Effects Of Spinal Cord Injury Research Articles

Neuroprotective effect of alpha-lipoic acid and methylprednisolone on the spinal cord ischemia/reperfusion injury in rabbits

Objective. The aim of this study is to investigate the putative neuroprotective effect of alpha-lipoic acid (LA) on spinal ischemia/reperfusion (I/R) injury in rabbits. Methods. Thirty-five adult female New Zeland rabbits, weighing 2,000–3,500 g (mean: 2,800), were divided randomly into five groups of seven rabbits each (n: 7) as Group 1: sham, only laparotomy; Group 2 (İ/R): I/R; Group 3 (LA): I/R and 100 mg/kg of LA; Group 4 (MP): I/R and 30 mg/kg of methylprednisolone (MP); and Group 5 (LA + MP): I/R and 100 mg/kg of LA plus 30 mg/kg of MP. Results. A statically significant effect of LA, MP, and LA plus MP on lowering malondialdehyde levels both in the blood and in the cerebrospinal fluid (CSF) has been observed. Nitric oxide is significantly decreased in the blood and spinal cord tissues, and also in the CSF but it is not significant. Superoxide dismutase, catalase, and glutathione levels were increased by LA administration. Conclusion. LA exhibits antioxidant efficacy in spinal cord I/R injury, but it cannot decrease the oxidative stress. The histopathological result of the present study also demonstrated that LA has neuroprotective effect in spinal cord injury.

Rapamycin plays a neuroprotective effect after spinal cord injury via anti-inflammatory effects.

Whether rapamycin has neuroprotective effects in spinal cord injury remains controversial. The present study shows that rapamycin protects neurons from death after spinal cord injury by inhibiting the secondary inflammatory response. The effects of rapamycin were tested using a myeloperoxidase assay, Western blotting, immunohistochemistry, and the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The experimental results showed that after spinal cord injury, rapamycin reduced the numbers of activated microglia and neutrophils in the damage zone, lowered the expression levels of TNF-α and IL-1β, reduced the apoptotic cells, and increased the survival of neurons. The above data proved that rapamycin diminishes inflammatory cell activation and proliferation, downregulates the expression of inflammatory factors, reduces the microenvironmental damage effects on neurons in the acute injury phase, and thus promotes the survival of neurons. Therefore, we believe that rapamycin has neuroprotective effects in spinal cord injury.

Reactive oxygen species and lipid peroxidation inhibitors reduce mechanical sensitivity in a chronic neuropathic pain model of spinal cord injury in rats.

Chronic neuropathic pain is a common consequence of spinal cord injury (SCI), develops over time and negatively impacts quality of life, often leading to substance abuse and suicide. Recent evidence has demonstrated that reactive oxygen species (ROS) play a role in contributing to neuropathic pain in SCI animal models. This investigation examines four compounds that reduce ROS and the downstream lipid peroxidation products, apocynin, 4-oxo-tempo, U-83836E, and tirilazad, and tests if these compounds can reduce nocioceptive behaviors in chronic SCI animals. Apocynin and 4-oxo-tempo significantly reduced abnormal mechanical hypersensitivity measured in forelimbs and hindlimbs in a model of chronic SCI-induced neuropathic pain. Thus, compounds that inhibit ROS or lipid peroxidation products can be used to ameliorate chronic neuropathic pain. We propose that the application of compounds that inhibit reactive oxygen species (ROS) and related downstream molecules will also reduce the behavioral measures of chronic neuropathic pain. Injury or trauma to nervous tissue leads to increased concentrations of ROS in the surviving tissue. Further damage from ROS molecules to dorsal lamina neurons leads to membrane excitability, the physiological correlate of chronic pain. Chronic pain is difficult to treat with current analgesics and this research will provide a novel therapy for this disease.

Tu1973 Esophageal Dysmotility Is Highly Prevalent in Persons With SCI Compared to Able-Bodied Controls As Identified With High-Resolution Manometry and the Use of the Chicago Classification

BACKGROUND: A paucity of information exists with regard to the effects of spinal cord injury (SCI) on esophageal motility. Due to the complete or partial loss of sensory innervation to the esophagus, a symptom-based diagnosis of esophageal dysmotility is often delayed, if even appreciated, although some degree of occult impaired motility is likely to be present. AIM: To compare the incidence and to determine the differences in esophageal motility parameters between persons with chronic SCI and able-bodied controls by the use of high resolution manometry (HRM) and the Chicago Classification (CC). METHODS: HRM was performed in 39 asymptomatic individuals: 14 able-bodied controls (AB) and 25 SCI subjects (level of injury between C5-T10). A catheter that contained multiple pressure sensors which were arranged at 360 degrees was introduced into the esophagi of subjects at a distance that permitted both the upper (UES) and lower (LES) esophageal sphincters to be captured. After a baseline period to assess basal pressures, each subject was asked to perform 10 wet swallows of 5 ml boluses of isotonic saline while esophageal pressure and impedance were recorded. Esophageal topography parameters (EPT) were calculated using analysis software and two independent reviewers classified the manometric findings according to the CC. RESULTS: There were no significant differences in gender, age or BMI between AB and SCI groups. Eighty-four % (21 out of 25) of the SCI subjects studied were diagnosed with at least one motility abnormality: 12% with Type II achalasia, 4% with Type III achalasia, 20% with EGJ outflow obstruction, 4%with a hypercontractile esophagus, and 48%with peristaltic abnormalities (i.e., weak peristalsis with small or large defects or frequent failed peristalsis). In contrast, only 7% (1 out of 14) of the AB subjects was diagnosed with any type of motility disorder (hypercontractile esophagus). CONCLUSION: Despite the lack of subjective complaints or clinical awareness, esophageal dysmotility appears to be relatively prevalent in the SCI population. The use of new and improved esophageal manometry techniques and a more stringent classification system permitted the presence of wide array of motility disorders in almost all subjects with SCI to be identified, including achalasia that went previously undiagnosed in 4 subjects. Future work will be required to clarify the clinical

O perfil da sexualidade em homens com lesão medular

Introdução Entre as consequências da lesão medular (LM), está o deficit na função sexual, o que interfere na qualidade de vida do indivíduo. Objetivos Conhecer e descrever o perfil da sexualidade de homens com LM, comparando os períodos pré e pós-lesão. Materiais e métodos Estudo transversal com 36 homens com LM. Os dados foram coletados através de um questionário (QSH-LM) e um roteiro. As variáveis quantitativas foram apresentadas por média e desvio padrão. As variáveis categóricas foram apresentadas por frequências absolutas e relativas e as associações foram realizadas através do teste Qui-quadrado. Todos os testes apresentaram significância de 5%. Resultados Houve prevalência de pacientes paraplégicos e de lesões do tipo completa. A prática, frequência, desejo e satisfação sexual decaíram após a LM, assim como as respostas sexuais. Dentre essas estão ereção, ejaculação e orgasmo, que decaíram de forma relevante após a LM. A sensação mais relatada durante o ato sexual foi o aumento da resposta cardiorrespiratória, antes ou após a LM, e mais indivíduos passaram a sentir nenhuma sensação durante a atividade sexual após a LM. Houve significativa associação entre tipo de lesão e presença de orgasmo e entre prática e satisfação sexual após a LM. Conclusão Foi observado que a resposta sexual após a LM altera na ordem crescente: ereção, orgasmo e ejaculação. Percebe-se que muitas vezes a reabilitação é focada nas capacidades motoras e a sexualidade é pouco abordada.

Increased Risk of Deep Vein Thrombosis and Pulmonary Thromboembolism in Patients with Spinal Cord Injury: A Nationwide Cohort Prospective Study

We investigated the effect of spinal cord injury (SCI) on the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) by conducting a nationwide longitudinal cohort study. We studied the entire hospitalized population in Taiwan for the 1998-2008 period, with a follow-up period extending to the end of 2010. We identified SCI patients using the Taiwan National Health Insurance Research Database (NHIRD), and selected a cohort that was 1:4 frequency-matched by age (5-y span), sex, and index year from the general population. We analyzed the risks of DVT and PE using Cox proportional-hazards regression models, which included the demographic variables of sex, age, and comorbidities. A total of 47,916 SCI patients (62.7% men, mean age of 50.0 y) and 191,664 controls were followed for 308,266 and 1,341,169 person-years, respectively. The adjusted hazard ratio (HR) of DVT and PE development was 2.46-fold and 1.57-fold among the SCI patients, respectively. The highest risk of DVT and PE developed within 3months after an SCI occurred (HR: 16.9 and 3.64, respectively). The adjusted HR of DVT and PE rose markedly with increasing age. The adjusted HR of DVT was highest among C-spine SCI patients, and the adjusted HR of PE was highest among T-spine SCI patients. This nationwide prospective cohort study demonstrated that the risk of DVT and PE increased significantly in SCI patients compared with that of the general population. The highest risk of DVT and PE developed within 3months after an SCI occurred.

Prediction of gait recovery in spinal cord injured individuals trained with robotic gait orthosis

BackgroundMotor impairment is a major consequence of spinal cord injury (SCI). Earlier studies have shown that robotic gait orthosis (e.g., Lokomat) can improve an SCI individual’s walking capacity. However, little is known about the differential responses among different individuals with SCI. The present longitudinal study sought to characterize the distinct recovery patterns of gait impairment for SCI subjects receiving Lokomat training, and to identify significant predictors for these patterns.MethodsForty SCI subjects with spastic hypertonia at their ankles were randomly allocated to either control or intervention groups. Subjects in the intervention group participated in twelve 1-hour Lokomat trainings over one month, while control subjects received no interventions. Walking capacity was evaluated in terms of walking speed, functional mobility, and endurance four times, i.e. baseline, 1, 2, and 4 weeks after training, using the 10-Meter-Walking, Timed-Up-and-Go, and 6-Minute-Walking tests. Growth Mixture Modeling, an analytical framework for stratifying subjects based on longitudinal changes, was used to classify subjects, based on their gait impairment recovery patterns, and to identify the effects of Lokomat training on these improvements.ResultsTwo recovery classes (low and high walking capacity) were identified for each clinical evaluation from both the control and intervention groups. Subjects with initial high walking capacity (i.e. shorter Timed-Up-and-Go time, higher 10-Meter-Walking speed and longer 6-Minute-Walking distance) displayed significant improvements in speed and functional mobility (0.033 m/s/week and–0.41 s/week respectively); however no significant change in endurance was observed. Subjects with low walking capacity exhibited no significant improvement. The membership in these two classes—and thus prediction of the subject’s gait improvement trajectory over time—could be determined by the subject’s maximum voluntary torque at the ankle under both plantar-and dorsi-flexion contractions determined prior to any training.ConclusionOur findings demonstrate that subjects responded to Lokomat training non-uniformly, and should potentially be grouped based on their likely recovery patterns using objective criteria. Further, we found that the subject’s ankle torque can predict whether he/she would benefit most from Lokomat training prior to the therapy. These findings are clinically significant as they can help individualize therapeutic programs that maximize patient recovery while minimizing unnecessary efforts and costs.

Posttraumatic Stress Disorder in Patients Following Intensive Care Unit Treatment: A Review of Studies Regarding Prevalence and Risk Factors

Charcot spine, also known as neuropathic spinal arthropathy and Charcot spinal arthropathy, is a rare and potentially devastating consequence of spinal cord injury. Treatment of this condition ranges from observation, immobilization with bracing or jacket, or surgical stabilization. A 52-year-old male, with a history of a C6-7 spinal cord injury over 30 years ago, presented to our hospital with complaints of worsening of his chronic low back pain over the prior 6 months. His pain was exacerbated with movement, and he also found it more difficult to sit up straight in his wheelchair. MR imaging of the spine demonstrated the large fluid collection with transection of the thecal sac and spinal cord at T10-11, along with the prior known spinal cord injury at C6-7. Given the patient’s clinical presentation and signs of progressive degenerative changes with worsening kyphosis, the patient underwent a T7- L3 posterior instrumented fusion for stabilization. Through the same incision, an extracavitary approach was utilized for placement of an expandable titanium case for anterior column support. After the operation, he experienced a significant reduction in pain and noted improved posture in his wheelchair

Charcot Spine after Remote Cervical Spine Injury

Charcot spine, also known as neuropathic spinal arthropathy and Charcot spinal arthropathy, is a rare and potentially devastating consequence of spinal cord injury. Treatment of this condition ranges from observation, immobilization with bracing or jacket, or surgical stabilization. A 52-year-old male, with a history of a C6-7 spinal cord injury over 30 years ago, presented to our hospital with complaints of worsening of his chronic low back pain over the prior 6 months. His pain was exacerbated with movement, and he also found it more difficult to sit up straight in his wheelchair. MR imaging of the spine demonstrated the large fluid collection with transection of the thecal sac and spinal cord at T10-11, along with the prior known spinal cord injury at C6-7. Given the patient's clinical presentation and signs of progressive degenerative changes with worsening kyphosis, the patient underwent a T7- L3 posterior instrumented fusion for stabilization. Through the same incision, an extracavitary approach was utilized for placement of an expandable titanium case for anterior column support. After the operation, he experienced a significant reduction in pain and noted improved posture in his wheelchair.

The effects of spinal cord injury on bone healing in patients with femoral fractures

BackgroundOrthopedic literature states that fractures of long bones, when associated with traumatic brain injuries, frequently heal with excessive callus and faster than normal. Few studies, however, have reported these phenomena being induced by spinal cord injury (SCI). Our objective is to compare the extent of callus and the rate of healing of long-bone fractures in patients with or without SCI. Subgroup comparisons were performed among the patients with SCI in terms of different levels of SCI.MethodsThe final mean volume of callus formation and the rate of union of nailed fractures of the femur were determined radiologically in 22 femoral fracture patients with SCI (seven cervical, six thoracic, and nine lumbar spine injury) and compared with those in a group of 22 patients with similar types of fractures but without SCI.ResultsThe final mean callus volume in the fracture/SCI group was significantly higher than the fracture-only group (P < 0.001). The fractures in the fracture/SCI group united in an average time of 22.86 weeks compared with 25.04 weeks in the fracture-only group (P < 0.05). We observed 84.6% (11 of 13) of patients with cervical and thoracic SCI patients with accelerated fracture healing (cervical 6 of 7, thoracic 5 of 6), but only 44.4% (4 of 9) of patients with lumbar SCI appeared to show this phenomenon (P < 0.05).ConclusionsThese results confirm that SCI may be associated with accelerated fracture healing and enhanced callus formation. Furthermore, our study revealed a trend toward enhanced osteogenesis in cervical or thoracic SCI compared with lumbar SCI.

Phenotypes and Predictors of Pain Following Traumatic Spinal Cord Injury: A Prospective Study

Pain is a serious consequence of spinal cord injury (SCI). Our aim was to investigate the temporal aspects of different types of pain following traumatic SCI and to determine possible predictors of neuropathic pain. Prospective data on 90 patients were collected at 1, 6, and 12 months after traumatic SCI. The patients completed questionnaires on pain severity, descriptors, and impact and underwent clinical examination with bedside sensory testing. Eighty-eight patients completed the 12-month follow-up. Approximately 80% of patients reported any type of pain at all 3 time points. Neuropathic pain related to SCI increased over time, and musculoskeletal pain decreased slightly, with both being present in 59% of patients at 12 months; other neuropathic pain not related to SCI and visceral pain were present in 1 to 3%. At-level neuropathic pain present at 1 month resolved in 45% and below-level pain resolved in 33%. Early (1 month) sensory hypersensitivity (particularly cold-evoked dysesthesia) was a predictor for the development of below-level, but not at-level, SCI pain at 12 months. In conclusion, the present study demonstrates phenotypical differences between at-level and below-level SCI pain, which is important for future studies aiming to uncover underlying pain mechanisms. PerspectiveThe finding that early sensory hypersensitivity predicts later onset of below-level central neuropathic pain may help to identify patients at risk of developing neuropathic pain conditions after traumatic spinal cord injury. Information about onset of pain may help to identify different phenotypes in neuropathic pain conditions.

Hyperexcitability of Bladder Afferent Neurons Associated with Reduction of Kv1.4 α-Subunit in Rats with Spinal Cord Injury

To clarify the functional and molecular mechanisms inducing hyperexcitability of C-fiber bladder afferent pathways after spinal cord injury we examined changes in the electrophysiological properties of bladder afferent neurons, focusing especially on voltage-gated K channels. Freshly dissociated L6-S1 dorsal root ganglion neurons were prepared from female spinal intact and spinal transected (T9-T10 transection) Sprague Dawley® rats. Whole cell patch clamp recordings were performed on individual bladder afferent neurons. Kv1.2 and Kv1.4 α-subunit expression levels were also evaluated by immunohistochemical and real-time polymerase chain reaction methods. Capsaicin sensitive bladder afferent neurons from spinal transected rats showed increased cell excitability, as evidenced by lower spike activation thresholds and a tonic firing pattern. The peak density of transient A-type K+ currents in capsaicin sensitive bladder afferent neurons from spinal transected rats was significantly less than that from spinal intact rats. Also, the KA current inactivation curve was displaced to more hyperpolarized levels after spinal transection. The protein and mRNA expression of Kv1.4 α-subunits, which can form transient A-type K+ channels, was decreased in bladder afferent neurons after spinal transection. Results indicate that the excitability of capsaicin sensitive C-fiber bladder afferent neurons is increased in association with reductions in transient A-type K+ current density and Kv1.4 α-subunit expression in injured rats. Thus, the Kv1.4 α-subunit could be a molecular target for treating overactive bladder due to neurogenic detrusor overactivity.

Longstanding neuropathic pain after spinal cord injury is refractory to transcranial direct current stimulation: A randomized controlled trial

Neuropathic pain remains one of the most difficult consequences of spinal cord injury (SCI) to manage. It is a major cause of suffering and adds to the physical, emotional, and societal impact of the injury. Despite the use of the best available treatments, two thirds of people experiencing neuropathic pain after SCI do not achieve satisfactory pain relief. This study was undertaken in response to a recent clinical trial reporting short-term, clinically significant reductions in neuropathic SCI pain with primary motor cortex transcranial direct current stimulation (tDCS). In this investigation, we aimed to build on this previous clinical trial by extending the assessment period to determine the short-, medium-, and long-term efficacy of tDCS for the treatment of neuropathic pain after SCI. We found that, contrary to previous reports, after 5 tDCS treatment periods, mean pain intensity and unpleasantness rating were not significantly different from initial assessment. That is, in this trial tDCS did not provide any pain relief in subjects with neuropathic SCI pain (n=10). A similar lack of effect was also seen after sham treatment. Because the injury duration in this study was significantly greater than that of previous investigations, it is possible that tDCS is an effective analgesic only in individuals with relatively recent injuries and pain. Future investigations comparing a range of injury durations are required if we are to determine whether this is indeed the case.

TRPV1 channels make major contributions to behavioral hypersensitivity and spontaneous activity in nociceptors after spinal cord injury

Chronic neuropathic pain is often a severe and inadequately treated consequence of spinal cord injury (SCI). Recent findings suggest that SCI pain is promoted by spontaneous activity (SA) generated chronically in cell bodies of primary nociceptors in dorsal root ganglia (DRG). Many nociceptors express transient receptor potential V1 (TRPV1) channels, and in a preceding study most dissociated DRG neurons exhibiting SA were excited by the TRPV1 activator, capsaicin. The present study investigated roles of TRPV1 channels in behavioral hypersensitivity and nociceptor SA after SCI. Contusive SCI at thoracic segment T10 increased expression of TRPV1 protein in lumbar DRG 1month after injury and enhanced capsaicin-evoked ion currents and Ca2+ responses in dissociated small DRG neurons. A major role for TRPV1 channels in pain-related behavior was indicated by the ability of a specific TRPV1 antagonist, AMG9810, to reverse SCI-induced hypersensitivity of hind limb withdrawal responses to mechanical and thermal stimuli at a dose that did not block detection of noxious heat. Similar reversal of behavioral hypersensitivity was induced by intrathecal oligodeoxynucleotides antisense to TRPV1, which knocked down TRPV1 protein and reduced capsaicin-evoked currents. TRPV1 knockdown also decreased the incidence of SA in dissociated nociceptors after SCI. Prolonged application of very low concentrations of capsaicin produced nondesensitizing firing similar to SA, and this effect was enhanced by prior SCI. These results show that TRPV1 makes important contributions to pain-related hypersensitivity long after SCI, and suggest a role for TRPV1-dependent enhancement of nociceptor SA that offers a promising target for treating chronic pain after SCI.

THE EFFECT OF SPINAL CORD INJURY LEVEL ON THE INTENSITY AND DYNAMICS OF ELECTRIC NEUROPHYSIOLOGICAL CHARACTERISTICS OF SENSORIMOTOR DISORDER SEVERITY

Objective. To compare electroneuromyography (ENMG) characteristics of sensomotor innervation status of lower limb muscles in patients with different level injuries in the thoracic and lumbar spine. Material and Methods. Findings of global (maximal voluntary muscle tension) and stimulated (M-response, Н-reflexes) ENMG were analyzed in 48 patients aged 11 to 55 years. All patients were divided into three groups depending on the injury level. Results. The most marked ENMG signs of functional insufficiency in pre- and postoperative periods were registered in patients with spinal cord injuries at the D9 through D12 levels, which topologically correspond to localization of segmental neuronal populations responsible for formation of spinal motor centres controlling voluntary and reflex activity of lower limb muscles. Conclusion. Consideration of the study results can be useful in predicting functional outcomes of surgical treatment and rehabilitation of patients with consequences of spinal cord injury.

Motor imagery in spinal cord injury patients: Moving makes the difference

Both real action control and execution and motor imagery abilities require knowledge of the spatial location of body parts, in other words efference copy information and feedbacks from the sensory system (Frith etal., 2000, Philos. Trans. R. Soc. Lond. B. Biol. Sci., 355, 1771). Spinal cord injuries induce severe motor disability, due to a damage of the descending motor pathways (Cramer etal., 2007, Exp. Brain. Res., 177, 233). Patients' motor imagery competences are variably reported as either normal or defective (Decety & Boisson, 1990, Eur. Arch. Psychiatry Clin. Neurosci., 240, 39; Lacourse etal., 1999, Behav. Brain Sci., 104, 73). We explored biomechanical constraint effects in Spinal Cord Injury (SCI) patients, as they are considered the most reliable indexes of motor imagery abilities (Parsons, 1987b, Cogn. Psychol., 19, 178). Sixteen spinal cord injuries patients and 16 neurologically unimpaired subjects have been administered with (1) the Hand Laterality Task (HLT), in which subjects were asked to judge the laterality of a rotated hand; and (2) the Mirror Letter Discrimination Task (MLD), in which subjects were asked to judge if a rotated character was in its correct upright position or mirror-reversed form. Our patients did not present the effect of stimulus orientation, neither did they show any effect related to biomechanical constraints. Based on these data, the hypothesis is that SCI patients' performance may be ascribed to the use of a different strategy to solve the tasks, based on memory rather than on mental rotation.

Chronic At- and Below-Level Pain after Moderate Unilateral Cervical Spinal Cord Contusion in Rats

Chronic neuropathic pain is a significant consequence of spinal cord injury (SCI) that is associated with evoked pain, including allodynia and/or hyperalgesia. Allodynia is defined as a painful response to normally innocuous stimuli, and hyperalgesia occurs when there is an amplified pain response to normally noxious stimuli. We describe a model of a unilateral cervical level (C5) contusion injury where sensory recovery was assessed weekly for 6 weeks in 32 adult, female, Sprague-Dawley rats. Bilateral thermal hyperalgesia and tactile allodynia are detectable in the fore- and hindpaws as early as 7 days post-injury (dpi) and persist for at least 42 days. Paw withdrawal latency in response to a noxious thermal stimulus significantly intra-animal pre-operative values. Change in paw withdrawal latency plateaued at 21 dpi. Interestingly, bilateral forepaw allodynia develops in fewer than 40% of rats as measured by von Frey monofilament testing. Similar results occur in the hindpaws, where bilateral allodynia occurs in 46% of rats with SCI. The contralesional forepaw and both hindpaws of rats showed a slight increase in paw withdrawal threshold to tactile stimuli acutely after SCI, corresponding to ipsilesional forelimb motor deficits that resolve over time. That there is no difference among allodynic and non-allodynic groups in overall spared tissue or specifically of the dorsal column or ventrolateral white matter where ascending sensory tracts reside suggests that SCI-induced pain does not depend solely on the size or extent of the lesion, but that other mechanisms are in play. These observations provide a valid model system for future testing of therapeutic interventions to prevent the onset or to reduce the debilitating effects of chronic neuropathic pain after SCI.

The impact of discrete modes of spinal cord injury on bladder muscle contractility

BackgroundPrior studies have compared the effect of spinal cord injury elicited using distinct approaches on motor and visceral function. However, the impact of such discrete modes of injury specifically on bladder muscle contractility has not been explored in detail. The goal of this study is to compare the impact of complete spinal cord transection versus clip compression at thoracic vertebra eight (T8) on bladder muscle contractility.MethodsRats underwent no treatment (Control), laminectomy (Sham, SH); complete extradural transection (TX); or cord compression with an aneurysm clip (CX). Bladders and spinal cords were harvested at 6 wk for contractility studies or histological analysis.ResultsDetrusor strips from TX and CX rats showed higher spontaneous activity than those from SH rats. Furthermore, the duration of the neurally-mediated contractile response was longer in TX and CX rats compared to controls and showed attenuated relaxation. No significant differences were observed between muscle strips from SH, TX or CX rats in response to KCl, ATP or phenylephrine. However, tissues from TX and CX rats showed a higher sensitivity to carbachol compared to that from SH animals.ConclusionsComplete SCI in rats either by cord transection or compression elicits qualitatively similar changes in bladder muscle contractility. Whereas cord transection is arguably easier to perform experimentally, cord compression better models the situation observed clinically, such that each approach has clear advantages and limitations.

Can diffusion tensor imaging predict outcome in acute traumatic deterioration of degenerative cervical spine disease

IntroductionPatients with degenerative diseases of cervical spine are likely to develop acute cord injury following trivial trauma. However many of them can have a poor functional outcome. Routine MRI may not be helpful in accurately predicting the recovery in these cases. DTI of spinal cord is a promising tool in prognostication of various neurological diseases. Materials and methodA prospective study was done to know the use of DTI in predicting outcome in acute deterioration of degenerative cervical spine disease. Cases presenting within 48 h of acute traumatic deterioration were included in the study. A screening MRI was done to know the extent of disease and cord damage. Using DTI, apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated at the level of injury. 3D tractography was done using Label map seeding technique. Clinical correlation was done with ASIA and FIM scores. ResultsFive cases of cervical cord injury with a mean age of 46 ± 11 years were studied. The diffusion parameters were compared with three age matched controls. The cases were followed up prospectively. All the cases had a decrease in ADC values and increase in FA at the level of injury compared to other levels (p = 0.02) and to normal controls (p = 0.001). It was extending beyond the level of cord contusion identified by routine MRI. DiscussionDTI is well suited for evaluating effects of spinal cord injury like cellular swelling and myelin membrane disruption which is not diagnosed using conventional MRI. ADC helps us to define the type and extent of spinal cord injury. 3D tractography delineates the fiber disruption. ConclusionADC is a sensitive marker of acute cervical cord injury, in degenerative spine disease.3D tractography can help us to select the cases for early surgical intervention and to predict clinical outcome.

Evaluation of bone mineral density and morphology using pQCT in children after spinal cord injury

Objective: To evaluate the effects of spinal cord injury (SCI) on bone density and morphology in children using peripheral quantitative computer tomography (pQCT).Design: Retrospective cohort study of 19 paediatric patients with SCI (9 paraplegics and 10 tetraplegics).Results: There was significant reduction in tibial metaphysial volumetric bone mineral density (vBMD), diaphysial cortical cross-sectional area (CSA), cortical thickness and polar strength–strain index. There was a significant loss of calf muscle CSA. Those who were able to stand had greater trabecular vBMD, tibial cortical thickness and tibial muscle CSA Z-scores. Lower limb fractures did not occur if tibial trabecular vBMD was greater than 100 mg/cm3. Tibial geometry following SCI was more circular compared to controls.Conclusions: pQCT provides a valuable insight into the regional changes in bone and muscle development in children following SCI. Residual muscle function with the ability to weight bear provides a significant benefit to bone development.