Mechanism of the spinal cord injury and the cervical spondylotic myelopathy: new approach based on the mechanical features of the spinal cord white and gray matter

2003 ◽  
Vol 99 (3) ◽  
pp. 278-285 ◽  
Author(s):  
Kazuhiko Ichihara ◽  
Toshihiko Taguchi ◽  
Itsuo Sakuramoto ◽  
Shunichi Kawano ◽  
Shinya Kawai
Keyword(s):  
Mechanical Properties ◽  
Spinal Cord ◽  
Stress Distribution ◽  
Gray Matter ◽  
Clinical Symptoms ◽  
Cervical Spinal Cord ◽  
Strain Rates ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

Object. The authors have previously investigated the mechanical properties of the white and gray matter in the bovine cervical spinal cord, demonstrating that the gray matter is more rigid, although more fragile, than the white matter. In the present study they conducted additional tensile tests on the bovine cervical spinal cord by changing strain levels and strain rates applied to the white and gray matter. Methods. Based on their testing, the authors found the following: 1) Stress within the spinal cord relaxes over time. 2) Intracord stress is related to the strain rates or levels. The finite element method was used to compute the stress distribution within the spinal cord under three compressive loading conditions. Results from the computations showed a different stress distribution in the white and gray matter, where the distribution of stress varied with strain rate, compression volume, and the position of compression. Conclusions. These differences in mechanical properties between the white and gray matter constitute different mechanisms contributing to the development of tissue damage and clinical symptoms.

Cruciate paralysis

1986 ◽  
Vol 65 (1) ◽  
pp. 108-110 ◽  
Author(s):  
Daniel Dumitru ◽  
James E. Lang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Rare Case ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Cervical Spinal Cord ◽  
Content Type ◽  
Vehicle Accident ◽  
Cord Injury ◽  
Fine Print

✓ A rare case of cruciate paralysis is reported in a 39-year-old man following a motor-vehicle accident. The differentiation of this syndrome from a central cervical spinal cord injury is delineated.

Presence and significance of CD-95 (Fas/APO1) expression after spinal cord injury

2001 ◽  
Vol 94 (2) ◽  
pp. 257-264 ◽  
Author(s):  
Mercedes Zurita ◽  
Jesús Vaquero ◽  
Isabel Zurita
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
White Matter ◽  
Gray Matter ◽  
Spinal Cord Tissue ◽  
Injured Spinal Cord ◽  
Content Type ◽  
Cord Injury ◽  
Positive Immunostaining ◽  
Fine Print

Object. A glycoprotein, CD95 (Fas/APO1) is widely considered to be implicated in the development of apoptosis in a number of tissues. Based on the hypothesis that apoptosis is related to cell death after spinal cord injury (SCI), the authors studied the presence and distribution of CD95 (Fas/APO1)-positive cells in injured spinal cord tissue for the purpose of determining the significance of this protein during the early phases of SCI. Methods. The presence and distribution of cells showing positive immunostaining for CD95 (Fas/APO1) were studied 1, 4, 8, 24, 48, and 72 hours and 1, 2, and 4 weeks after induction of experimental SCI in rats. Studies were conducted using a monoclonal antibody to the CD95 (Fas/APO1) protein. Positivity for CD95 (Fas/APO1) was observed in apoptotic cells, mainly in the gray matter, 1 hour after trauma, and the number of immunostained cells increased for the first 8 hours, at which time the protein was expressed in both gray and white matter. From 24 to 72 hours postinjury, the number of immunostained cells decreased in the gray matter, but increased in the white matter. From then on, there were fewer CD95 (Fas/APO1)-positive cells, but some cells in the white matter still exhibited positive immunostaining 1 and 2 weeks after injury. At 4 weeks, there remained no CD95 (Fas/APO1)-positive cells in injured spinal cord. Conclusions. These findings indicate that CD95 (Fas/APO1) is expressed after SCI, suggesting a role for this protein in the development of apoptosis after trauma and the possibility of a new therapeutic approach to SCI based on blocking the CD95 (Fas/APO1) system.

Effects of epidural hypothermic saline infusion on locomotor outcome and tissue preservation after moderate thoracic spinal cord contusion in rats

2005 ◽  
Vol 2 (3) ◽  
pp. 308-318 ◽  
Author(s):  
Carlos E. Casas ◽  
Loren P. Herrera ◽  
Chad Prusmack ◽  
Gladys Ruenes ◽  
Alexander Marcillo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Gray Matter ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Treatment Groups ◽  
Thoracic Spinal ◽  
Cord Injury ◽  
Spinal Cord Contusion ◽  
Tissue Sparing ◽  
Fine Print

Object. Regionally delivered hypothermia has advantages over systemic hypothermia for clinical application following spinal cord injury (SCI). The effects of local hypothermia on tissue sparing, neuronal preservation, and locomotor outcome were studied in a moderate thoracic spinal cord contusion model. Methods. Rats were randomized to four treatment groups and data were collected and analyzed in a blinded fashion. Chilled saline was perfused into the epidural space 30 minutes postcontusion to achieve the following epidural temperatures: 24 ± 2.3°C (16 rats), 30 ± 2.4°C (13 rats), and 35 ± 0.9°C (13 rats). Hypothermia was continued for 3 hours when a 45-minute period of rewarming was instituted. In a fourth group a moderate contusion only was induced in 14 animals. Rectal (core) and T9–10 (epidural) temperatures were measured continuously. Locomotor testing, using the Basso-Beattie-Bresnahan (Ba-Be-Br) scale, was performed for 6 weeks, and rats were videotaped for subsequent analysis. The lesion/preserved tissue ratio was calculated throughout the entire lesion cavity and the total lesion, spinal cord, and spared tissue volumes were determined. The rostral and caudal extent of gray matter loss was also measured. At 6 weeks locomotor recovery was similar in all groups (mean Ba-Be-Br Scale scores 14.88 ± 3.71, 14.83 ± 2.81, 14.50 ± 2.24, and 14.07 ± 2.39 [p = 0.77] for all four groups, respectively). No significant differences in spared tissue volumes were found when control and treatment groups were compared, but gray matter preservation was reduced in the infusion-treated groups. Conclusions. Regional cooling applied 30 minutes after a moderate contusive SCI was not beneficial in terms of tissue sparing, neuronal preservation, or locomotor outcome. This method of cooling may reduce blood flow in the injured spinal cord and exacerbate secondary injury.

Olfactory glia transplantation into cervical spinal cord contusion injuries

2005 ◽  
Vol 3 (4) ◽  
pp. 308-317 ◽  
Author(s):  
Jorge E. Collazos-Castro ◽  
Vilma C. Muñetón-Gómez ◽  
Manuel Nieto-Sampedro
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Axonal Growth ◽  
Cell Transplant ◽  
Tracer Injection ◽  
Neural Repair ◽  
Content Type ◽  
Cord Injury ◽  
Contusion Injury ◽  
Fine Print

Object. The results of olfactory ensheathing cell (OEC) transplantation have raised great expectations as a potential treatment for spinal cord injury (SCI). Its capacity to promote functional neural repair, however, remains unclear. The authors studied axonal growth and locomotor recovery after C-7 contusion injury and OEC transplantation in adult rats. Methods. Twenty-four male Wistar rats underwent a mild C-7 contusion injury that completely disrupted the dorsal corticospinal tract (DCST). In 14 rats OECs were transplanted into the lesion, and 10 were used as controls. At 3 months postcontusion, the kinematics of locomotion were assessed, and the CST was traced by injecting dextran tetramethylrhodamine bilaterally into the cerebral cortex. The animals were killed 2 weeks after tracer injection, and their spinal cords were studied immunohistochemically. Although the survival of transplanted cells varied, they were present in all cases. The authors observed neither OEC migration nor DCST axon regeneration in any of the cell transplant—treated rats. Corticospinal axons ended in retraction bulbs at the proximal edge of the lesion or, exceptionally, a few micrometers inside the transplant. The results of neurofilament immunohistochemical analysis provided evidence of neurites from systems other than the DCST growing into the transplant, but in some cases these neurites formed loops of pathological appearance. Contusion injury of C-7 caused chronic locomotor deficits that did not improve after OEC transplants. Conclusions. The findings in this study indicate that OEC transplants alone are not sufficient for neural repair and functional recovery after SCI. In addition, OECs can induce abnormal axonal growth, making further studies necessary before considering their clinical use.

Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A

2004 ◽  
Vol 100 (1) ◽  
pp. 20-23 ◽  
Author(s):  
James S. Harrop ◽  
Ashwini D. Sharan ◽  
Edward H. Scheid ◽  
Alexander R. Vaccaro ◽  
Gregory J. Przybylski
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Acute Injury ◽  
Smoking History ◽  
American Spinal Injury Association ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

Object. The authors sought to identify variables that predispose patients with acute American Spinal Injury Association (ASIA) Grade A cervical spinal cord injury (SCI) to require tracheostomies for ventilator support or airway protection. Methods. A retrospective analysis was performed of 178 consecutive patients with a cervical ASIA Grade A SCI who were admitted through the Delaware Valley SCI Center at Thomas Jefferson Hospital during a 6-year period. Exclusion criteria included injury occurring more than 48 hours prior to admission, death within 14 days of admission or nontraumatic SCI. Twenty-two patients were excluded based on these criteria. Parameters evaluated in the remaining population (156 patients) included demographics, cervical vertebral ASIA level, tracheostomy placement, pneumonia, premorbid pulmonary disease, smoking history, evidence of direct thoracic/lung trauma, operative intervention, associated appendicular trauma, and preexisting medical comorbidities. The ASIA classification of the 156 patients included in this analysis were C-2 (eight), C-3 (11), C-4 (64), C-5 (36), C-6 (20), C-7 (13), and C-8 (four). Tracheostomies were performed in 107 of these 156 patients. Statistical analysis revealed a significant relationship between tracheostomy and patient age (p = 0.0048), preexisting medical conditions (p = 0.0417), premorbid lung disease (p = 0.0177), higher cervical ASIA level (p < 0.0001), and the presence of pneumonia (p < 0.0001). No patient with a C-8 ASIA A injury required tracheostomy, whereas all C-2 and C-3 ASIA A—injured patients underwent tracheostomies. Patients older than 45 years of age with ASIA A levels between C-4 and C-7 more commonly required tracheostomy (p < 0.005) than patients younger than 45 years of age. Conclusions. Several risk factors were identified that corresponded to the frequent tracheostomy placement in the acute injury phase after complete cervical SCI. Early tracheostomy may be considered in patients with multiple risk factors to reduce duration of stay in the intensive care unit and facilitate ventilatory weaning.

Alternating Horner's syndrome and hyperhidrosis due to dural adhesions following cervical spinal cord injury

1980 ◽  
Vol 53 (1) ◽  
pp. 97-100 ◽  
Author(s):  
Michinori Ottomo ◽  
Robert F. Heimburger
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Dura Mater ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Horner’S Syndrome ◽  
Content Type ◽  
Cord Injury ◽  
Intramedullary Cyst ◽  
Fine Print

✓ Alternating Horner's sign and hyperhidrosis appeared in this patient 8 years after a spinal cord injury at C6–7. An intramedullary cyst was suspected but was not found at operation. There was a striking improvement in both symptoms after adhesions between the spinal cord and the dura mater were freed.

Does chronic cervical myelopathy affect respiratory function?

2004 ◽  
Vol 1 (2) ◽  
pp. 175-178 ◽  
Author(s):  
Hiromitsu Toyoda ◽  
Hiroaki Nakamura ◽  
Sadahiko Konishi ◽  
Hidetomi Terai ◽  
Kunio Takaoka
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Respiratory Function ◽  
Vital Capacity ◽  
Cervical Spinal Cord ◽  
Control Group ◽  
Content Type ◽  
Cord Injury ◽  
Expiratory Flow ◽  
Fine Print

Object. Although respiratory function is often impaired by acute cervical spinal cord injury, changes in respiratory function in patients with chronic cervical myelopathy (CCM) are not well documented. The purpose of this study was to evaluate the respiratory function of patients with CCM. Methods. Spirometric parameters were measured in 94 patients with CCM before they underwent expansive laminoplasty. These measurements were compared with those obtained in age- and sex-matched control group patients without myelopathy. The study patients were also subdivided into two groups: those with spinal compressive lesions above or below the C3–4 disc level were compared in terms of respiratory function. The vital capacity values measured in patients with CCM were significantly lower than those in the control group. In patients in whom spinal cord compression was present above C3–4, vital capacity values were lower than in patients in whom the compression level was below C3–4. The resting respiratory rate per minute was elevated in the CCM group. Peak expiratory flow rate was significantly decreased, and expiratory velocities at 50 and 25% of vital capacity were significantly increased in the CCM group. Conclusions. The results indicated that expiratory flow may be impaired or incomplete in patients with CCM. An underlying subclinical respiratory dysfunction appears to be associated with CCM.

The syndrome of acute central cervical spinal cord injury after a gunshot lesion

1977 ◽  
Vol 47 (2) ◽  
pp. 290-292 ◽  
Author(s):  
Wolf I. Steudel ◽  
William Ingunza
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Canal ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Unique Case ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

✓ The authors describe a unique case in which a bullet was lodged in the spinal canal at the C2–3 level. The patient exhibited clinically the syndrome of acute central cervical spinal cord injury. The pathogenesis is discussed with reference to three similar cases in the literature.

Effect of experimental cervical spinal cord injury on respiratory function

1974 ◽  
Vol 41 (4) ◽  
pp. 455-462 ◽  
Author(s):  
Satoru Kadoya ◽  
Leo C. Massopust ◽  
L. R. Wolin ◽  
N. Taslitz ◽  
R. J. White
Keyword(s):  
Spinal Cord ◽  
Respiratory Function ◽  
Cervical Spinal Cord ◽  
Pressure Effects ◽  
Spontaneous Respiration ◽  
Mechanical Trauma ◽  
Content Type ◽  
Cord Injury ◽  
Cord Lesion ◽  
Fine Print

✓ The effect on respiratory function of crushing the C-4 level of the cervical spinal cord was evaluated in monkeys. Spontaneous respiration ceased immediately after the crush due to direct mechanical trauma, but could be recovered provided a respirator was used and certain areas of the anterolateral columns remained intact. This acute respiratory paralysis occurred even in minimally damaged cords in which most of the anterolateral columns were spared, and led to death due to hypoxia if a respirator was not used. The delayed spinal cord swelling due to edema and centrifugal pressure from an expanding central cord lesion gradually caused delayed respiratory paralysis; durotomy relieved the pressure effects and markedly facilitated recovery.

The effects of methylprednisolone and the ganglioside GM1 on acute spinal cord injury in rats

1994 ◽  
Vol 80 (1) ◽  
pp. 97-111 ◽  
Author(s):  
Shlomo Constantini ◽  
Wise Young
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Body Weight Loss ◽  
Ganglioside Gm1 ◽  
Rat Spinal Cord ◽  
Neuroprotective Effects ◽  
Content Type ◽  
Human Spinal Cord ◽  
Cord Injury ◽  
Fine Print

✓ Recent clinical trials have reported that methylprednisolone sodium succinate (MP) or the monosialic ganglioside GM1 improves neurological recovery in human spinal cord injury. Because GM1 may have additive or synergistic effects when used with MP, the authors compared MP, GM1, and MP+GM1 treatments in a graded rat spinal cord contusion model. Spinal cord injury was caused by dropping a rod weighing 10 gm from a height of 1.25, 2.5, or 5.0 cm onto the rat spinal cord at T-10, which had been exposed via laminectomy. The lesion volumes were quantified from spinal cord Na and K shifts at 24 hours after injury and the results were verified histologically in separate experiments. A single dose of MP (30 mg/kg), given 5 minutes after injury, reduced 24-hour spinal cord lesion volumes by 56% (p = 0.0052), 28% (p = 0.0065), and 13% (p > 0.05) in the three injury-severity groups, respectively, compared to similarly injured control groups treated with vehicle only. Methylprednisolone also prevented injury-induced hyponatremia and increased body weight loss in the spine-injured rats. When used alone, GM1 (10 to 30 mg/kg) had little or no effect on any measured variable compared to vehicle controls; when given concomitantly with MP, GM1 blocked the neuroprotective effects of MP. At a dose of 3 mg/kg, GM1 partially prevented MP-induced reductions in lesion volumes, while 10 to 30 mg/kg of GM1 completely blocked these effects of MP. The effects of MP on injury-induced hyponatremia and body weight loss were also blocked by GM1. Thus, GM1 antagonized both central and peripheral effects of MP in spine-injured rats. Until this interaction is clarified, the authors recommend that MP and GM1 not be used concomitantly to treat acute human spinal cord injury. Because GM1 modulates protein kinase activity, protein kinases inhibit lipocortins, and lipocortins mediate anti-inflammatory effects of glucocorticoids, it is proposed that the neuroprotective effects of MP are partially due to anti-inflammatory effects and that GM1 antagonizes the effects of MP by inhibiting lipocortin. Possible beneficial effects of GM1 reported in central nervous system injury may be related to the effects on neural recovery rather than acute injury processes.

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