Sacral Segments Research Articles

Prediction of the outcome of bladder dysfunction based on electrically induced reflex findings in patients with cauda equina syndrome: A retrospective study.

The evaluation of the electrically induced bulbocavernosus reflex (BCR) using electromyography (EMG) is a useful tool for evaluating the integrity of sacral spinal segments 2 to 4, and that of their afferent and efferent connections in the urogenital region. In the current retrospective study, the value of this technique in predicting the outcome of bladder dysfunction was investigated in patients with cauda equina syndrome (CES). Electrically induced BCR (E-BCR) was evaluated in 40 patients with bladder dysfunction due to CES at the subacute stage (7–90 days). Manually examined BCR, perianal pinprick sensation, and voluntary anal contraction were also investigated. The recovery of bladder function was evaluated 1 year after the onset of CES. All patients with the presence of E-BCR showed successful recovery of the bladder function, while all patients in whom E-BCR was absent showed poor recovery. E-BCR showed a higher positive predictive value than perianal pinprick sensation and voluntary anal contraction, and showed a higher negative predictive value than manually examined BCR. Results show that E-BCR has advantages in predicting the outcome of bladder dysfunction. Thus, this method can be used as a reference to predict the final outcome of bladder dysfunction at the subacute stage of CES.

Localization of zinc transporters in the spinal cord of cynomolgus monkey

Zinc is abundant in the spinal cord, where it participates in several physiological and pathophysiological processes, including neurotransmission, spinal cord injury, and amyotrophic lateral sclerosis. However, the mechanisms underlying zinc homeostasis in the spinal cord are largely unknown. Zinc transporters (ZnTs) are responsible for transporting zinc from the cytoplasm to the extracellular space or to intracellular compartments. In the present study, we examined the distribution of ZnT1-10 proteins in the spinal cord of cynomolgus monkey. Immunohistochemical studies demonstrate that all detected ZnT family members are expressed in the gray matter. ZnT1-10 immunoreactivity can be seen in both motor and sensory neurons in the dorsal and ventral horn from the cervical to sacral segments. No obvious immunostaining was found in the glia cells. The present study demonstrates that ZnT proteins are functionally important for regulating zinc metabolism in both motor and sensory functions in monkey spinal cord.

Peculiarities of spinal cord segments structural organization in human fetuses with anencephaly of 17–18 weeks of intrauterine development

The principles of the human spinal cord development constitute the basis for understanding of appearance of congenital abnormalities of the CNS development, which make 7 % of the total number of malformations in the embryonic period of human’s development.Purpose – to find out the cytoarchitectonic structure of the spinal cord segments of human fetuses with anencephaly, their morphometric parameters and the degree of the proliferation of neural stem cells.Materials and methods – anatomical and histological, immunohistochemical and morphometric research was carried out related to the spinal cord of 4 human fetuses with anencephaly of the gestational period of 17–18 weeks.Results. The length of the spinal cord of 17–18 weeks anencephalic fetuses corresponds to the length of human fetuses without malformations of 11–12 weeks, the rest macrometric parameters – 8–9 weeks. The largest area of grey matter was that of segments at the level of lumbosacral and cervical enlargements, the least one at the level of thoracic segments. The specific gravity of neuroepithelium in the grey matter of cervical, thoracic, lumbar and sacral segments was 0.4, 0.1, 0.6, 1.6 % respectively. The expression of the proliferation protein in the spinal cord neuroepithelium segments of anencephalic fetuses is approaching 0 %. However, in the ventral horns near the location of neural complexes single mitoses of glial cells occur. In quantitative terms, in the ventral horns 1.5 % of glial cells reacted, while in the dorsal ones – 0.6 %. The expression of vimentin in the mantle and marginal layers is poor. On the border between the ventral and dorsal horns an insignificant number of fibers have a radial direction. Moderate expression of synaptophysin was observed in the marginal layer, except for cuneate fasciculi where the relatively weak expression has been established, which testifies to the insufficient myelination of the conduction tracts fibers.Conclusions. Macro- and morphometric parameters of the spinal cord of human fetuses with 17–18 week anencephaly point out to the significant retardation in development. Numerous disorders in the structural organization of both grey matter and white matter have been found out. The proliferation of neural stem cells in neuroepithelium is approaching 0 %.

Incidence and clinical features of sacral insufficiency fracture in the emergency department

IntroductionA sacral insufficiency fracture (SIF) often manifests as low back pain or sciatica in the absence of any antecedent trauma. These fractures may be missed because of lack of appropriate imaging. The purpose of this study was to clarify the incidence and clinical features of SIF as well as the characteristic findings on magnetic resonance imaging (MRI) of the lumbar spine. Materials and methodsThe study participants comprised 250 patients (132 male, 118 female; mean age 58.6years) with pelvic trauma. SIF was identified on computed tomography or MRI. The incidence, initial symptoms, and time delay between the first visit and an accurate diagnosis of SIF were recorded. ResultsWe detected 11 cases of SIF. Initial symptoms of SIF were low back pain (36.4%), gluteal pain (63.6%), and coxalgia (18.2%). Two patients complained of both low back pain and gluteal pain. The mean delay between the first visit and an accurate diagnosis of SIF was 23.9days. This time interval was significantly longer than in patients with other types of pelvic fracture. Four patients underwent MRI targeting the lumbar spine to investigate their symptoms. In all 4 patients, the signal intensity on T1-weighted and fat-suppressed images of the second sacral segment was low and high, respectively. ConclusionThis study demonstrates that accurate diagnosis of SIF may be delayed because of difficulties in detecting this type of fracture on plain X-ray and the non-specific nature of the presenting complaints. Emergency physicians should keep SIF in mind when investigating patients who complain of low back pain or gluteal pain. Findings at the second sacral segment on MRI targeting the lumbar spine may aid early diagnosis of this type of pelvic fracture.

Caudal Regression Syndrome in a 12-Year-Old Boy Associated with Thecal Sac Ending at Fifth Lumbar Vertebrae Associated with Caudal Stenotic Dural Sac and Thickened Filum Terminale, Bifid Lumbar Vertebrae with Sacral Vertebral Agenesis: Pentads Defects

Caudal regression syndrome is characterized by a spectrum of structural defects of the caudal vertebral region, varying from isolated agenesis or dysgenesis of coccyx to lumbosacral agenesis. It may be associated with congenital anomaly, spinal cord, distal genitourinary tract, and gastrointestinal tract. The authors report late presentation of caudal regression syndrome in a 12-year-old male student who had low backache and deformity of foot since childhood. He developed urinary incontinence by the age of 7 years. Magnetic resonance imaging revealed complete agenesis of lower three sacral and coccyx vertebral segments, with spina bifida of lower lumbar vertebra, stenosis of lumbar dural sac and thecal sac ending at L5, associated thickened filum terminale, and tethered cord. He underwent L2–L5 laminectomy with duraplasty and detethering of cord. Intraoperatively, markedly overcrowded lumbar and sacral nerve roots were observed. He noticed improvement of foot weakness and relief of backache following surgery.

Lumbosacral Transitional Vertebrae: Neglected Problem: A Case Report

Lumbosacral transitional vertebrae(LSTVs) is a common within the spine, and their association with low back pain has been debated in the literature for nearly a century. It affects 4-8% of the population. LSTVs are congenital spinal anomalies defined as either sacralization of the lowest lumbar segment or mbarization of the most superior sacral segment of the spine. These anomalies are usually identified incidentally because CT is not typically indicated solely to identify LSTVs, due to radiation concerns, nor is it the preferred imaging technique used to evaluate patients with nontraumatic low back pain.Correct identification of an LSTV is essential because there are important clinical implications. Inaccurate identification may lead to surgical and procedural errors and poor correlation with clinical symptoms.

AB311. SPR-38 Clarification of the innervation of genitourinary structures: a neuronal tracing study in female mongrel hound dogs

ObjectiveMany studies focus on either afferent or efferent inputs (but not both), or on one structure of the genitourinary system. Only a few recent studies include information on inputs from sympathetic chain ganglia (SCG), and even fewer have examined the possibility of direct motor (autonomic or somatic) inputs from spinal cord ventral horns to genitourinary end organs. We sought to clarify origins of afferent and efferent information conveyed between the spinal cord, peripheral nervous system ganglia and genitourinary structures using retrograde and anterograde dye tracing methods.MethodsRetrograde dyes were injected into the bladder wall, EUS and clitoris of 14 female mongrel dogs (fluorogold, true blue, or nuclear yellow). Dorsal root ganglia (DRG), SCG, caudal mesenteric ganglion (CMG), pelvic plexus ganglia and spinal cord ventral horns were collected and examined for dye-labeled neuronal cell bodies. Detrusor muscle intramural ganglia were examined by injecting an anterograde dye (DiI) into the pelvic nerve’s anterior vesicle branch.ResultsRetrograde labeled cells were observed in several DRG, representative of afferent input from the bladder, EUS and clitoris. Anterograde labeling revealed a number of intramural ganglia in the bladder wall after distal pelvic nerve labeling. Sympathetic efferents included: (I) labeled cells in the CMG primarily from the bladder, yet small numbers from the EUS and clitoris; (II) labeled cells in SCG primarily from the bladder (widespread) and more localized input from EUS and clitoris; and (III) labeled cells in the intermediolateral cell column of thoracolumbar cord segments directly to the bladder and clitoris, a locale typically considered as sympathetic. Parasympathetic efferents included: (I) labeled neurons in pelvic plexus ganglia in bladder mesenteries; and (II) cells in lamina VII of sacral cord segments directly to the bladder and clitoris, a locale typically considered as sympathetic. Lastly, somatic (skeletal muscle) efferents to the EUS were evident as retrogradely labeled cells in sacral lamina IX cells.ConclusionsAfferent and efferent inputs to genitourinary structures are complex, yet a clear knowledge is needed to understand dysfunction after spinal cord injury and mechanisms underlying chronic pain syndromes in this region.Funding Source(s)NIH-NINDS NS070267

Normative spino-pelvic parameters in patients with the lumbarization of S1 compared to a normal asymptomatic population

Normal spino-pelvic values for patients with lumbarization of S1 have not been described in the literature. Presented are the normal values for this population group, the prevalence of S1 lumbarization, and the correlation between pelvic incidence (PI) and lumbar lordosis (LL) in this group. Two databases of asymptomatic patients were combined to identify 11 patients with the lumbarization of S1. The whole spine images were used to measure the true prevalence rate. Lumbar 3D EOS models were built to measure spino-pelvic parameters for the lumbarization group compared to the asymptomatic population. Seven patients appeared at first to have six lumbar vertebrae, but counting caudally from C2 showed this was not the case. 11/268 patients demonstrated the lumbarization of S1 to give a true prevalence rate of 4.1%. The lumbarization group demonstrated a statistically significant difference with regard to PI, PT, and SS, and total lordosis measured from superior endplate of L1 to the superior endplate of the first fixed sacral segment. L6I was not significantly correlated to lordosis; however, PI did have a significant correlation with lordosis. Lordosis could be estimated in this group by the equation: [Formula: see text]. Incomplete imaging of the spine may lead to false estimation of the prevalence of lumbarization. Patients with lumbarization have higher lordosis values and lordosis can now be estimated during pre-operative planning for this group.

Morphologic characteristics of sacra associated with assimilation of the last lumbar vertebra.

The impact of lumbosacral transitional states on biomechanics of load transmission between the spine and the legs has been sporadically reported. The aims of the study were to identify morphostructural alterations of sacra associated with assimilation of the last lumbar vertebra and to analyse them in the light of their biomechanical impact. Linear dimensions of sacrum, its body and base and articular surfaces were measured in 31 normal and 41 transitory sacra. Nineteen sacra presented articular and 22 osseous fusion of the last lumbar vertebra. Measured parameters were compared between normal sacra and the two variations of transitory sacra. Sacra with articular fusion of the last lumbar vertebra showed more pronounced concavity of the sacral curvature and wider than long sacral bodies. The first sacral segment was modified, broaden, ventrally wider and elevated. Almost the whole segment bore at its sides auricular surfaces. Very small portion of the segment was non-articular with less pronounced wedging. Sacra with osseous fusion of the last lumbar vertebra showed similar concavity of the sacral curvature as normal sacra, but longer than wide sacral bodies. The ventral sloping half of the newly formed first segment bore auricular surfaces. The non-articular part was enlarged with pronounced wedging. The term "sacralisation" includes both types of transitory sacra with mutually different morphostructural characteristics in contrast to the normal sacra. Analysis of these morphologic variations may help in understanding the different biomechanical properties and patterns of load transmission.

Developmental identity versus typology: Lucy has only four sacral segments.

Both interspecific and intraspecific variation in vertebral counts reflect the action of patterning control mechanisms such as Hox. The preserved A.L. 288-1 ("Lucy") sacrum contains five fused elements. However, the transverse processes of the most caudal element do not contact those of the segment immediately craniad to it, leaving incomplete sacral foramina on both sides. This conforms to the traditional definition of four-segmented sacra, which are very rare in humans and African apes. It was recently suggested that fossilization damage precludes interpretation of this specimen and that additional sacral-like features of its last segment (e.g., the extent of the sacral hiatus) suggest a general Australopithecus pattern of five sacral vertebrae. We provide updated descriptions of the original Lucy sacrum. We evaluate sacral/coccygeal variation in a large sample of extant hominoids and place it within the context of developmental variation in the mammalian vertebral column. We report that fossilization damage did not shorten the transverse processes of the fifth segment of Lucy's sacrum. In addition, we find that the extent of the sacral hiatus is too variable in apes and hominids to provide meaningful information on segment identity. Most importantly, a combination of sacral and coccygeal features is to be expected in vertebrae at regional boundaries. The sacral/caudal boundary appears to be displaced cranially in early hominids relative to extant African apes and humans, a condition consistent with the likely ancestral condition for Miocene hominoids. While not definitive in itself, a four-segmented sacrum accords well with the "long-back" model for the Pan/Homo last common ancestor. Am J Phys Anthropol 160:729-739, 2016. © 2016 Wiley Periodicals, Inc.

Unique Spatiotemporal Neuromodulation of the Lumbosacral Circuitry Shapes Locomotor Success after Spinal Cord Injury.

Spinal cord epidural stimulation has resulted in the initiation of voluntary leg movements and improvement in postural, bladder, and sexual function. However, one of the limitations in reaching the full potential of epidural stimulation for therapeutic purposes in humans has been the identification of optimal stimulation configurations that can neuromodulate the spinal cord for stepping. In the present work, we investigated the mechanisms underlying the specificity of interaction between the rostral and caudal spinal cord circuitries in enabling locomotion in spinal rats (n = 10) by epidural spinal cord stimulation. By using unique spatiotemporal epidural stimulation parameters of the lumbar and sacral spinal cords, a robust stepping pattern in spinal rats was observed with only six training sessions and as early as 3 weeks post-injury. Electrophysiological evidence reveals that in addition to frequency of stimulation pulses at the stimulation sites, the relative timing between stimulation pulses applied at the lumbar (L2) and sacral (S1) segments of the spinal cord heavily impacted stepping performance. Best stepping was established at a higher stimulation frequency (40 Hz vs. 5, 10, 15, and 20Hz) and at specific relative time-intervals between the stimulation pulses (L2 pulse applied at 18-25 msec after the onset of the S1 pulse; S1 pulse applied 0-7 msec after the L2 pulse). Our data suggest that controlling pulse-to-pulse timing at multiple stimulation sources provides a novel strategy to optimize spinal stepping by fine-tuning the physiological state of the locomotor networks. These findings hold direct relevance to the clinician who will incorporate electrical stimulation strategies for optimizing control of locomotion after complete paralysis.

Implications of structural variations in the human sacrum: why is an anatomical classification crucial?

An array of diversity in sacral anatomy including lumbosacral transitional variations is commonly found in the general population. These anatomical variations involve alterations in number of sacral segments, auricular surface area, and neural arch dimensions and are associated with biomechanical, surgical and obstetric implications. The present study reports screening >300 dried human sacral specimens and grouping them based on the common variations observed specifically in context of the number of sacral segments, position of the auricular surfaces, and type of the neural arch components. Screening and grouping of the samples presented a five-group classification and coding system that incorporates specific structural characteristic in a sacrum. The grouping and coding system developed in this study classifies variabilities associated with sacral anatomy along a common-to-rare anatomical spectrum that may provide handy information needed in a clinical, biomechanical, obstetric or medico-legal context.

Sacral Alar Iliac Fixation for Spine Deformity.

As the anatomy of the lumbosacral junction presents a unique challenge for the spine surgeon with regard to achieving a solid fusion, we describe the sacral alar iliac (SAI) technique, which can be used for the placement of pelvic anchors during posterior spinal arthrodesis. Position the patient prone on a radiolucent table. In approaching the starting point, perform limited dissection of the soft tissue between the S1 and S2 dorsal foramina, while taking care to minimize unnecessary dissection and blood loss. As the ideal screw pathway is one-third in the sacral ala and two-thirds in the ilium, start at the junction between the 1st and 2nd sacral segments, cross the sacroiliac joint, travel caudally toward the sciatic notch, cross between the inner and outer table of the ilium, and end close to the anterior inferior iliac spine cranial to the acetabular roof (Figs. 5-A and 5-B). In most children and adults, use screws with an outer diameter ≥9 mm, which are recommended to prevent screw breakage. Ensure that the SAI screws are in line with the remainder of the spinal anchors to allow for ease of rod insertion. Perform carefully layered wound closure per routine at the end of the case, with special attention to meticulous hemostasis. In a review of the cases of 32 pediatric patients treated with SAI fixation, Sponseller et al.27 reported a mean pelvic obliquity correction of 70% and a mean major coronal Cobb angle correction of 67%.

Distribution of 28 kDa Calbindin-Immunopositive Neurons in the Cat Spinal Cord.

The distribution of vitamin D-dependent calcium-binding protein (28 kDa calbindin) was investigated in cat lumbar and sacral spinal cord segments (L1-S3). We observed specific multi-dimensional distributions over the spinal segments for small immunopositive cells in Rexed laminae II-III and medium-to-large cells of varying morphology in lamina I and laminae V-VIII. The small neurons in laminae II-III were clustered into the columns along the dorsal horn curvature. The medium-to-large cells were grouped into four assemblages that were located in (1) the most lateral region of lamina VII at the L1-L4 level; (2) the laminae IV-V boundary at the L5-L7 level; (3) the lamina VII dorsal border at the L5-L7 level; and (4) the lamina VIII at the L5-S3 level. The data obtained suggest that the morphological and physiological heterogeneity of calbindin immunolabeling cells formed morpho-functional clusters over the gray matter. A significant portion of the lumbosacral enlargement had immunopositive neurons within all Rexed laminae, suggesting an important functional role within and among the spinal networks that control hindlimb movements.

Space Available for Sacroiliac Screws in the S1 Vertebral Body

Objectives: To define the maximal sagittal cross sectional dimensions of the S1 vertebral body and quantify the area available for safe placement of transverse sacroiliac (SI) screws. Methods: A laboratory investigation was performed using twelve fresh, frozen, non-preserved cadaveric pelvic specimens (six males, six females). The sacrum was dissected and removed from each pelvis. After the gross height and widths were measured, the sacra were split in the midsagittal plane and the dimensions of the first sacral segment were recorded. Then, starting from the center, the vertebral bodies were sequentially reamed in a medial to lateral direction in increasing one millimeter increments until a cortical breech occurred in the narrowest portion of the ala at the first sacral neural foramina. Using the diameter of the largest reamer, the cross-sectional area of space available for a transverse sacroiliac screw in the S1 body was calculated. Results: The cross-sectional area of space in the sagittal plane, corresponding to a transverse sacroiliac screw trajectory, of the first sacral vertebral body averaged 204 mm2 (range, 153 mm2 to 226 mm2 ), corresponding to a mean maximum reamer diameter of 16.1 mm (SD 1.08). The male and female sacra did not differ significantly with respect to overall size (mean height, 15.6 cm, SD 1.02; mean width 10.7 cm; SD 0.75) and the dimensions of the S1 body (mean height 28.41 mm, SD 2.23, mean depth 27.17 mm, SD 3.69). Conclusions: Our results improve upon our understanding of the surgical anatomic parameters of the upper sacral segment with respect to placement of transverse sacroiliac screw(s) by quantifying the cross-sectional area in the sagittal plane.

Do Safe Radiographic Sacral Screw Pathways Exist in a Pediatric Patient Population and Do They Change With Age?

Iliosacral screw pathways in the first (S1) and second (S2) sacral segments are commonly used for adult pelvic ring stabilization. We hypothesize that radiographically "safe" pathways exist in pediatric patients. Academic level I Trauma Center. All patients between ages 2 and 16 years with a computed tomography scan including the pelvis obtained over a 6-week period (174 children, mean age 10.8 ± 3.9 years; 90 boys, 84 girls). The width and height at the "constriction point" in 3 safe screw pathways were measured bilaterally by 3 orthopaedists (resident, trauma fellow, trauma attending). Pathways corresponding to: (1) an "iliosacral" screw at S1, a "trans-sacral trans-iliac" (TSTI) screw at S1, and a TSTI screw at S2. (1) Mean width and height of pathways, (2) interrater reliability coefficient, (3) availability of pathways greater than 7 mm, (4) growth of pathways with age, (5) sacral morphology. The interrater reliability coefficient was above 0.917 for all measurements. Radiographically safe pathways were available for 99%, 51%, and 89% of children for iliosacral screws at S1 (width 16.4 ± 2.8 mm, height 15.1 ± 3.3 mm), TSTI screws at S1 (width 7.2 ± 4.9 mm, height 8.3 ± 5.6 mm), and TSTI at S2 (width 9.3 ± 2.2 mm, height 11.5 ± 2.7 mm), respectively. Contrary to our hypothesis, almost all children aged 2-16 had a radiographically safe screw pathway for an iliosacral screw at S1, and most of the children had an available pathway for a TSTI screw at S2. However, only 51% had a pathway for a TSTI screw at S1.

De Anquin syndrome-rare cause of low back pain: A case report with review of literature

Introduction: Low back pain is common medical disorder that can be caused by different etiologies, some of them being very rare. During the past decades, much of the etiology and pato-mechanics of low back pain has been clarified. However, defining precise cause of low back pain in a small subset of patients is still challenging. Case presentation: We are presenting a case of long lasting low back pain caused by impingement of the enlarged spinous process of the fifth lumbar spine into the spina bifida of the first sacral segment, so called De Anquin syndrome. We delineated the precise morphology of the anomaly using CT scans, and since the patient was symptomatic, the resection of the enlarged spinous process was undertaken. During the follow up period, the patient remained completely symptom free. Discussion and Literature review : We undertook literature review and small number of studies describing De Anquin syndrome were found. The most remarkable finding of the case presented is the immediate and complete release of pain. Conclusion: We do recommend seeking for the exact etiology in the patients with long lasting low back pain.

Sexual Rehabilitation of Patients with Spinal Cord Injury

Sexual and reproductive health is important for quality of life and has a significant influence on patient satisfaction. Spinal cord pathology occurs from trauma, deformity, and degenerative disease processes may be leads to damage sexual function and reproductive system. There are two control systems situated in the spinal cord associated with erection; parasympathetic and sympathetic nervous systems. The parasympathetic center is in sacral segments S2–S4 and is responsible for reflexogenic erection and the sympathetic center is placed in T11–L2 segments of the spinal cord, which is responsible for psychogenic erection. Approximately 10-20% of erectile dysfunction (ED) is of neurological origin. The neurogenic ED is classified into 3 groups, as supraspinal, spinal (sacral and suprasacral) and peripheral.

α-Synuclein pathology in the cranial and spinal nerves in Lewy body disease.

Accumulation of phosphorylated α-synuclein in neurons and glial cells is a histological hallmark of Lewy body disease (LBD) and multiple system atrophy (MSA). Recently, filamentous aggregations of phosphorylated α-synuclein have been reported in the cytoplasm of Schwann cells, but not in axons, in the peripheral nervous system in MSA, mainly in the cranial and spinal nerve roots. Here we conducted an immunohistochemical investigation of the cranial and spinal nerves and dorsal root ganglia of patients with LBD. Lewy axons were found in the oculomotor, trigeminal and glossopharyngeal-vagus nerves, but not in the hypoglossal nerve. The glossopharyngeal-vagus nerves were most frequently affected, with involvement in all of 20 subjects. In the spinal nerve roots, Lewy axons were found in all of the cases examined. Lewy axons in the anterior nerves were more frequent and numerous in the thoracic and sacral segments than in the cervical and lumbar segments. On the other hand, axonal lesions in the posterior spinal nerve roots appeared to increase along a cervical-to-sacral gradient. Although Schwann cell cytoplasmic inclusions were found in the spinal nerves, they were only minimal. In the dorsal root ganglia, axonal lesions were seldom evident. These findings indicate that α-synuclein pathology in the peripheral nerves is axonal-predominant in LBD, whereas it is restricted to glial cells in MSA.

Histopathological and immunohistochemical study of spinal cord tissues in neurodegenerative diseases

To investigate histopathology and proteinopathy in the spinal cord of patients with common neurodegenerative diseases. Spinal cord tissues from clinically and neuropathologically confirmed neruodegnerative diseases were enrolled in this study, including 3 cases of multiple system strophy, 4 cases of amyotrophic lateral sclerosis, 5 cases of Alzheimer's disease (AD, included 2 cases of AD combined with Parkinson's disease), 2 cases of progressive supranuclear palsy, 1 case of dementia with lewy body and 1 case of corticobasal degeneration from 1955 to 2013 at Chinese People's Liberation Army General Hospital. Four normal control cases were also included. Routine HE and Gallyas-Braak staining, and immunohistochemical stainings for anti-PHF tau (AT8), anti-α-synuclein, anti-TDP-43 and anti-ubiquitin were performed. Examination of the spinal cord in 3 cases with multiple system strophy revealed severe neuron loss in the intermediolateral nucleus of thoracic segment and Onuf's nucleus of the sacral segment, along with moderate neuron loss in the anterior horn of the cervical segment and mild myelin pallor in the anterior funiculus and anterolateral funiculus in the cervical and thoracic segments. Large amount of argentophilic, ubiquitin and synuclein positive oligodendroglial cytoplasmic inclusions were found widely distributed in the anterior horn and the anterior funiculus and anterolateral funiculus of the full spinal cord. Severe neuron loss and several morphological changes with gliosis in the anterior horn and severe loss of myelin in the anterior funiculus and anterolateral funiculus of the full spinal cord were observed in 4 cases of amyotrophic lateral sclerosis, 2 of which were found with Bunina bodies in neurons of the anterior horn. Three amyotrophic lateral sclerosis cases had ubiquitin-positive neuronal inclusions and TDP-43 positive neuronal and glial inclusions in the anterior horn at cervical and lumbar segments. A few argentophilic, tau positive neurofibrillary tangles (NFTs) and neuropil threads in the anterior horn at cervical and lumbar segments were found in 4 AD cases. Examination of spinal cord in 2 cases with Parkinson's disease combined with AD and 1 case with dementia with lewy body revealed severe neuron loss in the intermediolateral nucleus of thoracic segment, and a few synuclein positive lewy bodies and neuritis were also observed. There was mild neuron loss in the anterior horn at cervical and lumbar segments, along with some argentophilic, tau positive globous NFTs and many argentophilic, tau positive neutrophil threads were observed in 2 progressive supranuclear palsy cases and 1 corticobasal degeneration case. Each common neurodegenerative diseases of the spinal cord including multiple system strophy, amyotrophic lateral sclerosis and Parkinson's disease has its own specific histopathology and proteinopathy characteristics.