Gunshot injury of the spinal cord

108 pigs were shot at the level of lumbar 1 to investigate the changes of spinal cord in relation to the speed of shooting and the trajectory through which the bullet passed. The cord lesions of the specimens could be divided, according to its severity, into 4 grades: (1) transection in 41; (2) complete destruction in 43; both lesion 1&2 resulted in permanent paraplegia; (3) incomplete destruction in 13, those resulted in incomplete paraplegia eventually recovered; (4) mild damage, that was concussion in 11, resumed perfectly. Through a transducer sealed into the spinal canal, the intracanal pressure was recorded: (1) Shooting through spinal canal with a pressure over 5 kg caused cord transection. (2) shooting through canal wall with a pressure of 2.5 to 5; 0 kg caused complete cord destruction. (3) shooting nearby the outer margin of vertebra with a pressure less than 1.0 kg caused mild cord damage. It was found that the speed of bullet, the trajectory with relation to cord and the grade of cord lesion are in agreement with each other. The mutual effects among them would make one think it reasonable to classify cord injury as follows: 1. Injury from bullet through spinal canal or vertebral body usually causes cord transaction; 2. Injury from bullet through canal wall at high speed would make a chance of complete destruction in 94%; at low speed, a chance of either complete or incomplete lesion in 50% each. 3. Injury nearby vertebra, high speed bullet would cause a chance of complete cord lesion in 86%; low speed one would make a chance of incomplete lesion in 1/3 and mild lesion in 2/3.     

脊髓血管母细胞瘤的MRI特点

【摘要】〓目的〓分析探讨脊髓血管母细胞瘤的MRI表现特征。方法〓回顾性分析经手术病理证实的7例脊髓血管母细胞瘤的临床及MRI表现。全部患者均行MRI平扫及增强扫描。结果〓单发6例,多发1例,共有脊髓血管母细胞瘤病灶8个,所有病灶均位于髓内。其中,延髓1个,颈段4个,胸段2个,腰段1个。肿瘤多呈点状、结节状、香肠状或不规则形状,肿瘤在MRI T1WI呈等或稍低信号,T2WI呈稍高信号,增强扫描上下径<20 mm的病灶呈明显、均匀强化,上下径>20 mm的病灶呈明显不均匀强化,其内可见多发流空的血管影;7例患者均伴有不同程度脊髓空洞或水肿。结论〓脊髓血管母细胞在MRI中具有特征性的影像表现,MRI对诊断脊髓血管母细胞瘤具有重要价值。     

Non-dysraphic intramedullary spinal cord lipoma of the child: Report of 3 cases

Background and purposeNon-dysraphic intramedullary spinal cord lipomas (NDSCL) represent 1% of spinal cord tumors. They are less frequent than dysraphic spinal cord lipomas and clinical presentation is unspecific. There are no guidelines on surgical management.Material and methodsWe report three observations of NDSCL in children, focusing on the clinical presentation, surgical management and postoperative outcome.ResultsThe patients, one female and two males, aged from 5 months to 10 years presented with neurological deterioration, pain, spinal rigidity and in two cases, a subcutaneous mass. Spinal MRI found intradural lipomas without spina bifida, located in the cervico-thoracic area in all cases. The lipoma extended to the medulla oblongata in two cases and was in the lumbar region in the third. These lipomas were massive, requiring decompression surgery. Surgery confirmed the lipoma to be subpial. We performed debulking of the lipoma without attempting total resection, and with or without dural plasty and laminoplasty, followed by minerva cast in two cases, and avoidance of standing in the youngest. Satisfactory recovery occurred in all three cases. After a follow-up between 4 months and 9 years, the outcome was favorable in all cases, and no patient presented with secondary spinal deformation or lipoma progression.ConclusionNDSCL is a rare entity, which often manifests with progressive pain and neurological deficits. In our experience, partial resection with or without dural plasty and laminoplasty has been associated with satisfactory postoperative outcomes and no recurrence of symptoms. We should be attentive to the risk of postoperative spinal deformity in these young patients.     

国人胎儿脊髓和脊柱发育的测量

对９～４１周的１９３例胎儿尸体分别就脊髓和脊柱的颈、胸、腰、骶尾各部及全长的逐月发育情况进行了测量。求得了脊髓和脊柱从胎龄３个月至出生期间８个不同月龄的发育数据。脊髓与脊柱的发育在早期较快，６个月（２１～２４周）之后逐渐减慢下来。脊髓与脊柱各部发育都不平衡。脊髓的增长率显示了从上到下渐次减少的趋势，即颈髓及胸髓较快，腰髓及骶尾髓较慢。而脊柱则是颈椎最慢，腰椎最快。由于发育速率的不同，导致二者的差额从３个月的５．７５ｍｍ增加到出生时的８５．６０ｍｍ。脊髓发育的性别差异不明显。     

胸腰椎脊髓损伤侧前方减压的适应证与术式选择

胸腰椎骨折脱位并截瘫主要系椎管前方的椎体骨拆块、椎体后上角与椎间盘突出及大于２０°的脊柱后弓成角所致，是侧前方减压的适应证。经后正中入路椎弓根侧前方减压的优点是手术创伤较小，可同时探查脊髓与安置后方内固定；缺点是不能直视脊髓前方，对侧减压可能不彻底或需对侧辅助减压。适于Ｔ１０以上的胸椎与Ｌ２以下腰椎，亦适于胸腰段，特别是已行椎板切除者。     

Gross quantitative measurements of spinal cord segments in human

STUDY DESIGN: Anatomical measurement. OBJECTIVE: To obtain quantitative anatomical data on each spinal cord segment in human, and determine the presence of correlations between the measures. SETTING: Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan, Korea. METHODS: A total of 15 embalmed Korean adult human cadavers (13 males, two females; mean age 57.3 years) were used. The length of each cord segment was defined as the root attachment length plus the upper inter-root length. After performing a total vertebrectomy, a transverse cut was made at the approximate proximal and distal point of each segment from segment C3 to S5. Sagittal and transverse diameters at the proximal end of each segment, and cross-sectional area, height, and volume of the segment were measured. RESULTS: The transverse diameter was largest at segment C5, and decreased progressively to segment T8. However, the sagittal diameter of each segment did not change distinctly with the segment. The cervical and lumbar enlargements were determined by the transverse diameters of the segments. Segment C5 had the largest cross-sectional area, at 75.0 mm(2). Segment T6 was the longest, averaging 22.4 mm in length. The longest segment in the cervical spinal cord was segment C5, at 15.5 mm, and segment L1 in the lumbar spinal cord. The volume was largest at segment C5, with a value of 1173.9 mm(3). CONCLUSIONS: We found characteristic quantitative differences in the values of the parameters measured in the thoracic spinal cord compared to those measured in the cervical and lumbar or lumbosacral spinal cords. These measurements of spinal cord segments appear to provide valuable and practical standard quantitative features and may provide basic data for understanding the morphometric characteristics relevant to pathophysiologic conditions of the spinal cord.     

Correlation between spinal cord blood flow and arterial diameter following acute spinal cord injury in rats

Summary Simultaneous measurements of spinal cord blood flow and arterial diameter at areas adjacent to a site of spinal cord injury were carried out to determine changes in CO₂ reactivity and autoregulation. The spinal cord injury was made at T10 level by the epidural clip compression method. A spinal window was drilled at an area either 7 mm caudal or 7 mm rostral to the injury site for the measurement of spinal cord blood flow and arterial diameter at the same time. Spinal cord blood flow was decreased at both spinal windows, especially at the rostral window. Arterial diameter was also decreased significantly at both sites. The ischaemic zone evaluated histologically tended to expand more diffusely in the rostral direction than in the caudal direction.In the pre-injury stage, both CO₂ reactivity and autoregulation were present in the spinal cord. Following the clip injury, CO₂ reactivity and autoregulation were both impaired in the areas 7 mm adjacent to the impact site. Correlation coefficients suggested that the rostral spinal cord tended to sustain more injury than the caudal spinal cord.The histologically proven spinal cord ischaemia following the injury may have resulted from the decreased arterial diameter and impaired CO₂ reactivity and dysautoregulation of the spinal cord.     

胚胎脊髓移植联合应用MK-801促进大鼠脊髓损伤后功能恢复

目的　研究胚胎脊髓移植并应用N 甲基 D 天门冬氨酸 (NMDA)受体拮抗剂MK 80 1能否促进半切洞脊髓损伤后功能恢复。方法　将成年大鼠分为 3组 ,A组 :单纯脊髓半切洞损伤组 ;B组 :脊髓半切洞损伤 胚胎脊髓移植组 ;C组 :脊髓半切洞损伤 胚胎脊髓移植 MK 80 1组。手术后应用联合行为评分 (CBS)、感觉诱发电位 (SEP)、运动诱发电位 (MEP)检查。结果　 3组CBS得分A组>B组 >C组 ,SEP和MEP潜峰时A组 >B组 >C组 ,统计学分析差异有显著性 (P <0 0 5 )。结论　胚胎脊髓移植联合应用NMDA受体拮抗剂MK 80 1能够促进脊髓损伤后功能恢复     

脱细胞脊髓天然支架的制备及形态学观察

[目的]采用化学脱细胞方法去除细胞和髓鞘成分制作细胞外基质支架,为桥接脊髓损伤缺损提供理想的天然神经支架。[方法]取SD大鼠胸段脊髓约2cm,运用冻融 化学萃取(3%脱氧胆酸钠和1KU/mlDNaseI、RNaseA)的组织工程学方法处理大鼠脊髓组织,并对处理后的脊髓支架分别进行组织学检查,了解脱细胞情况及细胞外基质支架形态。[结果]经过脱细胞处理后,光镜下HE染色脊髓横断面呈网状结构,未见细胞成分存留,纵切面上呈互相交错的管状通路;未见轴突、髓鞘和细胞核。髓鞘染色可见髓鞘脱除彻底,未见髓鞘成分。[结论]本实验采用冻融 化学萃取的组织工程学方法可制备出理想的天然脊髓支架,该支架与脊髓三维组织结构具有高度相似性,有望作为脊髓损伤后桥接物和神经组织工程种子细胞的支架,本实验结果显示3%脱氧胆酸钠和1KU/mlDNa-seI、RNaseA进行脱细胞处理两次是较为合适的,能较为彻底去除细胞及髓鞘成分并较为完整地保留细胞外基质的三维结构。     

Exophytic ependymomas of the spinal cord

Summary Intramedullary ependymomas of the spinal cord with exophytic components are rare outside the filum or conus region. Two cases of combined intradural intramedullary and extramedullary ependymomas of the spinal cord are presented. At operation, the tumours proved to be primarily intramedullary but had a contiguous exophytic component that extruded either through a defect in the ventral pia to encase the anterior spinal artery in one patient, or through the dorsal root entry zone in the second patient. When removing intramedullary spinal tumours with an exophytic component, separate removal of the intramedullary and extramedullary components is recommended, rather than en bloc resection, to prevent possible injury to the vascular supply of the spinal cord.     

脊柱手术中脊髓损伤的危险因素分析及其预防策略

目的探讨脊柱外科术中导致脊髓损伤的危险因素及其预防策略。方法报告2000年2月～2006年3月,作者共手术治疗脊柱患者1357例次。分组按照术前危险因素:临床因素、影像学因素、病理因素和手术因素4大部分。干预措施包括:出血倾向患者术前术中应用止血药物或成分输血,控制性降压,激素,高压氧等。结果在1357例中,根据界定标准,共有43例符合高危患者的标准,其中颈椎21例,胸椎19例,腰椎3例。结论胸椎的危险性及发生率明显高于颈椎,腰椎最少。年龄不是影响术中脊髓损伤的主要原因。多节段骨性狭窄的颈椎前路手术是脊髓损伤的危险因素。颈椎手术中高血压和糖尿病患者的出血控制相对困难。脊柱侧凸的术前牵引,解除前方压迫的经椎间孔途径减压,以及脊髓肿瘤术中应用"布袋"技术可以减少脊髓损伤。高速磨钻可以避免胸椎黄韧带骨化和颈椎OPLL患者的脊髓损伤。激素和高压氧可以促进脊髓损伤的恢复。     

Midodrine improves ejaculation in spinal cord injured men

PURPOSE: We evaluated the effect of the alpha1-adrenergic agonist midodrine given orally for anejaculation in spinal cord injured men. MATERIALS AND METHODS: A total of 185 spinal cord injured patients who reported absent ejaculation during sexual intercourse and who failed to respond to penile vibratory stimulation were treated with midodrine 30 to 120 minutes before a new stimulation. The procedure was repeated weekly, increasing doses by 7.5 mg to a maximum of 30 mg. Cardiovascular effects were monitored throughout the procedure. RESULTS: Antegrade or retrograde ejaculation was achieved in 102 spinal cord injured men (64.6%). A positive response was more frequent in patients with complete lesions (American Spinal Injury Association A) and upper motor neuron lesions above T10. Midodrine induced a significant but moderate increase (maximum 10 mm Hg) in mean arterial pressure in all patients. The highest systolic blood pressure (more than 200 mm Hg) was seen in patients with quadriplegia. No other significant side effect was recorded. The average dose of midodrine required for ejaculation was 18.7 mg. CONCLUSIONS: Midodrine is a safe and efficient adjunct to penile vibratory stimulation for anejaculation in spinal cord injured patients.     

脊髓线预测颈椎后路开门术后脊髓减压效果的临床研究

目的 探讨颈椎后路开门手术后脊髓减压程度的预测及方法.方法 收集2008年3月至2009年8月25例行颈椎单开门椎管成形术患者术前、术后的MRI图像.根据脊髓前方的压迫程度可分为0～4分;其中＞3分(3和4分)表明有脊髓压迫,＜3分表明脊髓无压迫.在开门节段上位椎体下终板做一水平线与脊髓前方成一交点,在开门节段下位椎体...     

无脊髓神经损伤胸腰段椎体骨折脱位的临床治疗

目的探讨无脊髓神经损伤胸腰段椎体骨折脱位的治疗方法.方法 15例无脊髓神经损伤的胸腰段椎体骨折脱位患者中,12例为不稳定性行手术治疗,3例为稳定性行保守治疗.结果全部病例随访观察,神经症状均获得改善.结论稳定性的无脊髓神经损伤胸腰段椎体骨折脱位采用保守治疗,不稳定性的应选择手术治疗.     

Experimental bypass surgery between the spinal cord and caudal nerve roots for spinal cord injuries

Spinal cord injuries often cause permanent neurological deficits and are still considered as inaccessible to efficient therapy. Injured spinal cord axons are unable to spontaneously regenerate in adult mammalians. Re-establishing functional activity especially in the lower limbs by reinnervating the caudal infra-lesional territories could represent an attractive therapeutic strategy. For several years, we have studied and developed surgical bypasses using peripheral nerve grafts bridging the supra-lesional rostral spinal cord to the caudal infra-lesional lumbar roots. Main objectives were: 1- to overcome the spinal cord lesion and the consecutive glial barrier blocking the axonal regeneration; 2- to find and bring an alternative source of regenerating axons; 3- to guide those axons toward precisely definite targets (for example, lower limb muscles). We report here the results of our experimental research, which led us from animal experimental models (rodents, primates) to the first human experimentation. Limitations of the method (especially technical pitfalls) are numerous. However, we have obtained encouraging results in our attempts to "repair" the motor pathway. Functional recovery with strong evidence of centrifugal axonal regeneration from the spinal cord to the periphery has been observed. Regarding the sensory pathway, we have found evidence of centripetal axonal regeneration from the periphery toward the spinal cord. Further studies are obviously advocated, but our experimental model of spinal cord - nerve roots bypasses may be integrated in future "repair" strategies of both motor and sensory pathways following spinal cord injury.     

Interesting case of subependymoma of the spinal cord

Background contextSubependymomas are rare, slow-growing, and usually noninvasive/nonaggressive World Health Organization Grade I tumors that tend to occur in the ventricles. Their most common site of occurrence is the fourth ventricle followed by the lateral ventricles. Spinal cord subependymomas typically manifest as cervical and cervicothoracic intramedullary or, rarely, extramedullary mass lesions. They often present clinically with pain and neurologic symptoms, including motor, sensory, urinary, and sexual dysfunction. Histologically, there are hypocellular areas with occasional clusters of cells and frequent microcystic changes, calcifications, and hemorrhage. Radiologically, subependymomas generally manifest as eccentric well circumscribed nodular lesions with mild-to-moderate enhancement.PurposeTo highlight an interesting and rare presentation for subependymoma of the spinal cord.Study designThis is a case report of a single patient in whom a subependymoma was resected from the cervical spinal cord with return to normal functioning.MethodsClinical examination, magetic resonance imaging evaluation, surgical resection, and histological analysis were performed for diagnosis and treatment of this patient.ResultsThe patient experiencing myelopathy symptoms underwent a surgical resection of cervical spinal cord subependymoma that resulted in return to normal function.ConclusionsSubependymoma should be included in the differential diagnosis of atypical presentations for myelopathy, as discrete surgical resection can result in good outcome.     

Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature

CONTEXT: Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. FINDINGS: A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. Clinical Relevance: The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression.     

"Backfiring" in spinal cord monitoring. High thoracic spinal cord stimulation evokes sciatic response by antidromic sensory pathway conduction, not motor tract conduction.

Spinal cord stimulation has been advocated as an alternative to motor cortex stimulation for motor tract activation. To test this theory, evoked responses were recorded from lumbar spinal cord (L2; n = 14), spinal roots (L4-L7; n = 112), peripheral nerves (sciatics; n = 28), and hind limb muscles (n = 28) after epidural stimulation of the T1-T2 segment of the spinal cord in dogs (n = 12), cats (n = 2), and monkeys (n = 2). The spinal response evoked by spinal cord stimulation was resistant to a dorsal hemisectioning (depth, 7-8 mm) of the midthoracic spinal cord. A minimal attenuation of latency and amplitude occurred with dorsal hemisectioning, suggesting signal transmission through descending or ascending pathways in the ventrolateral and ventral quadrants of the spinal cord. The sciatic nerve response was abolished by a dorsal column transection (depth, 3-4 mm) or ipsilateral lumbar dorsal rhizotomy (four dorsal roots). This shows that the evoked response recorded from the sciatic nerve in our animals was not travelling, as we expected, through the ventral roots, but rather was conducted antidromically through sensory fibers in dorsal roots.     

An experimental study of spinal cord traction syndrome

An experimental study was carried out on the pathophysiology of spinal cord traction syndrome. In fifty dogs, spinal cord traction impairment was created by gradual lumbosacral cord traction. Physiological integrity of the spinal cord was monitored and recorded by the spinal evoked potentials. The earliest change of the spinal evoked potentials and lumbar roots potentials was transient augmentation of the amplitude. With greater traction force, the potentials gradually decreased in amplitude. The spinal cord vulnerability to compression was increased by spinal cord traction. Under 200 g traction, the vulnerability of the lower thoracic cord was most increased while those of the upper thoracic and lumbar cord were unchanged. The authors conclude that tethered cord syndrome is caused by the impairment of the spinal cord and lumbosacral roots due to traction, and that spinal cord traction not only causes spinal cord impairment but increases the spinal cord vulnerability to compression.     

Posttraumatic anterior spinal cord syndrome: Pathological studies of two patients

Two patients sustained acute anterior spinal cord injury associated with a posteriorly displaced bone fragment and herniated cervical disc. Postmortem examination of both spinal cords showed extensive destruction of the cord at the site of injury with sparing of the posterior portion of the dorsal columns; the anterior spinal artery was patent. We conclude that posttraumatic anterior spinal cord syndrome can be caused by damage to the anterior part of the cord without involvement of the anterior spinal artery.