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PubMedDate not supplied

Role of calpain in spinal cord injury: increased mcalpain immunoreactivity in spinal cord after compression injury in the rat.

Spinal cord injury was induced in rats by compression technique using 10 or 20 g compression for 5-10 min. Calpain immunoreactivity was examined in the lesion as well as in the adjacent areas of the cord at different times following injury. Elevated calpain immunoreactivity was found in the lesion compared to sham control. The increase in calpain immunoreactivity was dependent on the time and the degree of trauma. Areas adjacent posterior or caudal to the lesion also showed increased calpain immunoreactivity. Most of the cells in the dorsal and ventral funiculi with increased calpain staining were astrocytes and microglia. Proliferation of microglia and/or activation of astrocytes in the lesion, identified with lectin binding GSA and glial fibrillary acidic protein staining, was seen at 1 and 3 days after trauma, respectively. Eccentric nuclei and shrunken neurons with increased calpain staining were seen in the ventral horn. The extent of increase in calpain immunoreactivity in the lesion was also proportional to the degree of trauma. The elevated calpain immunoreactivity suggests increased calpain expression (mRNA), synthesis (protein level), and activity in the lesion of cord following injury as compared to sham control. This finding supports a pivotal role for calpain in tissue degeneration in spinal cord trauma.

Animals↗
PubMed1977

The use of hyperbaric oxygenation in the treatment of spinal cord lesions.

In 13 patients with compressive spinal cord lesions we performed a trial of treatment with hyperbaric oxygen (HO). This therapy was postoperatively administered when neurological deficit persisted. In order to assess the effect of each individual HO session (given daily at an inspiratory oxygen pressure (PO2) of 1.5 atmospheres absolute for 40 min) as well as of the entire HO therapy (consisting of 10-15 single sessions in each case) neurological and electromyographical follow-up examinations were regularly performed. In 6 of the 13 patients we found a marked improvement, particularly in motor functions. The other patients only showed little change in neurological status. Arterial and cerebrospinal fluid (CSF) PO2 were concurrently measured in 8 patients during HO sessions. The values of both showed a considerable increase. The rise in CSF PO2 may be regarded as indicative for an improved oxygenation of the spinal cord tissue during HO treatment. On the basis of these findings we may assume that repetitive HO treatment can be helpful in the management of compressive spinal cord lesions.

Adolescent↗
PubMed1987

The role of MR imaging in evaluating metastatic spinal disease.

Fifty-eight patients with suspected epidural metastases were evaluated with MR imaging. Six patients were examined on two separate occasions. MR was judged to be diagnostic in 60 of the 64 examinations. Twenty-two patients also underwent myelography. MR was as diagnostic as myelography in all cases of epidural metastases. In addition, MR offered several advantages over myelography in the evaluation of metastatic spinal disease, including demonstration of paravertebral tumor extension, identification of additional osseous metastatic lesions, and visualization of areas of spinal cord compression occurring between areas of myelographic blocks. We conclude that MR imaging is the examination of choice for evaluating suspected metastatic spinal disease.

Adolescent↗
PubMed2003

Diffusion-weighted MRI of the cervical spinal cord using a single-shot fast spin-echo technique: findings in normal subjects and in myelomalacia.

We have implemented a new diffusion-weighted MRI (DWI) sequence based on the single-shot fast spin-echo technique. We hypothesised that this would add information to conventional MRI for diagnosis of lesions of the cervical spinal cord. DWI was performed using a technique in which echo collection after the application of motion-probing gradients was done in the same manner as in the single-shot fast spin-echo technique. We first imaged six healthy volunteers to demonstrate the cervical spinal cord using the sequence. Then we applied the sequence to 12 patients with cervical myelomalacia due to chronic cord compression. The spinal cord was well seen in all subjects without the distortion associated with echo-planar DWI. In the patients, lesions appeared as areas of low- or isointense signal on DWI. Calculated apparent diffusion coefficients of the lesions (3.30+/-0.38x10(-3) mm(2)/s) were significantly higher than those of normal volunteers (2.26+/-0.08x10(-3) mm(2)/s). Increased diffusion in areas of cervical myelomalacia, suggesting irreversible damage, can be detected using this technique.

Adult↗
PubMed2005

The therapeutic window for spinal cord decompression in a rat spinal cord injury model.

OBJECT: There are no clinically based guidelines to direct the spine surgeon as to the proper timing to undertake decompression after spinal cord injury (SCI) in patients with concomitant stenosis-induced cord compression. The following three factors affect the prognosis: (1) severity of SCI; (2) degree of extrinsic spinal cord compression; and (3) duration of spinal cord compression. METHODS: To elucidate further the relationship between varying degrees of spinal stenosis and a mild contusion-induced SCI (6.25 g-cm), a rat SCI/stenosis model was developed in which 1.13- and 1.24-mm-thick spacers were placed at T-10 to create 38 and 43% spinal stenosis, respectively. Spinal cord damage was observed after the stenosis-SCI that was directly proportional to the duration of spinal cord compression. The therapeutic window prior to decompression was 6 and 12 hours in the 43 and 38% stenosis-SCI lesions, respectively, to maintain locomotor activity. A significant difference in total lesion volume was observed between the 2-hour and the delayed time(s) to decompression (38% stenosis-SCI, 12 and 24 hours, p < 0.05; 43% stenosis-SCI, 24 hours, p < 0.05) indicating a more favorable neurological outcome when earlier decompression is undertaken. This finding was further supported by the animal's ability to support weight when decompression was performed by 6 or 12 hours compared with 24 hours after SCI. CONCLUSIONS: Analysis of the findings in this study suggests that early decompression in the rat improves locomotor function. Prolongation of the time to decompression may result in irreversible damage that prevents locomotor recovery.

Animals↗
PubMed1992

Epidural lipomatosis in steroid-treated patients.

Epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It is most frequently seen in patients on chronic steroid treatment for a variety of medical problems and can present as nonspecific back pain, radiculopathy, or frank spinal cord compression. Diagnosis and treatment have generally relied on multi-level decompressive laminectomy after myelography and computed tomography. The immunocompromised state and the reported postoperative mortality (22%) of these patients, however, suggests that nonoperative therapy may be preferable whenever possible. Five cases of epidural lipomatosis are reported, and previous literature is reviewed for presentation, evaluation, and treatment of this condition.

Adult↗
PubMed2003

[Spinal epidural involvement as presentation form of non-Hodgkin's lymphoma: report of 6 cases].

Spinal cord compression and radicular involvement are infrequent events in the natural history of non-Hodgkin's lymphoma, which usually are secondary to invasion of spinal extradural space, and rarely are the presenting manifestations of this condition. Thoracic segment is predominantly affected, but any spinal region can be affected. Histologically, the spinal tumour are frequently a high-grade B lymphoma with aggressive behaviour. The aim of this work was to describe six new cases of non-Hodgkin's lymphoma in adults (five woman and one men), presenting with spinal neurological complications. The medical literature about this entity are revised.

Adult↗
PubMed1975

Remyelination after transient compression of the spinal cord.

Transient mild compression of the spinal cord produces a lesion in which demyelination with preservation of axon continuity is the predominant nerve fibre change. This damage is repaired by oligodendrocytes which produce complete though abnormally thin and short internodes of myelin along demyelinated stretches of axons. When compression is more severe, this damage is also repaired by Schwann cells which migrate into the spinal cord from nearby root entry zones and form complete segments of peripheral nervous system-type myelin around demyelinated central axons.

Animals↗
PubMed2005

Results of posterior surgery with intraoperative radiotherapy for spinal metastases.

OBJECT: Spinal cord compression from spinal metastasis represents a substantial clinical problem. Complete resection of spinal metastases is difficult in many cases, and conventional surgical decompression of the spinal cord with or without instrumentation often results in unsatisfactory neurological recovery and local recurrence, even if combined with external radiotherapy. To increase rates of local control and improve neurological recovery in such cases, we introduced decompressive surgery combined with intraoperative radiotherapy (IORT) for the treatment of spinal metastasis in 1992. We report the results of neurological recovery and local control in cases that received surgery with IORT. METHODS: Between November 1992 and December 2001, 133 cases (117 patients) were treated using IORT at Tokyo Metropolitan Komagome Hospital. The 79 cases (74 patients) that received posterior spine surgery only for spinal paresis due to spinal metastasis were reviewed. RESULTS: Improvement of at least one level according to Frankel's classification was attained in 68 cases (86%). Of the 58 patients unable to walk preoperatively, 45 patients (78%) regained walking ability postoperatively. Rate of local recurrence was 2.5%. CONCLUSIONS: IORT, combined with posterior surgery and FERT, might be one of the effective methods for local control of spinal metastasis and neurological improvement, especially in cases with progressive and multi-level lesions.

Adult↗
PubMed1990

Effect of dosage and timing of administration of naloxone on outcome in the rat ventral compression model of spinal cord injury.

The effect of the dosage and timing of administration of naloxone after spinal cord injury in rats via the ventral compression technique is presented. The rat ventral compression technique allows for a ventral compression of the spinal cord without the requirement of a previous laminectomy. It therefore facilitates the creation of an experimental lesion that is similar to that observed in the human clinicopathological situation. The first part of the two-part study presented herein involved the determination of the optimal dose of naloxone, administered intraperitoneally 45 minutes after the creation of the lesion. Of the groups studied (control group through 10.0 mg/kg group), 2.0 mg/kg of naloxone proved to be superior to both lesser and greater dosages. The second part of the study involved the administration of a 2.0 mg/kg dose of naloxone at varying intervals ranging from 10 minutes before lesioning to 24 hours after lesioning. A multiphasic response was again demonstrated, with an optimal time of administration occurring 45 minutes after the creation of the lesion. A significant effect was offered by a midrange dose of naloxone (2.0 mg/kg), administered at 45 minutes after injury (P less than 0.02 by analysis of variance and Duncan's multiple range test). These findings are discussed with respect to recent evidence regarding the effects of narcotic antagonists on both mu and kappa narcotic receptors. Past and future experiments must account for these responses to multiphasic dosage and timing of administration. Failure to do so may lead to erroneous conclusions.

Animals↗
PubMed1998

Neuroimaging and treatment implications of patients with multiple epidural spinal metastases.

BACKGROUND: Although multiple spinal epidural metastases (MEMs) commonly occur in cancer patients, their clinical significance remains uncertain. The authors attempted to ascertain the incidence of MEMs and their association with the completeness of spinal imaging by magnetic resonance (MR) scanning versus myelography to determine how often they are missed because of incomplete spinal imaging and to assess their prognostic and treatment implications. METHODS: A review of 337 epidural spinal cord compression (ESCC) cases seen at the Mayo Clinic between 1985 and 1993 was conducted. RESULTS: ESCC patients undergoing myelography only were significantly more likely to undergo complete spinal imaging (CSI)than patients undergoing either MR scan only or both imaging modalities (P < 0.0001). MEMs were detected in 32% of patients undergoing CSI and 18% of patients with incomplete spinal imaging (P=0.02). Failure to image the cervical spine in patients with symptomatic thoracic or lumbar epidural lesions would have missed secondary epidural lesions in only 1% of patients; however, this figure increased to 21% for failure to image either the thoracic or lumbosacral spine when symptomatic disease was located elsewhere. Radiation oncologists included secondary epidural deposits in treatment ports in 93% of MEM cases. In a multivariate model, the presence of MEMs was an independent prognostic factor for poorer survival. CONCLUSION: The incidence of MEMs in patients with ESCC is approximately 30%, and their presence frequently alters treatment plans. It appears safe to forgo cervical spine MR scanning in patients with radiographically verified thoracic or lumbar ESCC; however, careful imaging of the thoracic and lumbar spine should be considered in all ESCC patients to detect MEMs.

Adolescent↗
PubMed1992

A comparison between M.R.I. and C.T. in acute spinal trauma.

Magnetic Resonance Imaging (MRI) at 0.3T and Computed Tomography (CT) were compared in the retrospective evaluation of 34 patients with acute spinal cord injury. MRI was highly accurate in the imaging of vertebral body fracture, and spondylitic changes, and is the method of choice for imaging ligament injury, traumatic disc protrusion and spinal cord compression. It was also useful for the identification of subtle subluxations in the sagittal plane. CT remains the method of choice for imaging neural arch fractures. MRI at 0.3T is a valid technique for assessing patients with acute spinal trauma.

Acute Disease↗
PubMedDate not supplied

Isolated intraspinal relapse of neuroblastoma after autologous bone marrow transplantation.

Neuroblastoma may present with spinal cord compression due to dumbbell extension of thoracic or abdominal disease. Isolated intraspinal involvement as the sole site of relapse is rare. Two infants with poor-prognosis stage IV neuroblastoma presented early after high-dose therapy and autologous bone marrow transplant with isolated spinal relapse heralded by misleading symptoms. The rarity of such isolated relapses is reviewed, and an etiologic hypothesis is proposed.

Bone Marrow Transplantation↗
PubMedDate not supplied

US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases.

Ultrasonography (US) of the spinal cord is performed in newborns with signs of spinal disease (cutaneous lesions of the back, deformities of the spinal column, neurologic disturbances, suspected spinal cord injury due to traumatic birth, and syndromes with associated spinal cord compression). The examination is performed with high-frequency linear- and curved-array transducers in the sagittal and axial planes from the craniocervical junction to the sacrum. Normal variants such as transient dilatation of the central canal and ventriculus terminalis can be demonstrated with US. US allows detection of congenital malformations, such as myelocele or myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, terminal myelocystocele, lateral meningocele, caudal regression syndrome, and hydromyelia or syringomyelia. Acquired intraspinal diseases following birth trauma and transient alterations after lumbar puncture can also be detected with US. US can demonstrate the entire spectrum of intraspinal anatomy and pathologic conditions with high geometric resolution. Therefore, US should be considered the initial imaging modality of choice for investigating the spinal cord in newborns.

Birth Injuries↗
PubMed1991

On the significance of Lhermitte's sign in oncology.

We present three cases of Lhermitte's sign out of twenty consecutive cases of epidural spinal cord compression due to metastatic cancer. The three patients were diagnosed with epidural thoracic compressions. The literature on Lhermitte's sign is reviewed with emphasis on the differential diagnosis of this symptom in oncological patients.

Adult↗
PubMed1980

[Experimental and clinical studies of the evoked electrospinogram for monitoring spinal cord function (author's transl)].

The evoked electrospinograms (EESG), by stimulation of and recording from the spinal cord, was investigated as a means of estimating spinal cord function and damage. Sixteen mongrel adult dogs were monitored in a basic examination of EESG. Relationship between change of EESG and spinal cord function was examined in 27 dogs. A spinal compression device was placed at L2 level, and bipolar electrodes at the T11 and L5 levels respectively. Supramaximal electric stimulation with rectangular pulses of 0.1 millisecond and 2 to 5 volt was given once per second by constant current stimulation. EESGs were classified according to the change in amplitude caused by acute spinal cord compression and were observed for three weeks. Results 1. Spike potentials in short latency of EESG were interpreted as action potentials which directly pass through superficial layer of posterolateral tracts of spinal cord, and change of spike potentials were through not to reflect the histological degeneration of gray matter and one side of the spinal cord. 2. Spike potentials on acute spinal cord compression showed temporary increase of amplitude followed by reduction of amplitude with increasing latency, finally disappearance. Decrease of amplitude of spike potentials was noted initially at the compression which narrowed spinal canal diameter about 5%. Disappearance of spike potentials took place suddenly at the compression causing 80% narrowing of spinal canal diameter. 3. Change of spike potentials by acute spinal cord compression corresponded well to the prognosis of motor function. Voluntary motor function may be estimated subjectively by change of amplitude of spike potentials of EESG. Namely, in dogs with decrease of the amplitude by half, a full recovery of hind-limb paralysis took place. In 1/3 of the dogs with decrease of the amplitude of more than half, incomplete paralysis persisted, and disappearance of the potential indicated of severe paralysis. Based on the data from the above experiments, EESGs induced from 40 clinical cases were analyzed. Conclusions. This study showed that EESG by stimulation of the spinal cord was an effective method in spinal cord monitoring. However, the clinical data showed no distinct correlation between EESG and the degree of spinal cord function as did the animal experiments.

Adolescent↗
PubMed2006

Thoracic myelopathy in Japan: epidemiological retrospective study in Miyagi Prefecture during 15 years.

Thoracic myelopathy is defined as spinal cord compression in the thoracic region, leading to sensory and motor dysfunctions in the trunk and lower extremities, and can be caused by various degenerative processes of the spine. Thoracic myelopathy is rare, and there are many unsolved problems including its epidemiological and clinical features. We have established a registration system of spinal surgeries, which covered almost all surgeries in Miyagi Prefecture, and enrolled the data of 265 patients with thoracic myelopathy from 1988 to 2002. The annual rate of surgery gradually increased and averaged 0.9 per 100,000 inhabitants, which was less than 1/10 of that for cervical myelopathy. About 20 patients with thoracic myelopathy are operated on in Miyagi Prefecture each year. It frequently develops in middle-aged males. About half of the cases were caused by ossification of the ligamentum flavum, followed by ossification of the posterior longitudinal ligament, intervertebral disc herniation and posterior spur. Patients usually noticed numbness or pain in the legs and the preoperative duration was long, averaging 2 years. Its symptomatic similarities to lumbar disorders might cause difficulty in making a correct diagnosis. Since thoracic myelopathy can markedly restrict the activities of daily life, even general physicians should recognize this entity.

Adult↗