脊柱脊髓损伤的病理变化

脊柱损伤主要包括两方面：脊椎骨折及其附着的韧带断裂。前者可按照一般骨折愈合的病理进程达到愈合；断裂的韧带则通过纤维组织的再生修复。脊柱骨折或脱位后合并脊髓损伤的病理改变分为以下几类。1脊髓震荡又称生理性脊髓横断或“脊髓休克”征，是脊髓的一种可逆性功能性紊乱，一般于伤后24～48h内症状体征消失，且不留任何神经系统的后遗症。手术探查未见脊髓有明显器质性改变，无压迫，脑脊液通畅无阻。镜下仅见脊髓灰质中有少数点状出血灶，神经细胞及轴突少数退变，此病理改变持续6～8周。有些学者认为脊髓震荡的病理基础是神经细胞分…     

中央型颈脊髓损伤机制的探讨

通过对我院收治的２１例中央型颈脊髓损伤病人的年龄、脊柱损伤类型、伤因、临床特点诸因素综合分析发现：中央型颈脊髓损伤可发生在任何年龄组伤员，与脊柱损伤类型无绝对相关性。和其他类型脊髓损伤病例相比，中央型颈脊髓损伤主要特点是原始伤力轻。我们认为中央型颈脊髓损伤实际上是一种较轻型的脊髓不完全损伤，它的发生取决于脊髓损伤的程度，伤力是主要因素。     

实验性脊髓损伤病理生理变化研究进展

目前普遍认为急性脊髓损伤包括原发和继发损伤两个阶段。1911年Allenn首先发现将犬脊髓致伤，然后消除伤后的脊髓出血有助于神经功能恢复。3年后他提出的脊髓损伤区的周边可能存在的某些生化因素继发了后续损伤。这一观点被扩展应用到蛛网膜下腔出血、脑及脊髓缺血、创伤等多个方面。     

进一步提高脊柱脊髓损伤的临床和基础研究水平

近 2 0年来 ,随着理论与技术的提高和相关专业的发展 ,脊柱脊髓损伤的临床和基础研究有了长足的进步 ,但要获得理想的疗效 ,尚需不断努力。现就以下几个问题阐述个人意见 ,供同道参考。一、认真研究脊柱脊髓损伤的病理过程研究脊柱脊髓损伤的力学机制和病理过程 ,有助于加深对伤椎的认识 ,有助于合理选择治疗方案 ,具有临床价值。临床上经常发现脊柱损伤后 ,影像学上的椎管占位情况与脊髓损伤程度并无显著相关性。实验表明 ,组织负载时的瞬间变形与去载后有很大不同。例如对颈椎施加轴向压缩载荷 ,加载速度大者产生爆裂型骨折 ,此时椎管瞬间…     

脊髓损伤与基因治疗

随着分子生物学技术的日益成熟,不少学者在中枢神经系统（ＣＮＳ）损伤方面进行了潜心研究,并取得一定成绩,为脊髓损伤后神经再生寻找到新的途径。一、影响脊髓损伤后神经再生的因素成熟神经元再生轴突的能力依赖于以下几个因素：（１）再表达生长相关基因的能力;（２）再生轴突能攀附及伸展的有效基质分子;（３）促进及引导轴突再生的有效神经营养因子;（４）是否存在损害轴突延伸的伴髓生长抑制因子［１］。脊髓组织作为成熟的中枢神经系统,其神经元已失去分裂和再生新神经元的能力,其髓鞘由少突胶质细胞而不是雪旺细胞组成,成熟…     

脊髓继发性损伤的机制

研究表明 ,脊髓继发性损伤的机制包括以下三个方面 :( 1)炎症水肿 ,钙、阿片肽和兴奋性氨基酸介质途径 ;( 2 )自由基和血管机制 ;( 3)最近发现 ,凋亡也可出现在脊髓继发性损伤 ,被称为第三种调节因素 ,并已受到高度重视[1 ,2 ] 。现将国内外有关脊髓继发性损伤的病理机制和临床表现以及研究现状综述如下。一、炎症水肿 ,钙、阿片肽和兴奋性氨基酸介质途径1.水肿 :脊髓损伤后血脑屏障破坏 ,中枢神经系统 (ＣＮＳ)内皮细胞选择性渗透作用受到损害 ,导致血管性水肿 ,富含蛋白的浆液性液体在细胞外间隙积聚。脊髓损伤后出现水肿的组织学证实最早…     

离子与脊髓损伤

脊髓损伤后,组织中钙、镁、钾、钠等离子的浓度发生改变,同时,这些离子失衡又加重脊髓损伤。研究脊髓损伤后组织中离子浓度的变化规律,对脊髓损伤的救治具有重要意义。本文就此作一综述。     

脊髓损伤后胃肠功能障碍的机制

脊髓损伤(SCI)后的患者常出现肠梗阻、便秘、大便失禁、腹胀等胃肠功能障碍的症状,严重影响患者的生活质量。但是相比而言,人们大多数关注患者的运动功能,对于脊髓损伤后胃肠功能障碍的发生机制研究报道并不多见,笔者就目前国内外有关脊髓损伤急性期后胃肠功能障碍发生机制的研究进展作一综述。     

Spinal and spinal cord infection

This review article includes infections of the vertebral body, intervertebral disc, ligaments and paravertebral soft tissues, epidural space, meninges and subarachnoid space, and the spinal cord. A wide range of infective organisms may be implicated and the incidence of some, notably tuberculosis, is rising due to increased immunocompromise and other factors. Imaging plays a key role in early diagnosis of these diseases, which may be severe and potentially life threatening. Infection may be acquired by the hematogenous route, by infection from contiguous structures or from direct inoculation. Of available imaging techniques, CT and MRI offer the clinically most valuable methods of evaluating all the structures potentially involved in infection. Although many signs are non-specific, indication is given of where appearances raise strong suspicion of infection. The extent of the inflammatory process is well evaluated by imaging, particularly in terms of severity and morbidity of clinical sequelae, which may be severe. Early investigation is mandatory and as MRI presently has the key role in investigation, it should be employed at an early stage of clinical suspicion.     

Spinal and spinal cord infection

This review article includes infections of the vertebral body, intervertebral disc, ligaments and paravertebral soft tissues, epidural space, meninges and subarachnoid space, and the spinal cord. A wide range of infective organisms may be implicated and the incidence of some, notably tuberculosis, is rising due to increased immunocompromise and other factors. Imaging plays a key role in early diagnosis of these diseases, which may be severe and potentially life threatening. Infection may be acquired by the hematogenous route, by infection from contiguous structures or from direct inoculation. Of available imaging techniques, CT and MRI offer the clinically most valuable methods of evaluating all the structures potentially involved in infection. Although many signs are non-specific, indication is given of where appearances raise strong suspicion of infection. The extent of the inflammatory process is well evaluated by imaging, particularly in terms of severity and morbidity of clinical sequelae, which may be severe. Early investigation is mandatory and as MRI presently has the key role in investigation, it should be employed at an early stage of clinical suspicion.     

Angiography of the spinal cord after vertebral trauma

Summary Angiography of the spinal cord after trauma to the spine is reported in 14 new cases with neurological signs. Three types of angiographic signs are demonstrated: (1) arterial interruption of the anterior spinal artery, the ascending branch of the radiculomedullary arteries or the extravertebral arteries; (2) displacement of the anterior spinal artery without interruption; (3) hyperemia. The mechanism and significance of these signs are discussed.     

MRI in chronic spinal cord trauma

Summary Eighty-seven patients aged 16–68 years have been examined by magnetic resonance imaging (MRI) following spinal injury. The MRI findings have been correlated with length of history between trauma and investigation, extent of residual function and site of injury. They include changes at the site of injury consistent with myelomalacia in 37%, a syrinx in 40%, persistent cord compression in 32% and atrophy in 18%. An extensive syrinx can develop within 2 months of injury and it is nearly twice as common in patients with complete paralysis as in those whose paralysis was incomplete. It is suggested that investigation and management of spinal trauma should include early and repeated MRI examinations to detect sequelae at an early stage.     

MR imaging of acute spinal cord trauma

The thoracic spinal cords of five mongrel dogs were imaged with a 1.5 T MR scanner before and after trauma induced by a well-established method of spinal cord impaction that produces central cord hemorrhagic necrosis. The anesthetized dogs were studied acutely with a 5-in. circular surface coil, 12-cm field of view, sagittal and axial partial-saturation (TR = 600, TE = 25 msec) and spin-echo (TR = 2000, TE = 25-100 msec) techniques. One normal dog was used as a control. The cords were surgically removed and histologically examined. Direct correlation of the pathologic findings and imaging data showed that at the level of trauma there was obliteration of epidural fat and CSF spaces secondary to central cord hemorrhage and edema. The traumatized cords expanded to fill the bony canal, and there was loss of visualization of the internal anatomy of the cord (gray- and white-matter structures). We conclude that MR can accurately identify cord hemorrhage and edema within a few hours of spinal trauma.     

Absent cord sign in acute spinal trauma

Review of magnetic resonance imaging (MRI) findings in 100 patients suffering acute spinal trauma from 1985 to 1987 revealed four patients who had suffered thoracic spine fractures and acute subarachnoid hematomas. The spinal cord was not demonstrated on the T1-weighted sagittal MRI due to the similarities in signal intensity between the spinal cord and acute hemorrhage. Nonvisualization of the thoracic cord should not be presumed to be artifactual until subarachnoid hematoma is excluded.     

Herniation of the spinal cord 38 years after childhood trauma

We report an unusual post-traumatic spinal cord herniation, which became symptomatic 38 years after the trauma. A 44-year-old man presented with a 2-year history of increasing impotence, neuropathic bladder dysfunction and dissociated sensory loss below the level of T6. At the age of 6 years he had a severe blunt spinal injury with transient paraparesis. MRI revealed right lateral and ventral displacement of the spinal cord at the T5/6 level. The spinal cord was surgically exposed and found to herniate through a ventral defect of the arachnoid membrane and the dura mater. As there were no other events that could have precipitated spinal cord herniation the reported blunt trauma in childhood is the most likely cause for the spinal cord herniation in this patient.     

Spinal cord vascularity. II. Extraspinal sources of spinal cord arteries in the rat.

The arrangement of extravertebral sources of spinal cord arteries in the rat is similar to that in man. Some differences, however, do exist, concerning mainly the arrangement of spinal branches supplied by the subclavian-vertebral arteries. Contrary to the situation in man, the vertebral artery in the rat appears to be the sole source of blood supply to the cervical cord. A high incidence of variations or anomalies of the vertebral artery in the rat existed. Vascular variations in the upper left thoracic spaces were frequent in the rat and more complicated than in man. In both species, a poor supply of significant spinal cord feeders from the superior intercostal artery of the costocervical trunk was found. Variations in the origin and branching of the aortic segmental arteries occur in both species. In man the major variation consists of two or more intercostal arteries arising from a common stem, while the rat more often displays a rudimentary subcostal artery. Finally, the ileolumbar arteries in the rat are constant branches of the lumbar aorta. Despite these differences in the vascular anatomy, the rat seems to be well suited for experimental comparative investigations, not feasible in man.     

MRI in Lyme disease of the spinal cord

We report a case of Lyme myelitis in a 31-year-old man, presenting with a conus medullaris syndrome. MRI demonstrated contrast enhancement on the pial surface of the lower thoracic cord and conus medullaris. Elevated blood immunoglobulins and IgM antibodies against Borrelia burgdorferi in the cerebrospinal fluid (CSF) were found. Leptomeningitis may be the first stage of spinal infection in Lyme disease, preceding parenchymal infection leading to myelitis. Vasculitis is probably the major mechanism. MRI findings are nonspecific and the diagnosis is given by serum and CSF analyses. Early treatment with antibiotics and high doses steroids may result in complete recovery, as in this case. Received: 29 December 1999 Accepted: 31 January 2000