유전자 변화를 근거로 한 척수손상의 단계의 구분

양준영,이준호,이준규,주용범,차수민 대한척추외과학회 2011 대한척추외과학회지 Vol.18 No.3

Study Design: An experimental study. Objectives: To define the phases of chronic spinal cord injury by researching the changes in gene expression. Summary of the Literature Review: The exact time of conversion from acute stage to chronic stage in spinal cord injury is unknown. Materials and Methods: We used 18 month-old Beagle dogs as study subjects. Under spinal cord monitoring, we underwent laminectomy on thoracic vertebra 10 and 11, and induced cord injury by a weight-drop injury method. Dogs in each group with spinal cord injury and group without spinal cord injury on POD 1, 7, 30, and 90. The motor functions were evaluated using the Tarlov scale. Tissues were prepared from 0.5cm up and down from the 10th thoracic level. Additional cephalic and caudal lesions from the injured site were prepared. We have checked the differentially expressed gene(DEG). Results: The mean Tarlov value was 0.67 which indicated a significant cord injury. 4 DEG (GP3, 9, 25, 34) were detected among 40primers after screening, the detection percentage of which was 10. In the tissues of study subjects with spinal injury, DEG was found at the injury site and cephalic lesion. DEG expressed GP3, GP9 and GP34 started expression on day 30, and GP25 was expressed on day 90. Conclusions: According to the changes in gene expression, the day 30 would be considered as the date of conversion from acute to chronic phase of cord injury. Inhibiting secondary inflammatory change and apoptosis following spinal cord injury until this period would maximize the effect of chronic phase therapy such as cell-transplantation. Key Words: Spinal cord injury, Differentially expressed gene

급성 척수 손상 고양이에서 Nimodipine 투여가 척수 혈류 및 척수 신경 기능 회복에 미치는 영향

조용은,김영수 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.1

Spinal cord injury causes immediate neuronal dysfunction and remained paralysis in life without clinical improvement. The spinal cord injury is caused by initial mechanical damage and secondary neuronal damage. The exact mechanisms of secondary neuronal damage are still unknown and their treatment is obscure even though many studies about them. The vascular change after injury is supported widely as a mechanism of secondary neuronal damage which causes decreased microcirculation and cord ischemia. There is considerable evidence that Ca ^(++) ions play a key role in the pathogenesis of posttraumatic ischemia and Ca^(++) ion influx promotes cellular dysfuction and cell death. So calcium antagonist is considered that it can improve spinal cord blood flow and restore impaired neuronal function. In this report, the effects of calcium channel blocker, nimodipine on spinal cord blood flow and spinal somatosensory evoked potential were measured and it was compared with vehicle group in 400 g-cm cord injured cat. And the effects of nimodipine were compared between nimodipine and adrenaline treated group of which mean systolic blood pressure was maintained above 100㎜Hg and nimodipine only treated group. Spinal cord blood flow was measured at T_(6)(injury level). T_(4), T_(12) by the hydrogen clearance technique and spinal somatosensory evoked potential was recorded at T_(4), T_(12) after injury at T6 level. The results of this study are summarized as follows: 1) The spinal cord blood flow was decreased abruptly just after spinal cord injury and it deceased progressively. 2) In nimodipine treated group, there was a improvement of spinal cord blood flow inspite of decreased mean systemic arterial pressure. It might be thought that the vasodilatory effect of nimodipine was more potent in spinal vasculature than in systemic peripheral vessels. 3) The increased spinal cord blood flow was more prominant and prolonged in nimodipine and adrenaline treated group than nimodipine only treated group. It was thought that increased heart beat and cardiac contratility by adrenaline counteracted systemic hypotension which resulted from vasodilatory effect of nimodipine. It suggests that maintenance of mean systemic arterial pressure is inportant during nimodipine theraphy in spinal cord injury. 4) The improvements of spinal somatosensory evoked potential were more evident in nimodipine and adenaline treated group. It might be caused by spinal cord blood flow improvement. From the above result it is speculated that the calcium channel blocker, nimodipine can improve spinal blood flow and impaird neuronal function in spinal cord injury.

급성 척수손상시 세포사망의 특성

진동규,김영수,윤도흠,주진양,이경희,성제경 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.12

MR-histological Correlations of Wallerian Degeneration in Spinal Cord Injury

Cho, Kyoung-Suok,Bunge, Richard P.,Choi, Chang-Rak 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

본 연구의 목적은 척수 손상 후 위 또는 아래 level에서 wallerian degeneration의 MR 소견을 관찰하고, 척수 손상 후 magnetic resonance(MR)에 이상 소견이 나타나는 time interval 관찰하며 그리고 MR 소견과 post mortem histopathology 비교하는데 있다. 척수손상후 사망까지 생존 기간이 8일부터 22년까지 다양한 23명의 척수손상 환자에서 post mortem에 척수를 채취해서 T1과 T2 weighted MR imaging 얻었고, 조직검사는 MR section과 같은 level에서 axon, myelin, connective tissue stain 실시하여 MR 소견과 비교하였다. 결과는 척수손상 후 7주 이후에 사망한 모든 예에서, 손상된 척수 위 level의 dorsal column과 아래 level의 lat, corticospinal tract에서 MR 소견상 increased signal intensity 나타났다. 그리고 손상 후 8일만에 사망한 예에서는 MR 소견상 변화는 없지만, 조직 검사상 wallerian degeneration이 손상의 위 level dorsal column에서는 나타났지만 아래 level의 lat, corticospinal tract에서는 보이지 않았다. 그러나 12일 후 사망한 예에서는 wallerian degeneration이 척수손상 위 dorsal column과 아래 lat, corticospinal tract에서 MR의 이상 소견이 보였다. 결론적으로 척수손상 후 Wallerian degeneration이 나타나지만, 손상 level 위의 dorsal column과 아래의 lat, corticospinal tract의 wallerian degeneration은 최소한 7주 이상이 지나야 MR에서 변화가 보인다. MR로서 wallerian degeneration 관찰함으로 척수손상의 정확한 분석과, epicenter로부터 멀리 떨어진 부위의 MR signal 변화의 설명, 그리고 나아가서는 치료의 평가에도 유용하게 이용될 것으로 생각된다. The purpose of this study were to describe the magnetic resonance(MR) manifestations of wallerian degeneration occurring above and below a spinal cord injury site, to determine the post-injury time interval when the wallerian degeneration becomes evident in MR images, and to correlate the MR findings with post mortem histopathology. Twenty-three postmortem spinal cords, all from patients with cervical (14), thoracic (5), and lumbar (4) cord, injuries, were studied with axial T1- and T2-weighted spin-echo MR imaging. Injury to death intervals varied from 8 days to 22 years. We examined these specimen for abnormal cord contour and alteration of signal above and below the injury site. Histological studies of these cords with axon, myelin, and connective tissue stains were performed at levels equivalent to the MR sections. Studies using plastic embedded sections and antibodies to Glial Fibrillarg Acetic Protein(GF AP) were also performed on some of the above cords. Pathological-imaging correlations were made. MR images of the cord specimen showed increased signal intensity in the dorsal columns above the injury level as well as in the lateral corticospinal tracts below the injury level in all cases in which cord injury had occurred seven or more weeks premortem. In one case where cord injury had occurred eight days prior to death the MR showed no signal abnormalites : histological analysis showed evidence of early wallerian degeneration in the dorsal columns above the lesion but no change was detected in the lateral columns below the lesion. After 12 days, early stage wallerian degeneration was detected by histological examination in both the lateral columns below the lesion and in the dorsal columns above the lesion. Wallerian degeneration in spinal cords, as demonstrated by histological examination, was identified on MR as areas of increased T2 weighted signal intensity site in the dorsal column above the injury site and in the corticospinal tracts below the injury site in all specimen in which the injury-to-death interval was greater than 7 weeks. The ability to recognize wallerian degeneration on MR allows a more comprehensive analysis of the injury, explains abnormal MR signals at sites that are remote from the epicenter of injury, and may be helpful in the assessing of results of therapeutic interventions.

남성 상부운동신경원 손상 환자에서 척수손상의 위치와 청결간헐적도뇨가 성기능에 미치는 영향

차우헌,김기호,서영진,이경섭 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.12

Purpose: We investigated the effect of the level of spinal cord injury and urinary catheterization on sexual function and activity in male patients with upper motor neuron (UMN) injury. Materials and Methods: We reviewed patient's chart, radiologic and urodynamic study. We interviewed patient's sexual activity according to educational status, economic and marriage state, occupation, duration of spinal cord injury and pattern of voiding. A total of 114 male patients with neurogenic bladder due to UMN injury were included in the study. Group 1 consisted of 33 patients who underwent a clean intermittent catheterization (CIC) regimen and group 2 consisted of 81 patients with a suprapubic catheter, condom catheter, or Foley catheter. A detailed sexual behavior was taken for all patients to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). Results: Satisfaction with intercourse (p=0.037) and total score (p=0.032) on the IIEF-5 were significantly higher in group 1 than in group 2. The other items on the IIEF-5 did not differ significantly between the groups. When the subjects were stratified according to level of spinal cord injury, 8 patients (18.6%) with cervical cord injury had no sexual activity, whereas 24 patients (33.8%) with non-cervical-cord injury did (p=0.048). Patients with no sexual activity were 12.1% (4/33) of the patients in the CIC group and 34.6% (28/81) of the patients who underwent other regimens (p= 0.016). Conclusions: Our results demonstrate that level of spinal cord injury and urinary catheterization may influence the sexual activity of male patients with UMN injury. Our results suggest that the CIC regimen had a positive effect on the sexual activity of these patients. Purpose: We investigated the effect of the level of spinal cord injury and urinary catheterization on sexual function and activity in male patients with upper motor neuron (UMN) injury. Materials and Methods: We reviewed patient's chart, radiologic and urodynamic study. We interviewed patient's sexual activity according to educational status, economic and marriage state, occupation, duration of spinal cord injury and pattern of voiding. A total of 114 male patients with neurogenic bladder due to UMN injury were included in the study. Group 1 consisted of 33 patients who underwent a clean intermittent catheterization (CIC) regimen and group 2 consisted of 81 patients with a suprapubic catheter, condom catheter, or Foley catheter. A detailed sexual behavior was taken for all patients to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). Results: Satisfaction with intercourse (p=0.037) and total score (p=0.032) on the IIEF-5 were significantly higher in group 1 than in group 2. The other items on the IIEF-5 did not differ significantly between the groups. When the subjects were stratified according to level of spinal cord injury, 8 patients (18.6%) with cervical cord injury had no sexual activity, whereas 24 patients (33.8%) with non-cervical-cord injury did (p=0.048). Patients with no sexual activity were 12.1% (4/33) of the patients in the CIC group and 34.6% (28/81) of the patients who underwent other regimens (p= 0.016). Conclusions: Our results demonstrate that level of spinal cord injury and urinary catheterization may influence the sexual activity of male patients with UMN injury. Our results suggest that the CIC regimen had a positive effect on the sexual activity of these patients.

Effect of Regular Exercise on Cardiopulmonary Fitness in Males With Spinal Cord Injury

이영희,오경준,공인덕,김성훈,신종목,김종현,이동수,이진형,장재승,김태호,김은주 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.1

Objective To evaluate the cardiopulmonary endurance of subjects with spinal cord injury by measuring the maximal oxygen consumption with varying degrees of spinal cord injury level, age, and regular exercise.Methods We instructed the subjects to perform exercises using arm ergometer on healthy adults at 20 years of age or older with spinal cord injury, and their maximal oxygen consumption (VO2max) was measured with a metabolic measurement system. The exercise proceeded stepwise according to the exercise protocol and was stopped when the subject was exhausted or when VO2 reached an equilibrium.Results Among the 40 subjects, there were 10 subjects with cervical cord injury, 27 with thoracic cord injury, and 3 with lumbar cord injury. Twenty-five subjects who were exercised regularly showed statistically higher results of VO2max than those who did not exercise regularly. Subjects with cervical injury showed statistically lower VO2max than the subjects with thoracic or lumbar injury out of the 40 subjects with neurologic injury. In addition, higher age showed a statistically lower VO2max. Lastly, the regularly exercising paraplegic group showed higher VO2max than the non-exercising paraplegic group.Conclusion There are differences in VO2max of subjects with spinal cord injury according to the degree of neurologic injury, age, and whether the subject participates in regular exercise. We found that regular exercise increased the VO2max in individuals with spinal cord injury.

Methylprednisolone투여가 흰쥐 척수손상모델의 운동유발전위의 변화에 미치는 영향

황용순,박상근 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Objectives: For the last two decades. various chemicals have been applied for the treatment of spinal cord injury but no chemicals were found to be as effective as methylprednisolone. And motor evoked potentials(MEPs) have been utilized clinically in monitoring and diagnosis of the motor disorders. To evaluate the efficacy of methylprednisolone on functional recovery following spinal cord injury and to determine the usefulness of motor evoked potential as a monitoring tool in spinal cord injury, the author used spinal cord injury model in rats. Methods: In the present study, the effects of methylprednisolone on functional recovery after spinal cord injury were carefully quantified behaviorally as well as electrophysiologically in white rats. Spinal cord injury was produced using NYU-spinal cord impactor. BBB(Basso, Beattie, and Bresnahan) test was conducted to measure the change of neurological status behaviorally, and MEPs and somatosensory evoked potentials (SSEPs) were recorded to determine the effects of methylprednisolone electrophysiologically. The results of these studios were compared each other to determine the usefulness of MEPs. Results: 1. According to the behavioral test using BBB test, methylprednisolone - treated animals showed improved functional recovery compared to the saline-treated animals. 2. MEP latencies in methylprednisolone-treated group were shorter than those in control group. Peak amplitudes of MEPs were larger in methylprednisolone-treated group than those in control group. 3. Peak amplitudes of SSEPs were larger in methylprednisolone-treated group than those in control group. In summary, the amplitudes of MEPs were recovered more rapidly in methylprednisolone-treated group than those of SSEPs and the latencies of MEPs showed similar tendency compared to those of SSEPs. 4. The thresholds of MEPs and SSEPs tended to be lower in methylprednisolone-treated group than those of control group. Conclusions: These results suggest that methylprednisolone may minimize the secondary spinal injury and improve the functional recovery after spinal cord injury. And motor evoked potential seems to be reliable as a tool monitoring the functional recovery after spinal cord injury, and be compensatory with SSEPs.

A Review of Functional Restoration From Spinal Cord Stimulation in Patients With Spinal Cord Injury

Alice Lin,Elias Shaaya,Jonathan S. Calvert,Samuel R. Parker,David A. Borton,Jared S. Fridley 대한척추신경외과학회 2022 Neurospine Vol.19 No.3

Traumatic spinal cord injury often leads to loss of sensory, motor, and autonomic function below the level of injury. Recent advancements in spinal cord electrical stimulation (SCS) for spinal cord injury have provided potential avenues for restoration of neurologic function in affected patients. This review aims to assess the efficacy of spinal cord stimulation, both epidural (eSCS) and transcutaneous (tSCS), on the return of function in individuals with chronic spinal cord injury. The current literature on human clinical eSCS and tSCS for spinal cord injury was reviewed. Seventy-one relevant studies were included for review, specifically examining changes in volitional movement, changes in muscle activity or spasticity, or return of cardiovascular pulmonary, or genitourinary autonomic function. The total participant sample comprised of 327 patients with spinal cord injury, each evaluated using different stimulation protocols, some for sensorimotor function and others for various autonomic functions. One hundred eight of 127 patients saw improvement in sensorimotor function, 51 of 70 patients saw improvement in autonomic genitourinary function, 32 of 32 patients saw improvement in autonomic pulmonary function, and 32 of 36 patients saw improvement in autonomic cardiovascular function. Although this review highlights SCS as a promising therapeutic neuromodulatory technique to improve rehabilitation in patients with SCI, further mechanistic studies and stimulus parameter optimization are necessary before clinical translation.

급성 척수 손상의 병태생리와 치료에서 최신 접근

유재원,손홍문 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.3

Study Design: This is a literature review Objectives: We wanted to provide updated information for spine clinicians on the pathophysiology, medical treatment and the timing of surgical treatment after acute spinal cord injury. Summary of the Literature Review: There are many studies concerned with understanding the mechanisms of injury and improving the neurologic function after acute spinal cord injury. However, methylprednisolone therapy has been used only recently for the treatment of this malady. Materials and Methods: We conducted a literature review, with a particular focus on the development of pathophysiology and the emerging pharmacologic treatment of acute spinal cord injury, and on the effectiveness of performing early decompression. Results: After primary mechanical impact, a complex cascade of secondary injury follows during acute spinal cord injury. Neuroprotection and axonal regeneration are the main strategies to treat spinal cord injury. Beyond methylprednisolone, a number of other pharmacological treatments have been studied for the acute treatment of spinal cord injury. Animal studies support early decompression of the injured cord. Although there is no standard regarding the timing of decompression, there are many advantages of performing early decompression in human. Conclusion: Although a number of pharmacological therapies seem to have neuroprotective potential, high-dose methyprednisolone therapy is the only clinically approved treatment for acute spinal cord injury. Urgent decompression for acute spinal cord injury remains a reasonable practice option.

경수 손상 환자의 삼킴 양상

한상형 ( Sang Hyoung Han ),서정환 ( Jeong Hwan Seo ),고명환 ( Myoung Hwan Ko ),박성희 ( Sung Hee Park ),송경진 ( Kyung Jin Song ) 전북대학교 의과학연구소 2008 全北醫大論文集 Vol.32 No.1

Objective: To evaluate the characteristics of dysphagia by using the videofluoroscopic swallowing study (VFSS) and the clinical dysphagia scale in patients with cervical spinal cord injury. Method: Twelve patients with cervical spinal cord injury and six normal adults were included in this study. Physical examination and clinical dysphagia scale were checked before VFSS. The parameters observed were penetration, aspiration, oral transit time (OTT), pharyngeal transit time (PTT), and pharyngeal delay time (PDT) during VFSS. Results: Five (41.7%) cervical spinal cord injury patients showed penetration or aspiration in VFSS. The duration of each phases in swallowing (OTT, PTT, PDT) was longer in cervical spinal cord injury patients than normal adults in VFSS (p<0.05). The score of clinical dysphagia scale was higher in patients with cervical spinal cord injury than normal adults. Tracheostomy and mechanical ventilation history seemed to be the predictor of dysphagia in cervical spinal cord injury patients. Conclusion: Swallowing abnormalities were very frequent (41.7%) in cervical spinal cord injury patients. We suggest that the risk of dysphagia should be evaluated for all of the cervical spinal cord injury patients to increase the quality of life via VFSS and clinical dysphagia scale.