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PubMed2003

"Approaches and surgical results in the treatment of ventral thoracic meningiomas. Review of our experience with a postero-lateral combined transpedicular-transarticular approach.".

BACKGROUND: The surgical treatment of anterior thoracic meningiomas provides a set of technical difficulties: the access is obstructed by the spinal cord posteriorly, thoracic cage and musculature laterally, mediastinum and pleural cavity anteriorly. It is fundamental to avoid any manipulation of the compressed, but also undamaged spinal cord: this shows significant plastic capabilities. Any effort should be directed to maximizing the contribution of the plasticity in order to obtain a good functional recovery. METHOD: We have utilized a postero-lateral combined transpedicular-transarticular approach in order to obtain less invasiveness on the neural structures. Ten patients with ventral thoracic meningioma were operated in the last 5 years. The preoperative clinical evaluation, follow-up monitoring, timing of recovery, Clinical/Functional Grade change were analysed. FINDINGS: 8 Patients had significant neurological improvement, 2 were unchanged. Magnetic Resonance Imaging (MRI) was useful in preoperative planning. Radical excision was possible in all patients and the late postoperative MRI did not reveal recurrence of the lesions at this time. To date, there has been no evidence of clinical or radiological instability. INTERPRETATION: We found this surgical exposure very helpful in the treatment of anterior thoracic meningiomas. The related morbidity and risk of instability are minimal. The combined postero-lateral approach offers a good surgical access to ventral, lateral and dorsal aspects of the thoracic spinal canal without manipulation of the spinal cord. Exposure is obtained by avoiding damage to the pleura and manipulation of the lungs and mediastinum and may be a feasible alternative in elderly patients, too.

Aged↗
PubMed1994

Time course of locomotor recovery and functional regeneration in spinal cord-transected lamprey: in vitro preparations.

1. Previous studies indicate that after transection of the rostral spinal cord, larval lamprey begin to recover locomotor behavior 2 wk posttransection and recovery is complete at approximately 8 wk. To examine the mechanisms underlying behavioral recovery after spinal cord transection, in the present study the time course and extent of recovery of locomotor function was examined in in vitro brain/spinal cord preparations. With these preparations the contributions of functional regeneration of descending brain stem projections to recovery of spinal locomotor function can be examined in the absence of mechanosensory inputs and descending propriospinal relay systems. 2. In in vitro preparations from normal lamprey, stimulation in brain stem locomotor regions resulted in direct descending activation of locomotor networks in the rostral, middle, and caudal spinal cord. 3. At 4 wk posttransection, in vitro locomotor activity was usually confined to the rostral spinal cord a few millimeters below the transection site. At 8 wk posttransection locomotor activity was present in both the rostral and middle spinal cord, and spinal locomotor networks at these levels could be directly activated by restored descending projections from the brain stem. 4. At 16-32 wk posttransection locomotor activity similar to that seen in normal animals was present along the spinal cord. Additional manipulations suggest that at 32 wk posttransection descending axons from brain stem command/initiation neurons had grown for relatively long distances and could directly activate the locomotor networks in the caudal spinal cord. At each recovery time examined the ranges of locomotor parameters (cycle time, burst proportion, and intersegmental phase lag) overlapped with those in normal animals. 5. In vitro locomotor activity in spinal cord-transected animals could be recorded at progressively more caudal levels below the transection site during the course of recovery. However, locomotor activity in in vitro preparations occurred for shorter distances below the lesion than in whole animals at comparable recovery times. 6. Our recent double-labeling experiments suggest that behavioral recovery in spinal cord-transected lamprey is largely due to true regeneration of preexisting descending axons rather than development of new descending projections. Thus, these results in conjunction with our behavioral, in vitro, and anatomic data suggest that functional regeneration of descending axons from the brain, as well as other mechanisms such as descending propriospinal relay systems and mechanosensory inputs, account for the gradual restoration of locomotor function in spinal cord-transected lamprey.

Animals↗
PubMed1986

Motor evoked potential in cats with acute spinal cord injury.

We have previously reported that a motor evoked potential (MEP) can be produced by transcranial stimulation of the motor cortex in cats and humans. This signal travels in both dorsolateral and ventral spinal cord. We report here the evaluation of this evoked potential in comparison to the somatosensory evoked potential (SEP) in an acute spinal cord weight drop model. In all animals, the peripheral nerve signal was the component of the MEP most sensitive to injury. Often, it was significantly reduced in amplitude by incidental manipulation of the spinal cord during a careful laminectomy and then returned. It was lost first in animals with weight drop spinal cord injury and was abolished with as little as 50 to 75 g/cm of force. The spinal cord signal of the MEP was consistently more sensitive to injury than the SEP and was abolished at about 100 to 150 g/cm of impact. The cortical SEP was abolished at about 200 to 250 g/cm, and the spinal cord SEP was abolished at similar levels. The SEP returned earlier after injury than the MEP. Anesthetic agents had an effect on the MEP in the spinal cord and substantially changed the peripheral nerve signal, in both wave form shape and optimal stimulation frequency. Marginal cord injury and abnormal metabolic conditions caused the peripheral nerve signal to decrement in amplitude with increasing trial numbers during a run and become unstable. These latter effects need further characterization and are critical guides to investigative and clinical use of this test. This study indicates that the MEP is more sensitive than the SEP in detecting spinal cord injury.

Animals↗
PubMed1989

Chronic cervical dysfunction: correlation of myoelectric findings with clinical progress.

In this pilot study, four patients with motion impairment and chronic cervical pain after cervical spine injury received osteopathic manipulative treatment for spinal dysfunction for periods in excess of 3 months. Records were compared for changes in the patient's subjective complaints, in the physician's findings, and in the standardized measurement of electrical activity of the cervical spine musculature. All three measures demonstrated parallel improvement in the health status of these patients. Attention to functional aspects of a neuromusculoskeletal problem appears to provide reliable indicators for directing treatment of somatic dysfunction and registering both subjective and objective change.

Adult↗
PubMed1981

Ventral spinal tumor: the value of computed tomography in its localization.

We are reporting a case of a ventrally placed intradural meningioma at the C-7, T-1 level that was shown clearly on a computed tomographic scan without the use of metrizamide. This greatly facilitated the planning of our posterolateral approach, which permitted a complete removal of the tumor with minimal manipulation of the spinal cord.

Female↗
PubMed2006

H-reflex operant conditioning in mice.

Rats, monkeys, and humans can alter the size of their spinal stretch reflex and its electrically induced analog, the H-reflex (HR), when exposed to an operant conditioning paradigm. Because this conditioning induces plasticity in the spinal cord, it offers a unique opportunity to identify the neuronal sites and mechanisms that underlie a well-defined change in a simple behavior. To facilitate these studies, we developed an HR operant conditioning protocol in mice, which are better suited to genetic manipulation and electrophysiological spinal cord study in vitro than rats or primates. Eleven mice under deep surgical anesthesia were implanted with tibial nerve stimulating electrodes and soleus and gastrocnemius intramuscular electrodes for recording ongoing and stimulus-evoked EMG activity. During the 24-h/day computer-controlled experiment, mice received a liquid reward for either increasing (up-conditioning) or decreasing (down-conditioning) HR amplitude while maintaining target levels of ongoing EMG and directly evoked EMG (M-responses). After 3-7 wk of conditioning, the HR amplitude was 133 +/- 7% (SE) of control for up-conditioning and 71 +/- 8% of control for down-conditioning. HR conditioning was successful (i.e., > or =20% change in HR amplitude in the appropriate direction) in five of six up-conditioned animals (mean final HR amplitude = 139 +/- 5% of control HR for successful mice) and in four of five down-conditioned animals (mean final HR amplitude = 63 +/- 8% of control HR for successful mice). These effects were not attributable to differences in the net level of motoneuron pool excitation, stimulation strength, or distribution of HR trials throughout the day. Thus mice exhibit HR operant conditioning comparable with that observed in rats and monkeys.

Afferent Pathways↗
PubMed1998

Control of size and excitability of mechanosensory receptive fields in dorsal column nuclei by homolateral dorsal horn neurons.

Both accidental and experimental lesions of the spinal cord suggest that neuronal processes occurring in the spinal cord modify the relay of information through the dorsal column-lemniscal pathway. How such interactions might occur has not been adequately explained. To address this issue, the receptive fields of mechanosensory neurons of the dorsal column nuclei were studied before and after manipulation of the spinal dorsal horn. After either a cervical or lumbar laminectomy and exposure of the dorsal column nuclei in anesthetized cats, the representation of the hindlimb or of the forelimb was defined by multiunit recordings in both the dorsal column nuclei and in the ipsilateral spinal cord. Next, a single cell was isolated in the dorsal column nuclei, and its receptive field carefully defined. Each cell could be activated by light mechanical stimuli from a well-defined cutaneous receptive field. Generally the adequate stimulus was movement of a few hairs or rapid skin indentation. Subsequently a pipette containing either lidocaine or cobalt chloride was lowered into the ipsilateral dorsal horn at the site in the somatosensory representation in the spinal cord corresponding to the receptive field of the neuron isolated in the dorsal column nuclei. Injection of several hundred nanoliters of either lidocaine or cobalt chloride into the dorsal horn produced an enlargement of the receptive field of the neuron being studied in the dorsal column nuclei. The experiment was repeated 16 times, and receptive field enlargements of 147-563% were observed in 15 cases. These data suggest that the dorsal horn exerts a tonic inhibitory control on the mechanosensory signals relayed through the dorsal column-lemniscal pathway. Because published data from other laboratories have shown that receptive field size is controlled by signals arising from the skin, we infer that the control of neuronal excitability, receptive field size and location for lemniscal neurons is determined by tonic afferent activity that is relayed through a synapse in the dorsal horn. This influence of dorsal horn neurons on the relay of mechanosensory information through the lemniscal pathways must modify our traditional views concerning the relative independence of these two systems.

Animals↗
PubMed1989

Spinal cord stimulation in deafferentation pain.

Spinal cord stimulation (SCS) was used in 49 cases to control resistant deafferentation pain resulting from causalgia, phantom limb, plexus and nerve root avulsion, postherpetic neuralgia, reflex sympathetic dystrophy and amputation. In all cases, one or two standard percutaneous leads were introduced into the epidural space and manipulated until the spinal segment at which external stimulation provoked paresthesic sensation in the painful area. Two weeks of external stimulation trial was used to determine the efficiency of the system. Pulse width of 0.1-0.2 ms, a rate of 80-120 cps and amplitude to low paresthesia threshold were programmed as electric parameters. In 36 out of the 49 tested cases showing a positive response to percutaneous SCS, the device was permanently implanted. After a mean follow-up of 5.5 years, 57% of patients had satisfactory pain relief (over 75%). Side effects were limited to dislodgement of the electrode in 1 case and wire extrusion in another, both requiring replacement of the stimulator.

Chronic Disease↗
PubMed1982

Effects of manipulating stimulation intensity and duration on fixation of a peripherally-induced spinal reflex alteration in rats.

Two studies were conducted to examine the effects of manipulating stimulation intensity and duration on post-spinal-section retention of a peripherally induced postural asymmetry. In the first experiment, two groups of rats received 1-3 mA of hindlimb stimulation for 60 or 90 min followed by a spinal cord section. Even though all animals demonstrated postsection persistence of asymmetry, significant differences between the two groups of animals were not discerned. Experiment 2 was conducted to more systematically evaluate intensity and duration manipulations. Twelve groups of rats that received 1, 3, or 5 mA of stimulation for either 30, 45, 60, or 90 min were used. Significant differences were found between intensity groups when presection asymmetry, postsection asymmetry, and percentage retention measures were analyzed. Significant differences between duration groups were found only when the 90 min groups were compared with animals that were given shorter periods of stimulation and when 60 min groups were compared to 30 min groups. From these data we have concluded that the intensity of the fixating stimulus is a major determinant of the magnitude of asymmetry persistence observed after spinal section.

Animals↗
PubMed2002

The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects.

STUDY DESIGN: A blinded, randomized controlled trial was conducted. OBJECTIVE: To test the hypothesis that chiropractic side-posture manipulation (adjusting) of the lumbar spine separates (gaps) the zygapophysial (Z) joints. SUMMARY OF BACKGROUND DATA: Spinal adjusting is thought to gap the Z joints, yet no studies have conclusively validated this hypothesis, and some investigators have reported that the lumbar Z joints do not gap during rotation. METHODS: For this study, 64 healthy student volunteers (32 men and 32 women) ages 22 to 30 years with no history of significant low back pain were randomized into four groups of 8 men and 8 women each. Interventions included lumbar side-posture spinal adjusting (manipulation) and side-posture positioning. Anterior to posterior measurements of the Z joints from MRI scans taken before and after side-posture spinal adjusting and before and after side-posture positioning were compared. RESULTS: Observers performing the measurements were blinded as to group and first and second scans. Reliability of the measurements was established. Differences were found between the groups (F = 24.15; P < 0.000, analysis of variance). Side-posture positioning showed greater gapping than the control condition (mean difference, 1.18; P < 0.000); side-posture adjusting showed greater gapping than the control condition (mean difference, 1.89; P < 0.000), and side-posture adjusting showed greater gapping than side-posture positioning (mean difference, 0.71; P = 0.047). CONCLUSIONS: Spinal adjusting produced increased separation (gapping) of the Z joints. Side-posture positioning also produced gapping, but less than that seen with lumbar side-posture adjusting. This study helps to increase understanding about the mechanism of action for spinal manipulation.

Adult↗
PubMed1986

Laser resection of fifty spinal lipomas.

The value of laser resection was assessed in the last 50 of 128 consecutive cases of pediatric spinal lipoma. In this series, there was no mortality. No patient suffered increase in neurological or urological deficit. Postoperatively, 8 of 20 patients with prior motor deficit (40%) had substantially improved motor function. Two of 17 previously incontinent patients became continent of urine (12%). Use of the CO2 laser reduced the length of operation, the intraoperative blood loss, and the degree of manipulation of the spinal cord and nerve roots. Most of the fat could be removed successfully from the liponeural junction, permitting more nearly anatomical removal of the intramedullary component of the lesion and greater ease in replacing the cord into a reconstructed arachnoid-dural canal. In the authors' opinions, proper management of the patient with spinal lipoma now requires early prophylactic resection of the lipoma and untethering of the spinal cord.

Adolescent↗
PubMed1996

Cervical ventral epithelial cyst treated by anterior corpectomy--case report.

A 15-year-old boy presented with a cervical ventral epithelial cyst manifesting as intractable cervical pain. Neurological examination revealed weakness of his left grasp and increased deep tendon reflexes. The anterior approach was selected because the lesion was located directly ventral to the spinal cord. He underwent C4-5 anterior corpectomy and subtotal resection of the cyst wall. He made a good recovery without additional deficits. Most previously reported cases have been treated using the posterior approach despite the ventral location of the lesion. The anterior approach offers a safer and more effective means of treating such lesions because it allows direct access to the lesion without manipulation of the spinal cord.

Adolescent↗
PubMedDate not supplied

Spinal anesthesia for lumbar disc surgery: review of 576 operations.

Neurologic complications accompanying spinal anesthesia were examined in 576 lumbar disc operations on 507 patients. The single serious complication did not seem attributable to the choice of anesthetic method. Minor neurologic complications, with the exception of spinal headache, could be explained by surgical manipulation. The authors conclude that spinal anesthesia is safe for surgical operations on the laterally herniated lumbar disc.

Adolescent↗
PubMed2005

Protein kinases mediate increment of the phosphorylation of cyclic AMP-responsive element binding protein in spinal cord of rats following capsaicin injection.

BACKGROUND: Strong noxious stimuli cause plastic changes in spinal nociceptive neurons. Intracellular signal transduction pathways from cellular membrane to nucleus, which may further regulate gene expression by critical transcription factors, convey peripheral stimulation. Cyclic AMP-responsive element binding protein (CREB) is a well-characterized stimulus-induced transcription factor whose activation requires phosphorylation of the Serine-133 residue. Phospho-CREB can further induce gene transcription and strengthen synaptic transmission by the activation of the protein kinase cascades. However, little is known about the mechanisms by which CREB phosphorylation is regulated by protein kinases during nociception. This study was designed to use Western blot analysis to investigate the role of mitogen-activated protein (MAP)/extracellular signal-regulated kinase (ERK) kinase (MEK 1/2), PKA and PKC in regulating the phosphorylation of CREB in the spinal cord of rats following intraplantar capsaicin injection. RESULTS: We found that capsaicin injection significantly increased the phosphorylation level of CREB in the ipsilateral side of the spinal cord. Pharmacological manipulation of MEK 1/2, PKA and PKC with their inhibitors (U0126, H89 and NPC 15473, respectively) significantly blocked this increment of CREB phosphorylation. However, the expression of CREB itself showed no change in any group. CONCLUSION: These findings suggest that the activation of intracellular MAP kinase, PKA and PKC cascades may contribute to the regulation of phospho-CREB in central nociceptive neurons following peripheral painful stimuli.

Animals↗
PubMed2001

Early evolution of bladder emptying after myelomeningocele closure.

OBJECTIVES: To analyze bladder emptying in newborns with spina bifida after closure of the myelomeningocele defect. Manipulation of the spinal cord and nerve roots results in temporary changes in bladder function in many settings. METHODS: We reviewed 62 consecutive newborn patients who underwent closure of a myelomeningocele defect at our institution from January 1990 to December 1997. We examined the catheterized urine volumes obtained before and after closure, radiographic and urodynamic studies, and the subsequent need for intermittent catheterization. Poor bladder emptying was defined as most catheterized urine volumes greater than 10 mL (20% of expected bladder capacity). Adequate follow-up was available for 54 patients for a period of 4 to 96 months (mean 42). One patient with posterior urethral valves was excluded from the study, leaving 53 for evaluation. RESULTS: Of the 53 patients, 4 with high outflow resistance and dyssynergy never emptied the bladder adequately before or after closure. Of the remaining 49 patients, 6 (12%) emptied well immediately after the myelomeningocele repair. In the other 43 (88%), the bladder did not empty as well after closure. The mean volume obtained with catheterization after closure was 20 mL, significantly higher (P <0.001) than the mean volume obtained before repair (6.5 mL) or after resumption of better spontaneous emptying (4 mL). Intermittent catheterization done for poor emptying was required for an average duration of 11 days (range 2 to 42). Of the 43 patients with poor emptying immediately after closure, 32 (74%) required catheterization for 2 weeks or less; the remaining 11 (26%) required catheterization for 2 to 6 weeks. Despite the relatively early resumption of good emptying, numerous patients (19 of 49) required additional intervention (clean intermittent catheterization or vesicostomy) before attempts to toilet train. CONCLUSIONS: A clinical pattern similar to spinal shock does occur in most newborns after closure of a myelomeningocele defect. Resumption of near-complete emptying usually occurs less than 2 weeks after repair but may require up to 6 weeks.

Female↗
PubMed1997

Variability of forces applied by experienced therapists during spinal mobilization.

OBJECTIVE: To determine the variation in forces used by different therapists during mobilization of the lumbar spine and the repeatability and reproducibility of individual therapists. DESIGN: An instrumented mobilization couch was developed to measure the forces applied to the trunk during spinal mobilization. BACKGROUND: Due to limitations in equipment design and data analysis, previous related studies demonstrate equivocal results. METHODS: The system was used to collect data from a sample of 30 experienced therapists to evaluate variation, repeatability and reproducibility during the application of five mobilization procedures. RESULTS: The variation in forces used by different therapists when performing the same technique was substantial, ranging between 63 and 347 N for one technique. During this procedure, 30% of the therapists were found to be relatively consistent, repeating the magnitude of the force applied at the first session within 5%. Others demonstrated considerable variation, exhibiting a difference as great as 34%. CONCLUSIONS: The inconsistency between experienced therapists has considerable implications for clinical practice. Changes in the magnitude and rate of loading are likely to have different effects due to the inherent viscoelastic behaviour of soft tissues. RELEVANCE: Spinal mobilization and manipulation techniques are frequently used by manual therapists in the treatment of musculoskeletal disorders. Despite the reliance on these techniques in clinical practice, there is little scientific evidence to substantiate their use. Before progress in this area can be made, it is necessary to characterize the forces used during typical mobilization procedures. The results can be used to develop teaching strategies and as a basis for comparative research on the efficacy of these techniques.

Journal Article↗
PubMed1999

Redox manipulation of NMDA receptors in vivo: alteration of acute pain transmission and dynorphin-induced allodynia.

The redox modulatory site of the N-methyl-D-aspartate (NMDA) receptor directly regulates NMDA receptor function. Sulfhydryl reducing agents, such as dithiothreitol (DTT), potentiate NMDA receptor-evoked currents in vitro, whereas oxidizing agents, such as 5,5'-dithio-bis-(2-nitrobenzoic acid) (DTNB), attenuate these currents. In this study, we examined the effect of this redox manipulations on nociceptive spinal cord signaling in mice. Intrathecal (i.t.) administration of DTT (0.1-30 nmol), presumably reducing the NMDA receptor, dose-dependently enhanced NMDA-induced nociceptive behaviors, and this enhancement was blocked by the oxidizing agent, DTNB. Pretreatment with DTT (10 nmol, i.t.) enhanced NMDA-induced tail-flick thermal hyperalgesia and intraplantar formalin-induced nociceptive behaviors. Finally, DTT pretreatment enhanced the long lasting allodynia induced by i.t. administration of dynorphin, whereas post-treatment with DTNB reduced the permanent allodynia induced by dynorphin for 5 days. Potentiation of all four of these NMDA-dependent nociceptive behaviors by DTT suggests that the reduction of the NMDA receptor by endogenous reducing agents may contribute to augmented pain transmission in response to activation by endogenous glutamate. Moreover, blockade of in vivo NMDA receptor reducing agents or oxidation of the NMDA receptor redox site may prove therapeutically useful in the treatment of chronic pain.

Acute Disease↗