Complete Spinal Cord Lesion Research Articles

Circulatory changes during mental stress in tetraplegic and paraplegic man

In ten patients suffering from complete chronic cervical spinal cord lesion, the effect of mental stress was studied. Before, during and after stress, variations of blood pressure, heart rate and plasma catecholamines were tested. The study showed a loss of hemodynamic reactions under mental stress in tetraplegics, namely the pressure response, the typical increase in heart rate and in plasma noradrenaline and adrenaline. It is concluded, that changes in sympathectomized man interfere with the acute hemodynamic stress reaction and impair the blood pressure homeostasis.

Myositis ossificans circumscripta in para/tetraplegics.

At the Hospital of Physical Medicine, Hornbaek, we analysed in retrospect 52 cases of myositis ossificans circumscripta (MOC) among 605 patients with para/tetraplegia. MOC proved significantly more common after total than after subtotal spinal cord injuries. MOC was not observed in any case above the motor level of the spinal cord lesion. This neurological relationship appears to "explain" the finding that MOC is more common in para/tetraplegia of traumatic origin (more complete spinal cord lesions) than among those caused by slipped discs or tumours. Twenty-five per cent of the patients ended up with fairly mild and 12% with more severe hip contractures, the latter causing recurrent, contralateral decubital ulcers over the ischial tuberosity and protracted hospitalization. To aid diagnosis, the authors suggest a simple programme for all para/tetraplegics. In our opinion, routine X-ray examination is not necessary. Intensified research into the causative factors and treatment is needed, not only to facilitate these patients' social adaptation, but also for socio-economic reasons.

Psychiatric Disorders in Patients With Spinal Cord Injuries

Although previous studies have reported that all patients with spinal cord injuries experience depression, they have not distinguished between despondency and depressive disorder. Of 30 patients with spinal cord lesions and depressive disorders diagnosed using the Schedule for Affective Disorders and Schizophrenia and the Research Diagnostic Criteria (RDC). 15 patients had RDC diagnoses before or after their injury. A depressive disorder developed in nine after injury. Eight depressive disorders developed within a month of the injury. Postinjury depressive disorders were more common in patients with complete spinal cord lesions but were divided equally between paraplegics and quadriplegics. Only one patient received antidepressants. The remainder recovered without treatment other than the rehabilitation program. The accident causing the injury seemed related to a psychiatric disorder before injury in six patients (four alcoholics and two hypomanics) and to drinking before the accident in 15 patients.

Reflex ejaculation under vibratory stimulation in paraplegic men.

In 12 of 21 men with complete or nearly complete spinal cord lesions who had not ejaculated since their injuries, application of a powerful vibrator to the penis caused ejaculation.

Management of bilateral locked facets of the cervical spine.

The management of 15 cases of bilateral locked facets of the cervical spine is reviewed. The C-6, C-7 interspace was the most common interspace involved. There were 4 females and 11 males who were 16 to 63 years old (average, 26 years). Thirteen patients had a complete spinal cord lesion with loss of function below the level of the locked facets. Two had intact dorsal column function. One patient had an ascending spinal cord deficit, which did not change after open reduction. The remainder had no change in spinal cord function after reduction. However, after reduction, 1 patient had a transient root deficit and 2 patients improved in the function of the involved roots. Closed reduction was accomplished by (a) skeletal traction and weight application, (b) manual reduction under sedatives, or (c) manual reduction under general anesthesia. Five patients required open reduction. The failure of closed reduction was attributed to accompanying fractures of one of the facets in 2 cases, increasing neurological deficits during traction in 2 cases, and associated higher cervical fractures in 1 case. Internal stabilization with wire and bone or external stabilization with a halo vest or a brace was used. Twelve patients were followed for 1 1/2 to 7 years (average, 2.7 years). Stabilization after reduction was successful irrespective of the methods used. The various methods of reduction and stabilization are reviewed and discussed.

Clinical features, investigation and treatment of post-traumatic syringomyelia.

Thirteen patients who sustained spinal cord trauma causing persisting disability, developed new symptoms, the chief one of which was severe pain unrelieved by analgesics. The clinical diagnosis of post traumatic syringomyelia was confirmed in each case by means of myelography, as well as endomyelography in seven patients. In every case exploration of the spinal cord syrinx was performed. Ten patients were troubled by severe pain while three patients were mainly subject to altered sensation in the upper limbs. Of the six patients who had initially sustained complete cord transections, three were treated by cord transection and three were treated by syringostomy. The seven patients who sustained incomplete cord lesions were all treated by syringostomy. The patients who initially sustained incomplete sensory motor spinal cord damage had a better symptomatic response to surgery than hose who had sustained a complete spinal cord lesion. The ten patients whose main symptom was severe pain were completely relieved of their symptoms by surgery.

The effect of diazepam on presynaptic inhibition in patients with complete and incomplete spinal cord lesions.

The effect of diazepam on presynaptic inhibition in man has been examined in 5 patients with complete spinal transections and 7 patients with incomplete lesions. The inhibition of the H reflex by vibration applied to the tendo Achilles was used to assess presynaptic inhibition of the Ia monosynaptic pathway. Diazepam increased this inhibition in the patients with incomplete lesions, but had no significant effect on the inhibition in the patients with complete spinal transections. Evidently diazepam can enhance presynaptic inhibition in man. The effect, however, cannot be demonstrated in patients with longstanding complete spinal lesions possibly because of some alteration in the segmental presynaptic inhibitory mechanism in this group.

Plasma catecholamines in tetraplegics.

1. Six patients with long-standing physiologically complete cervical spinal cord lesions and two normal subjects were examined. 2. In the tetraplegic subjects, arterial blood pressure, heart rate, plasma noradrenaline and adrenaline were measured at rest and during bladder percussion, during electrical stimulation of muscles and during infusion of noradrenaline. 3. In the normal subjects arterial blood pressure and heart rate were recorded before and during noradrenaline infusion. 4. Bladder percussion and muscle stimulation caused a rise in plasma noradrenaline from a subnormal level, together with a rise in blood pressure. 5. A similar rise in blood pressure due to noradrenaline infusion occurred at a very much greater level of plasma noradrenaline. 6. It is concluded that hypertension in tetraplegic subjects who have bladder percussion or muscle stimulation, is due to sympathetic overactivity rather than adrenal medullary secretion. Findings are consistent with, but not conclusive of, supersensitivity of the blood vessels of tetraplegic subjects to noradrenaline.