No abstract available.
Stroke*

Using computerized motion analysis techniques, kinematics of foot trajectories were quantitatively analyzed in twelve rats before and after dorsal spinal cord hemisection at the T6 level. Although overground locomotion in these animals returned to normal within four weeks, some kinematic variables during treadmill locomotion did not recover to pre-lesion level. Immediately following dorsal hemisection, amplitudes of both hindfeet horizontal and vertical movements were dramatically reduces. However, in three weeks, the amplitudes of horizontal movement(stride length) became significantly larger than of pre-lesion strides. On the other hand, amplitude of hindlimb vertical movement showed very little recovery. Forelimb-hindmill coordination was also disrupted initially but returned to normal within three weeks. The duration of hindlimb swing phase became significantly longer after sectioning and gradually recovered, but never to pre-lesion levels. Interestingly, amplitudes of forelimb vertical movement. which was depressed initially, became significantly largery three weeks after lesioning. A dramatic increase in the statistical variation of limb kinematics, which persisted even after motor recovery, is an important parameter for the evaluation of neural deficits in spinal cord injuries. Kinematic analysis is a sensitive technique for the detection of minor motor deficits following nerve injuries.
Animals ; Biomechanical Phenomena ; Extremities ; Foot ; Forelimb ; Hand ; Hindlimb ; Locomotion* ; Rats* ; Spinal Cord Injuries ; Spinal Cord*

The purposes of this study were to describe the magnetic resonance(MR) manifestations of wallerian degeneration occurring above and below a spinal cord injury site, to determine the post-injury time interval when the wallerian degeneration becomes evident in MR images, and to correlate the MR findings with post mortem histopathology. Twenty-three postmortem spinal cords, all from patients with cervical(14), thoracic(5), and lumbar(4) cord injuries, were studied with axial TI-and T2-weighted spin-echo MR imaging. Injury to death intervals varied from 8 days to 22 years. We examined these specimen for abnormal cord contour and alteration of signal above and below the injury site. Histological studies of these cords with axon, myelin, and connective tissue stains were performed at levels equivalent to the MR sections. Studies using plastic embedded sections and antibodies to Glial Fibrillary Acetic Protein(GFAP) were also performed on some of the above cords. Pathological-imaging correlations were made. MR images of the cord specimen showed increased signal intensity in the dorsal columns above the injury level as well as in the lateral corticospinal tracts below the injury level in all cases in which cord injury had occurred seven or more weeks premortem. In one case where cord injury had occurred eight days prior to death the MR showed no signal abnormalities, histological analysis showed evidence of early wallerian degeneration in the dorsal columns above the lesion but no change was detected in the lateral columns below the lesion. After 12 days, early stage wallerian degeneration was detected by histological examination in both the lateral columns below the lesion and in the dorsal columns above the lesion. Wallerian degeneration in spinal cords, as demonstrated by histological examination, was identified on MR as areas of increased T2 weighted signal intensity site in the dorsal column above the injury site and in the corticospinal tracts below the injury site in all specimen in which the injury-to-death interval was greater than 7 weeks. The ability to recognize wallerian degeneration on MR allows a more comprehensive analysis of the injury, explains abnormal MR signals at sites that are remote from the epicenter of injury, and may be helpful in the assessing of results of therapeutic interventions.
Antibodies ; Axons ; Coloring Agents ; Connective Tissue ; Humans ; Magnetic Resonance Imaging ; Myelin Sheath ; Plastics ; Pyramidal Tracts ; Spinal Cord Injuries* ; Spinal Cord* ; Wallerian Degeneration*

No abstract available.
Brain Abscess* ; Brain* ; Catheters*

The detailed knowledge of the microvascular anatomy and the recognition of the anatomical variations of the middle cerebral artery (MCA) are very important for neurosurgeons to construct a better and safer microdissection plan and to prevent postoperative neurological deficits. This paper mainly reviewed segments, perforators, cortical arteries, branching patterns, anomalies, and regional anatomy relating various neurovascular surgery such as vascular anastomosis and the management of aneurysms and arteriovenous malformations of the MCA.
Anatomy, Regional ; Aneurysm ; Arteries ; Arteriovenous Malformations ; Microdissection ; Middle Cerebral Artery*

The detailed knowledge of the microvascular anatomy and the recognition of the anatomical variations of the middle cerebral artery (MCA) are very important for neurosurgeons to construct a better and safer microdissection plan and to prevent postoperative neurological deficits. This paper mainly reviewed segments, perforators, cortical arteries, branching patterns, anomalies, and regional anatomy relating various neurovascular surgery such as vascular anastomosis and the management of aneurysms and arteriovenous malformations of the MCA.
Anatomy, Regional ; Aneurysm ; Arteries ; Arteriovenous Malformations ; Microdissection ; Middle Cerebral Artery*

Intramedullary spinal abscesses are rare and potentially devastating lesions. The first case of spinal abscess was described in 1830 and fewer than 100 cases have been reported subsequently. Only sixteen previous reports have described an intramedullary abscess of the central nervous system secondary to a dermal sinus. Involvement of the entire cord is thus exceedingly rare. We present a case of a 7-month-old girl who had rapidly progressing quadriplegia with urinary and bowel retention and was found to have an intramedullary abscess as a result of a dermal sinus. Spine MRI shows thick irregular ring enhancement appeared within the broadest area of the spinal cord on the thoracic and lumbar area on mid thoracic level to L3 and high cervical area which extended to medulla. Immediate decompressive surgery and antibiotic treatment were performed. Excellent clinical outcome was obtained with a combination of medical and surgical management. Complete neurological assessment and diagnostic study of all patients with a congenital dermal sinus are very important. Prophylatic surgery is indicated in many cases to prevent dangerous and recurrent infections of the central nervous system.
Abscess ; Central Nervous System ; Humans ; Infant ; Quadriplegia ; Retention (Psychology) ; Spina Bifida Occulta ; Spinal Cord ; Spine

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of 3-level hybrid surgery (HS), which combines fusion and cervical disc replacement (CDR), compared to 3-level fusionin patient with cervical spondylosis involving 3 levels. METHODS: Patients in the anterior cervical discectomy and fusion (ACDF) group (n=30) underwent 3-level fusion and the HS group (n=19) underwent combined surgery with fusion and CDR. Clinical outcomes were evaluated using the visual analogue scale for the arm, the neck disability index (NDI), Odom criteria and postoperative complications. The cervical range of motion (ROM), fusion rate and adjacent segments degeneration were assessed with radiographs. RESULTS: Significant improvements in arm pain relief and functional outcome were observed in ACDF and HS group. The NDI in the HS group showed better improvement 6 months after surgery than that of the ACDF group. The ACDF group had a lower fusion rate, higher incidence of device related complications and radiological changes in adjacent segments compared with the HS group. The better recovery of cervical ROM was observed in HS group. However, that of the ACDF group was significantly decreased and did not recover. CONCLUSION: The HS group was better than the ACDF group in terms of NDI, cervical ROM, fusion rate, incidence of postoperative complications and adjacent segment degeneration.
Arm ; Arthroplasty ; Diskectomy* ; Humans ; Incidence ; Neck ; Postoperative Complications ; Range of Motion, Articular ; Spondylosis ; Total Disc Replacement*

Esophageal perforation is a serious possible complication after anterior cervical discectomy and fusion (ACDF). It usually occurs during the first postoperative day. Esophageal perforation is a potentially life-threatening complication. A 63-year-old man who underwent ACDF 8 years prior visited our emergency room with recurrent aspiration pneumonia, fever, dysphagia and neck pain. Endoscopic study showed esophageal perforation by cervical plate. Successful treatment of the perforation resulted after surgical repair using a sternocleidomastoid muscle flap. We presented a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using a sternocleidomastoid muscle flap.
Cervical Vertebrae ; Deglutition Disorders ; Diskectomy ; Emergency Service, Hospital ; Esophageal Perforation ; Esophagus* ; Female ; Fever ; Humans ; Middle Aged ; Neck Pain ; Pneumonia, Aspiration ; Spine*

Abnormalities of the posterior arch, including congenitally absent cervical pedicle and cervical spondylolysis, are rare entities that are usually found incidentally on neck radiographs. It is important to recognize these characteristic radiological features because their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. Also, it is important to distinguish these abnormalities from similar pathologies to prevent the use of inappropriate treatment. We report the relevant clinical and radiological findings seen in three cases of posterior arch defect after trauma with review of pertinent literature.
Congenital Abnormalities ; Neck ; Spine ; Spondylolysis