German] Die Spinalkanalstenose ist eine umschriebene, knoechern-ligamentaer bedingte Einengung des Spinalkanals, die zur Kompression der Nervenwurzeln oder des Duralsacks fuehren kann. Die lumbale Spinalkanalstenose manifestiert sich klinisch als Komplex aus Rueckenschmerzen sowie sensiblen und motorischen neurologischen Ausfaellen, die in der Regel belastungsabhaengig sind (Claudicatio spinalis). Die bildgebende Diagnostik mittels Magnetresonanztomographie, Computertomographie und Myelographie spielt eine entscheidende Rolle bei der optimalen patientenbezogenen Therapieentscheidung. (orig.)

  15. Quantitative assessment of physiological cerebrospinal fluid flow in the cervical spinal canal with 3.0T phase-contrast cine MRI

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    Hua Shang; Huaijun Liu; Leka Yan; Jianming Lei; Caixia Cui; Hui Li

    2012-01-01

    A total of 50 healthy volunteers aged between 18 and 54 years underwent phase-contrast cine MRI to assess cerebrospinal fluid flow characteristics in different regions of the vertebral canal. The results revealed that the cerebrospinal fluid peak flow velocity and peak flow rate in the systolic phase were significantly greater than those in the diastolic phase at the same level in the subarachnoid space of the cervical spinal canal. The ventral peak flow velocity and peak flow rate were significantly greater than the post-lateral peak flow velocity and flow rate, while there were no differences between left and right post-lateral subarachnoid peak velocity and flow rate. Moreover, there were no significant differences in peak flow velocity and peak flow rate between the systolic and diastolic phases, ventral, right post-lateral or left post-lateral peak flow velocity and peak flow rate at the same level in the subarachnoid space of the cervical spinal canal among different age groups (18-24, 25-34, 35-44, ≥ 45 years).

  16. Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison

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    Savni R Satoskar

    2014-01-01

    Full Text Available Objective : The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ′Goel facet spacer′ in the treatment of degenerative spinal canal stenosis. Materials and Methods : Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results : The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. Conclusions : Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.

  17. Could spinal canal compression be a cause of polyneuropathy?

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    Richard Bostelmann

    2016-04-01

    Full Text Available Causality between spinal cord compression and polyneuropathy is difficult to define, especially under the circumstances that polyneuropathy can have many causes. Seven patients with spinal cord compression and electrophysiological signs of polyneuropathy were treated surgically on decompression of their spinal canal stenosis in the time from April 2010 to January 2013. Median follow up time was 9 months (2-23 months. Causes of polyneuropathy were: 1 patient with methotrexate-induced polyneuropathy, 1 endocrine-dysfunction-induced, 2 with diabetic- polyneuropathy, and 3 patients had unknown reasons. The localization of the spinal canal stenosis was also varying: 2 patients suffered of cervical spinal canal stenosis and 5 of lumbar. Decompressive surgery led to pain relieve in all patients initially. Surprisingly, also symptoms of polyneuropathy seemed to regress in all 7 patients for the first 5 months after surgery, and in 5 patients for the time of 9 months after surgery. There are two points we would like to emphasize in this short report. Since 5/7 patients with polyneuropathy and spinal canal stenosis improved clinically after surgery, surgery has a place in the treatment of such a combined pathology. Since it seems to be a possible causality between polyneuropathy of unknown origin and spinal cord stenosis, decompression of the spinal canal could also be a therapeutic step in a specific kind of polyneuropathy. Which patients could possibly have a spinal canal stenosis induced polyneuropathy remains a subject of further studies.

  18. MRI Findings in Spinal Canal Stenosis

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    Maryam Barzin

    2010-01-01

    Spinal canal stenosis results from progressive narrowing of the central spinal canal and the lateral recesses. Primary (congenital) lumbar spinal stenosis is associated with achondroplastic dwarfism. The spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposus posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the facet joints, hypertrophy of the ligamentum flavum, epidural fat deposition, spon...

  19. Nuclear magnetic resonance tomography of the cervical canal

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    Terwey, B.; Koschorek, F.; Jensen, H.P.

    1985-12-01

    170 patients with suspected lesions of the cervical part of the medulla were examined using nuclear magnetic resonance (NMR) tomography. 27 cases revealed no pathological changes in the regions of the cervical medulla, the cervical canal and of the cervical spine. 143 cases produced pathological findings whose diagnoses determined therapeutical approach. Verified pathological changes comprised anomalies of the cranio-cervical junction like basilar impression and Arnold-Chiari malformation, various types of cavity formation in the cervical medulla (syringomyelia, hydromyelia), demyelinization processes, intramedullary and extramedullary tumours, intervertebral disk degeneration processes, dislocation of intervertebral disks and spondylophytes with spinal stenoses. Sagittal sections in different functional positions allowed to demonstrate the biomechanical effects of extramedullary masses on the cervical medulla. However, proven tumours could not be differentiated successfully using histological methods. Nevertheless, NMR tomography will replace invasive methods like conventional cervical myelography and CT myelography in diagnostic clarification of diseases of the cervical medulla.

  20. Developmental spinal canal stenosis and somatotype.

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    Nightingale, S.

    1989-01-01

    The hypothesis that somatotype and cervical spine developmental canal stenosis may be associated has been investigated by anthropometry and measurement of lateral projection cervical spine radiographs. A significant association of canal size with somatotype has been found such that those with developmentally narrow canals are more likely to have relatively shorter long-bones, particularly in the upper arm, and longer trunks.

  1. The Epidemiological Study on Cervical Spinal Canal Ratio of Xinjiang Uighur%新疆维吾尔族人正常颈椎管率的流行病学研究

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    张鹰; 杨宇; 凯赛尔江·艾合买提; 徐子昂; 倪鹏辉

    2016-01-01

    目的:研究新疆维吾尔族正常颈椎管率的流行病学特点。方法应用随机、整群、分层抽样法,抽取新疆5个市(喀什、和田、吐鲁番、哈密、伊宁)健康成年人群脊柱样本,收集维吾尔民族不同性别、不同年龄组人群的正常颈椎侧位 X 线片,测量并统计颈椎 C2~7各节段椎管矢状径(a)及与其对应的椎体矢状径(b),并换算成颈椎管率(a/ b)。结果新疆维吾尔族的平均颈椎 C2~7节段(除 C4稍低于 C5节段外)椎管率呈现从高到低的趋势;不同性别间的椎管率在颈椎C2~7节段男性明显小于女性( P ﹤0.05),不同性别间的椎体矢状径在颈椎C2~7节段男性大于女性( P ﹤0.05),不同性别间的椎管矢状径在颈椎 C2~7节段女性与男性接近,差异无统计学意义(P ﹥0.05)。维吾尔族不同年龄组的颈椎管率在 C2、C3、C4、C6、C7节段的差异有统计学意义(P ﹤0.05),但不同年龄组颈椎管率在颈椎 C5节段的差异无统计学意义(P ﹥0.05),不同年龄组的椎管及椎体矢状径在颈椎 C2~7节段女性与男性接近,差异均无统计学意义(P ﹥0.05)。结论颈椎管率的相关测量结果揭示了新疆维吾尔族正常颈椎管率的流行病学特点,为临床应用及进一步基因学研究新疆维吾尔族颈椎管率的解剖学和遗传学的特点提供统计学依据。%Objective To study the epidemiological characteristics of the rate of cervical spinal canal of Xinjiang uygur. Methods We selected five cities(kashi,hotan,turpan,hami,yining)of Xinjiang and examed the adults of healthy spine as samples by random layer sampling method. Lateral X-ray of cervical vertebral of different genders groups and different age groups of Xinjiang uygur were collected. We measured sagittal diameter of vertebral canal(a)and the sagittal diameter of ver-tebral body(b)of each of cervical vertebra C2 ~ 7 and converted to

  2. MRI study on spinal canal content in Western Maharashtrian population

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    Khanapurkar SV, Kulkarni DO, Bahetee BH, Vahane MI

    2014-07-01

    Full Text Available The morphology of the spinal canal content has been studied since the invention of myelography. However, most studies have measured the diameters of the spinal cord only, not the size of the subarachnoid space. The present study complements the current data on the morphology of the spinal contents, and in particular, the spinal subarachnoid space, by analyzing MRI images. Objective: To study morphology of the dural sac, spinal cord & subarachnoid space using MRI. To define the inner geometrical dimensions of spinal canal content that confine the maneuver of an endoscope inserted in cervical spine. 3. To have comprehensive knowledge of the anatomy of cervical spinal canal. Method: Based on MRI images of the spine from 60 normal patients of age between 25-60 years, the dimensions of spinal cord, dural sac & subarachnoid space were measured at mid-vertebral & intervertebral level from C1-C7 vertebrae. The parameters measured were transverse, sagittal diameter of spinal cord & dural sac. The subarachnoid space was measured as anterior, posterior, right, left distance between spinal cord and dura mater. Results: It was found that at each selected transverse level, the subarachnoid space tends to be symmetrical on the right and left sides of the cord, and measures 3.38 mm on an average. However, the anterior and posterior segment, measured on the mid-sagittal plane are generally asymmetric & varies greatly in size ranging 1mm to 6mm with mean 2.57 of anterior & 2.59 of posterior. These measurements match those found in previous studies. The coefficient of variance for the dimensions of the subarachnoid space is as high as 36.16%, while that for the dimensions of the spinal cord (transverse & sagittal are11.08%&13.28%respectively. Conclusion: The findings presented here, expand our knowledge of morphology of spinal canal and show that a thecaloscope must be smaller than 3.38 mm in diameter.

  3. Classification, mechanism and surgical treatments for spinal canal cysts

    Institute of Scientific and Technical Information of China (English)

    Jianjun Sun

    2016-01-01

    A variety of cystic lesions may develop in spinal canal. These cysts can be divided into intramedullary, intradural, extradural, cervical, thoracic, lumbar, and sacral cysts according to anatomical presentation, as well as arachnoid, meningeal, perineural, juxtafacet, discal, neurenteric cysts, and cyst-like lesions according to different etiologies. Mechanisms of initiation and growth vary for different cysts, such as congenital, trauma, bleeding, inflammatory, instability, hydrostatic pressure, osmosis of water, secretion of cyst wall, and one-way-valve effect, etc. Up to now, many treatment methods are available for these different spinal canal cysts. One operation method can be applied in cysts with different types. On the other hand, several operation methods may be utilized in one type of cyst according to the difference of location or style. However, same principle should be obeyed in surgical treatment despite of difference among spinal canal cysts, given open surgery is melely for symptomatic cyst. The surgical approach should be tailored to the individual patient.

  4. MANAGEMENT OF LUMBAR SPINAL CANAL STENOSIS

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    Mukhergee G. S

    2016-06-01

    Full Text Available BACKGROUND Spinal stenosis is one of the most common conditions in the elderly. It is defined as a narrowing of the spinal canal. The term stenosis is derived from the Greek word for narrow, which is “Stenos”. The first description of this condition is attributed to Antoine portal in 1803. Verbiest is credited with coining the term spinal stenosis and the associated narrowing of the spinal canal as its potential cause. [1-10] Kirkaldy–Willis subsequently described the degenerative cascade in the lumbar spine as the cause for the altered anatomy and pathophysiology in spinal stenosis. [11-15] If compression does not occur, the canal should be described as narrow but not stenotic. Some studies defined lumbar spinal stenosis as a “narrowing of the osteoligamentous vertebral canal and/or the intervertebral foramina causing compression of the thecal sac and/or the caudal nerve roots; at a single vertebral level, narrowing may affect the whole canal or part of it” (Postacchini 1983. This definition distinguished between disc herniation and stenosis. [16] . The most common type of spinal stenosis is caused by degenerative arthritis of the spine. Hypertrophy and ossification of the posterior longitudinal ligament which usually are confined to the cervical spine, and diffuse idiopathic skeletal hyperostosis (DISH syndrome also may result in an acquired form of spinal stenosis. Congenital forms caused by disorders such as achondroplasia and dysplastic spondylolisthesis are much less common. Congenital spinal stenosis usually is central and is evident or imaging studies. Idiopathic congenital narrowing usually involves the anteroposterior dimension of the canal secondary to short pedicles; the patient otherwise is normal. In contrast, in achondroplasia, the canal is narrowed in the anteroposterior plane owing to shortened pedicles and in lateral dimension because of diminished interpedicular distance. Acquired forms of spinal stenosis usually are

  5. Transient oedema of the cervical spinal cord

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    Sartoretti-Schefer, S.; Kollias, S.; Valavanis, A. [Institute of Neuroradiology, University Hospital of Zuerich (Switzerland)

    2000-04-01

    Transient but very intense oedema of the cervical spinal cord was observed in two patients with obstruction of the cerebrospinal fluid (CSF) pathways. Both presented with hydrocephalus, one due to an infratentorial obstructing mass and the other due to postmeningitic adhesive obstruction of the outlet foramina of the fourth ventricle. In animal experiments with obstruction of CSF pathways (due to outlet foramina obstruction or to downward tentorial herniation) flattening and stretching of the ependymal cells along the central canal is observed, followed by disruption and splitting of the ependymal lining and then by extracellular oedema of the subependymal tissue. Without treatment, frank cavity formation develops in a fourth stage. In our two patients, however, most probably because of appropriate decompressive therapy, the oedema disappeared completely without a residual spinal cord lesion. (orig.)

  6. Cervical spinal cord injury without radiological abnormality in adults.

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    Bhatoe H

    2000-07-01

    Full Text Available Spinal cord injury occurring without concomitant radiologically demonstrable trauma to the skeletal elements of the spinal canal rim, or compromise of the spinal canal rim without fracture, is a rare event. Though documented in children, the injury is not very well reported in adults. We present seventeen adult patients with spinal cord injury without accompanying fracture of the spinal canal rim, or vertebral dislocation, seen over seven years. None had preexisting spinal canal stenosis or cervical spondylosis. Following trauma, these patients had weakness of all four limbs. They were evaluated by MRI (CT scan in one patient, which showed hypo / isointense lesion in the cord on T1 weighted images, and hyperintensity on T2 weighted images, suggesting cord contusion or oedema. MRI was normal in two patients. With conservative management, fifteen patients showed neurological improvement, one remained quadriplegic and one died. With increasing use of MRI in the evaluation of traumatic myelopathy, such injuries will be diagnosed more often. The mechanism of injury is probably acute stretching of the cord as in flexion and torsional strain. Management is essentially conservative and prognosis is better than that seen in patients with fracture or dislocation of cervical spine.

  7. MR determination of neonatal spinal canal depth

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    Arthurs, Owen, E-mail: owenarthurs@uk2.net [Centre for Cardiovascular MR, Great Ormond Street Hospital for Children, London WC1N 3JH (United Kingdom); Thayyil, Sudhin, E-mail: s.thayyil@ucl.ac.uk [Academic Neonatology, Institute for Women' s Health, London WC1E 6AU (United Kingdom); Wade, Angie, E-mail: a.wade@ucl.ac.uk [Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London (United Kingdom); Chong, W.K., E-mail: Kling.Chong@gosh.nhs.uk [Paediatric Neuroradiology, Great Ormond Street Hospital for Children, London (United Kingdom); Sebire, Neil J., E-mail: Neil.Sebire@gosh.nhs.uk [Histopathology, Great Ormond Street Hospital for Children, London WC1E 6AU (United Kingdom); Taylor, Andrew M., E-mail: a.taylor76@ucl.ac.uk [Centre for Cardiovascular MR, Cardiorespiratory Unit, Great Ormond Street Hospital for Children and UCL Institute of Cardiovascular Science, London WC1E 6AU (United Kingdom)

    2012-08-15

    Objectives: Lumbar punctures (LPs) are frequently performed in neonates and often result in traumatic haemorrhagic taps. Knowledge of the distance from the skin to the middle of the spinal canal (mid-spinal canal depth - MSCD) may reduce the incidence of traumatic taps, but there is little data in extremely premature or low birth weight neonates. Here, we determined the spinal canal depth at post-mortem in perinatal deaths using magnetic resonance imaging (MRI). Patients and methods: Spinal canal depth was measured in 78 post-mortem foetuses and perinatal cases (mean gestation 26 weeks; mean weight 1.04 kg) at the L3/L4 inter-vertebral space at post-mortem MRI. Both anterior (ASCD) and posterior (PSCD) spinal canal depth were measured; MSCD was calculated and modelled against weight and gestational age. Results: ASCD and PSCD (mm) correlated significantly with weight and gestational age (all r > 0.8). A simple linear model MSCD (mm) = 3 Multiplication-Sign Weight (kg) + 5 was the best fit, identifying an SCD value within the correct range for 87.2% (68/78) (95% CI (78.0, 92.9%)) cases. Gestational age did not add significantly to the predictive value of the model. Conclusion: There is a significant correlation between MSCD and body weight at post-mortem MRI in foetuses and perinatal deaths. If this association holds in preterm neonates, use of the formula MSCD (mm) = 3 Multiplication-Sign Weight (kg) + 5 could result in fewer traumatic LPs in this population.

  8. Cervical spinal meningioma mimicking intramedullary spinal tumor.

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    Senturk, Senem; Guzel, Aslan; Guzel, Ebru; Bayrak, Aylin Hasanefendioğlu; Sav, Aydin

    2009-01-01

    Case report. To report a very unusual spinal meningioma, mimicking an intramedullary spinal tumor. Spinal meningiomas, usually associated with signs and symptoms of cord or nerve root compression, are generally encountered in women aged over 40. Radiologic diagnosis is often established by their intradural extramedullary location on magnetic resonance images. A 60-year-old woman had a 6-month history of progressive weakness in her upper extremities, difficulty in walking, and cervical pain radiating through both arms. Neurologic examination revealed motor strength deficiency in all her extremities, with extensor reflexes, clonus, and bilateral hyper-reflexiveness. A sensory deficit was present all over her body. Magnetic resonance images revealed that the spinal cord appeared expanded with an ill-defined, homogeneously contrast-enhanced, lobulated, eccentric mass at the C1-C3 level. The patient was operated with a preliminary diagnosis of an intramedullary tumor. At surgery, the mass was found to be extramedullary, and gross total resection was performed. Histopathological examination revealed a meningioma characterized by the presence of fibrous and meningothelial components. The patient was able to ambulate with a cane, and extremity strength and sensation improved 2 months after surgery. Spinal meningiomas can mimic intramedullary tumors, and should be considered in differential diagnosis of intradural tumors with atypical appearance.

  9. "INTRAOPERATIVE SPINAL STIFFNESS MEASUREMENT IN MANAGEMENT OF SPINAL CANAL STENOSIS "

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    M. Karami

    2005-08-01

    Full Text Available In this study to determine whether spine stiffness is predictive of clinical results after lumbar spinal fusion for spinal stenosis, a total of 78 patients were measured intraoperatively with Kocher clamp manual distraction technique to determine motion segment stiffness then spinal fusion was performed for any loose segment. ‎Statistical analysis revealed that stiffness measurement correlate with clinical results of surgery. During a minimum of 2 years follow up after surgery, patients who had loose motion segment before or after decompression and were fused had the same level of satisfaction with surgical results as patients without loose segments and fusion. ‎We concluded that intraoperative spinal stiffness measurement provide a good indicator to spine fusion after lumbar canal stenosis ‎surgery.

  10. Cervical perineural cyst masquerading as a cervical spinal tumor.

    Science.gov (United States)

    Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha; Agrawal, Amit

    2014-04-01

    Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor.

  11. Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor

    Science.gov (United States)

    Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha

    2014-01-01

    Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204

  12. Non-contiguous spinal injury in cervical spinal trauma: evaluation with cervical spine MRI

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    Choi, Soo Jung; Shin, Myung Jin; Kim, Sung Moon [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Bae, Sang Jin [Sanggyepaik Hospital, Inje University, Seoul (Korea, Republic of)

    2004-12-15

    We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries. Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18-81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury. Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.5%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance ({rho} > 0.05). Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the non-contiguous CTJ or upper thoracic spinal injury.

  13. High cervical and lumbar canal stenosis of varied etiology : a case report.

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    Arunkumar M

    2002-01-01

    Full Text Available Developmental stenosis without any significant spondylotic changes frequently occurs at C3 vertebra or below, and typically extends to C6-C7. However, high cervical focal canal stenosis is unusual. A case of cervical canal segmental stenosis at C2-3 level in addition to a developmental stenosis of the lumbar region, in a 45 year old male, has been presented in this article. The dynamics of the spinal canal in relation to the likely pathology of such conditions are reviewed. We speculate that focal segmental stenosis in the high cervical region may be due to a possible premature fusion of the neurocentral synchondrosis of the cartilage, or due to an abnormal rotary biomechanics which can result in facetal hypertrophy.

  14. 高位颈段椎管内神经鞘瘤显微手术治疗59例%Microsurgical treatment of neurilemmoma in upper cervical spinal canal: 59 cases report

    Institute of Scientific and Technical Information of China (English)

    王林; 傅先明; 牛朝诗; 钱若兵; 凌士营; 计颖; 汪业汉

    2011-01-01

    目的 探讨高位颈段神经鞘瘤显微手术技巧和疗效.方法从2004年1月至2007年12月,对59例均采用后正中入路显微手术治疗,采用德国产Laika显微镜下切除肿瘤,较大肿瘤不能完整切除时,用分块切除或囊内切除,术后常规颈托限制颈部活动,55例术后随访6个月~2年.结果 痊愈54例,症状改善5例,无死亡.55例随访6个月~2年,4例失访.35例术后3~12个月MR检查未见肿瘤残存或复发,42例术后6个月颈椎正侧位及张口位片检查未见脊柱骨性结构变形,脊柱稳定性好.结论 高位颈段神经鞘瘤一旦确诊,就应该及早显微手术治疗.手术安全、效果良好.%Objective To explore surgical techniques and curative effects of microsurgical treatment for neurilemmoma in upper cervical spinal canal. Methods From Jan. 2004 to Nov. 2007, 59 cases of schwannoma was resected through microoperation, the operation was conducted through a posteromedial approach, using German Laika microscope resection of the tumor, large tumors cannot complete resection,block or sac, resection postoperative neck activity conventional neck restrictions, with following observation of 6 months-2 years. Results A complete recovery was achieved in 54 cases, an improvement of symptoms was achieved in 5 cases, no death was encountered. Follow-up observations were carried out in 55 cases from 3 months-2 years (6.5 ± 1.5 months). MRI examinations 3-12 months after operation in 35 cases found no residual or recurrent tumor. X-ray radiography under anteroposterior, lateral, and open-mouth view 6 months after operation in 42 cases showed no spinal deformation and good vertebral stability. Conclusions As long as neurilemmoma in upper cervical spinal canal are diagnosed, a microsurgical treatment should be given as early as possible. Appropriate selection of surgical approach, skillful microsurgical techniques in accordance with pathological types of lesions, and principles of minimal

  15. Differential diagnosis of cervical spinal cord demyelinating diseases and cervical intramedullary gliomas

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    Gui-nü HE

    2014-09-01

    Full Text Available Objective To analyze the imaging characteristics of cervical spinal cord demyelinating diseases and cervical intramedullary gliomas, so as to improve the differential diagnosis between them.  Methods A retrospective analysis was conducted using clinical and MRI data from 22 cases of cervical spinal cord demyelinating diseases and 16 cases of cervical intramedullary gliomas.  Results Clinical features in both groups included paresthesia [77.27% (17/22, 12/16], weakness of limbs [72.73% (16/22, 10/16], and dysfunction of autonomic nerve [45.45% (10/22, 4/16]. In cervical MRI, the lesions involving more than 3 vertebras were 63.64% (14/22 in demyelinating group and 15/16 in glioma group, and the average lengths of lesions were (3.41 ± 1.74 and (3.59 ± 1.28 vertebras in 2 groups. The lesions showed long T1 signal [68.18% (15/22, 7/16], equisignal T1 [31.82% (7/22, 6/16] and long T2 signal [100% (22/22, 8/15] in 2 groups. Mixed T1 and T2 signals (3/16, 6/15 could be seen in glioma group. Demyelinating lesions had unclear boundary [90.91% (20/22] with patchy and ribbon-like enhancement (13/16. Limited enlargement of spinal cord (15/16 and thickening spinal meninges (14/16 were more common in glioma group, usually with block and circular enhancement (12/16. Spinal cord involvement around central canal could be seen (14/15, and the cysts or central canal enlargement, hemorrhage and "cap sign" were showed frequently (7/16, 5/16 and 4/16.  Conclusions Although none of one single clinical or MRI feature was sufficient enough to identify cervical spinal demyelinating diseases from cervical glioma, the comprehensive analysis of multiple features could help to make differential diagnosis of these diseases. doi: 10.3969/j.issn.1672-6731.2014.09.008

  16. Trigemino-cervical-spinal reflexes after traumatic spinal cord injury.

    Science.gov (United States)

    Nardone, Raffaele; Höller, Yvonne; Orioli, Andrea; Brigo, Francesco; Christova, Monica; Tezzon, Frediano; Golaszewski, Stefan; Trinka, Eugen

    2015-05-01

    After spinal cord injury (SCI) reorganization of spinal cord circuits occur both above and below the spinal lesion. These functional changes can be determined by assessing electrophysiological recording. We aimed at investigating the trigemino-cervical reflex (TCR) and trigemino-spinal reflex (TSR) responses after traumatic SCI. TCR and TSR were registered after stimulation of the infraorbital nerve from the sternocleidomastoid, splenius, deltoid, biceps and first dorsal interosseous muscles in 10 healthy subjects and 10 subjects with incomplete cervical SCI. In the control subjects reflex responses were registered from the sternocleidomastoid, and splenium muscles, while no responses were obtained from upper limb muscles. In contrast, smaller but clear short latency EMG potentials were recorded from deltoid and biceps muscles in about half of the SCI patients. Moreover, the amplitudes of the EMG responses in the neck muscles were significantly higher in patients than in control subjects. The reflex responses are likely to propagate up the brainstem and down the spinal cord along the reticulospinal tracts and the propriospinal system. Despite the loss of corticospinal axons, synaptic plasticity in pre-existing pathways and/or formation of new circuits through sprouting processes above the injury site may contribute to the findings of this preliminary study and may be involved in the functional recovery. Trigemino-cervical-spinal reflexes can be used to demonstrate and quantify plastic changes at brainstem and cervical level following SCI. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Surgical Strategies for Cervical Spinal Neurinomas.

    Science.gov (United States)

    Ito, Kiyoshi; Aoyama, Tatsuro; Miyaoka, Yoshinari; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

    2015-01-01

    Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis.

  18. Pressure changes in spinal canal and evaluation of spinal cord injuries in spinal section subjected to impact

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To observe pressure changes in the spinal canal of the vertebrarium subjected to impact. From the point of view of impact, pressure changes and spinal cord injuries, the relationship between the type of spinal fracture and the severity of spinal cord injuries were analyzed and some experimental data were provided for early evaluation of severity of spinal cord injuries.   Methods: An experimental model of spinal burst fracture was made with Type BIM-I bio-impact machine and techniques of high velocity vertical loading in static pattern and stress shielding were adopted. Vertebral sections T10-L4 taken from fresh cadavers were impacted and pressure changes in the spinal canal were observed. The types and severity of spinal fracture were studied with gross and radiography examination.   Results: Great positive pressure wave (wave A) in the spinal canal of the 4 vertebral specimens with burst fracture was recorded. The peak value of pressure was correlated with the severity of posterior column injuries. Generally, the peak value of pressure was low in the samples with posterior column injuries, but high in the samples without injuries. The predominant features of fractures were burst fractures of vertebral body and severe destruction of the skeletal and fiber structure of the spinal canal. Positive and negative pressure waves (wave B) were recorded in 2 vertebral samples in which no significant abnormal changes were found by radiography examination, however, a little liquid effusion in the vertebral body was found by gross examination.   Conclusions: The type of pressure wave in the spinal canal is related to the deformation or the destruction of the spinal canal structure. The peak value of the pressure is non-linearly related to the obstruction in the spinal canal, but related to posterior column injuries.

  19. The Outcomes of Anterior Spinal Fusion for Cervical Compressive Myelopathy—A Retrospective Review

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    Tsz-King Suen

    2011-12-01

    Conclusion: Anterior cervical decompression with bone fusion is a viable surgical option for patients with one level of anterior cervical cord compression, especially for patients with kyphosis or straight canal spine. For patients with two- to three-level involvement, anterior cervical decompression with bone fusion provides good functional result in proper selection of cases. We also identified some prognostic factors (male sex, symptoms less than 1 year, and age less than 70 years in predicting a favourable outcome of anterior spinal fusion for CCM.

  20. Poro-elastic modeling of Syringomyelia - a systematic study of the effects of pia mater, central canal, median fissure, white and gray matter on pressure wave propagation and fluid movement within the cervical spinal cord.

    Science.gov (United States)

    Støverud, Karen H; Alnæs, Martin; Langtangen, Hans Petter; Haughton, Victor; Mardal, Kent-André

    2016-01-01

    Syringomyelia, fluid-filled cavities within the spinal cord, occurs frequently in association with a Chiari I malformation and produces some of its most severe neurological symptoms. The exact mechanism causing syringomyelia remains unknown. Since syringomyelia occurs frequently in association with obstructed cerebrospinal fluid (CSF) flow, it has been hypothesized that syrinx formation is mechanically driven. In this study we model the spinal cord tissue either as a poro-elastic medium or as a solid linear elastic medium, and simulate the propagation of pressure waves through an anatomically plausible 3D geometry, with boundary conditions based on in vivo CSF pressure measurements. Then various anatomic and tissue properties are modified, resulting in a total of 11 variations of the model that are compared. The results show that an open segment of the central canal and a stiff pia (relative to the cord) both increase the radial pressure gradients and enhance interstitial fluid flow in the central canal. The anterior median fissure, anisotropic permeability of the white matter, and Poisson ratio play minor roles.

  1. NMR imaging of the vertebral column and the spinal canal. 2. rev. and enl. ed.; MRT der Wirbelsaeule und des Spinalkanals

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    Forsting, Michael [Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie; Uhlenbrock, Detlev [St.-Josefs-Hospital, Dortmund (Germany). MVZ Radiologie, Nuklearmedizin und Strahlentherapie; Wanke, Isabel [Privatklinikengruppe Hirslanden, Zurich (Switzerland); Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie

    2009-07-01

    The book on the MRT (magnetic resonance tomography) of the vertebral cord and spinal canal covers the following topics: physics fundamentals and application; malformation of the spinal canal; degenerative vertebral column diseases; vertebral column and spinal canal carcinomas; inflammatory diseases of the vertebral column and the spinal canal; applicability of MRT in case of acute spinal cord traumata; vascular diseases of the spinal canal.

  2. The antero-lateral approach with corpectomy in the management of the ventral meningioma of the spinal canal.

    Science.gov (United States)

    Radek, Maciej; Grochal, Marek; Tomasik, Bartłomiej; Radek, Andrzej

    2016-01-01

    The authors present the anterior approach to cervical spine, which enabled complete resection of tumor located in the anterior part of the spinal canal. Considering there are not many reports in the literature, the authors present a case of a meningioma at the level C5-C6 resected with good result through anterolateral approach. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  3. An electron microscopic study of the development of the ependyma of the central canal of the mouse spinal cord.

    OpenAIRE

    Sturrock, R R

    1981-01-01

    The central canal of the adult mouse spinal cord is lined for most of its extent by ependymal cells which are rich in microfilaments and whose apical surface is covered with matted, broad microvilli. The canal itself is filled with amorphous material containing glycogen granules. Two forms of this material are present, a dark form rich in glycogen, and a light form containing a few glycogen granules. Each type appears to be surrounded by a membrane. The upper cervical region, however, has a l...

  4. Management of cervical spinal lesions in rheumatoid arthritis.

    Science.gov (United States)

    Yonenobu, Kazuo; Oda, Takenori

    2004-01-01

    We review the management of cervical spinal lesions in rheumatoid arthritis. Surgical treatment for cervical lesions presents several potential problems, such as spinal cord injury during surgery, prolonged and painful postoperative immobilization, poor outcome incompatible with surgical invasiveness, and a high failure rate of arthrodesis. The introduction of spinal instrumentation techniques to surgery for cervical lesions has solved some of these problems. Rigid spinal fixation using screws, rods, and wires has made surgery more reliable, and has freed patients from painful postoperative immobilization methods such as the Halo vest. However, the effects of surgical treatment have not been clearly examined using methods of evidence-based medicine. There is a need for clinical studies of treatment for cervical lesions, in order to help establish better methods for the management of cervical spinal lesions.

  5. MRI morphometric characterisation of the paediatric cervical spine and spinal cord in children with MPS IVA (Morquio-Brailsford syndrome).

    Science.gov (United States)

    Solanki, Guirish A; Lo, William B; Hendriksz, Christian J

    2013-03-01

    Nearly all children with MPS IVA develop skeletal deformities affecting the spine. At the atlanto-axial spine, odontoid hypoplasia occurs. GAG deposition around the dens, leads to peri-odontoid infiltration. Transverse/alar ligament incompetence causes instability. Atlanto-axial instability is associated with cord compression and myelopathy, leading to major morbidity and mortality. Intervention is often required. Does the presence of widened bullet shaped vertebra in platyspondily encroach on the spinal canal and cause spinal stenosis in MPS IVA? So far, there have been no standardised morphometric measurements of the paediatric MPS IVA cervical spine to evaluate whether there is pre-existing spinal stenosis predisposing to compressive myelopathy or whether this is purely an acquired process secondary to instability and compression. This study provides the first radiological quantitative analysis of the cervical spine and spinal cord in a series of affected children. MRI morphometry indicates that the MPS IVA spine is narrower at C1-2 level giving an inverted funnel shape. There is no evidence of a reduction in the Torg ratio (canal-body ratio) in the cervical spine. The spinal canal does not exceed 11 mm at any level, significantly smaller than normal historical cohorts (14 mm). The sagittal diameter and axial surface area of both spinal canal and cord are reduced. C1-2 level cord compression was evident in the canal-cord ratio but the Torg ratio was not predictive of cord compression. In MPS IVA the reduction in the space available for the cord (SAC) is multifactorial rather than due to congenital spinal stenosis.

  6. X-ray signs of traumas of the cervical region of the spinal cord in the acute period

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    Brodskaya, Z.L. (Inst. Usovershenstvovaniya Vrachej, Novokuznetsk (USSR))

    The results are analyzed of an X-ray examination of 208 patients with traumas of the cervical region of the spinal column and spinal cord in the acute period of trauma. The authors proposed a scheme that included telespondylography in standard and oblique projections, flebospondylography, discography and pneumomyelography in the Schantz collar with a patient lying on the back. Four types of the spinal cord traumas were diagnosed: compression with osseous elements (76.92%), with sharp discs and strained epidural hematomas (3.85%), isolated contusion of the spinal cord (10.1%) and disorder of the spinal circulation (9.13%). Special emphasis was laid on clinicospondylographic correlations, a critical distance, congenital narrowing of the vertebral canal. The concept of traumatic decompression of the spinal cord was stressed. Symptoms of its contusion and trauma of the spinal circulation were indicated.

  7. Spinal canal stenosis at the level of Atlas

    Directory of Open Access Journals (Sweden)

    Suchanda Bhattacharjee

    2011-01-01

    Full Text Available We report here a rare case of high cervical stenosis at the level of atlas who presented with progressively deteriorating quadriparesis and respiratory distress. A 10-year-old boy presented with above symptoms of one-year duration with a preceding history of trivial trauma prior to onset of such symptoms. Cervical spine MRI revealed a significant stenosis at the level of atlas from the posterior side with a syrinx extending above and below. High-resolution computed tomography of the above level yielded an ill-defined osseous bar compressing the canal at the level of C 1 posterior arch, which appeared bifid in the midline. The patient was immediately taken up for surgery in view of his respiratory complaints. The child showed an excellent recovery after excision of the posterior arch of atlas and removal of the compressing osseous structure.

  8. Intradural extramedullary spinal canal secondary neoplasms: MR findings in 30 patients

    Energy Technology Data Exchange (ETDEWEB)

    Frey, I.; Le Breton, C.; Lefkopoulos, A.; Perrot, N.; Khalil, A.; Chopier, J.; Le Blanche, A.; Bigot, J.M. [Department of Radiology, Tenon Hospital, Paris (France)

    1998-09-01

    The purpose of this study was to describe magnetic resonance findings of intradural spinal canal secondaries and to select the best way of investigating this condition. Thirty patients with a known malignancy [breast carcinoma (n = 14), lung carcinoma (n = 10), other sites (n = 6)] and unexplained neurologic signs were studied with pre- and post-contrast T1-weighted images and T2-weighted images. Cerebrospinal fluid cytology was available in 16 patients and positive in 11 patients. In all the patients, post-contrast T1-weighted images demonstrated abnormal enhanced lesions. Most of them were nodular, located on the conus medullaris and the cauda equina. Few lesions appeared at the thoracic or cervical levels, as nodular or thin areas of enhancement. Pre-contrast T1-weighted sequences failed or were equivocal to detect the lesions. Eighteen of 30 patients had cerebral metastases. Fourteen had osseous metastases. In conclusion, post-contrast T1-weighted sequence is the optimal modality for the diagnostic of intradural spinal canal metastases. Axial and coronal images may be a useful adjunct to precise anatomic changes. T1-weighted and T2-weighted sequences remain necessary when further information is expected on vertebra or soft tissue. (orig.) With 3 figs., 4 tabs., 23 refs.

  9. Spinal metaplastic meningioma with osseous differentiation in the ventral thoracic spinal canal.

    Science.gov (United States)

    Yamane, Kentaro; Tanaka, Masato; Sugimoto, Yoshihisa; Ichimura, Kouichi; Ozaki, Toshifumi

    2014-01-01

    Ossified meningioma is classified histologically as a phenotype of metaplastic meningioma, and it is extremely rare. There are only 12 cases involving ossified spinal meningiomas in the literature. We present the case of a 61-year-old female with a primary tumor within the ventral spinal canal at T12. Although we performed a total tumor excision using an ultrasonic bone aspirator, a temporary deterioration of motor evoked potentials (MEPs) was observed during curettage with a Kerrison rongeur. The neurologic findings worsened immediately after surgery. Histologically, the tumor was diagnosed as a metaplastic meningioma with osseous differentiation. In order to avoid spinal cord injury, great care must be taken when removing an ossified meningioma located on the ventral spinal cord.

  10. Microsurgical resection of tumors lateroventral and ventral to the high cervical spinal cord

    Institute of Scientific and Technical Information of China (English)

    LEI Peng; WU Yi; LI Zhi-yun; WANG Yu

    2005-01-01

    Background Since there are a complex anatomic structure and vital function in the high cervical spinal cord, it is difficult to remove the tumors lateroventral and ventral to the high cervical spinal cord. This clinical study was undertaken to analyze surgical approaches, manner of tumor resection and postoperative management. Methods Thirty-four patients underwent microsurgical excision of tumors lateroventral and ventral to the high cervical spinal cord by means of three approaches. The tumors comprised mostly Schwannoma and meningioma (88.24%, 30/34) in this group. Tumor volume varied from 3.0 cm×2.5 cm×2.0 cm to 12 cm×3.0 cm×2.5 cm. Of the 34 patients, 4 had dumbbell-shaped tumors growing outside the spinal canal and 7 tumors growing into the intracranium. Results The tumor was totally removed in 32 patients (94.1%). Follow-up for 7 months to 6.4 years (median 3.6 years) showed a recovery of a normal life or work ability in 30 (83.3%) patients. Conclusion Modified operative approaches and microsurgical techniques can raise the rate of total tumor removal and reduce the disability of patients.

  11. The influence of changes in cervical lordosis on bulging disk and spinal stenosis: functional MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Joon; Eun, Choong Ki [Pusan Paik Hospital, Inje Univ. College of Medicine, Pusan (Korea, Republic of)

    2001-05-01

    To assess the effect of lordotic curve change of the cervical spine on disk bulging and spinal stenosis by means of functional cervical MR imaging at the flexion and extension position. Using a 1.5T imager, kinematic MR examinations of 25 patients with degenerative spondylosis (average age, 41 years) were performed at the neutral, flexed and extended position of the cervical spine. Sagittal T2-weighted turbo spin-echo images were obtained during each of the three phases. Lordotic angle, bulging thickness of the disk, AP diameter of the spinal canal, and distance between the disk and spinal cord were measured on the workstation at each disk level. After qualitative independent observation of disk bulging, one of four grades(0, normal; 1, mild; 2, moderate; 3, marked) was assigned at each phase, and after further comparative observation, one of five scores (-2, prominent decrease; -1, mild decrease; 0, no change; 1, notable increase; 2 prominent increase) was also assigned. In addition, bulging thickness of the disk was measured and compared at the neutral, flexed, and extended positions. Average angles of the cervical spine were 160.5{+-}5.9 deg (neutral position, lordotic angle); 185.4{+-}8.5 deg (flexion, kyphotic angle); and 143.7{+-}6.7 deg (extension, lordotic angle). Average grades of disk bulging were 0.55 at the neutral position. 0.16 at flexion, and 0.7 at extension. Comparative observation showed that average scores of disk bulging were -0.39 at flexion and 0.31 at extension. The bulging thickness of the disk decreased by 24.2% at flexion and increased by 30.3% at extension, while the diameter of the spinal canal increased by 4.5% at flexion and decreased by 3.6% at extension. The distance from the posterior margin of the disk to the anterior margin of the spinal cord decreased at both flexion(6.6%) and extension(19.1%). Functional MRI showed that compared with the neutral position, disk bulging and spinal stenosis are less prominent at flexion and

  12. Acute cervical spinal subdural hematoma not related to head injury.

    Science.gov (United States)

    Kim, Hee Yul; Ju, Chang Il; Kim, Seok Won

    2010-06-01

    We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm(3). She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

  13. The Relationship Between Cervical Degeneration and Global Spinal Alignment in Patients With Adult Spinal Deformity.

    Science.gov (United States)

    Fujimori, Takahito; Le, Hai; Schairer, William; Inoue, Shinichi; Iwasaki, Motoki; Oda, Takenori; Hu, Serena S

    2017-05-01

    To examine the relationship between cervical degeneration and spinal alignment by comparing patients with adult spinal deformity versus the control cohort. The effect of degeneration on cervical alignment has been controversial. Cervical and full-length spine radiographs of 57 patients with adult spinal deformity and 78 patients in the control group were reviewed. Adult spinal deformity was classified into 3 types based on the primary characteristics of the deformity: "Degenerative flatback" group, "Positive sagittal imbalance" group, and "Hyperthoracic kyphosis" group. Cervical degeneration was assessed using the cervical degeneration index scoring system. The "Degenerative flatback" group had significantly higher total cervical degeneration index score (25±7) than the control group (16±8), the "Positive sagittal imbalance" group (18±8), and the "Hyperthoracic kyphosis" group (12±7) (Psagittal imbalance" group (20±15 degrees) and the "Hyperthoracic kyphosis" group (26±9 degrees) compared with the control group (11±12 degrees) (PFlat cervical spine coexisted with cervical degeneration when compensatory hypothoracic kyphosis was induced by degenerative flatback. In other situations, cervical lordosis could increase as a compensatory reaction against sagittal imbalance or hyperthoracic kyphosis.

  14. Dorsal border periaqueductal gray neurons project to the area directly adjacent to the central canal ependyma of the C4-T8 spinal cord in the cat.

    Science.gov (United States)

    Mouton, L J; Kerstens, L; Van der Want, J; Holstege, G

    1996-11-01

    In a previous study horseradish peroxidase (HRP) injections in the upper thoracic and cervical spinal cord revealed some faintly labeled small neurons at the dorsal border of the periaqueductal gray (PAG). The present light microscopic and electronmicroscopic tracing study describes the precise location of these dorsal border PAG-spinal neurons and their terminal organization. Wheat germ agglutinin-conjugated HRP (WGA-HRP) injections into cervical and upper thoracic spinal segments resulted in several hundreds of small retrogradely labeled neurons at the dorsal border of the ipsilateral caudal PAG. These neurons were not found after injections in more caudal segments. WGA-HRP injections in the dorsal border PAG region surprisingly resulted in anterogradely labeled fibers terminating in the area dorsally and laterally adjoining the central canal ependyma of the C4-T8 spinal cord. No anterogradely labeled fibers were found more caudal in the spinal cord. The labeled fibers found in the upper cervical cord were not located in the area immediately adjoining the ependymal layer of the central canal, but in the lateral part of laminae VI, VII and VIII and in area X bilaterally. Electronmicroscopic results of one case show that the dorsal border PAG-spinal neurons terminate in the neuropil of the subependymal area and in the vicinity of the basal membranes of capillaries located laterally to the central canal. The terminal profiles contain electron-lucent and densecored vesicles, suggesting a heterogeneity of possible transmitters. A striking observation was the lack of synaptic contacts, suggesting nonsynaptic release from the profiles. The function of the dorsal border PAG-spinal projection is unknown, but considering the termination pattern of the dorsal border PAG neurons on the capillaries the intriguing similarity between this projection system and the hypothalamohypophysial system is discussed.

  15. Automatic Segmentation of the Spinal Cord and Spinal Canal Coupled With Vertebral Labeling.

    Science.gov (United States)

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

    2015-08-01

    Quantifying spinal cord (SC) atrophy in neurodegenerative and traumatic diseases brings important diagnosis and prognosis information for the clinician. We recently developed the PropSeg method, which allows for fast, accurate and automatic segmentation of the SC on different types of MRI contrast (e.g., T1-, T2- and T2(∗) -weighted sequences) and any field of view. However, comparing measurements from the SC between subjects is hindered by the lack of a generic coordinate system for the SC. In this paper, we present a new framework combining PropSeg and a vertebral level identification method, thereby enabling direct inter- and intra-subject comparison of SC measurements for large cohort studies as well as for longitudinal studies. Our segmentation method is based on the multi-resolution propagation of tubular deformable models. Coupled with an automatic intervertebral disk identification method, our segmentation pipeline provides quantitative metrics of the SC and spinal canal such as cross-sectional areas and volumes in a generic coordinate system based on vertebral levels. This framework was validated on 17 healthy subjects and on one patient with SC injury against manual segmentation. Results have been compared with an existing active surface method and show high local and global accuracy for both SC and spinal canal (Dice coefficients =0.91 ± 0.02) segmentation. Having a robust and automatic framework for SC segmentation and vertebral-based normalization opens the door to bias-free measurement of SC atrophy in large cohorts.

  16. Current status of full-endoscopic techniques in the surgical treatment of disk herniations and spinal canal stenosis

    Institute of Scientific and Technical Information of China (English)

    Ruetten S; Komp M; Oezdemir S

    2014-01-01

    Degenerative constrictions of the spinal canal with compression of neural elements arise as a result of bony, disk, capsular or ligament structures. The most frequent causes are disk herniations and spinal stenoses. The lumbar and cervical spine is the most prominent cause. After conservative treatments have been exhausted, surgical intervention may be necessary. Today, microsurgical or microscopically-assisted decompression is regarded as the standard procedure for disk herniation and spinal stenosis in the lumbar region, while in the cervical spine, microsurgical or microscopically-assisted anterior decompression and fusion are standard. Both procedures demonstrate good clinical results but present problems associated with the operation. Decompressions in the area of the spine must be carried out under continuous visualization and must entail the possibility of adequate bone resection. Taking this into account, completely new endoscopes and instrument sets has been developed for full-endoscopic operations in tandem with the development of the lateral transforaminal and interlaminar approaches for the lumbar spine and the posterior, contralateral and anterior approaches for the cervical spine. The possibilities and results of comparable and established standard procedures have been used as a benchmark in the course of clinical validation. The development of surgically created approaches and the new rod lens endoscopes combined with appropriate instrument sets have laid the technical foundations for full-endoscopic operation in the lumbar spine on all primary and recurrent disk herniations inside and outside the spinal canal and on spinal stenoses. This development has also permitted resection of soft disk herniations in the cervical spine. The use of the relevant approaches depends on anatomical and pathological inclusion and exclusion criteria. The clinical results of standard procedures are achieved, which must be regarded as a minimum criterion for the

  17. The effect of lateral eccentricity on failure loads, kinematics, and canal occlusions of the cervical spine in axial loading.

    Science.gov (United States)

    Van Toen, C; Melnyk, A D; Street, J; Oxland, T R; Cripton, P A

    2014-03-21

    Current neck injury criteria do not include limits for lateral bending combined with axial compression and this has been observed as a clinically relevant mechanism, particularly for rollover motor vehicle crashes. The primary objectives of this study were to evaluate the effects of lateral eccentricity (the perpendicular distance from the axial force to the centre of the spine) on peak loads, kinematics, and spinal canal occlusions of subaxial cervical spine specimens tested in dynamic axial compression (0.5 m/s). Twelve 3-vertebra human cadaver cervical spine specimens were tested in two groups: low and high eccentricity with initial eccentricities of 1 and 150% of the lateral diameter of the vertebral body. Six-axis loads inferior to the specimen, kinematics of the superior-most vertebra, and spinal canal occlusions were measured. High speed video was collected and acoustic emission (AE) sensors were used to define the time of injury. The effects of eccentricity on peak loads, kinematics, and canal occlusions were evaluated using unpaired Student t-tests. The high eccentricity group had lower peak axial forces (1544 ± 629 vs. 4296 ± 1693 N), inferior displacements (0.2 ± 1.0 vs. 6.6 ± 2.0 mm), and canal occlusions (27 ± 5 vs. 53 ± 15%) and higher peak ipsilateral bending moments (53 ± 17 vs. 3 ± 18 Nm), ipsilateral bending rotations (22 ± 3 vs. 1 ± 2°), and ipsilateral displacements (4.5 ± 1.4 vs. -1.0 ± 1.3 mm, pcervical spine injuries with lateral eccentricities. © 2013 Published by Elsevier Ltd.

  18. The Prediction of Mobility Gains in Cervical Spinal Cord Injuries

    Science.gov (United States)

    1976-01-01

    U.S. DEPARTMENT OF COMMERCE National Technical Information Service AD-A027 771 THE PREDICTION OF MOBILITY GAINS IN CERVICAL SPINAL CORD INJURIES ...The treatment of spinal cord injuries is a controversial subject among physicians 8,10 The choice of a particular procedure depends ~on the...location and severity of the injury as well as ffhe physical condition of the patient. The effectiveness of the treatment is usually rrasured in terms of

  19. Head Position and Football Equipment Influence Cervical Spinal-Cord Space During Immobilization

    Science.gov (United States)

    Tierney, Ryan T.; Mattacola, Carl G.; Sitler, Michael R.; Maldjian, Catherine

    2002-01-01

    Objective: To assess the effect of head position and football equipment (ie, helmet and shoulder pads) on cervical spinal cord space in individuals lying supine on a spine board. Design and Setting: The independent variables were head position (0-cm, 2-cm, and 4-cm occiput elevation with no helmet and shoulder pads and with helmet and shoulder pads) and cervical spine level (C3, C4, C5, C6, and C7). The 3 dependent variables were sagittal space available for the cord (SAC) (mm), sagittal spinal-cord diameter (mm), and cervical-thoracic angle (°), determined via magnetic resonance imaging. Subjects: Twelve men (age = 24.3 ± 2.1 years; height = 181.1 ± 5.7 cm; weight = 93.9 ± 3.6 kg). Measurements: Sagittal space available for the cord was determined by subtracting the sagittal spinal-cord diameter from the corresponding sagittal spinal-canal diameter. The spinal-canal diameter was measured as the shortest distance from the vertebral body to the spinolaminar line at each of the spinal levels. Each measurement was taken 3 times, and the 3 measurements were averaged. Results: Sagittal space available for the cord was significantly greater (P < .01) for 0-cm (mean = 5.50 mm) than for 2-cm (mean = 4.86 mm) and 4-cm (mean = 5.07 mm) occiput elevation. SAC was also significantly greater (P < .01) for the equipment condition (mean = 5.34 mm) than for the 2-cm and 4-cm elevation levels. No significant difference (P = .093) in SAC existed between 0-cm elevation and the equipment condition. Conclusions: The helmet and shoulder pads should be left on during spine-board immobilization of the injured football player. Similarly, during spine-board immobilization of an individual without football helmet and shoulder pads, the head should be maintained at 0 cm of occiput elevation. Sagittal spinal-cord space is optimized in both of these conditions. PMID:12937433

  20. The circulation of the cerebrospinal fluid (CSF) in the spinal canal

    Science.gov (United States)

    Sanchez, Antonio L.; Martinez-Bazan, Carlos; Lasheras, Juan C.

    2016-11-01

    Cerebrospinal Fluid (CSF) is secreted in the choroid plexus in the lateral sinuses of the brain and fills the subarachnoid space bathing the external surfaces of the brain and the spinal canal. Absence of CSF circulation has been shown to impede its physiological function that includes, among others, supplying nutrients to neuronal and glial cells and removing the waste products of cellular metabolism. Radionuclide scanning images published by Di Chiro in 1964 showed upward migration of particle tracers from the lumbar region of the spinal canal, thereby suggesting the presence of an active bulk circulation responsible for bringing fresh CSF into the spinal canal and returning a portion of it to the cranial vault. However, the existence of this slow moving bulk circulation in the spinal canal has been a subject of dispute for the last 50 years. To date, there has been no physical explanation for the mechanism responsible for the establishment of such a bulk motion. We present a perturbation analysis of the flow in an idealized model of the spinal canal and show how steady streaming could be responsible for the establishment of such a circulation. The results of this analysis are compared to flow measurements conducted on in-vitro models of the spinal canal of adult humans.

  1. Measurement of normal cervical spinal cord in metrizamide CT myelography

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Fumio; Koyama, Tsunemaro; Aii, Heihachirou

    1985-04-01

    The shape of the spinal cord is the most important factor in diagnosis of spinal disorders by metrizamide CT myelography (met. CT). Even in cases where the spinal cord looks normal in shape its size might be abnormal, for example in cases with spinal cord atrophy, syringomyelia, intramedullary tumor and several other conditions. In detecting the slightest abnormality in such cases, it is absolutely necessary to have in hand the knowledge of the nomal size of the spinal cord at each level. We measured, therefore, the sagittal and transverse diameters of the cervical spinal cord in 55 patients with no known lesions on met. CT. Comparing our results with those by others, we found some differences as to the size of the spinal cord. We assume that these differences are due to the differences in resolution of the CT scanners used. The size of the spinal cord tends to measure larger with a CT scanner with high resolution than with others. Previous authors reported that the size of the spinal cord would vary by window center settings. Our experimental results indicate, however, that window center settings do not significantly affect the measurements. It is concluded that the normal values of the spinal cord dimensions at each level somewhat differ by CT equipments used. One should have normal values with one's own equipment in hand in order to take full advantage of this sophisticated diagnostic technique. (author).

  2. Comparison of lumbar spinal canal measurements on MRI and CT; Comparaison des mesures du canal lombaire en IRM et TDM

    Energy Technology Data Exchange (ETDEWEB)

    Malghem, J.; Willems, X.; Vande Berg, B.; Cosnard, G.; Lecouvet, F. [Cliniques Universitaires Saint Luc, Dept. d' Imagerie Medicale, Bruxelles (Belgium); Robert, A. [Ecole de Sante Publique, Faculte de Medecine, Unite d' Epidemiologie, Biostatistique et Methodes Operationnelles en Sante, Bruxelles (Belgium)

    2009-04-15

    Purpose. To compare AP diameter measurements of spinal canal and thecal sac on MM and CT. Materials and methods. The AP diameter of the spinal canal at L4 and thecal sac at L4-5 were measured on both MRI and CT performed on patients at less than one month interval. Measurements were obtained from axial CT images of the abdomen on CT and sagittal T1W (n=98 ) and T2W (n=78) MR images of the spine. The examinations were reviewed at more than 24 hours interval. Radiologists were blinded. Inter-observer agreement evaluation was performed prior to this study. Measurements were compared using a t test for paired variables. Results. For the spinal canal, mean measurements were 0.4 {+-} 1.5 mm inferior on CT compared to MRI. For the thecal sac, mean measurements were 0.1 {+-} 1.4 mm inferior on CT compared to MRI. Conclusion. Measurements on CT and MRI for lumbar spinal canal and thecal sac are fairly comparable, with mean measurement differences inferior to the degree of precision of the measurement technique itself. (authors)

  3. Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT

    Energy Technology Data Exchange (ETDEWEB)

    Karantanas, A.H. [Department of CT-MRI, Larissa General Hospital (Greece); Zibis, A.H.; Papaliaga, M.; Georgiou, E.; Rousogiannis, S. [Larissa Medical School, University of Thessaly, Larissa (Greece)

    1998-12-01

    The aim of this study was to investigate the correlation of vertebral dimensions with somatometric parameters in patients without clinical symptoms and radiological signs of central lumbar spinal stenosis. One hundred patients presenting with low back pain or sciatica were studied with CT. In each of the L3, L4 and L5 vertebra three slices were taken with the following measurements: 1. Slice through the intervertebral disc: (a) spinal canal area; (b) interarticular diameter; (c) interligamentous diameter. 2. Slice below the vertebral arcus: (a) dural sac area; (b) vertebral body area. 3. Pediculolaminar level: (a) anteroposterior diameter and interpedicular diameter of the spinal canal; (b) spinal canal area; (c) width of the lateral recesses. The Jones-Thomson index was also estimated. The results of the present study showed that there is a statistically significant correlation of height, weight and age with various vertebral indices. The conventional, widely accepted, anteroposterior diameter of 11.5 mm of the lumbar spinal canal is independent of somatometric parameters, and it is the only constant measurement for the estimation of lumbar spinal stenosis with a single value. The present study suggests that there are variations of the dimensions of the lumbar spinal canal and correlations with height, weight and age of the patient. (orig.) With 1 fig., 6 tabs., 24 refs.

  4. Exophytic intramedullary meningioma of the cervical spinal cord.

    Science.gov (United States)

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

    2008-10-01

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

  5. MRI of anterior spinal artery syndrome of the cervical spinal cord

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, S. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Yamada, T. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Ishii, K. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Saito, H. (Dept. of Neurology, Tohoku Univ. School of Medicine, Sendai (Japan)); Tanji, H. (Dept. of Neurology, Tohoku Univ. School of Medicine, Sendai (Japan)); Kobayashi, T. (Inst. of Rehabilitation Medicine, Tohoku Univ. School of Medicine, Miyagi (Japan)); Soma, Y. (Div. of Neurology, Takeda Hospital, Aizuwakamatsu (Japan)); Sakamoto, K. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan))

    1992-12-01

    Cervical spinal cord lesions in the anterior spinal artery syndrome were delineated on magnetic resonance images (MRI) in four patients. The lesion was always seen anteriorly in the cervical cord. On T2-weighted images, the lesions appeared hyperintense relative to the normal spinal cord, while on T1-weighted images, two chronic lesions appeared hypointense, with local atrophy of the cord. In one case, repeated T1-weighted images showed no signal abnormality 4 days after the ictus, but the lesion became hypointense 18 days later, when contrast enhancement was also recognized after injection of Gd-DTPA; this sequence of intensity changes was similar to that of cerebral infarction. The extent of the lesion seen MRI correlated closely with neurological findings in all cases. Although the findings may not be specific, MRI is now the modality of choice for confirming the diagnosis in patients suspected of having an anterior spinal artery syndrome. (orig.)

  6. Diagnosis and management of traumatic cervical central spinal cord injury: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: The classical clinical presentation, neuroradiographic features, and conservative vs. surgical management of traumatic cervical central spinal cord (CSS injury remain controversial. Methods: CSS injuries, occurring in approximately 9.2% of all cord injuries, are usually attributed to significant hyperextension trauma combined with congenital/acquired cervical stenosis/spondylosis. Patients typically present with greater motor deficits in the upper vs. lower extremities accompanied by patchy sensory loss. T2-weighted magnetic resonance (MR scans usually show hyperintense T2 intramedullary signals reflecting acute edema along with ligamentous injury, while noncontrast computed tomography (CT studies typically show no attendant bony pathology (e.g. no fracture, dislocation. Results: CSS constitute only a small percentage of all traumatic spinal cord injuries. Aarabi et al. found CSS patients averaged 58.3 years of age, 83% were male and 52.4% involved accidents/falls in patients with narrowed spinal canals (average 5.6 mm; their average American Spinal Injury Association (ASIA motor score was 63.8, and most pathology was at the C3-C4 and C4-C5 levels (71%. Surgery was performed within 24 h (9 patients, 24-48 h (10 patients, or after 48 h (23 patients. In the Brodell et al. study of 16,134 patients with CSS, 39.7% had surgery. In the Gu et al. series, those with CSS and stenosis/ossification of the posterior longitudinal ligament (OPLL exhibited better outcomes following laminoplasty. Conclusions: Recognizing the unique features of CSS is critical, as the clinical, neuroradiological, and management strategies (e.g. conservative vs. surgical management: early vs. late differ from those utilized for other spinal cord trauma. Increased T2-weighted MR images best document CSS, while CT studies confirm the absence of fracture/dislocation.

  7. First aid and treatment for cervical spinal cord injury with fracture and dislocation

    Directory of Open Access Journals (Sweden)

    Yisheng W

    2007-01-01

    Full Text Available Background: Traumatic cervical spinal cord injury with subaxial fracture and dislocation not only indicates a highly unstable spine but can also induce life-threatening complications. This makes first aid critically important before any definitive operative procedure is undertaken. The present study analyzes the various first aid measures and operative procedures for such injury. Materials and Methods: Two hundred and ninety-five patients suffered from cervical spinal cord injury with fracture and dislocation. The average period between injury and admission was 4.5 days (range 5 h-12 weeks. The injury includes burst fractures ( n = 90, compression fractures with herniated discs ( n = 50, fractures and dislocation ( n = 88 and pure dislocation ( n = 36. Other injuries including developmental spinal canal stenosis and/or multi-segment spinal cord compression associated with trauma ( n = 12, lamina fractures compressing the spinal cord ( n = 6, ligament injuries ( n = 7 and hematoma ( n = 6 were observed in the present study. The injury level was C4 ( n = 17, C5 ( n = 29, C6 ( n = 39, C7 ( n = 35, C4-5 ( n = 38, C5-6 ( n = 58, C6-7 ( n = 49, C4-6 ( n = 16 and C5-7 ( n = 14. According to the Frankel grading system, grade A was observed in 20 cases, grade B in 91, grade C in 124 and grade D in 60. One hundred and eighteen (40% patients had a high fever and difficulty in breathing on presentation. First aid measures included early reduction and immobilization of the injured cervical spine, controlling the temperature, breathing support,and administration of high-dose methylprednisolone within eight hours of the injury ( n = 12 and administration of dehydration and neurotrophy medicine. Oxygen support was given and tracheotomy was performed for patients with serious difficulty in breathing. Measures were taken to prevent bedsores and infections of the respiratory and urological systems. Two hundred and thirty six patients were treated with anterior

  8. Epidural lipomatosis and congenital small spinal canal in spinal anaesthesia: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Flisberg Per

    2009-11-01

    Full Text Available Abstract Introduction Complications after lumbar anaesthesia and epidural blood patch have been described in patients with congenital small spinal canal and increased epidural fat or epidural lipomatosis. These conditions, whether occurring separately or in combination, require magnetic resonance imaging for diagnosis and grading, but their clinical significance is still unclear. Case presentation A 35-year-old Caucasian woman who was undergoing a Caesarean section developed a longstanding L4-L5 unilateral neuropathy after the administration of spinal anaesthesia. There were several attempts to correctly position the needle, one of which resulted in paraesthesia. A magnetic resonance image revealed that the patient's bony spinal canal was congenitally small and had excess epidural fat. The cross-sectional area of the dural sac was then reduced, which left practically no free cerebrospinal fluid space. Conclusion The combination of epidural lipomatosis of varying degrees and congenital small spinal canal has not been previously discussed with spinal anaesthesia. Due to the low cerebrospinal fluid content of the small dural sac, the cauda equina becomes a firm system with a very limited possibility for the nerve roots to move away from the puncture needle when it is inserted into the dural sac. This constitutes risks of technical difficulties and neuropathies with spinal anaesthesia.

  9. The adult macaque spinal cord central canal zone contains proliferative cells and closely resembles the human.

    Science.gov (United States)

    Alfaro-Cervello, Clara; Cebrian-Silla, Arantxa; Soriano-Navarro, Mario; Garcia-Tarraga, Patricia; Matías-Guiu, Jorge; Gomez-Pinedo, Ulises; Molina Aguilar, Pilar; Alvarez-Buylla, Arturo; Luquin, Maria-Rosario; Garcia-Verdugo, Jose Manuel

    2014-06-01

    The persistence of proliferative cells, which could correspond to progenitor populations or potential cells of origin for tumors, has been extensively studied in the adult mammalian forebrain, including human and nonhuman primates. Proliferating cells have been found along the entire ventricular system, including around the central canal, of rodents, but little is known about the primate spinal cord. Here we describe the central canal cellular composition of the Old World primate Macaca fascicularis via scanning and transmission electron microscopy and immunohistochemistry and identify central canal proliferating cells with Ki67 and newly generated cells with bromodeoxyuridine incorporation 3 months after the injection. The central canal is composed of uniciliated, biciliated, and multiciliated ependymal cells, astrocytes, and neurons. Multiciliated ependymal cells show morphological characteristics similar to multiciliated ependymal cells from the lateral ventricles, and uniciliated and biciliated ependymal cells display cilia with large, star-shaped basal bodies, similar to the Ecc cells described for the rodent central canal. Here we show that ependymal cells with one or two cilia, but not multiciliated ependymal cells, proliferate and give rise to new ependymal cells that presumably remain in the macaque central canal. We found that the infant and adult human spinal cord contains ependymal cell types that resemble those present in the macaque. Interestingly, a wide hypocellular layer formed by bundles of intermediate filaments surrounded the central canal both in the monkey and in the human, being more prominent in the stenosed adult human central canal.

  10. The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis

    DEFF Research Database (Denmark)

    Madsen, Rasmus; Jensen, Tue Secher; Pope, Malcolm

    2007-01-01

    STUDY DESIGN: A method comparison study. OBJECTIVE: To investigate the effect of body position and axial load of the lumbar spine on disc height, lumbar lordosis, and dural sac cross-sectional area (DCSA). SUMMARY OF BACKGROUND DATA.: The effects of flexion and extension on spinal canal diameters...

  11. Mechanisms of Spinal Micro-adjustment Manipulations in Treating Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    ZHU Guo-miao; SUN Wu-quan; SHEN Guo-quan; FANG Min; XIAO Yuan-chun

    2007-01-01

    On the basis of the investigation of the pathogenesis of cervical spondylotic radiculopathy, this paper studies the mechanisms of spinal micro-adjustment manipulations in recovering and improving cervical dynamic and stationary balance from the perspective of biomechanics.

  12. Diagnosis and treatment of hematoma-induced spinal cord injury after operation for fluorosis cervical canal stenosis%氟骨病颈椎管狭窄症术后血肿致脊髓损伤的诊治对策

    Institute of Scientific and Technical Information of China (English)

    夏英鹏; 申庆丰; 徐天同; 李辉南

    2013-01-01

    Objective To study the causes of hematoma-induced spinal cord injury after surgical treatment of fluorosis cervical canal stenosis (FCCS) so as to conclude the methods for early diagnosis and treatment.Methods A retrospective review was conducted on 329 cases of FCCS undergone expansive laminoplasty (ELOP) between 2006 and 2009.Eighteen out of the 329 cases presented with neural deterioration in postoperative 2 weeks,including l 1 males and 7 females at age of 45-73 years (mean 56.9 years).MRI scan at postoperative 1-5 days confirmed that the injury cause was hematoma formation (incidence of 5.47%).Once the definite diagnosis was made,immediate local puncture decompression,immobilization in the prone position as well as a timely second surgical probe and spinal decompression were performed.Results Nerve symptom of the 18 cases obtained different degree of recovery.Japanese Orthopedic Association (JOA) score promoted from preoperative (7.44 ± 1.25) points to (12.6 ± 2.1)points at 12 months after second operation.Scatter plot between time of definite diagnosis and improvement value in JOA score before and after the second operation was drawn so as to establish linear equation (Y =6.240 7-0.777 8X(F =9.89,P <0.01).As a result,the two variables presented a negative linear relationship,which suggested a better outcome after early treatment than delayed treatment.Conclusions Hematoma compression is the main cause of spinal cord injury following operation for FCCS patients.Strict hematosis and alternate lateral clinostatism after operation were effective prevention methods.Besides,early diagnosis and timely treatment are critically important.%目的 分析氟骨病颈椎管狭窄症(flurosis cervical canal stenosis,FCCS)术后血肿造成脊髓损伤的原因,总结早期诊断和治疗方法. 方法 回顾性分析2006-2009年采用后路单开门椎管成形术(expansive laminoplasty,ELOP)治疗的FCCS患者329例.18例患者术后2周内出

  13. Cervical spinal extradural meningioma: Case report.

    Science.gov (United States)

    Benzagmout, M; Azzal, F; Bitar, A; El Faïz Chaoui, M; Van Effenterre, R

    2010-10-01

    Extradural meningiomas account for approximately 7% of all spinal meningiomas and are most commonly located in the thoracic spine. Although rare, they should be included in the differential diagnosis of an extradural contrast-enhancing mass. Prognosis depends greatly on the extent of surgical resection. If considered safe, complete resection should be attempted to decrease the risk of recurrence. We report a case of spinal epidural meningioma diagnosed in an elderly woman complaining of right cervicobrachial pain of several years duration, associated with diffuse paresthesia and permanent numbness of her right index finger. The surgical removal of the tumor was incomplete because of the deep lateral extension of the lesion. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  14. A Unilateral Cervical Spinal Cord Contusion Injury Model in Non-Human Primates (Macaca mulatta).

    Science.gov (United States)

    Salegio, Ernesto A; Bresnahan, Jacqueline C; Sparrey, Carolyn J; Camisa, William; Fischer, Jason; Leasure, Jeremi; Buckley, Jennifer; Nout-Lomas, Yvette S; Rosenzweig, Ephron S; Moseanko, Rod; Strand, Sarah; Hawbecker, Stephanie; Lemoy, Marie-Josee; Haefeli, Jenny; Ma, Xiaokui; Nielson, Jessica L; Edgerton, V R; Ferguson, Adam R; Tuszynski, Mark H; Beattie, Michael S

    2016-03-01

    The development of a non-human primate (NHP) model of spinal cord injury (SCI) based on mechanical and computational modeling is described. We scaled up from a rodent model to a larger primate model using a highly controllable, friction-free, electronically-driven actuator to generate unilateral C6-C7 spinal cord injuries. Graded contusion lesions with varying degrees of functional recovery, depending upon pre-set impact parameters, were produced in nine NHPs. Protocols and pre-operative magnetic resonance imaging (MRI) were used to optimize the predictability of outcomes by matching impact protocols to the size of each animal's spinal canal, cord, and cerebrospinal fluid space. Post-operative MRI confirmed lesion placement and provided information on lesion volume and spread for comparison with histological measures. We evaluated the relationships between impact parameters, lesion measures, and behavioral outcomes, and confirmed that these relationships were consistent with our previous studies in the rat. In addition to providing multiple univariate outcome measures, we also developed an integrated outcome metric describing the multivariate cervical SCI syndrome. Impacts at the higher ranges of peak force produced highly lateralized and enduring deficits in multiple measures of forelimb and hand function, while lower energy impacts produced early weakness followed by substantial recovery but enduring deficits in fine digital control (e.g., pincer grasp). This model provides a clinically relevant system in which to evaluate the safety and, potentially, the efficacy of candidate translational therapies.

  15. Spinal Headaches

    Science.gov (United States)

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

  16. Rehabilitation outcome of upper extremity skilled performance in persons with cervical spinal cord injuries

    NARCIS (Netherlands)

    Spooren, Annemie I.F.; Janssen-Potten, Yvonne J.M.; Snoek, Govert J.; IJzerman, Maarten J.; Kerckhofs, Eric; Seelen, Henk A.M.

    2010-01-01

    Objective: To investigate changes in arm hand skilled performance during and after active rehabilitation in (sub)groups of subjects with cervical spinal cord injuries. Design: Longitudinal multi-centre cohort study. Patients: Persons with cervical spinal cord injuries during (n?=?57) and after (n?=

  17. Rehabilitation outcome of upper extremetiy skilled performance in persons with cervical spinal cord injuries

    NARCIS (Netherlands)

    Spooren, Annemie I.F.; Janssen-Potten, Yvonne J.M.; Snoek, Govert J.; IJzerman, Maarten Joost; Kerckhofs, Eric; Seelen, Henk A.M.

    2008-01-01

    Objective: To investigate changes in arm hand skilled performance during and after active rehabilitation in (sub)groups of subjects with cervical spinal cord injuries. Design: Longitudinal multi-centre cohort study. Patients: Persons with cervical spinal cord injuries during (n?=?57) and after (n?=?

  18. Spinal cord central canal of the German shepherd dog: morphological, histological, and ultrastructural considerations.

    Science.gov (United States)

    Marín-García, P; González-Soriano, J; Martinez-Sainz, P; Contreras-Rodríguez, J; Del Corral-Gros, C; Rodríguez-Veiga, E

    1995-05-01

    This study deals with some macroscopical, microscopical, and ultrastructural aspects of the spinal cord central canal of the German shepherd dog. The caudal end of the spinal cord is constituted by the conus medullaris, which may extend to the first sacral vertebra, the terminal ventricle, and the filum terminale. The latter structure is considered as internum (second to third sacral vertebrae) or externum (fifth caudal vertebra), according to its relation to the dura mater. Occasionally, there is a second anchorage which is close to the level of the sixth caudal vertebra. The central canal is surrounded by a ciliated ependymal epithelium, which differs depending upon the levels. The most caudal part of the filum terminale bears a columnar ciliated ependymal epithelium surrounded by two layers of glia and pia mater, which separate the central canal from the subarachnoid space. Microfil injections show a communication between the cavity and the subarachnoid space, as the plastic is able to pass through the ependymal epithelium. At the level of the terminal ventricle there are real separations of the ependymal epithelium, which seem to connect the lumen of the spinal canal with the subarachnoid space. These structures probably constitute one of the drainage pathways of the cerebrospinal fluid. The diameter of the central canal is related to the age of the animal. However, even in very old animals the spinal cord central canal reaches the tip of the filum terminale and remains patent until death. At the ultrastructural level the ependymal cells present villi, located on cytoplasmic projections, cilia, dense mitochondria, and oval nuclei.

  19. Effect of low back posture on the morphology of the spinal canal

    Energy Technology Data Exchange (ETDEWEB)

    Chung, S.S.; Lee, C.S.; Kim, S.H.; Chung, M.W. [Dept. of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea); Ahn, J.M. [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea)

    2000-04-01

    Objective. To define the possible mechanism of posture-dependent symptoms of spinal stenosis by measuring the effect of low back posture on morphologic changes of the intervertebral discs and spinal canal in healthy young people.Design. Twenty healthy young volunteers underwent magnetic resonance imaging while supine with their spine in neutral, flexed, extended, and right and left rotational positions. The axial MR images at the middle of the intervertebral discs of L3-4 and L4-5 were analyzed to measure the difference in the size and shape of the intervertebral discs and spinal canal in each posture.Results. Extension or rotation decreased the sagittal diameters and cross-sectional areas of the dural sac and spinal canal and increased the thickness of the ligamentum flavum, whereas flexion had the opposite effects. The gap between the convex posterior disc margin and the anterior margin of the facet joint on each side, represented as the subarticular sagittal diameter, increased with flexion and decreased with extension or rotation. The direction of rotation did not result in asymmetry of the subarticular sagittal diameter, but right rotation caused thickening of the right ligamentum flavum, and vice versa. The shape and dimensions of the disc did not change significantly according to the positions of the low back.Conclusions. With extension or rotation, the thickness of the ligamentum flavum increased and the posterior margin of the intervertebral disc was approximated to the facet joint without any change in shape and size of the disc. These phenomena result in a decrease in the size of the spinal canal and dural sac in extension or rotation postures in young healthy people without disc degeneration, and may explain the posture-dependent symptom of spinal stenosis. (orig.)

  20. Rugby union injuries to the cervical spine and spinal cord.

    Science.gov (United States)

    Quarrie, Kenneth L; Cantu, Robert C; Chalmers, David J

    2002-01-01

    Injuries to the cervical spine are among the most serious injuries occurring as a result of participation in rugby. Outcomes of such injuries range from complete recovery to death, depending on the degree of spinal cord damage sustained. Much information has been gained regarding the mechanisms and frequency of such injuries, from case reports and case series studies. The most commonly reported mechanism of injury has been hyperflexion of the cervical spine, resulting in fracture dislocation of C4-C5 or C5-C6. Tracking both the trends of incidence of spinal injuries, and the effectiveness of injury prevention initiatives has proved difficult because of a lack of properly conducted epidemiological studies. Within the constraints of the research published to date, it appears that hookers and props have been at disproportionate risk of cervical spine injury, predominantly because of injuries sustained during scrummaging. While the scrum was the phase of play most commonly associated with spinal injuries throughout the 1980s in most rugby playing countries, there has been a trend through the 1990s of an increasing proportion of spinal injuries occurring in the tackle situation. The majority of injuries have occurred early in the season, when grounds tend to be harder, and players are lacking both practice and physical conditioning for the physical contact phases of the sport. A number of injury prevention measures have been launched, including changes to the laws of the game regarding scrummaging, and education programmes aimed at enforcing safe techniques and eliminating illegal play. Calls for case-registers and effective epidemiological studies have been made by researchers and physicians in most countries where rugby is widespread, but it appears to be only recently that definite steps have been made towards this goal. Well-designed epidemiological studies will be able to provide more accurate information about potential risk factors for injury such as age, grade

  1. PARAMETERS OF NUCLEAR MAGNETIC RESONANCE IN PATIENTS WITH CONGENITAL NARROWING OF THE LUMBAR SPINAL CANAL

    Directory of Open Access Journals (Sweden)

    ELIU HAZAEL MORALES-RANGEL

    Full Text Available ABSTRACT Objective: To compare the morphological parameters of magnetic resonance in patients with congenital narrowing of the lumbar spinal canal with patients with low back pain. Methods: A descriptive, retrospective, observational study was conducted with measurements in the axial and sagittal magnetic resonance sections of the vertebral body and canal of the lumbar spine of 64 patients with diagnosis of low back pain, which were compared with resonance images taken from 31 Mexican patients with congenital narrowing of the lumbar spinal canal. Results: The results show that patients with congenital narrowing of the lumbar spinal canal in the axial sections have a difference in diameters, being L2<13.9 mm, L3<13.3 mm, L4<12.9 mm, L5<13.1 mm, compared with controls L2<20.5 mm, L3<20.5 mm, L4<19.3 mm, L5<18.1 mm with p = 0.000. Conclusions: We found different measurements in the Mexican population compared to those found by similar studies. With the parameters obtained, it would be possible to make the proper diagnosis, surgical planning, and treatment.

  2. Central canal ependymal cells proliferate extensively in response to traumatic spinal cord injury but not demyelinating lesions.

    Science.gov (United States)

    Lacroix, Steve; Hamilton, Laura K; Vaugeois, Alexandre; Beaudoin, Stéfanny; Breault-Dugas, Christian; Pineau, Isabelle; Lévesque, Sébastien A; Grégoire, Catherine-Alexandra; Fernandes, Karl J L

    2014-01-01

    The adult mammalian spinal cord has limited regenerative capacity in settings such as spinal cord injury (SCI) and multiple sclerosis (MS). Recent studies have revealed that ependymal cells lining the central canal possess latent neural stem cell potential, undergoing proliferation and multi-lineage differentiation following experimental SCI. To determine whether reactive ependymal cells are a realistic endogenous cell population to target in order to promote spinal cord repair, we assessed the spatiotemporal dynamics of ependymal cell proliferation for up to 35 days in three models of spinal pathologies: contusion SCI using the Infinite Horizon impactor, focal demyelination by intraspinal injection of lysophosphatidylcholine (LPC), and autoimmune-mediated multi-focal demyelination using the active experimental autoimmune encephalomyelitis (EAE) model of MS. Contusion SCI at the T9-10 thoracic level stimulated a robust, long-lasting and long-distance wave of ependymal proliferation that peaked at 3 days in the lesion segment, 14 days in the rostral segment, and was still detectable at the cervical level, where it peaked at 21 days. This proliferative wave was suppressed distal to the contusion. Unlike SCI, neither chemical- nor autoimmune-mediated demyelination triggered ependymal cell proliferation at any time point, despite the occurrence of demyelination (LPC and EAE), remyelination (LPC) and significant locomotor defects (EAE). Thus, traumatic SCI induces widespread and enduring activation of reactive ependymal cells, identifying them as a robust cell population to target for therapeutic manipulation after contusion; conversely, neither demyelination, remyelination nor autoimmunity appears sufficient to trigger proliferation of quiescent ependymal cells in models of MS-like demyelinating diseases.

  3. Central canal ependymal cells proliferate extensively in response to traumatic spinal cord injury but not demyelinating lesions.

    Directory of Open Access Journals (Sweden)

    Steve Lacroix

    Full Text Available The adult mammalian spinal cord has limited regenerative capacity in settings such as spinal cord injury (SCI and multiple sclerosis (MS. Recent studies have revealed that ependymal cells lining the central canal possess latent neural stem cell potential, undergoing proliferation and multi-lineage differentiation following experimental SCI. To determine whether reactive ependymal cells are a realistic endogenous cell population to target in order to promote spinal cord repair, we assessed the spatiotemporal dynamics of ependymal cell proliferation for up to 35 days in three models of spinal pathologies: contusion SCI using the Infinite Horizon impactor, focal demyelination by intraspinal injection of lysophosphatidylcholine (LPC, and autoimmune-mediated multi-focal demyelination using the active experimental autoimmune encephalomyelitis (EAE model of MS. Contusion SCI at the T9-10 thoracic level stimulated a robust, long-lasting and long-distance wave of ependymal proliferation that peaked at 3 days in the lesion segment, 14 days in the rostral segment, and was still detectable at the cervical level, where it peaked at 21 days. This proliferative wave was suppressed distal to the contusion. Unlike SCI, neither chemical- nor autoimmune-mediated demyelination triggered ependymal cell proliferation at any time point, despite the occurrence of demyelination (LPC and EAE, remyelination (LPC and significant locomotor defects (EAE. Thus, traumatic SCI induces widespread and enduring activation of reactive ependymal cells, identifying them as a robust cell population to target for therapeutic manipulation after contusion; conversely, neither demyelination, remyelination nor autoimmunity appears sufficient to trigger proliferation of quiescent ependymal cells in models of MS-like demyelinating diseases.

  4. Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury.

    Science.gov (United States)

    Singhal, B; Mohammed, A; Samuel, J; Mues, J; Kluger, P

    2008-09-01

    Retrospective study based on a reference paper. Neurological outcome in patients who were managed surgically with closed traumatic cervical spine injury was evaluated using the ASIA motor scoring system and Frankel grading. To assess the accuracy of motor charting and Frankel grading as tools to evaluate neurological outcome in closed traumatic cervical spine injury, and also to evaluate how the surgically treated patients fared in their neurological recovery by measurement tools as in the reference paper. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Fifty-seven patients were admitted within 2 days of the injury with closed traumatic cervical spine injuries (1997-2004). Thirty-seven (65%) met the inclusion criteria as per the referenced paper, that is, were treated surgically, were Frankel grade B and above and had at least 12 months follow up. The remaining 20 patients were not included as they did not meet the inclusion criteria. The breakdown of the 20 patients is given in Table 1. The mean recovery percentage (MRP) and mean deficit percentage (MDP) were calculated as per the referenced paper. An evaluation of 37 patients surgically treated, who had follow up of at least 12 months, showed that preservation of pin prick below the level of lesion, and preservation of anal tone and perianal sensation were good prognostic indicators. There was no correlation between degree of encroachment of canal or the degree of kyphosis to MDP or MRP. The mean time from injury to mobilization was 7.6 days in 25 out of 37 patients. Twelve of the 37 patients had prolonged immobilization because of ITU stay or because they were initially treated conservatively. Three out of the 37 patients developed DVT/PE. Mean hospital stay was 6.4 months. The neurological outcome in surgically treated patients is comparable to the conservatively treated patients. The Frankel grading and ASIA motor charting combined is a powerful tool in assessing the neurological

  5. Somatostatinergic nerves in the cervical spinal cord of the monkey.

    Science.gov (United States)

    Burnweit, C; Forssmann, W G

    1979-08-03

    Somatostatinergic nerves in the spinal cord of the monkey were investigated utilizing immunohistochemistry with various antibodies against synthetic somatostatin. In contrast to earlier investigations, it is shown that somatostatinergic nerve endings occur in most of the areas of the grey matter of the spinal cord. The somatostatinergic axons are, however, characteristically distributed in three main regions: (1) Densely-packed endings are seen in lamina II of the substantia gelatinosa, forming a crescent-shaped pattern in the columna dorsalis. Somatostatin immunoreactivity is also seen in lamina I and in the Lissauer tract. (2) A fine network of fibers is observed around the central canal; the endings are concentrated on special cell bodies. Some single perikarya are also stained in this region. (3) A loose network of single fibers is found ending on perikarya of the columna lateralis or ventralis. The perikarya of the nerve axons, with the exception of those terminating in the columna dorsalis, have as yet not been identified. In order to better understand the somatostatinergic system of the spinal cord, these newly-detected somatostatinergic nerves must be studied and their exact pathways analyzed.

  6. RADIOLOGICAL DIAGNOSTIC METHODS OF SOFT-TISSUE COMPONENTS IN THE SPINAL CANAL FORMING LUMBAR STENOSIS

    Directory of Open Access Journals (Sweden)

    OTABEK ABLYAZOV

    2011-08-01

    Full Text Available The modern categorization defines the different forms of lumbar part spine stenosis, coming from anatomical and pathological of the principle. One of the varieties is a central lumbar stenosis. Compression of medulla spinalis occurs due to reduction of sizes of the spine central cannel caused either by osseous structure or softtissue of the spine canal. All softtissue components of the spinal canal can form stenos including defeat of intervertebral disk (the hernia of the disk. This work studies efficiency of Xray (at 33 patients and MRI (at 92 patients methods in diagnostics of the hernia of the disk that participates in forming lumbar part spine stenosis.

  7. Clear-cell meningioma; CT and MR imaging findings in two cases involving the spinal canal and cerebellopontine angle

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Ki Bong; Lim, Myung Kwan; Kim, Hyung Jin; Suh, Chang Hae; Park, Hyung Chun; Kim, Eun Young; Han, Hye Seung [Inha University Hospital College of Medicine, Incheon (Korea, Republic of)

    2002-06-01

    Clear-cell meningioma is a rare subtype of meningioma which occurs at a younger age and has a higher recurrence rate than other subtypes. We report two cases of clear-cell meningioma, one in the thoracolumbar spinal canal and the other in the cerebellopontine angle. Though the CT and MR imaging findings were not different from those of ordinary meningioma, after surgical removal the condition recurred repeatedly in the patient with spinal canal involvement.

  8. Clear-Cell Meningioma: CT and MR Imaging Findings in Two Cases Involving the Spinal Canal and Cerebellopontine Angle

    Science.gov (United States)

    Yu, Ki Bong; Kim, Hyung Jin; Suh, Chang Hae; Park, Hyung Chun; Kim, Eun Young; Han, Hye Seung

    2002-01-01

    Clear-cell meningioma is a rare subtype of meningioma which occurs at a younger age and has a higher recurrence rate than other subtypes. We report two cases of clear-cell meningioma, one in the thoracolumbar spinal canal and the other in the cerebellopontine angle. Though the CT and MR imaging findings were not different from those of ordinary meningioma, after surgical removal the condition recurred repeatedly in the patient with spinal canal involvement. PMID:12087202

  9. Imaging diagnosis of cervical spine and spinal cord injuries in children

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To provide the experience in imaging diagnosis of cervical spine and spinal cord injuries in children.Methods: Imaging data of cervical spine and spinal cord injuries in 62 children were retrospectively reviewed.The routine radiography including the lateral,anteroposterior and open-mouth odontoid views were performed in all the patients. Tomography was available for 25 patients, and flexion-extension lateral views for 28patients, CT scanning for 21 patients, MRI for 26 patients.Results: Of these patients, 46 patients were identified with injuries of upper cervical spine (9 with atlantal arch fracture, seven with axial fracture, 21 with odontoid fracture, 1 with atlantal arch fracture combining with odontoid fracture, and 1 with atlantal transverse ligament disruption); 7 patients sustained injuries of lower cervical spine (3 fractures of vertebral body, 2 dislocations and 6fracture-dislocations ); 2 patients had multiple noncontiguous cervical injuries; and 3 had cervical spinal cord injury without radiographic abnormalities (SCIWORA).Conclusions: Imaging assessment is of great importance in the diagnosis of cervical spine and spinal cord injuries in children. Whenever cervical spine and spinal cord injuries are suspected for children patients, and the three-views should be routinely indicated. MRI should be routinely performed in all children with cervical SCIWORA.

  10. Stress myelography. A new functional examination for diseases of the lumbar spinal canal

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, M.

    1986-12-01

    To optimize functional diagnostics in lumbar syndromes a new myelographic technique was developed termed 'loading myelography'. During the procedure the patient stands with a 10 kg weight on his out-stretched arms. Based on the law of leverage the load exercised on the vertebral column is more than two and a half times of one-half of the body weight. The author tested the efficacy of the method in 119 patients suffering from disc prolapse, spinal canal stenosis, spondylolisthesis or arachnitis. The results of the conventional myelogram compared with myelography under load conditions demonstrate the value of the method: without load the diagnosis would have remained uncertain in 25% and in 18% load myelogram revealed a pathological finding although conventional myelography was normal. We consider as indications for load myelography: Discrepancy between clinical and conventional myelographic findings; clinically expected multisegmental lesions; spinal canal stenosis; and spondylolisthesis.

  11. BOLD MRI of the human cervical spinal cord at 3 tesla.

    Science.gov (United States)

    Stroman, P W; Nance, P W; Ryner, L N

    1999-09-01

    The feasibility of functional MRI of the spinal cord was investigated by carrying out blood oxygen-level dependent (BOLD) imaging of the human cervical spinal cord at a field of 3 T. BOLD imaging of the cervical spinal cord showed an average intensity increase of 7.0% during repeated exercise with the dominant hand with a return to baseline during rest periods. The areas of activation were predominantly on the same side of the spinal cord as the hand performing the exercise, between the levels of the sixth cervical and first thoracic spinal cord segments. The direct correspondence between these areas and those involved with the transmission of motor impulses to the hand, and reception of sensory information from the hand, demonstrates that spinal functional magnetic resonance imaging is feasible. Magn Reson Med 42:571-576, 1999. Copyright 1999 Wiley-Liss, Inc.

  12. STUDY OF VARIATION OF THE DIAMETER OF THE SPINAL CANAL AND THE FORAMINA IN SPONDYLOLISTHESIS

    Directory of Open Access Journals (Sweden)

    Enguer Beraldo Garcia

    2016-03-01

    Full Text Available ABSTRACT Objective: To define and quantify the degree of change of the spinal canal diameter in patients with degenerative and spondylolytic spondylolisthesis. Methods: We studied CT scans of 54 patients. Of this total, 37 (29 women and 8 men had degenerative type and 17 (7 women and 10 men had spondylolytic type. Results: In the degenerative spondylolisthesis group, the average diameter of the spinal canal at the injured vertebra level was 17.35 mm and 17.64 mm for the upper vertebra level. The average diameter of the foramen at the level of the affected vertebra was 14.61 mm to left side and 15.00 mm to the right side. The average diameter of the foramen at the upper vertebra level was 16.82 mm to the left side and 16.51 mm to the right side. In the spondylolytic group, the average diameter of the spinal canal at the level of the affected vertebra was 23.25 mm and at the upper vertebra level was 18.66 mm. The average diameter of the foramen at the level of the affected vertebra was 11.98 mm to the left side and 12.34 mm to the right side. The average diameter of the foramen at the level of the upper vertebra was 16.97 mm to the left side and 15.58 mm to the right side. Conclusion: The diameter of the spinal canal in the sagittal plane showed no statistically significant increase in the spondylolytic spondylolisthesis group, in contrast to what is found in the degenerative spondylolisthesis group. It was also observed a reduction in vertebral foramina of the injured level in both groups.

  13. HOMICIDE BY CERVICAL SPINAL CORD GUNSHOT INJURY WITH SHOTGUN FIRE PELLETS: CASE REPORT

    Directory of Open Access Journals (Sweden)

    Dana Turliuc, Serban Turliuc, Iustin Mihailov, Andrei Cucu, Gabriel Dumitrescu,Claudia Costea

    2015-10-01

    Full Text Available This case present a rare forensic case of cervical spinal gunshot injury of a female by her husband, a professional hunter, during a family fight with a shotgun fire pellets. The gunshot destroyed completely the cervical spinal cord, without injury to the neck vessels and organs and with the patient survival for seven days. We discuss notions of judicial ballistics, assessment of the patient with spinal cord gunshot injury and therapeutic strategies. Even if cervical spine gunshot injuries are most of the times lethal for majority of patients, the surviving patients need the coordination of a multidisciplinary surgical team to ensure the optimal functional prognostic.

  14. Correlation between cervical lordosis and adjacent segment pathology after anterior cervical spinal surgery.

    Science.gov (United States)

    Lee, Soo Eon; Jahng, Tae-Ahn; Kim, Hyun Jib

    2015-12-01

    To evaluate the incidence and risk factors for adjacent segment pathology (ASP) after anterior cervical spinal surgery. Fourteen patients (12 male, mean age 47.1 years) who underwent single-level cervical disk arthroplasty (CDA group) and 28 case-matched patients (24 male, mean age 53.6 years) who underwent single-level anterior cervical discectomy and fusion (ACDF group) were included. Presence of radiologic ASP (RASP) was based on observed changes in anterior osteophytes, disks, and calcification of the anterior longitudinal ligament on lateral radiographs. The mean follow-up period was 43.4 months in the CDA group and 44.6 months in the ACDF group. At final follow-up, ASP was observed in 5 (35.7%) CDA patients and 16 (57.1%) ACDF patients (p = 0.272). The interval between surgery and ASP development was 33.8 months in the CDA group and 16.3 months in the ACDF group (p = 0.046). The ASP risk factor analysis indicated postoperative cervical angle at C3-7 being more lordotic in non-ASP patients in both groups. Restoration of lordosis occurred in the CDA group regardless of the presence of ASP, but heterotopic ossification development was associated with the presence of ASP in the CDA group. And the CDA group had significantly greater clinical improvements than those in the ACDF group when ASP was present. In both CDA and ACDF patients, RASP developed, but CDA was associated with a delay in ASP development. A good clinical outcome was expected in CDA group, even when ASP developed. Restoration of cervical lordosis was an important factor in anterior cervical spine surgery.

  15. Acupoints for cervical spondylosis

    OpenAIRE

    Zhu, Jihe; Arsovska, Blagica; Vasileva, Dance; Petkovska, Sofija; Kozovska, Kristina

    2015-01-01

    Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck, as well as the contents of the spinal canal. This is one of the most common degenerative disorders of the spine. The disease can be symptomatic and asymptomatic. Symptoms that are distinctive for cervical spondylosis are: tingling, numbness and weakness in the limbs, lack of coordination, stiff neck, shoulder pain, occipital pain, vertigo, poor...

  16. Sagittal MR findings of L5 spondylolysis : changes of spinal canal

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Cheol; Choi, Woo Suk; Kim, Eui Jong; Ryu, Kyung Nam; Oh, Joo Hyeong; Kim, Ihn Sub; Yoon, Yup [Kyunghee Univ. Hospital, Seoul (Korea, Republic of)

    1997-07-01

    To evaluate changes in the spinal canal in cases of L5 spondylolysis, as seen on sagittal MR images. We retrospectively analysed the MR findings of 27 patients suffering from L5 spondylolysis without spondylolisthesis and compared them with 100 control subjects. Spondylolysis had been confirmed by conventional radiography. On midsagittal MR images, sagittal canal ratio (SCR) was defined as midsagittal canal diameter at L5 devided by that at L1. We analysed the frequency of posterior epidural fat deposition(posterior epidural fat between the posterior margin of the dural sac and the anterior cortical margin of the spinous process on the midsagittal line), and compared this with the frequency in 100 control subjects. Mean SCR value in 27 patients with L5 spondylolysis(1.22) was significantly greater than 100 control subjects(0.96, p<0.001). Mean SCR value in 17 patients with L5 spondylolysis and posterior epidural fat deposition(1.27) was significantly higher than in nine control subjects with posterior epidural fat deposition(0.97). Posterior epidural fat deposition was more frequently indentified in patients with L5 spondylolysis(63%) than in control subjects(9%). The possibility of L5 spondylolysis is suggested when on midsaggital MR imaging, the anteroposterior diameter of the L5 spinal canal is seen to be widened and posterior epidural fat deposition is noted.

  17. Automated extraction method for the center line of spinal canal and its application to the spinal curvature quantification in torso X-ray CT images

    Science.gov (United States)

    Hayashi, Tatsuro; Zhou, Xiangrong; Chen, Huayue; Hara, Takeshi; Miyamoto, Kei; Kobayashi, Tatsunori; Yokoyama, Ryujiro; Kanematsu, Masayuki; Hoshi, Hiroaki; Fujita, Hiroshi

    2010-03-01

    X-ray CT images have been widely used in clinical routine in recent years. CT images scanned by a modern CT scanner can show the details of various organs and tissues. This means various organs and tissues can be simultaneously interpreted on CT images. However, CT image interpretation requires a lot of time and energy. Therefore, support for interpreting CT images based on image-processing techniques is expected. The interpretation of the spinal curvature is important for clinicians because spinal curvature is associated with various spinal disorders. We propose a quantification scheme of the spinal curvature based on the center line of spinal canal on CT images. The proposed scheme consists of four steps: (1) Automated extraction of the skeletal region based on CT number thresholding. (2) Automated extraction of the center line of spinal canal. (3) Generation of the median plane image of spine, which is reformatted based on the spinal canal. (4) Quantification of the spinal curvature. The proposed scheme was applied to 10 cases, and compared with the Cobb angle that is commonly used by clinicians. We found that a high-correlation (for the 95% confidence interval, lumbar lordosis: 0.81-0.99) between values obtained by the proposed (vector) method and Cobb angle. Also, the proposed method can provide the reproducible result (inter- and intra-observer variability: within 2°). These experimental results suggested a possibility that the proposed method was efficient for quantifying the spinal curvature on CT images.

  18. Vasoactive intestinal polypeptide cerebrospinal fluid-contacting neurons of the monkey and cat spinal central canal.

    Science.gov (United States)

    LaMotte, C C

    1987-04-22

    Neurons immediately adjacent to the central canal were demonstrated in the cat and monkey to be immunoreactive for the peptide vasoactive intestinal polypeptide (VIP), by means of the peroxidase antiperoxidase method. Most of the cells were found in the thoracic and sacral segments, although a few were present at each level. The thoracic neurons were multipolar and either ependymal or subependymal; they usually had a large, thick dendrite that was oriented radially toward the center of the central canal; this dendrite penetrated through the ependymal layer and ended as a large, fringed podlike process (4-5-microns diameter) along the canal surface in contact with the cerebrospinal fluid (CSF). From the basal surface of the thoracic cell arose several small dendrites and a varicose axon. A few of the thoracic VIP neurons also contained two nuclei. In the sacral cord, the VIP neurons that lie along the central canal were of several types. They were round or multipolar and were either subependymal, within the ependyma, or supraependymal. Many had long dendrites and thin varicose axons stretching for long distances parallel to the cord surface. Other VIP neurons were smaller cells with short, highly branched, varicose processes. Most prominent in the sacral cord of the cat was a massive intricate network of intensely labelled processes extending in parallel along the canal surface. This network contained thick dendrites, highly varicose axons, and small neurons. Electron microscopy demonstrated VIP axons and varicosities containing small round clear vesicles and dense core vesicles. These processes were in desmosomal contact with ependymal cells and in direct contact with the CSF space. VIP processes were also found along the pial surface of the spinal cord at each level. In some cases single axons and bundles of axons arising from the area around the central canal could be traced to terminal fields along the ventral median fissure and the ventral and ventral lateral

  19. Strategies for autonomy used by people with cervical spinal cord injury : A qualitative study

    NARCIS (Netherlands)

    Van De Ven, Leontine; Post, Marcel; De Witte, Luc; Van Den Heuvel, Wim

    2008-01-01

    Purpose. To identify strategies used by people with high cervical spinal cord injury (SCI) to function autonomously. A multidimensional concept of autonomy was used, with four dimensions: independence, self-determination, participation and identification. Methods. Qualitative methods were used, invo

  20. Strategies for autonomy used by people with cervical spinal cord injury : A qualitative study

    NARCIS (Netherlands)

    Van De Ven, Leontine; Post, Marcel; De Witte, Luc; Van Den Heuvel, Wim

    2008-01-01

    Purpose. To identify strategies used by people with high cervical spinal cord injury (SCI) to function autonomously. A multidimensional concept of autonomy was used, with four dimensions: independence, self-determination, participation and identification. Methods. Qualitative methods were used, invo

  1. An investigation of cervical spinal posture in cervicogenic headache.

    Science.gov (United States)

    Farmer, Peter K; Snodgrass, Suzanne J; Buxton, Anthony J; Rivett, Darren A

    2015-02-01

    Cervicogenic headache (CGH) is defined as headache symptoms originating from the cervical spine. Cervical dysfunction from abnormal posture has been proposed to aggravate or cause CGH, but there are conflicting reports as to whether there is an association between posture and CGH. The purpose of this study was to evaluate differences in cervical spinal posture, measured on radiographs, between patients with probable CGH and asymptomatic control participants. A single-blinded comparative measurement design was used. Differences in postural variables from radiographs between participants with CGH (n=30) and age- and sex-matched asymptomatic control participants (n=30) were determined using paired t tests or the nonparametric equivalent. Postural variables were general cervical lordosis (GCL, Cobb angle C2-C7), upper cervical lordosis (UCL, sagittal alignment C2 compared with C3-C4), and C2 spinous process horizontal deviation. Logistic regression determined postural variables, increasing the likelihood of CGH. There were no significant differences in posture between the CGH and control groups. The mean GCL was 10.97 degrees (SD=7.50) for the CGH group and 7.17 degrees (SD=5.69) for the control group. The mean UCL was 11.86 degrees (SD=6.46) for the CGH group and 9.44 degrees (SD=4.28) for the control group. The mean C2 spinous process horizontal deviation was 3.00 mm (SD=1.66) for the CGH group and 2.86 mm (SD=2.04) for the control group. However, there was a significant association between greater GCL and an increased likelihood of having CGH (odds ratio=1.08; 95% confidence interval=1.001, 1.191). The findings are limited to an association between GCL and posture, as cause and effect cannot be determined. The association between greater GCL and increased likelihood of having CGH suggests that GCL might be considered in the treatment of patients with CGH. However, as the data do not support posture as a cause of CGH, it is unknown whether addressing posture would

  2. Trigemino-cervical reflex in spinal cord injury.

    Science.gov (United States)

    Gündüz, Ayşegül; Uzun, Nurten; Örnek, Nurettin İrem; Ünalan, Halil; Karamehmetoğlu, Şafak Sahir; Kızıltan, Meral E

    2014-09-19

    Abnormal enhancement of polysynaptic brainstem reflexes has been previously reported in patients with spinal cord injury (SCI). We aimed to investigate trigemino-cervical reflex (TCR) in SCI since it may reflect alterations in the connections of trigeminal proprioceptive system and cervical motoneurons. Consecutive 14 patients with SCI and 16 healthy subjects were included in this study. All patients were in the chronic phase. TCR was recorded over sternocleidomastoid (SCM) and splenius capitis (SC) muscles by stimulation of infraorbital nerve. We measured onset latency, amplitudes and durations of responses and compared between groups. We obtained stable responses over both muscles after one sided stimulation in healthy volunteers whereas probability of TCR was decreased in patients over both SCM (78.6% vs. 100%, p=0.050) and SC (71.4% vs. 100%, p=0.022). The absence of TCR was related to use of oral baclofen (≥50mg/day). However, when present, responses of SCI group had higher amplitudes and were more persistent. We demonstrated that TCR probability was similar to healthy subjects in SCI patients who used no or low dose oral baclofen. But it had higher amplitudes and longer durations. It was not obtained in only two patients who used oral baclofen more than 50mg/day.

  3. Use of versapoint to refashion the cervical canal to overcome unusually difficult embryo transfers and improve in-vitro fertilization-embryo transfer outcome: A case series

    Directory of Open Access Journals (Sweden)

    Nalini Mahajan

    2011-01-01

    Full Text Available Background : Smooth atraumatic embryo transfer is paramount for the success of in-vitro fertilization (IVF. In difficult cases, cervical canal manipulation may be required. Aim : To see if surgical correction of the cervical canal or cervical canal refashioning could improve ease of embryo transfer. Setting : Private infertility and IVF hospital. Design : Prospective study. Materials and Methods : Patients: 11 women with failed 1-3 IVF cycles with history of extremely difficult embryo transfers (ETs despite undergoing cervical dilatation in the cycle prior to IVF. Interventions : Operative hysteroscopy using Versapoint for refashioning of the cervical canal. Main Outcome Measures : Ease of ET in the subsequent IVF cycle. Secondary outcome measure was to assess reproductive outcome. Results : Easy and atraumatic ET in the IVF cycle after procedure in 100% patients. PR was 46.5%. Conclusions : Use of Versapoint for refashioning the cervical canal can improve the quality of ET and PR.

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

    Science.gov (United States)

    Scher, A T

    1982-06-12

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

  5. Relationship Between Depressive State and Treatment Characteristics of Acute Cervical Spinal Cord Injury in Japan

    OpenAIRE

    2016-01-01

    Background Few studies have assessed whether treatment of acute cervical spinal cord injury (SCI) patients contributes to depression. Methods Using an administrative database, we assessed patients for whom the diagnosis was unspecified injuries of cervical spinal cord (International Classification of Diseases and Injuries-10th (ICD-10) code; S14.1). We categorized patients with codes for depressive episode (ICD-10 code; F32) or recurrent depressive disorder (F33), or those prescribed antidepr...

  6. Posterior approach to the degenerative cervical spine.

    Science.gov (United States)

    Yonenobu, Kazuo; Oda, Takenori

    2003-10-01

    Laminoplasty has been gradually accepted as a treatment for choice for cervical compression myelopathy. The historical perspective of laminoplasty is described. The aims of laminoplasty are to expand the spinal canal, to secure spinal stability, to preserve the protective function of the spine, and to preserve spinal mobility. Laminoplasty is indicated in myelopathic patients with a developmentally narrow spinal canal or multiple-level involvement combined with a relatively narrow canal. Several laminoplasty techniques and supplementary techniques are described, together with expected outcomes and complications of surgery.

  7. Asymptomatic Cervical Isthmic Spondylolisthesis and Associated Occult Spinal Bifida: A Case Report

    OpenAIRE

    Lim, Jeong-Wook; Kang, Sang-Kuk; Jeon, Su-Gi; Lim, Byeong-Chul

    2013-01-01

    We report a case of rare cervical isthmic spondylolisthesis of C6-7 combined occult spinal bifida at C6, and review the radiologic finding, different diagnosis and treatment. A 23-year old female presented nuchal, back pain after traffic accident. Radiologic finding showed the 6th cervical isthmic defect, spondylolisthesis and dysplasia. The patient was conservatively treated about 8 weeks, and 10 months after injury, she was symptom free with full range of motion of cervical spine and she wa...

  8. Phrenic nerve afferents elicited cord dorsum potential in the cat cervical spinal cord

    Directory of Open Access Journals (Sweden)

    Davenport Paul W

    2005-05-01

    Full Text Available Abstract Background The diaphragm has sensory innervation from mechanoreceptors with myelinated axons entering the spinal cord via the phrenic nerve that project to the thalamus and somatosensory cortex. It was hypothesized that phrenic nerve afferent (PnA projection to the central nervous system is via the spinal dorsal column pathway. Results A single N1 peak of the CDP was found in the C4 and C7 spinal segments. Three peaks (N1, N2, and N3 were found in the C5 and C6 segments. No CDP was recorded at C8 dorsal spinal cord surface in cats. Conclusion These results demonstrate PnA activation of neurons in the cervical spinal cord. Three populations of myelinated PnA (Group I, Group II, and Group III enter the cat's cervical spinal segments that supply the phrenic nerve

  9. Cervical spinal cord injury during cerebral angiography with MRI confirmation: case report

    Energy Technology Data Exchange (ETDEWEB)

    Bejjani, G.K.; Rizkallah, R.G.; Tzortidis, F. [Department of Neurosurgery, George Washington University Medical Center, Washington, DC (United States); Mark, A.S. [Department of Neuroradiology, Washington Hospital Center, Washington, DC (United States)

    1998-01-01

    We report the first case of MRI-documented cervical spinal cord injury during cerebral angiography. A 54-year-old woman underwent an angiogram for subarachnoid hemorrhage. Her head was secured in a plastic head-holder. At the end of the procedure, she was found to have a left hemiparesis. MRI revealed high signal in the cervical spinal cord. The etiology may have been mechanical due to patient positioning, or toxic, from contrast medium injection in the vessels feeding the spinal cord, or a combination of both. (orig.) With 3 figs., 26 refs.

  10. [Metastasis of a spinal myxopapillary ependymoma to the inner auditory canal].

    Science.gov (United States)

    Kittel, K; Gjuric, M; Niedobitek, G

    2001-04-01

    Ependymomas are usually benign tumors of the central nervous system that derive from the ependymal cells lining liquor-filled spaces. Myxopapillary ependymomas are a variant occurring almost exclusively in the region of the cauda equina. Histologically, these tumors are benign (WHO grade I). The following case describes the first reported spread of a spinal myxopapillary ependymoma into the internal auditory canal. The symptoms and diagnostic results are similar to other tumors of this location. There are no typical findings in the diagnostic imaging (CT, MRI). The extended middle cranial fossa approach was chosen for surgical treatment. Adjuvant radiotherapy is indicated in cases of incomplete resection or recurrence.

  11. Follow-up CT myelography of severe cervical spinal cord injury

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Keiichi; Onoda, Kimio; Kawashima, Yasuhiro; Muto, Atsushi; Kobayashi, Yoichi

    1987-11-01

    There are many reports describing gross anatomical and microscopical findings of severely injured cervical cords in autopsy of the acute and chronic state, but no morphological findings of a severe cervical spinal cord injury in a chronic state by follow-up CT myelography have been found in the literature so far. The sagittal and transverse diameters of the cervical spinal cord and subarachnoid space of 9 out of 14 severe cervical spinal cord injury patients were measured with CT myelography within 7.5 years after the tranuma and their size compared with a control group which was made up of 29 patients with slight radiculopathy due to cervical spondylosis and whiplash injuries. Injured cord levels were C4 4 cases, C5 4 cases and C6 1 case. Remarkable spinal cord atrophy was recogniged in the sagittal diameter from C1 to C7 and in the transverse diameter below C4 and narrowing of the cervical subarachnoid space in the sagittal diameter from C2 to C5. The significance level was set at 1 - 5 %. From these fingings, we have concluded that atrophy appeared not only in the injured segment but also the whole cervical cord after the trauma. There was less cord atrophy in a good functional prognosis than in a poor prognosis.

  12. Histopathological and behavioral characterization of a novel cervical spinal cord displacement contusion injury in the rat.

    Science.gov (United States)

    Pearse, D D; Lo, T P; Cho, K S; Lynch, M P; Garg, M S; Marcillo, A E; Sanchez, A R; Cruz, Y; Dietrich, W D

    2005-06-01

    Cervical contusive trauma accounts for the majority, of human spinal cord injury (SCI), yet experimental use of cervical contusion injury models has been limited. Considering that (1) the different ways of injuring the spinal cord (compression, contusion, and transection) induce very different processes of tissue damage and (2) the architecture of the spinal cord is not uniform, it is important to use a model that is more clinically applicable to human SCI. Therefore, in the current study we have developed a rat model of contusive, cervical SCI using the Electromagnetic Spinal Cord Injury Device (ESCID) developed at Ohio State University (OSU) to induce injury by spinal cord displacement. We used the device to perform mild, moderate and severe injuries (0.80, 0.95, and 1.1 mm displacements, respectively) with a single, brief displacement of <20 msec upon the exposed dorsal surface of the C5 cervical spinal cord of female (180-200 g) Fischer rats. Characterization of the model involved the analysis of the temporal histopathological progression of the injury over 9 weeks using histochemical stains to analyze white and gray mater integrity and immunohistochemistry to examine cellular changes and physiological responses within the injured spinal cord. Accompanying the histological analysis was a comprehensive determination of the behavioral functionality of the animals using a battery of motor tests. Characterization of this novel model is presented to enable and encourage its future use in the design and experimental testing of therapeutic strategies that may be used for human SCI.

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

    Science.gov (United States)

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

    2009-02-01

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

  14. Synergistic impact of acute kidney injury and high level of cervical spinal cord injury on the weaning outcome of patients with acute traumatic cervical spinal cord injury.

    Science.gov (United States)

    Yu, Wen-Kuang; Ko, Hsin-Kuo; Ho, Li-Ing; Wang, Jia-Horng; Kou, Yu Ru

    2015-07-01

    Respiratory neuromuscular impairment severity is known to predict weaning outcome among patients with cervical spinal cord injury; however, the impact of non-neuromuscular complications remains unexplored. This study was to evaluate possible neuromuscular and non-neuromuscular factors that may negatively impact weaning outcome. From September 2002 to October 2012, acute traumatic cervical spinal cord injury patients who had received mechanical ventilation for >48h were enrolled and divided into successful (n=54) and unsuccessful weaning groups (n=19). Various neuromuscular, non-neuromuscular factors and events during the intensive care unit stay were extracted from medical charts and electronic medical records. Variables presenting with a significant difference (pspinal cord injury (C1-3), lower pulse rates, and lower Glasgow Coma Scale score on admission, higher peak blood urea nitrogen, lower trough albumin, and lower trough blood leukocyte counts. Furthermore, unsuccessful weaning patients had a higher incidence of pneumonia, acute respiratory distress syndrome, shock and acute kidney injury during the intensive care unit stay. Multivariate logistic regression analysis revealed acute kidney injury and high level of cervical spinal cord injury were independent risk factors for failure of weaning. Importantly, patients with both risk factors showed a large increase in odds ratio for unsuccessful weaning from mechanical ventilation (pinjury during the intensive care unit stay and high level of cervical spinal injury are two independent risk factors that synergistically work together producing a negative impact on weaning outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. GABAergic responses of mammalian ependymal cells in the central canal neurogenic niche of the postnatal spinal cord ☆

    OpenAIRE

    Corns, Laura F; Deuchars, Jim; Deuchars, Susan A

    2013-01-01

    The area surrounding the central canal of the postnatal mammalian spinal cord is a highly plastic region that exhibits many similarities to other postnatal neurogenic niches, such as the subventricular zone. Within this region, ependymal cells have been identified as neural stem cells however very little is known about their properties and how the local environment, including neurotransmitters, is capable of affecting them. The neurotransmitter GABA is present around the central canal and is ...

  16. Using Magnetic Resonance Myelography to Improve Interobserver Agreement in the Evaluation of Lumbar Spinal Canal Stenosis and Root Compression.

    Science.gov (United States)

    Al-Tameemi, Haider Najim; Al-Essawi, Sattar; Shukri, Mahmud; Naji, Farah Kasim

    2017-04-01

    Cross-sectional retrospective study designed to assess interobserver agreement. To investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM). The interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression. Hardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics. Regarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively). Interobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone.

  17. Asymptomatic cervical isthmic spondylolisthesis and associated occult spinal bifida: a case report.

    Science.gov (United States)

    Lim, Jeong-Wook; Kang, Sang-Kuk; Jeon, Su-Gi; Lim, Byeong-Chul

    2013-03-01

    We report a case of rare cervical isthmic spondylolisthesis of C6-7 combined occult spinal bifida at C6, and review the radiologic finding, different diagnosis and treatment. A 23-year old female presented nuchal, back pain after traffic accident. Radiologic finding showed the 6(th) cervical isthmic defect, spondylolisthesis and dysplasia. The patient was conservatively treated about 8 weeks, and 10 months after injury, she was symptom free with full range of motion of cervical spine and she was followed up. Cervical spondylolysis is a very rare condition. This clinical importance is vulnerable to trauma. For whatever reasons, symptomatic patients need to be treated by conservative or surgical option.

  18. Decreased cerebrospinal fluid flow through the central canal of the spinal cord of rats immunologically deprived of Reissner's fibre.

    Science.gov (United States)

    Cifuentes, M; Rodríguez, S; Pérez, J; Grondona, J M; Rodríguez, E M; Fernández-Llebrez, P

    1994-01-01

    The subcommissural organ is an ependymal brain gland that secretes glycoproteins to the cerebrospinal fluid (CSF) of the third ventricle. They condense to form a fibre, Reissner's fibre (RF), that runs along the aqueduct and fourth ventricle and the central canal of the spinal cord. A single injection of an antibody against the secretory glycoproteins of RF into a lateral ventricle of adult rats results in animals permanently deprived of RF in the central canal and bearing a "short" RF extending only along the aqueduct and the fourth ventricle. These animals, together with untreated control animals were used to investigate the probable influence of RF in the circulation of CSF in the central canal of the spinal cord. For this purpose, two tracers, (horseradish peroxidase and rabbit immunoglobulin) were injected into the ventricular CSF. The animals were killed 13, 20, 60, 120 and 240 min after the injection, and the amount of the tracers was estimated in tissue sections obtained at proximal, medial and distal levels of the spinal cord. In rats deprived of RF, a significant decrease in the amount of tracers present in the central canal was observed at all experimental intervals, being more evident at 20 min after the injection of the tracers. This suggests that lacking a RF in the central canal decreases the bulk flow of CSF along the central canal. Turbulences of the CSF at the entrance of the central canal of RF-deprived rats might explain the inability of the regenerating RF to progress along the central canal, as well as the reduced flow of CSF in the central canal of these animals.

  19. Weight-based determination of spinal canal depth for paediatric lumbar punctures.

    Science.gov (United States)

    Bailie, Helen C; Arthurs, Owen J; Murray, Matthew J; Kelsall, A Wilf

    2013-11-01

    The aim of this study was to evaluate whether spinal canal depth (SCD), measured using ultrasound, could be estimated from simple body measurements in a sample of children. We measured SCD in a group of 225 children aged 0-18 years in the curved left lateral position using ultrasound. Statistical analysis was performed using Pearson's correlation coefficient at the 5% level of significance. We also performed linear regression analyses (analysis of variance) for mid-spinal canal depth (MSCD), including five potential predictors of age, gender, height, weight and body surface area, in each model. The mean MSCD was 33.0 mm (18.1-56.4) across the whole cohort. The best linear correlation of MSCD (mm) was found with weight (W; kg), approximating the formula MSCD=0.4W+20 (R(2)=0.72). Body weight accounted for 85% of the variance in the data (adjusted R(2)=0.72). Our formula gives values outside of the actual measured SCD range in 23/225 (10.2%) of cases and estimates MSCD at 24 mm at 10 kg, 32 mm at 30 kg and 40 mm at 50 kg. We demonstrate a good correlation between weight and MSCD in a large group of children. Use of the simple formula MSCD (mm)=0.4 W+20 could improve the success rates of lumbar puncture in the paediatric population, but remains to be validated.

  20. Cervical and Ocular VEMP Testing in Diagnosing Superior Semicircular Canal Dehiscence.

    Science.gov (United States)

    Hunter, Jacob B; Patel, Neil S; O'Connell, Brendan P; Carlson, Matthew L; Shepard, Neil T; McCaslin, Devin L; Wanna, George B

    2017-05-01

    Objective To determine the sensitivity and specificity of ocular and cervical vestibular evoked myogenic potentials (VEMPs) in the diagnosis of superior semicircular canal dehiscence (SCD) and to describe the VEMP response characteristics that are most sensitive to SCD and compare the findings to previous reports. Study Design Case series with chart review. Setting Two tertiary neurotologic referral centers. Subjects and Methods Cervical and ocular VEMP peak-to-peak amplitudes and thresholds from 39 adult patients older than 18 years with surgically confirmed SCD were compared with 84 age-matched controls. Results Using receiver operating characteristic (ROC) curves, cervical VEMP (cVEMP) amplitudes, cVEMP thresholds, and ocular VEMP (oVEMP) amplitudes had areas under the curve of 0.731, 0.912, and 0.856, respectively, all of which were statistically significant ( P 12.0 µV, the sensitivity and specificity were 78.6% and 81.7%, respectively. Conclusion Data from this multicenter study suggest that both cVEMP thresholds and oVEMP amplitudes remain good diagnostic tests for identifying SCD, with each test dependent on a number of factors. The sensitivity and specificity of these individual tests may vary slightly between centers depending on testing parameters used.

  1. Anterior cervical surgery methods for central cord syndrome without radiographic spinal fracture-dislocation

    Institute of Scientific and Technical Information of China (English)

    Chengwei JING; Qin FU; Xiaojun XU

    2009-01-01

    This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation (CCSWORFD), retrospectively analyze the cases of CCSWORFD, and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD. Twenty four cases of CCSWORFD (19 males and 5 females), all suffering from cervical hyperextension injury, between 45-68 (average 59) years old, were operated on by anterior cervical surgery methods. Among these, 18 cases had been followed up for 6-24 (average 15) months; 18 cases, who had anterior decompression and plate fixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association (JOA) evaluation (improved scores of cases with titanium mesh bone grafting, t = 2.800, P0.05). Most of these cases had degeneration of cervical vertebra. The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord, and early fixation for stability of cervical vertebra is better for the recovery of spinal cord injury. Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD, and titanium mesh bone grafting can avoid the trauma of the supplying graft. Mesh bone grafting can also shorten hospital stay.

  2. Cervical spinal monostotic fibrous dysplasia: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ok Hwa [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2013-09-15

    Monostotic fibrous dysplasia of the cervical vertebra is quite unusual. The author reports a case of monostotic fibrous dysplasia affecting the second cervical vertebra with descriptions from the CT, MR and bone scanning findings.

  3. The natural history and clinical syndromes of degenerative cervical spondylosis.

    LENUS (Irish Health Repository)

    Kelly, John C

    2012-01-01

    Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy.

  4. Translational constraint influences dynamic spinal canal occlusion of the thoracic spine: an in vitro experimental study.

    Science.gov (United States)

    Zhu, Qingan; Lane, Chris; Ching, Randal P; Gordon, Jeff D; Fisher, Charles G; Dvorak, Marcel F; Cripton, Peter A; Oxland, Thomas R

    2008-01-01

    Mechanical constraints to spine motion can arise in a variety of real-world situations such as when shoulder belts prevent anterior translation of the thorax during automotive collisions. The effect of such constraint on spinal column-spinal cord interaction during injury remains unknown. The purpose of the present study was to compare maximal dynamic spinal canal occlusion, measured via a specialized transducer, in cadaveric upper thoracic spine specimens under a variety of anterior-posterior constraint conditions. Four injury models were produced using 24 cadaveric spine specimens (T1-T4). Incremental compressive trauma was applied under constrained (i.e. blocked anterior-posterior translation) flexion-compression, pure-compression and extension-compression, and under unconstrained (i.e. free anterior-posterior translation) flexion-compression. All displacements were applied at 500 mm/s. For all three constrained trauma groups, complete transducer occlusion occurred between 20 and 30 mm of compressive displacement. The extension-compression caused transducer occlusion significantly less than the other constrained models (p design of injury prevention devices.

  5. Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases

    Directory of Open Access Journals (Sweden)

    Tayfun Hakan

    2016-01-01

    Conclusion: Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability.

  6. Ocular versus cervical VEMPs in the diagnosis of superior semicircular canal dehiscence syndrome.

    Science.gov (United States)

    Zuniga, M Geraldine; Janky, Kristen L; Nguyen, Kimanh D; Welgampola, Miriam S; Carey, John P

    2013-01-01

    To determine whether cervical vestibular evoked myogenic potential (cVEMP) thresholds or ocular VEMP (oVEMP) amplitudes are more sensitive and specific in the diagnosis of superior semicircular canal dehiscence syndrome (SCDS). Prospective case-control study. Tertiary referral center. Twenty-nine patients with SCDS (mean age 48 yr; range, 31-66 yr) and 25 age-matched controls (mean age 48 yr; range, 30-66 yr). cVEMP and oVEMP in response to air-conducted sound. All patients underwent surgery for repair of SCDS. cVEMP thresholds; oVEMP n10 and peak-to-peak amplitudes. cVEMP threshold results showed sensitivity and specificity ranging from 80% to 100% for the diagnosis of SCDS. In contrast, oVEMP amplitudes demonstrated sensitivity and specificity greater than 90%. oVEMP amplitudes are superior to cVEMP thresholds in the diagnosis of SCDS.

  7. Anatomical study of blood supply to the cervical spinal cord in the guinea pig.

    Science.gov (United States)

    Mazensky, David; Danko, Jan; Petrovova, Eva; Flesarova, Slavka; Supuka, Peter; Supukova, Anna; Luptakova, Lenka; Purzyc, Halina

    2015-06-01

    The aim of this study was to describe the arterial arrangement of the cervical spinal cord in the guinea pig. The study was carried out on 20 adult English self guinea pigs using corrosion and dissection technique. Batson's corrosion casting kit no. 17(©) was used as a casting medium. The origin of the ventral spinal artery from the left vertebral artery was found on average in 35% of the cases and from the right vertebral artery on average in 40% of the cases. The ventral spinal artery with origin from the anastomosis of two medial branches was found on average in 25% of the cases. The presence of ventral radicular branches of rami spinales entering the ventral spinal artery in the cervical region was observed in 42% of the cases on the right side and in 58% of the cases on the left side. The presence of dorsal radicular branches of rami spinales that reached the spinal cord was observed in 63% of the cases on the left side and in 37% of the cases on the right side. The number of radicular branches supplying the spinal cord is greater in guinea pig than in humans.

  8. Spinal cord herniation following cervical meningioma excision: a rare clinical entity and review of literature.

    Science.gov (United States)

    Aiyer, Siddharth N; Shetty, Ajoy Prasad; Kanna, Rishi; Maheswaran, Anupama; Rajasekaran, S

    2016-05-01

    Spinal cord herniation following surgery is an extremely uncommon clinical condition with very few reports in published literature. This condition usually occurs as a spontaneous idiopathic phenomenon often in the thoracic spine or following a scenario of post traumatic spinal cord/nerve root injury. Rarely has it been reported following spinal cord tumor surgery. To document a case of cervical spinal cord herniation as a late onset complication following spinal cord tumor surgery with an atypical presentation of monoparesis. Case report. We describe the clinical presentation, operative procedure, post operative outcome and review of literature of this rare clinical condition. A 57-year-old man presented with right upper limb monoparesis due to a spinal cord herniation 6 years after a cervical intradural meningioma excision. The patients underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. Spinal cord herniation must be considered as differential diagnosis in scenarios of spinal cord tumor excision presenting with late onset neurological deficit. These cases may present as paraparesis, Brown-sequard syndrome and rarely as in our case as monoparesis.

  9. Fatal Fever of Unknown Origin in Acute Cervical Spinal Cord Injury: Five Cases

    Science.gov (United States)

    Ulger, Fatma; Dilek, Ahmet; Karakaya, Deniz; Senel, Alparslan; Sarihasan, Binnur

    2009-01-01

    Background/Objective: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature. Methods: Case reports of 5 patients with cervical spinal cord injury (SCI). Results: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin. Conclusions: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal. PMID:19810636

  10. Outcomes of Spinal Fusion for Cervical Kyphosis in Children with Neurofibromatosis.

    Science.gov (United States)

    Helenius, Ilkka J; Sponseller, Paul D; Mackenzie, William; Odent, Thierry; Dormans, John P; Asghar, Jahangir; Rathjen, Karl; Pahys, Joshua M; Miyanji, Firoz; Hedequist, Daniel; Phillips, Jonathan H

    2016-11-02

    Cervical kyphosis may occur with neurofibromatosis type I (NF1) and is often associated with vertebral dysplasia. Outcomes of cervical spinal fusion in patients with NF1 are not well described because of the rarity of the condition. We aimed to (1) characterize the clinical presentation of cervical kyphosis and (2) report the outcomes of posterior and anteroposterior cervical fusion for the condition in these children. The medical records and imaging studies of 22 children with NF1 who had undergone spinal fusion for cervical kyphosis (mean, 67°) at a mean age of 11 years and who had been followed for a minimum of 2 years were reviewed. Thirteen children presented with neck pain; 10, with head tilt; 9, with a previous cervical laminectomy or fusion; and 5, with a neurologic deficit. Two patients had spontaneous dislocation of the mid-cervical spine without a neurologic deficit. Eleven had scoliosis, with the major curve measuring a mean of 61°. Nine patients underwent posterior and 13 underwent anteroposterior surgery. Twenty-one received spinal instrumentation, and 1 was not treated with instrumentation. Preoperative halo traction was used for 9 patients, and it reduced the mean preoperative kyphosis by 34% (p = 0.0059). At the time of final follow-up, all spinal fusion sites had healed and the cervical kyphosis averaged 21° (mean correction, 69%; p < 0.001). The cervical kyphosis correction was significantly better after the anteroposterior procedures (83%) than after the posterior-only procedures (58%) (p = 0.031). Vertebral dysplasia and erosion continued in all 17 patients who had presented with dysplasia preoperatively. Thirteen patients had complications, including 5 new neurologic deficits and 8 cases of junctional kyphosis. Nine patients required revision surgery. Junctional kyphosis was more common in children in whom ≤5 levels had been fused (p = 0.054). Anteroposterior surgery provided better correction of cervical kyphosis than posterior spinal

  11. Automatic segmentation of the ribs, the vertebral column, and the spinal canal in pediatric computed tomographic images.

    Science.gov (United States)

    Banik, Shantanu; Rangayyan, Rangaraj M; Boag, Graham S

    2010-06-01

    We propose methods to perform automatic identification of the rib structure, the vertebral column, and the spinal canal in computed tomographic (CT) images of pediatric patients. The segmentation processes for the rib structure and the vertebral column are initiated using multilevel thresholding and the results are refined using morphological image processing techniques with features based on radiological and anatomical prior knowledge. The Hough transform for the detection of circles is applied to a cropped edge map that includes the thoracic vertebral structure. The centers of the detected circles are used to derive the information required for the opening-by-reconstruction algorithm used to segment the spinal canal. The methods were tested on 39 CT exams of 13 patients; the results of segmentation of the vertebral column and the spinal canal were assessed quantitatively and qualitatively by comparing with segmentation performed independently by a radiologist. Using 13 CT exams of six patients, including a total of 458 slices with the vertebra from different sections of the vertebral column, the average Hausdorff distance was determined to be 3.2 mm with a standard deviation (SD) of 2.4 mm; the average mean distance to the closest point (MDCP) was 0.7 mm with SD = 0.6 mm. Quantitative analysis was also performed for the segmented spinal canal with three CT exams of three patients, including 21 slices with the spinal canal from different sections of the vertebral column; the average Hausdorff distance was 1.6 mm with SD = 0.5 mm, and the average MDCP was 0.6 mm with SD = 0.1 mm.

  12. Correlation of force control with regional spinal DTI in patients with cervical spondylosis without signs of spinal cord injury on conventional MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lindberg, Paavel G. [Universite Paris Descartes, Sorbonne Paris Cite, FR 3636 Neurosciences, Paris (France); Centre de Psychiatrie et Neurosciences, Inserm U894, Paris (France); Universite Paris Descartes, Sorbonne Paris Cite, Paris (France); Universite Paris Descartes, Service de Radiologie B, APHP, CHU Cochin, Faculte de Medecine, Paris (France); Sanchez, Katherine; Rannou, Francois; Poiraudeau, Serge [Universite Paris Descartes, Sorbonne Paris Cite, Paris (France); Service de Medecine Physique et de Readaptation, APHP, CHU Cochin, Paris (France); INSERM U1153 Epidemiologie Clinique des Maladies Osteo-Articulaires, Paris (France); Ozcan, Fidan [Universite Paris Descartes, Sorbonne Paris Cite, FR 3636 Neurosciences, Paris (France); Feydy, Antoine [Universite Paris Descartes, Sorbonne Paris Cite, FR 3636 Neurosciences, Paris (France); Universite Paris Descartes, Sorbonne Paris Cite, Paris (France); Universite Paris Descartes, Service de Radiologie B, APHP, CHU Cochin, Faculte de Medecine, Paris (France); Maier, Marc A. [Universite Paris Descartes, Sorbonne Paris Cite, FR 3636 Neurosciences, Paris (France); Universite Paris Descartes, Sorbonne Paris Cite, Paris (France); Universite Paris Diderot, Sorbonne Paris Cite, Paris (France)

    2016-03-15

    The aim of this study was to investigate spinal cord structure in patients with cervical spondylosis where conventional MRI fails to reveal spinal cord damage. We performed a cross-sectional study of patients with cervical spondylosis without conventional MRI findings of spinal cord damage and healthy controls. Subjects were studied using spinal diffusion tensor imaging (DTI), precision grip and foot force-tracking tasks, and a clinical examination including assessment of neurological signs. A regional analysis of lateral and medial spinal white matter across multiple cervical levels (C1-C5) was performed. DTI revealed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) in the lateral spinal cord at the level of greatest compression (lowest Pavlov ratio) in patients (p < 0.05). Patients with spondylosis had greater error and longer release duration in both grip and foot force-tracking. Similar spinal cord deficits were present in patients without neurological signs. Increased error in grip and foot tracking (low accuracy) correlated with increased RD in the lateral spinal cord at the level of greatest compression (p ≤ 0.01). Spinal DTI can detect subtle spinal cord damage of functional relevance in cervical spondylosis, even in patients without signs on conventional T2-imaging and without neurological signs. (orig.)

  13. Disc-like herniation in association with gas collection in the spinal canal: CT evaluation

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    Tsitouridis, Ioannis [Radiology Department, Papageorgiou General Hospital, Peripheral Rd., Nea Efkarpia, 546 29 Thessaloniki (Greece)]. E-mail: hanjk@radcom.snu.ac.kr; Sayegh, Fares E. [3rd Orthopaedic Department, Aristotle University of Thessaloniki (Greece); Papapostolou, Panagiota [Radiology Department, Papageorgiou General Hospital, Peripheral Rd., Nea Efkarpia, 546 29 Thessaloniki (Greece); Chondromatidou, Stella [Radiology Department, Papageorgiou General Hospital, Peripheral Rd., Nea Efkarpia, 546 29 Thessaloniki (Greece); Goutsaridou, Fotini [Radiology Department, Papageorgiou General Hospital, Peripheral Rd., Nea Efkarpia, 546 29 Thessaloniki (Greece); Emmanouilidou, Maria [Radiology Department, Papageorgiou General Hospital, Peripheral Rd., Nea Efkarpia, 546 29 Thessaloniki (Greece); Sidiropoulou, Maria S. [Radiology Department, Papageorgiou General Hospital, Peripheral Rd., Nea Efkarpia, 546 29 Thessaloniki (Greece); Kapetanos, George A. [3rd Orthopaedic Department, Aristotle University of Thessaloniki (Greece)

    2005-10-01

    Gas production as a part of disk degeneration can occur but rarely causes nerve compression syndromes. Few cases have been reported in which lumbar intraspinal epidural gas cause nerve root compression symptoms. We present 12 cases of gas collection in the spinal canal that were presented to the orthopaedic out-patient department with symptoms of low back pain and sciatica. CT showed the presence of free epidural gas collections adjacent to or over the affected nerve roots. Relief of symptoms was noted with the change of positions, lying down or sleeping. In this study, we conclude that the presence of lumbar intraspinal epidural gas that causes radicular compressing phenomena, can be easily detected with the use of CT.

  14. Minimally invasive space shuttle laminotomy for degenerative lumbar spinal canal stenosis

    Directory of Open Access Journals (Sweden)

    Shunji Asamoto

    2016-01-01

    Full Text Available Study Design: Technical note. Objectives: To show microsurgical technique, considering the meticulous anatomy of the ligamentum flavum (LF. Background: Different methods are available for treating lumbar spinal canal stenosis (LSCS. A minimally invasive surgery, namely, space shuttle laminotomy, has recently been proposed. Here, we describe the surgical method for this novel technique. To conduct this surgery accurately, surgeons must have perfect knowledge of anatomy, especially regarding the LF. Materials and Methods and Results: We use this interlaminectomy technique for all cases of LSCS. All patients with LSCS recovered from their neurological deficits in shorter hoslital stays than regular laminectomy. Conclusion: Minimally invasive space shuttle laminotomy (MISSL, which involves a microsurgical technique, is a safe, complication-free procedure.

  15. Oxygenation status of cervical carcinomas before and during spinal anesthesia for application of brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Weitmann, H.D.; Knocke, T.H.; Poetter, R. [Dept. of Radiotherapy and Radiobiology, Univ. of Vienna, General Hospital of Vienna (Austria); Gustorff, B. [Dept. of Anesthesia and General Intensive Care B, Univ. of Vienna, General Hospital of Vienna (Austria); Vaupel, P. [Inst. of Physiology and Pathophysiology, Univ. of Mainz (Germany)

    2003-09-01

    Background and Purpose: To date, no information is available concerning the impact of spinal anesthesia on the oxygenation status of carcinomas of the uterine cervix. The aim of this study was therefore to determine the influence of spinal anesthesia on the oxygenation status of cervical carcinomas. Patients and Methods: In ten patients with cervical carcinoma who received spinal anesthesia for a first application of brachytherapy, intratumoral pO{sub 2} measurements (pO{sub 2} histography system, Eppendorf-Netheler-Hinz, Hamburg, Germany) were performed. Systemic parameters were documented prior to and during spinal anesthesia. Patients breathed room air spontaneously. For further evaluation, all intratumoral pO{sub 2} values were pooled, and overall median pO{sub 2} values and fractions of hypoxic pO{sub 2} values {<=} 5 mm Hg were calculated. Overall median pO{sub 2} values in the subcutis were also calculated. Results: There were no significant changes of systemic parameters, median subcutaneous pO{sub 2} values, median intratumoral pO{sub 2} values, and the fractions of hypoxic pO{sub 2} values {<=} 5 mm Hg in the tumor upon administration of spinal anesthesia. The variability of measured pO{sub 2} values increased during spinal anesthesia, although substantial changes in the oxygenation status were only seen in individual cases (n = 2). Conclusion: This study shows for the first time that the oxygenation status of cervical carcinomas, in general, is not influenced by spinal anesthesia prior to application of brachytherapy. To conclude, the data presented suggest that reliable pO{sub 2} measurements can be performed under spinal anesthesia. At the same time, since no substantial changes in tumor oxygenation were observed, spinal anesthesia should not affect the O{sub 2}-related efficacy of high-dose-rate brachytherapy. (orig.)

  16. Cervical spinal cord injury:tailoring clinical trial endpoints to relfect meaningful functional improvements

    Institute of Scientific and Technical Information of China (English)

    Lisa M Bond; Lisa McKerracher

    2014-01-01

    Cervical spinal cord injury (SCI) results in partial to full paralysis of the upper and lower extrem-ities. Traditional primary endpoints for acute SCI clinical trials are too broad to assess functional recovery in cervical subjects, raising the possibility of false positive outcomes in trials for cervical SCI. Endpoints focused on the recovery of hand and arm control (e.g., upper extremity motor score, motor level change) show the most potential for use as primary outcomes in upcoming trials of cervical SCI. As the field moves forward, the most reliable way to ensure meaningful clinical testing in cervical subjects may be the development of a composite primary endpoint that measures both neurological recovery and functional improvement.

  17. Spinal cord injury of cervical vertibrae and early diagnosis and treatment

    Institute of Scientific and Technical Information of China (English)

    陈扬; 李振宇; 等

    1999-01-01

    Objective:To sum up clinical data and CT and MRI examination in 22 patients with spinal cord injury of cervical vertebrae.Methods:CT and MRI examination of the 22 patients with spinal cord injury of cervical vertebrae revealed that 16 patients had spinal comprssion caused by fracture dislocation and protrusion of intervertebral disc,5 suffered from intramedullary hemorrhage and 1 had complete spinal cord injury.A combined modality therapy of intramedullary and extramedullary decompression for spinal cord,skull traction and avoiding reinjury to spinal cord were used. Results:According to Frankel Classification,before operation 3 cases were classified as A degree,2 as B degree,5as C degree,8 as D degree and 4 as Edegree;after operation 2 were classified as A degree,1 as B degree,6 as C degree,6 as D degree and 7 as E degree.Conclusions:Early diagnosis and timely treatmetn,clear mechanism and degree of injury and early selection of effective treatment are very important in raising the rate of curing spinal cord injury.

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

    Science.gov (United States)

    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.

  19. Functional evaluation using several evoked spinal cord potentials in elderly patients with cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    Zhenglin Li

    2006-01-01

    BACKGROUND: The recordings of evoked spinal cord potentials following epidural spinal cord stimulation are thought to be generated by volleys traversing the dorsal column pathway, and it may not directly reflect conduction defects in corticospinal tracts of cervical spinal cord. To our knowledge there has been few report using several evoked spinal cord potentials in function evaluation of the cervical spinal cord in elderly patients with cervical spondylotic myelopathy (CSM).OBJECTIVE: To investigate the function states of the cervical spinal cord in elderly patients with CSM and explore its pathophysiologic mechanism.DESIGN: Case observation.SETTING: Department of Qrthopedics for the aged, Shenzhen Pingle Hospital of Orthopedics. Department of Orthopedic Surgery, Yamaguchi University School of Medicine.PARTICIPANTS: A total of 23 elderly patients with CSM who received treatment in the Department of Orthopedic Surgery, Yamaguchi University School of Medicine of Japan from January 2003 to February 2004 were enrolled in this study. Inclusive criteria: ① Multiple intervertebral levels of cervical spinal cord compression confirmed by MRI, e.g. 3 or more than 3 levels of compressin. ② Age >70 years old. ③ Numbness and sensory disturbance in the upper limbs and showed hyperreflexia in the lower limbs. Exclusive criteria: Patients with abnormal motor and sensory nerve conduction velocities in both upper and lower limbs were excluded.METHODS: Evoked spinal cord potentials (ESCPs) following transcranial electric stimulation (TCE-ESCPs),epidural spinal cord stimulation (Spinal-ESCPs) and median nerve stimulation (MN-ESCPs) were recorded in 23 patients from posterior epidural space intraoperatively. The abnormalities of TCE-ESCPs were defined as attenuation of amplitude of the D wave. The most cranial intervertebral level showing abnormal TCE-ESCPs with a marked reduction in size of the negative peak (reduction of over 50%) was considered as the upper level of the

  20. Posterior arthrodesis of C1-C3 for the stabilization of multiple unstable upper cervical fractures with spinal cord compromise

    Science.gov (United States)

    Xue, Deting; Chen, Qixin; Chen, Gang; Zhuo, Wenhai; Li, Fangcai

    2017-01-01

    Abstract Background: Multiple fractures of the atlas and axis are rare. The management of multiple fragment axis fractures and unstable atlas fractures is still challenging for the spinal surgeon. There are no published reports of similar fractures with 3-part fracture of axis associated with an unstable atlas fracture. Case summary: We present a patient with concurrent axis and atlas fractures, which have not been reported. The patient suffered hyperextension injury with neck pain and numbness of the bilateral upper extremity associated with weakness after a 2-m fall. The axis fractures included an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3. The atlas fracture was unstable. The neurological examination manifested as central canal syndrome, which was due to the hyperextension injury of cervical spine and spondylolisthesis of C2-C3. The patient was diagnosed as multiple unstable upper cervical fractures with spinal cord compromise. We performed posterior arthrodesis of C1-C3. Postoperatively, the patient showed neurological improvement, and C1-C3 had fused at the 3-month follow-up. Conclusion: Posterior arthrodesis of C1-C3 could provide a stable fixation for the 3 parts of axis (an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3) combined an unstable atlas fracture. Both the patient and the doctor were satisfied with the results of the treatment. So posterior arthrodesis of C1-C3 is a suitable treatment option for the treatment of a concurrent unstable atlas fracture and multiple fractures of the axis. PMID:28072744

  1. EVALUATION OF THE RESULTS OF CERVICAL SPINE & SPINAL CORD TRAUMA IN CHILDREN

    Directory of Open Access Journals (Sweden)

    G.R. Bahadorkhan

    2009-04-01

    Full Text Available ObjectivesMajor differences exist in the anatomy and biomechanics of the growing spine that causes failure patterns different from those in adults. Spinal injury in the pediatric patient is a main concern because timely diagnosis and appropriate treatment can prevent further neurologic damage and deformity and potentiate recovery. We conducted a retrospective clinical study of 137 cases (93 boys, 44 girls of pediatric cervical spine injuries, managed over fifteen years, to present data from a large series of pediatric patients with cervical spine injuries from a single regional trauma center. The aim was to assess and analyze complications, etiology, pathogenesis, site of injuries and age difference of cervical spine and spinal cord injury in a pediatric age group and compare the findings with current literature.Materials & MethodsOne hundred and thirty seven children with cervical spine injuries, seen over twelve years, were divided into two age groups: 54 patients were in group one (0-9 years and 83 patients were in group two (10 - 17 years . We managed them according to status at presentation and type of injury. Forty seven patients were managed surgically and ninety nonsurgically (52 wore a halo brace and 38 wore different hard collars and braces. T-test and Chi squares were used to analyze differences between groupsResultsThe most common cause of injury was motor vehicle accidents(MVA. Our younger patients (Group 1 had sustained more neurological injuries than the older ones (Group 2, 77% vs.48%.; upper cervical spine was the most common site involved in 76%, while 43% suffered head injuries. In group two, 88% of children two sustained fractures or fracture/ subluxations; also in this group, subluxation, and fracture/ subluxation was present in 10 and 25% of children respectively. The most common radiological findings were vertebral fractures (38%. Solid fusions were demonstrated in all patients at late follow-up review (mean 6 years. None

  2. Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit

    OpenAIRE

    Dunham, C Michael; Brocker, Brian P; Collier, B David; Gemmel, David J

    2008-01-01

    Introduction In blunt trauma, comatose patients (Glasgow Coma Scale score 3 to 8) with a negative comprehensive cervical spine (CS) computed tomography assessment and no apparent spinal deficit, CS clearance strategies (magnetic resonance imaging [MRI] and prolonged cervical collar use) are controversial. Methods We conducted a literature review to delineate risks for coma, CS instability, prolonged cervical collar use, and CS MRI. Results Based on our search of the literature, the numbers of...

  3. Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

    Directory of Open Access Journals (Sweden)

    Murphy Donald R

    2009-08-01

    Full Text Available Abstract Background It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with information upon which to base advice to patients. The evidence behind claims of increased risk is investigated as well as the evidence regarding the risk of decompression surgery. Methods A literature search was conducted on the risk of spinal cord injury in individuals with asymptomatic cord encroachment and the risk and benefit of preventive decompression surgery. Results Three studies on the risk of spinal cord injury in this population met the inclusion criteria. All reported increased risk. However, none were prospective cohort studies or case-control studies, so the designs did not allow firm conclusions to be drawn. A number of studies and reviews of the risks and benefits of decompression surgery in patients with cervical myelopathy were found, but no studies were found that addressed surgery in asymptomatic individuals thought to be at risk. The complications of decompression surgery range from transient hoarseness to spinal cord injury, with rates ranging from 0.3% to 60%. Conclusion There is insufficient evidence that individuals with spondylotic spinal cord encroachment are at increased risk of spinal cord injury from minor trauma. Prospective cohort or case-control studies are needed to assess this risk. There is no evidence that prophylactic decompression surgery is helpful in this patient population. Decompression surgery appears to be helpful in patients with cervical myelopathy, but the significant risks may outweigh the unknown benefit in asymptomatic individuals. Thus, broad recommendations for decompression surgery in suspected at-risk individuals cannot be made

  4. Mechanical Design and Analysis of a Unilateral Cervical Spinal Cord Contusion Injury Model in Non-Human Primates.

    Science.gov (United States)

    Sparrey, Carolyn J; Salegio, Ernesto A; Camisa, William; Tam, Horace; Beattie, Michael S; Bresnahan, Jacqueline C

    2016-06-15

    Non-human primate (NHP) models of spinal cord injury better reflect human injury and provide a better foundation to evaluate potential treatments and functional outcomes. We combined finite element (FE) and surrogate models with impact data derived from in vivo experiments to define the impact mechanics needed to generate a moderate severity unilateral cervical contusion injury in NHPs (Macaca mulatta). Three independent variables (impactor displacement, alignment, and pre-load) were examined to determine their effects on tissue level stresses and strains. Mechanical measures of peak force, peak displacement, peak energy, and tissue stiffness were analyzed as potential determinants of injury severity. Data generated from FE simulations predicted a lateral shift of the spinal cord at high levels of compression (>64%) during impact. Submillimeter changes in mediolateral impactor position over the midline increased peak impact forces (>50%). Surrogate cords established a 0.5 N pre-load protocol for positioning the impactor tip onto the dural surface to define a consistent dorsoventral baseline position before impact, which corresponded with cerebrospinal fluid displacement and entrapment of the spinal cord against the vertebral canal. Based on our simulations, impactor alignment and pre-load were strong contributors to the variable mechanical and functional outcomes observed in in vivo experiments. Peak displacement of 4 mm after a 0.5N pre-load aligned 0.5-1.0 mm over the midline should result in a moderate severity injury; however, the observed peak force and calculated peak energy and tissue stiffness are required to properly characterize the severity and variability of in vivo NHP contusion injuries.

  5. Catastrophic cervical spinal injury in an amateur college wrestler

    National Research Council Canada - National Science Library

    Jayakrishnan Kelamangalathu Narayana Kurup; Ravitheja Jampani; Simanchal P Mohanty

    2017-01-01

    .... Trainers, assistants and institutions should be well equipped to diagnose and provide initial care of people with a spinal injury to prevent a partial injury from progressing to complete injury...

  6. Targeted, activity-dependent spinal stimulation produces long-lasting motor recovery in chronic cervical spinal cord injury.

    Science.gov (United States)

    McPherson, Jacob G; Miller, Robert R; Perlmutter, Steve I

    2015-09-29

    Use-dependent movement therapies can lead to partial recovery of motor function after neurological injury. We attempted to improve recovery by developing a neuroprosthetic intervention that enhances movement therapy by directing spike timing-dependent plasticity in spared motor pathways. Using a recurrent neural-computer interface in rats with a cervical contusion of the spinal cord, we synchronized intraspinal microstimulation below the injury with the arrival of functionally related volitional motor commands signaled by muscle activity in the impaired forelimb. Stimulation was delivered during physical retraining of a forelimb behavior and throughout the day for 3 mo. Rats receiving this targeted, activity-dependent spinal stimulation (TADSS) exhibited markedly enhanced recovery compared with animals receiving targeted but open-loop spinal stimulation and rats receiving physical retraining alone. On a forelimb reach and grasp task, TADSS animals recovered 63% of their preinjury ability, more than two times the performance level achieved by the other therapy groups. Therapeutic gains were maintained for 3 additional wk without stimulation. The results suggest that activity-dependent spinal stimulation can induce neural plasticity that improves behavioral recovery after spinal cord injury.

  7. Myelin water fraction in human cervical spinal cord in vivo.

    Science.gov (United States)

    Wu, Yijing; Alexander, Andrew L; Fleming, John O; Duncan, Ian D; Field, Aaron S

    2006-01-01

    The noninvasive discrimination of myelin disease from axonal loss and other pathologic confounds remains an unsolved problem in multiple sclerosis but may be possible through magnetic resonance quantitation of the intramyelinic water compartment. Technical challenges have limited the study of this approach in the spinal cord, a common site of involvement in multiple sclerosis. This technical note reports the test-retest reproducibility of a short T2-based estimate of myelin content in human spinal cord in vivo.

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

    Directory of Open Access Journals (Sweden)

    Keirstead Hans S

    2007-09-01

    Full Text Available Abstract Background Chronic spinal cord injury (SCI can lead to an insidious decline in motor and sensory function in individuals even years after the initial injury and is accompanied by a slow and progressive cytoarchitectural destruction. At present, no pathological mechanisms satisfactorily explain the ongoing degeneration. Methods Adult female Sprague-Dawley rats were anesthetized laminectomized at T10 and received spinal cord contusion injuries with a force of 250 kilodynes using an Infinite Horizon Impactor. Animals were randomly distributed into 5 groups and killed 1 (n = 4, 28 (n = 4, 120 (n = 4, 450 (n = 5, or 540 (n = 5 days after injury. Morphometric and immunohistochemical studies were then performed on 1 mm block sections, 6 mm cranial and 6 mm caudal to the lesion epicenter. The SPSS 11.5 t test was used to determine differences between quantitative measures. Results Here, we document the first report of an ascending central canal dilation and progressive ependymal disruption cranial to the epicenter of injury in a contusion model of chronic SCI, which was characterized by extensive dural fibrosis and intraparenchymal cystic cavitation. Expansion of the central canal lumen beyond a critical diameter corresponded with ependymal cell ciliary loss, an empirically predictable thinning of the ependymal region, and a decrease in cell proliferation in the ependymal region. Large, aneurysmal dilations of the central canal were accompanied by disruptions in the ependymal layer, periependymal edema and gliosis, and destruction of the adjacent neuropil. Conclusion Cells of the ependymal region play an important role in CSF homeostasis, cellular signaling and wound repair in the spinal cord. The possible effects of this ascending pathology on ependymal function are discussed. Our studies suggest central canal dilation and ependymal region disruption as steps in the pathogenesis of chronic SCI, identify central canal dilation as a marker of

  9. Damage control of multiple injuries headed by cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    LIU Si-hai; WANG Ai-min; DU Quan-yin; ZHAO Yu-feng; WANG Zi-ming; GUO Qing-shan; SHEN Yue

    2008-01-01

    Objective: To explore the strategy of damage control in clinical treatment of multiple injuries headed by cervical spinal cord injury.Methods: A retrospective analysis was performed in 32 patients. Cervical fractures associated with tetraplegia occurred in 18 patients, traumatic intervertebral disk hernia associated with tetraplegia in 2 patients, and cervical fractures and dislocation associated with tetraplegia in 12 patients. Seventeen cases were combined with craniocerebral injury, 7 combined with pulmonary contusion, multi-fractures of rib or hemopneumothorax, 2 combined with pelvic fracture and other 8 combined with fracture of limbs. The neural function was assessed by the American Spinal Injury Association (ASIA) scale.Results:Thirty-one patients were followed up for an average of 14 months. Of them, 10 got complete recovery, 13 obtained improvement of more than one ASIA grade, 8 did not improve, and 1 died.Conclusions: For the emergency treatment of multiple injuries headed by cervical spinal cord injury, the damage control strategy is the principle to follow. The final operations are preferably performed within 5 to 10 days after injury so as to raise the successful rate of remedy.

  10. MR-myelography in patients with spinal canal stenosis; MR-Myelographie bei Spinalkanalstenosen

    Energy Technology Data Exchange (ETDEWEB)

    Freund, M.; Hutzelmann, A.; Steffens, J.C.; Heller, M. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet zu Kiel (Germany); Buhl, R. [Klinik fuer Neurochirurgie, Christian-Albrechts-Universitaet zu Kiel (Germany)

    1997-11-01

    Purpose: The purpose of this prospective study was to evaluate the clinical value of 3D-MR-myelography (3D-MRM) in comparison to myelography and intra-operative findings. Material and Methods: 25 patients with suspected lumbar spinal canal stenosis were studied via myelography and 3D-MRM (volume-data set, 3D-FISP sequenz, T{sub R} 73 ms, T{sub E} 21 ms, flipangle 7 , sagittal slices) besides the routinely acquired sagittal and axial T{sub 1}- and T{sub 2}-weighted images. Diagnoses were made by two radiologists and one neurosurgeon without knowing the clinical history and symptoms, in two separate sessions. Results were compared to intraoperative findings. Results: 3D-MRM has the same diagnostic sensitivity (25/25=100%) as conventional X-ray myelography (25/25=100%) compared to intraoperative findings, but is not invasive and shows more diagnostic details than myelography. Especially in cases of high-grade spinal canal stenosis there is often a lack of intrathecal contrast medium distally of the stenosis. (orig./AJ) [Deutsch] Ziel: Bewertung der 3D-MR-Myelographie (3D-MRM) in der Diagnostik lumbaler Spinalkanalstenosen im Vergleich zu Myelographie und Korrelation mit intraoperativem Befund. Material und Methode: In einer fortlaufenden, prospektiven Studie wurden 25 Patienten mit den Symptomen einer lumbalen Spinalkanalstenose kernspintomographisch untersucht. Neben den ueblichen sagittalen und axialen T{sub 1}- und T{sub 2}-gewichteten Aufnahmen wurde ein Volumendatensatz mit einer 3D-FISP Sequenz (T{sub R} 73 ms, T{sub E} 21 ms, Flipwinkel 7 ) akquisiert. Die Nachverarbeitung erfolgte mittels Maximum Intensitaets-Projektion (MIP): 18 Projektionen von 0 -180 . Die 3D-MRM wurde der Myelographie gegenuebergestellt, beide Untersuchungen wurden getrennt von drei Untersuchern blind ausgewertet. Ergebnisse: Sowohl die 3D-MRM als auch die der Myelographie zeigten bei Patienten mit lumbaler Spinalkanalstenose in Korrelation zum intraoperativen Befund eine Uebereinstimmung

  11. Ocular vs. Cervical VEMPs in the Diagnosis of Superior Semicircular Canal Dehiscence Syndrome

    Science.gov (United States)

    Zuniga, M. Geraldine; Janky, Kristen L.; Nguyen, Kimanh D.; Welgampola, Miriam S.; Carey, John P.

    2012-01-01

    Objectives To determine whether cervical vestibular evoked myogenic potential (cVEMP) thresholds or ocular VEMP amplitudes are more sensitive and specific in the diagnosis of superior semicircular canal dehiscence syndrome (SCDS). Study design Prospective case-control study Setting Tertiary referral center Subjects and Methods 29 patients with SCDS (mean age 48y; range 31–66y) and 25 age-matched controls (mean age 48y; range 30–66y). Intervention(s) cVEMP and oVEMP in response to air-conducted sound (ACS). All patients underwent surgery for repair of SCDS. Main outcome measure(s) cVEMP thresholds; oVEMP n10 and peak-to-peak amplitudes. Results cVEMP threshold results showed sensitivity and specificity ranging from 80–100% for the diagnosis of SCDS. In contrast, oVEMP amplitudes demonstrated sensitivity and specificity >90%. Conclusions oVEMP amplitudes are superior to cVEMP thresholds in the diagnosis of SCDS. PMID:23183641

  12. Diaphragm and intercostal muscle activity following mid-cervical spinal cord contusion in the rat.

    Science.gov (United States)

    Wen, Ming-Han; Lee, Kun-Ze

    2017-08-26

    The present study was designed to investigate the diaphragm and intercostal muscle activity following unilateral mid-cervical spinal cord contusion in rats. Electromyogram (EMG) activity of the bilateral diaphragm and T2 intercostal muscle was measured in anesthetized and spontaneously breathing rats. Unilateral mid-cervical contusion caused an immediate reduction in inspiratory bursting in the bilateral diaphragm and intercostal muscles. From 3 days to 8 weeks post-contusion, the contused animals displayed significantly lower tidal volume than uninjured animals, regardless of the time point after injury. The burst amplitude of the contralateral diaphragm EMG was augmented in contused animals at 3 days post-injury. When the data were normalized by the maximal response during hypoxic-hypercapnic challenge (12-13 % O2, 3-4 % CO2), the ipsilateral diaphragm EMG of contused animals was greater than that of uninjured animals at 3 days and 2 weeks post-injury. Moreover, hypoxia-hypercapnia induced increases in ipsilateral diaphragm EMG activity were blunted in contused animals at 2 weeks post-injury but recovered at 8 weeks post-injury. Bilateral diaphragm EMG activity in contused animals was comparable to uninjured animals at 8 weeks post-injury. Notably, intercostal muscle activity was not substantially changed by mid-cervical spinal cord contusion from 3 days to 8 weeks post-contusion. These results suggest that mid-cervical spinal contusion induces a compensatory increase in contralateral diaphragmatic activity and greater utilization of a percentage of maximal inspiratory activity in the ipsilateral diaphragm. The maintenance of intercostal muscle activity may enable the animal to sustain essential breathing capacity following cervical spinal cord injury.

  13. 浅谈椎管内麻醉的特点%The Characteristics of Spinal Canal Anesthesia

    Institute of Scientific and Technical Information of China (English)

    王勇

    2015-01-01

    To discuss spinal canal anesthesia. The spinal canal anesthesia includes subarachnoid block(lumbar hemp),epidural space block. It could adjust the subarachnoid block(lumbar hemp),the epidural space block anesthesia centesis,anesthesia drug use and the adjustment of the anesthesia plane and complications. Spinal canal anesthesia surgery for lower limbs extremity,which can provide perfect analgesia and muscle relaxant. The sympathetic nerve block can provide good perfusion status for limb reattachment surgeries.%探讨椎管内麻醉患者的临床麻醉方法。椎管内麻醉包括蛛网膜下腔阻滞(腰麻)、硬膜外腔阻滞。对蛛网膜下腔阻滞(腰麻)、硬膜外腔阻滞的麻醉的穿刺术,局麻用药及麻醉平面的调节。椎管内麻醉多用于下肢手术,可提供完善的镇痛和肌松,伴发的交感神经阻滞可为肢体再植手术提供良好的灌注状态。

  14. Elastofibromatous changes in tissues from spinal biopsies. A degenerative process afflicting a small but important subset of patients operated for spinal canal compression: report of 18 cases.

    Science.gov (United States)

    Daum, Ondrej; Ferda, Jiri; Curik, Romuald; Choc, Milan; Mukensnabl, Petr; Michal, Michal

    2010-12-01

    Elastofibroma is a tumorlike lesion occurring usually in the subscapular region of elderly females. In this study, 18 cases of elastofibromatous tissue retrieved from the spinal canal were analyzed to elucidate its frequency and possible clinical associations. The patients included 8 men and 10 women with a mean age of 63.4 years (range, 40-84 years). The elastic nature of the material was confirmed by Weigert's elastic stain and immunohistochemically. Elastofibroma was diagnosed in 6 patients, and elastofibroma-like tissue was found in 11 samples. The finding of elastofibromatous tissue was associated with clinical diagnosis of juxtaarticular cysts (3 cases), thickening of ligamentum flavum (4 cases), extradural expansion (2 cases), metastatic involvement of the dorsal spine (3 cases), and a vertebral fracture (1 case). Two cases were located above the transpedicular fixation. Elastofibromatous tissue may be found in approximately 2.6% of all spinal biopsies and it may take part in compression of spinal cord and nerve roots.

  15. Cervical spondylosis anatomy: pathophysiology and biomechanics.

    Science.gov (United States)

    Shedid, Daniel; Benzel, Edward C

    2007-01-01

    Cervical spondylosis is the most common progressive disorder in the aging cervical spine. It results from the process of degeneration of the intervertebral discs and facet joints of the cervical spine. Biomechanically, the disc and the facets are the connecting structures between the vertebrae for the transmission of external forces. They also facilitate cervical spine mobility. Symptoms related to myelopathy and radiculopathy are caused by the formation of osteophytes, which compromise the diameter of the spinal canal. This compromise may also be partially developmental. The developmental process, together with the degenerative process, may cause mechanical pressure on the spinal cord at one or multiple levels. This pressure may produce direct neurological damage or ischemic changes and, thus, lead to spinal cord disturbances. A thorough understanding of the biomechanics, the pathology, the clinical presentation, the radiological evaluation, as well as the surgical indications of cervical spondylosis, is essential for the management of patients with cervical spondylosis.

  16. Increased number of neurons in the cervical spinal cord of aged female rats.

    Directory of Open Access Journals (Sweden)

    Enrique L Portiansky

    Full Text Available In the brain, specific signaling pathways localized in highly organized regions called niches allow the persistence of a pool of stem and progenitor cells that generate new neurons in adulthood. Much less is known about the spinal cord where a sustained adult neurogenesis is not observed. Moreover, there is scarce information concerning cell proliferation in the adult mammalian spinal cord and virtually none in aging animals or humans. We performed a comparative morphometric and immunofluorescence study of the entire cervical region (C1-C8 in young (5 mo. and aged (30 mo. female rats. Serum prolactin (PRL, a neurogenic hormone, was also measured. Gross anatomy showed a significant age-related increase in size of all of the cervical segments. Morphometric analysis of cresyl violet stained segments also showed a significant increase in the area occupied by the gray matter of some cervical segments of aged rats. The most interesting finding was that both the total area occupied by neurons and the number of neurons increased significantly with age, the latter increase ranging from 16% (C6 to 34% (C2. Taking the total number of cervical neurons the age-related increase ranged from 19% (C6 to 51% (C3, C3 being the segment that grew most in length in the aged animals. Some bromodeoxyuridine positive-neuron specific enolase negative (BrdU(+-NSE(- cells were observed and, occasionally, double positive (BrdU(+-NSE(+ cells were detected in some cervical segments of both young and aged rats groups. As expected, serum PRL increased markedly with age. We propose that in the cervical spinal cord of female rats, both maturation of pre-existing neuroblasts and/or possible neurogenesis occur during the entire life span, in a process in which PRL may play a role.

  17. Diseases in the cranio-cervical junction: Anatomical and pathological aspects and detailed clinical accounts

    Energy Technology Data Exchange (ETDEWEB)

    Voth, D.; Glees, P.

    1987-01-01

    This book contains over 40 selections. Some of the titles are: Radionuclide imaging of the cranio-cervical region; Magnetic resonance imaging in the cranio-cervical region: Experiences in 194 cases; NMR-finding in a case of Morquio's syndrome with syncope; The dynamic evaluation of the cervical spinal canal and spinal cord by magnetic resonance imaging during movement; and A review of clinical and radiological aspects of rheumatoid arthritis of head joints.

  18. MR imaging in neuroborreliosis of the cervical spinal cord

    Energy Technology Data Exchange (ETDEWEB)

    Hattingen, Elke; Weidauer, Stefan; Zanella, Friedhelm E. [University of Frankfurt, Institute of Neuroradiology, Frankfurt (Germany); Kieslich, Matthias; Boda, Volker [University of Frankfurt, Department of Pediatric Neurology, Frankfurt (Germany)

    2004-11-01

    The central nervous system is involved in 10-20% of cases in Lyme disease. The neurological symptoms, time course of the disease and imaging findings are multifaceted. We report two patients with cervical radiculitis. Magnetic resonance imaging revealed strong enhancement of the cervical nerve roots on contrast-enhanced T1-weighted images. These imaging patterns of borrelia-associated radiculitis have not been reported before. Knowledge of these imaging features may help to diagnose neuroborreliosis, which presents with non-specific symptoms. (orig.)

  19. Coupling between the spinal cord and cervical vertebral column under tensile loading.

    Science.gov (United States)

    Kroeker, Shannon G; Ching, Randal P

    2013-02-22

    Current neck injury criteria are based on structural failure of the spinal (vertebral) column without consideration of injury to the spinal cord. Since one of the primary functions of the vertebral column is to protect the cord, it stands to reason that a more refined measure of neck injury threshold would be the onset of spinal cord injury (SCI). This study investigated the relationship between axial strains in the cervical vertebral column and the spinal cord using an in vitro primate model (n=10) under continuous tensile loading. Mean failure loads occurred at 1951.5±396N with failure strains in the vertebral column of 16±5% at the level of failure. Average tensile strains in the spinal cord at failure were 11±5% resulting in a mean coupling ratio of 0.54±0.17 between C1 and C7. The level of peak strain measured in the spinal cord did not always occur at the location of vertebral column failure. Spinal cord strains were less than spine strains and coupling ratios were not significantly different along the length of the spine. The largest coupling ratio was measured in the atlanto-occipital joint whereas the smallest coupling ratio occurred at the adjacent C1-C2 joint.

  20. Clinical forensic sample collection techniques following consensual intercourse in volunteers - cervical canal brush compared to conventional swabs.

    Science.gov (United States)

    Joki-Erkkilä, Minna; Tuomisto, Sari; Seppänen, Mervi; Huhtala, Heini; Ahola, Arja; Rainio, Juha; Karhunen, Pekka J

    2014-10-01

    The purpose of the research was to evaluate gynecological evidence collection techniques; the benefit of cervical canal brush sample compared to vaginal fornix and cervical swab samples and the time frame for detecting Y-chromosomal material QiAmp DNA Mini Kit(®) and Quantifiler Y Human Male DNA Quantification Kit(®) in adult volunteers following consensual intercourse. Eighty-four adult female volunteers following consensual intercourse were recruited for the study. By combining all sample collecting techniques, 81.0% of the volunteers were Y-DNA positive. Up to 60 h the conventional swab sampling techniques detected more Y-DNA positive samples when compared to the brush technique. However, after 60 h, the cervical canal brush sample technique showed its benefit by detecting 27.3% (6/22) of Y-DNA positive samples, which were Y-DNA negative in both conventional swab sampling techniques. By combining swab and brush techniques, 75% of the volunteers were still Y-DNA positive in 72-144 post-coital hours. The rate of measurable Y-DNA decreased approximately 3% per hour. Despite reported consensual intercourse, 6.8% (3/44) of volunteers were Y-DNA negative within 48 h. Y-DNA was not detected after 144 post-coital hours (6 days). In conclusion, the brush as a forensic evidence collection method may provide additional biological trace evidence from the cervical canal, although the best biological trace evidence collection can be obtained by combining all three sampling techniques. The time frame for gynecological forensic evidence sample collection should be considered to be at least a week if sexual violence is suspected.

  1. Decision-making process in patients with lumbar spinal canal stenosis.

    Science.gov (United States)

    Azimi, Parisa; Mohammadi, Hassan R; Benzel, Edward C; Shahzadi, Shorab; Azhari, Shirzad; Montazeri, Ali

    2017-08-01

    The aim of this study was to develop a strategy to determine a sound methodology for decision-making in lumbar spinal canal stenosis (LSCS). This was a retrospective study of patients with LSCS to determine the rationale for those who underwent surgery and those who received conservative treatment. All case records were assessed to extract information on the morphology grade and dural sac cross-sectional surface area (DSCA) on MRI. Patients' functionality and satisfaction were examined as outcome measures in order to understand factors that were associated with benefit from either treatment strategy. In all 357 patients, case records were reviewed. The mean age of patients was 57.5 (SD=10.9) years. Of these, 176 patients underwent surgery. Post-treatment satisfaction was found in a large portion of the surgical group (93.2%) whereas this was 84.5% for those who received conservative treatment. Most patients (86.4%) who underwent surgery were identified as having grade C and grade D stenosis, while those who received conservative treatment were identified as having grade A and grade B stenosis (Pmake clinically sound decisions in LSCS patients.

  2. [Myelopathies caused by dorsal spinal canal spondylotic stenosis. 3 cases and a review of the literature].

    Science.gov (United States)

    Bazin, A; Rousseaux, P; Bernard, M H; Peruzzi, P; Baudrillard, J C; Scherpereel, B

    1989-01-01

    Thoracic spondylotic myelopathies are exceptional, only 29 observations could be found in the literature; we intend to describe three new cases here. The patients, two women and one man, 64, 69 and 72 years old, complained of weakness of the lower limbs, more marked on one side, which had been progressing slowly from several months to eight years. Examination revealed asymmetrical paraparesis with distal sensitivity deficits without thoracic sensory level. In the first case, the myelography remained virtually unchanged in front of T11, T12; in the second and third cases, there was slight extradural compression at T9 and T10 respectively. Magnetic Resonance Imaging (M.R.I.) performed in two patients was evocative of a thoracic disk herniation. A chest CT scan enabled us to establish correct diagnosis: in the three cases irregular hypertrophy of the posterior elements was evident at T11 and T12, T9 and T10, T10 and T11 respectively, with osteophytes originating in the articular process and deeply embedded in the spinal canal. Decompressive laminectomy associated with medial facetectomy resulted in the gradual improvement of walking in all three patients. Myelography and MRI are both useful in demonstrating the level compression, usually situated in the low thoracic spine, however only the CT allows differential diagnosis with other etiologies, especially anterior compression such as disk herniation.

  3. Notalgia paresthetica associated with cervical spinal stenosis and cervicothoracic disk disease at C4 through C7.

    Science.gov (United States)

    Alai, Nili N; Skinner, Harry B; Nabili, Siamak T; Jeffes, Edward; Shahrokni, Seyed; Saemi, Arash M

    2010-02-01

    Notalgia paresthetica (NP) is a common refractory, sensory, neuropathic syndrome with the hallmark symptom of localized pruritus of the unilateral infrascapular back. It generally is a chronic noncurable condition with periodic remissions and exacerbations. While the dermatologic syndrome may be multifactorial in etiology, a possible association with underlying cervical spine disease should be evaluated for proper treatment. Collaborative multispecialty evaluation by dermatology, radiology, orthopedic surgery, and neurology may be indicated for primary management of this condition. First-line therapy for NP with associated cervical disease may include nondermatologic noninvasive treatments such as spinal manipulation, physical therapy, massage, cervical traction, cervical muscle strengthening, and oral nonsteroidal anti-inflammatory drugs and muscle relaxants. Notalgia paresthetica may in fact be a cutaneous sign of an underlying degenerative cervical spine disease. We report a case of a patient with cervical spinal stenosis that corresponded directly with the clinical findings of NP.

  4. Pathological impairments induced by interstitial implantation of 125I Seeds in spinal canal of banna mini-pigs

    Directory of Open Access Journals (Sweden)

    Yang Zuozhang

    2012-03-01

    Full Text Available Abstract Background Use a banna mini-pig to set up 125I implantation model, and investigate the consequence of radiation-related impairments. Methods In present study, 125I seeds were implanted into spinal canal of T13 level of spine in banna mini-pigs. After operation, the pigs were raised up to 8 months, behavior changes were recorded within this period. After 8 months, spinal cords were collected for pathological analysis. Results In this study, a 125I brachytherapy animal model had been successfully established, in the model group, the banna pigs' Tarlov scale decreased from 5 to 2.57 ± 0.36, significant cellular impairments were noted by pathological analysis. Conclusions Without any protection and operation improvement, 125I implantation can cause serious histological impairments and moving difficulty for banna mini-pigs; this present research provides an alternative tool to study spinal 125I brachytherapy.

  5. Increased intracranial pressure in a case of spinal cervical glioblastoma multiforme: analysis of these two rare conditions

    Directory of Open Access Journals (Sweden)

    C.M. de Castro-Costa

    1994-03-01

    Full Text Available The authors describe a rare case of increased intracranial hypertension consequent to a spinal cervical glioblastoma multiforme in a young patient. They analyse the physiopathology of intracranial hypertension in spinal tumors and the rarity of such kind of tumor in this location, and its clinico-pathological aspects.

  6. Diagnosis of anterior cervical spinal epidural abscess by US and MRI in a newborn

    Energy Technology Data Exchange (ETDEWEB)

    Gudinchet, F.; Chapuis, L. (University Hospital, Lausanne (Switzerland). Dept. of Radiology); Berger, D. (University Hospital, Lausanne (Switzerland). Dept. of Pediatric Surgery)

    1991-11-01

    A 10-day-old girl who initially presented with fever developed over five days a complete paresis of both upper arms and swallowing difficulty. After emergency drainage of a retropharyngeal abscess, cervical US demonstrated a cervical anterior epidural mass compressing the cord. MRI confirmed the diagnosis of spinal epidural abscess secondary to C4-C5 spondylodiscitis. Surgical removal of the abscess was followed by complete disappearance of the neurologic symptoms after six months of follow-up. This is the first case of spinal epidural abscess in a newborn to be diagnosed by US and MRI preoperatively. The advantages of these non-invasive imaging modalities are discussed, and compared to myelography. (orig.).

  7. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

    OpenAIRE

    2011-01-01

    The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior–posterior and lateral radiographs of the entire spine were reviewed to assess the chan...

  8. Stenosis of central canal of spinal cord in man: incidence and pathological findings in 232 autopsy cases.

    Science.gov (United States)

    Milhorat, T H; Kotzen, R M; Anzil, A P

    1994-04-01

    The central canal of the spinal cord is generally regarded as a vestigial structure that is obliterated after birth in 70% to 80% of the general population. This report describes the first detailed histological study of the human central canal in 232 subjects ranging in age from 6 weeks' gestation to 92 years. Whole spinal cords were harvested at autopsy and sectioned serially from the conus medullaris to the upper medulla. Histological findings and morphometric analysis of the cross-sectional luminal area were used to grade stenosis at seven levels of the canal. Varying grades of stenosis were present at one or more levels in none (0%) of 60 fetuses, one (3%) of 34 infants, three (18%) of 17 children, 21 (88%) of 24 adolescents and young adults, 67 (96%) of 70 middle-aged adults, and all 27 adults aged 65 years or older (100%). The stenotic process was most pronounced in the thoracic segments of the canal and involved more levels with higher grades of stenosis in older individuals. Histological findings consisted of disorganization of the ependymal epithelium, formation of ependymal rosettes or microcanals, proliferation of subependymal gliovascular buds, and intracanalicular gliosis. These features are consistent with a pathological lesion involving ependymal injury and scarring and are less compatible with an involutional or degenerative process. Stenosis of the central canal probably influences the anatomical features of syringomyelia and may account for variations in cavity formation such as the prevalence of holocord syrinxes in children, the formation of focal and paracentral syrinxes in adults, and the rare incidence of syrinx formation in many older individuals with acquired lesions known to produce syringomyelia.

  9. Specialisation of spinal services: consequences for cervical trauma management in the district hospital

    Directory of Open Access Journals (Sweden)

    Cordell-Smith James

    2007-11-01

    Full Text Available Abstract Background Specialisation in spinal services has lead to a low threshold for referral of cervical spine injuries from district general hospitals. We aim to assess the capability of a district general hospital in providing the halo vest device and the expertise available in applying the device for unstable cervical spine injuries prior to transfer to a referral centre. Methods The study was a postal questionnaire survey of trauma consultants at district general hospitals without on-site spinal units in the United Kingdom. Seventy institutions were selected randomly from an electronic NHS directory. We posed seven questions on the local availability, expertise and training with halo vest application, and transferral policies in patients with spinal trauma. Results The response rate was 51/70 (73%. Nineteen of the hospitals (37% did not stock the halo vest device. Also, one third of the participants (18/51, 35%, 95% confidence interval 22 – 50% were not confident in application of the halo vest device and resorted to transfer of patients to referral centres without halo immobilization. Conclusion The lack of equipment and expertise to apply the halo vest device for unstable cervical spine injuries is highlighted in this study. Training of all trauma surgeons in the application of the halo device would overcome this deficiency.

  10. Time-Dependent Discrepancies between Assessments of Sensory Function after Incomplete Cervical Spinal Cord Injury.

    Science.gov (United States)

    Macklin, Richard A; Bae, Jihye; Orell, Melanie; Anderson, Kim D; Ellaway, Peter H; Perez, Monica A

    2017-05-01

    We recently demonstrated that the electrical perceptual threshold (EPT) examination reveals spared sensory function at lower spinal segments compared with the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination in humans with chronic incomplete cervical spinal cord injury (SCI). Here, we investigated whether discrepancies in sensory function detected by both sensory examinations change over time after SCI. Forty-five participants with acute (10 years) incomplete cervical SCI and 30 control subjects were tested on dermatomes C2-T4 bilaterally. EPT values were higher in subjects with acute (2.5 ± 0.8 mA), chronic (2.2 ± 0.7 mA), or extended-chronic (2.8 ± 1.1 mA) SCI compared with controls (1.0 ± 0.1 mA). The EPT examination detected sensory impairments in spinal segments above (2.3 ± 0.9) and below (4.2 ± 2.6) the level detected by the ISNCSCI sensory examination in participants with acute and chronic SCI, respectively. Notably, both examinations detected similar levels of spared sensory function in the extended-chronic phase of SCI (0.8 ± 0.5). A negative correlation was found between differences in EPT and ISNCSCI sensory levels and time post-injury. These observations indicate that discrepancies between EPT and ISNCSCI sensory scores are time-dependent, with the EPT revealing impaired sensory function above, below, or at the same spinal segment as the ISNCSCI examination. We propose that the EPT is a sensitive tool to assess changes in sensory function over time after incomplete cervical SCI.

  11. Cervical Spinal Meningeal Melanocytoma Presenting as Intracranial Superficial Siderosis

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    Savitha Srirama Jayamma

    2015-01-01

    Full Text Available Meningeal melanocytoma is a rare pigmented tumor of the leptomeningeal melanocytes. This rare entity results in diagnostic difficulty in imaging unless clinical and histopathology correlation is performed. In this case report, we describe a case of meningeal melanocytoma of the cervical region presenting with superficial siderosis. Extensive neuroradiological examination is necessary to locate the source of the bleeding in such patients. Usually, the patient will be cured by the complete surgical excision of the lesion.

  12. [Coffin-Lowry syndrome. Its association with congenitally narrow cervical canal and myelomalacia].

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    García-Suárez, Adrián; Dansac-Rivera, Arie Benoit

    2014-01-01

    INTRODUCCIÓN: Las características clínicas típicas del síndrome de Coffin-Lowry son facies con hipertelorismo, nariz pequeña, boca amplia, labios amplios y evertidos; estatura corta, retardo mental, deformidad del pectus, disfunción de la válvula mitral, afectación de hipocampo y cerebelo, pérdida de la audición y trastornos de la columna, como cifosis o escoliosis. Debido a su escasa incidencia es difícil realizar el diagnóstico temprano. El objetivo de este informe fue documentar las peculiaridades anatómicas identificadas durante el tratamiento quirúrgico de un paciente con este síndrome. CASO CLÍNICO: varón con síndrome de Coffin-Lowry quien evolucionó con canal cervical estrecho más mielomalacia a corta edad, por lo que fue necesaria descompresión de C3 a C6 e instrumentación de C2 a C7. Durante la cirugía se encontró, además de la calcificación del ligamento amarillo, adherencias a la duramadre desde C4 a C5, color violáceo obscuro en esta área y adelgazamiento en forma de reloj de arena; los extremos en C3 y C6 eran normales. El objetivo de la cirugía fue detener la miopatía. En el posquirúrgico, el paciente presentó complicaciones pulmonares; al sexto día falleció por complicaciones ventilatorias y mal manejo de secreciones.

  13. EVALUATION OF THE RESULTS OF CERVICAL SPINE & SPINAL CORD TRAUMA IN CHILDREN

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    G.R. Bahadorkhan

    2009-01-01

    Full Text Available Objectives Major differences exist in the anatomy and biomechanics of the growing spine that causes failure patterns different from those in adults. Spinal injury in the pediatric patient is a main concern because timely diagnosis and appropriate treatment can prevent further neurologic damage and deformity and potentiate recovery. We conducted a retrospective clinical study of 137 cases (93 boys, 44 girls of pediatric cervical spine injuries, managed over fifteen years, to present data from a large series of pediatric patients with cervical spine injuries from a single regional trauma center. The aim was to assess and analyze complications, etiology, pathogenesis, site of injuries and age difference of cervical spine and spinal cord injury in a pediatric age group and compare the findings with current literature.Materials & Methods One hundred and thirty seven children with cervical spine injuries, seen over twelve years, were divided into two age groups: 54 patients were in group one (0-9 years and 83 patients were in group two (10 – 17 years . We managed them according to status at presentation and type of injury. Forty seven patients were managed surgically and ninety nonsurgically (52 wore a halo brace and 38 wore different hard collars and braces. T-test and Chi squares were used to analyze differences between groups ResultsThe most common cause of injury was motor vehicle accidents(MVA. Our younger patients (Group 1 had sustained more neurological injuries than the older ones (Group 2, 77% vs.48%.; upper cervical spine was the most common site involved in 76%, while 43% suffered head injuries. In group two, 88% of children two sustained fractures or fracture/ subluxations; also in this group, subluxation, and fracture/subluxation was present in 10 and 25% of children respectively. The most common radiological findings were vertebral fractures (38%. Solid fusions were demonstrated in all patients at late follow–up review (mean 6 years

  14. Hemiparesis Caused by Cervical Spontaneous Spinal Epidural Hematoma: A Report of 3 Cases

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    Kinya Nakanishi

    2011-01-01

    Full Text Available We report three cases of spontaneous spinal epidural hematoma (SSEH with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.

  15. Human cervical spinal cord funiculi: investigation with magnetic resonance diffusion tensor imaging.

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    Onu, Mihaela; Gervai, Patricia; Cohen-Adad, Julien; Lawrence, Jane; Kornelsen, Jennifer; Tomanek, Boguslaw; Sboto-Frankenstein, Uta Nicola

    2010-04-01

    To use spinal cord diffusion tensor imaging (DTI) for investigating human cervical funiculi, acquire axial diffusion magnetic resonance imaging (MRI) data with an in-plane resolution sufficient to delineate subquadrants within the spinal cord, obtain corresponding DTI metrics, and assess potential regional differences. Healthy volunteers were studied with a 3 T Siemens Trio MRI scanner. DTI data were acquired using a single-shot spin echo EPI sequence. The spatial resolution allowed for the delineation of regions of interest (ROIs) in the ventral, dorsal, and lateral spinal cord funiculi. ROI-based and tractography-based analyses were performed. Significant fractional anisotropy (FA) differences were found between ROIs in the dorsal and ventral funiculi (P = 0.0001), dorsal and lateral funiculi (P = 0.015), and lateral and ventral funiculi (P = 0.0002). Transverse diffusivity was significantly different between ROIs in the ventral and dorsal funiculi (P = 0.003) and the ventral and lateral funiculi (P = 0.004). Tractography-based quantifications revealed DTI parameter regional differences that were generally consistent with the ROI-based analysis. Original contributions are: 1) the use of a tractography-based method to quantify DTI metrics in the human cervical spinal cord, and 2) reported DTI values in various funiculi at 3 T. (c) 2010 Wiley-Liss, Inc.

  16. Rugby injuries to the cervical spine and spinal cord: a 10-year review.

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    Scher, A T

    1998-01-01

    A 10-year review (1987-1996) of injuries sustained to the spine and spinal cord in rugby players with resultant paralysis has been undertaken. This article reviews that the incidence of serious rugby spine and spinal cord injuries in South Africa has increased over the 10-year period reviewed, despite stringent new rules instituted in an attempt to decrease the incidence of these injuries. The mechanisms of injury, as previously reported, remain the same as well as the phases of game responsible for injury of the tight scrum, tackle, rucks, and mauls. Two new observations are reported: the first is related to the occurrence of spinal cord concussion with transient paralysis, and the second is related to the increased incidence of osteoarthritis of the cervical spine in rugby players.

  17. Functional magnetic resonance imaging of the cervical spinal cord during thermal stimulation across consecutive runs.

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    Weber, Kenneth A; Chen, Yufen; Wang, Xue; Kahnt, Thorsten; Parrish, Todd B

    2016-12-01

    The spinal cord is the first site of nociceptive processing in the central nervous system and has a role in the development and perpetuation of clinical pain states. Advancements in functional magnetic resonance imaging are providing a means to non-invasively measure spinal cord function, and functional magnetic resonance imaging may provide an objective method to study spinal cord nociceptive processing in humans. In this study, we tested the validity and reliability of functional magnetic resonance imaging using a selective field-of-view gradient-echo echo-planar-imaging sequence to detect activity induced blood oxygenation level-dependent signal changes in the cervical spinal cord of healthy volunteers during warm and painful thermal stimulation across consecutive runs. At the group and subject level, the activity was localized more to the dorsal hemicord, the spatial extent and magnitude of the activity was greater for the painful stimulus than the warm stimulus, and the spatial extent and magnitude of the activity exceeded that of a control analysis. Furthermore, the spatial extent of the activity for the painful stimuli increased across the runs likely reflecting sensitization. Overall, the spatial localization of the activity varied considerably across the runs, but despite this variability, a machine-learning algorithm was able to successfully decode the stimuli in the spinal cord based on the distributed pattern of the activity. In conclusion, we were able to successfully detect and characterize cervical spinal cord activity during thermal stimulation at the group and subject level. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Klippel-Feil syndrome – the risk of cervical spinal cord injury: A case report

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    Singh Gurpreet

    2002-04-01

    Full Text Available Abstract Background Klippel-Feil syndrome is defined as congenital fusion of two or more cervical vertebrae and is believed to result from faulty segmentation along the embryo's developing axis during weeks 3–8 of gestation. Persons with Klippel-Feil syndrome and cervical stenosis may be at increased risk for spinal cord injury after minor trauma as a result of hypermobility of the various cervical segments. Persons with Klippel-Feil Syndrome often have congenital anomalies of the urinary tract as well. Case presentation A 51-year male developed incomplete tetraplegia in 1997 when he slipped and fell backwards hitting his head on the floor. X-rays of cervical spine showed fusion at two levels: C2 and C3 vertebrae, and C4 and C5 vertebrae. Intravenous urography (IVU revealed no kidneys in the renal fossa on both sides, but the presence of crossed, fused renal ectopia in the left ilio-lumbar region. This patient had a similar cervical spinal cord injury about 15 years ago, when he developed transient numbness and paresis of the lower limbs following a fall. Discussion and Conclusion 1 Persons with Klippel-Feil syndrome should be made aware of the increased risk of sustaining transient neurologic deterioration after minor trauma if there is associated radiographic evidence of spinal stenosis. 2 Patients with Klippel-Feil syndrome often have congenital anomalies of the urinary tract. Our patient had crossed, fused, ectopia of kidney. 3 When patients with Klippel-Feil syndrome sustain tetraplegia they have increased chances of developing urinary tract calculi. Treatment of kidney stones may pose a challenge because of associated renal anomalies. 4 Health professionals caring for cervical spinal cord injury patients with Klippel-Feil syndrome and renal anomalies should place emphasis on prevention of kidney stones. A large fluid intake is recommended for these patients, as a high intake of fluids is still the most powerful and certainly the most

  19. Experimental protein malnutrition as a causative factor in the histological and histochemical disruption of the ependymal cells of the third ventricla and cervical central canal of squirrel monkeys.

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    Sharma, S P; Manocha, S L

    1977-01-01

    The histologic disturbances of the cuboidal and columnar ependymal cells of the neonates under the extrinsic influence of maternal protein deprivation during most of the gestation period have been demonstrated in the central canal of the cervical spinal cord and III ventricle of the squirrel monkey brain. The control animals whose mothers were maintained on high protein diets showed an unbroken ependymal layer with an intact glial fiber layer and the subependymal cell plate. Taking birth-weight as an indication of the degree of malnutrition, maximum disruption of the ependymal layer was observed in those animals born around 80 g birth-weight. In the latter, most of the ependymal cells lost their characteristic arrangement and columnar shapes. The ependymal cells of the manourished animals show a marked reduction of oxidative enzyme content and relatively active glycogen metabolism as compared to the healthy controls. The significance of these changes has been discussed in the light of parallels in the embryological development and, to some extent, functions between the orinary neurons, ependymal cells of the choroid plexus, other ependymal cells and the glial cells. In this context, the changes observed in the present studies under the effect of protein malnutrition must be taken as part of overall changes experienced by various kinds of cells comprising the nervous system.

  20. GABAergic responses of mammalian ependymal cells in the central canal neurogenic niche of the postnatal spinal cord.

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    Corns, Laura F; Deuchars, Jim; Deuchars, Susan A

    2013-10-11

    The area surrounding the central canal of the postnatal mammalian spinal cord is a highly plastic region that exhibits many similarities to other postnatal neurogenic niches, such as the subventricular zone. Within this region, ependymal cells have been identified as neural stem cells however very little is known about their properties and how the local environment, including neurotransmitters, is capable of affecting them. The neurotransmitter GABA is present around the central canal and is known to affect cells within other postnatal neurogenic niches. This study used whole cell patch clamp electrophysiology and intracellular dye-loading in in vitro Wistar rat spinal cord slices to characterise ependymal cells and their ability to respond to GABA. Ependymal cells were defined by their passive response properties and low input resistances. Extensive dye-coupling was observed between ependymal cells; this was confirmed as gap junction coupling using the gap junction blocker, 18β-glycyrrhetinic acid, which significantly increased the input resistance of ependymal cells. GABA depolarised all ependymal cells tested; the partial antagonism of this response by bicuculline and gabazine indicates that GABA(A) receptors contribute to this response. A lack of effect by baclofen suggests that GABA(B) receptors do not contribute to the GABAergic response. The ability of ependymal cells to respond to GABA suggests that GABA could be capable of influencing the proliferation and differentiation of cells within the neurogenic niche of the postnatal spinal cord.

  1. Degenerative lumbar spinal canal stenosis: intra- and inter-reader agreement for magnetic resonance imaging parameters.

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    Winklhofer, Sebastian; Held, Ulrike; Burgstaller, Jakob M; Finkenstaedt, Tim; Bolog, Nicolae; Ulrich, Nils; Steurer, Johann; Andreisek, Gustav; Del Grande, Filippo

    2017-02-01

    To assess the inter- and intra-reader agreement of commonly used quantitative and qualitative image parameters for the assessment of degenerative lumbar spinal canal stenosis (LSS) by magnetic resonance imaging (MRI). In this ethical board approved cross-sectional multicenter study, MRI of 100 randomly selected patients (median age 72.5 years, 48 % female) of the prospective Lumbar Stenosis Outcome Study (LSOS) were evaluated by two independent readers. A set of five previously published core imaging parameters as well as nine qualitative and five quantitative additional parameters regarding LSS and degenerative changes of the lumbar spine were assessed to calculate κ and intraclass correlation coefficients (ICC) for the inter-reader agreement. Additional repeated image evaluations were performed by one reader to calculate the intra-reader agreement. κ values for the core image parameters ranged between 0.42 (compromise of the foraminal zone) and 0.77 (relation between fluid and cauda equina) for inter-reader agreement and between 0.59 (compromise of the foraminal zone) and 0.8 (compromise of the central zone) for intra-reader agreement. The inter-reader agreement for the non-core parameters showed κ values of 0.27-0.69 and ICC values of 0.46-0.85. The intra-reader agreement showed κ values of 0.53-0.69 and ICC values of 0.81-0.88. The inter- and intra-reader agreement of commonly used quantitative and qualitative image parameters for the assessment of LSS showed quite a variability with previously defined core parameters having good to excellent inter- and intra-reader agreements.

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

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    Kato, Yoshihiko; Koga, Michiaki; Taguchi, Toshihiko

    2010-05-12

    A 17-year-old male soccer player presented with numbness in the upper- and lower-left extremities of 6 months' duration. He had no apparent history of trauma but experienced neck pain during heading of the ball 5 years prior. A high-signal intensity area was seen on T2-weighted magnetic resonance imaging (MRI) of the cervical spine. No muscle weakness was observed. Hypoesthesia was observed in bilateral forearms, hands, and extremities below the inguinal region. Plain radiographs in the neutral position showed local kyphosis at C3/4. A small protrusion of the C3/4 disk was observed on T1-weighted MRI. A high-signal area in the spinal cord at the C3/4 level was observed on T2-weighted MRI, but this was not enhanced by gadolinium. Multiple sclerosis, intramedullary spinal cord tumor, sarcoidosis and malignant lymphoma, and spinal cord injury were all considered in the differential diagnosis. However, in view of the clinical, laboratory, and radiological investigations, we concluded that repeated impacts to the neck caused by heading of the ball during soccer induced a chronic, minor spinal cord injury. This contributed to the high-signal intensity change of the spinal cord in T2-weighted MRI. The present case demonstrates that repeated impact may cause chronic spinal cord injury. Soccer, American football, or rugby players presenting with neck or extremity symptoms should not be overlooked for the possibility of latent spinal cord injury, as this could present later development of more severe or unrecoverable spinal cord injuries. Copyright 2010, SLACK Incorporated.

  3. Interneuronal systems of the cervical spinal cord assessed with BOLD imaging at 1.5 T

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    Stracke, C.P.; Schoth, F.; Moeller-Hartmann, W.; Krings, T. [University Hospital of the University of Technology, Departments of Neuroradiology and Diagnostic Radiology, Aachen (Germany); Pettersson, L.G. [University of Goeteborg, Department of Physiology, Goeteborg (Sweden)

    2005-02-01

    The purpose of this study was to investigate if functional activity with spinal cord somatosensory stimulation can be visualized using BOLD fMRI. We investigated nine healthy volunteers using a somatosensory stimulus generator. The stimuli were applied in three different runs at the first, third, and fifth finger tip of the right hand, respectively, corresponding to dermatomes c6, c7, and c8. The stimuli gave an increase of BOLD signal (activation) in three different locations of the spinal cord and brain stem. First, activations could be seen in the spinal segment corresponding to the stimulated dermatome in seven out of nine volunteers for c6 stimulation, two out of eight for c7, and three out of eight for c8. These activations were located close to the posterior margin of the spinal cord, presumably reflecting synaptic transmission to dorsal horn interneurons. Second, activation in the medulla oblongata was evident in four subjects, most likely corresponding to the location of the nucleus cuneatus. The third location of activation, which was the strongest and most reliable observed was inside the spinal cord in the c3 and c4 segments. Activation at these spinal levels was almost invariably observed independently of the dermatome stimulated (9/9 for c6, 8/8 for c7, and 7/8 for c8 stimulation). These activations may pertain to an interneuronal system at this spinal level. The results are discussed in relation to neurophysiological studies on cervical spinal interneuronal pathways in animals and humans. (orig.)

  4. Extensive Spinal Decussation and Bilateral Termination of Cervical Corticospinal Projections in Rhesus Monkeys

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    Rosenzweig, Ephron S.; Brock, John H.; Culbertson, Maya D.; Lu, Paul; Moseanko, Rod; Edgerton, V. Reggie; Havton, Leif A.; Tuszynski, Mark H.

    2009-01-01

    To examine neuroanatomical mechanisms underlying fine motor control of the primate hand, adult Rhesus monkeys underwent injections of biotinylated dextran amine (BDA) into the right motor cortex. Spinal axonal anatomy was examined using detailed serial-section reconstruction and modified stereological quantification. 87% of corticospinal tract (CST) axons decussated in the medullary pyramids and descended through the contralateral dorsolateral tract of the spinal cord. 11% of CST axons projected through the dorsolateral CST ipsilateral to the hemisphere of origin, and 2% of axons projected through the ipsilateral ventromedial CST. Notably, corticospinal axons decussated extensively across the spinal cord midline. Remarkably, nearly two-fold more CST axons decussated across the cervical spinal cord midline (~12,000 axons) than were labeled in all descending components of the CST (~6,700 axons). These findings suggest that CST axons extend multiple segmental collaterals. Furthermore, serial-section reconstructions revealed that individual axons descending in either the ipsilateral or contralateral dorsolateral CST can: 1) terminate in the gray matter ipsilateral to the hemisphere of origin; 2) terminate in the gray matter contralateral to the hemisphere of origin; or 3) branch in the spinal cord and terminate on both sides of the spinal cord. These results reveal a previously unappreciated degree of bilaterality and complexity of corticospinal projections in the primate spinal cord. This bilaterality is more extensive than that of the rat CST, and may resemble human CST organization. Thus, augmentation of sprouting of these extensive bilateral CST projections may provide a novel target for enhancing recovery after spinal cord injury. PMID:19125408

  5. Motor cortex and spinal cord neuromodulation promote corticospinal tract axonal outgrowth and motor recovery after cervical contusion spinal cord injury.

    Science.gov (United States)

    Zareen, N; Shinozaki, M; Ryan, D; Alexander, H; Amer, A; Truong, D Q; Khadka, N; Sarkar, A; Naeem, S; Bikson, M; Martin, J H

    2017-08-10

    Cervical injuries are the most common form of SCI. In this study, we used a neuromodulatory approach to promote skilled movement recovery and repair of the corticospinal tract (CST) after a moderately severe C4 midline contusion in adult rats. We used bilateral epidural intermittent theta burst (iTBS) electrical stimulation of motor cortex to promote CST axonal sprouting and cathodal trans-spinal direct current stimulation (tsDCS) to enhance spinal cord activation to motor cortex stimulation after injury. We used Finite Element Method (FEM) modeling to direct tsDCS to the cervical enlargement. Combined iTBS-tsDCS was delivered for 30min daily for 10days. We compared the effect of stimulation on performance in the horizontal ladder and the Irvine Beattie and Bresnahan forepaw manipulation tasks and CST axonal sprouting in injury-only and injury+stimulation animals. The contusion eliminated the dorsal CST in all animals. tsDCS significantly enhanced motor cortex evoked responses after C4 injury. Using this combined spinal-M1 neuromodulatory approach, we found significant recovery of skilled locomotion and forepaw manipulation skills compared with injury-only controls. The spared CST axons caudal to the lesion in both animal groups derived mostly from lateral CST axons that populated the contralateral intermediate zone. Stimulation enhanced injury-dependent CST axonal outgrowth below and above the level of the injury. This dual neuromodulatory approach produced partial recovery of skilled motor behaviors that normally require integration of posture, upper limb sensory information, and intent for performance. We propose that the motor systems use these new CST projections to control movements better after injury. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Magnetic Resonance Imaging of the Cervical, Thoracic, and Lumbar Spine in Children: Spinal Incidental Findings in Pediatric Patients

    Science.gov (United States)

    Ramadorai, Uma E.; Hire, Justin M.; DeVine, John G.

    2014-01-01

    Study Design Retrospective case series. Objective To determine the rate of spinal incidental findings on magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine in the pediatric population. Methods We reviewed MRI imaging of the neuraxial spine in patients less than 18 years of age and documented abnormal spinal findings. We then reviewed the charts of these patients to determine the reason for ordering the study. Those who presented with pain were considered symptomatic. Those who had no presenting complaint were considered asymptomatic. The data were analyzed to break down the rate of spinal incidental findings in the cervical, thoracic, and lumbar spine, respectively. Results Thirty-one of the 99 MRIs had positive findings, with the most common being disk protrusion (51.6%). Spinal incidental findings were most common in the lumbar spine (9.4%) versus the cervical spine (8%) or thoracic spine (4.7%). In this group, Schmorl nodes and disk protrusion were the two most common findings (37.5% each). Other spinal incidental findings included a vertebral hemangioma and a Tarlov cyst. In the thoracic spine, the only spinal incidental finding was a central disk protrusion without spinal cord or nerve root compression. Conclusion MRI is a useful modality in the pediatric patient with scoliosis or complaints of pain, but the provider should remain cognizant of the potential for spinal incidental findings. PMID:25396102

  7. High cervical spinal subdural hemorrhage as a harbinger of craniocervical arteriovenous fistula: an unusual clinical presentation.

    Science.gov (United States)

    Kasliwal, Manish K; Moftakhar, Roham; O'Toole, John E; Lopes, Demetrius K

    2015-05-01

    Craniocervical dural arteriovenous fistula (dAVF) is rare as compared with the typical thoracolumbar dAVFs of the spine and usually presents with hemorrhagic manifestation, predominantly intracranial subarachnoid hemorrhage. We describe the first case of craniocervical dAVF with initial presentation as neck pain and spinal subdural hemorrhage. Case report. We present the case of a 59-year-old woman who presented with sudden onset of neck pain at an outside institution emergency department (ED) and was discharged after negative cervical spine radiographs. Magnetic resonance imaging of the cervical spine performed because of persistent pain demonstrated presence of high cervical spinal subdural hematoma and she was managed conservatively. She subsequently presented to our ED a week later with headache and was found to have an intraventricular hemorrhage on computed tomography scan of the head, which on subsequent workup with an angiography revealed the presence of a craniocervical dAVF. Surgical obliteration of the fistula was performed with use of intraoperative angiography as an adjunct to confirm complete fistula obliteration. She had an excellent clinical outcome with no deficits at her last follow-up at 9 months. Even though hemorrhagic presentation is fairly common in craniocervical dAVFs, there is no report of a craniocervical dAVF presenting with spinal subdural hemorrhage. The present case further highlights the propensity of these vascular lesions to bleed and emphasizes the clinical importance of including these lesions in the differential diagnosis of hemorrhage in the vicinity of foramen magnum region, whether subarachnoid or subdural in location. Physicians treating spinal pathologies should be aware of this entity and clinical presentation, as an angiography needs to be considered in these cases to direct appropriate referral and treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.

    Science.gov (United States)

    Canavese, Federico; Turcot, Katia; De Rosa, Vincenzo; de Coulon, Geraldo; Kaelin, André

    2011-07-01

    The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior-posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0° ± 12.3° (range -30° to 40°) of lordosis. Postoperatively, the average CSA was 1.7° ± 11.4° (range -24° to 30°). After surgery, it was less than 20° in 27 patients (84.4%) and between 20° and 40° in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.

  9. Achondroplasia and cervical laminoplasty.

    Science.gov (United States)

    Yoshii, June; Traynelis, Vincent C

    2009-10-01

    Achondroplasia is associated with short pedicles that predispose individuals with this trait to develop symptomatic spinal canal stenosis. Laminoplasty is an excellent means of treating cervical myelopathy due to stenosis in selected individuals. Laminoplasty preserves segmental motion and stability, both of which are of benefit to all individuals. The authors report the successful surgical treatment of an achondroplastic adult woman with laminoplasty. This procedure alleviated her symptoms, and she was doing well at 2-year follow-up.

  10. Lipoma with dumb-bell extradural extension through the intervertebral foramen into the spinal canal. Case report.

    Science.gov (United States)

    Park, Jin Soo; Shirachi, Isao; Sato, Kimiaki; Ando, Noriyuki; Nagata, Kensei

    2005-01-01

    The authors present the case of a 60-year-old woman with a neck lipoma that developed dumb-bell extradural extension, causing radiculopathy. To the best of the authors' knowledge, this is the first report of a lipoma originating in the neck with dumb-bell extradural extension through the intervertebral foramen and into the spinal canal. The lipoma was first excised from the foramen via a posterior approach to allow decompression of the nerve roots. The remaining lipomatous tissue was then resected via an anterior approach to avoid the region around the vertebral artery.

  11. A rare cause of cervical spinal stenosis: posterior arch hypoplasia in a bipartite atlas

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    Atasoy, C. [Emek, Kirim Caddesi, Ankara (Turkey); Department of Radiology, Ankara University School of Medicine (Turkey); Fitoz, S.; Karan, B.; Erden, I.; Akyar, S. [Department of Radiology, Ankara University School of Medicine (Turkey)

    2002-03-01

    We describe CT and MRI of a previously unreported combination of atlantoaxial anomalies consisting of posterior arch hypoplasia in a bipartite atlas with an os odontoideum, in a 30-year-old woman presenting with neck and left arm pain. MRI showed the os odontoideum, marked stenosis of the spinal canal at the level of the atlas, with cord compression and evidence of myelopathy. CT revealed a bipartite atlas with midline clefts in anterior and posterior arches, thickening in the anterior arch and hypoplasia of the posterior arch with incurving of both hemiarches. Flexion and extension radiographs demonstrated atlantoaxial instability. (orig.)

  12. Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury: Update and Preliminary Outcomes.

    Science.gov (United States)

    Fox, Ida K; Davidge, Kristen M; Novak, Christine B; Hoben, Gwendolyn; Kahn, Lorna C; Juknis, Neringa; Ruvinskaya, Rimma; Mackinnon, Susan E

    2015-10-01

    Cervical spinal cord injury can result in profound loss of upper extremity function. Recent interest in the use of nerve transfers to restore volitional control is an exciting development in the care of these complex patients. In this article, the authors review preliminary results of nerve transfers in spinal cord injury. Review of the literature and the authors' cases series of 13 operations in nine spinal cord injury nerve transfer recipients was performed. Representative cases were reviewed to explore critical concepts and preliminary outcomes. The nerve transfers used expendable donors (e.g., teres minor, deltoid, supinator, and brachialis) innervated above the level of the spinal cord injury to restore volitional control of missing function such as elbow extension, wrist extension, and/or hand function (posterior interosseous nerve or anterior interosseous nerve/finger flexors reinnervated). Results from the literature and the authors' patients (after a mean postsurgical follow-up of 12 months) indicate gains in function as assessed by both manual muscle testing and patients' self-reported outcomes measures. Nerve transfers can provide an alternative and consistent means of reestablishing volitional control of upper extremity function in people with cervical level spinal cord injury. Early outcomes provide evidence of substantial improvements in self-reported function despite relatively subtle objective gains in isolated muscle strength. Further work to investigate the optimal timing and combination of nerve transfer operations, the combination of these with traditional treatments (tendon transfer and functional electrical stimulation), and measurement of outcomes is imperative for determining the precise role of these operations. Therapeutic, IV.

  13. Factors associated with upper extremity contractures after cervical spinal cord injury: A pilot study.

    Science.gov (United States)

    Hardwick, Dustin; Bryden, Anne; Kubec, Gina; Kilgore, Kevin

    2017-06-05

    To examine the prevalence of joint contractures in the upper limb and association with voluntary strength, innervation status, functional status, and demographics in a convenience sample of individuals with cervical spinal cord injury to inform future prospective studies. Cross-sectional convenience sampled pilot study. Department of Veterans Affairs Research Laboratory. Thirty-eight participants with cervical level spinal cord injury. Not applicable. Contractures were measured with goniometric passive range of motion. Every joint in the upper extremity was evaluated bilaterally. Muscle strength was measured with manual muscle testing. Innervation status was determined clinically with surface electrical stimulation. Functional independence was measured with the Spinal Cord Independence Measure III (SCIM-III). Every participant tested had multiple joints with contractures and, on average, participants were unable to achieve the normative values of passive movement in 52% of the joints tested. Contractures were most common in the shoulder and hand. There was a weak negative relationship between percentage of contractures and time post-injury and a moderate positive relationship between percentage of contractures and age. There was a strong negative correlation between SCIM-III score and percentage of contractures. Joint contractures were noted in over half of the joints tested. These joint contractures were associated with decreased functional ability as measured by the SCIM-III. This highlights the need the need for detailed evaluation of the arm and hand early after injury as well as continued monitoring of joint characteristics throughout the life course of the individual with tetraplegia.

  14. Localisation of glycine receptors in the human forebrain, brainstem, and cervical spinal cord: an immunohistochemical review

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    Kristin Baer

    2009-11-01

    Full Text Available Inhibitory neurotransmitter receptors for glycine (GlyR are heteropentameric chloride ion channels that are comprised of four functional subunits, alpha1-3 and beta and that facilitate fast-response, inhibitory neurotransmission in the mammalian brain and spinal cord. We have investigated the distribution of GlyRs in the human forebrain, brainstem, and cervical spinal cord using immunohistochemistry at light and confocal laser scanning microscopy levels. This review will summarize the present knowledge on the GlyR distribution in the human brain using our established immunohistochemical techniques. The results of our immunohistochemical labeling studies demonstrated GlyR immunoreactivity (IR throughout the human basal ganglia, substantia nigra, various pontine regions, rostral medulla oblongata and the cervical spinal cord present as intense and abundant punctate IR along the membranes of the neuronal soma and dendrites. This work is part of a systematic study of inhibitory neurotransmitter receptor distribution in the human CNS, and provides a basis for additional detailed physiological and pharmacological studies on the inter-relationship of GlyR, GABAAR and gephyrin in the human brain. This basic mapping exercise, we believe, will provide important baselines for the testing of future pharmacotherapies and drug regimes that modulate neuroinhibitory systems. These findings provide new information for understanding the complexity of glycinergic functions in the human brain, which will translate into the contribution of inhibitory mechanisms in paroxysmal disorders and neurodegenerative diseases such as Epilepsy, Huntington's and Parkinson’s Disease and Motor Neuron Disease.

  15. Serotonin(2) receptors mediate respiratory recovery after cervical spinal cord hemisection in adult rats.

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    Zhou, S Y; Basura, G J; Goshgarian, H G

    2001-12-01

    The aim of the present study was to specifically investigate the involvement of serotonin [5-hydroxytryptamine (5-HT(2))] receptors in 5-HT-mediated respiratory recovery after cervical hemisection. Experiments were conducted on C(2) spinal cord-hemisected, anesthetized (chloral hydrate, 400 mg/kg ip), vagotomized, pancuronium- paralyzed, and artificially ventilated female Sprague-Dawley rats in which CO(2) levels were monitored and maintained. Twenty-four hours after spinal hemisection, the ipsilateral phrenic nerve displayed no respiratory-related activity indicative of a functionally complete hemisection. Intravenous administration of the 5-HT(2A/2C)-receptor agonist (+/-)-2,5-dimethoxy-4-iodoamphetamine hydrochloride (DOI) induced respiratory-related activity in the phrenic nerve ipsilateral to hemisection under conditions in which CO(2) was maintained at constant levels and augmented the activity induced under conditions of hypercapnia. The effects of DOI were found to be dose dependent, and the recovery of activity could be maintained for up to 2 h after a single injection. DOI-induced recovery was attenuated by the 5-HT(2)-receptor antagonist ketanserin but not with the 5-HT(2C)-receptor antagonist RS-102221, suggesting that 5-HT(2A) and not necessarily 5-HT(2C) receptors may be involved in the induction of respiratory recovery after cervical spinal cord injury.

  16. Traumatic induced total myelomalacia of the cervical spinal cord associated with a space-occupying subdural hematoma.

    Science.gov (United States)

    Oehmichen, M; Meissner, C

    1999-01-01

    We report the case of a 20-year-old male driver who suffered from a trauma to the cervical vertebral column in a head-on collision with a tree. The injuries included subluxation of the 2nd and 3rd cervical vertebrae and fracture of the odontoid process of the axis with ventrally directed displacement of the proximal fragment and dorsally directed displacement of the distal fragment. Already at admission to hospital a space-occupying spinal subdural hematoma was diagnosed. Clinically, paraplegia was diagnosed with progressive loss of consciousness. Pneumonia led to death 40 days after the accident. Autopsy disclosed a total myelomalacia of the cervical spinal cord obviously resulting from an ischemia caused by a traumatic lesion of the dorsal truncus arteriosus spinalis as well as a compression by the spinal subdural hematoma.

  17. Multiple meningiomas within the spinal canal: case report with 23 tumors Meningiomas intrarraqueanos múltiplos: relato de caso com 23 tumores

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    José Alberto Gonçalves da Silva

    2005-03-01

    Full Text Available In most series of neoplasms of the spinal canal, spinal cord and its leptomeninges, the incidence of meningioma group comprises approximately 25%. The incidence of multiple meningiomas is small when compared with the frequency of its single occurrence. In the majority of cases, their multiplicity is intracranial and spinal. Multiple meningiomas confined exclusively to the spinal canal are extremely rare. We report on a 33 years-old man, with 23 tumors located in the spinal thoracic region.Na maioria das casuísticas de neoplasias do canal espinhal, medula espinhal e leptomeninges, os meningiomas compreendem 25%. A incidência de meningiomas múltiplos é pequena quando comparada com sua freqüência isolada. Na maioria dos casos, a ocorrência múltipla é intracraniana e espinhal. Meningiomas múltiplos localizados exclusivamente no canal raqueano são extremamente raros. Relatamos o caso de homem de 33 anos com 23 tumores, localizados na região torácica espinhal.

  18. Functional recovery after cervical spinal cord injury: Role of neurotrophin and glutamatergic signaling in phrenic motoneurons.

    Science.gov (United States)

    Gill, Luther C; Gransee, Heather M; Sieck, Gary C; Mantilla, Carlos B

    2016-06-01

    Cervical spinal cord injury (SCI) interrupts descending neural drive to phrenic motoneurons causing diaphragm muscle (DIAm) paralysis. Recent studies using a well-established model of SCI, unilateral spinal hemisection of the C2 segment of the cervical spinal cord (SH), provide novel information regarding the molecular and cellular mechanisms of functional recovery after SCI. Over time post-SH, gradual recovery of rhythmic ipsilateral DIAm activity occurs. Recovery of ipsilateral DIAm electromyogram (EMG) activity following SH is enhanced by increasing brain-derived neurotrophic factor (BDNF) in the region of the phrenic motoneuron pool. Delivery of exogenous BDNF either via intrathecal infusion or via mesenchymal stem cells engineered to release BDNF similarly enhance recovery. Conversely, recovery after SH is blunted by quenching endogenous BDNF with the fusion-protein TrkB-Fc in the region of the phrenic motoneuron pool or by selective inhibition of TrkB kinase activity using a chemical-genetic approach in TrkB(F616A) mice. Furthermore, the importance of BDNF signaling via TrkB receptors at phrenic motoneurons is highlighted by the blunting of recovery by siRNA-mediated downregulation of TrkB receptor expression in phrenic motoneurons and by the enhancement of recovery evident following virally-induced increases in TrkB expression specifically in phrenic motoneurons. BDNF/TrkB signaling regulates synaptic plasticity in various neuronal systems, including glutamatergic pathways. Glutamatergic neurotransmission constitutes the main inspiratory-related, excitatory drive to motoneurons, and following SH, spontaneous neuroplasticity is associated with increased expression of ionotropic N-methyl-d-aspartate (NMDA) receptors in phrenic motoneurons. Evidence for the role of BDNF/TrkB and glutamatergic signaling in recovery of DIAm activity following cervical SCI is reviewed.

  19. Anterior Cervical Discectomy and Fusion: Practice Patterns Among Greek Spinal Surgeons

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    Spanos, Savvas L.; Siasios, Ioannis D.; Dimopoulos, Vassilios G.; Fountas, Kostas N.

    2016-01-01

    Background A web-based survey was conducted among Greek spinal surgeons to outline the current practice trends in regard to the surgical management of patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathology. Various practice patterns exist in the surgical management of patients undergoing anterior cervical discectomy for degenerative pathology. No consensus exists regarding the type of the employed graft, the necessity of implanting a plate, the prescription of an external orthotic device, and the length of the leave of absence in these patients. Methods A specially designed questionnaire was used for evaluating the criteria for surgical intervention, the frequency of fusion employment, the type of the graft, the frequency of plate implantation, the employment of an external spinal orthosis (ESO), the length of the leave of absence, and the prescription of postoperative physical therapy. Physicians’ demographic factors were assessed including residency and spinal fellowship training, as well as type and length in practice. Results Eighty responses were received. Neurosurgeons represented 70%, and orthopedic surgeons represented 30%. The majority of the participants (91.3%) considered fusion necessary. Allograft was the preferred type of graft. Neurosurgeons used a plate in 42.9% of cases, whereas orthopedic surgeons in 100%. An ESO was recommended for 87.5% of patients without plates, and in 83.3% of patients with plates. The average duration of ESO usage was 4 weeks. Physical therapy was routinely prescribed postoperatively by 75% of the neurosurgeons, and by 83.3% of the orthopedic surgeons. The majority of the participants recommended 4 weeks leave of absence. Conclusions The vast majority of participants considered ACDF a better treatment option than an ACD, and preferred an allograft. The majority of them employed a plate, prescribed an ESO postoperatively, and recommended physical therapy to their

  20. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions

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    Pampati Vidyasagar

    2004-05-01

    Full Text Available Abstract Background Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Methods Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine, in accordance with the criteria established by the International Association for the Study of Pain (IASP. The study was performed in the United States in a non-university based ambulatory interventional pain management setting. Results The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%, with thoracic spine pain was 42% (95% CI, 30% – 53%, and in with lumbar spine pain was 31% (95% CI, 27% – 36%. The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72% in the cervical spine, 55% (95% CI, 39% – 78% in the thoracic spine, and 27% (95% CI, 22% – 32% in the lumbar spine. Conclusion This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain.

  1. Pathogenesis of spinal cord involvement induced by lower cervical instability in rheumatoid spondylitis

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    Taniguchi, Hironobu; Kuwabara, Shigeru; Fukuda, Kenji; Kuroki, Tatsuji; Tajima, Naoya (Miyazaki Medical Coll., Kiyotake (Japan))

    1994-07-01

    To examine prognostic factors in rheumatoid arthritis (RA), plain radiography findings and magnetic resonance imaging (MRI) findings were compared with histopathological findings in 129 RA patients who had local or neurologic symptoms due to the cervical spine. All patients underwent plain radiography, and subdislocation more than 2 mm towards the anterior and posterior directions on plain radiographs was defined as instability. In predicting induction of instability of the inferior cervical spine and risk for spinal compression, erosion of the vertebral rim, as seen on plain X-rays, and irregular findings of the end-plate of the vertebral body and Gd-enhanced nodules around the intervertebral disk, as seen on MRI, seemed to be important. (N.K.).

  2. Widening of the spinal canal and dural ectasia in Marfan's syndrome: assessment by CT

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    Villeirs, G.M.; Verstraete, K.L.; Kunnen, M.F. [Dept. of Radiology, Univ. Hospital, Gent (Belgium); Tongerloo, A.J. van; Paepe, A.M. de [Dept. of Medical Genetics, Univ. Hospital, Gent (Belgium)

    1999-11-01

    We describe a method for diagnosing dural ectasia (DE) and spinal canal widening (SCW) using CT. We examined 23 patients with Marfan's syndrome (MFS), 17 with Ehlers-Danlos syndrome (EDS) and 29 normal subjects, using six axial slices at the level of the L1-S1 pedicles. Transverse diameters of the vertebral bodies, spinal canal and dural sac were measured and indices were defined to differentiate patients with DE and SCW from normal. Statistical significance was assessed using Student's t -test, {chi} {sup 2}-test and Pearson's correlation coefficient. DE and SCW occurred in 69.6 % and 60.9 % of cases of MFS and in 23.5 % and 35.3 % of EDS respectively. In MFS, prevalence was significantly higher than in the control group. DE was significantly more frequent in MFS than in EDS. A strong correlation existed between DE and SCW in MFS and the control group, but not in EDS. Our system enables quantitative assessment of SCW and DE. The latter is particularly important in subjects suspected of having MFS, in whom it is a common and characteristic sign. (orig.)

  3. Topiramate treatment is neuroprotective and reduces oligodendrocyte loss after cervical spinal cord injury.

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    John C Gensel

    Full Text Available Excess glutamate release and associated neurotoxicity contributes to cell death after spinal cord injury (SCI. Indeed, delayed administration of glutamate receptor antagonists after SCI in rodents improves tissue sparing and functional recovery. Despite their therapeutic potential, most glutamate receptor antagonists have detrimental side effects and have largely failed clinical trials. Topiramate is an AMPA-specific, glutamate receptor antagonists that is FDA-approved to treat CNS disorders. In the current study we tested whether topiramate treatment is neuroprotective after cervical contusion injury in rats. We report that topiramate, delivered 15-minutes after SCI, increases tissue sparing and preserves oligodendrocytes and neurons when compared to vehicle treatment. In addition, topiramate is more effective than the AMPA-receptor antagonist, NBQX. To the best of our knowledge, this is the first report documenting a neuroprotective effect of topiramate treatment after spinal cord injury.

  4. Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case report

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    Wildermuth Simon

    2010-11-01

    Full Text Available Abstract Background Congenital spinal abnormalities can easily be misdiagnosed on plain radiographs. Additional imaging is warranted in doubtful cases, especially in a setting of acute trauma. Case Presentation This patient presented at the emergency unit of our university hospital after a motor vehicle accident and was sent to our radiology department for imaging of the cervical spine. Initial clinical examination and plain radiographs of the cervical spine were performed but not conclusive. Additional CT of the neck helped establish the right diagnosis. Conclusion CT as a three-dimensional imaging modality with the possibility of multiplanar reconstructions allows for the exact diagnosis and exclusion of acute traumatic lesions of the cervical spine, especially in cases of doubtful plain radiographs and when congenital spinal abnormalities like absent cervical spine pedicle with associated spina bifida may insinuate severe trauma.

  5. Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case report.

    Science.gov (United States)

    Guggenberger, Roman; Andreisek, Gustav; Scheffel, Hans; Wildermuth, Simon; Leschka, Sebastian; Stolzmann, Paul

    2010-11-09

    Congenital spinal abnormalities can easily be misdiagnosed on plain radiographs. Additional imaging is warranted in doubtful cases, especially in a setting of acute trauma. This patient presented at the emergency unit of our university hospital after a motor vehicle accident and was sent to our radiology department for imaging of the cervical spine. Initial clinical examination and plain radiographs of the cervical spine were performed but not conclusive. Additional CT of the neck helped establish the right diagnosis. CT as a three-dimensional imaging modality with the possibility of multiplanar reconstructions allows for the exact diagnosis and exclusion of acute traumatic lesions of the cervical spine, especially in cases of doubtful plain radiographs and when congenital spinal abnormalities like absent cervical spine pedicle with associated spina bifida may insinuate severe trauma.

  6. Investigation of the Differential Contributions of Superficial and Deep Muscles on Cervical Spinal Loads with Changing Head Postures.

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    Chih-Hsiu Cheng

    Full Text Available Cervical spinal loads are predominately influenced by activities of cervical muscles. However, the coordination between deep and superficial muscles and their influence on the spinal loads is not well understood. This study aims to document the changes of cervical spinal loads and the differential contributions of superficial and deep muscles with varying head postures. Electromyography (EMG of cervical muscles from seventeen healthy adults were measured during maximal isometric exertions for lateral flexion (at 10°, 20° and terminal position as well as flexion/extension (at 10°, 20°, 30°, and terminal position neck postures. An EMG-assisted optimization approach was used to estimate the muscle forces and subsequent spinal loads. The results showed that compressive and anterior-posterior shear loads increased significantly with neck flexion. In particular, deep muscle forces increased significantly with increasing flexion. It was also determined that in all different static head postures, the deep muscle forces were greater than those of the superficial muscle forces, however, such pattern was reversed during peak efforts where greater superficial muscle forces were identified with increasing angle of inclination. In summary, the identification of significantly increased spinal loads associated with increased deep muscle activation during flexion postures, implies higher risks in predisposing the neck to occupationally related disorders. The results also explicitly supported that deep muscles play a greater role in maintaining stable head postures where superficial muscles are responsible for peak exertions and reinforcing the spinal stability at terminal head postures. This study provided quantitative data of normal cervical spinal loads and revealed motor control strategies in coordinating the superficial and deep muscles during physical tasks.

  7. Investigation of the Differential Contributions of Superficial and Deep Muscles on Cervical Spinal Loads with Changing Head Postures.

    Science.gov (United States)

    Cheng, Chih-Hsiu; Chien, Andy; Hsu, Wei-Li; Chen, Carl Pai-Chu; Cheng, Hsin-Yi Kathy

    2016-01-01

    Cervical spinal loads are predominately influenced by activities of cervical muscles. However, the coordination between deep and superficial muscles and their influence on the spinal loads is not well understood. This study aims to document the changes of cervical spinal loads and the differential contributions of superficial and deep muscles with varying head postures. Electromyography (EMG) of cervical muscles from seventeen healthy adults were measured during maximal isometric exertions for lateral flexion (at 10°, 20° and terminal position) as well as flexion/extension (at 10°, 20°, 30°, and terminal position) neck postures. An EMG-assisted optimization approach was used to estimate the muscle forces and subsequent spinal loads. The results showed that compressive and anterior-posterior shear loads increased significantly with neck flexion. In particular, deep muscle forces increased significantly with increasing flexion. It was also determined that in all different static head postures, the deep muscle forces were greater than those of the superficial muscle forces, however, such pattern was reversed during peak efforts where greater superficial muscle forces were identified with increasing angle of inclination. In summary, the identification of significantly increased spinal loads associated with increased deep muscle activation during flexion postures, implies higher risks in predisposing the neck to occupationally related disorders. The results also explicitly supported that deep muscles play a greater role in maintaining stable head postures where superficial muscles are responsible for peak exertions and reinforcing the spinal stability at terminal head postures. This study provided quantitative data of normal cervical spinal loads and revealed motor control strategies in coordinating the superficial and deep muscles during physical tasks.

  8. Individualized three-dimensional printed cage for spinal cervical fusion

    Directory of Open Access Journals (Sweden)

    Uwe Spetzger

    2017-01-01

    Uwe Spetzger, MD, is the Chairman of Department of Neurosurgery, Klinikum Karlsruhe, and Institute for Anthropomatics, Karlsruhe Institute of Technology (KIT, Karlsruhe, Germany. Uwe Spetzger received his medical degree in 1989 at the Medical Faculty, University of Heidelberg, Germany. He passed the US American medical exam (ECFMG in 1990. He has started his neurosurgical training in 1990 at the Department of Neurosurgery, Technical University (RWTH Aachen and got his board certification of neurosurgeon in 1996. The Grant of the Wilhelm-Tonnis-Foundation of the German Society of Neurosurgery (DGNC enables his scientific internship in 1999 at Department of Neurosurgery, University of Illinois at Chicago (UIC. In June 1999, he passed the European Examination in Neurosurgery (EANS. From 1999 - 2002 he was vice-chairman of the Department of Neurosurgery at the University of Freiburg and the director of the interdisciplinary centre for skull base surgery at Freiburg University. Since 2002 he is Chairman of the Department of Neurosurgery, Klinikum Karlsruhe and in 2003 he became an active member of the Faculty of Computer Science, Humanoids and Intelligence Systems Lab - Institute for Anthropomatics at KIT. Prof. Spetzger became the president of the international Society of Medical Innovation and Technology iSMIT in 2013 and the congress president of the 66th Annual Meeting of German Society of Neurosurgery DGNC in 2015 and the Vice-President of the International Society of Digital Medicine in 2016. He is member of several national and international neurosurgical and medical technological societies. His main surgical and research interests are cerebrovascular surgery, skull base surgery, computer-assisted and robotic surgery, neuronavigation and spinal microsurgery.

  9. Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord

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    Sharpe, Abigail N.; Jackson, Andrew

    2014-02-01

    Objective. Electrical stimulation of the spinal cord has potential applications following spinal cord injury for reanimating paralysed limbs and promoting neuroplastic changes that may facilitate motor rehabilitation. Here we systematically compare the efficacy, selectivity and frequency-dependence of different stimulation methods in the cervical enlargement of anaesthetized monkeys. Approach. Stimulating electrodes were positioned at multiple epidural and subdural sites on both dorsal and ventral surfaces, as well as at different depths within the spinal cord. Motor responses were recorded from arm, forearm and hand muscles. Main results. Stimulation efficacy increased from dorsal to ventral stimulation sites, with the exception of ventral epidural electrodes which had the highest recruitment thresholds. Compared to epidural and intraspinal methods, responses to subdural stimulation were more selective but also more similar between adjacent sites. Trains of stimuli delivered to ventral sites elicited consistent responses at all frequencies whereas from dorsal sites we observed a mixture of short-latency facilitation and long-latency suppression. Finally, paired stimuli delivered to dorsal surface and intraspinal sites exhibited symmetric facilitatory interactions at interstimulus intervals between 2-5 ms whereas on the ventral side interactions tended to be suppressive for near-simultaneous stimuli. Significance. We interpret these results in the context of differential activation of afferent and efferent roots and intraspinal circuit elements. In particular, we propose that distinct direct and indirect actions of spinal cord stimulation on motoneurons may be advantageous for different applications, and this should be taken into consideration when designing neuroprostheses for upper-limb function.

  10. Surgical management of cervical spinal epidural abscess caused by Brucella melitensis : report of two cases and review of the literature.

    Science.gov (United States)

    Ekici, Mehmet Ali; Ozbek, Zühtü; Gökoğlu, Abdülkerim; Menkü, Ahmet

    2012-06-01

    Spinal epidural abscess, if especially caused by Brucellosis is a very rare disease which is usually a consequence of spondylodiscitis. The spinal column can be affected at any joint; however, the lumbar spine is the most common region, especially at the level of the L4-5 and L5-S1. The frequency of spinal involvement usually seen at the lumbar, thoracic and cervical spine respectively. As an occupational disease in farmers, veterinaries, butchers, laboratory staff and shepherds, brucellosis can also occur by direct contact to animals and infected materials or ingestion of raw cheese, milk or unpasteurized milk products. In this study, we presented two cases with cervical spinal epidural abscess caused by brucella melitensis, which was successfully treated by surgical approach. Initial treatment was combined with antibiotic therapy after the surgery for 3 months.

  11. The influence of cervical spinal cord compression and vertebral displacement on somatosympathetic reflexes in the rat.

    Science.gov (United States)

    Bigland, Mark J; Budgell, Brian S; Bolton, Philip S

    2015-06-01

    One theory within chiropractic proposes that vertebral subluxation in the upper cervical region induces spinal cord compression sufficient to alter spinal cord efferent output. We report on the feasibility of three different experimental approaches to test this theory. A high threshold electrical-evoked somatosympathetic reflex was recorded in adrenal or renal nerves of 10 anaesthetized adult male rats before and after (1) graded pressure was applied directly to the C1/C2 spinal cord segment in eight rats by the use of either direct compression or inflation of an extradural balloon and (2) displacement, less than a dislocation applied posterior to anterior, to the C2 vertebra in two rats. The latency and amplitude of the pre- and postintervention reflex responses were compared. The reflex amplitude was not significantly changed by pressure (26 mmHg) from an extra-dural balloon or direct compression of the dura mater onto the dorsal spinal cord. Additional pressure, at least sufficient to occlude the dorsal vessels, induced a significant reduction in the amplitude of the reflex, and this reduction persisted for 20 minutes after removal of the pressure (Dunn's method for all pairwise multiple comparison Q stat=3.437; critical value for k=6 with α=0.05 is 2.936). Maximal vertebral (C2) displacement (4 mm), without dislocation did not induce significant changes compared with the control period. Although this feasibility study suggests it is unlikely that upper cervical vertebral subluxation, displacement less than a dislocation, compromises the sympathetic outflow in the adrenal or renal nerves, further vertebral displacement studies are necessary to formally test this. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Investigation of human cervical and upper thoracic spinal cord motion: implications for imaging spinal cord structure and function.

    Science.gov (United States)

    Figley, C R; Stroman, P W

    2007-07-01

    Spinal cord (SC) motion is thought to be the dominant source of error in current diffusion and spinal functional MRI (fMRI) methods. However, until now, such motion has not been well characterized in three dimensions. While previous studies have predominantly examined motion in the superior/inferior (S/I) direction, the foci of the present study were the anterior/posterior (A/P) and right/left (R/L) components of human cervical and upper thoracic SC motion. Cardiac-gated, turbofast low-angle shot (turbo-FLASH) cinematic MRI was employed at 3T to acquire images of the cord at 24 phases throughout the cardiac cycle. Time-dependent signal fluctuations within voxels adjacent to the cord/cerebrospinal fluid (CSF) interface were then used to measure SC motion, which was found to occur predictably as a function of cardiac activity. Cord movement was largest in the A/P direction, for which principal components of motion were calculated, thereby indicating consistent patterns of SC oscillation that can potentially be used to improve SC imaging.

  13. Esophageal carcinoma extending into the spinal canal - case report and review of the literature; Carcinoma do esofago com invasao do canal medular - relato de caso e revisao da literatura

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    Urban, Linei A.B.D.; Rogacheski, Enio; Ledesma, Jorge A. [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas. Servico de Radiologia]. E-mail: radiohc@terra.com.br; Zaparolli, Mauricio; Duarte, Maria Cecilia B. [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas; Sakamoto, Danielle G. [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas. Servico de Anatomia Patologica

    2002-06-01

    The authors report the case of a 62-year-old male with a 4 month history of weight loss and a 2 day complaint of weakness and paraesthesia on the lower limbs. A computed tomography myelogram revealed a mass in the posterior mediastinum associated with destruction of the vertebral body, spinal canal extension and irregular esophageal wall thickening. The patient was later submitted to a barium esophagogram that showed an irregular filling defect. A biopsy confirmed the presence of a squamous cell carcinoma. This is the first report in the Latin-American literature (Lilacs) of a patient with an esophageal carcinoma with spinal canal extension and spinal cord compression syndrome at initial presentation. (author)

  14. Lumbar spinal anesthesia with cervical nociceptive blockade. Critical review of a series of 1,330 procedures

    Directory of Open Access Journals (Sweden)

    Percio Ramón Becker Benitez

    2016-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. CONTENT: Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. CONCLUSION: Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia.

  15. Design of COSMIC: a randomized, multi-centre controlled trial comparing conservative or early surgical management of incomplete cervical cord syndrome without spinal instability

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Hosman, A.J.F.; Meent, H. van de; Hofmeijer, J.; Vos, P.E.; Slooff, W.B.; Oner, F.C.; Coppes, M.H.; Peul, W.C.; Verbeek, A.L.M.

    2013-01-01

    ABSTRACT: BACKGROUND: Incomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family. It is estimated that up to 25% of all traumatic spinal cord lesions belong to this category. The treatment for this type of spinal cord lesion is still subje

  16. Flexible active electrode arrays with ASICs that fit inside the rat’s spinal canal

    NARCIS (Netherlands)

    Giagka, V.; Demosthenous, A.; Donaldson, N.

    2015-01-01

    Epidural spinal cord electrical stimulation (ESCS) has been used as a means to facilitate locomotor recovery in spinal cord injured humans. Electrode arrays, instead of conventional pairs of electrodes, are necessary to investigate the effect of ESCS at different sites. These usually require a large

  17. A novel myoelectric pattern recognition strategy for hand function restoration after incomplete cervical spinal cord injury.

    Science.gov (United States)

    Liu, Jie; Zhou, Ping

    2013-01-01

    This study presents a novel myoelectric pattern recognition strategy towards restoration of hand function after incomplete cervical spinal cord Injury (SCI). High density surface electromyogram (EMG) signals comprised of 57 channels were recorded from the forearm of nine subjects with incomplete cervical SCI while they tried to perform six different hand grasp patterns. A series of pattern recognition algorithms with different EMG feature sets and classifiers were implemented to identify the intended tasks of each SCI subject. High average overall accuracies (> 97%) were achieved in classification of seven different classes (six intended hand grasp patterns plus a hand rest pattern), indicating that substantial motor control information can be extracted from partially paralyzed muscles of SCI subjects. Such information can potentially enable volitional control of assistive devices, thereby facilitating restoration of hand function. Furthermore, it was possible to maintain high levels of classification accuracy with a very limited number of electrodes selected from the high density surface EMG recordings. This demonstrates clinical feasibility and robustness in the concept of using myoelectric pattern recognition techniques toward improved function restoration for individuals with spinal injury.

  18. Surgical Treatment for No Fracture Dislocation Cervical Spinal Cord Injury%无骨折脱位型颈脊髓损伤的手术治疗

    Institute of Scientific and Technical Information of China (English)

    项惠灿; 叶君健; 欧国潮; 卢生香; 赵庆淞

    2011-01-01

    titanium plate fixation in 14 cases. Using posterior approach single open-door or both cervical spinal canal expansion Laminectomy plasty for three or more paragraphs and multi-segment spinal cord compression in 7 cases. Results 21 patients received an average of 30 months follow-up,2 patients with complete cervical spinal cord injury patients with belted excruciating sense of chest and abdomen were released,but the limbs ,muscle strength,toilet functions didnot recover. 19 cases by JOA estimating,preoperative average of 5.58 points,increased up to 11.46 after operation.Conclusion No fracture dislocation cervical spinal cord injury,according to segment parts of the spinal cord compression should early treated by surgical treatment ,and selecting the appropriate surgical approach may be better to improve spinal function and the quality of life of patients.

  19. Relationship Between Depressive State and Treatment Characteristics of Acute Cervical Spinal Cord Injury in Japan

    Science.gov (United States)

    Matsuda, Yasufumi; Kubo, Tatsuhiko; Fujino, Yoshihisa; Matsuda, Shinya; Wada, Futoshi; Sugita, Atsuko

    2016-01-01

    Background Few studies have assessed whether treatment of acute cervical spinal cord injury (SCI) patients contributes to depression. Methods Using an administrative database, we assessed patients for whom the diagnosis was unspecified injuries of cervical spinal cord (International Classification of Diseases and Injuries-10th (ICD-10) code; S14.1). We categorized patients with codes for depressive episode (ICD-10 code; F32) or recurrent depressive disorder (F33), or those prescribed antidepressants (tricyclic, tetracyclic, Selective Serotonin Reuptake Inhibitors, Serotonin Noradrenaline Reuptake Inhibitors, Trazodone, Sulpiride, or Mirtazapine) as having a depressive state. We compared the rate of each acute treatment between the depressive state group and the non-depressive state group using chi-square tests, and a multiple logistic regression model was used to identify the association between the acute treatment and depressive state. Results There were 151 patients who were judged to be in a depressive state, and the other 2115 patients were categorized into the non-depressive state group. Intervention of intravenous anesthesia, tracheostomy, artificial respiration, and gastrostomy had a significant positive correlation with depressive state. Multiple logistic regression analysis showed that tracheostomy (odds ratio [OR] 2.18; 95% confidence interval [CI], 1.09–4.38) and artificial respiration (OR 2.28; 95% CI, 1.32–3.93) were significantly associated with depressive state, and men had a 36% reduction in the risk of depressive state compared with women (OR 0.64; 95% CI, 0.44–0.94), whereas age, wound-treatment, all of the orthopedic procedures, intravenous anesthesia, and gastrostomy were not associated with depressive state. Conclusions These findings suggest that tracheostomy, artificial respiration and female gender in the acute phase after cervical SCI might be associated with the development of depression. PMID:26567604

  20. Evaluation of Melatonin for Prevention of Radiation Myelopathy in Irradiated Cervical Spinal Cord

    Directory of Open Access Journals (Sweden)

    Alireza Shirazi

    2009-01-01

    Full Text Available Objective: Radiation myelopathy (RM is known as a serious complication of head andneck radiation therapy. Furthermore, the radioprotective roles of melatonin have beeninvestigated on different tissues. The aim of this study was to assess the radio protectiveeffects of melatonin on biochemical, histopathological and clinical manifestations of RMin the rat cervical spinal cord.Materials and Methods: Four groups of rats were investigated as follows: The controlgroup was treated with vehicle. The second group (melatonin only was intraperitoneallyinjected with 100 mg/kg melatonin. The third group's (radiation cervical spinal cord areawas irradiated with 22 Gy cobalt-60 gamma-rays. The fourth group (melatonin plus irradiationreceived 100 mg/kg melatonin intraperitoneally, and after 30 minutes their spinalcord area was irradiated with 22 Gy gamma radiation. Five animals from each group wererandomly selected. 72 hours, 8 and 22 weeks after irradiation for analysis of malondialdehyde(MDA and glutathione (GSH levels, and underwent histopathological studies.Results: The MDA levels in the irradiation group were significantly higher than in the controlgroup (p<0.001. Furthermore, the GSH levels in this group were significantly lowerthan that of those in the control group (p<0.001. Administration of melatonin markedlyreduced MDA (p<0.001 and increased GSH (p<0.05 levels in this group. Demyelinationand clinical signs of myelopathy were decreased in the melatonin plus irradiation group incomparison to the irradiated group.Conclusion: Our study confirms the radioprotective effects of melatonin at early stagesof biochemical, as well as late histological and clinical changes in the spinal cord.

  1. Systemic hypothermia improves histological and functional outcome after cervical spinal cord contusion in rats.

    Science.gov (United States)

    Lo, Thomas Pang; Cho, Kyoung-Suok; Garg, Maneesh Sen; Lynch, Michael Patrick; Marcillo, Alexander Eduardo; Koivisto, Denise Leigh; Stagg, Monica; Abril, Rosa Marie; Patel, Samik; Dietrich, W Dalton; Pearse, Damien Daniel

    2009-06-10

    Hypothermia has been employed during the past 30 years as a therapeutic modality for spinal cord injury (SCI) in animal models and in humans. With our newly developed rat cervical model of contusive SCI, we investigated the therapeutic efficacy of transient systemic hypothermia (beginning 5 minutes post-injury for 4 hours, 33 degrees C) with gradual rewarming (1 degrees C per hour) for the preservation of tissue and the prevention of injury-induced functional loss. A moderate cervical displacement SCI was performed in female Fischer rats, and behavior was assessed for 8 weeks. Histologically, the application of hypothermia after SCI resulted in significant increases in normal-appearing white matter (31% increase) and gray matter (38% increase) volumes, greater preservation (four-fold) of neurons immediately rostral and caudal to the injury epicenter, and enhanced sparing of axonal connections from retrogradely traced reticulospinal neurons (127% increase) compared with normothermic controls. Functionally, a faster rate of recovery in open field locomotor ability (BBB score, weeks 1-3) and improved forelimb strength, as measured by both weight-supported hanging (43% increase) and grip strength (25% increase), were obtained after hypothermia. The current study demonstrates that mild systemic hypothermia is effective for retarding tissue damage and reducing neurological deficits following a clinically relevant contusive cervical SCI.

  2. Changes in Strenght, Sensation, and Prehension in Acute Cervical Spinal Cord Injury: European Multicenter Responsiveness Study of the GRASSP

    NARCIS (Netherlands)

    Velstra, I.; Curt, A.; Frotzler, A.; Abel, R.; Kalsi-Ryan, S.; Rietman, J.S.; Bolliger, M.

    2015-01-01

    Objective: To investigate the internal and external responsiveness and recovery profiles of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) instrument in revealing changes in upper limb function within the first year following cervical spinal cord injury (SCI). Met

  3. Posterior Correction Without Rib-head Resection for Patients With Neurofibromatosis Type 1, Dystrophic Scoliosis, and Rib-head Protrusion Into the Spinal Canal.

    Science.gov (United States)

    Cai, Siyi; Zhang, Jianguo; Shen, Jianxiong; Zhao, Hong; Weng, Xisheng; Qiu, Guixing

    2017-02-01

    A retrospective study. The objective of this study is to report the result of patients with neurofibromatosis type 1(NF-1), dystrophic scoliosis, and rib-head protrusion into the spinal canal who received posterior scoliosis correction surgery without rib-head resection. A total of 124 patients with NF-1 and dystrophic scoliosis were treated at our institution during the study period. Eight patients with a median age of 12 years had rib-head protrusion into the spinal canal and received surgery and were included in the analysis. All 8 patients (6 male, 2 female) were treated from 2003 to 2013 and received posterior correction with a pedicle screw-rod 3-dimensional correction system or screw-hook hybrid system. Scoliosis correction rate and percentage of spinal canal occupied by the rib head were analyzed. The median patient age, number of segments fused, and follow-up duration were 12 years, 10.5, and 22.5 months, respectively. There were no surgery-related complications, and symptoms in all patients improved after surgery. The median postoperative and 1-year follow-up sagittal kyphotic angles were significantly smaller as compared with the preoperative value (28.5 and 31 vs. 62.5 degrees, P=0.012). The median postoperative coronal Cobb angle of the main thoracic curve was significantly smaller compared with the preoperative value (29 vs. 64.5 degrees, P=0.012). The median percentage of the spinal canal occupied by the intraspinal rib was significantly lower at 1-year follow-up compared with the preoperative value (23.1% vs. 28.6%, P=0.018). Posterior correction without rib-head excision can provide good outcomes for patients with NF-1 and dystrophic scoliosis and rib-head protrusion into the spinal canal.

  4. Cervical dorsal rhizotomy increases brain-derived neurotrophic factor and neurotrophin-3 expression in the ventral spinal cord.

    Science.gov (United States)

    Johnson, R A; Okragly, A J; Haak-Frendscho, M; Mitchell, G S

    2000-05-15

    Although neurotrophic factors have been implicated in several forms of neuroplasticity, little is known concerning their potential role in spinal plasticity. Cervical dorsal rhizotomy (CDR) enhances serotonin terminal density near (spinal) phrenic motoneurons and serotonin-dependent long-term facilitation of phrenic motor output (Kinkead et al., 1998). We tested the hypothesis that selected neurotrophic factors change in a manner consistent with an involvement in this model of spinal plasticity. Brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), glial cell line-derived neurotrophic factor (GDNF), and transforming growth factor-beta(1) (TGF-beta(1)) concentrations were measured (ELISA) in three regions of interest to respiratory control: (1) ventral cervical spinal segments associated with the phrenic motor nucleus (C3-C6), (2) ventral thoracic spinal segments associated with inspiratory intercostal motor output (T3-T6) and (3) the diaphragm. Tissues were harvested from rats 7 d after bilateral CDR and compared with sham-operated and unoperated control rats. CDR increased BDNF (110%; p = 0.002) and NT-3 (100%; p = 0.002) in the cervical and NT-3 in the thoracic spinal cord (98%; p = 0.009). GDNF and TGF-beta(1) were not altered by CDR in any tissue. Immunohistochemistry localized BDNF and NT-3 to motoneurons and interneurons of the ventral spinal cord. These studies provide novel, suggestive evidence that BDNF and NT-3, possibly through their trophic effects on serotonergic neurons and/or motoneurons, may underlie serotonin-dependent plasticity in (spinal) respiratory motor control after CDR.

  5. Medida da área do canal vertebral lombar em diferentes faixas etárias Medida de la superficie del canal vertebral lumbar en los diferentes grupos de edad Lumbar spinal canal area in different age groups

    Directory of Open Access Journals (Sweden)

    Jair Ortiz

    2009-03-01

    rango de edad fue 0,258 y para el sexo de 0,062; en el caso de la L5, el "p-value" para el rango de edad fue 0,279 y el sexo de 0,003. CONCLUSIÓN: no hay diferencia en el ámbito de la canal vertebral lumbar entre los grupos de edad analizados, pero hay diferencias entre los sexos, siendo mayor en los hombres.OBJECTIVE: to measure the lumbar spinal canal area, using computerized tomography, compare different age groups and determine if there are differences between those. METHODS: the lumbar spinal canal area was measured in 78 individuals, divided in eight age groups, with data obtained from computerized tomography scans of the abdomen. The measurements were made at L1, L3 and L5 levels at the transpedicular section. RESULTS: the values for L1 produced a p-value of 0,586 for the age group and a p-value of 0,003 for sex. Therefore, we can say that there is no evidence of differences among age rage groups, but shows evidence of difference for sex being larger in males. For L3, the p-value of age rage was 0,258, and the value for sex was 0,062. For L5, the p-value for the age range was 0279, and the value for sex was 0,003. CONCLUSION: there is no difference of spinal canal area between the age groups, but there is difference for the sex being larger in males.

  6. Efficacy and results of expansive laminoplasty in patients with severe cervical myelopathy due to cervical canal stenosis

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    Agrawal D

    2004-01-01

    Full Text Available Aims and objectives: To assess the efficacy and results of expansive laminoplasty in advanced (Nurick's Grade III or greater cervical myelopathy. Materials and Methods: We reviewed data in 24 patients who underwent cervical laminoplasty from January 1999 to December 2002. Nuricks grading was used for quantifying the neurological deficits and outcome analysis was done using Odom's criteria. A modified Hirabayashi's open door laminoplasty was done using Titanium miniplates and screws in 22 patients, autologous bone in one and hydroxyapatite spacer in one patient. Observations: There were 3 females and 21 males with a mean age of 56 years (range 39-72 years. Four patients presented in Nuricks Grade III, 15 in Grade IV and five in Grade V. MR imaging showed MSCS in 21 cases, OPLL in nine cases and ligamentum flavum hypertrophy in nine cases with cord signal changes being present in 19 cases. Results: All patients with duration of symptoms less than three years, and 50 % with duration ranging from three to six years had improvement by at least one Nurick's grade following surgery. Eighty-seven per cent Grade IV patients (ambulatory with support improved to Grade III (ambulatory without support following laminoplasty. Using Odom's criteria, 23 patients (95.8% had a good to fair outcome. Conclusions: Cord decompression with expansive laminoplasty using titanium miniplate fixation may improve the neurological outcome even in patients presenting late, and improvement by even one grade may have major 'quality of life' benefits for these patients.

  7. Tumor Occupation in the Spinal Canal and Clinical Symptoms of Cauda Equina Schwannoma: An Analysis of 22 Cases

    Science.gov (United States)

    Sakane, Masataka; Abe, Tetsuya; Nakagawa, Tsukasa; Sakai, Shinsuke; Tatsumura, Masaki; Funayama, Toru; Yamazaki, Masashi

    2016-01-01

    Study Design Retrospective, radiological study. Purpose To determine the relationship between clinical symptoms and the extent of tumor occupation of the spinal canal by cauda equina schwannoma. Overview of Literature Little is known about the relationship between the size of tumors of the cauda equina and the manifestation of clinical symptoms. We analyzed this relationship by estimating the percentage of tumor occupation (PTO) in the spinal canal in cauda equina schwannomas and by correlating this parameter with the presence and severity of clinical symptoms. Methods Twenty-two patients (9 men and 13 women; age, 19–79 years; mean age, 55.3 years) who were radiologically diagnosed with schwannomas of the cauda equina between April 2004 and July 2014 were retrospectively analyzed. PTO was measured in axial and sagittal magnetic resonance imaging slices in which the cross-sectional area of the tumor was the largest. Data regarding clinical symptoms and results of physical examinations were collected from patient medical records. PTO differences between symptom-positive and -negative groups were analyzed for each variable. Results In the 4 cases in which tumor presence was not related to clinical symptoms, PTO was 5%–10% (mean, 9%) in axial slices and 23%–31% (mean, 30%) in sagittal slices. In the 18 cases in which symptoms were associated with the tumor, PTO was 11%–86% (mean, 50%) in axial slices and 43%–88% (mean, 71%) in sagittal slices. PTO in axial slices was significantly higher in the presence of Déjèrine symptoms and/or muscle weakness, a positive straight leg raise test, and a positive Kemp sign. Conclusions PTO >20% in axial slices and >40% in sagittal slices can be an indication of symptomatic cauda equina schwannoma. PMID:27994784

  8. Right-sided infective endocarditis as a potentially fatal complication in patients with long-term refractory severe bradyarrhythmia after cervical spinal cord injury: A case report

    Directory of Open Access Journals (Sweden)

    Naoki Miura

    2015-08-01

    Full Text Available Bradyarrhythmia is usually a spontaneously subsiding complication of cervical spinal cord injury. However, in severe cases, it can lead to cardiac arrest. We report a case of cervical spinal cord injury, complicated by right-sided infective endocarditis after the placement of a temporary pacing catheter in the right ventricle for severe bradyarrhythmia that led to cardiac arrest. Although the patient׳s condition was successfully treated by pacing catheter removal and pharmacological therapy, right-sided infective endocarditis would be a fatal complication in cases of cervical spinal cord injury where cardiac pacing is required for long-term refractory severe bradyarrhythmia.

  9. Cervical Spine Injuries: A Whole-Body Musculoskeletal Model for the Analysis of Spinal Loading

    Science.gov (United States)

    Holsgrove, Timothy P.; Preatoni, Ezio; Gill, Harinderjit S.; Trewartha, Grant

    2017-01-01

    Cervical spine trauma from sport or traffic collisions can have devastating consequences for individuals and a high societal cost. The precise mechanisms of such injuries are still unknown as investigation is hampered by the difficulty in experimentally replicating the conditions under which these injuries occur. We harness the benefits of computer simulation to report on the creation and validation of i) a generic musculoskeletal model (MASI) for the analyses of cervical spine loading in healthy subjects, and ii) a population-specific version of the model (Rugby Model), for investigating cervical spine injury mechanisms during rugby activities. The musculoskeletal models were created in OpenSim, and validated against in vivo data of a healthy subject and a rugby player performing neck and upper limb movements. The novel aspects of the Rugby Model comprise i) population-specific inertial properties and muscle parameters representing rugby forward players, and ii) a custom scapula-clavicular joint that allows the application of multiple external loads. We confirm the utility of the developed generic and population-specific models via verification steps and validation of kinematics, joint moments and neuromuscular activations during rugby scrummaging and neck functional movements, which achieve results comparable with in vivo and in vitro data. The Rugby Model was validated and used for the first time to provide insight into anatomical loading and cervical spine injury mechanisms related to rugby, whilst the MASI introduces a new computational tool to allow investigation of spinal injuries arising from other sporting activities, transport, and ergonomic applications. The models used in this study are freely available at simtk.org and allow to integrate in silico analyses with experimental approaches in injury prevention. PMID:28052130

  10. Multimodal decoding and congruent sensory information enhance reaching performance in subjects with cervical spinal cord injury

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    Elaine Anna Corbett

    2014-05-01

    Full Text Available Cervical spinal cord injury (SCI paralyzes muscles of the hand and arm, making it difficult to perform activities of daily living. Restoring the ability to reach can dramatically improve quality of life for people with cervical SCI. Any reaching system requires a user interface to decode parameters of an intended reach, such as trajectory and target. A challenge in developing such decoders is that often few physiological signals related to the intended reach remain under voluntary control, especially in patients with high cervical injuries. Furthermore, the decoding problem changes when the user is controlling the motion of their limb, as opposed to an external device. The purpose of this study was to investigate the benefits of combining disparate signal sources to control reach in people with a range of impairments, and to consider the effect of two feedback approaches. Subjects with cervical SCI performed robot-assisted reaching, controlling trajectories with either shoulder electromyograms (EMGs or EMGs combined with gaze. We then evaluated how reaching performance was influenced by task-related sensory feedback, testing the EMG-only decoder in two conditions. The first involved moving the arm with the robot, providing congruent sensory feedback through their remaining sense of proprioception. In the second, the subjects moved the robot without the arm attached, as in applications that control external devices. We found that the multimodal decoding algorithm worked well for all subjects, enabling them to perform straight, accurate reaches. The inclusion of gaze information, used to estimate target location, was especially important for the most impaired subjects. In the absence of gaze information, congruent sensory feedback improved performance. These results highlight the importance of proprioceptive feedback, and suggest that multi-modal decoders are likely to be most beneficial for highly impaired subjects and in tasks where such

  11. High-resolution multi-parametric quantitative magnetic resonance imaging of the human cervical spinal cord at 7T.

    Science.gov (United States)

    Massire, Aurélien; Taso, Manuel; Besson, Pierre; Guye, Maxime; Ranjeva, Jean-Philippe; Callot, Virginie

    2016-12-01

    Quantitative MRI techniques have the potential to characterize spinal cord tissue impairments occurring in various pathologies, from both microstructural and functional perspectives. By enabling very high image resolution and enhanced tissue contrast, ultra-high field imaging may offer further opportunities for such characterization. In this study, a multi-parametric high-resolution quantitative MRI protocol is proposed to characterize in vivo the human cervical spinal cord at 7T. Multi-parametric quantitative MRI acquizitions including T1, T2(*) relaxometry mapping and axial diffusion MRI were performed on ten healthy volunteers with a whole-body 7T system using a commercial prototype coil-array dedicated to cervical spinal cord imaging. Automatic cord segmentation and multi-parametric data registration to spinal cord templates enabled robust regional studies within atlas-based WM tracts and GM horns at the C3 cervical level. T1 value, cross-sectional area and GM/WM ratio evolutions along the cervical cord were also reported. An original correction method for B1(+)-biased T1 mapping sequence was additionally proposed and validated on phantom. As a result, relaxometry and diffusion parameters derived from high-resolution quantitative MRI acquizitions were reported at 7T for the first time. Obtained images, with unmatched resolutions compared to lower field investigations, provided exquisite anatomical details and clear delineation of the spinal cord substructures within an acquisition time of 30min, compatible with clinical investigations. Regional statistically significant differences were highlighted between WM and GM based on T1 and T2* maps (pquantitative MRI is feasible and lays the groundwork for future clinical investigations of degenerative spinal cord pathologies. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Evaluation of Clinical Findings and Treatment Results in Patients With Lumber Spinal Canal Stenosis and Osteoporosis Treated With Calcitonin and Physical Therapy

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    Hidayet Sarı

    2002-06-01

    Full Text Available Objective: The role of osteoporosis in the etiology of degenerative lumbar spinal canal stenosis is debatable. The aim of this study was to evaluate clinic as well as therapeutic results in subjects with osteoporosis combined with lumbar spinal canal stenosis (LSS. Material and Methods: The study was conducted in İ.Ü. Cerrahpaşa Medical Faculty PMR Department on 40 patients diagnosed as spinal canal stenosis . Lumbar canal was imaged by computerized tomography (CT. Bone mineral content (BMC was assessed by quantitative computerized tomography (QCT. Subjects were divided into three groups according to their BMC. Pain, motion, neurologic findings and walking distance were reevaluated after 1 months conservative treatment consisting of physical therapy IR, US, currents and exercises and medical treatment (100 IU Salmon Calcitonin injections and calcium. Results: Pain parameters showed significant improvement in Group II and III(low and very low BMC. Walking distance showed greatest increase in Group II and III, with these results being statistically significant. Conclusion: In subjects with combined LSS and osteoporosis one months conservative therapy resulted in significant improvements in pain and walking distance parameters, especially in groups with low BMC .We suggest that BMC should be considered and treated in patients with LSS.

  13. Dorsal border periaqueductal gray neurons project to the area directly adjacent to the central canal ependyma of the C4-T8 spinal cord in the cat

    NARCIS (Netherlands)

    Mouton, LJ; Kerstens, L; VanderWant, J; Holstege, G

    1996-01-01

    In a previous study horseradish peroxidase (HRP) injections in the upper thoracic and cervical spinal cord revealed some faintly labeled small neurons at the dorsal border of the periaqueductal gray (PAG). The present light microscopic and electronmicroscopic tracing study describes the precise loca

  14. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion.

    Science.gov (United States)

    Martínez-Pérez, R; Paredes, I; Cepeda, S; Ramos, A; Castaño-León, A M; García-Fuentes, C; Lobato, R D; Gómez, P A; Lagares, A

    2014-05-01

    In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length. We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression. There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion. In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies

  15. Early posterior spinal canal decompression and circumferential reconstruction of rotationally unstable thoracolumbar burst fractures with neurological deficit

    Institute of Scientific and Technical Information of China (English)

    ZHENG Guo-quan; WANG Yan; TANG Pei-fu; ZHANG Yong-gang; ZHANG Xue-song; GUO Yi-zhu; TAO Sheng

    2013-01-01

    Background Among the various treatments of neurologically involved unstable thoracolumbar burst fractures,the combination of anterior and posterior instrumentation provides the most stable reconstruction.However,the use of both approaches on a trauma patient may increase the morbidity.This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.Methods From March 2005 to September 2009,patients with matched type spinal fracture,ages at surgery,and involved levels in our institute underwent either a single stage posterior approach (group one,n=12) or traditional combined approach (group two,n=14) for spinal canal decompression and circumferential reconstruction were reviewed.Pre-and post-operative X-ray films were reviewed and changes in Cobb angle of thoracolumbar spine were documented.Intra-operative,post-operative,and general complications were registered.Results The mean follow-up was (27.7±9.6) months (range,14 to 56 months) in group one and (29.2±7.4) months (range,20 to 60 months) in group two (P >0.05).The mean operation time was 214 minutes (range,186-327 minutes) in group one and 284 minutes (range,219-423 minutes) in group two (P <0.05).The average volume of intraoperative blood loss was 1856 ml (range,1250-3480 ml) in group one and 2453 ml (range,1600-3680 ml) in group two (P <0.05).There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery.Postoperatively,there was an epidural hematoma in one patient in group one and two patients in group two.Bony union after stabilization was obtained in all patients,without loosening or breakage of screws.Loss of correction (5°) was seen in 1 patient in group one at the 6th month

  16. Alterations in multidimensional motor unit number index of hand muscles after incomplete cervical spinal cord injury.

    Science.gov (United States)

    Li, Le; Li, Xiaoyan; Liu, Jie; Zhou, Ping

    2015-01-01

    The objective of this study was to apply a novel multidimensional motor unit number index (MD-MUNIX) technique to examine hand muscles in patients with incomplete cervical spinal cord injury (SCI). The MD-MUNIX was estimated from the compound muscle action potential (CMAP) and different levels of surface interference pattern electromyogram (EMG) at multiple directions of voluntary isometric muscle contraction. The MD-MUNIX was applied in the first dorsal interosseous (FDI), thenar and hypothenar muscles of SCI (n = 12) and healthy control (n = 12) subjects. The results showed that the SCI subjects had significantly smaller CMAP and MD-MUNIX in all the three examined muscles, compared to those derived from the healthy control subjects. The multidimensional motor unit size index (MD-MUSIX) demonstrated significantly larger values for the FDI and hypothenar muscles in SCI subjects than those from healthy control subjects, whereas the MD-MUSIX enlargement was marginally significant for the thenar muscles. The findings from the MD-MUNIX analyses provide an evidence of motor unit loss in hand muscles of cervical SCI patients, contributing to hand function deterioration.

  17. Concurrent spinal schwannoma and meningioma mimicking a single cervical dumbbell-shaped tumor: case report.

    Science.gov (United States)

    Oichi, Takeshi; Chikuda, Hirotaka; Morikawa, Teppei; Mori, Harushi; Kitamura, Daisuke; Higuchi, Junya; Taniguchi, Yuki; Matsubayashi, Yoshitaka; Oshima, Yasushi; Tanaka, Sakae

    2015-12-01

    Dumbbell-shaped tumors consisting of 2 different tumors are extremely rare. Herein, the authors present a case of concurrent spinal schwannoma and meningioma mimicking a single cervical dumbbell-shaped tumor. A 64-year-old man presented with a 5-year history of gradually exacerbating left occipital pain without clinical evidence of neurofibromatosis. Magnetic resonance imaging showed an extradural tumor along the left C-2 nerve root with a small intradural component. The tumor was approached via a C-1 hemilaminectomy. The intradural tumor was resected together with the extradural tumor after opening the dura mater. The intradural tumor was attached to the dura mater around the exit point of the C-2 nerve root. Intraoperative biopsy revealed that the extradural tumor was a schwannoma and that the intradural tumor was a meningioma. The dura mater adjacent to the tumor was then coagulated and resected. Postoperative pathological examination confirmed the same diagnoses with no evidence of continuity between the intra- and extradural components. The patient's postoperative clinical course was uneventful. Clinicians should be aware that cervical dumbbell-shaped tumors can consist of 2 different tumors.

  18. Functional electrical stimulation therapy improves grasping in chronic cervical spinal cord injury: Two case studies

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    Miller Rosalynn C.

    2008-01-01

    Full Text Available OBJECTIVE AND IMPORTANCE: To present case studies of two individuals with chronic cervical spinal cord injury (SCI who participated in functional electrical stimulation (FES therapy with the objective to restore voluntary grasp function. CLINICAL PRESENTATION: Both individuals (right hand dominant males, age 24 and 31 had a sustained a cervical SCI (C6 and C4-5, respectively at least 8 years prior to participation in this study. INTERVENTION: Both individuals participated in an individualized FES therapy program for 6 weeks. FES therapy was administered through a regimen of three, one-hour sessions, per week for three months. A single arm of each participant (n = 2 was treated. FES therapy is an integrative intervention strategy combining muscle strengthening, functional movement training and stretching. The participant's hand movement abilities were assessed pre and post FES therapy using the Manual Muscle Test (MMT, a modified Sollerman Hand Function Test (mSHFT, and the Reach, Grasp, Transport and Release Task (RGTR. DISCUSSION: As the injuries of participants in the current study were chronic and thus neurologically stable, no spontaneous improvements/recovery in hand function was expected. However, FES as part of an integrated therapeutic approach affected restoration and improvement of hand function in both participants. CONCLUSION: The concurrent improvement in strength, integrated motor function and object contact following FES therapy, demonstrated that there is potential for affecting change in hand function of individuals with chronic SCI.

  19. Profile of the cardiac repolarization in cervical spinal cord injury subjects performing physical exercise

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    Roberto Magalhães

    2017-08-01

    Full Text Available The aim of the study was to compare rest QT interval and QTcorrected intervals of electrocardiogram in trained men with and without cervical spinal cord injury (CSCI and investigate cardiac electrocardiogram parameters in trained men with CSCI submitted to maximal effort test. Thirty men were separated into three groups: Control without CSCI (CON, 25.3 ± 4.1 yrs, strength training: 3 days week-1; aerobic training 1day week-1; n = 10, high volume exercise (30.5 ± 4.3 yrs, 3 day week-1 rugby specific exercises, 60min. day-1; n = 12 and moderate volume of exercise (33.7 ± 5.9 yrs, 2 days week-1 specific rugby exercises, 60 min. day-1; n = 8 with incomplete CSCI (C5-C7 cervical vertrebae more than 12 months. Electrocardiogram was recorded in rest, during and after effort test. QT interval was significantly reduced (p = 0.001 in the high volume exercise group compared to control. Corrected QT interval showed no difference between moderate vs. high volume exercise group (p > 0.05. No changes were observed in QT, corrected QT, PR and QRS intervals of electrocardiogram between rest and post effort (p > 0.05. Thus, effort test does not change electrocardiogram parameters in CSCI subjects. High volume of week exercise promotes abnormalities in cardiac repolarization compared to a moderate training program.

  20. Characterization of DTI Indices in the Cervical, Thoracic, and Lumbar Spinal Cord in Healthy Humans

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    Rachael L. Bosma

    2012-01-01

    Full Text Available The aim of this study was to characterize in vivo measurements of diffusion along the length of the entire healthy spinal cord and to compare DTI indices, including fractional anisotropy (FA and mean diffusivity (MD, between cord regions. The objective is to determine whether or not there are significant differences in DTI indices along the cord that must be considered for future applications of characterizing the effects of injury or disease. A cardiac gated, single-shot EPI sequence was used to acquire diffusion-weighted images of the cervical, thoracic, and lumbar regions of the spinal cord in nine neurologically intact subjects (19 to 22 years. For each cord section, FA versus MD values were plotted, and a k-means clustering method was applied to partition the data according to tissue properties. FA and MD values from both white matter (average FA=0.69, average MD=0.93 × 10−3 mm2/s and grey matter (average FA=0.44, average MD=1.8 × 10−3 mm2/s were relatively consistent along the length of the cord.

  1. Epicritic sensation in cervical spinal cord injury: diagnostic gains beyond testing light touch.

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    Velstra, Inge-Marie; Bolliger, Marc; Baumberger, Michael; Rietman, Johan Swanik; Curt, Armin

    2013-08-01

    Abstract Applied as a bedside test of gross dorsal column function, the testing of light touch (LT) sensation is of high clinical value in the diagnosis of human spinal cord injury (SCI). However, the assessment of overall dorsal column deficit by testing only LT may be limited, because the dorsal column pathway conveys several large diameter afferent modalities (e.g., sensation of touch, two-point discrimination, and proprioception). Therefore, the objective of this study was to compare the epicritic sensation assessed by LT, Semmes-Weinstein monofilament (SWM), and electrical perception threshold (EPT) across cervical dermatomes (C3-C8) in individuals with cervical SCI. A multicenter cross-sectional study was performed at 6 months after cervical SCI, applying combined measures of LT, SWM, and EPT, bilaterally over predefined key sensory points (C3-C8). A total of 300 left- and right-sided dermatomes were tested for each outcome measure in 25 participants. The percentage agreement between classifications according to LT and SWM/EPT testing for all dermatomes between C3 and C8 ranged from 95.5% to 36.2%. The degree of agreement showed considerably variable κ coefficients (-0.1≥kw≤0.7) for each dermatome between C3 and C8. The additional measurements of epicritic sensation by SWM and EPT increased sensitivity by detecting and quantifying differences in sensory thresholds above, at, and below the LT level of injury. This is relevant for early clinical trials (phase 1/2), in which disclosing any biological activity of an intervention may be revealed by subtle sensory changes that might gain a clinical relevance.

  2. Analysis of functional CT scan in cervical vertebral disease

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    Hirofuji, Eiichi; Tanaka, Seisuke; Tomihara, Mitsuo; Kita, Hiroshi; Yamasaki, Hiroyuki

    1982-12-01

    The atlantoaxial joint showed displacement in various directions in rheumatoid arthritis and cervical spondylosis. The displacements were promoted by anterior flexion and rotatory movements, exerting great influences on the spnial cord. The intervertebral space between the 5th and 6th vertebra showed narrowing of the vertebral canal in cervical spondylosis and was promoted by posterior flexion to affect the spinal cord to a great extent. Functional CT scan was useful for observation of pathologic conditions of vertebral diseases.

  3. The relationship between the imaging features and prognosis in the patients with cervical spinal stenosis and cervical spondylotic myelopathy%先天性颈椎管狭窄与脊髓型颈椎病影像学表现以及预后的关系

    Institute of Scientific and Technical Information of China (English)

    丁文元; 曹来震; 申勇; 张为; 王林峰; 张英泽

    2011-01-01

    ,Hoffmann sign, Babinski sign, sensory loss or hypoesthesia, and lower-extremity/upper-extremity hyperreflexia were recorded. Results The incidence rate of cervical spinal stenosis was 33.6% in patients with cervical spondylotic myelopathy. The study showed that the age was smaller (P< 0.001 ), preoperative JOA score was higher(P=0.0018), duration of disease was longer(P=0.009), and the recovery rate was lower(P< 0.001 )in cervical spinal canal narrowing group comparing with control group. There was no significant difference between the two groups in gender (x2=0.006,P=l.00). There was significant difference between two groups in the incidence of ISI in spinal cord through x2 test(x2=62.396,P< 0.001 ). Multivariate analysis indicated that the likelihood of the recovery rate of cervical myelopathy decreased with the presence of cervical spinal stenosis, duration of dieaase, number of neurological signs, age (R2=0.565). Conclusion Patients with congenitally narrow cervical spinal canal have to suffer severe spinal cord compression and high incidence of ISI in spinal cord. The duration of disease is long, and prognosis is poor.

  4. Favourable outcome of posterior decompression and stabilization in lordosis for cervical spondylotic myelopathy: the spinal cord "back shift" concept.

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    Denaro, Vincenzo; Longo, Umile Giuseppe; Berton, Alessandra; Salvatore, Giuseppe; Denaro, Luca

    2015-11-01

    Surgical management of patients with multilevel CSM aims to decompress the spinal cord and restore the normal sagittal alignment. The literature lacks of high level evidences about the best surgical approach. Posterior decompression and stabilization in lordosis allows spinal cord back shift, leading to indirect decompression of the anterior spinal cord. The purpose of this study was to investigate the efficacy of posterior decompression and stabilization in lordosis for multilevel CSM. 36 out of 40 patients were clinically assessed at a mean follow-up of 5, 7 years. Outcome measures included EMS, mJOA Score, NDI and SF-12. Patients were asked whether surgery met their expectations and if they would undergo the same surgery again. Bone graft fusion, instrumental failure and cervical curvature were evaluated. Spinal cord back shift was measured and correlation with EMS and mJOA score recovery rate was analyzed. All scores showed a significative improvement (p 0.05). Ninety percent of patients would undergo the same surgery again. There was no deterioration of the cervical alignment, posterior grafted bones had completely fused and there were no instrument failures. The mean spinal cord back shift was 3.9 mm (range 2.5-4.5 mm). EMS and mJOA recovery rates were significantly correlated with the postoperative posterior cord migration (P lordosis is a valuable procedure for patients affected by multilevel CSM, leading to significant clinical improvement thanks to the spinal cord back shift. Postoperative lordotic alignment of the cervical spine is a key factor for successful treatment.

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

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

    2009-05-01

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

  6. 颈神经在颈椎间孔及脊神经沟处受嵌压的解剖学因素%Anatomical factors of wedge pressure on cervical nerves in cervical intervertebral foramen of cervical nerve and sulcus of spinal nerve

    Institute of Scientific and Technical Information of China (English)

    李英平; 郭瑞芳

    2005-01-01

    nerve root.OBJECTIVE: To probe into the anatomical factors of cervical spondylosis of nerve root type with occurrence rate of involved cervical nerve in cervical intervertebral foramen and sulcus of spinal nerve.DESIGN: Single sample observation was designed.SETTING: Department of Anatomy of Chengde Medical College.PARTICIPANTS: Totally 120 sides of 60 adult corpses were employed with formaldehyde fixation (28 cases of male and 32 cases of female).METHODS: Sixty adult corpses were measured with the vernier of 0.02 mm spinal nerve and the transverse diameter of anterior branch (A-diameter) of superoinferior diameter (S - I diameter) of cervical intervertebral foramen and its spinal nerve root. The ratios were calculated between A-diameter cervical nerve and E-diameter of the corresponding sulcus of spinal nerve and between A - P diameter and S - I diameter of spinal nerve root and those of corresponding intervertebral foramen respectively. The rates of occurrence were concluded for those cervical nerves whose A-diameter larger than or equal to E-diameter of sulcus of spinal nerves and for those spinal nerve roots whose rations larger than or equal to those of corresponding intervertebral foramens.cervical nerve in C3-6 larger than or equal to E-diameter of sulcus of spinal nerve roots in C3-6 larger than or equal to those of corresponding intervertebral foramens.RESULTS: Totally 120 sides of 60 corpses were measured (56 cases of male wedge pressure in intervertebral foramen of cervical nerve root for both male and female, of which, that of female was remarkably superior to the male was 6. 3% for wedge pressure of anterior branch of cervical spinal nerve in sulcus in spinal nerve for both male and female, of which, that of male was remarkably superior to the female(8.9%, 3.9%, χ2 = 6.65, P < 0. 01 ).CONCLUSION: The involvement of cervical nerve is related not only to the stenosis of bone canal but also to the injury of peripheral soft tissues. By the ratios between E

  7. Carcinoma do esôfago com invasão do canal medular: relato de caso e revisão da literatura Esophageal carcinoma extending into the spinal canal: case report and review of the literature

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    Linei A.B.D. Urban

    2002-06-01

    Full Text Available Os autores apresentam o caso de paciente do sexo masculino, 62 anos de idade, com emagrecimento há quatro meses e diminuição da força muscular associada a parestesias em membros inferiores há dois dias. Foi submetido a mielotomografia, que demonstrou massa no mediastino posterior com destruição dos corpos vertebrais e invasão do canal medular, além de espessamento irregular das paredes do esôfago. Na evolução, foi submetido a estudo contrastado do esôfago, que demonstrou falha de enchimento irregular. A biópsia confirmou a presença de carcinoma de células escamosas. Este é o primeiro relato na literatura latino-americana (Lilacs de carcinoma de esôfago com invasão de canal medular e manifestação inicial de síndrome de compressão medular.The authors report the case of a 62-year-old male with a 4 month history of weight loss and a 2 day complaint of weakness and paresthesia on the lower limbs. A computed tomography myelogram revealed a mass in the posterior mediastinum associated with destruction of the vertebral body, spinal canal extension and irregular esophageal wall thickening. The patient was later submitted to a barium esophagogram that showed an irregular filling defect. A biopsy confirmed the presence of a squamous cell carcinoma. This is the first report in the Latin-American literature (Lilacs of a patient with an esophageal carcinoma with spinal canal extension and spinal cord compression syndrome at initial presentation.

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

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    Bartanusz Viktor

    2012-09-01

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

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

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    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.

  10. Coupling multielectrode array recordings with silver labeling of recording sites to study cervical spinal network connectivity.

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    Streeter, K A; Sunshine, M D; Patel, S R; Liddell, S S; Denholtz, L E; Reier, P J; Fuller, D D; Baekey, D M

    2017-03-01

    Midcervical spinal interneurons form a complex and diffuse network and may be involved in modulating phrenic motor output. The intent of the current work was to enable a better understanding of midcervical "network-level" connectivity by pairing the neurophysiological multielectrode array (MEA) data with histological verification of the recording locations. We first developed a method to deliver 100-nA currents to electroplate silver onto and subsequently deposit silver from electrode tips after obtaining midcervical (C3-C5) recordings using an MEA in anesthetized and ventilated adult rats. Spinal tissue was then fixed, harvested, and histologically processed to "develop" the deposited silver. Histological studies verified that the silver deposition method discretely labeled (50-μm resolution) spinal recording locations between laminae IV and X in cervical segments C3-C5. Using correlative techniques, we next tested the hypothesis that midcervical neuronal discharge patterns are temporally linked. Cross-correlation histograms produced few positive peaks (5.3%) in the range of 0-0.4 ms, but 21.4% of neuronal pairs had correlogram peaks with a lag of ≥0.6 ms. These results are consistent with synchronous discharge involving mono- and polysynaptic connections among midcervical neurons. We conclude that there is a high degree of synaptic connectivity in the midcervical spinal cord and that the silver-labeling method can reliably mark metal electrode recording sites and "map" interneuron populations, thereby providing a low-cost and effective tool for use in MEA experiments. We suggest that this method will be useful for further exploration of midcervical network connectivity.NEW & NOTEWORTHY We describe a method that reliably identifies the locations of multielectrode array (MEA) recording sites while preserving the surrounding tissue for immunohistochemistry. To our knowledge, this is the first cost-effective method to identify the anatomic locations of neuronal

  11. Cervical lordotic alignment following posterior spinal fusion for adolescent idiopathic scoliosis: reciprocal changes and risk factors for malalignment.

    Science.gov (United States)

    Hayashi, Kazunori; Toyoda, Hiromitsu; Terai, Hidetomi; Suzuki, Akinobu; Hoshino, Masatoshi; Tamai, Koji; Ohyama, Shoichiro; Nakamura, Hiroaki

    2017-04-01

    OBJECTIVE Numerous reports have been published on the effectiveness and safety of correction of the coronal Cobb angle and thoracolumbar sagittal alignment in patients with adolescent idiopathic scoliosis (AIS). Suboptimal sagittal alignment, such as decreased thoracic kyphosis (TK), after corrective surgery, is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment; however, few reports are available on reciprocal changes outside of the fused segments, such as the cervical lordotic angle (CLA). This study aimed to investigate the relationship between the perioperative CLA and other radiographic factors or clinical results in AIS, and to identify independent risk factors of postoperative cervical hyperkyphosis. METHODS A total of 51 AIS patients who underwent posterior spinal fusion with the placement of pedicle screw (PS) constructs at thoracic levels were included in the study. Clinical and radiographic follow-up of patients was conducted for a minimum of 2 years, and the postoperative course was evaluated. The authors measured and identified the changes in the CLA and other radiographic parameters using whole-spine radiography, with the patient in the standing position, performed immediately before surgery, 2 weeks after surgery, and 2 years after surgery. The postoperative cervical hyperkyphosis group included patients whose CLA at 2-year follow-up was smaller than -10°. The reciprocal changes of the CLA and other parameters were also investigated. Univariate and multivariate analyses were conducted to determine the associated risk factors for postoperative cervical hyperkyphosis. RESULTS This study comprised 48 females and 3 males (mean age 16.0 years). The mean follow-up period was 47 months (range 24-90 months). The main coronal thoracic curve was corrected from 54.6° to 16.4°, and the mean correction rate was 69.8% at 2 years. The CLA significantly increased from the mean preoperative measurement (-5.4° ± 14°) to the 2

  12. Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws

    Science.gov (United States)

    Mahesh, Bijjawara; Vijay, Shekarappa; Arun, Kumar; Srinivasa, Reddy

    2016-01-01

    Study Design Technique description and retrospective data analysis. Purpose To describe the technique of cervical kyphosis correction with partial facetectomies and evaluate the outcome of single-stage posterior decompression and kyphosis correction in multilevel cervical myelopathy. Overview of Literature Kyphosis correction in multilevel cervical myelopathy involves anterior and posterior surgery. With the advent of cervical pedicle screw-rod instrumentation, single-stage posterior kyphosis correction is feasible and can address stretch myelopathy by posterior shortening. Methods Nine patients underwent single-stage posterior decompression and kyphosis correction for multilevel cervical myelopathy using cervical pedicle screw instrumentation from March 2011 to February 2014 and were evaluated preoperatively and postoperatively with modified Japanese Orthopaedic Association (mJOA) scoring and computed tomography scans for radiological measurements. Kyphosis assessment was made with Ishihara curvature index and C2–C7 Cobb's angle. The linear length of the spinal canal and the actual spinal canal length were also evaluated. The average follow-up was 40.56 months (range, 20 to 53 months). Results The average preoperative C2–7 Cobb's angle of 6.3° (1° to 12°) improved to 2° (10° to −9°). Ishihara index improved from −15.8% (−30.5% to −4.7%) to −3.66% (−14.5% to +12.6%). The actual spinal canal length decreased from 83.64 mm (range, 76.8 to 91.82 mm) to 82.68 mm (range, 75.85 to 90.78 mm). The preoperative mJOA score of 7.8 (range, 3 to 11) improved to 15.0 (range, 13 to 17). Conclusions Single-stage posterior decompression and kyphosis correction using cervical pedicle screws for multilevel cervical myelopathy may address stretch myelopathy, in addition to decompression in the transverse plane. However, cervical lordosis was not achieved with this method as predictably as by the anterior approach. The present study shows evidence of mild

  13. Five-level noncontiguous spinal injuries of cervical region:report of a case and literature review

    Institute of Scientific and Technical Information of China (English)

    GUO Hong-gang; MA Xin-long; LI Feng-tan; FENG Shi-qing

    2012-01-01

    The incidence of multiple noncontiguous spinal injuries (MNSI) in the cervical spine is rare but has catastrophic consequences.The patient in this report was a 34-year-old woman with five-level cervical MNSI.CT and MRI showed that injuries included atlantoaxial instability,burst fracture of C6,dislocation of G6/7,rupture of the intervertebal disc or ligamentous complex,and irreversible cord damage.The mechanism for this case was a combined pattern of hyperflexion,compression,and hyperextension injuries.A review of the literature revealed that this case is the first report in the literature of a vehicle related accident causing five-level noncontiguous injuries of the cervical spine.

  14. Successful operative management of an upper lumbar spinal canal stenosis resulting in multilevel lower nerve root radiculopathy

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    Shearwood McClelland

    2015-01-01

    Full Text Available Lumbar stenosis is a common disorder, usually characterized clinically by neurogenic claudication with or without lumbar/sacral radiculopathy corresponding to the level of stenosis. We present a case of lumbar stenosis manifesting as a multilevel radiculopathy inferior to the nerve roots at the level of the stenosis. A 55-year-old gentleman presented with bilateral lower extremity pain with neurogenic claudication in an L5/S1 distribution (posterior thigh, calf, into the foot concomitant with dorsiflexion and plantarflexion weakness. Imaging revealed grade I spondylolisthesis of L3 on L4 with severe spinal canal stenosis at L3-L4, mild left L4-L5 disc herniation, no stenosis at L5-S1, and no instability. EMG revealed active and chronic L5 and S1 radiculopathy. The patient underwent bilateral L3-L4 hemilaminotomy with left L4-L5 microdiscectomy for treatment of his L3-L4 stenosis. Postoperatively, he exhibited significant improvement in dorsiflexion and plantarflexion. The L5-S1 level was not involved in the operative decompression. Patients with radiculopathy and normal imaging at the level corresponding to the radiculopathy should not be ruled out for operative intervention should they have imaging evidence of lumbar stenosis superior to the expected affected level.

  15. One stage anterior-posterior approach for traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    WANG Chang-sheng; LIU Mou-jun; LIN Jian-hua; XU Wei-hong; LUO Hong-bin

    2011-01-01

    Objectives: To explore the clinical features of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury (CSCI), and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases.Methods: From March 2004 to September 2009, 16cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied.Results: All operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association (JOA) scores ranged from 10to 16 one year postoperatively, 13.95±2.06 on average (improvement rate= 70.10% ). X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants' position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed.Conclusions: Traumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal

  16. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index.

    Science.gov (United States)

    Rodine, Robert J; Vernon, Howard

    2012-03-01

    Cervical radiculopathy (CR), while less common than conditions with neck pain alone, can be a significant cause of neck pain and disability; thus the determination of adequate treatment options for patients is essential. Currently, inadequate scientific literature restricts specific conservative management recommendations for CR. Despite a paucity of evidence for high-velocity low-amplitude (HVLA) spinal manipulation in the treatment for CR, this strategy has been frequently labeled as contraindicated. Scientific support for appropriate outcome measures for CR is equally deficient. While more scientific data is needed to draw firm conclusions, the present review suggests that spinal manipulation may be cautiously considered as a therapeutic option for patients suffering from CR. With respect to outcome measures, the Neck Disability Index appears well-suited for spinal manipulative treatment of CR.

  17. Vibration-induced finger flexion reflex and inhibitory effect of acupuncture on this reflex in cervical spinal cord injury patients.

    Science.gov (United States)

    Takakura, N; Iijima, S; Kanamaru, A; Shibuya, M; Homma, I; Ohashi, M

    1996-12-01

    The vibration-induced finger flexion reflex (VFR) and the inhibitory effect of acupuncture on this reflex were studied in five cervical spinal cord injury patients (C-SCIs). VFR, which is a tonic finger flexion reflex induced by vibratory stimulation on the finger tip, was induced before and after acupuncture was carried out on the same hand. A stainless steel needle was inserted to the Hoku point. As in healthy subjects, VFR was performed and it was significantly inhibited by acupuncture in the C-SCIs; mean maximum VFR was 204.2 +/- S.E. 68.6 g before and 119.8 +/- S.E. 42.2 g after acupuncture. The present results suggest that at least part of the reflex center for VFR is located in the spinal cord and that part of VFR inhibition by acupuncture may be mediated via the spinal cord.

  18. Thoracic spinal cord and cervical vagosympathetic neuromodulation obtund nodose sensory transduction of myocardial ischemia.

    Science.gov (United States)

    Salavatian, Siamak; Beaumont, Eric; Gibbons, David; Hammer, Matthew; Hoover, Donald B; Armour, J Andrew; Ardell, Jeffrey L

    2017-08-18

    Autonomic regulation therapy involving either vagus nerve stimulation (VNS) or spinal cord stimulation (SCS) represents emerging bioelectronic therapies for heart disease. The objective of this study was to determine if VNS and/or SCS modulate primary cardiac afferent sensory transduction of the ischemic myocardium. Using extracellular recordings in 19 anesthetized canines, of 88 neurons evaluated, 36 ventricular-related nodose ganglia sensory neurons were identified by their functional activity responses to epicardial touch, chemical activation of their sensory neurites (epicardial veratridine) and great vessel (descending aorta or inferior vena cava) occlusion. Neural responses to 1min left anterior descending (LAD) coronary artery occlusion (CAO) were then evaluated. These interventions were then studied following either: i) SCS [T1-T3 spinal level; 50Hz, 90% motor threshold] or ii) cervical VNS [15-20Hz; 1.2× threshold]. LAD occlusion activated 66% of identified nodose ventricular sensory neurons (0.33±0.08-0.79±0.20Hz; baseline to CAO; p<0.002). Basal activity of cardiac-related nodose neurons was differentially reduced by VNS (0.31±0.11 to 0.05±0.02Hz; p<0.05) as compared to SCS (0.36±0.12 to 0.28±0.14, p=0.59), with their activity response to transient LAD CAO being suppressed by either SCS (0.85±0.39-0.11±0.04Hz; p<0.03) or VNS (0.75±0.27-0.12±0.05Hz; p<0.04). VNS did not alter evoked neural responses of cardiac-related nodose neurons to great vessel occlusion. Both VNS and SCS obtund ventricular ischemia induced enhancement of nodose afferent neuronal inputs to the medulla. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Schwann cell transplantation improves reticulospinal axon growth and forelimb strength after severe cervical spinal cord contusion.

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    Schaal, S M; Kitay, B M; Cho, K S; Lo, T P; Barakat, D J; Marcillo, A E; Sanchez, A R; Andrade, C M; Pearse, D D

    2007-01-01

    Schwann cell (SC) implantation alone has been shown to promote the growth of propriospinal and sensory axons, but not long-tract descending axons, after thoracic spinal cord injury (SCI). In the current study, we examined if an axotomy close to the cell body of origin (so as to enhance the intrinsic growth response) could permit supraspinal axons to grow onto SC grafts. Adult female Fischer rats received a severe (C5) cervical contusion (1.1 mm displacement, 3 KDyn). At 1 week postinjury, 2 million SCs ex vivo transduced with lentiviral vector encoding enhanced green fluorescent protein (EGFP) were implanted within media into the injury epicenter; injury-only animals served as controls. Animals were tested weekly using the BBB score for 7 weeks postimplantation and received at end point tests for upper body strength: self-supported forelimb hanging, forearm grip force, and the incline plane. Following behavioral assessment, animals were anterogradely traced bilaterally from the reticular formation using BDA-Texas Red. Stereological quantification revealed a twofold increase in the numbers of preserved NeuN+ neurons rostral and caudal to the injury/graft site in SC implanted animals, corroborating previous reports of their neuroprotective efficacy. Examination of labeled reticulospinal axon growth revealed that while rarely an axon was present within the lesion site of injury-only controls, numerous reticulospinal axons had penetrated the SC implant/lesion milieu. This has not been observed following implantation of SCs alone into the injured thoracic spinal cord. Significant behavioral improvements over injury-only controls in upper limb strength, including an enhanced grip strength (a 296% increase) and an increased self-supported forelimb hanging, accompanied SC-mediated neuroprotection and reticulospinal axon growth. The current study further supports the neuroprotective efficacy of SC implants after SCI and demonstrates that SCs alone are capable of supporting

  20. Comparison of Cervical Spine Anatomy in Calves, Pigs and Humans.

    Science.gov (United States)

    Sheng, Sun-Ren; Xu, Hua-Zi; Wang, Yong-Li; Zhu, Qing-An; Mao, Fang-Min; Lin, Yan; Wang, Xiang-Yang

    2016-01-01

    Animals are commonly used to model the human spine for in vitro and in vivo experiments. Many studies have investigated similarities and differences between animals and humans in the lumbar and thoracic vertebrae. However, a quantitative anatomic comparison of calf, pig, and human cervical spines has not been reported. To compare fundamental structural similarities and differences in vertebral bodies from the cervical spines of commonly used experimental animal models and humans. Anatomical morphometric analysis was performed on cervical vertebra specimens harvested from humans and two common large animals (i.e., calves and pigs). Multiple morphometric parameters were directly measured from cervical spine specimens of twelve pigs, twelve calves and twelve human adult cadavers. The following anatomical parameters were measured: vertebral body width (VBW), vertebral body depth (VBD), vertebral body height (VBH), spinal canal width (SCW), spinal canal depth (SCD), pedicle width (PW), pedicle depth (PD), pedicle inclination (PI), dens width (DW), dens depth (DD), total vertebral width (TVW), and total vertebral depth (TVD). The atlantoaxial (C1-2) joint in pigs is similar to that in humans and could serve as a human substitute. The pig cervical spine is highly similar to the human cervical spine, except for two large transverse processes in the anterior regions ofC4-C6. The width and depth of the calf odontoid process were larger than those in humans. VBW and VBD of calf cervical vertebrae were larger than those in humans, but the spinal canal was smaller. Calf C7 was relatively similar to human C7, thus, it may be a good substitute. Pig cervical vertebrae were more suitable human substitutions than calf cervical vertebrae, especially with respect to C1, C2, and C7. The biomechanical properties of nerve vascular anatomy and various segment functions in pig and calf cervical vertebrae must be considered when selecting an animal model for research on the spine.

  1. Cervical spinal clearance: A prospective Western Trauma Association Multi-institutional Trial.

    Science.gov (United States)

    Inaba, Kenji; Byerly, Saskya; Bush, Lisa D; Martin, Matthew J; Martin, David T; Peck, Kimberly A; Barmparas, Galinos; Bradley, Matthew J; Hazelton, Joshua P; Coimbra, Raul; Choudhry, Asad J; Brown, Carlos V R; Ball, Chad G; Cherry-Bukowiec, Jill R; Burlew, Clay Cothren; Joseph, Bellal; Dunn, Julie; Minshall, Christian T; Carrick, Matthew M; Berg, Gina M; Demetriades, Demetrios

    2016-12-01

    For blunt trauma patients who have failed the NEXUS (National Emergency X-Radiography Utilization Study) low-risk criteria, the adequacy of computed tomography (CT) as the definitive imaging modality for clearance remains controversial. The purpose of this study was to prospectively evaluate the accuracy of CT for the detection of clinically significant cervical spine (C-spine) injury. This was a prospective multicenter observational study (September 2013 to March 2015) at 18 North American trauma centers. All adult (≥18 years old) blunt trauma patients underwent a structured clinical examination. NEXUS failures underwent a CT of the C-spine with clinical follow-up to discharge. The primary outcome measure was sensitivity and specificity of CT for clinically significant injuries requiring surgical stabilization, halo, or cervical-thoracic orthotic placement using the criterion standard of final diagnosis at the time of discharge, incorporating all imaging and operative findings. Ten thousand seven hundred sixty-five patients met inclusion criteria, 489 (4.5%) were excluded (previous spinal instrumentation or outside hospital transfer); 10,276 patients (4,660 [45.3%] unevaluable/distracting injuries, 5,040 [49.0%] midline C-spine tenderness, 576 [5.6%] neurologic symptoms) were prospectively enrolled: mean age, 48.1 years (range, 18-110 years); systolic blood pressure 138 (SD, 26) mm Hg; median, Glasgow Coma Scale score, 15 (IQR, 14-15); Injury Severity Score, 9 (IQR, 4-16). Overall, 198 (1.9%) had a clinically significant C-spine injury requiring surgery (153 [1.5%]) or halo (25 [0.2%]) or cervical-thoracic orthotic placement (20 [0.2%]). The sensitivity and specificity for clinically significant injury were 98.5% and 91.0% with a negative predictive value of 99.97%. There were three (0.03%) false-negative CT scans that missed a clinically significant injury, all had a focal neurologic abnormality on their index clinical examination consistent with central cord

  2. Concentration of nitric oxide (NO in spinal fluid of chronic spinal disease.

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    Yumite Y

    2001-08-01

    Full Text Available We studied total nitric oxide (nitrite + nitrate (NO levels in cerebrospinal fluid (CSF of chronic spinal diseases in nonsmokers (133 patients: 76 men and 57 women; mean age, 63 years; range, 15-92 years by the Griess method to clarify the role of NO in different spinal diseases. The extent of compression in terms of numbers of disc level at the compressed spinal nerve and neurological evaluation were also assessed according to the Japanese Orthopaedic Association scores. The spinal diseases included cervical myelopathy and radiculopathy (cervical disease group, ossification of yellow ligament (thoracic disease group, and lumbar disc herniation, lumbar canal stenosis and lumbar spondylolisthesis (lumbar disease group. NO levels in the spinal disease groups (4.98+/-2.28 micromol/l: mean +/- SD were significantly higher than that in the control group (2.53+/-0.94 micromol/l. An inverse correlation was detected between the elevated levels of NO and the grade of clinical symptoms in the cervical disorders. The number of disc level at the compressed spinal nerve was positively correlated with elevated NO levels in CSF in the cervical and lumbar disorder groups. These results indicate that nerve compression may elevate NO levels in CSF, and that NO concentration in the CSF might be a useful marker of damage to nervous system in spinal disorders.

  3. An optimized framework for quantitative magnetization transfer imaging of the cervical spinal cord in vivo.

    Science.gov (United States)

    Battiston, Marco; Grussu, Francesco; Ianus, Andrada; Schneider, Torben; Prados, Ferran; Fairney, James; Ourselin, Sebastien; Alexander, Daniel C; Cercignani, Mara; Gandini Wheeler-Kingshott, Claudia A M; Samson, Rebecca S

    2017-09-16

    To develop a framework to fully characterize quantitative magnetization transfer indices in the human cervical cord in vivo within a clinically feasible time. A dedicated spinal cord imaging protocol for quantitative magnetization transfer was developed using a reduced field-of-view approach with echo planar imaging (EPI) readout. Sequence parameters were optimized based in the Cramer-Rao-lower bound. Quantitative model parameters (i.e., bound pool fraction, free and bound pool transverse relaxation times [ T2F, T2B], and forward exchange rate [kFB ]) were estimated implementing a numerical model capable of dealing with the novelties of the sequence adopted. The framework was tested on five healthy subjects. Cramer-Rao-lower bound minimization produces optimal sampling schemes without requiring the establishment of a steady-state MT effect. The proposed framework allows quantitative voxel-wise estimation of model parameters at the resolution typically used for spinal cord imaging (i.e. 0.75 × 0.75 × 5 mm(3) ), with a protocol duration of ∼35 min. Quantitative magnetization transfer parametric maps agree with literature values. Whole-cord mean values are: bound pool fraction = 0.11(±0.01), T2F = 46.5(±1.6) ms, T2B = 11.0(±0.2) µs, and kFB  = 1.95(±0.06) Hz. Protocol optimization has a beneficial effect on reproducibility, especially for T2B and kFB . The framework developed enables robust characterization of spinal cord microstructure in vivo using qMT. Magn Reson Med, 2017. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of

  4. Diffusion tensor MR imaging of the cervical spinal cord in patients with multiple sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Ohgiya, Yoshimitsu [University of Rochester Medical Center, Division of Diagnostic and Interventional Neuroradiology, Department of Imaging Science, Rochester, NY (United States); Showa University School of Medicine, Department of Radiology, Tokyo (Japan); Oka, Masaki; Hiwatashi, Akio; Liu, Xiang; Kakimoto, Naoya; Westesson, Per-Lennart A.; Ekholm, Sven E. [University of Rochester Medical Center, Division of Diagnostic and Interventional Neuroradiology, Department of Imaging Science, Rochester, NY (United States)

    2007-10-15

    Our purpose was to evaluate the ability of diffusion tensor imaging (DTI) to characterize cervical spinal cord white matter (WM) in patients with multiple sclerosis (MS). DTI were obtained in 21 MS patients and 21 control subjects (CS). Regions of interest (ROIs) were placed at C2/3, C3/4, and C4/5 within the right, left, and dorsal (WM) to calculate fractional anisotropy (FA) and the apparent diffusion coefficient (ADC). Measurements in plaques and normal-appearing white matter (NAWM) of MS patients were compared with mean FA and ADC of WM in CS. FA was significantly lower in all regions in MS patients than in CS. ADC was significantly higher in all regions in MS patients than in CS except for in the dorsal WM at C2/3 and the bilateral WM at C4/5. The mean FA was 0.441 for plaques and 0.542 for NAWM, as compared with 0.739 in CS. The mean ADC was 0.810 x 10{sup -3} mm{sup 2}/s for plaques and 0.722 x 10{sup -3} mm{sup 2}/s for NAWM, as compared with 0.640 x 10{sup -3} mm{sup 2}/s for CS. FA and ADC showed significant differences between plaques, NAWM and control WM(P < 0.01). (orig.)

  5. Motor imagery reinforces brain compensation of reach-to-grasp movement after cervical spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Sébastien eMateo

    2015-09-01

    Full Text Available Individuals with cervical spinal cord injury (SCI that causes tetraplegia are challenged with dramatic sensorimotor deficits. However, certain rehabilitation techniques may significantly enhance their autonomy by restoring reach-to-grasp movements. Among others, evidence of motor imagery (MI benefits for neurological rehabilitation of upper limb movements is growing. This literature review addresses motor imagery (MI effectiveness during reach-to-grasp rehabilitation after tetraplegia. Among articles from MEDLINE published between 1966 and 2015, we selected ten studies including 34 participants with C4 to C7 tetraplegia and 22 healthy controls published during the last fifteen years. We found that MI of possible non-paralyzed movements improved reach-to-grasp performance by i increasing both tenodesis grasp capabilities and muscle strength, ii decreasing movement time, and trajectory variability, and, iii reducing the abnormally increased brain activity. MI can also strengthen motor commands by potentiating recruitment and synchronization of motoneurons, which leads to improved recovery. These improvements reflect brain adaptations induced by MI. Furthermore, MI can be used to control brain computer interfaces (BCI that successfully restore grasp capabilities. These results highlight the growing interest for MI and its potential to recover functional grasping in individuals with tetraplegia, and motivate the need for further studies to substantiate it.

  6. Identifying Homogeneous Subgroups in Neurological Disorders: Unbiased Recursive Partitioning in Cervical Complete Spinal Cord Injury.

    Science.gov (United States)

    Tanadini, Lorenzo G; Steeves, John D; Hothorn, Torsten; Abel, Rainer; Maier, Doris; Schubert, Martin; Weidner, Norbert; Rupp, Rüdiger; Curt, Armin

    2014-07-01

    Background The reliable stratification of homogeneous subgroups and the prediction of future clinical outcomes within heterogeneous neurological disorders is a particularly challenging task. Nonetheless, it is essential for the implementation of targeted care and effective therapeutic interventions. Objective This study was designed to assess the value of a recently developed regression tool from the family of unbiased recursive partitioning methods in comparison to established statistical approaches (eg, linear and logistic regression) for predicting clinical endpoints and for prospective patients' stratification for clinical trials. Methods A retrospective, longitudinal analysis of prospectively collected neurological data from the European Multicenter study about Spinal Cord Injury (EMSCI) network was undertaken on C4-C6 cervical sensorimotor complete subjects. Predictors were based on a broad set of early (homogeneous subgroups. The partitioning is carried out in a data-driven manner, independently from a priori decisions or predefined thresholds. Conclusion Unbiased recursive partitioning techniques may improve prediction of future clinical endpoints and the planning of future SCI clinical trials by providing easily implementable, data-driven rationales for early patient stratification based on simple decision rules and clinical read-outs.

  7. Accuracy of diffusion tensor imaging for diagnosing cervical spondylotic myelopathy in patients showing spinal cord compression

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    Lee, Seung Bo; Chung Tae Sub; Kim, Sung Jun; Yoo, Yeon Hwa; Yoon, Choon Sik; Park, Jung Hyun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Young Han [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Jeong, Eun Kee [Dept. of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake (United States); Kim, In Seong [Siemens Healthcare, Seoul (Korea, Republic of)

    2015-12-15

    To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings. A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard. The MD, LD, and RD cut-off values were 1.079 × 10'-{sup 3}, 1.719 × 10{sup -3}, and 0.749 × 10{sup -3} mm{sup 2}/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD

  8. Acquired lumbar spinal stenosis.

    Science.gov (United States)

    Deasy, JoAnn

    2015-04-01

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

  9. The effects of cervical transcutaneous spinal direct current stimulation on motor pathways supplying the upper limb in humans.

    Science.gov (United States)

    Dongés, Siobhan C; D'Amico, Jessica M; Butler, Jane E; Taylor, Janet L

    2017-01-01

    Non-invasive, weak direct current stimulation can induce changes in excitability of underlying neural tissue. Many studies have used transcranial direct current stimulation to induce changes in the brain, however more recently a number of studies have used transcutaneous spinal direct current stimulation to induce changes in the spinal cord. This study further characterises the effects following cervical transcutaneous spinal direct current stimulation on motor pathways supplying the upper limb. In Study 1, on two separate days, participants (n = 12, 5 F) received 20 minutes of either real or sham direct current stimulation at 3 mA through electrodes placed in an anterior-posterior configuration over the neck (anode anterior). Biceps brachii, flexor carpi radialis and first dorsal interosseous responses to transcranial magnetic stimulation (motor evoked potentials) and cervicomedullary stimulation (cervicomedullary motor evoked potentials) were measured before and after real or sham stimulation. In Study 2, on two separate days, participants (n = 12, 7 F) received either real or sham direct current stimulation in the same way as for Study 1. Before and after real or sham stimulation, median nerve stimulation elicited M waves and H reflexes in the flexor carpi radialis. H-reflex recruitment curves and homosynaptic depression of the H reflex were assessed. Results show that the effects of real and sham direct current stimulation did not differ for motor evoked potentials or cervicomedullary motor evoked potentials for any muscle, nor for H-reflex recruitment curve parameters or homosynaptic depression. Cervical transcutaneous spinal direct current stimulation with the parameters described here does not modify motor responses to corticospinal stimulation nor does it modify H reflexes of the upper limb. These results are important for the emerging field of transcutaneous spinal direct current stimulation.

  10. High frequency epidural stimulation across the respiratory cycle evokes phrenic short-term potentiation after incomplete cervical spinal cord injury.

    Science.gov (United States)

    Gonzalez-Rothi, Elisa J; Streeter, Kristi A; Hanna, Marie H; Stamas, Anna C; Reier, Paul J; Baekey, David M; Fuller, David D

    2017-06-14

    C2 spinal hemilesion (C2Hx) paralyzes the ipsilateral diaphragm, but recovery is possible through activation of "crossed spinal" synaptic inputs to ipsilateral phrenic motoneurons. We tested the hypothesis that high frequency epidural stimulation (HF-ES) would potentiate ipsilateral phrenic output after subacute and chronic C2Hx. HF-ES (300 Hz) was applied to the ventrolateral C4 or T2 spinal cord ipsilateral to C2Hx in anesthetized and mechanically ventilated adult rats. Stimulus duration was 60-sec and currents ranged from 100-1000 µA. Bilateral phrenic nerve activity and ipsilateral hypoglossal nerve activity were recorded before and after HF-ES. Higher T2 stimulus currents potentiated ipsilateral phasic inspiratory activity at both 2- and 12-wks post-C2Hx, while higher stimulus currents delivered at C4 potentiated ipsilateral phasic phrenic activity only at 12-wks (P=0.028). Meanwhile, tonic output in the ipsilateral phrenic nerve reached 500% of baseline values at the high currents with no difference between 2- and 12-wks. HF-ES did not trigger inspiratory burst frequency changes. Similar responses occurred following T2 HF-ES. Increases in contralateral phrenic and XII nerve output were induced by C4 and T2 HF-ES at higher currents, but the relative magnitude of these changes was small compared to the ipsilateral phrenic response. We conclude that following incomplete cervical SCI, HF-ES of the ventrolateral mid-cervical or thoracic spinal cord can potentiate efferent phrenic motor output with little impact on inspiratory burst frequency. However, the substantial increases in tonic output indicate that the uninterrupted 60-sec stimulation paradigm used here is unlikely to be useful for respiratory muscle activation after spinal injury. Copyright © 2016, Journal of Neurophysiology.

  11. The roles of mechanical compression and chemical irritation in regulating spinal neuronal signaling in painful cervical nerve root injury.

    Science.gov (United States)

    Zhang, Sijia; Nicholson, Kristen J; Smith, Jenell R; Gilliland, Taylor M; Syré, Peter P; Winkelstein, Beth A

    2013-11-01

    Both traumatic and slow-onset disc herniation can directly compress and/or chemically irritate cervical nerve roots, and both types of root injury elicit pain in animal models of radiculopathy. This study investigated the relative contributions of mechanical compression and chemical irritation of the nerve root to spinal regulation of neuronal activity using several outcomes. Modifications of two proteins known to regulate neurotransmission in the spinal cord, the neuropeptide calcitonin gene-related peptide (CGRP) and glutamate transporter 1 (GLT-1), were assessed in a rat model after painful cervical nerve root injuries using a mechanical compression, chemical irritation or their combination of injury. Only injuries with compression induced sustained behavioral hypersensitivity (p≤0.05) for two weeks and significant decreases (p<0.037) in CGRP and GLT-1 immunoreactivity to nearly half that of sham levels in the superficial dorsal horn. Because modification of spinal CGRP and GLT-1 is associated with enhanced excitatory signaling in the spinal cord, a second study evaluated the electrophysiological properties of neurons in the superficial and deeper dorsal horn at day 7 after a painful root compression. The evoked firing rate was significantly increased (p=0.045) after compression and only in the deeper lamina. The painful compression also induced a significant (p=0.002) shift in the percentage of neurons in the superficial lamina classified as low- threshold mechanoreceptive (sham 38%; compression 10%) to those classified as wide dynamic range neurons (sham 43%; compression 74%). Together, these studies highlight mechanical compression as a key modulator of spinal neuronal signaling in the context of radicular injury and pain.

  12. Preliminary results after upper cervical chiropractic care in patients with chronic cerebro-spinal venous insufficiency and multiple sclerosis.

    Science.gov (United States)

    Mandolesi, Sandro; Marceca, Giuseppe; Moser, Jon; Niglio, Tarcisio; d'Alessandro, Aldo; Ciccone, Matteo Marco; Zito, Annapaola; Mandolesi, Dimitri; d'Alessandro, Alessandro; Fedele, Francesco

    2015-01-01

    The aim of the study is to evaluate the clinical and X-ray results of the Upper Cervical Chiropractic care through the specific adjustments (corrections) of C1-C2 on patients with chronic venous cerebral-spinal insufficiency (CCSVI) and multiple sclerosis (MS). We studied a sample of 77 patients before and after the Upper Cervical Chiropractic care, and we analyzed: A) The change of the X-ray parameters; B) The clinical results using a new set of questions. The protocol of the C1- C2 upper Cervical Chiropractic treatment, specific for these patients, lasts four months. From a haemodynamic point of view we divided the patients in 3 types: Type 1 - purely vascular with intravenous alterations; Type 2 - "mechanical" with of external venous compressions; Type 3 - mixed. We found an improvement in all kinds of subluxations after the treatment with respect to the pre-treatment X-ray evaluation, with a significant statistical difference. The differences between the clinical symptoms before and after the specific treatment of C1-C2 are statistically significant with pcerebro-spinal fluid.

  13. [Combined spinal and epidural anesthesia for cesarean delivery in a patient with a cervical fracture at C2].

    Science.gov (United States)

    Mochidome, Mariko; Sakamoto, Akiyuki; Tanaka, Hidenori; Sugiyama, Daisuke; Kawamata, Mikito

    2013-04-01

    There are only a few reports on cesarean section in a patient with cervical fracture without spinal cord injury (SCI). Such patients have high risks for deterioration of SCI following general or regional anesthesia. Here, we present a patient with a fracture of C2 vertebra who underwent cesarean section safely under combined spinal and epidural anesthesia(CSEA). A 30-year-old woman had a fracture of the C2 cervical vertebra (Hangman's fracture) due to a traffic accident at 34 weeks of gestation. Conservative immobilization of the head and neck was done with a neck collar (Philadelphia brace) in order to prevent subsequent SCI after the spine injury. Pre-viability amniorrhexis was seen at 37 weeks' gestation, and an emergency cesarean section was scheduled under combined epidural and spinal anesthesia (CSEA). Her neck and head were carefully fixed before, during and after surgery in order to prevent subsequent SCI. As a result, cesarean section under CSEA was successfully performed in the patient without any deterioration of the spine and/or SCI.

  14. Awake behaving electrophysiological correlates of forelimb hyperreflexia, weakness and disrupted muscular synchronization following cervical spinal cord injury in the rat

    Science.gov (United States)

    Ganzer, Patrick Daniel; Meyers, Eric Christopher; Sloan, Andrew Michael; Maliakkal, Reshma; Ruiz, Andrea; Kilgard, Michael Paul; Rennaker, Robert LeMoine

    2016-01-01

    Spinal cord injury usually occurs at the level of the cervical spine and results in profound impairment of forelimb function. In this study, we recorded awake behaving intramuscular electromyography (EMG) from the biceps and triceps muscles of the impaired forelimb during volitional and reflexive forelimb movements before and after unilateral cervical spinal cord injury (cSCI) in rats. C5/C6 hemicontusion reduced volitional forelimb strength by more than 50% despite weekly rehabilitation for one month post-injury. Triceps EMG during volitional strength assessment was reduced by more than 60% following injury, indicating reduced descending drive. Biceps EMG during reflexive withdrawal from a thermal stimulus was increased by 500% following injury, indicating flexor withdrawal hyperreflexia. The reduction in volitional forelimb strength was significantly correlated with volitional and reflexive biceps EMG activity. Our results support the hypothesis that biceps hyperreflexia and descending volitional drive both significantly contribute to forelimb strength deficits after cSCI and provide new insight into dynamic muscular dysfunction after cSCI. The use of multiple automated quantitative measures of forelimb dys-function in the rodent cSCI model will likely aid the search for effective regenerative, pharmacological, and neuroprosthetic treatments for spinal cord injury. PMID:27033345

  15. The possible meaning of fractional anisotropy measurement of the cervical spinal cord in correct diagnosis of amyotrophic lateral sclerosis.

    Science.gov (United States)

    Budrewicz, Slawomir; Szewczyk, Pawel; Bladowska, Joanna; Podemski, Ryszard; Koziorowska-Gawron, Ewa; Ejma, Maria; Słotwiński, Krzysztof; Koszewicz, Magdalena

    2016-03-01

    Diagnosis of amyotrophic lateral sclerosis (ALS) is based on clinical criteria and electrophysiological tests (electromyography, and transcranial magnetic stimulation). In the search for ALS biomarkers, the role of imaging procedures is currently emphasized, especially modern MR techniques. MR procedures were performed on 15 ALS patients and a sex- and age-matched control group. The MR examinations were performed with a 1.5-T MR unit, and the protocol consisted of sagittal T1-weighed images, sagittal and axial T2-weighed images, and sagittal T2-weighed FAT SAT images followed by an axial diffusion tensor imaging (DTI) sequence of the cervical spinal cord. FA values in individual segments of the cervical spinal cord were decreased in the ALS group in comparison with the control group. After comparing FA values for anterior, posterior, and lateral corticospinal columns, the greatest difference was observed between the C2 and C5 segments. Spinal cord assessment with the use of FA measurements allows for confirmation of the motor pathways lesion in ALS patients. The method, together with clinical criteria, could be helpful in ALS diagnosis, assessment of clinical course, or even the effects of new drugs. The results also confirmed the theory of the generalized character of ALS.

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

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    Atsushi Hasegawa

    2016-01-01

    Full Text Available 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.

  17. Laminoplasty for the Treatment of Spinal Canal Stenosis%椎板成形术治疗椎管狭窄的手术方式

    Institute of Scientific and Technical Information of China (English)

    陈萍萍

    2012-01-01

    As a common disease of spine and spinal cord,spinal stenosis is often associated with many factors,such as spinal degenerative diseases and the spinal canal content lesions or trauma. Along with the trend of higher incidence of the diseases,treatment technologies have also been developed constantly and accordingly. When many segments are involved, posterior surgery treatments are recommended, which has the following advantages compared with traditional laminectomy:better stability of postoperative spinal,relatively low incidence of spinal deformity and axial symptoms, less restenosis resulting from spinal meningeal adhesions, easier for the second surgery,and so on. However,it still has high rate of postoperative axial symptom and the reclosure of open-door laminoplasty,which will influence the curative effect in the long term. Therefore, many scholars have adopted all kinds of improved operation and have obtained good curative effect. Here is to make a review on the progress in laminoplasty for the treatment of spinal canal stenosis in recent years at home and abroad.%椎管狭窄症是脊髓脊柱常见疾病,常与脊柱退行性病变、椎管内内容物病变或外伤等因素有关,发病有增多趋势,治疗技术也在不断发展.多节段受累时,多主张行后路手术治疗,后路手术中椎板成形术与传统椎板切除术相比,具有术后脊柱稳定性好、脊柱畸形及轴性症状发生率低、硬膜粘连致再狭窄少、再次手术易等优点,而较高的术后轴性症状、开门椎板再关闭等影响手术远期疗效.为此许多学者采取各种改良术式,取得了较好的疗效.现就近年来国内外椎板成形术治疗椎管狭窄症术式的进展进行综述.

  18. Comparison of CT and MR in 400 patients with suspected disease of the brain and cervical spinal cord

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    Bradley, W.G. Jr.; Waluch, V.; Yadley, R.A.; Wycoff, R.R.

    1984-09-01

    Magnetic resonance imaging (MR) (0.35T) and computed tomography (CT) were compared in 400 consecutive patients with suspected disease of the brain and cervical spinal cord. Of 325 positive diagnoses, MR detected abnormality while CT was normal in 93; MR was more specific in 68; MR and CT gave equivalent information in 129; CT was more specific in 32; and CT was positive while MR was normal in 3. MR was superior to CT in detection of multiple sclerosis, subcortical arteriosclerotic encephalopathy, posterior fossa infarcts and tumors, small extra-axial fluid collections, and cervical syringomyelia. CT was preferable in evaluation of meningiomas and separation of tumor from edema. CT takes less time and may be preferable in patients with acute trauma as well as very young or elderly individuals. Thus the two studies should be considered complementary.

  19. A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome.

    Science.gov (United States)

    Jimenez, O; Marcillo, A; Levi, A D

    2000-09-01

    We have applied conventional histochemical and morphometric techniques to study the changes within the human spinal 'hand' motor neuron pool after spinal cord injury in patients who presented with acute traumatic central cord syndrome (ATCCS). To determine whether a reduction of large alpha motor neurons at the C7, C8 and T1 spinal cord levels underlies the mechanism which causes hand dysfunction seen in patients with (ATCCS). The etiology of upper extremity weakness in ATCCS is debated and injury and/or degeneration of motor neurons within the central gray matter of the cervical enlargement has been advanced as one potential etiology of hand weakness. The spinal cords of five individuals with documented clinical evidence of ATCCS and three age-matched controls were obtained. The ATCCS spinal cords were divided into acute/sub-acute (two cases) and chronic (three cases) groups depending on the time to death after their injury; the chronic group was further subdivided according to the epicenter of injury. We counted the motor neurons using light microscopy in 10 randomly selected axial sections at the C7, C8 and T1 spinal cord levels for each group. We also analyzed the lateral and ventral corticospinal tracts (CST) in all groups for evidence of Wallerian degeneration and compared them to controls. A primary injury to the lateral CST was present in each case of ATCCS with evidence of Wallerian degeneration distal to the epicenter of injury. There was minimal Wallerian degeneration within the ventral corticospinal tracts. In the chronic low cervical injury group, there was a decrease in motor neurons supplying hand musculature relative to the other injury groups where the motor neurons sampled at the time of death were not reduced in number when compared to the control group. We hypothesize that hand dysfunction in ATCCS can be observed after spinal cord injury without any apparent loss in the number of motor neurons supplying the hand musculature as seen in our acute

  20. Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries

    Science.gov (United States)

    Guirgis, Akram H.; Menon, Venugopal K.; Suri, Neelam; Chatterjee, Nilay; Attallah, Emil; Saad, Maged Y.; Elshaer, Shereen

    2016-01-01

    Objectives This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs). Methods This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU) stay among patients with high (C1–C2 vertebrae) and low (C3–C7 vertebrae) CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined. Results Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041). Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035). Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015). However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure. Conclusion An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury. PMID:28003892

  1. Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries

    Directory of Open Access Journals (Sweden)

    Akram H. Guirgis

    2016-11-01

    Full Text Available Objectives: This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs. Methods: This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU stay among patients with high (C1–C2 vertebrae and low (C3–C7 vertebrae CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined. Results: Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041. Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035. Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015. However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure. Conclusion: An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury.

  2. Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip.

    Science.gov (United States)

    Yokogawa, Noriaki; Toribatake, Yasumitsu; Murakami, Hideki; Hayashi, Hiroyuki; Yoneyama, Takeshi; Watanabe, Tetsuyou; Tsuchiya, Hiroyuki

    2015-01-01

    It is important to differentially diagnose thigh pain from lumbar spinal stenosis (particularly lumbar fourth nerve root radiculopathy) and osteoarthritis of the hip. In this study, using a treadmill and a motion analysis method, gait characteristics were compared between these conditions. Patients with lumbar fourth nerve root radiculopathy had increased physiological knee flexion immediately after foot-ground contact, possibly owing to a slight decrease in the muscle strength of the quadriceps femoris muscle. Patients with osteoarthritis of the hip had decreased range of motion of the hip joint probably due to anatomically limited mobility as well as gait strategy to avoid pain resulting from increased internal pressure on the hip joint during its extension. Our facile and noninvasive method can be useful for the differential diagnosis of lumbar spinal canal stenosis from osteoarthritis of the hip.

  3. The cervical spinal cord in neuromyelitis optica patients: A comparative study with multiple sclerosis using diffusion tensor imaging

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    Pessôa, Fernanda Miraldi Clemente, E-mail: fernandamiraldi@hotmail.com [Federal University of Rio de Janeiro, Medical Student, Rua Rodolpho Paulo Rocco, 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ (Brazil); Lopes, Fernanda Cristina Rueda, E-mail: frueda81@hotmail.com [Department of Radiology, Federal University of Rio de Janeiro, Avenida das Américas, 4666 sl 325, Barra da Tijuca, Rio de Janeiro, RJ (Brazil); Costa, João Victor Altamiro, E-mail: victoraltamiro@gmail.com [Department of Radiology, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco, 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ (Brazil); Leon, Soniza Vieira Alves, E-mail: sonizavleon@globo.com [Department of Neurology, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco, 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ (Brazil); Domingues, Romeu Côrtes, E-mail: romeu@CDPi.com.br [CDPI – Clínica de Diagnóstico Por Imagem, Avenida das Américas, 4666 sl 325, Barra da Tijuca, Rio de Janeiro, RJ (Brazil); Gasparetto, Emerson Leandro, E-mail: egasparetto@gmail.com [Department of Radiology, Federal University of Rio de Janeiro, Avenida das Américas, 4666 sl 325, Barra da Tijuca, Rio de Janeiro, RJ (Brazil); CDPI – Clínica de Diagnóstico Por Imagem, Avenida das Américas, 4666 sl 325, Barra da Tijuca, Rio de Janeiro, RJ (Brazil)

    2012-10-15

    Introduction: This study aims to evaluate “in vivo” the integrity of the normal-appearing spinal cord in patients with neuromyelitis optica (NMO), using diffusion tensor MR imaging, comparing to controls and patients with multiple sclerosis (MS). Materials and methods: We studied 8 patients with NMO and 17 without any neurologic disorder. Also, 32 MS patients were selected. Fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) were calculated within regions of interest at C2 and C7 levels in the four columns of the spinal cord. Results: At C2, the FA value was decreased in NMO patients compared to MS and controls in the anterior column. Also in this column, RD value showed increase in NMO compared to MS and to controls. The FA value of the posterior column was decreased in NMO in comparison to controls. At C7, AD value was higher in NMO than in MS in the right column. At the same column, MD values were increased in NMO compared to MS and to controls. Conclusions: There is extensive NASC damage in NMO patients, including peripheral areas of the cervical spinal cord, affecting the white matter, mainly caused by demyelination. This suggests a new spinal cord lesion pattern in NMO in comparison to MS.

  4. Reproducibility of tract-specific magnetization transfer and diffusion tensor imaging in the cervical spinal cord at 3 tesla.

    Science.gov (United States)

    Smith, Seth A; Jones, Craig K; Gifford, Aliya; Belegu, Visar; Chodkowski, BettyAnn; Farrell, Jonathan A D; Landman, Bennett A; Reich, Daniel S; Calabresi, Peter A; McDonald, John W; van Zijl, Peter C M

    2010-02-01

    Damage to specific white matter tracts within the spinal cord can often result in the particular neurological syndromes that characterize myelopathies such as traumatic spinal cord injury. Noninvasive visualization of these tracts with imaging techniques that are sensitive to microstructural integrity is an important clinical goal. Diffusion tensor imaging (DTI)- and magnetization transfer (MT)-derived quantities have shown promise in assessing tissue health in the central nervous system. In this paper, we demonstrate that DTI of the cervical spinal cord can reliably discriminate sensory (dorsal) and motor (lateral) columns. From data derived from nine healthy volunteers, two raters quantified column-specific parallel (lambda(||)) and perpendicular (lambda(perpendicular)) diffusivity, fractional anisotropy (FA), mean diffusivity (MD), and MT-weighted signal intensity relative to cerebrospinal fluid (MTCSF) over two time-points separated by more than 1 week. Cross-sectional means and standard deviations of these measures in the lateral and dorsal columns were as follows: lambda(||): 2.13 +/- 0.14 and 2.14 +/- 0.11 microm(2)/ms; lambda(perpendicular): 0.67 +/- 0.16 and 0.61 +/- 0.09 microm(2)/ms; MD: 1.15 +/- 0.15 and 1.12 +/- 0.08 microm(2)/ms; FA: 0.68 +/- 0.06 and 0.68 +/- 0.05; MTCSF: 0.52 +/- 0.05 and 0.50 +/- 0.05. We examined the variability and interrater and test-retest reliability for each metric. These column-specific MR measurements are expected to enhance understanding of the intimate structure-function relationship in the cervical spinal cord and may be useful for the assessment of disease progression. (c) 2009 John Wiley & Sons, Ltd.

  5. A rare cause of spinal cord compression: imaging appearances of gout of the cervical spine

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    Dharmadhikari, R.; Hide, I.G. [Freeman Hospital, Department of Radiology, High Heaton, Newcastle-upon-Tyne (United Kingdom); Dildey, P. [Freeman Hospital, Department of Pathology, High Heaton, Newcastle-upon-Tyne (United Kingdom)

    2006-12-15

    Gout is a metabolic disorder typically affecting the peripheral joints, more commonly in males. Spinal involvement is uncommon and is usually associated with hyperuricemia. We present the imaging findings of a case of spinal gout in a female patient with no previous history of hyperuricaemia, involving multiple spinal segments. (orig.)

  6. Syringomyelia associated with cervical spondylosis: A rare condition.

    Science.gov (United States)

    Landi, Alessandro; Nigro, Lorenzo; Marotta, Nicola; Mancarella, Cristina; Donnarumma, Pasquale; Delfini, Roberto

    2013-06-16

    Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-year-old woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging (MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using PubMed database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid (CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow

  7. Trauma related changes in cervical spine and spinal cord in myelography and MRI; Zmiany pourazowe kregoslupa i rdzenia w odcinku szyjnym, w mielografii i w obrazie NMR

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    Wozniak, E.; Bronarski, J.; Kiwerski, J.; Krasuski, M. [Akademia Medyczna, Warsaw (Poland)]|[Stoleczny Zespol Rehabilitacji, Konstancin (Poland)

    1993-12-31

    Myelographic and MRI results in 14 patients treated in 1992 because of cervical spine injury with neurological complications have been presented. Myelography proves to be useful in posttraumatic spine diagnostics but in some cases does not render sufficient information, especially if the trauma superimposes previously existing pathological changes. MRI is exceptionally valuable diagnostic modality in cervical spine injuries offering an advantage of both early and late evaluation of the post-traumatic spinal cord changes. (author). 12 refs, 6 figs, 2 tabs.

  8. Effects of a cervical disc prosthesis on maintaining sagittal alignment of the functional spinal unit and overall sagittal balance of the cervical spine.

    Science.gov (United States)

    Kim, Seok Woo; Shin, Jae Hyuk; Arbatin, Jose Joefrey; Park, Moon Soo; Chung, Yung Khee; McAfee, Paul C

    2008-01-01

    The object of this study is to review the early clinical results and radiographic outcomes following insertion of the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN), together with its effect on maintaining sagittal alignment of the functional spinal unit (FSU) and overall sagittal balance of the cervical spine for the treatment of single-level or two-level symptomatic disc disease. Forty-seven patients with symptomatic single or two-level cervical disc disease who received the Bryan Cervical Artificial Disc were reviewed prospectively. A total of 55 Bryan disc were placed in 47 patients. A single-level procedure was performed in 39 patients and a two-level procedure in the other eight. Radiographic and clinical assessments were made preoperatively and at 1.5, 3, 6, 9, 12, and 18 and up to 33 months postoperatively. Mean follow-up duration was 24 months, ranging from 13 to 33 months. Periods were categorized as early follow up (1.5-3 months) and late follow up (6-33 months). The visual analogue scale (VAS), neck disability index(NDI), Odom's criteria were used to assess pain and clinical outcomes. Static and dynamic radiographs were measured by hand and computer to determine the range of motion (ROM), the angle of the functional segmental unit (FSU), and the overall cervical alignment (C2-7 Cobb angle). With all of these data, we evaluated the change of the preoperative lordosis (or kyphosis) of the FSU and Overall sagittal balance of the cervical spine during the follow-up period. There was a statistically significant improvement in the VAS score from 7.0 +/- 2.6 to 2.0 +/- 1.5 (paired-t test, P = 0.000), and in the NDI from 21.5 +/- 5.5 to 4.5 +/- 3.9 (paired-t test P = 0.000). All of the patients were satisfied with the surgical results by Odom's criteria. The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level. Only 36% of patients with a preoperative lordotic

  9. Dynamic function MR of the cervical vertebral column. Dynamische Funktions-MRT der Halswirbelsaeule

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    Naegele, M.; Woell, B.; Reiser, M. (Radiologische Universitaetsklinik, Bonn (Germany)); Koch, W. (Orthopaedische Universitaetsklinik, Bonn (Germany)); Kaden, B. (Neurochirurgische Universitaetsklinik, Bonn (Germany))

    1992-09-01

    To obtain functional studies of the cervical spine, a device has been developed which allows MRI examinations to be carried out in five different degrees of flexion. T[sub 1] and T[sub 2][sup *] weighted FFE sequences were used. Dynamic functional MRI was performed on 5 normals and 31 patients (5 disc herniation, 4 whiplash injuries, 6 spinal canal stenoses, 14 laminectomies and spinal fusions, 2 rheumatoid arthritis). The relationship of the spinal cord to the bony and ligamentous components in different degrees of flexion was particularly well shown in whiplash injury, spinal stenosis and postoperative situations. (orig.).

  10. Systemic vascular resistance is increased and associated with accelerated arterial stiffening change in patients with chronic cervical spinal cord injury.

    Science.gov (United States)

    Huang, S C; May-Kuen Wong, A; Lien, H Y; Fuk-Tan Tang, S; Fu, T C; Lin, Y; Wang, J S

    2013-02-01

    Despite of stiffening change of conduit arteries, how total peripheral resistance (TPR) is adapted to chronic spinal cord injury (SCI) remains unclear. To investigate how chronic cervical SCI influences hemodynamic characteristics Cross-sectional, case-control study. Rehabilitation department in the tertiary medical center. Twenty-one male patients with traumatic SCI resulting from cervical spine fracture were recruited. The injury occurred three to 289 months (46 months in average) previously. Twenty-one healthy male participants with matched age and body mass index were enrolled as control group. The subjects were asked to maintain supine rest (SR) and then head-up tilt (HUT) at 60 degree for five minutes, respectively. A novel noninvasive bio-reactance device was employed to measure cardiac hemodynamics, whereas heart rate variability was used to determine cardiac autonomic activity. Additionally, the digital volume pulse analysis was applied to calculate arterial stiffness index (SI) and arteriolar reflection index (RI). SCI patients revealed less stroke volume and cardiac output (CO), as well as, greater total peripheral resistance (TPR) and SI during SR than normal subjects did. Moreover, the positive correlation between TPR and SI was observed in SCI patients rather than normal subjects. In SCI patients, HUT (1) markedly decreased TPR while CO and cardio-acceleration responses remained intact and (2) decreased HF power value but failed to change LF/HF ratio. Furthermore, the degree of orthostatic hypotension was correlated with the TPRHUT/TPRSR ratio but not the COHUT/COSR ratio. Chronic cervical SCI leads to a progressively accelerated increase in vascular stiffness, which is associated with increase in systemic vascular resistance. Furthermore, the cervical SCI-related orthostatic hypotension lies in the impairment of vasoconstriction without cardiac dysfunction. Clinical Rehabilitation Impact. SI, rather than blood pressure, reflects not only

  11. PREVALENCE OF ANATOMICAL VARIATION OF THE SIXTH CERVICAL VERTEBRA AND ASSOCIATION WITH VERTEBRAL CANAL STENOSIS AND ARTICULAR PROCESS OSTEOARTHRITIS IN THE HORSE.

    Science.gov (United States)

    DeRouen, Anthony; Spriet, Mathieu; Aleman, Monica

    2016-05-01

    The sixth cervical vertebra (C6) has unique morphology due to a ventral extension from the transverse process known as the ventral lamina. Little information was found regarding the prevalence and clinical relevance of morphologic variations. Aims of this observational, retrospective study were to characterize C6 morphologic variations in a large sample of horses. Cervical radiographic studies of 100 horses were retrieved. Data recorded were signalment, clinical history, morphology of the C6 ventral lamina, presence of articular process osteoarthritis, and presence of static vertebral canal stenosis. Morphologic variations were found in C6 vertebrae for 24/100 horses, with symmetric absence of the ventral lamina in nine horses and asymmetric absence in 15. Anomalous C6 vertebrae were more common in Warmbloods, with 19/55 Warmbloods in the population being affected (P = 0.006). No association was found with sex. There was no significant difference in the mean of the intravertebral sagittal ratios between horses with normal or anomalous C6 vertebrae; however there was a significantly greater proportion of horses with anomalous C6 vertebrae that had an intravertebral sagittal ratio of less than 0.5 at C6 (P = 0.047). There was no association between the morphology of C6 and articular process osteoarthritis. Anomalous C6 vertebrae in our population were associated with a higher likelihood of cervical pain (P = 0.013). Authors propose that morphologic variations in the C6 ventral laminae could be linked to other developmental abnormalities such as vertebral canal stenosis, might affect regional biomechanics and should therefore be considered clinically relevant in horses. Future, controlled prospective studies are needed to test this theory.

  12. Transfer of the brachialis to the anterior interosseous nerve as a treatment strategy for cervical spinal cord injury: technical note.

    Science.gov (United States)

    Hawasli, Ammar H; Chang, Jodie; Reynolds, Matthew R; Ray, Wilson Z

    2015-04-01

    Study Design Technical report. Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI.

  13. Cervical disc herniation manifesting as a Brown-Sequard syndrome

    Directory of Open Access Journals (Sweden)

    Kunio Yokoyama

    2012-01-01

    Full Text Available Brown-Sequard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm. The clinical picture reflects hemisection of the spinal cord. We report a rare case of Brown-Sequard syndrome caused by a large cervical herniated disc. A 63-year-old man presented with progressive right hemiparesis and disruption of pain and temperature sensation on the left side of the body. Magnetic resonance imaging showed large C3-C4 disc herniation compressing the spinal cord at that level, with severe canal stenosis from C4 through C7. Decompressive cervical laminoplasty was performed. After surgery, complete sensory function was restored and a marked improvement in motor power was obtained.

  14. Improving Survival and Promoting Respiratory Motor Function after Cervical Spinal Cord Injury

    Science.gov (United States)

    2016-09-01

    increases the demand for health care. However, despite these drastic interventions, the cervical injured patient is still susceptible to death due to...increases the demand for health care. However, despite these drastic interventions, the cervical injured patient is still susceptible to death due to...contusion will promote survival and independence immediately after cervical SCI. 4) Test the hypothesis that respiratory motor patterns and variability

  15. Tuina treatment in cervical spondylosis

    Directory of Open Access Journals (Sweden)

    Florin Mihai Hinoveanu

    2010-12-01

    Full Text Available Cervical spondylosis is a common, chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck as well as the contents of the spinal canal. Common clinical syndromes associated with cervical spondylosis include cervical pain, cervical radiculopathy and/or mielopathy. This study show the main principles, indication and side effects of tuina in cervical spondylosis´ treatment; tuina is one of the external methods based on the principles of Traditional Chinese Medicine (TCM, especially suitable for use on the elderly population and on infants. While performing Tuina, the therapist concentrates his mind, regulates his breathing, and actuates the Qi and power of his entire body towards his hands. For a better result is recommended to try to combine acupuncture with tuina treatment. Tuina can help relieve the pain associated with spondylosis. After this kind of treatment, the symptomes produced by irritated nerves and sore muscles can find some relief. Tuina helps patients with cervical spondylosis regain muscle control, nerve function and flexibility, all through the restoration of the life force flow.

  16. Systemic bisperoxovanadium activates Akt/mTOR, reduces autophagy, and enhances recovery following cervical spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Chandler L Walker

    Full Text Available Secondary damage following primary spinal cord injury extends pathology beyond the site of initial trauma, and effective management is imperative for maximizing anatomical and functional recovery. Bisperoxovanadium compounds have proven neuroprotective effects in several central nervous system injury/disease models, however, no mechanism has been linked to such neuroprotection from bisperoxovanadium treatment following spinal trauma. The goal of this study was to assess acute bisperoxovanadium treatment effects on neuroprotection and functional recovery following cervical unilateral contusive spinal cord injury, and investigate a potential mechanism of the compound's action. Two experimental groups of rats were established to 1 assess twice-daily 7 day treatment of the compound, potassium bisperoxo (picolinato vanadium, on long-term recovery of skilled forelimb activity using a novel food manipulation test, and neuroprotection 6 weeks following injury and 2 elucidate an acute mechanistic link for the action of the drug post-injury. Immunofluorescence and Western blotting were performed to assess cellular signaling 1 day following SCI, and histochemistry and forelimb functional analysis were utilized to assess neuroprotection and recovery 6 weeks after injury. Bisperoxovanadium promoted significant neuroprotection through reduced motorneuron death, increased tissue sparing, and minimized cavity formation in rats. Enhanced forelimb functional ability during a treat-eating assessment was also observed. Additionally, bisperoxovanadium significantly enhanced downstream Akt and mammalian target of rapamycin signaling and reduced autophagic activity, suggesting inhibition of the phosphatase and tensin homologue deleted on chromosome ten as a potential mechanism of bisperoxovanadium action following traumatic spinal cord injury. Overall, this study demonstrates the efficacy of a clinically applicable pharmacological therapy for rapid initiation of

  17. Robot-Assisted Training of Arm and Hand Movement Shows Functional Improvements for Incomplete Cervical Spinal Cord Injury.

    Science.gov (United States)

    Francisco, Gerard E; Yozbatiran, Nuray; Berliner, Jeffrey; OʼMalley, Marcia K; Pehlivan, Ali Utku; Kadivar, Zahra; Fitle, Kyle; Boake, Corwin

    2017-10-01

    The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. Arm and hand function tests (Jebsen-Taylor Hand Function Test, Action Research Arm Test), strength of upper limb (upper limb motor score, grip, and pinch strength), and independence in daily living activities (Spinal Cord Independence Measure II) were performed at baseline, end of training, and 6 mos later. After 12 sessions of training, improvements in arm and hand functions were observed. Jebsen-Taylor Hand Function Test (0.14[0.04]-0.21[0.07] items/sec, P = 0.04), Action Research Arm Test (30.7[3.8]-34.3[4], P = 0.02), American Spinal Injury Association upper limb motor score (31.5[2.3]-34[2.3], P = 0.04) grip (9.7[3.8]-12[4.3] lb, P = 0.02), and pinch strength (4.5[1.1]-5.7[1.2] lb, P = 0.01) resulted in significant increases. Some gains were maintained at 6 mos. No change in Spinal Cord Independence Measure II scores and no adverse events were observed. Results from this pilot study suggest that repetitive training of arm movements with MAHI Exo-II exoskeleton is safe and has potential to be an adjunct treatment modality in rehabilitation of persons with spinal cord injury with mild to moderate impaired arm functions.

  18. Distribution of serotonin 2A and 2C receptor mRNA expression in the cervical ventral horn and phrenic motoneurons following spinal cord hemisection.

    Science.gov (United States)

    Basura, G J; Zhou, S Y; Walker, P D; Goshgarian, H G

    2001-06-01

    Cervical spinal cord injury leads to a disruption of bulbospinal innervation from medullary respiratory centers to phrenic motoneurons. Animal models utilizing cervical hemisection result in inhibition of ipsilateral phrenic nerve activity, leading to paralysis of the hemidiaphragm. We have previously demonstrated a role for serotonin (5-HT) as one potential modulator of respiratory recovery following cervical hemisection, a mechanism that likely occurs via 5-HT2A and/or 5-HT2C receptors. The present study was designed to specifically examine if 5-HT2A and/or 5-HT2C receptors are colocalized with phrenic motoneurons in both intact and spinal-hemisected rats. Adult female rats (250-350 g; n = 6 per group) received a left cervical (C2) hemisection and were injected with the fluorescent retrograde neuronal tracer Fluorogold into the left hemidiaphragm. Twenty-four hours later, animals were killed and spinal cords processed for in situ hybridization and immunohistochemistry. Using (35)S-labeled cRNA probes, cervical spinal cords were probed for 5-HT2A and 5-HT2C receptor mRNA expression and double-labeled using an antibody to Fluorogold to detect phrenic motoneurons. Expression of both 5-HT2A and 5-HT2C receptor mRNA was detected in motoneurons of the cervical ventral horn. Despite positive expression of both 5-HT2A and 5-HT2C receptor mRNA-hybridization signal over phrenic motoneurons, only 5-HT2A silver grains achieved a signal-to-noise ratio representative of colocalization. 5-HT2A mRNA levels in identified phrenic motoneurons were not significantly altered following cervical hemisection compared to sham-operated controls. Selective colocalization of 5-HT2A receptor mRNA with phrenic motoneurons may have implications for recently observed 5-HT2A receptor-mediated regulation of respiratory activity and/or recovery in both intact and injury-compromised states.

  19. Bovine Reissner's fiber (RF) and the central canal of the spinal cord: an immunocytochemical study using a set of monoclonal antibodies against the RF-glycoproteins.

    Science.gov (United States)

    Pérez, J; Garrido, O; Cifuentes, M; Alonso, F J; Estivill-Torrús, G; Eller, G; Nualart, F; López-Avalos, M D; Fernández-Llebrez, P; Rodríguez, E M

    1996-10-01

    The subcommissural organ secretes N-linked complex-type glycoproteins into the cerebrospinal fluid. These glycoproteins condense to form Reissner's fiber (RF), which extends along the fourth ventricle and central canal of the spinal cord. A set of three monoclonal antibodies (Mabs 3E6, 3B1, and 2A5) has been obtained using these glycoproteins as immunogens. Competitive and sandwich enzyme-linked immunoassay methods have demonstrated that the three monoclonal antibodies are directed against different epitopes, and that there is no competition among them for their binding to glycoproteins of RF. Mab 3E6 displays immunoblotting properties that are similar to those of a polyclonal antibody against the pool of glycoproteins from RF, but that are different from those of Mabs 3B1 and 2A5. All three antibodies immunostain the bovine subcommissural organ and RF. A population of ependymal cells is stained by the polyclonal antibody, and Mabs 2A5 and 3E6, but not by Mab 3B1. The material present in a population of ependymal cells of the central canal, and the glycoproteins secreted by the subcommissural organ thus probably have partial chemical identity. Some evidence suggests that the immunoreactive ependymal cells are secretory cells. The luminal surface of the central canal is coated by a thin layer of material with immunocytochemical characteristics different from those of the ependymal cells; such a coat may correspond to material released from RF.

  20. Fratura toracolombar explosão: correlação entre o comprometimento do canal vertebral e os resultados do tratamento conservador Fractura toralumbar por explosión: correlación entre el comprometimiento del canal vertebral y resultados del tratamiento conservador Thoracolumbar burst fracture: correlation between the spinal canal compromise and the clinical results of conservative treatment

    Directory of Open Access Journals (Sweden)

    Osmar Avanzi

    2009-03-01

    el mayor estrechamiento del canal vertebral y los peores resultados clínicos, conforme descrito en la literatura.INTRODUCTION: there has been considerable controversy regarding what constitutes the best treatment for lumbar burst fractures without neurological compromise. The percentage of spinal canal compromise has been used as a parameter of surgical indication, but its significance in patients without neurological deficit remains uncertain. OBJECTIVE: the purpose of this study was to evaluate patients with thoracolumbar burst fractures correlating the initial percentage of spinal canal compromise and the clinical results of the conservative treatment. METHODS: we have retrospectively evaluated the clinical records, radiographs and CT scans of adult patients with thoracolumbar burst fractures including the levels of T11 to L2, A3 type of Magerl's classification with less than 10 days of evolution, submitted to conservative treatment with TLSO (Jewett or hyperextension plaster. A questionnaire was also applied including the Visual Analog Pain Scale (VAS, Denis Work and Pain Scale, Oswestry Index and the Quality of Life assessment questionnaire SF-36. RESULTS: it was not found correlation between the percentage of spinal compromise and the VAS or the Denis pain scale. Negative correlation was found between the percentage of spinal canal compromise and the Denis work scale. Negative correlation was also found between the Oswestry index and the percentage of spinal canal compromise, indicating that patients with higher disability scores presented less percentage of spinal canal stenosis. In the correlation analysis between the SF-36 values and the percentage of spinal canal stenosis, significant correlation was found only with the Physical Functioning domain, suggesting that the patients with best physical function also presented higher percentage of stenosis. CONCLUSION: the obtained results confirm the absence of correlation between higher percentages of spinal

  1. Pediatric Cervical Spine and Spinal Cord Injuries%小儿颈椎及颈脊髓损伤

    Institute of Scientific and Technical Information of China (English)

    戴力扬; 倪斌; 袁文; 贾连顺

    1999-01-01

    Objective This study is designed to provide the experience in diagnosis and treatment of cervical spine and spinal cord injuries in children.Methods Forty seven children with cervical spine and spinal cord injuries were retrospectively reviewed.There were 31 males and 16 females,with their age ranging 6 to 14 years(mean,11.6 years).Nineteen children had fresh injuries,whereas the remaining 28 sustained old iniuries.Of these patients,thirty one patients were identified with injuries of upper cervical spine.10 were with injuries of lower cervical spine,1 was with multiple noncontiguous injuries of cervical spine,and 3 were with spinal cord injuries without radiographic abnormalities.All these patients underwent nonoperative(27 cases)or operative(19 cases)treatment except one who refuse treatment.Results A follow-up for 1 to 12 years showed that 34 patients had complete or significant improvement,six had moderate improvement and 5 remained unchanged.Conclusions Imaging assessment is of great importance to diagnosis and treatment of cervical spine and spinal cord injuries in children.Most injuries do not require surgical intervention,but decompression and/or fusion should be indicated in those patients with unstable injuries that cannot he reduced and stablilized by conservative therapy or progressive neurological deficit.%目的 总结小儿颈椎及颈脊髓损伤的诊断治疗经验.方法 回顾分析47例小儿颈椎及颈脊髓损伤,男31例,女16例,年龄6~14岁,平均11.6岁.新鲜损伤19例,陈旧性损伤28例.其中上颈椎损伤33例,下颈椎损伤10例,多节段间隔性颈椎损伤1例,无X线异常的脊髓损伤3例.非手术治疗27例,手术治疗19例,未治1例.结果 早期死亡1例.45例获1~12年随访,恢复正常或接近正常者34例,明显改善者6例,5例无改善.结论 影像学检查对于小儿颈椎及颈脊髓损伤的诊断具有重要价值,小儿颈椎损伤多数不需手术治疗,不稳定性损伤非手术治疗无

  2. Comparison of T{sub 2}-weighted turbo-spin echo sequence and ultra-fast HASTE sequence in the diagnosis of cervical myelopathies and spinal stenoses against static and kinematic MRT of the cervical spine; Vergleich von T{sub 2}-gewichteter Turbo-Spin-Echo- und ultraschneller, HASTE-Sequenz in der Diagnostik von zervikalen Myelopathien und Spinalstenosen mit der statischen und kinematischen MRT der Halswirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Muhle, C.; Metzner, J.; Brinkmann, G.; Kuehn, B.; Bischoff, L.; Hutzelmann, A.; Wesner, F.; Heller, M. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet zu Kiel (Germany)

    1997-11-01

    Purpose: The purpose of this study was to compare HASTE-sequence with T{sub 2}-weighted TSE-sequence in the detection of cervical myelopathy and cervical spinal stenosis in kinematic MRI. Methods: 24 patients with degenerative disease of the cervical spine were studied. Images were evaluated according to the following criteria: Artifacts, delineation of the vertebra, disks and degenerative changes, grade of spinal stenosis (grade 0-3) and evaluation of the cervical spinal cord. Results: Due to image blurring and artifacts, evaluation and delineation of the cervical spine was possible in all cases in the T{sub 2}-weighted TSE-sequence, but only in 23 of 24 patients using HASTE-sequence. Differentiation between osteophytes and disks was obtained in most cases (23/24) in the T{sub 2}-weighted TSE-sequence but none in the HASTE-sequence. Cervical myelopathy was observed in 4 patients in T{sub 2}-weighted TSE images but only in two cases using HASTE-sequence. Compared to T{sub 2}-weighted TSE-sequence spinal canal stenosis was underestimated using HASTE-sequence. (orig./AJ) [Deutsch] Ziel: Beurteilung von zervikalen Myelopathien und Spinalstenosen im Vergleich von ultraschneller HASTE-Sequenz sowie T{sub 2}-TSE-Sequenz. Methode: 24 Patienten mit degenerativen Halswirbelsaeulenveraenderungen wurden untersucht. Die Aufnahmen wurden hinsichtlich der Artefaktanfaelligkeit, der Darstellung von Halswirbelkoerper, Bandscheiben und degenerativen Veraenderungen, dem Grad einer Spinalstenose (Stadium 0-3) sowie der Beurteilung des Zervikalmarks ausgewertet. Ergebnisse; Aufgrund von ausgepraegten Artefakten konnten nur 23 von 24 Untersuchungen mit der HASTE-Sequenz, hingegen alle Untersuchungen mit der T{sub 2}-TSE-Sequenz ausgewertet werden. Eine Differenzierung von osteophytaeren Randanbauten von Bandscheiben und Wirbelkoerpern war in der HASTE-Sequenz gegenueber der T{sub 2}-TSE-Sequenz nur eingeschraenkt moeglich. Eine in 4 Faellen in der T{sub 2}-TSE-Sequenz diagnostizierte

  3. Age-related changes of the diffusion tensor imaging parameters of the normal cervical spinal cord

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Kun, E-mail: medsciwangkun@126.com [Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai (China); Song, Qingxin; Zhang, Fan; Chen, Zhi; Hou, Canglong; Tang, Yixing [Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai (China); Chen, Shiyue [Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai (China); Hao, Qiang, E-mail: haoqiang@189.cn [Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai (China); Shen, Hongxing, E-mail: shenhxgk@126.com [Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai (China)

    2014-12-15

    Highlights: • It is essential to determine the DTI parameters in the whole CSC. • To analyze DTI parameters in all intervertebral space levels of the CSC. • To study the impact of age on these parameters in healthy Chinese subjects. • Provide better insights in factors that could bias the diagnosis of CSC pathologies. - Abstract: Background: The diffusion tensor imaging (DTI) parameters of the cervical spinal cord (CSC) changes with age. However, previous studies only examined specific CSC areas. Objectives: To analyze the DTI parameters in all intervertebral space levels of the whole normal CSC and to study the impact of age on these parameters in a Chinese population. Methods: Thirty-six healthy subjects aged 20–77 years were recruited. DTI parameters were calculated for gray matter (GM) and white matter (WM) funiculi in all the CSC intervertebral spaces (C1/2-C6/7). Age-related changes of DTI parameters were analyzed for the GM and WM funiculi. Results: Fractional anisotropy (FA) and mean diffusivity (MD) were lower in GM than in WM. MD and FA values were lower in the WM in the lower CSC compared with the upper CSC (all P < 0.05), but no difference was observed in GM. In ventral funiculi, MD increased with age, while FA decreased (all P < 0.001). In lateral and dorsal funiculi, MD and FA decreased with age (all P < 0.001). In GM, MD and FA decreased with age (all P < 0.001). Significant age-related changes were observed in FA and MD from GM and WM funiculi. FA was correlated with age in all funiculi (ventral: r = −0.733; lateral: r = −0.468; dorsal: r = −0.607; GM: r = −0.724; all P < 0.01). Conclusion: Important changes in MD and FA were observed with advancing age at all levels of CSC in Chinese patients. DTI parameters may be useful to assess CSC pathology, but the influence of age and segments need to be taken into account in diagnosis.

  4. Theophylline-induced respiratory recovery following cervical spinal cord hemisection is augmented by serotonin 2 receptor stimulation.

    Science.gov (United States)

    Basura, Gregory J; Nantwi, Kwaku D; Goshgarian, Harry G

    2002-11-22

    Cervical spinal cord hemisection leads to a disruption of bulbospinal innervation of phrenic motoneurons resulting in paralysis of the ipsilateral hemidiaphragm. We have previously demonstrated separate therapeutic roles for theophylline, and more recently serotonin (5-HT) as modulators to phrenic nerve motor recovery; mechanisms that likely occur via adenosine A1 and 5-HT2 receptors, respectively. The present study was designed to specifically determine if concurrent stimulation of 5-HT2 receptors may enhance motor recovery induced by theophylline alone. Adult female rats (250-350 g; n=7 per group) received a left cervical (C2) hemisection that resulted in paralysis of the ipsilateral hemidiaphragm. Twenty-four hours later rats were given systemic theophylline (15 mg/kg, i.v.), resulting in burst recovery in the ipsilateral phrenic nerve. Theophylline-induced recovery was enhanced with the 5-HT2A/2C receptor agonist, (+/-)-2,5-dimethoxy-4-iodoamphetamine hydrochloride (DOI; 1.0 mg/kg). DOI-evoked augmentation of theophylline-induced recovery was attenuated following subsequent injection of the 5-HT2 receptor antagonist, ketanserin (2.0 mg/kg). In a separate group, rats were pretreated with ketanserin, which did not prevent subsequent theophylline-induced respiratory recovery. However, pretreatment with ketanserin did prevent DOI-induced augmentation of the theophylline-evoked phrenic nerve burst recovery. Lastly, using immunocytochemistry and in situ hybridization, we showed for the first time a positive co-localization of adenosine A1 receptor mRNA and immunoreactivity with phrenic motoneurons of the cervical ventral horns. Taken together, the results of the present study suggest that theophylline may induce motor recovery likely at adenosine A1 receptors located at the level of the spinal cord, and the concurrent stimulation of converging 5-HT2 receptors may augment the response.

  5. Discrepancies between Clinical Assessments of Sensory Function and Electrical Perceptual Thresholds after Incomplete Chronic Cervical Spinal Cord Injury

    Science.gov (United States)

    Macklin, Richard A.; Brooke, Valerie J.; Calabro, Finnegan J.; Ellaway, Peter H.; Perez, Monica A.

    2015-01-01

    Study Design Prospective experimental. Objectives To compare sensory function as revealed by light touch and pin prick tests of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the electrical perceptual threshold (EPT) exams in individuals with chronic incomplete cervical spinal cord injury (SCI). Setting Pittsburgh, United States. Methods EPT was tested using cutaneous electrical stimulation (0.5 ms pulse width, 3 Hz) in 32 healthy controls and in 17 participants with SCI over key points on dermatomes C2 to T4 on each side of the body. Light touch and pin prick ISNCSCI scores were tested at the same key dermatomes in SCI participants. Results In controls, EPT values were higher in older males (1.26±0.2 mA, mean±s.d.) compared with younger males (1.0±0.2 mA) and older females (0.9±0.2 mA), regardless of the dermatome and side tested. Fifteen out of seventeen SCI participants showed that the level of sensory impairment detected by the EPT was below the level detected by the ISNCSCI (mean=4.5±2.4, range 1–9). The frequency distribution of EPTs was similar to older male controls in dermatomes above but not below the ISNCSCI sensory level. The difference between EPT and ISNCSCI sensory level was negatively correlated with the time post injury. Conclusions The results show that, in the chronic stage of cervical SCI, the EPT reveals spared sensory function at lower (~5) spinal segments than the ISNCSCI sensory exam. It is hence found that the EPT is a sensitive tool to assess recovery of sensory function after chronic SCI. PMID:26123212

  6. Transplantation of autologous bone marrow mesenchymal stem cells in the treatment of complete and chronic cervical spinal cord injury.

    Science.gov (United States)

    Dai, Guanghui; Liu, Xuebin; Zhang, Zan; Yang, Zhijun; Dai, Yiwu; Xu, Ruxiang

    2013-10-02

    Neuronal injuries have been a challenging problem for treatment, especially in the case of complete and chronic cervical spinal cord injury (SCI). Recently, particular attention is paid to the potential of stem cell in treating SCI, but there are only few clinical studies and insufficient data. This study explored the efficacy of autologous bone marrow mesenchymal stem cells (BMMSCs) transplantation in the treatment of SCI. Forty patients with complete and chronic cervical SCI were selected and randomly assigned to one of the two experimental groups, treatment group and control group. The treatment group received BMMSCs transplantation to the area surrounding injury, while the control group was not treated with any cell transplantation. Both the transplant recipients and the control group were followed up to 6 months, postoperatively. Preoperative and postoperative neurological functions were evaluated with AIS grading, ASIA score, residual urine volume and neurophysiological examination. Results showed that in the treatment group 10 patients had a significant clinical improvement in terms of motor, light touch, pin prick sensory and residual urine volume, while nine patients showed changes in AIS grade. Neurophysiological examination was consistent with clinical observations. No sign of tumor was evident until 6 months postoperatively. In the control group, no improvement was observed in any of the neurological functions specified above. BMMSCs transplantation improves neurological function in patients with complete and chronic cervical SCI, providing valuable information on applications of BMMSCs for the treatment of SCI. © 2013 Published by Elsevier B.V.

  7. Lumbar Spinal Canal Stenosis

    Science.gov (United States)

    ... can strengthen your back muscles and improve your posture. Your doctor may also prescribe medicine to help reduce inflammation (soreness and swelling) in your spine. If you have more severe symptoms, you may ...

  8. Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl

    Directory of Open Access Journals (Sweden)

    Łukasz Wiktor

    2015-01-01

    Full Text Available The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of “halo-vest” system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of “halo-vest” traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department.

  9. Influence of gravity compensation on kinematics and muscle activation patterns during reach and retrieval in subjects with cervical spinal cord injury An explorative study

    NARCIS (Netherlands)

    Kloosterman, Marieke G. M.; Snoek, Govert J.; Kouwenhoven, Mirjam; Nene, Anand V.; Jannink, Michiel J. A.

    2010-01-01

    Many interventions in upper-limb rehabilitation after cervical spinal cord injury (CSCI) use arm support (gravity compensation), however, its specific effects on kinematics and muscle activation characteristics in subjects with a CSCI are largely unknown We conducted a cross-sectional explorative

  10. The arterial supply of the cervical and thoracic spinal muscles and overlying skin: Anatomical study with implications for surgical wound complications.

    Science.gov (United States)

    Yue, Brian Yin Ting; le Roux, Cara Michelle; Corlett, Russell; De La Harpe, David; Richardson, Martin; Ashton, Mark

    2013-07-01

    Postoperative spinal wound dehiscence is a significant complication following the posterior midline approach. It is postulated that this approach disrupts the vasculature supplying the paraspinal muscles and overlying skin. Although the spinal vasculature has been investigated previously, the smaller arterioles have not been described in the context of the posterior midline approach. Eight cadaveric neck and posterior torso specimens were dissected after injection with a radio-opaque lead oxide mixture and subsequent radiographs taken were analyzed. The deep cervical, vertebral, superficial cervical, and occipital arteries consistently supplied the cervical paraspinal muscles. The latter two arteries also vascularized the overlying skin. The deep cervical arteries were found to be located lateral to the C3 to C6 vertebrae, vulnerable to damage with the posterior approach. In the thoracic region, the superior and posterior intercostal arteries consistently supplied the spinal muscles. In all specimens, two small anastomotic vessels posterior to the laminae were found connecting the intercostal artery perforators. Both the arterial perforators and their anastomotic channels were situated in the surgical field and susceptible to damage with the posterior approach. It is likely that the disruption in spinal vasculature contributes to the multifactorial problem of wound dehiscence with the posterior midline approach. Copyright © 2012 Wiley Periodicals, Inc.

  11. Long-term viral brain-derived neurotrophic factor delivery promotes spasticity in rats with a cervical spinal cord hemisection

    Directory of Open Access Journals (Sweden)

    Karim eFouad

    2013-11-01

    Full Text Available We have recently reported that rats with spinal cord injury (SCI that received a combinatorial treatment, including viral BDNF delivery in the spinal cord, did not only show enhanced axonal regeneration, but also deterioration of hindlimb motor function. By demonstrating that BDNF over-expression can trigger spasticity-like symptoms in another rat model of spinal cord injury (SCI, we proposed a causal relationship between the observed spasticity-like symptoms (i.e., resistance to passive range of motion and the over-expression of BDNF. The current study was originally designed to evaluate a comparable combined treatment to rats with cervical SCI to improve motor recovery. Once again we found similar signs of spasticity, involving clenching of the paws and wrist flexion. Using electromyographic measurements changed the focus of the study and explored whether this spasticity like symptom is directly related to the over-expression of BDNF by administering a BDNF antagonist. In an acute experiment this treatment gradually diminished the resistance to overcome forelimb flexion. Thus, we conclude that neuro-excitatory effects of chronic BDNF delivery together with diminished descending control after SCI can result in adverse effects.

  12. Altered spinal kinematics and muscle recruitment pattern of the cervical and thoracic spine in people with chronic neck pain during functional task.

    Science.gov (United States)

    Tsang, Sharon M H; Szeto, Grace P Y; Lee, Raymond Y W

    2014-02-01

    Knowledge on the spinal kinematics and muscle activation of the cervical and thoracic spine during functional task would add to our understanding of the performance and interplay of these spinal regions during dynamic condition. The purpose of this study was to examine the influence of chronic neck pain on the three-dimensional kinematics and muscle recruitment pattern of the cervical and thoracic spine during an overhead reaching task involving a light weight transfer by the upper limb. Synchronized measurements of the three-dimensional spinal kinematics and electromyographic activities of cervical and thoracic spine were acquired in thirty individuals with chronic neck pain and thirty age- and gender-matched asymptomatic controls. Neck pain group showed a significantly decreased cervical velocity and acceleration while performing the task. They also displayed with a predominantly prolonged coactivation of cervical and thoracic muscles throughout the task cycle. The current findings highlighted the importance to examine differential kinematic variables of the spine which are associated with changes in the muscle recruitment in people with chronic neck pain. The results also provide an insight to the appropriate clinical intervention to promote the recovery of the functional disability commonly reported in patients with neck pain disorders.

  13. Recombinant human bone morphogenic protein-2-enhanced anterior spine fusion without bone encroachment into the spinal canal: a histomorphometric study in a thoracoscopically instrumented porcine model.

    Science.gov (United States)

    Zhang, Hong; Sucato, Daniel J; Welch, Robert D

    2005-03-01

    A thoracoscopically assisted 5-level anterior spinal fusion and instrumentation model analyzing new bone formation when using recombinant human bone morphogenic protein-2 (rhBMP-2) with a collagen hydroxyapatite-tricalcium phosphate (HA/TCP) composite sponge carrier. To determine whether new bone formation extends beyond the posterior confines of the vertebral body encroaching into the spinal canal when rhBMP-2 is used to enhance anterior fusion. A possible concern regarding the use of rhBMP-2 to enhance spinal fusion is the risk of unwanted bone formation leading to inadvertent fusion of adjacent levels or compression of neural elements. The safety of rhBMP-2 in one spinal application does not ensure similar results in other applications. Therefore, the expanded use of rhBMP-2 should occur only after carefully monitored preclinical and clinical studies for each new application. Eighteen pigs underwent thoracoscopically-assisted instrumentation and fusion of 5 contiguous levels (T5-T10) and randomly assigned to 4 treatment groups: group 1 (n = 6): rh-BMP-2 on a HA/TCP-collagen sponge (Medtronic Sofamor Danek, Memphis, TN); group 2 (n = 4): iliac crest autograft; group 3 (n = 4): empty; group 4 (n = 4): HA/TCP-collagen sponge (Medtronic Sofamor Danek) only. In groups 1 and 4, the HA/TCP collagen sponge was morselized into small granules and pushed through a bone delivery funnel for implantation into the disc. At 4 months after surgery, spines were sectioned longitudinally through the midsagittal plane and underwent undecalcified processing. Bone formation extending beyond the margins of the original discectomy and the confines of vertebral body were evaluated histomorphometrically at each operative level. Recombinant human bone morphogenic protein-2 on a HA/TCP-collagen sponge induced significant new bone formation extending anterior to the confines of the vertebral body compared with the other treatment groups (P fusion area and beyond the discectomy area (P fusion

  14. 下段颈椎脊椎功能单位活动度与椎管狭窄程度间相关性分析%To investigate the correlation between the segmental activity of the functional units and extent of the vertebral canal stenosis in the lower cervical spine

    Institute of Scientific and Technical Information of China (English)

    张晓光; 王淑丽; 张晓林; 潘涛; 崔壮

    2012-01-01

    Objective: To investigate relationships between the degree of the cervical spinal canal stenosis and lower cervical segmental stability in patients with cervical spondylotic myelopathy(CSM). Methods: Sixty-two patients with CSM for prepared surgery were examined with the lateral dynamic radiographs (flexion-extension) and MR scanner. Radiographic evaluation included the C2~C7 Cobb angle and FSU-Cobb angle at C3~C4, C4~C5, and C5~C6. Cervical spinal stenosis was classified by means of the T2-weighted MR images into four grades. Radiological change was analyzed according to the degree of the spinal stenosis during flexion-extension motion. Results: The segmental activity of the C4-~C5, C5~C6 was greater than that at the C3~ C4 in Grade I spinal stenosis, and statistical difference was observed between the C4~C5 and the C3~C4. The segmental activity at the C4~C5 decreased significantly in Grade III compared with Grade I and Grade II spinal stenosis, and implied the segmental units at the C4~C5 contributed the majority of the mobility on the cervical spine and motion decreased in the severe spinal stenosis. There was no statistical difference on the range of the motion of the overall cervical spine between grade 0~ II and grade IH groups. Conclusion: The functional spinal unit(FSU) is the smallest functional unit of the cervical spine and exhibits the generic characteristics of the spine. The mobility of the FSU was significantly reduced in the severe cervical spinal stenosis, from an unstable phase to an ankylosed stage, with the progression of the degenerative change. Hence, combined application of the common lateral dynamic radiographs and MRI in judging the activity of the cervical spine and spinal canal stenosis plays an important role in the clinical practice.%目的:探讨退变性下段颈椎的脊椎功能单位(FSU)活动度与相应节段椎管狭窄程度间相关性.资料与方法:随机选取拟行手术治疗的脊髓型颈椎病病人62例.全部拍

  15. Hydrocephalus following bilateral dumbbell-shaped c2 spinal neurofibromas resection and postoperative cervical pseudomeningocele in a patient with neurofibromatosis type 1: a case report.

    Science.gov (United States)

    Montemurro, Nicola; Cocciaro, Ardico; Meola, Antonio; Lutzemberger, Ludovico; Vannozzi, Riccardo

    2014-10-01

    Study Design Case report. Objective To present a rare case of hydrocephalus following bilateral dumbbell-shaped C2 spinal neurofibromas resection and postoperative cervical pseudomeningocele in a patient with neurofibromatosis type 1 (NF1). Methods The patient's clinical course is retrospectively reviewed. A 37-year-old man affected by NF1 referred to our department for progressive weakness of both lower extremities and gait disturbance. Radiological imaging showed bilateral dumbbell-shaped C2 spinal neurofibromas. After its resection, at the 1-month follow-up evaluation, the patient reported headache and nausea. A CT brain scan showed a postoperative cervical pseudomeningocele and an increase in the ventricular sizes, resulting in hydrocephalus. Results A ventriculoperitoneal shunting was performed using a programmable valve opening pressure set to 120 mmH20. After surgery, the patient's neurological status markedly improved. Conclusion Hydrocephalus must be considered a possible complication of cervical spine tumor resection.

  16. Early clinical efficacy of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for cervical spinal stenosis%单开门颈椎管扩大成形Centerpiece钛板内固定术治疗颈椎管狭窄症的早期临床疗效

    Institute of Scientific and Technical Information of China (English)

    汪雷; 李涛; 宋跃明; 刘浩; 裴福兴; 刘立岷; 龚全; 孔清泉; 曾建成

    2011-01-01

    levels in 9 cases,four levels in 15 and five levels in 6.The neurofunction was evaluated by Japan Orthopaedic Association (JOA) score;X-ray,CT and MRI were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side.The sagittal diameter of C5 spinal canal on the lateral X-ray was measured before operation and 3 days,6 months after operation respectively,and the expansion rate of spinal canal was termed [as(postoperative sagittal diameter-preoperative sagittal diameter)/(preoperative sagittal diameter)×l00%].Result:The average operation time was 145±20min;the average intraoperative blood loss was 215±75mi;no complications was noted during operation. C5 palsy was noted in 1 case 1 day after operation,which was relieved significantly after 2 weeks of correspondent intervention and resolved completely 2 months after operation. All patients were followed up for 9-20 months (mean 14.6 months). The average JOA score for preoperation was 8.7±0.8 and 15.2±1.1 at 6 months after operation,with the improvement rate of (75±8)%.Radiographic findings showed spinal canal enlarged perfectly at 3 days and 6 months after operation. The mean sagittal diameter of C5 spinal canal was 9.2±0.8mm before operation and 15.9±1.2mm at 3 days and 6 months after operation,with the expansion rate of (71.8±11.0)%.CT scan showed bony fusion at hinge side at 6 months after operation without recurrence of cervical stenosis and neurofunction deterioration.Conclusion:Unilateral open-door expansive laminoplasty plus centerpiece titanium plate fixation is simple and reliable,and the early clinical efficacy is satisfactory.

  17. The Incremental Hospital Cost and Length-of-Stay Associated with Treating Adverse Events Among Medicare Beneficiaries Undergoing Cervical Spinal Fusion during Fiscal Year 2013 and 2014.

    Science.gov (United States)

    Culler, Steven D; McGuire, Kevin J; Little, Kenneth M; Jevsevar, David; Shea, Kevin; Schlosser, Michael; Ambrose, Karen E; Simon, April W

    2017-06-06

    A retrospective study. To report the incremental hospital resources consumed with treating adverse events experienced by Medicare beneficiaries undergoing a two or three vertebrae level cervical spinal fusion. Hospitals are increasingly at financial risk for patients experiencing adverse events due "pay for performance". Little is known about incremental resources consumed when treating patients who experienced an adverse event following cervical spinal fusions. Fiscal years 2013 and 2014 Medicare Provider Analysis and Review file was used to identify 86,265 beneficiaries who underwent 2 or 3 vertebrae level cervical spinal fusion. International Classification of Diseases-9-Clinical Modification diagnostic and procedure codes were used to identify ten adverse events. This study estimated both the observed and risk-adjusted incremental hospital resources consumed (cost (2014 US $) and length-of-stay [LOS]) in treating beneficiaries experiencing each adverse event. Overall, 6.2% of beneficiaries undergoing cervical spinal fusion experienced at least one of the study's adverse events. Beneficiaries experiencing any complication consumed significantly more hospital resources (incremental cost of $28,638) and had longer LOS (incremental stays of 9.1 days). After adjusting for patient demographics and comorbid conditions, incremental cost of treating adverse events ranged from a high of $42,358 (infection) to a low of $10,100 (dural tear). Adverse events frequently occur and add substantially to the hospital costs of patients undergoing cervical spinal fusion. Shared decision-making instruments should clearly provide these risk estimates to the patient prior to surgical consideration. Investment in activities that have been shown to reduce specific adverse events is warranted, and this study may allow health systems to prioritize performance improvement areas. 3.

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

    Science.gov (United States)

    Vallejo, Ricardo; Kramer, Jeffery; Benyamin, Ramsin

    2007-03-01

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

  19. Effect of Spinal Manipulation of Upper Cervical Vertebrae on Blood Pressure: Results of a Pilot Sham-Controlled Trial.

    Science.gov (United States)

    Goertz, Christine M; Salsbury, Stacie A; Vining, Robert D; Long, Cynthia R; Pohlman, Katherine A; Weeks, William B; Lamas, Gervasio A

    2016-06-01

    The purpose of this pilot sham-controlled clinical trial was to estimate the treatment effect and safety of toggle recoil spinal manipulation for blood pressure management. Fifty-one participants with prehypertension or stage 1 hypertension (systolic blood pressure ranging from 135 to 159 mm Hg or diastolic blood pressure ranging from 85 to 99 mm Hg) were allocated by an adaptive design to 2 treatments: toggle recoil spinal manipulation or a sham procedure. Participants were seen by a doctor of chiropractic twice weekly for 6 weeks and remained on their antihypertensive medications, as prescribed, throughout the trial. Blood pressure was assessed at baseline and after study visits 1, 6 (week 3), and 12 (week 6), with the primary end point at week 6. Analysis of covariance was used to compare mean blood pressure changes from baseline between groups at each end point, controlling for sex, age, body mass index, and baseline blood pressure. Adjusted mean change from baseline to week 6 was greater in the sham group (systolic, -4.2 mm Hg; diastolic, -1.6 mm Hg) than in the spinal manipulation group (systolic, 0.6 mm Hg; diastolic, 0.7 mm Hg), but the difference was not statistically significant. No serious and few adverse events were noted. Six weeks of toggle recoil spinal manipulation did not lower systolic or diastolic blood pressure when compared with a sham procedure. No serious adverse events from either treatment were reported. Our results do not support a larger clinical trial. Further research to understand the potential mechanisms of action involving upper cervical manipulation on blood pressure is warranted before additional clinical investigations are conducted. Copyright © 2016. Published by Elsevier Inc.

  20. Alterations in Cortical Sensorimotor Connectivity following Complete Cervical Spinal Cord Injury: A Prospective Resting-State fMRI Study.

    Directory of Open Access Journals (Sweden)

    Akinwunmi Oni-Orisan

    Full Text Available Functional magnetic resonance imaging (fMRI studies have demonstrated alterations during task-induced brain activation in spinal cord injury (SCI patients. The interruption to structural integrity of the spinal cord and the resultant disrupted flow of bidirectional communication between the brain and the spinal cord might contribute to the observed dynamic reorganization (neural plasticity. However, the effect of SCI on brain resting-state connectivity patterns remains unclear. We undertook a prospective resting-state fMRI (rs-fMRI study to explore changes to cortical activation patterns following SCI. With institutional review board approval, rs-fMRI data was obtained in eleven patients with complete cervical SCI (>2 years post injury and nine age-matched controls. The data was processed using the Analysis of Functional Neuroimages software. Region of interest (ROI based analysis was performed to study changes in the sensorimotor network using pre- and post-central gyri as seed regions. Two-sampled t-test was carried out to check for significant differences between the two groups. SCI patients showed decreased functional connectivity in motor and sensory cortical regions when compared to controls. The decrease was noted in ipsilateral, contralateral, and interhemispheric regions for left and right precentral ROIs. Additionally, the left postcentral ROI demonstrated increased connectivity with the thalamus bilaterally in SCI patients. Our results suggest that cortical activation patterns in the sensorimotor network undergo dynamic reorganization following SCI. The presence of these changes in chronic spinal cord injury patients is suggestive of the inherent neural plasticity within the central nervous system.

  1. Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal.

    Science.gov (United States)

    Singh, Niraj Kumar; Apeksha, Kumari

    2016-09-01

    Benign paroxysmal positional vertigo (BPPV) constitutes a major proportion of the population with peripheral vestibulopathies. Although the freely floating otoconia within the semicircular canals is responsible for the symptoms of BPPV, the source of the otoconia debris is mainly believed to be the otolith organs. Therefore, the pathology in either or both the otolith organs appears a logical proposition. Cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), being the tests for functional integrity of the otolith organs, appear promising for investigating otolith involvement in BPPV. While recent evidences are suggestive of equivocal findings for cVEMP, there are only a few studies on oVEMP. Additionally, both these potentials have never been explored in the same set of individuals with BPPV. Therefore, the present study aimed to evaluate the functional integrity of the otolith organs through cVEMP and oVEMP in individuals with posterior canal BPPV. Thirty-one individuals with unilateral posterior canal BPPV and 31 age- and gender-matched healthy controls underwent 500 Hz tone-burst-evoked cVEMP and oVEMP. The results demonstrated no significant group difference on any of the cVEMP parameters (p > 0.05). A similar trend was noticed for the latency-related parameters of oVEMP. However, the peak-to-peak amplitude was significantly smaller in the affected ears of individuals with BPPV than their unaffected ears and the ears of healthy controls (p < 0.05). The BPPV group showed significantly higher inter-aural amplitude difference ratio than the healthy controls (p < 0.05). Further, the sensitivity and specificity of oVEMP were also found to be far superior to those of cVEMP. Thus, the outcome of the present study revealed involvement of utricle rather than saccule in posterior canal BPPV, and therefore, oVEMP appears to be better suited to clinical investigation than cVEMP in individuals with posterior canal BPPV.

  2. Spinal coning after lumbar puncture in a patient with undiagnosed giant cervical neurofibroma

    Directory of Open Access Journals (Sweden)

    Prasad Krishnan

    2013-01-01

    Full Text Available Lumbar puncture in the presence of an intracranial tumor with raised intracranial pressure is known to have catastrophic consequences due to herniation of intracranial contents through the tentorial hiatus or foramen magnum. There are relatively few case reports about the same sequence of events when lumbar puncture is performed below the level of a complete spinal block. The mechanism of such deterioration is also subject to conjecture as the spinal cord (unlike the uncus or cerebellar tonsils is tethered by the dentate ligament and roots on either side, and is hence less mobile. We present one such case of spinal coning and review the available literature.

  3. Medida da área do canal vertebral lombar em diferentes faixas etárias Medida de la superficie del canal vertebral lumbar en los diferentes grupos de edad Lumbar spinal canal area in different age groups

    National Research Council Canada - National Science Library

    Jair Ortiz; Alex Veneziano Oliveira Junior; José Luis Amim Zabeu

    2009-01-01

    OBJETIVO: medir as dimensões do canal vertebral lombar por meio de tomografia computadorizada, de modo a comparar os valores das diferentes faixas etárias e determinação da possível diferença entre elas. MÉTODOS...

  4. Nestin-positive cells in the spinal cord: a potential source of neural stem cells.

    Science.gov (United States)

    Xu, Renshi; Wu, Chengsi; Tao, Yuhui; Yi, Juan; Yang, Yunzhu; Zhang, Xiong; Liu, Rugao

    2008-11-01

    Some literatures have reported neural precursor cells (NPCs) exist in spinal cord of adult mammal, however, the NPCs distribution feature in spinal cord of adult mice so far is not described in detail. In order to observe and compare the distribution feature of NPCs in various spinal cord regions of adult mice, to research a potential source of neural stem cells (NSCs), we obtained NPCs distribution feature by analyzing the distribution of the nestin-containing cells (NCCs) in spinal cord of adult nestin second-intron enhancer controlled LacZ reporter transgenic mice (pNes-Tg) with LacZ staining and positive cell quantification. The results showed that: NCCs were observed in various regions of spinal cord of adult mice, but amount of NCCs was different in distinct region, the rank order of NCCs amount in various spinal cord regions was dorsal horn region greater than central canal greater than the ventral and lateral horn. NCCs in dorsal horn region mainly distributed in substantia gelatinosa, NCCs in central canal mainly distributed in ependymal zone, on the contrary, NCCs in ventral, lateral horn, medullae, nucleus regions of spinal cord were comparatively less. The rank order of NCCs amount in various spinal cord segments was cervical segment greater than lumbar sacral segment greater than thoracic segment. There was no significantly difference between NCCs amount in the left and right sides, and within cervical 1-7, thoracic 1-12, lumbar 1-5, sacral segment of spinal cord in adult mice. These data collectively indicate that NPCs extensively distribute in various regions of spinal cord of adult mice, especially in substantia gelatinosa and ependymal zone. NPCs in cervical segment are abundant, NPCs in thoracic segment are the least while compared the different spinal cord segment, the NPCs in various regions of spinal cord of adult mice are a potential source of NSCs.

  5. Spinal cord stimulation for Raynaud's syndrome: long-term alleviation of bilateral pain with a single cervical lead.

    Science.gov (United States)

    Wolter, Tilman; Kieselbach, Kristin

    2011-01-01

    Spinal cord stimulation (SCS) has been described in a variety of neuropathic and vasospastic pain conditions including Raynaud's syndrome.   We report here the outcome of single lead SCS in the case of a 49-year-old woman with severe Raynaud's syndrome, which had failed to respond to medical therapy.   With a single quadripolar cervical lead in midline position at the C2/C3 level sustained pain relief of the bilateral pain was accomplished. Pain scores sank from 7/10 to 2-3/10 on the nominal analog scale and remained stable more than nearly four years by now.   Treatment of bilateral pain in Raynaud's syndrome with SCS in a single technique is feasible. Advantages and disadvantages as compared with stimulation with bilateral leads are discussed. © 2011 International Neuromodulation Society.

  6. 颈前路减压植骨治疗脊髓型颈椎病%Treatment of Anterior Cervical Decompression and Fusion with Cervical Spinal Cord

    Institute of Scientific and Technical Information of China (English)

    余润泽; 喻德富; 章杰斌; 陶学顺; 王家顺; 吕建军

    2011-01-01

    Objective To observe the cervical spinal column fusion anterior cervical decompression and clinical efficacy. Methods 21 cases of single or double in patients with cervical myclopathy were selected,Central Bank of antcrior cervical discectomy and decompression saws,implantation of autologous iliac bone fusion columnar neck immobilization were performed.The patients were followed up by cervical spine X-ray observations,fell,clinical functional evaluation of nerve function recovery.Results 21 patients were followed up for 12 to 24 months( mean 16 months ). Recovery after surgery,bone fusion,the basic life of patients were satisfactory, Some patients returned to work.Neurological function according to the Japanese Orthopacdic Association(JOA) evaluation system,excellent in 16 cases,good in 2 cases,in 2 cases,1 patient;JOA score improved from(9.3±2.1) points up to postoperative(15.4±1.6) points.Conclusion Anterior decompression and fusion was a single,double cervical myclopathy effective treatment,with complete decompression,shorter operation time,trauma,neurological recovery was good,and with low cost advantage.%目的 观察脊髓型颈稚病颈前路减压柱状植骨融合的临床疗效.方法 21例单或双节段脊髓型颈椎病患者,行颈前路环锯椎间盘切除减压,自体柱状髂骨植入融合,颈托外固定.术后随访观察颈椎X线片、自我感觉、临床功能评价、神经功能恢复情况.结果 21例患者全部获得随访,随访时间12~24个月(平均16个月).术后恢复满意,植骨全部融合,患者生活基本可自理,部分患者重返工作.神经功能改善依据日本矫形外科学会(JOA)评定标准,优16例,良2例,中2例,无效1例;JOA评分由术前(9.3±2.1)分上升至术后的(15.4±1.6)分.结论 前路减压植骨是单、双节段脊髓型颈椎病的有效治疗方法,具有减压彻底,手术时间短,创伤小,神经恢复好,费用低等优点;术后需较长期外固定.

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

    OpenAIRE

    Keirstead Hans S; Nistor Gabriel; Radojicic Milan

    2007-01-01

    Abstract Background Chronic spinal cord injury (SCI) can lead to an insidious decline in motor and sensory function in individuals even years after the initial injury and is accompanied by a slow and progressive cytoarchitectural destruction. At present, no pathological mechanisms satisfactorily explain the ongoing degeneration. Methods Adult female Sprague-Dawley rats were anesthetized laminectomized at T10 and received spinal cord contusion injuries with a force of 250 kilodynes using an In...

  8. Extensive Spinal Decussation and Bilateral Termination of Cervical Corticospinal Projections in Rhesus Monkeys

    OpenAIRE

    2009-01-01

    To examine neuroanatomical mechanisms underlying fine motor control of the primate hand, adult Rhesus monkeys underwent injections of biotinylated dextran amine (BDA) into the right motor cortex. Spinal axonal anatomy was examined using detailed serial-section reconstruction and modified stereological quantification. 87% of corticospinal tract (CST) axons decussated in the medullary pyramids and descended through the contralateral dorsolateral tract of the spinal cord. 11% of CST axons projec...

  9. Comparison of the occurrence rates of cervical nerve entrapment at cervical intervertebral foramen and spinal nervous sulcus%颈神经在椎间孔与脊神经沟处受嵌压的出现率比较

    Institute of Scientific and Technical Information of China (English)

    李英平; 郭瑞芳; 温海青

    2005-01-01

    背景:椎间盘髓核向侧后方脱出以及神经根管内的软组织炎性肿胀可直接或间接压迫神经根,但颈神经在椎间孔及脊神经沟处的嵌压因素与严重性待进一步研究.目的:探讨颈神经在椎间孔及脊神经沟处受嵌压的出现率与颈椎病严重程度关系.设计:单一样本研究.单位:承德医学院解剖教研室、附属医院老年病科、教务处.对象:实验选用承德医学院解剖教研室提供的经甲醛固定成尸60具,男28,女32;共120侧.方法:取60具成尸,测量颈椎间孔及其脊神经根的外径以及对脊神经沟外口宽度及其沟内段脊神经前支横径,数据进行统计学处理.主要观察指标:颈神经前支横径/脊神经沟宽度和颈神经根外径/椎间孔大小的均值,比值≥1的出现率.结果:颈神经根与椎间孔之比值明显大于脊神经与脊神经沟之比值(t=2.66,P<0.01);颈神经在椎间孔处受压的出现率(24.6%)明显高于脊神经沟处(6.3%),二者比较差异有非常显著性意义(x2=6.95,P<0.01).结论:颈神经在颈椎间孔和脊神经沟处均可受累,颈神经在椎间孔处受累的严重性明显大于在脊神经沟处.临床诊治颈椎病在充分考虑椎间孔处神经受累的同时,也不可忽视颈椎脊神经沟处神经受累的可能性.%BACKGROUND: Nerve root could be directly or indirectly entrapped due to lateral backward prolapse of nucleus pulposus of intervertebral disc, as well as parenchymal inflammatory tumefaction of the soft tissues in nerve root tube. But the factors and their severity related to cervical nerve entrapment at cervical intervertebral foramen and spinal nervous sulcus still need further studies.OBJECTIVE: To investigate the relationship between the occurrence rate of cervical nerve entrapment at cervical intervertebral foramen and spinal nervous sulcus and the severity of cervical syndrome.DESIGN: A single sample study.SETTING: Department of Anatomy, Department of

  10. 大鼠脊髓损伤椎管内蛛网膜下腔持续给药模型的建立%Establishment of spinal cord injury rat model of continuous infusion inside subarachnoid space of spinal canal

    Institute of Scientific and Technical Information of China (English)

    刘德华; 王建; 高志强; 邹连生; 张功亮

    2014-01-01

    Objective To establish spinal cord injury rat model of continuous infusion inside subarachnoid space of spinal canal .Methods By using Allen′s method as a reference ,rat models of acute spinal canal injury was prepared to simulate spinal cord injuries similar to clinical trauma .Continuous infusion device was installed inside subarachnoid space in the lesion .The behaviors of rat models were observed and the effects of this device was evalua‐ted by measuring the level of glucose in the drug delivery device .Results Rats in the experimental group suffered from paraplegia in double hindlimb ,and the tension of muscle below the level of spinal injury was decreased ,with myodynamia level of 0 grade ,without reaction to acupuncture ,and with apparent urine retention .The four limbs of rats in the control group functioned normally .Among all of the 30 rats ,1 rat died in 2 days ,2 rats suffered from spas‐tic paralysis ,catheter of 2 rats were lost or blocked ,and 6 rats showed various degree of self mutilation after surgery . Conclusion The rat model of acute spinal canal injury ,prepared in reference to Allen′s method and installed with continuous infusion device inside subarachnoid space in the lesion ,might be with fine repeatability and could provide stable injured rat model .%目的:建立一种脊髓损伤椎管内蛛网膜下腔持续给药的动物模型。方法参照A llen重物坠落法制备急性脊髓挫伤动物模型,模拟临床上外伤所致的脊髓损伤,并在损伤灶安装蛛网膜下腔持续给药装置,观察大鼠的行为表现,并通过检测给药装置内葡萄糖含量判断该装置效果。结果脊髓损伤实验组大鼠麻醉清醒后均表现为双后肢截瘫,损伤平面以下肌张力降低,肌力0级,对针刺亦无反应,并明显尿潴留;对照组大鼠四肢活动正常。30只大鼠中,1只在术后2 d死亡,2只大鼠表现为痉挛性瘫痪,2只大鼠导管脱落或堵塞,6只大鼠表

  11. Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Aurora Messina

    2016-09-01

    Full Text Available Loss of hand function after cervical spinal cord injury (SCI impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirectly using muscle strength testing and intramuscular electromyography, but these measures cannot show the manifestation that SCI has on the peripheral nerves. We directly assessed the morphology of nerves biopsied at the time of surgery, from three patients within 18 months post injury. Our objective was to document their morphologic features. Donor nerves included teres minor, posterior axillary, brachialis, extensor carpi radialis brevis and supinator. Recipient nerves included triceps, posterior interosseus (PIN and anterior interosseus nerves (AIN. They were fixed in glutaraldehyde, processed and embedded in Araldite Epon for light microscopy. Eighty percent of nerves showed abnormalities. Most common were myelin thickening and folding, demyelination, inflammation and a reduction of large myelinated axon density. Others were a thickened perineurium, oedematous endoneurium and Renaut bodies. Significantly, very thinly myelinated axons and groups of unmyelinated axons were observed indicating regenerative efforts. Abnormalities exist in both donor and recipient nerves and they differ in appearance and aetiology. The abnormalities observed may be preventable or reversible.

  12. Cervical Spinal Cord Injury without Computed Tomography Evidence of Trauma in Adults: Magnetic Resonance Imaging Prognostic Factors.

    Science.gov (United States)

    Martinez-Perez, Rafael; Munarriz, Pablo M; Paredes, Igor; Cotrina, Javier; Lagares, Alfonso

    2017-03-01

    Spinal cord injury (SCI) without computed tomography evidence of trauma is underreported in adults and is considered a subtype of SCI with relatively good outcome. Despite this, few studies have been performed to determine specific imaging-related prognostic factors. Our objective is to describe the imaging characteristics of patients experiencing blunt cervical spine trauma with neurologic deficits, but without radiologic abnormalities and associated prognostic factors. A retrospective review of all adult patients with cervical SCI admitted to the emergency room of 2 university hospitals from January 2004 to December 2013 was performed. Only patients with a magnetic resonance imaging (MRI) performed within 72 hours after trauma were included for further analysis. All patients with bony injury or traumatic malalignment were excluded. Data gathered on the remaining patients included demographics, mechanism of injury, severity of SCI, long-term patient outcome, improvement in neurologic condition, and MRI results. There were 48 patients who met the inclusion and exclusion criteria, and 40 who demonstrated improvement in the neurologic examination at follow-up. Disruption of either the anterior longitudinal ligament or ligamentum flavum and larger lesions in the MRI were predictors of lack of neurologic improvement. Early MRI has prognostic value in patients suffering SCI without computed tomography evidence of trauma. Lesion length is a powerful predictor of outcome in this subgroup of patients. Soft tissue injury plays a role in the severity of injury and the ability to recover in this subgroups of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Task-dependent modulation of primary afferent depolarization in cervical spinal cord of monkeys performing an instructed delay task.

    Science.gov (United States)

    Seki, Kazuhiko; Perlmutter, Steve I; Fetz, Eberhard E

    2009-07-01

    Task-dependent modulation of primary afferent depolarization (PAD) was studied in the cervical spinal cord of two monkeys performing a wrist flexion and extension task with an instructed delay period. We implanted two nerve cuff electrodes on proximal and distal parts of the superficial radial nerve (SR) and a recording chamber over a hemi-laminectomy in the lower cervical vertebrae. Antidromic volleys (ADVs) in the SR were evoked by intraspinal microstimuli (ISMS, 3-10 Hz, 3-30 microA) applied through a tungsten microelectrode, and the area of each ADV was measured. In total, 434 ADVs were evoked by ISMS in two monkeys, with onset latency consistently shorter in the proximal than distal cuffs. Estimated conduction velocity suggest that most ADVs were caused by action potentials in cutaneous fibers originating from low-threshold tactile receptors. Modulation of the size of ADVs as a function of the task was examined in 281 ADVs induced by ISMS applied at 78 different intraspinal sites. The ADVs were significantly facilitated during active movement in both flexion and extension (Pmodulation of PAD. This facilitation started 400-900 ms before the onset of EMG activity. Such pre-EMG modulation is hard to explain by movement-induced reafference and probably is associated with descending motor commands.

  14. Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis.

    Science.gov (United States)

    Vidal, Christophe; Ilharreborde, Brice; Azoulay, Robin; Sebag, Guy; Mazda, Keyvan

    2013-06-01

    Radiological reproducibility study. To assess intra and interobserver reliability of radiographic measurements for global sagittal balance parameters and sagittal spine curves, including cervical spine. Sagittal spine balance in adolescent idiopathic scoliosis (AIS) is a main issue and many studies have been reported, showing that coronal and sagittal deformities often involve sagittal cervical unbalance. Global sagittal balance aims to obtain a horizontal gaze and gravity line at top of hips when subject is in a static position, involving adjustment of each spine curvature in the sagittal plane. To our knowledge, no study did use a methodologically validated imaging analysis tool able to appreciate sagittal spine contours and distances in AIS and especially in the cervical region. Lateral full-spine low-dose EOS radiographs were performed in 75 patients divided in three groups (control subjects, AIS, operated AIS). Three observers digitally analyzed twice each radiograph and 11 sagittal measures were collected for each image. Reliability was assessed calculating intraobserver Pearson's r correlation coefficient, interobserver intra-class correlation coefficient (ICC) completed with a two-by-two Bland-Altman plot analysis. This measurement method has shown excellent intra and interobserver reliability in all parameters, sagittal curvatures, pelvic parameters and global sagittal balance. This study validated a simple and efficient tool in AIS sagittal contour analysis. It defined new relevant landmarks allowing to characterize cervical segmental curvatures and cervical involvement in global balance.

  15. Chronological observation in early radiation myelopathy of the cervical spinal cord; Gadolinium-enhanced MRI findings in two cases

    Energy Technology Data Exchange (ETDEWEB)

    Hirota, Saeko; Yoshida, Shoji; Soejima, Toshinori (Hyogo Medical Center for Adults, Akashi (Japan)) (and others)

    Gd-enhanced MR images of two patients with clinically and histopathologically diagnosed chronic progressive radiation myelitis (CPRM) were observed chronologically. One of them had had nasopharyngeal cancer and received radiotherapy at a dose of 100 Gy to the C1-2 level of the spinal cord. She developed CPRM 25 months after the termination of radiotherapy. The other had had malignant lymphoma originating from the tonsil and received chemoradiotherapy. The dose delivered to her cervical spinal cord was 40 Gy, and she developed CPRM 30 months later. Gd-enhanced MRI in the early phase revealed a small crescent-shaped nidus with or without a very small central nonenhanced area in both cases. Enhancement was not great. At that time, patients noticed only the inability to perceive pain and temperature or paresthesia in the opposite side. In a few months, MRI revealed a much more strongly enhanced and larger nidus with enlargement of a central nonenhanced area accompanied by long segmental cord enlargement. The patients' neurological symptoms had also progressed, with hemiparesis developing, for example. (author).

  16. Spinal Fusion

    Science.gov (United States)

    ... vertebrae. These include: treatment of a fractured (broken) vertebra; correction of deformity (spinal curves or slippages); elimination of pain from painful motion; treatment of instability; and treatment of some cervical disc herniations. One of the less controversial reasons ...

  17. Self-healing photo-neuropathy and cervical spinal arthrosis in four sisters with brachioradial pruritus

    Directory of Open Access Journals (Sweden)

    Wallengren Joanna

    2009-11-01

    Full Text Available Abstract The cause of brachioradial pruritus (a localized itching on the arms or shoulders is controversial. The role of sun and cervical spine disease has been discussed. This is a report on four sisters suffering from brachioradial pruritus recurring every summer. The sisters spent much time outdoors and exposed themselves extensively to the sun. They also had occupations requiring heavy lifting. Cervical radiographs indicated arthrosis. The density of sensory nerve fibers in the skin biopsies from the itchy skin of the arms, visualized by antibodies against a pan-neuronal marker, protein gene product 9.5, was reduced compared with biopsies from the same skin region during the symptom-free period in the winter. This data exemplifies that brachioradial pruritus is a self healing photoneuropathy occurring in middle aged adults predisposed by cervical arthrosis.

  18. Computed tomography in the foramen magnum and high cervical cord lesion

    Energy Technology Data Exchange (ETDEWEB)

    Isu, T.; Ito, T.; Iwasaki, Y.; Tsuru, M. (Hokkaido Univ., Sapporo (Japan). School of Medicine); Kitaoka, K.

    1981-10-01

    The value of computed tomography in the spine and spinal cord disease recently has been well documented. However, little attention is made to the role of computed tomography in foramen magnum and high cervical cord lesion. We report 16 cases of the foramen magnum and high cervical cord lesion. Method: Either EMI Head Scanner, CT 1010 (slice thickness 10 mm) or EMI Whole Body Scanner, CT 5005 (slice thickness 13 mm) was used. In 9 cases enhanced CT with intravenous injection of contrast medium was performed. Eleven cases received intrathecal injection of metrizamide. Materials: 1) control group without cervical pathology 70 cases, 2) spinal cord tumor 6 cases, 3) atlanto-axial dislocation 6 cases, 4) Chiari malformation (type 1) 3 cases, 5) spinal foreign body (acupuncture needle) 1 case. Results: 1. plain CT. 1) In control group without cervical pathology the cervical cord at C/sub 1/ level was seen as area surrounded by ring of subarachnoid space. 2) In 14 cases except for 1 case of atlanto-axial dislocation and 1 case of spinal foreign body identification of the cervical cord at C/sub 1/ level was impossible. 3) CT was of diagnostic value in detecting altanto-axial dislocation and spinal foreign body. 2. enhanded CT. Meningioma and neurinoma showed positive contrast enhancement. However, astrocytoma and herniated cerebellar tonsils were not detectable. 3. CT metrizamide myelography visualized the subarachnoid space and made it possible to localize the lesion in the spinal canal in relation to the spinal cord. Conclusion: Attention should be given to plain CT finding at C/sub 1/ level in diagnosis of foramen magnum and high cervical cord lesion. If identification of cervical cord at C/sub 1/ level is impossible, it is suspected that subarachnoid space is blocked by the lesion, and enhanced CT and CT metrizamide myelography must be performed.

  19. Effect of Alpha-1-Adrenergic Agonist, Midodrine for the Management of Long-Standing Neurogenic Shock in Patient with Cervical Spinal Cord Injury: A Case Report

    OpenAIRE

    Kim, Taikwan; Jwa, Cheol Su

    2015-01-01

    We report a rare case of a 71-year-old male patient who had suffered from long-lasting neurogenic shock for 13 weeks after cervical spinal cord injury (SCI) caused by a bicycle accident. The neurogenic shock was resolved dramatically 2 weeks after the administration of alpha-1-adrenergic agonist, midodrine hydrochloride. In usual cases, neurogenic shock tends to improve between 2 and 6 weeks after SCI; however, in a few cases, the shock lasts for several months. In our case, spinal shock last...

  20. Ependyma of the central canal of the rat spinal cord: a light and transmission electron microscopic study.

    OpenAIRE

    Bruni, J.E.; Reddy, K

    1987-01-01

    Ependymal cells of the rat central canal were examined with a view to identifying features that distinguish them regionally and from their counterparts elsewhere in the ventricular system. The results revealed that the lining consisted for the most part of a pseudostratified layer of uniformly organised cuboidal to columnar ependymal cells present in largest numbers in lumbar and sacral segments and in the conus. Two cell variants were identified on the basis of the presence or absence of a r...

  1. Spinal dural ossification causing neurological signs in a cat.

    Science.gov (United States)

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

    2013-06-19

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

  2. Long descending cervical propriospinal neurons differ from thoracic propriospinal neurons in response to low thoracic spinal injury

    Directory of Open Access Journals (Sweden)

    Stelzner Dennis J

    2010-11-01

    Full Text Available Abstract Background Propriospinal neurons, with axonal projections intrinsic to the spinal cord, have shown a greater regenerative response than supraspinal neurons after axotomy due to spinal cord injury (SCI. Our previous work focused on the response of axotomized short thoracic propriospinal (TPS neurons following a low thoracic SCI (T9 spinal transection or moderate spinal contusion injury in the rat. The present investigation analyzes the intrinsic response of cervical propriospinal neurons having long descending axons which project into the lumbosacral enlargement, long descending propriospinal tract (LDPT axons. These neurons also were axotomized by T9 spinal injury in the same animals used in our previous study. Results Utilizing laser microdissection (LMD, qRT-PCR, and immunohistochemistry, we studied LDPT neurons (located in the C5-C6 spinal segments between 3-days, and 1-month following a low thoracic (T9 spinal cord injury. We examined the response of 89 genes related to growth factors, cell surface receptors, apoptosis, axonal regeneration, and neuroprotection/cell survival. We found a strong and significant down-regulation of ~25% of the genes analyzed early after injury (3-days post-injury with a sustained down-regulation in most instances. In the few genes that were up-regulated (Actb, Atf3, Frs2, Hspb1, Nrap, Stat1 post-axotomy, the expression for all but one was down-regulated by 2-weeks post-injury. We also compared the uninjured TPS control neurons to the uninjured LDPT neurons used in this experiment for phenotypic differences between these two subpopulations of propriospinal neurons. We found significant differences in expression in 37 of the 84 genes examined between these two subpopulations of propriospinal neurons with LDPT neurons exhibiting a significantly higher base line expression for all but 3 of these genes compared to TPS neurons. Conclusions Taken collectively these data indicate a broad overall down

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

    Directory of Open Access Journals (Sweden)

    Mohamed-Mounir El Mendili

    Full Text Available 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.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.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.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.

  4. Epicritic Sensation in Cervical Spinal Cord Injury: Diagnostic Gains Beyond Testing Light Touch

    NARCIS (Netherlands)

    Velstra, Inge-Marie; Bolliger, Marc; Baumberger, Michael; Rietman, Johan Swanik; Curt, Armin

    2013-01-01

    Applied as a bedside test of gross dorsal column function, the testing of light touch (LT) sensation is of high clinical value in the diagnosis of human spinal cord injury (SCI). However, the assessment of overall dorsal column deficit by testing only LT may be limited, because the dorsal column pat

  5. Degenerative diseases of the cervical spine: comparison of a multiecho data image combination sequence with a magnetisation transfer saturation pulse and cervical myelography and CT

    Energy Technology Data Exchange (ETDEWEB)

    Dorenbeck, U. [Department of Neuroradiology, University Hospital of the Saarland, 66421, Homburg (Germany); Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany); Schreyer, A.G.; Held, P.; Feuerbach, S.; Seitz, J. [Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany); Schlaier, J. [Department of Neurosurgery, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany)

    2004-04-01

    Assessing degenerative disease in the cervical spine remains a challenge. There is much controversy about imaging the cervical spine using MRI. Our aim in this prospective study was to compare a T2*-weighted 2D spoiled gradient-echo multiecho sequence (MEDIC) with a magnetisation transfer saturation pulse with cervical myelography and postmyelographic CT. Using an assessment scale we looked at the vertebral bodies, intervertebral discs, neural foramina, anterior and posterior nerve roots, grey matter, ligamenta flava, oedema in the spinal cord and stenosis of the spinal canal. We also evaluated postmyelography CT and the MEDIC sequence for assessing narrowing of the neural foramina in a cadaver cervical spine. We examined 67 disc levels in 18 patients, showing 18 disc prolapses and 21 osteophytes narrowing the spinal canal or the neural foramina. All MRI studies showed these abnormalities findings equally well. Postmyelography CT was significantly better for showing the bony structures and the anterior and posterior nerve roots. The MEDIC sequence provided excellent demonstration of soft-tissue structures such as the intervertebral disc and ligamentum flavum. No statistical differences between the imaging modalities were found in the assessment of narrowing of the neural foramina or the extent of spinal stenosis. The cadaver measurements showed no overestimation of abnormalities using the MEDIC sequence. (orig.)

  6. Clinical and radiological profile of Hirayama disease: A flexion myelopathy due to tight cervical dural canal amenable to collar therapy

    Directory of Open Access Journals (Sweden)

    K M Hassan

    2012-01-01

    Full Text Available Background: Hirayama disease (HD is benign focal amyotrophy of the distal upper limbs, often misdiagnosed as motor neuron disease. Routine magnetic resonance imaging (MRI is often reported normal. Objective: To study the clinicoradiological profile of hand wasting in young males. Materials and Methods: Patients presenting with insidious-onset hand wasting from March 2008 to May 2011 were evaluated electrophysiologically. Cervical MRI in neutral position was done in 11 patients and flexion contrast imaging was done in 10 patients. Results: All patients were males less than 25 years of age, with median age 23 years, except one patient who was 50 years old. Duration of illness was 3 months to 3 years. All (100% had oblique amyotrophy, four (36% cold paresis, 10 (91% minipolymyoclonus and three (27% had fasciculations. Regional reflexes were variably absent. Two patients (18% had brisk reflexes of lower limbs with flexor plantars. Electromyography (EMG showed chronic denervation in the C7-T1 myotomes. Neutral position MRI showed loss of cervical lordosis in 10/11 (91%, localized lower cervical cord atrophy in 9/11 (82%, asymmetric cord flattening in 11/11 (100% and intramedullary hyperintensity in 2/11 (18%; flexion study showed loss of dural attachment, anterior displacement of dorsal dura, epidural flow voids in 9/10 (90% and enhancing epidural crescent in 10/10 (100%. Clinical profile, imaging and electrophysiological findings of the patient aged 50 years will be described in detail as presentation at this age is exceptional. Collar therapy slowed progression in most cases. Conclusion: Clinical features of HD corroborated well with electrophysiological diagnosis of anterior horn cell disease of lower cervical cord. While dynamic contrast MRI is characteristic, routine studies have a high predictive value for diagnosis. Prompt diagnosis is important to institute early collar therapy.

  7. One-stage microsurgical excision for intra- and extra-spinal dumbbell-shaped tumors in cervical spine: a report of 11 cases

    Directory of Open Access Journals (Sweden)

    GAO Fang-you

    2013-07-01

    Full Text Available Objective To investigate the clinical characteristics and surgical treatment strategy of intra- and extra-spinal dumbbell-shaped tumors in cervical spine. Methods Clinical data of 11 patients with intra- and extra-spinal dumbbell-shaped tumors in cervical spine were retrospectively studied. Male was in 7 cases, female in 4 cases. The tumors were in stageⅠin 4 cases, Ⅱ in 2 cases, Ⅲ in 4 cases and Ⅳ in one case. The tumors were resected via posterior midline approach alone in 9 cases, among whom unilateral hemilaminectomy was performed in 4 cases (screw fixation via posterior approach was performed for fusion of lesion segments after tumor resection in 2 cases, one was stage Ⅳ tumor, another one was stage Ⅲ tumor in cervicothoracic junction, total laminotomy and reduction by titanium miniplates and screws in 2 cases, and via interlaminar approach in 3 cases. Posterior midline approach combined with anterior lateral approach was performed in the rest 2 cases. Results Tumors were one-stage totally resected in all of the cases. Histological types of the tumors included schwannoma in 10 cases, and ganglioneuroma in one case. The numbness area was enlarged in one case, and the motor function improved in other cases. All of the patients were followed-up from 8 months to 3.50 years with an average of 21 months. No tumor relapse and spinal deformity were found. Conclusion Most cases of intra- and extra-spinal dumbbell-shaped tumors can be treated with one-stage microsurgery. The surgical treatment strategy can be reached according to the location and surgical staging of tumors. Unilateral hemilaminectomy technique is useful to maintain the stability of the cervical spine for most of tumors. Combined approach is needed in some of the tumors and fixation should be implemented in the case of stability of cervical spine damaged after tumor resection.

  8. The proposed use of cervical spinal cord stimulation for the treatment and prevention of cognitive decline in dementias and neurodegenerative disorders.

    Science.gov (United States)

    Tomycz, Nestor D

    2016-11-01

    Cervical spinal cord stimulation is a well-established treatment for intractable neuropathic upper extremity pain. More than 20years ago it was demonstrated that cervical spinal cord stimulation could engender an increase in cerebral blood flow. Cerebral blood flow has been shown to be decreased in many patients with dementia and in various neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease. Furthermore, there is evidence that reduced cerebral blood flow worsens neurodegenerative disease and may also predict which patients progress from mild cognitive impairment to full blown Alzheimer's disease. Thus, the identification of decreased cerebral blood flow in patients with early cognitive problems may offer clinicians a window of opportunity to intervene and prevent further brain damage. Further evidence that supports augmenting cerebral blood flow as an effective strategy for preventing and treating cognitive brain dysfunction comes from experimental studies with omental transposition. The author proposes cervical spinal cord stimulation as a titratable, programmable extracranial neuromodulation technique to increase cerebral blood flow for the purposes of improving cognitive function and preventing cognitive deterioration in patients with dementias and neurodegenerative disorders.

  9. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    Directory of Open Access Journals (Sweden)

    Laxmaiah Manchikanti, Kimberly A. Cash, Carla D. McManus, Vidyasagar Pampati

    2013-01-01

    Full Text Available Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied.Study Design: A prospective evaluation.Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis.Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter.Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS, the Oswestry Disability Index 2.0 (ODI, employment status, and opioid intake with assessment at 3, 6

  10. Craniofacial and Cervical Morphology Related to Sagittal Spinal Posture in Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Emil Segatto

    2014-01-01

    Full Text Available Studies on the relationship between body posture and craniofacial parameters often focus on the cervical spine. Thus, less attention has been paid to the morphology of the vertebra C2 that serves as both a structural and functional link between the craniofacial area and the other part of the spine. The objective of this study was to assess the relation of craniofacial features to certain morphological and positional characteristics of the cervical vertebrae and the spine during growth. We determined body posture indices for 69 children and adolescents by means of a radiation-free method (rasterstereography. The morphological and positional analysis of the craniofacial area and the cervical vertebrae was based on standardized lateral X-ray cephalograms. Medium to strong correlations were found between body posture, C2 morphology, and craniofacial parameters. We found significant correlations between the C2 dens axis height and maxillary indices as well as between the C2 dens axis inclination and cephalometrical values of the mandibular area. Similarly the correlation between the C2 dens axis inclination and the postural index flèche cervicale was highly significant (P<0.05, r=0.333. These results suggest that morphological features of the odontoid process may serve as valuable predictive markers in interdisciplinary orthopedic-orthodontic diagnostics.

  11. Craniofacial and cervical morphology related to sagittal spinal posture in children and adolescents.

    Science.gov (United States)

    Segatto, Emil; Segatto, Angyalka; Braunitzer, Gábor; Kirschneck, Christian; Fanghänel, Jochen; Danesh, Gholamreza; Lippold, Carsten

    2014-01-01

    Studies on the relationship between body posture and craniofacial parameters often focus on the cervical spine. Thus, less attention has been paid to the morphology of the vertebra C2 that serves as both a structural and functional link between the craniofacial area and the other part of the spine. The objective of this study was to assess the relation of craniofacial features to certain morphological and positional characteristics of the cervical vertebrae and the spine during growth. We determined body posture indices for 69 children and adolescents by means of a radiation-free method (rasterstereography). The morphological and positional analysis of the craniofacial area and the cervical vertebrae was based on standardized lateral X-ray cephalograms. Medium to strong correlations were found between body posture, C2 morphology, and craniofacial parameters. We found significant correlations between the C2 dens axis height and maxillary indices as well as between the C2 dens axis inclination and cephalometrical values of the mandibular area. Similarly the correlation between the C2 dens axis inclination and the postural index flèche cervicale was highly significant (P orthodontic diagnostics.

  12. Craniofacial and Cervical Morphology Related to Sagittal Spinal Posture in Children and Adolescents

    Science.gov (United States)

    Segatto, Angyalka; Braunitzer, Gábor

    2014-01-01

    Studies on the relationship between body posture and craniofacial parameters often focus on the cervical spine. Thus, less attention has been paid to the morphology of the vertebra C2 that serves as both a structural and functional link between the craniofacial area and the other part of the spine. The objective of this study was to assess the relation of craniofacial features to certain morphological and positional characteristics of the cervical vertebrae and the spine during growth. We determined body posture indices for 69 children and adolescents by means of a radiation-free method (rasterstereography). The morphological and positional analysis of the craniofacial area and the cervical vertebrae was based on standardized lateral X-ray cephalograms. Medium to strong correlations were found between body posture, C2 morphology, and craniofacial parameters. We found significant correlations between the C2 dens axis height and maxillary indices as well as between the C2 dens axis inclination and cephalometrical values of the mandibular area. Similarly the correlation between the C2 dens axis inclination and the postural index flèche cervicale was highly significant (P < 0.05, r = 0.333). These results suggest that morphological features of the odontoid process may serve as valuable predictive markers in interdisciplinary orthopedic-orthodontic diagnostics. PMID:25276804

  13. Ependyma of the central canal of the rat spinal cord: a light and transmission electron microscopic study.

    Science.gov (United States)

    Bruni, J E; Reddy, K

    1987-06-01

    Ependymal cells of the rat central canal were examined with a view to identifying features that distinguish them regionally and from their counterparts elsewhere in the ventricular system. The results revealed that the lining consisted for the most part of a pseudostratified layer of uniformly organised cuboidal to columnar ependymal cells present in largest numbers in lumbar and sacral segments and in the conus. Two cell variants were identified on the basis of the presence or absence of a radially directed cytoplasmic process originating from the base of the cell. The tanycytic form of ependymal cell was encountered along the entire length of the central canal but with increased frequency in caudalmost segments. Ependymal cells were largely similar in ultrastructural appearance along the length of the cord. Although they were also similar in appearance and orientation to their counterparts in the ventricles they did exhibit some unique features. The most notable were the prominent junctional complexes and associated filaments present along the lateral border of the cells near their apex and the abundance of intermediate filaments in tanycytes. The central canal of the filum differed most markedly from other segments of the cord and resembled in structure the primitive ependymal tube of the caudal cord in lower vertebrates. Ependymal cells of the cord were not sufficiently dissimilar morphologically from their counterparts in the ventricles to account for differences in proliferative capacity in response to localised injury. A factor that merits further study is the difference in numbers of tanycyte ependymal cells in the two locations for they may be the reactive elements that proliferate in response to injury.

  14. Analyse of 18 cases with cervical injury without fracture and dislocation%无骨折脱位型颈髓损伤18例分析

    Institute of Scientific and Technical Information of China (English)

    孟庆波; 刘俊山; 项永胜

    2003-01-01

    @@ BACKGROUND: Traditionaly , operation should not be performed on patients suffered from cervical injury without fracture and dislocation during rehabilitation or patients with complete paralysis. Dang Gengting suggested that although external force resulting cervical injury is slight, fracture and dislocation are rare, spinal damage is severe. So, doctors should consider risk factors of vertebral canal affecting spinal cord. Acute nerve and spinal injury, for example, will progress into chronic spinal disease or nerve root disease if not properly managed. So, once diagnosis was confirmed, traction, mobilization should be carried out to prevent other injury. Treatment protocol should be determined according to type of injury. If object increasing pressure, operation should be done to remove pressure. Additionaly, stability of cervical cord must be ensured.

  15. Effect of Fujian tablet on the expression of Nogo-A mRNA in the cervical spinal cord of middle cerebral artery occlusion model rats

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Inhibiting the expression of Nogo-A in cervical spinal cord by use of interaction of antigen and antibody can help the remodeling of corticospinal projection of focal cerebral ischemia model rats to facilitate neurological recovery, which provides a new possible mechanism for drugs to promote neurological recovery. However, the effects of drugs on the expression of Nogo-A in cervical spinal cord are still unclear.OBJECTIVE: To observe the effect of Fujian tablet on the expression of Nogo-A mRNA in cervical spinal cords of middle cerebral artery occlusion (MCAO) rats, and to investigate the possible regulatory effect of Fujian tablet on the regenerated microenvironment of spinal conduction bundle.DESIGN: A randomized and controlled trial taking Wistar rats as experimental animals.SETTING: Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine.MATERIALS: This experiment was carried out in the laboratory of Shandong Academy of Medical Science between June 2005 and July 2006. A total of 40 healthy male Wistar rats, aged 12 weeks, weighing 250 -300 g, were provided by the Experimental Animal Center of Shandong University. Fujian tablets (main components: Heshouwu, Yinyanghuo, etc) were provided by office of Pharmaceutics of Shandong University of traditional Chinese medicine. Nogo-A detection kit was provided by Wuhan Boster Biotechnology Co.,Ltd.,and batch number was 040309009. This experiment was approved by Local Animal Ethics Committee.METHODS: Forty male rats were randomly divided into 4 groups, with 10 in each: normal group,sham-operation group, model group and administration group. Rats in the administration group and model group were subjected to MCAO. Rats in the sham-operation group underwent the same craniotomy, and their middle cerebral arteries (MCA) were not occluded. Rats in the normal group were untouched. Rats in administration group were intragastrically administrated with the solution of Fujian

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

    Science.gov (United States)

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

    2013-01-01

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

  17. A primary spinal extradural atypical teratoid/rhabdoid tumor of the cervical spine with bony involvement.

    Science.gov (United States)

    Xin, Xiaoyan; Zhu, Bin; Shen, Jingtao; Tian, Chuanshuai; Fan, Xiangshan; Liu, Bao-rui

    2014-05-01

    Primary spinal atypical teratoid/rhabdoid tumors are extremely rare and most commonly occur as intramedural or extramedural intradural. The location of extradural type is rarely reported. A 10-year-old girl presented with a 2-month history of nape pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an extradural tumor from C2-C5 with bony destruction of the C3 vertebral body. Subtotal removal of the tumor was performed and atypical teratoid/rhabdoid tumor was proven histologically. But 2 months after surgery, the neck pain became worse. There were metastasic lesions in bilateral lung fields and multiple enlarged lymph nodes around the carotid sheath. She died 8 months after the initial symptoms. The present case is the third detailed report of spinal extradural. We describe the CT and MRI findings of this case and review the literature describing this rare disease.

  18. Dimensions of the spinal canal in individuals symptomatic and non-symptomatic for sciatica: A CT study

    Energy Technology Data Exchange (ETDEWEB)

    Wilmink, J.T.; Korte, J.H.; Penning, L.

    1988-12-01

    Measurements obtained in 50 spinal CT studies of patients referred for suspected lumbosacral nerve root compression, were compared to those of a group of 30 individuals asymptomatic in this respect, who had been referred for abdominal pathology. Transverse ligamentous interfacet and transverse dural dimensions were significantly reduced in the sciatica group, with usually normal interpedicular and sagittal dimensions ruling out idiopathic developmental stenosis. The borderline value for ligamentous interfacet distance (ILD) at L4-5 appeared to be 11 mm.

  19. MR imaging of spine and spinal canal neoplasms: value of Gd-DTPA contrast enhancement; Diagnostyka MR zmian nowotworowych kregoslupa i kanalu kregowego: rola wzmocnienia kontrastowego Gadolinium-DTPA

    Energy Technology Data Exchange (ETDEWEB)

    Paprzycki, W.; Gradzki, J.; Sosnowski, P.; Stajgis, M. [Osrodek Diagnostyki Obrazowej IR, Akademia Medyczna, Poznan (Poland)]|[Zaklad Neuroradiologii IR, Akademia Medyczna, Poznan (Poland)

    1994-12-31

    Value of Gadolinium-DTPA contrast enhancement in diagnosis of neoplastic diseases of spinal canal was estimated on the basis of retrospective analysis of MR examinations performed in 75 patients. The analyzed material consisted of 15 cases of intramedullary tumors (group 1.), 38 of subdural extramedullary (group 2.) and 22 extradural ones (group 3.). Contrast enhanced MR contributed significant information to the final diagnosis in all groups. The utmost significance of Gd-DTPA contrast enhancement was ascertained in group 1. Authors conclude that contrast enhancement with Gd-DTPA is indispensable in all these cases of spinal canal neoplasms, where non-contrast MR did not reveal pathologic changes in optimal manner. (author) 12 refs, 5 figs, 4 tabs

  20. Correlation between magnetic resonance T2 image signal intensity ratio and cell apoptosis in a rabbit spinal cord cervical myelopathy model

    Institute of Scientific and Technical Information of China (English)

    Ma Lei; Zhang Di; Chen Wei; Shen Yong; Zhang Yingze; Ding Wenyuan; Zhang Wei

    2014-01-01

    Background Cervical spondylotic myelopathy (CSM) is a common cause of disability in elderly patients.Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role in the pathology of myelopathy.Although changes in magnetic resonance imaging (MRI) T2 signal intensity ratio (SIR) are considered to be an indicator of CSM,little information is published supporting the correlation between changes in MRI signal and pathological changes.This study aims to testify the correlation between MRI T2 SIR changes and cell apoptosis using a CSM animal model.Methods Forty-eight rabbits were randomly assigned to four groups:one control group and three experimental chronic compression groups,with each group containing 12 animals.Chronic compression of the cervical spinal cord was implemented in the experimental groups by implanting a screw in the C3 vertebra.The control group underwent sham surgery.Experimental groups were observed for 3,6,or 9 months after surgery.MRI T2-weighted SIR Tarlov motor scores and cortical somatosensory-evoked potentials (CSEPs) were periodically monitored.At each time point,rabbits from one group were sacrificed to determine the level of apoptosis by histology (n=6) and Western blotting (n=6).Results Tarlov motor scores in the compression groups were lower at all time points than the control group scores,with the lowest score at 9 months (P <0.001).Electrophysiological testing showed a significantly prolonged latency in CSEP in the compression groups compared with the control group.All rabbits in the compression groups showed higher MRI T2 SIR in the injury epicenter compared with controls,and higher SIR was also found at 9 months compared with 3 or 6 months.Histological analysis showed significant apoptosis in the spinal cord tissue in the compression groups,but not in the control group.There were significant differences in apoptosis degree over time (P <0.001),with the 9-month group displaying the

  1. Spinal cord injury without radiographic abnormality

    Directory of Open Access Journals (Sweden)

    Singh Anil

    2006-01-01

    Full Text Available Spinal cord injury without radiological abnormality is rare in adults. Below we present a case report of 20 yrs old male with isolated cervical cord injury, without accompanying vertebral dislocation or fracture involving the spinal canal rim. He fell down on plain and smooth ground while carrying 40 kg weight overhead and developed quadriparesis with difficulty in respiration. Plain radiographs of the neck revealed no fractures or dislocations. MRI showed bulky spinal cord and an abnormal hyper intense signal on the T2W image from C2 vertebral body level to C3/4 intervertebral disc level predominantly in the anterior aspect of the cord The patient was managed conservatively with head halter traction and invasive ventilatory support for the initial 7 days period in the ICU. In our patient recovery was good and most of the neurological deficit improved over 4 weeks with conservative management.

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

    Science.gov (United States)

    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

    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. 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. 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 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.

  3. Diffusion tensor magnetic resonance imaging may show abnormalities in the normal-appearing cervical spinal cord from patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Fernanda Miraldi

    2013-09-01

    Full Text Available Objective This study aims to evaluate “in vivo” the integrity of the normal-appearing spinal cord (NASC in patients with multiple sclerosis (MS compared to controls, using diffusion tensor MR imaging. Methods We studied 32 patients with MS and 17 without any neurologic disorder. Fractional anisotropy (FA, axial diffusivity (AD, radial diffusivity (RD and mean diffusivity (MD were calculated within regions of interest at C2 and C7 levels in the four columns of the spinal cord. Results At C2, FA value was decreased in MS patients. Besides, RD value was higher in MS than in controls. At C7, MD values were increased in MS. Conclusion The NASC in the right column of the cervical spinal cord showed abnormal FA, RD and MD values, which is possibly related to demyelination, since the FA abnormality was related to the RD and not to the AD.

  4. The Impact of Spinal Cord Nerve Roots and Denticulate Ligaments on Cerebrospinal Fluid Dynamics in the Cervical Spine

    Science.gov (United States)

    Heidari Pahlavian, Soroush; Yiallourou, Theresia; Tubbs, R. Shane; Bunck, Alexander C.; Loth, Francis; Goodin, Mark; Raisee, Mehrdad; Martin, Bryn A.

    2014-01-01

    Cerebrospinal fluid (CSF) dynamics in the spinal subarachnoid space (SSS) have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM), and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL), have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (∼6 mm). Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS. PMID:24710111

  5. The impact of spinal cord nerve roots and denticulate ligaments on cerebrospinal fluid dynamics in the cervical spine.

    Directory of Open Access Journals (Sweden)

    Soroush Heidari Pahlavian

    Full Text Available Cerebrospinal fluid (CSF dynamics in the spinal subarachnoid space (SSS have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM, and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL, have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (∼ 6 mm. Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS.

  6. The impact of spinal cord nerve roots and denticulate ligaments on cerebrospinal fluid dynamics in the cervical spine.

    Science.gov (United States)

    Heidari Pahlavian, Soroush; Yiallourou, Theresia; Tubbs, R Shane; Bunck, Alexander C; Loth, Francis; Goodin, Mark; Raisee, Mehrdad; Martin, Bryn A

    2014-01-01

    Cerebrospinal fluid (CSF) dynamics in the spinal subarachnoid space (SSS) have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM), and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL), have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (∼ 6 mm). Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS.

  7. Tumor de vaina de nervio periférico en el segmento cervical del canal vertebral en un perro

    OpenAIRE

    Francisco Carvallo Chaigneau; Emma Bermúdez Maldonado; Fernando Constantino Casas; Carlos Santoscoy Mejía; Luis I. Montesinos Ramírez; Celedonio Gómez Ruiz

    2007-01-01

    Se presentó el caso de un perro doméstico, macho, mestizo, de 6 años de edad, con tetraparesis progresiva no ambulatoria que propicia tetraplejia, atrofi a muscular, ausencia de la sensibilidad superfi cial e hiporrefl exia de miembros torácicos, aunado a dolor en la manipulación del cuello. La resonancia magnética del segmento cervical reveló pérdida de densidad del segmento medular a nivel de C6-C7. Se aplicó la eutanasia al animal y en el examen patológico, se confi rmó la presencia de tej...

  8. Long segmental thoracic intra-spinal canal epidural angiolipoma and review of literature:1 case report%长节段胸椎管内硬膜外血管脂肪瘤一例报告

    Institute of Scientific and Technical Information of China (English)

    袁振超; 黄保华

    2016-01-01

    Objective To report a case with long segmental thoracic intra-spinal canal epidural angiolipoma. Methods Retrospective analysis was done on the data of a case with long segmental thoracic intra-spinal canal epidural angiolipoma treated in our hospital in Feburary. 2012. Results The patient was male, 46 years old. More than 10 years ago, the patient developed left lower extremity weakness without remarkable precipitating factors. Numbness was not obvious, walking became more difficult, often accompanied of left shoulder and lower back pain, left lower extremity weakness was gradually worsened. In the past 3 months, left lower limb weakness and difficulty in walking exacerbated, and were accompanied by the numbness on the left side of the body from the nipple. Examination showed tottering gait. He could walk with crutches, and his longest walking distance on the flat ground was 50 m. He could not climb up and walk down the stairs, and had reduced sensation on the left side of the body from the nipple downward. Left lower limb muscle atrophy existed. His left iliopsoas muscle strength was grade 3, left femoral quadriceps muscle strength was grade 3, extensor digitorum longus had a grade 4 strength. He had left knee tendon hyperreflexia. Babinski sign was ( + ) on the left and was ( - ) on the right, Hoffmann’s sign was ( - ) on the left andright. Thoracic and enhanced MRI examination revealed T1-9 long segment spinal canal space-occupying lesions. T1, T2-weighted images showed internal high signal mixed uneven images, while T2-weighted images had high signal intensity. There was left thoracic spinal cord compression, which was more dramatic at T4-5 levels. It was found intraoperatively that there was an epidural band-like mass at thoracic spinal canal at T1 to T9 levels, which was about 20 cm, dark red color, elastic, with clear boundary and rich blood supply, loose dural adhesions, easy to isolate. The dura and spinal cord at the corresponding section was obviously

  9. Effect of combined treadmill training and magnetic stimulation on spasticity and gait impairments after cervical spinal cord injury.

    Science.gov (United States)

    Hou, Jiamei; Nelson, Rachel; Nissim, Nicole; Parmer, Ronald; Thompson, Floyd J; Bose, Prodip

    2014-06-15

    Spasticity and gait impairments are two common disabilities after cervical spinal cord injury (C-SCI). In this study, we tested the therapeutic effects of early treadmill locomotor training (Tm) initiated at postoperative (PO) day 8 and continued for 6 weeks with injury site transcranial magnetic stimulation (TMSsc) on spasticity and gait impairments after low C6/7 moderate contusion C-SCI in a rat model. The combined treatment group (Tm+TMSsc) showed the most robust decreases in velocity-dependent ankle torques and triceps surae electromyography burst amplitudes that were time locked to the initial phase of lengthening, as well as the most improvement in limb coordination quantitated using three-dimensional kinematics and CatWalk gait analyses, compared to the control or single-treatment groups. These significant treatment-associated decreases in measures of spasticity and gait impairment were also accompanied by marked treatment-associated up-regulation of dopamine beta-hydroxylase, glutamic acid decarboxylase 67, gamma-aminobutyric acid B receptor, and brain-derived neurotrophic factor in the lumbar spinal cord (SC) segments of the treatment groups, compared to tissues from the C-SCI nontreated animals. We propose that the treatment-induced up-regulation of these systems enhanced the adaptive plasticity in the SC, in part through enhanced expression of pre- and postsynaptic reflex regulatory processes. Further, we propose that locomotor exercise in the setting of C-SCI may decrease aspects of the spontaneous maladaptive segmental and descending plasticity. Accordingly, TMSsc treatment is characterized as an adjuvant stimulation that may further enhance this capacity. These data are the first to suggest that a combination of Tm and TMSsc across the injury site can be an effective treatment modality for C-SCI-induced spasticity and gait impairments and provided a pre-clinical demonstration for feasibility and efficacy of early TMSsc intervention after C-SCI.

  10. Reliable volumetry of the cervical spinal cord in MS patient follow-up data with cord image analyzer (Cordial).

    Science.gov (United States)

    Amann, Michael; Pezold, Simon; Naegelin, Yvonne; Fundana, Ketut; Andělová, Michaela; Weier, Katrin; Stippich, Christoph; Kappos, Ludwig; Radue, Ernst-Wilhelm; Cattin, Philippe; Sprenger, Till

    2016-07-01

    Spinal cord (SC) atrophy is an important contributor to the development of disability in many neurological disorders including multiple sclerosis (MS). To assess the spinal cord atrophy in clinical trials and clinical practice, largely automated methods are needed due to the sheer amount of data. Moreover, using these methods in longitudinal trials requires them to deliver highly reliable measurements, enabling comparisons of multiple data sets of the same subject over time. We present a method for SC volumetry using 3D MRI data providing volume measurements for SC sections of fixed length and location. The segmentation combines a continuous max flow approach with SC surface reconstruction that locates the SC boundary based on image voxel intensities. Two cutting planes perpendicular to the SC centerline are determined based on predefined distances to an anatomical landmark, and the cervical SC volume (CSCV) is then calculated in-between these boundaries. The development of the method focused on its application in MRI follow-up studies; the method provides a high scan-rescan reliability, which was tested on healthy subject data. Scan-rescan reliability coefficients of variation (COV) were below 1 %, intra- and interrater COV were even lower (0.1-0.2 %). To show the applicability in longitudinal trials, 3-year follow-up data of 48 patients with a progressive course of MS were assessed. In this cohort, CSCV loss was the only significant predictor of disability progression (p = 0.02). We are, therefore, confident that our method provides a reliable tool for SC volumetry in longitudinal clinical trials.

  11. MR imaging of compressive cervical myelopathy after surgery; High signal intensity of the spinal cord on T2 weighted images

    Energy Technology Data Exchange (ETDEWEB)

    Mimura, Fumitoshi; Fujiwara, Kazuhisa; Otake, Shoichiro (Tenri Hospital, Nara (Japan)) (and others)

    1990-06-01

    We reviewed the MR images of 32 patients with cervical myelopathy, showing lesions of high signal intensity in the spinal cord on the sagittal T2 weighted images (T2WI) after surgery: 16 with ossification of posterior longitudinal ligament (OPLL); 9 with spondylosis; 4 with disc herniation and 3 with trauma. All images were obtained on a superconducting 1.5 Tesla system. The lesions were classified into five groups, according to the shape and grade of signal intensity on the sagittal T2WI: (I) oval-shaped lesion of signal intensity less brighter than CSF with blurred margin, (II) longitudinal linear-shaped lesion of signal intensity similar to CSF, (III) spindle-shaped lesion of signal intensity similar to CSF, (IV) round-shaped lesion of signal intensity similar to CSF, and (V) mixed-types lesions which consisted of group I and II. The present study was summarized as follows: Oval-shaped lesions were seen in the cases of disc herniation and spondylosis with relatively short duration of the symptom, presumptively with relatively short duration of the symptom, presumptively indicative of edema. Most cases of OPLL and spondylosis showed linear-shaped lesions, suggesting necrosis and/or cavitations of the central gray matter. One case of spondylosis developed a spindle-shaped lesion, implicating syringomyelia. Round-shaped lesions were seen in the cases of spinal trauma, suggesting postraumatic cyst. In a case of mixed-typed lesion examined pre- and postoperatively, only an oval-shaped lesion decreased in size after surgery. (author).

  12. Reduced field-of-view DTI segmentation of cervical spine tissue.

    Science.gov (United States)

    Tang, Lihua; Wen, Ying; Zhou, Zhenyu; von Deneen, Karen M; Huang, Dehui; Ma, Lin

    2013-11-01

    The number of diffusion tensor imaging (DTI) studies regarding the human spine has considerably increased and it is challenging because of the spine's small size and artifacts associated with the most commonly used clinical imaging method. A novel segmentation method based on the reduced field-of-view (rFOV) DTI dataset is presented in cervical spinal canal cerebrospinal fluid, spinal cord grey matter and white matter classification in both healthy volunteers and patients with neuromyelitis optica (NMO) and multiple sclerosis (MS). Due to each channel based on high resolution rFOV DTI images providing complementary information on spinal tissue segmentation, we want to choose a different contribution map from multiple channel images. Via principal component analysis (PCA) and a hybrid diffusion filter with a continuous switch applied on fourteen channel features, eigen maps can be obtained and used for tissue segmentation based on the Bayesian discrimination method. Relative to segmentation by a pair of expert readers, all of the automated segmentation results in the experiment fall in the good segmentation area and performed well, giving an average segmentation accuracy of about 0.852 for cervical spinal cord grey matter in terms of volume overlap. Furthermore, this has important applications in defining more accurate human spinal cord tissue maps when fusing structural data with diffusion data. rFOV DTI and the proposed automatic segmentation outperform traditional manual segmentation methods in classifying MR cervical spinal images and might be potentially helpful for detecting cervical spine diseases in NMO and MS.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

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

    2016-02-15

    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 24h 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.

  15. Effect of a robotic rehabilitation device on upper limb function in a sub-acute cervical spinal cord injury population.

    Science.gov (United States)

    Zariffa, José; Kapadia, Naaz; Kramer, John L K; Taylor, Philippa; Alizadeh-Meghrazi, Milad; Zivanovic, Vera; Willms, Rhonda; Townson, Andrea; Curt, Armin; Popovic, Milos R; Steeves, John D

    2011-01-01

    Robotic rehabilitation devices have been suggested as a tool to increase the amount of rehabilitation delivered after a neurological injury. Clinical robotic rehabilitation studies of the upper extremity have generally focused on stroke survivors. We present the results of a multi-center pilot study where an upper-limb robotic rehabilitation device (Armeo Spring®, Hocoma AG) was incorporated into the rehabilitation program of 12 subjects with sub-acute cervical spinal cord injury (motor level C4-C6, AIS A-D). Outcomes were measured using two tests of upper extremity function: ARAT and GRASSP. The change in scores for the arm receiving the Armeo training were not statistically significant when compared to the arm not receiving the Armeo training at discharge from therapy and over follow up assessments (8.7 +/- 2.9 compared to 7.4 +/- 2.5 for ARAT at discharge, p = 0.98, and 13.0 +/- 3.2 compared to 13.3 +/- 3.3 for GRASSP at discharge, p = 0.69). Nevertheless, subjects with some minimal (partial) hand function at baseline had a significantly larger increase in GRASSP scores than subjects with no minimal hand function preserved at baseline (19.3 +/- 2.4 compared to 6.6 +/- 4.7, p = 0.02). This suggests that the initial functional capabilities of patients can influence the benefits measured after robotic rehabilitation training and heterogeneous subject populations should be avoided in early phase studies. © 2011 IEEE

  16. Intramedullary spinal cord primitive neuroectodermal tumor presenting with hydrocephalus.

    Science.gov (United States)

    Alexiou, George A; Siozos, George; Stefanaki, Kalliopi; Moschovi, Maria; Prodromou, Neofytos

    2013-02-01

    Spinal primitive neuroectodermal tumors are exceedingly rare. Herewith, we present the first case of an intramedullary spinal cord tumor associated with hydrocephalus in a 2-month-old boy that presented with left hemiparesis. The patient had been diagnosed on prenatal ultrasound with enlarged ventricular system. At his current admission, a brain magnetic resonance imaging (MRI) revealed hydrocephalus and an intramedullary lesion extending from the second cervical to the first thoracic vertebrae. Dissemination of the tumor was revealed intracranially and in the spinal canal. After a ventriculoperitoneal shunt placement a radical resection of the tumor was performed, however some small tumor remnants could not be safely removed. Postoperative there was no neurologic deterioration. The tumor was diagnosed as a central nervous system primitive neuroectodermal tumor (World Health Organization grade IV). Spinal intramedullary primitive neuroectodermal tumors are extremely rare. In such rare tumors, multiinstitutional studies are needed for treatment guidelines to be established.

  17. MiR-21 promotes fibrosis and hypertrophy of ligamentum flavum in lumbar spinal canal stenosis by activating IL-6 expression.

    Science.gov (United States)

    Sun, Chao; Tian, Jiwei; Liu, Xinhui; Guan, Guoping

    2017-08-26

    The molecular mechanism underlying the fibrosis of ligamentum flavum(LF) in patients with lumbar spinal canal stenosis(LSCS) remains unknown. MicroRNAs are reported to play important roles in regulating fibrosis in different organs. The present study aimed to identify fibrosis related miR-21 expression profile and investigate the pathological process of miR-21 in the fibrosis of LF hypertrophy and associated regulatory mechanisms. 15 patients with LSCS underwent surgical treatment were enrolled in this study. For the control group, 11 patients with lumbar disc herniation(LDH) was included. The LF thickness was measured on MRI. LF samples were obtained during the surgery. Fibrosis score was assessed by Masson's trichrome staining. The expression of miR-21 in LF tissues were determined by RT-PCR. Correlation among LF thickness, fibrosis score, and miR-21 expression was analyzed. In addition, Lentiviral vectors for miR-21 mimic were constructed and transfected into LF cells to examine the role of miR-21 in LF fibrosis. Types I and III collagen were used as indicators of fibrosis. IL-6 expression in LF cells after transfection was investigated by RT-PCR and ELISA. Patients in two groups showed similar outcomes regarding age, gender, level of LF tissue. The thickness and fibrosis score of LF in the LSCS group were significantly greater than those in LDH group (all P hypertrophy. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. The structure and development of avian lumbosacral specializations of the vertebral canal and the spinal cord with special reference to a possible function as a sense organ of equilibrium.

    Science.gov (United States)

    Necker, R

    2005-08-01

    The avian lumbosacral vertebral column and spinal cord show a number of specializations which have recently been interpreted as a sense organ of equilibrium. This sense organ is thought to support balanced walking on the ground. Although most of the peculiar structures have been described previously, there was a need to reevaluate the specializations with regard to the possible function as a sense organ. Specializations were studied in detail in the adult pigeon. The development of the system was studied both in the pigeon (semiprecocial at hatching) and in the chicken (precocial). Specializations in the vertebral canal consist of a considerable enlargement, which is not due to an increase in the size of the spinal nervous tissue, but to a large glycogen body embedded in a dorsal rhomboid sinus. The dorsal wall of the vertebral canal shows segmented bilateral dorsal grooves, which are covered by the meninges towards the lumen of the vertebral canal leaving openings in the midline and laterally. This results in a system of lumbosacral canals which look and may function similar to the semicircular canals in the inner ear. Laterally these canals open above ventrolateral protrusions or accessory lobes of the spinal cord which contain neurons. There are large subarachnoidal cerebrospinal fluid spaces, lateral and ventral to the accessory lobes. Movement of this fluid is thought to stimulate the lobes mechanically. As to the development of avian lumbosacral specializations, main attention was given to the organization of the lobes and the adjacent fluid spaces including the dorsal canals. In the pigeon the system is far from being adult-like at hatching but maturates rapidly after hatching. In the chicken the system looks already adult-like at hatching. The implications derived from the structural findings are discussed with regard to a possible function of the lumbosacral specializations as a sense organ of equilibrium. The adult-like organization in the newly hatched

  19. Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient.

    Science.gov (United States)

    Bodman, Alexa; Riordan, Margaret; Chin, Lawrence S

    2016-05-23

    Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient's history and MRI findings, a spinal epidural abscess was found during surgery. The patient underwent laminectomy and instrumented fusion with successful treatment of her infection.

  20. Radilogic evaluation of pedicle lumbar and spinal canal dimensions in north-west of Iran using computed tomography

    Directory of Open Access Journals (Sweden)

    Lotfinia I

    2010-05-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Pedicular screws are currently the gold standard of internal fixation of spinal column. Pedicular screws have their own complications, however the surgeon should be aware of morphometery of pedicles, as well as the anatomy of surrounding neural structures to minimize these risks. No national study has ever examined the physical characteristics of lumbar pedicles and this study is unique for this purpose."n"nMethods: This study covers the patients undergoing lumbar spinal CT-scanning due to variable causes. 25 vertebrae were selected in either gender, 18 years or older and E-Film computer software was employed to measure different diameters of pedicle and the results were analyzed with p≤0.05 regarded as significant."n"nResults: L5 pedicle was the widest (16.8 mm, while L1 was the narrowest (8.25 mm. this figure was 8.82, 10.48 and 12.86 mm for L2, L3, L4 respectively. Longitudinal depth of pedicle was 47.98, 48.68, 50.42, 48.32 and 47.8 mm for L1, L2, L3, L4, L5 respectively. Statistically significant differences were found between some dimensions detected in our study and similar studies."n"nConclusions: The advantages of pedicular screws and rods to stabilize spinal column are well known. To avoid

  1. Persistent at-level thermal hyperalgesia and tactile allodynia accompany chronic neuronal and astrocyte activation in superficial dorsal horn following mouse cervical contusion spinal cord injury.

    Science.gov (United States)

    Watson, Jaime L; Hala, Tamara J; Putatunda, Rajarshi; Sannie, Daniel; Lepore, Angelo C

    2014-01-01

    In humans, sensory abnormalities, including neuropathic pain, often result from traumatic spinal cord injury (SCI). SCI can induce cellular changes in the CNS, termed central sensitization, that alter excitability of spinal cord neurons, including those in the dorsal horn involved in pain transmission. Persistently elevated levels of neuronal activity, glial activation, and glutamatergic transmission are thought to contribute to the hyperexcitability of these dorsal horn neurons, which can lead to maladaptive circuitry, aberrant pain processing and, ultimately, chronic neuropathic pain. Here we present a mouse model of SCI-induced neuropathic pain that exhibits a persistent pain phenotype accompanied by chronic neuronal hyperexcitability and glial activation in the spinal cord dorsal horn. We generated a unilateral cervical contusion injury at the C5 or C6 level of the adult mouse spinal cord. Following injury, an increase in the number of neurons expressing ΔFosB (a marker of chronic neuronal activation), persistent astrocyte activation and proliferation (as measured by GFAP and Ki67 expression), and a decrease in the expression of the astrocyte glutamate transporter GLT1 are observed in the ipsilateral superficial dorsal horn of cervical spinal cord. These changes have previously been associated with neuronal hyperexcitability and may contribute to altered pain transmission and chronic neuropathic pain. In our model, they are accompanied by robust at-level hyperaglesia in the ipsilateral forepaw and allodynia in both forepaws that are evident within two weeks following injury and persist for at least six weeks. Furthermore, the pain phenotype occurs in the absence of alterations in forelimb grip strength, suggesting that it represents sensory and not motor abnormalities. Given the importance of transgenic mouse technology, this clinically-relevant model provides a resource that can be used to study the molecular mechanisms contributing to neuropathic pain

  2. Laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: A retrospective study.

    Science.gov (United States)

    Zhou, Hua; Liu, Zhong-Jun; Wang, Shao-Bo; Pan, Sheng-Fa; Yan, Ming; Zhang, Feng-Shan; Sun, Yu

    2016-09-01

    Although several studies report various treatment solutions for cervical spondylotic myelopathy in patients with athetoid cerebral palsy, long-term follow-up studies are very rare. None of the reported treatment solutions represent a gold standard for this disease owing to the small number of cases and lack of long-term follow-up. This study aimed to evaluate the outcomes of laminoplasty with lateral mass screw fixation to treat cervical spondylotic myelopathy in patients with athetoid cerebral palsy from a single center.This retrospective study included 15 patients (9 male patients and 6 female patients) with athetoid cerebral palsy who underwent laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy at our hospital between March 2006 and June 2010. Demographic variables, radiographic parameters, and pre- and postoperative clinical outcomes determined by the modified Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were assessed.The mean follow-up time was 80.5 months. Developmental cervical spinal canal stenosis (P = 0.02) and cervical lordosis (P = 0.04) were significantly correlated with lower preoperative modified JOA scores. The mean modified JOA scores increased from 7.97 preoperatively to 12.1 postoperatively (P cerebral palsy. Laminoplasty with lateral mass screw fixation is an effective treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy and developmental cervical spinal canal stenosis.

  3. Cervical Fracture Dislocation with Spinal Cord Injury Preoperative Observation and Nursing%颈椎骨折脱位合并颈髓损伤的术前观察和护理

    Institute of Scientific and Technical Information of China (English)

    赵勤娟; 蔡梅芬

    2014-01-01

    Objective To study the cervical spine fracture with cervical spinal injury patients combined observation and ef ective nursing methods, improve the cervical spine fracture with cervical spinal injury patients combined nursing level. Methods Analyzed and 1 case of cervical fracture with cervical spinal injury patients combined care, including observation patient's condition carefully, lie the hard bed, prevent infection, the nursing measures such as nutrition support. When merging spinal cord injury, notify the doctor according to the fracture type and line pressure parts needed surgery. Results The patients were cured by surgical treatment. Conclusion The observation patient's condition careful y, positive and appropriate nursing measures are effective treatment for cervical spine fracture dislocation with cervical spinal injury patients and improve the level of care.%目的探讨颈椎骨折脱位合并颈髓损伤患者的观察和有效护理方法,提高颈椎骨折脱位合并颈髓损伤患者的护理水平。方法分析探讨1例颈椎骨折脱位合并颈髓损伤患者的护理,包括严密观察病情变化,卧硬板床,防止感染,营养支持等护理措施。合并脊髓损伤时,通知医生根据骨折类型和受压部位行必要手术治疗。结果本例患者经手术治疗治愈出院。结论严密观察病情变化,采取积极适当的护理措施是有效治疗颈椎骨折脱位合并颈髓损伤患者及提高护理水平的重点。

  4. Clinical Trial of Human Fetal Brain-Derived Neural Stem/Progenitor Cell Transplantation in Patients with Traumatic Cervical Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Ji Cheol Shin

    2015-01-01

    Full Text Available In a phase I/IIa open-label and nonrandomized controlled clinical trial, we sought to assess the safety and neurological effects of human neural stem/progenitor cells (hNSPCs transplanted into the injured cord after traumatic cervical spinal cord injury (SCI. Of 19 treated subjects, 17 were sensorimotor complete and 2 were motor complete and sensory incomplete. hNSPCs derived from the fetal telencephalon were grown as neurospheres and transplanted into the cord. In the control group, who did not receive cell implantation but were otherwise closely matched with the transplantation group, 15 patients with traumatic cervical SCI were included. At 1 year after cell transplantation, there was no evidence of cord damage, syrinx or tumor formation, neurological deterioration, and exacerbating neuropathic pain or spasticity. The American Spinal Injury Association Impairment Scale (AIS grade improved in 5 of 19 transplanted patients, 2 (A → C, 1 (A → B, and 2 (B → D, whereas only one patient in the control group showed improvement (A → B. Improvements included increased motor scores, recovery of motor levels, and responses to electrophysiological studies in the transplantation group. Therefore, the transplantation of hNSPCs into cervical SCI is safe and well-tolerated and is of modest neurological benefit up to 1 year after transplants. This trial is registered with Clinical Research Information Service (CRIS, Registration Number: KCT0000879.

  5. Surgical treatment of lumbar spinal canal stenosis%腰椎椎管狭窄症的外科治疗

    Institute of Scientific and Technical Information of China (English)

    庞晓东; 彭宝淦; 杨洪; 李端明; 高春华

    2011-01-01

    目的 探讨腰椎椎管狭窄症外科治疗的临床疗效.方法 回顾性研究手术治疗退变性腰椎椎管狭窄患者共172例,其中10例有脊柱侧凸改变,22例I~Ⅱ度滑脱.单节段狭窄者90例,双节段狭窄者51例,3个节段狭窄者31例.采用单纯开窗减压者5例,后路融合固定者100例,后路椎间融合固定62例,Dynesys弹性内固定5例.临床疗效评定采用疼痛视觉模拟量表(visual analogue scale,VAS)评分,功能评分采用北美脊柱外科学会改良腰椎功能障碍指数(modified Oswestry low back pain disability questionaire index,MODI),从腰腿痛、生活自理、行走和举重物等10个方面评估患者腰椎的ODI分数.结果 所有病例随访6~72个月,平均50个月.术前腰腿痛平均评分为7.5分,术后3个月为3.2分,末次随访时为3.6分.术后3个月随访,MODI改善的优良率为94.3%;末次随访时优良率为87.6%.结论 对退行性腰椎椎管狭窄根据术前临床及影像学检查,有针对性地进行椎管减压或联合椎弓根螺钉内固定治疗均可取得较好疗效.%Objective To evaluate the clinical outcomes of surgical treatment for the patients with degenerative lumbar spinal stenosis ( DLSS ). Methods A retrospective study was conducted with a total of 172 DLSS patients who underwent decompression surgery with or without arthrodesis. The patients included 90 with single segment stenosis, 51 with double stenoses, and 31 with triple stenosis. Ten of the patients also had scoliosis and 22 had Ⅰ - Ⅱ degrees of spondylolysis. Five patients underwent simple decompression, 100 patients underwent posterior spinal fusion and fixation, 62 underwent posterior spinal fusion and fixation, and 5 underwent Dynesys semirigid fixation. The symptom relief and function improvement were assessed with a visual analogue scale ( VAS ) and modified Oswestry low back pain disability questionaire index ( MODI ), respectively. Results The patients were followed-up for 6

  6. Daily acute intermittent hypoxia elicits functional recovery of diaphragm and inspiratory intercostal muscle activity after acute cervical spinal injury

    Science.gov (United States)

    Navarrete-Opazo, A.; Vinit, S; Dougherty, B.J.; Mitchell, G.S.

    2015-01-01

    A major cause of mortality after spinal cord injury is respiratory failure. In normal rats, acute intermittent hypoxia (AIH) induces respiratory motor plasticity, expressed as diaphragm (Dia) and second external intercostal (T2 EIC) long-term facilitation (LTF). Dia (not T2 EIC) LTF is enhanced by systemic adenosine 2A (A2a) receptor inhibition in normal rats. We investigated the respective contributions of Dia and T2 EIC to daily AIH-induced functional recovery of breathing capacity with/without A2a receptor antagonist (KW6002, i.p.) following C2 hemisection (C2HS). Rats received daily AIH (dAIH: 10, 5-min episodes, 10.5% O2; 5-min normoxic intervals; 7 successive days beginning 7 days post-C2HS) or daily normoxia (dNx) with/without KW6002, followed by weekly (reminder) presentations for 8 weeks. Ventilation and EMGs from bilateral diaphragm and T2 EIC muscles were measured with room air breathing (21% O2) and maximum chemoreceptor stimulation (MCS: 7% CO2, 10.5% O2). dAIH increased tidal volume (Vt) in C2HS rats breathing room air (dAIH + vehicle: 0.47 ± 0.02, dNx + vehicle: 0.40 ± 0.01ml/100 g; p<0.05) and MCS (dAIH + vehicle: 0.83 ± 0.01, dNx + vehicle: 0.73 ± 0.01ml/100g; p<0.001); KW6002 had no significant effect. dAIH enhanced contralateral (uninjured) diaphragm EMG activity, an effect attenuated by KW6002, during room air breathing and MCS (p<0.05). Although dAIH enhanced contralateral T2 EIC EMG activity during room air breathing, KW6002 had no effect. dAIH had no statistically significant effects on diaphragm or T2 EIC EMG activity ipsilateral to injury. Thus, two weeks post-C2HS: 1) dAIH enhances breathing capacity by effects on contralateral diaphragm and T2 EIC activity; and 2) dAIH-induced recovery is A2a dependent in diaphragm, but not T2 EIC. Daily AIH may be a useful in promoting functional recovery of breathing capacity after cervical spinal injury, but A2a receptor antagonists (eg. caffeine) may undermine its effectiveness shortly after

  7. TREATMENT OF COMPRESSION SYNDROME OF CERVICAL POSTERIOR BRANCH BY CERVICAL NERVE BLOCK OUTSIDE VERTEBRAL CANAL AND MANIPULATION%椎管外颈神经阻滞加手法治疗颈神经后支卡压综合症

    Institute of Scientific and Technical Information of China (English)

    王希; 袁君君

    2001-01-01

    为探讨评价颈神经后支卡压综合症的诊治方法,根据YabukiS等对颈神经解剖学的研究,结合临床回顾性地分析了89例颈神经后支卡压综合症患者椎管外颈神经阻滞及手法治疗的效果。经平均6个月随访,结果47例单纯行颈神经阻滞术者,治愈38例,占80.1%;42例配合手法治疗者,全部治愈,占100%。组间比较(P<0.05),两组治愈率有明显差异。提示对病因不明及无明显神经体征的头、颈肩痛患者,应诊断为颈神经后支卡压综合症,与颈神经后支在关节突出部位的卡压有关。椎管外颈神经阻滞配合手法治疗,是一种针对性强、有效的治疗方法。%To explore the diagnostic and therapeutic methods of compressionsyndrome of cervical posterior branch, according to Yabukis'research about anatomy of cervical nerve, analyze retrospectively the therapeutic effect of compression syndrome of cervical posterior branch(89 cases) with cervical nerve block outside vertebral canal and manipulation. The average follow-up time was half a year. 38 out of 47 patients were cured with cervical nerve block and the curative rate was 80%, but other 42 patients were all cured with cervical nerve block outside vertebral canal and manipulation, the curative rate was 100%. There was a significant difference(P<0.05) in two groups. For head-neck-shoulder pain patients without clear cause and obvious nervous signs, they should be diagnosed as compression syndrome of cervical posterior branch, which related to being compressed of cervical posterior branch at the articular process. It was suggested that cervical nerve block outside vertebral canal with manipulation was a pointed and effective therapeutic method.

  8. The value of MR and other methods in evaluation of cervical spondylosis; Wartosc badania MR i innych metod obrazowania w ocenie stopnia zaawansowania spondylozy szyjnej

    Energy Technology Data Exchange (ETDEWEB)

    Konopka, M.; Rejniak, I.; Kluczewska, E.; Baron, J.; Collie, D. [Pracownia Rezonansu Magnetycznego, Instytut Pediatrii w Budowie, Katowice (Poland) and Zaklad Diagnostyki Obrazowej, Centrum Medyczne Ksztalcenia Podyplomowego, Centralny Szpital Kliniczny, Warsaw-Miedzylesie (Poland) and Western General Hospital, Edinburgh (United Kingdom)

    1995-12-31

    38 patients with clinical symptoms of myelopathy, radiculopathy and neck pain have undergone X-ray and MR examinations in order to estimate spinal canal and degenerative changes of cervical vertebral column. The correlation between degree of degenerative changes and myelopathy or radiculopathy or neck pain was established on MR. In patients with myelopathy advanced degeneration changes (2. and 3. degree) were observed more often than in radiculopathy and neck pain. Disorders of mobility and cervical spine instability were found in 50%. Focal changes with high signal on T2 images in cervical cord were found in 2 cases. (author) 17 refs, 4 figs , 7 tabs

  9. Clinical diagnosis analysis in 21 cases of spinal cord disease

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hong

    2000-01-01

    21 cases of spinal cord disease were clinically analyzed of which 14 cases were male. 7 female, aged from 30 to 69, weraged 50.9. This group contained 2 cases of consciusness dysfunction. 2l of sensational dysfunction. 19 of morion dysrunction, 11 of aotonomic nerve dysrunction, 2 of, sexual dysfunction. 2 of Brown-Sequrd syndrome. llhad been chrmcally sympromatic for more than two months. the other were of acute for sub acute onset. The segments of the diseases were found mainly at cervical and thoracic ones. to which more attention should be pazd clincally. The incidences of intramedullary lesions were a bit more than that of extramedullary ones. Of the 11 extramendullary cases, 8 arised srorn verteoral body (72.7%), of which 6 cases arisen form the intervertebral dies, or 75%. On which emphasis should be laid clinically Foci in brain and spinal cord were found synchronically in 5 cases (23.8%). They were Wernick cerebral disease, metastetic cerebral tumor, cerebral infarction, polioencephalomyelitis. So possibility of brain disease should also be considerod when diagnosing spinai cord disease, especially in stenosis of cervical canal. Oppressed spinal cord was accodiated with cerebellopontine angle tumor. Disease in brain was negiected because of concermng spinal cord disease and cerehellopontine angie giant meningiona was discovered 5 yeas laaer. There are several methods to diagnose spinal cord disease, including X-rays photography, CSF test, CT, and MRI, etc. X-rays photography should be used for involved vertebral body in lateral and P-A position at first when to suspect spinal cord disease. It should be avoided that neglecting X-rays photography and using CT or MRIfirst. It should be noted when taking segments examination by CT or MRI, thut the actual vertebral body is usually located 7'- 14 segments below the spinal cord involved. Otherwise, misdiagnosis would be resulted. 4 c ases of oppressive spinal cord disease of this group were treated with operating

  10. Colonização bacteriana do canal cervical em gestantes com trabalho de parto prematuro ou ruptura prematura de membranas Cervical bacterial colonization in women with preterm labor or premature rupture of membranes

    Directory of Open Access Journals (Sweden)

    Giuliane Jesus Lajos

    2008-08-01

    Full Text Available OBJETIVO: estudar a colonização bacteriana do canal cervical em gestantes com trabalho de parto prematuro ou com ruptura prematura de membranas. MÉTODOS: foram avaliadas 212 gestantes com trabalho de parto prematuro ou ruptura prematura de membranas. Na admissão hospitalar foram coletadas duas amostras do conteúdo endocervical e realizadas bacterioscopia e cultura em meios ágar sangue e ágar chocolate. Foram analisadas associações da colonização endocervical com infecção do trato urinário materno, corioamnionite, utilização de antibióticos, sofrimento fetal, prematuridade e infecção e óbito neonatais. RESULTADOS: a prevalência de colonização endocervical foi 14,2% (IC95%=9,5-18,9%, com resultados similares entre os casos com trabalho de parto prematuro ou ruptura prematura de membranas. O microorganismo mais prevalente na população estudada foi o estreptococo do grupo B (9,4%, sendo também isolados Candida sp, Streptococcus sp, Streptococcus pneumoniae, Escherichia coli e Enterococcus sp. Das bacterioscopias analisadas, os achados mais freqüentes foram baixa prevalência de bacilos de Döderlein e elevado número de leucócitos. Em mulheres colonizadas, houve maior prevalência de infecção do trato urinário (23,8 versus 5,4%; pPURPOSE: to study cervical colonization in women with preterm labor or premature rupture of membranes. METHODS: two hundred and twelve pregnant women with preterm labor or premature rupture of membranes were studied. Two cervical samples from each woman were collected and bacterioscopy and culture were performed. Association of cervical microorganisms and urinary tract infection, chorioamnionitis, fetal stress, antibiotic use, prematurity, neonatal infection, and neonatal death were evaluated. RESULTS: the prevalence of endocervical colonization was 14.2% (CI95%=9.5-18.9%, with similar results in preterm labor or premature rupture of membranes. Group B streptococcus was the most prevalent

  11. Effect of Alpha-1-Adrenergic Agonist, Midodrine for the Management of Long-Standing Neurogenic Shock in Patient with Cervical Spinal Cord Injury: A Case Report.

    Science.gov (United States)

    Kim, Taikwan; Jwa, Cheol Su

    2015-10-01

    We report a rare case of a 71-year-old male patient who had suffered from long-lasting neurogenic shock for 13 weeks after cervical spinal cord injury (SCI) caused by a bicycle accident. The neurogenic shock was resolved dramatically 2 weeks after the administration of alpha-1-adrenergic agonist, midodrine hydrochloride. In usual cases, neurogenic shock tends to improve between 2 and 6 weeks after SCI; however, in a few cases, the shock lasts for several months. In our case, spinal shock lasted for 13 weeks and exhibited very sensitive decline of blood pressure for even a slight decrease of dopamine despite recovered bulbospongiosus reflex. Three days after midodrine hydrochloride was added, hypotension improved dramatically. We discuss our rare case with pertinent literatures.

  12. Cine phase-contrast MRI measurement of CSF flow in the cervical spine: a pilot study in patients with spinal cord injury

    Science.gov (United States)

    Negahdar, MJ; Shakeri, M.; McDowell, E.; Wells, J.; Vitaz, T.; Harkema, S.; Amini, A.

    2011-03-01

    MRI velocimetry (also known as phase-contrast MRI) is a powerful tool for quantification of cerebrospinal fluid (CSF) flow in various regions of the brain and craniospinal junction and has been accepted as a diagnostic tool to assist with the diagnosis of certain conditions such as hydrocephalus and chiari malformations. Cerebrospinal fluid is continually produced in the ventricles of the brain, flows through the ventricular system and then out and around the brain and spinal cord and is reabsorbed over the convexity of the brain. Any disease process which either impedes the normal pattern of flow or restricts the area where flow occurs can change the pattern of these waveforms with the direction and velocity of flow being determined by the pressure transmitted from the pulsation of the heart and circulation of blood within the central nervous system. Therefore, we hypothesized that phase-contrast MRI could eventually be used as a diagnostic aid in determining the degree of spinal cord compression following injury to the cervical or thoracic spine. In this study, we examined CSF flow in 3 normal subjects and 2 subjects with non-acute injuries in the cervical spine using Cine phasecontrast MRI. CSF flow analysis was performed using an in-house developed software. The flow waveform was calculated in both normal subjects (n=3) as well as subjects with spinal cord injury in the cervical spine (n=2). The bulk flow at C2 was measured to be 0.30 +/- 0.05 cc, at 5 cm distal to C2, it was 0.19+/- 0.07 cc, and at 10 cm distal to C2, it was 0.17+/- 0.05 cc. These results were in good agreement with previously published results. In patients with spinal cord injury, at the site of injury in the cervical spine, bulk flow was found to be 0.08 +/- 0.12 cc, at 5 cm proximal to the site of injury it was found to be 0.18 +/- 0.07 cc, and at 5 cm distal to the site of injury, it was found to be 0.12 +/- 0.01 cc.

  13. Chronobiological aspects of changes in straight electro stimulation of spinal cord for treatment of neurological complications of cervical vertebrae osteochondro-sis

    Directory of Open Access Journals (Sweden)

    Chekhonatsky V.A.

    2012-06-01

    Full Text Available

    Research Goal was to study infuence of treatment seance time, disease duration, and age on effcacy of straight electrostimulation of spinal cord. Materials. Biorhythmological characteristics of optimal time choice for electrostimula-tion séance were studied based on the sample of 32 patients with cervical osteochondrosis, who were subjected to paracentetic electrodes placement on posterior part of spinal cord. Results. Group of patients used morning séance, demonstrated change of clinical manifestations severity in accordance to JOA scale from 8,4±0,2 to 12,8±0,3 points that formed 46,6 %. Séance during daylight hours helped to decrease clinical manifestations severity by 25,1 %; evening séance promoted reduction by 22,1 %. In patients under 40 the average percentage of decrease of posttreatment neurological symptomatology consisted 83,6±3,6 %, in patients aged 60 and upwards this index was 74,6±3,2 %. Decrease of myelopathy severity was marked in the following way: 1 – 4 years of disease duration — by 73,6±4,8 %, more than 10 years — 63,7±2,1 %; estimation was carried out using JOA scale. Conclusion. Maximum effect of straight elec-trostimulation of spinal cord was observed in the morning hours. Clinical effect of isolated use of straight electrostimula-tion of spinal cord in the complex of treating neurological symptoms of cervical vertebrae osteochondrosis decreases while disease duration extends. Effect of electrostimulation reduces in accordance with patients’ age; maximum positive results of this method can be achieved in 1 – 4 years of disease duration.

  14. Comparative review of computed tomography of the spinal column and conventional x-ray films

    Energy Technology Data Exchange (ETDEWEB)

    Shin, H.; Yamaura, A.; Horie, T.; Makino, H. (Chiba Univ. (Japan). School of Medicine)

    1982-04-01

    Computerized tomography (CT) of the cervical spinal column was carried out in 39 patients using a GE.CT/T or Toshiba TCT60A scanner. There were 22 cervical disk lesions, 4 spinal neoplasms, 5 narrow spinal canals with or without ossification of the posterior longitudinal ligament, 2 syringomyelias, 5 traumas, and one Arnold-Chiari malformation. In all the patients, tomography was done after conventional spinal X-ray studies. The correlation between the CT findings and conventional X-ray films revealed the excellent capability of the CT. The measurement of the midline sagittal diameter of the spinal canal in the patient with the narrowest canal in this series showed 7.4 mm when done by CT and 9.6 mm when done by the conventional plain film at the C/sub 5/ level. To ascertain the precise sagittal diameter of the cord itself, CT myelography is indispensable after the intrathecal injection of metrizamide A; metrizamide CT myelogram is useful in determining the nature of the disease, the risk of and best approach to surgery, and the evaluation after a surgical procedure. Although the range of motion of cervical joints and intervertebral foramen are visible with the conventional films, the size of the spinal tumors, the degree of bony change, and the tumor extension to the paraspinal connective tissue can be precisely demonstrated only by CT. A CT study of the spine is a simple procedure and is less likely to produce complication, even with a metrizamide CT myelogram, though there are certain limitations in the examination.

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

    Directory of Open Access Journals (Sweden)

    Guru Dutta Satyarthee

    2016-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    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

  17. Novel biodegradable α-TCP/poly(amino acid) composite artificial lamina following spinal surgery for prevention of intraspinal scar adhesion.

    Science.gov (United States)

    Ran, Bo; Song, Yue-Ming; Liu, Hao; Liu, Li-Min; Gong, Quan; Li, Tao; Zeng, Jian-Cheng; Yuan, Hai-Feng

    2011-12-01

    Biodegradable copolymer α-TCP/poly(amino acid) composite artificial lamina was prepared and used in goat cervical vertebra resection repair. Cervical 4 was removed by laminectomy, and a vertebra defect of 27 × 9 mm was made. α-TCP/poly(amino acid) composite artificial lamina was inserted in the test group. The efficiency of the copolymer during repair and reconstruction of the goats' vertebra was tested by using X-ray, CT scanning, and histological and biomechanical measurements. In the 24 weeks following the operation, the artificial lamina refrained from shifting, and no dural adhesion pressure was observed. In contrast, the control group suffered from infiltration of soft tissue in the spinal canal, dural pressure and α-TCP/poly(amino acid) degradation. In conclusion, α-TCP/poly(amino acid) composite artificial lamina can significantly prevent scar tissue from infiltrating the spinal canal.

  18. 颈椎过伸性脊髓损伤节段的相关性因素研究%Research on correlative factor of spinal segment distribution in cervical hyperextension injury

    Institute of Scientific and Technical Information of China (English)

    张永进; 何海潮; 吕晓强; 刘志英; 徐杰; 杜英勋; 贾连顺

    2010-01-01

    目的 探讨颈椎过伸性损伤的退变性因素、损伤节段的分布及其原因.方法 温州医学院附属东阳医院89例颈椎过伸性损伤患者进行回顾性分析,统计颈椎退行性病变、T2WI相脊髓高信号的位置及颜面部外伤的位置.结果 间盘突出58例,居首位;其后依次为后纵韧带骨化(8例)、发育性椎管狭窄(7例)及椎间盘突出+黄韧带肥厚(6例).单节段T2WI相脊髓高信号在椎间盘水平:C2~3者4例,额部外伤1例;C3~4者12例,额部外伤10例,颧部外伤1例;CA~5者12例,额部外伤5例,额部+颧部外伤1例,额部+下颌部外伤1例;C5~6者11例,额部外伤3例,颧部外伤3例,下颌部外伤2例.单节段脊髓高信号位置不在椎间盘水平4例,脊髓高信号在两个不连续节段10例,脊髓高信号超过2个节段2例,脊髓高信号超过3个节段6例.结论 椎间盘突出是颈椎过伸性损伤患者最多见的退变性因素,T2WI相脊髓高信号的水平与额面部撞击的部位相关,拐点的剪切力(inflection point shear force)合并(或)颈椎过伸的前后挤压力是颈椎过伸性损伤的机制.%Objective To discuss the degenerative factors, the spinal segment distribution, and the mechanism in hyperextension injury of cervical spine. Method Eighty-nine patients with hyperextension injury of cervical spine were retrospectively analyzed by observing the degenerativelesion, the spinal cord segment with high signal in T2WI, and the location of facial trauma. Results Fifty-eight cases showed the disc hemiation which was the most common lesion, followed by 8 cases showing the calcification of the posterior longitudinal ligament. Besides, 7 cases presented the developmental stenosis of spinal canal, and also, 6 cases showed disc hemiation combined with the yellow ligament hypertrophy. The intervertebral level of the spinal cord with high signal in T2WI were distributed as follows:4 cases were at C2/3, of which onesuffered the forehead trauma

  19. A PET/CT approach to spinal cord metabolism in amyotrophic lateral sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Cecilia [CNR Institute of Bioimages and Molecular Physiology, Milan, Section of Genoa (Italy); University of Genoa, Nuclear Medicine, IRCCS San Martino IST, and Depth of Health Science, Genoa (Italy); IRCCS AOU San Martino-IST, CNR Institute of Bioimages and Molecular Physiology, Section of Genoa, C/o Nuclear Medicine, Genoa (Italy); Cistaro, Angelina; Fania, Piercarlo [Positron Emission Tomography Centre IRMET, Affidea, Turin (Italy); Campi, Cristina; Perasso, Annalisa; Massone, Anna Maria [SPIN Institute, CNR, Genoa (Italy); Calvo, Andrea; Moglia, Cristina; Canosa, Antonio; Cammarosano, Stefania; Chio, Adriano [University of Turin, ALS Center, ' ' Rita Levi Montalcini' ' Department of Neuroscience, Turin (Italy); AUO Citta della Salute e della Scienza, Turin (Italy); Caponnetto, Claudia; Nobili, Flavio Mariano; Novi, Giovanni; Scialo, Carlo; Mancardi, Gianluigi [IRCCS San Martino IST, Department of Neuroscience, Genoa (Italy); DINOGMI University of Genoa, Genoa (Italy); Beltrametti, Mauro C. [University of Genoa, Department of Mathematics (DIMA), Genoa (Italy); Buschiazzo, Ambra; Pomposelli, Elena; Morbelli, Silvia; Sambuceti, Gianmario [University of Genoa, Nuclear Medicine, IRCCS San Martino IST, and Depth of Health Science, Genoa (Italy); Bagnara, Maria Claudia [IRCCS AOU San Martino-IST, Medical Physics unit, Genoa (Italy); Bruzzi, Paolo [IRCCS AOU San Martino-IST, Statistics and Epidemiology Unit, Genoa (Italy); Piana, Michele [SPIN Institute, CNR, Genoa (Italy); University of Genoa, Department of Mathematics (DIMA), Genoa (Italy)

    2016-10-15

    In amyotrophic lateral sclerosis, functional alterations within the brain have been intensively assessed, while progression of lower motor neuron damage has scarcely been defined. The aim of the present study was to develop a computational method to systematically evaluate spinal cord metabolism as a tool to monitor disease mechanisms. A new computational three-dimensional method to extract the spinal cord from {sup 18}F-FDG PET/CT images was evaluated in 30 patients with spinal onset amyotrophic lateral sclerosis and 30 controls. The algorithm identified the skeleton on the CT images by using an extension of the Hough transform and then extracted the spinal canal and the spinal cord. In these regions, {sup 18}F-FDG standardized uptake values were measured to estimate the metabolic activity of the spinal canal and cord. Measurements were performed in the cervical and dorsal spine and normalized to the corresponding value in the liver. Uptake of {sup 18}F-FDG in the spinal cord was significantly higher in patients than in controls (p < 0.05). By contrast, no significant differences were observed in spinal cord and spinal canal volumes between the two groups. {sup 18}F-FDG uptake was completely independent of age, gender, degree of functional impairment, disease duration and riluzole treatment. Kaplan-Meier analysis showed a higher mortality rate in patients with standardized uptake values above the fifth decile at the 3-year follow-up evaluation (log-rank test, p < 0.01). The independence of this value was confirmed by multivariate Cox analysis. Our computational three-dimensional method enabled the evaluation of spinal cord metabolism and volume and might represent a potential new window onto the pathophysiology of amyotrophic lateral sclerosis. (orig.)

  20. Cervical spine injuries in American football.

    Science.gov (United States)

    Rihn, Jeffrey A; Anderson, David T; Lamb, Kathleen; Deluca, Peter F; Bata, Ahmed; Marchetto, Paul A; Neves, Nuno; Vaccaro, Alexander R

    2009-01-01

    American football is a high-energy contact sport that places players at risk for cervical spine injuries with potential neurological deficits. Advances in tackling and blocking techniques, rules of the game and medical care of the athlete have been made throughout the past few decades to minimize the risk of cervical injury and improve the management of injuries that do occur. Nonetheless, cervical spine injuries remain a serious concern in the game of American football. Injuries have a wide spectrum of severity. The relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Recent data on American football suggest that approximately 0.2 per 100,000 participants at the high school level and 2 per 100,000 participants at the collegiate level are diagnosed with cervical cord neuropraxia. Characterized by temporary pain, paraesthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury. Stenosis of the spinal canal, whether congenital or acquired, is thought to predispose the athlete to cervical cord neuropraxia. Although quite rare, catastrophic neurological injury is a devastating entity referring to permanent neurological injury or death. The mechanism is most often a forced hyperflexion injury, as occurs when 'spear tackling'. The mean incidence of catastrophic neurological injury over the past 30 years has been approximately 0.5 per 100,000 participants at high school level and 1.5 per 100,000 at the collegiate level. This incidence has decreased significantly when compared with the incidence in the early 1970s. This decrease in the incidence of

  1. An Inquiry into Acupuncture Treatment on Cervical Vertebral Disease

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Introduction: The cervical vertebral diseases are the diseases of cervical osteoarticular and ligament hypertrophy that cause stenosis of vertebral canals and intervertebral foraminae and compression of nerve roots or cervical segments.

  2. Effects of orthotic therapeutic electrical stimulation in the treatment of patients with paresis associated with acute cervical spinal cord injury: a randomized control trial.

    Science.gov (United States)

    Iwahashi, K; Hayashi, T; Watanabe, R; Nishimura, A; Ueta, T; Maeda, T; Shiba, K

    2017-06-27

    A randomized controlled trial. To determine the effects of orthotic therapeutic electrical stimulation (TES) on the hand in patients with paresis associated with acute cervical spinal cord injury. Spinal Injuries Center, Fukuoka, Japan. The study included patients treated for spinal cord injuries (Frankel classification, grades B and C) at our institution within 1 week post injury between May 2011 and December 2014. The patients were allocated randomly to TES and control groups at the time of admission and underwent TES+conventional training or conventional training alone, respectively. Both hands of each patient were treated in the same way. The primary outcome was total passive motion (TPM) of the fingers (degrees). The secondary outcomes were edema (cm) and the upper-extremity motor scores of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). After randomization, outcomes were assessed at 1 week, 1 month and 3 months post injury in both groups. Twenty-nine individuals were assessed at 3 months (15, TES; 14, control). There were no significant between-group differences for TPM of the fingers, edema and upper-extremity motor scores at 1 week, 1 month and 3 months after injury, although TPM of the fingers tended to be lower in the control group. It is unclear from the results of this study whether TES has a therapeutic effect on TPM, edema or the upper-extremity motor score of the ISNCSCI. The results of this study provide useful data for future meta-analyses.Spinal Cord advance online publication, 27 June 2017; doi:10.1038/sc.2017.74.

  3. Design of COSMIC: a randomized, multi-centre controlled trial comparing conservative or early surgical management of incomplete cervical cord syndrome without spinal instability

    Directory of Open Access Journals (Sweden)

    Bartels Ronald HMA

    2013-01-01

    Full Text Available Abstract Background Incomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family. It is estimated that up to 25% of all traumatic spinal cord lesions belong to this category. The treatment for this type of spinal cord lesion is still subject of discussion. From a biological point of view early surgery could prevent secondary damage due to ongoing compression of the already damaged spinal cord. Historically, however, conservative treatment was propagated with good clinical results. Proponents for early surgery as well those favoring conservative treatment are still in debate. The proposed trial will contribute to the discussion and hopefully also to a decrease in the variability of clinical practice. Methods/Design A randomized controlled trial is designed to compare the clinical outcome of early surgical strategy versus a conservative approach. The primary outcome is clinical outcome according to mJOA. This also measured by ASIA score, DASH score and SCIM III score. Other endpoints are duration of the stay at a high care department (medium care, intensive care, duration of the stay at the hospital, complication rate, mortality rate, sort of rehabilitation, and quality of life. A sample size of 36 patients per group was calculated to reach a power of 95%. The data will be analyzed as intention-to-treat at regular intervals, but the end evaluation will take place at two years post-injury. Discussion At the end of the study, clinical outcomes between treatments attitudes can be compared. Efficacy, but also efficiency can be determined. A goal of the study is to determine which treatment will result in the best quality of life for the patients. This study will certainly contribute to more uniformity of treatment offered to patients with a special sort of spinal cord injury. Trial Registration Gov: NCT01367405

  4. Application of Laminoplasty of Pedicled Complex Replantation on Reconstruction of Spinal Canal at Degenerative Lumbar Spinal Stenosis%带蒂椎板复合体回植钛网固定在退变性腰椎管狭窄治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    肖睿; 李同相; 官清; 李兴波; 魏书一

    2015-01-01

    Objective To investigate the therapeutic effects of laminoplasty of pedicled complex replantation on recon-struction of spinal canal at lumbar spinal stenosis. Methods The involved segments were determinged by symptoms, clinical fea-tures and radiographic at the initial examination. 15patients with lumbar spinal stenosis were treated in our hospital. Each case was reserved bilateral facet joint,one or several vertebral lamina were cut by burr drill or micro-rongeur along the inner edge of bilateral facet joint,Superspinal and interspinal ligaments of one side were cut,then pedicelar vertehral lamina complex was retroflexed and intraspinal canal was exposured. After Lumbar spinal canal decompression,pedicelar vertebral lamina complex was replanted and ti-tanic mesh was fixated to reconstruct the integrity of vertebral canal and the stability of spinal column. Application VAS and ODI scoring method for subjective and objective evaluation of clinical curative effect before and after operation. Results The patients were followed up for 12 to 28 months[(13 ± 0. 5) months on average],during which no collapse of the replanted tissues or spinal canal stenosis occurred. Postoperative patients VAS and ODI score significantly higher than before,the difference was statistically sig-nificant(P<0. 05). Conclusion Retroflexing pedicelar vertebral plate complex and fixating with titanium plate in the lumbar spi-nal stenosis is simple,safe. The spinal column active naturelv without limit postoperatively,the technique can maintain the spinal col-umn good stability and protect the spinal column from degradation.%目的:探讨带蒂椎板复合体回植、钛网固定行椎管成形术治疗退行性腰椎管狭窄症的临床疗效。方法根据临床表现和影像学检查确定减压部位,对15例退行性腰椎管狭窄患者保留双侧关节突关节,采用磨钻或微型咬骨钳沿双侧关节突内侧缘打开一个或多个椎板,切断一端棘上和棘间韧

  5. Isolated subacute tuberculous spinal epidural abscess of the cervical spine: a brief report of a special case.

    Science.gov (United States)

    Alg, Varinder S; Demetriades, Andreas K; Naik, Sunil; Gunasekera, Lal

    2009-06-01

    A tuberculous spinal epidural abscess is seen rarely as a late complication of Pott's disease or in immunocompromised patients. Such abscesses in isolation are rare indeed and very uncommon in the developed and developing world. We report a patient with an isolated subacute tuberculous spinal epidural abscess without disc or vertebral involvement and no primary focus or risk factors associated with the development of spinal tuberculosis.

  6. Posttraumatic Stress Disorder After High-Dose-Rate Brachytherapy for Cervical Cancer With 2 Fractions in 1 Application Under Spinal/Epidural Anesthesia: Incidence and Risk Factors

    Energy Technology Data Exchange (ETDEWEB)

    Kirchheiner, Kathrin, E-mail: kathrin.kirchheiner@meduniwien.ac.at [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna (Austria); Czajka-Pepl, Agnieszka [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Ponocny-Seliger, Elisabeth [Department of Psychology, Sigmund Freud Private University Vienna, Vienna (Austria); Scharbert, Gisela; Wetzel, Léonore [Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Nout, Remi A. [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands); Sturdza, Alina [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Dimopoulos, Johannes C. [Metropolitan Hospital, Athens (Greece); Dörr, Wolfgang; Pötter, Richard [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna (Austria)

    2014-06-01

    Purpose: To investigate the psychological consequences of high-dose-rate brachytherapy with 2 fractions in 1 application under spinal/epidural anesthesia in the treatment of locally advanced cervical cancer. Methods and Materials: In 50 patients with locally advanced cervical cancer, validated questionnaires were used for prospective assessment of acute and posttraumatic stress disorder (ASD/PTSD) (Impact of Event Scale–Revision), anxiety/depression (Hospital Anxiety and Depression Scale), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Cervical Cancer 24), physical functioning (World Health Organization performance status), and pain (visual analogue scale), before and during treatment and 1 week and 3 months after treatment. Qualitative interviews were recorded in open format for content analysis. Results: Symptoms of ASD occurred in 30% of patients 1 week after treatment; and of PTSD in 41% 3 months after treatment in association with this specific brachytherapy procedure. Pretreatment predictive variables explain 82% of the variance of PTSD symptoms. Helpful experiences were the support of the treatment team, psychological support, and a positive attitude. Stressful factors were pain, organizational problems during treatment, and immobility between brachytherapy fractions. Conclusions: The specific brachytherapy procedure, as performed in the investigated mono-institutional setting with 2 fractions in 1 application under spinal/epidural anesthesia, bears a considerable risk of traumatization. The source of stress seems to be not the brachytherapy application itself but the maintenance of the applicator under epidural anesthesia in the time between fractions. Patients at risk may be identified before treatment, to offer targeted psycho-social support. The patients' open reports regarding helpful experiences are an encouraging feedback for the treatment team; the reported stressful

  7. Changes of gene expression profiles in the cervical spinal cord by acupuncture in an MPTP-intoxicated mouse model: microarray analysis.

    Science.gov (United States)

    Choi, Yeong-Gon; Yeo, Sujung; Hong, Yeon-Mi; Kim, Sung-Hoon; Lim, Sabina

    2011-07-15

    It has been shown that acupuncture at acupoints GB34 and LR3 inhibits the degeneration of nigrostriatal neurons in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of Parkinson's disease. The degeneration of spinal cord was reported to be induced in the MPTP-treated pre-symptomatic mouse. In this study, the gene expression profile changes following acupuncture at the acupoints were investigated in the cervical spinal cord of an MPTP-induced parkinsonism model using a whole transcript array (Affymetrix GeneChip mouse gene 1.0 ST array). It was shown that 8 of the probes up-regulated in MPTP, as compared to the control, were down-regulated after acupuncture at the acupoints. Of these 8 probes, 6 probes (4 annotated genes in 6 probes: Ctla2a, EG383229, Ppbp and Ube2l6) were exclusively down-regulated by acupuncture at the specific acupoints except for 2 probes as these 2 probes were commonly down-regulated by acupuncture at both the acupoints and the non-acupoints. In addition, 11 of the probes down-regulated in MPTP, as compared to the control, were up-regulated by acupuncture at the acupoints. Of these 11 probes, 10 probes (5 annotated genes in 10 probes: EG665033, ENSMUSG00000055323, Obox6, Pbp2 and Tmem150) were exclusively up-regulated by acupuncture at the specific acupoints except for the Fut11 because the Fut11 was commonly up-regulated by acupuncture at both the acupoints and the non-acupoints. The expression levels of the representative genes in the microarray were validated by real-time RT-PCR. These data suggest that the expression of these exclusively regulated 16 probes (9 genes) may be, at least in part, affected by acupuncture at the acupoints in the cervical spinal cord which can be damaged by MPTP intoxication.

  8. A PET/CT approach to spinal cord metabolism in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Marini, Cecilia; Cistaro, Angelina; Campi, Cristina; Calvo, Andrea; Caponnetto, Claudia; Nobili, Flavio Mariano; Fania, Piercarlo; Beltrametti, Mauro C; Moglia, Cristina; Novi, Giovanni; Buschiazzo, Ambra; Perasso, Annalisa; Canosa, Antonio; Scialò, Carlo; Pomposelli, Elena; Massone, Anna Maria; Bagnara, Maria Caludia; Cammarosano, Stefania; Bruzzi, Paolo; Morbelli, Silvia; Sambuceti, Gianmario; Mancardi, Gianluigi; Piana, Michele; Chiò, Adriano

    2016-10-01

    In amyotrophic lateral sclerosis, functional alterations within the brain have been intensively assessed, while progression of lower motor neuron damage has scarcely been defined. The aim of the present study was to develop a computational method to systematically evaluate spinal cord metabolism as a tool to monitor disease mechanisms. A new computational three-dimensional method to extract the spinal cord from (18)F-FDG PET/CT images was evaluated in 30 patients with spinal onset amyotrophic lateral sclerosis and 30 controls. The algorithm identified the skeleton on the CT images by using an extension of the Hough transform and then extracted the spinal canal and the spinal cord. In these regions, (18)F-FDG standardized uptake values were measured to estimate the metabolic activity of the spinal canal and cord. Measurements were performed in the cervical and dorsal spine and normalized to the corresponding value in the liver. Uptake of (18)F-FDG in the spinal cord was significantly higher in patients than in controls (p amyotrophic lateral sclerosis.

  9. Ⅰ期前后联合入路手术治疗颈椎骨折合并颈髓损伤%Microneurosurgery through anterio-posterior approach for cervical spine fracture and cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    耿凤阳; 张学广; 杜池刚; 侯磊; 张志逖; 李忠民

    2016-01-01

    目的:比较Ⅰ期手术与分期手术治疗颈椎骨折合并颈髓损伤的疗效差异。方法2010年6月至2014年10月收治颈椎骨折合并颈髓损伤26例,其中16例采用Ⅰ期前后联合入路手术,10例采用分期手术(Ⅰ期后路减压+内固定手术、Ⅱ期前路椎间盘摘除+椎体固定术),以Frankel分级和日本骨科协会(JOA)评分评估脊髓功能,并计算改善率=(术后JOA评分-术前JOA评分)/(17-术前JOA评分)×100%。结果两组手术前后Frankel分级均无统计学差异(P>0.05)。两组术前JOA评分无统计学差异(P>0.05),两组术后2 d、3个月、6个月JOA评分较术前均明显增高(P<0.05),Ⅰ期手术组增高更明显(P<0.05);术后3、6个月,Ⅰ期手术组改善率均明显高于分期手术组(P<0.05)。结论Ⅰ期前后联合入路手术治疗颈椎骨折合并颈髓损伤,能及时、彻底地解除对脊髓压迫,恢复颈椎稳定性,缩短疗程,近期、远期疗效明显,是安全有效的手术方式。%Objective To compare clinical effects of one-stage microneurosurgery through anterio-posterior approach on cervical spine fracture and cervical spinal cord injury (SCI) with those of two-stage operations, of which, stageⅠoperation included posterior decompression and internal fixation and stageⅡdid intervertebral disk removal and vertebral body fixation. Methods The clinical data of 26 patients with cervical spine fracture and cervical spinal cord injury, of whom, 16 (group A) were treated by the above-mentioned one-stage microsurgery, and 10 (group B) were treated by the above-mentioned two-stage operations, were analyzed retrospectively. The spinal cord functions were assessed by Japanese Orthopedics Association (JOA) scores before and after the surgery. Results There was no significant difference in the preoperative JOA scores between groups A and B. JOA scores and spinal cord function improvement rates were (9.94

  10. [Cervical myelopathy caused by bilateral vertebral artery compression].

    Science.gov (United States)

    Nishiura, T; Fujiwara, K; Handa, A; Gotoh, M; Tsuno, K; Ishimitsu, H

    1998-01-01

    We report a rare case of myelopathy caused by compression of the upper cervical cord by the bilateral anomalous vertebral arteries. A 49-year-old man had dragged his right foot for 4 years. He also complained of a tingling sensation in his right arm and occipitalgia. Neurological examination disclosed right hemiparesis, hypalgesia in the right half of the body and hypertonicity of the lower extremities. MRIs showed a flow void area which compressed and distorted the spinal cord bilaterally at the level of the atlas. A vertebral angiogram showed that the bilateral vertebral arteries had pierced the dura matter under the posterior arch of the atlas, turned upward and laterally in the vertebral canal, making vascular loops at the level of the atlas. 3D CT angiography showed the loops convex medially in the anterior part of the vertebral canal. With these findings, we diagnosed the patient as suffering compression of the cervical cord by the bilateral anomalous vertebral arteries. Suboccipital craniectomy and C1 laminectomy were performed. When the dura mater was opened, the dorsolateral aspect of the spinal cord was found to be compressed and indented markedly by the vertebral arteries. To decompress the spinal cord, the vertebral arteries were retracted dorsolaterally by means of Gore-tex tape and anchored to the spinous process of the axis. Postoperatively, his neurological symptoms improved. Postoperative MRIs showed that the spinal cord was decompressed and had recovered its contour. A review of the literature revealed that only 3 such cases as this one have been reported. The clinical features of these rare cases are nonspecific myelopathy and concomitant occipitalgia or neck pain. The main cause of this rare entity seemed to be the compression of the vertebral artery through its course when it enters the vertebral canal between the atlas and the axis.

  11. Spinal stenosis surgery in pediatric patients with achondroplasia.

    Science.gov (United States)

    Sciubba, Daniel M; Noggle, Joseph C; Marupudi, Neena I; Bagley, Carlos A; Bookland, Markus J; Carson, Benjamin S; Ain, Michael C; Jallo, George I

    2007-05-01

    Achondroplasia is a hereditary form of dwarfism caused by a defect in endochondral bone formation, resulting in skeletal abnormalities including short stature, shortened limb bones, macrocephaly, and small vertebral bodies. In the pediatric population, symptomatic spinal stenosis occurs at all spinal levels due to the abnormally narrow bone canal. In this study, clinical outcomes were assessed in children with achondroplasia after spinal canal decompression. A retrospective review was conducted involving pediatric patients with heterozygous achondroplasia and symptomatic stenosis after decompressive procedures at the authors' institution within a 9-year period. Measured outcomes included resolution of symptoms, need for repeated surgery, presence of fusion, development of deformity, and complications. Forty-four pediatric patients underwent a total of 60 decompressive procedures. The average patient age at surgery was 12.7 years (range 5-21 years). Forty-nine operations were performed for initial treatment of stenosis, and 11 were performed as revision surgeries on previously operated levels. A large proportion of patients (> 60%) required additional cervicomedullary decompressions, most often preceding the symptoms of spinal stenosis. Of the initial procedures, decompression locations included 32 thoracolumbar (65%), 10 lumbar (20%), four cervical (8%), two cervicothoracic (4%), and one thoracic (2%). Forty-three of the decompressive procedures (72%) included spinal fusion procedures. Of the 11 revisions, five were fusion procedures for progressive deformity at levels previously decompressed but not fused (all thoracolumbar), five were for decompressions of symptomatic junctional stenosis with extension of fusion, and one was for repeated decompression at the same level due to recurrence of symptomatic stenosis. Decompression of the spinal canal in pediatric patients with achondroplasia can be accomplished safely with significant clinical benefit. Patients with a

  12. Subdural fluid collection and hydrocephalus following cervical schwannoma resection: hydrocephalus resolution after spinal pseudomeningocele repair: case report.

    Science.gov (United States)

    Benedetto, Nicola; Cagnazzo, Federico; Gambacciani, Carlo; Perrini, Paolo

    2016-12-01

    The authors report the case of a 31-year-old man who developed neck pain and headache 2 months after the uncomplicated resection of a cervical schwannoma. MR imaging revealed infratentorial subdural fluid collections and obstructive hydrocephalus associated with cervical pseudomeningocele. The clinical symptoms, subdural fluid collections, and ventricular dilation resolved after surgical correction of the pseudomeningocele. This report emphasizes that hydrocephalus may be related to disorders of cerebrospinal fluid flow dynamics induced by cervical pseudomeningocele. In these rare cases, both the hydrocephalus and the symptoms are resolved by the simple correction of the pseudomeningocele.

  13. Civilian spinal cord injuries due to terror explosions.

    Science.gov (United States)

    Zeilig, G; Weingarden, H P; Zwecker, M; Rubin-Asher, D; Ratner, A; Ohry, A

    2010-11-01

    Retrospective analysis of civilians with spinal cord injuries (SCIs) due to terror explosions. To analyze and describe the clinical characteristics and rehabilitation outcomes of civilians with SCI due to explosions admitted for in-patient rehabilitation from 2000-2004. SCI rehabilitation service, Tel Hashomer, Israel. Retrospective chart review. Civilians with SCI due to terror-related gunshot wounds (GSWs) served as a control group. Eleven civilians with SCI caused by penetrating atypical foreign objects (PAFOs) and eight with GSWs were identified. The male-to-female ratio was approximately 2:1. Foreign objects were present within the spinal canal in seven patients, causing bone injury without canal penetration in three, and one patient had both bone injury and canal penetration. The most common level of injury was thoracic. Seven had complete motor SCI. Three individuals improved in American Spinal Injury Association status: one individual improved from B to C (cervical); one from C to D (thoracic); and the third from D to E (lumbar). Despite the similar acute hospital length of stay and functional independence measure (FIM) scores on admission, the PAFO group had a shorter rehabilitation length of stay with higher FIM scores and higher FIM efficiency at discharge. Although the pathophysiology of PAFO blast injuries is similar to the high-velocity GSWs or the high-energy military munition injuries, better rehabilitation outcomes were seen, with slightly higher FIM efficiency and efficacy at discharge. This result is likely to be caused by less neurological tissue damage at impact.

  14. The Anatomy Study of Impact on Spinal Canal Through Lumbar Pedicle Extended Laminoplasty%腰椎椎弓根延长椎管扩大成形术对椎管影响的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    杨惠林; 朱若夫; 魏旺; 陈康武; 杨炎; 唐天驷

    2011-01-01

    Objective To explore the variation of L1 to L5 spinal canal dimension with the application of spiral three dimentional CT reconstruction after transpedicle osteotomy so as to provide anatomical evidence for lumbar spinal cannal decompression. Method Ten cadaver specimens of adult lumbarsacral spine ( L1 to L5 ) were prepared for spiral three dimentional CT reconstruction before and after pedicle was recected. The CT screenage datas were measured in respect of the spinal canal dimension when pedicle was intact and when disarticulated pedicle was transferred backward at 2 mm, 4 mm, and 6 mm distance.Results Compared with the intact spinal canal, there were statistically significant dimension change in L1 to L5 when recected pedicle was transferred backward at 4 mm and 6 mm distance( P <0.05 ), and as well as in L1 -3, L5 when disarticulated pedicle was transferred backward at 2 mm distance( P < 0.05 ).Conclusion Transpedicle osteotomy increased spinal canal dimension significantly, which will be a new way for lumbar spinal cannal decompression.%目的 通过经椎弓根截骨延长椎弓根扩大椎管,并应用螺旋CT三维重建测量各节段腰椎截骨椎弓根延长前后椎管面积,为临床进行腰椎管减压提供解剖学依据.方法 10具成人腰椎标本(L1~L5),螺旋CT分别对椎弓根截断前后的腰椎标本进行扫描,对CT重建后的图像进行测量,包括原始腰椎各节段椎管面积,椎弓根截断后椎弓根后移2、4、6 mm后的椎管面积.结果 对椎弓根截断前后椎管面积进行比较,结果显示,L1~L5椎弓根后移4、6 mm,椎弓根截断前后椎管面积对比有统计学差异(P<0.05),L1~L3、L5节段椎弓根后移2 mm,椎弓根截断前后椎管面积对比有统计学差异(P<0.05).结论 经椎弓根截骨椎管扩大成形术,可以明显增加腰椎管的面积,为临床进行腰椎管减压提供一种新的方法.

  15. 半椎板-小关节突切除术后颈椎稳定性的研究%Postoperative change of spinal stability after hemi -laminectomy and facetectomy approach for resection of dumbbell shaped cervical spinal cord tumor

    Institute of Scientific and Technical Information of China (English)

    谢京城; 王振宇; 马长城; 刘彬; 陈晓东

    2011-01-01

    Objective To evaluate the postoperative changes of spinal stability and relevant factors followed posterior approach via hemilaminectomy and facetectomy for removal of dumbbell shaped cervical spinal cord tumor. Method The authors retrospectively analyzed a series of 25 patients with dumbbell intra -extra spinal tumors surgically treated through hemilaminectomy and facetectomy from 1999 to 2009. 30 patients with intra - spinal tumor removed through hemilaminectomy approach during the same period were chosen as comparative group. The clinical and radiographic data were reviewed. The short and long - term follow - up was performed to evaluate the clinical outcome and biomechanical change of the spine. Results 25 operations had been performed with gross total of tumor resection in all cases with histological of neurolemomas in 19 cases, neurofibroma in 1 case, ganglioneuroma in 5 cases. As comparative group, 30 tumors which had been removed successfully including neurolemomas in 24, meningiomas in 6 cases were analyzed. The short - term clinical outcome was satisfactory in the two groups ( P > 0. 05 ). The period of follow - up was ranged from 7 months to 10 years with average of 4. 28 years. There was no change in terms of range of motion of cervical spine in both groups The incidence of worsen of cervical curvature was found to be 8% in research group, 10% in comparative group ( P > 0. 05 ). The incidence of cervical spinal instability during the follow - up period was 4% in research group, and 3% in comparative group ( P >0. 05). During the follow- up, no significant different was found between the two groups in terms of long - term clinical outcome ( P > 0. 05 ). Conclusions Benign dumbbell shaped spinal cord tumor of cervical spine are well exposed and totally removed with satisfactory outcome via hemilaminectomy and facetectomy approach. Compared with hemilaminectomy, hemilaminectomy and facetectomy equally pose little impact of cervical

  16. 颈椎前路减压植骨钛板内固定治疗颈脊髓损伤%Treatment of Cervical Spinal Cord Injury by Anterior Decompression, Bone Graft and Titanium Plate Internal Fixation

    Institute of Scientific and Technical Information of China (English)

    沈宁江; 王先安; 林庆彪; 林明侠; 陈建

    2013-01-01

    Objective To evaluate the clinical efficacy of anterior decompression, bone graft and internal fixation for cervical spine fracture with cervical spinal cord injury. Methods 215 cases of cervical spine fracture with cervical spinal cord injury had been treated by the method of anterior decompression,iliac bone graft and cervical locking titanium plate fixation. X-rays were taken regularly after surgery and recovery of spinal cord function were recorded. Results 184 cases were followed for an average time of 3. 5 years. Bone graft union was achieved 3 months after surgery. The cervical intervertebral height and the physiological curvature maintained satisfactory without implant complications. Nerve function of 172 patients improved 1 to 2 degree. Only 12 cases with stage A nerve function obtained no recovery. Conclusion Patients of cervical fracture with cervical spinal cord injury should undergo surgery of anterior decompression,bone graft and plate fixation as soon as possible. It is good to spinal cord function recovery. The injured segments can obtain instant and firm stability, which makes care and functional exercises easier.%目的 评价颈椎前路减压植骨内固定治疗颈椎骨折合并颈脊髓损伤的临床疗效.方法 对215例颈椎骨折合并颈脊髓损伤的患者施行颈椎前路减压、自体髂骨植骨和颈椎带锁钛板内固定术.术后定期复查X线片,判定脊髓功能恢复情况.结果 随访184例患者,平均随访时间3.5年.术后3个月植骨块获得骨性愈合,颈椎椎间高度和生理曲度维持满意,无内置物并发症,172例患者神经功能提高1~2级,仅12例A级患者神经功能无恢复.结论 颈椎骨折合并颈脊髓损伤应尽早行前路减压、植骨、钛板内固定术,有利于脊髓功能恢复,能使损伤节段获得即刻、坚强的稳定,方便护理和功能锻炼.

  17. Vasoactive intestinal polypeptide (VIP) immunoreactivity in the ependymal cells of the rat spinal cord.

    Science.gov (United States)

    Chung, K; Lee, W T

    1988-12-19

    Vasoactive intestinal polypeptide (VIP) was demonstrated immunohistochemically in the entire ependymal and subependymal cells in all levels (cervical: C, thoracic: T, lumbar: L and sacral: S) of normal adult rat spinal cord. The VIP-immunoreactive basal processes from the apical ependymal cells coursed dorsally or ventrally along the median plane and reached the pia mater of the dorsal and ventral median septa. Many VIP-immunoreactive basal processes terminated on the blood vessels in the neuropil around the central canal. A few microvilli of the ependymal cells that project into the central canal also demonstrated intense VIP immunoreactivity. These observations suggest that ependymal cells may be involved in the modulation of VIP levels in the cerebrospinal fluid and regulation of vascular tone of the blood vessels in the spinal cord.

  18. Functional Outcomes in Individuals Undergoing Very Early (h) and Early (5-24 h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study.

    Science.gov (United States)

    Mattiassich, Georg; Gollwitzer, Maria; Gaderer, Franz; Blocher, Martina; Osti, Michael; Lill, Markkus; Ortmaier, Reinhold; Haider, Thomas; Hitzl, Wolfgang; Resch, Herbert; Aschauer-Wallner, Stephanie

    2017-08-10

    Our study aim was to assess the neurological outcomes of surgical decompression and stabilization within 5 and 24 h after injury. We performed a multi-center, retrospective cohort study in adolescents and adults 15-85 years of age presenting cervical spinal cord injury (CSCI) at one of 6 Austrian trauma centers participating in the Austrian Spinal Cord Injury Study (ASCIS). Neurological outcomes were measured using the American Spinal Injury Association Impairment Scale (AIS) grade according to the International Standards For Neurological Classification Of Spinal Cord Injury (ISNCSCI) form after at least 6 months of follow-up (FU). Of the 49 enrolled patients with acute CSCI, 33 underwent surgical decompression within 5 h (mean 3.2 h ± 1.1 h; very early group) after injury, and 16 underwent surgical decompression between 5 and 24 h (mean 8.6 h ± 5.5 h; early group). Significant neurological improvement was observed among the entire study population between the preoperative assessment and the FU. We identified a significant difference in the AIS grade at the last FU between the groups the using Jonckheere-Terpstra test for doubly ordered crosstabs (p = 0.011) and significantly different AIS improvement rates in the early group (Poisson model, p = 0.018). Improvement by one AIS grade was observed in 31% and 42% of the patients in the early and very early groups, respectively (p = 0.54). Improvement by two AIS grades was observed in 31% and 6% of the patients in the early and very early groups, respectively (p = 0.03; relative risk [RR], 5.2; 95% CI, 1.1-35). Improvement by three AIS grades was observed in 6% and 3% of patients in the early and very early groups, respectively (p = 1.0). Decompression of the spinal cord within 24 h after SCI was associated with an improved neurological outcome. No additional neurological benefit was observed in patients who underwent decompression within 5 h of injury.

  19. 探讨颈椎骨折伴脊髓损伤护理%To Explore the Nursing of Cervical Fracture Combined With Spinal Cord Injury

    Institute of Scientific and Technical Information of China (English)

    韩旭

    2015-01-01

    目的:探讨颈椎骨折伴脊髓损伤护理。方法选取我院2014年1~12月间收治的颈椎骨折患者10例进行分析。结果经临床治疗及精心的规范化的康复护理,10例患者均达到了预期治疗效果,患者及家属满意。结论护理工作的开展有利于患者康复,提高了医疗满意度。%Objective To investigate the cervical spine fracture with spinal cord injury care.Methods Patients with cervical spine fracture between January 2014 to December 10 cases admitted to our hospital for analysis. ResultsThe clinical treatment and rehabilitation care carefully standardized, 10 patients have reached the desired therapeutic effect, patient and family satisfaction.ConclusionThe work carried out in favor of patient care and rehabilitation, to improve the health care satisfaction.

  20. Spinal curves (image)

    Science.gov (United States)

    There are four natural curves in the spinal column. The cervical, thoracic, lumbar, and sacral curvature. The curves, along with the intervertebral disks, help to absorb and distribute stresses that occur from everyday activities such as walking or from ...

  1. Analysis of motor fibers in the communicating branch between the cervical nerves and the spinal accessory nerve to innervate trapezius in the rat.

    Science.gov (United States)

    Yan, Jun; Hitomi, Jiro

    2006-11-01

    The communicating branch between the ventral rami of cervical nerves and the spinal accessory nerve (SAN) has been reported to also send motor fibers to supply the trapezius. However, the motor fiber type of the communicating branch and its peripheral distribution are still unclear. To determine the fiber elements within the branch and its peripheral distribution of the motor fibers in the trapezius, the anterograde tracing method was used in this study. The results show that a few a motor end plates from the communicating branch were observed on the extrafusal fibers, while in the muscle spindle the motor elements from the communicating branch were distributed to the polar portions of the intrafusal fibers. These results indicated that the motor fibers passing through the communicating branch to supply the trapezius are mainly y motor fibers, with some a motor fibers. Moreover, the a and y motor fibers from the communicating branch were observed in the clavotrapezius, acromiotrapezius and the rostral part of spinotrapezius. These findings also correlate with the clinical observation indicating that even when the spinal accessory nerve is injured, the trapezius is still capable of slight movement.

  2. Predictive value on premature delivery of fFN combined with cervical canal length in twin pregnancy%fFN联合宫颈管长度对双胎妊娠早产的预测价值

    Institute of Scientific and Technical Information of China (English)

    梁梅芬; 石雪金

    2016-01-01

    目的:研究胎儿纤维连接蛋白(fFN)联合宫颈管长度对双胎妊娠早产的预测价值。方法选择2014年9月~2015年9月在我院进行产检和住院安胎的双胎妊娠孕妇91例,入选孕妇在24~34周测定宫颈管长度(CL)和fFN,并追踪统计孕妇的妊娠结局。结果卡方检验结果表明在CL≤25mm的40例孕妇中, fFN阳性孕妇的早产率89.3%显著高于fFN阴性孕妇早产率50%(x2=7.431,P<0.05);在CL>25mm的51例孕妇中,fFN阳性孕妇早产率28.6%显著高于fFN阴性孕妇16.2%(x2=5.251,P<0.05)。fFN和宫颈管长度联合检测预测双胎妊娠早产的敏感性和特异度分别为89.3%和74.0%。结论 fFN联合宫颈管长度对双胎妊娠早产具有较高的预测价值,能够满足临床应用,值得在产科临床推广应用。%Objective To study the predictive value on premature delivery of fFN (fetal fibronectin) combined with cervical canal length in twin pregnancy.Methods 91 pregnant women with twin pregnancy, who were carried out prenatal examination and hospitalization miscarriage prevention in our hospital from September 2014 to September 2015, were selected to mensurate the cervical canal length(CL) and fFN at 24-34 weeks, to tracking statistics the pregnancy outcome of pregnant women.Results The Chi-square test result showed that, of the 40 pregnant women of CL≤25mm, the premature delivery rate of fFN in positive pregnant women(89.3%) was significantly higher than which in negative pregnant women (50%)(x2=7.431,P25mm, the premature delivery rate of fFN in positive pregnant women(28.6%) was significantly higher than which in negative pregnant women(16.2%)(x2=5.251,P<0.05). The sensitivity and specificity of fFN and cervical canal length joint detection and prediction on premature delivery in twin pregnancy were respectively 89.3% and 74.0%. Conclusion FFN combined with cervical canal length on premature delivery in twin pregnancy has higher predictive

  3. Diagnostic validity of space available for the spinal cord at C1 level for cervical myelopathy in patients with rheumatoid arthritis.

    Science.gov (United States)

    Oda, Takenori; Yonenobu, Kazuo; Fujimura, Yoshikazu; Ishii, Yushin; Nakahara, Shinnosuke; Matsunaga, Shunji; Shimizu, Takachika; Matsumoto, Morio

    2009-06-01

    Retrospective cohort study. To evaluate diagnostic validity of space available for the spinal cord (SAC) at C1 level for myelopathy in patients with rheumatoid arthritis (RA). The relationship of SAC at C1 level with myelopathy has been evaluated by relatively small number of the patients, and 2 criteria have been proposed. Two cohorts of the patients with RA were established. Group A consisted of 140 patients with myeopathy due to upper cervical involvement selected from the database. Group B consisted of 99 patients with upper cervical subluxation, but not associated with myelopathy selected from the consecutive series of the hospitalized patients. Distributions of SAC at C1 level in both groups were evaluated. Efficacy indexes for screening (sensitivity, specificity, etc.) were calculated for these patients' population by previously demonstrated 2 criteria. In addition, analysis according to receiver operating characteristic (ROC) curve was performed. The average values of SAC were 11.1 mm in Group A and 16.5 mm in Group B. When cut-off point for myelopathy was defined as 13 mm or less, sensitivity and specificity were 82% and 85%, respectively. When it was defined as 14 mm or less, sensitivity increased (88%) while specificity decreased (74%). Accuracies by these 2 criteria were almost the same (83%, 82%). The left upper corner point of ROC curve was located between these 2 cut-off points. Distributions of SAC showed that SAC was a reliable parameter for relating myelopathy in patients with upper cervical subluxation in RA. The plots according to ROC curve showed adequacy of previously demonstrated 2 cut-off points. For the purpose to screen the patients with high risk for myelopathy, 14 mm or less was recommended as a cut-off point of SAC.

  4. The effect of word prediction settings (frequency of use) on text input speed in persons with cervical spinal cord injury: a prospective study.

    Science.gov (United States)

    Pouplin, Samuel; Roche, Nicolas; Antoine, Jean-Yves; Vaugier, Isabelle; Pottier, Sandra; Figere, Marjorie; Bensmail, Djamel

    2017-06-01

    To determine whether activation of the frequency of use and automatic learning parameters of word prediction software has an impact on text input speed. Forty-five participants with cervical spinal cord injury between C4 and C8 Asia A or B accepted to participate to this study. Participants were separated in two groups: a high lesion group for participants with lesion level is at or above C5 Asia AIS A or B and a low lesion group for participants with lesion is between C6 and C8 Asia AIS A or B. A single evaluation session was carried out for each participant. Text input speed was evaluated during three copying tasks: • without word prediction software (WITHOUT condition) • with automatic learning of words and frequency of use deactivated (NOT_ACTIV condition) • with automatic learning of words and frequency of use activated (ACTIV condition) Results: Text input speed was significantly higher in the WITHOUT than the NOT_ACTIV (pword prediction software with the activation of frequency of use and automatic learning increased text input speed in participants with high-level tetraplegia. For participants with low-level tetraplegia, the use of word prediction software with frequency of use and automatic learning activated only decreased the number of errors. Implications in rehabilitation   Access to technology can be difficult for persons with disabilities such as cervical spinal cord injury (SCI). Several methods have been developed to increase text input speed such as word prediction software.This study show that parameter of word prediction software (frequency of use) affected text input speed in persons with cervical SCI and differed according to the level of the lesion. • For persons with high-level lesion, our results suggest that this parameter must be activated so that text input speed is increased. • For persons with low lesion group, this parameter must be activated so that the numbers of errors are decreased. • In all cases, the

  5. 慢性颈脊髓压迫的磁共振质谱成像%Magnetic resonance spectroscopy study of the chronic compression of cervical spinal cord.

    Institute of Scientific and Technical Information of China (English)

    张琥; 杜炎鑫; 林定坤; 陈博来; 田铁桥; 陈树良; 陈加良; 蔡懿

    2011-01-01

    Objective To evaluate the clinical application of magnetic resonance spectroscopy ( MRS ) in chronic compression of cervical spinal cord, and to study the risk factors of symptomatic rnyelopathy. Methods Tirty - four patients with MRI -proved compressed cervical spinal cord, were divided into two groups according to JOA scores: symptomatic group ( Group Ⅰ , n = 15 ) and presymptomatic group ( Group Ⅱ, n = 19 ). Fifteen aged - matched healthy volunteers were enrolled in control group ( Group Ⅲ ). Preoperative neurological examination, functional assessment, and cervicai spine MR spectroscopy were carried out in patients preoperatively. Voxels were placed at the adjacent level to the maxis compressive level. The main metabolite concentration ratios, including N -acetylaspartate/creatine ( NAA/Cr ),choline/creatine ( Cho/Cr ), myoinositol/creatine ( mI/Cr ), lactate/creatine( Lac/Ct ) and glutamate/creatine ( Glx/Cr), were obtained. Results Total 49 cases succeeded to have MR spectroscopy. Epidural compression, spinal cord compression and abnormal signal were observed in 4, 30 and 17 cases, respectively. When comparing with those in Group Ⅲ, significant reduction of NAA/Cr and Glx/Cr were revealed in Group Ⅰ ( P <0. 01 ); so was significant reduction of Glx/Cr in Group Ⅱ ( P <0. 05 ). Glx/Cr was proved as a protective factor for cervical spondylotic myelopathy ( Wald x2=3. 951, P <0. 05, OR =0. 23 ), while altered MRI signal was a risk factor ( Wald x2 = 13. 561, P < 0. 001, OR =35. 991 ). Conclusion MRS provides useful semi - quantitative estimates of the cellular biochemistry of the spinal cord in patients with chronic compression. Reduced ratios of NAA/Cr and Glx/Cr in patients with CSM indicates the axonal and neuronal loss in cervical spinal cord. Seventy percent of the patients with spondylotic cervical cord compression had significant Lac peaks, which further supports the role of ischemia in the pathophysiology of chronic compression. The

  6. [A case of malignant extrameningeal meningioma of the spinal canal with multiple metastases in a 17-year-old patient. Clinical and morphologic studies].

    Science.gov (United States)

    Sobaniec, W; Czerwińska-Ciechan, K; Zimnoch, L; Sobaniec-Lotowska, M; Lewko, J

    1988-01-01

    A clinical description and pathological findings are reported in a case of extrameningeal, angiogenic malignant meningioma of the vertebral canal (Th7-Th11) in a patient aged 17 years. Clinical picture was that of transverse myelitis at the Th9 level, with spastic paraparesis, funicular loss of all sensory functions and sphincter disturbances. The authors suppose that the used combined treatment (chemotherapy and radiotherapy, surgery) improved greatly the health state inhibiting the spread of metastases and prolonged survival to 3 years. Autopsy demonstrated recurrence of he tumour in the vertebral canal and numerous metastases to the brain, lungs, liver, bones and pancreas.

  7. Cervical spine in patients with diastrophic dysplasia--radiographic findings in 122 patients.

    Science.gov (United States)

    Remes, Ville M; Marttinen, Eino J; Poussa, Mikko S; Helenius, Ilkka J; Peltonen, Jari I

    2002-09-01

    In previous studies, typical radiological findings in the cervical spine of patients with diastrophic dysplasia (DD) have been kyphosis, displacement of the vertebrae, spina bifida occulta (SBO), anterior hypoplasia of vertebrae C3-5, and hyperplasia and dysmorphism of the odontoid process. To make a radiological analysis of the cervical spine in patients with DD. The study comprised 122 patients (50 males, 72 females), with an average age of 19 years (range newborn-63 years). Follow-up was available on 62 patients (51%), for an average duration of 11 years. Cervical spine alignment was measured according to Cobb's method. The height (H) and depth (D) of the vertebral body and sagittal diameter (S) of the spinal canal were measured. H/D and S/D ratios were then calculated from the measurements. The shape of the vertebrae was assessed. Displacement and movement of cervical vertebrae in neutral and bending radiographs were measured. RESULTS. The average lordosis in the last radiograph was 17(degrees) (range 4 degrees -55(degrees)). Five (4%) patients had a cervical kyphosis with an average of 92(degrees) (range 10-165(degrees)) on their last radiograph. The H/D ratio increased slowly during growth and showed significant correlation with age. There was no growth spurt at puberty. The S/D ratio was fairly stable until 7-8 years of age, when it started to decline slowly. The percentage of vertebrae with a flat vertebral body and narrow spinal canal value tended to increase with age. Vertebral hypoplasia and displacement between vertebrae were most common in the mid-cervical region and resolved spontaneously with age. Degenerative changes seemed to increase with age and were already visible during the second decade of life. SBO was noted in 79% of patients. The most common alignment in the cervical spine is lordosis in adulthood. The vertebral bodies are flattened and the spinal canal is narrowed. Vertebral body hypoplasia and displacement usually resolve spontaneously

  8. Cervical spine in patients with diastrophic dysplasia - radiographic findings in 122 patients

    Energy Technology Data Exchange (ETDEWEB)

    Remes, Ville M.; Helenius, Ilkka J.; Peltonen, Jari I. [Hospital for Children and Adolescents, Helsinki University Central Hospital, P.O. Box 281, 00029 HUS (Finland); Marttinen, Eino J. [Helsinki University Central Hospital (Finland); Poussa, Mikko S. [Orton Orthopaedic Hospital, Helsinki (Finland)

    2002-09-01

    Heading AbstractBackground. In previous studies, typical radiological findings in the cervical spine of patients with diastrophic dysplasia (DD) have been kyphosis, displacement of the vertebrae, spina bifida occulta (SBO), anterior hypoplasia of vertebrae C3-5, and hyperplasia and dysmorphism of the odontoid process.Objectives. To make a radiological analysis of the cervical spine in patients with DD.Materials and methods. The study comprised 122 patients (50 males, 72 females), with an average age of 19 years (range newborn-63 years). Follow-up was available on 62 patients (51%), for an average duration of 11 years. Cervical spine alignment was measured according to Cobb's method. The height (H) and depth (D) of the vertebral body and sagittal diameter (S) of the spinal canal were measured. H/D and S/D ratios were then calculated from the measurements. The shape of the vertebrae was assessed. Displacement and movement of cervical vertebrae in neutral and bending radiographs were measured.Results. The average lordosis in the last radiograph was 17 (range 4 -55 ). Five (4%) patients had a cervical kyphosis with an average of 92 (range 10-165 ) on their last radiograph. The H/D ratio increased slowly during growth and showed significant correlation with age. There was no growth spurt at puberty. The S/D ratio was fairly stable until 7-8 years of age, when it started to decline slowly. The percentage of vertebrae with a flat vertebral body and narrow spinal canal value tended to increase with age. Vertebral hypoplasia and displacement between vertebrae were most common in the mid-cervical region and resolved spontaneously with age. Degenerative changes seemed to increase with age and were already visible during the second decade of life. SBO was noted in 79% of patients.Conclusions. The most common alignment in the cervical spine is lordosis in adulthood. The vertebral bodies are flattened and the spinal canal is narrowed. Vertebral body hypoplasia and

  9. Evaluation of the anatomical and functional consequences of repetitive mild cervical contusion using a model of spinal concussion.

    Science.gov (United States)

    Jin, Ying; Bouyer, Julien; Haas, Christopher; Fischer, Itzhak

    2015-09-01

    Spinal cord concussion is characterized by a transient loss of motor and sensory function that generally resolves without permanent deficits. Spinal cord concussions usually occur during vehicular accidents, falls, and sport activity, but unlike brain concussions, have received much less attention despite the potential for repeated injury leading to permanent neurological sequelae. Consequently, there is no consensus regarding decisions related to return to play following an episode of spinal concussion, nor an understanding of the short- and long-term consequences of repeated injury. Importantly, there are no models of spinal concussion to study the anatomical and functional sequelae of single or repeated injury. We have developed a new model of spinal cord concussion focusing on the anatomical and behavioral outcomes of single and repeated injury. Rats received a very mild (50 kdyn, IH impactor) spinal contusion at C5 and were separated into two groups three weeks after the initial injury--C1, which received a second, sham surgery, and C2, which received a second contusion at the same site. To track motor function and recovery, animals received weekly behavioral tests--BBB, CatWalk™, cylinder, and Von Frey. Analysis of locomotor activity by BBB demonstrated that rats rapidly recovered, regaining near-normal function by one week after the first and second injury, which was confirmed using the more detailed CatWalk™ analysis. The cylinder test showed that a single contusion did not induce significant deficits of the affected limb, but that repeated injury resulted in significant alteration in paw preference, with animals favoring the unaffected limb. Intriguingly, Von Frey analysis demonstrated an increased sensitivity in the contralateral hindlimb in the C2 group vs. the C1 group. Anatomical analyses revealed that while the lesion volume of both groups was minimal, the area of spared white matter in the C2 group was significantly reduced 1 and 2mm rostral to

  10. Spinal Cord Studies in the African Giant Rat (Cricetomys gambianus ...

    African Journals Online (AJOL)

    olayemitoyin

    Keywords: African giant rat; spinal cord; spinal tract; nuclei; spinal segment; morphometry. ©Physiological Society .... cervical segment appeared as a vertical slit (Figure 3a), the second to the sixth ... Intermediomedial column. Lsg. Laminae of ...

  11. Dynamic monitoring of the relationship between the cervical canal shortening length rate and preterm birth of threatened preterm labor maternal%动态监测先兆早产孕妇宫颈管长度缩短率与早产的关系

    Institute of Scientific and Technical Information of China (English)

    张计华; 王杏芹; 马虹; 杨京卫; 孙玉红

    2013-01-01

    Objective To investigate the relationship between the cervical canal length shortening rate and preterm delivery by perineal ultrasound dynamic monitoring.Methods Two hundred and ninety-eight cases of preterm symptoms primipara were selected,transperineal measuring cervical canal length every day to calculate the length of the cervical canal shortening rate.And then observe the preterm birth rate of the cervical canal length shortening rate ≤ 15% group,16%-30% group,31%-60% group,> 60% group at the first week,second week and third week respectively.And calculate the total of preterm birth rate of the three weeks.Results When the cervical length shortening rate ≤15%,premature birth was highly unlikely.With the cervical canal shortening rate increased,the preterm birth rate also increased significantly,when the cervical canal length shortening rate of 16%-30% and 31%-60% group,the preterm birth rate were 3.4% and 7.9%,the difference of preterm birth rate was statistically significant(P < 0.05) between the two groups.When the cervical length shortening rate > 60%,premature birth rate was 48%.The differences were statistically significant compared with other groups(P <0.01).Cervical canal length shortening rate was the greater,the higher the preterm birth rate.Conclusions The cervical canal length shortening rate can be used as a predictor of preterm birth,the shortening rate is proportional to the preterm birth rate.%目的 探讨经会阴超声动态监测宫颈管长度缩短率与早产的关系.方法 选择有早产症状的初产妇298例,每天经会阴测量1次宫颈管长度,计算宫颈管长度缩短率.然后观察不同宫颈管长度缩短率≤15%组,16% ~ 30%组,31% ~60%组,>60%组,第1、2周及第3周内的早产率的情况.并计算3周总的早产率.结果当宫颈管长度缩短率≤15%时,早产可能性极低.随着宫颈管缩短率的上升,早产率也明显增

  12. Influence of adjacent low-dose fields on tolerance to high doses of protons in rat cervical spinal cord

    NARCIS (Netherlands)

    Bijl, HP; van Luijk, P; Coppes, RP; Schippers, JM; Konings, AWT; van der Kogel, AJ

    2006-01-01

    Purpose: The dose-response relationship for a relatively short length (4 mm) of rat spinal cord has been shown to be significantly modified by adjacent low-dose fields. In an additional series of experiments, we have now established the dose-volume dependence of this effect. Methods and Materials: W

  13. Ascending and descending axon-collaterals from cervical spinal neurons : a retrograde fluorescent double-labeling study in the rat.

    NARCIS (Netherlands)

    C.A. Verburgh

    1990-01-01

    textabstractIn order to gain insight into the function of the central nervous system it is of importance to know the lay-out of fiber connections between its constituent cells and cell-groups. Much is already known of the anatomy of the spinal cord and its afferent and efferent fibers; this will be

  14. Distribution of collateral fibers in the monkey cervical spinal cord detected with diffusion-weighted magnetic resonance imaging

    DEFF Research Database (Denmark)

    Lundell, Henrik; Nielsen, Jens Bo; Ptito, Maurice

    2011-01-01

    in the white matter of the spinal cord is an invalid assumption due to collateral fibers. We also demonstrate that (ii) collateral fibers can be resolved as distinct peaks in the water diffusion propagator in white matter using multi-fiber models. Finally, we show that (iii) crossing fibers are mainly located...

  15. Electrophysiological and MRI study on poor outcome after surgery for cervical myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, Osamu; Kawakita, Hirofumi; Ogawa, Ryokei [Kansai Medical Univ., Moriguchi, Osaka (Japan)

    1995-11-01

    Occasionally, the outcome from laminoplasty for cervical spondylosis is disappointing despite an adequate operation. Before surgery, it is difficult to diagnose the pathological extent of the involvement of the spinal cord. The purpose of this study is to determine the efficacy of magnetic resonance imaging (MRI) and of the motor evoked potentials (MEPs) for the indication of the surgery and prognosis. Retrospectively, we investigated the MEPs and the MRI of 31 patients in surgery for cervical myelopathy, involving 21 with cervical spondylosis and 10 with ossification of the posterior longitudinal ligamentum, and compared the findings from those with a poor outcome (n=3l) with the findings from those with a good outcome (n=32). The MEPs from the thenar muscle and the tibialis anterior were evoked by transcranial magnetic brain stimulation. In the poor-outcome patients, the spinal canal was narrow and lumbar spinal canal stenosis was seen in 5 cases which required lumbar laminectomy. Before operation, the MEPs from the thenar muscle could not be evoked in 5 cases while there was a remarkably prolonged central motor conduction time in the other 26 cases. MRI revealed the deformed spinal cord in the involved area, and the signal intensity of the involved spinal cord in the T2 weighted image was remarkably high. The signal intensity ratio was significantly higher in the poor-outcome patients than in the good-outcome patients. This study suggested that a high signal intensity in the T2 weighted image and a prolonged conduction time or absence of MEPs largely corresponded to the clinical and other investigative features of myelopathy responsible for a poor outcome. (author).

  16. Histochemical characterization, distribution and morphometric analysis of NADPH diaphorase neurons in the spinal cord of the agouti

    Directory of Open Access Journals (Sweden)

    Marco Aurelio M Freire

    2008-05-01

    Full Text Available We evaluated the neuropil distribution of the enzymes NADPH diaphorase (NADPH-d and cytochrome oxidase (CO in the spinal cord of the agouti, a medium-sized diurnal rodent, together with the distribution pattern and morphometrical characteristics of NADPH-d reactive neurons across different spinal segments. Neuropil labeling pattern was remarkably similar for both enzymes in coronal sections: reactivity was higher in regions involved with pain processing. We found two distinct types of NADPH-d reactive neurons in the agouti’s spinal cord: type I neurons had large, heavily stained cell bodies while type II neurons displayed relatively small and poorly stained somata. We concentrated our analysis on type I neurons. These were found mainly in the dorsal horn and around the central canal of every spinal segment, with a few scattered neurons located in the ventral horn of both cervical and lumbar regions. Overall, type I neurons were more numerous in the cervical region. Type I neurons were also found in the white matter, particularly in the ventral funiculum. Morphometrical analysis revealed that type I neurons located in the cervical region have dendritic trees that are more complex than those located in both lumbar and thoracic regions. In addition, NADPH-d cells located in the ventral horn had a larger cell body, especially in lumbar segments. The resulting pattern of cell body and neuropil distribution is in accordance with proposed schemes of segregation of function in the mammalian spinal cord.

  17. Study of position control to cervical spinal cord injury of hemiplegic patients during functional activities%颈髓挫伤致偏瘫患者功能锻炼中抗肌痉挛体位的研究

    Institute of Scientific and Technical Information of China (English)

    何瑞琼

    2009-01-01

    目的 抗痉挛体位对颈髓挫伤致瘫痪患者功能锻炼中降低肌痉挛的效果.方法 观察82例