| Spinal Cord 2004 Abstracts （www.nature.com/sc ） （Jan-June 2004） |
■ February 2004, Volume 42, Number 2
1MR Technology Group, Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, MB, Canada 2Department of Physiology, University of Manitoba, Winnipeg, MB, Canada 3Department of Rehabilitation Medicine, Health Sciences Center, Winnipeg, MB, Canada
Noninvasive assessment of the injured human spinal cord by means of functional magnetic resonance imaging P W Stroman1,2, J Kornelsen2, A Bergman2, V Krause1, K Ethans3, K L Malisza1,2 and B Tomanek1
Study design: A magnetic resonance imaging technique that enables indirect detection of neuronal activity has been developed for the spinal cord. In the present study, this method, spinal functional magnetic resonance imaging (fMRI), is applied to the first study of the injured spinal cord, with the goal of better clinical assessment of the entire cord.
Objectives: The objectives of this project are: (1) to investigate the neuronal activity that can be detected in the spinal cord caudal to a chronic injury by means of spinal fMRI, and (2) to develop spinal fMRI as a clinical diagnostic tool.
Setting: Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, Manitoba, Canada.
Methods: fMRI of the spinal cord was carried out in 27 volunteers with cervical or thoracic spinal cord injuries (SCIs). Of these volunteers, 18 had complete injuries, and nine had incomplete injuries. Spinal fMRI was carried out in a 1.5 T clinical MR system, using established methods. Thermal stimulation at 10°C was applied to the fourth lumbar dermatome on each leg, and images were obtained of the entire lumbar spinal cord.
Results: Areas of neuronal activity were consistently observed in the lumbar spinal cord in response to the thermal stimulation, even when the subjects had no awareness of the sensation. The pattern of activity was notably different compared with noninjured subjects. In general, subjects with complete SCI showed absent or diminished dorsal gray matter activity, but had enhanced ventral activity, particularly contralateral to the stimulation.
Conclusions: Spinal fMRI is able to provide a noninvasive assessment of the injured spinal cord that does not depend on the patient's perception of the stimulus being applied. This work was carried out on a standard clinical MRI system without modification, and so is readily applicable in most MR units.
Sponsorship: This work was funded by a grant from the Canadian Institutes of Health Research (CIHR).
1Department of Neurology, University of Munich, Klinikum Grosshadern, Munich, Germany
Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs P Krause1, T Edrich1 and A Straube1
Study Design: Comparison of spinal lesion subjects and normal subjects.
Objective: To investigate the effects of a paravertebral repetitive magnetic stimulation on spastic tone increase of the lower limbs.
Setting: Munich, Germany.
Methods: We compared the effects in 15 patients with different spinal lesions and in 16 healthy subjects. The spastic tone increase was evaluated clinically with the Ashworth scale and apparatively with the pendulum test, both at fixed times before and after stimulation. Unilateral stimulation was applied to the lumbar nerve roots L3 and L4 of the clinically more spastic leg.
Results: The spastic tone decreased significantly in the interval between 4 and 24 h after stimulation. This effect was slightly more pronounced in the contralateral extremity. Furthermore, the stimulation motor threshold of the patients was significantly raised.
Conclusion: Repetitive magnetic unilateral stimulation has a positive effect on spastic tone increase due to spinal lesions, causing a decrease that lasts for about 1 day not only on the ipsilateral but also on the contralateral side.
1Department of Health Sciences, University of Technology, Sydney, NSW, Australia
Levels of brain wave activity (8-13 Hz) in persons with spinal cord injury Y Tran1, P Boord1, J Middleton2 and A Craig1
2Moorong Spinal Unit, Royal Rehabilitation Centre, Sydney, NSW, Australia
Study design: Brain wave activity in people with spinal cord injury (SCI) was compared to brain wave activity in able-bodied controls.
Objectives: To investigate whether a spinal injury results in changes in levels of brain wave activity in the 8-13 Hz spectrum of the electroencephalography (EEG).
Setting: Sydney, Australia.
Methods: Monopolar, multichannel EEG assessment was completed for 20 persons with SCI and 20 able-bodied, sex- and age-matched controls. A total of 14 channels of EEG were measured across the entire scalp for all participants. Comparisons between the able-bodied and SCI participants were made across the frontal, central, parietal, occipital and temporal regions. Comparisons were also made for impairment level, that is, between participants with tetraplegia and paraplegia.
Results: Compared to the able-bodied controls, consistently reduced brain wave activity (measured by magnitude and peak amplitude) in the 8-13 Hz component of the EEG occurred in persons with SCI across all regions and sites, and differences were larger in the central, parietal and occipital sites. The SCI group also had consistently lower frequencies than the able-bodied controls. Furthermore, the subgroup of SCI participants with tetraplegia generally had significantly reduced brain activity (magnitude and peak amplitude) compared with the paraplegic subgroup and able-bodied controls.
Conclusions: The findings of this research enhance our understanding of changes in brain wave activity that could be associated with deafferentation that occurs following SCI, as well as provide essential data on the potential of SCI persons to use a 'hands free' environmental control system that is based upon 8?13 Hz brain activity.
1Bouffard-Vercelli Centre, Cap Peyrefite, Cerbere, France
Motor capacities of upper limbs in tetraplegics: a new scale for the assessment of the results of functional surgery on upper limbs C Fattal1
Study design: Metrological investigation.
Objectives: To study the validity and the reliability of a Motor Capacities Scale (MCS) specifically designed for tetraplegics who undergo a functional surgery of upper limbs.
Setting: Bouffard-Vercelli Centre, Cerbere, France.
Methods: From diverse sources (observation of patients, review of literature, discussions with occupational therapists and physicians), we compiled a list of 300 activities relating to daily living tasks. From this list, 80 items of motor capacities were retained. They correspond to the abilities of a patient to perform basic and functional tasks regardless of contextual factors (environmental and personal factors). In a preliminary study, items were reviewed by occupational therapists and by 40 tetraplegics for criticism. An open study and an intermediate study were conducted to assess, respectively, the feasibility and the reliability of the MCS. A prefinal study was focused on construct validity. Convergent and divergent hypotheses were formulated and tested against other measures. Four criteria were identified for the elimination of some of the 36 remaining items: a variance of the item equal to 0, a low reproducibility, a high level of redundancy studied by item-to-item correlation and a low level of comprehension.
Results: In all, 52 tetraplegics were included in the prefinal study. Global inter-rater reproducibility was excellent (intraclass correlation coefficient of 0.99). In accordance with the criteria of elimination, the number of items was reduced to 31. Correlations with the Sollerman test and the Asia Motor Score were, respectively, 0.959 and 0.7444 (P<0.0001). Correlation with the interval since the onset of the tetraplegia and the educational level were, respectively, 0.20 and 0.195 (P=0.163).
Conclusion: MCS displays a good apparent and content validity, and excellent reproducibility and construct validity. Metrological properties were good enough to allow the evaluation of sensitivity to change in the final study.
1Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands
Submaximal physical strain and peak performance in handcycling versus handrim wheelchair propulsion A J Dallmeijer1, I D B Zentgraaff1, N I Zijp1 and L H V van der Woude1
Study design: Experimental study in subjects with paraplegia and nondisabled subjects.
Objective: To compare submaximal physical strain and peak performance in handcycling and handrim wheelchair propulsion in wheelchair-dependent and nondisabled control subjects
Setting: Amsterdam, The Netherlands.
Methods: Nine male subjects with paraplegia and 10 nondisabled male subjects performed two exercise tests on a motor-driven treadmill using a handrim wheelchair and attach-unit handcycle system. The exercise protocol consisted of two 4-min submaximal exercise bouts at 25 and 35 W, followed by 1-min exercise bouts with increasing power output until exhaustion.
Results: Analysis of variance for repeated measures showed a significantly lower oxygen uptake (VO2), ventilation (Ve), heart rate (HR), rate of perceived exertion and a higher gross efficiency for handcycling at 35 W in both subject groups, while no significant differences were found at 25 W. Peak power output and peak VO2, Ve and HR were significantly higher during handcycling in both groups. The differences between handcycling and wheelchair propulsion were the same in subjects with paraplegia and the nondisabled subjects.
Conclusions: Handcycling induces significantly less strain at a moderate submaximal level of 35 W, and shows noticeably higher maximal exercise responses than wheelchair propulsion, which is consistent in subjects with paraplegia and nondisabled controls. These results demonstrate that handcycling is beneficial for mobility in daily life of wheelchair users.
1Department of Oncotherapy, Semmelweis University, Hungary 2Department of Radiotherapy, National Institute of Oncology, Hungary 3Outpatient Department of Neurology, National Institute of Oncology, Budapest, Hungary 4PET Center, University of Debrecen, Debrecen, Hungary 5Department of Molecular and Tumor Biology, National Institute of Radiobiology and Radiation Hygiene, Budapest, Hungary 6PET Study Group of the Hungarian Academy of Sciences, Debrecen, Hungary
Characteristics of radiogenic lower motor neurone disease, a possible link with a preceding viral infection O Esik1,2, K Vonoczky3, Z Lengyel4, G Safrany5 and L Tron4,6
Objective: To investigate the pathogenesis of the rare radiogenic lower motor neurone disease (LMND) on the basis of a meta-analysis of the published case histories.
Materials and methods: The authors reviewed 47 well-documented radiogenic LMND cases from the English literature.
Results: The disease typically occurs following the irradiation of radiosensitive cancers situated near the spinal cord. It arises predominantly (46 cases) in the lower extremities; only one case involved the upper extremities. There is a male predominance (male:female ratio 7.8:1), and the patients are characteristically young (13?40 years, with four exceptions). An overdose does not seem to be a particular risk factor for the development of the disease, as total dose, fraction size and biologically effective dose are typically below 50 Gy, 2 Gy and 128 Gy2, respectively, which are regarded as safe doses. Other risk factors (chemotherapy, operations, etc) have been identifed only rarely. Radiogenic LMND is manifested in an apparently random manner, 4-312 (mean 48.7) months after the completion of radiotherapy.
Discussion: The complete lack of a dose?effect relationship argues strongly against a pure radiogenic nature of the pathological process. The latency period is typically several years and it varies extremely, which excludes a direct and complete causal relationship between radiotherapy and LMND. As the interaction of ionizing radiation with living tissues is highly unspecific, thus a selective motor injury due to irradiation alone, without comparable effects on the sensory and vegetative fibers, seems improbable.
Conclusions: On analogy with the viral motor neurone diseases, we suppose that radiogenic LMND may be preceded by viral (enterovirus?poliovirus) infection. Based on the meta-analysis, it is suggested that irradiation may be only a single component of the set of factors jointly resulting in the clinical state regarded as radiogenic LMND.
1Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Selcuk University, Meram, Konya, Turkey 2Department of Microbiology, Faculty of Medicine, Selcuk University, Meram, Konya, Turkey 3Department of Infectious Disease, Faculty of Medicine, Selcuk University, Meram, Konya, Turkey
Urethral cultures in patients with spinal cord injury F Levendoglu1, H Ugurlu1, O M Ozerbil1, I Tuncer2 and O Ural3
Study design: Prospective analysis.
Objectives: To investigate the colonization of the distal urethra and bladder during the initial stages of rehabilitation in acute spinal-cord injury (SCI) and to examine the association between bacteriuria and colonization of the distal urethra.
Setting: Selcuk University Meram Faculty of Medicine, Konya, Turkey.
Methods: A total of 27 patients with SCI (13 females and 14 males) and 40 controls without evidence of disease of the urinary tract were studied. Cultures were taken from the patients who applied clean intermittent catheterization and compared with normal subjects.
Results: Escherichia coli was predominantly isolated from the urine and urethral cultures of both female and male SCI patients. Colonization of other bacteria in the urine and urethral cultures was similar in both female and male patients, except for Pseudomonas, which was colonized in male patients. In all, 72% of patients who had E. coli positive urethral cultures also had E. coli colonization in their simultaneous urine cultures. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.82). When urethral cultures collected 1 week before were evaluated in patients with E. coli positive urine cultures (n=24 cultures), 15 of these urethral cultures also had E. coli colonization. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.66).
Conclusions: Our study suggested that urethral flora was a significant source for the development of urinary infection in spinal cord-injured patients.
1Ankara Physical Medicine & Rehabilitation Education and Research Hospital of Ministry of Health, Ankara, Turkey
Bladder-filling sensation in patients with spinal cord injury and the potential for sensation-dependent bladder emptying M Ersoz1 and M Akyuz1
Study design: Investigation of bladder-filling sensation in 73 consecutive traumatic spinal cord injury (SCI) patients during laboratory cystometry.
Objectives: To determine the frequencies of bladder-filling sensation in SCI patients with complete lesions above T11 and below T10 and with incomplete lesions, to examine the quality of the preserved sensation, as well as to determine the potential for sensation-dependent bladder emptying in this patient group.
Setting: Physical Medicine and Rehabilitation Education and Research Hospital of Ministry of Health, Ankara, Turkey.
Methods: Bladder-filling sensation was investigated in 73 consecutive patients with traumatic SCI using continuous medium fill cystometry. Bladder-filling sensation was categorised as absent, partially preserved or preserved. Presence of bladder-filling sensation before intravesical pressure (Pves) reached 25 and 40 cmH2O, and simultaneous presence of bladder capacity of more than 150 ml were investigated as the measures of the quality of the sensation.
Results: Bladder-filling sensation was present to some degree in all incomplete SCI patients, in 82.4% of the patients with complete lesions below T10, and 38.9% of the patients with complete lesions above T11. There were statistically significant differences between three groups with respect to bladder sensation category (P<0.001). About 86% of the patients with incomplete lesions, 53% of the patients with complete lesions below T10 and 22% of those with lesions above T11 had bladder-filling sensation before Pves reached 25 cmH2O and simultaneous bladder capacity of more than 150 ml was present in 61.2, 41.2 and 22.2% of the patients in the groups, respectively. Bladder-filling sensation investigations were reliable in terms of bladder filling sensation category in 36 SCI patients who had second cystometric examination.
Conclusion: Presence of bladder-filling sensation in many of the SCI patients observed in this study revealed the potential for sensation-dependent bladder emptying in SCI patients, especially in the ones with complete lesions below T10 and the ones with incomplete lesions. This method may prevent early emptying attempts, unnecessary catheterisations and overdistension episodes and may improve the patient's self-esteem and quality of life. However, further studies on clinical experience and patient compliance for this method are needed.
1Department of Neurological Surgery, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
Spinal cord compression in beta-thalassemia: case report and review of the literature S A Salehi1, T Koski1 and S L Ondra1
Study design: A case report of thoracic spinal cord compression in a 34-year-old male with beta-thalassemia is reported.
Objectives: In patients with thalassemia, neurologic complaints should lead to a high index of suspicion for spinal cord compression from marrow expansion, ectopic bone formation and resultant stenosis. Initial presentation, diagnosis, radiographic findings, surgical treatment and follow-up are reviewed.
Setting: This case is reported from Chicago, Illinois.
Method: A chart review is performed for the purposes of this case report.
Results: Patient underwent decompressive laminectomy with good surgical outcome.
Conclusion: Rapid diagnosis and treatment of such a condition is essential to optimize the chances of recovery.
1Division of Orthopaedic Surgery, Niigata University Hospital, Niigata Japan 2Department of Orthopaedic Surgery, Niigata Cancer Center Hospital, Niigata, Japan
Painful Schmorl's node treated by lumbar interbody fusion K Hasegawa1, A Ogose1, T Morita2 and Y Hirata2
Study design: A case report of painful lumbar Schmorl's node is presented.
Objective: To describe diagnostic evidence and the result of surgical treatment of a rare case of painful Schmorl's node.
Setting: Niigata, Japan.
Case report: A 55-year-old housewife was diagnosed with painful Schmorl's node of L3 by discography, which depicted leakage of the contrast medium into the L3 vertebra through a disruption of the central part of the cranial end plate with concomitant back pain. Segmental fusion surgery was performed. Mechanical low back pain of the patient improved just after surgery. Histologic examination demonstrated that fibrocartilaginous tissue herniated through a disruption of the superior end plate and forced into the vertebral spongiosa.
Conclusions: Painful Schmorl's node can be diagnosed by discography, which demonstrates an intravertebral disc herniation with concomitant back pain. Surgical treatment should be considered in a patient with persistent disabling back pain. When surgical treatment is indicated, eradication of the intervertebral disc including Schmorl's node and segmental fusion are preferable.
1Department of Neurosurygery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey 2Department of Otorhinolaryngology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
Abnormal bony protuberance of anterior atlas causing dysphagia. A rare congenital anomaly K Ilbay1, C Evliyao lu1, V Etus1, H Ozkarakas2 and S Ceylan1
Study design: A Case report.
Objective: To report an exceedingly rare case of dysphagia caused by abnormal bony protuberance of anterior atlas.
Setting: Kocaeli University Faculty of Medicine, Departments of Neurosurgery and Otorhinolaryngology.
Method: Radiological examinations revealed a large anterior abnormal bony tuberance of atlas in an 11-year-old boy who complained of dysphagia of 5 years donation.
Result: The anterior bony tuberance of the atlas was resected by a transoral approach. Histopathological examination of the surgical specimens showed normal bone tissue. Resection resulted in complete resolution of the dysphagia.
Conclusions: Dysphagia can be caused by disorders of the cervical spine. These disorders are usually seen in elderly adults. In the pediatric population, spinal abnormality is an exceedingly rare cause of dysphagia. Abnormal inductive signals from the adjacent notocord and ventral neural tube may play role in the pathogenesis of this abnormal bony protuberance.