Spinal electro-magnetic stimulation combined with transgene delivery of neurotrophin NT-3 and exercise: novel combination therapy for spinal contusion injury.

Science.gov (United States)

Petrosyan, Hayk A; Alessi, Valentina; Hunanyan, Arsen S; Sisto, Sue A; Arvanian, Victor L

2015-11-01

Our recent terminal experiments revealed that administration of a single train of repetitive spinal electromagnetic stimulation (sEMS; 35 min) enhanced synaptic plasticity in spinal circuitry following lateral hemisection spinal cord injury. In the current study, we have examined effects of repetitive sEMS applied as a single train and chronically (5 wk, every other day) following thoracic T10 contusion. Chronic studies involved examination of systematic sEMS administration alone and combined with exercise training and transgene delivery of neurotrophin [adeno-associated virus 10-neurotrophin 3 (AAV10-NT3)]. Electrophysiological intracellular/extracellular recordings, immunohistochemistry, behavioral testing, and anatomical tracing were performed to assess effects of treatments. We found that administration of a single sEMS train induced transient facilitation of transmission through preserved lateral white matter to motoneurons and hindlimb muscles in chronically contused rats with effects lasting for at least 2 h. These physiological changes associated with increased immunoreactivity of GluR1 and GluR2/3 glutamate receptors in lumbar neurons. Systematic administration of sEMS alone for 5 wk, however, was unable to induce cumulative improvements of transmission in spinomuscular circuitry or improve impaired motor function following thoracic contusion. Encouragingly, chronic administration of sEMS, followed by exercise training (running in an exercise ball and swimming), induced the following: 1) sustained strengthening of transmission to lumbar motoneurons and hindlimb muscles, 2) better retrograde transport of anatomical tracer, and 3) improved locomotor function. Greatest improvements were seen in the group that received exercise combined with sEMS and AAV-NT3.

Radiological evaluation of the cervical spinal trauma

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Bae, W. K.; Koh, B. H.; Hahm, C. K.; Kim, J. J. [School of Medicine, Hanyang University, Seoul (Korea, Republic of)

1983-03-15

Acute injuries of the cervical spine are the most common causes of severe disability following trauma, yet the diagnosis of these injuries are often delayed and the treatment, inadequate. Traumatic injuries of the cervical spine are diagnosed by radiological examinations. And complete evaluations of bony structures and soft tissue changes on conventional radiograms are very important for determining the therapeutic plans and prognoses of the injuries patients. During the period of 5 years from June 1976 to May 1981, the radiological and clinical evaluation had been made on 38 patients suffered from acute cervical spinal injuries which were confirmed by the radiological examinations. The results were as follows. 1. Age distribution of total 38 patients was broad ranging from 19 years to 72 years. 2. The most common cause of injury was traffic accident, next fall down, other accident respectively. 3. Levels of the cervical spinal injuries were as follows: Upper cervical spine in 15.8%, lower cervical spine in 84.2%, and the most common injuries level was C 5. Most of the lower cervical spinal injuries were located in the vertebral body and spinous process. 4. Anatomical sites of the cervical spinal injuries were as follows; vertebral body in 55.5%, spinous process in 23.7%, neural arch in 15.8%, and locked facet in 18.4%, etc. 5. Most of the patients with severe mental changes were injuries in upper cervical spine rather than lower. And most of the patients with quadriplegia or paraplegia were shown marked disruption of spinal canal.

Radiological evaluation of the cervical spinal trauma

International Nuclear Information System (INIS)

Bae, W. K.; Koh, B. H.; Hahm, C. K.; Kim, J. J.

1983-01-01

Acute injuries of the cervical spine are the most common causes of severe disability following trauma, yet the diagnosis of these injuries are often delayed and the treatment, inadequate. Traumatic injuries of the cervical spine are diagnosed by radiological examinations. And complete evaluations of bony structures and soft tissue changes on conventional radiograms are very important for determining the therapeutic plans and prognoses of the injuries patients. During the period of 5 years from June 1976 to May 1981, the radiological and clinical evaluation had been made on 38 patients suffered from acute cervical spinal injuries which were confirmed by the radiological examinations. The results were as follows. 1. Age distribution of total 38 patients was broad ranging from 19 years to 72 years. 2. The most common cause of injury was traffic accident, next fall down, other accident respectively. 3. Levels of the cervical spinal injuries were as follows: Upper cervical spine in 15.8%, lower cervical spine in 84.2%, and the most common injuries level was C 5. Most of the lower cervical spinal injuries were located in the vertebral body and spinous process. 4. Anatomical sites of the cervical spinal injuries were as follows; vertebral body in 55.5%, spinous process in 23.7%, neural arch in 15.8%, and locked facet in 18.4%, etc. 5. Most of the patients with severe mental changes were injuries in upper cervical spine rather than lower. And most of the patients with quadriplegia or paraplegia were shown marked disruption of spinal canal

Treat high cervical spinal arteriovenous malformation with Cyberknife radiosurgery

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Yu-Fen Huang

2014-01-01

Full Text Available This paper describes the use of CyberKnife radiosurgery in the treatment of accidentally found cervical spinal arteriovenous malformation (AVM. We present the case of a patient with cervical spinal AVM, who developed progressive neck pain, gait disturbance, urine and stool incontinence 2 weeks after the fell down accident. The patient underwent CyberKnife radiosurgery. After CyberKnife radiosurgery for 2 years, the patient′s neck pain diminished and was able to keep the walk without any assistance. The management of cervical spinal AVM varies. This patient demonstrated a successful treatment of cervical spinal AVM with CyberKnife radiosurgery.

Endogenous stem cell proliferation induced by intravenous hedgehog agonist administration after contusion in the adult rat spinal cord.

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Bambakidis, Nicholas C; Horn, Eric M; Nakaji, Peter; Theodore, Nicholas; Bless, Elizabeth; Dellovade, Tammy; Ma, Chiyuan; Wang, Xukui; Preul, Mark C; Coons, Stephen W; Spetzler, Robert F; Sonntag, Volker K H

2009-02-01

Sonic hedgehog (Shh) is a glycoprotein molecule that upregulates the transcription factor Gli1. The Shh protein plays a critical role in the proliferation of endogenous neural precursor cells when directly injected into the spinal cord after a spinal cord injury in adult rodents. Small-molecule agonists of the hedgehog (Hh) pathway were used in an attempt to reproduce these findings through intravenous administration. The expression of Gli1 was measured in rat spinal cord after the intravenous administration of an Hh agonist. Ten adult rats received a moderate contusion and were treated with either an Hh agonist (10 mg/kg, intravenously) or vehicle (5 rodents per group) 1 hour and 4 days after injury. The rats were killed 5 days postinjury. Tissue samples were immediately placed in fixative. Samples were immunohistochemically stained for neural precursor cells, and these cells were counted. Systemic dosing with an Hh agonist significantly upregulated Gli1 expression in the spinal cord (p < 0.005). After spinal contusion, animals treated with the Hh agonist had significantly more nestin-positive neural precursor cells around the rim of the lesion cavity than in vehicle-treated controls (means +/- SDs, 46.9 +/- 12.9 vs 20.9 +/- 8.3 cells/hpf, respectively, p < 0.005). There was no significant difference in the area of white matter injury between the groups. An intravenous Hh agonist at doses that upregulate spinal cord Gli1 transcription also increases the population of neural precursor cells after spinal cord injury in adult rats. These data support previous findings based on injections of Shh protein directly into the spinal cord.

[Biomechanical behaviors of cervical spinal cord injury related to various bone fragment impact velocities: a finite element study].

Science.gov (United States)

Duan, S; Zhu, Z Q; Wang, K F; Liu, C J; Xu, S; Xia, W W; Liu, H Y

2018-03-20

Objective: To establish a three-dimensional (3D) finite element (FE) model of the whole cervical spinal cord (WSCS) and explore the biomechanical behaviors of cervical spinal cord injury related to different bone fragment impact velocities by FE analysis. Methods: A 3D FE model of WCSC was established based on the morphologic data of each segment of the human cervical cord. The reconstruction structures, which included the dura mater, the cerebrospinal fluid, the gray and white matter in the C(2) to C(7) cervical vertebrae, were validated.On the validated WCSC model, three kinds of pellets with same mass (7 g) but different impact areas (314, 157 and 78.5 mm(2)) were created to represent the bone fragments.These were positioned in the middle of the spinal cord to impact at various initial velocities.The maximum of von Mises stress and the reduction of the cross-sectional area (CSA) of the spinal cord were measured from each impact. Results: The compression of WCSC (percentage) and the time to reach maximum compression were similar with the results reported in literatures, indicating the validity of the model.Regardless of the impact areas of the pellet, the maximum of von Mises stress and the reduction of CSA of the spinal cord increased with the increased velocity.The maximum of von Mises stress was 5.0-7.0 kPa at a pellet velocity of 1.5 m/s, and the reduction of CSA was 9.3%-12.3%.At a velocity of 3.5 m/s, the maximum of von Mises stress was 42-54 kPa and the reduction of CSA was over 30%.The stress of the spinal cord significantly increased when pellet velocity exceeded 3.5 m/s, and the fastest increase was recorded at 4.5 m/s.The von Mises stress of the spinal cord ranged between 240 and 320 kPa at a velocity of 6.0 m/s, and CSA decreased by more than 50%. Conclusion: The 3D FE model of WSCS could provide more insights on the biomechanical mechanisms of spinal cord injury through various bone fragment impacts in burst fracture.When the impact velocity of the

Cervical spinal canal narrowing in idiopathic syringomyelia

International Nuclear Information System (INIS)

Struck, Aaron F.; Carr, Carrie M.; Shah, Vinil; Hesselink, John R.; Haughton, Victor M.

2016-01-01

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.)

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.)

Magnetic resonance imaging of traumatic cervical injury

International Nuclear Information System (INIS)

Juhng, S. K.; Lee, K. S.; Sohn, K. J.; Choi, S. S.; Won, J. J.

1994-01-01

To evaluate magnetic resonance imaging (MRI) findings of cevical injuries. MRI studies of 34 patients with cervical spinal injuries were analyzed retrospectively. All MRI scans were obtained with an 1.0T superconductive MRI scanner (Siemens Magnetom 42SPE) and their findings were analyzed regarding the spinal cord, bony spine, ligaments, and intervertebral disks. A variety of abnormal findings were detected: 25 cord abnormalities including cord compression (15 cases), cord edema (4 cases), syringomyelia (4 cases), myelomalacia (1 case), and hemorrhagic contusion (1 case), 18 ligamentous injuries, 22 disk herniations (9 post-traumatic, 13 chronic degenerative), 11 spine fractures, and 4 subluxations. MRI is useful in evaluating the spinal cord itself, in depicting ligamentous injuries, in establishing the presence of disc herniation, and in assessing the alignment of cervical spine

Magnetic resonance imaging of traumatic cervical injury

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Juhng, S. K.; Lee, K. S.; Sohn, K. J.; Choi, S. S.; Won, J. J. [Wonkwang University School of Medicine, Iri (Korea, Republic of)

1994-04-15

To evaluate magnetic resonance imaging (MRI) findings of cevical injuries. MRI studies of 34 patients with cervical spinal injuries were analyzed retrospectively. All MRI scans were obtained with an 1.0T superconductive MRI scanner (Siemens Magnetom 42SPE) and their findings were analyzed regarding the spinal cord, bony spine, ligaments, and intervertebral disks. A variety of abnormal findings were detected: 25 cord abnormalities including cord compression (15 cases), cord edema (4 cases), syringomyelia (4 cases), myelomalacia (1 case), and hemorrhagic contusion (1 case), 18 ligamentous injuries, 22 disk herniations (9 post-traumatic, 13 chronic degenerative), 11 spine fractures, and 4 subluxations. MRI is useful in evaluating the spinal cord itself, in depicting ligamentous injuries, in establishing the presence of disc herniation, and in assessing the alignment of cervical spine.

Arteriovenous malformations of the cervical spinal cord

International Nuclear Information System (INIS)

Nagasawa, Shiro; Yoshida, Shinzo; Ishikawa, Masatsune; Yonekawa, Yasuhiro; Handa, Hajime

1984-01-01

Arteriovenous malformation (AVM) of the cervical spinal cord has been known to constitute 5-13% of all spinal AVMs. In contrast to the AVMs located in thoracic or thoraco-lumbar regions, cervical AVM has several characteristic features such as preponderance in younger generation, high incidence of subarachnoid hemorrhage, intramedullary location of the nidus usually fed by the anterior spinal arterial system. We reported three cases of cervical AVMs, which located intramedullary at the levels of C 4 -C 6 , C 1 -C 4 and C 1 -C 2 , respectively. Although selective angiography (vertebral artery, thyrocervical artery, costocervical artery) was essential for the diagnosis of these lesions, computerized tomographic (CT) study with both intrathecal injection of metrizamide and intravenous infusion of contrast material (dynamic and static study) was found to be extremely advantageous in detecting the topography of AVMs in the concerned horizontal planes of the spinal cord. Removal of AVM was given up in one case because of its possible involvement of the anterior spinal artery and central artery shown by CT scan. Removal of AVMs were performed in other two cases. A lateral approach was tried in one case with the AVM located in C 1 -C 2 level, in which CT scan revealed not only an intramedullary but the associated extramedullary AVM in ventrolateral surface of the spinal cord. This operative approach was found to involve less bone removal and markedly reduce spinal cord manipulation necessary to deal with ventrally situated high cervical lesions, compared with a posterior approach with laminectomy. (author)

Cervical spinal cord injuries in patients with cervical spondylosis.

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Regenbogen, V S; Rogers, L F; Atlas, S W; Kim, K S

1986-02-01

Eighty-eight patients over age 40 with traumatic cervical spinal cord injuries were clinically and radiographically evaluated, and comparison was made with 35 spinal cord injury patients under age 36. While most older patients sustained obvious bony and/or ligamentous damage commensurate with their neurologic findings, 25 (28%) of the 88 patients had no demonstrable bony abnormalities and 17 (20%) of the 88 patients had only minimal evidence of bony injury. Of particular interest are the patients with severe cord injuries, yet no bony abnormalities, who seem to form a distinct subgroup of the cervical spinal cord injury patient on the basis of radiographic and clinical features. Of these 25 patients, 24 (96%) had severe cervical spondylosis. Fourteen (56%) of the 25 patients were injured in falls, five (36%) of these 14 being of a seemingly trivial nature. Of the 42 patients with minimal or no demonstrable bony abnormalities, 33 (79%) were evaluated with plain tomography and no occult fractures or other significant pathology was demonstrated. Pantopaque myelography in 27 (64%) of the 42 cases revealed no extruded disk or other surgical lesion in any patient. In large measure, these injuries can be attributed to cervical spondylosis, which narrows the canal and makes the cord more susceptible to compression by the bulging ligamenta flava during hyperextension.

Morphological analysis of the cervical spinal canal, dural tube and spinal cord in normal individuals using CT myelography

International Nuclear Information System (INIS)

Inoue, H.; Ohmori, K.; Takatsu, T.; Teramoto, T.; Ishida, Y.; Suzuki, K.

1996-01-01

To verify the conventional concept of ''developmental stenosis of the cervical spinal canal'', we performed a morphological analysis of the relations of the cervical spinal canal, dural tube and spinal cord in normal individuals. The sagittal diameter, area and circularity of the three structures, and the dispersion of each parameter, were examined on axial sections of CT myelograms of 36 normal subjects. The spinal canal was narrowest at C4, followed by C5, while the spinal cord was largest at C4/5. The area and circularity of the cervical spinal cord were not significantly correlated with any parameter of the spinal canal nor with the sagittal diameter and area of the dural tube at any level examined, and the spinal cord showed less individual variation than the bony canal. Compression of the spinal cord might be expected whenever the sagittal diameter of the spinal canal is below the lower limit of normal, that is about 12 mm on plain radiographs. Thus, we concluded that the concept of ''developmental stenosis of the cervical spinal canal'' was reasonable and acceptable. (orig.). With 2 figs., 3 tabs

Neurologic Outcome of Laminoplasty for Acute Traumatic Spinal Cord Injury without Instability

OpenAIRE

Lee, Hwa Joong; Kim, Hwan Soo; Nam, Kyoung Hyup; Han, In Ho; Cho, Won Ho; Choi, Byung Kwan

2013-01-01

Objective The purpose of this study is to evaluate the efficacy of laminoplasty in the treatment of spinal cord injury (SCI) without instability. Methods 79 patients with SCI without instability who underwent surgical treatment in our institute between January 2005 and September 2012 were retrospectively reviewed. Twenty nine patients fulfilled the inclusion criteria as follows: SCI without instability, spinal cord contusion in MRI, cervical stenosis more than 20%, follow up at least 6 months...

The increased prevalence of cervical spondylosis in patients with adult thoracolumbar spinal deformity.

Science.gov (United States)

Schairer, William W; Carrer, Alexandra; Lu, Michael; Hu, Serena S

2014-12-01

Retrospective cohort study. To assess the concomitance of cervical spondylosis and thoracolumbar spinal deformity. Patients with degenerative cervical spine disease have higher rates of degeneration in the lumbar spine. In addition, degenerative cervical spine changes have been observed in adult patients with thoracolumbar spinal deformities. However, to the best of our knowledge, there have been no studies quantifying the association between cervical spondylosis and thoracolumbar spinal deformity in adult patients. Patients seen by a spine surgeon or spine specialist at a single institution were assessed for cervical spondylosis and/or thoracolumbar spinal deformity using an administrative claims database. Spinal radiographic utilization and surgical intervention were used to infer severity of spinal disease. The relative prevalence of each spinal diagnosis was assessed in patients with and without the other diagnosis. A total of 47,560 patients were included in this study. Cervical spondylosis occurred in 13.1% overall, but was found in 31.0% of patients with thoracolumbar spinal deformity (OR=3.27, Pspondylosis (OR=3.26, Pspondylosis or thoracolumbar spinal deformity had significantly higher rates of the other spinal diagnosis. This correlation was increased with increased severity of disease. Patients with both diagnoses were significantly more likely to have received a spine fusion. Further research is warranted to establish the cause of this correlation. Clinicians should use this information to both screen and counsel patients who present for cervical spondylosis or thoracolumbar spinal deformity.

MRI of anterior spinal artery syndrome of the cervical spinal cord

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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.)

Characterizing the location of spinal and vertebral levels in the human cervical spinal cord.

Science.gov (United States)

Cadotte, D W; Cadotte, A; Cohen-Adad, J; Fleet, D; Livne, M; Wilson, J R; Mikulis, D; Nugaeva, N; Fehlings, M G

2015-04-01

Advanced MR imaging techniques are critical to understanding the pathophysiology of conditions involving the spinal cord. We provide a novel, quantitative solution to map vertebral and spinal cord levels accounting for anatomic variability within the human spinal cord. For the first time, we report a population distribution of the segmental anatomy of the cervical spinal cord that has direct implications for the interpretation of advanced imaging studies most often conducted across groups of subjects. Twenty healthy volunteers underwent a T2-weighted, 3T MRI of the cervical spinal cord. Two experts marked the C3-C8 cervical nerve rootlets, C3-C7 vertebral bodies, and pontomedullary junction. A semiautomated algorithm was used to locate the centerline of the spinal cord and measure rostral-caudal distances from a fixed point in the brain stem, the pontomedullary junction, to each of the spinal rootlets and vertebral bodies. Distances to each location were compared across subjects. Six volunteers had 2 additional scans in neck flexion and extension to measure the effects of patient positioning in the scanner. We demonstrated that substantial variation exists in the rostral-caudal position of spinal cord segments among individuals and that prior methods of predicting spinal segments are imprecise. We also show that neck flexion or extension has little effect on the relative location of vertebral-versus-spinal levels. Accounting for spinal level variation is lacking in existing imaging studies. Future studies should account for this variation for accurate interpretation of the neuroanatomic origin of acquired MR signals. © 2015 by American Journal of Neuroradiology.

The dynamic evaluation of the cervical spinal canal and spinal cord by magnetic resonance imaging during movement

International Nuclear Information System (INIS)

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

1987-01-01

The authors present results of in vivo measurements of the cervical canal and spinal cord. They indicate that tension in the spinal cord increases during flexion. They conclude that, as the dorsal approach avoids this increased tension of the spinal cord, the surgical treatment in chronic cervical myelopathy using this route seems to be preferable

Persistent polyuria in a rat spinal contusion model.

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Ward, Patricia J; Hubscher, Charles H

2012-10-10

Polyuria contributes to bladder overdistention, which confounds both lower and upper urinary tract management in individuals having a spinal cord injury (SCI). Bladder overdistention post-SCI is one of the most common triggers for autonomic dysreflexia, a potentially life-threatening condition. Post-SCI polyuria is thought to result from loss of vascular tone in the lower extremities, leading to edema and subsequent excess fluid, resulting in polyuria. Mild SCIs that have near complete recovery would therefore be expected to have little to no polyuria, while severe injuries resulting in flaccid limbs and lower extremity edema would be expected to exhibit severe polyuria. Since interventions that may decrease lower extremity edema are recommended to lessen the severity of polyuria, step training (which promotes vascular circulation) was evaluated as a therapy to reduce post-SCI polyuria. In the present study, polyuria was evaluated in mild, moderate, and severe contusive SCI in adult male rats. The animals were housed in metabolic cages for 24-hour periods pre- and post-SCI (to 6 weeks). Urine, feces, food, water, and body weights were collected. Other assessments included residual expressed urine volumes, locomotor scoring, in-cage activity, and lesion histology. SCI produced an immediate increase in 24-hour urine collection, as early as 3 days post-SCI. Approximately 2.6-fold increases in urine collection occurred from weeks 1-6 post-SCI for all injury severities. Even with substantial gains in locomotor and bladder function following a mild SCI, polyuria remained severe. Step training (30 min/day, 6 days/week) did not alleviate polyuria in the moderate SCI contusion group. These results indicate that (1) mild injuries retaining weight-bearing locomotion that should have mild, if any, edema/loss of vascular tone still exhibit severe polyuria, and (2) step training was unable to reduce post-SCI polyuria. Taken together, these results indicate that the current

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

Science.gov (United States)

Daniels, Alan H; Hart, Robert A; Hilibrand, Alan S; Fish, David E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Tortolani, P Justin; Stroh, D Alex; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

Retrospective cohort study of prospectively collected data. To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury. In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged from 0.0% to 0.24%. Of the 3 patients with quadriplegia, one underwent anterior-only surgery with 2-level cervical corpectomy, one underwent anterior surgery with corpectomy in addition to posterior surgery, and one underwent posterior decompression and fusion surgery alone. One patient had complete neurologic recovery, one partially recovered, and one did not recover motor function. Iatrogenic spinal cord injury following cervical spine surgery is a rare and devastating adverse event. No standard protocol exists that can guarantee prevention of this complication, and there is a lack of consensus regarding evaluation and treatment when it does occur. Emergent imaging with magnetic resonance imaging or computed tomography myelography to evaluate for compressive etiology or malpositioned instrumentation and avoidance of hypotension should be performed in cases of intraoperative and postoperative spinal cord injury.

Acute cervical cord injury without fracture or dislocation of the spinal column.

Science.gov (United States)

Koyanagi, I; Iwasaki, Y; Hida, K; Akino, M; Imamura, H; Abe, H

2000-07-01

It is known that the spinal cord can sustain traumatic injury without associated injury of the spinal column in some conditions, such as a flexible spinal column or preexisting narrowed spinal canal. The purpose of this study was to characterize the clinical features and to understand the mechanisms in cases of acute cervical cord injury in which fracture or dislocation of the cervical spine has not occurred. Eighty-nine patients who sustained an acute cervical cord injury were treated in our hospitals between 1990 and 1998. In 42 patients (47%) no bone injuries of the cervical spine were demonstrated, and this group was retrospectively analyzed. There were 35 men and seven women, aged 19 to 81 years (mean 58.9 years). The initial neurological examination indicated complete injury in five patients, whereas incomplete injury was demonstrated in 37. In the majority of the patients (90%) the authors found degenerative changes of the cervical spine such as spondylosis (22 cases) or ossification of the posterior longitudinal ligament (16 cases). The mean sagittal diameter of the cervical spinal canal, as measured on computerized tomography scans, was significantly narrower than that obtained in the control patients. Magnetic resonance (MR) imaging revealed spinal cord compression in 93% and paravertebral soft-tissue injuries in 58% of the patients. Degenerative changes of the cervical spine and developmental narrowing of the spinal canal are important preexisting factors. In the acute stage MR imaging is useful to understand the level and mechanisms of spinal cord injury. The fact that a significant number of the patients were found to have spinal cord compression despite the absence of bone injuries of the spinal column indicates that future investigations into surgical treatment of this type of injury are necessary.

Follow-up CT myelography of severe cervical spinal cord injury

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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.

Follow-up CT myelography of severe cervical spinal cord injury

International Nuclear Information System (INIS)

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

1987-01-01

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. (author)

Morphology of the cervical spinal cord with myelopathy on computed myelography

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Iwasaki, Hiroaki; Asano, Masafumi; Yokota, Hidemaro

1984-01-01

The relationship between morphological changes in the spinal cord shown on computer-assisted myelography and symptoms was investigated in 73 patients with cervical spondylotic myelopathy. Flatness of the spinal cord was seen in many of the patients. Symptoms were likely to be severer with increasing the degree of flatness of the spinal cord. The length of the flat spinal cord will help to select the operative method for cervical spondylotic myelopathy. (Namekawa, K.)

Perioperative Vision Loss in Cervical Spinal Surgery.

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Gabel, Brandon C; Lam, Arthur; Chapman, Jens R; Oskouian, Rod J; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Hamilton, Steven R; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

Retrospective multicenter case series. To assess the rate of perioperative vision loss following cervical spinal surgery. Medical records for 17 625 patients from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify occurrences of vision loss following surgery. Of the 17 625 patients in the registry, there were 13 946 patients assessed for the complication of blindness. There were 9591 cases that involved only anterior surgical approaches; the remaining 4355 cases were posterior and/or circumferential fusions. There were no cases of blindness or vision loss in the postoperative period reported during the sampling period. Perioperative vision loss following cervical spinal surgery is exceedingly rare.

Distracted cervical spinal fusion for management of caudal cervical spondylomyelopathy in large-breed dogs

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Ellison, G. W.; Seim, III, H. B.; Clemmons, R. M.

1988-08-15

Using an autogenous bone graft (obtained from the iliac crest), 4-mm cancellous bone screws, and polymethylmethacrylate, a distracted cervical spinal fusion technique was performed on 10 dogs with myelographic evidence of caudal cervical spondylomyelopathy. All dogs had evidence of dynamic soft tissue spinal cord compression, as indicated by flexion, extension, and traction myelographic views. Of the 10 dogs, 4 previously had undergone surgery by use of ventral slot or cervical disk fenestration techniques, and their neurologic status had deteriorated after the original surgery. Preoperative neurologic status of the 10 dogs included nonambulatory tetraparesis (n = 5), severe ataxia with conscious proprioceptive deficits (n = 2), and mild ambulatory ataxia with conscious proprioceptive deficits (n = 3). Five dogs had signs of various degrees of cervical pain. Clinical improvement was observed in 8 of 10 dogs--either improved neurologic status or elimination of cervical pain. Implant loosening developed in 3 dogs; 2 of them were euthanatized because of lack of neurologic improvement. Radiographic evidence of bony cervical fusion was observed during a 9- to 24-week period in 6 of the 8 surviving dogs. The distracted cervical fusion technique appears to be a valid surgical procedure to manage cervical spondylomyelopathy in those dogs in which the lesions are limited to one cervical intervertebral disk space.

Distracted cervical spinal fusion for management of caudal cervical spondylomyelopathy in large-breed dogs

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Ellison, G.W.; Seim, H.B. III; Clemmons, R.M.

1988-01-01

Using an autogenous bone graft (obtained from the iliac crest), 4-mm cancellous bone screws, and polymethylmethacrylate, a distracted cervical spinal fusion technique was performed on 10 dogs with myelographic evidence of caudal cervical spondylomyelopathy. All dogs had evidence of dynamic soft tissue spinal cord compression, as indicated by flexion, extension, and traction myelographic views. Of the 10 dogs, 4 previously had undergone surgery by use of ventral slot or cervical disk fenestration techniques, and their neurologic status had deteriorated after the original surgery. Preoperative neurologic status of the 10 dogs included nonambulatory tetraparesis (n = 5), severe ataxia with conscious proprioceptive deficits (n = 2), and mild ambulatory ataxia with conscious proprioceptive deficits (n = 3). Five dogs had signs of various degrees of cervical pain. Clinical improvement was observed in 8 of 10 dogs--either improved neurologic status or elimination of cervical pain. Implant loosening developed in 3 dogs; 2 of them were euthanatized because of lack of neurologic improvement. Radiographic evidence of bony cervical fusion was observed during a 9- to 24-week period in 6 of the 8 surviving dogs. The distracted cervical fusion technique appears to be a valid surgical procedure to manage cervical spondylomyelopathy in those dogs in which the lesions are limited to one cervical intervertebral disk space

Imaging of Spinal Cord Injury: Acute Cervical Spinal Cord Injury, Cervical Spondylotic Myelopathy, and Cord Herniation.

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Talekar, Kiran; Poplawski, Michael; Hegde, Rahul; Cox, Mougnyan; Flanders, Adam

2016-10-01

We review the pathophysiology and imaging findings of acute traumatic spinal cord injury (SCI), cervical spondylotic myelopathy, and briefly review the much less common cord herniation as a unique cause of myelopathy. Acute traumatic SCI is devastating to the patient and the costs to society are staggering. There are currently no "cures" for SCI and the only accepted pharmacologic treatment regimen for traumatic SCI is currently being questioned. Evaluation and prognostication of SCI is a demanding area with significant deficiencies, including lack of biomarkers. Accurate classification of SCI is heavily dependent on a good clinical examination, the results of which can vary substantially based upon the patient׳s condition or comorbidities and the skills of the examiner. Moreover, the full extent of a patients׳ neurologic injury may not become apparent for days after injury; by then, therapeutic response may be limited. Although magnetic resonance imaging (MRI) is the best imaging modality for the evaluation of spinal cord parenchyma, conventional MR techniques do not appear to differentiate edema from axonal injury. Recently, it is proposed that in addition to characterizing the anatomic extent of injury, metrics derived from conventional MRI and diffusion tensor imaging, in conjunction with the neurological examination, can serve as a reliable objective biomarker for determination of the extent of neurologic injury and early identification of patients who would benefit from treatment. Cervical spondylosis is a common disorder affecting predominantly the elderly with a potential to narrow the spinal canal and thereby impinge or compress upon the neural elements leading to cervical spondylotic myelopathy and radiculopathy. It is the commonest nontraumatic cause of spinal cord disorder in adults. Imaging plays an important role in grading the severity of spondylosis and detecting cord abnormalities suggesting myelopathy. Copyright © 2016 Elsevier Inc. All rights

MR spectroscopy of cervical spinal cord in patients with multiple sclerosis

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Kendi, Ayse Tuba Karaguelle; Kendi, Mustafa; Tan, Funda Uysal; Tellioglu, Serdar; Huvaj, Sinef

2004-01-01

MR spectroscopy (MRS) of the brain in patients with multiple sclerosis has been well studied. However, in vivo MRS of the spinal cord in patients with MR spectroscopy has not been reported to our knowledge. We performed MRS of normal-appearing cervical spinal cords in multiple sclerosis patients and in healthy controls. N-acetyl aspartate was shown to be reduced within the cervical spinal cord of multiple sclerosis patients when compared with healthy controls. This finding supports axonal loss and damage within even normal-appearing spinal cords of multiple sclerosis patients. (orig.)

Role of spared pathways in locomotor recovery after body-weight-supported treadmill training in contused rats.

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Singh, Anita; Balasubramanian, Sriram; Murray, Marion; Lemay, Michel; Houle, John

2011-12-01

Body-weight-supported treadmill training (BWSTT)-related locomotor recovery has been shown in spinalized animals. Only a few animal studies have demonstrated locomotor recovery after BWSTT in an incomplete spinal cord injury (SCI) model, such as contusion injury. The contribution of spared descending pathways after BWSTT to behavioral recovery is unclear. Our goal was to evaluate locomotor recovery in contused rats after BWSTT, and to study the role of spared pathways in spinal plasticity after BWSTT. Forty-eight rats received a contusion, a transection, or a contusion followed at 9 weeks by a second transection injury. Half of the animals in the three injury groups were given BWSTT for up to 8 weeks. Kinematics and the Basso-Beattie-Bresnahan (BBB) test assessed behavioral improvements. Changes in Hoffmann-reflex (H-reflex) rate depression property, soleus muscle mass, and sprouting of primary afferent fibers were also evaluated. BWSTT-contused animals showed accelerated locomotor recovery, improved H-reflex properties, reduced muscle atrophy, and decreased sprouting of small caliber afferent fibers. BBB scores were not improved by BWSTT. Untrained contused rats that received a transection exhibited a decrease in kinematic parameters immediately after the transection; in contrast, trained contused rats did not show an immediate decrease in kinematic parameters after transection. This suggests that BWSTT with spared descending pathways leads to neuroplasticity at the lumbar spinal level that is capable of maintaining locomotor activity. Discontinuing training after the transection in the trained contused rats abolished the improved kinematics within 2 weeks and led to a reversal of the improved H-reflex response, increased muscle atrophy, and an increase in primary afferent fiber sprouting. Thus continued training may be required for maintenance of the recovery. Transected animals had no effect of BWSTT, indicating that in the absence of spared pathways this

Improving Survival and Promoting Respiratory Motor Function After Cervical Spinal Cord Injury

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2017-09-01

AWARD NUMBER: W81XWH-15-1-0378 TITLE: Improving Survival and Promoting Respiratory Motor Function After Cervical Spinal Cord Injury PRINCIPAL...TITLE AND SUBTITLE CordCorInjury 5a. CONTRACT NUMBER Improvi g Survival and Promoting Respiratory Motor Function After Cervical Spinal Cord...care. However, despite these drastic interventions, the cervical injured patient is still susceptible to death due to respiratory complications

Normal morphology of the cervical spinal cord and spinal canal using MRI in Japanese

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Kato, Fumihiko; Yukawa, Yasutsugu; Suda, Kota; Yamagata, Masatsune; Ueta, Takayoshi

2010-01-01

The purpose of this study was to establish standard MRI values for the cervical spinal canal, dural tube, and spinal cord in healthy Japanese subjects and to define developmental stenosis of the cervical spinal canal based on MRI data. To establish standard values for ''finger grip and release in 10 seconds (G and R test)'' and ''10 second step test'' in healthy Japanese subjects. There were approximately 100 volunteers representing each gender and generation, including persons aged in their 20s to 70s. The sagittal diameter of the spinal canal, and the sagittal diameter and axial area of the dural tube and spinal cord were measured on MRIs of 1,211 subjects. From this data, we calculated the spinal cord occupation rate in the dural tube for defining developmental stenosis of the cervical spinal canal. ''Finger grip and release in 10 seconds (G and R test)'' and ''10 second step test'' were also examined on 1,211 subjects. The spinal canal diameter in sagittal images for all ages at the C5/6 intervertebral disc level was 11.7±1.6 mm in males and 11.6±1.5 mm in females, while that at the C5 vertebral body level was 12.9±1.4 mm in males and 12.5±1.3 mm in females. Dural tube diameter in sagittal images for all ages at the C5/6 intervertebral disc level was 9.5±1.8 mm in males and 9.6±1.6 mm in females, while that at the C5 vertebral body level was 11.2±1.4 mm in males and 11.1±1.4 mm in females. Dural tube area in axial images for all ages at the C5/6 intervertebral disc level was 155.7±32.1 mm 2 in males and 149.6±29.0 mm 2 in females, while that at the C5 vertebral body level was 187.4±32.6 mm 2 in males and 177.0±32.7 mm 2 in females. Spinal cord diameter in sagittal images for all ages at the C5/6 intervertebral disc level was 5.9±1.0 mm in males and 5.8±0.9 mm in females, while that at the C5 vertebral body level was 6.5±0.7 mm in males and 6.4±0.7 mm in females. Spinal cord area in axial images for all ages at the C5/6 intervertebral disc level

Feasibility of Diffusion Tensor Imaging for Assessing Functional Recovery in Rats with Olfactory Ensheathing Cell Transplantation After Contusive Spinal Cord Injury (SCI).

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Gu, Mengchao; Gao, Zhengchao; Li, Xiaohui; Zhao, Feng; Guo, Lei; Liu, Jiantao; He, Xijing

2017-06-17

BACKGROUND Olfactory ensheathing cell transplantation is a promising treatment for spinal cord injury. Diffusion tensor imaging has been applied to assess various kinds of spinal cord injury. However, it has rarely been used to evaluate the beneficial effects of olfactory ensheathing cell transplantation. This study aimed to explore the feasibility of diffusion tensor imaging in the evaluation of functional recovery in rats with olfactory ensheathing cell transplantation after contusive spinal cord injury. MATERIAL AND METHODS Immunofluorescence staining was performed to determine the purity of olfactory ensheathing cells. Rats received cell transplantation at week 1 after injury. Basso, Beattie, and Bresnahan score was used to assess the functional recovery. Magnetic resonance imaging was applied weekly, including diffusion tensor imaging. Diffusion tensor tractography was reconstructed to visualize the repair process. RESULTS The results showed that olfactory ensheathing cell transplantation increased the functional and histological recovery and restrained the secondary injury process after the initial spinal cord injury. The fractional anisotropy values in rats with cell transplantation were significantly higher than those in the control group, while the apparent diffusion coefficient values were significantly lower. Basso, Beattie, and Bresnahan score was positively and linearly correlated with fractional anisotropy value, and it was negatively and linearly correlated with apparent diffusion coefficient value. CONCLUSIONS These findings suggest that diffusion tensor imaging parameters are sensitive biomarker indices for olfactory ensheathing cell transplantation interventions, and diffusion tensor imaging scan can reflect the functional recovery promoted by the olfactory ensheathing cell transplantation after contusive spinal cord injury.

MR imaging in severe upper cervical spinal cord injury in childhood

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Robertson, H.J.; Steele, N.; Tilton, A.; Bodin, R.A.

1990-01-01

This paper demonstrates that MR imaging of the cervical spine in patients with upper cervical spinal cord injury can accurately define the extent of cord injury for prognostic and rehabilitative purpose. Seven patients, ages newborn to 11 y, had acute upper cervical spinal cord injury and required continuous respiratory assistance. All patients had cervical spine radiography initially, but the extent of injuries precluded transport for early MR imaging. One or more MR imaging studies were done when the acute injury phase subsided. Manual ventilatory support by Ambu bag with oxygen was combined with careful respiratory and cardiac monitoring during imaging

Preliminary clinical applications of DTI in human cervical spinal cord

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Song Ting; Mai Weiwen; Liang Biling; Shen Jun; Huang Suiqiao; Hu Chunhong

2007-01-01

Objective: To condcut preliminary study of the value of DTI(diffusion tensor imaging) in human cervical spinal cord. Methods: Twenty-one patients suffering from cervical spondylotic myelopathy and twenty volunteers without any clinical symptoms underwent routine MRI and DTI examination. DTI was performed in six non-collinear directions with single-shot fast spin echo echo, planar imaging sequence(b value = 400 s·mm -2 ). ADC(apparent diffusion coefficient) and FA(fractional anisotropy)values were measured by ROIs(regions of interest) in 4 different level segment spinal cord (C 2/3 , C 3/4 , C 4/5 , C 5/6 ) in normal volunteers, in lesions and normal segmental spinal cord in clinical cases respectively. DTI original images were automatically processed by using IDL (Version 5.6) soft- ware to produce color tensor images. SPSS11.0 software for windows was used for t-test and one-way ANOVA analysis. The difference was considered statistically significant if P 2/3 , C 3/4 , C 4/5 , C 5/6 , were analyzed and it was found that FA value between them had a significant difference by ANOVA, F=159.24, P 2/3 level. However, ADC value between 4 segments had no significant difference(F=2.191, P>0.05). (2)In patients of cervical spondylotic myelopathy, routine MRI T2WI showed abnormal signal in 9 cases, and showed no abnormal signal in 12 dases. In sixteen cases it was found that abnormal patchy green signal on colorized tensor maps appeared on the normal blue spinal cord. Also, in patients of cervical spondylotic myelopathy, there was significant difference in ADC and FA value between lesions and normal spinal cord (paired t test, for ADC, t=2.88, P 2/3 level segment spinal cord in normal volunteers (0.85 ± 0.03) is the highest among other segments. FA value decreases gradually along cervical spinal cord towards the caudal direction. However, the difference of ADC values amongst 4 segments is not significant. DTI colorized tensor maps can show more lesions than routine MRI

Enhanced motor function by training in spinal cord contused rats following radiation therapy.

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Ronaldo Ichiyama

Full Text Available Weight-bearing stepping, without supraspinal re-connectivity, can be attained by treadmill training in an animal whose spinal cord has been completely transected at the lower thoracic level. Repair of damaged tissue and of supraspinal connectivity/circuitry following spinal cord injury in rat can be achieved by specific cell elimination with radiation therapy of the lesion site delivered within a critical time window, 2-3 weeks postinjury. Here we examined the effects of training in the repaired spinal cord following clinical radiation therapy. Studies were performed in a severe rat spinal cord contusion injury model, one similar to fracture/crush injuries in humans; the injury was at the lower thoracic level and the training was a combined hindlimb standing and stepping protocol. Radiotherapy, in a similar manner to that reported previously, resulted in a significant level of tissue repair/preservation at the lesion site. Training in the irradiated group, as determined by limb kinematics tests, resulted in functional improvements that were significant for standing and stepping capacity, and yielded a significant direct correlation between standing and stepping performance. In contrast, the training in the unirradiated group resulted in no apparent beneficial effects, and yielded an inverse correlation between standing and stepping performance, e.g., subject with good standing showed poor stepping capacity. Further, without any training, a differential functional change was observed in the irradiated group; standing capacity was significantly inhibited while stepping showed a slight trend of improvement compared with the unirradiated group. These data suggest that following repair by radiation therapy the spinal circuitries which control posture and locomotor were modified, and that the beneficial functional modulation of these circuitries is use dependent. Further, for restoring beneficial motor function following radiotherapy, training seems

Locomotor recovery after spinal cord hemisection/contusion injures in bonnet monkeys: footprint testing--a minireview.

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Rangasamy, Suresh Babu

2013-07-01

Spinal cord injuries usually produce loss or impairment of sensory, motor and reflex function below the level of damage. In the absence of functional regeneration or manipulations that promote regeneration, spontaneous improvements in motor functions occur due to the activation of multiple compensatory mechanisms in animals and humans following the partial spinal cord injury. Many studies were performed on quantitative evaluation of locomotor recovery after induced spinal cord injury in animals using behavioral tests and scoring techniques. Although few studies on rodents have led to clinical trials, it would appear imperative to use nonhuman primates such as macaque monkeys in order to relate the research outcomes to recovery of functions in humans. In this review, we will discuss some of our research evidences concerning the degree of spontaneous recovery in bipedal locomotor functions of bonnet monkeys that underwent spinal cord hemisection/contusion lesions. To our knowledge, this is the first report to discuss on the extent of spontaneous recovery in bipedal locomotion of macaque monkeys through the application of footprint analyzing technique. In addition, the results obtained were compared with the published data on recovery of quadrupedal locomotion of spinally injured rodents. We propose that the mechanisms underlying spontaneous recovery of functions in spinal cord lesioned monkeys may be correlated to the mature function of spinal pattern generator for locomotion under the impact of residual descending and afferent connections. Moreover, based on analysis of motor functions observed in locomotion in these subjected monkeys, we understand that spinal automatism and development of responses by afferent stimuli from outside the cord could possibly contribute to recovery of paralyzed hindlimbs. This report also emphasizes the functional contribution of progressive strengthening of undamaged nerve fibers through a collateral sprouts/synaptic plasticity formed

Diaphragm electromyographic activity following unilateral midcervical contusion injury in rats

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Sieck, Gary C.

2016-01-01

Contusion-type injuries to the spinal cord are characterized by tissue loss and disruption of spinal pathways. Midcervical spinal cord injuries impair the function of respiratory muscles and may contribute to significant respiratory complications. This study systematically assessed the impact of a 100-kDy unilateral C4 contusion injury on diaphragm muscle activity across a range of motor behaviors in rats. Chronic diaphragm electromyography (EMG) was recorded before injury and at 1 and 7 days postinjury (DPI). Histological analyses assessed the extent of perineuronal net formation, white-matter sparing, and phrenic motoneuron loss. At 7 DPI, ∼45% of phrenic motoneurons were lost ipsilaterally. Relative diaphragm root mean square (RMS) EMG activity increased bilaterally across a range of motor behaviors by 7 DPI. The increase in diaphragm RMS EMG activity was associated with an increase in neural drive (RMS value at 75 ms after the onset of diaphragm activity) and was more pronounced during higher force, nonventilatory motor behaviors. Animals in the contusion group displayed a transient decrease in respiratory rate and an increase in burst duration at 1 DPI. By 7 days, following midcervical contusion, there was significant perineuronal net formation and white-matter loss that spanned 1 mm around the injury epicenter. Taken together, these findings are consistent with increased recruitment of remaining motor units, including more fatigable, high-threshold motor units, during higher force, nonventilatory behaviors. Changes in diaphragm EMG activity following midcervical contusion injury reflect complex adaptations in neuromotor control that may increase the risk of motor-unit fatigue and compromise the ability to sustain higher force diaphragm efforts. NEW & NOTEWORTHY The present study shows that unilateral contusion injury at C4 results in substantial loss of phrenic motoneurons but increased diaphragm muscle activity across a range of ventilatory and higher

Transplantation of oligodendrocyte precursors and sonic hedgehog results in improved function and white matter sparing in the spinal cords of adult rats after contusion.

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Bambakidis, Nicholas C; Miller, Robert H

2004-01-01

A substantial cause of neurological disability in spinal cord injury is oligodendrocyte death leading to demyelination and axonal degeneration. Rescuing oligodendrocytes and preserving myelin is expected to result in significant improvement in functional outcome after spinal cord injury. Although previous investigators have used cellular transplantation of xenografted pluripotent embryonic stem cells and observed improved functional outcome, these transplants have required steroid administration and only a minority of these cells develop into oligodendrocytes. The objective of the present study was to determine whether allografts of oligodendrocyte precursors transplanted into an area of incomplete spinal cord contusion would improve behavioral and electrophysiological measures of spinal cord function. Additional treatment incorporated the use of the glycoprotein molecule Sonic hedgehog (Shh), which has been shown to play a critical role in oligodendroglial development and induce proliferation of endogenous neural precursors after spinal cord injury. Laboratory study. Moderate spinal cord contusion injury was produced in 39 adult rats at T9-T10. Ten animals died during the course of the study. Nine rats served as contusion controls (Group 1). Six rats were treated with oligodendrocyte precursor transplantation 5 days after injury (Group 2). The transplanted cells were isolated from newborn rat pups using immunopanning techniques. Another eight rats received an injection of recombinant Shh along with the oligodendrocyte precursors (Group 3), while six more rats were treated with Shh alone (Group 4). Eight additional rats received only T9 laminectomies to serve as noninjured controls (Group 0). Animals were followed for 28 days. After an initial complete hindlimb paralysis, rats of all groups receiving a contusive injury recovered substantial function within 1 week. By 28 days, rats in Groups 2 and 3 scored 4.7 and 5.8 points better on the Basso, Beattie, Bresnahan

The effectiveness of the anti-CD11d treatment is reduced in rat models of spinal cord injury that produce significant levels of intraspinal hemorrhage.

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Geremia, N M; Hryciw, T; Bao, F; Streijger, F; Okon, E; Lee, J H T; Weaver, L C; Dekaban, G A; Kwon, B K; Brown, A

2017-09-01

We have previously reported that administration of a CD11d monoclonal antibody (mAb) improves recovery in a clip-compression model of SCI. In this model the CD11d mAb reduces the infiltration of activated leukocytes into the injured spinal cord (as indicated by reduced intraspinal MPO). However not all anti-inflammatory strategies have reported beneficial results, suggesting that success of the CD11d mAb treatment may depend on the type or severity of the injury. We therefore tested the CD11d mAb treatment in a rat hemi-contusion model of cervical SCI. In contrast to its effects in the clip-compression model, the CD11d mAb treatment did not improve forelimb function nor did it significantly reduce MPO levels in the hemi-contused cord. To determine if the disparate results using the CD11d mAb were due to the biomechanical nature of the cord injury (compression SCI versus contusion SCI) or to the spinal level of the injury (12th thoracic level versus cervical) we further evaluated the CD11d mAb treatment after a T12 contusion SCI. In contrast to the T12 clip compression SCI, the CD11d mAb treatment did not improve locomotor recovery or significantly reduce MPO levels after T12 contusion SCI. Lesion analyses revealed increased levels of hemorrhage after contusion SCI compared to clip-compression SCI. SCI that is accompanied by increased intraspinal hemorrhage would be predicted to be refractory to the CD11d mAb therapy as this approach targets leukocyte diapedesis through the intact vasculature. These results suggest that the disparate results of the anti-CD11d treatment in contusion and clip-compression models of SCI are due to the different pathophysiological mechanisms that dominate these two types of spinal cord injuries. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Diagnosis of cervical spinal cord disorders with MRI

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Suyama, Naohito; Iizuka, Tadashi

1991-01-01

From September 1987 through May 1989, magnetic resonance imaging (MRI) has been performed in 58 patients with myelopathy and 9 patients with spinal cord injuries. This study was designed to determine the rate of spinal cord stricture and changes of signal intensities. Increased signal intensity on T2-weighted images was more frequently observed than decreased intensity on T1-weighted images in the group of myelopathy (19/58 vs 10/58). In the group of spinal cord injuries, however, there was no significant difference in the incidence between increased intensity on T2-weighted images (4/9) and decreased intensity on T1-weighted images (7/9). Twelve patients with chronic compressive spinal myelopathy tended to have an increased intensity on T2-weighted images. In such cases, although JOA scores were low before surgery, signal intensity returned to that without marked signal changes. In chronic compressive cervical myelopathy, the degree of preoperative compression was the same as the postoperative JOA scores. Regarding cervical spinal injury, there was a good correlation between the size of low signal area and the degree of paralysis. (N.K.)

Intravenous Infusion of Magnesium Chloride Improves Epicenter Blood Flow during the Acute Stage of Contusive Spinal Cord Injury in Rats

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Muradov, Johongir M.

2013-01-01

Abstract Vasospasm, hemorrhage, and loss of microvessels at the site of contusive or compressive spinal cord injury lead to infarction and initiate secondary degeneration. Here, we used intravenous injection of endothelial-binding lectin followed by histology to show that the number of perfused microvessels at the injury site is decreased by 80–90% as early as 20 min following a moderate T9 contusion in adult female rats. Hemorrhage within the spinal cord also was maximal at 20 min, consistent with its vasoconstrictive actions in the central nervous system (CNS). Microvascular blood flow recovered to up to 50% of normal volume in the injury penumbra by 6 h, but not at the epicenter. A comparison with an endothelial cell marker suggested that many microvessels fail to be reperfused up to 48 h post-injury. The ischemia was probably caused by vasospasm of vessels penetrating the parenchyma, because repeated Doppler measurements over the spinal cord showed a doubling of total blood flow over the first 12 h. Moreover, intravenous infusion of magnesium chloride, used clinically to treat CNS vasospasm, greatly improved the number of perfused microvessels at 24 and 48 h. The magnesium treatment seemed safe as it did not increase hemorrhage, despite the improved parenchymal blood flow. However, the treatment did not reduce acute microvessel, motor neuron or oligodendrocyte loss, and when infused for 7 days did not affect functional recovery or spared epicenter white matter over a 4 week period. These data suggest that microvascular blood flow can be restored with a clinically relevant treatment following spinal cord injury. PMID:23302047

Computer tomographic investigations of cervical spinal stenosis

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Rodiek, S.O.

1983-10-01

Computed tomography was applied in 29 patients with cervical spinal stenosis. In 8 cases there was a congenital narrowed spinal canal. In 18 cases we found dorsal spondylotic ridges of the vertebral bodies and in three cases an atlanto-dental dislocation. The complaints showed either radicular character or in case of myelopathy came out as para- and quadriplegia. In 25 cases the spinal sagittal diamter was a lot below a critical borderline of about 13 mm. The kind and localisation of the underlying process can be demonstrated very excellent by computed tomography.

Computer tomographic investigations of cervical spinal stenosis

International Nuclear Information System (INIS)

Rodiek, S.O.

1983-01-01

Computed tomography was applied in 29 patients with cervical spinal stenosis. In 8 cases there was a congenital narrowed spinal canal. In 18 cases we found dorsal spondylotic ridges of the vertebral bodies and in three cases an atlanto-dental dislocation. The complaints showed either radicular character or in case of myelopathy came out as para- and quadriplegia. In 25 cases the spinal sagittal diamter was a lot below a critical borderline of about 13 mm. The kind and localisation of the underlying process can be demonstrated very excellent by computed tomography. (orig.) [de

Morphological study of the axial view of the cervical spinal cord by MR images

International Nuclear Information System (INIS)

Suzuki, Masahiro; Shimamura, Tadashi

1994-01-01

To investigate the morphological changes in the cervical spinal cord in patients with cervical myelopathy, we examined the axial anatomy of the cervical spinal cord and the spinal canal using MRI and CT scans. This study involved 35 patients (mean age=56.8) with cervical myelopathy and 118 adult normal volunteers (mean age=48.1) as controls. The transverse area of the spinal cord was measured on MR images (T 1 images), while the transverse area of the spinal canal was measured on CT. In normal subjects, the transverse area, the sagittal diameter, and the coronal diameter of the spinal cord showed a significant positive correlation with body height, and a significant negative correlation with age. No significant difference was identified between males and females. The transverse area, the sagittal diameter, the coronal diameter, and the ratio of the sagittal/coronal diameter of the spinal cord and the spinal canal showed significant positive correlations among each other in normal subjects, but no significant correlation was noted in the patients with cervical myelopathy. These was no significant difference between the normal subjects and the patients in the transverse area or in the ratio of the sagittal/coronal diameter of the spinal cord at the levels without cord compression. However, the transverse area of the spinal canal in the patients with myelopathy was significantly smaller than that of normal subjects. In conclusion, a poor or no correlation between the size of the spinal cord and the spinal canal is a frequent finding in patients with myelopathy. Furthermore, this study suggests that patients with myelopathy present a narrow spinal canal more frequently than do normal subjects. (author)

Boomerang deformity of cervical spinal cord migrating between split laminae after laminoplasty.

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Kimura, S; Gomibuchi, F; Shimoda, H; Ikezawa, Y; Segawa, H; Kaneko, F; Uchiyama, S; Homma, T

2000-04-01

Patients with cervical compression myelopathy were studied to elucidate the mechanism underlying boomerang deformity, which results from the migration of the cervical spinal cord between split laminae after laminoplasty with median splitting of the spinous processes (boomerang sign). Thirty-nine cases, comprising 25 patients with cervical spondylotic myelopathy, 8 patients with ossification of the posterior longitudinal ligament, and 6 patients with cervical disc herniation with developmental canal stenosis, were examined. The clinical and radiological findings were retrospectively compared between patients with (B group, 8 cases) and without (C group, 31 cases) boomerang sign. Moderate increase of the grade of this deformity resulted in no clinical recovery, although there was no difference in clinical recovery between the two groups. Most boomerang signs developed at the C4/5 and/or C5/6 level, where maximal posterior movement of the spinal cord was achieved. Widths between lateral hinges and between split laminae in the B group were smaller than in the C group. Flatness of the spinal cord in the B group was more severe than in the C group. In conclusion, the boomerang sign was caused by posterior movement of the spinal cord, narrower enlargement of the spinal canal and flatness of the spinal cord.

Spinal CT scan, 1. Cervical and thoracic spines

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Nakagawa, Hiroshi (Aichi Medical Univ. (Japan))

1982-01-01

Methods of CT of the cervical and thoracic spines were explained, and normal CT pictures of them were described. Spinal CT was evaluated in comparison with other methods in various spinal diseases. Plain CT revealed stenosis due to spondylosis or ossification of posterior longitudinal ligament and hernia of intervertebral disc. CT took an important role in the diagnosis of spinal cord tumors with calcification and destruction of the bone. CT scan in combination with other methods was also useful for the diagnosis of spinal injuries, congenital anomalies and infections.

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

International Nuclear Information System (INIS)

Lindberg, Paavel G.; Sanchez, Katherine; Rannou, Francois; Poiraudeau, Serge; Ozcan, Fidan; Feydy, Antoine; Maier, Marc A.

2016-01-01

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.)

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

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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.)

Technique and results of the spinal computed tomography in the diagnosis of cervical disc disease

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Artmann, H.; Salbeck, R.; Grau, H.

1985-01-01

We give a description of a technique of the patient's positioning with traction of the arms during the cervical spinal computed tomography which allows to draw the shoulders downwards by about one to three cervical segments. By this method the quality of the images can be improved in 96% in the cervical segment 6/7 and in 81% in the cervical/thoracal segment 7/1 to such a degree that a reliable judgement of the soft parts in the spinal canal becomes possible. The diagnostic reliability of the computed tomography of the cervical disc herniation is thus improved so that the necessity of a myelography is decreasing. The results of 396 cervical spinal computed tomographies are presented. (orig.) [de

Preliminary study of diffusion tensor MR on the cervical spinal cord in normal subjects

International Nuclear Information System (INIS)

Zheng Kuihong; Ma Lin; Guo Xinggao; Liang Li

2006-01-01

Objective: To investigate a simplified and practical strategy for MR diffusion tensor imaging (DTI) of the cervical spinal cord and acquire the normal values of DTI parameters in normal subjects, and to offer the basis for the research of the cervical spinal cord disorders. Methods: DTI examinations were performed in 36 consecutive healthy subjects by using SE-EPI sequence on the cervical spinal cord. The values of apparent diffusion coefficient (ADC), fractional anisotropy (FA), λ 1 , λ 2 , and λ 3 were measured in regions of interest positioned in the normal cervical cords. Results: All 36 subjects completed the examinations. The cervical spinal cords were clearly demonstrated on the postprocessing images, and there were no obvious artifacts on the diffusion tensor images. The average value of ADC was (914.44±82.61) x 10 -6 mm 2 /s and FA was (593.84±52.22) x 10 -3 . The diffusivity components parallel (λ 1 ) and orthogonal (λ 2 and λ 3 ) to the longitudinal axes of the spinal cord were (1585.10±130.07) x 10 -6 mm 2 /s, (559.84±66.49) x 10 -6 mm 2 /s, and (613.28±128.71) x 10 -6 mm 2 /s, respectively. The value of λ 1 was significantly higher than that of λ 2 and λ 3 (P 2 and λ 3 (P>0.05). The value of 2λ 1 /(λ 2 +λ 3 ) was 2.74± 0.32. Conclusion: The normal cervical spinal cord can be well demonstrated in vivo by using DTI with SE-EPI sequence, and various parameters acquired on DTI are stable. The water diffusivity in the direction parallel to the longitudinal axes of the spinal cord is found to be higher than that in directions perpendicular to the longitudinal axes of the spinal cord, thus suggesting the cylindrical anisotropic characteristics in the cervical spinal cord. (authors)

Intrinsic Vertebral Markers for Spinal Level Localization in Anterior Cervical Spine Surgery: A Preliminary Report.

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Jha, Deepak Kumar; Thakur, Anil; Jain, Mukul; Arya, Arvind; Tripathi, Chandrabhushan; Kumari, Rima; Kushwaha, Suman

2016-12-01

Prospective clinical study. To observe the usefulness of anterior cervical osteophytes as intrinsic markers for spinal level localization (SLL) during sub-axial cervical spinal surgery via the anterior approach. Various landmarks, such as the mandibular angle, hyoid bone, thyroid cartilage, first cricoid ring, and C6 carotid tubercle, are used for gross cervical SLL; however, none are used during cervical spinal surgery via the anterior approach. We present our preliminary assessment of SLL over anterior vertebral surfaces (i.e., intrinsic markers) in 48 consecutive cases of anterior cervical spinal surgeries for the disc-osteophyte complex (DOC) in degenerative diseases and granulation or tumor tissue associated with infectious or neoplastic diseases, respectively, at an ill-equipped center. This prospective study on patients undergoing anterior cervical surgery for various sub-axial cervical spinal pathologies aimed to evaluate the feasibility and accuracy of SLL via intraoperative palpation of disease-related morphological changes on anterior vertebral surfaces visible on preoperative midline sagittal T1/2-weighted magnetic resonance images. During a 3-year period, 48 patients (38 males,10 females; average age, 43.58 years) who underwent surgery via the anterior approach for various sub-axial cervical spinal pathologies, including degenerative disease (n= 42), tubercular infection (Pott's disease; n=3), traumatic prolapsed disc (n=2), and a metastatic lesion from thyroid carcinoma (n=1), comprised the study group. Intrinsic marker palpation yielded accurate SLL in 79% of patients (n=38). Among those with degenerative diseases (n=42), intrinsic marker palpation yielded accurate SLL in 76% of patients (n=32). Intrinsic marker palpation is an attractive potential adjunct for SLL during cervical spinal surgeries via the anterior approach in well-selected patients at ill-equipped centers (e.g., those found in developing countries). This technique may prove helpful

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

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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.

Regional differences in radiosensitivity across the rat cervical spinal cord

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Bijl, Hendrik P.; Luijk, Peter van; Coppes, Rob P.; Schippers, Jacobus M.; Konings, Antonius W.T.; Kogel, Albert J. van der

2005-01-01

Purpose: To study regional differences in radiosensitivity within the rat cervical spinal cord. Methods and materials: Three types of inhomogeneous dose distributions were applied to compare the radiosensitivity of the lateral and central parts of the rat cervical spinal cord. The left lateral half of the spinal cord was irradiated with two grazing proton beams, each with a different penumbra (20-80% isodoses): lateral wide (penumbra = 1.1 mm) and lateral tight (penumbra = 0.8 mm). In the third experiment, the midline of the cord was irradiated with a narrow proton beam with a penumbra of 0.8 mm. The irradiated spinal cord length (CT-2) was 20 mm in all experiments. The animals were irradiated with variable single doses of unmodulated protons (150 MeV) with the shoot-through method, whereby the plateau of the depth-dose profile is used rather than the Bragg peak. The endpoint for estimating isoeffective dose (ED 50 ) values was paralysis of fore and/or hind limbs within 210 days after irradiation. Histology of the spinal cords was performed to assess the radiation-induced tissue damage. Results: High-precision proton irradiation of the lateral or the central part of the spinal cord resulted in a shift of dose-response curves to higher dose values compared with the homogeneously irradiated cervical cord to the same 20-mm length. The ED 50 values were 28.9 Gy and 33.4 Gy for the lateral wide and lateral tight irradiations, respectively, and as high as 71.9 Gy for the central beam experiment, compared with 20.4 Gy for the homogeneously irradiated 20-mm length of cervical cord. Histologic analysis of the spinal cords showed that the paralysis was due to white matter necrosis. The radiosensitivity was inhomogeneously distributed across the spinal cord, with a much more radioresistant central white matter (ED 50 = 71.9 Gy) compared with lateral white matter (ED 50 values = 28.9 Gy and 33.4 Gy). The gray matter did not show any noticeable lesions, such as necrosis or

Pathological changes in the white matter after spinal contusion injury in the rat.

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C Joakim Ek

Full Text Available It has been shown previously that after spinal cord injury, the loss of grey matter is relatively faster than loss of white matter suggesting interventions to save white matter tracts offer better therapeutic possibilities. Loss of white matter in and around the injury site is believed to be the main underlying cause for the subsequent loss of neurological functions. In this study we used a series of techniques, including estimations of the number of axons with pathology, immunohistochemistry and mapping of distribution of pathological axons, to better understand the temporal and spatial pathological events in white matter following contusion injury to the rat spinal cord. There was an initial rapid loss of axons with no detectable further loss beyond 1 week after injury. Immunoreactivity for CNPase indicated that changes to oligodendrocytes are rapid, extending to several millimetres away from injury site and preceding much of the axonal loss, giving early prediction of the final volume of white matter that survived. It seems that in juvenile rats the myelination of axons in white matter tracts continues for some time, which has an important bearing on interpretation of our, and previous, studies. The amount of myelin debris and axon pathology progressively decreased with time but could still be observed at 10 weeks after injury, especially at more distant rostral and caudal levels from the injury site. This study provides new methods to assess injuries to spinal cord and indicates that early interventions are needed for the successful sparing of white matter tracts following injury.

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

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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.

Comparing the radiosensitivity of cervical and thoracic spinal cord using the relative seriality model

International Nuclear Information System (INIS)

Adamus-Gorka, M.; Lind, B.K.; Brahme, A.

2003-01-01

Spinal cord is one of the most important normal tissues that are aimed to be spared during radiation therapy of cancer. This organ has been known for its strongly serial character and its high sensitivity to radiation. In order to compare the sensitivity of different parts of spinal cord, the early data (1970's) for radiation myelopathy available in the literature could be used. In the present study the relative seriality model (Kallman et al. 1992) has been fitted to two different sets of clinical data for spinal cord irradiation: radiation myelitis of cervical spinal cord after treating 248 patients for malignant disease of head and neck (Abbatucci et al. 1978) and radiation myelitis of thoracic spinal cord after radiation treating 43 patients with lung carcinoma (Reinhold et al. 1976). The maximum likelihood method was applied for the fitting and the corresponding parameters together with their 68% confidence intervals calculated for each of the datasets respectively. The alpha-beta ratio for the thoracic survival was also obtained. On the basis of the present study the following conclusions can be drawn: 1. radiation myelopathy is a strongly serial endpoint, 2. it appears to be differences in radiosensitivity between the cervical and thoracic region of spinal cord, 3. thoracic spinal cord revealed very serial characteristic of dose response, while the cervical myelopathy seems to be a bit less serial endpoint, 4. the dose-response curve is much steeper in case of myelopathy of cervical spinal cord, due to the much higher gamma value for this region. This work compares the fitting of NTCP model to the cervical and thoracic regions of the spinal cord and shows quite different responses. In the future more data should be tested for better understanding the mechanism of spinal cord sensitivity to radiation

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

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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.

Tissue sparing, behavioral recovery, supraspinal axonal sparing/regeneration following sub-acute glial transplantation in a model of spinal cord contusion.

Science.gov (United States)

Barbour, Helen R; Plant, Christine D; Harvey, Alan R; Plant, Giles W

2013-09-27

It has been shown that olfactory ensheathing glia (OEG) and Schwann cell (SCs) transplantation are beneficial as cellular treatments for spinal cord injury (SCI), especially acute and sub-acute time points. In this study, we transplanted DsRED transduced adult OEG and SCs sub-acutely (14 days) following a T10 moderate spinal cord contusion injury in the rat. Behaviour was measured by open field (BBB) and horizontal ladder walking tests to ascertain improvements in locomotor function. Fluorogold staining was injected into the distal spinal cord to determine the extent of supraspinal and propriospinal axonal sparing/regeneration at 4 months post injection time point. The purpose of this study was to investigate if OEG and SCs cells injected sub acutely (14 days after injury) could: (i) improve behavioral outcomes, (ii) induce sparing/regeneration of propriospinal and supraspinal projections, and (iii) reduce tissue loss. OEG and SCs transplanted rats showed significant increased locomotion when compared to control injury only in the open field tests (BBB). However, the ladder walk test did not show statistically significant differences between treatment and control groups. Fluorogold retrograde tracing showed a statistically significant increase in the number of supraspinal nuclei projecting into the distal spinal cord in both OEG and SCs transplanted rats. These included the raphe, reticular and vestibular systems. Further pairwise multiple comparison tests also showed a statistically significant increase in raphe projecting neurons in OEG transplanted rats when compared to SCs transplanted animals. Immunohistochemistry of spinal cord sections short term (2 weeks) and long term (4 months) showed differences in host glial activity, migration and proteoglycan deposits between the two cell types. Histochemical staining revealed that the volume of tissue remaining at the lesion site had increased in all OEG and SCs treated groups. Significant tissue sparing was

Lhermitte's sign: Incidence and treatment variables influencing risk after irradiation of the cervical spinal cord

International Nuclear Information System (INIS)

Fein, D.A.; Marcus, R.B. Jr.; Parsons, J.T.; Mendenhall, W.M.; Million, R.R.

1993-01-01

Lhermitte's sign is a relatively infrequent sequela of irradiation of the cervical spinal cord. In this study, the authors sought to determine whether various treatment parameters influenced the likelihood of developing Lhermitte's sign. Between October 1964 and December 1987, 2901 patients with malignancies of the upper respiratory tract were treated at the University of Florida. The dose of radiation to the cervical spinal cord was calculated for those patients who had a minimum 1-year follow-up. A total of 1112 patients who received a minimum of 3000 cGy to at least 2 cm of cervical spinal cord were included in this analysis. Forty patients (3.6%) developed Lhermitte's sign. The mean time to development of Lhermitte's sign after irradiation was 3 months, and the mean duration of symptoms was 6 months. No patient with Lhermitte's sign developed transverse myelitis. Several variables were examined in a univariate analysis, including total dose to the cervical spinal cord, length of cervical spinal cord irradiated, dose per fraction, continuous-course compared with split-course radiotherapy, and once-daily compared with twice-daily irradiation. Only two variables proved to be significant. Six (8%) of 75 patients who received > 5000 cGy to the cervical spinal cord developed Lhermitte's sign compared with 34 (3.3%) of 1037 patients who received < 5000 cGy (p = .04). For patients treated with once-daily fractionation, 28 (3.4%) of 821 patients who received < 200 cGy per fraction developed Lhermitte's sign compared with 6 (10%) of 58 patients who received ≥ 200 cGy (p = .02). An increased risk of developing Lhermitte's sign was demonstrated for patients who received either ≥ 200 cGy per fraction (one fraction per day) or ≥ 5000 cGy total dose to the cervical spinal cord. 29 refs., 1 fig., 5 tabs

MRI of cervical spine injuries complicating ankylosing spondylitis

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Koivikko, Mika P.; Koskinen, Seppo K. [Helsinki Medical Imaging Center, Helsinki University Central Hospital, Toeoeloe Hospital, Department of Radiology, Helsinki (Finland)

2008-09-15

The objective was to study characteristic MRI findings in cervical spine fractures complicating ankylosing spondylitis (AS). Technical issues related to MRI are also addressed. A review of 6,774 consecutive cervical spine multidetector CT (MDCT) scans obtained during 6.2 years revealed 33 ankylosed spines studied for suspected acute cervical spine injury complicating AS. Of these, 20 patients also underwent MRI. On MRI, of these 20 patients, 19 had a total of 29 cervical and upper thoracic spine fractures. Of 20 transverse fractures traversing both anterior and posterior columns, 7 were transdiskal and exhibited less bone marrow edema than did those traversing vertebral bodies. One Jefferson's, 1 atlas posterior arch (Jefferson's on MDCT), 2 odontoid process, and 5 non-contiguous spinous process fractures were detectable. MRI showed 2 fractures that were undetected by MDCT, and conversely, MDCT detected 6 fractures not seen on MRI; 16 patients had spinal cord findings ranging from impingement and contusion to complete transection. Magnetic resonance imaging can visualize unstable fractures of the cervical and upper thoracic spine. Paravertebral hemorrhages and any ligamentous injuries should alert radiologists to seek transverse fractures. Multiple fractures are common and often complicated by spinal cord injuries. Diagnostic images can be obtained with a flexible multipurpose coil if the use of standard spine array coil is impossible due to a rigid collar or excessive kyphosis. (orig.)

Magnetic resonance imaging of the cervical and thoracic spine and the spinal cord

International Nuclear Information System (INIS)

Larsson, E.M.

1989-01-01

Magnetic resonance imaging (MR), using a 0.3 T resistive scanner with an iron core and a vertical magnetic field, was evaluated in patients with different diseases affecting the cervical and thoracic spine and the spinal cord. The results indicate that MR is well suited as the procedure of choice for emergency examination of patients with spinal cord symptoms, for examination of patients with suspected spinal multiple sclerosis and for pre-operative evaluation of patients with rheumatoid arthritis with neurological symptoms emanating from the cranio-cervical junction. In patients with cervical radiculapathy and/or myelopathy, caused by spondylosis or disk herniation, MR was found to be equivalent with myelography and CT myelography but MR has several practical advantages. MR at 0.3 T using a vertical magnetic field provided information comparable to that reported from examinations performed with superconducting MR scanners. In order to optimize the MR examinations of the spine, the signal characteristics of different coils available when using a vertical magnetic field were determined by phantom studies. Recommendations for optimal coil selection for different levels of the cervical and thoracic spine are given. In addition, the paramagnetic contrast medium gadolinium-DTPA was administered intravenously to patients with suspected spinal multiple sclerosis. Enhancement of clinically active lesions in the cervical spinal cord was observed. Serial MR examinations with gadolinium-DTPA showed that a decrease in enhancement could be correlated with decrease in clinical symptoms and signs. (author)

Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery

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Dong-Gun Kim

Full Text Available Objective: Motor evoked potentials (MEPs changes might be caused to the non-surgically induced factors during cervical spinal surgery. Therefore, control MEPs recorded cranially to the exit of the C5 root are highly recommendable in cervical spinal surgery. We studied whether corticobulbar MEPs (C-MEPs from tongue muscle could be used as a control MEPs in cervical spinal surgery. Methods: Twenty-five consecutive cervical spinal surgeries were analyzed. Stimulation of motor area for tongue was done by subcutaneous electrodes placed at C3/C4 (10–20 EEG System, and recording was done from both sides of tongue. Results: C-MEPs were recorded successfully 24 out of the 25 (96% tested patients. Forty-six out of fifty MEPs (92% from tongue muscles were monitorable from the baseline. In two patients, we could obtain only unilateral C-MEPs. Mean MEPs latencies obtained from the left and right side of the tongue were 11.5 ± 1 ms and 11.5 ± 0.8 ms, respectively. Conclusions: Monitoring C-MEPs from tongue muscles might be useful control in cervical spinal surgery. They were easily elicited and relatively free from phenomenon of peripheral stimulation of the hypoglossal nerves. Significance: This is first study to identify the usefulness of C-MEPs as a control of cervical spinal surgery. Keywords: Intraoperative neurophysiological monitoring, Motor-evoked potential, Corticospinal tract, Corticobulbar MEPs, Hypoglossal nerve

Cervical Lordosis Actually Increases With Aging and Progressive Degeneration in Spinal Deformity Patients.

Science.gov (United States)

Kim, Han Jo; Lenke, Lawrence G; Oshima, Yasushi; Chuntarapas, Tapanut; Mesfin, Addisu; Hershman, Stuart; Fogelson, Jeremy L; Riew, K Daniel

2014-09-01

Retrospective. The authors hypothesized that cervical lordosis (CL) would decrease with aging and increasing degeneration. It is theorized that with age and degeneration, the cervical spine loses lordosis and becomes progressively more kyphotic; however, no studies support these conclusions in patients with various spinal deformities. The authors performed a radiographic analysis of asymptomatic adults (referring to their cervical spine) of varying ages, with differing forms of spinal deformity to the thoracic/lumbar spine to see how cervical lordosis changes with increasing age. A total of 104 total spine EOS X-rays of adult (aged >18 years) spinal deformity patients without documented neck pain, prior neck surgery, or cervical deformity were reviewed. The researchers only reviewed EOS X-rays because they allow complete visualization from occiput to feet. Cervical lordosis, standard Cobb measurements, sagittal balance parameters, and cervical degeneration were quantified radiographically by the method previously described by Gore et al. Statistical analysis was performed with 1-way analysis of variance to compare significant differences between groups aged 60 years as well as changes in sagittal balance. A p-value 60 years, respectively; p 60 years, respectively; p < .01), with the highest degeneration at the C5-6 and C6-7 disc spaces (3.7 ± 3.3 and 3.2 ± 2.9, respectively; p < .01). This increase did not correlate with the increase in CL seen with aging (r = 0.02; p = .84). Cervical lordosis increased with aging in adult spinal deformity patients. There was no relationship between cervical degeneration and lordosis despite the strong relationship seen between increasing CL in older age groups. Copyright © 2014 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Complications of the lateral C1-C2 puncture myelography for cervical spinal canal

International Nuclear Information System (INIS)

Mihale, J.; Traubner, P.

1998-01-01

This reviewed the complications of 106 patients of the lateral C1-C2 puncture myelography for cervical spinal canal and cervical spinal cord disorders. Spinal cord puncture and contrast injection, puncture between the occiput and C1, and blood vessel puncture were the main complications. These principally depended on the misdirection of the X ray beam. For preventing major arterial puncture determined the pathway of the vertebral arteries and incidence of anomaly. (authors)

SSFSE sequence functional MRI of the human cervical spinal cord with complex finger tapping

International Nuclear Information System (INIS)

Xie Chuhai; Kong Kangmei; Guan Jitian; Chen Yexi; He Jiankang; Qi Weili; Wang Xinjia; Shen Zhiwei; Wu Renhua

2009-01-01

Purpose: Functional MR imaging of the human cervical spinal cord was carried out on volunteers during alternated rest and a complex finger tapping task, in order to detect image intensity changes arising from neuronal activity. Methods: Functional MR imaging data using single-shot fast spin-echo sequence (SSFSE) with echo time 42.4 ms on a 1.5 T GE Clinical System were acquired in eight subjects performing a complex finger tapping task. Cervical spinal cord activation was measured both in the sagittal and transverse imaging planes. Postprocessing was performed by AFNI (Analysis of Functional Neuroimages) software system. Results: Intensity changes (5.5-7.6%) were correlated with the time course of stimulation and were consistently detected in both sagittal and transverse imaging planes of the cervical spinal cord. The activated regions localized to the ipsilateral side of the spinal cord in agreement with the neural anatomy. Conclusion: Functional MR imaging signals can be reliably detected with finger tapping activity in the human cervical spinal cord using a SSFSE sequence with 42.4 ms echo time. The anatomic location of neural activity correlates with the muscles used in the finger tapping task.

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

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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

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.

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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.

Should suspected cervical spinal cord injury be immobilised?: a systematic review.

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Oteir, Ala'a O; Smith, Karen; Stoelwinder, Johannes U; Middleton, James; Jennings, Paul A

2015-04-01

Spinal cord injuries occur worldwide; often being life-threatening with devastating long term impacts on functioning, independence, health, and quality of life. Systematic review of the literature to determine the efficacy of cervical spinal immobilisation (vs no immobilisation) in patients with suspected cervical spinal cord injury (CSCI); and to provide recommendations for prehospital spinal immobilisation. Searches were conducted of the Cochrane library, CINAHL, EMBASE, Pubmed, Scopus, Web of science, Google scholar, and OvidSP (MEDLINE, PsycINFO, and DARE) databases. Studies were included if they were relevant to the research question, published in English, based in the prehospital setting, and included adult patients with traumatic injury. The search identified 1471 citations, of which eight observational studies of variable quality were included. Four studies were retrospective cohorts, three were case series and one a case report. Cervical collar application was reported in penetrating trauma to be associated with unadjusted increased risk of mortality in two studies [(OR, 8.82; 95% CI, 1.09-194; p=0.038) & (OR, 2.06; 95% CI, 1.35-3.13)], concealment of neck injuries in one study and increased scene time in another study. While, in blunt trauma, one study indicated that immobilisation might be associated with worsened neurological outcome (OR, 2.03; 95% CI, 1.03-3.99; p=0.04, unadjusted). We did not attempt to combine study results due to significant heterogeneity of study design and outcome measures. There is a lack of high-level evidence on the effect of prehospital cervical spine immobilisation on patient outcomes. There is a clear need for large prospective studies to determine the clinical benefit of prehospital spinal immobilisation as well as to identify the subgroup of patients most likely to benefit. Copyright © 2015 Elsevier Ltd. All rights reserved.

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation.

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Chan, Andrew K; Winkler, Ethan A; Jacques, Line

2016-07-01

OBJECTIVE Cervical spinal cord stimulation (cSCS) is used to treat pain of the cervical region and upper extremities. Case reports and small series have shown a relatively low risk of complication after cSCS, with only a single reported case of perioperative spinal cord injury in the literature. Catastrophic cSCS-associated spinal cord injury remains a concern as a result of underreporting. To aid in preoperative counseling, it is necessary to establish a minimum rate of spinal cord injury and surgical complication following cSCS. METHODS The Nationwide Inpatient Sample (NIS) is a stratified sample of 20% of all patient discharges from nonfederal hospitals in the United States. The authors identified discharges with a primary procedure code for spinal cord stimulation (ICD-9 03.93) associated with a primary diagnosis of cervical pathology from 2002 to 2011. They then analyzed short-term safety outcomes including the presence of spinal cord injury and neurological, medical, and general perioperative complications and compared outcomes using univariate analysis. RESULTS Between 2002 and 2011, there were 2053 discharges for cSCS. The spinal cord injury rate was 0.5%. The rates of any neurological, medical, and general perioperative complications were 1.1%, 1.4%, and 11.7%, respectively. There were no deaths. CONCLUSIONS In the largest series of cSCS, the risk of spinal cord injury was higher than previously reported (0.5%). Nonetheless, this procedure remains relatively safe, and physicians may use these data to corroborate the safety of cSCS in an appropriately selected patient population. This may become a key treatment option in an increasingly opioid-dependent, aging population.

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

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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

Extraction of motor activity from the cervical spinal cord of behaving rats

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Prasad, Abhishek; Sahin, Mesut

2006-12-01

Injury at the cervical region of the spinal cord results in the loss of the skeletal muscle control from below the shoulders and hence causes quadriplegia. The brain-computer interface technique is one way of generating a substitute for the lost command signals in these severely paralyzed individuals using the neural signals from the brain. In this study, we are investigating the feasibility of an alternative method where the volitional signals are extracted from the cervical spinal cord above the point of injury. A microelectrode array assembly was implanted chronically at the C5-C6 level of the spinal cord in rats. Neural recordings were made during the face cleaning behavior with forelimbs as this task involves cyclic forelimb movements and does not require any training. The correlation between the volitional motor signals and the elbow movements was studied. Linear regression technique was used to reconstruct the arm movement from the rectified-integrated version of the principal neural components. The results of this study demonstrate the feasibility of extracting the motor signals from the cervical spinal cord and using them for reconstruction of the elbow movements.

A Cadaveric Study of the Morphometry of the Cervical Spinal Canal ...

African Journals Online (AJOL)

Morphometry of the cervical spinal canal is of clinical importance in traumatic, degenerative and inflammatory conditions. A small canal diameter has been associated with an increase of injury mainly in athletes who participate in contact or collision sports. Before abnormal spinal morphometry can be determined, it is first ...

The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine.

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Aebli, Nikolaus; Wicki, Anina G; Rüegg, Tabea B; Petrou, Nassos; Eisenlohr, Heidrun; Krebs, Jörg

2013-06-01

Acute cervical spinal cord injury (SCI) has been observed in some patients after a minor trauma to the cervical spine. The discrepancy between the severity of the trauma and the clinical symptoms has been attributed to spinal canal stenosis. However, to date, there is no universally established radiological parameter for identifying critical spinal stenosis in these patients. The spinal canal-to-vertebral body ratio (Torg-Pavlov ratio) has been proposed for assessing developmental spinal canal stenosis. The relevance of the Torg-Pavlov ratio for predicting the occurrence and severity of acute cervical SCI after a minor trauma to the cervical spine has not yet been established. To investigate the Torg-Pavlov ratio values of the cervical spine in patients suffering from acute cervical SCI after a minor trauma to the cervical spine and the use of the Torg-Pavlov ratio for identifying patients at risk of cervical SCI and predicting the severity and course of symptoms. Retrospective radiological study of consecutive patients. Forty-five patients suffering from acute cervical SCI and 68 patients showing no neurologic symptoms after a minor trauma to the cervical spine. Midvertebral sagittal cervical spinal canal diameter and the sagittal vertebral body diameter. Calculation of the Torg-Pavlov ratio values. Conventional lateral radiographs of the cervical spine (C3-C7) were analyzed to determine the Torg-Pavlov ratio values. Receiver operating characteristic curves were calculated for evaluating the classification accuracy of the Torg-Pavlov ratio for predicting SCI. The Torg-Pavlov ratio values in the SCI group were significantly (pPavlov ratio cutoff value of 0.7 yielded the greatest positive likelihood ratio for predicting the occurrence of SCI. However, there were no significant differences in the Torg-Pavlov ratio values between the different American Spinal Injury Association Impairment Score groups and between patients with complete, partial, and no recovery of

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery

OpenAIRE

Daniels, Alan H.; Hart, Robert A.; Hilibrand, Alan S.; Fish, David E.; Wang, Jeffrey C.; Lord, Elizabeth L.; Buser, Zorica; Tortolani, P. Justin; Stroh, D. Alex; Nassr, Ahmad; Currier, Bradford L.; Sebastian, Arjun S.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.

2017-01-01

Study Design: Retrospective cohort study of prospectively collected data. Objective: To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17?625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011,...

Anatomical Recruitment of Spinal V2a Interneurons into Phrenic Motor Circuitry after High Cervical Spinal Cord Injury.

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Zholudeva, Lyandysha V; Karliner, Jordyn S; Dougherty, Kimberly J; Lane, Michael A

2017-11-01

More than half of all spinal cord injuries (SCIs) occur at the cervical level, often resulting in impaired respiration. Despite this devastating outcome, there is substantial evidence for endogenous neuroplasticity after cervical SCI. Spinal interneurons are widely recognized as being an essential anatomical component of this plasticity by contributing to novel neuronal pathways that can result in functional improvement. The identity of spinal interneurons involved with respiratory plasticity post-SCI, however, has remained largely unknown. Using a transgenic Chx10-eGFP mouse line (Strain 011391-UCD), the present study is the first to demonstrate the recruitment of excitatory interneurons into injured phrenic circuitry after a high cervical SCI. Diaphragm electromyography and anatomical analysis were used to confirm lesion-induced functional deficits and document extent of the lesion, respectively. Transneuronal tracing with pseudorabies virus (PRV) was used to identify interneurons within the phrenic circuitry. There was a robust increase in the number of PRV-labeled V2a interneurons ipsilateral to the C2 hemisection, demonstrating that significant numbers of these excitatory spinal interneurons were anatomically recruited into the phrenic motor pathway two weeks after injury, a time known to correspond with functional phrenic plasticity. Understanding this anatomical spinal plasticity and the neural substrates associated with functional compensation or recovery post-SCI in a controlled, experimental setting may help shed light onto possible cellular therapeutic candidates that can be targeted to enhance spontaneous recovery.

Crocin improved locomotor function and mechanical behavior in the rat model of contused spinal cord injury through decreasing calcitonin gene related peptide (CGRP).

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Karami, Masoume; Bathaie, S Zahra; Tiraihi, Taqi; Habibi-Rezaei, Mehran; Arabkheradmand, Jalil; Faghihzadeh, Soghrat

2013-12-15

Various approaches have been offered to alleviate chronic pain resulting from spinal cord injuries (SCIs). Application of herbs and natural products, with potentially lower adverse effects, to cure diseases has been recommended in both traditional and modern medicines. Here, the effect of crocin on chronic pain induced by spinal cord contusion was investigated in an animal model. Female Wistar rats were randomly divided into five groups (5 rats in each); three groups were contused at the L1 level. One group was treated with crocin (150mg/kg) two weeks after spinal cord injury; the second group, control, was treated with vehicle only; and the third group was treated with ketoprofen. Two normal groups were also considered with or without crocin treatment. The mechanical behavioral test, the locomotor recovery test and the thermal behavioral test were applied weekly to evaluate the injury and recovery of rats. Significant improvements (plocomotor recovery tests were seen in the rats treated with crocin. Thermal behavioral test did not show any significant changes due to crocin treatment. Plasma concentration of calcitonin-gene related peptide (CGRP) changed from 780.2±2.3 to 1140.3±4.5pg/ml due to SCI and reached 789.1±2.7pg/ml after crocin treatment. These changes were significant at the level of p<0.05. The present study shows the beneficial effects of crocin treatment on chronic pain induced by SCI, through decreasing CGRP as an important mediator of inflammation and pain. Copyright © 2013 Elsevier GmbH. All rights reserved.

Utility of MR imaging in pediatric spinal cord injury

International Nuclear Information System (INIS)

Felsberg, G.J.; Tien, R.D.; Osumi, A.K.; Cardenas, C.A.

1995-01-01

We evaluated the utility of MR imaging in pediatric patients with acute and subacute spinal cord injuries. MR imaging of 22 pediatric patients with suspected traumatic spinal cord injuries was reviewed. MR findings were correlated with physical examination and compared to available radiographs and CT examinations performed at time of presentation. Twelve patients had abnormalities on MR imaging. Seven had spinal cord contusions; five contusions were hemorrhagic. Five of seven patients with cord contusion had normal radiographs and CT exams. Six patients with normal radiographs and CT examinations had abnormal MR studies revealing cord contusion, ligamentous injury, disc herniation, and epidural hematoma. MR is useful in initial evaluation of pediatric patients with spinal cord injuries and in prognosis of future neurologic function. In the setting of spinal cord symptomatology and negative radiographic studies, MR imaging should be performed. Surgically correctable causes of cord compression demonstrated by MR imaging include disc herniation, epidural hematoma, and retropulsed fracture fragments. The entity of spinal cord injury without radiographic abnormality is a diagnosis of exclusion which should only be made after radiologic investigation with radiographs, high-resolution thin-section CT, and MR imaging. (orig.)

Fast and accurate semi-automated segmentation method of spinal cord MR images at 3T applied to the construction of a cervical spinal cord template.

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Mohamed-Mounir El Mendili

Full Text Available To design a fast and accurate semi-automated segmentation method for spinal cord 3T MR images and to construct a template of the cervical spinal cord.A semi-automated double threshold-based method (DTbM was proposed enabling both cross-sectional and volumetric measures from 3D T2-weighted turbo spin echo MR scans of the spinal cord at 3T. Eighty-two healthy subjects, 10 patients with amyotrophic lateral sclerosis, 10 with spinal muscular atrophy and 10 with spinal cord injuries were studied. DTbM was compared with active surface method (ASM, threshold-based method (TbM and manual outlining (ground truth. Accuracy of segmentations was scored visually by a radiologist in cervical and thoracic cord regions. Accuracy was also quantified at the cervical and thoracic levels as well as at C2 vertebral level. To construct a cervical template from healthy subjects' images (n=59, a standardization pipeline was designed leading to well-centered straight spinal cord images and accurate probability tissue map.Visual scoring showed better performance for DTbM than for ASM. Mean Dice similarity coefficient (DSC was 95.71% for DTbM and 90.78% for ASM at the cervical level and 94.27% for DTbM and 89.93% for ASM at the thoracic level. Finally, at C2 vertebral level, mean DSC was 97.98% for DTbM compared with 98.02% for TbM and 96.76% for ASM. DTbM showed similar accuracy compared with TbM, but with the advantage of limited manual interaction.A semi-automated segmentation method with limited manual intervention was introduced and validated on 3T images, enabling the construction of a cervical spinal cord template.

Fast and accurate semi-automated segmentation method of spinal cord MR images at 3T applied to the construction of a cervical spinal cord template.

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El Mendili, Mohamed-Mounir; Chen, Raphaël; Tiret, Brice; Villard, Noémie; Trunet, Stéphanie; Pélégrini-Issac, Mélanie; Lehéricy, Stéphane; Pradat, Pierre-François; Benali, Habib

2015-01-01

To design a fast and accurate semi-automated segmentation method for spinal cord 3T MR images and to construct a template of the cervical spinal cord. A semi-automated double threshold-based method (DTbM) was proposed enabling both cross-sectional and volumetric measures from 3D T2-weighted turbo spin echo MR scans of the spinal cord at 3T. Eighty-two healthy subjects, 10 patients with amyotrophic lateral sclerosis, 10 with spinal muscular atrophy and 10 with spinal cord injuries were studied. DTbM was compared with active surface method (ASM), threshold-based method (TbM) and manual outlining (ground truth). Accuracy of segmentations was scored visually by a radiologist in cervical and thoracic cord regions. Accuracy was also quantified at the cervical and thoracic levels as well as at C2 vertebral level. To construct a cervical template from healthy subjects' images (n=59), a standardization pipeline was designed leading to well-centered straight spinal cord images and accurate probability tissue map. Visual scoring showed better performance for DTbM than for ASM. Mean Dice similarity coefficient (DSC) was 95.71% for DTbM and 90.78% for ASM at the cervical level and 94.27% for DTbM and 89.93% for ASM at the thoracic level. Finally, at C2 vertebral level, mean DSC was 97.98% for DTbM compared with 98.02% for TbM and 96.76% for ASM. DTbM showed similar accuracy compared with TbM, but with the advantage of limited manual interaction. A semi-automated segmentation method with limited manual intervention was introduced and validated on 3T images, enabling the construction of a cervical spinal cord template.

Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study.

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Shilton, Michael; Branney, Jonathan; de Vries, Bas Penning; Breen, Alan C

2015-01-01

The association between cervical lordosis (sagittal alignment) and neck pain is controversial. Further, it is unclear whether spinal manipulative therapy can change cervical lordosis. This study aimed to determine whether cervical lordosis changes after a course of spinal manipulation for non-specific neck pain. Posterior tangents of C2 and C6 were drawn on the lateral cervical fluoroscopic images of 29 patients with subacute/chronic non-specific neck pain and 30 healthy volunteers matched for age and gender, recruited August 2011 to April 2013. The resultant angle was measured using 'Image J' digital geometric software. The intra-observer repeatability (measurement error and reliability) and intra-subject repeatability (minimum detectable change (MDC) over 4 weeks) were determined in healthy volunteers. A comparison of cervical lordosis was made between patients and healthy volunteers at baseline. Change in lordosis between baseline and 4-week follow-up was determined in patients receiving spinal manipulation. Intra-observer measurement error for cervical lordosis was acceptable (SEM 3.6°) and reliability was substantial ICC 0.98, 95 % CI 0.962-0991). The intra-subject MDC however, was large (13.5°). There was no significant difference between lordotic angles in patients and healthy volunteers (p = 0.16). The mean cervical lordotic increase over 4 weeks in patients was 2.1° (9.2) which was not significant (p = 0.12). This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation.

[Traumatic spinal complications of cervical arthrosis].

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Verstichel, P; Berthelot, J L; Randriananja, H; Crozier, S; Masson, C

1996-02-17

Cervical spondylotic myelopathy is usually a chronic and progressive disease. In a few cases, however, dramatic tetraplegia sometimes occurs after even minor injury. We report seven patients (6 males, 1 female, aged from 41 to 63), who suffered from acute myelopathy after an injury. In 5 cases, the injury revealed the cervical spondylotic myelopathy. A hyperextension of the cervical spine was found in 5 cases. The injury was severe in only one case, but there was no bony abnormalities, except arthrosis. The most common cause was a fall. In contrast, severe tetraplegia was found in 4 cases. Spontaneous, but incomplete, recuperation occurred in 4 patients. In all 7 cases, CT scan and MRI showed congenital cervical stenosis associated with cervical spondylosis. The level of disco-osteophytic changes was mainly in C4, C5, C6. On T2-weighted spin-echo image, an increased signal intensity was present in the cord of 3 patients, but was not correlated with the severity of the symptoms, nor with improvement. Surgical treatment was performed in 6 cases: 3 laminectomies, 3 anterior or antero-lateral approaches. Improvement after operative decompression was observed in all but one case, even when the motor or sensory deficit persists for more than one year. Motricity of the inferior limbs improved better than the other deficits, perhaps because of the location of non-reversible lesions in the spinal gray matter. The acute medullary syndrome of cervical spondylotic myelopathy is serious and can cause major handicaps. This complication justifies a preventive surgical attitude when medullar signs are moderate, and cervical imagery shows a spondylotic compression of the cord with congenital stenosis.

Human hepatocyte growth factor promotes functional recovery in primates after spinal cord injury.

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Kitamura, Kazuya; Fujiyoshi, Kanehiro; Yamane, Jun-Ichi; Toyota, Fumika; Hikishima, Keigo; Nomura, Tatsuji; Funakoshi, Hiroshi; Nakamura, Toshikazu; Aoki, Masashi; Toyama, Yoshiaki; Okano, Hideyuki; Nakamura, Masaya

2011-01-01

Many therapeutic interventions for spinal cord injury (SCI) using neurotrophic factors have focused on reducing the area damaged by secondary, post-injury degeneration, to promote functional recovery. Hepatocyte growth factor (HGF), which is a potent mitogen for mature hepatocytes and a mediator of the inflammatory responses to tissue injury, was recently highlighted as a potent neurotrophic factor in the central nervous system. We previously reported that introducing exogenous HGF into the injured rodent spinal cord using a herpes simplex virus-1 vector significantly reduces the area of damaged tissue and promotes functional recovery. However, that study did not examine the therapeutic effects of administering HGF after injury, which is the most critical issue for clinical application. To translate this strategy to human treatment, we induced a contusive cervical SCI in the common marmoset, a primate, and then administered recombinant human HGF (rhHGF) intrathecally. Motor function was assessed using an original open field scoring system focusing on manual function, including reach-and-grasp performance and hand placement in walking. The intrathecal rhHGF preserved the corticospinal fibers and myelinated areas, thereby promoting functional recovery. In vivo magnetic resonance imaging showed significant preservation of the intact spinal cord parenchyma. rhHGF-treatment did not give rise to an abnormal outgrowth of calcitonin gene related peptide positive fibers compared to the control group, indicating that this treatment did not induce or exacerbate allodynia. This is the first study to report the efficacy of rhHGF for treating SCI in non-human primates. In addition, this is the first presentation of a novel scale for assessing neurological motor performance in non-human primates after contusive cervical SCI.

Human hepatocyte growth factor promotes functional recovery in primates after spinal cord injury.

Directory of Open Access Journals (Sweden)

Kazuya Kitamura

Full Text Available Many therapeutic interventions for spinal cord injury (SCI using neurotrophic factors have focused on reducing the area damaged by secondary, post-injury degeneration, to promote functional recovery. Hepatocyte growth factor (HGF, which is a potent mitogen for mature hepatocytes and a mediator of the inflammatory responses to tissue injury, was recently highlighted as a potent neurotrophic factor in the central nervous system. We previously reported that introducing exogenous HGF into the injured rodent spinal cord using a herpes simplex virus-1 vector significantly reduces the area of damaged tissue and promotes functional recovery. However, that study did not examine the therapeutic effects of administering HGF after injury, which is the most critical issue for clinical application. To translate this strategy to human treatment, we induced a contusive cervical SCI in the common marmoset, a primate, and then administered recombinant human HGF (rhHGF intrathecally. Motor function was assessed using an original open field scoring system focusing on manual function, including reach-and-grasp performance and hand placement in walking. The intrathecal rhHGF preserved the corticospinal fibers and myelinated areas, thereby promoting functional recovery. In vivo magnetic resonance imaging showed significant preservation of the intact spinal cord parenchyma. rhHGF-treatment did not give rise to an abnormal outgrowth of calcitonin gene related peptide positive fibers compared to the control group, indicating that this treatment did not induce or exacerbate allodynia. This is the first study to report the efficacy of rhHGF for treating SCI in non-human primates. In addition, this is the first presentation of a novel scale for assessing neurological motor performance in non-human primates after contusive cervical SCI.

Neurologic Outcome of Laminoplasty for Acute Traumatic Spinal Cord Injury without Instability.

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Lee, Hwa Joong; Kim, Hwan Soo; Nam, Kyoung Hyup; Han, In Ho; Cho, Won Ho; Choi, Byung Kwan

2013-09-01

The purpose of this study is to evaluate the efficacy of laminoplasty in the treatment of spinal cord injury (SCI) without instability. 79 patients with SCI without instability who underwent surgical treatment in our institute between January 2005 and September 2012 were retrospectively reviewed. Twenty nine patients fulfilled the inclusion criteria as follows: SCI without instability, spinal cord contusion in MRI, cervical stenosis more than 20%, follow up at least 6 months. Preoperative neurological state, clinical outcome and neurological function was measured using the American Spinal Injury Association (ASIA) impairment scale, modified Japanese Orthopedic Association (mJOA) grading scale and Hirabayashi recovering rate. Seventeen patients showed improvement in ASIA grade and twenty six patients showed improvement in mJOA scale at 6 month follow up. However, all patients with ASIA grade B and C have shown improvement of one or more ASIA grade. Mean Hirabayashi recovery rate was 47.4±23.7%. There was better neurologic recovery in those who had cervical spondylosis without ossification of posterior longitudinal ligament (OPLL) (pcervical canal stenosis, especially spondylosis without OPLL and neurologic deterioration in ASIA B, C and D.

7 Tesla 22-channel wrap-around coil array for cervical spinal cord and brainstem imaging.

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Zhang, Bei; Seifert, Alan C; Kim, Joo-Won; Borrello, Joseph; Xu, Junqian

2017-10-01

Increased signal-to-noise ratio and blood oxygenation level-dependent sensitivity at 7 Tesla (T) have the potential to enable high-resolution imaging of the human cervical spinal cord and brainstem. We propose a new two-panel radiofrequency coil design for these regions to fully exploit the advantages of ultra-high field. A two-panel array, containing four transmit/receive and 18 receive-only elements fully encircling the head and neck, was constructed following simulations demonstrating the B1+ and specific absorption rate (SAR) benefits of two-panel over one-panel arrays. This array was compared with a previously reported posterior-only array and tested for safety using a phantom. Its anatomical, functional, and diffusion MRI performance was demonstrated in vivo. The two-panel array produced more uniform B1+ across the brainstem and cervical spinal cord without compromising SAR, and achieved 70% greater receive sensitivity than the posterior-only array. The two-panel design enabled acceleration of R = 2 × 2 in two dimensions or R = 3 in a single dimension. High quality in vivo anatomical, functional, and diffusion images of the human cervical spinal cord and brainstem were acquired. We have designed and constructed a wrap-around coil array with excellent performance for cervical spinal cord and brainstem MRI at 7T, which enables simultaneous human cervical spinal cord and brainstem functional MRI. Magn Reson Med 78:1623-1634, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

Extradural spinal schwannoma at cervical spine in 12 year old child

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Madoori Srinivas

2016-10-01

Full Text Available Spinal schwannomas are benign tumors arising from spinal nerve root sheaths. It is a primary spinal tumor which are rare in children. We report a case of a 12 year old girl who presented with weakness of all limbs and unable to walk. Imaging studies demonstrated an extradural spinal tumor at cervical spine. The patient was operated and tumor was totally removed. The postoperative course was uneventful. Histology confirmed the diagnosis of schwannoma. After surgery there was improvement in signs and symptoms. After two months of operation, child could able to walk normally.

Intraspinal cell transplantation for targeting cervical ventral horn in amyotrophic lateral sclerosis and traumatic spinal cord injury.

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Lepore, Angelo C

2011-09-18

Respiratory compromise due to phrenic motor neuron loss is a debilitating consequence of a large proportion of human traumatic spinal cord injury (SCI) cases (1) and is the ultimate cause of death in patients with the motor neuron disorder, amyotrophic laterals sclerosis (ALS) (2). ALS is a devastating neurological disorder that is characterized by relatively rapid degeneration of upper and lower motor neurons. Patients ultimately succumb to the disease on average 2-5 years following diagnosis because of respiratory paralysis due to loss of phrenic motor neuron innnervation of the diaphragm (3). The vast majority of cases are sporadic, while 10% are of the familial form. Approximately twenty percent of familial cases are linked to various point mutations in the Cu/Zn superoxide dismutase 1 (SOD1) gene on chromosome 21 (4). Transgenic mice (4,5) and rats (6) carrying mutant human SOD1 genes ((G93A, G37R, G86R, G85R)) have been generated, and, despite the existence of other animal models of motor neuron loss, are currently the most highly used models of the disease. Spinal cord injury (SCI) is a heterogeneous set of conditions resulting from physical trauma to the spinal cord, with functional outcome varying according to the type, location and severity of the injury (7). Nevertheless, approximately half of human SCI cases affect cervical regions, resulting in debilitating respiratory dysfunction due to phrenic motor neuron loss and injury to descending bulbospinal respiratory axons (1). A number of animal models of SCI have been developed, with the most commonly used and clinically-relevant being the contusion (8). Transplantation of various classes of neural precursor cells (NPCs) is a promising therapeutic strategy for treatment of traumatic CNS injuries and neurodegeneration, including ALS and SCI, because of the ability to replace lost or dysfunctional CNS cell types, provide neuroprotection, and deliver gene factors of interest (9). Animal models of both ALS and

Severe cervical spinal cord injuries related to rugby union and league football in New South Wales, 1984-1996.

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Rotem, T R; Lawson, J S; Wilson, S F; Engel, S; Rutkowski, S B; Aisbett, C W

1998-04-20

To determine the frequency and circumstances of serious cervical cord injuries associated with rugby union and league football in New South Wales. Retrospective review of patients with rugby football-related cervical spinal cord injuries. The two central spinal units in NSW, from January 1984 to July 1996. Admission to spinal units; injury resulting in permanent tetraplegia. During the review period, 115 rugby football players (56 union and 59 league) were admitted to the spinal units because of cervical spinal cord injuries. 49 patients had resultant permanent neurological deficits (complete tetraplegia [quadriplegia])--26 associated with rugby union and 23 with rugby league. Two patients died of injury sequelae within two weeks of admission. There was no significant change in the rate of football-related admissions to spinal units for either code. There was a small decline in the number (from 15 in 1984 to 1987 to 7 in 1992 to 1996) and incidence (from 1.2 to 0.5 per 10,000 participants) of patients with tetraplegia associated with rugby union. When this decline was tested as a trend over the years, it was found to be statistically significant (P = 0.06). No significant trend was found in the tetraplegia data associated with rugby league. Cervical spinal cord injuries leading to complete tetraplegia were most commonly associated with scrum-like plays in union and with tackles in league. Serious cervical spinal injuries associated with both codes of rugby continue to occur in NSW. Rugby football in its various forms is still an inherently dangerous game.

Temporary occipital fixation in young children with severe cervical-thoracic spinal deformity.

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Kelley, Brian J; Minkara, Anas A; Angevine, Peter D; Vitale, Michael G; Lenke, Lawrence G; Anderson, Richard C E

2017-10-01

OBJECTIVE The long-term effects of instrumentation and fusion of the occipital-cervical-thoracic spine on spinal growth in young children are poorly understood. To mitigate the effects of this surgery on the growing pediatric spine, the authors report a novel technique used in 4 children with severe cervical-thoracic instability. These patients underwent instrumentation from the occiput to the upper thoracic region for stabilization, but without bone graft at the craniovertebral junction (CVJ). Subsequent surgery was then performed to remove the occipital instrumentation, thereby allowing further growth and increased motion across the CVJ. METHODS Three very young children (15, 30, and 30 months old) underwent occipital to thoracic posterior segmental instrumentation due to cervical or upper thoracic dislocation, progressive kyphosis, and myelopathy. The fourth child (10 years old) underwent similar instrumentation for progressive cervical-thoracic scoliosis. Bone graft was placed at and distal to C-2 only. After follow-up CT scans demonstrated posterior arthrodesis without unintended fusion from the occiput to C-2, 3 patients underwent removal of the occipital instrumentation. RESULTS Follow-up cervical spine flexion/extension radiographs demonstrated partial restoration of motion at the CVJ. One patient has not had the occipital instrumentation removed yet, because only 4 months have elapsed since her operation. CONCLUSIONS Temporary fixation to the occiput provides increased biomechanical stability for spinal stabilization in young children, without permanently eliminating motion and growth at the CVJ. This technique can be considered in children who require longer instrumentation constructs for temporary stabilization, but who only need fusion in more limited areas where spinal instability exists.

Rapid myelin water imaging in human cervical spinal cord.

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Ljungberg, Emil; Vavasour, Irene; Tam, Roger; Yoo, Youngjin; Rauscher, Alexander; Li, David K B; Traboulsee, Anthony; MacKay, Alex; Kolind, Shannon

2017-10-01

Myelin water imaging (MWI) using multi-echo T 2 relaxation is a quantitative MRI technique that can be used as an in vivo biomarker for myelin in the central nervous system. MWI using a multi-echo spin echo sequence currently takes more than 20 min to acquire eight axial slices (5 mm thickness) in the cervical spinal cord, making spinal cord MWI impractical for implementation in clinical studies. In this study, an accelerated gradient and spin echo sequence (GRASE), previously validated for brain MWI, was adapted for spinal cord MWI. Ten healthy volunteers were scanned with the GRASE sequence (acquisition time 8.5 min) and compared with the multi-echo spin echo sequence (acquisition time 23.5 min). Using region of interest analysis, myelin estimates obtained from the two sequences were found to be in good agreement (mean difference = -0.0092, 95% confidence interval =  - 0.0092 ± 0.061; regression slope = 1.01, ρ = 0.9). MWI using GRASE was shown to be highly reproducible with an average coefficient of variation of 6.1%. The results from this study show that MWI can be performed in the cervical spinal cord in less than 10 min, allowing for practical implementation in multimodal clinical studies. Magn Reson Med 78:1482-1487, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

Morphology of the cervical spinal cord on computed myelography

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Thijssen, H O.M. [Katholieke Universiteit Nijmegen (Netherlands). Dept. of Neuroradiology; Keyser, A; Horstink, M W.M. [Katholieke Universiteit Nijmegen (Netherlands). Dept. of Neurology; Meijer, E [Katholieke Universiteit Nijmegen (Netherlands). Dept. of Neurosurgery

1979-01-01

To ensure adequate use of the technique of computed myelography (CM) it is necessary to have an exact picture of the morphology of the normal spinal cord as demonstrated by this technique. This has been obtained by studying the morphology and measuring the frontal and sagittal diameter of the cervical cord in 20 patients. The normal values are presented. The changes of this morphology in one patient with a tumour, one patient with atrophy of the spinal cord and in some patients with congenital malformations are also reported.

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

International Nuclear Information System (INIS)

Weitmann, H.D.; Knocke, T.H.; Poetter, R.; Gustorff, B.; Vaupel, P.

2003-01-01

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 2 measurements (pO 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 2 values were pooled, and overall median pO 2 values and fractions of hypoxic pO 2 values ≤ 5 mm Hg were calculated. Overall median pO 2 values in the subcutis were also calculated. Results: There were no significant changes of systemic parameters, median subcutaneous pO 2 values, median intratumoral pO 2 values, and the fractions of hypoxic pO 2 values ≤ 5 mm Hg in the tumor upon administration of spinal anesthesia. The variability of measured pO 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 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 2 -related efficacy of high-dose-rate brachytherapy. (orig.)

Radiation tolerance of the cervical spinal cord

International Nuclear Information System (INIS)

McCunniff, A.J.; Liang, M.J.

1989-01-01

The incidence of permanent injury to the spinal cord as a complication of radiation therapy generally correlates positively with total radiation dosage. However, several reports in the literature have indicated that fraction size is also an important factor in the development or nondevelopment of late injuries in normal tissue. To determine the effect of fraction size on the incidence of radiation-induced spinal cord injuries, we reviewed 144 cases of head and neck cancer treated at our institution between 1971 and 1980 with radiation greater than 5600 cGy to a portion of the cervical spinal cord. Most of these patients received greater than or equal to 6000 cGy, with fraction sizes ranging from 133 cGy to 200 cGy. Fifty-three of the 144 patients have been followed up for 2 years or more. Nearly half of these (26 patients) received greater than 6000 cGy with fraction sizes of 133 cGy to 180 cGy. Only 1 of the 53 (1.9%) has sustained permanent spinal cord injury; 20 months after completion of radiation treatments he developed Brown-Sequard syndrome. Our experience suggests that radiation injuries to the spinal cord correlate not only with total radiation dosage, but also with fraction size; low fraction sizes appear to decrease the incidence of such injuries

MR imaging of spinal factors and compression of the spinal cord in cervical myelopathy

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Kokubun, Shoichi; Ozawa, Hiroshi; Sakurai, Minoru; Ishii, Sukenobu; Tani, Shotaro; Sato, Tetsuaki.

1992-01-01

Magnetic resonance (MR) images of surgical 109 patients with cervical spondylotic myelopathy were retrospectively reviewed to examine whether MR imaging would replace conventional radiological procedures in determining spinal factors and spinal cord compression in this disease. MR imaging was useful in determining spondylotic herniation, continuous type of ossification of posterior longitudinal ligament, and calcification of yellow ligament, probably replacing CT myelography, discography, and CT discography. When total defect of the subarachnoid space on T2-weighted images and block on myelograms were compared in determining spinal cord compression, the spinal cord was affected more extensively by 1.3 intervertebral distance (IVD) on T2-weighted images. When indentation of one third or more in anterior and posterior diameter of the spinal cord was used as spinal cord compression, the difference in the affected extension between myelography and MR imaging was 0.2 IVD on T1-weighted images and 0.6 IVD on T2-weighted images. However, when block was seen in 3 or more IVD on myelograms, the range of spinal cord compression tended to be larger on T1-weighted images. For a small range of spinal cord compression, T1-weighted imaging seems to be helpful in determining the range of decompression. When using T2-weighted imaging, the range of decompression becomes large, frequently including posterior decompression. (N.K.)

Minimally Invasive Drainage of a Post-Laminectomy Subfascial Seroma with Cervical Spinal Cord Compression.

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Kitshoff, Adriaan Mynhardt; Van Goethem, Bart; Cornelis, Ine; Combes, Anais; Dvm, Ingeborgh Polis; Gielen, Ingrid; Vandekerckhove, Peter; de Rooster, Hilde

2016-01-01

A 14 mo old female neutered Doberman pinscher was evaluated for difficulty in rising, a wide based stance, pelvic limb gait abnormalities, and cervical pain of 2 mo duration. Neurologic examination revealed pelvic limb ataxia and cervical spinal hyperesthesia. Spinal reflexes and cranial nerve examination were normal. The pathology was localized to the C1-C5 or C6-T2 spinal cord segments. Computed tomography (CT) findings indicated bony proliferation of the caudal articular processes of C6 and the cranial articular processes of C7, resulting in bilateral dorsolateral spinal cord compression that was more pronounced on the left side. A limited dorsal laminectomy was performed at C6-C7. Due to progressive neurological deterioration, follow-up CT examination was performed 4 days postoperatively. At the level of the laminectomy defect, a subfacial seroma had developed, entering the spinal canal and causing significant spinal cord compression. Under ultrasonographic guidance a closed-suction wound catheter was placed. Drainage of the seroma successfully relieved its compressive effects on the spinal cord and the patient's neurological status improved. CT was a valuable tool in assessing spinal cord compression as a result of a postoperative subfascial seroma. Minimally invasive application of a wound catheter can be successfully used to manage this condition.

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

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Epstein, Nancy E.; Hollingsworth, Renee

2015-01-01

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 accomp...

Contribution of 5-HT2A receptors on diaphragmatic recovery after chronic cervical spinal cord injury.

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Lee, Kun-Ze; Gonzalez-Rothi, Elisa J

2017-10-01

Unilateral C2 spinal cord hemisection (C2Hx) interrupts bulbospinal respiratory pathways innervating ipsilateral phrenic motoneurons, resulting in cessation of ipsilateral diaphragm motor output. Plasticity within the spinal neural circuitry controlling the diaphragm can induce partial recovery of phrenic bursting which correlates with the time-dependent return of spinal serotonin (5-HT) immunoreactivity in the vicinity of phrenic motoneurons. The 5-HT 2A receptor subtype is present on phrenic motoneurons and its expression is up-regulated after cervical spinal cord injury; however the functional role of these receptors following injury has not been clearly defined. The present study evaluated the functional role of 5-HT 2A receptors by testing the hypothesis that pharmacologic blockade would attenuate diaphragm activity in rats with chronic cervical spinal cord injury. Bilateral diaphragm electromyography (EMG) was performed in vagal-intact and spontaneously breathing rats before and after intravenous administration of the 5-HT 2A receptor antagonist Ketanserin (1mg/kg). Intravenous ketanserin significantly attenuated ipsilateral diaphragm EMG activity in C2Hx animals but had no impact on diaphragm output in uninjured animals. We conclude that 5-HT 2A receptor activation contributes to the recovery of ipsilateral phrenic motor output after chronic cervical spinal cord injury. Copyright © 2017 Elsevier B.V. All rights reserved.

Magnetic resonance imaging in cervical spinal cord compression

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Giovanni Giammona

1993-09-01

Full Text Available In patients with cervical spondylotic myelopathy MRI sometimes shows increased signal intensity zones on the T2-weighted images. It has been suggested that these findings carry prognostic significance. We studied 56 subjects with cervical spinal cord compression. Twelve patients showed an increased signal intensity (21.4% and a prevalence of narrowing of the AP-diameter (62% vs 24%. Furthemore, in this group, there was evidence of a longer mean duration of the symptoms and, in most of the patients, of more serious clinical conditions. The importance of these predisposing factors remains, however, to be clarified since they are also present in some patients without the increased signal intensity.

The relationship between central motor conduction time and spinal cord compression in patients with cervical spondylotic myelopathy.

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Rikita, T; Tanaka, N; Nakanishi, K; Kamei, N; Sumiyoshi, N; Kotaka, S; Adachi, N; Ochi, M

2017-04-01

Retrospective study. Few studies have reported a relationship between central motor conduction time (CMCT), which evaluates corticospinal function, and degree of spinal cord compression in patients with myelopathy. Thus, there is no consensus on predicting the degree of prolonged CMCT on the basis of the degree of spinal cord compression. If a correlation exists between CMCT and spinal cord compression, then spinal cord compression may be a useful noninvasive clinical indicator of corticospinal function. Therefore, this study evaluated the relationship between CMCT and cervical spinal cord compression measured by magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM). Hiroshima University Hospital in Japan. We studied 33 patients undergoing laminoplasty. Patients exhibited significant cervical spinal cord compression on both MRI and intraoperative electrophysiological examination. We assessed transcranial magnetic stimulation measurement of CMCT; spinal cord compression parameters such as area, lateral diameter, anteroposterior diameter and flattening of the spinal cord at the lesion site and C2/3 levels on MRI; and pre- versus postoperative Japanese Orthopaedic Association (JOA) scores. Correlations between CMCT and flattening as well as anteroposterior diameter of the spinal cord at the lesion level were observed. Strong correlations between CMCT and the ratio of the flattening and anteroposterior diameter parameters at the lesion level to that at the C2/3 level were also observed. Measurement of spinal cord compression may be useful for the evaluation of corticospinal function as a proxy for CMCT in patients with CSM.

Approach to the irradiation of extensive cervical and upper thoracic spinal astrocytoma

International Nuclear Information System (INIS)

Dvorak, E.

1981-01-01

Intramedullary spinal cord tumors are relatively rare, especially to the extent presented in this report. A 31-year-old woman had been diagnosed as having an inoperable astrocytoma, grade I-II, involving the entire cervical spinal cord and two upper thoracic segments. After decompressive laminectomy, she was referred for a radical course of radiation therapy. An irradiation technique was devised which allowed treatment of a single cylindrical volume of tissue encompassing the known tumor. Field fractionation with undesirable gaps and/or excessive dose to overlying normal structures was avoided. To the cervical spinal cord she received 5590 cGy in 29 fractions over 42 days. By this schedule she received at the same time 4820 cGy to the medulla oblongata and 4880 cGy to the upper thoracic cord. Partial neurological improvement occurred at the end of the treatment. The treatment approach is discussed in the background of the literature data. (orig.) [de

Computed tomography in the treatment of cervical spinal cord tumors

International Nuclear Information System (INIS)

Shin, Hideo

1984-01-01

Computed tomography (CT) of the cervical and thoracic spinal column was carried out in 12 patients of spinal cord tumor. There were 6 schwannomas, 2 metastatic tumors and other 4 cases of different tumors, which were studied by either a General Electric CT/T or a Toshiba TCT 60 Type A scanner. In all patients, CT-examination followed conventional spinal X-ray studies. The usefulness of the plain spinal CT (PCT: CT without any contrast enhancement neither intravenously nor intrathecally) was to detect subtle bony changes as well as paraspinal soft tissue abnormalities, although it was hard to distinguish the spinal cord by PCT. Metrizamide CT myelography (CTM: CT with intrathecal instillation of metrizamide) was indispensable to identify the intracanalicular architecture. It provided the clue to determine the site and the size of tumor, and it was also useful after surgical procedure. CTM with intravenous contrast enhancement (CTM-CE) together with CTM distinguished the spinal tumor from the spinal cord very well, particularly in the cases of schwannoma. The author supports significant reliability of PCT, CTM and CTM-CE in identifying the presence, the extension and the bony involvement of spinal cord tumors. (author)

Catastrophic cervical spinal injury in an amateur college wrestler.

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Narayana Kurup, Jayakrishnan Kelamangalathu; Jampani, Ravitheja; Mohanty, Simanchal P

2017-07-18

A young amateur wrestler presented with a burst fracture of the seventh cervical vertebra with complete paraplegia. He was treated with surgery for spine stabilisation and was actively rehabilitated. Adolescents and teenagers are indulging in high-contact sports like wrestling, without proper training and technical know-how, which can lead to severe injuries and possibly, permanent handicap or death. 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. Athletes, coaches and the public should be aware of methods of first aid and how to transport a patient with a cervical spine injury. Authorities should take steps to improve infrastructures in training institutions and ambulance services. Specialised spinal centres should be established throughout the country for management and rehabilitation of patients with paraplegia. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Dose-volume effects in the rat cervical spinal cord after proton irradiation

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Bijl, Hendrik P.; Vuijk, Peter van; Coppes, Rob P.; Schippers, Jacobus M.; Konings, Antonius W.T.; Kogel, Albert J. van der

2002-01-01

Purpose: To estimate dose-volume effects in the rat cervical spinal cord with protons. Methods and Materials: Wistar rats were irradiated on the cervical spinal cord with a single fraction of unmodulated protons (150-190 MeV) using the shoot through method, which employs the plateau of the depth-dose profile rather than the Bragg peak. Four different lengths of the spinal cord (2, 4, 8, and 20 mm) were irradiated with variable doses. The endpoint for estimating dose-volume effects was paralysis of fore or hind limbs. Results: The results obtained with a high-precision proton beam showed a marginal increase of ED 50 when decreasing the irradiated cord length from 20 mm (ED 50 = 20.4 Gy) to 8 mm (ED 50 = 24.9 Gy), but a steep increase in ED 50 when further decreasing the length to 4 mm (ED 50 = 53.7 Gy) and 2 mm (ED 50 = 87.8 Gy). These results generally confirm data obtained previously in a limited series with 4-6-MV photons, and for the first time it was possible to construct complete dose-response curves down to lengths of 2 mm. At higher ED 50 values and shorter lengths irradiated, the latent period to paralysis decreased from 125 to 60 days. Conclusions: Irradiation of variable lengths of rat cervical spinal cord with protons showed steeply increasing ED 50 values for lengths of less than 8 mm. These results suggest the presence of a critical migration distance of 2-3 mm for cells involved in regeneration processes

Scissors stab wound to the cervical spinal cord at the craniocervical junction.

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Zhang, Xiao-Yong; Yang, Ying-Ming

2016-06-01

Stab wounds resulting in spinal cord injury of the craniocervical junction are rare. A scissors stab wound to the cervical spinal cord has been reported only once in the literature. This paper aimed to report a case of Brown-Séquard-plus syndrome in an 8-year-old boy secondary to a scissors stab wound at the craniocervical junction. Case report and review of the literature. Case report of an 8-year-old boy accidentally stabbed in the neck by scissors, which were thrown as a dart. The case study of an 8-year-old boy who was hospitalized because of a scissors stab wound at the craniocervical junction. The patient developed Brown-Séquard-plus syndrome on the left side of the body. Magnetic resonance imaging revealed a laceration of the spinal cord at the craniocervical junction with cerebrospinal fluid leakage. Careful cleansing and interrupted sutures of the wounds were performed to prevent cerebrospinal fluid leakage. Rehabilitation therapy was performed 2 days later. A follow-up examination revealed complete recovery of the neurologic deficit 8 months post-injury. Treatment of scissors stab wounds to the cervical spinal cord, whether conservative management or thorough surgical exploration, should be individualized based on history, examination, and imaging. As shown in this case report, despite conservative management, complete recovery, which was unexpected, was attributed to the initial mild laceration of the spinal cord and ipsilateral spinal cord functional compensation. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessment of the narrow cervical spinal canal: a prospective comparison of MRI, myelography and CT-myelography

International Nuclear Information System (INIS)

Reul, J.; Gievers, B.; Weis, J.; Thron, A.

1995-01-01

This study was designed to compare the accuracy of magnetic resonance imaging (MRI), myelography and computed tomography in the assessment of degenerative cervical spinal stenosis. We prospectively examined a total of 75 spinal segments in 18 patients with suspected cervical spinal canal stenosis, using sagittal spin-echo and axial gradient-echo sequences generated by a 1.5 Tesla imager, conventional myelography, and computed tomography with intrathecal contrast medium (CT-myelography). The degree of stenosis was often overestimated using MRI. This error was most prominent in cases of severe stenosis but was significant with minor to moderate stenosis. In these cases, the clinical consequences of such an overestimation can be serious, because treatment is misdirected. The error is probably caused by pulsation of the cerebrospinal fluid and truncation artefact (Gibbs phenomenon). MRI at 1.5 Tesla is thus frequently inadequate for diagnostic assessment of degenerative cervical spinal stenosis. Myelography and myelographic CT are still useful for decisions on operative treatment, especially in cases of moderate stenosis. This may, however, not apply to imagers operating at 0.5 Tesla as below. (orig.)

Induced Pluripotent Stem Cell Therapies for Cervical Spinal Cord Injury

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Doulames, Vanessa M.; Plant, Giles W.

2016-01-01

Cervical-level injuries account for the majority of presented spinal cord injuries (SCIs) to date. Despite the increase in survival rates due to emergency medicine improvements, overall quality of life remains poor, with patients facing variable deficits in respiratory and motor function. Therapies aiming to ameliorate symptoms and restore function, even partially, are urgently needed. Current therapeutic avenues in SCI seek to increase regenerative capacities through trophic and immunomodulatory factors, provide scaffolding to bridge the lesion site and promote regeneration of native axons, and to replace SCI-lost neurons and glia via intraspinal transplantation. Induced pluripotent stem cells (iPSCs) are a clinically viable means to accomplish this; they have no major ethical barriers, sources can be patient-matched and collected using non-invasive methods. In addition, the patient’s own cells can be used to establish a starter population capable of producing multiple cell types. To date, there is only a limited pool of research examining iPSC-derived transplants in SCI—even less research that is specific to cervical injury. The purpose of the review herein is to explore both preclinical and clinical recent advances in iPSC therapies with a detailed focus on cervical spinal cord injury. PMID:27070598

Advantages of computed tomography over conventional x-ray examination in the treatment of cervical spinal diseases

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Shin, Hideo; Yamaura, Akira; Makino, Hiroyasu (Chiba Univ. (Japan). School of Medicine)

1982-07-01

Computed tomography (CT) of the cervical spinal column was carried out in 42 patients using a General Electric CT/T of a Toshiba TCT60 Type A scanner. There were 22 cervical disk lesions, 4 spinal neoplasms, 6 narrow spinal canals with or without ossification of posterior longitudinal ligament, 2 syringomyelias, 6 traumas and 2 Arnold-Chiari malformations. In all patients, CT-examination followed conventional spinal X-ray studies. Correlation between the CT and conventional X-ray findings revealed the better diagnostic capability of the CT. For example, the measured midline sagittal diameter of the spinal canal in a patient with the narrowest canal in this series was 7.4 mm on the CT and 9.6 mm on the conventioned plain film at the C/sub 5/ level. To know the precise sagittal diameter of the cord itself, CT myelography (CTM) is indispensable. CTM is useful in determining the nature of the disease, the risk and approach of surgery, and for evaluation after the surgical procedure. Although the range of motion of cervical joints and intervertebral foramen are visible with conventional films, the size and extension of a tumor, the degree of bony errosion and the spinal subarachnoid space can be precisely identified only by CT. CT study of the spine and spinal cord is a simple procedure and less likely to produce complication, even with CTM, although there are certain limitations in the examination which are also presented.

Delayed expression of cell cycle proteins contributes to astroglial scar formation and chronic inflammation after rat spinal cord contusion

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Wu Junfang

2012-07-01

Full Text Available Abstract Background Traumatic spinal cord injury (SCI induces secondary tissue damage that is associated with astrogliosis and inflammation. We previously reported that acute upregulation of a cluster of cell-cycle-related genes contributes to post-mitotic cell death and secondary damage after SCI. However, it remains unclear whether cell cycle activation continues more chronically and contributes to more delayed glial change. Here we examined expression of cell cycle-related proteins up to 4 months following SCI, as well as the effects of the selective cyclin-dependent kinase (CDKs inhibitor CR8, on astrogliosis and microglial activation in a rat SCI contusion model. Methods Adult male rats were subjected to moderate spinal cord contusion injury at T8 using a well-characterized weight-drop model. Tissue from the lesion epicenter was obtained 4 weeks or 4 months post-injury, and processed for protein expression and lesion volume. Functional recovery was assessed over the 4 months after injury. Results Immunoblot analysis demonstrated a marked continued upregulation of cell cycle-related proteins − including cyclin D1 and E, CDK4, E2F5 and PCNA − for 4 months post-injury that were highly expressed by GFAP+ astrocytes and microglia, and co-localized with inflammatory-related proteins. CR8 administrated systemically 3 h post-injury and continued for 7 days limited the sustained elevation of cell cycle proteins and immunoreactivity of GFAP, Iba-1 and p22PHOX − a key component of NADPH oxidase − up to 4 months after SCI. CR8 treatment significantly reduced lesion volume, which typically progressed in untreated animals between 1 and 4 months after trauma. Functional recovery was also significantly improved by CR8 treatment after SCI from week 2 through week 16. Conclusions These data demonstrate that cell cycle-related proteins are chronically upregulated after SCI and may contribute to astroglial scar

Cerebral Contusions and Lacerations

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... Contusions and Lacerations Concussion Diffuse Axonal Injury Intracranial Hematomas Skull Fracture Sports-Related Concussion Cerebral contusions are ... Contusions and Lacerations Concussion Diffuse Axonal Injury Intracranial Hematomas Skull Fracture Sports-Related Concussion NOTE: This is ...

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

International Nuclear Information System (INIS)

Lee, Young Joon; Eun, Choong Ki

2001-01-01

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 accentuated

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

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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

Bipedal locomotion of bonnet macaques after spinal cord injury.

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Babu, Rangasamy Suresh; Anand, P; Jeraud, Mathew; Periasamy, P; Namasivayam, A

2007-10-01

Experimental studies concerning the analysis of locomotor behavior in spinal cord injury research are widely performed in rodent models. The purpose of this study was to quantitatively evaluate the degree of functional recovery in reflex components and bipedal locomotor behavior of bonnet macaques (Macaca radiata) after spinal contusive injury. Six monkeys were tested for various reflex components (grasping, righting, hopping, extension withdrawal) and were trained preoperatively to walk in bipedal fashion on the simple and complex locomotor runways (narrow beam, grid, inclined plane, treadmill) of this investigation. The overall performance of the animals'motor behavior and the functional status of limb movements during bipedal locomotion were graded by the Combined Behavioral Score (CBS) system. Using the simple Allen weight-drop technique, a contusive injury was produced by dropping a 13-g weight from a height of 30 cm to the exposed spinal cord at the T12-L1 vertebral level of the trained monkeys. All the monkeys showed significant impairments in every reflex activity and in walking behavior during the early part of the postoperative period. In subsequent periods, the animals displayed mild alterations in certain reflex responses, such as grasping, extension withdrawal, and placing reflexes, which persisted through a 1-year follow-up. The contused animals traversed locomotor runways--narrow beam, incline plane, and grid runways--with more steps and few errors, as evaluated with the CBS system. Eventually, the behavioral performance of all spinal-contused monkeys recovered to near-preoperative level by the fifth postoperative month. The findings of this study reveal the recovery time course of various reflex components and bipedal locomotor behavior of spinal-contused macaques on runways for a postoperative period of up to 1 year. Our spinal cord research in primates is advantageous in understanding the characteristics of hind limb functions only, which possibly

Panax ginseng Improves Functional Recovery after Contusive Spinal Cord Injury by Regulating the Inflammatory Response in Rats: An In Vivo Study

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Young Ock Kim

2015-01-01

Full Text Available Spinal cord injury (SCI results in permanent loss of motor function below the injured site. Neuroinflammatory reaction following SCI can aggravate neural injury and functional impairment. Ginseng is well known to possess anti-inflammatory effects. The present study investigated the neuroprotective effects of Panax ginseng C.A. Mayer (P. ginseng after SCI. A spinal contusion was made at the T11-12 spinal cord in adult male Sprague-Dawley rats (n=47 using the NYU impactor. Motor function was assessed using the Basso-Beattie-Bresnahan (BBB score in P. ginseng (0.1, 0.5, 1, 3, and 5 mg/kg or vehicle (saline treated after SCI. We also assessed the protein expression of cyclooxygenase-2 (COX-2 and inducible nitric oxide synthase (iNOS at the lesion site by western blot and then measured the cavity area using luxol fast blue/cresyl violet staining. P. ginseng treated group in SCI showed a significant improvement in locomotor function after the injury. The protein expression of COX-2 and iNOS at the lesion site and the cavity area were decreased following SCI by P. ginseng treatment. These results suggest that P. ginseng may improve the recovery of motor function after SCI which provides neuroprotection by alleviating posttraumatic inflammatory responses.

Congenital spondylolysis of the cervical spine with spinal cord compression: MR and CT studies

International Nuclear Information System (INIS)

Martinez, M.J.; Marti-Bonmati, L.; Molla, E.; Poyatos, C.; Cerda, E. de la; Urrizola, J.

1997-01-01

Spondylolysis of the cervical spine is a rare disorder that is characterized by a defect in the articular mass between the superior and inferior facets of a cervical vertebra. It is considered to be congenital because it is usually associated with dysplastic changes, especially involving the posterior arch of the vertebra, which differentiates it from its traumatic equivalent. We present two cases of spondylolysis of the cervical spine without spondylolisthesis, which were studied by means of magnetic resonance (MR) and computerized tomography (CT). One patient showed contralateral involvement at two levels and the other had a single lesion presenting canal stenosis with chronic spinal cord compression, an unusual association in previously reported series. the combination of MR and CT makes it possible to limit the spectrum of bone changes and their impact on the spinal cord in these patients. (Author) 12 refs

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.

Measurement of normal cervical spinal cord in metrizamide CT myelography

International Nuclear Information System (INIS)

Suzuki, Fumio; Koyama, Tsunemaro; Aii, Heihachirou

1985-01-01

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 (Fig. 1). 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)

The advantages of computed tomography over conventional x-ray examination in the treatment of cervical spinal diseases

International Nuclear Information System (INIS)

Shin, Hideo; Yamaura, Akira; Makino, Hiroyasu

1982-01-01

Computed tomography (CT) of the cervical spinal column was carried out in 42 patients using a General Electric CT/T of a Toshiba TCT60 Type A scanner. There were 22 cervical disk lesions, 4 spinal neoplasms, 6 narrow spinal canals with or without ossification of posterior longitudinal ligament, 2 syringomyelias, 6 traumas and 2 Arnold-Chiari malformations. In all patients, CT-examination followed conventional spinal X-ray studies. Correlation between the CT and conventional X-ray findings revealed the better diagnostic capability of the CT. For example, the measured midline sagittal diameter of the spinal canal in a patient with the narrowest canal in this series was 7.4 mm on the CT and 9.6 mm on the conventioned plain film at the C 5 level. To know the precise sagittal diameter of the cord itself, CT myelography (CTM) is indispensable. CTM is useful in determining the nature of the disease, the risk and approach of surgery, and for evaluation after the surgical procedure. Although the range of motion of cervical joints and intervertebral foramen are visible with conventional films, the size and extension of a tumor, the degree of bony errosion and the spinal subarachnoid space can be precisely identified only by CT. CT study of the spine and spinal cord is a simple procedure and less likely to produce complication, even with CTM, although there are certain limitations in the examination which are also presented. (author)

Modelling of the CSF flow in the spinal canal in cervical stenosis

Czech Academy of Sciences Publication Activity Database

Kaczmarská, A.; Štěpáník, Z.; Vaněk, P.; Maršík, František; Převorovská, Světlana; Otáhal, J.

2007-01-01

Roč. 40, - (2007), s. 477-477 ISSN 0021-9290 Institutional research plan: CEZ:AV0Z20760514 Keywords : cerebrospinal fluid flow * spinal canal * cervical stenosis Subject RIV: BK - Fluid Dynamics Impact factor: 2.897, year: 2007

A Case Involving Needles in the Medulla Oblongata, Cervical Spinal Cord, and Abdomen.

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Zhang, Hao-Yu; Li, Da; Wu, Zhen; Zhang, Li-Wei; Zhang, Jun-Ting

2014-10-01

It is extremely rare to encounter intracranial foreign bodies caused by penetrating injuries other than gunshot wounds or low-velocity wounds. We present a case describing a 5-year-old girl with metallic foreign bodies in the medulla oblongata, cervical spinal cord, and abdomen. The foreign bodies may have been there and remained silent for several years until the patient developed nausea and vomiting that persisted for 3 months. A craniotomy and a laparotomy were performed after a thorough discussion. Five pieces of metallic foreign bodies were removed, and the patient had a good outcome. Despite the precarious location of the needles in the medulla oblongata and cervical spinal cord, this rare case supports the use of surgery to remove the foreign bodies.

Assessment of the neuroprotective effects of Lavandula angustifolia extract on the contusive model of spinal cord injury in Wistar rats

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Gholamreza eKaka

2016-02-01

Full Text Available IntroductionSpinal cord injury (SCI involves a primary trauma and secondary cellular processes that can lead to severe damage to the nervous system, resulting in long-term spinal deficits. At the cellular level, SCI causes astrogliosis, of which glial fibrillary acidic protein (GFAP is a major index. ObjectiveThe aim of this study was to investigate the neuroprotective effects of Lavandula angustifolia (Lav on the repair of spinal cord injuries in Wistar rats.Materials and MethodsForty-five female rats were randomly divided into six groups of seven rats each: the intact, sham, control (SCI, Lav 100, Lav 200, and Lav 400 groups. Every week after SCI onset, all animals were evaluated for behavior outcomes by the Basso, Beattie, and Bresnahan (BBB score. H&E staining was performed to examine the lesions post-injury. GFAP expression was assessed for astrogliosis. Somatosensory evoked potential (SEP testing was performed to detect the recovery of neural conduction.Results BBB scores were significantly increased and delayed responses on sensory tests were significantly decreased in the Lav 200 and Lav 400 groups compared to the control group. The greatest decrease of GFAP was evident in the Lav 200 and Lav 400 groups. EMG results showed significant improvement in the hindlimbs in the Lav 200 and Lav 400 groups compared to the control group. Cavity areas significantly decreased and the number of ventral motor neurons significantly increased in the Lav 200 and Lav 400 groups.ConclusionLav at doses of 200 mg/kg and 400 mg/kg can promote structural and functional recovery after SCI. The neuroprotective effects of L. angustifolia can lead to improvement in the contusive model of spinal cord injury in Wistar rats.Keywords Spinal cord injury (SCI; Lavandula angustifolia; neuroprotection; Basso, Beattie, and Bresnahan (BBB; glial fibrillary acidic protein (GFAP; somatosensory evoked potential (SEP

Thermal Stimulation Alters Cervical Spinal Cord Functional Connectivity in Humans.

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Weber, Kenneth A; Sentis, Amy I; Bernadel-Huey, Olivia N; Chen, Yufen; Wang, Xue; Parrish, Todd B; Mackey, Sean

2018-01-15

The spinal cord has an active role in the modulation and transmission of the neural signals traveling between the body and the brain. Recent advancements in functional magnetic resonance imaging (fMRI) have made the in vivo examination of spinal cord function in humans now possible. This technology has been recently extended to the investigation of resting state functional networks in the spinal cord, leading to the identification of distinct patterns of spinal cord functional connectivity. In this study, we expand on the previous work and further investigate resting state cervical spinal cord functional connectivity in healthy participants (n = 15) using high resolution imaging coupled with both seed-based functional connectivity analyses and graph theory-based metrics. Within spinal cord segment functional connectivity was present between the left and right ventral horns (bilateral motor network), left and right dorsal horns (bilateral sensory network), and the ipsilateral ventral and dorsal horns (unilateral sensory-motor network). Functional connectivity between the spinal cord segments was less apparent with the connectivity centered at the region of interest and spanning spinal cord functional network was demonstrated to be state-dependent as thermal stimulation of the right ventrolateral forearm resulted in significant disruption of the bilateral sensory network, increased network global efficiency, and decreased network modularity. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

Reversible Parkinson-Like Symptoms in Patient with Bilateral Chronic Subdural Hematomas and Cervical Spinal Stenosis.

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Guppy, Kern H; Khandhar, Suketu M; Ochi, Calvin

2018-01-01

Gait abnormalities have been seen in patients with Parkinson disease or Parkinson-like (P-L) disorders and cervical spinal stenosis. Acute presentation of P-L symptoms has been reported in 24 cases caused by chronic subdural hematomas with 11 cases due to bilateral chronic subdural hematomas. When a patient also presents with cervical spinal stenosis, the correct therapeutic decision between P-L disorders and myelopathy is challenging. An 80-year-old male presented with a 2-week history of weakness in his left leg. A few days before presentation, his gait had deteriorated quite dramatically. Neurologic examination showed mild leg weakness, hyperreflexia, and a gait that was slow and wide based, at times festinating but with relatively spared arm movement. He also had masked facial features with increased tone in his extremities. Magnetic resonance imaging of the cervical spine showed cervical stenosis at C5-6, and computed tomography of the head showed large bilateral subdural hematomas. The subdural hematomas were drained. Immediate improvement in his symptoms was observed with complete resolution by his third month of follow-up. The patient never had a history of Parkinson disease. This paper reports for the first time a patient who presented with acute P-L symptoms and cervical myelopathy with findings of both bilateral chronic subdural hematomas and cervical spinal stenosis. The decision to drain the subdural hematoma in our case resulted in full recovery of the patient's gait and other extrapyramidal symptoms. This paper reviews the literature on reversible P-L symptoms caused by bilateral chronic subdural hematomas. Copyright © 2017 Elsevier Inc. All rights reserved.

Controversies in the differential diagnosis of Brown-Sequard syndrome due to cervical spinal disease from stroke: A case series

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Vaner Koksal, M.D.

2017-09-01

Full Text Available Stroke is generally considered to be the first preliminary diagnosis in patients presenting with acute hemiparesia in the emergency department. But rarely in unexpected spontaneous neurological pathologies that may lead to hemiparesis. The data from 8 non-traumatic patients who underwent surgical treatment for brown-sequard syndrome (BSS were reviewed retrospectively. All patients were initially misdiagnosed with strokes. Two of the patients had spinal canal stenosis, two had spinal epidural hematomas, one had an ossified herniated disc and three had soft herniated discs. None of the patients complained of significant pain at the initial presentation. All of the patients had a mild sensory deficit that was initially unrecognized. The pain of the patients began to become evident after hospitalization and, patients transferred to neurosurgery department. Cervical spinal pathologies compressing the corticospinal tract in one-half of the cervical spinal canal may present with only hemiparesis, without neck and radicular pain. If it's too late, permanent neurological damage may become inevitable while it is a correctable pathology. Keywords: Brown-Sequard syndrome, Cervical cord, Herniated disc, Spinal epidural hematoma, Stroke

Morphometry of the spinal canal at cervical region in asymptomatic military young men Morfometria do canal vertebral no segmento cervical em militares jovens assintomáticos

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Augustin Malzac

2002-12-01

Full Text Available Spinal canal measurements obtainned from radiographic imaging studies are an integral part of diagnostic evaluation of cervical spine stenosis. Before abnormal spinal morphometry can be determined, it is first necessary to establish normal values for the specific patient population being evaluated. Cervical spinal canal stenosis increase risk of quadriplegia after "minor trauma" in the head or neck, mainly in athletes who participate in contact or collision sports. Prospective and random selection of 500 plain film of the lateral cervical spine in young militaries population in age group 18-20 years old. Those were performed a hundred set of film were for each geographic region, including Manaus, Recife, São Paulo, Porto Alegre and Campo Grande. The first part of this study established normal values for cervical morphometry. The second part determined the most accurate screenning method for detecting cervical spinal stenosis. Normal spinal canal mean value for C3 was 18,27mm, C4 17,98mm, C5 18,33mm and 18,76mm in C6. The TORG ratio was evaluated as a method to detect significant cervical spinal stenosis and was shown to have sensitivity and high positive predictive value. It was observed TORG's ratio of 0,80 or less in 14,4% of the X-rays.A medição do diâmetro sagital do canal vertebral é parte integrante da avaliação diagnóstica de estenose da coluna cervical. Antes de identificar a morfometria anormal é necessário estabelecer valores normais para uma população específica. A estenose do canal cervical pode se converter em fator agravante na vigência de um "trauma menor" na cabeça ou no pescoço, aumentando o risco de dano medular especialmente naqueles que praticam esporte de contato. Foram selecionadas de maneira prospectiva e randomizada quinhentas radiografias em perfil da coluna cervical de militares jovens assintomáticos na faixa etária dos 18 aos 20 anos, agrupados em cem em cada região geográfica, nas cidades de Manaus

Allograft versus autograft in cervical and lumbar spinal fusions: an examination of operative time, length of stay, surgical site infection, and blood transfusions.

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Murphy, Meghan E; McCutcheon, Brandon A; Grauberger, Jennifer; Shepherd, Daniel; Maloney, Patrick R; Rinaldo, Lorenzo; Kerezoudis, Panagiotis; Fogelson, Jeremy L; Nassr, Ahmad; Bydon, Mohamad

2016-11-23

Autograft harvesting for spine arthrodesis has been associated with longer operative times and increased blood loss. Allograft compared to autograft in spinal fusions has not been studied in a multicenter cohort. Patients enrolled in the ACS-NSQIP registry between 2012 and 2013 who underwent cervical or lumbar spinal fusion with either allograft or autograft through a separate incision were included for analysis. The primary outcomes of interest were operative time, length of stay, blood transfusion, and surgical site infection (SSI). A total of 6,790 and 6,718 patients received a cervical or lumbar spinal fusion, respectively. On unadjusted analysis in both cervical and lumbar cohorts, autograft was associated with increased rates of blood transfusion (cervical: 2.9% vs 1.0%, poperative time (cervical: 167 vs 128 minutes, poperative times (cervical: 27.8 minutes, 95% CI 20.7-35.0; and lumbar: 25.4 minutes, 95% CI 17.7-33.1) relative to allograft. Autograft was not associated with either length of stay or SSI. In a multicenter cohort of patients undergoing cervical or lumbar spinal fusion, autograft was associated with increased rates of blood transfusion and increased operative time relative to allograft.

Phrenic motor outputs in response to bronchopulmonary C‐fibre activation following chronic cervical spinal cord injury

Science.gov (United States)

2016-01-01

Key points Activation of bronchopulmonary C‐fibres, the main chemosensitive afferents in the lung, can induce pulmonary chemoreflexes to modulate respiratory activity.Following chronic cervical spinal cord injury, bronchopulmonary C‐fibre activation‐induced inhibition of phrenic activity was exaggerated.Supersensitivity of phrenic motor outputs to the inhibitory effect of bronchopulmonary C‐fibre activation is due to a shift of phrenic motoneuron types and slow recovery of phrenic motoneuron discharge in cervical spinal cord‐injured animals.These data suggest that activation of bronchopulmonary C‐fibres may retard phrenic output recovery following cervical spinal cord injury.The alteration of phenotype and discharge pattern of phrenic motoneuron enables us to understand the impact of spinal cord injury on spinal respiratory activity. Abstract Cervical spinal injury interrupts bulbospinal pathways and results in cessation of phrenic bursting ipsilateral to the lesion. The ipsilateral phrenic activity can partially recover over weeks to months following injury due to the activation of latent crossed spinal pathways and exhibits a greater capacity to increase activity during respiratory challenges than the contralateral phrenic nerve. However, whether the bilateral phrenic nerves demonstrate differential responses to respiratory inhibitory inputs is unclear. Accordingly, the present study examined bilateral phrenic bursting in response to capsaicin‐induced pulmonary chemoreflexes, a robust respiratory inhibitory stimulus. Bilateral phrenic nerve activity was recorded in anaesthetized and mechanically ventilated adult rats at 8–9 weeks after C2 hemisection (C2Hx) or C2 laminectomy. Intra‐jugular capsaicin (1.5 μg kg−1) injection was performed to activate the bronchopulmonary C‐fibres to evoke pulmonary chemoreflexes. The present results indicate that capsaicin‐induced prolongation of expiratory duration was significantly attenuated in C2Hx

Phrenic motor outputs in response to bronchopulmonary C-fibre activation following chronic cervical spinal cord injury.

Science.gov (United States)

Lee, Kun-Ze

2016-10-15

Activation of bronchopulmonary C-fibres, the main chemosensitive afferents in the lung, can induce pulmonary chemoreflexes to modulate respiratory activity. Following chronic cervical spinal cord injury, bronchopulmonary C-fibre activation-induced inhibition of phrenic activity was exaggerated. Supersensitivity of phrenic motor outputs to the inhibitory effect of bronchopulmonary C-fibre activation is due to a shift of phrenic motoneuron types and slow recovery of phrenic motoneuron discharge in cervical spinal cord-injured animals. These data suggest that activation of bronchopulmonary C-fibres may retard phrenic output recovery following cervical spinal cord injury. The alteration of phenotype and discharge pattern of phrenic motoneuron enables us to understand the impact of spinal cord injury on spinal respiratory activity. Cervical spinal injury interrupts bulbospinal pathways and results in cessation of phrenic bursting ipsilateral to the lesion. The ipsilateral phrenic activity can partially recover over weeks to months following injury due to the activation of latent crossed spinal pathways and exhibits a greater capacity to increase activity during respiratory challenges than the contralateral phrenic nerve. However, whether the bilateral phrenic nerves demonstrate differential responses to respiratory inhibitory inputs is unclear. Accordingly, the present study examined bilateral phrenic bursting in response to capsaicin-induced pulmonary chemoreflexes, a robust respiratory inhibitory stimulus. Bilateral phrenic nerve activity was recorded in anaesthetized and mechanically ventilated adult rats at 8-9 weeks after C2 hemisection (C2Hx) or C2 laminectomy. Intra-jugular capsaicin (1.5 μg kg -1 ) injection was performed to activate the bronchopulmonary C-fibres to evoke pulmonary chemoreflexes. The present results indicate that capsaicin-induced prolongation of expiratory duration was significantly attenuated in C2Hx animals. However, ipsilateral phrenic

Alpha particle excited x-ray fluorescence analysis for trace elements in cervical spinal cords of amyotrophic lateral sclerosis

International Nuclear Information System (INIS)

Mizumoto, Yoshihiko; Iwata, Shiro; Sasajima, Kazuhisa; Yase, Yoshio; Yoshida, Shohei.

1980-01-01

The mean contents of trace elements in anterior gray horn section of cervical spinal cords of six amyotrophic lateral sclerosis (ALS) cases were relatively determined against those of six control cases by α-particle excited X-ray fluorescence analysis. The anterior gray horn section of cervical spinal cord samples were excited by 1.6 MeV α-particle beam of 2 mm diameter accelerated with a Van de Graaff accelerator, and characteristic X-ray spectra were measured with a Si(Li) detector. From the peak areas on the X-ray spectra, the relative mean contents of the trace elements in cervical spinal cords of ALS and control cases were determined. As a result, the X-ray peaks of Al, Si, P, S, Cl, K, Ca, Ti, V, Mn, Fe, Cu and Zn were detected. The contents of Al, Si, P, Ca, Ti, V, Mn and Fe in ALS cases were higher than those in control cases. The contents of S, Cl, K, Cu and Zn in ALS and in control cases were equal to each other within standard deviation. The precipitation mechanisms of Al, Si, P, Ca, Ti, V, Mn and Fe into cervical spinal cord of ALS cases are discussed on the basis of the previous studies. (author)

Evolution of spinal cord injuries due to cervical canal stenosis without radiographic evidence of trauma (SCIWORET): a prospective study.

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Lamothe, G; Muller, F; Vital, J-M; Goossens, D; Barat, M

2011-06-01

Traumatic spinal cord injuries on cervical canal stenosis represent a steadily increasing pathology, of which clinical and functional outcomes remain largely unknown. We present the results of a prospective study of 20 patients followed for one year who had presented with traumatic spinal cord injury involving initially acute neurological symptoms and cervical canal stenosis defined in the imaging by a Torg ratio0.65, without vertebral fracture. Traumatic spinal cord injuries on cervical canal stenosis are caused mainly by falls in the elderly population and by unsafe behaviour among younger subjects. Most of the patients present with initially incomplete tetraplegia, and two thirds have centromedullary syndrome. Association of complete tetraplegia with advanced age would seem to be a predictive factor of death in the early post-traumatic period. For incomplete tetraplegics, the main phase of neurological and functional recovery is observed over the first six months. Radiological data and timing of surgery do not appear to affect the prognosis. This study underlines the need for individualized specialized care of patients with spinal cord injuries on cervical canal stenosis, particularly according to their demographic and lesional characteristics. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

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.

Functional MRI of the cervical spinal cord on 1.5 T with fingertapping: to what extent is it feasible?

International Nuclear Information System (INIS)

Govers, N.; Beghin, J.; Goethem, J.W.M. van; Hauwe, L. van den; Vandervliet, E.; Parizel, P.M.; Michiels, J.

2007-01-01

Until recently, functional magnetic resonance imaging (fMRI) with blood oxygen level-dependent (BOLD) contrast, was mainly used to study brain physiology. The activation signal measured with fMRI is based upon the changes in the concentration of deoxyhaemoglobin that arise from an increase in blood flow in the vicinity of neuronal firing. Technical limitations have impeded such research in the human cervical spinal cord. The purpose of this investigation was to determine whether a reliable fMRI signal can be elicited from the cervical spinal cord during fingertapping, a complex motor activity. Furthermore, we wanted to determine whether the fMRI signal could be spatially localized to the particular neuroanatomical location specific for this task. A group of 12 right-handed healthy volunteers performed the complex motor task of fingertapping with their right hand. T2*-weighted gradient-echo echo-planar imaging on a 1.5-T clinical unit was used to image the cervical spinal cord. Motion correction was applied. Cord activation was measured in the transverse imaging plane, between the spinal cord levels C5 and T1. In all subjects spinal cord responses were found, and in most of them on the left and the right side. The distribution of the activation response showed important variations between the subjects. While regions of activation were distributed throughout the spinal cord, concentrated activity was found at the anatomical location of expected motor innervation, namely nerve root C8, in 6 of the 12 subjects. fMRI of the human cervical spinal cord on an 1.5-T unit detects neuronal activity related to a complex motor task. The location of the neuronal activation (spinal cord segment C5 through T1 with a peak on C8) corresponds to the craniocaudal anatomical location of the neurons that activate the muscles in use. (orig.)

Adverse events after cervical spinal manipulative therapy: consensus based classification and definitions

NARCIS (Netherlands)

Dr. C.P. van der Schans; M. Schmitt; dr. S.E. Lakke; H.A. Kranenburg

2015-01-01

Cervical spinal manipulations (CSM) are frequently employed techniques to alleviate neck pain and headache. Minor and major complications following CSM have been described, though clear consensus on definition and the classification of the complications had not yet been achieved. As a result,

Adverse events after cervical spinal manipulative therapy: consensus based classification and definitions

NARCIS (Netherlands)

Kranenburg, Rik; Jorna-Lakke, Sandra; Schmitt, M.A.; van der Schans, Cees

2016-01-01

Cervical spinal manipulations (CSM) are frequently employed techniques to alleviate neck pain and headache. Minor and major complications following CSM have been described, though clear consensus on definition and the classification of the complications had not yet been achieved. As a result,

Cervical spondylodiscitis with spinal epidural abscess caused by Aggregatibacter aphrophilus.

Science.gov (United States)

Pasqualini, Leonella; Mencacci, Antonella; Scarponi, Anna Maria; Leli, Christian; Fabbriciani, Gianluigi; Callarelli, Laura; Schillaci, Giuseppe; Bistoni, Francesco; Mannarino, Elmo

2008-05-01

Spondylodiscitis caused by Aggregatibacter aphrophilus, formerly known as Haemophilus paraphrophilus, is an unusual condition and can be very difficult to diagnose. We report a case of cervical spondylodiscitis complicated by spinal epidural abscess in a 63-year-old woman, without underlying predisposing conditions. The source of infection was identified as a periodontal infection. The patient was successfully treated with systemic antibiotics.

Enhancing Propriospinal Relays to Improve Functional Recovery after SCI

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2016-10-01

cervical spinal cord (Figure 4). These propriospinal neurons are thought to connect spinal cord segments to support intersegmental communication ...These are the primary neuronal population with surviving axons bypassing the lesion after a moderate contusion injury to the T10 region. This...supraspinal pathways onto the cervical propriospinal neurons . The slight delay in analysis will not delay the overall experimental goals and we are

Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy: A Case Report and Literature Review.

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Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil

2016-02-01

Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain.The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty.Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4-C5 and C5-C6 that caused severe spinal cord compression and surrounding edema. We performed C4-C5-C6 anterior cervical discectomy and fusion.The patient's limb weakness improved rapidly within 1 day postoperatively, and he was discharged 4 weeks later. At his 12-month follow-up, the patient had

MR microscopy of the cervical spinal cord

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Carvlin, M.J.; Asato, R.; Hackney, D.B.; Kassab, E.A.; Muraki, A.S.; Joseph, P.M.; Fielding, R.M.; Hennessy, M.J.

1988-01-01

High-resolution magnetic resonance (MR) imaging was performed on ten fresh cadaver cervical spinal cords in order to identify internal features of the spinal cord and to distinguish anatomy from artifact. Axial, sagittal, and coronal long repetition time (TR), long echo time (TE) and short TR, short TE spin-echo, gradient-echo, and inversion-recovery images were acquired at 1.5 T (Siemens), 1.9T, and 4.7T (Varian/Sisco) with an inplane resolution of 0.05-1mm. The dorsal and ventral horns of the gray matter as well as the lateral and posterior funiculi of the white matter were distinctly resolved from truncation artifacts in sagittal and axial images. In short TR, short TE, long TR, long TE spin-echo and gradient-echo (TR, 35 msec; TE, 7 msec; flip angle, 10 0 -90 0 ) images, the central gray matter demonstrated higher signal intensity than the white matter. These findings are in contradistinction to the image contrast typically observed in brain. High-resolution MR imaging techniques capable of demonstrating this anatomy in vivo are being developed

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.

Desferrioxamine Reduces Oxidative Stress in the Lung Contusion

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Umit Nusret Basaran

2013-01-01

Full Text Available Our hypothesis in this study is that desferrioxamine (DFX has therapeutic effects on experimental lung contusions in rats. The rats were divided into four groups (n=8: control, control+DFX, contusion, and contusion+DFX. In the control+DFX and contusion+DFX groups, 100 mg/kg DFX was given intraperitoneally once a day just after the contusion and the day after the contusion. Contusions led to a meaningful rise in the malondialdehyde (MDA level in lung tissue. MDA levels in the contusion+DFX group experienced a significant decline. Glutathione levels were significantly lower in the contusion group than in the control group and significantly higher in the contusion+DFX group. Glutathione peroxidase (GPx and superoxide dismutase (SOD levels in the contusion group were significantly lower than those in the control group. In the contusion+DFX group, SOD and GPx levels were significantly higher than those in the contusion group. In light microscopic evaluation, the contusion and contusion+DFX groups showed edema, hemorrhage, alveolar destruction, and leukocyte infiltration. However, histological scoring of the contusion+DFX group was significantly more positive than that of the contusion group. The iNOS staining in the contusion group was significantly more intensive than that in all other groups. DFX reduced iNOS staining significantly in comparison to the contusion group. This study showed that DFX reduced oxidative stress in lung contusions in rats and histopathologically ensured the recovery of the lung tissue.

Long descending cervical propriospinal neurons differ from thoracic propriospinal neurons in response to low thoracic spinal injury

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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

White matter organization in cervical spinal cord relates differently to age and control of grip force in healthy subjects.

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Lindberg, Påvel G; Feydy, Antoine; Maier, Marc A

2010-03-17

Diffusion tensor imaging (DTI) can be used to elucidate relations between CNS structure and function. We hypothesized that the degree of spinal white matter organization relates to the accuracy of control of grip force. Healthy subjects of different age were studied using DTI and visuomotor tracking of precision grip force. The latter is a prime component of manual dexterity. A regional analysis of spinal white matter [fractional anisotropy (FA)] across multiple cervical levels (C2-C3, C4-C5, and C6-C7) and in different regions of interest (left and right lateral or medial spinal cord) was performed. FA was highest at the C2-C3 level, higher on the right than the left side, and higher in the lateral than in the medial spinal cord (p level in the lateral spinal cord, in which the corticospinal tract innervates spinal circuitry controlling hand and digit muscles. FA of the medial spinal cord correlated consistently with age across all cervical levels, whereas FA of the lateral spinal cord did not. The results suggest (1) a functionally relevant specialization of lateral spinal cord white matter and (2) an increased sensitivity to age-related decline in medial spinal cord white matter in healthy subjects.

Systemic hypothermia for the treatment of acute cervical spinal cord injury in sports.

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Dietrich, William Dalton; Cappuccino, Andrew; Cappuccino, Helen

2011-01-01

Spinal cord injury is a devastating condition that affects approximately 12,000 patients each year in the United States. Major causes for spinal cord injury include motor vehicle accidents, sports-related injuries, and direct trauma. Moderate hypothermia has gained attention as a potential therapy due to recent experimental and clinical studies and the use of modest systemic hypothermia (MSH) in high profile case of spinal cord injury in a National Football League (NFL) player. In experimental models of spinal cord injury, moderate hypothermia has been shown to improve functional recovery and reduce overall structural damage. In a recent Phase I clinical trial, systemic hypothermia has been shown to be safe and provide some encouraging results in terms of functional recovery. This review will summarize recent preclinical data, as well as clinical findings that support the continued investigations for the use of hypothermia in severe cervical spinal cord injury.

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

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Epstein, Nancy E; Hollingsworth, Renee

2015-01-01

The classical clinical presentation, neuroradiographic features, and conservative vs. surgical management of traumatic cervical central spinal cord (CSS) injury remain controversial. 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). 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. 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.

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

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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.

Magnetisation transfer ratio measurement in the cervical spinal cord: a preliminary study in multiple sclerosis

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Silver, N.C.; Barker, G.J.; Losseff, N.A.; Gawne-Cain, M.L.; MacManus, D.G.; Thompson, A.J.; Miller, D.H.

1997-01-01

MRI readily detects the lesions of multiple sclerosis (MS) in the brain and spinal cord. Conventional MRI sequences do not, however, permit distinction between the various pathological characteristics (oedema, demyelination, axonal loss and gliosis) of lesions in MS. Magnetisation transfer (MT) imaging may be more specific in distinguishing the pathologies responsible for disability in MS, namely demyelination and axonal loss, and therefore may have a potential role in monitoring treatment. We have applied MT imaging to the cervical spinal cord to see if it is feasible to measure MT ratios (MTR) in this region where pathological changes may result in considerable disability. We studied 12 patients with MS and 12 age- and sex-matched normal controls using a sagittal T2-weighted fast spin-echo sequence with and without an MT pulse. The median value for cervical cord mean MTR measurement in normal controls was 19.30 % units (interquartile range 19.05-19.55), whereas values were significantly lower in MS patients (median = 17.95 % units, interquartile range 17.25-19.00, P 0.0004). There was a low intrarater variability for repeated mean MTR measurements. We conclude that it is possible to measure MTR in the cervical spinal cord, that a significant reduction occurs in patients with MS, and that there may be a role for this measure in future MS treatment trials. (orig.). With 2 figs., 1 tab

Magnetisation transfer ratio measurement in the cervical spinal cord: a preliminary study in multiple sclerosis

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Silver, N.C. [NMR Research Unit and Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG (United Kingdom); Barker, G.J. [NMR Research Unit and Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG (United Kingdom); Losseff, N.A. [NMR Research Unit and Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG (United Kingdom); Gawne-Cain, M.L. [NMR Research Unit and Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG (United Kingdom); MacManus, D.G. [NMR Research Unit and Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG (United Kingdom); Thompson, A.J. [NMR Research Unit and Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG (United Kingdom); Miller, D.H. [NMR Research Unit and Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG (United Kingdom)

1997-06-01

MRI readily detects the lesions of multiple sclerosis (MS) in the brain and spinal cord. Conventional MRI sequences do not, however, permit distinction between the various pathological characteristics (oedema, demyelination, axonal loss and gliosis) of lesions in MS. Magnetisation transfer (MT) imaging may be more specific in distinguishing the pathologies responsible for disability in MS, namely demyelination and axonal loss, and therefore may have a potential role in monitoring treatment. We have applied MT imaging to the cervical spinal cord to see if it is feasible to measure MT ratios (MTR) in this region where pathological changes may result in considerable disability. We studied 12 patients with MS and 12 age- and sex-matched normal controls using a sagittal T2-weighted fast spin-echo sequence with and without an MT pulse. The median value for cervical cord mean MTR measurement in normal controls was 19.30 % units (interquartile range 19.05-19.55), whereas values were significantly lower in MS patients (median = 17.95 % units, interquartile range 17.25-19.00, P = 0.0004). There was a low intrarater variability for repeated mean MTR measurements. We conclude that it is possible to measure MTR in the cervical spinal cord, that a significant reduction occurs in patients with MS, and that there may be a role for this measure in future MS treatment trials. (orig.). With 2 figs., 1 tab.

Diffusion tensor MR imaging (DTI) metrics in the cervical spinal cord in asymptomatic HIV-positive patients

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Mueller-Mang, Christina; Mang, Thomas; Fruehwald-Pallamar, Julia; Weber, Michael; Thurnher, Majda M. [Medical University of Vienna, Department of Radiology, Vienna (Austria); Law, Meng [University of Southern California, Los Angeles County Hospital and USC Medical Center, Department of Radiology, Keck School of Medicine, Los Angeles, CA (United States)

2011-08-15

This study was conducted to compare diffusion tensor MR imaging (DTI) metrics of the cervical spinal cord in asymptomatic human immunodeficiency virus (HIV)-positive patients with those measured in healthy volunteers, and to assess whether DTI is a valuable diagnostic tool in the early detection of HIV-associated myelopathy (HIVM). MR imaging of the cervical spinal cord was performed in 20 asymptomatic HIV-positive patients and in 20 healthy volunteers on a 3-T MR scanner. Average fractional anisotropy (FA), mean diffusivity (MD), and major (E1) and minor (E2, E3) eigenvalues were calculated within regions of interest (ROIs) at the C2/3 level (central and bilateral anterior, lateral and posterior white matter). Statistical analysis showed significant differences with regard to mean E3 values between patients and controls (p = 0.045; mixed-model analysis of variance (ANOVA) test). Mean FA was lower, and mean MD, mean E1, and mean E2 were higher in each measured ROI in patients compared to controls, but these differences were not statistically significant. Asymptomatic HIV-positive patients demonstrate only subtle changes in DTI metrics measured in the cervical spinal cord compared to healthy volunteers that currently do not support using DTI as a diagnostic tool for the early detection of HIVM. (orig.)

Assessment of the Neuroprotective Effects of Lavandula angustifolia Extract on the Contusive Model of Spinal Cord Injury in Wistar Rats

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Kaka, Gholamreza; Yaghoobi, Kayvan; Davoodi, Shaghayegh; Hosseini, Seyed R.; Sadraie, Seyed H.; Mansouri, Korosh

2016-01-01

Introduction: Spinal cord injury (SCI) involves a primary trauma and secondary cellular processes that can lead to severe damage to the nervous system, resulting in long-term spinal deficits. At the cellular level, SCI causes astrogliosis, of which glial fibrillary acidic protein (GFAP) is a major index. Objective: The aim of this study was to investigate the neuroprotective effects of Lavandula angustifolia (Lav) on the repair of spinal cord injuries in Wistar rats. Materials and Methods: Forty-five female rats were randomly divided into six groups of seven rats each: the intact, sham, control (SCI), Lav 100, Lav 200, and Lav 400 groups. Every week after SCI onset, all animals were evaluated for behavior outcomes by the Basso, Beattie, and Bresnahan (BBB) score. H&E staining was performed to examine the lesions post-injury. GFAP expression was assessed for astrogliosis. Somatosensory evoked potential (SEP) testing was performed to detect the recovery of neural conduction. Results: BBB scores were significantly increased and delayed responses on sensory tests were significantly decreased in the Lav 200 and Lav 400 groups compared to the control group. The greatest decrease of GFAP was evident in the Lav 200 and Lav 400 groups. EMG results showed significant improvement in the hindlimbs in the Lav 200 and Lav 400 groups compared to the control group. Cavity areas significantly decreased and the number of ventral motor neurons significantly increased in the Lav 200 and Lav 400 groups. Conclusion: Lav at doses of 200 and 400 mg/kg can promote structural and functional recovery after SCI. The neuroprotective effects of L. angustifolia can lead to improvement in the contusive model of SCI in Wistar rats. PMID:26903793

Cervical Cord-Canal Mismatch: A New Method for Identifying Predisposition to Spinal Cord Injury.

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Nouri, Aria; Montejo, Julio; Sun, Xin; Virojanapa, Justin; Kolb, Luis E; Abbed, Khalid M; Cheng, Joseph S

2017-12-01

The risk for spinal cord injuries (SCIs) ranging from devastating traumatic injuries, compression because of degenerative pathology, and neurapraxia is increased in patients with congenital spinal stenosis. Classical diagnostic criteria include an absolute anteroposterior diameter of spinal cord, which varies across patients, independent of canal size. Recent large magnetic resonance imaging studies of population cohorts have allowed newer methods to emerge that account for both cord and canal size by measuring a spinal cord occupation ratio (SCOR). A SCOR defined as ≥70% on midsagittal imaging or ≥80% on axial imaging appears to be an effective method of identifying cord-canal mismatch, but requires further validation. Cord-canal size mismatch predisposes patients to SCI because of 1) less space within the canal lowering the amount of degenerative changes needed for cord compression, and 2) less cerebrospinal fluid surrounding the spinal cord decreasing the ability to absorb kinetic forces directed at the spine. Patients with cord-canal mismatch have been reported to be at a substantially higher risk of traumatic SCI, and present with degenerative cervical myelopathy at a younger age than patients without cord-canal mismatch. However, neurologic outcome after SCI has occurred does not appear to be different in patients with or without a cord-canal mismatch. Recognition that canal and cord size are both factors which predispose to SCI supports that cord-canal size mismatch rather than a narrow cervical canal in isolation should be viewed as the underlying mechanism predisposing to SCI. Copyright © 2017. Published by Elsevier Inc.

Longitudinal study on diffusion tensor imaging and diffusion tensor tractography following spinal cord contusion injury in rats.

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Zhao, Can; Rao, Jia-Sheng; Pei, Xiao-Jiao; Lei, Jian-Feng; Wang, Zhan-Jing; Yang, Zhao-Yang; Li, Xiao-Guang

2016-06-01

Diffusion tensor imaging (DTI) as a potential technology has been used in spinal cord injury (SCI) studies, but the longitudinal evaluation of DTI parameters after SCI, and the correlation between DTI parameters and locomotor outcomes need to be defined. Adult Wistar rats (n = 6) underwent traumatic thoracic cord contusion by an NYU impactor. DTI and Basso-Beattie-Bresnahan datasets were collected pre-SCI and 1, 3, 7, 14, and 84 days post-SCI. Diffusion tensor tractography (DTT) of the spinal cord was also generated. Fractional anisotropy (FA) and connection rate of fibers at the injury epicenter and at 5 mm rostral/caudal to the epicenter were calculated. The variations of these parameters after SCI were observed by one-way analysis of variance and the correlations between these parameters and motor function were explored by Pearson's correlation. FA at the epicenter decreased most remarkably on day 1 post-SCI (from 0.780 ± 0.012 to 0.330 ± 0.015), and continued to decrease slightly by day 3 post-SCI (0.313 ± 0.015), while other parameters decreased significantly over the first 3 days after SCI. DTT showed residual fibers concentrated on ventral and ventrolateral sides of the cord. Moreover, FA at the epicenter exhibited the strongest correlation (r = 0.887, p = 0.000) with the locomotion performance. FA was sensitive to degeneration in white matter and DTT could directly reflect the distribution of the residual white matter. Moreover, days 1 to 3 post-SCI may be the optimal time window for SCI examination and therapy.

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.

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

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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

Macrophage depletion and Schwann cell transplantation reduce cyst size after rat contusive spinal cord injury.

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Lee, Yee-Shuan; Funk, Lucy H; Lee, Jae K; Bunge, Mary Bartlett

2018-04-01

Schwann cell transplantation is a promising therapy for the treatment of spinal cord injury (SCI) and is currently in clinical trials. In our continuing efforts to improve Schwann cell transplantation strategies, we sought to determine the combined effects of Schwann cell transplantation with macrophage depletion. Since macrophages are major inflammatory contributors to the acute spinal cord injury, and are the major phagocytic cells, we hypothesized that transplanting Schwann cells after macrophage depletion will improve cell survival and integration with host tissue after SCI. To test this hypothesis, rat models of contusive SCI at thoracic level 8 were randomly subjected to macrophage depletion or not. In rat subjected to macrophage depletion, liposomes filled with clodronate were intraperitoneally injected at 1, 3, 6, 11, and 18 days post injury. Rats not subjected to macrophage depletion were intraperitoneally injected with liposomes filled with phosphate buffered saline. Schwann cells were transplanted 1 week post injury in all rats. Biotinylated dextran amine (BDA) was injected at thoracic level 5 to evalute axon regeneration. The Basso, Beattie, and Bresnahan locomotor test, Gridwalk test, and sensory test using von Frey filaments were performed to assess functional recovery. Immunohistochemistry was used to detect glial fibrillary acidic protein, neurofilament, and green fluorescent protein (GFP), and also to visulize BDA-labelled axons. The GFP labeled Schwann cell and cyst and lesion volumes were quantified using stained slides. The numbers of BDA-positive axons were also quantified. At 8 weeks after Schwann cell transplantation, there was a significant reduction in cyst and lesion volumes in the combined treatment group compared to Schwann cell transplantation alone. These changes were not associated, however, with improved Schwann cell survival, axon growth, or locomotor recovery. Although combining Schwann cell transplantation with macrophage

Macrophage depletion and Schwann cell transplantation reduce cyst size after rat contusive spinal cord injury

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Lee, Yee-Shuan; Funk, Lucy H.; Lee, Jae K.; Bunge, Mary Bartlett

2018-01-01

Schwann cell transplantation is a promising therapy for the treatment of spinal cord injury (SCI) and is currently in clinical trials. In our continuing efforts to improve Schwann cell transplantation strategies, we sought to determine the combined effects of Schwann cell transplantation with macrophage depletion. Since macrophages are major inflammatory contributors to the acute spinal cord injury, and are the major phagocytic cells, we hypothesized that transplanting Schwann cells after macrophage depletion will improve cell survival and integration with host tissue after SCI. To test this hypothesis, rat models of contusive SCI at thoracic level 8 were randomly subjected to macrophage depletion or not. In rat subjected to macrophage depletion, liposomes filled with clodronate were intraperitoneally injected at 1, 3, 6, 11, and 18 days post injury. Rats not subjected to macrophage depletion were intraperitoneally injected with liposomes filled with phosphate buffered saline. Schwann cells were transplanted 1 week post injury in all rats. Biotinylated dextran amine (BDA) was injected at thoracic level 5 to evalute axon regeneration. The Basso, Beattie, and Bresnahan locomotor test, Gridwalk test, and sensory test using von Frey filaments were performed to assess functional recovery. Immunohistochemistry was used to detect glial fibrillary acidic protein, neurofilament, and green fluorescent protein (GFP), and also to visulize BDA-labelled axons. The GFP labeled Schwann cell and cyst and lesion volumes were quantified using stained slides. The numbers of BDA-positive axons were also quantified. At 8 weeks after Schwann cell transplantation, there was a significant reduction in cyst and lesion volumes in the combined treatment group compared to Schwann cell transplantation alone. These changes were not associated, however, with improved Schwann cell survival, axon growth, or locomotor recovery. Although combining Schwann cell transplantation with macrophage

Macrophage depletion and Schwann cell transplantation reduce cyst size after rat contusive spinal cord injury

Directory of Open Access Journals (Sweden)

Yee-Shuan Lee

2018-01-01

Full Text Available Schwann cell transplantation is a promising therapy for the treatment of spinal cord injury (SCI and is currently in clinical trials. In our continuing efforts to improve Schwann cell transplantation strategies, we sought to determine the combined effects of Schwann cell transplantation with macrophage depletion. Since macrophages are major inflammatory contributors to the acute spinal cord injury, and are the major phagocytic cells, we hypothesized that transplanting Schwann cells after macrophage depletion will improve cell survival and integration with host tissue after SCI. To test this hypothesis, rat models of contusive SCI at thoracic level 8 were randomly subjected to macrophage depletion or not. In rat subjected to macrophage depletion, liposomes filled with clodronate were intraperitoneally injected at 1, 3, 6, 11, and 18 days post injury. Rats not subjected to macrophage depletion were intraperitoneally injected with liposomes filled with phosphate buffered saline. Schwann cells were transplanted 1 week post injury in all rats. Biotinylated dextran amine (BDA was injected at thoracic level 5 to evalute axon regeneration. The Basso, Beattie, and Bresnahan locomotor test, Gridwalk test, and sensory test using von Frey filaments were performed to assess functional recovery. Immunohistochemistry was used to detect glial fibrillary acidic protein, neurofilament, and green fluorescent protein (GFP, and also to visulize BDA-labelled axons. The GFP labeled Schwann cell and cyst and lesion volumes were quantified using stained slides. The numbers of BDA-positive axons were also quantified. At 8 weeks after Schwann cell transplantation, there was a significant reduction in cyst and lesion volumes in the combined treatment group compared to Schwann cell transplantation alone. These changes were not associated, however, with improved Schwann cell survival, axon growth, or locomotor recovery. Although combining Schwann cell transplantation with

Spinal cord edema with contrast enhancement mimicking intramedullary tumor in patient with cervical myelopathy: A case report and a brief literature review.

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Gkasdaris, Grigorios; Chourmouzi, Danai; Karagiannidis, Apostolos; Kapetanakis, Stylianos

2017-01-01

Cervical myelopathy (CM) is a clinical diagnosis that may be associated with hyperintense areas on T2-weighted magnetic resonance imaging (MRI) scan. The use of contrast enhancement in such areas to differentiate between neoplastic and degenerative disease has rarely been described. We present a 41-year-old female with a 5-month course of progressive CM. The cervical MRI revealed spinal cord swelling, stenosis, and a hyperintense signal at the C5-C6 and C5-C7 levels. Both the neurologic and radiologic examinations were consistent with an intramedullary cervical cord tumor. To decompress the spinal canal, an anterior cervical discectomy and fusion was performed from C5 to C7 level. This resulted in immediate and significant improvement of the myelopathy. Postoperatively, over 1.5 years, the hyperintense, enhancing intramedullary lesion gradually regressed on multiple postoperative MRI scans. Spinal cord edema is occasionally seen on MR studies of the cervical spine in patients with degenerative CM. Contrast-enhanced MR studies may help differentiate hyperintense cord signals due to edema vs. atypical intramedullary tumors. Routine successive postoperative MRI evaluations are crucial to confirm the diagnosis of degenerative vs. neoplastic disease.

Bimanual reach to grasp movements after cervical spinal cord injury.

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Laura Britten

Full Text Available Injury to the cervical spinal cord results in bilateral deficits in arm/hand function reducing functional independence and quality of life. To date little research has been undertaken to investigate control strategies of arm/hand movements following cervical spinal cord injury (cSCI. This study aimed to investigate unimanual and bimanual coordination in patients with acute cSCI using 3D kinematic analysis as they performed naturalistic reach to grasp actions with one hand, or with both hands together (symmetrical task, and compare this to the movement patterns of uninjured younger and older adults. Eighteen adults with a cSCI (mean 61.61 years with lesions at C4-C8, with an American Spinal Injury Association (ASIA grade B to D and 16 uninjured younger adults (mean 23.68 years and sixteen uninjured older adults (mean 70.92 years were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, and had longer deceleration phases than uninjured participants. These differences were exacerbated during bimanual reach-to-grasp tasks. Maximal grasp aperture was no different between groups, but reached earlier by people with cSCI. Participants with a cSCI were less synchronous than younger and older adults but all groups used the deceleration phase for error correction to end the movement in a synchronous fashion. Overall, this study suggests that after cSCI a level of bimanual coordination is retained. While there seems to be a greater reliance on feedback to produce both the reach to grasp, we observed minimal disruption of the more impaired limb on the less impaired limb. This suggests that bimanual movements should be integrated into therapy.

Clinical analysis of spinal cord injury with or without cervical ossification of the posterior longitudinal ligament, spondylosis, and canal stenosis in elderly head injury patients

International Nuclear Information System (INIS)

Nakae, Ryuta; Onda, Hidetaka; Yokobori, Shoji; Araki, Takashi; Fuse, Akira; Toda, Shigeki; Kushimoto, Shigeki; Yokota, Hiroyuki; Teramoto, Akira

2010-01-01

Patients with degenerative diseases of the cervical spine, such as ossification of the posterior longitudinal ligament, spondylosis, and canal stenosis, sometimes present with acute spinal cord injury caused by minor trauma. However, the relative risk of cervical cord injury with these diseases is unknown. The clinical and radiological features of 94 elderly patients with head injury, 57 men and 37 women aged from 65 to 98 years (mean 76.6 years), were retrospectively analyzed to assess the association of spinal cord injury with degenerative cervical diseases. Degenerative cervical diseases were present in 25 patients, and spinal cord injury was more common in the patients with degenerative diseases (11/25 patients) than in the patients without such diseases (3/69 patients; relative risk=10.2). The incidence of degenerative cervical diseases seems to be increasing in Japan because life expectancy has increased and the elderly are a rapidly growing part of the population. A fall while walking or cycling is a common mechanism of head injury and/or cervical cord injury in the elderly. To decrease the occurrence of cervical myelopathy, prevention by increasing social awareness and avoiding traffic accidents and falls is important. (author)

Pathophysiology of cervical myelopathy.

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Baptiste, Darryl C; Fehlings, Michael G

2006-01-01

Cervical myelopathy is a group of closely related disorders usually caused by spondylosis or by ossification of the posterior longitudinal ligament and is characterized by compression of the cervical spinal cord or nerve roots by varying degrees and number of levels. The decrease in diameter of the vertebral canal secondary to disc degeneration and osteophytic spurs compresses the spinal cord and nerve roots at one or several levels, producing direct damage and often secondary ischemic changes. Clinicians who treat cervical myelopathy cord injuries should have a basic understanding of the pathophysiology and the processes that are initiated after the spinal cord has been injured. Literature review. Literature review of human cervical myelopathy and clinically relevant animal models to further our understanding of the pathological mechanisms involved. The pathophysiology of cervical myelopathy involves static factors, which result in acquired or developmental stenosis of the cervical canal and dynamic factors, which involve repetitive injury to the cervical cord. These mechanical factors in turn result in direct injury to neurons and glia as well as a secondary cascade of events including ischemia, excitotoxicity, and apoptosis; a pathobiology similar to that occurring in traumatic spinal cord injury. This review summarizes some of the significant pathophysiological processes involved in cervical myelopathy.

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.

Paired motor cortex and cervical epidural electrical stimulation timed to converge in the spinal cord promotes lasting increases in motor responses.

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Mishra, Asht M; Pal, Ajay; Gupta, Disha; Carmel, Jason B

2017-11-15

Pairing motor cortex stimulation and spinal cord epidural stimulation produced large augmentation in motor cortex evoked potentials if they were timed to converge in the spinal cord. The modulation of cortical evoked potentials by spinal cord stimulation was largest when the spinal electrodes were placed over the dorsal root entry zone. Repeated pairing of motor cortex and spinal cord stimulation caused lasting increases in evoked potentials from both sites, but only if the time between the stimuli was optimal. Both immediate and lasting effects of paired stimulation are likely mediated by convergence of descending motor circuits and large diameter afferents onto common interneurons in the cervical spinal cord. Convergent activity in neural circuits can generate changes at their intersection. The rules of paired electrical stimulation are best understood for protocols that stimulate input circuits and their targets. We took a different approach by targeting the interaction of descending motor pathways and large diameter afferents in the spinal cord. We hypothesized that pairing stimulation of motor cortex and cervical spinal cord would strengthen motor responses through their convergence. We placed epidural electrodes over motor cortex and the dorsal cervical spinal cord in rats; motor evoked potentials (MEPs) were measured from biceps. MEPs evoked from motor cortex were robustly augmented with spinal epidural stimulation delivered at an intensity below the threshold for provoking an MEP. Augmentation was critically dependent on the timing and position of spinal stimulation. When the spinal stimulation was timed to coincide with the descending volley from motor cortex stimulation, MEPs were more than doubled. We then tested the effect of repeated pairing of motor cortex and spinal stimulation. Repetitive pairing caused strong augmentation of cortical MEPs and spinal excitability that lasted up to an hour after just 5 min of pairing. Additional physiology

[Post-traumatic reconnection of the cervical spinal cord with skeletal striated muscles. Study in adult rats and marmosets].

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Horvat, J C; Affane-Boulaid, F; Baillet-Derbin, C; Davarpanah, Y; Destombes, J; Duchossoy, Y; Emery, E; Kassar-Duchossoy, L; Mira, J C; Moissonnier, P; Pécot-Dechavassine, M; Reviron, T; Rhrich-Haddout, F; Tadié, M; Ye, J H

1997-01-01

In an attempt at repairing the injured spinal cord of adult mammals (rat, dog and marmoset) and its damaged muscular connections, we are currently using: 1) peripheral nerve autografts (PNG), containing Schwann cells, to trigger and direct axonal regrowth from host and/or transplanted motoneurons towards denervated muscular targets; 2) foetal spinal cord transplants to replace lost neurons. In adult rats and marmosets, a PNG bridge was used to joint the injured cervical spinal cord to a denervated skeletal muscle (longissimus atlantis [rat] or biceps brachii [rat and marmoset]). The spinal lesion was obtained by the implantation procedure of the PNG. After a post-operative delay ranging from 2 to 22 months, the animals were checked electrophysiologically for functional muscular reconnection and processed for a morphological study including retrograde axonal tracing (HRP, Fast Blue, True Blue), histochemistry (AChE, ATPase), immunocytochemistry (ChAT) and EM. It was thus demonstrated that host motoneurons of the cervical enlargement could extend axons all the way through the PNG bridge as: a) in anaesthetized animals, contraction of the reconnected muscle could be obtained by electrical stimulation of the grafted nerve; b) the retrograde axonal tracing studies indicated that a great number of host cervical neurons extended axons into the PNG bridge up to the muscle; c) many of them were assumed to be motoneurons (double labelling with True Blue and an antibody against ChAT); and even alpha-motoneurons (type C axosomatic synapses in HRP labelled neurons seen in EM in the rat); d) numerous ectopic endplates were seen around the intramuscular tip of the PNG. In larger (cavitation) spinal lesions (rat), foetal motoneurons contained in E14 spinal cord transplants could similarly grow axons through PNG bridges up to the reconnected muscle. Taking all these data into account, it can be concluded that neural transplants are interesting tools for evaluating both the

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

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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. Copyright © 2013 Elsevier Ltd. All rights reserved.

Magnetic resonance imaging susceptibility artifacts in the cervical vertebrae and spinal cord related to monocortical screw-polymethylmethacrylate implants in canine cadavers.

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Jones, Brian G; Fosgate, Geoffrey T; Green, Eric M; Habing, Amy M; Hettlich, Bianca F

2017-04-01

OBJECTIVE To characterize and compare MRI susceptibility artifacts related to titanium and stainless steel monocortical screws in the cervical vertebrae and spinal cord of canine cadavers. SAMPLE 12 canine cadavers. PROCEDURES Cervical vertebrae (C4 and C5) were surgically stabilized with titanium or stainless steel monocortical screws and polymethylmethacrylate. Routine T1-weighted, T2-weighted, and short tau inversion recovery sequences were performed at 3.0 T. Magnetic susceptibility artifacts in 20 regions of interest (ROIs) across 4 contiguous vertebrae (C3 through C6) were scored by use of an established scoring system. RESULTS Artifact scores for stainless steel screws were significantly greater than scores for titanium screws at 18 of 20 ROIs. Artifact scores for titanium screws were significantly higher for spinal cord ROIs within the implanted vertebrae. Artifact scores for stainless steel screws at C3 were significantly less than at the other 3 cervical vertebrae. CONCLUSIONS AND CLINICAL RELEVANCE Evaluation of routine MRI sequences obtained at 3.0 T revealed that susceptibility artifacts related to titanium monocortical screws were considered mild and should not hinder the overall clinical assessment of the cervical vertebrae and spinal cord. However, mild focal artifacts may obscure small portions of the spinal cord or intervertebral discs immediately adjacent to titanium screws. Severe artifacts related to stainless steel screws were more likely to result in routine MRI sequences being nondiagnostic; however, artifacts may be mitigated by implant positioning.

Phrenic nerve neurotization utilizing the spinal accessory nerve: technical note with potential application in patients with high cervical quadriplegia.

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Tubbs, R Shane; Pearson, Blake; Loukas, Marios; Shokouhi, Ghaffar; Shoja, Mohammadali M; Oakes, W Jerry

2008-11-01

High cervical quadriplegia is associated with high morbidity and mortality. Artificial respiration in these patients carries significant long-term risks such as infection, atelectasis, and respiratory failure. As phrenic nerve pacing has been proven to free many of these patients from ventilatory dependency, we hypothesized that neurotization of the phrenic nerve with the spinal accessory nerve (SAN) may offer one potential alternative to phrenic nerve stimulation via pacing and may be more efficacious and longer lasting without the complications of an implantable device. Ten cadavers (20 sides) underwent exposure of the cervical phrenic nerve and the SAN in the posterior cervical triangle. The SAN was split into anterior and posterior halves and the anterior half transposed to the ipsilateral phrenic nerve as it crossed the anterior scalene muscle. The mean distance between the cervical phrenic nerve and the SAN in the posterior cervical triangle was 2.5 cm proximally, 4 cm at a midpoint, and 6 cm distally. The range for these measurements was 2 to 4 cm, 3.5 to 5 cm, and 4 to 8.5 cm, respectively. The mean excess length of SAN available after transposition to the more anteromedially placed phrenic nerve was 5 cm (range 4 to 6.5 cm). The mean diameter of these regional parts of the spinal accessory and phrenic nerves was 2 and 2.5 mm, respectively. No statistically significant difference was found for measurements between sides. To our knowledge, using the SAN for neurotization to the phrenic nerve for potential use in patients with spinal cord injury has not been previously explored. Following clinical trials, these data may provide a mechanism for self stimulation of the diaphragm and obviate phrenic nerve pacing in patients with high cervical quadriplegia. Our study found that such a maneuver is technically feasible in the cadaver.

Diffusion tensor imaging of the cervical spinal cord in healthy adult population: normative values and measurement reproducibility at 3T MRI.

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Brander, Antti; Koskinen, Eerika; Luoto, Teemu M; Hakulinen, Ullamari; Helminen, Mika; Savilahti, Sirpa; Ryymin, Pertti; Dastidar, Prasun; Ohman, Juha

2014-05-01

Compared to diffusion tensor imaging (DTI) of the brain, there is a paucity of reports addressing the applicability of DTI in the evaluation of the spinal cord. Most normative data of cervical spinal cord DTI consist of relatively small and arbitrarily collected populations. Comprehensive normative data are necessary for clinical decision-making. To establish normal values for cervical spinal cord DTI metrics with region of interest (ROI)- and fiber tractography (FT)-based measurements and to assess the reproducibility of both measurement methods. Forty healthy adults underwent cervical spinal cord 3T MRI. Sagittal and axial conventional T2 sequences and DTI in the axial plane were performed. Whole cord fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were determined at different cervical levels from C2 to C7 using the ROI method. DTI metrics (FA, axial, and radial diffusivities based on eigenvalues λ1, λ2, and λ3, and ADC) of the lateral and posterior funicles were measured at C3 level. FA and ADC of the whole cord and the lateral and posterior funicles were also measured using quantitative tractography. Intra- and inter-observer variation of the measurement methods were assessed. Whole cord FA values decreased and ADC values increased in the rostral to caudal direction from C2 to C7. Between the individual white matter funicles no statistically significant difference for FA or ADC values was found. Both axial diffusivity and radial diffusivity of both lateral funicles differed significantly from those of the posterior funicle. Neither gender nor age correlated with any of the DTI metrics. Intra-observer variation of the measurements for whole cord FA and ADC showed almost perfect agreement with both ROI and tractography-based measurements. There was more variation in measurements of individual columns. Inter-observer agreement varied from moderate to strong for whole cord FA and ADC. Both ROI- and FT-based measurements are applicable

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.; Hosman, A.J.F.; Meent, H.; Hofmeijer, Jeannette; Vos, P.E.; Slooff, W.B.; Öner, F.C.; Coppes, M.H.; Peul, W.C.; Verbeek, A.L.M.

2013-01-01

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

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

A study of measurement of the spinal cord of cervical myelopathy with CT-myelography and forecast of operative result from the size of the spinal cord

International Nuclear Information System (INIS)

Oosawa, Yoshimitsu

1985-01-01

The antero-posterior (AP) and transverse (T) diameter and the T area of the spinal canal, dural canal, and spinal cord were measured using CT-myelography (CT-M) in 44 patients with cervical myelopathy (CM) and 20 control subjects. The AP diameter of these canals and cord and the T diameter of the spinal canal were smaller in the CM group than in the control group. Postoperative CT-M showed that the dural canal and spinal cord had an increase in the AP diameter and T area and a decrease in the T diameter. Preoperative symptoms were well correlated with the AP diameter and the T area of the spinal canal, dural canal, and spinal cord, and spinal cord compression. The symptoms tended to be milder with larger AT diameter and T area of the spinal canal, dural canal, and spinal cord and with smaller spinal cord compression and deformity. Functional damage was reversible in patients with slight spinal cord compression. Favorable operative outcome tended to be achieved when the preoperative AP diameter and T area of the spinal cord were ≥ 5 mm and ≥ 50 mm 2 , respectively. (Namekawa, K.)

Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

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Gupta, Deepak Kumar; Vaghani, Gaurang; Siddiqui, Saquib; Sawhney, Chhavi; Singh, Pankaj Kumar; Kumar, Atin; Kale, S. S.; Sharma, B. S.

2015-01-01

Aims: This study was done with the aim to compare the clinical outcome and patients’ quality of life between early versus delayed surgically treated patients of acute subaxial cervical spinal cord injury. The current study was based on the hypothesis that early surgical decompression and fixations in acute subaxial cervical spinal cord trauma is safe and is associated with improved outcome as compared to delayed surgical decompression. Materials and Methods: A total of 69 patients were recrui...

Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia.

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Heffez, Dan S; Ross, Ruth E; Shade-Zeldow, Yvonne; Kostas, Konstantinos; Shah, Sagar; Gottschalk, Robert; Elias, Dean A; Shepard, Alan; Leurgans, Sue E; Moore, Charity G

2004-10-01

While patients with fibromyalgia report symptoms consistent with cervical myelopathy, a detailed neurological evaluation is not routine. We sought to determine if patients with fibromyalgia manifest objective neurological signs of cervical myelopathy. Two hundred and seventy patients, 18 years and older, who carried the diagnosis of fibromyalgia but who had no previously recognized neurological disease underwent detailed clinical neurological and neuroradiological evaluation for the prevalence of objective evidence of cervical myelopathy and radiological evidence of cerebellar tonsillar herniation (Chiari 1 malformation) or cervical spinal canal stenosis. Patients were primarily women (87%), of mean age 44 years, who had been symptomatic for 8 years (standard deviation, 6.3 years). The predominant complaints were neck/back pain (95%), fatigue (95%), exertional fatigue (96%), cognitive impairment (92%), instability of gait (85%), grip weakness (83%), paresthesiae (80%), dizziness (71%) and numbness (69%). Eighty-eight percent of patients reported worsening symptoms with neck extension. The neurological examination was consistent with cervical myelopathy: upper thoracic spinothalamic sensory level (83%), hyperreflexia (64%), inversion of the radial periosteal reflex (57%), positive Romberg sign (28%), ankle clonus (25%), positive Hoffman sign (26%), impaired tandem walk (23%), dysmetria (15%) and dysdiadochokinesia (13%). MRI and contrast-enhanced CT imaging of the cervical spine revealed stenosis. The mean antero-posterior (AP) spinal canal diameter at C2/3, C3/4, C4/5, C5/6, C6/7 and C7/T1 was 13.5 mm, 11.8 mm, 11.5 mm, 10.4 mm, 11.3 mm and 14.5 mm respectively, (CT images). In 46% of patients, the AP spinal diameter at C5/6 measured 10 mm, or less, with the neck positioned in mild extension, i.e., clinically significant spinal canal stenosis. MRI of the brain revealed tonsillar ectopia >5 mm in 20% of patients (mean=7.1+/-1.8 mm), i.e., Chiari 1 malformation

Fast spin-echo MR assessment of patients with poor outcome following spinal cervical surgery

International Nuclear Information System (INIS)

Wu, W.; Thuomas, K.AA.; Hedlund, R.; Leszniewski, W.; Vavruch, L.

1996-01-01

The aim of the investigation was to evaluate poor outcome following spinal cervical surgery. A total of 146 consecutive patients operated with anterior discectomy and fusion (ADF) with the Cloward technique were investigated. Clinical notes, plain radiography, CT, and fast spin-echo (FSE) images were retrospectively evaluated. Some 30% of the patients had unsatisfactory clinical results within 12 months after surgery; 13% had initial improvement followed by deterioration of the preoperative symptoms, while 14.4% were not improved or worsened. Disc herniation and bony stenosis above, below, or at the fused level were the most common findings. In 45% of patients, surgery failed to decompress the spinal canal. In only 4 patients was no cause of remaining myelopathy and/or radiculopathy found. FSE demonstrated a large variety of pathological findings in the patients with poor clinical outcome after ADF. Postoperatively, patients with good clinical outcome had a lower incidence of pathological changes. FSE is considered the primary imaging modality for the cervical spine. However, CT is a useful complement in the axial projection to visualize bone changes. (orig.)

Lateral cervical puncture for cervical myelography

International Nuclear Information System (INIS)

Seol, Hae Young; Cha, Sang Hoon; Kim, Yoon Hwan; Suh, Won Hyuck

1985-01-01

Eleven cervical myelograms were performed by lateral cervical puncture using Metrizamide. So, following results were obtained: 1. Site of lateral cervical puncture; Posterior one third of bony cervical canal at C 1-2 level. 2. Advantages as compared with lumbar puncture for cervical myelograms; 1) Small amount of contrast media 2) Excellent image 3) Less position charge 4) Short time 5) Well visualization of superior margin of obstructive lesion in spinal canal 3. Cessation of lateral cervical puncture, when; 1) Pain during injection of contrast media 2) Localized collection of contrast media

Lateral cervical puncture for cervical myelography

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Seol, Hae Young; Cha, Sang Hoon; Kim, Yoon Hwan; Suh, Won Hyuck [Korea University College of Medicine, Seoul (Korea, Republic of)

1985-12-15

Eleven cervical myelograms were performed by lateral cervical puncture using Metrizamide. So, following results were obtained: 1. Site of lateral cervical puncture; Posterior one third of bony cervical canal at C 1-2 level. 2. Advantages as compared with lumbar puncture for cervical myelograms; 1) Small amount of contrast media 2) Excellent image 3) Less position charge 4) Short time 5) Well visualization of superior margin of obstructive lesion in spinal canal 3. Cessation of lateral cervical puncture, when; 1) Pain during injection of contrast media 2) Localized collection of contrast media.

Spinal cord injury triggers an intrinsic growth-promoting state in nociceptors.

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Bedi, Supinder S; Lago, Michael T; Masha, Luke I; Crook, Robyn J; Grill, Raymond J; Walters, Edgar T

2012-03-20

Although most investigations of the mechanisms underlying chronic pain after spinal cord injury (SCI) have examined the central nervous system (CNS), recent studies have shown that nociceptive primary afferent neurons display persistent hyperexcitability and spontaneous activity in their peripheral branches and somata in dorsal root ganglia (DRG) after SCI. This suggests that SCI-induced alterations of primary nociceptors contribute to central sensitization and chronic pain after SCI. Does SCI also promote growth of these neurons' fibers, as has been suggested in some reports? The present study tests the hypothesis that SCI induces an intrinsic growth-promoting state in DRG neurons. This was tested by dissociating DRG neurons 3 days or 1 month after spinal contusion injury at thoracic level T10 and measuring neuritic growth 1 day later. Neurons cultured 3 days after SCI exhibited longer neurites without increases in branching ("elongating growth"), compared to neurons from sham-treated or untreated (naïve) rats. Robust promotion of elongating growth was found in small and medium-sized neurons (but not large neurons) from lumbar (L3-L5) and thoracic ganglia immediately above (T9) and below (T10-T11) the contusion site, but not from cervical DRG. Elongating growth was also found in neurons immunoreactive to calcitonin gene-related peptide (CGRP), suggesting that some of the neurons exhibiting enhanced neuritic growth were nociceptors. The same measurements made on neurons dissociated 1 month after SCI revealed no evidence of elongating growth, although evidence for accelerated initiation of neurite outgrowth was found. Under certain conditions this transient growth-promoting state in nociceptors might be important for the development of chronic pain and hyperreflexia after SCI.

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.).

The correlation between evoked spinal cord potentials and magnetic resonance imaging before Surgery in cervical spondylotic myelopathy

International Nuclear Information System (INIS)

Akashi, Kosuke; Kanchiku, Tsukasa; Taguchi, Toshihiko; Kato, Yoshihiko; Imajo, Yasuaki; Suzuki, Hidenori

2010-01-01

The purpose of this study is to clarify the correlation between electrophysiological examination and MRI diagnosis. Twenty-four patients with cervical spondylotic myelopathy were examined with magnetic resonance imaging and evoked spinal cord potentials (ESCPs) before surgery. In all the patients, only the intervertebral level was symptomatic, as shown by ESCPs. ESCPs following median nerve stimulation (MN-ESCPs), transcranial electric stimulation (TCE-ESCPs), and spinal cord stimulation (Spinal-ECSPs) were recorded. The patients were grouped into two groups as follows: group A, all ESCPs were abnormal; group B, normal spinal cord stimulation. Spinal cord transverse area and compression ratio (central and 1/4-lateral anteroposterior diameter divided by transverse diameter) were measured on T1-weighted axial imaging, with abnormal ESCPs as indicators of spinal cord morphology. Central and 1/4-lateral compression ratio was significantly lower in group A. Spinal cord morphology of magnetic resonance imaging is useful for functional diagnosis. (author)

Acute intermittent hypoxia and rehabilitative training following cervical spinal injury alters neuronal hypoxia- and plasticity-associated protein expression.

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Hassan, Atiq; Arnold, Breanna M; Caine, Sally; Toosi, Behzad M; Verge, Valerie M K; Muir, Gillian D

2018-01-01

One of the most promising approaches to improve recovery after spinal cord injury (SCI) is the augmentation of spontaneously occurring plasticity in uninjured neural pathways. Acute intermittent hypoxia (AIH, brief exposures to reduced O2 levels alternating with normal O2 levels) initiates plasticity in respiratory systems and has been shown to improve recovery in respiratory and non-respiratory spinal systems after SCI in experimental animals and humans. Although the mechanism by which AIH elicits its effects after SCI are not well understood, AIH is known to alter protein expression in spinal neurons in uninjured animals. Here, we examine hypoxia- and plasticity-related protein expression using immunofluorescence in spinal neurons in SCI rats that were treated with AIH combined with motor training, a protocol which has been demonstrated to improve recovery of forelimb function in this lesion model. Specifically, we assessed protein expression in spinal neurons from animals with incomplete cervical SCI which were exposed to AIH treatment + motor training either for 1 or 7 days. AIH treatment consisted of 10 episodes of AIH: (5 min 11% O2: 5 min 21% O2) for 7 days beginning at 4 weeks post-SCI. Both 1 or 7 days of AIH treatment + motor training resulted in significantly increased expression of the transcription factor hypoxia-inducible factor-1α (HIF-1α) relative to normoxia-treated controls, in neurons both proximal (cervical) and remote (lumbar) to the SCI. All other markers examined were significantly elevated in the 7 day AIH + motor training group only, at both cervical and lumbar levels. These markers included vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), and phosphorylated and nonphosphorylated forms of the BDNF receptor tropomyosin-related kinase B (TrkB). In summary, AIH induces plasticity at the cellular level after SCI by altering the expression of major plasticity- and hypoxia-related proteins at spinal regions

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.

Cervical spinal canal stenosis first presenting after spinal cord injury due to minor trauma: An insight into the value of preventive decompression.

Science.gov (United States)

Shigematsu, Hideki; Cheung, Jason Pui Yin; Mak, Kin-Cheung; Bruzzone, Mauro; Luk, Keith D K

2017-01-01

Patients with pre-existing cervical spinal canal stenosis (CSCS) may have minimal or no symptoms. However, performing preventive decompression is controversial as the incidence of CSCS leading to severe cord injury is unknown. Hence, this study aims to revisit the threshold for surgery in "silent" CSCS by reviewing the neurologic outcomes of patients with undiagnosed CSCS who sustained a cervical spinal cord injury (CSCI). Two groups of subjects were recruited for analysis. Firstly, patients with trauma-induced CSCI without fracture or dislocation were included. Pre-existing CSCS was diagnosed by MRI measurements. The second group consisted of asymptomatic subjects recruited from the general population who also had MRIs performed. Canal sizes were compared between this control group and the patient group. Within the patient group, neurological assessments and outcomes by Frankel classification were performed in patients treated surgically or conservatively. 32 patients with CSCS were recruited. The mean spinal canal sagittal diameter (disc-level) of all CSCS cases was 5.3 ± 1.4 mm (1.3-8.2). In comparison, the diameter was 10.5 ± 1.7 mm (6.6-14.6) in the 47 asymptomatic individuals recruited from the general population. Decompression was performed in 17 patients and conservative treatment in 15. Mean follow-up was 19.3 ± 17.0 months (6-84). At the final follow-up, 3 patients (9.3%) returned to their pre-injury Frankel grade, whereas 26 patients (83.3%) lost one or more neurological grade. Three patients (9.3%) died. Majority of patients with "silent" CSCS who sustained cervical cord injuries did not return to their pre-injury neurological status. All of these subjects have pre-existing canal stenosis hence the risk of cord injury. Given the poor neurological outcome of CSCS, a lower threshold for surgery could be indicated to avoid these disastrous injuries. However, before making any conclusive recommendation we must first identify the prevalence of

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.

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

2018-05-01

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.

Comparison of MRI pulse sequences for investigation of lesions of the cervical spinal cord

International Nuclear Information System (INIS)

Campi, A.; Pontesilli, S.; Gerevini, S.; Scotti, G.

2000-01-01

Small spinal cord lesions, even if clinically significant, can be due to the low sensitivity of some pulse sequences. We compared T2-weighted fast (FSE), and conventional (CSE) spin-echo and short-tau inversion-recovery (STIR)-FSE overlooked on MRI sequences to evaluate their sensitivity to and specificity for lesions of different types. We compared the three sequences in MRI of 57 patients with cervical spinal symptoms. The image sets were assessed by two of us individually for final diagnosis, lesion detectability and image quality. Both readers arrived at the same final diagnoses with all sequences, differentiating four groups of patients. Group 1 (30 patients, 53 %), with a final diagnosis of multiple sclerosis (MS). Demyelinating lesions were better seen on STIR-FSE images, on which the number of lesions was significantly higher than on FSE, while the FSE and CSE images showed approximately equal numbers of lesions; additional lesions were found in 9 patients. The contrast-to-noise ratio (CNR) of 17 demyelinating lesions was significantly higher on STIR-FSE images than with the other sequences. Group 2, 19 patients (33 %) with cervical pain, 15 of whom had disc protrusion or herniation: herniated discs were equally well delineated with all sequences, with better myelographic effect on FSE. In five patients with intrinsic spinal cord abnormalities, the conspicuity and demarcation of the lesions were similar with STIR-FSE and FSE. Group 3, 4 patients (7 %) with acute myelopathy of unknown aetiology. In two patients, STIR-FSE gave better demarcation of lesions and in one a questionable additional lesions. Group 4, 4 patients (7 %) with miscellaneous final diagnoses. STIR-FSE had high sensitivity to demyelinating lesions, can be considered quite specific and should be included in spinal MRI for assessment of suspected demyelinating disease. (orig.)

The morphometric analysis of the intervertebral foramen and the spinal nerve root in the cervical spine

International Nuclear Information System (INIS)

Yoshida, Yasuo

2008-01-01

The purpose of this study was to clarify the onset of cervical myelopathy and cervical spondylotic radiculopathy as well as what influence the anatomy of the cervical spine and cervical nerves have on their onset and occurrence of various types of disease state. We conducted imaging and morphological measurements on specimens of cervical spine of Japanese people, focusing attention on the running of intervertebral foramen and dorsal nerve rootlets of the cervical spine. The subjects were cervical spine specimens from 12 cadavers (7 males and 5 females, age at the time of death ranged from 48 to 93 years with a mean of 71 years) obtained at Showa University School of Dentistry in 2005 and 2006. Specimens were prepared by removing the atlas through the 1st thoracic vertebra from the cadavers, then resecting the soft tissue such as muscles to expose the cervical spine in whole circumference. The removed cervical spine specimens, from 1st to 7th cervical spines, were imaged by volume scan of radiographic helical CT at 0.6 mm spatial resolution, and their images were stored as Digital Imaging and Communications in Medicine (DICOM) data. Image measurement on the vertebral body, vertebral foramen, and intervertebral foramen was conducted based on DICOM data. Furthermore, macroscopic observation and measurement were conducted on the dorsal nerve rootlets of cervical spine specimens. The image measurement of cervical spine specimens showed that the intervertebral foramen at C5/6 was the narrowest, followed by C3/4, C4/5, C6/7, and C2/3, respecting. With regard to angles in the frontal section and horizontal section of the groove for the spinal nerve, there was no significant difference in the angle between the right and the left. In the frontal section, the angle was about 63deg at C3, about 57deg at C4, about 52deg at C5, and about 55deg at C6, showing a significantly acute angle at C5, while in the horizontal section, it was about 54deg at C3, about 59deg at C4, about 63

Myocardial contusion following nonfatal blunt chest trauma

International Nuclear Information System (INIS)

Kumar, S.A.; Puri, V.K.; Mittal, V.K.; Cortez, J.

1983-01-01

Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. Myocardial scan was positive in seven of eight patients (87.5%). CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma

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. Copyright 2001 Academic Press.

Activation of Central Pattern Generator for Respiration Following Complete High Cervical Spinal Cord Interruption

Science.gov (United States)

2017-09-01

hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and...neurotransmitter profile (GABAa- and Glycine-ergic). Epidural stimulation applied at frequencies 100-300 Hz to the area of phrenic nucleus location...C4 cervical segment) in spinal (C1-transected) rats induced time -frequency depended facilitation of phrenic nerve activity and was able to maintain

Sensory Loss Mimicking Cauda Equina Syndrome due to Cervical Spinal Lesion in a Patient with Clinically Isolated Syndrome

OpenAIRE

Vinceti, Giulia; Zini, Andrea; Nichelli, Paolo; Mandrioli, Jessica

2012-01-01

We describe the case of a 39-year-old woman with signs and symptoms suggesting cauda equina syndrome. Lumbosacral magnetic resonance imaging (MRI) demonstrated no lesion at this level, while cervical MRI showed a T2-hyperintense lesion in the middle-right anterolateral region of the cervical spinal cord, which may explain the symptoms by involving the anterior spinothalamic tract. We suggest that in cases with cauda equina syndrome presentation and normal lumbosacral MRI, a cervicodorsal lesi...

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

techniques. We calculate the diffusion tensor and the persistent angular structure (PAS), a multi-fiber reconstruction technique, from high quality post mortem data of a perfusion-fixed vervet monkey cervical spinal cord sample and simulated crossing fiber data. Our results show that (i) cylindrical geometry...

Increased expression of vascular endothelial growth factor attenuates contusion necrosis without influencing contusion edema after traumatic brain injury in rats.

Science.gov (United States)

Tado, Masahiro; Mori, Tatsuro; Fukushima, Masamichi; Oshima, Hideki; Maeda, Takeshi; Yoshino, Atsuo; Aizawa, Shin; Katayama, Yoichi

2014-04-01

To clarify the role of vascular endothelial growth factor (VEGF) in the formation of contusion edema and necrosis after traumatic brain injury, we examined the time course of changes in the VEGF expression (enzyme-linked immunosorbent assay), cerebrovascular permeability (extravasation of Evans blue), and water content (dry-wet weight method) of the contused brain tissue in a cortical impact injury model using rats. In addition, we tested the effects of administration of bevacizumab (VEGF monoclonal antibody) on changes in the cerebrovascular permeability and water content of the contused brain tissue, as well as the neurological deficits (rota rod test) and volume of contusion necrosis. Increased VEGF expression was maximal at 72 h after injury (pnecrosis at 21 days (pnecrosis. This is probably because of an increased angiogenesis and improved microcirculation in the areas surrounding the core of contusion.

Reproducibility, temporal stability, and functional correlation of diffusion MR measurements within the spinal cord in patients with asymptomatic cervical stenosis or cervical myelopathy.

Science.gov (United States)

Ellingson, Benjamin M; Salamon, Noriko; Woodworth, Davis C; Yokota, Hajime; Holly, Langston T

2018-05-01

OBJECTIVE The purpose of this study was to quantify the reproducibility, temporal stability, and functional correlation of diffusion MR characteristics in the spinal cord in patients with cervical stenosis with or without myelopathy. The association between longitudinal diffusion tensor imaging (DTI) measurements and serial neurological function assessment was explored at both the group and individual level. METHODS Sixty-six nonoperatively treated patients with cervical stenosis were prospectively followed (3 months to > 5 years) using synchronous serial MRI and functional outcome assessment. A total of 183 separate MRI examinations were performed, separated by at least 3 months, and each patient had a minimum of 2 MRI scans (range 2-5 scans). Anatomical and DTI measurements were performed within the spinal cord at the C1-2 region as well as at the area of highest compression. Coefficients of variance (COVs) were compared across measurements in both reference tissue and areas of compression for anatomical measurements, fractional anisotropy (FA), and mean diffusivity (MD). The correlation between diffusion MR measures at the site of compression and evaluations of neurological function assessed using the modified Japanese Orthopaedic Association (mJOA) scale at multiple time points was evaluated. RESULTS The COVs for anatomical measurements (Torg ratio and canal diameter) were between 7% and 10%. The median COV for FA measurements at the site of compression was 9%, and for reference tissue at C1-2 it was 6%. The median COV for MD at the site of compression was approximately 12%, and for reference tissue at C1-2 it was 10%. The FA and MD measurements of C1-2 averaged 0.61 and 0.91 μm 2 /msec, respectively, whereas the FA and MD measurements at the site of compression averaged 0.51 and 1.26 μm 2 /msec, respectively. Both FA (slope = 0.037; R 2 = 0.3281, p slope = -0.074; R 2 = 0.1101, p = 0.0084) were significantly correlated with the mJOA score. The FA decreased

Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion

Science.gov (United States)

Huang, H.; Nightingale, R. W.

2018-01-01

Objectives Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. Methods A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Results Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Conclusion Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone

MRI Prognostication Factors in the Setting of Cervical Spinal Cord Injury Secondary to Trauma.

Science.gov (United States)

Martínez-Pérez, Rafael; Cepeda, Santiago; Paredes, Igor; Alen, Jose F; Lagares, Alfonso

2017-05-01

Several studies have looked for an association between radiologic findings and neurologic outcome after cervical trauma. In the current literature, there is a paucity of evidence proving the prognostic role of soft tissue damage or bony integrity. Our objective is to determine radiologic findings related to neurologic prognosis in patients after incomplete acute traumatic cervical spinal cord injury, regardless of initial neurologic examination results. We retrospectively reviewed patients with acute traumatic cervical spinal cord injury who had a magnetic resonance imaging (MRI) performed within the first 96 hours. Clinical and epidemiologic data were recorded from the medical records along with several radiologic findings from the initial computed tomographic scan and MRI. Data were analyzed using a non-parametric test. Significant prognostic factors were analyzed through a stepwise multivariable logistic regression, adjusted by neurologic status at baseline. The receiver-operating characteristic curve was used to test the discriminative capacity of the model. Eighty-six patients (68 males and 18 females) were included for the analysis. Mean age was 49 years. Ligamentum flavum injury, intramedullary edema larger than 36 mm, and facet dislocation were demonstrated to be associated with a lack of neurologic improvement at follow-up. Multivariable analysis showed that edema larger than 36 mm and facet dislocation were strong predictors of clinical outcome, regardless of the initial neurologic examination result. Early MRI has an intrinsic prognostic value. Ligamentous injury and larger edema are strong predicting factors of a bad neurologic outcome at long-term follow-up. Copyright © 2017 Elsevier Inc. All rights reserved.

Local delivery of thyroid hormone enhances oligodendrogenesis and myelination after spinal cord injury

Science.gov (United States)

Shultz, Robert B.; Wang, Zhicheng; Nong, Jia; Zhang, Zhiling; Zhong, Yinghui

2017-06-01

Objective. Traumatic spinal cord injury (SCI) causes apoptosis of myelin-forming oligodendrocytes (OLs) and demyelination of surviving axons, resulting in conduction failure. Remyelination of surviving denuded axons provides a promising therapeutic target for spinal cord repair. While cell transplantation has demonstrated efficacy in promoting remyelination and functional recovery, the lack of ideal cell sources presents a major obstacle to clinical application. The adult spinal cord contains oligodendrocyte precursor cells and multipotent neural stem/progenitor cells that have the capacity to differentiate into mature, myelinating OLs. However, endogenous oligodendrogenesis and remyelination processes are limited by the upregulation of remyelination-inhibitory molecules in the post-injury microenvironment. Multiple growth factors/molecules have been shown to promote OL differentiation and myelination. Approach. In this study we screened these therapeutics and found that 3, 3‧, 5-triiodothyronine (T3) is the most effective in promoting oligodendrogenesis and OL maturation in vitro. However, systemic administration of T3 to achieve therapeutic doses in the injured spinal cord is likely to induce hyperthyroidism, resulting in serious side effects. Main results. In this study we developed a novel hydrogel-based drug delivery system for local delivery of T3 to the injury site without eliciting systemic toxicity. Significance. Using a clinically relevant cervical contusion injury model, we demonstrate that local delivery of T3 at doses comparable to safe human doses promoted new mature OL formation and myelination after SCI.

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.

Influence of the Number of Predicted Words on Text Input Speed in Participants With Cervical Spinal Cord Injury.

Science.gov (United States)

Pouplin, Samuel; Roche, Nicolas; Vaugier, Isabelle; Jacob, Antoine; Figere, Marjorie; Pottier, Sandra; Antoine, Jean-Yves; Bensmail, Djamel

2016-02-01

To determine whether the number of words displayed in the word prediction software (WPS) list affects text input speed (TIS) in people with cervical spinal cord injury (SCI), and whether any influence is dependent on the level of the lesion. A cross-sectional trial. A rehabilitation center. Persons with cervical SCI (N=45). Lesion level was high (C4 and C5, American Spinal Injury Association [ASIA] grade A or B) for 15 participants (high-lesion group) and low (between C6 and C8, ASIA grade A or B) for 30 participants (low-lesion group). TIS was evaluated during four 10-minute copying tasks: (1) without WPS (Without); (2) with a display of 3 predicted words (3Words); (3) with a display of 6 predicted words (6Words); and (4) with a display of 8 predicted words (8Words). During the 4 copying tasks, TIS was measured objectively (characters per minute, number of errors) and subjectively through subject report (fatigue, perception of speed, cognitive load, satisfaction). For participants with low-cervical SCI, TIS without WPS was faster than with WPS, regardless of the number of words displayed (Pwords displayed in a word prediction list on TIS; however, perception of TIS differed according to lesion level. For persons with low-cervical SCI, a small number of words should be displayed, or WPS should not be used at all. For persons with high-cervical SCI, a larger number of words displayed increases the comfort of use of WPS. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Restoring tactile awareness through the rubber hand illusion in cervical spinal cord injury.

Science.gov (United States)

Lenggenhager, Bigna; Scivoletto, Giorgio; Molinari, Marco; Pazzaglia, Mariella

2013-10-01

Bodily sensations are an important component of corporeal awareness. Spinal cord injury can leave affected body parts insentient and unmoving, leading to specific disturbances in the mental representation of one's own body and the sense of self. Here, we explored how illusions induced by multisensory stimulation influence immediate sensory signals and tactile awareness in patients with spinal cord injuries. The rubber hand illusion paradigm was applied to 2 patients with chronic and complete spinal cord injury of the sixth cervical spine, with severe somatosensory impairments in 2 of 5 fingers. Both patients experienced a strong illusion of ownership of the rubber hand during synchronous, but not asynchronous, stroking. They also, spontaneously reported basic tactile sensations in their previously numb fingers. Tactile awareness from seeing the rubber hand was enhanced by progressively increasing the stimulation duration. Multisensory illusions directly and specifically modulate the reemergence of sensory memories and enhance tactile sensation, despite (or as a result of) prior deafferentation. When sensory inputs are lost, and are later illusorily regained, the brain updates a coherent body image even several years after the body has become permanently unable to feel. This particular example of neural plasticity represents a significant opportunity to strengthen the sense of the self and the feelings of embodiment in patients with spinal cord injury.

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. Copyright © 2015 Elsevier B.V. All rights reserved.

Management of Penetrating Spinal Cord Injuries in a Non Spinal ...

African Journals Online (AJOL)

Management of Penetrating Spinal Cord Injuries in a Non Spinal Centre: Experience at Enugu, Nigeria. ... The thoracic spine{9(41%)}was most often involved. ... Five (23%) patients with injury at cervical level died from respiratory failure.

A novel device for studying weight supported, quadrupedal overground locomotion in spinal cord injured rats.

Science.gov (United States)

Hamlin, Marvin; Traughber, Terence; Reinkensmeyer, David J; de Leon, Ray D

2015-05-15

Providing weight support facilitates locomotion in spinal cord injured animals. To control weight support, robotic systems have been developed for treadmill stepping and more recently for overground walking. We developed a novel device, the body weight supported ambulatory rodent trainer (i.e. BART). It has a small pneumatic cylinder that moves along a linear track above the rat. When air is supplied to the cylinder, the rats are lifted as they perform overground walking. We tested the BART device in rats that received a moderate spinal cord contusion injury and in normal rats. Locomotor training with the BART device was not performed. All of the rats learned to walk in the BART device. In the contused rats, significantly greater paw dragging and dorsal stepping occurred in the hindlimbs compared to normal. Providing weight support significantly raised hip position and significantly reduced locomotor deficits. Hindlimb stepping was tightly coupled to forelimb stepping but only when the contused rats stepped without weight support. Three weeks after the contused rats received a complete spinal cord transection, significantly fewer hindlimb steps were performed. Relative to rodent robotic systems, the BART device is a simpler system for studying overground locomotion. The BART device lacks sophisticated control and sensing capability, but it can be assembled relatively easily and cheaply. These findings suggest that the BART device is a useful tool for assessing quadrupedal, overground locomotion which is a more natural form of locomotion relative to treadmill locomotion. Published by Elsevier B.V.

Remyelination of the injured spinal cord

Science.gov (United States)

Sasaki, Masanori; Li, Bingcang; Lankford, Karen L.; Radtke, Christine; Kocsis, Jeffery D.

2008-01-01

Contusive spinal cord injury (SCI) can result in necrosis of the spinal cord, but often long white matter tracts outside of the central necrotic core are demyelinated. One experimental strategy to improve functional outcome following SCI is to transplant myelin-forming cells to remyelinate these axons and improve conduction. This review focuses on transplantation studies using olfactory ensheathing cell (OEC) to improve functional outcome in experimental models of SCI and demyelination. The biology of the OEC, and recent experimental research and clinical studies using OECs as a potential cell therapy candidate are discussed. PMID:17618995

Pulmonary Contusion in Mechanically Ventilated Subjects After Severe Trauma.

Science.gov (United States)

Dhar, Sakshi Mathur; Breite, Matthew D; Barnes, Stephen L; Quick, Jacob A

2018-03-13

Pulmonary contusions are thought to worsen outcomes. We aimed to evaluate the effects of pulmonary contusion on mechanically ventilated trauma subjects with severe thoracic injuries and hypothesized that contusion would not increase morbidity. We conducted a single-center, retrospective review of 163 severely injured trauma subjects (injury severity score ≥ 15) with severe thoracic injury (chest abbreviated injury score ≥ 3), who required mechanical ventilation for >24 h at a verified Level 1 trauma center. Subject data were analyzed for those with radiographic documentation of pulmonary contusion and those without. Statistical analysis was performed to determine the effects of coexisting pulmonary contusion in severe thoracic trauma. Pulmonary contusion was present in 91 subjects (55.8%), whereas 72 (44.2%) did not have pulmonary contusions. Mean chest abbreviated injury score (3.54 vs 3.47, P = .53) and mean injury severity score (32.6 vs 30.2, P = .12) were similar. There was no difference in mortality (11 [12.1%] vs 9 [12.5%], P > .99) or length of stay (16.29 d vs 17.29 d, P = .60). Frequency of ventilator-associated pneumonia was comparable (43 [47.3%] vs 32 [44.4%], P = .75). Subjects with contusions were more likely to grow methicillin-sensitive Staphylococcus aureus in culture (33 vs 10, P = .004) as opposed to Pseudomonas aeruginosa in culture (6 vs 13, P = .003). Overall, no significant differences were noted in mortality, length of stay, or pneumonia rates between severely injured trauma subjects with and without pulmonary contusions. Copyright © 2018 by Daedalus Enterprises.

Brain Contusion and Cervical Fracture in a Professional Boxer.

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Jordan, Barry D.; And Others

1988-01-01

This case study of an injury sustained by a 22-year old boxer who was knocked out in the ring demonstrates two aspects of medical care for boxers: the potential for cervical spine fracture and the importance of ringside emergency medical services. The injury, diagnosis, and treatment are discussed. (Author/JL)

"White Cord Syndrome" of Acute Hemiparesis After Posterior Cervical Decompression and Fusion for Chronic Cervical Stenosis.

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Antwi, Prince; Grant, Ryan; Kuzmik, Gregory; Abbed, Khalid

2018-05-01

"White cord syndrome" is a very rare condition thought to be due to acute reperfusion of chronically ischemic areas of the spinal cord. Its hallmark is the presence of intramedullary hyperintense signal on T2-weighted magnetic resonance imaging sequences in a patient with unexplained neurologic deficits following spinal cord decompression surgery. The syndrome is rare and has been reported previously in 2 patients following anterior cervical decompression and fusion. We report an additional case of this complication. A 68-year-old man developed acute left-sided hemiparesis after posterior cervical decompression and fusion for cervical spondylotic myelopathy. The patient improved with high-dose steroid therapy. The rare white cord syndrome following either anterior cervical decompression and fusion or posterior cervical decompression and fusion may be due to ischemic-reperfusion injury sustained by chronically compressed parts of the spinal cord. In previous reports, patients have improved following steroid therapy and acute rehabilitation. Copyright © 2018 Elsevier Inc. All rights reserved.

Experimental spinal cord trauma: a review of mechanically induced spinal cord injury in rat models.

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Abdullahi, Dauda; Annuar, Azlina Ahmad; Mohamad, Masro; Aziz, Izzuddin; Sanusi, Junedah

2017-01-01

It has been shown that animal spinal cord compression (using methods such as clips, balloons, spinal cord strapping, or calibrated forceps) mimics the persistent spinal canal occlusion that is common in human spinal cord injury (SCI). These methods can be used to investigate the effects of compression or to know the optimal timing of decompression (as duration of compression can affect the outcome of pathology) in acute SCI. Compression models involve prolonged cord compression and are distinct from contusion models, which apply only transient force to inflict an acute injury to the spinal cord. While the use of forceps to compress the spinal cord is a common choice due to it being inexpensive, it has not been critically assessed against the other methods to determine whether it is the best method to use. To date, there is no available review specifically focused on the current compression methods of inducing SCI in rats; thus, we performed a systematic and comprehensive publication search to identify studies on experimental spinalization in rat models, and this review discusses the advantages and limitations of each method.

Chronological observation in early radiation myelopathy of the cervical spinal cord

International Nuclear Information System (INIS)

Hirota, Saeko; Yoshida, Shoji; Soejima, Toshinori

1993-01-01

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)

Cervical spine disease may result in a negative lumbar spinal drainage trial in normal pressure hydrocephalus: case report.

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Komotar, Ricardo J; Zacharia, Brad E; Mocco, J; Kaiser, Michael G; Frucht, Stephen J; McKhann, Guy M

2008-10-01

In this case report, we present a patient with normal pressure hydrocephalus in whom a lumbar drainage trial yielded a false-negative result secondary to cervical spondylosis. An 80-year-old woman presented with classic symptoms of normal pressure hydrocephalus as well as evidence of cervical myelopathy. Magnetic resonance imaging of the brain and spine showed enlarged ventricles and single-level cervical canal narrowing. An initial lumbar drainage trial was performed, which revealed negative results. The patient then underwent cervical decompression and fusion. Despite this procedure, the patient's symptoms continued to worsen. A repeat lumbar drainage trial was performed with positive results. Subsequently, a ventriculoperitoneal shunt was placed, resulting in significant improvement of her symptoms. This case report illustrates how altered cerebrospinal fluid flow dynamics may impact the accuracy of the lumbar spinal drainage trial in patients with normal pressure hydrocephalus.

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

International Nuclear Information System (INIS)

Stracke, C.P.; Schoth, F.; Moeller-Hartmann, W.; Krings, T.; Pettersson, L.G.

2005-01-01

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.)

Organization of projections from the spinal trigeminal subnucleus oralis to the spinal cord in the rat: a neuroanatomical substrate for reciprocal orofacial-cervical interactions.

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Devoize, Laurent; Doméjean, Sophie; Melin, Céline; Raboisson, Patrick; Artola, Alain; Dallel, Radhouane

2010-07-09

The organization of efferent projections from the spinal trigeminal nucleus oralis (Sp5O) to the spinal cord in the rat was studied using the anterograde tracer Phaseolus vulgaris leucoagglutinin. Sp5O projections to the spinal cord are restricted to the cervical cord. No labeled terminal can be detected in the thoracic and lumbar cord. The organization of these projections happens to critically depend on the dorso-ventral location of the injection site. On the one hand, the dorsal part of the Sp5O projects to the medial part of the dorsal horn (laminae III-V) at the C1 level, on the ipsilateral side, and to the ventral horn, on both sides but mainly on the ipsilateral one. Ipsilateral labeled terminals are distributed throughout laminae VII to IX but tend to cluster around the dorso-medial motor nuclei, especially at C3-C5 levels. Within the contralateral ventral horn, label terminals are found particularly in the region of the ventro-medial motor nucleus. This projection extends as far caudally as C3 or C4 level. On the other hand, the ventral part of the Sp5O projects to the lateral part of the dorsal horn (laminae III-V) at the C1 level, on the ipsilateral side, and to the ventral horn, on both sides but mainly on the contralateral one. Contralateral labeled terminals are distributed within the region of the dorso- and ventro-medial motor nuclei at C1-C4 levels whereas they are restricted to the dorso-medial motor nucleus at C5-C8 levels. These findings suggest that Sp5O is involved in the coordination of neck movements and in the modulation of incoming sensory information at the cervical spinal cord. Copyright (c) 2010 Elsevier B.V. All rights reserved.

[Cervical spine trauma].

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Yilmaz, U; Hellen, P

2016-08-01

In the emergency department 65 % of spinal injuries and 2-5 % of blunt force injuries involve the cervical spine. Of these injuries approximately 50 % involve C5 and/or C6 and 30 % involve C2. Older patients tend to have higher spinal injuries and younger patients tend to have lower injuries. The anatomical and development-related characteristics of the pediatric spine as well as degenerative and comorbid pathological changes of the spine in the elderly can make the radiological evaluation of spinal injuries difficult with respect to possible trauma sequelae in young and old patients. Two different North American studies have investigated clinical criteria to rule out cervical spine injuries with sufficient certainty and without using imaging. Imaging of cervical trauma should be performed when injuries cannot be clinically excluded according to evidence-based criteria. Degenerative changes and anatomical differences have to be taken into account in the evaluation of imaging of elderly and pediatric patients.

MR imaging of acute cervical spine injuries

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Kim, Kyu Hwa; Lee, Jung Hyung; Joo, Yang Goo [School of Medicine, Keimyung University, Daegu (Korea, Republic of)

1995-01-15

To describe magnetic resonance (MR) findings of the patients with acute cervical spinal injury and to assess the usefulness of the MR imagings. We retrospectively reviewed the MR images of 32 patients with acute cervical spinal injury. MR images were obtained with a 2.0 T superconductive MR imaging units (Spectro-20000, Gold-Star, Seoul), using spin-echo and gradient-echo technique. Most of patients were in their 3rd-4th decades and motor vehicle accident was the most frequent cause of acute cervical trauma. We assessed the MR findings with respect to the spinal cord, ligaments, paravertebral soft tissues, intervertebral disk, and bony spine. Spinal cord injury was the most common (65%), where cord swelling, edema, and/or hematoma were demonstrated most frequently at C5-6 level. Traumatic intervertebral disk herniations were the second most common (62.5%) and frequently occurred at the lower cervical levels, mostly at C5-6. Paravertebral soft tissue injury, vertebral body fracture, bone marrow edema and displacement were also well shown on MR images. MR imaging appears to be essential for the evaluation of traumatic disk herniations, spinal cord abnormalities, and injury of paravertebral soft tissue in the acute injury of the cervical spine.

MR imaging of acute cervical spine injuries

International Nuclear Information System (INIS)

Kim, Kyu Hwa; Lee, Jung Hyung; Joo, Yang Goo

1995-01-01

To describe magnetic resonance (MR) findings of the patients with acute cervical spinal injury and to assess the usefulness of the MR imagings. We retrospectively reviewed the MR images of 32 patients with acute cervical spinal injury. MR images were obtained with a 2.0 T superconductive MR imaging units (Spectro-20000, Gold-Star, Seoul), using spin-echo and gradient-echo technique. Most of patients were in their 3rd-4th decades and motor vehicle accident was the most frequent cause of acute cervical trauma. We assessed the MR findings with respect to the spinal cord, ligaments, paravertebral soft tissues, intervertebral disk, and bony spine. Spinal cord injury was the most common (65%), where cord swelling, edema, and/or hematoma were demonstrated most frequently at C5-6 level. Traumatic intervertebral disk herniations were the second most common (62.5%) and frequently occurred at the lower cervical levels, mostly at C5-6. Paravertebral soft tissue injury, vertebral body fracture, bone marrow edema and displacement were also well shown on MR images. MR imaging appears to be essential for the evaluation of traumatic disk herniations, spinal cord abnormalities, and injury of paravertebral soft tissue in the acute injury of the cervical spine

Age-related changes of the spinal cord: A biomechanical study.

Science.gov (United States)

Okazaki, Tomoya; Kanchiku, Tsukasa; Nishida, Norihiro; Ichihara, Kazuhiko; Sakuramoto, Itsuo; Ohgi, Junji; Funaba, Masahiro; Imajo, Yasuaki; Suzuki, Hidenori; Chen, Xian; Taguchi, Toshihiko

2018-03-01

Although it is known that aging plays an important role in the incidence and progression of cervical spondylotic myelopathy (CSM), the underlying mechanism is unclear. Studies that used fresh bovine cervical spinal cord report the gray matter of the cervical spinal cord as being more rigid and fragile than the white matter. However, there are no reports regarding the association between aging an tensile and Finite Element Method (FEM). Therefore, FEM was used based on the data pertaining to the mechanical features of older bovine cervical spinal cord to explain the pathogenesis of CSM in elderly patients. Tensile tests were conducted for white and gray matter separately in young and old bovine cervical spinal cords, and compared with their respective mechanical features. Based on the data obtained, FEM analysis was further performed, which included static and dynamic factors to describe the internal stress distribution changes of the spinal cord. These results demonstrated that the mechanical strength of young bovine spinal cords is different from that of old bovine spinal cords. The gray matter of the older spinal cord was significantly softer and more resistant to rupture compared with that of younger spinal cords (Pspinal cords in response to similar compression, when compared with young spinal cords. These results demonstrate that in analyzing the response of the spinal cord to compression, the age of patients is an important factor to be considered, in addition to the degree of compression, compression speed and parts of the spinal cord compression factor.

Radiation response of the rat cervical spinal cord after irradiation at different ages: Tolerance, latency and pathology

International Nuclear Information System (INIS)

Ruifrok, A.C.C.; Van Der Kogel, A.J.; Stephens, L.C.

1994-01-01

Investigation of the age dependent single-dose radiation tolerance, latency to radiation myelopathy, and the histopathological changes after irradiation of the rat cervical spinal cord is presented. Rats were irradiated with graded single doses of 4 MV photons to the cervical spinal cord. When the rats showed definite signs of paresis of the forelegs, they were killed and processed for histological examination. The radiation dose resulting in paresis due to white matter damage in 50% of the animals (ED 50 ) after single dose irradiation was about 21.5 Gy at all ages ≥ 2 weeks. Only the Ed 50 at 1 week was significantly lower. The latency to the development of paresis clearly changed with the age at irradiation, from about 2 weeks after irradiation at 1 week to 6-8 months after irradiation at age ≥ 8 weeks. The white matter damage was similar in all symptomatic animals studied. The most prominent were areas with diffuse demyelination and swollen axons, often with focal necrosis, accompanied by glial reaction. This was observed in all symptomatic animals, irrespective of the age at irradiation. Expression of vascular damage appeared to depend on the age at irradiation. Although the latency to myelopathy is clearly age dependent, single dose tolerance is not age dependent at age ≥ 2 weeks in the rat cervical spinal cord. The white matter damage is similar in all symptomatic animals studied, but the vasculopathies appear to be influenced by the age at irradiation. It is concluded that white matter damage and vascular damage are separate phenomena contributing to the development of radiation myelopathy, expression of which may depend on the radiation dose applied and the age at irradiation. 28 refs., 5 figs., 3 tabs

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.

Neuroradiology of the spinal canal

International Nuclear Information System (INIS)

Lehmann, R.; Molsen, H.P.

1985-01-01

Radiodiagnostics of the vertebral column and of the spinal cord under normal conditions and under different pathological alterations are elaborated. Especially cervical and thoracal myelography, lumbosacral myeloradiculography, spinal arteriography and phlebography as well as spinal computerized tomography are discussed in detail

MRI findings in posterior disc prolapse associated with cervical fracture dislocation

International Nuclear Information System (INIS)

Maeda, Go; Shiba, Keiichiro; Ueta, Takayoshi; Shirasawa, Kenzo; Ohta, Hideki; Mori, Eiji; Rikimaru, Shunichi; Hida, Shinichi; Tokunaga, Masami

1994-01-01

Although disc injury is common in cervical spinal fractures the mechanism of disc herniation in cervical fracture dislocations is not known. This study evaluated the pathogenesis of disc hernia in cervical fracture dislocations. Twenty-two patients who underwent anterior and posterior spinal fixation were studied. Findings of preoperative magnetic resonance imaging (MRI) were compared with surgical findings. During surgery, cervical disk hernia were found in six patients (27 %), and the MRI finding of these patients were evaluated in detail. We concluded that the characteristic MRI findings of cervical disc hernia are as follows: 1) discontinuity of injured disc, 2) anterior indentation of spinal cord at the site of dislocated vertebral body, and 3) signal irregularity at the site of interspace between dislocated vertebral body and spinal cord. (author)

MRI findings in posterior disc prolapse associated with cervical fracture dislocation

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Maeda, Go; Shiba, Keiichiro; Ueta, Takayoshi; Shirasawa, Kenzo; Ohta, Hideki; Mori, Eiji; Rikimaru, Shunichi; Hida, Shinichi; Tokunaga, Masami (Spinal Injuries Center, Fukuoka (Japan))

1994-03-01

Although disc injury is common in cervical spinal fractures the mechanism of disc herniation in cervical fracture dislocations is not known. This study evaluated the pathogenesis of disc hernia in cervical fracture dislocations. Twenty-two patients who underwent anterior and posterior spinal fixation were studied. Findings of preoperative magnetic resonance imaging (MRI) were compared with surgical findings. During surgery, cervical disk hernia were found in six patients (27 %), and the MRI finding of these patients were evaluated in detail. We concluded that the characteristic MRI findings of cervical disc hernia are as follows: (1) discontinuity of injured disc, (2) anterior indentation of spinal cord at the site of dislocated vertebral body, and (3) signal irregularity at the site of interspace between dislocated vertebral body and spinal cord. (author).

Safety of intramedullary autologous peripheral nerve grafts for post-rehabilitated complete motor spinal cord injuries: a phase I study.

Directory of Open Access Journals (Sweden)

Nazi Derakhshanrad

2013-12-01

Full Text Available Many experimental studies have reported behavioral improvement after transplantation of peripheral nerve tissue into the contused spinal cord, even in large animals. The safety of this treatment in human remains unknown. In this translational phase 1 study, safety of peripheral nerve grafting for chronic spinal cord injuries and possible outcomes are being reported. Twelve complete motor spinal cord injury patients, who had finished their rehabilitation program, were enrolled. There were 4 thoracic and 8 cervical cases. Patients underwent sural nerve preconditioning in the calf, followed 1 week later, by intramedullary transplantation of the harvested nerve fascicles. The patients were followed up for potential complications periodically, and final assessment by American Spinal Injury association (ASIA and Spinal Cord Independence Measure (SCIM III were reported after 2 years of follow-up. The median duration of the spinal cord injury was 31 months. At two years of follow up, out of 7 cases with ASIA Impairment Scale (AIS A, 4(57.1% cases improved to AIS B and 1 (14.3% case became AIS C. There were 1 patient with transient increased spasm, one case of transient cystitis, 3 patients with transient increased neuropathic pain and 1 case with transient episode of autonomic dysreflexia, all being managed medically. There was no case of donor site infection. The above complications were transient as they responded to temporary medical treatment. It may be deduced that after two years follow-up of patients that the procedure may be safe, however further controlled studies are needed to prove its efficacy.

Ketogenic diet improves forelimb motor function after spinal cord injury in rodents.

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Femke Streijger

Full Text Available High fat, low carbohydrate ketogenic diets (KD are validated non-pharmacological treatments for some forms of drug-resistant epilepsy. Ketones reduce neuronal excitation and promote neuroprotection. Here, we investigated the efficacy of KD as a treatment for acute cervical spinal cord injury (SCI in rats. Starting 4 hours following C5 hemi-contusion injury animals were fed either a standard carbohydrate based diet or a KD formulation with lipid to carbohydrate plus protein ratio of 3:1. The forelimb functional recovery was evaluated for 14 weeks, followed by quantitative histopathology. Post-injury 3:1 KD treatment resulted in increased usage and range of motion of the affected forepaw. Furthermore, KD improved pellet retrieval with recovery of wrist and digit movements. Importantly, after returning to a standard diet after 12 weeks of KD treatment, the improved forelimb function remained stable. Histologically, the spinal cords of KD treated animals displayed smaller lesion areas and more grey matter sparing. In addition, KD treatment increased the number of glucose transporter-1 positive blood vessels in the lesion penumbra and monocarboxylate transporter-1 (MCT1 expression. Pharmacological inhibition of MCTs with 4-CIN (α-cyano-4-hydroxycinnamate prevented the KD-induced neuroprotection after SCI, In conclusion, post-injury KD effectively promotes functional recovery and is neuroprotective after cervical SCI. These beneficial effects require the function of monocarboxylate transporters responsible for ketone uptake and link the observed neuroprotection directly to the function of ketones, which are known to exert neuroprotection by multiple mechanisms. Our data suggest that current clinical nutritional guidelines, which include relatively high carbohydrate contents, should be revisited.

The radiographic observation of the cervical strain

International Nuclear Information System (INIS)

Rhee, Chung Sik

1972-01-01

A total of 100 cases of cervical disorders were analysed of clinical signs and symptoms. The cervical strain is proved by the loss of normal lordotic curvature of the cervical spinal column on the lateral x-ray film in Ewha University Hospital from January, 1970 to december 1971 with the following results. 1. The 53 cervical strain was diagnosed in radiographic study for its abnormal locations. The hyperextension with abnormal curve is twice more after than hyperflection type. 2. The most frequent location of the cervical strain is demonstrated in the 4-6 th cervical spinal bodies (80%). 3. Most pronounced symptoms of cervical strain are local tenderness (40%), limitation of motion (17%) and radiating pain (15%). 4. The ratio of the sex incidence of male female was 3:2

The radiographic observation of the cervical strain

Energy Technology Data Exchange (ETDEWEB)

Rhee, Chung Sik [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

1972-12-15

A total of 100 cases of cervical disorders were analysed of clinical signs and symptoms. The cervical strain is proved by the loss of normal lordotic curvature of the cervical spinal column on the lateral x-ray film in Ewha University Hospital from January, 1970 to december 1971 with the following results. 1. The 53 cervical strain was diagnosed in radiographic study for its abnormal locations. The hyperextension with abnormal curve is twice more after than hyperflection type. 2. The most frequent location of the cervical strain is demonstrated in the 4-6 th cervical spinal bodies (80%). 3. Most pronounced symptoms of cervical strain are local tenderness (40%), limitation of motion (17%) and radiating pain (15%). 4. The ratio of the sex incidence of male female was 3:2.

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.

Comparison of CT myelography performed in the prone and supine positions in the detection of cervical spinal stenosis

International Nuclear Information System (INIS)

Blease Graham, Cole III; Wippold, Franz J. II; Bae, Kyongtae T.; Pilgram, Thomas K.; Shaibani, Ali; Kido, Daniel K.

2001-01-01

AIM: To quantify the change in the cross-sectional area of the cervical spinal cord and subarachnoid space (SAS) in the supine neutral vs prone extension positions in patients with myelopathy undergoing cervical CT myelography. MATERIAL AND METHODS: Axial CT myelgrams of 21 myelopathic patients were performed in both the supine neutral and prone extension positions. The SAS and cord cross-sectional areas were then measured at the disk spaces and mid-pedicle levels from C2 to T1 in both the supine and prone positions using a public domain NIH Image program, version 156b18. Mean area measurements in both positions were then compared for each level examined. RESULTS: Mean SAS cross-sectional area in the prone position was notably reduced compared with the supine position at C4-C5 [128.8 mm 2 vs 168.1 mm 2 (P 2 vs 143.2 mm 2 (P< .05)] disk levels. The mean cord cross-sectional area failed to change signficantly with positioning. CONCLUSIONS: Prone myelography may demonstrate a greater degree of cervical spine stenosis compared with CT myelography performed in the supine position in myelopathic patients. Imaging with the patient prone with neck extended in both myelography and CTM may improve precision in the results of measurements of the stenotic spinal canal when comparing these two methods. Blease Graham III, C. (2001)

Calcium channel alpha-2-delta-1 protein upregulation in dorsal spinal cord mediates spinal cord injury-induced neuropathic pain states.

Science.gov (United States)

Boroujerdi, Amin; Zeng, Jun; Sharp, Kelli; Kim, Donghyun; Steward, Oswald; Luo, Z David

2011-03-01

Spinal cord injury (SCI) commonly results in the development of neuropathic pain, which can dramatically impair the quality of life for SCI patients. SCI-induced neuropathic pain can be manifested as both tactile allodynia (a painful sensation to a non-noxious stimulus) and hyperalgesia (an enhanced sensation to a painful stimulus). The mechanisms underlying these pain states are poorly understood. Clinical studies have shown that gabapentin, a drug that binds to the voltage-gated calcium channel alpha-2-delta-1 subunit (Ca(v)α2δ-1) proteins is effective in the management of SCI-induced neuropathic pain. Accordingly, we hypothesized that tactile allodynia post SCI is mediated by an upregulation of Ca(v)α2δ-1 in dorsal spinal cord. To test this hypothesis, we examined whether SCI-induced dysregulation of spinal Ca(v)α2δ-1 plays a contributory role in below-level allodynia development in a rat spinal T9 contusion injury model. We found that Ca(v)α2δ-1 expression levels were significantly increased in L4-6 dorsal, but not ventral, spinal cord of SCI rats that correlated with tactile allodynia development in the hind paw plantar surface. Furthermore, both intrathecal gabapentin treatment and blocking SCI-induced Ca(v)α2δ-1 protein upregulation by intrathecal Ca(v)α2δ-1 antisense oligodeoxynucleotides could reverse tactile allodynia in SCI rats. These findings support that SCI-induced Ca(v)α2δ-1 upregulation in spinal dorsal horn is a key component in mediating below-level neuropathic pain states, and selectively targeting this pathway may provide effective pain relief for SCI patients. Spinal cord contusion injury caused increased calcium channel Ca(v)α2δ-1 subunit expression in dorsal spinal cord that contributes to neuropathic pain states. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery.

Science.gov (United States)

Oliveira, Marcio Aparecido; Vidotto, Milena Carlos; Nascimento, Oliver Augusto; Almeida, Renato; Santoro, Ilka Lopes; Sperandio, Evandro Fornias; Jardim, José Roberto; Gazzotti, Mariana Rodrigues

2015-01-01

Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. Prospective study in a tertiary-level university hospital. Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

Generation patterns of four groups of cholinergic neurons in rat cervical spinal cord: a combined tritiated thymidine autoradiographic and choline acetyltransferase immunocytochemical study

International Nuclear Information System (INIS)

Phelps, P.E.; Barber, R.P.; Vaughn, J.E.

1988-01-01

This report examines the generation of cholinergic neurons in the spinal cord in order to determine whether the transmitter phenotype of neurons is associated with specific patterns of neurogenesis. Previous immunocytochemical studies identified four groups of choline acetyltransferase (ChAT)-positive neurons in the cervical enlargement of the rat spinal cord. These cell groups vary in both somatic size and location along the previously described ventrodorsal neurogenic gradient of the spinal cord. Thus, large (and small) motoneurons are located in the ventral horn, medium-sized partition cells are found in the intermediate gray matter, small central canal cluster cells are situated within lamina X, and small dorsal horn neurons are scattered predominantly through laminae III-V. The relationships among the birthdays of these four subsets of cholinergic neurons have been examined by combining 3H-thymidine autoradiography and ChAT immunocytochemistry. Embryonic day 11 was the earliest time that neurons were generated within the cervical enlargement. Large and small ChAT-positive motoneurons were produced on E11 and 12, with 70% of both groups being born on E11. ChAT-positive partition cells were produced between E11 and 13, with their peak generation occurring on E12. Approximately 70% of the cholinergic central canal cluster and dorsal horn cells were born on E13, and the remainder of each of these groups was generated on E14. Other investigators have shown that all neurons within the rat cervical spinal cord are produced in a ventrodorsal sequence between E11 and E16. In contrast, ChAT-positive neurons are born only from E11 to E14 and are among the earliest cells generated in the ventral, intermediate, and dorsal subdivisions of the spinal cord

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

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

2017-10-01

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 s, and currents ranged from 100 to 1,000 µA. Bilateral phrenic nerve activity and ipsilateral hypoglossal (XII) nerve activity were recorded before and after HF-ES. Higher T2 stimulus currents potentiated ipsilateral phasic inspiratory activity at both 2 and 12 wk post-C2Hx, whereas higher stimulus currents delivered at C4 potentiated ipsilateral phasic phrenic activity only at 12 wk ( 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 wk. 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 with the ipsilateral phrenic response. We conclude that following incomplete cervical spinal cord injury, HF-ES of the ventrolateral midcervical 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-s stimulation paradigm used is unlikely to be useful for respiratory muscle activation after spinal injury. NEW & NOTEWORTHY Previous studies reported that high-frequency epidural stimulation (HF-ES) activates the diaphragm following acute spinal transection. This study examined HF-ES and phrenic motor output

Effect of ghrelin on inflammatory response in lung contusion

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Berrak Guven

2013-02-01

Full Text Available The purpose of this study was to investigate the effects of ghrelin on inflammatory response and tissue damage following trauma-induced acute lung injury. Thirty male wistar albino rats (300–400 g were randomly assigned into three groups: control group (n = 6, lung contusion plus saline (saline-treated, n = 12, and lung contusion plus ghrelin (ghrelin-treated, n = 12. Saline- or ghrelin-treated traumatic rats were sacrificed at two time points (24 and 72 hours after lung contusion. Blood was collected for the analysis of serum adenosine deaminase (ADA. Tissue transforming growth factor-beta 1 (TGF-β1 and matrix metalloproteinase-2 (MMP-2 levels were measured by enzyme-linked immunosorbent assay and histopathological examination was performed on the lung tissue samples. Our results indicated that ghrelin significantly reduced morphologic damages. Serum ADA activities were significantly decreased after lung contusion and this decline started early with ghrelin treatment. TGF-β1 and MMP-2 levels in lung tissue were elevated at 72 hours after lung contusion and treatment with ghrelin significantly increased TGF-β1 level and reduced MMP-2 level. In conclusion, our study demonstrates that acute lung injury initiated proinflammatory responses and ghrelin administration showed an anti-inflammatory effect in lung contusion.

Identifying the Long-Term Role of Inducible Nitric Oxide Synthase after Contusive Spinal Cord Injury Using a Transgenic Mouse Model

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Dominic M. Maggio

2017-01-01

Full Text Available Inducible nitric oxide synthase (iNOS is a potent mediator of oxidative stress during neuroinflammation triggered by neurotrauma or neurodegeneration. We previously demonstrated that acute iNOS inhibition attenuated iNOS levels and promoted neuroprotection and functional recovery after spinal cord injury (SCI. The present study investigated the effects of chronic iNOS ablation after SCI using inos-null mice. iNOS−/− knockout and wild-type (WT control mice underwent a moderate thoracic (T8 contusive SCI. Locomotor function was assessed weekly, using the Basso Mouse Scale (BMS, and at the endpoint (six weeks, by footprint analysis. At the endpoint, the volume of preserved white and gray matter, as well as the number of dorsal column axons and perilesional blood vessels rostral to the injury, were quantified. At weeks two and three after SCI, iNOS−/− mice exhibited a significant locomotor improvement compared to WT controls, although a sustained improvement was not observed during later weeks. At the endpoint, iNOS−/− mice showed significantly less preserved white and gray matter, as well as fewer dorsal column axons and perilesional blood vessels, compared to WT controls. While short-term antagonism of iNOS provides histological and functional benefits, its long-term ablation after SCI may be deleterious, blocking protective or reparative processes important for angiogenesis and tissue preservation.

Segmental neuropathic pain does not develop in male rats with complete spinal transections.

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Hubscher, Charles H; Kaddumi, Ezidin G; Johnson, Richard D

2008-10-01

In a previous study using male rats, a correlation was found between the development of "at-level" allodynia in T6-7 dermatomes following severe T8 spinal contusion injury and the sparing of some myelinated axons within the core of the lesion epicenter. To further test our hypothesis that this sparing is important for the expression of allodynia and the supraspinal plasticity that ensues, an injury that severs all axons (i.e., a complete spinal cord transection) was made in 15 male rats. Behavioral assessments were done at level throughout the 30-day recovery period followed by terminal electrophysiological recordings (urethane anesthesia) from single medullary reticular formation (MRF) neurons receiving convergent nociceptive inputs from receptive fields above, at, and below the lesion level. None of the rats developed signs of at-level allodynia (versus 18 of 26 male rats following severe contusion). However, the terminal recording (206 MRF neurons) data resembled those obtained previously post-contusion. That is, there was evidence of neuronal hyper-excitability (relative to previous data from intact controls) to high- and low-threshold mechanical stimulation for "at-level" (dorsal trunk) and "above-level" (eyelids and face) cutaneous territories. These results, when combined with prior data on intact controls and severe/moderate contusions, indicate that (1) an anatomically incomplete injury (some lesion epicenter axonal sparing) following severe contusion is likely important for the development of allodynia and (2) the neuronal hyper-excitability at the level of the medulla is likely involved in nociceptive processes that are not directly related to the conscious expression of pain-like avoidance behaviors that are being used as evidence of allodynia.

The radiation response of the cervical spinal cord of the pig: Effects of changing the irradiated volume

International Nuclear Information System (INIS)

Van den Aardweg, G.J.M.J.; Hopewell, J.W.; Whitehouse, E.M.

1995-01-01

An investigation of the field size effect for the cervical spinal cord of the pig after single doses of γ-rays. In this study, clinically relevant volumes of the spinal cord were irradiated. The effects of the local irradiation of different lengths of the spinal cord (2.5 cm, 5.0 cm, and 10.0 cm) have been evaluated in mature pigs (37-43 weeks). Single doses of 25-31 Gy were given using a 60 Co γ-source, at a dose rate of 0.21-0.30 Gy/min. The incidence of radiation-induced paralysis was used as the endpoint. The data were analyzed using probit analysis and a normal tissue complication probability (NTCP)-model. Twenty-five animals out of a total of 53 developed paralysis, with histological evidence of parenchymal and vascular changes in their white matter. The slope of the dose-response curves decreased with the decrease in field size; however, there was no significant difference at the radiation dose associated with a 50% incidence of paralysis (ED 50 ) irrespective of the method of analysis. The ED 50 values ± standard errors (± SE) were 27.02 ± 0.36 Gy, 27.68 ± 0.57 Gy, and 28.28 ± 0.78 Gy for field lengths of 10, 5, and 2.5 cm, respectively. Analysis of the data with a normal tissue complication probability (NCTP) model gave similar results. The latent period of paralysis was 7.5-16.5 weeks with no significant differences between dose and field size. No significant field size-related differences in response were detectable in the cervical spinal cord of mature pigs after single dose irradiations, specifically at a clinically relevant level of effect ( 10 ). 21 refs., 1 fig., 1 tab

The radiation response of the cervical spinal cord of the pig: effects of changing the irradiated volume

International Nuclear Information System (INIS)

Aardweg, Gerard J.M.J. van den; Hopewell, John W.; Whitehouse, Elizabeth M.

1995-01-01

Purpose: An investigation of the field size effect for the cervical spinal cord of the pig after single doses of γ-rays. In this study, clinically relevant volumes of the spinal cord were irradiated. Methods and Materials: The effects of the local irradiation of different lengths of the spinal cord (2.5 cm, 5.0 cm, and 10.0 cm) have been evaluated in mature pigs (37-43 weeks). Single doses of 25-31 Gy were given using a 60 Co γ-source, at a dose rate of 0.21-0.30 Gy/min. The incidence of radiation-induced paralysis was used as the endpoint. The data were analyzed using probit analysis and a normal tissue complication probability (NTCP)-model. Results: Twenty-five animals out of a total of 53 developed paralysis, with histological evidence of parenchymal and vascular changes in their white matter. The slope of the dose-response curves decreased with the decrease in field size; however, there was no significant difference at the radiation dose associated with a 50% incidence of paralysis (ED 50 ) irrespective of the method of analysis. The ED 50 values ± standard errors (± SE) were 27.02 ± 0.36 Gy, 27.68 ± 0.57 Gy, and 28.28 ± 0.78 Gy for field lengths of 10, 5, and 2.5 cm, respectively. Analysis of the data with a normal tissue complication probability (NCTP) model gave similar results. The latent period for paralysis was 7.5-16.5 weeks with no significant differences between dose and field size. Conclusion: No significant field size-related differences in response were detectable in the cervical spinal cord of mature pigs after single dose irradiations, specifically at a clinically relevant level of effect ( 10 )

Cervical spinal epidural abscess following acupuncture and wet-cupping therapy: A case report.

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Yao, Yindan; Hong, Wenke; Chen, Huimin; Guan, Qiongfeng; Yu, Hu; Chang, Xianchao; Yu, Yaoping; Xu, Shanhu; Fan, Weinv

2016-02-01

Report of an uncommon complication of acupuncture and wet cupping. A 54-year-old man presented with neck pain and fever. Magnetic resonance imaging of the cervical spine revealed an epidural abscess at C4 to T2. The symptoms related to epidural abscess resolved partially after treatment with antibiotics. Acupuncture and wet-cupping therapy should be taken into consideration as a cause of spinal epidural abscesses in patients who present with neck pain and fever. Furthermore, acupuncture and wet-cupping practitioners should pay attention to hygienic measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

Adjacent segment pathology following anterior decompression and fusion using cage and plate for the treatment of degenerative cervical spinal diseases.

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Song, Kyung-Jin; Choi, Byung-Wan; Kim, Jong-Kil

2014-12-01

Retrospective study. To analyze the incidence and prevalence of clinical adjacent segment pathology (CASP) following anterior decompression and fusion with cage and plate augmentation for degenerative cervical diseases. No long-term data on the use of cage and plate augmentation have been reported. The study population consisted of 231 patients who underwent anterior cervical discectomy and fusion (ACDF) with cage and plate for degenerative cervical spinal disease. The incidence and prevalence of CASP was determined by using the Kaplan-Meier survival analysis. To analyze the factors that influence CASP, data on preoperative and postoperative sagittal alignment, spinal canal diameter, the distance between the plate and adjacent disc, extent of fusion level, and the presence or absence of adjacent segment degenerative changes by imaging studies were evaluated. CASP occurred in 15 of the cases, of which 9 required additional surgery. At 8-year follow-up, the average yearly incidence was 1.1%. The rate of disease-free survival based on Kaplan-Meier survival analysis was 93.6% at 5 years and 90.2% at 8 years. No statistically significant differences in CASP incidence based on radiological analysis were observed. Significantly high incidence of CASP was observed in the presence of increased adjacent segment degenerative changes (pdegenerative cervical disease is associated with a lower incidence in CSAP by 1.1% per year, and the extent of preoperative adjacent segment degenerative changes has been shown as a risk factor for CASP.

Diseases of the spine, spinal cord, and extremities

International Nuclear Information System (INIS)

Tanaka, H.

1983-01-01

This paper covers the following topics: acupuncture needle in the spinal canal of the neck; thoracic tuberculous spondylitis: cold abscess; comminuted fracture of the fifth cervical vertebra; lumbar spondylolysis; lumbar spondylosis; ossification of the posterior longitudinal ligament; disk herniation of the cervical spine: narrowing of the root tunnel; ankylosing spondylitis: narrowing of the root tunnel; ossification of the ligamentum flavum; narrow spinal canal syndrome; syringomyelia; epidural neurinoma of the cervical spine; neurofibromatosis; spinal arteriovenous malformation; atrophy of the thoracic spinal cord; osteomyelitis tuberculosa of the rib; osteomyelitis tuberculosa of the left femur; chronic osteomyelitis of the left humerus; malignant giant cell tumor of the left femur; rheumatoid arthritis of the left hip joint; arthrosis deformans of the left hip joint; and enchondroma of the left index finger: Proximal Phalanx

Disorders of spinal blood circulation

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Hevyak, O.M.; Kuzminskyy, A.P.

2017-01-01

Spinal strokes are rare. The most common causes of the haemorrhage are spinal cord trauma, vasculitis with signs of haemorrhagic diathesis, spinal vascular congenital anomalies (malformations) and haemangioma. By localization, haemorrhagic strokes are divided into three groups: haematomyelia, spinal subarachnoid haemorrhage, epidural hematoma. Most cavernous malformations are localized at the cervical level, fewer — at thoracic and lumbar levels of the spinal cord. The clinical case of diagno...

Cervical spine abnormalities and instability with myelopathy in warfarin-related chondrodysplasia: 17-year follow-up

International Nuclear Information System (INIS)

Takano, Hideyuki; Smith, W.L.; Sato, Yutaka; Kao, S.C.S.

1998-01-01

A patient with warfarin embryopathy developed progressive cervical spinal myelopathy owing to bony cervical spinal damage. While there are several descriptions of warfarin embryopathy, the long-term complication of cervical spinal instability has not been reported. This cervical instability may, as in our patient, cause severe neurological dysfunction or even sudden death; therefore, it is important that pediatric radiologists should be alert to this condition. (orig.)

Life threatening spinal shock and complete neurological recovery ...

African Journals Online (AJOL)

Mild to moderate trauma to the spinal cord that is complicated by existing cervical canal stenosis or spondylosis can be a life threatening event. It is against this background that we present a 41 year old male with cervical spinal stenosis who developed marked quadriparesis and respiratory embarrassment following ...

Alternative technique of cervical spinal stabilization employing lateral mass plate and screw and intra-articular spacer fixation

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Atul Goel

2013-01-01

Full Text Available Aim: The author discusses an alternative technique of segmental cervical spinal fixation. Material and Methods: The subtleties of the technique are discussed on the basis of experience with 3 cases with a follow-up of between 30 and 36 months. Technique: The technique involves debridement of facetal articular cartilage, distraction of facets, jamming of ′Goel spacer′ into the articular cavity and fortification of the fixation by lateral mass plate and screw fixation. The ′double-insurance′ method of fixation is safe for vertebral artery, nerve roots and spinal neural structures and the fixation is strong. Conclusions: The discussed technique is safe and provides a strong fixation and a ground for ultimate arthrodesis.

Computed tomography in the foramen magnum and high cervical cord lesion

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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.

Computed tomography in the foramen magnum and high cervical cord lesion

International Nuclear Information System (INIS)

Isu, Toyohiko; Ito, Terufumi; Iwasaki, Yoshnobu; Tsuru, Mitsuo; Kitaoka, Kenichi.

1981-01-01

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 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 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 1 level in diagnosis of foramen magnum and high cervical cord lesion. If identification of cervical cord at C 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. (author)

Morphometric analysis of cervical spinal canal diameter, transverse foramen, and pedicle width using computed tomography in Indian population.

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Sureka, Binit; Mittal, Aliza; Mittal, Mahesh K; Agarwal, Kanhaiya; Sinha, Mukul; Thukral, Brij Bhushan

2018-01-01

Accurate and detailed measurements of spinal canal diameter (SCD) and transverse foraminal morphometry are essential for understanding spinal column-related diseases and for surgical planning, especially for transpedicular screw fixation. This is especially because lateral cervical radiographs do not provide accurate measurements. This study was conducted to measure the dimensions of the transverse foramen sagittal and transverse diameters (SFD, TFD), SCD, and the distance of spinal canal from the transverse foramina (dSC-TF) at C1-C7 level in the Indian population. The study population comprised 84 male and 42 female subjects. The mean age of the study group was 44.63 years (range, 19-81 years). A retrospective study was conducted, and data were collected and analyzed for patients who underwent cervical spine computed tomography (CT) imaging for various reasons. One hundred and twenty-six patients were included in the study. Detailed readings were taken at all levels from C1-C7 for SCD, SFD, TFD, and dSc-TF. Values for male and female subjects were separately calculated and compared. For both the groups, the widest SCD were measured at the C1 level and the narrowest SCD at the C4 level. The narrowest SFD was measured at C7 for both male and female subjects on the right and left sides. The widest SFD was measured at C1 both for male and female subjects on the right and left side. The narrowest TFD on the left side was measured at C7 for male and at C1 for female subjects. The narrowest mean distance of dSC-TF was found to be at C4 for both male and female subjects on both left and right side. The computed tomographic (CT) imaging is better than conventional radiographs for the preoperative evaluation of cervical spine and for better understanding cervical spine morphometry. Care must be taken during transpedicular screw fixation, especially in female subjects, more so at the C2, C4, and C6 levels due to a decrease in the distance of dSC-TF.

Biomimetic hydrogels direct spinal progenitor cell differentiation and promote functional recovery after spinal cord injury

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Geissler, Sydney A.; Sabin, Alexandra L.; Besser, Rachel R.; Gooden, Olivia M.; Shirk, Bryce D.; Nguyen, Quan M.; Khaing, Zin Z.; Schmidt, Christine E.

2018-04-01

Objective. Demyelination that results from disease or traumatic injury, such as spinal cord injury (SCI), can have a devastating effect on neural function and recovery. Many researchers are examining treatments to minimize demyelination by improving oligodendrocyte availability in vivo. Transplantation of stem and oligodendrocyte progenitor cells is a promising option, however, trials are plagued by undirected differentiation. Here we introduce a biomaterial that has been optimized to direct the differentiation of neural progenitor cells (NPCs) toward oligodendrocytes as a cell delivery vehicle after SCI. Approach. A collagen-based hydrogel was modified to mimic the mechanical properties of the neonatal spinal cord, and components present in the developing extracellular matrix were included to provide appropriate chemical cues to the NPCs to direct their differentiation toward oligodendrocytes. The hydrogel with cells was then transplanted into a unilateral cervical contusion model of SCI to examine the functional recovery with this treatment. Six behavioral tests and histological assessment were performed to examine the in vivo response to this treatment. Main results. Our results demonstrate that we can achieve a significant increase in oligodendrocyte differentiation of NPCs compared to standard culture conditions using a three-component biomaterial composed of collagen, hyaluronic acid, and laminin that has mechanical properties matched to those of neonatal neural tissue. Additionally, SCI rats with hydrogel transplants, with and without NPCs, showed functional recovery. Animals transplanted with hydrogels with NPCs showed significantly increased functional recovery over six weeks compared to the media control group. Significance. The three-component hydrogel presented here has the potential to provide cues to direct differentiation in vivo to encourage regeneration of the central nervous system.

Cine phase-contrast MRI measurement of CSF flow in the cervical spine: a pilot study in patients with spinal cord injury

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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.

Phrenic motoneuron discharge patterns following chronic cervical spinal cord injury

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Lee, Kun-Ze; Dougherty, Brendan J.; Sandhu, Milapjit S.; Lane, Michael A.; Reier, Paul J.; Fuller, David D.

2013-01-01

Cervical spinal cord injury (SCI) dramatically disrupts synaptic inputs and triggers biochemical, as well as morphological, plasticity in relation to the phrenic motor neuron (PhMN) pool. Accordingly, our primary purpose was to determine if chronic SCI induces fundamental changes in the recruitment profile and discharge patterns of PhMNs. Individual PhMN action potentials were recorded from the phrenic nerve ipsilateral to lateral cervical (C2) hemisection injury (C2Hx) in anesthetized adult male rats at 2, 4 or 8 wks post-injury and in uninjured controls. PhMNs were phenotypically classified as early (Early-I) or late inspiratory (Late-I), or silent according to discharge patterns. Following C2Hx, the distribution of PhMNs was dominated by Late-I and silent cells. Late-I burst parameters (e.g., spikes per breath, burst frequency and duration) were initially reduced but returned towards control values by 8 wks post-injury. In addition, a unique PhMN burst pattern emerged after C2Hx in which Early-I cells burst tonically during hypocapnic inspiratory apnea. We also quantified the impact of gradual reductions in end-tidal CO2 partial pressure (PETCO2) on bilateral phrenic nerve activity. Compared to control rats, as PETCO2 declined, the C2Hx animals had greater inspiratory frequencies (breaths*min−1) and more substantial decreases in ipsilateral phrenic burst amplitude. We conclude that the primary physiological impact of C2Hx on ipsilateral PhMN burst patterns is a persistent delay in burst onset, transient reductions in burst frequency, and the emergence of tonic burst patterns. The inspiratory frequency data suggest that plasticity in brainstem networks is likely to play an important role in phrenic motor output after cervical SCI. PMID:23954215

Phrenic motoneuron discharge patterns following chronic cervical spinal cord injury.

Science.gov (United States)

Lee, Kun-Ze; Dougherty, Brendan J; Sandhu, Milapjit S; Lane, Michael A; Reier, Paul J; Fuller, David D

2013-11-01

Cervical spinal cord injury (SCI) dramatically disrupts synaptic inputs and triggers biochemical, as well as morphological, plasticity in relation to the phrenic motor neuron (PhMN) pool. Accordingly, our primary purpose was to determine if chronic SCI induces fundamental changes in the recruitment profile and discharge patterns of PhMNs. Individual PhMN action potentials were recorded from the phrenic nerve ipsilateral to lateral cervical (C2) hemisection injury (C2Hx) in anesthetized adult male rats at 2, 4 or 8 wks post-injury and in uninjured controls. PhMNs were phenotypically classified as early (Early-I) or late inspiratory (Late-I), or silent according to discharge patterns. Following C2Hx, the distribution of PhMNs was dominated by Late-I and silent cells. Late-I burst parameters (e.g., spikes per breath, burst frequency and duration) were initially reduced but returned towards control values by 8wks post-injury. In addition, a unique PhMN burst pattern emerged after C2Hx in which Early-I cells burst tonically during hypocapnic inspiratory apnea. We also quantified the impact of gradual reductions in end-tidal CO2 partial pressure (PETCO2) on bilateral phrenic nerve activity. Compared to control rats, as PETCO2 declined, the C2Hx animals had greater inspiratory frequencies (breaths∗min(-1)) and more substantial decreases in ipsilateral phrenic burst amplitude. We conclude that the primary physiological impact of C2Hx on ipsilateral PhMN burst patterns is a persistent delay in burst onset, transient reductions in burst frequency, and the emergence of tonic burst patterns. The inspiratory frequency data suggest that plasticity in brainstem networks is likely to play an important role in phrenic motor output after cervical SCI. © 2013.

Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study.

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Huang, H; Nightingale, R W; Dang, A B C

2018-01-01

Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t -test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article : H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28-35. DOI: 10

Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study.

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Smith, Justin S; Lafage, Virginie; Ryan, Devon J; Shaffrey, Christopher I; Schwab, Frank J; Patel, Alpesh A; Brodke, Darrel S; Arnold, Paul M; Riew, K Daniel; Traynelis, Vincent C; Radcliff, Kris; Vaccaro, Alexander R; Fehlings, Michael G; Ames, Christopher P

2013-10-15

Post hoc analysis of prospectively collected data. Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM). CSM is the leading cause of spinal cord dysfunction. The association between cervical alignment, sagittal balance, and myelopathy has not been well characterized. This was a post hoc analysis of the prospective, multicenter AOSpine North America CSM study. Inclusion criteria for this study required preoperative cervical magnetic resonance imaging (MRI) and neutral sagittal cervical radiography. Techniques for MRI assessment of spinal cord dimensions were developed. Correlations between imaging and health-related quality-of-life scores were assessed. Fifty-six patients met inclusion criteria (mean age = 55.4 yr). The modified Japanese Orthopedic Association (mJOA) scores correlated with C2-C7 sagittal vertical axis (SVA) (r = -0.282, P = 0.035). Spinal cord volume correlated with cord length (r = 0.472, P balance (C2-C7 SVA) to myelopathy severity. We found a moderate negative correlation in kyphotic patients of cord volume and cross-sectional area to mJOA scores. The opposite (positive correlation) was found for lordotic patients, suggesting a relationship of cord volume to myelopathy that differs on the basis of sagittal alignment. It is interesting to note that sagittal balance but not kyphosis is tied to myelopathy score. Future work will correlate alignment changes to cord morphology changes and myelopathy outcomes. SUMMARY STATEMENTS: This is the first study to correlate sagittal balance (C2-C7 SVA) to myelopathy severity. We found a moderate negative correlation in kyphotic patients of cord volume and cross-sectional area to mJOA scores. The opposite (positive correlation) was found for lordotic patients, suggesting a relationship of cord volume to myelopathy that differs on the

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.

Cervical Spinal Cord Injury at the Victorian Spinal Cord Injury Service: Epidemiology of the Last Decade

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Simon C.P. Lau

2014-01-01

Full Text Available Introduction Cervical spinal cord injury (CSCI is a significant medical and socioeconomic problem. In Victoria, Australia, there has been limited research into the incidence of CSCI. The Austin Hospital's Victorian Spinal Cord Injury Service (VSCIS is a tertiary referral hospital that accepts referrals for surgical management and ongoing neurological rehabilitation for south eastern Australia. The aim of this study was to characterise the epidemiology of CSCI managed operatively at the VSCIS over the last decade, in order to help fashion public health campaigns. Methods This was a retrospective review of medical records from January 2000 to December 2009 of all patients who underwent surgical management of acute CSCI in the VSCIS catchment region. Patients treated non-operatively were excluded. Outcome measures included: demographics, mechanism of injury and associated factors (like alcohol and patient neurological status. Results Men were much more likely to have CSCI than women, with a 4:1 ratio, and the highest incidence of CSCI for men was in their 20s (39%. The most common cause of CSCI was transport related (52%, followed by falls (23% and water-related incidents (16%. Falls were more prevalent among those >50 years. Alcohol was associated in 22% of all CSCIs, including 42% of water-related injuries. Discussion Our retrospective epidemiological study identified at-risk groups presenting to our spinal injury service. Young males in their 20s were associated with an increased risk of transport-related accidents, water-related incidents in the summer months and accidents associated with alcohol. Another high risk group were men >50 years who suffer falls, both from standing and from greater heights. Public awareness campaigns should target these groups to lower incidence of CSCI.

Cervical spine abnormalities and instability with myelopathy in warfarin-related chondrodysplasia: 17-year follow-up

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Takano, Hideyuki; Smith, W.L.; Sato, Yutaka; Kao, S.C.S. [Department of Radiology, The University of Iowa Clinics and Hospitals, 200 Hawkins Dr., F3966 JPP, Iowa City, IA 52242-1077 (United States)

1998-07-01

A patient with warfarin embryopathy developed progressive cervical spinal myelopathy owing to bony cervical spinal damage. While there are several descriptions of warfarin embryopathy, the long-term complication of cervical spinal instability has not been reported. This cervical instability may, as in our patient, cause severe neurological dysfunction or even sudden death; therefore, it is important that pediatric radiologists should be alert to this condition. (orig.) With 5 figs., 9 refs.

Salvianolic Acid B Ameliorates Motor Dysfuntion in Spinal Cord ...

African Journals Online (AJOL)

Purpose: To evaluate the effect of salvianolic acid B (Sal B) treatment on the motor function of spinal cord injury (SCI) rat. Methods: SCI rats were modelled by contusion, and then received 10 mg/kg Sal B, or methylprednisolone, or phosphate-buffered saline (PBS) intraperitoneally daily for 4 weeks, two hours after the ...

Does timing of transplantation of neural stem cells following spinal cord injury affect outcomes in an animal model?

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Cheng, Ivan; Park, Don Y; Mayle, Robert E; Githens, Michael; Smith, Robert L; Park, Howard Y; Hu, Serena S; Alamin, Todd F; Wood, Kirkham B; Kharazi, Alexander I

2017-12-01

We previously reported that functional recovery of rats with spinal cord contusions can occur after acute transplantation of neural stem cells distal to the site of injury. To investigate the effects of timing of administration of human neural stem cell (hNSC) distal to the site of spinal cord injury on functional outcomes in an animal model. Thirty-six adult female Long-Evans hooded rats were randomized into three experimental and three control groups with six animals in each group. The T10 level was exposed via posterior laminectomy, and a moderate spinal cord contusion was induced by the Multicenter Animal Spinal Cord Injury Study Impactor (MASCIS, W.M. Keck Center for Collaborative Neuroscience, Piscataway, NJ, USA). The animals received either an intrathecal injection of hNSCs or control media through a separate distal laminotomy immediately, one week or four weeks after the induced spinal cord injury. Observers were blinded to the interventions. Functional assessment was measured immediately after injury and weekly using the Basso, Beattie, Bresnahan (BBB) locomotor rating score. A statistically significant functional improvement was seen in all three time groups when compared to their controls (acute, mean 9.2 vs. 4.5, P=0.016; subacute, mean 11.1 vs. 6.8, P=0.042; chronic, mean 11.3 vs. 5.8, P=0.035). Although there was no significant difference in the final BBB scores comparing the groups that received hNSCs, the group which achieved the greatest improvement from the time of cell injection was the subacute group (+10.3) and was significantly greater than the chronic group (+5.1, P=0.02). The distal intrathecal transplantation of hNSCs into the contused spinal cord of a rat led to significant functional recovery of the spinal cord when injected in the acute, subacute and chronic phases of spinal cord injury (SCI), although the greatest gains appeared to be in the subacute timing group.

The relationship between electrodiagnosis using spinal cord evoked potential after spinal cord stimulation and MRI evaluation for cervical myelopathy

International Nuclear Information System (INIS)

Kato, Tsuyoshi; Shiba, Keiichiro; Ueta, Takayoshi; Ohta, Hideki; Mori, Eiji; Kaji, Kozo; Yuge, Itaru; Kawano, Osamu

2006-01-01

We studied the correlation between the site of high intensity spinal cord signals on preoperative sagittal T2 MRIs (T2-high signal) and that of intrdaperative electrophysiological abnormalities for 200 cervical myelopathy cases. We recorded the Sp(E)-SCEPs during posterior cervical laminoplasty operations. In the cases with a T2-high signal at single levels, conduction abnormality matched the site of T2-high signal in 50%, and no conduction abnormalities were detected in 44%. In the cases with a T2-high signal at two levels, conduction abnormality matched the site of T2-high signal in only 11%, and no conduction abnormalities were disclosed in 59%. In the cases with a T2-high signal at three or more levels, conduction abnormalities matched the site of T2-high signal in 8% and no conduction abnormalities were disclosed in 72%. Our study showed a higher correspondence between the MRI finding and conduction abnormalities in the cases with T2-high signal at single levels, although our Sp(E)-SCEP study could not disclose conduction abnormalities in nearly half the cases. False negative findings of Sp(E)-SCEPs may result from the simplified recording technique. (author)

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

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

2006-12-01

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

Computerized axial tomography in traumatic cervical lesions

International Nuclear Information System (INIS)

Koyama, Tsunemaro

1982-01-01

Although plain computerized axial tomography cannot routinely demonstrate the spinal cord, it does provide excellent visualization of the bony outline of the spinal canal and vertebral column. So it should be reasonable to use this technique in cases of cervical traumatic disorders. In this paper we presented 10 cases of cervical traumatic lesions; 3 atlanto-axial dislocation, 2 cervical canal stenosis, 3 OPLL, 1 intramedullary hematoma and 1 C 2 -neurinoma. In some patients neurologic deficits were induced by cervical trauma. Bony lesions appeared more adequately deliniated than intraspinal lesions, however, in some cases intramedullary changes could also be demonstrated. The use of metrizamide with high resolution CT-scanner could improve the usefullness of this technique. (author)

Time-dependent gene expression analysis after mouse skeletal muscle contusion

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Weihua Xiao

2016-03-01

Conclusion: The sequence of immune cells invaded after muscle contusion was neutrophils, M1 macrophages and M2 macrophages. Some CC (CCL2, CCL3, and CCL4 and CXC (CXCL10 chemokines may be involved in the chemotaxis of these immune cells. HGF may be the primary factor to activate the satellite cells after muscle contusion. Moreover, 2 weeks are needed to recover when acute contusion happens as used in this study.

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

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SHEN Peng

2013-06-01

Full Text Available 【Abstract】We report electroversion in treatment of atrial fibrillation (AF and atrioventricular nodal reentry ta-chycardia (AVNRT in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury. At first, the pa-tient sustained respiratory failure and weak cough reflex, thereafter repeated bronchoscopy was used to aspirate the sputum as well as control the pneumonia, which resulted in arrhythmia (AF and AVNRT. Two doses of intravenous amiodarone failed to correct the arrhythmia. After restora-tion of sinus rhythm by electroversion, he was successfully weaned from mechanical ventilation and discharged from the intensive care unit without recurrent arrhythmia. Key words: Arrhythmia, cardiac; Atrial fibrillation; Electric countershock; Wolff-Parkinson-White syndrome; Spinal cord injuries

Occipital dysplasia and associated cranial spinal cord abnormalities in two dogs

International Nuclear Information System (INIS)

Bagley, R.S.; Harrington, M.L.; Tucker, R.L.; Sande, R.D.; Root, C.R.; Kramer, R.W.

1996-01-01

Occipital dysplasia was found in association with cervical spinal cord abnormalities in two dogs. One dog presented for tetraparesis and cervical hyperesthesia, the other for historical cervical hyperesthesia and mild paraparesis. In dog 1, a midline cervical spinal cord defect consistent with a communicating syrinx was found. In the other dog, a presumptive syringo/hydromyelia of the cervical spinal cord was found on magnetic resonance imaging. While occipital dysplasia alone is not thought to cause any clinical abnormalities, the dogs of this report suggest that intramedullary central nervous system abnormalities may be present concurrently with occipital dysplasia and should be considered as a possible cause of the clinical signs. The relationship between occipital dysplasia and syringo/hydromyelia in these dogs remains unclear, however, similar associated abnormalities are occasionally found in humans with Chiari malformation

Thoracolumbar spinal neurenteric cyst with tethered cord syndrome and extreme cervical lordosis in a child: A case report and literature review.

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Lan, Zhi Gang; Richard, Seidu A; Lei, Chuanfen; Huang, Siqing

2018-04-01

Neurenteric cysts, are rare benign tumors of the central nervous system that are mostly located in the spinal cord and predominantly seen in male children although adult form of the disorder also occurs. The etiology and treatment of this disorder is still a matter of debate. Our case further throws more light on the pathogenesis and treatment of this disorder. A 4-year-old boy presented with 5-month history of cervical lordosis and bilateral lower extremity pain that progressed to his abdomen and upper body. The pain was general, recurrent, non-persistent and progressive in nature with no paralysis. The pain was aggravated by trunk stretching and relieved when he assumed opisthotonos position so he preferred sleeping in this position at night. Magnetic resonance imaging (MRI) revealed a cystic lesion at the thoracolumbar spine with tethering of spinal cord and cervical lordosis. He was operated on successfully and the cervical lordosis and pain resolved. The child recovered well with no tumor recurrence and massive improvement of his life. The gold standard treatment for this disorder is surgery although the precise surgical approach is still a matter of debate. We are of the view that surgical approach should be individualized and aim at total excision of the cyst.

Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial.

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Bautista-Aguirre, Francisco; Oliva-Pascual-Vaca, Ángel; Heredia-Rizo, Alberto M; Boscá-Gandía, Juan J; Ricard, François; Rodriguez-Blanco, Cleofás

2017-06-01

Cervical and thoracic spinal manipulative therapy has shown positive impact for relief of pain and improve function in non-specific mechanical neck pain. Several attempts have been made to compare their effectiveness although previous studies lacked a control group, assessed acute neck pain or combined thrust and non-thrust techniques. To compare the immediate effects of cervical and thoracic spinal thrust manipulations on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain. Randomized, single-blinded, controlled clinical trial. Private physiotherapy clinical consultancy. Eighty-eight subjects (32.09±6.05 years; 72.7% females) suffering neck pain (grades I or II) of at least 12 weeks of duration. Participants were distributed into three groups: 1) cervical group (N.=28); 2) thoracic group (N.=30); and 3) control group (N.=30). One treatment session consisting of applying a high-velocity low-amplitude spinal thrust technique over the lower cervical spine (C7) or the upper thoracic spine (T3) was performed, while the control group received a sham-manual contact. Measurements were taken at baseline and after intervention of the pressure pain threshold over the median, ulnar and radial nerves. Secondary measures included assessing free-pain grip strength with a hydraulic dynamometer. No statistically significant differences were observed when comparing between-groups in any of the outcome measures (P>0.05). Those who received thrust techniques, regardless of the manipulated area, reported an immediate increase in mechanosensitivity over the radial (both sides) and left ulnar nerve trunks (Ppain perception over the radial nerve also improved (P≤0.025). Low-cervical and upper-thoracic thrust manipulation is no more effective than placebo to induce immediate changes on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain. A single

Contiguous spinal metastasis mimicking infectious spondylodiscitis

International Nuclear Information System (INIS)

Lee, Chul Min; Lee, Seung Hun; Bae, Ji Yoon

2015-01-01

Differential diagnosis between spinal metastasis and infectious spondylodiscitis is one of the occasional challenges in daily clinical practice. We encountered an unusual case of spinal metastasis in a 75-year-old female breast cancer patient that mimicked infectious spondylodiscitis. Magnetic resonance imaging (MRI) showed diffuse bone marrow infiltrations with paraspinal soft tissue infiltrative changes in 5 contiguous cervical vertebrae without significant compression fracture or cortical destruction. These MRI findings made it difficult to differentiate between spinal metastasis and infectious spondylodiscitis. Infectious spondylodiscitis such as tuberculous spondylodiscitis was regarded as the more appropriate diagnosis due to the continuous involvement of > 5 cervical vertebrae. The patient's clinical presentation also supported the presumptive diagnosis of infectious spondylodiscitis rather than spinal metastasis. Intravenous antibiotics were administered, but clinical symptoms worsened despite treatment. After pathologic confirmation by computed tomography-guided biopsy, we were able to confirm a final diagnosis of spinal metastasis

Contiguous spinal metastasis mimicking infectious spondylodiscitis

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Lee, Chul Min; Lee, Seung Hun [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of); Bae, Ji Yoon [Dept. of Pathology, National Police Hospital, Seoul (Korea, Republic of)

2015-12-15

Differential diagnosis between spinal metastasis and infectious spondylodiscitis is one of the occasional challenges in daily clinical practice. We encountered an unusual case of spinal metastasis in a 75-year-old female breast cancer patient that mimicked infectious spondylodiscitis. Magnetic resonance imaging (MRI) showed diffuse bone marrow infiltrations with paraspinal soft tissue infiltrative changes in 5 contiguous cervical vertebrae without significant compression fracture or cortical destruction. These MRI findings made it difficult to differentiate between spinal metastasis and infectious spondylodiscitis. Infectious spondylodiscitis such as tuberculous spondylodiscitis was regarded as the more appropriate diagnosis due to the continuous involvement of > 5 cervical vertebrae. The patient's clinical presentation also supported the presumptive diagnosis of infectious spondylodiscitis rather than spinal metastasis. Intravenous antibiotics were administered, but clinical symptoms worsened despite treatment. After pathologic confirmation by computed tomography-guided biopsy, we were able to confirm a final diagnosis of spinal metastasis.

SPINAL CORD- A CADAVERIC STUDY

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Vijayamma K. N

2018-01-01

Full Text Available BACKGROUND Spinal cord is situated within the vertebral canal extending from the lower end of the medulla oblongata at the upper border of first cervical vertebra. In early foetal life, it extends throughout the length of the vertebral canal, and at the time of birth, it reaches the level of third lumbar vertebra. In adult, it ends at the lower border of first lumbar vertebra and thereafter continued as filum terminale, which gets attached to tip of coccyx. Spinal cord is covered by three protective membranes called spinal meninges, diameter, arachnoid and pia mater. The diameter and arachnoid mater extent up to second sacral vertebra and the pia mater forms filum terminale and extend at the tip of coccyx. MATERIALS AND METHODS Forty spinal cord cadaveric specimen were studied by dissection method after exposing the vertebral canal. The roots of spinal nerve were sectioned on both sides and the cord is released along with its coverings. The dura and arachnoid mater were incised longitudinally and the subarachnoid space, blood vessels, nerve roots, ligament denticulata, cervical and lumbar enlargements were observed. The blood vessels including radicular arteries were also studied photographed. RESULTS The spinal cord is a highly vascular structure situated within the vertebral canal, covered by diameter, arachnoid mater and pia mater. Spinal dura is thicker anteriorly than posteriorly. The pia mater forms linea splendens, which extend along the whole length of the cord in front of the anterior median fissure. The average length of the cord is 38 cm. The length and breadth of cervical enlargement was more compared to lumbar enlargement. The number of rootlets in both dorsal and ventral roots accounts more in cervical compared to other regions of the cord. The ligament denticulata is a thin transparent bands of pia mater attached on either sides of the cord between the dorsal and ventral roots of spinal nerves. The tooth like extensions are well

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.

Clinical Trial of Human Fetal Brain-Derived Neural Stem/Progenitor Cell Transplantation in Patients with Traumatic Cervical Spinal Cord Injury

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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.

Image analysis of open-door laminoplasty for cervical spondylotic myelopathy: comparing the influence of cord morphology and spine alignment.

Science.gov (United States)

Lin, Bon-Jour; Lin, Meng-Chi; Lin, Chin; Lee, Meei-Shyuan; Feng, Shao-Wei; Ju, Da-Tong; Ma, Hsin-I; Liu, Ming-Ying; Hueng, Dueng-Yuan

2015-10-01

Previous studies have identified the factors affecting the surgical outcome of cervical spondylotic myelopathy (CSM) following laminoplasty. Nonetheless, the effect of these factors remains controversial. It is unknown about the association between pre-operative cervical spinal cord morphology and post-operative imaging result following laminoplasty. The goal of this study is to analyze the impact of pre-operative cervical spinal cord morphology on post-operative imaging in patients with CSM. Twenty-six patients with CSM undergoing open-door laminoplasty were classified according to pre-operative cervical spine bony alignment and cervical spinal cord morphology, and the results were evaluated in terms of post-operative spinal cord posterior drift, and post-operative expansion of the antero-posterior dura diameter. By the result of study, pre-operative spinal cord morphology was an effective classification in predicting surgical outcome - patients with anterior convexity type, description of cervical spinal cord morphology, had more spinal cord posterior migration than those with neutral or posterior convexity type after open-door laminoplasty. Otherwise, the interesting finding was that cervical spine Cobb's angle had an impact on post-operative spinal cord posterior drift in patients with neutral or posterior convexity type spinal cord morphology - the degree of kyphosis was inversely proportional to the distance of post-operative spinal cord posterior drift, but not in the anterior convexity type. These findings supported that pre-operative cervical spinal cord morphology may be used as screening for patients undergoing laminoplasty. Patients having neutral or posterior convexity type spinal cord morphology accompanied with kyphotic deformity were not suitable candidates for laminoplasty. Copyright © 2015 Elsevier B.V. All rights reserved.

Driving Safety after Spinal Surgery: A Systematic Review.

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Alhammoud, Abduljabbar; Alkhalili, Kenan; Hannallah, Jack; Ibeche, Bashar; Bajammal, Sohail; Baco, Abdul Moeen

2017-04-01

This study aimed to assess driving reaction times (DRTs) after spinal surgery to establish a timeframe for safe resumption of driving by the patient postoperatively. The MEDLINE and Google Scholar databases were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) Statement for clinical studies that investigated changes in DRTs following cervical and lumbar spinal surgery. Changes in DRTs and patients' clinical presentation, pathology, anatomical level affected, number of spinal levels involved, type of intervention, pain level, and driving skills were assessed. The literature search identified 12 studies that investigated postoperative DRTs. Six studies met the inclusion criteria; five studies assessed changes in DRT after lumbar spine surgery and two studies after cervical spina surgery. The spinal procedures were selective nerve root block, anterior cervical discectomy and fusion, and lumbar fusion and/ordecompression. DRTs exhibited variable responses to spinal surgery and depended on the patients' clinical presentation, spinal level involved, and type of procedure performed. The evidence regarding the patients' ability to resume safe driving after spinal surgery is scarce. Normalization of DRT or a return of DRT to pre-spinal intervention level is a widely accepted indicator for safe driving, with variable levels of statistical significance owing to multiple confounding factors. Considerations of the type of spinal intervention, pain level, opioid consumption, and cognitive function should be factored in the assessment of a patient's ability to safely resume driving.

Lavandula angustifolia Extract Improves the Result of Human Umbilical Mesenchymal Wharton's Jelly Stem Cell Transplantation after Contusive Spinal Cord Injury in Wistar Rats

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Yaghoobi, Kayvan; Kaka, Gholamreza; Mansouri, Korosh; Davoodi, Shaghayegh; Sadraie, Seyed Homayoon; Hosseini, Seyed Ruhollah

2016-01-01

Introduction. The primary trauma of spinal cord injury (SCI) results in severe damage to nervous functions. At the cellular level, SCI causes astrogliosis. Human umbilical mesenchymal stem cells (HUMSCs), isolated from Wharton's jelly of the umbilical cord, can be easily obtained. Previously, we showed that the neuroprotective effects of Lavandula angustifolia can lead to improvement in a contusive SCI model in rats. Objective. The aim of this study was to investigate the effect of L. angustifolia (Lav) on HUMSC transplantation after acute SCI. Materials and Methods. Sixty adult female rats were randomly divided into eight groups. Every week after SCI onset, all animals were evaluated for behavior outcomes. H&E staining was performed to examine the lesions after injury. GFAP expression was assessed for astrogliosis. Somatosensory evoked potential (SEP) testing was performed to detect the recovery of neural conduction. Results. Behavioral tests showed that the HUMSC group improved in comparison with the SCI group, but HUMSC + Lav 400 was very effective, resulting in a significant increase in locomotion activity. Sensory tests and histomorphological and immunohistochemistry analyses verified the potentiation effects of Lav extract on HUMSC treatment. Conclusion. Transplantation of HUMSCs is beneficial for SCI in rats, and Lav extract can potentiate the functional and cellular recovery with HUMSC treatment in rats after SCI. PMID:27057171

Cervical peridural calcification in dialysed patients. Report of seven cases

International Nuclear Information System (INIS)

Okubo, Yasuhiro; Komura, Masayoshi; Fukuda, Minoru; Yamanaka, Mariko; Inose, Kazuto; Honda, Masanori; Shiraishi, Tateru

2007-01-01

Though a variety of bone joint complications are widely recognized in long-term dialysis patients, myelopathy caused by ectopic calcification surrounding the cervical spinal dura has not been reported. We encountered seven patients with the cervical peridural calcification (CPC) and performed surgery on four. The present study investigated the clinical features of this condition. All seven had a dialysis history over 20 years, and the Ca X P product was high. Plain cervical CT scan was the most useful diagnostic tool for CPC, though was quite difficult to establish the diagnosis by plain X-ray, MRI or myelography. Clinical symptoms of CPC resembled those of spinal canal stenosis caused by thickening or ossification of the ligament. The spinal cord in the area of CPC was comppressed with calcified fibrous membrane surrounding the cervical dura mater, swelling and pulsation of spinal cord was obtained after not only excising the vertebral arch but also opening and removing the calcified membrane from the dura. Clinical improvement was obtained only in two patients with a short symptomatic period. Based on these findings, CPC should be recognized as an important complication in dialysed patients. Patients demonstrating any sign of numbness and/or muscle weakness in upper and/or lower limbs should be examined by plain cervical CT scan. If calcification around the spinal dura is identified, surgery should be considered in the early stage. (author)

Hypoxia triggers short term potentiation of phrenic motoneuron discharge after chronic cervical spinal cord injury

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Lee, Kun-Ze; Sandhu, Milapjit S.; Dougherty, Brendan J.; Reier, Paul J.; Fuller, David D.

2014-01-01

Repeated exposure to hypoxia can induce spinal neuroplasticity as well as respiratory and somatic motor recovery after spinal cord injury (SCI). The purpose of the present study was to define the capacity for a single bout of hypoxia to trigger short-term plasticity in phrenic output after cervical SCI, and to determine the phrenic motoneuron (PhrMN) bursting and recruitment patterns underlying the response. Hypoxia-induced short term potentiation (STP) of phrenic motor output was quantified in anesthetized rats 11 wks following lateral spinal hemisection at C2 (C2Hx). A 3-min hypoxic episode (12–14% O2) always triggered STP of inspiratory burst amplitude, the magnitude of which was greater in phrenic bursting ipsilateral vs. contralateral to C2Hx. We next determined if STP could be evoked in recruited (silent) PhrMNs ipsilateral to C2Hx. Individual PhrMN action potentials were recorded during and following hypoxia using a “single fiber” approach. STP of bursting activity did not occur in cells initiating bursting at inspiratory onset, but was robust in recruited PhrMNs as well as previously active cells initiating bursting later in the inspiratory effort. We conclude that following chronic C2Hx, a single bout of hypoxia triggers recruitment of PhrMNs in the ipsilateral spinal cord with bursting that persists beyond the hypoxic exposure. The results provide further support for the use of short bouts of hypoxia as a neurorehabilitative training modality following SCI. PMID:25448009

Spinal CT scan, 1

International Nuclear Information System (INIS)

Nakagawa, Hiroshi

1982-01-01

Methods of CT of the cervical and thoracic spines were explained, and normal CT pictures of them were described. Spinal CT was evaluated in comparison with other methods in various spinal diseases. Plain CT revealed stenosis due to spondylosis or ossification of posterior longitudinal ligament and hernia of intervertebral disc. CT took an important role in the diagnosis of spinal cord tumors with calcification and destruction of the bone. CT scan in combination with other methods was also useful for the diagnosis of spinal injuries, congenital anomalies and infections. (Ueda, J.)

The outcome after head injury in patients with radiologically demonstrated brain contusion

International Nuclear Information System (INIS)

Eide, P.K.; Tysnes, O.B.

1993-01-01

The early and late outcome was evaluated in head injury patients who presented brain contusion(s) on the cranial CT scan and in patients hospitalized for concussion. There was a high degree of concurrence between mortality and CT findings. Late complaints were common among cases of concussion of the brain. However, the frequency of impaired memory and concentration, speech problems, paresis and epileptic seizures was increased in cases where the CT scan showed brain contusion. Adaptive and social functioning was most impaired in cases with multifocal contusions in both hemispheres. 16 refs., 5 tabs

Complications and Causes of Death in Spinal Cord Injury Patients in ...

African Journals Online (AJOL)

Conclusion: Most common complication and cause of death following SCI are muscle spasm and respiratory failure respectively. The risk factors associated with mortality are age, GCS<9, cervical spinal injury, and complete neurologic injury and those for complications were cervical spinal injury and Frankel Type A injury.

A Study of Risk Factors for Tracheostomy in Patients With a Cervical Spinal Cord Injury.

Science.gov (United States)

Tanaka, Jun; Yugue, Itaru; Shiba, Keiichiro; Maeyama, Akira; Naito, Masatoshi

2016-05-01

A retrospective, consecutive case series. To determine the risk factors for a tracheostomy in patients with a cervical spinal cord injury. Respiratory status cannot be stabilized in patients with a cervical spinal cord injury (CSCI) for various reasons, so a number of these patients require long-term respiratory care and a tracheostomy. Various studies have described risk factors for a tracheostomy, but none have indicated a relationship between imaging assessment and the need for a tracheostomy. The current study used imaging assessment and other approaches to assess and examine the risk factors for a tracheostomy in patients with a CSCI. Subjects were 199 patients who were treated at the Spinal Injuries Center within 72 hours of a CSCI over 8-year period. Risk factors for a tracheostomy were retrospectively studied. Patients were assessed in terms of 10 items: age, sex, the presence of a vertebral fracture or dislocation, ASIA Impairment Scale, the neurological level of injury (NLI), PaO2, PaCO2, the level of injury on magnetic resonance imaging (MRI), the presence of hematoma-like changes (a hypointense core surrounded by a hyperintense rim in T2-weighted images) on MRI, and the Injury Severity Score.Items were analyzed multivariate logistic regression, and P tracheostomy, accounting for 11.6% of patients with a CSCI. Univariate analyses of the risk factors for tracheostomy revealed significant differences for six items: age, Injury Severity Score, presence of fracture or dislocation, ASIA Impairment Scale A, NLI C4 or above, and MRI scans revealing hematoma-like changes. Multivariate logistic regression analyses revealed significant differences in terms of two items: NLI C4 or above and MRI scans revealing hematoma-like changes. Thirty patients had both an NLI C4 or above and MRI scans revealing hematoma-like changes. Of these, 17 (56.7%) required a tracheostomy. Patients with an NLI C4 or above and MRI scans revealing hematoma-like changes were likely to

Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

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Jangsup Moon

2017-01-01

Full Text Available Introduction: Transforaminal epidural steroid injection (TFESI is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods: We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results: After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion: Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid.

An analysis of cervical myelopathy due to cervical spondylosis or ossification of posterior longitudinal ligament by CT myelography

International Nuclear Information System (INIS)

Fujiwara, Keiju; Yonenobe, Sakuo; Ebara, Sohei; Yamashita, Kazuo; Ono, Keiro

1988-01-01

CT-myelographic (CTM) findings of 20 patients with ossification of posterior longitudinal ligament (OPLL) and 24 patients with cervical spondylotic myelopathy (CSM) were reviewed for the evaluation of (1) contributing factors to preoperative neurologic symptoms and therapeutic prognosis in OPLL, and (2) differences in pathology between OPLL and CSM. In OPLL, the severity of preoperative neurologic symptoms was not related to the degree of deformed spinal cord - as expressed by the transverse area of the spinal cord and the rate of flatness - nor the degree of ossification - as expressed by the rate of stricture, and the transverse areas of the effective spinal canal and ossification. The transverse areas of the spinal cord and effective spinal canal were correlated with both postoperative scores for neurologic symptoms and the recovery rate. Osseous compression to the spinal cord was severer in OPLL than OSM. Regarding other factors, such as size and shape of the spinal cord and therapeutic prognosis, there was no difference between the two diseases. This implied the association of dynamic compression to the spinal cord that resulted from the unstable cervical spine in the case of CSM. (Namekawa, K.)

Anatomical architecture and responses to acidosis of a novel respiratory neuron group in the high cervical spinal cord (HCRG) of the neonatal rat.

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Okada, Y; Yokota, S; Shinozaki, Y; Aoyama, R; Yasui, Y; Ishiguro, M; Oku, Y

2009-01-01

It has been postulated that there exists a neuronal mechanism that generates respiratory rhythm and modulates respiratory output pattern in the high cervical spinal cord. Recently, we have found a novel respiratory neuron group in the ventral portion of the high cervical spinal cord, and named it the high cervical spinal cord respiratory group (HCRG). In the present study, we analyzed the detailed anatomical architecture of the HCRG region by double immunostaining of the region using a neuron-specific marker (NeuN) and a marker for motoneurons (ChAT) in the neonatal rat. We found a large number of small NeuN-positive cells without ChAT-immunoreactivity, which were considered interneurons. We also found two and three clusters of motoneurons in the ventral portion of the ventral horn at C1 and C2 levels, respectively. Next, we examined responses of HCRG neurons to respiratory and metabolic acidosis in vitro by voltage-imaging together with cross correlation techniques, i.e., by correlation coefficient imaging, in order to understand the functional role of HCRG neurons. Both respiratory and metabolic acidosis caused the same pattern of changes in their spatiotemporal activation profiles, and the respiratory-related area was enlarged in the HCRG region. After acidosis was introduced, preinspiratory phase-dominant activity was recruited in a number of pixels, and more remarkably inspiratory phase-dominant activity was recruited in a large number of pixels. We suggest that the HCRG composes a local respiratory neuronal network consisting of interneurons and motoneurons and plays an important role in respiratory augmentation in response to acidosis.

MRI signal intensity as a maker of impairment in incomplete cervical spinal cord injuries

International Nuclear Information System (INIS)

Chiba, Hidefumi; Aoki, Haruhito; Hamabe, Masaki; Sasao, Yutaka; Miura, Takehiko

1998-01-01

Incomplete cervical spinal cord injuries such as central cord syndrome may result in prolonged spasticity of the limbs, especially disabilities of the upper extremities, even if the patient is able to walk. In this study, relationship between cord impairment and clinical outcome was investigated using MRI. Results showed that small foci of low signal intensity in T 1 -weighted imaging combined with foci of high signal intensity in T 2 -weighted imaging in follow-up MRI are closely related to the severity of sequelae. Small foci of low signal intensity in T 1 -weighted imaging are considered in the literature to indicate myelomalacia or cyst formation with gliosis. (author)

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

Computed tomography in the evaluation of caudal cervical spondylomyelopathy of the Doberman Pinscher

International Nuclear Information System (INIS)

Sharp, N.J.H.; Cofone, M.; Robertson, I.D.; DeCarlo, A.; Smith, G.K.; Thrall, D.E.

1995-01-01

Caudal cervical spondylomyelopathy is a common neurologic disorder of Doberman pinschers which has a number of striking similarities to cervical spondylotic myelopathy in humans. Diagnosis of this human disease is facilitated considerably by the use of computed tomographic (CT) myelography. Sixteen Doberman pinscher dogs with caudal cervical spondylomyelopathy were studied by conventional myelography followed by CT myelography. A close correlation was noted between the CT myelographic appearance of the cervical spinal cord in these dogs, and that reported for human cervical spondylotic myelopathy. Five dogs had atrophy of the spinal cord, and in another there was an accumulation of contrast medium within the spinal cord. These features are often associated with a poor response to surgical decompression in humans with cervical spondylotic myelopathy. The CT examination provided information that could not be obtained by conventional myelography alone and should be considered as an additional diagnostic procedure in dogs with caudal cervical spondylomyelopathy

Neuroimaging for spine and spinal cord surgery

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Koyanagi, Izumi [Hokkaido Neurosurgical Memorial Hospital (Japan); Iwasaki, Yoshinobu; Hida, Kazutoshi

2001-01-01

Recent advances in neuroimaging of the spine and spinal cord are described based upon our clinical experiences with spinal disorders. Preoperative neuroradiological examinations, including magnetic resonance (MR) imaging and computerized tomography (CT) with three-dimensional reconstruction (3D-CT), were retrospectively analyzed in patients with cervical spondylosis or ossification of the posterior longitudinal ligament (130 cases), spinal trauma (43 cases) and intramedullary spinal cord tumors (92 cases). CT scan and 3D-CT were useful in elucidating the spine pathology associated with degenerative and traumatic spine diseases. Visualization of the deformity of the spine or fracture-dislocation of the spinal column with 3D-CT helped to determine the correct surgical treatment. MR imaging was most important in the diagnosis of both spine and spinal cord abnormalities. The axial MR images of the spinal cord were essential in understanding the laterality of the spinal cord compression in spinal column disorders and in determining surgical approaches to the intramedullary lesions. Although non-invasive diagnostic modalities such as MR imaging and CT scans are adequate for deciding which surgical treatment to use in the majority of spine and spinal cord disorders, conventional myelography is still needed in the diagnosis of nerve root compression in some cases of cervical spondylosis. (author)

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

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Dario Cazzola

Full Text Available 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.

[Case report: Iatrogenic shoulder pain syndrome following spinal accessory nerve injury during lateral cervical neck dissection for tongue cancer: the role of rehabilitation and ethical-deontological issues].

Science.gov (United States)

Ronconi, Gianpaolo; Spagnolo, Antonio Gioacchino; Ferriero, Giorgio; Giovannini, Silvia; Amabile, Eugenia; Maccauro, Giulio; Ferrara, Paola Emilia

2017-01-01

The shoulder pain syndrome is the most frequent complication of lateral cervical neck dissection and may be caused by iatrogenic injury to the spinal accessory nerve, causing pain and functional limitation of the upper limb and of the cervical spine. Interdisciplinary collaboration and early rehabilitation can reduce the consequences of disability and the possible issues that can arise due to inadequate management of the problem.

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.

Effects of hyperthermia applied to previously irradiated cervical spinal cord in the rat

International Nuclear Information System (INIS)

Sminia, P.; Haveman, J.; Koedoder, C.

1991-01-01

Rat cervical spinal cord was X-ray irradiated at doses of 15, 18, 20 and 26 Gy. Approximately the same part of the spinal cord was heated by means of a 434 MHz microwave applicator 90 days later. After treatment, animals were observed for 18 months, for expression of neurological complications. These could either be result of the heat or of the radiation treatment. The time course showed 3 distinct peaks in the incidence of neurological symptoms. The 1st peak was due to the acute response to hyperthermia. The ED 50 value for neurological complications one day after treatment at 42.3±0.4 o C was 74 ±2 min. Previous X-ray irradiation of spinal cord with 18, 20 and 26 Gy reduced ED 50 to 57±7,65±4 and 55±5 min (12-26% of control), resp. Recovery from heat-induced neurological complications was diminished in previously irradiated animals. The 2nd peak (150-300 days after X-rays) concerned expression of 'early-delayed' radiation damage. Hyperthermia given in 90 days after irradiation did not influence either the percentage of animals with paralysis or the latent period. Neurological symptoms developing after day 300 were due to the late delayed radiation response. Significant difference was not observed in data on paralysis induced by radiation alone or radiation followed by heat. The late radiation-induced minor neurological symptoms, were however, influenced by retreatment with heat. (author). 30 refs., 6 figs., 3 tabs

Magnetic resonance imaging in patients with progressive myelopathy following spinal surgery.

OpenAIRE

Avrahami, E; Tadmor, R; Cohn, D F

1989-01-01

Thirty one patients with insidious progressive myelopathy 2 to 8 years following surgery of the cervical spine were subjected to magnetic resonance imaging (MRI). In 15 patients operated on for vascular malformations or intramedullary tumours, syringomyelia and cystic lesions of the spinal cord were shown. Seven of these patients also showed a combination of a recurrent tumour and spinal atrophy. Out of 16 patients who had surgery for herniated disc or spinal stenosis of the cervical spine, f...

Management of Cervical Kyphosis in Larsen Syndrome: A Case Report

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Ebrahim Ameri

2016-10-01

Full Text Available Introduction Larsen syndrome is a congenital skeletal disorder manifested by several facial, ligamentous and spinal complications. Cervical kyphosis is one of the serious manifestations of the Larsen syndrome. However, there is no consensus regarding the best procedure of cervical kyphosis management in these patients. Case Presentation A 1-year-old boy with the diagnosis of the Larsen syndrome was admitted to our hospital and undergone several corrective surgeries for knee, hip and foot deformities. At the age of 2 years, scoliosis was diagnosed and surgically managed. At the same time, cervical kyphosis was observed and monitored until the symptoms of neurological deficit due to cord compression led to the correction of cervical Kyphosis at the age of 4.5 years. Accordingly, an anterior/posterior (360 degree cervical spinal fusion surgery was performed. Subsequently, cervicothoracic fusion was performed to correct cervicothoracic instability. No neurological complications were reported afterward. Conclusions In spite of existing controversy around the best method of cervical kyphosis management in Larsen syndrome’s patients older than 2- year old, anterior release and posterior fixation followed by anterior spinal fusion and strut grafting led to the satisfactory result in our case.

Diffusion tensor magnetic resonance imaging may show abnormalities in the normal-appearing cervical spinal cord from patients with multiple sclerosis

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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.

Cervical disc herniation manifesting as a Brown-Sequard syndrome

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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.

Operation of a P300-based brain-computer interface by individuals with cervical spinal cord injury.

Science.gov (United States)

Ikegami, Shiro; Takano, Kouji; Saeki, Naokatsu; Kansaku, Kenji

2011-05-01

This study evaluates the efficacy of a P300-based brain-computer interface (BCI) with green/blue flicker matrices for individuals with cervical spinal cord injury (SCI). Ten individuals with cervical SCI (age 26-53, all male) and 10 age- and sex-matched able-bodied controls (age 27-52, all male) with no prior BCI experience were asked to input hiragana (Japanese alphabet) characters using the P300 BCI with two distinct types of visual stimuli, white/gray and green/blue, in an 8×10 flicker matrix. Both online and offline performance were evaluated. The mean online accuracy of the SCI subjects was 88.0% for the white/gray and 90.7% for the green/blue flicker matrices. The accuracy of the control subjects was 77.3% and 86.0% for the white/gray and green/blue, respectively. There was a significant difference in online accuracy between the two types of flicker matrix. SCI subjects performed with greater accuracy than controls, but the main effect was not significant. Individuals with cervical SCI successfully controlled the P300 BCI, and the green/blue flicker matrices were associated with significantly higher accuracy than the white/gray matrices. The P300 BCI with the green/blue flicker matrices is effective for use not only in able-bodied subjects, but also in individuals with cervical SCI. Copyright © 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Analysis of cervical kyphosis and spinal balance in young idiopathic scoliosis patients classified by the apex of thoracic kyphosis.

Science.gov (United States)

Ito, Kenyu; Imagama, Shiro; Ito, Zenya; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Tsushima, Mikito; Ishikawa, Yoshimoto; Matsumoto, Akiyuki; Nishida, Yoshihiro; Ishiguro, Naoki

2016-10-01

Sagittal balance has recently been the focus of studies aimed at understanding the correction force required for both coronal and sagittal malalignment. However, the correlation between cervical kyphosis and sagittal balance in AIS patients has yet to be thoroughly investigated. This study aimed to clarify the correlation between cervical alignment and spinal balance in patients with adolescent idiopathic scoliosis (AIS). Here, we hypothesized that cervical kyphosis patients can be classified into groups by the apex of thoracic kyphosis. This study included 92 AIS patients (84 females, 8 males; mean age, 15.1 years). Patients were divided into the cervical lordosis (CL), cervical sigmoid (CS), or cervical kyphosis (CK) groups and further classified according to the apex of thoracic kyphosis into High (above T3), Middle (T4-T9), and Low (below T10) groups. There were 17 (18.5 %), 22 (23.9 %), and 53 (57.6 %) patients with CL, CS, and CK, respectively. In the CK group, 13 had CK-High, 35 had CK-Middle, and 5 had CK-Low. The C7 sagittal vertical axis (C7SVA) measurements were most backward in CK-High and most forward in CK-Low. The T5-12 kyphosis (TK) measurement was significantly lower in CK-High. Most AIS patients had kyphotic cervical alignment. Patients with CK can be classified as having CK-High, CK-Middle, or CK-Low according to the apex of thoracic kyphosis. CK-High is due to thoracic hypokyphosis with a backward balanced C7SVA. CK-Middle is well-balanced cervical kyphosis. CK-Low has forward-bent global kyphosis of the cervicothoracic spine that positioned the C7SVA forward.

Diffusion tensor imaging in spinal cord injury

International Nuclear Information System (INIS)

Kamble, Ravindra B; Venkataramana, Neelam K; Naik, Arun L; Rao, Shailesh V

2011-01-01

To assess the feasibility of spinal tractography in patients of spinal cord injury vs a control group and to compare fractional anisotropy (FA) values between the groups. Diffusion tensor imaging (DTI) was performed in the spinal cord of 29 patients (18 patients and 11 controls). DTI was done in the cervical region if the cord injury was at the dorsal or lumbar region and in the conus region if cord injury was in the cervical or dorsal region. FA was calculated for the patients and the controls and the values were compared. The mean FA value was 0.550±0.09 in the control group and 0.367±0.14 in the patients; this difference was statistically significant (P=0.001). Spinal tractography is a feasible technique to assess the extent of spinal cord injury by FA, which is reduced in patients of spinal cord injury, suggesting possible Wallerian degeneration. In future, this technique may become a useful tool for assessing cord injury patients after stem cell therapy, with improvement in FA values indicating axonal regeneration

Dynamic changes in the dural space and spinal cord cross-sectional area during flexion and extension in patients with cervical spondylotic myelopathy

International Nuclear Information System (INIS)

Machino, Masaaki; Yukawa, Yasutsugu; Ito, Keigo; Nakashima, Hiroaki; Kato, Fumihiko

2009-01-01

The number of patients with cervical spondylotic myelopathy (CSM) is increasing with the aging of the population. The patients' during spinal cord tends to be compressed neck extension, because the yellow ligaments and intervertebral discs protrude into the spinal canal during neck extension (pincer mechanism). A total of 100 patients with CSM were prospectively enrolled in this study. After preoperative myelography, multi-detector-row CT (MDCT) scans were acquired in flexion and extension, and the dural space and spinal cord cross-sectional area at each disc level from C2/3 to C7/Th1 were measured by using Scion imaging software. The average dural space and average spinal cord cross-sectional area were smaller in extension than in flexion from the C3/4 to C7/Th1 disc level, and the greatest dynamic changes were seen at the C5/6 level. MDCT demonstrated dynamic factors in patients with CSM. The spinal cord cross-sectional area became narrower during extension in patients with CSM. (author)

Narrow cervical canal in 1211 asymptomatic healthy subjects: the relationship with spinal cord compression on MRI.

Science.gov (United States)

Nakashima, Hiroaki; Yukawa, Yasutsugu; Suda, Kota; Yamagata, Masatsune; Ueta, Takayoshi; Kato, Fumihiko

2016-07-01

Narrow cervical canal (NCC) has been a suspected risk factor for later development of cervical myelopathy. However, few studies have evaluated the prevalence in asymptomatic subjects. The purpose of this study was to investigate the prevalence of NCC in a large cohort of asymptomatic volunteers. This study was a cross-sectional study of 1211 asymptomatic volunteers. Approximately 100 men and 100 women representing each decade of life from the 20s to the 70s were included in this study. Cervical canal anteroposterior diameters at C5 midvertebral level on X-rays, and the prevalence of spinal cord compression (SCC) and increased signal intensity (ISI) changes on MRI were evaluated. Receiver operating characteristic analysis was performed to determine the cut-off value of the severity of canal stenosis resulting in SCC. NCC (<14 mm) was observed in 123 (10.2 %) subjects. SCC and ISI were found in 64 (5.3 %) and 28 (2.3 %) subjects, respectively. The prevalence of NCC was significantly higher in females and older subjects, but the occurrence of severe NCC (<12 mm) did not increase with age. The canal size in subjects with SCC or ISI was significantly smaller than in those without SCC (p < 0.0001). The cut-off values of cervical canal stenosis resulting in SCC were 14.8 and 13.9 mm in males and females, respectively. The prevalence of NCC was considerably lower among asymptomatic healthy volunteers; the cervical canal diameter in subjects with SCC or ISI was significantly smaller than in asymptomatic subjects; NCC is a risk factor for SCC.

Modulation of hand aperture during reaching in persons with incomplete cervical spinal cord injury.

Science.gov (United States)

Stahl, Victoria A; Hayes, Heather B; Buetefisch, Cathrin M; Wolf, Steven L; Trumbower, Randy D

2015-03-01

The intact neuromotor system prepares for object grasp by first opening the hand to an aperture that is scaled according to object size and then closing the hand around the object. After cervical spinal cord injury (SCI), hand function is significantly impaired, but the degree to which object-specific hand aperture scaling is affected remains unknown. Here, we hypothesized that persons with incomplete cervical SCI have a reduced maximum hand opening capacity but exhibit novel neuromuscular coordination strategies that permit object-specific hand aperture scaling during reaching. To test this hypothesis, we measured hand kinematics and surface electromyography from seven muscles of the hand and wrist during attempts at maximum hand opening as well as reaching for four balls of different diameters. Our results showed that persons with SCI exhibited significantly reduced maximum hand aperture compared to able-bodied (AB) controls. However, persons with SCI preserved the ability to scale peak hand aperture with ball size during reaching. Persons with SCI also used distinct muscle coordination patterns that included increased co-activity of flexors and extensors at the wrist and hand compared to AB controls. These results suggest that motor planning for aperture modulation is preserved even though execution is limited by constraints on hand opening capacity and altered muscle co-activity. Thus, persons with incomplete cervical SCI may benefit from rehabilitation aimed at increasing hand opening capacity and reducing flexor-extensor co-activity at the wrist and hand.

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.

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

International Nuclear Information System (INIS)

Pessôa, Fernanda Miraldi Clemente; Lopes, Fernanda Cristina Rueda; Costa, João Victor Altamiro; Leon, Soniza Vieira Alves; Domingues, Romeu Côrtes; Gasparetto, Emerson Leandro

2012-01-01

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

Cervical spinal cord injury without radiological abnormality in adults.

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Bhatoe H

2000-01-01

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 c...

Enhancing neural activity to drive respiratory plasticity following cervical spinal cord injury

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Hormigo, Kristiina M.; Zholudeva, Lyandysha V.; Spruance, Victoria M.; Marchenko, Vitaliy; Cote, Marie-Pascale; Vinit, Stephane; Giszter, Simon; Bezdudnaya, Tatiana; Lane, Michael A.

2016-01-01

Cervical spinal cord injury (SCI) results in permanent life-altering sensorimotor deficits, among which impaired breathing is one of the most devastating and life-threatening. While clinical and experimental research has revealed that some spontaneous respiratory improvement (functional plasticity) can occur post-SCI, the extent of the recovery is limited and significant deficits persist. Thus, increasing effort is being made to develop therapies that harness and enhance this neuroplastic potential to optimize long-term recovery of breathing in injured individuals. One strategy with demonstrated therapeutic potential is the use of treatments that increase neural and muscular activity (e.g. locomotor training, neural and muscular stimulation) and promote plasticity. With a focus on respiratory function post-SCI, this review will discuss advances in the use of neural interfacing strategies and activity-based treatments, and highlights some recent results from our own research. PMID:27582085

Local injection of Lenti-Olig2 at lesion site promotes functional recovery of spinal cord injury in rats.

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Tan, Bo-Tao; Jiang, Long; Liu, Li; Yin, Ying; Luo, Ze-Ru-Xin; Long, Zai-Yun; Li, Sen; Yu, Le-Hua; Wu, Ya-Min; Liu, Yuan

2017-06-01

Olig2 is one of the most critical factors during CNS development, which belongs to b-HLH transcription factor family. Previous reports have shown that Olig2 regulates the remyelination processes in CNS demyelination diseases models. However, the role of Olig2 in contusion spinal cord injury (SCI) and the possible therapeutic effects remain obscure. This study aims to investigate the effects of overexpression Olig2 by lentivirus on adult spinal cord injury rats. Lenti-Olig2 expression and control Lenti-eGFP vectors were prepared, and virus in a total of 5 μL (10 8 TU/mL) was locally injected into the injured spinal cord 1.5 mm rostral and caudal near the epicenter. Immunostaining, Western blot, electron microscopy, and CatWalk analyzes were employed to investigate the effects of Olig2 on spinal cord tissue repair and functional recovery. Injection of Lenti-Olig2 significantly increased the number of oligodendrocytes lineage cells and enhanced myelination after SCI. More importantly, the introduction of Olig2 greatly improved hindlimb locomotor performances. Other oligodendrocyte-related transcription factors, which were downregulated or upregulated after injury, were reversed by Olig2 induction. Our findings provided the evidence that overexpression Olig2 promotes myelination and locomotor recovery of contusion SCI, which gives us more understanding of Olig2 on spinal cord injury treatment. © 2017 John Wiley & Sons Ltd.

Reference values for radiological evaluation of cervical vertebral body shape and spinal canal

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Remes, V.M. [Hospital for Children and Adolescents, Helsinki University Central Hospital (Finland); Heinaenen, M.T.; Marttinen, E.J. [Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Kinnunen, J.S. [Department of Radiology, Helsinki University Central Hospital, HYKS (Finland)

2000-03-01

Background. Defining normal values is essential for reliable evaluation of growth disturbances. Previous studies of the cervical spine have mainly focused on the sagittal canal diameter and interpedicular distances. Values for vertebral body height and depth have been published only in adult men and cadavers.Objectives. To define normal values for vertebral body height (H)/vertebral body depth (D) ratio (H/D ratio) and sagittal canal diameter (S)/vertebral body depth ratio (S/D ratio) in C2-7.Materials and methods. Lateral cervical spine radiographs were available from 441 children and 192 adults. Subjects' ages varied from newborn to 39 years. Vertebral body height and depth and sagittal canal diameter were measured and ratios were calculated. This was a cross-sectional and retrospective study.Results. Vertebral bodies grow relatively more in height than in depth, most actively at puberty. At all levels, the H/D ratio remains below 1, indicating that vertebral body depth is greater than height. The SD ratio is quite stable until 7-8 years of age and then it starts to decline slowly.Conclusions. When estimating platyspondyly, the age of the patient must be taken into consideration because vertebral body height is lower in children. Growth of the spinal canal declines after 7-8 years of age. (orig.)

Reference values for radiological evaluation of cervical vertebral body shape and spinal canal

International Nuclear Information System (INIS)

Remes, V.M.; Heinaenen, M.T.; Marttinen, E.J.; Kinnunen, J.S.

2000-01-01

Background. Defining normal values is essential for reliable evaluation of growth disturbances. Previous studies of the cervical spine have mainly focused on the sagittal canal diameter and interpedicular distances. Values for vertebral body height and depth have been published only in adult men and cadavers.Objectives. To define normal values for vertebral body height (H)/vertebral body depth (D) ratio (H/D ratio) and sagittal canal diameter (S)/vertebral body depth ratio (S/D ratio) in C2-7.Materials and methods. Lateral cervical spine radiographs were available from 441 children and 192 adults. Subjects' ages varied from newborn to 39 years. Vertebral body height and depth and sagittal canal diameter were measured and ratios were calculated. This was a cross-sectional and retrospective study.Results. Vertebral bodies grow relatively more in height than in depth, most actively at puberty. At all levels, the H/D ratio remains below 1, indicating that vertebral body depth is greater than height. The SD ratio is quite stable until 7-8 years of age and then it starts to decline slowly.Conclusions. When estimating platyspondyly, the age of the patient must be taken into consideration because vertebral body height is lower in children. Growth of the spinal canal declines after 7-8 years of age. (orig.)

[Clinical study on spinal cord decompression combined with traditional Chinese medicine for the treatment of cervical spondylotic myelopathy].

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Yang, Feng; Tan, Ming-Sheng; Yi, Ping; Tang, Xiang-Sheng; Hao, Qing-Ying; Qi, Ying-Na

2018-01-25

To compare the clinical effect between spinal card decompression combined with traditional Chinese medicine and simple spinal card decompression for cervical spondylotic myelopathy. From June 2012 to June 2015, 73 patients with cervical spondylotic myelopathy were treated, including 42 males and 31 females, aged from 29 to 73 years old with a mean of 50.9 years old. The patients were divided into the simple operation group (34 cases) and the operation combined with traditional Chinese medicine group(39 cases) according to the idea of themselves. The anterior discectomy or subtotal corpectomy with internal fixation or posterior simple open-door decompression with lateral mass screw fixation were performed in the patients. Among them, 39 cases were treated with traditional Chinese medicine after surgery. The Japanese orthopedic association (JOA) score of spinal cord function, the improvement rate of neural function, the neck dysfunction index (NDI) score and the governor vessel stasis syndrome score were compared between two groups preoperative and postoperative 1 week, 1 month and the final follow-up respectively. The internal fixation and the condition of spinal cord decompression were observed by CT, MRI and X-rays before and after operation. All the operations were successful, no injuries such as dura mater, spinal cord and nerve root were found. All the wounds were healed without infection except one patient had a superficial infection. It was solved after intermittent debridement and anti-infective therapy. Hematoma occurred in 1 case, complicated with spinal cord compression, caused incomplete paralysis, and promptly performed the re-operation to remove the hematoma without any obvious sequelae. All the patients were followed up from 12 to 24 months, (14.6±0.8) months for simple operation group and (13.5±0.7) months for operation combined with traditional Chinese medicine group, and there was no significant difference( P >0.05). The scores of JOA, NDI and

Clearance of the cervical spine in clinically unevaluable trauma patients.

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Halpern, Casey H; Milby, Andrew H; Guo, Wensheng; Schuster, James M; Gracias, Vicente H; Stein, Sherman C

2010-08-15

Meta-analytic costeffectiveness analysis. Our goal was to compare the results of different management strategies for trauma patients in whom the cervical spine was not clinically evaluable due to impaired consciousness, endotracheal intubation, or painful distracting injuries. We performed a structured literature review related to cervical spine trauma, radiographic clearance techniques (plain radiography, flexion/extension, CT, and MRI), and complications associated with semirigid collar use. Meta-analytic techniques were used to pool data from multiple sources to calculate pooled mean estimates of sensitivities and specificities of imaging techniques for cervical spinal clearance, rates of complications from various clearance strategies and from empirical use of semirigid collars. A decision analysis model was used to compare outcomes and costs among these strategies. Slightly more than 7.5% of patients who are clinically unevaluable have cervical spine injuries, and 42% of these injuries are associated with spinal instability. Sensitivity of plain radiography or fluoroscopy for spinal clearance was 57% (95% CI: 57%-60%). Sensitivities for CT and MRI alone were 83% (82%-84%) and 87% (84%-89%), respectively. Complications associated with collar use ranged from 1.3% (2 days) to 7.1% (10 days) but were usually minor and short-lived. Quadriplegia resulting from spinal instability missed by a clearance test had enormous impacts on longevity, quality of life, and costs. These impacts overshadowed the effects of prolonged collar application, even when the incidence of quadriplegia was extremely low. As currently used, neuroimaging studies for cervical spinal clearance in clinically unevaluable patients are not cost-effective compared with empirical immobilization in a semirigid collar.

Gemistocytic astrocytoma in the spinal cord in a dog: a case report

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R.O. Chaves

2016-08-01

Full Text Available ABSTRACT This paper reports a case of a rare variant of the cervical spinal cord astrocytoma diagnosed in a dog with progressive neurological signs, initially asymmetrical, not ambulatory tetraparesis, segmental reflexes and normal muscle tone in all four limbs and absence of pain upon palpation of the cervical spine. Myelography revealed attenuation of the ventral and dorsal contrast line in the third region of the fifth cervical vertebra. At necropsy intramedullary cylindrical mass that stretched from the third to the sixth cervical vertebra, which replaced all the gray matter of the spinal cord was observed. In the histological study, there was the replacement of the substance by neoplastic cells mantle arranged loosely. The cells were large and slightly rounded. The eosinophilic cytoplasm was well defined, sometimes forming processes interconnecting cells. The nucleus was eccentric, round, oval or kidney-shaped, and the nucleolus was evident. Thus, the microscopic changes observed in the cervical spinal cord were consistent with gemistocytic astrocytoma.

The prevalence of cervical myelopathy among subjects with narrow cervical spinal canal in a population-based magnetic resonance imaging study: the Wakayama Spine Study.

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Nagata, Keiji; Yoshimura, Noriko; Hashizume, Hiroshi; Muraki, Shigeyuki; Ishimoto, Yuyu; Yamada, Hiroshi; Takiguchi, Noboru; Nakagawa, Yukihiro; Minamide, Akihito; Oka, Hiroyuki; Kawaguchi, Hiroshi; Nakamura, Kozo; Akune, Toru; Yoshida, Munehito

2014-12-01

A narrow cervical spinal canal (CSC) is a well-known risk factor for cervical myelopathy (CM). However, no epidemiologic data of the CSC based on a population-based cohort are available. The purpose of the study was to investigate the age-related differences in CSC diameters on plain radiographs and to examine the associated magnetic resonance imaging (MRI) abnormalities including cervical cord compression and increased signal intensity (ISI) as well as the clinical CM with the narrow CSC. This was a cross-sectional study. Data were obtained from the baseline survey of the Wakayama Spine Study that was performed from 2008 to 2010 in a western part of Japan. Finally, a total of 959 subjects (319 men and 640 women; mean age, 66.4 years) were included. The outcome measures included in the study were the CSC diameter at C5 level on plain radiographs, cervical cord compression and ISI on sagittal T2-weighted MRI, and physical signs related to CM (eg, the Hoffmann reflex, hyperreflexia of the patellar tendon, the Babinski reflex, sensory and motor function, and bowel/bladder symptoms). The age-related differences of CSC diameters in men and women were investigated by descriptive statistics. The prevalence of MRI abnormalities and clinical CM was compared among the groups divided by the CSC diameter (less than 13, 13-15, and 15 mm or more). In addition, a logistic regression analysis was performed to determine the association of the CSC diameter with cervical cord compression/clinical CM after overall adjustment for age, sex, and body mass index. The CSC diameter was narrower with increasing age in both men and women. The prevalence of cervical cord compression, ISI, and the clinical CM was significantly higher in the narrower CSC group. The prevalence of cervical cord compression, ISI, and CM among subjects with CSC diameter less than 13 mm was 38.0%, 5.4%, and 10.1%, respectively. In the logistic model, the CSC diameter was a significant predictive factor for the

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.

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

International Nuclear Information System (INIS)

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

1984-01-01

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

Functional restoration of the paralyzed diaphragm in high cervical quadriplegia via phrenic nerve neurotization utilizing the functional spinal accessory nerve.

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Yang, Ming-liang; Li, Jian-jun; Zhang, Shao-cheng; Du, Liang-jie; Gao, Feng; Li, Jun; Wang, Yu-ming; Gong, Hui-ming; Cheng, Liang

2011-08-01

The authors report a case of functional improvement of the paralyzed diaphragm in high cervical quadriplegia via phrenic nerve neurotization using a functional spinal accessory nerve. Complete spinal cord injury at the C-2 level was diagnosed in a 44-year-old man. Left diaphragm activity was decreased, and the right diaphragm was completely paralyzed. When the level of metabolism or activity (for example, fever, sitting, or speech) slightly increased, dyspnea occurred. The patient underwent neurotization of the right phrenic nerve with the trapezius branch of the right spinal accessory nerve at 11 months postinjury. Four weeks after surgery, training of the synchronous activities of the trapezius muscle and inspiration was conducted. Six months after surgery, motion was observed in the previously paralyzed right diaphragm. The lung function evaluation indicated improvements in vital capacity and tidal volume. This patient was able to sit in a wheelchair and conduct outdoor activities without assisted ventilation 12 months after surgery.

The cranial-spinal junction in medulloblastoma: does it matter?

International Nuclear Information System (INIS)

Narayana, Ashwatha; Jeswani, Sam; Paulino, Arnold C.

1999-01-01

Purpose: Late effects of treatment in children and young adults with medulloblastoma can be influenced by the technique employed in radiating the craniospinal axis. The purpose of this study is to determine whether the placement of the cranial-spinal junction has an impact on dose to the cervical spinal cord and surrounding organs. Methods and Materials: Five patients underwent computed tomography (CT) simulation in the prone position for craniospinal irradiation. A dose of 36 Gy was prescribed to the entire neuraxis. The doses to the cervical spinal cord and surrounding organs were calculated using a cranial-spinal junction at the C1-C2 vertebral interspace (high junction) or at the lowest point in the neck, with exclusion of the shoulders in the lateral cranial fields (low junction).The volume of critical organs at risk, as well as dose to these structures using the cranial and spinal field(s) were outlined and calculated using the CMS FOCUS 3-dimensional treatment planning system. Results: The average dose to the cervical spinal cord was 11.9% higher than the prescribed dose with the low junction, and 6.7% higher with the high junction. However, doses to the thyroid gland, mandible, pharynx, and larynx were increased by an average of 29.6%, 75.8%, 70.6%, and 227.7%, respectively, by the use of the high junction compared to the low junction. Conclusion: A higher dose to the cervical spinal cord can be minimized by using a high junction. However, this would be at the cost of substantially increased doses to surrounding organs such as the thyroid gland, mandible, pharynx, and larynx. This can be critical in children and young adults, where hypothyroidism, mandibular hypoplasia, and development of second malignancies may be a late sequela of radiation therapy

Venous hypertensive myelopathy associated with cervical spondylosis.

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Okada, Seiji; Chang, Charles; Chang, Geraldine; Yue, James J

2016-11-01

Venous hypertensive myelopathy (VHM) results from spinal vascular malformations of arteriovenous shunting that increases spinal venous pressure, leading to congestive edema and neurologic dysfunction. There has been no report of VHM associated with cervical spondylotic myelopathy (CSM). The aim of this study was to report an extremely rare case of VHM likely due to CSM. This study is a case report and review of the literature. The patient was a 51-year-old man with CSM exhibiting relatively rapid neurologic deterioration with an abnormal expansion of a centromedullary hyperintense lesion on T2-weighted magnetic resonance imaging (MRI) in the absence of traumatic injury. Neurologic examination and radiologic imaging were taken by various means. The patient developed a cervical radiculopathy, followed by gait disturbance and motor weakness. The MRI of the cervical spine demonstrated spinal canal stenosis due to disc bulging and flavum hypertrophy at the C5/C6 and C6/C7 levels as well as hyperintense area over the C5-C7 levels on T2-weighted images. Although decompression surgery was planned, an acute inflammatory process such as transverse myelitis or demyelinating disease other than cord compression was also considered, and the patient received intravenous steroids. His walking improved for several days. However, his symptoms then became significantly worse, and he had difficulty walking. Subsequent MRI demonstrated marked progression of the T2 hyperintense lesion over the C4-T1 vertebral levels. Flow voids were also noted on the dorsal surface of the upper cervical cord on T2-weighted MRI. His lab work, medical history, and the local enhancement on contrast-enhanced MRI indicated low probability of spinal inflammatory diseases. Therefore, the decision was made to perform anterior cervical discectomy and fusion surgery on two levels. Following surgery, his symptoms improved promptly. Our case indicates that VHM could be caused by spondylotic cord compression in the

Asymptomatic grotesque deformities of the cervical spine. An occupational hazard in railway porters.

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Kelkar, P; O'Callaghan, B; Lovblad, K O

1998-03-15

A case report. To illustrate an extremely rare occurrence of chronic, occupational, low-grade trauma leading to asymptomatic grotesque cervical spine deformities in railroad station porters. Occupational trauma causing spinal deformities has been described in relation to thoracic and lumbar spines in miners. To the authors' knowledge, this is the first reported case of asymptomatic cervical spinal deformity in railway porters as a result of chronic occupational trauma. A magnetic resonance imaging study was performed on both patients. The magnetic resonance images showed advanced degenerative changes in the cervical spine causing obvious deformities, along with apparently normal cord signal intensity. Chronic, occupational, low-grade trauma of the cervical vertebral region is extremely unusual in industrialized countries. Nevertheless, in view of the increasing mobility of people in general and of the labor force in particular, this complication of an occupational exposure deserves attention as an unusual cause of cervical spinal deformity.

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

International Nuclear Information System (INIS)

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

Lavandula angustifolia Extract Improves the Result of Human Umbilical Mesenchymal Wharton’s Jelly Stem Cell Transplantation after Contusive Spinal Cord Injury in Wistar Rats

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Kayvan Yaghoobi

2016-01-01

Full Text Available Introduction. The primary trauma of spinal cord injury (SCI results in severe damage to nervous functions. At the cellular level, SCI causes astrogliosis. Human umbilical mesenchymal stem cells (HUMSCs, isolated from Wharton’s jelly of the umbilical cord, can be easily obtained. Previously, we showed that the neuroprotective effects of Lavandula angustifolia can lead to improvement in a contusive SCI model in rats. Objective. The aim of this study was to investigate the effect of L. angustifolia (Lav on HUMSC transplantation after acute SCI. Materials and Methods. Sixty adult female rats were randomly divided into eight groups. Every week after SCI onset, all animals were evaluated for behavior outcomes. H&E staining was performed to examine the lesions after injury. GFAP expression was assessed for astrogliosis. Somatosensory evoked potential (SEP testing was performed to detect the recovery of neural conduction. Results. Behavioral tests showed that the HUMSC group improved in comparison with the SCI group, but HUMSC + Lav 400 was very effective, resulting in a significant increase in locomotion activity. Sensory tests and histomorphological and immunohistochemistry analyses verified the potentiation effects of Lav extract on HUMSC treatment. Conclusion. Transplantation of HUMSCs is beneficial for SCI in rats, and Lav extract can potentiate the functional and cellular recovery with HUMSC treatment in rats after SCI.

Radiation tolerance of the cervical spinal cord: incidence and dose-volume relationship of symptomatic and asymptomatic late effects following high dose irradiation of paraspinal tumors

International Nuclear Information System (INIS)

Liu, Mitchell C.C.; Munzenrider, John E.; Finkelstein, Dianne; Liebsch, Norbert; Adams, Judy; Hug, Eugen B.

1997-01-01

Purpose: Low grade chordomas and chondrosarcomas require high radiation doses for effective, lasting tumor control. Fractionated, 3-D planned, conformal proton radiation therapy has been used for lesions along the base of skull and spine to deliver high target doses, while respecting constraints of critical, normal tissues. In this study, we sought to determine the incidence of myelopathy after high dose radiotherapy to the cervical spine and investigated the influence of various treatment parameters, including dose-volume relationship. Methods and Materials: Between December 1980 and March 1996, 78 patients were treated at the Massachusetts General Hospital and Harvard Cyclotron Laboratory for primary or recurrent chordomas and chondrosarcomas of the cervical spine using combined proton and photon radiation therapy. In general, the tumor dose given was between 64.5 to 79.2 CGE (Cobalt Gray Equivalent). The guidelines for maximum permissible doses to spinal cord were: ≤ 64 CGE to the spinal cord surface and ≤ 53 CGE to the spinal cord center. Dose volume histograms of the spinal cord were analyzed to investigate a possible dose and volume relationship. Results: With a mean follow-up period of 46.6 months (range: 3 - 157 months), 4 of 78 patients (5.1%) developed high-grade (RTOG Grade 3 and 4) late toxicity: 3 patients (3.8%) experienced sensory deficits without motor deficits, none had any limitations of daily activities. One patient (1.2%) developed motor deficit with loss of motor function of one upper extremity. The only patient, who developed permanent motor damage had received additional prior radiation treatment and therefore received a cumulative spinal cord dose higher than the treatment guidelines. No patient treated within the guidelines experienced any motor impairment. Six patients (7.7%) experienced transient Lhermitt's syndrome and 1 patient (1.2%) developed asymptomatic radiographic MR findings only. Time to onset of symptoms of radiographic

Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine.

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Tetreault, Lindsay; Goldstein, Christina L; Arnold, Paul; Harrop, James; Hilibrand, Alan; Nouri, Aria; Fehlings, Michael G

2015-10-01

Cervical spinal cord dysfunction can result from either traumatic or nontraumatic causes, including tumors, infections, and degenerative changes. In this article, we review the range of degenerative spinal disorders resulting in progressive cervical spinal cord compression and propose the adoption of a new term, degenerative cervical myelopathy (DCM). DCM comprises both osteoarthritic changes to the spine, including spondylosis, disk herniation, and facet arthropathy (collectively referred to as cervical spondylotic myelopathy), and ligamentous aberrations such as ossification of the posterior longitudinal ligament and hypertrophy of the ligamentum flavum. This review summarizes current knowledge of the pathophysiology of DCM and describes the cascade of events that occur after compression of the spinal cord, including ischemia, destruction of the blood-spinal cord barrier, demyelination, and neuronal apoptosis. Important features of the diagnosis of DCM are discussed in detail, and relevant clinical and imaging findings are highlighted. Furthermore, this review outlines valuable assessment tools for evaluating functional status and quality of life in these patients and summarizes the advantages and disadvantages of each. Other topics of this review include epidemiology, the prevalence of degenerative changes in the asymptomatic population, the natural history and rates of progression, risk factors of diagnosis (clinical, imaging and genetic), and management strategies.

X-ray picture of lung contusion in penetrating chest wounds

International Nuclear Information System (INIS)

Ishchenko, B.I.; Bisenkov, L.N.; Bol'shakov, G.A.

1983-01-01

From the view-point of an x-ray appearance gUnshot lUng in uries are characterized by nonhomogeneous darkening of an oblong or spheroidal shape which is more intense in the center with unclear contours UsUally sited in the peripheral zones of the lung. Sometimes a cavity of 4-5 cm in diame-- ter is determined in the zone of contUsion. In half of the patients contusion injuries of the lungs were combined with hemopneumothorax. With respect to differential diagnosis it is necessary to distinguish lung contusions from atelectasis, pneumonia and abscesses. Importance shoUld be attached to the peculiarities of a skialogical picture, the time of development and the time course of changes in the lungs, the nature and degree of clinical minifestations

Blast overpressure induced axonal injury changes in rat brainstem and spinal cord

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Srinivasu Kallakuri

2015-01-01

Full Text Available Introduction: Blast induced neurotrauma has been the signature wound in returning soldiers from the ongoing wars in Iraq and Afghanistan. Of importance is understanding the pathomechansim(s of blast overpressure (OP induced axonal injury. Although several recent animal models of blast injury indicate the neuronal and axonal injury in various brain regions, animal studies related to axonal injury in the white matter (WM tracts of cervical spinal cord are limited. Objective: The purpose of this study was to assess the extent of axonal injury in WM tracts of cervical spinal cord in male Sprague Dawley rats subjected to a single insult of blast OP. Materials and Methods: Sagittal brainstem sections and horizontal cervical spinal cord sections from blast and sham animals were stained by neurofilament light (NF-L chain and beta amyloid precursor protein immunocytochemistry and observed for axonal injury changes. Results: Observations from this preliminary study demonstrate axonal injury changes in the form of prominent swellings, retraction bulbs, and putative signs of membrane disruptions in the brainstem and cervical spinal cord WM tracts of rats subjected to blast OP. Conclusions: Prominent axonal injury changes following the blast OP exposure in brainstem and cervical spinal WM tracts underscores the need for careful evaluation of blast induced injury changes and associated symptoms. NF-L immunocytochemistry can be considered as an additional tool to assess the blast OP induced axonal injury.

Indication for the operative methods in surgical treatment of cervical spondylotic myelopathy

International Nuclear Information System (INIS)

Kobayashi, Akira; Inoue, Shunichi; Watabe, Tsuneo; Nagase, Joji; Harada, Yoshitada

1984-01-01

Indication for the operative methods for cervical spondylotic myelopathy was examined in 16 patients undergoing CT-myelography before and after operation. There was a highly significant correlation between the anteroposterior (A-P) diameter of the spinal cord and clinical symptoms. Patients with shorter A-P diameter of the spinal cord tended to have severer preoperative clinical symptoms. Clinical symptoms improved as the post operative A-P diameter of the spinal cord increased. Fixation with decompression of the anterior spinal cord should be indicated when constriction of 5 mm or less of the spinal cord is seen segmentally at the level of the intervertebral disc. Dilation of the spinal cavity should be indicated when the constriction of the spinal cord is 5 mm or less at all levels of the cervical spinal cord. In performing fixation with anterior decompression, 15 mm is considered to be the most suitable width for complete and safe decompression of the flattened spinal cord with a wide transverse diameter. (Namekawa, K)

Imaging of spinal injury in abusive head trauma: a retrospective study

International Nuclear Information System (INIS)

Choudhary, Arabinda K.; Ishak, Ramsay; Zacharia, Thomas T.; Dias, Mark S.

2014-01-01

Spinal imaging has been a neglected part of abusive head trauma (AHT) imaging. As most of the radiographs and CT spine are negative in AHT in infants, the cervical spine is assumed to be normal. There is increasing evidence in the role of injury to brainstem and cervical cord in the pathogenesis of AHT. In addition, in courts of law, there is fierce debate about AHT, its mimics and other disparate nontraumatic diagnoses explaining the neuroradiological and skeletal findings. However, this discussion ignores the evidence and significance of spinal injury. We sought to study the cervical spine in an AHT cohort to understand the true prevalence of spinal injuries in AHT and contrast it with cohorts of accidental and nontraumatic groups to give the clinicians a robust diagnostic tool in evaluating AHT. The purpose of this study is to compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages < 48 months: (1) those with AHT, (2) those with accidental trauma, and (3) those with nontraumatic conditions. This comparative study included 183 children who underwent spine MRI: 67 with AHT, 46 with accidental trauma and a clinical suspicion of spinal injury, and 70 with nontraumatic conditions. Clinical and radiographic findings were collected in all cases and were analyzed retrospectively to identify MRI evidence of traumatic spinal injuries. The incidence of spinal injuries among the three groups was compared. The incidence of spinal ligamentous injuries was calculated for those with and without radiographic evidence of hypoxic-ischemic encephalopathy. All comparisons were performed using Fisher exact test with P < 0.05 considered statistically significant. Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were

Imaging of spinal injury in abusive head trauma: a retrospective study

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Choudhary, Arabinda K. [Nemours A.I. DuPont Children Hospital, Department of Radiology, Wilmington, DE (United States); Ishak, Ramsay; Zacharia, Thomas T. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

2014-09-15

Spinal imaging has been a neglected part of abusive head trauma (AHT) imaging. As most of the radiographs and CT spine are negative in AHT in infants, the cervical spine is assumed to be normal. There is increasing evidence in the role of injury to brainstem and cervical cord in the pathogenesis of AHT. In addition, in courts of law, there is fierce debate about AHT, its mimics and other disparate nontraumatic diagnoses explaining the neuroradiological and skeletal findings. However, this discussion ignores the evidence and significance of spinal injury. We sought to study the cervical spine in an AHT cohort to understand the true prevalence of spinal injuries in AHT and contrast it with cohorts of accidental and nontraumatic groups to give the clinicians a robust diagnostic tool in evaluating AHT. The purpose of this study is to compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages < 48 months: (1) those with AHT, (2) those with accidental trauma, and (3) those with nontraumatic conditions. This comparative study included 183 children who underwent spine MRI: 67 with AHT, 46 with accidental trauma and a clinical suspicion of spinal injury, and 70 with nontraumatic conditions. Clinical and radiographic findings were collected in all cases and were analyzed retrospectively to identify MRI evidence of traumatic spinal injuries. The incidence of spinal injuries among the three groups was compared. The incidence of spinal ligamentous injuries was calculated for those with and without radiographic evidence of hypoxic-ischemic encephalopathy. All comparisons were performed using Fisher exact test with P < 0.05 considered statistically significant. Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were

Changes in the neuroglial cell populations of the rat spinal cord after local X-irradiation

International Nuclear Information System (INIS)

Hubbard, B.M.; Hopewell, J.W.

1979-01-01

A 16 mm length of cervical spinal cord of young adult female rats was irradiated with 4000 rad of 250 kV X-rays. Counts of astrocyte and oligodendrocyte nuclei were made in the dorsal columns of both irradiated and control cervical cords during the latent period before the onset of radionecrosis. The numbers of both astrocyte and oligodendrocyte nuclei were reduced one month after exposure to radiation. Both cell populations showed an apparent recovery but this was subsequently followed by a rapid loss of cells prior to the development of white-matter necrosis. The oligodendrocyte population in unirradiated spinal cords increased with age, and mitotic figures were observed among the neuroglia of both irradiated and control cervical spinal cords. A slow, natural turnover of neuroglial cells in the cervical spinal cord is proposed and the relevance of this to the manifestation of delayed white matter necrosis is discussed. (author)

Spinal cord motion. Influence of respiration and cardiac cycle

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Winklhofer, S. [RWTH Aachen University Hospital (Germany). Dept. of Neuroradiology; University Hospital Zurich (Switzerland). Inst. of Diagnostic and Interventional Radiology; Schoth, F. [RWTH Aachen University Hospital (Germany). Dept. of Diagnostic Radiology; Stolzmann, P. [University Hospital Zurich (Switzerland). Inst. of Diagnostic and Interventional Radiology; Krings, T. [Toronto Western Hospital, ON (Canada). Div. of Neuroradiology; Mull, M.; Wiesmann, M. [RWTH Aachen University Hospital (Germany). Dept. of Neuroradiology; Stracke, C.P. [RWTH Aachen University Hospital (Germany). Dept. of Neuroradiology; Alfried-Krupp-Hospital, Essen (Germany). Dept. of Neuroradiology

2014-11-15

To assess physiological spinal cord motion during the cardiac cycle compared with the influence of respiration based on magnetic resonance imaging (MRI) measurements. Anterior-posterior spinal cord motion within the spinal canal was assessed in 16 healthy volunteers (median age, 25 years) by cardiac-triggered and cardiac-gated gradient echo pulse sequence MRI. Image acquisition was performed during breath-holding, normal breathing, and forced breathing. Normal spinal cord motion values were computed using descriptive statistics. Breathing-dependent differences were assessed using the Wilcoxon signed-rank test and compared with the cardiac-based cord motion. A normal value table was set up for the spinal cord motion of each vertebral cervico-thoracic-lumbar segment. Significant differences in cord motion were found between cardiac-based motion while breath-holding and the two breathing modalities (P < 0.01 each). Spinal cord motion was found to be highest during forced breathing, with a maximum in the lower cervical spinal segments (C5; mean, 2.1 mm ± 1.17). Image acquisition during breath-holding revealed the lowest motion. MRI permits the demonstration and evaluation of cardiac and respiration-dependent spinal cord motion within the spinal canal from the cervical to lumbar segments. Breathing conditions have a considerably greater impact than cardiac activity on spinal cord motion.

Spinal cord motion. Influence of respiration and cardiac cycle

International Nuclear Information System (INIS)

Winklhofer, S.; University Hospital Zurich; Schoth, F.; Stolzmann, P.; Krings, T.; Mull, M.; Wiesmann, M.; Stracke, C.P.; Alfried-Krupp-Hospital, Essen

2014-01-01

To assess physiological spinal cord motion during the cardiac cycle compared with the influence of respiration based on magnetic resonance imaging (MRI) measurements. Anterior-posterior spinal cord motion within the spinal canal was assessed in 16 healthy volunteers (median age, 25 years) by cardiac-triggered and cardiac-gated gradient echo pulse sequence MRI. Image acquisition was performed during breath-holding, normal breathing, and forced breathing. Normal spinal cord motion values were computed using descriptive statistics. Breathing-dependent differences were assessed using the Wilcoxon signed-rank test and compared with the cardiac-based cord motion. A normal value table was set up for the spinal cord motion of each vertebral cervico-thoracic-lumbar segment. Significant differences in cord motion were found between cardiac-based motion while breath-holding and the two breathing modalities (P < 0.01 each). Spinal cord motion was found to be highest during forced breathing, with a maximum in the lower cervical spinal segments (C5; mean, 2.1 mm ± 1.17). Image acquisition during breath-holding revealed the lowest motion. MRI permits the demonstration and evaluation of cardiac and respiration-dependent spinal cord motion within the spinal canal from the cervical to lumbar segments. Breathing conditions have a considerably greater impact than cardiac activity on spinal cord motion.

Novel Sensor Technology To Assess Independence and Limb-Use Laterality in Cervical Spinal Cord Injury.

Science.gov (United States)

Brogioli, Michael; Popp, Werner L; Albisser, Urs; Brust, Anne K; Frotzler, Angela; Gassert, Roger; Curt, Armin; Starkey, Michelle L

2016-11-01

After spinal cord injury (SCI), levels of independence are commonly assessed with standardized clinical assessments. However, such tests do not provide information about the actual extent of upper limb activities or the impact on independence of bi- versus unilateral usage throughout daily life following cervical SCI. The objective of this study was to correlate activity intensity and laterality of upper extremity activity measured by body-fixed inertial measurement units (IMUs) with clinical assessment scores of independence. Limb-use intensity and laterality of activities performed by the upper extremities was measured in 12 subjects with cervical SCI using four IMUs (positioned on both wrists, on the chest, and on one wheel of the wheelchair). Algorithms capable of reliably detecting self-propulsion and arm activity in a clinical environment were applied to rate functional outcome levels, and were related to clinical independence measures during inpatient rehabilitation. Measures of intensity of upper extremity activity during self-propulsion positively correlated (p laterality were positively correlated (p laterality as measured by IMUs during "daily life," and increased laterality was negatively correlated (p laterality in human cervical SCI. Continuous and objective movement data of distinct daily activities (i.e., mobility and day-to-day activities) can be related to levels of independence. Therefore, IMU sensor technology is suitable not only for monitoring activity levels during rehabilitation (including during clinical trials) but could also be used to assess levels of participation after discharge.

Presentation and outcome of traumatic spinal fractures

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Ahmed El-Faramawy

2012-01-01

Full Text Available Background: Motor vehicle crashes and falls account for most of the spine fractures with subsequent serious disability. Aim: To define the incidence, causes, and outcome of spinal fractures. Materials and Methods: Data were collected retrospectively from trauma registry database of all traumatic spinal injuries admitted to the section of trauma surgery in Qatar from November 2007 to December 2009. Results: Among 3712 patients who were admitted to the section of trauma surgery, 442 (12% injured patients had spinal fractures with a mean age of 33.2 ± 12 years. The male to female ratio was 11.6:1. Motor vehicle crashes (36.5% and falls from height (19.3% were the leading causes of cervical injury (P = 0.001. The injury severity score ranged between 4 and 75. Nineteen percent of cases with cervical injury had thoracic injury as well (P = 0.04. Lumber injury was associated with thoracic injury in 27% of cases (P < 0.001. Combined thoracic and lumber injuries were associated with cervical injury in 33% of cases (P < 0.001. The total percent of injuries associated with neurological deficit was 5.4%. Fifty-three cases were managed surgically for spine fractures; 14 of them had associated neurological deficits. Overall mortalityrate was 5%. Conclusions: Spine fractures are not uncommon in Qatar. Cervical and thoracic spine injuries carry the highest incidence of associated neurological deficit and injuries at other spinal levels. Young males are the most exposed population that deserves more emphasis on injury prevention programs in the working sites and in enforcement of traffic laws.

Dolor cervical incoercible

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Adrián F Narváez-Muñoz

2014-03-01

Astrocytomas are relatively common glial neoplasm of the central nervous system, but only a small percentage of them are located in the spinal cord, with a predilection for the cervical and dorsal regions. In most cases, extend longitudinally, affecting several cord segments. Pain is a frequent symptom of local character bone segments involving the tumor, associated with sensory deficit and / or motor. The following is the case of a 60 year old woman with cervical cord astrocytoma extended to the brainstem.

Spinal cord infarction: MR imaging and clinical features in 16 cases

International Nuclear Information System (INIS)

Weidauer, Stefan; Lanfermann, Heinrich; Zanella, Friedhelm E.; Nichtweiss, Michael

2002-01-01

Spinal cord infarctions are rare and due to heterogeneous etiologies. The aim of the study was to analyze the MR imaging findings and evaluate their correlations with clinical symptoms in ischemic spinal cord lesions. MR images and clinical features of 16 patients (11 male, 5 female) with typical sudden onset of neurological deficits caused by spinal cord ischemia were evaluated. MR imaging was performed within 2 h to 14 days after the initial neurological symptoms. Eight patients had follow-up examinations including contrast-enhanced MR imaging. MR abnormalities were best demonstrated on sagittal T2-weighted images, with ''pencil-like'' hyperintensities (16/16) and cord enlargement (9/16). Axial T2-weighted images showed bilateral (13/16) and unilateral (3/16) hyperintensities according, in 15 patients, to anterior spinal artery (ASA) territory, with three of them located particularly in the spinal sulcal artery territory. In one patient only the posterior spinal artery (PSA) territory was involved. Spinal cord was affected at the cervical level (especially C2-C3) in seven patients, at the upper thoracic level (T3-T5) in two patients and at the thoracolumbar region including the conus medullaris (T10-L1) in seven patients. Presumed etiologies were vascular surgery (3 patients), infrarenal aortic aneurysm (1 patient), bilateral vertebral artery dissection (1 patient), hypotension (1 patient), spine operation (1 patient), excessive cocaine misuse (1 patient) and cardioembolic vertebral artery occlusion (1 patient); six of seven patients with unclear etiologies had vascular risk factors such as hypertension, diabetes and cigarette smoking. MR imaging is therefore useful in detecting spinal cord infarction, with axial T2-weighted images showing hyperintensities in the ASA territory in 15 of 16 patients. Contrary to the presumed spinal cord watershed at the lower cervical and upper thoracic level, and despite numerous central arteries in the cervical cord, our data

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

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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.

Neuroendoscopic Removal of Acute Subdural Hematoma with Contusion: Advantages for Elderly Patients

Directory of Open Access Journals (Sweden)

Ryota Tamura

2016-01-01

Full Text Available Background. Large craniotomy for acute subdural hematoma is sometimes too invasive. We report good outcomes for two cases of neuroendoscopic evacuation of hematoma and contusion by 1 burr hole surgery. Case Presentation. Both patients arrived by ambulance at our hospital with disturbed consciousness after falling. Case 1 was an 81-year-old man who took antiplatelet drugs for brain infarction. Case 2 was a 73-year-old alcoholic woman. CT scanning showed acute subdural hematoma and frontal contusion in both cases. In the acute stage, glycerol was administered to reduce edema; CTs after 48 and 72 hours showed an increase of subdural hematoma and massive contusion of the frontal lobe. Disturbed consciousness steadily deteriorated. The subdural hematoma and contusion were removed as soon as possible by neuroendoscopy under local anesthesia, because neither patient was a good candidate for large craniotomy considering age and past history. 40%~70% of the hematoma was removed, and the consciousness level improved. Conclusion. Neuroendoscopic removal of acute subdural hematoma and contusion has advantages and disadvantages. For patients with underlying medical issues or other risk factors, it is likely to be effective.

Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries.

Science.gov (United States)

Hammer, Mark M; Raptis, Demetrios A; Cummings, Kristopher W; Mellnick, Vincent M; Bhalla, Sanjeev; Schuerer, Douglas J; Raptis, Constantine A

2016-05-01

Blunt cardiac injury (BCI) may manifest as cardiac contusion or, more rarely, as pericardial or myocardial rupture. Computed tomography (CT) is performed in the vast majority of blunt trauma patients, but the imaging features of cardiac contusion are not well described. To evaluate CT findings and associated injuries in patients with clinically diagnosed BCI. We identified 42 patients with blunt cardiac injury from our institution's electronic medical record. Clinical parameters, echocardiography results, and laboratory tests were recorded. Two blinded reviewers analyzed chest CTs performed in these patients for myocardial hypoenhancement and associated injuries. CT findings of severe thoracic trauma are commonly present in patients with severe BCI; 82% of patients with ECG, cardiac enzyme, and echocardiographic evidence of BCI had abnormalities of the heart or pericardium on CT; 73% had anterior rib fractures, and 64% had pulmonary contusions. Sternal fractures were only seen in 36% of such patients. However, myocardial hypoenhancement on CT is poorly sensitive for those patients with cardiac contusion: 0% of right ventricular contusions and 22% of left ventricular contusions seen on echocardiography were identified on CT. CT signs of severe thoracic trauma are frequently present in patients with severe BCI and should be regarded as indirect evidence of potential BCI. Direct CT findings of myocardial contusion, i.e. myocardial hypoenhancement, are poorly sensitive and should not be used as a screening tool. However, some left ventricular contusions can be seen on CT, and these patients could undergo echocardiography or cardiac MRI to evaluate for wall motion abnormalities. Copyright © 2015 Elsevier Ltd. All rights reserved.

Spinal surgery - cervical - series (image)

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... problems include: pain that interferes with daily activities neck pain that extends (radiates) to the shoulder or arm ... done while the patient is deep asleep and pain-free (general anesthesia). For the neck (cervical spine), an incision may be made either in ...

Apolipoprotein E as a novel therapeutic neuroprotection target after traumatic spinal cord injury.

Science.gov (United States)

Cheng, Xiaoxin; Zheng, Yiyan; Bu, Ping; Qi, Xiangbei; Fan, Chunling; Li, Fengqiao; Kim, Dong H; Cao, Qilin

2018-01-01

Apolipoprotein E (apoE), a plasma lipoprotein well known for its important role in lipid and cholesterol metabolism, has also been implicated in many neurological diseases. In this study, we examined the effect of apoE on the pathophysiology of traumatic spinal cord injury (SCI). ApoE-deficient mutant (apoE -/- ) and wild-type mice received a T9 moderate contusion SCI and were evaluated using histological and behavioral analyses after injury. At 3days after injury, the permeability of spinal cord-blood-barrier, measured by extravasation of Evans blue dye, was significantly increased in apoE -/- mice compared to wild type. The inflammation and spared white matter was also significantly increased and decreased, respectively, in apoE -/- mice compared to the wild type ones. The apoptosis of both neurons and oligodendrocytes was also significantly increased in apoE -/- mice. At 42days after injury, the inflammation was still robust in the injured spinal cord in apoE -/- but not wild type mice. CD45+ leukocytes from peripheral blood persisted in the injured spinal cord of apoE -/- mice. The spared white matter was significantly decreased in apoE -/- mice compared to wild type ones. Locomotor function was significantly decreased in apoE -/- mice compared to wild type ones from week 1 to week 8 after contusion. Treatment of exogenous apoE mimetic peptides partially restored the permeability of spinal cord-blood-barrier in apoE -/- mice after SCI. Importantly, the exogenous apoE peptides decreased inflammation, increased spared white matter and promoted locomotor recovery in apoE -/- mice after SCI. Our results indicate that endogenous apoE plays important roles in maintaining the spinal cord-blood-barrier and decreasing inflammation and spinal cord tissue loss after SCI, suggesting its important neuroprotective function after SCI. Our results further suggest that exogenous apoE mimetic peptides could be a novel and promising neuroprotective reagent for SCI. Copyright �

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.

Cervical myelopathy: magnetic imaging findings

International Nuclear Information System (INIS)

Kholin, A.V.; Makarov, A.Yu.; Gurevich, D.V.

1996-01-01

69 patients with clinical signs of cervical myelopathy were examined using magnetic imaging (T1- and T2-suspended tomograms of the sagittal and transverse section using a device with 0.04 T field intensity). Vertebral disk hernias were revealed in 35 patients, compression of the spinal cord with metastases into vertebral body in 2, extramedullary tumor in 11, intramedullary tumor in 9, and syringomyelia in 12 patients. T2-suspended tomograms proved to be more informative due to their higher sensitivity to aqueous content. T1-suspended tomograms help assess the degree of spinal cord compression and the direction of the disk protrusion. Magnetic imaging is an informative method used for objective identification of the cases of myelopathy of cervical localization [ru

Application of Piezosurgery in Anterior Cervical Corpectomy and Fusion.

Science.gov (United States)

Pan, Sheng-Fa; Sun, Yu

2016-05-01

Anterior cervical corpectomy and fusion (ACCF) is frequently used to decompress the cervical spine; however, this procedure is risky when dealing with a hard disc or ossification of the posterior longitudinal ligament (OPLL). Piezosurgery offers a useful tool for performing this procedure. In this article, we present a 50 years old man who had cervical spondylotic myelopathy with OPLL at the C 6 level and segmental stenosis of the cervical spinal canal. When removing the posterior wall of his C 6 vertebral body and OPLL, piezosurgery was used to selectively cut hard structures piece by piece without injuring delicate soft tissues like the nerve roots and spinal cord. Because there is no bleeding from the bone surface with piezosurgery, it provides a clean operative field. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Transplantation of adult monkey neural stem cells into a contusion spinal cord injury model in rhesus macaque monkeys

DEFF Research Database (Denmark)

Nemati, Shiva Nemati; Jabbari, Reza; Hajinasrollah, Mostafa

2014-01-01

, therefore, to explore the efficacy of adult monkey NSC (mNSC) in a primate SCI model. MATERIALS AND METHODS: In this experimental study, isolated mNSCs were analyzed by flow cytometry, immunocytochemistry, and RT-PCR. Next, BrdU-labeled cells were transplanted into a SCI model. The SCI animal model...... on Tarlov's scale and our established behavioral tests for monkeys. CONCLUSION: Our findings have indicated that mNSCs can facilitate recovery in contusion SCI models in rhesus macaque monkeys. Additional studies are necessary to determine the im- provement mechanisms after cell transplantation....

Pediatric cervical spondylolysis and American football.

Science.gov (United States)

Alton, Timothy B; Patel, Amit M; Lee, Michael J; Chapman, Jens R

2014-06-01

Cervical spondylolysis (CS) is a rare condition and is even more uncommon in pediatric patients. It is characterized by a disruption of the articular mass at the junction of the superior and inferior facet joints and often is diagnosed incidentally. The C6 level is most commonly involved, and the cause of CS remains unknown. There are no recommendations in the literature regarding activity modification in patients with CS and no discussion as to risks of participation in American football or other contact sports. To report a case of C6 bilateral cervical spondylolysis with bicuspid spinous process and to discuss radiographic/clinical findings and issues related to participation in contact sports and minimizing the risk of spinal cord injury. Case report with 6 months clinical/radiographic follow-up Radiographic description, clinical findings, and current review of the literature. A pediatric patient presented with a bilateral C6 cervical spondylolysis and bicuspid spinous process after an American football-related minor cervical spine trauma. Findings on radiographs indicated that the spondylolysis appeared to be chronic in nature, without evidence of instability. The patient and his family were educated on ways to decrease the risk of spinal cord injury with contact sports, after which the patient was allowed to participate fully in sports without restrictions or adverse events. Pediatric cervical spondylolysis is a rare condition, the cause of which remains debated. Although there is theoretical risk, more than 1.5 million youth participate in American football annually, and there have been no reported cases of significant spinal cord injury in patients with CS from football or other contact sports. Copyright © 2014 Elsevier Inc. All rights reserved.

Apport de l'echographie dans les contusions abdominales de l ...

African Journals Online (AJOL)

Conclusion : l'échographie joue un rôle déterminant dans le bilan lésionnel dans les contusions abdominales, cependant son utilisation reste limitée dans le domaine pédiatrique au CHU SO de Lomé, d'où la nécessité d'une plus large diffusion de cet outil diagnostic. Mots clés : contusion abdominale, enfant, échographie, ...

Cervical stenosis in spinal cord injury and disorders.

Science.gov (United States)

Burns, Stephen P; Weaver, Frances; Chin, Amy; Svircev, Jelena; Carbone, Laura

2016-07-01

The purpose of this study was to characterize etiologies of spinal cord injury and disorders (SCI/D) in persons with and without cervical stenosis/spondylosis (CSS) and to describe clinical characteristics and underlying comorbidities in these populations. We reviewed administrative data for 1954 Veterans who had onset of traumatic or non-traumatic tetraplegia during FY 1999-2007. This included 1037 with a diagnosis of CSS at or in the two years prior to SCI onset of SCI/D and 917 without a diagnosis of CSS. Demographics, etiologies of SCI/D and comorbidities by CSS status. Veterans with SCI/D and CSS were older, more likely to have incomplete injuries and more likely to be Black than those with SCI/D and no CSS. Of patients with traumatic etiologies for SCI, 35.1% had a diagnosis of CSS at the time of or in the 2 years prior to SCI onset. Of those with tetraplegia due to falls, 40.0% had CSS, whereas for other known traumatic etiologies the percentages with CSS were lower: vehicular (25.0%); sports (16.1%); and acts of violence (10.2%). Total comorbidity scores measured by the Charlson co morbidity index and CMS Hierarchical Condition Category (CMS-HCC) were higher in those with CSS and SCI/D compared to those with SCI/D without CSS (P traumatic tetraplegia. Falls are a particularly important potentially modifiable risk for SCI in patients with CSS.

Operative Outcomes for Cervical Myelopathy and Radiculopathy

Directory of Open Access Journals (Sweden)

J. G. Galbraith

2012-01-01

Full Text Available Cervical spondylotic myelopathy and radiculopathy are common disorders which can lead to significant clinical morbidity. Conservative management, such as physical therapy, cervical immobilisation, or anti-inflammatory medications, is the preferred and often only required intervention. Surgical intervention is reserved for those patients who have intractable pain or progressive neurological symptoms. The goals of surgical treatment are decompression of the spinal cord and nerve roots and deformity prevention by maintaining or supplementing spinal stability and alleviating pain. Numerous surgical techniques exist to alleviate symptoms, which are achieved through anterior, posterior, or circumferential approaches. Under most circumstances, one approach will produce optimal results. It is important that the surgical plan is tailored to address each individual's unique clinical circumstance. The objective of this paper is to analyse the major surgical treatment options for cervical myelopathy and radiculopathy focusing on outcomes and complications.

Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

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Kwon, Jong Won; Lee, Joon Woo; Kim, Sung Hyun; Kwack, Kyu-Sung [Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-do (Korea); Choi, Ja-Young; Moon, Sung Gyu; Jun, Woo Sun [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Yeom, Jin-Sup [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Gyeongi-Do (Korea); Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Gyeongi-Do (Korea); Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-do (Korea); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea)

2007-05-15

To verify the usefulness of a fluoroscopy guided cervical interlaminar epidural steroid injection (CIESI) in patients with neck pain and cervical radiculopathy and to evaluate outcome predictors. We retrospectively analyzed 91 patients from July 2004 to June 2005 in whom CIESI was initially performed for neck pain and cervical radiculopathy. Therapeutic effects were evaluated 2 weeks after the administration of CIESI, and CIESI effectiveness was graded using a five-point scale, namely, whether the pain had disappeared, was much improved, slightly improved, the same, or aggravated. We also used a visual analog scale (VAS) for the clinical evaluation. According to documentation and follow-up charts, we categorized treatments as effective or ineffective. Possible outcome predictors, namely, diagnosis (spinal stenosis vs herniated disc), primary symptoms (neck pain vs radiculopathy vs both), age, gender, and duration of pain (more or less than 6 months) were also analyzed. Fisher's exact test, the chi-square test, and multiple logistic regression analysis were used for the statistical analysis. After their medical records had been reviewed, 76 patients were included in this study. Inclusion criteria were: the availability of a cross-sectional image, such as a CT scan or an MR image, and a follow-up record after injection. The medical records of 76 patients (male:female = 41: 35) of mean age 53.1 years (range 32 years to 82 years) were reviewed. Two weeks after injection, 55 patients (72.4%) had experienced effective pain relief. Patients with herniated discs had significantly better results than patients with spinal stenosis (86.1% vs 60.0%) (P < 0.05). Other non-significant predictors of an improved outcome included: a symptom duration of <6 months, a young age, and the presence of cervical radiculopathy. Multiple regression analysis showed that the only factor that was significantly associated with outcome was the cause of the pain, i.e., herniated disc or

Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

International Nuclear Information System (INIS)

Kwon, Jong Won; Lee, Joon Woo; Kim, Sung Hyun; Kwack, Kyu-Sung; Choi, Ja-Young; Moon, Sung Gyu; Jun, Woo Sun; Yeom, Jin-Sup; Kim, Hyun-Jib; Kang, Heung Sik

2007-01-01

To verify the usefulness of a fluoroscopy guided cervical interlaminar epidural steroid injection (CIESI) in patients with neck pain and cervical radiculopathy and to evaluate outcome predictors. We retrospectively analyzed 91 patients from July 2004 to June 2005 in whom CIESI was initially performed for neck pain and cervical radiculopathy. Therapeutic effects were evaluated 2 weeks after the administration of CIESI, and CIESI effectiveness was graded using a five-point scale, namely, whether the pain had disappeared, was much improved, slightly improved, the same, or aggravated. We also used a visual analog scale (VAS) for the clinical evaluation. According to documentation and follow-up charts, we categorized treatments as effective or ineffective. Possible outcome predictors, namely, diagnosis (spinal stenosis vs herniated disc), primary symptoms (neck pain vs radiculopathy vs both), age, gender, and duration of pain (more or less than 6 months) were also analyzed. Fisher's exact test, the chi-square test, and multiple logistic regression analysis were used for the statistical analysis. After their medical records had been reviewed, 76 patients were included in this study. Inclusion criteria were: the availability of a cross-sectional image, such as a CT scan or an MR image, and a follow-up record after injection. The medical records of 76 patients (male:female = 41: 35) of mean age 53.1 years (range 32 years to 82 years) were reviewed. Two weeks after injection, 55 patients (72.4%) had experienced effective pain relief. Patients with herniated discs had significantly better results than patients with spinal stenosis (86.1% vs 60.0%) (P < 0.05). Other non-significant predictors of an improved outcome included: a symptom duration of <6 months, a young age, and the presence of cervical radiculopathy. Multiple regression analysis showed that the only factor that was significantly associated with outcome was the cause of the pain, i.e., herniated disc or spinal

Imaging in spinal trauma

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Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

2005-03-01

Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

Imaging in spinal trauma

International Nuclear Information System (INIS)

Goethem, J.W.M. van; Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M.

2005-01-01

Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

[Characteristics and treatment of traumatic cervical disc herniation].

Science.gov (United States)

Miao, Jing-Lei; Zhang, Chao-Yue; Peng, Zhi

2012-10-01

To explore clinical presentations and the operational opportunity of traumatic cervical disc herniation. From June 2002 to June 2009,40 patients with traumatic cervical disc herniation were treated. There were 24 males and 16 females, with an average age of 43.2 years old ranging from 30 to 56 years. There were 36 patients with single intervertebral disc herniation and 4 patients with double. The injury level of those patients were at C3,4 in 16 cases, C4,5 in 10 cases, C5,6 in 12 cases and C6,7 in 6 cases. Among them, 18 patients showed spinal cord signal changes by MRI, 5 patients suffered from nothing but neck and shoulder pain, 8 patients with nerve root stimulation; 10 patients with spinal cord compression, and 17 patients had both nerve root stimulation and spinal cord compression symptoms. Conservative treatment were applied to 13 patients with neck and shoulder pain and nerve root stimulation, 5 cases of which were transferred to operation in case of poor effects, and Odom criteria were used to assess operational effects. Twenty-seven patients with spinal cord compression accepted operation from 1 to 27days after their trauma, 16 of which were operated in 5 days (early operational group with an JOA score of 11.3 +/- 2.8), other 11 cases were operated from 5 to 27 days (delayed operational group with an JOA score of 11.4 +/- 2.9 ), then functional assessment of spinal cord were assessed according to JOA criteria. Three patients who were transferred from conservative treatment recovered excellently according to Odom criteria and the other 2 were good at final followed-up. JOA score of early operational group increased from (11.3 +/- 2.8) to (15.3 +/- 1.8) one week after operation (P traumatic cervical disc herniation and cervical spondylosis. Early operation is favorable to the recovery of neurological function in patients with spinal cord compression.

Spinal cord injury in Parkour sport (free running: a rare case report

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Derakhshan Nima

2014-06-01

Full Text Available A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport, which is also called double front flip. Neurological examination revealed that the patient’s muscle power was 0/5 at all extremities. The patient did not show any sense of light touch or pain in his extremities. In radiological studies, cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury. The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome. Key words: Spinal cord injuries; Cervical vertebrae; Athletic injuries

Prediction of the recovery rate after surgery for cervical myelopathy from the view of CT-myelography

International Nuclear Information System (INIS)

Koyanagi, Takahiro; Satomi, Kazuhiko; Asazuma, Takahito; Toyama, Yoshiaki; Fujimura, Shoichi; Hirabayashi, Kiyoshi; Hamano, Yasuyuki; Shiraishi, Takeshi.

1991-01-01

This study was designed to prepare a formula for predicting postoperative recovery in cervical myelopathy. Preoperative CT-myelography (CT-M) was performed in a total of 103 patients, consisting of 44 with cervical spinal myelopathy (CSM), 39 with ossification of the posterior longitudinal ligament (OPLL), and 20 with cervical disk herniation (CDH). Multivariate analyses were used to obtain correlations between CT-M findings (spinal cord area and the rate of spinal cord flatness) and clinical items (age, disease duration, preoperative JOA score, and postoperative recovery rate). There was a strong positive correlation between spinal cord area and postoperative recovery rate. Because both spinal cord area and disease duration for the CSM and OPLL groups had a strong positive correlation with the recovery rate, they were found to predict postoperative recovery. In the CDH group, there was no predictive index. Spinal cord area was more potential index than preoperative severity. Disease duration may also serve as an index complementing spinal cord area in the evaluation of postoperative recovery. (N.K.)

Heritability of spinal pain and consequences of spinal pain: a comprehensive genetic epidemiologic analysis using a population-based sample of 15,328 twins ages 20-71 years

DEFF Research Database (Denmark)

Hartvigsen, Jan; Nielsen, Jan; Kyvik, Kirsten Ohm

2009-01-01

on 15,328 twin individuals (44% monozygotic and 56% dizygotic) from complete twin pairs were included. Genetic susceptibility explained approximately 38% of lumbar pain, 32% of thoracic pain, and 39% of neck pain. For patterns of pain, estimates were 7% for lumbar/thoracic, 24% for lumbar/cervical, 0......% for thoracic/cervical, and 35% for pain in all 3 areas. Moderate to high genetic correlations indicated a common genetic basis for many spinal pain syndromes. In general, heritability was higher for women, and only a minor age effect was seen. CONCLUSION: Heritability estimates for pain in different spinal......OBJECTIVE: To assess the relative contribution of genetic and environmental factors to different definitions of spinal pain and consequences of spinal pain. METHODS: The Danish Twin Registry contains detailed survey information on spinal pain and its consequences in twins ages 20-71 years...

Distribution of elements in human spinal cord

International Nuclear Information System (INIS)

Yukawa, Masae; Kobayashi, T.; Qiu, Y.; Kameda, N.; Ito, Y.; Otomo, E.

1992-01-01

The distribution of elements in human spinal cord was investigated on unfixed frozen cord material using PIXE technique. Distribution of Cu, Zn and Fe were not uniform in the cross section of the spinal cord and concentrations of these elements were higher in the anterior gray horn than in the other areas, while K and Cl distributed uniformly. The content of K changed along the spinal cord from the cervical to the lumbar level. These findings are discussed in relation to current understanding of the physiology of the spinal cord. (author)

Variation in radiation sensitivity and repair kinetics in different parts of the spinal cord

International Nuclear Information System (INIS)

Adamus-Gorka, Magdalena; Brahme, Anders; Mavroidis, Panayiotis; Lind, Bengt K.

2008-01-01

Background. The spinal cord, known for its strongly serial character and high sensitivity to radiation even when a small segment is irradiated, is one of the most critical organs at risk to be spared during radiation therapy. To compare the sensitivity of different parts of the spinal cord, data for radiation myelopathy have been used. Material and methods. In the present study, the relative seriality model was fitted to two different datasets of clinical radiation myelitis concerning cervical spinal cord after treating 248 patients for head and neck cancer and thoracic spinal cord after treating 43 patients with lung carcinoma. The maximum likelihood method was applied to fit the clinical data. The model parameters and their 68% confidence intervals were calculated for each dataset. The α/β ratio for the thoracic cord was also was also found to be 0.9 (0-3.0) Gy. Results. The dose-response curve for the more sensitive cervical myelopathy is well described by the parameters D 50 =55.9 (54.8-57.1) Gy, γ=6.9 (5.0-9.2), s=0.13 (0.07-0.24), whereas the thoracic myelopathy is described by the parameters D 50 =75.5 (70.5-80.8) Gy, γ=1.1 (0.6-1.6), s=36 (3.3-8). Discussion and conclusions. Large differences in radiation response between the cervical and thoracic region of spinal cord are thus observed: cervical myelopathy seems to be characterized by medium seriality, while thoracic spinal cord is characterized by a highly serial dose-response. The much steeper dose-response curve for cervical spinal cord myelopathy can be interpreted as a higher number of functional subunits consistent with a higher amount of white matter close to the brain

Epidural tumour (calcified fibroma) as cause of a 'Cervical Syndrome'

Energy Technology Data Exchange (ETDEWEB)

Piotrowski, W P

1983-01-01

A calcified fibroma caused a so called Cervical Syndrome not responding to medical treatment. In the computerized tomography a compression of the cervical spinal cord could be demonstrated. From this the indication for the operation was given.

Intraoperative contrast-enhanced ultrasonography for microcirculatory evaluation in rhesus monkey with spinal cord injury.

Science.gov (United States)

Huang, Lin; Chen, Keng; Chen, Fu-Chao; Shen, Hui-Yong; Ye, Ji-Chao; Cai, Zhao-Peng; Lin, Xi

2017-06-20

This study tried to quantify spinal cord perfusion by using contrast-enhanced ultrasound (CEUS) in rhesus monkey models with acute spinal cord injury. Acute spinal cord perfusion after injury was detected by CEUS, coupling with conventional ultrasound (US) and Color Doppler US (CDFI). Time-intensity curves and perfusion parameters were obtained by autotracking contrast quantification (ACQ) software in the epicenter and adjacent regions of injury, respectively. Neurological and histological examinations were performed to confirm the severity of injury. US revealed spinal cords were hypoechoic and homogeneous, whereas dura maters, pia maters, and cerebral aqueducts were hyperechoic. After spinal cord contusion, the injured spinal cord was hyperechoic on US, and intramedullary vessels of adjacent region of injury were increased and dilated on CDFI. On CEUS hypoperfusion were found in the epicenter of injury, while hyperperfusion in its adjacent region. Quantitative analysis showed that peak intensity (PI) decreased in epicenters of injury but significantly increased in adjacent regions at all time points (p spinal cord injury in overall views and real-time.

Plasticity and Activation of Spared Intraspinal Respiratory Circuits Following Spinal Cord Injury

Science.gov (United States)

2016-10-01

will lead to a significant shift in current approaches for managing respiratory dysfunction following cervical SCIs. Knowledge obtained from this...cervical spinal cord injury. Exp Neurol 263: 314–324, 2015. Mansel JK, Norman JR. Respiratory complications and management of spinal cord injuries...location (versus the electrode track) while also 92 preserving tissue integrity, poses a further challenge ( Borg et al. 2015; Li et al. 2015; Nuding et 93

Transplantation of human embryonic stem cell-derived oligodendrocyte progenitors into rat spinal cord injuries does not cause harm.

Science.gov (United States)

Cloutier, Frank; Siegenthaler, Monica M; Nistor, Gabriel; Keirstead, Hans S

2006-07-01

Demyelination contributes to loss of function following spinal cord injury. We have shown previously that transplantation of human embryonic stem cell-derived oligodendrocyte progenitors into adult rat 200 kD contusive spinal cord injury sites enhances remyelination and promotes recovery of motor function. Previous studies using oligodendrocyte lineage cells have noted a correlation between the presence of demyelinating pathology and the survival and migration rate of the transplanted cells. The present study compared the survival and migration of human embryonic stem cell-derived oligodendrocyte progenitors injected 7 days after a 200 or 50 kD contusive spinal cord injury, as well as the locomotor outcome of transplantation. Our findings indicate that a 200 kD spinal cord injury induces extensive demyelination, whereas a 50 kD spinal cord injury induces no detectable demyelination. Cells transplanted into the 200 kD injury group survived, migrated, and resulted in robust remyelination, replicating our previous studies. In contrast, cells transplanted into the 50 kD injury group survived, exhibited limited migration, and failed to induce remyelination as demyelination in this injury group was absent. Animals that received a 50 kD injury displayed only a transient decline in locomotor function as a result of the injury. Importantly, human embryonic stem cell-derived oligodendrocyte progenitor transplants into the 50 kD injury group did not cause a further decline in locomotion. Our studies highlight the importance of a demyelinating pathology as a prerequisite for the function of transplanted myelinogenic cells. In addition, our results indicate that transplantation of human embryonic stem cell-derived oligodendrocyte progenitor cells into the injured spinal cord is not associated with a decline in locomotor function.

Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report.

Science.gov (United States)

Lee, Dong Gyu; Chang, Min Cheol

2017-10-01

Information on referred pain can be helpful for diagnosing diseases of the visceral organs. Here, the authors report a patient with cervical spinal cord injury (SCI) who had referred pain at the right side from the neck to shoulder, as a presentation of pulmonary embolism (PE). A 55-year-old man with complete tetraplegia, due to cervical SCI after C5 and C6 vertebral body fracture, complained of right neck-to-shoulder pain (numerical scale rating: 6). Despite pain medication (meloxicam 15 mg, gabapentin 400 mg, and propacetamol HCl 1 g), the pain was not reduced. Along with right neck-to-shoulder pain, he presented mild fever (37.8°C) and mildly elevated respiratory rate (20 breaths/min). D-dimer level was also mildly elevated to 6.09 mg/mL (normal value: pain completely disappeared. This study shows that pain at the neck-to-shoulder area can occur following unexpected causes such as PE. Not limited to PE, the evaluation of diseases in the thoracic or abdominal organs is recommended if patients with cervical SCI present refractory pain in the dermatomes innervated by high cervical nerve roots.

Epidural tumour (calcified fibroma) as cause of a 'Cervical Syndrome'

International Nuclear Information System (INIS)

Piotrowski, W.P.

1983-01-01

A calcified fibroma caused a so called cervical syndrome not responding to medical treatment. In the computerized tomography a compression of the cervical spinal cord could be demonstrated. From this the indication for the operation was given. (Author)

The adult spinal cord injury without radiographic abnormalities syndrome: magnetic resonance imaging and clinical findings in adults with spinal cord injuries having normal radiographs and computed tomography studies.

Science.gov (United States)

Kasimatis, Georgios B; Panagiotopoulos, Elias; Megas, Panagiotis; Matzaroglou, Charalambos; Gliatis, John; Tyllianakis, Minos; Lambiris, Elias

2008-07-01

Spinal cord injury without radiographic abnormalities (SCIWORA) is thought to represent mostly a pediatric entity and its incidence in adults is rather underreported. Some authors have also proposed the term spinal cord injury without radiologic evidence of trauma, as more precisely describing the condition of adult SCIWORA in the setting of cervical spondylosis. The purpose of the present study was to evaluate adult patients with cervical spine injuries and radiological-clinical examination discrepancy, and to discuss their characteristics and current management. During a 16-year period, 166 patients with a cervical spine injury were admitted in our institution (Level I trauma center). Upper cervical spine injuries (occiput to C2, 54 patients) were treated mainly by a Halo vest, whereas lower cervical spine injuries (C3-T1, 112 patients) were treated surgically either with an anterior, or posterior procedure, or both. Seven of these 166 patients (4.2%) had a radiologic-clinical mismatch, i.e., they presented with frank spinal cord injury with no signs of trauma, and were included in the study. Magnetic resonance imaging was available for 6 of 7 patients, showing intramedullary signal changes in 5 of 6 patients with varying degrees of compression from the disc and/or the ligamentum flavum, whereas the remaining patient had only traumatic herniation of the intervertebral disc and ligamentum flavum bulging. Follow-up period was 6.4 years on average (1-10 years). This retrospective chart review provides information on adult patients with cervical spinal cord injuries whose radiographs and computed tomography studies were normal. It furthers reinforces the pathologic background of SCIWORA in an adult population, when evaluated by magnetic resonance imaging. Particularly for patients with cervical spondylosis, special attention should be paid with regard to vascular compromise by predisposing factors such as smoking or vascular disease, since they probably contribute in

Magnetic resonance imaging of spinal cord injury in chronic stage

International Nuclear Information System (INIS)

Tobimatsu, Haruki; Nihei, Ryuichi; Kimura, Tetsuhiko; Yano, Hideo; Touyama, Tetsuo; Tobimatsu, Yoshiko; Suyama, Naoto; Yoshino, Yasumasa

1991-01-01

Magnetic resonance (MR) images of a total of 195 patients with cervical (125) or thoracic (70) spinal cord injury were reviewed. The imaging studies of the spinal cord lesions were correlated with clinical manifestations. Sequential MR imaging revealed hypointensity on T1-weighted images (T1WI) and hyperintensity on T2-weighted images (T2WI) in all patients, except for five patients showing no signal changes and two showing isointensity, suggesting gliosis, myelomalacia, and syringomyelia. Spinal cord lesions were classified into four types: small lesions, large lesions, complete transverse, and longitudinal rupture. These lesions were well correlated with the severity of injury and paralysis. Complete paralysis was frequently associated with enlarged, complete transverse for cervical spinal cord injury, and longitudinal ruptured or thinned complete transverse for thoracic spinal cord injury. The height of paralysis was well in agreement with that of lesions. For incomplete paralysis, localized lesions were seen within the spinal cord, coinciding with the paralysis or severity. Traumatic syringomyelia was seen in 17 patients (8.7%)-- for the cervical site (10 patients, 8%) and the thoracic site (7 patients, 10%). When homogeneous and marginally clear hypointensity is shown on T1-weighted images and vacuolated hyperintensity is shown on T2-weighted images, in addition to lesions spreading two or more cords or 1.5 or more cords above the nervous root level of paralysis, traumatic syringomyelia is strongly suspected, requiring the follow up observation. (N.K.)

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

Fixed cord in spinal stenosis

International Nuclear Information System (INIS)

Levy, L.M.; Wang, H.; Francomano, C.; Hurko, O.; Carson, B.; Heffez, D.S.; DiChiro, G.; Bryan, R.N.

1990-01-01

This paper evaluates patients with cervical spinal canal compromise due to congenital anomalies (achondroplasia, Chiari malformation) and degenerative diseases using MR cord motion and cerebrospinal fluid (CSF) flow studies. Pulsatile longitudinal motion of the cervical cord was determined by means of cardiac-gated velocity phase contrast methods, including cine. Pathology included dwarfism (n = 15), Chiari malformation (n = 10), spondylosis (n = 10), and acute cord compression (n = 9). Symptomatic cases of congenital cervical stenosis had decreased cord motion, although CSF flow was not always significantly compromised. Postoperative cases demonstrated good cord and CSF motion, unless compression or obstruction was present

Anterolisthesis and retrolisthesis of the cervical spine in cervical spondylotic myelopathy in the elderly

International Nuclear Information System (INIS)

Kawasaki, Motohiro; Tani, Toshikazu; Ushida, Takahiro; Ishida, Kenji

2007-01-01

Degenerative spondylolisthesis of the cervical spine has received insufficient attention in contrast to that of the lumbar spine. The authors analyzed the functional significance of anterior and posterior degenerative spondylolisthesis (anterolisthesis and retrolisthesis) of the cervical spine to elucidate its role in the development of cervical spondylotic myelopathy (CSM) in the elderly. A total of 79 patients aged 65 or older who eventually had surgical treatment for CSM were evaluated radiographically. Altogether, 24 patients (30%) had displacement of 3.5 mm or more (severe spondylolisthesis group), 31 had displacement of 2.0-3.4 mm (moderate spondylolisthesis group), and 24 had less than 2.0 mm displacement (mild spondylolisthesis group). The severe spondylolisthesis group consisted of 14 patients with anterolisthesis (anterolisthesis group) and 10 patients with retrolisthesis (retrolisthesis group). Patients with severe spondylolisthesis had a high incidence (93%) of degenerative spondylolisthesis at C3/4 or C4/5 and significantly greater cervical mobility than those with mild spondylolisthesis. The anterolisthesis group, but not the retrolisthesis group, had a significantly wider spinal canal than the mild spondylolisthesis group, although the degree of horizontal displacement and cervical mobility did not differ significantly between the anterolisthesis and retrolisthesis groups. Severe cord compression seen on T1-weighted magnetic resonance imaging (MRI) scans and high-intensity spinal cord signals seen on T2-weighted MRI scans corresponded significantly to the levels of the spondylolisthesis. Degenerative spondylolisthesis is not a rare radiographic finding in elderly patients with CSM, which tends to cause intense cord compression that is seen on MRI scans. Greater mobility of the upper cervical segments may be a compensatory reaction for advanced disc degeneration of the lower cervical segments, leading to the development of degenerative

Management of Esophageal and Pharyngeal Perforation as Complications of Anterior Cervical Spine Surgery.

Science.gov (United States)

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

2017-06-01

To describe our experience in treating esophageal and pharyngeal perforation after anterior cervical spine surgery. Six patients with esophageal injury and one patient with pharyngeal injury after anterior cervical spinal surgery, managed at our department between 2000 and 2015, were analyzed retrospectively. During the study period, 7 patients (6 male and 1 female; mean age, 45 years) presented with esophageal perforation. The original anterior cervical spinal surgery was performed due to trauma in 2 patients and because of a degenerative cervical disorder in 5. Early esophageal perforation was diagnosed in 2 patients, and delayed esophageal injury due to chronic irritation with the cervical implants was noted in 5. Three of the five delayed perforation cases were related to cervical instrument displacement. Two patients showed no definite signs of infection, whereas 5 patients had various symptoms, including fever, neck pain, odynophagia, neck swelling, and upper extremity weakness. Two patients with a large defect underwent surgical repair and three with minimal perforation due to chronic irritation from the implants underwent instrument removal without direct repair of defect. Two asymptomatic patients received no intervention. Six patients with infection completely recovered from esophageal injury after treatment for a mean duration of 5.2 weeks (range, 4-8 weeks). One patient died because of postoperative pneumonia and sepsis after implant removal. Esophageal and pharyngeal injury after cervical spinal surgery may occur either directly due to spinal trauma and vigorous intraoperative retraction or due to chronic irritation with cervical implants. In cases of perforation associated with infection, various surgical modalities, including primary closure and reinforcement with a flap, could be considered depending on factors such as esophageal defect size, infection severity, and timing of recognition of injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Paralysis following stereotactic spinal irradiation in pigs suggests a tolerance constraint for single-session irradiation of the spinal nerve

International Nuclear Information System (INIS)

Medin, Paul M.; Foster, Ryan D.; Kogel, Albert J. van der; Meyer, Jeffrey; Sayre, James W.; Huang, Hao; Öz, Orhan K.

2013-01-01

Background and purpose: Paralysis observed during a study of vertebral bone tolerance to single-session irradiation led to further study of the dose-related incidence of motor peripheral neuropathy. Materials and methods: During a bone tolerance study, cervical spinal nerves of 15 minipigs received bilateral irradiation to levels C5–C8 distributed into three dose groups with mean maximum spinal nerve doses of 16.9 ± 0.3 Gy (n = 5), 18.7 ± 0.5 Gy (n = 5), and 24.3 ± 0.8 Gy (n = 5). Changes developing in the gait of the group of pigs receiving a mean maximum dose of 24.3 Gy after 10–15 weeks led to the irradiation of two additional animals. They received mean maximum dose of 24.9 ± 0.2 Gy (n = 2), targeted to the left spinal nerves of C5–C8. The followup period was one year. Histologic sections from spinal cords and available spinal nerves were evaluated. MR imaging was performed on pigs in the 24.9 Gy group. Results: No pig that received a maximum spinal nerve point dose ⩽19.0 Gy experienced a change in gait while all pigs that received ⩾24.1 Gy experienced paralysis. Extensive degeneration and fibrosis were observed in irradiated spinal nerves of the 24.9 Gy animals. All spinal cord sections were normal. Irradiated spinal nerve regions showed increased thickness and hypointensity on MR imaging. Conclusion: The single-session tolerance dose of the cervical spinal nerves lies between 19.0 and 24.1 Gy for this model

Spinal cord potentials in traumatic paraplegia and quadriplegia.

Science.gov (United States)

Sedgwick, E M; el-Negamy, E; Frankel, H

1980-01-01

Cortical, cervical and lumbar somatosensory evoked potentials were recorded following median and tibial nerve stimulation in patients with traumatic paraplegia and quadriplegia. The isolated cord was able to produce normal potentials even during spinal shock if the vertical extent of the lesion did not involve the generator mechanisms. The cervical potentials showed subtle changes in paraplegia at Th5 levels and below. In high cervical lesions the early cervical potentials may still be present but the later potentials were absent or, in partial lesions, delayed. PMID:7420105

Primary multifocal gliosarcoma of the spinal cord

Directory of Open Access Journals (Sweden)

Ramesh M. Kumar

2016-03-01

Full Text Available Gliosarcoma (GS is a rare and exceedingly malignant neoplasm of the central nervous system. It displays clinical features similar to glioblastoma, yet is histologically unique as it harbors both gliomatous and sarcomatous cellular components. Involvement of the neuroaxis is predominantly limited to the cerebral parenchyma and meninges. Primary GS of the spinal cord is rarely encountered. We report a case of a 54 year old male who presented with 2 months of progressive, bilateral lower extremity sensory deficits. Magnetic resonance imaging of the neuro-axis revealed multiple intradural lesions involving the cervical and thoracic spinal cord without evidence of intracranial involvement. Surgical resection of a dural based, extramedullary cervical lesion and two exophytic, intramedullary thoracic lesions revealed gliosarcoma, WHO grade IV. The patient died approximately 11 months after presentation. This report confirms that GS is not limited to supratentorial involvement and can primarily affect the spinal cord.

Cervical spine cord injury in pregnancy. Conservative management ...

African Journals Online (AJOL)

Study design A prospective study of 3 patients with incomplete cervical spinal cord injury in the 3rd trimester of pregnancy. Objectives To determine the effect of spinal cord injury and treatment with Gardner-Wells\\' Tong traction on pregnancy, labour and parturition; and ascertain the effectiveness and safety of this ...

The relation between location of cervical cord compression and the location of myelomalacia

International Nuclear Information System (INIS)

Smorgick, Yossi; Anekstein, Yoram; Tal, Sigal; Yassin, Amit; Tamir, Eran; Mirovsky, Yigal

2015-01-01

The purpose of this study was to examine the relationship between the location of the cervical cord compression and the increased signal intensity within the cervical cord on T2-weighted imaging (T2WI) in patients with cervical myelopathy and myelomalacia. We reviewed 1,615 MRI reports from January 2011 to May 2013 from a single institution. Of the 1,615 reports reviewed, 168 patients were diagnosed with increased signal intensity within the cervical spine on T2WI. After applying the exclusion criteria 82 patients were included in the study. The MRIs of these 82 patients were then reviewed and the location of the increased signal intensity on T2WI in relation to the location of the pressure on the spinal cord was recorded. In more than 50 % of the cases the lesions with increased signal intensity on T2WI either were located distal to the pressure on the spinal cord or started at the level of the pressure and extended to an area distal to the pressure. In 26 out of the 92 lesions with increased signal intensity on T2WI, the lesion started proximal to the pressure on the spinal cord and extended distal to it. In only 3 out of the 92 lesions, the lesion with increased signal intensity on T2WI was solely located proximal to the pressure on the spinal cord. In 5 other cases the lesion with increased signal intensity on T2WI started proximal to the level of pressure on the spinal cord and extended into the level of pressure on the spinal cord (p < 0.001; Table 1). Cervical myelomalacia may appear proximal, distal or at the level of the compressed cord. It rarely appears solely proximal to the pressure area on the cord. (orig.)

Diagnosis of spinal cord diseases

International Nuclear Information System (INIS)

Halimi, P.; Sigal, R.; Doyon, D.; David, P.

1989-01-01

Magnetic resonance imaging (MRI) nowadays plays a predominant role in the diagnosis and evaluation of spinal canal pathologies and has reduced the other exploratory methods, including computerized tomography (CT) and myelography, to an ancillary role. These pathologies are divided into three groups: those where MRI is the only imaging method (syringomyela, tumours in the spinal canal, phakomatoses, external pachimeningitis, spinal cord injuries, myelitis); those where MRI is the initial method and is completed by other examinations (vascular malformations, dysraphism, myelopathies due to cervical osteoarthritis) and those where MRI still play a lesser role than CT (degenerative lesions of the lumbar column) [fr

MR evaluation of cervical CSF flow. An examination in patients with spinal canal stenosis

Energy Technology Data Exchange (ETDEWEB)

Iida, Makoto [Miyoshi General Hospital, Hiroshima (Japan); Kajima, Toshio; Miyasaka, Kenji; Nakanishi, Tadashi; Ono, Chiaki; Ito, Katsuhide

1999-06-01

To evaluate the flow dynamics of cerebrospinal fluid (CSF) throughout the cervical spine, 18 healthy controls and 14 patients with spinal canal stenosis were examined by phase-contrast cine MR. MR imaging was performed using a sagittal technique that is flow-sensitive in the craniocaudal direction. Flow encoding depicted craniocaudal flow as high intensity and caudocranial flow as low intensity. In this technique, either retrospective cardiac or peripheral gating was used to cover the complete cardiac cycle. This pulse sequence yielded 16 quantitative flow-encoded images per cardiac cycle. Using a region-of-interest cursor at each vertebral level, the graphs of flow-velocity versus time were generated. The recorded CSF at each vertebral level in the controls showed almost the same pattern in the change of flow in the craniocaudal direction, indicating that the onset of craniocaudal CSF flow was synchronous with the onset of cardiac systole in these subjects. At all vertebral levels, flow-velocity time curves showed the same variation in pattern. CSF flow was significantly lower in patients than in controls at each vertebral level (p<0.01). In addition, the flow patterns of the patients with spinal canal stenosis differed at each vertebral level. As a results, the total sum of the difference in velocity between graphs of two serial vertebrae at all sampling points (the area between the curves: ABC) per mean velocity amplitude in the patients was significantly higher than controls (p<0.05). Furthermore, the ABC per mean velocity amplitude at the stenotic level was significantly larger in the patients than that at the non-stenotic level (p<0.01). These data suggest that turbulent CSF flow occurs at the stenotic level. Thus, assessment of CSF flow dynamics is a useful adjunct to routine MRI in patients with spinal canal stenosis. (author)

Phrenic motoneuron expression of serotonergic and glutamatergic receptors following upper cervical spinal cord injury

Science.gov (United States)

Mantilla, Carlos B.; Bailey, Jeffrey P.; Zhan, Wen-Zhi; Sieck, Gary C.

2012-01-01

Following cervical spinal cord injury at C2 (SH hemisection model) there is progressive recovery of phrenic activity. Neuroplasticity in the postsynaptic expression of neurotransmitter receptors may contribute to functional recovery. Phrenic motoneurons express multiple serotonergic (5-HTR) and glutamatergic (GluR) receptors, but the timing and possible role of these different neurotransmitter receptor subtypes in the neuroplasticity following SH are not clear. The current study was designed to test the hypothesis that there is an increased expression of serotonergic and glutamatergic neurotransmitter receptors within phrenic motoneurons after SH. In adult male rats, phrenic motoneurons were labeled retrogradely by intrapleural injection of Alexa 488-conjugated cholera toxin B. In thin (10 μm) frozen sections of the spinal cord, fluorescently-labeled phrenic motoneurons were visualized for laser capture microdissection (LCM). Using quantitative real-time RT-PCR in LCM samples, the time course of changes in 5-HTR and GluR mRNA expression was determined in phrenic motoneurons up to 21 days post-SH. Expression of 5-HTR subtypes 1b, 2a and 2c and GluR subtypes AMPA, NMDA, mGluR1 and mGluR5 was evident in phrenic motoneurons from control and SH rats. Phrenic motoneuron expression of 5-HTR2a increased ~8-fold (relative to control) at 14 days post-SH, whereas NMDA expression increased ~16-fold by 21-days post-SH. There were no other significant changes in receptor expression at any time post-SH. This is the first study to systematically document changes in motoneuron expression of multiple neurotransmitter receptors involved in regulation of motoneuron excitability. By providing information on the neuroplasticity of receptors expressed in a motoneuron pool that is inactivated by a higher-level spinal cord injury, appropriate pharmacological targets can be identified to alter motoneuron excitability. PMID:22227062

Transplantation of Neural Precursor Cells Attenuates Chronic Immune Environment in Cervical Spinal Cord Injury