Traumatic Spinal Cord Lesion Research Articles

Neuropathic bladder dysfunction in patients with ossification of the posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament (OPLL) may cause neuropathic bladder dysfunction due to spinal cord involvement. OPLL, unlike a traumatic spinal cord lesion, progresses insidiously and sometimes affects longer cord segments. As the manifestation of bladder dysfunction may depend on the development of OPLL, we studied the relationship between bladder function and roentgenographic changes in the spinal canals of OPLL patients. Eighteen surgical candidates (11 males and 7 females, 34 to 85 years old) were studied urodynamically. Sixteen underwent CO2-filling cystometry, uroflowmetry and measurement of their residual urine volume. Cystometry was omitted in the remaining 2 patients. The vertical extent of OPLL and the degree of stenosis in the spinal canal was estimated by x-ray films and CT. The cystometric study revealed detrusor hyperreflexia in 2 patients and areflexic or underactive detrusors in 5 patients. Intermittent flows or considerable amounts of residual urine were also observed in the arefilexia/underactive group. Uroflowmetry showed a normal flow with little residual urine in both patients in whom cystometry was omitted. Bladder sensation was maintained in all patients. The occurrence of abnormal detrusor activity had no relationship to the degree of canal stenosis, while the occurrence of an areflexic or underactive detrusor correlated with the vertical extent of OPLL. Although detrusor hyperreflexia is common in an upper spinal cord lesion, attention should also be paid to the development of detrusor underactivity in patients with a wide vertical extent of OPLL.

Therapy Suggested in the Treatment of 94 Cases of Vesico-Ureteral Reflux in Neurologic Bladder after a Traumatic Spinal Cord Lesion

The Authors present their experience in the treatment of vesico-ureteral reflux in 623 patients, admitted to the “A. Gemelli” Hospital from 1976 to 1995, with neurologic bladder due to traumatic spinal cord lesion. Ninety-four patients with medium-high level reflux were treated; in 71 cases, the reflux was bilateral. The various therapies practised and the medium-long term results achieved are given.

Central cord syndrome presenting as unilateral weakness

Central cord syndrome is the most common incomplete traumatic spinal cord lesion. It is characterized by disproportionately greater upper-extremity motor impairment than lower-extremity motor impairment, bladder dysfunction, and variable degree of sensory loss below the level of the injury. This article reports the case of a patient who presented with unilateral weakness after a fall and later developed the typical central cord syndrome. The variability of central cord syndrome has been discussed by other authors, but this is the first case of a patient that initially presented as unilateral weakness.

Spinal cord stimulation in management of chronic pain

Between 1978 and 1986, 109 patients with chronic pain underwent spinal cord stimulation (SCS) at the authors' institute as part of their pain treatment program. The results of SCS in these patients at the end of the test period and at the latest follow-up examination are analyzed in relation to the etiology of their pain. In 40 patients pain was associated with an obstructive peripheral vasculopathy, in 10 with a previous herpes zoster infection, in 15 with an incomplete traumatic spinal cord lesion, in nine with root and/or nerve damage, in 11 with cancer, and in 19 with previous back surgery. The etiology of the pain in five patients was uncertain. This experience supports the conclusion that the best indications for SCS are vasculopathic pain and post-herpetic neuralgia. No clinical usefulness was found for SCS in cancer pain or in central deafferentation types of pain.

Autonomic hyperreflexia during cystoscopy in patients with high spinal cord injuries.

Cystoscopic procedures were performed on 102 patients with histories of traumatic spinal cord lesion; 57 patients had sensorimotor levels above T7, and the remaining 45 patients had levels below T7. In 40 of the 57 patients (70 per cent) with levels above T7, signs and symptoms of autonomic hyperreflexia were seen during bladder distension and cystoscopy; the remaining 17 of these patients (30 per cent) did not have this response. No autonomic hyperreflexia was seen during cystoscopy in any of the 45 patients with sensorimotor levels below T7.

Evaluation of experimental spinal cord injury using cortical evoked potentials.

✓ Experiments were performed to determine if changes in cortical evoked responses could be used to predict the extent of the neurological deficits following spinal cord injury by sudden inflation of a Fogarty balloon in the epidural space cephalad to a laminectomy. The cortical responses to stimulation of the posterior tibial nerve were recorded over the sigmoid gyrus at various times following the lesion and compared with the control response. Severe, irreversible neurological deficits occurred in cats in which the cortical response either could not be evoked immediately after injury or disappeared rapidly during this period. At the end of at least 6 weeks following injury, all of these animals were paraplegic and showed severe cystic degeneration of the spinal cord. In animals in which the post-injury cortical response did not completely disappear, only mild changes were observed in a spinal cord 6 weeks following injury. This technique may be helpful in ascertaining the severity and irreversibility of a traumatic spinal cord lesion; because the technique is simple, the method may prove helpful in the clinical management of patients with spinal cord injury.

Acquired Atresia of the Bulbous Urethra in Traumatic Spinal Cord Lesion

Acquired Atresia of the Bulbous Urethra in Traumatic Spinal Cord Lesion

Convulsions of spinal cord origin

This paper reports a patient who developed clonic convulsions of the upper limbs and grand mal attacks after a high thoracic traumatic spinal cord lesion. Repeated EEG recordings showed fast and spike background activity, as well as many bursts of spikes and low waves.