Level Of Cord Lesion Research Articles

Multidisciplinary management of people with spina bifida across the lifespan.

The average worldwide prevalence of neural tube defects (NTDs) is 1.0 per 1000 births. Its development is multifactorial due to genetic and non-genetic factors. Spina bifida (SB) is one of main representatives of NTD. The spinal cord lesion level is the main determinant of the level of paralysis, numbness, and difficulties with bladder/bowel functions. Myelomeningocele prenatal repair reduces hydrocephalus and hindbrain herniation and improves motor function. The severity of hydrocephalus is associated with poorer neurodevelopmental outcomes whether operated on prenatally or after birth. People with SB tend to have a lower IQ and cognitive difficulties. Early diagnosis, proactivity, and lifelong multidisciplinary follow-up are key protective issues. Invasive urological interventions should be considered in selected patients after failure of conservative treatment. Transition to adult care should be well planned as it is challenging. Health literacy is directly associated with success at transition. Sexuality and fertility should be addressed before/during puberty. Overall, the rates of fecal and urinary continence and skin breakdown increase with age, whereas the ability to ambulate declines with age. Bowel and urinary incontinence are independent predictors of lower health-related quality of life (HRQoL) in adults with SB. Bowel incontinence has negative impact on HRQoL regardless of frequency or amount. Long-term caregiver support should be offered at diagnosis. Survival at a mean of 50years is poor, at 32%, due to central nervous system deaths, cancer, urological disease, and sepsis. Challenges to implementation of recommended practices exist, especially in low and middle-income countries.

Current synthetic overview on spinal cord injury epidemiological data

Aim. To have updated information on the epidemiology of spinal cord injury (SCI) is required for developing an adequate and effective related health policy strategies and consequent contextual decisions making regarding this category of patients and also for planning and implementing SCI prevention education and measures. Accordingly, the rationale of this article is to provide a systematic overview of the literature regarding SCI epidemiology. Material and methods. We reviewed epidemiological published reports and searched on internet specifically databases, from different centres, worldwide, about SCI, collecting descriptive data for properly estimating the incidence, prevalence, and/ or causes of SCI. Results. The global annual incidence rate is considered to be 23 cases of Traumatic Spinal Cord Injury (TSCI) per million (179,312 new cases per annum – results provided by World Health Organisation’s (WHO) in 2007). Prevalence per million inhabitants varies quite largely among statistics in different countries (from 280 in Finland to 681 in Australia, 755 in the United States of America or maybe even more, and even bigger in Canada). Men more commonly suffer from this kind of pathology and the direction of SCI evolution is to have a higher cord lesion level (more tetraplegics than paraplegics) and age at injury. Conclusion. Even if the results of this literature review showed that the SCI incidence and prevalence are rising, they did not suffer significant changes in the last three decades of time. The prevalence surveys remain poor, mainly because a basic requirement for having correct and appropriately updated figures would need national and or regional electronic dedicated registers of evidence, and this is not a situation frequent enough. But the incidence studies from USA and Europe have been increased in the last years. This article asserts the need for improving the SCI data standardised collection in many countries, especially in the ones from low developed or emergent areas.

Influence of spinal cord lesion level and severity on H-reflex excitability and recovery curve.

Changes in spinal reflexes can result from alterations in the spinal cord and descending pathways. We studied whether H-reflex excitability and its recovery depend on the level and/or severity of spinal cord injury (SCI). The soleus Hmax and Mmax responses and the H-reflex recovery curve (HRC) at interstimulus intervals (ISIs) ranging from 50 to 1,000 ms were recorded in 38 SCI individuals and 18 healthy subjects. Amplitude of Mmax correlated with level and severity of lesion (smaller amplitude correlated with more severe SCI or with more caudal lesion). Hmax/Mmax correlated only with age in the SCI group. HRC was increased significantly in complete SCI at ISIs < 500 ms and in incomplete SCI at ISIs > 200 ms with respect to healthy subjects. The changes in spinal reflexes as measured by the H-reflex and its recovery curve after SCI depend on the severity, but not on the level of the lesion.

Fuctional Significance of Spinal Cord Lesion Level

Fuctional Significance of Spinal Cord Lesion Level

Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Cross-sectional study. To analyze the predictors of severe neurogenic bowel dysfunction (NBD) in persons with spinal cord injury (SCI). The Kaohsiung Medical University Hospital, Taiwan. Two questionnaires-the NBD score and the Beck Depression Inventory second edition-were sent to 232 persons with SCI by mail. The demographic factors and injury-related factors were recorded to evaluate any relationships with severe NBD. The associations between the severity of NBD and psychological condition were also measured. In all, 39.4% of the respondents suffered from severe NBD. Multiple logistic regression analysis showed that those with a cervical injury (odds ratios (OR)=10.5, 95% confidence interval (CI) 1.6-67.7) or a thoracic injury (OR=7.1, 95% CI 1.2-40.3) had a higher risk of severe NBD than those with a lumbar injury. Persons with American Spinal Injury Association (ASIA) A had a 12.8-fold higher risk of severe NBD than persons with ASIA D (OR=12.8, 95% CI 3.3-50.1). Longer duration of injury (> or =10 years) was another risk factor of severe NBD. Moderate-to-severe depression was associated with reduced bowel function. This study showed that high level of cord lesion, completeness of cord injury and longer duration of injury (> or =10 years) could predict the severity of NBD in patients with SCI.

Pattern of sports- and recreation-related spinal cord injuries in Beijing

Retrospective study. To determine the characteristics of sports- and recreation-related (SR-related) spinal cord injuries (SCIs) in Beijing. Beijing, China. A review of the complete medical records of 57 consecutive SR-related SCI patients referred to four general hospitals and two rehabilitation institutions was carried out. Patients were injured between 1993 and 2006. The variables studied included demography, sports and recreation characteristics, diagnoses and outcome. There were 44 males and 13 females with a ratio of 3.3:1. The mean age was 24.49+/-11.92 years. In 37 patients (64.9%), water sports was the single most commont cause. Of them, injury because of diving was seen in 34, which constituted 59.6% of the total. Other types of sports and recreation accounted for 35.1%. Level of cord lesion was cervical in 89.5% and thoracic in 10.5% of the injured. The lesion of C4 alone constituted 45.6% of the total. The ratio of complete to incomplete lesion was 1.2:1. In all, two patients died, and one with an injury at the C4 level recovered completely. Of the other 54 survivals, 48 (89%) remained tetraplegic and six remained paraplegic (11%). The main underlying cause was the lack of safety awareness, safety regulations and their implementation. SR-related SCI was most commonly seen among young male adults, predominantly as a result of diving accidents. There was a significant increase in sports injuries, other than those caused by diving, in later years. Successful prevention programs of other countries are being adopted in Beijing in recent years, hence an improvement in safety is expected in the years to come. This work was sponsored by Funding Project for Academic Human Resources Development in Institutions of Higher Learning Under the Jurisdiction of Beijing Municipality(2007) and Funding Project for Science and Technology Development of Beijing Municipality(km200710029003).

Effects of spinal cord lesion level upon thermoregulation during exercise in the heat.

This study examined the effects of the level of spinal cord injury upon the thermoregulatory responses of wheelchair athletes during prolonged wheelchair exercise in warm conditions. Eight tetraplegic (TP), 10 high-level paraplegic (HP), and 10 low-level paraplegic (LP) athletes exercised for 60 min at 60% [OV0312]O(2peak) in a warm environment (31.5 +/- 1.7 degrees C, 42.9 +/- 8.0% relative humidity). Skin temperature and aural temperature were monitored. Aural temperature increased gradually during the exercise period by 1.1 +/- 0.3 and 1.4 +/- 0.5 degrees C for the HP and LP groups, with a more marked increase observed for the TP group (2.1 +/- 0.5 degrees C; P < 0.05). Upper-arm skin temperature was higher for the TP when compared with the HP and LP between 30 and 60 min (P < 0.05). Back skin temperature was higher for the TP when compared with the HP and LP between 45 and 60 min (P < 0.05). No differences were noted between groups for the thigh or calf skin temperatures. During recovery, skin temperature remained elevated for the TP group when compared with the HP and LP groups (P < 0.05). Heat storage was greatest for the TP athletes at the end of exercise and remained elevated throughout recovery (P < 0.05). All athletes completed the exercise task even though the gradual increase in aural temperature observed for the HP and LP groups suggests a degree of thermal imbalance. However, this was much less than observed for TP athletes, who demonstrated a much greater imbalance in temperature regulation. Increasing the exercise or environmental strain may result in the thermoregulatory responses of athletes with a spinal cord injury being compromised.

EVIDENT TRANSSYNAPTIC DEGENERATION OF MOTOR NEURONS AFTER SPINAL CORD INJURY

Neuronal degradation accompanied with axonal degeneration has been known to occur in spinal motor neurons after an upper level of spinal cord lesion. In the present study, the functional integrity of neuromuscular transmission was assessed by utilizing a sensitive electrodiagnostic method comprising of stimulated single-fiber electromyography (SFEMG), along with axonal microstimulation, in paralytic muscles of patients with spinal cord injury (SCI). Neuromuscular jitter was measured in anterior tibial muscles for 30 patients with SCI and also for 12 normal controls. Mean jitter of 37.4 +/- 14.7 (mean +/- SD) micros, as obtained in SCI patients, was found to be significantly greater than the results of 20.1 +/- 8.4 micros in normal controls (P < 0.01). Jitter measurement was not significantly different in varied functional scales of SCI. A positive correlation was noted between the increased jitter and the disease duration from the onset of cord lesion till the time of stimulated SFEMG test (r = 0.68; P < 0.01). The present abnormal finding of neuromuscular jitter provides an electrophysiologic evidence for axonal degeneration and suggests that transsynaptic degeneration of motor neuron may occur below the level of cord lesion in SCI patients. Furthermore, the neuronal degradation in SCI was positively correlated with the course duration of the disease.

Increased spasticity in a chronic spinal cord injury patient after scabies infestation: A case report

Spasticity is a common feature of spinal cord injury (SCI). Spasticity exacerbation is commonly encountered with nociceptive and exteroceptive stimuli including bladder and bowel dysfunction, pressure sores, contracture, tight-fitting leg bags and clothing, and ingrown toenail. This report describes a patient with chronic SCI (T4 level) who complained of increasing spasticity of bilateral lower extremities for 5 weeks. He also had skin lesions on different parts of his body, accompanied by itching above the spinal cord lesion level. A clinical diagnosis of scabies was made and pharmacologic treatment was initiated. Following treatment, spasticity was significantly reduced and the skin rash with itching faded out. This report is the first of scabies skin infestation lesions triggering exacerbation of spasticity in an SCI patient.

Assessment of Stimulated Single-Fiber Electromyography in Paralytic Muscles of Patients with Spinal Cord Injury

Neuronal dropout accompanied with axonal degeneration may occur below the level of cord lesion after spinal cord injury (SCI). By using a sensitive electrodiagnostic method of stimulated single fiber electromyography (SFEMG), it is possible to assess the functional integrity of neuromuscular transmission in paralytic muscles of SCI. Neuromuscular jitter and fiber density were measured in 21 anterior tibial muscles of 18 patients with SCI and 11 muscles in 11 normal controls. The results showed an increased mean jitter value but without increased fiber density in SCI patients. There is a positive correlation between the increased jitter and the disease duration from the onset of cord lesion to the time of SFHMG test. This provides an electrophysiological evidence of axonal degeneration and dysfunction of neuromuscular transmission below the level of cord lesion in SCI. Also the neural degeneration may become prominent in the later course of the disease.

Periodical, neurological-functional assessment for cervical cord injury.

The residual, reversible potentials of neurological-functional recovery in patients paralysed due to a cervical cord injury were periodically checked according to the various assessment methods from the initial period of 72 hours after injury to the final follow-up of 7 years. In our series, the data on the neurological changes were a little different from those reported in the literature. In the complete paralysis group, only 2 of the 30 patients showed slight functional recovery of less than 1 grade in the Frankel classification with descent of the cord lesion level. Twenty three patients showed descent of a half to one segment from the initial cord lesion level. The remaining 5 patients deteriorated because of ascent of a half to two segments from the initial cord lesion level. All patients with complete paralysis remained essentially unchanged. In the incomplete group, 58 of the 70 patients had significant recovery of more than 1 grade in the Frankel classification. The grade of neurological recovery was different in each patient. Patients with a central cord lesion showed remarkably better recovery of the cord function than those with other types of cord lesions. Nineteen of the 49 patients with a central cord lesion regained independent walking ability with or without aid. Neurological recovery in the incomplete paralysis group might be expected until approximately 6 months after injury. The early appearance of signs of recovery was an indication of better results. There was no difference in the neurological recovery between patients who had been realigned surgically and those who have been realigned non-surgically. Our neurological-functional assessment method reflecting the sectional and logitudinal cord level function and expressing more detailed information was demonstrated. Magnetic resonance imaging (MRI) was used to assess residual cord function. The area of abnormal signal intensity almost corresponded to the cord level diagnosed neurologically.

Testicular Function in Patients with Spinal Cord Damage

Vaying degrees of testicular dysfunction are found in men with traumatic spinal cord damage. Eighteen paraplegic men have been studied and the gonadotropin response to luteinizing hormone-releasing hormone (LRH) measured. Basal serum testosterone estimations were made and in eight of the patients testicular testosterone reserve was assessed by the testosterone response to human chorionic gonadotropin (HCG). Testicular biopsies were performed in seven cases. In three of these patients, the testicular biopsies were abnormal. Five of the patients had elevated Follicle stimulating hormone levels and abnormalities of Luteinizing hormone kinetics were found in the same five patients. There was no significant difference between the plasma testosterone levels of the paraplegic patients when compared to the control group. In all the patients tested, there was an adequate testosterone reserve, and this included the three patients with the abnormal testicular biopsies. No relationship was found between the level of cord lesion and any of the hormonal parameters measured. This study confirms the primary nature of the seminiferous tubular damage which occurs in some patients with paraplegia.

General surgery problems in patients with spinal cord injuries.

Twenty-four patients with spinal cord injuries were studied to correlate their responses to intra-abdominal disease with the level and completeness of the cord lesion. Patients with complete cervical lesions and lesions of the upper part of the thoracic region (C-4 to T-6) usually responded by early noniocalized abdominal pain associated with signs of autonomic dysreflexia. As the disease progressed to involve the parietal peritoneum, these patients were more capable of localizing pain to the corresponding dermatome, whereas patients with incomplete lesions were able to localize their pain earlier. Patients with lumbar lesions and lesions of the lower part of the thoracic region (T-7 to L-3) were able to localize their pain earlier than those with lesions located higher in the thoracic region. All patients had delayed diagnoses except those with hemorrhage of the upper part of the gastrointestinal tract. Irrespective of level of cord lesion, increased pulse rate was themost prominent objective acute intra-abdominal pathologic finding. Shoulder pain in the quadriplegic is a most helpful sign.

Clinical study of urethral pressure profile (author's transl)

Pre-and post-operative urethral pressure profile in various lower uropathies, obtained by Brown's method was analyzed for urethral length and pressure in the external sphincteric area.1) The posterior urethral length in normal male was 3.6cm (2.0-4.5cm) on the average, and pressure in the external sphincteric area was 30mmHg (20-42mmHg).2) The average posterior urethra was lengthened to 4.3cm (3.0-7.0cm) and the average pressure at the external sphincteric area increased to 39mmHg (20-50mmHg) in 16 cases of benign prostatic hypertrophy and 3 cases of prostatic carcinoma. There was a marked reduction in both length and pressure in postoperative profile.3) In vesical neck contracture, preoperative urethral length was 4.0cm (3.0-4.5cm) and pressure was 35mmHg (28-50mmHg). The postoperative reduction in length and pressure was less marked comparing to the prostatic hypertrophy group.4) In chronic paraplegic patients the length was 1.8cm (1.3-2.5cm) and the pressure was 23.9 (10-36mmHg). The profile was independent of the level of cord lesion and the duration after injury. No difference in profile was observed between the groups with or without subarachnoidal phenol block. The wave and the spike in anterior urethral profile, which were scarecely found in nonparaplegics, were frequently observed.5) The urethral pressure profile offered valuable clues to the identification of the position and the size of anterior urethral diverticulum and urethral stricture, which helped the diagnosis, selection of operative approach and evaluation of postoperative result.6) Pressure at the external sphincteric area of patients with post-prostatectomy incontinence is lower than 10mmHg. No patient with pressure above 14mmHg at this area was incontinent.This is on easily performable method even in the outpatient clinic, and yet the careful analysis of the curvature gives valuable informations as to the management of various lower uropathies.

Sweat inhibition by cutaneous cooling in normal sympathectomized and paraplegic man.

ArticleSweat inhibition by cutaneous cooling in normal sympathectomized and paraplegic man.R O Rawson, and J D HardyR O Rawson, and J D HardyPublished Online:01 Feb 1967https://doi.org/10.1152/jappl.1967.22.2.287MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByHuman temperature regulation under heat stress in health, disease, and injuryMatthew N. Cramer, Daniel Gagnon, Orlando Laitano, and Craig G. Crandall19 August 2022 | Physiological Reviews, Vol. 102, No. 4Integrated fan cooling of the lower back for wheelchair users14 September 2022 | Journal of Rehabilitation and Assistive Technologies Engineering, Vol. 9A Primary Care Provider’s Guide to Autonomic Dysfunction Following Spinal Cord InjuryTopics in Spinal Cord Injury Rehabilitation, Vol. 26, No. 2Heat-related issues and practical applications for Paralympic athletes at Tokyo 202027 June 2019 | Temperature, Vol. 7, No. 1Thermoregulation following spinal cord injuryImplications of altered autonomic control on sports performance in athletes with spinal cord injuryAutonomic Neuroscience, Vol. 209Cooling Athletes with a Spinal Cord Injury15 August 2014 | Sports Medicine, Vol. 45, No. 1Disordered cardiovascular control after spinal cord injuryThermoregulation during Exercise in Individuals with Spinal Cord InjuriesSports Medicine, Vol. 36, No. 10Effects of Spinal Cord Lesion Level upon Thermoregulation during Exercise in the HeatMedicine & Science in Sports & Exercise, Vol. 35, No. 7Thermoregulatory set point in patients with spinal cord injuries (spinal man)Spinal Cord, Vol. 21, No. 4COMPARATIVE PHYSIOLOGY OF SWEATING29 July 2006 | British Journal of Dermatology, Vol. 88, No. 4Experimental hyperthermia in traumatic quadriplegiaInternational Journal of Biometeorology, Vol. 15, No. 2-4 More from this issue > Volume 22Issue 2February 1967Pages 287-91 https://doi.org/10.1152/jappl.1967.22.2.287PubMed6017896History Published online 1 February 1967 Published in print 1 February 1967 Metrics

Debridement

<b>Objective:</b> To ascertain clinical predictors of final diagnosis of spinal dural arteriovenous fistulas (SDAVF) in patients with myelopathy. <b>Background:</b> SDAVF are an uncommon but treatable cause of myelopathy. This study explores clinical factors which predict SDAVF in the setting of radiographic lesions concerning for demyelination. <b>Methods:</b> We performed a retrospective chart review of PACS imaging system for the term “spinal dural arteriovenous fistula” to obtain cases. Inclusion criteria included any confirmed case of SDAVF. We performed another retrospective chart review of PACS for the term “demyelinating” to serve as controls. Inclusion criteria included any demyelinating lesion in the spinal cord. Exclusion criteria included previous diagnosis of demyelinating lesion. The SDAVF group was compared with the demyelinating group across demographics, vascular risk factors, smoking history, spinal cord lesion level on MRI, and back pain symptoms using t-test or Chi-square analyses. Multivariate analysis was used to further evaluate if these factors had any predictive value. <b>Results:</b> SDAVF patients were significantly older (mean 65.5 vs. 39.2, p&lt;0.001), more likely to be male (80[percnt] vs 35.6[percnt], p&lt;0.001), more likely to have vascular risk factors (65[percnt] vs. 26[percnt], p=0.001), more likely to have back pain (50[percnt] vs. 18[percnt], p=0.004), less likely to have cervical lesions (25[percnt] vs. 69[percnt], p&lt;0.001), and more likely to have thoracic (80[percnt] vs 49[percnt], p=0.008) and lumbosacral lesions (40[percnt] vs. 3[percnt], p&lt;0.001). Multivariate analysis showed age (OR=1.14, 95[percnt] CI 1.06-1.22), back pain (OR=5.33, 95[percnt] CI 1.13-25.14) and lumbosacral lesions (OR11.20, 95[percnt] CI 1.31-95.98) predict SDAVF. Cervical lesions predict that patients are less likely to have SDAVF (OR=0.18, 95[percnt] CI 0.04-0.84). <b>Conclusions:</b> Patients are more likely to have SDAVF than a demyelinating lesion if they are male, present at an older age, with back pain, and with lumbosacral lesions, and less likely with cervical myelopathy. <b>Disclosure:</b> Dr. Tipirneni has nothing to disclose. Dr. Tipirneni has nothing to disclose. Dr. Atchaneeyasakul has nothing to disclose. Dr. Bleicher has nothing to disclose. Dr. Yavagal has received personal compensation for activities with Covidien/evV3 as a consultant and Steering Committee Member.