Correlation between operative outcomes of cervical compression myelopathy and mri of the spinal cord.

STUDY DESIGN: Magnetic resonance images of cervical compression myelopathy were retrospectively analyzed in comparison with surgical outcomes. OBJECTIVES: To investigate which magnetic resonance findings in patients with cervical compression myelopathy reflect the clinical symptoms and prognosis, and to determine the radiographic and clinical factors that correlate with the prognosis. SUMMARY OF BACKGROUND DATA: Signal intensity changes of the spinal cord on magnetic resonance imaging in chronic cervical myelopathy are thought to be indicative of the prognosis. However, the prognostic significance of signal intensity change remains controversial. METHODS: The participants in this study were 73 patients who underwent cervical expansive laminoplasty for cervical compression myelopathy. Their mean age was 64 years, and the mean postoperative follow-up period was 3.4 years. The pathologic conditions were cervical spondylotic myelopathy in 42 patients and ossification of the posterior longitudinal ligament in 31 patients. Magnetic resonance imaging (spin-echo sequence) was performed in all the patients. The transverse area of the spinal cord at the site of maximal compression was computed, and spinal cord signal intensity changes were evaluated before and after surgery. Three patterns of spinal cord signal intensity changes on T1-weighted sequences/T2-weighted sequences were detected as follows: normal/normal, normal/high-signal intensity changes, and low-signal/high-signal intensity changes. Surgical outcomes were compared among these three groups. The most useful combination of parameters for predicting prognosis was determined using a stepwise regression analysis. RESULTS: The findings showed 2 patients with normal/normal, 67 patients with normal/high-signal, and 4 patients with low-signal/high-signal change patterns before surgery. Regarding postoperative recovery, the preoperative low-signal/high-signal group was significantly inferior to the preoperative normal/high-signal group. There was no significant difference between the transverse area of the spinal cord at the site of maximal compression in the normal/high-signal group and the low-signal/high-signal group. A stepwise regression analysis showed that the best combination of surgical outcome predictors included age (correlation coefficient R = -0.348), preoperative signal pattern, and duration of symptoms (correlation coefficient R = -0.231). CONCLUSIONS: The low-signal intensity changes on T1-weighted sequences indicated a poor prognosis. The authors speculate that high-signal intensity changes on T2 weighted images include a broad spectrum of compressive myelomalacic pathologies and reflect a broad spectrum of spinal cord recuperative potentials. Predictors of surgical outcomes are preoperative signal intensity change pattern of the spinal cord on radiologic evaluations, age at the time of surgery, and chronicity of the disease.

Effects of ovariectomy and estrogen replacement therapy on arthritis and bone mineral density in rats with collagen-induced arthritis.

We investigated the effects of ovariectomy (ovx) and estrogen replacement therapy (ERT) on bone mineral density (BMD) and arthritis severity in rats with collagen-induced arthritis (CIA). Seven-month-old female Sprague-Dawley rats were separated into a sham group (n = 8), CIA group (n = 14), ovx group (n = 10), CIA + ovx group (n = 11), and CIA + ovx + ERT group (n = 14). In these groups, ovx was performed at 7 days, and ERT (17beta-estradiol at 20 microg/kg three times per week) was initiated 8 days after sensitization. Every 2 weeks, until 8 weeks after sensitization, arthritis score and hind paw thickness were evaluated, and BMD of the trabecular and cortical bones in the metaphysis and diaphysis of the tibia were measured by peripheral quantitative computed tomography. The arthritis score was highest in the CIA + ovx group at all timepoints after sensitization. The hind paw thickness was significantly higher in the CIA + ovx group than in the CIA group at 8 weeks after sensitization (p < 0.05). Both the arthritis score and hind paw thickness were lower in the CIA + ovx + ERT group than in the CIA + ovx group. BMD in the metaphysis was significantly decreased in both the trabecular and cortical bones in the CIA + ovx group compared with those in the CIA group at 4, 6, and 8 weeks after sensitization. In the CIA + ovx group, trabecular BMD was changed by -34 +/- 11%, and cortical BMD changed by -14 +/- 7% in the metaphysis at 8 weeks compared with those at 0 week. In the CIA group, changes of BMD in the metaphysis were -7 +/- 11% in trabecular bone and 0 +/- 7% in cortical bone. These differences of trabecular and cortical bone loss in the metaphysis were significant (both p < 0.01). BMD reduction was significantly less in the CIA + ovx + ERT group than in the CIA + ovx group at 6 and 8 weeks after sensitization. Although BMD in the diaphysis was also reduced in the groups with CIA, the degree of reduction was smaller than in the metaphysis. We conclude that ovx in CIA rats could enhance the severity of arthritis and bone loss, and that ERT could suppress arthritis and bone loss.

Tensile properties of rat anterior cruciate ligament in collagen induced arthritis.

OBJECTIVES: To investigate the effects of collagen induced arthritis (CIA) on the tensile properties of rat anterior cruciate ligament (ACL). METHODS: The tensile strength, bone mineral density (BMD), and histology of ACL units from rats with CIA were investigated. RESULTS: The tensile strength of the ACL unit was significantly lower in the rats with CIA at 10 weeks after immunisation (ultimate failure load, 74.9% of the control; stiffness, 62.0% of the control). The major mode of failure was femoral avulsion, and the BMD was significantly lower in the rats with CIA. A histological examination of the ligament insertion in rats with CIA showed resorption of the cortical bone beneath the ACL insertion and an enlarged mineralised fibrocartilage zone. CONCLUSIONS: These findings indicate that the decrease in tensile strength of ACL units correlated with histological changes in the ligament-bone attachment, such as bone resorption beneath the ligament insertion site and an enlargement of the mineralised fibrocartilage zone.

Bone mass changes of tibial and vertebral bones in young and adult rats with collagen-induced arthritis.

To study the effect of arthritis on bone mass, bone mineral density (BMD) of cancellous and cortical bone in the tibial metaphysis and diaphysis in 2- and 7-month-old rats with collagen-induced arthritis (CIA) was serially measured using peripheral quantitative computed tomography (pQCT). BMD in the fourth lumbar vertebra in 7-month-old CIA rats was also measured by pQCT. The fourth lumbar vertebral body, distal femur, and proximal tibia in 7-month-old CIA rats were analyzed histomorphometrically. Changes in BMD differed between 2-month-old (young) and 7-month-old (adult) CIA rats. Although the BMD for the proximal tibia (2 mm and 5 mm distal from the growth cartilage) in young CIA rats decreased compared with that in control rats, the values exceeded the initial value during the arthritis course. On the other hand, bone loss in adult CIA rats occurred predominantly in the cancellous bone of the periarticular region of the tibia (2 mm distal from the growth cartilage), in which the enhancement of bone resorption and reduced bone formation were observed histomorphometrically. No remarkable changes were demonstrated in BMD or histomorphometrical analysis for the lumbar vertebra during the experimental course. These results suggest that bone loss in adult CIA rats resembles the osteoporosis that develops during the early stage of human rheumatoid arthritis. We conclude that adult CIA rats are more appropriate than young CIA rats as an experimental model of secondary osteoporosis due to rheumatoid arthritis.

Receptive field changes after strokelike cortical ablation: a role for activation dynamics.

The reorganization of neural activity that takes place after stroke is of paramount importance in producing functional recovery. Experimental stroke models have suggested that this reorganization may have two phases, but physiology alone cannot fully resolve what causes each phase. Computer modeling suggests that these phases might involve an initial change in dynamics occurring immediately, followed by synaptic plasticity. We combined physiological recording from macaque middle temporal cortex (area MT) with a neural network computer model to examine this first phase of altered cortical function after a small, experimentally induced cortical lesion. Major receptive field (RF) changes seen in the first few days postlesion included both expansion and contraction of receptive fields. Although only expansion could be reproduced in an initial model, addition of inhibitory interneuron loss in a ring around the primary ablation, suggested by immunohistochemical examination, permitted contraction to be replicated as well. We therefore predict that this immunochemical observation reflects an immediate extension of the lesion rather than a late response. Additionally our model successfully predicted a correlation between increased firing rate and RF size. Our model suggests that activation dynamics alone, without anatomic remodeling, can cause the large receptive field changes that allow the rapid behavioral recovery seen after middle temporal lesions.

Recovery of function after lesions in the superior temporal sulcus in the monkey.

1. Ibotenic acid lesions in the monkey's middle temporal area (MT) and the medial superior temporal area (MST) in the superior temporal sulcus (STS) have previously been shown to produce a deficit in initiation of smooth-pursuit eye movements to moving visual targets. The deficits, however, recovery within a few days. In the present experiments we investigated the factors that influence that recovery. 2. We tested two aspects of the monkey's ability to use motion information to acquire moving targets. We used eye-position error as a measure of the monkey's ability to make accurate initial saccades to the moving target. We measured eye speed within the first 100 ms after the saccade to evaluate the monkey's initial smooth pursuit. 3. We determined that pursuit recovery was not dependent specifically on the use of neurotoxic lesions. Although the rate of recovery was slightly altered by replacing the usual neurotoxin (ibotenic acid) with another neurotoxin [alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)] or with an electrolytic lesion, pursuit recovery still occurred within a period of days to weeks. 4. There was a relationship between the size and location of the lesion and the recovery time. The time to recovery for eye-position error and initial eye speed increased with the fraction of MT removed. Whether the rate of recovery and size of lesions within regions on the anterior bank were related was unresolved. 5. We found that a large AMPA lesion within the STS that removed all of MT and nearly all of MST drastically altered the rate of recovery. Recovery was incomplete more than 7 mo after the lesion. Even with this lesion, however, the monkey's ability to use motion information for pursuit was not completely eliminated. 6. The large lesion also included parts of areas V1, V2, V3, and V4, but analysis of the visual fields associated with this lesion indicated that these areas probably did not have a substantial effect on recovery. 7. We tested whether visual motion experience of the monkey after a lesion was necessary for recovery by limiting the monkey's experience either by using a mask or by using 4-Hz stroboscopic illumination. In one monkey the eye-position error component of pursuit was prolonged to greater than 2 wk, but recovery of eye speed was not. Reduced motion experience had little effect on recovery in the other two monkeys. These results suggest that such visual motion experience is not necessary for the recovery of pursuit.(ABSTRACT TRUNCATED AT 400 WORDS)

Somatosensory neurons projecting from the superior colliculus to the intralaminar thalamus in the rat.

Neurons of the rat superior colliculus projecting to the intralaminar thalamus were tested for their responses to somatosensory stimulation. They were identified by antidromic stimulation of the parafascicular nucleus and central lateral nucleus. To establish the existence of descending as well as ascending axon collaterals antidromic stimulation was applied to the upper cervical spinal cord in some cases. Somatosensory receptive fields were delineated and their laminar location in the superior colliculus was noted. Units were distributed throughout the intermediate and deep tectal layers, none were located in the superficial layers. Units with somatosensory receptive fields could be classified as low threshold, high threshold, wide dynamic range or complex. The majority of the peripherally responsive units (52%) were low threshold somatosensory units with contralateral receptive fields. All units were distributed throughout the intermediate and deep layers. Their distribution reflected the typical somatotopic organization of the superior colliculus. These results indicate that the intralaminar thalamus receives some sensory information by way of the tectum. In turn, the basal ganglia may gain direct access to this information by way of the thalamoneostriatal projection.

A grid system and a microsyringe for single cell recording.

The designs of two instruments are presented which have proven to be useful in single cell and chemical injection studies performed in awake monkeys. The first is a plastic grid that acts as a guide to produce parallel penetrations with either a microelectrode or microsyringe. The second is a syringe for injecting microliter quantities of a solution that also allows recording of neuronal activity.

The spinal and commissural projections from the superior colliculus in rat and hamster arise from distinct neuronal populations.

Multiple retrograde labelling techniques were used to determine whether the superior collicular (SC) cells that project to the spinal cord in hamster and rat also innervate the contralateral colliculus. In 25 rats and 13 hamsters, various combinations of the tracers horseradish peroxidase, True blue, Diamidino yellow, fluorogold and rhodamine-labelled latex microspheres were used to label tectospinal and SC commissural neurons. No double-labelled cells were observed in any of these experiments. Analysis of neurons that were retrogradely labelled with horseradish peroxidase showed further that SC commissural neurons were much smaller than tectospinal cells. The average soma area for tectospinal cells in hamster was 225.9 micron 2 and that for such neurons in rat was 214.4 micron 2. The mean soma areas for SC commissural neurons in hamster and rat were 85.4 micron 2, respectively. In additional experiments (6 rats and 6 hamsters), True blue was injected into the left predorsal bundle and Diamidino yellow was deposited into the left SC. In both hamsters and rats, these injections invariably produced a small number of double-labelled cells in the deep layers of the right SC. In a final group of animals (7 rats and 2 hamsters), large thalamic deposits of Diamidino yellow were combined with bilateral injections of True blue into the spinal cord. This combination also produced small numbers of double-labelled neurons in both colliculi. These results indicate that the tectospinal and SC commissural pathways arise from distinct neuronal populations, but that a small number of cells that send axons into the predorsal bundle also have commissural collaterals. They demonstrate further that some tectospinal cells also send axon collaterals to the thalamus.

Superior collicular projection to intralaminar thalamus in rat.

The superior collicular (SC) cells which project to the intralaminar thalamus (IT; nuclei centralis lateralis, CL; paracentralis, PC; parafascicularis, Pf) in the rat were identified by means of retrograde transport of wheatgerm agglutinin conjugated horseradish peroxidase (WGA-HRP). SC-IT cells were located throughout the mediolateral and rostrocaudal extents of the tectum ipsilateral to the thalamic injection. In this SC, they had a primarily bilaminar distribution in the lower one-half of the stratum griseum intermediale (SGI) and upper portion of the stratum griseum profundum (SGP). In these laminae, SC-IT cells were arranged in clusters or patches similar to those which have been described for many inputs to the deep SC laminae. A small number of SC-IT cells were also observed in the deep laminae of the tectum contralateral to the thalamic injection. Double labelling experiments using True Blue (TB) and Diamidino Yellow (DY) demonstrated that less than 1% of the contralaterally projecting SC-IT cells also innervated ipsilateral IT. Anterograde tracing with [3H]leucine demonstrated further that SC projected heavily to CL, PC and Pf. This projection also extended into the medial portion of the posterior thalamus (PO).

Age-related changes in venous catecholamines basally and during epinephrine infusion in man.

Plasma epinephrine (EPI) and norepinephrine (NE) levels were examined among healthy men aged 20 to 25 and 60 to 65 years basally and during EPI infusions. On separate days, 14.3 and 42.9 ng/kg/min EPI was administered intravenously for 45 min. Although there was no age difference in venous EPI levels basally, the old had less increase during the EPI infusions. The plasma metabolic clearance rate of EPI was greater among the old men. Plasma NE levels were elevated among the elderly men, but both age groups had an increase in NE during the EPI 42.9 ng/kg/min infusion rate. During EPI infusions, the old men had less increase in systolic but not diastolic blood pressure or heart rate compared with the young men. The different pattern of change in venous EPI levels and increased metabolic clearance rate of EPI observed among the old men could, in part, explain diminished end-organ responsivity.

Organization of the intercollicular pathway in rat.

The intercollicular pathway of the rat was studied using autoradiographic (ARG) and horseradish peroxidase (HRP) tracing techniques. The HRP experiments demonstrated that the cells of origin of the intertectal pathway were located primarily in the rostral stratum griseum intermediale ( SGI ), stratum album intermedium (SAI) and stratum griseum profundum (SGP). Intertectal neurons were in most cases multipolar and had average somal diameters which ranged between 8 and 33 micron. Only a small number of superficial layer neurons contributed axons to the intercollicular pathway. ARG tracing showed that the intertectal pathway terminated in the deep layers of the rostral one half of the colliculus. The primary terminal zone was SGP. In addition, labeled axons left this region and coursed dorsally to terminate in a series of patches in the lower SGI and upper SAI. A small number of labeled fibers also reached the stratum opticum (SO) and lower stratum griseum superficiale (SGS).

A wide field electron microscopic analysis of the fiber constituents of the major splanchnic nerve in cat.

The fiber composition of the left major splanchnic nerve was studied in cats by electron microscopy. Comparisons were made between normal and partially degenerated nerve specimens following ventral rhizotomy (T3-L1), or spinal nerve division (T3-L1). Normal, major splanchnic nerves contained 2,500-4,000 myelinated and 10,000-15,000 unmyelinated fibers. Preganglionic fibers included approximately 90% of the finely myelinated (1-7 micrometers) and over 50% of the unmyelinated fibers. Removal of the sensory and preganglionic components by spinal nerve division revealed a third postganglionic fiber category. This included 13-38 small myelinated (1-5 micrometers) and 1,645-7,619 unmyelinated fibers. Finally, a comparison of normal and partially degenerated nerve specimens of both groups (ventral rhizotomy and spinal nerve cut) indicated that splanchnic afferents are made up of virtually all of the 120-350 large myelinated (8-14 micrometers) and 10% of the small myelinated (1-7 micrometers) fibers. A preliminary estimate indicated that about 10-20% of the unmyelinated fibers were sensory. The implications of these findings are discussed.

The organization of visceral sensory neurons in thoracic dorsal root ganglia (DRG) of the cat studied by horseradish peroxidase (HRP) reaction using the cryostat.

The organization of visceral sensory neurons in thoracic dorsal root ganglia (DRG) was studied by retrograde transport of horseradish peroxidase (HRP) from the central cut end of the left major splanchnic nerve of the cat. The majority of HRP-labeled cells were concentrated between T5 and T11. Within a DRG, labeled splanchnic neurons were found in all sectors. There was no consistent pattern of localization within the ganglion although clustering of visceral cell bodies was apparent. It may be that each clustered group of cells innervates individual viscera or reflects a degree of functional segregation.

Segmental organization of sympathetic preganglionic neurons of the splanchnic nerve as revealed by retrograde transport of horseradish peroxidase.

Spinal nerves were transected at selected thoracic levels on the left side and the central cut end of the left major splanchnic nerve was exposed to horseradish peroxidase (HRP) in order to study the preganglionic sympathetic organization in the spinal cord of the cat. In three animals, a total of 4235 HRP labeled neurons were observed (uncorrected counts) in five regions: intermediolateral nucleus (IML) (82.8%), lateral funiculus (LF) (14.7%), intercalatus nucleus (IC) (2.1%), central autonomic (CA) (0.3%) and the anterior horn (AH) (0.1%). The neuronal distribution indicates that sympathetic preganglionic neurons in the thoracic spinal cord are segmentally organized.