Neurological Investigations
John Greene, Ian Bone in Understanding Neurology a problem-orientated approach, 2007
The role of plain radiology in the diagnosis of spinal cord disease has become less valuable, particularly with the increasing accessibility of CT and MRI. Degenerative changes can be anticipated with increasing age and the radiological presence of cervical or lumbar spondylosis does not, in isolation, result in a clinical diagnosis. A complete radiological cervical spine assessment consists of lateral, anteroposterior (AP), open-mouth, and right and left oblique views. The thoracic spine series consists of an AP view and a lateral view, though the upper part of the thoracic spine is very difficult to visualize on the lateral view because of the overlying shoulders. A complete lumbosacral spine series consists of AP, lateral, coned-down lateral, and right and left oblique views (oblique views are useful in evaluating the pars interarticularis for spondylolysis). Guidelines on the use of plain films must be followed, thus limiting unnecessary radiation exposure.
Chronic Back Pain
Andrea Kohn Maikovich-Fong in Handbook of Psychosocial Interventions for Chronic Pain, 2019
Invasive treatments initially may be recommended in cases such as disc hernia, spinal instability, and spinal tumor. Specific interventions for these conditions include: laminectomy, laminotomy, spinal fusion therapy, and spinal cord stimulators (SCS). Despite generally positive outcomes, surgical interventions are not without controversy. Spinal surgery is performed in the U.S. at a rate up to five times higher than in other developed countries, even though spinal disease and injury are no more prevalent (Chan & Peng, 2011). In one study, even though surgery was “objectively” successful in 84% of patients, 49% of patients reported worse pain following surgery, 44% were dissatisfied with the outcome, and 38% were significantly disabled at follow-up (LaCaille, DeBerard, Masters, Colledge, & Bacon, 2005). Another study found that opioid pain medication use, taken more than 90 days post-operatively, actually increased following surgery (Nguyen, Randolph, Talmage, Succop, & Travis, 2011). Therefore, even when the surgeon has labeled the spinal surgery a success, it does not necessarily improve patient functioning or satisfaction with care. With every intervention, the probability of success decreases and the pain syndrome can become more complex.
Neuromonitoring
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
The aging spinal cord experiences changes that increase the difficulty of obtaining IONM. With increased age, there is decreased density of the small myelinated fibers in the corticospinal tract, reduced neurons in the ventral horn (intermediate zone), and a decreased number of large alpha- and medium-size gamma-motor neurons (3,10). Common spinal and spinal cord disorders that need surgical intervention include myelopathy secondary to degenerative cervical disease, central cord syndrome after hyperextension injuries, degenerative scoliosis and kyphosis, vertebral compression fractures, degenerative spondylolisthesis, stenosis, and spinal axial instability, among others (Table 12.2). All degenerative changes in the spinal elements cause spinal canal narrowing, increased venous pressure, and decreased flow of the cerebrospinal fluid. These changes predispose elderly patients to central cord syndrome after hyperextension injuries (3,11).
Development of Tissue Integrity indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project
Published in The Journal of Spinal Cord Medicine, 2019
Heather Flett, Matheus J. Wiest, Vivian Mushahwar, Chester Ho, Jane Hsieh, Farnoosh Farahani, S. Mohammad Alavinia, Maryam Omidvar, Pamela E. Houghton, B. Catharine Craven
Spinal cord injury or disease (SCI/D) is a life-altering condition that impacts multiple body systems leading to several secondary health conditions. Pressure injury (PI) is a common yet serious health complication following SCI/D, with lifetime prevalence of 85–95%.1,2 The National Pressure Ulcer Advisory Panel (NPUAP)3 defines PI as “localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.”4 Up to 66% of individuals with SCI will experience a PI in their lifetime.5 It has been reported that 50% of wheelchair users experience tissue breakdown due to prolonged sitting.6 Thirty-one percent of PI in individuals with SCI occur over the ischium, followed by trochanters (26%), sacrum (18%), heel (5%), malleolus (4%) and feet (2%).7
Leptomeningeal metastasis presenting with blurry vision, nausea and headache
Published in Clinical and Experimental Optometry, 2021
Ocular and systemic symptoms from LM can be classified as arising from one of three domains: the cerebral hemispheres, the cranial nerves, or the spinal cord. Cerebral hemisphere dysfunction may cause papilloedema and headache typical of raised intracranial pressure; as well as hemiparesis, and mental status changes such as confusion, dementia, or seizures. LM most often affects the third, seventh, and eighth cranial nerves, but the fourth and sixth can also be involved. Symptoms may present as double vision, vision loss, facial numbness, and hearing loss.3,10 Any type of visual field defect may be present. Ocular fundus examination is often normal.5 Proposed mechanisms by which LM affects the optic nerve include direct infiltration, tumour cuffing of the leptomeninges leading to compression of the nerve and compromised vascular supply.11 Spinal cord symptoms may include pain, limb weakness, numbness, and urinary and bowel incontinence. In most patients more than one domain is involved.3
Epidemiological study of Spinal Cord Injury individuals from halfway houses in Shanghai, China
Published in The Journal of Spinal Cord Medicine, 2018
Feng-Shui Chang, Qi Zhang, Mei Sun, Hui-Jiong Yu, Long-Jun Hu, Jing-Hua Wu, Gang Chen, Lian-Ding Xue, Jun Lu
The symptoms of spinal cord lesions depend on the extent of the injury or non-traumatic cause, and they can include deficits in the ability to perform basic bodily functions, such as breathing, sensation, bowel and bladder control. Deficit in sensation, or sensory loss, refers to the loss of sensations such as pain, touch or temperature. Deficits in motion, or motor loss, refer to muscle weakness and the inability to use the body. We defined urination disorders as urinary retention, urinary incontinence or both, and disorders of defecation as constipation, fecal incontinence, or both. The SCI complications included bedsores, pain, urinary tract infections, and spasticity. The main medical and rehabilitation treatments received included surgery, medicine, traditional therapy (e.g., acupuncture, moxibustion, and massage), physical therapy, rehabilitation training, assistive devices (e.g., orthosis and prosthesis) and other methods appropriate for SCI individuals.
Related Knowledge Centers
- Animal
- Brainstem
- Cerebrospinal Fluid
- Meninges
- Nervous Tissue
- Vertebra
- Medulla Oblongata
- Vertebral Column
- Lumbar
- Central Canal