Type Of Spinal Cord Injury Research Articles

Pediatric musculoskeletal trauma

Purpose of review: Articles in this survey were selected for clinical relevance, quality, controversy, or because they appeared in groups that could present, a useful theme and comparison. This review looks specifically at studies that address injury prevention and the types of injuries that an orthopaedic surgeon may see in clinical practice. Recent findings: An excellent series of articles appeared this year that discussed the severe nature of injuries related to use of high-energy devices, including all-terrain vehicles, snowmobiles, power lawnmowers, trampolines, and motor vehicles. Certainly, young children should never be allowed to operate these devices. All involve a high-energy injury mechanism in a child who is not developmentally prepared to use these machines safely. Sporting injuries have specific characteristics that, through an organized approach, may be reduced in prevalence and severity. Other topics of interest in this review include outcome studies of olecranon fractures that show good long-term results for isolated injuries with reasonable articular restoration, a more specific description of the different types of spinal cord injury without radiographic abnormality, and an excellent protocol for use of cervical MRI in the child who may have sustained a spine injury. Summary: The thoughtful orthopaedic surgeon can make a difference in prevention, accurate diagnosis and effective treatment of these conditions.

Effect of spinal cord injury on the respiratory system.

There are >200,000 persons living with a spinal cord injury in the United States, with approximately 10,000 new cases of traumatic injury per year. Advances in the care of these patients have significantly reduced acute and long-term mortality rates, although life expectancy remains decreased. This article will review the alterations in respiratory mechanics resulting from a spinal cord injury and will examine the contribution of respiratory complications to morbidity and mortality associated with various types of spinal cord injury.

Recovery of locomotion after ventral and ventrolateral spinal lesions in the cat. II. Effects of noradrenergic and serotoninergic drugs.

The effects of serotoninergic and noradrenergic drugs (applied intrathecally) on treadmill locomotion were evaluated in two adult cats subjected to a ventral and ventrolateral spinal lesion (T13). Despite the extensive spinal lesion, severely damaging important descending pathways such as the reticulo- and vestibulospinal tracts, both cats recovered quadrupedal voluntary locomotion. As detailed in a previous paper, the locomotor recovery occurred in three stages defined as early period, when the animal could not walk with its hindlimbs, recovery period, when progressive improvement occurred, and plateau period, when a more stable locomotor performance was observed. At this latter stage, the cats suffered from postural and locomotor deficits, such as poor lateral stability, irregular stepping of the hindlimbs, and inconsistent homolateral fore- and hindlimb coupling. The present study aimed at evaluating the potential of serotoninergic and/or noradrenergic drugs to improve the locomotor abilities in the early and late stages. Both cats were implanted chronically with an intrathecal cannula and electromyographic (EMG) electrodes, which allowed determination, under similar recording conditions, of the locomotor performance pre- and postlesion and comparisons of the effects of different drugs. EMG and kinematic analyses showed that norepinephrine (NE) injected in early and plateau periods improved the regularity of the hindlimb stepping and stabilized the interlimb coupling, permitting to maintain constant locomotion for longer periods of time. Methoxamine, the alpha1-agonist (tested only at the plateau period), had similar effects. In contrast, the alpha2-agonist, clonidine, deteriorated walking. Serotoninergic drugs, such as the neurotransmitter itself, serotonin (5HT), the precursor 5-hydroxytryptophan (5HTP), and the agonist quipazine improved the locomotion by increasing regularity of the hindlimb stepping and by increasing the step cycle duration. In contrast, the 5HT1A agonist 8-hydroxy-dipropylaminotetralin (DPAT) caused foot drag in one of the cats, resulting in frequent stumbling. Injection of combination of methoxamine and quipazine resulted in maintained, regular stepping with smooth movements and good lateral stability. Our results show that the effects of drugs can be integrated to the residual voluntary locomotion and improve some of its postural aspects. However, this work shows clearly that the effects of drugs (such as clonidine) may depend on whether or not the spinal lesion is complete. In a clinical context, this may suggest that different classes of drugs could be used in patients with different types of spinal cord injuries. Possible mechanisms underlying the effect of noradrenergic and serotoninergic drugs on the locomotion after partial spinal lesions are discussed.

Motor Performance Score: A New Algorithm for Accurate Behavioral Testing of Spinal Cord Injury in Rats

To evaluate the usefulness of standard neurological tests in predicting the neurological outcome after photochemically induced spinal cord lesions in rats, we inflicted injuries of different severity to adult female rats. The behavior of the rats was followed for 6 weeks and the results of the behavioral tests were correlated with morphological indicators of tissue destruction at the end of this period. We found many behavioral tests to be highly correlated with the loss of tissue, whereas some tests were inaccurate in correlating with degree of tissue destruction. Motor score, beam walk, and righting reflex were all highly correlated with the volume of the lesion as well as with the depth of the lesion cavity at its epicenter. We propose a protocol for neurological evaluation of this type of spinal cord injury consisting of six individual tests, hierarchally organized such that injured rats can be divided into 11 groups of neurological deficit, scored from 10 to 0. This so-called motor performance score is fast and easy to perform and shows high correlation with the lesion volume, and is thus suitable for neurological evaluation of photochemically induced spinal cord injury.

Hyponatremia in acute spinal cord injury.

To define the occurrence rate, time course, and potential etiologic factors of hyponatremia in patients with acute spinal cord injury. Analysis of data obtained from a retrospective review of medical records and from a systematized, prospective database pertaining to patients with spinal cord injury. A university hospital with a federally funded regional spinal cord injury center and a dedicated spinal cord injury intensive care unit. Two hundred eighty-two patients admitted between January 1, 1988 and December 31, 1989 with acute (< 24-hr duration) spinal cord or vertebral column injury. None. The mean age of patients was 36.7 +/- 17.6 (SD) yrs; 225 (80%) of the patients were male and 57 (20%) were female. Hyponatremia, when it occurred, developed at a mean time of 6.4 +/- 6.7 days postadmission, reached its nadir at 8.7 +/- 8.8 days, and occurred in 28% of those patients with cervical injuries, 34% with thoracic injuries, and 27% with lumbar injuries (p = NS). Logistic regression analysis demonstrated that the type of spinal cord injury (Frankel class: range is A = complete neurologic lesion to E = no neurologic lesion) was the strongest predictor of hyponatremia. The occurrence rate of hyponatremia was as follows: Frankel class-A 62%; Frankel class-B 48%; Frankel class-C 41%; Frankel class-D 23%; Frankel class-E 16% (p < .0001). The prevalence of hyponatremia in acute spinal cord injury is much higher than in the general medical or surgical patient population. This abnormality usually occurs within the first week postinjury. The most significant predictor of hyponatremia is the type rather than the level of spinal cord injury. The potential etiological factors are many and these factors are probably interrelated. The pathophysiological mechanisms that result in hyponatremia must be explored so that this occurrence and its consequences can be prevented.

中下位頚椎損傷に対する観血的治療成績

Data was collected retrospectively on 72 patients with lower cervical spine injury treated in our Institues. Fifty two patients were treated surgically and twenty treated nonsurgically. At final follow-up no significant difference in neurological recovery was noted between patients treated surgically and those treated nonsurgically. We concluded that the timing of the operation was not effective and that the type of spinal cord injury was the most important prognoshe factor in tems of neurological recovery.

Pediatric Spinal Cord Injury Without Radiographic Abnormalities

Spinal cord injury without radiographic abnormality (SCIWORA) occurs primarily in the pediatric population but is less common than other forms of spinal injury among children. Between 1972 and 1990, 159 pediatric patients were admitted to the Barrow Neurological Institute with acute traumatic spinal cord or vertebral column injuries. Of these, 26 children (16%) sustained SCIWORA. The mechanism of injury, its severity, and the prognosis for recovery were related to the patient's age. In young children, SCIWORA accounted for 32% of all spinal injuries and tended to be severe; 70% were complete injuries. In older children, SCIWORA accounted for only 12% of the spinal injuries, was rarely associated with a complete injury, and had an excellent prognosis for complete recovery of neurologic function. As with other types of spinal cord injuries, the severity of neurological injury was the most important predictor of outcome. Patients with complete neurological deficits from SCIWORA had a poor prognosis for recovery of neurological function.

Spinal Cord Injury: What is the Effect on Sexual Response?

In this paper the sexual response cycle and neurologic pathways involved in sexual functioning are reviewed. This is used as a foundation to review the spinal cord injury literature and examine what is primarily self-reported regarding sexual function with varying types of spinal cord injury. A recommendation is made for more thorough, objective studies through which hypotheses can be tested and a foundation built for prognostication of how sexual functioning will be altered after varying types of SCI.

Barbiturate protection in acute experimental spinal cord ischemia.

Ischemia is the pathophysiological mechanism in many types of spinal cord injury. In the present study, the infrarenal segment of the aorta was occluded for 25 minutes to produce spinal cord infarction in rabbits. Paraplegia occurred in 100% of control animals. Thiopental administered before aortic occlusion resulted in paraplegia in only 40% of animals so treated (p less than 0.01). Histological study of the spinal cord demonstrated infarction of the gray matter in all paraplegic animals, whereas the microscopic appearance was normal in animals without neurological deficit. The protective influence of thiopental therapy in spinal cord ischemia was demonstrated.

The effect of spinal distraction on regional spinal cord blood flow in cats.

Distraction is considered to be a factor in many spinal cord injuries. With a specially designed distraction apparatus and the 14C-antipyrine autoradiographic technique, the effect of distraction on spinal cord blood flow (SCBF) in cats was studied. Distraction was performed at L2-3 at a rate of 0.25 cm/10 min, and the spinal evoked response (SER) was monitored by stimulating the sciatic nerve and recording at T-13. The SCBF was assessed in five control animals, four animals in whom the SER was markedly altered by distraction, and five animals after the SER had been abolished and an additional 0.5 cm distraction applied. Control cats had gray- and white-matter flows of 44.5 +/- 1.4 (SEM) and 10.5 +/- 0.4 ml/100 gm/min, respectively. Distraction to the point of marked SER alteration caused a 50% loss of SCBF at and caudal to the distraction site. An additional 0.5 cm distraction produced total abolition of SCBF at the distraction site and for a considerable distance rostral and caudal to it. Thus, it is shown that spinal distraction causes cord ischemia similar to that seen with other types of spinal cord injury. In addition, distraction severe enough to cause loss of the SER has already produced severe cord ischemia.

Spinal cord energy metabolism following compression trauma to the feline spinal cord.

The purpose of this study was to determine the spinal cord metabolic state for 24 hours after compression trauma to the feline spinal cord. Cats were anesthetized with pentobarbital and injured by placing a 190-gm weight on the spinal cord for 5 minutes. Biochemical analysis of the injured segment revealed a significant depletion in the levels of adenosine triphosphate (ATP), phosphocreatine (P-creatine), and total adenylates for the entire 24-hour recovery period. Glucose levels initially declined, but by 1 hour had normalized, and at 8 and 24 hours were significantly supranormal. The lactate/pyruvate ratio and tissue lactate concentrations increased four and five and half times, respectively, for the first 4 hours after injury. Between 8 and 24 hours, lactate levels remained elevated, whereas the lactate/pyruvate ratio declined to contol levels as the result of a significant rise in the tissue pyruvate concentration. This sequence of metabolic changes suggested that metabolism was probably not homogeneous throughout the injured segment, and that tissue metabolic rate was depressed for the initial 4 hours after trauma then increased in metabolically active tissue for the remainder of the 24-hour recovery period. This model of spinal cord trauma results in a severe, prolonged ischemia and metabolic injury to the affected tissue. Whether these metabolic changes results from or cause the tissue damage and irreversible paraplegia associated with this type of spinal cord injury remains to be determined.

Prognosis and management of spinal cord and cauda equina bullet injuries in sixty-five civilians.

HE purpose of this study of patients with spinal cord injury was to isolate a single wounding agent, namely, bullets, and to discuss in detail one aspect of the problem, the efficacy of surgical therapy. On the basis of this analysis certain predictions as to outcome can be made and a degree of uniformity introduced into the management of this type of spinal cord injury. Material and Methods The data in this study have been gathered from 42 patients with civilian bullet injuries of the spinal cord and 23 patients with similar wounds of the conus medullaris and cauda equina. These patients were admitted consecutively after 1955 to three facilities with which the authors were associated, and 25 were under their personal care. The remainder were identified from the archives of the various institutions and then traced for follow-up. Each individual had a single bullet wound of the spinal cord or cauda equina; other types of spinal cord or cauda injuries were not included. All patients had an initial neurological deficit, which was in most cases profound. Patients had anteroposterior and lateral x-rays of the spine and usually antibiotics and tetanus prophylaxis. The familiar general problems related to acute spinal cord injury and paraplegia have been discussed in detail in other publications s,1~ and will not be emphasized in this paper. The patients were separated into four clinical groups according to the spinal cord deficit:

Central Spinal Cord Syndrome in Hyper-extension Injuries of the Cervical Spine

The syndrome of acute central cervical spinal-cord damage, as originally described by Bailey and subsequently by Schneider, Cherry, and Pantek, consists of disproportionately greater weakness in the upper extremities as compared with the lower, with various sensory changes at or below the site of the lesion, and urinary bladder dysfunction. Three patients with this problem are presented. The mechanism of injury is discussed and related to pre-existing conditions such as cervical spondylosis as well as acute pathological entities causing central cord damage, such as hematomyelia, contusion, cord swelling, and ischemia. The treatment and prognosis of patients with this type of spinal-cord injury is outlined.