Lumbar Injuries Research Articles

Sleep Complaints and Sleep Quality in Spinal Cord Injury: A Web-Based Survey.

The purpose of this study was to determine sleep quality and presence of sleep disorders in participants with spinal cord injury (SCI). A web-based survey, available online from February 2011 to July 2013, using validated sleep questionnaires, advertised via the internet and locally through SCI consumer organizations in the United States, Australia, New Zealand, and Canada, was designed to evaluate sleep in adults with self-reported SCI. Demographic characteristics and medical history were obtained from participant self-report. In our study population, 70% of the 304 participants were male with a mean age of 45 ± 13 years. The mean duration of injury was 16 ± 12 years. Cervical injuries were reported by 49% and thoracic injuries noted in 40% of participants. Increased sleep apnea risk was noted in 31% of participants, with 66% reporting snoring. Insomnia symptoms were reported by 54% of the respondents. Almost 40% of participants ranked their sleep quality as "fairly bad" to "very bad" in the previous month, 29% reported "often" or "almost always" waking up because of pain, and 22% had difficulty falling asleep because of leg cramps. In the past year, 27% of the respondents reported daily uncomfortable leg sensations and 28% found these leg symptoms to be "moderately to extremely distressing." This study increases the awareness that insomnia, sleep apnea, and poor sleep quality are common in individuals with chronic SCI; often coexisting. There is a need for increased screening for sleep problems by healthcare providers taking care of individuals living with SCI.

Effect of impact velocity and ligament mechanical properties on lumbar spine injuries in posterior-anterior impact loading conditions: a finite element study.

Traumatic events may lead to lumbar spine injuries ranging from low severity bony fracture to complex fracture dislocation. Injury pathomechanisms as well as the influence of loading rate and ligament mechanical properties were not yet fully elucidated. The objective was to quantify the influence of impact velocity and ligament properties variability on the lumbar spine response in traumatic flexion-shear conditions. An L1-L3 finite element spinal segment was submitted to a posterior-anterior impact at three velocities (2.7, 5, or 10m/s) and for 27 sets of ligament properties. Spinal injury pathomechanism varied according to the impact velocities: initial osseous compression in the anterior column for low and medium velocities versus distraction in the posterior column for high velocity. Impact at 2.7 and 5m/s lead to higher extent of bony injury, i.e., volume of ruptured bone, compared to the impact at 10m/s (1140, 1094, and 718mm3 respectively), lower L2 anterior displacement (2.09, 5.36, and 7.72mm respectively), and lower facet fracture occurrence. Ligament properties had no effect on bony injury initiation but influenced the presence of facet fracture. These results improve the understanding of lumbar injury pathomechanisms and provide additional knowledge of lumbar injury load thresholds that could be used for injury prevention. Graphical abstract Stress distribution analysis at the injury initiation and final injury pattern identification for a lumbar segment submitted to a traumatic posterior-anterior impact.

The Application and Forensic Significance of Imaging Examination in Lumbar Intervertebral Disc Herniation after Injury

X-ray and CT are commonly used in post-traumatic examination of bone joints, spine, etc, as a traditional imaging examination method. It is a correct and meaningful method and procedure to observe signs and measurement data by imaging examination, in the cases of traumatic lumbar injuries which need forensic identification. What is the first that spring to our mind is the simple, economical, and practical X-ray examinations, as well as the CT examinations that have unique advantages for bone changes in all traditional and conventional imaging techniques before the performing imaging studies. The changes of the morphological, is also reflected on the changes of MR signal intensity. The distance of the lumbar MR disc more than the median sagittal line, the degree of spinal stenosis etc, as a quantifiable data, can be used to improve the detection of this disease. On this basis, MR has become the first imaging examination method what we need to consider. MRI not only has characteristic imaging performance, but also has rich observation indicators and projects. It can be further used to identify the new injury or old wounds of lumbar disc herniation on the basis of image signs by quantitative and qualitative aspects. MR examination method is regarded as an important means of inspection in the forensic identification of this disease.

Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury

Pneumocephalus, the presence of intracranial air, is a complication especially seen after neurotrauma or brain surgery. When it leads to a pressure gradient, a so-called tension pneumocephalus, it may require emergency surgery. Clinical symptomatology, especially in young children, does not differentiate between a pneumocephalus and a tension pneumocephalus. An additional CT scan is therefore warranted. Here, we report on a rare case of pneumocephalus after penetrating lumbar injury. Additionally, the pathophysiology of pneumocephalus, as well as its recommendations for diagnosis and treatment, will be elucidated.

Presentation of an Approach on Determination of the Natural Frequency of Human Lumbar Spine Using Dynamic Finite Element Analysis

Occurring resonance may negatively affect the health of the human lumbar spine. Hence, vibration generated in working and living environments should be optimized to avoid resonance when identifying the natural frequency of the human lumbar spine. The range of the natural frequency of the human lumbar spine has been investigated, but its specific numerical value has not been determined yet. This study aimed at presenting an approach based on resonance for predicting the specific numerical value of the natural frequency of the human lumbar spine. The changes in the numerical fluctuation amplitudes and the cycles of lumbar mechanical parameters during resonance are greater than those during nonresonant vibration. Given that the range of the natural frequency has been identified, vibrations at different excitation frequencies within this range can be applied in a human lumbar finite element model for dynamic finite element analysis. When the excitation frequency is close to the natural frequency, resonance occurs, causing great changes in the numerical fluctuation amplitudes and the cycles of lumbar mechanical parameters. Therefore, the natural frequency of the lumbar finite element model could be back-calculated. Results showed that the natural frequency of the established model was 3.5 Hz. Meanwhile, the closer the excitation frequency was to the natural frequency, the greater the changes in the numerical fluctuation amplitudes and cycles in the parameters would be. This study presented an approach for predicting the specific numerical value of the natural frequency of the human lumbar spine. Identifying the natural frequency assists in finding preventive measures for lumbar injury caused by vibration and in designing the vibration source in working and living environments to avoid approximating to the natural frequency of the human lumbar spine.

Assessment of spinal arthrodesis in dorsolumbar spine trauma using hydroxyapatite, tricalcium phosphate, and 60% hydroxyapatite + 40% tricalcium phosphate: A comparative study

Study Design: Open level experimental design. Purpose: Ceramics are effective, safe, and good alternatives of iliac crest autograft for spinal fusion. There were not enough study available to compare among ceramics for fusion in spinal surgery. Our aim was comparative assessment of posterolateral spinal arthrodesis radiologically and clinically in dorsolumbar spine trauma using hydroxyapatite (HA), tricalcium phosphate (TCP), and 60% HA + 40% TCP. Overview of Literature: Surgical management of thoracolumbar spine injury has encouraged early rehabilitation and avoided adverse effects of prolonged recumbency. Instrumentation enhanced spinal fusion which was the main technique of spinal stabilization. Although iliac crest autograft is the gold standard for spinal fusion,the procedure is not devoid of major and minor complications. A variety of ceramics are available as good alternatives for spinal arthrodesis. There are not any studies in the literature comparing spinal fusion rate among commonly used ceramics. Materials and Methods: Patients having Thoraco Lumbar Injury Classification and Severity score ≥4 underwent pedicle screw fixation and decompression (if required). We applied chips of HA, TCP, or 60% HA + 40% TCP for fusion. At 12-month follow-up, computed tomography scan of involved spine was done to assess posterolateral fusion by Lenke classification. Clinical follow-up was done evaluating pain status (visual analog scale). Mean follow-up duration was 27.8 months. Radiological and clinical parameters were compared among three groups. Results: A total of 45 patients (16 received HA, 15 received TCP, and 14 received [60%HA + 40%TCP]) were analyzed. About 28.88% of total patients had Lenke Grade A fusion and 51.11% had Grade B, but no statistically significant difference (P = 0.09) among three groups. Although reduction of pain score occurred individually in all three groups,no significant difference (P = 0.3)was noted among three groups. Conclusions: There was no statistically significant difference in fusion rate and change in pain perception with applied ceramics (HA/TCP/[60%HA + 40%TCP]).

PATRONES ELECTROMIOGRÁFICOS DE LA “VIRADA POR AVANTE” EN REGATISTAS DE CLASE “OPTIMIST

A pilot study has been carried out, on the muscular groups involved in roll tacking, in two optimist dinghy sailors of different age and experience. The purpose was to elaborate suggestions for a training plan. Trials have been carried out in a swimming pool, where it was possible to measure the activation of seven muscles during the entire maneuver, by means of electromyographic technique. It has been possible to describe different temporal patterns and activation peaks. Patterns were affected by the subject age and by the wind conditions. We suggested that training should be focused to prevent possible lumbar injuries and help them in their technique.

Locomotor central pattern generator excitability states and serotonin sensitivity after spontaneous recovery from a neonatal lumbar spinal cord injury

The spinal locomotor central pattern generator (CPG) in neonatal mice exhibits diverse output patterns, ranging from sub-rhythmic to multi-rhythmic to fictive locomotion, depending on its general level of excitation and neuromodulatory status. We have recently reported that the locomotor CPG in neonatal mice rapidly recovers the ability to produce neurochemically induced fictive locomotion following an upper lumbar spinal cord compression injury. Here we address the question of recovery of multi-rhythmic activity and the serotonin-sensitivity of the CPG. In isolated spinal cords from control and 3 days post-injury mice, application of dopamine and NMDA elicited multi-rhythmic activity with slow and fast components. The slow component comprised 10–20 s episodes of activity that were synchronous in ipsilateral or all lumbar ventral roots, and the fast components involved bursts within these episodes that displayed coordinated patterns of alternation between ipsilateral roots. Rhythm strength was the same in control and injured spinal cords. However, power spectral analysis of signal within episodes showed a reduced peak frequency after recovery. In control spinal cords, serotonin triggered fictive locomotion only when applied at high concentration (30 µM, constant NMDA). By contrast, in about 50% of injured preparations fictive locomotion was evoked by 2–3 times lower serotonin concentrations (10–15 µM). This increased serotonin sensitivity was correlated with post-injury changes in the expression of specific serotonin receptor transcripts, but not of dopamine receptor transcripts.

Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: Clinical characteristics by fracture level

BackgroundDiffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. This study was conducted to assess clinical and radiographic features of spinal fractures in DISH by the level of spinal injury, and to evaluate the optimal treatment for each level. MethodsA multicenter retrospective study over a 5-year period, including 46 patients (35 males; 11 females) with a mean age of 77.2 ± 9.7 years at the time of injury. By fracture level, there were 7 cervical (15.2%), 25 thoracic (54.3%), and 14 lumbar (30.4%) fractures. We recorded the cause of injury, whether diagnosis was delayed, and neurological status by Frankel grade. Ossification and fracture patterns were assessed by CT-multi-planar reconstruction (MPR). ResultsNeurological status immediately after the cervical-spine injury was C (28.6%) or E (71.4%); after thoracic injury, C (12.0%) or E (88.0%); and after lumbar injury, D (21.4%) or E (78.6%). Inability to walk at admission was more frequent in patients with a spinal-cord injury above the lumbar level (P = .033). Vertebral-body fractures were observed in 14.3% of the cervical injuries, 80.0% of the thoracic injuries, and 50.0% of the lumbar injuries (P = .004). Most patients with a cervical fracture had a disc-level fracture (85.7%). Posterior-column ankylosis was observed in 14.3% of the cervical-fracture group, 72.0% of the thoracic-fracture group, and 78.6% of the lumbar-fracture group (P = .008). ConclusionOssification and fracture patterns in patients with DISH varied distinctly by the level of spinal injury. Intervertebral-disc fractures were frequently observed in the cervical spine. Delayed diagnosis, vertebral-body fracture, and posterior-column ankylosis were observed in the thoracolumbar spine. This study recommends 3 above and 3 below fusion, to avoid instrumentation failure in the fixation of spinal fracture in patients with DISH.

Position of the abdominal seat belt sign and its predictive utility for abdominal trauma.

In a motor vehicle crash, compressive forces from the lap component of the seat belt may produce an abdominal abrasion/contusion known as the 'seat belt sign', and is associated with abdominal and lumbar injuries. Previous research has not taken into account the position of this sign in relation to the anterior superior iliac spine (ASIS). Our aim was to demonstrate an association between the seat belt sign position in relation to ASIS and the presence of abdominal/lumbar injury. A mixed prospective and retrospective observational study of patients involved in a motor vehicle crash was conducted. The presence of a seat belt sign was recorded as above ASIS, at/below ASIS, or none. Injury data were extracted from discharge summaries, radiology reports and operation reports. Proportions of patients with injuries were compared across the three groups. Four hundred and sixty-four participants were enrolled. For participants with a seat belt sign above ASIS, compared to those with no seat belt sign, the positive likelihood ratio for a seat belt related injury was 4.2 (95% CI 2.6-6.8). When the seat belt sign was at/below the level of ASIS the positive likelihood ratio was 1.5 (95% CI 0.4-5.7). The seat belt sign is associated with abdominal and lumbar injury; however, the location is important. This association is strong when the seat belt sign is above ASIS, but when the sign is at/below the ASIS the injury rate is similar to participants with no seat belt sign. Routine imaging of the abdomen may be appropriate only for those with a seat belt sign above ASIS.

Differences in serum IL-6 response after 1 °C rise in core body temperature in individuals with spinal cord injury and cervical spinal cord injury during local heat stress

Objectives: Passive rise in core body temperature achieved by head-out hot water immersion (HHWI) results in acute increases in serum interleukin (IL)-6 but no change in plasma adrenaline in patients with cervical spinal cord injury (CSCI). The purpose of the present study was to determine the mechanism of heat stress-induced increase in serum IL-6.Setting: A cross-sectional study.Methods: The study subjects were nine with CSCI, ten with thoracic and lumbar spinal cord injury (TLSCI) and eight able-bodied (AB) subjects. Time since injury was 16.1 ± 3.4 years in TLSCI and 16.4 ± 4.1 years in CSCI. Subjects were subjected to lower-body heat stress (LBH) by wearing a hot water-perfused suit until 1 °C increase in core temperature. The levels of serum IL-6, plasma adrenaline, tumour necrosis factor (TNF)-α, C-reactive protein (CRP), and counts of blood cells were measured at normothermia and after LBH.Results: Serum IL-6 concentrations increased significantly immediately after LBH in all the three groups. ΔIL-6% was lower in CSCI subjects compared with AB subjects. Plasma adrenaline concentrations significantly increased after LBH in AB and TLSCI subjects, but did not change throughout the study in CSCI subjects. Cardiac output and heart rate increased at the end of LBH in all three groups.Conclusions: Under a similar increase in core temperature, ΔIL-6% was lower in the CSCI group compared with the AB group. These findings suggest that the observed rise in IL-6 during hyperthermia is mediated, at least in part, by plasma adrenaline.

Ground reaction force, spinal kinematics and their relationship to lower back pain and injury in cricket fast bowling: A review.

Fast bowlers display a high risk of lower back injury and pain. Studies report factors that may increase this risk, however exact mechanisms remain unclear. To provide a contemporary analysis of literature, up to April 2016, regarding fast bowling, spinal kinematics, ground reaction force (GRF), lower back pain (LBP) and pathology. Key terms including biomechanics, bowling, spine and injury were searched within MEDLINE, Google Scholar, SPORTDiscuss, Science Citation Index, OAIster, CINAHL, Academic Search Complete, Science Direct and Scopus. Following application of inclusion criteria, 56 studies (reduced from 140) were appraised for quality and pooled for further analysis. Twelve times greater risk of lumbar injury was reported in bowlers displaying excessive shoulder counter-rotation (SCR), however SCR is a surrogate measure which may not describe actual spinal movement. Little is known about LBP specifically. Weighted averages of 5.8 ± 1.3 times body weight (BW) vertically and 3.2 ± 1.1 BW horizontally were calculated for peak GRF during fast bowling. No quantitative synthesis of kinematic data was possible due to heterogeneity of reported results. Fast bowling is highly injurious especially with excessive SCR. Studies adopted similar methodologies, constrained to laboratory settings. Future studies should focus on methods to determine biomechanics during live play.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM Spinal Trauma: 50. Military lumbar injuries from vertical loading are more unstable than civilian automobile trauma: field and biomechanical studies

BACKGROUND CONTEXT Many clinical and biomechanical studies have delineated the injuries and injury mechanisms to the thoracolumbar spine in the civilian population. The stability of the spine is assessed based on the three-column, AO, and other classifications. Thoracolumbar injuries are also prevalent in military populations due to recent events such as underbody blast loading from improvised explosive devices, IEDs. These injuries have not been reproduced in a realistic laboratory setting. The stability associated with military injuries and their comparison with the civilian automobile trauma have not been addressed. PURPOSE Reproduce military injuries, determine their mechanisms and compare with the civilian trauma. STUDY DESIGN/SETTING Field data using motor vehicle databases and biomechanical study using a human cadaver model simulating military loads. PATIENT SAMPLE Fourteen human cadaver specimens and civilian field data. OUTCOME MEASURES Injuries to human cadaver specimens, classification based on clinical scales, and identification of injuries to the civilian trauma population. METHODS Real-world data consisted of an analysis of motor vehicle crash injuries to restrained occupants using US national databases for the years 1993-2012. Thoracolumbar injuries and their patterns were obtained from medical records, X-ray images, and CT scans. For the biomechanical study, 14 human cadaver thoracolumbar spines (T12-S1) were procured, pretest CT scans were taken, and QCT-based BMD were obtained. They were fixed at the ends using PMMA, and they were positioned according to the military seating posture, that is the T12 midbody was oriented at 5° above the horizontal, and the line joining the center of T12-L1 and L5-S1 discs was aligned at a posterior angle of 12° from the vertical line. X-ray studies were taken in the aligned posture before loading, while the specimen was still in the impacting device. The specimens were accelerated from S1 along the caudal to cephalad direction. The impact trajectory was applied from a custom vertical accelerator, simulating underbody blast conditions, with velocities up to 9 m/s and time to peak within 0.002 to 0.01 seconds. Forces and bending moments were recorded at the distal and proximal ends using six-axis load cells. Post-test X-ray images and CT were obtained, and dissection was done. Injuries were identified and classified using standard classification systems. RESULTS In the field data study, the thoracolumbar junction was found to be most susceptible to fractures, more commonly at the L1 level (30%). The vertebral body compression was most common (37%) followed by burst (33%) fractures. In the biomechanical study, L1 was most frequently involved in the injuries, and vertebral body compression and burst fractures occurred in all specimens. However, 58% had burst fractures with posterior column involvements, and 43% had fractures at more than one level and all were contiguous. These burst fracture injuries were more severe and typically of the three-column type, ie, unstable. CONCLUSIONS Similarities of burst fractures were noted in military and civilian populations; however, there was an increased incidence of L1 injuries in the military and a higher occurrence of injuries to the posterior columns in the military. The proposed mechanism is that the personal protective equipment required by the military may alter the normal seating posture, exposing the individual to altered axial load patterns allowing for greater involvement of the posterior column resulting in more unstable injuries with potential consequences. Because of the greater instability, MRI should be considered to assess the status of the adjacent vertebral bodies and ligamentous structures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

FREQUENCY OF VERTEBRAL FRACTURES IN HIGH-ENERGY TRAUMA

ABSTRACT Objective: Traumatic injuries due to accidents are the leading causes of death and disability in the population of young adults in many countries. Spinal fractures are among the multiple injuries by traumatic mechanisms. The incidence of these injuries is estimated between 8,000 and 16,000 new cases per year and are associated with high-energy trauma. Methods: Retrospective, cross-sectional, descriptive study conducted at the Hospital Central Cruz Roja Mexicana. We reviewed 68 medical records of patients admitted to the emergency department of that hospital and were diagnosed with some type of traumatic vertebral fracture associated with high-energy trauma. Results: The sample consisted of 53 men and 15 women, of whom 11 patients with cervical spine injury, 2 with cervicothoracic injury, 16 with thoracic injury, five with thoracolumbar fracture and 34 with lumbar injury. Conclusions: The lumbar spine is more prone to suffer injuries by high-energy mechanism, followed by the thoracic and cervical spine, respectively. The thoracolumbar junction is more frequently affected than the cervicothoracic junction in a ratio of 2:1. Level of Evidence II; Retrospective studyf.

A biomechanical comparison in the lower limb and lumbar spine between a hit and drag flick in field hockey

ABSTRACTResearch has revealed that field hockey drag flickers have greater odds of hip and lumbar injuries compared to non-drag flickers (DF). This study aimed to compare the biomechanics of a field hockey hit and a specialised field hockey drag flick. Eighteen male and seven female specialised hockey DF performed a hit and a drag flick in a motion analysis laboratory with an 18-camera three-dimensional motion analysis system and a calibrated multichannel force platform to examine differences in lower limb and lumbar kinematics and kinetics. Results revealed that drag flicks were performed with more of a forward lunge on the left lower limb resulting in significantly greater left ankle dorsiflexion, knee, hip and lumbar flexion (Ps<0.001) compared to a hit. Drag flicks were also performed with significantly greater lateral flexion (P < 0.002) and rotation of the lumbar spine (P < 0.006) compared to a hit. Differences in kinematics lead to greater shear, compression and tensile forces in multiple left lower limb and lumbar joints in the drag flick compared to the hit (P < 0.05). The biomechanical differences in drag flicks compared to a hit may have ramifications with respect to injury in field hockey drag flickers.

Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study.

Cross-sectional study. To determine the prevalence of, and factors associated with, spinal pain among wheelchair users. Four Spanish hospitals specialized in providing care for wheelchair users. Persons who had used a wheelchair for a median (IRQ) of 10 (5;19) years, 27% of them due to reasons other than spinal cord injury, were recruited consecutively (n = 750). Data on 43 demographic, psychosocial, ergonomic, and clinical variables were collected, and analyzed. Main outcome measures were: point prevalence of neck (NP), thoracic (TP), low back pain (LBP), and pain at any spinal level (PASL); and factors associated with them. Point prevalence was 56% for NP, 54% for TP, 45% for LBP, and 76% for PSAL. PASL was associated with a lower quality of life (OR (95% CI) 0.91 (0.86; 0.97)). Multivariable regression models showed that the main factors associated with significant pain (≥1.5 VAS points) were: (a) For NP: cervical spinal injury and wheelchair seat cushion thickness, (b) For TP: thoracic spinal injury and sagittal index, (c) For LBP: thoracic or lumbar spinal injury, with some sensitivity remaining, (d) For PASL: being female, living alone, and using a non-power wheelchair. Discrimination (AUC) of these models ranged between 0.638 and 0.818. p-values in the Hosmer-Lemeshow test ranged between 0.420 and 0.701. Prevalence of spinal pain among wheelchair users is high. It is associated with a lower quality of life. Future studies should assess whether using a power wheelchair affects PASL, and if the thickness of seat cushion affects NP. Spanish Back Pain Research Network.

Rapid recovery and altered neurochemical dependence of locomotor central pattern generation following lumbar neonatal spinal cord injury.

Spinal compression injury targeted to the neonatal upper lumbar spinal cord, the region of highest hindlimb locomotor rhythmogenicity, leads to an initial paralysis of the hindlimbs. Behavioural recovery is evident within a few days and approaches normal function within about 3weeks. Fictive locomotion in the isolated injured spinal cord cannot be elicited by a neurochemical cocktail containing NMDA, dopamine and serotonin 1day post-injury, but can 3days post-injury as readily as in the uninjured spinal cord. Low frequency coordinated rhythmic activity can be elicited in the isolated uninjured spinal cord by NMDA + dopamine (without serotonin), but not in the isolated injured spinal cord. In both the injured and uninjured spinal cord, eliciting bona fide fictive locomotion requires the additional presence of serotonin. Following incomplete compression injury in the thoracic spinal cord of neonatal mice 1day after birth (P1), we previously reported that virtually normal hindlimb locomotor function is recovered within about 3weeks despite substantial permanent thoracic tissue loss. Here, we asked whether similar recovery occurs following lumbar injury that impacts more directly on the locomotor central pattern generator (CPG). As in thoracic injuries, lumbar injuries caused about 90% neuronal loss at the injury site and increased serotonergic innervation below the injury. Motor recovery was slower after lumbar than thoracic injury, but virtually normal function was attained by P25 in both cases. Locomotor CPG status was tested by eliciting fictive locomotion in isolated spinal cords using a widely used neurochemical cocktail (NMDA, dopamine, serotonin). No fictive locomotion could be elicited 1day post-injury, but could within 3days post-injury as readily as in age-matched uninjured control spinal cords. Burst patterning and coordination were largely similar in injured and control spinal cords but there were differences. Notably, in both groups there were two main locomotor frequencies, but injured spinal cords exhibited a shift towards the higher frequency. Injury also altered the neurochemical dependence of locomotor CPG output, such that injured spinal cords, unlike control spinal cords, were incapable of generating low frequency rhythmic coordinated activity in the presence of NMDA and dopamine alone. Thus, the neonatal spinal cord also exhibits remarkable functional recovery after lumbar injuries, but the neurochemical sensitivity of locomotor circuitry is modified in the process.

Understanding the Presentations and Patterns of Traumatic Spinal Cord Injuries to Develop the Data Collection Format

Abstract Background The intensity of the damage to the nerve fibers is not measured through the severity of the spinal cord injury. Objective To understand the pattern of neurologic features in traumatic spinal cord injuries. Methods This was a case series of the total care of patients with consecutive acute spinal cord injury at different levels during the years 2015 to 2017, from extrication and transportation following the accident to death, or the completion of primary definitive rehabilitation. This work examined demographic and clinical characteristics of 220 consecutive cases of acute spinal injuries with or without neurologic symptoms subjected to conservative and surgical interventions. Age, sex, addiction patterns of smoking and alcohol, presenting symptoms, neurologic status, and postoperative outcomes are compared with the preoperative findings. Results The registry included 220 patients with spinal injury; majority in 41 to 50 years age group (28.6%) and males (77.7%). Nearly one-half had cervical (46.3%) injuries; 84.3% male; comparable proportion of dorsal and lumbar injuries had male dominance. One-fifth of the patients were smokers and alcoholics, all males. Mean hospital stay was 36.7 ± 140.5 days. Majority presented with neck pain (48.9%), radicular pain (56.4%), limb weakness (73.3%), and tingling sensation (47.7%); 14.4% reported tightness in limbs and 18.8% bladder involvement. In postoperative period, symptoms persisted in varied proportions. Significantly of postoperative neck pain was observed more among males (88.5%), yet symptoms that reduced postoperatively were neck pain, limb weakness, and tingling sensation. However, bladder involvement increased significantly. Conclusion The results showed that greater attention should be paid to older and male population that has more spinal cord injuries while comparable to those of the other studies in neurodeficits and clinical features.

An Accident-Prone Employee: No, Multiple Sclerosis.

An employee is labeled "accident-prone," and sustained an acute lumbar injury at work. Upon physical examination, a diagnosis of multiple sclerosis was suspected. She was referred to a public health clinic for further evaluation. This is a review article of multiple sclerosis and workplace interventions.

Muscle Strength: The Missing Link between Lesion Height and Gait Pathologies in Patients with Lumbar and Sacral Spinal Cord Injuries – a Theoretical Approach

Muscle Strength: The Missing Link between Lesion Height and Gait Pathologies in Patients with Lumbar and Sacral Spinal Cord Injuries – a Theoretical Approach