经椎弓根椎体截骨术治疗脊柱后凸畸形的临床疗效观察

目的：探讨经椎弓根椎体截骨脊柱缩短术治疗并发脊髓神经功能障碍的脊柱后凸畸形的临床疗效。方法将2013年5月至2014年6月期间我院收治的80例并发脊髓神经功能障碍的脊柱后凸畸形患者纳入研究对象,采用随机数字表法分为观察组和对照组各40例,观察组患者接受经椎弓根椎体截骨术治疗,对照组患者接受经椎板和小关节突截骨术,比较2组患者手术情况、椎体愈合和神经功能恢复、治疗效果。结果观察组患者手术时间[(76.52±9.1) min]、术后下床活动时间[(3.28±0.43) d]短于对照组[(113.46±13.44) min,(5.67±0.68) d],术中出血量[(36.14±4.28) mL]、术后引流量[(17.92±2.12) mL]少于对照组[(55.23±7.15) mL,(29.64±4.28) mL]。观察组患者的Cobb角、出现初始尿意和强烈尿意时的膀胱容量[(6.12±0.68) mL,(456.56±51.78) mL]、残余尿量[(241.45±28.56) mL,(63.78±7.24) mL]低于对照组[(9.78±1.21) mL,(335.54±36.86) mL,(586.35±63.12) mL,(96.32±10.22) mL],椎间隙高度[(12.62±2.81) mL]高于对照组[(8.41±1.32) mm]。观察组治疗优良率(97.50%)明显高于对照组(82.50%)。结论经椎弓根椎体截骨脊柱缩短术治疗有助于减小手术创伤,促进术后恢复,纠正后凸畸形,改善神经功能,提高治疗效果。     

A rare case of extramedullary spinal cord germinoma

A rare case of spinal cord germinoma in a 20-year-old Japanese female is presented. The tumor was detected at the level of T11 and L3 by myelography. Histological findings of the resected tumor were identical to germinoma, which is characterized by polygonal tumor cells, lymphocytic infiltrate, and granuloma. Tumor cells and lymphocytes reacted with antibodies for placental alkaline phosphatase and CD45, respectively. A few multinucleated giant cells, negative immunohistochemically for human chorionic gonadotropin were also seen. The present case is the 10th case of spinal cord germinoma and is thought to be the first case of such a tumor located extramedullary. Diagnosis of such a rare tumor in an unusual location needs proper histological, ultrastructural and immunohistochemical evaluation.     

Electromyographic assessment of damage to the injured spinal cord

The possibility of assessing the degree of damage to the spinal cord by electromyography in the early stage of treatment was demonstrated. The following indices obtained during attempts at movement are evidence of the absence of anatomical loss of continuity of the spinal cord: 1) in the case of injury at level D₅–D₁₀, absence of delay in activation of the lower segments of the long muscles of the trunk compared with their upper segments; 2) in the case of trauma at the level D₁₀-L₁, the presence of activity in the thigh and leg muscles, even if recordable only as single potentials of low amplitude; 3) whatever the level of trauma, the appearance of activity in symmetrical muscles of one lower limb during the attempt to move the opposite limb. In most cases, even if only one index is positive, the patient's motor functions will be restored by restitution.Material for this work was obtained by periodic examination of patients under treatment by Dr. A. N. Trankvillitati, Honored Physician of the RSFSR. Neurological examinations in the course of the investigation were made by Candidate of Medical Sciences L. S. Goncharova.Institute of Higher Nervous Activity and Neurophysiology, Academy of Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR A. A. Vishnevskii.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 80, No. 10, pp. 25–29, October, 1975.     

Bronchogenic cyst of the conus medullaris with spinal cord tethering: a case report and review of the literature

Bronchogenic cysts (BCs) are congenital malformations that originate from remnants of the primitive foregut. Intraspinal BCs, especially those of the conus medullaris are rare with only one case reported until now. To date, a bronchogenic cyst with spinal cord tethering has not been previously reported. We reviewed the clinical course of a 44-year-old woman, who presented with low back pain and leg weaknesss as well as sphincter disturbance. Magnetic resonance imaging showed an intradural oval mass located at the conus medullaris. A tethered cord was also observed, as well as a dermal sinus tract. The mass was totally removed after an L3-L4 laminectomy without detethering during operation. Pathologic examination confirmed the diagnosis of bronchogenic cyst. By six months after treatment, the patient had experienced nearly complete recovery. The review of literature indicated that detethering was performed in most reported cases of neurenteric cysts with spinal cord tethering, and one of six patients was diagnosed with a postoperative recurrence. The co-existence of bronchogenic cyst and a tethered spinal cord would imply associated developmental errors in embryogenesis. It is worth noting that whether detethering is necessary after the cyst removal.     

大鼠脊髓星形胶质细胞培养方法的改良

目的:改进大鼠脊髓星形胶质细胞的体外培养方法,为研究脊髓星形胶质细胞的生物学作用及脊髓相关疾病提供实验模型.方法:新生1～2d的SD乳鼠,无菌操作下游离整段脊柱,将脊髓从椎管中冲出,机械吹打制成单细胞悬液,差速黏附处理以去除成纤维细胞成分.利用GFAP免疫荧光显色对培养细胞进行鉴定.结果:经原代和传代培养,获得的星形胶质细胞纯化率高达99%以上.结论:采用本实验室改进的方法,操作简便快捷,培养的大鼠脊髓星形胶质细胞生长良好,纯度高,为后续实验对脊髓星形胶质细胞的生物学作用研究奠定实验基础.     

大鼠新型挫伤型脊髓损伤模型的建立及评价

目的:制备新型挫伤型脊髓损伤大鼠模型,通过行为学评分和形态学方法进行评价,为进一步研究脊髓损伤的机制及早期治疗提供依据。方法:SD大鼠随机分为对照组和实验组,对照组(A组)采用改良的Allen法制备急性脊髓挫伤模型,实验组在打击的基础上分别受压3s(B组)、5s(C组)和10s(D组),制备新型挫伤型脊髓损伤模型;各组分别于术后1、3、7、14、21d观察其行为学评分和病理学改变;免疫组织化学方法检测促炎因子高迁移率族蛋白B1(HMGB1)在各组不同时间点的表达变化。结果:实验组各时间点BBB评分和损伤程度与对照组比较均有显著差异(P0.05),其中A组和B组术后损伤程度差别微小;C组后肢运动功能障碍明显,脊髓损伤区域出现典型的病理改变;D组损伤最严重,死亡率高。HMGB1表达以损伤C组为典型代表,术后阳性表达明显增多,第3d达高峰,主要表达部位为神经元胞浆和神经胶质细胞核内。结论:采用改良Allen法打击再受压5s制备的脊髓损伤模型能很好地模拟临床实际,且稳定性高、可复制性好,为一种新型挫伤型脊髓损伤模型。     

Functional recovery of stepping in rats after a complete neonatal spinal cord transection is not due to regrowth across the lesion site

Rats receiving a complete spinal cord transection (ST) at a neonatal stage spontaneously can recover significant stepping ability, whereas minimal recovery is attained in rats transected as adults. In addition, neonatally spinal cord transected rats trained to step more readily improve their locomotor ability. We hypothesized that recovery of stepping in rats receiving a complete spinal cord transection at postnatal day 5 (P5) is attributable to changes in the lumbosacral neural circuitry and not to regeneration of axons across the lesion. As expected, stepping performance measured by several kinematics parameters was significantly better in ST (at P5) trained (treadmill stepping for 8 weeks) than age-matched non-trained spinal rats. Anterograde tracing with biotinylated dextran amine showed an absence of labeling of corticospinal or rubrospinal tract axons below the transection. Retrograde tracing with Fast Blue from the spinal cord below the transection showed no labeled neurons in the somatosensory motor cortex of the hindlimb area, red nucleus, spinal vestibular nucleus, and medullary reticular nucleus. Retrograde labeling transsynaptically via injection of pseudorabies virus (Bartha) into the soleus and tibialis anterior muscles showed no labeling in the same brain nuclei. Furthermore, re-transection of the spinal cord at or rostral to the original transection did not affect stepping ability. Combined, these results clearly indicate that there was no regeneration across the lesion after a complete spinal cord transection in neonatal rats and suggest that this is an important model to understand the higher level of locomotor recovery in rats attributable to lumbosacral mechanisms after receiving a complete ST at a neonatal compared to an adult stage.     

A double-labelling study of reticular collaterals to the spinal cord and cerebellum of the North American opossum

Injections of horseradish peroxidase into either the spinal cord or cerebellum label neurons in the gigantocellular and lateral reticular nuclei of the North American opossum. In order to determine if neurons which project to the spinal cord and cerebellum are intermingled in these two nuclei and if single neurons provide collaterals to both areas, we have employed fluorescent markers in double-labelling experiments. Our results show that reticular neurons innervating either the spinal cord or cerebellum are often close together and that a few provide collaterals to both areas. Neurons providing such collaterals are rare, however, comprising 2% or less of those innervating either target alone.     

大脑和脊髓原始神经外胚叶肿瘤临床病理学

目的：探讨原发于大脑和脊髓原始神经外胚叶肿瘤的临床病理特征、组织学发生及生物学行为。方法：采用组织病理学、免疫组化标记和电镜观察对１１例原发于大脑及脊髓的原始神经外胚叶肿瘤进行研究。结果：组织学特征为弥漫原始的小细胞,并形成Ｈｏｍｅｒ－Ｗｒｉｇｈｔ菊形团和明显的纤维组织分隔成小叶。免疫组化标记：ＮＳＥ阳性,Ｓｙｎ阳性,部分瘤组织中散在ＧＦＡＰ阳性。电镜：瘤细胞胞浆内可见致密核心的分泌颗粒。结论：该     

Metastatic prostatic adenocarcinoma to the brain and spinal cord: a contemporary clinicopathologic analysis of 30 cases

Metastatic prostatic adenocarcinoma (PCa) to lymph nodes and bone is well documented in the literature, however only case reports and small series of metastatic PCa to the brain and spinal cord with clinicopathologic analysis have been published. We identified 30 cases of metastatic PCa to the brain and spinal cord. The mean patient age was 67 years (range: 50 to 87 years). Thirteen (43%) cases involved the brain and 17 (57%) cases involved the spinal cord. Most of the cases (60%) were a single mass. Of the 13 cases involving the brain, the temporal lobe 6 (46%) was the most common site and the spinal cord lesions involved the thoracic region in 13/17 (76%) cases. All patients had one or more metastases to other organs. In 8 patients, the brain or spinal cord metastasis was the initial diagnosis of PCa. In the patients that had prior prostate biopsy specimens available, the Gleason score ranged from 3+3=6 (Grade group 1: indicating unsampled higher grade PCa) to Gleason score 4+5=9 (Grade group 5). Follow-up was available in 21 cases with a mean duration of 20 months (range: 1 to 130 months). This is one of the largest clinicopathologic studies to date of metastatic PCa to the brain and spinal cord. Although rare, metastatic PCa should be considered in the differential diagnosis of a solitary brain or spinal cord mass in male patients, even over a decade after the initial diagnosis of PCa.     

Cellular and molecular alterations in spinal cord injury patients with pressure ulcers: a preliminary report

The study was designed to investigate the changes, both numerically and functionally, of the molecules critical to wound healing in spinal cord injury (SCI) patients. Spinal cord injury patients who demonstrated delayed healing of their pressure ulcers were used as study subjects. Age-matched healthy individuals served as controls. Adhesion molecule expression of the peripheral blood leukocytes, including lymphocytes and granulocytes, was measured by flow cytometric analysis. Binding capacity of the lymphocytes was evaluated using human umbilical cord vein endothelial cells (HUVECs) as the binding matrix. Samples from pressure ulcers of the patients were immunostained to define fibronectin, kalinin, beta4 integrin, alpha2beta1, alpha3beta1, alpha5beta1, and CD138 expression. Compared to healthy controls, there was decreased expression of CD11a, CD11b, CD18, CD49b, CD49c, CD49d, CD54, and CD8 in patients' lymphocyte populations and CD11a, CD18, CD49c, CD49d, and CD8 in patients' granulocyte populations. The binding capacity, expressed as percentage binding of the lymphocytes to the HUVEC matrix, was greatly diminished in the patients. There was markedly diminished immunohistochemical staining of fibronectin in pressure ulcers. These findings showed that delayed healing of pressure ulcers in SCI patients can be attributed to reduced adhesion molecule expression, impaired cell-cell interaction, and lack of extracellular matrix structural and functional protein.     

Reduction of CAG expansions in cerebellar cortex and spinal cord of DRPLA

Recent studies have identified an unstable expansion of a CAG repeat in a gene located on chromosome 12 as a cause of dentatorubropallidoluysian atrophy (DRPLA). To investigate whether the somatic heterogeneity may relate to the selective neuronal damage caused by the disease, genomic DNA from various tissues of an autopsied patient with DRPLA was examined to compare possible variations of expanded CAG repeats for the disease. Although the size of the expanded CAG repeat from many organs was almost the same as that from peripheral lymphocytes, those from cerebellar cortex and spinal cord were unexpectedly reduced and numbers of peaks within an expanded allele were relatively strict. These results suggest that the CAG repeat is not simply expanded in the genome of the tissues that are most involved in DRPLA, but that another mechanism might be responsible for the specific neuronal death.     

Kainate and metabolic perturbation mimicking spinal injury differentially contribute to early damage of locomotor networks in the in vitro neonatal rat spinal cord

Acute spinal cord injury evolves rapidly to produce secondary damage even to initially spared areas. The result is loss of locomotion, rarely reversible in man. It is, therefore, important to understand the early pathophysiological processes which affect spinal locomotor networks. Regardless of their etiology, spinal lesions are believed to include combinatorial effects of excitotoxicity and severe stroke-like metabolic perturbations. To clarify the relative contribution by excitotoxicity and toxic metabolites to dysfunction of locomotor networks, spinal reflexes and intrinsic network rhythmicity, we used, as a model, the in vitro thoraco-lumbar spinal cord of the neonatal rat treated (1 h) with either kainate or a pathological medium (containing free radicals and hypoxic/aglycemic conditions), or their combination. After washout, electrophysiological responses were monitored for 24 h and cell damage analyzed histologically. Kainate suppressed fictive locomotion irreversibly, while it reversibly blocked neuronal excitability and intrinsic bursting induced by synaptic inhibition block. This result was associated with significant neuronal loss around the central canal. Combining kainate with the pathological medium evoked extensive, irreversible damage to the spinal cord. The pathological medium alone slowed down fictive locomotion and intrinsic bursting: these oscillatory patterns remained throughout without regaining their control properties. This phenomenon was associated with polysynaptic reflex depression and preferential damage to glial cells, while neurons were comparatively spared. Our model suggests distinct roles of excitotoxicity and metabolic dysfunction in the acute damage of locomotor networks, indicating that different strategies might be necessary to treat the various early components of acute spinal cord lesion.     

结扎数支肋间后动脉对胸腰段脊髓血供影响

目的：探讨在脊柱侧凸前人路手术中结扎第7～11肋间后动脉对脊髓血供的影响。方法：将11例14～50岁、无严重心血管疾病和中枢神经系统无损伤的新鲜尸体随机分在A组(不手术)、B组和C组(分别结扎左侧和双侧第7～11肋间后动脉起始部)，全身墨汁福尔马林灌注，取T5～L1段脊髓作250μm连续冰冻切片，镜下观察和拍照，并进行测量和统计分析。结果：C组标本的节段间血管数及血管密度有显著性差异；A组与B组及A组与C组某些节段的血管数或／和血管密度存在差异。结论：胸腰段脊髓的血供不存在节段间差异，双侧结扎第7～11肋间后动脉起始段对脊髓血供影响较大，单侧结扎第7～11肋间后动脉起始段对胸腰段脊髓血供有影响。     

诱导多功能干细胞治疗脊髓损伤的现状及思考

背景：目前对脊髓损伤的治疗方法有激素冲击治疗,急诊手术减压及最新发展的干细胞治疗等方法。已有大量工作聚焦于干细胞治疗脊髓损伤的研究方面,并已成为热点。 目的：综述诱导多功能干细胞治疗脊髓损伤的相关研究现状及未来发展趋势。 方法：应用计算机检索PubMed 数据库1980年1月至2012年12 月期间的相关文章,检索关键词为“spine injury,induced pluripotent stem cells,IPS”。 结果与结论：共纳入35篇文章,均就诱导多能干细胞治疗脊髓损伤持赞同或支持态度。结果表明,诱导多功能干细胞直接来源于自体分离得到,解决了干细胞移植中伦理以及道德等问题,同时避免了异体排斥反应也为移植提供了大量的细胞来源。对于脊髓损伤的治疗方面目前只有动物实验及少量临床实验支持,但其在动物实验中效果良好,安全性较高。诱导多功能干细胞治疗脊髓损伤现存的问题主要是诱导多功能干细胞的诱导分化方法不成熟,并发症也较多。因此,诱导多功能干细胞的诱导分化及使用安全性将成为研究关键。     

Anatomical relationship and positions of the lumbar and sacral segments of the spinal cord according to the vertebral bodies and the spinal roots

Segments of the spinal cord generally do not correspond to the respective vertebral level and there are many anatomical variations in terms of the segment and the level of vertebra. The aim of this study is to investigate the variations and levels of lumbar and sacral spinal cord segments with reference to the axilla of the T11, T12, and L1 spinal nerve roots and adjacent vertebrae. Morphometric measurements were made on 16 formalin fixed adult cadaveric spinal cords. We observed termination of the spinal cord between the axilla of the L1 and L2 spinal nerve roots in 15 specimens (93.8%). In all cadavers the emergence of the T11, T12, and the L1 spinal nerve roots was at the level of the lower one‐third of the same vertebral body. In 15 specimens (93.8%), the beginning of the lumbar spinal cord segment was found to be above the T11 spinal nerve root axilla and corresponded to the upper one‐third of the T11 vertebral body. The beginning of the sacral spinal cord segment occurred above the L1 spinal nerve root axilla and corresponded to the upper one‐third of the L1 vertebral body. The results of this study showed that when the conus medullaris is located at the L1–L2 level, the beginning of the lumbar spinal cord segment always corresponds to the body of T11 vertebra. This study provides detailed information about the correspondence of the spinal cord segments with reference to the axilla of the spinal nerve roots. Clin. Anat. 27:227–233, 2014. © 2013 Wiley Periodicals, Inc.     

Vertebral level of the ending of the spinal cord and its relationship to the length of the vertebral column in Northern Turkish neonates

Summary Racial and sex differences in the level of ending of the spinal cord of the adult have been reported. It is lower in Africans and in females. Since such differences may affect even fetuses and newborns we aimed to study in Northern Turkish neonates. The study was made on 40 full-term newborn still-births (23 male, 17 female). In all cases, the length of the vertebral column, the length of the spinal cord and the body weight were measured and the vertebral level of ending of the spinal cord was noted. It was found that the termination of the spinal cord varied from the first lumbar to the second sacral vertebra, with a mean level between L2 and L3. In female neonates, it was observed that the spinal cord ended at a slightly lower level (0.2 vertebra) than in males. Our findings approximately agreed with those of Barson [2] who studied neonates in England and of Jit and Charnalia [5] in North India. However, we found that the spinal cord ended one and half vertebrae lower in Northern Turkish neonates than in South African and South Indian subjects. The correlations between body-weight and length of the spinal cord, weight and length of the vertebral column, length of the spinal cord and length of vertebral column, length of the vertebral column and level of ending of the cord were statistically highly significant for males, females and both sexes together (p<0.001). The longer the vertebral column, the higher the termination of the spinal cord.

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Niveau vertébral de la terminaison de la moelle épinière et sa relation avec la longueur de la colonne vertébrale chez le nouveau-né en Turquie du Nord

Résumé Selon la race et le sexe, les différences de niveau de la terminaison de la moelle épinière ont été rapportées chez l'adulte. Elle est plus basse chez les Africains et chez les femmes. Dès lors il se peut qu'il existe déjà des différences raciales et selon le sexe, chez le foetus et le nouveau-né. Nous nous proposons d'étudier une population de nouveau-nés du Nord de la Turquie. Cette étude est faite à partir de 40 nouveau-nés à terme, décèdes (23 garçons et 17 filles). Chez tous ces nouveau-nés, la longueur de la colonne vertébrale, la longueur de la moelle épinière et le poids ont été mesurés. Le niveau vertébral de la terminaison de la moelle épinière variait entre la première vertèbre lombaire et la deuxième vertèbre sacrée. Le niveau moyen de cette terminaison était situé entre L2 et L3. Chez les filles nouveau-nés, il était observé que la moelle épinière se terminait légèrement plus bas (0,2 vertèbre) que chez les garçons nouveaunés. Nos observations rejoignent celles de Barson [2] qui étudia des nouveaunés d'Angleterre et celles de Jit et Charnalia [5] qui étudièrent des nouveau-nés du Nord de l'Inde. Cependant, nous avons trouvé que la moelle épinière se terminait une vertèbre et demie plus bas chez les nouveau-nés de la Turquie du Nord que chez les nouveau-nés d'Afrique du Sud et d'Inde du Sud. La corrélation entre le poids des spécimens et la longueur de la moelle épinière; le poids et la longueur de la colonne vertébrale, la longueur de la moelle épinière et la longueur de la colonne vertébrale, la longueur de la colonne vertébrale et le niveau vertébral de la terminaison de la moelle épinière parmi les garçons, les filles, et dans les deux sexes, étaient statistiquement très significatifs (p<0.001). Plus la colonne vertébrale était longue, plus haute était située la terminaison de la moelle épinière.

     

大鼠脊髓腰节段神经营养因子及其受体的增龄变化

目的 观察不同月龄(1、3、6、12、18和24月龄)大鼠脊髓腰节段神经营养因子及其受体的变化,探讨其与增龄之间的关系。方法 用免疫组织化学和Western blot 法观察脊髓腰节段神经营养因子及其受体的表达,用尼氏染色法观察脊髓腰节段存活神经元数量。结果 大鼠脊髓腰节段神经生长因子(NGF)及其受体TrkA、脑源性神经营养因子(BDNF)及其受体TrkB和胶质细胞源性神经营养因子(GDNF)表达具有明显的随增龄变化规律,即1月龄（幼年期）时表达量较低,随年龄增高逐渐上升,至6月龄（青年期）达高峰,24月龄（老年期）明显减低,其中以GDNF的变化更为明显。大鼠脊髓腰节段存活神经元数量在1月龄至6月龄均保持在较高水平,之后开始逐渐下降,24月龄时降至最低。结论 神经营养因子及其受体在大鼠脊髓腰节段中的表达存在增龄变化,特别是老年期表达量显著降低,可能是导致脊髓老化的重要机制之一。     

Regulation and function of Dbx genes in the zebrafish spinal cord.

Dbx homeodomain proteins are important for spinal cord dorsal/ventral patterning and the production of multiple spinal cord cell types. We have examined the regulation and function of Dbx genes in the zebrafish. We report that Hedgehog signaling is not required for the induction or maintenance of these genes; in the absence of Hedgehog signaling, dbx1a/1b/2 are expanded ventrally with concomitant increases in postmitotic neurons that differentiate from this domain. Also, we find that retinoic acid signaling is not required for the induction of Dbx expression. Furthermore, we are the first to report that knockdown of Dbx1 function causes a dorsal expansion of nkx6.2, which is thought to be the cross-repressive partner of Dbx1 in mouse. Our data confirm that the dbx1a/1b/2 domain in zebrafish spinal cord development behaves similarly to amniotes, while extending knowledge of Dbx1 function in spinal cord patterning.