Thoracic Cord Injury Research Articles

Clinical Update on Vasopressors and Titration Strategies.

Clinical Update on Vasopressors and Titration Strategies.

The incidence, clinical characteristics, and outcome of polytrauma patients with the combination of pulmonary contusion, flail chest and upper thoracic spinal injury

BackgroundChest trauma was the third most common cause of death in polytrauma patients, accounting for 25% of all deaths from traumatic injury. Chest trauma involves in injury to the bony thorax, intrathoracic organs and thoracic medulla. This study aimed to investigate the incidence, clinical characteristics, and outcome of polytrauma patients with pulmonary contusion, flail chest and upper thoracic spinal injury. MethodsPatients who met inclusion criteria were divided into groups: Pulmonary contusion group (PC); Pulmonary contusion and flail chest group (PC + FC); Pulmonary contusion and upper thoracic spinal cord injury group (PC + UTSCI); Thoracic trauma triad group (TTT): included patients with flail chest, pulmonary contusion and the upper thoracic spinal cord injury coexisted. Outcomes were determined, including 30-day mortality and 6-month mortality. ResultsA total 84 patients (2.0%) with TTT out of 4176 polytrauma patients presented to Tongji trauma center. There was no difference in mean ISS among PC + FC group, PC + UTSCI group and TTT group. Patients with TTT had a longer ICU stay (21.4 days vs. 7.5 and 6.2; p<0.01), relatively higher 30-day mortality (40.5% vs. 6.0% and 4.3%; p<0.01), and especially higher 6-month mortality (71.4% vs. 6.5%, 13.0%; p<0.01), compared to patients with PC + FC or with PC + UTSCI. The leading causes of death for patients with TTT were ARDS (44.1%) and pulmonary infection (26.5%) during first 30 days after admission. For those patients who died later than 30 days during the 6 months, the predominant underlying cause of death was MOF (53.8%). ConclusionsLethal triad of thoracic trauma (LTTT) were described in this study, which consisting of pulmonary contusion,flail chest and the upper thoracic spine cord injury. Like the classic “lethal triad”, there was a synergy between the factors when they coexist, resulting in especially high mortality rates. Polytrauma patients with LTTT were presented relatively high 30-day mortality and 6 months mortality. We should pay much more attention to the patients with LTTT for further minimizing complications and mortality.

Longitudinal changes of spinal cord grey and white matter following spinal cord injury

ObjectivesTraumatic and non-traumatic spinal cord injury produce neurodegeneration across the entire neuraxis. However, the spatiotemporal dynamics of spinal cord grey and white matter neurodegeneration above and below the injury is...

Rostro-caudal different energy metabolism leading to differences in degeneration in spinal cord injury.

Spinal cord injury gradually spreads away from the epicentre of injury. The rate of degeneration on the rostral side of the injury differs from that on the caudal side. Rostral degeneration is an immediate process, while caudal degeneration is delayed. In this study, we demonstrated that the rostro-caudal differences in energy metabolism led to differences in the spread of degeneration in early thoracic cord injury using in vivo imaging. The blood flow at the rostral side of the injury showed ischaemia-reperfusion, while the caudal side presented stable perfusion. The rostral side had an ATP shortage 20 min after spinal cord injury, while the ATP levels were maintained on the caudal side. Breakdown products of purine nucleotides were accumulated at both sides of injury 18 h after spinal cord injury, but the principal metabolites in the tricarboxylic acid cycle and glycolytic pathway were elevated on the caudal side. Although the low-ATP regions expanded at the rostral side of injury until 24 h after spinal cord injury, the caudal-side ATP levels were preserved. The low-ATP regions on the rostral side showed mitochondrial reactive oxygen species production. Administration of 2-deoxy-d-glucose as a glycolysis inhibitor decreased the caudal ATP levels and expanded the low-ATP regions to the caudal side until 24 h after spinal cord injury. These results suggest that deficits in the glycolytic pathway accelerate the caudal degeneration, while immediate rostral degeneration is exacerbated by oxidative stress in early thoracic cord injury.

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

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

Thoracic Unilateral Spinal Cord Syndrome Following Neuraxial Anaesthesia for Periprosthetic Knee Fracture: A Case Report

Neuraxial anaesthesia is widely used in surgical procedures; overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.

The effect of transitional care of physical and mental health of the thoracic spinal cord injury and paraplegic patients

Objective To investigate the effect of transitional care of physical and mental health of the thoracic spinal cord injury and paraplegic patients discharged on its recovery. Methods Randomized controlled analysis of patients in Spine and Spinal Cord Injury Surgery between June 2014 to October 2015, a total of 65 patients with thoracic spinal cord injury and paraplegic were studied, according to hospital mantissa odd and even numbers divided into observation group (35 cases) and control group (30 cases). The observation group was instituted to extending posthospital care, not the control group. The selfcare ability and psychological state were evaluated by Function Independent Measure (FIM), Hamilton Anxiety Scale(HAMA), Hamilton Depression Scale (HAMD)within discharge and in 3 months. And the incidence of complications between the two groups were compared. Results At discharge, the difference of FIM, HAMA, HAMD score between the observation group and the control group was not statistically significant (P>0.05). Discharged after 3 months, the score of FIM, HAMA, HAMD in observation group was (72.35±4.35) , (4.80±4.50) , (12.13±7.25) points, (63.95±5.02) , (10.15±4.91) , (19.48±8.31) points in control group. The difference between the two groups was statistically significant(t=-4.798, 3.524, 3.110, P 0.05); The incidence of urinary tract infection, pressure ulcers,constipation were 8.57% (3/35), 5.71% (2/35), 17.14% (6/35) in observation group, 40.00% (12/30), 33.33% (10/30), 63.33% (19/30) in control group, there were significant differences between, two groups (χ2= 4.324, 4.219, 5.337, P < 0.05). Conclusions Transitional care can significantly improve the psychological state of patients with thoracic spinal cord injury and paraplegia discharged, reduce the incidence of complications and improve quality of life. Key words: Quality of life; Transitional care; Spinal cord injury; Psychology

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

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

The thermic response to food intake in persons with thoracic spinal cord injury.

[Purpose] To investigate the influence of the level of spinal cord injury on the thermic effect of food intake (TEF) in persons with thoracic spinal cord injury. [Subjects and Methods] Seven male subjects with spinal cord injury (SCI; age, 40 ± 6 years) and six able-bodied subjects (AB; age, 37 ± 8 years) volunteered to participate in the present study. The subjects consumed an identical test meal consisting of 7.9 kcal/kg of body weight. Energy expenditure and plasma norepinephrine concentrations were measured over a 3-hour period. [Results] The adjusted TEF at 60 min was almost the same among the three groups [AB, SCI with high thoracic cord (T5–6) injury (HSCI), and SCI with low thoracic cord (T9–12) injury (LSCI)]. Although the LSCI group had almost the same adjusted TEF at 120 min as the AB group, the adjusted TEF at 120 min of the HSCI group was significantly lower than that of the AB group. The changes in plasma norepinephrine concentration and heart rate in response to food intake were similar among the three groups. [Conclusion] SCI at the T5–6 level results in a lower TEF due to sympathetic decentralization.

Unknown Input Observer for Understanding Sitting Control of Persons with Spine Cord Injury

The present paper introduces a simple model to study sitting control for persons with complete thoracic spine cord injury. The system is obtained via Lagrangian techniques; this procedure leads to a nonlinear descriptor form, which can be written as a Takagi-Sugeno model. A first attempt to estimate the sitting control in disabled people is done via an unknown input observer. The conditions are expressed as linear matrix inequalities, which can be efficiently solved. Simulation results validate the proposed methodology as the observations are coherent with and without perturbations.

Demographic and injury characteristics of spinal cord injury in 275 children

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

Alteration of brain regional homogeneity of monkeys with spinal cord injury: A longitudinal resting-state functional magnetic resonance imaging study

PurposeTo investigate the longitudinal brain regional homogeneity (ReHo) changes in nonhuman primate after spinal cord injury (SCI) by resting-state functional magnetic resonance imaging (fMRI). MethodsThree adult female rhesus monkeys underwent unilateral thoracic cord injury. A resting-state fMRI examination was performed in the healthy stage and 4, 8, and 12weeks after the injury. The ReHo value of each voxel in the monkey brain was calculated and compared between pre- and post-SCI monkeys with paired t test. The regions of interest (ROIs) in the significantly changed ReHo regions were set. The correlations between the ReHo change and the time after injury were also determined. ResultsCompared with those in healthy period, the ReHo values of the left premotor cortex and the anterior cingulate cortex (ACC) in post-SCI rhesus monkeys significantly increased in 4-week follow-up examinations. The ReHo values of posterior cingulate cortex, left precuneus, left temporal parietooccipital area, and bilateral superior parietal lobules decreased at 8-week follow-up examinations. In 12-week follow-up examinations, the ReHo values of the left postcentral gyrus, right caudate nucleus, and superior temporal gyrus increased. Correlation analysis showed positive correlations between left ACC and the postoperative time. ConclusionSCI can change the regional synchronism of brain activity in sensorimotor system and the default mode network. These findings may help us to understand the potential pathophysiological changes in the central nervous system after SCI.

Effect of regular exercise on cardiopulmonary fitness in males with spinal cord injury.

ObjectiveTo evaluate the cardiopulmonary endurance of subjects with spinal cord injury by measuring the maximal oxygen consumption with varying degrees of spinal cord injury level, age, and regular exercise.MethodsWe instructed the subjects to perform exercises using arm ergometer on healthy adults at 20 years of age or older with spinal cord injury, and their maximal oxygen consumption (VO2max) was measured with a metabolic measurement system. The exercise proceeded stepwise according to the exercise protocol and was stopped when the subject was exhausted or when VO2 reached an equilibriuResultsAmong the 40 subjects, there were 10 subjects with cervical cord injury, 27 with thoracic cord injury, and 3 with lumbar cord injury. Twenty-five subjects who were exercised regularly showed statistically higher results of VO2max than those who did not exercise regularly. Subjects with cervical injury showed statistically lower VO2max than the subjects with thoracic or lumbar injury out of the 40 subjects with neurologic injury. In addition, higher age showed a statistically lower VO2max. Lastly, the regularly exercising paraplegic group showed higher VO2max than the non-exercising paraplegic group.ConclusionThere are differences in VO2max of subjects with spinal cord injury according to the degree of neurologic injury, age, and whether the subject participates in regular exercise. We found that regular exercise increased the VO2max in individuals with spinal cord injury.

Video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients

To explore the video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients. Video-urodynamic examination was performed in 113 patients with complete cervical and thoracic spinal cord injury from January 2008 to May 2010. And their characteristics, managements and 3-year follow-up outcomes were reviewed and analyzed retrospectively. Among them, there were detrusor overactivity (n = 82, 72.57%), detrusor areflexia (n = 31, 27.43%), detrusor external sphincter dyssynergia (n = 71, 62.83%), low-compliance (n = 59, 52.21%), reflux (n = 6, 5.31%) and ultrasonic uronephrosis (n = 12, 10.62%). According to the result of the video-urodynamic examination, detrusor overactivity patients chose oral anticholinergic agents, botulinum toxin type A injection method, detrusor areflexia patients chose regular intermittent catheterization for bladder training. During a 3-year follow-up, there were cystic calculus (n = 2) and urinary infection (n = 7).No special complication occurred. The video-urodynamic characteristics vary in complete cervical and thoracic spinal cord injury patients. The major symptoms include detrusor overactivity, detrusor external sphincter dyssynergia and low-compliance bladder. Proper management is essential for protecting upper urinary tract and preventing urinary system complication.

A prospective evaluation of hemodynamic management in acute spinal cord injury patients

Prospective observational study of acute spinal cord-injured (SCI) patients. To determine how effectively mean arterial blood pressure (MAP) and spinal cord perfusion pressure (SCPP) are maintained at target levels in acute SCI patients. Single-institution study at a Canadian level-one trauma center. Twenty-one individuals with cervical or thoracic SCI were enrolled within 48 h of injury. A lumbar intrathecal drain was inserted for monitoring intrathecal cerebrospinal fluid pressure (ITP). The MAP was monitored concurrently with ITP, and the SCPP was calculated. Data was recorded hourly from the time of first assessment until at least the end of the 5th day post injury. All subjects had at least one recorded episode with a MAP below 80 mm Hg, and 81% had at least one episode with a MAP below 70 mm Hg. On average, subjects with cervical injuries had 18.4% of their pressure recordings below 80 mm Hg. Subjects with thoracic cord injuries had on average 35.9% of their MAP recordings <80 mm Hg. It is common practice to establish MAP targets for optimizing cord perfusion in acute SCI. This study suggests that even in an acute SCI referral center, when prospectively scrutinized, the actual MAP may frequently fall below the intended targets. Such results raise awareness of the vigilance that must be kept in the hemodynamic management of these patients, and the potential discrepancy between routinely setting target MAP according to 'practice guidelines' and actually achieving them.

胸髄損傷術後に発見された後天性血友病Aの1例

後天性血友病Aは，その多くが出血症状を契機に発見され，しばしば重篤な転機をとることが知られている稀な疾患である。今回，我々は出血症状の出現前に診断･治療を行い，良好な臨床経過をとった症例を経験した。症例は47歳の男性。交通事故による多発外傷にて当救命救急センターへ入院となった。家族歴・既往歴・職歴に特記事項を認めない。全身状態が安定していることを確認後，主たる損傷部位である胸椎破裂骨折に対して後方固定術を施行した。外傷部位および術創部に活動性出血を認めないことを確認後，リハビリテーションおよび対麻痺に合併する下肢深部静脈血栓症の予防を目的としたワーファリン投与を開始した。その後行った凝固能血液検査にて，経過中正常値であった活性化部分トロンボプラスチン時間APTTの著明な延長が出現，再検査でも同所見を認めることから凝固系疾患を疑い精査を行った。その結果，凝固系第VIII因子活性の低下（2%）と抗第VIII因子自己抗体の検出（4 Bethesda U/ml）を確認し，他に凝固系因子を含む異常所見を認めないことから後天性血友病Aと診断した。本例は抗第VIII因子自己抗体が低力価で出血兆候は認めず，治療はステロイドの内服を選択した。投薬後は第VIII因子活性，抗第VIII因子自己抗体価，APTTは改善を示したが，ステロイド減量中にAPTTの再延長を認めたことから，一時ステロイド内服の増量と免疫抑制剤併用を行った。ステロイド開始から9か月が経過した現在は一日プレドニン服用量5mgにて凝固能および臨床経過とも良好である。本例は，静脈血栓予防を目的とした抗凝固療法中に出現した後天性血友病Aの稀な1例であり，血栓症および出血症状各々に対する管理が必要と考えられた。

Comparison of Arm-Trunk Movement between Complete Paraplegic and Able- Bodied Subjects during Circle Drawing

Abstract Study design : This study was a cross sectional, controlled trial. Objectives: To examine the performance of repetitive circle drawing on dynamic sitting balance between subject with spinal cord injury (SCI) and age-matched able-bodied (AB) adults. Summary of background data : Previous studies showed that the dynamic sitting balance is impaired in SCI. However, the arm-trunk coordinated movement for different directions in seated SCI has not been examined yet. Methods: Twelve subjects with complete T7-T12 thoracic cord injury (mean age: 36.3 ± 3.0 years) and 12 age- matched AB adults were recruited. Subjects performed 10 repetitive circle drawing at seated position. The three- dimensional motion system (Vicon) was used to measure shoulder, trunk and pelvic angles at sitting position. Results : The SCI group displayed an arm-trunk movement with a significantly larger shoulder adduction/ abduction angle (p<0.001), but less trunk flexion/extension, pelvic anterior/posteriortilt and pelvic rotation angles than AB controls (p<0.05, p<0.001, and p<0.001, respectively). Conclusions: The small circle drawing is feasible to detect the compensatory movement of shoulder for the impairment of trunk and pelvic control in thoracic SCI. Furthermore, the assistance and guidance of trunk and pelvic movements is important for the arm-trunk coordinated movement in thoracic SCI.

Clinical study of resiniferatoxin on neurogenic bladder

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

Correlation between serous neuron specific enolase and acute spinal cord injury severity

Objective To explore the correlation between serous level of neuron specific enolase (NSE) and severity of acute spinal cord injury. Methods The NSE serous levels were determined by enzyme-labeled immunosorbent assay (ELISA) in 41 consecutive patients with acute spinal cord injury. There were 7 cases of cervical cord injury, 13 cases of thoracic cord injury and 21 cases of lumbar cord injury. They were 24 males and 17 females, aged 21 to 67 years (average, 43.8 years). The correlations between the NSE serous levels and the severities of acute spinal cord injury in all the patients were analyzed using the statistic software SPSS 13.0. The NSE serous level was compared with MRI and CT in evaluating the severity of acute spine cord injury. Results The NSE serous levels at the 1, 2, 3, 5, 7 days after the acute spinal cord injury were significantly correlated with the severities of acute spine cord injury (P<0.05). The correlations between the NSE serous level and the severity of spine cord injury were higher than those between the MRI index and the severity of spine cord injury at the 2 and 3 days after the injury. Conclusion As the NSE serous level may be positively correlated with the severity of acute spine cord injury, we can evaluate the severity of acute spine cord injury by determine the NSE serous level of the patient. Key words: Spinal cord injury; Serum; Phosphopyruvate hydratase; Enzyme-linked im-munosorbent assay

Cerebrospinal Fluid Concentrations of Nitric Oxide Metabolites in Spinal Cord Injury

Multiple center study to evaluate cerebrospinal fluid (CSF) concentrations of nitric oxide metabolites [NOx] in relation to neurologic severity and prognosis in spinal cord injury (SCI). To examine whether CSF [NOx] correlates with neurologic severity and recovery in SCI. Inducible nitric oxide synthase is expressed in rat spinal cord immediately after SCI. Excessive nitric oxide production is cytotoxic, causing neuronal apoptosis with subsequent neurodysfunction in the spinal cord. We previously reported a significant correlation between initial [NOx] after incomplete cervical cord injury (CCI) and neurologic recovery at the final follow-up in 25 cases. Ninety-six cases (SCI group), including 76 patients with CCI and 20 patients with thoracic cord injury were examined. Mean follow-up period was 11 months. The control group comprised 40 cases (3 healthy volunteers and 37 patients with neither pain nor neurologic disorders). CSF [NOx] were measured using the Griess method. Severity of neurologic impairment was assessed using Frankel's classification and the American Spinal Injury Association motor score (ASIA MS). Degree of neurologic recovery was assessed using Frankel's classification and the ASIA motor recovery percentage. CSF [NOx] did not differ significantly among the control, CCI, and thoracic cord injury groups at the initial examination. In the CCI group, [NOx] in the Frankel A and B classes were significantly higher than [NOx] in the control group at 5 to 14 days, in the Frankel A and B classes at 0 to 4 days, and in the Frankel C and D classes at 5 to 14 days. Also, in the CCI group at 5 to 14 days, [NOx] correlated significantly with ASIA MS and motor recovery percentage. There was a significant correlation between CSF [NOx] at the pathologic early subacute stage (approximately 5-14 days) and neurologic severity and recovery in SCI.