Complete Thoracic Cord Research Articles

Ultrasound-driven piezoelectric current activates spinal cord neurocircuits and restores locomotion in rats with spinal cord injury

BackgroundNeuromodulation via electrical stimulation (ES) is a common technique to treat numerous brain and spinal cord related neurological conditions. In the present study, we examined the efficacy of piezoelectric stimulation (pES) by a custom miniature piezostimulator to activate the spinal cord neurocircuit in comparison with conventional epidural ES in rats.MethodsStimulation electrodes were implanted on L2 and S1 spinal cord and were connected to a head-plug for ES, and a piezostimulator for pES. EMG electrodes were implanted into hindlimb muscles. To generate piezoelectric current, an ultrasound beam was delivered by an external ultrasound probe. Motor evoked potentials (MEPs) were recorded during the piezoelectric stimulation and compared with the signals generated by the ES.ResultsOur results suggest that ultrasound intensity as low as 0.1 mW/cm2 could induce MEPs in the hindlimbs. No significant difference was found either in MEPs or in muscle recruitments for ES and pES. Similar to ES, pES induced by 22.5 mW/cm2 ultrasound restored locomotion in paralyzed rats with complete thoracic cord injury. Locomotion EMG signals indicated that pES works same as ES.ConclusionWe propose piezoelectric stimulation as a new avenue of neuromodulation with features overtaking conventional electrical stimulation to serve future bioelectronic medicine.83StwwHHYaD7oZ4SVru6w9Video abstract.

Effects of pulsed radiofrequency on spasticity in patients with spinal cord injury: a report of two cases.

Spasticity following spinal cord injury (SCI) results in functional deterioration and reduced quality of life. Herein, we report two SCI patients who presented with good response to pulsed radiofrequency (PRF) for the management of spasticity in the lower extremities. Patient 1 (a 47-year-old man) had complete thoracic cord injury and showed a phasic spasticity on the extensor of both knees (3–4 beats clonus per every 30 seconds) and tonic spasticity (Modified Ashworth Scale: 3) on both hip adductors. Patient 2 (a 64-year-old man) had incomplete cervical cord injury and showed a right ankle clonus (approximately 20 beats) when he walked. After the application of PRF to both L2 and L3 dorsal root ganglion (DRG) (patient 1) and right S1 DRG (patient 2) with 5 Hz and 5 ms pulsed width for 360 seconds at 45V under the C-arm guide, all spasticity disappeared or was reduced. Moreover, the effects of PRF were sustained for approximately 6 months with no side effects. We believe that PRF treatment can be useful for patients with spasticity after SCI.

Demographic and injury characteristics of spinal cord injury in 275 children

Objective To study the demographic and injury characteristics of pediatric spinal cord injury(SCI) in children less than 14 years old in order to provide the guide for its prevention and treatment. Methods A retrospective study was performed and a total of 275 cases of children (less than 14 years old) with SCI were identified in China Rehabilitation Research Center(CRRC) from January 1989 to December 2014.The clinical information including gender, age, causes of injury, date of injury and injury condition were analyzed. Results Among 275 cases(male 111 cases, female 164 cases), 48.0% of the cases were 4.0-7.0 years old (132/275 cases), including 93 female cases (70.5%, 93/132 cases). Transport activities(74 cases, 26.9%), non traumatic causes(72 cases, 26.2%), sports and leisure activities (70 cases, 25.5%) were the main causes of SCI.Significant difference was observed in a number of patients in sports between 2003-2014 group (28.0%, 65/232 cases) and 1987-2002 group(11.6%, 5/43 cases)(χ2=5.135, P=0.023). The largest gender gap among kids was doing sports (7 male cases, 63 female cases), and the chief reason for children aged 4.0 to 7.0 years was also sports (48.2%, 55/114 cases). Patients suffered with SCI without radiologic abnormality (SCIWORA), in greater number (69.5%, 141/203 cases), and 121 (85.8%, 121/141 cases) patients were thoracic cord injury without radiologic abnormality(TCIWORA). Sports was the main cause of injury (64.1%, 50/78 cases) for 4.0 to 7.0 years old children (64.5%, 78/121cases) who were the greatest number of patients with TCIWORA.The earliest case of sports occurred in 1995, which happened nationwide each year since 2001.Spine hyperextension (90.0%, 63/70 cases) was the most common in sports, which caused 62 patients with SCIWORA (98.4%, 62/63 cases) including 47 children with complete thoracic cord injury (75.8%, 47/62 cases), and it often occurred in summer and autumn. Conclusions Sports injury was the most common cause of SCI children in CRRC nearly 12 years.The incidence of this damage was growing up and the girl(4-7 years old) because of spine hyperextension in sports(bend down in dancing practice) was the largest proportion of children with SCI.This severe damage which often resulted in complete thoracic cord injury should arouse more attention in clinic.The main crowd protection was the children who exercised back bend.This results provided important clues to develop related etiologic study and pointed out that it was needed to collect more information to investigate its injury mechanism. Key words: Spinal cord injury; Spinal cord injury without radiologic abnormality; Retrospective analysis; Child

Clinical study of resiniferatoxin on neurogenic bladder

To understand the effect of resiniferatoxin on neurogenic bladder by intravesical filling. Twenty-four male spinal cord injury patients with an obviously low cystometric capacity, 2 incomplete cervical cord injury, 5 complete thoracic cord injury, 4 incomplete thoracic cord injury, 5 incomplete lumbar cord injury and 8 complete lumbar cord injury were examined. The age range was 24 - 58 years old and the course of disease 1 - 6 years. There were 0.0063 mg/4 ml RTX in each bottle, it was dissolved in 50 ml physiologic saline and was infused into bladder slowly, kept 30 min, then was discharged by intermittent catheterization (IC). During the process, the patients were requested to fill a micturition chart and conduct urodynamic examination before and after the infusion. We regulated that it was utility when the amount of increased maximal cystometric capacity (MCC) exceeded or was 100 ml, otherwise it was invalid. The urodynamic examination before intravesical filling and 1 week after intravesical filling showed that the average MCC were (210 ± 23) ml and (360 ± 30) ml respectively, the average bladder compliance were (17 ± 3) ml/cm H2O and (24 ± 5) ml/cm H2O, there were statistic difference between them (both P < 0.01). The overall effective rate was 62.5%. It lasted 1 - 4 months. Resiniferatoxin is effective to increase the cystometric capacity and booster the bladder compliance.

Reorganization of the cortico-spinal pathway in patients with chronic complete thoracic spinal cord injury: A study of motor evoked potentials

To evaluate the change in motor evoked potential parameters following transcranial magnetic stimulation in patients with chronic complete thoracic cord injury. A cross-sectional study. Eighteen patients with chronic complete thoracic cord injury and 18 age- and sex-matched healthy controls were included in the study. The mean post-injury duration was 13.0 (standard deviation (SD) 6.0) years. The latency, amplitude, central conduction time and peripheral conduction time of motor evoked potentials from bilateral abductor pollicis brevis and first dorsal interosseous muscles following transcranial magnetic stimulation were measured and compared between the patients and healthy controls. The predicting variables for central conduction time, including age, sex, height, illness duration and job activity, were analysed using a simple correlation and stepwise multiple regression model. The patients with complete thoracic cord injury had longer central conduction time recording of the dominant hand in both abductor pollicis brevis and first dorsal interosseous muscles. The difference in latency approached significance between the patients and controls. There was no statistical difference in amplitude between them. Regression analysis demonstrated that patients who were older, less physically active and with longer illness duration showed prolonged central conduction time. The central conduction time in the dominant hand of chronic complete thoracic cord injury is prolonged. This study revealed motor reorganization of the central nervous system in complete thoracic cord injury. Decreased physical activity and prolonged illness may cause these changes.

クモ膜下フェノールブロックによる脊髄損傷患者の尿路管理

Subarachnoid phenol block was applied to four traumatic spinal cord injury patients who had been suffering from urinary incontinence caused by detrusor hyperreflexia. Two were females with complete thoracic cord injury, the others were males with incomplete cervical cord injury. In all patients, detrusor hyperreflexia and urinary incontinence disappeared after 0.3-0.6 ml injection of 10% phenol glycerin. Vesicoureteral reflux observed in three ureters of two patients disappeared or improved. Two obtained sufficient bladder capacity for urine storage, while the others who had been treated by continuous urine drainage for a long time prior to the block could not obtain sufficient bladder compliance. The cause seemed to be organization of the bladder wall.

Effect of differential spinal cord transection on human cerebral blood flow

Regional cerebral blood flow (rCBF) was measured by 133Xe inhalation in 17 patients with chronic spinal cord transection. This was done to investigate any effects such spinal cord deafferentation might have on resting rCBF and to test whether resulting chronic preganglionic sympathectomy influenced cerebral vasomotor CO 2 responsiveness and autoregulation. Thirteen patients had complete cervical cord transection (CCT) at levels C4–C6 (age 37 ± 15 years, time interval, 2 months–20 years). Four patients had complete thoracic cord transection at levels T3–4, T8 and T12 (TCT; age 49 ± 22 years; time interval 2–5 months). CO 2 responsiveness was tested by induced hypercapnia in 11 patients with CCT and 2 patients with TCT. Autoregulation was tested in 10 patients with CCT and 4 patients with TCT by decreasing cerebral perfusion pressure during postural tilting. Mean resting hemispheric Fg values (MHFg) were significantly reduced only in patients with CCT ( MHFg = 69 ± 12 ml 100 g brain/min ), while brain stem-cerebellar Fg values (BSC Fg) were reduced significantly both in patients with CCT (BSC Fg = 85 ± 10) and with TCT (BSC Fg = 88 ± 12) compared to values measured in healthy normals (N = 21, MHFg = 81 ± 10, BSC Fg = 98 ± 10). Hemispheric CO 2 responsiveness showed a trend toward reduction in patients with CCT but this was not statistically significant. Hemispheric autoregulation was significantly impaired in CCT compared to healthy normals but improved with time and rehabilitation. Results are taken to indicate that deafferentation due to cervical cord transection reduces rCBF in both hemispheres and brain stem-cerebellar regions while deafferentation due to thoracic cord transection only reduces brain stem-cerebellar flow. Extracerebral sympathetic innervation plays a role in autoregulation but has less influence on cerebral CO 2 responsiveness.