Stenotic syndrome of the lumbar spinal canal.
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The normal intraoperative sonographic features of the spinal canal, spinal cord, conus medullaris, and cauda equina are described and illustrated. Important observations concerning the normal spinal cord include its highly reflective dorsal and ventral surfaces, its uniform hypoechogenicity, and the presence of a central echo. Other easily identified structures within the spinal canal include the dura-arachnoid layer, subarachnoid space, denticulate ligament, dorsal arachnoid septations, and the roots of the cauda equina. In addition the sonographic appearance of commonly encountered iatrogenically introduced material including Gelfoam, Pantopaque, cottonoid pledgets, suture material, Harrington rods, and freeze-dried dura is also demonstrated. These normal images can serve as a baseline for the interpretation of various pathologic conditions of the spinal canal and its contents as seen with intraoperative spinal sonography.
Spinal manipulation is commonly used by some therapists for the treatment of cervical pain. Flexion-extension of the cervical spine produces sliding movements of one vertebra over the one below it, which leads to physiological reduction in the antero-posterior diameter of the spinal canal. Spinal manipulation provokes movements that exceed the physiological limits of these articulations and thereby lead to a more significant reduction of the canal diameter. In patients with pre-existing stenosis of the canal or those with vertebral instability, these movements may cause (or aggravate) myelopathy. For this reason, a thorough neurological examination and cervical spine films should be considered mandatory in patients being considered for spinal manipulation. This report describes four patients with cervical myelopathy and/or radiculopathy caused or aggravated by spinal manipulation. In one patient, magnetic resonance scans before and after chiropractic treatment strongly suggests that the disc prolapse syndrome experienced by the patient was provoked by the spinal manipulation.
The electromotor system of the electric eel, Electrophorus electricus, was studied by injection of horseradish peroxidase as a retrograde tracer. The electromotor neurons, which innervate the electrocytes, comprise a midline nucleus, largely dorsal to the spinal canal. Spinal motoneurons lie ventrolaterally. The electromotor and skeletal motor neuron populations correspond to the acetylcholinesterase-negative and -positive cells previously described. The medullary relay neurons were labeled following HRP injection into the spinal cord at a level where electromotor neurons occurred, but not after injection into the cord in the abdominal region rostral to these cells. Other medullary neurons, presumably bulbospinal motor fibers, were labeled after both levels of spinal cord injection. The results suggest that these axosomatic synapses, which are electrically transmitting but morphologically mixed, take up retrograde tracers in a manner similar to chemical synapses and that tracer uptake is at least largely at terminal regions.