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Karolinska Institutet 200-Year Anniversary. Symposium on Traumatic Injuries in the Nervous System: Injuries to the Spinal Cord and Peripheral Nervous System – Injuries and Repair, Pain Problems, Lesions to Brachial Plexus  [PDF]
Mattias K. Sk?ld,Mikael Svensson,Jack Tsao,Thomas Landegren,Thomas Carlstedt,Staffan Cullheim
Frontiers in Neurology , 2011, DOI: 10.3389/fneur.2011.00029
Abstract: The Karolinska Institutet 200-year anniversary symposium on injuries to the spinal cord and peripheral nervous system gathered expertise in the spinal cord, spinal nerve, and peripheral nerve injury field spanning from molecular prerequisites for nerve regeneration to clinical methods in nerve repair and rehabilitation. The topics presented at the meeting covered findings on adult neural stem cells that when transplanted to the hypoglossal nucleus in the rat could integrate with its host and promote neuron survival. Studies on vascularization after intraspinal replantation of ventral nerve roots and microarray studies in ventral root replantation as a tool for mapping of biological patterns typical for neuronal regeneration were discussed. Different immune molecules in neurons and glia and their very specific roles in synapse plasticity after injury were presented. Novel strategies in repair of injured peripheral nerves with ethyl-cyanoacrylate adhesive showed functional recovery comparable to that of conventional epineural sutures. Various aspects on surgical techniques which are available to improve function of the limb, once the nerve regeneration after brachial plexus lesions and repair has reached its limit were presented. Moreover, neurogenic pain after amputation and its treatment with mirror therapy were shown to be followed by dramatic decrease in phantom limb pain. Finally clinical experiences on surgical techniques to repair avulsed spinal nerve root and the motoric as well as sensoric regain of function were presented.
Schwann cells for spinal cord repair
Oudega, M.;Moon, L.D.F.;de Almeida Leme, R.J.;
Brazilian Journal of Medical and Biological Research , 2005, DOI: 10.1590/S0100-879X2005000600003
Abstract: the complex nature of spinal cord injury appears to demand a multifactorial repair strategy. one of the components that will likely be included is an implant that will fill the area of lost nervous tissue and provide a growth substrate for injured axons. here we will discuss the role of schwann cells (scs) in cell-based, surgical repair strategies of the injured adult spinal cord. we will review key studies that showed that intraspinal sc grafts limit injury-induced tissue loss and promote axonal regeneration and myelination, and that this response can be improved by adding neurotrophic factors or anti-inflammatory agents. these results will be compared with several other approaches to the repair of the spinal cord. a general concern with repair strategies is the limited functional recovery, which is in large part due to the failure of axons to grow across the scar tissue at the distal graft-spinal cord interface. consequently, new synaptic connections with spinal neurons involved in motor function are not formed. we will highlight repair approaches that did result in growth across the scar and discuss the necessity for more studies involving larger, clinically relevant types of injuries, addressing this specific issue. finally, this review will reflect on the prospect of scs for repair strategies in the clinic.
Schwann cells for spinal cord repair  [cached]
Oudega M.,Moon L.D.F.,de Almeida Leme R.J.
Brazilian Journal of Medical and Biological Research , 2005,
Abstract: The complex nature of spinal cord injury appears to demand a multifactorial repair strategy. One of the components that will likely be included is an implant that will fill the area of lost nervous tissue and provide a growth substrate for injured axons. Here we will discuss the role of Schwann cells (SCs) in cell-based, surgical repair strategies of the injured adult spinal cord. We will review key studies that showed that intraspinal SC grafts limit injury-induced tissue loss and promote axonal regeneration and myelination, and that this response can be improved by adding neurotrophic factors or anti-inflammatory agents. These results will be compared with several other approaches to the repair of the spinal cord. A general concern with repair strategies is the limited functional recovery, which is in large part due to the failure of axons to grow across the scar tissue at the distal graft-spinal cord interface. Consequently, new synaptic connections with spinal neurons involved in motor function are not formed. We will highlight repair approaches that did result in growth across the scar and discuss the necessity for more studies involving larger, clinically relevant types of injuries, addressing this specific issue. Finally, this review will reflect on the prospect of SCs for repair strategies in the clinic.
Spinal cord injuries in children  [cached]
Muzumdar D,Ventureyra Enrique
Journal of Pediatric Neurosciences , 2006,
Abstract: Spinal injuries in the pediatric population are relatively rare. Hence there is not enough knowledge, experience and exposure amongst pediatric neurosurgeons about spinal injuries in children. They have to rely on general spinal or pediatric orthopedic colleagues for a comprehensive management of spine and spinal cord trauma. In addition, the advances in spinal instrumentation techniques and vast array of implantable devices for spinal stabilization add to the complexity of the problem. It is imperative that a pediatric neurosurgeon should be aware of the mechanics of spinal injury and recent advances in the management strategy of pediatric spinal injuries.
Spinal cord injuries in Ilorin, Nigeria
Babatunde A. Solagberu
West African Journal of Medicine , 2002,
Abstract: Background: Spinal Cord Injuries (SCI) usually result from road traffic accidents (RTA), falls, sports and some misadventures. This study was carried out to examine the aetiology of SCI in Ilorin, Nigeria; factors contributory to morbility and mortality and to suggest measures for reducing them. Methods: Age, sex, mechanism of injury, complications, duration of treatment and eventual outcome of patients admitted for SCI from 1995 to 1999 were retrospectively studied, Results: Thirty-nine patients, age 19 to 60 years (mean 37.3), 36 males and three females were seen. Cervical spine injuries accounted for 46.2% of the cases. Road traffic accidents caused 67% and falls 23%. Accidents involving passengers in open lories are associated with SCI when the goods fall on passengers as seen in five of the 26 RTA's (19.2%). More falls from kola-nut (44%) than from palm tree (11%) were observed. Limb paralysis and bladder dysfunction were the commonest complications. Ten patients died, 70% of them had cervical spine injuries. Nine of the ten deaths had multiple transfers of different centers before admission. Conclusion: This pattern of SCI in Ilorin, Nigeria showed that RTA has surpassed falls from trees, as the most common cause of SCI in Ilorin and probably in Nigeria. Indeed, the predominant tree implicated in this study has been kola nut tree unlike the palm tree in earlier reports. Imperative measures to improve morbidity and mortality include health education on passenger and load carriage, use of manual or motorized wheel barrow as against bearing heavy load on the head, principles of moving spinal injured patients thought every road traveler and establishment of spinal centers and training of specialized personnel.
Nursing rehabilitation of patients with spin and spinal cord injuries  [cached]
Stavrou V.,Zika J.,Ploumis A.
Interscientific Health Care , 2012,
Abstract: The injury of the Spine cord is a major problem because of the high mortality and morbidity in patients. Despite the advanced medical care and specialized rehabilitation the life expectancy of people with injuries of the spinal cord is lower than the general population. Hospitalization in modern rehabilitation centers reduces the mortality and severity of the complications with comprehensive programs which include the prevention of complications. It also educates the patient and his carer with psychological and social support. The nursing interventions have perhaps the most significant impact on the area of functional independence, rehabilitation and the quality of the patients life. The development of better rehabilitation programs will improve the life of people with injury of the spine and Spinal Cord.
Astrocytes derived from glial-restricted precursors promote spinal cord repair  [cached]
Davies Jeannette E,Huang Carol,Proschel Christoph,Noble Mark
Journal of Biology , 2006, DOI: 10.1186/jbiol35
Abstract: Background Transplantation of embryonic stem or neural progenitor cells is an attractive strategy for repair of the injured central nervous system. Transplantation of these cells alone to acute spinal cord injuries has not, however, resulted in robust axon regeneration beyond the sites of injury. This may be due to progenitors differentiating to cell types that support axon growth poorly and/or their inability to modify the inhibitory environment of adult central nervous system (CNS) injuries. We reasoned therefore that pre-differentiation of embryonic neural precursors to astrocytes, which are thought to support axon growth in the injured immature CNS, would be more beneficial for CNS repair. Results Transplantation of astrocytes derived from embryonic glial-restricted precursors (GRPs) promoted robust axon growth and restoration of locomotor function after acute transection injuries of the adult rat spinal cord. Transplantation of GRP-derived astrocytes (GDAs) into dorsal column injuries promoted growth of over 60% of ascending dorsal column axons into the centers of the lesions, with 66% of these axons extending beyond the injury sites. Grid-walk analysis of GDA-transplanted rats with rubrospinal tract injuries revealed significant improvements in locomotor function. GDA transplantation also induced a striking realignment of injured tissue, suppressed initial scarring and rescued axotomized CNS neurons with cut axons from atrophy. In sharp contrast, undifferentiated GRPs failed to suppress scar formation or support axon growth and locomotor recovery. Conclusion Pre-differentiation of glial precursors into GDAs before transplantation into spinal cord injuries leads to significantly improved outcomes over precursor cell transplantation, providing both a novel strategy and a highly effective new cell type for repairing CNS injuries.
Sexual and reproductive abnormalities in patients with spinal cord injuries  [cached]
Ramazan A?c?
Turkish Journal of Urology , 2012,
Abstract: Spinal cord injuries (SCIs) may cause predictable abnormalities in genital sexual arousal and changes in the ability to achieve orgasm. In this review, sexual dysfunction and reproductive abnormalities and their treatment possibilities in male and female patients with SCI were reviewed. Literature from 1982-2011 examining the neuroanatomy of sexual functions, sexual dysfunction and reproductive abnormalities and their treatment alternatives both in male and female patients with SCI was reviewed with PubMed. In both genders, the sympathetic, parasympathetic and motor-sensory innervations of genitals are localized at the T11-L2, and S2-4 and S2-3 spinal cord levels, respectively. Patients with lesions above or at level of T11-L2 have reflex erections but no psychogenic erections. Patients with lesions in between levels of L2 and S2 spinal segments have reflex and psychogenic erections. Patients with lesions at level of S2-3 or below can have psychogenic erections but no reflex erections. Patients with lesions above the T10 level have autonomic, somatic, vibration and electroejaculations but no nocturnal ejaculation. Patients with lesions at the level of the thoracolumbar (T11-L2) region can have electroejaculation but no autonomic, somatic, vibration and nocturnal ejaculations. Patients with lesions below the L2 levels can produce emissions and electroejaculation but no other type of ejaculation. Reproductive dysfunction in men with SCI is due to a combination of ED, ejaculatory failure, and abnormal semen parameters. Women with no lesions at the T11-L2 levels may have psychogenic genital vasocongestion, while reflex lubrication and orgasm is more prevalent in women who have preserved the sacral reflex arc (S2-S5). A better knowledge of neuroanatomy and neurophysiology in SCI patients provides a more predictable understanding of sexual and reproductive dysfunctions.
Quality of Life Among People with Spinal Cord Injuries
H Shahandeh,R Wameghi,N Hatamizadeh,A Kazemnejad
Journal of School of Public Health and Institute of Public Health Research , 2005,
Abstract: Nowadays the Quality of Life (QOL) among different groups of people, especially in disabled people, is recognized as a very important topic. In order to assess quality of life in people with spinal cord injuries, 86 members of Tehran spinal cord injury(SCI) society were selected randomly. Data were gathered through a questionnaire that consisted of two parts. The first part contained questions about sex, age, plus the cause, type and duration of injury. The second part contained questions that measured quality of life in an objective manner. The test was adapted from Lancashire and Wisconsin tests and modified to suit the cultural background of Iranian people. Results showed that %73.3 of people with SCI perceived their QOL as good or fair. In assessing different areas of quality of life, the highest scores were given to social relations (3.67 out of 5). In the married group the mean score for satisfaction in family relations was 3.95 out of 5 score. Sub-scores for work/education, finances, physical health and psychological health status were lower than the other ones. Results of study indicated that there was a significant difference in the mean QOL score between the two sexes: the score for women was higher (mean score was 3.3 for women and 2.9 for men). But Quality of Life was not significantly related to age, cause of SCI, type of SCI, or duration of SCI.
Controversies in the Surgical Management of Spinal Cord Injuries  [PDF]
Ahmed M. Raslan,Andrew N. Nemecek
Neurology Research International , 2012, DOI: 10.1155/2012/417834
Abstract: Traumatic spinal cord injury (SCI) affects over 200,000 people in the USA and is a major source of morbidity, mortality, and societal cost. Management of SCI includes several components. Acute management includes medical agents and surgical treatment that usually includes either all or a combination of reduction, decompression, and stabilization. Physical therapy and rehabilitation and late onset SCI problems also play a role. A review of the literature in regard to surgical management of SCI patients in the acute setting was undertaken. The controversy surrounding whether reduction is safe, or not, and whether prereduction magnetic resonance (MR) imaging to rule out traumatic disc herniation is essential is discussed. The controversial role of timing of surgical intervention and the choice of surgical approach in acute, incomplete, and acute traumatic SCI patients are reviewed. Surgical treatment is an essential tool in management of SCI patients and the controversy surrounding the timing of surgery remains unresolved. Presurgical reduction is considered safe and essential in the management of SCI with loss of alignment, at least as an initial step in the overall care of a SCI patient. Future prospective collection of outcome data that would suffice as evidence-based is recommended and necessary. 1. Introduction Traumatic spinal cord injury (SCI) affects over 200,000 people in the USA, with nearly 10,000 new injuries reported annually [1–3]. People affected by SCI are usually young (average age 32 years) and life expectancy is marginally lower when compared with a non-SCI population. Hence, the ramifications of the injury itself as well as the medical decisions made can result in enormous economic burden and social cost [4]. Long-term outcome after SCI comprises a combination of the initial extent of the injury, natural recovery from injury, medical interventions, rehabilitation, and social/community reintegration. Several components play a role in management of SCI. Initially, acute management includes medical agents administered with the goal of reducing secondary injury cascade, and an initial surgical treatment that usually includes either all or a combination of reduction, decompression, and stabilization. Physical therapy and rehabilitation, which can lead to a significant impact on overall recovery is an additional component. Finally, late onset SCI problems, such as bowel and bladder dysfunction, pain, spasticity, and problems with automatic breathing, play a role. This paper focuses on the surgical management of SCI in the acute setting. Later
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