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1.
J Trauma Acute Care Surg ; 89(2): 365-370, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32744833

RESUMO

BACKGROUND: Increasing evidence supports the limited use of magnetic resonance imaging (MRI) for cervical spine (C-spine) clearance following blunt trauma. We sought to characterize the utilization of MRI of the C-spine at a Level I trauma center. METHODS: All blunt trauma patients undergoing a computed tomography (CT) of the C-spine between January 2009 and December 2018 were reviewed. The CT and MRI results, demographics, clinical presentation, subspecialty consultations, and interventions were recorded. The MRI results were considered clinically significant if they resulted in cervical thoracic orthosis/halo placement or surgical intervention. Linear regression models were utilized to identify trends. RESULTS: There were 9,101 patients that underwent a CT of the C-spine, with 513 (5.6%) being positive for an acute injury. MRI was obtained for 375 (4.1%) of patients. A linear increase in the proportion of patients undergoing an MRI was noted, from 0.9% in 2009 to 5.6% in 2018 (p < 0.01). Of the 513 patients with a positive CT, 290 (56.5%) had an MRI. In 40 (13.8%) of them, the CT demonstrated a minor injury. Clinically significant MRI findings were noted only in two (5.0%) of the 40 patients, and both had a neurologic deficit on initial examination. Of the 8,588 patients with a negative CT, 85 (1.0%) underwent an MRI. Of those, 9 (10.6%) had a clinically significant MRI with all but one presenting with a neurological deficit. CONCLUSION: MRI is increasingly utilized for C-spine clearance following blunt trauma. MRI was exceedingly unlikely to demonstrate a clinically significant finding in the absence of a neurological deficit, when the CT was negative or included minor injuries. Trauma centers are encouraged to constantly evaluate their own practices and intervene with education and collaboration to limit the excessive use of unnecessary resources. LEVEL OF EVIDENCE: Therapeutic/Care Management Study, Level III or IV. Diagnostic test, level IV.


Assuntos
Vértebras Cervicais/lesões , Serviço Hospitalar de Emergência , Imagem por Ressonância Magnética/estatística & dados numéricos , Traumatismos da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Estados Unidos , Procedimentos Desnecessários
2.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1221-1230, July-Aug. 2020. tab, graf, ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1131493

RESUMO

Traumatic events such as a motor vehicle accident or falling from heights are very common in veterinary medicine and often lead to vertebral fracture-luxation with concomitant spinal cord injuries, mostly in the thoracolumbar spine. The purpose of this cadaveric biomechanical study was to determine the feasibility of the three-column concept in canine thoracolumbar segments with induced fractures. Eighteen Functional Spinal Units (FSU) of the thoracolumbar segments (T12-L2) were collected from 18 medium-sized adult dog cadavers and were subjected to flexion-extension and lateral bending tests so that range of motion (ROM) was recorded with a goniometer. Fractures were induced by compressive loads applied by a universal testing machine (EMIC®). After this, specimens were screened using computed tomography (CT) and the fractures were graded as affecting one, two or three columns, and divided into groups A, B, and C, respectively. Post-fracture range of motion (ROM) was compared with the previous results. Groups B and C (with fractures in two or three columns) had instability in the two axes evaluated (P<0.05). The outcomes of this study support the applicability of the three-column theory to thoracolumbar spines of dogs, as the FSUs that suffered fractures in two or more columns showed axial instability.(AU)


Eventos traumáticos, como acidentes automobilísticos ou quedas, são muito comuns na medicina veterinária e, frequentemente, levam a fraturas ou luxações vertebrais, associadas a lesões medulares concomitantes, mais frequentemente na coluna toracolombar. O propósito deste estudo biomecânico em cadáveres foi determinar a viabilidade da teoria dos três compartimentos em fraturas induzidas em segmentos toracolombares de cães. Dezoito unidades espinhais funcionais (UEF) de segmentos toracolombares (T12-L2) foram coletadas de 18 cadáveres de cães adultos de médio porte e submetidas a testes de flexão-extensão e curvamento lateral, de modo que a amplitude de movimento (ADM) foi registrada com um goniômetro. Fraturas foram induzidas por meio de cargas compressivas aplicadas por uma máquina universal de ensaios (EMIC®). As amostras foram submetidas à tomografia computadorizada (TC), e as fraturas foram classificadas como afetando um, dois ou três compartimentos e divididas nos grupos A, B e C, respectivamente. A ADM pós-fratura foi comparada com os resultados prévios. Os grupos B e C (com fraturas em dois ou três compartimentos) apresentaram instabilidade nos dois eixos avaliados (P<0,05). Os resultados deste estudo corroboram a aplicabilidade da teoria dos três compartimentos para segmentos de coluna toracolombar em cães, uma vez que as UEF que sofreram as fraturas em dois ou mais compartimentos apresentaram instabilidade axial.(AU)


Assuntos
Animais , Cães , Traumatismos da Medula Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Cadáver , Fraturas Ósseas/diagnóstico por imagem , Fenômenos Biomecânicos , Acidentes por Quedas , Acidentes de Trânsito , Tomografia Computadorizada por Raios X/veterinária
3.
Am Surg ; 86(5): 531-533, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684028

RESUMO

Spinal column injuries are very commonly diagnosed in the multitrauma population, and extensive distraction injuries are often fatal due to cerebrovascular injuries or spinal cord injuries. We present a 62-year-old female who presented after an MVC with a 2-cm vertical distraction injury of C5-6 with a right vertebral artery transection and left vertebral artery dissection. She received multidisciplinary treatment which resulted in her survival, albeit with severe neurologic deficits. We challenge the current literature that suggests a blunt vertebral artery transection is 100% fatal.


Assuntos
Traumatismo Múltiplo , Traumatismos da Medula Espinal , Artéria Vertebral/lesões , Vértebras Cervicais , Feminino , Humanos , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem
4.
Am J Phys Med Rehabil ; 99(8): 674-676, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32487972

RESUMO

During the pandemic of coronavirus disease 2019, it is possible for rehabilitation physicians and personnel to take care of patients with concurrent spinal cord injury and coronavirus disease 2019. Here, we describe a case of acute cervical spinal cord injury resulting in complete tetraplegia C5 American Spinal Injury Association Impairment Scale A with unrecognized, severe acute respiratory syndrome coronavirus 2 infection. This resulted in large-scale quarantines of related surgical and rehabilitation staff, and the unexpected death of the patient despite receiving the treatments according to the standard guideline. Rehabilitation personnel who take care of acute spinal cord injury patients with coronavirus disease 2019 should consider the effect of spinal cord injury on the course of coronavirus disease 2019, the effect of coronavirus disease 2019 and its treatments on the course of spinal cord injury, and risks of severe acute respiratory syndrome coronavirus 2 transmission between patients and rehabilitation staff, to continue providing safe and effective rehabilitation programs.


Assuntos
Infecções por Coronavirus/complicações , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Isolamento de Pacientes/métodos , Pneumonia Viral/complicações , Quadriplegia/complicações , Traumatismos da Medula Espinal/complicações , Acidentes de Trânsito , Adulto , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Progressão da Doença , Evolução Fatal , Humanos , Controle de Infecções/métodos , Masculino , Lesões do Pescoço/complicações , Lesões do Pescoço/diagnóstico por imagem , Lesões do Pescoço/terapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Quadriplegia/diagnóstico , Quadriplegia/terapia , Medição de Risco , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/terapia
5.
Orthop Surg ; 12(2): 570-581, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32347006

RESUMO

OBJECTIVE: To evaluate the feasibility and safety of cervical kinematic MRI (KMRI) in patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD). METHODS: This was a single-institution case-only study. Patients with CSCIWFD were enrolled in our institution from February 2015 to July 2019. Cervical radiography and CT were performed first to exclude cervical tumors, and major fracture or dislocation. Then neutral static and kinematic (flexion and extension) MRI was performed for patients who met the inclusion criteria under the supervision of a spinal surgeon. Any adverse events during the KMRI examination were recorded. Patients received surgical or conservative treatment based on the imaging results and patients' own wishes. The American Spinal Injury Association impairment scale (AIS) grade and the Japanese Orthopedic Association (JOA) score were evaluated on admission, before KMRI examination, and after KMRI examination. For the surgical patients, AIS grade and JOA score were evaluated again 1 week after the operation. The JOA scores were compared among different time points using the paired t-test. RESULTS: A total of 16 patients (12 men and 4 women, mean age: 51.1 [30-73] years) with CSCIWFD were included in the present study. Clinical symptoms included facial trauma, neck pain, paraplegia, paresthesia, hyperalgesia, sensory loss or weakness below the injury level, and dyskinesia. On admission, AIS grades were B for 2 cases, C for 5, and D for 9. A total of 14 patients underwent neutral, flexion, and extension cervical MRI examination; 2 patients underwent neutral and flexion examination because they could not maintain the position for a prolonged duration. No patient experienced deterioration of neurological function after the examinations. The AIS grades and JOA scores evaluated post-examination were similar to those evaluated pre-examination (P > 0.05) and significantly higher than those on admission (P < 0.05). A total of 12 patients received surgical treatment, 11 of whom underwent anterior cervical discectomy and interbody fusion and 1 underwent posterior C3/4 fusion with lateral mass screws. The remaining 4 patients were offered conservative therapy. None of the patients experienced any complications during the perioperative period. The AIS grade did not change in most surgical patients, except that 1 patient changed from grade C to D 1 week after the operation. The JOA score 1 week after surgery was significantly higher than those on admission and around examination for the surgical patients (P < 0.05). CONCLUSION: Cervical KMRI is a safe and useful technique for diagnosis of CSCIWFD, which is superior to static cervical MRI for therapeutic decision-making in patients with CSCIWFD.


Assuntos
Medula Cervical/diagnóstico por imagem , Medula Cervical/lesões , Imagem por Ressonância Magnética , Traumatismos da Medula Espinal/diagnóstico por imagem , Adulto , Idoso , Fenômenos Biomecânicos , Medula Cervical/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/cirurgia
6.
Brain Stimul ; 13(3): 783-785, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32289708

RESUMO

OBJECTIVE: Damage to the spinal cord is known to be associated with a posterior shift of the motor cortical upper limb representation, i.e. towards the somatosensory cortex. Due to missing pre-traumatic data, knowledge resulted from comparing findings between patients and healthy subjects. Here, we present a case of transient spinal cord injury resulting in a left-sided hemiparesis for 4 weeks. By chance, this patient had a pre-lesional navigated transcranial magnetic stimulation (nTMS) motor mapping 2 years before. Hence, nTMS mapping was repeated during the acute (after 1 day), sub-acute (after 10 days) and chronic (after 2 years) phase to trace the cortical reorganization following this incident. METHODS: Acute clinical work-up included magnetic resonance imaging and navigated transcranial magnetic stimulation (nTMS). Motor mapping was performed with 110% of the abductor pollicis brevis muscle (APB) resting motor threshold (rMT). Amplitudes and latencies of the motor-evoked potential (MEPs) were recorded and analyzed. In addition, motor function was evaluated by the Medical Research Council (MRC) scale, a standard Purdue Pegboard test and by a reaction time (RT) task. RESULTS: MRI revealed no aberrant findings. nTMS mapping, however, showed a posterior shift of the APB representation from the anatomical hand knob towards the somatosensory cortex in the acute in comparison to the pre-lesional phase. Concomitantly, there was an increase of rMT (6%). Within 10 days, there was an incomplete reversal of the posterior shift in parallel with improvement of the clinical motor function. Long-term follow-up revealed a complete restitution of nTMS cortical mapping and motor function. CONCLUSION: The present case report thoroughly documents a rapid cortical reorganization within a few days after a transient spinal shock. Our data adds further evidence to the literature suggesting a posterior shift of motor cortical representation following spinal cord injury. For the first time, 52 cortical reorganization was shown idiosyncratically in a single patient arising from the fortuitous fact of having a pre - lesional nTMS map.


Assuntos
Mapeamento Encefálico/métodos , Córtex Motor/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Adulto , Vértebras Cervicais , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Córtex Motor/diagnóstico por imagem , Paresia/diagnóstico por imagem , Paresia/fisiopatologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Fatores de Tempo , Estimulação Magnética Transcraniana/métodos
7.
Fluids Barriers CNS ; 17(1): 11, 2020 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-32111246

RESUMO

BACKGROUND: Syringomyelia is a serious complication of spinal cord trauma, occurring in approximately 28% of spinal cord injuries. Treatment options are limited and often produce unsatisfactory results. Post-traumatic syringomyelia (PTS) is presumably related to abnormalities of cerebrospinal fluid (CSF) and interstitial fluid hydrodynamics, but the exact mechanisms are unknown. METHODS: Transmission electron microscopy (TEM) was used to investigate in detail the interfaces between fluid and tissue in the spinal cords of healthy Sprague-Dawley rats (n = 3) and in a rat model of PTS (n = 3). PTS was induced by computer-controlled impact (75 kDyn) to the spinal cord between C6 and C8, followed by a subarachnoid injection of kaolin to produce focal arachnoiditis. Control animals received a laminectomy only to C6 and C7 vertebrae. Animals were sacrificed 12 weeks post-surgery, and spinal cords were prepared for TEM. Ultra-thin spinal cord sections at the level of the injury were counterstained for structural anatomy. RESULTS: Spinal cords from animals with PTS displayed several abnormalities including enlarged perivascular spaces, extracellular edema, cell death and loss of tissue integrity. Additionally, alterations to endothelial tight junctions and an abundance of pinocytotic vesicles, in tissue adjacent to syrinx, suggested perturbations to blood-spinal cord barrier (BSCB) function. CONCLUSIONS: These findings support the hypothesis that perivascular spaces are important pathways for CSF flow into and out of the spinal cord, but also suggest that fluid may enter the cord through vesicular transport and an altered BSCB.


Assuntos
Traumatismos da Medula Espinal/diagnóstico por imagem , Medula Espinal/ultraestrutura , Siringomielia/diagnóstico por imagem , Animais , Aracnoidite/etiologia , Medula Cervical/diagnóstico por imagem , Medula Cervical/lesões , Medula Cervical/ultraestrutura , Modelos Animais de Doenças , Masculino , Microscopia Eletrônica de Transmissão , Ratos , Ratos Sprague-Dawley , Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/complicações , Siringomielia/etiologia
8.
Phys Ther ; 100(6): 946-962, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32201890

RESUMO

BACKGROUND: Pain is one of the main symptoms associated with spinal cord injury (SCI) and can be associated with changes to the central nervous system (CNS). PURPOSE: This article provides an overview of the evidence relating to CNS changes (structural and functional) associated with pain in SCIs. DATA SOURCES: A systematic review was performed, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on PubMed, Embase, and Web of Science in March 2018. STUDY SELECTION: Studies were selected if they concerned changes in the CNS of patients with SCI, regardless of the type of imagery. DATA EXTRACTION: Data were extracted by 2 blinded reviewers. DATA SYNTHESIS: There is moderate evidence for impaired electroencephalographic function and metabolic abnormalities in the anterior cingulate in patients experiencing pain. There is preliminary evidence that patients with pain have morphological and functional changes to the somatosensory cortex and alterations to thalamic metabolism. There are conflicting data regarding the relationships between lesion characteristics and pain. In contrast, patients without pain can display protective neuroplasticity. LIMITATIONS AND CONCLUSION: Further studies are required to elucidate fully the relationships between pain and neuroplasticity in patients with SCIs. However, current evidence might support the use of physical therapist treatments targeting CNS plasticity in patients with SCI pain.


Assuntos
Sistema Nervoso Central/patologia , Sistema Nervoso Central/fisiopatologia , Dor Crônica/etiologia , Neuralgia/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Sistema Nervoso Central/diagnóstico por imagem , Sistema Nervoso Central/metabolismo , Dor Crônica/fisiopatologia , Eletroencefalografia/métodos , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Neuralgia/fisiopatologia , Neuroimagem/métodos , Plasticidade Neuronal/fisiologia , Viés de Seleção , Córtex Somatossensorial/diagnóstico por imagem , Córtex Somatossensorial/patologia , Córtex Somatossensorial/fisiopatologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/metabolismo , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Tálamo/diagnóstico por imagem , Tálamo/metabolismo
9.
PLoS One ; 15(3): e0226584, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32191733

RESUMO

The pathogenesis of spinal cord injury (SCI) remains poorly understood and treatment remains limited. Emerging evidence indicates that post-SCI inflammation is severe but the role of reactive astrogliosis not well understood given its implication in ongoing inflammation as damaging or neuroprotective. We have completed an extensive systematic study with MRI, histopathology, proteomics and ELISA analyses designed to further define the severe protracted and damaging inflammation after SCI in a rat model. We have identified 3 distinct phases of SCI: acute (first 2 days), inflammatory (starting day 3) and resolution (>3 months) in 16 weeks follow up. Actively phagocytizing, CD68+/CD163- macrophages infiltrate myelin-rich necrotic areas converting them into cavities of injury (COI) when deep in the spinal cord. Alternatively, superficial SCI areas are infiltrated by granulomatous tissue, or arachnoiditis where glial cells are obliterated. In the COI, CD68+/CD163- macrophage numbers reach a maximum in the first 4 weeks and then decline. Myelin phagocytosis is present at 16 weeks indicating ongoing inflammatory damage. The COI and arachnoiditis are defined by a wall of progressively hypertrophied astrocytes. MR imaging indicates persistent spinal cord edema that is linked to the severity of inflammation. Microhemorrhages in the spinal cord around the lesion are eliminated, presumably by reactive astrocytes within the first week post-injury. Acutely increased levels of TNF-alpha, IL-1beta, IFN-gamma and other pro-inflammatory cytokines, chemokines and proteases decrease and anti-inflammatory cytokines increase in later phases. In this study we elucidated a number of fundamental mechanisms in pathogenesis of SCI and have demonstrated a close association between progressive astrogliosis and reduction in the severity of inflammation.


Assuntos
Aracnoidite/imunologia , Gliose/imunologia , Traumatismos da Medula Espinal/complicações , Medula Espinal/patologia , Animais , Anti-Inflamatórios , Aracnoidite/diagnóstico , Aracnoidite/patologia , Astrócitos/imunologia , Astrócitos/metabolismo , Citocinas/imunologia , Citocinas/metabolismo , Modelos Animais de Doenças , Gliose/diagnóstico , Gliose/patologia , Humanos , Macrófagos/imunologia , Macrófagos/metabolismo , Imagem por Ressonância Magnética , Masculino , Bainha de Mielina/imunologia , Bainha de Mielina/patologia , Ratos , Índice de Gravidade de Doença , Medula Espinal/citologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/imunologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/imunologia , Traumatismos da Medula Espinal/patologia , Fatores de Tempo
10.
Sci Rep ; 10(1): 2762, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066802

RESUMO

More than a quarter of a million individuals in the US live with spinal cord injury (SCI). SCI disrupts neural circuitry to vital organs in the body. Despite severe incidences of long-term peripheral complications from SCI, the cardio-metabolic consequences and divergences in sex-related responses are not well described. We examined the effects of SCI on functional recovery, cardiac structure and function, body composition, and glucose metabolism on adult female and male Sprague Dawley (SD) rats. SCI was induced at T10 via contusion. Measured outcomes include behavioral assessment, body weight, dual-energy X-ray absorptiometry (DEXA) for body composition, echocardiography for cardiac structure and function, intraperitoneal glucose tolerance test (IPGTT) for glucose metabolism, insulin tolerance test (ITT), and histology of cardiac structure at the endpoint. There was a decrease in body fat percentage in both sexes, with SCI females disproportionately affected in percent body fat change. Left ventricular internal diameter during systole (LVIDs) was decreased in SCI females more than in SCI males. No significant differences in glucose metabolism were observed up to 20 weeks post-injury (PI). These data show significant cardio-metabolic differences as a consequence of SCI and, furthermore, that sex is an underlying factor in these differences.


Assuntos
Ventrículos do Coração/metabolismo , Miocárdio/metabolismo , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/metabolismo , Medula Espinal/metabolismo , Absorciometria de Fóton , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/metabolismo , Animais , Composição Corporal , Ecocardiografia , Feminino , Glucose/metabolismo , Teste de Tolerância a Glucose , Ventrículos do Coração/diagnóstico por imagem , Insulina/metabolismo , Masculino , Ratos , Ratos Sprague-Dawley , Caracteres Sexuais , Fatores Sexuais , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/patologia
11.
J Orthop Surg Res ; 15(1): 8, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918713

RESUMO

BACKGROUND: The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. METHODS: Over a 5-year period (2010-2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. RESULTS: Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities (p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients (p = 0.01). CONCLUSION: Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.


Assuntos
Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/cirurgia , Osso Occipital/cirurgia , Traumatismos da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Idoso , Idoso de 80 Anos ou mais , Articulação Atlantoaxial/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osso Occipital/diagnóstico por imagem , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/tendências , Resultado do Tratamento
12.
J Neurosci ; 40(13): 2633-2643, 2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-31996455

RESUMO

An increasing number of studies supports the view that transcutaneous electrical stimulation of the spinal cord (TESS) promotes functional recovery in humans with spinal cord injury (SCI). However, the neural mechanisms contributing to these effects remain poorly understood. Here we examined motor-evoked potentials in arm muscles elicited by cortical and subcortical stimulation of corticospinal axons before and after 20 min of TESS (30 Hz pulses with a 5 kHz carrier frequency) and sham-TESS applied between C5 and C6 spinous processes in males and females with and without chronic incomplete cervical SCI. The amplitude of subcortical, but not cortical, motor-evoked potentials increased in proximal and distal arm muscles for 75 min after TESS, but not sham-TESS, in control subjects and SCI participants, suggesting a subcortical origin for these effects. Intracortical inhibition, elicited by paired stimuli, increased after TESS in both groups. When TESS was applied without the 5 kHz carrier frequency both subcortical and cortical motor-evoked potentials were facilitated without changing intracortical inhibition, suggesting that the 5 kHz carrier frequency contributed to the cortical inhibitory effects. Hand and arm function improved largely when TESS was used with, compared with without, the 5 kHz carrier frequency. These novel observations demonstrate that TESS influences cortical and spinal networks, having an excitatory effect at the spinal level and an inhibitory effect at the cortical level. We hypothesized that these parallel effects contribute to further the recovery of limb function following SCI.SIGNIFICANCE STATEMENT Accumulating evidence supports the view that transcutaneous electrical stimulation of the spinal cord (TESS) promotes recovery of function in humans with spinal cord injury (SCI). Here, we show that a single session of TESS over the cervical spinal cord in individuals with incomplete chronic cervical SCI influenced in parallel the excitability cortical and spinal networks, having an excitatory effect at the spinal level and an inhibitory effect at the cortical level. Importantly, these parallel physiological effects had an impact on the magnitude of improvements in voluntary motor output.


Assuntos
Córtex Cerebral/fisiopatologia , Plasticidade Neuronal/fisiologia , Quadriplegia/terapia , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal/métodos , Adulto , Córtex Cerebral/diagnóstico por imagem , Medula Cervical/diagnóstico por imagem , Medula Cervical/fisiopatologia , Eletromiografia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Quadriplegia/diagnóstico por imagem , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/fisiopatologia , Adulto Jovem
13.
Neurochem Res ; 45(1): 180-187, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31055738

RESUMO

Spinal cord injury (SCI) is a severe disorder of the CNS leading to tissue damage and disability. Because it is critical to understand the pathological processes, it is important to find efficient ways to diagnose the severity of injured spinal cord tracts in situ from beginning up to a certain level of recovery following therapeutic interventions. In the current study, we set-up the criteria for diffusion tensor imaging (DTI) in order to capture changes of nerve fibre tracts in rat spinal cord compression injury. We tested four DTI parameters, such as fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity at the lesion site, in time course of 7 weeks. Afterwards, we compared DTI data with histological results and locomotor outcomes to examine their consistency and capability of reflecting the lesion development in time. Our data confirm that DTI is a valuable in vivo imaging tool capable to distinguish damaged white matter tracts after mild SCI in rat. Fractional anisotropy showed decreased values for injury site, while the mean diffusivity had higher values, with increased both axial and radial diffusivity in comparison to control subjects. Thus, the combination of DTI parameters can reflect the severity of lesion in time and may correlate with histological evaluation of spared tissue, but not with locomotor recovery following mild injury associated with spontaneous recovery.


Assuntos
Imagem de Tensor de Difusão/métodos , Fibras Nervosas Mielinizadas/patologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Animais , Masculino , Ratos , Ratos Wistar , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões
14.
J Orthop Sci ; 25(2): 206-212, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31000376

RESUMO

BACKGROUND: Farming is one of the effective community activities for preventing the need for new long-term care insurance services. This study was conducted to compare spinal canal diameters between patients injured during orchard work (i.e., cultivating apples) and other situations that lead to cervical spinal cord injury without major fracture or dislocation and to investigate the frequency of cervical spinal canal stenosis among farmers in a Japanese community. METHODS: Subjects were 23 patients with cervical spinal cord injury without major fracture and dislocation. Charts and radiographs of these patients were retrospectively reviewed to evaluate the characteristics of the spinal cord injury. The spinal canal diameter at the injury level in the mid-sagittal plane of magnetic resonance imaging (MRI) and mechanism of injury were compared between patients injured by orchard work and other situations. Moreover, 358 Japanese general residents were evaluated for the prevalence of cervical canal stenosis using MRI and comparisons were made between farmers group and non-farmers group. RESULTS: Spinal canal diameters at the injury level were 5.8 ± 1.4 mm in patients injured during orchard work and 5.6 ± 1.0 mm in those injured in other situations; there were no differences between the two groups. Head contusion as mechanism of injury was more frequent in the orchard work group than in other situations group. Among farmers, the rate of spinal canal stenosis increased with age, and it was 62.3% in men and 66.2% in women. CONCLUSIONS: The frequency of cervical spinal canal stenosis was high with age regardless of farming work. In addition, head contusion might be a characteristic mechanism that causes spinal cord injury during orchard work. Therefore, screening of cervical degenerative conditions among farmers and education for prevention of cervical spinal cord injury during farming work are necessary.


Assuntos
Vértebras Cervicais/lesões , Fazendeiros , Canal Vertebral/lesões , Traumatismos da Medula Espinal/epidemiologia , Estenose Espinal/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Canal Vertebral/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem
15.
Neurochem Res ; 45(1): 134-143, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31006093

RESUMO

Spinal cord injury (SCI) often leads to irreversible neuro-degenerative changes with life-long consequences. While there is still no effective therapy available, the results of past research have led to improved quality of life for patients suffering from partial or permanent paralysis. In this review we focus on the need, importance and the scientific value of experimental animal models simulating SCI in humans. Furthermore, we highlight modern imaging tools determining the location and extent of spinal cord damage and their contribution to early diagnosis and selection of appropriate treatment. Finally, we focus on available cellular and acellular therapies and novel combinatory approaches with exosomes and active biomaterials. Here we discuss the efficacy and limitations of adult mesenchymal stem cells which can be derived from bone marrow, adipose tissue or umbilical cord blood and its Wharton's jelly. Special attention is paid to stem cell-derived exosomes and smart biomaterials due to their special properties as a delivery system for proteins, bioactive molecules or even genetic material.


Assuntos
Modelos Animais de Doenças , Neuroimagem/métodos , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/terapia , Animais , Humanos , Imagem por Ressonância Magnética/métodos , Procedimentos Neurocirúrgicos/métodos , Tomografia por Emissão de Pósitrons/métodos , Traumatismos da Medula Espinal/patologia , Transplante de Células-Tronco/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
Clin Biomech (Bristol, Avon) ; 71: 107-114, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31710950

RESUMO

BACKGROUND: Following incomplete spinal cord injury, people often move slowly in an effort to maintain stability during walking maneuvers. Here we examine how maneuver speed impacts frontal-plane stability in people with incomplete spinal cord injury. We hypothesized that the challenge to control frontal-plane stability would increase with maneuver speed; specifically, the minimum lateral margin of stability would be smaller and the required coefficient of friction to avoid a slip would be greater during fast vs. preferred speed maneuvers. METHODS: We measured kinematics and ground reaction forces as 12 individuals with incomplete spinal cord injury performed side-step, lateral maneuvers at preferred and fast speeds. We examined four sequential steps: the Setup and Pushoff steps initiated the maneuver, and the Landing and Recovery steps arrested the maneuver. FINDINGS: Our hypotheses were partially supported. Maneuver time was shorter during fast vs. preferred speed maneuvers (p = 0.003). Minimum lateral margin of stability was smaller during the Setup step of fast vs. preferred speed maneuvers (p = 0.026). We found no differences in minimum lateral margin of stability between speeds for the Landing and Recovery steps (p > 0.05). The required coefficient of friction was not different between fast and preferred speed maneuvers (p = 0.087). INTERPRETATION: The greatest effect of increasing maneuver speed occurred during the Setup step; as speed increased, participants reduced their minimum lateral margin of stability ipsilateral to the maneuver direction. This action allowed maneuvers to be performed more quickly without requiring a greater lateral impulse during the Pushoff step. However, this strategy reduced passive stability.


Assuntos
Marcha , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/fisiopatologia , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Caminhada , Adulto Jovem
17.
Forensic Sci Int ; 307: 110118, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31869653

RESUMO

Brain and cervical injuries are often described after major facial impacts but rarely after low-intensity mandibular impacts. Force transmission to the brain and spinal cord from a mandibular impact such as a punch was evaluated by the creation and validation of a complete finite element model of the head and neck. Anteroposterior uppercut impacts on the jaw were associated with considerable extension and strong stresses at the junction of the brainstem and spinal cord. Hook punch impacts transmitted forces directly to the brainstem and the spinal cord without extension of the spinal cord. Deaths after this type of blow with no observed histological lesions may be related to excessive stressing of the brainstem, through which pass the sensory-motor pathways and the vagus nerve and which is the regulatory center of the major vegetative functions. Biological parameters are different in each individual, and by using digital modeling they can be modulated at will (jaw shape, dentition…) for a realistic approach to forensic applications.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Simulação por Computador , Traumatismos Mandibulares/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Adulto , Lesões Encefálicas/etiologia , Análise de Elementos Finitos , Medicina Legal/métodos , Humanos , Imageamento Tridimensional , Masculino , Traumatismos Mandibulares/complicações , Abuso Físico , Traumatismos da Medula Espinal/etiologia , Tomografia Computadorizada por Raios X
18.
Spinal Cord Ser Cases ; 5: 101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31871766

RESUMO

Study design: Prospective observational pilot study. Objectives: To compare quantitative electromyographic (EMG), imaging and strength data at two time points in individuals with cervical spinal cord injury (SCI). Setting: SCI center, Veterans Affairs Health Care System, Palo Alto, California, USA. Methods: Subjects without suspected peripheral nerve injury were recruited within 3 months of injury. Needle EMG examination was performed in myotomes above, at, and below the SCI level around 11- and 12-months post injury. EMG data were decomposed using custom software into constituent motor unit trains and each distinct motor unit was analyzed for firing rate and amplitude. Strength measurements were made with dynamometry and according to the International Standard of Neurologic Classification of SCI (ISNCSCI). Cervical magnetic resonance images (MRI) were evaluated by two neuroradiologists for gray and white matter damage around the SCI. Here, we compare the EMG, strength, and imaging findings of the one of the four participants who completed both 3- and 12-month EMG evaluations. Results: There was an increase in force generation in all muscles tested at 1 year. Localized findings of very fast firing motor units helped localize spinal cord damage and revealed gray matter damage in spinal segments where MRI was normal. Meanwhile, improvement in strength over time corresponded with different electrophysiologic patterns. Conclusions: Electromyographic decomposition at two time points provides valuable information about localization of spinal cord damage, integrity of motor neuron pools and may provide a unique understanding of neural recovery mechanisms.


Assuntos
Eletrodiagnóstico/métodos , Eletromiografia/métodos , Força Muscular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Vértebras Cervicais/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Traumatismos da Medula Espinal/fisiopatologia
19.
J Orthop Surg Res ; 14(1): 414, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31805960

RESUMO

OBJECTIVE: The purpose of this study was to investigate the effects of the number of fused segments, the timing of surgery and their interaction on the prognosis of patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD), and to determine the appropriate time restrictions for early surgery in CSCIWFD patients based on the current diagnosis and treatment system in southern China. METHODS: CSCIWFD patients who underwent anterior cervical decompression and internal fusion (ACDF) from January 2012 to June 2017 were selected. The patients were grouped according to the timing of surgery and the number of fused segments and evaluated based on their American Spinal Injury Association (ASIA) score, ASIA impairment scale, and Japanese Orthopaedic Association (JOA) score before and after surgery. SPSS22.0 software was used for the statistical analysis. RESULTS: The ASIA score, JOA score, and ASIA impairment scale in all follow-ups were significantly higher than before surgery (p < 0.05). The ASIA and JOA scores at 6, 12, and 24 months after surgery of the patients who underwent ACDF within 72 h were significantly better than those of the patients who underwent ACDF after 72 h (p < 0.05). There were significant differences in postoperative ASIA and JOA scores at 12 and 24 months between the short-segment and three-segment fusion groups (p < 0.05). The results of the interaction between the surgical timing and the number of the fused segments showed that the postoperative ASIA and JOA scores at 6, 12, and 24 months were significantly higher in the patients who underwent early short-segment fusion than in those who underwent delayed short-segment fusion (p < 0.05). However, no statistically significant difference was found between early and delayed surgery in the patients who underwent three-segment fusion (p > 0.05). CONCLUSION: ACDF is safe and effective for the treatment of CSCIWFD. For patients with single- or double-segment injury, early (within 72 h) ACDF is associated with a more satisfactory prognosis. Due to the limitation of the small sample size, we cautiously recommend that 72 h can be used as a time limit for early surgery for CSCIWFD patients in regions where earlier surgery cannot be provided by the current diagnosis and treatment system.


Assuntos
Vértebras Cervicais/cirurgia , Luxações Articulares , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral , Fusão Vertebral/métodos , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/tendências , Resultado do Tratamento
20.
Nat Rev Neurol ; 15(12): 718-731, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31673093

RESUMO

Pathophysiological changes in the spinal cord white and grey matter resulting from injury can be observed with MRI techniques. These techniques provide sensitive markers of macrostructural and microstructural tissue integrity, which correlate with histological findings. Spinal cord MRI findings in traumatic spinal cord injury (tSCI) and nontraumatic spinal cord injury - the most common form of which is degenerative cervical myelopathy (DCM) - have provided important insights into the pathophysiological processes taking place not just at the focal injury site but also rostral and caudal to the spinal injury. Although tSCI and DCM have different aetiologies, they show similar degrees of spinal cord pathology remote from the injury site, suggesting the involvement of similar secondary degenerative mechanisms. Advanced quantitative MRI protocols that are sensitive to spinal cord pathology have the potential to improve diagnosis and, more importantly, predict outcomes in patients with tSCI or nontraumatic spinal cord injury. This Review describes the insights into tSCI and DCM that have been revealed by neuroimaging and outlines current activities and future directions for the field.


Assuntos
Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/patologia , Imagem de Tensor de Difusão/métodos , Humanos
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