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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.
Kinematic Analysis of Locomotion Following Dorsal Hemisection of Spinal Cord in the Rat
Cho, Kyoung-Suok,Madsen, Parley W.,Kim, Jong H.,Choi, Chang Rak 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.7
저자들은 12마리의 흰쥐에서 제 6 흉수에서 후방의 반을 절제하는 척수손상 모델을 만들어 computerized motion analysis을 이용하여 척수손상전과 손상후 6주 간 보행 모습을 분석하였다. 보행은 보폭(stride length), 걸음의 높이, 보폭과 높이의 최고 속도, 걸음의 Swing Phase시간(duration)과 앞뒷 발의 걸음 횟수의 비교(ratio of fore/hindlimb coordination) 등을 분석하였다. Open ground에서의 보행은 척수손상후 4주 이내에 정상 같이 보이나, 저자들이 Treadmill에서 분석에 의하면 몇가지 parameter는 정상으로 회복되지 않았다. 척수손상 후 즉시 양측 하지의 보폭과 높이가 감소되고, 손상후 3주 후에는 보폭은 손상전보다 더 커진다. 흥미있는 것은 걸음의 높이가 손상 후 6주가 되더라도 전혀 손상 전으로 회복되지 않았다. 앞 뒷 다리의 coordination은 손상 후 초기에는 깨졌다가 손상 후 3주 후에는 거의 정상으로 회복되었다. Swing phase 시간은 손상 후 증가되었다가 점차적으로 회복되었지만 손상 전으로는 회복되지 않았다. Kinematic motion analysis system은 척수손상 후 아주 미세한 이상을 분석하는데 매우 유용한 방법이다. Using computerized motion analysis techniques, kinematics of foot trajectories were quantitatively analyzed in twelve rats before and after dorsal spinal cord hemisection at the T6 level. Although overground locomotion in these animals returned to normal within four weeks, some kinematic variables during treadrd locomotion did not recover to pre-lesion levels. Immediately following dorsal hemisection, amplitudes of both hindfeet horizontal and vertical movements were dramatically reduced. However, in three weeks, the amplitudes of horizontal movemendstride length) became significantly larger than that of pre-lesion strides. On the other hand, amplitude of hindlimb vertical movement showed veiy little recovery. Forelimb-hindlimb coordination was also disrupted initially but returned to normal within three weeks. The duration of hindlimb swing phase became significantly longer after sectioning and gradually recovered, but never to pre-lesion levels. Interestingly, amplitudes of forelimb vertical movement, which was depressed initially, became significantly largery three weeks after lesioning A dramatic increase in the statistical variation of limb kinematics, which persisted even after motor recovery, is an important parameter for the evaluation of neural deficits in spinal cord injuries. Kinematic analysis is a sensitive technique for the detection of minor motor deficits following nerve injuries.
Cho, Kyoung-Suok,Kang, Suk-Gu,Yoo, Do-Sung,Huh, Pil-Woo,Kim, Dal-Soo,Lee, Sang-Bok The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.46 No.5
Objective : The present study analyzed the risk factors, prevalence and clinical results following revision surgery for adjacent segment degeneration (ASD) in patients who had undergone lumbar fusion. Methods : Over an 8-year period, we performed posterior lumbar fusion in 81 patients. Patients were followed a minimum of 2 years (mean 5.5 years). During that time, 9 patients required revision surgery due to ASD development. Four patients underwent autogenous posterolateral arthrodesis and extended transpedicle screw fixation, 4 patients underwent decompressive laminectomy and interspinous device implantation, and 1 patient underwent simple decompression. Results : Of the 9 of patients with clinical ASD, 33.3% (3 of 9) of patients did not have radiographic ASD on plain radiographs. Following revision surgery, the clinical results were excellent or good in 8 patients (88.9%). Age > 50 years at primary surgery was a significant risk factor for ASD development, while number of fusion levels, initial diagnosis and type of fusion were not. Conclusion : The incidence of ASD development after lumbar surgery was 11.1% (9 of 81) in this study. Age greater than 50 was the statistically significant risk factor for ASD development. Similar successful clinical outcomes were observed after extended fusion with wide decompression or after interspinous device implantation. Given the latter procedure is less invasive, the findings suggest it may be considered a treatment alternative in selected cases but it needs further study.
Song, Kyo-Chang,Cho, Kyoung-Suok,Lee, Sang-Bok The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.3
Abnormalities of the posterior arch, including congenitally absent cervical pedicle and cervical spondylolysis, are rare entities that are usually found incidentally on neck radiographs. It is important to recognize these characteristic radiological features because their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. Also, it is important to distinguish these abnormalities from similar pathologies to prevent the use of inappropriate treatment We report the relevant clinical and radiological findings seen in three cases of posterior arch defect after trauma with review of pertinent literature.
Song, Gyo-Chang,Cho, Kyoung-Suok,Yoo, Do-Sung,Huh, Pil-Woo,Lee, Sang-Bok The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.1
Objective : Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. Methods : Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. Results : Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. Conclusion : The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.
Lee, Sang-Bok,Cho, Kyoung-Suok,Kim, Jong-Youn,Yoo, Do-Sung,Lee, Tae-Gyu,Huh, Pil-Woo The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.5
Objective : In the present study, we evaluated the effect, safety and radiological outcomes of cervical hybrid surgery (cervical disc prosthesis replacement at one level, and interbody fusion at the other level) on the multilevel cervical degenerative disc disease (DDD). Methods : Fifty-one patients (mean age 46.7 years) with symptomatic multilevel cervical spondylosis were treated using hybrid surgery (HS). Clinical [neck disability index (NDI) and Visual Analogue Scale (VAS) score] and radiologic outcomes [range of motion (ROM) for cervical spine, adjacent segment and arthroplasty level] were evaluated at routine postoperative intervals of 1, 6, 12, 24 months. Review of other similar studies that examined the HS in multilevel cervical DDD was performed. Results : Out of 51 patients, 41 patients received 2 level hybrid surgery and 10 patients received 3 level hybrid surgery. The NDI and VAS score were significantly decreased during the follow up periods (p<0.05). The cervical ROM was recovered at 6 and 12 month postoperatively and the mean ROM of inferior adjacent segment was significantly larger than that of superior adjacent segments after surgery. The ROM of the arthoplasty level was preserved well during the follow up periods. No surgical and device related complications were observed. Conclusion : Hybrid surgery is a safe and effective alternative to fusion for the management of multilevel cervical spondylosis.
Experimental Syringomyelia : Intraspinal Injections of Quisqualic Acid in the Rat
Kang, Joon-Ki,Kim, Dal-Soo,Cho, Kyoung-Suok CATHOLIC MEDICAL CENTER 1996 Bulletin of the Clinical Research Institute Vol.21 No.1
The neurotoxic effects of excitatory amino acids (EAA) in the brain are well documented, but the toxicity of these substances in the spinal cord has not been as thoroughly studied. Intraspinal microinjections of quisqualic acid (QA) were made to evaluate the neurotoxic effects of this EAA agonist on neurons in the adult rat spinal cord. Animals were divided into four groups based on times post QA injection ranging from 7-49 days. Injection volumes ranging from 0.3-2.0μl of 8-3mM, 83mM and 125mM QA and normal saline (vehicle) were made in the lower thoracic and upper lumbar spinal cord. The results show that unilateral injections of quisqualic acid produce unilateral or bilateral neuronal degeneration at all survival times evaluated. This was accompanied by an in inflammatory reaction and the initiation of a pathological process leading to spinal cavitation in 23 of 25 animals. Segments affected by QA injections contained darkly stained, hypertrophied neuronal profiles, and an increased expression of glial fibrillary acidic factor (GFAP). Immunostaining for GFAP was especially intense in the areas of neuronal degeneration and around the border of spinal cavities. The results of this study have shown that the intraspinal injection of QA may be a suitable model to study the cellular events of EAA induced neurotoxicity on spinal neurons and the pathological process of spinal cavitation following neuronal degeneration.