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A cervical propriospinal system in man.

Abstract

Peripheral stimuli facilitate, at a pre-motoneuronal level, the responses elicited in human upper limb motoneurons (MNs) by transcranial magnetic stimulation over the motor cortex (TMS). Several features indicate that the relevant premotoneurones are distinct from segmental interneurones and located rostral to MNs. Thus, corticospinal volleys would have an indirect (propriospinal) pathway to upper limb MNs, in addition to the direct cortico-motoneuronal pathway. Slightly increasing the corticospinal input causes the facilitation to be reversed to inhibition. This is consistent with a well-developed system of inhibitory intemeurones activated by corticospinal and afferent inputs inhibiting propriospinal neurones (PNs). Corticospinal activation of these inhibitory interneurones would explain why propriospinally-mediated corticospinal EPSPs are weak in primate MNs after artificial (electrical or magnetic) activation of the corticospinal system by itself. However, indirect evidence for descending facilitation of PNs can be provided during normal voluntary contractions, while using the modulation of the ongoing EMG or of the H reflex.

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BibTeXRIS

Emmanuel Pierrot-Deseilligny, Véronique Marchand-Pauvert. 2002. A cervical propriospinal system in man.. https://doi.org/10.1007/978-1-4615-0713-0_33

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Surgical treatment of cervical kyphosis in Larsen syndrome: report of 3 cases and review of the literature.

STUDY DESIGN: A retrospective case series. OBJECTIVE: To review the surgical results for midcervical kyphosis in 3 cases with Larsen syndrome, and to discuss the choice of surgical treatments. SUMMARY OF BACKGROUND DATA: Cervical kyphosis is the most hazardous and serious manifestation of Larsen syndrome due to the risk of life-threatening paralysis, and thus usually requires surgical treatment. However, little information has been reported concerning surgical treatments for this challenging condition. METHODS: Three patients with Larsen syndrome were surgically treated for midcervical kyphosis at our institution. RESULTS: An infant with mild cervical kyphosis was successfully treated with posterior arthrodesis using a halo immobilization, and anterior vertebral growth with a mature posterior fusion mass resulted in spontaneous correction of the kyphosis. In the remaining 2 infants with myelopathic symptoms due to severe and structural kyphosis, anterior decompression and fusion via a lateral approach followed by posterior fusion with segmental spinal instrumentation and halo immobilization resulted in improved neurologic symptoms and solid fusion. CONCLUSIONS: Posterior spinal fusion is only indicated for patients with mild and flexible cervical kyphosis, and anterior decompression and circumferential arthrodesis is required for patients with severe kyphotic deformity, who usually develop myelopathic symptoms. Anterior surgery for such a small patient with severe kyphosis involves much higher risk of spinal cord injury during decompression maneuvers and difficulty in stabilization of the reconstructed cervical spine. Therefore, all patients with Larsen syndrome should be screened with radiographs at the first visit to detect cervical kyphosis early so that posterior alone fusion is possible.

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