Intraoperative identification of the corticospinal tract and dorsal column of the spinal cord by electrical stimulation

2018 ◽  
Vol 89 (7) ◽  
pp. 754-761 ◽  
Author(s):  
Vedran Deletis ◽  
Kathleen Seidel ◽  
Francesco Sala ◽  
Andreas Raabe ◽  
Darko Chudy ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Corticospinal Tract ◽  
Dorsal Column ◽  
Anatomical Landmarks ◽  
Direct Stimulation ◽  
Stimulus Train ◽  
Recovery Times ◽  
Spinal Cord Surgery ◽  
Stimulation Paradigm ◽  
Train Stimulation

ObjectivesAnatomical identification of the corticospinal tract (CT) and the dorsal column (DC) of the exposed spinal cord is difficult when anatomical landmarks are distorted by tumour growth. Neurophysiological identification is complicated by the fact that direct stimulation of the DC may result in muscle motor responses due to the centrally activated H-reflex. This study aims to provide a technique for intraoperative neurophysiological differentiation between CT and DC in the exposed spinal cord.MethodsRecordings were obtained from 32 consecutive patients undergoing spinal cord tumour surgery from July 2015 to March 2017. A double train stimulation paradigm with an intertrain interval of 60 ms was devised with recording of responses from limb muscles.ResultsIn non-spastic patients (55% of cohort) an identical second response was noted following the first CT response, but the second response was absent after DC stimulation. In patients with pre-existing spasticity (45%), CT stimulation again resulted in two identical responses, whereas DC stimulation generated a second response that differed substantially from the first one. The recovery times of interneurons in the spinal cord grey matter were much shorter for the CT than those for the DC. Therefore, when a second stimulus train was applied 60 ms after the first, the CT-fibre interneurons had already recovered ready to generate a second response, whereas the DC interneurons were still in the refractory period.ConclusionsMapping of the spinal cord using double train stimulation allows neurophysiological distinction of CT from DC pathways during spinal cord surgery in patients with and without pre-existing spasticity.

Utility of neurophysiological monitoring using dorsal column mapping in intramedullary spinal cord surgery

2010 ◽  
Vol 12 (6) ◽  
pp. 623-628 ◽  
Author(s):  
Daniel S. Yanni ◽  
Sedat Ulkatan ◽  
Vedran Deletis ◽  
Ignacio J. Barrenechea ◽  
Chandranath Sen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Dorsal Column ◽  
Posterior Column ◽  
Anatomical Landmarks ◽  
Spinal Cord Tumors ◽  
Intramedullary Tumors ◽  
Intramedullary Spinal Cord ◽  
Strip Electrode ◽  
Spinal Cord Surgery

Object Intramedullary spinal cord tumors can displace the surrounding neural tissue, causing enlargement and distortion of the normal cord anatomy. Resection requires a midline myelotomy to avoid injury to the posterior columns. Locating the midline for myelotomy is often difficult because of the distorted anatomy. Standard anatomical landmarks may be misleading in patients with intramedullary spinal cord tumors due to cord rotation, edema, neovascularization, or local scar formation. Misplacement of the myelotomy places the posterior columns at risk of significant postoperative disability. The authors describe a technique for mapping the dorsal column to accurately locate the midline. Methods A group of 10 patients with cervical and thoracic intramedullary spinal cord lesions underwent dorsal column mapping in which a strip electrode was used to define the midline. After the laminectomy and durotomy, a custom-designed multielectrode grid was placed on the exposed dorsal surface of the spinal cord. The electrode is made up of 8 parallel Teflon-coated stainless-steel wires (76-μm diameter, spaced 1 mm apart) embedded in silastic with each of the wires stripped of its insulating coating along a length of 2 mm. This strip electrode maps the amplitude gradient of conducted spinal somatosensory evoked potentials elicited by bilateral tibial nerve stimulation. Using these recordings, the dorsal columns are topographically mapped as lying between two adjacent numbers. Results The authors conducted a retrospective analysis of the preoperative, immediate, and short-term postoperative neurological status, focusing especially on posterior column function. There were 8 women and 2 men whose mean age was 52 years. There were 4 ependymomas, 1 subependymoma, 1 gangliocytoma, 1 anaplastic astrocytoma, 1 cavernous malformation, and 2 symptomatic syringes requiring shunting. In all patients the authors attempted to identify the midline by using anatomical landmarks, and then proceeded with dorsal column mapping to identify the midline electrophysiologically. In the 2 patients with syringomyelia and in 5 of the patients with tumors, the authors were unable to identify the midline anatomically with any certainty. In 2 patients with intramedullary tumors, they were able to identify the midline anatomically with certainty. Dorsal column mapping allowed identification of the midline and to confirm the authors' anatomical localization. In 2 patients with intramedullary tumors, posterior column function was preserved only on 1 side. All other patients had intact posterior column function preoperatively. Conclusions Dorsal column mapping is a useful technique for guiding the surgeon in locating the midline for myelotomy in intramedullary spinal cord surgery. In conjunction with somatosensory evoked potential, motor evoked potential, and D-wave recordings, we have been able to reduce the surgical morbidity related to dorsal column dysfunction in this small group of patients.

Probable Corticospinal Tract Control of Spinal Cord Plasticity in the Rat

2002 ◽  
Vol 87 (2) ◽  
pp. 645-652 ◽  
Author(s):  
Xiang Yang Chen ◽  
Jonathan R. Wolpaw
Keyword(s):  
Spinal Cord ◽  
Corticospinal Tract ◽  
Recovery Of Function ◽  
Dorsal Column ◽  
H Reflex ◽  
Sprague Dawley ◽  
Lateral Column ◽  
Gradual Loss ◽  
Cord Injury ◽  
Spinal Stretch Reflex

Descending activity from the brain shapes spinal cord reflex function throughout life, yet the mechanisms responsible for this spinal cord plasticity are poorly understood. Operant conditioning of the H-reflex, the electrical analogue of the spinal stretch reflex, is a simple model for investigating these mechanisms. An earlier study in the Sprague-Dawley rat showed that acquisition of an operantly conditioned decrease in the soleus H-reflex is not prevented by mid-thoracic transection of the ipsilateral lateral column (LC), which contains the rubrospinal, reticulospinal, and vestibulospinal tracts, and is prevented by transection of the dorsal column, which contains the main corticospinal tract (CST) and the dorsal column ascending tract (DA). The present study explored the effects of CST or DA transection on acquisition of an H-reflex decrease, and the effects of LC, CST, or DA transection on maintenance of an established decrease. CST transection prior to conditioning prevented acquisition of H-reflex decrease, while DA transection did not do so. CST transection after H-reflex decrease had been acquired led to gradual loss of the decrease over 10 days, and resulted in an H-reflex that was significantly larger than the original, naive H-reflex. In contrast, LC or DA transection after H-reflex decrease had been acquired did not affect maintenance of the decrease. These results, in combination with the earlier study, strongly imply that in the rat the corticospinal tract (CST) is essential for acquisition and maintenance of operantly conditioned decrease in the H-reflex and that other major spinal cord pathways are not essential. This previously unrecognized aspect of CST function gives insight into the processes underlying acquisition and maintenance of motor skills and could lead to novel methods for inducing, guiding, and assessing recovery of function after spinal cord injury.

scholarly journals Second-order spinal cord pathway contributes to cortical responses after long recoveries from dorsal column injury in squirrel monkeys

2018 ◽  
Vol 115 (16) ◽  
pp. 4258-4263 ◽  
Author(s):  
Chia-Chi Liao ◽  
Jamie L. Reed ◽  
Hui-Xin Qi ◽  
Eva K. Sawyer ◽  
Jon H. Kaas
Keyword(s):  
Spinal Cord ◽  
Dorsal Column ◽  
Squirrel Monkeys ◽  
Second Order ◽  
Spinal Cord Neurons ◽  
Somatotopic Organization ◽  
Recovery Times ◽  
Spinal Cord Dorsal ◽  
Hand Region ◽  
Area 3B

Months after the occurrence of spinal cord dorsal column lesions (DCLs) at the cervical level, neural responses in the hand representation of somatosensory area 3b hand cortex recover, along with hand use. To examine whether the second-order spinal cord pathway contributes to this functional recovery, we injected cholera toxin subunit B (CTB) into the hand representation in the cuneate nucleus (Cu) to label the spinal cord neurons, and related results to cortical reactivation in four squirrel monkeys (Saimiri boliviensis) at least 7 months after DCL. In two monkeys with complete DCLs, few CTB-labeled neurons were present below the lesion, and few neurons in the affected hand region in area 3b responded to touch on the hand. In two other cases with large but incomplete DCLs, CTB-labeled neurons were abundant below the lesion, and the area 3b hand cortex responded well to tactile stimulation in a roughly somatotopic organization. The proportions of labeled neurons in the spinal cord hand region reflected the extent of cortical reactivation to the hand. Comparing monkeys with short and long recovery times suggests that the numbers of labeled neurons below the lesion increase with time following incomplete DCLs (<95%) but decrease with time after nearly complete DCLs (≥95%). Taken together, these results suggest that the second-order spinal cord pathway facilitates cortical reactivation, likely through the potentiation of persisting tactile inputs from the hand to the Cu over months of postlesion recovery.

scholarly journals Wallerian degeneration in cervical spinal cord tracts is commonly seen in routine T2-weighted MRI after traumatic spinal cord injury and is associated with impairment in a retrospective study

2020 ◽  
Author(s):  
Tim Fischer ◽  
Christoph Stern ◽  
Patrick Freund ◽  
Martin Schubert ◽  
Reto Sutter
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Wallerian Degeneration ◽  
Evoked Potential ◽  
Corticospinal Tract ◽  
Cervical Spinal Cord ◽  
Dorsal Column ◽  
Traumatic Spinal Cord Injury ◽  
Spinothalamic Tract ◽  
Cord Injury

Abstract Objectives Wallerian degeneration (WD) is a well-known process after nerve injury. In this study, occurrence of remote intramedullary signal changes, consistent with WD, and its correlation with clinical and neurophysiological impairment were assessed after traumatic spinal cord injury (tSCI). Methods In 35 patients with tSCI, WD was evaluated by two radiologists on T2-weighted images of serial routine MRI examinations of the cervical spine. Dorsal column (DC), lateral corticospinal tract (CS), and lateral spinothalamic tract (ST) were the analyzed anatomical regions. Impairment scoring according to the American Spinal Injury Association Impairment Scale (AIS, A–D) as well as a scoring system (0–4 points) for motor evoked potential (MEP) and sensory evoked potential (SEP) was included. Mann-Whitney U test was used to test for differences. Results WD in the DC occurred in 71.4% (n = 25), in the CS in 57.1% (n = 20), and in 37.1% (n = 13) in the ST. With WD present, AIS grades were worse for all tracts. DC: median AIS B vs D, p < 0.001; CS: B vs D, p = 0.016; and ST: B vs D, p = 0.015. More pathological MEP scores correlated with WD in the DC (median score 0 vs 3, p < 0.001) and in the CS (0 vs 2, p = 0.032). SEP scores were lower with WD in the DC only (1 vs 2, p = 0.031). Conclusions WD can be detected on T2-weighted scans in the majority of cervical spinal cord injury patients and should be considered as a direct effect of the trauma. When observed, it is associated with higher degree of impairment. Key Points • Wallerian degeneration is commonly seen in routine MRI after traumatic spinal cord injury. • Wallerian degeneration is visible in the anatomical regions of the dorsal column, the lateral corticospinal tract, and the lateral spinothalamic tract. • Presence of Wallerian degeneration is associated with higher degree of impairment.

Conditioned H-Reflex Increase Persists After Transection of the Main Corticospinal Tract in Rats

2003 ◽  
Vol 90 (5) ◽  
pp. 3572-3578 ◽  
Author(s):  
Xiang Yang Chen ◽  
Lu Chen ◽  
Jonathan R. Wolpaw
Keyword(s):  
Spinal Cord ◽  
Operant Conditioning ◽  
Corticospinal Tract ◽  
Dorsal Column ◽  
H Reflex ◽  
Initial Value ◽  
Cord Injury ◽  
Training Mode ◽  
The Right ◽  
Spinal Stretch Reflex

The brain shapes spinal cord function throughout life. Operant conditioning of the H-reflex, the electrical analog of the spinal stretch reflex (SSR), is a relatively simple model for exploring the spinal cord plasticity underlying this functional change and may provide a new method for modifying spinal cord reflexes after spinal cord injury. In response to an operant conditioning protocol, rats can gradually increase (i.e., up-training mode) or decrease (i.e., down-training mode) the soleus H-reflex. This study explored the effects of midthoracic transection of the ipsilateral lateral column (LC) (rubrospinal, vestibulospinal, and reticulospinal tracts), the dorsal column corticospinal tract (CST), or the dorsal column ascending tract (DA) on maintenance of an H-reflex increase that has already occurred. Rats were implanted with EMG electrodes in the right soleus muscle and a nerve-stimulating cuff on the right posterior tibial nerve. After initial (i.e., control) H-reflex size was determined, the rats were exposed for 50 days to the up-training mode, in which reward was given when the H-reflex was above a criterion value. H-reflex size gradually rose to 168 ± 12% (mean ± SE) of its initial value. Each rat then received an LC, CST, or DA transection and continued under the up-training mode for 50 more days. None of the transections abolished the H-reflex increase. H-reflex size increased further to 197 ± 19% of its initial value and did not differ significantly among LC, CST, and DA rats ( P > 0.78 by ANOVA). Although earlier studies show that the main CST is needed for acquisition of H-reflex up-training and down-training and for maintenance of down-training, this study shows that it is not needed for maintenance of up-training. It adds to the evidence that H-reflex conditioning changes the spinal cord and that the spinal cord plasticity associated with up-training is different from that associated with down-training.

Dorsal Column But Not Lateral Column Transection Prevents Down-Conditioning of H Reflex in Rats

1997 ◽  
Vol 78 (3) ◽  
pp. 1730-1734 ◽  
Author(s):  
Xiang Yang Chen ◽  
Jonathan R. Wolpaw
Keyword(s):  
Spinal Cord ◽  
Corticospinal Tract ◽  
Dorsal Column ◽  
H Reflex ◽  
Transient Effects ◽  
Sprague Dawley ◽  
Initial Value ◽  
Lateral Column ◽  
The Right ◽  
Spinal Stretch Reflex

Chen, Xiang Yang and Jonathan R. Wolpaw. Dorsal column but not lateral column transection prevents down-conditioning of H reflex in rats. J. Neurophysiol. 78: 1730–1734, 1997. Operant conditioning of the H reflex, the electrical analogue of the spinal stretch reflex, in freely moving rats is a relatively simple model for studying long-term supraspinal control over spinal cord function. Motivated by food reward, rats can gradually increase or decrease the soleus H reflex. This study is the first effort to determine which spinal cord pathways convey the descending influence from supraspinal structures that changes the H reflex. In anesthetized Sprague-Dawley rats, the entire dorsal column (DC), which includes the main corticospinal tract, or the right lateral column (LC) was transected by electrocautery. Animals recovered quickly and the minimal transient effects of transection on the right soleus H reflex disappeared within 16 days. Beginning at least 18 days after transection, 12 rats were exposed to the HRdown-conditioning mode, in which reward was given when the H reflex of the right soleus muscle was below a criterion value. In seven LC rats exposed to the HRdown mode, the H reflex fell to 71 ± 8% (mean ± SE) of its initial value. In six of the seven, conditioning was successful (i.e., decrease to ≤80%). These results were comparable with those previously obtained from normal rats. In contrast, in five DC rats exposed to the HRdown mode, the H reflex at the end of exposure was 106 ± 12% of its initial value. In none of these rats was HRdown-conditioning successful. DC rats differed significantly from normal and LC rats in both final H reflex values and number successful. In five DC and three LC rats that continued under control conditions over 30–78 days, the H reflex at the end of the period was 98 ± 4% and 100 ± 8%, respectively, of its initial value, indicating that DC or LC transection itself did not lead to gradual increase or decrease in the H reflex. The results indicate that the DC, containing the main corticospinal tract, is essential for HRdown-conditioning, whereas the ipsilateral LC, containing the main rubrospinal, vestibulospinal, and reticulospinal tracts, is not essential. Combined with the known muscular specificity of conditioning, these results suggest that the main corticospinal tract is essential for HRdown-conditioning. The DC ascending tract might also be necessary. The respective roles of the DC descending and ascending tracts, and transection effects on HRup-conditioning and on the maintenance of both HRup- and HRdown-conditioning after they have occurred, remain to be defined.

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