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PubMed1992

Membrane lipids of human peripheral nerve and spinal cord.

Major membrane lipids were determined in specimens of human peripheral nerve (cauda equina) and spinal cord of 10 subjects aged 20-70 years. The same lipids were also assayed in myelin from the same tissues isolated with two different procedures and in myelin of cauda equina from 3 subjects aged 17-91 years isolated with a third method. The concentrations (mean and standard deviation) of phospholipids were 90 +/- 11 and 96 +/- 9 nmol/g fresh weight; of cholesterol 70 +/- 15 and 101 +/- 16; of cerebroside 19 +/- 3 and 41 +/- 7; of sulfatide 10 +/- 1 and 11 +/- l; and of gangliosides 0.80 +/- 0.08 and 0.40 +/- 0.05 N in cauda equina and spinal cord, respectively. The proportion of ethanolamine phosphoglyceride was lower and that of sphingomyelin higher in cauda equina than in spinal cord. The myelin of peripheral nerve and spinal cord contained almost the same proportions of lipids as the whole tissue. The protein-bound sialic acid content was 3-fold higher than the lipid-bound sialic acid content in cauda myelin. The fatty acid patterns of choline, ethanolamine, inositol and serine phosphoglycerides of spinal cord and its myelin, were very similar to those of cerebral white matter, while the phosphoglycerides of cauda equina had higher proportions of monoenoic acids and lower proportions of polyunsaturated fatty acids. The fatty acid patterns of sphingomyelin, cerebroside and sulfatide of spinal cord were similar to those of cerebral white matter, while those of cauda equina contained significantly more saturated fatty acids. This suggests that the lipid and fatty acid compositions of peripheral nerve are particularly suitable for the formation of a tightly packed myelin membrane which can be a powerful shield against infections and other injuries.

Adolescent↗
PubMed2005

Characterization of pain and pharmacologic responses in an animal model of lumbar adhesive arachnoiditis.

STUDY DESIGN: The study used a small animal laminectomy model with kaolin to investigate the relationship of cauda equina pathology to pain, and the effects of systemic and intrathecal drugs to reduce pain. OBJECTIVE: To determine if higher amounts of cauda equina adhesions produce increased pain-related behavior following laminectomy and epidural kaolin application. SUMMARY OF BACKGROUND DATA: Clinically, the relationship of cauda equina pathology to pain is controversial. An established animal model produces cauda equina adhesions. The correlation of this anatomic pathology with pain-related behavior has not been examined. METHODS: A laminectomy was performed in Sprague-Dawley rats at the L5-L6 vertebrae, and kaolin was applied extradurally. Sham control animals had vertebrae exposed but no laminectomy/kaolin. Animals were monitored for pain-related behavior using vocalization in response to straight leg raising. Histology was performed at 6 weeks postoperatively. Laminectomy animals were tested with systemic or intrathecal drugs to reduce straight leg raising vocalizations. RESULTS: In laminectomy animals, the pain response developed over 6 weeks, with vocalizations increasing from 0 to 1.65, out of 5 leg lifts. Cauda equina clumping was related to pain severity. Systemic morphine 3 mg/kg, but not 1 mg/kg, decreased vocalization to straight leg raising. Intrathecal morphine at 30 nmol, but not 10 nmol, gabapentin at 60 nmol, but not 20 nmol, decreased vocalizations. Intrathecal clonidine up to 90 nmol did not reduce vocalization. CONCLUSIONS: An animal model of adhesive lumbar arachnoiditis yields a quantifiable pain-related response that can be used to evaluate the effects of various analgesic interventions.

Amines↗
PubMed1982

A comparative study of ependymomas by site of origin.

Sixty-one patients with histologically proven ependymoma were irradiated between 1954 and 1976. Supra-and infratentorial tumors occurred more often in children and spinal cord--cauda equina tumors more often in adults. Local control was achieved in four of 20 supratentorial, 13 of 26 infratentorial, three of seven intramedullary spinal cord, and seven of eight cauda equina tumors. Improved local control of infratentorial tumors was noted for patients who received higher biologically effective doses of radiation but no dose-response for supratentorial, spinal cord or cauda equina tumors could be found. Five-year actuarial survival was 56% for all patients, 35% for supratentorial, 59% for infratentorial, 57% for spinal cord and 83% for cauda equina tumors. Spinal metastases were pathologically documented in 5 of 46 (11%) patients with ependymomas above the foramen magnum. They were clinically evident in two patients and most common in patients with infratentorial tumors whose spines had not been irradiated. One patient who was irradiated externally for cauda equina tumor developed radiation myelopathy 1-1/2 years later; three of eight patients who received intrathecal gold 198 developed myelopathy and/or cauda equina syndrome 3-1/2 to 17 years later.

Adolescent↗
PubMed2005

Symptomatic epidural hematoma caused by lumbar synovial cyst rupture: report of two cases and review of the literature.

OBJECTIVE AND IMPORTANCE: Juxtafacet cysts of the lumbar spine are a recognized cause of back pain, radicular symptoms, neurogenic claudication, and, less often, cauda equina compression syndrome. Hemorrhagic rupture of a juxtafacet cyst and the resulting epidural hematoma may cause chronic and/or acute cauda equina compression. CLINICAL PRESENTATION: We report two cases of ruptured hemorrhagic lumbar synovial cysts resulting in epidural hematoma and progressive symptomatic cauda equina compression. INTERVENTION: Surgical excision of the epidural hematoma and the associated cyst resulted in complete resolution of symptoms. CONCLUSION: Rarely, juxtafacet cysts of the lumbar spine may rupture and hemorrhage into the epidural space causing symptomatic cauda equina compression. It is important to consider this entity when evaluating the patient with cauda equina compression. The findings of these cases give insight into the clinical presentation, operative treatment, and outcome in these patients.

Aged↗
PubMed1980

Spinal evoked potential in the monkey.

Computer-averaged evoked potential responses (EPs) to stimulation of the sciatic nerve and cervical spinal cord were recorded from the dura and skin over the causda equina and spinal cord in seven monkeys, three with chronic spinal cord lesions. Sciatic EPs consited of predominantly negative triphasic propagated potentials recorded at all spinal levels and greatest in amplitude over the cauda equina and caudal spinal cord. The conduction velocity of this EP was faster over the cauda equina and rostral spinal cord than over caudal cord segments. Triphasic potentials were succeeded by small negative potentials over the cauda equina and larger negative potentials over the lumbar enlargement. Sciatic EPs over the upper lumbar and thoracic cord were more sensitive to asphyxia than the initial triphasic potentials recorded over cauda equina and caudal cord but resisted changes from increasing the rate of stimulation up to 100 per second. Propagated thoracic EPs were preceded by nonpropagated potentials. The longer latency negative potentials occurring locally over the cauda equina and lower lumbar enlargement were abolished at levels of asphyxia and were attenuated at rates of stimulation that did not affect the preceding triphasic potentials. Following complete spinal cord transection, nonpropagated sciatic EPs were recorded in leads rostral to the section. In preparations with chronic partial cord hemisection involving dorsal and lateral quadrants, ipsilateral sciatic EPs had increased latency, reduced amplitude, and poor definition in the vicinity of and rostral to the lesion. Direct cervical cord stimulation elicited caudally propagated potentials which were followed by large, broad potentials over the number enlargement.

Animals↗
PubMed1996

Increased resistance to acute compression injury in chronically compressed spinal nerve roots. An experimental study.

STUDY DESIGN: Nerve conduction velocity was studied in the dog cauda equina subjected to chronic and, 1 week later, additional acute compression. OBJECTIVES: To model the situation of spinal stenosis by first inducing a controlled, chronic compression injury and then to add compression at various pressure levels to the already compressed cauda equina. SUMMARY OF BACKGROUND DATA: Previous models on nerve root and cauda equina compression have analyzed the effects of compression only on noninjured nerves. Clinically, the nerves that are compressed in spinal stenosis already are exposed to chronic compression. METHODS: The cauda equine in the lumbar spine of 10 dogs was first compressed by inflating a plastic balloon, which was placed in the spinal canal, to 10 mm Hg with a viscous substance or leaving it noninflated for control. After 1 week, a second plastic balloon, which was welded together with the first balloon, which had been located in the spinal canal for 1 week, was inflated to 50 or 100 mm Hg for 2 hours with 1.5 hour of recovery, and changes in the nerve conduction velocity were analyzed. Before inflation, baseline data, reflecting the effects of the chronic compression per se, were obtained. RESULTS: After 1 week, the nerve conduction velocity was significantly lower in the compressed cauda equina than in the control series, as an effect of the chronic compression. Additional compression demonstrated that the chronically compressed cauda equina was less susceptible to the compression-induced effects at 100 mm Hg compression. CONCLUSIONS: The data of the present study indicate that chronically compressed nerve roots acquire a tolerance to acute compression, which may indicate that there has been adaptation processes present in the compressed nerve tissue.

Acute Disease↗
PubMed1996

The post-irradiation lower motor neuron syndrome neuronopathy or radiculopathy?

It is not known whether the post-irradiation lower motor neuron syndrome results from radiation damage to motor neuron cell bodies or from damage to the nerve roots of the cauda equina. We studied six cases who had presented with testicular neoplasms, subsequently undergoing irradiation that encompassed inter alia para-aortic nodes with co-irradiation of the distal spinal cord and cauda equina. A predominantly motor disorder affecting the legs ensued after variable and often prolonged latencies (3-25 years). However, all patients also developed mild sensory features either initially or on prolonged follow-up. Sural sensory nerve action potentials (SNAPs) were normal in five. Mild sphincter symptoms occurred in three of five surviving cases after a mean of 7.9 years. MRI showed gadolinium enhancement of the cauda equina in two of three patients. The first reported neuropathological study, uncomplicated by metastatic disease, of the conus and cauda equina was performed in one patient who died. This showed a radiation-induced vasculopathy of the proximal spinal roots, with preservation of motor neuronal cell bodies and spinal cord architecture. These clinical, radiological, neurophysiological and pathological findings all point to a predominantly, but not exclusively, motor radiculopathy affecting the irradiated portion of the cauda equina proximal to the dorsal root ganglia. Radiation exposure exceeded 40 Gy both in our series and in previous reports. The natural history of this disorder is one of relentless deterioration occasionally punctuated by 1-2-year periods of stability. Post-irradiation lumbosacral radiculopathy is a more accurate name for this condition.

Adult↗
PubMed1978

Experimental neurogenic bladder disorder in non-human primates.

These studies indicate that the monkey Macaca nemestrina provides a suitable model to evaluate the neurological mechanism of micturition. This animal has a sacral spinal center for micturition whereby the classification of primary patterns of neurogenic disorder into spinal reflex after suprasacral spinal cord section and autonomous after cauda equina section is validated. Attempts at dissociation of the spinal and vesical neurons by section of the cauda equina were characterized generally by raised rather than lowered tonus, irrespective of previous urinary diversion to prevent inadvertent overstretch of the bladder. No evidence was obtained to indicate that overstretch of the autonomous bladder is followed by loss of tonus but the survival times of the animals after cauda equina section were comparatively short. There was some indication that overstretch may induce coordinated contractility of the bladder when only the peripheral neuron and sympathetic innervation of the bladder are intact. Evidence was obtained that the monkey has a dual innervation of the mid urethra, in which the pressure profile is supported by alpha adrenergic receptors as well as some somatic neural control. The resting urethral pressure profile is preserved after low level section of the spinal cord or division of the cauda equina but is lower in amplitide after overstretch of the autonomous bladder.

Animals↗
PubMed1991

Motor evoked potential monitoring during neurosurgical operations on the spinal cord.

In order to monitor descending pathways during neurosurgical operations on the spinal cord, motor evoked potentials (MEP) were recorded from the epidural space of the spinal cord and the cauda equina following transcranial electrical cortex stimulation in a total of 40 patients. It was the aim of our study to test this invasive recording technique with regard to recordability of potentials as well as correlation to post-operative neurological conditions. In 15 of 23 patients (65.2%) intraoperative potentials were obtained from the spinal cord and in 33 of 40 patients (82.5%) they were obtained from the cauda equina. On the basis of acceptable changes in amplitudes of up to 50% at the end of the operation, 13 of 15 (86.7%) recordings from the spinal cord and 28 of 33 (84.8%) from the cauda equina correlated correctly with the post-operative motor status. At the same time, there were false positive results in 2 (13.3%) and 5 (15.2%) recordings, respectively. False negative results were not observed. Post-operative deterioration of the motor status as observed in 3 patients coincided in 2 patients with a permanent reduction in amplitudes of more than 50% of the baselines and in 1 patient with an intra-operative loss of potentials. Thus both spinal cord and cauda equina recording of MEP elicited by transcranial electrical stimulation were proven to be sensitive methods for detection of impending neurological complications. Cauda equina recording, however, seems to allow recording in more cases.

Adolescent↗
PubMed1990

Experimental lumbar spinal stenosis. Analysis of the cortical evoked potentials, microvasculature, and histopathology.

An animal model of lumbar spinal stenosis was developed in which the pathophysiology of this condition could be examined. Four experimental groups, each containing six dogs, were studied. One group had a laminectomy of the sixth and seventh lumbar vertebrae only; these animals served as controls. In the three other groups, a laminectomy was performed and the cauda equina was constricted by 25, 50, or 75 per cent to produce chronic compression. Cortical evoked potentials were recorded preoperatively, immediately after constriction, and at one, two, and three months postoperatively. Daily neurological examinations were carried out, and the neurological deficits were graded using the Tarlov system. After three months of constriction, the cauda equina of three dogs in each group was examined histologically, and the vascular circulation was examined by latex and India-ink injection with a modification of the Spalteholz technique. The animals in the control group showed no neurological abnormalities, no changes in cortical evoked potentials, normal microvascularity, and no histopathological changes in the nerve roots or the spinal cord. The dogs in which the cauda equina had been constricted 25 per cent had no neurological deficits, mild changes in cortical evoked potentials, slight histological changes, and venous congestion of the root and dorsal root ganglion of the seventh lumbar nerve. The dogs in which the cauda equina had been constricted 50 per cent had mild initial motor weakness, major changes in cortical evoked potentials, edema and loss of myelin in the root of the seventh lumbar nerve, and moderate or severe venous congestion of the root and dorsal root ganglion of the seventh lumbar nerve. The dogs in which the cauda equina had been constricted 75 per cent had significant weakness, paralysis of the tail, and urinary incontinence; two dogs recovered by the third month, but all had neurogenic claudication for three months. All six dogs had dramatic changes in cortical evoked potentials and had complete nerve-root atrophy at the level of the constriction. There was blockage of axoplasmic flow and wallerian degeneration of the motor nerve roots distal to the constriction and of the sensory roots proximal to the constriction, as well as degeneration of the posterior column. Severe arterial narrowing at the level of the constriction and venous congestion of the roots and dorsal root ganglia of the seventh lumbar and first sacral nerves were also present. Cortical evoked potentials revealed neurological abnormalities before the appearance of neurological signs and symptoms.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2002

Somatosensory evoked potentials produced by stimulation of the dorsomedial nerves innervating the tail in dogs.

To record the somatosensory evoked potentials (SEPs) produced by stimulation of tail nerves and determine the effects of acute compression of the cauda equina on SEPs. The subjects were 10 adult Beagles. SEPs were recorded after stimulating the dorsomedial nerves (DMN) innervating the tail. The cauda equina was compressed using a balloon catheter inserted into the vertebral arch. In SEPs, two negative and one positive peak were often observed. The compression of the cauda equina caused significant depression of the positive component. The SEPs produced by stimulation of the DMN reflect the activities of ascending neuronal pathways above the coccygeal spinal segments and may be a useful tool for examining cauda equina syndrome.

Animals↗
PubMed1993

N24 spinal response to tibial nerve stimulation and magnetic resonance imaging in lesions of the lumbosacral spinal cord.

We studied tibial nerve somatosensory evoked potentials (SEPs) in 22 patients with progressive clinical signs of sensory and motor involvement of the lower limbs. Magnetic resonance imaging (MRI) in 21 patients revealed lesions of the thoracolumbar cord in 18 and of the cauda equina in the remaining three. SEP recordings enabled us to clearly differentiate the response generated by the dorsal horns of the lumbosacral cord from the activity generated in the cauda equina dorsal roots. Neurophysiologic findings strongly correlated with the lesion site demonstrated by the MRI (cauda equina, lumbosacral cord, or thoracic cord immediately above the lumbar enlargement). The N24 cord potential was absent with a normal cauda equina response in 10 of 12 patients with MRI signs of lumbosacral cord lesions. Clinical examination often failed to localize the spinal cord as the lesion site, suggesting pure peripheral involvement in six of the 12 patients with MRI signs of lumbosacral cord lesions.

Adult↗
PubMed1990

[Intraspinal paraganglioma. Apropos of 3 cases with a review of the literature].

The authors present three cases of paraganglioma located in the cauda equina. In all cases pre-operative diagnosis was neurinoma of the cauda equina and only the histology permitted correct identification. All were intradural extramedullary tumors and in two cases the presenting and dominant symptom was low back pain and sciatica. The remaining third case experimented a paraparesis with urinary and fecal incontinence. The follow-up (range of 4 months-4 years) after total excision was uneventful in two cases and showed in the third case with preoperative paraparesis, some persistent urinary incontinence (follow-up: 3 years) with good motor recovery. The light microscopic features were a Zellballen pattern of cells containing argyrophil granules. Electron microscopy was not performed. The most likely theory regarding the embryogenesis of cauda equina paragangliomas is that they arise from pre-existing paraganglia, possibly of the visceral-autonomic group. The prognosis after complete excision appears to be good. The literature is thoroughly reviewed.

Adult↗
PubMed2005

[Experimental studies of lumbar spinal stenosis].

Neurophysiologic function and ischemia causes neurogenic symptoms in lumbar spinal stenosis. Neurophysiologic function and potential therapeutic agents were investigated using a chronic cauda equina compression model that was developed according to a clinical pathogenesis. In the chronic cauda equina compression model, nerve conduction velocity and blood flow in spinal nerves decreased but mechanical allodynia was not induced. Prostaglandins and 5-HT receptor antagonist effected to improve blood flow in nerve roots after cauda equina compression;therefore, they might be potential agents for lumbar spinal stenosis.

Animals↗
PubMed1995

Laminectomy-induced arachnoradiculitis: a postoperative serial MRI study.

Time-related changes of laminectomy-induced cauda equina adhesions were investigated by MRI in ten patients with degenerative spinal disease who underwent posterior surgery to the lumbar spine; seven had disc herniations and three spinal stenosis. Axial MRI was performed before and 3, 7, 21 and 42 days after surgery. Cauda equina adhesions were most severe at the laminectomised levels L3-4, L4-5 and L5-S1 (n = 16); partial adhesions were found in 9 of 16 levels at 6 weeks after surgery. At the L3-4 or L5-S1 levels (n = 14), the area of laminar exposure without laminectomy, the cauda equina adhesions continued 1 week after surgery, but thereafter resolved; only partial adhesions were seen at 5 of 14 levels 6 weeks after surgery. Shrinkage of the arachnoid sac was also found at the level of the laminectomy, but it re-expanded 3 weeks after surgery in all cases. Cauda equina adhesions and shrinkage of the sac were correlated closely with laminectomy, with or without discectomy, suggesting that an inflammatory process of deep wound healing may be involved in the mechanism of a laminectomy-induced arachnoradiculitis which may be correlated with post-operative leg symptoms.

Adolescent↗
PubMed1987

[Intracranial hypertension and hydrocephalus caused by spinal cord tumors. Apropos of 3 cases].

Three cases of spinal cord tumor, revealed by hydrocephalus, are reported. Two patients showed symptoms of increased intracranial pressure and the third one presented himself with ataxic gait without intellectual impairment nor incontinence. In two cases ventriculo atrial shunt was initially inserted and the correct diagnosis was made only later on myelogram because lombosciatalgia or syndrome of the cauda equina. Clinical outcome was satisfying after surgical removal of the tumor. The nature of which was a neurinoma of the cauda equina; a lumbar intradural granuloma and an ependymoma of the cauda equina. The mechanism by which spinal cord tumors raised intracranial hypertension is discussed.

Adolescent↗
PubMedDate not supplied

Ependymomas: a clinical and pathologic study. Part II. Survival features.

A survival analysis of cases of ependymoma was performed. Patients with ependymomas of the infratentorium were found to have shorter disease-free intervals and to live for a shorter time after treatment than those with tumors of the cauda equina. Children with infratentorial tumors did not have a recurrence if they survived 3 or more years after operation, whereas adults with infratentorial tumors could have a first recurrence even 5 or more years after surgery. Younger patients did not survive as long as older patients in the group of infratentorial ependymomas. In contrast, age did not influence survival in patients with cauda equina ependymomas. Patients with ependymomas of the infratentorium and the cauda equina having long histories had a better prognosis than those with short histories. Changes in mitotic index and tumor cell number could not be correlated with the length of survival. In the infratentorial group, patients with rosette-bearing tumors had a poor prognosis, whereas patients with subependymal areas in their tumor had a better prognosis. Total surgical removal with no further treatment appeared to be as effective as subtotal removal followed by radiotherapy for the cauda equina tumors.

Adolescent↗
PubMed1996

Myeloscopic observation of adhesive arachnoiditis in patients with lumbar spinal canal stenosis.

In this study a myeloscope was used to assess the influence of adhesive arachnoiditis on the surgical outcome of patients with lumbar spinal canal stenosis (LSS). The presence or absence and the degree of the complication of adhesive arachnoiditis were preoperatively determined by myeloscopy in 36 patients with LSS, and these findings were compared with the postoperative results. Various degrees of adhesive changes in the cauda equina were observed in all 36 patients. Patients with marked adhesions, which may indicate a blocked cauda equina, had distinctly worse operative results than did patients with slight or moderate adhesions. Adhesive arachnoiditis was considered to be one of the causes for the poor operative results for LSS. Myeloscopy is useful in diagnosing the morbid condition of the cauda equina in LSS, and for predicting the operative results.

Adult↗