Primary epidural malignant hemangiopericytoma of thoracic spinal column causing cord compression: case report.

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Mohammadianpanah, Mohammad; Torabinejad, Simin; Bagheri, Mohammad Hadi; Omidvari, Shapour; Mosalaei, Ahmad; Ahmadloo, Niloofar

2004-09-02

Hemangiopericytoma is an uncommon mesenchymal neoplasm that rarely affects the spinal canal. Primary malignant hemangiopericytoma of the spinal column is extremely rare. We report on a case of primary epidural malignant hemangiopericytoma of the thoracic spinal column that invaded vertebral bone and caused spinal cord compression in a 21-year-old man. The patient presented with progressive back pain over a four-month period that progressed to paraparesis, bilateral leg paresthesia and urinary incontinence. The surgical intervention involved laminectomy and subtotal resection of the tumor, with posterior vertebral fixation. Postoperative involved-field radiotherapy was administered. A marked neurological improvement was subsequently observed. We describe the clinical, radiological, and histological features of this tumor and review the literature.

Primary epidural malignant hemangiopericytoma of thoracic spinal column causing cord compression: case report

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Mohammad Mohammadianpanah

Full Text Available CONTEXT: Hemangiopericytoma is an uncommon mesenchymal neoplasm that rarely affects the spinal canal. Primary malignant hemangiopericytoma of the spinal column is extremely rare. CASE REPORT: We report on a case of primary epidural malignant hemangiopericytoma of the thoracic spinal column that invaded vertebral bone and caused spinal cord compression in a 21-year-old man. The patient presented with progressive back pain over a four-month period that progressed to paraparesis, bilateral leg paresthesia and urinary incontinence. The surgical intervention involved laminectomy and subtotal resection of the tumor, with posterior vertebral fixation. Postoperative involved-field radiotherapy was administered. A marked neurological improvement was subsequently observed. We describe the clinical, radiological, and histological features of this tumor and review the literature.

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.)

Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study.

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Patel, N P; El-Wahab, N; Fernando, R; Wilson, S; Robson, S C; Columb, M O; Lyons, G R

2014-05-01

We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Acute presentation of solitary spinal epidural cavernous angioma in a child

International Nuclear Information System (INIS)

Khalatbari, M.R.; Moharamzad, Y.; Hamidi, M.

2013-01-01

Solitary spinal epidural cavernous angiomas are rare lesions, especially in paediatric age group. They are infrequently considered in the differential diagnosis of spinal epidural masses in children. We report a case of solitary epidural cavernous angioma of the thoracic spine in a child presenting with acute onset of back pain and myelopathy. Magnetic resonance imaging of the thoracic spine demonstrated a posterior epidural mass at T6-T8 levels with compression of the spinal cord. Using microsurgical technique and bipolar coagulation, total excision of the lesion was achieved. Histopathological examination confirmed the diagnosis of cavernous angioma. At the five-year follow-up, there was no recurrence of the tumour. (author)

A Brain–Spinal Interface Alleviating Gait Deficits after Spinal Cord Injury in Primates

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Capogrosso, Marco; Milekovic, Tomislav; Borton, David; Wagner, Fabien; Moraud, Eduardo Martin; Mignardot, Jean-Baptiste; Buse, Nicolas; Gandar, Jerome; Barraud, Quentin; Xing, David; Rey, Elodie; Duis, Simone; Jianzhong, Yang; Ko, Wai Kin D.; Li, Qin; Detemple, Peter; Denison, Tim; Micera, Silvestro; Bezard, Erwan; Bloch, Jocelyne; Courtine, Grégoire

2016-01-01

Spinal cord injury disrupts the communication between the brain and the spinal circuits that orchestrate movement. To bypass the lesion, brain–computer interfaces1–3 have directly linked cortical activity to electrical stimulation of muscles, which have restored grasping abilities after hand paralysis1,4. Theoretically, this strategy could also restore control over leg muscle activity for walking5. However, replicating the complex sequence of individual muscle activation patterns underlying natural and adaptive locomotor movements poses formidable conceptual and technological challenges6,7. Recently, we showed in rats that epidural electrical stimulation of the lumbar spinal cord can reproduce the natural activation of synergistic muscle groups producing locomotion8–10. Here, we interfaced leg motor cortex activity with epidural electrical stimulation protocols to establish a brain–spinal interface that alleviated gait deficits after a spinal cord injury in nonhuman primates. Rhesus monkeys were implanted with an intracortical microelectrode array into the leg area of motor cortex; and a spinal cord stimulation system composed of a spatially selective epidural implant and a pulse generator with real-time triggering capabilities. We designed and implemented wireless control systems that linked online neural decoding of extension and flexion motor states with stimulation protocols promoting these movements. These systems allowed the monkeys to behave freely without any restrictions or constraining tethered electronics. After validation of the brain–spinal interface in intact monkeys, we performed a unilateral corticospinal tract lesion at the thoracic level. As early as six days post-injury and without prior training of the monkeys, the brain–spinal interface restored weight-bearing locomotion of the paralyzed leg on a treadmill and overground. The implantable components integrated in the brain–spinal interface have all been approved for investigational

MR imaging and clinical findings of spontaneous spinal epidural hematoma

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Kim, Sam Soo [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Han, Moon Hee; Kim, Hyun Beom [College of Medicine, Seoul National University, Seoul (Korea, Republic of)] [and others

2000-01-01

To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

An epidural neuroblastoma causing spinal cord compression in a 67-year-old woman

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Ethan Taub

2010-04-01

Full Text Available We report a case of disseminated neuroblastoma (NB causing epidural spinal cord compression in a 67-year-old woman. Because NB is primarily a tumor of infancy and childhood, less is known about its clinical course and optimal treatment in adults. This patient was treated with a thoracic laminectomy and tumor resection; polychemotherapy with one cycle of vindesine, cisplatin, and etoposide; one cycle of vincristine, dacarbazine, ifosfamide, and doxorubicin; and radiotherapy to the spine. She remained able to walk but died 8.5 months later of diffuse systemic tumor progression.

Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient.

Science.gov (United States)

Bodman, Alexa; Riordan, Margaret; Chin, Lawrence S

2016-05-23

Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient's history and MRI findings, a spinal epidural abscess was found during surgery. The patient underwent laminectomy and instrumented fusion with successful treatment of her infection.

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

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.

Spinal cord injury arising in anaesthesia practice.

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Hewson, D W; Bedforth, N M; Hardman, J G

2018-01-01

Spinal cord injury arising during anaesthetic practice is a rare event, but one that carries a significant burden in terms of morbidity and mortality. In this article, we will review the pathophysiology of spinal cord injury. We will then discuss injuries relating to patient position, spinal cord hypoperfusion and neuraxial techniques. The most serious causes of spinal cord injury - vertebral canal haematoma, spinal epidural abscess, meningitis and adhesive arachnoiditis - will be discussed in turn. For each condition, we draw attention to practical, evidence-based measures clinicians can undertake to reduce their incidence, or mitigate their severity. Finally, we will discuss transient neurological symptoms. Some cases of spinal cord injury during anaesthesia can be ascribed to anaesthesia itself, arising as a direct consequence of its conduct. The injury to a spinal nerve root by inaccurate and/or incautious needling during spinal anaesthesia is an obvious example. But in many cases, spinal cord injury during anaesthesia is not caused by, related to, or even associated with, the conduct of the anaesthetic. Surgical factors, whether direct (e.g. spinal nerve root damage due to incorrect pedicle screw placement) or indirect (e.g. cord ischaemia following aortic surgery) are responsible for a significant proportion of spinal cord injuries that occur concurrently with the delivery of regional or general anaesthesia. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

Analysis of the Relationship Between the Epidural Spinal Cord Compression (ESCC) Scale and Paralysis Caused by Metastatic Spine Tumors.

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Uei, Hiroshi; Tokuhashi, Yasuaki; Maseda, Masafumi

2018-04-15

A retrospective, single-institute, and radiographic study. To evaluate the relationship between the epidural spinal cord compression (ESCC) scale and the severity of metastatic spine tumor-induced paralysis. The ESCC scale is used to evaluate the grade of spinal cord compression on T2-weighted magnetic resonance imaging (MRI). However, few studies have investigated the relationship between such MRI findings and paralysis. The subjects were 467 patients with metastatic spine tumors and grade 1b or worse spinal cord compression according to the ESCC scale. Evaluations using this scale were performed by three spine surgeons, and results that were obtained by two or more surgeons were adopted. We also examined patients whose spinal cord compression deteriorated by one grade or more to American Spinal Injury Association (ASIA) grade C or worse within the first 3 weeks after MRI. The kappa coefficients for inter- and intraexaminer variability were 0.90 and 0.95, respectively. ASIA grade D or worse paralysis developed in at least 50% of the patients with ESCC grade 1b or worse spinal cord compression at the C1-T2 and at least 50% of those with ESCC grade 1c or worse spinal cord compression at the T3-L5. The frequency of ASIA grade C or worse paralysis was high among the patients with ESCC grade 2 or worse spinal cord compression at the C7-L1. Nineteen patients experienced rapid deterioration of one grade or more to ASIA grade C or worse paralysis within the first 3 weeks after MRI. Of these, paralysis occurred in at least 30% of the patients with anterolateral or circumferential cord compression combined with ESCC grade 2 or 3 compression at the C7-L1. The severity of paralysis was not correlated with the ESCC scale. Patients with anterolateral or circumferential ESCC grade 2 or 3 cord compression at the C7-L1 are at high risk of rapidly progressive paralysis. 4.

Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression

International Nuclear Information System (INIS)

Thomas, Kenneth C.; Nosyk, Bohdan; Fisher, Charles G.; Dvorak, Marcel; Patchell, Roy A.; Regine, William F.; Loblaw, Andrew; Bansback, Nick; Guh, Daphne; Sun, Huiying; Anis, Aslam

2006-01-01

Purpose: A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches. Methods and Materials: In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death. In this study, an incremental cost-effectiveness analysis was performed from a societal perspective. Costs related to treatment and posttreatment care were estimated and extended to the lifetime of the cohort. Weibull regression was applied to extrapolate outcomes in the presence of censored clinical effectiveness data. Results: From a societal perspective, the baseline incremental cost-effectiveness ratio (ICER) was found to be $60 per additional day of ambulation (all costs in 2003 Canadian dollars). Using probabilistic sensitivity analysis, 50% of all generated ICERs were lower than $57, and 95% were lower than $242 per additional day of ambulation. This analysis had a 95% CI of -$72.74 to 309.44, meaning that this intervention ranged from a financial savings of $72.74 to a cost of $309.44 per additional day of ambulation. Using survival as the measure of effectiveness resulted in an ICER of $30,940 per life-year gained. Conclusions: We found strong evidence that treatment of metastatic epidural spinal cord compression with surgery in addition to radiotherapy is cost-effective both in terms of cost per additional day of ambulation, and cost per life-year gained

Acute spinal epidural hematoma: MR imaging study

International Nuclear Information System (INIS)

Xu Wenjian; Xu Aide

2003-01-01

Objective: To study the pathogenesis of acute spinal epidural hematomas (ASEHs), MRI features, and its value on diagnosis and differential diagnosis. Methods: Fifteen patients with ASEHs (8 males, 7 females, mean age 37.8 years) were reviewed. Seven of the patients were secondary to spinal injuries (5 spinal trauma, 1 post-spinal operation, and 1 post-lumbar puncture) and 8 were spontaneous. Eleven patients were confirmed by operation. MRI was performed in all patients in sagittal SE T 1 WI and SE or FSE T 2 WI, 12 in axial FSE T 2 WI, 8 in axial SE T 1 WI, and 4 in contrast-enhanced SE T 1 WI. Results: Fifteen ASEHs involved 18 spinal segments, 6 of the segments (6/18) in cervical spine, 9 segments (9/18) in thoracic spine, and 3 segments (3/18) in lumbar spine. The hematomas located at pre-epidural space in 7 segments (7/18) and at posterolateral epidural space in 11 segments (11/18). The craniocaudal extent of the hematomas varied from 1 to 13 vertebral levels (average 4.87 vertebral level). There were low signal intensity lines between hematomas and spinal cord in all of the cases on T 1 WI. The low signal intensity line between hematoma and subarachnoid space was demonstrated in 8 cases (8/12) and 4 cases (4/15) on axial T 2 WI and sagittal T 2 WI, respectively. The figure of hematomas was biconvex on axial imaging in all of the cases, and long lentiform on sagittal imaging in 13 cases (13/15). The hematomas showed variable signal intensity. On T 1 WI, 5 showed isointensity to cord, 6 with hyperintensity, and 4 with inhomogeneous iso-hyperintensity. On T 2 WI, 5 showed hypointensity, 10 with inhomogeneous hypo-hyperintensity. There was no special MR manifestation after contrast administration. Conclusion: ASEHs is a rare disorder, and MRI features are characteristic for the diagnosis and differential diagnosis

Periodic modulation of repetitively elicited monosynaptic reflexes of the human lumbosacral spinal cord

OpenAIRE

Hofstoetter, Ursula S.; Danner, Simon M.; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank; Minassian, Karen

2015-01-01

In individuals with motor-complete spinal cord injury, epidural stimulation of the lumbosacral spinal cord at 2 Hz evokes unmodulated reflexes in the lower limbs, while stimulation at 22–60 Hz can generate rhythmic burstlike activity. Here we elaborated on an output pattern emerging at transitional stimulation frequencies with consecutively elicited reflexes alternating between large and small. We analyzed responses concomitantly elicited in thigh and leg muscle groups bilaterally by epidural...

Multishot diffusion-weighted MR imaging features in acute trauma of spinal cord

International Nuclear Information System (INIS)

Zhang, Jin Song; Huan, Yi

2014-01-01

To analyse diffusion-weighted MRI of acute spinal cord trauma and evaluate its diagnostic value. Conventional MRI and multishot, navigator-corrected DWI were performed in 20 patients with acute spinal cord trauma using 1.5-T MR within 72 h after the onset of trauma. Twenty cases were classified into four categories according to the characteristics of DWI: (1) Oedema type: ten cases presented with variable hyperintense areas within the spinal cord. There were significant differences in the apparent diffusion coefficients (ADCs) between lesions and unaffected regions (t = -7.621, P < 0.01). ADC values of lesions were markedly lower than those of normal areas. (2) Mixed type: six cases showed heterogeneously hyperintense areas due to a mixture of haemorrhage and oedema. (3) Haemorrhage type: two cases showed lesions as marked hypointensity due to intramedullary haemorrhage. (4) Compressed type (by epidural haemorrhage): one of the two cases showed an area of mild hyperintensity in the markedly compressed cord due to epidural haematoma. Muti-shot DWI of the spinal cord can help visualise and evaluate the injured spinal cord in the early stage, especially in distinguishing the cytotoxic oedema from vasogenic oedema. It can assist in detecting intramedullary haemorrhage and may have a potential role in the evaluation of compressed spinal cord. (orig.)

Prognosis after spinal cord and cauda compression in spontaneous spinal epidural hematomas

NARCIS (Netherlands)

Bakker, Nicolaas A.; Veeger, Nic J. G. M.; Vergeer, Rob A.; Groen, Rob J. M.

2015-01-01

Objective:Spontaneous spinal epidural hemorrhage (SSEH) warrants urgent surgical treatment in most cases. Which patients will benefit most from decompression is not known and the disease's rarity hampers the collection of large data series to ascertain this. Therefore, using an individual patient

Chronic spinal epidural hematoma in hemophilia A in a child

Energy Technology Data Exchange (ETDEWEB)

Stanley, P.; McComb, J.G.

1983-06-01

A case of chronic spinal epidural hematoma in a thirteen-year-old male, subsequently found to have hemophilia A is reported. Following myelography, surgery was undertaken with clotting factor replacement with relief of cord compression. The patient made an uneventful recovery.

Chronic spinal epidural hematoma in hemophilia A in a child

International Nuclear Information System (INIS)

Stanley, P.; McComb, J.G.; University of Southern California, Los Angeles

1983-01-01

A case of chronic spinal epidural hematoma in a thirteen-year-old male, subsequently found to have hemophilia A is reported. Following myelography, surgery was undertaken with clotting factor replacement with relief of cord compression. The patient made an uneventful recovery. (orig.)

The Protective Effect of Spinal Cord Stimulation Postconditioning Against Spinal Cord Ischemia/Reperfusion Injury in Rabbits.

Science.gov (United States)

Li, Huixian; Dong, Xiuhua; Jin, Mu; Cheng, Weiping

2018-01-18

Delayed paraplegia due to spinal cord ischemia/reperfusion injury (IRI) remains one of the most severe complications of thoracoabdominal aneurysm surgery, for which effective prevention and treatment is still lacking. The current study investigates whether spinal cord stimulation (SCS) postconditioning has neuroprotective effects against spinal cord IRI. Ninety-six New Zealand white male rabbits were randomly divided into four groups as follows: a sham group and three experimental groups (C group, 2 Hz group, and 50 Hz group) n = 24/group. Spinal cord ischemia was induced by transient infrarenal aortic balloon occlusion for 28 min, after which rabbits in group C underwent no additional intervention, while rabbits in the other two experimental groups underwent 2 Hz or 50 Hz epidural SCS for 30 min at the onset of reperfusion and then daily until sacrifice. Hind limb neurologic function of rabbits was assessed using Jacob scale. Lumbar spinal cords were harvested immediately after sacrifice for histological examination and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. The number of viable α-motor neurons in ventral horn was counted and TUNEL-positive rate of α-motor neurons was calculated. Spinal cord IRI was caused by transient infrarenal aorta occlusion for 28 min. Both 2 Hz and 50 Hz SCS postconditioning had neuroprotective effects, particularly the 2 Hz SCS postconditioning. Comparing to C group and 50 Hz group, rabbits in the 2 Hz group demonstrated better hind limb motor function and a lower rate of TUNEL-positive α-motor neuron after eight hours, one day, three days, and seven days of spinal cord reperfusion. More viable α-motor neurons were preserved after one and three days of spinal cord reperfusion in 2 Hz group rabbits than in C group and 50 Hz group rabbits. SCS postconditioning at 2 Hz protected the spinal cord from IRI. © 2018 International Neuromodulation Society.

Spontaneous spinal epidural haematoma: a rare cause of quadriplegia in the post-partum period.

Science.gov (United States)

Bose, S; Ali, Z; Rath, G P; Prabhakar, H

2007-12-01

Spontaneous spinal epidural haematoma (SSEH) is a rare cause of neurological deficit in the pregnant and post-partum patients. However, SSEH with associated myelitis presenting as quadriplegia and respiratory paralysis in the post-partum period has never been reported. We report the development of acute onset quadriplegia progressing to respiratory arrest in a 24-yr-old woman 2 weeks after normal vaginal delivery. There was no history suggestive of any coagulopathy (inherited or acquired), eclampsia, pre-existing neurological deficit, or iatrogenic manipulations such as spinal/epidural injections. Magnetic resonance imaging revealed a posterior epidural haematoma extending from C4-C7 and areas of signal changes in spinal cord from cervicomedullary junction to D5 level (suggestive of demyelination). We highlight this rare cause of quadriplegia; focusing on the altered dynamics of the epidural vasculature in the peripartum period leading to SSEH.

Can the human lumbar posterior columns be stimulated by transcutaneous spinal cord stimulation? A modeling study

OpenAIRE

Danner, Simon M.; Hofstoetter, Ursula S.; Ladenbauer, Josef; Rattay, Frank; Minassian, Karen

2011-01-01

Stimulation of different spinal cord segments in humans is a widely developed clinical practice for modification of pain, altered sensation and movement. The human lumbar cord has become a target for modification of motor control by epidural and more recently by transcutaneous spinal cord stimulation. Posterior columns of the lumbar spinal cord represent a vertical system of axons and when activated can add other inputs to the motor control of the spinal cord than stimulated posterior roots. ...

Spinal cord stimulation: modeling results and clinical data

NARCIS (Netherlands)

Struijk, Johannes J.; Struijk, J.J.; Holsheimer, J.; Barolat, Giancarlo; He, Jiping

1992-01-01

The potential distribution in volume couductor models of the spinal cord at cervical, midthoracic and lowthoracic levels, due to epidural stimulation, was calculated. Treshold stimuli of modeled myelhated dorsal column and dorsal root fibers were calculated and were compared with perception

Twisted tail: spinal epidural lipomatosis responding to chemotherapy in a patient with non-small-cell lung cancer

International Nuclear Information System (INIS)

Nasoodi, A.; McAleese, J.; Grey, A.; Stranex, S.

2008-01-01

Full text: Spinal epidural lipomatosis is a rare condition, described in corticoadrenal hyperactivity. It is most commonly seen in association with steroid administration and occasionally with Cushing's syndrome. This is the first case report of spinal epidural lipomatosis as presenting finding in a patient with non-small-cell lung carcinoma without any evidence of endogenous or exogenous hypercortisolism. The additional interesting feature is the paraneoplastic behaviour of this condition and even more interestingly its resolution following chemo-treatment of the primary cancer. Spinal epidural lipomatosis is a benign condition, which must be considered in the differential diagnosis of spinal cord compression in this category of patients. Its pathophysiology remains to be discovered in future.

Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

International Nuclear Information System (INIS)

Tok, Chung Hong; Kaur, Shaleen; Gangi, Afshin

2011-01-01

Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202–211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202–211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

Spontaneous Spinal Epidural Hematoma as a Potentially Important Stroke Mimic

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Tetsu Akimoto

2014-01-01

Full Text Available Hemiparesis develops in response to a wide range of neurological disorders, such as stroke, neoplasms and several inflammatory processes. Occasionally, it may also occur due to a lesion located in the high cervical spinal cord. In this concise review, we describe the features of spontaneous spinal epidural hematoma, which should be included in the large list of stroke mimics. Various concerns regarding the diagnostic and therapeutic conundrums relating to the condition are also discussed.

Reducing risk of spinal haematoma from spinal and epidural pain procedures.

Science.gov (United States)

Breivik, Harald; Norum, Hilde; Fenger-Eriksen, Christian; Alahuhta, Seppo; Vigfússon, Gísli; Thomas, Owain; Lagerkranser, Michael

2018-04-25

Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory. We searched recent guidelines, PubMed (MEDLINE), SCOPUS and EMBASE for new and relevant randomised controlled trials (RCT), case-reports and original articles concerning benefits of neuraxial blocks, risks of SH due to anti-haemostatic drugs, patient-related risk factors, especially renal impairment with delayed excretion of antihaemostatic drugs, and specific risk factors related to the neuraxial pain procedures. Epidural and spinal analgesic techniques, as well as their combination provide superior analgesia and reduce the risk of postoperative and obstetric morbidity and mortality. Spinal pain procedure can be highly effective for cancer patients, less so for chronic non-cancer patients. We did not identify any RCT with SH as outcome. We evaluated risks and recommend precautions for SH when patients are treated with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients' comorbidities may increase risks, and when procedure-specific risk factors are present. Inserting and withdrawing epidural catheters appear to have similar risks for initiating a SH. Invasive neuraxial pain procedures, e.g. spinal cord stimulation, have higher risks of bleeding than traditional neuraxial blocks. We recommend robust monitoring routines and treatment protocol to ensure early diagnosis and effective treatment of SH should this rare but potentially serious complication occur. When neuraxial analgesia is considered for a patient on anti

Non-traumatic acute epidural spinal hematomas diagnosed by magnetic resonance

International Nuclear Information System (INIS)

Rovira, A.; Grive, E.; Pedraza, S.; Capellades, J.; Nos, C.; Alarcon, M.; Rovira, A.

2000-01-01

The non-traumatic spinal epidural hematoma (NTSEH) is a rare entity that can be the cause of an acute spinal compression syndrome. the objective of this review is to identify the characteristics by MRI and NTSEH and to analyze the factors that influence in its prognosis. In the years 1994 and 1999, 12 patients with NTSEH have been diagnosed in our hospital, and a MRI was performed during the acute phase. the characteristics of the lesions have been analyzed by MRI, with special emphasis on the topographic data and resonance signal and the factors that can influence in the clinical prognosis of the patients. Initially, all of the patients presented pain in the cervical dorsal or interscapular site, followed by a sensitive-motor deficit picture. The MRI showed a lesion of expansive character and posterior epidural location in every case that would produce varying degrees of compression on the spinal cord. The NTSEH should be considered as one of the causes of acute spinal cord compression. The clinical association of intense cervical, dorsal or interscapular pain followed by a sensomotor deficit picture should lead to the suspicion of this entity, that would require an immediate examination with MRI to verify its diagnosis. Both the clinical manifestations as well as the characteristics observed by MRI of the NTSEH have a prognostic value and determine the therapeutic decision. (Author) 34 refs

[Spinal cord compression due to extramedullary hematopoiesis in a patient with myelofibrosis].

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Hijikata, Yasuhiro; Ando, Tetsuo; Inagaki, Tomonori; Watanabe, Hirohisa; Ito, Mizuki; Sobue, Gen

2014-01-01

Development and growth of hematopoietic tissue outside of the bone marrow is termed extramedullary hematopoiesis (EMH). It occurs in patients with hematological diseases such as myelofibrosis and thalassemia. Liver and spleen are the usual sites of EMH. However, spinal cord compression caused by EMH is a rare complication. A 65-year-old man with myelofibrosis was admitted to our hospital with progressive paraparesis. Thoracic spine MRI revealed epidural masses causing cord compression. Histological examination of the epidural mass showed evidence of EMH consisting of megakaryocytic and erythroid hyperplasia. After surgical decompression and radiotherapy, lower limb weakness and sensory disturbance were significantly improved. MRI showed disappearance of the spinal cord compression. With this therapy, he had no recurrence until he died of myelofibrosis. Spinal EMH should be considered as a differential diagnosis in patients with hematological diseases presenting with paraparesis. Surgical decompression and radiotherapy are effective approaches for the treatment of paraparesis due to EMH.

[Relationship of motor deficits and imaging features in metastatic epidural spinal cord compression].

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Liu, Shu-Bin; Liu, Yao-Sheng; Li, Ding-Feng; Fan, Hai-Tao; Huai, Jian-Ye; Guo, Jun; Wang, Lei; Liu, Cheng; Zhang, Ping; Cui, Qiu; Jiang, Wei-Hao; Cao, Yun-Cen; Jiang, Ning; Sui, Jia-Hong; Zhang, Bin; Zhou, Jiu

2010-06-15

To explore the relationship of motor deficits of the lower extremities with the imaging features of malignant spinal cord compression (MESCCs). From July 2006 through December 2008, 56 successive MESCC patients were treated at our department. All were evaluated by magnetic resonance imaging and computed tomography and were scored according to motor deficits Frankel grading on admission. Imaging assessment factors of main involved vertebrae were level of vertebral metastatic location, epidural space involvement, vertebral body involvement, lamina involvement, posterior protrusion of posterior wall, pedicle involvement, continuity of main involved vertebrae, fracture of anterior column, fracture of posterior wall, location in upper thoracic spine and/or cervicothoracic junction. Occurrence was the same between paralytic state of MESCCs and epidural space involvement of imaging features. Multiple regression equation showed that paralytic state had a linear regression relationship with imaging factors of lamina involvement (X1), posterior protrusion of posterior wall (X2), location in upper thoracic spine and/or cervicothoracic junction (X7) of main involved vertebrae. The optimal regression equation of paralytic state (Y) and imaging feature (X) was Y = -0.009 +0.639X, + 0.149X, +0.282X. Lamina involvement of main involved vertebrae has a greatest influence upon paralytic state of MESCC patients. Imaging factors of lamina involvement, posterior protrusion of posterior wall, location in upper thoracic spine and/or cervicothoracic junction of main involved vertebrae can predict the paralytic state of MESCC patients. MESCC with lamina involvement is more easily encroached on epidural space.

MRI findings in spinal subdural and epidural hematomas

International Nuclear Information System (INIS)

Braun, Petra; Kazmi, Khuram; Nogues-Melendez, Pablo; Mas-Estelles, Fernando; Aparici-Robles, Fernando

2007-01-01

Background: Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. Patients and Methods: From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. Results: Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. Discussion: MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment

MRI findings in spinal subdural and epidural hematomas

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Braun, Petra [Department of Radiology, Hospital La Plana, Ctra. De Vila-real a Borriana km. 0.5, 12540 Vila-real (Castello) (Spain)], E-mail: PetraBraun@gmx.de; Kazmi, Khuram [Department of Radiology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 (United States); Nogues-Melendez, Pablo; Mas-Estelles, Fernando; Aparici-Robles, Fernando [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)

2007-10-15

Background: Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. Patients and Methods: From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. Results: Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. Discussion: MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.

Spinal cord stimulation therapy for localized central pain

International Nuclear Information System (INIS)

Hirato, Masafumi; Takahashi, Akio; Watanabe, Katsushige; Kazama, Ken; Yoshimoto, Yuhei

2008-01-01

We studied the pathophysiology of localized central pain and the surgical result of spinal cord stimulation. There were 10 cases; 7 males and 3 females from 24 to 77 years old. Pain was caused by peripheral nerve injury in one case, spinal cord injury in two cases and cerebrovascular disease (CVD) (thalamic pain) in 7 cases. All cases were treated by epidural spinal cord stimulation and followed from 0.8 to 8.8 years. Sufficient pain relief was achieved in one case of peripheral nerve and spinal cord injury and in 4 cases of CVD. Moderate pain control was achieved in 2 cases of CVD. In one each case of spinal cord injury and of CVD, pain control was ineffective. In cases with thalamic pain, we studied the correlation between the surgical result of spinal cord stimulation and the clinical features, MRI, fluoro-deoxyglucose (FDG)-positron emission tomography (PET), and somatosensory evoked potentials (SEP) findings before operation. MRI revealed a small to moderate sized lesion on the thalamus or putamen in each case. PET also showed decreased accumulation of FDG on the affected thalamus. In all cases without one fair responder to spinal cord stimulation, we could recognize definite SEP originating in the sensory cortex ipsilateral side to the CVD lesion during contralateral median or posterior tibial nerve stimulation. In the good responders, we could recognize SEP originating in the sensory cortex of the lesion side with less delayed latency or decreased amplitude than in the moderate responders. In this group, test stimulation with low voltage on the spinal cord evoked a sensory effect (paresthesia) over the painful part of the body. Spinal cord stimulation proved to be an effective treatment for localized central pain. In cases with localized central pain after CVD, we could expect to ameliorate the intractable pain in those cases in which SEP or spinal cord test stimulation revealed that the thalamo-cortical system was preserved. (author)

Spinal cord arteriovenous shunts: from imaging to management

International Nuclear Information System (INIS)

Rodesch, G.; Lasjaunias, P.

2003-01-01

Spinal cord arteriovenous shunts (SCAVSs) are either fistulas or niduses that can be separated in four different groups according to their localization and relationship to the dura. Paraspinal AVSs are located outside the spine and are responsible for neurological symptoms because of cord compression by ertatic veins, venous congestion or arterial steal. Epidural shunts are located in the epidural space and drain in epidural veins with secondary intradural congestion. Dural shunts are embedded in the dura, produce a cord venous myelopathy after draining through veins that either pierce the dura far from a nerve root or accompany a nerve root. Intradural shunts affect the cord, the roots or the filum. Additionally, they can be classified according to their potential relationships with genetics, vascular biological features and angiogenesis into genetic hereditary lesions (hereditary hemorrhagic telangiectasia), genetic non-hereditary lesions (multiple lesions with metameric links) and single lesions (AVMs or micro AVFs). MRI and MRA are able to visualise SCAVS early after the onset of clinical symptoms. The type of shunt and its localization may remain difficult to be precise. Angiography remains the gold standard for analysis of the anatomical, morphological and architectural features necessary for therapeutic decisions in both paediatric and adult populations. In our series, embolisation is chosen in first intention whatever the type of shunt responsible for the clinical symptoms and glue is preferably used. In paraspinal, dural or epidural arteriovenous shunts, the goal of treatment should be complete closure of the shunt. A complete cure by embolization is rather easily achieved in paraspinal lesions. Failure of endovascular therapy in dural or epidural shunts must bring the patient to surgery. The prognosis of most intradural shunts seems better than previously thought, even after haemorrhage. In intradural spinal cord arteriovenous shunts, embolisation

Epidural venous stasis in spinal stenosis

International Nuclear Information System (INIS)

Kaiser, M.C.; Capesius, P.; Poos, D.; Gratia, G.; Roilgen, A.; Sandt, G.

1984-01-01

Computed tomography permits reliable demonstration of the spinal canal and its contents. Measurements of the sagittal diameter of the bony canal do not take into consideration size, shape and state of intraspinal soft tissue structures, i.e. the thecal sac and its own contents, epidural fat and blood circulation pattern. Three particularly illustrative cases were selected in which obvious epidural venous engorgement was visualized in association with spinal stenosis. The authors think that epidural venous stasis occuring in segmental spinal stenosis is a CT sign of clinically significant narrowing of the neural canal. Accurate recognition of the type of lumbar stenosis together with epidural blood flow alterations permits a better understanding of the existing lesions. Thus, a more precise and specific surgical approach is possible. (orig.)

Primary epidural lymphoma without vertebral involvement in a HIV-positive patient; Linfoma epidural primario sin afectacion vertebral en un paciente VIH positivo

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Perez, M. O.; Grive, E.; Quiroga, S.; Rovira, A. [Hospital General Universitari Vall d`Hebron. Barcelona. (Spain)

1999-05-01

Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin`s lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs.

A RARE CASE OF QUADRIPLEGIA DUE TO SPINAL EPIDURAL HAEMATOMA FOLLOWING SPINAL ANAESTHESIA

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Meher Kumar

2015-03-01

Full Text Available Quadriplegia following spinal anaesthesia due to spinal epidural haematoma is a rare but critical complication that usually occurs within 24 hours to a few days of the procedure. I report a case of a 32 year old male who underwent Uretero - Renal Scopy (URS and double ‘J’ (DJ stenting for right ureteric calculus under spinal anaesthesia. The patient was on nonsteroidal anti - inflammatory agents (NSAIDS and oral Prednisolone for sero - negative rheumatoid arthritis. The preoperative investigations were normal. About four hours after surgery, the patient developed paraesthesia of lower limbs, a little later paraplegia and gradually quadriplegia within 12 to 15 hours of surgery. Magnetic Resonance Imaging (MRI revealed an extensive spinal epidural haematoma and cord oedema extending from C2 to L5 vertebrae. In consultation with neuro - surgeon, the patient was treated conservatively, while awaiting for the results of coagulation profile, which proved to be Haemophilia. By the end of 2nd and 3rd postoperative day, the upper limbs showed signs of recovery and within a week’s time, both the upper limbs regained normal power and tone. The lower limbs showed sensory as well as motor recovery by 3 rd week and about total recovery to normalcy by 6 weeks. Residual paresis remained in left lower limb. The patient was sent for physiotherapy and he recovered completely by 9 months

Functional and metabolic changes in the brain in neuropathic pain syndrome against the background of chronic epidural electrostimulation of the spinal cord.

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Sufianov, A A; Shapkin, A G; Sufianova, G Z; Elishev, V G; Barashin, D A; Berdichevskii, V B; Churkin, S V

2014-08-01

Changes in functional and metabolic activities of the brain were evaluated by EEG and positron-emission/computer tomography with 18F-fluorodeoxyglucose in patients with neuropathic pain syndrome previous to and 3 months after implantation of a system for chronic epidural spinal cord stimulation. In most cases, the use of a nerve stimulator was followed by alleviation of neuropathic pain and partial normalization of functional and metabolic activities of brain structures responsible for pain perception, emotiogenic, behavioral, and autonomic responses.

A novel approach for automatic visualization and activation detection of evoked potentials induced by epidural spinal cord stimulation in individuals with spinal cord injury.

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Mesbah, Samineh; Angeli, Claudia A; Keynton, Robert S; El-Baz, Ayman; Harkema, Susan J

2017-01-01

Voluntary movements and the standing of spinal cord injured patients have been facilitated using lumbosacral spinal cord epidural stimulation (scES). Identifying the appropriate stimulation parameters (intensity, frequency and anode/cathode assignment) is an arduous task and requires extensive mapping of the spinal cord using evoked potentials. Effective visualization and detection of muscle evoked potentials induced by scES from the recorded electromyography (EMG) signals is critical to identify the optimal configurations and the effects of specific scES parameters on muscle activation. The purpose of this work was to develop a novel approach to automatically detect the occurrence of evoked potentials, quantify the attributes of the signal and visualize the effects across a high number of scES parameters. This new method is designed to automate the current process for performing this task, which has been accomplished manually by data analysts through observation of raw EMG signals, a process that is laborious and time-consuming as well as prone to human errors. The proposed method provides a fast and accurate five-step algorithms framework for activation detection and visualization of the results including: conversion of the EMG signal into its 2-D representation by overlaying the located signal building blocks; de-noising the 2-D image by applying the Generalized Gaussian Markov Random Field technique; detection of the occurrence of evoked potentials using a statistically optimal decision method through the comparison of the probability density functions of each segment to the background noise utilizing log-likelihood ratio; feature extraction of detected motor units such as peak-to-peak amplitude, latency, integrated EMG and Min-max time intervals; and finally visualization of the outputs as Colormap images. In comparing the automatic method vs. manual detection on 700 EMG signals from five individuals, the new approach decreased the processing time from several

Periodic modulation of repetitively elicited monosynaptic reflexes of the human lumbosacral spinal cord

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Danner, Simon M.; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank; Minassian, Karen

2015-01-01

In individuals with motor-complete spinal cord injury, epidural stimulation of the lumbosacral spinal cord at 2 Hz evokes unmodulated reflexes in the lower limbs, while stimulation at 22–60 Hz can generate rhythmic burstlike activity. Here we elaborated on an output pattern emerging at transitional stimulation frequencies with consecutively elicited reflexes alternating between large and small. We analyzed responses concomitantly elicited in thigh and leg muscle groups bilaterally by epidural stimulation in eight motor-complete spinal cord-injured individuals. Periodic amplitude modulation of at least 20 successive responses occurred in 31.4% of all available data sets with stimulation frequency set at 5–26 Hz, with highest prevalence at 16 Hz. It could be evoked in a single muscle group only but was more strongly expressed and consistent when occurring in pairs of antagonists or in the same muscle group bilaterally. Latencies and waveforms of the modulated reflexes corresponded to those of the unmodulated, monosynaptic responses to 2-Hz stimulation. We suggest that the cyclical changes of reflex excitability resulted from the interaction of facilitatory and inhibitory mechanisms emerging after specific delays and with distinct durations, including postactivation depression, recurrent inhibition and facilitation, as well as reafferent feedback activation. The emergence of large responses within the patterns at a rate of 5.5/s or 8/s may further suggest the entrainment of spinal mechanisms as involved in clonus. The study demonstrates that the human lumbosacral spinal cord can organize a simple form of rhythmicity through the repetitive activation of spinal reflex circuits. PMID:25904708

Thalassemia, extramedullary hematopoiesis, and spinal cord compression: A case report

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Bukhari, Syed Sarmad; Junaid, Muhammad; Rashid, Mamoon Ur

2016-01-01

Background: Extramedullary hematopoiesis (EMH) refers to hematopoiesis outside of the medulla of the bone. Chronic anemia states such as thalassemia can cause hematopoietic tissue to expand in certain locations. We report a case of spinal cord compression due to recurrent spinal epidural EMH, which was treated with a combination of surgery and radiotherapy. Pakistan has one of the highest incidence and prevalence of thalassemia in the world. We describe published literature on diagnosis and m...

Spinal cord contusion.

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Ju, Gong; Wang, Jian; Wang, Yazhou; Zhao, Xianghui

2014-04-15

Spinal cord injury is a major cause of disability with devastating neurological outcomes and limited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result.

Neuroarthropathy of the hip following spinal cord injury

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Bibek Banskota

2011-01-01

Full Text Available We present the case of a 33-year-old male who sustained a burst fracture D12 vertebrae with spinal cord injury (ASIA impairment scale A and a right mid-diaphysial femoral shaft fracture around 1.5 years back. The patient reported 1.5 years later with a swelling over the right buttock. Arthrotomy revealed serous fluid and fragmented bone debris. The biopsy showed a normal bony architecture with no evidence of infection and malignant cells. Hence, a diagnosis of Charcot′s hip was made. Charcot′s neuroarthropathy of the feet is a well-recognized entity in the setting of insensate feet resulting from causes such as diabetes or spina bifida. Although Charcot′s disease of the hips has been described, it is uncommon in association with spinal cord injury, syphilis and even with the use of epidural injection. The present case highlights the fact that neuroarthropathy of the hip can occur in isolation in the setting of a spinal cord injury, and this can lead to considerable morbidity.

Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature.

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Vinay, S; Khan, S K; Braybrooke, J R

2011-01-01

Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression.

Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases

International Nuclear Information System (INIS)

Mahadevan, Anand; Floyd, Scott; Wong, Eric; Jeyapalan, Suriya; Groff, Michael; Kasper, Ekkehard

2011-01-01

Purpose: When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials: SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy × 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results: The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions: SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.

Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases

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Mahadevan, Anand, E-mail: amahadev@bidmc.harvard.edu [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Floyd, Scott [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Wong, Eric; Jeyapalan, Suriya [Department of Neuro-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Groff, Michael; Kasper, Ekkehard [Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel)

2011-12-01

Purpose: When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials: SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy Multiplication-Sign 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results: The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions: SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.

Stereotactic body radiotherapy reirradiation for recurrent epidural spinal metastases.

Science.gov (United States)

Mahadevan, Anand; Floyd, Scott; Wong, Eric; Jeyapalan, Suriya; Groff, Michael; Kasper, Ekkehard

2011-12-01

When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy×3=24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gyx5=25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients. Copyright © 2011 Elsevier Inc. All rights reserved.

Spinal Epidural Haemangioma Associated with Extensive Gastrointestinal Haemangiomas

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Cheng, L.T.E.; Lim, W.E.H.

2005-01-01

Summary A case of spinal epidural cavernous haemangioma associated with gastrointestinal haemangiomas is discussed. The patient was a young Chinese female presenting with chronic lower back pain. She had a history of extensive gastric and small bowel haemangiomas. Lumbar spine MRI showed a heterogeneously enhancing epidural mass infiltrating the paravertebral muscles. Open biopsy confirmed an epidural cavernous haemangioma. To our knowledge, an association between spinal epidural cavernous haemangiomas and gastrointestinal haemangiomas has not been reported. PMID:20584496

Primary epidural lymphoma without vertebral involvement in a HIV-positive patient

International Nuclear Information System (INIS)

Perez, M. O.; Grive, E.; Quiroga, S.; Rovira, A.

1999-01-01

Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin's lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs

Epidural Spinal Stimulation to Improve Bladder, Bowel, and Sexual Function in Individuals With Spinal Cord Injuries: A Framework for Clinical Research.

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Pettigrew, Roderic I; Heetderks, William J; Kelley, Christine A; Peng, Grace C Y; Krosnick, Steven H; Jakeman, Lyn B; Egan, Katharine D; Marge, Michael

2017-02-01

While some recent studies that apply epidural spinal cord stimulation (SCS) have demonstrated a breakthrough in improvement of the health and quality of the life of persons with spinal cord injury (SCI), the numbers of people who have received SCS are small. This is in sharp contrast to the thousands of persons worldwide living with SCI who have no practical recourse or hope of recovery of lost functions. Thus, the vision is to understand the full potential of this new intervention and to determine if it is safe and effective in a larger cohort, and if it is scalable so that it can be made available to all those who might benefit. To achieve this vision, the National Institute of Biomedical Imaging and Bioengineering called for and organized a consortium of multiple stakeholder groups: foundations addressing paralysis, federal and public agencies, industrial partners, academicians, and researchers, all interested in the same goal. Based on input from consortium participants, we have reasoned that a first step is to define a scalable SCS approach that is effective in restoring lost autonomic physiology, specifically bladder, bowel, and sexual function. These functions are most critical for improving the quality of life of persons living with SCI. This report outlines a framework for conducting the research needed to define such an effective SCS procedure that might seek Food and Drug Administration approval and be implemented at the population level.

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

International Nuclear Information System (INIS)

Brodskaya, Z.L.

1983-01-01

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

Nontraumatic spinal epidural hematomas. MR features

International Nuclear Information System (INIS)

Loevblad, K.O.; Baumgartner, R.W.; Zambaz, B.D.; Remonda, L.; Ozdoba, C.; Schroth, G.

1997-01-01

Purpose: Spinal epidural hematoma (SEH) is a rare clinical entity with a bleak outcome. The aim of our study was to establish the value of MR findings in the diagnosis of nontraumatic SEH. Material and Methods: Seven patients with nontraumatic SEH were examined by MR at 1.5 T. Two patients were under anticoagulation therapy with heparin, and 2 others were taking salicylic acid. One patient had lupus erythematodes with a marked thrombocytopenia. One patient had a spinal arteriovenous malformation. Results: MR imaging permitted the accurate localization of extradural intraspinal expansive lesions which exhibited the characteristic signal intensities of blood. Five patients underwent laminectomy and evacuation of the hematoma. In the acute phase, the hematomas appeared isointense when compared with the spinal cord on T1-weighted images and hyperintense on T2-weighted images. Later the hematomas were hyperintense on T1-weighted images and showed signals identical to those of cerebrospinal fluid (CSF) on T2-weighted images. Conclusion: MR imaging established the exact diagnosis and localization of SEH in all cases. MR also can provide useful information about the age of the hematomas. (orig.)

Spinal Cord Injury 101

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Spinal Cord Injury 101

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Spinal Cord Injury 101

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Full Text Available menu Understanding Spinal Cord Injury What is a Spinal Cord Injury Levels of Injury and What They Mean Animated Spinal Cord Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal ...

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

Spontaneous spinal epidural abscess.

LENUS (Irish Health Repository)

Ellanti, P

2011-10-01

Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

Spinal Cord Injury 101

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Spinal Cord Injury 101

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Full Text Available ... Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation ... Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation ...

Spinal Cord Diseases

Science.gov (United States)

Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back ... of the spine, this can also injure the spinal cord. Other spinal cord problems include Tumors Infections such ...

Paresthesia thresholds in spinal cord stimulation: a comparison of theoretical results with clinical data

NARCIS (Netherlands)

Struijk, J.J.; Struijk, Johannes J.; Holsheimer, J.; Barolat, Giancarlo; He, Jiping; Boom, H.B.K.

1993-01-01

The potential distributions produced in the spinal cord and surrounding tissues by dorsal epidural stimulation at the midcervical, midthoracic, and low thoracic levels were calculated with the use of a volume conductor model. Stimulus thresholds of myelinated dorsal column fibers and dorsal root

How effective is a virtual consultation process in facilitating multidisciplinary decision-making for malignant epidural spinal cord compression?

Science.gov (United States)

Fitzpatrick, David; Grabarz, Daniel; Wang, Lisa; Bezjak, Andrea; Fehlings, Michael G; Fosker, Christopher; Rampersaud, Raja; Wong, Rebecca K S

2012-10-01

The purpose of this study was to assess the accuracy of a virtual consultation (VC) process in determining treatment strategy for patients with malignant epidural spinal cord compression (MESCC). A prospective clinical database was maintained for patients with MESCC. A virtual consultation process (involving exchange of key predetermined clinical information and diagnostic imaging) facilitated rapid decision-making between oncologists and spinal surgeons. Diagnostic imaging was reviewed retrospectively (by R.R.) for surgical opinions in all patients. The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation. After excluding 20 patients who were referred directly to the spinal surgeon, 125 patients were eligible for virtual consultation. Of the 46 patients who had a VC, surgery was recommended in 28 patients and actually given to 23. A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical candidates. The overall accuracy of the virtual consultation process was estimated at 92%. The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer. This can potentially shorten treatment decision time and enhance clinical outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.

Innovative Approaches to Neuraxial Blockade in Children: The Introduction of Epidural Nerve Root Stimulation and Ultrasound Guidance for Epidural Catheter Placement

Directory of Open Access Journals (Sweden)

Ban CH Tsui

2006-01-01

Full Text Available Continuous epidural blockade remains the cornerstone of pediatric regional anesthesia. However, the risk of catastrophic trauma to the spinal cord when inserting direct thoracic and high lumbar epidural needles in anesthetized or heavily sedated pediatric patients is a concern. To reduce this risk, research has focused on low lumbar or caudal blocks (ie, avoiding the spinal cord and threading catheters from distal puncture sites in a cephalad direction. However, with conventional epidural techniques, including loss-of-resistance for localization of the needle, optimal catheter tip placement is difficult to assess because considerable distances are required during threading. Novel approaches include electrical epidural stimulation for physiological confirmation and segmental localization of epidural catheters, and ultrasound guidance for assessing related neuroanatomy and real-time observation of the needle puncture and, potentially, catheter advancement. The present article provides a brief and focused review of these two advances, and outlines recent clinical experiences relevant to pediatric epidural anesthesia.

A Fully Implantable Stimulator With Wireless Power and Data Transmission for Experimental Investigation of Epidural Spinal Cord Stimulation.

Science.gov (United States)

Xu, Qi; Hu, Dingyin; Duan, Bingyu; He, Jiping

2015-07-01

Epidural spinal cord stimulation (ESCS) combined with partial weight-bearing therapy (PWBT) has been shown to facilitate recovery of functional walking for individuals after spinal cord injury (SCI). The investigation of neural mechanisms of recovery from SCI under this treatment has been conducted broadly in rodent models, yet a suitable ESCS system is still unavailable. This paper describes a practical, programmable, and fully implantable stimulator for laboratory research on rats to explore fundamental neurophysiological principles for functional recovery after SCI. The ESCS system is composed of a personal digital assistant (PDA), an external controller, an implantable pulse generator (IPG), lead extension, and stimulating electrodes. The stimulation parameters can be programmed and adjusted through a graphical user interface on the PDA. The external controller is placed on the rat back and communicates with the PDA via radio-frequency (RF) telemetry. An RF carrier from the class-E power amplifier in the external controller provides both data and power for the IPG through an inductive link. The IPG is built around a microcontroller unit to generate voltage-regulated pulses delivered to the bipolar electrode for ESCS in rats. The encapsulated IPG measures 22 mm × 23 mm × 7 mm with a mass of  ∼  3.78 g. This fully implantable batteryless stimulator provided a simplified and efficient method to carry out chronic experiments in untethered animals for medical electro-neurological research.

Spinal Cord Injuries

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... forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures or ... down on the nerve parts that carry signals. Spinal cord injuries can be complete or incomplete. With a complete ...

Radiologic evaluation of spinal epidural mass

International Nuclear Information System (INIS)

Lee, Ho Kyu; Lee, Moon Kyu; Chang, Kee Hyun

1987-01-01

It is often difficult to differentiate each pathologic entity among various spinal epidural masses on the radiologic basis. We retrospectively analysed radiologic findings of 67 cases of pathologically proven spinal epidural mass to find out any specific findings of each epidural mass. The results are as follows : 1. Of 67 cases, metastasis (16 cases), epidural abscess (15 cases), neurogenic tumor (16 cases) and meningioma (8 cases) are most common. The others consist of epidural angioma (3 cases), vertebral hemangioma (2 cases), chondrosarcoma (2 cases), fibrosarcoma (1 case), eosinophilic granuloma (1 case), lymphoma (1 case), lipoma (1 case) and lymphoid hyperplasia (1 case). 2. Destruction of the adjacent bone was commonly associated with the epidural mass in metastasis (75%) and epidural abscess (67%). It was also noted in 2 cases of chondrosarcoma, 1 fibrosarcoma and 1 eosinophilic granuloma. 3. Pressure erosion of adjacent bone was demonstrated in neurogenic tumor (75%) and meningioma (25%). 4. Narrowing of intervertebral space was seen in only 27% of epidural abscess. 5. The paraspinal tumor was associated in 67% of metastasis, 80% of epidural abscess, 75% of neurogenic tumor, 33% of meningioma. It was also seen in 2 cases of chondrosarcoma, 1 fibrosarcoma and 1 eosinophilic granuloma. 6. The intradural tumor was associated in 50% of neurogenic tumor and 67% of meningioma. 7. On axial CT image, most of the epidural mass shows eccentric location with displacing dural sac to the opposite side. The diseases that occasionally show encircling location are metastasis, epidural abscess, vertebral hemangioma, chondrosarcoma, eosinophilic granuloma, and lymphoma. Neurogenic tumor only shows multicentric location. 8. The disease extent more than height of one vertebral body was seen in 80% of epidural abscess, 58% of neurogenic tumor, 100% of epidural angioma. It was also seen in 2 cases of chondrosarcoma, 1 fibrosarcoma, 1 eosinophilic granuloma, 1 lymphoma, 1

Ambulation and survival following surgery in elderly patients with metastatic epidural spinal cord compression.

Science.gov (United States)

Itshayek, Eyal; Candanedo, Carlos; Fraifeld, Shifra; Hasharoni, Amir; Kaplan, Leon; Schroeder, Josh E; Cohen, José E

2017-12-28

Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore/preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management. Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC. Retrospective file review of a prospective database, under IRB waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from 8/2008-3/2015. Patients ≥65 years presenting neurological and/or radiological signs of cord compression due to metastatic disease, who underwent surgical decompression. Duration of ambulation and survival. Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared with age, pre- and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS], and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed-rank tests, Pearson correlation coefficient, Cox regression model, log rank analysis, and Kaplan Meir analysis. 40 patients were included (21 male, 54%; mean age 74 years, range 65-87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0-1662) and 525 days (range 11-1662), respectively; 53% of patients (21/40) survived and 43% (17/40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65-69, 70-79, or 80-89, although Kaplan Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=0.0342, p=0.0358, respectively) and postoperative KPS (p=0.0221). Tokuhashi score was not significantly related to duration of

MRI features of spinal epidural angiolipomas

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Hu, Su; Hu, Chun Hong; Wang, Xi Ming; Dai, Hui [Dept. of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu (China); Hu, Xiao Yun; Fang, Xiang Ming [Dept. of Radiology, Wuxi People' s Hospital Affiliated to Nanjing Medical University, Jiangsu (China); Cui, Lei [Dept. of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu (China)

2013-10-15

To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.

Spinal Epidural Haemangioma Associated with Extensive Gastrointestinal Haemangiomas: A Case Report

OpenAIRE

Cheng, L.T.E.; Lim, W.E.H.

2005-01-01

A case of spinal epidural cavernous haemangioma associated with gastrointestinal haemangiomas is discussed. The patient was a young Chinese female presenting with chronic lower back pain. She had a history of extensive gastric and small bowel haemangiomas. Lumbar spine MRI showed a heterogeneously enhancing epidural mass infiltrating the paravertebral muscles. Open biopsy confirmed an epidural cavernous haemangioma. To our knowledge, an association between spinal epidural cavernous haemangiom...

Epidural anesthesia as a cause of acquired spinal subarachnoid cysts

International Nuclear Information System (INIS)

Sklar, E.M.L.; Quencer, R.M.; Green, B.A.; Post, M.J.D.; Montalvo, B.M.

1988-01-01

Six patients with acquired spinal subarachnoid cysts secondary to epidural anesthesia were evaluated with MR imaging (seven patients) and intraoperative US (three patients). The cysts were located in the lower cervical and thoracic spine. Adhesions and irregularity of the cord surface were frequently noted. Associated intramedullary lesions, including intramedullary cysts and myelomalacia, were seen in two of the patients. Arachnoiditis was unsuspected clinically in three patients, and MR imaging proved to be the diagnostic examination that first suggested the cause of the patients symptoms. The underlying mechanism for the formation of these cysts is a chemically induced arachnoiditis

Solitary Spinal Epidural Metastasis from Gastric Cancer

Directory of Open Access Journals (Sweden)

Taisei Sako

2016-01-01

Full Text Available Solitary epidural space metastasis of a malignant tumor is rare. We encountered a 79-year-old male patient with solitary metastatic epidural tumor who developed paraplegia and dysuria. The patient had undergone total gastrectomy for gastric cancer followed by chemotherapy 8 months priorly. The whole body was examined for suspected metastatic spinal tumor, but no metastases of the spine or important organs were observed, and a solitary mass was present in the thoracic spinal epidural space. The mass was excised for diagnosis and treatment and was histopathologically diagnosed as metastasis from gastric cancer. No solitary metastatic epidural tumor from gastric cancer has been reported in English. Among the Japanese, 3 cases have been reported, in which the outcome was poor in all cases and no definite diagnosis could be made before surgery in any case. Our patient developed concomitant pneumonia after surgery and died shortly after the surgery. When a patient has a past medical history of malignant tumor, the possibility of a solitary metastatic tumor in the epidural space should be considered.

Successful spinal cord stimulation for neuropathic below-level spinal cord injury pain following complete paraplegia: a case report.

Science.gov (United States)

Reck, Tim A; Landmann, Gunther

2017-01-01

Neuropathic pain is common in patients with spinal cord injury (SCI) and often difficult to treat. We report a case where epidural spinal cord stimulation (SCS) below the level of injury has been successfully applied in a patient with a complete spinal cord lesion. A 53-year-old female presented with neuropathic below-level SCI pain of both lower legs and feet due to complete SCI below T5. Time and pain duration since injury was 2 years. Pain intensity was reported on numeric rating scale with an average of 7/10 (0 meaning no pain, 10 meaning the worst imaginable pain), but also with about 8-10 pain attacks during the day with an intensity of 9/10, which lasted between some minutes and half an hour. SCS was applied below the level of injury at-level T11-L1. After a successful 2 weeks testing period the pulse generator has been implanted permanently with a burst-stimulation pattern. The average pain was reduced to a bearable intensity of 4/10, in addition attacks could be reduced both in frequency and in intensity. This effects lasted for at least three months of follow-up. Even in case of complete SCI, SCS might be effective. Mechanisms of pain relief remain unclear. A modulation of suggested residual spinothalamic tract function may play a role. Further investigation has to be carried out to support this theory.

Spinal Cord Injury 101

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Spinal Cord Injury 101

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Full Text Available ... Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury 101 Adult Injuries Spinal Cord Injury 101 David ...

Spinal Cord Independence Measure, version III: applicability to the UK spinal cord injured population.

Science.gov (United States)

Glass, Clive A; Tesio, Luigi; Itzkovich, Malka; Soni, Bakul M; Silva, Pedro; Mecci, Munawar; Chadwick, Raymond; el Masry, Waghi; Osman, Aheed; Savic, Gordana; Gardner, Brian; Bergström, Ebba; Catz, Amiram

2009-09-01

To examine the validity, reliability and usefulness of the Spinal Cord Independence Measure for the UK spinal cord injury population. Multi-centre cohort study. Four UK regional spinal cord injury centres. Eighty-six people with spinal cord injury. Spinal Cord Independence Measure and Functional Independence Measure on admission analysed using inferential statistics, and Rasch analysis of Spinal Cord Independence Measure. Internal consistency, inter-rater reliability, discriminant validity; Spinal Cord Independence Measure subscale match between distribution of item difficulty and patient ability measurements; reliability of patient ability measures; fit of data to Rasch model; unidimensionality of subscales; hierarchical ordering of categories within items; differential item functioning across patient groups. Scale reliability (kappa coefficients range 0.491-0.835; (p Spinal Cord Independence Measure subscales compatible with stringent Rasch requirements; mean infit indices high; distinct strata of abilities identified; most thresholds ordered; item hierarchy stable across clinical groups and centres. Misfit and differences in item hierarchy identified. Difficulties assessing central cord injuries highlighted. Conventional statistical and Rasch analyses justify the use of the Spinal Cord Independence Measure in clinical practice and research in the UK. Cross-cultural validity may be further improved.

Spinal Cord Injury 101

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Full Text Available ... Abuse and Spinal Cord Injury Allen Heinemann, PhD How Peer Counseling Works Julie Gassaway, MS, RN Pediatric Injuries Pediatric Spinal ... What is a spinal cord injury? play_arrow How does the spinal cord work? play_arrow Why is the level of a ...

Postoperative Paraplegia as a Result of Undiagnosed Primitive Neuroectodermal Tumor, Not Epidural Analgesia

Directory of Open Access Journals (Sweden)

Pei-Ching Hung

2007-10-01

Full Text Available Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.

An ovine model of spinal cord injury.

Science.gov (United States)

Wilson, Saul; Abode-Iyamah, Kingsley O; Miller, John W; Reddy, Chandan G; Safayi, Sina; Fredericks, Douglas C; Jeffery, Nicholas D; DeVries-Watson, Nicole A; Shivapour, Sara K; Viljoen, Stephanus; Dalm, Brian D; Gibson-Corley, Katherine N; Johnson, Michael D; Gillies, George T; Howard, Matthew A

2017-05-01

To develop a large animal model of spinal cord injury (SCI), for use in translational studies of spinal cord stimulation (SCS) in the treatment of spasticity. We seek to establish thresholds for the SCS parameters associated with reduction of post-SCI spasticity in the pelvic limbs, with implications for patients. The weight-drop method was used to create a moderate SCI in adult sheep, leading to mild spasticity in the pelvic limbs. Electrodes for electromyography (EMG) and an epidural spinal cord stimulator were then implanted. Behavioral and electrophysiological data were taken during treadmill ambulation in six animals, and in one animal with and without SCS at 0.1, 0.3, 0.5, and 0.9 V. All surgical procedures were carried out at the University of Iowa. The gait measurements were made at Iowa State University. Nine adult female sheep were used in these institutionally approved protocols. Six of them were trained in treadmill ambulation prior to SCI surgeries, and underwent gait analysis pre- and post-SCI. Stretch reflex and H-reflex measurements were also made in conscious animals. Gait analysis revealed repeatable quantitative differences in 20% of the key kinematic parameters of the sheep, pre- and post-SCI. Hock joint angular velocity increased toward the normal pre-injury baseline in the animal with SCS at 0.9 V. The ovine model is workable as a large animal surrogate suitable for translational studies of novel SCS therapies aimed at relieving spasticity in patients with SCI.

Spinal Cord Injury 101

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Full Text Available ... spinal cord injury? play_arrow What kind of surgery is common after a spinal cord injury? play_ ... How soon after a spinal cord injury should surgery be performed? play_arrow Is it common to ...

Clinical applicability of biologically effective dose calculation for spinal cord in fractionated spine stereotactic body radiation therapy

International Nuclear Information System (INIS)

Lee, Seung Heon; Lee, Kyu Chan; Choi, Jinho; Ahn, So Hyun; Lee, Seok Ho; Sung, Ki Hoon; Kil, Se Hee

2015-01-01

The aim of the study was to investigate whether biologically effective dose (BED) based on linear-quadratic model can be used to estimate spinal cord tolerance dose in spine stereotactic body radiation therapy (SBRT) delivered in 4 or more fractions. Sixty-three metastatic spinal lesions in 47 patients were retrospectively evaluated. The most frequently prescribed dose was 36 Gy in 4 fractions. In planning, we tried to limit the maximum dose to the spinal cord or cauda equina less than 50% of prescription or 45 Gy 2/2 . BED was calculated using maximum point dose of spinal cord. Maximum spinal cord dose per fraction ranged from 2.6 to 6.0 Gy (median 4.3 Gy). Except 4 patients with 52.7, 56.4, 62.4, and 67.9 Gy 2/2 , equivalent total dose in 2-Gy fraction of the patients was not more than 50 Gy 2/2 (12.1–67.9, median 32.0). The ratio of maximum spinal cord dose to prescription dose increased up to 82.2% of prescription dose as epidural spinal cord compression grade increased. No patient developed grade 2 or higher radiation-induced spinal cord toxicity during follow-up period of 0.5 to 53.9 months. In fractionated spine SBRT, BED can be used to estimate spinal cord tolerance dose, provided that the dose per fraction to the spinal cord is moderate, e.g. < 6.0 Gy. It appears that a maximum dose of up to 45–50 Gy 2/2 to the spinal cord is tolerable in 4 or more fractionation regimen

Spontaneous spinal epidural hematoma diagnosed by CT scan

International Nuclear Information System (INIS)

Abumiya, Takeo; Isu, Toyohiko; Iwasaki, Yoshinobu; Akino, Minoru; Abe, Hiroshi

1985-01-01

A case of spinal epidural hematoma diagnosed by CT scan is reported. A 58-year-old man was admitted on June 18, 1984. He had had a sudden onset of severe low-back pain 7 days before admission and had developed paraparesis and numbness of the lower limbs 4 day before admission. Physical examination revealed weakness in the lower limbs, with the reflexes there decreased. The Babinski reflex and the Chaddock reflex were, however, present on both sides. Sensory disturbances were noted below L 2 . Urinary incontinence was present, too. Metrizamide myelography revealed an epidural mass which was located from the power part of T 11 to the upper part of L 2 . A CT scan revealed a biconvex, relatively high-density mass in the posterior spinal canal. On the day of admission, a laminectomy was performed from T 11 to L 1 , and the epidural hematoma was evacuated. The postoperative course was uneventful. Spinal epidural hematoma is uncommon. A CT scan can be used for an early diagnosis of this lesion. According to the review of the CT findings in 15 reported cases, including our case, CT reveals a smoothly marginated biconvex homogeneous density mass. The density of the hematoma decreases with the time. An acute type (within 3 days) is high-density, while a chronic type has a relatively high or isodensity. The acute type is easily differentiated from other epidural masses, such as a herniated disc, an epidural abscess, and an epidural tumor. On the other hand, the diagnosis of the chronic type is not always easy. (author)

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Registered nurses' and midwives' knowledge of epidural analgesia.

Science.gov (United States)

Bird, Annette; Wallis, Marianne; Chaboyer, Wendy

2009-01-01

Despite epidural analgesia increasingly being utilized in hospitals, very little research-based evidence is available about registered nurses' (RNs) and midwives' knowledge of this technique. To describe the current epidural knowledge levels of RNs and midwives in a multi-site setting. RNs and midwives at four, regional teaching facilities completed an epidural knowledge test. The instrument included demographic items and five knowledge subscales relating to epidural analgesia: spinal cord anatomy and physiology; epidural pharmacology; complications of epidural analgesia; assessment of sensory and motor blockade and the general management of patients with epidural analgesia. A total of 408 (99.7% response) RNs and midwives completed the test. Respondents demonstrated good knowledge of sensory and motor blockade assessment and the general management of epidural analgesia subscales with correct responses to 75 and 77% of the questions in these subscales, respectively. Fair knowledge relating to the spinal cord anatomy and physiology subscale was demonstrated with 69% of the questions answered correctly. The knowledge subscales relating to epidural pharmacology (57% correct responses) and the complications of epidural analgesia (56% correct responses) were problematic for the sample. The research results provide generalizable information about what RNs and midwives know about epidural analgesia. These results are an important guide in the development of new and existing dedicated epidural education programs. The results also provide some direction for further research into this important topic.

The spontaneous spinal epidural hematoma : a study of the etiology

NARCIS (Netherlands)

Groen, R J; Ponssen, H

From the literature 199 cases of spontaneous spinal epidural hematoma (SSEH) are analyzed. With these data and the vascular anatomical characteristics of the spinal epidural space, the theories on the etiology of the SSEH are discussed. There seems to be no relationship between the SSEH and arterial

Epidural varix at the cervicothoracic junction: unusual cause of quadriplegia: a case report.

Science.gov (United States)

Bapat, Mihir; Metkar, Umesh

2006-02-01

A case report describing an unusual incident of quadriplegia in a young adult male caused by an epidural varix at the cervicothoracic junction. To report an unusual case of quadriplegia caused by an epidural varix at the cervicothoracic junction. Epidural varices are dilated tortuous elongated veins inside the central canal. In degenerative spinal stenosis, these varices are a result of venous stagnation and contribute to the pathogenesis of radicular pain. In the absence of stenosis, primary varicosities develop as a result of dynamic obstruction to venous outflow during spinal movements. A primary epidural varix can produce neurologic deficit similar to a space occupying lesion within the spinal canal. The myeloradiculopathy is of a slow progressive nature. A young man presented with an acute onset flaccid quadriplegia in the absence of significant trauma. Magnetic resonance imaging revealed an extradural space occupying lesion at the cervicothoracic junction that was diagnosed as an isolated epidural varix during surgery. No neurologic recovery occurred. Postoperative magnetic resonance imaging revealed a syrinx in the cervicothoracic cord. In the absence of other precipitating factors, the cord injury was attributed to the epidural varix. A temporary impedance to the venous outflow with the increase in the venous pressure has been hypothesized as the mechanism of cord injury.

Spinal Cord Injury 101

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Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury

Directory of Open Access Journals (Sweden)

Adam R Ferguson

2012-10-01

Full Text Available Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI. Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. The mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain pathways in the spinal cord may emerge with certain patterns of activity, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after spinal cord injury. We review these basic phenomena, discuss the cellular and molecular mechanisms, and discuss implications of these findings for improved rehabilitative therapies after spinal cord injury.

Epidural versus In postoperatIve intramuscular pain relief pethidine

African Journals Online (AJOL)

Epidural versus. •. •. In postoperatIve ... would be left entirely up to them and they would receive analge- sia whenever they .... Fusion right knee. Epidural. 15 ..... reaches the brain but that its action persists in the spinal cord. The onset of ...

Spinal Cord Injury 101

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Full Text Available ... Cord Injury Rehabilitation Pediatric Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal ... Cord Injury Rehabilitation Pediatric Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal ...

Thalassemia, extramedullary hematopoiesis, and spinal cord compression: A case report.

Science.gov (United States)

Bukhari, Syed Sarmad; Junaid, Muhammad; Rashid, Mamoon Ur

2016-01-01

Extramedullary hematopoiesis (EMH) refers to hematopoiesis outside of the medulla of the bone. Chronic anemia states such as thalassemia can cause hematopoietic tissue to expand in certain locations. We report a case of spinal cord compression due to recurrent spinal epidural EMH, which was treated with a combination of surgery and radiotherapy. Pakistan has one of the highest incidence and prevalence of thalassemia in the world. We describe published literature on diagnosis and management of such cases. An 18-year-old male presented with bilateral lower limb paresis. He was a known case of homozygous beta thalassemia major. He had undergone surgery for spinal cord compression due to EMH 4 months prior to presentation. Symptom resolution was followed by deterioration 5 days later. He was operated again at our hospital with complete resection of the mass. He underwent local radiotherapy to prevent recurrence. At 2 years follow-up, he showed complete resolution of symptoms. Follow-up imaging demonstrated no residual mass. The possibility of EMH should be considered in every patient with ineffective erythropoiesis as a cause of spinal cord compression. Treatment of such cases is usually done with blood transfusions, which can reduce the hematopoietic drive for EMH. Other options include surgery, hydroxyurea, radiotherapy, or a combination of these on a case to case basis.

Spinal Cord Injury 101

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Full Text Available ... the spinal cord work? play_arrow Why is the level of a spinal cord injury important? play_arrow What role does “compression” play in a spinal cord injury? play_arrow Why are high-dose steroids often used right after an injury? play_arrow What is meant ...

Can the human lumbar posterior columns be stimulated by transcutaneous spinal cord stimulation? A modeling study.

Science.gov (United States)

Danner, Simon M; Hofstoetter, Ursula S; Ladenbauer, Josef; Rattay, Frank; Minassian, Karen

2011-03-01

Stimulation of different spinal cord segments in humans is a widely developed clinical practice for modification of pain, altered sensation, and movement. The human lumbar cord has become a target for modification of motor control by epidural and, more recently, by transcutaneous spinal cord stimulation. Posterior columns of the lumbar spinal cord represent a vertical system of axons and when activated can add other inputs to the motor control of the spinal cord than stimulated posterior roots. We used a detailed three-dimensional volume conductor model of the torso and the McIntyre-Richard-Grill axon model to calculate the thresholds of axons within the posterior columns in response to transcutaneous lumbar spinal cord stimulation. Superficially located large-diameter posterior column fibers with multiple collaterals have a threshold of 45.4 V, three times higher than posterior root fibers (14.1 V). With the stimulation strength needed to activate posterior column axons, posterior root fibers of large and small diameters as well as anterior root fibers are coactivated. The reported results inform on these threshold differences, when stimulation is applied to the posterior structures of the lumbar cord at intensities above the threshold of large-diameter posterior root fibers. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Spinal cord stimulation

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... this page: //medlineplus.gov/ency/article/007560.htm Spinal cord stimulation To use the sharing features on this page, please enable JavaScript. Spinal cord stimulation is a treatment for pain that uses ...

Spontaneous spinal epidural hematoma presenting with quadriplegia after sit-ups exercise.

Science.gov (United States)

Chen, Chun-Lin; Lu, Ching-Hsiang; Chen, Nan-Fu

2009-11-01

Spontaneous spinal epidural hematoma (SSEH) represents 0.3% to 0.9% of spinal epidural space-occupying lesions, and most surgeons advocate aggressive and early surgical intervention. In this article, we describe a patient with SSEH with sudden quadriplegia after sit-ups exercise.

Reinforcement of spinal anesthesia by epidural injection of saline: a comparison of hyperbaric and isobaric tetracaine.

Science.gov (United States)

Yamazaki, Y; Mimura, M; Hazama, K; Namiki, A

2000-04-25

An epidural injection of saline was reported to extend spinal anesthesia because of a volume effect. The aim of this study was to evaluate the influence of the baricity of spinal local anesthetics upon the extension of spinal anesthesia by epidural injection of saline. Forty patients undergoing elective lower-limb surgery were randomly allocated to four groups of 10 patients each. Group A received no epidural injection after the spinal administration of hyperbaric tetracaine (dissolved in 10% glucose). Group B received an epidural injection of 8 ml of physiological saline 20 min after spinal hyperbaric tetracaine. Group C received no epidural injection after spinal isobaric tetracaine (dissolved in physiological saline). Group D received an epidural injection of 8 ml of saline 20 min after spinal isobaric tetracaine. The level of analgesia was examined by the pinprick method at 5-min intervals. The levels of analgesia 20 min after spinal anesthesia were significantly higher in hyperbaric groups than in isobaric groups [T5 (T2-L2) vs. T7 (T3-12)]. After epidural injection of saline, the levels of analgesia in groups B and D were significantly higher than in groups A and C. The segmental increases after epidural saline injection were 2 (0-3) in group B and 2 (1-7) in group D. Sensation in the sacral area remained 20 min after spinal block in one patient in group D; however, it disappeared after epidural saline injection. In this study, 8 ml of epidural saline extended spinal analgesia. However, there was no difference between the augmenting effect in isobaric and hyperbaric spinal anesthesia. We conclude that the reinforcement of spinal anesthesia by epidural injection of saline is not affected by the baricity of the spinal anesthetic solution used.

Spinal Cord Injury 101

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Full Text Available ... injury? play_arrow How does the spinal cord work? play_arrow Why is the level of a spinal cord injury important? play_arrow What role does “compression” play in a spinal cord injury? play_arrow Why are high-dose steroids often used right after an injury? play_arrow What is meant ...

Disorders of spinal blood circulation

OpenAIRE

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...

Anterior spinal cord syndrome of unknown etiology

OpenAIRE

Klakeel, Merrine; Thompson, Justin; Srinivasan, Rajashree; McDonald, Frank

2015-01-01

A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome.

Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS: a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

Directory of Open Access Journals (Sweden)

Friedly Janna L

2012-03-01

Full Text Available Abstract Background Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis. Methods We will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone. Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention. Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization

Spinal Cord Injury 101

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Full Text Available ... Spinal Cord Injury 101 Lawrence Vogel, MD The Basics of Pediatric SCI Rehabilitation Sara Klaas, MSW Transitions for Children with Spinal Cord Injury Patricia Mucia, RN Family Life After Pediatric Spinal Injury Dawn Sheaffer, MSW Rehabilitation ...

MRI in the early stage of spinal cord injury: does it have clinical relevance? An experimental study

International Nuclear Information System (INIS)

Hannmann, T.T.; Freund, M.

2007-01-01

Purpose: An experimental technique for producing a ventral spinal trauma which imitates a slipped intervertebral disc or a fractured vertebra was evaluated using magnetic resonance imaging and histology. The results were evaluated with respect to their clinical importance. Materials and Methods: A total of 69 Wistar rats were used for this study. An inflatable angioplasty balloon device was placed dorsally or ventrally to the spinal cord in order to produce a spinal trauma. 30 rats were used to compare neurological pathologies between ventral and dorsal trauma. 30 animals underwent graded ventral spinal cord compression. Magnetic resonance imaging was performed and the results were compared to histology. Results: Using this technique, the balloon device can be placed ventrally to the spinal cord. The compression time had a direct effect on changes on magnetic resonance images and edema in histology, but a longer compression time did not produce increased bleeding. The T2-weighted MRI scans showed hyperintense changes immediately after spinal compression. Therefore, they are the appropriate way for diagnosing acute spinal injuries. Although the T1-weighted MRI scans did not change after spinal compression, they are important for diagnosing epidural hematomas. (orig.)

Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury

Science.gov (United States)

Ferguson, Adam R.; Huie, J. Russell; Crown, Eric D.; Baumbauer, Kyle M.; Hook, Michelle A.; Garraway, Sandra M.; Lee, Kuan H.; Hoy, Kevin C.; Grau, James W.

2012-01-01

Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI). Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. A mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain) pathways in the spinal cord may emerge in response to various noxious inputs, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord below the level of SCI. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Prior work from our group has shown that stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after SCI. We review these basic phenomena, how these findings relate to the broader spinal plasticity literature, discuss the cellular and molecular mechanisms, and finally discuss implications of these and other findings for improved rehabilitative therapies after SCI. PMID

Non-traumatic acute epidural spinal hematomas diagnosed by magnetic resonance; Hematomas espinales epidurales agudos no traumaticos: diagnostico por resonancia magnetica

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Rovira, A.; Grive, E.; Pedraza, S.; Capellades, J.; Nos, C.; Alarcon, M.; Rovira, A. [Hospital Universitari Vall d' Hebron. Barcelona (Spain)

2000-07-01

The non-traumatic spinal epidural hematoma (NTSEH) is a rare entity that can be the cause of an acute spinal compression syndrome. the objective of this review is to identify the characteristics by MRI and NTSEH and to analyze the factors that influence in its prognosis. In the years 1994 and 1999, 12 patients with NTSEH have been diagnosed in our hospital, and a MRI was performed during the acute phase. the characteristics of the lesions have been analyzed by MRI, with special emphasis on the topographic data and resonance signal and the factors that can influence in the clinical prognosis of the patients. Initially, all of the patients presented pain in the cervical dorsal or interscapular site, followed by a sensitive-motor deficit picture. The MRI showed a lesion of expansive character and posterior epidural location in every case that would produce varying degrees of compression on the spinal cord. The NTSEH should be considered as one of the causes of acute spinal cord compression. The clinical association of intense cervical, dorsal or interscapular pain followed by a sensomotor deficit picture should lead to the suspicion of this entity, that would require an immediate examination with MRI to verify its diagnosis. Both the clinical manifestations as well as the characteristics observed by MRI of the NTSEH have a prognostic value and determine the therapeutic decision. (Author) 34 refs.

Hypothermia with Extreme Bradycardia following Spinal Cord Infarction of Septic Origin

Directory of Open Access Journals (Sweden)

Philippe Hantson

2017-01-01

Full Text Available Among other autonomic dysfunctions complicating acute spinal cord injury, deep hypothermia is rare but may induce serious cardiovascular complications. There are few pharmacological options to influence hypothermia. A 66-year-old woman was transferred to the intensive care unit (ICU for serious cardiac arrhythmias (atrial fibrillation and asystole in the context of a deep hypothermia (axillary temperature below 32°C. She had been admitted to the hospital two months before for an acute L4-L5 infectious spondylodiscitis without any initial neurological deficit. After surgery for epidural abscess drainage, she became paraplegic due to spinal cord infarction (from C7 to T6 levels in the upper territory of the anterior spinal artery. In the ICU, the patient experienced several episodes of asystole and hypotension associated with a core body temperature below 35°C. Common causes of hypothermia (drugs, hypothyroidism, etc. were excluded. A definitive pacemaker had to be inserted, but hypotension persisted. The prescription of oral progesterone (200 mg·d−1 helped to maintain a core temperature higher than 35°C, with a withdrawal of vasopressors. This case report illustrates that patients with incomplete spinal cord injury may present with delayed and deep hypothermia leading to serious cardiovascular complications. Progesterone could be able to influence positively central and peripheral thermal regulation.

Optogenetics of the Spinal Cord: Use of Channelrhodopsin Proteins for Interrogation of Spinal Cord Circuits.

Science.gov (United States)

Rahman, Habibur; Nam, Youngpyo; Kim, Jae-Hong; Lee, Won-Ha; Suk, Kyoungho

2017-12-29

Spinal cord circuits play a key role in receiving and transmitting somatosensory information from the body and the brain. They also contribute to the timing and coordination of complex patterns of movement. Under disease conditions, such as spinal cord injury and neuropathic pain, spinal cord circuits receive pain signals from peripheral nerves, and are involved in pain development via neurotransmitters and inflammatory mediators released from neurons and glial cells. Despite the importance of spinal cord circuits in sensory and motor functions, many questions remain regarding the relationship between activation of specific cells and behavioral responses. Optogenetics offers the possibility of understanding the complex cellular activity and mechanisms of spinal cord circuits, as well as having therapeutic potential for addressing spinal cord-related disorders. In this review, we discuss recent findings in optogenetic research employing the channelrhodopsin protein to assess the function of specific neurons and glia in spinal cord circuits ex vivo and in vivo. We also explore the possibilities and challenges of employing optogenetics technology in future therapeutic strategies for the treatment of spinal disorders. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

MR imaging and spinal cord injury

International Nuclear Information System (INIS)

Azar-Kia, B.; Fine, M.; Naheedy, M.; Elias, D.

1987-01-01

MR imaging has significantly improved diagnostic capability of spinal cord injuries. Other available diagnostic modalities such as plain films, myelography, CT, and post-CT myelography have failed to consistently show the secific evidence of spinal cord injuries and their true extent. The authors are presenting our experiences with MR imaging in spinal column injury. They have found MR imaging to be the procedure of choice for prognostic evaluation of spinal cord trauma. They are showing examples of recent and old spinal cord injury such as hematomyelia, myelomalacia, transection, spinal cord edema, and cavitation

Spinal cord compression secondary to extramedullary hematopoiesis in a dog.

Science.gov (United States)

Williams, Lindsay M; Skeen, Todd M

2013-03-15

An 11-year-old spayed female Siberian Husky was evaluated because of a 2-week history of progressive paraparesis. Results of neurologic examination were consistent with a T3-L3 myelopathy. There were no abnormalities on CBC, and hypercalcemia was noted on serum biochemical analysis. Several hypoechoic splenic nodules were evident on abdominal ultrasonography, and results of fine-needle aspiration cytology were consistent with splenic extramedullary hematopoiesis (EMH). Two compressive, extradural masses in the dorsal epidural space of the thoracolumbar region of the spinal cord were seen on MRI images. A dorsal laminectomy was performed to remove the extradural spinal masses. Results of histologic examination of tissue samples were consistent with EMH. Following surgery, clinical signs of paraparesis resolved, and there was no recurrence of the masses 24 months after surgery. Extramedullary hematopoesis should be considered as a differential diagnosis in dogs in which results of diagnostic imaging indicate a epidural mass. In human patients, spinal EMH usually occurs secondary to an underlying hematologic disease, but it can also occur spontaneously. Treatment options reported for humans include surgical decompression, radiation therapy, chemotherapy, and blood transfusion. The dog of this report responded favorably to surgical decompression and was clinically normal 2 years after surgery.

Extensive spinal epidural hematoma: a rare complication of aortic coarctation

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Zizka, J.; Elias, P.; Michl, A. [Dept. of Radiology, Charles University Hospital, Hradec Kralove (Czech Republic); Harrer, J. [Dept. of Cardiac Surgery, Charles University Hospital, Hradec Kralove (Czech Republic); Cesak, T. [Dept. of Neurosurgery, Charles University Hospital, Hradec Kralove (Czech Republic); Herman, A. [1. Dept. of Internal Medicine, Charles University Hospital, Hradec Kralove (Czech Republic)

2001-07-01

Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

Extensive spinal epidural hematoma: a rare complication of aortic coarctation

International Nuclear Information System (INIS)

Zizka, J.; Elias, P.; Michl, A.; Harrer, J.; Cesak, T.; Herman, A.

2001-01-01

Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

Trauma: Spinal Cord Injury.

Science.gov (United States)

Eckert, Matthew J; Martin, Matthew J

2017-10-01

Injuries to the spinal column and spinal cord frequently occur after high-energy mechanisms of injury, or with lower-energy mechanisms, in select patient populations like the elderly. A focused yet complete neurologic examination during the initial evaluation will guide subsequent diagnostic procedures and early supportive measures to help prevent further injury. For patients with injury to bone and/or ligaments, the initial focus should be spinal immobilization and prevention of inducing injury to the spinal cord. Spinal cord injury is associated with numerous life-threatening complications during the acute and long-term phases of care that all acute care surgeons must recognize. Published by Elsevier Inc.

Arterial Blood Supply to the Spinal Cord in Animal Models of Spinal Cord Injury. A Review.

Science.gov (United States)

Mazensky, David; Flesarova, Slavka; Sulla, Igor

2017-12-01

Animal models are used to examine the results of experimental spinal cord injury. Alterations in spinal cord blood supply caused by complex spinal cord injuries contribute significantly to the diversity and severity of the spinal cord damage, particularly ischemic changes. However, the literature has not completely clarified our knowledge of anatomy of the complex three-dimensional arterial system of the spinal cord in experimental animals, which can impede the translation of experimental results to human clinical applications. As the literary sources dealing with the spinal cord arterial blood supply in experimental animals are limited and scattered, the authors performed a review of the anatomy of the arterial blood supply to the spinal cord in several experimental animals, including pigs, dogs, cats, rabbits, guinea pigs, rats, and mice and created a coherent format discussing the interspecies differences. This provides researchers with a valuable tool for the selection of the most suitable animal model for their experiments in the study of spinal cord ischemia and provides clinicians with a basis for the appropriate translation of research work to their clinical applications. Anat Rec, 300:2091-2106, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Spinal Cord Dysfunction (SCD)

Data.gov (United States)

Department of Veterans Affairs — The Spinal Cord Dysfunction (SCD) module supports the maintenance of local and national registries for the tracking of patients with spinal cord injury and disease...

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

Science.gov (United States)

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.

Spinal cord swelling and candidiasis

International Nuclear Information System (INIS)

Ho, K.; Gronseth, G.; Aldrich, M.; Williams, A.

1982-01-01

Fusiform swelling of the spinal cord was noted myelographically in a patient with Hodgkin's disease. Autopsy revealed that the swelling was cauused by Candida infection of the spinal cord. It is suggested that fungal infection be included in the differential diagnosis of spinal cord swelling in the immunsupporessed cancer patient. (orig.)

Acute Thoracolumbar Spinal Cord Injury: Relationship of Cord Compression to Neurological Outcome.

Science.gov (United States)

Skeers, Peta; Battistuzzo, Camila R; Clark, Jillian M; Bernard, Stephen; Freeman, Brian J C; Batchelor, Peter E

2018-02-21

Spinal cord injury in the cervical spine is commonly accompanied by cord compression and urgent surgical decompression may improve neurological recovery. However, the extent of spinal cord compression and its relationship to neurological recovery following traumatic thoracolumbar spinal cord injury is unclear. The purpose of this study was to quantify maximum cord compression following thoracolumbar spinal cord injury and to assess the relationship among cord compression, cord swelling, and eventual clinical outcome. The medical records of patients who were 15 to 70 years of age, were admitted with a traumatic thoracolumbar spinal cord injury (T1 to L1), and underwent a spinal surgical procedure were examined. Patients with penetrating injuries and multitrauma were excluded. Maximal osseous canal compromise and maximal spinal cord compression were measured on preoperative mid-sagittal computed tomography (CT) scans and T2-weighted magnetic resonance imaging (MRI) by observers blinded to patient outcome. The American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades from acute hospital admission (≤24 hours of injury) and rehabilitation discharge were used to measure clinical outcome. Relationships among spinal cord compression, canal compromise, and initial and final AIS grades were assessed via univariate and multivariate analyses. Fifty-three patients with thoracolumbar spinal cord injury were included in this study. The overall mean maximal spinal cord compression (and standard deviation) was 40% ± 21%. There was a significant relationship between median spinal cord compression and final AIS grade, with grade-A patients (complete injury) exhibiting greater compression than grade-C and D patients (incomplete injury) (p compression as independently influencing the likelihood of complete spinal cord injury (p compression. Greater cord compression is associated with an increased likelihood of severe neurological deficits (complete injury) following

Spinal Cord Injury 101

Medline Plus

Full Text Available ... Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation Pediatric Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal Experiences ...

Spinal cord swelling and candidiasis

Energy Technology Data Exchange (ETDEWEB)

Ho, K.; Gronseth, G.; Aldrich, M.; Williams, A.

1982-11-01

Fusiform swelling of the spinal cord was noted myelographically in a patient with Hodgkin's disease. Autopsy revealed that the swelling was caused by Candida infection of the spinal cord. It is suggested that fungal infection be included in the differential diagnosis of spinal cord swelling in the immunosuppressed cancer patient.

Focal Anterior Displacement of the Thoracic Spinal Cord without Evidence of Spinal Cord Herniation or an Intradural Mass

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Lee, Jong Yoon; Lee, Joon Woo; Lee, Guen Young; Kang, Heung Sik [Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of)

2014-07-01

We report magnetic resonance imaging (MRI) findings on focal anterior displacement of the thoracic spinal cord in asymptomatic patients without a spinal cord herniation or intradural mass. We identified 12 patients (male:female = 6:6; mean age, 51.7; range, 15-83 years) between 2007 and 2011, with focal anterior displacement of the spinal cord and without evidence of an intradural mass or spinal cord herniation. Two radiologists retrospectively reviewed the MRI findings in consensus. An asymmetric spinal cord deformity with a focal dented appearance was seen on the posterior surface of the spinal cord in all patients, and it involved a length of 1 or 2 vertebral segments in the upper thoracic spine (thoracic vertebrae 1-6). Moreover, a focal widening of the posterior subarachnoid space was also observed in all cases. None of the patients had myelopathy symptoms, and they showed no focal T2-hyperintensity in the spinal cord with the exception of one patient. In addition, cerebrospinal fluid (CSF) flow artifacts were seen in the posterior subarachnoid space of the affected spinal cord level. Computed tomography myelography revealed preserved CSF flow in the two available patients. Focal anterior spinal cord indentation can be found in the upper thoracic level of asymptomatic patients without a spinal cord herniation or intradural mass.

Focal Anterior Displacement of the Thoracic Spinal Cord without Evidence of Spinal Cord Herniation or an Intradural Mass

International Nuclear Information System (INIS)

Lee, Jong Yoon; Lee, Joon Woo; Lee, Guen Young; Kang, Heung Sik

2014-01-01

We report magnetic resonance imaging (MRI) findings on focal anterior displacement of the thoracic spinal cord in asymptomatic patients without a spinal cord herniation or intradural mass. We identified 12 patients (male:female = 6:6; mean age, 51.7; range, 15-83 years) between 2007 and 2011, with focal anterior displacement of the spinal cord and without evidence of an intradural mass or spinal cord herniation. Two radiologists retrospectively reviewed the MRI findings in consensus. An asymmetric spinal cord deformity with a focal dented appearance was seen on the posterior surface of the spinal cord in all patients, and it involved a length of 1 or 2 vertebral segments in the upper thoracic spine (thoracic vertebrae 1-6). Moreover, a focal widening of the posterior subarachnoid space was also observed in all cases. None of the patients had myelopathy symptoms, and they showed no focal T2-hyperintensity in the spinal cord with the exception of one patient. In addition, cerebrospinal fluid (CSF) flow artifacts were seen in the posterior subarachnoid space of the affected spinal cord level. Computed tomography myelography revealed preserved CSF flow in the two available patients. Focal anterior spinal cord indentation can be found in the upper thoracic level of asymptomatic patients without a spinal cord herniation or intradural mass

Spinal Cord Injury 101

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Full Text Available ... spinal cord injuries? play_arrow What does stem-cell research on animals tell us? play_arrow When can we expect stem-cell treatments to become available for spinal cord injuries? ...

Spinal cord involvement in tuberculous meningitis.

Science.gov (United States)

Garg, R K; Malhotra, H S; Gupta, R

2015-09-01

To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis. Reports from multiple countries were included. An extensive review of the literature, published in English, was carried out using Scopus, PubMed and Google Scholar databases. Tuberculous meningitis frequently affects the spinal cord and nerve roots. Initial evidence of spinal cord involvement came from post-mortem examination. Subsequent advancement in neuroimaging like conventional lumbar myelography, computed tomographic myelography and gadolinium-enhanced magnetic resonance-myelography have contributed immensely. Spinal involvement manifests in several forms, like tuberculous radiculomyelitis, spinal tuberculoma, myelitis, syringomyelia, vertebral tuberculosis and very rarely spinal tuberculous abscess. Frequently, tuberculous spinal arachnoiditis develops paradoxically. Infrequently, spinal cord involvement may even be asymptomatic. Spinal cord and spinal nerve involvement is demonstrated by diffuse enhancement of cord parenchyma, nerve roots and meninges on contrast-enhanced magnetic resonance imaging. High cerebrospinal fluid protein content is often a risk factor for arachnoiditis. The most important differential diagnosis of tuberculous arachnoiditis is meningeal carcinomatosis. Anti-tuberculosis therapy is the main stay of treatment for tuberculous meningitis. Higher doses of corticosteroids have been found effective. Surgery should be considered only when pathological confirmation is needed or there is significant spinal cord compression. The outcome in these patients has been unpredictable. Some reports observed excellent recovery and some reported unfavorable outcomes after surgical decompression and debridement. Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications. Available treatment options are far from satisfactory.

Spinal Cord Injury 101

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Comparison between fast contrast-enhanced MR angiography and DSA in diagnosing spinal cord vascular malformations

International Nuclear Information System (INIS)

Wang Wu; Li Minghua; Fang Chun; Wang Jue; Xiao Yunfeng

2007-01-01

Objective: To evaluate the diagnostic and clinical value of fast contrast-enhanced MR angiography (CE-MRA) with elliptic centric phase-encoding in spinal cord vascular malformations. Methods Fast three-dimensional contrast-enhanced MR angiography with elliptic centric phase-encoding and superconducting 1.5T system was applied prospectively in twenty-five consecutive patients with clinically suspected of spinal cord vascular malformations. All cases were performed with selective spinal digital subtraction angiography, including 18 cases treated by surgery and 2 of them with embolization before surgery, MR angiography follow up were undertaken in ten patients after surgery. Comparing fast contrast-enhanced MR angiography with DSA in diagnosing spinal cord vascular malformations included the origin of feeding artery, the feeding artery, the fistula or the nidus, the draining vein, and the vessel image quality based on the gold standard of selective spinal digital subtraction angiography. Results: Surgically proven diseases included spinal arteriovenous malformations(3 cases), spinal cord perimedullary arteriovenous fistulas (5 cases), spinal dural arteriovenous fistulas (8 cases), paravertebral arteriovenous fistulas (1 case), and spontaneous spinal epidural hematomas (2 eases). Comparing with DSA, the accuracy of MR angiography in diagnosing spinal cord vascular malformations; and detecting the origin of the feeding artery, the feeding artery, the shunt or the nidus and the draining vein were 93.8%, 92%, 96.2%, 100% and 100%, respectively. Overall the degree vascular enhencement were judged to be similar(P>0.05), but the vessel continuity of MRA was inferior to DSA (P<0.05). However, 9 cases of MRA showed no abnormal vascular malformation coinciding with those of surgery. Posttreatment MR angiography did not depict any abnormal vessels again. Conclusions: Fast three-dimensional contrast-enhanced MR angiography with elliptic centric phase-encoding may provide

Spinal Cord Injury 101

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The Effects of Epidural Top-Up Technique with Serum Physiological On Unilateral Spinal Anesthesia

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İlkay Cömert

2006-01-01

Full Text Available This study was designed to investigate the influence of saline injections as epidural top-up on the sensory block duration, quality and hemodynamic effects of unilateral spinal anesthesia. The cases from ASA I-Il containing of 18-65 age group were randomly separated into three groups. For the purpose of unilateral spinal anesthesia, 6 mg 0.5% ‘heavy’ bupivacaine and for the purpose of epidural top-up, 10 mL saline were applied to the each patients of the groups. The study protocol was designed as:Ist group: Coming after the epidural catheter installation, unilateral spinal anesthesia was applied (n=20.IInd group: At first, unilateral spinal anesthesia was applied and after one minute, epidural top-up was done via the pre-installed epidural catheter (n=20.IIIrd group: At first the epidural catheter was installed and epidural top-up was applied. After one minute, unilateral spinal anesthesia was fulfilled (n=2O. Starting from the pre-anesthesic period, the hemodynamic data and following the anesthesia, the sensorial and motor block levels were recorded and evaluated.As the outcome of the inter-groups comparison of heart rate and mean arterial pressure, a statistically note-worthy differance was not determined; statistically significant but clinically acceptable hemodynamic changes were observed in intra-group evaluations, when the data was compared with control levels. The sensorial block levels were significantly higher in group II and significantly lower in group III.The application of 10 mL saline via epidural catheter 1 minute after the unilateral spinal anesthesia and remaining the patient leaning on the side of the extremity to be operated for 15 minutes improves the sensory block level of unilateral spinal anesthesia. It is determined that, for the lower extremity surgical operations with 1-1.5 hour estimated period, this method alone can be a worthwhile alternative.

Spinal Cord Injury 101

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Full Text Available ... of Spinal Cord Injury Rehabilitation Kristine Cichowski, MS Occupational Therapy after Spinal Cord Injury Katie Powell, OT ... does not provide medical advice, recommend or endorse health care products or services, or control the information ...

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Spinal Cord Injury 101

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Pleural puncture with thoracic epidural: A rare complication?

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Rachna Wadhwa

2011-01-01

Full Text Available Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

Spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces: A case report

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Yim, Bong Guk; Lee, Young Jun; Lee, Ji Young; Park, Chan Kum; Paik, Seung Sam [Hanyang University Medical Center, Hanyang University College of Medicine, Seoul (Korea, Republic of); Park, Dong Woo [Dept. of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)

2015-07-15

Spinal capillary hemangiomas in the epidural space are extremely rare; however, a preoperative radiological diagnosis is very important because of the risk of massive intraoperative hemorrhage. We report a case of a spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces.

Spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces: A case report

International Nuclear Information System (INIS)

Yim, Bong Guk; Lee, Young Jun; Lee, Ji Young; Park, Chan Kum; Paik, Seung Sam; Park, Dong Woo

2015-01-01

Spinal capillary hemangiomas in the epidural space are extremely rare; however, a preoperative radiological diagnosis is very important because of the risk of massive intraoperative hemorrhage. We report a case of a spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces

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Pericytes Make Spinal Cord Breathless after Injury.

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Almeida, Viviani M; Paiva, Ana E; Sena, Isadora F G; Mintz, Akiva; Magno, Luiz Alexandre V; Birbrair, Alexander

2017-09-01

Traumatic spinal cord injury is a devastating condition that leads to significant neurological deficits and reduced quality of life. Therapeutic interventions after spinal cord lesions are designed to address multiple aspects of the secondary damage. However, the lack of detailed knowledge about the cellular and molecular changes that occur after spinal cord injury restricts the design of effective treatments. Li and colleagues using a rat model of spinal cord injury and in vivo microscopy reveal that pericytes play a key role in the regulation of capillary tone and blood flow in the spinal cord below the site of the lesion. Strikingly, inhibition of specific proteins expressed by pericytes after spinal cord injury diminished hypoxia and improved motor function and locomotion of the injured rats. This work highlights a novel central cellular population that might be pharmacologically targeted in patients with spinal cord trauma. The emerging knowledge from this research may provide new approaches for the treatment of spinal cord injury.

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Initiation of bladder voiding with epidural stimulation in paralyzed, step trained rats.

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Gad, Parag N; Roy, Roland R; Zhong, Hui; Lu, Daniel C; Gerasimenko, Yury P; Edgerton, V Reggie

2014-01-01

The inability to control timely bladder emptying is one of the most serious challenges among the several functional deficits that occur after a complete spinal cord injury. Having demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis, we hypothesized that a similar approach could be used to recover bladder function after paralysis. Also knowing that posture and locomotion can be initiated immediately with a specific frequency-dependent stimulation pattern and that with repeated stimulation-training sessions these functions can improve even further, we reasoned that the same two strategies could be used to regain bladder function. Recent evidence suggests that rats with severe paralysis can be rehabilitated with a multisystem neuroprosthetic training regime that counteracts the development of neurogenic bladder dysfunction. No data regarding the acute effects of locomotion on bladder function, however, were reported. In this study we show that enabling of locomotor-related spinal neuronal circuits by epidural stimulation also influences neural networks controlling bladder function and can play a vital role in recovering bladder function after complete paralysis. We have identified specific spinal cord stimulation parameters that initiate bladder emptying within seconds of the initiation of epidural stimulation. The clinical implications of these results are substantial in that this strategy could have a major impact in improving the quality of life and longevity of patients while simultaneously dramatically reducing ongoing health maintenance after a spinal cord injury.

Initiation of bladder voiding with epidural stimulation in paralyzed, step trained rats.

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Parag N Gad

Full Text Available The inability to control timely bladder emptying is one of the most serious challenges among the several functional deficits that occur after a complete spinal cord injury. Having demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis, we hypothesized that a similar approach could be used to recover bladder function after paralysis. Also knowing that posture and locomotion can be initiated immediately with a specific frequency-dependent stimulation pattern and that with repeated stimulation-training sessions these functions can improve even further, we reasoned that the same two strategies could be used to regain bladder function. Recent evidence suggests that rats with severe paralysis can be rehabilitated with a multisystem neuroprosthetic training regime that counteracts the development of neurogenic bladder dysfunction. No data regarding the acute effects of locomotion on bladder function, however, were reported. In this study we show that enabling of locomotor-related spinal neuronal circuits by epidural stimulation also influences neural networks controlling bladder function and can play a vital role in recovering bladder function after complete paralysis. We have identified specific spinal cord stimulation parameters that initiate bladder emptying within seconds of the initiation of epidural stimulation. The clinical implications of these results are substantial in that this strategy could have a major impact in improving the quality of life and longevity of patients while simultaneously dramatically reducing ongoing health maintenance after a spinal cord injury.

Evaluation of electrical nerve stimulation for epidural catheter positioning in the dog.

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Garcia-Pereira, Fernando L; Sanders, Robert; Shih, Andre C; Sonea, Ioana M; Hauptman, Joseph G

2013-09-01

To evaluate the accuracy of epidural catheter placement at different levels of the spinal cord guided solely by electrical nerve stimulation and resultant segmental muscle contraction. Prospective, experiment. Six male and two female Beagles, age (1 ± 0.17 years) and weight (12.9 ± 1.1 kg). Animals were anesthetized with propofol and maintained with isoflurane. An insulated epidural needle was used to reach the lumbosacral epidural space. A Tsui epidural catheter was inserted and connected to a nerve stimulator (1.0 mA, 0.1 ms, 2 Hz) to assess positioning of the tip at specific spinal cord segments. The catheter was advanced to three different levels of the spinal cord: lumbar (L2-L5), thoracic (T5-T10) and cervical (C4-C6). Subcutaneous needles were previously placed at these spinal levels and the catheter was advanced to match the needle location, guided only by corresponding muscle contractions. Catheter position was verified by fluoroscopy. If catheter tip and needle were at the same vertebral body a score of zero was assigned. When catheter tip was cranial or caudal to the needle, positive or negative numbers, respectively, corresponding to the number of vertebrae between them, were assigned. The mean and standard deviation of the number of vertebrae between catheter tip and needle were calculated to assess accuracy. Results are given as mean ± SD. The catheter position in relation to the needle was within 0.3 ± 2.0 vertebral bodies. Positive predictive values (PPV) were 57%, 83% and 71% for lumbar, thoracic and cervical regions respectively. Overall PPV was 70%. No significant difference in PPV among regions was found. Placement of an epidural catheter at specific spinal levels using electrical nerve stimulation was feasible without radiographic assistance in dogs. Two vertebral bodies difference from the target site may be clinically acceptable when performing segmental epidural regional anesthesia. © 2013 Association of Veterinary

Spinal-cord swelling in acute multiple sclerosis

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Kikuchi, Seiji; Tashiro, Kunio; Naganuma, Mutsuo; Hida, Kazutoshi; Iwasaki, Yoshinobu; Abe, Hiroshi; Miyasaka, Kazuo

1986-01-01

Despite the frequent involvement of the spinal cord by multiple sclerosis, reports concerning neuroradiological findings regarding these lesions have been limited; most of them have demonstrated a normal or small spinal cord. Two cases of acute paraparesis showed evidence of spinal-cord swelling on myelography and CT myelography, initially suggesting the diagnosis of an intramedullary tumor. Spinal-cord swelling was demonstrated more clearly on CT myelography than on conventional myelography. The diagnosis of multiple sclerosis was made with the aid of the CSF findings, the clinical course, and the contracting-cord sign. The ''contracting-cord sign'' means the diminution of the spinal-cord diameter in the chronic stage. Since acute multiple sclerosis may produce spinal-cord swelling simulating a tumor, careful investigations are necessary to avoid unwarranted surgical interventions. (author)

Twiddler's syndrome in spinal cord stimulation.

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Al-Mahfoudh, Rafid; Chan, Yuen; Chong, Hsu Pheen; Farah, Jibril Osman

2016-01-01

The aims are to present a case series of Twiddler's syndrome in spinal cord stimulators with analysis of the possible mechanism of this syndrome and discuss how this phenomenon can be prevented. Data were collected retrospectively between 2007 and 2013 for all patients presenting with failure of spinal cord stimulators. The diagnostic criterion for Twiddler's syndrome is radiological evidence of twisting of wires in the presence of failure of spinal cord stimulation. Our unit implants on average 110 spinal cord stimulators a year. Over the 5-year study period, all consecutive cases of spinal cord stimulation failure were studied. Three patients with Twiddler's syndrome were identified. Presentation ranged from 4 to 228 weeks after implantation. Imaging revealed repeated rotations and twisting of the wires of the spinal cord stimulators leading to hardware failure. To the best of our knowledge this is the first reported series of Twiddler's syndrome with implantable pulse generators (IPGs) for spinal cord stimulation. Hardware failure is not uncommon in spinal cord stimulation. Awareness and identification of Twiddler's syndrome may help prevent its occurrence and further revisions. This may be achieved by implanting the IPG in the lumbar region subcutaneously above the belt line. Psychological intervention may have a preventative role for those who are deemed at high risk of Twiddler's syndrome from initial psychological screening.

Therapeutic approaches for spinal cord injury

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Alexandre Fogaça Cristante

2012-10-01

Full Text Available This study reviews the literature concerning possible therapeutic approaches for spinal cord injury. Spinal cord injury is a disabling and irreversible condition that has high economic and social costs. There are both primary and secondary mechanisms of damage to the spinal cord. The primary lesion is the mechanical injury itself. The secondary lesion results from one or more biochemical and cellular processes that are triggered by the primary lesion. The frustration of health professionals in treating a severe spinal cord injury was described in 1700 BC in an Egyptian surgical papyrus that was translated by Edwin Smith; the papyrus reported spinal fractures as a ''disease that should not be treated.'' Over the last biological or pharmacological treatment method. Science is unraveling the mechanisms of cell protection and neuroregeneration, but clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration. The combination of several therapeutic strategies should, at minimum, allow for partial functional recoveries for these patients, which could improve their quality of life.

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

Radiation treatment of spinal cord neoplasms

International Nuclear Information System (INIS)

Smirnov, R.V.

1982-01-01

Results of radiation treatment of spinal cord neoplasms are presented. The results of combined (surgical and radiation) treatment of tumors are studied. On the whole it is noted that radiation treatment of initial spinal cord tumours is not practised on a large scale because of low radiostability of spinal cord

Postoperative re-irradiation using stereotactic body radiotherapy for metastatic epidural spinal cord compression.

Science.gov (United States)

Ito, Kei; Nihei, Keiji; Shimizuguchi, Takuya; Ogawa, Hiroaki; Furuya, Tomohisa; Sugita, Shurei; Hozumi, Takahiro; Keisuke Sasai; Karasawa, Katsuyuki

2018-06-15

OBJECTIVE This study aimed to clarify the outcomes of postoperative re-irradiation using stereotactic body radiotherapy (SBRT) for metastatic epidural spinal cord compression (MESCC) in the authors' institution and to identify factors correlated with local control. METHODS Cases in which patients with previously irradiated MESCC underwent decompression surgery followed by spine SBRT as re-irradiation between April 2013 and May 2017 were retrospectively reviewed. The surgical procedures were mainly performed by the posterior approach and included decompression and fixation. The prescribed dose for spine SBRT was 24 Gy in 2 fractions. The primary outcome was local control, which was defined as elimination, shrinkage, or no change of the tumor on CT or MRI obtained approximately every 3 months after SBRT. In addition, various patient-, treatment-, and tumor-specific factors were evaluated to determine their predictive value for local control. RESULTS Twenty-eight cases were identified in the authors' institutional databases as meeting the inclusion criteria. The histology of the primary disease was thyroid cancer in 7 cases, lung cancer in 6, renal cancer in 3, colorectal cancer in 3, and other cancers in 9. The most common previous radiation dose was 30 Gy in 10 fractions (15 cases). The mean interval since the most recent irradiation was 16 months (range 5-132 months). The median duration of follow-up after SBRT was 13 months (range 4-38 months). The 1-year local control rate was 70%. In the analysis of factors related to local control, Bilsky grade, number of vertebral levels in the treatment target, the interval between the latest radiotherapy and SBRT, recursive partitioning analysis (RPA), the prognostic index for spinal metastases (PRISM), and the revised Tokuhashi score were not significantly correlated with local control. The favorable group classified by the Rades prognostic score achieved a significantly higher 1-year local control rate than the unfavorable

Rapidly Progressive Spontaneous Spinal Epidural Abscess

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Abdurrahman Aycan

2016-01-01

Full Text Available Spinal epidural abscess (SEA is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

The epidural needle guidance with an intelligent and automatic identification system for epidural anesthesia

Science.gov (United States)

Kao, Meng-Chun; Ting, Chien-Kun; Kuo, Wen-Chuan

2018-02-01

Incorrect placement of the needle causes medical complications in the epidural block, such as dural puncture or spinal cord injury. This study proposes a system which combines an optical coherence tomography (OCT) imaging probe with an automatic identification (AI) system to objectively identify the position of the epidural needle tip. The automatic identification system uses three features as image parameters to distinguish the different tissue by three classifiers. Finally, we found that the support vector machine (SVM) classifier has highest accuracy, specificity, and sensitivity, which reached to 95%, 98%, and 92%, respectively.

The Lesioned Spinal Cord Is a “New” Spinal Cord: Evidence from Functional Changes after Spinal Injury in Lamprey

Science.gov (United States)

Parker, David

2017-01-01

Finding a treatment for spinal cord injury (SCI) focuses on reconnecting the spinal cord by promoting regeneration across the lesion site. However, while regeneration is necessary for recovery, on its own it may not be sufficient. This presumably reflects the requirement for regenerated inputs to interact appropriately with the spinal cord, making sub-lesion network properties an additional influence on recovery. This review summarizes work we have done in the lamprey, a model system for SCI research. We have compared locomotor behavior (swimming) and the properties of descending inputs, locomotor networks, and sensory inputs in unlesioned animals and animals that have received complete spinal cord lesions. In the majority (∼90%) of animals swimming parameters after lesioning recovered to match those in unlesioned animals. Synaptic inputs from individual regenerated axons also matched the properties in unlesioned animals, although this was associated with changes in release parameters. This suggests against any compensation at these synapses for the reduced descending drive that will occur given that regeneration is always incomplete. Compensation instead seems to occur through diverse changes in cellular and synaptic properties in locomotor networks and proprioceptive systems below, but also above, the lesion site. Recovery of locomotor performance is thus not simply the reconnection of the two sides of the spinal cord, but reflects a distributed and varied range of spinal cord changes. While locomotor network changes are insufficient on their own for recovery, they may facilitate locomotor outputs by compensating for the reduction in descending drive. Potentiated sensory feedback may in turn be a necessary adaptation that monitors and adjusts the output from the “new” locomotor network. Rather than a single aspect, changes in different components of the motor system and their interactions may be needed after SCI. If these are general features, and where

Central nociceptive sensitization vs. spinal cord training: Opposing forms of plasticity that dictate function after complete spinal cord injury

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Adam R Ferguson

2012-10-01

Full Text Available The spinal cord demonstrates several forms of plasticity that resemble brain-dependent learning and memory. Among the most studied form of spinal plasticity is spinal memory for noxious (nociceptive stimulation. Numerous papers have described central pain as a spinally-stored memory that enhances future responses to cutaneous stimulation. This phenomenon, known as central sensitization, has broad relevance to a range of pathological conditions. Work from the spinal cord injury (SCI field indicates that the lumbar spinal cord demonstrates several other forms of plasticity, including formal learning and memory. After complete thoracic SCI, the lumbar spinal cord can be trained by delivering stimulation to the hindleg when the leg is extended. In the presence of this response-contingent stimulation the spinal cord rapidly learns to hold the leg in a flexed position, a centrally mediated effect that meets the formal criteria for instrumental (response-outcome learning. Instrumental flexion training produces a central change in spinal plasticity that enables future spinal learning on both the ipsilateral and contralateral leg. However, if stimulation is given in a response-independent manner, the spinal cord develops central maladaptive plasticity that undermines future spinal learning on both legs. The present paper tests for interactions between spinal cord training and central nociceptive sensitization after complete spinal cord transection. We found that spinal training alters future central sensitization by intradermal formalin (24 h post-training. Conversely intradermal formalin impaired future spinal learning (24 h post-injection. Because the NMDA receptor has been implicated in formalin-induced central sensitization, we tested whether pretreatment with NMDA affects spinal learning. We found intrathecal NMDA impaired learning in a dose-dependent fashion, and that this effect endures for at least 24h. These data provide strong evidence for an

SCT: Spinal Cord Toolbox, an open-source software for processing spinal cord MRI data.

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De Leener, Benjamin; Lévy, Simon; Dupont, Sara M; Fonov, Vladimir S; Stikov, Nikola; Louis Collins, D; Callot, Virginie; Cohen-Adad, Julien

2017-01-15

For the past 25 years, the field of neuroimaging has witnessed the development of several software packages for processing multi-parametric magnetic resonance imaging (mpMRI) to study the brain. These software packages are now routinely used by researchers and clinicians, and have contributed to important breakthroughs for the understanding of brain anatomy and function. However, no software package exists to process mpMRI data of the spinal cord. Despite the numerous clinical needs for such advanced mpMRI protocols (multiple sclerosis, spinal cord injury, cervical spondylotic myelopathy, etc.), researchers have been developing specific tools that, while necessary, do not provide an integrative framework that is compatible with most usages and that is capable of reaching the community at large. This hinders cross-validation and the possibility to perform multi-center studies. In this study we introduce the Spinal Cord Toolbox (SCT), a comprehensive software dedicated to the processing of spinal cord MRI data. SCT builds on previously-validated methods and includes state-of-the-art MRI templates and atlases of the spinal cord, algorithms to segment and register new data to the templates, and motion correction methods for diffusion and functional time series. SCT is tailored towards standardization and automation of the processing pipeline, versatility, modularity, and it follows guidelines of software development and distribution. Preliminary applications of SCT cover a variety of studies, from cross-sectional area measures in large databases of patients, to the precise quantification of mpMRI metrics in specific spinal pathways. We anticipate that SCT will bring together the spinal cord neuroimaging community by establishing standard templates and analysis procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management.

Science.gov (United States)

Ikpeze, Tochukwu C; Mesfin, Addisu

2017-06-01

Spinal cord injuries (SCIs) are sustained by more than 12 500 patients per year in the United States and more globally. The SCIs disproportionately affect the elderly, especially men. Approximately 60% of these injuries are sustained traumatically through falls, but nontraumatic causes including infections, tumors, and medication-related epidural bleeding have also been documented. Preexisting conditions such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis can render the spine stiff and are risk factors as well as cervical spondylosis and ensuing cervical stenosis. Treatment options vary depending on the severity, location, and complexity of the injury. Surgical management has been growing in popularity over the years and remains an option as it helps reduce spinal cord compression and alleviate pain. Elevating mean arterial pressures to prevent spinal cord ischemia and avoiding the second hit of SCI have become more common as opposed to high dose steroids. Ongoing clinical trials with pharmacological agents such as minocycline and riluzole have shown early, promising results in their ability to reduce cellular damage and facilitate recovery. Though SCI can be life changing, the available treatment options have aimed to reduce pain and minimize complications and maintain quality of life alongside rehabilitative services.

International Spinal Cord Injury

DEFF Research Database (Denmark)

Dvorak, M F; Itshayek, E; Fehlings, M G

2015-01-01

STUDY DESIGN: Survey of expert opinion, feedback and final consensus. OBJECTIVE: To describe the development and the variables included in the International Spinal Cord Injury (SCI) Spinal Interventions and Surgical Procedures Basic Data set. SETTING: International working group. METHODS......: A committee of experts was established to select and define data elements. The data set was then disseminated to the appropriate committees and organizations for comments. All suggested revisions were considered and both the International Spinal Cord Society and the American Spinal Injury Association endorsed...... spinal intervention and procedure is coded (variables 1 through 7) and the spinal segment level is described (variables 8 and 9). Sample clinical cases were developed to illustrate how to complete it. CONCLUSION: The International SCI Spinal Interventions and Surgical Procedures Basic Data Set...

Directly measuring spinal cord blood flow and spinal cord perfusion pressure via the collateral network: correlations with changes in systemic blood pressure.

Science.gov (United States)

Kise, Yuya; Kuniyoshi, Yukio; Inafuku, Hitoshi; Nagano, Takaaki; Hirayasu, Tsuneo; Yamashiro, Satoshi

2015-01-01

During thoracoabdominal surgery in which segmental arteries are sacrificed over a large area, blood supply routes from collateral networks have received attention as a means of avoiding spinal cord injury. The aim of this study was to investigate spinal cord blood supply through a collateral network by directly measuring spinal cord blood flow and spinal cord perfusion pressure experimentally. In beagle dogs (n = 8), the thoracoabdominal aorta and segmental arteries L1-L7 were exposed, and a temporary bypass was created for distal perfusion. Next, a laser blood flow meter was placed on the spinal dura mater in the L5 region to measure the spinal cord blood flow. The following were measured simultaneously when the direct blood supply from segmental arteries L2-L7 to the spinal cord was stopped: mean systemic blood pressure, spinal cord perfusion pressure (blood pressure within the aortic clamp site), and spinal cord blood flow supplied via the collateral network. These variables were then investigated for evidence of correlations. Positive correlations were observed between mean systemic blood pressure and spinal cord blood flow during interruption of segmental artery flow both with (r = 0.844, P flow with and without distal perfusion (r = 0.803, P network from outside the interrupted segmental arteries, and high systemic blood pressure (∼1.33-fold higher) was needed to obtain the preclamping spinal cord blood flow, whereas 1.68-fold higher systemic blood pressure was needed when distal perfusion was halted. Spinal cord blood flow is positively correlated with mean systemic blood pressure and spinal cord perfusion pressure under spinal cord ischemia caused by clamping a wide range of segmental arteries. In open and endovascular thoracic and thoracoabdominal surgery, elevating mean systemic blood pressure is a simple and effective means of increasing spinal cord blood flow, and measuring spinal cord perfusion pressure seems to be useful for monitoring

New imaging characteristics for predicting postoperative neurologic status in patients with metastatic epidural spinal cord compression. A retrospective analysis of 81 cases.

Science.gov (United States)

Lei, Mingxing; Liu, Shubin; Yang, Shaoxing; Liu, Yaosheng; Wang, Cheng; Gao, Hongjun

2017-06-01

Several clinical features have been proposed for the prediction of postoperative functional outcome in patients with metastatic epidural spinal cord compression (MESCC). However, few articles address the relationship between preoperative imaging characteristics and the postoperative neurologic status. This study aims to analyze the postoperative functional outcome and to identify new imaging parameters for predicting postoperative neurologic status in patients with MESCC. This study is a retrospective consecutive case series of patients with MESCC who were treated surgically. We assessed 81 consecutive patients who were treated with decompressive surgery for MESCC between 2013 and 2015. Eight imaging characteristics were analyzed for postoperative motor status by logistic regression models. Neurologic function was assessed using the Frankel grade preoperatively and postoperatively. The following imaging characteristics were assessed for postoperative motor status: location of lesions in the spine, lamina involvement, retropulsion of the posterior wall, number of vertebrae involved, pedicle involvement, fracture of any involved vertebrae, T2 signal of the spinal cord at the compression site, and circumferential angle of spinal cord compression (CASCC). The postoperative neurologic outcome was better than the preoperative neurologic status (p<.01). In the entire group, 40.7% of the patients were non-ambulatory before the surgical procedure, whereas 77.8% of the patients could walk after surgery (p=.01). In the multivariate analysis, the location of the lesions (odds ratio [OR]: 3.89, 95% confidence interval [CI]: 1.19-12.77, p=.02) and CASCC (OR: 2.31, 95% CI: 1.44-3.71, p<.01) were significantly associated with postoperative neurologic outcome. A CASCC of more than 180° was associated with an increased OR that approached significance, and the larger the CASCC, the higher the risk of poor postoperative neurologic status. The postoperative neurologic status was

[YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia].

Science.gov (United States)

Tulgar, Serkan; Selvi, Onur; Serifsoy, Talat Ercan; Senturk, Ozgur; Ozer, Zeliha

Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p>0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p>0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87±4.28 vs. 5.84±2.90, p=0.044 and 3.89±5.43 vs. 1.19±3.35, p=0.01 respectively). Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

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Emine Rabia Koç

2014-09-01

Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking

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)

Microdialysis to optimize cord perfusion and drug delivery in spinal cord injury.

OpenAIRE

Phang, I; Zoumprouli, A; Papadopoulos, MC; Saadoun, S

2016-01-01

OBJECTIVE: There is lack of monitoring from the injury site to guide management of patients with acute traumatic spinal cord injury. Here we describe a bedside microdialysis monitoring technique for optimizing spinal cord perfusion and drug delivery at the injury site. METHODS: 14 patients were recruited within 72 hours of severe spinal cord injury. We inserted intradurally at the injury site a pressure probe, to monitor continuously spinal cord perfusion pressure, and a microdialysis cathete...

Computed tomography of the spinal canal for the cervical spine and spinal cord injury

International Nuclear Information System (INIS)

Kimura, Isao; Niimiya, Hikosuke; Nasu, Kichiro; Shioya, Akihide; Ohhama, Mitsuru

1983-01-01

The cervical spinal canal and cervical spinal cord were measured in normal cases and 34 cases of spinal or spinal cord injury. The anteroposterior diameter and area of the normal cervical spinal canal showed a high correlation. The area ratio of the normal cervical spinal canal to the cervical spinal cord showed that the proportion of the cervical spinal cord in the spinal canal was 1/3 - 1/5, Csub(4,5) showing a particularly large proportion. In acute and subacute spinal or spinal cord injury, CT visualized in more details of the spinal canal in cases that x-ray showed definite bone injuries. Computer assisted myelography visualized more clearly the condition of the spinal cord in cases without definite findings bone injuries on x-ray. Demonstrating the morphology of spinal injury in more details, CT is useful for selection of therapy for injured spines. (Chiba, N.)

Operative treatment of spontaneous spinal epidural hematomas : a study of the factors determining postoperative outcome

NARCIS (Netherlands)

Groen, R J; van Alphen, H A

OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was

Topologically preserving straightening of spinal cord MRI.

Science.gov (United States)

De Leener, Benjamin; Mangeat, Gabriel; Dupont, Sara; Martin, Allan R; Callot, Virginie; Stikov, Nikola; Fehlings, Michael G; Cohen-Adad, Julien

2017-10-01

To propose a robust and accurate method for straightening magnetic resonance (MR) images of the spinal cord, based on spinal cord segmentation, that preserves spinal cord topology and that works for any MRI contrast, in a context of spinal cord template-based analysis. The spinal cord curvature was computed using an iterative Non-Uniform Rational B-Spline (NURBS) approximation. Forward and inverse deformation fields for straightening were computed by solving analytically the straightening equations for each image voxel. Computational speed-up was accomplished by solving all voxel equation systems as one single system. Straightening accuracy (mean and maximum distance from straight line), computational time, and robustness to spinal cord length was evaluated using the proposed and the standard straightening method (label-based spline deformation) on 3T T 2 - and T 1 -weighted images from 57 healthy subjects and 33 patients with spinal cord compression due to degenerative cervical myelopathy (DCM). The proposed algorithm was more accurate, more robust, and faster than the standard method (mean distance = 0.80 vs. 0.83 mm, maximum distance = 1.49 vs. 1.78 mm, time = 71 vs. 174 sec for the healthy population and mean distance = 0.65 vs. 0.68 mm, maximum distance = 1.28 vs. 1.55 mm, time = 32 vs. 60 sec for the DCM population). A novel image straightening method that enables template-based analysis of quantitative spinal cord MRI data is introduced. This algorithm works for any MRI contrast and was validated on healthy and patient populations. The presented method is implemented in the Spinal Cord Toolbox, an open-source software for processing spinal cord MRI data. 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1209-1219. © 2017 International Society for Magnetic Resonance in Medicine.

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)

Risk factors in iatrogenic spinal cord injury.

Science.gov (United States)

Montalva-Iborra, A; Alcanyis-Alberola, M; Grao-Castellote, C; Torralba-Collados, F; Giner-Pascual, M

2017-09-01

In the last years, there has been a change in the aetiology of spinal cord injury. There has been an increase in the number of elderly patients with spinal cord injuries caused by diseases or medical procedures. The aim of this study is to investigate the frequency of the occurrence of iatrogenic spinal cord injury in our unit. The secondary aim is to study what variables can be associated with a higher risk of iatrogenesis. A retrospective, descriptive, observational study of patients with acute spinal cord injury admitted from June 2009 to May 2014 was conducted. The information collected included the patient age, aetiology, neurological level and grade of injury when admitted and when discharged, cardiovascular risk factors, a previous history of depression and any prior treatment with anticoagulant or antiplatelet drugs. We applied a logistic regression. The grade of statistical significance was established as Pinjury was the thoracic level (48%). The main aetiology of spinal cord injury caused by iatrogenesis was surgery for degenerative spine disease, in patients under the age of 30 were treated with intrathecal chemotherapy. Iatrogenic spinal cord injury is a frequent complication. A statistically significant association between a patient history of depression and iatrogenic spinal cord injury was found as well as with anticoagulant and antiplatelet drug use prior to iatrogenic spinal cord injury.

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

Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

DEFF Research Database (Denmark)

Callesen, T; Schouenborg, Lars Øland; Nielsen, D

1999-01-01

Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1...... or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P ... for hysterectomy caused less PONV, but with less effective analgesia compared with general anaesthesia with postoperative continuous epidural morphine and bupivacaine....

Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

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Rochana Girish Bakhshi

2011-11-01

Full Text Available Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000- 40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.

Nuclear magnetic imaging for MTRA. Spinal canal and spinal cord

International Nuclear Information System (INIS)

Fritzsch, Dominik; Hoffmann, Karl-Titus

2011-01-01

The booklet covers the following topics: (1) Clinical indications for NMR imaging of spinal cord and spinal canal; (2) Methodic requirements: magnets and coils, image processing, contrast media: (3) Examination technology: examination conditions, sequences, examination protocols; (4) Disease pattern and indications: diseases of the myelin, the spinal nerves and the spinal canal (infections, tumors, injuries, ischemia and bleedings, malformations); diseases of the spinal cord and the intervertebral disks (degenerative changes, infections, injuries, tumors, malformations).

A Good Short-term Outcome in Delayed Decompression of Cauda Equina Syndrome in Klebsiella pneumoniae Spinal Epidural Abscess: A Case Report

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Hanifah J

2017-07-01

Full Text Available Spinal epidural abscess is a severe, generally pyogenic, infection of the epidural space of spinal cord or cauda equina. The swelling caused by the abscess leads to compression or vascular disruption of neurological structures that requires urgent surgical decompression to avoid significant permanent disability. We share a rare case of Klebsiella pneumoniae spinal epidural abscess secondary to haematogenous spread of previous lung infection that presented late at our centre with cauda equina syndrome that showed good short-term outcome in delayed decompression. A 50-year old female presented with one-week history of persistent low back pain with progressively worsening bilateral lower limb weakness for seven days and urinary retention associated with saddle anesthesia of 2-day duration. Magnetic resonance imaging with contrast of the lumbo-sacral region showed an intramuscular collection of abscess at left gluteus maximus and left multifidus muscle with a L3-L5 posteriorly placed extradural lesion enhancing peripherally on contrast, suggestive of epidural abscess that compressed the cauda equina. The pus was drained using the posterior lumbar approach. Tissue and pus culture revealed Klebsiella pneumoniae, suggestive of bacterial infection. The patient made immediate improvement of muscle power over bilateral lower limbs postoperative followed by ability to control micturition and defecation in the 4th post-operative day. A good short-term outcome in delayed decompression of cauda equine syndrome is extremely rare. Aggressive surgical decompression combined with antibiotic therapy led to good short-term outcome in this patient despite delayed decompression of more than 48 hours.

MRI features of epidural extramedullary hematopoiesis

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Alorainy, Ibrahim A. E-mail: alorainy@ksu.edu.sa; Al-Asmi, Abdullah R.; Carpio, Raquel del

2000-07-01

A case of {beta}-thalassemia intermedia with spinal cord compression due to extramedullary hematopoiesis, which was successfully treated by blood transfusion, is presented. Emphasis was made on the MRI appearance of extramedullary hematopoiesis on different pulse sequences. The theories that aimed to explain the involvement of the epidural space by extramedullary hematopoiesis are discussed.

MRI features of epidural extramedullary hematopoiesis

International Nuclear Information System (INIS)

Alorainy, Ibrahim A.; Al-Asmi, Abdullah R.; Carpio, Raquel del

2000-01-01

A case of β-thalassemia intermedia with spinal cord compression due to extramedullary hematopoiesis, which was successfully treated by blood transfusion, is presented. Emphasis was made on the MRI appearance of extramedullary hematopoiesis on different pulse sequences. The theories that aimed to explain the involvement of the epidural space by extramedullary hematopoiesis are discussed

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

Science.gov (United States)

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.

[CSE vs. augmented epidural anesthesia for cesarean section. Spinal and epidural anesthesia with bupivacaine 0.5% "isobar" require augmentation].

Science.gov (United States)

Halter, F; Niesel, H C; Gladrow, W; Kaiser, H

1998-09-01

Incomplete anaesthesia is a major clinical problem both in single spinal and in single epidural anaesthesia. The clinical efficacy of epidural anaesthesia with augmentation (aEA) and combined epidural and spinal anesthesia (CSE) for cesarean section was investigated in a prospective randomized study on 45 patients. Anaesthesia extending up to Th5 was aimed for. Depending on the patient's height, epidural anaesthesia was administered with a dose of 18-22 ml 0.5% bupivacaine and spinal anaesthesia with a dose of 11-15 mg 0.5% bupivacaine. Augmentation was carried out in all cases in epidural anaesthesia, initially with 7.5 ml 1% Lidocaine with epinephrine 1:400,000, raised by 1.5 ml per missing segment. The epidural reinjection in CSE was carried out as necessary with 9.5-15 ml 1% lidocaine with epinephrine, depending on the height and difference from the segment Th5. The extension of anaesthesia achieved in epidural anaesthesia after an initial dose of 101.8 mg bupivacaine and augmenting dose of 99 mg lidocaine reached the segment Th5. The primary spinal anaesthesia dose up to 15 mg corresponding to height led to a segmental extension to a maximum of Th3 under CSE. Augmentation was necessary in 13 patients; in 5 cases because of inadequate extent of anaesthesia and 8 cases because of pain resulting from premature reversion. The augmenting dose required was 13.9 ml. Readiness for operation was attained after 19.8 min (aEA) and after 10.5 min (CSE). No patient required analgesics before delivery. The additional analgesic requirement during operation was 63.6% (aEA) and 39.1% (CSE). Taking into account pain in the area of surgery, the requirement of analgesics was 50% (aEA) vs. 17.4% (CSE). Antiemetics were required in 18.2 (aEA) and in 65.2% (CSE). The systolic blood pressure fell by 17.7% (aEA) and in 30.3% (CSE). The minimum systolic pressure was observed after 13.4 min in aEA, and after 9.5 min in CSE. The APGAR score and the umbilical pH did not show any

Independent spinal cord atrophy measures correlate to motor and sensory deficits in individuals with spinal cord injury

DEFF Research Database (Denmark)

Lundell, Hans Magnus Henrik; Barthelemy, Dorothy; Skimminge, A.

2011-01-01

touch and pinprick, and muscle strength. Antero-posterior width (APW), left-right width (LRW) and cross-sectional spinal cord area (SCA) were extracted from MRI at the spinal level of C2. The angular variation of the spinal cord radius over the full circle was also extracted and compared...... with the clinical scores.Results:The motor score was correlated to LRW and the sensory scores were correlated to APW. The scores correlated also well with decreases in spinal cord radius in oblique angles in coherent and non-overlapping sectors for the sensory and motor qualities respectively.Conclusion:APW and LRW...

Spinal cord injury reveals multilineage differentiation of ependymal cells.

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Konstantinos Meletis

2008-07-01

Full Text Available Spinal cord injury often results in permanent functional impairment. Neural stem cells present in the adult spinal cord can be expanded in vitro and improve recovery when transplanted to the injured spinal cord, demonstrating the presence of cells that can promote regeneration but that normally fail to do so efficiently. Using genetic fate mapping, we show that close to all in vitro neural stem cell potential in the adult spinal cord resides within the population of ependymal cells lining the central canal. These cells are recruited by spinal cord injury and produce not only scar-forming glial cells, but also, to a lesser degree, oligodendrocytes. Modulating the fate of ependymal progeny after spinal cord injury may offer an alternative to cell transplantation for cell replacement therapies in spinal cord injury.

Modification of spasticity by transcutaneous spinal cord stimulation in individuals with incomplete spinal cord injury

Science.gov (United States)

Hofstoetter, Ursula S.; McKay, William B.; Tansey, Keith E.; Mayr, Winfried; Kern, Helmut; Minassian, Karen

2014-01-01

Context/objective To examine the effects of transcutaneous spinal cord stimulation (tSCS) on lower-limb spasticity. Design Interventional pilot study to produce preliminary data. Setting Department of Physical Medicine and Rehabilitation, Wilhelminenspital, Vienna, Austria. Participants Three subjects with chronic motor-incomplete spinal cord injury (SCI) who could walk ≥10 m. Interventions Two interconnected stimulating skin electrodes (Ø 5 cm) were placed paraspinally at the T11/T12 vertebral levels, and two rectangular electrodes (8 × 13 cm) on the abdomen for the reference. Biphasic 2 ms-width pulses were delivered at 50 Hz for 30 minutes at intensities producing paraesthesias but no motor responses in the lower limbs. Outcome measures The Wartenberg pendulum test and neurological recordings of surface-electromyography (EMG) were used to assess effects on exaggerated reflex excitability. Non-functional co-activation during volitional movement was evaluated. The timed 10-m walk test provided measures of clinical function. Results The index of spasticity derived from the pendulum test changed from 0.8 ± 0.4 pre- to 0.9 ± 0.3 post-stimulation, with an improvement in the subject with the lowest pre-stimulation index. Exaggerated reflex responsiveness was decreased after tSCS across all subjects, with the most profound effect on passive lower-limb movement (pre- to post-tSCS EMG ratio: 0.2 ± 0.1), as was non-functional co-activation during voluntary movement. Gait speed values increased in two subjects by 39%. Conclusion These preliminary results suggest that tSCS, similar to epidurally delivered stimulation, may be used for spasticity control, without negatively impacting residual motor control in incomplete SCI. Further study in a larger population is warranted. PMID:24090290

Spinal cord magnetic resonance imaging in suspected multiple sclerosis

International Nuclear Information System (INIS)

Lycklama a Nijeholt, G.J.; Bergers, E.; Castelijns, J.A.; Barkhof, F.; Uitdehaag, B.M.J.; Polman, C.H.

2000-01-01

We examined the value of spinal cord magnetic resonance imaging (MRI) in the diagnostic work-up of multiple sclerosis (MS). Forty patients suspected of having MS were examined within 24 months after the start of symptoms. Disability was assessed, and symptoms were categorized as either brain or spinal cord. Work-up further included cerebrospinal fluid analysis and standard proton-density, T2-, and T1-weighted gadolinium-enhanced brain and spinal cord MRI. Patients were categorized as either clinically definite MS (n = 13), laboratory-supported definite MS (n = 14), or clinically probable MS (n = 4); four patients had clinically probable MS, and in nine MS was suspected. Spinal cord abnormalities were found in 35 of 40 patients (87.5 %), consisting of focal lesions in 31, only diffuse abnormalities in two, and both in two. Asymptomatic spinal cord lesions occurred in six patients. All patients with diffuse spinal cord abnormality had clear spinal cord symptoms and a primary progressive disease course. In clinically definite MS, the inclusion of spinal imaging increased the sensitivity of MRI to 100 %. Seven patients without a definite diagnosis had clinically isolated syndromes involving the spinal cord. Brain MRI was inconclusive, while all had focal spinal cord lesions which explained symptoms and ruled out other causes. Two other patients had atypical brain abnormalities suggesting ischemic/vascular disease. No spinal cord abnormalities were found, and during follow-up MS was ruled out. Spinal cord abnormalities are common in suspected MS, and may occur asymptomatic. Although diagnostic classification is seldom changed, spinal cord imaging increases diagnostic sensitivity of MRI in patients with suspected MS. In addition, patients with primary progressive MS may possibly be earlier diagnosed. Finally, differentiation with atypical lesions may be improved. (orig.)

Tolerance of the human spinal cord to single dose radiosurgery

International Nuclear Information System (INIS)

Ryu, S.; Zhu, G.; Yin, F.-F.; Ajlouni, M.; Kim, J.H.

2003-01-01

Tolerance of the spinal cord to the single dose of radiation is not well defined. Although there are cases of human spinal cord tolerance from re-irradiation to the same cord level, the information about the tolerance of human spinal cord to single large dose of radiosurgery is not available. We carried out spinal radiosurgery to treat spinal metastasis and studied the single dose tolerance of the human spinal cord in an ongoing dose escalation paradigm. A total of 39 patients with 48 lesions of spinal metastasis were treated with single dose radiosurgery at Henry Ford Hospital. The radiosurgery dose was escalated from 8 Gy to 16 Gy at 2 Gy increment. The radiation dose was prescribed to periphery of the spinal tumor. The radiation dose to the spinal cord was estimated by computerized dosimetry. The median follow-up time was 10 months (range 6-18 months) from the radiosurgery. The endpoint of the study was to demonstrate the efficacy of the spinal radiosurgery and to determine the tolerance of human spinal cord to single dose radiosurgery. The dose to the spinal cord was generally less than 50 % of the prescribed radiation dose. The volume of the spinal cord that received higher than this dose was less than 20 % of the anterior portion of the spinal cord. Maximum single dose of 8 Gy was delivered to the anterior 20 % of the spinal cord in this dose escalation study. The dose volume histogram will be presented. There was no acute or subacute radiation toxicity detected clinically and radiologically during the maximum follow-up of 20 months. Further dose escalation is in progress. The single tolerance dose of the human spinal cord appears to be at least 8 Gy when it was given to the 20 % of the cord volume, although the duration of follow up is not long enough to detect severe late cord toxicity. This study offers a valuable radiobiological basis of the normal spinal cord tolerance, and opens spinal radiosurgery as a safe treatment for spinal metastasis

Delayed onset of a spinal epidural hematoma after facet joint injection

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Mirko Velickovic

2016-10-01

Full Text Available The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.

Spinal cord motion. Influence of respiration and cardiac cycle

Energy Technology Data Exchange (ETDEWEB)

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.

Spinal Cord Stimulation

DEFF Research Database (Denmark)

Meier, Kaare

2014-01-01

Spinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain that is refractory to other treatment. Originally described by Shealy et al. in 1967(1), it is used to treat a range of conditions such as complex regional pain syndrome (CRPS I)(2), angina pectoris(3), radicular...... pain after failed back surgery syndrome (FBSS)(4), pain due to peripheral nerve injury, stump pain(5), peripheral vascular disease(6) and diabetic neuropathy(7,8); whereas phantom pain(9), postherpetic neuralgia(10), chronic visceral pain(11), and pain after partial spinal cord injury(12) remain more...

Imaging procedures in spinal infectious diseases

International Nuclear Information System (INIS)

Rodiek, S.O.

2001-01-01

A targeted successful treatment of spinal infectious diseases requires clinical and laboratory data that are completed by the contribution of imaging procedures. Neuroimaging only provides essential informations on the correct topography, localisation, acuity and differential diagnosis of spinal infectious lesions. MRI with its sensitivity concerning soft tissue lesions is a useful tool in detecting infectious alterations of spinal bone marrow, intervertebral disks, leptomeninges and the spinal cord itself. Crucial imaging patterns of typical spinal infections are displayed and illustrated by clinical case studies. We present pyogenic, granulomatous and postoperative variants of spondylodicitis, spinal epidural abscess, spinal meningitis and spinal cord infections. The importance of intravenous contrastmedia application is pointed out. (orig.) [de

MRI of infections and neoplasms of the spine and spinal cord in 55 patients with AIDS

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Thurnher, M.M. [Neuroradiology Section, Department of Radiology, University Hospital Vienna (Austria); Post, M.J.D. [Department of Radiology, Neuroradiology Section, University of Miami School of Medicine, Miami, FL (United States); Jinkins, J.R. [Neuroimaging Research, Department of Radiology, Nebraska Medical Center, Omaha, NE (United States)

2000-08-01

Our purpose was to describe the range of MRI findings in infectious and neoplastic involvement of the spine and spinal cord in symptomatic patients with the acquired immunodeficiency syndrome (AIDS). MRI studies in 55 patients with AIDS and neurological signs and symptoms thought to be related to the spine or spinal cord were reviewed. We categorized the findings according to the spinal compartment involved. There were 29 patients with extradural, 11 with intradural-extramedullary and 9 with intramedullary disease. In 6 patients more than one compartment was involved simultaneously, and patients presented with multiple lesions in the same compartment. The most common causes of extradural disease were bone lesions (28); an epidural mass was seen in 14 and spondylodiscitis in 4 patients. Cytomegalovirus polyradiculitis was the most common cause of intradural-extramedullary disease (in 10 cases); herpes radiculitis was seen in two, and tuberculous infection in another two. In three cases leptomeningeal contrast enhancement was due to lymphoma. Human immunodeficiency virus (HIV) myelitis was seen in two patients, presumed vacuolar myelopathy in two, toxoplasma myelitis in four, intramedullary lymphoma in one, and herpes myelitis in one. Familiarity with the various potential pathological entities that can affect the spine and spinal cord in the AIDS population and their imaging characteristics is crucial for initiation of further diagnostic tests and appropriate medical or surgical treatment. (orig.)

MRI of infections and neoplasms of the spine and spinal cord in 55 patients with AIDS

International Nuclear Information System (INIS)

Thurnher, M.M.; Post, M.J.D.; Jinkins, J.R.

2000-01-01

Our purpose was to describe the range of MRI findings in infectious and neoplastic involvement of the spine and spinal cord in symptomatic patients with the acquired immunodeficiency syndrome (AIDS). MRI studies in 55 patients with AIDS and neurological signs and symptoms thought to be related to the spine or spinal cord were reviewed. We categorized the findings according to the spinal compartment involved. There were 29 patients with extradural, 11 with intradural-extramedullary and 9 with intramedullary disease. In 6 patients more than one compartment was involved simultaneously, and patients presented with multiple lesions in the same compartment. The most common causes of extradural disease were bone lesions (28); an epidural mass was seen in 14 and spondylodiscitis in 4 patients. Cytomegalovirus polyradiculitis was the most common cause of intradural-extramedullary disease (in 10 cases); herpes radiculitis was seen in two, and tuberculous infection in another two. In three cases leptomeningeal contrast enhancement was due to lymphoma. Human immunodeficiency virus (HIV) myelitis was seen in two patients, presumed vacuolar myelopathy in two, toxoplasma myelitis in four, intramedullary lymphoma in one, and herpes myelitis in one. Familiarity with the various potential pathological entities that can affect the spine and spinal cord in the AIDS population and their imaging characteristics is crucial for initiation of further diagnostic tests and appropriate medical or surgical treatment. (orig.)

Pretreatment with AQP4 and NKCC1 Inhibitors Concurrently Attenuated Spinal Cord Edema and Tissue Damage after Spinal Cord Injury in Rats.

Science.gov (United States)

Yan, Xiaodong; Liu, Juanfang; Wang, Xiji; Li, Wenhao; Chen, Jingyuan; Sun, Honghui

2018-01-01

Spinal cord injury (SCI) affects more than 2.5 million people worldwide. Spinal cord edema plays critical roles in the pathological progression of SCI. This study aimed to delineate the roles of aquaporin 4 (AQP4) and Na + -K + -Cl - cotransporter 1 (NKCC1) in acute phase edema and tissue destruction after SCI and to explore whether inhibiting both AQP4 and NKCC1 could improve SCI-induced spinal edema and damage. Rat SCI model was established by modified Allen's method. Spinal cord water content, cerebrospinal fluid lactose dehydrogenase (LDH) activity, AQP4 and NKCC1 expression, and spinal cord pathology from 30 min to 7 days after SCI were monitored. Additionally, aforementioned parameters in rats treated with AQP4 and/or NKCC1 inhibitors were assessed 2 days after SCI. Spinal cord water content was significantly increased 1 h after SCI while AQP4 and NKCC1 expression and spinal fluid LDH activity elevated 6 h after SCI. Spinal cord edema and spinal cord destruction peaked around 24 h after SCI and maintained at high levels thereafter. Treating rats with AQP4 inhibitor TGN-020 and NKCC1 antagonist bumetanide significantly reduced spinal cord edema, tissue destruction, and AQP4 and NKCC1 expression after SCI in an additive manner. These results demonstrated the benefits of simultaneously inhibiting both AQP4 and NKCC1 after SCI.

Spinal cord regeneration: moving tentatively towards new perspectives.

Science.gov (United States)

Jones, D G; Anderson, E R; Galvin, K A

2003-01-01

The failure of the adult human spinal cord to regenerate following injury is not absolute, but appears to be amenable to therapeutic manipulation. Recent work has shown that the provision of a growth permissive environment by the neutralization of inhibitory influences, or the grafting of fetal tissue, peripheral nerve, Schwann cells, or olfactory ensheathing cells can enhance regeneration in animal models of spinal cord injury. Stem cells are gaining ever-increasing favour as a treatment option for spinal cord injury. The potential of neural stem cells, embryonic stem cells, and bone marrow stromal cells is discussed. Additional treatment options such as pharmacological interventions, functional electrical stimulation and physiotherapy approaches are also explored. Basic science insights are used as a foundation for a discussion of a variety of clinical perspectives including repair of the chronically injured spinal cord, animal models of human spinal cord injuries and clinical trials. A more holistic approach towards spinal cord injury is suggested, one where a hierarchy of needs is recognised and quality of life is paramount. Finally, this review cautions against overly grandiose claims of an imminent miracle cure for human spinal cord injury.

[Combined spinal-epidural anesthesia for cesarean section in a parturient with myotonic dystrophy].

Science.gov (United States)

Mori, Kosuke; Mizuno, Ju; Nagaoka, Takehiko; Harashima, Toshiya; Morita, Sigeho

2010-08-01

Myotonic dystrophy (MD) is a muscle disorder characterized by progressive muscle wasting and weakness, and is the most common form of muscular dystrophy that begins in adulthood, often after pregnancy. MD might be related to occurrence of malignant hyperthermia. Therefore, the cesarean section is often performed for the parturient with MD. We had an experience of combined spinal-epidural anesthesia for cesarean section in a parturient complicated with MD. A 40-year-old woman had rhabdomyolysis caused by ritodrine at 15-week gestation and was diagnosed as MD by electromyography. Her first baby died due to respiratory failure fourth day after birth. She had hatchet face, slight weakness of her lower extremities, and easy fatigability. Her manual muscle test was 5/5 at upper extremities and 4/5 at lower extremities. She underwent emergency cesarean section for premature rupture of the membrane, weak pain during labor, and obstructed labor at 33-week gestation. We placed an epidural catheter from T12/L1 and punctured arachnoid with 25 G spinal needle. We performed spinal anesthesia using 0.5% hyperbaric bupivacaine 1.5 ml and epidural anesthesia using 2% lidocaine 6 ml. Her anesthetic level reached bilaterally to T7 and operation started 18 minutes after combined spinal-epidural anesthesia. Her baby was born 23 minutes after the anesthesia. As her baby was 1/5 at Apgar score, the baby was tracheally intubated and artificially ventilated. The cesarean section was finished in 33 minutes uneventfully. She had no adverse events and was discharged on the 8th postoperative day. Later her baby was diagnosed as congenital MD by gene analysis. Combined spinal-epidural anesthesia with the amide-typed local anesthetic agents could be useful and safe for cesarean section in the parturient with MD.

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.

Diffusion tensor imaging in spinal cord compression

International Nuclear Information System (INIS)

Wang, Wei; Qin, Wen; Hao, Nanxin; Wang, Yibin; Zong, Genlin

2012-01-01

Background Although diffusion tensor imaging has been successfully applied in brain research for decades, several main difficulties have hindered its extended utilization in spinal cord imaging. Purpose To assess the feasibility and clinical value of diffusion tensor imaging and tractography for evaluating chronic spinal cord compression. Material and Methods Single-shot spin-echo echo-planar DT sequences were scanned in 42 spinal cord compression patients and 49 healthy volunteers. The mean values of the apparent diffusion coefficient and fractional anisotropy were measured in region of interest at the cervical and lower thoracic spinal cord. The patients were divided into two groups according to the high signal on T2WI (the SCC-HI group and the SCC-nHI group for with or without high signal). A one-way ANOVA was used. Diffusion tensor tractography was used to visualize the morphological features of normal and impaired white matter. Results There were no statistically significant differences in the apparent diffusion coefficient and fractional anisotropy values between the different spinal cord segments of the normal subjects. All of the patients in the SCC-HI group had increased apparent diffusion coefficient values and decreased fractional anisotropy values at the lesion level compared to the normal controls. However, there were no statistically significant diffusion index differences between the SCC-nHI group and the normal controls. In the diffusion tensor imaging maps, the normal spinal cord sections were depicted as fiber tracts that were color-encoded to a cephalocaudal orientation. The diffusion tensor images were compressed to different degrees in all of the patients. Conclusion Diffusion tensor imaging and tractography are promising methods for visualizing spinal cord tracts and can provide additional information in clinical studies in spinal cord compression

Simplified spinal cord phantom for evaluation of SQUID magnetospinography

International Nuclear Information System (INIS)

Adachi, Y; Oyama, D; Uehara, G; Somchai, N; Kawabata, S

2014-01-01

Spinal cord functional imaging by magnetospinography (MSG) is a noninvasive diagnostic method for spinal cord diseases. However, the accuracy and spatial resolution of lesion localization by MSG have barely been evaluated in detail so far. We developed a simplified spinal cord phantom for MSG evaluation. The spinal cord phantom is composed of a cylindrical vessel filled with saline water, which acts as a model of a neck. A set of modeled vertebrae is arranged in the cylindrical vessel, which has a neural current model made from catheter electrodes. The neural current model emulates the current distribution around the activated site along the axon of the spinal cord nerve. Our MSG system was used to observe the magnetic field from the phantom; a quadrupole-like pattern of the magnetic field distribution, which is a typical distribution pattern for spinal cord magnetic fields, was successfully reproduced by the phantom. Hence, the developed spinal cord phantom can be used to evaluate MSG source analysis methods.

Spinal Cord Injury 101

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Full Text Available ... OT Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury Patti Rogers, SW Marguerite ... play_arrow What are the latest developments in the use of electrical stimulation for spinal ...

Spinal Cord Injury Rehabilitation in Nepal

Directory of Open Access Journals (Sweden)

Nabina Shah

2013-06-01

Full Text Available Spinal cord injury is a major trauma, with its short and long term effects and consequences to the patient, his friends and family. Spinal cord injury is addressed in the developed countries with standard trauma care system commencing immediately after injury and continuing to the specialized rehabilitation units. Rehabilitation is important to those with spinal injury for both functional and psychosocial reintegration. It has been an emerging concept in Nepal, which has been evident with the establishment of the various hospitals with rehabilitation units, rehabilitation centres and physical therapy units in different institutions. However, the spinal cord injury rehabilitation setting and scenario is different in Nepal from those in the developed countries since spinal cord injury rehabilitation care has not been adequately incorporated into the health care delivery system nor its importance has been realized within the medical community of Nepal. To name few, lack of human resource for the rehabilitation care, awareness among the medical personnel and general population, adequate scientific research evidence regarding situation of spinal injury and exorbitant health care policy are the important hurdles that has led to the current situation. Hence, it is our responsibility to address these apparent barriers to successful implementation and functioning of rehabilitation so that those with spinal injury would benefit from enhanced quality of life. Keywords: rehabilitation; spinal injury.

The spinal cord: a review of functional neuroanatomy.

Science.gov (United States)

Bican, Orhan; Minagar, Alireza; Pruitt, Amy A

2013-02-01

The spinal cord controls the voluntary muscles of the trunk and limbs and receives sensory input from these areas. It extends from the medulla oblongata to the lower border of the first lumbar vertebra. A basic knowledge of spinal cord anatomy is essential for interpretation of clinical signs and symptoms and for understanding of pathologic processes involving the spinal cord. In this article, anatomic structures are correlated with relevant clinical signs and symptoms and a step-wise approach to spinal cord diagnosis is outlined. Copyright © 2013 Elsevier Inc. All rights reserved.

Spinal Cord Injury 101

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Full Text Available ... Resources Peer Counseling Blog About Media Donate close search Understanding Spinal Cord Injury What is a Spinal ... health care products or services, or control the information found on external websites. The Hill Foundation is ...

Spinal Cord Injury 101

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Full Text Available ... with SCI Personal Experiences by Topic Resources Peer Counseling Blog About Media Donate close search Understanding Spinal ... with SCI Personal Experiences by Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical ...

Spinal Cord Injury 101

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Full Text Available ... spinal cord injuries? play_arrow What is “Braingate” research? play_arrow How would stem-cell therapies work ... cord injuries? play_arrow What does stem-cell research on animals tell us? play_arrow When can ...

Spinal cord injury drives chronic brain changes

Directory of Open Access Journals (Sweden)

Ignacio Jure

2017-01-01

Full Text Available Only a few studies have considered changes in brain structures other than sensory and motor cortex after spinal cord injury, although cognitive impairments have been reported in these patients. Spinal cord injury results in chronic brain neuroinflammation with consequent neurodegeneration and cognitive decline in rodents. Regarding the hippocampus, neurogenesis is reduced and reactive gliosis increased. These long-term abnormalities could explain behavioral impairments exhibited in humans patients suffering from spinal cord trauma.

Sonographic findings of normal newborn spinal cord

International Nuclear Information System (INIS)

Park, Chan Sup; Kim, Dong Gyu

1988-01-01

The authors performed spinal cord ultrasonography of 21 healthy newborn infants in Gyeongsang National University Hospital. Normal spinal cord revealed low echogenecity at that of cerebrospinal fluid and was demarcated by intense reflections from its dorsal and ventral surfaces. The central canal was routinely seen as a thin linear reflection in the center of the cord. The nerve roots making up the cauda equina formed a poorly defined collection of intense linear echoes extending from the conus. On real time image, the normal spinal cord exhibited rather slow and rhythmical anteroposterior movement within the subarachnoid fluid. A distinct and rapid vascular pulsation of the spinal cord was usually recognizable. The approximate level of vertebral bodies was determined as follows; most ventrally located vertebral body was thought to be L5 and S1 was seen slightly posterior to the L5 directed inferoposteriorly. According to the above criteria terminal portions of spinal cord were seen around the L2 body in 5 MHz and pointed termination of conus medullaris was clearly seen at L2-3 junction and in upper body of L3 by 7.5 MHz. So it would be better to examine by 5 MHz for spatial orientation and then by 7.5 MHz for more accurate examination. High-resolution, real-time ultrasonography was a safe, rapid screening technique for evaluation of the spinal cord in infants. Additional applications of spinal sonography may be possible in the evaluation of neonatal syringohydromyelia and meningocele as well as intraspinal cyst localization for possible percutaneous puncture by ultrasound guidance

An Implantable Versatile Electrode-Driving ASIC for Chronic Epidural Stimulation in Rats.

Science.gov (United States)

Giagka, Vasiliki; Eder, Clemens; Donaldson, Nick; Demosthenous, Andreas

2015-06-01

This paper presents the design and testing of an electrode driving application specific integrated circuit (ASIC) intended for epidural spinal cord electrical stimulation in rats. The ASIC can deliver up to 1 mA fully programmable monophasic or biphasic stimulus current pulses, to 13 electrodes selected in any possible configuration. It also supports interleaved stimulation. Communication is achieved via only 3 wires. The current source and the control of the stimulation timing were kept off-chip to reduce the heat dissipation close to the spinal cord. The ASIC was designed in a 0.18- μm high voltage CMOS process. Its output voltage compliance can be up to 25 V. It features a small core area (ASIC was developed to be suitable for integration on the epidural electrode array, and two different versions were fabricated and electrically tested. Results from both versions were almost indistinguishable. The performance of the system was verified for different loads and stimulation parameters. Its suitability to drive a passive epidural 12-electrode array in saline has also been demonstrated.

Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report.

Science.gov (United States)

Imbelloni, Luiz Eduardo; Fornasari, Marcos; Fialho, José Carlos

2009-01-01

Combined spinal epidural anesthesia (CSEA) has advantages over single injection epidural or subarachnoid blockades. The objective of this report was to present a case in which segmental subarachnoid block can be an effective technique for gastrointestinal surgery with spontaneous respiration. Patient with physical status ASA III, with diabetes mellitus type II, hypertension, and chronic obstructive pulmonary disease was scheduled for resection of a right colon tumor. Combined spinal epidural block was performed in the T5-T6 space and 8 mg of 0.5% isobaric bupivacaine with 50 microg of morphine were injected in the subarachnoid space. The epidural catheter (20G) was introduced four centimeters in the cephalad direction. Sedation was achieved with fractionated doses of 1 mg of midazolam (total of 6 mg). A bolus of 25 mg of 0.5% bupivacaine was administered through the catheter two hours after the subarachnoid block. Vasopressors and atropine were not used. This case provides evidence that segmental spinal block can be the anesthetic technique used in gastrointestinal surgeries with spontaneous respiration.

Spinal cord toxoplasmosis in AIDS

International Nuclear Information System (INIS)

Carteret, M.; Petit, E.; Granat, O.; Marichez, M.; Gilquin, J.

1995-01-01

Toxoplasmosis is the most common brain parasitic infection in acquired immunodeficiency syndrome (AIDS). Spinal cord localizations are still rare (2 cases with cerebral involvement, 2 cases without). A case of both spinal cord and cerebral involvement is reported. Magnetic resonance imaging (MR imaging) was performed because of sensory level (L 1). A focal conus medullaris enlargement was seen, iso intense on T 1 weighted images. This lesion was hyperintense on T 2 weighted sequence, and was homogeneously enhanced after Gadolinium on T 1 weighted images. A medullary oedema was noted. A toxoplasmosis treatment was initiated, without cortico therapy. MR imaging performed one month later (D 30), while important clinical improvements were seen, pointed out normal thickness of conus medullaris, without enhancement after Gadolinium. Disease lesions in AIDS with focal spinal cord processes are reviewed, and diagnostic work-up is discussed. Spinal cord single lesion, associated or not with brain involvements should be treated as a toxoplasmic infection, with MR imaging follow up. This work up should avoid medullary biopsy, still required in case of treatment failure. Cerebral involvements, with multiples lesions can mask medullary localization. (authors). 8 refs., 2 figs

Magnetic resonance imaging of acute spinal-cord injury

International Nuclear Information System (INIS)

Yamamoto, Hideki; Nakagawa, Hiroshi; Yamada, Takahisa; Iwata, Kinjiro; Okumura, Terufumi; Hoshino, Daisaku.

1992-01-01

Magnetic resonance imaging (MRI) provides a noninvasive and very important method of investigating spinal-cord injuries. By means of MRI we examined 36 patients with spinal injuries, 34 of them in the acute stage. 19 cases had complete spinal-cord injury with paraplegia, while 17 cases had incomplete spinal-cord injury. MRI showed the injured spinal-cord in the acute stage to be partially swollen, with a high signal intensity in the T 2 -weighted images. In the chronic stage, the injured cord may show atrophic changes with a post-traumatic cavity or myelomalacia, which appears as a high-signal-intensity lesion in the T 2 -weighted images and as a low-signal intensity in the T 1 -weighted images. The cases with complete spinal injuries showed a high signal intensity at the wide level, and these prognoses were poor. The cases with incomplete injuries showed normal findings or a high-signal-intensity spot. In the Gd-DTPA enhanced images, the injured cords were enhanced very well in the subchronic stage. MRI is thus found to be useful in the diagnosis of spinal injuries; it also demonstrates a potential for predicting the neurological prognosis. (author)

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.)

Noninvasive Optical Monitoring of Spinal Cord Hemodynamics and Oxygenation after Acute Spinal Cord Injury

Science.gov (United States)

2017-09-01

model in anesthetized (immobile) animals. Task 1: Evaluating the NIRS system function in a pig model of SCI in conjunction with IP measurements...started. We are collecting spinal cord NIRS data, using the V1 and OXT5 NIRS systems, in conjunction with IP measurements of spinal cord tissue...model of SCI in conjunction with IP measurements of oxygen, perfusion, pressure, and metabolism. SC150178 Kwon - Anual Report – Sep 01 2016 – Aug 31

Spinal Cord Subependymoma Surgery : A Multi-Institutional Experience.

Science.gov (United States)

Yuh, Woon Tak; Chung, Chun Kee; Park, Sung-Hye; Kim, Ki-Jeong; Lee, Sun-Ho; Kim, Kyoung-Tae

2018-03-01

A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas. We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions. The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89). Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.

Differential gene expression in the EphA4 knockout spinal cord and analysis of the inflammatory response following spinal cord injury.

Directory of Open Access Journals (Sweden)

Kathryn M Munro

Full Text Available Mice lacking the axon guidance molecule EphA4 have been shown to exhibit extensive axonal regeneration and functional recovery following spinal cord injury. To assess mechanisms by which EphA4 may modify the response to neural injury a microarray was performed on spinal cord tissue from mice with spinal cord injury and sham injured controls. RNA was purified from spinal cords of adult EphA4 knockout and wild-type mice four days following lumbar spinal cord hemisection or laminectomy only and was hybridised to Affymetrix All-Exon Array 1.0 GeneChips™. While subsequent analyses indicated that several pathways were altered in EphA4 knockout mice, of particular interest was the attenuated expression of a number of inflammatory genes, including Arginase 1, expression of which was lower in injured EphA4 knockout compared to wild-type mice. Immunohistological analyses of different cellular components of the immune response were then performed in injured EphA4 knockout and wildtype spinal cords. While numbers of infiltrating CD3+ T cells were low in the hemisection model, a robust CD11b+ macrophage/microglial response was observed post-injury. There was no difference in the overall number or spread of macrophages/activated microglia in injured EphA4 knockout compared to wild-type spinal cords at 2, 4 or 14 days post-injury, however a lower proportion of Arginase-1 immunoreactive macrophages/activated microglia was observed in EphA4 knockout spinal cords at 4 days post-injury. Subtle alterations in the neuroinflammatory response in injured EphA4 knockout spinal cords may contribute to the regeneration and recovery observed in these mice following injury.

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

Science.gov (United States)

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

Posterior epidural disc fragment masquerading as spinal tumor: Review of the literature.

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Park, Taejune; Lee, Ho Jun; Kim, Jae Seong; Nam, Kiyeun

2018-03-09

Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report. We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment. We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%. As

Effect of lycopene on the blood-spinal cord barrier after spinal cord injury in mice.

Science.gov (United States)

Zhang, Qian; Wang, Jianbo; Gu, Zhengsong; Zhang, Qing; Zheng, Hong

2016-09-05

The current study aimed to investigate the effect of lycopene on the blood-spinal cord barrier (BSCB) after spinal cord injury (SCI) in a mouse model. Lycopene inhibited lipid peroxidation and oxidative DNA damage as a highly efficient antioxidant and free radical scavenger. Lycopene (4 mg/kg/d) was administrated immediately following SCI. The permeability of the BSCB and water content in the spinal cord tissue were evaluated. Additionally, levels of expression of tight junction proteins and heme oxygenase-1 (HO-1) were determined with Western blotting. An enzyme-linked immunosorbent assay analysis of spinal cord tissue homogenates was performed 48 h after SCI to evaluate the expression of inflammation-related cytokines. In addition, recovery of motor function was assessed 1 d, 2 d, 5 d, 10 d, and 15 d after SCI using the Basso Mouse Scale to score locomotion. Compared to the group with an untreated SCI, mice with an SCI treated with lycopene had significantly reduced spinal cord tissue water content and BSCB permeability. Furthermore, motor function of mice with an SCI was also greatly improved by lycopene administration. The expression of the proinflammatory factors TNF-α and NF-kB increased markedly 48 h after SCI, and their upregulation was significantly attenuated by lycopene treatment. The expression of molecules that protect tight junctions, zonula occluden-1 and claudin-5, was upregulated by lycopene treatment after SCI. Taken together, these results clearly indicate that lycopene attenuated SCI by promoting repair of the damaged BSCB, so lycopene is a novel and promising treatment for SCI in humans.

A study of spinal cord tumors by magnetic resonance imaging

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Gushiken, Isao; Nishihira, Takeshi; Nakasone, Tomohiro [Ryukyu Univ., Nishihara, Okinawa (Japan). School of Medicine; Takara, Hiroaki; Oshiro, Yutaka; Oshiro, Takashi; Isa, Makoto; Kinjo, Yukio; Ibaraki, Kunio

1989-10-01

We studied 17 cases of spinal cord tumors using magnetic resonance imaging. According to the intensity of image and histological feature of spinal cord tumors, we identified two groups in T2 weighted imaging. One was a hypointensity group showing cystic or vascular tumors, and the other was hyperintensity group of solid tumors. Preoperative images of swelling, narrowing, deviation of the spinal cord were remained after the operations. Grafted free fatty tissue for the prevention of adhesion was recognized well also after the operation. Postoperative imagings sometime showed pseudo-deviation of the spinal cord which was easy to be mistaken as the remains of tumors and narrowing of the spinal cord. In conclusion, the magnetic resonance imaging makes very early detection of spinal cord tumors possible, and it is valuable for a diagnosis of the spinal cord tumor associated with brain tumor. (author).

A study of spinal cord tumors by magnetic resonance imaging

International Nuclear Information System (INIS)

Gushiken, Isao; Nishihira, Takeshi; Nakasone, Tomohiro; Takara, Hiroaki; Oshiro, Yutaka; Oshiro, Takashi; Isa, Makoto; Kinjo, Yukio; Ibaraki, Kunio.

1989-01-01

We studied 17 cases of spinal cord tumors using magnetic resonance imaging. According to the intensity of image and histological feature of spinal cord tumors, we identified two groups in T2 weighted imaging. One was a hypointensity group showing cystic or vascular tumors, and the other was hyperintensity group of solid tumors. Preoperative images of swelling, narrowing, deviation of the spinal cord were remained after the operations. Grafted free fatty tissue for the prevention of adhesion was recognized well also after the operation. Postoperative imagings sometime showed pseudo-deviation of the spinal cord which was easy to be mistaken as the remains of tumors and narrowing of the spinal cord. In conclusion, the magnetic resonance imaging makes very early detection of spinal cord tumors possible, and it is valuable for a diagnosis of the spinal cord tumor associated with brain tumor. (author)

Diffusion tensor imaging of spinal cord parenchyma lesion in rat with chronic spinal cord injury.

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

2018-04-01

Adequate evaluation of spinal cord parenchyma and accurate identification of injury range are considered two premises for the research and treatment of chronic spinal cord injury (SCI). Diffusion tensor imaging (DTI) provides information about water diffusion in spinal cord, and thus makes it possible to realize these premises. In this study, we conducted magnetic resonance imaging (MRI) for Wistar rats 84days after spinal cord contusion. DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) from different positions of the injured cord were collected, analyzed, and compared with the histological results and locomotor outcomes. Moreover, we performed fiber tractography, and examined the difference in cavity percentage obtained respectively via conventional MRI, DTI and histology. Results showed that the chronic SCI rats had the largest changes of all DTI metrics at the epicenter; the farther away from the epicenter, the smaller the variation. FA, AD and RD were all influenced by SCI in a greater space range than MD. The good consistency of FA values and histological results in specific regions evidenced FA's capability of reflecting Wallerian degeneration after SCI. DTI metrics at the epicenter in ventral funiculus also showed a close correlation with the BBB scores. Additionally, supported by the histological results, DTI enables a more accurate measurement of cavity percentage compared to the conventional MRI. DTI parameters might comprehensively reflect the post-SCI pathological status of spinal cord parenchyma at the epicenter and distal parts during the chronic stage, while showing good consistency with locomotor performance. DTI combined with tractography could intuitively display the distribution of spared fibers after SCI and accurately provide information such as cavity area. This may shed light on the research and treatment of chronic SCI. Copyright © 2017 Elsevier Inc. All rights

Spinal cord blood flow measured by 14C-iodoantipyrine autoradiography during and after graded spinal cord compression in rats

International Nuclear Information System (INIS)

Holtz, A.; Nystroem, B.G.; Gerdin, B.

1989-01-01

The relations between degree of thoracic spinal cord compression causing myelographic block, reversible paraparesis, and extinction of the sensory evoked potential on one hand, and spinal cord blood flow on the other, were investigated. This was done in rats using the blocking weight-technique and 14 C-iodoantipyrine autoradiography. A load of 9 g caused myelographic block. Five minutes of compression with that load caused a reduction of spinal cord blood flow to about 25%, but 5 and 60 minutes after the compression spinal cord blood flow was restored to 60% of the pretrauma value. A load of 35 g for 5 minutes caused transient paraparesis. Recovery to about 30% was observed 5 and 60 minutes thereafter. During compression at a load of 55 g, which caused almost total extinction of sensory evoked potential and irreversible paraplegia, spinal cord blood flow under the load ceased. The results indicate that myelographic block occurs at a load which does not cause irreversible paraparesis and that a load which permits sensory evoked potential to be elicited results in potentially salvageable damage

MRI in diagnosis of spinal cord diseases

International Nuclear Information System (INIS)

Kobayashi, Naotoshi; Ono, Yuko; Kakinoki, Yoshio; Kimura, Humiko; Ebihara, Reiko; Nagayama, Takashi; Okada, Takaharu; Watanabe, Hiromi

1985-01-01

64 MRI studies of 57 cases of spinal cord diseases were reviewed, and following results were obtained. (1) MRI is usefull for screening method of spinal cord diseases, as CT in cerebral diseases. (2) MRI might replaces myelography in most of spinal cord disease, and more reliable informations might be obtained by MRI than in myelography in some cases, but (3) in detection of small organic changes, some technological problems are layed regarding to the image resolution of MRI. (author)

Contrast enhanced CT of spinal cord angioma

International Nuclear Information System (INIS)

Nakamura, Takahiko; Ebitani, Tsutomu; Honma, Takao; Sofue, Muroto; Nakamura, Shigeru

1982-01-01

Contrast enhanced CT on 6 patients with spinal cord angioma showed enhancement in 2 of them. The conditions to produce contrast enhancement were the window width of 100 - 200, and the window level of 0 - 50. In spinal cord angioma, contrast enhanced CT is presently only an adjunct to angiography and myelography. Nevertheless, contrast enhanced CT is useful in the screening test for spinal cord angioma, in the patients who are nonindicated to angiography, and in the postoperative follow-up. (Ueda, J.)

Nanomedicine for treating spinal cord injury

Science.gov (United States)

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

2013-09-01

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

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.

Prognosis by tumor location for pediatric spinal cord Ependymomas

OpenAIRE

Oh, MC; Sayegh, ET; Safaee, M; Sun, MHZ; Kaur, G; Kim, JM; Aranda, D; Molinaro, AM; Gupta, N; Parsa, AT

2013-01-01

Object. Ependymoma is a common CNS tumor in children, with spinal cord ependymomas making up 13.1% of all ependymomas in this age group. The clinical features that affect prognosis in pediatric spinal cord ependymomas are not well understood. A comprehensive literature review was performed to determine whether a tumor location along the spinal cord is prognostically significant in children undergoing surgery for spinal cord ependymomas. Methods. A PubMed search was performed to identify all p...

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.

Are there endogenous stem cells in the spinal cord?

Science.gov (United States)

Ferrucci, Michela; Ryskalin, Larisa; Busceti, Carla L; Gaglione, Anderson; Biagioni, Francesca; Fornai, Francesco

2017-12-01

Neural progenitor cells (NPC) represent the stem-like niche of the central nervous system that maintains a regenerative potential also in the adult life. Despite NPC in the brain are well documented, the presence of NPC in the spinal cord has been controversial for a long time. This is due to a scarce activity of NPC within spinal cord, which also makes difficult their identification. The present review recapitulates the main experimental studies, which provided evidence for the occurrence of NPC within spinal cord, with a special emphasis on spinal cord injury and amyotrophic lateral sclerosis. By using experimental models, here we analyse the site-specificity, the phenotype and the main triggers of spinal cord NPC. Moreover, data are reported on the effect of specific neurogenic stimuli on these spinal cord NPC in an effort to comprehend the endogenous neurogenic potential of this stem cell niche.

Real-time direct measurement of spinal cord blood flow at the site of compression: relationship between blood flow recovery and motor deficiency in spinal cord injury.

Science.gov (United States)

Hamamoto, Yuichiro; Ogata, Tadanori; Morino, Tadao; Hino, Masayuki; Yamamoto, Haruyasu

2007-08-15

An in vivo study to measure rat spinal cord blood flow in real-time at the site of compression using a newly developed device. To evaluate the change in thoracic spinal cord blood flow by compression force and to clarify the association between blood flow recovery and motor deficiency after a spinal cord compression injury. Until now, no real-time measurement of spinal cord blood flow at the site of compression has been conducted. In addition, it has not been clearly determined whether blood flow recovery is related to motor function after a spinal cord injury. Our blood flow measurement system was a combination of a noncontact type laser Doppler system and a spinal cord compression device. The rat thoracic spinal cord was exposed at the 11th vertebra and spinal cord blood flow at the site of compression was continuously measured before, during, and after the compression. The functioning of the animal's hind-limbs was evaluated by the Basso, Beattie and Bresnahan scoring scale and the frequency of voluntary standing. Histologic changes such as permeability of blood-spinal cord barrier, microglia proliferation, and apoptotic cell death were examined in compressed spinal cord tissue. The spinal blood flow decreased on each increase in the compression force. After applying a 5-g weight, the blood flow decreased to compression), while no significant difference was observed between the 20-minute ischemia group and the sham group. In the 20-minute ischemia group, the rats whose spinal cord blood flow recovery was incomplete showed significant motor function loss compared with rats that completely recovered blood flow. Extensive breakdown of blood-spinal cord barrier integrity and the following microglia proliferation and apoptotic cell death were detected in the 40-minute complete ischemia group. Duration of ischemia/compression and blood flow recovery of the spinal cord are important factors in the recovery of motor function after a spinal cord injury.

MRI diagnosis of acute spinal cord decompression sickness

International Nuclear Information System (INIS)

Tang Xiaofeng; Yuan Fengmei; Ma Heng; Xu Yongzhong; Gai Qingzhu; Wang Ying

2008-01-01

Objective: To describe MRI findings of acute spinal cord decompression sickness. Methods: MRI findings of 5 cases with clinical definite acute spinal cord decompression sickness were retrospectively analyzed. The main clinical informations included underwater performance history against regulations, short-term complete or incomplete spinal cord injury symptoms after fast going out of water, sensory disability and urinary and fecal incontinence, etc. Results: Spinal cord vacuole sign was found in all 5 cases. Iso-signal intensity (n=3), high signal intensity (n=1), and low signal intensity (n=1) was demonstrated on T 1 WI, and high signal intensity (n=5) was found on T 2 WI. Owl eye sign was detected in 3 cases, and lacune foci were seen in 2 cases. Conclusion: MRI findings of acute spinal cord decompression sickness had some characteristics, and it was easy to diagnose by combining diving history with clinical manifestations. (authors)

Suicide in a spinal cord injured population

DEFF Research Database (Denmark)

Hartkopp, A; Brønnum-Hansen, Henrik; Seidenschnur, A M

1998-01-01

To determine the relation between functional status and risk of suicide among individuals with spinal cord injury (SCI).......To determine the relation between functional status and risk of suicide among individuals with spinal cord injury (SCI)....

MR imaging with Gd-DTPA enhancement in experimental acute injury of the spinal cord

International Nuclear Information System (INIS)

Hackney, D.B.; Asato, R.; Joseph, P.M.; McGrath, J.T.; Grossman, R.I.; Shetty, A.

1986-01-01

The authors performed MR imaging with Gd-DTPA enhancement in adult male Sprague-Dawley rats, with experimentally induced acute spinal cored injuries. After epidural compression of the spinal cored the pathologic changes of acute cord contusion were allowed to develop for 30 minutes to 4 hours. MR imaging was then performed at 1.4 T. Both short spin-echo (TR = 400 msec, TE = 15-20 msec) and long spin-echo (TR = 2,000 msec, TE = 100 msec) images were obtained. After the initial imaging, Gd-DTPA (0.1 mmol/kg) and Evans blue dye were administered intravenously and imaging was repeated. Enhancement of normal central gray matter was consistently observed. However, neither pathologic enhancement on MR images nor extravasation of Evans blue dye on histologic inspection were identified

Advantages of soft subdural implants for the delivery of electrochemical neuromodulation therapies to the spinal cord

Science.gov (United States)

Capogrosso, Marco; Gandar, Jerome; Greiner, Nathan; Moraud, Eduardo Martin; Wenger, Nikolaus; Shkorbatova, Polina; Musienko, Pavel; Minev, Ivan; Lacour, Stephanie; Courtine, Grégoire

2018-04-01

Objective. We recently developed soft neural interfaces enabling the delivery of electrical and chemical stimulation to the spinal cord. These stimulations restored locomotion in animal models of paralysis. Soft interfaces can be placed either below or above the dura mater. Theoretically, the subdural location combines many advantages, including increased selectivity of electrical stimulation, lower stimulation thresholds, and targeted chemical stimulation through local drug delivery. However, these advantages have not been documented, nor have their functional impact been studied in silico or in a relevant animal model of neurological disorders using a multimodal neural interface. Approach. We characterized the recruitment properties of subdural interfaces using a realistic computational model of the rat spinal cord that included explicit representation of the spinal roots. We then validated and complemented computer simulations with electrophysiological experiments in rats. We additionally performed behavioral experiments in rats that received a lateral spinal cord hemisection and were implanted with a soft interface. Main results. In silico and in vivo experiments showed that the subdural location decreased stimulation thresholds compared to the epidural location while retaining high specificity. This feature reduces power consumption and risks of long-term damage in the tissues, thus increasing the clinical safety profile of this approach. The hemisection induced a transient paralysis of the leg ipsilateral to the injury. During this period, the delivery of electrical stimulation restricted to the injured side combined with local chemical modulation enabled coordinated locomotor movements of the paralyzed leg without affecting the non-impaired leg in all tested rats. Electrode properties remained stable over time, while anatomical examinations revealed excellent bio-integration properties. Significance. Soft neural interfaces inserted subdurally provide the

The negotiated equilibrium model of spinal cord function.

Science.gov (United States)

Wolpaw, Jonathan R

2018-04-16

The belief that the spinal cord is hardwired is no longer tenable. Like the rest of the CNS, the spinal cord changes during growth and aging, when new motor behaviours are acquired, and in response to trauma and disease. This paper describes a new model of spinal cord function that reconciles its recently appreciated plasticity with its long recognized reliability as the final common pathway for behaviour. According to this model, the substrate of each motor behaviour comprises brain and spinal plasticity: the plasticity in the brain induces and maintains the plasticity in the spinal cord. Each time a behaviour occurs, the spinal cord provides the brain with performance information that guides changes in the substrate of the behaviour. All the behaviours in the repertoire undergo this process concurrently; each repeatedly induces plasticity to preserve its key features despite the plasticity induced by other behaviours. The aggregate process is a negotiation among the behaviours: they negotiate the properties of the spinal neurons and synapses that they all use. The ongoing negotiation maintains the spinal cord in an equilibrium - a negotiated equilibrium - that serves all the behaviours. This new model of spinal cord function is supported by laboratory and clinical data, makes predictions borne out by experiment, and underlies a new approach to restoring function to people with neuromuscular disorders. Further studies are needed to test its generality, to determine whether it may apply to other CNS areas such as the cerebral cortex, and to develop its therapeutic implications. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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

International Nuclear Information System (INIS)

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.)

Spinal Cord Injury Rehabilitation in Nepal

OpenAIRE

Nabina Shah; Binav Shrestha; Kamana Subba

2013-01-01

Spinal cord injury is a major trauma, with its short and long term effects and consequences to the patient, his friends and family. Spinal cord injury is addressed in the developed countries with standard trauma care system commencing immediately after injury and continuing to the specialized rehabilitation units. Rehabilitation is important to those with spinal injury for both functional and psychosocial reintegration. It has been an emerging concept in Nepal, which has been evident with the...

45 Gy - tolerance dose spinal cord - dogma or the facts?

International Nuclear Information System (INIS)

Maciejewski, B.; Hliniak, A.; Danczak-Ginalska, Z.; Meder, M.; Skolyszewski, J.; Reinfuss, M.; Korzeniowski, S.; Peszynski, J.; Jassem, J.

1993-01-01

Dose of 45 Gy as a tolerance dose for spinal cord was questioned based on review of clinical data. Some data show that for conventional fractionation with the dose per fraction of less than 2.0 Gy spinal cord tolerance dose may arise up to 50-55 Gy. This was the base for round-table discussion and the importance of clinical and physical risk factors of postirradiation spinal cord injury was discussed and previous diseases of spinal cord, size of dose per fraction and length of irradiated spinal cord were pointed out as high risk factors. It was concluded that from clinical point of view there is no reason and on need to verify and to increase tolerance dose for spinal cord. (author)

Re-irradiation of the human spinal cord

International Nuclear Information System (INIS)

Sminia, P.; Oldenburger, F.; Hulshof, M.C.C.M.; Slotman, B.J.; Schneider, J.J.

2002-01-01

Purpose: Experimental animal data give evidence of long-term recovery of the spinal cord after irradiation. By extrapolation of these data, re-irradiation regimes were designed for eight patients who required palliative radiotherapy. As a consequence of reirradiation, their spinal cords were exposed to cumulative doses exceeding the tolerance dose. Radiobiological and clinical data are presented. Patients and method: Eight patients were re-irradiated on the cervical (n=1), thoracic (n=5) and lumbar (n=2) spinal cord. The time interval between the initial and re-treatment ranged from 4 months to 12.7 years (median: 2.5 years). (Re-)treatment schemes were designed and analyzed on basis of the biologically effective dose (BED) according to the linear-quadratic model. The repair capacity (α/β ratio) for the cervico-thoracic and lumbar spinal cord was assumed to be 2 Gy and 4 Gy, with a BED tolerance of 100 Gy and 84 Gy, respectively. Results: The cumulative irradiation dose applied to the spinal cord varied between 125 and 172% of the BED tolerance . During follow-up, ranging from 33 days to >4.5 years (median: 370 days) none of the patients developed neurological complications. Seven patients died from tumor progression, and one patient is still alive. Conclusion: Long-term recovery of the spinal cord from radiation injury, which has been demonstrated in rodents and primates, may also occur in humans. (orig.) [de

Radiation effects in brain and spinal cord

International Nuclear Information System (INIS)

Franke, H.D.; Lierse, W.

1978-01-01

Radiation sensitivity of both the brain and spinal cord in prenatal and postnatal stages, in infancy and adult age is represented also in consideration of a combined treatment with methotrexate. In adults, application of important doses of high-energy radiation increases the risk of injurious effects to the central nervous system. If the spinal cord is involved, more than 60% of the radiolesions have a progredient course ending with death. The pathogenesis and disposing factors are referred to, and the incidence of radiation necrosis with regard to age and sex, the degrees of injury and their frequence within different ranges of dosage are analyzed on the basis of data from universal literature. An examination of 'tolerance doses' for the spinal cord is made by means of Strandquist-diagrams and of the Ellis-formula. The slopes of regression lines are reported for various 'degrees of response' in skin, brain and spinal cord following radiation therapy. In the Strandquist-diagram, slopes of regression lines are dependent on the 'degree of response', flattening if skin and spinal cord are affected by radiation in the same degree, necroses having the same slope for both the organs. (orig./MG) [de

Changes in galanin immunoreactivity in rat lumbosacral spinal cord and dorsal root ganglia after spinal cord injury.

Science.gov (United States)

Zvarova, K; Murray, E; Vizzard, M A

2004-08-02

Alterations in the expression of the neuropeptide galanin were examined in micturition reflex pathways 6 weeks after complete spinal cord transection (T8). In control animals, galanin expression was present in specific regions of the gray matter in the rostral lumbar and caudal lumbosacral spinal cord, including: (1) the dorsal commissure; (2) the superficial dorsal horn; (3) the regions of the intermediolateral cell column (L1-L2) and the sacral parasympathetic nucleus (L6-S1); and (4) the lateral collateral pathway in lumbosacral spinal segments. Densitometry analysis demonstrated significant increases (P < or = 0.001) in galanin immunoreactivity (IR) in these regions of the S1 spinal cord after spinal cord injury (SCI). Changes in galanin-IR were not observed at the L4-L6 segments except for an increase in galanin-IR in the dorsal commissure in the L4 segment. In contrast, decreases in galanin-IR were observed in the L1 segment. The number of galanin-IR cells increased (P < or = 0.001) in the L1 and S1 dorsal root ganglia (DRG) after SCI. In all DRG examined (L1, L2, L6, and S1), the percentage of bladder afferent cells expressing galanin-IR significantly increased (4-19-fold) after chronic SCI. In contrast, galanin expression in nerve fibers in the urinary bladder detrusor and urothelium was decreased or eliminated after SCI. Expression of the neurotrophic factors nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) was altered in the spinal cord after SCI. A significant increase in BDNF expression was present in spinal cord segments after SCI. In contrast, NGF expression was only increased in the spinal segments adjacent and rostral to the transection site (T7-T8), whereas spinal segments (T13-L1; L6-S1), distal to the transection site exhibited decreased NGF expression. Changes in galanin expression in micturition pathways after SCI may be mediated by changing neurotrophic factor expression, particularly BDNF. These changes may contribute to

Medication before and after a spinal cord lesion

DEFF Research Database (Denmark)

Jensen, Elmo K; Biering-Sørensen, F

2014-01-01

for each Anatomical Therapeutic Chemical (ATC) Classification System group were registered for all patients, who were discharged from Department for Spinal Cord Injuries during 2010. The changes in medication per se were calculated for different parts of the population: non-traumatic, traumatic patients......OBJECTIVE: To map the impact of spinal cord lesion (SCL) on medication. STUDY DESIGN: Registration of medication for 72 patients before SCL and at discharge from the Department for Spinal Cord Injuries. SETTING: Department for Spinal Cord Injuries, East Denmark. METHODS: The changes in medication......, men, women, paraplegia, tetraplegia, American Spinal Injury Association Impairment Scale (AIS) A, B or C, AIS D, age 0-45, 46-60 and 60+. In addition, comparisons of changes in medication were made between complementary parts of the population. RESULTS: The overall increase in medication after SCL...

Production of lesions in rabbit spinal cord with microwave hyperthermia

International Nuclear Information System (INIS)

Sutton, C.H.; Popovic, P.

1984-01-01

The use of a variety of injury models in different species to produce spinal cord lesions by trauma or ischemia has often given rise to conflicting or inconclusive data. A new model has been developed in rabbits. Spinal cord lesions were produced in selected spinal cord segments of male New Zealand white rabbits by non-invasive irradiation with microwaves in the near field at 915 MHz. Graded injuries of predictable severity can be produced by the non-invasive induction of moderate hyperthermia in the thoracic spinal cord at precise dosage levels of temperature elevation and duration. Histological changes in microwave-induced hyperthermia closely parallel those seen in traumatic lesions of the human spinal cord, as well as those produced in animals with the classical weight-drop method of Allen. In addition to grading the spinal cord lesions with respect to residual neurological function, dose-response observations made with somatosensory evoked responses, blood-spinal cord barrier tracers, and neurohistological and enzyme histochemical preparations, suggest that it will be possible to use this approach to develop a standardized, calibrated model in rabbits to evaluate the efficacy of new therapeutic modalities for the treatment of spinal cord injury

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.)

Complement elevation in spinal cord injury.

Science.gov (United States)

Rebhun, J; Botvin, J

1980-05-01

Laboratory studies revealed an elevated complement in 66% of patients with spinal cord injury. It is postulated that the activated complement may be a component of self-feeding immunological mechanism responsible for the failure of regeneration of a mature mammalian spinal cord. There was no evidence that such an injury had any effect on pre-existing atopy.

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)

Epidural lipomatosis

International Nuclear Information System (INIS)

Quint, D.J.; Boulos, R.S.; Sanders, W.P.; Patel, S.C.; Mehta, B.A.; Tiel, R.L.; Washington, J.M.

1987-01-01

Central deposition of fat is a well-known clinical feature of long-term elevated corticosteroid levels. Rarely described is increased extadural fat within the spinal canal causing compression of the spinal cord and neurologic deficits. Together with 12 previously reported cases, the authors present six additional cases of epidural lipomatosis, review presenting signs and symptoms, and demonstrate the myelographic, CT, and MR findings in this condition. Previously undescribed examples of (1) normal myelography with diagnostic postmyelogram CT, (2) MR imaging of this condition, and (3) cases not associated with exogenous steroid use or morbid obesity are presented. The importance of considering this entity in the appropriate clinical setting is stressed. In particular, if clinical suspicion is high, even in the setting of a normal myelogram, CT or MR imaging should be considered

Brain protection by methylprednisolone in rats with spinal cord injury.

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Chang, Chia-Mao; Lee, Ming-Hsueh; Wang, Ting-Chung; Weng, Hsu-Huei; Chung, Chiu-Yen; Yang, Jen-Tsung

2009-07-01

Traumatic spinal cord injury is clinically treated by high doses of methylprednisolone. However, the effect of methylprednisolone on the brain in spinal cord injury patients has been little investigated. This experimental study examined Bcl-2 and Bax protein expression and Nissl staining to evaluate an apoptosis-related intracellular signaling event and final neuron death, respectively. Spinal cord injury produced a significant apoptotic change and cell death not only in the spinal cord but also in the supraventricular cortex and hippocampal cornu ammonis 1 region in the rat brains. The treatment of methylprednisolone increased the Bcl-2/Bax ratio and prevented neuron death for 1-7 days after spinal cord injury. These findings suggest that rats with spinal cord injury show ascending brain injury that could be restricted through methylprednisolone management.

Spinal cord: motor neuron diseases.

Science.gov (United States)

Rezania, Kourosh; Roos, Raymond P

2013-02-01

Spinal cord motor neuron diseases affect lower motor neurons in the ventral horn. This article focuses on the most common spinal cord motor neuron disease, amyotrophic lateral sclerosis, which also affects upper motor neurons. Also discussed are other motor neuron diseases that only affect the lower motor neurons. Despite the identification of several genes associated with familial amyotrophic lateral sclerosis, the pathogenesis of this complex disease remains elusive. Copyright © 2013 Elsevier Inc. All rights reserved.

The Spinal Cord Injury-Interventions Classification System

NARCIS (Netherlands)

van Langeveld, A.H.B.

2010-01-01

Title: The Spinal Cord Injury-Interventions Classification System: development and evaluation of a documentation tool to record therapy to improve mobility and self-care in people with spinal cord injury. Background: Many rehabilitation researchers have emphasized the need to examine the actual

High-field MR imaging of spinal cord multiple sclerosis

International Nuclear Information System (INIS)

De La Paz, R.L.; Floris, R.; Norman, D.; Enzmann, D.R.

1987-01-01

Fifty-one high-field MR imaging studies (1.5 T, General Electric Signa) of the spinal cord were performed in 42 patients (27 female, 15 male; mean age, 40 years) with clinically definitive (n = 34) or probable (n = 8) multiple sclerosis and suspected spinal cord lesions. MR imaging showed focal spinal cord abnormalities in 38 (75%) of 51 studies. T2-weighted images were abnormal (showing foci of high signal intensity) in 38 studies, T1-weighted images were abnormal (showing areas of low signal intensity or mass effect) in 16 (42%) of 38, and GRASS images were abnormal (showing foci of high signal intensity) in 9 (82%) of 11 cases. Brain MR imaging showed periventricular lesions typical of multiple sclerosis in 34 (81%) of 42 studies. Spinal cord studies were positive in eight cases with normal brain MR images, and brain studies were positive in 13 instances of normal spinal cord MR images. Four lesions were at the cervicomedullary junction, 44 in the cervical spinal cord, and three in the thoracic cord. Mass effect in cord lesions, simulating neoplasm, was seen in seven patients during the acute symptomatic phase. Serial studies in three patients with decreasing symptoms showed a reduction after 3-4 weeks and resolution of the mass effect after 2-6 months

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

Science.gov (United States)

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.

Clinical and imaging findings in spinal cord arteriovenous malformations

International Nuclear Information System (INIS)

Kim, Sang Heum; Kim, Dong Ik; Yoon, Pyeong Ho; Jeon, Pyoung; Ihn, Yeon Kwon

1997-01-01

The purpose of this study is to evaluate the findings of magnetic resonance (MR) imaging and selective spinal angiography of spinal cord arteriovenous malformations (SCAVMs) and to investigate the correlation of these findings with the development of clinical symptoms. In 16 patients diagnosed as suffering from SCAVMs, MR imaging and selective spinal angiograms were retrospectively analyzed and correlated with clinical symptoms. Clinical data were reviewed, especially concerning the mode of onset of clinical symptoms, and MR images of SCAVMs were evaluated with regard to the following parameters: spinal cord swelling with T2 hyperintensity, cord atrophy, intramedullary hemorrhage, and contrast enhancement of the spinal cord. Selective spinal angiographic findings of SCAVMs were also evaluated in terms of the following , parameters: type of SCAVM, presence of aneurysms, and patterns of venous drainage. Imaging findings were also correlated with the development of clinical symptoms. Systematic evaluation of the findings of MR imaging and angiography provides detailed information on the type of AVM and status of the spinal cord parenchyma, and this can be correlated with clinical manifestations of SCAVM. In patients suffering from this condition, spinal cord dysfunction due to venous congestion appears to be the main cause of clinical symptoms. (author). 18 refs., 2 tabs., 3 figs

Childhood Brain and Spinal Cord Tumors Treatment Overview

Science.gov (United States)

... The tentorium separates the supratentorium from the infratentorium (right panel). The skull and meninges protect the brain and spinal cord (left panel). The spinal cord connects the brain with ...

21 CFR 882.5880 - Implanted spinal cord stimulator for pain relief.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted spinal cord stimulator for pain relief... Implanted spinal cord stimulator for pain relief. (a) Identification. An implanted spinal cord stimulator for pain relief is a device that is used to stimulate electrically a patient's spinal cord to relieve...

Idiopathic thoracic transdural intravertebral spinal cord herniation

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Mazda K Turel

2017-01-01

Full Text Available Idiopathic spinal cord herniation is a rare and often missed cause of thoracic myelopathy. The clinical presentation and radiological appearance is inconsistent and commonly confused with a dorsal arachnoid cyst and often is a misdiagnosed entity. While ventral spinal cord herniation through a dural defect has been previously described, intravertebral herniation is a distinct entity and extremely rare. We present the case of a 70-year old man with idiopathic thoracic transdural intravertebral spinal cord herniation and discuss the clinico-radiological presentation, pathophysiology and operative management along with a review the literature of this unusual entity.

Spinal Meninges and Their Role in Spinal Cord Injury: A Neuroanatomical Review.

Science.gov (United States)

Grassner, Lukas; Grillhösl, Andreas; Griessenauer, Christoph J; Thomé, Claudius; Bühren, Volker; Strowitzki, Martin; Winkler, Peter A

2018-02-01

Current recommendations support early surgical decompression and blood pressure augmentation after traumatic spinal cord injury (SCI). Elevated intraspinal pressure (ISP), however, has probably been underestimated in the pathophysiology of SCI. Recent studies provide some evidence that ISP measurements and durotomy may be beneficial for individuals suffering from SCI. Compression of the spinal cord against the meninges in SCI patients causes a "compartment-like" syndrome. In such cases, intentional durotomy with augmentative duroplasty to reduce ISP and improve spinal cord perfusion pressure (SCPP) may be indicated. Prior to performing these procedures routinely, profound knowledge of the spinal meninges is essential. Here, we provide an in-depth review of relevant literature along with neuroanatomical illustrations and imaging correlates.

Spinal Cord Tolerance in the Age of Spinal Radiosurgery: Lessons From Preclinical Studies

International Nuclear Information System (INIS)

Medin, Paul M.; Boike, Thomas P.

2011-01-01

Clinical implementation of spinal radiosurgery has increased rapidly in recent years, but little is known regarding human spinal cord tolerance to single-fraction irradiation. In contrast, preclinical studies in single-fraction spinal cord tolerance have been ongoing since the 1970s. The influences of field length, dose rate, inhomogeneous dose distributions, and reirradiation have all been investigated. This review summarizes literature regarding single-fraction spinal cord tolerance in preclinical models with an emphasis on practical clinical significance. The outcomes of studies that incorporate uniform irradiation are surprisingly consistent among multiple small- and large-animal models. Extensive investigation of inhomogeneous dose distributions in the rat has demonstrated a significant dose-volume effect while preliminary results from one pig study are contradictory. Preclinical spinal cord dose-volume studies indicate that dose distribution is more critical than the volume irradiated suggesting that neither dose-volume histogram analysis nor absolute volume constraints are effective in predicting complications. Reirradiation data are sparse, but results from guinea pig, rat, and pig studies are consistent with the hypothesis that the spinal cord possesses a large capacity for repair. The mechanisms behind the phenomena observed in spinal cord studies are not readily explained and the ability of dose response models to predict outcomes is variable underscoring the need for further investigation. Animal studies provide insight into the phenomena and mechanisms of radiosensitivity but the true significance of animal studies can only be discovered through clinical trials.

Gd-DTPA MR imaging enhancement of spinal cord tumors

International Nuclear Information System (INIS)

Dillon, W.P.; Bolla, K.; Mark, A.S.; Tsudura, J.S.; Norman, D.; Newton, T.H.

1987-01-01

Nineteen patients with suspected spinal cord tumors were imaged with T1- and T2-weighted sequences before and after the administration of Gd-DTPA (0.1 mmol/kg). Eleven of the 19 patients had spinal cord tumors (three unproven). Eight of 11 patients had intramedullary tumors (four astrocytomas, two ependymomas) and two had extra-medullary tumors (one meningioma, one metastatic melanoma). Other lesions studied include idiopathic syringomyelia (two), spinal arteriovenous malformation (AVM) (one), posttraumatic arachnoiditis (one), and cord infarct (one). All of the tumors enhanced after the administration of Gd-DTPA. Spinal cord enhancement was also noted in association with a spinal cord AVM, a suspected cord infarct, and in the patient with severe arachnoiditis. No enhancement was present in patients with idiopathic or posttraumatic syringomyelia or in the three normal patients. In six of the patients, enhancement was critical in confirming disease that was questionable on the precontrast MR images. Gadolinium enhancement allowed differentiation of tumor from postoperative changes in two patients with spinal cord tumors. Enhanced images localized the lesion more accurately than precontrast MR images in eight patients. In four patients a lesion could only be detected after the administration of contrast. The postcontrast images better defined the margin of tumor from surrounding edema, operative scarring, and cord cavitation. The AVM case had enhancement of slowly flowing veins with Gd-DTPA posterior to an ischemic cord segment. Gd-DTPA enhancement is extremely useful in the detection and therapeutic assessment of spinal cord tumors; however, enhancement is not specific for tumors and should be interpreted in light of the clinical setting

A clinical perspective of spinal cord injury.

NARCIS (Netherlands)

Nandoe Tewarie, R.D.S.; Hurtado, A.; Bartels, R.H.M.A.; Grotenhuis, J.A.; Oudega, M.

2010-01-01

Spinal cord injury (SCI) results in loss of nervous tissue in the spinal cord and consequently loss of motor and sensory function. The impairments are permanent because endogenous repair events fail to restore the damaged axonal circuits that are involved in function. There is no treatment available

Alterations in cardiac autonomic control in spinal cord injury.

Science.gov (United States)

Biering-Sørensen, Fin; Biering-Sørensen, Tor; Liu, Nan; Malmqvist, Lasse; Wecht, Jill Maria; Krassioukov, Andrei

2018-01-01

A spinal cord injury (SCI) interferes with the autonomic nervous system (ANS). The effect on the cardiovascular system will depend on the extent of damage to the spinal/central component of ANS. The cardiac changes are caused by loss of supraspinal sympathetic control and relatively increased parasympathetic cardiac control. Decreases in sympathetic activity result in heart rate and the arterial blood pressure changes, and may cause arrhythmias, in particular bradycardia, with the risk of cardiac arrest in those with cervical or high thoracic injuries. The objective of this review is to give an update of the current knowledge related to the alterations in cardiac autonomic control following SCI. With this purpose the review includes the following subheadings: 2. Neuro-anatomical plasticity and cardiac control 2.1 Autonomic nervous system and the heart 2.2 Alteration in autonomic control of the heart following spinal cord injury 3. Spinal shock and neurogenic shock 3.1 Pathophysiology of spinal shock 3.2 Pathophysiology of neurogenic shock 4. Autonomic dysreflexia 4.1 Pathophysiology of autonomic dysreflexia 4.2 Diagnosis of autonomic dysreflexia 5. Heart rate/electrocardiography following spinal cord injury 5.1 Acute phase 5.2 Chronic phase 6. Heart rate variability 6.1 Time domain analysis 6.2 Frequency domain analysis 6.3 QT-variability index 6.4 Nonlinear (fractal) indexes 7. Echocardiography 7.1 Changes in cardiac structure following spinal cord injury 7.2 Changes in cardiac function following spinal cord injury 8. International spinal cord injury cardiovascular basic data set and international standards to document the remaining autonomic function in spinal cord injury. Copyright © 2017 Elsevier B.V. All rights reserved.

Biomarkers in spinal cord compression Ethics and perspectives

Directory of Open Access Journals (Sweden)

Iencean A.St.

2016-09-01

Full Text Available The phosphorylated form of the high-molecular-weight neurofilament subunit NF-H (pNF-H in serum or in cerebro-spinal fluid (CSF is a specific lesional biomarker for spinal cord injury. The lesional biomarkers and the reaction biomarkers are both presented after several hours post-injury. The specific predictive patterns of lesional biomarkers could be used to aid clinicians with making a diagnosis and establishing a prognosis, and evaluating therapeutic interventions. Diagnosis, prognosis, and treatment guidance based on biomarker used as a predictive indicator can determine ethical difficulties by differentiated therapies in patients with spinal cord compression. At this point based on studies until today we cannot take a decision based on biomarker limiting the treatment of neurological recovery in patients with complete spinal cord injury because we do not know the complexity of the biological response to spinal cord compression.

Thermal Stimulation Alters Cervical Spinal Cord Functional Connectivity in Humans.

Science.gov (United States)

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.

Pure spinal epidural cavernous hemangioma: A case series of seven cases

Directory of Open Access Journals (Sweden)

Ignatius Ngene Esene

2016-01-01

Conclusion: PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis.

[Experience with combined spinal and epidural anesthesia at cesarean section].

Science.gov (United States)

Levinzon, A S; Taran, O I; Pura, K R; Mishchenko, G S; Mamaeva, N V

2006-01-01

The paper analyzes some experience gained in using various modes of regional anesthesia as an anesthetic appliance at cesarean sections and comparatively characterizes various types of central segmental blocks. The results of 213 cases of cesarean section performed under spinal or combined spinal and epidural anesthesia (CSEA) were generalized by the following parameters: block onset, maternal and fetal action, the quality of anesthesia and postoperative analgesia, which leads to the conclusion that CSEA is the method of choice.

MR imaging of stable posttraumatic spinal cord injury

International Nuclear Information System (INIS)

Braun, I.F.; Hoffman, J.C. Jr.; Murphy, C.; Davis, P.C.

1986-01-01

Posttraumatic spinal cord cysts have been thought to be infrequent sequelae of spinal trauma. To evaluate the incidence of spinal cord abnormalities in patients who have previously sustained cord trauma, the authors studied the incidence of these changes in clinically stable patients following injury. Twenty-five patients with a history of previous cord injury and stable neurologic status volunteered for MR imaging studies. Studies performed using a 0.5-T and 1.5-T unit revealed focal kinking of the cord at the trauma site as well as intramedullary hypointense areas on T1-weighted images in most volunteers. There was close clinical correlation between MR imaging findings and experimental pathologic data, which suggests that these lesions are much more prevalent than once thought

A Direct Comparison between Norepinephrine and Phenylephrine for Augmenting Spinal Cord Perfusion in a Porcine Model of Spinal Cord Injury.

Science.gov (United States)

Streijger, Femke; So, Kitty; Manouchehri, Neda; Gheorghe, Ana; Okon, Elena B; Chan, Ryan M; Ng, Benjamin; Shortt, Katelyn; Sekhon, Mypinder S; Griesdale, Donald E; Kwon, Brian K

2018-03-28

Current clinical guidelines recommend elevating the mean arterial blood pressure (MAP) to increase spinal cord perfusion in patients with acute spinal cord injury (SCI). This is typically achieved with vasopressors such as norepinephrine (NE) and phenylephrine (PE). These drugs differ in their pharmacological properties and potentially have different effects on spinal cord blood flow (SCBF), oxygenation (PO 2 ), and downstream metabolism after injury. Using a porcine model of thoracic SCI, we evaluated how these vasopressors influenced intraparenchymal SCBF, PO 2 , hydrostatic pressure, and metabolism within the spinal cord adjacent to the injury site. Yorkshire pigs underwent a contusion/compression SCI at T10 and were randomized to receive either NE or PE for MAP elevation of 20 mm Hg, or no MAP augmentation. Prior to injury, a combined SCBF/PO 2 sensor, a pressure sensor, and a microdialysis probe were inserted into the spinal cord adjacent to T10 at two locations: a "proximal" site and a "distal" site, 2 mm and 22 mm from the SCI, respectively. At the proximal site, NE and PE resulted in little improvement in SCBF during cord compression. Following decompression, NE resulted in increased SCBF and PO 2 , whereas decreased levels were observed for PE. However, both NE and PE were associated with a gradual decrease in the lactate to pyruvate (L/P) ratio after decompression. PE was associated with greater hemorrhage through the injury site than that in control animals. Combined, our results suggest that NE promotes better restoration of blood flow and oxygenation than PE in the traumatically injured spinal cord, thus providing a physiological rationale for selecting NE over PE in the hemodynamic management of acute SCI.

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 demonstration of spontaneous acute epidural hematoma of the thoracic spine

International Nuclear Information System (INIS)

Avrahami, E.; Tadmor, R.; Feibel, M.; Itzhak, Y.; Tel Aviv Univ.; Ram, Z.; Tel Aviv Univ.

1989-01-01

Two patients with spontaneous epidural hematoma of the thoracic spine are presented. The magnetic resonance (MR) examination performed within the first hours following the onset of symptoms demonstrated an epidural elongated lesion impinging on the spinal cord, compatible with hematoma. In one of the patients this finding was surgically confirmed. The second patient improved under steroid treatment. The MR findings were highly suggestive of the pathological nature of the lesion. The MR examination should replace other diagnostic procedures, such as computerised tomography (CT) and myelography. (orig.)

Neuroprotective effect corilagin in spinal cord injury rat model by ...

African Journals Online (AJOL)

Background: Neurological functions get altered in a patient suffering from spinal cord injury (SCI). Present study evaluates the neuroprotective effect of corilagin in spinal cord injury rats by inhibiting nuclear factor-kappa B (NF-κB), inflammatory mediators and apoptosis. Materials and method: Spinal cord injury was ...

Evaluation of spinal cord vessels using multi-slice CT angiography

International Nuclear Information System (INIS)

Chen Shuang; Zhu Ruijiang; Feng Xiaoyuan

2006-01-01

Objective: To evaluate the value of Multi-slice spiral CT angiography for spinal cord vessels. Methods: 11 adult subjects with suspected of myelopathy were performed with Multi-slice spiral CT angiography, An iodine contrast agent was injected at 3.5 ml/s, for total 100 ml. The parameters were axial 16 slice mode, 0.625 mm slice thickness, 0.8 s rotation, delay time depending on smartprep(15-25 s), multi-phase scan. The coronal and sagittal MPR and SSD were generated on a workstation compared with spinal digital subtraction angiography (DSA) to analyze normal or abnormal spinal cord vessels. Results: Normal findings at spinal CTA and digital subtraction angiography in six adult normal subjects and spinal cord vascular malformations (1 intradural extramedullary AVF, 4 dural AVFs) in five cases, Recognizable intradural vessels corresponding to anterior median (midline) veins and/or anterior spinal arteries were show in six adult normal subjects. Abnormal intradural vessels were detected in all five spinal cord vascular malformation with CT angiography, in comparison with digital subtraction angiography these vessels were primarily enlarged veins of the coronal venous plexus on the cord surface, radiculomedullary-dural arteries could not be clearly shown in four dural AVF, only one anterior spinal artery was detected in one patient with intradural medullary AVF, which direct shunt between anterior spinal artery and perimedullary vein with tortuous draining vessel. Conclusion: Multi-slice CT angiography is able to visualize the normal or abnormal spinal cord vessels. It could be used as a noninvasive method to screen the spinal cord vascular disease. (authors)

Nonsurgical management of an extensive spontaneous spinal epidural hematoma causing quadriplegia and respiratory distress in a choledocholithiasis patient

Science.gov (United States)

Raasck, Kyle; Khoury, Jason; Aoude, Ahmed; Abduljabbar, Fahad; Jarzem, Peter

2017-01-01

Abstract Rationale: Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord, and leading to acute neurological deficits. The disease's cloudy etiology and rarity contribute to dangerously suboptimal therapeutic principles. These neural deficits can be permanent, even fatal, if the SSEH is not treated in a timely and appropriate manner. Standard therapy is decompressive laminectomy, though nonsurgical management is a viable course of action for patients who meet a criterion that is continuously being refined. Patient concerns: A 76-year-old woman on warfarin for a past pulmonary embolism presented to the emergency room with jaundice, myalgia, hematuria, neck pain, and an International Normalized Ratio (INR) of 14. Upon admission, she rapidly developed quadriplegia and respiratory distress that necessitated intubation. Diagnoses: T2-weighted magnetic resonance imaging (MRI) revealed an epidural space-occupying hyperintensity from C2 to S5 consistent with a spinal epidural hematoma. An incidental finding of dilated intrahepatic and common bile ducts prompted an endoscopic retrograde cholangiopancreatography, which demonstrated choledocholithiasis. Interventions: The patient's INR was normalized with Vitamin K and Beriplex. Upon transfer to the surgical spine team for assessment of a possible intervention, the patient began to demonstrate recovery of neural functions. The ensuing sustained motor improvement motivated the team's preference for close neurologic monitoring and continued medical therapy over surgery. Thirteen hours after the onset of her symptoms, the patient was extubated. A sphincterotomy was later performed, removing 81 common bile duct stones. Outcomes: MRI demonstrated complete resorption of the SSEH and the patient maintained full neurological function at final follow-up. Lessons: Nonsurgical management of SSEH should be considered in the context of early and sustained recovery

Acute spinal cord injuries

International Nuclear Information System (INIS)

Takahashi, M.; Izunaga, H.; Sato, R.; Shinzato, I.; Korogi, Y.; Yamashita, Y.

1991-01-01

This paper reports on sequential MR images and neurologic findings that were correlated in 40 acute spinal cord injuries. Within 1 week after injury, frequent initial MR changes appeared isointense on both T1- and T2-weighted images and isointense on T1- and hyperintense on T2-weighted images. After 2 months, hypointensity appeared on T1-weighted images and hyperintensity persisted or appeared on T2-weighted images. Clinical improvements were observed in patients with isointensity on both T1- and T2-weighted images at the initial examination. A larger area of hyperintensity on subsequent T2-weighted images was correlated with no neurologic improvement. MR findings were good indicators of the spinal cord injury

Spinal cord injury below-level neuropathic pain relief with dorsal root entry zone microcoagulation performed caudal to level of complete spinal cord transection.

Science.gov (United States)

Falci, Scott; Indeck, Charlotte; Barnkow, Dave

2018-06-01

OBJECTIVE Surgically created lesions of the spinal cord dorsal root entry zone (DREZ) to relieve central pain after spinal cord injury (SCI) have historically been performed at and cephalad to, but not below, the level of SCI. This study was initiated to investigate the validity of 3 proposed concepts regarding the DREZ in SCI central pain: 1) The spinal cord DREZ caudal to the level of SCI can be a primary generator of SCI below-level central pain. 2) Neuronal transmission from a DREZ that generates SCI below-level central pain to brain pain centers can be primarily through sympathetic nervous system (SNS) pathways. 3) Perceived SCI below-level central pain follows a unique somatotopic map of DREZ pain-generators. METHODS Three unique patients with both intractable SCI below-level central pain and complete spinal cord transection at the level of SCI were identified. All 3 patients had previously undergone surgical intervention to their spinal cords-only cephalad to the level of spinal cord transection-with either DREZ microcoagulation or cyst shunting, in failed attempts to relieve their SCI below-level central pain. Subsequent to these surgeries, DREZ lesioning of the spinal cord solely caudal to the level of complete spinal cord transection was performed using electrical intramedullary guidance. The follow-up period ranged from 1 1/2 to 11 years. RESULTS All 3 patients in this study had complete or near-complete relief of all below-level neuropathic pain. The analyzed electrical data confirmed and enhanced a previously proposed somatotopic map of SCI below-level DREZ pain generators. CONCLUSIONS The results of this study support the following hypotheses. 1) The spinal cord DREZ caudal to the level of SCI can be a primary generator of SCI below-level central pain. 2) Neuronal transmission from a DREZ that generates SCI below-level central pain to brain pain centers can be primarily through SNS pathways. 3) Perceived SCI below-level central pain follows a unique

Seminal plasma PSA in spinal cord injured men

DEFF Research Database (Denmark)

Brasso, K; Sønksen, J; Sommer, P

1998-01-01

The aim of the study was to evaluate the impact of spinal cord injury on seminal plasma PSA concentration.......The aim of the study was to evaluate the impact of spinal cord injury on seminal plasma PSA concentration....

Magnetic resonance imaging of spinal cord syndromes

International Nuclear Information System (INIS)

Einsiedel, H. von; Stepan, R.

1985-01-01

Thirty-four patients with intramedullary space-occupying lesions or cord compression syndromes were examined with a resistive and two different superconductive magnetic resonance (MR) imaging units. Studies were done primarily by the spin-echo (SE) technique and in the majority of patients different pulse sequences were used. Images with short echo-time (TE) and short recovery-time (TR) were best for demonstration of spinal cord anatomy, for depicting cystic portions in intramedullary tumours and for showing syringomyelia. Solid intramedullary tumours showed normal cord signal intensity. Images with prolonged TE and TR predominantly enhanced CSF signal intensity and, to a more considerable extent, solid intramedullary tumours. Thus, the diameter of the subarachnoid space and the presence of a solid intramedullary tumour, not concomittant with a significant enlargement of the spinal cord, could only be recognized on these prolonged SE images. Major advantages of MR in comparison to CT are that the spinal cord can be imaged in the sagittal plane and that beam hardening artifacts do not occur; in comparison to myelography the cord can be imaged directly by MR. Partial volume is a major limitation of MR, not only in the preferably applied sagittal plane. The choice of slice thickness adequate to the diameter of the lesion and straight positioning of the patient for sagittal single slice midline images are fundamental for reliable MR investigations. Another limitation to MR is that cortical bone gives no signal. The actual diameter of the spinal canal therefore cannot be correctly appreciated and consequently it was difficult or impossible to assess spinal stenosis. (orig.)

Radiation-induced apoptosis in the neonatal and adult rat spinal cord.

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Li, Y Q; Wong, C S

2000-09-01

This study was designed to characterize radiation-induced apoptosis in the spinal cord of the neonatal and young adult rat. Spinal cords (C2-T2) of 1-, 2- and 10-week-old rats were irradiated with a single dose of 8, 18 or 22 Gy. Apoptosis was assessed histologically according to its specific morphological features or by using the TUNEL assay. Cell proliferation was assessed immunohistochemically using BrdU. Identities of cell types undergoing apoptosis were assessed using immunohistochemistry or in situ hybridization using markers for neurons, glial progenitor cells, microglia, oligodendrocytes and astrocytes. The time course of radiation-induced apoptosis in 1- or 2-week-old rat spinal cord was similar to that in the young adult rat spinal cord. A peak response was observed at about 8 h after irradiation, and the apoptosis index returned to the levels in nonirradiated spinal cords at 24 h. The neonatal rat spinal cord demonstrated increased apoptosis compared to the adult. Values for total yield of apoptosis over 24 h induced by 8 Gy in the neonatal rat spinal cord were significantly greater than that in the adult. Immunohistochemistry studies using Leu7, galactocerebroside, Rip and adenomatous polyposis coli tumor suppressor protein indicated that most apoptotic cells were cells of the oligodendroglial lineage regardless of the age of the animal. No evidence of Gfap or factor VIII-related antigen-positive apoptotic cells was observed, and there was a small number of apoptotic microglial cells (lectin-Rca1 positive) in the neonatal and adult rat spinal cord. In the neonatal but not adult rat spinal cord, about 10% of the apoptotic cells appeared to be neurons and were immunoreactive for synaptophysin. Labeling indices (LI) for BrdU in nonirradiated 1- and 2-week-old rat spinal cord were 20.0 and 16.3%, respectively, significantly greater than the LI of 1.0% in the 10-week-old rat spinal cord. At 8 h after a single dose of 8 Gy, 13.4% of the apoptotic cells were

Spontaneous Spinal Epidural Hematoma; a Case Report

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Maryam Motamedi

2014-09-01

Full Text Available Spontaneous spinal epidural hematoma (SSHE is a rare entity can have several reasons. Its prevalence in population is 0.1 per 100,000 with the male to female ratio of 1/4:1. For the first time Jackson in 1869 reported a case of SSHE and after that it was declared as several hundred cases in literatures. Here, a case of SSHE was reported in a 52 year-old male referred to emergency department following severe low back pain.

Levetiracetam in spinal cord injury pain: a randomized controlled trial

DEFF Research Database (Denmark)

Finnerup, N B; Grydehøj, J; Bing, J

2009-01-01

. OBJECTIVES: The objective of the study was primarily to evaluate the efficacy of the anticonvulsant levetiracetam in patients with spinal cord injury (SCI) at- and below-level pain and secondarily to evaluate the effect on spasm severity. SETTING: Outpatients at two spinal cord units and a pain center...... severity following spinal cord injury....

Spinal Cord Doses in Palliative Lung Radiotherapy Schedules

International Nuclear Information System (INIS)

Ffrrcsi, F.H.; Parton, C.

2006-01-01

Aim: We aim to check the safety of the standard palliative radiotherapy techniques by using the Linear quadratic model for a careful estimation of the doses received by the spinal cord, in all standard palliative lung radiotherapy fields and fractionation. Material and Methods: All patients surveyed at this prospective audit were treated with palliative chest radio-therapy for lung cancer over a period from January to June 2005 by different clinical oncology specialists within the department. Radiotherapy field criteria were recorded and compared with the recommended limits of the MRC trial protocols for the dose and fractionation prescribed. Doses delivered to structures off the field central axis were estimated using a standard CT scan of the chest. Dose estimates were made using an SLPLAN planning system. As unexpected spinal cord toxicity has been reported after hypo fractionated chest radiotherapy, a sagittal view was used to calculate the isodoses along the length of the spinal cord that could lie within the RT field. Equivalent dose estimates are made using the Linear Quadratic Equivalent Dose formula (LQED). The relative radiation sensitivity of spinal cord for myelopathy (the a/b dose) cord has been estimated as a/b = 1 Gy. Results: 17 Gy in 2 fraction and 39 Gy in 13 fraction protocols have spinal cord equivalent doses (using the linear-quadratic model) that lie within the conventional safe limits of 50 Gy in 25 fractions for the 100% isodose. However when the dosimetry is modelled for a 6 MV 100 cm isocentric linac in 3 dimensions, and altered separations and air space inhomogeneity are considered, the D-Max doses consistently fall above this limit on our 3 model patients. Conclusion: The 17 Gy in 2 fraction and 39 Gy in 13 fraction protocol would risk spinal cord damage if the radio therapist was unaware of the potential spinal cord doses. Alterative doses are suggested below 15.5 Gy/ 2 fractions (7 days apart) would be most acceptable

Spinal Cord Injury 101

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Cervical spinal cord injury without radiological abnormality in adults.

OpenAIRE

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...

The pathologic mechanisms underlying lumbar distraction spinal cord injury in rabbits.

Science.gov (United States)

Wu, Di; Zheng, Chao; Wu, Ji; Xue, Jing; Huang, Rongrong; Wu, Di; Song, Yueming

2017-11-01

A reliable experimental rabbit model of distraction spinal cord injury (SCI) was established to successfully simulate gradable and replicable distraction SCI. However, further research is needed to elucidate the pathologic mechanisms underlying distraction SCI. The aim of this study was to investigate the pathologic mechanisms underlying lumbar distraction SCI in rabbits. This is an animal laboratory study. Using a self-designed spine distractor, the experimental animals were divided into a control group and 10%, 20%, and 30% distraction groups. Pathologic changes to the spinal cord microvessels in the early stage of distraction SCI were identified by perfusion of the spinal cord vasculature with ink, production of transparent specimens, observation by light microscopy, and observation of corrosion casts of the spinal cord microvascular architecture by scanning electron microscopy. Malondialdehyde (MDA) and superoxide dismutase (SOD) concentrations in the injured spinal cord tissue were measured after 8 hours. With an increasing degree and duration of distraction, the spinal cord microvessels were only partially filled and had the appearance of spasm until rupture and hemorrhage were observed. The MDA concentration increased and the SOD concentration decreased in the spinal cord tissue. Changes to the internal and external spinal cord vessels led to spinal cord ischemia, which is a primary pathologic mechanism of distraction SCI. Lipid peroxidation mediated by free radicals took part in secondary pathologic damage of distraction SCI. Copyright © 2017 Elsevier Inc. All rights reserved.

Hybrid surgery-radiosurgery therapy for metastatic epidural spinal cord compression: A prospective evaluation using patient-reported outcomes.

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Barzilai, Ori; Amato, Mary-Kate; McLaughlin, Lily; Reiner, Anne S; Ogilvie, Shahiba Q; Lis, Eric; Yamada, Yoshiya; Bilsky, Mark H; Laufer, Ilya

2018-05-01

Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery-radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief. Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory-Spine Tumor (MDASI-SP), PROs validated in the cancer population, were prospectively collected. Patients with MESCC who underwent separation surgery followed by stereotactic radiosurgery were included. Separation surgery included a posterolateral approach without extensive cytoreductive tumor excision. A median postoperative radiosurgery dose of 2700 cGy was delivered. The change in PRO 3 months after the hybrid therapy represented the primary study outcome. Preoperative and postoperative evaluations were analyzed using the Wilcoxon signed-rank test for matched pairs. One hundred eleven patients were included. Hybrid therapy resulted in a significant reduction in the BPI items "worst" and "right now" pain ( P < .0001), and in all BPI constructs (severity, interference with daily activities, and pain experience, P < .001). The MDASI-SP demonstrated reduction in spine-specific pain severity and interference with general activity ( P < .001), along with decreased symptom interference ( P < .001). Validated PRO instruments showed that in patients with MESCC, hybrid therapy with separation surgery and radiosurgery results in a significant decrease in pain severity and symptom interference. These prospective data confirm the benefit of hybrid therapy for treatment of MESCC and should facilitate referral of patients with MESCC for surgical evaluation.

The Animal Model of Spinal Cord Injury as an Experimental Pain Model

Directory of Open Access Journals (Sweden)

Aya Nakae

2011-01-01

Full Text Available Pain, which remains largely unsolved, is one of the most crucial problems for spinal cord injury patients. Due to sensory problems, as well as motor dysfunctions, spinal cord injury research has proven to be complex and difficult. Furthermore, many types of pain are associated with spinal cord injury, such as neuropathic, visceral, and musculoskeletal pain. Many animal models of spinal cord injury exist to emulate clinical situations, which could help to determine common mechanisms of pathology. However, results can be easily misunderstood and falsely interpreted. Therefore, it is important to fully understand the symptoms of human spinal cord injury, as well as the various spinal cord injury models and the possible pathologies. The present paper summarizes results from animal models of spinal cord injury, as well as the most effective use of these models.

The Animal Model of Spinal Cord Injury as an Experimental Pain Model

Science.gov (United States)

Nakae, Aya; Nakai, Kunihiro; Yano, Kenji; Hosokawa, Ko; Shibata, Masahiko; Mashimo, Takashi

2011-01-01

Pain, which remains largely unsolved, is one of the most crucial problems for spinal cord injury patients. Due to sensory problems, as well as motor dysfunctions, spinal cord injury research has proven to be complex and difficult. Furthermore, many types of pain are associated with spinal cord injury, such as neuropathic, visceral, and musculoskeletal pain. Many animal models of spinal cord injury exist to emulate clinical situations, which could help to determine common mechanisms of pathology. However, results can be easily misunderstood and falsely interpreted. Therefore, it is important to fully understand the symptoms of human spinal cord injury, as well as the various spinal cord injury models and the possible pathologies. The present paper summarizes results from animal models of spinal cord injury, as well as the most effective use of these models. PMID:21436995

Morphology of the cervical spinal cord with myelopathy on computed myelography

International Nuclear Information System (INIS)

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.)

Right-sided vagus nerve stimulation inhibits induced spinal cord seizures.

Science.gov (United States)

Tubbs, R Shane; Salter, E George; Killingsworth, Cheryl; Rollins, Dennis L; Smith, William M; Ideker, Raymond E; Wellons, John C; Blount, Jeffrey P; Oakes, W Jerry

2007-01-01

We have previously shown that left-sided vagus nerve stimulation results in cessation of induced spinal cord seizures. To test our hypothesis that right-sided vagus nerve stimulation will also abort seizure activity, we have initiated seizures in the spinal cord and then performed right-sided vagus nerve stimulation in an animal model. Four pigs were anesthetized and placed in the lateral position and a small laminectomy performed in the lumbar region. Topical penicillin, a known epileptogenic drug to the cerebral cortex and spinal cord, was next applied to the dorsal surface of the exposed cord. With the exception of the control animal, once seizure activity was discernible via motor convulsion or increased electrical activity, the right vagus nerve previously isolated in the neck was stimulated. Following multiple stimulations of the vagus nerve and with seizure activity confirmed, the cord was transected in the midthoracic region and vagus nerve stimulation performed. Right-sided vagus nerve stimulation resulted in cessation of spinal cord seizure activity in all animals. Transection of the spinal cord superior to the site of seizure induction resulted in the ineffectiveness of vagus nerve stimulation in causing cessation of seizure activity in all study animals. As with left-sided vagus nerve stimulation, right-sided vagus nerve stimulation results in cessation of induced spinal cord seizures. Additionally, the effects of right-sided vagus nerve stimulation on induced spinal cord seizures involve descending spinal pathways. These data may aid in the development of alternative mechanisms for electrical stimulation for patients with medically intractable seizures and add to our knowledge regarding the mechanism for seizure cessation following peripheral nerve stimulation.

Propitious Therapeutic Modulators to Prevent Blood-Spinal Cord Barrier Disruption in Spinal Cord Injury.

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Kumar, Hemant; Ropper, Alexander E; Lee, Soo-Hong; Han, Inbo

2017-07-01

The blood-spinal cord barrier (BSCB) is a specialized protective barrier that regulates the movement of molecules between blood vessels and the spinal cord parenchyma. Analogous to the blood-brain barrier (BBB), the BSCB plays a crucial role in maintaining the homeostasis and internal environmental stability of the central nervous system (CNS). After spinal cord injury (SCI), BSCB disruption leads to inflammatory cell invasion such as neutrophils and macrophages, contributing to permanent neurological disability. In this review, we focus on the major proteins mediating the BSCB disruption or BSCB repair after SCI. This review is composed of three parts. Section 1. SCI and the BSCB of the review describes critical events involved in the pathophysiology of SCI and their correlation with BSCB integrity/disruption. Section 2. Major proteins involved in BSCB disruption in SCI focuses on the actions of matrix metalloproteinases (MMPs), tumor necrosis factor alpha (TNF-α), heme oxygenase-1 (HO-1), angiopoietins (Angs), bradykinin, nitric oxide (NO), and endothelins (ETs) in BSCB disruption and repair. Section 3. Therapeutic approaches discusses the major therapeutic compounds utilized to date for the prevention of BSCB disruption in animal model of SCI through modulation of several proteins.

General Information about Childhood Brain and Spinal Cord Tumors

Science.gov (United States)

... The tentorium separates the supratentorium from the infratentorium (right panel). The skull and meninges protect the brain and spinal cord (left panel). The spinal cord connects the brain with ...

Spontaneous cervical epidural hematoma: Report of a case managed conservatively

Directory of Open Access Journals (Sweden)

Halim Tariq

2008-01-01

Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

Spontaneous herniation of the thoracic spinal cord : a case report

International Nuclear Information System (INIS)

Jin, Sung Chan; Lee, Seong Ro; Park, Dong Woo; Joo, Kyung Bin

2001-01-01

Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dural. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord through a dural defect

Human spinal locomotor control is based on flexibly organized burst generators

OpenAIRE

Danner, Simon M.; Hofstoetter, Ursula S.; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank; Minassian, Karen

2015-01-01

Understanding the organisation of human spinal locomotor circuitry after severe CNS damage is essential for improving neurorehabilitation strategies. Danner et al. present evidence of flexibly organised burst-generating elements within the functionally isolated human lumbosacral spinal cord that generate rhythmic patterns in response to constant, repetitive epidural stimulation.

Spinal Cord Injury 101

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Full Text Available ... com is an informational and support website for families facing spinal cord injuries. The website does not provide medical advice, recommend or endorse health care products or ...

Does the intrathecal propofol have a neuroprotective effect on spinal cord ischemia?

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Sahin, Murat; Gullu, Huriye; Peker, Kemal; Sayar, Ilyas; Binici, Orhan; Yildiz, Huseyin

2015-11-01

The neuroprotective effects of propofol have been confirmed. However, it remains unclear whether intrathecal administration of propofol exhibits neuroprotective effects on spinal cord ischemia. At 1 hour prior to spinal cord ischemia, propofol (100 and 300 µg) was intrathecally administered in rats with spinal cord ischemia. Propofol pre-treatment greatly improved rat pathological changes and neurological function deficits at 24 hours after spinal cord ischemia. These results suggest that intrathecal administration of propofol exhibits neuroprotective effects on spinal cord structural and functional damage caused by ischemia.

Protein composition and synthesis in the adult mouse spinal cord

International Nuclear Information System (INIS)

Stodieck, L.S.; Luttges, M.W.

1983-01-01

Properties of spinal cord proteins were studied in adult mice subjected to unilateral crush or electrical stimulation of sciatic nerve. The protein composition of spinal tissue was determined using SDS-polyacrylamide gel electrophoresis coupled with subcellular fractionation. Comparisons of mouse spinal cord and brain revealed similarities in the types but differences in the concentrations of myelin associated proteins, nuclear histones and other proteins. Comparisons with sciatic nerve proteins demonstrated differences in types of proteins but similarities in the concentration of myelin proteins and nuclear histones. The short term (less than 2 hrs.) incorporation of radioactive amino acids into spinal cord proteins revealed heterogeneous rates of incorporation. Neither nerve crush six days prior to testing nor sciatic nerve stimulation had a significant effect on the protein composition or amino acid incorporation rates of spinal cord tissue. These observations suggest that known differences in spinal cord function following alterations in nerve input may be dependent upon different mechanisms than have been found in the brain

Spinal cord compression in {beta}-thalassemia: follow-up after radiotherapy

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Fonseca, Silvana Fahel da; Figueiredo, Maria Stella; Cancado, Rodolfo Delfini; Nakadakare, Fernando; Segreto, Roberto; Kerbauy, Jose [Universidade Federal de Sao Paulo (UNIFESP), SP (Brazil). Escola Paulista de Medicina

1998-12-01

Spinal cord compression due to extramedullary hematopoiesis is a well-described bu rare syndrome encountered in several hematologic disorders, including {beta}-thalassemia. We report a case of a patient with intermediate {beta}-thalassemia and crural paraparesis due to spinal cord compression by a paravertebral extramedullary mass. She was successfully treated with low-dose radiotherapy and transfusions. After splenectomy, she was regularly followed up for over four years without transfusion or recurrence of spinal cord compression. Extramedullary hematopoiesis should be investigated in patients with hematologic disorders and spinal cord symptoms. The rapid recognition and treatment with radiotherapy can dramatically alleviate symptoms. (author)

Spinal cord compression in β-thalassemia: follow-up after radiotherapy

International Nuclear Information System (INIS)

Fonseca, Silvana Fahel da; Figueiredo, Maria Stella; Cancado, Rodolfo Delfini; Nakadakare, Fernando; Segreto, Roberto; Kerbauy, Jose

1998-01-01

Spinal cord compression due to extramedullary hematopoiesis is a well-described bu rare syndrome encountered in several hematologic disorders, including β-thalassemia. We report a case of a patient with intermediate β-thalassemia and crural paraparesis due to spinal cord compression by a paravertebral extramedullary mass. She was successfully treated with low-dose radiotherapy and transfusions. After splenectomy, she was regularly followed up for over four years without transfusion or recurrence of spinal cord compression. Extramedullary hematopoiesis should be investigated in patients with hematologic disorders and spinal cord symptoms. The rapid recognition and treatment with radiotherapy can dramatically alleviate symptoms. (author)

Vascular anatomy of the spinal cord

International Nuclear Information System (INIS)

Thron, A.K.

1988-01-01

The book summarizes the anatomic guidelines of external blood supply to the spinal cord. The basic principles of arterial supply and venous drainage are illustrated by explicit schemes for quick orientation. In the first part of the book, systematic radiologic-anatomic investigations of the superficial and deep vessels of all segments of the spinal cord are introduced. The microvascular morphology is portrayed by numerous microradiographic sections in all three dimensions without overshadowing. The three-dimensional representation of the vascular architecture illustrates elementary outlines and details of arterial territories, anastomotic cross-linking as well as the capillary system, particularly the hitherto unknown structure of the medullary venous system with its functionally important anastomoses and varying regional structures. These often now radiologic-anatomic findings are discussed as to their functional and pathophysiologic impact and constitute the basic on which to improve one's understanding of vascular syndromes of the spinal cord

Ischemic Tolerance of the Brain and Spinal Cord: A Review.

Science.gov (United States)

Yunoki, Masatoshi; Kanda, Takahiro; Suzuki, Kenta; Uneda, Atsuhito; Hirashita, Koji; Yoshino, Kimihiro

2017-11-15

Ischemic tolerance is an endogenous neuroprotective phenomenon induced by sublethal ischemia. Ischemic preconditioning (IPC), the first discovered form of ischemic tolerance, is widely seen in many species and in various organs including the brain and the spinal cord. Ischemic tolerance of the spinal cord is less familiar among neurosurgeons, although it has been reported from the viewpoint of preventing ischemic spinal cord injury during aortic surgery. It is important for neurosurgeons to have opportunities to see patients with spinal cord ischemia, and to understand ischemic tolerance of the spinal cord as well as the brain. IPC has a strong neuroprotective effect in animal models of ischemia; however, clinical application of IPC for ischemic brain and spinal diseases is difficult because they cannot be predicted. In addition, one drawback of preconditioning stimuli is that they are also capable of producing injury with only minor changes to their intensity or duration. Numerous methods to induce ischemic tolerance have been discovered that vary in their timing and the site at which short-term ischemia occurs. These methods include ischemic postconditioning (IPoC), remote ischemic preconditioning (RIPC), remote ischemic perconditioning (RIPerC) and remote ischemic postconditioning (RIPoC), which has had a great impact on clinical approaches to treatment of ischemic brain and spinal cord injury. Especially RIPerC and RIPoC to induce spinal cord tolerance are considered clinically useful, however the evidence supporting these methods is currently insufficient; further experimental or clinical research in this area is thus necessary.

Making sense out of spinal cord somatosensory development

Science.gov (United States)

Seal, Rebecca P.

2016-01-01

The spinal cord integrates and relays somatosensory input, leading to complex motor responses. Research over the past couple of decades has identified transcription factor networks that function during development to define and instruct the generation of diverse neuronal populations within the spinal cord. A number of studies have now started to connect these developmentally defined populations with their roles in somatosensory circuits. Here, we review our current understanding of how neuronal diversity in the dorsal spinal cord is generated and we discuss the logic underlying how these neurons form the basis of somatosensory circuits. PMID:27702783

A Review of the Segmental Diameter of the Healthy Human Spinal Cord.

Science.gov (United States)

Frostell, Arvid; Hakim, Ramil; Thelin, Eric Peter; Mattsson, Per; Svensson, Mikael

2016-01-01

Knowledge of the average size and variability of the human spinal cord can be of importance when treating pathological conditions in the spinal cord. Data on healthy human spinal cord morphometrics have been published for more than a century using different techniques of measurements, but unfortunately, comparison of results from different studies is difficult because of the different anatomical landmarks used as reference points along the craniocaudal axis for the measurements. The aim of this review was to compute population estimates of the transverse and anteroposterior diameter of the human spinal cord by comparing and combining previously published data on a normalized craniocaudal axis. We included 11 studies presenting measurements of spinal cord cross-sectional diameters, with a combined sample size ranging from 15 to 488 subjects, depending on spinal cord level. Based on five published studies presenting data on the lengths of the segments of the spinal cord and vertebral column, we calculated the relative positions of all spinal cord neuronal segments and vertebral bony segments and mapped measurements of spinal cord size to a normalized craniocaudal axis. This mapping resulted in better alignment between studies and allowed the calculation of weighted averages and standard deviations (SDs) along the spinal cord. These weighted averages were smoothed using a generalized additive model to yield continuous population estimates for transverse and anteroposterior diameter and associated SDs. The spinal cord had the largest transverse diameter at spinal cord neuronal segment C5 (13.3 ± 2.2), decreased to segment T8 (8.3 ± 2.1), and increased slightly again to 9.4 ± 1.5 at L3. The anteroposterior diameter showed less variation in size along the spinal cord at C5 (7.4 ± 1.6), T8 (6.3 ± 2.0), and L3 (7.5 ± 1.6). All estimates are presented in millimeters ± 2 SDs. We conclude that segmental transverse and anteroposterior

Symptomatic spinal cord deformity secondary to a redundant intramedullary shunt catheter

International Nuclear Information System (INIS)

Quencer, R.M.; Montalvo Morse, B.M.; Green, B.A.; Eismont, F.J.

1985-01-01

Right arm pain, motor and sensory loss in the right arm and right facial numbness recurred in a 27 year old quadraplegic shortly after a posttraumatic spinal cord cyst (PTSCC) was shunted via a catheter into the adjacent subarachnoid space. Although shunt malfunction was clinically suspected, metrizamide computed tomography (MCT) suggested that redundancy of the catheter had caused deformity of the spinal cord. This hypothesis was confirmed at surgery when intraoperative spinal sonography (IOSS) showed that the spinal cord deformity at C 1 -C 2 disappeared when the catheter was withdrawn. This case shows that new or recurrent spinal cord symptoms may be due to a mechanical deformity of the cord rather than shunt malfunction, that restricting the length of the shunt catheter which is used to decompress PTSCCs is important, and that IOSS is an indispensible tool for visualizing the changes in spinal cord morphology during shunting procedures. (orig.)

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)

Spinal Cord Injury 101

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Spinal Cord Injury 101

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Detrusor Acontractility after Acute Spinal Cord Injury-Myth or Reality?

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Bywater, Mirjam; Tornic, Jure; Mehnert, Ulrich; Kessler, Thomas M

2018-01-17

We assessed urodynamic parameters within the first 40 days after spinal cord injury to investigate whether the detrusor is acontractile during the acute phase of spinal cord injury. We performed a prospective cohort study in 54 patients with neurogenic lower urinary tract dysfunction due to acute spinal cord injury who underwent urodynamic investigation within the first 40 days after injury at a single university spinal cord injury center. Urodynamic investigation revealed an acontractile detrusor in only 20 of the 54 patients (37%) but unfavorable urodynamic parameters in 34 (63%). We found detrusor overactivity in 32 patients, detrusor-sphincter dyssynergia in 25, maximum storage detrusor pressure greater than 40 cm H 2 O in 17, vesicoureteral reflux in 3 and low bladder compliance (less than 20 ml/cm H 2 O) in 1. More than 1 unfavorable urodynamic parameter per patient was possible. In contrast to the common notion of an acontractile detrusor during acute spinal cord injury, almost two-thirds of our patients showed unfavorable urodynamic parameters within the first 40 days after spinal cord injury. Considering that early treatment of neurogenic lower urinary tract dysfunction in patients with acute spinal cord injury might improve the long-term urological outcome, urodynamic investigation should be performed timely to optimize patient tailored therapy. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. 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.

Cytoarchitecture of the spinal cord of the postnatal (P4) mouse.

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Sengul, Gulgun; Puchalski, Ralph B; Watson, Charles

2012-05-01

Interpretation of the new wealth of gene expression and molecular mechanisms in the developing mouse spinal cord requires an accurate anatomical base on which data can be mapped. Therefore, we have assembled a spinal cord atlas of the P4 mouse to facilitate direct comparison with the adult specimens and to contribute to studies of the development of the mouse spinal cord. This study presents the anatomy of the spinal cord of the P4 C57Bl/6J mouse using Nissl and acetyl cholinesterase-stained sections. It includes a detailed map of the laminar organization of selected spinal cord segments and a description of named cell groups of the spinal cord such as the central cervical (CeCv), lateral spinal nucleus, lateral cervical, and dorsal nuclei. The motor neuron groups have also been identified according to the muscle groups they are likely to supply. General features of Rexed's laminae of the P4 spinal cord showed similarities to that of the adult (P56). However, certain differences were observed with regard to the extent of laminae and location of certain cell groups, such as the dorsal nucleus having a more dispersed structure and a more ventral and medial position or the CeCv being located in the medial part of lamina 5 in contrast to the adult where it is located in lamina 7. Motor neuron pools appeared to be more tightly packed in the P4 spinal cord. The dorsal horn was relatively larger and there was more white matter in the P56 spinal cord. Copyright © 2012 Wiley Periodicals, Inc.

Neuroprotection and its molecular mechanism following spinal cord injury☆

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Liu, Nai-Kui; Xu, Xiao-Ming

2012-01-01

Acute spinal cord injury initiates a complex cascade of molecular events termed ‘secondary injury’, which leads to progressive degeneration ranging from early neuronal apoptosis at the lesion site to delayed degeneration of intact white matter tracts, and, ultimately, expansion of the initial injury. These secondary injury processes include, but are not limited to, inflammation, free radical-induced cell death, glutamate excitotoxicity, phospholipase A2 activation, and induction of extrinsic and intrinsic apoptotic pathways, which are important targets in developing neuroprotective strategies for treatment of spinal cord injury. Recently, a number of studies have shown promising results on neuroprotection and recovery of function in rodent models of spinal cord injury using treatments that target secondary injury processes including inflammation, phospholipase A2 activation, and manipulation of the PTEN-Akt/mTOR signaling pathway. The present review outlines our ongoing research on the molecular mechanisms of neuroprotection in experimental spinal cord injury and briefly summarizes our earlier findings on the therapeutic potential of pharmacological treatments in spinal cord injury. PMID:25624837

Does the intrathecal propofol have a neuroprotective effect on spinal cord ischemia?

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Murat Sahin

2015-01-01

Full Text Available The neuroprotective effects of propofol have been confirmed. However, it remains unclear whether intrathecal administration of propofol exhibits neuroprotective effects on spinal cord ischemia. At 1 hour prior to spinal cord ischemia, propofol (100 and 300 µg was intrathecally administered in rats with spinal cord ischemia. Propofol pre-treatment greatly improved rat pathological changes and neurological function deficits at 24 hours after spinal cord ischemia. These results suggest that intrathecal administration of propofol exhibits neuroprotective effects on spinal cord structural and functional damage caused by ischemia.

Regulatory effect of neuroglobin in the recovery of spinal cord injury.

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Dai, Ji-Lin; Lin, Yun; Yuan, Yong-Jian; Xing, Shi-Tong; Xu, Yi; Zhang, Qiang-Hua; Min, Ji-Kang

2017-11-16

The present study was aimed to investigate the therapeutic potential of neuroglobin in the recovery of spinal cord injury. The male albino Wistar strain rats were used as an experimental model, and adeno associated virus (AAV) was administered in the T12 section of spinal cord ten days prior to the injury. Basso Beattie Bresnahan (BBB) locomotor rating scale was used to determine the recovery of the hind limb during four weeks post-operation. Malondialdehyde (MDA), catalase and superoxide dismutase (SOD) were determined in the spinal cord tissues. Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay was carried out to determine the presence of apoptotic cells. Immunofluorescence analysis was carried out to determine the neuroglobin expression. Western blot analysis was carried out to determine the protein expressions of caspase-3, cytochrome c, bax and bcl-2 in the spinal cord tissues. Experimental results showed that rats were recovered from the spinal cord injury due to increased neuroglobin expression. Lipid peroxidation was reduced, whereas catalase and SOD activity were increased in the spinal cord tissues. Apoptosis and lesions were significantly reduced in the spinal cord tissues. Caspase-3, cytochrome c and bax levels were significantly reduced, whereas bcl-2 expression was reduced in the spinal cord tissues. Taking all these data together, it is suggested that the increased neuroglobin expression could improve the locomotor function.

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

Shriners Hospital Spinal Cord Injury Self Care Manual.

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Fox, Carol

This manual is intended for young people with spinal cord injuries who are receiving rehabilitation services within the Spinal Cord Injury Unit at Shriners Hospital (San Francisco, California). An introduction describes the rehabilitation program, which includes family conferences, an individualized program, an independent living program,…

Spinal Cord Injury 101

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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.

Novel aspects of spinal cord evoked potentials (SCEPs) in the evaluation of dorso-ventral and lateral mechanical impacts on the spinal cord

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Rad, Iman; Kouhzaei, Sogolie; Mobasheri, Hamid; Saberi, Hooshang

2015-02-01

Objectives. The aim of the current study was to mimic mechanical impacts on the spinal cord by manifesting the effects of dorsoventral (DVMP) and lateral (LMP) mechanical pressure on neural activity to address points to be considered during surgery for different purposes, including spinal cord decompression. Approaches. Spinal cords of anesthetized rats were compressed at T13. Different characteristics of axons, including vulnerability, excitability, and conduction velocity (CV), in response to promptness, severity, and duration of pressure were assessed by spinal cord evoked potentials (SCEPs). Real-time SCEPs recorded at L4-5 revealed N1, N2, and N3 peaks that were used to represent the activity of injured sensory afferents, interneurons, and MN fibers. The averaged SCEP recordings were fitted by trust-region algorithm to find the equivalent Gaussian and polynomial equations. Main results. The pyramidal and extrapyramidal pathways possessed CVs of 3-11 and 16-80 m s-1, respectively. DVMP decreased the excitability of myelinated neural fibers in antidromic and orthodromic pathways. The excitability of fibers in extrapyramidal and pyramidal pathways of lateral corticospinal (LCS) and anterior corticospinal (ACS) tracts decreased following LMP. A significant drop in the amplitude of N3 and its conduction velocity (CV) revealed higher susceptibility of less-myelinated fibers to both DVMP and LMP. The best parametric fitting model for triplet healthy spinal cord CAP was a six-term Gaussian equation (G6) that fell into a five-term equation (G5) at the complete compression stage. Significance. The spinal cord is more susceptible to dorsoventral than lateral mechanical pressures, and this should be considered in spinal cord operations. SCEPs have shown promising capabilities for evaluating the severity of SCI and thus can be applied for diagnostic or prognostic intraoperative monitoring (IOM).

Spinal Cord Injury 101

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Full Text Available ... How Peer Counseling Works Julie Gassaway, MS, RN Pediatric Injuries Pediatric Spinal Cord Injury 101 Lawrence Vogel, MD The Basics of Pediatric SCI Rehabilitation Sara Klaas, MSW Transitions for Children ...

Spinal Cord Injury 101

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Spinal Cord Injury 101

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Diagnosis and surgical treatment of terminal syringomyelia within spinal cord combined with tethered cord syndrome

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Jing-cheng XIE

2016-04-01

Full Text Available Objective To summarize the clinical manifestations, imaging characteristics and experience of surgical treatment of spinal cord terminal syringomyelia with tethered cord syndrome (TCS.  Methods and Results Clinical data of 10 patients with spinal cord syringomyelia combined with TCS surgically treated under microscope from January 1999 to March 2014 in our hospital were retrospectively analyzed. There were 3 males and 7 females with average age of 15.06 years old (ranged from 2 to 35 years old. The course of disease ranged from 3 months to 20 years (average 42.17 months. Among those patients, one patient presented hydromyelia, 8 patients suffered from meningeal cyst within the sacral canal, and one patient were concurrent with sacral dermal sinus. The weakness of lower extremities, especially distal limbs, was the main clinical manifestation. Five patients were accompanied with bowel and bladder dysfunction and 5 patients with sensory disturbance below the level of syringomyelia, especially hypesthesia. Preoperative MRI showed conus medullaris disappeared at the end of spinal cord, and there was fluid signal in the lower spinal cord with hypo-intensity signal in T1WI and hyper-intensity signal in T2WI without enhancement. All patients underwent surgical procedures. Under microscope, filum terminale was cut off, drainage was performed, meningeal cyst within the sacral canal was removed, and tethered cord was released. The success rate of operations was 100%. The duration of surgery ranged from 1.52 to 3.07 h (average 2.15 h, with average intraoperative blood loss 220 ml (ranged from 100 to 410 ml. The tethering filum had been totally resected and histological examination showed typical filum tissue in all cases. No operative complication was found. Visual Analogue Scale (VAS score was decreased, and the lower limbs weakness as well as bowel and bladder dysfunction was gradually relieved after operation. The period of follow-up was ranged from 6

Spinal cord compression in b-thalassemia: follow-up after radiotherapy

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Silvana Fahel da Fonseca

Full Text Available CONTEXT: Spinal cord compression due to extramedullary hematopoiesis is a well-described but rare syndrome encountered in several clinical hematologic disorders, including b-thalassemia. CASE REPORT: We report the case of a patient with intermediate b-thalassemia and crural paraparesis due to spinal cord compression by a paravertebral extramedullary mass. She was successfully treated with low-dose radiotherapy and transfusions. After splenectomy, she was regularly followed up for over four years without transfusion or recurrence of spinal cord compression. DISCUSSION: Extramedullary hematopoiesis should be investigated in patients with hematologic disorders and spinal cord symptoms. The rapid recognition and treatment with radiotherapy can dramatically alleviate symptoms.

Surgical reconstruction of spinal cord circuit provides functional return in humans

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Thomas Carlstedt

2017-01-01

Full Text Available This mini review describes the current surgical strategy for restoring function after traumatic spinal nerve root avulsion in brachial or lumbosacral plexus injury in man. As this lesion is a spinal cord or central nervous injury functional return depends on spinal cord nerve cell growth within the central nervous system. Basic science, clinical research and human application has demonstrated good and useful motor function after ventral root avulsion followed by spinal cord reimplantation. Recently, sensory return could be demonstrated following spinal cord surgery bypassing the injured primary sensory neuron. Experimental data showed that most of the recovery depended on new growth reinnervating peripheral receptors. Restored sensory function and the return of spinal reflex was demonstrated by electrophysiology and functional magnetic resonance imaging of human cortex. This spinal cord surgery is a unique treatment of central nervous system injury resulting in useful functional return. Further improvements will not depend on surgical improvements. Adjuvant therapy aiming at ameliorating the activity in retinoic acid elements in dorsal root ganglion neurons could be a new therapeutic avenue in restoring spinal cord circuits after nerve root avulsion injury.

Development of an instrumented spinal cord surrogate using optical fibers: A feasibility study.

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Facchinello, Yann; Wagnac, Éric; Ung, Bora; Petit, Yvan; Pradhan, Prabin; Peyrache, Louis-Marie; Mac-Thiong, Jean-Marc

2017-10-01

In vitro replication of traumatic spinal cord injury is necessary to understand its biomechanics and to improve animal models. During a traumatic spinal cord injury, the spinal cord withstands an impaction at high velocity. In order to fully assess the impaction, the use of spinal canal occlusion sensor is necessary. A physical spinal cord surrogate is also often used to simulate the presence of the spinal cord and its surrounding structures. In this study, an instrumented physical spinal cord surrogate is presented and validated. The sensing is based on light transmission loss observed in embedded bare optical fibers subjected to bending. The instrumented surrogate exhibits similar mechanical properties under static compression compared to fresh porcine spinal cords. The instrumented surrogate has a compression sensing threshold of 40% that matches the smallest compression values leading to neurological injuries. The signal obtained from the sensor allows calculating the compression of the spinal cord surrogate with a maximum of 5% deviation. Excellent repeatability was also observed under repetitive loading. The proposed instrumented spinal cord surrogate is promising with satisfying mechanical properties and good sensing capability. It is the first attempt at proposing a method to assess the internal loads sustained by the spinal cord during a traumatic injury. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Idiopathic epidural lipomatosis as a cause of pain and neurological symptoms attributed initially to radiation damage.

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Millwater, C J; Jacobson, I; Howard, G C

1992-09-01

Epidural lipomatosis is a rare condition in which overgrowth of extradural fat can lead to back pain, spinal cord compression and radiculopathy. A 51-year-old man developed back pain and reduced mobility following a standard course of radiotherapy for a Stage I seminoma. His symptoms and radiological appearances were initially attributed to radiation fibrosis. Further investigations and operative intervention revealed epidural lipomatosis. The excess lipomatous tissue was removed with complete resolution of his symptoms.

Postmortem diffusion MRI of the entire human spinal cord at microscopic resolution

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Evan Calabrese

Full Text Available The human spinal cord is a central nervous system structure that plays an important role in normal motor and sensory function, and can be affected by many debilitating neurologic diseases. Due to its clinical importance, the spinal cord is frequently the subject of imaging research. Common methods for visualizing spinal cord anatomy and pathology include histology and magnetic resonance imaging (MRI, both of which have unique benefits and drawbacks. Postmortem microscopic resolution MRI of fixed specimens, sometimes referred to as magnetic resonance microscopy (MRM, combines many of the benefits inherent to both techniques. However, the elongated shape of the human spinal cord, along with hardware and scan time limitations, have restricted previous microscopic resolution MRI studies (both in vivo and ex vivo to small sections of the cord. Here we present the first MRM dataset of the entire postmortem human spinal cord. These data include 50 μm isotropic resolution anatomic image data and 100 μm isotropic resolution diffusion data, made possible by a 280 h long multi-segment acquisition and automated image segment composition. We demonstrate the use of these data for spinal cord lesion detection, automated volumetric gray matter segmentation, and quantitative spinal cord morphometry including estimates of cross sectional dimensions and gray matter fraction throughout the length of the cord. Keywords: Spinal cord, Magnetic resonance microscopy, Tractography, Human, Gray matter

Spinal Cord Injury 101

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Ultrastructure of canine meninges after repeated epidural injection of S(+)-ketamine.

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Acosta, Alinne; Gomar, Carmen; Bombí, Josep A; Graça, Dominguita L; Garrido, Marta; Krauspenhar, Cristina

2006-01-01

The safety of ketamine when administered by the spinal route must be confirmed in various animal species before it is approved for use in humans. This study evaluates the ultrastructure of canine meninges after repeated doses of epidural S(+)-ketamine. Five dogs received S(+)-ketamine 5%, 1 mg/kg, twice a day for 10 days through an epidural catheter with its tip located at the L5 level. One dog received the same volume of normal saline at the same times. The spinal cord and meninges were processed for histopathological and ultrastructural studies. Clinical effects were assessed after each injection. Motor and sensory block appeared after each injection of S(+)-ketamine, but not in the dog receiving saline. No signs of clinical or neurologic alterations were observed. Using light microscopy, no meningeal layer showed alterations except focal infiltration at the catheter tip level by macrophages, lymphocytes, and a few mast cells. The cells of different layers were studied by electron microscopy and interpreted according to data from human and other animal species because no ultrastructural description of the canine meninges is currently available. There were no cellular signs of inflammation, phagocytosis, or degeneration in meningeal layers and no signs of atrophy, compression, or demyelinization in the areas of dorsal root ganglia and spinal cord around the arachnoid. These findings were common for dogs receiving S(+)-ketamine and the dog receiving saline. Repeated doses of epidural S(+)-ketamine 5%, 1 mg/kg, twice a day for 10 days was not associated to cellular alterations in canine meninges.

Spinal Cord Gray Matter Atrophy in Amyotrophic Lateral Sclerosis.

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Paquin, M-Ê; El Mendili, M M; Gros, C; Dupont, S M; Cohen-Adad, J; Pradat, P-F

2018-01-01

There is an emerging need for biomarkers to better categorize clinical phenotypes and predict progression in amyotrophic lateral sclerosis. This study aimed to quantify cervical spinal gray matter atrophy in amyotrophic lateral sclerosis and investigate its association with clinical disability at baseline and after 1 year. Twenty-nine patients with amyotrophic lateral sclerosis and 22 healthy controls were scanned with 3T MR imaging. Standard functional scale was recorded at the time of MR imaging and after 1 year. MR imaging data were processed automatically to measure the spinal cord, gray matter, and white matter cross-sectional areas. A statistical analysis assessed the difference in cross-sectional areas between patients with amyotrophic lateral sclerosis and controls, correlations between spinal cord and gray matter atrophy to clinical disability at baseline and at 1 year, and prediction of clinical disability at 1 year. Gray matter atrophy was more sensitive to discriminate patients with amyotrophic lateral sclerosis from controls ( P = .004) compared with spinal cord atrophy ( P = .02). Gray matter and spinal cord cross-sectional areas showed good correlations with clinical scores at baseline ( R = 0.56 for gray matter and R = 0.55 for spinal cord; P amyotrophic lateral sclerosis. © 2018 by American Journal of Neuroradiology.

Injury-induced ctgfa directs glial bridging and spinal cord regeneration in zebrafish

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Mokalled, Mayssa H.; Patra, Chinmoy; Dickson, Amy L.; Endo, Toyokazu; Stainier, Didier Y. R.; Poss, Kenneth D.

2016-01-01

Unlike mammals, zebrafish efficiently regenerate functional nervous system tissue after major spinal cord injury. Whereas glial scarring presents a roadblock for mammalian spinal cord repair, glial cells in zebrafish form a bridge across severed spinal cord tissue and facilitate regeneration, a relatively unexplored process. Here, we performed a genome-wide profiling screen for secreted factors that are upregulated during zebrafish spinal cord regeneration. We find that connective tissue growth factor a (ctgfa) is induced in and around glial cells that participate in initial bridging events. Mutations in ctgfa disrupt spinal cord repair, while transgenic ctgfa overexpression and local human CTGF recombinant protein delivery accelerate bridging and functional regeneration. Our study reveals that CTGF is necessary and sufficient to stimulate glial bridging and natural spinal cord regeneration. PMID:27811277

Localization of Brain Natriuretic Peptide Immunoreactivity in Rat Spinal Cord

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Essam M Abdelalim

2016-12-01

Full Text Available Brain natriuretic peptide (BNP exerts its functions through natriuretic peptide receptors. Recently, BNP has been shown to be involved in a wide range of functions. Previous studies reported BNP expression in the sensory afferent fibers in the dorsal horn of the spinal cord. However, BNP expression and function in the neurons of the central nervous system are still controversial. Therefore, in this study, we investigated BNP expression in the rat spinal cord in detail using RT-PCR and immunohistochemistry. RT-PCR analysis showed that BNP mRNA was present in the spinal cord and DRG. BNP immunoreactivity was observed in different structures of the spinal cord, including the neuronal cell bodies and neuronal processes. BNP immunoreactivity was observed in the dorsal horn of the spinal cord and in the neurons of the intermediate column and ventral horn. Double-immunolabeling showed a high level of BNP expression in the afferent fibers (laminae I-II labeled with calcitonin gene-related peptide (CGRP, suggesting BNP involvement in sensory function. In addition, BNP was co-localized with CGRP and choline acetyltransferase in the motor neurons of the ventral horn. Together, these results indicate that BNP is expressed in sensory and motor systems of the spinal cord, suggesting its involvement in several biological actions on sensory and motor neurons via its binding to NPR-A and/or NPR-B in the DRG and spinal cord.

Sleep disordered breathing in spinal cord injury: A systematic review.

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Chiodo, Anthony E; Sitrin, Robert G; Bauman, Kristy A

2016-07-01

Spinal cord injury commonly results in neuromuscular weakness that impacts respiratory function. This would be expected to be associated with an increased likelihood of sleep-disordered breathing. (1) Understand the incidence and prevalence of sleep disordered breathing in spinal cord injury. (2) Understand the relationship between injury and patient characteristics and the incidence of sleep disordered breathing in spinal cord injury. (3) Distinguish between obstructive sleep apnea and central sleep apnea incidence in spinal cord injury. (4) Clarify the relationship between sleep disordered breathing and stroke, myocardial infarction, metabolic dysfunction, injuries, autonomic dysreflexia and spasticity incidence in persons with spinal cord injury. (5) Understand treatment tolerance and outcome in persons with spinal cord injury and sleep disordered breathing. Extensive database search including PubMed, Cochrane Library, CINAHL and Web of Science. Given the current literature limitations, sleep disordered breathing as currently defined is high in patients with spinal cord injury, approaching 60% in motor complete persons with tetraplegia. Central apnea is more common in patients with tetraplegia than in patients with paraplegia. Early formal sleep study in patients with acute complete tetraplegia is recommended. In patients with incomplete tetraplegia and with paraplegia, the incidence of sleep-disordered breathing is significantly higher than the general population. With the lack of correlation between symptoms and SDB, formal study would be reasonable. There is insufficient evidence in the literature on the impact of treatment on morbidity, mortality and quality of life outcomes.