Surgery for acute subaxial traumatic central cord syndrome without fracture or dislocation.

Science.gov (United States)

Song, Joonsuk; Mizuno, Junichi; Nakagawa, Hiroshi; Inoue, Tatsushi

2005-05-01

Twenty-two patients with subaxial acute traumatic central cord syndrome (CCS) without fracture or dislocation who underwent surgery between 1995 and 2002 were reviewed, retrospectively. There were 13 males and nine females ranging in age from 24 to 84 years (mean 61.2). Falls were the most common injury (68%), followed by motor vehicle accidents (32%). All patients had dynamic cervical lateral radiographs and magnetic resonance imaging (MRI). Cord compression was present in all cases and cervical instability in 11. Associated pathology included disc herniation in seven patients, cervical spondylosis (CS) in 11 and ossification of the posterior longitudinal ligament (OPLL) in four. Anterior decompression and fusion was performed in 12 patients with 1- or 2-level lesions. Posterior decompression and fusion was performed for multilevel lesions in 11 patients, including one patient who required re-operation. The interval between injury and surgery ranged from 1 to 37 days (mean 8.0). Postoperatively, all patients improved clinically. We conclude that surgical management of subaxial acute traumatic CCS without fracture or dislocation improved neurological status and prevented delayed neurological deterioration in our patients.

A traumatic central cord syndrome occurring after adequate decompression for cervical spondylosis: biomechanics of injury: case report.

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Dickerman, Rob D; Lefkowitz, Michael; Epstein, Joseph A

2005-10-15

Case report with review of the literature. To present the first case of a central cord syndrome occurring after adequate decompression, and review the mechanics of the cervical spinal cord injury and postoperative biomechanical and anatomic changes occurring after cervical decompressive laminectomy. Cervical spondylosis is a common pathoanatomic occurrence in the elderly population and is thought to be one of the primary causes for a central cord syndrome. Decompressive laminectomy with or without fusion has been a primary treatment for spondylotic disease and is thought to be protective against further injury. To our knowledge, there are no cases of a central cord syndrome occurring after adequate decompression reported in the literature. Case study with extensive review of the literature. The patient underwent C3-C7 cervical laminectomy without complications. After surgery, the patient's spasticity and gait difficulties improved. She was discharged to inpatient rehabilitation for further treatment of upper extremity weakness. The patient fell in the rehabilitation center, with a central cord syndrome despite adequate decompression of her spinal canal. The patient was treated conservatively for the central cord and had minimal improvement. Decompressive laminectomy provides an immediate decompressive effect on the spinal cord as seen by the dorsal migration of the cord, however, the biomechanics of the cervical spine after decompressive laminectomy remain uncertain. This case supports the ongoing research and need for more intensive research on postoperative cervical spine biomechanics, including decompressive laminectomies, decompressive laminectomy and fusion, and laminoplasty.

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

Science.gov (United States)

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

2000-07-01

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

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

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Lepore, Angelo C

2011-09-18

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

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

International Nuclear Information System (INIS)

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

1997-01-01

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

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

NARCIS (Netherlands)

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

2013-01-01

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

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

NARCIS (Netherlands)

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

2013-01-01

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

A comparison of cervical cancer screening rates among women with traumatic spinal cord injury and the general population.

Science.gov (United States)

Guilcher, Sara J T; Newman, Alice; Jaglal, Susan B

2010-01-01

Previous qualitative and survey studies have suggested women with spinal cord injury (SCI) are screened less often for cervical cancer compared with the general population. We investigated whether cervical cancer screening rates differ between population-based women with and without traumatic SCI, matched for age and geography. A double cohort design was used, comparing women with SCI to the general population (1:4) using administrative data for Ontario, Canada. Women with SCI, identified using the Discharge Abstract Database for the fiscal years 1995-1996 to 2001-2002, were female residents of Ontario between the ages of 25 and 66, admitted to an acute care facility with a traumatic SCI (ICD-9 CM code 806 or 952). Women in the general Ontario population were randomly matched by age and geography. Screening rates were calculated from fee codes related to Papanicolaou (Pap) smear tests for a 3-year period preinjury and postinjury. There were 339 women with SCI matched to 1506 women in the general Ontario population. Screening rates pre-SCI were 55% for women with SCI and 57% during this same time period for matched women in the general population; post-SCI rates were 58% for both the two groups. Factors predicting the likelihood of receiving a Pap test for SCI cases included younger age and higher socioeconomic status. Utilization data suggest that there are no significant differences in screening rates for women with SCI compared with the general population. However, screening rates for women with SCI were significantly influenced by age as well as income.

Post-traumatic upper cervical subluxation visualized by MRI: a case report

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Demetrious James

2007-12-01

Full Text Available Abstract Background This paper describes MRI findings of upper cervical subluxation due to alar ligament disruption following a vehicular collision. Incidental findings included the presence of a myodural bridge and a spinal cord syrinx. Chiropractic management of the patient is discussed. Case presentation A 21-year old female presented with complaints of acute, debilitating upper neck pain with unremitting sub-occipital headache and dizziness following a vehicular collision. Initial emergency department and neurologic investigations included x-ray and CT evaluation of the head and neck. Due to persistent pain, the patient sought chiropractic care. MRI of the upper cervical spine revealed previously unrecognized clinical entities. Conclusion This case highlights the identification of upper cervical ligamentous injury that produced vertebral subluxation following a traumatic incident. MRI evaluation provided visualization of previously undetected injury. The patient experienced improvement through chiropractic care.

Follow-up CT myelography of severe cervical spinal cord injury

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

1987-11-01

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

Follow-up CT myelography of severe cervical spinal cord injury

International Nuclear Information System (INIS)

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

1987-01-01

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

Traumatic spinal cord injury in the north-east Tanzania - describing incidence, etiology and clinical outcomes retrospectively.

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Moshi, Haleluya; Sundelin, Gunnevi; Sahlen, Klas-Göran; Sörlin, Ann

2017-01-01

Causes, magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region. There is a scarcity of literature on profile of traumatic spinal cord injury to inform prevention and rehabilitation of this health condition in African rural settings, particularly Tanzania. To describe the incidence, etiology and clinical outcomes of traumatic spinal cord injury and issues related to retrospective study in underdeveloped setting. Records for patients with traumatic spinal cord injury for five consecutive years (2010-2014) were obtained retrospectively from the admission wards and health records archives of the Kilimanjaro Christian Medical Center. Sociodemographic, cause, complications and patients' condition on discharge were recorded and analyzed descriptively. The admission books in the wards registered 288 new traumatic spinal cord injury cases from January 2010 to December 2014. Of the 288 cases registered in the books, 224 were males and 64 females with mean age 39.1(39.1 ± 16.3) years and the majority of individuals 196(68.1%) were aged between 16 and 45 years. A search of the hospital archives provided 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). Cervical 81(39.9%) and lumbar 71(34.74%) spinal levels were the most affected. The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million population. The most documented complications were pressure ulcers 42(19.7%), respiratory complications 32(15.0%) and multiple complications 28(13.1%). The mean length of hospital stay was 64.2 ± 54.3 days and the mortality rate was 24.4%. Prevention of traumatic spinal cord injury in North-east Tanzania should consider falls (particularly from height) as the leading cause, targeting male teenagers and young adults. Pressure ulcers, respiratory

Cervical stenosis in spinal cord injury and disorders.

Science.gov (United States)

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

2016-07-01

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

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

Science.gov (United States)

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

2018-05-01

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

Pathophysiology of cervical myelopathy.

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Baptiste, Darryl C; Fehlings, Michael G

2006-01-01

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

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

Science.gov (United States)

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

2017-05-01

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

Computed tomography in the foramen magnum and high cervical cord lesion

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Isu, T.; Ito, T.; Iwasaki, Y.; Tsuru, M. (Hokkaido Univ., Sapporo (Japan). School of Medicine); Kitaoka, K.

1981-10-01

The value of computed tomography in the spine and spinal cord disease recently has been well documented. However, little attention is made to the role of computed tomography in foramen magnum and high cervical cord lesion. We report 16 cases of the foramen magnum and high cervical cord lesion. Method: Either EMI Head Scanner, CT 1010 (slice thickness 10 mm) or EMI Whole Body Scanner, CT 5005 (slice thickness 13 mm) was used. In 9 cases enhanced CT with intravenous injection of contrast medium was performed. Eleven cases received intrathecal injection of metrizamide. Materials: 1) control group without cervical pathology 70 cases, 2) spinal cord tumor 6 cases, 3) atlanto-axial dislocation 6 cases, 4) Chiari malformation (type 1) 3 cases, 5) spinal foreign body (acupuncture needle) 1 case. Results: 1. plain CT. 1) In control group without cervical pathology the cervical cord at C/sub 1/ level was seen as area surrounded by ring of subarachnoid space. 2) In 14 cases except for 1 case of atlanto-axial dislocation and 1 case of spinal foreign body identification of the cervical cord at C/sub 1/ level was impossible. 3) CT was of diagnostic value in detecting altanto-axial dislocation and spinal foreign body. 2. enhanded CT. Meningioma and neurinoma showed positive contrast enhancement. However, astrocytoma and herniated cerebellar tonsils were not detectable. 3. CT metrizamide myelography visualized the subarachnoid space and made it possible to localize the lesion in the spinal canal in relation to the spinal cord. Conclusion: Attention should be given to plain CT finding at C/sub 1/ level in diagnosis of foramen magnum and high cervical cord lesion. If identification of cervical cord at C/sub 1/ level is impossible, it is suspected that subarachnoid space is blocked by the lesion, and enhanced CT and CT metrizamide myelography must be performed.

Computed tomography in the foramen magnum and high cervical cord lesion

International Nuclear Information System (INIS)

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

1981-01-01

The value of computed tomography in the spine and spinal cord disease recently has been well documented. However, little attention is made to the role of computed tomography in foramen magnum and high cervical cord lesion. We report 16 cases of the foramen magnum and high cervical cord lesion. Method: Either EMI Head Scanner, CT 1010 (slice thickness 10 mm) or EMI Whole Body Scanner, CT 5005 (slice thickness 13 mm) was used. In 9 cases enhanced CT with intravenous injection of contrast medium was performed. Eleven cases received intrathecal injection of metrizamide. Materials: 1) control group without cervical pathology 70 cases, 2) spinal cord tumor 6 cases, 3) atlanto-axial dislocation 6 cases, 4) Chiari malformation (type 1) 3 cases, 5) spinal foreign body (acupuncture needle) 1 case. Results: 1. plain CT. 1) In control group without cervical pathology the cervical cord at C 1 level was seen as area surrounded by ring of subarachnoid space. 2) In 14 cases except for 1 case of atlanto-axial dislocation and 1 case of spinal foreign body identification of the cervical cord at C 1 level was impossible. 3) CT was of diagnostic value in detecting altanto-axial dislocation and spinal foreign body. 2. enhanded CT. Meningioma and neurinoma showed positive contrast enhancement. However, astrocytoma and herniated cerebellar tonsils were not detectable. 3. CT metrizamide myelography visualized the subarachnoid space and made it possible to localize the lesion in the spinal canal in relation to the spinal cord. Conclusion: Attention should be given to plain CT finding at C 1 level in diagnosis of foramen magnum and high cervical cord lesion. If identification of cervical cord at C 1 level is impossible, it is suspected that subarachnoid space is blocked by the lesion, and enhanced CT and CT metrizamide myelography must be performed. (author)

Traumatic spinal cord injury in MR imaging

International Nuclear Information System (INIS)

Bronarski, J.; Wozniak, E.

1993-01-01

Spinal cord injuries in tetraplegics were briefly discussed on the basis of MR imaging. It was found that severe cervical spine trauma usually results in concussion - the complete transection of the cord is rare. A case of 19 years old male with total cord transection confirmed by MR imaging is described. (author)

Cervical cord compression presenting with sciatica-like leg pain

OpenAIRE

Chan, Chee Keong; Lee, Ho-Yeon; Choi, Won-Chul; Cho, Ji Young; Lee, Sang-Ho

2010-01-01

Sciatica-like leg pain can be the main presenting symptom in patients with cervical cord compression. It is a false localizing presentation, which may lead to missed or delayed diagnosis, resulting in the wrong plan of management, especially in the presence of concurrent lumbar lesions. Medical history, physical findings and the results of imaging studies were reviewed in two cases of cervical cord compressions, which presented with sciatica-like leg pain. There was multi-level cervical spond...

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

Science.gov (United States)

2017-09-01

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

MR imaging in severe upper cervical spinal cord injury in childhood

International Nuclear Information System (INIS)

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

1990-01-01

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

MR imaging of acute cervical spine injuries

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

1995-01-15

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

MR imaging of acute cervical spine injuries

International Nuclear Information System (INIS)

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

1995-01-01

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

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

Science.gov (United States)

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

2017-04-01

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

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

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)

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.)

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.)

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

Science.gov (United States)

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

1997-01-01

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

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

Science.gov (United States)

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

2015-04-01

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

Post-traumatic cervical pneumorrhachis--a rare entity.

Science.gov (United States)

Gill, Maneet; Sreenivas, Mukkamala; Beniwal, Rajveer Singh

2011-02-01

Pneumorrhachis(PR) is a rare phenomenon and post traumatic PR even more so. Presentation can vary from asymptomatic to significant neurological deficit and so the management has to be individualised. We present a case of post-traumatic cervical PR.

Traumatic spinal cord injury in the United States, 1993-2012.

Science.gov (United States)

Jain, Nitin B; Ayers, Gregory D; Peterson, Emily N; Harris, Mitchel B; Morse, Leslie; O'Connor, Kevin C; Garshick, Eric

2015-06-09

Acute traumatic spinal cord injury results in disability and use of health care resources, yet data on contemporary national trends of traumatic spinal cord injury incidence and etiology are limited. To assess trends in acute traumatic spinal cord injury incidence, etiology, mortality, and associated surgical procedures in the United States from 1993 to 2012. Analysis of survey data from the US Nationwide Inpatient Sample databases for 1993-2012, including a total of 63,109 patients with acute traumatic spinal cord injury. Age- and sex-stratified incidence of acute traumatic spinal cord injury; trends in etiology and in-hospital mortality of acute traumatic spinal cord injury. In 1993, the estimated incidence of acute spinal cord injury was 53 cases (95% CI, 52-54 cases) per 1 million persons based on 2659 actual cases. In 2012, the estimated incidence was 54 cases (95% CI, 53-55 cases) per 1 million population based on 3393 cases (average annual percentage change, 0.2%; 95% CI, -0.5% to 0.9%). Incidence rates among the younger male population declined from 1993 to 2012: for age 16 to 24 years, from 144 cases/million (2405 cases) to 87 cases/million (1770 cases) (average annual percentage change, -2.5%; 95% CI, -3.3% to -1.8%); for age 25 to 44 years, from 96 cases/million (3959 cases) to 71 cases/million persons (2930 cases), (average annual percentage change, -1.2%; 95% CI, -2.1% to -0.3%). A high rate of increase was observed in men aged 65 to 74 years (from 84 cases/million in 1993 [695 cases] to 131 cases/million [1465 cases]; average annual percentage change, 2.7%; 95% CI, 2.0%-3.5%). The percentage of spinal cord injury associated with falls increased significantly from 28% (95% CI, 26%-30%) in 1997-2000 to 66% (95% CI, 64%-68%) in 2010-2012 in those aged 65 years or older (P spinal cord injury remained relatively stable but, reflecting an increasing population, the total number of cases increased. The largest increase in incidence was observed in older

MR spectroscopy of cervical spinal cord in patients with multiple sclerosis

International Nuclear Information System (INIS)

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

2004-01-01

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

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

Science.gov (United States)

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

2014-05-01

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

Preliminary clinical applications of DTI in human cervical spinal cord

International Nuclear Information System (INIS)

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

2007-01-01

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

[Traumatic spinal complications of cervical arthrosis].

Science.gov (United States)

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

1996-02-17

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

Regional differences in radiosensitivity across the rat cervical spinal cord

International Nuclear Information System (INIS)

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

2005-01-01

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

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

African Journals Online (AJOL)

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

Cervical spinal canal narrowing and cervical neurologi-cal injuries

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ZHANG Ling

2012-04-01

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

Significance of T2 Hyperintensity on Magnetic Resonance Imaging After Cervical Cord Injury and Return to Play in Professional Athletes.

Science.gov (United States)

Tempel, Zachary J; Bost, Jeffrey W; Norwig, John A; Maroon, Joseph C

2015-07-01

Cervical cord magnetic resonance imaging (MRI) T2 hyperintensity is used as evidence of cord trauma in the evaluation and management of athletes in contact sports. The long-term pathophysiologic and prognostic value of this finding is poorly understood, especially in return to play (RTP). To examine the significance of T2 hyperintensity in the cervical spinal cord of professional athletes. Retrospective review of MRI T2 hyperintensity findings between 2007 and 2014 in 5 professional athletes. Pertinent examination and demographics, including mechanism of injury, surgical intervention, radiographs, MRI studies, long-term outcomes, and RTP recommendations were collected. Four National Football League players and 1 professional wrestler had prior traumatic neurapraxia that at the time of initial consultation had resolved. MRIs showed congenitally small cervical canal (1) and multilevel spondylosis/stenosis/disc herniation (4) along with focal cord T2 hyperintensity (5). The signal abnormalities were at C3/C4 (3), C4 mid-vertebral body (1), and C5/C6 (1). Four athletes had single-level anterior cervical discectomy and fusion, and 1 was nonoperative. Serial MRI imaging at 3 months after surgery showed hyperintensity partially resolved (4) and unchanged (1), and at 9-months 3 of the 5 completely resolved. Based on the author's RTP criteria, 4 of 5 were released to return to their sport. Clearance for RTP preceded complete resolution of MRI T2 hyperintensity in 3 of 4 athletes. The 2 athletes that have returned to profession sport have not had any additional episodes of neurapraxia or any cervical spine-related complications. MRI T2 hyperintensity in contact sport athletes who are symptom-free with normal examination and no evidence of spinal instability may not be a contraindication to RTP. Additional observations are needed to confirm this observation.

A profile of traumatic spinal cord injury and medical complications in Latvia

OpenAIRE

Nulle, Anda; Tjurina, Uljana; Erts, Renars; Vetra, Anita

2017-01-01

Study design A single centre retrospective study. Objectives To collect data and analyse the epidemiological profile of traumatic spinal cord injury and its medical complications during the subacute rehabilitation period. Setting Spinal Cord Injury Rehabilitation Programme of the National Rehabilitation Centre, ‘Vaivari’, Jurmala, Latvia. Methods Information was collected in 2015 from the medical records of 134 patients with a traumatic spinal cord injury admitted for primary rehabilitation b...

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

International Nuclear Information System (INIS)

Zheng Kuihong; Ma Lin; Guo Xinggao; Liang Li

2006-01-01

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

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

International Nuclear Information System (INIS)

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

2015-01-01

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

Magnetic resonance imaging of spinal cord injury in chronic stage

International Nuclear Information System (INIS)

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

1991-01-01

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

Urodynamic Bladder Patterns in Spinal Cord Injury Patients

International Nuclear Information System (INIS)

Aziz, T.; Khan, A. A.; Iqbal, S.; Aziz, U.; Jilani, S.; Ayyub, A.

2017-01-01

Objective: To determine the frequency of various neurogenic bladder patterns in patients with traumatic spinal cord injury presenting at Armed Forces Institute of Rehabilitation Medicine Rawalpindi based on urodynamic studies. Study Design: Descriptive cross sectional study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi, from Jul 2014 to Jun 2016. Material and Methods: One hundred and forty traumatic spinal cord injury patients fulfilling the inclusion criteria were included both from indoor and outdoor departments through non-probability purposive sampling. Urodynamic studies were performed using the urodynamic equipment at urodynamic laboratory. Data were collected and recorded on specialized proforma by the principal investigator. Results: Among 140 study participants detrusor overactivity was found in 100 patients out of which 76 (76 percent) had thoracic level of injury, 20 (20 percent) had cervical level and 4 (4 percent) had lumbar level of injury. Detrusor areflexia was the bladder pattern in 40 patients out of which 26 (65 percent) had thoracic level of injury, 10 (25 percent) had cervical level, and 4 (10 percent) had lumbar level of injury. Conclusion: Detrusor overactivity was the commonest neurogenic bladder pattern among the traumatic spinal cord injury patients. (author)

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

Science.gov (United States)

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

2000-04-01

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

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

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

1993-12-31

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

Non-traumatic spinal cord compression at Parirenyatwa Hospital in ...

African Journals Online (AJOL)

Compression of the spinal cord by encroachment on its space is of major importance as a cause of injury to its tissues, with serious neurological consequences. Patients with non-traumatic spinal cord compression represent a significant proportion of paraplegic/paretic individuals attended to in the neurosurgical units in ...

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

International Nuclear Information System (INIS)

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

2003-01-01

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

Change in the profile of traumatic spinal cord injury over 15 years in Spain.

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Bárbara-Bataller, Enrique; Méndez-Suárez, José Luis; Alemán-Sánchez, Carolina; Sánchez-Enríquez, Jesús; Sosa-Henríquez, Manuel

2018-04-05

Traumatic spinal cord injury remains a serious public health and social problem. Although incidence rates are decreasing in our environment, it is a high cost condition that is associated with great disability. The objective of this study was to describe the epidemiological and demographic characteristics of traumatic spinal cord injury and to analyse its epidemiological changes. This study was an observational study with prospective monitoring of all traumatic spinal cord injury patients in the Canary Islands, Spain (2.1 million inhabitants) between 2001 and 2015. Over the specified period of the study, 282 patients suffered a traumatic spinal cord injury. The crude incidence rate was 9.3 cases per million people/year. The patients' mean age increased from 38 years (2001-2005) to 48 years (2011-2015) (p spinal cord injury were falls in 44%, traffic accidents in 36.5%, diving accidents in 8.9% and others in 10.7%. While traffic accidents decreased, falls increased, particularly in the elderly (p injuries and injuries associated with poor functionality (p spinal cord injury in our environment. This change in the profile of new traumatic spinal cord injuries led us to reformulate the functional objectives planned for these patients upon admission to specialized units, to plan destination-upon-discharge in advance and to promote campaigns to prevent spinal cord injury in older adults.

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

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

1998-01-01

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

MR imaging of multiple sclerosis in the cervical cord

International Nuclear Information System (INIS)

Shakudo, Miyuki; Takemoto, Kazumasa; Inoue, Yuichi; Onoyama, Yasuto; Nishimura, Masataka; Fujita, Masayuki.

1987-01-01

This is a case of a 34-year-old woman with multiple sclerosis (MS) in whom an enlarged cervical spinal cord with long T 1 and T 2 relaxation times was demonstrated on MR images. This report seems to be the first description of MR imaging of MS with an enlarged spinal cord. (author)

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

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Choi, Soo Jung; Shin, Myung Jin; Kim, Sung Moon; Bae, Sang Jin

2004-01-01

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

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

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

2004-12-15

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

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

International Nuclear Information System (INIS)

Suzuki, Masahiro; Shimamura, Tadashi

1994-01-01

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

GLT1 overexpression reverses established neuropathic pain-related behavior and attenuates chronic dorsal horn neuron activation following cervical spinal cord injury.

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Falnikar, Aditi; Hala, Tamara J; Poulsen, David J; Lepore, Angelo C

2016-03-01

Development of neuropathic pain occurs in a major portion of traumatic spinal cord injury (SCI) patients, resulting in debilitating and often long-term physical and psychological burdens. Following SCI, chronic dysregulation of extracellular glutamate homeostasis has been shown to play a key role in persistent central hyperexcitability of superficial dorsal horn neurons that mediate pain neurotransmission, leading to various forms of neuropathic pain. Astrocytes express the major CNS glutamate transporter, GLT1, which is responsible for the vast majority of functional glutamate uptake, particularly in the spinal cord. In our unilateral cervical contusion model of mouse SCI that is associated with ipsilateral forepaw heat hypersensitivity (a form of chronic at-level neuropathic pain-related behavior), we previously reported significant and long-lasting reductions in GLT1 expression and functional GLT1-mediated glutamate uptake in cervical spinal cord dorsal horn. To therapeutically address GLT1 dysfunction following cervical contusion SCI, we injected an adeno-associated virus type 8 (AAV8)-Gfa2 vector into the superficial dorsal horn to increase GLT1 expression selectively in astrocytes. Compared to both contusion-only animals and injured mice that received AAV8-eGFP control injection, AAV8-GLT1 delivery increased GLT1 protein expression in astrocytes of the injured cervical spinal cord dorsal horn, resulting in a significant and persistent reversal of already-established heat hypersensitivity. Furthermore, AAV8-GLT1 injection significantly reduced expression of the transcription factor and marker of persistently increased neuronal activation, ΔFosB, in superficial dorsal horn neurons. These results demonstrate that focal restoration of GLT1 expression in the superficial dorsal horn is a promising target for treating chronic neuropathic pain following SCI. © 2015 Wiley Periodicals, Inc.

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

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

2015-10-01

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

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

International Nuclear Information System (INIS)

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

1993-01-01

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

CT-myelography of cervical cord injury

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Koyanagi, Izumi; Isu, Toyohiko; Iwasaki, Yoshinobu

1986-01-01

We reported seven cases of acute cervical cord injuries who were examined by CT-Myelography (CTM) within 7 days after trauma. The presence or absence of spinal cord enlargement, the initial neurological status and the neurological prognosis of these patients were studied. The neurological status of each patient was graded by the method of Frankel who defined five grades from A to E according to the severity of neurological deficits. Seven patients were all males. The youngest was 18 and the oldest was 73 years old, with a mean age of 40.7 years. Follows up periods ranged from 7 to 23 months. Result: CTM revealed the enlargement of spinal cord in two cases, who had severe neurological deficits and were graded to A. No neurological improvements were obtained in these cases. Five cases without cord enlargement were graded to A in one patient, B in one patient and C in three patients. Four of these five patients improved neurologically. One grade C patient remained grade C. Complete block of subarachnoid space was observed in two out of seven cases. Cord enlargement was present in one of them. Another case of complete block improved from C to D. Conclusion: We consider the presence of cord enlargement which can be demonstrated by CTM well correlates the severity of the cord damage and presume poor neurological prognosis. Internal decompression, such as posterior longitudinal myelotomy may be recommended to the case of cord enlargement. When the cord enlargement is absent, improvement of neurological grade is expected although the initial neurological status shows severe deficits. (author)

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

International Nuclear Information System (INIS)

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

2009-01-01

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

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

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Murphy Donald R

2009-08-01

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

Morphology of the cervical spinal cord on computed myelography

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

1979-01-01

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

Diagnosis of cervical spinal cord disorders with MRI

International Nuclear Information System (INIS)

Suyama, Naohito; Iizuka, Tadashi

1991-01-01

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

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

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

2016-07-01

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

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.)

Traumatic spinal cord injuries – epidemiologic and medico-legal issues

OpenAIRE

Hanganu Bianca; Velnic Andreea Alexandra; Petre-Ciudin Valentin; Manoilescu Irina; Ioan Beatrice Gabriela

2017-01-01

Spinal cord injuries represent a special category of injuries in traumatic pathology, with high morbidity and mortality, which justify their analysis with the aim to identify useful aspects in order to prevent and treat them. We therefore performed a retrospective study on 426 cases in order to analyze epidemiology and medico-legal issues related to spinal cord injuries. The studied items regarded socio-demographic aspects (gender, age, home region), type of lesions (vertebral, spinal cord, a...

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

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Prasad, Abhishek; Sahin, Mesut

2006-12-01

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

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

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Lennart Riemann

2018-06-01

Full Text Available Inflammation after traumatic spinal cord injury (SCI is non-resolving and thus still present in chronic injury stages. It plays a key role in the pathophysiology of SCI and has been associated with further neurodegeneration and development of neuropathic pain. Neural precursor cells (NPCs have been shown to reduce the acute and sub-acute inflammatory response after SCI. In the present study, we examined effects of NPC transplantation on the immune environment in chronic stages of SCI. SCI was induced in rats by clip-compression of the cervical spinal cord at the level C6-C7. NPCs were transplanted 10 days post-injury. The functional outcome was assessed weekly for 8 weeks using the Basso, Beattie, and Bresnahan scale, the CatWalk system, and the grid walk test. Afterwards, the rats were sacrificed, and spinal cord sections were examined for M1/M2 macrophages, T lymphocytes, astrogliosis, and apoptosis using immunofluorescence staining. Rats treated with NPCs had compared to the control group significantly fewer pro-inflammatory M1 macrophages and reduced immunodensity for inducible nitric oxide synthase (iNOS, their marker enzyme. Anti-inflammatory M2 macrophages were rarely present 8 weeks after the SCI. In this model, the sub-acute transplantation of NPCs did not support survival and proliferation of M2 macrophages. Post-traumatic apoptosis, however, was significantly reduced in the NPC group, which might be explained by the altered microenvironment following NPC transplantation. Corresponding to these findings, reactive astrogliosis was significantly reduced in NPC-transplanted animals. Furthermore, we could observe a trend toward smaller cavity sizes and functional improvement following NPC transplantation. Our data suggest that transplantation of NPCs following SCI might attenuate inflammation even in chronic injury stages. This might prevent further neurodegeneration and could also set a stage for improved neuroregeneration after SCI.

Magnetic resonance imaging of post-traumatic syringomyelia and its surgical treatment

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Isu, Toyohiko; Iwasaki, Yoshinobu; Nunomura, Mitsuru; Akino, Minoru; Koyanagi, Izumi; Abe, Hiroshi [Hokkaido Univ., Sapporo (Japan). School of Medicine; Saito, Hisatoshi

1991-01-01

The purpose of this study was to review magnetic resonance imaging (MRI) scans of post-traumatic syringomyelia and to assess the outcome of surgical treatment. The subjects were 16 patients (13 men and 3 women) whose ages ranged from 22 to 69 years, with a mean of 42 years. Nine patients had delayed neurologic symptoms 2 years and 2 months through 32 years after spinal injuries. The site of initial spinal cord injury was the lower cervical region in 4 patients, the thoracic region in 8, and the upper lumbar region in 4. In all patients, post-traumatic syringomyelia was easy to diagnose on MRI. MRI showed the syrinx extending superiorly and/or inferiorly from the area of old trauma, sometimes extending to the medulla oblongata. In the cervical cord and the upper thoracic cord, the syrinx was unilaterally or bilaterally situated in the postero-lateral portion. Below the middle thoracic cord, the syrinx was centrally located. Surgery was performed in 6 patients. At an average follow up of 2 years and 9 months, both pain and numbness were relieved in all patients (100%) and neurologic symptoms improved in 5 patients (83%). Post-traumatic syringomyelia should be considered in all patients having delayed onset or aggravation of neurologic symptoms after spinal injury. MRI appears promising for the early diagnosis of post-traumatic syringomyelia that can be treated favorably by surgical procedures. (N.K.).

Magnetic resonance imaging of post-traumatic syringomyelia and its surgical treatment

International Nuclear Information System (INIS)

Isu, Toyohiko; Iwasaki, Yoshinobu; Nunomura, Mitsuru; Akino, Minoru; Koyanagi, Izumi; Abe, Hiroshi; Saito, Hisatoshi.

1991-01-01

The purpose of this study was to review magnetic resonance imaging (MRI) scans of post-traumatic syringomyelia and to assess the outcome of surgical treatment. The subjects were 16 patients (13 men and 3 women) whose ages ranged from 22 to 69 years, with a mean of 42 years. Nine patients had delayed neurologic symptoms 2 years and 2 months through 32 years after spinal injuries. The site of initial spinal cord injury was the lower cervical region in 4 patients, the thoracic region in 8, and the upper lumbar region in 4. In all patients, post-traumatic syringomyelia was easy to diagnose on MRI. MRI showed the syrinx extending superiorly and/or inferiorly from the area of old trauma, sometimes extending to the medulla oblongata. In the cervical cord and the upper thoracic cord, the syrinx was unilaterally or bilaterally situated in the postero-lateral portion. Below the middle thoracic cord, the syrinx was centrally located. Surgery was performed in 6 patients. At an average follow up of 2 years and 9 months, both pain and numbness were relieved in all patients (100%) and neurologic symptoms improved in 5 patients (83%). Post-traumatic syringomyelia should be considered in all patients having delayed onset or aggravation of neurologic symptoms after spinal injury. MRI appears promising for the early diagnosis of post-traumatic syringomyelia that can be treated favorably by surgical procedures. (N.K.)

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

International Nuclear Information System (INIS)

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

1987-01-01

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

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery

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

2017-01-01

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

Effect of technique and timing of tracheostomy in patients with acute traumatic spinal cord injury undergoing mechanical ventilation

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Ganuza, Javier Romero; Forcada, Angel Garcia; Gambarrutta, Claudia; De La Lastra Buigues, Elena Diez; Gonzalez, Victoria Eugenia Merlo; Fuentes, Fátima Paz; Luciani, Alejandro A.

2011-01-01

Objective To assess the effect of timing and techniques of tracheostomy on morbidity, mortality, and the burden of resources in patients with acute traumatic spinal cord injuries (SCIs) undergoing mechanical ventilation. Design Review of a prospectively collected database. Setting Intensive and intermediate care units of a monographic hospital for the treatment of SCI. Participants Consecutive patients admitted to the intensive care unit (ICU) during their first inpatient rehabilitation for cervical and thoracic traumatic SCI. A total of 323 patients were included: 297 required mechanical ventilation and 215 underwent tracheostomy. Outcome measures Demographic data, data relevant to the patients’ neurological injuries (level and grade of spinal cord damage), tracheostomy technique and timing, duration of mechanical ventilation, length of stay at ICU, incidence of pneumonia, incidence of perioperative and early postoperative complications, and mortality. Results Early tracheostomy (tracheostomy was performed in 101 patients (47%) and late (≥7 days) in 114 (53%). Surgical tracheostomy was employed in 119 cases (55%) and percutaneous tracheostomy in 96 (45%). There were 61 complications in 53 patients related to all tracheostomy procedures. Two were qualified as serious (tracheoesophageal fistula and mediastinal abscess). Other complications were mild. Bleeding was moderate in one case (late, percutaneous tracheostomy). Postoperative infection rate was low. Mortality of all causes was also low. Conclusion Early tracheostomy may have favorable effects in patients with acute traumatic SC. Both techniques, percutaneous and surgical tracheostomy, can be performed safely in the ICU. PMID:21528630

Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders.

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Etingen, Bella; Locatelli, Sara M; Miskevics, Scott; LaVela, Sherri L

2017-07-26

The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder. A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder. Veterans with (vs. without) post-traumatic stress disorder (n = 896) reported lower social participation (40.2 vs. 43.9, p stress disorder, while a greater number of health conditions (OR = 1.43, 95% CI: 1.25-1.64, p stress disorder (OR = 0.94, 95% CI: 0.90-0.98, p = 0.003). Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation. Implications for Rehabilitation Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences. Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder. Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans

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

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

2015-10-01

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

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

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Mohamed-Mounir El Mendili

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

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

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

2015-01-01

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

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

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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

Cannabis use in persons with traumatic spinal cord injury in Denmark

DEFF Research Database (Denmark)

Andresen, Sven R; Biering-Sørensen, Fin; Hagen, Ellen Merete

2017-01-01

OBJECTIVE: To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences. DESIGN: Cross-sectional survey in Denmark. METHODS: A 35-item questionnaire was sent to 1,101 pati......OBJECTIVE: To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences. DESIGN: Cross-sectional survey in Denmark. METHODS: A 35-item questionnaire was sent to 1......,101 patients with spinal cord injury who had been in contact with a rehabilitation centre between 1990 and 2012. RESULTS: A total of 537 participants completed the questionnaire. Of these, 36% had tried cannabis at least once and 9% were current users. Of current users, 79% had started to use cannabis before...... their spinal cord injury. The main reason for use was pleasure, but 65% used cannabis partly for spinal cord injury-related consequences and 59% reported at least good effect on pain and spasticity. Negative consequences of use were primarily inertia and feeling quiet/subdued. Lower age, living in rural areas...

Traumatic spinal cord lesions: impact of comprehensive nursing care

OpenAIRE

Roshanpour, Farah; Pourmirza, Reza; Khodarahmi, Reza; Saleki, Alireza

2012-01-01

Abstract: Background: In the United States, about 12,000 spinal cord injuries (SCIs) are reported each year. The mean age of involved individuals is 39.5 years and 80 percent of victims are men. Most of spinal cord injuries are accompanied with brain traumatic lesions. In this way, nursing care may be important in preventing of undesired injuries. Methods: In this paper, relevant literature published in various periodicals as well as book resources are reviewed. Results: The main goal of SCI ...

MRI findings of traumatic cervical disc herniation

International Nuclear Information System (INIS)

Tanaka, Hisato; Kasahara, Takaki; Akiyama, Nanae

2011-01-01

In general practice, disc hernia is increasingly being questioned about its relation with traffic injuries. In this study, we examined the image findings of cervical disc herniation for findings indicative of traumatic hernia. In 2008, we examined 35 cases of cervical disc herniation at our hospital by MRI. The patients were divided into two groups; patients with trauma history (19 cases) and those without (16 cases), and their images were compared. Disc herniation in the trauma group showed high intensity at T2, with some of the patients in this group also indicating continuous high intensity of the internal and herniated discs. Traumatic force was found to cause swelling under the laryngeal soft tissue. Cases with further flexion injury showed interspinous ligament hemorrhage. These findings strongly suggest the involvement of injury. But given that some younger patients in the non-trauma group also show high intensity at T2*, attention must be paid not to confuse swelling below the larynx with inflammation of the longus colli muscle. (author)

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

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

2017-10-01

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

Outcome of Cloward technique in cervical disc prolapse.

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Rehman, Lal; Qayoom Khan, Hina Abdul; Hashim, A Sattar M

2010-11-01

To determine the association of pre-operative assessment of MRI findings, neurological status and symptoms with postoperative Cloward surgical outcome in cervical disc prolapse. Descriptive study. The Neurosurgery Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from May 2008 to May 2009. Patients presenting with neck pain, brachialgia, limb weakness and spasticity were clinically examined for pre-operative neurological status of power, reflexes and sensation. The exclusion criteria were, cervical disc prolapsed patients, planned for smith-Robinson and micro-discectomy, traumatic cervical disc prolapse and cervical spondylosis. Neuroradiological investigations included cervical spine X-rays and MRI. All patients were surgically treated for cervical prolapsed intervertebral disc with anterior cervical discectomy and interbody fusion with Cloward technique. Postoperative neck immobilization was done with cervical collar for 7-8 weeks. Drain was removed on first postoperative day while check plain cervical X-rays were taken on third day. Results were analysed using chi-square test with significance at p cervical disc prolapse were C 5-6 (43.3%) and C 6-7 (23.3%); 26 (86.6%) patients had disc herniation causing thecal effacement with cord compression and 04 (13.3%) patients showed ischemia of cord. Single-level Cloward surgery done in 26 (86.3%) patients while two-level Cloward surgery performed in 04 (13.3%) only. About 83.3% patients improved and 13.3% did not while 01 patient was re-operated. No complications and mortality was related to the surgical procedure. Statistically different variables identified, related to outcome were pre-operative neurological status (p=0.001) and spinal cord involvement on MRI (p=0.001). Cloward technique for cervical disc prolase was simple and safe surgical procedure with favourable results and few complications; 100% fusion occurred after Cloward surgery, even without instrumentation. Outcome was significantly

Rapid myelin water imaging in human cervical spinal cord.

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

2017-10-01

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

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

International Nuclear Information System (INIS)

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

2002-01-01

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

Acute Scrotum Following Traumatic Spermatic Cord Hematoma: A Case Report and Review

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Pietro Pepe

2015-03-01

Full Text Available Acute scrotum constitutes the most common urological emergency secondary to spermatic cord torsion, testicular trauma, orchiepididymitis and hernias. We report a very rare case of unique traumatic spermatic cord hematoma following scrotum injury occurred during a football match. Clinical exam showed an increased volume of the left spermatic cord; the color Doppler ultrasound (CDU demonstrated left testicular ischemia secondary to a large spermatic cord hematoma that needs surgical exploration. Spermatic cord hematoma rarely induces acute scrotum, however it could be treated conservatively surgery is mandatory when pain is persistent or testicular ischemia is confirmed by CDU.

Unraveling ALS due to SOD1 mutation through the combination of brain and cervical cord MRI.

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Agosta, Federica; Spinelli, Edoardo Gioele; Marjanovic, Ivan V; Stevic, Zorica; Pagani, Elisabetta; Valsasina, Paola; Salak-Djokic, Biljana; Jankovic, Milena; Lavrnic, Dragana; Kostic, Vladimir S; Filippi, Massimo

2018-02-20

To explore structural and functional changes of the brain and cervical cord in patients with amyotrophic lateral sclerosis (ALS) due to mutation in the superoxide dismutase ( SOD1 ) gene compared with sporadic ALS. Twenty patients with SOD1 ALS, 11 with sporadic ALS, and 33 healthy controls underwent clinical evaluation and brain MRI. Cortical thickness analysis, diffusion tensor MRI of the corticospinal tracts (CST) and corpus callosum, and resting-state functional connectivity were performed. Patients with ALS also underwent cervical cord MRI to evaluate cord cross-sectional area and magnetization transfer ratio (MTR). Patients with SOD1 ALS showed longer disease duration and slower rate of functional decline relative to those with sporadic ALS. No cortical thickness abnormalities were found in patients with ALS compared with controls. Fractional anisotropy showed that sporadic ALS patients had significant CST damage relative to both healthy controls ( p = 0.001-0.02) and SOD1-related ALS ( p = 0.05), although the latter showed alterations that were intermediate between controls and sporadic ALS. Functional hyperconnectivity of the motor cortex in the sensorimotor network was observed in patients with sporadic ALS relative to controls. Conversely, patients with SOD1 ALS showed lower cord cross-sectional area along the whole cervical cord relative to those with sporadic ALS ( p ALS showed cervical cord atrophy relative to those with sporadic ALS and a relative preservation of brain motor structural and functional networks. Neurodegeneration in SOD1 ALS is likely to occur primarily in the spinal cord. An objective and accurate estimate of spinal cord damage has potential in the future assessment of preventive SOD1 ALS therapies. © 2018 American Academy of Neurology.

Promising neuroprotective strategies for traumatic spinal cord injury with a focus on the differential effects among anatomical levels of injury [version 1; referees: 2 approved

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Antigona Ulndreaj

2017-10-01

Full Text Available Traumatic spinal cord injury (SCI is a devastating condition of motor, sensory, and autonomic dysfunction. The significant cost associated with the management and lifetime care of patients with SCI also presents a major economic burden. For these reasons, there is a need to develop and translate strategies that can improve outcomes following SCI. Given the challenges in achieving regeneration of the injured spinal cord, neuroprotection has been at the forefront of clinical translation. Yet, despite many preclinical advances, there has been limited translation into the clinic apart from methylprednisolone (which remains controversial, hypertensive therapy to maintain spinal cord perfusion, and early decompressive surgery. While there are several factors related to the limited translational success, including the clinical and mechanistic heterogeneity of human SCI, the misalignment between animal models of SCI and clinical reality continues to be an important factor. Whereas most clinical cases are at the cervical level, only a small fraction of preclinical research is conducted in cervical models of SCI. Therefore, this review highlights the most promising neuroprotective and neural reparative therapeutic strategies undergoing clinical assessment, including riluzole, hypothermia, granulocyte colony-stimulating factor, glibenclamide, minocycline, Cethrin (VX-210, and anti-Nogo-A antibody, and emphasizes their efficacy in relation to the anatomical level of injury. Our hope is that more basic research will be conducted in clinically relevant cervical SCI models in order to expedite the transition of important laboratory discoveries into meaningful treatment options for patients with SCI.

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

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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.

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

International Nuclear Information System (INIS)

Larsson, E.M.

1989-01-01

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

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

Neuroimaging for spine and spinal cord surgery

Energy Technology Data Exchange (ETDEWEB)

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)

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

Science.gov (United States)

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

2017-04-01

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

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

International Nuclear Information System (INIS)

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

1996-01-01

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

Sudden onset of cervical spondylotic myelopathy during sleep: a case report.

Science.gov (United States)

Young, Irene A; Burns, Stephen P; Little, James W

2002-03-01

Cervical spondylotic myelopathy is a common cause of compressive spinal cord dysfunction. The typical course involves either a gradual or an episodic increase in symptoms and neurologic deficits, with impairment evolving over a period of months to years. Acute neurologic deterioration in conjunction with cervical spondylosis has been described almost exclusively in traumatic situations such as disk herniation. We report a case of an acute, nontraumatic onset of tetraplegia in association with cervical spondylosis. A 56-year-old man developed tetraplegia during a 1-hour nap, with loss of volitional control of his extremities, impaired sensation below the C3 dermatome, and increased muscle tone. Magnetic resonance imaging of the cervical spine revealed canal stenosis and increased T2 signal within the cord. This case report describes the rehabilitation course for this patient and reviews the clinical spectrum of onset and progression of cervical spondylotic myelopathy. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Magnetic resonance imaging in cervical spinal cord compression

Directory of Open Access Journals (Sweden)

Giovanni Giammona

1993-09-01

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

Study of cervical cord injury without radiological abnormality using MRI at injury

International Nuclear Information System (INIS)

Park, Jin-Soo; Ei, Terumi; Uchida, Yoko; Kodai, Yujiro; Yasumatsu, Hideo; Yoshino, Kazutaka; Hirakawa, Takashi.

1994-01-01

This study was undertaken, using MRI at the time of injury, to examine cervical cord injury without radiological abnormality. The subjects were 30 patients (24 men and 6 women) seen during the 4-year period 1989-1993, who ranged in age from 31 to 83 years (an average age of 62.8 years). Of these patients, 10 had a slightly irregular alignment of the vertebral body on plain X-rays. These 10 patients were examined using MRI early after sustaining trauma (within 24 hours in 9 and 48 hours in one). As a result, spinal cord was seen as isointensity on T1-weighted images and hyperintensity on T2-weighted images, corresponding to irregular alignment. These findings suggest that reduction of a dislocation may transiently occur due to patient transfer or natural elasticity, as plain X-rays indicated no evidence of bone abnormalities. Thus injuries like dislocations may have occurred at the time of trauma, and structural changes of the vertebral body may be responsible for the occurrence of cervical spinal cord. Spinal cord injuries, even if not evidenced on plain X-rays, should not be categorized as non-osseous injuries. (N.K.)

Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study.

Science.gov (United States)

Popovic, Milos R; Zivanovic, Vera; Valiante, Taufik A

2016-01-01

Non-traumatic spinal cord pathology is responsible for 25-52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16-21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials, showing that functional electrical stimulation therapy (FEST) can restore voluntary reaching and/or grasping function, in people with stroke and traumatic SCI. Motivated by this success, we decided to examine changes in the upper limb function following FEST in a patient who suffered loss of hand function due to myelopathy secondary to cervical spondylosis. The participant was a 61-year-old male who had C3-C7 posterior laminectomy and instrumented fusion for cervical myelopathy. The participant presented with progressive right hand weakness that resulted in his inability to voluntarily open and close the hand and to manipulate objects unilaterally with his right hand. The participant was enrolled in the study ~22 months following initial surgical intervention. Participant was assessed using Toronto Rehabilitation Institute's Hand Function Test (TRI-HFT), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Spinal Cord Independence Measure (SCIM). The pre-post differences in scores on all measures clearly demonstrated improvement in voluntary hand function following 15 1-h FEST sessions. The changes observed were meaningful and have resulted in substantial improvement in performance of activities of daily living. These results provide preliminary evidence that FEST has a potential to improve upper limb function in patients with non-traumatic SCI, such as myelopathy secondary to cervical spondylosis.

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

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Zhang, Xiao-Yong; Yang, Ying-Ming

2016-06-01

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

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

International Nuclear Information System (INIS)

Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang

2009-01-01

Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

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Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang [Gachon University of Medicine and Science, Incheon (Korea, Republic of)

2009-12-15

Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

Traumatic spinal cord injury in MR imaging; Urazowe przerwanie ciaglosci rdzenia kregowego w obrazie MR

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Bronarski, J.; Wozniak, E. [Stoleczne Centrum Rehabilitacji, Konstancin (Poland)]|[Inst. Psychiatrii i Neurologii, Warsaw (Poland)

1993-12-31

Spinal cord injuries in tetraplegics were briefly discussed on the basis of MR imaging. It was found that severe cervical spine trauma usually results in concussion - the complete transection of the cord is rare. A case of 19 years old male with total cord transection confirmed by MR imaging is described. (author). 5 refs, 3 figs.

Induced Pluripotent Stem Cell Therapies for Cervical Spinal Cord Injury

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Doulames, Vanessa M.; Plant, Giles W.

2016-01-01

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

Neuroprotective effects of Ganoderma lucidum polysaccharides against traumatic spinal cord injury in rats.

Science.gov (United States)

Gokce, Emre Cemal; Kahveci, Ramazan; Atanur, Osman Malik; Gürer, Bora; Aksoy, Nurkan; Gokce, Aysun; Sargon, Mustafa Fevzi; Cemil, Berker; Erdogan, Bulent; Kahveci, Ozan

2015-11-01

Ganoderma lucidum (G. lucidum) is a mushroom belonging to the polyporaceae family of Basidiomycota and has widely been used as a traditional medicine for thousands of years. G. lucidum has never been studied in traumatic spinal cord injury. The aim of this study is to investigate whether G. lucidum polysaccharides (GLPS) can protect the spinal cord after experimental spinal cord injury. Rats were randomized into five groups of eight animals each: control, sham, trauma, GLPS, and methylprednisolone. In the control group, no surgical intervention was performed. In the sham group, only a laminectomy was performed. In all the other groups, the spinal cord trauma model was created by the occlusion of the spinal cord with an aneurysm clip. In the spinal cord tissue, caspase-3 activity, tumour necrosis factor-alpha levels, myeloperoxidase activity, malondialdehyde levels, nitric oxide levels, and superoxide dismutase levels were analysed. Histopathological and ultrastructural evaluations were also performed. Neurological evaluation was performed using the Basso, Beattie, and Bresnahan locomotor scale and the inclined-plane test. After traumatic spinal cord injury, increases in caspase-3 activity, tumour necrosis factor-alpha levels, myeloperoxidase activity, malondialdehyde levels, and nitric oxide levels were detected. After the administration of GLPS, decreases were observed in tissue caspase-3 activity, tumour necrosis factor-alpha levels, myeloperoxidase activity, malondialdehyde levels, and nitric oxide levels. Furthermore, GLPS treatment showed improved results in histopathological scores, ultrastructural scores, and functional tests. Biochemical, histopathological, and ultrastructural analyses and functional tests reveal that GLPS exhibits meaningful neuroprotective effects against spinal cord injury. Copyright © 2015 Elsevier Ltd. All rights reserved.

Magnetic resonance imaging of acute trauma of the cervical spine: spectrum of findings

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Forster, B.B.; Koopmans, R.A. [British Columbia Univ., Vancouver, BC (Canada). Faculty of Medicine

1995-06-01

The magnetic resonance imaging (MRI) spectrum of acute injury to the cervical spine was illustrated in this pictorial essay. The appearance of the traumatized cord was discussed, including intramedullary hemorrhage, and the causes of spinal cord compression, such as disk herniation, epidural hematoma, fracture, dislocation and underlying spinal stenosis. The ability of MRI to directly reveal the severity of cord injury and simultaneously indicate the cause of cord compression proved particularly useful in the management of incomplete injury, for which surgical intervention may prevent further deterioration. The protocol for MRI of cervical spinal trauma included sagittal T1-weighted and T2-weighted conventional spin-echo sequences. In addition, transverse T2-weighted gradient-echo images were obtained. MRI`s ability to directly reveal the extent of cord injury was said to be a powerful tool in the management of incomplete injuries where further deterioration could be prevented by timely surgical intervention. 7 refs., 12 figs.

[Central cervical cord syndrome: a case report on rehabilitation, with special references to accidental falls in the elderly].

Science.gov (United States)

Ina, G; Eto, F; Furuichi, T; Suzuki, H; Shibuya, K

1995-03-01

An 81-year-old man with Parkinson's disease was admitted to our hospital with impaired function of all extremities. Four weeks before his symptoms developed, he had tripped on the steps, fallen and bruised his jaw. Following this episode he experienced a few more falls inside his house. On examination his greatest weakness was in the hands and wrists. He was hyper-reflexic in all extremities and had bilateral Babinski's sign. He could not walk and needed physical assistance in most of his daily living activities. X-ray films of the cervical spine showed significant degenerative changes. The magnetic resonance images suggested central cervical cord damage at the level of the C6 vertebral body. After three months' rehabilitation treatment, he became able to walk with a cane and became independent in all the basic activities of daily living except for bathing. He never regained skillful function of his hands despite later levodopa treatment of Parkinson's disease. His clinical features were consistent with the central cervical cord syndrome, described by Schnneider and co-workers in 1954. This syndrome may occur as a result of hyperextension neck injury, occasionally associated with an accidental fall in the elderly with cervical spondylosis. Thirteen patients with cervical spinal cord injury above 65 of age were admitted to our department from 1983 to 1993. Six of them presented with the central cervical cord syndrome, and all patients had a history of accidental injuries related to falling.

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

Science.gov (United States)

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

2015-10-01

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

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

OpenAIRE

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

2013-01-01

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

Traumatic Migration of the Bryan Cervical Disc Arthroplasty.

Science.gov (United States)

Wagner, Scott C; Kang, Daniel G; Helgeson, Melvin D

2016-02-01

Study Design Case study. Objective To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5-C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively.

The cervical cord in amyotrophic lateral sclerosis. A comparison of the CT-myelography with pathological observation

International Nuclear Information System (INIS)

Sugamiya, Hitoshi; Tokumaru, Yukio; Arai, Kimihito; Hirayama, Keizo

1995-01-01

The spinal cord with amyotrophic lateral sclerosis was macroscopically examined in five patients using CT-myelography (CTM) and autopsied specimens. The autopsied ages were from 48 to 75 years old (average: 64), and their clinical follow-up periods were from 0.8 to 4.0 years (average: 1.9). Muscular atrophy developed from an upper limb in three patients, whereas from a lower limb in one case and from bulbar muscles in another case. Cervical CTM was performed at C3 to C7 cervical vertebrae less than one year (four cases) and 1.9 years (one case) prior to autopsy. The macroscopical examination of the CTM and autopsied specimens showed the following characteristics: Two patients, whose clinical courses were less than one year from the onset, showed no abnormalities. Three patients, whose clinical courses were more than one year from the onset, showed a marked cervical flattening and concave of the posterolateral fissure, especially at the lower cervical level. It was supposed that this lower cervical abnormalities caused pronounced amyotrophy in the upper limbs and pyramidal tract sign of the lower limbs. Although muscular atrophy was asymmetric in one case, the spinal cord was symmetric in macroscopic appearance in both CTM and autopsied specimens. It was concluded that marked flattening and concave at the posterolateral fissure of the lower cervical spinal cord were revealed by CTM in patients whose clinical courses of amyotrophic lateral sclerosis were more than one year from the onset. (author)

The cervical cord in amyotrophic lateral sclerosis. A comparison of the CT-myelography with pathological observation

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Sugamiya, Hitoshi; Tokumaru, Yukio; Arai, Kimihito; Hirayama, Keizo [Chiba Univ. (Japan). School of Medicine

1995-08-01

The spinal cord with amyotrophic lateral sclerosis was macroscopically examined in five patients using CT-myelography (CTM) and autopsied specimens. The autopsied ages were from 48 to 75 years old (average: 64), and their clinical follow-up periods were from 0.8 to 4.0 years (average: 1.9). Muscular atrophy developed from an upper limb in three patients, whereas from a lower limb in one case and from bulbar muscles in another case. Cervical CTM was performed at C3 to C7 cervical vertebrae less than one year (four cases) and 1.9 years (one case) prior to autopsy. The macroscopical examination of the CTM and autopsied specimens showed the following characteristics: Two patients, whose clinical courses were less than one year from the onset, showed no abnormalities. Three patients, whose clinical courses were more than one year from the onset, showed a marked cervical flattening and concave of the posterolateral fissure, especially at the lower cervical level. It was supposed that this lower cervical abnormalities caused pronounced amyotrophy in the upper limbs and pyramidal tract sign of the lower limbs. Although muscular atrophy was asymmetric in one case, the spinal cord was symmetric in macroscopic appearance in both CTM and autopsied specimens. It was concluded that marked flattening and concave at the posterolateral fissure of the lower cervical spinal cord were revealed by CTM in patients whose clinical courses of amyotrophic lateral sclerosis were more than one year from the onset. (author).

Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study

OpenAIRE

Popovic, Milos R.; Zivanovic, Vera; Valiante, Taufik A.

2016-01-01

Non-traumatic spinal cord pathology is responsible for 25–52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16–21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials,...

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.

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

Science.gov (United States)

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

2014-10-01

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

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)

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

International Nuclear Information System (INIS)

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

2007-01-01

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

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

Science.gov (United States)

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

2016-01-01

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

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

International Nuclear Information System (INIS)

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

2016-01-01

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

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

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

2016-03-15

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

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

International Nuclear Information System (INIS)

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

2010-01-01

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

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

International Nuclear Information System (INIS)

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

1980-01-01

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

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

International Nuclear Information System (INIS)

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

1997-01-01

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

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

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

1997-06-01

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

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

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

2017-10-01

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

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

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

2014-05-01

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

Computed tomography in cervical spondylotic myelopathy and radiculopathy: Visualisation of structures, myelographic comparison, cord measurements and clinical utility

International Nuclear Information System (INIS)

Yu, Y.L.; Du Boulay, G.H.; Stevens, J.M.; Kendall, B.E.

1986-01-01

Sixty-nine patients with cervical spondylotic myelopathy (CSM), radiculopathy (CSR), or both (CSMR) were studied with computed tomography (CT). Computer-assisted myelography (CAM) accurately determines the site and nature of spondylotic protrusions and provides good visualisation of the subarachnoid space and cord deformities even in areas with dilute metrizamide. However, excessive vertebral movement and bulging ligamenta flava with their effects on cord deformity, so easily visualised in myelograms, are completely or partially missed. In the assessment of CSM, metrizamide myelography (MM) followed by CAM should be performed, particularly when the myelographic images are unsatisfactory due to contrast dilution or blockage, when cord compression cannot be ascertained with MM and when cord atrophy is suspected. In CSR, the diagnostic information from MM and CAM is comparable. The diagnostic criteria in CAM are, however, less direct and since MM is adequate in uncomplicated cases, CAM is generally not necessary. The APD, APD/TD ratio, area and circularity are sensitive indices of cord deformity and the first two should be used more often to assist visual assessment of cord deformity. The relation between cord parameters and treatment response is better reflected in CSM cases managed conservatively and the results suggest that the degree of cord deformity is helpful in determining the outcome and hence the choice between surgical and conservative treatment. In plain CT, the osteophytes and calcified discs are adequately visualised and canal dimensions measured with accuracy, but the cervical cord and roots cannot be properly assessed and the diagnosis of CSM or CSR cannot be ascertained. At present, its role in cervical spondylosis is therefore limited. (orig.)

Acute traumatic spinal cord injury induces glial activation in the cynomolgus macaque (Macaca fascicularis).

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Miller, A D; Westmoreland, S V; Evangelous, N R; Graham, A; Sledge, J; Nesathurai, S

2012-06-01

Traumatic spinal cord injury leads to direct myelin and axonal damage and leads to the recruitment of inflammatory cells to site of injury. Although rodent models have provided the greatest insight into the genesis of traumatic spinal cord injury (TSCI), recent studies have attempted to develop an appropriate non-human primate model. We explored TSCI in a cynomolgus macaque model using a balloon catheter to mimic external trauma to further evaluate the underlying mechanisms of acute TSCI. Following 1hour of spinal cord trauma, there were focal areas of hemorrhage and necrosis at the site of trauma. Additionally, there was a marked increased expression of macrophage-related protein 8, MMP9, IBA-1, and inducible nitric oxide synthase in macrophages and microglia at the site of injury. This data indicate that acute TSCI in the cynomolgus macaque is an appropriate model and that the earliest immunohistochemical changes noted are within macrophage and microglia populations. © 2012 John Wiley & Sons A/S.

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

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

2008-07-01

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

Magnetic resonance tomography for trauma of the cervical spine

International Nuclear Information System (INIS)

Meydam, K.; Sehlen, S.; Schlenkhoff, D.; Kiricuta, J.C.; Beyer, H.K.

1986-01-01

Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed. (orig.) [de

Magnetic resonance tomography for trauma of the cervical spine

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Meydam, K.; Sehlen, S.; Schlenkhoff, D.; Kiricuta, J.C.; Beyer, H.K.

1986-12-01

Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed.

Traumatic spinal cord injuries – epidemiologic and medico-legal issues

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Hanganu Bianca

2017-12-01

Full Text Available Spinal cord injuries represent a special category of injuries in traumatic pathology, with high morbidity and mortality, which justify their analysis with the aim to identify useful aspects in order to prevent and treat them. We therefore performed a retrospective study on 426 cases in order to analyze epidemiology and medico-legal issues related to spinal cord injuries. The studied items regarded socio-demographic aspects (gender, age, home region, type of lesions (vertebral, spinal cord, association with other trauma, circumstances leading to trauma (cause of the injury, season, data regarding hospitalization (medical condition at the hospital admission, number of days of hospitalization, clinical diagnosis, imaging exploration level and data resulting from autopsy (diagnosis, toxicological examination. Most of our results are consistent with literature data, except for some epidemiological items, which might be explained with cultural differences, life style and inhomogeneous population. Based on our results, the general conclusion is the need for prevention campaigns, focusing on road traffic accidents and falls (especially in elderly as the main causes of spinal cord injuries.

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

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

1998-04-20

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

Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury

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Nobuhiro Tanaka

2018-01-01

Full Text Available Traumatic cervical syndrome comprises the various symptoms that occur as a result of external force such as that of a traffic accident. In 1995, the Quebec Task Force on whiplash-associated disorders (WAD formulated the Quebec classification, with accompanying clinical practice guidelines. These guidelines were in accordance with the stated clinical isolated or combined symptoms of the syndrome: neck pain, headaches, dizziness, numbness of head or face, eye pain, vision loss, double vision, tinnitus, hearing loss, nausea, and numbness and/or weakness of extremities. In recent years, cerebrospinal fluid hypovolemia or fibromyalgia has been recognized as a major notable cause of a variety of symptoms, although many clinical questions remain regarding the pathology of this syndrome. Therefore, its diagnosis and treatment should be conducted extremely carefully. While the Quebec classification and its guidelines are very useful for the normalization and standardization of symptoms of traumatic cervical syndrome, in the future, we would like to see the emergence of new guidelines that better address the diversity of this disease.

MR microscopy of the cervical spinal cord

International Nuclear Information System (INIS)

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

1988-01-01

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

The impact of spine stability on cervical spinal cord injury with respect to demographics, management, and outcome: a prospective cohort from a national spinal cord injury registry.

Science.gov (United States)

Paquet, Jérôme; Rivers, Carly S; Kurban, Dilnur; Finkelstein, Joel; Tee, Jin W; Noonan, Vanessa K; Kwon, Brian K; Hurlbert, R John; Christie, Sean; Tsai, Eve C; Ahn, Henry; Drew, Brian; Bailey, Christopher S; Fourney, Daryl R; Attabib, Najmedden; Johnson, Michael G; Fehlings, Michael G; Parent, Stefan; Dvorak, Marcel F

2018-01-01

Emergent surgery for patients with a traumatic spinal cord injury (SCI) is seen as the gold standard in acute management. However, optimal treatment for those with the clinical diagnosis of central cord syndrome (CCS) is less clear, and classic definitions of CCS do not identify a unique population of patients. The study aimed to test the authors' hypothesis that spine stability can identify a unique group of patients with regard to demographics, management, and outcomes, which classic CCS definitions do not. This is a prospective observational study. The sample included participants with cervical SCI included in a prospective Canadian registry. The outcome measures were initial hospitalization length of stay, change in total motor score from admission to discharge, and in-hospital mortality. Patients with cervical SCI from a prospective Canadian SCI registry were grouped into stable and unstable spine cohorts. Bivariate analyses were used to identify differences in demographic, injury, management, and outcomes. Multivariate analysis was used to better understand the impact of spine stability on motor score improvement. No conflicts of interest were identified. Compared with those with an unstable spine, patients with cervical SCI and a stable spine were older (58.8 vs. 44.1 years, p<.0001), more likely male (86.4% vs. 76.1%, p=.0059), and have more medical comorbidities. Patients with stable spine cervical SCI were more likely to have sustained their injury by a fall (67.4% vs. 34.9%, p<.0001), and have high cervical (C1-C4; 58.5% vs. 43.3%, p=.0009) and less severe neurologic injuries (ASIA Impairment Scale C or D; 81.3% vs. 47.5%, p<.0001). Those with stable spine injuries were less likely to have surgery (67.6% vs. 92.6%, p<.0001), had shorter in-hospital lengths of stay (median 84.0 vs. 100.5 days, p=.0062), and higher total motor score change (20.7 vs. 19.4 points, p=.0014). Multivariate modeling revealed that neurologic severity of injury and spine stability

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

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

2018-03-20

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

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

Science.gov (United States)

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

2017-01-01

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

Imaging of Spontaneous and Traumatic Cervical Artery Dissection : Comparison of Typical CT Angiographic Features.

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Sporns, Peter B; Niederstadt, Thomas; Heindel, Walter; Raschke, Michael J; Hartensuer, René; Dittrich, Ralf; Hanning, Uta

2018-01-26

Cervical artery dissection (CAD) is an important etiology of ischemic stroke and early recognition is vital to protect patients from the major complication of cerebral embolization by administration of anticoagulants. The etiology of arterial dissections differ and can be either spontaneous or traumatic. Even though the historical gold standard is still catheter angiography, recent studies suggest a good performance of computed tomography angiography (CTA) for detection of CAD. We conducted this research to evaluate the variety and frequency of possible imaging signs of spontaneous and traumatic CAD and to guide neuroradiologists' decision making. Retrospective review of the database of our multiple injured patients admitted to the Department of Trauma, Hand, and Reconstructive Surgery of the University Hospital Münster in Germany (a level 1 trauma center) for patients with traumatic CAD (tCAD) and of our stroke database (2008-2015) for patients with spontaneous CAD (sCAD) and CT/CTA on initial clinical work-up. All images were evaluated concerning specific and sensitive radiological features for dissection by two experienced neuroradiologists. Imaging features were compared between the two etiologies. This study included 145 patients (99 male, 46 female; 45 ± 18.8 years of age), consisting of 126 dissected arteries with a traumatic and 43 with spontaneous etiology. Intimal flaps were more frequently observed after traumatic etiology (58.1% tCADs, 6.9% sCADs; p < 0.001); additionally, multivessel dissections were much more frequent in trauma patients (3 sCADs, 21 tCADs) and only less than half (42%) of the patients with traumatic dissections showed cervical spine fractures. Neuroradiologists should be aware that intimal flaps and multivessel dissections are more common after a traumatic etiology. In addition, it seems important to conduct a CTA in a trauma setting, even if no cervical spine fracture is detected.

Anaesthetic and Intensive Care Management of Traumatic Cervical Spine Injury

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G S Umamaheswara Rao

2008-01-01

Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.

Early MRI findings in stab wound of the cervical spine: two case reports

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Alkan, A.; Baysal, T.; Sarac, K.; Sigirci, A.; Kutlu, R. [Inonu Universitesi Turgut Ozal Tip Merkezi, Radyoloji Anabilim Dali, Malatya (Turkey)

2002-01-01

MR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings. (orig.)

MR imaging findings of neuroschistosomiasis manifested as the cerebellar granuloma and transverse myelitis of cervical cord

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Hong, Hyun Sook; Kwon, Kui Hyang; Kim, Ki Jung; Choi, Soon Kwan; Lee, Dong Wha [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

1994-08-15

To our knowledge, MR findings of neuroshistosomiasis has not been reported in Korea. A case of neuroshistosomiasis involving cerebellum and presumably spinal cord is reported. A 40 years old man who had lived in Middle East complained of low back pain and progressive paraparesis for 6 months, and subsequently developed headache, dizziness and diplopia. On cervical sine MRI, there was diffuse enlargement of cervical cord with increased signal intensity on T2 weighted image and nodular heterogenous enhancement after Gd-DTPA administration. Brain MR imaging obtained 4 months later showed ill- defined, irregularly enhancing heterogenous mass in cerebellar vermis which was proved to be a granulomatous lesion containing schistosomiasis mansonil ova.

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

Science.gov (United States)

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

2011-01-01

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

Computed tomography in the treatment of cervical spinal cord tumors

International Nuclear Information System (INIS)

Shin, Hideo

1984-01-01

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

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

Directory of Open Access Journals (Sweden)

Steve Lacroix

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

Chronic neck pain patients with traumatic or non-traumatic onset

DEFF Research Database (Denmark)

Ris Hansen, Inge; Juul-Kristensen, Birgit; Boyle, Eleanor

2017-01-01

. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics...... tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index...... in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p = 0.005, cranio-cervical flexion test p = 0.007, cervical extensor test p = 0.006) and cervical pressure pain threshold bilateral (p = 0...

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

Science.gov (United States)

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

2015-11-01

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

Prospective observational research on the clinical profile and outcome analysis among a cohort of patients sustaining traumatic cervical spine and cord injury in a peripheral tertiary spine care centre in Nepal [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Sunil Munakomi

2017-11-01

Full Text Available Background: In developing nations like Nepal, spinal cord injury has multispectral consequences for both the patient and their family members. It has the tendency to cripple and handicap the patients, and burn out their caretakers, both physically and mentally. Furthermore, the centralization of health care with only a handful of dedicated rehabilitation centers throughout Nepal further places patients into disarray. This study was carried out as a pilot study to determine the modes of injury, age groups affected, clinical profiles and patterns of injury sustained, as well as the efficacy of managing a subset of patients, who have sustained cervical spine and cord injuries. Methods: This was a prospective cohort study comprising of 163 patients enrolled over a period of three years that were managed in the spine unit of College of Medical Sciences, Bharatpur, Nepal. Results: Road traffic accidents were implicated in 51% of these patients. 65% of them were in the age group of 30-39 years. Traumatic subluxation occurred in 73 patients with maximum involvement of the C4/5 region (28.76%. Good outcome was seen in patients with ASIA ‘C’ and ‘D’ with 55% of patients showed improvement from ‘C’ to ‘D’ and 95% of patients showed improvement from ‘D’ to ‘E’ at 1 year follow up. The overall mortality in the patients undergoing operative interventions was only 1.98%. Conclusions: The prevalence of cervical spine injuries in the outreach area is still significant. The outcome of managing these patients, even in the context of a resource limited setup in a spine unit outside the capital city of a developing nation, can be as equally as effective and efficient compared to the outcome from a well-equipped and dedicated spine unit elsewhere.

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

International Nuclear Information System (INIS)

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

1998-01-01

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

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

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

2011-08-15

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

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

International Nuclear Information System (INIS)

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

2010-01-01

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

The radiographic distinction of degenerative slippage (spondylolisthesis and retrolisthesis) from traumatic slippage of the cervical spine

International Nuclear Information System (INIS)

Lee, C.; Woodring, J.H.; Rogers, L.F.; Kim, K.S.

1986-01-01

In a review of 42 cases of degenerative arthritis of the cervical spine and 22 cases of cervical spine trauma with an observed anterior slip-page (spondylolisthesis) or posterior slippage (retrolisthesis) of the vertebral bodies of 2 mm or more, characteristic features were observed which allowed distinction between degenerative and traumatic slippage of the cervical spine. In degenerative slippage the shape of the articular facets and width of the facet joint space may remain normal; however, in most cases the articular facets become 'ground-down' with narrowing of the facet joint space and the articular facets themselves becoming thinned or ribbon-like. In traumatic slippage the articular facets will either be normally shaped or fractured and the facet joint space will be abnormally widened. Plain radiographs will usually allow this distinction to be made; however, in difficult cases polytomography may be required. (orig.)

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

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

Science.gov (United States)

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

2010-03-17

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

Cannabis use in persons with traumatic spinal cord injury in Denmark.

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Andresen, Sven R; Biering-Sørensen, Fin; Hagen, Ellen Merete; Nielsen, Jørgen F; Bach, Flemming W; Finnerup, Nanna B

2017-01-31

To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences. Cross-sectional survey in Denmark. A 35-item questionnaire was sent to 1,101 patients with spinal cord injury who had been in contact with a rehabilitation centre between 1990 and 2012. A total of 537 participants completed the questionnaire. Of these, 36% had tried cannabis at least once and 9% were current users. Of current users, 79% had started to use cannabis before their spinal cord injury. The main reason for use was pleasure, but 65% used cannabis partly for spinal cord injury-related consequences and 59% reported at least good effect on pain and spasticity. Negative consequences of use were primarily inertia and feeling quiet/subdued. Lower age, living in rural areas/larger cities, tobacco-smoking, high alcohol intake and higher muscle stiffness were significantly associated with cannabis use. Those who had never tried cannabis reported that they would mainly use cannabis to alleviate pain and spasticity if it were legalized. Cannabis use is more frequent among individuals with spinal cord injury in Denmark than among the general population. High muscle stiffness and various demographic characteristics (lower age, living in rural areas/larger cities, tobacco-smoking and high alcohol intake) were associated with cannabis use. Most participants had started using cannabis before their spinal cord injury. There was considerable overlap between recreational and disability-related use.

Road collisions as a cause of traumatic spinal cord injury in ireland, 2001-2010.

LENUS (Irish Health Repository)

Smith, Eimear

2014-01-01

Road collisions remain the leading cause of traumatic spinal cord injury (TSCI) in the world. Half of all TSCIs in Ireland in 2000 were caused by road collisions. Since then, there has been a downward trend in road fatalities coincident with implemented road safety strategies.

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

Science.gov (United States)

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

2013-09-01

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

Spinal Cord Injury without Radiographic Abnormality (SCIWORA) – Clinical and Radiological Aspects

OpenAIRE

Szwedowski, Dawid; Walecki, Jerzy

2014-01-01

Summary The acronym SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) was first developed and introduced by Pang and Wilberger who used it to define “clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability”. SCIWORA is a clinical-radiological condition that mostly affects children. SCIWORA lesions are found mainly in the cervical spine but can also be seen, although much less frequently, in the thoracic or l...

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

Science.gov (United States)

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

2013-10-15

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

Respiratory Disorders in Complicated Cervical Spine Injury

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S. A. Pervukhin

2016-01-01

Full Text Available Objective. Evaluating the results of respiratory therapy in patients with complicated traumatic injury of the cervical spine.Materials and methods. A retrospective comparative analysis of the clinical course was carried out in 52 patients with complicated traumatic injury of the cervical spine: group A: complete spinal cord injury (ASIA A, 37 patients and group B: incomplete injury (ASIA B, 15 patients. The severity of patients' status on integral scales, parameters of the respiratory pattern and thoracopulmonary compliance, gas composition, and acidbase status of the blood were assessed. Data on patients who required prolonged mechanical ventilation, duration of mechanical ventilation, incidence of nosocomial pneumonia, duration of stay in the ICU, time of hospital treatment, and mortality were included in the analysis. Results. The average APACHE II and SOFA scores were higher in group A patients. The development of the acute respiratory failure required longterm mechanical ventilation (more than 48 hours in 91.4% of group A patients and in 53.3% of group B patients. Ventilatorassociated pneumonia complicated the disease in 81.3% of group A patients and 62.5% of group B patients and was accompanied by sepsis in 25% and 12.5% of cases, respectively. Statistically significant deterioration of biomechanical properties and gas exchange function of the lungs was observed in patients complicated with septic pneumonia.Conclusion. Patients with complicated ASIA A and ASIA B cervical spine injuries demonstrate the presence of respiratory failure of neurogenic origin. In addition, the infectious bronchopulmonary complications aggravated respiratory failure in patients with ASIA A injury in 70.3% versus 33.3% in patients with ASIA B. Developmentof pulmonogenic sepsis led to deterioration of the biomechanical and gas exchange functions of the lungs and increased the likelihood of unfavorable outcome of the disease in 77.8% of cases. The high

Chronological observation in early radiation myelopathy of the cervical spinal cord

International Nuclear Information System (INIS)

Hirota, Saeko; Yoshida, Shoji; Soejima, Toshinori

1993-01-01

Gd-enhanced MR images of two patients with clinically and histopathologically diagnosed chronic progressive radiation myelitis (CPRM) were observed chronologically. One of them had had nasopharyngeal cancer and received radiotherapy at a dose of 100 Gy to the C1-2 level of the spinal cord. She developed CPRM 25 months after the termination of radiotherapy. The other had had malignant lymphoma originating from the tonsil and received chemoradiotherapy. The dose delivered to her cervical spinal cord was 40 Gy, and she developed CPRM 30 months later. Gd-enhanced MRI in the early phase revealed a small crescent-shaped nidus with or without a very small central nonenhanced area in both cases. Enhancement was not great. At that time, patients noticed only the inability to perceive pain and temperature or paresthesia in the opposite side. In a few months, MRI revealed a much more strongly enhanced and larger nidus with enlargement of a central nonenhanced area accompanied by long segmental cord enlargement. The patients' neurological symptoms had also progressed, with hemiparesis developing, for example. (author)

Venous hypertensive myelopathy associated with cervical spondylosis.

Science.gov (United States)

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

2016-11-01

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

Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States, 1972-2014.

Science.gov (United States)

Chen, Yuying; He, Yin; DeVivo, Michael J

2016-10-01

To document trends in the demographic and injury profile of new spinal cord injury (SCI) over time. Cross-sectional analysis of longitudinal data by injury years (1972-1979, 1980-1989, 1990-1999, 2000-2009, 2010-2014). Twenty-eight Spinal Cord Injury Model Systems centers throughout the United States. Persons with traumatic SCI (N=30,881) enrolled in the National Spinal Cord Injury Database. Not applicable. Age, sex, race, education level, employment, marital status, etiology, and severity of injury. Age at injury has increased from 28.7 years in the 1970s to 42.2 years during 2010 to 2014. This aging phenomenon was noted for both sexes, all races, and all etiologies except acts of violence. The percentage of racial minorities expanded continuously over the last 5 decades. Virtually among all age groups, the average education levels and percentage of single/never married status have increased, which is similar to the trends noted in the general population. Although vehicular crashes continue to be the leading cause of SCI overall, the percentage has declined from 47.0% in the 1970s to 38.1% during 2010 to 2014. Injuries caused by falls have increased over time, particularly among those aged ≥46 years. Progressive increases in the percentages of high cervical and motor incomplete injuries were noted for various age, sex, race, and etiology groups. Study findings call for geriatrics expertise and intercultural competency of the clinical team in the acute and rehabilitation care for SCI. This study also highlights the need for a multidimensional risk assessment and multifactorial intervention, especially to reduce falls and SCI in older adults. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

2017-04-01

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

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

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Lee, Kun-Ze

2016-10-15

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

A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms

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Kishi S

2012-04-01

Full Text Available Seiji Kishi1, Kenji Kanaji2, Toshio Doi1, Tadashi Matsumura21Department of Nephrology, Tokushima University Hospital, Kuramoto-cho Tokushima, 2Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho Yamashina-ku Kyoto, JapanAbstract: Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2.Keywords: vertebral artery dissection, brainstem infarction, bilateral spinal cord infarction, neck trauma

Facet joint injuries in acute cervical spine trauma : evaluation with CT and MRI

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Ha, Jeon Ju; Kim, Dong Hyun; Lee, Jeong Hwa; Lee, Keon; Kwon, Hyeok Po; Kwon, Jung Hyeok; Yun, Seong Mun [Dongkang General Hospital, Seoul (Korea, Republic of)

1999-05-01

To evaluate injury patterns of facet joints and associated soft tissue injuries in patients with acute traumatic cervical facet joint injuries. From among patients with cervical spine trauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzed with regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, and other associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury, intervertebral disc herniation, and spinal cord injury. The most common location of facet joint injury was C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) had bilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fracture of inferior facet was more frequent than superior. Patterns of fracture were vertical, transverse, or comminuted, but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facet fractures. Fractures other than facet included pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13), and spinous process(n=3). On MR images, anterior longitudinal ligament injury was found in 8 patients(30%), posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelve patients(44%) had spinal cord injuries including edema(n=8) and hemorrhage(n=4). Among patients with disc abnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. Traumatic cervical facet joint injuries were manifested as various patterns and frequently associated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patterns helped formulate a therapeutic plan and determine of prognosis.

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

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

2015-01-01

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

Cervical Klippel-Feil syndrome predisposing an elderly African man to central cord myelopathy following minor trauma

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Olufemi Adeleye, A; Olusola Akinyemi, R

2010-01-01

An otherwise-healthy, active 83-year-old Nigerian man developed reversible central cord myelopathy from a mild fall on a level surface. Cervical spine magnetic resonance imaging (MRI) revealed C5, 6, and 7 block vertebrae and marked disc extrusions only at the immediately adjoining upper and lower non-fused segments of the cervical spine. There was no spinal canal stenosis otherwise. We think that the unique presentation of this case of Klippel-Feil syndrome further supports the impression th...

The kinematic relationships of the upper cervical spine.

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Morishita, Yuichiro; Falakassa, Jonathan; Naito, Masatoshi; Hymanson, Henry J; Taghavi, Cyrus; Wang, Jeffrey C

2009-11-15

A retrospective radiographic study. To elucidate the kinematic relationships of the upper cervical spine. To our knowledge, few reports have described the kinematic relationships of the upper cervical spine in patients with general age-related cervical spondylosis. We performed Kinetic magnetic resonance imaging for 295 consecutive patients experiencing neck pain without neurologic symptoms. Subjects with rheumatoid arthritis, traumatic history, and severe degenerative changes in the upper cervical spine were excluded. Anterior atlantodens interval (AADI) and the cervicomedullary angle in 3 different postures were measured, and the variations in each value between flexion and neutral (F-N), neutral and extension (N-E), and flexion and extension (F-E) were calculated. The subjects were classified into 3 groups according to the space available for the cord values (A: or=15 mm). AADI significantly increased from extension to flexion posture, however, no significant differences were observed in every posture among the groups. F-N variation in AADI showed no significant differences among the groups; however, N-E variation between Groups A and C and between Groups B and C and F-E variation between Groups A and C showed significant differences. The cervicomedullary angle significantly increased from flexion to extension posture, however, no significant differences were observed in every posture among the groups. Angle variations among the groups showed no significant differences, except for F-N angle variation between Groups B and C. None of the variations in AADI and the cervicomedullary angle were significantly correlated. Our results suggest that only the kinematics of the atlantoaxial movement, especially the posterior movement, was greatly affected by the narrowing of space available for the cord. The central atlantoaxial joint may be closely related to the mechanisms for protecting the spinal cord by restriction of the atlantoaxial movement.

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

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Kato, Yoshihiko; Koga, Michiaki; Taguchi, Toshihiko

2010-05-12

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

[A case of the myelitis due to Toxocara canis infection complicated with cervical spondylosis].

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Mitsuhashi, Yutaka; Naitou, Kentarou; Yamauchi, Shigeru; Naruse, Hirotsune; Matsuoka, Yoshimi; Nakamura-Uchiyama, Fukumi; Hiromatsu, Kenji

2006-11-01

A 59-year-old male had suffered from numbness of the hands for 7 months. With a diagnosis of cervical spondylosis, he had been treated conservatively at a nearby clinic. After he fell off his bicycle, the numbness intensified and limb weakness developed. Cervical MRI revealed spinal cord compression at the C4/5 and C5/6 levels due to cervical spondylosis with prominent edema in the spinal cord spreading from the C4 to C6 level. The edema was very serious. Therefore, we suspected that the traumatic spinal injury underlying the cervical spondylosis was complicated by another disease. Cervical spinal angiography revealed no apparent vascular disorder. Contrast enhanced MRI showed a small enhanced area in the spinal cord at the C5 level. Because of the rapid progression of gait disturbance, expansive laminoplasty was performed without further examination. Although remarkable amelioration of the symptoms was seen just after the surgery, the symptoms worsened again about 1 month later. The patient's clinical history was reconsidered, revealing that he likes raw bovine liver. Serological examination, because of suspicion of parasitic infection showed elevated titers of anti-Toxocara canis antibody in the serum and cerebrospinal fluid. Administration of albendazole improved the clinical symptoms, and normalized the serological and MRI findings. Myelitis due to T canis infection is a rare disease. For an early and accurate diagnosis, it is important to be fully aware of this disease and to include detailed information on food preferences and pet-keeping in the process of compiling a clinical history.

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

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Bartels, Ronald H M A; Hosman, Allard J F; van de Meent, Henk; Hofmeijer, Jeannette; Vos, Pieter E; Slooff, Willem Bart; Öner, F Cumhur; Coppes, Maarten H; Peul, Wilco C; Verbeek, André L M

2013-01-31

Incomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family. It is estimated that up to 25% of all traumatic spinal cord lesions belong to this category. The treatment for this type of spinal cord lesion is still subject of discussion. From a biological point of view early surgery could prevent secondary damage due to ongoing compression of the already damaged spinal cord. Historically, however, conservative treatment was propagated with good clinical results. Proponents for early surgery as well those favoring conservative treatment are still in debate. The proposed trial will contribute to the discussion and hopefully also to a decrease in the variability of clinical practice. A randomized controlled trial is designed to compare the clinical outcome of early surgical strategy versus a conservative approach. The primary outcome is clinical outcome according to mJOA. This also measured by ASIA score, DASH score and SCIM III score. Other endpoints are duration of the stay at a high care department (medium care, intensive care), duration of the stay at the hospital, complication rate, mortality rate, sort of rehabilitation, and quality of life. A sample size of 36 patients per group was calculated to reach a power of 95%. The data will be analyzed as intention-to-treat at regular intervals, but the end evaluation will take place at two years post-injury. At the end of the study, clinical outcomes between treatments attitudes can be compared. Efficacy, but also efficiency can be determined. A goal of the study is to determine which treatment will result in the best quality of life for the patients. This study will certainly contribute to more uniformity of treatment offered to patients with a special sort of spinal cord injury. Gov: NCT01367405.

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

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Bartels Ronald HMA

2013-01-01

Full Text Available Abstract Background Incomplete cervical cord syndrome without spinal instability is a very devastating event for the patient and the family. It is estimated that up to 25% of all traumatic spinal cord lesions belong to this category. The treatment for this type of spinal cord lesion is still subject of discussion. From a biological point of view early surgery could prevent secondary damage due to ongoing compression of the already damaged spinal cord. Historically, however, conservative treatment was propagated with good clinical results. Proponents for early surgery as well those favoring conservative treatment are still in debate. The proposed trial will contribute to the discussion and hopefully also to a decrease in the variability of clinical practice. Methods/Design A randomized controlled trial is designed to compare the clinical outcome of early surgical strategy versus a conservative approach. The primary outcome is clinical outcome according to mJOA. This also measured by ASIA score, DASH score and SCIM III score. Other endpoints are duration of the stay at a high care department (medium care, intensive care, duration of the stay at the hospital, complication rate, mortality rate, sort of rehabilitation, and quality of life. A sample size of 36 patients per group was calculated to reach a power of 95%. The data will be analyzed as intention-to-treat at regular intervals, but the end evaluation will take place at two years post-injury. Discussion At the end of the study, clinical outcomes between treatments attitudes can be compared. Efficacy, but also efficiency can be determined. A goal of the study is to determine which treatment will result in the best quality of life for the patients. This study will certainly contribute to more uniformity of treatment offered to patients with a special sort of spinal cord injury. Trial Registration Gov: NCT01367405

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.)

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.)

Estimating the global incidence of traumatic spinal cord injury.

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Fitzharris, M; Cripps, R A; Lee, B B

2014-02-01

Population modelling--forecasting. To estimate the global incidence of traumatic spinal cord injury (TSCI). An initiative of the International Spinal Cord Society (ISCoS) Prevention Committee. Regression techniques were used to derive regional and global estimates of TSCI incidence. Using the findings of 31 published studies, a regression model was fitted using a known number of TSCI cases as the dependent variable and the population at risk as the single independent variable. In the process of deriving TSCI incidence, an alternative TSCI model was specified in an attempt to arrive at an optimal way of estimating the global incidence of TSCI. The global incidence of TSCI was estimated to be 23 cases per 1,000,000 persons in 2007 (179,312 cases per annum). World Health Organization's regional results are provided. Understanding the incidence of TSCI is important for health service planning and for the determination of injury prevention priorities. In the absence of high-quality epidemiological studies of TSCI in each country, the estimation of TSCI obtained through population modelling can be used to overcome known deficits in global spinal cord injury (SCI) data. The incidence of TSCI is context specific, and an alternative regression model demonstrated how TSCI incidence estimates could be improved with additional data. The results highlight the need for data standardisation and comprehensive reporting of national level TSCI data. A step-wise approach from the collation of conventional epidemiological data through to population modelling is suggested.

Dolor cervical incoercible

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Adrián F Narváez-Muñoz

2014-03-01

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

Coping strategies used by traumatic spinal cord injury patients in Sri Lanka: a focus group study.

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Arya, Sumedha; Xue, Siqi; Embuldeniya, Amanda; Narammalage, Harsha; da Silva, Tricia; Williams, Shehan; Ravindran, Arun

2016-10-01

Psychosocial consequences of traumatic spinal cord injury (SCI) have been well documented in Western populations, but there is no published literature on such incidence in the Sri Lankan population. The purpose of this study was to explore the psychosocial impact of SCI in a Sri Lankan population and to examine this population's coping mechanisms. Participants were recruited purposively at the Ragama Rheumatology and Rehabilitation Hospital, the sole rehabilitation facility for SCI patients in Sri Lanka. Focus groups were conducted with 23 consenting individuals. Interview transcripts were analysed using descriptive thematic analysis. Four domains of life impact, three types of active coping strategies and four types of external supports were identified. Decreased ambulation and burden on family life were significant concerns for male and female participants alike. Religious practices were reported most frequently as active coping strategies, followed by positive reframing and goal-setting. Reported external supports included guided physiotherapy, informational workshops, social support and peer networks. Rehabilitation efforts for Sri Lankan SCI patients should be sensitive to psychosocial concerns in addition to physical concerns in order to help patients re-integrate into their family lives and community. Furthermore, religious practices should be respected as possible aids to rehabilitation. Implications for Rehabilitation Rehabilitative efforts should be conscientious of patients' psychosocial well-being in addition to their physical well-being. Hospital-based rehabilitative efforts for traumatic spinal cord injury patients should promote functional independence and community re-integration. Spiritual and/or religious practices should be respected as ways by which traumatic spinal cord injury patients may confront personal challenges that arise following injury.

Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

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Catarina C. Lins

Full Text Available ABSTRACT Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD, but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients’ final outcomes.

Apolipoprotein E epsilon 4 allele and outcomes of traumatic spinal cord injury in a Chinese Han population.

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Sun, Chongyi; Ji, Guangrong; Liu, Qingpeng; Yao, Meng

2011-10-01

The association between apolipoprotein E (APOE) epsilon 4 (ε4) allele and outcomes of traumatic spinal cord injury (SCI) is still controversial and ambiguous. The objective of this study was to test the hypothesis that APOE polymorphisms are associated with outcomes after SCI in Chinese Han patients. APOE polymorphisms were determined in 100 patients with cervical SCI (C3-C8). The genotype frequency of this polymorphism was determined by using a polymerase chain reaction-restriction fragment length polymorphism assay. Patients with an APOE ε4 allele had significantly less motor recovery during rehabilitation than did patients without an APOE ε4 allele (mean 3.7 vs. 6.1; P = 0.04) and a longer rehabilitation length of stay (LOS) (mean 117.4 vs. 94.5; P = 0.02), but better sensory-pinprick recovery (mean 6.1 vs. 4.0; P = 0.03). There were no significant differences by APOE ε4 allele status in sensory-light touch recovery or acute LOS. This study suggests that the APOE ε4 allele is associated with outcomes after SCI and longer rehabilitation LOS in Chinese Han patients.

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

International Nuclear Information System (INIS)

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

2010-01-01

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

Traumatic atlantoaxial subluxation, posterior transfacet fixation: a case report

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Mario Cahueque Lemus

2015-03-01

Full Text Available Cervical spine injuries are often described as catastrophic events in neurological terms, with very low survival rate. Lesions to C3-C7 segment are the most common (about 80% followed by segment C1-C2 (20%. The cervical spine injuries are of great importance, both by severity as the neurological implications. It is important to consider that among cervical traumas that do not present neurological damage at the time of the accident, 10% have deficits later, so all cervical trauma should be considered as potential spinal cord traumas, until the evolution of the case shows that definitively there is no spinal cord or nerve root damage. Cases have been reported with both atlantooccipital and atlantoaxial dislocations without neurological deficit, so these lesions went unnoticed in the emergency services. Some of the events to be considered at the time of the accident are suboccipital pain on axial skull pressure and spontaneous stiffness of the patient's neck. Dysphagia, pain on palpation of the anterior neck and a visible increase of prepharyngeal mass can also be observed, which is why it is important to keep the suspicion of craniocervical trauma in all patients who have these symptoms and carry out the relevant tests. This paper presents a case of post-traumatic atlantoaxial dislocation, which showed no neurological deficit at the time of the accident, but was later presented, as well as the surgical procedure carried out.

How important is resilience among family members supporting relatives with traumatic brain injury or spinal cord injury?

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Simpson, Grahame; Jones, Kate

2013-04-01

To investigate the relationship between resilience and affective state, caregiver burden and caregiving strategies among family members of people with traumatic brain or spinal cord injury. An observational prospective cross-sectional study. Inpatient and community rehabilitation services. Convenience sample of 61 family respondents aged 18 years or older at the time of the study and supporting a relative with severe traumatic brain injury (n = 30) or spinal cord injury (n= 31). Resilience Scale, Positive And Negative Affect Schedule, Caregiver Burden Scale, Functional Independence Measure, Carer's Assessment of Managing Index. Correlational analyses found a significant positive association between family resilience scores and positive affect (r(s) = 0.67), and a significant negative association with negative affect (r(s) = -0.47) and caregiver burden scores (r(s) = -0.47). No association was found between family resilience scores and their relative's severity of functional impairment. Family members with high resilience scores rated four carer strategies as significantly more helpful than family members with low resilience scores. Between-groups analyses (families supporting relative with traumatic brain injury vs. spinal cord injury) found no significant differences in ratings of the perceived helpfulness of carer strategies once Bonferroni correction for multiple tests was applied. Self-rated resilience correlated positively with positive affect, and negatively with negative affect and caregiver burden. These results are consistent with resilience theories which propose that people with high resilience are more likely to display positive adaptation when faced by significant adversity.

Comparative analysis of cervical spine management in a subset of severe traumatic brain injury cases using computer simulation.

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Kimbroe J Carter

Full Text Available BACKGROUND: No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study's goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia. METHODS/FINDINGS: The severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cervical spine instability is studied with one-way and two-way sensitivity analyses providing rankings of cervical spine management strategies for probabilities of management complications based on QALYs. Early collar removal received more QALYs than the alternative strategies in most arrangements of these comparisons. A limitation of the model is the absence of testing against an independent data set. CONCLUSIONS: When clinical logic and components of cervical spine management are systematically altered, changes that improve health outcomes are identified. In the absence of controlled clinical studies, the results of this comparative computer assessment show that early collar removal is preferred over a wide range of realistic inputs for this subset of traumatic brain injury. Future research is needed on identifying factors in

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

Science.gov (United States)

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

2018-05-01

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

"Wrestling induced cervical spondylosis, fact or fiction? A study conducted in 148 athletes "

OpenAIRE

"Fakhr Tabatabai SA; Hussain Khan Z; Nabaei B "

2000-01-01

Traumatic injuries are leading causes of spinal cord damage. The purpose of this study was to evaluate whether wrestling induced cervical spondylosis amongst professional wrestlers or not. To test this assumption, two groups of athletes, 72 wrestlers versus 76 non-wrestlers 15-55 years of age were studied. Radiographic findings and clinical assessment were compared in both groups. Significant difference (Odd ratio=2.91, P=0.007) were noted between the two groups regarding the prevalence of ra...

Large armored bridging over fractured vertebra with intraspinal tumor mimicking bony mass caused by migrated fragments of burst cervical vertebra presenting with severe cervical myelopathy

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Satyarthee Guru Dutta

2017-06-01

Full Text Available Vertebral body may get displaced anterior or posteror with elements of rotation. However, burst cervical spine vertebral fracture may migrate anteriorly and posteriorly simultaneously. However anterior displaced fragment forming armor like mass is very rare. Similarly, the posteriorly propelled fragments migrating caudally and posterolaterally producing a large osseous mass inside spinal canal mimicking bony tumour causing severe cervical canal stenosis and presenting with marked myelopathy is extremely rare. To the best knowledge of authors, association of such traumatic dual pathology represents first of its kind in western literature, who was neglected early medical advice and presenting with marked compressive cervical myelopathy. She underwent successful surgical decompression with gradual recovery of spastic limb weakness and recovery of sensation. Authors also highlights the importance of early resuscitation and adequate maintainace of mean arterial pressure following acute spinal cord injury. Pertinent literature is briefly reviewed.

Mechanism of Restoration of Forelimb Motor Function after Cervical Spinal Cord Hemisection in Rats: Electrophysiological Verification

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Takumi Takeuchi

2017-01-01

Full Text Available The objective of this study was to electrophysiologically assess the corticospinal tracts of adult rats and the recovery of motor function of their forelimbs after cervical cord hemisection. Of 39 adult rats used, compound muscle action potentials (CMAPs of the forelimbs of 15 rats were evaluated, before they received left C5 segmental hemisection of the spinal cord, by stimulating the pyramid of the medulla oblongata on one side using an exciting microelectrode. All 15 rats exhibited contralateral electrical activity, but their CMAPs disappeared after hemisection. The remaining 24 rats received hemisection first, and CMAPs of 12 rats were assessed over time to study their recovery time. All of them exhibited electrical activity of the forelimbs in 4 weeks after surgery. The remaining 12 rats received additional right C2 segmental hemisection, and variation of CMAPs between before and after surgery was examined. The right side of the 12 rats that received the additional hemisection exhibited no electrical activity in response to the stimulation of the pyramids on both sides. These results suggest that changes in path between the resected and healthy sides, activation of the ventral corticospinal tracts, and propriospinal neurons were involved in the recovery of motor function after cervical cord injury.

[Combined surgical and physical treatment in traumatic painful syndromes of the cervical spine].

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Stachowski, B; Kaczmarek, J; Nosek, A; Kocur, L

1976-01-01

Clinical observations suggest the need for changing therapeutic management to a more active one in cases of cervical spine injury with damage to the spinal cord and nerve roots or brachial plexus. In 248 patients with these injuries treated initially conservatively the incidence of cervicobrachial pain was analysed. Neuralgic pains were present in 31.5% of cases, causalgic pains in 2.4% and sympathalgic pains in 2%. Conservative treatment conducted in these patients (89 cases) during many months after trauma had no effect on return of mobility. Long-term application of physioterapy prevented only temporarily the development of trophic changes and only partially relieved pains. Only surgical decompression of the spinal cord or spinal nerves with stabilization of damaged vertebrae caused disappearance of painful syndromes and improvement in the motor activity of the extremities. These observations show that early surgical intervention for decompression of the spinal cord, roots or brachial plexus should be advocated in these cases.

Traumatic Brain and Spinal Cord Fatalities Among High School and College Football Players - United States, 2005-2014.

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Kucera, Kristen L; Yau, Rebecca K; Register-Mihalik, Johna; Marshall, Stephen W; Thomas, Leah C; Wolf, Susanne; Cantu, Robert C; Mueller, Frederick O; Guskiewicz, Kevin M

2017-01-06

An estimated 1.1 million high school and 75,000 college athletes participate in tackle football annually in the United States. Football is a collision sport; traumatic injuries are frequent (1,2), and can be fatal (3). This report updates the incidence and characteristics of deaths caused by traumatic brain injury and spinal cord injury (4) in high school and college football and presents illustrative case descriptions. Information was analyzed from the National Center for Catastrophic Sport Injury Research (NCCSIR). During 2005-2014, a total of 28 deaths (2.8 deaths per year) from traumatic brain and spinal cord injuries occurred among high school (24 deaths) and college football players (four deaths) combined. Most deaths occurred during competitions and resulted from tackling or being tackled. All four of the college deaths and 14 (58%) of the 24 high school deaths occurred during the last 5 years (2010-2014) of the 10-year study period. These findings support the need for continued surveillance and safety efforts (particularly during competition) to ensure proper tackling techniques, emergency planning for severe injuries, availability of medical care onsite during competitions, and assessment that it is safe to return to play following a concussion.

Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center.

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Katzberg, R W; Benedetti, P F; Drake, C M; Ivanovic, M; Levine, R A; Beatty, C S; Nemzek, W R; McFall, R A; Ontell, F K; Bishop, D M; Poirier, V C; Chong, B W

1999-10-01

To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

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

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

2017-11-15

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

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

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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.

Distribution of collateral fibers in the monkey cervical spinal cord detected with diffusion-weighted magnetic resonance imaging

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Lundell, Henrik; Nielsen, Jens Bo; Ptito, Maurice

2011-01-01

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

Post-traumatic Winking Induced by Extension of the Hand: A Case Report of a Novel Synkinesis

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Riet Vangheluwe

2014-09-01

Full Text Available Several synkinesis syndromes have been reported in the literature. Synkinesis syndromes are rare and are most commonly congenital or follow post-traumatic reinnervation. We describe a novel synkinesis syndrome that developed several months after cervical spinal cord infarction due to a herniated disc in a 29-year-old woman. When the patient overstretched the extensor muscles of the right hand, the right upper eyelid raised automatically and nasal congestion developed. We hypothesize that aberrant reinnervation of the intermediolateral columns of the spinal cord at level C8–T2 by motor neurons of the extensor muscles of the hand occurred.

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

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

2018-05-01

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

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

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

2013-10-01

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

Bimanual reach to grasp movements after cervical spinal cord injury.

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Laura Britten

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

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

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2016-01-01

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

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

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

2001-12-01

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

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

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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.

Surgical results of open-door laminoplasty for cervical cord injury without fracture or dislocation

International Nuclear Information System (INIS)

Hamada, Kenichiro; Oda, Takenori; Kobashi, Masumi; Yamamura, Mitsuyoshi; Tsukamoto, Yasunori; Suzuki, Shozo; Fujita, Satoru; Mori, Shigeki; Fujiwara, Keiju

2003-01-01

The purpose of this study is to evaluate the efficacy of spinal cord decompression surgery for cervical spinal cord injury without fracture or dislocation of the spinal column. Twenty-nine patients treated by expansive open-door laminoplasty are the subjects to this study. Severity of neurological deficit was assessed by the Japanese Orthopaedic Association (JOA) scoring system. Therapeutic outcome was evaluated by the recovery rate of JOA score. Seventeen patients were treated by surgically during the acute phase (within three months after injury), and the remaining 12 were in chronic phase (after 3 months). The recovery rate showed no significant difference between the two groups (46.9% vs. 34.0%). In 16 patients, the lesion responsible for spinal cord damage was recognized as a change of the intramedullary signal intensity on MRI, which was most frequently located at C3/4 level. In 7 out of the 16 patients, the most stenotic level agreed with recognized cord injury on MRI, and in the remaining 9 patients, it did not. The recovery rate showed no significant difference between the two groups (57.3% vs. 31.1%). Even if the neurological dysfunction has been present more than 3 months and spontaneous improvement reaches plateau, or spinal cord injury level recognized as a signal intensity change on MRI is not stenotic, there is still some possibility for improving the neurological function through surgery. (author)

Caregiver outcomes and interventions: a systematic scoping review of the traumatic brain injury and spinal cord injury literature.

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Baker, Anne; Barker, Samantha; Sampson, Amanda; Martin, Clarissa

2017-01-01

To identify factors reported with negative and positive outcomes for caregivers of the traumatic brain injury and spinal cord injury cohorts, to investigate what interventions have been studied to support carers and to report what effectiveness has been found. Scoping systematic review. Electronic databases and websites were searched from 1990 to December 2015. Studies were agreed for inclusion using pre-defined criteria. Relevant information from included studies was extracted and quality assessment was completed. Data were synthesised using qualitative methods. A total of 62 studies reported caregiver outcomes for the traumatic brain injury cohort; 51 reported negative outcomes and 11 reported positive outcomes. For the spinal cord injury cohort, 18 studies reported caregiver outcomes; 15 reported negative outcomes and three reported positive outcomes. Burden of care was over-represented in the literature for both cohorts, with few studies looking at factors associated with positive outcomes. Good family functioning, coping skills and social support were reported to mediate caregiver burden and promote positive outcomes. A total of 21 studies further described interventions to support traumatic brain injury caregivers and four described interventions to support spinal cord injury caregivers, with emerging evidence for the effectiveness of problem-solving training. Further research is required to explore the effects of injury severity of the care recipient, as well as caregiver age, on the outcome of the interventions. Most studies reported negative outcomes, suggesting that barriers to caregiving have been established, but not facilitators. The interventions described to support carers are limited and require further testing to confirm their effectiveness.

Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder.

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Kalsi-Ryan, Sukhvinder; Karadimas, Spyridon K; Fehlings, Michael G

2013-08-01

Cervical spondylotic myelopathy (CSM) is a common disorder involving chronic progressive compression of the cervical spinal cord due to degenerative disc disease, spondylosis, or other degenerative pathology. CSM is the most common form of spinal cord impairment and causes functional decline leading to reduced independence and quality of life. Despite a sound understanding of the disease process, clinical presentation and management, a universal definition of CSM and a standardized index of severity are not currently used universally. Work is required to develop a definition and establish clinical predictors of progression to improve management of CSM. Despite advances in decompressive and reconstructive surgery, patients are often left with residual disability. Gaps in knowledge of the pathobiology of CSM have limited therapeutic advances to complement surgery. Although the histopathologic and pathophysiologic similarities between CSM and traumatic spinal cord injury have long been acknowledged, the unique pathomechanisms of CSM remain unexplored. Increased efforts to elucidate CSM pathobiology could lead to the discovery of novel therapeutic targets for human CSM and other spinal cord diseases. Here, the natural history of CSM, epidemiology, clinical presentation, and current methods of clinical management are reported, along with the current state of basic scientific research in the field.

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

International Nuclear Information System (INIS)

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

1994-01-01

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

Umbilical cord-derived mesenchymal stem cell transplantation combined with hyperbaric oxygen treatment for repair of traumatic brain injury

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Zhou, Hai-xiao; Liu, Zhi-gang; Liu, Xiao-jiao; Chen, Qian-xue

2016-01-01

Transplantation of umbilical cord-derived mesenchymal stem cells (UC-MSCs) for repair of traumatic brain injury has been used in the clinic. Hyperbaric oxygen (HBO) treatment has long been widely used as an adjunctive therapy for treating traumatic brain injury. UC-MSC transplantation combined with HBO treatment is expected to yield better therapeutic effects on traumatic brain injury. In this study, we established rat models of severe traumatic brain injury by pressurized fluid (2.5–3.0 atm impact force). The injured rats were then administered UC-MSC transplantation via the tail vein in combination with HBO treatment. Compared with monotherapy, aquaporin 4 expression decreased in the injured rat brain, but growth-associated protein-43 expression, calaxon-like structures, and CM-Dil-positive cell number increased. Following combination therapy, however, rat cognitive and neurological function significantly improved. UC-MSC transplantation combined with HBO therapyfor repair of traumatic brain injury shows better therapeutic effects than monotherapy and significantly promotes recovery of neurological functions. PMID:26981097

Umbilical cord-derived mesenchymal stem cell transplantation combined with hyperbaric oxygen treatment for repair of traumatic brain injury

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Hai-xiao Zhou

2016-01-01

Full Text Available Transplantation of umbilical cord-derived mesenchymal stem cells (UC-MSCs for repair of traumatic brain injury has been used in the clinic. Hyperbaric oxygen (HBO treatment has long been widely used as an adjunctive therapy for treating traumatic brain injury. UC-MSC transplantation combined with HBO treatment is expected to yield better therapeutic effects on traumatic brain injury. In this study, we established rat models of severe traumatic brain injury by pressurized fluid (2.5-3.0 atm impact force. The injured rats were then administered UC-MSC transplantation via the tail vein in combination with HBO treatment. Compared with monotherapy, aquaporin 4 expression decreased in the injured rat brain, but growth-associated protein-43 expression, calaxon-like structures, and CM-Dil-positive cell number increased. Following combination therapy, however, rat cognitive and neurological function significantly improved. UC-MSC transplantation combined with HBO therapyfor repair of traumatic brain injury shows better therapeutic effects than monotherapy and significantly promotes recovery of neurological functions.

Tracheostomy following anterior cervical spine fusion in trauma patients.

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Binder, Harald; Lang, Nikolaus; Tiefenboeck, Thomas M; Bukaty, Adam; Hajdu, Stefan; Sarahrudi, Kambiz

2016-06-01

Traumatic injuries to the cervical spine are frequently accompanied by cervical spinal cord injuries-often necessitating tracheostomy. The purpose of this study was to evaluate patient characteristics and outcomes after undergoing anterior cervical spine fusion (ACSF) with tracheostomy. All patients with cervical spine injury (CSI) who underwent ACSF and tracheostomy between December 1992 and June 2014 were included in this retrospective data analysis. The study group consisted of 32 men (84 %) and six women (16 %), with an average age of 47 ± 20 years. Blunt trauma to the cervical spine was the cause of CSI in all 38 patients. The mean Injury Severity Score (ISS) was 30.50 ± 6.25. Eighteen patients sustained severe concomitant injuries related to the spinal injury. In 15 patients (39.5 %), traumatic brain injury (TBI) with fractures of the cranium and/or intracranial lesions were observed. The mean Glasgow Coma Scale (GCS) score was 11 ± 4.5 (range 3-15). Two tracheostomies (5.3 %) were performed simultaneously with ACSF. The remaining 36 were performed with an average "delay" of 15 ± ten days. We observed no difference in time to tracheostomy among patients initially presenting with an American Spinal Injury Association (ASIA) score of either A, B, C or D. Only two patients (5.3 %) were identified as having an infection at the site of ACSF after placement of a tracheostomy. There were no deaths directly related to airway difficulties in our cohort. Our data show that tracheostomy is safely performed after an average of 15 days post-ACSF, thereby being associated with a very low rate of complications. However, future prospective randomised studies are needed to identify the optimal timing of tracheostomy placement after ACSF. IV; retrospective case series.

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

Effect of melatonin on the functional recovery from experimental traumatic compression of the spinal cord

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Schiaveto-de-Souza, A. [Departamento de Morfofisiologia, Universidade Federal do Mato Grosso do Sul, Campo Grande, MS (Brazil); Silva, C.A. da [Departamento de Morfologia,Estomatologia e Fisiologia, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Defino, H.L.A. [Departamento de Orthopedia e Traumatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Bel, E.A.Del [Departamento de Morfologia,Estomatologia e Fisiologia, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)

2013-04-12

Spinal cord injury is an extremely severe condition with no available effective therapies. We examined the effect of melatonin on traumatic compression of the spinal cord. Sixty male adult Wistar rats were divided into three groups: sham-operated animals and animals with 35 and 50% spinal cord compression with a polycarbonate rod spacer. Each group was divided into two subgroups, each receiving an injection of vehicle or melatonin (2.5 mg/kg, intraperitoneal) 5 min prior to and 1, 2, 3, and 4 h after injury. Functional recovery was monitored weekly by the open-field test, the Basso, Beattie and Bresnahan locomotor scale and the inclined plane test. Histological changes of the spinal cord were examined 35 days after injury. Motor scores were progressively lower as spacer size increased according to the motor scale and inclined plane test evaluation at all times of assessment. The results of the two tests were correlated. The open-field test presented similar results with a less pronounced difference between the 35 and 50% compression groups. The injured groups presented functional recovery that was more evident in the first and second weeks. Animals receiving melatonin treatment presented more pronounced functional recovery than vehicle-treated animals as measured by the motor scale or inclined plane. NADPH-d histochemistry revealed integrity of the spinal cord thoracic segment in sham-operated animals and confirmed the severity of the lesion after spinal cord narrowing. The results obtained after experimental compression of the spinal cord support the hypothesis that melatonin may be considered for use in clinical practice because of its protective effect on the secondary wave of neuronal death following the primary wave after spinal cord injury.

Effect of melatonin on the functional recovery from experimental traumatic compression of the spinal cord

International Nuclear Information System (INIS)

Schiaveto-de-Souza, A.; Silva, C.A. da; Defino, H.L.A.; Bel, E.A.Del

2013-01-01

Spinal cord injury is an extremely severe condition with no available effective therapies. We examined the effect of melatonin on traumatic compression of the spinal cord. Sixty male adult Wistar rats were divided into three groups: sham-operated animals and animals with 35 and 50% spinal cord compression with a polycarbonate rod spacer. Each group was divided into two subgroups, each receiving an injection of vehicle or melatonin (2.5 mg/kg, intraperitoneal) 5 min prior to and 1, 2, 3, and 4 h after injury. Functional recovery was monitored weekly by the open-field test, the Basso, Beattie and Bresnahan locomotor scale and the inclined plane test. Histological changes of the spinal cord were examined 35 days after injury. Motor scores were progressively lower as spacer size increased according to the motor scale and inclined plane test evaluation at all times of assessment. The results of the two tests were correlated. The open-field test presented similar results with a less pronounced difference between the 35 and 50% compression groups. The injured groups presented functional recovery that was more evident in the first and second weeks. Animals receiving melatonin treatment presented more pronounced functional recovery than vehicle-treated animals as measured by the motor scale or inclined plane. NADPH-d histochemistry revealed integrity of the spinal cord thoracic segment in sham-operated animals and confirmed the severity of the lesion after spinal cord narrowing. The results obtained after experimental compression of the spinal cord support the hypothesis that melatonin may be considered for use in clinical practice because of its protective effect on the secondary wave of neuronal death following the primary wave after spinal cord injury

Cervical Vertigo(Vertigo)

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本間, 隆夫; Homma, Takao

1992-01-01

Cervical vertigo was reviewed as to its mechanism, diagnosis and treatment, and nine cases which had operation done were briefly presented. Cervical vertigo has been seen occasionaly in the cases of cervical spondylosis, frequently in the cases of traumatic cervical syndrome. The mechanism is attributed to either vertebrobasilar insufficiency caused by compression on vertebral artery or irritation of poterior cervical sympathetic system. The diagnosis consists of reccurent vertigo attack with...

Differences in response between traumatic and non-traumatic chronic neck pain patients in a multimodal intervention?

DEFF Research Database (Denmark)

Ris Hansen, Inge; Søgaard, Karen; Gram, Bibi

, Pain Bothersomeness, Patient-Specific Functioning Scale, Tampa Scale of Kinesiophobia, Global Perceived Effect) and clinical tests (cervical Range of Motion, Pressure Pain Threshold at infraspinatus, tibialis anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function......) showed statistically significant improvements in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold, cervical extension movement, muscle function, and oculomotion. Per protocol analyses confirmed these results with additional significant improvements in the exercise group......Abstract title: Do traumatic and non-traumatic chronic neck pain patients respond different on a combination of pain education, exercises and training? Authors: Inge Ris, Karen Søgaard, Bibi Gram, Karina Agerbo, Eleanor Boyle, Birgit Juul-Kristensen Background: Previous studies have investigated...

A Case of Adult-Onset Alexander Disease Featuring Severe Atrophy of the Medulla Oblongata and Upper Cervical Cord on Magnetic Resonance Imaging

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Yonezu, Tadahiro; Ito, Shoichi; Kanai, Kazuaki; Masuda, Saeko; Shibuya, Kazumoto; Kuwabara, Satoshi

2012-01-01

Adult-onset Alexander disease (AOAD) has been increasingly recognized since the identification of the glial fibrillary acidic protein gene mutation in 2001. We report on a 56-year-old man who was genetically confirmed as AOAD with the glial fibrillary acidic protein mutation of p.M74T. He developed spastic tetraparesis, sensory disturbances in four limbs, and mild cognitive impairment without apparent dysarthria and dysphagia. The case was characterized by severe atrophy of the medulla oblongata and upper cervical cord with intramedullary signal intensity changes on magnetic resonance imaging. While AOAD is diverse in clinical presentation, the peculiar magnetic resonance imaging findings of marked atrophy of the medulla oblongata and cervical cord are thought to be highly suggestive of the diagnosis of AOAD. PMID:23185175

Traumatic spinal cord injuries in southeast Turkey: an epidemiological study.

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Karamehmetoğlu, S S; Nas, K; Karacan, I; Sarac, A J; Koyuncu, H; Ataoğlu, S; Erdoğan, F

1997-08-01

In 1994, a retrospective study of new cases of traumatic Spinal Cord Injury (SCI) was conducted in all the hospitals in Southeast Turkey: 75 new traumatic SCI were identified. The estimated annual incidence was 16.9 per million population. The male/female ratio was 5.8/1. The mean age was 31.3, being 31.25 for male patients and 31.36 for female patients. 70.7% of all patients were under the age of 40. The major causes of SCI were falls (37.3%) and gunshot wounds (29.3%), followed by car accidents (25.3%), and stab wounds (1.3%). Thirty one patients (41.3%) were tetraplegic and 44 (58.7%) paraplegic. In tetraplegic patients the commonest level was C5, in those with paraplegia L1. The commonest associated injury was head trauma followed by fractures of the extremity(ies). Severe head trauma, being a major cause of death, may have obscured the actual incidence of SCI. Most of gunshot injured SCI patients were young soldiers fighting against the rebels. As there was no available data for the rebels with SCI, the actual incidence of SCI in Southeast (SE) Turkey should be higher than that found in this study.

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

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

2006-12-01

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

Incidence, aetiology and injury characteristics of traumatic spinal cord injury in Stockholm, Sweden: A prospective, population-based update.

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Joseph, Conran; Andersson, Nina; Bjelak, Sapko; Giesecke, Kajsa; Hultling, Claes; Nilsson Wikmar, Lena; Phillips, Julie; Seiger, Åke; Stenimahitis, Vasilios; Trok, Katarzyna; Åkesson, Elisabet; Wahman, Kerstin

2017-05-16

To update the incidence rate, aetiology and injury characteristics of acutely-injured adults with traumatic spinal cord injury in Stockholm, Sweden, using international standards of reporting. Prospective, (regional) population-based observation. Forty-nine consecutively enrolled individuals. A surveillance system of newly-injured adults with traumatic spinal cord injury was implemented for an 18-month period. The International Spinal Cord Injury Core Data Set was used to collect data on those who survived the first 7 days post-injury. After an 18-month period, 49 incident cases were registered, of whom 45 were included in this study. The crude incidence rate was 19.0 per million, consisting mainly of men (60%), and the mean age of the cohort was 55 years (median 58). Causes of injury were almost exclusively limited to falls and transport-related events, accounting for 58% and 40% of cases, respectively. The incidence has remained stable when compared with the previous study; however, significant differences exist for injury aetiology (p = 0.004) and impairment level (p = 0.01) in that more fall- and transport-related spinal cord injury occurred, and a larger proportion of persons was left with resultant tetraplegia, in the current study, compared with more sport-related injuries and those left with paraplegia in the previous study. The incidence rate appeared to remain stable in Stockholm, Sweden. However, significant changes in injury aetiology and impairment-level post injury were found, compared with the previous study. There remains a need for developing fall-related prevention strategies in rehabilitation settings as well as in population-based programmes.

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

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

2018-01-01

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

"Wrestling induced cervical spondylosis, fact or fiction? A study conducted in 148 athletes "

Directory of Open Access Journals (Sweden)

"Fakhr Tabatabai SA

2000-11-01

Full Text Available Traumatic injuries are leading causes of spinal cord damage. The purpose of this study was to evaluate whether wrestling induced cervical spondylosis amongst professional wrestlers or not. To test this assumption, two groups of athletes, 72 wrestlers versus 76 non-wrestlers 15-55 years of age were studied. Radiographic findings and clinical assessment were compared in both groups. Significant difference (Odd ratio=2.91, P=0.007 were noted between the two groups regarding the prevalence of radiological cervical spondylosis. The clinical radiculo-myelopathy was significantly developing in wrestlers in higher ages (odd ratio=77.5, P<0.001. Torg ratio of < 80% was found to be somehow more in the younger age group. Considering the awesome and debilitating implications of this entity among professional wrestlers, it seems prudent to keep an eye on the cervical spine of all new entrants and closely follow up the professional wrestlers to prevent developing myelopathy.

Design and testing of a controlled electromagnetic spinal cord impactor for use in large animal models of acute traumatic spinal cord injury.

Science.gov (United States)

Petteys, Rory J; Spitz, Steven M; Syed, Hasan; Rice, R Andrew; Sarabia-Estrada, Rachel; Goodwin, C Rory; Sciubba, Daniel M; Freedman, Brett A

2017-09-01

Spinal cord injury (SCI) causes debilitating neurological dysfunction and has been observed in warfighters injured in IED blasts. Clinical benefit of SCI treatment remains elusive and better large animal models are needed to assess treatment options. Here, we describe a controlled electromagnetic spinal cord impactor for use in large animal models of SCI. A custom spinal cord impactor and platform were fabricated for large animals (e.g., pig, sheep, dog, etc.). Impacts were generated by a voice coil actuator; force and displacement were measured with a load cell and potentiometer respectively. Labview (National Instruments, Austin, TX) software was used to control the impact cycle and import force and displacement data. Software finite impulse response (FIR) filtering was employed for all input data. Silicon tubing was used a surrogate for spinal cord in order to test the device; repeated impacts were performed at 15, 25, and 40 Newtons. Repeated impacts demonstrated predictable results at each target force. The average duration of impact was 71.2 ±6.1ms. At a target force of 40N, the output force was 41.5 ±0.7N. With a target of 25N, the output force was 23.5 ±0.6N; a target of 15Newtons revealed an output force of 15.2 ±1.4N. The calculated acceleration range was 12.5-21.2m/s 2 . This custom spinal cord impactor reliably delivers precise impacts to the spinal cord and will be utilized in future research to study acute traumatic SCI in a large animal. Published by Elsevier Ltd.

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

Science.gov (United States)

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

2016-03-01

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

Epidemiology and risk factors of cervical spine injury during heating season in the patients with cervical trauma: a cross-sectional study.

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Sidong Yang

Full Text Available PURPOSE: The purpose of this study was to describe the epidemiology of cervical spine injury in the patients with cervical trauma and analyze its associated risk factors during the special heating season in North China. METHODS: This cross-sectional study investigated predictors for cervical spine injury in cervical trauma patients using retrospectively collected data of Hebei Provincial Orthopaedic Hospital from 11/2011 to 02/2012, and 11/2012 to 02/2013. Binary logistic regression analysis was used to determine risk factors for cervical fractures/dislocations or cord injury. RESULTS: A total of 106 patients were admitted into this study. Of all, 34 patients (32.1% were treated from 11/2011 to 02/2012 and 72 patients (67.9% from 11/2012 to 02/2013. The mean age was 41.9±13.3 years old; 85 patients (80.2% were male and 82 (77.4% from rural areas. Eighty patients (75.5% were caused by fall including 45 (42.5% by severe fall (>2 m. Sixty-five patients (61.3% of all suffered injuries to other body regions and 32 (30.2% got head injury. Thirty-one patients (29.2% sustained cervical cord injury with cervical fractures/dislocations. Twenty-six (83.9% of cervical cord injury patients were from rural areas and 24 (77.4% of those resulted from fall including 15 (48.4% from severe fall (>2 m. Logistic regression displayed that age (OR, 1.47; 95% CI, 1.05-2.07, head injury (OR, 5.63; 95% CI, 2.23-14.26, were risk factors for cervical cord injury and snowing (OR, 8.25; 95% CI, 2.26-30.15 was a risk factor for cervical spine injury due to severe fall (>2 m. CONCLUSIONS: The elder male patients and patients with head trauma are high-risk population for cervical cord injury. As a seasonal factor, snowing during heating season is of note a risk factor for cervical spine injury resulting from severe fall (>2 m in the patients with cervical trauma in North China.

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...

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

Science.gov (United States)

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

2001-06-01

Cervical spinal cord injury leads to a disruption of bulbospinal innervation from medullary respiratory centers to phrenic motoneurons. Animal models utilizing cervical hemisection result in inhibition of ipsilateral phrenic nerve activity, leading to paralysis of the hemidiaphragm. We have previously demonstrated a role for serotonin (5-HT) as one potential modulator of respiratory recovery following cervical hemisection, a mechanism that likely occurs via 5-HT2A and/or 5-HT2C receptors. The present study was designed to specifically examine if 5-HT2A and/or 5-HT2C receptors are colocalized with phrenic motoneurons in both intact and spinal-hemisected rats. Adult female rats (250-350 g; n = 6 per group) received a left cervical (C2) hemisection and were injected with the fluorescent retrograde neuronal tracer Fluorogold into the left hemidiaphragm. Twenty-four hours later, animals were killed and spinal cords processed for in situ hybridization and immunohistochemistry. Using (35)S-labeled cRNA probes, cervical spinal cords were probed for 5-HT2A and 5-HT2C receptor mRNA expression and double-labeled using an antibody to Fluorogold to detect phrenic motoneurons. Expression of both 5-HT2A and 5-HT2C receptor mRNA was detected in motoneurons of the cervical ventral horn. Despite positive expression of both 5-HT2A and 5-HT2C receptor mRNA-hybridization signal over phrenic motoneurons, only 5-HT2A silver grains achieved a signal-to-noise ratio representative of colocalization. 5-HT2A mRNA levels in identified phrenic motoneurons were not significantly altered following cervical hemisection compared to sham-operated controls. Selective colocalization of 5-HT2A receptor mRNA with phrenic motoneurons may have implications for recently observed 5-HT2A receptor-mediated regulation of respiratory activity and/or recovery in both intact and injury-compromised states. Copyright 2001 Academic Press.

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

International Nuclear Information System (INIS)

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

1988-01-01

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

Effect of melatonin on the functional recovery from experimental traumatic compression of the spinal cord

Directory of Open Access Journals (Sweden)

A. Schiaveto-de-Souza

2013-12-01

Full Text Available Spinal cord injury is an extremely severe condition with no available effective therapies. We examined the effect of melatonin on traumatic compression of the spinal cord. Sixty male adult Wistar rats were divided into three groups: sham-operated animals and animals with 35 and 50% spinal cord compression with a polycarbonate rod spacer. Each group was divided into two subgroups, each receiving an injection of vehicle or melatonin (2.5 mg/kg, intraperitoneal 5 min prior to and 1, 2, 3, and 4 h after injury. Functional recovery was monitored weekly by the open-field test, the Basso, Beattie and Bresnahan locomotor scale and the inclined plane test. Histological changes of the spinal cord were examined 35 days after injury. Motor scores were progressively lower as spacer size increased according to the motor scale and inclined plane test evaluation at all times of assessment. The results of the two tests were correlated. The open-field test presented similar results with a less pronounced difference between the 35 and 50% compression groups. The injured groups presented functional recovery that was more evident in the first and second weeks. Animals receiving melatonin treatment presented more pronounced functional recovery than vehicle-treated animals as measured by the motor scale or inclined plane. NADPH-d histochemistry revealed integrity of the spinal cord thoracic segment in sham-operated animals and confirmed the severity of the lesion after spinal cord narrowing. The results obtained after experimental compression of the spinal cord support the hypothesis that melatonin may be considered for use in clinical practice because of its protective effect on the secondary wave of neuronal death following the primary wave after spinal cord injury.

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

International Nuclear Information System (INIS)

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

1995-01-01

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

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

International Nuclear Information System (INIS)

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

1995-01-01

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

Significance of T2 weighted image on magnetic resonance. Imaging in diagnosis of acute cervical cord injury

International Nuclear Information System (INIS)

Takahashi, Isao; Kitahara, Takao; Endo, Masataka; Ohwada, Takashi

1999-01-01

Thirty-eight patients with acute cervical cord injury with neurological deficit were examined within 72 hours of injury by magnetic resonance imaging (MRI). This study evaluated early MRI as a neurological status and prognostic indicator of the eventual neurological outcome. The neurological status was determined using Frankel classification at admission and follow-up examination. Three different patterns of T2 weighted image (T2WI) on MRI were observed in these patients: 7 patients (Frankel A in all) had coexistence of low and high signal (mixed type); 9 (A in 3, B in 5, C in one) had high signal over more than one spinal segment (diffuse high type); 14 (A in 5, B in 3, C in 6) had high signal within one spinal segment (local high type); 8 (C in 6, D in 2) had no abnormality (normal type). At follow-up examination, the improvement rate was 14.3% for mixed type, 33.3% for diffuse high type, 78.6% for local high type and 100% for normal type. These studies suggest that the early MRI is very useful in the diagnosis of acute cervical cord injury and in predicting neurological recovery. (author)

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

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Negahdar, MJ; Shakeri, M.; McDowell, E.; Wells, J.; Vitaz, T.; Harkema, S.; Amini, A.

2011-03-01

MRI velocimetry (also known as phase-contrast MRI) is a powerful tool for quantification of cerebrospinal fluid (CSF) flow in various regions of the brain and craniospinal junction and has been accepted as a diagnostic tool to assist with the diagnosis of certain conditions such as hydrocephalus and chiari malformations. Cerebrospinal fluid is continually produced in the ventricles of the brain, flows through the ventricular system and then out and around the brain and spinal cord and is reabsorbed over the convexity of the brain. Any disease process which either impedes the normal pattern of flow or restricts the area where flow occurs can change the pattern of these waveforms with the direction and velocity of flow being determined by the pressure transmitted from the pulsation of the heart and circulation of blood within the central nervous system. Therefore, we hypothesized that phase-contrast MRI could eventually be used as a diagnostic aid in determining the degree of spinal cord compression following injury to the cervical or thoracic spine. In this study, we examined CSF flow in 3 normal subjects and 2 subjects with non-acute injuries in the cervical spine using Cine phasecontrast MRI. CSF flow analysis was performed using an in-house developed software. The flow waveform was calculated in both normal subjects (n=3) as well as subjects with spinal cord injury in the cervical spine (n=2). The bulk flow at C2 was measured to be 0.30 +/- 0.05 cc, at 5 cm distal to C2, it was 0.19+/- 0.07 cc, and at 10 cm distal to C2, it was 0.17+/- 0.05 cc. These results were in good agreement with previously published results. In patients with spinal cord injury, at the site of injury in the cervical spine, bulk flow was found to be 0.08 +/- 0.12 cc, at 5 cm proximal to the site of injury it was found to be 0.18 +/- 0.07 cc, and at 5 cm distal to the site of injury, it was found to be 0.12 +/- 0.01 cc.

Phrenic motoneuron discharge patterns following chronic cervical spinal cord injury

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

2013-01-01

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

Phrenic motoneuron discharge patterns following chronic cervical spinal cord injury.

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

2013-11-01

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

Role of Melatonin in Traumatic Brain Injury and Spinal Cord Injury

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Mehar Naseem

2014-01-01

Full Text Available Brain and spinal cord are implicated in incidences of two of the most severe injuries of central nervous system (CNS. Traumatic brain injury (TBI is a devastating neurological deficit involving primary and secondary injury cascades. The primary and secondary mechanisms include complex consequences of activation of proinflammatory cytokines, cerebral edema, upregulation of NF-κβ, disruption of blood-brain barrier (BBB, and oxidative stress. Spinal cord injury (SCI includes primary and secondary injury cascades. Primary injury leads to secondary injury in which generation of free radicals and oxidative or nitrative damage play an important pathophysiological role. The indoleamine melatonin is a hormone secreted or synthesized by pineal gland in the brain which helps to regulate sleep and wake cycle. Melatonin has been shown to be a versatile hormone having antioxidative, antiapoptotic, neuroprotective, and anti-inflammatory properties. It has a special characteristic of crossing BBB. Melatonin has neuroprotective role in the injured part of the CNS after TBI and SCI. A number of studies have successfully shown its therapeutic value as a neuroprotective agent in the treatment of neurodegenerative diseases. Here in this review we have compiled the literature supporting consequences of CNS injuries, TBI and SCI, and the protective role of melatonin in it.

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

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

2006-01-01

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

Usefulness of polyetheretherketone (PEEK) cage with plate augmentation for anterior arthrodesis in traumatic cervical spine injury.

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Song, Kyung-Jin; Choi, Byung-Wan; Kim, Gyu-Hyung; Song, Ji-Hun

2010-01-01

Even though many clinical reports about cages have been documented in patients with degenerative disorders, reports were scarce for traumatic injury cases, and those cases using metal cages were restricted to only one-level injury. To evaluate the usefulness of polyetheretherketone (PEEK) cage and plate construction in anterior interbody fusions (AIF) for traumatic cervical spine injuries by analyzing radiographic changes and clinical outcomes. Retrospective study. Fifty-eight patients (91 levels) underwent cage and plate construction for treatment of traumatic cervical spine injury. The fusion rate, fusion time, changes of Cobb angle, subsidence rate, and adjacent level changes were assessed as a radiographic outcome. Clinical analysis includes the recovery rate on the American Spinal Injury Association (ASIA) impairment scale and the presence of the complications. We evaluated 58 patients (91 levels) who underwent surgery and had at least 24 months in follow-up study. Radiographic evaluation included the assessment of interbody fusion rate, fusion time, changes of Cobb angle, subsidence rate, and adjacent level changes. Clinical assessment was done by analyzing recovery state of ASIA impairment scale from preoperative period to the last follow-up and by evaluating complications. Fifty-four cases showed bony fusion within 3 months after the surgery. The mean Cobb angle between the vertebral bodies was 2.54 degrees before operation, 9.13 degrees after operation, and 8.39 degrees at the latest follow-up. The mean intervertebral disc height was increased by 3.01 mm after the operation, but the mean height was 2.17 mm shorter at the last follow-up than after postoperation. In terms of clinical results, five Grade A cases and one Grade B case as assessed by the ASIA impairment scale were unchanged until the last follow-up. Twenty-three cases of Grade C, 16 cases of Grade D, and 13 cases of Grade E improved to seven cases, 26 cases, and 19 cases, respectively. Three

Occipital dysplasia and associated cranial spinal cord abnormalities in two dogs

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

1996-01-01

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

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

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SHEN Peng

2013-06-01

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

Spinal Cord Injury without Radiographic Abnormality (SCIWORA) – Clinical and Radiological Aspects

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Szwedowski, Dawid; Walecki, Jerzy

2014-01-01

The acronym SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) was first developed and introduced by Pang and Wilberger who used it to define “clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability”. SCIWORA is a clinical-radiological condition that mostly affects children. SCIWORA lesions are found mainly in the cervical spine but can also be seen, although much less frequently, in the thoracic or lumbar spine. Based on reports from different authors, SCIWORA is responsible for 6 to 19% and 9% to 14% of spinal injuries in children and adults, respectively. Underlying degenerative changes, including spondylosis or spinal canal stenosis, are typically present in adult patients. The level of spinal cord injury corresponds to the location of these changes. With recent advances in neuroimaging techniques, especially in magnetic resonance imaging, and with increasing availability of MRI as a diagnostic tool, the overall detection rate of SCIWORA has significantly improved

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

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

2018-04-01

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

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

Cervical spondylosis anatomy: pathophysiology and biomechanics.

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Shedid, Daniel; Benzel, Edward C

2007-01-01

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

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

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

2002-11-22

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

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

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

2016-06-01

Cervical spinal cord injury (SCI) interrupts descending neural drive to phrenic motoneurons causing diaphragm muscle (DIAm) paralysis. Recent studies using a well-established model of SCI, unilateral spinal hemisection of the C2 segment of the cervical spinal cord (SH), provide novel information regarding the molecular and cellular mechanisms of functional recovery after SCI. Over time post-SH, gradual recovery of rhythmic ipsilateral DIAm activity occurs. Recovery of ipsilateral DIAm electromyogram (EMG) activity following SH is enhanced by increasing brain-derived neurotrophic factor (BDNF) in the region of the phrenic motoneuron pool. Delivery of exogenous BDNF either via intrathecal infusion or via mesenchymal stem cells engineered to release BDNF similarly enhance recovery. Conversely, recovery after SH is blunted by quenching endogenous BDNF with the fusion-protein TrkB-Fc in the region of the phrenic motoneuron pool or by selective inhibition of TrkB kinase activity using a chemical-genetic approach in TrkB(F616A) mice. Furthermore, the importance of BDNF signaling via TrkB receptors at phrenic motoneurons is highlighted by the blunting of recovery by siRNA-mediated downregulation of TrkB receptor expression in phrenic motoneurons and by the enhancement of recovery evident following virally-induced increases in TrkB expression specifically in phrenic motoneurons. BDNF/TrkB signaling regulates synaptic plasticity in various neuronal systems, including glutamatergic pathways. Glutamatergic neurotransmission constitutes the main inspiratory-related, excitatory drive to motoneurons, and following SH, spontaneous neuroplasticity is associated with increased expression of ionotropic N-methyl-d-aspartate (NMDA) receptors in phrenic motoneurons. Evidence for the role of BDNF/TrkB and glutamatergic signaling in recovery of DIAm activity following cervical SCI is reviewed. Copyright © 2015 Elsevier B.V. All rights reserved.

Post-traumatic syringomyelia

International Nuclear Information System (INIS)

Freund, M.; Sartor, K.; Aschoff, A.; Spahn, B.

1999-01-01

The improvement of preclinical emergency medicine, better surgical and conservative therapies, and the development of intensive care units and specialized centers have improved the survival rate for patients with serious spinal cord injuries. Therefore, more sequelae of chronic spinal cord injuries such as post-traumatic spinal cord cavitations also occur. The first such case was described by Bastian in 1867. Generally, these cavitations were diagnosed from 2 months up to 32 years after the trauma. The overall prevalence of post-traumatic syringomyelia (PTS) is not known; however, with the increasing use of magnetic resonance imaging (MRI), its diagnosis has increased, ranging from 2.3% of paraplegic and tetraplegic patients in 1976 and 3.2% in 1985, to nearly 50% in a selected group of patients in 1991 and 1993. In 1995, a 4.45% incidence was reported. In our clinic we are currently treating 440 cases of syringomyelia, 140 of which are PTS. Several observations suggest more than one potential mechanism for the evolution of a post-traumatic cyst or PTS. Various factors, such as hemorrhage or, in particular, ischemia within the spinal cord, blockage of the cerebrosinal fluid (CSF) pathways around the cord or localized meningeal fibrosis either alone or in combination with other factors, may be involved. Clinically, sensory disturbances, loss of motor function, pain, and modification of the deep tendon reflexes are observed in most patients. On MRI, PTS is seen as a longitudinal, cystic cavity within the spinal cord, giving a hypointense signal on T 1 -weighted images and a hyperintense signal on T 2 -weighted images. For treatment planning it is mandatory to identify the lower and upper end of the PTS on the MRI. (orig.) [de

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

Care of post-traumatic spinal cord injury patients in India: An analysis

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Pandey V

2007-01-01

Full Text Available Background: The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup. Materials and Methods: Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed. Results: Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years. Twenty-nine (48.33% of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5% cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33% patients were given injection solumedrol with conservative treatment, 35 (60% patients were given only conservative treatment and seven patients were operated (11.66% upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42% and two (28.57% were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance. Conclusion: Awareness

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

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

2017-01-01

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

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.

Magnetic resonance imaging of diseased cervical and lumbar intervertebral discs

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Kadoya, Satoru; Nakamura, Tsutomu; Takarada, Akira; Yamamoto, Itaru; Sato, Shuji.

1989-02-01

Magnetic resonance images (MRI) of diseased cervical and lumbar intervertebral discs involving both intrinsic and extrinsic cord lesions were examined using either a 0.15 T resistive or a 0.5 T superconductive magnetic imaging system. The vertebrae, intervertebral discs, and spinal cord were delineated on spin-echo (SE) images with a long repetition time (TR) and a short echo time (proton density-weighted image). Protrusion of degenerated intervertebral discs into the spinal canal was clearly demonstrated not only on sagittal but also on parasagittal and transverse views. The location of protruded discs and compression of the spinal cord, caudal sac, and nerve roots were well visualized three-dimensionally. Pathological features of intervertebral discs were well appreciated on T/sub 2/-weighted images with long TR and SE pulse sequences. Degeneration of intervertebral discs resulted in decreased signal intensity in cases of lumbar disc involvement. For suspected myelomalacia, the intrinsic cord lesion resulting from traumatic disc protrusion appeared as focal low signal intensity on T/sub 1/-weithed images and as somewhat high intensity on T/sub 2/ weighted images. The inversion recovery sequence with median inversion time displayed an inferior image of low contrast and was judged uninformative in comparison to SE imags. The findings showed MRI to be an essential diagnostic technique for spinal cord disorders. It clearly pinpoints the anatomic structures of the spine and the features of disc degeneration. Both extrinsic and intrinsic cord abnormalities can be identified with MRI. The selection of proper pulse sequences is required for the differentiation of the object of interest. (Namekawa, K).

Magnetic resonance imaging of diseased cervical and lumbar intervertebral discs

International Nuclear Information System (INIS)

Kadoya, Satoru; Nakamura, Tsutomu; Takarada, Akira; Yamamoto, Itaru; Sato, Shuji.

1989-01-01

Magnetic resonance images (MRI) of diseased cervical and lumbar intervertebral discs involving both intrinsic and extrinsic cord lesions were examined using either a 0.15 T resistive or a 0.5 T superconductive magnetic imaging system. The vertebrae, intervertebral discs, and spinal cord were delineated on spin-echo (SE) images with a long repetition time (TR) and a short echo time (proton density-weighted image). Protrusion of degenerated intervertebral discs into the spinal canal was clearly demonstrated not only on sagittal but also on parasagittal and transverse views. The location of protruded discs and compression of the spinal cord, caudal sac, and nerve roots were well visualized three-dimensionally. Pathological features of intervertebral discs were well appreciated on T 2 -weighted images with long TR and SE pulse sequences. Degeneration of intervertebral discs resulted in decreased signal intensity in cases of lumbar disc involvement. For suspected myelomalacia, the intrinsic cord lesion resulting from traumatic disc protrusion appeared as focal low signal intensity on T 1 -weithed images and as somewhat high intensity on T 2 weighted images. The inversion recovery sequence with median inversion time displayed an inferior image of low contrast and was judged uninformative in comparison to SE imags. The findings showed MRI to be an essential diagnostic technique for spinal cord disorders. It clearly pinpoints the anatomic structures of the spine and the features of disc degeneration. Both extrinsic and intrinsic cord abnormalities can be identified with MRI. The selection of proper pulse sequences is required for the differentiation of the object of interest. (Namekawa, K)

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

Science.gov (United States)

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

2009-01-01

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

Epidemiology of worldwide spinal cord injury: a literature review

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Kang Y

2017-12-01

Full Text Available Yi Kang,1,2,* Han Ding,1,2,* Hengxing Zhou,1,2 Zhijian Wei,1,2 Lu Liu,1,2 Dayu Pan,1,2 Shiqing Feng1,2 1Department of Orthopaedics, Tianjin Medical University General Hospital, 2Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, People’s Republic of China *These authors contributed equally to this work Study design: A literature review of worldwide epidemiology of spinal cord injury (SCI. Objectives: To review the epidemiological indicators of SCI, such as incidence, prevalence, demographic characteristics, etiology, level and severity of injury, complications and mortality. Setting: The Department of Orthopaedics, Tianjin Medical University General Hospital, ­Heping District, Tianjin, People’s Republic of China. Methods: We searched articles published in PubMed, Medline, EMBASE and the Web of ­Science between January 1993 and June 2017 using the key words “spinal cord injury”, “­traumatic spinal cord injury”, “non-traumatic spinal cord injury” and “epidemiology”. The incidence, etiology, prevalence, patient demographics, level and severity of injury, complications and mortality were reviewed from the articles. Results: The epidemiology of SCI has changed. Motor vehicle accidents and falls have become the most common reasons of injury gradually. Incidence of SCI varies by regions or countries, and it has gradually increased with the expansion of human activities. The number of male patients were significantly more than female, the average age of patients with SCI had a tendency to increase gradually. The cervical level of spine was the most common part of injury; there were more number of patients with tetraplegia than patients with paraplegia. Electrolyte disturbances, pulmonary infections, urinary tract infections and bedsores were the four most common complications. Conclusion: We must have a greater

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

NARCIS (Netherlands)

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

2010-01-01

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

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

International Nuclear Information System (INIS)

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

2007-01-01

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

Magnetic resonance imaging of spinal cord injury

International Nuclear Information System (INIS)

Shakudo, Miyuki; Inoue, Yuichi; Fukuda, Teruo

1988-01-01

Forty-three MR examinations of 30 patients with spinal cord injuries were retrospectively reviewed to evaluate MR findings of the injured cord and to correlate them with the time interval from the day of spinal cord injury. There were 18 cysts, 8 ''myelomalacias'', 2 cord atrophies, one intramedullary hematoma and two transections. In one patient, ''myelomalacia'' became a cyst on the follow-up study. Large cysts of more than 6 vertebral segments were found in 7 patients, all of whom had had trauma more than 5 years prior to examination. Small cysts of less than half a vertebral height were seen in 5 patients, all of whom were studied 3 to 6 months after the injury. Intermediate cysts were seen in 7 patients who had sustained trauma more than a year before. In a majority (13/14 scans) of ''myelomalacia'', the time interval from injury until examination was only 2 weeks to 6 months. Of the 14 patients who showed post-traumatic progressive myelopathy, seven had large cysts. It is known that intramedullary hematoma becomes a cyst, and that post-traumatic myelomalacia probably results in a cyst in animal studies. Our clinical study seems to support a strong causal relation between myelomalacia and post-traumatic cysts. Since post-traumatic progressive myelopathy with a cyst is surgically treatable, follow-up MR imaging is preferable in cases with myelomalacia. (author)

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

International Nuclear Information System (INIS)

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

1979-01-01

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

The Radiation Dose-Response of the Human Spinal Cord

International Nuclear Information System (INIS)

Schultheiss, Timothy E.

2008-01-01

Purpose: To characterize the radiation dose-response of the human spinal cord. Methods and Materials: Because no single institution has sufficient data to establish a dose-response function for the human spinal cord, published reports were combined. Requisite data were dose and fractionation, number of patients at risk, number of myelopathy cases, and survival experience of the population. Eight data points for cervical myelopathy were obtained from five reports. Using maximum likelihood estimation correcting for the survival experience of the population, estimates were obtained for the median tolerance dose, slope parameter, and α/β ratio in a logistic dose-response function. An adequate fit to thoracic data was not possible. Hyperbaric oxygen treatments involving the cervical cord were also analyzed. Results: The estimate of the median tolerance dose (cervical cord) was 69.4 Gy (95% confidence interval, 66.4-72.6). The α/β = 0.87 Gy. At 45 Gy, the (extrapolated) probability of myelopathy is 0.03%; and at 50 Gy, 0.2%. The dose for a 5% myelopathy rate is 59.3 Gy. Graphical analysis indicates that the sensitivity of the thoracic cord is less than that of the cervical cord. There appears to be a sensitizing effect from hyperbaric oxygen treatment. Conclusions: The estimate of α/β is smaller than usually quoted, but values this small were found in some studies. Using α/β = 0.87 Gy, one would expect a considerable advantage by decreasing the dose/fraction to less than 2 Gy. These results were obtained from only single fractions/day and should not be applied uncritically to hyperfractionation

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

International Nuclear Information System (INIS)

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

2005-01-01

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

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

International Nuclear Information System (INIS)

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

1991-01-01

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

Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

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Miguel L. Tedde

2012-11-01

Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological survey from Denmark

DEFF Research Database (Denmark)

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

1997-01-01

Life expectancy among individuals with spinal cord injuries (SCI) has remained lower than in the normal population, even with optimal medical management. But significant improvement has been achieved, as will be illustrated in this retrospective study of an unselected group of traumatic survivors...... treatment and were rehabilitated at the centre for Spinal Cord Injured in Hornbaek, Denmark. At the end of the follow-up, 31st December 1992, 236 (197 men and 39 women) had died. The commonest causes of death were lung diseases, particularly pneumonia; suicide; and ischaemic heart disease. Among...... and pneumonia. A significant decrease in the overall mortality was observed from the first (1953-1973) to the second half of the observation period (1972-1992). Similarly the survival curves for both men and women demonstrate that the gap in survival probability between the normal population and the SCI has...

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

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Fernanda Miraldi

2013-09-01

Full Text Available Objective This study aims to evaluate “in vivo” the integrity of the normal-appearing spinal cord (NASC in patients with multiple sclerosis (MS compared to controls, using diffusion tensor MR imaging. Methods We studied 32 patients with MS and 17 without any neurologic disorder. Fractional anisotropy (FA, axial diffusivity (AD, radial diffusivity (RD and mean diffusivity (MD were calculated within regions of interest at C2 and C7 levels in the four columns of the spinal cord. Results At C2, FA value was decreased in MS patients. Besides, RD value was higher in MS than in controls. At C7, MD values were increased in MS. Conclusion The NASC in the right column of the cervical spinal cord showed abnormal FA, RD and MD values, which is possibly related to demyelination, since the FA abnormality was related to the RD and not to the AD.

Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study.

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Divanoglou, A; Seiger, A; Levi, R

2010-06-01

Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS). To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI). The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden. Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry. There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki. Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not.

Chronological observation in early radiation myelopathy of the cervical spinal cord; Gadolinium-enhanced MRI findings in two cases

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Hirota, Saeko; Yoshida, Shoji; Soejima, Toshinori (Hyogo Medical Center for Adults, Akashi (Japan)) (and others)

Gd-enhanced MR images of two patients with clinically and histopathologically diagnosed chronic progressive radiation myelitis (CPRM) were observed chronologically. One of them had had nasopharyngeal cancer and received radiotherapy at a dose of 100 Gy to the C1-2 level of the spinal cord. She developed CPRM 25 months after the termination of radiotherapy. The other had had malignant lymphoma originating from the tonsil and received chemoradiotherapy. The dose delivered to her cervical spinal cord was 40 Gy, and she developed CPRM 30 months later. Gd-enhanced MRI in the early phase revealed a small crescent-shaped nidus with or without a very small central nonenhanced area in both cases. Enhancement was not great. At that time, patients noticed only the inability to perceive pain and temperature or paresthesia in the opposite side. In a few months, MRI revealed a much more strongly enhanced and larger nidus with enlargement of a central nonenhanced area accompanied by long segmental cord enlargement. The patients' neurological symptoms had also progressed, with hemiparesis developing, for example. (author).

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

International Nuclear Information System (INIS)

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

1995-01-01

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

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

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

2012-10-15

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

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

International Nuclear Information System (INIS)

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

2012-01-01

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

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

International Nuclear Information System (INIS)

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

2000-01-01

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

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

Science.gov (United States)

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

2011-05-01

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

Effects of single dose X-irradiation on the guinea-pig spinal cord

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Knowles, J F [Medical Research Council, Harwell (UK). Radiobiological Research Unit

1981-09-01

Lumbar or cervical regions of the guinea-pig spinal cord were irradiated with a single dose of 250 kV X-rays. The latency for paralysis, whether of hind- or fore-limbs, and the histopathology of the radiation-induced cord lesions depended critically on the radiation dose. There were definite but only minor differences between the reactions of lumbar and cervical cord to the same radiation dose. After 30 or 40 Gy there was white matter necrosis but after 20 Gy widespread demyelination associated with vacuolar spaces occurred. After irradiation of the lumbar cord with 30-40 Gy, the lesions in the guinea-pig differed from those reported in the rat. White-matter necrosis in the guinea-pig cord was only occasionally associated with spinal nerve root necrosis, whereas in the rat, nerve-root necrosis with sparing of the white matter was the main lesion. After 20 Gy to the cervical or lumbar cord the guinea-pig showed widespread demyelination and vacuolation whereas in rats vascular lesions were the main result.

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

Science.gov (United States)

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

2015-03-01

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

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...

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

Science.gov (United States)

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

2016-07-01

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

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

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R.O. Chaves

2016-08-01

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

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

Science.gov (United States)

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

2016-01-01

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

The rheumatoid cervical spine: Signs of instability on plain cervical radiographs

International Nuclear Information System (INIS)

Roche, Clare J.; Eyes, Brian E.; Whitehouse, Graham H.

2002-01-01

The cervical spine is a common focus of destruction from rheumatoid arthritis, second only to the metacarpophalangeal joints. Joint, bone and ligament damage in the cervical spine leads to subluxations which can cause cervical cord compression resulting in paralysis and even sudden death. Because many patients with significant subluxations are asymptomatic, the radiologist plays a key role in recognizing the clinically important clues to instability on plain radiographs of the cervical spine-often difficult in rheumatoid arthritis when the bony landmarks are osteoporotic or eroded. This review focuses on the signs of instability on plain radiographs of the cervical spine, using diagrams and clinical examples to illustrate methods of identifying significant subluxations in rheumatoid arthritis. Roche, C.J., Eyes, B.E. and Whitehouse, G.H. (2002)

Cervical spine injuries in American football.

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Rihn, Jeffrey A; Anderson, David T; Lamb, Kathleen; Deluca, Peter F; Bata, Ahmed; Marchetto, Paul A; Neves, Nuno; Vaccaro, Alexander R

2009-01-01

American football is a high-energy contact sport that places players at risk for cervical spine injuries with potential neurological deficits. Advances in tackling and blocking techniques, rules of the game and medical care of the athlete have been made throughout the past few decades to minimize the risk of cervical injury and improve the management of injuries that do occur. Nonetheless, cervical spine injuries remain a serious concern in the game of American football. Injuries have a wide spectrum of severity. The relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Recent data on American football suggest that approximately 0.2 per 100,000 participants at the high school level and 2 per 100,000 participants at the collegiate level are diagnosed with cervical cord neuropraxia. Characterized by temporary pain, paraesthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury. Stenosis of the spinal canal, whether congenital or acquired, is thought to predispose the athlete to cervical cord neuropraxia. Although quite rare, catastrophic neurological injury is a devastating entity referring to permanent neurological injury or death. The mechanism is most often a forced hyperflexion injury, as occurs when 'spear tackling'. The mean incidence of catastrophic neurological injury over the past 30 years has been approximately 0.5 per 100,000 participants at high school level and 1.5 per 100,000 at the collegiate level. This incidence has decreased significantly when compared with the incidence in the early 1970s. This decrease in the incidence of

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)

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

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

1984-09-01

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

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

International Nuclear Information System (INIS)

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

1984-01-01

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

Functional status predicts acute care readmission in the traumatic spinal cord injury population.

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Huang, Donna; Slocum, Chloe; Silver, Julie K; Morgan, James W; Goldstein, Richard; Zafonte, Ross; Schneider, Jeffrey C

2018-03-29

Context/objective Acute care readmission has been identified as an important marker of healthcare quality. Most previous models assessing risk prediction of readmission incorporate variables for medical comorbidity. We hypothesized that functional status is a more robust predictor of readmission in the spinal cord injury population than medical comorbidities. Design Retrospective cross-sectional analysis. Setting Inpatient rehabilitation facilities, Uniform Data System for Medical Rehabilitation data from 2002 to 2012 Participants traumatic spinal cord injury patients. Outcome measures A logistic regression model for predicting acute care readmission based on demographic variables and functional status (Functional Model) was compared with models incorporating demographics, functional status, and medical comorbidities (Functional-Plus) or models including demographics and medical comorbidities (Demographic-Comorbidity). The primary outcomes were 3- and 30-day readmission, and the primary measure of model performance was the c-statistic. Results There were a total of 68,395 patients with 1,469 (2.15%) readmitted at 3 days and 7,081 (10.35%) readmitted at 30 days. The c-statistics for the Functional Model were 0.703 and 0.654 for 3 and 30 days. The Functional Model outperformed Demographic-Comorbidity models at 3 days (c-statistic difference: 0.066-0.096) and outperformed two of the three Demographic-Comorbidity models at 30 days (c-statistic difference: 0.029-0.056). The Functional-Plus models exhibited negligible improvements (0.002-0.010) in model performance compared to the Functional models. Conclusion Readmissions are used as a marker of hospital performance. Function-based readmission models in the spinal cord injury population outperform models incorporating medical comorbidities. Readmission risk models for this population would benefit from the inclusion of functional status.

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

International Nuclear Information System (INIS)

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

1997-01-01

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

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

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Simon C.P. Lau

2014-01-01

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

Spinal cord atrophy in anterior-posterior direction reflects impairment in multiple sclerosis

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Lundell, H; Svolgaard, O; Dogonowski, A-M

2017-01-01

OBJECTIVE: To investigate how atrophy is distributed over the cross section of the upper cervical spinal cord and how this relates to functional impairment in multiple sclerosis (MS). METHODS: We analysed the structural brain MRI scans of 54 patients with relapsing-remitting MS (n=22), primary...... progressive MS (n=9), secondary progressive MS (n=23) and 23 age- and sex-matched healthy controls. We measured the cross-sectional area (CSA), left-right width (LRW) and anterior-posterior width (APW) of the spinal cord at the segmental level C2. We tested for a nonparametric linear relationship between...... and specific MSIS subscores. CONCLUSION: In patients with MS, atrophy of the upper cervical cord is most evident in the antero-posterior direction. As APW of the cervical cord can be readily derived from standard structural MRI of the brain, APW constitutes a clinically useful neuroimaging marker of disease...

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

International Nuclear Information System (INIS)

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

1988-01-01

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

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.

Spinal cord motion. Influence of respiration and cardiac cycle

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

2014-11-15

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

Spinal cord motion. Influence of respiration and cardiac cycle

International Nuclear Information System (INIS)

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

2014-01-01

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

Reliable volumetry of the cervical spinal cord in MS patient follow-up data with cord image analyzer (Cordial).

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Amann, Michael; Pezold, Simon; Naegelin, Yvonne; Fundana, Ketut; Andělová, Michaela; Weier, Katrin; Stippich, Christoph; Kappos, Ludwig; Radue, Ernst-Wilhelm; Cattin, Philippe; Sprenger, Till

2016-07-01

Spinal cord (SC) atrophy is an important contributor to the development of disability in many neurological disorders including multiple sclerosis (MS). To assess the spinal cord atrophy in clinical trials and clinical practice, largely automated methods are needed due to the sheer amount of data. Moreover, using these methods in longitudinal trials requires them to deliver highly reliable measurements, enabling comparisons of multiple data sets of the same subject over time. We present a method for SC volumetry using 3D MRI data providing volume measurements for SC sections of fixed length and location. The segmentation combines a continuous max flow approach with SC surface reconstruction that locates the SC boundary based on image voxel intensities. Two cutting planes perpendicular to the SC centerline are determined based on predefined distances to an anatomical landmark, and the cervical SC volume (CSCV) is then calculated in-between these boundaries. The development of the method focused on its application in MRI follow-up studies; the method provides a high scan-rescan reliability, which was tested on healthy subject data. Scan-rescan reliability coefficients of variation (COV) were below 1 %, intra- and interrater COV were even lower (0.1-0.2 %). To show the applicability in longitudinal trials, 3-year follow-up data of 48 patients with a progressive course of MS were assessed. In this cohort, CSCV loss was the only significant predictor of disability progression (p = 0.02). We are, therefore, confident that our method provides a reliable tool for SC volumetry in longitudinal clinical trials.

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

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

2018-05-01

To develop a framework to fully characterize quantitative magnetization transfer indices in the human cervical cord in vivo within a clinically feasible time. A dedicated spinal cord imaging protocol for quantitative magnetization transfer was developed using a reduced field-of-view approach with echo planar imaging (EPI) readout. Sequence parameters were optimized based in the Cramer-Rao-lower bound. Quantitative model parameters (i.e., bound pool fraction, free and bound pool transverse relaxation times [ T2F, T2B], and forward exchange rate [k FB ]) were estimated implementing a numerical model capable of dealing with the novelties of the sequence adopted. The framework was tested on five healthy subjects. Cramer-Rao-lower bound minimization produces optimal sampling schemes without requiring the establishment of a steady-state MT effect. The proposed framework allows quantitative voxel-wise estimation of model parameters at the resolution typically used for spinal cord imaging (i.e. 0.75 × 0.75 × 5 mm 3 ), with a protocol duration of ∼35 min. Quantitative magnetization transfer parametric maps agree with literature values. Whole-cord mean values are: bound pool fraction = 0.11(±0.01), T2F = 46.5(±1.6) ms, T2B = 11.0(±0.2) µs, and k FB  = 1.95(±0.06) Hz. Protocol optimization has a beneficial effect on reproducibility, especially for T2B and k FB . The framework developed enables robust characterization of spinal cord microstructure in vivo using qMT. Magn Reson Med 79:2576-2588, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc

Rhabdomyolysis and acute kidney injury in patients with traumatic spinal cord injury

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Galeiras, Rita; Mourelo, Mónica; Pértega, Sonia; Lista, Amanda; Ferreiro, Mª Elena; Salvador, Sebastián; Montoto, Antonio; Rodríguez, Antonio

2016-01-01

Background: Patients with acute traumatic spinal cord injuries (SCIs) exhibit factors that, in other populations, have been associated with rhabdomyolysis. Purpose: The aim of the study is to determine the incidence of rhabdomyolysis in patients with acute traumatic SCI admitted to the Intensive Care Unit (ICU), as well as the development of secondary acute kidney injury and associated factors. Study Design and Setting: This was an observational, retrospective study. Patient Sample: All adult patients admitted to the ICU with acute traumatic SCI who presented rhabdomyolysis, diagnosed through creatine phosphokinase (CPK) levels >500 IU/L. Outcome Measures: Incidence of rhabdomyolysis and subsequent renal dysfunction was calculated. Materials and Methods: Data about demographic variables, comorbidity, rhabdomyolysis risk factors, and variables involving SCI, severity scores, and laboratory parameters were obtained from clinical records. Multivariate logistic regression was used to identify renal injury risk factors. Results: In 2006–2014, 200 patients with acute SCI were admitted to ICU. Of these, 103 had rhabdomyolysis (incidence = 51.5%; 95% confidence interval [CI]: 44.3%–58.7%). The most typical American Spinal Injury Association classification was A (70.3%). The injury severity score was 30.3 ± 12.1 and sequential organ failure assessment (SOFA) score was 5.6 ± 3.3 points. During their stay, 57 patients (55.3%; 95% CI: 45.2%–65.4%) presented renal dysfunction (creatinine ≥1.2 mg/dL). In the multivariate analysis, variables associated with renal dysfunction were creatinine at admission (odds ratio [OR] = 9.20; P = 0.006) and hemodynamic SOFA score the day following admission (OR = 1.33; P = 0.024). Creatinine was a better predictor of renal dysfunction than the peak CPK value during the rhabdomyolysis (area under the receiver operating characteristic curve: 0.91 vs. 0.63, respectively). Conclusions: Rhabdomyolysis is a frequent condition in patients

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

International Nuclear Information System (INIS)

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

2008-01-01

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

Value of MRI and DTI as Biomarkers for Classifying Acute Spinal Cord Injury

Science.gov (United States)

2014-10-29

Datasets were checked for goodness of fit as part of the quality assurance process. Whole cord FA, MD, LD (λ1) and TD (λ23) were calculated for...discussion 1658. 10. Marino RJ, Ditunno JF,Jr, Donovan WH, Maynard F ,Jr. Neurologic recovery after traumatic spinal cord injury: Data from the model spinal...Jan;75(1):67-72. 17. Foo D, Subrahmanyan TS, Rossier AB. Post-traumatic acute anterior spinal cord syndrome. Paraplegia. 1981;19(4):201-5. 18

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

Science.gov (United States)

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

2010-07-09

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

Medication before and after a spinal cord lesion.

Science.gov (United States)

Jensen, E K; Biering-Sørensen, F

2014-05-01

To map the impact of spinal cord lesion (SCL) on medication. Registration of medication for 72 patients before SCL and at discharge from the Department for Spinal Cord Injuries. Department for Spinal Cord Injuries, East Denmark. The changes in medication 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, 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. The overall increase in medication after SCL was 3.29 times (Ppopulation, the increase was most constantly seen for the medicine in the groups 'Alimentary tract and metabolism' and 'Nervous system'. The highest overall increases were seen in patients with AIS A, B and C compared with AIS D (P<0.05). There was no difference between traumatic and non-traumatic SCL, men and women, and younger compared with older patients. SCL elicits a general massive need for medicine. The relative increase is most pronounced for the more severely injured (AIS A, B and C). The increase in medication may have implications for side effects and for the economy of all involved.

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

International Nuclear Information System (INIS)

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

2009-01-01

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

International Spinal Cord Injury Data Sets for non-traumatic spinal cord injury.

Science.gov (United States)

New, P W; Marshall, R

2014-02-01

Multifaceted: extensive discussions at workshop and conference presentations, survey of experts and feedback. Present the background, purpose and development of the International Spinal Cord Injury (SCI) Data Sets for Non-Traumatic SCI (NTSCI), including a hierarchical classification of aetiology. International. Consultation via e-mail, presentations and discussions at ISCoS conferences (2006-2009), and workshop (1 September 2008). The consultation processes aimed to: (1) clarify aspects of the classification structure, (2) determine placement of certain aetiologies and identify important missing causes of NTSCI and (3) resolve coding issues and refine definitions. Every effort was made to consider feedback and suggestions from participants. The International Data Sets for NTSCI includes basic and an extended versions. The extended data set includes a two-axis classification system for the causes of NTSCI. Axis 1 consists of a five-level, two-tier (congenital-genetic and acquired) hierarchy that allows for increasing detail to specify the aetiology. Axis 2 uses the International Statistical Classification of Diseases (ICD) and Related Health Problems for coding the initiating diseases(s) that may have triggered the events that resulted in the axis 1 diagnosis, where appropriate. Additional items cover the timeframe of onset of NTSCI symptoms and presence of iatrogenicity. Complete instructions for data collection, data sheet and training cases are available at the websites of ISCoS (http://www.iscos.org.uk) and ASIA (http://www.asia-spinalinjury.org). The data sets should facilitate comparative research involving NTSCI participants, especially epidemiological studies and prevention projects. Further work is anticipated to refine the data sets, particularly regarding iatrogenicity.

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

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

2016-11-01

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

MRI of acute cervical injury: correlation with neurologic deficit

International Nuclear Information System (INIS)

Hyun, Chang Dong; Kwon, Soon Tae; Lim, Seung Chul; Shin, Myung Jin; Han, Boo Kyung; Kim, Sang Joon; Park, Man Soo; Yoon, Hyun Ki; Suh, Dae Chul

1995-01-01

To evaluate MRI findings of spinal cord according to mechanism in acute cervical spinal injury. 25 patients under went MRI within 1 month after acute cervical trauma. Axial T1Wl (TR/TE: 500/20), gradient-echo (TR/TE: 300/14), sagittal T1Wl (TR/TE: 500/20), proton (TR/TE: 2000. 20 msec), T2Wl (TR/TE: 2000/80) were performed. In 11 patients, post-enhancement T1Wl was done. Change of spinal cord signal intensity on MRI in addition to the presence of abnormal changes of vertebral body, intervertebral disc and paraspinal soft tissue were evaluated. 15 patients had flexion injury, seven had extension injury and three had injury of unknown mechanism. Twelve patients showed iso-signal intensity on T2Wl and high signal intensity on T2Wl. Three patients showed low signal intensity on T1Wl and high signal intensity on T2Wl. Spinal cord hemorrhage occured in 10 patients. We found cord swelling in nine patients and cord compression in 12 patients. In nine patients with cord swelling, extent of cord injury was more than one segment of vertebral body. Ligamentous injury, disc injury, soft tissue injury occurred in 16 (64%), 17 (68%), 15 (60%) patients respectively. Vertebral body fracture was found in 17 patients (68%). The levels of fracture were C6 (eight patients) and C5 (five patients). MRI is valuable in exaluetion of the spinal cord, intervertebral disc, and soft tissue lesions in acute cervical spinal injury. Prognosis is worse in flexion injury than in extension injury, and is well correlated with cord hemorrhage and lesion extent

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

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

2016-02-01

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

Delayed Transient Post-Traumatic Quadriplegia

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Khaloud Al-Shaaibi

2015-03-01

Full Text Available Transient neurological deficit following cervical trauma have been reported following sports injuries, and has been referred to as cervical cord neurapraxia. The so-called "whiplash injuries" following minor motor vehicle collisions usually do not produce any neurological deficit. Here we report the case of a whiplash type of injury presenting with a delayed onset neurological deficit, which was followed by rapid and complete recovery. The patient, an otherwise healthy 34-year-old male, attended the emergency department of Sultan Qaboos University Hospital following a rear-end motor vehicle collision. We present images showing degenerative disc disease causing spinal canal narrowing and mild cord compression in the patient, but no spinal instability. Differential diagnoses are also discussed.

Post-traumatic syringomyelia: CSF hydrodynamic changes following spinal cord injury are the driving force in the development of PTSM.

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Shields, Christopher B; Zhang, Yi Ping; Shields, Lisa B E

2012-01-01

Post-traumatic syringomyelia (PTSM) is a disorder that occurs infrequently following spinal cord injury (SCI), characterized by progressive neurological deterioration resulting from syrinx expansion originating in proximity to the traumatic epicenter. Several pathogenetic factors are associated with this disorder, however, the precise mechanism of the development of PTSM is controversial. Combined anatomical alterations and molecular changes following trauma to the spinal cord and arachnoid participate in the development of this condition. These factors include narrowing or obstruction of the subarachnoid space (SAS), central canal occlusion, myelomalacia, and alterations in intramedullary water permeability. If a patient sustains a SCI with delayed progressive deterioration in neurological function, in association with the MRI appearance of syringomyelia (SM), the diagnosis of PTSM is straightforward. The treatment of PTSM has not undergone any significant changes recently. The surgical treatment of PTSM consists of reconstructing the SAS or shunting fluid away from the syrinx to other locations. The advantages and disadvantages of each procedure will be discussed. With greater understanding of the mechanisms contributing to the development of SM, including advanced diagnostic methods and further advances in the development of artificial dural and shunting tubing, future therapies of PTSM will be more effective and long-lasting. Incorporation of alterations of AQP4 expression provides an intriguing possibility for future treatment of PTSM. Copyright © 2012 Elsevier B.V. All rights reserved.

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

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

2002-01-01

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

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

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

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

2013-06-01

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

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

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Vaner Koksal, M.D.

2017-09-01

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

Cervical injuries scored according to the Subaxial Injury Classification system: An analysis of the literature

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Andrei F Joaquim

2014-01-01

Full Text Available Introduction: The Subaxial Injury Classification (SLIC system and severity score has been developed to help surgeons in the decision-making process of treatment of subaxial cervical spine injuries. A detailed description of all potential scored injures of the SLIC is lacking. Materials and Methods: We performed a systematic review in the PubMed database from 2007 to 2014 to describe the relationship between the scored injuries in the SLIC and their eventual treatment according to the system score. Results: Patients with an SLIC of 1-3 points (conservative treatment are neurologically intact with the spinous process, laminar or small facet fractures. Patients with compression and burst fractures who are neurologically intact are also treated nonsurgically. Patients with an SLIC of 4 points may have an incomplete spinal cord injury such as a central cord syndrome, compression injuries with incomplete neurologic deficits and burst fractures with complete neurologic deficits. SLIC of 5-10 points includes distraction and rotational injuries, traumatic disc herniation in the setting of a neurological deficit and burst fractures with an incomplete neurologic deficit. Conclusion: The SLIC injury severity score can help surgeons guide fracture treatment. Knowledge of the potential scored injures and their relationships with the SLIC are of paramount importance for spine surgeons who treated subaxial cervical spine injuries.

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

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Derakhshan Nima

2014-06-01

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

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

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

2016-06-15

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

Pre-Hospital Care Management of a Potential Spinal Cord Injured Patient: A Systematic Review of the Literature and Evidence-Based Guidelines

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Ahn, Henry; Singh, Jeffrey; Nathens, Avery; MacDonald, Russell D.; Travers, Andrew; Tallon, John; Fehlings, Michael G.

2011-01-01

Abstract An interdisciplinary expert panel of medical and surgical specialists involved in the management of patients with potential spinal cord injuries (SCI) was assembled. Four key questions were created that were of significant interest. These were: (1) what is the optimal type and duration of pre-hospital spinal immobilization in patients with acute SCI?; (2) during airway manipulation in the pre-hospital setting, what is the ideal method of spinal immobilization?; (3) what is the impact of pre-hospital transport time to definitive care on the outcomes of patients with acute spinal cord injury?; and (4) what is the role of pre-hospital care providers in cervical spine clearance and immobilization? A systematic review utilizing multiple databases was performed to determine the current evidence about the specific questions, and each article was independently reviewed and assessed by two reviewers based on inclusion and exclusion criteria. Guidelines were then created related to the questions by a national Canadian expert panel using the Delphi method for reviewing the evidence-based guidelines about each question. Recommendations about the key questions included: the pre-hospital immobilization of patients using a cervical collar, head immobilization, and a spinal board; utilization of padded boards or inflatable bean bag boards to reduce pressure; transfer of patients off of spine boards as soon as feasible, including transfer of patients off spinal boards while awaiting transfer from one hospital institution to another hospital center for definitive care; inclusion of manual in-line cervical spine traction for airway management in patients requiring intubation in the pre-hospital setting; transport of patients with acute traumatic SCI to the definitive hospital center for care within 24 h of injury; and training of emergency medical personnel in the pre-hospital setting to apply criteria to clear patients of cervical spinal injuries, and immobilize patients

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

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

2017-06-01

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

MRI findings in posterior disc prolapse associated with cervical fracture dislocation

International Nuclear Information System (INIS)

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

1994-01-01

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

MRI findings in posterior disc prolapse associated with cervical fracture dislocation

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

1994-03-01

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

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

International Nuclear Information System (INIS)

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

1984-01-01

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

Changing demographics of spinal cord injury over a 20-year period: a longitudinal population-based study in Scotland.

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McCaughey, E J; Purcell, M; McLean, A N; Fraser, M H; Bewick, A; Borotkanics, R J; Allan, D B

2016-04-01

A retrospective cohort study. To review demographic trends in traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI). The Queen Elizabeth National Spinal Injuries Unit (QENSIU), sole provider of treatment for TSCI in Scotland; a devolved region of the UK National Health Service. A retrospective review of the QENSIU database was performed between 1994 and 2013. This database includes demographic and clinical data from all new TSCI patients in Scotland, as well as patients with severe NTSCI. Over this 20-year period there were 1638 new cases of TSCI in Scotland; 75.2% occurring in males. TSCI incidence increased non-significantly (13.3 per million population to 17.0), while there were significant increases in mean age at time of TSCI (44.1-52.6 years), the proportion of TSCIs caused by falls (41-60%), the proportion of TSCIs resulting in an American Spinal Injury Association Impairment Scale score of C and D on admission (19.7-28.6% and 34.5-39.5%, respectively) and the proportion of cervical TSCIs (58.4-66.3%). The increase in cervical TSCI was specifically due to an increase in C1-C4 lesions (21.7-31.2%). NTSCI patients (n=292) were 5 years older at injury, more likely to be female (68.1% male) and had a range of diagnoses. This study supports the suggestion that demographic profiles in SCI are subject to change. In this population, of particular concern is the increasing number of older patients and those with high level tetraplegia, due to their increased care needs. Prevention programmes, treatment pathways and service provision need to be adjusted for optimum impact, improved outcome and long-term care for their target population.

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

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2016-10-01

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

Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

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Rick Hong

2014-07-01

Full Text Available Introduction: We wanted to compare 3 existing emergency medical services (EMS immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based; the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria; and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness.To determine the proportion of patients who would require cervical immobilization per protocol and the number of missed cervical spine injuries, had each protocol been followed with 100% compliance. Methods: This was a cross-sectional study of patients ≥18 years transported by EMS post-traumatic mechanism to an inner city emergency department. Demographic and clinical/historical data obtained by physicians were recorded prior to radiologic imaging. Medical record review ascertained cervical spine injuries. Both physicians and EMS were blinded to the objective of the study. Results: Of 498 participants, 58% were male and mean age was 48 years. The following participants would have required cervical spine immobilization based on the respective protocol: PHTLS, 95.4% (95% CI: 93.1-96.9%; Domeier, 68.7% (95% CI: 64.5-72.6%; Hankins, 81.5% (95% CI: 77.9-84.7%. There were 18 cervical spine injuries: 12 vertebral fractures, 2 subluxations/dislocations and 4 spinal cord injuries. Compliance with each of the 3 protocols would have led to appropriate cervical spine immobilization of all injured patients. In practice, 2 injuries were missed when the PHTLS criteria were mis-applied. Conclusion: Although physician-determined presence of cervical spine immobilization criteria cannot be generalized to the findings obtained by EMS personnel, our findings suggest that the mechanism-based PHTLS criteria may result in unnecessary cervical spine immobilization without apparent benefit to injured patients. PHTLS

Diffusion tensor tractography of normal and compressed spinal cord: a preliminary study at 3.0 T MR

International Nuclear Information System (INIS)

Wang Wei; Chang Shixin; Hao Nanxin; Du Yushan; Wang Yibin; Zong Genlin; Cao Kaiming; Lu Jianping; Zhao Cheng; Qin Wen

2007-01-01

Objective: To study the feasibility and clinical values of diffusion tensor tractography (DTT) in the spinal cord at 3.0 T MR. Methods: Forty patients with spinal cord compression including cervical cord herniation and cervical spondylosis (30 cases), tumors in spinal canal (9 cases) and old injury in cervical vertebrae (1 cases) and 20 healthy volunteers participated in this study. Single-shot spin- echo echo-planar diffusion tensor sequence for tractography of the spinal cord was performed. The fibers of spinal cord were visualized by using fiber tracking software. Results: On the DTT maps, the normal spinal cord was depicted as a fiber tract showing color-encoded cephalocaudally, which indicated anisotropy in the cephalocaudal direction. By setting two ROI, the main spinal cord fiber tracts, such as corticospinal or spinothalamic tract, were visualized. The tracts from two sides of the brain did not completely cross. It was asymmetric in the number of tracts on the two sides in most normal subjects (8/10). The tracts of all patients with cord compression were seen oppressed or damaged in different degrees. The DTT in patients with cervical spondylosis and extramedullary-intradural neurolemmoma demonstrated that tracts were oppressed but not damaged. The DTT in one ependymoma showed that tract was markedly compressed and slightly damaged. Conclusion: DTT is a promising tool for demonstrating the spinal cord tracts and abnormalities, can provide useful information for the localization of compression and evaluation of the impairment extent on the white matter tracts of the spinal cord. (authors)

Primary multifocal gliosarcoma of the spinal cord

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Ramesh M. Kumar

2016-03-01

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

MRI of the cranio-cervical region in rheumatoid arthritis

International Nuclear Information System (INIS)

Algra, P.R.; Breedveld, F.C.; Vielvoye, G.J.; Doornbos, J.; Roos, A. de

1987-01-01

16 patients suffering from rheumatoid arthritis and suspected compressive cervical myelopathy were studied with a 0.5 T superconducting magnetic resonance imaging (MRI) scanner. MRI findings were compared with those of plain radiography and myelography. Subluxation was detected equally well by MRI and radiography. MRI was able to detect the presence, level and origin of cord compression. MRI was superior in diagnosing the extent of cord compression. Cord distortion detected by MRI correlated better with clinical evidence of myelopathy than did the radiographically established extent of the subluxation. MRI correctly diagnosed the level and cause of cord compression in six patients who were subsequently operated upon because of progressive neurological signs. These findings suggest that MRI has potential in the diagnosis and management of patients with rheumatoid arthritis suspected of compressive cervical myelopathy. 20 refs.; 4 figs.; 1 table

Cervical myelopathy: magnetic imaging findings

International Nuclear Information System (INIS)

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

1996-01-01

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

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

Science.gov (United States)

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

2014-12-01

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

Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

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Kadom, Nadja [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Boston University Medical Center, Boston, MA (United States); Khademian, Zarir; Vezina, Gilbert; Shalaby-Rana, Eglal [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Rice, Amy [Independent Consultant (Biostatistics), Chevy Chase, MD (United States); Hinds, Tanya [Children' s National Medical Center, Child and Adolescent Protection Center, Washington, DC (United States)

2014-07-15

In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories. This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1. The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20-679 days). Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with abusive head trauma (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a

Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

International Nuclear Information System (INIS)

Kadom, Nadja; Khademian, Zarir; Vezina, Gilbert; Shalaby-Rana, Eglal; Rice, Amy; Hinds, Tanya

2014-01-01

In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories. This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1. The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20-679 days). Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with abusive head trauma (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a

Resilience in the initial year of caregiving for a family member with a traumatic spinal cord injury.

Science.gov (United States)

Elliott, Timothy R; Berry, Jack W; Richards, J Scott; Shewchuk, Richard M

2014-12-01

Individuals who assume caregiving duties for a family member disabled in a traumatic injury often exhibit considerable distress, yet few studies have examined characteristics of those who may be resilient in the initial year of caregiving. Reasoning from the influential Pearlin model of caregiving (Pearlin & Aneshensel, 1994) and the resilience process model (Bonanno, 2005), we expected a significant minority of caregivers would be chronically distressed and another group would be resilient throughout the inaugural year of caregiving for a person with a traumatic spinal cord injury (SCI), and these groups would differ significantly in primary and secondary stress and in personal resources and mediators. Twenty men and 108 women who identified as caregivers for a family member who incurred a traumatic SCI consented to complete measures during the inpatient rehabilitation and at 1 month, 6 months, and 12 months postdischarge. Latent growth mixture modeling of depression symptoms over time revealed 3 groups of caregivers: chronic (24%), recovery (24%) and resilient (48%). The chronic group reported more anxiety, negative affect, and ill health than the other 2 groups throughout the year. The resilient group was best characterized by their enduring levels of positive affect and supportive social networks. A large percentage of individuals are resilient in the initial year of caregiving, and those who have problems adapting exhibit significant distress soon following the traumatic event. Early detection of and psychological interventions for individuals who have difficulty adjusting are indicated, as their distress is unlikely to abate untreated over the year.

Pediatric cervical spondylolysis and American football.

Science.gov (United States)

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

2014-06-01

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

The experience of seeking, gaining and maintaining employment after traumatic spinal cord injury and the vocational pathways involved.

Science.gov (United States)

Hilton, Gillean; Unsworth, Carolyn A; Stuckey, Ruth; Murphy, Gregory C

2018-01-01

Vocational potential in people with spinal cord injury (SCI) are unrealised with rates of employment substantially lower than in the labour force participation of the general population and the pre-injury employment rates. To understand the experience and pathway of people achieving employment outcome after traumatic spinal cord injury by; classifying participants into employment outcome groups of stable, unstable and without employment; identifying pre and post-injury pathways for participants in each group and, exploring the experiences of people of seeking, gaining and maintaining employment. Thirty-one participants were interviewed. Mixed methods approach including interpretive phenomenological analysis and vocational pathway mapping of quantitative data. The most common pathway identified was from study and work pre-injury to stable employment post-injury. Four super-ordinate themes were identified from the interpretive phenomenological analysis; expectations of work, system impacts, worker identity and social supports. Implications for clinical practice include fostering cultural change, strategies for system navigation, promotion of worker identity and optimal use of social supports. The findings increase insight and understanding of the complex experience of employment after spinal cord injury. There is opportunity to guide experimental research, policy development and education concerning the complexity of the return to work experience and factors that influence pathways.

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

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Srinivasu Kallakuri

2015-01-01

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

Vulnerable, but strong: The spinal cord-injured patient during rehabilitation

DEFF Research Database (Denmark)

Angel, Sanne

2010-01-01

A traumatic spinal cord injury affects the body to an extent that the patient requires the assistance of others to survive and recover. The rehabilitation phase puts the patient in a vulnerable position and involves a considerable amount of strength on the patient's part. The aim of this paper...... is to explore the vulnerability of the spinal cord patient and how this vulnerability connects to the necessary strength, as the patient struggles to survive the injury and get through the rehabilitation. The circumstances of 12 traumatic spinal cord-injured patients were observed in the rehabilitation unit...... and after discharge. A phenomenological-hermeneutic narrative approach applying Ricoeur's theory was used. Data were collected by field observation and interviews during the first 2 years after the spinal cord injury. The patient's strength during the rehabilitation was portrayed by their endurance and from...

Conservative Management Of Third Trimester Cervical Spinal Cord ...

African Journals Online (AJOL)

Spinal cord injury, though an important cause of morbidity appears to be uncommon in pregnant women or perhaps, has not been accurately documented among them. Superimposed on the many impairments resulting from spinal cord injury is the presence of the foetus in the womb, which in itself normally brings about ...

Predicting surgical outcome in cases of cervical myelopathy with magnetic resonance imaging. Critical parameters

International Nuclear Information System (INIS)

Akiyama, Takashi

1997-01-01

In this study, the author attempted to correlate clinical factors significant in cases of cervical myelopathy with postoperative recovery. It is hoped that the results will aid in the preoperative prediction of surgical outcomes. The factors considered were the transverse area of the spinal cord, the cord compression rate, the presence of a high intensity area in T2-weighted MRI, the duration of symptoms before surgery, and age at surgery. Because there are variations in the transverse area of the spinal cord, 100 normal individuals were selected and the standard transverse area was calculated. The transverse area of the spinal cord and the cord constriction rate in the myelopathy cases was then measured and compared to the standard. The data indicated that the constriction rate was most relevant to recovery rate. Clinical thresholds found to correlate with a better than average rate of recovery in cases of cervical spondylotic myelopathy (CSM) were: a cord constriction rate; under 28.7%, cord compression rate; over 0.38, duration of symptoms before surgery; less than 9.2 months, and age at surgery; under 59.2 yrs. In patients with ossification of the longitudinal ligament (OPLL), cord constriction rate; under 36.2%, cord compression rate; over 0.30, duration of symptoms before surgery; less than 14.2 months, and age at surgery; under 57.6 yrs., all correlated with superior recovery, as did cord constriction rate; under 22.3%, and duration of symptoms before surgery; less than 3.7 months with patients suffering from cervical disc herniation (CDH). Furthermore, the absence of a T2-weighted high intensity area in CSM and OPLL patients also correlated with improved recovery. These results suggest that a favorable postoperative recovery rate can be expected in cases of cervical myelopathy that conform to the above criteria. (author)

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

Science.gov (United States)

Lee, Dong Gyu; Chang, Min Cheol

2017-10-01

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

Traumatic spinal cord injury caused by suspected hyperflexion of the atlantoaxial joint in a 10-year-old cat

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Annette Wessmann

2015-06-01

Full Text Available Case summary A 10-year-old cat presented 5 days after a traumatic event with acute recumbency followed by some clinical improvement. The neuroanatomical localisation was the C1–C5 spinal cord segments. Initial survey radiographs, including lateral flexed views, showed no convincing abnormalities. Magnetic resonance imaging (MRI revealed a marked focal intramedullary lesion at the level of the dens and suspected oedema extending over C2–C3 vertebrae, suggesting early syrinx formation. The cat made an initial excellent recovery on restricted exercise without medical treatment. The MRI changes largely resolved on follow-up MRI 4 weeks later yet recurred following a relapse 4 months later. At this stage, a post-traumatic syrinx had developed. Moreover, the suspected atlantoaxial instability was finally diagnosed on radiography with fully flexed lateral views. A hyperflexion injury causing tearing of the atlantoaxial ligaments was considered most likely given the lack of malformations or fractures. The cat made a full recovery on conservative management. Relevance and novel information This is the first report of sequential MRI findings in a cat with atlantoaxial instability. Moreover, post-traumatic syringomyelia formation following atlantoaxial injury has not been reported. Sequential MRI aids in the diagnosis of hyperflexion injury if survey radiographs fail to identify atlantoaxial instability.

The corticospinal tract lesion of amyotrophic lateral sclerosis. Magnetic resonance imaging of the spinal cord

International Nuclear Information System (INIS)

Terao, Shin-ichi; Sobue, Gen; Mitsuma, Terunori; Yasuda, Takeshi; Kachi, Teruhiko.

1994-01-01

Magnetic resonance imaging by gradient echo method demonstrated lesions of the lateral corticospinal tract at cervical cord levels in three ALS patients. Patient 1 was a 43-year-old woman with common from of ALS. She developed right-side predominant pyramidal signs, and right-side predominant prolongation of central motor conduction time. MRI showed hypersignal intensity areas in the dorsal region of the lateral column at the 4th and 5th cervical segments with right-side predominacy. Patient 2 was a 65-year-old man with pseudopolyneuritic from of ALS, who showed lower motor neuron signs without a pyramidal sign. MRI of the 3rd and 4th cervical cord segments demonstrated bilateral hypersignal intensity areas in the dorsal part of the lateral column. Patient 3 was a 62-year-old man with common form of ALS, who showed marked bilateral pyramidal signs with Babinski's sign. MRI of the 5th cervical spinal cord segment demonstrated bilateral hypersignal intensity areas in the dorsolateral column. MR images of the spinal cord thus obtained corresponded well to the postmortem confirmed degeneration of the spinal corticospinal tract. MRI of the spinal cord performed by gradient echo method would provide additional information on the upper motor neuron involvement in ALS. (author)

The corticospinal tract lesion of amyotrophic lateral sclerosis. Magnetic resonance imaging of the spinal cord

Energy Technology Data Exchange (ETDEWEB)

Terao, Shin-ichi; Sobue, Gen; Mitsuma, Terunori (Aichi Medical Univ., Nagakute (Japan)); Yasuda, Takeshi; Kachi, Teruhiko

1994-09-01

Magnetic resonance imaging by gradient echo method demonstrated lesions of the lateral corticospinal tract at cervical cord levels in three ALS patients. Patient 1 was a 43-year-old woman with common from of ALS. She developed right-side predominant pyramidal signs, and right-side predominant prolongation of central motor conduction time. MRI showed hypersignal intensity areas in the dorsal region of the lateral column at the 4th and 5th cervical segments with right-side predominacy. Patient 2 was a 65-year-old man with pseudopolyneuritic from of ALS, who showed lower motor neuron signs without a pyramidal sign. MRI of the 3rd and 4th cervical cord segments demonstrated bilateral hypersignal intensity areas in the dorsal part of the lateral column. Patient 3 was a 62-year-old man with common form of ALS, who showed marked bilateral pyramidal signs with Babinski's sign. MRI of the 5th cervical spinal cord segment demonstrated bilateral hypersignal intensity areas in the dorsolateral column. MR images of the spinal cord thus obtained corresponded well to the postmortem confirmed degeneration of the spinal corticospinal tract. MRI of the spinal cord performed by gradient echo method would provide additional information on the upper motor neuron involvement in ALS. (author).

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

Directory of Open Access Journals (Sweden)

Elaine Anna Corbett

2014-05-01

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

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

Science.gov (United States)

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

2012-01-01

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

Application of Color Transformation Techniques in Pediatric Spinal Cord MR Images: Typically Developing and Spinal Cord Injury Population.

Science.gov (United States)

Alizadeh, Mahdi; Shah, Pallav; Conklin, Chris J; Middleton, Devon M; Saksena, Sona; Flanders, Adam E; Krisa, Laura; Mulcahey, M J; Faro, Scott H; Mohamed, Feroze B

2018-01-16

The purpose of this study was to evaluate an improved and reliable visualization method for pediatric spinal cord MR images in healthy subjects and patients with spinal cord injury (SCI). A total of 15 pediatric volunteers (10 healthy subjects and 5 subjects with cervical SCI) with a mean age of 11.41 years (range 8-16 years) were recruited and scanned using a 3.0T Siemens Verio MR scanner. T2-weighted axial images were acquired covering entire cervical spinal cord level C1 to C7. These gray-scale images were then converted to color images by using five different techniques including hue-saturation-value (HSV), rainbow, red-green-blue (RGB), and two enhanced RGB techniques using automated contrast stretching and intensity inhomogeneity correction. Performance of these techniques was scored visually by two neuroradiologists within three selected cervical spinal cord intervertebral disk levels (C2-C3, C4-C5, and C6-C7) and quantified using signal to noise ratio (SNR) and contrast to noise ratio (CNR). Qualitative and quantitative evaluation of the color images shows consistent improvement across all the healthy and SCI subjects over conventional gray-scale T2-weighted gradient echo (GRE) images. Inter-observer reliability test showed moderate to strong intra-class correlation (ICC) coefficients in the proposed techniques (ICC > 0.73). The results suggest that the color images could be used for quantification and enhanced visualization of the spinal cord structures in addition to the conventional gray-scale images. This would immensely help towards improved delineation of the gray/white and CSF structures and further aid towards accurate manual or automatic drawings of region of interests (ROIs).

The effects of gender on clinical and neurological outcomes after acute cervical spinal cord injury.

Science.gov (United States)

Furlan, Julio C; Krassioukov, Andrei V; Fehlings, Michael G

2005-03-01

The potential clinical relevance of gender on clinical and neurological outcome after spinal cord injury (SCI) has received little attention. In order to address this issue, we examined all consecutive cases of acute traumatic cervical SCI admitted to our institution from 1998 to 2000. There were 38 males (ages 17-89 years, mean of 51.6) and 17 females (ages 18-84 years, mean of 63.2). Both groups were comparable regarding level (C1 to C7) and severity of SCI (ASIA A to D) at admission. Age differences between the groups approached significance (p = 0.057), and thus this factor was treated as a covariate in the analysis. Co-morbidities were as frequent in men (86.8%) as in women (76.5%). The therapeutic approaches, length-of-stay in the acute care unit, mortality, and discharge disposition were similar in men and women. During hospitalization, 44.7% of men and 52.9% of women developed post-SCI secondary complications without any significant gender-related differences. Both groups showed a similar incidence of infections, cardiovascular complications, thromboembolism, and pressure sores. Univariate analysis revealed a trend for higher incidence of psychiatric complications (p = 0.054) and deep venous thrombosis (p = 0.092) in women, which was confirmed by multivariate analysis. Neurological outcome was not correlated with gender. A similar number of males and females (42.1%, 47.1%) showed evidence of neurological recovery as revealed by an improvement in ASIA scores. Moreover, 18.4% of males and 29.4% of females recovered to ASIA E status. Our data suggest a shift in the demographics of acute SCI with an increasing incidence in elderly women. Although neurological outcomes were not significantly related to gender, we observed a trend for higher rates of reactive depression and deep venous thrombosis in women. These issues may be of key clinical importance in developing improved management protocols for SCI so as to maximize functional recovery and quality-of-life.

Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery

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João Simão de Melo-Neto

Full Text Available ABSTRACT OBJECTIVE: To identify the characteristics of patients with spinal cord injury (SCI undergoing surgery. METHODS: Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected. RESULTS: A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n= 92. The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality. CONCLUSION: These factors enable investments in prevention, rehabilitation, and treatment.

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

Directory of Open Access Journals (Sweden)

Akinwunmi Oni-Orisan

Full Text Available Functional magnetic resonance imaging (fMRI studies have demonstrated alterations during task-induced brain activation in spinal cord injury (SCI patients. The interruption to structural integrity of the spinal cord and the resultant disrupted flow of bidirectional communication between the brain and the spinal cord might contribute to the observed dynamic reorganization (neural plasticity. However, the effect of SCI on brain resting-state connectivity patterns remains unclear. We undertook a prospective resting-state fMRI (rs-fMRI study to explore changes to cortical activation patterns following SCI. With institutional review board approval, rs-fMRI data was obtained in eleven patients with complete cervical SCI (>2 years post injury and nine age-matched controls. The data was processed using the Analysis of Functional Neuroimages software. Region of interest (ROI based analysis was performed to study changes in the sensorimotor network using pre- and post-central gyri as seed regions. Two-sampled t-test was carried out to check for significant differences between the two groups. SCI patients showed decreased functional connectivity in motor and sensory cortical regions when compared to controls. The decrease was noted in ipsilateral, contralateral, and interhemispheric regions for left and right precentral ROIs. Additionally, the left postcentral ROI demonstrated increased connectivity with the thalamus bilaterally in SCI patients. Our results suggest that cortical activation patterns in the sensorimotor network undergo dynamic reorganization following SCI. The presence of these changes in chronic spinal cord injury patients is suggestive of the inherent neural plasticity within the central nervous system.

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

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Piotrowski, W P

1983-01-01

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

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

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

2016-05-01

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

Spinal cord lesions in Bangladesh: an epidemiological study 1994 - 1995.

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Hoque, M F; Grangeon, C; Reed, K

1999-12-01

Spinal Cord Lesions are a major public health problem in Bangladesh. This epidemiological study was undertaken in order to identify the causes of spinal cord lesions and thus to allow prevention and control programs to be developed. The records of 247 patients with spinal cord lesions admitted to The Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka from January 1994 to June 1995 were reviewed retrospectively. Comparisons were made with the reports of studies from other countries, both developing and developed. The most common cause of traumatic lesions was a fall from a height followed by falling when carrying a heavy weight on the head and road traffic accidents. Most of the patients were between 20 - 40 years old and the overall age group ranged from 10 - 70 years. The male:female ratio was 7.5 : 1.0. Among the traumatic spinal cord lesions, 60% were paraplegics and 40% tetraplegics. Among the non-traumatic spinal cord lesions cases 84% were paraplegics and 16% tetraplegics. The leading cause of death resulted from respiratory complications and these deaths occurred in the very early period of admission. From the results it can be deduced that the high incidence of spinal cord lesion as a result from falls from a height, and from falling when carrying a heavy weight on the head, can be explained by the mainly agricultural based economy of Bangladesh. The most common age group (10 - 40 years) of patients reflects the socio-economic conditions of Bangladesh. The male:female ratio (7.5 : 1.0) of patients with a spinal cord lesion is due to the socio-economic status and to the traditional culture of the society.

Epidemiology of Pediatric Traumatic Spinal Cord Injury in a Population-Based Cohort, 1998-2012.

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Saunders, Lee L; Selassie, Anbesaw; Cao, Yue; Zebracki, Kathy; Vogel, Lawrence C

2015-01-01

Traumatic spinal cord injury (SCI) that occurs in children and adolescents who are still developing represents a different challenge than SCI in adults. However, information on the epidemiology and incidence of SCI in a population-based cohort is lacking. To describe the epidemiology of pediatric SCI in a population-based cohort in the United States and to assess trend in incidence over a 15-year period (1998-2012). Children and adolescents (0-21 years) with SCI were identified through the South Carolina SCI Surveillance Registry using hospital discharge records from 1998 to 2012. Overall age-adjusted incidence rates were calculated for each year, and incidence rates were stratified by age, gender, and race. The overall age-adjusted incidence rate was 26.9 per million population, and there was a trend (P = .0583) toward decreasing incidence of pediatric SCI. When stratified by race, there was a significant decrease in incidence among Whites(P = .0052) but not among non-Whites. Younger participants were more likely to be female, to be injured through sports, and to be more likely to have concomitant traumatic brain injury. Since 1998, the proportion of older pediatric patients (16-22 years) with SCI has increased, as has the proportion of non-White patients. Although there was an overall trend toward decreasing incidence in this population-based cohort, when stratified by race, this trend only occurred in the White population.

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

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Piotrowski, W.P.

1983-01-01

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

A radiological study on the cervical spine in rheumatoid arthritis

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Taketomi, Eiji; Sakoh, Takashi; Sunahara, Nobuhiko [Kagoshima Univ. (Japan). Faculty of Medicine

1995-03-01

The cervical spine was examined with the magnetic resonance imaging (MRI) and the conventional roentgenograms in 95 patients with rheumatoid arthritis. The MRI findings of upper cervical disorders were compared with various values determined in roentgenograms: the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat and Redlund-Johnell values. In patients with vertical setting (VS), MRI showed medullary compression in all those with abnormal Redlund-Johnell values and Ranawat values of 7 mm or less. In patients with anterior atlanto-axial subluxation, compression of the upper cervical cord was observed in all patients with SAC of 13 mm or less. In subaxial lesion of the cervical spine, MRI was found to be as good as roentgenograms in evaluating plate erosion and disc space narrowing and MRI showed extradural pannus. (author).

A radiological study on the cervical spine in rheumatoid arthritis

International Nuclear Information System (INIS)

Taketomi, Eiji; Sakoh, Takashi; Sunahara, Nobuhiko

1995-01-01

The cervical spine was examined with the magnetic resonance imaging (MRI) and the conventional roentgenograms in 95 patients with rheumatoid arthritis. The MRI findings of upper cervical disorders were compared with various values determined in roentgenograms: the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat and Redlund-Johnell values. In patients with vertical setting (VS), MRI showed medullary compression in all those with abnormal Redlund-Johnell values and Ranawat values of 7 mm or less. In patients with anterior atlanto-axial subluxation, compression of the upper cervical cord was observed in all patients with SAC of 13 mm or less. In subaxial lesion of the cervical spine, MRI was found to be as good as roentgenograms in evaluating plate erosion and disc space narrowing and MRI showed extradural pannus. (author)

Morphometric changes in the spinal cord during prenatal life: a stereological study in sheep.

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Sadeghinezhad, Javad; Zadsar, Narges; Hasanzadeh, Beal

2018-03-01

This study describes the volumetric changes in the spinal cord during prenatal life in sheep using quantitative stereological methods. Twenty healthy sheep fetuses were included in the present study, divided into four groups representing 9-11, 12-14, 15-17, and 18-20 weeks of gestation. In each group, the spinal cord was dissected out and sampled according to the unbiased systematic random sampling method then used for stereological estimations. The total volume of spinal cord, volume of gray matter (GM), volume of white matter (WM), ratio of GM volume to WM volume, and volume of central canal (CC) were estimated in the whole spinal cord and its various regions using Cavalieri's principle. The total volume of the spinal cord increased 8 times from week 9 to week 20. The cervical region showed the greatest (9.7 times) and the sacral region the least (6.3 times) volumetric change. The CC volume of the whole spinal cord increased 5.8 times from week 9 to week 20. The cervical region developed faster (8.2 times) and the thoracic region slower (4.4 times) than the total spinal cord. During development, the volume ratio of GM to WM decreased from lower toward upper regions. The greatest volume changes occurred mostly in weeks 9-11 and 12-14. The cervical region showed the greatest volume changes in comparison with other regions of the spinal cord.

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

International Nuclear Information System (INIS)

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

1991-01-01

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

Elevated levels of plasminogen activators in the pathogenesis of delayed radiation damage in rat cervical spinal cord in vivo

International Nuclear Information System (INIS)

Sawaya, R.; Rayford, A.; Kono, S.; Rao, J.S.; Ang, K.K.; Feng, Y.; Stephens, L.C.

1994-01-01

The pathophysiology of the cellular basis of radiation-induced demyelination and white-matter necrosis of the central nervous system (CNS) is poorly understood. Preliminary data suggest that tissue damage is partly mediated through changes in the proteolytic enzymes. In this study, we irradiated rat cervical spinal cords with single doses of 24 Gy of 18 MV photons or 20 MeV electrons and measured the levels of plasminogen activators at days 2, 7, 30, 60, 90, 120, 130 and 145 after irradiation, using appropriate controls at each time. Fibrin zymography revealed fibrinolytic bands representing molecular weights of 68,000 and 48,000 in controls and irradiated samples; these bands increased significantly at days 120, 130 and 145 after irradiation. Inhibition of these enzymatic bands with specific antibodies against tissue-type plasminogen activator (tPA) and amiloride, an inhibitor for urokinase plasminogen activator (uPA), confirmed that these bands were tPA and uPA. Enzymatic levels quantified by densitometry showed a twofold elevation in the levels of tPA and more than a tenfold increase in uPA after 120 days' irradiation. Activity of uPA was increased threefold by day 2 and increased steadily with time compared to nonirradiated control samples. Enzyme-linked immunosorbent assay (ELISA) also showed a threefold increase in the tPA content in the extracts of irradiated rat cervical spinal cords at days 120, 130 and 145. This study adds additional information to the proposed role of plasminogen activators in the pathogenic pathways of radiation damage in the CNS. 38 refs., 6 figs

Elevated levels of plasminogen activators in the pathogenesis of delayed radiation damage in rat cervical spinal cord in vivo

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Sawaya, R.; Rayford, A.; Kono, S.; Rao, J.S.; Ang, K.K.; Feng, Y.; Stephens, L.C. [Univ. of Texas, Houston, TX (United States)

1994-06-01

The pathophysiology of the cellular basis of radiation-induced demyelination and white-matter necrosis of the central nervous system (CNS) is poorly understood. Preliminary data suggest that tissue damage is partly mediated through changes in the proteolytic enzymes. In this study, we irradiated rat cervical spinal cords with single doses of 24 Gy of 18 MV photons or 20 MeV electrons and measured the levels of plasminogen activators at days 2, 7, 30, 60, 90, 120, 130 and 145 after irradiation, using appropriate controls at each time. Fibrin zymography revealed fibrinolytic bands representing molecular weights of 68,000 and 48,000 in controls and irradiated samples; these bands increased significantly at days 120, 130 and 145 after irradiation. Inhibition of these enzymatic bands with specific antibodies against tissue-type plasminogen activator (tPA) and amiloride, an inhibitor for urokinase plasminogen activator (uPA), confirmed that these bands were tPA and uPA. Enzymatic levels quantified by densitometry showed a twofold elevation in the levels of tPA and more than a tenfold increase in uPA after 120 days` irradiation. Activity of uPA was increased threefold by day 2 and increased steadily with time compared to nonirradiated control samples. Enzyme-linked immunosorbent assay (ELISA) also showed a threefold increase in the tPA content in the extracts of irradiated rat cervical spinal cords at days 120, 130 and 145. This study adds additional information to the proposed role of plasminogen activators in the pathogenic pathways of radiation damage in the CNS. 38 refs., 6 figs.

MR imaging in cervical hyperextension injuries

International Nuclear Information System (INIS)

Davis, S.J.; Teresi, L.M.; Bradley, W.G. Jr.; Ziemba, M.R.

1990-01-01

This paper reports on cervical hyperextension injuries that are common and often show minimal radiographic abnormalities, even with severe or unstable lesions. MR images and clinical records of 14 patients scanned within 4 months of hyperextension cervical injuries were reviewed. Clinical, radiographic, and MR findings were correlated. Nine patients had acceleration hyperextension whiplash injuries, four with acute cervical disk herniations developing radiculopathy after several weeks. Five patients injured by direct frontal head trauma presented with myelopathy and had MR evidence of cord injury, and four had acute disk herniation

Identifying depression severity risk factors in persons with traumatic spinal cord injury.

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Williams, Ryan T; Wilson, Catherine S; Heinemann, Allen W; Lazowski, Linda E; Fann, Jesse R; Bombardier, Charles H

2014-02-01

Examine the relationship between demographic characteristics, health-, and injury-related characteristics, and substance misuse across multiple levels of depression severity. 204 persons with traumatic spinal cord injury (SCI) volunteered as part of screening efforts for a randomized controlled trial of venlafaxine extended release for major depressive disorder (MDD). Instruments included the Patient Health Questionnaire-9 (PHQ-9) depression scale, the Alcohol Use Disorders Identification Test (AUDIT), and the Substance Abuse in Vocational Rehabilitation-Screener (SAVR-S), which contains 3 subscales: drug misuse, alcohol misuse, and a subtle items scale. Each of the SAVR-S subscales contributes to an overall substance use disorder (SUD) outcome. Three proportional odds models were specified, varying the substance misuse measure included in each model. 44% individuals had no depression symptoms, 31% had mild symptoms, 16% had moderate symptoms, 6% had moderately severe symptoms, and 3% had severe depression symptoms. Alcohol misuse, as indicated by the AUDIT and the SAVR-S drug misuse subscale scores were significant predictors of depression symptom severity. The SAVR-S substance use disorder (SUD) screening outcome was the most predictive variable. Level of education was only significantly predictive of depression severity in the model using the AUDIT alcohol misuse indicator. Likely SUD as measured by the SAVR-S was most predictive of depression symptom severity in this sample of persons with traumatic SCI. Drug and alcohol screening are important for identifying individuals at risk for depression, but screening for both may be optimal. Further research is needed on risk and protective factors for depression, including psychosocial characteristics. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Comparison of MRI sequences for evaluation of multiple sclerosis of the cervical spinal cord at 3 T

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Philpott, Cristina; Brotchie, Peter

2011-01-01

Purpose: Debate remains regarding the utility of the traditional STIR (short inversion time recovery) sequence in aiding MRI diagnosis of spinal cord lesions in patients with multiple sclerosis (MS) and this sequence is not included in the current imaging guidelines. A recent study proposed a T1 weighted STIR as a superior alternative to the traditional STIR and T2 fast spin echo (FSE). Thus, the aim of this study was to compare the sensitivity of T2, standard STIR and T1 weighted STIR sequences in the evaluation of MS plaques on our 3 T system. Methods and materials: A retrospective analysis of patients with multiple sclerosis who presented to our institution over a period of 5 months and who had cervical cord lesions was undertaken. Patients had been examined with our institutional protocol which included T2 FSE, STIR and the recommended T1 STIR. Quantitative analysis of the lesions versus background cord using sample T-tests was performed for each sequence, and comparative analysis of the lesion contrast:background cord ratios of the 3 sequences (using two-way ANOVA tests) was performed. Results: The T2 sequence was not as sensitive in detecting lesions versus the traditional STIR and T1 weighted STIR, with 10% of lesions not detected using statistical analysis (p < 0.05). The traditional STIR also demonstrated greater contrast ratios than the T2 sequence (p < 0.05) suggesting increased sensitivity. However, the T1 STIR demonstrated even greater contrast ratios than both the traditional STIR and T2 sequences (p < 0.05). Conclusion: This study confirms earlier findings of the traditional STIRs increased sensitivity versus the T2 sequence. However, the new “T1 weighted STIR” appears to be even more sensitive than both these sequences showing potential promise as an alternative method to monitor demyelinating plaques of MS.

Low virulence bacterial infections in cervical intervertebral discs: a prospective case series.

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Chen, Yilei; Wang, Xianjun; Zhang, Xuyang; Ren, Hong; Huang, Bao; Chen, Jian; Liu, Junhui; Shan, Zhi; Zhu, Zhihai; Zhao, Fengdong

2018-04-19

A prospective cross-sectional case series study. To investigate the prevalence of low virulence disc infection and its associations with characteristics of patients or discs in the cervical spine. Low virulence bacterial infections could be a possible cause of intervertebral disc degeneration and/or back pain. Controversies are continuing over whether these bacteria, predominantly Propionibacterium acnes (P. acnes), represent infection or contamination. However, the current studies mainly focus on the lumbar spine, with very limited data on the cervical spine. Thirty-two patients (20 men and 12 women) who underwent anterior cervical fusion for degenerative cervical spondylosis or traumatic cervical cord injury were enrolled. Radiological assessments included X-ray, CT, and MRI of the cervical spine. Endplate Modic changes, intervertebral range of motion, and disc herniation type were evaluated. Disc and muscle tissues were collected under strict sterile conditions. Samples were enriched in tryptone soy broth and subcultured under anaerobic conditions, followed by identification of the resulting colonies by the PCR method. Sixty-six intervertebral discs were excised from thirty-two patients. Positive disc cultures were noted in eight patients (25%) and in nine discs (13.6%). The muscle biopsy (control) cultures were negative in 28 patients and positive in 4 patients (12.5%); three of whom had a negative disc culture. Seven discs (10.6%) were positive for coagulase-negative Staphylococci (CNS) and two discs were positive for P. acnes (3.0%). A younger patient age and the extrusion or sequestration type of disc herniation, which represented a complete annulus fibrous failure, were associated with positive disc culture. Our data show that CNS is more prevalent than P. acnes in degenerative cervical discs. The infection route in cervical discs may be predominantly through an annulus fissure. Correlation between these infections and clinical symptoms is uncertain

Dual Differentiation-Exogenous Mesenchymal Stem Cell Therapy for Traumatic Spinal Cord Injury Repair in a Murine Hemisection Model

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Hai Liu

2013-01-01

Full Text Available Mesenchymal stem cell (MSC transplantation has shown tremendous promise as a therapy for repair of various tissues of the musculoskeletal, vascular, and central nervous systems. Based on this success, recent research in this field has focused on complex tissue damage, such as that which occurs from traumatic spinal cord injury (TSCI. As the critical event for successful exogenous, MSC therapy is their migration to the injury site, which allows for their anti-inflammatory and morphogenic effects on fracture healing, neuronal regeneration, and functional recover. Thus, there is a need for a cost-effective in vivo model that can faithfully recapitulate the salient features of the injury, therapy, and recovery. To address this, we review the recent advances in exogenous MSC therapy for TSCI and traumatic vertebral fracture repair and the existing challenges regarding their translational applications. We also describe a novel murine model designed to take advantage of multidisciplinary collaborations between musculoskeletal and neuroscience researchers, which is needed to establish an efficacious MSC therapy for TSCI.

MRI and clinical symptoms in chronic cervical cord injury

International Nuclear Information System (INIS)

Soeda, Shuichi; Maruiwa, Hirofumi; Yokoi, Masahiro; Saitoh, Seiya; Yamauchi, Kenji.

1992-01-01

To assess the ability of magnetic resonance (MR) imaging to determine the prognosis of spinal cord injury in the chronic stage and to detect the injured myelomere, 39 patients were examined with MR images obtained by T1-weighted spin echo method 5 months to 4 years and 8 months (mean, one year and 5 months) after they had sustained spinal cord injury. According to hypointensity area of the ventrodorsad diameter of the spinal cord, MR images were classified as non-hypointensity (I), discrete (II), central (III), large cavity (IV), and transverse (V). The most common type was III (25%), followed by IV (26%), II (18%), V (15%), and I (13%). In 21 patients with bone injury, 14 (67%) had type IV or V, in contrast to 2 (11%) of 18 patients without bone injury. Increased hypointensity on MR images was associated with severer injury of the spinal cord. When hypointensity accounted for less than 1/2 of the ventrodorsad diameter of the spinal cord, walking ability was recovered in more than 80% of the patients. When less than 1/3 of the ventrodorsad diameter of the spinal cord was seen as hypointensity, arm function was well preserved, and the anterior horn of gray matter was found less injured. In 60% of the patients, there was difference in the injured level of myelomere between MR images and the neurological examination; the injured level of myelomere tended to be more cephalad level in the neurological examination than MR appearance.(N.K.)

The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings.

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Talbott, Jason F; Whetstone, William D; Readdy, William J; Ferguson, Adam R; Bresnahan, Jacqueline C; Saigal, Rajiv; Hawryluk, Gregory W J; Beattie, Michael S; Mabray, Marc C; Pan, Jonathan Z; Manley, Geoffrey T; Dhall, Sanjay S

2015-10-01

Previous studies that have evaluated the prognostic value of abnormal changes in signals on T2-weighted MRI scans of an injured spinal cord have focused on the longitudinal extent of this signal abnormality in the sagittal plane. Although the transverse extent of injury and the degree of spared spinal cord white matter have been shown to be important for predicting outcomes in preclinical animal models of spinal cord injury (SCI), surprisingly little is known about the prognostic value of altered T2 relaxivity in humans in the axial plane. The authors undertook a retrospective chart review of 60 patients who met the inclusion criteria of this study and presented to the authors' Level I trauma center with an acute blunt traumatic cervical SCI. Within 48 hours of admission, all patients underwent MRI examination, which included axial and sagittal T2 images. Neurological symptoms, evaluated with the grades according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS), at the time of admission and at hospital discharge were correlated with MRI findings. Five distinct patterns of intramedullary spinal cord T2 signal abnormality were defined in the axial plane at the injury epicenter. These patterns were assigned ordinal values ranging from 0 to 4, referred to as the Brain and Spinal Injury Center (BASIC) scores, which encompassed the spectrum of SCI severity. The BASIC score strongly correlated with neurological symptoms at the time of both hospital admission and discharge. It also distinguished patients initially presenting with complete injury who improved by at least one AIS grade by the time of discharge from those whose injury did not improve. The authors' proposed score was rapid to apply and showed excellent interrater reliability. The authors describe a novel 5-point ordinal MRI score for classifying acute SCIs on the basis of axial T2-weighted imaging. The proposed BASIC score stratifies the SCIs according to the extent of transverse T2

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.

Spinal Cord Studies in the African Giant Rat (Cricetomys gambianus ...

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olayemitoyin

J. Physiol. Sci. 30 (2015) 025 – 032 www.njps.com.ng. Spinal Cord Studies in the African Giant Rat (Cricetomys gambianus .... Body and Spinal Cord measurements of the AGR (C. gambianus), Mean ±SEM ... the eighth cervical segment appeared circular in shape. ... other lumbar segments, sacral and coccygeal segments.

Analysis of the Functional Independence Measure Value of Cervical Spine Injury Patients with Conservative Management

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M. Zafrullah Arifin

2012-06-01

Full Text Available Analysis of the Functional Independence Measure Value of Cervical Spine Injury Patients with Conservative Management. Cervical spine injury is one of the most common spinal cord injuries in trauma patients. From 100,000 spinal cord injury cases reported in the United States of America (2008, sixty seven percent involve cervical spine injury. American Spinal Cord Injury Association (ASIA impairment score is used as an initial assessment but not enough attention prognostic outcome of these patients was paid to. The objective of this study is to analyze the value of functional independence measure (FIM cervical spine injury patients with conservative management and its correlation with age, sex, type of trauma, onset of trauma, cervical abnormalities, type of cervical spine lesion and ASIA impairment score. A prospective cohort study was performed to all patients with cervical spine injury treated inNeurosurgery Department of Dr. Hasan Sadikin Hospital Bandung that fullfiled the inclusion criteria. The subjects were classified based on age, sex, single/multiple trauma, acute /chronic, cervical abnormalities, complete/incomplete lesion and ASIA impairment score. The FIM examination was performed in Outpatient clinic of Neurosurgery. T-test and chi-square test was done to analyze the data. There were 17 cervical spine injury patients treated in Neurosurgery Department of Dr. Hasan Sadikin Hospital during April 2009–April 2010. The average FIM value of cervical spine injury in those patients is 4+ 1.63 by cohort prospective study. There were no correlation between FIM value with age, sex, type of trauma, onset of trauma and cervical abnormalities. Significant correlations were found between FIM value with type of cervical spine lesion and ASIA impairment score in cervical spine patients. Type of cervical spine lesion and ASIA impairment score have significant correlation with FIM value of patients in 6 months after cervical injury.

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

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

2017-11-01

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

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.

The natural history and clinical syndromes of degenerative cervical spondylosis.

LENUS (Irish Health Repository)

Kelly, John C

2012-01-01

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

Spinal cord injury at birth

DEFF Research Database (Denmark)

Fenger-Gron, Jesper; Kock, Kirsten; Nielsen, Rasmus G

2008-01-01

UNLABELLED: A case of perinatally acquired spinal cord injury (SCI) is presented. The foetus was vigorous until birth, the breech presented and delivery was performed by a non-traumatic Caesarean section. The infant displayed symptoms of severe SCI but diagnosis was delayed due to severe co...

Motor tic disorder and traumatic cervical myelopathy: a case report Trastorno de tic motor y mielopatía cervical traumática: relato de caso Transtorno de tique motor e mielopatia cervical traumática: relato de caso

Directory of Open Access Journals (Sweden)

Ericson Sfredo

2011-01-01

Full Text Available The association between motor tics and cervical myelopathy is rare and not well understood. Only a few papers in the literature reported this disorder until the present date. This is a case report of a cervical myelopathy case secondary to a motor tic disorder. A 23-year-old male with a 10-year history of motor tic disorder, involving sudden forced extension of the head and cervical spine. Disturbed tactile sensation and kinetic posturing that progressed to the Lhermitte sign every time he made the movement were detected over the last six months. Magnetic resonance imaging (MRI showed hyperintense intramedullary lesion at C2-C3, degeneration at C3-C4, and no signs of spinal cord compression. On sagittal view, functional MRI with head extension showed anterior compression with protrusion of the intervertebral disc and posterior compression of the yellow ligaments causing spinal cord stenosis. Anterior discectomy and fixation of C3-C4 were performed. There were no complications. The patient showed improvement and the motor tics were controlled by haloperidol. The patient remains symptom-free after 2 years of follow-up. Uncontrolled motor tics can compromise spinal cord function. Functional MRI can reproduce the abnormal movements and clarify the physiopathology.La asociación entre tics motores y mielopatía cervical es rara y no es bien comprendida. Pocos estudios, que analizan este disturbio, han sido encontrados en la literatura hasta el momento. Este es el relato de un caso de mielopatía cervical secundaria a tics motores. Paciente masculino de 23 años con historial de trastorno de tic motor desde hace diez años, involucrando extensión forzada de la cabeza y columna cervical. En los últimos seis meses, se diagnosticaron deficiencias de sensaciones táctiles y postura cinética que progresaron hacia la señal de Lhermitte, cada vez que el paciente se movía. La Resonancia Magnética (RM reveló lesión intramedular hiperintensa al nivel de

Functional MR imaging of the cervical spine in patients with rheumatoid arthritis

International Nuclear Information System (INIS)

Allmann, K.H.; Uhl, M.; Uhrmeister, P.; Neumann, K.; Langer, M.; Kempis, J. von

1998-01-01

Purpose: To evaluate functional MR imaging in patients with rheumatoid arthritis (RA) involving the cervical spine. Material and Methods: We used a device that allows MR examination to be made of the cervical spine in infinitely variable degrees of flexion and extension. Dynamic functional MR imaging was performed on 25 patients with RA. Results: Functional MR imaging was able to show the degree of vertebral instability of the occipito-atlantal or atlanto-axial level as well as the subaxial level. By performing functional MR imaging, we were able to demonstrate the extent of synovial tissue around the dens, and the impingement and displacement of the spinal cord during flexion and extension. The basilar impression, the cord impingement into the foramen magnum, the cord compression, the slipping of vertebrae, and the angulation of the cord were all much more evident in functional than in static MR imaging. Conclusion: Functional MR imaging provided additional information in patients with RA, and is valuable in patients who have a normal MR study in the neutral position and yet have signs of a neurological deficit. Functional MR imaging is important in the planning of stabilizing operations of the cervical spine. (orig.)

Sudden post-traumatic sciatica caused by a thoracic spinal meningioma.

Science.gov (United States)

Mariniello, Giuseppe; Malacario, Francesca; Dones, Flavia; Severino, Rocco; Ugga, Lorenzo; Russo, Camilla; Elefante, Andrea; Maiuri, Francesco

2016-10-01

Spinal meningiomas usually present with slowly progressive symptoms of cord and root compression, while a sudden clinical onset is very rare. A 35-year-old previously symptom-free woman presented sudden right sciatica and weakness of her right leg following a fall with impact to her left foot. A neurological examination showed paresis of the right quadriceps, tibial and sural muscles, increased bilateral knee and ankle reflexes and positive Babinski sign. Magnetic resonance imaging (MRI) revealed the presence of a spinal T11 meningioma in the left postero-lateral compartment of the spinal canal; at this level, the spinal cord was displaced to the contralateral side with the conus in the normal position. At surgery, a meningioma with dural attachment of the left postero-lateral dural surface was removed. The intervention resulted in rapid remission of both pain and neurological deficits. Spinal meningiomas may exceptionally present with sudden pain and neurological deficits as result of tumour bleeding or post-traumatic injury of the already compressed nervous structures, both in normal patients and in those with conus displacement or tethered cord. In this case, the traumatic impact of the left foot was transmitted to the spine, resulting in stretching of the already compressed cord and of the contralateral lombosacral roots. This case suggests that low thoracic cord compression should be suspected in patients with post-traumatic radicular leg pain with normal lumbar spine MRI. © The Author(s) 2016.

Analysis of the diffusion tensor imaging parameters of a normal cervical spinal cord in a healthy population.

Science.gov (United States)

Wei, Liang-Feng; Wang, Shou-Sen; Zheng, Zhao-Cong; Tian, Jun; Xue, Liang

2017-05-01

Diffusion tensor imaging (DTI) shows great advantage in the diagnosis of brain diseases, including cervical spinal cord (CSC) disease. This study aims to obtain the normal values of the DTI parameters for a healthy population and to establish a baseline for CSC disease diagnosis using DTI. A total of 36 healthy adults were subjected to magnetic resonance imaging (MRI) for the entire CSC using the Siemens 3.0 T MR System. Sagittal DTI acquisition was carried out with a single-shot spin-echo echo-planar imaging (EPI) sequence along 12 non-collinear directions. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were determined at different cervical levels using a region of interest (ROI) method, following which they were correlated with parameters, like age and sex. Further, diffusion tensor tracking (DTT) was carried out to reconstruct the white matter fiber bundles of the CSC. The full and complete fiber bundle structure of a normal CSC was confirmed in both the T2-weighted and DTI images. The FA and ADC values were significantly negatively correlated with each other and showed strongly negative and positive correlations with age, respectively, but not with sex. Additionally, there was no significant difference between the FA and the ADC values at different cervical levels. The DTI technique can act as an important supplement to the conventional MRI technique for CSC observation. Moreover, the FA and ADC values can be used as sensitive parameters in the DTI study on the CSC by taking the effects of age into consideration.

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

OpenAIRE

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

2010-01-01

Many interventions in upper-limb rehabilitation after cervical spinal cord injury (CSCI) use arm support (gravity compensation); however, its specific effects on kinematics and muscle activation characteristics in subjects with a CSCI are largely unknown. We conducted a cross-sectional explorative study to study these effects. Nine subjects with a CSCI performed two goal-directed arm movements (maximal reach, reach and retrieval) with and without gravity compensation. Angles at elbow and shou...

Mechanical properties of the human spinal cord under the compressive loading.

Science.gov (United States)

Karimi, Alireza; Shojaei, Ahmad; Tehrani, Pedram

2017-12-01

The spinal cord as the most complex and critical part of the human body is responsible for the transmission of both motor and sensory impulses between the body and the brain. Due to its pivotal role any types of physical injury in that disrupts its function following by shortfalls, including the minor motor and sensory malfunctions as well as complicate quadriplegia and lifelong ventilator dependency. In order to shed light on the injuries to the spinal cord, the application of the computational models to simulate the trauma impact loading to that are deemed required. Nonetheless, it has not been fulfilled since there is a paucity of knowledge about the mechanical properties of the spinal cord, especially the cervical one, under the compressive loading on the grounds of the difficulty in obtaining this tissue from the human body. This study was aimed at experimentally measuring the mechanical properties of the human cervical spinal cord of 24 isolated fresh samples under the unconfined compressive loading at a relatively low strain rate. The stress-strain data revealed the elastic modulus and maximum/failure stress of 40.12±6.90 and 62.26±5.02kPa, respectively. Owing to the nonlinear response of the spinal cord, the Yeoh, Ogden, and Mooney-Rivlin hyperelastic material models have also been employed. The results may have implications not only for understanding the linear elastic and nonlinear hyperelastic mechanical properties of the cervical spinal cord under the compressive loading, but also for providing a raw data for investigating the injury as a result of the trauma thru the numerical simulations. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Science.gov (United States)

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

2017-11-01

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

Cervical spine injury in the elderly: imaging features

Energy Technology Data Exchange (ETDEWEB)

Ehara, S. [Dept. of Radiology, Iwate Medical University School of Medicine, Morioka (Japan); Shimamura, Tadashi [Dept. of Orthopedic Surgery, Iwate Medical University School of Medicine, Morioka (Japan)

2001-01-01

An increase in the elderly population has resulted in an increased incidence of cervical spine injury in this group. No specific type of cervical spine trauma is seen in the elderly, although dens fractures are reported to be common. Hyperextension injuries due to falling and the resultant central cord syndrome in the mid and lower cervical segments due to decreased elasticity as a result of spondylosis may be also characteristic. The imaging features of cervical spine injury are often modified by associated spondylosis deformans, DISH and other systemic disorders. The value of MR imaging in such cases is emphasized. (orig.)

Structural and Functional Substitution of Deleted Primary Sensory Neurons by New Growth from Intrinsic Spinal Cord Nerve Cells: An Alternative Concept in Reconstruction of Spinal Cord Circuits

Directory of Open Access Journals (Sweden)

Nicholas D. James

2017-07-01

Full Text Available In a recent clinical report, return of the tendon stretch reflex was demonstrated after spinal cord surgery in a case of total traumatic brachial plexus avulsion injury. Peripheral nerve grafts had been implanted into the spinal cord to reconnect to the peripheral nerves for motor and sensory function. The dorsal root ganglia (DRG containing the primary sensory nerve cells had been surgically removed in order for secondary or spinal cord sensory neurons to extend into the periphery and replace the deleted DRG neurons. The present experimental study uses a rat injury model first to corroborate the clinical finding of a re-established spinal reflex arch, and second, to elucidate some of the potential mechanisms underlying these findings by means of morphological, immunohistochemical, and electrophysiological assessments. Our findings indicate that, after spinal cord surgery, the central nervous system sensory system could replace the traumatically detached original peripheral sensory connections through new neurite growth from dendrites.

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

International Nuclear Information System (INIS)

Mihale, J.; Traubner, P.

1998-01-01

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