Injury zone denervation in traumatic quadriplegia in humans

Berman, Stephen; Young, Robert R.; Sarkarati, Mehdi; Shefner, Jeremy M.

doi:10.1002/(sici)1097-4598(199606)19:6<701::aid-mus3>3.0.co;2-e

Cited by 29 publications

(18 citation statements)

References 13 publications

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“…While electrophysiological testing has been performed in SCI for predicting injury [74][75][82][83][84][85], examining the nature of neurological injury [71][72][86][87][88][89][90][91][92], monitoring the integrity of spinal conduction [77,[93][94], and assessing for concomitant or secondary neurological conditions [95][96][97][98][99], its role as a method of evaluating the impact of various interventions [65][66][81][82][100][101][102][103][104][105][106] is the concern of this article.…”

Section: Electrodiagnosticsmentioning

confidence: 99%

Assessment of upper limb in tetraplegia: Considerations in evaluation and outcomes research

Mulcahey¹,

Hutchinson²,

Kozin³

2007

JRRD

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Abstract-This article briefly discusses several measurement tools for evaluating the upper limb of persons with tetraplegia. Muscle strength testing and electrodiagnostics are discussed as they relate to technique and usefulness for clinical trials. Standardized measures of hand function are reviewed; their limitations for clinical trials during acute spinal cord injury (SCI) care are acknowledged and their strengths for interventional studies and clinical trials during chronic phases of SCI care are defined. Recommendations are set forth for incorporating the International Classification for Surgery of the Hand in Tetraplegia motor and sensory examinations as adjuncts to the International Standards for Neurological Classification of SCI motor and sensory examinations and for further developing electrodiagnostic techniques as measurement tools for acute clinical trials. The Grasp and Release Test is described and recommended for clinical trials involving persons in the chronic stages of SCI. Lastly, we note that much work remains in the development, validation, and clinical deployment of an assessment of upper-limb function in SCI.

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Section: Electrodiagnosticsmentioning

confidence: 99%

Assessment of upper limb in tetraplegia: Considerations in evaluation and outcomes research

Mulcahey¹,

Hutchinson²,

Kozin³

2007

JRRD

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“…[14][15][16][17][18] Other studies have shown signs of partial denervation (low motor unit counts, positive sharp waves, small amplitude compound muscle action potentials, muscle weakness that exceeds that expected from disuse atrophy, atrophied and angular muscle fibers), including indications of intramuscular motor axon sprouting, an important compensatory mechanism for recovery of muscle innervation after death of some motoneurons in a motor pool (large polyphasic motor unit potentials, stronger than usual motor unit forces, increased motor unit fiber density, increased jitter in re-innervated muscle fibers). 12,[19][20][21][22][23] In this study, we address an important and often overlooked aspect of SCI-the effect of injury on the lesioned spinal cord segment and denervation of skeletal muscle as a contributor to muscular weakness. Our aim was to estimate the extent of motoneuron death from the number of large diameter myelinated axons in ventral roots taken post-mortem from individuals who had sustained a spinal cord injury at least 6 months earlier.…”

Section: Introductionmentioning

confidence: 99%

Motoneuron Death after Human Spinal Cord Injury

Grumbles

Thomas

2017

Journal of Neurotrauma

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The severe muscle weakness and atrophy measured after human spinal cord injury (SCI) may relate to chronic muscle denervation due to motoneuron death and/or altered muscle use. The aim of this study was to estimate motoneuron death after traumatic human SCI. The diameter and number of myelinated axons were measured in ventral roots post-mortem because ventral roots contain large diameter (> 7 lm) myelinated axons that typically arise from motoneurons and innervate skeletal muscle. In four cases (SCI levels C7, C8, T4, and L1) involving contusion (n = 3) or laceration (n = 1), there was a significant reduction in the number of large diameter myelinated axons at the lesion epicenter (mean -standard error [SE]: 45 -11% Uninjured), one level above (51 -14%), and one (27 -12%), two (45 -40%), and three (54 -23%) levels below the epicenter. Reductions in motoneuron numbers varied by side and case. These deficits result from motoneuron death because the gray matter was destroyed at and near the lesion epicenter. Muscle denervation must ensue. In seven cases, ventral roots at or below the epicenter had large diameter myelinated axons with unusually thin myelin, a sign of incomplete remyelination. The mean -SE g ratio (axon diameter/fiber diameter) was 0.60 -0.01 for axons of all diameters in five above-lesion ventral roots, but increased significantly for large diameter fibers ( ‡ 12 lm) in three roots at the lesion epicenter. Motoneuron death after human SCI will coarsen muscle force gradation and control, while extensive muscle denervation will stifle activity-based treatments.

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“…Unfortunately, diagnosing a radiculopathy after SCI is exceedingly difficult. In a study seeking to electrophysiologically characterize the injury zone, Berman et al (13) found that cervical SCIs cause a loss of motor axons in regions several segments caudal to the rostral injury level. For example, in patients with C5 or higher injury levels, lower motor neuron damage, evident electrophysiologically, was most commonly observed several segments lower in the C8/T1 level.…”

Section: Discussionmentioning

confidence: 99%

Intractable Pruritus After Traumatic Spinal Cord Injury

Crane

Jaffee

Kundu

2009

The Journal of Spinal Cord Medicine

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Background: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. Method: Case report. Findings: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. Conclusions: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective.

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Injury zone denervation in traumatic quadriplegia in humans

Cited by 29 publications

References 13 publications

Assessment of upper limb in tetraplegia: Considerations in evaluation and outcomes research

Assessment of upper limb in tetraplegia: Considerations in evaluation and outcomes research

Motoneuron Death after Human Spinal Cord Injury

Intractable Pruritus After Traumatic Spinal Cord Injury

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