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

스키와 스노보드 사고에서 척추손상의 특징

차용성 ( Yong Sung Cha ),이강현 ( Kang Hyun Lee ),김선휴 ( Sun Hyu Kim ),장용수 ( Yong Su Jang ),김현 ( Hyun Kim ),신태용 ( Tae Yong Shin ),황성오 ( Sung Oh Hwang ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.1

Purpose: Few studies have been done for spinal injuries after skiing and snowboarding accidents. Assuming that the riding patterns of skiing and snowboarding were different, we analyzed the differences between the mechanisms, diagnoses and levels of spinal injuries caused by them. The purpose of this study was to gain a better understanding of spinal hazards associated with skiing and snowboarding in order to educate skiers and snowboarders. Methods: We conducted a prospective study of 96 patients who had sustained spinal injuries as a result of skiing and snowboarding accidents from January 2003 to March 2006. We used a questionnaire, radiological studies, history taking, and physical examinations. We analyzed the mechanism of injury, the level of spinal injury, the severity of spinal injury, and the Abbreviated Injury Scale scores (AIS score). We used the t-test and the chi-square test. Results: The skiing and the snowboarding injury group included in 96 patients. The skiing injury group included 30 patients (31.2%), and the snowboarding injury group included the remaining 66 patients (69.8%). The primary mechanism of injury in skiing was collisions and in snowboarding was slip downs (p=0.508). The primary level of spinal injury in skiing and snowboarding was at the L-spine level (p=0.547). The most common athlete ability of the injured person was at the intermediate level (p=0.954). The injured were most commonly at the beginner or the intermediate level (p=0.302). The primary diagnosis of spinal injury in skiing and snowboarding was back spain (p=0.686). The AIS scores did not differed between the two groups (p=0.986). Conclusion: The most common spinal injury after skiing and snowboarding accidents was back sprain. There was no difference in the severity of spinal injury between skiing and snowboarding accidents. (J Korean Soc Traumatol 2007;20:33-39)

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

Animals models of spinal cord contusion injury

Verma, Renuka,Virdi, Jasleen Kaur,Singh, Nirmal,Jaggi, Amteshwar Singh The Korean Pain Society 2019 The Korean Journal of Pain Vol.32 No.1

Spinal cord contusion injury is one of the most serious nervous system disorders, characterized by high morbidity and disability. To mimic spinal cord contusion in humans, various animal models of spinal contusion injury have been developed. These models have been developed in rats, mice, and monkeys. However, most of these models are developed using rats. Two types of animal models, i.e. bilateral contusion injury and unilateral contusion injury models, are developed using either a weight drop method or impactor method. In the weight drop method, a specific weight or a rod, having a specific weight and diameter, is dropped from a specific height on to the exposed spinal cord. Low intensity injury is produced by dropping a 5 g weight from a height of 8 cm, moderate injury by dropping 10 g weight from a height of 12.5-25 mm, and high intensity injury by dropping a 25 g weight from a height of 50 mm. In the impactor method, injury is produced through an impactor by delivering a specific force to the exposed spinal cord area. Mild injury is produced by delivering $100{\pm}5kdyn$ of force, moderate injury by delivering $200{\pm}10kdyn$ of force, and severe injury by delivering $300{\pm}10kdyn$ of force. The contusion injury produces a significant development of locomotor dysfunction, which is generally evident from the $0-14^{th}$ day of surgery and is at its peak after the $28-56^{th}$ day. The present review discusses different animal models of spinal contusion 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.

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.

Animals models of spinal cord contusion injury

Renuka Verma,Jasleen Kaur Virdi,Nirmal Singh,Amteshwar Singh Jaggi 대한통증학회 2019 The Korean Journal of Pain Vol.32 No.1

Spinal cord contusion injury is one of the most serious nervous system disorders, characterized by high morbidity and disability. To mimic spinal cord contusion in humans, various animal models of spinal contusion injury have been developed. These models have been developed in rats, mice, and monkeys. However, most of these models are developed using rats. Two types of animal models, i.e. bilateral contusion injury and unilateral contusion injury models, are developed using either a weight drop method or impactor method. In the weight drop method, a specific weight or a rod, having a specific weight and diameter, is dropped from a specific height on to the exposed spinal cord. Low intensity injury is produced by dropping a 5 g weight from a height of 8 cm, moderate injury by dropping 10 g weight from a height of 12.5–25 mm, and high intensity injury by dropping a 25 g weight from a height of 50 mm. In the impactor method, injury is produced through an impactor by delivering a specific force to the exposed spinal cord area. Mild injury is produced by delivering 100 ± 5 kdyn of force, moderate injury by delivering 200 ± 10 kdyn of force, and severe injury by delivering 300 ± 10 kdyn of force. The contusion injury produces a significant development of locomotor dysfunction, which is generally evident from the 0–14th day of surgery and is at its peak after the 28–56th day. The present review discusses different animal models of spinal contusion injury.

척추 골절에서 동반 손상의 정도와 양상

박훈 ( Hun Park ),송경진 ( Kyung Jin Song ),이광복 ( Kwang Bok Lee ),심주현 ( Joo Hyun Sim ) 대한골절학회 2012 대한골절학회지 Vol.25 No.3

목적: 척추골절 시 동반 손상의 양상 및 심각성 정도와의 연관성을 조사하고자 하였다. 대상 및 방법: 척추골절로 수술적 치료를 시행한 291명을 대상으로, 골절은 상경추, 하경추, 흉추, 흉요추, 요추로 분류하였고, 동반손상은 두경부, 안면부, 흉부, 복부, 사지 및 표피로 분류하였으며, Abbreviated Injury Scale과 Injury Severity Score (ISS)를 이용하여 손상의 심각성 정도를 구분하였다. 척추 골절 위치와 동반 손상 발생 및 심각성 정도의 연관성을 조사하였고, 골절 위치와 동반 손상의 유무에 따른 신경 손상의 빈도를 비교하였다. 결과: 척추골절은흉요추부 (42.3%)에서 호발하였고, 134명 (47%)에서 동반 손상이 있었다. 동반 손상 부위는 사지 (41.2%)에서 가장 높았다. 흉추부골절 (81.3%)에 비해 하경추부골절 (34.5%)시 동반 손상 발생이 적었다. 흉추부 골절 시 ISS가 평균 17.14점으로 동반손상이 가장 심하였다 (p=0.001). 신경 손상은 하경추부에서 가장 높았고, 상경추부에서 가장 낮았다 (p=0.032). 결론: 수술적 치료를 시행한 척추 골절 중 하경추부는 동반 손상의 빈도는 낮았으나, 동반 손상 발생 시 신경 손상의 가능성은 가장 높아 이 부위의 손상 시 환자의 처치에 있어서 주의를 기울일 필요가 있으며, 흉추부 골절 시에 동반손상의 심각성이 높으므로 이부 위의 골절 시 동반손상의 적절한 처치를 염두에 두어야 할 필요가 있다고 생각한다. Purpose: To examine the relationship between injury severity and patterns of associated injury in spinal fracture. Materials and Methods: From March 2004 to March 2010, a retrospective study was conducted on 291 patients who had undergone surgeries due to spinal fractures. Spinal fractures were categorized as upper cervical, lower cervical, thoracic, thoracolumbar, and lumbar region, and the severity of fracture was measured using the Abbreviated Injury Scale and Injury Severity Score (ISS). We evaluated the correlation between the fracture site and the incidence and injury severity of the associated injury, and compared the neurologic damage according to the presence/absence of the associated injury. Results: Spinal fracture occurred in the thoracic (43.5%) and lower cervical (30.0%) levels, and associated injury developed in 134 patients (47%). The area of associated injury was in the extremity (41.2%), thorax (25.5%), head, neck, and face (21.9%). Lower cervical fracture (34.5%) had a lower prevalence than thoracic (81%) and lumbar fracture (61%). The average ISS of the associated injury was 17.14 for the thoracic fracture, 12.30 for the lower cervical fracture, 8.7 for the thoracolumbar fracture and 5.69 for the lumbar fracture. Neurologic damage was highly frequent in the lower cervical fracture and included 54 patients (62.1%) and was less frequent in the upper cervical fracture, which included 7 patients (17.9%) (p=0.032). Conclusion: Although the associated injury was less frequent in the lower cervical spine among the spinal fractures that underwent surgical treatment, there was a high risk of neurologic damage in the case of associated injury; therefore, there is a need to pay special attention to patients that suffer damage in this area. In addition, since the degree of the associated injury in the thoracic and lower cervical fracture is significant, an appropriate management strategy for the associated injury must be considered.

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.