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1.
J Neuroinflammation ; 21(1): 63, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429643

RESUMO

Next-generation humanised mouse models and single-cell RNA sequencing (scRNAseq) approaches enable in-depth studies into human immune cell biology. Here we used NSG-SGM3 mice engrafted with human umbilical cord haematopoietic stem cells to investigate how human immune cells respond to and/or are changed by traumatic spinal cord injury (SCI). We hypothesised that the use of such mice could help advance our understanding of spinal cord injury-induced immune depression syndrome (SCI-IDS), and also how human leukocytes change as they migrate from the circulation into the lesion site. Our scRNAseq experiments, supplemented by flow cytometry, demonstrate the existence of up to 11 human immune cell (sub-) types and/or states across the blood and injured spinal cord (7 days post-SCI) of humanised NSG-SGM3 mice. Further comparisons of human immune cell transcriptomes between naïve, sham-operated and SCI mice identified a total of 579 differentially expressed genes, 190 of which were 'SCI-specific' (that is, genes regulated only in response to SCI but not sham surgery). Gene ontology analysis showed a prominent downregulation of immune cell function under SCI conditions, including for T cell receptor signalling and antigen presentation, confirming the presence of SCI-IDS and the transcriptional signature of human leukocytes in association with this phenomenon. We also highlight the activating influence of the local spinal cord lesion microenvironment by comparing the transcriptomes of circulating versus infiltrated human immune cells; those isolated from the lesion site were enriched for genes relating to both immune cell activity and function (e.g., oxidative phosphorylation, T cell proliferation and antigen presentation). We lastly applied an integrated bioinformatics approach to determine where immune responses in humanised NSG-SGM3 mice appear congruent to the native responses of human SCI patients, and where they diverge. Collectively, our study provides a valuable resource and methodological framework for the use of these mice in translational research.


Assuntos
Doenças da Medula Espinal , Traumatismos da Medula Espinal , Camundongos , Humanos , Animais , Traumatismos da Medula Espinal/metabolismo , Leucócitos/patologia , Expressão Gênica , Análise de Sequência de RNA
2.
Acta Neurochir (Wien) ; 166(1): 134, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38472541

RESUMO

BACKGROUND: Biportal endoscopic spine surgery independently controls two hands, similar to microscopic surgery, and utilizes a broader working space that is not disturbed by retractors under clear-magnified endoscopic vision. These advantages facilitate successful neural decompression and safe transforaminal interbody fusion, even in patients with thoracic spondylotic myelopathy. METHODS: A wide laminectomy and precise total facetectomy, in conjunction with partial pediculotomy, establish a secure transforaminal space for cage insertion. Endplate preparation and cage insertion were performed without retracting the spinal cord under direct endoscopic vision. CONCLUSION: Biportal endoscopic transforaminal thoracic interbody fusion can be a feasible technique for treating thoracic spondylotic myelopathy at the thoracolumbar junction levels.


Assuntos
Doenças da Medula Espinal , Fusão Vertebral , Espondilose , Humanos , Fusão Vertebral/métodos , Endoscopia/métodos , Doenças da Medula Espinal/cirurgia , Laminectomia , Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Espondilose/cirurgia , Resultado do Tratamento , Estudos Retrospectivos
3.
Spinal Cord Ser Cases ; 10(1): 8, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38438370

RESUMO

INTRODUCTION: Patients with spinal cord injuries/disorders (SCI/D) often suffer from bladder dysfunction, commonly referred to as neurogenic bladder or neurogenic lower urinary tract dysfunction (NLUTD). Standard urologic evaluation and management help to minimize complications such as vesicoureteral reflux, urinary tract infection, and nephrolithiasis. However, we have further encountered patients with more complex issues, such as chronic kidney disease (CKD), end-stage renal disease (ESRD), bilateral nephrectomies, and urinary diversion/augmentation surgeries. Of particular interest, there is a lack of standardized guidance for bladder management in SCI/D patients with ESRD. These patients are at high risk for urological complications and would benefit from codified bladder management strategies. CASE PRESENTATION: In this article, we present eleven unique cases of NLUTD with associated ESRD and discuss recommendations utilizing simple and commonly available clinical interventions. DISCUSSION: The inherently small population size of SCI/D patients with NLUTD and ESRD makes detailing a large sample size case series difficult. Future studies must aim to include a larger sample size as able, however, to better determine standardized protocols for chronic bladder management in SCI/D patients with NLUTD and ESRD. Experiences from this small case series are offered for consideration.


Assuntos
Falência Renal Crônica , Doenças da Medula Espinal , Traumatismos da Medula Espinal , Bexiga Urinaria Neurogênica , Humanos , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinaria Neurogênica/terapia , Traumatismos da Medula Espinal/complicações , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Bexiga Urinária/cirurgia
5.
Artigo em Inglês | MEDLINE | ID: mdl-38434714

RESUMO

Background: A wide variety of associated movement disorders has been described in multiple sclerosis. Phenomenology Shown: A 57-year-old woman with primary progressive multiple sclerosis developed spinal segmental myoclonus associated with focal myelitis. Educational Value: Movement disorders in multiple sclerosis are phenomenologically diverse and have varied pathophysiological mechanisms, making it essential to identify them to initiate appropriate treatment.


Assuntos
Transtornos dos Movimentos , Esclerose Múltipla Crônica Progressiva , Esclerose Múltipla , Mioclonia , Doenças da Medula Espinal , Feminino , Humanos , Pessoa de Meia-Idade , Mioclonia/tratamento farmacológico , Mioclonia/etiologia , Esclerose Múltipla/complicações , Esclerose Múltipla Crônica Progressiva/complicações , Esclerose Múltipla Crônica Progressiva/tratamento farmacológico
6.
Handb Clin Neurol ; 200: 193-201, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38494277

RESUMO

Paraneoplastic myelopathies are a rare but important category of myelopathy. They usually present with an insidious or subacute progressive neurologic syndrome. Risk factors include tobacco use and family history of cancer. Cerebrospinal fluid analysis usually shows lymphocytic pleocytosis with elevated protein. MRI findings suggest that paraneoplastic myelopathies include longitudinally extensive T2 hyperintensities that are tract-specific and accompanied by enhancement, but spinal MRIs can also be normal. The most commonly associated neural antibodies include amphiphysin and collapsin-response-mediator-protein-5 (CRMP5/anti-CV2) antibodies with lung and breast cancers being the most frequent oncologic accompaniments. The differential diagnosis of paraneoplastic myelopathies includes nutritional deficiency myelopathy (B12, copper) as well as autoimmune/inflammatory conditions such as primary progressive multiple sclerosis or spinal cord sarcoidosis. Patients treated with immune checkpoint inhibitors for cancer may develop myelitis, that can be considered along the spectrum of paraneoplastic myelopathies. Management of paraneoplastic myelopathy includes oncologic treatment and immunotherapy. Despite these treatments, the prognosis is poor and the majority of patients eventually become wheelchair-dependent.


Assuntos
Doenças Autoimunes , Neoplasias , Doenças da Medula Espinal , Humanos , Doenças da Medula Espinal/complicações , Autoanticorpos , Doenças Autoimunes/complicações , Neoplasias/complicações
7.
Neurology ; 102(7): e209256, 2024 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-38484224

RESUMO

Bibrachial amyotrophy signifies a clinical phenotype characterized by weakness in both upper extremities with preserved strength in the face, neck, and lower extremities. The underlying causes of bibrachial amyotrophy are broad. We report a patient exhibiting bibrachial amyotrophy who initially received a diagnosis of amyotrophic lateral sclerosis (ALS); however, his clinical course and NCS/EMG were atypical for ALS. Further evaluation demonstrated dural tears with CSF leak, resulting in a compressive extradural fluid collection, ventral myelopathy, and intracranial hypotension. Dural tear and ALS have overlapping features, including the manifestation of the bibrachial amyotrophy phenotype and the presence of T2 hyperintensities in the anterior horn cells, recognized by an "owl's eye" appearance on spine MRI. Clinical and radiologic vigilance is required to identify rare cases of dural tear causing ventral myelopathy that manifest as bibrachial amyotrophy.


Assuntos
Esclerose Amiotrófica Lateral , Hipotensão Intracraniana , Doenças da Medula Espinal , Humanos , Esclerose Amiotrófica Lateral/diagnóstico , Imageamento por Ressonância Magnética , Pescoço
8.
Clin Neurol Neurosurg ; 237: 108149, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38350172

RESUMO

Dural arteriovenous fistulas may have insidious clinical presentations and are often challenging to diagnose. A small number of cases have been associated with perimedullary venous congestion and cord oedema, mimicking common pathologies, such as cervical myelopathy. We describe a case report of a patient presenting with a constellation of symptoms and radiological signs mimicking C5/6 cervical myelopathy secondary to disc herniation. The patient was managed with anterior cervical discectomy and fusion, with postoperative neurological deterioration unresponsive to steroid therapy. This prompted further investigation of other pathologies. An infratentorial Cognard 5 and Borden type 3 dural arteriovenous fistula was diagnosed on 6-vessel DSA and managed with onyx embolization. Marked improvement of neurological symptoms, notably bilateral lower limb weakness, was achieved postoperatively. In summary, this case demonstrates the importance of considering alternative, less common pathologies that involve the cervical spinal cord when neurological improvement is not achieved following decompressive surgery for cervical myelopathy.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Medula Cervical , Doenças da Medula Espinal , Humanos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Discotomia
9.
BMC Musculoskelet Disord ; 25(1): 181, 2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38413918

RESUMO

BACKGROUND: Previous studies have demonstrated the relationship between sagittal facet orientation and cervical degenerative spondylolisthesis. However, the associations between facet orientation and cervical spinal stenosis (CSS) have rarely been studied. METHODS: One hundred twenty patients with CSS (CSS group) and 120 healthy participants (control group) were consecutively enrolled. The cervical facet angles and anteroposterior diameter (A-P diameter) of spinal canal at each subaxial cervical levels were measured using axial magnetic resonance imaging. The intersection angle of the midsagittal line of the vertebra to the facet line represents the orientation of the facet joint. RESULTS: The facet angles on the right side at C2- C3 and C3-C4 in CSS group and at C2- C3 in control group had significantly higher values than those of the other sides. Besides, the facet angles and A-P diameter of spinal canal in CSS group were significantly smaller than those in control group at all levels (p < 0.05). CONCLUSIONS: Our study demonstrated that patients with CSS have smaller axial cervical facet joint angles compared to the healthy individuals. Further studies are needed to elicit the specific underlying mechanism between sagittalization of the cervical facet joints and the pathology of CSS.


Assuntos
Doenças da Medula Espinal , Estenose Espinal , Espondilolistese , Articulação Zigapofisária , Humanos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/patologia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Pescoço , Imageamento por Ressonância Magnética/métodos , Doenças da Medula Espinal/patologia , Vértebras Lombares/patologia
10.
BMC Surg ; 24(1): 74, 2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38424546

RESUMO

BACKGROUND: Nowadays, both lateral mass screw (LMS) and pedicle screw were effective instrumentation for posterior stabilization of cervical spine. This study aims to evaluate the feasibility of a new free-hand technique of C7 pedicle screw insertion without fluoroscopic guidance for cervical spondylotic myelopathy (CSM) patients with C3 to C6 instrumented by lateral mass screws. METHODS: A total of 53 CSM patients underwent lateral mass screws instrumentation at C3 to C6 levels and pedicle screw instrumentation at C7 level were included. The preoperative 3-dimenional computed tomography (CT) reconstruction images of cervical spine were used to determine 2 different C7 pedicle screw trajectories. Trajectory A passed through the axis of the C7 pedicle while trajectory B selected the midpoint of the base of C7 superior facet as the entry point. All these 53 patients had the C7 pedicle screw inserted through trajectory B by free-hand without fluoroscopic guidance and the postoperative CT images were obtained to evaluate the accuracy of C7 pedicle screw insertion. RESULTS: Trajectory B had smaller transverse angle, smaller screw length, and smaller screw width but both similar sagittal angle and similar pedicle height when compared with trajectory A. A total of 106 pedicle screws were inserted at C7 through trajectory B and only 8 screws were displaced with the accuracy of screw placement as high as 92.5%. CONCLUSION: In CSM patients with C3 to C6 instrumented by LMS, using trajectory B for C7 pedicle screw insertion is easy to both identify the entry point and facilitate the rod insertion.


Assuntos
Parafusos Pediculares , Doenças da Medula Espinal , Fusão Vertebral , Humanos , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia
11.
Continuum (Minneap Minn) ; 30(1): 180-198, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38330478

RESUMO

OBJECTIVE: Immune-mediated myelopathies are conditions in which the immune system attacks the spinal cord. This article describes the distinguishing characteristics of immune-mediated myelopathies and treatment strategies for patients affected by these disorders. LATEST DEVELOPMENTS: New biomarkers, such as aquaporin 4 and myelin oligodendrocyte glycoprotein antibodies, in the blood and spinal fluid have led to the identification of antigen-specific immune-mediated myelopathies and approved therapies to prevent disease progression. ESSENTIAL POINTS: The first step in the diagnosis of an immune-mediated myelopathy is confirming that the immune system is the cause of the attack by excluding non-immune-mediated causes. The second step is to narrow the differential diagnosis based on objective biomarkers such as serology and MRI patterns. The third step is to treat the specific immune-mediated myelopathy by using evidence-based medicine.


Assuntos
Doenças da Medula Espinal , Humanos , Doenças da Medula Espinal/terapia , Aquaporina 4 , Progressão da Doença , Biomarcadores
12.
Continuum (Minneap Minn) ; 30(1): 73-98, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38330473

RESUMO

OBJECTIVE: This article illustrates the clinical importance, diagnosis, and management of degenerative and nondegenerative structural myelopathies. It also aims to create a diagnostic approach for the evaluation of patients with suspected degenerative myelopathies. LATEST DEVELOPMENTS: There is considerable interest in developing diagnostic methods that can assist in deciding if surgery is indicated in patients with structural myelopathy and the optimal timing for surgery. Diffusion tensor imaging has emerged as a promising imaging modality although it is not used routinely in clinical practice. Neuroprotective medications and interventions are being studied in patients with degenerative myelopathies. ESSENTIAL POINTS: Structural myelopathies and particularly degenerative myelopathies are common disorders that are routinely encountered in clinical practice, with symptoms that frequently overlap with other neurologic disorders. The prompt diagnosis and treatment of patients are essential in achieving good functional outcomes.


Assuntos
Imagem de Tensor de Difusão , Doenças da Medula Espinal , Humanos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia
13.
Continuum (Minneap Minn) ; 30(1): 14-52, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38330471

RESUMO

OBJECTIVE: This article describes an integrative strategy to evaluate patients with suspected myelopathy, provides advice on diagnostic approach, and outlines the framework for the etiologic diagnosis of myelopathies. LATEST DEVELOPMENTS: Advances in diagnostic neuroimaging techniques of the spinal cord and improved understanding of the immune pathogenic mechanisms associated with spinal cord disorders have expanded the knowledge of inflammatory and noninflammatory myelopathies. The discovery of biomarkers of disease, such as anti-aquaporin 4 and anti-myelin oligodendrocyte glycoprotein antibodies involved in myelitis and other immune-related mechanisms, the emergence and identification of infectious disorders that target the spinal cord, and better recognition of myelopathies associated with vascular pathologies have expanded our knowledge about the broad clinical spectrum of myelopathies. ESSENTIAL POINTS: Myelopathies include a group of inflammatory and noninflammatory disorders of the spinal cord that exhibit a wide variety of motor, sensory, gait, and sensory disturbances and produce major neurologic disability. Both inflammatory and noninflammatory myelopathies comprise a broad spectrum of pathophysiologic mechanisms and etiologic factors that lead to specific clinical features and presentations. Knowledge of the clinical variety of myelopathies and understanding of strategies for the precise diagnosis, identification of etiologic factors, and implementation of therapies can help improve outcomes.


Assuntos
Mielite , Doenças da Medula Espinal , Humanos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/terapia , Medula Espinal/irrigação sanguínea , Mielite/diagnóstico , Neuroimagem , Aquaporina 4
14.
Continuum (Minneap Minn) ; 30(1): 160-179, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38330477

RESUMO

OBJECTIVE: Vascular injuries of the spinal cord are less common than those involving the brain; however, they can be equally devastating. This article discusses the diagnosis and management of ischemic and hemorrhagic vascular disorders of the spinal cord. LATEST DEVELOPMENTS: Clinical suspicion remains the mainstay for recognizing vascular myelopathies, yet diagnoses are often delayed and challenging in part because of their rarity and atypical manifestations. Noninvasive imaging such as CT and MRI continues to improve in spatial resolution and diagnostic precision; however, catheter-based spinal angiography remains the gold standard for defining the spinal angioarchitecture. In addition to hemorrhagic and ischemic disease, the contribution of venous dysfunction is increasingly appreciated and informs treatment strategies in conditions such as intracranial hypotension. ESSENTIAL POINTS: Vascular disorders of the spine manifest in variable and often atypical ways, which may lead to delayed diagnosis. Increased awareness of these conditions is critical for early recognition and treatment. The goal of treatment is to minimize long-term morbidity and mortality.


Assuntos
Doenças da Medula Espinal , Doenças Vasculares , Humanos , Medula Espinal/diagnóstico por imagem , Medula Espinal/irrigação sanguínea , Doenças Vasculares/diagnóstico , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/terapia , Coluna Vertebral , Imageamento por Ressonância Magnética
15.
Continuum (Minneap Minn) ; 30(1): 199-223, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38330479

RESUMO

OBJECTIVE: This article reviews the clinical presentation, diagnostic evaluation, and treatment of metabolic and toxic myelopathies resulting from nutritional deficiencies, environmental and dietary toxins, drugs of abuse, systemic medical illnesses, and oncologic treatments. LATEST DEVELOPMENTS: Increased use of bariatric surgery for obesity has led to higher incidences of deficiencies in nutrients such as vitamin B12 and copper, which can cause subacute combined degeneration. Myelopathies secondary to dietary toxins including konzo and lathyrism are likely to become more prevalent in the setting of climate change leading to drought and flooding. Although modern advances in radiation therapy techniques have reduced the incidence of radiation myelopathy, patients with cancer are living longer due to improved treatments and may require reirradiation that can increase the risk of this condition. Immune checkpoint inhibitors are increasingly used for the treatment of cancer and are associated with a wide variety of immune-mediated neurologic syndromes including myelitis. ESSENTIAL POINTS: Metabolic and toxic causes should be considered in the diagnosis of myelopathy in patients with particular clinical syndromes, risk factors, and neuroimaging findings. Some of these conditions may be reversible if identified and treated early, requiring careful history, examination, and laboratory and radiologic evaluation for prompt diagnosis.


Assuntos
Mielite , Doenças da Medula Espinal , Traumatismos da Medula Espinal , Humanos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/terapia , Neuroimagem , Traumatismos da Medula Espinal/complicações , Mielite/diagnóstico , Diagnóstico Diferencial
16.
Continuum (Minneap Minn) ; 30(1): 133-159, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38330476

RESUMO

OBJECTIVE: Infectious myelopathy of any stage and etiology carries the potential for significant morbidity and mortality. This article details the clinical presentation, risk factors, and key diagnostic components of infectious myelopathies with the goal of improving the recognition of these disorders and guiding subsequent management. LATEST DEVELOPMENTS: Despite our era of advanced multimodal imaging and laboratory diagnostic technology, a causative organism often remains unidentified in suspected infectious and parainfectious myelopathy cases. To improve diagnostic capability, newer technologies such as metagenomics are being harnessed to develop diagnostic assays with a greater breadth of data from each specimen and improvements in infection identification. Conventional assays have been optimized for improved sensitivity and specificity. ESSENTIAL POINTS: Prompt recognition and treatment of infectious myelopathy decreases morbidity and mortality. The key diagnostic tools include serologies, CSF analysis, and imaging; however clinical presentation, epidemiologic risk factors, and history of recent illness are all vital to making the proper diagnosis because current laboratory and imaging modalities are often inconclusive. The cornerstone of recommended treatment is targeted antimicrobials with appropriate immune modulation, surgical intervention, supportive care, and interdisciplinary involvement, all of which further improve outcomes for patients with infectious myelopathy.


Assuntos
Doenças da Medula Espinal , Humanos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/terapia , Diagnóstico Diferencial
17.
J Vet Intern Med ; 38(2): 1101-1110, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38339888

RESUMO

BACKGROUND: No available literature supports the claim that the patellar and withdrawal (flexor) reflexes are the only reliable segmental reflexes in dogs. OBJECTIVE: Measure intra- and interobserver agreement of 8 segmental reflexes in dogs without clinical evidence of orthopedic or neurologic disease. ANIMALS: One-hundred and one client- or staff-owned dogs between 1 and 10 years of age with no clinical evidence of orthopedic disease, myelopathy, or neuromuscular disease. METHODS: Descriptive study. The intraobserver proportion of agreement (%) of responses to selected segmental reflexes in right versus left limbs by 3 observers was calculated and reported. The interobserver agreement of 2 observers of responses to selected reflexes was estimated by calculating proportions of agreement, kappa values, and 95% confidence intervals. A segmental reflex with an acceptable agreement was defined as that with a proportion of agreement ≥90% and a Kappa value ≥0.61 in both limbs. RESULTS: The intraobserver proportion of agreement for all 3 observers was high (≥95%) for the extensor carpi radialis, withdrawal, patellar, and cranial tibial reflexes. Between observers 1 and 3 and observers 2 and 3, the interobserver proportion of agreement was high (≥ 92%) for the extensor carpi radialis (κ 0.66, not determined [ND]), withdrawal (both limbs, κ ND), patellar (κ ND), and cranial tibial reflexes (κ ND). CONCLUSIONS AND CLINICAL IMPORTANCE: The extensor carpi radialis, withdrawal, patellar, and cranial tibial reflexes had a higher proportion of agreement and kappa values between 2 observers.


Assuntos
Doenças do Cão , Doenças da Medula Espinal , Humanos , Cães , Animais , Variações Dependentes do Observador , Reflexo , Extremidades , Doenças da Medula Espinal/veterinária , Reprodutibilidade dos Testes
18.
Gait Posture ; 109: 303-310, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38412683

RESUMO

BACKGROUND: People with degenerative cervical myelopathy are known to have impaired standing balance and walking abilities, but less is known about balance responses during walking. RESEARCH QUESTION: The aim of this project was to assess reactive balance impairments during walking in people with degenerative cervical myelopathy (PwDCM). We hypothesized that center of mass motion following perturbations would be larger in PwDCM and gluteus medius electromyographic amplitude responses would be decreased in PwDCM. METHODS: Reactive balance responses were quantified during unanticipated lateral pulls to the waist while treadmill walking. Walking biomechanics data were collected from 10 PwDCM (F=6) and 10 non-myelopathic controls (F=7) using an 8 camera Vicon System (Vicon MX T-Series). Electromyography was collected from lower limb muscles. Participants walked on an instrumented treadmill and received lateral pulls at random intervals and in randomized direction at 5% and 2.5% body mass. Participants walked at 3 prescribed foot placements to control for effects of the size of base of support. RESULTS: As compared with controls, the perturbation-related positional change of the center of mass motion (ΔCOM) was increased in PwDCM (p=0.001) with similar changes in foot placement (p>0.05). Change in gluteus medius electromyography, however, was less in PwDCM than in controls (p<0.001). SIGNIFICANCE: After experimentally controlling step width, people with mild-to-moderate degenerative cervical myelopathy at least 3 months following cervical spine surgery have impaired reactive balance during walking likely coupled with reduced gluteus medius electromyographic responses. Rehabilitation programs focusing on reactive balance and power are likely necessary for this population.


Assuntos
Doenças da Medula Espinal , Caminhada , Humanos , Caminhada/fisiologia , Músculo Esquelético/fisiologia , Eletromiografia , Doenças da Medula Espinal/complicações , Equilíbrio Postural/fisiologia , Nádegas
19.
J Inherit Metab Dis ; 47(2): 217-219, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38326670

RESUMO

We report the case of a Syrian female refugee with late diagnosis of glutaric aciduria type 1 characterised by massive axial hypotonia and quadriplegia who only started adequate diet upon arrival in Switzerland at the age of 4 years, after a strenuous migration journey. Soon after arrival, she died from an unexpected severe upper cervical myelopathy, heralded by acute respiratory distress after a viral infection. This was likely due to repeated strains on her hypotonic neck and precipitated by an orthotopic os odontoideum who led to atlanto-axial subluxation. This case reminds us not to omit handling patients with insufficient postural control and hypotonia with great care to avoid progressive cervical myelopathy.


Assuntos
Erros Inatos do Metabolismo dos Aminoácidos , Encefalopatias Metabólicas , Glutaril-CoA Desidrogenase/deficiência , Processo Odontoide , Doenças da Medula Espinal , Humanos , Criança , Feminino , Pré-Escolar , Hipotonia Muscular , Erros Inatos do Metabolismo dos Aminoácidos/complicações , Erros Inatos do Metabolismo dos Aminoácidos/diagnóstico
20.
Vet Med Sci ; 10(2): e1377, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38358058

RESUMO

Two surgically treated haematomyelia cases were documented. One dog and one cat were presented for acute progressive paraplegia following a fall from height incident. Neurological examinations suggested a L4-S3 myelopathy in both cases. Radiography and magnetic resonance imaging in both cases revealed no fracture or subluxation of the spine, but well-defined intramedullary mass lesions in lower lumbar regions compatible with haemorrhage and haematoma formation. Exploratory surgeries were performed over the lesions. Dark-red friable masses were removed via myelotomy. Histopathological examinations revealed organizing haematomas at the acute to subacute stage. Postoperatively, both cases improved and regained ambulation. The dog walked normally but remained urinary and faecal incontinent 9 months after the surgery. The cat was continent and ambulatory with a paraparetic gait 5 months after the surgery. In both cases, the outcomes and the patients' quality of life were considered satisfactory by the owners.


Assuntos
Doenças do Cão , Doenças da Medula Espinal , Doenças Vasculares da Medula Espinal , Cães , Animais , Qualidade de Vida , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Doenças da Medula Espinal/veterinária , Imageamento por Ressonância Magnética/veterinária , Doenças Vasculares da Medula Espinal/complicações , Doenças Vasculares da Medula Espinal/veterinária , Resultado do Tratamento , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/etiologia
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