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

2017 ◽  
Vol 108 ◽  
pp. 112-117 ◽  
Author(s):  
Aria Nouri ◽  
Julio Montejo ◽  
Xin Sun ◽  
Justin Virojanapa ◽  
Luis E. Kolb ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
New Method ◽  
Cervical Cord ◽  
Cord Injury

Deterioration following spinal cord injury

1987 ◽  
Vol 66 (3) ◽  
pp. 400-404 ◽  
Author(s):  
Lawrence F. Marshall ◽  
Sharen Knowlton ◽  
Steven R. Garfin ◽  
Melville R. Klauber ◽  
Howard M. Eisenberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Cord ◽  
Skeletal Traction ◽  
Systemic Complications ◽  
Content Type ◽  
Management Procedures ◽  
Cord Injury ◽  
Specific Management ◽  
Fine Print

✓ The results are presented of a prospective study of the course of 283 spinal cord-injured patients who were consecutively admitted to five trauma centers participating in the Comprehensive Central Nervous System Injury Centers' program of the National Institutes of Health. Of the 283 patients, 14 deteriorated neurologically during acute hospital management. In 12 of the 14, the decline in neurological function could be associated with a specific management event, and in nine of these 12 the injury involved the cervical cord. Nine of the 14 patients who deteriorated had cervical injuries, three had thoracic cord injuries, and two had thoracolumbar junction injuries. Management intervention was identified as the cause of deterioration in four of 134 patients undergoing operative intervention, in three of 60 with skeletal traction application, in two of 68 with halo vest application, in two of 56 undergoing Stryker frame rotation, and in one of 57 undergoing rotobed rotation. Early surgery on the cervical spine when cord injury is present appears hazardous, since each of the three patients with a cervical cord injury who deteriorated was operated on within the first 5 days. No such deterioration was observed following surgery performed from the 6th day on. In two other patients, deterioration did not appear to be related to management but was a direct product of the underlying disease or of systemic complications. Deterioration following hospitalization for spinal cord injury is relatively uncommon — 4.9% in this large series. In most instances, decline in function could be attributed to specific management procedures. These changes must not be interpreted as representing failure to provide optimal care but rather should be seen as the inevitable product of an attempt to manage patients with spinal cord and column injuries, many of which are clearly unstable.

Pediatric spinal injury: review of 174 hospital admissions

1992 ◽  
Vol 77 (5) ◽  
pp. 700-704 ◽  
Author(s):  
Mark G. Hamilton ◽  
S. Terence Mylks
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Hospital Admissions ◽  
Spinal Injury ◽  
Neurological Injury ◽  
Cervical Cord ◽  
Mature Adult ◽  
Younger Patients ◽  
Cord Injury ◽  
Radiological Abnormality

✓ Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. A review of 174 pediatric patients is presented, representing 5.4% of all patients admitted with spinal injury, Spinal cord injury was present in 45% of patients. A distinct injury profile, explained by anatomical and biomechanical features, distinguishes the young patient with an immature spine from older adolescents with a more mature, adult-like spine. The younger patients, while less likely to have spinal injury, had a higher incidence of neurological injury, in addition to a higher frequency of both spinal cord injury without radiological abnormality and upper cervical cord injury. In addition, younger patients with spinal cord injury and no radiological abnormality were more likely to have complete or severe cord injury. Prognosis was determined by the severity of spinal cord injury. Patients with complete cord injuries showed little improvement, while patients with incomplete injuries generally fared much better, with 74% showing significant improvement and 59% experiencing a complete recovery of neurological functions. There were six deaths, but none was attributed solely to spinal injury. The authors conclude that outcome is quite good after pediatric spinal cord injury that does not produce a physiologically complete cord deficit.

Toxic Substances in Spinal Cord Injury

Neurosurgery ◽  
1979 ◽  
Vol 4 (3) ◽  
pp. 239-243 ◽  
Author(s):  
Sherman C. Stein ◽  
Roger Q. Cracco ◽  
Peter Farmer ◽  
Curtis A. Kiest
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Evoked Potentials ◽  
Autologous Blood ◽  
Cervical Cord ◽  
Base Line ◽  
Toxic Substances ◽  
Cord Injury ◽  
Sciatic Nerve Stimulation ◽  
Clinical Changes

Abstract Several investigators have implicated norepinephrine and other toxic substances released in the region of a spinal cord injury in the genesis of the progressive pathological and clinical changes that follow spinal trauma. To test this hypothesis. we subjected cats to T-10 to T-12 laminectomy and monitored epidural spinal evoked potentials from sciatic nerve stimulation. The spinal subarachnoid space was perfused with normal saline, with norepinephrine solution, or with heparinized autologous blood or the pial surface of the spinal cord was exposed to macerated gray matter taken from the upper cervical cord. During 1- to 2-hour exposure periods, we noted no significant changes in the base line spinal evoked potentials. In another series of cats, we have shown that norepinephrine perfused over the spinal cord in this manner diffuses rapidly into the subpial white matter. Therefore, its failure to affect spinal evoked potentials does not represent a failure to penetrate the spinal cord. Putative toxins must originate either in extravasated blood or damaged neural tissue in the region of the spinal cord injury. The failure of ascending spinal tracts to react to blood or cord tissue in our experiment suggests that toxins are not involved in the spinal cord dysfunction that occurs soon after injury.

scholarly journals Microstructural plasticity in nociceptive pathways after spinal cord injury

2021 ◽  
pp. jnnp-2020-325580
Author(s):  
Sreenath P Kyathanahally ◽  
Michela Azzarito ◽  
Jan Rosner ◽  
Vince D Calhoun ◽  
Claudia Blaiotta ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Primary Motor Cortex ◽  
Statistical Parametric Mapping ◽  
Anterior Cingulate ◽  
Cervical Cord ◽  
Transverse Relaxation Rate ◽  
Microstructural Changes ◽  
Nociceptive Pathways ◽  
Cord Injury

ObjectiveTo track the interplay between (micro-) structural changes along the trajectories of nociceptive pathways and its relation to the presence and intensity of neuropathic pain (NP) after spinal cord injury (SCI).MethodsA quantitative neuroimaging approach employing a multiparametric mapping protocol was used, providing indirect measures of myelination (via contrasts such as magnetisation transfer (MT) saturation, longitudinal relaxation (R1)) and iron content (via effective transverse relaxation rate (R2*)) was used to track microstructural changes within nociceptive pathways. In order to characterise concurrent changes along the entire neuroaxis, a combined brain and spinal cord template embedded in the statistical parametric mapping framework was used. Multivariate source-based morphometry was performed to identify naturally grouped patterns of structural variation between individuals with and without NP after SCI.ResultsIn individuals with NP, lower R1 and MT values are evident in the primary motor cortex and dorsolateral prefrontal cortex, while increases in R2* are evident in the cervical cord, periaqueductal grey (PAG), thalamus and anterior cingulate cortex when compared with pain-free individuals. Lower R1 values in the PAG and greater R2* values in the cervical cord are associated with NP intensity.ConclusionsThe degree of microstructural changes across ascending and descending nociceptive pathways is critically implicated in the maintenance of NP. Tracking maladaptive plasticity unravels the intimate relationships between neurodegenerative and compensatory processes in NP states and may facilitate patient monitoring during therapeutic trials related to pain and neuroregeneration.

scholarly journals Evaluation of the stability of normal subjects and patients with Perthes and spinal cord injury disorders during short and long periods of time

2012 ◽  
Vol 37 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Mohammad Karimi ◽  
Amir Esrafilian
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Stability Analysis ◽  
Traditional Method ◽  
Force Plate ◽  
Normal Subjects ◽  
New Method ◽  
Cord Injury ◽  
The Stability ◽  
Normal Adults

Background:Stability during standing is achieved by a complex coordination process between various human systems. The stability of normal subjects and patients with various neuromuscular disorders has been evaluated by common methods based on force plate data analysis for one minute. However, most of the people frequently stand for a prolonged period during daily activities.Objectives:This study aimed to evaluate the stability of subjects during a longer period of time. Moreover, the new method was introduced to analyze the stability of subjects with musculoskeletal disorders.Study Design:Experimental.Methods:Four groups of normal adults and children, individuals with spinal cord injury (SCI) and Perthes disease were recruited in this study. Stability of the subjects was evaluated by using parameters collected from centre of pressure (COP) sways obtained while subjects standing on force plate for one and then five minutes based on the old and new methods. Two sample t-test was used to compare the stability of the subjects by the commonly used method. The number of stable to unstable frames was selected for final analysis based on the new method.Results:Based on the traditional method, the SCI and Perthes patients were more stable than normal subjects ( p < 0.05). Moreover, children were more unstable in the anteroposterior plane than adults. However, based on the new method, SCI and patients with Perthes disease were more unstable than normal adults. Moreover, in mediolateral direction the results of stability analysis with the new method differed from that of the traditional method.Conclusion:The new method of stability analysis seems to be more sensitive and accurate than that of the traditional commonly used method. Based on the new method, stability is the ability of a subject to return from an unstable position to a stable one and to remain in a stable one for a certain period of time.Clinical relevanceThe results of this research can be used by most clinicians to evaluate the stability of subjects with various musculoskeletal disorders.

scholarly journals Neurophysiological and Spinal Cord Perfusion Changes at Dynamic Neck Positions in a Compressive Spinal Cord Injury Rat Model

2021 ◽  
Author(s):  
Zhengran Yu ◽  
Xing Cheng ◽  
Jiacheng Chen ◽  
Sixiong Lin ◽  
Hao Hu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Rat Model ◽  
Dynamic Compression ◽  
Dynamic Change ◽  
Cervical Cord ◽  
Post Injury ◽  
Doppler Flowmetry ◽  
Cord Injury ◽  
Behavioural Tests

Abstract Background: Cervical spondylotic myelopathy (CSM) is a degenerative condition of the spine that caused by static and dynamic compression of the spinal cord. However, the pathophysiological changes at dynamic neck positions remain poor. This study investigated the interplay between neurophysiological and haemodynamic responses at dynamic neck positions in a chronic compressive spinal cord injury (CCSCI) rat model. Methods: Behavioural tests including Basso, Beattie, and Bresnahan scores and an inclined plane test were used to evaluate the motor function recovery. Combined examination of dynamic motor and somatosensory evoked potentials (DMEPs and DSSEPs, respectively) was performed regularly to evaluate the dynamic motor and sensory conduction of the cervical cord. At 4 weeks post-injury (wpi), dynamic magnetic resonance imaging (MRI) and dynamic laser Doppler flowmetry (LDF) were used to demonstrate the interstructure and spinal cord blood flow (SCBF) at the compression site at dynamic neck positions. Hematoxylin and eosin (HE) staining was performed to assess the cords' pathological changes.Results: Behavioural tests and combined DMEPs and DSSEPs examination showed that spinal cord neurological function and dynamic neural conduction deteriorated gradually within a 4-week compression period. The DMEPs were mainly deteriorated upon flexion, while DSSEPs were upon all neck positions after the compression. At 4 wpi, dynamic MRI showed increased T2-weighted image (T2WI) signal intensities. Also, dynamic LDF demonstrated decreased SCBF at the spinal cord compression site. Both of them altered especially upon cervical flexion. The dynamic change in SCBF was significantly correlated with the change in DMEP amplitude upon flexion. Conclusions: This exploratory study revealed that changes in axonal conduction in the motor and somatosensory tracts of the spinal cord were significantly related to chronic compression time and neck position. Furthermore, spinal cord ischaemia may be intimately related to motor conduction dysfunction upon flexion in CCSCI models. These results indicated the potential for therapies targeting dynamic spinal cord perfusion to prevent progression and functional loss in CSM.

Spinal cord injury without radiographic abnormalities in children

1982 ◽  
Vol 57 (1) ◽  
pp. 114-129 ◽  
Author(s):  
Dachling Pang ◽  
James E. Wilberger
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Cord ◽  
Content Type ◽  
Age Related ◽  
Surgical Fusion ◽  
Flexion Extension ◽  
Cord Injury ◽  
Upper Cervical ◽  
Long Term Prognosis

✓ Spinal cord injury in children often occurs without evidence of fracture or dislocation. The mechanisms of neural damage in this syndrome of spinal cord injury without radiographic abnormality (SCIWORA) include flexion, hyperextension, longitudinal distraction, and ischemia. Inherent elasticity of the vertebral column in infants and young children, among other age-related anatomical peculiarities, render the pediatric spine exceedingly vulnerable to deforming forces. The neurological lesions encountered in this syndrome include a high incidence of complete and severe partial cord lesions. Children younger than 8 years old sustain more serious neurological damage and suffer a larger number of upper cervical cord lesions than children aged over 8 years. Of the children with SCIWORA, 52% have delayed onset of paralysis up to 4 days after injury, and most of these children recall transient paresthesia, numbness, or subjective paralysis. Management includes tomography and flexion-extension films to rule out incipient instability, and immobilization with a cervical collar. Delayed dynamic films are essential to exclude late instability, which, if present, should be managed with Halo fixation or surgical fusion. The long-term prognosis in cases of SCIWORA is grim. Most children with complete and severe lesions do not recover; only those with initially mild neural injuries make satisfactory neurological recovery.

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