Spine Healing Therapy

Dorn Spinal Therapy

Dorn Spinal Therapy has been in uses in the past 40 years. The credit of this method goes to Dieter Dorn, who has made a significant impact in the medical field. DORN- Method has been used on various patients where results could get witnessed instants. Due to the impact, this method has brought in the country. It has been declared the standard practice in treating Pelvical Disorders, Spinal, and Back pain. Dieter Dorn first used this method on his family, which was a sign of confidence in a method, which later gained much attention from different people in the country and also globally. Every day Dorn was able to offer treatment to 15- 20 patients in a day. His services were purely free which attracted attention both in the local and also global. The primary treatment that DORN-Method which could be treated using this method include spine healing therapy, misalignments of the spine, resolving pelvis and joints, and also solving out significant problems which could get attributed to vertebrae.

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Resorbable Technology for Spinal Stabilization

Incredible advances in the surgeon's ability to restore stability to the unstable spine have been made in the last decade. Using metal implants, surgeons can now effectively stabilize any motion segment of the spine. With the concomitant use of autograft or allograft bone, high fusion rates can be achieved in the vast majority of cases. There are, however, drawbacks to the use of such systems. In response to these drawbacks, several companies have developed resorbable biomaterials that can serve as temporary fixation devices, structural supports, and osteoconductive or even osteoinductive conduits for new bone growth. These products offer the potential advantages of unlimited supply, significant cost savings, and a reduction in patient morbidity. This chapter is intended to serve as an overview of some of these new biomaterials and their potential applications. This overview will be incomplete, as the pace of new development in this field is staggering. Many of the substances and...

An Update on Endoscopic Thoracic Spinal Surgery Thoracic Microendoscopic Discectomy

Thoracic Stabilization Surgery

A Directory of Minimally Invasive Spine Surgery, Department of Neurosurgery, Chicago Institute of Neurosurgery and Neuroresearch, Rush-Presbyterian St. Luke's Medical Center and 0 Division of Neurosurgery, University of Chicago, Chicago, Ill., USA Clinically significant thoracic disc herniation is a relatively rare condition with an estimated annual incidence of approximately one per million. Surgical management of thoracic disc herniation comprises between 0.15 and 4 of all operations for herniated discs including those of the cervical and lumbar spine 3, 40, 41 . Several surgical techniques have been developed to approach the thoracic spine including costotransversectomy, lateral extracavitary, lateral parascapular extrapleural, transfacet, transpedicular, and transthoracic approaches 1, 17, 41 . Although all of these approaches have been successful in reaching thoracic pathology, each procedure requires a relatively large skin incision and extensive bony work that subsequently may...

Spinal tap umbar puncture or LP

Due to the blood-brain barrier, systemic chemotherapy usually cannot destroy any blasts in the central nervous system (brain and spinal cord). Chemotherapy drugs must be directly injected into the cerebrospinal fluid to kill any blasts present and prevent a possible central nervous system relapse. The drugs most commonly used intrathecally are methotrexate, ARA-C, and hydrocortisone. The number of spinal Some hospitals routinely sedate children for spinal taps, and others do not. If the child is not sedated, EMLA cream is usually prescribed. EMLA is an anesthetic cream put on the spinal tap site one to two hours prior to the procedure. It anesthetizes deep into the tissue, preventing some or all of the pain associated with the procedure. To perform a spinal tap, the physician or nurse practitioner will ask the child to lie on her side with her head tucked close to the chest and knees drawn up. A nurse usually helps hold the child in this position. The doctor will feel the designated...

Epidemiology and Variations in Care of Spine Disease

Spine disease, with associated neck, back, and radicular pain, is common and costly. In the current American health care environment, many types of practitioners (primary care physicians, spine surgeons, physical therapists, chiropractors, and others) are involved in managing patients with spine disease, often with very different approaches. The varied nature and economic costs of spine disease are driving a growing interest in research. The coming years may reveal the fundamental aspects of this problem, as well as standardized treatment regimens, in more detail. Epidemiology of Spine Disease Degenerative spine disease is extremely common in our society. It is well accepted that the vast majority of the population will develop degenerative spinal abnormalities some form of spondylosis is present radiographically in more than 80 of males and females older than 55 years 1 . In the more mobile cervical and lumbar spinal segments, the development of bony and ligamentous hypertrophy,...

The muscles which work the spine

Masculine And Feminine Tree Life

As superbly designed as the spine is, it amounts to naught without the dynamic contribution of the muscles. In the way a puppet is a flummoxed pile of sticks on the floor without its working strings, the human spine and its segments are an inert, toppling pole without its muscles. The muscles of the human body work just like the strings of a puppet. They pull on levers and make the body move. They allow us to keep the thinking, top part of the body up there and active so we can operate effectively in the outside world. Without the dynamic support of the muscles the spine would fall over. More than you would ever imagine, the muscles play a dynamically synchronised role in keeping the skeleton upright and controllable. You only have to see unfortunate cases of poliomyelitis to understand this point. With paralysis of the trunk muscles, the spine tumbles down around itself in slow motion, like a collapsing circular staircase, with the chest disappearing into the abdomen and into the...

Overview of Spinal Navigation

An important advance in spinal surgery has been the development and application of image-guided techniques for spinal navigation and fixation. Image-guided technology includes both spinal stereotaxis as well as fluoroscopy-based image guidance systems. Both of these techniques offer significant advantages over commonly used plain radiography and fluoroscopy for complex spine procedures. Image-guided spine surgery has been utilized for cervical, thoracic, and lumbar fixation 1, 3-5, 7, 9-11, 13, 15-17, 19-22, 24, 28, 31, 34, 35 . This chapter will highlight the newest techniques in image-guided spine surgery and discuss their advantages and nuances compared to standard open techniques. Traditionally, intraoperative image guidance in spine surgery was directed primarily by plain radiography and fluoroscopy. Although these conventional imaging techniques offer surgeons better visualization compared with simple open exposure and recognition of the anatomy, they still have a limited...

Cellular and Genetic Approaches for Spinal Fusions

Spinal Stabilization

A variety of evolving technologies are currently being evaluated in preclinical studies to promote tissue repair and or regeneration in the spinal region. Cellular and genetic techniques to induce bone formation for interbody or posterolateral spinal arthrodesis are an attractive approach, since this technology could be employed through a minimally invasive approach with decreased morbidity and potentially higher fusion rates compared to traditional open procedures. Tissue engineering techniques are also being evaluated for disc repair and regeneration using various growth and differentiation factors, mesenchymal stem cells (MSCs) and genetic therapies. Percutaneous soft tissue stabilization techniques are also within the scope of current technologies, potentially allowing stabilization of the spine by the induction of ligamentous tissues, thus avoiding extensive spinal arthrodesis procedures. Clearly, tissue-engineering techniques will continue to evolve and certainly lead to more...

Cervical Techniques with Image Guided Spinal Navigation

Localizers Cervical Spine

Section of Spinal Surgery, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA Image-guided spinal navigation is a computer-based surgical technology that was developed to improve intraoperative orientation to the unexposed anatomy during complex spinal procedures 12, 17 . It evolved from the principles of stereotaxy which have been used by neurosurgeons for several decades to help localize intracranial lesions. Stereotaxy is defined as the localization of a specific point in space using three-dimensional coordinates. The application of stereotaxy to intracranial surgery initially involved the use of an external frame attached to the patient's head. However, the evolution of computer-based technologies has eliminated the need for this frame and has allowed for the expansion of stereo-tactic technology into other surgical fields, in particular spinal surgery. The management of complex spinal disorders has been greatly influenced by the increased acceptance and...

What Is A Stiff Spinal Segment

Microtrauma The Spine

In the well-oiled spinal chain, a stiff spinal segment is a sluggish vertebra which participates less willingly than the others in overall spinal movement. More often than not the stiffer one causes no trouble it just sits there being coaxed along by other more vigorous neighbours and also being compensated for by them. When the spine performs its usual grand-scale activity, each segment contributes a tiny bit more to make up for the stiffer one doing a little bit less. Most spines have a patchy distribution of stiff links randomly scattered throughout, from the base of the skull to the sacrum. Some areas of the spine are naturally more mobile than others. The neck, for example, is more freewheeling in all its movements, while the low back is much more a fundamental pillar of support. In other parts of the spine, some movements are generous and others meagre. In the thoracic region, sideways bending is never very expansive because the ribs are in the way, but rotation or twist here is...

Spinal meningitis See meningitis

Spinal tap The common name for a lumbar puncture, a procedure in which cerebrospinal fluid is removed by using a hollow needle inserted into the lower back, usually between the third and fourth lumbar vertebrae. The fluid is checked for appearance, white blood cells, sugar, and protein in a lab and is also sent for culture, which can help determine what sort of germ is causing symptoms. While some children fear the thought of a spinal tap, in fact the procedure is not terribly painful. It is a safe procedure when done in a large hospital

The Changing Economics of Spine Surgery

Advances in minimally invasive as well as complex spinal surgery during the past decade have been revolutionary. The practical application of molecular, biomechanical and computer engineering have enabled the spinal surgeon to have more options available in treating patients with a variety of simple and complex spinal disorders. However, the contraction of health care dollars available to pay for this wonderful growth of technology has begun to limit the choices available to the physician that hospitals are willing to purchase and maintain. This chapter will examine the separate issues facing spinal surgeons in their personal practice as well as the problems that hospitals face in managing the ever-changing and concurrently more expensive technological innovations brought to us. The complexity of managing the spinal physician's practice has faced similar dramatic change, requiring increasing direct physician involvement to reduce the risk of fraud and abuse accusations and even...

United Spinal Association formerly called Eastern Paralyzed Veterans Association

This organization's mission is to enhance the lives of all individuals with spinal cord injuries or diseases by ensuring quality health care, promoting research, and advocating for civil rights and independence. The organization continues to remain com mitted to veterans but has expanded services to all people with spinal cord injuries or diseases, MS being one of them. The United Spinal Association has programs to assist members to improve accessibility of their homes. It also publishes the MS Quarterly Report.

The Brain And Spinal Cord And Ms

Sexual response is controlled by emotional responses in concert with the central nervous system the brain, and the spinal cord. The brain is involved in many aspects of sexual functioning, including sexual desire, the perception of sexual stimuli and pleasure, movement, sensation, cognition, and attention. Throughout the sexual response cycle, sexual messages are communicated between the brain, spinal cord, and the genitals. Because MS can cause lesions along myelinated pathways, it is not surprising that changes in sexual function are reported so frequently by people with MS.

H3 Spinal Accessory Muscular

This point contains both spinal and accessory nerves, as indicated by its name. The spinal accessory nerve (XI) originates both from cranial roots (nucleus ambiguus in medulla) and from spinal roots (C1 to C6), and it contains both afferent (sensory) and efferent (motor) fibers. A branch of the spinal accessory nerve enters the trapezius muscle, in the middle of the upper front edge, at the point over the shoulder bridge. This point is a neuro-muscular attachment point. The H3 spinal accessory ARP appears sensitive in more than 98 of the population. The author uses a needle of no more than 2.5 cm in length and inserts the needle perpendicularly to the skin. Practitioners should be extremely careful when needling this point because the apex of the lung is just below this point (see Fig. 8-14). Another branch of the spinal accessory nerve also innervates the sternocleidomastoid muscle.

Cerebrospinal Fluid Testing

Cerebrospinal fluid (CSF) is analyzed by performing a lumbar puncture, also known as a spinal tap. It is a relatively easy test in most circumstances. The only time it is unsafe to do a lumbar puncture is if there is increased pressure in the brain, which can be detected by examining the patient's eyes for evidence of increased pressure or by a CAT scan or MRI of the brain. In diseases such as lupus that may affect the brain, the child may start acting strangely. Often no one is sure whether the strange behavior is due to the drugs being used to treat the lupus, the child's being upset about being ill, the illness itself, or an infection. Examining the spinal fluid is the only way to be sure there is not an infection.

The bending human spine

Elegant and strong as the human back is, the job of bending and straightening is a tall order. The trunk and spinal muscles which actively control the movement are discussed further on. However, several other anatomical features help make bending possible, by working as a physical brake to control the free fall of the spine when it tips forward. (Illustration acknowledgement N. Bogduk, 'Clinical Anatomy of the Lumbar Spine') (Illustration acknowledgement N. Bogduk, 'Clinical Anatomy of the Lumbar Spine') As the segments glide forward the stiff fibrous mesh of the wall retards the initial movement. When the spinal segments then tip forward and the back of the interspaces opens up, the same diagonal mesh pulls up, like stretching up a garden lattice. Figure 1.20 As the spine bends, the facet surface of the upper vertebra slides up the stop-ramp of the one below, increasing the tension between the two segments and bringing movement to a halt. Figure 1.20 As the spine bends, the facet...

Pairs of spinal nerves

These nerves pass out of the spinal cord and each has two thin branches which link it with the autonomic nervous system. Spinal nerves receive sensory impulses from the body and transmit motor signals to specific regions of the body, thereby providing two-way communication between the central nervous system and the body. Each of the spinal nerves are numbered and named according to the level of the spinal column from which they emerge. There are 1 coccygeal spinal nerve. Each spinal nerve is divided into several branches forming a network of nerves or plexuses which supply different parts of the body Base of spine

Spinal Cord Injury

The most cataclysmic interference with autonomic feedback occurs when people suffer injury to the spinal cord and lose feeling in part of the body. Without sensations from the body, people cannot feel the effects of autonomic arousal, such as a pounding heart or butterflies in the stomach. Thus, individuals with spinal cord injuries would be expected to feel less intense emotions. The first study of this sort was conducted by Hohmann (1966). Hohmann interviewed people who had suffered spinal cord injuries about the changes in their emotional experiences and found that they reported less intense feelings of the high-arousal emotions of fear, anger, and sexual excitement. They reported no loss of intensity of low-arousal emotions such as sentimentality. The amount of sensation lost following a spinal cord injury is proportional to the height of the injury in the spinal cord. At the extreme, people whose injury occurs in the cervical area lose almost all sensation from their bodies,...

What is spinal MS

Spinal MS was a term used for primary progressive MS but has not generally been used for the last 30 years or so. It was a good descriptor for this illness because the predominant symptoms were those of slowly progressive weakness and sensory problems, predominantly affecting the legs. In the past, it was especially difficult to distinguish from cervical spondylosis. Modern imaging has made this distinction much easier. For the sake of clarity, the term primary progressive MS is preferable.

Spinal block

A spinal block is given during active labor or, if necessary, shortly before a Caesarean birth. The medication is injected into the fluid-filled space around the spinal nerves. It takes effect in seconds. Side effects for you may include spinal headache or low blood pressure. Spinal headaches are somewhat more frequent in this technique than with epidural blocks because the perforation of the membrane that holds the spinal fluid is intentional. A smaller needle is used than that used with an epidural, though, so temporary leakage isn't common. You may need a catheter for your bladder because you'll lack bladder control.

Spinal cord

It forms a two-way information pathway between the brain and the rest of the body via the spinal nerves. It is protected by three layers of tissues called the meninges and by cerebospinal fluid. Its function is to relay impulses to and from the brain. Sensory tracts conduct impulses to the brain and motor tracts conduct impulses from the brain. The spinal cord provides the nervous tissue link between the brain and other organs of the body and is the centre for reflex actions which provide a fast response to external or internal stimuli.

The spinal nerves

In the lumbar area, the nerve roots emerge from the spine under their corresponding vertebra. Thus the left and right L1 nerve roots come out under the first lumbar vertebra at the L1-2 interspace and so on. The L5 nerve roots come out at the lumbo-sacral junction. The spinal nerves carry messages to the muscles to make the legs work and also carry sensory messages back inside, relaying information from the outside world back to the brain. As the nerve roots leave the spine they travel out through small canals (intervertebral foraminae) bordered on one side by the facet joint and on the other by the disc. It is less than ideal to have these fragile strands of nerve making their exit right through the machinery of a complex human hinge. It means they run the gauntlet between the very two structures most likely to cause trouble in the spine. Figure 1.23 The spinal nerve root exiting the spine passes between the disc sucking and blowing on one side and the facet capsule pulling and...

Lumbar Interbody Fusion Using Bone Morphogenetic Protein Results and Fusion Assessment

Lumbar Pseudarthrosis Cage Device

Of a pseudarthrosis can be determined by a single finding on an isolated radiographic study, the presence of a solid fusion cannot be determined by a single radiographic finding. Failure of fusion is established by the absence of bridging trabecular bone and the presence of a radiolucent area that extends through the entire fusion mass. Pseudarthrosis can also be identified by marginal radiolucency around the implant, progressive subsidence of implants, and angular changes in the spinal motion segment. At present, no single study or technique is definitive for establishing the presence of a fusion after anterior interbody surgery 14 . A successful arthrodesis within a spinal motion segment can be determined by using radiographic evaluation to assess a stable spinal alignment on sequential examinations, a reduction in angular and translational changes on dynamic motion studies, an absence of fibrous tissue reaction at the device-host interface, and the presence of new bone formation...

Percutaneous Lumbar Pedicle Screws Indications Technique Results

Percutaneous Pedicle Screws

Simultaneous biplanar fluoroscopy offers immediate feedback in two planes. Ergonomically, it is challenging to operate inside of and around two C-arms placed for lateral and AP or lateral and oblique views. Simultaneous dual views allow for instant feedback when an instrument trajectory is altered manually by the surgeon in one plane. One limitation of biplanar fluoroscopy in percutaneous procedures, however, is the difficulty in seeing the tip of an instrument at the level of the skin surface. This is particularly true in patients with a large body habitus where there is a great distance between skin surface and the spine. Computer-assisted, virtual fluoroscopic systems offer a tremendous advantage. We have had extensive experience using the FluoroNav virtual fluoroscopic system (Medtronic Sofamor Danek, Memphis, Tenn., USA). With this technology, a stereotactic reference arc with light-emitting diodes is attached rigidly to the patient's spine through a small stab incision. The arc...

Cervical Lateral Mass Advances

Laterol Mass Screws

However, lateral mass plates have numerous drawbacks. They are difficult to contour, and the screw positions are dictated by the fixed plate entry holes. In addition, the screw trajectories are divergent from the plate entry holes, and the connection of the screw to the plate is not rigid. There is no space to pack autograft bone under the screw-plate connection. Screws placed medially or laterally cannot be captured by the plate. Successive screws cannot be compressed or distracted because of the fixed plate hole distances. Moreover, if the plate needs to be revised, the screws must be removed. Finally, most of the systems currently available do not easily allow for extension of fusion up to the occiput or down to the thoracic spine 8 . The SUMMIT system shares many of the features of the VERTEX system. SUMMIT polyaxial screw heads are placed independently of the rod and are then connected directly to the rod through a rigid locked connection. Recently, an adaptive occipital...

Thoracolumbar Deformity Advances

Measure Ilium

A Department of Neurosurgery, Emory University, Atlanta, Ga., b Department of Neurosurgery, Northwestern University, Chicago, Ill., and c Department of Orthopaedic Surgery, Indiana University School of Medicine, Indiana Spine Group, Indianapolis, Ind., USA The terms 'scoliosis, kyphosis, and lordosis' were first coined by the Greek physician Galen in the second century AD 1 . Since that time, significant advances have occurred in the classification and management of patients with spinal deformities. Early physicians attempted to correct thoracolumbar deformities with nonoperative treatments. Hippocrates, and later Galen, unsuccessfully used longitudinal traction to try to pull the deformed spine back into alignment 2 . Ambrose Pare was the first physician to use an orthosis to brace a scoliotic patient (approximately 1,500 AD). Pare soon realized that bracing was not useful once a patient had reached skeletal maturity 1 . During the past several centuries, more sophisticated and...

Laparoscopic versus Mini Open Anterior Lumbar Interbody Fusion

Early in the development of the ALIF technique, open approaches, such as the transperitoneal or retroperitoneal approach, were utilized to expose the anterior lumbar spine. Although providing adequate visualization, these more extensive exposures were associated with increased postoperative morbidity. As the ALIF technique evolved, emphasis was placed on exposing the spine through less invasive approaches. These minimally invasive techniques are intended to decrease postoperative morbidity, reduce hospitalization time, and shorten the Today's spine surgeon has two such options for approaching an ALIF the laparoscopic approach and the 'mini-open' laparotomy. Zucherman et al. 11 were the first to report the use of the laparoscopic approach for an anterior interbody fusion. This technique is considered by many as the least invasive approach to the ventral lumbar spine and in many centers has become the standard technique when performing an ALIF, particularly at the L5 S1 disc interspace....

Placement of Thoracic Pedicle Screws

Lenke Pedicle Screw Placement

When placing pedicle screws in the thoracic spine, the surgeon primarily uses his or her knowledge of general thoracic pedicle anatomy along with a preoperative plan founded on sound biomechanical principles for the initial approach. Preoperative patient-specific imaging studies aid the surgeon in adapting general anatomy knowledge to patient-specific anatomy. These include a detailed study of the preoperative radiographs for pedicle position and size, in addition to possible computerized tomography (CT) and magnetic resonance (MR) imaging, which can further detail the pertinent anatomy. In concert with a thorough understanding of this anatomy, tactile feedback, however, remains the primary means of confirmation for successful screw placement. This tactile feedback can be supplemented with a number of adjunctive technologies 1 . Conventional fluoroscopy has been widely used, with a high level of accuracy 2 . It has the advantage of being a real time evaluation in a familiar format....

Bone Morphogenetic Protein rhBMP2 Experimental Review and Clinical Update

Doctor Patient Impregnation

In order to function as a suitable graft for bridging bone defects or fusing fracture lines and unstable motion segments, the prospective material would ideally possess three characteristics. The material would provide a source of primitive osteoprogenitor cells, which, under the appropriate influence, would form osteoblasts and osteocytes (osteopromotive). Such precursor cells are unfortunately relatively scarce. Bone marrow, for example, contains a ratio of only one osteprogenitor cell to approximately 50,000 nucleated cells in a young adult. This ratio may dip to 1 200,000 cells in an elderly individual afflicted by degenerative spinal disease 21 . Despite techniques to concentrate marrow extracts, successful efforts have only resulted in a maximum of 5-fold improvement of the unfavorable cellular ratio. Second, the graft material would produce local growth factors to stimulate bone growth and vascularity in the area (osteoinductive). There are numerous reports in the literature...

C1 Lateral Mass Fixation

Laterol Mass Screws

A variety of techniques exist for fixation of the upper cervical spine. Recently, several authors have published case series reporting the use of C1 lateral mass screws for posterior cervical fixation 1-3 . In this chapter we describe our surgical technique for placement of C1 lateral mass screws, including indications and results from our experience. C1 lateral mass screws may be used to provide additional fixation points in occipitocervical constructs, possibly increasing resistance to construct failure in the cervical spine without increasing the number of cervical levels fused. Additionally, C1 lateral mass screws may be used as a supplement to or substitute for other forms of atlantocervical fixation. Techniques for achieving atlantocervical fusion include posterior interspinous fusion with sublaminar cables and iliac crest bone graft 4, 5 , C1-C2 transarticular screw fixation 5-7 , and interlaminar clamp fixation 8 . While each of these methods has been successfully employed to...

Virtual Fluoroscopy Overview and Future Implications

Mri After Pedicle Screw Fixation

The utilization of neuronavigation in spinal surgery continues to grow. Numerous advances in this field have facilitated more practical clinical applications and have led to greater acceptance of this technology. The successful combination of neuronavigational technology with a practical intraoperative imaging modality (i.e. fluoroscopy) has significantly increased the clinical utility of computer-assisted surgery. Consequently, the introduction of computerassisted fluoroscopy ('virtual fluoroscopy') has had a significant impact across multiple surgical specialties. The complex anatomy of the spine necessitates reliable preoperative and intraoperative imaging. In spinal surgery, a significant number of surgical complications are a direct result of poor intraoperative anatomical localization. However, due to technical limitations and cost considerations, detailed intraoperative imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) are not readily...

Endoscopic Posterior Cervical Foraminotomy and Microdiscectomy

Metrx Medtronic

Institute for Spine Care, Chicago Institute of Neurosurgery and Neuroresearch, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill., USA Recently microendoscopic discectomy (MED) techniques have been applied to perform laminoforaminotomy and discectomy for unilateral cervical radiculopathy 1, 11 utilizing the MED technique and instrumentation (fig. 1) developed by Smith and Foley in 1997 for lumbar disc disease 4, 6 . The muscle-splitting approach used in this technique is effective in limiting postoperative pain and muscle spasms while maintaining the integrity of midline posterior muscular and ligamentous attachments to the spine. Minimally invasive posterior cervical microendoscopic discectomy and laminoforaminotomy (CMED) can provide a number of advantages including reduced approach-related morbidity, preservation of the motion segment, reduced patient postoperative pain and discomfort, and quicker patient recovery. In avoiding an anterior approach to the spine and...

Cervical Laminoplasty

Resection Ligament Flavum

And Neurosurgery, London, and b Spinal Surgery Unit, The Royal National Orthopaedic Hospital, Stanmore, UK Cervical laminoplasty is very much a Japanese invention. Its popularity in Japan arises from the formidable challenges of anterior decompression for ossification of the posterior longitudinal ligament 1-5 . These anterior multilevel surgeries would be frequently complicated by dural tears as the dura is usually intimately associated with the ossified ligament 1, 6-9 . There was also a significant risk of instrumentation or graft failure 2 . It has been reported that the rate of these complications including cerebrospinal fluid leakage and dislodg-ment or pseudarthrosis of the strut grafted bone was 24 and the rate of the salvage operation required was 12.5 10 . In the past, laminectomy has been the most common method to achieve posterior decompression of the cervical spine in these patients. However, the procedure has been complicated by postoperative instability resulting in...

Interbody Carbon Fiber

Elisabeth, Spinal Department, Straubing, Germany The fusion of spinal segments is one of the major goals in surgical treatment of degenerative disc disease (DDD). To obtain the best biomechanical support and fusion rates, interbody fusion is the preferred method. The main advantages of implants made of carbon fiber reinforced plastic (CFRP) are the radiolucency and the fact that there is no distortion on CT and MRI. The surgeon can chronologically follow the biological reaction in the fusion section and can clearly detect bony fusion. Regions which are hidden using metal implants could now be analyzed on standard radiographs. In implants made of CFRP matrix materials such as thermoset epoxy resin systems (EPN DDS) or thermoplastic systems PEAK (PEKEKK , PEEK , ULTRAPEK ) are used. The first ones have been clinically used since 1988 following detailed in vitro and in vivo tests starting 1975 according to ISO 10993-1 1 . In the spine these implant materials have been used...

Dr Steve Abel Back Specialists

After appropriate preoperative evaluation and medical clearance, patients were brought to the operative suite. Following the induction of general endotracheal anesthesia, adequate intravenous access was secured. An arterial line is placed to enable continuous blood pressure monitoring and control. Adequate blood pressure is maintained to assure spinal cord perfusion during this procedure. During the initial experience with the CMED technique, patients were placed in the prone position. However, this led to bleeding that often obscured the endoscopic image during the operative procedure and resulted in increased operative times and blood loss (fig. 3). A change to the semisitting position using a Mayfield head holder (fig. 4) has resulted in significantly improved operative visualization, relieved epidural venous congestion, and decreased operative blood loss and operative times (fig. 3). The advantage of this position is that blood does not accumulate at the bottom of the tubular...

Thoracic Pedicle Screw Placement

Orthopaedic Surgery, Pediatric and Adult Spinal, Scoliosis and Reconstructive Surgery, Washington University Medical Center, Shriners Hospital in St. Louis, St. Louis, Mo., USA The use of thoracic pedicle screws in the treatment of various spinal disorders has shown a dramatic increase in the last decade 1-4 . The bio-mechanical stability afforded by transpedicular fixation, the ability to correct various sagittal and coronal plane spinal malalignments and deformities, and the available room for bone grafting around the implants provide an optimal environment for spinal fusion success 5-10 . This chapter will discuss the technique of free-hand thoracic pedicle screw placement using anatomic landmarks, and a special thoracic pedicle probe combined with appropriate surgical 3-dimensional orientation and 'feel' to access the vertebral body via the pedicle channel 11 . This free-hand technique can be adopted by any surgeon comfortable placing lumbar pedicle screws and experienced with...


Boden SD, Schimandle JH, Hutton WC 1995 Volvo Award in basic sciences. The use of an osteoinductive growth factor for lumbar spinal fusion. II. Study of dose, carrier, and species. Spine 1995 20 2633-2644. Boden SD, Schimandle JH, Hutton WC Lumbar intertransverse-process spine arthrodesis using a bovine-derived osteoinductive bone protein. J Bone Joint Surg Am 1995 77 1404-1417. Boden SD, Schimandle JH, Hutton WC Evaluation of a bovine-derived osteoinductive bone protein in a non-human primate model of lumbar spinal fusion. Trans Orthop Res Soc 1996 21 118. Boden SD, Schimandle JH, Hutton WC, Damien CJ, Benedict JJ, Baranowski C, Collier S In vivo evaluation of a resorbable osteoinductive composite as a graft substitute for lumbar spinal fusion. J Spinal Disord 1997 10 1-11. Boden SD, Sumner DR Biologic factors affecting spinal fusion and bone regeneration. Spine 1995 20(suppl) 102S-112S. Boden SD, Titus L, Hair G, Liu Y, Viggeswarapu M, Nanes MS, Baranowski C 1998 Volvo Award in...

Dickman Retractor

Metastatic colon cancer, pathologic C2 burst fracture, spinal cord compression The risk of vertebral artery injury must always be assessed when placement of lateral mass screws or transarticular screws is planned. In this small case series, there were no vertebral artery injuries. To minimize this risk, preoperative assessment of the path of the vertebral artery using CT scanning is mandatory prior to placement of C1 lateral mass screws. Magnetic resonance angiography or catheter angiography may be performed to provide additional information concerning the path and patency of the vertebral arteries, although in our experience we have not found this to be necessary. The surgeon must note that the trajectory of the C1 lateral mass screw is very different from that of lateral mass screws placed in the subaxial cervical spine. Particularly important is that the C1 screw is placed with a slight medial angulation to avoid the vertebral artery laterally and the spinal canal medially. We...

T12 Stablisation

Curvature, which is utilized to avoid penetration of the spinal canal at all times 17 . We almost always start our probe with the curve facing lateral for this purpose. After a cortical window is drilled with a 4.0-mm burr, the gearshift is taken and placed perpendicular to the plane of the lamina at the level being instrumented. This 'perpendicularity' is an extremely important feature for obtaining both correct sagittal plane and transverse plane angulation to allow placement of the screw parallel to the superior end-plate of the instrumented level. The pedicle probe tip starts out with the curve facing lateral in the pedicle tract. A 'soft spot' of the cancellous pedicle is identified with an initial light push of the probe tip into the burred surface. Once this 'soft spot' is acknowledged by 'feel', then the probe is advanced deeper into the pedicle past the spinal canal. Once the pedicle probe has been engaged down to 15-20 mm (i.e. past the spinal canal and into the posterior...


Advances in Spinal Stabilization Advances in spinal stabilization volume editors, Regis W. Haid, Jr., Brian R. Subach, Gerald E, Rodts, Jr. 1. Spine-Surgery. 2. Spinal implants. I. Haid, Regis W. II. Subach, Brian R. III. Rodts, Gerald E. IV Series. DNLM 1. Spine-surgery. 2. Orthopedic Procedures-methods. 3. Spinal Fusion-methods. WE 725 A2447 2003 RD533 A285 2003

Isbn 3805574312

14 Cellular and Genetic Approaches for Spinal Fusions 39 Resorbable Technology for Spinal Stabilization 71 Overview of Spinal Navigation 107 Cervical Techniques with Image-Guided Spinal Navigation 154 Cervical Pedicle Screws Advances in Spinal Stabilization 266 An Update on Endoscopic Thoracic Spinal Surgery Thoracic Microendoscopic Discectomy 290 Epidemiology and Variations in Care of Spine Disease 302 The Changing Economics of Spine Surgery

Bone Substitutes

There has long been a need to minimize the morbidity associated with spinal fusions. Bone substitutes are the most recent focus of this process, in an attempt to minimize the morbidities of donor site harvesting without compromising fusion. Autograft bone, consisting primarily of cancellous and some cortical bone, is the current standard for spinal fusion constructs. However, harvesting autograft usually requires a second incision and involves a risk of associated morbidities, such as infection, blood loss, hematoma formation, neurologic and vascular damage, pain, joint destabilization, and fractures. Furthermore there is a limit to the size, shape, and volumes of harvested autograft. Methods for strengthening the spine and improving nonunion delayed healing rates are actively being pursued. The ideal graft should be biocompatible, osteoinductive, and resorbable. This allows for incorporation with the surrounding tissues, including vascular-ization 1, 2 . An ideal graft should be...

Series Editors Note

Three eminent spine surgeons have collaborated as editors for this volume of Progress in Neurological Surgery. There is no question that new spinal stabilization techniques, minimally invasive approaches to the spine, and new concepts of biomechanics have revolutionized our understanding of disorders of spinal stability. In this comprehensive volume, the authors describe various techniques and clinically relevant procedures designed to improve the outcomes of spine surgery. Neuronavigational techniques, new bone fusion concepts, and both open and percutaneous spinal stabilization techniques are described. Progress in Neurological Surgery is dedicated to providing timely updates of important neurosurgical paradigm shifts. The volume of spinal surgery across the world has dramatically increased. The chapters in volume 16 help to elucidate the role and rationale of these new kinds of spinal stabilization. I am grateful to the editorial efforts of Dr. Haid, Dr. Subach and Dr. Rodts and to...

What is multiple sclerosis

In the classic sense, multiple sclerosis (MS) is a disease of the central nervous system (the brain and spinal cord) that most commonly affects young adults. Sclerosis means hardening MS means that there are multiple areas of hardened tissue in the brain and spinal cord. The word disease means a loss of a feeling of ease (i.e., dis-ease), or otherwise stated, a loss of a sense of well-being. This is a meaningful definition for MS patients faced with a bewildering variety of other specific symptoms. Often, patients afflicted with MS have difficulty describing just how they feel. Although the MS patient appreciates and understands this concept, many healthy persons, including physicians, unfortunately, often do not.

Some basic neurobiological characteristics of sleepwake cycles

Acetylcholine, norepinephrine, serotonin, histamine and hypocretin levels are increased in wakefulness and low in non-REM sleep, whereas during REM sleep the noradrenergic, serotonergic and histaminergic cells become silent (Jones, 2005). A high cholinergic tone in the pontine reticular formation combined with a low GABAergic tone contributes to the generation of REM sleep (Vanini et al., 2011). Animal studies showed that the neurotransmitter glutamate enhances REM sleep by activation of the kainite receptor within the cholinergic cell compartment of the brainstem pedunculo pontine tegmentum of cat and rat (Datta, 2002). During REM sleep and waking, the release of acetylcholine activated dopamine in the ventral tegmental neurons, which were higher in the prefrontal cortex and nucleus accumbens. It was also suggested that glutamate and asparate release can reciprocally affect dopamine release (Forster and Blaha, 2000 Morari et al., 1998). The animal study of Lena and colleagues in 2005...

Metabolism Of Vitamin E

Retention within tissues depends on intracellular binding proteins which, like the liver a-tocopherol transfer protein, have the highest affinity for RRR-a-tocopherol. The retention of a-tocopherol in tissues varies. In the lungs the vitamin has a half-life of 7.6 days, in liver 9.8 days, in skin 23.4 days, in brain 29.4 days, and in the spinal cord 76.3 days (Ingold et al., 1987).

Folate and Neural Tube Defects

Much attention has focused over the past 15 years on a number of diseases for which the risks are inversely related to folate status even within the range of serum folate levels previously considered 'normal.' Foremost among these is NTD, a malformation in the developing embryo that is related to a failure of the neural tube to close properly during the fourth week of embryonic life. Incomplete closure of the spinal cord results in spina bifida, while incomplete closure of the cranium results in anencephaly. The risk of NTD was found to be 10-fold higher (6 affected pregnancies per 1000) in people with poor folate status (i.e., less than 150 mg red cell folate per litre) than in those with good folate status (400 mgl-1). International agencies have published folic acid recommendations for the prevention of NTD. To prevent recurrence, 5 mg of folic acid daily in tablet form is recommended, while 400 mg daily is recommended for the prevention of occurrence, to be commenced prior to...

The Orthopedic Surgeon

Orthopedic surgeons are experts at evaluating joints and bones and determining if a surgical intervention would be helpful. Every person with FM has spine pain since it is part of the diagnostic criteria, but FM patients are referred for spine evaluation by the primary provider when neurologic signs and severe symptoms are evident. Spinal surgery is successful in the right patient, for the right diagnosis, such as spinal stenosis (abnormal narrowing). However, outcomes for spinal surgery designed to eliminate pain, when done in the absence of neurological signs, may be disappointing to the patient. For instance, neurosurgeons are sometimes asked to evaluate persons with FM for Chiari (pronounced kee-AR-ee) malformation. Chiari malformation is an anatomical problem in which part of the brainstem protrudes downward toward the spinal column. Research has shown that only a small number of patients with FM have anatomic abnormalities consistent with a Chiari malformation confirmed by...

Pure Autonomic Failure

A somewhat less catastrophic medical condition may provide a somewhat purer test of the role of arousal cues in feelings. Pure autonomic failure (PAF) is, as the name says, a failure of the autonomic nervous system with the result that arousal responses can no longer occur. Pure Au-tonomic Failure characteristically occurs in adults in their 30s and 40s and is not thought to involve any central nervous system damage. While doubtless troublesome, PAF certainly does not produce the degree of life disruption that spinal cord injuries do. Thus, it provides a relatively straightforward test of the role of arousal in emotional experience. Since the disorder is rare, samples are small, but the results are entirely consistent with Schachterian and Jamesian theories. These people seem to have dramatically diminished intensities of emotional experience. When asked how much they agreed with the statement I no longer feel emotional, the PAF group did not overlap with normal controls in the...

Regulation Of Tight Junctions

McLay RN, Kimura M, Banks WA, Kastin AJ. 1997. Granulocyte-macrophage colony stimulating factor 54 crosses the blood-brain and blood spinal cord barriers. Brain. 120, 2083-2091 Hirase T, Staddon JM, Saitou M, AndoAkatsuka Y, Itoh M, Furuse M, Fujimoto K, Tsukita S, Rubin LL. 1997 Occludin as a possible determinant of tight

Habits vs Mental Problems

Haemophilus influenzae type B (Hib) A type of rod-shaped bacterium not to be confused with the influenza virus that causes the flu. Haemophilus influenzae type B (Hib) is a bacterium that causes potentially deadly meningitis, pneumonia, and blood infection (bacterial sepsis). H. flu meningitis is a serious infection characterized by inflammation of the brain and spinal cord that may be fatal.

What is the role of the immune system in MS

The occurrence of inflammatory disease of the brain and spinal cord (acute encephalomyelitis) following infections and immunizations (especially after a killed virus rabies vaccine made from rabbit spinal cord) led to studies of the allergic potential of certain proteins in the nervous system. Most research has been focused on a single protein, myelin basic protein, because it has a high potential for the induction of experimental demyelinating disease in rats, guinea pigs, monkeys, and other animals. Only 10 millionths of a gram (there are 450 grams in a pound) injected into a genetically susceptible rat can result in experimental disease resembling MS. Over 30 years ago we found that MS patients have cells reactive to this protein in their blood. More recently, Swedish scientists have also found cells with similar reactivity in the spinal fluid of MS patients. Importantly, the original research into a treatment now approved for use in MS (Copaxone) arose from this work. Copaxone is...

Issues and Specific Experimental Preparations

Diagrams illustrate the concepts of vertical induction (A) and planar induction (B). In vertical induction, the organizer mesoderm (stippled) first involutes beneath the prospective neural tissue, and then sends signals radially (outward or vertically) to the overlying neural tissue (arrows, A). In planar induction, the Organizer mesoderm sends signals animally, from its posterior edge, into the prospective neural tissue (arrow, B). One difference is that vertical signaling requires involution of the Organizer and thus must occur at a relatively older stage (stage 10.5 shown in A), whereas planar signaling can occur early (stage 10- shown in B). The prospective fore- and midbrain (F, M), rhombencephalon (RH), and spinal cord (SC) are shown. The components of the organizer in the sagittal plane, the prospective prechordal mesoderm (PM) and notochordal mesoderm, are indicated with fine and course stippling, respectively. Fig. 5. Diagrams illustrate the concepts of vertical...

Evidencebased Research

The author emphasizes the systemic approach in treating both asymptomatic (no discernible symptoms) and symptomatic athletes, and this is well supported by his own clinical experience and equally by findings of evidence-based research in sports medicine. The purpose of the systemic approach is to adjust the biomechani-cal alignment and balance of the core structure, especially to release stress in the soft tissue of the spine to facilitate stability and strengthening of the core. Hodges and Richardson2 revived the concept of core stability in the 1990s. They described the spine as inherently unstable and requiring active support from intra-abdominal pressure and tension-ing of the thoracolumbar fascia and deep lumbar stabilizers. Core strength is thus considered to be the muscular support of the lumbar spine, which is necessary to achieve and maintain functional stability.3 More recently, this concept has been expanded to include muscles of the hip4 and the

Neural Plate Explants

Another difficulty is controlling whether or not mesoderm is left in planar apposition with the posterior neural plate. This requires knowing precisely where the posterior boundary of the neural plate lies. If one desires mesoderm to be present, the explant should be cut at the blastoporal lip. If not, one must err on the neural side of the boundary to be assured that no mesoderm will be included. This presents a dilemma. Although considerable convergent extension has occurred at the mid- to late-gas-trula stages, the posterior neural tissue is still relatively short and wide. Cutting a little too far animally will remove all the prospective posterior neural tissue that would have converged, extended, and made the spinal cord. Likewise, lateral epidermis can be included in the explant, or not, depending on where the lateral cuts isolating the explant are made with respect to the boundaries shown in the fate maps. This type of explant has been used to study the effect of the lateral...

Anterior Cruciate Ligament

The mechanism of injury is usually noncontact, with the foot planted when a twisting injury occurs at the knee. Athletes usually hear or feel a pop and have immediate pain and swelling within 24 hours. Contact injuries may also damage the ACL. On examination they can usually weight bear but have a large effusion. They have a positive Lachman test suggesting that the ACL is torn (Fig. 7). Radiographs are usually normal although a Segund Fracture is pathognomonic for an ACL tear (Fig. 8). An MRI may be useful in equivocal cases or in those with a soft endpoint on Lachman testing. Athletes with a torn ACL need surgical repair if they wish to return to cutting and pivoting sports as without an ACL, cutting and pivoting will damage the meniscus and may lead to early arthritis. Adolescents may also sustain a tibial spine fracture with the same mechanism that tears the ACL. Mechanisms that injure the ACL can also cause damage to the MCL or meniscus.

Choices in pain management

Medications to relieve pain are known medically as analgesics. A common pain medication used in labor is nalbuphine (Nubain), which is given either intravenously or by injection. Anesthetics are medications that cause loss of sensation. Two examples of anesthetic techniques used in childbirth are epidural blocks and spinal blocks.

Acute Administration

Langeron, O., Lille, F., Zerhouni, O., Orliaguet, G., Saillant, G., Riou, B. and Coriat, P., Comparison of the effects of ketamine-midazolam with those of fentanyl- midazolam on cortical somatosensory evoked potentials during major spine surgery. Br. J. Anaesth. 78 701-706, 1997.


Muscular pain usually occurs with prolonged sitting or standing especially in those with poor posture. Pain may also be elicited during or after sports activity or with overuse. Adolescents with hyperlor-dosis may experience pain as they grow secondary to pulling along the apophyses of the lumbar spine. Pain occurs along the low back paraspinal muscles or spinous processes and is usually bilateral. There is no radiation of pain, neurologic symptoms, night pain, or bowel bladder dysfunction.

The Way This Back Behaves

There is a world of difference between the acute and chronic forms of the stiff spinal segment. Strange to say, the more advanced pathologies are often less painful. This is because the segment is so stiff it is almost fused, and where there is little movement there is little pain. At this stage, however, the low internal pressure of the disc means that it retains the inherent risk of knocking loose from its jammed impaction and very quickly becoming unstable. Its lack of intrinsic tensile strength means, quite literally, that if the segment is not stiffly stuck together it is vulnerable to instability. A typical sub-clinical problem is the 'jumpy legs' syndrome, which feels as if two live wires touch when you sit for too long. A lesser form of the affliction is not being able to keep your legs still when sitting, usually combined with a dull sense of pressure in your back. Both conditions are more a nuisance than a problem, and although there is never any pain, it is unnerving and...

Violence and Serotonin

In 1976, Asperg and others found reduced levels of the serotonin metabolite 5-HIAA in the cerebrospinal fluid of depressed patients who had made suicide attempts (Arch Gen Psychiatry 1976 33 1193-7). Brown and others also found a relationship between aggression, history of suicidal behavior, and 5-HIAA in cerebrospinal fluid (Psychiatry Res 1979 1 131-9. 29). 5-HIAA in the cerebrospinal fluid (CSF) was low in impulsive, violent offenders. (Linnoila, Life Sci 1983 33 2609-14.). Low levels of CSF 5-HIAA were also found in impulsive arsonists and other violent criminal offenders.

Thrust to occipitoatlantal joint supine

Tips Most useful in cases of sidebending restriction. Least useful in patients who have a very mobile mid cervical spine as the force will too easily dissipate there and not accumulate at the occipito-atlantal joint. Extra considerations Try using this position as a firm articulation procedure, but do not carry it on for very long as the forces generated are very strong and will provoke discomfort.

On accepting disabilities

My diagnosis of high-risk ALL gave me a 50 percent chance of survival. Cranial radiation and three years of blood tests, IV, chemotherapy, bone marrows, and spinal taps were my prescription. A positive outlook pushed me through the bad times. Somehow I understood that all the hurt was for a good reason, and that it would make me well.

Bone Mass Acquisition

The fetal skeleton at term contains about 21 g of calcium, the adult skeleton about 1000 g. Many studies evaluated the factors controlling calcium accumulation in the skeleton during growth and development. Maximal accumulation occurs during puberty. Ninety percent of adult bone mass is accumulated by age 18 years, while the remaining 10 will be added in the subsequent skeletal consolidation phase. It is important to know that bone mass acquisition has different characteristics in cortical and trabecular bone. Trabecular bone density is strongly influenced by the hormonal and metabolic factors associated with sexual development during adolescence. On average, spine bone mass (mostly trabecular bone) increases by 13 during puberty, in both sexes. Beyond their direct action, sex hormones act also indirectly, through the modifications that they induce on protein and calcium metabolism, and through the sequence of events triggered by the higher production of GH and IGF-1. Consolidation of...

Anatomical Evidence Of Asymmetries In The Cortical Hand Areas

White et al.'s finding of a lack of asymmetry stands in contrast with several other anatomical papers in which some asymmetry was found. One of the earliest indications came from an examination of the level at which the pyramidal tracts cross over in 87 of cases, there was a priority for pyramidal tract fibres coming from the left hemisphere (Yakovlev & Rakic, 1966). However, Kertesz & Geschwind (1971) found that the crossover pattern did not correlate with handedness because the pattern favouring the left was also seen in their sample of left handers. In the latter study, an attempt was made to ascertain handedness, which was not the case in the former study. It is not entirely clear how crossover patterns relate to handedness. One possibility concerns simply an asymmetry in the rate of development in the left as opposed to the right hemisphere with earlier differentiation leading to the crossover pattern of left above right, with some intercalation. However, this is entirely...

Other Medical Complications

Data from the Drug Abuse Warning Network. National Institute on Drug Abuse Statistical Series, 1 12-A. DHHS Pub. no. (SMA) 94-2080. Annual medical EXAMINER DATA, (1992). Data from the Drug Abuse Warning Network. National Institute on Drug Abuse Statistical Series. 1 12-B. DHHS Pub. no. (SMA) 94-2081. Ballantyne, J. C., Loach, A. B., & Carr, D. B. (1988). Itching after epidural and spinal opiates. Pain, 33, 149-160. Martin, W. R., et AL. (1976). The effects of morphine and nalorphine-like drugs in the non-dependent and morphine-dependent chronic spinal dog. Journal of Pharmacol. Exp. Ther. 197, 517-532.

Subcortical Structures

From the standpoint of function, these data suggest the existence of a mechanism responsible for spontaneous activity. This mechanism is based on tissue production of acetylcholine (local hormone) and on the local effect on neuronal excitability. It has been demonstrated histo-chemically that Cholinesterase activity is particularly pronounced in the dendrite layers of the cortex and in layer V (Pope, 1952). Analysis of the distribution of Cholinesterase in different parts of the neuron, as illustrated by cells in the anterior horn of the rat spinal cord (Giacobini, 1959), shows that it is not evenly distributed. Most activity is found in the cytoplasm and dendrites, least activity in the axons, and 100 times less in the nucleus. 1956), 52-69 of the total specific Cholinesterase is concentrated in the mitochondria. It would seem that the mitochondria contain acetylcholine and nonspecific Cholinesterase, while the microsomes contain acetylcholinesterase. The same nerve structure may...

Neuroprotective Effects Of Monoamine Oxidase Inhibitors

Models that have demonstrated neuroprotection by either rasagiline or selegi-line include glutamate toxicity in hippocampal neurons (48), focal brain ischemia in rats (39,40), memory and learning tasks following anoxic brain injury (49) and motor and spatial memory in a rodent closed head injury model (50), optic nerve crush injury (51), rescue of dorsal root ganglia sensory neurons (52) and of axotomized motoneu-rons (53), and protection against cell death in rat pheochromocytoma PC-12 cells deprived of oxygen and glucose (54). Selegiline given after intrathecal injection of rat pups with cerebrospinal fluid from human amyotrophic lateral sclerosis (ALS) subjects protects against anterior horn cell loss (55). Pretreatment with rasagiline is neu-roprotective in primate MPTP (56) and rodent 6-OHDA models of PD (38). Primates treated with selegiline and MPTP simultaneously do not develop parkinsonism (57).

The Influence of Thermoplastic Patient Fixation on Tumor Motions

Our purposes with this study were to detect, describe and analyze tumor motions and to assess the effectiveness of our immobilization system regarding tumor motion restriction. During this study, we had to eliminate two critical problems. The first was the question of patient immobilization associated with the reduction of tumor motions, the second the selection of reference points. The selection of the comparison points in the motion analysis was a critical question. During the respiratory cycle almost all parts of the chest are in motion, making it difficult to determine fixed points of reference. DeNeve et al. defined diaphragms, chest wall, carina and intervertebral discus as bases of comparison 32 . In the study of Plathow et al., cranio-caudal displacement was measured from the T6 T7 disk space to the proximal external tumor edge. Antero-posterior displacement was measured in relation to a line tangential to the anterior edge of the vertebrae. Medio-lateral displacement was...

Muscle Strain of the Back

Of all the medical modalities available, dry needling acupuncture is most effective in reducing pain and stiffness and in restoring the normal function of the spine. The core system affects all peripheral movement, which means that spinal disorder affects the movement of the limbs therefore the treatment should be systemic. In addition to the lumbar region, the shoulders, neck, hips, iliotibial bands, hamstring muscles, and calf muscles should all be treated together. Two treatment sessions per week are recommended.

Ligament Sprain of the Back

Ligaments provide strong and flexible connections between bones. The spine is supported by several ligaments The anterior and posterior longitudinal ligaments connect the vertebral bodies of the entire spine (cervical, thoracic, and lumbar). The causes of ligament sprain are the same as those of muscle sprain, and the injured soft tissue can be simultaneously both the muscles and the ligaments of the back.

What Are Economic Consequences

In the middle 1980s, Paralyzed Veterans of America (PVA) initiated a research agenda on the economic consequences of spinal cord injury and MS. The goal of this ambitious agenda was to document that costs for either spinal cord injury or MS could be identified and estimated for a year and a lifetime. The work was completed under contract to the Disability Income Systems, Inc. of Rutgers University, directed by Monroe Berkowitz, PhD and Carol Harvey, PhD. Three publications resulted from this agenda. See the references at the end of this chapter for these and other publications on this topic.

Absorption Transport and Storage

Transport of niacin between the liver and the intestine can occur in vivo, as indicated by radioactive probes in animals, and the liver appears to be a major site of conversion of niacin to its ultimate functional products the nicotinamide nucleo-tide coenzymes. Nicotinamide can pass readily between the cerebrospinal fluid and the plasma, thus ensuring a supply also to the brain and spinal cord. Liver contains greater niacin coenzyme concentrations than most other tissues, but all metabolically active tissues contain these essential

Hazard Identification

No data were found on apparently healthy humans given oral L-threonoine supplements. However, L-threonine has been used clinically with the aim of increasing glycine concentrations in the cerebral spinal fluid of patients with spasticity. When given in amounts of 4.5 to 6.0 g d for 14 days, no adverse clinical effects were noted in such patients (Growdon et al., 1991). Threonine also has been studied in low birth weight infants. In a study of 163 low birth weight infants, threonine serum concentrations were directly related to the threonine concentrations of the formula (Rigo and Senterre, 1980). The authors suggested that threonine intakes should not exceed about 140 mg kg body weight d for premature infants.

Osteoporosis Prevention

In a recent trial by Atkinson et al, loss of lumbar spine bone mineral content and bone mineral density was significantly reduced in women taking red clover-derived isoflavones (43.5 mg day) compared to placebo in a double-blind, placebo-controlled, randomised trial in 205 women over 12 months (Atkinson et al 2004c). Bone formation markers were also significantly increased however, no improvement in hipbone mineral content or bone mineral density was noted. A double-blind study of 46 postmenopausal women investigated the effects of a red clover isoflavone preparation (Rimostil) containing genistein, daidzein, formononetin and biochanin A after a single-blind placebo phase and followed by a single-blind washout phase. Patients were randomly assigned to receive 28.5 mg, 57 mg or 85.5 mg phyto-oestrogens daily for a 6-month period. After the test period, the bone mineral density of the proximal radius and ulna rose significantly, by 4.1 with a dose of 57 mg day and by 3.0 with a dose of...

History And Physical Examination

The physical examination should be thorough. The position of the hip at rest should be noted, as it may indicate the underlying pathology. For example, a hip that is abducted, flexed, and externally rotated achieves the greatest capsular volume, suggesting an effusion or synovitis. The patient's gait should be noted. Examination of the lumbar spine including motor function, sensation, range of motion, reflexes, and straight-leg raises must be performed to rule out lumbar spine pathology as the cause of symptoms. Leg-length discrepancies should be assessed 12,13 .

The central nervous system

The central nervous system, consisting of the brain and spinal cord, is covered by a special type of connective tissue called the meninges. The meninges has three layers dura mater - this is the outer protective fibrous connective tissue sheath covering the brain and spinal cord arachnoid mater - this provides a space for the blood vessels and circulation of cerebrospinal fluid.

Transport and cellular uptake

Blood-brain barrier Brain capillary endothelium effectively blocks the movement of water between cells. Water can reach the brain, w ith a few regional exceptions, only by transcellular transport. One of the exceptions is the ehorioid villous where cerebrospinal fluid is produced,

Breast Cancer Metastasis

Abstract Distant metastases from breast cancer are common, especially in patients with positive axillary nodes. They often develop late and are the predominant cause of mortality from the disease. The natural history of breast cancer remains controversial. It is unclear whether metastasis has already occurred by the time of presentation, especially in the case of small, screen-detected tumours. The commonest sites of distant metastasis are bone, liver and lungs. Bony metastases are commonest in the axial skeleton, but also frequently occur in the long bones. Their complications include spinal cord compression, pathological fracture and hypercalcaemia. When there is clinical suspicion of distant metastasis, investigation consists predominantly of imaging techniques, such as bone scans, plain films, computed tomography and magnetic resonance imaging. After surgery to the primary tumour, adjuvant chemotherapy and hormonal therapy is used to treat occult micrometastatic deposits....

Is it true that baclofen can be injectedHow does that work

Baclofen can be injected to reduce spasticity, but it is only available for injection into the spinal fluid using an implantable pump. Direct injection into the spinal fluid is used only as a test to evaluate the patient's response before implanting the pump. This device allows the baclofen to be delivered into the spinal fluid continuously. It is called intrathecal baclofen and is used only for patients with severe spasticity that cannot tolerate the side effects of or do not benefit from oral baclofen. The injectable drug differs in its composition, making it more effective. Ordinarily, intrathecal baclofen is not considered in ambulatory patients.

Sentences For Drug Offenses

SEROTONIN Chemically named 5-hydroxy-tryptamine, this Monoamine transmitter is a widely distributed substance particularly prevalent in the gut, blood, platelets, and pineal gland, as well as in nine major sets of brain neurons (nerve cells). In the 1950s, chemical similarity between serotonin and the chemical Hallucinogen Lysergic Acid Diethylamide (LSD) focused attention on this Neurotransmitter in mental illness, a link strengthened by experimental studies in animals and humans. Neurons containing serotonin, atypical monoamine, project widely throughout the brain and spinal cord, and a large number of well-characterized serotonin-receptor subtypes mediate both direct and indirect regulation of ion channels that exist in the membranes of neurons. By regulating these channels, these serotonin Receptors influence the concentration within the neuron of such ions as K+ (potassium) and Ca++ (calcium) and thereby the activity of the cell.

Chronic Administration

V., Rosenbloom, M. J., Shear, P. K., Mathalon, D. H. and Lim, K. O., Increase in brain cerebrospinal fluid volume is greater in older than in younger alcoholic patients a replication study and CT MRI comparison. Psychiatry Res. 50 257-274, 1993. Pfefferbaum, A., Sullivan, E. V., Rosenbloom, M. J., Shear, P. K., Mathalon, D. H. and Lim, K. O., Increase in brain cerebrospinal fluid volume is greater in older than in younger alcoholic patients a replication study and CT MRI comparison. Psychiatry Res. 50 257-274, 1993.

Module 1 Days 1 3 and 5

Assume a comfortable position with your spine stabilized against the rear pad of the machine. Adjust the height of the seat so that your arms form a 90-degree angle at the elbow. In order to prevent an impingement of the shoulder joint, I recommend that you position your arms so that your palms face each other.

Why arent drugs used together to get a better effect

ACTH and IV steroids aren't ordinarily used together. However, high-dose IV steroids (in 1-gram daily doses) could be used for a 3- to 5-day period in patients who have especially severe attacks to reduce swelling in the optic nerve or spinal cord, with ACTH added to maintain adrenal function (since steroids suppress the adrenal glands) and thereby obtain the benefit of the other actions of ACTH. This would also provide the neuroprotective effect of ACTH.

Clinical associations with RLS or secondary RLS 61 RLS and multiple sclerosis

In 2007, Manconi et al examined prevalence of RLS in an Italian population of MS patients. In this population of 156 patients, 100 were female and a prevalence of 32.7 was found who met the 2003 IRRLSG diagnostic criteria. However, in contrast to the French-Canadian population, a positive family history for RLS was only reported by 5 of the (total) population. In the majority of these patients ( 90 ), RLS symptoms followed or were simultaneous in onset with MS clinical features onset. The authors speculate that the coexistence of MS and RLS may be the result of a particular lesional pattern (Manconi et al, 2007). In a subsequent study of 82 MS patients of whom 30 patients had co-existing RLS, brain and cervical spinal cord MRIs were done. The MS and RLS patients were observed to have a greater degree of cervical cord involvement than those MS patients without RLS. The authors state that cervical cord damage represents a significant risk factor for RLS in MS patients (Manconi et al,...

Module 1 Days 2 4 and 6

Begin by inhaling, then exhale as you pull your stomach to your spine, rounding your back upward and dropping your head until you are looking toward your pelvis. Feel this movement in your lower back. 3. Lower your back, inhale as you pass through the neutral position, then exhale as you bring your head up, pulling your shoulders down as you feel your spine extend.

Surgical Complications

Surgical complications are those that occur within 30 days of surgery. These complications are typical of those seen with other intracranial stereotactic procedures and generally occur in less than 5 of the patients. These complications include hemorrhage, ischemic lesions, seizures, infections, and misplaced leads. Several studies have focused on the examination of surgical complications related to DBS. Beric et al. (46) reported 86 patients who received 149 DBS implants in the VIM nucleus of the thalamus, GPi or STN for PD, essential tremor, multiple sclerosis, or dystonia. In this cohort, 2.3 (n 2) of the patients had a hemorrhage, 2.3 (n 2) had seizures, 1.2 (n 1) had a delayed hematoma two months after surgery, and 4.7 (n 4) had postsurgical confusion. Umemura et al. (47) reported surgical complications in 109 patients receiving DBS of the VIM nucleus of the thalamus, GPi, STN, or anterior nucleus of the thalamus for PD, essential tremor, epilepsy, or dystonia. They reported two...

The Cholinergic System in AD

Nerve growth factor (NGF) is the prototypical member of the neurotropin family. It is a low-molecular-weight polypeptide with trophic effects for cholin-ergic neurons. NGF up-regulates choline acetyltransferase. The role of NGF in the support of the cholinergic system was elucidated through a series of studies that first examined the anatomical distribution of neurons that expressed NGF and NGF receptors. Later studies examined the effect of NGF on normal and injured target cells. Medial septal cholinergic neurons express both low-affinity (p75) and high-affinity (trkA) NGF receptors on their cell bodies and their terminals, which project to the hippocampus (20-22). The NGF that is expressed by cortical neurons binds to these receptors on cholinergic fibers and is transported retrograde to the cell bodies in the NBM (23). Fimbria fornix lesions in both rats and monkeys that interrupt this pathway lead to the degeneration of cholinergic neurons (24,25). NGF...

Aetiology of mental fatigue

Interleukin-1 (IL-1) crosses the blood-brain barrier, with the highest rate of entry occurring in the hypothalamus (Dantzer et al. 1992). The hypothalamus has rich connections with the brainstem, frontal cortex, and limbic system. IL-1 and its receptors are found in many areas of the brain. IL-1 messenger RNA is found in abundance in the hippocampus (Dantzer et al. 1992), a critical structure for memory processes. IL-1P depresses the influx of calcium into hippocampus neurons, which may explain the preponderance of memory impairment in patients with IL-1-associated toxicity (Plata-Salaman and Ffrench-Mullen 1992). TNF is also neurotoxic, and is associated with demyelination in the brain (Ellison and Merchant 1991). TNF and IL-1 are synergisti-cally toxic (Waage and Espevik 1988) and are associated with the development of multiple sclerosis plaques and gliosis (Wollman et al. 1992). Patients with Alzheimer's disease have elevated levels of IL-6 (Huberman et al. 1995). We have found...

Cell Selection for Gene Therapy Grafting

And reliability of transduced fibroblasts as vehicles for delivering NGF to the CNS has been demonstrated in a number of studies (45,46). Genetically modified fibroblasts grafted into the spinal cord have been shown to survive, produce NGF, and promote the growth of specific neuronal subtypes (47). In transplanted tissue, the NGF produced is released intrapa-renchymally and has a restricted area of action.

Homeopathic medicine

Ac. is prescribed for weakness in the spinal cord and associated nerves Nat. mur. is effective for fatigue affecting the knees, ankles, and dorsal spine in particular caused by mental exertion. Calc. carb. is used to treat fatigue, particularly of the thigh muscles, caused by walking and Arsen. alb. is given for fatigue, especially of the chest muscles, caused by walking.

Chemical Name Amitriptyline ameetriptileen

Description Amitriptyline is a tricyclic anti-depressant used to treat mental depression. In multiple sclerosis, it is frequently used to treat painful paresthesias in the arms and legs (e.g., burning sensations, pins and needles, stabbing pains) caused by damage to the pain regulating pathways of the brain and spinal cord. Description Baclofen acts on the central nervous system to relieve spasms, cramping, and tightness of muscles caused by spastic-ity in multiple sclerosis. Intrathecal baclofen therapy (ITB) consists of long-term delivery of baclofen to the intrathecal space in the spinal column. It is used in MS for those individuals with severe spasticity whose symptoms are not sufficiently relieved with oral baclofen and other oral medications. Because ITB is administered directly into the intrathecal space, it provides better spas-ticity reduction at lower doses than can be achieved with oral medications that, at higher doses, can produce sedation, sleepiness, and imbalance. As...

How do the side effects compare

When I was first diagnosed with MS, my doctor at the time prescribed steroids, specifically oral prednisone, intravenous steroid methylprednisolone, and then more oral prednisone. As a result, I was simultaneously dealing with the diagnosis, my body going through things it had never done before (such as vision loss, MRI, and spinal tap), emotionally managing the logistics of a nurse for the IV steroids, processing the mounds of insurance forms, and coping with the side effects of the steroids.

Agents That Attenuate Drinking Behavior

Agents That Affect the Serotonin System. Several lines on animal and human research suggest that brain serotonin is associated with alcoholism. Serotonin levels are lower in several regions of the brain in rats selectively bred to drink alcohol than in rats that do not prefer alcohol. In humans, measurements of cerebral spinal fluid levels of 5-hydroxyindoleacetic acid (5-HIAA), a metabolite of serotonin, revealed lower levels of 5-HIAA in

Why are IVsteroids given for attacks of MS

More than 30 years ago, after performing myelograms to rule out tumors, we found that the spinal cord was swollen during severe attacks of MS, causing paralysis. When CT scans of the brain and orbits became available to study patients with severe attacks of optic neuritis, we also found the optic nerves to be markedly swollen. We reasoned that with high doses of steroids we should be able to reduce the swelling in the spinal cord and optic nerve to prevent further damage from the lack of circulation in the affected areas of the ner x-ray studies of the spinal cord and spinal canal performed by the injection of contrast media. CT and MRI studies have replaced this procedure.

Fortification Of Food With Folic Acid Could Mask Hematologic Symptoms In The Case Of Vitamin B12 Deficiency

NTDs are serious birth defects of the spine and the brain. Two of the most common NTDs are spina bifida and anencephaly, which together affect approximately 1 pregnancy out of 1000, resulting in 2500 3000 affected births in the United States annually (Honein et al, 2001).

Neuroanatomical Substrates Of Facial Expression

The muscles of the face are composed of two groups, the mastication muscles and the expressive or mimic muscles. On each side of the face, there are four muscles. These are the temprails, the masseter, and the internal and external pteryoid muscles (Rinn, 1984). Motor neurons of the brain that innervate facial muscles are of two types the upper motor neurons that send impulses from the motor centre of the cortex to the brain stem and or spinal cord and the lower motor neurons that send impulses from brain stem spinal cord to the facial muscles (for details, see Rinn, 1984). The lower motor neuron tract that provides major motor innervation of the muscles of facial expression is known as the facial nerve or seventh cranial nerve (Brodal, 1957 Miehlke, 1973).

Techniques For The Calf Area32

It is performed with the knee extended to reach the gastrocnemius, and flexed to take the gastrocnemius off stretch and make it easier to reach the deeper muscles. Calf muscles are closely concerned with posture, which means that there may be only partly reversible contracture and fibrosis present. Techniques should usually be slow and deep to produce the best result. Control of rhythm is also important. There may be remote causes of calf muscle hypertonicity, such as nerve root pressure in the lumbar spine or circulatory deficit in the arterial supply. Initial attention to these extraneous causes should be considered to get the best result from any later work on the calf.

Will I be able to walk

If you walk with short steps stand sideways and look in your mirror. Is your neck flexed on your chin Are your shoulders rounded Do they slope forward Is your spine bent or curved If the answer to two or three of the above is yes, then the bent or curved spine may be part of the problem. The cause of the bent or curved or twisted spine is unknown. In some patients this results from an unequal pull of muscles in the front over muscles in the back of the spine. The spine is a fulcrum around which your hip, thigh, and back muscles exert leverage. If your spine is bent, curved, or twisted, or if your posture is stooped, you will not generate as much force with your hip, thigh, and back muscles. Consequently you take shorter, smaller steps than usual to cover a set distance and you fatigue easily. If your spine is straight, you generate more force with your hip, thigh, and back muscles, you take longer steps, you take fewer steps to cover a set distance, you walk more...

Longterm Product Secretion And Delivery

Before patients can be routinely implanted with encapsulated cells, long-term survival ( 6 months) of the encapsulated cells and continued release of the therapeutic molecule must be demonstrated. Although effective immunoisolation should result in long-term survival of encapsulated cells, surprisingly few studies have examined long-term ( 3 months) implant viability. A few notable exceptions exist and provide compelling evidence about the potential for long-term survival and release of molecules from the cells. Encapsulated PC12 cells secrete high levels of catecholamines under both basal and evoked conditions, and have been evaluated as a potential means of delivering dopamine to the striatum of PD patients. Following encapsulation, PC12 cells have been maintained in vitro and in vivo for at least 6 months, while maintaining a typical morphology and clustered arrangement along the lumen of the device (32,51,61,62). The cells remain tyrosine hydroxylase (TH)-immunoreactive and can be...