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1.
BMC Med Imaging ; 22(1): 107, 2022 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-35659198

RESUMO

BACKGROUND: Diffusion tensor imaging (DTI) was used to quantitatively study the characteristics of the related spinal cord and nerve root compression parameters in patients with cervical spondylosis (CS), and diffusion tensor tractography (DTT) was used to visualize the spinal cord and nerve root and analyze their relevance to clinical evaluation. METHODS: A total of 67 patients with CS and 30 healthy volunteers received 3.0 T magnetic resonance imaging. Cervical DTI and DTT were performed in all the participants, where the b value of DTI was set at 800 s/mm2. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the spinal cord and cervical nerve roots were measured by using DTI. Patients with CS were scored according to the modified Japanese Orthopedic Association (mJOA) score. RESULTS: In all the participants, the spinal cord and cervical nerve roots were clearly visible by DTT. Compared to the healthy volunteers, the FA values were significantly decreased and ADC values were significantly increased in patients with CS. mJOA score was significantly correlated with the DTI index (ADC and FA) values. Receiver operator characteristic curve analysis revealed that FA and ADC could identify mild, moderate, and severe CS. CONCLUSIONS: DTI parameters of cervical spinal cord and nerve root compression are associated with the clinical evaluation of patients with CS and may be helpful in assessing the severity of CS.


Assuntos
Medula Cervical , Radiculopatia , Espondilose , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Imagem de Tensor de Difusão/métodos , Humanos , Radiculopatia/complicações , Radiculopatia/patologia , Medula Espinal , Espondilose/diagnóstico por imagem , Espondilose/patologia
2.
J Neuroeng Rehabil ; 19(1): 53, 2022 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-35659259

RESUMO

OBJECTIVE: The objective of this study was to develop a portable and modular brain-computer interface (BCI) software platform independent of input and output devices. We implemented this platform in a case study of a subject with cervical spinal cord injury (C5 ASIA A). BACKGROUND: BCIs can restore independence for individuals with paralysis by using brain signals to control prosthetics or trigger functional electrical stimulation. Though several studies have successfully implemented this technology in the laboratory and the home, portability, device configuration, and caregiver setup remain challenges that limit deployment to the home environment. Portability is essential for transitioning BCI from the laboratory to the home. METHODS: The BCI platform implementation consisted of an Activa PC + S generator with two subdural four-contact electrodes implanted over the dominant left hand-arm region of the sensorimotor cortex, a minicomputer fixed to the back of the subject's wheelchair, a custom mobile phone application, and a mechanical glove as the end effector. To quantify the performance for this at-home implementation of the BCI, we quantified system setup time at home, chronic (14-month) decoding accuracy, hardware and software profiling, and Bluetooth communication latency between the App and the minicomputer. We created a dataset of motor-imagery labeled signals to train a binary motor imagery classifier on a remote computer for online, at-home use. RESULTS: Average bluetooth data transmission delay between the minicomputer and mobile App was 23 ± 0.014 ms. The average setup time for the subject's caregiver was 5.6 ± 0.83 min. The average times to acquire and decode neural signals and to send those decoded signals to the end-effector were respectively 404.1 ms and 1.02 ms. The 14-month median accuracy of the trained motor imagery classifier was 87.5 ± 4.71% without retraining. CONCLUSIONS: The study presents the feasibility of an at-home BCI system that subjects can seamlessly operate using a friendly mobile user interface, which does not require daily calibration nor the presence of a technical person for at-home setup. The study also describes the portability of the BCI system and the ability to plug-and-play multiple end effectors, providing the end-user the flexibility to choose the end effector to accomplish specific motor tasks for daily needs. Trial registration ClinicalTrials.gov: NCT02564419. First posted on 9/30/2015.


Assuntos
Interfaces Cérebro-Computador , Medula Cervical , Traumatismos da Medula Espinal , Eletroencefalografia , Mãos , Humanos , Imagens, Psicoterapia , Interface Usuário-Computador
3.
J Spinal Cord Med ; 45(4): 556-563, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35759392

RESUMO

STUDY DESIGN: A hospital-based retrospective epidemiological study. OBJECTIVE: To describe the recent epidemiological profile and characteristics of traumatic cervical spinal cord injury (TCSCI) in Nanchang, Jiangxi Province, China. SETTING: The First Affiliated Hospital of Nanchang University, The Second Affiliated Hospital of Nanchang University and The Third Affiliated Hospital of Nanchang University. METHODS: We retrieved the medical records of 1290 persons with TCSCI admitted to The First Affiliated Hospital of Nanchang University, The Second Affiliated Hospital of Nanchang University and The Third Affiliated Hospital of Nanchang University between January 2012 and December 2018. The characteristics recorded were age, sex, aetiology of the injury, neurological level, American Spinal Injury Association (ASIA) impairment scale, patient source, and associated trauma. Categorical data were reported as frequency and proportions and compared using the Fisher's exact or Chi-square test. P < 0.05 was considered to be statistically significant. RESULTS: A total of 1290 persons with TCSCI were included in the present study. The largest age group was 46-60 years, accounting for 31.6% of the patients; the mean age was 53.1 ± 16.2 years, and the male/female ratio was 7.06:1. More than 87.4% of persons were transferred from a primary or secondary hospital. The leading cause of injury was motor vehicle collision (41.3%), followed by low fall (26.5%). The most common cervical spine injury level was the C5 segment, accounting for 24.3% of cases. As for severity, ASIA grade D was encountered most frequently, with a total of 518 persons (40.2%). Among all participants, 56.8% had associated trauma, the most common being head injuries (18.2%). Surgery was the major treatment choice (51.2%), and the number of patients undergoing surgery is increasing from 2012 to 2018, P = 0.02. CONCLUSION: Persons with TCSCI in Nanchang had specific epidemiological characteristics, and preventive measures should focus on middle-aged and older adults. In addition, more attention should be paid to balancing development of medical resources and technology between urban and rural areas.


Assuntos
Medula Cervical , Lesões do Pescoço , Traumatismos da Medula Espinal , Traumatismos da Coluna Vertebral , Adulto , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/complicações , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/etiologia
4.
J Physiol ; 600(12): 2973-2999, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35639046

RESUMO

Opioid overdose suppresses brainstem respiratory circuits, causes apnoea and may result in death. Epidural electrical stimulation (EES) at the cervical spinal cord facilitated motor activity in rodents and humans, and we hypothesized that EES of the cervical spinal cord could antagonize opioid-induced respiratory depression in humans. Eighteen patients requiring surgical access to the dorsal surface of the spinal cord between C2 and C7 received EES or sham stimulation for up to 90 s at 5 or 30 Hz during complete (OFF-State) or partial suppression (ON-State) of respiration induced by remifentanil. During the ON-State, 30 Hz EES at C4 and 5 Hz EES at C3/4 increased tidal volume and decreased the end-tidal carbon dioxide level compared to pre-stimulation control levels. EES of 5 Hz at C5 and C7 increased respiratory frequency compared to pre-stimulation control levels. In the OFF-State, 30 Hz cervical EES at C3/4 terminated apnoea and induced rhythmic breathing. In cadaveric tissue obtained from a brain bank, more neurons expressed both the neurokinin 1 receptor (NK1R) and somatostatin (SST) in the cervical spinal levels responsive to EES (C3/4, C6 and C7) compared to a region non-responsive to EES (C2). Thus, the capacity of cervical EES to oppose opioid depression of respiration may be mediated by NK1R+/SST+ neurons in the dorsal cervical spinal cord. This study provides proof of principle that cervical EES may provide a novel therapeutic approach to augment respiratory activity when the neural function of the central respiratory circuits is compromised by opioids or other pathological conditions. KEY POINTS: Epidural electrical stimulation (EES) using an implanted spinal cord stimulator (SCS) is an FDA-approved method to manage chronic pain. We tested the hypothesis that cervical EES facilitates respiration during administration of opioids in 18 human subjects who were treated with low-dose remifentanil that suppressed respiration (ON-State) or high-dose remifentanil that completely inhibited breathing (OFF-State) during the course of cervical surgery. Dorsal cervical EES of the spinal cord augmented the respiratory tidal volume or increased the respiratory frequency, and the response to EES varied as a function of the stimulation frequency (5 or 30 Hz) and the cervical level stimulated (C2-C7). Short, continuous cervical EES restored a cyclic breathing pattern (eupnoea) in the OFF-State, suggesting that cervical EES reversed the opioid-induced respiratory depression. These findings add to our understanding of respiratory pattern modulation and suggest a novel mechanism to oppose the respiratory depression caused by opioids.


Assuntos
Medula Cervical , Insuficiência Respiratória , Traumatismos da Medula Espinal , Analgésicos Opioides/efeitos adversos , Apneia , Estimulação Elétrica/métodos , Humanos , Remifentanil , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/terapia , Medula Espinal/fisiologia
5.
Top Spinal Cord Inj Rehabil ; 28(2): 111-115, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35521064

RESUMO

Background: Using magnetic resonance imaging (MRI), widths of ventral tissue bridges demonstrated significant predictive relationships with future pinprick sensory scores, and widths of dorsal tissue bridges demonstrated significant predictive relationships with future light touch sensory scores, following spinal cord injury (SCI). These studies involved smaller participant numbers, and external validation of their findings is warranted. Objectives: The purpose of this study was to validate these previous findings using a larger independent data set. Methods: Widths of ventral and dorsal tissue bridges were quantified using MRI in persons post cervical level SCI (average 3.7 weeks post injury), and pinprick and light touch sensory scores were acquired at discharge from inpatient rehabilitation (average 14.3 weeks post injury). Pearson product-moments were calculated and linear regression models were created from these data. Results: Wider ventral tissue bridges were significantly correlated with pinprick scores (r = 0.31, p < 0.001, N = 136) and wider dorsal tissue bridges were significantly correlated with light touch scores (r = 0.31, p < 0.001, N = 136) at discharge from inpatient rehabilitation. Conclusion: This retrospective study's results provide external validation of previous findings, using a larger sample size. Following SCI, ventral tissue bridges hold significant predictive relationships with future pinprick sensory scores and dorsal tissue bridges hold significant predictive relationships with future light touch sensory scores.


Assuntos
Medula Cervical , Lesões dos Tecidos Moles , Traumatismos da Medula Espinal , Medula Cervical/lesões , Humanos , Imageamento por Ressonância Magnética/métodos , Estudos Retrospectivos , Traumatismos da Medula Espinal/reabilitação
6.
Spinal Cord Ser Cases ; 8(1): 50, 2022 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-35504871

RESUMO

STUDY DESIGN: Retrospective comparative clinical study. OBJECTIVE: To establish eligible diagnostic criteria for traumatic cervical spinal cord injury (TCSCI) without major fracture or dislocation and create a definitive clinical protocol by comparing the pathophysiology of CSCI in both traumatic and degenerative disorders. SETTING: Fukuoka, Japan. METHODS: A total of 21 TCSCI patients and 16 rapid progressive clinical deterioration of cervical spondylotic myelopathy (rp-CSM: additional cervical spinal cord injury with an existing cervical myelopathy) patients with impairment graded as C or D on the American Spinal Injury Association (ASIA) Impairment Scale were included in the study. Magnetic resonance (MR) images and ASIA motor scores were evaluated for all of the patients at the time of admission and 12 months postoperatively. RESULTS: The T2-weighted MR images for all patients showed an abnormally high intramedullary signal in the area of the injured segment at the first examination. At 12 months post-surgery, 47.62% of patients with TCSCI and none with rp-CSM had an abnormally low intramedullary signal change on T1-weighted MR images. The neurological improvement with rp-CSM was significantly greater than that with TCSCI at 12 months postoperatively. CONCLUSIONS: Our results suggest that the pathophysiology of CSCI between traumatic injury and degenerative disorder are similar, but not identical. The most important factor in the early pathophysiological differential diagnosis between these two pathologies is the presence of an existing cervical myelopathy. We believe that early prognosis with eligible diagnosis for CSCI may lead to early preparations for social rehabilitation in each case.


Assuntos
Medula Cervical , Lesões do Pescoço , Doenças da Medula Espinal , Traumatismos da Medula Espinal , Medula Cervical/diagnóstico por imagem , Humanos , Lesões do Pescoço/complicações , Estudos Retrospectivos , Doenças da Medula Espinal/complicações , Traumatismos da Medula Espinal/complicações
7.
Exp Neurol ; 354: 114105, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35525308

RESUMO

BACKGROUND: Neuropathic pain (NP) is a frequent finding in patients diagnosed with spinal cord injuries (SCIs). To improve our understanding of the maladaptive changes taking place in the lumbar spinal cord that can lead to the development of NP and to find alternative options to treat this condition, we aimed to investigate the effects of voluntary exercise on NP after SCI and to elucidate its potential mechanisms. METHODS: A rat model of post-SCI NP induced by compression of the posterior or lateral cervical spinal cord was used to evaluate the effects of voluntary exercise by measuring the bilateral withdrawal of the hind paws using the Von Frey filament and Hargreaves tests. The place escape/avoid paradigm was used to evaluate supraspinal pain processing and somatosensory evoked potentials (SEPs) were used to examine disturbances in proprioception. Locomotor function was evaluated using Basso, Beattie, and Bresnahan (BBB) scoring. Pathologic findings in hematoxylin and eosin-stained tissue and magnetic resonance imaging were used to evaluate the morphological changes after SCI. The lesion size within the cervical spinal cord was evaluated by staining with Eriochrome cyanine R. Quantitative polymerase chain reaction and immunohistochemistry were used to assess the expression of calcitonin gene-related peptide (CGRP) and ionized calcium-binding adapter molecule 1 (Iba-1) in the lumbar dorsal horns. RESULTS: All injured rats developed mechanical hypersensitivity, hyposensitivity, and thermal hyperalgesia in the contralateral hind paws at 1 week post-injury. Rats that underwent lateral compression injury developed NP in the ipsilateral hind paws 1 week later than rats with a posterior compression injury. Our findings revealed that voluntary exercise ameliorated mechanical allodynia and thermal hyperalgesia, and significantly improved proprioception as measured by SEP, but had no impact on mechanical hypoalgesia or motor recovery and provided no significant neuroprotection after recovery from an acute SCI. SCI-induced NP was accompanied by increased expression of CGRP and Iba-1 in the lumbar dorsal horn. These responses were reduced in rats that underwent voluntary exercise. CONCLUSIONS: Voluntary exercise ameliorates NP that develops in rats after compression injury. Increased expression of CGRP and Iba-1 in the lumbar dorsal horns of rats exhibiting symptoms of NP suggests that microglial activation might play a crucial role in its development. Collectively, voluntary exercise may be a promising therapeutic modality to treat NP that develops clinically in response to SCI.


Assuntos
Medula Cervical , Neuralgia , Traumatismos da Medula Espinal , Animais , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Cálcio/metabolismo , Medula Cervical/metabolismo , Humanos , Hiperalgesia/tratamento farmacológico , Hiperalgesia/terapia , Neuralgia/complicações , Neuralgia/terapia , Ratos , Medula Espinal/patologia , Corno Dorsal da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/patologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-35627855

RESUMO

BACKGROUND: The aim of the present study was to evaluate the impact of robotic therapy in patients with cervical spinal cord injury (SCI), measured on the basis of the patients' self-perception of limited upper limb function and level of independence in activities of daily living. METHODS: Twenty-six patients with cervical SCI completed the treatment after being randomly assigned to the intervention or control group. The training consisted of 40 experimental sessions 1 h in duration, ideally occurring 5 days/week for 8 weeks. In addition to the conventional daily therapy (30 min), the control group received another 30 min of conventional therapy, whereas the intervention group received 30 min of robotic therapy. Patients were evaluated by means of the Capabilities of Upper Extremity Questionnaire (CUE) and Spinal Cord Independence Measure (SCIM) clinical scales. RESULTS: The improvement in the feeding item of SCIM was significantly higher in the intervention group than in the control group after the treatment (2.00 (0.91) vs. 1.18 (0.89), p = 0.03). The correlation between the CUE and SCIM scales was higher at the ending than at baseline for both groups. CONCLUSIONS: Although both groups improved, the clinical relevance related to the changes observed for both assessments was slightly higher in the intervention group than in the control group.


Assuntos
Medula Cervical , Lesões do Pescoço , Procedimentos Cirúrgicos Robóticos , Traumatismos da Medula Espinal , Atividades Cotidianas , Humanos , Projetos Piloto , Autoimagem , Traumatismos da Medula Espinal/terapia , Extremidade Superior
9.
Neurochem Int ; 157: 105340, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35398187

RESUMO

INTRODUCTION: Cervical spondylotic myelopathy (CSM) is the most prevalent type of non-traumatic spinal cord injury. The pathological process of CSM is relatively complicated. Most of the chronic cervical cord compression animal models established using hydrophilic expanding polymer are single-segment compression, which was deviated from clinical practice with double-segment or multi-segment compression. This study aims to better mimic the actual clinical compression by using a new type of hydrophilic expanding polymer to establish an animal model of double-level cervical cord compression. MATERIALS AND METHODS: Progressive cord compression was done with implantation of polyvinyl alcohol-polyacrylamide hydrogel in the spinal canal at the C3-4 and C5-6 levels. Sprague-Dawley rats (n = 32) were divided into three groups: sham (no compression, n = 12) and screw compression group (n = 8), and hydrogel compression group (n = 12). Functional deficits were characterized using motor function scores, forelimb grip strength, hindlimb pain threshold, and gait analysis, while compression was imaged with magnetic resonance imaging. The apoptosis, inflammation, and demyelination were assessed by hematoxylin and eosin staining, Luxol fast blue staining, TUNEL assay, immunofluorescence staining, and Western blot analysis. RESULTS: Motor function scores for rats with cervical cord hydrogel compression were significantly decline in motor function scores, an increase in allodynia, neurons and oligodendrocytes apoptosis related to B cell lymphoma-2 (Bcl-2)/Bcl-2 associated X (Bax)/cleaved caspase-3, and impaired axonal conduction, as well as neuroinflammation zone related to microglia or macrophages aggregation related to the nucleotide-binding domain, leucine-rich-repeat-containing family, pyrin domain-containing 3 (NLRP3) inflammasome activation, and activation of astrocytes, as well as oxidative stress were observed. CONCLUSION: We believe that this model utilizing compression on double-level cervical cord will allow researchers to investigate of translationally relevant therapeutic methods for CSM.


Assuntos
Medula Cervical , Compressão da Medula Espinal , Doenças da Medula Espinal , Animais , Apoptose/fisiologia , Medula Cervical/patologia , Hidrogéis/farmacologia , /patologia , Polímeros , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Ratos Sprague-Dawley , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/metabolismo , Doenças da Medula Espinal/patologia , Doenças da Medula Espinal/cirurgia
10.
Exp Neurol ; 354: 114085, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35460760

RESUMO

Injuries to the cervical spinal cord represent around 60% of all spinal cord injuries (SCIs). A major priority for patients with cervical SCIs is the recovery of any hand or arm function. The similarities between human and rodent "reach-to-eat movements" indicate that analyzing mouse forelimb reaching behavior may be a method of identifying clinically relevant treatments for people with cervical SCIs. One popular behavioral measure of forelimb functional recovery comprises the Single Pellet Retrieval Task (SPRT). The most common outcome measure for this task, however (percentage of pellets successfully retrieved), cannot readily distinguish between recovery of pre-injury motor patterns and strategic compensation. Our objective was to establish outcome measures for the SPRT that are readily adopted by different investigators and capable of measuring recovery of limb function after SCI. We used a simple semi-automated approach to high-speed tracking of mouse forepaw movements during pellet retrieval. DeepLabCut™, a machine learning based computer vision software package, was used to track individual features of the mouse forepaw, allowing a more detailed assessment of reaching behavior after SCI. Interestingly, kinematic analysis of movements pre- and post-injury illuminated persistent deficits in specific features of the reaching motor patterns, namely pronation and paw trajectory, that were poorly correlated with recovery of the ability to successfully retrieve pellets. Thus, we have developed an inexpensive method for detailed analysis of mouse reach-to-eat behavior following SCI. Further, our results suggest that binary success/fail outcome measures primarily assess an animal's ability to compensate rather than a restoration of normal function in the injured pathways and networks.


Assuntos
Medula Cervical , Traumatismos da Medula Espinal , Animais , Medula Cervical/lesões , Modelos Animais de Doenças , Membro Anterior , Humanos , Camundongos , Destreza Motora , Recuperação de Função Fisiológica , Medula Espinal
11.
Rinsho Shinkeigaku ; 62(5): 386-390, 2022 May 31.
Artigo em Japonês | MEDLINE | ID: mdl-35474288

RESUMO

A 61-year-old man who had suffered two episodes of generalized convulsion in a two-year period was admitted to our hospital because of progressive gait disturbance during the previous five months. Neurological examination revealed cognitive impairment, spasticity of the lower limbs, truncal ataxia, and dysautonomia including orthostatic hypotension, dysuria and hypohydrosis. Brain fluid-attenuated inversion recovery (FLAIR) MRI detected high-signal-intensity lesions in the periventricular white matter and centrum semiovale, with punctate gadolinium (Gd) enhancement. Spinal MRI detected swollen cervical long cord lesions extending from C2 to C6. Although methylprednisolone pulse treatment initially ameliorated the symptoms and MRI abnormal findings, clinical symptoms and MRI abnormalities including new cervical lateral column lesions reminiscent of those in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy (GFAP-A) relapsed two months later. At this point, anti-GFAPα antibody was detected in the cerebrospinal fluid. Although the clinical course of GFAP-A has been well reported, the present case showed a chronic refractory course.


Assuntos
Medula Cervical , Astrócitos , Gadolínio , Proteína Glial Fibrilar Ácida , Humanos , Masculino , Pessoa de Meia-Idade , Medula Espinal/diagnóstico por imagem
12.
J Clin Neurosci ; 100: 148-154, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35472680

RESUMO

OBJECTIVE: To investigate the incidence of cervical spine deformity and instability after posterior cervical spinal cord tumor (CSCT) resection without fusion or fixation in adults and examine relevant risk factors by reviewing and summarizing previously reported studies. METHODS: We selected peer reviewed articles published between January 1990 and December 2020 from the MEDLINE and Cochrane Library databases using relevant key words. Articles in which the authors mainly described spinal cord tumor resection through posterior surgery without fusion or fixation in adults were selected for analysis. Patient's data including age, sex, extensive number of laminectomy levels, laminectomy at C2, C3, or C7, multilevel facetectomy, facet destruction, preoperative cervical kyphosis, and preoperative motor deficit were documented. Comparable factors were assessed using the odds ratio (OR) and weighted mean difference (WMD) of 95% confidence intervals (CI). RESULTS: Among 133 articles identified, 18 met selection criteria. Overall incidence of deformity and instability after CSCT surgery was 0%-41.7% and 0%-20.5%, respectively. Younger age (WMD, -5.5; 95% CI, -10.52 âˆ¼ -0.49; P = 0.03), C2 laminectomy (OR, 5.33; 95% CI, 2.39 âˆ¼ 11.91; P < 0.0001), more laminectomy level (WMD, 2.77; 95% CI, 1.78 âˆ¼ 3.76; P < 0.00001) were identified as risk factors for deformity and instability after CSCT surgery. CONCLUSION: Patients undergoing CSCT resection should receive careful follow-up for postoperative spinal deformity and instability. Younger age, C2 laminectomy, and more laminectomy level were significantly associated with occurrence of deformity and instability after CSCT surgery. Upfront spinal fixation at the time of resection should be considered in selected patients.


Assuntos
Medula Cervical , Cifose , Neoplasias da Medula Espinal , Fusão Vertebral , Adulto , Medula Cervical/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Cifose/cirurgia , Laminectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral/efeitos adversos
13.
Neuroimage Clin ; 34: 103006, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35468568

RESUMO

BACKGROUND: The vast majority of magnetic resonance imaging (MRI) studies on multiple sclerosis (MS) covered the spinal cord (SC), if at all, incompletely. OBJECTIVE: To assess SC involvement in MS, as detectable by whole SC MRI, with regard to distribution across vertebral levels and relation to clinical phenotypes and disability. METHODS: We investigated SC MRI with sagittal and axial coverage. Analyzed were brain and SC MRI scans of 17 healthy controls (HC) and of 370 patients with either clinically isolated syndrome (CIS, 27), relapsing remitting MS (RRMS, 303) or progressive MS (PMS, 40). Across vertebral levels, cross-sectional areas were semiautomatically segmented, and lesions manually delineated. RESULTS: The frequency of SC lesions was highest at the level C3-4. The volume of SC lesions increased from CIS to RRMS, and from RRMS to PMS whereas lesion distribution across SC levels did not differ. SC atrophy was demonstrated in RRMS and, to a higher degree, in PMS; apart from an accentuation at the level C3-4, it was evenly distributed across SC levels. SC lesions and atrophy volume were not correlated with each other and were independently associated with disability. CONCLUSION: SC lesions and atrophy already exist at the stage of RRMS in the whole SC with an accentuation in the cervical enlargement; SC lesions and atrophy are more pronounced in the stage of PMS. Both contribute to the clinical picture but are largely independent.


Assuntos
Medula Cervical , Esclerose Múltipla Crônica Progressiva , Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Doenças da Medula Espinal , Atrofia/patologia , Medula Cervical/patologia , Avaliação da Deficiência , Progressão da Doença , Humanos , Imageamento por Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/patologia , Esclerose Múltipla Crônica Progressiva/patologia , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/patologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Doenças da Medula Espinal/patologia
14.
Spinal Cord Ser Cases ; 8(1): 41, 2022 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-35397633

RESUMO

INTRODUCTION: Neuropathic pain after spinal cord injury is difficult to treat, and it is associated with abnormalities in the function of the thalamus-to-cortex neural circuitry. Aerobic exercise provides immediate improvement in neuropathic pain and is associated with abnormal resting electroencephalography (EEG) findings in patients with spinal cord injury. This study aimed to investigate whether physical therapy, including walking, can improve neuropathic pain and EEG peak alpha frequency (PAF) in the long term in a patient with cervical spinal cord injury. CASE PRESENTATION: A 50-year-old man was admitted with a cervical spinal cord insufficiency injury sustained one week prior. The residual height was C5. Neuropathic pain was observed in the fingers bilaterally. A numerical rating scale (NRS) was evaluated to measure the weekly mean and maximum intensities of pain. Resting EEG was measured, and the PAF was calculated. Each time point was evaluated in 2-week intervals from the time of admission, and the rate of change (Δ) of PAF was calculated based on the initial evaluation. Interventions included 18 weeks of standard physical therapy focusing on gait, with additional intensive gait training (4-10 weeks). The NRS scores for the mean and maximum intensities of pain decreased significantly after 6 weeks, and ΔPAF increased significantly after 4 weeks. Improvement in PAF coincided with the start of intensive gait training. DISCUSSION: PAF shifts to a high frequency during intensive gait training, suggesting the effectiveness of aerobic exercise. Furthermore, there is a close relationship between PAF, pain, and the quantification of pain changes.


Assuntos
Medula Cervical , Neuralgia , Traumatismos da Medula Espinal , Eletroencefalografia , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/terapia , Modalidades de Fisioterapia , Traumatismos da Medula Espinal/reabilitação
15.
Magn Reson Med ; 88(2): 1002-1014, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35468243

RESUMO

PURPOSE: To develop a wireless integrated parallel reception, excitation, and shimming (iPRES-W) coil array for simultaneous imaging and wireless localized B0 shimming, and to demonstrate its ability to correct for distortions in DTI of the spinal cord in vivo. METHODS: A 4-channel coil array was modified to allow an RF current at the Larmor frequency and a direct current to flow on each coil element, enabling imaging and localized B0 shimming, respectively. One coil element was further modified to allow additional RF currents within a wireless communication band to flow on it to wirelessly control the direct currents for shimming, which were supplied from a battery pack within the scanner bore. The RF signals for imaging were transferred via conventional wired connections. Experiments were conducted to evaluate the RF, B0 shimming, and wireless performance of this coil design. RESULTS: The coil modifications did not degrade the SNR. Wireless localized B0 shimming with the iPRES-W coil array substantially reduced the B0 RMSE (-57.5% on average) and DTI distortions in the spinal cord. The antenna radiation efficiency, antenna gain pattern, and battery power consumption of an iPRES-W coil measured in an anechoic chamber were minimally impacted by the introduction of a saline phantom representing tissue. CONCLUSION: The iPRES-W coil array can perform imaging and wireless localized B0 shimming of the spinal cord with no SNR degradation, with minimal change in wireless performance and without any scanner modifications or additional antenna systems within the scanner bore.


Assuntos
Medula Cervical , Imageamento por Ressonância Magnética , Encéfalo , Imageamento por Ressonância Magnética/métodos , Imagens de Fantasmas , Medula Espinal/diagnóstico por imagem
16.
Magn Reson Med ; 88(2): 849-859, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35476875

RESUMO

PURPOSE: Spinal cord gray-matter imaging is valuable for a number of applications, but remains challenging. The purpose of this work was to compare various MRI protocols at 1.5 T, 3 T, and 7 T for visualizing the gray matter. METHODS: In vivo data of the cervical spinal cord were collected from nine different imaging centers. Data processing consisted of automatically segmenting the spinal cord and its gray matter and co-registering back-to-back scans. We computed the SNR using two methods (SNR_single using a single scan and SNR_diff using the difference between back-to-back scans) and the white/gray matter contrast-to-noise ratio per unit time. Synthetic phantom data were generated to evaluate the metrics performance. Experienced radiologists qualitatively scored the images. We ran the same processing on an open-access multicenter data set of the spinal cord MRI (N = 267 participants). RESULTS: Qualitative assessments indicated comparable image quality for 3T and 7T scans. Spatial resolution was higher at higher field strength, and image quality at 1.5 T was found to be moderate to low. The proposed quantitative metrics were found to be robust to underlying changes to the SNR and contrast; however, the SNR_single method lacked accuracy when there were excessive partial-volume effects. CONCLUSION: We propose quality assessment criteria and metrics for gray-matter visualization and apply them to different protocols. The proposed criteria and metrics, the analyzed protocols, and our open-source code can serve as a benchmark for future optimization of spinal cord gray-matter imaging protocols.


Assuntos
Medula Cervical , Substância Branca , Substância Cinzenta/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Estudos Multicêntricos como Assunto , Medula Espinal/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
17.
Lakartidningen ; 1192022 03 03.
Artigo em Sueco | MEDLINE | ID: mdl-35266131

RESUMO

Regaining upper extremity function is a prioritized matter for patients with tetraplegia after a cervical spinal cord injury (cSCI). The purpose of this article is to describe the current evidence and treatment strategies for upper extremity reconstruction after cSCI at the Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Sweden. The specialized unit works in a multidisciplinary setting to optimize the care of the patient population. Preoperative planning and an individualized treatment according to the needs and abilities of the patient are considered key points to achieve the best possible outcome. The addition of nerve transfers to the established method of tendon transfers for grip reconstruction has led to increased possibilities to achieve both functional hand opening and grip. Here we present our preferred method of upper extremity reconstruction, which involves a two-staged procedure where the tendon-based grip reconstruction is preceded by nerve transfer of the supinator to posterior intraosseous nerve whenever possible. Important clinical aspects as well as future perspectives are discussed.


Assuntos
Medula Cervical , Transferência de Nervo , Traumatismos da Medula Espinal , Mãos , Humanos , Transferência de Nervo/métodos , Quadriplegia/etiologia , Quadriplegia/cirurgia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/cirurgia , Transferência Tendinosa/métodos
18.
Spinal Cord ; 60(5): 422-427, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35273373

RESUMO

STUDY DESIGN: Post hoc analysis of prospective multi-national, multi-centre cohort study. OBJECTIVE: Determine whether cerebral dominance influences upper extremity recovery following cervical spinal cord injury (SCI). SETTING: A multi-national subset of the longitudinal GRASSP dataset (n = 127). METHODS: Secondary analysis of prospective, longitudinal multicenter study of individuals with cervical SCI (n = 73). Study participants were followed for up to 12 months after a cervical SCI, and the following outcome measures were serially assessed - the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) and the International Standards for the Neurological Classification of SCI (ISNCSCI), including upper extremity motor and sensory scores. Observed recovery and relative (percent) recovery were then determined for both the GRASSP and ISNCSCI, based on change from initial to last available assessment. RESULTS: With the exception of prehension performance (quantitative grasping) following complete cervical SCI, there were no significant differences (p < 0.05) for observed and relative (percent) recovery, between the dominant and non-dominant upper extremities, as measured using GRASSP subtests, ISNCSCI motor scores and ISNCSCI sensory scores. CONCLUSION: Despite well documented differences between the cerebral hemispheres, cerebral dominance appears to play a limited role in upper extremity recovery following acute cervical SCI.


Assuntos
Medula Cervical , Traumatismos da Medula Espinal , Estudos de Coortes , Humanos , Estudos Prospectivos , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/complicações , Extremidade Superior
19.
Neurorehabil Neural Repair ; 36(4-5): 269-273, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35227121

RESUMO

BACKGROUND: It is unknown whether assessment of autonomic pathway integrity in newly injured traumatic cervical spinal cord injury (SCI) patients contributes to their neurological prognosis. OBJECTIVE: The objective is to investigate the relationship of heart rate variability (HRV) and sympathetic skin response (SSR) at initial evaluation of American Spinal Injury Association Impairment Scale (AIS) A/B tetraplegic patients, with their short-term neurological recovery. METHODS: In this prospective cohort study, short-term HRV indices and SSR to supra-lesional stimuli were computed in 24 acute traumatic cervical AIS A/B SCI patients at admission for rehabilitation. The relationship of these autonomic parameters with motor and sensory score improvement, AIS grade improvement, and time taken for recovery was tested, respectively, with Spearman's correlation coefficient test, Fisher's exact test, and Kaplan-Meier analysis. RESULTS: SSR was present in 11 (45.8%) patients at initial evaluation. After rehabilitation, 5 (20.8%) patients improved from AIS A/B to AIS C (greater recovery), while the rest remained at AIS A/B (lesser recovery). Both AIS improvement and mean time for 'greater' recovery did not associate with the presence/absence of SSR. Further, HRV indices did not correlate with improvement in motor or sensory scores. CONCLUSIONS: Interim neurological recovery was not related to autonomic parameters of short-term HRV indices and SSR in the AIS A/B tetraplegic patients of our study. Interestingly, about half of the patients with clinically complete SCI had evidence of preserved autonomic function. Our data add to the knowledge base of autonomic findings in cervical SCI patients and will promote research relating neurophysiological parameters and recovery.


Assuntos
Medula Cervical , Traumatismos da Medula Espinal , Traumatismos da Coluna Vertebral , Medula Cervical/lesões , Humanos , Pacientes Internados , Estudos Prospectivos , Recuperação de Função Fisiológica
20.
Exp Neurol ; 353: 114030, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35247372

RESUMO

Upper cervical spinal cord injuries (SCI) disrupt descending inputs to phrenic motor neurons (PhMNs), impairing respiratory function. Unilateral spinal hemisection at C2 (C2SH) results in loss of ipsilateral rhythmic diaphragm muscle (DIAm) EMG activity associated with lower force behaviors accomplished by recruitment of smaller PhMNs in rats. Activity during higher force, non-ventilatory behaviors that recruit larger PhMNs is minimally impaired following C2SH. We previously showed neuroplasticity in glutamatergic receptor expression in PhMN post-C2SH with changes in NMDA receptor expression reflecting functional recovery over time. We hypothesize that C2SH-induced changes in glutamatergic receptor (AMPA and NMDA) mRNA expression in PhMNs vary with motor neuron size, with more pronounced changes in smaller PhMNs. Retrogradely-labelled PhMNs were classified in tertiles according to somal surface area and mRNA expression was measured using single-cell, multiplex fluorescence in situ hybridization. Ipsilateral to C2SH, a pronounced reduction in NMDA mRNA expression in PhMNs was evident at 3 days post-injury with similar impact on PhMNs in the lower size tertile (~68% reduction) and upper tertile (~60%); by 21 days, there was near complete restoration of NMDA receptor mRNA expression across all PhMNs. There were no changes in NMDA mRNA expression contralateral to C2SH. There were no changes in AMPA mRNA expression at PhMNs on either side of the spinal cord or at any time-point post-C2SH. In summary, following C2SH there is ipsilateral reduction in PhMN NMDA mRNA expression at 3 days that is not limited to smaller PhMN recruited in the generation of lower force ventilatory behaviors. The recovery of NMDA mRNA expression by 21 days post-C2SH is consistent with evidence of spontaneous recovery of ipsilateral DIAm activity at this timepoint. These findings suggest a possible role for NMDA receptor mediated glutamatergic signaling in mechanisms supporting postsynaptic neuroplasticity at the PhMN pool and recovery of DIAm activity after cervical SCI.


Assuntos
Medula Cervical , Traumatismos da Medula Espinal , Animais , Medula Cervical/lesões , Diafragma/fisiologia , Hibridização in Situ Fluorescente , Neurônios Motores/fisiologia , N-Metilaspartato/metabolismo , Nervo Frênico/fisiologia , RNA Mensageiro/metabolismo , Ratos , Receptores de N-Metil-D-Aspartato/genética , Receptores de N-Metil-D-Aspartato/metabolismo , Recuperação de Função Fisiológica/fisiologia , Ácido alfa-Amino-3-hidroxi-5-metil-4-isoxazol Propiônico/metabolismo
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