We present the results of a 1 year longitudinal study of bone mineral measurements and soft tissue composition in supra-and infra-lesional areas of 31 patients with a spinal cord injury (level D2-L3)_ Like others, we observed a rapid decrease of BMC in the paralysed areas, of -4%/month during the first year in areas rich in trabecular bone and of -2%/month in areas containing mainly compact bone. Lean soft tissue mass (muscle mass) decreases dramatically during the first months post injury in the legs, while fat content tends to increase. Though lean mass is better maintained in patients who develop spasticity, the evolution of BMC does not differ significantly between the groups of flaccid and spastic patients. In patients with partial or complete neurological recovery, a deficit in BMC of -10% with regards to the initial value is still observed at 1 year in the lower limbs. The lean mass of the upper limbs increases early after the cord injury, because of intensive rehabilitation. No significant change in BMC was observed in the supra-lesional areas. These data confirm the rapid loss of bone in the paralysed areas of paraplegic patients, which occurs independently of the presence of spontaneous muscle activity or of passive verticalisation. In patients with recovery, BMC does not return to pre-injury values within 1 year. Thus, there would be an interest in preventing bone loss early in the course of the disease.

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We have previously shown that subjects with traumatic tetraplegia use the clavicular portion of the pectoralis major to expire actively. To determine if we could improve the expiratory function of these subjects, we studied six patients in whom the pectoralis major was trained by repetitive, strenuous, isometric contractions for 6 wk. Six patients receiving conventional respiratory rehabilitation served as control subjects. Training of the pectoralis major produced marked increases in the maximal isometric muscle strength (mean +/- SE: 54.6 +/- 5.8%; p less than 0.005) and in expiratory reserve volume (46.6 +/- 9.9%; p less than 0.005). Functional residual capacity did not change, such that residual volume decreased by 14.1 +/- 2.9% (p less than 0.005). In contrast, the control patients did not develop any significant alterations. We conclude that unlike conventional rehabilitation, training the pectoralis major for strength improves expiratory function in tetraplegic subjects. Therefore, training of this muscle should increase the effectiveness of coughing and might reduce the prevalence of bronchopulmonary infections in such subjects.

Traumatic tetraplegia produces paralysis of all the well-recognized muscles of expiration. Yet, tetraplegic subjects usually have a small expiratory reserve volume on spirographic examination. To understand the mechanism that enables these patients to empty their lungs actively, we studied the pattern of chest-wall motion during voluntary expiration. We found negligible changes in abdominal dimension, but all subjects had a marked and reproducible decrease in the dimension of the upper rib cage. Electrical measurements established that the subjects had active use of the clavicular portion of the pectoralis major, and changing the orientation of these muscle fibers by maintaining the shoulders in abduction reduced their expiratory reserve volume by about 60 percent (P less than 0.001). We therefore conclude that the clavicular portion of the pectoralis major plays a crucial part in the mechanism of active expiration in tetraplegic subjects. Training of this muscle bundle could, by increasing its strength and endurance, improve the effectiveness of coughing in such subjects and perhaps diminish the prevalence of bronchopulmonary infections.

Abstract. A longitudinal study of bone and calcium metabolism in 28 patients with spinal chord lesion shows an enhancement of bone calcium accretion, generalized to the whole skeleton. The bone calcium turnover rate is more increased in the non-paralysed area during the first 2 months.

Patients with traumatic transection of the lower segments of the cervical cord contract the clavicular portion of the pectoralis major during forced expiration and cough, and the rise in intrathoracic pressure resulting from this contraction produces dynamic airway compression in many patients. Because the abdominal muscles are paralyzed, however, there is paradoxical expansion of the abdomen, which may reduce the rise in intrathoracic pressure and the degree of airway collapse. To evaluate the magnitude of this effect, we measured expiratory flow rate (Vexp) and esophageal pressure (Pes) during a series of forced expiratory vital capacity maneuvers and constructed isovolume-pressure flow (IVPF) curves before and after abdominal strapping in eight C5-8 tetraplegic subjects. Strapping produced small and inconsistent changes in maximal Vexp and Pes and resulted in the development of small flow plateaus in only four patients. In tetraplegic subjects, abdominal strapping thus has small effects on forced expiration and is unlikely, therefore, to improve the efficiency of cough.

We have shown that orchidectomy in postpubertal 55-day-old rats led beyond 2 months to a decrease in bone growth and loss of weight. At 1 month postorchidectomy, we observed a three-fold increase in bone blood flow, an increase in calcium accretion rate, and an increase in the number of osteoclasts in the metaphysis. In the present experimental study, orchidectomy was performed in 1-year-old rats when bone growth in length was no longer measurable. In the tibia and femur we observed a decrease in bone volume, a still more rapid decrease of bone calcium during the first postoperative month, a thinning of the cortical width, an initial increase in calcium accretion rate (+20% when compared to 31 days controls) followed by a decrease at 120 days (-22% and -11% when compared to controls for tibia and femur respectively), a 29% increase in bone blood flow, and an increase in the number of osteoclasts. We conclude that androgen deprivation in young and old animals leads to a modified bone architecture, independent of the androgen impact on bone growth.

The incidence of post-traumatic syringomyelia ranges between 0·3 and 3·2%, dependent on the authors, with a mean of about 1·3%. 2,7, 2S, 27, 29, 33, 41, 42 The interval between spinal trauma and the appearance of neurological symp The first symptom in most cases is pain, which is increased by straining, coughing or sneezing/ 27, 41 followed by sensory deficit, motor loss and increase of spasticity.29 Autonomous symptoms such as abnormal sweating or hypertension are less frequent,29 but can also be the first symptom.37 The earliest clinical sign is loss of reflexes. 7, 42Diagnostic techniques have undergone an important evolution in recent years.Oil and gas myelography being replaced by metrizamide myelography associated with CT scan imaging. The recently developed MR imaging has now become the technique of choice. 11, 3 6 Intra-operative sonography is used to detect septations