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. More here...

Dorn Spinal Therapy Summary


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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.

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

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.

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 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...

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

Branch Point Helix

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

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.

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...

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.

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,...

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...

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

Scoliosis Curve Direction

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

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

Bone Morphogenetic Protein

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

Cervical Laminoplasty Single Door

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...


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

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...


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...

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...

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...

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.

Where should your child receive treatment

Usually the child is admitted through the emergency room or the oncology clinic, where a physical exam is performed. An intravenous line (IV) is started, more blood is drawn, and a chest x-ray is obtained. Early in your child's hospitalization, the oncologist will perform a spinal tap to determine if any leukemia cells are present in the cerebrospinal fluid and a bone marrow aspiration to identify the type of leukemia. Details of these procedures are described in Chapter 3, Coping with Procedures.

About the Paralyzed Veterans of America

Founded in 1946, PVA is the only congressionally chartered veterans service organization dedicated solely to individuals with spinal cord injury or diseases. PVA has 34 local chapters around the country and represents over 21,000 members. Approximately 20 percent of PVA members have MS. To serve them better, PVA has published a number of books on MS, promoted the development of MS Centers of Excellence within the Department of Veterans Affairs and engaged with other organizations in vigorous efforts to promote MS program building.

Embryological Development

The development of the embryo is guided by very precise instructions contained in the genetic code, with a specific reproducible timetable for every species. Starting from a small group of polyvalent cells, each organ and function is built and interconnected. The crucial role of the nervous system as control integrator explains its early identification in the ectoderm of the embryo as neural plate, neural groove and then neural tube induced by the notochord which also organizes the construction with the metameric segmented mesoblas-tic components of the spine and muscles. This initial overdevelopment of the neural tube is responsible, in all species, for the spiral shape of the embryo, rolled up around the vascular system, with the heart pump in the center pulsating very early in order to transport the required building and trophic material to all parts. At the end of the third month, each organ and function is in place. This complex growth program is perfectly regulated in its timing...

Fluid Retention Dropsy Kidney Failure

Increasing protein consumption often relieves the body of extra fluid. Fresh parsley is an excellent kidney purifying herb. Try adding it to your salads or make parsley tea with hot water. We support heart function with low dosage, cold-processed nutritional supplements and see reduced swelling as a result. I check all patients for proper alignment of the spinal segments associated with heart and kidney function. Correction aids restoration.

In Vivo Studies and Tissue Specificity of Gene Transfer

The feasibility of Ad vector-mediated gene transfer in vitro posed the question of the efficiency of this vector system in vivo. Because Ad gene transfer vectors are made from human adenoviruses, there was no a priori reason to believe they would infect rodents or other model animals. Some early studies used cotton rats because this species had been shown previously to be permissive for replication of human adenoviruses (52-54). For example, intratracheal administration of a replication-deficient virus expressing the reporter gene p-galac-tosidase to cotton rats resulted in expression of p-galactosi-dase in the airway epithelium (55). Numerous other animals have been used to demonstrate efficient adenovirus vector-mediated gene transfer, including rats, mice, pigs, rabbits, and nonhuman primates. From these studies, a number of general conclusions can be drawn. Importantly, many tissues can be infected based on the route of administration. As expected from the tropism of Ad5, the...

Common Symptoms Of Multiple Sclerosis

Double vision, another common symptom, is caused by plaques in the brainstem, the part of the brain directly above the spinal cord. Brainstem plaques may also cause vertigo, a sensation of spinning, or dizziness. The spinal cord is frequently affected by MS. Individuals sometimes experience a sharp, seemingly electrical sensation, called L'hermitte'ssign, when they flex their necks. Plaques in the spine can cause a variety of symptoms, including numbness, weakness, bowel or bladder difficulty, or gait imbalance. Plaques in the brainstem or higher levels of the brain can also cause these symptoms, but the hallmark of MS involvement in the spinal cord is simultaneous involvement of both the right and left sides of the body. In addition to muscle weakness, spasticity may also occur. This results when communication from the brain to the motor cells that directly control muscle movement in the spinal cord is interrupted and primitive spinal cord reflexes take over. Spastic weakness may...

How Is Multiple Sclerosis Diagnosed

None of the symptoms described so far occurs only in MS. Strokes, tumors, or infections can cause the same disabilities when they affect the same areas of the brain and spinal cord. Therefore, the diagnosis of MS requires the exclusion of other neurologic diseases. Diagnosing MS was a greater problem in the past, before physicians could produce sophisticated images of the brain and spinal cord and test other aspects of neurologic function. In the past, the diagnosis of MS relied primarily on a patient's medical history and a physical examination. Criteria for the diagnosis required at least two verified neurologic attacks, separated in time, and caused by damage in at least two different areas of the CNS. These criteria reflected the natural history of relapsing forms of MS. Progressive MS could be diagnosed, in the absence of another known neurologic condition, after a progressive worsening of neurologic symptoms over a six-month period. These criteria have been modified in light of...

What Are The Tests For Multiple Sclerosis

Magnetic Resonance Imaging (MRI) The most revolutionary advance in diagnosis of MS, as well as other diseases of the CNS, is imaging the brain and spinal cord by magnetic resonance. The MRI has revolu Evoked potentials are useful additions to other tests, particularly the MRI when the brain scan is normal. Although MRI scanning of the brain is very sensitive in detecting MS plaques, the technique is less precise in the spinal cord or optic nerve because they are smaller areas. visual evoked potentials may be particularly helpful when demyelination in the optic nerve is not yet sufficient to cause visual complaints by individuals. Cerebrospinal Fluid Examination Cerebrospinal fluid surrounds the brain and spinal cord and often reflects disease conditions in the CNS. in MS, certain abnormalities in the spinal fluid reflect the inflammatory nature of the disease. These abnormal In MS, the number of white blood cells in the spinal fluid may be mildly elevated, but a more characteristic...

Guidelines for Survivorship Care

In many situations, however, there is not even a plausible rationale to intensely monitor asymptomatic patients in order to find incurable distant recurrence. Conventional wisdom is that if cancer is caught early it can be cured, but unfortunately the same is usually not true of early detection of metastatic cancer. Second-look surgeries to detect recurrence of ovarian and pancreatic cancers have not been associated with improved outcomes because such recurrences are generally not curable.17 Moreover, early institution of palliative chemotherapy in asymptomatic patients does not appear to provide benefit in most situations.11,18 Detecting and preventing potentially catastrophic complications of recurrence like spinal cord compression and pathological fracture has been put forth as a rationale for surveillance in situations in which recurrences will always be incurable, but randomized trials have not been able to detect a benefit from this.19

What causes the inflammation in the plaque

(mostly CD4+ cells) monocytes (macrophages) from the blood stream usually cause inflammation in the nervous system. Cells and fluids in the blood are normally restricted from entering the nervous system by the blood-brain barrier. This is formed by endothelial cells lining the venules with tight junctions uniquely occurring in the brain and spinal cord. A second layer of foot processes from astrocytes (star-like cells) buttresses this barrier. In the process of inflammation, these WBCs eat holes through the lining of the smallest blood vessels (venules) and enter the nervous system. Lymphocytes and macrophages are not normally present in the nervous system. However, in some patients, a different type of immune reaction occurs

Potentials On The Neuron Surface

The membrane potential of the cell body is measured with a micro-electrode 0.2-0.5 ,j in diameter impaled in the cell, with an indifferent electrode at a remote point. The membrane potential is 60 mV for a pyramidal cell of the cat cerebral cortex (Phillips, 1955, 1956a, b), whereas it is somewhat larger (70 mV) for a spinal cord motor neuron in the same animal (Frank and Fuortes, 1955). The lowest membrane potential has been recorded in the ganglion cell of the snail (from 30 to 60 mV) (Tauc, 1954). The membrane potential of the axon in this

Water Soluble Vitamins

Folic acid is transported into brain as methylenete-trahydrofolic acid, the major form of folic acid in the circulation. It is then transported rapidly into neurons and glia from the CSF extracellular fluid. Once inside cells, folates are polyglutamated. Methylenetetrahydrofolate is used by neurons and glia in reactions involving single carbon groups, such as in the conversion of serine to glycine or homocysteine to methionine. Once methylenetetra-hydrofolate is consumed in these reactions, folic acid is transported out of the brain into the circulation. Folate has become an issue of neurologic concern because of a link between folate deficiency and abnormal CNS development. The incidence of spina bifida, a serious spinal cord abnormality, rises above the population mean in the children of women who are folate-deficient during pregnancy. Moreover, the incidence of spina bifida can be reduced by folic acid supplementation during pregnancy, beginning prior to conception. Initiating...

Excitatory And Inhibitory Synapses

It was assumed at one time that the postsynaptic potential in the neuron can be evoked both by chemical and by electrical stimulation. It was later shown that some types of peripheral synapses are not excitable electrically the electrical organ of several fishes (Grundfest, 1957a), the end plates of muscle (Castillo and Katz, 1956), and the smooth musculature of frogs (Kuffler and Vaughan-Williams, 1953). Electrical nonexcitability of the postsynaptic membrane was found in the apical dendrites of cortical neurons and in spinal cord motor neurons (Eccles et al., 1954). Many investigators are inclined to believe that electrical nonexcitability of the postsynaptic apparatus of the nerve cells and transmission of excitation from the axon to the nerve cell through a chemical transmitter released in the synapse, is a universal phenomenon.

Planning for procedures

Procedures are needed to make diagnoses, check for spread of disease, give treatment, and monitor response to treatment. Interventions range from figuring out the best way for your child to take numerous pills to having multiple spinal taps. Some procedures are pain-free, and the family merely needs clear explanations about what to expect. Other procedures can cause both physical and psychological distress. These reactions can be avoided or minimized by preparation, appropriate medications, and good coping skills. Parents can ask for the medical professional with the most experience to perform procedures, such as spinal taps. In the hospital hierarchy, attending physicians are above fellows and residents. However, at some large teaching facilities, attending physicians may not do these procedures very often. Many times, the fellow (and in some states where it is allowed, the nurse practioner) is more skilled, because they do the vast majority of these procedures. Katy and I wrote down...

Force and Stress on the Skeletal System

Some external forces are capable of causing injury during movement. Each time a person takes a step and the heel strikes the floor, a ground reaction force is transmitted through the whole body. As the speed of walking increases, so do the ground reaction forces, which leads to greater forces through the lower limb and an increased likelihood of injury. The human body has evolved mechanisms to attenuate the effects of ground reaction forces so that it is not damaged by their repeated occurrence. When the heel strikes the ground, the relatively soft heel pad on the sole of the foot absorbs some of the initial force. The knee flexes as the limb takes the load of the body, and this knee flexion movement, up to approximately 40 degrees, also has a shock absorption effect. Through small movements at the hip and spine, residual forces are further absorbed, which ensures that the effect of these forces is minimal by the time they reach the skull and brain. The healthy muscles are major...

Classification Of Potentials In The Cerebral Cortex By Their Duration

Slow local potentials spread decrementally and last about 10-30 msec. They generally arise in response to presynaptic excitation. The nature and classification of the rhythms of electrical activity were discussed in detail by Beritov (1948a) and Roitbak (1950, 1955), who showed that slow potentials in the spinal cord and brain may be connected with dendrite activity.

Hormones affecting renal function

ADH is formed in supraoptic and ventricular nuclei and secreted into cerebrospinal fluid the portal capillaries of the median eminence (which supply the anterior pituitary la the long p nal vein), and the posterior pituitary gland. ADH release is governed through osmoreceptors. Through the venous system of the pituitary gland ADH can then reach systemic circulation and act on kidney, blood vessels, and other tissues. ADH activates cAMI1-mediated signaling in epithelial cells of collecting tubules, thereby increasing water permeability of the apical membranes. ADH acts mainly by inducing the insertion of AQ2 into the luminal membrane of the ADH-sensitive collecting tubules. The increase in the number of these water-channels facilitates osmotic equilibration and water moves from the lumen into the more concentrated inlersti-tium. With an inadequate level of ADH, urine, for instance 111 old people, cannot be concentrated properly.

Prevention of Birth Defects

In the past ten years, there have been significant strides in understanding ways to prevent some birth defects. For example, a daily supplement to the diet of 500 micrograms of folic acid, a B vitamin, has been shown to prevent up to 70 percent of cases of neural tube defects. Neural tube defects, which include an-encephaly, spina bifida, and encephalocele, are serious and often lethal birth defects of the spine and central nervous system. The recognition that many of these birth defects can be prevented with folic acid has led to initiatives at the state and national levels aimed at educating women about the importance of consuming the appropriate amount of this vitamin on a daily basis. In 1996 the U.S. Food and Drug Administration issued a rule (effective January 1, 1998) requiring that all enriched grain products sold in the United States be fortified with 140 micrograms of folic acid per 100 grams of product. As a result of these public health initiatives, the rate of spina...

Your body during weeks 25 to

You're probably continuing to curve your lower spine backward to compensate for how your center of gravity has shifted under the weight of your baby. If you didn't do this, you might fall over. This change in posture puts a strain on your back muscles and ligaments, and it may be causing back pain.

Anatomical background

Cerebrospinal fluid (CSF). which bathes and internally suspends the brain and the spinal cord and conveys nutrients and waste products around the intracerebral space. The choroidal epithelial cells are polarized cells with a specialized complement of carriers and channels on the luminal and ablumina sides. The spaces between adjacent choroidal cells are sealed much less tightly than those between typical brain capillaries and allow significant movement of water, electrolytes and small molecules through them. Transport from blood into brain can thus follow the more circuitous route of secretion into CSF and later uptake into brain cells.

Cornerstone Significance

The cornerstone in your body frame is the spine. We don't think much about the spine since we cannot see it, like our teeth. For optimal health we need to focus on standing and sitting erect. Here is a tip. When standing, focus on holding your shoulders back. I encourage my patients to grasp their hands and place them in the small of their back. This will naturally position your shoulders behind a forward head alignment. Spinal breakdown is effortless erect posture requires energy.

Pain Management Through Surgery

Severe spasticity in the lower extremities can be associated with pain. In these cases, benefit may be obtained from an intrathecal (within the spine) baclofen pump, which delivers tiny doses of baclofen directly into the spinal fluid by a surgically implanted pump. Morphine can also be delivered this way. When there is spinal the spinal cord and In severe cases of pain, surgery can be performed to cut some of the spinal sensory nerves. Called partial posterior rhizoto-my, these surgical cuts are irreversible.

Stage 2 Facet joint arthropathy

As a disc at the front of the spine drops in height it causes overriding of the bone-to-bone junctions (called the facet joints) at the back of the spine. The upper vertebra settles down on the one below, causing bony rub between parts of the spine which should only have fleeting contact. Early on, this simply inflames the soft tissues around the facet joints but eventually it causes arthritic change as it erodes the cartilage covering the bone. Facet joint trouble also is a relatively common form of low-back pain.

Posture And Muscle Imbalance

Posture is the state of balance and coordination of musculoskeletal and visceral systems. Skeletal asymmetry is a major source of muscle strain inasmuch as compensatory muscular control is necessary to maintain a working posture and to keep the eyes level. For example, a length discrepancy between the lower limbs causes a chain reaction of muscular overloads of the entire musculoskeletal system. The tilted pelvis requires contraction of the quadra-tus lumborum muscle to curve the lumbar spine in order to bring the rest of the body over the pelvis. Consequently, the spine above is tilted to the other side. This tilt requires further compensation of neck muscles such as the sternocleidomastoid and upper trapezius. This sustained contraction and overload facilitates the development of trigger points inside the postural muscles, from gastrocnemius through soleus, adductors, iliotibial band, gluteus muscles, piriformis, iliopsoas, quadratus lumborum, muscles of the shoulder girdle,...

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...

Bit of History Step Climbing

Stair climbing, in the natural, is an excellent cardiovascular exercise for your heart and lungs. I encourage my patients to walk regularly. A stair-step machine is a valuable piece of equipment which strengthens your butt muscles and supports your spine and thigh muscles and will even tighten up painful weak knees.

Difference In Potentials Between Different Points And At Various Depths Of The Cerebral Cortex

Sechenov's work (1882) was a prerequisite of further elaboration of the problem of cerebral electrogenesis. Sechenov showed that excitation of the frog spinal cord in response to stimulation of nerves is associated with aperiodic negative current oscillation. His discovery of spontaneous periodic oscillations derived from the medulla oblongata was particularly important. A similar pattern of electrical phenomena in the brain and spinal cord was also noted by Vvedenskii (1884) and Verigo (1889).

Exerciseassociated Muscle Cramps

It was believed that muscle cramps were caused by disturbances in fluid and electrolyte balance, particularly sodium balance, in association with high rates of sweating, as is the case with heat cramps. This may be true for some exercise-associated muscle cramps, and more recent research suggests that these cramps result from sustained a-motor neuron activity, which is caused by aberrant control at the spinal level.10 Muscle fatigue appears to cause this lack of control through an effect on both Golgi tendon spindles and muscle spindles. Muscle spindle activity increases and tendon organ activity decreases.

The Effect of Experience on Brain Development

Neurons must travel from the spot where they are born to arrive at the particular region where they will be used in the mature brain. (Frank Lane Picture Agency Corbis) Spinal cord neurons. Neurons must travel from the spot where they are born to arrive at the particular region where they will be used in the mature brain. (Frank Lane Picture Agency Corbis)

Children and Adults with Attention Deficit Hyperactivity Disorder

Children's Brain Tumor Foundation, The A nonprofit organization established in 1988 by parents, physicians, and friends dedicated to improving the treatment, quality of life, and long-term outlook for children with brain and spinal cord tumors. The foundation funds research for basic, clinical, and psychosocial research on pediatric brain and spinal cord tumors and their consequences. If offers support services and a parent-to-parent network and publishes a free resource guide on pediatric brain and spinal cord tumors for families. The foundation also cosponsors conferences on pediatric brain tumors. (For contact information, see Appendix I.)

Why is PD called a movement disorder

Movement disorder is the term given to a broad category of problems that includes disorders of increased and decreased movement. Movement disorders can involve all parts of the nervous system the majority originate in the brain, although injuries or disorders of the spinal cord and peripheral nerves may also cause problems with movement. Diagnosing these disorders requires specialized training. Knowledge about the causes and mechanisms of movement disorders is growing rapidly, as are advances in treatment. Recent developments have added to the understanding of genetic abnormalities and are also revealing some of the causes of specific movement

Precipitating Events and the Possible Role of Central Sensitization

Scientists know that a local injury resulting from trauma can lead to lingering pain. Pain that lasts for weeks, months, or years is termed chronic pain and is accompanied by changes in the chemical and anatomical makeup of the brain and spinal cord. Chronic pain that goes untreated can increase in intensity and spread from an original site to body areas that weren't previously affected, further damaging health and functioning. At that point, chronic pain becomes a disorder in itself. Why this happens in some people and not others is unclear, although genetics may play a role. What is certain is that sometimes an injury will lead to a constellation of changes, including an elevation of spontaneous CNS firing, an increase in pain response level and length, and a decrease of pain threshold. These are the changes collectively termed central sensitization, and they appear to be fundamental to the pain sensitivity that defines chronic pain.

Hostpathogen factors that influence the effectiveness of antimicrobial therapy

Other recognized host factors include the site of infection. Site-specific effectiveness of the host immune response and penetration of antimicrobial agents into the site are two factors related to the site of infection. These factors are nicely illustrated by pneumococcal meningitis 17 . Pneumococcal meningitis, unlike pneumococcal pneumonia, has a mortality approaching 100 if untreated. Antimicrobial therapy of pneumococcal meningitis has reduced the mortality to 30 18 . Early in the antimicrobial era, the necessity of using a bactericidal agent such as penicillin versus a bacteristatic agent such as tetracycline for the therapy of pneumococcal meningitis readily became apparent. In addition, the problem of antimicrobial penetration into the central nervous system (CNS) was appreciated. Specifically, this was and remains an issue of the concentration of antibiotic in the CNS being sufficient to kill the pneumococcus. Newer cephalosporins were more active against pneumococci and were...

Pharmacological Management Of Chronic Pain

Other medications used in the treatment of chronic pain include antidepressants and anticon-vulsants. Nerve blocks, injection of anesthetics into trigger points, or injection of steroids into the epi-dural space of the spinal cord may also be utilized. Implantable methods are utilized as treatments of last resort. These methods involve implanting drug delivery systems or electrodes into specific areas of the spinal cord.

The Cesarean Operation

The cesarean operation, which usually takes from thirty to sixty minutes, begins with the administration of anesthesia by use of intravenous and inhaled anesthetic agents (general anesthesia) or the injection of anesthetic medications into the spinal canal (spinal anesthesia) or just outside of the spinal canal (epidu-ral anesthesia). The skin of the abdomen is cleansed with antiseptic solution and surgical drapes are placed to maintain a sterile operating field during the procedure. An incision is made in the abdomen, after which a second incision is made in the uterus (womb) that is large enough to permit removal of the baby. The umbilical cord is clamped and cut, and the infant is handed to a nurse or doctor assigned specifically to care for the infant. The placenta (afterbirth) is then delivered through the same incisions. The incisions are closed with sutures (stitches) or other types of wound-closure devices. The expense of a cesarean birth is about two to three times that of a...

Susceptibility testing and the clinical microbiology laboratory

Moreover, any susceptibility testing method used must be accurate, reliable, and provide clinically relevant results. A number of important examples of these varied methods are as follows. Glycopeptide-intermediate S aureus can be detected by a screening method using vancomycin-containing brain-heart infusion agar followed by confirmation by broth microdilution testing 40 . Similar screening methods have been developed to detect vancomycin resistance in enterococci 41 and such active surveillance has been shown to reduce the incidence of vancomycin-resistant enterococcal bacteremia 42 . The susceptibility testing of Streptococcus pneumoniae has similarly evolved in the past 2 decades from no susceptibility testing at all to a screening process that only looked for penicillin resistance 43 to susceptibility testing of multiple antimicrobial agents 44 that uses specific penicillin breakpoints for pneumococcal isolates from cerebral spinal fluid 45 ....

Stage 3 The acute locked back

This is a fluke incident when you are caught off-guard by a movement with pain like an electric cleaver going through your back. The body locks itself rigid and moving in any direction is excruciating. Although there never appears to be any warning, the problem usually has its origins in lack of hydrostatic pressure caused by incipient disc breakdown and corresponding weakness of the local deep spinal muscles. All spines, even healthy ones, must brace themselves as they pass through a vulnerable part of range at the beginning of a bending movement. If a disc between two vertebrae has flattened through the degenerative process, it may be unable to generate sufficient springingapart tension to keep its segments stable as the spine goes over. The top vertebra can imperceptibly slip askew or mis-joint at one of the facets, and the muscles go into instantaneous protective spasm to stop the slippage going further.

Cerebrovascular Effects

While reports of major cerebrovascular complications accompanying heroin use are rare, several case reports have documented vascular effects of the drug. White matter demyelination was found in two chronic heroin abusers, and was attributed to vascular pathology (Volkow et al., 1988b). A case of anterior choroidal artery infarction was reported in a heroin abuser who sniffed the drug (Bartolomei et al., 1992). Heroin snorting has also been associated with the development of globus pallidus infarcts (Benassi et al., 1996 Zuckerman et al., 1996). Vila and Chamorro reported two cases of basal ganglia ischemic strokes associated with intravenous heroin administration (Vila and Chamorro, 1997). In both cases, patients demonstrated ballistic movements, yet the subthalamic nuclei were spared, an unusual finding in cases of vascular ballism (Vila and Chamorro, 1997). Additional cases of basal ganglia infarctions in heroin abusers have been reported along with a single case of thoracic spinal...

What causes walking difficulty in MS

Difficulty with walking in MS can result from plaques in different places in the brain stem and spinal cord. The location of the plaques determines, in large part, whether that difficulty is due to the particular problems of weakness, loss of sensation, or incoordination of the legs. In certain places in the brain and spinal cord, plaques can produce weakness those in the back part of the spinal cord cause certain kinds of sensation loss (position sense) others in the cerebellum and its connections lead to incoordination in the legs. Any or all of these disturbances can contribute to gait difficulty. The most common problem that causes difficulty in walking is weakness. When a patient complains of weakness, he or she is often describing one of several different problems. Muscle weakness in nervous system disease is often the result of messages not getting to the muscles from the brain and spinal cord. A signal or message may begin in the brain (the precentral or motor area of the...

Juvenile Ankylosing Spondylitis And Ankylosing Spondylitis

Virtually all adult men with ankylosing spondylitis (AS), which is chronic inflammation of the spine and sacroiliac joints, are positive for the genetic marker HLA B27 positive, but we do not know how many boys who are positive for HLA B27 will never develop AS. Most individuals with AS do not fulfill criteria for the diagnosis until after they reach thirty years of age, and it is difficult to keep track of HLA B27 positive teenagers for the fifteen years or more of follow-up needed to answer that question. Therefore, I do not recommend diagnosing every boy who is positive for HLA B27 and has a spondyloarthropathy as having juvenile ankylosing spondylitis (JAS). Not only does it cause undue worry for many parents, but it may also make life and health insurance difficult to obtain. Although some will develop AS, not all will, and labeling them is unnecessary. However, an HLA B27 positive boy who has swollen joints and an elevated sedimentation rate is at risk of progressing to definite...

Addressing Cognitive Problems

Multiple sclerosis (MS) is a disease that affects both the body and the mind. It causes damage to tissue in both the brain and the spinal cord. When it affects the brain, MS is highly likely to affect cognition. Cognition includes high-level functions carried out by the human brain, including comprehension and use of speech, visual perception and construction, calculation ability, attention (information processing), memory, and executive functions such as planning, problem-solving, and self-monitoring.

Manipulative and Body Based Methods

Chiropractic medicine stems from the work of David Daniel Palmer, who in the late 1800s came to believe that abnormal nerve function could cause illness. He theorized that spinal manipulation could improve a person's health. Palmer's ideas were not well received in the medical community, and some early chiropractors, including Palmer, were imprisoned. Thus began a long and often contentious relationship between conventional doctors and chiropractors. In the 1970s, the American Medical Association (which represents medical doctors) was successfully sued by chiropractors for bias in an antitrust case. Chiropractors now attend accredited colleges and have national guidelines and standards that they must adhere to. Chiropractors are not the same as osteopaths, however they do not have the same training or privileges (for example, to prescribe medications) that medical doctors and osteopaths share. mon, risks associated with manipulation of the spine or other body parts. All manipulation...

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).

Clinical Manifestations

Other clinical and laboratory features that may accompany the systemic vasculitis of KD include arthralgia and arthritis, hydrops of the gallbladder with associated abdominal pain and elevated g glutamyltranspeptidase, sterile pyuria, anterior uveitis, meningitis with cerebrospinal fluid (CSF) pleocytosis and irritability, and sensorineural hearing loss (26,46,47). Case reports from the United States and Japan have documented 20 patients

Neural Induction and Neurulation

At stage 5, the first formation of the head process becomes apparent. It is a short aggregation of mesoderm directly anterior to the node and continuous with prechordal mesoderm, and it derives from the deep part of the node (primitive pit). The head process condenses to form the notochord, which is readily apparent anterior to the node as the latter starts to regress at subsequent stages. The first pair of somites condense either side of the notochord at HH stage 7, and these, and the subsequent four pairs, lie beneath part of the neural plate fated to form the hind-brain. The remainder underlie prospective spinal cord. The cardiac primordium begins to form at the anterior end of the embryo at HH stage 8 (four somites). Neural tube closure (neurulation) begins at stage 8 at the level of the mid-brain and extends both anteriorly and posteriorly. Closure at the rostral extremity (anterior neuropore) is complete by stage 10, whereas the posterior neuropore remains open until the tail...

Electrophysiology Of Acureflex Points

The author discovered similar electrical activity in response to peripheral pain in the neurons of the spinal cord and mid-brain (periaqueductal gray matter) in rats. In normal tissues, the neurons in the spinal cord and the periaqueductal gray matter are silent. When pain or inflammation is present in the muscles, the spikes and spontaneous electrical activity appear in both the spinal cord and the

What is chronic progressive MS

SpinalMS a disease in which the disks between the vertebral bodies in the neck extrude like mortar between bricks. Sometimes the disks will compress the spinal cord, producing MS-like symptoms of weakness and loss of sensation in the legs. The disease process can result in pressure on nerve roots as they leave the spinal canal, resulting in weakness and or pain in the arms and hands.

Multiple System Atrophy

MSA refers to a neurodegenerative disease characterized by parkinsonism, cerebellar ataxia, and orthostatic hypotension (31). There is no known genetic risk factor or genetic locus in MSA. The MSA brain shows varying degrees of atrophy of the cerebellum, cerebellar peduncles, pons and medulla, as well as atrophy and discoloration of the posterolateral putamen and pigment loss in the substantia nigra. The histopathological findings include neuronal loss, gliosis, and microvacuolation, involving the putamen, substantia nigra, cerebellum, olivary nucleus, pontine base, and intermediolateral cell column of the spinal cord. White matter inevitably shows demyelination, with the brunt of the changes affecting white matter tracts in the cerebellum and pons (Fig. 3).

Who gets progressive disease without attacks

In France, Charcot first described the spinal form (primary progressive MS) as an incomplete form of MS, occurring in about 10 of patients. Subsequently, this form of illness was recognized as occurring in about 30 of Irish patients and later still as occurring in about 30 of the European Jews in Israel. Primary progressive illness also appears to be more common in Spain and in patients of Spanish descent, including Cubans, who live in the United States. Several other disorders must be distinguished from primary progressive MS. The most common of these is cervical spondylosis (compression of the spinal cord because of disc disease). Although people fear spinal cord tumors, only a tiny percentage (about 1 ) of patients will be diagnosed as having a spinal cord tumor.

Pathophysiologic mechanisms

As stated previously, the response of the body to maintain its stability in the face of a challenge (eg, infection or an instable social situation) comprises the allostatic response. The brain plays a pivotal role in the maintenance of body homeostasis 23 . For this purpose the brain has two avenues of communication hormones and neurons. The sensory organs inform the brain about the external environment. The state of the internal environment is reported to the spinal cord and brain stem through feedback from virtually all organs 24 . In addition, the brain integrates information about circulating hormone and substrate availability through receptors located in areas where the blood-brain barrier allows this information to be passed to the brain. Processing of internal and external stress stimuli results

The vertebral movements

The movements of the vertebrae in the spine are a combination of gliding, tipping and twisting, although each one individually contributes only a small degree. Superimposed one on one however, the net result is the grandiose wide-ranging mobility of the spine, which is so well known to us. From our towering height we can arch backwards under a limbo bar and bend over to cut our toenails. Well, some of us can. The right amount of vertebral glide is important it is what healthy backs have. Too little or too much glide leads to trouble. If a segment has too little it will be stiff. And significantly, when the degenerative process sets in, it is the first movement to go. Although you cannot necessarily see it first you only feel it this lack of background movement makes your spine feel tighter more restricted and laboured in everything it does. In short it makes you feel rigid and older than you are. At the other extreme, a vertebral segment is unstable if it has too much glide. It comes...

Do all people with MS become disabled

Some neurologists, many in academic circles, have a perception that MS is predictably associated with disability. Before the advent of new testing procedures, particularly MRI of the brain and spinal cord, many patients were not diagnosed during life. Without proven treatments, there was little incentive to do so in those without disability. The training of many more

Genesis of Hand Preference

Another theory suggests that the fetus in its mother's womb is more likely to be in a position where its left arm and hand are toward the mother's spine and thus have less freedom to move than does the right arm. This gives the right hand-left brain an advantage that increases as the child matures. The problem with this theory is that it cannot account for the observation that the position of the fetus in the womb is not random and again this theory will have little explanatory value for the relationship between hand preference and creativity. Deftness is defined as the ability to make fine, precise, and independent finger movements. Although the term dexterity is also used for these abilities, this word derives from the word dextral, which pertains to the right hand or right side, and many people are more deft with their left hand than with their right. Nonhuman primates, such as old world are very deft, and Lawrence and Kuypers (1968) found that in monkeys, injury to the...

Prevention of Transmission of BSE from Cattle to Humans

Mechanically recovered meat (MRM or mechanically separated meat, MSM) was derived from the flesh-bearing bones and carcass remnants of cattle, sheep, pigs and poultry. During the early 1960 s automated high-pressure devices were developed whereby residual material, which was difficult to remove by hand, could be removed from bones and carcasses in a puree form. The vertebral column was often used for the production of MRM and this resulted in the risk of cross contamination of MRM by spinal cord and dorsal root ganglia which potentially contained high titres of BSE infectivity. MRM was used in the preparation of various meat products, including economy burgers, sausages, meat pies, soups, some baby foods and prepared meals (www.bseinquiry.gov.uk). In 1995 the United Kingdom banned the use of cattle vertebral column in MRM. This ban was extended in 1998 in the United Kingdom to cover the vertebral column of all grazing animals. The production of MRM from all ruminant bones was...

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...

Analysis of the Grafts

A growing number of species-specific nucleic probes can be used on sections or whole-mount preparations. As examples, the use of a chick probe of the homeobox gene goosecoid has demonstrated the induction of this gene in a chick in which goosecoid-producing tissues had been grafted (40). The quail specific SMP (Schwann cell myelin protein) probe (41) allows quail oligodendrocytes in chimeric spinal cord to be distinguished (15) (Fig. 1C). Chick Wntl and quail Wntl probes have been combined to demonstrate the induction of Wntl in quail-chick chimeras (42).

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