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PubMed1994

Spermatogenesis and the pituitary-testicular hormone axis in rats during the acute phase of spinal cord injury.

Male infertility frequently occurs after spinal cord injury (SCI). However, little is known about the acute effects of SCI on male reproductive function. This study evaluated the effects of SCI on spermatogenesis and testicular-pituitary function in rats 2 and 4 weeks after injury. Spinal cord injury was produced in rats by T9 spinal cord transection. Controls received similar surgery without transection. Complete spermatogenesis was seen 2 weeks after SCI; however, abnormalities were present in the seminiferous tubules. Hormone levels were similar in the two groups. Four weeks after SCI, incomplete spermatogenesis was noted in 3 of 9 rats, 4 others had delayed spermiation, and the last 2 had nonspecific regression of seminiferous epithelium. Serum testosterone levels were lower at 4 weeks in SCI rats than in controls, but testicular testosterone content was not. Plasma gonadotropin levels were similar in the two groups 4 weeks after SCI. Quantitative analysis revealed a 26 to 33% decrease in the number of spermatogenic cells in stage VII seminiferous tubules at 4 weeks in SCI rats (p < 0.01). This study demonstrated that qualitative and quantitative impairments of spermatogenesis occur during the acute phase of SCI in rats.

Acute Disease↗
PubMed2000

Classifying incomplete spinal cord injury syndromes: algorithms based on the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients.

OBJECTIVE: To develop an objective and uniform means for classifying patients with incomplete spinal cord injury (SCI) according to SCI syndromes. DESIGN: Criteria for assigning the syndromes (defined by the International Standards for Neurological and Functional Classification of SCI Patients) were operationalized by means of sensory and motor scores and were incorporated into a set of six independent algorithms and two composite algorithms. SETTING: A regional SCI rehabilitation center in Canada. PATIENTS: SCI patients (n = 56) with incomplete injuries (American Spinal Injury Association classes B, C, D) and stable neurologic deficits. RESULTS: Individual algorithms allowed the highest classification rate but with some patients meeting the criteria for more than one syndrome. A composite, differential allocation algorithm, with selected thresholds at decision nodes, yielded a classification rate approximating that of the individual algorithms but without double classifications. CONCLUSIONS: The composite algorithm provided an objective and standardized means of assigning patients to syndromes based on clinically measurable sensory and motor scores. The thresholds used to implement criteria and the order of decision nodes greatly influenced the outcomes and may be adjusted to suit the needs of the classification, that is, embracing liberal or stringent criteria. Controversy remains about the interpretation of some syndromes, and many patients remain unclassifiable because of mixed clinical presentation.

Adult↗
PubMed1995

Role of sodium in the pathophysiology of secondary spinal cord injury.

STUDY DESIGN: Experimental study using an in vitro model of compressive injury to isolated adult rat dorsal column axons. OBJECTIVES: To examine the role of extracellular Na+ (Na+e) in mediating secondary injury to spinal cord axons after compressive trauma. The mechanisms of intracellular sodium entry were examined using ion substitution techniques and pharmacologic blockers. SUMMARY OF BACKGROUND DATA: There is evidence that intracellular Na+ entry potentiates hypoxic-ischemic cell death by causing cytotoxic cell swelling, intracellular acidosis, and gating of Ca++ entry through reverse activation of the Na(+)-Ca++ exchanger. In the present study, we have examined the role of Na+e in the pathophysiology of spinal cord injury. METHODS: Dorsal column segments isolated from the thoracic cord of adult rats (n = 40) were pinned in a recording chamber and superfused with oxygenated Ringer's solution. Extracellular field potentials were recorded from glass microelectrodes (150 mmol KCl; 5-10 mol). Injury was accomplished in vitro by compression with a modified aneurysm clip (closing force, 2 g) for 15 seconds. The effect of zero Na+e (equimolar substitution with NMDG+), the Na(+)-H+ exchange blocker amiloride, the Na+ channel blocker procaine, and the Na(+)-Ca++ exchanger blocker benzamil on CAP recovery after compressive injury were assessed. RESULTS: Pretreatment with zero Na+, amiloride and procaine conferred significant neuroprotection (P < 0.05). In contrast, the NCE blocker benzamil was ineffective in attenuation secondary injury. CONCLUSIONS: Reduction of extracellular Na+, inhibition of the Na(+)-H+ exchanger or blockade of voltage gated Na+ channels is neuroprotective after spinal cord injury. The mechanism of Na(+)-associated cytotocity does not involve reverse gating of the Na(+)-Ca++ exchanger.

Action Potentials↗
PubMed1991

Back injury prevention program on a spinal cord injury unit.

A back injury prevention program was developed for the Spinal Cord Injury (SCI) nursing staff at the San Diego Veterans Affairs Medical Center (SDVAMC). This preventive program has the following components: 1. All nursing staff are sent to a one hour "back school" in order to learn and practice proper body mechanics. This program is held in the therapy clinic and conducted by a kinesiotherapist. In addition, each nurse must be certified in transfer techniques by our clinical nurse specialist, before performing transfers on patients. 2. All nursing staff participate in 5-10 minutes of stretching, warm-up exercises at the beginning of their shift. These exercises are helpful as injuries are less likely to occur when muscles have been warmed up prior to lifting and moving patients. 3. All nursing staff wear a lumbar sacral back support while on duty. This device will offer physical support to the lower back as well as provide a mental reminder to use proper body mechanics when transferring patients. This back injury prevention program has been in effect since the opening of the SCI unit in March 1989. The rate of low-back injuries on the SCI unit from October 1989 to September 1990 was compared to the rate of low-back injuries on the other hospital units. As a result of this program, there were only four low-back injuries with six lost work days on the SCI unit. This rate compares favorably with the incidence of low-back injuries in other patient care areas.

Back Pain↗
PubMed1981

The prevention of iatrogenic spinal cord injury utilizing the evoked spinal cord potential.

The evoked spinal cord potential elicited by direct stimulation of the cord has been used clinically to monitor cord function in the course of operations on the spine. The technique used allows measurement of a relatively large amplitude of potential, which is fairly stable against anaesthetics and related drugs, by means of a simple recording system and is sensitive enough to indicate cord damage. Continuous monitoring can easily be carried out. We have encountered no complications when using this method on 99 patients.

Adolescent↗
PubMed1994

Treatment strategies in traumatic cervical spinal cord injuries with tetraplegia.

In our unit between 1984 and January 1988 we have operatively reduced the hospital treatment time in 21 cases of cervical injuries including spinal cord lesions. An initial reposition was carried out according to the principles of Lorenz Böhler and the fixation achieved using a Smith-Robinson H-plate widge spondylodesis. Further conservative management was carried out as advocated by the late Sir Ludwig Guttmann. Early use of operative techniques meant that we were able to shorten significantly the period of medical rehabilitation as compared with previous conservative methods of treatment.

Adult↗
PubMed1993

Spinal cord injury and pregnancy.

Spinal cord injuries occur more frequently in women than in the past because of the societal and cultural changes in this country. Female survivors of spinal cord injuries have an improved prognosis for return to independence and societal contribution over their counterparts of 15 to 20 years ago. Because fertility is not affected, it is reasonable to predict that perinatal centers will continue to see an increase in spinal cord-injured patients. The unique nature of the injury makes pregnancy in these women a challenging event. The objectives of care are to prevent the complications associated with pregnancy while supporting independence. A multidisciplinary team approach best serves these patients and provides the best possible outcome for both mother and baby.

Adult↗
PubMed2005

Involvement of 5-lipoxygenase in spinal cord injury.

A traumatic spinal cord injury (SCI) induces a sequelae of events which conduce biochemical and cellular alterations. Here we compare the degree of spinal cord injury caused by the application of vascular clips, in mice lacking the 5-lipoxygenase and in the corresponding wild-type mice. Biochemical, immunohistochemical and functional studies revealed respectively an increase of neutrophils infiltration, of IL-1beta, TNF-alpha immunoreactivity, apoptosis (measured by Annexin-V staining) and loss of hind legs movement in SCI operated 5-LO wild-type mice. In contrast, the degree of (1) neutrophil infiltration at different time points, (2) cytokine expression (TNF-alpha and IL-1beta), (3) histological damage, (4) apoptosis, was markedly reduced in the tissues obtained from SCI operated 5-LO deficient mice and (5) the motor recovery was ameliorated.

Animals↗
PubMed1979

Urethral hypotonicity after suprasacral spinal cord injury.

Established suprasacral spinal cord injuries usually are associated with detrusor hyperreflexia and varying degrees of detrusor-sphincter dyssynergia. Occasionally, such injuries result in detrusor areflexia or urethral hypotonicity or both. The results of the urodynamic evaluation of 4 patients with suprasacral spinal cord injuries are described. Detrusor areflexia and urethral hypotonicity were demonstrated in 3 cases and urethral smooth muscular hypotonia but preserved reflex detrusor function in 1. It is shown that destruction of the thoracolumbar sympathetic outflow can cause the complete loss of urethral smooth muscular closing function and that resting urethral closure is totally independent of preganglionic cholinergic influences.

Adult↗
PubMed1986

Assessment of closed head injury in trauma-related spinal cord injury.

The complete medical records of 122 patients who sustained traumatic spinal cord injuries were reviewed to determine the frequency and results of emergency room assessments for loss of consciousness (LOC) and post-traumatic amnesia (PTA). Eighty-eight percent of the patients were assessed for LOC and 19% were assessed for PTA. Fifty patients (41% of the total population) admitted to LOC, PTA or both. Fourteen of these 50 patients underwent subsequent radiographic examinations of the skull, all of which were negative. Because of the association of intracranial complications and long-term cognitive sequelae with even brief LOC or PTA, early recognition of craniocerebral trauma is an important component of the acute management of spinal cord injured patients.

Adolescent↗
PubMed1991

Clinical neurophysiology of focal spinal cord injury.

A focal spinal cord injury produces a host of electrophysiologic abnormalities, most of which reflect either local spinal cord destruction or the functional disconnection of rostral and caudal portions. Routine electromyographic and nerve conduction studies are most useful to investigate the deficits that result from local cord damage and have demonstrated that the injury zone most often extends at least 3 to 4 myotomes. Electromyographic studies of muscles innervated by more caudal myotomes have also shown abnormalities, but the extent to which these reflect primary changes of spinal cord injury is uncertain. Electrophysiologic studies of spinal cord function caudal to the site of injury have shown alterations in autonomic output, as well as changes in the level of excitability of reflex pathways. These changes may provide insight into the mechanisms that underlie the development of spasticity.

Humans↗
PubMed2006

Spinal cord stimulation: a new method to produce an effective cough in patients with spinal cord injury.

Patients with spinal cord injury have an increased risk of developing respiratory tract infections as the result of expiratory muscle paralysis and consequent inability to cough. We have developed a method by which the expiratory muscles can be activated via lower thoracic and upper lumbar spinal cord stimulation to produce an effective cough mechanism. In a tetraplegic patient who required frequent (8.57+/-2.3 times per week [mean+/-SEM]) caregiver assistance to facilitate airway clearance and expectoration of secretions, three epidural electrodes were applied in the T9, T11, and L1 spinal cord regions. During stimulation at the T9 and L1 levels, airway pressures were 90 and 82 cm H2O, respectively. Peak expiratory flow rates were 6.4 L/s and 5.0 L/s; respectively. During combined (T9+L1) stimulation, airway pressure and expiratory flow rate increased to 132 cm H2O and 7.4 L/s, respectively. Addition of the third lead did not result in further increases in pressure generation. These values are characteristic of those observed with a normal subject. Because the patient is able to trigger the device independently, he no longer requires caregiver support for airway management. If confirmed in additional patients, spinal cord stimulation may be a useful method to restore an effective cough mechanism in patients with spinal cord injury.

Cough↗
PubMed2005

Traumatic lower limb fractures following complete spinal cord injury.

Patients with complete spinal cord injury experience a rapid bone mineral density loss that places them at an increased risk of lower limb fracture following trivial injury. We aimed to establish if spinal cord injured patients treated at our unit have an increased incidence of lower limb fracture, and if so to identify a cohort of patients who may benefit from prophylactic treatment to preserve bone mineral density. We reviewed 158 patients treated between January 1994 and July 2002. There was a significantly increased incidence of lower limb fracture in patients with complete spinal cord injury (5 fractures in 4 patients), when compared to the cohort of patients with spinal injury who subsequently attained mobility (no fractures). Prophylactic bisphosphonates reduce disuse osteopenia and warrant prospective assessment in patients with complete spinal cord injury in whom they may confer a protective effect against lower limb fracture.

Adult↗
PubMed1990

Benefits of early admission to a comprehensive trauma center for patients with spinal cord injury.

Patients with spinal cord injury may be admitted directly to a trauma center with a dedicated rehabilitation unit or transferred there days or weeks later. This study analyzed the relationship between time of transfer to a Level I Trauma Center with a spinal cord injury service and efficacy of subsequent rehabilitation. We examined the records of all patients admitted to the service between September 1981 and August 1983 and followed at least one year. There were 197 patients, 102 quadriplegics and 95 paraplegics, aged 15 to 77 years (average = 29.4 years). Median time from injury to admission was 11 days for quadriplegics and 21 days for paraplegics; this was used to define early and late groups. The early quadriplegic group began rehabilitation 2.94 days postinjury; the late quadriplegic group, 74.87 days (p less than .01). Time in rehabilitation did not differ (128.22 days, early; 122.61, late), but total hospitalization--from injury to discharge--was 131.16 days for the early quadriplegic group and 197.27 for the late quadriplegic group (p less than .01). Average duration of prerehabilitation care for the paraplegic groups was 6.19 days (early) and 58.58 days (late) (p less than .01). Time in rehabilitation was the same for both paraplegic groups, but total hospitalization was shorter for early admissions (82.91 days vs 125.90 days, p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1999

The psychological effects of spinal cord injury: a review.

Spinal cord injury (SCI) usually necessitates considerable changes in the life of an individual, and their family members. SCI may demand difficult psychological adjustment and in addition place great strain on family roles and relationships. Glass (1993) summarises the situation thus: 'The experience of spinal cord injury is one of the most devastating injuries which might affect an individual. The resultant disability, after which normal cognitive function and intellectual ability usually remains, produces not only an inability to move and feel limbs, but also the inability to control the function of internal organs and even, in severe cases, the ability to breathe independently.'1

Humans↗
PubMed2005

Neuroprotective effects of ebselen on experimental spinal cord injury in rats.

Spinal cord injury (SCI) results in rapid and significant oxidative stress. This study was aimed to investigate the possible beneficial effects of Ebselen in comparison with Methylprednisolone in experimental SCI. Thirty six Wistar albino rats (200-250 g) were divided in to six groups; A (control), B (only laminectomy), C (Trauma; laminectomy + spinal trauma), D (Placebo group; laminectomy + spinal trauma + serum physiologic), E (Methylprednisolone group; laminectomy + spinal trauma + Methylprednisolone treated), F (Ebselen group; laminectomy + spinal trauma + Ebselen treated), containing 6 rats each. Spinal cord injury (SCI) was performed by placement of an aneurysm clip, extradurally at the level of T11-12. After this application, group A, B and C were not treated with any drug. Group D received 1 ml serum physiologic. Group E received 30 mg/kg Methylprednisolone and, Group F received 10 mg/kg Ebselen intraperitoneally (i.p.). Rats were neurologically examined 24 h after trauma and spinal cord tissue samples had been harvested for both biochemical and histopathological evaluation. All rats were paraplegic after SCI except the ones in group A and B. Neurological scores were not different in traumatized rats than that of non-traumatized ones. SCI significantly increased spinal cord tissue malondialdehyde (MDA) and protein carbonyl (PC) levels and also decreased superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) enzyme activities compared to control. Methylprednisolone and Ebselen treatment decreased tissue MDA and PC levels and prevented inhibition of the enzymes SOD, GSH-Px and CAT in the tissues. However, the best results were obtained with Ebselen. In groups C and D, the neurons of the spinal cord tissue became extensively dark and degenerated with picnotic nuclei. The morphology of neurons in groups E and F were very well protected, but not as good as the control group. The number of neurons in the spinal cord tissues of the groups C and D were significantly less than the groups A, B, E and F. We concluded that the use of Ebselen treatment might have potential benefits in spinal cord tissue damage on clinical grounds.

Animals↗