Effect of sacral nerve blocks on the function of the urinary bladder in humans

1974 ◽  
Vol 40 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Gaylan L. Rockswold ◽  
William E. Bradley ◽  
Shelley N. Chou
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Urinary Bladder ◽  
Nerve Roots ◽  
Nerve Blocks ◽  
Content Type ◽  
Sacral Nerve ◽  
Spinal Cord Involvement ◽  
Fine Print

✓ The authors report over 100 sacral root blocks performed in 50 patients with detrusor activation by air cystometry. The detrusor reflex was abolished with unilateral sacral blocks in over 50% of the patients. The nerve roots most frequently innervating the bladder were S-3 and S-4. Most of these patients suffered from multiple sclerosis and had spinal cord involvement. The possible pathophysiology and its significance regarding urinary bladder innervation is discussed.

Elasticity of the spinal cord dura in the dog

1977 ◽  
Vol 47 (3) ◽  
pp. 391-396 ◽  
Author(s):  
Archie R. Tunturi
Keyword(s):  
Spinal Cord ◽  
Elastic Modulus ◽  
Connective Tissue ◽  
Elastic Fibers ◽  
Filum Terminale ◽  
Nerve Roots ◽  
Content Type ◽  
Collagenous Fibers ◽  
Fine Print

✓ The elasticity of the spinal cord dura in the dog has been investigated histologically, in situ, and by measurement. The dura was composed of collagenous and elastic connective tissue fibers. The collagenous fibers were arranged in longitudinal bundles, straight when stretched and wavy when unstretched, with a delicate network of fine elastic fibers coursing in all directions. Transecting the cord and dura at T-5 caused a separation of 25 to 30 mm of the dura and a 15- to 20-mm gap in the cord. By means of an appropriate sequence of transections of nerve roots and denticulate ligaments within the dura, and transections of the dural sheaths and nerves outside the dura, the strain on the dura was found to be imposed by the attachments of the dural nerve sheaths from T-6 to S-7. The filum terminale was not appreciably strained. By adding weights to a suspended dura, two components of elasticity were found. For loads of 0 to 50 gm, the incremental displacements in the length were large. The elastic modulus was about 4 × 106 dynes/sq cm, which was comparable to that of elastic fibers. For loads of 50 to 150 gm the displacements in length were small. The elastic modulus was about 5 × 108 dynes/sq cm, which was comparable to that of collagenous fibers.

Neurocutaneous melanosis with extensive intracerebral and spinal cord involvement

1984 ◽  
Vol 61 (4) ◽  
pp. 782-785 ◽  
Author(s):  
Walter J. Faillace ◽  
Shige-Hisa Okawara ◽  
Joseph V. McDonald
Keyword(s):  
Spinal Cord ◽  
Nervous System ◽  
Malignant Melanoma ◽  
Peritoneal Metastasis ◽  
Content Type ◽  
Neurocutaneous Melanosis ◽  
Spinal Cord Involvement ◽  
Leptomeningeal Involvement ◽  
Ventriculoperitoneal Shunting ◽  
Fine Print

✓ Two unusual cases of neurocutaneous melanosis are presented. Both patients had congenital giant hairy nevi and both developed hydrocephalus, seizures, and myelopathy. The first patient displayed multicentric cerebral and spinal cord melanosis, as opposed to the more commonly described basilar leptomeningeal involvement. The second patient had total spinal leptomeningeal involvement, and ventriculoperitoneal shunting for hydrocephalus produced peritoneal metastasis of melanoma. An individual born with a congenital giant hairy nevus or marked generalized cutaneous pigmentation should be closely observed for the development of malignant melanoma of the nervous system.

Progressive posttraumatic myelomalacic myelopathy: treatment with untethering and expansive duraplasty

1997 ◽  
Vol 86 (4) ◽  
pp. 624-628 ◽  
Author(s):  
Thomas T. Lee ◽  
Jose M. Arias ◽  
Heather L. Andrus ◽  
Robert M. Quencer ◽  
Steven F. Falcone ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Motor Function ◽  
Tethered Cord ◽  
Sensory Function ◽  
Autonomic Dysreflexia ◽  
Nerve Roots ◽  
Content Type ◽  
Fine Print

✓ Patients with progressive posttraumatic myelomalacic myelopathy (PPMM), or tethered cord syndrome, present with symptoms and signs similar to those observed in cases of progressive posttraumatic cystic myelopathy, that is, sensorimotor function deterioration, local and/or radicular pain, increased spasticity, increased autonomic dysreflexia, and sphincter dysfunction. The authors investigated surgical outcomes of untethering combined with expansive duraplasty. Forty patients with PPMM who presented with functional deterioration underwent untethering of the spinal cord and nerve roots with an expansive duraplasty. Meticulous dissections of adhesions on the dorsal and lateral aspects of the spinal cord and nerve roots were performed. Intraoperative ultrasonography was used to detect the presence of a confluent cyst and to assess the success of untethering. After surgery, the patients were treated using a protocol that involved frequent turning for 48 hours and subsequently mobilization. Preoperative magnetic resonance (MR) imaging, with and without administration of a contrast agent, was obtained in all patients, except one patient who underwent immediate and delayed computerized tomography (CT) myelography. The mean follow-up period was 3 years (range 20–57 months) for the 36 patients available for follow-up review. Spinal cord tethering was observed in all patients preoperatively. Trauma was the most common cause of this pathology, accounting for 31 of the 40 cases. Preoperative MR imaging did not demonstrate tumor recurrence in the group of five patients who had undergone an initial operation for tumor excision. The interval between the causative event and the operation was less than 5 years in half of the patients (20 of 40), with the longest interval lasting up to 37 years. Motor function deterioration was the most frequent manifestation; it was present in 31 of 40 patients. Improvements in motor function, autonomic dysreflexia, pain, sphincter dysfunction, and sensory function were found during the most recent follow-up examination in 79%, 75%, 62%, 50%, and 43% of the patients, respectively. Two patients experienced retethering of the spinal cord and one underwent a second operation. Surgical untethering and expansive duraplasty, followed by postoperative position rotation to avoid retethering, provide symptomatic relief for patients with PPMM.

Innervation of caudal denervated ventral roots and their target muscles by the rostral spinal motoneurons after implanting a nerve autograft in spinal cord—injured adult marmosets

2001 ◽  
Vol 94 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Song Liu ◽  
Nozar Aghakhani ◽  
Nazaire Boisset ◽  
Gérard Said ◽  
Marc Tadie
Keyword(s):  
Spinal Cord ◽  
Clinical Signs ◽  
Control Group ◽  
Nerve Roots ◽  
Content Type ◽  
Axonal Regrowth ◽  
Cord Injury ◽  
Ventral Roots ◽  
Nerve Autograft ◽  
Fine Print

Object. The authors conducted a study to determine the effects of using a nerve autograft (NAG) to promote and guide axonal regrowth from the rostral spinal cord to the caudal lumbar ventral nerve roots to restore hindlimb motor function in adult marmosets after lower thoracic cord injury. Methods. Nine animals underwent a left-sided hemisection of the spinal cord at T-12 via left-sided T9—L3 hemilaminectomy, with section of all ipsilateral lumbrosacral ventral nerve roots. In the experimental group (five animals), an NAG obtained from the right peroneal nerve was anastomosed with the sectioned and electrophysiologically selected lumbar ventral roots (left L-3 and L-4) controlling the left quadriceps muscle and then implanted into the left ventrolateral T-10 cord. In the control group (four animals), the sectioned/selected lumbar ventral roots were only ligated. After surgery, all marmosets immediately suffered from complete paralysis of their left hindlimb. Five months later, some clinical signs of reinnervation such as tension and resistance began to appear in the paralyzed quadriceps of all experimental animals that received autografts. Nine months postoperatively, three of the five experimental marmosets could maintain their lesioned hindlimb in hip flexion. Muscle action potentials and motor evoked potentials were recorded from the target quadriceps in all experimental marmosets, but these potentials were absent in the control animals. Horseradish peroxidase retrograde labeling from the distal sectioned/reconnected lumbar ventral roots traced 234 ± 178 labeled neurons in the ipsilateral T8–10 ventral horn, mainly close to the NAG tip. Histological analysis showed numerous regenerating axons in this denervated/reconnected nerve root pathway, as well as newly formed motor endplates in the denervated/reinnervated quadriceps. No axonal regeneration was detected in the control animals. Conclusions. These data indicate that the rostral spinal neurons can regrow into the caudal ventral roots through an NAG, thereby innervating the target muscle in adult marmosets after spinal cord injury.

Spinal nerve root repair and reimplantation of avulsed ventral roots into the spinal cord after brachial plexus injury

2000 ◽  
Vol 93 (2) ◽  
pp. 237-247 ◽  
Author(s):  
Thomas Carlstedt ◽  
Praveen Anand ◽  
Rolf Hallin ◽  
Peter Vigay Misra ◽  
Georg Norén ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Time Lag ◽  
Sensory Function ◽  
Successful Outcome ◽  
Nerve Roots ◽  
Content Type ◽  
Root Repair ◽  
Fine Print

Object. The authors review the first series of 10 cases in which injured intraspinal brachial plexus were surgically repaired. They describe the technique of spinal cord implantation or repair of ruptured nerve roots, as well as patient outcome. Methods. Spinal root repair/implantation was performed from 10 days to 9 months postinjury. There were nine male patients and one female patient. Postoperatively in most cases, regeneration of motor neurons from the spinal cord to denervated muscles could be demonstrated. The first signs of regeneration were noted approximately 9 to 12 months postoperatively. Useful function with muscle power of at least Medical Research Council Grade 3 occurred in three of 10 cases. Magnetic brain stimulation studies revealed a normal amplitude and latency from the cortex to reinnervated muscles on surgically treated and control sides. A certain degree of cocontraction between antagonistic muscles (for example, biceps—triceps) compromised function. With time there was a reduction of cocontractions, probably due to spinal cord plasticity. In these cases there was also, surprisingly, a return of sensory function, although the mechanism by which this occurred is uncertain. Sensory stimulation (thermal and mechanical) within the avulsed dermatomes was perceived abnormally and/or experienced at remote sites. There was some return of patients' sense of joint position. Conclusions. A short time lag between the accident and the surgery was recognized as a significant factor for a successful outcome. Reimplantation of avulsed nerve roots may be combined with other procedures such as nerve transfers in severe cases of brachial plexus injury.

scholarly journals Tethering of the spinal cord in mouse fetuses and neonates with spina bifida

2003 ◽  
Vol 99 (2) ◽  
pp. 206-213 ◽  
Author(s):  
Dorothea Stiefel ◽  
Takashi Shibata ◽  
Martin Meuli ◽  
Patrick G. Duffy ◽  
Andrew J. Copp
Keyword(s):  
Spinal Cord ◽  
Spina Bifida ◽  
Mouse Model ◽  
Spinal Nerve ◽  
Nerve Roots ◽  
Content Type ◽  
Spina Bifida Aperta ◽  
Mouse Fetuses ◽  
Spinal Cord Tethering ◽  
Fine Print

Object. Tethering of the spinal cord is a well-known complication in humans with spina bifida aperta or occulta. Its pathogenesis consists of a pathological fixation of the spinal cord resulting in traction on the neural tissue which, in turn, leads to ischemia and progressive neurological deterioration. Although well established in humans, this phenomenon has not been described in animal models of spina bifida. Methods. A fetal mouse model with naturally occurring, genetically determined spina bifida was produced by generating double mutants between the curly tail and loop-tail mutant strains. Microdissection, labeling with 1,1′-dioctadecyl-3,3,3,′,3′-tetramethylindocarbocyanine perchlorate, immunohistochemistry for neurofilaments, H & E staining of histological sections, and whole-mount skeletal preparations were performed and comparisons made among mutant and normal fetuses. Normal fetuses exhibited the onset of progressive physiological ascent of the spinal cord from embryonic Day 15.5. Spinal cord ascent resulted, by embryonic Day 18.5, in spinal nerve roots that pass caudolaterally from the spinal cord toward the periphery. In contrast, fetuses with spina bifida exhibited spinal cord tethering that resulted, at embryonic Day 18.5, in nerve roots that run in a craniolateral direction from the spinal cord. The region of closed spinal cord immediately cranial to the spina bifida lesion exhibited marked narrowing, late in gestation, suggesting that a potentially damaging stretch force is applied to the spinal cord by the tethered spina bifida lesion. Conclusions. This mouse model provides an opportunity to study the onset and early sequelae of spinal cord tethering in spina bifida.

Cervical myeloradiculopathy caused by arthrotic hypertrophy of the posterior facets and laminae

1978 ◽  
Vol 49 (3) ◽  
pp. 387-392 ◽  
Author(s):  
Joseph A. Epstein ◽  
Bernard S. Epstein ◽  
Leroy S. Lavine ◽  
Robert Carras ◽  
Alan D. Rosenthal
Keyword(s):  
Spinal Cord ◽  
Spinal Canal ◽  
Anterior Approach ◽  
Nerve Root Compression ◽  
Nerve Roots ◽  
Anatomical Studies ◽  
Content Type ◽  
Significant Pathology ◽  
Cervical Spinal Stenosis ◽  
Fine Print

✓ Five patients with typical cervical myeloradiculopathy caused by focal cervical spinal stenosis are presented. Dorsal intrusions into the spinal canal by hypertrophied apophyseal joints and thickened laminae resulted in cord and nerve root compression. Minor spondylotic changes were present in the floor of the spinal canal. Laminar decompression with foraminotomy and facetectomy relieved the patients of their symptoms. An anterior approach should not be considered in the management of this disorder. Our findings of severe apophyseal arthrosis with lesser degrees of associated spondylosis are similar to those described in anatomical studies by other authors. While uncommon, myelopathy caused by dorsal compression of the spinal cord and nerve roots deserves specific mention so that therapy can be directed to the proper quadrants of the spinal canal wherein the significant pathology is located.

Ninety-degree rotation of the thoracic spinal thecal sac

1998 ◽  
Vol 89 (1) ◽  
pp. 133-138 ◽  
Author(s):  
Sagun K. Tuli ◽  
R. John Hurlbert ◽  
David Mikulis ◽  
J. F. Ross Fleming
Keyword(s):  
Spinal Cord ◽  
Adipose Tissue ◽  
Magnetic Resonance Images ◽  
Nerve Roots ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Epidural Lipomatosis ◽  
Thoracic Spinal ◽  
History Of ◽  
Fine Print

✓ This 44-year-old man presented with a 4-year history of progressive spastic weakness of his legs. He was found to have epidural lipomatosis behind the thoracic spinal cord, and the nerve roots exited from the posterior and anterior midline planes of the dura, indicating a 90° rotation of the thoracic cord. Magnetic resonance images clearly demonstrated the segmental thoracic nerve roots exiting from the dorsal midline of the dura, a finding confirmed at surgery. The authors found only one previously published case of rotation of the spinal cord. Directed mechanical stress caused by deformation of the rotated spinal cord, rather than compression from adipose tissue, is proposed as the mechanism of the myelopathy. The extent, location, and thickness of the associated extradural adipose tissue is suggestive of epidural lipomatosis. The lipomatous tissue might have been an epiphenomenon and cord rotation an isolated congenital anomaly. Alternatively, asymmetrical growth of epidural fat may have exerted torque, rotating the thecal sac.

Thoracic myelopathy caused by osteophytes of the articular processes

1979 ◽  
Vol 50 (6) ◽  
pp. 779-783 ◽  
Author(s):  
Joseph M. Marzluff ◽  
G. Douglas Hungerford ◽  
Ludwig G. Kempe ◽  
Stephen E. Rawe ◽  
Richard Trevor ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Lumbar Region ◽  
Thoracic Region ◽  
Thoracic Myelopathy ◽  
Nerve Roots ◽  
Content Type ◽  
Radiological Evidence ◽  
Fine Print

✓ Compression of the spinal cord or nerve roots resulting from degenerative spondylosis is commonly seen in the cervical or lumbar region, but it has not previously been described in the thoracic region. Despite this, the authors believe that the syndrome is not rare. They describe four cases, three of which were seen at one institution within 2 years. Decompression of the spinal cord by removal of the osteophytes may produce gratifying results, even when symptoms have been present for years. The syndrome should be considered in any patient who has a thoracic myelopathy and radiological evidence of spondylosis.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

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