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Pediatric spinal trauma is relatively rare with roughly 5% of injuries occurring in this group. Cervical spinal trauma is most common in the pediatric population, followed by thoracic and lumbar injuries. The biomechanics of the evolving pediatric anatomy alter the injury characteristics and radiographic interpretation of pediatric spinal trauma patients. Systematic assessment paradigms are necessary in the evaluation and treatment of pediatric spinal cord trauma patients. Common treatment modalities for this subgroup of patients include halo fixation, bracing, and surgical instrumentation. While the surgical management options for pediatric spinal injuries have improved, the anatomical considerations associated with the size and growth potential of pediatric patients provide room for improvement of these modalities.

Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary mechanisms of injury, clinicians may be able to offer improved recovery after SCI.In this review, we highlight advances in the field of SCI by framing three questions: (1) What is the preclinical evidence for the neuroprotective agent riluzole that has allowed this agent to move into clinical trials? (2) What is the preclinical evidence for Rho antagonists that have allowed this group of compounds to move into clinical trials? (3) What is the evidence for early surgical decompression after SCI?We conducted a systematic review of MEDLINE and EMBASE-cited articles related to SCI to address these questions.As a result of an improved understanding of the secondary mechanisms of SCI, specific clinical strategies have been established. We highlight three strategies that have made their way from bench to bedside: the sodium-glutamate antagonist riluzole, the Rho inhibitor Cethrin, and early surgical decompression. Each of these modalities is under clinical investigation. We highlight the fundamental science that led to this development.As our understanding of the fundamental mechanisms of SCI improves, we must keep abreast of these discoveries to translate them into therapies that will hopefully benefit patients. We summarize this process of bench to bedside with regard to SCI.

The specific effects of resistance and endurance training on upper extremity work capacity, muscular strength, and anaerobic power in chronic survivors of paraplegia have not been previously determined.This study compared the effects of 12 wk of endurance training (ET) with 12 wk of resistance training (RT) on VO(2peak), upper extremity strength, and power output in persons with chronic paraplegia.Eighteen subjects with neurologically complete paraplegia, T6-T10, participated in three weekly exercise sessions during a 12-wk training period. Subjects were matched into pairs (body mass and gender) and were randomly assigned to ET or RT. The ET group performed 30 min of arm cranking at 70%-85% of HR(peak). The RT group performed three sets of 10 repetitions at six exercise stations with an intensity of ranging from 60% to 70% of 1 repetition maximum (1RM). Values of upper extremity strength (1RM) were established using the Mayhew regression equation. VO(2peak) was determined during arm ergometry testing using open circuit spirometry. Arm Wingate anaerobic testing (WAnT) was used to determine subjects' peak and mean anaerobic power output.VO(2peak) values were significantly greater after RT (15.1%) and ET (11.8%). Muscular strength significantly increased for all exercise maneuvers in the RT group (P values0.01) with no changes detected in the ET group. Mean WAnT power increased in the RT and ET groups by 8% and 5%, respectively. The RT group displayed significantly greater gains in peak WAnT power (P0.001) than ET, 15.6% and 2.6%, respectively.Persons with paraplegia can significantly improve their upper extremity work capacity, muscular strength, and power by participating in RT.

OBJECTIVE: To provide a comprehensive review of the treatment trials in the field of spinal cord injury, emphasizing what has been learned about the effectiveness of the agents and strategies tested and the quality of the methodology. The review aims to provide useful information for the improvement of future trials. The review audience includes practitioners, researchers, and consumers. METHODS: All publications describing organized trials since the 1960s were analyzed in detail, emphasizing randomized, prospective controlled trials and published Phase I and II trials. Trials were categorized into neuroprotection, surgery, regeneration, and rehabilitation trials. Special attention was paid to design, outcome measures, and case selection. RESULTS: There are 10 randomized prospective control trials in the acute phase that have provided much useful information. Current neurological grading systems are greatly improved, but still have significant shortcomings, and independent, trained, and blinded examiners are mandatory. Other trial designs should be considered, especially those using adaptive randomization. Only methylprednisolone and thyrotropin-releasing hormone have been shown to be effective, but the results of the former are controversial, and studies involving the latter involved too few patients. None of the surgical trials has proven effectiveness. Currently, a multitude of cell-based Phase I trials in several countries are attracting large numbers of patients, but such treatments are unproven in effectiveness and may cause harm. Only a small number are being conducted in a randomized or blinded format. Several consortia have committed to a promise to improve the conduct of trials. CONCLUSION: A large number of trials in the field of spinal cord injury have been conducted, but with few proven gains for patients. This review reveals several shortcomings in trial design and makes several recommendations for improvement.

A new model of experimental spinal cord injury is detailed based on the application of tensile (distraction) force to the vertebral column of the rat.: To develop an experimental model of graded spinal cord injury by application of tensile forces to the vertebral column.: Distraction is frequently an integral component of human spinal cord injury, but the acute application of tensile forces to the spinal cord has not been modeled rigorously.: A computer-controlled, motorized outrigger device was used to apply a longitudinal stretching force to sublaminar hooks oriented proximally at T9 and distally at T11. Distraction force was applied using a program that varied the length, speed, and duration of its distraction. A modified 14-point Tarlov score was used to establish the presence of hindlimb dysfunction. This score was correlated with acute changes in somatosensory-evoked potential amplitude, the comprehensive open-field test of locomotor function at 4 weeks, and postmortem measurements of serotonin content and metabolism in spinal cord rostral and distal to the site of injury.: Of distraction parameters, only length of distraction correlated significantly with each outcome measure. For outcome measures, open-field test inventory and distal/proximal ratio of the spinal content of serotonin were correlated most closely with final Tarlov scores. Acute somatosensory-evoked potential amplitudes proved to be an excellent index of the acute injury but were poor measures of long-term outcome.: Distraction-induced spinal cord injury was uniformly mild in rats with intact facet capsular ligaments, regardless of distraction parameters. Cutting the facet joint ligaments consistently generated outcome measures associated with mild, moderate, and severe spinal cord injury at 3-, 5-, and 7-mm distraction lengths, respectively.

OBJECTIVE This study was conducted to determine the association between lesion length measured on MRI and the severity of mechanical injury in a rat model of spinal cord trauma. MATERIALS AND METHODS Sprague-Dawley rats were subjected to a modified Allen weight drop injury and killed 4 h after injury. Their fixed, exercised cords were studied with MRI at 1.9 T. RESULTS There were strong correlations between lesion length on MR images and weight drop height and square root of drop height (r2 = 0.55, p < 0.0001 and r2 = 0.63, p < 0.0001, respectively). The lesion length differences were significant versus controls for all drop heights at p values of < or = 0.002 and for the 2.5 cm animals versus the 5 and 15 cm animals (p = 0.01 and p = 0.0002, respectively), but the lengths of the 5 vs. 15 cm groups only approached significance (p = 0.06). CONCLUSION These results suggest that lesion length determined on MR images is a reliable indicator of the severity of trauma among animals subjected to weight drop injury.

Salvatore Cuzzocrea, Tiziana Genovese, Emanuela Mazzon, Concetta Crisafulli, Rosanna Di Paola, Carmelo Muia, Emanuela Esposito, Placido Bramanti, Jie Zhang, Achille P.Caputi and Zhao-Qi Wang Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Italy; IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Italy; Department of Experimental Pharmacology, University of Naples “Federico II”, Napoli, Italy; Guilford Pharmaceuticals Inc., Baltimore, USA; nternational Agency for Research on Cancer, Lyon, France

Posttraumatic spinal cord cysts have traditionally been diagnosed late. The condition is usually considered after the neurological sequelae of spinal cord trauma have not resolved. The diagnosis has usually required invasive radiographic techniques, or even surgical exploration. Magnetic resonance imaging is a new, non-invasive diagnostic technique that appears to be more accurate than previous procedures. Moreover, it has the ability to delineate spinal cord parenchymal lesions much earlier than other methods. We present a case report and literature review of posttraumatic spinal cord cyst.

The effect of alcohol on the injured spinal cord in cats is assessed by use of a standardized trauma model at both nonparaplegic and paraplegic trauma forces. Prior administration of an intoxicant dose of ethyl alcohol resulted in a potentiation of the trauma response at the 100 gm-cm and 260 gm-cm contusion levels. No significant changes were noted at the higher trauma grades. The results suggest that alcohol acts synergistically with mechanical injury of the spinal cord to amplify the trauma response by increasing edema formation within the contused tissue. The mechanism by which this potentiation may occur ar possibly in the areas of antidiuresis and fluid retention from increased tissue hydration in alcohol-treated animals. Language: en

Magnetic resonance imaging (MRI) has proven to be an invaluable tool for evaluating neoplastic, congenital, and degenerative conditions of the spine and spinal cord. Because of various technical limitations, however, the use of MRI in acutely spinal cord-injured patients has not been fully explored. Sixty-two spinal cord-injured patients underwent MRI within the first 36 hours of injury. A variety of pathological findings were detected on the MRI scans: anatomical cord transection (7 cases), spinal cord deformity secondary to extrinsic compression (28), focal cord enlargement/swelling (21), hyperintense intramedullary lesions (17), and disc herniations (2). MRI may be a useful adjunct in the evaluation of acute spinal cord injury.

There is considerable confusion and controversy regarding the incidence of radiologic abnormalities, prognosis, and pathomechanics of spinal cord injuries in children. The comparison of mechanisms of injury, severity of trauma, methods of management, and outcome has been very difficult because some authors have used 12 years as the upper age limit, while others have included patients as old as 18 years. This article critically analyzes the neurologic patterns of injury, radiologic features, management, outcome, and pathomechanics in 97 children whose acute spinal cord injury was managed and followed at The Institute for Rehabilitation and Research. Pertinent literature on the subject is also extensively reviewed.

Forty-three magnetic resonance studies were performed on 28 patients with suspected spinal cord injury using a 1.5 Tesla magnet and surface coils. Imaging was performed between day 1 and day 16 post injury. In several patients, repeat magnetic resonance studies were performed to evaluate the resolution of the cord lesions. Three types of magnetic resonance signal patterns were seen in association with the cord injuries. Patients with intraspinal hemorrhage did not have significant neurological recovery, whereas patients with cord edema/contusion recovered significant neurological function. Magnetic resonance imaging appears to be useful in the diagnosis of acute cord injury and also appears to demonstrate the potential for predicting neurological recovery.

Fifty-eight patients with a clinical or radiographic diagnosis of cervical spinal cord injury underwent Pantopaque myelography on an emergency basis. Twenty-five per cent of these patients demonstrated evidence of spinal cord compression after reduction by spinal traction, as evidenced by the presence of a myelographic defect. Less than half of these patients had a defect that the authors thought required emergency surgical decompression. Two of the five patients so operated upon demonstrated an improvement in neurological function after operation that was much greater than that which would have been predicted before operation. The finding of these few patients who made a significant improvement after operation may justify the myelographic investigation of all patients with evidence of serious cervical spinal cord injury. Based on our experience, Pantopaque myelography may offer adequate, accurate, and useful information for the immediate management of spinal cord-injured patients.

Permanent paralysis was induced in dogs by a 500 gram centimeter force injury on the spinal cord, and drug treatments were given 1 hour after injury and were continued for 3 days. Dogs were evaluated for 90 days. Isotonic saline or mannitol administration were ineffective in reversing the paralysis. In dogs receiving either dimethyl sulfoxide or dexamethasone, six of eight animals in the former and two of eight in the latter group regained partial or full recovery. The presence of somatosensory evoked responses taken before and at various intervals following trauma showed a good correlation in the prognostic recovery of each animal. It is concluded that dimethyl sulfoxide and dexamethasone can reverse a permanent experimental injury to the spinal cord when given within an hour after trauma.

The effects of denervation on healing of experimental fractures of the tibia after sciatic nerve section or spinal cord transsection or both were studied in rats. In addition to normal weight-bearing controls, non-weight-bearing controls were prepared by means of experimental hip luxations. The healing of fractures was monitored by tensile strength measurements, and by X-ray studies up to two months. The tensile strengths of the fractures with peripheral nerve lesion or with spinal cord trauma were significantly higher than those of the respective weight-bearing or non-weight-bearing control fractures at the early phase of healing. Osseous union of denervated fractures was radiographically evident earlier or at least at the same time as in the controls. Denervation, however, caused irregularities in the radiopacity and increased the length of fracture callus. These results confirm the clinical observations on enhanced healing of fractures in extremities of patients with spinal cord trauma.