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PubMedDate not supplied

Chromatographic identification of Met- and Leu-enkephalin in the human fetal spinal cord.

Using the indirect immunofluorescence method, enkephalin-like immunoreactivity was visualized on human fetus spinal cord sections (gestational age from 17 to 25 weeks). Immunolabeled varicose fibers and terminal-like structures were seen through the whole length fetal spinal cord principally in the dorsal gray, in the intermediate gray and in the lateral funiculus. A few enkephalin-like immunoreactive cells were sometimes detected in the intermediate gray. Finally, some immunolabeled fibers were also visible in the ventral spinal cord especially proximate to the motor nuclei areas at the sacral level. Fetal spinal cord tissue extracts from the cervical thoracic and lumbosacral region were chromatographically analyzed using high pressure liquid chromatography in combination with the radioimmunoassay. This biochemical analysis indicates that authentic pentapeptides Met- and Leu-enkephalin may account for a large part (more than 90%) of the enkephalin-like immunoreactivity detected in the fetal spinal cord investigated. Taken together our results suggest that the biosynthetic processing of Met- and Leu-enkephalin in this tissue might be functional early before birth.

Chromatography, High Pressure Liquid↗

PubMed1987

Immunohistochemical evidence for the coexistence of cholinergic and catecholaminergic phenotypes in neurones of the vagal motor nucleus in the adult rat.

Catecholaminergic nerve cell bodies have been recently identified in the rat spinal cord. They lie in the rostral cervical segments and at the lumbosacral junction. Among them, many are located in parasympathetic areas. This finding led us to investigate the interactions between these catecholaminergic neurones and the cholinergic ones. To address this question, we performed sequential immunocytochemical detection of choline acetyltransferase (ChAT) and tyrosine hydroxylase (TH) in the same sections. We could then identify the co-expression of both TH and ChAT-like immunoreactivities (LI) in some perikarya of the cervical spinal cord and medulla oblongata. Such cells are located in the caudal extension of the dorsal motor nucleus of the vagus nerve (DMNX) as well as in the caudal part of the medullary DMNX itself. Such a co-expression of TH-LI and ChAT-LI could not be found in the lumbosacral region, another parasympathetic territory where cell bodies displaying TH-LI were intermingled with those containing ChAT-LI. This is one of the first demonstrations of the co-existence of catecholaminergic and cholinergic phenotypes in some neurones of the adult mammalian nervous system. These observations also support the presence of catecholaminergic efferents within the vagus nerve.

Animals↗

PubMed1987

Neural modulation of cutaneous differentiation: epidermal hyperplasia and precocious hair development following partial neuralectomy in opossum pups.

The original intent of the present study was to evaluate the compensatory response of the nervous system to areas of denervation. A portion of the spinal cord in the lumbosacral region of one-day opossum pups (Monodelphis domesticus) was removed by cauterization. This partial neuralectomy produced an expected compensatory response of neurons in the dorsal root ganglia, but in addition produced unexpected abnormalities of cutaneous differentiation. At 4-6 days following surgery, an increase in the thickness of the epidermis resembling glabrous palmar or plantar skin was seen. This hyperplastic epidermis appeared to be associated with an abnormally dense innervation of the dermis and epidermis. Eight days following partial neuralectomy most animals showed areas of precocious hair development. Nerve fibers were always seen in the dermis associated with these precocious hairs and were seen to penetrate the basal lamina in the region of the epidermal-hair shaft boundary. These results imply a critical role for afferent nerves in the normal development of the skin and its appendages.

Animals↗

PubMed1990

Parturition pain treated by intracutaneous injections of sterile water.

Forty-five pregnant women in the first stage of labour presenting with lower back pain were randomized into 2 groups. One group received intracutaneous injections of sterile water in the lumbosacral region, while the other group was given corresponding subcutaneous injections of isotonic saline, regarded as a placebo treatment. In the group that received intracutaneous sterile water injections the mean VAS score was significantly more reduced compared to the placebo group at 10 min (P less than 0.001), 45 min (P less than 0.02), and at 90 min (P less than 0.05) after the treatment. The midwives' blind estimation of the effectiveness of treatment was consistent with the VAS assessment. However, the requirement of pethidine (meperidine) was similar in the 2 groups. The analgesic method presented was found to be an effective treatment against lower back pain during the first stage of labour and it is speculated that the mode of action resembles acupuncture.

Adult↗

PubMed1985

Light and electron microscopy of contacts between primary afferent fibres and neurones with axons ascending the dorsal columns of the feline spinal cord.

In addition to primary afferent fibres, the dorsal columns of the cat spinal cord contain ascending second-order axons which project to the dorsal column nuclei. The aim of the present study was to obtain morphological evidence that certain primary afferent axons form monosynaptic contacts with cells of origin of this postsynaptic dorsal column pathway. In ten adult cats, neurones with axons ascending the dorsal columns were retrogradely labelled with horseradish peroxidase using a pellet implantation method in the thoracic dorsal columns. In the lumbosacral regions of the same animals, primary afferent fibres were labelled intra-axonally with ionophoretic application of horseradish peroxidase. Tissue containing labelled axons was prepared for light and combined light and electron microscopy. Ultrastructural examination demonstrated that slowly adapting (Type I), hair follicle, Pacinian corpuscle and group Ia muscle spindle afferents formed monosynaptic contacts with labelled cells and light microscopical analysis suggested that they also received monosynaptic input from rapidly adapting (Krause) afferents. This evidence suggests that sensory information from large-diameter cutaneous and muscle spindle afferent fibres is conveyed disynaptically via the postsynaptic dorsal column pathway to the dorsal column nuclei. Some of the input to this pathway is probably modified in the spinal cord as the majority of primary afferent boutons forming monosynaptic contacts were postsynaptic to other axon terminals. The postsynaptic dorsal column system appears to constitute a major somatosensory pathway in the cat.

Animals↗

PubMed1992

Prevalence of isthmic lumbar spondylolisthesis in middle-aged subjects from eastern and western Finland.

Isthmic spondylolisthesis of the lumbosacral spine is a common radiologic finding in patients with low back pain, but its prevalence in unselected populations is poorly known. We examined X-ray pictures of the lumbosacral region of 1147 randomly selected 45-64-yr-old subjects living in eastern or western Finland. Of them, 69 subjects were found to have isthmic spondylolisthesis. The finding was more common in men (7.7%) than in women (4.6%; p = 0.026). The prevalence of spondylolisthesis was not age-related; it was higher in women with an occupation causing a high back load than in those with a low load occupation (p = 0.049), but this difference was not seen in men. The prevalence of spondylolisthesis tended to be higher in women with multiple pregnancies than in those with less than or equal to 2 pregnancies (p = 0.074). Women from eastern Finland had a higher prevalence of spondylolisthesis (7.2%) than those from western Finland (2.6%; p = 0.007), whereas no such difference was seen in men. The difference in women may partly be explained by factors causing loading of the low back, i.e. heavier work and a higher number of pregnancies.

Female↗

PubMed2004

Lumbosacral clear-cell meningioma treated with subtotal resection and radiotherapy.

We wish to report a rare case of clear-cell meningioma in the lumbosacral region in a 34-year-old male patient who presented to us with lower back pain and leg pain. The management of the patient will be reported and histological appearance discussed. This rare tumour in a difficult anatomical position presents a challenge that requires management in a multidisciplinary fashion.

Adult↗

PubMed2006

Spontaneous pyogenic facet joint infection.

OBJECTIVE: To analyze the clinical features, approaches to management, and outcome of spontaneous pyogenic facet joint infection (PFJI) in adults. PATIENTS AND METHODS: Case series of 10 adults with microbiologically proven PFJI diagnosed during a 10-year period in a teaching hospital, plus a review of 32 additional cases previously reported (PubMed 1972 to 2003). Patients with prior spinal instrumentation or surgery and injection drug users were excluded. Only cases that were sufficiently detailed to be individually analyzed were included. These 32 cases, together with our 10 patients, form the basis of the present analysis. RESULTS: PFJI represented nearly 20% of all spontaneous pyogenic spinal infection diagnosed in our hospital during a 10-year period. This data suggest that PFJI is more common than was previously thought. Of the 42 patients with PFJI, 26 (62%) were men and 16 (38%) were women, with ages ranging from 20 to 86 years (mean age, 59+/-15 years); 55% of patients were older than 60 years. The most common location of infections was the lumbosacral region (86%). All patients presented with severe back pain; fever was noted in 83% of the cases and neurological impairment in nearly 48%. In 38% of patients a systemic predisposing factor for infection was present; the most common conditions were diabetes mellitus, malignancies, and alcoholism. In almost 36% of cases, one or more concomitant infectious processes due to the same microorganism was found, mainly arthritis, skin and soft-tissue infections, endocarditis, and urinary tract infections. Staphylococcus aureus was the most common etiologic microorganism (86% of cases). Bacteremia was documented in 81% of the cases. The diagnosis of PFJI was based mainly on imaging study findings. Paraspinal and/or epidural extension was frequent (81% of cases), but its presence did not indicate a worse prognosis. Medical treatment alone was usually successful. The overall prognosis of PFJI was good, with a mortality rate of only 2%. The great majority of patients were cured without functional sequelae. CONCLUSION: Incidence data from our institution reveal that PFJI is not a rare condition, representing approximately 20% of all pyogenic spinal infections. This entity should be considered in the differential diagnosis of patients with low back pain, especially in the presence of fever, whatever the patient's immunological status.

Adolescent↗

PubMed2001

Fetal intervention for myelomeningocele: effect on postnatal bladder function.

PURPOSE: Myelomeningocele is the most common congenital malformation of the central nervous system noted on prenatal ultrasound. Due to its significant postnatal sequelae, treatment in utero could potentially have a profound impact on the newborn. Others have reported fetal surgical techniques for in utero repair of myelomeningocele and its potential benefits on motor and neurological function. We report our urodynamic findings in the newborn after in utero repair of spina bifida in an effort to characterize postnatal bladder function. MATERIALS AND METHODS: A retrospective review of the fetal surgery database at University of California San Francisco was performed identifying patients with a diagnosis of myelomeningocele. Prenatal surgical repair of myelomeningocele was considered if a normal karyotype was present, no other significant congenital anomalies were evident and gestational age was less than 24 weeks. The spinal defects were in the lumbar or lumbosacral region. All surgery was performed before 24 weeks of gestations. RESULTS: Fetal surgery to correct myelomeningocele was performed in 6 patients. All patients were born premature at 32 weeks of gestation or less. Videourodynamics performed at age 1 month in 4 patients indicated decreased bladder capacity for weight, increased detrusor storage pressures and significant post-void residual. Hydronephrosis was demonstrated in 4 patients on renal/bladder ultrasound, and moderate vesicoureteral reflux was seen in 3. CONCLUSIONS: Patients with spinal bifida treated in utero appear to have the same changes in urodynamic parameters and anatomical abnormalities in the urinary tract as other children with spinal defects who have undergone standard postnatal care. In utero treatment of spinal bifida may expose the newborn to the effects of prematurity. The long-term effects on bladder function in the fetus after in utero repair of myelomeningocele remain unknown. A randomized controlled trial is necessary to evaluate long-term bladder function as well as other outcome variables in this experimental approach to patients with myelomeningocele.

Female↗

PubMed2005

[Results at skeletal maturity after double-approach hemivertebral resection].

PURPOSE OF THE STUDY: The natural history of congenital scoliosis or kypho-scoliosis resulting from a hemivertebra is well documented. The spinal deformation generally worsens in children with a free or semi-segmented hemivertebra situated in the thoraco-lumbar, lumbar or lumbosacral region. MATERIAL AND METHODS: From 1982 to 1997, fifteen pediatric patients with 15 hemivertebrae causing progressive scoliosis or kypho-scolisosis underwent hemivertebral resection via a double posterior and anterior approach associated with convex fusion. Mean age at surgery was 4.4 years. The fifteen patients were reviewed at bone maturity (Risser 4 or 5) to assess outcome. RESULTS: Genitourinary tract anomalies were associated in five of the 15 patients and intrathecal anomalies in two. Mean follow-up was 12.1 years. Segmental scoliosis was 30.2 degrees preoperatively, 12.3 degrees postoperatively and 8.9 degrees at last follow-up. The values for total scoliosis were 30.5 degrees, 12.3 degrees and 12.6 degrees respectively. This was a 70.5% improvement at last follow-up for segmental scoliosis and 58.7% for total scoliosis. The real trunk imbalance improved from 31% preoperatively to 9% at last follow-up. All these differences were significant. DISCUSSION: The main objective of surgical treatment for congenital scoliosis due to hemivertebra is to prevent the development of severe deformation which would necessitate a dangerous and difficult procedure to achieve correction. Resection of the hemivertebra via a double approach is the ideal method for early correction. The procedure not only corrects the spinal deformation but also prevents later deterioration. Correction should be performed as early as possible. The result is sustained over time if there is no other associated spinal anomaly. The procedure is safe and the technique well controlled in experimented hands. Patients need to wear a corset for only six months after resection of the hemivertebra.

Adolescent↗

PubMed2002

A split cord malformation with paresis of the unilateral lower limb: case report.

BACKGROUND: We report a rare case of split cord malformation. CASE DESCRIPTION: A female neonate presented with split cord malformation (SCM) manifesting as right lower limb paresis. Myelomeningocele and meningocele were found in the lumbosacral region at birth. Magnetic resonance imaging (MRI) demonstrated division of the spinal cord into two hemicords below the T5 level. The right hemicord formed a hemimyelomeningocele and the left hemicord terminated in the low-lying conus. Three-dimensional computed tomography (3D CT) showed extensive vertebral body abnormalities. The hemimyelomeningocele was repaired 1 day after birth, and septectomy and the repair of the meningocele were performed when the patient was 1 year old. The patient has been followed up as an outpatient, and has residual right lower limb paresis. CONCLUSION: SCM can be associated with multiple spinal abnormalities. MRI and 3D-CT are useful for identifying such abnormalities and planning the surgical treatment.

Abnormalities, Multiple↗

PubMed2003

Spinal subdural hematoma: a sequela of a ruptured intracranial aneurysm?

BACKGROUND: A case of spinal subdural hematoma (SSDH) following subarachnoid hemorrhage (SAH) because of a ruptured internal carotid aneurysm is described. Such a case has never been reported. CASE DESCRIPTION: A 52-year-old woman underwent a craniotomy for a ruptured internal carotid aneurysm. A computed tomography scan showed that SAH existed predominantly in the posterior fossa and subdural hematoma beneath the cerebellar tentorium. Intrathecal administration of urokinase, IV administration of fasudil hydrochloride, and continuous cerebrospinal fluid (CSF) evacuation via cisternal drainage were performed as prophylactic treatments for vasospasm. On the sixth postoperative day, the patient complained of severe lower back and buttock pain. Magnetic resonance imaging showed a subdural hematoma in the lumbosacral region. Although the mass effect was extensive, the patient showed no neurologic symptoms other than the sciatica. She was treated conservatively. The hematoma dissolved gradually and had diminished completely 15 weeks later. Her pain gradually subsided, and she was discharged 7 weeks later without any neurologic deficit. CONCLUSION: Although the exact mechanism of SSDH in this case is unclear, we speculate that this SSDH was a hematoma that migrated from the intracranial subdural space. Low CSF pressure because of continuous drainage and intrathecal thrombolytic therapy may have played an important role in the migration of the hematoma through the spinal canal. It is important to recognize the SSDH as a possible complication of the SAH accompanied with intracranial subdural hematoma.

Aneurysm, Ruptured↗

PubMed1997

Transcondylar approach for dural arteriovenous fistulas of the cervicomedullary junction.

BACKGROUND: Spinal dural arteriovenous fistulas are abnormal arteriovenous connections on the surface of the dura. The site of the fistula is most commonly in the thoracic and lumbosacral regions and they are rarely located in the cervical region. CASES: The patients had two asymptomatic dural arteriovenous fistulas of the cervicomedullary junction fed by the left posterior meningeal artery and draining to the dilated coronal venous plexus and the radiculomedullary vein. RESULTS: The lesions were successfully treated by surgical interruption of the intrathecal vein with coagulation via a suboccipital transcondylar approach and a condylar fossa approach. Both patients left the hospital without significant deficits. CONCLUSIONS: We recommend that dural arteriovenous fistulas in the cervical region be surgically treated.

Arteriovenous Fistula↗

PubMed1997

Altered cell proliferation in the spinal cord of mouse neural tube mutants curly tail and Pax3 splotch-delayed.

The mutant mouse strains splotch-delayed (Pax3Sp-d) and curly tail (ct) develop neural tube defects (NTDs) in the lumbosacral region of the neuraxis. Some research has focused on cell proliferation around the time of posterior neuropore closure in these mutants; however, there are little data on the effects of NTDs on cell birth at later stages of development. To investigate the role neural tube closure might play in cytogenesis of the spinal cord, the thymidine analog 5-bromo-2'-deoxyuridine (BrdU) was injected into pregnant splotch-delayed and curly tail mice at various stages of gestation. The mean number of labelled cells in the dorsal and ventral halves of spina bifida and control embryos was then calculated per section and per mm2. Mutagenically separated PCR (MS-PCR), was used to ascertain the genotype of splotch-delayed embryos. Our data indicate that the peak proliferation dates, for both the dorsal and ventral regions of the cord, are similar in spina bifida and control embryos. However, the quantity of proliferation is significantly different between affected and unaffected embryos. In general, there are markedly fewer cells born in spina bifida embryos in early neural tube development, followed by a short period of equal proliferation, and culminating in a significant increase in cell proliferation later in gestation. This increase in proliferation results in a greater number of cells being born in spina bifida embryos compared to controls. Several possible explanations for this phenomenon are considered, including the hypothesis that the roof plate, or other factors induced by neural tube closure, might have an anti-mitotic activity.

Animals↗

PubMed1992

Decompressive procedures. Indications and techniques.

Hemilaminectomy and dorsal laminectomy are the surgical techniques most suited for decompression of the thoracic, thoracolumbar, lumbar, and lumbosacral spine. Hemilaminectomy is preferred for decompressing the spinal cord before applying fixation devices for fractures/luxations. Dorsal laminectomy is the method of choice for exploration of the spinal canal and for decompression of the lumbosacral region. Either method is applicable to removal of herniated intervertebral disc material and fenestration of other disc spaces.

Animals↗

PubMed1998

The morphology and biomechanics of latissimus dorsi.

OBJECTIVE: To determine the morphology of the latissimus dorsi in order to assess its actions on the shoulder, the lumbar spine and the sacroiliac joint. DESIGN: A dissection study accompanied by an analysis of the force vectors of the muscle and its parts. BACKGROUND: Although recognised as a muscle of the shoulder, latissimus dorsi has been accorded a role as an extensor of the lumbar spine, and is said to brace the sacroiliac joint. Consideration of the anatomy of the latissimus dorsi suggests that the magnitude of these actions has been overstated. METHODS: The fascicular anatomy of the latissimus dorsi was determined by dissection in five adult cadavers. The size, attachments, and orientation of each fascicle were determined. By applying a force coefficient the maximum force of each fascicle was estimated from its physiological cross-sectional area. By summing the forces and moments of each fascicle the maximum force exerted by latissimus dorsi was calculated for its actions on the shoulder, the lumbar spine, and the sacroiliac joint. RESULTS: The latissimus dorsi was found to consist of a series of fascicles with segmental attachments to the lower six thoracic spinous processes, the L1 and L2 spinous processes, the lateral raphe of the thoracolumbar fascia, the iliac crest and the lower three ribs. These fascicles were uniform in size across a given muscle but varied from specimen to specimen. The maximum total force exerted by the latissimus dorsi on the shoulder was estimated to range between 162 and 529 N, but in view of the attachments of the muscle, only a portion of that force can be exerted on the lumbar spine. The maximum extensor moment exerted on the lumbar spine was calculated to be 6.3 N m. The maximum force exerted across the sacroiliac joint was calculated to be 30 N. CONCLUSIONS: The latissimus dorsi is designed to move the upper limb or to raise the entire trunk in brachiation. Its possible contribution to extension of the lumbar spine is trivial as is its capacity to brace the sacroiliac joint. RELEVANCE: Despite assertions and concerns to the contrary, the latissimus dorsi is of little mechanical importance in the lumbosacral region.

Journal Article↗

PubMed2001

Familial history, age and smoking are important risk factors for disc degeneration disease in Arabic pedigrees.

The present study used computed tomography imaging to evaluate the extent and pattern of the intergenerational transmission of spinal disc degeneration disease (DDD) in complex pedigrees. Contribution of a number of the potential covariates was also studied using univariate and multivariate logistic regression analysis, as well as two types of complex segregation analysis models. Among 161 individuals studied, DDD was diagnosed in 60 individuals. The number of protruded discs varied from 1 to 4, mostly in lumbar or lumbosacral regions. The average age at onset of the disease was similar for both women (36.0 years) and men (34.8 years). The proportion of the individuals affected by the DDD status of their parents ranged from 10% in families of two healthy parents to 55.5% of two affected parents (p < 0.01). The results of the logistic regression analyses and complex segregation analysis were qualitatively the same: DDD status of parents, age and smoking were the main risk factors for disc herniation in the Arabic families we examined. All analyses showed a predominating role of the family history as a risk factor for DDD in offsprings. It showed, for example, four times higher risk at age 50 for individuals with two affected parents vs. those who have two non-affected parents. However, the results of models-fitting genetic analysis, did not confirm a monogenic Mendelian pattern of inheritance.

Adult↗

PubMed1993

Cervical spinal cord atrophy associated with spina bifida.

We treated three patients with spina bifida who had atrophy of the cervical spinal cord. One patient presented with a gradually progressive paresis of the upper right extremity, and two patients developed tetraparesis. MRI (magnetic resonance imaging) of the cervical spine demonstrated cord atrophy with enlargement of the subarachnoid space. The three patients were treated by releasing the tethered spinal cord in the lumbosacral area. Two of the three patients had neurological recovery soon after the operation, but this was transient and was followed by later deterioration; and the third patient showed no recovery. The transient recovery suggests that the tethering in the lumbosacral region affects the entire spinal cord and causes atrophy of the cervical spinal cord.

Adult↗