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PubMed2003

Long-term spinal cord injury increases susceptibility to isometric contraction-induced muscle injury.

Complete spinal cord injury (SCI) results in inactivation and unloading of affected skeletal muscles. Unloading causes an increased susceptibility of muscle to contraction-induced injury. This study used magnetic resonance imaging (MRI) to test the hypothesis that isometric contractions would evoke greater muscle damage to the quadriceps femoris muscle (mQF) of SCI subjects than that of able-bodied (AB) controls. MR images were taken of the mQF prior to, immediately post, and 3 days post electromyostimulation (EMS). EMS consisted of five sets of ten isometric contractions (2 s on/6 s off, 1 min between sets) followed by another three sets of ten isometric contractions (1 s on/1 s off, 30 s between sets). Average muscle cross-sectional area (CSA) and the relative areas of stimulated and injured muscle were obtained from MR images by quantifying the number of pixels with an elevated T2 signal. SCI subjects had significantly greater relative area [90 (2)% versus 66 (4)%, P<0.05; mean (SE)] but a lesser absolute area [16 (3) cm(2) versus 44 (6) cm(2), P<0.05] of mQF stimulated than AB controls. During EMS, peak torque was reduced by 66% and 37% for SCI and control subjects, respectively. Three days post EMS, there was a greater relative area of stimulated mQF injured for the SCI subjects [25 (6)% versus 2 (1)%, P<0.05]. Peak torque remained decreased by 22% on day 3 in the SCI group only. These results indicate that affected muscle years after SCI is more susceptible to contraction-induced muscle damage, as determined by MRI, compared to AB controls. They also support the contention that electrically elicited isometric contractions are sufficient to cause muscle damage after a prolonged period of inactivity.

Adult↗
PubMed1999

Breathlessness and exercise in spinal cord injury.

After spinal cord injury (SCI), breathlessness during daily activities is common. In 308 individuals with SCI, the authors measured pulmonary function and administered a survey regarding health status, participation in wheelchair athletics, and breathlessness during different activities. The following questions were included: A. Are you troubled by shortness of breath when hurrying on the level or going up a slight hill?; B. Do you have to go slower than people of your own age on the level because of breathlessness?; C. Do you ever have to stop for breath when going at your own pace on the level?; and D. Do you ever have to stop for breath after going about 100 yards on the level? The analysis was restricted to 183 subjects with neurologically motor complete or incomplete SCI who, to get around, used hand-propelled wheelchairs more than 50% of the time. Of these, 56 (31%) reported breathlessness during some types of activities. Subjects with neurologically motor complete cervical or high thoracic SCI (T-6 and above) were more likely to report breathlessness than others (39% compared with 25%, p = .039). Among wheelchair athletes, the prevalence of breathlessness was 8/49 (16%) versus 48/134 (36%) for non-athletes (p = .011). Adjusting for smoking, neurological level, and history of obstructive lung disease, non-athletes were 2.3 times more likely to report breathlessness than athletes were (p = .049 to .075, depending on regression model). This relationship persisted when adjusted for percent predicted forced expiratory volume (FEV1) and maximal expiratory and inspiratory pressures. Therefore in SCI, wheelchair athletes are less likely to report breathlessness than non-athletes, but the mechanism does not appear to be improvement in respiratory muscle performance or pulmonary function.

Activities of Daily Living↗
PubMed1995

Vitamin D deficiency in veterans with chronic spinal cord injury.

Chronic spinal cord injury (SCI) is associated with osteopenia, increasing the prevalence of long-bone fractures. Although disuse may be the primary cause of osteopenia, identification of any additional mechanisms of bone loss may lead to potential therapeutic interventions. We investigated the relationships of serum calcium (Ca), phosphorus (PO4), albumin, alkaline phosphatase (Alk P), and parathyroid hormone (PTH) with serum 25-hydroxyvitamin D [25(OH)D] in 100 subjects with chronic SCI and 50 control subjects. in a subgroup of 50 subjects with SCI and 50 control subjects, we correlated these parameters with serum 1,25-dihydroxyvitamin D [1,25(OH)2D]. Mean ages for the group with SCI and the controls were the same. In subjects with SCI, the duration of injury was 20 +/- 1 years (mean +/- SD). Thirty-two of 100 subjects with SCI, as compared with eight of 50 controls, had serum 25(OH)D levels less than the normal range (chi2 = 4.36, P < .05). In subjects with SCI, a negative correlation was demonstrated between serum 25(OH)D and PTH (r = .29, P < .005). Mean serum 1.25(OH)2D levels were significantly elevated in subjects with SCI as compared with controls (61 +/- 21 v 46 +/- 18 pg/mL, P < .0005). Twenty of 50 subjects with SCI had serum 1.25(OH)2D levels greater than 62 pg/mL, as compared with 10 of 50 controls (chi2 = 4.76 P < .05). A positive correlation was found between serum PTH and 1,25(OH)2D in subjects with SCI and controls (r = .41, P < .005 and r = .30, P < .05, respectively). Twelve subjects with SCI had serum PTH levels greater than the normal range. In this high-serum PTH subgroup, serum 15(OH)D concentration was significantly lower (P < .05) and serum 1,25(OH)2D and Alk P concentrations were significantly higher (P < .005 and P < .05, respectively) as compared with the subgroup with serum PTH values within the normal range. In subjects with SCI, 17 had a serum Ca concentration less than 8.5 mg/dL. In persons with SCI, depressed levels of serum 25(OH)D, as well as other factors, may result in forces inclined to reduce the serum calcium concentration. A state of mild secondary hyperparathyroidism may result, thus increasing the conversion of serum 25(OH)D to 1.25(OH)2D. These data suggest that in chronic SCI subjects, as in the general population, secretion of PTH and the increase of circulating 1.25(OH)2D are subject to control by negative-feedback mechanisms. Higher levels of serum PTH would be expected to accelerate bone resorption of a skeleton already regionally osteoporotic as a consequence of the bone mineral loss due to acute immobilization.

Adult↗
PubMed2005

Gangliosides for acute spinal cord injury.

BACKGROUND: Spinal cord injury (SCI) results in loss of feeling and movement. The consequences can be devastating for the patient and his or her carers. Global estimates of the number of new cases annually range from 15 to 40 per million. Leading causes of acute SCI are road traffic injury, violence, and injuries sustained in sports and other recreational activities. Care for people with SCI has improved, leading to an increase in survival rates. Attempts to improve patients' feeling and movement have involved the use of a wide range of treatments. Gangliosides are compounds that occur naturally in cell membranes. Laboratory studies have suggested they may have protective effects on nerves and even help them to re-grow. Clinical trials have taken place using gangliosides (usually GM1 ganglioside) for a number of neurological conditions. OBJECTIVES: To quantify the evidence for the effectiveness and safety of gangliosides when used to treat acute SCI. SEARCH STRATEGY: We searched the following databases to identify trials for inclusion: CENTRAL, MEDLINE, EMBASE, and the National Research Register. We also searched web-based trials registers, such as Current Controlled Trials. We approached the manufacturers of the most widely used ganglioside and researchers in this field to try to locate any unpublished data. SELECTION CRITERIA: Randomised controlled trials of any ganglioside versus controls, in patients with SCI. Outcome measures specified were: mortality, recovery of motor function, improvement in sensory measures, measures of functional activity, infections and any other adverse events. DATA COLLECTION AND ANALYSIS: Data were extracted from published studies and authors were contacted for further information. All data found was dichotomous and odds ratios (with 95% CIs) were calculated. A fixed-effects model was assumed. MAIN RESULTS: Two studies met the inclusion criteria. There were no deaths in one (n=37). In the other (n=760), there were slightly more deaths in the treatment group than in the control group; odds ratio 1.07 (0.57, 2.00 95%CI) - a result that can be explained by the play of chance. Methodological weaknesses regarding the collection and presentation of data from the two studies made it impossible to reach any conclusions regarding the effect of gangliosides on the other specified outcomes. AUTHORS' CONCLUSIONS: The evidence available does not support the use of ganglioside treatment to reduce the death rate in SCI patients. No evidence has yet emerged that ganglioside treatment improves recovery or quality of life in survivors.

Acute Disease↗
PubMed1985

Safe intubation in cervical spine injury.

Traumatic spinal injury is an ongoing community problem. Anatomical stability of the cervical spine depends on the integrity of the bony and ligamentous structures forming the cervical spine. Such stabilising structures are divided into two groups. These are designated anterior and posterior columns. One or both columns may be damaged during traumatic spinal injury. Not all spinal injuries are unstable. Instability may be predicted by viewing anterior-posterior and lateral X-rays of the cervical spine. C1 and C2 injury necessitates special through-mouth views. Instability of the neck requires a different intubation technique. A safe intubation technique is described, the essence of which is to stabilise the neck with longitudinal traction and avoid extension at the fracture site.

Anesthesia↗
PubMed1982

Missed injuries of the spinal cord.

Damage to the spinal cord had not been recognised initially in 15 patients out of a consecutive series of 353 admitted over a decade to the National Spinal Injuries Centre with paralysis due to trauma to the cord. In some patients the missed diagnosis led to mismanagement and a greater neurological deficit. Missed injuries of the spinal cord are seen in patients with multiple injuries and head injuries and in those without any paralysis. Various radiological errors contribute to the failure to recognise the vertebral injury. In addition to causing severe disability to the victim these missed and mismanaged injuries of the spinal cord cost the National Health Service large sums in compensation. A careful evaluation of the history of each accident, with greater awareness of the potential of certain types of accidents to cause spinal cord injury, should reduce the incidence of missed injuries of the spinal cord.

Accidents↗
PubMed1996

The International Spinal Research Trust's strategic approach to the development of treatments for the repair of spinal cord injury.

The International Spinal Research Trust (ISRT) has selected a sub-set of the key molecular and cellular events underlying spinal injury and nerve regeneration, to be focus of their funding and other means of research support. These priority targets are (i) to understand and to minimise the damage caused by spinal injury and the resulting inflammatory and fibrotic events, in order to prevent the establishment of a post-acute situation that is ill-placed for regeneration; and (ii) to understand and then to manipulate the integrated environment for regrowth that is created by the interplay of soluble and matrix- or membrane-associated factors, both trophic and inhibitory. Investigation and, ultimately, exploitation of these targets requires the development of standardised and representative animal models and the application of quantitative methods for assessing functional re-innervation. The ISRT will also sponsor the networking of different disciplines and technologies to apply the most productive skills to spinal repair.

Humans↗
PubMed1990

New spinal cord injury model produced by spinal cord compression in the rat.

Graded spinal cord injuries were produced in rats by compressing the spinal cord at the level of the T11 vertebra for 5, 15, 30, 60, or 180 min with stainless steel screws of 2-mm diameter and 2.8-mm length, or for 60 min with screws of the same diameter and various lengths (2.5, 2.8, 3.1, or 3.4 mm). The main neurologic symptoms caused by spinal cord compression were motor deficits, sensory deficits, and urinary incontinence. Neurologic scores, based on both motor and sensory deficits, correlated significantly with both the screw length and the duration of compression at every observation point from 4 hr to 21 days after removal of the screw. The incidence of urinary incontinence (from 24 hr to 21 days) and the percentage of rats surviving (from 14 days to 21 days) also correlated closely with the two factors (screw length and duration of compression). These results suggest that the present procedure could be a useful and simple model for studying traumatic spinal cord injury in rats.

Animals↗
PubMed2005

Pediatric spinal trauma: injuries in very young children.

Injuries to the spine in very young children are comparatively rare. The prevalence of upper cervical injuries and spinal cord injuries is greater. Spinal cord injury is more common in young children and fracture is less common than in older children and adolescents. This is because of the anatomic and biomechanical differences in the growing spine including a more horizontal facet orientation, greater elasticity of the soft tissues, less muscular development, and relatively greater head size compared to the trunk. These features are more pronounced in the very young child. The clinical and radiographic evaluation of small children can be difficult. Unossified bone and physeal cartilage can be confused with fractures. The evaluation, safe transportation, and spinal clearance of the unconscious multiply injured child suspected of having spinal injury present special challenges.

Atlanto-Occipital Joint↗
PubMed1996

Sports-related spinal cord injury in Japan (from the nationwide spinal cord injury registry between 1990 and 1992).

The Injury Prevention Committee of the Japan Medical Society of Paraplegia (JMSoP) conducted a nationwide epidemiological survey on spinal cord injury (SCI) using postal questionnaires for 3 years periods from 1990 to 1992, and the annual incidence of the spinal cord injury was estimated as 40.2 per million. From this registry, we investigated SCI related to sports activities. In 3 years, 528 patients were registered and 374 of them had neurological deficits. The incidence was 1.95 per million per annum. Mean age at injury was 28.5 years (10-77), and 88.1% of the patients were males. Diving was the commonest cause of SCI (21.6%), which was followed by skiing (13.4%), football including rugby, American football and soccer (12.7%), sky sports (7.0%), judo (6.8%) and gymnastics (6.6%). Mean age at injury was higher than 30 years in skiing (38.6 years) and sky sports (38.2 years). Cervical injury was predominant in all but sky sports and accounted for 83.5% of SCI. Motor complete paralysis was reported in 35.0% of the patients. Bony injury was observed in 55.9% of the patients; most of the patients who sustained the SCI in diving and sky sports had bony injury, and no bony injury was detected in more than a half of the patients who sustained injuries in skiing, judo or gymnastics. Although the percentage of sports-related SCI was small in the present study as compared to the data from previous reports, it is not difficult to imagine the increase in the number of sports-related SCI. We have launched an injury prevention campaign and are planning to conduct a similar study in future to evaluate the effect of the campaign as well as the changes in the incidence and pattern of SCI.

Adolescent↗
PubMedDate not supplied

Suicidal ideation among patients with acute life-threatening physical illness: patients with stroke, traumatic brain injury, myocardial infarction, and spinal cord injury.

Suicide is one of the leading causes of death in the community. The risk of suicide is greater among patients with physical illnesses than among the general population. This study was undertaken to evaluate the clinical characteristics and correlates of suicidal ideation in patients with acute life-threatening physical illnesses and to assess the duration of suicidal ideation. The study included a consecutive series of patients admitted with stroke, traumatic brain injury, myocardial infarction, or spinal cord injury (n=496). Study participants were administered a semistructured psychiatric interview as well as a series of standardized quantitative scales of mood, cognitive function, physical impairment, social ties, and social functioning. Follow-up evaluations of up to 24 months were also carried out. This study found that 36 (7.3%) patients with acute medical illness had clinically significant suicidal ideation. The suicidal ideation occurred mostly among patients with major depression and sometimes in those with minor depression. About 25% of patients with major depression and acute physical illnesses developed suicidal ideation. After the improvement of depressive disorders, suicidal ideations were ameliorated. These findings suggest that the detection and treatment of depressive disorders is the most important factor in preventing suicide among this patient population.

Acute Disease↗
PubMed2005

Glial and neuronal connexin expression patterns in the rat spinal cord during development and following injury.

Spinal cord injury induces a complex cascade of degenerative and remodeling events evolving over time. The possible roles of changed intercellular communication via gap junctions after spinal cord injury (SCI) have remained relatively unexplored. We investigated the temporospatial expression patterns of gap junctional genes and proteins, connexin 43 (Cx43), Cx36, and Cx32, by in situ hybridization and immunohistochemistry in the rat neonatal, adult normal, and adult injured spinal cord. Cx36 was strongly expressed in immature neurons, and levels declined markedly during development, whereas Cx43 and Cx32 persisted throughout adulthood. After a complete transection of the adult spinal cord, the levels of Cx43 mRNA and protein were up-regulated within hours, especially in gray matter rostral to the lesion, reaching over three times normal levels at 4 weeks postinjury. Cx43 immunoreactivity was seen primarily in astrocytes and rarely in microglia. In contrast, Cx36 and Cx32 mRNA and proteins were relatively sparse and unchanged after spinal cord injury along the entire axis of the spinal cord. Cx43 is the most abundant gap junctional protein in the adult CNS and has been shown to form channels between astrocytes as well as between astrocytes and oligodendrocytes. Long-term up-regulation of Cx43 in reactive astrocytes may be one critical component in the rearrangement of the local astroglial network following SCI.

Animals↗
PubMed1999

Why does the central nervous system not regenerate after injury?

Spinal cord injuries in humans and in other mammals are never followed by regrowth. In recent years, considerable progress has been made in analyzing mechanisms that promote and inhibit regeneration. The focus of this review is changes that occur in the transition period in development when the central nervous system (CNS) changes from being able to regenerate to the adult state of failure. In our experiments we have used the neonatal opossum (Monodelphis domestica), which corresponds to a 14-day embryonic rat or mouse. The CNS isolated from an opossum pup and maintained in culture shows dramatic regeneration. Fibers grow through and beyond lesions and reform synaptic connections with their targets. Similarly, anesthetized neonatal pups attached to the mother recover the ability to walk after complete spinal cord transection. Although the CNS isolated from a 9-day-old animal will regenerate in vitro, CNS from a 12-day-old will not. This is the stage at which glial cells in the CNS develop. Present research is devoted toward molecular screening to determine which growth-promoting molecules decrease during development, which inhibitory molecules increase, and which receptors on growing axons become altered. Despite progress in many laboratories, major hurdles must be overcome before patients can hope to be treated. Nevertheless, the picture today is not as discouraging as it was: one can think of strategies for research on spinal cord injury so as to promote regeneration and restore function.

Animals↗
PubMed2004

Exercise recommendations for individuals with spinal cord injury.

Persons with spinal cord injury (SCI) exhibit deficits in volitional motor control and sensation that limit not only the performance of daily tasks but also the overall activity level of these persons. This population has been characterised as extremely sedentary with an increased incidence of secondary complications including diabetes mellitus, hypertension and atherogenic lipid profiles. As the daily lifestyle of the average person with SCI is without adequate stress for conditioning purposes, structured exercise activities must be added to the regular schedule if the individual is to reduce the likelihood of secondary complications and/or to enhance their physical capacity. The acute exercise responses and the capacity for exercise conditioning are directly related to the level and completeness of the spinal lesion. Appropriate exercise testing and training of persons with SCI should be based on the individual's exercise capacity as determined by accurate assessment of the spinal lesion. The standard means of classification of SCI is by application of the International Standards for Classification of Spinal Cord Injury, written by the Neurological Standards Committee of the American Spinal Injury Association. Individuals with complete spinal injuries at or above the fourth thoracic level generally exhibit dramatically diminished cardiac acceleration with maximal heart rates less than 130 beats/min. The work capacity of these persons will be limited by reductions in cardiac output and circulation to the exercising musculature. Persons with complete spinal lesions below the T(10) level will generally display injuries to the lower motor neurons within the lower extremities and, therefore, will not retain the capacity for neuromuscular activation by means of electrical stimulation. Persons with paraplegia also exhibit reduced exercise capacity and increased heart rate responses (compared with the non-disabled), which have been associated with circulatory limitations within the paralysed tissues. The recommendations for endurance and strength training in persons with SCI do not vary dramatically from the advice offered to the general population. Systems of functional electrical stimulation activate muscular contractions within the paralysed muscles of some persons with SCI. Coordinated patterns of stimulation allows purposeful exercise movements including recumbent cycling, rowing and upright ambulation. Exercise activity in persons with SCI is not without risks, with increased risks related to systemic dysfunction following the spinal injury. These individuals may exhibit an autonomic dysreflexia, significantly reduced bone density below the spinal lesion, joint contractures and/or thermal dysregulation. Persons with SCI can benefit greatly by participation in exercise activities, but those benefits can be enhanced and the relative risks may be reduced with accurate classification of the spinal injury.

Electric Stimulation Therapy↗
PubMed1995

Comparison of residual stability in thoracolumbar spine fractures using neutral zone measurements.

Because treatment algorithms for spinal injuries depend largely on the clinical assessment of stability after injury, this study both quantified and compared the mechanical stability after three different patterns of injury in the thoracolumbar spine. We created compression fractures, burst fractures, and flexion-distraction injuries in 26 thoracolumbar specimens from human cadavers in order to compare residual stability as a function of type of injury. Spinal stability was evaluated using measurements of the boundaries of the neutral zone, which provide a measure of spinal laxity in various directions of motion. An increase after injury was indicative of greater spinal laxity and hence reduced residual stability. Geometric characteristics (or parameters) of the neutral zone boundaries were used for statistical comparison between the types of injury. Of the three groups, burst fractures retained the least residual stability and compression fractures, the greatest. The angular ranges of motion in the neutral zone for burst fractures demonstrated increases (compared with average values for intact specimens) of 154% in flexion-extension, 134% in lateral bending, and 108% in torsion after injury. The results for flexion-distraction injuries were similar to those for burst fractures in flexion-extension (126%) and torsion (62%); however, more residual stability was retained in lateral bending than was seen for burst fractures (48%). Compression fractures retained the most residual stability, with increases in motion of 40% in flexion-extension, 56% in lateral bending, and 3% in torsion. These findings may be useful in determining the necessity for surgical stabilization of the spine and selection of the appropriate system of fixation.

Biomechanical Phenomena↗