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At least 1,207 records · Page 67Linked to original sources
PubMed2003

Transplantation treatment of spinal cord injury patients.

The minimally manipulated cells from fetal nervous and hemopoietic tissues (gestational age 16-22 weeks) were subarachnoidally implanted into 15 patients (18-52 years old) with severe consequences of traumatic spinal cord injury (SCI) at cervical or thoracic spine level. The times after SCI were from 1 month to 6 years. Each patient underwent from one to four cell transplantations (CT) with various time intervals. In 11 of 15 cases, CT was combined with an operative partial disruption of a connective tissue cyst and with implantation into a spinal cord lesion of a spinal cord fragment together with olfactory ensheathing cells. Before CT the patients showed complete motor and sensory function disorder consistent with a grade A of SCI according to Frankel classification. With CT treatment, six patients improved their neurological status from A to C grade of SCI, exhibiting incomplete restoration of both motor and sensory function. The status of other five CT-treated patients became consistent with SCI grade B and was characterized by appearance of contracting activity in some muscles and incomplete restoration of sensitivity. The remaining four patients did not exhibit any clinical improvements. No serious complications of CT were noted. The results suggest a clinical relevance of the CT-based approach to treating severe consequences of SCI.

Adolescent↗
PubMed1992

Incidence of hypotension induced by spinal anesthesia with xylocaine for cesarean section and postpartum tubal ligation.

The incidence of hypotension induced by spinal anesthesia in 154 ASA class I or II patients having Cesarean section and postpartum bilateral tubal ligation was studied. Xylocaine (2%) 60-65 mg was used for spinal anesthesia. There was 41.0% of patients in Cesarean section group developed hypotension induced by spinal anesthesia, and 13.5% in tubal ligation group. We found no correlation between the time after delivery and the occurrence of hypotension induced by spinal anesthesia. In addition, 20.3% of the patients in tubal ligation group required intravenous narcotics because of inadequate sensory blockade during skin incision, but only 9.0% in Cesarean section needed the same supplement which was due to visceral pain during intra-abdominal manipulation. We conclude that spinal anesthesia with 2% xylocaine is safe and effective in both Cesarean section and postpartum tubal ligation although a significant difference of spinal hypotension existed.

Adult↗
PubMed1995

Degeneration of axons in the corticospinal tract secondary to spinal cord ischemia in rats.

Occlusion of the thoracic aorta and both subclavian arteries (XC) in the rat model produces spastic paraplegia. In order to characterize the lesion of white matter, 14 male Sprague-Dawley rats underwent XC for 10.5 to 12 min, were observed for 32 days and assessed with a lesion score. A sham group of eight underwent surgical manipulations without XC. The spinal cords were studied by optical microscopy and electron microscopy. An additional group of normal animals (n = 8) underwent spinal cord blood flow measurement with the autoradiographic technique. Optical microscopy showed normal histology in sham operated rats and rats with aortic cross-clamp and lesion score = 2-4 (n = 5), rare changes in the white matter of rats with lesion score = 8 (n = 2), and demyelination of the anterior and lateral tracts of the white matter and motor neuron loss in the gray matter of rats with lesion score = 13-15 (n = 7) and spastic paraplegia. In this last group, electron microscopy disclosed severe axonal degeneration of corticospinal tracts. In the same region spinal cord blood flow was higher than the remaining white matter. This study confirms that spastic paraplegia observed in the rat model after XC is due to degeneration of the pyramidal tracts, perhaps more susceptible to injury due to the high spinal cord blood flow.

Animals↗
PubMed1985

The effects of questionnaire design on the determination of end results in lumbar spinal surgery.

Two hundred and seven patients followed a minimum of 10 years after a single lumbar disc operation were evaluated using 14 different questionnaires that measure surgical outcomes. Dependent on the questionnaire design, the satisfactory outcomes for this population ranged from 97% to 60%, which is statistically significant. The authors conclude that the reported outcomes for lumbar spinal surgery are significantly manipulated by the criteria selected for the assessment of end results.

Follow-Up Studies↗
PubMed2006

Genetic manipulation of neural stem cells for transplantation into the injured spinal cord.

The injured adult spinal cord is not conducive for neuronal regeneration and neurogenesis. Engrafted neural precursor cells (NPCs) differentiate largely into astroglia, with only a very small percentage becoming neurons (which might replace injured neurons) or oligodendroglia (which might improve injury induced demyelination of spared neurons). Several recent attempts have been made to enhanced neurogenesis or oligodendroglia differentiation of transplanted NPCs by genetic manipulation. These include exogenous expression of noggin, with the idea of antagonizing the astroglia differentiation promoting Bone Morphogenetic Proteins (BMPs). Direct attempts to enhance neurogenesis have also been made in transgenic over-expression of neurogenic basic helix-loop-helix transcription factors. These experiments resulted in some interesting observations, which we discuss here in the light of recent advances in development of cell-based engraftment therapy for spinal cord injuries.

Animals↗
PubMed2006

[Veracity of cortical somatosensory evoked potential monitoring and influencing factors in operation for cervical spondylitic myelopathy].

OBJECTIVE: To investigate the veracity of cortical somatosensory evoked potential (CSEP) and the influencing factors of manipulation of CSEP monitoring during the operation for cervical spondylitic myelopathy (CSM). METHODS: Sixty-eight CSM patients, 45 males and 23 females, aged 52.3, underwent CSEP monitoring at the ulnar, median, and posterior tibial nerves. The impact and level to CSEP of different period and manipulation during operation were recorded. The spinal cord function of post-operation were analyzed and evaluated. RESULTS: The CSEP monitoring was successful in all cases. CSEP pre-warning appeared 44 times in 24 cases. Among them 31 times of common pre-warning of CSEP were recorded because of operative manipulations and all of the 31 times of common pre-warning recovered after careful manipulation. Dangerous pre-warning was recorded for 11 times, and then the operation had to be stopped to search for the causes and awaken test was needed in one case. When the agents causing dangerous pre-warning of CSEP were found and corrected, the CSEP was able to recover. Not a patient showed aggravation of nervous function damage and no false negative result was found. CONCLUSION: CSEP can monitor the spinal cord function immediately and exactly. The main factors of operative manipulation causing pre-warning of CSEP include overextension and overflexion, overbrazing the space, operative manipulations for spinal cord thorough decompression, and overdeepening of graft.

Adult↗
PubMed2005

Airway management of an achondroplastic dwarf with hydrocephalus undergoing decompression surgery.

The neurological problem of achondroplasia is hydrocephalus which may arise from stenosis of the foramen magnum secondary to occipital hypertrophy. The spine is also affected by abnormalities in the cervical region (odontoid hypoplasia and occipitalization of C1), which can compound the problem of cord compression. We report a rare instance of achondroplasia in a 3-month-old female infant with the risk of spinal cord compression during the manipulation of endotracheal intubation. For fear of that the surgeon inclined awake intubation in order that spinal cord intactness could be confirmed by neurological test on the spot after intubation. Awake oral endotracheal intubation was performed although with some difficulty, yet the motor function at the first cervical spinal level was unmolested as revealed by neurological test after intubation.

Achondroplasia↗
PubMed2002

Near infrared spectroscopy for intraoperative monitoring of the spinal cord.

STUDY DESIGN: Animal model study of three healthy commercial pigs was conducted. OBJECTIVE: To determine whether near infrared spectroscopic monitoring of the spinal cord is feasible, and whether changes in near infrared spectroscopy correlate with changes in blood flow to the cord or operative maneuvers. SUMMARY OF BACKGROUND DATA: Near infrared spectroscopy is a noninvasive continuous monitoring tool capable of measuring absolute changes in the concentration of three chromophores: oxygenated hemoglobin, deoxygenated hemoglobin, and cytochrome aa3, the terminal enzyme in the electron transfer chain and a measure of cellular energy equilibrium. Near infrared spectroscopy has been used to monitor the brain intraoperatively in multiple circumstances. The authors hypothesized that near infrared spectroscopy could be used to monitor the spinal cord's cellular energy equilibrium during spinal surgery (i.e., that vascular compromise could be identified before irreversible damage occurred). METHODS: The posterior elements of the spine were exposed, and near infrared spectroscopy optodes (fiberoptic bundles) were sutured to either the lamina or the spinous processes of T9, T10, or both and directed toward the spinal cord. Interventions included manipulation of oxygen saturation and distraction of the T9-T10 disc space. RESULTS: With reduced oxygen delivery (lower arterial oxygen saturation and blood flow), oxygenated hemoglobin concentration decreased and deoxygenated hemoglobin concentration increased. With distraction, blood volume (oxygenated hemoglobin plus deoxygenated hemoglobin) decreased, and cytochrome aa3 became more oxidized. Changes were apparent within 1 second of the intervention beginning, and recovery to the baseline of near infrared spectroscopy occurred with relief of each intervention. CONCLUSIONS: This near infrared spectroscopy technique monitors changes in oxygenation of the spinal cord, and therefore appears capable of intraoperative warning about impending vascular compromise of the spinal cord.

Animals↗
PubMed1994

Evoked neuronal secretion of false transmitters.

The ability of differentiated neurons to secrete false transmitters in response to depolarization was examined by loading exogenous transmitters into the neuronal cytoplasm with a whole-cell recording pipette. We found that within minutes following loading of exogenous glutamate into the cytoplasm of cholinergic Xenopus spinal neurons, depolarization-evoked glutamate secretion could be detected by an acutely dissociated hippocampal pyramidal neuron manipulated into contact with the spinal neuron. Similarly, when ACh was loaded into a glutamatergic hippocampal neuron, evoked ACh secretion could be detected by a myocyte. The evoked secretion of the false transmitter was Ca2+ dependent and appeared to be vesicular in nature. These results suggest that differentiated neurons are capable of packaging and secreting multiple nonpeptide transmitters, provided that sufficient concentrations of the transmitters are available in the cytoplasm.

Acetylcholine↗
PubMed2004

Stem cell transplantation and other novel techniques for promoting recovery from spinal cord injury.

A number of potential approaches aim to optimize functional recovery after spinal cord injury. They include minimizing the progression of secondary injury, manipulating the neuroinhibitory environment of the spinal cord, replacing lost tissue with transplanted cells or peripheral nerve grafts, remyelinating denuded axons, and maximizing the intrinsic regenerative potential of endogenous progenitor cells. We review the application of stem cell transplantation to the spinal cord, emphasizing the use of embryonic stem cells for remyelinating damaged axons. We speculate that harnessing the potential of endogenously born stem cells already present in the spinal cord represents an important therapeutic target. We also discuss the potential application of peripheral nervous system reconstruction to recovery from spinal cord injury. The principles of peripheral nerve regeneration and concepts of nerve grafting are reviewed. Particular attention is given to peripheral nerve allotransplantation for repairing extensively injured tissue when autologous donor nerve material is scarce. The potential role of nerve transfers for reconstructing the injured spinal cord, particularly the cauda equina and lumbosacral plexus, are also described.

Animals↗
PubMed2006

New strategies for repairing the injured spinal cord: the role of stem cells.

Thanks to advances in the stem cell biology of the central nervous system, the previously unconceivable regeneration of the damaged spinal cord is approaching reality. A number of potential strategies aim to optimize functional recovery after spinal cord injury. They include minimizing the progression of secondary injury, manipulating the inhibitory environment of the spinal cord, replacing lost tissue with transplanted cells or peripheral nerve grafts, remyelinating denuded axons and maximizing the intrinsic regenerative potential of endogenous progenitor cells. We review the application of stem cell transplantation to the spinal cord, emphasizing the use of embryonic stem cells for remyelinating damaged axons. Recent advancements in neural injury and repair, and the progress towards development of neuroprotective and regenerative interventions are discussed.

Animals↗
PubMed2005

A spine frame for intra-operative fixation to increase accuracy in spinal navigation and robotics.

OBJECTIVE: Intra-operative movements due to mechanical ventilation or manipulations are a limiting factor for accurate spinal navigation or robotic-assisted spinal surgery. The purpose of this study was to assess the accuracy of an intra-operative spinal fixation device in an experimental setup. MATERIALS AND METHODS: We developed a fixation device, attached to the operating table, that combines soft tissue retraction with spinal process fixation. Using a lumbar spine cadaver, tightness of fixation was evaluated using two measurement systems. Accuracy measurements using changes in spatial co-ordinates of implanted reference markers were performed in three segments, following different manipulations of the spine. In addition, for intra-operative movements of the spine during mechanical ventilation, the range of motion was determined in 10 patients during lumbar interbody fusion. RESULTS: The spine frame was easy to use and did not restrict screw insertion. Mean deviations of the markers' in all segments were measured at between 0.35 and 0.8 mm, following pedicle screw insertion and lateral traction. Intra-operative range of motion of the spine was measured with a mean value of 8.7 +/- 3.3 mm. CONCLUSION: Using our spine frame, a rigid fixation following manipulation of the spine was demonstrated. By overcoming the intra-operative movement-dependent inaccuracy, safety in navigated spine surgery and robotic-assisted procedures might be improved.

Analysis of Variance↗
PubMed2002

Cervical manipulation--how might informed consent be obtained before treatment?

This article discusses methods and mediums of obtaining informed consent in physiotherapy clinical practice, specifically in relation to cervical manipulation. Whilst cervical manipulation is a useful method of treatment for spinal joint pain and dysfunction, it has also been shown to be ineffective or even positively harmful. Legal precedents have set boundaries for informing patients of such adverse consequences. However, a degree of uncertainty exists in the physiotherapy profession, as in other health care professions, as to how to obtain informed consent in a busy clinical setting in order to discharge the legal duties owed. Obtaining meaningful informed consent in clinical practice raises issues of patient comprehension, memory and decision-making capacity. A large quantity of research directed at enhancing patient understanding has been undertaken in recent years. The important findings are that a variety of communication methods and mediums need to be employed in both providing information and assessing patient understanding. A combination of verbal, written and audiovisual information provides patients with maximum opportunity to be involved in treatment decisions.

Audiovisual Aids↗
PubMed2005

Status of activator methods chiropractic technique, theory, and practice.

OBJECTIVE: To provide an historical overview, description, synthesis, and critique of the Activator Adjusting Instrument (AAI) and Activator Methods Chiropractic Technique of clinical assessment. METHODS: Online resources were searched including Index to Chiropractic Literature, EBSCO Online, MANTIS, CHIROLARS, CINAHL, eJournals, Ovid, MDConsult, Lane Catalog, SU Catalog, and Pubmed. Relevant peer-reviewed studies, commentaries, and reviews were selected. Studies fell into 2 major content areas: instrument adjusting and the analysis system for therapy application. Studies were categorized by research content type: biomechanical, neurophysiological, and clinical. Each study was reviewed in terms of contribution to knowledge and critiqued with regard to quality. DISCUSSION: More than 100 studies related to the AAI and the technique were found, including studies on the instrument's mechanical effects, and a few studies on clinical efficacy. With regard to the analysis, there is evidence for good reliability on prone leg-length assessment, but to date, there is only 1 study evaluating the Activator Methods Chiropractic Technique analysis. CONCLUSION: A body of basic science and clinical research has been generated on the AAI since its first peer-reviewed publication in 1986. The Activator analysis may be a clinically useful tool, but its ultimate scientific validation requires testing using sophisticated research models in the areas of neurophysiology, biomechanics, and statistical analysis.

Clinical Trials as Topic↗
PubMed1999

Validation of the force and frequency characteristics of the activator adjusting instrument: effectiveness as a mechanical impedance measurement tool.

OBJECTIVE: To determine the dynamic force-time and force-frequency characteristics of the Activator Adjusting Instrument and to validate its effectiveness as a mechanical impedance measurement device; in addition, to refine or optimize the force-frequency characteristics of the Activator Adjusting Instrument to provide enhanced dynamic structural measurement reliability and accuracy. METHODS: An idealized test structure consisting of a rectangular steel beam with a static stiffness similar to that of the human thoracolumbar spine was used for validation of a method to determine the dynamic mechanical response of the spine. The Activator Adjusting Instrument equipped with a load cell and accelerometer was used to measure forces and accelerations during mechanical excitation of the steel beam. Driving point and transfer mechanical impedance and resonant frequency of the beam were determined by use of a frequency spectrum analysis for different force settings, stylus masses, and stylus tips. Results were compared with beam theory and transfer impedance measurements obtained by use of a commercial electronic PCB impact hammer. RESULTS: The Activator Adjusting Instrument imparted a very complex dynamic impact comprising an initial high force (116 to 140 N), short duration pulse (<0.1 ms) followed by several lower force (30 to 100 N), longer duration impulses (1 to 5 ms). The force profile was highly reproducible in terms of the peak impulse forces delivered to the beam structure (<8% variance). Spectrum analysis of the Activator Adjusting Instrument impulse indicated that the Activator Adjusting Instrument has a variable force spectrum and delivers its peak energy at a frequency of 20 Hz. Added masses and different durometer stylus tips had very little influence on the Activator Adjusting Instrument force spectrum. The resonant frequency of the beam was accurately predicted by both the Activator Adjusting Instrument and electronic PCB impact hammer, but variations in the magnitude of the driving point impedance at the resonant frequency were high (67%) compared with the transfer impedance measurements obtained with the electronic PCB impact hammer, which had a more uniform force spectrum and was more repeatable (<10% variation). The addition of a preload-control frame to the Activator Adjusting Instrument improved the characteristics of the force frequency spectrum and repeatability of the driving point impedance measurements. CONCLUSION: These findings indicate that the Activator Adjusting Instrument combined with an integral load cell and accelerometer was able to obtain an accurate description of a steel beam with readily identifiable geometric and dynamic mechanical properties. These findings support the rationale for using the device to assess the dynamic mechanical behavior of the vertebral column. Such information would be useful for SMT and may ultimately be used to evaluate the [corrected] biomechanical effectiveness of various manipulative, surgical, and rehabilitative spinal procedures.

Acceleration↗
PubMed2001

Amino acids are still as exciting as ever.

Glutamate is probably the most important excitatory transmitter in the vertebrate central nervous system. Its multiple functional roles in the brain and spinal cord make therapeutic manipulation of these systems fraught with difficulties. There has, however, been recent progress in pharmacological manipulations of NMDA receptor subtypes and non-NMDA receptors, and understanding of the roles of NAAG, that promise rapid advances in pain control.

Animals↗